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REPORT OF THE DEPARTMENT OF MENTAL HEALTH
NOVEMBER 30, 1939
Commissioner
Clifton T. Perkins, M.D Melrose
Assistant Commissioner
Bardwell H. Flower, M.D Auburndale
Table of Contents
Duties and Proceedings of the Department
Changes in Personnel
Activities of the Department:
1. Mental Examination of Persons Coming Before the Courts
2. Examination of Juvenile Delinquents ....
General Matters:
1. Changes in Private Institutions
2. Conferences .
3. Departmental Committees
4. Deportations .
5. Legislation for the Year
Report of the Financial Division
Report of the Pathologist
Report of the Division of Mental Hygiene
Report of the Division of Mental Deficiency
Report of the Support Division
Report of the Division of Statistical Research
Report of the Division of Statistics :
(a) Table of Contents
(b) Departmental Statistics, Tables and Graphs
(c) Statistical Review: Text, Tables and Graphs
Mental Disorders
Mental Deficiency .
Epileptics, Non-Psychotic
(d) Detailed Tables
Mental Disorders
Mental Deficiency .
Directory of Department and Institutions
Index
PAGE
2
2
3
3
5
5
5
13
13
20
39
54
90
125
128
128
131
141
239
288
29S
426
457
467
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100 Nashua Street
Boston, Massachusetts
To His Excellency the Governor and Honorable Council:
The twentieth annual report of the Massachusetts Department of Mental Health for
the year ending November 30, 1939 is respectfully submitted herewith. The matters
relating to general statistics, however, cover the year ending September 30th.
Clifton T. Perkins, M.D.
Commissioner
REPORT OF THE MASSACHUSETTS DEPARTMENT
OF MENTAL HEALTH
DUTIES OF THE DEPARTMENT
The Department has general supervision of all public and private institutions for the
mentally ill, mentally defective, epileptic and of persons in private hospitals addicted to
the intemperate use of narcotics and stimulants. It has the right to make investigations
and recommendations as to any matter relative to the classes under care, but the local
administration of each State institution is under the control of its own Board of Trustees
appointed by the Governor and Council.
The direct powers of the Department concern the interrelations of institutions and
matters which are common to them all, such as the distribution and transfer of patients
between them, deportation of patients to other states and countries, and the determina-
tion within statutory limits of the amount to be charged for the support of patients in
institutions.
The work of construction under special appropriations for new buildings and unusual
repairs is under the control of the Department, and also expenditures of money for such
purposes. The Department is required to prepare plans for buildings and also to select
land to be taken by the Commonwealth for new or existing institutions.
All requirements for maintenance appropriations are analyzed by the Department.
The statutes relating to the Department of Mental Health are to be found in Chapters
19, 123 and 486 of the General Laws.
CHANGES IN PERSONNEL
On November 15, 1939, Charles W. Greenough was appointed Second Assistant Com-
missioner, in accordance with the provisions of Chapter 511, of the Acts of 1939, and his
appointment was approved by the Governor and Executive Council the same day. Mr.
Greenough qualified under this appointment directly after approval.
Mr. Greenough was born in Cambridge. He received his preliminary education in
Noble and Greenough School; in 1919 he was graduated from Harvard University with
the degree of A.B. (Honoris Causae); his academic work was interrupted for a period
from 1917-1919 when he was a member of the Naval Aviation Service overseas on sub-
marine patrol work. Following graduation from college, Mr. Greenough was engaged
in the textile business at Lockwood Greene Co., in 1921 he joined the First of Boston
Corporation; in recent years he has been connected with Lee Higginson Corporation
up to his present appointment.
Hans Molholm, M.D.
On June 30, 1939, Dr. Hans Molholm, part-time psychiatrist in the Division of Mental
Hygiene, resigned to accept the position as Assistant Physician at the Worcester State
Hospital.
Charles Brenner, M.D.
On September 1, 1939, Charles Brenner was appointed as part-time psychiatrist in
the Division of Mental Hygiene to replace Dr. Hans B. Molholm who resigned on July 1,
1939.
Dr. Brenner received his preliminary education in the Boston schools and in 1931
was graduated from Harvard University with the degree of A.B. Cum Laude; in 1935
he was graduated from the Harvard Medical School with the degree of M.D. After his
graduation he served as Medical House officer at the Peter Bent Brigham Hospital;
from February to June of 1936 he was on the staff of the Boston State Hospital; from
1937 to 1938 was Assistant Physician at the Boston Psychopathic Hospital and from
P.D. 117 3
September 1938, to the present time has been serving as Assistant Resident Neurologist
at the Boston City Hospital.
Julia A. Deming, M.D.
On January 9, 1939, Julia A. Deming was appointed part-time psychiatrist in the
Division of Mental Hygiene to replace Dr. Margaret D. Welch who resigned on January
7, 1939.
Dr. Deming is a graduate of the Women's Medical College, Philadelphia. She began
her psychiatric work with three months' interneship at the Westboro State Hospital;
following this she was resident physician at the Boston Psychopathic Hospital for one
year; was psychiatrist at the New England Home for Little Wanderers; was connected
with a clinic in Vienna for several years and up to the present time has been doing part-
time psychiatric work at the Coit House, Concord, New Hampshire.
Robert P. Kemble, M.D.
On May 3, 1939, Dr. Robert P. Kemble was appointed Director of Clinical Psychiatry
to succeed Dr. Milton Kirkpatrick at the Worcester Child Guidance Clinic. Dr. Kemble
was graduated from Princeton University with the degree of A.B.; from Susquehanna
University with the degree of B.S. and from the Jefferson Medical College in 1933 with
the degree of M.D.
He served a rotating interneship in the Pennsylvania Hospital ; a residency in psychi-
atry at the Pennsylvania Hospital for Mental and Nervous Diseases; a residency at the
Institute of the Pennsylvania Hospital and a residency in psychiatry at the Payne
Whitney Psychiatric Clinic, also a Fellowship at the Philadelphia Child Guidance Clinic.
He is a Diplomate of the National Board of Medical Examiners.
ACTIVITIES OF THE DEPARTMENT
Mental Examination of Persons Coming Before the Courts
During the year, 725 cases have been examined under the so-called "Briggs Law,"
Section 100 A, Chapter 123, of the General Laws.
Forty-three cases were examined under the provisions of Section 99, Chapter 123,
of the General Laws.
Examination of Juvenile Delinquents
The examination of juvenile delinquents under the provisions of Chapter 119, Section
58. A, General Laws, Tercentenary Edition, is a service rendered to juvenile sessions
of courts as an aid to final decision regarding the disposition of each case.
During the year ending September 30, 1939, examinations under the provisions of
this statute were made by the following clinics :
Boston Psychopathic Hospital 45
Boston State Hospital 160
Danvers State Hospital . 237
Foxborough State Hospital 19
Gardner State Hospital 29
Grafton State Hospital 22
Medfield State Hospital . . . 70
Monson State Hospital . . . 21
Northampton State Hospital 97
Taunton State Hospital 107
Westborough State Hospital . 7
Worcester State Hospital 56
Belchertown State School 32
Walter E. Fernald State School 87
Wrentham State School 23
Dr. Henry M. Baker 24
Judge Baker Guidance Center 105
Total Examinations . . 1,141
The total cases examined, 1,141, shows an increase of about 14% over the number
reported as examined during the previous year. An accompanying chart gives the mental
classification of these cases by total number and percentage.
P.D. 117
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The majority of courts appear to have availed themselves of this service. In some
instances, however, the usefulness of the examination has been largely negated by the
fact that it was requested and carried out only after final disposition of the case had been
made. It is interesting to note that 26 courts (more than 25%) referred no cases for
such examination and that 18 additional courts requested the examination of only 3
or less cases during the year.
GENERAL MATTERS
Changes in Private Institutions
On January 6, 1939, Dr. Donald Gregg of Channing Sanitarium died, and a new
license was granted to Dr. Jackson M. Thomas.
Dr. Hosea M. McAdoo resigned from the Ring Sanatorium and Hospital on February
1, 1939 and a new license was granted to Dr. Curtis T. Prout.
On February 1, 1939, Dr. Frank E. Leslie was transferred to Wisconsin, a new license
to conduct the Veterans' Administration Facility at Northampton was given to Dr.
William M. Dobson.
On July 5, 1939, a license was issued to George M. Schlomer, M.D. of Georgetown
to conduct a Private Hospital known as the Baldpate, Inc.
A license was issued on September 6, 1939 to Morris P. Pollock to conduct a private
school for the Mentally Defectives in Brookline to be known as The Pollock School.
Conferences
Eight conferences of the Commissioner, Superintendents of the State Institutions
under the Department and the Department officials, were held during the year.
In addition to this the following Division Head Conferences were held: —
Medical Division Heads ... 35 Business Division Heads . . 30
Departmental Committees
Several Committees were formed during 1939 for the purpose of studying the details
of various problems and making recommendations. These recommendations were to
form the basis for the formation of definite Departmental policies.
The following Committees were appointed by the Commissioner to serve throughout
the year: Committee on Care of Institutional Patients, Committee on Construction,
Committee on Family Care, Committee on Finance, Committee on Food, Committee
on Forms and Statistics, Committee on Legislation and Regulations, Committee on
Mental Hygiene, Committee on Nurses' Training Schools, Committee on Personnel and
Labor Relations, Committee on Public Relations and Scientific Publications, and Com-
mittee on Research.
The Commissioner wishes to express his appreciation of the services of the members
of the various Committees.
Report of the Committee on Care of Institutional Patients
Chairman — Dr. William A. Bryan
Dr. Arthur N. Ball Dr. Morgan B. Hodskins
Dr. Ransom A. Greene Dr. Earl K. Holt
The Committee on the Care of Institutional Patients held sixteen meetings during
the record year — twelve at Worcester and one each at the Statler Hotel, Boston ; the
Norfolk State Prison; Concord Reformatory; and Sherborn Reformatory. In addition,
committee members attended the combined meeting of all committees held with the
Commissioner at the Westboro State Hospital June 19, 1939. At this last mentioned
meeting a report containing sixty-five specific recommendations was submitted to the
Commissioner.
Among subjects considered were — standards and care of clothing, personal hygiene,
beauty parlors, bathing facilities, outdoor activities, bed and mattress standardization,
qualifications of personnel in relation to care of patients, visiting staff of specialists,
boarding-out of patients, treatment units, optimum size of wards, diagnostic and ther-
apeutic equipment requirements, pharmacies, dental departments, recreational direction
and library facilities.
In addition to the above, a special bed was designed by the Committee in collaboration
with the Industrial Department of Norfolk State Prison which might be considered as a
standard design; a chair designed by Dr. Greene of the Walter E. Fernald State School
6 P.D. 117
which can hold personal belongings in a special section, and an invalid chair developed
at Worcester were tentatively approved by the Committee.
Recommendations were made regarding problems of the aged, creation of an eligibility
list for promotion of physicians, preparation and service of food, and the care of tubercu-
lous and syphilitic patients. At the request of the Committee, Dr. Harry Solomon
prepared a brochure on the Treatment of Syphilis in State Hospitals which was sent to
all institutions with the approval of the Commissioner. Studies were made of the time
factor involved in the proper toileting of patients in institutions represented on the
Committee. Specific recommendations regarding the tuberculosis problem and need for
a special survey were offered.
Consideration was given to the utilization of various specialists. The Committee
favored separate medical and surgical services in principle, but feel that personnel is
inadequate in many institutions to properly operate separate services. Laboratory
standards were considered in detail. Recommendations regarding restraint and seclusion
were made.
Respectfully submitted,
Francis H. Sleeper, M.D.
Secretary.
Report of the Committee on Construction
Chairman — Dr. Walter E. Lang
Dr. Roderick B. Dexter Mr. Clarence D. Maynard
Dr. Ransom A. Greene Dr. Harlan L. Paine
The Committee on Construction met a number of times during the year and discussed
several important topics, namely : Housing Survey and Low Cost Housing Projects.
The work of Dr. Roderick B. Dexter, who conducted a housing survey while a member
of the Department, was reviewed and certain changes in space allotment were suggested.
The Committee felt that a re-survey of the housing facilities should be made in order to
bring the material up to date, and certain standards, when adopted, should remain
permanent unless definitely changed by the Department of Mental Health.
The Committee felt that as a substitute for the more specialized building for acute
reception of patients, or building for disturbed patients, considerable thought should be
given to the low cost housing of quiet, continued treatment cases, thereby releasing space
in the main group of buildings for specialized activities.
The Committee thought that buildings which cost not more than $1,000 per bed
might be considered for this group of patients.
Respectfully submitted,
William C. Gaebler, M.D.
Secretary.
Report of the Committee on Family Care
Chairman — Dr. Charles E. Thompson
Dr. Arthur N. Ball Dr. Walter E. Lang
Dr. Clarence A. Bonner Dr. George E. McPherson
Dr. William A. Bryan Dr. Harlan L. Paine
Dr. Neil A. Dayton
On November 12, 1939, the statute governing Family Care of patients, as amended
by Section I of Chapter 500 of the Acts of 1939, became effective. The important change
by the amendment was in the rate to be paid. This was raised from $4.50 to $6 maximum
per week.
In order to give study to the movement of Family Care, which had gained considerable
impetus during the past few years, the Commissioner appointed a special committee of
superintendents and members of the Department to consider the problem.
The committee considered the subject exhaustively and went on record as favoring a
Family Care Program in every institution as far as facilities permitted.
The committee recommended that the selection of patients, the amount to be paid
and the selection of the home be left to the superintendent or other authority. To assists
however, in the administration of Family Care Placement, certain standard practice,
were recommended:
1 . Mental patients placed in homes at the expense of the State or privately sup-
ported were to be considered as in Family Care.
P.D. 117 7
2. A suitable application on a prescribed form was to be made by the person seeking
patient.
3. A detailed inspection and investigation of the home — in accordance with a
suggested outline — was to be made.
4. Approval in writing of the home by the Superintendent before patient placement
was to be necessary.
In addition to the above, the committee suggested that patients be placed only in the
building in which the family resided — each patient to have a separate bed. No patients
were to be permitted to sleep or reside above the second floor of a dwelling. Patients in
Family Care were to be eligible for Medical and Dental care and other services of the
hospital, as if resident in the hospital. Patients were to be visited at intervals by hospital
representatives.
Respectfully submitted,
William C. Gaebler, M.D.,
Secretai y
Report of the Committee on Finance
Chairman — Dr. Harlan L. Paine
'■■■■ Dr. Ralph M. Chambers Dr. Harold F. Norton
Dr. Morgan B. Hodskins Gen. William I. Rose
The Committee on Finance gave considerable thought to the program for economy
which was instituted by his excellency, Governor Saltonstall. The year was peculiar
in that it was the first year of the Biennial Budget. Economy in hospital operation was
stressed.
The Committee discussed proposed legislation of an increase in rate to be paid for
boarding-out patients. The Committee recommended that Old Age Assistance be made
available to patients when ready to leave the hospital on visit status.
The financial value of a central bakery was discussed. The Committee felt that con-
siderable savings in the Food Budget by such centralization would ensue.
Respectfully submitted,
William C. Gaebler, M.D.
Secretary
Report of the Committee on Food
Chairman — Dr. William A. Bryan
Dr. Roy D. Halloran Gen. William I. Rose
Mr. Albert Houde Dr. Charles E. Thompson
Dr. George E. McPherson
The Committee on Food gave considerable attention to the theoretical ration allow-
ance and the methodology of computing the Food Budget. Budgeting of food on a
per diem basis in comparison with a ration was considered. The Committee felt that
much study was needed and suggested a study of the past two years' food consumption,
together with the next two years ensuing, as a basis for comparison.
Considerable thought was given to centralization and consolidation of various pro-
cedures, such as: standardized recipes, establishment of a central bakery, etc.
Training classes for chefs, cooks, butchers and other food workers were recommended
as being of benefit to the service.
The Committee felt that food inventories should be low and suggested that further
study betnade along this line.
Farm production was discussed and the Committee suggested that a careful study
be made, particularly as to farm costs.
Respectfully submitted,
William C. Gaebler, M.D.
Secretary
Report of the Committee on Forms and Statistics
Chairman — Dr. Roy D. Halloran
Dr. Arthur N. Ball Dr. George E. McPherson
Mr. Joseph P. Gentile Dr. Francis H. Sleeper
The Report of the Committee on Forms and Statistics for the year ended November 30,
1939, is hereby respectfully submitted:
8 P.D. 117
The purpose of this Committee was to scrutinize the forms in use in the various insti-
tutions, particularly the B forms and the Special mimeographed forms. A meeting was
held on Monday, February 6, 1939 and the general policy of the Department was out-
lined by the Commissioner.
It was determined that the first step should be a complete review of all of the forms
in use in all of the institutions. This proved to be a tremendous task, as many hundreds
of forms, other than the Standard A forms, were being used by the various institutions.
It was thought advisable to first collect all Special and B forms so that they would be
available in the Department for scrutiny by the Committee. This was done, a total
of 789 Special forms and 41 B forms being collected. Subsequently, it was deemed advis-
able to subject all of these forms in use to scrutiny by the various Superintendents to
see whether or not any particular Special or B form now in use might be adopted for
all of the institutions and made a Standard A form. With this thought in mind, seventeen
copies of every B and Special mimeographed form in use were collected from each insti-
tution. The Superintendents were requested to attach an explanatory paragraph to
each form so that the recipient might have no difficulty in determining the exact use of
the form that was being made.
Forms from some one hospital were sent out every two weeks, so that the Superin-
tendents might review the forms and send in comments. Each form was given a number
and was accompanied by a mimeographed description. When the replies were received
by the Secretary, the forms approved of or desired by each Superintendent were entered
in tables drawn up for the purpose. This process was quite time-consuming as the
amount of detail work involved was very large. For instance, the total forms received
from one institution in sets of 17 forms each, had to be numbered, the descriptive para-
graphs had to be mimeographed, and one form from each set of 17 had to be sorted out
for each institution. A total of 789 Special Forms and 41 B Forms were thus circulated
throughout the institutions. The handling of 17 copies of each of these forms involved
a total of 14,110 forms. A total of 322 letters have been written in reference to the work
of the Committee. The Committee is now ready to study the forms individually, taking
advantage of the suggestions and comments made by the sixteen Superintendents con-
sulted.
When all forms had been circularized, and comments received, the forms were gone
over and sorted into the following groups :
1. Medical Forms 11. Industrial Department Forms
2. Administrative Forms 12. Industrial Therapy Forms
3. Steward Forms 13. Laundry Forms
4. Clothing Forms 14. Library Forms
5. Dental Forms 15. Occupational Therapy Forms
6. Diet Forms 16. Pharmacist Forms
7. Engineer Forms 17. Social Service Forms
8. Financial Forms 18. Traveling School Clinic Forms
9. Farm Forms 19. Miscellaneous Forms
10. Hydrotherapy Forms
Tables were drawn up under each heading listing the forms at the left of the table
and the names of all the institutions across the page. Institutions were checked if they
approved or desired particular forms. After the tables had been drawn up, the forms
were collected in loose leaf books in exactly the same order as listed in the tables and
both tables and books are now ready for consideration by the Committee.
Respectfully submitted,
Neil A. Dayton, M.D.,
Secretary
Report of the Committee on Legislation and Regulations
Chairman — Dr. Charles E. Thompson
Dr. Roderick B. Dexter Dr. Harlan L. Paine
Dr. Earl K. Holt
This Committee has been active throughout the year. Its first duties consisted pri-
marily of close scrutiny and recommendations upon bills pending before the General
Court. Attention was given to all bills which had direct or indirect bearing upon the
functions of the Department as a whole. Thereafter, there was undertaken the task of
revising and bringing up to date Department Regulations. This has proven to be a
P.D. 117 9
difficult, prolonged project and work upon it still is being carried on. The new D.M.H.
Regulation No. 7 regarding escaped patients which was promulgated November 13,
1939 was based chiefly upon the recommendations of this Committee. It has also re-
viewed Chapter 123 making recommendations for any necessary corrections or proposed
amendments to be submitted to the next General Court.
Respectfully submitted,
Bardwell H. Flower, M.D.,
Secretary
Report of the Committee on Mental Hygiene
Chairman — Dr. Clarence A. Bonner
Dr. C. Stanley Raymond Dr. Douglas A. Thorn
The Committee on Mental Hygiene takes great pleasure in submitting the first annual
report of its activities for the year ending November 30, 1939.
During the year, five meetings were held by the Committee for the purpose of dis-
cussing mental hygiene in its various phases, and making certain definite recommenda-
tions to the Commissioner.
The first major accomplishment of this Committee was a survey of the various types
of mental hygiene clinics operating under the Department of Mental Health. This
survey, made by the Director of the Division of Mental Hygiene, included a study of the
time and place of meeting of each clinic, the clinic personnel, and the case load, and,
in some instances, the cost of operation. As a result of this survey, it was revealed that
geographically the State as a whole was adequately supplied with clinics, although in
some instances the service being rendered indicated opportunities for improvement.
For example, in certain clinics, first thought was given to diagnostic rather than ther-
apeutic service. The Child Guidance Clinics adequately provided service to the com-
munities in the State. There was, however, only a limited number of clinics available
for therapy with reference to incipient cases of mental illness.
The Committee wishes to stress the point that some of the Child Guidance Clinics
now operating under the Division of Mental Hygiene should be reallocated to the hospi-
tals, under the jurisdiction of the Department, in the immediate vicinity of the clinics.
This would then give the Division the opportunity to provide a demonstration clinic
and a clinic for the training of personnel.
Much thought was given by the Committee to the educational and publicity programs
to be conducted by the Division of Mental Hygiene in cooperation with the Massa-
chusetts Society for Mental Hygiene. Definite programs for the education of lay persons
is the goal which is expected to be attained within the next year.
On September 1, 1939, a much needed Directory of Clinics, listing all the clinical
facilities under the supervision of the Department of Mental Health was published by
the Division of Mental Hygiene. This Directory was published for the purpose of assist-
ing physicians, schools and various agencies in the more effective utilization of our
community clinics.
Another activity of the Committee was the study by the Director of the Division of
Mental Hygiene of the publicity and educational programs being sponsored by the
Massachusetts Tuberculosis League and the Department of Public Health. During
this study, much valuable information and literature was obtained, which will be used
as a basis for the building of a library of propaganda of an educational nature.
The Committee has given serious thought to the subject of mental hygiene, having
in mind the improvement and expansion of the work in the mental hygiene field to be
conducted by the Department. The Committee as a whole agreed that all Child Guid-
ance Clinics should have as a minimum personnel a psychiatrist, psychologist and
psychiatric social worker; that the age limit for referrals to the Child Guidance Clinics
should be fourteen years, and that standard records should be kept in each case; that
mental hygiene work might be divided under the headings of School Clinics, Child
Guidance Clinics, Clinics for Adult Incipient Cases, and Clinics for Patients on Visit
from the Hospitals; that educational information should be disseminated by lectures,
radio talks, demonstration clinics, and through the Directory of Clinics; and, that more
clinical facilities should be made available for adult incipient cases.
Respectfully submitted,
Edgar C. Yerbury, M.D.,
Secretary
10
P.D. 117
Report of the Committee on Nurses' Training Schools
Chairman — Dr. Ralph M. Chambers
Dr. Earl K. Holt Dr. Walter E. Lang
The Committee on Nurses' Training submits the twenty-third annual report of the
Nurses' Training Schools for the year ending November 30, 1939. A new Committee
was appointed by the Commissioner on January 1, 1939 to serve for a period of one year.
The Committee consisted of Doctor Ralph M. Chambers, Chairman; Doctor Earl K.
Holt and Doctor Walter E. Lang, Members; and Doctor Edgar C. Yerbury, Secretary.
During the year, five regular and special meetings were held by the Committee to
act upon the many routine and special matters pertaining to the administration of the
several schools of nursing under the jurisdiction of the Department of Mental Health.
These matters worthy of mention include :
1. A study of all legislative matters relative to nursing.
2. An inspection and survey of all the regular and psychiatric training schools under
the Department of Mental Health.
3. The adoption of new forms of certificates for:
(a) Affiliate Nurses.
(b) Postgraduate Nurses completing courses in psychiatric nursing.
(c) Attendant Nurses.
(d) Residents in Psychiatry.
4. The adoption of new forms of diplomas for:
(a) Psychiatric Nurses.
(b) Nurses completing the regular three-year course.
5. The adoption of forms for records of nurses as recommended by the National
League of Nursing Education.
6. The adoption of a new style cap for both nurses and attendant nurses in our
institutions.
The following hospitals have continued to conduct the regular three-year course of
instruction in the art of nursing during the year:
Danvers State Hospital Taunton State Hospital
Medfield State Hospital Westborough State Hospital
The hospitals listed below have conducted the two-year course in psychiatric nursing :
Foxborough State Hospital Grafton State Hospital
Gardner State Hospital Northampton State Hospital
Classes in psychiatric nursing procedures for affiliate nurses have been held in the
following institutions:
Boston Psychopathic Hospital Taunton State Hospital
Danvers State Hospital Worcester State Hospital
Nurses interested in furthering their education by postgraduate instruction in psychi-
atric nursing have been trained at the Worcester State Hospital and the Taunton State
Hospital.
During the week of June 19-23, the regular nurses' examinations for all schools of
nursing under the jurisdiction of the Department of Mental Health was given by the
Committee. The results of these examinations are indicated in the following table:
Training Schools
Juniors
Seniors
Passed
Failed
Percent
Passed
Passed
Failed
Percent
Passed
23
44
1
0
95.8
100
21
41
0
0
100
100
The results of training in both the regular and psychiatric nurses' training schools
are very gratifying, as only one student enrolled in the regular school of nursing failed
to meet the requirements of the examination.
On November 30, 1939, the total enrollment of all nurses in both the regular accredited
and psychiatric training schools is presented in the tables which follow :
P.D. 117
11
Accredited Training Schools
Prelim-
inary
Inter-
mediate
Senior
Affiliate
Post-
graduate
Boston Psychopathic Hospital
Danvers State Hospital . . . .
Medfield State Hospital
Taunton State Hospital
Westborough State Hospital ....
Worcester State Hospital . . .
0
3
7
0
14
0
0
6
3
0
8
0
0
7
4
5
6
0
18
10
0
25
0
13
0
0
0
0
0
2
24
17
22
66
2
Psychiatric Training Schools
Senior
Foxborough State Hospital .
Gardner State Hospital .
Grafton State Hospital .
Northampton State Hospital .
Total
The matter of affiliate training in psychiatric nursing for all schools approved by the
Board of Registration of Nurses has been given much consideration during the year.
Early in June a conference was held between the Secretary and Supervisor of the Board
of Registration of Nurses and the Committee on Nurses' Training. At this conference,
it was brought out that at the present time the facilities in our mental hospitals are far
less than the demand for affiliate training. A study of the number of affiliate nurses
now receiving psychiatric training in our mental hospitals in a year's time would indicate
that nearly three hundred were given formal training for at least a three months' period.
This training has been available even though the housing facilities have not been in-
creased. The Committee desires to go on record as definitely favoring the training of
affiliate nurses as a desirable procedure to be continued by the Department of Mental
Health.
The Committee wishes to express its sincere appreciation to the Commissioner for
his helpful cooperation and assistance throughout the year.
. Respectfully submitted,
Edgar C. Yerbury, M.D.,
Secretary
t Report of the Committee on Personnel and Labor Relations
Chairman — Dr. Roderick B. Dexter
Dr. Ralph M. Chambers Dr. Roy D. Halloran
Dr. Ransom A. Greene Dr. Walter E. Lang
During the early part of the year the Committee scrutinized bills pending before the
General Court which had to do entirely with matters pertaining to personnel. It then
gave consideration to many proposals from various sources including vacation allow-
ances, central employment, residence of employees on hospital grounds, institution
accommodations for employees, formation of grievance committees, intra-institutional
employee promotional schemes, employee quotas and ratios, etc.
Throughout the latter half of the year the Committee has given intensive attention
to a program of standardized sick leave for the entire Department. Its recommendations
in this regard have been phrased in the form of a Regulation and are complete, except
for a few minor correlative and technical details.
Respectfully submitted,
Bardwell H. Flower, M.D.,
Secretary
Report of the Committee on Public Relations
and Scientific Publications
Chairman — Dr. Arthur N. Ball
Dr. Clarence A. Bonner Dr. William A. Bryan
Dr. Harold F. Norton
12 P.D. 117
Six meetings of the Committee on Public Relations and Scientific Publications were
held during the year — one at Boston State and five at Worcester, in addition to the
Superintendents' Meeting at Grafton on June 12, 1939 when the Committee Report
was presented for discussion.
A careful survey of the various methods used by the schools and hospitals in the
maintenance of cordial public relations was made by the Committee by means of a
detailed questionnaire. After the questionnaire data were analyzed consideration was
given in committee to such subjects as the issuance of basic data concerning schools
and hospitals in brochure form to new employees; the organization of women's auxiliaries,
the creation of formal institutional speakers' bureaus; the utilization of radio, moving
pictures and lantern slides with automatic slide demonstrators. Special admission
letters to patients explaining procedures to be followed in their care and privileges to
be extended were discussed. Policies regarding relationships with medical societies,
dental societies, service and women's clubs were considered. The entire matter of
relationships with newspapers and magazines was considered in detail, with particular
emphasis on type of publicity to be released. The advisability of special activities on
National Hospital Day in the institutions, the question of annual expositions depicting
basic information regarding mental health and illness received attention. The establish-
ment of special lecture courses for various groups was advocated as well as educational
symposia for staff members.
Considerable discussion was held on the subject of a medium for publication of admin-
istrative and psychiatric data from the different institutions. Recommendations on
various aspects of the aforementioned topics were made by the Committee to the Com-
missioner.
Respectfully submitted,
Francis H. Sleeper, M.D.,
Secretary
Report op the Committee on Research
Chairman — Dr. Abraham Myerson
Dr. Neil A. Dayton Dr. Francis H. Sleeper
Dr. Henry B. Elkind Dr. Harry C. Solomon
Dr. Roy G. Hoskins Dr. Douglas A. Thorn
We take great pleasure in submitting the annual report of the activities of the Research
Advisory Committee for the year ending November 30, 1939.
The Committee was appointed by the Commissioner on January 1, 1939 to serve for a
period of one year. The Committee was appointed to give advice and recommend
policies regarding research in our State institutions under the supervision of the Depart-
ment of Mental Health. The object of the Committee was to build a living organization
for research through those men who have a broader outlook in this field than men who
have been actively tied up with the duties of research in our hospitals and schools. Dur-
ing the year, seven regular and special meetings were held.
The first State-wide research project instituted by the Committee was the Total
Push or Total Activation Treatment Program for Chronic Schizophrenia. Any male
patient between the ages of thirty-five and forty years who had been ten years in the
hospital was considered for this study, provided he was in generally good physical con-
dition but mentally showed evidence of deterioration so as to be unresponsive, hostile,
asocial or untidy. This program was worked up carefully in protocol form, and standard
procedures and forms were drawn up by the Committee to be used in working out this
project so that the results which were reported could be favorably compared and tab-
ulated. This procedure was begun in twelve of our institutions. Prior to the institution
of this program, a meeting was held at the McLean Hospital on May 26, to which our
Superintendents and physicians who would be delegated to assume responsibility for
the work in their respective hospitals were invited. At this meeting, the work which
had been carried on by the staff of the McLean Hospital was reviewed, and the results
demonstrated to the group.
Another special research project which the Committee favored and sponsored was
the study of the problem of the aged. This problem has continued to increase as far
as hospital admissions are concerned, and statistics indicate that this type of problem
represents 22.2% of all the admissions in our State mental hospitals. In addition to the
point of view of looking upon research for advancement and the ultimate cure of patients,
P.D. 117 13
there is the economic point of view. This increase in admissions in the old age group
represents increased costs to the State, a fact which was considered at the time this
program was instituted. It was decided that this problem should be approached oh a
State-wide basis, assigning various portions of the total problem to each interested
hospital.
During the year, many protocols have been presented to the Committee by members
of the various hospital staffs for recommendations and approval before undertaking
the work.
In order to stimulate research throughout our mental institutions, plans have been
considered for the organization of a research society, and these plans will be presented
at a meeting to be called in December. All those who have indicated an interest in
research, as well as those who have shown their ability to do research, will be invited
to attend this meeting to consider the organization of a society which will have as its
chief interest the promotion and stimulation of further research in Massachusetts.
Respectfully submitted,
Edgar C. Yerbury, M.D.,
Secretary
Deportations
One hundred sixty-one cases were considered for deportation during 1939, in compari-
son to one hundred fifty cases in 1938. The Department deported seventy-one to other
states and three to other countries and, in addition, the United States Department of
Labor deported two to other countries; in all, seventy-six.
Since October 1, 1898, 4,950 patients have been deported by this Department.
Details of the disposition of cases under consideration for deportation are shown in
Table 175.
New Legislation — 1939
Chapter 54. — An Act Further Regulating the Temporary Absence on Leave of Certain
Prisoners Committed to the Bridgewater State Hospital.
Section one hundred and five of chapter one hundred and twenty-three of the General
Laws, as amended by chapter one hundred and thirty of the acts of nineteen hundred
and thirty-six, is hereby further amended by inserting after the word "director" in
the seventy-first line the words : — and the commissioner, — so that the last paragraph
will read as follows : —
If a prisoner under complaint or indictment is committed in accordance with section
one hundred, and such complaint or indictment is dismissed or nol prossed or if a pris-
oner is committed in accordance with sections one hundred and three or one hundred
and four, and his sentence has expired, the superintendent of the institution to which
commitment was made or said medical director and the commissioner, in case of com-
mitment to the Bridgewater state hsopital, as the case may be, may permit such prisoner
temporarily to leave such institution in accordance with sections eighty-eight and ninety.
The word "prisoner" as used in this section shall include all persons committed under
section one hundred, whether or not in custody, when so committed; and in construing
this section a maximum and minimum sentence shall be held to have expired at the end
of the minimum term, and an indeterminate sentence, at the end of the maximum period
fixed by law. (Approved March 11, 1939 )
Chapter 197. — An Act Prohibiting Employees and other persons connected with Hospitals
from furnishing certain information about certain personal injury cases to Attorneys at
Law or their Representatives, and making changes in the law relating to Runners, so called.
Section 1. Chapter two hundred and twenty-one of the General Laws is hereby
amended by striking out section forty-three, as appearing in the Tercentenary Edition,
and inserting in place thereof the following: — Section 43. No attorney at law shall,
through any runner, agent or person, hereinafter called a runner, who is employed by
him solicit a person to employ him, nor shall any such runner solicit a person to employ
such attorney, to present a claim for damages, or to prosecute an action for the enforce-
ment thereof, and no attorney at law or runner shall directly or indirectly give or promise
any person any money, fee, commission, profitable employment or other personal advan-
tage in consideration of his employing such attorney on behalf of a person having a claim
for damages, or of his soliciting or procuring the person who has such claim to employ
such attorney to present such claim or to prosecute an action for the enforcement thereof.
14 P.D. 117
No attorney at law shall appear in any action or suit for the enforcement of a claim in
connection with which he has violated this section. A district court, upon complaint
alleging violation of any provision of this section by any runner who resides or has a
place of business within its judicial district, may issue an order of notice to the person
complained of to show cause why he should not be ordered to desist and refrain from
violation of any such provision on penalty of contempt.
Section 2. Said chapter two hundred and twenty-one is hereby further amended by
inserting after section forty-four, as so appearing, the two following new sections : —
Section 44-4- • No person in the employ of, or in any capacity attached to or connected
with, any hospital, infirmary or other institution, public or private, which receives
patients for medical or surgical treatment, shall communicate directly or indirectly,
with any attorney at law, or any person representing such attorney, for the purpose of
enabling such attorney, or any associate or employee of such attorney, to solicit employ-
ment to present a claim for damages or prosecute an action for the enforcement thereof,
on behalf of any patient in any such institution. A district court, upon complaint alleging
violation of any provision of this section by any person employed by, or attached to,
or connected with, any such hospital, infirmary or other institution situated within its
judicial district, may issue an order of notice to the person complained of to show cause
why he should not be ordered to desist and refrain from violation of any such provision
on penalty of contempt.
Section 44B. The superintendent or other person in immediate charge of each hospital,
infirmary or institution referred to in section forty-four A shall cause to be posted and
kept posted in a conspicuous place therein printed copies of said section. Printed copies
of said section shall, on application therefor, be furnished to each such hospital, infirmary
and institution by the department of public health at a price to be determined by the
commission on administration and finance. Any such superintendent or other person
who violates any provision of this section shall be punished by a fine of not more than
five hundred dollars. (Approved May 12, 1989.)
Chapter 272. — An Act Changing the Name of the State Infirmary to the Tewksbury State
Hospital and Infirmary.
Section 1. The name of the State Infirmary is hereby changed to the Tewksbury
State Hospital and Infirmary.
Section 2. When used in any statute, ordinance, by-law, rule or regulation, the phrase
"State Infirmary," or any words connoting the same, shall mean the Tewksbury State
Hospital and Infirmary, unless a contrary intent clearly appears. (Approved June 8,
1939.)
Chapter 417. — An Act further extending the Provisions of certain Enabling Acts so that
the Commonwealth may accept and use for Public Projects certain Federal Funds.
Whereas, The deferred operation of this act would tend to defeat its purpose, therefore
it is hereby declared to be an emergency law, necessary for the immediate preservation
of the public convenience.
Section 1. Wherever in chapter three hundred and sixty-five of the acts of nineteen
hundred and thirty-three, and acts in amendment thereof and in addition thereto,
reference is made to the National Industrial Recovery Act or any title or part thereof,
or to the Emergency Relief Appropriation Act of 1935, such reference shall be deemed
and held to refer also to all acts and joint resolutions of Congress enacted during nineteen
hundred and thirty-nine, nineteen hundred and forty and nineteen hundred and forty-
one, authorizing grants or loans, or both, of federal funds for public projects.
Section 2. Section two of said chapter three hundred and sixty-five, as most recently
amended by section two of chapter three hundred and eighty of the acts of nineteen
hundred and thirty-five, is hereby further amended by inserting after the word "grant"
in the thirteenth line and the first time it appears in the forty-first line, in each instance,
the words : — or loan, — so as to read as follows : — Section 2. The commonwealth may
engage in any public works project included in any "comprehensive program of public
works" prepared under section two hundred and two of Title II of the National Industrial
Recovery Act and in any public project falling within one or more of the classes of pro-
jects for which an appropriation of federal funds has been made available by section one
of the joint resolution of Congress known as the Emergency Relief Appropriation Act
of nineteen hundred and thirty-five, but only in case such project is approved, as herein-
after provided, by the commission and by the governor and in case the proper federal
P.D. 117 15
authorities have approved a grant or loan therefor of federal money; provided, that such
approval by the commission or by the governor shall not be granted for any project
which will cause the aggregate expenditure hereunder to be in excess of twenty-five
million dollars; and provided, further, that out of such sum not more than ten million
dollars shall be expended for the construction, reconstruction and resurfacing of roads
and for projects similar to those enumerated in section two hundred and four of said
Title II. All projects for the construction, reconstruction or resurfacing of roads and the
construction of sewers shall be done by human labor, except in so far as machinery is,
in the opinion of the state or federal officer or department having charge of the project,
reasonably necessary, and the wages for such labor shall not be less than the prevailing
rate of wages as established by the federal government. Nothing contained in this act
shall be construed to prevent the commonwealth from engaging hereunder in any project
for which funds have already been appropriated in whole or in part, if such project shall
be approved as herein required. Such projects, so approved, shall be carried out in all
respects subject to the provisions of said Title II and of said Emergency Relief Appro-
priation Act and to such terms, conditions, rules and regulations, not inconsistent with
the applicable federal laws and regulations, as the commission may establish, with the
approval of the governor, to ensure the proper execution of such projects. The common-
wealth may accept and use for carrying out any projects so approved any grant or loan,
or any grant and loan, of federal funds under section two hundred and three of said Title
II or under said Emergency Relief Appropriation Act and, for the purpose only of carry-
ing out such projects except as provided in section two A, may from time to time borrow
from the United States of America or other sources, or both, on the credit of the common-
wealth such sums, not exceeding, in the aggregate, seventeen million dollars, exclusive of
amounts borrowed for repurchase of obligations under said section two A, as may be
required, and may issue bonds, notes or other forms of written acknowledgment of debt,
referred to in this act as obligations.
In anticipation of the sale of obligations issued under this section, the state treasurer
may from time to time, with the approval of the governor, pay from the Highway Fund,
without appropriation, any of the expenses of carrying out any projects authorized by
this act; but all money so paid from said fund shall be repaid to such fund out of the
proceeds of obligations issued and sold under this section or under said section two A.
{Approved Augvst 3, 1939.)
Chapter 1+25, General Laws
Section 54. Any person in the service of the commonwealth, or of a county, city or
town which, by vote of its county commissioners or city council or of its inhabitants at
a town meeting, accepts this section, shall be entitled, during the time of his service in
the organized militia, under sections eleven, seventeen, eighteen, nineteen, one hundred
and five or one hundred and fifty-four, or during his annual tour of duty of not exceeding
fifteen days as a member of the organized reserve of the army of the United States or
of the United States naval reserve forces, to receive pay therefor, without loss of his
ordinary remuneration as a.n employee or official of the commonwealth, or of such county,
city or town, and shall also be entitled to the same leaves of absence or vacation with
pay given to other like employees or officials. {Approved August 3, 1939.)
Chapter 427. — An Act relative to competitive bidding on state contracts.
Chapter twenty-nine of the General Laws is hereby amended by inserting after section
eight, as appearing in the Tercentenary Edition, the following new section: — Section
8 A. No officer having charge of any office, department or undertaking which receives a
periodic appropriation from the commonwealth shall award any contract for the con-
struction, reconstruction, alteration, repair or development at public expense of any
building, road, bridge or other physical property if the amount involved therein is one
thousand dollars or over, unless a notice inviting proposals therefor shall have been
posted, not less than one week prior to the time specified in such notice for the opening
of said proposals, in a conspicuous place on or near the premises of such officer, and shall
have remained so posted until the time so specified, and, if the amount involved therein
is in excess of five thousand dollars, unless such a notice shall also have been published
at least once not less than three weeks prior to the time so specified, and at such other
times prior thereto, if any, as the commission on administration and finance shall direct,
in such newspaper or newspapers as said commission, having regard to the locality of
the work involved in such contract, shall prescribe; provided, that such newspaper
16 P.D. 117
publication may be omitted, in cases of special emergencies involving the health and
safety of the people and their property, upon the written approval of said commission.
Proposals for any contract subject to this section shall be in writing and shall be opened
in public at a time and place specified in the posted or published notice, and after being
so opened shall be open to public inspection. No contract or preliminary plans and
specifications shall be split or divided for the purpose of evading the provisions of this
section. The provisions of this section shall not apply to any transaction between the
commonwealth and any of its political subdivisions. {Approved August 4, 1939.)
Chapter 500. — An Act relative to the Care of the Mentally Diseased and the Work of the
Department of Mental Health.
Section 1. Section sixteen of chapter one hundred and twenty-three of the General
Laws, as amended by section nine of chapter four hundred and eighty-six of the acts of
nineteen hundred and thirty-eight, is hereby further amended by striking out, in the
eighth and ninth lines, the words "four dollars and fifty cents" and inserting in place
thereof the words : — six dollars, — and by adding at the end the following new sen-
tence : — The department shall have the same authority in the case of patients directly
committed to it, — so as to read as follows: — Section 16. The superintendent of each
state hospital may place at board in a suitable family or in a place in this commonwealth
or elsewhere any patient in such hospital who is in the charge of the department and is
quiet and not dangerous nor committed as a dipsomaniac or inebriate, nor addicted to
the intemperate use of narcotics or stimulants. The cost to the commonwealth of the
board of such patients supported at the public expense shall not exceed six dollars a week
for each patient. The department shall have the same authority in the case of patients
directly committed to it.
Section 2. Section forty-three of said chapter one hundred and twenty-three, as
appearing in the Tercentenary Edition, is hereby repealed.
Section 3. Nothing in this act shall be deemed to terminate the employment or the
term of office of the superintendent and the assistant phj^sicians at the Westborough
state hospital, or any of them, in office immediately prior to the taking effect of this act.
Section 4. Section fifty-six of said chapter one hundred and twenty-three, as so
appearing, is hereby repealed.
Section 5. Said chapter one hundred and twenty-three is hereby further amended by
striking out section seventy-seven, as amended by section five of chapter three hundred
and fourteen of the acts of nineteen hundred and thirty-five, and inserting in place
thereof the following: — Section 77. If a person is found by two physicians qualified as
provided in section fifty-three to be in such mental condition that his commitment to an
institution for the insane is necessary for his proper care or observation, he may be
committed by any judge mentioned in section fifty, to a state hospital, to the McLean
hospital, or, in case such person is eligible for admission, to an institution established
and maintained by the United States government, the person having charge of which is
licensed under section thirty-four A, for a period of forty days pending the determination
of his insanity. Within thirty days after such commitment the superintendent of the
institution to which the person has been committed shall discharge him if he is not insane,
and shall notify the judge who committed him, or, if he is insane he shall report the
patient's mental condition to the judge, with the recommendation that he shall be com-
mitted as an insane person, or discharged to the care of his guardian, relatives or friends
if he is harmless and can properly be cared for by them. Within the said forty days the
committing judge may authorize a discharge as aforesaid, or he may commit the patient
to any institution for the insane as an insane person if, in his opinion, such commitment
is necessary. If, in the opinion of the judge, additional medical testimony as to the mental
condition of the alleged insane person is desirable, he may appoint a physician to examine
and report thereon.
In case of the death, resignation or removal of the judge committing a person for
observation, his successor in office, or, in case of the absence or disability of the judge
committing a person as aforesaid, any judge or special justice of the same court, shall
receive the notice or report provided for by this section and carry out any subsequent
proceedings hereunder.
Section 6. Section sixty-six of said chapter one hundred and twenty-three, as appear-
ing in the Tercentenary Edition, is hereby amended by adding at the end the following
new paragraph: —
P.D. 117 17
If a feeble-minded person is committed to such a school, the department shall there-
after have power, whenever advisable, to transfer him to the custody or supervision of
the department; and thereafter the provisions of section sixty-six A, relative to removal,
temporary release and discharge of feeble-minded persons, shall apply to such person.
Section 7. Said chapter one hundred and twenty-three is hereby further amended
by striking out section seventy-nine, as amended by section seven of said chapter three
hundred and fourteen, and inserting in place thereof the following: — Section 79. The
superintendent or manager of any institution for the insane may, when requested by a
physician, member of the board of health, sheriff, deputy sheriff, member of the state
police, selectman, police officer of a town, or by an agent of the institutions department
of Boston, receive and care for in such institution as a patient, for a period not exceeding
ten days, any person deemed by such superintendent or manager to be in need of immedi-
ate care and treatment because of mental derangement other than drunkenness. Such
request for admission of a patient shall be put in writing and be filed at the institution
at the time of his reception, or within twenty-four hours thereafter, together with a
statement in a form prescribed or approved by the department, giving such information
as it deems appropriate. Any such patient deemed by the superintendent or manager
not suitable for such care shall, upon the request of the superintendent or manager, be
removed forthwith from the institution by the person requesting his reception, and, if
he is not so removed, such person shall be liable to the commonwealth or to the person
maintaining the private institution, as the case may be, for all reasonable expenses
incurred under this section on account of the patient, which may be recovered in contract
by the state treasurer or by such person, as the case may be. The superintendent or
manager shall either cause every such patient to be examined by two physicians, quali-
fied as provided in section fifty-three, and cause application to be made for his admission
or commitment to such institution, or cause him to be removed therefrom before the
expiration of said period of ten days, unless he signs a request to remain therein under
section eighty-six. Reasonable expenses incurred for the examination of the patient and
his transportation to the institution shall be allowed, certified and paid as provided by
section seventy-four.
Section 8. Section eighty of said chapter one hundred and twenty-three, as appearing
in the Tercentenary Edition, is hereby amended by striking out, in the eighth line, the
word "needing" and inserting in place thereof the following: — deemed by such super-
intendent or manager to be in need of, — so as to read as follows : — Section 80. The
superintendent or manager of any institution to which commitments may be made
under section sixty-two may, when requested by a physician, by a member of the board
of health or a police officer of a town, by an agent of the institutions department of
Boston, by a member of the state police, or by the wife, husband, guardian or, in the
case of an unmarried person having no guardian, by the next of kin, receive and care
for in such institution, as a patient for a period not exceeding fifteen days, any person
deemed by such superintendent or manager to be in need of immediate care and treat-
ment because he has become so addicted to the intemperate use of narcotics or stimulants
that he has lost the power of self-control. Such request for the admission of a patient
shall be made in writing and filed at the institution at the time of his reception, or within
twenty-four hours thereafter, together with a statement, in a form prescribed by the
department having supervision of the institution, giving such information as it deems
appropriate. The trustees, superintendent or manager of such institutions shall cause to
be kept a record, in such form as the department having supervision of the institution
requires of each case treated therein, which shall at all times be open to the inspection
of such department and its agents. Such record shall not be a public record, nor shall
the same be received as evidence in any legal proceeding. The superintendent or manager
of such an institution shall not detain any person received as above for more than fifteen
days, unless, before the expiration of that period, such person has been committed under
section sixty-two, or has signed a request to remain at said institution under section
eighty-six.
Section 9. Section eighty-two of said chapter one hundred and twenty-three, as so
appearing, is hereby amended by striking out, in the second line, the words "delirium
tremens and", — so as to read as follows: — Section 82. No person suffering from in-
sanity, mental derangement, deliriums, or mental confusion, except drunkenness, shall,
except in case of emergency, be placed or detained in a lockup, police station, city prison,
house of detention, jail or other penal institution or place for the detention of criminals.
18 P.D. 117
If, in case of emergency, any such person is so placed or detained, he shall forthwith be
examined by a physician and shall be furnished suitable medical care and nursing and
shall not be so detained for more than twelve hours. Any such person not so placed or
detained who is arrested by or comes under the care or protection of the police, and any
other such person who is in need of immediate care and treatment which cannot be
provided without public expense, shall be cared for by the board of health of the town
where such person may be. Such board of health shall cause such person to be examined
by a physician as soon as possible, shall furnish him with suitable medical care and
nursing, and shall cause him to be duly admitted or committed to an institution, unless
prior to such admission or commitment he shall recover or be suitably provided for by his
relatives or friends. Reasonable expenses for board, lodging, medical care, nursing,
clothing and all other necessary expenses incurred by the board of health, under this
section, shall be allowed, certified and paid in the same manner as provided by section
seventy-four.
Section 10. Said chapter one hundred and twenty-three is hereby further amended
by striking out section eighty-six, as amended by section eight of said chapter three
hundred and fourteen, and inserting in place thereof the following: — Section 86. The
trustees, superintendent or manager of any institution to which an insane person, a
dipsomaniac, an inebriate, or one addicted to the intemperate use of narcotics or stimu-
lants, may be committed may receive and detain therein as a boarder and patient any
person who is desirous of submitting himself to treatment, and who makes written
application therefor and is mentally competent to make the application; and any such
person who desires so to submit himself for treatment may make such written application.
Except as otherwise hereinafter provided, no such person shall be detained more than
three days after having given written notice of his intention or desire to leave the institu-
tion; provided, that if his condition is deemed by the trustees, superintendent or manager
to be such that further hospital care is necessary and that he is no longer mentally com-
petent to be detained therein as a voluntary patient, or that he could not be discharged
from such institution with safety to himself and to others, said superintendent or manager
shall forthwith cause application to be made for his commitment to an institution for
the insane, and, during the pendency of such application, may detain him under the
written application hereinbefore referred to.
Section 11. Section eighty-seven of said chapter one hundred and twenty-three,
as so appearing, is hereby amended by striking out, in the eighth line, the words "three
months" and inserting in place thereof the words : — ten days, — so as to read as follows :
— Section 87. The trustees of the Monson state hospital may receive and detain therein
as a patient any person who is certified to be subject to epilepsy by a physician qualified
as provided in section fifty-three, and who desires to submit himself to treatment and
makes written application therefor, and whose age and mental condition are such as to
render him competent to make such application, or for whom application is made by
a parent or guardian. No such patient shall be detained more than ten days after having
given written notice of his intention or desire to leave the hospital. Upon the patient's
reception at the hospital, the superintendent shall report the particulars of the case to
the department, which may investigate the same.
Section 12. Said chapter one hundred and twenty-three is hereby further amended
by striking out section thirty-six, as so appearing, and inserting in place thereof the
following: — Section 86. The superintendent or head physician of each institution shall
cause all implements or devices of restraint to be kept under lock and key when not
in actual use.
Section 13. Section forty of said chapter one hundred and twenty-three, as so appear-
ing, is hereby amended by adding at the end the following new sentence: — Locked
doors on buildings housing patients in institutions under the jurisdiction of the depart-
ment shall not be construed as constituting an obstruction of egress within the meaning
of any section of chapter one hundred and forty-three, — so as to read as follows : —
Section Ifi. Each institution shall be provided with proper means of escape from fire
and suitable apparatus for the extinguishment of fire, and no building shall be erected
or maintained at such institution without a written certificate of approval from the
building inspector of the department of public safety for the district in which it is to be
erected or maintained. Locked doors on buildings housing patients in institutions under
the jurisdiction of the department shall not be construed as constituting an obstruction
of egress within the meaning of any section of chapter one hundred and forty-three.
{Approved August 12, 1939.)
P.D. 117 19
Chapter 511. — An Act providing for a Second Assistant Commissioner in the Department
of Mental Health.
Section 1. Chapter nineteen of the General Laws is hereby amended by striking out
section one, as amended by section two of chapter four hundred and eighty-six of the
acts of nineteen hundred and thirty-eight, and inserting in place thereof the following: —
Section 1. There shall be a department of mental health, in this chapter called the
department, and a commissioner of mental health who shall have the exclusive super-
vision and control of the department. All action of the department shall be taken by
the commissioner or, under his direction, by such agents or subordinate officers as he
may determine. There shall be in the department an assistant commissioner, qualified
as hereinafter provided, who shall perform such duties as the commissioner may pre-
scribe, and a second assistant commissioner qualified as hereinafter provided who shall,
under the direction of the commissioner, have charge of the financial matters relating
to the department and perform such other duties as the commissioner may prescribe.
The commissioner and assistant commissioner shall be physicians who are diplomates
in psychiatry of the American Board of Psychiatry and Neurology, Incorporated, and
shall have had at least five years' experience on the resident administrative staff of a
state or federal hospital for mental diseases or in any equivalent psychiatric organization,
or at least four years' experience as aforesaid and at least one year's experience in the
department controlling such hospital. The second assistant commissioner shall be a
man of business experience qualified to undertake the management of the financial and
business interests of the department. In the event of the disability or absence of the
commissioner, or of a vacancy in his office by reason of death or otherwise, the assistant
commissioner shall exercise the powers and perform the duties of the commissioner. In
the event of the death, absence or disability of both the commissioner and the assistant
commissioner, the governor, with the advice and consent of the council, may appoint an
acting commissioner, who shall serve until the commissioner or the assistant commissioner
is able to perform the duties of the office.
Section 2. Said chapter nineteen is hereby further amended by striking out section
two, as amended by section three of said chapter four hundred and eighty-six, and insert-
ing in place thereof the following: — Section 2. Upon the expiration of the term of office
of the commissioner, his successor shall be appointed for six years by the governor, with
the advice and consent of the council; and the commissioner shall receive such salary,
not exceeding ten thousand dollars, as the governor and council may determine. Upon
the expiration of the term of office of an assistant commissioner, his successor shall be
appointed for four years by the commissioner, with the approval of the governor and
council ; and the assistant commissioner shall receive such salary, not exceeding seventy-
five hundred dollars, as the governor and council may determine. Upon the expiration
of the term of office of the second assistant commissioner, his successor shall be appointed
for four years by the commissioner, with the approval of the governor and council;
and the second assistant commissioner shall receive such salary, not exceeding five
thousand dollars, as the governor and council may determine. The commissioner, assist-
ant commissioner and second assistant commissioner shall be reimbursed for expenses
necessarily incurred in the performance of their duties, and shall devote their entire
time to the affairs of the department.
Section 3. As soon as may be after the effective date of this act, a second assistant
commissioner in the department of mental health, qualified as provided in section one,
shall be appointed for four years by the commissioner of mental health, with the approval
of the governor and council. Nothing in this act shall affect the commissioner of mental
health or the assistant commissioner in said department, except as expressly provided
therein. (Approved August 12, 1989.)
Additional Legislation of General Interest in 1939
1. Chapter 238. — Abolishing the Commissioner ship and Associate Commissioner ship
in the Division of Civil Service and placing said Division under the supervision and control
of a Director and a Commission, and fw ther defining the powers and duties of said Division,
its officers and employees.
2. Chapter 387. — An act making effective certain limitations on expenditures con-
tained in the general appropriation act and providing further reductions in certain items
thereof.
20 P.D. 117
3. Chapter 415. — An act further regulating the practice of medicine and dentistry
within the Commonwealth by aliens.
4. Chapter 480. — An act requiring fair competition foi bidders on the construction,
reconstruction, alteration, remodelling or repair of certain public works by the Common-
wealth or any political subdivision thereof.
5. Chapter 502. — Making certain State fiscal requirements biennial instead of annual.
6. Chapter 508. — Making miscellaneous changes in the laws which have become neces-
sary or advisable to provide for Biennial Sessions of the General Court.
REPORT OF THE FINANCIAL DIVISION
(Including Financial Statistics for the Year Ended November 30, 1939.
Tables 1 to 11, inclusive, immediately follow this report.)
To the Commissioner of Mental Health:
The report of the activities for the Financial Division is submitted for the fiscal year
ending November 30, 1939. This report has embodied in it the finances of the depart-
ment, the institutions under its financial control, report of the Engineering, Farm and
Food sub-divisions, information relating to the work of the division on appropriations for
special purposes, supervision of major repairs, and various tables dealing with these
activities.
In Table 1 are brought together in consolidated form expenditures from appropriations
controlled by the Department, having to do with the care of patients in hospitals for
mental diseases (including epilepsy) and schools for mental defectives. The total expend-
itures show an increase of $286,881.81. Of this amount $213,052.90 is under "Personal
Services" and $293,250.02 under "New Construction". "Maintenance and Operation"
shows a decrease of $219,421.11.
The expenditures of the Department itself, given in Table 2, amount to $341,541.71,
an increase over 1938 of $32,031.34. "Personal Services" shows a large increase because
of the filling of a number of vacant positions. "Expenses" shows a slight increase. The
amount spent under "Persons Boarded in Hospital Cottages" was increased $1,233.89
because of a change in rate from $8.50 to $10 in the middle of the year. Additional
money was spent on research under "Investigation of Mental Diseases", and on "Board-
ing Feeble-minded Persons".
Table 3 shows the amount appropriated by the legislature for the fiscal year and the
balance available from the previous year (which represents liabilities for indebtedness
incurred prior to the close of the previous fiscal year). These two amounts represent
the total appropriation available for the current year. Next is the gross expenses, then
the receipts which are for sales only. Receipts for board of patients are shown in Table 8.
They are not deducted to arrive at the net expenses and net weekly per capita cost.
Next are shown the expenses arrived at by deducting sales from the gross expenses and
then with the daily average number of patients, the weekly per capita cost is obtained.
The weekly per capita cost average for the twelve mental hospitals is $8,084; that for
schools for defectives is $7,101, with an average of $7,899 for the sixteen institutions
whose appropriations are supervised by the Department. Comparing the previous fiscal
year ending November 30, 1938, the average weekly per capita cost for the twelve mental
hospitals was $8,231 or $.15 higher than 1939. For the schools for mental defectives
for the fiscal year 1938 the average weekly per capita cost was $7,066 or $.03 lower than
the average per capita cost for the fiscal year 1939. Taking the total of the sixteen institu-
tions for 1938, the average weekly per capita cost was $8,011 as compared with the
average per capita cost of 1939 of $7,899 or $.11 higher than the average of 1939. As
the net weekly per capita cost for the Boston Psychopathic Hospital is exceptional
compared with that for the other institutions, the average weekly per capita cost for the
twelve mental hospitals, when recomputed without the Boston Psychopathic Hospital
for 1939 is $7,905, and the average per capita cost for the fifteen institutions computed
without the Boston Psychopathic Hospital is $7,753.
Table 4 gives in detail the expenses and weekly per capita costs grouped according
to the adopted standard of analysis of maintenance expenses of all classes of institutions
in the Commonwealth. In comparison with the expenses of 1938, increases are shown
under Personal Services, Food and Medical and General Care. Decreases were shown
under all other classifications, particularly under Repairs Ordinary and Repairs and
Renewals.
P.D. 117 21
The average weekly per capita cost per patient for personnel for 1938 was $4,554 and
for 1939, $4,632, an increase of $.078 from 1938. This detail will be noted in Table 5.
The rotation of persons employed for the year shows a slight increase per person for
the hospitals for 1939. (Table 6.)
Appropriations for construction, permanent betterments, real estate and furnishings,
unlike that for maintenance and operation, are made for two years, beginning with the
passage of the act dealing with special appropriations by the legislature. Detail of all
special appropriations is given in the report of the Engineering division and in Table 7
where are shown all of the appropriations of this nature active during the fiscal year.
This table deals with indebtedness incurred and balances available rather than with the
actual cash payments and cash balances, and more clearly represents the actual condi-
tion of the appropriation as it shows the true balances available for additional expendi-
tures. In its budget request for 1939 the Department asked for $6,878,743.20. The
amount appropriated was $148,300.
Receipts during the year from paying patients, collected under the direction of the
Division of Legal Settlement and Support Claims, amounted to $831,091.54, an increase
over the receipts of 1938 of $29,336.92. The per capita amount received in 1939, based
on average daily patient population, was $30.04. The receipts from paying patients
were 7.188% of the total cost of maintenance. (Table 8.)
Section 27, chapter 123 of the General Laws reads as follows: "The Trustees of each
state hospital shall be a corporation for the purpose of taking and holding by them
and their successors, in trust for the Commonwealth, any grant or devise of land, and
any gift or bequest of money or other personal property, made for the use of the state
hospitals of which they are trustees, and for the purpose of preserving and investing the
proceeds thereof in notes or bonds secured by good and sufficient mortgages or other
securities, with all the powers necessary to carry said purposes into effect. They may
expend any unrestricted gift or bequest, or part thereof, in the erection or alteration of
buildings on land belonging to the state hospital, subject to the approval of the depart-
ment, but all such buildings shall belong to the state hospital and be managed as a part
thereof."
Under this section hospitals have received gifts as shown in Table 9 which have been
deposited as funds, the proceeds of which have been used for the benefit of the patients
in accordance with the terms or restrictions placed thereon by the donor. This depart-
ment encourages gifts made under this law and from them special benefits are derived
by the patients in ways not always possible from the funds of the Commonwealth.
The printing plant, conducted by the Department at the Gardner State Hospital, is
carried on as occupational therapy for the benefit of patients, and at the same time
meets the printing needs of the Department and its institutions. During the year approx-
imately the following material was printed: 310,000 letterheads; 63,500 envelopes; 38,700
each Christmas folders and envelopes; 37,350 Christmas labels, 67,200 triplicate order
blanks; 3,500,000 medical and other forms and cards of 240 varieties; 173,984 pay roll
checks; 3,000 booklets; 1,200 bulletins and books, 10,450 annual reports for the depart-
ment and its institutions, and 1,000 reprints.
The reports of the Engineering, Farm and Food sub-divisions follow.
Report of Supervising Hospital Construction Engineer — Walter E. Boyd
There were few special appropriations for the year 1939 and none were of any size.
Those that were available were for correcting defects in service.
An appropriation for Steam lines at the Boston State Hospital provides for the instal-
lation of a new large steam line from the Power Plant in the east group to a distribution
center in the west group. This line will be adequate to serve the entire west group should
the existing mains break down. It also will enable the return of all of the condensate
from the west group instead of wasting a large percentage as is necessarily done now.
Plans have been completed but as the work cannot be installed during the winter it will
be started early in the spring. The installation should result in a material saving at
the power plant.
An extension of the replacement of open wiring was carried on at the Danvers State
Hospital. Most of the work consisted of new wiring and fixtures at the Middleton
Colony. Flood lights were installed around the colony buildings and the ground lighting
improved. The stairway and night lights in both groups were placed on a time switch
automatically turning them on and off as required. The project put the wiring at the
Danvers State Hospital on an efficient and up-to-date basis.
22 P.D. 117
Sewer beds at the Hersey Farm of the Foxborough State Hospital were completed
and placed in operation.
At the Grafton State Hospital contracts were awarded and work started on the instal-
lation of multiple retort stokers and coal handling apparatus. The work was started
late in the fall and two stokers and the coal handling equipment were put into operation
for the winter. The entire project will be completed early in 1940 and is expected to
result in marked savings and more efficient operation.
Plans were prepared for additional sewer beds at the Grafton State Hospital but
unsuccessful negotiations for drainage rights delayed the project so that the actual work
will not start until 1940.
The dining room in Ward R Building at the Medfield State Hospital was renovated
by the installation of tile floors and walls, repainting and the installation of modern
sanitary serving-room equipment.
A contract was awarded and work started on the replacement of open wiring at the
Taunton State Hospital. This reduces one more fire hazard. The piggery was practically
completed, so that this activity can be removed from the main hospital to the farm at
Raynham Colony.
Several sewer beds at the Westborough State Hospital were resurfaced by the addition
of a layer of filter sand, improving the filtering and simplifying the maintenance of the
beds.
At the Monson State Hospital an additional steam line was installed in the steam
tunnel from the power house to the head of the tunnel at the old power house. This is a
smaller line for use in the summer and will result in steam economies and also permit
repairs to the large line. The garage at this institution was completed by contract.
The water supply at Templeton Colony of the Walter E. Fernald State School was
continued with the awarding of further contracts, for the pumps, filter, standpipe and
house connections. Because of delays due to large quantities of rock and shortage of
ground water, causing changes in plans, the work was not finished in 1939 as anticipated.
It will be completed in 1940, giving the Colony a central water supply and eliminating
the present shallow wells.
Studies were made of power plant operation, budget requests on special appropriations
and heat and other plant operation were considered, and the usual inspections of insti-
tutions were made.
Report of the Senior Structural Engineer — Clarence D. Maynard
The institution requests for funds under the Repairs and Renewals and Garage sections
of the budget were investigated and conferences were held with the Budget Commissioner
and important items included in the budget requests. Fire prevention and renewal of
equipment programs were continued. Budget requests were made for the years 1939
and 1940.
A new control table was installed, operating room equipment purchased and self-
closing fire doors installed at the Boston Psychopathic Hospital.
At the Boston State Hospital, bakery and kitchen equipment was installed, the steam
turbines were repaired and overhauled, the program of floor covering continued, cafeteria
equipment installed in West A building, and new porches erected at West B building.
Extensive repairs to the exterior walls were necessary at the Middleton Colony of the
Dan vers State Hospital; temperature controls and dial thermometers were installed on
hot water lines; steel access panels to ventilating ducts were installed and remote control
of fire pump installed.
At the Foxborough State Hospital, the fire protection program was continued and
stair grilles and window guards were installed. A new brooder house was built and the
steam and hot water lines to cottages were completed.
The program of replacing ice refrigeration with electric refrigeration was continued
at the Gardner State Hospital. New ranges were installed, the water standpipe was
painted, farm scales were purchased and new laundry equipment installed.
At the Grafton State Hospital, a ceramic floor was laid in the Pines D dining-room.
A new silo was constructed and a central brooder house built. A program of weather-
stripping and caulking windows was inaugurated and a new smoke flue was erected at
the boiler house.
At the Medfield State Hospital an ice cream freezer and hardening cabinet was pur-
chased, bakery equipment installed, and a new silo erected, and the program of weather-
stripping continued.
P.D. 117 23
A new silo was built at the Taunton State Hospital, equipment was purchased for the
new piggery and metal shelving provided for the Infirmaries which were recently reno-
vated.
A new floor was laid in the chapel at the Worcester State Hospital and the water tower
was painted and a protective wire fence erected around the tank. A new pasteurizer
was purchased for the dairy.
At the Monson State Hospital the walls and ceiling of the cow barn were renewed
and the program of replacement of domestic hot water tanks continued. The main
electric cable was laid underground at the north side of the boiler plant and the roofing
replaced at Farm Groups No. 1 and 2.
A new pasteurizer was installed in the dairy of the Belchertown State School and the
hot water thermostatic mixing valves repaired. The number one stoker was remodelled
and an asphalt tile floor installed in Infirmary Building K.
The program of renewal of plumbing, wiring and roofing was continued at the Walter
E. Fernald State School and dairy equipment installed. Boiler baffle walls in the boiler
plant also were installed.
At the Wrentham State School new tile floors were installed in dormitories E and F.
A new silo was built and funds provided for the completion of the cow barn. New sewing
room equipment was installed in "F" building. New window shades were installed in
"O" building.
Fire prevention inspections were made at the institutions and contract supervision
was given to the following special appropriation projects: Reslating Roofs, Dan vers;
Steam and Hot Water lines, Foxborough; Pines E Ward Building and Dining and Service
Building including furnishings, Grafton State Hospital; Fire Protection, Westborough;
Medical Equipment and Bake Ovens, Worcester State Hospital.
A total of sixty-three visits was made to the institutions.
Report of the Assistant Engineer — Joseph P. Gentile
During 1939 the institutions of the Department were visited for the purpose of con-
ducting the routine inspections on fire protection; for obtaining data necessary to prepare
projects; and for maintaining supervision of projects during their progress.
At the Boston State Hospital the Work of building hard-surfaced roads, concrete walks
and curbing, installing sewers for surface drainage, grading and landscaping was con-
tinued with W. P. A. labor.
A new water main with hydrants was installed at the Belcher Group of the Gardner
State Hospital. This water main will be used for fire fighting purposes exclusively. Work
has been started on the installation of sprinklers in the cow and horse barns at the Belcher
Group.
Enclosed fireproof stairs were erected to replace open fire escapes on the Speare and
Dewson Buildings of Warren Colony at the Westborough State Hospital.
The reconstruction of Richmond Sanatorium at the Westborough State Hospital
was completed.
The X-Ray suite of the Worcester State Hospital was remodeled and new X-Ray
Equipment installed.
The Administration Building of the Worcester State Hospital was completely rewired
including new lighting fixtures in the offices and the superintendent's suite.
Work has been started on the installation of walk-in refrigerator boxes in the basement
of the kitchen and dining building of the Monson State Hospital.
Two additional exits were provided for each ward of the Clough and South Buildings
at the Monson State Hospital by the erection of two enclosed fireproof stairs on each
building.
A study is being made of paints, being used at the institutions, to determine a standard
of quality for the different paints.
Report of Assistant Engineer — Francis D. Kirby
During the year general alterations and installations, surveys and inspections of
plumbing work were made by the department and maintenance personnel at the various
institutions, including the drawing of plans and specifications by the department.
At the Worcester State Hospital a general survey of the plumbing in the main execu-
tive building was made, including the completion of plans and specifications for the work
to be done.
24 P.D. 117
Plumbing work in the Employees' Building was done to the amount of funds allowed.
A final survey was made of all plumbing work to be done at the Summer Street building.
All work on the hydrotherapy suite in "O" Building was completed and a plumbing
and heating survey was made of the hydrotherapy suite to be completed in "E" Building
at the Foxborough State Hospital.
At the Gardner State Hospital plans and specifications were drawn for additional
plumbing facilities on the second and third floors of the Men's and Women's Infirmary
Buildings.
At the end of the year 75% of the work on the hydrotherapy suite at the Grafton
State Hospital was completed.
At the Medfield State Hospital a survey of plumbing for additional toilet facilities
for use of employees on the second floor in G-2 and G-4 building was made. All plumbing
alteration work started at this hospital was completed.
A general survey was made for additional toilet facilities for plumbing in East and
West Godding Buildings. All plumbing and ventilation work previously started in wards
1, 2, 3, 4, 5, 6, 7, 8, and 9 was completed at the Taunton State Hospital.
At the Monson State Hospital a complete survey was made for the renovation of all
plumbing in Farm Group Building No. 6, including the preparation of plans and specifi-
cations.
In general, check-ups were made of hot water temperature controls in the various
hospitals and of cross connections in water supply lines. Inspections were made of
plumbing work done by institution maintenance plumbers.
All of the renovation projects included plumbing, heating, electric work, plastering,
carpentry, tile and marble work, painting and general work necessary for the completion
of each project.
At present there are five uncompleted projects: Hydrotherapy suite, E Building,
Foxborough State Hospital; Hydrotherapy suite, Elms A Building, Grafton State Hospi-
tal; Completion of unfinished work, Employees' Building, Worcester State Hospital;
Completion of unfinished work, Summer Street department, Worcester State Hospital;
Completion of unfinished work in C and D Buildings, Boston State Hospital.
Report of Senior Engineering Aid — Lloyd C. Latimer
Following is the location and brief description of work performed during the year
1939.
Boston State Hospital — Prepared plans, specifications and alternate design for two
(2) reinforced concrete porch additions to Building H.
Foxborough State Hospital — Completed field engineering and inspection work on
new Sewage Disposal plant at Hersey Farm.
Gardner State Hospital — Plans for third floor addition to toilet section of Men's
Infirmary Building. Made fire inspection and recommendations for minimizing hazards.
Medfield State Hospital — Plans for renovation of second floor toilets in Buildings
G-2 and G-4. Prepared plans for cafeteria in basement of Building R.
Northampton State Hospital — Made fire inspection and report.
Taunton State Hospital — Completed field engineering work for construction of
piggery at Raynham farm. Prepared plans for renovation of toilet sections in the East
and West Godding buildings.
Westborough State Hospital — Field engineering and inspection for resurfacing of
sewer beds.
Worcester State Hospital — Plans for toilet and bath renovations in Executive Build-
ing were made.
Monson State Hospital — Plans for renovation of plumbing in Farm Group No. 6
were made.
Belchertown State School — Made fire inspection and report.
General — Made estimates of material quantities and costs, annual check-up of
institutional housing survey with many new hospital floor plans for same, computation
of per capita tabulations, together with miscellaneous small plans, sketches and specifi-
cations for various purposes.
Report of the Farm Coordinator — Wallace F. Garrett
Partial reclaiming of forests and hospital woodlands continued as speedily as finances,
labor and equipment would permit, removing damage resulting from the hurricane of
P.D. 117 25
1938. Two million feet of native lumber were sawed into boards and distributed to all
units of the department. Reforesting of certain areas progressed in an attempt to pro-
mote the native lumber requirements of the future.
Vegetable production reached a maximum poundage despite the excessive drought
existing during the summer season. Products conserved were in abundance thus reducing
the purchased food requirement during the winter.
Eggs produced at the various hospital poultry projects increased compared with
previous year's statistics. Hybrid females were used in certain locations for the purpose
of comparison and results were satisfactory.
Dairy animals were again increased numerically in an endeavor to supply the fluid
milk requirements of the department. The livestock remained in excellent physical
condition throughout the period and excessive mortality was avoided.
Monthly meetings of all head farmers were held and interesting speakers provided
to discuss current problems. As a result of such discussions the efficiency of the group
has been held at a high level, a distinct benefit to the Commonwealth.
Experimental programs supervised by the Massachusetts Experimental Station con-
tinued at several selected units. The results of such projects is published and held as a
distinct benefit to the State's agricultural program.
The Federal Government, Department of Agriculture, has instituted erosion control
demonstration projects at several of the hospitals. It is anticipated such a program will
improve control methods of soil and moisture.
For farm detail note tables 10 and 11.
Report of Food Coordinator — Albert E. Houde
During 1939 measures were inaugurated to effect standards in food preparation.
Included in these standards were the economic application of quickly frozen fresh eggs,
milk solids, hydrogenated and emulsified shortenings, flavors, and pastry and bread
flours.
A standard formula for the making of bread was put into practice, this formula evolv-
ing from economic advantages and the consideration of hospital needs.
Practical demonstrations accompanied by moving picture explanations and dis-
cussions were conducted at both Westborough and Northampton State Hospitals.
As a movement toward the standardization of hospital food control — curtailment of
waste and similar subsidization — the foundation for a Unit Cost Report was made.
This report will provide the department and institutions with an intimate insight and
control of all food units purchased and produced by the institutions.
This report in its final developments will precipitate an eventual food ration as prac-
ticed by the hospitals and become the accurate medium for all hospitals making their
future food requests and subsequent allotments.
Respectfully submitted,
William I. Rose,
Business Agent.
26
P.D..117
Financial Statistics for the Year Ended November 30, 1939
• Table 1. Total Expenditures of Department and Institutions
New Con
Maintenance
struction.
Personal
and
Permanent
Department and Institutions
Services
Operation
(Net) i
Betterments,
Real Estate
and Furnishings
Total
Department of Mental Health .
$258,933.36
$82,573.30
$341,506.66
Hospitals for Mental Diseases:
Boston Psychopathic Hospital
179,507.35
66,339 . 23
-
245,846.58
Boston State Hospital ...
638,069.82
479,637.30
$38,863.14
1,156,570.26
Danvers State Hospital .
521,937.69
404,770.20
59,514.32
986,222.21
Foxborough State Hospital .
341,536.69
239,361.94
44,190.90
625,089.53
Gardner State Hospital .
332,652.78
266,331.65
74,351.81
673,336.24
Grafton State Hospital .
405,253.99
262,998.03
477,964.19
1,146,216.21
Medfield State Hospital
442,350.10
269,320.37
' 81,109.93
792,780.40
Metropolitan State Hospital
413,501.93
333,386.76
878.29
747,766.98
Northampton State Hospital
438,844.19
320.141.34
16,102.78
775,088.31
Taunton State Hospital
417,537.21'
279,228.64
65,280.80
762,046.65
Westborough State Hospital
404,322.28
,255,999.33
114,939.76
775,261.37
Worcester State Hospital
628,372.08
437,656.67
188,480.03
1,254,508.78
Monson State Hospital .
408/440.08
281,385.25
122,758.25
812,583.58
Total Hospitals
$5,572,326.19
$3,896,556.71
$1,284,434.20
$10,753,317.10
Schools for Mental Defectives:
Belchertown State School
$298,489.91
$217,867.16
$42,616.02
$558,973.09
Walter E. Fernald State School .
431,913.46
313,633.18
115,492.59
861,039.23
Wrentham State School
378,604.32
284,970.23
34,428.30
698,002.85
Total Schools ....
$1,109,007.69
$816,470.57
$192,536.91
$2,118,015.17
Grand Total . . . '.
$6,940,267.24
$4,795,600.58
$1,476,971.11
$13,212,838.93
'Less Sales
Table 2. Departmental Receipts and Expenditures
Expenditures
' 1
LPPROPRTATTOI'
s
Expenditures
,
Appro-
priation
1939
Brought
Forward
from 1938
Appropria-'
tion
Total
Available
Balance
Commissioner's Salary
Personal Services ....
Expenses
Transportation ....
Persons Boarded, Hospital Cot-
Investigation of Mental Diseases
Boarding Feeble-Minded Patients
$10,000.00
169,000.00
42,971.79
5,860.31
24,000.00
103,785.07
3,000.00
$ —
1,956.71
8,308.24
$10,000.00
169,000.00
44,928.50
5,860.31
24,000.00
112,093.31
3,000.00
$10,000.00
157,763.55
41,415.33
5,859.98
22,452.40
102,553.34
1,497.11
$1,236.45
3,513.17
.33
1,547.60
9,539.97
1,502.89
Total
$358,617.17
$10,264.95
$368,882.12
$341,541.71
$27,340.41
Receipts
Payable to State Treasurer:
Licenses, Private Hospitals
Board in Hospital Cottages
Sales:
Forms
Other Receipts:
Deposit on Plans
College — Training
Refunds a/c previous years
Total
$950.00
416.67
237.50
50.00
40.00
,729.22
P.D. 117
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Table 5.
Analy
sis of Pay Rolls — By Institution
Average Weekly Pee Capita Cost
Institutions
Industrial
Medical
Ward
Service
and Edu-
cational
All Others
Total
Hospitals for Mental Diseases:
Boston Psychopathic Hospital .
$8,851
$10,784
$.550
$19,561
$39,748
Boston State Hospital
.377
2.769
.156
1.993
5.296
Danvers State Hospital
.304
2.243
.072
1.635
4.255
Foxborough State Hospital
.357
2.153
.087
1.947
4.545
Gardner State Hospital
.329
1.892
.130
1.803
4.155
Grafton State Hospital
.369
2.207
.102
2.450
5.129
Medfield State Hospital
.279
2.274
.106
1.913
4.572
Metropolitan State Hospital
.264
2.268
.073
1.588
4.194
Northampton State Hospital
.332
2.082
.063
1.581
4.060
Taunton State Hospital
.377
2.288
.085
1.929
4.680
Westborough State Hospital
.356
2.178
.064
2.204
4.803
Worcester State Hospital .
.297
2.431
.085
1.942
4.757
Monson State Hospital (epileptic)
.331
2.669
.085
1.983
5.069
Averages
$.361
$2,337
$.094
$1,963
$4 . 757
Schools for Mental Defectives:
Belchertown State School ....
$.303
$1,889
$.311
$1,810
$4,314
Walter E. Fernald State School.
.332
2.116
.342
1.515
4.307
Wrentham State School ....
.298
1.875
.263
1.284
3.722
Averages
$.312
$1,968
$.305
$1,504
$4,089
$. 352
$2,267
$.134
$1,877
$4,632
Table 6. Rotation in Service of Persons Employed in Institutions
Persons
Institution
Industrial
Medical
Ward
Service
and Edu-
cational
All Others
Total
Hospitals for Mental Diseases:
Boston Psychopathic Hospital .
1.333
1.410
1.50
1.379
1.386
Boston State Hospital
1.736
1.801
1.235
1.566
1.710
Danvers State Hospital
1.411
1.578
1.125
1.245
1.455
Foxborough State Hospital
1.363
1.291
1.166
1.307
1.298
Gardner State Hospital
1.00
1.372
1.00
1.189
1.278
Grafton State Hospital
1.238
1.424
.857
1.195
1.306
Medfield State Hospital
1.454
1.428
1.50
1.55
1.467
Metropolitan State Hospital
1.095
1.360
1.142
1.185
1.291
Northampton State Hospital
1.066
1.303
1.00
1.238
1.268
Taunton State Hospital
1.379
1.347
.875
1.237
1.303
Westborough State Hospital
1.50
1.603
1.166
1.245
1.443
Worcester State Hospital .
1.411
1.671
1.20
1.201
1.485
Monson State Hospital (epileptic)
1.222
1.313
1.00
1.134
1.243
1.347
1.490
1.088
1.289
1.405
Schools for Mental Defectives:
Belchertown State School ....
1.142
1.331
1.256
1.161
1.259
Walter E. Fernald State School.
1.00
1.351
1.117
1.125
1.263
Wrentham State School ....
.909
1.50
1.038
1.231
1.382
1.00
1.40
1.126
1.169
1.303
Total Average
1.209
1.474
1.105
1.273
1.388
NOTE — Baser! on actual number employed as compared with quota
32
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to
c3
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Boiler House Improvements
Walks, Roads and Grading .
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Furnishings, Cardinal House
Hurricane and Flood Damage
Wrentham State.
Cow Barn ....
Clinical Building, Furnishings
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36
P.D. 117
Table 8. Receipts From Paying Patients — B[
/ Institution
Average
Institutions
Number
Amounts
Annual
Paying
Paid
Payments
Hospitals for Mental Diseases:
367
$13,113.69
$35,732
235
82,260.08
350.042
302
105,894.04
350.642
164
58,062.99
354.042
89
28,592.70
321.266
51
31,434.18
616.356
105
44,521.76
424.016
146
50,525.41
346 . 064
251
101,340.71
403 . 747
177
75,825.21
428.391
326
110,354.84
338.511
174
58,784.78
337.843
62
14,269.05
230.145
Total
2,449
$774,979.44
$316.47
Schools for Mental Defectives:
44
$11,780.18
$267,731
91
19,362.04
212.769
75
12,863.01
171.506
210
$44,005.23
$209 . 549
State Farm*
5
$4,759.49
$951,898
9
6,840.71
760.078
5
416.67
83.334
19
$12,016.87
$632,466
2,678
$831,001.54
$310,306
*The State Farm which is under the Department of Correction, and the State Infirmary which is under
the Department of Public Welfare, have mental wards where the Department of Mental Health has but
certain legal supervision of the patients therein. The Hospital Cottages for Children is a private institu-
tion in which certain mental defectives are boarded by the Department. However, the Division of Legal
Settlement and Support Claims of the Department of Mental Health investigates and collects under the
statutes, in the same manner as in the case of institutions directly under the Department. As this Depart-
ment has no control of their maintenance expenditures, these institutions do not appear on Table 4.
Table 9. Trust Funds — By Institution
(Held under Section 27, Chapter 123 of the General Laws)
On Hand
Received
On Hand
Institutions
December
During
Payments
November
1, 1938
Year
30, 1939
Hospitals for Mental Diseases:
Boston Psychopathic
—
-
—
-
—
-
-
-
-
-
—
-
-
-
-
-
-
-
-
-
—
—
-
-
$481.68
$9.64
-
$491.32
-
-
-
-
1,162.57
26.30
$114.17
1,074.70
—
—
—
—
4,858.58
115.80
401.75
4,572.63
4,471.67
109.75
80.00
4,501.42
5,148.31
89.20
901.84
4,335.67
$16,122.81
$350.69
$1,497.76
$14,975.74
Schools for Mental Defectives:
-
-
—
-
Walter E. Fernald ....
$101,944.51
$3,596.92
$1,086.72
$104,454.71
2,236.59
118.14
59.55
2,295.18
Total
$104,181.10
$3,715.06
$1,146.27
$106,749.89
Grand Total ....
$120,303.91
$4,065.75
$2,644.03
$121,725.63
P.D. 117
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P.D. 117 39
REPORT OF THE PATHOLOGIST
To the Commissioner of Mental Health:
The succeeding is the thirty-first report of the Pathologist and the thirtieth to cover
a full year's work.
General
Since 1939 finished (June 30) a twenty-five year period of a special officer acting as a
peripatetic agent for the Department, it would be well to review the changes in that
period.
"The pathological service of the State Board of Insanity came into existence July 1,
1914, with the appointment of Dr. Myrtelle M. Canavan as assistant pathologist. Dr.
Canavan was transferred from the laboratory of the Boston State Hospital. The service
has now been completed on its present level of efficiency by the appointment of a ste-
nographer and technician.
The duties of the assistant pathologist are in part as follows : —
The Board desires to have its pathological department represented at autopsies per-
formed at all hospitals, both public and private, upon cases of unusual importance,
whether from a social, pathological or research point of view.
First. — As to the cases of social interest, in addition to the statutory notice to the
Board, the Board has asked that its pathologist be immediately notified by telegraph or
telephone of all cases of suicide or homicide, sudden death and any cases to which the
medical examiner is called, addressed to Dr. E. E. Southard, 74 Fenwood Road, Boston.
Second. — As to cases of pathological or research interest the Board has stated that
it desires (a) so far as possible to provide an autopsy service for institutions not main-
taining such service; (b) to supplement existing autopsy services by providing for emer-
gencies, such as absence or disability of the institution pathologists; (c) to offer aid in
special work on certain epidemics; (d) to aid in the exchange of research material which
the various institution pathologists are from time to time working on and (e) to carry
on certain independent researches."
When this unique service was initiated July 1, 1914 the usual psychological resistances
to a new plan were minimized by the cordial understanding between the superintendents
and Dr. E. E. Southard, whose deputy I was. At this time there were only five pathol-
ogists in the hospitals and few other institutions had suitable postmortem operating
rooms or equipment. Accordingly your pathologist on a quest of 1,000 brains, besides
covering the cases for official inquiry, portered heavy bags of instruments. (Taxicabs
would have been frowned upon at that time.) Upon arrival at the hospitals, however,
plans for the event had been made. In extreme cases the operation might be carried on
in an abandoned vegetable room where the winter temperature was unmodified by any
heat and one operated with coat and hat on. In another location cold could be chosen
over the effects of a smoking fireplace which would cause acute discomfort. Little by
little, however, changes were made so that travelling and equipment in autopsy rooms
improved, or the local undertaker shop supplied enough pans to make operating less of
a problem. By 1924 when your pathologist was succeeded by Marjorie Fulstow (April
1924-Sept. 1931) the system was well under way. Dr. Douglas A. Thorn who had started
a branch department laboratory at Summer Street, Worcester, July 1, 1916, had left
it for the War, and the hospitals' staffs, depleted by the call to military service, had
resumed their activities. Dr. Fulstow brought especial training in general pathology to
the position, inaugurated reports to the hospitals on their surgical specimens, installed
better microscopes and a microphotographic apparatus with which she produced micro-
photographs for illustrations for her records and articles.
When she had leave of absence, Feb. 28-Oct. 1, 1928 — and when she resigned Sept. 1,
1931 1 came back to carry on the work so there would be no interruption. Dr. Anna Allen
was appointed June 1932 (with a year's leave of absence for foreign study), and served
from June 1933 to December 1935. She had brought a neurological training to the work
and contributed also a legal understanding. Since December 1935 to date the original
appointee has held the position and has officiated during about 15 of the 25 years the
service has been in operation. Now there are eleven pathologists and equipment as
noted in the following table.
40
P.D. 117
Equipment of the Pathological Department of State Hospitals and Schools, 1989,
by Institutions
Hospital
Refrig-
Autopsy
erator
Room
+
+
0
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
0
±
+
+
+
+
Toledo
Equipment
Scales or
Incinera-
His-
Other
ation
tology
± ttable poor
+
±
0
± ttable poor
+
±
0
+
+
0
+
+
+
+
±
+
+
±
±
+
+
0
0
+
+
0
+
+
+
±
+
+
Other
0
+
+
+
+
+
± ttable poor
Other
0
±
+
+
+
+
+
Other
±
+
± ttable poor
+
+
0
+
+
±
±
± ttable poor
+
0
±
Technicians
P Northampton
- Belchertown
Monson
P Worcester
P Westborough
- Grafton
P Boston .
* Psychopathic
P Foxborough
P Wrentham
P Medfield
P Taunton
P Metropolitan
- Fernald
P Danvers
P Gardner
2±
1±
1
1
1
1
2±
1
2
2
1
2
2
0
2 untrained
1±
P, Pathologist. *, done by Department Pathologist. -, no pathologist. ±, partial.
+, complete. ti no overhead water.
If there could be in each hospital a working group of a pathologist, an interne, a secre-
tary, and two technicians for each 100 autopsies, an attendant to sew up and clean up,
and a patient careful elderly man who would keep the instruments sharp — (saws, scis-
sors, knives), the ideal would be reached.
Worcester has the honor of having had Adolf Meyer as director of laboratories 1896-
1900. Theodore Hoch 1903-1905, Freeman A. Tower 1906-1909, Ada F. Harris 1918-
1921, Clarence A. Whitcomb 1922-1924, Vladimir T. Dimitroff 1930-1931, William
Freeman 1931 — have served as succeeding pathologists.
Dr. Freeman reports the relief afforded by having internes in pathology. He had two
during a six-months period. Also he reports the greater ease in operating provided by
a new autopsy table. Rearrangement of the rooms in the basement makes for better
working conditions (if one thinks basement rooms advisable). He reports progress in
the work of cross indexing post-mortem diagnoses.
From a Public Health point of view all handlers of milk are given monthly physical
examinations, which includes a smear and culture from the nose and throat. Milk from
the cows, after pasteurization, and as served, has counts made twice each month, and
each separate cow is tested monthly for possible mastitis. If a positive result is found
the animals are separated and treated with sulphanilamide! The vitamin carrying food
has also been increased during the year.
Occupational therapeutists and post-graduate nurses are given courses in neuro-
anatomy, medical students are guided in reviews of post-mortem cases and residents, a
review course in neuropathology. For the clinico-pathological conferences an extra
tissue technician is most urgently needed, as well as to foster research. A body weighing
scale, new microscopes, and completion of the reconstruction work for the rooms to be
used are urgently requested.
Taunton presents the list of pathologists as follows: Frederick S. Ward 1S97-1901,
Harry W. Miller, 1901-1907, Dora W. Faxon 1907-1908, Charles G. McGaffin 1909-
1912, Abraham Myerson 1912-1917, Fannie C. Haines 1917-1923, Frederick D. Parker
1923, Samuel Tartakoff 1924-1925, Naomi Raskin 1925-192S, Harold W. Williams
1931-1933, Donald G. Henderson 1933-1937, Robert I. Lewis 1937-1938, Walter W.
Jetter 1939 — .
Though Dr. Jetter has only been in the hospital since May 15, 1939, he has introduced
procedures and changes which compare favorably with those in general hospitals in
preventive measures and in clinical pathology. He has started a class for medical technol-
ogists in the hope of having his own technician registered, and to prepare others for
employment. He would be able to have internes in pathology if there were more surgical
specimens. A plan is on foot to increase them. Clinico-pathological conferences occur
at intervals. His own research is in chemistry, especially in regard to effects of alcohol.
P.D. 117 41
He wishes a full time chemist to carry out the necessary routine work involved in such
research, and animals and cages for the prosecution of his problems. Certain books and
magazines are desired.
Northampton chose to appoint Dr. Ruth Parker as their first pathologist Dec. 1, 1937
and she continues to date. The main problem has been to plan and equip the new labora-
tory and this has progressed slowly. There is still urgent need for a suitable autopsy
table with overhead light and water. Nothing is more time consuming or detrimental
to technical ease in autopsy performance than these lacks. The autopsy rate has risen
to 40 per cent.
Despite cramped quarters, raw and pasteurized milk has been examined for bacterio-
logical content twice each month. The laboratory has been approved for pneumococcus
typing by the Board of Health. Over 10,000 clinico-pathological tests have been made,
the majority being urine, blood counts, gynecological smears and blood chemistry.
Spinal fluid examinations and sputa also raised the numbers,, as well as pneumococcus
typing and miscellaneous tests. How it can all be accomplished with one full time and
one part time technician is a marvel. More equipment is needed and more help will be
necessary to make histological sections.
Danvers. Like many others, illustrious names have been associated with the labora-
tories and none more than Danvers. The official list follows: William L. Worcester April
1895- June 30, 1901, Albert M. Barrett Sept. 1902-Dec. 30, 1905, Elmer Ernest Southard
Jan. 1, 1906-May 30, 1909, Herman M. Adler July 1, 1909-June 14, 1912, Earl D. Bond
July 1, 1912-Nov. 27, 1913, Lawson G. Lowrey, June 21, 1914-Jan. 30, 1917, Curtis
E. Smith Feb. 1, 191&-Jan. 15, 1920, Shichi Uyematsu Nov. 24, 1918-Jan. 15, 1920,
Otis F. Kelley May 31, 1921-Sept, 10, 1925, L. Raymond Morrison Sept. 28, 1925-
July 3, 1926, Lillian DeArmit Nov. 1, 1927-Nov. 30, 1927, Anna M. Allen Nov. 1, 1931-
May 31, 1932, Charles C. Joyce Oct. 28, 1933-Nov. 21, 1936, Salvador Jacobs Oct. 10,
1937—.
Dr. Jacobs, since the last report has been relieved of the X-ray work, but otherwise
is doing too many autopsies (144) with two few workers (none trained). A resident
interne to divide the operating load would be most acceptable and a trained technician
to depend upon would greatly facilitate his work. The necessity of having always to stop
and help, instruct or admonish is not conducive to accomplishing a day's work. Monthly
clinico-pathological conferences arising from the interesting or obscure cases tax the
ingenuity of Dr. Jacobs to make them ready. Nevertheless he has ready for review
before publication several cases which need library work done upon them, this he lacks
time to do.
In a postponed plan for a worthy building for a laboratory at this hospital, a few more
rooms are promised in the makeshift location in the basement of a home for attendants,
but so far they are in use. Cramped quarters do not make for ease of working and yield
mistakes.
The bacteriological colony count done on the milk shows in general a satisfactory
result, but occasionally up to million, indicating some source of infection.
Less work, more time for the library, more help and a good laboratory building is
much needed by the Pathological Service at Danvers.
Wesibowugh has had four pathologists, Dr. George O. Welch 1888, Dr. James F.
Bothfield 1889, Dr. Solomon C. Fuller 1898-1919, and Dr. Lydia B. Pierce Feb. 1, 1921
— to date. Dr. Pierce was, in April 1939, certified by the American Board of Pathology.
She rejoices in the possession of a new microscope and a projection apparatus for slides.
It is to be regretted that there is no trained technician to make the sections of tissue
needed for demonstration and she must make them herself. Naturally the surgical
specimens come first. A technician for histological work would be of great help, relieving
Dr. Pierce, and furnishing results to demonstrate to the staff while interest is high.
The milk counts have showed the efficacy of pasteurization, dropping from an average
of 53,000 — to 5,000 colonies in one cc. The one technician who does "everything"
examined more than 4,500 urines and blood specimens, and was more than busy, taking
notes as well, at the autopsies. Dr. Pierce also has charge of the X-rays. She estimates
each one takes a full hour of time. The teaching goes on as usual for the nurses in anat-
omy, pathology, bacteriology and chemistry.
42 P.D. 117
Boston. The hospital had consulting pathologists before the time of the first resident.
Dr. William Gannett — Boston Lunatic Hospital 1S85, Dr. John J. Thomas — Boston
Insane Hospital — Consulting Pathologist 1S90, Dr. Elmer E. Southard — Boston
Insane Hospital — Consulting Pathologist before 1910, Dr. Myrtelle M. Canavan —
Boston State Hospital Sept. 10, 1910- June 30, 1914, Dr. Mary E. Morse April 15, 1912-
Aug. 8, 1912 and Jan. 19, 1915-April 20, 1916, Dr. Oscar J. Raeder Nov. 1, 1917- July
31, 1918, Dr. Schichi Uyematsu April 1, 1921-March 18, 1922, Dr. Julius Loman Jan. 1,
1927- June 5, 1929, Dr. Naomi Raskin July 1, 1929 — to the present.
The histological examinations (6180) exceeded the clinico-pathological ones (4680) in
this hospital, but toward the end of the year all activities must have ceased due to resig-
nations and illnesses of the two technicians, where three are needed.
Food handlers are examined for evidence of illness or of carrying disease both by blood
and chest survey. The state laboratory had helped by examining stools for dysentery
and the Sonne type of para-dysentery found.
Dr. Raskin finds traveling to the main library a hardship to consult reference books
in her subjects. She was certified by the American Board in Psychiatry this year.
Psychopathic. The Department's Pathologists — Dr. Myrtelle M. Canavan 1914-24,
Dr. Marjorie Fulstow 1924-31, Dr. Anna M. Allen 1933-35, Myrtelle M. Canavan
filling in during 31-33, and since 1935, have done the autopsies and made descriptions
of sections for the records, in this hospital. Separate copies of protocols have been bound.
The Department's interne in bacteriology, who assists in the autopsies, has been re-
sponsible for all dark field examinations. He also furnishes the hospital with cultural
reports on all organisms grown (or negative reports) from blood, spinal fluid, throats,
urine and feces (except for identification of Klebs-Loffler bacilli). He further does the
post-mortem cultures from the autopsies, makes media and counts the colonies twice
a month from the pasteurized milk delivered to the hospital.
The clinico-pathological laboratory for all of the other varied requests is maintained
by the hospital.
Dr. Myrtelle M. Canavan was qualified by the American Board in Pathology, April,
1939.
Grafton has had the advantage of consultation from Dr. Frederick H. Baker in Pathol-
ogy before brief periods 1916-1917, when Dr. Douglas A. Thom and Myrtelle M. Cana-
van were residents at the then Summer Street Department. As a staff member Dr. Buell
L. Ashmore, 1923-26 functioned as pathologist on call for such service, but many a staff
member has done so in later years.
At present one technician undertakes the milk counts and such requests for clinico-
pathology as are made. The first autopsy on the hospital's new table, (replacing 23
years service at the undertaker's) was done on Sept. 11, 1939.
Medfield. While autopsies were done for many years and urgent clinico-pathological
examinations done in small quarters, a laboratory could not have been said to have been
installed until 1919 when the basement of the surgical building was given over and the
laboratory equipped under the planning of Dr. Anna H. Kandib, Oct. 1, 1919-Aug. 24,
1921. She was succeeded by Dr. Frederick D. Parker to January 1922. Dr. William
T. Cluney March 7, 1923 to March 20, 1925, Dr. Seth Howes 1925-1926, Dr. Howard
M. Jamieson 1928-1929, Dr. William T. Cluney 1929-1930, Dr. Vincente A. Navarro
1930 — to date.
During this year, shifts of the burdens have been made to relieve the laboratory of a
great excess qf chores. For example, during half the year 1,158 typhoid inoculations
and 271 smallpox vaccinations were given; then the work was allotted the Infirmary
service. Further shifts were made to relieve the laboratory of the luetic clinic work,
but Dr. Navarro continued the actual treatment of the cases, 71S in number in the
half year.
The X-ray work still is assigned to the laboratory — (2,671 exposures) with reports,
and the grand total of 20,178 items covered by the laboratory included bacteriological,
serological, parasitological, hematology, chemistry urine and spinal fluids besides the
40 autopsies, 30 of which he did himself. These, reader, with one technician. A pace
like this does not speak for thriving of any but numbers of laboratory tests. Two extra
technicians would think they were busy sharing the labor.
P.D. 117 43
Gardner had its first pathologist, Dr. Edward J. Palmer, Dec. 1, 1938-Nov. 30, 1939.
With but one technical assistant and a volunteer worker for three months, he was able
to further equip and maintain an active clinico-pathological laboratory, reporting on
about 8,500 determinations. These included the 113 pork samples, spinal fluids, clinical
chemistry as well as the bulking numbers in blood and urine examinations. Dr. Palmer
participated in the neuro-anatomy teaching during the course given at the Metropolitan
Hospital.
Monson. The names of the pathologists and their exact terms of service since the
opening of the hospital are as follows: Dr. Morgan B. Hodskins Sept. 5, 1899- Jan. 1,
1909, Dr. Annie E. Taft, Jan. 1, 1909-Aug. 1, 1910, Dr. Morgan B. Hodskins Aug. 1,
1910-Dec. 28, 1911, Dr. Annie E. Taft Dec. 28, 1911-Jan. 20, 1912, Dr. Douglas A.
Thorn July 1, 1912-July 1, 1916, Dr. Heiman Cara Dec. 27, 1915-Sept. 1, 1917, Dr.
Leslie H. Wright May 18, 1922-Nov. 28, 1924, Dr. Paul I. Yakovlev July 23, 1926-May
20, 1936, Dr. Rudolf Osgood Aug. 3, 1936-Sept. 12, 1939.
Since Dr. Osgood left the service before the year was completed, no report was forth-
coming concerning the activities of the year, but thirty-seven autopsies no doubt pro-
vided the same unusual percentage of curios in the way of material. That the pathol-
ogist's interest turned toward clinical correlations and newer methods of treatment is
indicated in the article he wrote with Dr. Robinson on Brilliant Vital Red as an anti-
convulsant. Also he had procured a total brain microtome for use in a special clinico-
pathological problem, which will be a boon to his successor.
Foxborough has been fortunate in having notable pathologists, Dr. Willard C. Rap-
pleye July 1917- June 1918 — now Dean of Columbia Medical and Dental Schools;
Dr. John I. Wiseman 1919-1920, Dr. William A. Malamud 1922-23, and again 1926-
29; later he was Associate Director of the Iowa Psychopathic Hospital, — and Dr.
David Rothschild 1929 — to present time.
Dr. Rothschild reports clinico-pathological conferences, (one may note the need of an
incinerator and a Toledo scale to replace the one in use). Dr. Rothschild comments on
the value of pasteurizing the milk as indicated in the lowered count after its use. He
deplores the appearance of diphtheria bacilli in throats of some patients and employees —
very difficult organisms to eradicate. Possibly the X-ray therapy used elsewhere for
streptococci throats might be of avail. There are two paid technicians and two in training
— all very busy.
Dr. Rothschild continues his interest in the brains of senile and arteriosclerotic patients
hoping to be able to evolve criteria for differentiation.
A new microscope, better heating, and a microphotographic outfit would be most
acceptable.
Mental Wards, State Infirmary (now Tewksbury State Hospital and Infirmary). Dr.
Kelley states — ■ "In answer to your question relating to the exact term of service of your
pathologists since the opening of your hospital, to date," it would be almost impossible
for us to give you this information in full, as often times this work has been carried on
by members of our regular medical staff in conjunction with their general hospital work.
The following physicians have been classified as pathologists since 1906: Dr. Samuel
R. Haythorn 1906-1908 (became Professor of Pathology at University Pittsburg School
of Medicine); Dr. Carroll D. Partridge 1908-1910, Dr. Rudolph Kohn 1915-1916, Dr.
Thomas Buckman 1917, Dr. Edward J. O'Donoghue 1918-1930, Dr. Spencer Glidden
1932 — to date.
It has often been mentioned in these reports that the autopsy room at this hospital
leads in lighting, arrangement, convenience, and in seating for visitors. Dr. Glidden
conducts a modernized laboratory in an approved manner.
Walter E. Fernald State School. While never having had a pathologist, Dr. Paul I.
Yakovlev, the clinical director appointed October 1, 1938, functions in that capacity,
and mourns that construction work in his department has not been completed, so that
next steps after autopsies have been delayed. Dr. Yakovlev points out that there is
abundant neurological material in hospitals for mental disease and defect. (They do not
all come to autopsy so that collection of material is still a slow process). Dr. Yakovlev
has been busy teaching neuro-anatomy and neuropathology, to local staffs, and arrang-
ing the big seminar for those in New England wishing to prepare for the qualifying
examinations in Neurology and Psychiatry. Beside arranging the increasingly valuable
u
P.D. 117
course, he teaches in it, and serves as an examiner (1938-1939) in the New York meeting
of the board with the candidates. Dr. Yakovlev's pupils have a high rate of acceptance
by this board. Besides these and other academic teaching, he carries a number of re-
search problems of his own and frequently publishes. The crying need is for a laboratory
to work in, a trained technician, and a younger associate. Dr. Yakovlev joins a group
of pathologists in meetings at their various hospitals to stimulate and enjoy their anatom-
ico-pathological problems.
Wrentham. Dr. Benda finds that with a staff of four, biochemist, X-ray and photo-
graphic technician, and two laboratory technicians, there is still more than they all can
do in specimens mounting to a fifty brain and cord total for the year, with the other
work. He wishes for a student technician. This hospital has purchased a large brain
microtome and it has been working very acceptably. Much time has been spent in
examination of skull and brain in cases of mongolism, and in congenital syphilis.
Belchertown is one of the few places without a pathologist. Their autopsy equipment
including a Toledo scale is adequate, but there is no refrigeration and the autopsy table
has no overhead water system. With these alterations and a unit of workers, Belcher-
town would do well.
Metropolitan had Dr. Paul I. Yakovlev as first pathologist May 1936-Sept. 1938,
Dr. Richard Wadsworth Oct. 1938 — to date.
Dr. Wadsworth presents a spirit of great interest in the laboratory and regrets rapid
personnel changes among technicians and overload of both tissue and clinico-patho-
logical workers. He urges that the next helper be a junior bacteriologist. They turned
out 2,000 sections, 14,685 clinico-pathological reports this year.
Routine of the Pathological Service
Autopsies
From the establishment of the Pathological Service on July 1, 1914, to November 30,
1939 — 3,535 autopsies have been performed. The protocols have been bound or are
in the bindery to May 5, 1939.
During the year ending November 30, 1939, 48 autopsies have been performed; 20
were done for hospitals without resident pathologists or where pathologists were ill or
absent. The remaining 28 were done to determine the cause of death in patients who
died suddenly or unexpectedly, or for other reasons.
Foxborough State Hospital
Medfield State Hospital
Boston State Hospital
Boston Psjrchopathic Hospital
Westborough State Hospital
Gardner State Hospital
Total ....
5 Taunton State Hospital
7 Monson State Hospital
7 Danvers State Hospital
6 Belchertown State School .
4 Veterans Adm. Facility, Bedfor
4 Vets. Adm. Facility, Northampton
3
3
3
1
1
1
48
Besides these 4S autopsies (28 of which were sudden death cases), there were 287 other
cases which also required investigation. Since 315 is an all time high, still more conflicts
occurred to prevent your investigator from arriving in time to antedate the claiming of
the bodies. Train service is less and less frequent and undertakers, always on the alert,
make for less contact with the cases. More reports have been delegated this year and
the courtesy of the hospital officers in sending reports continues. In all 160 visits have
been made. Other factors making for delegation of reports are the increase in numbers
of hospital pathologists who are of course well qualified to do autopsies. The number of
sudden death autopsies done without your pathologist's aid was 135.
P.D. 117
45
Proportion of Autopsies to Deaths in Institutions
Deaths Autopsies Per cent
Metropolitan State Hospital
Monson State Hospital
Gardner State Hospital
Taunton State Hospital
Worcester State Hospital .
Danvers State Hospital
Walter E. Fernald State School
Boston State Hospital
Wrentham State School
Grafton State Hospital
Medfield State Hospital
Northampton State Hospital
Veterans Administration, Bedford
Boston Psychopathic Hospital .
Veterans Administration, Northampt
Foxborough State Hospital
Westborough State Hospital
State Infirmary, Mental Wards
Belchertown State School .
Hospital Cottages for Children
State Farm
Totals
44
37
84
76
37
54
68
37
54
243
128
53
192
100
52
284
143
50
15
7
47
311
138
44
21
9
43
77
32
42
100
40
40
200
80
40
25
9
36
17
6
35
29
10
34
111
35
32
147
35
24
19
3
16
13
1
8
1
0
0
49
0
0
2,042
887
43
Total number of deaths in State Hospitals in Massachusetts in 1939, fiscal year 2,042
Total number of autopsies performed (43%) 887
(a) By laboratories independent of Department 839
(b) Department 48
Sudden Deaths
The following table relates to the causative factors in the sudden deaths occurring
in State Hospitals in 1939:
Sudden deaths reported to the Department 315
Number autopsied (total) . 163
Number autopsied by service . . . . . . . . . . . 28
Analysis of the Autopsied Sudden Death Cases in 1939
(62 others had had fractures within a year — one a dislocation)
Pulmonary edema** .
Burns ....
Brain tumor
Diabetes
Mesenteric thrombosis
Ruptured bladder
Ruptured stomach
Alcoholism
Encephalitis lethargica
Pulmonary tuberculosis
Incarcerated hernia .
Asphyxiation by fall .
Pulmonary thrombosis
Heart disease*8!1
48
Acute infections*13 .
35
Arteriosclerosis*8
20
Intracranial hemorrhage*2
11
Fractures
8
Syphilis**2!1 ....
6
Epilepsy*1
5
Malignancies!1 ....
4
Suicide
4
Edema brain ....
3
Homicide
2
Chronic nephritis
2
Rupture aorta ....
2
* Complicated by fractures.
** Complicated bv treatment.
("Complicated by burns.
45
P.D. 117
The sudden deaths in the State Hospitals
in twenty-six years are
herewith presented
(either autopsied or non-autopsied) :
Year
Deaths Year
Deaths
Year
Deaths
Year
Deaths
1914 .
. 69 1921 .
. 87
1928 .
. 177
1935
. 243
1915 .
. 85 1922 .
. 89
1929 .
. 148
1936
. 234
1916 .
. 74 1923 .
. 122
1930 .
. 170
1937
. 247
1917 .
. 83 1924 .
. 121
1931 .
. 175
1938
. 285
1918 .
. 117 1925 .
. 129
1932 .
. 215
1939
. 315
1919 .
. 77 1926 .
. 136
1933 .
. 232
1920 .
. 84 1927 .
. 126
1934 .
. 225
a total of 4,065 of which 1,831, or 45%, have been autopsied.
Analysis of Autopsies of Sudden Death Cases
Three hundred and fifteen cases in which death occurred suddenly were reported to
the Department in 1939, an increase of 30 over 1938, when there were 285. The exoge-
nous causes in the autopsied cases (163) were fractures 8, suicide 4, homicide 2, alcoholism
1, burns 1, a total of 16. If one includes cases in which fractures complicate the cause
of death, 36 could be added. Of the endogenous causes, heart disease (all kinds) leads
this year, as a primary cause in 48 cases, infections in 35, arteriosclerosis 20, intracranial
hemorrhages in 11, others scattering. Ruptures of bladder, stomach and aorta were
surprises.
Suicides in State Hospitals*
Year
Suicides
Year
Suicides
Year
Suicides
Year
Suicides
1914 .
9
1921 .
12
1928 .
19
1935
19
1915 .
6
1922 .
. 10
1929 .
. 13
1936
. 12
1916 .
9
1923 .
14
1930 .
. 13
1937
. 27
1917 .
12
1924 .
10
1931 .
. 26
1938
18
1918 .
18
1925 .
15
1932 .
. 23
1939
. 14
1919 .
13
1926 .
. 14
1933 .
13
1920 .
13
1927 .
19
1934 .
15
*Two occurred in private hospitals, but for completeness are here included.
Analysis of Suicides Autopsied and N on- Autopsied
Fourteen suicidal deaths occurred during the year ending November 30, 1939. This
figure as before includes those who made the attempt before admission to the hospitals,
those on leave, on escape, and others in the hospitals. The males far exceeded the females
in number (9-5). The ages ranged from 26-72. By manner hanging 10, burns one,
razor to throat one, amputation of hand and sepsis one, drowning one.
As to diagnosis the Depressions led — 5, Dementia Praecox 3, Alcoholic 1, Psychoneu-
rosis Psychopathic Personality 1, Senile 1, Undiagnosed 2. This year shows a swing
backward in number, to 1936 — when there were 12.
As to homicides, one man of 74 met his death by reason of a kick which ruptured his
intestine, from an attendant. Responsibility was fixed and a jail sentence imposed:
One died from fractured ribs, followed by bronchitis and edema of lungs, but evidence
was not secured against any one.
Casualties
If the number of these caused concern in 1938, when 1,029 were listed, it is certainly
to be reemphasized this year when 1,087 is the total. As before these totals include
fractures or other injuries acquired before admission or while on visit, so that theoreti-
cally there are no unreported ones, but the number grows. Nearly as many women as
men received injuries this year, which is different from 1938 when the proportion was
much higher in males. Realizing that habit is stronger than principle, attention is again
called to the highly polished floors, the pride of the ward supervisors, as a source of falls.
I inquired of two hospitals whose population was low — (about 500) and who care (1)
for mental cases, (2) aged and infirm, how they manage to have so relatively few injuries.
In the mental wards the report was that they were not overcrowded; they arranged the
time of nurses so that there were more on duty when meals were served, and that not
many feeble patients had to walk far to meals. Also they had more single rooms, could
separate disturbed from feeble patients, had more nurses in disturbed wards, used hydro-
therapy, and had low beds for care of aged patients.
P.D. 117
47
In the non-mental hospital such accidents as occurred, were the result of patients
attempting to do more than they were muscularly equipped to do.
In Table B the fractures (825) were over 100 more than last year. The total severe
injuries (897) are higher by 113 than last year, when they were 784. The less severe
injuries dropped 65 in number, one advantage.
Casualties in State Hospitals
Casualties Year Casualties Year Casualties Year Casualties
Year
1914
1915
1916
1917
1918
1919
1920
346 1921
320 1922
304 1923
237 1924
221 1925
208 1926
240 1927
257 1928
258 1929
292 1930
297 1931
275 1932
351 1933
314 1934
387
1935 .
669
503
1936 .
723
557
1937 .
702
537
1938 .
1,029
688
1939 .
1,087
667
679
In the manner of injury (Table C), again, as before "Unavoidable Natural Causes"
occurred most often, "Asocial Acts of Another Patient" followed, then "Impulsive
Acts," and finally those which were "Unknown" in origin.
In the distribution of casualties by hospitals (Table A) Worcester heads the list,
followed by Boston, and thirdly, Danvers. They are mostly of the severe type (Table B) .
The Veterans' hospitals show marked differences (77- to 19), and this year the total
number of males exceed the females, but in some hospitals the reverse is shown.
Investigations
The habit of having an extra helper for typing protocols has been established in order
that we may have protocols bound consecutively. We now have at the bindery the 60th
volume of 50 protocols and cases investigated during the time taken for the collection
of autopsy reports, which will bring us nearly to date (May 5, 1939). We will have then
60 volumes or 3,000 autopsy protocols in Series A, and 500 in Series B — (so named
when Dr. Thorn operated the Western Branch at Worcester), or 3,500 bound protocols,
hard to equal or lose when in book form.
In February the trip to Atlanta, Ga., was taken to address the Fulton County Medical
Society on spinal cord lesions found in mental disease. Naked eye lesions were found
in 9.83% of 600 cords, microscopic ones in 71.83% in the periphery of the cord. This
finding was thought to be due to poorer blood supply, hypothetical anemia and vitamin
A lack in diets.
The work, copy and proof-reading was completed on the Fourth Ten of the Waverley
Researches, and only an inadvertence of a lack of paper prevented it from being com-
pleted in time to be fully announced in this publication.
Work has been completed on two hearts with interauricular congenital defects; also a
case report on Simmonds' disease (pituitary cachexia) and the paper on multiple sclerosis
occurring in a moron. Another bit of work which has taken time is that of making total
brain sections of an inoperable tumor of the brain running its course in four months.
This paper is to be offered in the July number of the Archives of Pathology in honor of
Dr. Wolbach's 60th birthday in a series of papers by his workers.
The Fifth Ten of the Waverley Researches is well under way, and will be presented
in time, (we hope) to avoid delay in production ; then the first half of the original tenta-
tive plan will have been completed.
One case which was of special interest (1939.9) presented clear-cut lesions in the
lenticular nuclei extending on one side into the internal capsule. These lesions were
due to thrombosis of the perforating arteries, and were clear cut. The remarkable thing
about the lesions were that they presented no signs when the patient was brought to
the hospital dying of pneumonia. The first patient to show hemochromatosis was 1939.24,
a man of 58, who had vascular syphilis. Since the hemochromatosis is regarded as a
metabolic disorder most often associated with food prepared in copper containers, syphilis
played no active part. In 1935.35 the man of 60 had had two operations on his neck for
melanotic sarcoma. He died two years later with metastasis to rectum, gall bladder
and brain.
48
P.D. 117
The following table shows the routine work of the investigative staff of the Depart-
ment's pathological service:
Visits to institutions . . 160 Less severe injuries . . . 303
Autopsies in cases of sudden deaths 28 Total injuries 1,200
Severe injuries in institutions . 897 Publications by state officers . 112
Casualty Table A. Casualties arranged by Institutions
Males
Females
Patients
Accidents
Injuries
Worcester Hospital
Boston Hospital
Danvers Hospital
Metropolitan Hospital .
Foxborough Hospital .
Walter E. Fernald State School .
Veterans Adm. Facility, Bedford .
Wrentham State School .
Northampton Hospital . . . .
Medfield Hospital
Taunton Hospital
Grafton Hospital
Monson Hospital
Westborough Hospital . . . .
Gardner Hospital
Veterans Adm. Facility, Northampton
Belchertown State School
McLean Hospital
Boston Psychopathic Hospital
State Infirmary, Mental Wards
Bridgewater Hospital . . . ,
Hospital Cottages for Children
Baldpate, Inc
Glenside Hospital
Wiswall Sanatorium .
57
46
24
48
31
54
67
47
23
21
16
18
10
11
9
16
11
10
6
1
4
89
60
74
35
38
19
30
28
24
14
23
22
9
4
4
0
6
1
1
Totals
146
106
98
83
69
76
67
66
53
49
40
32
33
33
18
16
15
14
6
7
4
3
1
1
1
1593,V
108yi
i032,y*
922 8
74V2
78*
722,5
671
54i,ii
525,n
41i, 13
32
33
33
18
18«
15
15i
610
7
4
3
1
1
1
183
121
116
90
87
83
77
68
63
59
47
37
36
35
20
19
17
15
9
8
4
3
1
1
1
533
1,037
1,087
1,200
'Two accidents to one patient.
2Three accidents to one patient.
3Four accidents to one patient.
4Two accidents to two patients.
5Two accidents to three patients.
fTwo accidents to five patients.
'Two accidents to six patients.
"Two accidents to seven patients.
'Three accidents to two patients.
10Aceident prior to admission.
nTwo accidents prior to admission.
I2Nine accidents prior to admission.
"Twelve accidents prior to admission.
Casualty Table B. — Casualties arranged by Institutions and Severity of Injury
Other
Total
Less
Institutions
Frac-
Dislo-
Gun-
Severe
Severe
Severe
Total
tures
cations
shot
Injuries
Injuries
Injuries
Injuries
Receiving Institutions
Boston Psychopathic Hospital
5
-
-
-
,5
4
9
Boston Hospital
102
3
—
2
107
14
121
Danvers Hospital
94
4
-
2
100
16
116
Foxborough Hospital
45
1
-
7
53
34
87
Northampton Hospital
42
4
-
2
48
15
63
Taunton Hospital
38
-
_
1
39
8
47
Westborough Hospital
33
-
-
-
33
0
35
Worcester Hospital
150
5
-
5
160
23
183
Institutions chiefly for Transfers
Grafton Hospital ....
25
3
-
1
29
8
37
Medfield Hospital ....
42
-
-
2
44
15
59
Gardner Hospital ....
13
3
-
2
18
2
20
State Infirmary, Mental Wards
6
—
_
-
6
0
8
Metropolitan Hospital
60
4
-
3
67
23
90
Institutions for the Feeble-Minded
Walter E. Fernald School .
32
2
_
4
38
45
83
Wrentham School ....
52
4
_
1
57
11
68
Belchertown School ....
12
2
-
-
14
3
17
Special Public Institutions
Monson Hospital ....
26
3
-
-
29
7
36
Bridgewater State Farm .
4
-
-
-
4
-
4
Veterans Adm. Facility, Bedford
23
-
-
1
24
53
77
Veterans Adm. Facility, Northampton
7
-
-
-
7
12
19
Special Private Institutions
1
_
_
-
1
-
1
Glenside Hospital ....
_
-
_
_
-
1
1
Hospital Cottages for Children
3
-
-
-
3
-
3
McLean Hospital ....
9
-
-
1
10
5
15
W iswall Sanatorium ....
1
-
-
-
1
-
1
825
38
-
34
897
303
1,200
P.D. 117
49
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50 P.D. 117
Publications
Alexander, L. — Alcoholism and mental disease. Pub. No. 9, p. 88-90 of Am. Assoc.
Adv. Science, 1939.
Alexander, L. and Looney, J. M. — Histologic changes in senile dementia and related
conditions studied by silver impregnation and microincineration. Arch. Neur. and
Psychiat. 40: 1075, Dec. 1938.
Alexander, L. and Myerson, A. — Cell minerals in amaurotic idiocy, tuberous sclero-
sis and related conditions, studied by microincineration and spectroscopy. Examples
of degenerative and neoplastic cell disease. Am. Jour. Psychiat. 96: 77-85 July 1939.
Alexander, L., Myerson, A. and Pijoan, M. — Beri-beri and scurvy. An experi-
mental study. Trans. Am. Neurol. Assoc, The William Byrd Press, Richmond, Va.,
64: 135-139, 1938.
Angyal, Andras — The structure of wholes. Phil, of Sci. 6: 25, Jan. 1939.
Atwell, C. R. — Comparison of Vocabulary Scores on the Stanford-Binet and the
Revised Stanford-Binet. Jour. Educ. Psychol., 30, 467-469, 1939.
Barton, W. E. — Narcosis treatment in the psychoses. Bull. Mass. Dept. Ment. Health,
Symposium on Therapy, p. 41, Sept. 1939.
Benda, Clemens — Studies in Mongolism, I. Growth and Physical Development.
Arch. Neur. and Psychiat., Jfl: pp. 83-97, January 1939.
Benda, Clemens — Studies in Mongolism, II. The Thyroid Gland. Arch. Neur. and
Psychiat., 41: pp. 245-259, February 1939.
Benda, Clemens — Studies in Mongolism, III. The Pituitary Body. Arch. Neur. and
Psychiat., 42: pp. 1-20, July 1939.
Benda, Clemens — Further Clinical and Pathologic Studies in Mongolism (with demon-
stration of lantern slides). Proceedings of the Am. Ass'n Mental Dene, 44-' 47-58,
1939.
Bonner, C. A. and Taylor, L. E. — A study of Accidents in a Mental Hospital. Am.
Jour. Psychiat., 96: No. 2, p. 283, September 1939.
Bryan, W. A. — Prima Donnas on the payroll. National Safety News. 39: 50 and
80-81, June 1939.
Bryan, W. A. — Cost in relation to standard of State Hospital care. Am. Ass'n Adv.
Sci., Mental Health, No. 9: p. 174, 1939.
Buermann, A. and Alexander, L. — The reaction of the cerebral vessels to intra-
carotid injection of horse serum in sensitized and non-sensitized guinea pigs. Confinia
Neurologica 2: 215-219, 1939.
Campbell, C. M. — ■ Human Needs and Social Resources. Mental Health. Publication
of the Am. Ass'n for the Adv. of Sci., No. 9: The Science Press, 1939.
Campbell, CM. — The Criteria of Specialists in Psychiatry and of Facilities for Gradu-
ate Work. Mental Health. Publication of the Am. Ass'n for the Adv. of Sci., No. 9.
The Science Press, 1939.
Campbell, C. M. — A Note on the Imagination and Its Exploitation; Psalmanazar
and Helene Smith. Transactions of the Am. Neur. Ass'n., pp. 198-200, 1939.
Cameron, D. E. and Jellinek, E. M. — Physiological studies in insulin treatment of
acute schizophrenia. II. Pulse rate and blood pressure. Endocrinology 25: 100, July
1939.
Can a van, Myrtelle M. — Lesions in Spinal Cord in Mental Disease and Defect
recognized by Myelin Sheath Stain. Jour, of the Med. Ass'n of Georgia, XXVIII,
No. 8, p. 324-331, August 1939.
Canavan, Myrtelle M. — Obituary. George Burgess Magrath. Arch. Path. 27, p.
620-623, March 1939.
Canavan, Myrtelle M. and Taft, A. E. — Waverley Researches in the Pathology of
the Feeble-Minded. (Research Series, Cases XXXI-to XL).
Chase, Louis S. — Effects of vitamin Bi in schizophrenia. Am. J. Psychiat., 95: 1035,
March 1939.
Cohen, B. and Myerson, A. — Benzedrine sulphate — an antidote for the untoward
hypnotic and ataxic effects of phenobarbital in the treatment of epilepsy. Bull. Mass.,
Dept. of Mental Health, "Symposium on Therapy," p. 49-55, September 1939.
Cohen, L. H. and Hoskins, R. G. — Neuro-endocrinology. Cyclopedia of Medicine,
Vol. 5: Chapt. X, pp. 690-713, F. A. Davis and Co., 1939.
P.D. 117 51
Cohen, L. H. — Psychiatric changes associated with induced hyper-thyroidism in
schizophrenia. Psychosomatic Med. 1: 414, July 1939.
Cohen, L. H. — The therapeutic significance of fear in the metrazol treatment of
schizophrenia. Am. Jour. Psychiat. 95: 1349, May 1939.
Cohen, L. H. — The pharmacologic antagonism of metrazol and sodium amytal as
seen in human individuals (schizophrenic patients). Jour. Lab. and Clin. Med., 24:
681, April 1939.
Cohen, L. H. — Factors involved in the stability of the therapeutic effect in the metrazol
treatment of schizophrenia. (A report of 146 cases.) New England Jour. Med. 220:
780, May 11, 1939.
Cohen, L. H. — The return of cognitive conscious functions after convulsions induced
with metrazol. Arch. Neur. and Psychiat., J^l: 489, March 1939.
Corwin, William and Thompson, J. W. — Experimental Anoxemia (Report of a Case).
Arch. Neur. and Psychiat., 40: pp. 1233-1240, December 1938.
Corwin, William and Thompson, J. W. — Treatment of the Total Organism in Schi-
zophrenic Patients. Am. Jour. Psychiat. 95, No. 5, p. 1059, March 1939.
Cottington, Frances and Gavigan, A. J. — Metrazol treatment of depressions. New
England Jour. Med. 220: 990, June 15, 1939.
Darrah, L. W. — The Difficulties of being "Normal." Jour, of Nerv. and Ment. Dis.,
90: 730, 1939.
Devereux, George — The social cultural implications of incest among the Mohave
Indians. Psychoanalytic Quart. 8: 510, October 1939.
Farrell, M. J. — Insulin Treatment and Psychotherapy in Chronic Dementia Praecox
Patients. Bull. Mass., Dept. of Mental Health, Symposium on Therapy, p. 11-16,
September 1939.
Flower, B. H. and Cohen B. — The Attention Defect in Schizophrenia, its Grada-
tions and Therapeutic Implications. Bull. Mass., Dept. of Mental Health, Symposium
on Therapy, p. 63-67, September, 1939.
Freeman, H. — Skin and body temperatures of schizophrenic and normal subjects
under varying environmental conditions. Arch. Neur. and Psychiat. J+2: 724, Oct.,
1939.
Freeman, H. and Lengyel, B. A. — The effects of high humidity on skin temperature
at cool and warm conditions. Jour. Nutrit. 17: 43, January 1939.
Friedman, Emerick — The Convulsive Irritative Therapy: Report of over 3,000 cases.
Jour. Am. Med. Ass'n. 112: 501, Feb. 1939.
Gavigan, A. J. and Pettee, Evelyn H. — The care of the aged. Am. Jour. Nurs. 39:
150, January 1939.
Hanfmann, Eugenia — A qualitative analysis of the Healy Pictorial Completion Test
II. Am. Jour. Orthopsychiat. 9: 325, April 1939.
Hanfmann, Eugenia — Thought disturbances in schizophrenia as revealed by per-
formance in a picture completion test. Jour. Abnorm. and Soc. Psych. 34: 248, April
1939.
Hoagland, Hudson; Rubin, M. A. and Cameron, D. Ewen — Brain wave frequencies
and cellular matabolism. Effects of dinitrophenol. Jour. Neurophysiol. 2: 170,
March 1939.
Holt, W. L. and Schwab, R. S. — An easily made apparatus for use in "Closed System"
pneumo-encephalography, with notes on technic for its use. Arch. Neur. and Psychiat.
41: 1021, May 1939.
Hoskins, R. G. and Cohen, L. H. — Psychopathy, psychosis and internal secretions.
Cyclopedia of Medicine. Vol. 5: Chapt. IX, pp. 646-690, F. A. Davis and Co. 1939.
Hoskins, R. G., Levene, H. M. and Bevin, S. — The relationship of male sex hormone
to the level of bodily vigor in senility. Endocrinology 25: 143, July 1939.
Jellinek, E. M. — The function of biometric methodology in psychiatric research.
Am. Ass'n Adv. Sci., Mental Health, No. 9: p. 48, 1939.
Jellinek, E. M. — Physiological studies in insulin treatment of acute schizophrenia.
I. Methods. Endocrinology 25: 96, July 1939.
Jellinek, E. M. and Looney, J. M. — Statistics on some biochemical variables on
healthy men in the age range of 20 to 45 years. Jour. Biol. Chem. 128: 621, May 1939.
Jellinek, E. M. — Some principles of psychiatric classification. Psychiatry 2: 161,
May 1939.
52 P.D. 117
Kent, Grace H. — The Use and Abuse of Mental Tests in Clinical Diagnoses. Psychol.
Rec, 2, No. 17, December 1938.
Kent, Grace H. — Self-Derived Norms for Institutions. Psychol. Rec. 3, No. 16,
October 1939.
Kopp, I. — Untreated Syphilis in Pregnancy, Juvenile Paresis — Case Report. Bull.
Genito-Infect. Dis., November 1939.
Kopp, I. — Technic, Physiology and Results in the Application of Therapeutic Hyper-
pyrexia. Jour. Conn. Med. Soc, 8, 38, 1939.
Kopp, I. — The Effect of Fever on Postural Changes in Blood Pressure and Pulse Rate.
Am. Heart Jour. 18, 46, 1939.
Kopp, I. and Solomon, H. C. — Reinfection (?) in Neurosyphilis. Am. Jour. Syph.,
Gonorr. and Ven. Dis., 23, 54, 1939.
Kopp, I. and Solomon, H. C. — The Malarial Treatment of General Paresis: Relation
of the Height, Duration and Frequency of Fever to the Clinical and Serologic Results.
Am. Jour. Syph., Gonorr. and Ven. Dis., 23, 585, 1939.
Kopp, I. and Solomon, H. C. — Interstitial Keratitis in Patients with Neurosyphilis
of Congenital Origin; with a Discussion of Fever as a Precipitating Factor of Keratitis
in the Paretic Variety. Am. Jour. Syph., Gonorr. and Ven. Disease, 23, 751, 1939.
Loman, J., Lesses, M. F. and Myerson, A. — Human Autonomic Pharmacology. XV.
The effect of a cetyl-beta-methylcholine chloride (mecholyl) by iontophoresis on
arterial hypertension. Annals Inst. Med. 12: 1213-1222 (Feb.) 1939.
Loman, J., Rinkel, M. and Myerson, A. — Comparative effects of amphetamine
sulfate (benzedrine sulfate) paredrine and propadrine on the blood pressure. Am.
Heart Jour. 18: 89-93, July, 1939.
Longpre, Fernand — The Use of Sodium Amytal Combined with Psychotherapy in
Non-Cooperative and Cataleptic Patients. Bull. Mass., Dept. of Mental Health —
"Symposium on Therapy" pp. 5-8, Sept., 1939.
Looney, J. M. — The determination of serum phosphatase and its clinical significance.
New England Jour. Med., 220: 623, April 1939.
Looney, J. M. — Changes in lactic acid, pH and gases produced in the blood of normal
and schizophrenic subjects by exercise. Am. Jour. Med. Sci. 198: 57, July 1939.
Looney, J. M. and Walsh, Anna I. — The determination of spinal fluid protein with
the photoelectric colorimeter. Jour. Biol. Chem. 127: 117, January 1939.
Looney, J. M., Jellinek, E. M. and Dyer, Cora J. — Physiological studies in insulin
treatment of acute schizophrenia. V. The blood minerals. Endocrinology 25: 282,
August 1939.
Looney, J. M., Freeman, William and Small, Rose R. — Studies on the Phytotoxic
Index. III. (An evaluation of the method with reference to depressed psychotic
patients). Am. Jour. Med. Sci. 198: 528, October 1939.
Looney, J. M. and Walsh, Anna I. — The determination of globulin and albumin in
blood serum by the photoelectric colorimeter. Jour. Biol. Chem. 130: 635, October
1939.
Maletz, Leo — The Place of the Mental Hygiene Clinic in the Community. Mental
Hygiene, 23, No. 2, April 1939.
Maletz, Leo — Pastoral Psychiatry — John Bonsell. Mental Hygiene, 23, No. 4,
October 1939.
Maletz, Leo — Experience with a Miniature Newspaper. Bull, of the Mass. Ass'n.
Occupat. Therapy, 13, No. 3, May 1939.
Michelson, Harry — The Use of Metrazol in the Treatment of Schizophrenia. Bull.
Mass., Dept. of Mental Health — Symposium on Therapy, pp. 25-29, Sept, 1939.
Myerson, A. — The relationship of hereditary factors to mental processes. Assoc.
Res. in Nerv. and Ment. Dis. 19: 16-49, Sept. 1939.
Myerson, A. — The relation of the autonomic nervous system to pharmacology. Jour.
Conn. State Med. Society 3: 1921, January 1939.
Myerson, A. — Theory and principles of the "total push" method in the treatment of
chronic schizophrenia. Am. Jour. Psychiat. 95: 1197-1204, March 1939.
Myerson, A. —Sources of mental disease: their amelioration and prevention. Sum-
mary and critique. Am. Ass'n Adv. of Science, No. 9, pp. 120-136, 1939.
Myerson, A. — The reciprocal pharmacologic effects of amphetamine (benzedrine)
sulfate and the barbiturates. New England Jour. Med. 221: 561-563, Oct. 12, 1939.
P.D. 117 53
Myerson, A. — Summary of the report of the American Neurological Association
Committee for the Investigation of Sterilization. Am. Jour. Med. Jurisprud. 1:
253-257, December 1938.
Myerson, A. and Neustadt, R. — Influence of ultraviolet irradiation upon excretion of
hormones in the male. Endocrinology 25: 7-12, July 1939.
Neustadt, R. — Photo-colorimetric method for the determination of androsterones in
urine. Endocrinology 23: 711-717, December 1938.
Osgood, R., and Robinson, L. J. — Brilliant Vital Red as an Anti-Convulsant in the
Treatment of Epilepsy. Arch. Neurol, and Psychiat. 40: 1178-1204, Dec. 1938.
Randall, Lowell O. — • The effects of insulin on serum lipids and choline esterase in
schizophrenia. (Preliminary Report) Jour. Biol. Chem. 128: LXXXII, June 1939.
Randall, L. O. and Cohen, L. H. — Serum lipids in schizophrenia. Psychiat. Quart.
13: 441, July 1939
Randall, L. O. and Jellinek, E. M. — Physiological studies in insulin treatment of
acute schizophrenia. IV. The choline esterase activity of the blood serum. Endo-
crinology 25: 278, Aug. 1939.
Randall, L. O. and Jellinek, E. M. — Physiological studies in insulin treatment of
acute schizophrenia. III. The serum lipids. Endocrinology 25: 105, July 1939.
Raymond, C. Stanley — A State Program for the Supervision and Training of the
Feebleminded. Am. Ass'n Adv. of Science, Dec. 30, 1938.
Robinson, L. J. — Syncope, Convulsions and the Unconscious State. Relation to the
Hyperactive Carotid Sinus Reflex. Arch. Neurol, and Psychiat. 41: 290-297, Feb.
1939.
Robinson, L. J. — Venous Blood Pressure Measurements During Syncope Caused by a
Hyperirritable Carotid Sinus Reflex. Am. Jour. Med. Sci. 197: 100-102, Jan. 1939.
Robinson, L. J. — Radiologic Gastrointestinal Studies in Epilepsy. Am. Jour. Psychiat.
95: 1095-1102, March 1939.
Robinson, L. J. — Induction of Seizures by Closing of the Eyes, or by Qcular Pressure
in a Patient with Epilepsy. Jour. Nerv. and Ment. Dis. 90: 333-336, Sept. 1939.
Roheim, Geza — Racial differences in the neurosis and psychosis. Psychiatry. 2: 375,
Aug. 1939.
Rosenzweig, Saul — The significance of frustration as a problem of research. Charac-
ter and Personality 7: 120, Dec. 1938.
Rosenzweig, Saul — General outline of frustration. Character and Personality 7:
151, Dec. 1938.
Rubin, M. A. — Electroencephalographic localization of atrophy in the cerebral cortex
of man. Proc. Soc. Exp. Biol, and Med. 40: 153, Feb. 1939.
Rubin, M. A. — The electroencephalogram of schizophrenic patients during administra-
tion of Vitamin Bi. Proc. Soc. Exp. Biol, and Med. 42: 440, Nov. 1939.
Rubin, M. A. and Wall, Conrad — Brain potential changes in man induced by metra-
zol. Jour. Neur. and Psychiat. 2: 107, Apr. 1939.
Rubin, M. A. and Cohen, L. H. — A variability study of the normal and schizophrenic
occipital alpha rhythm. II. The electroencephalogram and imagery-type. Jour.
Ment. Sci. 85: 779, July 1939.
Schube, P. G. and Cowell, J. G. — Art of Psychotic Persons — A Restraint-Activity
Index and its Relation to Diagnosis. Arch. Neurol, and Psychiat. 41: 711-720, 1939.
Schube, P. G. and Prescott, Blake — The Effect of Copper and Iron upon the Second-
ary Anemia of Therapeutic Malaria in General Paresis. Jour. Lab. and Clin. Med.
24: No. 4. p. 346-352, 1939.
Schube, P. G., Raskin, Naomi and Campbell, Eleanor — Cholesterolysis in the
Blood Plasma of Individuals with Mental Disorders. Jour. Lab. and Clin. Med. 25:
No. 2, p. 142-148, 1939.
Schube, P. G., Myerson, A. and Lambert, R. — Human Autonomic Pharmacology.
XVII. The effect of acetyl-beta-methylcholine chloride on the gall bladder. Am.
Jour. Digest. Dis. 5: 687-690, Dec. 1938.
Schube, P. G., Myerson, A. and Lambert, R. — The effect of benzedrine, benzedrine
and atrophine, and atrophine on the gall bladder. Am. Jour. Med. Sci. 197: 57-61,
Jan. 1939.
Schwager, Ethel Jeane — The art of understanding. Pac. Coast Jour. Nurs. 35:
474, Aug. 1939.
54 P.D. 117
Semrad, E. V. (joint author) — Observations in The Use of Fluid and Lumbar Puncture
in the Treatment of Delirium Tremens. Annals of Int. Med. 12: p. 2006, June 1939.
Shakow, David — Function of the psychologist in the state hospital. Jour. Con. Psych.
8: 20, Jan. 1939.
Shakow, David and Pazeian, Bessie — Adult norms for the K-S Clinical Formboards,
Jour. App. Psych. 23: 495, Aug. 1939.
Sullivan, Daniel J. and Flanagan, Norris B. — Practical Psychotherapy with
Adolescents — A Brief Survey of the Field for the General Practitioner. New England
Jour. Med. 221: 414-419.
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Mental Health, Symposium on Therapy, p. 21, Sept. 1939.
Watson, James — Psychotherapy for the poor. A state-city cooperative enterprise
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Abnorm. and Soc. Psych. 34: 166, April 1939.
Wells, F. L. — ■ The Plan of Search at Various Levels of Abstraction. The Jour. General
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Respectfully submitted,
Myrtelle M. Canavan, M.D.,
Pathologist.
REPORT OF THE DIVISION OF MENTAL HYGIENE
To the Commissioner of Mental Health:
I take much pleasure in submitting the seventeenth annual report of the Division of
Mental Hygiene, covering the period from December 1, 1938 to November 30, 1939.
In this report, various subjects are discussed in the following order:
I. General Functions and Development of the Division of Mental Hygiene.
II. The Child Guidance Clinics.
(a) Procedure at the Clinics.
(b) The clinics under the auspices of the Division —
(1) Report of Social Service.
(2) Report of Psychological Service.
(c) The clinics under the direction of the Division —
(1) Report of Springfield Child Guidance Clinic.
(2) Report of Worcester Child Guidance Clinic.
(d) The clinics under the auspices of the State Hospitals and supervised by
the Division.
III. The Educational Program.
(1) Staff conferences.
(2) Conferences with school personnel, social workers and other agencies.
(3) Dissemination of mental hygiene information by lectures to the public.
(4) Instruction of students in the Division —
(a) Speech students.
(b) Remedial tutors.
(c) Occupational therapy students.
(d) Social service students.
(e) Medical students.
IV. Research Activities.
A. Divisional.
B. Institutional.
I. General Functions and Development of the
Division of Mental Hygiene
There has been little change in the functions of the Division during the past year,
the work being carried on in the clinical, educational and research fields as in previous
years.
In 1922, the Division was organized for the purpose of carrying on a program dealing
with all matters pertaining to the causes and prevention of delinquency, convulsive
P.D. 117 55
disorders and mental illness. At the time of its organization, no trained personnel was
available for the undertaking of this program and it was, therefore, necessary to train
the personnel for its own needs, and later the Division trained personnel for other states
where similar programs were being instituted. Procedures and standardized techniques
were established only after careful study, analysis and practice.
The initial work of the Division was directed in conducting Habit Clinics. In 1922,
three such clinics were opened in East Boston, North End (Boston), and at the Roxbury
Neighborhood House. The following year several additional clinics were established in
Boston and nearby towns. Since that time, clinics have been established in communities
where the need for such service seemed essential. Some of the original clinics have been
absorbed as extramural hospital activities, while others were closed after functioning
for several years.
During the past year, twelve clinics have been operating under the auspices of the
Division.
Since the organization of the Division, it has been recognized that education in the
mental hygiene field has been one of increasing interest and importance. For the past
few years, much thought has been given to this matter as one of the outstanding phases
of the Division's endeavors. Plans have included the expansion of this service, so as to
reach a maximum number of persons. Growth of this phase of the work has been rapid
and encouraging. Detailed information relative to the various educational activities
will be found in a subsequent section of this report.
Several advisory committees were established by the Commissioner at the beginning
of the year, as part of the new organization program of the Department of Mental Health.
It was through the efforts of the Committees on Research and Mental Hygiene that
much ground work was laid for expanding the work of education and research in the
Division. Concentrated effort was made to stimulate the various staff physicians in our
mental institutions to give more thought and time to the vitally important subject of
research.
At the time of the organization of the Division, money was appropriated by the legis-
lature for the purpose of investigating the causes of delinquency, dependency, epilepsy
and mental illness. The original research program included a series of studies of con-
vulsive disorders by the staff of the Division. Biochemical studies and researches in
the field of neurosyphilis were started at the Boston State Hospital and the Boston
Psychopathic Hospital respectively, under the able direction of two well-trained psychi-
atrists. Previous to this time, the research activities had been confined to the Waverley
Researches, which have been carried on since 1919.
Interest increased in the field of preventive medicine, and other research centers were
established. In 1930, an appropriation was made for the study of Dementia Praecox
at the Worcester State Hospital, and, in 1937, additional money was appropriated to
be used for research in epilepsy at the Monson State Hospital. All of these research
centers have continued to devote much time and energy to the study of their specific
problems.
The survey of all institutions relative to extramural activities and the training of
students, which was begun last year, was completed by the Director prior to June 1.
The survey revealed that geographically the State as a whole has been adequately
provided with clinics. The service rendered showed opportunity for improvement,
certain clinics having given only diagnostic rather than therapeutic service. It was also
revealed that there were only a limited number of clinics available for adults, who sought
early treatment for mild mental disorders. One of the recommendations of the survey
was the expansion of this type of clinic, with the thought in mind that if patients were
given an opportunity to receive adequate treatment in the out-patient clinics, hospitali-
zation in many cases might be unnecessary.
The data obtained regarding extramural activities were compiled for publication in a
booklet entitled "Directory of Clinics under the direction of the Division of Mental
Hygiene." This publication has been sent to many of the social agencies, hospital super-
intendents, physicians and superintendents of schools throughout the State.
The information relative to student training will be assimilated by a special advisory
committee which will be appointed by the Commissioner at a future date.
The following changes in personnel occurred during the year :
Dec. 5, 1938 — Miss Edith Mason transferred from the Danvers State Hospital to fill
the vacancy in the social service staff as psychiatric social worker.
56 P.D. 117
Jan. 7, 1939. — Doctor Margaret D. Welch resigned her position as senior psychiatrist.
Jan. 9, 1939. — Doctor Julia Deming was appointed to the position of senior psychia-
trist.
July 1, 1939. — Doctor Hans B. Molholm resigned to accept a position at the Wor-
cester State Hospital.
Sept. 1, 1939. — Doctor Charles Brenner was appointed as senior psychiatrist to fill
the vacancy in the psychiatric staff. The appointment became permanent on November
20.
Sept. 1, 1939. — Mrs. Ada Allport resigned her position as psychologist.
Sept. 21, 1939. — Mrs. Edith Carlson was appointed to a full-time position as psy-
chologist, her position formerly being on a part-time basis.
Sept. 25, 1939. — Miss Sybil Stone was granted a leave of absence from her position
as psychologist for a period of six months. This vacancy has been filled on a temporary
basis.
Nov. 20, 1939. — Doctor Ella P. Cahill's appointment as senior psychiatrist, full time,
became permanent.
II. The Child Guidance Clinics
The aim of the Child Guidance Clinics is to prevent difficulties which arise from some
of the simple traits of childhood. Early correction of the simple problems may mean
the prevention of delinquency, dependency, and mental disorder in later life. The policy
of the clinics has been to give intensive study and treatment to children presenting per-
sonality, conduct and scholastic problems. Every case referred has been accepted for
some type of service. On January 1, the age range for admission to the clinics was
changed, so that children up through the age of fourteen years could be accepted for
study and treatment. At this time, the name Habit Clinic was changed to Child Guid-
ance Clinic.
(a) The procedure at the Child Guidance Clinics is briefly described for the benefit of
interested persons. The clinic offers assistance with the problems of child training and
personal development to persons interested in the welfare of children.
The first important procedure of the clinic begins with a careful physical examination,
except where recent and adequate reports of examinations are available. Physical defects
or disease must be carefully considered before proceeding with treatment of the child.
In some cases, physical defects are found to be the primary causative factor in the par-
ticular problem for which the case was referred to the clinic.
The next step in the study is made by the psychiatric social worker, who seeks to gain
insight into the child's background and environment in all of its phases; namely, home,
school and play aspects. This information is obtained from the parents, physicians,
teachers and other persons interested in the child. A complete report of the family
situation, together with developmental, personal and scholastic histories of the child
are included in the social service study.
The psychologist then proceeds to study the child by evaluating his intellectual
capacity, his achievement scholastically, and his special aptitudes and disabilities. In
recommended cases, special educational tests are given for the purpose of helping to
plan the child's educational program and school placement. Observation of the child's
conduct and reactions during the psychological examination offers an excellent oppor-
tunity for a better understanding of the child's personality.
The final step in the procedure is made by the psychiatrist, who establishes a contact
with the child and his parents. This study includes observations of the child's behavior
and reactions, his personality and inner mental life, together with other factors having a
bearing on the problem.
After all the facts have been coordinated and summarized, the case is reviewed at a
conference, where recommendations for treatment to be followed are outlined by the
psychiatrist. An interview with the parents or other persons interested in the child is
then held, and advice given as to the child's needs for healthy mental and physical
development.
In many clinics, special therapeutic services have been provided for speech and reading
difficulties. These services have been rendered by senior and graduate students of
Emerson College and Boston University, under the direction of well-trained supervisors.
During the past two years, the services of student occupational therapists have been
P.D. 117 57
available at the Brockton and Quincy Child Guidance Clinics. These specialized services
have proved valuable in many cases in aiding children to overcome handicaps which
interfere with satisfactory adjustment.
(b) The Clinics maintained and sponsored by the Division have continued to function
on a high level, serving the same communities as last year with one exception. The
clinic at Reading was closed on September 1, in view of the small number of cases being
referred for treatment. An additional weekly session of the Brockton Clinic was insti-
tuted on October 23, in order to more adequately serve the needs of the City of Brockton
and surrounding towns. It was through the efforts of the Superintendent of Schools of
Brockton that subsidy was obtained to help maintain the additional clinic session. At
the conclusion of the year, the Division was maintaining clinics in Boston at the Boston
Dispensary, the New England Hospital for Women and Children, and the West End
Health Unit, as well as at the Brockton School Department, the Lawrence General
Hospital, the Lowell General Hospital, the North Reading Sanitorium, the Norwood
Hospital and the Woodward Institute in Quincy. The Springfield Child Guidance Clinic
and the Worcester Child Guidance Clinic have continued to operate as incorporated
organizations, being subsidized by their respective Child Guidance Clinic Association.
(1) Report op Social Service
Social Service of the Division of Mental Hygiene has carried out during the year
various types of social therapy in keeping with high therapeutic standards in the special-
ized field of child guidance. Every case referred to the clinics has received some social
service guidance. The staff has considered each case from many angles to determine
whether or not a child would require or would be able to benefit from a full type of ser-
vice, or whether less intensive treatment would meet his needs.
The work has been divided into Full and Special Service, so as to better care for the
large number of cases known to the clinics during the year. Full Service indicates that
intensive treatment has been prescribed and the social worker has obtained a detailed
history from the child's parents in the home, the teacher in the school, and other persons
interested in the particular case. After the child has been examined at the clinic, it has
been the responsibility of the social worker to assist in carrying out the therapeutic
recommendations made by the psychiatrist. This might include carrying out certain
treatment with the parents and the child in the home, as well as contacting physicians,
clergymen, recreational directors and educators for the purpose of providing the child
with the type of treatment or program to fit his individual needs. Cases have been
classified as Special Service for various reasons and have required only partial histories
in most instances. Special Service cases include —
1 . Children brought to the clinic for diagnosis and consultation only.
2. Children, who because of mental retardation or other factors, have been unable to
benefit from clinic treatment.
3. Children referred to another agency qualified to meet their needs; such as, the
Division of Mental Deficiency, a general or specialized hospital, a school, or a social
organization. im
4. Children who can be treated at clinic without a social study; for example, infants
for simple habit training, or children with certain types of speech defect.
5. Cases in which clinic contact has to be brief because of the distance from the home
to the clinic, illness or because the family do not wish further service.
58
P.D. 117
4652
4517
3565
4185
3759
3492
3317
2857
2523
2412
2264
(671
1474
1570
1202
619
189
1923 1924 1925 1926 1927 1928 1929 1930 193) 1932 1933 1934 1935 1936 1937 1938 1939
Graph 1. - Number of Visits of Children to Child Guidance
Clinics 1923 - 1939
Graph I indicates the total number of visits made by children to the Child Guidance
Climes from the time of their organization in 1923 through the year 1939.
A summary of the work accomplished in the various clinics, together with an analysis,
is represented in the tables which follow : —
Table No. 1. Child Guidance Clinics — Types of Service Rendered, December 1,
1938 — November 30, 1939
Total
Full Service
Special Service
Cooper-
Cooper-
Unas-
Clinic
Case
Load
Total
Clinic
ative
Total
Clinic
ative
signed
Boston Dispensary .
159
99
99
57
57
3
Brockton ....
135
83
83
-
52
52
-
-
Lawrence ....
89
60
60
-
29
27
2
-
Lowell ....
77
35
34
1
42
40
2
-
New England Hospital
129
94
92
2
31
26
5
4
North Reading .
27
4
4
-
23
6
17
-
Norwood ....
108
82
82
-
26
26
—
-
Quincy ....
151
124
124
-
26
26
-
1
Reading ....
53
43
43
-
10
10
—
—
West End ....
149
120
118
2
29
24
5
-
Total ....
1,077
744
739
5
325
294
31
8
Table No. 1 shows that of the total case load, 1077, 744 cases were given full service.
Of this number, 5 were carried cooperatively; that is, another social agency took respon-
sibility for the social treatment, and the clinic social worker gave consultative service
and, in most instances, obtained the history. 31 of the 325 Special Service cases fall into
this cooperative group. There were 8 cases in which decision had not yet been reached
as to the type of service needed. These will be found in the last column as unassigned.
P.D. 117
59
Table No. 2. Child Guidance Clinics — Proportion of Different Types of Service
Rendered December 1, 1988 — November 30, 1939
Total
Full
Per
Special
Per
Unassigned
Per
Load
Service
Cent
Service
Cent
Cent
Boston Dispensary
159
99
62%
57
36%
3
2%
Brockton ....
135
83
61%
52
39%
—
—
Lawrence ....
89
60
67%
29
33%
-
_
Lowell
77
35
45%
42
55%
—
-
New England Hospital
129
94
73%
31
24%
4
3%
North Reading
27
4
15%
23
85%
-
—
Norwood ....
108
82
76%
26
24%
—
_
Quincy
151
124
82%
26
17%
1
1%
Reading ....
53
43
81%
10
19%
—
—
West End ....
149
120
80%
29
20%
—
~
Total ....
1,077
744
69%
325
30%
8
1
Table No. 2 shows both by numbers and per cent the proportion of the different types
of service rendered. 69% received Full Service, 30% Special Service, and 1% were
unassigned.
Table No. 3. Child Guidance Clinics — Cases Contacted During the Year,
December 1, 1938 — November 30, 1939
>>
a
03
C
O
a a
O m
a
o
a
c
a
a
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to
c
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0
o
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T3
a
m
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0
53
is
o
0
'3
V
o
Total Number of Cases Continued
309
707
25
26
45
11
36
12
32
48
21
53
Total Number of New Cases
123
108
37
64
85
13
62
97
31
87
Total Number of Old Cases Reopened
from Previous Year ....
11
1
7
2
8
2
14
6
1
9
61
Total Number of Cases Served During
159
135
89
77
129
27
108
151
53
149
1,077
Total Number of Cases Closed During
110
63
51
55
85
25
68
101
53
103
714
Total Number of Cases Continued to
363
49
72
38
22
44
2
40
50
46
*Clinic closed 9-30-39.
Table No. 3 indicates that of the 1,077 cases contacted during the year, 309 had been
continued from the previous year, 707 were new cases, and 61 reopened from the previous
year. Of the 1,077 cases, 714 were closed during the year, and 363 will be carried forward
to next year.
Table No. 4. Child Guidance Clinics — December 1, 1938 to November 30, 1939
Children
New Cases
Old Cases
Visits to
Clinic
Case
Attending
Attending
Attending
Clinic by
Clinic
Load
Clinic
Clinic
Clinic
Children
Sessions
Boston Dispensary ....
159
147
123
24
438
91
135
133
108
25
835
51
89
84
37
47
488
45
77
76
64
12
272
45
New England Hospital .
129
116
85
31
362
48
North Reading ....
27
17
13
4
24
8
108
102
62
40
569
47
151
132
97
. 35
628
46
53
43
31
12
170
31
149
137
87
50
731
45
Total
1,077
987
707
280
4,517
457
*Closed 9/39.
60
P.D. 117
Table No. 4 shows that 1,077 cases were served, of these 987 attended clinic. The
difference between these two numbers, 90, represents old cases which were continued by
social service, but did not attend clinic during the year. 707 represents the total intake
of new cases, as no new cases were accepted until they had attended clinic. In addition,
there were 280 continued or reopened cases which attended clinic sessions. The 9S7
children who attended made 4,517 visits to clinic, or an average of 5 visits per child.
This is not representative, however, as some children attended clinic only once, and
others as high as 38 times. The number of clinic sessions held was 457. This is an increase
over previous years, largely due to the fact that the Brockton Clinic increased its clinic
sessions during the last two months of the year. No clinic sessions were held in Reading
after July. The case load was carried over from the Reading Clinic to September in
order to determine whether cases should be referred to other clinics.
Table No. 5. Child Guidance Clinics — Monthly Statistics, December 1, 1938 to
November SO, 1939
Total Number
Total
Total Number
Total Number
Total
Total
of Children
Number
of Old Cases
of Visits
Number
Case
Attending
of New
Attending
to Clinic by
of Clinic
Load
Clinic
Cases
Clinic
Children
Sessions
December
381
235
67
168
372
45
January
424
236
72
164
420
45
February
416
244
61
183
360
37
March .
452
290
78
212
512
47
April
461
262
56
206
418
38
May
480
301
74
227
559
45
June . ,
459
260
54
206
396
43
July
395
176
46
130
268
38
September
400
184
45
139
255
35
October
404
252
76
186
419
40
November '■
431
281
78
203
538
44
Total
707
4,517
457
Table No. 5 shows the monthly statistics. To prevent duplication, the first, second
and fourth columns are not totaled, as the same children often attend clinic over a period
of months. It is indicated that the largest number of new cases and of visits to the clinics
occurred in the Spring and the Fall. The highest number of new cases, 78, attended in
both March and November, while the largest number of visits, 559, were made by
children in May, the second highest, 538, occurring in November. The highest number
of clinic sessions, 47, took place in March.
Table No. 6. Child' Guidance Clinics
Number and Percentage December
— Sex of the Children Served by the Clinics,
1, 1938 — November 30, 1939
Clinic
Male
Female
Total
88
71
159
95
40
135
66
23
89
47
30
77
70
59
129
13
14
27
78
30
108
98
53
151
33
20
53
104
45
149
692
385
1,077
64%
36%
100%
Table No. 6 indicates that of the total number of children, 1,077, served during the
year, 692 were boys and 385 were girls. The percentage is 64% male and 36% female.
This proportion has been much the same from year to year. It is noteworthy, however,
P.D. 117
61
that in the clinics where the majority of cases have been referred from general medical
clinics, including the Boston Dispensary, New England Hospital and North Reading
Sanatorium, there has been a more even distribution of boys and girls. In the clinics
where the schools have been the chief source of referral; namely, Brockton, Lawrence,
Lowell, Norwood, Quincy and Reading, the larger proportion served have been boys.
No definite conclusion can be drawn from these figures, since the West End Clinic does
not substantiate these facts.
Table No. 7. Child Guidance Clinics — Preschool and School Children —
December 1, 1938 to November 30, 1939
Clinic
Preschool
School
Total
53
106
159
18
117
135
4
85
89
16
61
77
48
81
129
3
24
27
26
82
108
39
112
151
11
42
53
45
104
149
263
814
1,077
24%
76%
100%
Table No. 7 shows that of the total, 1,077, 263 cases or 24% were of preschool age,
and 814 cases or 76% were of school age.
Table No. 8. Child Guidance Clinics — Sources of Neiv Cases — December 1,
1938 to November 30, 1939
Source of Referral
Per Cent
Schools ....
Health Agencies .
Friends and Relatives
Physicians
Family Agencies .
Children's Agencies
Clinic Staff .
Community Education
Nursery Schools .
Settlements and Churches
36.63%
33.52%
16.13%
5.80%
2.83%
2.12%
1.42%
1.13%
.28%
.14%
Total
100%
Table No. 8 gives the sources from which new cases were referred during the year.
The number of new cases totaled 707. The greatest number of cases 259 or 36.63% were
referred by schools; the second highest number, 237 or 33.52% were referred by health
agencies. Following these in order, the highest number of referrals came from friends
and relatives, physicians, family agencies, children's agencies, clinic staff, community
education, nursery schools, and settlement and churches.
This proportion of referrals varies little from last year, excepting that the previous
year health agencies stood highest in referrals and schools were second. This change is
probably due to the fact that the Brockton Clinic had only functioned during the last
two months of the previous year, and has functioned throughout the present year. It is
located in the school department building, and the large majority of the cases were
referred directly by the schools.
62
P.D. 117
Table No. 9. Child Guidance Clinics — Sources of New Cases —
December 1, 1938 to November 80, 1939
>>
G
03
CD
Tr a
a
—
73
Source or Referral
c a
O co
so
o
o
C
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o
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o
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03
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PQ
J
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!<
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O1
«
H
Health Agencies
33
2
-
5
19
2
b
4
-
17
88
75
4
2
6
30
11
1
4
4
13
149
Schools
—
7
-
1
-
—
4
1
1
-
14
3
74
23
22
(3
-
27
44
19
27
245
Friends and Relatives
-
4
1
6
10
-
9
9
4
b
48
2
5
4
9
12
-
11
13
1
9
66
Physicians
1
-
1
-
1
-
-
V
1
1
12
3
2
5
8
1
-
1
7
-
2
29
Nursery Schools
2
Children's Agencies
1
-
-
-
-
-
1
1
3
8
-
-
1
1
3
-
1
-
-
1
7
Family Agencies
3
1
—
1
7
1
3
-
1
-
-
2
3
-
3
13
Community Education
-
—
-
2
-
-
-
-
-
-
2
-
1
-
3
-
-
-
1
-
1
6
Clinic Staff
1
4
-
1
1
-
-
1
-
2
10
Settlements and Churches
-
-
-
-
-
-
-
1
-
-
1
Totals
123
108
37
64
85
13
62
97
31
87
707
Table No. 9 gives in detail not only the source of referral of new cases in each clinic,
but also the number of cases of preschool and school age. The highest number of pre-
school children, 88, were referred by health agencies, 48 by friends and relatives, 14 by
schools, 12 by physicians, 8 by children's agencies, 7 by family agencies, 2 by nursery
schools and 2 by community education, making a total of 181. Of the 526 children of
school age referred, the highest number, 245, were referred by schools, 149 by health
agencies, 66 by friends and relatives, 29 by physicians, 13 by family agencies, 10 by clinic
staff, 7 by children's agencies, 6 by community education, and 1 by settlements or
churches. 26% of the new cases were of preschool age, and 75% were of school age.
The preponderance of school over preschool age children is partly due to the fact that
the largest single source of referral of cases was the schools. It is interesting to note
that all agencies, except nursery schools, referred more children of school than preschool
age. It is probable that families and other persons do not consider the problems of early
childhood serious enough to refer to a clinic, or hope the child will outgrow his difficulties.
Another potent factor is that until children enter school they are less likely to come to
the attention of those outside the home who are familiar with clinical resources.
P.D. 117
63
Table No. 10. Child Guidance Clinics — Number of Interviews
December 1, 1938 to November 30, 1939
Clinic
Boston Dispensary .
Brockton .
Lawrence .
Lowell
New England Hospital
Total .
Number of
Interviews
1,564
2,166
1,161
946
1,165
Clinic
North Reading
Norwood
Quincy
Reading
West End
Number of
Interviews
50
1,746
2,517
577
2,026
13,918
Table No. 10 shows the total number of interviews, 13,918, given by the various
members of the clinic staff, including the psychiatrists, psychologists, social workers,
speech and occupational therapists and remedial tutors. This figure represents inter-
views with children, parents, teachers, representatives of social agencies, and other
interested persons.
The Quincy Clinic had the highest number of interviews, 2,517; the Brockton Clinic
was second with 2,166 interviews, and the West End Clinic was third with 2,026 inter-
views. These three clinics, in addition to having the services of psychiatrists, psycholo-
gists and social workers as provided in all of our child guidance Clinics, have had other
types of service to offer the child. The Brockton Clinic has had speech therapy, occupa-
tional therapy and remedial tutoring. The Quincy Clinic has had speech and occupational
therapy, and the West End Clinic has had speech therapy and remedial tutoring. The
Norwood, New England Hospital and Lawrence Clinics have had speech therapy. The
number of interviews at the Boston Dispensary Clinic was high, due in part to the many
interviews between the members of the hospital and clinic staffs. Speech therapy was
started at the Lowell Clinic in October. The North Reading Clinic has been conducted
on a consultation basis. There were no sessions of the Reading Clinic after July.
There has been only one change in the social service personnel during the past year.
Miss Edith Mason, psychiatric social worker at the Danvers State Hospital, transferred
to the Division on December 5, 1938 to fill the vacancy in our Social Service Department.
The social work has been carried on with a staff of five clinic social workers and one
research social worker. In October, there was a change in the distribution of the work
among the social service personnel. It was arranged to have one social worker give all
her time to the Brockton Clinic, in view of the additional weekly session of the clinic.
It had been the custom up to this time to have each social worker responsible for the
social case work, clinic management and community contacts in two clinic centers. There
have been eleven weekly clinic sessions during the year at which the social worker has
served as clinic manager, in addition to the North Reading Clinic session which has been
held on a consultation basis, and when request has been received for this service.
The social service staff has taken an active part in the educational program of the
Division of Mental Hygiene. It has cooperated in giving talks to social agencies, women's
and mothers' clubs, and other interested organizations.
Practice training and guidance of students from the Boston University School of
Religious and Social Work, and from the Simmons College School of Social Work have
continued in the Social Service Department as part of the student training program
of the Division.
The greatest educational work of the social service staff is carried on during the natural
performance of their various duties. Education is effected through contacts with clients,
educators, representatives of social agencies, of churches and hospitals, as well as with
physicians, nurses, and non-professional people.
While it is with gratification that we look upon the work accomplished by Social
Service during the past year, it is with the realization that it has only been possible
through the cooperation and support of many interested persons, including members of
the Department and the various personnel of the Division.
64 P.D. 117
(2) Report of Psychological Service
A review of the program of the Psychological Department for the past year is herewith
presented.
The work of psychological service was carried out during the greater part of the year
by a staff of five part-time psychologists. On September 1, Mrs. Ada L. Allport resigned
her position of psychologist. Miss Sybil A. Stone was granted a leave of absence for a
six months' period starting September 25, and her position has been filled on a temporary
basis by a substitute psychologist. One of the psychologists, who had been employed
on a part-time basis, was appointed to a full-time position. The psychological staff since
September has consisted of four psychologists, one on a full-time basis, and three on
a part-time basis.
The organization of the psychological service on a part-time basis has had advantages.
It has increased the number of workers available, so that it has been possible for clinics
to be held simultaneously or in quick succession in widely separated communities, and
it has enabled the psychologists to pursue other activities which would broaden their
usefulness to the clinics.
It was, however, deemed advisable to employ one psychologist on a full-time basis,
in order to integrate the psychological service more efficiently with the rest of the clinic
service, both from the administrative and the therapeutic point of view. The full-time
psychologist has been in charge of the psychological equipment, has substituted in the
clinics for an absent member of the psychological staff, and has been available for con-
ferences with the psychiatrist and social workers. She has arranged psychological staff
conferences, and has been responsible for the psychological statistics.
The function of the psychological service in the clinics is to appraise the child's intel-
lectual endowment, school achievement, and personality traits, and to discover his
particular abilities and disabilities in order to enable him to utilize his capacities to
optimal advantage in relation to his social, educational, and vocational needs. The
actual carrying out of this program varies in the different clinics, due to variations in the
types of problems presented. In some of the clinics, which are held in hospitals, the
psychologist may be asked to interview a young patient on the ward, studying the child
in relation to the total clinical and social picture as presented in the hospital records.
In the clinics which have a preponderance of school problems, part of the psychological
service may include the supervision of reading and speech therapy, consultation with the
schools' educational adviser and with teachers, planning of the child's academic program,
and participation in school conferences.
The psychologists have participated in the educational program of the Division,
interpreting their part of the service to students in training, to schools, and to other
interested agencies. They have taken part in the weekly staff conferences and, at inter-
vals throughout the year, have presented research and psychological material of general
interest.
During the fiscal year, 841 complete psychological examinations were made. This
figure does not represent the actual amount of psychological service rendered, as it does
not include the number of separate tests given, nor the number of interviews between
the psychologist and parents, teachers, and staff members.
The tests most frequently used in the clinics are :
The Stanford 1916 Revision of the Binet-Simon Scale. It is employed for children of
school age wherever it is applicable.
The Gesell Developmental Schedules. These schedules are used in making the psycho-
logical appraisal of infants.
The Merrill-Palmer Scale. This is a useful scale in studying the capacity of preschool
children.
. One of these three examinations is given routinely to the children at clinic wherever
it is expedient. In some cases, the routine examination suffices. Supplementary tests
may be given when the results of the examination do not seem entirely representative,
or where a more intensive study is desired.
The following are the supplementary tests most frequently used :
Language Tests: Otis Self-Administering Tests of Mental Ability; Pintner-Toops
Revised Direction Test; Kent Emergency Test.
Achievement Tests, Tests of General Information, and Diagnostic School Tests: Detroit
Word Recognition Tests; Durrell-Sullivan Reading Capacity and Achievement Tests;
P.D. 117 65
Gray's Oral Reading Test; Commonwealth of Massachusetts School Tests; Metropolitan
Achievement Tests; Monroe's Reading Aptitude Tests; Judge Baker Foundation Scaled
Information Test; Stanford Achievement Tests.
Performance Tests: Healy Pictorial Completion I and II; Porteus Mazes; Mare and
Foal Picture Form Board; Cube Imitation Test; Manikin, Kent-Kohs Color Cubes;
Lincoln Hollow Square; Healy Construction Tests A and B; Woodworth- Wells Sub-
stitution Test; Goodenough Drawing Test.
The psychologists, during the year, averaged over two studies per clinic session. This
pressure has made the maintaining of high standards of service increasingly difficult.
It is felt that further psychological service is essential, not only for the most efficient
functioning of the clinics, but also for the purpose of enabling the psychologists to con-
duct research studies along psychological lines on the material presented in their clinical
work. The opportunity for developing such research is especially inviting in the Brock-
ton Clinic, where the School Department has offered its full cooperation. Among the
aims of the psychology staff for the future is the development of research activities.
The projects which the psychologists have carried on outside the Division have in-
cluded research work, lecturing, teaching, preparing material for publication, and work
in other child guidance clinics. The knowledge and experience gained in these various
undertakings have been a real contribution to the high standards of psychological service
maintained in the Division.
(c) The Child Guidance Clinics under the direction of the Division
The Springfield and Worcester Child Guidance Clinics are distinctive in themselves,
as each operates on a full-time schedule and is subsidized by its respective community.
Each clinic is incorporated and is in charge of a full-time director, who is responsible to
both the Child Guidance Clinic Association and the Division for the efficient manage-
ment of the clinic.
The following reports indicate the accomplishments of the Springfield and Worcester
Child Guidance Clinics during the past year:
(1) Report of the Springfield Child Guidance Clinic
The Springfield Child Guidance Clinic completed its first year in November, 1939,
and reviewing its activities presents a gratifying and encouraging picture of accomplish-
ment. While the case load has been high in proportion to the amount of staff, one appre-
ciates that such a situation was inevitable in an area where they have been seeking a
full-time clinic for several years, because of inadequate clinic resources. The cases had
been accumulating over a long period and a sorting process and disposition of a portion
of them was imperative.
The inauguration of the clinic represented the fruition of sixteen years' effort on the
part of the community to provide a full-time psychiatric service for children. The first
stimulus toward the clinic occurred in 1922 when the Connecticut Valley Committee
for Mental Hygiene (a branch of the Massachusetts Society) manifested a sincere interest
in a psychiatric program and sponsored two lecture series in which prominent psychia-
trists participated. This aroused much enthusiasm in several groups who proceeded to
investigate the possibilities of securing some psychiatric clinical service from the State.
Their request was granted, and a weekly clinical unit was sent out by the Massachusetts
Division of Mental Hygiene in 1925. This plan operated for a year when the Division
found it necessary to discontinue the service. The local sponsors — resolute in their
desire for these specialized services and undaunted by the withdrawal of the Division's
unit — ■ succeeded in making arrangements with Monson State Hospital for a medical
psychiatric contribution and with Mt. Holyoke for the assistance of a psychologist.
A psychiatric social worker was secured and underwritten by the Springfield Women's
Club for a period of three years, while the Community Chest met incidental expenses
and the Springfield Hospital provided quarters. This arrangement continued from 1926
to 1929 when the Community Chest and Springfield Hospital assumed the expense of the
clinic with the exception of the medical service, which Monson State Hospital continued
to contribute by sending in a psychiatrist for two half days a week. Both the clinic and
the community concurred in the conviction that a part-time clime was inadequate to
meet the demands and continued in their quest for a full service. The mental hygiene
survey conducted by the Massachusetts Society for Mental Hygiene vividly portrayed
66 P.D. 117
the community's particular needs, and this gave added impetus to securing the full-time
services needed. The combined efforts of the community, the Massachusetts Society
for Mental Hygiene, and the State Department of Mental Health resulted in the opening
of a full-time clinic at the Wesson Memorial Hospital in November, 1938.
The clinic program has been of a far wider scope than might be indicated in a numerical
picture, and can perhaps be more clearly comprehended from the fact that 102 different
organizations have been contacted either through the medium of individual cases,
lectures and conferences, together with the fact that the clinic has served not only the
greater Springfield area, but also those part of Western Massachusetts not accessible to
Worcester and Pittsfield clinical resources. The clinic has demonstrated the usefulness
and value of a psychiatric service to children and parents, as well as the benefits of a
cooperative service with other agencies — a service which these agencies are unable to
provide and one which enhances their own effectiveness. Agencies recognizing the com-
plexities of psychiatric situations and their inability to deal with them in the absence of
specially trained staff, readily refer children in order that they may deliver a complete
and well rounded-out treatment program to those whom they are serving. The tabula-
tion of lectures and conferences represents the clinic's endeavor to have the mental
hygiene point of view permeate the manifold activities in this area as much as possible.
Obviously a small clinic such as ours has been able only to meet a small proportion
of the demands put upon it by those desiring the service, and additional staff is impera-
tive if we are to more efficiently and adequately serve this section of the State. A clinic
which defines its duties as consisting, not only of a distinctive service in the study and
treatment of psychiatric difficulties of children, but also that of a wider approach to the
community as a whole is inevitably faced with the question as to which is the more
effective and important task, and how best to divide its energies and resources.
Having a limited staff has necessitated a painstaking evaluation and distribution of
services, earnestly attempting to devote a proportionate amount to the study and treat-
ment of the individual child, and at the same time avoid any omission in other directions
of the program. This has not always been easy to accomplish because of the numerous
demands for educational service, but the staff's willingness to give unsparingly of their
time after hours has made it possible to effect a nice balance between the study and
treatment aspects of the program and the educational activities.
Research, while one appreciates its vital importance and value in a Child Guidance
Clinic, could not be considered because of insufficient staff and the presence of the other
phases of the program.
Utilization of the play situation as a part of child guidance techniques has become
valuable for both diagnostic and therapeutic purposes. It is considered as one of the
more important mediums of expression by which a child reveals his experiences, conflicts
and many times provides him with an excellent opportunity to work through his conflict.
This is particularly true in the younger age group where the use of play has been more
productive than direct procedure.
The Springfield Women's Club, by financial contribution and the services of one of
its committees, redecorated and furnished the children's play room. This project was
supplemented by one of the older clinic patients who donated a large, fully equipped doll
house. All of this has provided the clinic with the necessary equipment for this special-
ized form of inquiry into the child's mental life.
The psychological program, in addition to routine psychological appraisals (psycho-
metric examinations), has consisted of considerable work with Rorshack and Thematic
Apperception Techniques — the results of which have been most interesting and have
served as valuable aids in the diagnostic and therapeutic procedures.
There has been a particularly close working relationship between the schools and the
clinic, furthered by the interest and active participation of the superintendent, assistant
superintendent and other administrators in the various school departments. Throughout
the year, conferences have been held with the school personnel to discuss either individual
problems, general mental hygiene problems or clinic policies. One of the most convincing
indicators of the schools' interest in the clinic and in psychiatric problems in general is
seen in the number of referrals by the schools.
The accompanying statistical picture shows that the problems referred to this clinic
correlate closely with those seen in other child guidance clinics operating under the
direction of the Division of Mental Hygiene, and likewise the philosophy of function
P.D. 117 67
existing in these clinics one assumes to be fairly similar, with perhaps some minor differ-
ences. Of real import in the philosophy of this clinic is the fact that it is concerned with
problems whose origin is in the inner life of the child, rather than those which are the
result of external factors and hence the responsibility of another agency. In the interest
of economy, the staff have attempted to avoid accepting for treatment those cases where
problems were explainable in terms of environmental situations susceptible to treatment
by other agencies. Still another difference may be in our emphasis on a treatment service
rather than on diagnostic — this is made more possible in a full-time permanent clinic
than is sometimes practicable in a traveling clinic by reason of the time factor and con-
sequent arrangement of appointments.
The small number of defectives referred to the clinic certainly reflects understanding
on the part of the community regarding clinical resources and also assures one of a
minimum amount of duplication of effort in state clinics. It is clearly understood that
Belchertown State School provides opportunities for cases in which there is a question
of intellectual impairment. Inasmuch as we are attempting to do a distinctive „ob, it is
of paramount importance that we not duplicate the service offered by another agency.
During the year there have been some changes in the personnel which fortunately
did not embarrass the service too seriously.
Our first and temporary psychologist, Mrs. Mary Camp, resigned December 20, 1938,
when it was possible to appoint one permanently from the Civil Service list. Doctor
Elizabeth Hincks accepted the appointment on January 5, 1939, and remained until
November 1, 1939, when she resigned to accept a position at the New England Home for
Little Wanderers. The vacancy was filled by a temporary appointee, Miss Elizabeth
Starkweather, pending the publication of the list of Civil Service permanent psy-
chologists.
Miss Marion Kennedy, speech pathologist resigned in September to enter private
practice.
Miss Eileen Fleming, a second year student from the Boston College School of Social
Work, started her training in the clinic in September, 1939.
Miss Florence Slutz from the American International College has been with the clinic
on a volunteer part-time basis as record clerk and receptionist since September, 1939.
Edward Soles, M.A., a teacher for many years with a keen interest in and under-
standing of children's needs, organized a tutoring program in the clinic which has con-
tinued with excellent results. By reason of his psychological background and his experi-
ence in the reading field, he has played an important part in the treatment program of
many children. Such a role has been unavoidable for him, inasmuch as most all of our
reading problems have been accompanied by personality deviations of varying degrees —
in these situations his personal relationship with the children has been of real value.
Remedial work, particularly in reading has become an essential part of the clinic's pro-
gram — chiefly because of the related emotional problems. Frequently reading dis-
abilities are but symptoms of underlying emotional difficulties which make a purely
pedagogical approach to the problem ineffectual and calls for the assistance of someone
trained in dealing with emotional factors, a service which the schools are unequipped
to give at the present time.
The clinic has been most fortunate in having a Board of Directors whose interest and
energy have been responsible for the success of the clinic. The Director, in behalf of the
staff, wishes to express appreciation to the Department of Mental Health and the Board
of Directors for their fine support and whole-hearted cooperation. The clinic also sin-
cerely appreciates the generous consideration given by the Community Chest, Spring-
field Council of Social Agencies, the Junior League and Springfield Women's Club.
Teaching: Problems in Child Guidance (University Extension 15 lectures — 30 hours).
Single Lectures Given by the Staff:
Forest Park Junior High School.
Springfield Council of Social Agencies.
Children's Home.
Junior League.
Jewish Mother's Club.
Probus Club.
Council of Jewish Women.
City Health Nurses.
68
P.D. 117
Day Nursery.
Children's Aid Association — Board members and staff.
League of Women's Voters.
Federation of Women's Clubs.
Hampden Parent-Teacher Association.
Wesson Memorial Hospital Nurses.
Wesson Memorial Graduate Association.
Springfield Academy of Medicine.
Northampton Mental Hygiene Association.
Carew Street School Parent-Teacher Association.
Red Cross.
Girl Reserves.
South Congregational Mothers' Club.
Tatham Parent-Teacher Association.
Elias Brookings Parent-Teacher Association.
Table I.
New Cases
M.
F.
T.
Preschool .
27
116
25
68
52
184
Total
143
93
236
Table II. Cases Active on December 1, 1939
M.
F.
T.
School
8
27
5
21
13
48
Total
35
26
61
Table III.
Full Service Cases .
Special Service Cases
Diagnostic Service Cases
Type of Service Classification of New Cases
151
40
45
Total
Table IV. Summary of Sources of Referral
Health Agencies
Social Agencies
Interested Individuals
Educational Agencies
Police and Court
Recreational Agencies
236
66
62
54
50
3
1
Total 236
Table V. Intervieics
Interviews with Psychiatrist .
Interviews with Pediatrician .
Interviews with Psychologist
Interviews with Social Worker
History ....
Treatment
Agencies ....
Total
Number of Visits by Patients
Number of Clinic Sessions
1,229
56
248
378
367
200
745
1,528
242
P.D. 117 69
Table VI. Personnel Report
Regular Staff Full Time Part Time
Psychiatrist 1 -
Pediatrist - 1
Psychologist . - 1
Social Worker 1 -
Clerical Worker 1 -
Remedial Tutor - 1
Receptionist - 1
Staff in Training
Social Worker - 1
(2) Report of the Worcester Child Guidance Clinic
The Worcester Child Guidance Clinic has taken as a definition of its function, "The
treatment of behavior problems in the emotional and social growth of children and
adolescents." Developments of the past year have brought the clinic to a better realiz-
ation of this function, and viewing these developments in retrospect affords evidence of
this accomplishment.
The year was opened under difficulties. Doctor Kirkpatrick had just resigned from
the directorship and there was no psychiatrist attached to the staff until May, 1939,
when Doctor Robert Kemble began as director. During this time, psychiatrists from
the Worcester State Hospital gave their services to the clinic. In September, Doctor
Phyllis E. Schaefer began her duties as assistant psychiatrist, and Miss Alice Fleming
filled the position as psychometrist. Miss Ethel Burnell, one of our social workers, left
at the end of June to become chief social worker of the Colorado Springs Child Guidance
Clinic. The year was thus one of staff reorganization which had to be accomplished in
the face of increased demands for clinic services.
Fewer cases could be accepted for treatment, but the statistics show that cases were
given more service. The total number of interviews per case was greater, and the empha-
sis in these additional interviews was directed toward getting cases started on a treatment
basis, as contrasted with the more diagnostic type of service. Cases have been ap-
proached with the idea of helping them, rather than merely knowing or studying them,
and the treatment process has been scrutinized with an eye to the dynamic factors
influencing change and growth.
Thus the movement or progress of a case has become the focus of attention. This
has led an interest in the factors which bring a child to the clinic, and those which tend
to continue bringing him there. These factors lie partly in the individual and his prob-
lems, and partly in the clinic and the therapist, together they are important to the
relationship through which treatment must operate. This relationship and its factors
need not be vague or mysterious; they can be approached and investigated just as any
other processes or happenings. It is obvious that for growth and change to be seen and
helped, there must be continued interviews over a period of time. This will explain the
aim of the clinic in approaching each case with the idea of its continuing, instead of
merely studying and appraising it. In those cases that do continue, the clinic has been
of greatest service. Therefore, the emphasis has been on getting them to continue rather
than merely be studied and then left to their own devices.
The difference this makes can best be seen in the form of the application interview.
The application could be an elaborate and exhaustive collection of information about a
case, with investigation of every factor that seems significant. On the other hand, it can
be directed simply to the elements that decide whether the case will continue or not:
does this mother want the help the clinic offers; can she be given an understanding of
how treatment is carried ; or by regular appointments over a period of time, can she make
the necessary arrangements? This is an important shift in emphasis, and in making it
we have seen gratifying improvement in the continuity of treatment.
This is but one example of how attention to the dynamics of treatment adds to the
value of treatment and affords insight and perspective to the therapeutic process. Simi-
larly, an awareness of the therapeutic situation and the relationship between patient
and therapist is used to clarify and strengthen the relationships that the child must make
in his everyday life.
70
P.D. 117
The clinic has fulfilled and extended its other responsibilities to the community. The
number of talks to community groups was more than tripled in the past year. A pro-
gram of service to the public schools of Webster has been continued, with constant
examination into how that service can be made most effective. In the difficult problem
of delinquency, new approaches are being tried. Here the probation officers of the
Worcester courts have been most helpful with suggestions and cooperation.
The uses of group therapy in the form of a play group are being studied from the
material of the group completed in May, 1939. Another group is being formed to con-
tinue investigating this form of treatment, which seems to have some interesting possi-
bilities.
Miss Burnell continued her program at the Girls' Club, placing her emphasis this year
upon her work with the leaders, and discussion groups with the older girls in the club.
She gave a series of lectures on the emotional development of the child, at the same time
affording an opportunity for the discussion of problems of particular concern to the
leaders.
In the training of workers in this field, the clinic continues to afford a year's work to
three student social workers, and a student psychologist. One psychiatrist is in training
for the whole year, and in addition the resident psychiatrists of the Worcester State
Hospital each receive three months of training at the clinic. The training program has
been given more from and substance through the use of weekly seminars in each of the
three phases of work : therapy, social work, and psychological testing.
The critical evaluation of the clinic's work is being continued in the follow-up study,
the goal being approximately three hundred follow-up visits on cases that were carried
on a treatment basis. Though no predictions can be made concerning the form the
statistics will take, the staff has already learned a great deal from the individual reports.
This is an arduous and difficult task and it is expected to be completed during 1940.
In all, the Worcester Child Guidance Clinic seems definitely accepted by the com-
munity as a valuable resource. More cases come to us than we can handle at all times,
and this is perhaps the best indication that our services are appreciated. The clinic is
taking up its next responsibility, the critical evaluation and improvement of the quality
of the services it gives.
Annual Service Report — December 1, 1938 to November 30, 1939
I.
Report of Case Load
A. Carried Cases
1 . Cases carried over from last year
2. Intake a. New cases accepted .
b. Old cases reopened
(1) last closed before present year
(2) last closed within present year
3. Total cases open at some time in this year
4. Cases taken from service .
5. Cases carried forward to next year .
Closed Cases Followed Up (Not reopened)
Applications Rejected
Applications Withdrawn ....
B.
C.
D.
II. Type of Service Classification
A. New Accepted Cases
6. Full service a. Clinic staff cases (9 reopened)
b. Cooperative cases (7 reopened)
c. Full service not a or b
7. Special and Diagnostic Service (advice) (9 reopened)
8. Total new cases accepted .
Cases Taken From Service
9. Full service a. Clinic staff cases
b. Cooperative cases
10. Special service (advice)
Total
205
172
24
1
402
169
233
220
10
9
78
26
0
93
197
45
15
109
11. Total cases closed during this year
169
P.D. 117
71
III. Sources Referring New Accepted Cases
Full
Special
Total
12. Agencies a. Social
19
14 .
33
b. Medical .
3
4 .
7
13. Schools a. Public
6 .
3 .
9
b. Other
0 .
7 .
7
14. Juvenile Court
7 .
49
56
15. Private physicians
3 .
2
5
16. Parents, relatives, self
65
14 .
79
17. Others (friends) .
1
0 .
1
18. Total new cases accepted . . . 104 . . 93 . . 197
IV. Summary of Work With or About Patients
A. By Psychiatrists Total
1. Interviews with patients a. for examination 183
b. for treatment 591
2. Interviews about patients . . 33
3. Physical examinations by clinic staff members . . . . . 2
B. By Psychologists
1. Interviews with patients a. for examination 175
b. for re-examination . . . 17
c. for treatment 546
2. Interviews about patients . . 12
C. By Social Workers
1. Interviews in clinic 994
2. Interviews outside clinic . . . . . ... 300
3. Telephone calls 833
D. Referral Interviews 151
V. Service to Webster Schools
A. 1. Cases carried over from last year ....... 31
2. New cases 9
3. Cases closed • 29
4. Number of cases receiving service 40
B. 1. Social workers' interviews with patients, parents, teachers and
others 145
2. Psychiatrists' interviews with patients, parents, teachers and
others . . . . . . . . . . . . . 33
3. Total number of interviews in Webster schools .... 178
VI. Number of Interviews Given by Staff Members 3,402
VII. Number of Educational Lectures given by Staff Members to
Community Organizations ....... 75
VIII. Personnel Report (Average staff during year)
A. Regular Staff Full Time
1. Psychiatrists 2
2. Psychologists . . . . •;'•'. 2
3. Social Workers 3
4. Clerical Workers . . .... . 2
B. Staff in Training
1. Social Workers . . . . . .3
2. Psychologist . 1
3. Psychiatrists ... '.",'. : . 5 different internes each for
three month period.
(d) The Child Guidance Clinics under the auspices of the State Hospitals of the Depart-
ment of Mental Health were placed under the supervision of the Division on January 1.
This new policy has brought about no change in the clinic administration, but the Divi-
Part Time
1 (vol)
1
72
P.D. 117
sion has stimulated interest in maintaining the high level of therapeutic service which
has long been in existence in Massachusetts. The clinics operated by the various insti-
tutions have efficiently served the same communities as last year in Athol, Attleboro,
Beverly, Boston (Psychopathic Hospital), Brockton, Fall River, Fitchburg, Gardner,
Haverhill, Holyoke, Lawrence, Lynn, New Bedford, Newburyport, Northampton,
Quincy, Salem, Waltham, and Warwick.
A review of the work accomplished at these clinics would indicate that more thought
is being given to therapeutic rather than diagnostic service.
Table No. 1. Child Guidance Clinics — Under the Auspices of the State Hospitals
December 1, 1939 to November 30, 1939
New Cases
Visits
Re
-exami-
NATIONS
No. of
Clinic Center
Clinic
Sessions
M
F
T
M
F
T
M
F
T
Athol
2
2
3
1
4
1
1
2
3
15
9
24
• 20
12
32
4
1
5
52
26
16
42
66
62
128
10
10
20
40
Boston Psychopathic Hospital
167
133
300
319
183
502
25
21
46
302
29
8
37
74
21
95
4
1
5
50
Fall River
19
20
39
24
30
54
4
3
7
52
65
44
109
76
48
124
11
4
15
64
28
8
36
38
8
46
10
—
10
38
46
22
68
307
186
493
25
11
36
34
47
25
72
461
222
683
1
—
1
49
9
7
16
34
16
50
7
3
10
17
42
25
67
181
90
271
34
3
37
41
16
10
26
24
20
44
5
5
10
52
14
6
20
45
25
70
10
5
15
19
31
23
54
71
59
130
-
1
1
40
34
23
57
62
35
97
2
2
4
39
45
25
70
510
214
724
4
2
6
36
14
7
21
77
36
113
14
7
21
36
8
4
12
8
4
12
-
-
-
3
Total
657
415
1,072
2,400
1,272
3,672
171
80
251
967
*Cases from Attleboro were seen at the Taunton State Hospital.
III. The Educational Program
(1) Staff conferences.
The regular staff conferences have been held each week on Monday afternoons through-
out the year. The purpose of these meetings has been for the formal presentation of
challenging cases and other interesting subjects by the various staff members. This
type of roundtable conference has proved very valuable, as it has afforded those present
an opportunity of discussing, not only the case being considered, but also new phases
of treatment which might be helpful in dealing with the many problems revealed in the
total study. Several times during the year, guest speakers addressed the staff on various
subjects related to the field of child guidance.
(2) Conferences with personnel.
Another type of conference, which has been a vital part of the educational program
of the Division, has been held with school administrators, teachers, nurses and the
personnel of referring agencies. At these conferences, problems of the individual child
have been discussed with the thought in mind as to how each interested person could
contribute to the solution of the problems. These conferences have taken place at weekly
intervals in some communities, while in others they have been held at such times as the
need seemed urgent.
(3) The dissemination of mental hygiene information.
The Division has co-operated with many clubs and organizations by providing speakers
for their programs. The subjects of the talks have been confined to the functions of the
Division, and the principles of mental hygiene which apply to mental and physical
health. Much time has been devoted to this work by various staff members who have
given unselfishly of their time outside of office hours.
P.D. 117
73
Talks to Organizations
Date
12/ 6/3S-
1/16/39-
1/17/39-
1/17/39-
1/24/39-
2/ 6/39-
2/ 7/39-
2/14/39-
2/17/39-
2/28/39-
2/28/39-
3/ 6/39-
3/ 8/39-
3/14/39-
3/14/39-
3/15/39-
3/20/39-
3/28/39-
4/ 2/39-
4/ 4/39-
4/20/39-
4/26/39-
5/ 2/39-
5/12/39-
5/12/39-
5/23/39-
6/14/39-
9/14/39-
10/ 9/39-
10/17/39-
Speaker
-Dr. Yerbury.
-Miss Hillis.
-Dr, Yerbury.
-Miss Hoskins.
-Dr. Yerbury.
-Dr. Yerbury.
-Dr. Yerbury.
-Miss Hoskins.
-Dr. Cahill
-Dr. Yerbury.
-Dr. Yerbury.
-Dr. Yerbury.
-Dr. Yerbury.
-Dr. Yerbury.
-Miss Hoskins.
-Dr. Cahill.
-Dr. Yerbury.
-Dr. Cahill.
-Dr. Yerbury.
-Dr. Cahill.
-Dr. Yerbury.
-Dr. Yerbury.
-Miss Hillis.
-Dr. Yerbury.
-Dr. Yerbury.
-Dr. Yerbury.
-Dr. Yerbury.
-Dr. Yerbury.
-Miss Hoskins.
-Mrs. Newell.
10/24/39— Miss Hoskins.
10/27/39— Dr. Yerbury.
10/30/39— Dr. Cahill.
11/13/39— Mrs. Newell.
11/20/39— Miss Hoskins.
Organization
Gloucester Mother's Club.
Wollaston Mother's Club.
Dedham Nursing Assoc.
East Boston Social Center.
Women's Club of Lynn.
Gloucester Y.M.C.A.
New Bedford Professional and
Business Women's Club.
East Boston Social Center.
Probationers of Norwood Prac-
tical Nurses.
Radio Station WCOP.
Canton Mothers' Club.
The Hadley School, Swampscott.
Salem Mothers' Club.
Radio Station WCOP.
East Boston Social Center.
Teachers of the Highland Street
School, Reading.
South Yarmouth Women's Club.
Franklin School Parent-Teacher
Assoc, Lexington.
Young People's Forum, First
Church, Everett.
Parent-Teacher Assoc, Vose
School, Milton.
Mass. State Nurses' Assoc, Dis-
trict No. 3.
North Eastern District Mental
Hygiene Advisory Committee.
Social Agencies of Brockton.
First Congregational Church,
Winchester.
Danvers State Hospital.
South Eastern District Mental
Hygiene Advisory Committee.
Central District Mental Hygiene
Advisory Committee.
Nurses' Graduation Exercises,
Danvers State Hospital.
Unitarian Parish House, Jamaica
Plain.
Norwood Women's Community
Committee.
Mothers' Club, Church of the
Holy Spirit, Mattapan.
Bristol County Teachers' Assoc,
Fall River.
Mothers' Club, Canton.
Universalist Women's Assoc,
Quincy.
Mothers' Club, Norfolk House,
Roxbury.
Subject
The Understanding Heart.
Mental Training ofthePreschool Child.
Growing Usefulness of the Habit Clinic.
Habit Training for Children — I.
The Division of Mental Hygiene and
the Use of the Habit Clinics.
Mental Illness and Its Prevention.
Mental Health and Its Relation to the
Business Woman and Her Job.
Habit Training for Children— II.
Significance of Early Training and Im-
portance of Prevention.
The Habit Clinic and Its Relation to
the Child.
How the Habit Clinic Treats the Vari-
ous Problems of Childhood.
The Development of Character and
Personality.
Mental Health.
Some of the Problems Dealt with at
the Habit Clinic.
Habit Training for Children — III.
The Work of the Reading Habit Clinic.
Growing Usefulness of the Habit
Clinics.
Significance and Importance of Early
Habit Training.
Development of Character and Per-
sonality.
Significance of Early Habit Training.
-The Value of Affiliated Nursing.
Mental Hygiene.
Functions of the Brockton Habit
Clinic.
The Growing Usefulness of the Habit
Clinic.
Mental Hygiene.
Mental Hygiene.
Mental Hygiene.
Progress in Nursing.
The Importance of Mental Health in
Childhood.
Summary of the Work Accomplished
by the Norwood Child Guidance
Clinic since 1929.
How to Develop the Best in our
Children.
Teacher-Child Relationships.
Early Habit Training
nificance.
and Its Sig"
Mental Hygiene Program of Quincy
Child Guidance Clinic.
Parent-Child Relationships.
(4) Instruction of students in the Division.
(a) At the time of the reopening of the clinics in September, a change was made in the
policy of providing speech therapy in the clinics. Previously this had been conducted
in some of the clinics by the regular staff therapist. Arrangements for affiliation with
Emerson College were completed in September, so that regular service was made avail-
able for all the clinics. Senior graduate students from this college were assigned for a
definite period of training under direct supervision of the staff speech therapist. This
74 P.D. 117
service has proved to be mutually beneficial to both the clinics and the students, as
many more children needing this service have been able to receive instruction, and the
student teachers have been able to gain invaluable experience in their chosen profession.
(b) Work in remedial reading in some of the clinics has been continued as in previous
years. Graduate students from Boston University School of Education have been
assigned as instructors under the supervision of Miss Helen Sullivan, a member of the
Boston University Staff. These students have served for a period of nine months, during
which they have been able to gain much experience. In view of the great demand for
this type of service, and the few students available, student teachers were not available
for all clinics. It is the hope of the Director that in the near future the services of a
full-time remedial teacher will be added to the personnel of the Division.
(c) Occupational therapy has proved very effective in our clinics as a standard pro-
cedure. At the beginning of the year, two students from the Boston School of Occupa-
tional Therapy were assigned to the Division for training at the Quincy and Brockton
Clinics. These students remained until their summer vacation. At the reopening of
the clinics in September, the service of only one student was available, due to the limited
number of students in the senior class. The former policy, which permitted all children
to attend the occupational therapy class, was changed so that only cases referred by the
psychiatrist have been admitted. This arrangement has been much more desirable, as
it has given the student occupational therapist more time in which to plan and carry
out the therapeutic program with the individual child. The work of these students has
been carefully followed up by a supervisor from the Boston School of Occupational
Therapy.
(d) The Simmons School of Social Work and the Boston University School of Religious
and Social Work each continued to send two students to the Division until September,
at which time the quota from each school was raised to three. This has afforded the
students an excellent opportunity to get their practical training in the psychiatric field
under the able guidance of the Chief Social Worker in the Division. Lectures, conferences
and round table discussions, in addition to the field work, have oriented them in psychi-
atric social service.
(e) The Division has always cooperated in the educational program of medical students
from Tufts College Medical School and, up until September, continued to instruct
fourth-year students at the Boston Dispensary Child Guidance Clinic. It is with a
feeling of regret that I report the school saw fit to withdraw this affiliation at the opening
of the 1939-40 session, because of the small number present in the senior class. Psychi-
atric education of the young physician has been rather inadequate in the past and, if
physicians are to have a better understanding of the emotional and psychological needs
of their patients, much more training and experience in the psychiatric field will be
necessary. ,
The first step in the standardization of training given all students under the super-
vision of the Division of Mental Hygiene was accomplished when the Director completed
his survey of the training problems. This information will be available for use of the
advisory committee on student activities which the Commissioner is planning to appoint.
The question of setting up standard minimum curricula is an important one, as it will
provide more agencies in our institutions qualified to teach.
The training of personnel for Child Guidance Clinics is still a matter of concern to
the Director. There is no training center at present for persons desiring to enter the
child guidance field. I would recommend, as I did last year, that some definite plan for
the establishment of a large training center should be carefully considered as a future
program of the Division. This center should be affiliated with some medical unit, where
adequate consulting services for children are available. By training psychiatrists, psychol-
ogists, psychiatric social workers and other personnel doing special therapies, vacancies
which arise in the child guidance field throughout the State could readily be filled by
experienced persons. This would greatly enhance the service now being given in some
of the clinics.
IV. Research Activities
A. Divisional
The research activities within the Division have been conducted during the past year
by the Consultant in Research, assisted by the research social worker.
P.D. 117 75
I. The research project ''Environmental Factors and Their Relation to Social Adjust-
ment was completed by Douglas A. Thorn, M.D., and Florence S. Johnson, M.S.S. It
was published in Mental Hygiene, Vol. XXIII, No. 3, July, 1939, pp. 379-413. This
project consisted of a study of a group of well-adjusted children. In the concluding
remarks, it was stated that "certain observations have been made on a group of children
who have succeeded in making the necessary adjustments to life. These adjustments
have resulted in happiness and efficiency, which have benefited society as well as the
individual." It was further brought out in the follow-up studies that "habits, personality
traits, and attitudes have become so much a part of the individual's personality make-up
that they are likely to persist as the individual advances in years." The children who
made up this group were not simply adjusted to a particular life situation. In the process
of growing up, in their training and experiences, they had acquired an adjustability
which is essential in meeting the varied life situations with which mankind is confronted
in his journey from the cradle to the grave. This adjustability seems to be the objectives
which all philosophies and doctrines are seeking. As there is no one road leading to
success, it seems obvious that the contribution that the child's environment makes
during the early years is of paramount importance. In this particular study, the positive
influence of a healthy environment was stressed.
II. The Study of Adoptions, which was begun last year, was completed, and the results
were published in the Journal of Pediatrics, Vol. XV, No. 2, August, 1939. In this study,
it was concluded that "the problem at the moment is not one of getting the perfect
child into the perfect home, but rather the broad, socialized problem of bringing together
the largest number of acceptable children and the largest number of acceptable homes,
with the object of increasing the sum total of the satisfactions to be derived by both
adoptive parents and the child, and with the minimum amount of risk of creating in-
compatible relationships."
III. A Follow-Up Study of the Prepsychotic Child and the Pre-Delinquent Child, which
was started last year, has been continued throughout this year. This study was prompted
by a desire to learn the subsequent adjustment of children who had manifested delin-
quent and pre-delinquent behavior rather early in life. It was felt desirable to determine
some of the underlying factors contributing to delinquency and to the cessation of delin-
quent behavior. The study is being made on a group of one hundred boys who had
shown delinquent tendencies and who had previously been known to the child guidance
clinics. Each case record has been analyzed and the facts tabulated. A follow-up visit
has been made to the home of each boy, and all the agencies to which the case has been
known have been contacted. The study has been made by dividing the cases into two
groups; the first group dealing with personality adjustments of the boys, and the second
with their adjustment as regards delinquent conduct. As the study has progressed, it
has been found that there was a close correlation between the cooperation of the parents
with the clinic and the subsequent adjustment of these cases. It has also been learned
that a close relationship existed between poor environmental conditions and the con-
tinuance of delinquent behavior.
IV. A Study of Superior Children was started during the year. A group of one hundred
children, known to the child guidance clinics ten years ago, having intelligence quotients
at that time of 130 or higher, have been included in this project. The determination of
their present intelligence ratings is being made by psychological retests. Follow-up
visits are being made with the object of learning the present emotional stability of these
children, the relation between superior children and environmental factors, and the
intellectual equipment of the parents. This study has not progressed sufficiently to
draw any conclusions.
V. The study entitled "The Frequency of Convulsions in Children and the Effect of these
Convulsions in Later Life" was completed by Doctor Arthur Berk. As yet the material
has not been published and the conclusions are not available. It is expected that this
paper will be published in one of the leading journals in the very near future.
VI. The Study of the Relationship between Conduct Disorders and the Physical Condition
of the Child was started during the year, but has been temporarily discontinued.
B. Institutional
Active research has been carried on in the several research centers, which are located
in our mental institutions and supervised by the Director of the Division. The various
76 P.D. 117
projects conducted throughout the year have been under the immediate direction of
psychiatrists, who have had long experience and interest in this type of work.
I. The Psychiatric Institute, under the direction of Doctor Myrtelle M. Canavan,
concluded a section of the work on the Waverley Researches during the Fall season.
The results of this particular project were published in a concise and comprehensive
report entitled "Waverley Researches in the Pathology of the Feeble-minded," Research
Series, Cases XXXI-XL, by Myrtelle M. Canavan, M.D., and A. E. Taft, M.D.
II. The work carried on at the Boston Psychopathic Hospital, under the direction of
Doctor Harry C. Solomon, as in previous years has dealt with various studies of the
problem of neurosyphilis and the newer therapeutic means of treatment. In his report,
Doctor Solomon has enumerated the various projects which were completed during the
year, and also those which have been started as follows :
1. The effect of autohemotherapy upon "fixed" positive blood Wassermann reactions
in patients who have had syphilis of the central nervous system, but whose spinal fluids
have become negative, was tested out in sixteen patients who were treated by twenty-
five to fifty weekly intramuscular injections of their own blood in 25cc. quantity, and
the serological responses tested for over a year. No significant benefit was evident.
2. A study of the malarial treatment of general paresis and relation of the height,
duration, and frequency of fever, and the clinic and serologic results. A paper dealing
with this subject has been published.
3. The effect of artificial fever on the sedimentation rate. It was found that mechani-
cally-induced fever had no effect upon the sedimentation rate.
4. A study of anemia and the sedimentation rate in malaria. It was found that with
an anemia resulting from malaria, there was a marked increase in the sedimentation
rate. The sedimentation rate tends to parallel the red cell count. The greater the anemia,
the more rapid the fall, but the sedimentation rate does not parallel the fibrinogen values
nor does it follow the values of plasma protein, albumin, or globulin.
5. Comparison was made of the sedimentation rate during malaria with the same
patient's blood when artificially diluted. The sedimentation rate obtained during the
anemia due to malaria is more rapid than that obtained for similar red blood cell levels
produced by dilution of the patient's blood with his own serum, indicating that the red
cell count is not the sole factor in the sedimentation rate.
6. A study of the plasma proteins in malarial therapy. In four patients who were
having malaria, a study was made of the quantity of total plasma, albumin, globulin,
and fibrinogen. It was found that there was generally a slight fall in the total plasma
protein, a fall in the albumin, and an increase, both relative and absolute, in the globulin
fractions. In one patient receiving typhoid vaccine fever, there changes were not ob-
served.
7. A survey was made of the untoward reactions due to tryparsamide as they occurred
in the clinic from 1923-1939. It is interesting to note that there have been no case of
fatal outcome from the use of the drug during this period, and in the last three years,
there has been no evidence of visual damage. However, during the same period, there
has been an increase in the number of "allgergic" reactions and jaundice.
The following is a brief summary of the work under way, in addition to the foregoing:
1. The evaluation of the effect of the various components of vitamin B complex on the
lightening pains in tabetic neurosyphilis.
2. A study of the effect of vitamin B, on optic atrophy. The drug is being given both
intravenously and into the cisterna magnum, in conjuction with other types of treatment,
to see if improvement in the usual therapeutic results might be obtained.
3. Study is being made of the effect of pressor chugs; such as, benzedrine sulphate and
ephedrine upon cases of petit mal epilepsy.
4. Reduction of body temperature. We are at the present time dealing with the
problem of reduction of temperature, and then a swing up above normal ; thus, affording
a range in temperature of some twelve to fifteen degrees, which theoretically ought to be
extremely effective in dealing with spirochetal infections, especially general paresis.
P.D. 117 77
Publications
1. Reinfection (?) in Neurosyphilis. Am. Jour. Syphilis, Gonorrhea, & Venereal
Diseases, Vol. 23, No. 1, 54-68, Jan., 1939. (Harry C. Solomon and Israel Kopp).
2. The Effect of Treatment on the Mental Level of Patients with General Paresis.
Amer. Jour. Psychiat., Vol. 95, No. 5, Mar., 1939. (Samuel H. Epstein and Harry C.
Solomon).
3. The Effect of Fever on Postural Changes in Blood Pressure and Pulse Rate. Amer.
Heart Jour., Vol. 18, No. 1, 46-56, July, 1939. (Israel Kopp).
4. The Malarial Treatment of General Paresis : Relation of the Height, Duration, and
Frequency of Fever to the Clinical and Serologic Results. Amer. Jour. Syphilis, Gonor-
rhea, & Venereal Diseases, Vol. 23, No. 5, 585-597, Sept., 1939. (Harry C. Solomon
and Israel Kopp).
5. Interstitial Keratitis in Patients with Neurosyphilis of Congenital Origin; With a
Discussion of Fever as a Precipitating Factor of Keratitis in the Paretic Variety. Amer.
Jour. Syphilis, Gonorrhea, & Venereal Diseases, Vol. 23, No. 6, 751-758, Nov., 1939.
(Harry C. Solomon and Israel Kopp).
III. The Research Division of the Boston State Hospital has continued its work during
the year under the direction of Doctor Abraham Myerson. The fields of investigation
have been arranged under eight headings and are described in the following report :
I. Human autonomic pharmacology and allied subjects. The main efforts of the
laboratory in this field have been directed to the study and development of new drugs.
1. An interesting new chemical, furfuryl trimethyl ammonium iodide, shows the
following general characteristics. It acts on the eye as a parasympathetic drug and thus
narrows the palpebral fissure, constricts the pupil, lowers the intra-ocular tension, and
probably increases the power of accommodation. It has a marked effect upon sweating,
and thus reduces the temperature of the body very effectively. It increases salivation,
lacrimation and rhinorrhea. It has little effect on blood pressure, thus differing from the
true parasympathetic drugs, such as mecholyl (acetyl-beta-methylcholine chloride). It
has only a moderate effect upon heart muscle. It increases gastrointestinal peristalsis
and genitourinary smooth muscle activity. It probably has a clinical field of usefulness
inasmuch as it can be taken by mouth. We have not as yet entered into this phase of
work. A paper on this drug, which will be the first publication to concern its human
pharmacology, is already prepared for publication.
2. Extensive clinical work is now going on in regard to the relationship between
benzedrine (amphetamine) sulfate and the barbiturates. Present clinical studies show
that the two drugs act well in correcting the excess reactions to the other drug, and
furthermore produce a total effect which is of value in the neuroses and in manic-depres-
sive psychosis.
3. One of the important pharmaceutical houses is collaborating with the Director in
an effort to develop new and better antiepileptic drugs, and also to develop the interesting
mood effects of benzedrine (amphetamine) sulfate by linking up its molecule with that
of other drugs having an effect on the mood. This work will probably be an important
phase of the next year's activity.
4. Brain metabolism — (a) An important research, which has been conclusively and
satisfactorily carried out has been on the question of the metabolism of sugar by the
brain. This study involved the use of the jugular puncture method and is the first study
of its kind. In its results, it completely contraverts certain assumptions that have been
made. It shows conclusively that after insulin the brain loses the power to use sugar and
oxygen for a much longer period of time than the muscles of the body do, thus contra-
dicting the statement that following insulin the therapeutic results observed are due to
the greater use of oxygen and sugar by the brain. As a matter of actual fact, the brain
has a reduced power to use oxygen and sugar for a considerable period of time. This
research bears quite heavily on certain phases of narcosis and stupor. This study was
carried out by Doctor Julius Loman.
(b) Certain experimental studies on metrazol were also carried out in this laboratory.
It was shown that during and following the period of stupor the brain sugar was not
diminished, thus distinguishing this type of reaction from that found in insulin shock.
Certain other important metabolic results were observed which are incorporated in a
paper soon to be published.
78 P.D. 117
II. Biochemistry of alcohol. Under the leadership of Doctor Max Rinkel a long series
of experiments were carried out to study the quantitative relationship of alcohol in the
brain, arterial and basilic bloods. These studies are still in progress. They give some
measure of the activity of the brain under alcohol and will be published in extenso later
on.
III. Neuropathological studies. Studies in neuropathology have taken interesting and
important directions during the past year. These have been largely carried out by Doctor
Leo Alexander in association with the Director.
1. An investigation of cell minerals in various types of idiocy was carried out. This
study disclosed facts of great theoretic interest and also of diagnostic importance. It
showed that the ganglion cell disease of amaurotic family idiocy was characterized by
demineralization of an extreme degree, whereas the cells in tuberous sclerosis showed
marked hypermineralization of the cytoplasm. Consequently, amaurotic family idiocy,
in respect to its ganglion cells, aligns itself with other degenerative conditions, and
tuberous clerosis with diseases of a neoplastic nature.
2. Clinical and experimental investigations of brain damage due to alcoholism and
vitamin deficiency constituted an important part of the laboratory work during the past
year. The major result of these studies was the experimental reproduction of Wernicke's
disease (hemorrhagic polio-encephalitis) in pigeons, thus lining up vitamin deficiency
with the condition found in chronic alcoholism and the associated vitamin deficiencies
in man. The vitamin deficiency or imbalance was a diet rich in vitamins A, C, D, and
Bo, but lacking completely in vitamin Bj.
3. Many other studies were carried out in collaboration with other groups, but since
they did not constitute a primary part of the activities of this laboratory, they are only
mentioned here. Thus, studies of the vascular system, the role of the cerebral vessels in
disseminated encephalomyelitis, certain of the results and pathogenesis of electrical
injury to the brain, the experimental reproduction of brain tumors, a study of the histo-
logic changes in senile dementia and related conditions were carried out by Doctor
Alexander as part of his activities as a member of other organizations.
4. The laboratory has made an interesting connection with E. I. du Pont de Nemours
and Company, Inc., who most cordially sent us samples of their newest dyes which, it is
anticipated, will give us new methods of staining the nervous and other tissues of the
body.
IV. Vitamin deficiencies: their effects on the nervous system and the blood. A
vitamin B2 deficiency state was produced in pigeons by putting them on a diet of polished
rice, at the same time giving them injections of vitamin Bt. A characteristic deficiency
state ensued, easily identified, and associated with a moderate to marked anemia and
hyperplastic changes in the bone marrow. Therapies with riboflavin, nicotinic acid, and
vitamin BB were without effect. There was a striking effect on both the clinical and
hematological aspects of the deficiency by the administration of yeast, concentrated
tablets, or dilute liver extract injections. Concentrated liver extract injections had a less
marked effect than the dilute form. Suggestive results were obtained with Elvehjem's
anti-chick dermatitis factor. These researches were carried out by Doctor William
Dameshek and Doctor Paul G. Myerson.
V. Sex hormone studies. One of the most interesting activities of the laboratory has
been the study of the sex hormones in the urine of patients of diverse types and under
experimental conditions. The results of these investigations, carried out under the
leadership of Doctor Rudolf Neustadt, may be summaried as follows, although only a
hint, rather than a complete account, can be given in an abstract of this kind.
1. It has been shown that ultraviolet irradiation of the body and especially of the
genitalia immediately and markedly increases the output of sex hormones, male and
female, in the urine.
2. Studies carried out on thyroid gland conditions show that both hyperthyroidism
and hypothyroid conditions are very definitely associated with a deficient manufacture
or secretion of sexual hormones.
3. We believe we are developing a system of identification of the sexual constitution
of the individual by the study of the urinary hormones. This is by far the most important
part of our work and suggests leads of enormous importance for future work. We believe
at the present time that we can identify the true homosexual individual by the relative
amounts of male and female hormones in his urine, and that we can also identify the
P.D. 117 79
individual of deficient sexual drive by his hormonal content. We are receiving the col-
laboration of the state hospitals of Massachusetts in doing this work and within a few
months will have material for a conclusive publication.
4. Studies are being carried out in this laboratory in respect to the relationship of
iodine, cholesterol and the sexual hormones in the urine. This work is in a- preliminary
stage.
VI. Heredity studies. — 1. At the McLean Hospital in Waverley, we have been
carrying out a series of researches on the mental diseases of distinguished families. We
have selected very important American families, some of whose members have been
patients at the McLean Hospital, and we have attempted to build up a family tree which
will indicate the amount of mental disease in these families. The point of the research is
fundamentally this: The liabilities of mental disease have been sufficiently pointed out
but only very sporadic attempts have been made to show that there may be some degree
of asset value present. In other words, a certain amount of, or certain types of, mental
disease may occur in gifted individuals in disproportionate amount. This has been
pointed out in connection with manic-depressive psychoses by several workers. Our
researches indicate the following : That if the present sterilization laws of Germany and
of certain states of the United States, notably California had been carried out in the
early part of the nineteenth century, the most distinguished philosopher and the most
distinguished psychologist of America would not have been born. Moreover, very im-
portant individuals who have played a great role in the development of New England
had enough mental disease in their immediate ancestors and in their collaterals to brand
them, under the laws of some states and countries, as inferior individuals who should
have been sterilized. In other words, the question is raised, whether or not in bringing
up the matter of sterilization and mental disease, the nature of the particular and individ-
ual family group should not be taken into account, since mental disease, especially manic-
depressive psychosis, may be episodic in the history of a life which, on the whole, is
highly meritorious and socially valuable.
2. A research is also being carried out on a statistical basis to see whether or not the
families of dementia praecox patients have a low marriage and birth rate. It has been
shown quite conclusively that dementia praecox acts as a barrier to marriage. The
question which we raise is whether or not the collaterals and siblings of such individuals
also have a low marriage and birth rate, since it is from them that the constitutionally
disabled stock comes.
This work has been carried out under the auspices of the American Neurological
Association by a grant from the Carnegie Corporation. Mrs. Rosalie Boyle has acted as
field worker, Miss Mollie S. Levin as secretary, and Doctors Tillotson and Chittick
have generously collaborated.
VII. The "total push" method in the treatment of chronic schizophrenia. As Chair-
man of the Committee on Research for the State Department of Mental Health, the
Director has carried out in collaboration with various other hospitals of the State and
especially the McLean Hospital, researches on the treatment of schizophrenia by the
total push method. This was described in last year's report, and needs no amplification
nor description here.
It has been definitely shown that even the deteriorated and chronic schizophrenics
may be greatly improved in conduct, working ability, and general social contact by the
total push method, which perhaps had better be described as an "increased activation
method", since the technique is not that of "push" necessarily, nor is it by any stretch
of the imagination "total." The results at the McLean Hospital have been very satis-
factory. Patients who have been out of activity and exceedingly difficult to manage
for twenty years have improved greatly in conduct, work ability and social contact.
Patients of lesser periods of disease have also done well, although no patient has been
cured by the method. Utilization of the method at the McLean Hospital on acute
cases has given very promising results, especially in the type of case which shows merely
a passive retreat rather than a very active, hostile social attitude.
At the State hospitals where there are lesser facilities, the results have been more
difficult to obtain, yet in several institutions marked improvement in the condition of
the patients has been noted.
80 p.D. 117
The projected program is to carry on this research for a year, during which time
enough facts will have been gathered to lead to a further orientation of the problem
and a more developed approach.
VIII. Organization activities. 1. By virtue of the fact that the Director is chairman
of the State Research Committee, a lineup with other hospitals has taken place in re-
search activity. Thus, a very interesting research on the treatment of epilepsy has been
carried out for three years at the Grafton State Hospital, the active worker in this insti-
tution being Doctor Benjamin Cohen. Certain drugs have been selected for experi-
mental use and we have shown the following: (a) Large doses of phenobarbital effectively
reduce the incidence of major epileptic attacks. When toxic symptoms occur, they can
be corrected by the judicious use of benzedrine (amphetamine) sulfate, (b) The com-
bination of phenobarbital and dilantin greatly enhances the value of either drug in the
treatment of severe epilepsy. The attacks have been reduced SO and more per cent,
and in many instances the patients have been free of attacks indefinitely, (c) Mebaral
is a very useful non-toxic drug in the treatment of major and minor epileptic attacks.
So far as our researches go, it is equal to either dilantin or phenobarbital.
2. The Director is a member of the Research Council for the Study of Alcoholism
for the American Association for the Advancement of Science, and as such is collaborat-
ing on the study of alcoholism throughout the United States.
3. The Director has just been appointed consultant in research on drug addiction to
the government hospital in Louisville, Kentucky.
Achnowledgments are made to the Commonwealth of Massachusetts, the Rockefeller
Foundation, the Child Neurology Research (Friedsam Foundation), the Charlton Fund
(Tufts College Medical School), the Carnegie Corporation of New York, the Emergency
Committee for the Displacement of Foreign Medical Scientists, the Works Progress
Administration Project No. 18088, and to the following pharmaceutical houses: Smith,
Kline and French Laboratories; Winthrop Chemical Company; Sharp and Dohme;
Merck and Company, and Hoffmann-La Roche.
Papers Published
1. Summary of the Report of the American Neurological Association Committee
for the Investigation of Sterilization. Amer. Jour. Medical Jurisprudence 1: 253-257
(Dec.) 1938. (A. Myerson).
2. Beri-beri and Scurvy. An experimental study. Trans. Amer. Neurol. Assoc,
The William Byrd Press, Richmond, Va., 64: 135-139, 1938. (L. Alexander, A. Myerson,
M. Pijoan).
3. Photo-colorimetric method for the determination of androsterones in urine. Endo-
crinology 23: 711-717 (Dec.) 1938. (R. Neustadt).
4. Human Autonomic Pharmacology. XVII. The effect of acetyl-beta-methylcholine
chloride on the gallbladder. Amer. Jour. Digest, Dis. 5: 687-690 (Dec.) 1938. (P. G.
Schube, A. Myerson, R. Lambert).
5. The Relation of the Autonomic Nervous System to Pharmacology. Jour. Conn.
State Med. Soc. 3: 19-21 (Jan.) 1939. (A. Myerson).
6. The Effect of Benzedrine, Benzedrine and Atropine, and Atropine on the Gall
Bladder. Amer. Jour. Med. Sci. 197: 57-61 (Jan.) 1939. (P. G. Schube, A. Myerson,
R. Lambert).
7. Human Autonomic Pharmacology. XV. The Effect of Acetyl-beta-methylcholine
Chloride (mecholyl) by Iontophoresis on Arterial Hypertension. Annals Int. Med. 12:
1213-1222 (Feb.) 1939. (J. Loman, M. F. Lesses, A. Myerson).
8. Comparative Effects of Amphetamine Sulfate (benzedrine sulfate), Paredrine and
Propadrine on the Blood Pressure. Amer. Heart Jour. 18: 89-93 (July) 1939. (J. Loman,
M. Rinkel, A. Myerson).
9. The Reciprocal Pharmacologic Effects of Amphetamine (benzedrine) Sulfate and
the Barbiturates. New Eng. Jour. Med. 221: 561-563 (Oct. 12) 1939. (A. Myerson).
10. Benzedrine Sulphate — An Antidote for the Untoward Hypnotic and Ataxic
Effects of Phenobarbital in the Treatment of Epilepsy. In "Symposium on Therapy";
Bull. Mass. Dept. of Mental Health, (Sept.) 1939. (B. Cohen, A. Myerson).
11. Theory and Principles of the "Total Push" Method in the Treatment of Chronic
Schizophrenia. Amer. Jour. Psychiat. 95: 1197-1204 (March) 1939. (A. Myerson).
12. Influence of Ultraviolet Irradiation upon Excretion of Sex Hormones in the Male.
Endocrinology 25: 7-12 (July) 1939. (A. Myerson, R. Neustadt).
P.D. 117 81
13. The Reaction of the Cerebral Vessels to Intracarotid Injection of Horse Serum in
Sensitized and Non-sensitized Guinea Pigs. Confinia Neurologica 2: 215-219, 1939.
(A. Buermann, L. Alexander).
14. Cell Minerals in Amaurotic Idiocy, Tuberus Sclerosis and Related Conditions,
Studied by Microincineration and Spectroscopy. Examples of degenerative and of
neoplastic cell disease. Amer. Jour. Psychiat. 96: 77-85 (July) 1939. (L. Alexander,
A. Myerson).
15. The Relationship of Hereditary Factors to Mental Processes. Research Pub.
Assoc. Res. in Nerv. & Ment. Dis. 19: 16-49 (Sept.) 1939. (A. Myerson).
16. Sources of Mental Disease: Their Amelioration and Prevention. Summary and
Critique. Pub. No. 9, 120-136 Amer. Assoc, for the Advance of Sci., 1939. (A. Myerson).
17. Alcoholism and Mental Disease. Pub. No. 9, 83-90, Amer. Assoc, for the Advance
of Sci., 1939. (L. Alexander).
Papers in Press
1. Topographic and Histologic Identity of the Experimental (avitaminotic) Wernicke
Lesions with Those Occurring in Hemorrhagic Polioencephalitis in Chronic Alcoholism
in Man. Amer. Jour. Pathol. (L. Alexander).
2. The Rationale of Amphetamine (Benzedrine) Sulfate Therapy. Amer. Jour. Med.
Sci. (A. Myerson).
3. The Effect of Amphetamine Sulfate (benzedrine sulfate) and Paredrine Hydro-
bromide upon Sodium Amytal Narcosis. New Eng. Jour. Med. (A. Myerson, J. Loman,
M. Rinkel, M. F. Lesses).
4. The Synergism of Phenobarbital, Dilantin and Other Drugs in the Treatment of
Institutional Epilepsy. Jour. Amer. Med. Assoc. (B. Cohen, N. Showstack, A. Myerson)
5. Changes in Oxygen, Carbon Dioxide and Sugar Content in the Arterial and Internal
Jugular Blood during Metrazol Convulsions. Arch. Neurol. & Psychiat. (J. Loman,
M. Rinkel, A. Myerson).
6. The Attitudes of Neurologists, Psychiatrists, and Psychologists towards Psycho-
analysis. Amer. Jour. Psychiat. (A. Myerson).
7. Total Push Method. III. Schema for the Recording of Certain Important Atti-
tudes in Chronic Schizophrenia. Amer. Jour. Psychiat. (A. Myerson).
8. The Social Psychology of Alcoholism. Diseases of the Nervous System. (A. Myer-
son).
9. A Distinctive Vitamin B Deficiency State in Pigeons. Amer. Jour. Med. Sci.
(W. Dameshek, P. G. Myerson).
10. Errors and Problems in Psychiatry. Mental Hygiene. (A. Myerson).
Papers Read
1. A Group of Neurological Conditions of Interest to the General Practitioner: Elec-
trical Injuries, Eastern Equine Encephalitis, Brain Diseases Due to Chronic Alcoholism.
(Read by L. Alexander before the North Shore Medical Society, Dec. 8, 1938).
2. Human Autonomic Pharmacology. (Read by A. Myerson before the St. Lukes
Guild at Boston State Hospital, Dec. 14, 1938).
3. The Total Push Method in the Treatment of Schizophrenia. (Read by A. Myerson
before the Boston Society of Psychiatry and Neurology, Dec. 15, 1938).
4. Problems of Vitamin Deficiency and the Nervous System. (Read by A. Myerson
before the Hartford City Medical Society, Dec. 19, 1938).
5. Electrical Injuries. (Read by L. Alexander before the Utilities Accident Prevention
Committee of New England, Dec. 20, 1938).
6. Sources of Mental Disease: Their Amelioration and Prevention. (Read by A.
Myerson before the American Association for the Advancement of Science, Richmond,
Va., Dec. 28, 1938).
7. The Relationship of Heredity Factors to Mental Processes. (Read by A. Myerson
before the Association for Research in Nervous and Mental Disease, New York City,
Dec. 27, 1938).
8. The Neuropathology of Alcoholism. (Read by L. Alexander before the Boston
Society of Psychiatry and Neurology, Jan. 19, 1939).
9. Brain Waves. (Read by J. Loman before the Phi Lambda Kappa Medical Fra-
ternity, Jan. 20, 1939).
82 P.D. 117
10. Theory and Practice of the Total Push Method in the Treatment of Chronic
Schizophrenia. (Read by A. Myerson and K. Tillotson before the Massachusetts Psychi-
atric Society, Jan. 27, 1939).
11. Clinical Syndromes in Neurology. (Read by J. Loman before the Attleboro
Medical Society, Feb. 3, 1939).
12. Physiotherapeutics and Motivation in the Treatment of Chronic Schizophrenia.
(Read by A. Myerson before the New England Society of Physical Medicine, Mar. 15,
1939).
13. Human Autonomic Pharmacology. (Read by J. Loman before the Sir William
Osier Honor Society of the Middlesex University School of Medicine, Apr. 26, 1939).
14. The Total Push Method of Treatment of Chronic Schizophrenia. (Read by A.
Myerson and K. J. Tillotson before the American Psychiatric Association, Chicago, 111.,
May 12, 1939).
15. The Neuroses. (Read by A. Myerson before the Central Association of Public
Health Nurses, Grafton State Hospital, May 26, 1939).
. 16. The Total Push Method in the Treatment of Chronic Schizophrenia (with demon-
stration). (Read by A. Myerson before staff members of the various state hospitals of
Massachusetts at the McLean Hospital, May 26, 1939).
17. Cell Minerals in Amaurotic Idiocy, Tuberous Sclerosis and Related Conditions,
Studied by Microincineration and Spectroscopy. (Read by L. Alexander and A. Myerson
before the American Association on Mental Deficiency, Chicago, Illinois, May 3, 1939).
18. Exhibit: Mineral Studies of the Brain by Means of Microincineration and Spectro-
scopy: Exhibit of Apparatus Used; Photomicrographs of Normal and Pathologic Brain
Tissue; Reproduction of Spectroscopic Graphs. (By L. Alexander and A. Myerson at the
American Medical Association, St. Louis, Missouri, May 15-19, 1939).
19. The Social Psychology of Alcoholism. (Read by A. Myerson before the American
Psychopathological Association, Atlantic City, N. J., June 5, 1939).
20. The Synergism of Phenobarbital, Dilantin and Other Drugs in the Treatment of
Institutional Epilepsy. (Read by B. Cohen, N. Showstack and A. Myerson before the
American Psychopathological Association, Atlantic City, N. J., June 5, 1939).
21. Neuropathological Aspects of Alcoholism. (Read by L. Alexander before the
American Psychopathological Association, Atlantic City, N. J., June 5, 1939).
22. Topographic and Histologic Identity of the Experimental (avitaminotic) Wernicke
Lesions with Those Occurring in Hemorrhagic Polioencephalitis in Chronic Alcoholism
in Man. (Read by L. Alexander before the American Association of Neuropathologists,
Atlantic City, N. J., June 5, 1939).
23. Intracranial Dynamics. (Read by J. Loman before the American Psychopatho-
logical Association, Atlantic City, N. J., June 5, 1939).
24. The Legal Side of Medicine, or The Doctor in Court. (Read by A. Myerson before
the Boston City Hospital House Officers' Association, June 28, 1939).
25. Human Autonomic Pharmacology (with exhibit). (Read by A. Myerson before
the Third International Neurological Congress, Copenhagen, Denmark, August 21-25,
1939).
26. Beri-beri and Wernicke's Hemorrhagic Polioencephalitis. An experimental study.
(Read by L. Alexander before the Third International Neurological Congress, Copen-
hagen, Denmark, August 25, 1939).
27. Heredity and Environment in Relationship to Intelligence, Personality and Mental
Disease. (Read by A. Myerson before the Boston Dispensary Staff, October 20, 1939).
28. Clinical Review of the Disorders of Motion. (Read by A. Myerson before the
Jewish Memorial Hospital, October 31, 1939).
29. The Theories and Facts of the Inheritance of Mental Disease, and the Value of
Sterilization. (Read by A. Myerson before the New York Academy of Medicine, New
York City, November 30, 1939).
30. Alcoholism and Mental Disease. (Read by L. Alexander before the American
Association for the Advancement of Science, Richmond, Va., December 28, 1938).
IV. The chief research projects carried on during the year at the Monson State Hospital
by Doctor Leon J. Robinson and Doctor Rudolph Osgood, under the direction of Doctor
Morgan R. Hodgskins, Superintendent, were directed along two distinct lines.
1. The comparative effects of phenobarbital and dilantin in the treatment of epilepsy.
2. Electroencephalographic studies of epileptic patients.
P.D. 117 83
Preliminary reports of observations in the above projects have been made informally
from time to time, but the work will be carried over to the next year before summaries
of results are published.
Several papers have been prepared and published during the year ending November
30, 1939.
1. Brilliant Vital Red as an Anti-Convulsant in the Treatment of Epilepsy. Arch.
Neurol, and Psychiat. 40: 1178-1204, Dec, 1938. (R. Osgood, L. J. Robinson).
2. Venous Blood Pressure Measurements During Syncope Caused by a Hyperirritable
Carotid Sinus Reflex. Amer. Jour. Med. Sci. 197: 100-102, Jan., 1939. (L. J. Robinson).
3. Syncope, Convulsions and the Unconscious State. Relation to the Hyperactive
Carotid Sinus Reflex. Arch. Neurol, and Psychiat. 41: 290-297, Feb., 1939. (L. J.
Robinson) .
4. Radiologic Gastrointestinal Studies in Epilepsy. Amer. Jour. Psychiat. 95: 1095-
1102, Mar., 1939. (L. J. Robinson).
5. Induction of Seizures by Closing of the Eyes, or by Ocular Pressure in a Patient
with Epilepsy. Jour. Nerv. and Ment. Dis. 90: 333-336, Sept., 1939. (L. J. Robinson).
V. Dementia Praecox (schizophrenia) has continued to be the chief matter of investi-
gation of the Research Department of the Worcester State Hospital. A report of the
activities of this Department is herewith submitted by Doctor Andras Angyal, Resident
Director, for the year ending November 30, 1939.
The Research Department has, as in previous years, been subsidized by the Division
of Mental Hygiene of the Massachusetts Department of Mental Health, the Worcester
State Hospital, the Memorial Foundation for Neuro-Endocrine Research, and the Rocke-
feller Foundation. In addition, the Armour Company has contributed a special stipend
to be used for study of the biochemistry of hormones.
Doctor R. G. Hoskins has continued as Director of the Research Department. During
the year, several changes in personnel have taken place. Mr. E. M. Jellinek, Chief
Statistician, Doctor Louis H. Cohen, Senior Psychiatrist, and Doctor Bela Lengyel,
Statistician, left the Worcester State Hospital to assume positions elsewhere. Doctor
O. Kant, Senior Psychiatrist, Doctor N. Blackman, Assistant Physician, and Doctor
Allan Mather, Endocrinologist, joined our staff.
A considerable part of the activity of the Research Service during the last year was
devoted to the study of the effects of sex hormones in schizophrenia. This work is being
carried out under the direct supervision of Doctor R. G. Hoskins, and all departments are
contributing their share to this study. The endocrine preparation on which most work
has been done during this year is Testosterone Propionate. The schedule consists of
three six-week periods, one before, one during, and one following medication. The
program includes the study of the following biochemical and physiological items: sex
hormone assays on 24-hour-amount urine samples; basal oxygen consumption rate;
glucose tolerance, uric acid and adrenalin determination in the blood; blood lipids;
hematocrit determination; blood morphology; basal blood pressure and pulse; and tests
for autonomic reactivity with nicotine, adrenalin, and cyanide. Continued observations
on the behavior and mental status of the patients are recorded by the psychiatrists, and
also a standardized rating is filed weekly by the psychiatrists. The battery of psycho-
logical tests used with the patients on the Testosterone Study includes the Army Alpha,
Thematic Apperception, Attitude-Interest, Play Procedure, Drawing, Aspiration, Social
Situation, and a special association test containing sex-loaded words. The effect of the
latter is studied by means of the galvanic skin response, as well as the actual associations.
In suitably cooperative patients, electroencephalograms are obtained by Doctor Rubin.
The biochemical studies, which form the greater part of this program, are reported in
connection with the work of the biochemical laboratory.
Hormonal preparations other than Testosterone Propionate, the effects of which on
schizophrenic patients are being studied, include various pituitary preparations, pregnant
mare serum extract, and Stilboestrol.
Another group study which has been carried out is that in connection with the insulin
and metrazol treatments. The purpose of the study is to discover prognostic and differ-
ential therapeutic indicators which would allow the prediction of the type of patient most
likely to respond favorably to insulin or metrazol treatment respectively. A further
aim of this study is to utilize the therapeutic responsiveness as one of the means of divid-
ing the schizophrenic group into more meaningful sub-groups than the conventional
84 P.D. 117
sub-type classification. Each patient is subjected to two weeks' intensive study before
and after medication. The clinical observations on the insulin cases are made by Doctor
C. Wall, and on the metrazol cases by Doctor B. Simon. The program includes studies
of the following biochemical and physiological variables: blood minerals and choline
esterase, hematocrit and blood lipids, blood morphology, blood circulation time, daily
basal pulse rate, and tests with intravenous adrenalin. The main items of the psycho-
logical test battery in this study are the Stanford-Binet, K-R Association Test, Aspira-
tion and Play Procedure.
Another cooperative study under the direct supervision of Doctor Hoskins was under-
taken in order to determine how far an ameliorative therapeutic program may be worked
out for old schizophrenic patients. Twelve patients around sixty years of age are the
subjects of this study. The schedule includes a metabolic check-up of two weeks' dura-
tion, followed by a six-week period of treatment with such therapeutic agents as are
indicated in the results of the tests. After the six-week medication period, another
metabolic recheck is done, after which the therapeutic plans are reconsidered. It is
planned that the duration of study in each case should be about a year, consisting of
alternate six-week treatment and two-week test periods. Psychiatric observations and
weekly behavior ratings are made by members of the psychiatric department. The
psychological examinations consist mainly of tests on memory and deterioration.
Besides the aforementioned collective studies, a number of individual investigations
have also been carried out by the various members of the research staff. Doctor Andreas
Angyal, in collaboration with Doctor Blackman, has studied the nystagmic response to
rotatory and caloric stimulation of the vestibular organ in 58 schizophrenic and 20 normal
persons. The variables studied were absolute number and average frequency of ny-
stagmic beats
(Number of nystagmic beats)
(Total duration of reaction).
In response to rotatory stimulation, they found a 21% reduction of the absolute, and a
26.2% reduction of the nystagmic frequency in the patients as compared with normal
controls. In response to caloric stimulation, the schizophrenics showed a 38.8% reduction
of nystagmic frequency, and a 48.3% reduction of absolute number of nystagmic beats.
Besides the general reduction of vestibular reactivity, a small group with particularly
low responsiveness has been detected. It is noteworthy that all the patients who have
the clinical syndrome previously described by Doctor Angyal belong to this very low
group.
In previous years in a number of studies from our Research Service, a distinct reduction
of responsiveness to various physiological stimuli has been observed. Doctor Angyal,
in collaboration with Doctor Freeman and Doctor Hoskins, made a theoretical evaluation
of this fact, connecting these physiological features with the clinical symptoms of with-
drawal.
Doctor Conrad Wall continued his follow-up studies on the adjustment of patients
who recovered following insulin treatment and who were discharged from the hospital.
Preliminary evaluation of the data gives promise that this work will be particularly
informative as to the permanency of insulin recovery. Doctor Wall, in collaboration
with Doctor Hoskins, studied the effects of Testosterone in a homosexual individual with
acute psychotic episodes. The effects of the Testosterone were best revealed in the
patient's phantasies which, concomitantly with the medication periods, turned in a more
or less obviously heterosexual direction. Doctor Wall also studied the therapeutic effects
of Diethylstilboestrol in 8 female patients suffering from involutional melancholia.
In the majority of cases, a more or less marked improvement in mental and physical
condition was noted, and the results seem encouraging for the continuance of this experi-
ment.
Doctor Otto Kant carried out an intensive catamnestic study on a large group of
schizophrenic patients who have recovered and who have been living outside of the
hospital for at least the last five years. Two hundred fifty such cases were contacted by
letter, and Doctor Kant succeeded in examining personally about one hundred of these
patients, in addition to collecting the information which could be obtained from the
patients' relatives, friends, and from various social agencies. The material has not been
finally evaluated as yet, but various significant conclusions can already be made. It
appears that a schizophrenic heredity definitely decreases the chance for recovery, while
P.D. 117 85
a manic-depressive heredity increases it. Extroverted prepsychotic personality and
psychogenic precipitating factors are favorable for the prognosis. Simple, hebephrenic,
and paranoid types of schizophrenia are associated with an extremely poor prognosis.
Doctor Kant also completed a study on the problem of differential diagnosis in schizo-
phrenia. The significance of the various schizophrenic symptoms is discussed in the light
of Doctor Kant's theory of stratafication of personality structure.
Doctor Nathan Blackman made an interesting experiment in group therapy with
schizophrenic patients. As a result of this, a literary club has been organized by the
patients themselves, partially through their own initiative and partially through Doctor
Blackman's encouragement. The group edits a monthly publication, "The Current,"
of which to date four issues have appeared, and several hundred copies of each issue
have been sold by the patients. This method of occupational therapy, which lays par-
ticular emphasis on fostering the patients' initiative, is definitely useful in the process
of socialization.
Doctor Blackman is also studying the capillaries of the nail-bed in schizophrenic
patients and normal controls. The morphology of the capillaries as well as the rate of
flow of blood are being observed. The results are not conclusive as yet, but in some
cases in the patients quite marked abnormalities have been observed.
Doctor Harry Freeman has been studying the respiratory sensitivity to varying
percentages of C02 (2% to 6%) to determine whether this function is altered in schizo-
phrenia. Ten normal and ten schizophrenia subjects were tested. The factors investi-
gated were respiratory rate, respiratory volume, heart rate, and skin temperature.
Contrary to the findings of Golla, Doctor Freeman's data on preliminary analysis seem
to indicate no difference between patients and normals.
Doctor Freeman, in another study in collaboration with Doctor Neustatter, aimed
to remove the metrazol-produced fear reactions by preliminary induction of anesthesia
with cyclopropane and nitrous oxide. The anesthetic agent completely removed fear
of the treatment in the 5 patients so treated and did not seem to affect adversely the
convulsive threshold.
Doctor Morton A. Rubin has been working on an encephalography method of detec-
tion of cortical atrophy. The results obtained with this method are in fair agreement
with the findings obtained by pneumoencephalography and thus this method, if per-
fected, may prove to be of considerable practical value. Doctor Rubin, in collaboration
with Doctor Freeman, studied the effects of intravenously administered sodium cyanide
on the brain wave pattern in a case of catatonic stupor and in a patient with narcolepsy.
In these cases, slow rhythms were found. This was attributed to depressed cortical
activity presumably present in this type of patient. Consequently an attempt was made
to produce such a cortical state experimentally. Anesthesia is shown to depress cortical
function and to produce slow-wave activity. Cyclopropane was chosen for the anesthetic,
since it has a rapid induction period and recovery from its effects is also rapid. Sodium
cyanide was given to seven schizophrenic patients during light cyclopropane anesthesia,
expecting to obtain the same regular, slow rhythms as in the stuporous catatonic and the
narcoleptic under the influence of cyanide alone. In most experiments, the cyanide
was without effect. In those cases, however, in which it was possible to evoke a cortical
response to sodium cyanide during anesthesia there was, contrary to expectations, an
increase in the number of fast waves. These findings would indicate that slow rhythms
do not necessarily imply depressed cerebral activity, but that the slow rhythm is a
product of various factors at present not understood.
Working with the hypothesis that certain disturbances of affectivLty in schizophrenia
might be related to dysfunction of the hypothalamus, Doctor Rubin, following the
suggestion of Doctor Hoskins and in collaboration with Professor John Fulton of Yale,
has undertaken a study of the effects of surgically produced lesions of the hypothalamus
in monkeys. These animals with bilaterally placed lesions of the anterior hypothalamus
exhibited marked behavioral changes. They became "shy" and much easier to handle
after operation, and once caught they made no attempt to escape. In one of three
monkeys a clearcut adiposito-genital syndrome developed. In another animal, marked
atrophy of the ovaries and adrenals was found on autopsy. The third animal had lesions
in the posterior Itypothalamus, and, in contrast with the other two monkeys, showed no
atrophy of the gonads. Electroenphalographic tracings obtained- from these monkeys
before and after operation are still in the process of analysis.
86 P.D. 117
On the basis of reports from the Armour Company of a hypothalamic extract which
produced a state similar to catatonia in rats, at the suggestion of Doctor Hoskins, Doctor
Rubin undertook to investigate the experimental potentialities of such an extract. So
far, however, the tests have been confused by the action of the preservative that was
used in the extract, hence no evaluation is possible.
During the year, the biochemical laboratory, under the direction of Doctor Joseph
M. Looney, has collaborated on the sex hormone study, the insulin-metrazol study, and
in the study on old schizophrenic patients. Various chemical methods were tried for the
estimation of estrogens but none of these were found to be sensitive enough to be used
on the small amounts occurring in male urine. The method of chemical estimation has,
therefore, been held in abeyance and the method of assay using spayed mice is being
utilized. The use of the photoelectric colorimeter has been compared with the Oesting
technique and this method has been adapted for use. For large concentrations, it is
more accurate than the Oesting method but it will not serve for very small amounts.
Doctor Looney has also modified slightly the Oesting procedure so that it gives some-
what better results.
Miss Howe has been determining the androgen output of schizophrenic patients and
normal control subjects before and after giving Testosterone. The results so far indicate
a marked difference between patients and controls, the former not increasing their
androgen output after medication while the latter do.
Doctor Mather has taken up the work of utilizing the photoelectric colorimeter for
androgen assays, and also is continuing the study of better methods of extraction. This
investigation promises to be a valuable contribution to the sex-hormone field and to
offer a basis of more certain methods for separating the various hormones. He is also
making estimations of the estrogen output in the two groups, using the spayed mouse
as the test object.
Doctor Randall has carried on a number of investigations of changes in body lipids
under various experimental conditions. The results of these studies indicate that the
lipid metabolism may be significantly related to the schizophrenic process. There is an
increase in all lipid fractions except free cholesterol in patients when they are treated
with insulin or metrazol. Further, these levels are maintained in the recovered patients,
but not in the non-recovered group. In the Testosterone-treated patients, there is also
an increase in the lipid fractions. Doctor Randall has also studied the changes in fat
distribution on prolonged treatment with insulin, using rabbits for this experiment.
A similar study of the organs of pituitary-treated and pregnant rabbits has been com-
pleted in collaboration with Doctor Graubard of Clark University.
Miss Small has carried on investigations on the effect of Testosterone on the organ
weights of immature male and female rats. The uterine weight changes give a good
means of assay. A comparison with Oesting color units was not successful. Apparently,
the action of the color component is not the same as that of Testosterone. A further
study is contemplated, therefore, of the effect of Androsterone rather than Testosterone.
In connection with the general problem of vigor, she has also carried out an investigation
of the effects of Stilboestrol on the activity of rats. A significant increase in activity
was found during the period of injection.
Doctor Looney has devised a new method for the determination of serum albumin
and serum globulin which has greatly simplified the methods of analyses now used,
increased their accuracy, and cut the time required for an analysis from four or five hours
to about ten minutes. The method makes use of the photoelectric colorimeter to measure
the turbidity produced when a protein precipitant is added to serum. A protective
colloid is added which holds the precipitate in colloidal suspension and gives a stable
opalescent solution well adapted to measurement by the photoelectric cell. The total
protein is measured by precipitating all the proteins with sulfosalycylic acid and the
globulin estimated separated by precipitation with one-half saturation with ammonium
sulfate.
Miss Walsh studied the comparative efficiency of the old and new methods for the
determination of albumin and globulin. She has also made all analyses dealing with
lactic acid, blood sugar, uric acid, and glucose tolerance tests in connection with the
therapeutic studies.
Miss Dyer has been carrying out the determination on blood gases, and the deter-
minations of total nitrogen, creatine and cretinine on the patients on Testosterone medi-
cation. She has also modified the method for the determination of magnesium so that it
P.D. 117 87
can be carried out using the photoelectric colorimeter. Using this method, she is investi-
gating the magnesium metabolism of normal and schizophrenic subjects.
Mr. Romanoff has been carrying out estimations of choline esterase, which doubtfully
suggest that Testosterone causes some increase in the choline-esterase content of the
blood of patients under treatment but not in the normal subjects. He has also been
studying the effect of Testosterone on the tissue respiration of rat organs.
The Psychology Department, under the direction of Mr. David Shakow, has invested
a considerable amount of work in the devising, standardizing, and validating of psycho-
logical tests in an attempt to increase and improve our psychological tools for further
studies in schizophrenia. Three studies in the use and validity of the Thematic Apper-
ception Test with psychotic subjects were completed, two by Doctor Harrison and one
by Mr. Rotter. Doctor Harrison investigated the general clinical usefulness and validity
of the tests and reports the use of a semi-objective method of analysis which determined
attitudes and conflicts, as well as prevailing characteristics with a fairly high degree of
validity. The second and third studies — attempts at quantitative validations against
case history material and by the method of "blind analysis" — corroborated the findings
of the first study in a more quantitative way.
Mr. Snyder reorganized the items in the imagery test previously used by Doctor
Cohen, and examined 30 additional schizophrenics and 15 normals. The results of the
previous study are not corroborated, and it is now felt that this device is not a valid
diagnostic measure. It appears rather to measure the degree of confusion of the asso-
ciative processes, and the patients' ability to concentrate.
Doctor Rodnick is attempting to determine whether metrazol has a greater disrupting
effect upon a more recently acquired habit system than on an incompatible older habit
system. Qn the basis of 14 metrazol and 5 control subjects thus far obtained, the results
indicate a greater effect of metrazol on the more recently acquired habit system.
Doctor Rosenzweig, in collaboration with Doctor Hoskins, studied personality changes
concomitant with sex hormone medication in a selected case of schizophrenia. He is
also experimenting with a device (Photoscope) which exposes pictures of varying degrees
of sexual content. An experimental program has been organized from which it is hoped
to be able to evaluate this device for measuring changes in sexual interest and the effec-
tiveness of sex hormone medication.
Doctor Rodnick and Mr. Rotter have completed a preliminary study of 8 normal
subjects on the reactions to an experimentally induced frustrating situation. The re-
actions to the situation were studied by means of the responses to the Thematic Apper-
ception Test after success and failure. The results thus far indicate an increase in aggres-
sion after failure. It is now planned by Doctor Rodnick to continue the study with a
group of schizophrenics.
Mr. Shakow, in collaboration with various members of the Psychology Department,
is working on a comprehensive program on deterioration which will consider, besides
current material, the material collected over a period of ten years or so on the same
patients. With respect to intellectual functioning, the various psychometric data and the
various studies of the thinking process (Ach-Sacharov, Wegrocki Tests, etc.) are being
used. With respect to emotional and motivational deterioration, the work on aspiration,
frustration, and the various Lewin studies are being used.
All the analyses for such studies as required statistical treatment have been carried
out by the statistical office, which is at present under the direction of Mrs. Hazel Stone.
The following articles were published during the year from the Research Service:
1. Histologic Changes in Senile Dementia and Related Conditions Studied by Silver
Impregnation and Microincineration. Arch. Neurol. & Psychiat. Jfi: 1075, Dec, 1938.
(L. Alexander and J. M. Looney).
2. The Significance of Frustration as a Problem of Research. Character & Personality
7: 120, Dec, 1938. (S. Rosenzweig).
3. General Outline of Frustration. Character & Personality 7: 151, Dec, 1938. (S.
Rosenzweig) .
4. The Function of Biometric Methodology in Psychiatric Research. Amer. Assoc.
Adv. Sci., Mental Health, 9: 48, 1939. (E. M. Jellinek).
5. The Structure of Wholes. Phil, of Sc 6: 25, Jan., 1939. (Andras Angyal).
6. The Effects of High Humidity on Skin Temperature at Cool and Warm Conditions.
Jour. Nutrition 17: 43, Jan., 1939. (H. Freeman and B. A. Lengyel).
88 P.D. 117
7. Function of the Psychologist in the State Hospital. Jour. Con. Psychol. 8: 20,
Jan., 1939. (D. Shakow).
8. Electroencephalographic Localization of Atrophy in the Cerebral Cortex of Man.
Proc. Soc. Exper. Biol. & Med. 40: 153, Feb., 1939. (M. A. Rubin).
9. Brain Wave Frequencies and Cellular Metabolism. Effects of Dinitrophenol.
Jour. Neurophysiol. 2: 170, Mar., 1939. (H. Hoagland, M. A. Rubin, D. E. Cameron).
10. The Return of Cognitive Conscious Functions after Convulsions Induced with
Metrazol. Arch. Neurol. & Psychiat. 41: 4S9, Mar., 1939. (L. H. Cohen).
11. Effects of Vitamin Bi in Schizophrenia. Amer. Jour. Psychiat. 95: 1035, Mar.,
1939. (L. S. Chase).
12. A Critique of Cultural and Statistical Concepts of Abnormality. Jour. Abnorm.
& Social Psychol. 34: 166, Apr., 1939. (H. J. Wegrocki).
13. Thought Disturbances in Schizophrenia as Revealed by Performance in a Picture
Completion Test. Jour. Abnorm. & Social Psychol. 34: 248, Apr., 1939. (E. Hanfmann).
14. The Pharmacologic Antagonism of Metrazol and Sodium Amytal as Seen in
Human Individuals (Schizophrenic Patients). Jour. Lab. & Clin. Med. 24: 681, Apr.,
1939. (L. H. Cohen).
15. Brain Potential Changes in Man Induced by Metrazol. Brit. Jour. Neurol. &
Psychiat. 2: 107, Apr., 1939. (M. A. Rubin and C. Wall).
16. A Qualitative Analysis of the Healy Pictorial Completion Test II. Amer. Jour.
Grthopsychiat. 9: 325, Apr., 1939. (E. Hanfmann).
17. Factors Involved in the Stability of the Therapeutic Effect in the Metrazol Treat-
ment of Schizophrenia. (A report of 146 cases.) N. E. Jour. Med. 220: 780, May 11,
1939. (L. H. Cohen).
18. Some Principles of Psychiatric Classification. Psychiatry 2: 161, May, 1939.
(E. M. Jellinek).
19. Statistics on Some Biochemical Variables on Healthy Men in the Age Range of
20 to 45 years. Jour. Biol. Chem. 128: 621, May, 1939. (E. M. Jellinek, J. M. Looney).
20. The Therapeutic Significance of Fear in the Metrazol Treatment of Schizophrenia.
Amer. Jour. Psychiat. 95: 1349, May, 1939. (L. H. Cohen).
21. The Effects of Insulin on Serum Lipids and Choline Esterase in Schizophrenia.
(Preliminary Report) Jour. Biol. Chem. 128: LXXXII, June, 1939. (L. O. Randall).
22. Serum Lipids in Schizophrenia. Psychiat. Quart. 13: 441, July, 1939. (L. O.
Randall, Louis H. Cohen).
23. Changes in Lactic Acid, pH, and Gases Produced in the Blood of Normal and
Schizophrenia Subjects by Exercise. Amer. Jour. Med. Sci. 198: 57, July, 1939. (J. M.
Looney).
24. A Variability Study of the Normal and Schizophrenic Occipital Alpha Rhythm.
II. The Electro-encephalogram and Imagery-type. Jour. Ment. Sci. 85: 779, July, 1939.
(M. A. Rubin, L. H. Cohen).
25. Psychiatric Changes Associated with Induced Hyperthyroidism in Schizophrenia.
Psychosomatic Medicine 1: 414, July, 1939. (L. H. Cohen).
26. Physiological Studies in Insulin Treatment of Acute Schizophrenia. I. Methods.
Endocrinology 25: 96, July, 1939. (E. M. Jellinek).
27. Physiological Studies in Insulin Treatment of Acute Schizophrenia. II. Pulse
Rate and Blood Pressure. Endocrinology 25: 100, July, 1939. (D. E. Cameron, E. M.
Jellinek).
28. Physiological Studies in Insulin Treatment of Acute Schizophrenia. III. The
Serum Lipids. Endocrinology 25: 105, July, 1939. (L. O. Randall, E. M. Jellinek).
29. Physiological Studies in Insulin Treatment of Acute Schizophrenia. IV. The
Choline Esterase Activity of the Blood Serum. Endocrinology 25: 278, Aug., 1939.
(L. O. Randall, E. M. Jellinek).
30. Physiological Studies in Insulin Treatment of Acute Schizophrenia. V. The
Blood Minerals. Endocrinology 25: 282, Aug., 1939. (J. M. Looney, E. M. Jellinek,
C. J. Dyer).
31. Significance of Behavior During Hypoglycemia. Mass. Dept. Mental Health,
Symposium on Therapy, p. 21, Sept., 1939. (C. Wall).
32. Studies on the Phytotoxic Index. III. (An evaluation of the method with refer-
ence to depressed psychotic patients.) Amer. Jour. Med. Sci. 198: 528, Oct., 1939.
(J. M. Looney, W. Freeman, R. R. Small).
P.D. 117 89
33. Skin and Body Temperatures of Schizophrenic and Normal Subjects Under
Varying Environmental Conditions. Arch. Neurol. & Psychiat. J+2: 724, Oct., 1939.
(H. Freeman).
34. The Determination of Globulin and Albumin in Blood Serum by the Photo-
electric Colorimeter. Jour. Biol. Chem. 130: 635, Oct., 1939. (J. M. Looney, A. I.
Walsh).
35. The Electroencephalogram of Schizophrenic Patients During Administration of
Vitamin Bi. Proc. Soc. Exper. Biol. & Med. 42: 440, Nov., 1939. (M. A. Rubin).
36. Psychopathy, Psychosis and Internal Secretions. Cyclopedia of Med. 5: Chapt.
IX, pp. 646-690, F. A. Davis & Co., 1939. (R. G. Hoskins, L. H. Cohen).
37. Neuro-endocrinology. Cyclopedia of Medicine 5: Chapt. X, pp. 690-713, F. A.
Davis & Co., 1939. (L. H. Cohen, R. G. Hoskins).
In summarizing the work of the Division of Mental Hygiene for the fiscal year ending
November 30, 1939, it can be said that the Child Guidance Clinics have functioned on a
high level, serving the various sections of the State more adequately than in previous
years. A number of the clinics have adopted the policy of providing, not only diagnostic,
but therapeutic service as well. There has been considerable expansion of the educational
program in its various fields, including training of students, conferences with educators
and social agencies, talks and lectures to groups and organizations, and dissemination
of mental hygiene information to reach greater numbers of the general population.
Much enthusiasm has been shown during the past year in research by the members of
the Department of Mental Health and the personnel in our mental institutions, so that
very definite programs of research are now being carried out in most of our institutions
and in the Division.
I desire to express my sincere appreciation to the Commissioner of the Department
of Mental Health for his invaluable guidance and advice. Gratitude is extended to the
Directors of the various Divisions, and the members of the Mental Hygiene and Research
Committees for their cooperation and assistance. I wish to thank all those in the Division
who have served so faithfully and have given such loyal support throughout the year.
Respectfully submitted,
Edgar C. Ybrbury, M.D.,
Director, Division of Mental Hygiene.
90 RD. 117
REPORT OF THE DIVISION OF MENTAL DEFICIENCY
To the Commissioner of Mental Health:
A report of the Division of Mental Deficiency for the year ended November 30, 1939,
is respectfully submitted.
The subjects listed below are discussed in this report :
I. Traveling Psychiatric School Clinics for the Examination of Retarded Children
in the Public Schools.
(a) Historical Sketch of Organization, 1914-1939.
(b) Primary Reasons for Cases Being Referred to School Clinics, 1939.
(c) Age of School Clinic Cases Examined during the Year 1939.
(d) Intellectual Status of First Examinations, 1939.
(e) Intellectual Status of Re-Examinations, 1939.
(f) Personnel of Clinics, 1939, by Institution.
(g) Comparison between Intellectual Status of First Examinations and Re-
Examinations, 1939.
(h) Comparison between Intellectual Status of First Examinations and Re-
Examinations, 1928-1939.
(j) First Examinations, Re-Examinations and Subsequent Recommendations
of Psychiatrists, School Clinic Examinations, 1939, by Place of Residence
and Sex.
(k) Total Examinations, 1926-1939 by Clinic.
(1) Total Towns Examined, 1926-1939, by Clinic.
II. Incidence of Retardation, 1939.
III. Central Registry for Mental Defectives.
(a) Type of Contact in Mental Defectives Reported to Central Registry, 1939.
(b) Age, I. Q., and Sex of Mental Defectives Reported to Central Registry, 1939.
(c) Percentage Distribution of Age Groups in Mental Defectives Reported to
Central Registry, 1939.
IV. Research in Mental Deficiency.
V. Social Service Division.
VI. Analysis of Waiting Lists of All State Schools, 1939.
VII. Recommendations.
Graph I. Number of Clinic Examinations, 1915-1939.
Graph II. Residence of Applicants on Waiting Lists of State Schools, 1939 :
Rates Per 100,000 Estimated Population of Same County.
I. Traveling Psychiatric School Clinics
(a) History
During the year 1939, the Division continued its direction of the fifteen traveling
psychiatric school clinics coming under this Department. These clinics have been in
operation for twenty-five years, and have been state-wide in their function since 1921,
or a period of eighteen years.
The Massachusetts School Clinic System was devised and placed in operation by the
late Dr. Walter E. Fernald, who sent out the first traveling clinic from the Waverley
School on December 15, 1914. In 1917, the late Dr. George L. Wallace sent out the
second traveling clinic from the Wrentham State School. As time went on, however, it
soon became evident that these two clinics could not examine all the backward children
in the public schools of the entire State, and the formation of additional units became
imperative. Dr. Fernald placed the matter before the Commissioner of Mental Diseases,
the late Dr. George M. Kline, and in 1921, as a result of their collaboration, traveling
clinics were created to operate from each of the fourteen institutions under the Depart-
ment of Mental Diseases. Thus, for the first time an adequate state-wide system for the
examination of all retarded children was made possible. The fifteenth clinic was added
in January, 1928.
Dr. Kline saw that the withdrawal of a psychiatrist from the medical staff of the
various hospitals was impracticable and, therefore, increased the quota of each institution
by one physician and one psychologist to carry on this important work. Dr. Payson
Smith, former Commissioner of Education, took an active part in framing the law relat-
ing to retarded children, and in outlining and enforcing the school clinic regulations
which have contributed so materially to the school clinic system.
P.D. 117 91
The General Court of 1919 enacted a law to legalize the operation of the clinics in the
public school system. This law was later amended by the Legislature in 1922, and again
in 1931. It now reads as follows :
Chapter 71, section 46, General Laws, as amended by chapter 231, statutes of
1922, and chapter 358, statutes of 1931: — "The School Committee of every town
shall annually ascertain, under regulations prescribed by the Department of Education
and the Department of Mental Diseases, the number of children three years or more
retarded in mental development in attendance upon its public schools, or of school
age and resident therein. At the beginning of each school year the committee of
every town where there are ten or more such children shall establish special classes
for their instruction according to their mental attainments, under regulations
prescribed by the department. A child appearing to be mentally retarded in any
less degree may, upon request of the superintendent of schools of the town where
he attends school, be examined under such regulations as may be prescribed by the
department of education and the department of mental diseases. No child under
the control of the department of public welfare or of the child welfare division of the
institutions department of the city of Boston who is three years or more retarded
in mental development within the meaning of this section shall, after complaint
made by the school committee to the department of public welfare or said division,
be placed in a town which is not required to maintain a special class as provided
for in this section. (Approved May 26, 1931)."
It will be noted that radical changes in the school clinic law were effected during 1931.
Heretofore, only those children three or more years retarded were eligible for examina-
tion. The new law states specifically, "A child appearing to be mentally retarded in any
less degree may, upon the request of the superintendent of schools of the town where he
attends school, be examined under such regulations," etc. This permits the examination
of two very important groups: (1) children retarded but one or two years in school work;
and (2) children presenting various behavior problems which have been interfering
with their school progress. This is one of the most constructive moves ever made in our
particular field. It makes possible the early examination and placement of a child show-
ing retardation before he has progressed to the point that he is included in the classifi-
cation of "three years retarded."
The Department of Education has outlined certain regulations dealing with exami-
nations and special class provision. The first paragraph of these regulations applies in
particular to the school clinics under the supervision of this Division. It reads as follows :
1. The school committee shall require the examination of all children of school
age residing in the town who appear to be three or more years retarded in mental
development. The examination shall be given by the State Department of Mental
Diseases or an examiner approved by that Department.
The growth in the number of examinations completed by the traveling clinics each
year is outlined in Graph I. The striking increase in 1921 is due, of course, to the simul-
taneous operation of fourteen clinics. For the year 1933, also, we note a substantial
increase in the number of examinations due, of course, to the change in the law in 1931.
At the end of 1939, a grand total of 122,098 examinations of retarded children have been
conducted by the clinics during the twenty-five years of their operation.
In connection with the school clinic work, the Director has held numerous conferences
with officials of the Department of Education, with school superintendents, with clinic
psychiatrists and clinic social workers, so that the service rendered by the clinic may
best meet the varying needs of the school systems involved.
There has been a steady increase of interest throughout the State in the work which
is being done by our traveling clinics. School superintendents now welcome any assist-
ance which the clinics can give, and have become enthusiastic supporters of this system
of examining retarded children. They were not long in recognizing the fact that the
service provided is detached from the local school organization and, as such, can provide
an examination which is wholly impersonal. In the past, parents of retarded children
have been sometimes critical of the decisions made by the local school superintendent
in reference to the placement of retarded children in special classes. Now they are
proving to be less critical as they recognize that the decisions are based on very complete
medical and psychiatric examinations by a clinic which is not a part of the local school
organization.
92
P.D. 117
8BS6 67ZZ
I
43 43 ■ 4^
3°7 253 2/0 247 263
I
I9/5-/9/6 -19/7 /9/8/9I9-I920-/92H922/923- (924 /925/926-/927/928/92S-/930 /93/-/932-I933-/934-I93S-/936 /937- (938-/939
Graph I. — Number of School Clinic Examinations, 1915-
1939, by Years
It is a standard practice for the psychiatrist of the traveling clinics to invite the parents
of children examined to come to the schools and to confer with them following the exami-
nations. Many parents cooperate in this matter, and have come to a better understand-
ing of their children when behavior problems and other difficulties are interpreted to
them by the psychiatrist.
Superintendents of the various state hospitals and schools recognize the value of the
traveling school clinic as an out-patient activity. The service which can be rendered
to the community in the diagnosis and placement of backward children in the schools
is of incalculable value. Several of the superintendents have been most cooperative in
assuming extra territory in which to conduct examinations.
(b) Primary Reasons for Cases Being Referred to School Clinics, 1939: All Institutions.
Prior to 1931, the law regulating the activities of the traveling school clinics specified
definitely that children must be three or more years retarded before they could be ex-
amined. During 1931 a change in the law was effected which now makes it possible to
. examine children who show any lesser degree of retardation.
Insert Table
In Table 1 we present the primary reasons for cases being referred to our school clinics
during the year 1939. Of the 7,971 children examined during the year, 70% were referred
because of retardation; 16% because of some school problem; 1.6% had personality
difficulties; .9% were behavior problems; .5% were physical problems, and .2% were
social problems. Roughly, 70% of cases were referred because of retardation, and 30%
of cases because of other reasons. In the sexes we observe that the males show larger
relative proportions in cases referred because of retardation, behavior and person
ality problems. The females show larger proportions in school problems and physical
problems. As is to be expected, retardation makes up a smaller proportion in first exam-
inations, 64% as contrasted with 84% in the re-examinations. School problems make up
19% of first examinations and but 8% of re-examinations; behavior problems 1.1% of
first examinations and .3% of re-examinations; personality difficulties 1.8% of first
examinations and 1.2% of re-examinations; and social problems .2% of first examinations
and .3% of re-examinations.
The variety of problems now being presented to the clinic shows the rapidly changing
trend in the demands made upon our traveling school clinic. Formerly it was expected
that all of our children would be referred to the clinic because of retardation. In fact,
that was the primary reason for the creation of the clinics. Now we see that other prob-
lems are arising within the public schools and giving the educators serious concern.
P.D. 117
93
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These, of course, are problems quite apart from retardation, although in some instances
there is a combination of retardation and another type of problem. We see now that the
clinics are offering a broader and more useful service to the public schools in that they
are examining various school and behavior problems which are often the cause of such
serious difficulties within the various school systems.
(c) Age of School Clinic Cases Examined during the Year 1939, by Sex:
Numbers and Percentages.
In Table 2 we present the age distribution of all examinations made by the various
school clinics during the year 1939. It will be noticed that the substantial numbers
start at the chronological age of 5 years with 462 children examined, or 5.7 per cent of
the total. Children 6 years of age made up 10.5%. Fewer children were examined in
the ages of 7, 8 and 9 years. Children 10 years of age make up 10.6% of the total, and
the following two years place even larger percentages, the highest percentage of 11.4
being observed in the 12 year group. There is a steady dropping off at that point in
numbers, with children 16 years of age making up 1.6% of the total. In the sexes we
note that the highest percentage for the males, that of 11.3%, occurs in both the ages
10 and 11 years. In the females the high figure of 14.3% is noted in girls aged 6 years.
It is of interest that in the early examinations at the age of 5, 6 or 7 years the females
show much higher percentages than the males. However, in practically all ages from
8 to 15 years the males show higher percentages than the females.
Insert Table 2
(d) Intellectual Status of First Examinations, 1939
Table 3 records the intellectual status of first examinations, outlining the distribution
of intelligence quotient groups. In interpreting this table it must be recalled that the
decisions are not based upon the mental tests alone. The psychiatrist bases his decision
on facts resulting from a very complete survey of the child's history and life. This gives
a diagnosis which is the result of an accurate evaluating of the personality, the mental
and physical characteristics, and the environmental factors. It gives a diagnosis based
on the child's reaction to his educational and home environments rather than one based
solely upon arbitrary mental tests.
Insert Table 3
The first examinations present interesting sex differences. Of the total first examina-
tions of boys, 16.9% were diagnosed as mentally defective (I. Q. 0-.69), while 18.3%
of the girls fell in this grouping. However, it will be noted that in the dull group the
males presented higher proportions than the females. Higher proportions of females
are being diagnosed as mentally defective, borderline, normal, and superior. The average
I. Q. for both sexes was .83.
In .6% of first examinations the diagnosis was deferred. It has been a definite policy
of all clinic psychiatrists to defer the diagnosis in doubtful cases. If the psychiatrist
doubts the mental status of the child, he defers his diagnosis and requests that the child
return for another examination on the next visit of the clinic.
(e) Intellectual Status of Re-Examinations, 1939
Table 4 records the intellectual status of all re-examinations, divided into intelligence
quotient groups. When the clinics return to the schools for their next visit, the super-
intendents assemble the cases in which various factors suggest re-examination.
Insert Table-4
While the material is not presented in this table, it is interesting to observe the dis-
appearance of conduct disorders when children have been placed in a special class.
Children having had a great deal of difficulty in the regular classes show a very favorable
reaction when placed in classes suited to their respective mental ages. School superin-
tendents have repeatedly told of complete changes in the behavior patterns of children
following the placement of the child in a special class. Many of the conduct disorders
of these children disappear when they are no longer subjected to the strains and stresses
of regular class work in competition with children of higher intelligence.
Noticeable sex differences are observed in Table 4. Of the total re-examinations of
boys, 32.6% were diagnosed as mentally defective (I. Q. 0-.69), while 43.5% of the girls
fell in this grouping. That is, relatively larger proportions of girls were diagnosed as
feebleminded among the re-examinations than was noted in the first examinations.
However, in the borderline, dull, average and superior groups the males present higher
P.D. 117
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P.D. 117
proportions. These percentage distributions are reflected in the average intelligence
quotient. The average I. Q. of boys re-examined was .75 while that of the girls was .71.
(/) Personnel of Clinics, 1939, by Institutions
Table 5 gives the names of the psychiatrists, psychologists and social workers who
carried on the work of the various traveling school clinics during 1939. At this point
the Director wishes to say a word of appreciation for the very fine work which has been
done by the various traveling school clinics during the past year. The work of the clinic
personnel has been so satisfactory that a complete change in attitude on the part of local
school officials has been effected. In the early days of the traveling school clinic work,
which began on a state-wide basis in 1921, some resistance was encountered on the
part of school officials who were rather doubtful of the usefulness of the clinic work.
In that particular period the various clinics encountered many difficulties in the field.
Over the past years, however, there has been a quite universal change to a spirit of
complete cooperation on the part of school superintendents, school boards and boards
of selectmen. These individuals have come to the point of understanding completely
the value to the school of the clinic work, and have repeatedly expressed their apprecia-
tion of this service. Both the Department and the clinics are very appreciative of the
various expressions of commendation which have been received.
Insert Table-5
Table 5. — Personnel of Traveling School Clinics, by Institution, for Year Ended
November 30, 1939
Psychologist or
Institution
Psychiatrist in Charge
PSYCHOMETRIST
Social Worker
Belchertown
Herbert L. Flynn, M.D.
Catherine A. Burnham
Dorothy I. Peeso
Lulu H. Warner, M.D.
Lois R. Macomber
Boston Psychopathic
Mary Palmer, M.D.
Rosemary Mehan
—
Boston State
Margaret R. Simpson, M.D.
Ruth Lambert
Rose A. Long
Mary Foley
Danvers
Doris M. Sidwell, M.D.
Elaine Kelleher
Flora M. Remillard, M.D.
Norma Monroe
Josephine Tinsley
—
Barbara Foster
Marjorie Burnham
Foxborough
Mary Hammond, M.D.
Margaret R. Simpson, M.D.
Lillian F. Shapiro
—
Gardner
Janet S. Barnes, M.D.
Beatrice N. Wolfson
—
Grafton
Anna C. Wellington, M.D.
Emaline L. Kelly
Clara E. Barnes
—
Medfield .
Grace T. Cragg, M.D.
Esther Poutas
Dorothy Parkhurst
Edmund M. Pease, M.D.
Esther Odell
Monson
Florence A. Beaulieu, M.D.
Dorothy H. Roche
Lula P. Hayes
Ruth Holmes
Northampton .
Elizabeth Kundert, M.D.
Mabel Martin
Caroline Wright
Taunton .
Olga E. Steinecke, M.D.
Bettina S. Everett
Mary L. Lynch
W. E. Fernald .
Esther S. B. Woodward, M.D.
Eleanor E. Hobbie
—
Westborough .
Betsy Coffin, M.D.
Adelaide Proctor
Eda W. Anderson
Faith Hawkins
Annie Heal
Worcester .
Lonnie 0. Farrar, M.D.
David Shakow
Mr. Shakow's Staff
Wrentham
Charlotte A. Mitchell, M.D.
Dorothy R. McLellan
Clinic personnel really has a very serious responsibility in making a diagnosis of mental
deficiency and in rendering advice which may have a profound effect upon the future
life of the child. In all instances the clinic personnel has attempted to make clear to the
school and to the family, wherever possible, the details of the situation and the best
way in which their advice might be applied. Many difficult and trying situations have
had to be met, and the way in which the clinics have handled the many problems has
earned the commendation of all concerned.
The clinics report annually to the Department the cost of operation during the year.
These costs include salaries, maintenance, expenses in the field, traveling expenses,
supplies, etc. The average cost of each examination for the year 1939 was found to be
$5.83. The total cost for fifteen clinics in conducting 7,971 examinations was $46,530.06.
(g) Comparison between Intellectual Status of School Clinic
First Examinations and Re-Examinations, 1939
Table 6 shows the percentage comparisons between the I. Q. distributions of the first
examinations and re-examinations. We note distinct differences. In the first examina-
P.D. 117
97
tions 17.4% of the group were mentally defective, while in the re-examinations 35.5%
fell in this classification. We also note that the re-examinations present smaller percent-
ages in most of the higher mental classifications. The average intelligence quotient of
first examinations was .83, and that for re-examinations was .74 for both sexes.
Table 6. — Percentage Distribution of Intelligence Quotient Groupings of School
Clinic First Examinations, 1939, by Sex
First Examinations
Total
0-.69
.70-. 79
.80-. 89
.90-1.09
1 . 10 plus
Diagnosis
Deterred
Average
Male .
Female
100.0
100.0
16.9
18.3
26.8
27.6
27.9
20.9
23.7
25.7
3.8
6.6
.5
.6
.82
.83
Both Sexes .
100.0
17.4
27.1
25.4
24.4
4.8
.6
.83
Re-Examinations
Male .
Female
100.0
100.0
32.6
43.5
33.7
31.5
23.1
16.0
9.8
7.3
.4
.1
1.4
-
.75
.71
Both Sexes .
100.0
35.5
33.1
21.2
9.1
.3
.4
.74
Within both groups we see a larger percentage of females in the mentally defective
classification. Among the first examinations the percentages feebleminded are 16.9 for
males and 18.3 for females; in the re-examinations much greater differences are observed
with 32.6% for the males and 43.5% for the females. We expect the lower grade cases
to return for re-examination, but here we note that the females return in decidedly
larger proportions than the males.
(h) Comparison between Intellectual Status of School Clinic
First Examinations and Re-Examinations, 1928-1939
Table 7 presents the percentage distributions of intelligence groupings in first and
re-examinations for the years 1928-1939, inclusive. We note that there appears to be
an upward trend in the intelligence of cases coming up for first examinations from 1928
to 1939. The increase in average I. Q. to .79 for 1933 as compared with .74 for 1932 is
to be expected inasmuch as problem children as well as retarded children were being
referred for examination. The average I. Q. of these first examinations increased from
,69 in 1928 to .83 in 1939. We note also that the 43.8 per cent of mental defectives in
1928 decreased to 17.4% mentally defective in 1939.
Even in the re-examinations the intelligence quotients have increased. In 1928 the
average I. Q. of children re-examined was .66, and this increased to .74 in 1939. In 1928,
54.8% of children re-examined were mentally defective. In 1939 only 35.5% were
mentally defective. These figures demonstrate the expansion of the service rendered
by the traveling school clinic and point out that each year larger numbers of conduct
and behavior problems are contributing to retardation than have been observed in
previous years.
(,/) First Examinations, Re-Examinations and Subsequent Recommendations of
Psychiatrists, School Clinic Examinations, 1939, by Place of Residence and Sex.
Table 8 reveals that a total of 7,971 examinations were conducted by all clinics during
the year 1939. Of these, 5,702 or 71.5% were first examinations and 2,269 or 28.4%
were re-examinations. The sex difference is noticeable in that 5,379 or 67.4% of all
examinations were males and 2,592 or 32.5% were females.
Of all examinations 1,813 or 22.7% were recommended for special classes: 22.9%
of the males and 22.2% of the females. Three hundred sixty-six or 4.5% of the total
were recommended for placement within a state school: 3.9% of the males and 5.8%)
of the females. Those recommended for social supervision numbered 975 — 12.2% of
the total, and 1,102 or 13.8% of cases were in need of coaching in special subjects. A
total of 1,813 children were recommended for special class care in Massachusetts during a
single school year. As the total in special classes in the towns having first examinations
during 1939 is now 5,580, we can see the great need for additional special class provision.
98
P.D. 117
Table 7. — Intellectual Status of School Clinic First and Re-Examinations for the
Years 1928-1939
First Examinations
Total
0-.69
.70-. 79
.80-. 89
.90-1.09
1 . 10 plus
Diagnosis
Deferred
Average
1928
Number .
Per cent .
4,916
100.0
2,150
43.8
1,206
24.5
769
15.6
327
6.6
16
.3
448
9.1
.69
1929
Number .
Per cent .
4,923
100.0
1,772
35.9
1,437
29.1
722
14.6
407
8.2
34
.6
551
11.1
.73
1930
Number .
Per cent .
5,224
100.0
2,025
38.7
1,569
30.0
799
15.2
362
6.9
23
.4
446
8.5
.72
1931
Number .
Per cent .
5,015
100.0
1,610
32.1
1,536
30.6
960
19.2
371
7.4
16
.3
522
10.4
.73
1932
Number .
Per cent .
4,461
100.0
1,377
30.9
1,336
29.9
928
20.8
395
8.9
19
.4
406
9.1
.74
1933
Number .
Per cent .
6,569
100.0
1,571
23.9
1,609
24.5
1,365
20.8
1,209
18.4
180
2.7
635
9.7
.79
1934
Number .
Per cent .
6,445
100.0
1,459
22.6
1,563
24.2
1,303
20.2
1,177
18.3
153
2.4
790
12.3
.79
1935
Number .
Per cent .
6,636
100.0
1,371
20.7
1,893
28.5
1,688
25.4
1,446
21.8
182
2.7
56
.9
.81
1936
Number .
Per cent .
6,468
100.0
1,372
21.2
1,872
28.9
1,535
23.7
1,362
21.1
285
4.4
42
.7
.81
1937
Number .
Per cent .
6,266
100.0
1,191
19.0
1,714
27.3
1,526
24.4
1,506
24.0
273
4.4
56
.9
.82 .
1938
Number .
Per cent .
5,917
100.0
1,015
17.1
1,645
27.8
1,515
25.6
1,477
25.0
232
3.9
33
.6
.82 '
1939
Number .
Per cent .
5,702
100.0
993
17.4
1,548
27.1
1,454
25.4
1,395
24.4
277
4.8
35
.6
.83
Re-Examinations
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
Number
Per cent
1,370
100.0
1,336
100.0
1,303
100.0
1,424
100.0
1,618
100.0
2,087
100.0
1,792
100.0
2,087
100.0
1,918
100.0
2,039
100.0
2,180
100.0
2,269
100.0
746
54.8
357
26.1
158
11.5
56
4.0
2
.1
51
3.8
624
46.7
367
27.4
179
13.3
70
5.2
8
.5
88
6.5
648
49.7
390
29.9
165
12.6
48
3.6
1
.07
51
3.9
664
46.7
430
30.2
208
14.6
38
2.7
1
.07
83
5.8
734
45.4
539
33.3
201
12.4
53
3.3
-
91
5.6
973
46.6
588
28.2
290
13.9
97
4.7
3
.1
136
6.5
725
40.4
539
30.1
234
13.1
83
4.6
3
.2
208
11.6
787
37.7
695
33.3
425
20.4
166
7.9
6
.3
8
.4
763
39.8
630
32.8
350
18.2
143
7.5
17
.9
15
.8
743
36.4
653
32.0
438
21.5
173
8.5
13
.6
19
1.0
832
38.2
755
34.6
419
19.2
153
7.0
8
.4
13
.6
807
35.5
753
33.1
482
21.2
208
9.1
8
.3
11
.4
Several interesting sex differences are demonstrated in Table 8. In the total children
coming up for examination the boys outnumber the girls in a 2:1 ratio. In the first
examinations the ratio is 1.8:1. In the re-examinations the boys show a decidedly higher
P.iD. 117
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proportion, with a 2.7:1 ratio. In the total number recommended for special class the
males again present the 2:1 ratio. However, in cases recommended for placement in a
state school the boys make a better showing, the ratio dropping to 1.4:1. Again, in the
recommendations for social supervision and coaching in special subjects the boys show
a larger proportion, with ratios of 1.8:1 and 2.8:1, respectively. Conduct in boys plus
mental retardation has been suggested as the reason for the larger numbers being referred
for examination in the observed 2:1 ratio. However, the relatively smaller proportion
of boys recommended for admission to state schools interferes with the acceptance of
conduct as the deciding factor. This situation turns us to a consideration of other factors.
We may assume that the environmental and social stresses are practically the same for
both sexes. With conduct and environment ruled out of consideration we are forced
to turn to other possibilities. Is there some factor in the personality or adaptability of
males rendering difficult their adjustment to the present school curriculum? It is possible,
of course, that the present curriculum or scheme of school administration may be better
suited to the needs of girls than boys. Whatever the cause, the boys find it much more
difficult to adjust to that life period spent in the public schools and become retarded in
their school work in approximately a 2:1 ratio as compared with the girls.
(k) Total Examinations, 1926-1939, by Clinic
Table 9 outlines the total number of examinations conducted by the clinics at the
various institutions for the years 1926-1939, inclusive. In considering these last fourteen
years of operation, we notice that the greatest number of examinations was done by the
Walter E. Fernald State School Clinic, a total of 18,278 cases for the fourteen years.
The clinic of the Grafton State Hospital is second with 11,305 examinations; the clinic
of the Wrentham State School is third with a total of 11,092 examinations during this
period; Northampton is fourth, with 8,017 cases; Belchertown State School is fifth, with
6,566 examinations; and Taunton State Hospital is sixth with 6,281 examinations. The
foregoing clinics are to be particularly commended for their activities, inasmuch as they
have had a difficult task in molding public opinion, and have done outstanding work
in the territories assigned to them.
Insert Table 9
Table 9. — Total School
Clini
c Examinations Conducted j
or the Years 1926-1939
Clinic
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
Belchertown .
251
114
474
522
401
846
544
736
578
527
803
770
Boston Psycho.
271
121
141
130
81
126
113
200
57
104
93
79
90
76
Boston State .
355
527
441
502
454
397
410
527
439
398
426
307
91
376
Danvers .
162
132
176
255
338
343
324
425
433
646
717
640
784
549
Foxborough .
300
431
303
485
375
445
515
612
642
549
472
374
352
346
Gardner .
122
58
125
164
107
125
261
343
318
282
492
539
339
461
Grafton .
66
-
343
327
240
384
295
1,369
1,556
1,611
1,311
1,402
1,382
1,019
Medfield .
70
298
510
419
239
322
360
234
341
324
351
413
335
352
Monson .
384
398
225
395
494
439
304
514
398
525
461
495
439
501
Northampton .
708
876
1,000
581
769
523
443
697
582
447
305
435
296
355
Taunton .
90
230
360
292
324
353
309
335
339
522
676
778
765
908
W. E. Fernald .
1,411
1,413
1,492
1,518
1,602
1,438
1,355
1,284
1,166
1,208
1,172
1,087
1,113
1,019
Westborough .
-
26
85
-
34
78
117
78
71
80
89
124
141
126
Worcester
110
402
197
300
114
37
265
293
371
265
248
310
363
257
Wrentham
603
726
637
777
882
907
607
899
' 980
951
906
707
730
780
Div. Ment. Hyg.
75
89
88
74
76
Total
4,652
5,638
6,286
6,259
6,527
6,439
6,079
8,656
8,237
8,723
8,386
8,305
8,097
7,971
In comparing the number of examinations for the two years 1938 and 1939 we notice
increases for the following clinics : Boston State, Gardner, Medfield, Monson, Northamp-
ton, Taunton and Wrentham.
(1) Total Towns Examined, 1926-1939
Table 10 gives the number of towns in which clinics were conducted during 1939.
Between 1926 and 1939 the total number of towns in which examinations were held
increased from 113 to 247, the largest number of towns being examined during 1935.
The state-wide nature of the school clinic examining plan is clearly outlined in this figure.
In 1939 the clinics were visiting 59% of the 351 cities, towns and villages of the Common-
wealth. Some of the smaller towns and villages do not require a clinic visit each year ,
106
P.D. 117
so that the total towns already served by these clinics would present a much higher
figure. If these figures were presented on a population basis, we would find that the
proportion would be smaller. This is due to the fact that the large cities of Boston,
Springfield and several others are not served by our clinics. However, one of the greatest
values of the system has arisen from the fact that the smaller towns are rendered a type
of service which would be practically unobtainable otherwise.
Table 10. —
Number of Towns in Which School Clinics were Conducted, 1926-1 939
Clinic
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
Belchertown .
4
4
4
7
6
26
20
23
21
19
30
26
Boston Psycho
1
l
1
1
1
1
1
2
2
2
4
2
2
2
Boston State
2
3
2
2
2
2
2
2
2
3
2
2
1
2
Danvers .
7
9
7
15
15
9
10
18
13
29
26
30
26
21
Foxborough
7
13
14
12
13
15
16
17
21
22
20
17
18
14
Gardner .
11
9
12
8
13
9
9
12
19
17
15
15
19
20
Grafton .
2
-
10
11
10
17
11
20
18
18
18
20
18
18
Medfield .
2
5
7
7
2
7
10
10
10
12
7
5
9
9
Monson .
4
4
3
4
3
6
6
7
7
7
7
7
6
7
Northampton
40
34
36
28
6
18
20
18
24
19
13
18
14
8
Taunton .
4
19
15
17
15
20
16
20
25
34
34
38
33
33
W. E. Fernald
18
25
24
24
26
24
20
18
21
16
13
11
12
11
Westborough
-
1
3
-
1
2
4
3
4
5
3
4
3
4
Worcester
5
26
7
24
15
4
25
21
31
27
22
21
27
20
Wrentham
10
13
11
11
13
13
10
12
15
13
13
15
14
13
Total
113
162
156
168
139
154
166
206
232
247
218
224
232
208
Many inquiries from other states directed to this Division in reference to the school
clinic system reveal that the need for the examination of retarded or problem children
in rural districts is a major problem in most states of the Union. They find no difficulty
in providing a psychiatric service for the larger cities. However, the smaller communities
feel keenly the need for a psychiatric service, particularly in reference to the many
problems of retardation in school children. The traveling psychiatric unit as developed
in Massachusetts appears to be a very satisfactory answer to these questions.
II. Incidence op Retardation, 1939
Table 11 presents a summary of facts in connection with 218 towns in which first
examinations were held by one of our clinics during the year 1939. It presents the school
population in the grammar grades ; the number of special classes ; the number of children
in special classes; the number of first examinations by school clinics; the percentage of
school population (a) in special classes, (b) referred to psychiatric clinics, (c) diagnosed
as mentally defective, and (d) diagnosed as retarded; for each town concerned, during
the year 1939. As first examinations only are included, we may consider that the material
demonstrates, to a certain extent, the average rates for new cases of retardation occurring
during the year.
Insert Table 11
The school population served by these clinics during a single year amounted to a
total of 336,606 children. Of the total 218 cities, towns and villages having a first
examination, 121 were maintaining a total of 354 special classes, or one special class to
approximately every 950 children of the total grammar school population of the towns
examined. Ninety-seven smaller communities with a total population of 31,253 children
were not maintaining special classes. While 44% of the communities examined were not
maintaining special classes, we observed that 90% of the total school population had
special class provision. This demonstrates that the special classes have been established
in adequate numbers in the larger school systems. The schools failing to establish special
classes are the ones having smaller numbers of pupils enrolled, or the smaller communi-
ties. This is to be expected, as the smaller schools have many difficulties, financial and
otherwise, which interfere with the establishment of special classes. In column 10 we
observe that the percentage of the total school population referred for retardation during
1939 for the entire group was 1.69%. However, in the towns having no special classes
the percentage of the school population referred as retarded for 1939 was 2.37%.
P.D. 117
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114 P.D. 117
One hundred twenty-one towns maintaining 354 special classes accommodated 5,580
children in these classes, an average of 15 children per class. Comparing this total of
5,580 children in special classes with the total school population of 305,353, we note
that 1.82% were in special classes during the year 1939. The 97 towns not maintaining
special classes revealed a total grammar school population of 31,253 children. In these
towns a total of 741 children were referred to the clinics as retarded, and there appear
to be no special classes available for their instruction.
A total of 5,702 children were referred to the clinics for the first time during 1939.
In other words, 1.69% of the total school population were referred during a single school
year. Dividing the 1.69% of the total school population referred in accordance with
diagnosis, we note that .30% were diagnosed as mentally defective and 1.39% as not
mentally defective. This demonstrates that the ratio of not mentally defective children
to mentally defective children is 4:1. That is, the mentally defective child is not alone
in having difficulties in the public school. Other children with varying degrees of intel-
ligence between mental defect and normal have difficulties in meeting the requirements
of the school curriculum.
We may say in general that we are viewing the first steps of special class development.
The schools listed as having special classes are simply pioneers in the establishment of a
specialized service for children below average in intelligence or adjustment. The special
classes of today are simply taking care of the outstanding cases of mental retardation.
There is evidence piling up on all sides which would lead us to believe that the present
special class organization is simply a nucleus about which an expansion program should
be built. The findings of this report show that for every mental defective failing in
school work we have, in addition, four children of higher mental grade who do not make
a success of their school work.
The population of our special classes is made up of cases of obvious mental deficiency.
The question arises: Are we to leave the large number of high grade cases in the unhappy
half-way position between the special class and the regular class without adequate or
understanding provision for their training? We have found that it is quite difficult to
have unusual children coached in special subjects in the regular public school classes.
Lack of evenness in accomplishment in the various school subjects is quite commonly
observed.
Some of our public schools have made no provision for the outstanding cases of mental
deficiency which obviously should be segregated for special training. Others have pro-
vided these special classes, and have seen a remarkable reduction in the difficulties
observed in the regular classes, and an acceleration of the progress of the regular classes.
Some schools have gone further and have added sufficient classes to enable them to
classify their retarded children by both chronologic age and mental age. This is a step
in the right direction, but there is still a great unexplored field in the provision of special
classes for the borderline cases. Large numbers occur in these groups, and yet no ade-
quate provision for their care is being made at the present time.
We observe that 1.69% of the total school population served by our clinics were
referred because of retardation during 1939. This figure does not cover the total number
of cases of retardation which have accumulated in the particular schools. These are
first examinations of a single year only. Some of the children may be referred as retarded
at the age of nine years or earlier and others may become retarded between the ages of
nine and sixteen, the age of leaving school. Consequently, the total number of cases of
retardation is subject to an accumulation over 9 years. We note that the percentage
of .30% of the total school population diagnosed as mentally defective is small in pro-
portion to other estimates of the incidence of mental defect. Again, we must recall that
this, too, is a figure for a single year, and that the actual accumulated number of mental
defectives within the school system is much higher.
The previous paragraph outlines the fact that the proportions of children diagnosed
as mentally defective and children diagnosed as retarded (not mentally defective) for
any one year are quite small in relation to the total school population. Inasmuch as the
clinics are finding practically the same proportion of children retarded each year, it is
necessary to consider the accumulation of cases that is occurring year after year before
arriving at a total figure. The determination of this total number of retarded or mentally
defective who have accumulated in a school at any one time is rather difficult. There-
fore, we determined to use a different approach, and compare the new cases of retardation
or mental defect diagnosed during one year with the new cases entering school during the
P.D. 117' 115
same year. We recorded the number of children actually within the first grade of the
various schools, the new cases of retardation and mental defect diagnosed the same year,
and calculated the percentage. The total figure for children entering the first grade is
not typical of all grades, but is higher than the total entering other grades. Consequently,
the resulting rates will be smaller but the error will be on the side of conservatism.
It was found that there was a total of 38,183 children in the first grades of those schools
in which first examinations of retarded children were held during the year 1939. We
may say that this represents the approximate number of new students entering these
schools during a single year. We have observed in previous tables that a total of 5,702
children were referred to all clinics because of retardation for the first time during the
year 1939. Comparing this total of 5,702 with the 38,183 new students entering the
schools, we find that new cases of retardation and mental defect discovered during 1939
are 14.9% of the number entering school during the same year. That is, when we com-
pare the new cases of retardation discovered during a single year with the new children
entering school for the same year, we find that one child in six is retarded in some degree.
Dividing the mental defectives from those merely retarded, we note that the new
cases diagnosed as mentally defective during a single year are 2.6% of the number of
children entering school for the first time during a single year. The new cases diagnosed
as retarded (not mentally defective) constitute 11.2% of the number of children entering
school for the first time. All of this, of course, is for the year 1939. We feel that thes&
percentages of 2.6 for mental defect and 11.2 for retardation give us a much better
picture of the relative amounts of these conditions actually present in our school systems.
There is nothing to be gained in discussing the differences in the number of retardates
and mental defectives observed in the different towns. Some of the larger percentages
are observed in towns which are having an examination for the first time. In these
instances the children referred for first examination represent an accumulation of re-
tarded children over a period of years. The smaller numbers are observed in towns
which have been having these examinations every year. In other instances the small
number of cases referred is a matter of selection on the part of the superintendent. In
the long run we may say that the higher rates for retardation observed in particular
schools indicate simply the active interest of various superintendents in the problem of
retardation, and a comprehensive understanding of the necessity of special class care
of backward children. They are referring all of the children who are becoming retarded
in their particular school systems. The reasons for the smaller numbers presented by
some of the towns are more or less subject to conjecture.
We get some idea of the necessity for enlargement of our special class provision in the
figures presented for this one year. We note that 121 towns have provided a total of
354 special classes caring for 5,580 children. Referring to Table 8, we note that a total
of 1,813 children were recommended for special classes during 1939. That is, about one
third of the school rooms now devoted to special classes will be needed to take care of
the new cases recommended for special class care in 1939. We see the urgent need for
increasing the number of special classes now available.
III. Central Registry for Mental Defectives
In 1919 the Legislature amended Chapter 123 of the General Laws establishing a
registry for the feebleminded. This law was amended in 1936, and now reads as follows:
Chapter one hundred and twenty-three of the general Laws is hereby amended
by striking out section thirteen, as appearing in the Tercentenary Edition and
inserting in place thereof the following: — Section 13. "The department shall
establish and maintain a registry of mental defectives, and may report therefrom
such statistical information as it deems proper; but the name of any person so
registered shall not be made public except upon written request therefore, to public
officials or other persons having authority over the person so registered, or to chari-
table corporations incorporated in this commonwealth and subject to section twelve
of chapter one hundred and eighty, and the records constituting the registry shall
not be open to public inspection." (Approved May 22, 1936).
Dr. Walter E. Fernald for many years had expressed great interest in the carrying
out of such a registry, feeling that it would give invaluable information as to the com-
munity problem of mental defect and would provide opportunity for the building up of a
satisfactory plan for the care of such cases.
116 P.D. 117
In 1922 institutions under this Department started sending in cards to the Registry,
reporting all mental defectives examined by their traveling school clinics. For many
years the traveling school clinics constituted the sole source of information on mentally
defective children. In 1929 and 1930 the present Director of the Division undertook the
expansion of this work with the thought of bringing into use other sources contacting
mental defectives in the community. Up to that point little attention had been given
the mental defectives admitted to or cared for by mental hospitals. In addition, there
had been no uniform reporting on admissions to our state schools for mental defectives.
Arrangements were made to have all cases of this type reported by mental hospitals,
state schools and several other clinics. Each year following, additions have been made
to the number of sources reporting mental defectives to the Central Registry. At the
present time we are receiving reports on mental defectives from (1) traveling school
clinics; (2) admissions to state hospitals; (3) admissions to state schools; (4) cases placed
on the waiting lists of state schools; (5) defective delinquents examined by hospital and
Department psychiatrists; (6) out-patient examinations of state hospitals; (7) out-
patient examinations of state schools; (8) mental hygiene clinics; (9) habit clinics; (10)
child guidance clinics; (11) adjustment clinics; (12) defective delinquents admitted to
Bridgewater; (13) mentally defective prisoners examined under the Briggs Law; (14)
cases referred to the Division of Mental Deficiency; (15) cases examined by the Division
of Mental Hygiene; (16) children examined by the psychological clinic of the Springfield
schools; (17) cases referred to the Massachusetts Society for the Prevention of Cruelty
to Children; and (18) the New England Home for Little Wanderers.
(a) Type of Contact in Mental Defectives Reported to Central Registry, 1939.
Table 12 reports the type of contact in cases reported to the Central Registry during
1939. Reports were made by thirteen state hospitals; three state schools; the Depart-
ment for Defective Delinquents at Bridgewater; Department of Mental Health (Briggs
Law examinations); Division of Mental Deficiency, D. M. H.; Division of Mental Hy-
giene, D. M. H.; the Springfield public schools; the M. S. P. C. C; and the N. E. Home
for Little Wanderers. The largest number of cases was reported by the Wrentham State
School, 688. Fernald with 622 and Belchertown with 493 also reported large numbers.
In the state hospitals Monson reported the largest number, 378; Dan vers was second
with 301 ; and Taunton third with 297. The Springfield schools have been very coopera-
tive and reported a total of 108 children examined in their psychological clinics during
the year. Other clinics reporting were the M. S. P. C. C. with 22, and the N. E. Home
for Little Wanderers with 4.
Insert Table 12
Our reports came from clinics of many different types. The fifteen traveling school
clinics operating in the public schools furnished the largest number of defectives with a
total of 1,878. Admissions to state hospitals were second in order with 575 children
reported. Admissions to state schools were third with 551 cases reported; waiting lists of
state schools, fourth with 285; out-patient examinations of state schools were fifth in
order with 248 cases; and Defective Delinquents with 237 were sixth. These cases are
examined through the law requiring the examination of juvenile delinquents or through
admission to the Department for Defective Delinquents at Bridgewater.
(b) Age, I. Q., and Sex of Mental Defectives Reported to Central Registry, 1939
Table 13 outlines the age of cases reported to the Central Registry during 1939 by
intelligence quotient and sex. Of the total of 4,144 cases, 2,439 or 58.8% were males
and 1,705 or 41.1% were females. In the school clinic cases also we had greater amounts
of retardation among the males. Here, however, we see that this same sex proportion
persists only up to the age of 20 years. Over the age of 20 years the females are showing
larger numbers of cases reported to the Central Registry.
In discussing the intelligence of cases reported, we observe that there are comparatively
few cases in the lower I. Q. groupings. Substantial numbers are not encountered until
we reach the .40-49 and .50-59 groups. This, of course, is to be expected as the general
population shows this same general distribution. We know that there are many more
persons in the community with an intelligence quotient between .60 and .69 than there
are with intelligence quotients between 0 and .09. Therefore, we may expect to draw
more of these higher grade cases in those being reported to the Central Registry.
P.D. 117
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118
P.D. 117
In practically all I. Q. groups the excess of males noted in the totals is to be observed.
The sex differences appear to be becoming more marked as we go higher in the intellectual
scale. There are being relatively fewer high grade females reported to the Registry or,
vice versa, there are relatively more males reported as we go higher in the intellectual
scale.
(c) Percentage Distribution of Age Groups in Mental Defectives Reported to Central
Registry, 1939
Table 14 gives us a percentage distribution of the ages condensed from Table 13.
Surprisingly large numbers of children are being reported at comparatively young ages.
Thus in Table 14 we have 69 males and 70 females 4 years of age or less; 478 males and
286 females were between the ages of 5 and 9 years; 1,036 males and 589 females were
between the ages of 10 and 14 years. From this point on we see a sharp dropping off
in numbers. During the school period the intelligence of children is subjected to closer
scrutiny and, therefore, we may expect larger numbers during the school ages. The
cases examined under 4 years are reported, of course, by the various habit, child guidance
and adjustment clinics dealing essentially with younger children. We note that the males
predominate in cases reported in the groups 19 years or younger, 86% of the males and
76% of the females falling in these ages. Over 19, the females show larger percentages.
In the group 20-29 years they present 10.9%, with 6.7% for the males; in the group
30-39 years 6.7%, and 3.1% for the males. It appears that the male mental defectives
are reported to the Central Registry in the younger ages while the females show a tend-
ency to a greater scatter throughout the age groups. There is a greater chance that male
mental defectives will have their intellectual capacity interfere with their success in
younger ages and thus bring them to the attention of various examining or reporting
agencies. It is apparent that the female mental defectives tend to show greater success
in the community and postpone the discovery of their defect until they are considerably
older.
Table 14. — Age of Cases Reported to Central Registry for Mental Defectives, 1939,
by Sex: Numbers and Percentages
Age Group
Total
No.
%
Male
No.
Female
No.
0- 4 years
5- 9 years
10-14 years
15-19 vears
20-29 years
30-39 years
40-49 years
50 plus years
Unknown .
Total
139
764
1,625
876
351
193
94
95
7
3.3
18.4
39.2
21.1
8.4
4.6
2.2
2.2
.1
69
478
1,036
523
165
78
38
49
3
2.8
19.5
42.4
21.4
6.7
3.1
1.5
2.0
.1
70
286
589
353
186
115
56
46
4
4.1
16.7
34.5
20.7
10.9
6.7
3.2
2.6
.2
4,144 100.0
2,439 100.0
1,705 100.0
It is an interesting commentary on our present day civilization that a total of 4,144
cases of mental deficiency were reported to the Central Registry during a single year.
This is at a rate of 93 per 100,000 of the general population. The admission rate to our
state schools for mental defectives for the same year was 6 per 100,000, while the rate
for cases in residence in state schools was 118. The numbers and proportions of cases
being reported as mentally defective give us some idea of the possibilities for the future
as far as mental deficiency is concerned. Quite obviously the State cannot assume the
care of all these defective children, and yet there is a rather good chance that many of
them will be failures unless given a helping hand during the school period and the years
immediately following. We see here the need for a state-wide supervisory group interested
in and understanding the many problems connected with mental deficiency and retarda-
tion. The community adjustment of mental defectives is rarely accidental. It means
intelligent direction and supervision at the hands of understanding persons. Otherwise,
the economic load of caring for many thousands of failing mental defectives may become
unbearable.
P.D. 117 119
IV. Research in Mental Deficiency
In October, 1926, the Division inaugurated a research project in mental deficiency
based upon the school clinic examinations. In December, 1926, a research worker was
obtained to carry on the project. The worker visited the various institutions and recorded
the findings of the various school clinic examinations. A recording code was elaborated
and a code sheet printed. In 1929, however, the Department replaced the code sheet
with a printed statistical machine card which saved a great deal of time and effort in
the recording of data. The analysis of this material was made possible through the
utilization of the new statistical system established by the Department. The Division
research cards are punched and sorted by the machines in the Statistical Division. A
single research worker is available for this work. Inasmuch as the material available
now involves over 46,000 cases, it is extremely difficult to publish the results of this work
as rapidly as might be desired.
In 1938 the code was revised. It was felt desirable that the clinical diagnoses on the
school clinic code should agree with those on the state school statistical code, which was
based on the Standard Classified Nomenclature of Disease. Height and weight standards
were also altered. Consequently, in addition to coding current records, the worker has
corrected 6,784 old cards to agree with these changes.
As a total of over 122,098 examinations are now available, it is also highly desirable
that the coding work be continued so that this rather remarkable sample might be sub-
ject to a thoroughgoing analysis. One additional worker should be made available for
this research project in order that it may be completed. At present the new examinations
completed each year are more than one worker can possibly cover.
Table 15. — Statistical Survey of Cases — Division of Mental Deficiency Social Service
— Year Ending November 30, 1939
I
Status — December 1, 1938:
Committed cases 22
Voluntary cases 330
— 352
II
Cases referred during the year:
Referred by public agencies 57
Referred by private agencies 20
Referred by Dept. of Mental Health 8
Referred by individuals 8
Reopened from previous years 3
III
Type of cases referred for social supervision :
1. Wage earning . 20
2. Special class 26
3. Home Training 22
4. Boarding out 6
History 3
Investigation 19
96
IV
Nature of service rendered:
Investigation of homes 52
Placement in homes 34
Removal from homes 24
Arrangement for dental and medical care 83
Arrangement for recreation . 117
School adjustments 38
Home adjustments and home training lessons 150
History 22
Investigations • 24
Incidental services 269
V
Cases closed during the year:
Cases referred to public agencies 23
Cases referred to private agencies 5
Cases unable to locate 19
Cases committed to institutions 12
Investigations for Department 11
Cases not supervisable 28
Cases satisfactorily adjusted 38
136
VI
Status — November 30, 1939:
Committed cases 21
Voluntary cases 291
312
Summary of visits — Three Workers 1,957
120 P.D. 117
V. Social Service
Cases are referred to the Division of Mental Deficiency by child guidance clinics,
traveling school clinics, public and private agencies, by the Department and by indi-
viduals. Each case is studied carefully and a selected group becomes eligible for :
I. Supervision under commitment. Cases are under legal status authorizing the
Department to supervise in the community for an indefinite period.
II. Voluntary supervision. Cases not requiring commitment but which need our
services in adjusting to community living.
III. Special cases include investigations for the Department; such as, histories for
prison cases, cases referred from outside the state, etc.
Records kept for both committed and voluntary cases include: (1) History, (2) Inves-
tigation, (3) Social case work, (4) Social analysis.
During the year 1939 the Division of Mental Deficiency had 488 cases under its super-
vision (Table 15). Of these cases, 136 were closed as follows: 23 to public agencies; 5 to
private agencies; 19 moved, address unknown; 12 committed to institutions; 11 inves-
tigated for Department; 28 not supervisable or application withdrawn; 38 adjusted
satisfactorily in community. These 38 patients have reached the point where they
appeared capable of "carrying on", in most cases having been under the guidance of
the Department for a number of j^ears. One girl was discharged as she had been super-
vised for some time and proved capable, honest and reliable. It was felt she could be
self-supporting and make good without further supervision. It is interesting to note that
she still consults her social worker.
New cases referred for social supervision during the year classify as follows: 20 wage
earning; 26 special class; 22 home training; 6 boarding out; 3 history; 19 investigation.
Under Service Rendered the following was accomplished: 52 homes were investigated;
34 cases were placed in homes; 24 cases were removed from homes; 83 cases received
medical and dental care; 117 cases, recreation arranged for; 38 school adjustments;
150 home adjustments and home training lessons; 269 incidental services including
shopping.
The three visitors connected with the Division made 1,957 visits. Of these 716 were
made to patients; 498 were made to relatives and interested friends; 348 were made to
employers; 297 were made to agencies; 98 were made to clinics.
The Home Training for the children of very low mental ages who are living in their
own homes has been continued with very successful results. This work was described
in detail in the 1938 Annual Report. Both private and public agencies are interested
in this field and there are about forty children receiving the Home Training lessons at
the present time.
During the past year, the Division has been fortunate in finding a training home for
girls who have left special class but are not yet ready to become wage earners. They
average in age from sixteen to twenty and are trained in routine housework, cooking,
and the care of children. The home is situated in a rural section of a progressive town
where there are many church activities and a 4-H club. This affords a normal atmosphere
with wholesome recreation for these girls.
As time goes on more communities are aware of the need of planning for and working
with these handicapped people in their midst. We have found that even the low grade
child, under training adapted to his needs, may become at least a socially accepted
member of his own household and a happier human being. May we not then look for-
ward to doing greater things in bringing out inherent capacities and desirable traits in
others who classify as mental defectives?
An illustration of how much a community can do in a plan for a mentally deficient
girl follows:
1. Social worker from Division interviewed special class teacher re a possible
candidate for supervision by Department. Visitor gave teacher a typed program
telling her in detail what our work is and what our objectives are. School agreed
to keep girl until plan was made for her.
2. Special class teacher showed program to minister of church which girl attended.
This aroused his interest and he asked to keep program.
3. Public agency helping family interviewed. It was felt by agency and social
worker that girl should be removed from her home as a very undesirable older sister
was returning to the home and mother was away during the day. Mother was not
P.D. 117
121
willing to consider plan to remove girl from home at this time. The public agency
was finally able to persuade the mother with the help of the minister.
4. Girl examined at a State school clinic. Taken to clinic by special class teacher.
Girl found physically fit and community supervision recommended.
5. Public Welfare worker explained case fully to local judge. Girl committed
to the Department of Mental Health.
6. Minister found a home where woman was willing to train the girl.
In this instance the social worker interested a teacher in a program for mental defec-
tives. The teacher interested the girl's pastor. The public agency cooperated by arrang-
ing commitment to the Department of Mental Health. The judge in this case has shown
keen interest. The State schools helped by arranging for the examination of the girl to
determine her eligibility. A private agency was contacted in regard to placement of the
girl and became interested, too, in the program. Besides the agencies involved, the local
church people supplied uniforms for the girl, and lest she become homesick, the pastor
telephoned or saw her during her first weeks away from her home. Even if this girl
should not prove one of our "successes" she will have aroused a whole community to
work together to give her the chance she needed to bring out her potentialities and help
her to become a self-supporting member of her community.
VI. Analysis of Waiting Lists of All State Schools, 1939
In 1929 the Division assumed a new duty of assembling statistical data in reference
to the waiting lists comprising urgent applications to the three state schools for the
mentally deficient. A brief code was outlined embracing descriptive data on these wait-
ing list cases. The superintendents of the three schools reviewed their applicants, elim-
inating all cases not considered as urgent. They then filled out a code sheet for each
urgent case as of the date July 1, 1929, and forwarded these to the Division. The Sta-
tistical Division then transcribed the information from the coded sheets to punch cards,
and subjected the material to analysis.
The waiting lists are kept up to date at all times. Each month the state schools forward
to the Division their code sheets for all new cases placed on the waiting list during the
month. They also send in lists of all cases withdrawn from these waiting lists for any
reason whatsoever. This enables us to keep the lists balanced at the end of each calendar
month. Punch cards are then made up for new cases and filed pending further analysis.
The descriptive material presented is of incalculable value to the Department in deter-
mining the type of expansion program to be adopted.
A few facts resulting from the analysis are presented in the following summary: On
November 30, 1939 there were 123 cases on the waiting list of the Belchertown State
School, 1,491 cases on the waiting list of the Walter E. Fernald State School, and 1,253
cases on the waiting list of the Wrentham State School. The total number on the waiting
lists for the three state schools was 2,867. Of these, 48.2% were males and 51.7% were
females.
Table 16. — Cases on the Waiting List of the Three State Schools on November 30, 1939,
by County and City or Town of Residence
County and
City or Town
of Residence
Number
County and
City or Town
of Residence
Numb er
County and
City or Town
of Residence
Number
Barnstable .
38
Pittsfield .
9
Raynham
1
Sheffield .
1
Rehoboth
3
Barnstable
7
Washington
1
Somerset .
2
Bourne
1
Williamstown .
3
Swansea .
2
Brewster .
1
Windsor .
1
Taunton .
23
Chatham
1
Westport
4
Dennis
6
Bristol .
238
Falmouth
10
Dukes
. 2
Harwich .
1
Attleboro
12
Mashpee . .
2
Berkley
2
Edgartown
1
Orleans
3
Dartmouth
5
Gosnold .
1
Provincetown .
5
Dighton .
1
Yarmouth
1
Easton
Pairhaven
6
7
Essex
284
Berkshire
23
Fall River
65
Amesbury
8
Freetown
1
Andover .
10
Adams .
2
Mansfield
13
Beverly .
9
Cheshire .
1
New Bedford
83
Boxford .
1
Great Barrington .
4
North Attleboro
6
Danvers .
9
North Adams .
1
Norton
2
Georgetown
1
122 P.D. 117
Table 16. — Cases on the Waiting List of the Three State Schools on November 30, 1989,
by County and City or Town of Residence. — Concluded
County and
City or Town
of Residence
Number
County and
City or Town
of Residence
Number
County and
City or Town
of Residence
Number
Gloucester
Groveland
Hamilton
Haverhill
Ipswich
Lawrence
Lynn
Manchester
Marblehead
Merrimac
Methuen
Middleton
Nahant
Newburyport
North Andover
Peabody .
Rockport
Rowley
Salem
Salisbury
Saugus
Swampscott
Franklin
Bernardston
Buckland
Conway .
Deerfield .
Gill .
Greenfield
Hawley
Montague
Orange
Shelbourne
Shutesbury
Wendell .
Hampden
Agawam .
Chester .
Chicopee .
Hampden
Holyoke .
Ludlow
Palmer
Springfield
Westfield
West Springfield
Hampshire
Amherst .
Belchertown
Chesterfield
Easthampton
Granby
Huntington
Northampton
Ware
Middlesex
Acton
Arlington
Ashby
Ashland
Ayer
Bedford
Belmont
Billerica
Boxborough
Burlington
14
Cambridge
1
Carlisle
1
Chelmsford
29
Concord .
8
Dracut
46
Everett .
50
Framingham
2
Hudson
2
Lexington
2
Littleton
12
Lowell
1
Maiden
1
Marlborough .
18
Maynard
3
Medford .
14
Melrose .
2
Natick
1
Newton
28
North Reading
1
Pepperell
6
Reading .
4
Shirley .
Somerville
20
Stoneham
Tewksbury
1
Townsend
2
Wakefield
2
Waltham
1
Watertown
1
Wayland .
1
Westford .
1
Weston
4
Wilmington
2
Winchester
T
i
3
Woburn
Nantucket
40
Nantucket
1
Norfolk
3
8
Avon
1
Bellingham
6
Braintree
1
Brookline
1
Canton
15
Cohasset .
3
Dedham .
1
Foxborough
Franklin .
23
Holbrook
Medfield .
3
Medway .
7
Millis
1
Milton
2
Needham
4
Norwood .
1
Quincy
3
Randolph
2
Sharon
Stoughton
>43
Walpole .
Welles! ey
1
Westwood
14
1
1
2
2
Weymouth
Plymouth
Abington
11
Bridgewater
2
Brockton
2
Duxbury .
2
Hanover .
81
Hanson .
2
Hingham
4
Hull
2
Kingston ....
1
Lakeville ....
27
Marion . . . .
15
Middleborough
9
Norwell .
5
Plymouth
1
Rockland
51
Scituate ....
45
Wareham
11
West Bridgewater .
4
Whitman
41
15
Suffolk
11
37
Boston . . . .
1
Chelsea . . . .
2
Revere .
7
1
53
Winthrop
Worcester
10
70
Athol . . . .
2
Auburn . . . .
13
Barre . . . .
23
Blackstone
21
Boylston .
1
Brookfield
1
Charlton . . . .
1
Clinton . . . .
6
Fitchburg
15
Gardner . . . .
16
Grafton .
Harvard . . . .
1
Holden . . . .
Hopedale
1
Lancaster
Leicester . . . .
55
Leominster
Milford . . . .
4
Millbury . . . .
2
Northbridge
9
North Brookfield .
12
Oxford .
5
Phillipston
1
Royalston
8
Shrewsbury
3
Southborough
6
Southbridge
1
Sterling . . . .
2
Sturbridge
3
Sutton . . . .
2
Templeton
8
Upton . . . .
7
Uxbridge ....
11
Warren . . . .
36
Webster . . . .
6
Westborough .
6
Westminster .
4
Winchendon .
5
5
1
Worcester
Non-Residents
8
Unknown
01
9
Grand Total
14
27
3
3
Table 16 outlines the number of cases on the waiting lists of our three state schools
in accordance with place of residence. Residents of Suffolk County show the largest
number of cases on the waiting lists with a total of 791. Middlesex County is second with
643; Worcester third with 299; and Essex County fourth with 284. The smallest numbers
on the waiting lists are presented by Nantucket with 1 case, Dukes with 2, and Berkshire
and Hampshire with 23 cases each.
P.D. 117
123
In reviewing the reasons for the urgency of admission, we note that retardation was
the cause of application in 70% of both sexes together. Behavior was the primary reason
in 5% for both sexes. Marked physical defect was the reason in 1.1% of cases, and .2%
were social problems.
With regard to the intelligence quotient of children on the waiting lists, we note that
the males exceeded the females in the imbecile group (males 25.6%, females 24.3%),
and the not mentally defective group (males 7.1%, females 6.0%). The females showed
a higher percentage than the males in the moron group (females 31.2%, males 25.4%).
In reference to the ages of applicants on the waiting lists, 80% of the males were under
15 years of age, while but 60% of the females fell in this group. In the age group 15-19
years 12% of the males and 19% of the females were reported. But 3% of males are
placed on the waiting lists at ages of 20 years or over, as against 16% of the females.
Twenty-one cases on the list were 40 years of age or over. These cases make up .4%
of the males and .9% of the females. It is clear that many of the mentally defective
boys get into difficulties under 15 years of age. The girls have more difficulties in the
older ages.
A study was also made of the source of application by county of residence, and com-
pared with the estimated population of these counties in 1939 (Graph II). The highest
rate of applications per 100,000 of the population was observed in Barnstable County
with a rate of 94 applicants. Suffolk was second with 84; Middlesex third with 65;
Bristol fourth with 64; and Plymouth and Worcester fifth with 59. Essex, Norfolk,
Franklin, Dukes, Hampshire, Nantucket, Berkshire and Hampden presented the lowest
rates with 55, 45, 38, 31, 30, 29, 18 and 12 persons on the application list per 100,000 of
the population of each county, respectively.
Graph II. — Residence of Applicants on Waiting Lists of
State Schools, 1939: Rates per 100,000 Estimated
Population of Same County
The total of 2,867* on the waiting lists of the three schools indicates the urgent need
for the enlargement of our present schools and the construction of an additional institution
to care for these mentally deficient individuals.
*This total is revised monthly with consideration of all withdrawals and new additions during the month.
124 P.D. 117
VII. Recommendations
Every three months the Division prepares a detailed analysis of the waiting list of
each state school and presents it to the superintendent of the institution for his informa-
tion. Our analyses of the waiting lists for admission to the three state schools have
demonstrated the need for increases in institutional provision for mental defectives.
The total of 2,867 cases on the waiting lists indicates an urgent need for the enlargmeent
of existing facilities and the construction of an additional state school to care for mentally
defective individuals now in the community. The rate of increase in the number of new
and unsuccessful applicants for admission each year is so high that the foregoing con-
clusion is inescapable. In 1938 only 280 children could be admitted to our three state
schools, and in 1939 only 308, whereas 453 were admitted in 1937. When new construc-
tion does not keep up with the increasing demand, overcrowding results and the number
of possible admissions decreases from year to year. The state school is the nucleus around
which a satisfactory plan for the care of mental defectives must be built. There is a
type of mental defective with certain physical or conduct difficulties that can be best
cared for within a state school. Without adequate provision for this destructive institu-
tional type of case, other efforts in the care of this group are severely handicapped.
In the past the supposedly ideal treatment of the mental defective of high mental
grade has been admission to a specialized school, a period of education and training,
followed by placement at wages and supervision in the community. There is little doubt
but that this schedule is necessary and advisable for certain types of cases. However,
with changing economic and social conditions, increasing numbers of mental defectives
have come to the attention of various social and state agencies. For several years the
three state schools in Massachusetts have had a resident population of over 5,000 persons,
and about 300 admissions each year. To the Central Registry for Mental Defectives
over 4,000 cases of mental deficiency have been reported each year. Based on the 1939
figures, 7.4% or one in thirteen of the new cases being registered is gaining admission
to a state school, leaving 93% still in the community. Within ten years our registry
will have over 40,000 new cases recorded. About 3,000 of these will have gained admis-
sion to a state school, leaving 37,000 remaining in the community. The need for com-
munity supervision is obvious.
The cost of state school care in Massachusetts, including capital charges and depre-
ciation, is about $450 per year. Community supervision can be supplied by our Divisional
workers at a cost of about $30 per year. If we look ahead to the 40,000 new cases that
will be registered by 1949, we see that the cost of making institutional provision for this
entire group* would be approximately $80,000,000. In addition, the cost of maintenance
would be approximately $15,000,000 per annum. State-wide community care of this
group would cost approximately $1,200,000 per year. Here we have the suggestion that
community care is not going to be the advisable approach for the future but the abso-
lutely necessary one. During the past year the three workers of the Division were asked
to care for a total of 488 cases. As is well known, this is an impossible case load. This
average case load of 162 cases per worker means that only a limited service can be ex-
pected. It is requested that two additional social workers be made available to the
Division of Mental Deficiency for the more efficient carrying out of the present work
and the extension of our present activities.
The special class movement has been of great help in the keeping of the younger
retarded children in the community. Without this development in the field of education
many additional thousands of children would have had to be admitted to one of our
state schools. The special class cares for this retarded group until they are sixteen.
When they leave school this supervision is relaxed and difficulties arise. At the age of
16 the mental defective is not ready to stand on his own feet alone and unassisted. Ad-
ditional supervision for these children until they reach the age of 21 would be of tre-
mendous benefit in tiding them over a very critical period, and would undoubtedly keep
in the community many now being admitted to state schools between the ages of 16
and 21. In certain instances it may be feasible to continue special classes to older ages
than 16 years. In other instances the school itself may be able to provide the necessary
supervision for children leaving special classes. However, in the great bulk of cases
available, service such as is supplied by the Division of Mental Deficiency should be made
*This estimate is based upon a conservative construction cost per bed of $2,000. Recent costs in Massa-
chusetts have run above S3, 000 per bed.
P.D. 117
125
use of in this important supervision project. Community adjustment and self-support
are accomplishments which are beyond many mental defectives unless a guiding hand
is available. The means of providing this needed assistance should be effected at the
earliest possible date.
At the end of 1939 the Division was carrying a total of 312 persons on its books. Many
of these would require admission to a state school if this supervision were not available.
The keeping of these cases in the community has been responsible for a saving to the
Commonwealth of many thousands of dollars reckoned in terms of state school care.
At a time when expenses of state school provision are becoming almost prohibitive,
the enlargement of the divisional activities along the line of community supervision
seems a more sensible way of caring for the thousands of mental defectives coming to our
attention. We should be working toward a state- wide plan for the community super-
vision of mental defectives. A plan for the supervision of mental defectives in the younger
years will mean a smaller number of these individuals becoming public charges later
in life.
Appreciation is herewith expressed to the Commissioner for his cooperation through-
out the year.
Respectfully submitted,
Neil A. Dayton, M.D., Director
REPORT OF THE SUPPORT DIVISION
To the Commissioner of Mental Health:
I herewith report the work of this Division for the year ending November 30, 1939,
as follows:
Visits to the Hospitals 179
Histories taken at Hospitals 4,964
Visits to relatives of patients and others for investigation:
By outside visits 6,130
By office calls 814
By telephone 1,545
Total Investigations 8,489
Cases submitted for deportation to the U. S. Commissioner of Immi-
gration
Cases submitted for deportation by the Department
Support Cases not including Ex-Service men of the World War
Cases pending November 30, 1938 1,248
New Cases 3,502
Made Reimbursing .
Accepted as State Charges
Pending November 30, 1939
Reimbursing Cases
Cases remaining in Hospitals November 30, 1938
New Cases
Died
Discharged or on visit Nov. 30, 1939 .
Dropped — accepted as State Charges
Transferred toother Institutions .
Accepted by Veterans' Administration
Remaining in Hospitals Nov. 30, 1939 .
o
97
4,750
1,114
2,064
1,572
4,750
2,307
1,199
3,506
392
554
158
85
5
2,312
3,506
Cases of Ex-Service men of the World War considered by the U. S. Veterans' Ad-
ministration for support between November 30, 1938 and November 30, 1939
Cases remaining in Hospitals Nov. 30, 1938 „ 8
New Cases 14
22
P.D. 117
0
9
1
12
22
462
12
450
462
146
28
174
17
157
126
Died
Discharged or on visit
Made Reimbursing
Remaining in Hospitals Nov. 30, 1939 . . . ...
Ex-service men actually in the Hospitals November 30, 1939
Cases chargeable to Veterans' Administration
Cases not yet chargeable (rejected or pending)
Attorney General Cases
Cases pending in the office of the Attorney General, Nov. 30, 1938
Reported during the year
Cases closed during the year
Cases pending Nov. 30, 1939
174
Summary of Work of Investigators and Clerical Force
There were 946 investigations made at Probate Courts. In addition to outside work,
the staff of Investigators spent nearly 5,000 hours in the office preparing for such work
and reporting the results of their investigations.
Three thousand, three hundred and eight-four letters were written concerning the
general work of the Division and 1,209 letters concerning ex-service men and Veterans
Administration matters. 336 clinical abstracts and 579 stencils forms were transmitted
to the Veterans Administration.
Eight thousand, two hundred and twenty-eight documents relating to Probate matters
were handled. 5,758 history slips were prepared for the use of the Investigators and,
including transfer records, 6,770 histories were written.
About 20,000 bills were sent out, not including bills sent to the Veterans Administra-
tion. Bills amounting to $6,974.00 were rendered to the Veterans Administration during
the year.
Receipts for Support of Reimbursing Patients
Hospital
Psychopathic .
Boston
Danvers
Foxborough
Gardner
Grafton
Medfield .
Metropolitan .
Northampton .
Taunton .
Westborough .
Worcester .
Monson
Belchertown
Fernald
Wrentham
Infirmary .
Bridge water
Hospital Cottages
Family Care
Foxboro Labor
Alms Houses
Year ending:
Year ending:
Total since
Nov. 30, 1938
Nov. 30, 1939
Jan. 1, 1904
$565.00
$445.80
$41,400.93
88,072.67
82,353.79
1,881,539.35
105,145.07
105,904.04
2,455,426.56
52,139.61
58,028.42
828,526.74
37,779.24
28,592.70
495,414.79
25,384.34
31,529.68
511,521.74
48,817.39
44,521.76
885,599.95
47,763 . 74
50,525.41
331,803.35
89,610.11
101,359.63
1,912,465.10
61,196.50
75,872.36
1,387,172.14
110,590.70
110,354.84
2,439,731.34
66,865.87
58,769.07
1,792,045.19
15,040.37
14,269.05
419,497.25
5,733.47
11,780.18
98,654.03
19,242.14
19,362.04
379,550.15
11,299.52
13,033.07
191,491.25
1,444.47
6,840.71
102,048.23
3,077.57
4,759.49
121,993.42
416.69
416.67
3,443.29
-
—
17,344.87
—
-
3,370.45
-
-
923 . 66
$790,184.47
$818,718.71
$16,300,963.78
This report shows that the total collections on account of reimbursements for support
of patients were $818,718.71. Of this amount $6,288 was received for the support of
ex-service men of the World War, leaving a balance of $812,430.71 as the amount col-
lected for the support of civilian cases. ' ( ]
Total receipts for support indicate a per capita collection for the year of $28.07 as
against $27.52 for year ending Nov. 30, 1938.
P.D. 117
Yearly Totals from January 1, 1904
From January 1, 1904 to September 30, 1904
Year ending September 30, 1905
From October 1, 1905 to November 30, 1906 (14 months) . . . .
Year ending November 30, 1907
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
Year ending November 30
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919 (including soldiers $3,421.75)
1920 (including soldiers 99,008.25)
1921 (including soldiers 106,951.57)
1922 (including soldiers 127,106.00)
1923 (including soldiers 106,573.00)
1924 (including soldiers 302,434.00)
1925 (including soldiers 36,271 . 00)
1926 (including soldiers 67,369.00)
1927 (including soldiers
1928 (including soldiers
1929 (including soldiers
1930 (including soldiers
1931 (including soldiers
1932 (including soldiers
1933 (including soldiers
1934 (including soldiers
1935 (including soldiers
1936 (including soldiers
1937 (including soldiers
1938 (including soldiers
1939 (including soldiers
84,500.00)
87,599.00)
14,926.86)
18,104.00)
19,048.00)
849 . 00)
11,220.00)
6,698.00)
4,642.00)
7,634.00)
9,477.00)
7,823.00)
6,288.00)
127
$31,882.11
72,750,93
87,804.66
79,495.76
86,867.04
102,468.57
117,588.91
124,083.94
133,059.95
133,818.23
130,671.57
139,375.33
141,585.18
174,710.70
179,161.66
182,240.81
296,178.62
311,631.57
359,582.44
364,142.75
601,505.73
452,416.45
922,452 . 99
987,469 . 80
,006,625.43
939,846.19
947,503.03
917,593.67
819,870.81
778,830.53
754,582.59
779,117.76
765,727.72
769,417.17
790,184.47
818,718.71
$16,300,963.78
Number and Board Rates of Reimbursing Patients for the Year Ending
October 1, 1939
United States
Average
Weekly
per
Deportation Cases
Soldier C
ases
Institutions
Daily Average
October
Average
Average
Number
Capita
1,
1939
Daily
Weekly
Daily
Weekly
Rate
Average
Number
Per
Capita
Average
Number
Per
Capita
M.
F.
M.
F.
M. F.
M. F.
Psychopathic
.21
.46
6.94
0
0
.14
35.00
_ _
_
Boston .
65.63
155.71
7.42
72
164
— —
-
.06 .92
14.00
Danvers
88.06
179.12
7.49
97
211
- -
-
.58
14.00
Foxborough .
54.63
83.42
7.55
55
114
- -
-
.13
14.00.
Gardner
23.97
45.39
7.85
30
56
— —
-
— —
_
Grafton
18.27
43.55
8.17
18
29
- —
-
.47
14.00
Medfield
34.46
68.25
8.06
35
70
.34
35.00
.17
14.00
Metropolitan
34.67
90.82
7.87
49
102
- -
-
.18
14.00
Northampton
76.88
161.11
7.47
75
177
_ _ .
-
1.00
14.00
Taunton
58.73
108.40
7.56
54
126
.08
35.00
.36
14.00
Westborough
92.57
184.08
7.49
88
227
- -
-
.72 1.80
14.00
Worcester
60.99
87.17
7.85
72
107
— -
-
.20 .92
14.00
Monson Sane 1 .
Insane/
25.82
29.12
4.84
32
32
— —
—
— -
—
Belchertown
15.39
15.96
5.57
22
22
— —
—
— —
-
Fernald
33.93
27.61
6.12
54
36
— -
—
- —
—
Wrentham .
31.00
17.57
5.17
48
26
_ —
-
— —
—
Infirmary
.47
7.31
6.16
0
9
- -
-
- —
-
Bridgewater
9.72
-
7.24
5
0
— —
-
1.42
14.00
Hosp. Cottages .
2.43
1.00
2.47
4
1
- -
—
— -
-
Family Care
-
-
-
0
2
-
-
- _
727.83
1,306.06
7.39
810
1,511
.56
35.00
4.82 4.11
14.00
I am submitting on the same sheet, a statement showing receipts on account of support
for each year from January 1, 1904, which shows the receipts by hospitals for each year
and also for the year ending November 30, 1938, and the total receipts credited to each
hospital since January 1, 1904. The total receipts on account of reimbursements since
January 1, 1904 are $16,300,963.78.
This Division has an active reimbursing list of approximately 2,312, the maximum rate
in any case being $10 per week and the minimum rate being 50 cents per week.
128 P.D. 117
For the fiscal year ending November 30, 1939, this Division of the Department sub-
mitted 102 cases to the Medical Division, for deportation to other states and countries.
Respectfully submitted,
Paul A. Green, Supervisor.
Acknowledgment
Grateful appreciation is herewith expressed to the Rockefeller Foundation for the
appropriation received to be used in the work of completing and publishing some of the
researches conducted under previous grants. The first volume of publication is expected
in January, 1940. Under date of November 20, 1939 the Foundation was good enough
to extend the present grant for one year or until December 31, 1940. We anticipate
that additional material will be brought out within the coming year.
Clifton T. Perkins, M.D., Commissioner.
REPORT OF THE DIVISION OF STATISTICAL RESEARCH
To the Commissioner of Mental Health:
A report of the work of the Division of Statistical Research for the year ending Novem-
ber 30, 1939 is respectfully submitted.
During the past year the analysis and writing up of the Rockefeller Foundation Re-
search material has been continued and the material for the first volume was completed
and accepted by a publisher. It is anticipated that this book will come from the press
early in 1940. The analysis and writing up is being continued, and it is hoped that a
second volume will be completed in the coming year.
The Director wishes to express his appreciation to the Commissioner and to the other
members of the Research Committee for their cooperation and advice which has been
most helpful at all times.
Respectfully submitted,
Neil A. Dayton, M.D., Director.
REPORT OF THE DIVISION OF STATISTICS
To the Commissioner of Mental Health:
A report on the work of the Division of Statistics for the year ending November 30?
1939, is respectfully submitted.
Summary of Contents, Division of Statistics
I. Departmental Statistics, Tables A. to J. — Pages 131-138
II. Statistical Review: Subjects of Text Discussion.
A. General Discussion of All Classes under Care in Mental Hospitals — Pages
141-147
B. Admissions to Mental Hospitals During 1939. — Pages 147-176
C. Discharges to the Community from Mental Hospitals During 1939. — Pages
176-198
D. Deaths in Mental Hospitals During 1939. — Pages 198-216
E. Resident Population and Patients Out of Mental Hospitals on September 30,
1939. — Pages 216-238
F. General Discussion of All Classes under Care in State Schools. — Pages 238-243
G. Admissions to State Schools During 1939. — Pages 244-251
H. Discharges to the Community from State Schools During 1939. — Pages 251-261
J. Deaths in State Schools During 1939. — Pages 261-270
K. Resident Population and Patients Out of State Schools on September 30, 1939.
— Pages 270-287
L. General Discussion of Epileptics (Non-Psychotic) Under Care, 1939. — Page 288
M. Admission of Non-Psychotic Epileptic Patients, 1939. — Pages 288-289
N. Discharges to the Community of Epileptic Patients (Non-Psychotic), 1939. —
Pages 289-290
O. Deaths of Epileptic Patients (Non-Psychotic), 1939. — Pages 291-292
P. Non-Psychotic Epileptics in Residence on September 30, 1939. — Page 292
III. Graphs
Departmental Statistics — Graphs A. to C.
Mental Disorders — Graphs 1 to 9, inclusive.
Mental Deficiency — Graphs 10 to 16, inclusive.
P.D. 117 129
IV. Detailed Tables.
Mental Disorders — Pages 298-425
Mental Deficiency — Pages 426-456
Non-Psychotic Epileptics at Monson State Hospital — Pages 293-296
Since 1927, a completely centralized statistical system has been in operation in the
thirteen State Hospitals and the three State Schools. A new system of recording data
on all patients was put into effective operation, both at the individual institutions and
at the central Department. By this means the amount of available data on our patient
population, both insane and feebleminded, was tremendously increased. The system
was installed also at the Bridgewater State Hospital, the Mental Wards at Tewksbury,
the McLean Hospital, and U. S. Veterans' Hospitals Nos. 95 and 107, Northampton
and Bedford, respectively. A total of twenty-one institutions come under the Depart-
ment statistical system and this provides an invaluable Statewide sample of mental
disease or defect for any one year. Approximately ninety-eight per cent of admis-
sions for mental disease in the Commonwealth are reported by this means.
Each institution sends to the Department a statistical card indicating the admission,
discharge or death of each patient, and at the end of the year a set of twenty standard
tables are made up and returned to the institution for publication in its annual report.
All statistical work is removed from the institution and the machine equipment at the
central office made use of to relieve institutions of these duties. The Division also pre-
pares the annual report for each hospital and school which is required by the United
States Bureau of the Census. Other analyses are made from time to time in connection
with various research projects under way in certain hospitals and schools.
During 1934, a new departure was made in presenting statistics on patients in our
mental hospitals. In addition to presenting data in accordance with the new psychiatric
classification of mental disorders, all admissions, discharges, deaths, resident population
and patients out of institutions were divided into first and readmissions.
This is a new approach which has been developed and used for the first time in Massa-
chusetts.
The 1934 Report was the first to add an analysis of patients out of institutions, on
visit, etc., at the end of the year. In view of the fact that these patients comprise ten
per cent of the total number of cases on the books of mental hospitals in this State, their
inclusion in our annual statistics has been made a permanent procedure.
From year to year certain general refinements and additions are made to the Annual
Report. These are adopted in accordance with the numbers of requests for new and
heretofore unpublished data, or to complete the presentation of certain items which had
formerly been only partially covered.
The year of 1937 marked a very significant change in the presentation of statistics
by the Department. It has been deemed advisable to change completely the set-up used
in the past in reference to the cases designated as first or readmissions. When Massa-
chusetts adopted its statistical system in accordance with the advices of the National
Committee for Mental Hygiene in the year 1917, first admissions under court commit-
ment were to take precedence over all other forms of admissions. Consequently, pre-
vious admissions under temporary care or observation commitment were discarded in
deciding whether a case was a first or a readmission. At the time of the adoption of this
criterion, it was felt that the court commitment cases were usually psychotic, while the
other forms of admission embraced the non-psychotic group. Recently, an investigation
under our Rockefeller Research project showed that definite changes have taken place
over the years which render invalid these original assumptions*. Our research analyses
have shown that substantial numbers of temporary care and observation care cases
discharged at the end of the ten-day or thirty-five day period have been diagnosed as
"with psychosis". Under the old statistical plan, these admissions were not counted.
If these patients were admitted a year or two later on a court commitment, the previous
temporary care admission would be discarded and the present admission considered as a
first admission. Cases have been encountered with several previous admissions, all with
psychosis, coming in under the various short forms of admission. Yet, when first ad-
mitted on court commitment, they have been reported as a first admission.
* The research material for the years 1917-1933 has been used to give us the data for trend studies, all
presented on the new basis. The tables showing changes in the psychoses over the years 1917-1933 are
also based upon the research analysts. Otherwise the present report would offer data which could not be
compared with the earlier years.
130 P.D. 117
These facts have seemed to warrant a complete change in the classification of our
first and readmissions. Experience has taught that a first or readmission should mean
exactly what this classification suggests. A first admission should mean that the patient
is entering a mental hospital for the first time. Clearly, the administrative detail of his
entrance, such as form of admission, is a minor issue. In turn, a readmission should
mean that the patient has had a previous admission to a mental hospital and is again
being returned to a mental hospital. The old classification as to first and readmissions,
originally adopted in accordance with the criteria of the National Committee for Mental
Hygiene, no longer meets our changed requirements.
It may be well to explain that the inclusion of all types of admission forms in our
regular statistics will mean an increase in admission rates in comparison with the previous
statistics based on court commitments only. However, the admission rates of the past,
based on court admissions only, were understating the number of psychotic individuals
admitted to our mental hospitals. It is obvious that this condition should be corrected
at the earliest possible moment. While this change will increase our admission rates,
at the same time it will also increase the discharge rates. The past emphasis on court
cases tended to minimize the efficiency of our hospitals in that patients remaining for
shorter periods, those admitted by temporary care, observation or voluntary admission,
are excluded from the statistics on discharge. Many of these are definitely psychotic.
This means that our discharge rates were based on the court cases, which have a longer
hospital stay. Inclusion of the short residence psychoses will balance this situation and
show the true situation in reference to both discharge rates and the length of hospital
stay. For example, the court cases "with mental disorder" who were discharged during
1936 showed a hospital residence of 1.1 years (first admissions) and 1.8 years (read-
missions). By including all types of admissions, the 1939 cases "with mental disorder''
who were discharged show an average hospital stay of .8 years (first admissions) and 1 .3
years (readmissions). This change enables us to present the true picture of the outcome
of all admissions "with mental disorder" and of the general efficiency of our mental
hospitals in Massachusetts. ;
. Another change was initiated beginning with the 1937 report. For many years the
statistics of the Monson State Hospital have been unsatisfactory owing to the obvious
mixture of the patients at that institution. Monson has not only cared for epileptics
with psychoses but also for other, and often younger patients who have epilepsy without
the presence of a mental disorder. For some years, the section on convulsive disorders of
the American Psychiatric Association has presented a separate clinical classification for
epileptics without mental disorder. Other states have used this clinical classification in
reporting their non-psychotic epileptics and it has been deemed advisable that Massa-
chusetts should conform to this procedure so that comparable statistics may be available.
As a consequence, in 1937 the statistics of the Monson State Hospital were divided into
two sections. The first section is based on the psychiatric classification and presents
data on the epileptic psychoses using the regular standard tables of the American Psychi-
atric Association. The second section is based upon the clinical classification of con-
vulsive disorders, non-psychotic. These tables are presented completely in the Annual
Report of the Monson State Hospital, and certain of the tables on the non-psychotic
epileptics are also presented in a new section on the Annual Report of the Department
of Mental Health.
With the exception of the above changes, the present report presents the same material
as in preceding years. The main part of the report, devoted to mental diseases, offers
separate sections on admissions, discharges, deaths, and resident population. The
material of these sections, is, of course, divided into first and readmissions. The section
on mental deficiency presents the same divisions. Owing to the extremely small numbers
of readmissions, however, the discharges, deaths, and resident population are not divided
into first and readmissions. The third section on non-psychotic epileptics completes the
report which embraces a total of 278 tables.
Respectfully submitted,
Neil A. Dayton, M.D., Director
P.D. 117
131
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135
Table E. — Percentages of Total Net Expenditures by the State Expended for the
Care of Mental Disease, Mental Defect and Epilepsy from 1913 to 1989
Total Expended for
Fiscal Year Ended November 30 or
Total Expended
Care of Insane
Each Year
by the State
Feebleminded and
Epileptic*
Percentage
1913
$24,543,221.70
$4,632,593.84
18.88
1919 . , .
53,769,626.25
6,864,669.63
12.77
1920
46,648,928.67
7,852,184.56
16.83
1921
41,669,278.65
8,252,082.46
19.80
1922 ...
44,114,727.08
8,217,175.36
18.63
1923
45,438,413.85
8,777,574.59
19.10
1924
47,286,108.80
8,577,393.51
18.14
1925 .
46,613,633.49
8,506,305.01
18.25
1926 ....
49,164,754.28
8,674,918.98
17.64
1927
51,537,132.98
9,537,342.42
18.51
1928
53,763,560.75
10,441,689.17
19.42
1929 ....
58,346,381 . 85
12,030,668.66
20.62
1930
64,150,582.95
12,728,067.23
19.84
1931
75,282,580.95
12,408,228.22
16.48
1932
77,971,941.54
11,495,403.21
14.74
1933
64,091,084.85
8,921,067.31
13.92
1934
71,570,396.94
10,684,191.91
14.93
1935
83,034,847.94
14,314,064.13
17.33
1936
93,384,601.54
14,398,158.44
15.42
1937
98,604,007.51
13,533,255.49
13.72
1938
113,124,705.28
13,452,784.09
11.89
1939
131,571,492.03
13,790,233.58
10.48
* Includes Department, Institutions, Mental Wards at Tewksbury, and State Farm (Bridgewater) .
Note: — The absence of data for years 1914 to 1918 inclusive is due to the fact that figures are not avail-
able. Previous to 1918 the report of the Auditor of the Commonwealth did not show a recapitulation
giving the total State expenses inasmuch as many of the expenses of the State were paid out of funds. In
1924 a comparison of 1923 with 1913 was desired and an analysis of the Auditor's report of 1913 was made
throwing all fund expenditures into the revenue expenditures of that year. This was a task of such mag-
nitude that it has not been deemed advisable to continue covering the years 1914 to 1918 inclusive.
Table F. — Number of Patients in State Institutions for the Insane, Feebleminded,
and Epileptic, and Overcrowding, September 30, 1939
Institutions
Capacity
Patients
in
Institutions
Overcrowding
Number
Percent-
age
State Hospitals
Boston State Hospital
Boston Psychopathic Hospital
Danvers State Hospital .
Foxborough State Hospital
Gardner State Hospital .
Grafton State Hospital .
Medfield State Hospital
Metropolitan State Hospital
Northampton State Hospital
Taunton State Hospital
Westborough State Hospital
Worcester State Hospital
Total
Monson State Hospital (epileptic)
Total State Hospitals and Monson
State Schools
Belchertown State School
Walter E. Fernald State School .
Wrentham State School
Total
Aggregate All D. M. H. Institutions
Bridgewater
Tewksbury
Grand Total All Institutions
1,977
109
1,853
1,269
1,161
1,258
1,549
1,598
1,729
1,437
1,298
2,300
17,538
1,165
18,703
1,102
1,540
1,361
4,003
22,706
908
603
24,217
2,322
75
2,385
1,393
1,403
1,481
1,867
1,913
2,016
1,740
1,609
2,419
20,623
1,543
22,166
1,306
1,944
1,988
5,238
27,404
881
450
28,735
345
-34
532
124
242
223
318
315
287
303
311
119
3,085
378
3,463
204
404
627
1,235
4,698
-27
-153
4,518
17.45
-31.19
28.71
9.77
20.84
17.72
20.52
19.71
16.59
21.08
23.95
5.17
17.59
32.44
18.51
18.51
26.23
46.06
30.85
20.69
-2.97
-25.37
18.65
Note: — Minus sign indicates number or percentage below capacity.
136
P.D. 117
Table G. — Number of Patients and Overcrowding in State Institutions for the Insane
Feebleminded and Epileptic on September 30 for Five Year Periods,
1905-1980 and Yearly Periods 1930-1939 Inclusive
Rated
Capacity
Actual
Number of
Patients in
Institutions
Overcrowding
Institutions by Years
Excess
Number
of
Patients
Percent-
age
1905
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary
State Schools
8,552
462
9,014
1,022
1,002
8,552
521
9,073
998
1,028
59
59
-24
26
12.77
.65
-2.34
2.59
Total
1910
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary ....
State Schools ........
11,038
9,627
853
10,480
1,335
1,690
11,099
10,364
770
11,134
1,428
1,567
61
737
-83
654
93
-123
.55
7.65
-9.73
6.24
6.96
-7.27
Total
1915
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary ....
State Schools
13,505
11,489
968
12,457
1,491
2,488
14,129
12,240
1,015
13,255
1,531
2,309
624
751
47
798
40
-179
4.62
6.53
4.85
6.40
2.68
-7.19
Total .
1920
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary ....
State Schools .
16,436
12,593
967
13,560
1,508
2,823
17,095
13,204
960
14,164
1,522
2,820
659
611
-7
604
14
-3
4.00
4.85
-.72
4.45
.92
-.10
Total .
1925
State Hospitals
Monson Hospital — Epileptic . .
State Hospitals and Monson
Bridgewater and State Infirmary ....
State Schools
17,891
13,343
967
14,310
1,581
3,498
18,506
15,156
1,182
16,338
1,652
3,593
615
1,813
215
2,028
71
95
3.43
13.58
22.23
14.17
4.49
2.71
Total
1930
State Hospitals
Monson Hospital — Epileptic . . . . .
State Hospitals and Monson . . . . .
Bridgewater and State Infirmary ....
State Schools
19,389
14,689
1,131
15,820
1,581
3,866
21,583
16,809
1,290
18,099
1,749
4,159
2,194
2,120
159
2,279
168
293
11.31
14.43
14.05
14.40
10.62
7.57
Total
1931
State Hospitals
Monson Hospital — Epileptic . . . . .
State Hospitals and Monson . .
Bridgewater and State Infirmary . . . .
State Schools . . . . . .
21,267
16,171
1,131
17,302
1,581
4,061
24,007
17,474
1,340
18,814
1,632
4,412
2,740
1,303
209
1,512
51
351
12.88
8.05
18.47
8.73
3.22
8.64
Total . . : .
1932
State Hospitals . . . ... . ...
Monson Hospital — Epileptic . . . . .
State Hospitals and Monson . . . . .
Bridgewater and State Infirmary . . . .
State Schools
22,944
16,372
1,171
17,543
1,511
4,297
24,858
17,859
1,396
19,255
1,601
4,566
1,914
1,487
225
1,712
90
269
8.34
9.08
19.21
9.75
5.95
6.26
Total
1933
Monson Hospital — Epileptic . .
State Hospitals and Monson
Bridgewater and State Infirmary ....
State Schools .....
23,351
16,612
1,059
17,671
1,511
3,893
25,422
18,263
1,412
19,675
1,543
4,771
2,071
1,651
353
2,004
32
878
8.86
9.93
33.33
11.34
2.11
22.55
Total . ...
23,075
25,989
2,914
12.62
P.D. 117
137
Table G. — Number of Patients and Overcrowding in State Institutions for the Insane,
Feebleminded and Epileptic on September 30 for Five Year Periods,
1905-1930 and Yearly Periods 1930-1939 Inclusive — Concluded
Institutions by Years
Rated
Capacity
Actual
Number of
Patients in
Institutions
Overcrowding
Excess
Number
of
Patients
Percent-
age
1934
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary
State Schools ....
Total
1935
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary
State Schools ....
Total
1936
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary
State Schools ....
Total
1937
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary
State Schools ....
Total
1938
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary
State Schools ....
Total
1939
State Hospitals
Monson Hospital — Epileptic
State Hospitals and Monson
Bridgewater and State Infirmary
State Schools ....
Total
16,612
1,059
17,671
1,511
3,893
23,075
16,848
1,147
17,995
1,511
3,999
23,505
16,848
1,147
17,995
1,511
3,999
23,505
17,487
1,164
18,651
1,511
4,001
24,163
17,574
1,177
18,751
1,511
4,003
24,265
17,538
1,165
18,703
1,511
4,003
24,217
18,638
1,453
20,091
1,488
4,933
26,512
19,111
1,476
20,587
1,446
5,009
27,042
19,673
1,514
21,187
1,389
5,133
27,709
20,023
1,521
21,544
1,371
5,244
28,159
20,506
1,550
22,056
1,364
5,225
28,645
20,623
1,543
22,166
1,331
5,238
28,735
2,026
394
2,420
-23
1,040
3,437
2,263
329
2,592
-65
1,010
3,537
2,825
367
3,192
-122
1,134
4,204
2,536
357
2,893
-140
1,243
3,996
2,932
373
3,305
-147
1,222
4,380
3,085
378
3,463
-180
1,235
4,518
12.19
37.20
13.69
-1.52
26.71
14.89
13.43
28.68
14.40
-4.30
25.25
15.04
16.76
31.99
17.73
-8.07
28.35
17.88
14.50
30.67
15.51
-9.26
31.06
16.53
16.68
31.69
17.62
-9.72
30.52
18.05
17.59
32.44
18.51
-11.91
30.85
18.65
Note: — Minus sign indicates number or percentage below capacity.
138 P.D. 117
Table H. — Paying Patients, Number and Percent in State Hospitals on September 30,
1904-1939*
Number of
Number of
Percentage of
Year
Patients in
Paying
Resident
Institutions
Patients
Patients
1904
10,100
1,189
11.7
1905
10,071
1,217
12.1
1906 .
10,237
1,299
12.7
1907
10,602
1,300
12.3
1908
11,460
1,390
12.1
1909
11,994
1,488
12.4
1910
12,562
1,462
11.6
1911
12,972
1,521
11.3
1912
13,481
1,585
11.8
1913
13,949
1,603
11.5
1914
14,202
1,503
10.6
1915
14,786
1,506
10.2
1916
15,054
1,535
10.2
1917
15,434
1,512
9.8
1918
15,476
1.595
10.3
1919
15,217
1,548
10.2
1920
15,678
1,526
9.7
1921
16,428
1,683
10.2
1922
16,810
1,604
9.4
1923
17,051
1,985
11.6
1924
17,515
1,916
10.9
1925
17,990
2,051
11.4
1926
18,149
2,194
12.1
1927
18,573
2,282
12.3
1928
18,997
2,336
12.2
1929
19,391
2,345
12.0
1930
19,848
2,361
11.0
1931
20,446
2,310
11.2
1932
20,856
2,219
10.6
1933
21,218
2,156
10.1
1934
21,579
2,066
9.5
1935
22,033
1,998
9.0
1936
22,576
2,053
9.1
1937
22,915
2,081
9.1
1938
23,420
2,125
9.1
1939
23,497
2,106
8 9
1 Includes Mental Wards, Tewksbury, and Bridgewater.
Table J. — Paying Patients, Number and Percent in State Schools on September SO,
1904-1939
Number of
Number of
Percentage of
Year
Patients in
Paying
Resident
Schools
Patients
Patients
1904
897
95
8.9
1905
1,073
96
8.9
1906
1,170
92
7.9
1907
1,278
89
7.0
1908
1,382
82
5.9
1909
1,493
75
5.7
1910
1,617
60
3.7
1911
1,692
67
3.9
1912
1,895
70
3.7
1913
1,972
70
3.5
1914
2,244
41
1.8
1915
2,359
39
1.7
1916
2,632
37
1.5
1917
2,723
23
0.9
1918
2,813
21
0.7
1919
2,789
29
1.0
1920
2,870
30
1.0
1921
2,991
37
1.2
1922
2,899
31
1.0
1923
3,239
43
1.4
1924
3,510
52
1.5
1925
3,643
78
2.1
1926
3,710
121
3.3
1927
3,837
166
4.3
1928 ...
3,912
174
4.4
1929
3,941
151
3.8
1930
4,159
186
4.4
1931
4,412
192
4.3
1932
4,566
186
4.0
1933
4,771
192
4.0
1934
4,993
197
3.9
1935
5,009
199
3.9
1936
5,133
195
3.8
1937
5,244
203
3.9
1938
5,225
206
3.9
1939
5,238
208
3.9
P.D. 117
139
"5.54
/S/7
/920
WMM.
J930
1/93/
/932
W&3M
/934
1935
/936
/937
/938
WB'^s^
Graph A. — Average Weekly Per Capita Costs
for Maintenance, 1917 to 1939.
*7.32
#7.//
$6,4-7
1*5.76
*6.9B
*7.59
s4 / / / / //TTTTvv'
Graph B. — Per Cent of Cost of Maintenance
for All Patients, Collected from Paying
Patients, 1917 to 1939.
140
P.D. 117
JO .40
so .so */.oo
Graph C. — Portion of Every State
Dollar Expended on Mental
Health, 1919 to 1939.
P.D. 117
141
STATISTICAL REVIEW
Mental Disorders
Section A. General Discussions of All Glasses Within Mental Hospitals,
1939, and Previous Years
Section A is devoted to a general discussion of all classes within mental hospitals and
presents material in reference to the care of mental patients in Massachusetts for the
years 1904-1939. Other items of general interest are outlined.
All Classes Within Hospitals, 1939
Table 1 presents the number of patients in all classes within public and private institu-
tions on September 30, 1939.
Table 1. -
- Patients of All Classes Within Institutions
on September SO, 1989
Without Mental Disorder
Total
With
Institutions
All
Mental
Epileptic
Forms
Disorder
and
Epileptic
Mentally
Borderline
Other
Mentally
Defective
or Dull*
Groups
Defective
Mental Hospitals
Boston State
2,322
2,302
—
_
2
_
18
Boston Psychopathic
75
63
-
-
1
_
11
Danvers ....
2,385
2,366
—
—
3
_
16
Foxborough
1,393
1,393
—
_
_
_
Gardner
1,403
1,376
-
-
22
_
5
Grafton
1,481
1,477
_
_
3
_
1
Medfield
1,867
1,865
—
_
1
_
1
Metropolitan
1,913
1,913
—
—
_
_
Northampton
2,016
2,002
-
-
11
_
3
Taunton
1,740
1,740
-
_
-
_
Westborough
1,609
1,597
-
2
1
_
9
Worcester .
2,419
2,406
—
_
2
_
11
Monscn (Epileptic)
1,543
532
-
1,004
3
-
4
Total ....
22,166
21,032
-
1,006
49 .
79
State Schools
Belchertown
1,306
-
29
-
1,247
29
1
Walter E. Fernald .
1,944
-
49
-
1,860
33
2
Wrentham ....
1,988
-
146
-
1,796
46
Total ....
5,238
-
224
-
4,903
108
3
Other Public Institutions
Tewksbury State Hospital
and Infirmary
450
439
-
_
11
_
_
Bridgewater State Hospi-
tal (Mental) .
881
854
-
1
18
_
8
Bridgewater Defective De-
linquents
612
—
—
—
612
—
_
Infirmaries (County)
58
21
—
6
31
_
_
Hospital Cottages for
Children
64
-
-
-
64
-
-
Total ....
2,065
1,314
-
7
736
-
8
Private and Governmental
Institutions
McLean Hospital
211
206
-
1
_
_
4
Veterans' Adm. Facility,
No. 95 . .
779
775
-
_
2
_
2
Veterans' Adm. Facility,
No. 107 .
1,161
1,158
-
-
_
-
3
Twenty other private in-
stitutions
359
199
-
2
98
-
60
Total ....
2,510
2,338
-
3
100
-
69
Total — All Classes .
31,979
24,684
224
1,016
5,788
108
159
1 Patients not mentally defective.
There were 31,979 patients in all classes under treatment within public and private
institutions on September 30, 1939. This is a rate of 721 patients under treatment for
each 100,000 in the general population*, or approximately one person in 138. Of this
*Estimated population, 1939 — 4,431,946.
142 P.D. 117
total number 24,684 (77.1%) were diagnosed with mental disorder; 5,788 (18.0%) were
mentally defective; 224 (.7%) were both epileptic and mentally defective; 159 (.4%)
were classified as other groups; 108 (.3%) were borderline or dull; and 1,016 (3.1%) were
epileptic.
The total number under care in the twenty-two state and governmental institutions
was 31,409 or 98.2%. In the twenty-one private institutions the number was 570 or
1.7%. During the year the number of patients within hospitals increased from a total
of 31,248 on September 30, 1938 to a total of 31,979 on September 30, 1939, an increase
of 731 patients or 2.3%.
(a) The Mentally III
The patients with mental disorder in public and private institutions on September 30,
1939 number 24,684. This is a rate of 556 per 100,000 of the population of the State,
or one in every 179 of the population.
Those with mental disorder in State institutions numbered 22,346, a rate of 504 per
100,000 or one in every 198 of the population. This is an increase over the previous
year of 31 patients. Government hospitals cared for 1933 mental patients, a rate of
43 per 100,000 or one in every 2,325 of the population.
Mental patients in private institutions numbered 405, as compared with 383 for the
year 1938. This is a rate of 9 per 100,000 or one in every 11,111 of the population.
(b) The Epileptic and Mentally Defective
There were 224 patients who were both epileptic and mentally defective in public
institutions at the end of the year, a rate of 5 per 100,000 of the population.
(c) The Epileptic
The epileptic population numbered 1,016, most of whom were cared for in public
institutions. The rate is 22 per 100,000, or one in every 4,545 of the population. One
thousand six, or 99%, were at the Monson State Hospital for Epileptics.
(d) The Mentally Defective
There were 98 mentally defective patients in private institutions and 5,690 in public
and governmental institutions, a total of 5,788. This is a rate of 130 per 100,000 of the
population of the State, or one in every 769. There was an increase over the previous
year of 581 patients. The defective delinquents at Bridgewater were added to this
table during the present year and this accounts for the large increase over the preceding
year.
(e) Borderline or Dull
One hundred eight resident patients were classified as borderline or dull intelligence.
The rate for this group is 2 per 100,000 of the general population.
(/) Other Groups Without Mental Disorder
Patients in public, governmental and private institutions classified under "other
groups without mental disorder" numbered 159. Ninety-five were in public institutions,
comprising 59% of the total. The rate for this class is 3 per 100,000 of the general popu-
lation of the State. In the above group are included cases of alcoholism, drug addiction,
psychopathic personality and others not included in sections (b), (c), (d) or (e) above.
Patients Within Institutions and Annual Increase, 1904-1939
Table 2 presents the number of patients actually within public, private and govern-
mental institutions on September 30 of each year from 1904 to 1939 inclusive and the
annual increase for each year. In all hospitals, the number rose from 10,948 in 1904 to
31,309 in 1939, an increase of 185% or 5% per year. The average annual increase in
number of patients within hospitals is 589 cases.
The number of patients within State hospitals rose from 9,666 in 1904 to 23,497 in
1939, an increase of 143% or 4% per year. The average annual increase is 409 per year.
The number of patients within State Schools rose from 847 in 1904 to 5,238 in 1939, an
increase of 518% or 14% per year. The average annual increase was 123 patients per
year. The average annual increase of patients within private institutions for the insane
was 57. The mentally defective present an annual decrease of -.9.
P.D. 117
143
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P.D. 117
Table 3. — Patients on Visit and Escape from State Hospitals on September 30,
1928-1989: Numbers and Percentages
Yfar
Total Patients
on Books1
Patients
on Visit
Patients
on Escape
Percentage
on Visit
Percentage
on Escape
1928
1929 ....
1930
1931 .
1932 ....
1933 ....
1934 ....
1935 .
1936 ....
1937 ....
1938
1939
20,996
21,359
22,103
22,453
23,022
23,606
23,872
24,450
25,155
25,621
26,086
26,280
1,496
1.502
1,742
1,514
1,679
1,817
1,764
2,021
2,184
2,302
2,269
2,338
250
197
222
178
147
160
138
85
72
68
75
70
7.1
7 0
7.9
6.7
7.3
7.7
7.4
8.2
8.7
8.9
8.6
8.8
1.2
.9
1.0
.8
.6
.6
.6
.3
.3
.2
.2
.2
1 All classes on books of State Hospitals, Tewksbury and Bridgewater.
Patients Out of Institutions at End of Year
Table 3 records the number of patients out on visit and on escape at the end of each
year, 1928-1939. The number of patients on visit increased from 1,496 in 1928 to 2,338
in 1939 and the percentages from 7.1 to 8.8. Clearly the hospitals are placing a larger
percentage of their patients in the community as time goes on. The number of patients
on escape decreased from 250 in 1928 to 70 in 1939 and the percentages from 1.2 to .2.
Table 4 shows the number of visits taking place during the single year, 1939. We
have recorded the total number of visits made by patients during the entire year, have
compared this with the daily average population and calculated a visit rate for each
hospital. Psychopathic shows the highest rate with 507 visits per 1,000 of the daily
average population. Of the active admitting hospitals, Danvers shows the high rate of
366 and Northampton a rate of 329. Metropolitan leads the chronic transfer group
with a rate of 120. Monson shows a rate of 441. The rate for the entire State Hospital
group is 231. The females with a rate of 243 show a greater tendency to go out on visit
than the males, 223.
Table 4. — Number of Patients Placed on Visit during the Year 1939, by Institution
and Sex: Rates per 1,000 Daily Average Population on Books
Number of Patients
Rates per 1,000
Daily Average
Placed on
Visit
Daily Average
Institutions
Population on
Books
During Year
Population
M.
F.
T.
M.
F.
T.
M.
F.
T.
Boston Psychopathic
76
54
130
33
33
66
434.2
611.1
507.6
Danvers
1,242
1,448
2,690
458
528
986
368.7
364.6
366.5
Northampton
1,095
1,292
2,387
301
485
786
274.8
375.3
329.2
Westborough
790
1,083
1,873
234
303
537
296.2
279.7
286.7
Boston State
1,154
1,463
2,617
348
360
708
301.5
246.0
270.5
Taunton ....
939
991
1,930
221
262
483
235.3
264.3
250.2
Foxborough
717
831
1,548
169
214
383
235.7
257.5
247.4
Worcester ....
1,428
1,511
2,939
333
371
704
233.1
245.5
239.5
Monson ....
769
859
1,628
376
342
718
488.9
398.1
441.0
Metropolitan
892
1,040
1,932
92
141
233
103.1
135.5
120.6
Medfield ....
798
1,137
1,935
72
115
187
90.2
101.1
96.6
Gardner ....
855
743
1,598
46
83
129
53.8
111.7
80.7
Grafton ....
770
785
1,555
18
40
58
23.3
50.9
37.2
Total ....
11,525
13,237
24,762
2,701
3.277
5,978
234.3
247.5
241.4
McLean ....
102
160
262
63
66
129
617.6
412.5
492.3
Vet. Adm. Fac. No. 107 .
1,216
-
1,216
361
—
361
296.8
-
296.8
Vet. Adm. Fac. No. 95 .
773
-
773
127
—
127
164.2
—
164.2
Tewksbury
75
383
458
1
7
8
13.3
18.2
17.4
Bridgewater
880
-
880
2
-
2
2.2
-
2.2
Total ....
3,046
543
3,589
554
73
627
181.8
134.4
174.7
Grand Total
14,571
13,780
28,351
3,255
3,350
6,605
223 3
243.1
231.5
P.D. 117
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137 144 281
95 131 226
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12,493 13,658 26,151
10.9 10.5 10.7
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PS
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130 167 297
214 248 462
14 9 23
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fa
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183 248 431
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fa
285 368 653
210 220 430
11 6 17
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2 7 9
12,493 13,708 26,201
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228 234 462
146 175 321
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12,477 13,682 26,159
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fa
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2,704 3,284 5,988
1,919 2,343 4,262
271 66 337
244 59 303
97 228 325
55 166 221
150,115 164,011314,126
18.0 20.0 19.0
12.7 14.2 13.5
Placed on visit
Returned from visit
On escape
Returned from escape
Placed in family care
Returned from family care
On books at end of month
Visit rate per 1,000 on
books ....
Return rate per 1 ,000 on
books ....
«
a
n
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a
H
o.
a
CD
H
fa
241 288 529
179 210 389
35 7 42
32 7 39
6 11 17
2 15 17
12,588 13,692 26,280
19.1 21.0 20.1
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146
P.D. 117
Table 5 presents the number of visits, escapes and cases placed in family care during
each month of 1939 and also the cases returned each month. The visit rates show the
tendency for the fewest patients to go out in the months of January and February, the
rates being 11.3 and 10.7 respectively. The visit rates rise to higher levels in the warmer
months of April, May, June, July, August and September. The highest visit rate for
the year per 1,000 patients on the books is 31.0, in the holiday month of December.
In general, the rates for cases returned from visit follow the trend observed in the visit
rates themselves. The only month in which the return rate exceeds the visit rate is
January. The total visit rate is higher than the return rate due to the fact that a certain
proportion of cases sent on visit never return to the hospital but are discharged to the
community.
Table 6. — Family Care Under Institution Trustees During 1989
Other Cases
Patients Re-
Patients
in
Number
\d-
Number
Re-
leaving
maining in
Family Care
mitted during
turned to
Insti-
Familv Care
Familv Care
Hospitals
September 30,
Year
tution during
Status during
September 30,
and School
1938
Year
Year
1939
M. F.
T.
M.
F.
T.
M. F.
T.
M. F. T.
M. F. T.
Boston State .
_ 2
2
2 9
Danvers .
8
8
13
36
49
1 5
6
3 12 15
9 27 36
Foxborough .
— 5
5
-
8
8
7
7
- 3 3
- ' 3 3
Gardner
10 107
117
12
68
70
5 53
58
2 5 7
15 107 122
Grafton .
2 12
14
—
4
4
1 3
4
1 1
1 12 13
Medfield
8
8
-
2
2
1
1
- 2 2
- 7 7
Metropolitan
6
6
2
8
10
1 8
9
12 3
- 4 4
Northampton
7 16
23
5
7
3 2
5
3 3 6
3 16 19
Taunton
1 2
3
-
-
-
1
1
— — —
2 2
Westborough
11 16
27
o
6
8
1 3
4
- 2 2
12 17 29
Worcester
33 75
108
64
117
181
31 56
87
22 39 61
44 97 141
Belchertown .
4 16
20
15
33
48
1 12
13
1 1
18 36 54
Total
68 273
341
110
277
387
45 150
195
31 72 103
102 328 430
Table 7. — Patients in Family Care from Institutions and Under the Department
of All State Hospitals September 30, 1904-1939
Family Care
From
Under the
Year
Grand Total
Institutions
Department
M. F. T.
M. F. T.
M. F. T.
1904 ... . .
14 199 213
_
14 199 213
1905
13 243 256
1 2 3
12 241 253
1906
13 282 295
10 10
13 272 285
1907
13 270 283
8 8
13 262 275
1908
12 238 250
1 5 6
1 1 233 244
1909
10 239 249
8 8
10 231 241
1910
16 269 285
2 8 10
14 261 275
1911
15 294 309
1 10 11
14 284 298
1912
15 327 342
2 24 26
13 303 316
1913
14 352 366
2 28 30
12 324 336
1914
21 320 341
9 30 39
12 290 302
1915
28 375 403
27 290 317
1 85 86
1916
35 363 398
35 299 334
64 64
1917
29 296 325
29 249 278
47 47
1918
23 263 286
23 219 242
44 44
1919
27 228 255
27 190 217
38 38
1920
15 201 216
15 167 182
34 34
1921
10 185 195
10 154 164
31 31
1922
12 187 199
12 158 170
29 29
1923
9 159 168
9 132 141
27 27
1924
4 152 156
4 132 136
20 20
1925
10 154 164
10 131 141
23 23
1926
8 149 157
8 127 135
22 22
1927
14 156 170
14 136 150
20 20
1928
28 128 156
28 109 137
19 19
1929
23 147 170
23 130 153
17 17
1930
23 146 169
23 132 155
14 14
1931
19 173 192
19 151 170
22 22
1932
24 184 208
24 171 195
13 13
1933
34 231 265
34 217 251
14 14
1934
35 242 277
35 242 277
_ _ _
1935
38 273 311
38 273 311
_ _ _
1936
48 275 323
48 275 323
_ _ _
1937
63 273 336
63 273 336
- — -
1938
68 273 341
68 273 341
_ _ _
1939
102 328 430
102 328 430
_
P.D. 117
14-
Family Caee Under Institution Trustees and Under the Department
Table 6 shows that the number of cases in family care on September 30, 1939 (430)
increased by 89 from the figure for 193S (341). A total of 387 new cases were placed in
family care during the year. Of these, 195 were returned to the institution during the
year, while 103 cases were taken from family care through return to the community,
death, or change of status to visit. At the end of the year Worcester, with 141 patients
out, had the largest number in family care. Gardner was next with 122, Belchertown
third with 54, and Danvers fourth with 36 patients out in family care.
Table 7 shows the status of family care between 1904 and 1939. In the early years,
family care cases were supervised almost entirely by the Department of Mental Diseases.
Gradually this supervision has been taken over by the individual institutions. The
Department ceased to supervise family care cases in 1934. At the end of 1939 a total of
430 cases were under family care supervision, 328 females and 102 males. The number of
430 under care during 1939 is at the rate of approximately 9 per 100,000 of the general
population.
Ex-Service Men in State Hospitals, 1928-1939
On September 30, 1928, there were 387 ex-service men on the books of State Hospitals,
while on September 30, 1939 there were 474 (Table 8). The daily average number on
the books during each statistical year increased from 409.18 in 1928 to 503.38 in 1939.
The daily average number actually cared for during the twelve-year period increased
from 393.97 to 444.88.
Table 8. — Ex-Service Men in State Hospitals, 1928-1939: Daily Average Numbers^
Number on
Books
Daily
Average
Number
Daily
Average
dumber
Year
Septembe
-30
on Books during Year
Actually in Hospital during Year
M.
F.
T.
M.
F.
T.
M.
F.
T.
1928 .
387
387
408.18
1.00
409. 18
392.97
1.00
393.97
1929 .
414
7
421
409 . 07
7.35
416.42
350.46
6.36
356 . 82
1930 .
369
5
374
368.03
4.62
372.65
329.94
4.62
334 56
1931 .
360
8
368
371.24
7 15
378.39
339.55
7.15
346.70
1932 .
401
8
409
415.39
9.00
429 . 39
380.34
8.62
388.96
1933 .
383
8
391
417.22
8.00
425.22
374.86
8.00
382 . 86
1934 .
416
6
422
421.45
5.75
427 . 20
374.18
5.16
379.34
1935 .
475
6
481
464.41
5.70
470.11
401.47
4.26
405.73
1936 .
506
9
515
504 . 38
8.00
512.38
456.09
7.00
463 . 09
1937 .
528
8
536
587 . 96
9.23
597.19
515.14
5.39
520.53
1938 .
454
7
461
533 . 53
7.36
540.89
469 . 47
6.36
475 . 83
1939 .
466
8
474
497 . 07
6.31
503.38
438.57
6.31
444 . 88
1 Includes all State Hospitals, Bridgewater and Tewksbury.
Section B. All Admissions to Mental Hospitals During 193-9
As mentioned in the report of the Division of Statistics, (Page 129) the year 1937
marked a change in the presentation of the Department statistics. Up to 1937 Depart-
mental statistics were presented on the basis of cases admitted to hospitals under court
commitment, the data on temporary care, observation and voluntary admissions being
considered separately. As it was found that non-inclusion of these other types of admis-
sions made our statistics less complete than might be desired, the method of analysis
was changed. Beginning with 1937 we include in our statistics all types of admissions to
mental hospitals, whatever the legal form admitting the patient.
First and Readmissions, 1937-1939, by Form of Admission
Table 9 presents the number of first admissions and readmissions to mental hospitals
1937-1939 by forms of admission. There were 6,833 admissions during 1937, 3,798
males and 3,035 females. In 1939 the number of admissions decreased to 6,799, 3,741
males and 3,058 females. There is a decrease from 5,006 total first admissions 1937,
to 4,997, total first admissions in 1938 a further decrease to 4,869 in 1939. A decrease
is also observed in the court commitments, 3,101 in 1937 to 3,038 in 1939. The observa-
tion cases increased from 588 to 684. Only 992 cases were admitted under temporary
care, as compared with 1,142 in 1937 and 155 on voluntary papers, as compared with
175. The number of readmissions rose from 1,827 in 1937 to 1,937 in 1938 but decreased
to 1,930 in 1939. Increases are observed in all forms of commitment between the years
1937-1938 but some decreases are seen in 1939. The number of court cases rose from
148 P.D. 117
1,293 in 1937 to 1,326 in 1938 then dropped to 1,314 in 1939; temporary care, from 291
in 1937 to 325 in 1938 and dropped to 302 in 1939. Observations rose from 149 in 1937
to 191 in 1938 and continued to rise to 215 in 1939. A slight increase is observed in the
voluntary from 94 in 1937 to 99 in 1939.
Table 9. — First and Readmissions to State Hospitals, 1937-1939, by Form of Admission
and Sex
Sex
Aggre-
gate
First
Admiss
ONS
Readmissions
Year
Total
Court
Tempo-
rary
Care
Obser-
vation
Volun-
tary
Total
Court
Tempo-
rary
Care
Obser-
vation
Volun-
tary
1937
T.
M.
F.
6,833
3,798
3,035
5,006
2,775
2,231
3,101
1,563
1,538
1,142
700
442
588
401
187
175
111
64
1,827
1,023
804
1,293
679
614
291
190
101
149
101
48
94
53
41
1938
T.
M.
F.
6,934
3,838
3,096
4,997
2,797
2,200
3,119
1,619
1,500
1,074
615
459
665
479
186
139
84
55
1,937
1,041
896
1,326
659
667
325
196
129
191
131
60
95
55
40
1939
T.
M.
F.
6,799
3,741
3,058
4,869
2,723
2,146
3,038
1,552
1,486
992
592
400
684
487
197
155
92
63
1,930
1,018
912
1,314
651
663
302
175
127
215
144
71
99
48
51
First Admissions and Readmissions, 1917-1939
Table 10 presents the numbers and rates for first admissions and readmissions to all
Massachusetts mental hospitals over the years 1917-1939. The figures on this table are
presented on the new basis as they have been taken from our Rockefeller Research
Project. This analysis uses the same method of evaluation, including court commitment,
observation, temporary care and voluntary admissions, beginning with the year 1917.
It has been the aim of the Statistical Division to present a state-wide picture of mental
disorders and we, therefore, include figures for the private institutions as well as the
public mental hospitals. As economic and social changes may cause a shifting of patients
from private to public institutions, we feel that a report embracing both groups is neces-
sary to show us the true incidence of mental disease in our state population in so far as
incidence can be checked by the numbers of patients coming into mental hospitals. The
total column, showing the admission rates of first admissions to hospitals of all types,
presents a rate of 105 in 1917 which drops to 92, the low of all years, in 1920. This, it
will be recalled, is the first year of the Eighteenth Amendment. Gradual increases occur
but the 1917 rate of 105 is not surpassed until 1931 when a rate of 106 is observed. The
year 1936 presents the high rate of 119 and 1938 continues the 1937 rate of 114. The
rate for 1939 dropped to 111. Over the 23-year period between 1917 and 1939 the first
admission rates have increased from 105 to 111, or but 6 patients per 100,000. This is a
5.7% increase or about one quarter of 1% per year.
The readmissions show a rate of 38 in 1917 and 39 in 1918. In general the rates remain
flat until 1933. Beginning with 1934 increases are noted which rise to the high of 46.3
per 100,000 in the year 1939. Over the 22-year period the readmissions have shown an
increase of but 8 patients per 100,000 of the population. This is an increase of 20.3%
or .9% per year. These figures in the first and readmissions are for the state-wide sample,
including all types of institutions admitting mental patients.
In the State hospitals, we observe the first admission rate of 97 in 1917. The low of
84 occurs in 1920 and then there is a gradual return to a higher level. The rate of 100
in 1931 is the first to exceed the 1917 figure of 97. This continues to 1935 when a rise
to 105 is seen. The high rate of 110 occurs in 1936 with a decrease to 104 in 1939. The
readmissions to State hospitals show a rate of 34 in 1917, a slow drop to the low of 28
in 1925, 1926 and 1927. From 1934 on definite increases are observed. The first year
to surpass 1917 is 1934, with a rate of 37. The high rate of 40 is observed in 1939.
In summarizing this table, we can say that the State hospitals have shown a moderate
increase in first admission rates of about 7% between 1917 and 1939. The readmissions
operating on a lower level, have shown an increase of about 15%. When we come to the
total of all hospitals, including the governmental and private institutions, we find the
approximate increase for first admissions is 5% and for readmissions is 20%.
P.D. 117
149
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First and Read-missions, 1939, by Hospital
Table 11 presents the admission forms used in first admissions and readmissions in
1939, by hospital. Of the total first admissions, 56% were court commitments, 26%
were admitted under temporary care, 13% under observation commitment and 3% on
voluntary papers. In the readmissions, 60% were court admissions, 23% temporary
care, 10% observation commitments and 4% voluntary. As might be expected, court
commitment is being used more often in the case of readmissions.
Table 11. — First and Readmissions to Mental Hospitals, 1939, by Form of Admission
and by Hospital
Aggre-
Fir
st Admissions
Hospitals
gate
Total
Court
Temporary
Observation
Voluntary
Care
No.
%
No.
%
No.
%
No.
%
No.
%
B. Psychopathic
2,114
1,573
100.0
95
6.03
1,157
73.55
270
17.16
51
3.24
Boston State .
1,075
704
100.0
513
72.86
132
18.74
57
8.09
2
.28
Dan vers
890
633
100.0
451
71.24
89
14.06
90
14.21
3
.47
Foxborough .
323
229
100.0
181
79.03
12
5.24
34
14.84
9
.87
Northampton
582
438
100.0
373
85.15
23
5.25
38
8.67
4
.91
Taunton
574
436
100.0
332
76.14
39
8.94
58
13.30
7
1.60
Westborough .
521
330
100.0
284
86.06
1
.30
39
11.81
6
1.81
Worcester
821
552
100.0
423
76 . 63
13
2.35
109
19.74
7
1.26
136
95
100.0
67
70.52
14
14.73
12
12.63
2
2.10
Grafton
124
67
100.0
65
97.01
-
-
2
2.98
-
-
Medfield
283
161
100.0
138
85.71
10
6.21
11
6.83
2
1.24
Metropolitan
129
-
-
—
-
-
-
-
-
-
-
Monson .
135
96
100.0
30
31 . 25
-
_
1
1.04
65
67.70
Tewksbury
1
1
100.0
1
100.00
-
-
-
-
-
-
Bridgewater .
90
45
100.0
28
62.22
—
—
17
37.77
-
—
McLean
209
130
100.0
69
53.07
20
15.38
4
3.07
37
28.46
Vet. Adm. Fa-
cility No. 107
129
55
100.0
48
87.27
-
-
-
-
7
12.72
Vet. Adm. Fa-
cility No. 95
190
67
100.0
51
76.11
2
2.98
2
2.98
12
17.91
Total1
8,326
5,612
100.0
3,149
56.11
1,512
26.94
744
13.25
207
3.68
Readmissioi
<rs
Hospitals
Temporary
To
tal
Court
Care
Observation
Voluntary
Trans-
fers
No.
%
No.
%
No. %
No.
%
No.
%
B. Psychopathic .
534
100.0
27
5.05
422 79 . 02
77
14.41
8
1.49
7
Boston State .
334
100.0
235
70.35
51 15.26
39
11.67
9
2.69
37
Danvers .
242
100.0
170
70.24
39 16.11
30
12.39
3
1.23
15
Foxborough .
85
100.0
72
84.70
2 2.35
10
11.76
1
1.17
9
Northampton
138
100.0
116
84.05
6 4.34
11
7.97
5
3.62
6
Taunton
138
100.0
109
78.98
14 10.14
13
9.42
2
1.44
-
Westborough
182
100.0
147
80.76
3 1.64
21
11.53
11
6.04
9
\V orcester
221
100.0
180
81.44
3 1 . 35
31
14.02
7
3.16
48
40
100.0
32
80.00
4 10.00
2
5.00
2
5.00
1
Grafton .
27
100.0
24
88.88
- -
3
11.11
-
-
30
Medfield
117
100.0
110
94.01
3 2.56
4
3.41
-
-
5
Metropolitan
-
-
-
-
- -
-
-
-
-
129
Monson .
37
100.0
23
62.16
1 2.70
-
-
13
35.13
Tewksbury
_
_
_
-
_
-
-
-
-
-
Bridgewater .
39
100.0
32
82 . 05
- -
7
17.94
—
-
6
McLean .
76
100.0
32
42.10
3 3.94
5
6.57
36
47.36
3
Vet. Adm. Facility
No. 7 .
36
100.0
26
72.22
1 2.77
2
5.55
7
19.44
38
Vet. Adm. Facility
No. 95 . .
90
100.0
81
90.00
1 1.11
1
1.11
7
7.77
33
Total1 .
2,336
100.0
1,416
60.61
553 23.67
256
10 95
111
4.7.5
378
1 Totals are admissions, not persons due to admissions at Psychopathic being committed to other hospitals
Psychopathic admitted 73% of first admissions and 79% of readmissions on temporary
care papers. Among the active admitting hospitals, Westborough shows the high percent
of first admissions on court commitment, 86%, while Foxborough and Northampton
have 84% each in the court readmissions. Boston State admitted the largest percent
P.D. 117
151
under temporary care first admissions, 18%, while Danvers was high in the readmissions,
16%. Worcester shows the high percent of observation cases, 19% of first admissions
and 14% of readmissions. Westborough is high in first and readmissions in the voluntary
group, 1.81 and 6.04%, respectively.
Of the first admissions to Monson (for Epilepsy), 67% were voluntary, 31% court and
1 % observation cases; of the readmissions, 35% were voluntary, 62% court cases and 2%
temporary care cases. Among the chronic transfer hospitals, Grafton shows the high
per cent of court commitments, 97% of first admissions and Medfield, 94% of read-
missions. Gardner shows the largest per cent of first admissions entering the hospital
on temporary care, observation and voluntary papers, 14%, 12% and 2%, respectively.
In the readmissions Gardner is high in the temporary care, 10%, and in the observation
cases Grafton leads with 11%. The variations in the use of different types of admissions
to certain hospitals demonstrate clearly the differing administrative problems facing
the superintendents of those hospitals.
Voluntary Care Admissions to Public and Private Institutions, 1928-1939
In Table 12 we note that the admission rates for voluntary admissions to all mental
hospitals increased from 9.7 in 1928 to 11.0 in 1936 and dropped back to 9.6 in 1939.
The voluntary admissions to public mental hospitals increased from 238 in 1928 to 318
in 1939, an increase of 33%. Over the same years, the voluntary admissions to private
institutions decreased from 181 in 1928 to 110 in 1939, a decrease of 39%.
Table 12. — Voluntary Care Admissions to Public and Private Institutions,
1928-1939 >
Total Number
Rate per 100,000
Public
Private
Yeah
Public and
estimated popula-
Institution
Institution
Private
tion of
Number
Number
Institutions
State
1928
419
9.70
238
181
1929 .
448
10.22
266
182
193Q . .
437
10.28
321
,116
1931 .
466
10.96
367
< 99
1932 .
433
10.18
358
75
1933 .
432
9.88
324
108
1934 .
447
10.13
387
60
1935 .
454
10.43
398
56
1936 .
483
11.00
411
72
1937 .
451
10.27
381
70
1938 .
433
9.81
329
104
1939 .
428
9.65
318
no
i All publ
c an
d pr
vate
inst
tut
ions for the insan
i and epileptic.
Legal Status of First Admissions during 1939, by Hospital
Table 13 gives the various combinations of legal forms used in first admissions to
mental hospitals during 1939. For example, a patient may enter under temporary care
(ten day paper), be committed for observation (40 days) and at the end of that period
be committed for an indefinite period. The court commitment, used alone, is the most
common form, comprising 28% of first admissions. The temporary care admission is
second with 19%. Next we have the combination of temporary care followed by court
commitment, comprising 16%, and fourth the combination of observation commitment
followed by court commitment in 12%.
Considering the State hospitals only, regular court commitment was used to the great-
est extent in the following institutions: Grafton — 86%, Medfield — 59%, and West-
borough — 46%. In the temporary care form of admission, Boston Psychopathic
Hospital shows the high figure of 63%. In order follow Boston State with 17% and
Danvers and Gardner with 14% each. The combination of temporary care followed by
court commitment comprises 32% of admissions at Danvers, 22% at Boston State and
19% at Taunton.
The following table compares the percentage distributions of the combinations of
admission forms in first admissions and readmissions during 1939. Court commitment
and the voluntary forms are used more commonly in readmissions than in first admissions.
Temporary care and observation forms are substantially reduced in readmissions.
152
P.D. 117
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P.D. 117 153
Percentage Distribution in Legal Status of All Cases Admitted for the First Time and
All Readmissions, 1939
All Cases All
Admitted for Readmitted
First Time Cases
Court Commitment 28.2 30.1
Temporary Care 19.7 15.2
Observation 10.7 7.9
Voluntary 1.4 3.7
Temporary Care and Voluntary 1.2 1.0
Temporary Care and Observation .... 3.3 3.2
Temporary Care and Court 16.8 20.9
Temporary Care, Observation and Court ... 4.5 5.4
Observation and Court 12.7 10.1
Others and Court .1 1.3
Other Combinations 1.0 .6
Legal Status of Readmissions During 1939, by Hospital
Table 14 shows the distribution of the combinations of legal forms in readmissions
for 1939, by hospital. Court commitment was used most often at Grafton, Medfield and
Westborough, comprising 70%, 70% and 45% of readmissions, respectively.
Temporary care admissions followed by court commitment were found in 36% of the
Northampton and Dan vers readmissions, 28% at Foxborough and Taunton and 25%
at Worcester. Temporary care admissions were high at the Psychopathic Hospital with
69%, Boston State and Danvers being next in order with 14% and 16% respectively.
It is interesting to note that of the 2,107 cases admitted to the Boston Psychopathic
Hospital during 1939 over 90% were temporary care, observation or voluntary cases.
Of the 2,107 admissions a total of 946 went directly to other institutions. The remaining
1,082 were returned to the community. The cases going to other institutions are not
duplicated in our statistics, being counted but once.
Diagnosis of Admissions, 1939, by Form of Admission
Table 15 shows the psychoses admitted under the various legal forms. In the first
admissions, 99% of court commitments were diagnosed as "with mental disorder" and
only .6% "without mental disorder". The temporary care admissions comprised 69%
"with mental disorder" and 30% "without mental disorder". In the observation com-
mitments, 41% were "with mental disorder" and 58% "without mental disorder".
The voluntary form was made up of 61% "with mental disorder" and 38% "without
mental disorder". Obviously the temporary care, observation and voluntary forms
are being used in admitting the borderline cases of mental disorder, many of whom are
being diagnosed as "without mental disorder". In the readmissions, very similar percent-
ages are observed for the various admission forms.
In first admissions the psychoses with cerebral arteriosclerosis made up 26% of court
commitments, dementia praecox 22% and senile psychoses 8%. The temporary care
group shows without psychoses 25%, the alcoholic psychoses 17% and the psychoneu-
roses 12%. In the observations, the leading groups are without psychoses 50%, the
alcoholic psychoses and psychoneuroses with 9% each and primary behavior disorders
8%. In the voluntary admissions, without psychoses is high with 35%, followed by the
psychoneuroses with 16% and the convulsive disorders with 12%.
In the readmissions the leading psychoses among the court commitments are dementia
praecox 31%, manic-depressive psychoses 22% and psychoses with cerebral arterio-
sclerosis 8%. The temporary care cases show without psychoses high with 35%, the
alcoholic psychoses second with 13% and the manic-depressive group third with 11%.
Among the observation admissions, the without psychoses group with 59% is followed
by 11% in the alcoholic psychoses. Among the voluntary admissions the without psy-
choses group shows 31%, psychoneuroses, 23% and manic-depressive, 21%.
The outstanding point in this table is the large number of cases who are admitted on
short residence forms and classified as psychotic but who are returned to the community.
In the first admissions, 686 temporary care cases "with mental disorder" were allowed
to leave the hospital at the end of a ten-day period. In the observation group (40 days)
282 persons "with mental disorder" were allowed to leave. Among the readmissions
154
P.D. 117
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P.D. 117
190 temporary care cases and 83 observation cases also were returned to the community,
although diagnosed as having a mental disorder.
Number of Times Admitted, All Admissions, 1939
Table 16 presents the number of the present admission of patients coming into mental
hospitals during 1939. Of the 6,799 admissions, 4,869 or 71% were admitted for the
first time, 806 or 11% were having their second admission, 511 or 7% their third admis-
sion, 274 or 4% their fourth admission and 131 or 1% their fifth admission. Forty
patients, or .5% were having their tenth or higher admission. While nearly three-
quarters of mental cases coming into mental hospitals are first admissions, the read-
missions show many cases who have been in mental hospitals repeatedly. The 1,930
patients admitted two or more times represent at least 4,527 previous admissions. The
average number of times admitted for all admissions 1939 is 1.67 times, 1.65 times for
the males and 1.68 times for the females.
Table 16. — Number of Times Admitted, All Admissions, 1939: Percentage
Distribution
Times Admitted
Number
Percentage
Number
M.
F.
T.
M.
F.
T.
2,723
2,146
4,869
72.7
70.1
71.6
428
378
806
11.4
12.3
11.8
266
245
511
7.1
8.0
7.5
133
141
274
3.5
4.6
4.0
75
56
131
2.0
1.8
1.9
39
43
82
1.0
1.4
1.2
24
18
42
.6
.5
.6
11
10
21
.2
.3
.3
17
6
23
.4
.1
.3
Ten plus
25
15
40
.6
.4
.5
Total .
3,741
3,058
6,799
100.0
100.0
100.0
Average Number
of Times Admitted
1.65
1.68
1.67
(See Table 203 for detail)
Table 17. — Average Number of Times Admitted, All Admissions, 1939, by Diagnosis
Diagnoses
Number
Average
Number
of Times
Admitted
Manic-depressive psychoses
With psychopathic personality .
With convulsive disorders (epilepsy)
With mental deficiency
Dementia praecox ....
Without psychoses ....
With other forms of syphilis
With organic changes of nervous system
Undiagnosed psychoses
Alcoholic psychoses ....
Psychoneuroses . .
Paranoia and paranoid conditions
Involutional psychoses . .
With syphilitic meningoencephalitis
Due to drugs, etc. ....
Traumatic psychoses ....
With other disturbances of circulation
With other infectious diseases
Due to other metabolic diseases, etc.
With epidemic encephalitis
With cerebral arteriosclerosis
Senile psychoses
Primary behavior disorders
Due to new growth ....
656
90
156
206
1,219
958
27
122
93
575
384
136
248
225
46
22
38
21
101
11
1.036
293
123
13
2.77
2.53
2 12
L95
1.79
1.77
1.66
1.63
1.58
1.54
1.47
1.43
1.41
1.33
1.26
1.22
1.21
1.19
1 19
1.18
1.18
1.13
1.08
1.07
Total With Mental Disorder
Total Without Mental Disorder
Grand Total
5.718
1,081
6,799
1.66
1.69
1.67
(See Table 203 for detail)
P.D. 117
157
Table 17 gives the average number of times admitted, by diagnosis. These are ar-
ranged in order, showing the tendency for readmission in certain psychoses. The 6,799
admissions of 1939 have had a total of 11,354 admissions up to the present date. The
highest averages for the number of times admitted are as follows: manic-depressive,
2.77; with psychopathic personality; 2.53; with convulsive disorders, 2.12; with mental
deficiencjr, 1.95; dementia praecox, 1.79; and without psychoses, 1.77. The group show-
ing the least tendency to readmission is due to new growth, with an average of 1 .07. The
group "without mental disorder" comprises 15.8% of all admissions and shows an
average of 1.69 admissions per patient. The borderline group evidently shows symptoms
which cause return to hospital although no psychosis is present.
Nativity and Parentage op Admissions, 1939
Table 18 outlines the nativity of first admissions and readmissions for 1939, presenting
rates for the same nativity groups in the population 15 years of age and over (1930
Census). The foreign born show a first admission rate of 142 per 100,000 and the native
born a rate of 165. When the native born are subdivided in accordance with parentage,
the native born with both parents foreign born show an admission rate of 160 and the
native born with one parent foreign born and the other parent native born, an admission
rate of 166. Apparentl,v the higher rate for the native born is maintained by the high
admission rates in the native born of foreign or mixed parentage. The native born with
both parents native born show the low rate of 147 per 100,000.
In the readmissions, the foreign born present an admission rate of 47 per 100,000 while
the native born show a much higher rate of 70. When we subdivide this native born
group in accordance with parentage, we find the native born of foreign parentage with
an admission rate of 72, the native born of mixed parentage with an admission rate of 69
and the native born of native parentage with an admission rate of 64. In the readmissions
as in the first admissions the foreign born show the lowest admission rate of all the
nativity groups and all of the native born groups are decidedly higher.
Table 18. — Nativity and Parentage of First and Readmissions, 1939: Rates per 100,000
of Same Nativity Groups 15 Years of Age and Over, 1930 Census
Aggre-
gate
Foreign
Born
Native
Born
Nativity
Pa
RENTAGE Ol
? Native F
OSK
Admissions
Foreign
Mixed
Native
Unknown
Nu m beet-
First Admissions
Readmissions
4,869
1,930
1,464
489
3,394
1,439
11
2
1,285
582
517
216
1,388
605
204
36
All Types
Rates
First Admissions
Readmissions
All Types
6.799
158.0
62.6
220.6
1,953
142.1
47.4
189.5
4.833
165.4
70.1
235.5
13
1.867
160.3
72.6
232.9
733
166.2
69.4
235.6
1.993
147.7
64.4
212.1
240
(See Tables 178 and 179 for detail)
Admission Ages of Native and Foreign Born Admissions, 1939
Table 19 shows that the average age of the foreign born first admissions was 57 years
while that of the native born was 42 years. This finding renders remarkable the low
admission rate of the foreign born in Table 18. It is well known that the admission rates
are higher in the older ages. Here we note the older foreign born admissions showing
lower admission rates than the native born of younger average ages. When we subdivide
the native born in accordance with parentage, the native born of foreign parentage
present an average admission age of 40 years, the native born of mixed parentage present
an average admission age of 39 years and the native born of native parentage, an average
of 45 years.
In the readmissions, the foreign born show an average admission age of 51 years
while the native born present an average age of 39 years. Subdividing the native born,
we have an average of 38 years for both the native born of foreign parentage and the
native born of mixed parentage and 41 years for the native born of native parentage.
158
P.D. 117
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P.D. 117
159
In interpreting this table we must remember that there are comparatively few of the
foreign born in the younger age groups. Through restrictions of immigration the younger
age groups have not been replaced in the foreign born. The foreign born remaining are
steadily growing older while the native born are having the younger ages replaced each
year.
The most valuable comparisons can be made in the native born themselves, where the
age differential is not so pronounced. The native born with one parent foreign and the
other parent native tend to come into hospitals earliest, showing an average age of 39
years (first admissions). The native born with both parents foreign born are 40, one year
older than the first group. The native born with both parents native born are about
6 years older than the first group, or 45 years. Among the readmissions the native born
with both parents foreign come to mental hospitals earliest, presenting an average of
38.5 years. The native born of foreign parentage are next with an average of 38.9 years,
while the native born of native parentage (both parents), are admitted at an average
age of 41 years. In both first admissions and readmissions the native born of native
parentage come into mental hospitals at a later age than the native born of either foreign
or mixed parentage.
Economic Status of First Admissions, 1939, by Use of Alcohol
Table 20 points out that 43% of first admissions during 1939 were abstinent in alcoholic
habits, 25% temperate and 26% intemperate. The sexes vary markedly, the females
showing 10% of intemperance and the males 38%. Conversely, only 27% of the males
are abstinent while 64% of the females fall in this classification. In the male first admis-
sions, the highest per cent of abstinence is observed in the comfortable economic group,
33%, as compared to 30% for the dependent group and 26% for the marginal. The
highest per cent of intemperance is observed in the marginal group, 41%, as compared
to 33 % for the dependent and 26 % for the comfortable.
Similar proportions are found in the female first admissions. The comfortable show
the highest per cent abstinent, 69%; the dependent show 68% and the marginal 64%.
The marginal have 11% intemperate, the dependent 7% and the comfortable 6%.
However, the basic sex groups differ in that the men are showing almost four times as
much intemperance as the women.
Table 21. — Admission Ages of First and Readmissions by Diagnosis and Sex, 1939-
Averages in Years
First
Admissions
Re
idmissions
Diagnoses
M.
F.
T.
M.
F.
T.
Senile psychoses
77.6
75.3
76.2
75.1
74.2
74.7
With cerebral arteriosclerosis
71.8
71.5
71.7
68.4
67.3
67.8
With other disturbances of circulation
56.7
59.6
57.8
72.5
60.5
62.5
Due to new growth . .
58.9
53. 5
56.6
—
47.5
47.5
Due to other metabolic diseases, etc.
51.6
54.0
52.9
48.5
45.8
47.0
Involutional psvchoses ....
55.8
50.4
51.8
56.3
51.9
53.1
Traumatic psychoses
50.0
41.5
47.7
22.5
45.0
37.5
With other forms of syphilis
43.6
52.5
46.5
56.2
47.5
53.3
With syphilitic meningo-encephalitis .
46.5
45.6
46.3
40.9
45.9
42.7
Due to drugs, etc
44.5
47.2
45.8
48.5
52.5
49.6
Paranoia and paranoid conditions
45.4
45.6
45.5
51.1
48.7
49.5
Alcoholic psychoses ....
44.8
43.8
44.7
46.2
43.2
45.8
With organic changes of nervous system
45.0
42.3
44.1
41.0
37.5
39.7
Manic-depressive psychoses
42.1
38.0
39.6
44.6
44.8
44.8
Undiagnosed psychoses ....
36.0
41.2
39.4
44.5
45.9
45.6
Psychoneuroses
39.9
38.6
39.2
43.1
42.2
42.6
With other infectious diseases
44.3
34.5
38.9
57.5
22.5
34.1
With epidemic encephalitis .
38.7
33.5
35.8
47.5
-
47.5
With mental deficiencv ....
52.9
32.6
32.8
36.0
35.3
35.7
With convulsive disorders (epilepsy) .
32.2
32.9
32.5
35.0
34.7
34.9
Dementia praecox
30.4
32.0
31.2
33.3
37.3
35.4
With psychopathic personality
26.1
32.8
31 0
34.6
30.4
32.8
Without psvchoses
38.6
36.9
38.1
40.0
37.8
39.3
Primarv behavior disorders
22.1
23.6
22.7
18.6
17.7
18.3
Total With Mental Disorder .
48.7
50.0
49.3
42.6
44.5
43.5
Total Without Mental Disorder .
36.6
34.1
35.9
39.5
37.4
38.8
Grand Total
46.2
48.3
47.1
42.0
43.7
42.8
'See Tables 184 and 185 for detail)
160
p.d. iv,
Average Admission Ages of Admissions, 1939, by Diagnosis and
Hospital
Table 21 reveals that the average age of first admissions was 47.1 years and the average
age of readmissions 42.8 years. This lower admission age of readmissions is due to the
fact that first admissions of the younger ages comprise the readmissions of subsequent
years. Patients having a first admission in the older ages do not tend to readmission.
In both first admissions and readmissions, the patients "with mental disorder" show
higher admission ages than patients "without mental disorder". In first admissions, high
admission ages occur in senile psychoses — 76 years, cerebral arteriosclerosis — 71
years, other disturbances of circulation — 57 years, due to new growth — 56 years and
other metabolic diseases — 52 years. Of the twenty-two mental disorders, thirteen
show older admission ages in males than females. Psychoses presenting the younger
admission ages are psychopathic personalitj- — 31.0 years, dementia praecox — 31.2
years and convulsive disorders — 32 years.
In readmissions the high average ages occur in senile psychoses — 74 years, cerebral
arteriosclerosis — 67 years, other disturbances of circulation — 62 years and involutional
psychoses and other forms of syphilis — 53 years each. The younger admission ages are
observed in psychopathic personality — 32 years, mental deficiency and dementia
praecox — 35 years and convulsive disorders and other infectious diseases — 34 years.
Wide variations between the high average of 76 years for the senile psychoses and 31
years for psychopathic personality show how necessary it is to consider the matter of age
in any study of mental disorders.
Table 22 shows the differences in admission ages of the cases coming to the various
hospitals. The average admission age at Psychopathic is 35.0 years for the first admis-
sions and 36.2 years for the readmissions. Among the active admitting hospitals, the
highest average age of first admissions, 54.2 years, is observed at Boston State; the
lowest, 47.9 years, at Westborougli. The highest average age of readmissions, 45.0 years,
is observed at Northampton; the lowest, 39.5 years, at Foxborough. Among the chronic
transfer hospitals, the high average age in the first admissions is found at Grafton, 54.0
years, and in the readmissions at Gardner, 44.5 years. As would be expected, the average
age at Monson (for care of epilepsy) is low, 26.8 years for first admissions and 39.3 years
for readmissions.
Table 22. —
Age at Admission
of First and Readmissions, 1989
, by Hospital:
Averages
First
Admissions
R
pudmissions
Hospitals
M.
F.
T.
M.
F.
T.
Boston Psychop
athic
35.7
33.8
35.0
36.4
36.0
36.2
Boston State .
Taunton
Danvers .
Northampton .
Foxborough
Worcester
Westborougli
53.8
53.6
49.0
49.9
51.1
46.9
46.6
54~.7
52.7
54.0
50.8
46.3
50.1
49.0
54.2
53.1
51.1
50.3
49.1
48.3
47.9
42.1
41.9
44.6
45.8
38.7
43.1
42.7
47.0
42.8
45.1
44.1
40.6
44.7
44.6
44.6
42.3
44.9
45.0
39.5
43.9
43.8
Grafton
Gardner
Medfield .
Monson
56.6
52.0
46.0
26.4
50.7
51.3
42.4
27.2
54.0
51.6
44.5
26.8
44.5
38.3
42.8
38.0
37.9
47.1
41.7
41.5
41.8
44.5
42.2
39.3
Tewksbury
Veterans' Adnii
Veterans' Admi
McLean
Bridgewater
nistration Facility No
nistration Facility No
Is ... .
107' '.
95
52.8
50.8
47.5
33.9
65 . 0
45.8
65.0
52.8
50.8
46.6
33.9
46.8
44.4
43.4
42.5
45.8
46.8
44.4
44.6
42.5
All Hospitt
46.2
48.3
47.1
42.0
43.7
42.8
(See Tables 186 and 187 for detail)
Country of Origin of Foreign Born Admissions, 1939
Table 23 gives the country of origin of the foreign born admissions, 1939, and compares
these with the foreign born population 15 years of age and over from the same countries
of origin (1930 Census). In first admissions the high admission rates are shown by
Austria — 282 per 100,000, Portugal and Finland — 201 and Ireland — 200. The low
P.D. 117
161
admission rates are shown by Greece — 90, Sweden — 110, Scotland — 114 and Poland
— 115. In readmissions the high admission rates are shown by Austria — 164, Finland
— 108 and Russia — 87. The low rates are shown by Sweden, France and England —
33 each, and Canada and Germany — 34 each.
Table 23. — Country of Origin of Foreign Born First and Readmissions, 1989:
Rates per 100,000 of Corresponding Population 15 Years of Age and Over,
1930 Census
Rates per 100,000 Population
Country of Origin of Foreign Born
Same Country of Origin
Country
Population 1930
First
Read-
Census 15 -j-
Admissions
missions
Total
First
Read-
Years
19392
1939
Admissions
Admissions
missions
Austria
4,244
12
7
446.
282.
164.
Finland
12,902
26
14
309.
201.
108.
Portugal
24,376
49
18
274.
201.
73.
Ireland
157,770
317
93
258.
200.
58.
Russia
67,262
83
59
210.
123.
87.
France
5,925
10
2
201.
168.
33.
Germany
20,230
29
7
177.
143.
34.
Italy ....
123,452
163
53
174.
132.
42.
England .
76,943
106
26
170.
137.
33.
Poland
71,072
82
34
162.
115.
47.
Canada1 .
284,465
363
99
161.
127.
34.
Scotland
31,345
36
14
158.
114.
44.
Sweden . . " .
36,343
40
12
143.
110.
33.
Greece
16,598
15
7
132.
90.
42.
All Other Countries
96,862
133
44
182.
137.
45.
Unknown .
-
11
2
-
-
-
Total
1.029,789
1,475
491
190.
143.
47
(See Tables 180 and 181 for detail)
1 Includes Newfoundland.
2 Countries showing five or less First Admissions are included with "All Other Countries."
Table 24. — Country of Origin of Native Born of Foreign or Mixed Parentage,
First and Readmissions, 1939: Rates per 100,000 of Coiresponding
Population 15 Years of Age and Over, 1930 Census
Rates per 100,000 Population
Country of Origin of Native Born
Same Country- of Origin
Country
Population 1930
First
Read-
Census 15 +
Admissions
missions
Total
First
Read-
Years
1939
1939
Admissions
Admissions
missions
Greece
2,967
19
7
875.
640
235.
Portugal
13,628
51
23
542.
374.
168.
Finland
8,098
17
11
344.
209.
135.
Austria
4,238
12
2
330.
283.
47.
Italy .
77,738
168
74
311.
216.
95.
Russia
44,637
65
62
283.
145.
138.
Ireland
338,599
607
255
254.
179.
75.
Poland
49,170
83
25
218.
168.
50
France
6,937
10
5
216.
144.
72.
Canada1 .
304,303
454
184
209.
149.
60.
Scotland
31,272
47
17
204.
150.
54.
Sweden
32,419
44
20
196.
135.
61.
England .
95,684
122
60
189.
127.
62
Germany
43,570
56
26
187.
128.
59.
All Other Countries
58,824
70
34
175.
118.
57.
Unknown .
117
14
~
"
Total
1,112,084
1,942
819
247.
174.
73
(See Tables 182 and 183 for detail)
1 Includes Newfoundland.
Admission Rate — Native Born of Native Parentage: First Admissions — 154 (1,452 cases); Readmis-
sions — 66 (620 cases) .
Country of Origin of Native Born (Foreign or Mixed Parentage)
First and Readmissions, 1939
Table 24 presents the same data as the preceding table, but for the native born of
foreign or mixed parentage by country of origin. The numbers of admissions are com-
pared with the population of the same country of origin 15 years of age and over (1930
162
P.D. 117
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P.D. 117
163
Census). In first admissions the high admission rates are presented by Greece — 640
per 100,000, Portugal — 374, Austria — 283 and Italy — 216. The low admission rates
are shown by England — 127, Germany — 128 and Sweden — 135. In the native born
readmissions, the high rates are shown by Greece — 235, Portugal — 168 and Russia —
138. The low rates are shown by Austria — 47, Poland — 50 and Scotland — 54.
Citizenship of Admissions, 1939
Table 25 presents the citizenship of first and readmissions to all mental hospitals
during the year 1939. In both first admissions and readmissions, non-citizens who have
taken out their first papers show the low admission rates, 54 and 9 per 100,000 of the
corresponding population, respectively. Citizens by birth and naturalized citizens show
rates of 108 and 1 14 in first admissions. The high admission rate of 127 per 100,000 is
found in the alien group. The readmissions have their high rate, 48, in the alien group,
also.
As the United States Census data do not record citizenship by age, it is impossible to
exclude those under 15 years in making up the above rates. Citizens by birth include
thousands of individuals in the population who are under the age of 15 years while the
aliens present only a few in these ages. Therefore, the rates, based on the present popu-
lation figures, favor the citizens by birth decidedly. Comparisons should be confined,
therefore, to the groups with similar age distributions, namely the naturalized foreign
born and the alien foreign born. Apparently the naturalized foreign born are a better
prospect in regard to mental disorder than the foreign born who do not become citizens .
Graph 1. — Marital Condition of First
Admissions and Readmissions, 1939: Rates per
100,000 of Same Marital Condition in Massachusetts
Population, 1930 Census
Marital Condition of Admissions, 1939: Rates per 100,000 of Corresponding
Population
Table 26 and Graph I present the numbers and admission rates per 100,000 of the
population for the various marital groups entering mental hospitals. The total line
shows the male first admissions with a rate of 181 per 100,000 and the females with a
much lower rate of 132. In readmissions the males show a rate of 67 and the females a
lower rate of 56.
164
P.D. 117
In first admissions the married show the low admission rate of 110 per 100,000 of the
married population, the single a higher rate of 173 per 100,000, the widowed a much
higher rate of 296 and the divorced the extremely high rate of 600. In the readmissions
the married show the low rate of 43, the widowed the next lowest, 70, the single a rate
of 75 and the divorced the extremely high rate of 378.
Of all marital groups the low admission rates occur in the married. We now measure
these rates in terms of their departures from the low rates of the married group. The
rate of the single females is 38% higher than that of the married females, while the rate
of the single males is 80% higher than that of the married males. The widowed females
offer a rate 119% higher than that of the married females, while the widowed males are
205% higher than the married males. The rate of the divorced females is 400% higher
than that of the married females and the rate of the divorced males is 717% higher than
that of the married males.
Single, widowed or divorced males show a greater chance of developing mental disorder
than the females of these same groups. These differences suggest that marriage is more
of a protective factor in the case of the males than in the case of the females.
Marital Condition and Average Admission Age, 1939
Table 27 presents the average admission ages of first admissions and readmissions by
marital condition. Female first admissions are about 2.1 years older than male first
admissions (females — 48.3 years, males — 46.2 years). The widowed show the high
admission age of 69 years, the married and divorced 49 years each, the separated average
47 years and the single 36 years. In the married, the divorced and the separated the
females are admitted at younger average ages than the males.
In readmissions the high admission age of 62 years occurs in the widowed ; the married
average 46 years, the divorced 42 years, the separated 46 years and the single 34 years.
While the differences between the sexes are small, practically the same relationships as
in first admissions are seen. Female readmissions present the lower admission ages in
the married, the widowed, the divorced and the separated.
Table 27. — Admission Age of First and Readmissions, 1939, by Marital Condition:
Averages
Marital Condition
First Admissions
Readmissions
M.
F.
T.
M.
F.
T.
Single
Married
Widowed
Divorced
Separated
Unknown ........
35.0
51.4
69.5
50.5
50.3
56.6
38.1
46.4
69.6
46.6
42.8
61.6
36.2
49.2
69.6
49.1
47.5
58.3
34.3
47.4
63 8
45.4
48.9
35.7 I
45.8
61.8
40.6
43.4
34.9
46.6
62.6
42.8
46.5
All Groups
46.2
48.3
47.1
42.0
43.7
42.8
(See Tables 195 and 196 for detail)
The admission ages shown suggest that some of the variations in Table 26 may be due
to age differences. While we can explain the high admission rate for the widowed on a
basis of age, we cannot do so in the case of the divorced. The average admission age of
49 years for the divorced indicates that a large part of the admissions in this group come
from the same ages as the married admissions (average 49 years) yet the rate for the
divorced is over six times that of the married. Again, the single, drawing admissions
from the younger ages (average 36 years) with low admission rates, show a total admission
rate which is higher than that of the married.
Economic Status of Admissions, 1939
In Table 28 first admissions record 21% as dependent in economic status, 70% as
marginal and 4% as comfortable. The females show slightly higher percentages in the
comfortable. In readmissions 17% were reported as dependent, 73% as marginal and
6% as comfortable. Apparently, the dependents are under-represented in the read-
P.D. 117 165
Table 28. — Economic Status of First and Readmissions, 1989: Percentage Distribution
First Admissions
Readmissions
Status
Number
Percent
Number
Percent
M. F. T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
Dependent
Marginal
Comfortable
Unknown
607 445 1,052
1,926 1,490 3,416
105 105 210
85 106 191
22.2
70.7
3.8
3.1
20.7
69.4
4.8
4.9
21.6
70.1
4.3
3.9
181
762
52
23
159
665
65
23
340
1,427
117
46
17.7
74.8
5.1
2.2
17.4
72.9
7.1
2.5
17.6
73.9
6.0
2.3
Total
2,723 2,146 4,869
100.0
100.0
100.0
1,018
912
1,930
100.0
100 0
100.0
(See Tables 199 and 200 for detail)
Admissions from Rural and Urban Areas, 1939: Rates per
100,000 Population
In Table 29 first admissions from the urban areas show an admission rate of 118 and
those from the rural areas a much lower rate of 49. The rate for the cities is approximately
two and one-half times that of the rural areas. In the readmissions the urban group
shows an admission rate of 46 with 18 for the rural sections. Here also the urban rate is
approximately two and one-half times that of the rural rate. City dwellers have a far
greater chance of being admitted for mental disorders than those living in the villages
or rural areas.
Table 29. — Environment of First and Readmissions, 1989: Rates per 100,000
Population of Same Environment, 1980 Census
Admissions
Total
Urban
Rural
Unknown
First Admissions:
4,869
4,555
205
109
114.5
118.8
49.0
Readmissions :
1,930
1,796
76
58
45.4
46.8
18.1
All Admissions:
6,799
6,351
281
167
159.9
165.7
67.1
167
pop. o
3,499
2,500 tO.OOO 23,000 50,000 WO.OOO 250,000
9,999 24*999 49*999 99/999 249°999 MORE
Graph 2. — Population of Place of
Residence of First Admissions and
Readmissions, 1939: Admission Rates
per 100,000 of Same Population Group
1G6
P.D. 117
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Population of Place of Residence of Admissions, 1939
Table 30 and Graph 2 show the low admission rate (92.5 per 100,000) for first admis-
sions in the small cities with population between 10,000 and 24,999. The admission
rates for all population groups from the villages up to 250,000 population are fairly
constant. The large cities (250,000+) show a rate which is 59% higher than that of
any of the other groups.
In the readmissions the low rate of 30 occurs in the towns, the 2,500-9,999 group.
In readmissions, the large cities (250,000+), with a rate of 77, are 92% higher than any
of the other population groups. In the readmissions the difference between the admission
rates of the other population groups and the large cities is more pronounced than in first
admissions. The large cities are over-represented in readmissions.
Degree of Education of Admissions, 1939
Table 31 shows that 52% of first admissions during 1939 had a common school educa-
tion and 23% a high school education. Five per cent report a college education and 5%
were illiterate. The females present the higher percentages in the illiterate, "reads
only" and high school groups, and the males are higher in the groups "reads and
writes", common school and college.
In the readmissions, common school is again high with 53%, high school second with
28% and the college group third with 6%. If the educational accomplishments of first
admissions of previous years have remained constant, then the higher educational
groups are the ones tending to readmission.
Intemperate Use of Alcohol in Admissions, 1939
In Table 32, the total figures show that 26% of all first admissions and 28% of read-
missions were recorded as intemperate in the use of alcohol. In first admissions the total
for the group "with mental disorder" is 22% of intemperance and for the group "without
mental disorder" 46%. This borderline group, with short episodes of mental disorders,
shows nearly one half of admissions who are chronic alcoholics. In readmissions the
patients actually psychotic show 22% of intemperance while those "without mental
disorder" record 59% of intemperance. In this last group nearly 6 out of every ten
patients are chronic drinkers.
Marked sex differences are observed. In first admissions "with mental disorder" the
males show 34% intemperate and the females but 7%. In those "without mental dis-
order", however, the sex differences are much less, with 51% intemperate in the males
and 32% in the females. Essentially the same relationships occur in readmissions. In
male first admissions the high proportions of intemperance occur in the alcoholic psycho-
ses — 100%, traumatic psychoses and without psychoses — 57% and due to drugs —
55%. In the females we see the highest proportion of intemperance again in the alcoholic
psychoses — 100%; followed by without psychoses — 37%, with psychopathic personal-
ity — 24% and with syphilitic meningo-encephalitis — 21%.
In the male readmissions the alcoholic psychoses, traumatic psychoses and other
disturbances of circulation show 100% of intemperance; undiagnosed and due to drugs,
80% and without psychoses, 70%. In the females the alcoholic psychoses and due to
drugs show 100% of intemperance; without psychoses, 42% and psychopathic personal-
ity, 27%.
Intemperate alcoholic habits are present in a large per cent of mental disorders not
diagnosed as the alcoholic psychoses. One in every four of first admissions and one in
every three of readmissions were intemperate in the use of alcohol. The higher percent-
ages in the readmissions, particularly in certain psychoses, indicate that the intemperate
use of alcohol is a prominent factor in causing the readmission.
Intemperate Use of Alcohol in First Admissions, 1917-1939
In Table 33 first admissions for the year 1917 show the high intemperance of 25.8%.
This drops precipitately to the low of 14% in 1920, the first year of the Eighteenth
Amendment. From that point onward there are slightly higher percentages, reaching
20.2% in 1932. First admissions offered 19% of intemperance in 1933 when the Prohi-
bition Amendment was repealed. Since that time we have seen gradual increases with a
new high for all years since 1917 of 26.5% in 1938. In 1939 the figure for chronic alcohol-
ism is 26.0%. The numbers intemperate increased from 884 in 1933 to 1,325 in 1938,
an increase of 49%. Total admissions increased 9% between the same years. The
168
P.D. 117
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P.D. 117
169
males show vastly higher percentages of intemperance than females throughout the
years. During the years preceding the Eighteenth Amendment the percentages of
intemperance for the sexes were closer together than after the year 1920. It is to be
noted that since 1933 intemperance in the females has been increasing more rapidly
than in the males with the result that the relationship between males and females is
approaching the same relationship as was observed in the year 1917. Evidently prohibi-
tion was of the greatest assistance to the sex needing it the least, the female. Since the
return of liquor in 1933, a greater increase of intemperance in females than in males
is to be noted.
Table 33. — First Admissions, 1917-1939, Classified as Intemperate in the Use of
Alcohol: Percentage Distribution l
First
Number
Percent of
Year
Admissions
Intemperate
First Admissions j
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 ....
1,853
1,805
3,658
727
217
944
39.2
12.0
25.8
1918 .
1,860
1,727
3,587
589
144
733
31.6
8.3
20.4
1919 .
1,929
1,756
3,685
566
124
690
29.3
7.0
18.7
1920 .
1,708
1,571
3,279
392
69
461
22.9
4.3
14.0
1921 .
1,848
1,593
3,441
455
78
533
24.6
4.8
15.4
1922 .
2,049
1,764
3,813
555
100
655
27.0
5.6
17.1
1923 .
1,804
1,694
3,498
606
91
697
33.5
5.3
19.9
1924 .
1,959
1,677
3,636
683
95
778
34.8
5.6
21.3
1925 .
2,081
1,721
3,802
651
118
769
31.2
6.8
20.2
1926 .
1,941
1,714
3,655
608
154
762
31.3
8.9
20.8
1927 .
2,082
1,756
3,838
691
84
775
33.1
4.7
20.1
1928 .
2,212
1,820
4,032
681
118
799
30.7
6.4
19.8
1929 .
2,209
1,912
4,121
669
92
761
30.2
4.8
18.4
1930 .
2,295
1,978
4,273
674
111
785
29.3
5.6
18.3
1931 .
2,472
2,036
4,508
745
124
869
30.1
6.0
19.2
1932 .
2,510
1,988
4,498
786
126
912
31.3
6.3
20.2
1933 .
2,568
1,986
4,554
771
113
884
30.0
5.6
19.4
1934 .
2,590
1,975
4,565
833
148
981
32.1
7.4
21 4
1935 .
2,685
2,148
4,833
924
191
1,115
34.4
8.8
23.0
1936 .
2,847
2,203
5,050
1,028
217
1,245
36.1
9.8
24.6
1937 .
2,775
2,231
5,006
1,029
242
1,271
37.0
10.8
25.3
1938 .
2,797
2,200
4,997
1,080
245
1,325
38.6
11.1
26.5
1939 .
2,723
2,146
4,869
1,045
221
1,266
38.3
10.2
26.0
1 Includes all State Hospitals, Bridgewater, Tewksbury, and McLean,
and No. 107 included in 1929 and thereafter.
U. S. Vet. Adm. Facilities No. 95
Table 34A. — Number and Percentage with Senile Psychoses, First and
Readmissions, 1917-1939
First Admissions
Readmissions
Year
Number
Percent
Number
Percent
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 .
104
154
258
5.6
8.5
7.0
13
16
29
1.9
2.5
2.2
1918 .
110
188
298
5.9
10.8
8.3
11
15
26
1.5
2.3
1.9
1919 .
105
186
291
5.4
10.5
7.8
4
14
18
.5
2.2
1.3
1920 .
116
194
310
6.7
12.3
9.4
8
17
25
1.1
2.7
1.9
1921 .
133
203
336
7.1
12.7
9.7
15
26
41
2.0
3.9
2.9
1922 .
133
178
311
6.4
10.0
8.1
6
15
21
.9
2.3
1.6
1923 .
78
172
250
4.3
10.1
7.1
13
20
33
2.0
3.5
2.7
1924 .
84
137
221
4.2
8.1
6.0
13
17
30
1.8
2.8
2.2
1925 .
97
190
287
4.6
11.0
7.5
7
15
22
1.0
2.5
1.7
1926 .
88
184
272
4.5
10.7
7.4
8
18
26
1.2
3.0
2.0
1927 .
86
184
270
4.1
10.4
7.0
4
18
22
. 5
2.9
1.7
1928 .
140
205
345
6.3
11.2
8.5
6
20
26
.7
2.8
1.7
1929 .
87
200
287
3.9
10.4
6.9
6
20
26
.7
3.1
1.8
1930 .
105
178
283
4.5
8.9
6.6
9
22
31
1.1
3.0
2.0
1931 .
89
186
275
3.6
9.1
6.1
8
19
27
.9
2.5
1.6
1932 . - • .--
90
133
223
3.5
6.6
4.9
9
18
27
1.0
2.4
1.7
1933 .
92
166
258
3.5
8.3
5.6
5
15
20
.5
1.9
1.2
1934 .
93
157
250
3.5
7.9
5.4
18
11
29
1.8
1.3
1.6
1935 .
112
180
292
4.1
8.3
6.0
11
19
30
1.1
2.3
1.7
1936 .
95
151
246
3.3
6.8
4.8
6
11
17
.6
1.2
.9
1937 .
96
209
305
3.4
9.3
6.0
8
17
25
.7
2.1
1.3
1938 .
133
175
308
4.7
7.9
6.1
9
17
26
.8
1.8
1.3
1939 .
97
169
266
3.5
7.8
5.4
13
14
27
1.2
1.5
1.3
Total
2,363
4,079
6,442
4.5
9.3
6.7
210
394
604
1.1
2.4
1.7
170
P.D. 117
Incidence of Certain Diagnoses in First Admissions and
Readmissions, 1917-1939
Tables 34A to 34J, inclusive, show the percentage of first admissions and readmissions
in certain psychoses over the period 1917-1939, inclusive. Only those psychoses most
important numerically are reported. Since 1937 the data of our Rockefeller Research
Project have been used to give us these percentages based upon all first admissions and
all readmissions, regardless of the legal form of admission. Before this, the percentages
were calculated on court commitments only.
Senile Psychoses
Table 34A shows that 9.3% of female first admissions in the classification of senile
psychoses is over twice that of the males (4.5%). The males show the high of 7.1%
in 1921 and a gradual decrease to the low of 3.3% in 1936. The females show a decrease
from the high of 12.7% in 1921 to the low of 6.6% in 1932.
In the readmissions 1.1% of the males were classified as senile psychoses. The females
more than double this with 2.4%. The males have shown lower percentages during the
past ten years than during the first ten years of the period studied. The females show a
high of 3.9% in 1921, and a decrease to a low of 1.2% in 1936.
Psychoses with Cerebral Arteriosclerosis
Table 34B demonstrates that 13.3% of male first admissions and 12.9% of female
first admissions were classified as psychoses with cerebral arteriosclerosis. In this psy-
chosis we see definite increases. The male figure rises from a low of 7.6% in 1917 to
17.4% in 1934; the female increases from a low of 5.9% in 1919 to a high of 21.0% in
1939.
In the readmissions, also, the sexes are balanced; this psychosis constituting 3.9%
of male and 4.0% of female admissions. The males show a low of 2% in 1921 with high
percentages during the last ten years of the period. The females show an increase from
a low of 1.4% in 1917 to a high of 7.3% in 1939.
Table 34B. — Number and Percentage ivith Cerebral Arteriosclerosis, First and
Readmissions, 1917-1989
First Admissions
Readmi
SSIONS
Year
Number
Percent
Number
Percent
M.
F.
T.
M.
F.
T.
M.
F.
T
M.
F.
T.
1917 .
142
119
261
7.6
6.5
7.1
21
9
30
3.1
1.4
2.3
1918 .
165
120
285
8.8
6.9
7.9
17
11
28
2.3
1.7
2.0
1919 .
190
104
294
9.8
5.9
7.9
22
13
35
3.2
2.1
2.7
1920 .
169
123
292
9.8
7.8
8.9
17
18
35
2.5
2.9
2.7
1921 .
173
99
272
9.3
6.2
7.9
15
16
31
2.0
2.4
2.2
1922 .
193
158
351
9.4
8.9
9.2
15
10
25
2.3
1.5
1.9
1923 .
185
190
375
10.2
11.2
10.7
17
26
43
2.7
4.5
3.6
1924 .
204
202
406
10.4
12.0
11.1
22
23
45
3.1
3.8
3.4
1925 .
236
198
434
11.3
11.5
11.4
22
19
41
3.4
3.2
3.3
1926 .
239
201
440
12.3
11.7
12.0
16
27
43
2.4
4.5
3.4
1927 .
276
185
461
13.2
10.5
12.0
39
22
61
5.7
3.6
4.7
1928 .
280
186
466
12.6
10.2
11.5
26
18
44
3.3
2.5
2.9
1929 .
294
232
526
13.3
12.1
12.7
35
22
57
4.6
3.4
4.1
1930 .
318
258
576
13.8
13.0
13.4
23
16
39
2.9
2.2
2.5
1931 .
351
307
658
14.1
15.0
14.5
37
24
61
4.2
3.2
3.7
1932 .
378
288
666
15.0
14.4
14.8
42
42
84
5.0
5.7
5.3
1933 .
393
327
720
15.3
16.4
15.8
43
49
92
5.0
6.3
5.6
1934 .
453
347
800
17.4
17.5
17.5
47
40
87
4.8
5.0
4.9
1935 .
451
316
767
16.7
14.7
15.8
46
33
79
4.7
4.0
4.4
1936 .
473
399
872
16.6
18.1
17.2
52
46
98
5.5
5.1
5.3
1937 .
460
397
857
16.5
17.7
17.1
47
46
93
4.5
5.7
5.0
1938 .
420
393
813
15.0
17.8
16.2
54
53
107
5.1
5.9
5.5
1939 .
463
451
914
17.0
21.0
18.7
55
67
122
5.4
7.3
6.3
Total
6,906
5,600
12,506
13.3
12.9
13.1
730
650
1,380
3.9
4.0
4.0
Psychoses with Syphilitic Meningo-Encephalitis (General Paresis)
Table 34C points out that 8.0% of male and 2.4% of female first admissions were
classified as general paresis, the percentage for the males being over three times that
for the females. The males show a decrease from a high of 10.9% in 1923 to a low of
4.9% in 1937. The females show a decrease from a high of 3.6% in 1921 to a low of
1.3% in 1937.
P.D. 117
171
In the readmissions the males with general paresis, 4.9%, are nearly four times as
numerous as the females, 1.3%. The male percentage decreased from the high of 14.14%
in 1918 to the low of 2.2% in 1938. Females present, in general, lower percentages
during the last ten years of the period than during the first ten years.
Table 34C. — Number and Percentage with Syphilitic Meningoencephalitis,
(General Paresis), First and Readmissions, 1917-1939
First Admissions
Readmissions
Yeah
Number
Percent
Number
Percent
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 .
193
52
245
10.4
2.8
6.6
70
8
78
10.3
1.2
5.9
1918 .
201
51
252
10.8
2.9
7.0
105
13
118
14.4
2.0
8.6
1919 .
184
45
229
9.5
2.5
6.2
57
12
69
8.3
1.9
5.3
1920 .
186
51
237
10.8
3.2
7.2
57
11
68
8.5
1.8
5.3
1921 .
177
58
235
9.5
3.6
6.8
47
13
60
6.5
1.9
4.3
1922 .
190
58
248
9.2
3.2
6.5
30
12
42
4.6
1.9
3.2
1923 .
198
48
246
10.9
2.8
7.0
41
6
47
6.6
1.0
3.9
1924 .
201
57
258
10.2
3.3
7.0
36
7
43
5.0
1.1
3.2
1925 .
215
36
251
10.3
2.0
6.6
27
9
36
4.1
1.5
2.9
1926 .
183
50
233
9.4
2.9
6.3
32
9
41
4.9
1.5
3.3
1927 .
176
34
210
8.4
1.9
5.4
21
6
27
3.0
.9
2.0
1928 .
181
50
231
8.1
2.7
5.7
28
6
34
3.5
.8
2.2
1929 .
186
37
223
8.4
1.9
5.4
34
4
38
4.5
.6
2.7
1930 .
208
49
257
9.0
2.4
6.0
42
7
49
5.2
.9
3.2
1931 .
166
38
204
6.7
1.8
4.5
31
11
42
3.5
1.4
2.6
1932 .
170
54
224
6.7
2.7
4.9
43
6
49
5.1
.8
3.1
1933 .
182
38
220
7.0
1.9
4.8
30
12
42
3.5
1.5
2.5
1934 .
174
51
225
6.7
2.5
4.9
26
18
44
2.6
2.2
2.4
1935 .
191
46
237
7.1
2.1
4.9
31
9
40
3.1
1.1
2.2
1936 .
151
57
208
5.3
2.5
4.1
26
13
39
2.7
1.4
2.1
1937 .
137
30
167
4.9
1.3
3 3
32
10
42
3.1
1.2
2.2
1938 .
149
39
188
5.3
1.7
3.7
23
7
30
2.2
• .7
1.5
1939 .
149
32
181
5.4
1.4
3.7
28
16
44
2.7
1.7
2.2
Total
4,148
1,061
5,209
8.0
2.4
5.4
897
225
1,122
4.9
1.3
3.2
Table 34D.
Number and Percentage with Alcoholic Psychoses, First and Readmissions,
1917-1939
First Admissions
Readmissions
Year
Number
Percent
Number
Percent
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 .
346
89
435
18.6
4.9
11.8
113
22
135
16.7
3.4
10.3
1918 .
242
45
287
13.0
2.6
8.0
81
21
102
11.1
3.2
7.4
1919 .
233
54
287
12.0
3.0
7.7
66
20
86
9.7
3.2
6.6
1920 .
109
17
126
6.3
1.0
3.8
40
8
48
5.9
1.3
3.7
1921 .
149
27
176
8.0
1.6
5.1
67
17
84
9.2
2.5
6.1
1922 .
245
39
284
11.9
2.2
7.4
65
15
80
10.0
2.3
6.2
1923 .
279
39
318
15.4
2.3
9.0
78
11
89
12.5
1.9
7.4
1924 .
324
36
360
16.5
2.1
9.9
98
16
114
13.8
2.6
8.7
1925 .
272
35
307
13.0
2.0
8.0
69
8
77
10.7
1.3
6.2
1926 .
249
40
289
12.8
2.3
7.9
69
11
80
10.5
1.8
6.4
1927 .
309
32
341
14.8
1.8
8.8
84
12
96
12.3
1.9
7.4
1928 .
295
46
341
13.3
2.5
8.4
85
9
94
10.8
1.2
6.3
1929 .
320
39
359
14.4
2.0
8.7
93
13
106
12.3
2.0
7.6
1930 .
289
42
331
12.5
2.1
7.7
97
10
107
12.2
1.4
7.1
1931 .
339
41
380
13.7
2.0
8.4
92
10
102
10.5
1.3
6.3
1932 .
309
55
364
12.3
2.7
8.0
89
16
105
10.6
2.1
6.6
1933 .
292
40
332
11.3
2.0
7.2
91
12
103
10.6
1.5
6.3
1934 .
349
46
395
13.4
2.3
8.6
111
18
129
11.3
2.2
7.3
1935 .
362
66
428
13.4
3.0
8.8
151
21
172
15.4
2.6
9.6
1936 .
395
56
451
13.8
2.5
8.9
119
21
140
12.6
2.3
7.6
1937 .
387
67
454
13.9
3.0
9.0
138
17
155
13.4
2.1
8.4
1938 .
394
67
461
14.0
3.0
9.2
142
15
157
13.6
1.6
8.1
1939 .
351
68
419
12.8
3.1
8.6
136
20
156
13.3
2.1
8.0
Total
6,839
1,086
7,925
13.2
2.5
8.3
2,174
343
2,517
11.8
2.1
7.3
Alcoholic Psychoses
Table 34D demonstrates that the males, with 13.2%, show a percentage five times
as high as that of the females, 2.5%, for the alcoholic psychoses. The males show a
172
P.D. 117
high of 18.6% in 1917 and a drop to the low of 6.3% in 1920, the first year of the Eigh-
teenth Amendment. Gradual rises follow. After the repeal of prohibition in 1933, we see
a consistent increase from the 1933 figure of 11.3% to 14.0% in 1938. The females show
a high of 4.9% in 1917 and a drop to the low of 1.0% in 1920. From the 1933 figure of
2.0% there is a rise to 3.1% in 1939.
Among the readmissions the alcoholic psychoses comprise 2.1% of females and 11.8%
of males. The males show the high of 16.7% in 1917, the low of 5.9% in 1920 and a rise
from that point onward. Since 1933, with 10.6% of alcoholic psychoses there has been
a rise to 13.3% in 1939. In the females, the last year of prohibition, 1933, shows 1.5%
of alcoholic psychoses rising to 2.1% in 1939.
Dementia Praecox
Table 34E shows that 16.3% of male first admissions were diagnosed as dementia
praecox over the period 1917-1939 and that the females were one-quarter higher with
20.3%. The males show the high of 23.7% in 1920 and a decrease to the low of 12.2%
in 1936. The females show the high of 27.6% in 1919 and a decrease to 16.5% in 1936.
Dementia praecox comprises much higher percentages of readmissions than first
admissions. The males make up 25% and females 27% of all readmissions over the
period 1917-1939. Comparison of these percentages with first admissions suggests a
greater tendency to readmission in the males. The males show the high of 33.2% in
1920 and a decrease to 19.5% in 1934. The females show the high of 37.7% in 1917 and
a decrease to the low of 21.9% in 1936.
Table 34E. — Number and Percentage with Dementia Praecox, First and
Readmissions, 1917-1 939
First Admissions
Readmissions
Year
Number
Percent
Number
Percent
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 .
391
431
822
21.1
23.8
22.4
173
238
411
25.6
37.7
31.5
1918 .
424
429
853
22.7
24.8
23.7
216
219
435
29.7
34.3
31.9
1919 .
447
485
932
23.1
27.6
25.2
214
205
419
31.5
33.4
32.4
1920 .
405
387
792
23.7
24.6
24.1
222
224
446
33.2
36.6
34.8
1921 .
433
437
870
23.4
27.4
25.2
225
216
441
31.1
32.9
32.0
1922 .
411
391
802
20.0
22.1
21.0
171
188
359
26.3
29.8
28.0
1923 .
306
372
678
16.9
21.9
19.3
173
158
331
27.8
27.9
27.8
1924 .
382
359
741
19.4
21.4
20.3
205
179
384
28.9
29.8
29.3
1925 .
362
358
720
17.3
20.8
18.9
194
166
360
30.1
28.4
29.3
1926 .
364
368
732
18.7
21.4
20.0
191
150
341
29.3
25.3
27.4
1927 .
377
391
768
18.1
22.2
20.0
172
194
366
25.2
32.0
28.4
1928 .
317
326
643
14.3
17.9
15.9
213
175
388
27.1
25.0
26.1
1929 .
325
372
697
14.7
19.4
16.9
205
161
366
27.1
25.5
26.4
1930 .
311
357
668
13.5
18.0
15.6
202
182
384
25.4
25.5
25.5
1931 .
322
368
690
13.0
18.0
15.3
196
190
386
22.4
25.8
24.0
1932 .
335
346
681
13.3
17.4
15.1
177
167
344
21.2
22.7
21.9
1933 .
341
390
731
13.2
19.6
16.0
175
209
384
20.5
27.2
23.7
1934 .
335
350
685
12.9
17.7
15.0
191
207
398
19.5
26.3
22.5
1935 .
364
410
774
13.5
19.0
16.0
208
203
411
21.3
25.2
23.0
1936 .
350
364
714
12.2
16.5
14.1
206
195
401
21.9
21.9
21.9
1937 .
365
389
754
13.1
17.4
15.0
263
201
464
25.7
25.0
25.3
1938 .
390
368
758
13.9
16.7
15.1
252
218
470
24.2
24.3
24.2
1939 .
406
367
773
14.9
17.1
15.8
232
214
446
22.7
23.4
23.1
Total
8,463
8,815
17,278
16.3
20.3
18.1
4,676
4,459
9,135
25.5
27.7
26.5
Over the past 23 years the percentages of this very serious mental disorder have been
decreasing in both first admissions and readmissions. Particularly significant are the
larger decreases in first admissions.
Manic-Depressive Psychoses
Male first admissions diagnosed as manic-depressive make up 6.9% of all first admis-
sions (Table 34F). The females are higher with 12.1%. The male percentages, after
rising from a low of 5.2% in 1918 to 9.3% in 1932, have dropped to 4.2% for 1939. In
the females, the last ten years are showing higher percentages than the first ten years
of the period studied, except for 1939 when the low of all years is observed, 8.2%.
In common with dementia praecox, this diagnosis comprises much larger percentages
of the readmissions than of the first admissions, 16.1% of male and 26.8% of female
readmissions. As in first admissions, the percentage for the females is nearly twice
P.D. 117
173
that for the males. The male readmissions also show a rise from a low of 12.4% in 1918
to a high of 21.1% in 1931 and a drop to 12.9% in 1939. The females rose from a low of
21.9% in 1920 to a high of 32.0% in 1937.
Table 34F. — Number and Percentage with Manic-Depressive Psychoses,
First and Readmissions, 1917-1939
First Admissions
Readmissions
Yeah
Number
Percent
Number
Percent
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 .
105
198
303
5.6
10 9
8.2
98
158
256
14.5
25.0
19.6
1918 .
97
194
291
5.2
11.2
8.1
90
147
237
12.4
23.0
17.3
1919 .
108
190
298
5.5
10.8
8.0
101
158
259
14.8
25.8
20.0
1920 .
121
164
285
7.0
10.4
8.6
98
134
232
14.6
21.9
18.1
1921 .
120
163
283
6.4
10.2
8.2
134
164
298
18.5
25.0
21.6
1922 .
113
188
301
5.5
10.6
7.8
94
153
247
14.4
24.3
19.3
1923 .
134
210
344
7.4
12.3
9.8
103
153
256
16.5
27.0
21.5
1924 .
146
222
368
7.4
13.2
10.1
106
142
248
14.9
23.7
18.9
1925 .
142
252
394
6.8
14.6
10.3
99
145
244
15.3
24.8
19.8
1926 .
153
233
386
7.8
13.5
10.5
115
172
287
17.6
29.1
23.1
1927 .
128
235
363
6.1
13.3
9.4
114
155
269
16.7
25.5
20.9
1928 .
174
266
440
7.8
14.6
10.9
130
203
333
16.5
29.0
22.4
1929 .
157
261
418
7.1
13.6
10.1
142
190
332
18.8
30.1
23.9
1930 .
209
263
472
9.1
13.2
11.0
134
215
349
16.8
30.1
23.1
1931 .
221
246
467
8.9
12.0
10.3
184
188
372
21.1
25.5
23.1
1932 .
234
271
505
9.3
13.6
11.2
159
197
356
19.0
26.8
22.7
1933 .
190
260
450
7.3
13.0
9.8
154
204
358
18.0
26.6
22.1
1934 .
167
204
371
6.4
10.3
8.1
151
204
355
15.4
25.9
20.1
1935 .
175
267
442
6.5
12.4
9.1
169
219
388
17.3
27.2
21.7
1936 .
232
262
494
8.1
11.8
9.7
145
266
411
15.4
29.9
22.4
1937 .
198
277
475
7.1
12.4
9.4
163
258
421
15.9
32.0
23.0
1938 .
136
268
404
4.8
12.1
8.0
138
260
398
13.2
29.0
20.5
1939 .
116
176
292
4.2
8.2
5.9
132
232
364
12.9
25.4
18.8
Total
3,576
5,270
8,846
6.9
12.1
9.2
2,953
4,317
7,270
16.1
26.8
21.1
Psychoses with Mental Deficiency
Table 34G shows that 2.2% of male and 2.6% of female first admissions were placed
in this diagnostic classification. In the males the high of 2.6% occurs in 1926, 1930 and
1938 and the low of 1.7% in 1937. The females are high, with 3.3%, in 1920 and 1931
and low, with 1.7%, in 1927.
Table 34G. — Number and Percentage with Mental Deficiency, First and
Readmissions, 1917-1939
First Admissions
Readmissions
Year
Number
Percent
Number
Percent
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 .
47
43
90
2.5
2.3
2.4
29
25
54
4.3
3.9
4.1
1918 .
34
37
71
1.8
2.1
1.9
28
24
52
3.8
3.7
3.8
1919 .
44
42
86
2.2
2.3
2.3
23
30
53
3.3
4.9
4.1
1920 .
44
52
96
2.5
3.3
2.9
33
20
53
4.9
3.2
4.1
1921 .
41
43
84
2.2
2.6
2.4
35
32
67
4.8
4.8
4.8
1922 .
52
53
105
2.5
3.0
2.7
27
36
63
4.1
5.7
4.9
1923 . :
39
33
72
2.1
1.9
2.0
25
19
44
4.0
3.3
3.7
1924 .
45
51
96
2.2
3.0
2.6
19
27
46
2.6
4.5
3.5
1925 .
53
52
105
2.5
3.0
2.7
31
28
59
4.8
4.7
4.8
1926 .
52
40
92
2.6
2.3
2.5
27
29
56
4.1
4.9
4.5
1927 .
43
31
74
2.0
1.7
1.9
40
29
69
5.8
4.7
5.3
1928 .
47
48
95
2.1
2.6
2.3
49
27
76
6.2
3.8
5.1
1929 .
41
59
100
1.8
3.0
2.4
34
31
65
4.5
4.9
4.6
1930 .
61
69
130
2.6
3.4
3.0
29
43
72
3.6
6.0
4.7
1931 .
59
68
127
2.3
3.3
2.8
30
48
78
3.4
6.5
4.8
1932 .
58
58
116
2.3
2.9
2.5
38
40
78
4.5
5.4
4.9
1933 .
52
54
106
2.0
2.7
2.3
41
33
74
4.8
4.3
4.5
1934 .
48
57
105
1.8
2.8
2.3
34
39
73
3.4
4.9
4.1
1935 .
49
49
98
1.8
2.2
2.0
35
38
73
3.5
4.7
4.0
1936 .
65
48
113
2.2
2.1
2.2
41
38
79
4.3
4.2
4.3
1937 .
49
54
103
1.7
2.4
2.0
28
30
58
2.7
3.7
3.1
1938 .
74
59
133
2.6
2.6
2.6
41
38
79
3.9
4.2
4.0
1939 .
77
56
133
2.8
2.6
2.7
41
32
73
4.0
3.5
3.7
Total
1,174
1,156
2,330
2.2
2.6
2.4
758
736
1,494
4.1
4.5
4.3
174
P.D. 117
This psychosis tends to readmission. We note the higher proportions of 4.1% in the
males and 4.5% in the females. The distribution is evenly balanced in the males with
the last ten years on a slightly lower level than the first ten years. In the females the
level is higher in the last ten years of the period studied.
Table 34H. — Number and Percentage with Psychoses Due to Drugs, First and
Readmissions, 1917-1989
First Admissions
Readmissions
Year
Number
Percent
Number
Percent
M.
F. T.
M. F.
T.
M.
F.
T.
M. F.
T.
1917 .
4
6 10
.2 .3
.2
i
2
2 _
.1
1918 .
4
8 12
.2 .4
.3
3
2
0
.4 .3
.3
1919 .
5
2 7
.2 .1
.1
1
2
3
.1 .3
.2
1920 .
3
9 12
.1 .5
.3
1
3
4
.1 .4
.3
1921 .
7
4 11
.3 .2
. 3
3
6
9
.4 .9
.6
1922 .
11
12 23
.5 .6
.6
3
4
7
.4 .6
.5
1923 .
9
9 18
.4 .5
. 0
3
3
6
.4 .5
.5
1924 .
10
8 18
.5 .4
.4
4
—
4
. 5 -
. 5
1925 .
8
4 12
.3 .2
.3
2
2
4
.3 .3
.3
1926 .
12
8 20
- .6 .4
. 5
2
4
6
.3 .6
.4
1927 .
11
6 17
.5 .3
.4
2
3
5
.2 .4
.3
1928 .
9
7 16
.4 .3
.3
4
2
6
.5 .2
.4
1929 .
14
10 24
.6 .5
. o
4
3
7
.5 .4
.5
1930 .
13
21 34
.5 1.0
.7
9
4
13
1.1 .5
.8
1931 .
23
28 51
.9 1.3
1.1
6
6
12
.6 .8
.7
1932 .
20
18 38
.7 .9
.8
7
6
13
.8 .8
.8
1933 .
17
13 30
.6 .6
.6
6
3
9
.7 .3
.5
1934 .
15
13 28
.5 .6
.6
8
o
13
.8 .6
.7
1935 .
13
15 28
.4 .6
. 0
4
4
8
.4 .4
.4
1936 .
12
11 23
.4 .4
.4
.5
3
8
.5 .3
.4
1937 .
18
14 32
.6 .6
.6
o
6
11
.4 .7
.6
1938 .
11
18 29
.3 .8
. o
6
6
12
.5 .6
.6
1939 .
20
19 39
.7 .8
.8
o
2
7
.4 .2
.3
Total
269
263 532
.5 .6
. 5
95
79
174
.5 .4
.5
Table 34J.
Number and Percentage with Psychoneuroses, First and Readmissions,
1917-1939
First Admissions
Readmissions
Year
Number
Percent
Number
Percent
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 .
23
46
69
1.2
2.5
1.8
8
9
17
1.1
1.4
1.3
1918 .
33
42
75
1.7
2.4
2.0
o
19
24
.6
2.9
1.7
1919 .
25
47
72
1.2
2.6
1.9
14
10
24
2.0
1.6
1.8
1920 .
28
24
52
1.6
1.5
1.5
2
18
20
.2
2.9
1.5
1921 .
34
37
71
1.8
2.3
2.0
14
16
30
1.9
2.4
2.1
1922 .
48
62
110
2.3
3.5
2.8
16
18
34
2.4
2.8
2.6
1923 .
34
51
85
1.8
3.0
2.4
9
14
23
1.4
2.4
1.9
1924 .
34
50
84
1.7
2.9
2.3
12
14
26
1.6
2.3
1.9
1925 .
51
28
79
2.4
1.6
2.0
9
7
16
1.3
1.1
1.3
1926 .
32
48
80
1.6
2.8
2.1
11
21
32
1.6
3.5
2.5
1927 .
31
48
79
1.4
2.7
2.0
11
18
29
1.6
2.9
2.2
1928 .
33
48
81
1.4
2.6
2.0
7
24
31
.8
3.4
2.0
1929 .
42
45
87
1.9
2.3
2.1
7
17
24
.9
2.6
1.7
1930 .
57
49
106
2.4
2.4
2.4
20
21
41
2.5
2.9
2.7
1931 .
56
64
120
2.2
3.1
2.6
25
21
46
2.8
2.8
2.8
1932 .
46
75
121
1.8
3.7
2.6
13
38
51
1.5
5.1
3.2
1933 .
72
81
153
2.8
4.0
3.3
37
33
70
4.3
4.3
4.3
1934 .
80
76
156
3.0
3.8
3.4
27
28
55
2.7
3.5
3.1
1935 .
87
113
200
3.2
5.2
4.1
21
33
54
2.1
4.0
3.0
1936 .
106
123
229
3.7
5.5
4.5
37
43
80
3.9
4.8
4.3
1937 .
131
135
266
4.7
6.0
5.3
50
36
86
4.8
4.4
4.7
1938 .
135
168
303
4.8
7.6
6.0
43
60
103
4.1
6.6
5.3
1939 .
137
157
294
5.0
7.3
6 0
40
50
90
3.9
5.4
4.6
Total
1,355
1,617
2,972
2.6
3.7
3.1
438
568
1,006
2.3
3.5
2 9
Psychoses Due to Drugs
Table 34H shows that the sexes are fairly evenly balanced in first admissions. This
psychosis presents .5% for male and .6% for female first admissions. In the males the
low of .1% occurs in 1920 and the high of .9% in 1931. In the females the low of .1%
P.D. 117
175
occurs in 1919 and the high of 1.3% in 1931. Both sexes are showing higher levels over
the last ten years of the period.
This psychosis comprises .5% of male and .4% of female readmissions. A tendency
to higher levels during the past ten years is noted in both sexes. In 1939 there has been
a decided decrease in female readmissions from .6% in 1938 to .2% in 1939.
Psychoneuroses
Table 34J shows that 2.6% of male and 3.7% of female first admissions were diagnosed
as psychoneuroses. Definite increases have taken place over the years in this classifica-
tion. In the males the low of 1.2% occurs in 1917 and 1919, increasing fourfold to the
high of 5.0% in 1939. In the females there is a parallel increase, a rise from the low of
1.5% in 1920 to the high of 7.6% in 1938.
This diagnosis made up 2.3% of male and 3.5% of female readmissions. The male
percentages increase from the low of .2% in 1920 to the high of 4.8% in 1937. The
female percentages rise from the low of 1.1% in 1925 to the high of 6.6% in 1938. In
both first admissions and readmissions the psychoneuroses have increased more than
300% over the 23 year period.
Economic Status of First and Readmissions, 1939, by Diagnosis
Table 35 presents the percentage distribution of the psychoses in the groups dependent,
marginal and comfortable for both first admissions and readmissions. In the first admis-
sions nearly 40% of the entire dependent group are included in the old-age diagnoses,
31.8% in psychoses with cerebral arteriosclerosis and 8.5% in senile psychoses. Dementia
praecox includes 13.0% of the dependent and without psychoses, 9.4%. Of the cases of
marginal economic status, 17.2% are diagnosed dementia praecox, 15.3% without
psychoses, 13.9% with cerebral arteriosclerosis and 9.6% alcoholic psychoses. In the
comfortable group, 15.2% are diagnosed dementia praecox, 14.7% without psychoses
and manic-depressive, and 13.3% with cerebral arteriosclerosis.
Table 35. — Economic Status of First and Readmissions, 1939, by Diagnosis:
Percentage Distribution
Diagnoses
F
IEST AD1
•IISSIONS
Readmi
SSIONS
De-
Mar-
Com-
Un-
De-
Mar-
Com-
Un-
pendent
ginal
fortable
known
pendent
ginal
fortable
known
With syphilitic meningoencephalitis
3.1
3.9
3.3
3.1
3.8
1.9
6.5
With other forms of syphilis
.7
.3
-
—
.8
1
_
2.1
With epidemic encephalitis .
.1
.1
.4
.5
—
.1
-
—
With other infectious diseases
.3
.3
—
.5
—
.2
—
_
Alcoholic psychoses
6.6
9.6
2.3
6.8
6.1
8.5
6.8
10.8
Due to drugs, etc
.3
.9
.9
—
—
.4
—
Traumatic psychoses
.2
.4
-
-
-
.1
.8
_
With cerebral arteriosclerosis
31.8
13.9
13.3
39.7
12.3
4.9
3.4
10.8
With other disturbances of circula-
tion
.5
.6
.4
1.0
—
.3
.8
_
With convulsive disorders (epilepsy)
2.9
1.3
.4
.5
8.2
3.0
3.4
2.1
Senile psychoses ....
8.5
3.8
10.0
13.0
2.6
.9
1.7
4.3
Involutional psychoses . . .
1.8
4.3
5.2
4.1
.8
3.6
3.4
4.3
Due to other metabolic diseases, etc.
1.4
1.9
2.3
2.6
.8
.3
2.5
_
Due to new growth
.09
.3
-
—
-
.07
_
_
With organic changes of nervous
system ......
2.2
1.7
9
2.0
1.7
1.6
.8
4.3
Psychoneuroses ....
3.1
6.9
8.5
2.6
4.4
4.6
5.9
2.1
Manic-depressive psychoses
3.1
6.5
14.7
2.6
11.1
19.9
30.7
10.8
Dementia praecox ....
13.0
17.2
15.2
8.3
25.0
23.0
19.6
19.5
Paranoia and paranoid conditions
1.9
2.1
4.2
1.5
1.4
1.6
1.7
2.1
With psychopathic personality
.6
.9
.4
-
1.4
3.0
.8
-
With mental deficiency
5.9
1.9
1.4
1.0
7.6
3.1
—
4.3
Undiagnosed psychoses .
.8
1.6
-
1.5
.2
1.6
-
-
Without psychoses ....
9.4
15.3
14.7
7.8
10.5
15.6
17.0
15.2
Primary behavior disorders .
.4
3.2
.4
-
.2
.4
-
-
Total With Mental Disorder
90.1
81.3
84.7
92.1
89.1
83.8
82.9
84.7
Total Without Mental Disorder
9.8
18.6
15 2
7.8
10.8
16.1
17.0
15.2
Grand Total
100.0
100.0
100.0
100.0
100 0
100.0
100.0
100.0
(See Tables 199 and 200 for detail)
In the readmissions, dementia praecox dominates the dependent and marginal groups
with 25.0% and 23.0% respectively. Manic-depressive shows 11.1% and 19.9% and
without psychoses shows 10.5% and 15.6%. Cerebral arteriosclerosis is high only in the
176
P.D. 117
dependent group with 12.3%. Of the comfortable group, 30.7% are found in the manic-
depressive psychoses, 19.6% in dementia praecox and 17.0% in without psychoses.
Diagnosis of Readmissions Admitted by Transfer and Cases Admitted
Directly from Psychopathic
Table 36 shows the psychoses of cases transferred from one mental hospital to another
and those discharged from the Boston Psychopathic Hospital and admitted the same
day to another hospital. As these cases have remained in the resident population of
some one of our hospitals and thus within the State statistical system, they are not
included in the admission statistics. They do appear, of course, in the tables on resident
population. Manic-depressive psychoses made up 10% of the transfers and 16% of these
Psychopathic Hospital discharges. Alcoholic psychoses made up 5% of the transfers and
10% of the others. Twelve per cent of the Psychopathic cases were undiagnosed. De-
mentia praecox, which made up 15% of first admissions and 23% of readmissions in
1939, constitutes 50% of transfers and 26% of cases leaving Psychopathic and going
directly to another hospital. The tendency of this psychosis to chronicity, with a result-
ant retention within hospitals, is obvious.
Table 36. — Diagnosis of Cases Admitted by Transfer to Hospitals for Mental Disorders
and Cases Admitted Directly to Other Institutions from Psychopathic, 1939:
Percentage Distribution
Transfers
From Psychopathic to Other
B
OSPITALS1
Number
Percent
Number
]
5ercen1
M.
F.
T.
M.
F.
T
M.
F.
T.
M.
F.
T.
With syphilitic meningoen-
cephalitis ....
8
4
12
3.6
2.7
3 2
26
7
33
5.0
1.7
3.5
With other forms of syphilis
4
-
4
1.8
-
1.0
2
1
3
.3
2
.3
With epidemic encephalitis
-
—
—
-
-
—
1
—
1
.1
_
.1
With other infectious diseases
1
—
1
4
-
.2
-
_
-
_
_
_
Alcoholic psychoses
19
2
21
8^7
1.3
5.7
70
24
94
13.5
5.9
10.2
Due to drugs, etc.
-
-
-
-
-
-
1
8
9
.1
1.9
.9
Traumatic psychoses .
—
—
-
_
-
-
2
_
2
.3
_
.2
With cerebral arteriosclerosis
9
8
17
4.1
5.4
4.6
2
3
5
.3
.7
.5
With other disturbances of
circulation
1
_
1
.4
_
2
_
1
1
_
.2
.1
With convulsive disorders
(epilepsy)
5
1
6
2.2
.6
1.6
21
11
32
4.0
2.7
3.4
Senile psychoses
1
1
2
.4
.6
.5
8
12
20
1.5
2.9
2.1
Involutional psychoses
3
11
14
1.3
7.4
3.8
7
17
24
1.3
4.2
2.6
Due to other metabolic dis-
eases ....
—
1
1
—
.6
.2
3
5
8
. 5
1.2
.8
Due to new growth
—
-
-
-
—
-
1
-
1
.1
—
.1
With organic changes of ner-
vous system
5
3
8
2.2
2.0
2.1
14
8
22
2.7
1.9
2.3
Psychoneuroses
6
2
8
2.7
1.3
2.1
17
10
27
3.3
2.4
2.9
Manic-depressive psychoses
27
10
37
12.3
6.8
10.1
63
87
150
12.2
21.6
16.3
Dementia praecox
115
70
185
52.7
47.6
50.6
141
98
239
27.3
24.3
26.0
Paranoia and paranoid con-
ditions ....
3
13
16
1.3
8.8
4.3
19
30
49
3.6
7.4
5.3
With psychopathic personal-
ity
3
2
5
1.3
1.3
1.3
13
9
22
2.5
2.2
2.3
With mental deficiency
8
14
22
3.6
9.5
6.0
29
19
48
5.6
4.7
5.2
Undiagnosed psychoses
—
3
3
-
2.0
.8
63
51
114
12.2
12.6
12.4
Without psychoses
—
2
2
—
1.3
.5
10
—
10
1.9
-
1.0
Primary behavior disorders
—
-
—
-
-
—
2
1
3
.3
.2
.3
Total With Mental Dis-
order
218
145
363
99.9
98. G
99.4
503
401
904
97.6
99.7
98.5
Total Without Mental
Disorder .
-
2
2
-
1.3
.5
12
1
13
2.3
.2
1.4
Grand Total
218
147
365
100.0
100.0
100.0
515
402
917
100.0
100.0
100.0
1 These cases are discharges from the Psychopathic and committed to other institutions the same day.
Section G. First and Readmissions Discharged from
Mental Hospitals During 1939
The following section presents data in reference to patients discharged from mental
hospitals to the community during the year ended September 30, 1939. As in the case
of admissions, we have discarded the old criterion of court admission and have based
the outlined data on all patients leaving mental hospitals, including those admitted
under court, temporary care, observation and voluntary status. The deaths are con-
sidered separately in a later section.
P.D. 117
17-
Discharges to the Community, 1937-1939, by Form of Admission
Table 37 shows that 3,175 first admissions and 1,464 readmissions, a total of 4,639
cases, were discharged to the community in 1939. In the first admissions, 1,802 males
and 1,373 females, and in the readmissions 769 males and 695 females left hospitals to
return to the community.
Table 37. — First and Readmissions Discharged from All Hospitals for Mental Disorders,
1937-1939 by Form of Admission and Sex
Year
Sex
Aggre-
gate
First
Admissions
Readmissions
Total
Court
Tempo-
rary
Care
Obser-
vation
Volun-
tary
Total
Court
Tempo-
rary
Care
Obser-
vation
Volun-
tary
1937
T.
M.
F.
4,329
2,516
1,813
3,053
1,809
1,244
1,339
711
628
1,052
642
410
507
359
148
155
97
58
1,276
707
569
764
375
389
278
183
95
154
104
50
80
45
35
1938
T.
M.
F.
4,610
2,638
1,972
3,123
1,822
1,301
1,405
732
673
1,008
572
436
595
441
154
115
77
38
1,487
816
671
905
450
455
303
183
120
183
124
59
96
59
37
1939
T.
M.
F.
4,639
2,571
2,068
3,175
1,802
1,373
1,483
713
770
923
548
375
629
456
173
140
85
55
1,464
769
695
879
420
459
296
172
124
203
134
69
86
43
43
In the first admissions, the number of court commitments increased from 1,405 in
1938 to 1,483 in 1939, of observation cases from 595 to 629. The number of admissions
under temporary care papers and voluntary status decreased from 1,008 to 923 and from
115 to 140, respectively. Decreases are observed in the court, temporary care and volun-
tary forms among the readmissions. Court cases drop from 905 to 879, temporary care
from 303 to 296 and voluntary from 96 to 86. Observation forms increased from 183
to 203.
Diagnosis in Discharges to the Community, 1939
Table 38 reports that 15.3% of the 3,175 first admissions returned to the community
were diagnosed as dementia praecox. This is very interesting to compare with the
15.8% of the same diagnosis in first admissions entering mental hospitals during the
year. The alcoholic psychoses made up 11.4% of discharges and only 8.6% of first
admissions. Manic-depressive psychoses made up 9% of discharged first admissions
and 5% of first admissions entering. The percentage of discharges diagnosed "without
mental disorder" is high, 25.2%, as compared with 16.1% of admissions in this clinical
grouping during the same year.
In first admissions by court commitment discharged, dementia praecox comprises
26%, manic-depressive psychoses 15% and cerebral arteriosclerosis 12%. The group
"without mental disorder" is small, 1.6%. In temporary care first admissions dis-
charged, the total "without mental disorder" comprises 33%, the alcoholic psychoses
16% and psychoneuroses 13%. In the observation cases discharged, "without mental
disorder" comprises 64%, the alcoholic psychoses 10% and psychoneuroses 9%. The
voluntary cases discharged show "without mental disorder" 47%, psychoneuroses 17%
and syphilitic meningo-encephalitis 7%.
Temporary care, observation and voluntary forms of admission are high in cases
diagnosed "without mental disorder". Where no complicated legal obstructions are
placed in the way of patients coming into mental hospitals we see cases being admitted
before the psychosis has developed fully. They respond to treatment and are discharged
quickly. It is to be hoped, of course, that this early treatment will have an effect in
checking any further development of the incipient mental disorder. We do know that a
goodly proportion of these "with mental disorder" cases never return to mental hospitals.
Among the 1,464 readmissions returned to the community, the manic-depressive
psychoses comprise 24%, dementia praecox 20% and the alcoholic psychoses 8%. The
total "without mental disorder" makes up 20% of the readmissions discharged. In the
court readmissions, also, manic-depressive, dementia praecox and the alcoholic psychoses
comprise the largest proportion of the cases with 32%, 30% and 6% respectively. Lead-
ing the temporary care admissions are "without mental disorder" 39%, alcoholic psy-
choses 14% and manic-depressive 11%. In the observation admissions, "without
178
P.D. 117
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179
mental disorder" comprises 63%, alcoholic psychoses 9%, psychoneuroses and manic-
depressive 7% each. Among the voluntary cases discharged, "without mental disorder"
makes up 40%, manic-depressive psychoses 18%, psychoneuroses 17% and convulsive
disorders 6%.
Those cases discharged to other institutions by transfer are high in dementia praecox,
49%. Manic-depressive psychoses follow with 10%; then alcoholic psychoses 6%, and
with mental deficiency, 5%.
Discharges to the Community, 1939, by Diagnosis and Age:
Discharge Rates per 1,000 under Care
Table 39 outlines the total discharge rates per 1,000 cases under care i in various
psychoses for both first and readmissions. First admissions show a total discharge rate
of 156 per 1,000 under care, with 112 for the readmissions. The group "with mental
disorder" shows a discharge rate of 122 in first admissions and 92 in readmissions. Cases
"without mental disorder" present a discharge rate of 878 in first admissions and 791
in readmissions.
Table 39. — First and Readmissions Discharged, 1989, by Diagnosis: Discharge Rates
per 1,000 Under Care
Dis-
■
Dis-
charge
charge
First Admissions
Rate per
Readmissions
Rate per
1,000
1,000
Due to drugs, etc
696.
Undiagnosed psychoses ....
551 .
Psychoneuroses
600.
334.
Undiagnosed psychoses ....
549.
Due to drugs, etc
312.
Due to new growth ....
400.
With psychopathic personality
214.
With other infectious diseases
315.
Manic-depressive psychoses .
197.
With other disturbances of circulation
272.
Traumatic psychoses . . . .
193.
Due to other metabolic diseases, etc.
268.
Alcoholic psychoses ....
183.
Alcoholic psychoses ....
255.
Involutional psychoses ....
142.
With psychopathic personality
242.
With cerebral arteriosclerosis .
115.
Manic-depressive psychoses
220.
With other forms of syphilis .
108.
Involutional psychoses ....
170.
With organic changes of nervous system
107.
Traumatic psychoses ....
166.
Senile psychoses
102.
With organic changes of nervous system
142.
Due to other metabolic diseases, etc.
102.
With cerebral arteriosclerosis
120.
Paranoia and paranoid conditions
91.
Paranoia and paranoid conditions
120.
With syphilitic meningo-encephalitis
79.
With syphilitic meningo-encephalitis .
104.
With convulsive disorders (epilepsy)
70.
With epidemic encephalitis .
101.
With other disturbances of circulation .
66.
With convulsive disorders (epilepsy) .
66.
46.
Dementia praecox
61.
With mental deficiency ....
41.
Senile psychoses
45.
With epidemic encephalitis
— '
With mental deficiency ....
41.
With other infectious diseases
-
With other forms of syphilis
33.
Due to new growth
-
Without psychoses .....
864.
Without psychoses .
789.
Primary behavior disorders .
967.
Primary behavior disorders
Total With Mental Disorder .
888.
Total With Mental Disorder
122.
92.
Total Without Mental Disorder .
878.
156.
Total Without Mental Disorder .
Grand Total
791.
Grand Total . . .
112.
In the first admissions high discharge rates are shown by psychoses due to drugs, etc.,
with 696 persons discharged per 1,000 under care of the same diagnosis. The psy-
choneuroses offer a discharge rate of 600, undiagnosed 549 and due to new growth 400.
Dementia praecox with 61, senile psychoses with 45, psychoses with mental deficiency
with 41 and other forms of syphilis with 33, show the low discharge rates.
In readmissions, undiagnosed psychoses show the high discharge rate of 551 per 1,000
under care. Psychoneuroses present a discharge rate of 334, due to drugs 312, psycho-
pathic personality 214 and manic-depressive psychoses 197. The low discharge rates
are shown by convulsive disorders with 70, other disturbances of circulation 66, dementia
praecox 46 and mental deficiency 41.
Table 40 presents the influence of age upon discharge rates. In Table 39 the total
rates presented might have been influenced by the preponderance of younger or older
patients in a particular psychosis. Table 40 solves this problem by permitting compari-
son of the discharge rates of two psychoses within a single age group. It also shows
whether discharge rates in a specific psychosis are high in the younger or older ages.
1 Under care includes all patients within hospitals, patients out on visit, etc., deaths and discharges.
Present age of cases on books and age at discharge or death of discharges and deaths are used within the
various age groupings.
180
P.D. 117
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A review of first admissions shows the total "with mental disorder" with the high
discharge rate of 272 cases per 1,000 or one out of every four under care in the age group
0-19 years. The rates drop with age, the 20-29 year age group presenting a rate of 247,
30-39 years a rate of 174, 40-49 years a rate of 129, 50-59 years-92, 60-69 years-75,
and 70 years and over-61. The cases "without mental disorder" show high discharge
rates throughout all age groups, the high of 928 occurring in the age group 20-29 years
and the low of 720 occurring in the age group 60-69 years. In all psychoses the younger
age groups are showing the higher discharge rates. In other words, the younger the
patient, the greater chance he has of being returned to the community.
Discussing the age differences in discharge rates of the various psychoses, we exclude
under 20 years because of the small numbers involved. In the 20-29 year group, due to
drugs and other disturbances of circulation show the high discharge rates of 1,000. The
30-39 year group shows due to new growth, due to drugs, psychoneuroses and undiag-
nosed psychoses with the high discharge rates of 1,000, 722, 675 and 666, respectively.
In the 40-49 year group, due to drugs, due to new growth, psychoneuroses and undiag-
nosed psychoses show the high discharge rates of 684, 666, 606 and 533, respectively.
In the 50-59 year age group, due to drugs, psychoneuroses and other disturbances of
circulation show the high discharge rates of 571, 528 and 368, respectively. Due to
drugs, other infectious diseases and psychoneuroses have the high discharge rates in the
60-69 year group of 555, 500 and 400, respectively. In the group 70 years and over,
the high discharge rates are shown by psychoses due to drugs with 1,000 and psychoneu-
roses with 300. Certain psychoses tend to have high discharge rates in all age groups.
At the other extreme, we note that dementia praecox, psychoses with mental deficiency
and psychoses with convulsive disorders tend to have the low discharge rates whatever
the age group.
Sex differences are relatively small compared with those of previous years. Going
back only two years, when the new basis for outlining data was put into effect, we see the
male discharge rate in the total first admissions "with mental disorder" for all ages
combined is considerably higher than the female; 131 per 1,000 under care for the males
to 107 for the females in 1937 and 131 to 114 in 1938. This year the male discharge rate
is but 124 as compared with the female of 119. Again, in examining rates of the sexes
by age groups a change is noticed. In 1937 five of the seven age groups show higher
rates in the males and in 1938 six are higher in the males. However, in 1939 only four
of the age groups have higher male rates than female, while in three the female rates
are higher.
The discharge rates for readmissions are not discussed owing to space limitations.
However, Table 40 reveals that they show the same general characteristics as those
for the first admissions.
Economic Status of Discharges to the Community, 1939:
Discharge Rates per 1,000 Under Care
Table 41 shows the influence of economic status of patients upon the discharge rates
during 1939.
In first admissions the dependent show a discharge rate of 104 per 1,000 dependent
patients under care. The marginal show a higher discharge rate of 171 and the com-
fortable a rate of 159. The discharge rate of the marginal group is 64% higher than that
of the dependent while the discharge rate of the comfortable is 52% higher. The dis-
charge rates of the sexes stay close together in the dependent group where the male
rate is .9% higher. In the marginal classification the discharge rate for males is 30%
higher and in the comfortable group 22% higher. Apparently economic status has a
greater tendency to raise the discharge rates in the case of men than women.
In readmissions the dependent show a discharge rate of 95, the marginal a discharge
rate of 113 and the comfortable 162. Here the rate for the marginal is 18% higher than
that for the dependent, while the rate for the comfortable is 70% higher. Thus com-
fortable economic status would appear to influence the discharge rate of readmissions
to a greater extent than that of first admissions. Sex differences are less pronounced in
readmissions than in first admissions, the male rate being 4% higher than the female
rate in the dependent group, 13% higher in the marginal group and 8% higher in the
comfortable group.
P.D. 117
Table 41.
185
Economic Status of First and Read-missions Discharged, 1939, by Sex:
Discharge Rates per 1,000 Under Care .
Economic Status
Dependent:
Under Care .
Discharges
Rate per 1,000
Marginal:
Under Care .
Discharges
Rate per 1,000
Comfortable :
Under Care .
Discharges
Rate per 1,000
Unknown:
Under Care
Discharges
Rate per 1,000
Total :
Under Care .
Discharges
Rate per 1,000
Total
3,703
380
66.9
12,337
2,029
164.4
585
103
176.0
364
59
162.0
2,873
289
100.5
12,109
1,587
131.0
938
142
151.3
368
50
135.8
6,576
669
101.7
24,446
3,616
147.9
1,523
245
160.8
732
109
148.9
16,989 16,288
2,571 2,068
151.3 126.9
33,277
4,639
139.4
First Admissions
M.
2,442
257
105.2
7,412
1,435
193.6
363
65
179.0
274
45
164.2
1,884
197
104.5
7,122
1,056
148.2
533
78
146.3
279
42
150.5
4,326
454
104.9
14,534
2,491
171.3
896
143
159.5
553
87
157.3
10,491
1,802
171.7
9,818
1,373
139.8
20,309
3,175
156.3
Readmissions
M.
T.
1,261 989
123 92
97.5 93.0
4,925 4,987
594 531
120.6 106.4
222 405
38 64
171.1 158.0
90 89
14 8
155.5 89.8
2,250
215
95.5
9,912
1,125
113.4
627
102
162.6
179
22
122.9
6,498 6,470
769 695
118.3 107.4
12,968
1,464
112.8
Marital Condition of Discharges to the Community, 1939:
Discharge Rates per 1,000 Under Care
Table 42 and Graph 3 outline the discharge rates for the various marital conditions
in both first admissions and readmissions. In first admissions the high discharge rate
of 245 per 1,000 under care occurs in the separated. Next in order are the married with
a discharge rate of 198, the divorced 182, the widowed 133, and the single 128. The males
in all marital groups show decidedly higher discharge rates than the females. The
married and divorced females, particularly, are making a poorer showing in leaving
hospital than the males of the same groups.
In readmissions the high discharge rate of 213 occurs in the divorced. This is followed
by a rate of 181 in the separated, 142 in the married, 106 in the widowed and 88 in the
single.
Table 42. — Marital Condition of First and Readmissions Discharged, 1939, by Sex:
Discharge Rates per 1,000 Under Care
Total
First
Admissions
Readmissions
Marital Condition
M.
F.
T.
M.
F.
T.
M.
F.
T.
Single:
Under Care .
9,998
7,259
17,257
5,831
4,220
10.051
4,167
3,039
7,206
Discharges
1,167
760
1,927
808
483
1,291
359
277
636
Rate per 1,000
116.7
104.6
111.6
138.5
114.4
128.4
86.1
91.1
88.2
Married:
Under Care .
5,050
6,124
11,174
3,277
3,645
6,922
1,773
2,479
4,252
Discharges
1,052
929
1,981
747
629
1,376
305
300
605
Rate per 1,000
208.3
151.6
177.2
227.9
172.5
198.7
172.0
121.0
142.2
Widowed:
Under Care .
1,112
2,109
3,221
851
1,532
2,383
261
577
838
Discharges
164
243
407
131
187
318
33
56
89
Rate per 1,000
147.4
115.2
126.3
153.9
122.0
133 . 4
126.4
97.0
106.2
Divorced:
Under Care .
476
454
930
293
238
531
183
216
399
Discharges
102
80
182
60
37
97
42
43
85
Rate per 1,000
214.2
176.2
195.6
204.7
155.4
182.6
229.5
199.0
213.0
Separated:
Under Care .
309
326
635
200
171
371
109
155
264
Discharges
84
55
139
55
36
91
29
19
48
Rate per 1,000
271.8
168.7
218.8
275.0
210.5
245.2
266.0
122.5
181.8
Unknown:
Under Care .
44
16
60
39
12
51
5
4
9
Discharges
2
1
3
1
1
2
1
-
1
Rate per 1,000
45.4
62.5
50.0
25.6
83.3
39.2
200.0
—
111. 1
Total:
Under Care .
16,989
16,288
33,277
10,491
9,818
20,309
1,498
6,470
12,968
Discharges
2,571
2,068
4,639
1,802
1,373
3,175
769
695
1,464
Rate per 1,000
151.3
126.9
139.4
171.7
139.8
156.3
118.3
107.4
112.8
186
P.D. 117
First Admissions HUH Reodmissions
198
142
133
SINGLE MARRIED WIDOWED DIVORCED SEPARATED
Graph 3. — Marital Condition of First and Read-
missions Discharged, 1939: Discharge Rates per
1,000 Under Care
Country of Birth of Discharges to the Community, 1939:
Discharge Rates per 1,000 Under Care
Table 43 presents the discharge rates per 1,000 under care by country of birth of
patients. In first admissions discharged the United States shows the high rate of 176
and is followed by Scotland with 150, Italy with 140, Portugal with 131 and Canada
with 128. The lowest discharge rates occur in Greece with 78, Sweden with 72 and
Austria with 42.
Table 43. — Country of Birth of First and Readmissions Discharged, 1989:
Discharge Rates per 1,000 Under Care
First
Admissi
ONS
Readmissions
Country of Birth
Total
Total
Rate
Country of Birth
Total
Total
Rate
Under
Dis-
per
Under
Dis-
per
Care
charges
1,000
Care
charges
1,000
United States
13,087
2,316
176.9
Scotland
79
10
126.5
Scotland
146
22
150.6
United States
8,965
1,114
124.2
Italv
748
105
140.3
Russia
480
58
120.8
Portugal
251
33
131.4
Portugal
95
10
105.2
Canada1
1,671
215
128.6
Canada1
772
80
103.6
Finland
133
16
120.3
Italv
434
40
92.1
Russia .
485
56
115.4
Germany
77
7
90.9
Ireland .
1 ,478
167
112.9
Austria .
67
6
89.5
England
427
48
112.4
England
217
17
78.3
Poland
590
57
96.6
Greece .
64
5
78.1
Germany
139
12
86.3
Finland
78
6
76.9
102
8
78.4
Poland
246
17
69.1
207
15
72.4
Ireland .
845
58
68.6
Austria .
142
6
42 2
Sweden
129
6
46.5
All Other Countries
703
99
145.8
All Other Countries
420
30
71.4
Total
20,309
3,175
156.3
Total
12,968
1,464
112.8
(See Table 225 for detail)
1 Includes Newfoundland.
P.D. 117
187
In readmissions the high discharge rates are shown by Scotland with 126 per 1,000
under care, United States with 124, Russia 120, Portugal 105 and Canada 103. The
low discharge rates occur in Poland with 69, Ireland 68 and Sweden 46. The number
of discharges coming from any one country is rather small and for that reason no partic-
ular significance can be attached to the findings for any one year.
Discharges to the Community, 1939, by Number of This Admission:
Discharge Rates per 1,000 Under Care
Table 44 shows the discharge rates in accordance with the number of this admission.
For example, during 1939 the State hospitals had 5,015 patients under care who were
having their third admission to a mental hospital. Of this number 418 were discharged,
giving a discharge rate of 83 per 1,000 under care for this third admission group. While
the high discharge rate occurs in those having eleven admissions, 222, the numbers are
very small. Cases having twelve or more admissions show the next highest rate of 209.
Cases having their tenth admission show a rate of 208, ninth admission 178, eighth
admission 176 and seventh admission 157. After seeing this regular decrease in both
rates and number of admissions, it is interesting to note that the first and second admis-
sions are next with the rate of 156. The lowest discharge rate, 83, is shown by patients
having their third admission and the fourth admissions are close with the rate of 91.
In the totals, the males show a higher discharge rate, 151, than the females, 126. This
higher discharge rate for males persists throughout. Apparently patients having their
third or fourth admission are those tending to remain longest in mental hospitals.
Table 44.
- Discharge Rates of First and Readmissions Under Care in Hospitals for
Mental Disorders, 1939, by Number of This Admission and Sex
Number op This
Cases Under Care
Di
scharges
Rate per 1,000
Admission
M.
F.
T.
M.
F.
T.
M.
F.
T.
First
10,491
9,818
20,309
1,802
1,373
3,175
171.7
139.8
156.3
Second
1,926
1.810
3,736
297
287
584
154.2
158.5
156.3
Third .
2,542
2,473
5,015
221
197
418
86.9
79 6
83.3
Fourth
1,060
1,159
2,219
108
94
202
101.8
81.1
91.0
Fifth .
471
499
970
53
52
105
112.5
104.2
108.2
Sixth .
209
238
447
30
22
52
143.5
92.4
116.3
Seventh
123
112
235
23
14
37
186.9
125.0
157.4
Eighth .
55
70
125
9
13
22
163.6
185.7
176.0
Ninth .
41
43
84
9
6
15
219.5
139.5
178.5
Tenth .
23
25
48
7
3
10
304.3
120.0
208.3
Eleventh
14
13
27
3
3
6
214.2
230.7
222.2
Twelfth or over
34
28
62
9
4
13
264.7
142.8
209.6
Total
16,989
16,288
33,277
2,571
2,068
4,639
151.3
126.9
139 4
Mental Condition op Discharges to the Community, 1939, by Diagnosis
Table 45 presents the condition on discharge of cases returned to the community
during 1939. Of all first admissions leaving hospital, 21.5% were recorded as without
psychoses, 21.2% as recovered, 42.5% as improved and 14.6% as unimproved. Six out
of every seven patients discharged either were without a mental disorder or had shown
definite improvement. In the total "with mental disorder" 28.1% were discharged as
recovered, 54.3% as improved and 17.4% as unimproved. In other words, 82.4% of these
patients, once definitely psychotic, were returned to the community as either recovered
or improved. High proportions of recovery are observed in psychoses with other infec-
tious diseases, 66%; alcoholic psychoses, 64%; due to drugs, 56%; with mental deficiency,
45% and other metabolic diseases 42%. Leading the improved group are psychoses
with syphilitic meningo-encephalitis, 79%; with other forms of syphilis, 75%; involu-
tional psychoses, 68%; senile psychoses, 67% and epidemic encephalitis, 66%. Of the
three psychoses most important numerically, dementia praecox shows 11% recovered,
65% improved and 23% unimproved; alcoholic psychoses show 64% recovered, 31%
improved and 4% unimproved and manic-depressive show 31% recovered, 56% im-
proved and 12% unimproved. It is encouraging that dementia praecox shows over seven
out of every ten discharges of this diagnosis as either recovered or improved.
In the readmissions we find 19% of total discharges without psychoses, 21 % recovered,
48% improved and 12% unimproved. The readmissions have fewer unimproved (12%)
than the first admissions (14%). The readmissions are also making a better showing
188
P.D. 117
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189
than first admissions in the group "with mental disorder" with 26% recovered, 58%
improved and 14% unimproved. This last figure is lower than the 17% unimproved in
psychotic first admissions. Individual psychoses will not be discussed owing to space
limitations.
Length of Hospital Stay of Discharges to the Community, 1939, by
Condition on Discharge
Table 46 presents the average length of hospital stay during the present admission
of first admissions and readmissions returned to the community in 1939 by condition
on discharge and diagnosis. In the total "with mental disorder" the 668 recovered
remained-.98 years, the 1,289 improved-. 83 years, and the 415 unimproved-.45 years.
Complete recovery from the psychosis required a longer period of hospital residence
than the attainment of a condition permitting return to the community. In the re-
covered, due to drugs and due to new growth, .08 years each, remained the shortest time
in hospital. With epidemic encephalitis, 7.50 years; syphilitic meningo-encephalitis,
5.51 years; involutional psychoses, 3.17 years; and senile psychoses, 2.81 years remained
the longest time in hospital. Psychoses due to new growth show the short hospital stay
in the improved, .04 years. Psychoses with epidemic encephalitis, other disturbances
of circulation, other metabolic diseases, due to new growth and undiagnosed psychoses
all show the short hospital stay of .04 years in the unimproved. In comparison with the
general average, dementia praecox shows a long hospital residence in the recovered and
the unimproved.
Table 46. — Average Length of Hospital Stay during This Admission of First and Read-
missions Discharged during 1939, by Condition on Discharge and Diagnosis
First Ai
>MISSIONS
Readmissions
Diagnoses
Re-
Im
Unim-
Without
Re-
Im-
Unim-
Without
covered
proved
proved
Psychoses
covered
proved
proved
Psychoses
With syphilitic meningo-en-
cephalitis
5.51
.68
.23
—
4.50
1.89
.36
-
With other forms of syphilis
—
.69
.20
-
_
3.41
—
-
With epidemic encephalitis .
7.50
.74
.04
-
-
-
-
-
With other infectious diseases
.19
1.98
—
—
—
-
—
—
Alcoholic psychoses
.73
.81
1.17
-
.92
.90
6.27
-
Due to drugs, etc. .
.08
.14
.37
-
.20
.08
—
-
Traumatic psychoses
.51
.86
.12
-
.04
5.94
.29
-
With cerebral arteriosclerosis
1 10
.62
.23
-
.63
1.44
.67
—
With other disturbances of cir-
culation ....
.20
. 53
04
-
-
.04
-
-
With convulsive disorders (epi-
lepsy)
.23
.58
.99
-
1. 11
.29
.42
-
Senile psychoses
2.81
.96
.06
_
1.50
1.64
.61
-
Involutional psychoses .
3.17
1.37
.09
-
2.85
1.75
.43
-
Due to other metabolic dis-
eases, etc
.17
55
.04
—
.12
09
-
-
Due to new growth
.08
.04
.04
-
-
-
-
-
With organic changes of ner-
vous system
.37
.53
.29
-
3.89
1.14
.04
—
Psychoneuroses
.25
.20
.11
-
.71
.63
.05
-
Manic-depressive psychoses
1 . 35
.75
.40
-
1.42
.99
.87
-
Dementia praecox .
1.80
.76
.87
-
1.57
1.60
2 . 35
-
Paranoia and paranoid condi-
tions .....
1.20
1.21
.11
-
6.68
3.02
.78
-
With psychopathic personality
.66
1.38
.33
-
1.11
1.60
.15
-
With mental deficiency .
.87
2.61
.27
-
4.48
1.22
.70
-
Undiagnosed psychoses .
.12
.20
.04
-
.04
.04
04
-
Without psychoses .
-
-
-
10
-
-
-
.13
Primary behavior disorders .
.08
05
.05
-
.12
.04
.04
-
Total With Mental Disorder
.98
.83
.45
_
1.41
1.37
1.14
_
Total Without Mental Dis-
order1
.08
.05
05
.10
.12
.04
.04
13
Grand Total
97
79
41
10
1.40
1.37
1.11
.13
' Includes without psychoses and primary behavior disorders.
In the readmissions "with mental disorder" the recovered remained an average of
1.41 years in hospital before being returned to the community, the improved an average
of 1.37 years and the unimproved an average of 1.14 years. Undiagnosed psychosis
show a short hospital residence, whatever the condition on discharge. Also, traumatic
190
P.D. 117
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P.D. 117
191
psychoses show a short residence in the recovered, with other disturbances of circulation
in the improved and with organic changes of the nervous system and psychoneuroses
in the unimproved. Dementia praecox shows a long hospital residence in all groups of
the readmissions when compared with the general average.
MENTAL
REF/C/E/VCY
MVOLVT/ONAL
DEMENT/A
PRAECOX
SE/V/LE
PSYC//OPATH/C
PERSONAL/TV
SYPff/L/T/C
MEM/VGO-
E/VCEPffALir/S
PARAAfO/A
MAA//C~
DEPRESS/VE
ALCOffOL/C
CEREBRAL
ARTERIO-
SCLEROSIS
PSYC/fO-
A/EUROSES
TOTAL W/TH
MENTAL D/SORDi
7QTAL MTffOVr I . 09
MENTAL DISORDOfg ./
TOTAL-ALL FORMSX
2.3
2.5
F/rsi Ae/m/ssfons
fteadm/ss/Ofjs
Graph 4. — Length of Time in Residence during This Admission of
Certain Diagnoses, First Admissions and Readmissions
Discharged during 1939: Averages in Years
Length of Hospital Stay of Discharges to the Community, 1939, by
Diagnosis
Table 47 and Graph 4 present the average length of hospital residence during the
present admission of cases returning to the community during 1939. First admissions
"with mental disorder" show an average hospital residence of .80 years or over nine
months. The average residence of the females, .96 years, is much longer than that of
the males, .65 years. The long hospital residences are shown by psychoses with epidemic
encephalitis, 1.75 years; with mental deficiency, 1.64 years; with involutional psychoses,
192
P.D. 117
1.52 years; senile, 1.15 years; and dementia praecox, 1.12 years. The psychoses with
shorter hospital residences are those with due to drugs, .11 years; without psychoses,
.10 years; undiagnosed, .07 years; and due to new growth, .05 years. In with epidemic
encephalitis, with mental deficiency, senile psychoses, paranoia, with other infectious
diseases, traumatic psychoses and with other forms of syphilis, we observe the males
showing a greater length of hospital stay.
The readmissions "with mental disorder" show an average hospital stay of 1.35 years
or about a year and four months. The readmissions also show a longer hospital residence
for the females, 1.47 years, than for the males, 1.22 years. The traumatic psychoses
with 4.01 years, other forms of syphilis with 3.44 years, paranoia with 2.59 years and
mental deficienc}- with 2.35 years present the longer hospital residences. Due to other
metabolic diseases with an average stay of .10 years, and undiagnosed psychoses and
other disturbances of circulation with .04 years, show the short average hospital resi-
dences.
Remarkable differences in length of hospital stay are noted. In first admissions,
psychoses with epidemic encephalitis with a stay of 1.75 years, remain one year and
eight months longer than the psychoses due to new growth with an average of .05 years.
Among the readmissions, the traumatic psychoses with an average of 4.01 years remain
in hospital almost four years longer than the undiagnosed psychoses and with other
disturbances of circulation with an average stay of .04 years.
Total Length of Hospital Stay during Previous Admissions and the Present
Admission; Readmissions Discharged to the Community, 1939,
by Diagnosis
Table 48 shows the length of hospital stay during previous admissions as well as the
present admission of all readmissions discharged to the community during 1939. The
fourteen hundred sixty-four readmissions returned to the community during 1939 had
been in hospital an average of 2.03 years during their lives, .93 years in hospital during
previous admissions and 1.10 years during this admission. The average stay, 2.25 years,
of the females is 22% longer than the 1 .83 years of the males. During previous admissions
the females showed an average hospital stay which was 11% longer than that of the
males. During the present admission the hospital stay of the females averaged 33%
longer than that of the males.
Table 48. — Average Length of Hospital Stay > during Previous Admissions and the
Present Admission: Readmissions Discharged, 1939, by Diagnosis and Sex
Diagnoses
Readmissions Discharged — ■
■lOSPIT
ul Stat in Years
This
Admission
Previous Admissions
All Admissions
M.
F.
T.
M.
F.
T.
M.
F. T.
With syphilitic meningo-encephalitis
1.61
1.78
1.66
.54
1.58
.88
2.15
3.36 2.54
With other forms of syphilis .
3.44
-
3.44
1.44
—
1.44
4.88
4.88
Alcoholic psychoses ....
.94
1.33
1.00
.43
.41
.42
1.37
1 . 74 1 . 42
Due to drugs, etc. . *.
.15
.12
.13
.16
.33
.24
.31
.45 .37
Traumatic psychoses . .
4.81
.04
4.01
.29
.08
.26
5.10
.12 4.27
With cerebral arteriosclerosis .
.77
1.46
1.12
1.02
1.64
1.33
1.79
3.10 2.45
With other disturbances of circulation .
—
.04
.04
-
.08
.08
-
.12 .12
With convulsive disorders (epilepsy)
.16
.97
.51
.48
.29
.40
.64
1.26 .91
Senile psychoses . . " .
1.85
1.02
1.37
1.22
.64
.87
3.07
1.66 2.24
Involutional psychoses ....
2.38
1.65
1.72
1.11
.47
.54
3.49
2.12 2.26
Due to other metabolic diseases, etc.
.09
12
.10
1.30
.50
1.07
1.39
.62 1.17
With organic changes of nervous system
2 00
1.55
1.83
.81
.34
.62
2.81
1.89 2.45
Psychoneuroses .....
.82
.70
.76
.51
.29
.38
1.33
.99 1.14
Manic-depressive psychoses .
1.19
1.10
1.13
.82
1.16
1.04
2.01
2.26 2.17
Dementia praecox . . . .
1.53
1.97
1.73
1.25
1.21
1.23
2.78
3.18 2 96
Paranoia and paranoid conditions
1.80
3 05
2.59
1.40
1.36
1.37
3.20
4.41 3.96
With psychopathic personality
.74
1.44
1.13
1.10
1.63
1.38
1.84
3.07 2.51
With mental deficiency ....
.93
3.51
2.35
1.50
1.80
1.67
2.43
5.31 4.02
Undiagnosed psychoses ....
.04
.04
.04
1.07
.15
.38
1.11'
.19 .42
Without psychoses _
.13
.12
.13
.87
.58
.76
1.00
.70 .89
Primary behavior disorders
.04
.06
.05
09
.03
.07
.13
.09 .12
Total With Mental Disorder
1.22
1.47
1.35
.89
1.06
.97
2.11
2 . 53 2 . 32
Total Without Mental Disorder
.12
.12
.12
.86
.56
.75
.98
.68 .87
Grand Total
.95
1.27
1.10
.88
.98
.93
1.83
2.25 2.03
1 Exclusive of time spent out on visit, etc.
P.D. 117
193
Considering the total of all admissions, the long hospital residence is shown by the
psychoses with other forms of syphilis with 4.88 years and traumatic psychoses with
4.27 years. In order follow mental deficiency, 4.02 years; paranoia, 3.96 years; dementia
praecox, 2.96 years; and syphilitic meningo-encephalitis, 2.54 years. The short hospital
residences during all admissions are observed in psychoses with other disturbances of
circulation, .12 years; due to drugs, .37 years; undiagnosed psychoses, .42 years and
convulsive disorders .91 years.
It is observed that the psychoses in which definite organic changes have taken place
are the ones tending to long hospital residence. Four of the six psychoses showing the
longest hospital stay; namely, traumatic psychoses, mental deficiency, syphilitic meningo-
encephalitis and other forms of syphilis fall in this group. Dementia praecox and
paranoia are the only ones of the functional group appearing here. This table points
out definitely that the length of hospital stay during previous admissions must be con-
sidered if we are to obtain a satisfactory picture of the total time spent in mental hospitals
by the various groups of the clinical classification. Here we note that of the total average
time in mental hospitals, 2.03 years, .93 years or 45% occurred during previous admis-
sions.
Length of Hospital Stay during the Present Admission of Discharges
to the Community, 1939, by Hospital
Table 49 presents the average length of hospital stay of discharges during 1939, by
hospital. The Psychopathic Hospital, with a preponderance of temporary care cases,
shows the short hospital stay of .05 years or about 18 days. Of the active admitting
hospitals with court commitments predominating, Foxborough shows the short hospital
stay in first admissions of .47 years or five and one half months. Worcester is second
with a stay of .63 years or over seven months. Taunton and Dan vers are tied for third
place with a stay of .71 years or eight and one half months. Monson shows an average
residence of 1.46 years. Among the transfer hospitals, Gardner shows the shortest
average residence, .44 years or about five months. The numbers of first admissions
coming to the transfer hospitals are, of course, small.
Table 49. — Average Length of Hospital Stay during This Admission, First and
Readmissions Discharged, 1939, by Hospital
Hospitals
Length of Residence in Yeabs
Total
First
Admissions
Read-
missions
Boston Psychopathic ....
Worcester
Taunton
Danvers
Foxborough
Northampton
Westborough
Boston State
Gardner
Grafton
Monson
Medfield
Metropolitan
McLean .
Bridgewater
Veterans' Administration Facility No. 95
Veterans' Administration Facility No. 107
Tewksbury
Total With Mental Disorder
Total Without Mental Disorder .
Grand Total
.69
.73
.82
.88
.94
1.02
1.51
.81
1.04
1.22
1.30
2.72
.39
.61
.81
1.37
12.50
10
.77
.05
.63
.71
.71
.47
.90
.95
1.19
.44
.80
1.46
1.46
2.74
.33
.71
.31
.63
12.50
. 80
.09
.05
.90
.77
1.03
1.63
1.03
1.11
2.15
1.76
1.32
.59
1.00
2.71
.47
.41
1.23
1.65
1.35
.12
The readmissions at Psychopathic show the same short average stay of about 18
days. Among the active admitting hospitals, Taunton and Worcester again show short
residence, .77 years and .90 years, respectively. Monson readmissions are in hospital
for a much shorter period than first admissions, .59 years as compared with 1.46 years.
Of the transfer hospitals, the shortest residence, 1.00 years, is at Medfield.
194
P.D. 117
Length of Hospital Stay op Discharges Returned to the Community,
1939, by Age at Admission
Table 50 gives the average length of hospital stay in accordance with the age at
admission. All admissions together remained a total of .77 years or about 9 months.
First admissions remained .62 years and readmissions 1.10 years. The readmissions
remained in residence nearly six months longer than first admissions. In first admissions
the females remained .82 years, over 4 months longer than the males (.47 years). In
readmissions the females remained an average of 1 .27 years, which is about four months
longer than the average for the males, .95 years.
In the age groups we observe that patients coming into mental hospitals in the younger
and older years tend to have a short hospital stay, with the longer hospital residences
occurring in the ages 40-69 years. The first admissions admitted under 20 years of age
were discharged after a hospital stay of slightly less than six months. The long hospital
residence of .99 years or about one year occurs in patients admitted between 50 and 59
years. Those coming in at older ages show gradual decreases in length of hospital
residence.
Table 50. — Average Length of Hospital Stay during This Admission, First and
Readmissions Discharged, 1989, by Age at Admission and Sex
A
ge at Admission
Total
First Admissions
Readmissions
M.
F.
T.
M. F. T.
M. F. T.
0-19 Years
20-29 Years
30-39 Years
40-49 Years
50-59 Years
60-69 Years
70-79 Years
80-89 Years
90 Years and o
ver
.36
.71
.45
.56
.92
.77
.64
.28
.61
.77
.84
1.11
1.46
1.17
.56
.14
.12
.46
.74
.62
.80
1.17
.97
.60
.23
.12
.33 .60 .45
. 58 . 58 . 58
.30 .63 .43
.39 1 . 03 .67
.69 1 . 38 .99
.70 .87 .78
.49 .54 .52
.18 .14 .17
.12 .12
.45 .65 .53
1 . 06 1.13 1 . 09
.74 1.15 .94
.86 1 . 28 1 . 04
1 . 57 1 . 60 1 . 59
.94 1 . 72 1 . 35
1 . 28 .64 .99
1.10 - 1.10
Total
.61
.97
.77
.47 .82 .62
.95 1 . 27 1.10
(See Tables 212 and 213 for detail)
In general the readmissions, also, show short hospital residences in the younger and
older ages. Patients readmitted under the age of 20 remained .53 years or about six
months. Those readmitted between the ages of 50 and 59 years remained the longest
period of 1.59 years or one and one-half years. In readmissions there is a greater tendency
for long hospital residence to be associated with the ages from 40 to 49 years than in first
admissions.
Age of Discharges Returned to the Community, 1939, by Diagnosis
Table 51 shows the average age at discharge in first admissions and readmissions by
diagnosis. All first admissions "with mental disorder" were returned to the community
at an average age of 44.0 years. In the total "without mental disorder" the average at
discharge is lower, 35.6 years. This difference exists in the readmissions to a lesser
degree. The average age at discharge of these cases "with mental disorder" is 43.2 years
and of "without mental disorder", 39.0 years. Another similarity may be observed in the
total average ages of the sexes. In both the first and readmissions, the females "with
mental disorder" are one year older than the males; whereas, in the "without mental
disorder" groups the females are two years younger than the males. In the first ad-
missions the oldest average ages at discharge are found in the senile psychoses, 72 years ;
cerebral arteriosclerosis, 69 years; involutional psychoses, 53 years and due to new
growth and other disturbances of circulation, 51 years. The youngest discharge ages
are found in dementia praecox, epilepsy, with mental deficiency and epidemic enceph-
alitis, 32 years each. In the readmissions the oldest average discharge ages are found in
senile psychoses, 68 years; cerebral arteriosclerosis, 66 years and other disturbances of
circulation, 57 years. The youngest discharge ages are noted in convulsive disorders,
32 years; with psychopathic personality, 34 years and dementia praecox and mental
deficiency, 36 years each.
P.D. 117
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197
Age of Discharges to the Community, 1939, by Hospital
Table 52 gives the average age at discharge of first admissions and readmissions leaving
various hospitals. The Psychopathic Hospital, dealing almost exclusively with short
term residents, shows a discharge age of 34.4 years, 35.1 years in the males and 33.1
years in the females. In the readmissions the same hospital shows an average of 36.1
years, 36.8 years in the males and 35.1 years in the females. In the active admitting
hospitals, Boston State shows the high average discharge age of 53.3 years for first
admissions. The low average discharge age of this group is shown by Foxborough with
39.0 years. In the readmissions, Boston State shows the high average discharge age of
46.0 years and Taunton the low average of 40.2 years. In the second group, the chronic
transfer hospitals, the high discharge age of first admissions is shown by Gardner with
45.3 years and the low discharge age by Grafton with 38.4 years. In the readmissions
of this group Metropolitan shows the high average of 45.8 years and Grafton the low
average of 33.3 years. The Monson State Hospital, admitting epileptics only, cares for
many children. This, of course, distributes the discharge ages in the younger groups.
Length of Hospital Stay of Discharges Returned to the Community,
1939, by Nativity
Table 53 shows the average length of residence during the present admission of first
admissions and readmissions discharged during 1939, by nativity. The total native
born first admissions show a hospital residence of .58 years (about seven months), while
the foreign born remain in hospital .74 years (about nine months). In readmissions the
native born show a hospital stay of 1 .04 years and the foreign born remain about three
months longer, an average of one year and four months. In the foreign born first admis-
sions the females show a hospital residence of almost 2 months longer than the males.
In the native born the females show a hospital stay of five months longer than the males.
In the foreign born readmissions the males show a hospital stay of two months longer
than the females, but the native born males stay in hospitals almost five and one-
half months longer than the females.
Table 53. — Average Length of Residence During This Admission, First and
Readmissions Discharged, 1939, by Nativity Groups and Sex
Nativity
Total
First Admissions
Readmissions
M.
F.
T.
M. F. T.
M. F. T.
Foreign Born
Native Born:
Foreign Parentage
Mixed Parentage
Native Parentage
Unknown Parentage
Nativity Unknown
.88
.54
.58
.52
.52
.40
.05
.95
.98
1.10
.81
.98
.58
.52
.90
.73
.80
.64
.72
.47
.23
.66 .82 .74
.41 .82 .58
.46 .93 .66
.31 .81 .51
.41 .74 . 55
.37 .64 .49
.05 .77 .26
1.39 1.22 1.30
.83 1 . 28 1 . 04
.89 1.43 1.13
.98 .80 .89
.74 1 . 40 1 . 04
.51 .04 .38
.04 .04
Total
.61
.97
.77
.47 .82 .62
.95 1.27 1.10
Studying the native born in accordance with parentage, we find the native born with
parents foreign born show the long hospital stay of .66 years, the native born with both
parents native born an average of .55 years, and the native born of mixed parentage
the short hospital stay of .51 years. In the readmissions the native born of foreign
parentage offer a long hospital stay of 1.13 years and the native born of native parentage
show a hospital stay of 1.04 years. The native born of mixed parentage, with .89 years,
are lowest.
Times Out on Visit in Discharges to the Community, 1939, by Diagnosis
Table 54 outlines the number of times patients left the hospital on visit previous to
their discharge, by diagnosis. All patients discharged 1939, show an average of .84 times
out of hospital before being permanently returned to the community. Some 57% were
discharged directly from the hospital and 42% had one or more visits previous to dis-
charge. The group "with mental disorder" shows an average of 1.08 visits. The group
"without mental disorder" shows an average of .06 visits. The high average numbers
198
P.D. 117
of visits are shown by epidemic encephalitis, 1.83; other forms of syphilis, 1.77; dementia
praecox, 1.63; and syphilitic meningo-en cephalitis, 1.60. The smallest average number
of visits are shown by due to new growth, .16; without psychoses, .06 and undiagnosed
psychoses, .05.
Table 54. — Times Out on Visit during This Admission of Cases Discharged, 1989, by
Diagnosis
Total
Num
BEB OF
Times on Visit
Average
Number
of Times
Diagnoses
Cases
No. of
Visits
None
One
Two
Three
Four-
Six
Seven-
Nine
Ten or
More
Out
With epidemic encephalitis
6
11
2
1
1
1
1
1.83
With other forms of syphilis
9
16
4
3
1
-
-
-
1
1.77
Dementia praecox
784
1,279
192
322
143
46
50
14
17
1.63
With syphilitic meningo-
encephalitis
103
165
28
46
12
5
6
4
2
1.60
With mental deficiency
93
140
35
28
12
10
4
2
2
1.50
Involutional psychoses
159
224
39
73
28
7
9
T
2
1.40
Manic-depressive psychoses
654
873
191
277
97
40
35
10
4
1.33
Senile psychoses
52
65
1.5
21
10
3
3
_
_
1.25
Paranoia and paranoid con-
ditions ....
99
123
44
31
13
2
5
2
2
1.24
With convulsive disorders
(epilepsy)
S3
102
40
19
13
4
5
_
2
1.22
Traumatic psychoses .
21
24
5
12
3
-
1
-
-
1.14
With organic changes of ner-
vous system
53
58
27
16
5
2
1
1
1
1.09
With other disturbances of
circulation
19
17
10
7
-
1
-
1
_
.89
With psychopathic person-
ality
S3
71
46
23
6
2
5
1
—
.85
Due to other metabolic dis-
eases, etc.
56
36
31
19
4
1
1
-
-
.64
With cerebral arteriosclerosis
307
188
172
110
17
2
3
2
1
.61
Alcoholic psychoses
486
269
339
98
26
6
12
T
4
.55
With other infectious diseases
12
6
6
6
—
_
-
-
-
.50
Psychoneuroses
356
164
265
65
10
6
7
2
1
.46
Due to drugs, etc.
44
11
35
7
2
-
-
-
_
.25
Due to new growth
6
1
5
1
-
-
-
-
-
.16
Undiagnosed psychoses
55
3
52
3
—
—
—
-
-
.05
Without psychoses
972
65
941
19
5
1
5
-
1
.06
Primary behavior disorders
127
1
126
1
-
-
-
-
-
.007
Total With Mental Dis-
order ....
3,540
3,846
1,583
1,188
403
138
148
41
39
1.08
Total Without Mental
Disorder
1,099
66
1,067
20
5
1
5
-
1
.06
Grand Total
4.639
3,912
2,650
1,208
408
139
153
41
40
.84
Percent
100.0
57.1
26.0
8.7
...
3.2
.8
.8
Section D. Deaths in Mental Hospitals During the Year 1939
The following section presents data in reference to all cases dying in mental hospitals
during the year 1939. As in the case of admissions and discharges, the deaths reported
are no longer confined to court admissions. The data as outlined are based on all cases
dying in mental hospitals and include those admitted under court, temporary care,
observation and voluntary status.
Deaths in Mental Hospitals, 1939, by Form of Admission
Table 55 shows that 1,893 deaths occurred in 1939, 976 males and 917 females. This
is an increase of 11% over the 1,704 deaths in 1938. Of the 1,488 first admissions dying,
1,348 were admitted by court commitment, 71 under temporary care, 52 under observa-
tion and 17 on voluntary papers. Of the 405 readmissions, 386 were on court papers,
7 on temporary care, 4 on observation and 8 on voluntary. In first admissions there is
an increase over 1938 in the court and temporary cases dying and a slight decrease in
the observation and voluntary cases. The number of court readmissions dying decreased
14%.
Diagnosis in Deaths, 1939, by Form op Admission
Table 56 presents the legal form of admission of patients who died during 1939 by
diagnosis. Three psychoses are important among the deaths in first admissions. Six
hundred one deaths were diagnosed as psychoses with cerebral arteriosclerosis. They
P.D. 117
199
make up 40% of the court commitments, 33% of the temporary care cases and 53% of
observations. Senile psychoses, with 228 deaths, make up 16% of court commitments,
8% of temporary care admissions and 1% of the observation commitments. Dementia
praecox, with 190 deaths, comprises 13% of court commitments, 1% of temporary care
and 3% of observation cases.
Table 55. — First and Readmissions Dying in Hospitals for Mental Disorders,
1937-1939 by Form of Admission and Sex
Sex
Aggre-
First
Admiss
IONS
Readmissions
Year
gate
Tem-
Tem-
Total
Court
porary
Obser-
Volun-
Total
Court
porary
Obser-
Volun-
Care
vation
tary
Care
vation
tary
T.
1,974
1,580
1,432
71
64
13
394
377
10
4
3
1937
M.
1,023
831
735
52
34
10
192
183
5
2
2
F.
951
749
697
19
30
3
202
194
5
2
1
T.
1,704
1,232
1,085
60
69
18
472
452
7
7
6
1938
M.
873
646
553
46
34
13
227
212
6
5
4
F.
831
586
532
14
35
o
245
240
1
2
, 2
T
1,893
1,488
1.348
71
52
17
405
386
7
4
8
1939
M.
976
782
693
48
32
9
194
186
5
1
2
F.
917
706
655
23
20
8
211
200
2
3
6
Among the readmissions dementia praecox records 123 deaths, comprising 31% of
court commitments. Cerebral arteriosclerosis is second with 76 deaths, 18% of court
commitments, 42% of temporary care and 25% of observation. Manic-depressive is
third with 57 deaths, making up 13% of court commitments, 28% of temporary care
admissions and 50% of the observation cases dying during 1939.
Diagnosis in Deaths, 1939: Death Rates per 1,000 Under Treatment
In Table 57 we record the death rate per 1,000 under treatment of the various psy-
choses by first admissions and readmissions. The total death rate for first admissions
is 79. This rate is seven times the death rate of the general population for 1939, 11.3.
In the subdivision "with mental disorder" the death rate is 83 and in the group "without
mental disorder", 4. In the readmissions the total death rate is 34 per 1,000 under
treatment, or over three times that of the general population. The subgroup "with
mental disorder" shows a death rate of 35 and the group "without mental disorder" a
rate of 8.
In first admissions, psychoses due to new growth and other disturbances of circulation
show death rates of 533, and 311 per 1,000 under treatment respectively. Cerebral
arteriosclerosis is also high with a rate of 296. Senile psychoses and other metabolic
diseases show high rates of 270 and 275 respectively. The low death rates are shown in
epidemic encephalitis, 18, psychopathic personality, 13 and psychoneuroses, 4. Only in
psychoneuroses and without psychoses, 5, are the death rates lower than in the general
population, 11.3.
In the readmissions the four high rates are shown by psychoses with other disturbances
of circulation, 416; cerebral arteriosclerosis, 203; other infectious diseases, 200 and senile
psychoses, 159. The low rates are shown by dementia praecox, 20; mental deficiency,
18; and psychopathic personality, 11.
Diagnosis in Deaths 1939, by Age: Death Rates per 1,000 Under Treatment
Table 58 presents the death rates for the various psychoses in both first and read-
missions by age. The death rates for specific psychoses as outlined in Table 57 might
well be influenced by a preponderance of young patients with low death rates or old
patients with high death rates. Therefore, Table 58 offers the death rates by age, giving
the cases under treatment in each age group and the number dying within the same group.
In first admissions "with mental disorder" we notice the three age groups up to 39
years showing comparable death rates of 19, 16 and 22 per 1,000 under treatment. The
40-49 year age group increases to a death rate of 27, the 50-59 year group to 48, the
60-69 year group to 117, the 70-79 year group to 211 and the 80 years plus group to 381.
200
P.D. 117
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In seven of the eight age groups, the males show a higher death rate than the females.
Only in the 0-19 year group are the females higher.
Table 57. — First and Readmissions Dying, 1989, by Diagnosis, Death Rates per 1,000
Under Treatment
Death
Death
Rate
Rate
First Admissions
per
Readmissions
per
1,000
1,000
533.
With other disturbances of circulation
416.
With other disturbances of circulation .
311:
With cerebral arteriosclerosis
203.
With cerebral arteriosclerosis .
296.
With other infectious diseases
200.
Due to other metabolic diseases, etc.
275.
Senile psychoses .....
159.
Senile psychoses . _ .
270.
Due to other metabolic diseases, etc. .
142.
With other infectious diseases
172.
With syphilitic meningo-encephalitis .
79.
With organic changes of nervous system
143.
With other forms of syphilis
75.
With other forms of syphilis .
132.
With organic changes of nervous system
61.
With syphilitic meningo-encephalitis
122.
With convulsive disorders (epilepsy) .
53.
Undiagnosed psychoses ....
64.
Manic-depressive psychoses
38.
Due to drugs, etc
62.
Alcohohc psychoses ....
36.
With convulsive disorders (epilepsy)
57.
Involutional psychoses .
33.
Alcoholic psychoses ....
55.
Paranoia and paranoid conditions
32.
Involutional psychoses .
46.
With epidemic encephalitis . . ."'■
24.
Paranoia and paranoid conditions
42.
20.
Manic-depressive psychoses
41.
With mental deficiency ....
18.
Traumatic psychoses ....
37.
With psychopathic personality
11.
Dementia praecox
25.
Due to drugs, etc. .
_
With mental deficiency ....
24.
Traumatic psychoses ....
_
With epidemic encephalitis .
18.
Due to new growth ....
_
With psychopathic personality
13.
Psychoneuroses ....
_
Psychoneuroses
4.
Undiagnosed psychoses ....
-
Without psychoses
5.
Without psychoses
Total With Mental Disorder
S.
Total With Mental Disorder
83.
35.
Total Without Mental Disorder .
4.
Total Without Mental Disorder .
Grand Total
8.
Grand Total
79.
34.
Death Rate, General Population of Massachusetts, 1939, 11.3 per thousand population.
The readmissions show low death rates up to 60 years. The 60-69 year group presents
a rate of 66, the 70-79 year group, 110 and the 80 years plus group, 212. It will be
observed that these death rates are considerably lower than those of the first admissions.
As in the first admissions, the readmissions show consistently higher death rates in the
males. In only two age groups, 40-49 years and 50-59 years, do the death rates of the
females exceed those of the males.
We now consider the death rates in the various age groups of specific psychoses in
first admissions. In the group 0-19 years, the high death rate, 1,000, is shown by other
infectious diseases. In the 20-29 year group, the high death rates of 250, are shown by
other infectious diseases and other forms of syphilis. In the 30-39 year group, other
disturbances of circulation with 250 and other metabolic diseases with 142 present the
high death rates. Cerebral arteriosclerosis, with a death rate of 214, and other metabolic
diseases, with 166, are high in the group 40-49 years. In the 50-59 year group, psychoses
due to new growth, 750, and other metabolic diseases, 348, are high. In the group 60-69
years, psychoses due to new growth with 666 and other disturbances of circulation with
384 are high. The 70-79 year group records the high death rates in due to new growth,
1,000, other metabolic diseases, 526, and other disturbances of circulation, 500. In the
80 years plus group, organic changes of the nervous system and other disturbances of
circulation, with death rates of 1,000 each, are high. The psychoses involving the
circulatory system are showing high death rates in most of the age groups.
Economic Status of Deaths, 1939: Death Rates per 1,000 Under Treatment
Table 59 tests the possible influence of economic status of mental patients upon their
death rates in hospital, by first admissions and readmissions. In 1939, 4,023 first admis-
sions under treatment were classified as dependent in economic status. Of these 455
died, giving a death rate of 113 per 1,000 under treatment. This was the high rate of the
first admission group. The marginal show a lower rate of 66 and the comfortable, the
upper economic group, present the low death rate of 65. In the dependent first admis-
sions, the males show a death rate of 116, which is 7% higher than the rate of 108 for
202
P.D. 117
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P.D. 117
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205 P.D. 117
the females. In the marginal first admissions the death rates vary a little for the two
sexes, 63 for males and 69 for females. In the comfortable group the male death rate of
100 is 138% higher than the female rate of 42. Dependent economic status is associated
with the high death rate in mental disorders.
Table 59. — Economic Status of First and Readmissions Who Died, 1989, by Sex: Death
Rates per 1,000 Under Treatment
Total
First Admissions
Readmissions
M.
F.
T.
M.
F.
T.
M.
F.
T.
Dependent:
Under Treatment
Deaths .
Rate per 1,000 .
3,455
312
90.3
2,604
223
85.6
6,059
535
88.2
2,302
268
116.4
1,721
187
108.6
4,023
455
113.0
1,153
44
38.1
883
36
40.7
2,036
80
39.2
Marginal :
Under Treatment
Deaths .
Rate per 1,000
11,422
571
49.9
10,906
602
55.1
22,328
1,173
52.5
6,846
434
63.3
6,415
447
69.6
13,261
881
66.4
4,576
137
29.9
4,491
155
34.5
9,067
292
32.2
Comfortable:
Under Treatment .
Deaths .
Rate per 1,000
533
40
75.0
877
36
41.0
1,410
76
53.9
330
33
100.0
496
21
42.3
826
54
65.3
203
7
34.4
381
15
39.3
584
22
37.6
Unknown:
Under Treatment
Deaths .
Rate per 1,000
339
53
156.3
323
56
173.3
662
109
164.6
254
47
185.0
253
51
201.5
507
98
193.2
85
6
70.5
70
5
71.4
155
11
70.9
Total:
Under Treatment.
Deaths .
Rate per 1,000
15,749
976
61.9
14,710
917
62.3
30,459
1,893
62.1
9,732
782
80.3
8,885
706
79.4
18,617
1,488
79.9
6,017
194
32.2
5,825
211
36.2
11,842
405
34.2
Death Rate, General Population of Massachusetts, 1939, 11.3 per 1,000 population.
In the readmissions the dependent group presents the high death rate of 39. The
comfortable group is lower with a death rate of 37 and the marginal still lower with 32.
In readmissions the females show higher death rates than the males in all of the economic
status groups.
Table 60. — Marital Condition of First and Readmissions Who Died, 1939, by Sex:
Death Rates per 1,000 Under Treatment
Marital Condition
Total
First Admissions
Readmissions
M.
F.
T.
M.
F.
T.
M.
F.
T.
Single:
Under Treatment
Deaths .
Rate per 1,000
9,328
330
35.3
6,623
265
40.0
15,951
595
37.3
5,450
236
43.3
3,854
196
50.8
9,304
432
46.4
3,878
94
24.2
2,769
69
24.9
6,647
163
24.5
Married:
Under Treatment
Deaths .
Rate per 1,000 .
4,601
372
80.8
5,418
285
52.6
10,019
657
65.5
2,985
311
104.1
3,234
198
61.2
6,219
509
81.8
1,616
61
37.7
2,184
87
39.8
3,800
148
38.9
Widowed:
Under Treatment
Deaths .
Rater per 1,000 .
1,051
220
209.3
1,943
330
169.8
2,994
550
183.7
806
191
236.9
1,412
290
205.3
2,218
481
216.8
245
29
118.3
531
40
75.3
776
69
88.9
Divorced:
Under Treatment
Deaths .
Rate per 1,000
440
31
70.4
441
25
60.8
851
56
65.8
268
25
93.2
216
12
55.5
484
37
76.4
172
6
34.8
195
13
66.6
367
19
51.7
Separated:
Under Treatment
Deaths .
Rate per 1,000 .
287
21
73.1
299
12
40.1
586
33
56.3
185
17
91.8
157
10
63.6
342
27
78.9
102
4
39.2
142
2
14.0
244
6
24.5
Unknown:
Under Treatment
Deaths .
Rate per 1,000 .
42
2
47.6
16
58
2
34.4
38
2
52.6
12
50
2
40.0
4
4
8
Total:
Under Treatment
Deaths .
Rate per 1,000 .
15,749
976
61.9
14,710
917
62.3
30,459
1,893
62.1
9,732
782
80.3
8,885
706
79.4
18,617
1,488
79.9
6,017
194
32.2
5,825
211
36.2
11,842
405
34.2
P.D. 117
207
Marital Condition of Deaths, 1939: Death Rates per 1,000 Under Treatment
Table 60 outlines the death rates in the marital condition groups of first admissions
and readmissions dying in mental hospitals during 1939. In first admissions the low
death rate of 46 per 1,000 under treatment occurs in the single. Next in order are the
divorced with a death rate of 76, the separated with 78, the married with 81 and the
widowed with 216. While the single show younger age distributions and the widowed
show older age distributions, the married, the divorced and the separated are on similar
age levels and are comparable. In the single, the females show death rates higher than
the males. In the married, the widowed, the divorced and the separated, the male death
rates are decidedly higher than those of the females.
The low death rate of the readmissions, 24, occurs in the single and separated groups.
Then we have the married with a death rate of 38, the divorced, 51 and the widowed, 88.
In the married and the divorced, the females show higher death rates than the males.
In the widowed and the separated the males show much higher rates. The rate is the
same for both sexes in the single group. Readmission death rates of the various marital
groups show a smaller range than that of the first admissions. If marital condition
influences death rates, the effect is more pronounced in first admissions than in read-
missions.
Country of Birth of Patients Dying, 1939: Rates per 1,000 Under Treatment
Table 61 presents the death rates of first admissions and readmissions dying during
1939, by country of birth. One hundred thirty-one patients born in Germany were under
treatment in mental hospitals during 1939. Of these 27 died, giving the high death rate
of 206 per 1,000 under treatment. In order follow Sweden with a death rate of 140,
Canada with 135, Scotland with 115 and Ireland and England with 114 each. The United
States presents a death rate of 69. The low rates are shown by Russia, Poland and
Austria with death rates of 63, 50 and 30 respectively.
In readmissions the high death rate of 63 occurs in natives of Austria. England,
Scotland and Canada, all with a rate of 54 are in second place and Ireland, with 52, is
third. Greece, Russia and Poland show the low death rates of 16, 15 and 13 respectively.
Table 61. — Deaths in First and Readmissions during 1939, by Country of Birth: Death
Rates per 1,000 Under Treatment
Country of Birth
First Admissions
Total
Under
Treatment
Total
Deaths
Rate
per
1,000
Readmissions
Total
Under
Treatment
Total
Deaths
Rate
per
1,000
Germany
Sweden
Canada1 .
Scotland .
Ireland
England .
Portugal .
Greece
Finland .
Italy
United States .
Russia
Poland
Austria
All other countries
Total
131
192
1,570
138
1,398
403
243
119
682
11,855
460
540
133
655
27
27
213
16
160
46
21
8
9
48
821
29
27
4
32
206.1
140.6
135.6
115.9
114.4
114.1
86.4
81.6
75.6
70.3
69.2
63.0
50.0
30.0
48.8
73
117
719
74
799
201
86
60
69
406
1,112
444
226
63
393
3
5
39
4
42
11
2
1
2
12
259
7
3
4
11
41.0
42.7
54.2
54.0
52.5
54.7
23.2
16.6
28.9
29.5
31.9
15.7
13.2
63.4
27.9
18,617
1,488
79.9
405
34.2
(See Table 225 for detail)
1 Includes Newfoundland.
Number of This Admission in Deaths, 1939: Deaths Rates per 1,000
Under Treatment
Table 62 presents the death rates of first admissions and readmissions dying during
1939, in accordance with the number of the present admission. Excluding all orders of
admission showing less than 100 cases under treatment (those having eight or more
admissions) we note that the high death rate of 79 occurs in first admissions. Those
having six admissions follow with a death rate of 52 and second admissions with 46 are
third. Then, in order, are seventh admissions, third admissions, fourth admissions and
fifth admissions showing death rates of 33, 29, 28 and 19 respectively.
208
P.D. 117
Table 62. — Death Rates of First and Readmissions Under Treatment in Hospitals for
Mental Disorders, 1939, by Number of This Admission and Sex
Cases Under
Number of
Treatment
Deaths
Rate per
,000
This Admission
M. F. T.
M.
F.
T.
M.
F.
, T.
First ....
9,732 8,885 18,617
782
706
1,488
80.3
79.4
79.9
Second
1,759 1,606 3,365
85
73
158
48.3
45.4
46.9
Third
2,383 2,270 4,653
60
79
139
25.1
34.8
29.8
Fourth
992 1,049 2,041
26
33
59
26.2
31.4
28.9
Fifth
439 442 881
7
10
17
15.9
22.6
19.2
Sixth .
193 207 400
10
11
21
51.8
53.1
52.5
Seventh
106 101 207
4
3
7
37.7
29.7
33.8
Eighth
43 57 100
-
-
-
-
-
-
Ninth
38 40 78
-
2
2
—
50.0
50.0
Tenth
21 21 42
1
—
1
47.6
-
23.8
Eleventh
14 12 26
-
—
—
-
-
—
Twelfth or over
29 20 49
1
-
1
34.4
-
20.4
Total
15,749 14,710 30,459
976
917
1,893
61.9
62.3
62.1
Length of Hospital Stay during This Admission op Deaths, 1939:
by Diagnosis
Table 63 and Graph 5 show the length of hospital stay of first admissions and read-
missions dying during 1939, by diagnosis. First admissions of the group "with mental
disorder" remained 5.0 years previous to death; readmissions, 9.1 years during the
present admission. In first admissions dementia praecox shows the long hospital stay
of 17.5 years previous to death. Traumatic psychoses present a residence of 14.9 years;
mental deficiency, 14.4 years; psychopathic personality, 13.7 years; convulsive dis-
orders, 10.5 years and paranoia, 10.4 years. The shorter hospital residences previous
to death are shown by due to new growth with .40 years; psychoneuroses, .29 years;
other infectious diseases, .20 years and undiagnosed psychoses, .10 years. In four of
the seven psychoses presenting long hospital residences before death, the females show a
hospital stay which exceeds that of the males.
Length of Hospital Stay during the Present Admission and Previous
Admissions, Readmissions Dying during 1939, by Diagnosis
Table 64 presents the length of time spent in hospital by readmitted patients who
died during 1939. This is time in hospital during the present admission as compared
with the time spent in hospital during all previous admissions. This is carried out for
each psychosis. The data are important as they give the complete hospital history of
these patients. The group "with mental disorder" spent an average of 9.1 years in
hospital during the present admission previous to death. The same patients had been
in hospital an average of 3.6 years before the present admission, giving them a total
hospital residence during their lives of 12.7 years. If we consider this total of all admis-
sions together, in the separate psychoses it will be observed that mental deficiency shows
the longest period of time in hospital, 22.8 years. Other totals are 21.6 years for without
psychoses, 20.8 years for dementia praecox, 18.8 years for alcoholic psychoses, 17.5 years
for psychopathic personality and 12.3 years for both manic-depressive psychoses and
convulsive disorders. The short total hospital residences during life are shown by the
psychoses due to other metabolic diseases with .88 years, other disturbances of cir-
culation, .75 years, and other infectious diseases, .12 years. The seven psychoses showing
the long total hospital stay have a tendency towards shorter periods of residence in the
previous admissions and a longer period in the last admission. Conversely, the psychoses
showing the short total hospital stay tend to have a larger proportion of the total time
in the previous admissions, while the present admission is relatively short.
Length of Hospital Stay during this Admission of Deaths, 1939, by Hospital
Table 65 shows the length of hospital stay of cases dying in various hospitals during
1939. The Psychopathic Hospital shows a short stay of .06 years in the first admissions
and .08 years in the readmissions. Of the active admitting hospitals, Boston State
presents the longest hospital stay for first admissions, 4.2 years. Worcester follows with
3.6 years, Taunton shows 3.4 years and Foxborough, Westborough and Danvers, 3.1
P.D. 117
209
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P.D. 117
years each. Monson shows a long average residence of 9.9 years. Among the transfer
hospitals, the longest average residence, 14.9 years, is found at Medfield.
OEME7VT/A
PRAECOX
ME/VTAL
DEEIC/E/VCV
PSYCHOPATHIC
PEPSOA/Al/ry
W7TH CQJVWLSWE
07SOPDEPS
PA PA NO /A
ALCO/fOL/C
MA/V/C -
depressive
/a7volutiohal
syphilitic
MEM/A/GO -
E/VCEPHALITIS
SENILE
CEREBRAL
ARTERIO-
SCLEROSIS
OTHER META-\ <$
BOLIC DISEASES^ .5
TOTAL
ALL FORMS
izs
76.7
75.6
First Admissions
P eadmissions
9.2
Graph 5. — Length of Time in Residence during This
Admission of Certain Diagnoses, First Admissions and
Readmissions Dying, 1939: Averages in Years
In readmissions the long hospital residences previous to death are shown by Fox-
borough and Northampton with averages of 9.4 years and 8.6 years respectively. The
average residence at Monson, 10.3 years, is slightly longer than that for first admissions.
The transfer hospitals show long average residences for Grafton, 18.5 years and for
Medfield, 16.1 years.
Length of Hospital Stay of Deaths, 1939, by Age at Admission
Table 66 shows the length of time in hospital during the present admission of patients
dying during 1939, by age at admission. In first admissions patients admitted between
20-29 years of age remained in hospital 17 years, 30-39 years are next with 16 years and
P.D. 117
211
those admitted in the ages 40-49 remained 9 years. A certain proportion of patients
admitted under the age of 40 remain a long time in hospital prior to death; yet we re-
member that this same age span shows high discharge rates. The males show the longer
hospital stay in patients admitted under the age of 30 years. In all other age groups,
except 90 plus years, the females show the longer hospital residence previous to death.
Table 64. — Average Length of Hospital Stay during the Present Admission and Previous
Admissions, Readmissions Dying, 1939, by Diagnosis and Sex
Diagnoses
All Admissions
This Admission
Pbevious Admissions
M.
F.
T.
M.
F.
T.
M.
F.
T.
With mental deficiency
22.35
23.37
22.83
16.02
17.51
16.72
6.33
5.86
6.11
Without psychoses .
21.68
—
21.68
16.68
—
16.68
5.00
—
5.00
Dementia praecox
22.65
19.52
20.87
14.32
15.15
14.79
8.33
4.37
6.08
Alcoholic psychoses .
19.36
15.83
18.88
15.92
14.16
15.68
3.44
1.67
3.20
With psychopathic personality
17.50
17.50
17.50
17.50
12.50
15.00
-
5.00
2.50
Manic-depressive psychoses
14.07
10.79
12.34
11.07
5.87
8.33
3.00
4.92
4.01
With convulsive disorders
(epilepsy) ....
7.10
15. 56
12.31
5.89
14.00
10.88
1.21
1.56
1.43
Involutional psychoses
7.50
9.79
9.50
3.50
7.60
7.09
4.00
2.19
2.41
Paranoia and paranoid condi-
6.83
8.92
8.30
2.50
7.21
5.80
4.33
1.71
2.50
With other forms of syphilis
11.00
1.50
7.83
8.00
.12
5.37
3.00
1.38
2.46
With epidemic encephalitis
7.50
-
7.50
7.50
-
7.50
-
-
-
With organic changes of nervous
system
5.06
8.24
6.88
5.06
5.63
5.39
-
2.61
1.49
With syphilitic meningo-enceph-
4.64
o. oo
4.99
3.26
5.47
4.10
1.38
.08
.89
Senile psychoses
4.69
3.49
3.82
3.58
2.73
2.96
1.11
.76
.86
With cerebral arteriosclerosis .
3.86
3.76
3.81
1.48
2.12
1.78
2.38
1.64
2.03
Due to other metabolic diseases,
etc
.20
1.05
.88
.20
.67
.58
-
.38
.30
With other disturbances of cir-
culation
1.50
.57
.75
.04
.48
.39
1.46
.09
.36
With other infectious diseases .
.12
-
.12
.12
-
.12
-
-
—
Total With Mental Disorder
13.37
12.25
12.78
9.17
9.19
9.18
4.20
3.06
3.60
Total Without Mental Dis-
order
21.68
-
21.68
16.68
-
16.68
5.00
-
5.00
Grand Total
13.50
12.25
12.85
9.29
9.19
9.24
4.21
3.06
3.61
Table 65. — Length of Time in Residence During This Admission, First and
Readmissions Dying 1939, by Hospital: Averages in Years
Hospitals
Length of Hospital Stay
Total
First
Deaths
Admissions
Readmissions
.06
.06
.08
4.95
4.29
8.05
4.78
3.15
9.44
4.28
3.11
8.24
4.10
3.45
7.49
4.09
3.66
6.07
3.90
3.10
7.37
3.62
2.93
8.60
Medfield
15.21
14.90
16.13
Grafton
12.69
8.23
18.51
10.07
9.94
10.30
7.66
6.63
10.33
3.87
3.11
4.20
23.80
24.47
19.50
20.65
20.96
20.00
8.95
8.36
11.00
Veterans' Adm. Facility No. 107
2.30
2.86
1.86
Veterans' Adm. Facility No. 95
1.42
.40
7.50
Total
5.94
5.04
9.24
In readmissions the long hospital residence previous to death, 16 years, is shown by
patients admitted between the ages of 20 and 29 years. Admissions aged 30-39 years
show an average stay of 15 years. Patients 0-19 years present a stay of 14 years. In
the readmissions the ages under 40 years are important from the viewpoint of a possible
212
P.D. 117
long hospital stay previous to death. The females show the longer hospital stay in the
age groups 20-29 years, 60-69 years, 70-79 years and 80-89 years. In all other age
groups the males show the longer hospital residence.
Table 66. — Length of Time in Residence During THIS Admission, First and
Readmissions Dying, 1939, by Age at Admission and Sex: Averages in Years
Age at Admission
Total
M.
First Admissions
M.
F.
Readmissions
M.
0-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 vears
80-89 years
90 years and ov
Total
11.55
17.10
14.90
10.54
6.17
3.07
1.22
.93
.49
5.43
17.06
17.59
11.19
8.89
17.09
16.20
10.87
6.72
10.22
18.42
14.21
9.15
4.63
2.76
1.22
.79
.49
5.43
15.84
19.71
10.78
6.01
3.18
1.83
1.00
.12
7.70
17.63
16.61
9.92
5.29
2.95
1.53
.90
.36
14.55
14.30
17.20
13.60
11.03
4.20
1.22
2.23
18.85
13.91
11.85
9.88
4.28
2.79
2.86
14.55
16.09
15.22
12.62
10.37
4.24
2.06
2.47
5.73
6.15
5.94
4.85 5.24 5.04
9.29
9.19
(See Tables 220 and 221 for detail)
Age of Patients Dying, 1939, by Diagnosis
The average age at death of first admissions "with mental disorder" was 67.4 years,
68.6 years for the females and 66.3 years for the males (Table 67). The high average
ages at death in first admissions are shown by the senile psychoses with 78 years ; cerebral
arteriosclerosis, 73 years; other disturbances of circulation, 66 years and paranoia,
65 years. The young average ages at death are observed in psychoses with other in-
fectious diseases with 43 years, without psychoses, 38 years and epidemic encephalitis,
32 years.
In readmissions the males average 62.5 years at death and the females 63.1 years.
The high average ages at death are shown by the senile psychoses, 75 years; psychopathic
personality, 72 years; cerebral arteriosclerosis, 70 years and paranoia and without
psychoses, 67 years each. The younger ages at death occur in psychoses with other
infectious diseases and epidemic encephalitis, 37 years each.
Patients dying are drawn largely from the older age groups. The average age at death
of 66.4 years is 24.4 years higher than the average age of 42.0 years for cases discharged
to the community, 1939.
Age of Patients Dying, 1939, by Hospital
Table 68 presents the average age at death of first admissions and readmissions dying
in various hospitals, 1939. Among first admissions to the active admitting hospitals,
Westborough is high with the average age at death of 69.8 years. In order follow Wor-
cester with 69.0 years, Foxborough with 68.5 years and Northampton with 68.3 years.
Among the transfer hospitals, Medfield shows the high average age of 68.2 years.
In the readmissions, Northampton with 68.5 years and Westborough with 67.0 years
present the high average ages at death of the admitting hospital group. The average at
Grafton, 67.5 years, is the highest of the transfer hospitals.
Causes of Death of Patients Dying, 1939
Table 69 outlines the causes of death in patients dying, 1939, arranged in order of
importance. Diseases of the myocardium are the chief cause of death, 18% of cases
(population 11%). Other diseases of the heart with 11% (population 10%), broncho-
pneumonia with 10% (population 3%), arteriosclerosis with 8% (population 1%),
cerebral hemorrhage with 5% (population 8%) and tuberculosis of the respiratory
system with 5% (population 2%) are next in order. An interesting finding is presented
when we add together the percentages for cardio-vascular diseases (diseases of the
myocardium, arteriosclerosis, cerebral hemorrhage, other diseases of the heart, chronic
endocarditis and diseases of the coronary arteries and angina pectoris). These conditions
account for 48.2% of the deaths in connection with mental disorders (population 44.9%).
Disorders involving the lungs show a high incidence in mental disorders also. The total
(bronchopneumonia, tuberculosis of the respiratory system and lobar pneumonia) is
18.8% (population 9.0%). Combining these two major groups under the headings
"cardio-vascular disorders" and "respiratory disorders", we find that they account for
67.0% of deaths in mental diseases and only 53.9% of deaths in the general population.
P.D. 117
213
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P.D. 117
215
Nearly seven out of every ten deaths occurring in mental disorders involve the heart
or lungs. Also notable is the low for cancer deaths in mental diseases, 5% (population
13%).
Table 69. — Causes of Death of Patients Dying in Hospitals for Mental Disorders, 1939,
Compared with Causes of Death in the General Population: Numbers and Percentages
Causes of Death
Mental Disorders
Number
M.
F.
Per Cent
M.
T.
General
Population
Per Cent
Diseases of the myocardium
Other diseases of the heart
Bronchopneumonia
Arteriosclerosis
Cerebral hemorrhage
Tuberculosis of the respiratory system
Cancer and other malignant tumors
Nephritis
General paralysis of the insane
Diseases of the coronary arteries and angina
pectoris
Lobar pneumonia
Other external causes -.
Diabetes
Syphilis (non-nervous forms)
Chronic endocarditis (valvular disease) .
Epilepsy
Other diseases of the respiratory system .
Hernia, intestinal obstruction .
Suicides
Other diseases of the nervous system
Diarrhea and enteritis ....
Ill-defined causes of death
All other causes
183
92
95
100
51
60
42
43
61
45
18
17
11
15
9
14
5
7
7
7
3
91
176
122
104
54
53
42
57
39
16
21
39
32
15
8
13
6
4
1
96
359
214
199
154
104
102
99
82
77
66
57
49
26
23
22
20
13
12
11
9
4
4
187
4.6
1.8
1.7
.3
9.3
19.1
13.3
11.3
5.8
5.7
4.5
6.2
4.2
1.7
2.2
4.2
3.4
1.6
.8
1.4
.6
.8
.5
.4
.2
.4
.1
10.4
18.9
11.3
10.5
8.1
5.4
5.3
5.2
4.3
4.0
3.4
3.0
2.5
1.3
1.2
1.1
1.0
.6
.6
.5
.4
.2
.2
9.8
11.9
10.9
3.7
1.5
8.9
2.9
13.7
5.7
.2
8.6
2.4
5.5
2.9
.4
3.1
.1
.1
. 7
1.1
.2
.2
.06
14.1
Total
976 917 1,893
100.0 100.0 100.0
100.0
(See Table 224 for detail)
Length of Hospital Stay of Patients Dying, 1939, by Number of
Times Admitted
Table 70 gives the length of time in residence previous to death during the present
admission, and in addition, the total hospital stay during all previous admissions, by
number of times the patient was admitted to mental hospitals. The total figure on
average length of hospital stay of the last admission, during which the patient died,
was 5.9 years. When we add to this figure the total time these patients had spent in
hospital, during previous admissions, a hospital stay during life of 12.8 years is observed.
Table 70. — Length of Time in Residence during This Admission and All Admissions,
Cases Dying during 1939, by Number of Times Admitted: Averages in Years
Average Length of Hospital Stay in Years
Number of
Times
Admitted
Number
This
Admission
All Admissions
M.
F.
T.
M.
F. T.
M. F.
T.
One .
782
706
1,488
4.85
5.24 5.04
Two
85
73
158
6.75
6.39 6.59
8.07 6.89
7.53
Three
60
79
139
11.26
10.82 11.01
18.08 15.18
16.43
Four
26
33
59
13.37
11.57 12.37
18.51 16.63
17.46
Five
7
10
17
5.42
8.24 7.08
12.35 12.30
12.32
Six .
10
11
21
11.74
10.75 11.22
. 17.77 12.95
15.24
Seven
4
3
7
12.25
5 . 83 9 . 50
25.00 10.83
18.92
Eight
-
-
-
-
- -
- -
-
Nine
-
2
2
—
9.14 9.14
17.50
17.50
Ten or more .
2
-
2
.04
.04
1.48
1.48
Total
976
917
1,893
5.73
6 . 15 5 . 94
13.50 12.25
12.85
(See Tables 222 and 223 for detail)
Considering the present admission, during which the patient died, patients coming to
mental hospitals but once show the short hospital stay of 5.0 years; admitted twice
— 6.5 years. Patients having three and four admissions remained in hospital for their
last admission much longer; namely, 11.0 years and 12.3 years. Small numbers in other
216
P.D. 117
groups produce expected variations. In general, however, the averages of length of stay
before death are somewhat lower in patients having a large number of admissions.
We now consider the total length of hospital residence during all admissions. The
patients admitted twice show an average of 7.5 years. Patients admitted three times
spent 16.4 years in hospital during all admissions. Patients admitted four times spent
17.4 years in hospital during all admissions. The patients admitted five times spent a
total of 12.3 years.
Average Length of Hospital Stay per Admission of Patients Dying, 1939,
by Number of Times Admitted
Table 71 studies the readmissions and presents the average length of hospital residence
during all admissions in accordance with the number of times admitted. For example,
patients coming to mental hospitals twice showed a total length of hospital stay of 7.5
years or an average of 3.7 years for each of the two admissions. Patients admitted three
times spent 16.4 years in hospital or an average of 5.4 years for each of the three admis-
sions. Patients admitted four, five and six times showed an average hospital residence
per admission of 4.3 years, 2.4 years and 2.5 years respectively. Multiple admissions over
six are omitted because of small numbers. There is a tendency for the average time in
hospital per admission to decrease as the number of admissions increases.
Table 71. — Length of Time in Residence during Each Admission, Readmissions Dying
during 1939: Averages in Years
Number of Times Admitted
Average Length of
Stay in Years
During All
Admissions
Average Length of
Stay in Years
for Each Time
Admitted
7.53
16.43
17.46
12.32
15.24
18.92
17.50
1.48
3.76
5.47
4.36
2.46
Six
2.54
2.70
1.94
.13
(See Table 223 for detail)
Section E. Resident Population of Mental Hospitals
on September 30, 1939
In the preceding sections we have discussed admissions, discharges to the community
and deaths for 1939. We now discuss the whole number of patients under care and
analyze specific factors in patients within mental hospitals and all patients temporarily
out of mental hospitals, on September 30, 1939. On that date there were 25,910 patients
within the thirteen State hospitals under the Department, the Bridgewater State Hospi-
tal (Department of Correction), the Mental Wards at the Tewksbury State Hospital
and Infirmary (Department of Public Welfare), the two Veterans' Administration
Facilities, Nos. 95 and 107 (United States Government), and the twenty-one private
hospitals. Of this number 13,491 were males and 12,419 females.
In this analysis it should be recalled that the resident population is, in part, an accum-
ulation of admissions of previous years who have not died or who have not been dis-
charged. Of the patients coming into hospitals during any one year a certain number are
discharged after a fairly short hospital residence, another group dies and still others
remain within the institution for varying periods of time. Study of the resident popula-
tion will provide valuable information as to the characteristics of this last group, which
tends to chronicity and long residence within mental hospitals.
Patients in Residence in Public and Private Mental Hospitals on
September 30, 1904-1939
Table 72 presents the numbers of patients in the various types of mental hospitals
on September 30 of each year from 1904 to 1939, inclusive. Rates per 100,000 of the
population are presented for all hospitals together and for the State hospitals alone.
P.D. 117
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218 P.D. 117
Considering all hospitals together, 9,840 patients were in residence at the end of 1904.
In 1914 this number had increased to 14,582; in 1924 to 18,288; in 1934 to 23,419 and in
1939 to 25,910. The year 1904 presents a residence rate of 324 persons in mental hospitals
per 100,000 of the general population. In 1939 this rate had increased to 584. This is a
rate increase of 80% or 2.2% per year.
In the second section of this table the numbers and residence rates are restricted to
patients within the 13 State hospitals under the Department of Mental Health. In 1904
the State hospitals had 8,445 patients in residence or 85% of all mental patients in the
State. In 1939 the State hospitals cared for 22,166 patients, still 85%. The rates per
100,000 of the population rose from 278 in 1904, to 500 in 1939, an increase of 79% or
2.2% per year. Bridgewater and Tewksbury show an increase from 1,062 in 1904 to
the high of 1,749 in 1930 and a decrease to 1,331 in 1939. The Governmental hospitals
have shown a marked increase in numbers in residence, from 339 in 1924 to 1,940 in 1939.
McLean shows a small increase, from 189 patients in 1904 to 211 in 1939. The other
fourteen private hospitals show an increase from 144 in 1904 to 262 in 1939. In 1939
fifteen private institutions cared for but 1.8% of the total patients, two Government
hospitals for 7.4%, the Hospital for the Criminal Insane and the Mental Wards at
Tewksbury for 5.1%, and the State hospitals under the Department (13) for 85.5%.
Sex differences are observed. In the totals for all hospitals the residence rates for
males within hospitals are higher than females in 29 of the 36 years under consideration .
The females show higher residence rates in but 7 years, 1904 and the years 1918-1923,
inclusive. In the State hospitals alone the females show higher residence rates than the
males in all but one of the 36 years (1912). The sex differences observed demonstrate
clearly how incomplete are statistics based upon State hospital population alone and
emphasize the necessity for consideration of all patients in all types of institutions.
In State hospitals the residence rates for the males increased from 267 in 1904 to
487 in 1939. This is an increase of 82%. In the females the residence rates increased
from 289 in 1904 to 511 in 1939. This is an increase of 76%,, In other words, in the
State hospitals alone, the sexes have shown about the same degree of increase over the
36 year period. In making these same calculations in the total figures for all patients in
all types of mental hospitals we get radically different results, owing chiefly to the
establishment of the Government hospitals, which have absorbed males who ordinarily
would have gone to State hospitals. Residence rates for males increased from 321 in
1904 to 630 in 1939, an increase of 96%. The female rates increased from 328 in 1904
to 542 in 1939, an increase of 65%. Mental disease is becoming increasingly serious for
the males. The observed sex differences in all types of hospitals and in the State hospitals
demonstrate very clearly that the significance of mental disease as a state-wide problem
can be determined only by a thorough study of all cases of mental disease under care in
hospitals, whatever the type.
Diagnosis op Patients in Residence on September 30, 1939, by
Form of Admission
Table 73 and Graph 6 give the diagnosis of first admissions and readmissions in res-
idence in all mental hospitals by form of admission.* On September 30, 1939 there were
13,954 first admissions in mental hospitals, 7,148 males and 6,806 females. Of this total
13,865 were diagnosed as "with mental disorder" and 89 as "without mental disorder".
Dementia praecox makes up 48.0% of first admissions in residence. Then follow in order
psychoses with cerebral arteriosclerosis, 8.3%; with mental deficiency, 7.8%; alcoholic
psychoses, 6.1%; and manic-depressive psychoses, 5.6%. Dementia praecox comprises
15% of first admissions coming into mental hospitals in 1939, and 48% of the resident
population.
Resident court commitments (first admissions) show dementia praecox predominating
with 49.1%. Psychoses with cerebral arteriosclerosis comprise 8.5% and mental defi-
ciency 8.0%. In the resident temporary care first admissions the high groups are demen-
tia praecox with 21.0%; without psychosis and paranoia with 15.7% each. The leading
*The total number of patients discussed from this point on is 23,927 instead of the 25,910 noted in
Table 72. This difference is accounted for by the following three points: (1) exclusion of the 262 patients
in residence in the fourteen private hospitals, (2) exclusion of the 1,004 non-psychotic epileptics at the Mon-
son State Hospital (see separate section Epilepsy, beginning with Table 156) and (3) exclusion of the 717
non-residents of Massachusetts at the two Veterans' hospitals.
P.D. 117
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P.D. 117
221
diagnoses of the observation commitments are without psychosis with 42.3% and alco-
holic psychoses with 19.2%. Among the resident voluntary first admissions psychoses
with epilepsy comprise 86.8%.
In addition to the first admissions there were 9,973 readmitted cases in the resident
population on September 30, 1939, 5,054 males and 4,919 females. Of the grand total
9,909 were diagnosed as "with mental disorder" and 64 as "without mental disorder".
Psychoses prominent numerically in the resident readmissions are dementia praecox,
56.1%; manic-depressive, 10.9%; mental deficiency, 8.5%; alcoholic psychoses, 4.6%.
DEMENT/A
PRAECOX
CEREBRAL
ARTERfOSCLEROSL
m$8mmmmm&
mwMMwm*mwmm ao.i
BBB 8.3
9m2.s
MENTAL
DEFfCfE/VCY
mtaazs
mmmm s.s
PERCENT OF
ALCOffOUC
MAAf/C-
OEPRESSfVE
HI 6./
E^ 4.6
wmmrnm TO. 9
RESIDEAW
POPl/lATION,
7939
SEAffLE
1 .8 '
COA/VULSIVE
D/SOROERS
■ 3.9
mm 4.2
SYPfffLfTfC AfEMNGO-Wl 3.7
F/VCFP/fALfTfS m 2.2
mvoLur/ojvAi
m 3.r
m 1.9
PARAA/O/A
M3.0
m2.e
H First Admissions
PSYCffO/VEl/ROSES
PSyC/fOPAT/f/C
PERSONALITY
1 .8
EH Readmissions
G .9
0 7.2
without
psychoses
1.6
1.6
OTHER FORMS
OF SYPHILIS
1.6
1.3
OTffER METABOLIC 1 .5
DISEASES \.2
EPIDEMIC
FA/CEPHALITIS
1.4
Graph 6. — First Admissions and Readmissions in
Residence on September 30, 1939, by Diagnoses:
Percentage Distribution
In the readmissions in the resident population, entering hospitals through court
commitment, dementia praecox comprises 56.9%, manic-depressive 10.9% and mental
deficiency 8.6%. In temporary care resident readmissions dementia praecox and without
psychosis make up 25% each. The observation commitments in residence show 44.4%
without psychoses and 22.2% alcoholic psychoses. Psychoses with convulsive disorders
comprise 70.0% and psychoneuroses 10.0% in the resident voluntary readmissions.
222
P.D. 117
Economic Status of the Resident Population and Patients Out on
September 30, 1939
Table 74 shows the economic status of patients of the resident population, by first
admissions and readmissions. Of the 13,954 first admissions in residence, 22% are
recorded as dependent in economic status, 70% as marginal and 4% as comfortable.
In patients still on the books of the hospitals but in the community on visit, etc., we
have a lower proportion of the dependent, 17%; a higher proportion of the marginal,
75%; and an equal proportion of the comfortable, 4%. Here we have the suggestion
that a patient in a higher economic group has a greater chance of being placed on visit
than one in a lower group. This means a greater chance of discharge as visits commonly
precede discharge.
Table 74. — Economic Status of the Resident Population and Patients Out on September
30, 1939, First and Readmissions, by Sex: Numbers and Percentages
First Adm
ISSIONS
Readm
ISSIONS
Economic Status
Number
Per Cent
Number
Per Cent
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
Resident Popu-
lation:
Dependent
1,777
1,337
3,114
24.8
19.6
22.3
986
755
1,741
19.5
15.3
17.4
Marginal
4,977
4,912
9,889
69.6
72.1
70.8
3,845
3,805
7,650
76.0
77.3
76.7
Comfortable .
232
397
629
3.2
5.8
4.5
158
302
460
3.1
6.1
4.6
Unknown
162
160
322
2.2
2.3
2.3
65
57
122
1.2
1.1
1.2
Total .
7,148
6,806
13,954
100.0
100.0
100.0
5,054
4,919
9,973
100.0
100.0
100.0
Patients Out:
Dependent
140
163
303
18.4
17.4
17.9
108
106
214
22.4
16.4
19.0
Marginal
566
707
1,273
74.5
75.7
75.2
349
496
845
72.5
76.8
75.0
Comfortable .
33
37
70
4.3
3.9
4.1
19
24
43
3.9
3.7
3.8
Unknown1
20
26
46
2.6
2.7
2.7
5
19
24
1.0
2.9
2.1
Total
759
933
1,692
100.0
100.0
100.0
481
645
1,126
100.0
100.0
100.0
Of the 9,973 readmissions in residence, 17% are recorded as dependent, 76% as mar-
ginal and 4% as comfortable. Readmitted patients out on visit show about the same
distribution with 19% dependent, 75% marginal and 3% comfortable.
As we trace economic status through admissions, discharges, deaths and the resident
population, we find interesting material. First admissions entering mental hospitals
during 1939 showed 21% as dependent (Table 28). First admissions discharged pre-
sented 14% in the dependent group (Table 41). The deaths in first admissions listed
30% as dependent (Table 59). Now we observe the first admissions of the resident
population are showing 22% as dependent and of the patients out on visit, 17% dependent
(Table 74). Dependent economic status in first admissions is linked with a high death
rate and a low discharge rate.
Marital Condition of the Resident Population and Patients Out on
September 30, 1939
Table 75 presents the marital condition of the resident population and of patients
temporarily out on visit, etc., on September 30, 1939, by first admissions and read-
missions. Of the 13,954 first admissions in residence 54% were single, 31% married,
10% widowed, 2% divorced and 1% separated. Among the patients temporarily out on
visit (potential candidates for discharge) we see a lower proportion of the single, 44%,
a higher proportion of the married, 41%, and similar proportions of the widowed, di-
vorced and separated, 9%, 2% and 1%, respectively.
Of the 9,973 readmissions in the resident population, 58% were single, 30% married,
6% widowed, 2% divorced and 1% separated. The patients temporarily out on visit
show a lower per cent of the single, 49%, a higher per cent of the married, 40%, and a
lower per cent of the widowed, 5%.
Comparison of marital condition in the resident population with the marital condition
of admissions, discharges and deaths for the year provides interesting data. The single
comprise 39% of first admissions entering hospital in 1939 (Table 26), 40% of first
admissions discharged (Table 42), 29% of first admissions dying (Table 60) and 54%
of first admissions in the resident population (Table 75). The married make up 39%
P.D. 117
223
of first admissions entering, 43% of first admissions discharged, 34% of first admissions
dying and 31% of first admissions in the resident population. In first admissions the
single are showing a remarkable tendency towards accumulation within mental hospitals.
The married are higher in the discharges and deaths than the single and therefore have
little opportunity to accumulate. The widowed, the divorced and the separated are
not being retained.
In the readmissions also pa.tients of single marital condition are having long hospital
residences and are tending to comprise a large proportion of the resident population.
Patients of the married, widowed, divorced and separated groups are evidently leaving
hospitals more rapidly, either through discharge or death, and are showing no tendency
towards retention.
Table 75. — Marital Condition of the Resident Population and Patients Out on September
30, 1989, First and Readmissions, by Sex
Resident Population
Marital Condition
First Admissions
Readmissions
M.
F.
T.
%
M.
F.
T.
%
Single
Married ....
Widowed ....
Divorced ....
Separated ....
Unknown ....
4,406
1,927
484
183
113
35
3,175
2,407
935
167
111
11
7,581
4,334
1,419
350
224
46
54.3
31.0
10.1
2.5
1.6
.3
3,425
1,250
183
124
69
3
2,423
1,797
435
139
121
4
5,848
3,047
618
263
190
7
58.6
30.5
6.1
2.6
1.9
.07
Total ....
7,148
6,806
13,954
100.0
5,054
4,919
9,973
100.0
Patients Out
on Visit,
ETC.
Marital Condition
First
Admissions
Readmission
3
M.
F.
T.
%
M.
F. T.
%
Sinsrle
Married ....
Widowed ....
Divorced ....
Separated ....
Unknown ....
381
292
45
25
15
1
366
411
120
22
14
747
703
165
47
29
1
44.1
41.5
9.7
2.7
1.7
.05
289
157
16
11
7
1
270 559
295 452
46 62
21 32
13 20
1
49.6
40.1
5.5
2.8
1.7
.08
Total ....
759
933
1,692
100.0
481
645 1,126
100.0
Table 76. — Admission Ages of First and Readmissions in the Resident Population,
September 30, 1939
Age at Admission
Total
First Admissions
Readmissions
M.
F.
T.
M.
F.
T.
M.
F.
T.
Under 14 years .
68
81
149
58
60
118
10
21
31
15-19 years
447
363
8.10
297
254
551
150
109
259
20-29 vears
2,747
1,933
4,680
1.670
1,151
2,821
1,077
782
1,859
30-39 vears
3,288
2,870
6,158
1,747
1,602
3,349
1,541
1,268
2,809
40-49 years
2,577
2,819
5,398
1,387
1,511
2,898
1,190
1,308
2,498
50-59 years
1,696
1,997
3,693
976
1,080
2,056
720
917
1,637
60-69 years
896
1,029
1,925
608
629
1,237
288
400
688
70-79 years
398
494
892
330
400
730
68
94
162
80-89 years
80
130
210
70
112
182
10
18
28
90 years and over
5
9
14
5
7
12
-
2
Total .
12,202
11,725
23,927
7,148
6,806
13,954
5,054
4,919
9,973
Average admission age
40.7
43.3
42.0
41.3
43.8
42.5
39.8
42.7
41.2
(See Tables 231 and 232 for detail)
Age at Admission of Patients in Residence on September 30, 1939
Table 76 presents the distribution of first admissions and readmissions in the resident
population, by age at admission. First admissions now in the resident population pre-
sented an average age, at admission, of 42.5 years, 41.3 years for the males and 43.8
years for the females. Resident patients aged 30-39 years at time of admission show
224
P.D. 117
the largest number of patients, 3,349. Those aged 40-49 years include 2,898 cases and
the 20-29 year group 2,821. Thus, of these first admissions in residence, 9,068 or 64%
were admitted between the ages of 20 and 49 years. The males show the larger numbers
in all ages from 15 to 39 years. Under 14 years of age, and from 40 onward, the females
show the larger numbers.
Readmissions in the resident population show an average admission age of 41.2 years,
39.8 years for the males and 42.7 years for the females. The readmissions are younger
than the first admissions, due to the fact that persons developing a mental disorder early
in life are the ones tending to readmission. The readmissions in residence show the
largest number (2,809) who were aged 30-39 years at the time of admission. A total
of 2,498 were admitted in the ages 40-49 years and 1,859 in the ages 20-29 years. Here
we have a total of 7,166 patients, or 71% of all readmissions, who were admitted between
the ages of 20 and 49 years. The readmissions show the males with larger numbers in
the age groups 15-39 years. Females are higher in all other age groups.
Length of Hospital Stay of Patients in Residence on September 30, 1939,
by Age at Admission
Table 77 and Graph 7 give the average length of stay during the present admission of
all first admissions and readmissions in the resident population in accordance with the
age at admission. First admissions admitted between the ages 20-29 years have shown
the longest period of hospital residence, 13.6 years. Patients admitted in the age group
30-39 years are next with an average stay of 12.9 years. Then we observe a gradual
decrease of hospital residence as the older ages are approached.
Table 77. — ■ Average Length of Hospital Stay during the Present Admission, First
and Readmissions in Residence on September 30, 1939, by Age at Admission
Age at Admission
Average Length of Hospital Stay
All
Admissions
First
Admissions
Read-
Under 19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80-89 years
10.1
12.9
11.8
9.0
6.3
4.0
1.6
.6
10.5
13.6
12.9
9.6
6.2
3.9
1.4
.5
9.2
11.8
10.6
8.3
6.5
4.1
2.5
1.1
In readmissions also those admitted in the age group 20-29 years have shown the long
hospital residence, 11.8 years. As in first admissions we see a gradually decreasing length
of time in hospitals during the present admission as the older ages at admission are
approached. In previous tables it has been noted that patients admitted in younger
ages have shown high discharge rates and low death rates in comparison with the admis-
sions in the older age groups. It is evident, too, that a certain proportion of the cases
admitted in the younger ages tend toward chronicity and retention in hospitals. Over
a long period of time these cases will accumulate to high levels in spite of high death
and discharge rates.
Diagnosis in Admissions, Discharges and Deaths, 1939, and the Resident
Population and Patients Out on Visit on September 30, 1939
Table 78 is a combined table which gives a review of the mental disorders occurring
in patients coming into mental hospitals, in those leaving mental hospitals by discharge
or death, in the resident population, and in patients temporarily out of mental hospitals
on visit, by first admissions and readmissions.
Only the numerically important psychoses will be discussed. Psychoses with cerebral
arteriosclerosis made up 18% of first admissions entering hospital, 8% of first admissions
discharged, 40% of first admissions dying, and 8% of the first admissions in the resident
population. This psychosis shows a low discharge rate, an extremely high death rate
and no tendency towards retention within hospitals. Dementia praecox made up 15%
of first admissions, 15% of first admission discharges, 12% of first admission deaths and
48% of first admissions in the resident population. This psychosis is low in both dis-
P.D. 117
225
charges and deaths. Its outstanding point is the remarkable tendency to accumulation
in the resident population. The without psychosis group made up 13% of admissions,
21% of discharges, .2% of deaths and .6% of the resident population. Obviously this
group is leaving hospitals very rapidly. Manic-depressive psychoses made up 5% of
admissions, 9% of discharges, 3% of deaths and 5% of the resident population. This
psychosis is leaving hospitals rapidly, shows a low death rate and no tendency towards
retention.
12.9
UNDER 20-29 30-39 40'49 50-59 60-69 70YRS.
20YRS. YRS. YRS. YRS. YRS. YRS. &OVER
Age at Admission
Graph 7. — Length of Time in Residence during
This Admission of Cases in Residence in Hospitals
for Mental Disorders on September 30, 1939, by
Age at Admission: Averages in Years
In readmissions dementia praecox makes up 23% of patients entering mental hospitals
during the year, 20% of readmissions discharged, 30% of readmissions dying, and 56%
of the readmissions in the resident population. This psychosis has a low discharge rate
and a tendency toward retention within hospitals. The small number of discharges each
year and the long hospital stay tend to have an accumulative effect as 56 % of the resident
readmissions are classified as dementia praecox. Manic-depressive psychoses made up
18% of readmissions coming into hospitals, 24% of the readmissions discharged, 14%
of the deaths and 10% of the resident population. This psychosis is high in discharges
and low in retention.
Admission Ages of Admissions, Discharges and Deaths, 1939, Compared with
the Admission Ages of the Resident Population on September 30, 1939,
by Diagnosis
In Table 79 we compare the average age of first admissions and readmissions entering
hospitals during 1939, with the average age at admission of patients discharged, of
patients dying, of patients in the resident population and of patients on visit on Septem-
ber 30, 1939 by diagnosis. This table will show how patients of certain admission ages
tend to distribute themselves in the discharges, deaths and resident population.
226
P.D. 117
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P.D. 117
In the first admissions, the group "with mental disorder" presents an average admis-
sion age of 49.3 years. Patients who were discharged during that same year were 6.6
years younger at the time of admission, an average admission age of 42.7 years. As these
admission ages remain remarkably constant over the years, we may say that the patients
discharged during 1939 were selected from the younger ages of patients admitted during
previous years. The average admission age of patients dying during the year was 13.2
years higher than that of the admissions, an average of 62.5 years. Clearly the patients
who die are the patients of older ages in the admissions of previous years. First admis-
sions in the resident population presented an average admission age of 42.6 years, 6.7
years younger than the admission age of the admissions, 49.3 years. Apparently the
young admissions of previous years have gone to make up a certain portion of the resident
population.
The readmissions coming into mental hospitals during 1939 presented an average
admission age of 43.5 years. The readmissions discharged presented an admission age
of 41.3 years, 2.2 years younger. The deaths had an admission age 10.1 years higher
than the admissions, 53.6 years. Readmissions in the resident population, with an
admission age of 41.2 years, averaged 2.3 years younger at admission than readmissions
entering during the year.
Limitations of space present a separate discussion of the individual psychoses but the
figures are available for study. In general, both first admissions and readmissions coming
into hospitals each year are tending to divide themselves into three groups from the
viewpoint of age: (1) younger admissions who will reappear in the discharges, (2) other
young admissions who will remain and be found in the resident population and (3) a
group decidedly older at admission who will reappear among the deaths. Thus, the
young admissions contribute to both a favorable group discharged and an unfavorable
group tending to remain within the resident population of mental hospitals.
Present Age of Patients in Residence on September 30, 1939
Table 80 shows the -present age of first admissions and readmissions in the resident
population on September 30, 1939. The resident first admissions show an average
present age of 52.3 years, 51.0 years for the males and 53.5 years for the females. The
largest number of patients, 3,237, falls in the group who are now 50-59 years of age.
The group aged 40^9 years contains 2,880 patients and the 60-69 year group 2,593
patients. Thus, 62% of the first admissions in the resident population are between the
ages of 40 and 70.
Table 80. — Present Age of First and Readmissions in the Resident Population
September 30, 1989
Present Age
Total
M.
F.
First Admissions
M.
Readmissions
F.
Under 14 years
15-19 years
20-29 years
30-39 years
40-49 years
50-59 years
60-69 years
70-79 years
80-89 years
90 years and over
Total .
Average Present Age
24
122
987
2,052
2,968
2,845
2,011
974
206
13
26
117
735
1,583
2,550
2,776
2,299
1,296
310
33
50
239
1,722
3,635
5,518
5,621
4,310
2,270
516
46
22
88
603
1,117
1,493
1,706
1,250
701
156
12
17
78
455
860
1,387
1,531
1,343
889
227
19
39
166
1,058
1,977
2,880
3,237
2,593
1,590
383
31
2
34
384
935
1,475
1,139
761
273
50
1
9
39
280
723
1,163
1,245
956
407
83
14
11
73
664
1,658
2,638
2,384
1,717
680
133
15
12,202 11,725
50.1
52.8
23,927
51.4
7,148 6,806 13,954
51.0 53.5 52.3
5,054 4,919 9,973
48.7 51.8 50.2
(See Tables 233 and 234 for detail)
The readmissions in residence show an average present age of 50.2 years, 48.7 years
for the males and 51.8 years for the females. Patients aged 40-49 years at present com-
prise the largest number, 2,638. The group aged 50-59 years records 2,384 patients and
the group 60-69 years — 1,717. Readmissions in residence show 67% between the ages
of 40 and 70, a slightly larger proportion than the first admissions (62%).
P.D. 117
229
Present Age of Patients in Residence on September 30, 1939,
by Diagnosis
Table 81 gives the average present age of the different psychoses of first admissions
and readmissions now in the resident population. All first admissions in residence show
an average present age of 52.3 years, 52.3 years for those "with mental disorder" and
44.0 years for those "without mental disorder". The highest average present ages are
shown by senile psychoses with 75.3 years, cerebral arteriosclerosis with 70.7 years,
paranoia and involutional psychoses with 57.2 years each and alcoholic psychoses with
57.0 years. The young average ages are shown by convulsive disorders with an average
of 45.1 years, psychopathic personality with 43.7 years, without psychosis with 44.5
years and epidemic encephalitis with 33.6 years.
Table 81. — Average Present Age of Resident Population on September SO, 1939:
First and Readmissions, by Diagnosis
With syphilitic meningoencephalitis
With other forms of syphilis
With epidemic encephalitis
With other infectious diseases .
Alcoholic psychoses
Due to drugs, etc
Traumatic psychoses
With cerebral arteriosclerosis
With other disturbances of circulation .
With convulsive disorders (epilepsy)
Senile psychoses
Involutional psychoses . . . .
Due to other metabolic diseases, etc.
Due to new growth
With organic changes of nervous system
Psychoneuroses ......
Manic-depressive psychoses
Dementia praecox .
Paranoia and paranoid conditions .
With psychopathic personality
With mental deficiency . . . .
Undiagnosed psychoses . . . .
Without psychoses
Primary behavior disorders
Total With Mental Disorder .
Total Without Mental Disorder
Grand Total . . . .
First Admissions
Number
528
94
46
12
862
6
62
1,164
24
545
574
438
74
1
180
117
787
6,700
432
103
1,097
19
85
13,865
89
13,954
Average
Present
Age
48.6
52.8
33.6
47.5
57.0
50.0
52.2
70.7
56.6
45.1
75.3
57.2
53.7
45.0
48.1
46.5
50.0
48.6
57.2
43.7
45.3
51.3
44.5
33.5
52.3
44.0
Readmissions
Number
222
32
40
4
464
9
24
252
6
420
83
192
26
3
93
98
1,090
5,600
266
128
848
9
63
1
9,909
64
Average
Present
Age
48.5
50.9
38.1
35.5
57.1
58.3
47.5
69.1
65.0
44.6
75.5
58.9
50.3
48.3
42.2
47.4
53.3
48.9
58.0
42.5
43.9
53.8
44.6
25.0
50.2
44.3
(See Tables 227 and 229 for detail)
The readmissions in residence show an average present age of 50.2 years, 50.2 years
for cases "with mental disorder" and 44.3 years for cases "without mental disorder".
In readmissions high average present ages are shown by senile psychoses with 75.5 years,
cerebral arteriosclerosis with 69.1 years, other disturbances of circulation with 65.0
years and involutional psychoses with 58.9 years. The low average present ages are
shown by psychopathic personality, 42.5 years; organic changes of the nervous system,
42.2; epidemic encephalitis, 38.1 years and other infectious diseases, 35.5 years.
Present Age of the Resident Population and Patients Out on
September 30, 1939, by Hospital
Table 82 compares the average present age of patients in various mental hospitals
on September 30, 1939, with the age at admission of these same patients. The same
data are offered for patients temporarily out of hospital on visit, etc. The BostonPsycho-
pathic Hospital, with a preponderance of temporary care cases, has the youngest resident
population, averaging 36 years. Of the active admitting hospitals, the high averages in
present age of first admissions in the resident population are shown by Taunton with
53.5 years, Boston State with 53.2 years and Northampton with 51.7 years. The young-
est present age, 50.1 years, is shown by Foxborough. Of the transfer hospitals the high
230
P.D. 117
average is shown by Grafton, 55.7 years, and the low average by Metropolitan, 52.2
years. The Hospital for Epileptics at Monson presents an average present age of resident
patients of 43.4 years. The admission ages of these same patients are also available
by hospital. The hospitals which had a high average age of patients at time of admission
are now tending to show high average ages in the resident population.
Readmissions in the resident population show the high average present ages at North-
ampton with 52.1 years, Westborough with 51.0 years and Worcester with 50.7 years
Foxborough again shows the low average, 48.0 years, in the admitting group. Among
the transfer hospitals, Grafton shows the high present age of 53.4 years and Metropolitan
Hospital the low with 49.6 years. The Hospital for Epileptics shows an average of 44.1
3rears.
The study of the average present ages of patients who have been placed out on visit
shows that they have been drawn from the younger patients. The average present age
of first admissions in the resident population was 52.3 years, while the average of first
admissions out on visit, was 44.5 years. In the readmissions the present age of the
resident population was 50.2 years while the present age of readmissions out on visit,
was 43.4 years.
Table 82. — Average Present Age and Admission Age of First and Readmissions in the
Resident Population and Patients Out on September 30, 1939, by Hospital
Resident P(
JPTJLATION
Patieni
s Out
First Admissions
Readmissions
First Admissions
Readmissions
Hospitals
Age at
Age at
Age at
Age at
Present
Admis-
Present
Admis-
Present
Admis-
Present
Admis-
Age
sion
Age
sion
Age
sion
Age
sion
Boston Psychopathic
36.4
36.3
37.4
37.4
37.8
37.5
34.6
34.6
Taunton ....
53.5
45.4
49.5
41.6
43.0
40.7
39.8
35.3
Boston State
53.2
44.6
49.3
40.1
45.8
44.0
40.3
37.7
Northampton
51.7
43 8
52.1
43.6
43.1
40.7
45.0
43.3
Danvers ....
51.6
43.8
49.5
41.0
45.2
42.7
41.6
38.7
Worcester ....
51.6
42.4
50.7
41.2
45.4
42.1
44.5
41.7
Westborough
51.5
44.3
51.0
43.4
41.3
38.7
43.7
39.3
Foxborough
50.1
43.0
48.0
39.6'
42.0
39.9
39.4
36.9
Grafton ....
55.7
41.4
53.4
40.5
51.8
46.4
50.4
47.1
Medfield ....
54.6
41.7
52.1
40.8
44.5
43.5
40.0
36.5
Gardner ....
54.1
40.0
52.7
41.7
54.3
43.5
54.2
44.6
Metropolitan
52.2
47.5
49.6
43.8
49.7
45. 5
39.6
35.7
Monson ....
43.4
32.7
44.1
33.4
28.7
25.6
35.6
31.6
Tewksbury
58.4
37.0
59.3
39.0
-
-
-
-'
McLean ....
57.8
50.4
55.9
47.1
46.2
44.1
43.0
40.8
Bridgewater
51.2
34.5
48.0
38.2
-
-
45.0
25.0
Vet. Adm. Fac. No. 107 .
47.7
42.2
46.6
39.9
51.6
51.6
47.4
42.2
Vet. Adm. Fac. No. 95 .
46.7
39.0
45.5
35.6
45.0
43.0
47.8
39.2
Total
52.3
42.5
50.2
41.2
44.5
41.5
43.4
39.9
(See Tables 231-238 for detail)
Length op Hospital Stay op Patients in Residence on September 30, 1939,
by Diagnosis
Table 83 and Graph 8 present the average length of hospital stay of first admissions
and readmissions who were in residence within hospitals at the end of the year, by
diagnosis. The first admissions "with mental disorder" had remained in hospital a total
of 10.27 years up to the end of 1939, 10.34 years for the males and 10.21 years for the
females. In the resident first admissions, psychoses due to new growth had shown the
longest hospital stay, 17.5 years. Following in order are dementia praecox with a hospital
residence of 13.5 years; mental deficiency with 11.3 years; convulsive disorders, 11.2
years; alcoholic psychoses, 9.9 years and psychopathic personality, 8.1 years. The
shorter periods of time within hospital are shown by senile psychoses, 3.7 years; psycho-
neuroses, 3.3 years; with cerebral arteriosclerosis, 3.0 years; and undiagnosed psychoses,
.2 years.
P.D. 117
231
Table 83. — Average Length of Hospital Stay during the Present Admission,1 First and
Readmissions in the Resident Population on September SO, 1939, by Diagnosis
Total
First Admissions
Readmissions
Diagnoses
M.
F.
T.
M.
F.
T.
M.
F.
T.
With syphilitic meningoenceph-
alitis
5.40
6.23
5.59
5.15
6.72
5.50
6.01
5.10
5.80
With other forms of syphilis .
5.69
8.96
6.65
6.03
10.31
7.26
4.67
5.32
4.87
With epidemic encephalitis
7.82
7.79
7.81
7.93
8.24
8.07
7.73
7.00
7.51
With other infectious diseases .
11.35
4.81
6.85
14.00
4.92
7.94
.75
4.54
3.59
Alcoholic psychoses .
9.24
9.46
9.28
9.91
10.10
9.94
8.01
8.21
8.04
Due to drugs, etc.
8.22
15.00
10.03
3.96
13.75
7.22
10.66
16.52
11.90
Traumatic psychoses
6.50
6.29
6.46
6.21
5.41
6.02
7.10
12.87
7.58
With cerebral arteriosclerosis .
3.11
3.29
3.20
2.97
3.12
3.04
3.83
4.00
3.93
With other disturbances of cir-
culation . . .
3.09
8.24
5.32
3.43
8.20
5.22
.56
8.31
5.72
With convulsive disorders (epi-
lepsy)
9.36
12.44
10.84
9.80
12.65
11.29
8.90
12.11
10.24
Senile psychoses
3.69
4.00
3.89
3.60
3.82
3.74
4.22
5.39
4.93
Involutional psychoses
4.88
5.41
5.26
5.13
5.05
5.07
4.33
6.26
5.68
Due to other metabolic diseases,
etc
5.97
6.46
6.26
4.93
6.20
5.62
11.03
7.00
8.09
Due to new growth .
-
6.71
6.71
-
17.50
17.50
-
3.12
3.12
With organic changes of nervous
system
4.63
4.39
4.54
4.39
3.55
4.07
5.10
6.06
5.45
Psychoneuroses . . .
3.22
3.74
3.52
2.90
3.60
3.34
3.52
3.95
3.74
Manic-depressive psychoses .
6.91
7.71
7.41
7.12
7.89
7.60
6.75
7.58
7.27
Dementia praecox
12.38
12.22
12.30
13.81
13.34
13.57
10.69
10.86
10.78
Paranoia and paranoid condi-
tions
6.64
7.89
7.47
6.91
8.44
7.90
6.18
7.03
6.75
With psychopathic personality
6.87
7.59
7.20
7.53
8.80
8.16
6.39
6.49
6 43
With mental deficiency .
10.87
10.54
10.71
11.68
11.00
11.36
9.69
10.02
9.86
Undiagnosed psychoses .
.39
.32
.33
.45
.20
.26
.12
.53
.48
Without psychoses: .
7.87
8.97
8.24
9.30
9.86
9.48
5.94
7.79
6.55
Alcoholism ....
.17
.12
.16
.12
.12
.12
.25
.12
.22
Drug Addiction
-
.75
.75
-
-
-
-
.75
.75
Epidemic encephalitis .
12.50
-
12:50
-
—
—
12.50
_
12.50
Psychopathic personality —
pathological sexuality
■ .62
-
.62
.79
— '
.79
.12
-
.12
Psychopathic personality — -
pathological emotionality
.12
-
.12
.12
—
.12
—
-
_
Psychopathic personality —
asocial or amoral trends .
.35
.12
.32
.12
-
.12
.46
.12
.40
Psychopathic personality —
mixed types
.12
7.50
2.58
.12
—
.12
—
7.50
7.50
Epilepsy ....
7.00
2.62
4.81
1.50
-
1.50
12.50
2.62
5.91
Mental deficiency
13.16
13.20
13.17
15.15
13.42
14.54
9.70
12.76
10.68
Idiot
13.03
18.75
14.17
13.03
25.00
14.36
-
12.50
12.50
Imbecile ....
12.77
14.60
13.54
14.40
15.79
15.13
10.21
.37
8.98
Moron
13.46
10.76
12.61
16.94
5.42
13.91
9.40
14.57
11.30
Other non-psychotic diseases
5.09
6.18
5.63
4.27
5.52
4.95
5.77
6.97
6.31
No other condition
.75
.34
.61
1.25
.41
.83
.45
.12
.39
Primary behavior disorders
.96
.12
.80
.12
.12
.12
3.50
3.50
Total With Mental Disorder
9.88
9.93
9.90
10.34
10.21
10.27
9.23
9.54
9.38
Total Without Mental Dis-
order
7.61
8.79
7.99
8.84
9.52
9.06
5.88
7.79
6.50
Grand Total .
9.86
9.92
9.89
10.32
10.20
10.27
9.20
9.53
9.36
(See Tables 239-241 for detail)
1 This table considers only the length of time spent in hospitals during the present admission.
First admissions "without mental disorder" had remained an average of 9.0 years.
Table 83 presents the length of stay of the subdivisions of the without psychosis group.
The long residence observed appears to be due to cases of mental deficiency without
psychosis. Nine cases of idiocy had remained an average of 14.3 years each, 23 cases
of imbecility had remained 15.1 years each and 19 morons had remained 13.9 years each.
A total of 51 of the 85 resident cases without psychosis placed in the mental deficiency
classification.
In readmissions the total "with mental disorder" had remained in residence 9.3 years,
9.2 years for the males and 9.5 years for the females. Psychoses due to drugs presented
the long hospital stay of 11.9 years. Next in order are dementia praecox, 10.7 years;
convulsive disorders, 10.2 years; psychoses with mental deficiency, 9.8 years and alcoholic
psychoses and due to other metabolic diseases, 8.0 years each. The short hospital
residences are shown by psychoneuroses, 3.7 years; other infectious diseases, 3.5 years;
due to new growth, 3.1 years; and undiagnosed psychoses, .4 years.
The "without mental disorder" group of the readmissions had remained an average
of 6.5 years. Again, the mental deficiency subdivision in the group without psychosis
232 p.D. 117
shows the long average period in residence. One idiot remained 12.5 years, eight im-
beciles 8.9 years each and nineteen morons 11.3 years each. Of the 63 readmissions in
residence diagnosed without psychosis, 28 were in the mental deficiency classification.
Due to A/etv Growth
Dement/a Praecox
Mental Deficiency
Convulsive Disorders
Alcoholic
Psychopathic Personality
Epidemic Encephalitis
Paranoia
Other fnfectious Diseases
Manic -Depress/ye
Other Forms of Syphilis
Due to Drugs
Traumatic
Other AfetabolicDiseases
Syphilitic
Meningo-Encephalitis
Other Disturbances
of Circulation
involutional
Organic Changes
of jVervous System
Seniie
Psychoneuroses
Cerebraf
Arteriosclerosis
Aii Psychoses
Graph 8. — Length of Time in Residence during
This Admission of First Admissions and Readmissions
in Residence in Hospitals for Mental Disorders on
September 30, 1939, by Diagnoses: Averages in Years
While the medical staff of the various institutions have been unwilling to diagnose
these patients as psychotic, they have considered them unsuitable for return to the
community. The patients of the lower mental grades, at the idiot or imbecile level, are
quite obviously unable to care for themselves. These patients, together with the morons,
present such symptoms as irritability, excitability, assaultiveness and episodic outbursts
which render their return to the community highly inadvisable. Hospital administrators
report that these cases, necessarily diagnosed as non-psychotic, constitute some of their
most serious conduct problems and that continued institutional care is necessary.
If we calculate the maintenance cost, capital investment, cost of a central department,
depreciation, etc., we arrive at a total annual per capita cost of approximately $450. for
State hospital care of mental patients. With an average hospital stay during the present
admission of 9.89 years, the 23,927 patients in residence at present have cost the Com-
monwealth at the end of 1939, over one hundred six millions of dollars ($106,487,113.)
during the present admission.
Length of Hospital Stay during Previous Admissions and the Present
Admission, Readmissions in Residence on September 30, 1939
Table 84 records the total hospital stay during their lives of readmissions now in the
resident population. This is obtained by adding the length of time in hospitals during
P.D. 117
233
all previous admissions to the length of time in hospital during the present admission.
A total of 9,973 readmissions had spent an average of 4.42 years in hospitals during
previous admissions. During this present admission they have remained in hospitals
an average of 9.36 years, which gives a total hospital stay, up to the end of 1939, of
13.78 years.
Table 84. — Average Length of Hospital Stay during Previous Admissions and the Present
Admission, Readmitted Cases in Residence September 30, 1939, by Diagnosis
Time
in Institution
Time
in Institution
Time
in Institution
during Previous
during Present
during All
Admissions
Admission
Admissions
Diagnoses
M.
F.
T.
M.
F.
T.
M.
F.
T.
With syphilitic meningoenceph-
alitis ....
2.19
2.84
2.34
6.01
5.10
5.80
8.20
7.94
8.14
With other forms of syphilis
1.97
3.53
2.46
4.67
5.32
4.87
6.64
8.85
7.33
With epidemic encephalitis
2.25
1.59
2.05
7.73
7.00
7.51
9.98
8.59
9.56
With other infectious diseases
.75
.12
.28
.75
4.54
3.59
1.50
4.66
3.87
Alcoholic psychoses .
3.48
4.09
3.57
8.01
8.21
8.04
11.40
12.30
11.61
Due to drugs, etc.
4.17
4.12
4.16
10.66
16.52
11.90
14.83
20.64
16.06
Traumatic psychoses
1.38
3 93
1.59
7.10
12.87
7.58
8.48
16.80
9.17
With cerebral arteriosclerosis .
1.19
1.70
1.48
3.83
4.00
3.93
5.02
5.70
5.41
With other disturbances of cir-
culation .....
1.62
.53
.89
.56
8.31
5.72
2.18
8.84
6.61
With convulsive disorders (epi-
lepsy)
3.02
2.56
2.83
8.90
12.11
10.24
11.92
14.67
13.07
Senile psychoses
1.87
2.58
2.30
4.22
5.39
4.93
6.09
7.97
7.23
Involutional psychoses
1.32
1.78
1.64
4.33
6.26
5.68
5.65
8.04
7.32
Due to other metabolic diseases,
etc
2.37
2.59
2.53
11.03
7.00
8.09
13.40
9.59
10.62
Due to new growth .
—
2.66
2.66
—
3.12
3.12
_
5.78
5.78
With organic changes of nervous
system
2.19
2.24
2.20
5.10
6.06
5.45
7.29
8.30
7.65
Psychoneuroses
1.13
.94
1.03
3.52
3.95
3.74
4.65
4.89
4.77
Manic depressive psychoses .
2.68
3.29
3.07
6.75
7.58
7.27
9.43
10.87
10.34
Dementia praecox
4.81
5.40
5.10
10.69
10.86
10.78
15.50
16.26
15.88
Paranoia and paranoid condi-
tions
3.41
3.34
3.36
6.18
7.03
6.75
9.59
10.37
10.11
With psychopathic personality
2.41
2.81
2.59
6.39
6.49
6.43
8.80
9.30
9.02
With mental deficiency
6.72
7.09
6.91
9.69
10.02
9.86
16.41
17.11
16.77
Undiagnosed psychoses .
.75
1.04
1.01
.12
.53
.48
.87
1.57
1.49
Without psychoses .
4.20
3.40
3.93
5.94
7.79
6.55
10.14
11.19
10.48
Primary behavior disorders
4.50
-
4.50
3.50
-
3.50
8.00
-
8.00
Total With Mental Disorder
4.20
4.66
4.43
9.23
9.54
9.38
13.43
14.20
13.81
Total Without Mental Dis-
4.21
3.40
3.94
5.88
7.79
6.50
10.09
11.19
10.48
Grand Total
4.20
4.65
4.42
9.20
9.53
9.36
13.40
14.18
13.74
(See Tables 241 and 242 for detail)
The longest hospital residences during previous admissions are shown by the psychoses
with mental deficiency, 6.9 years and dementia praecox, 5.1 years. The short hospital
residences during previous admissions are shown by other disturbances of circulation,
.89 years, and other infectious diseases, .28 years. As the length of time spent in residence
during the present readmission has been demonstrated separately in Table 83 we pass
on to the total time in hospital during both the previous admissions and the present
admission. In this total time for all admissions the long hospital residences are observed
in psychoses with mental deficiency, 16.7 years; due to drugs, 16.0 years, dementia
praecox, 15.8 years; convulsive disorders, 13.0 years and alcoholic psychoses, 11.6 years.
The short total hospital residences are observed in psychoneuroses, 4.7 years; other
infectious diseases, 3.8 years; and undiagnosed psychoses, 1.4 years.
Using the estimated cost of $450 per year, these 9,973 readmissions have cost the
Commonwealth, an average of $1,989 each, during all previous admissions, or a total
of $19,836,297. This sum indicates the cost previous to the present admission. Adding
this earlier cost of $19,836,297 to the cost of the present admissions in residence of
$106,487,113 (see preceding section), we have a grand total cost during all admissions
for the resident population of $126,323,410.
23-1
P.D. 117
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235
Color or Race of Patients in Residence on September 30, 1939,
by Diagnosis
Table 85 presents the color or race of patients in residence in mental hospitals on
September 30, 1939, by diagnosis. Only the eight psychoses most important numerically
will be discussed. Dementia praecox makes up 75% of the yellow group, 59% of the
mulatto, 51% of the white and 50% of the black. Psychoses with mental deficiency
make up 8% of the white, 8% of black and 5% of the mulatto. Manic-depressive psy-
choses contribute 7% of the white, black and mulatto groups and 6% of the yellow.
Psychoses with cerebral arteriosclerosis make up 7% of the black, 5% of the white, 6%
of the yellow and 2% of the mulatto. The alcoholic psychoses comprise 6% of the black,
5% of the white, 4% of the mulatto and 3% of the yellow. Psychoses with convulsive
disorders contribute 4% of the white, 3% of the mulatto and 1 % of the black. Psychoses
with syphilitic meningo-encephalitis (general paresis) make up 10% of the mulatto,
5% of the black and 3% of both the white and the yellow. Paranoia shows 3% of the
yellow and 2% of both the black and the white.
Continuing to compare the figures of this table it is noted that the white group is
high in the mental deficiency, manic-depressive, and arteriosclerosis. The blacks are
high in alcoholism, cerebral arteriosclerosis, manic-depressive and mental deficiency.
The mulattoes are very high in general paresis, and high in manic-depressive. The
yellow group is high in cerebral arteriosclerosis and manic-depressive. Dementia praecox
is high in all of the groups.
Country of Birth of Patients in Residence on September 30, 1939
Table 86 shows the country of birth of patients in the resident population, giving
the residence rates per 100,000 of the same country of birth aged 15 years and over
(1930 census) by first admissions and readmissions. Of the 13,954 first admissions in the
resident population, immigrants to the United States from Austria show the high res-
idence rate of 2,898 per 100,000 of the State population born in Austria. Foreign born
immigrating to this country from Portugal, Turkey, Finland and Ireland show residence
rates of 775, 754, 728 and 678 per 100,000, respectively. Sweden, Canada, England,
Norway and Scotland present the low residence rates of 412, 401, 401, 372 and 319,
respectively. Eleven countries show residence rates for mental disorders which are
higher than the rate of the United States, 424; five countries are lower.
Table 86. — ■ Country of Birth of First and Readmissions in the Resident Population on
September 30, 1939: Rates per 100,000 of Same Country of Birth 15 Years of Age
and Over, 1930 Census
Country of Birth
First Ai
AMISSIONS
Readm
SSIONS
Number
Rate
Number
Rate
123
2,898.
53
1,248.
189
775.
74
303.
47
754.
46
738.
94
728.
61
472.
1,071
678.
699
443.
456
641.
206
289.
375
557.
379
563.
82
494.
54
325.
27
455.
21
354.
92
454.
63
311.
529
428.
354
286.
8,718
424.
6,739
328.
150
412.
106
291.
1,142
401.
600
210.
309
401.
173
224.
20
372.
18
335.
100
319.
60
191.
430
504.
267
313.
13,954
452.
9,973
323.
Austria
Portugal .
Turkey .
Finland .
Ireland
Poland
Russia
Greece
France
Germany .
Italy
United States .
Sweden
Canada1 .
England .
Norway .
Scotland .
All other Countries
Total
(See Table 225 for detail)
1 Includes Newfoundland.
For the 9,973 readmissions in residence in mental hospitals, the high residence rate
of 1,248 is shown by emigrants from Austria. Other countries with high rates are Turkey
236
P.D. 117
with 738, Russia with 563, Finland with 472 and Ireland with 443. The low residence
rates are shown by Poland — 289, Italy — 286, England — 224, Canada — 210, and
Scotland — 191.
The incidence of mental disorders in persons from certain countries may be measured
more accurately in the tables dealing with first admissions and readmissions entering
mental hospitals. These figures of Table 86, however, do measure any tendency towards
retention within mental hospitals of patients born in certain countries. The handicaps
imposed by language difficulties in reference to possible return to the community are
brought to mind in the finding that three of the four English speaking groups, Canada,
England and Scotland, are showing low retention rates in both first admissions and in
readmissions.
County of Residence of Admissions and of the Resident Population on
September 30, 1939: Rates per 100,000 Population
Table 87 and Graph 9 give the county of residence of the patient at the time of admis-
sion and the rates per 100,000 of the population of the same county for (1) patients
admitted during 1939 and (2) patients in residence at the end of 1939. Considering all
admissions during the year, we find Nantucket County showing the high admission rate
for 1939 of 239 persons per 100,000 of the population. Suffolk County is second with an
admission rate of 225. The next county, Plymouth, shows a drop of 28% to a rate of
161. Worcester and Middlesex follow with admission rates of 144 for both counties.
Berkshire, Hampden and Franklin show the low admission rates of 106, 105 and 97,
respectively.
Table 87. — County of Residence and Rates per 100,000 of (1) Patients Admitted to
Hospitals during the Year Ended September 30, 193,9; {2) Patients in Residence on
September 30, 1939
Rate per
Rate per
County of
Admissions
100,000
County of
Resident
100,000
Residence
During Year
Popula-
Residence
Population
Popula-
at Time of
tion
at Time of
tion
Admission
Same
County1
Admission
Same
County1
M.
F.
T.
M.
F.
T.
Nantucket
6
2
8
239.
Nantucket .
14
10
24
717.
Suffolk .
1,141
977
2,118
225.
Suffolk .
3,272
3,459
6,731
716.
Plymouth
153
121
274
161.
Hampshire .
263
191
454
602.
Worcester
400
320
720
144.
Hampden
946
1,010
1,956
589.
Middlesex
784
629
1,413
144.
Plymouth
550
424
974
574.
Barnstable
30
24
54
134.
Dukes .
15
20
35
555.
Hampshire
54
47
101
134.
Bristol .
984
970
1,954
531.
Essex
368
292
660
129.
Essex
1,425
1,257
2,682
526.
Norfolk .
224
180
404
119.
Berkshire
357
276
633
521.
Bristol
225
196
421
114.
Worcester
1,351
1,170
2,521
505.
Dukes
6
1
7
111.
Franklin
160
102
262
502.
Berkshire
75
54
129
106.
Middlesex .
2,376
2,494
4,870
497.
Hampden
173
178
351
105.
Norfolk
654
717
1,371
405.
Franklin .
29
22
51
97.
Barnstable .
78
82
160
398.
Non-resident
Non-resident
of State
94
50
144
—
of State
136
47
183
-
Unknown
18
5
23
-
Unknown
Total .
116
5
121
-
Total
3,780
3,098
6,878
155.
12,697
12,234
24,931
562.
(See Table 245 for detail)
1 Estimated population of each county, 1939.
Note: The number of admissions for 1939 is larger than the total of First and Readmissions of other
tables because of the fact that the Non-Psychotic (Epileptic) First and Readmissions to the Monson State
Hospital have been added to this particular table. The same applies to the Resident Population.
In reference to patients in the resident population of mental hospitals at the end of
the year, Nantucket again shows the high residence rate, 717 per 100,000 of the general
population of Nantucket. Suffolk is second with a residence rate of 716, Hampshire
third with 602 and Hampden fourth with 589. The low residence rate is shown by
Barnstable with 398. Comparing the counties in both admission rates and residence
rates, we find that Suffolk, Nantucket and Plymouth are the only counties appearing
in the first six positions in both groups. Barnstable, Middlesex and Worcester, high in
admissions, are low in the resident population.
P.D. 117
237
MENTAL D/SORDERS - ALL ADM/SS/OAfS - /SS9
Graph 9. — County of Residence at Time of Admission, All
Admissions, 1939, and Resident Population on September 30, 1939:
Rates per 100,000 Population
Admissions, 1939, and Patients in Residence on September 30, 1939,
from the Forty Largest Cities and Towns in Massachusetts:
Rates per 100,000 Population (1935)
Table 88 gives the numbers and rates per 100,000 for all admissions, 1939, and for
the resident population of mental hospitals at the end of 1939, in reference to the forty
Massachusetts cities largest in population at the time of the 1935 decennial census. The
238
P.D. 117
city of Boston shows the high admission rate for 1939 of 235 persons per 100,000. Then
follow in order Cambridge with 215, Chelsea with 213, Northampton with. 195, Brockton
with 187, Lynn with 185, Revere with 178 and Worcester with 175. The low admission
rates for 1939 are shown by Chicopee with 95, Fall River with 91, Lawrence with 89
and North Adams with 63.
In the resident population of mental hospitals at the end of 1939, patients who orig-
inally came from Boston show the high residence rate of 763. Other high residence
rates occur in patients originally resident in Cambridge, 686; Brockton, 685; Lowell,
680; Holyoke, 671 and Attleboro, 664. The low rates for patients in residence at the end
of 1939, are shown by patients coming originally from Quincy, 383; Melrose, 375; and
Watertown, 362.
Table 88. — Admissions to Hospitals for Mental Disorders, 1939, and Cases in Residence
on September 30, 1939, from the Forty Largest Cities and Towns in Massachusetts:
Rate per 100,000 Population (1935)
Resident
Population
Admissions
Rate per
Population
Rate per
City or Town
19351
1939
100,000
September
30, 1939
100,000
Boston
817,713
1,927
235.
6,247
763.
Cambridge
118,075
254
215.
811
686.
Brockton
62,407
117
187.
428
685.
Lowell
100,114
108
107.
681
680.
Holyoke .
56,139
66
117.
377
671.
Attleboro
21,835
31
141.
145
664.
Waltham
40,557
64
157.
261
643.
Springfield
149,642
170
113.
910
608.
Lynn
100,909
187
185.
613
607.
Lawrence
86,785
78
89.
522
601.
Northampton
24,525
48
195.
147
599.
Salem
43,472
55
126.
260
598.
New Bedford
110,022
150
136.
658
598.
Fitchburg
41,700
62
148.
248
594.
Chelsea
42,673
91
213.
251
588.
North Adams
22,085
14
63.
127
575.
Haverhill
49,516
53
107.
283
571.
Worcester
190,471
335
175.
1,077
565.
Chicopee
41,952
40
95.
237
564.
Framingham
22,651
26
114.
127
560.
Maiden .
57,277
100
174.
305
532.
Peabody
22,082
23
104.
117
529.
Fall River
117,414
107
91.
621
528.
Taunton
37,431
51
136.
198
528.
Somerville
100,773
142
140.
505
501.
Weymouth
21,748
26
119.
109
501.
Pittsfield
47,516
52
109.
238
500.
Gloucester
24,164
36
148.
115
475.
Leominster
21,894
23
105.
103
470.
Everett .
47,228
64
135.
213
451.
Revere .
35,319
63
178.
156
441.
Beverly .
25,871
43
166.
110
425.
Arlington
38,539
55
142.
160
415.
Newton
66,144
103
155.
271
409.
Belmont .
24,831
40
161.
101
406.
Brookline
50,319
74
147.
203
403.
Medford
61,444
84
136.
238
387.
Quincy .
76,909
105
136.
295
383.
Melrose .
24,256
39
160.
91
375.
Watertown
35,827
58
161.
130
362.
Total
3,080,229
5,164
167.
18,689
606.
(See Table 245 for detail)
1 Massachusetts Decennial Census, 1935.
P.D. 117
239
Mental Deficiency
Section F. General Discussion of all Classes Under Care in
State Schools for the Mentally Deficient, 1939
Section F is devoted to a general discussion of all classes of the mentally deficient under
care in public and private schools for the year 1939.
Patients in Schools for the Mentally Deficient on September 30„- 1939
Table 89 shows that the public and private institutions for the mentally deficient
had 6,002 patients within institutions at the end of the statistical year, 1939. A total
of 7,135 were on the books of the various schools including cases supervised by the
Division of Mental Deficiency and defective delinquents at Bridgewater. The Belcher-
town State School had a total of 1,306 within the institution and 1,500 on the books.
The Walter E. Fernald State School had 1,944 patients within the institution and 2,049
on the books. The Wrentham State School had 1,988 within the institution and 2,185
on the books. The Department for Defective Delinquents had 612 within the institution
and 938 on the books. The Division of Mental Deficiency was supervising 310 mentally
defective individuals. Seven private schools had 152 patients within institutions and
153 on the books.
Table 89. — Number of Patients in Public and Private Schools for the Mentally Defective,
September 30, 1939, by School
Schools
Actually in the
Institutions
On the
Books
State:
1,306
1,944
1,988
612
5,850
152
1,500
2,049
2,185
310
938
Walter E. Fernald
Div. Mental Deficiency-
Department Defective D
-Community Supervision ....
elinquents, Bridgewater ....
Total
20
64
6
36
8
11
7
20
65
6
36
8
11
7
6,982
Private:
Elm Hill -
Mentally Defective in
Hospital Cottages '
The Freer School
Total
Total, all Patients
6,002
7,135
Note: In addition to the above, there were 2,088 cases on the books (1,945 cases within and 143 cases
out of mental hospitals on September 30, 1939), who were diagnosed as "Psychoses with mental deficiency."
There were 93 on the books (79 cases within and 14 cases out of mental hospitals) who were diagnosed as
"Without psychoses — mental deficiency."
Comparing the figure of 5,850 actually within State institutions for 1939 with the
figure of 5,225 for 1938, we observe an increase of 11%. The rate per 100,000 of the
population for 1939 is 131.9 for patients actually within institutions and 157.5 for the
total on the books. These rates do not picture the incidence of mental defect but simply
reflect the rate of institutional provision for .mental defectives for the particular year,
1939.
All Admissions to State Schools for the Mentally Deficient, 1904-1939
. Table 90 gives the number of patients who entered the State schools during each year,
1904-1939 inclusive. The largest numbers of admissions to the Walter E. Fernald State
School occurred in 1905, 1909 and 1923 with 282, 275 and 323 admissions, respectively.
Wrentham State School admitted the largest numbers in 1916, 1914 and 1921 with 482,
240 and 238, respectively. Belchertown State School admitted the largest number in
1931, 202 cases.
For all three schools, the largest numbers of patients, 667 and 586, were admitted in
1916 and 1923 respectively. Observing particularly the period from 1923 onward, during
which all three State schools were functioning, we note a steady decrease from 586
240
P.D. 117
admissions in 1923 to 296 admissions in 1939. Mental deficiency is not decreasing in
Massachusetts, but overcrowding in State schools has reached the point where only a
small number can be admitted.
Table 90. — All Admissions from the Community ' to State Schools for the Mentally
Defective, 1 904-1939, by School
Walter E.
Yeab
Total
Fernald
Wrentham
Belchertown
1904
100
100
1905
282
282
-
—
187
187
—
-
1907
215
215
-
-
1908
273
273
—
-
1909
275
275
—
-
1910
377
250
127
-
1911
266
188
78
-
1912
361
190
171
-
1913
228
192
36
-
1914
468
228
240
-
1915
322
231
91
—
1916
667
185
482
-
1917
363
195
168
-
1918
418
190
228
—
1919
372
230
142
—
1920
356
220
136
-
1921
414
176
238
-
1922
283
174
109
-
1923
586
323
164
99
1924
556
245
196
115
1925
435
146
147
142
1926
355
147
117
91
1927
382
167
149
66
1928
410
172
113
125
1929
304
117
133
54
1930
434
101
180
153
1931
461
88
171
202
1932
369
109
141
119
1933
478
183
219
76
1934
471
157
213
101
1935
392
125
173
94
1936
455
137
209
109
1937
487
205
173
109
1938
280
88
117
75
1939
296
66
106
124
Total ....
13,378
6,557
4,967
1,854
1 All First and Readmissions included but not transfers.
During the entire 36-year period a total of 13,378 cases have been admitted to all
State schools. A total of 6,557 patients were admitted to the Walter E. Fernald State
School, or an average of 182 admissions per year. During the last 30 years, 4,967 cases
have been admitted to the Wrentham State School, or an average of 165 admissions
per year. Over the 17-year period 1923-1939, 1,854 patients have been admitted to the
Belchertown State School, or an average of 109 admissions per year. As the present
rated capacities of both Wrentham and Belchertown are smaller than that of Fernald,
their admission averages are necessarily lower.
All Admissions to State Schools, 1904-1939: Rates per 100,000
op the Population
Table 91 shows the total number of admissions to State schools for the years 1904-
1939 and the rate of admission per 100,000 of the general population for each year. In
general, the admission rates were higher during the middle period, 1914-1925, than
during the earlier or later periods. The number of admissions is, of course, dependent
upon the available accommodations. The rates for the years 1923-1925 are quite high,
due to the opening of the Belchertown State School. The rate of 6 admissions per 100,000
of the population for both 1938 and 1939 is a decided decrease from the rate of 11 for
1937. The admission rates for the males are higher than those for the females in all but
9 years of the 35-year period.
Over the entire period, 1904-1939, the admission rates for mental defectives have
remained on approximately the same level. It should be recalled that these admissions
do not represent the community demand for institutional care for the mental defective
but simply register the number of beds available for new admissions each year. The
P.D. 117
241
current list of 2,844 individuals awaiting admission during 1939 demonstrates how the
actual demands for institutional provision for mental defectives are exceeding the present
provisions.
Table 91. — Number of Patients Admitted to State Schools for Mental Defectives, 1904-
19S9, by Sex: Rates per 100,000 Population
Number of Admissions per
Year
Number
of Admissions1
100,000 Population2
M.
F. T.
M. F. T.
1904 ....
65
35 100
4. 2. 3.
1905 .
167
115 282
11. 7. 9.
1906 .
110
77 187
7. 4. 5.
1907 .
118
97 215
7. 5. 6.
1908 .
184
89 273
11. 5. 8.
1909 .
171
104 275
10. 6. 8.
1910 .
214
163 377
12. 9. 11.
1911 .
176
90 266
10. 5. 7.
1912 .
183
178 361
10. 10. 10.
1913 .
155
73 228
8. 4. 6.
1914 .
279
189 468
15. 10. 13.
1915 .
199
123 322
11. 6. 8.
1916 .
343
324 667
19. 17. 18.
1917 .
229
134 363
12. 7. 9.
1918 .
230
188 418
12. 9. 11.
1919 .
245
127 372
13. 6. 9.
1920 .
192
164 356
10. 8. 9.
1921 .
191
223 414
10. 11. 10.
1922 .
169
114 283
8. 5. 7.
1923 .
333
253 586
17. 12. 14.
1924 .
294
262 556
14. 12. 13.
1925 .
206
229 435
10. 11. 10.
1926 .
197
158 355
9. 7. 8.
1927 .
213
169 382
10. 7. 9.
1928 .
272
138 410
13. 6. 9.
1929 .
172
132 304
8. 6. 7.
1930 .
189
245 434
9. 11. 10.
1931 .
211
250 461
10. 11. 10.
1932 .
166
203 369
8. 9. 8.
1933 .
260
218 478
12. 9. 10.
1934 .
227
244 471
10. 10. 10.
1935 .
203
189 392
9. 8. 9.
1936 .
233
222 455
11. 9. 10.
1937 .
293
194 487
13. 8. 11.
1938 .
134
146 280
6. 6. 6.
1939 .
141
155 296
6. 6. 6.
1 Does not include transfers.
2 Population estimated for intercensal years.
Cases Resident in State Schools, 1904-1939: Rates per 100,000
of the Population
Table 92 reveals the number of patients within State schools and the residence rates
per 100,000 of the population for the years 1904-1939. In this table, we observe a gradual
increase from a rate of 27 patients in residence per 100,000 population in 1904 to the
high rate of 119 in the year 1937. This table shows the efforts made by the State to
meet the problem of the mental defective. Since 1904, the rate for patients in residence
increased 337% or about 10% per year. For mental disorders in State hospitals the
increase was 2% per year.
From 1904 to 1921 inclusive, the males showed higher rates for patients in residence.
From 1922 onward, however, a balance has been preserved between the sexes. From
1931 to 1937, the rates for the females exceeded those of the males. In 1937, 1938 and
1939 the male rates are higher.
The last column of Table 92 gives the percentage increase over the preceding year of
patients in residence. The largest increase, 22%, occurred in 1905. There is then a
period of smaller increases up to 1911. From 1912 to 1923, the percentage increases
are higher. From 1924 to 1937 the increases are consistent and on a low general level.
This year there is no change.
Number and Percentage of Patients on Visit, on Parole, on Escape,
and in Family Care from State Schools 1910-1939
Table 93 shows that the lowest percentage of patients on visit and on parole, 4.8%,
occurred in 1910. There was a gradual increase over the following years until the high
242
P.D. 117
percentage of 13.7% was reached in 1924. Between 1924 and 1927 there has been a
steady decline.
Table 92. — Number of Patients in Residence in State Schools for Mental Defectives, on
September 30 of each Year, 1904-1939: Rates per 100,000 Population
Resident Patients
IN
Rates per 100,000
per-
Year
State Schools
Population
centage
increases
M. F.
T.
M.
F.
T.
ON RATES
1904
513 334
847
34.
21.
27.
_
1905
617 411
1,028
40.
26.
33.
22
1906
668 452
1,120
43.
28.
35.
6
1907
713 515
1,228
45.
31.
38.
8
1908
793 539
1,332
49.
32.
40.
5
1909
856 587
1,443
52.
34.
43.
7
1910
915 652
1,567
55.
38.
46.
6
1911
968 674
1,642
57.
38.
48.
4
1912
1,049 796
1,845
61.
45.
53.
10
1913
1,091 829
1,920
63.
46.
54.
1
1914
1,227 967
2,194
70.
53.
61.
12
1915
1,292 1,016
2,308
72.
55.
63.
3
1916
1,376 1,206
2,582
76.
65.
70.
11
1917
1,419 1,254
2,673
77.
66.
72.
2
1918
1,431 1,332
2,763
77.
69.
73.
1
1919
1,432 1,307
2,739
76.
67.
71.
2*
1920
1,452 1,368
2,820
76.
69.
73.
2
1921
1,466 1,475
2,941
76.
74.
75.
2
1922
1,389 1,460
2,849
72.
72.
72.
4*
1923
1,592 1,647
3,239
81.
81.
81.
12
1924
1,699 1,761
3,460
86,
85.
86.
6
1925
1,746 1,847
3,593
88.
89.
88.
2
1926
1,796 1,864
3,660
89.
89.
89.
1
1927
1,852 1,935
3,787
91.
91.
91.
2
1928
1,956 1,956
3,912
95.
91.
93.
2
1929
1,980 1,961
3,941
96.
90.
93.
-
1930
2,050 2,109
4,159
98.
96.
97.
4
1931
2,135 2,277
4,412
103.
104.
103.
6
1932
2,205 2,361
4,566
106.
108.
107.
3
1933
2,316 2,455
4,771
108.
109.
109.
1
1934
2,375 2,558
4,933
110.
112.
111.
1
1935
2,399 2,610
5,009
113.
116.
115.
3
1936
2,461 2,672
5,133
116.
118.
117.
1
1937
2,570 2,674
5,244
120.
118.
119.
1
1938
2,547 2,678
5,225
119.
117.
118.
.8*
1939
2,541 2,697
5,238
118.
117.
118.
"
♦Indicates percentage decrease.
Since the year 1928, it has been possible to differentiate the cases on visit, on parole
and on escape. It will be noted that the percentage on visit has maintained an even
level, as has the percentage on parole. The parolees, who have been earning their own
living in the community in the face of economic conditions during the past ten years,
testify to the excellent work of the social service departments of the State schools. The
percentage of patients on escape at the end of each statistical year varies between the
low figures of .4% in 1910 and .3% in 1939 and the high point of 2.8% in 1919. In the
last five years there has been a decided drop in the percentage on escape. In 1939 a total
of 54 patients, were boarded in family care.
Patients out of State Schools on September 30, 1939
The number of patients on visit, on parole, on escape, and in family care from State
schools in 1939 was 496, 8.6% of the total number on the books (Table 94) ; 106, or 1 .8%
were on visit; 316 or 5.5% were on parole (in wage homes); 20 or .3% were on escape;
and 54 or .9% were in family care.
On September 30, 1939, the Belchertown State School had 26 patients or 1.7% of its
population out on visit; 102 or 6.8% on parole; 12 or .8% on escape; and 54 or 3.6% in
family care. A total of 194 patients or 12.9% of the cases on the books were out of the
institution. The Fernald State School had 22 patients or 1.0% of its total population
on visit; 80 or 3.9% on parole; and 3 or .1% on escape. A total of 105 patients or 5.1%
of the patients on the books were out of the institution on September 30, 1939. The
Wrentham State School had 58 patients or 2.6% of its population on visit; 134 or 6.1%
on parole; and 5 or .2% on escape. A total of 197 patients or 9.0% were out of the
institution at the end of the statistical year.
Table 95 outlines the total number of visits from State schools during the year 1939.
The Walter E. Fernald State School shows the highest visit rate for the year, 293 visits
P.D. 117
243
per 1,000 daily average population on the books. Wrentham is second with a rate of 243
and Belchertown third with a rate of 229. More males go out on visit than females, as
is shown in the rate of 285 for the males as compared with 232 for the females. Approx-
imately one patient in four left one of the schools on visit during the year.
Table 93. — Number and Percentage of Patients on Visit, on Parole, on Escape and
in Family Care from State Schools September 30, 1910-1989
Number
Number
Number
Number
Number
Year
on Visit
Per
Number
Per
on
Per
on
Per
in
Per
Books
and
Parole
Cent
on Visit
Cent
Parole
Cent
Escape
Cent
Family
Care
Cent
1910 .
1,654
80
4.8
-
-
-
-
7
.4
-
-
1911
1,772
115
6.4
—
-
—
—
15
.8
—
-
1912 .
1,985
130
6.5
-
-
-
-
10
.5
-
—
1913 .
2,049
104
5.0
—
-
-
-
23
1.1
-
-
1914 .
2,366
157
6.6
-
-
-
-
15
.6
-
-
1915 .
2,471
134
5.4
-
—
-
-
28
1.1
—
—
1916 .
2,873
237
8.2
-
-
-
-
54
1.8
-
—
1917 .
2,947
222
7.5
—
-
-
—
52
1.7
—
—
1918 .
3,115
305
9.8
—
-
-
-
47
1.5
—
-
1919 .
3,219
387
12.0
-
-
-
-
93
2.8
-
—
1920 .
3,163
290
9.1
-
-
-
-
53
1.6
-
-
1921 .
3,375
376
11.1
—
-
-
-
58
1.7
-
-
1922 .
3,315
401
12.1
—
-
-
—
65
1.9
—
-
1923 .
3,762
463
12.3
-
-
—
—
60
1.5
—
—
1924 .
4,075
560
13.7
-
-
-
-
55
1.3
-
—
1925 .
4,125
488
11.8
-
-
-
-
44
1.0
-
-
1926 .
4,145
429
10.3
-
-
-
—
56
1.3
-
-
1927 .
4,162
332
7.9
—
-
-
-
70
1.6
-
-
1928 .
4,304
—
-
109
2.5
216
5.0
67
1.5
-
—
1929 .
4,363
-
-
108
2.5
231
5.3
83
1.9
-
—
1930 .
4,557
-
-
111
2.4
218
4.7
69
1.5
-
-
1931
4,815
-
-
107
2.8
203
4.2
93
1.9
—
-
1932 .
4,957
-
-
91
1.8
205
4.1
95
1.9
-
-
1933 .
5,202
-
-
110
2.1
233
4.4
88
1.6
-
-
1934 .
5,410
—
-
142
2.6
247
4.5
88
1.6
—
-
1935 .
5,444
-
-
141
2.5
259
4.7
35
.6
-
-
1936 .
5,597
-
-
151
2.6
286
: 5.1
27
.4
-
-
1937 .
5,749
-
-
145
2.5
337
5.8
23
.4
-
—
1938 .
5,702
-
-
140
2.4
302
5.2
15
.2
20
.3
1939 .
5,734
_
_
106
1.8
316
5.5
20
.3
54
.9
Table 94. — Number of Patients on Visit, on Parole, on Escape, and in Family Care
from State Schools on September 30, 1939, by School
Number
on
Books
Cn Visit
On Escape
On Pabole
In Family
Care
Total
State Schools
Num-
ber
Per
Cent
Num-
ber
Per
Cent
Num-
ber
Per
Cent
Num- Per
ber Cent
Num-
ber
Per
Cent
Belchertown .
Walter E. Fernald
Wrentham
1,500
2,049
2,185
26
22
58
1.7
1.0
2.6
12
3
5
.8
.1
.2
102
80
134
6.8
3.9
6.1
54 3.6
194
105
197
12.9
5.1
9.0
Total .
5,734
106
1.8
20
.3
316
5.5
54 .9
496
S.6
Table 95. — Number of Visits during the Year 1939, by State Schools and Sex; Rates
per 1,000 Daily Average Population on Books
School
Daily Average
Population on Books
Number ob
During
Visits
Year
Rates per 1 ,000 Daily
Average Population
M. F. T.
M. F.
T.
M. F. T.
Belchertown ....
Walter E. Fernald .
Wrentham . .. ...
609.7 872.6 1,482.3
1,199.0 864.6 2,063 6
937.7 1,249.1 2,186.8
144 196
371 234
268 264
340
605
532
236. 224. 229.
309. 270. 293.
285. 211. 243.
Total .
2,746.4 2,986.3 5,732.7
783 694
1,477
285. 232. 257.
244
P.D. 117
Section G. Admissions to State Schools for the Mentally Deficient, 1939
The following section discusses various factors in connection with all admissions to
the three State schools for the mentally deficient for the year October 1, 1938 to Septem-
ber 30, 1939, inclusive.
Legal Status of First Admissions and Readmissions to State Schools, 1939
Table 96 reveals that a total of 308 admissions were received at the three State schools
during the year; 128 or 41.5% were admitted under regular court commitment, 168 or
54.5% were admitted on the voluntary or "school" status, and 12 or 3.8% were admitted
by transfer. First admissions comprise by far the larger proportion of admissions to
the State schools, 282 or 91.5% compared with 26 or 8.4% of readmissions.
Table 96. — Legal Status of Admissions to State Schools, 1939
Type of Admission
Total
Court
Voluntary
Observation
Transfer
M.
F.
T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
First Admissions
Readmissions .
134
9
148
17
282
26
40 82 122
2 4 6
94 66 160
5 3 8
_ _ _
2 10 12
Total
143
165
308
42 86 128
99 69 168
- - -
2 ,10 12
Mental Status of First Admissions to State Schools, 1928-1939
Table 97 shows the number of patients admitted, 1928-1939, in each of the mental
status groups with rates per 100,000 of the population 24 years of age and under (1930
Census). The comparison is restricted to this population age grouping as about 92% of
first admissions to State schools are less than 25 years of age. The total rate for all
groups presents considerable irregularity, with a high rate of 24 in 1933, 1934 and 1937.
Low rates occur in 1929, 1938 and 1939. In the case of mental defectives it must be
remembered that admissions are dependent upon the number of beds available. The
waiting list of nearly 3,000 children shows the number of urgent cases awaiting admis-
sion. The marked decrease to the rate of 15 for 1939 means that overcrowding has reach-
ed such a proportion the superintendents do not consider it safe to admit new patients.
All the mental status groups have shown fluctuation, but no definite trend. The
idiot and imbecile groups have now returned to the low rates of 1928, while the moron
group has sunk to a rate of 8 which is 27% lower than the rate for 1928 and 33% lower
than that for 1937.
Table 97. — Mental Status of First Admissions to State Schools, 1928-1939: Numbers
and Rates per 100,000 Population of State under 24 years of age, 1930 Census
Not
Total
Idiot
Imbecile
Moron
Mentally
Years
Defective
No. Rate
No. Rate
No. Rate
No. Rate
No. Rate
1928 ....
390 21.
40 2.
91 4.
211 11.
48 2.
1929
280 15.
55 2.
81 4.
134 7.
10 .5
1930
403 21 .
65 3.
104 5.
211 11.
23 1.
1931
426 23.
47 2.
97 5.
249 13.
33 1.
1932
346 18.
40 2.
82 4.
206 11.
18 .9
1933
447 24 .
77 4.
142 7.
204 11.
24 1.
1934
451 24.
58 3.
176 9.
193 10.
24 1.
1935
379 20.
59 3
133 7.
176 9.
11 .5
1936
428 23.
45 2.
158 8.
211 11.
14 .7
1937
453 24.
68 3.
145 7.
230 12.
10 .5
1938
251 13.
43 2.
85 4.
120 6.
3 .1
1939
282 15.
42 2.
77 4.
149 8.
14 .7
Mental Status of all Admissions to State Schools, 1939
Table 98 outlines the mental status of first admissions and readmissions for the year
1939. The idiots make up 14.8%, the imbeciles 27.3%, the morons 52.8% and the not
mentally defective 4.9% of first admissions. Among the readmissions there are no idiots
or cases not mentally defective; the percentage for the imbeciles is 21.4% and for the
morons 78.5%.
P.D. 117
245
Table 98. — Mental Status of First and Readmissions to State Schools, 1939: Number
and Percentage
First Admissions
Readmissions
Mental Status
Number
Per Cent
Number
Per Cent
M.
F. T.
M. F.
T.
M. F. T.
M. F.
T.
Idiot ....
Imbecile
Moron ....
Not Mentally Defective
21
38
70
5
21 42
39 77
79 149
9 14
15.6 14.1
28.3 26.3
52.2 53.3
3.7 6 0
14.8
27.3
52.8
4.9
2 1 3
5 6 11
28.5 14.2
71.4 85.7
21.4
78.5
Total
134
148 282
100.0 100.0
100.0
7 7 14
100.0 100.0
100.0
. (See Table 249 for detail)
For the sexes, the first admissions show a larger proportion of males in the idiot and
imbecile groups. However, in all groups the sex differences are small.
First Admissions and Readmissions to State Schools, 1939, by School
Of the total 296 admissions (exclusive of transfers) 282 or 95.2% were first admissions
and 14 or 4.7% were readmissions (Table 99). Belchertown State School contributes
124 admissions, 120 or 96.7% first admissions and 4 or 3.2% readmissions. The Fernald
State School contributes 66 admissions, 59 or 89.3% first admissions and 7 or 10.6%
readmissions. The Wrentham State School presents 106 admissions, 103 or 97.1%
first admissions and 3 or 2.8% readmissions. Apparently Wrentham is the most success-
ful in keeping its discharges in the community, with only 2.8% of readmissions. At the
other extreme, the Fernald State School shows the largest proportion of readmissions,
10.6%.
Table 99. — Number and Percentage of First Admissions and Readmissions to Slate
Schools, 1939, by School
State Schools
Total
Admissions
First A
3MISSIONS
Read
hissions
Number
Per Cent
Number
Per Cent
Walter E. Fernald
Wrentham
124
66
106
120
59
103
96.7
89.3
97.1
4
7
3
3.2
10.6
2.8
Total
296
282
95.2
14
4.7
Age of Admissions to State Schools, 1939, by Mental Status
Table 100 presents the average ages of first admissions and readmissions by mental
status. The average admission age of all first admissions was 13.6 years, 11.7 years for
the males and 15.2 years for the females. Evidently mental deficiency in boys means
earlier community difficulties and a younger admission age. This situation is emphasized
by the readmissions where we observed an average admission age of 13.2 years for the
males and 27.5 years for the females.
Table 100. — Average Age at Admission of First Admissions and Readmissions to State
Schools during 1939, by Mental Status and Sex
AVERA(
Mental Status
First Admissions
Readmissions
M.
F.
T.
M.
F.
T.
Idiot
Imbecile
Moron
Not Mentally Defective ....
12 5
10.4
12.5
8.5
11.9
12.8
17.4
14.7
12.2
11.6
15.1
12.5
17.5
11.5
32.5
26.6
22.5
19.7
Total
11,7
15.2
13.6
13.2
27.5
20.3
(See Table 249 for detail.)
246
P.D. 117
Among the first admissions, the imbeciles and the idiots show low average admis-
sion ages of 11.6 years and 12.2 years, respectively. The average admission age for
the not mentally defectives is 12.5 years and for the morons 15.1 years. In the sexes the
females show higher admission ages than the males, except in the idiots. Among the
readmissions, the morons show the low average age, 19.7 years and the imbeciles the
high, 22.5 years. The females show a higher average age in both groups.
Age of Admissions to State Schools, 1939: Rates per 100,000 Population
Table 101 and Graph 10 show the rate of admission for specific age groups per 100,000
of the general population (1930 Census). They present a fairly accurate picture of the
ages at which the urgency for admissions to State Schools is the greatest.
In the first admissions the high admission rate of 20 per 100,000 occurs in the age
group 15-19 years. The age group 5-9 years presents a rate of 19 and 10-19 years pre-
sents a rate of 17. The ages under 5 years and from 20 years upward show smaller admis-
sion rates. These rates are not true measures of the incidence of mental deficiency, but
simply record the ages of cases of such urgency that admission was imperative.
Table 101. — Ages of First Admissions and Readmissions to State Schools, 1989: Rates
per 100,000 of Same Ages in Massachusetts Population, 1930 Census
Total Admissions
First Admissions
Readmissions
Age Groups
Number
Rate
Number
Rate
Number
Rate
Under 5 years
26
7.4
26
7.4
5- 9 years .
77
19.7
76
19.4
1
.2
10-14 years .
71
18.3
66
17.0
5
1.2
15-19 years .
80
21.8
76
20.7
4
1.0
20-24 years .
23
6.6
23
6.6
-
-
25-29 years .
7
2.1
7
2.1
-
-
30 years plus
12
.5
8
.3
4
.1
Total .
296
6.9
282
6.6
14
.3
(See Table 249 for detail)
Graph 10. — Ages of First Admissions to State
Schools, 1939: Rates per 100,000 of Same Ages in
Massachusetts Population, 1930 Census
Population of Place of Residence of Admissions to State Schools, 1939
Table 102 and Graph 11 show the rates per 100,000 population for mental defectives
admitted from the various population units in Massachusetts. The villages (0-2,499
population) show the highest admission rate of 12.1 mental defectives admitted per
100,000 of the population. The next two population groups, show admission rates of
8.0 and 8.9 per 100,000. The cities of over 250,000 population and those with a population
P.D. 117
247
of 50,000-99,999 are fourth with a rate of 6.0. The low rates of 5.9 and 4.8 are observed
in the remaining two city groups.
Table 102. — Population of Place of Residence of Admissions to State Schools, 1989,
and Rates per 100,000 of Same Population Units, 1930 Census
Population Unit
Population in
Each Unit,
1930 Census
Total
Admissions
Rate per
100,000
0- 2,499
2,500- 9,999
10,000- 24,999
25,000- 49,999
50,000- 99,999
100,000-249,999
250,000 plus .
Unknown
Total
199,957
544,976
693,428
576,467
460,411
993,187
781,188
4,249,614
24
44
62
28
28
59
47
4
12.1
8.0
8.9
4.8
6.0
5.9
6.0
(See Table 251 for detail)
i2.r
O 2,500 IO,000
TO TO TO
2,499 9,999 24,999 49,999 99,999 249,999
POPULATION
25,000 50,000 /OO.OOO 250,000
to pL(JS
Graph 11. — Population of Place of Residence of
Admissions to State Schools, 1939: Rates per 100,000
of Same Population Units, 1930 Census
Evidently, the most favorable population groups from the standpoint of admission
to State schools are the intermediate cities, 25,000-49,999. The most unfavorable
population units are the villages.
Economic Status of First Admissions to State Schools, 1939,
by Mental Status
Table 103 shows that the largest proportion of first admissions, 50.3% belongs in the
marginal economic class; 47.1% are found in the dependent group and 1.7% in the
comfortable class. Admissions to State schools (47%) are higher in dependency than
admissions to State hospitals (21%). The marginal and comfortable groups combined
comprise 68.9% of idiots, 59.6% of imbeciles, 44.9% of morons and 35.6% of cases not
mentally defective. Conversely, the idiots show the smallest percentage coming from
dependent homes, 30.9%, while 38.9% of imbeciles come from this economic group,
54.3% of morons and 64.2% of the not mentally defective. The idiots and imbeciles
show large proportions in the marginal or higher groups while the morons and not
mentally defective show a large proportion coming from homes of dependent economic
status.
248
PD. 117
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P.D. 117
249
Nativity and Parentage of First Admissions to State Schools, 1939
Table 104 gives the admission rates to State schools for the native and foreign born.
The native born are divided by parentage into three groups; foreign, mixed and native.
When we compare the first admissions to our State schools with the population 24 years
of age and under, we find that the native born show an admission rate of 16.1 per 100,000
while the foreign born show a lower rate of 4.7. Relatively the foreign born of these
ages contribute one quarter as many mental defectives to our State schools as do the
native born 24 years of age and under. When we divide the native born in accordance
with the nativity of their parents, we find that the native born of native parentage
show the high admission rate of 18.9. The native born of mixed parentage are second
with a rate of 14.5, while the native born of foreign parentage show the low rate of 10.7.
The foreign born and the native born with both parents foreign born are making a very
good showing in incidence of admissions to State schools for mental defectives.
Age op First Admissions to State Schools 1939, by Nativity
Table 105 shows that the foreign born have a high average admission age, 17.5 years.
The native born have an average admission age of 13.5 years. Among the native born
the highest average admission age, 15.2 years, occurs in the native born of mixed parent-
age, 11.5 years for the males and 20.1 years for the females. The lowest average admis-
sion age, 12.0 years, occurs in the native born of native parentage, 11.4 years for the
males and 12.6 years for the females. The native born of native parentage present,
therefore, the low admission age as well as the high admission rate (Table 104).
Table 105. — Average Age of First Admissions to State Schools, 1939, by Nativity,
Parentage and Sex
Nativity Groups
Average Age
M.
F.
T.
12.5
18.7
15.2
16.4
20.1
12.6
17.8
7.5
17.5
Native Born:
Foreign Parentage (both parents foreign born) .
Mixed Parentage (one parent native — one foreign)
Native Parentage (both parents native born)
Unknown Parentage
Nativity Unknown
11.7
12.3
11.5
11.4
13.0
13.5
14.6
15.2
12.0
15.9
7.5
11 7
15.2
13.6
(See Table 247 for detail)
Clinical Diagnosis and Average Intelligence Quotient of Admissions
to State Schools, 1939
Table 106 outlines the average intelligence quotient of first admissions and read-
missions for 1939 in the various clinical diagnosis groups. Due to the fact that "other
forms" includes a number of small groups, it is omitted from discussion. Among the
first admissions the highest average admission I. Q. of .54 occurs in the familial classifica-
tion. The undifferentiated cases are second with an average admission I. Q. of .52.
This group, of course, comprises individuals who lack the outstanding characteristics
which would place them in one of the clinical groups. The low averages are observed in
mongolism, .25 and with developmental cranial anomalies, .28.
The male first admissions show an average admission I. Q. of .46, while that for the
females is .48. The males present a higher average admission I. Q. in four of the ten
diagnosis groups. Owing to the small numbers involved, the readmissions will not be
discussed.
Clinical Diagnosis and Average Age of Admissions to State Schools, 1939
Table 107 shows the average ages of first admissions and readmissions in the various
clinical diagnosis groups. Owing to difficulties with small numbers, the groups having
less than 10 first admissions will not be discussed. The highest average admission age,
14.9 years, occurs in the familial group. The undifferentiated are second with 14.4 years.
Patients with congenital cerebral spastic infantile paralyses show the low average admis-
sion age of 8.7 years.
250
P.D. 117
Table 106. — Clinical Diagnosis and Average Intelligence Quotient of First Admissions
and Readmissions to State Schools, 19S9, by Sex
First Admissions
Readmissions
Numbei
Average I.Q.
Number
Average
LQ.
Clinical Diagnoses
M.
F.
T.
M.
F.
T.
M.
F. T.
M.
F.
T.
12
9
21
.25
.26
.25
With developmental cranial anomalies
6
3
9
.30
.25
.28
"With other organic nervous disease .
3
2
5
.18
.50
.31
With congenital cerebral spastic in-
fantile paralyses ....
4
6
10
.32
.36
.35
1
1
.25
-
.25
Post-traumatic — natal
-
5
5
-
.37
.37
3
2
5
.45
.30
.39
-
1 1
-
.55
.55
Post-traumatic — post-natal
2
I
3
.55
.15
.41
With endocrine disorders .
3
3
6
.48
.38
.43
-
1 1
-
.25
.25
66
70
136
.52
.51
.52
4
3 7
.57
.68
.62
32
44
76
.49
.57
.54
2
1 3
.50
.55
.51
3
3
6
.58
.21
.40
-
1 1
-
.55
.55
Total
134
148
282
.46
.48
.47
7
7 14
.50
.56
.53
(See Tables 254 and 255 for detail)
Table 107.
Clinical Diagnosis and Average Age at Admission of First Admissions
and Readmissions to State Schools, 1939, by Sex
First Ae
missions
Real
missions
Clinical Diagnoses
Number
Average Age
Number
Average Age
M.
F.
T.
M. F. T.
M.
F.
T.
M. F. T.
With developmental cranial anomalies
With congenital cerebral spastic in-
fantile paralyses ....
Post-traumatic — post-natal
With endocrine disorders .
With other organic nervous disease .
Post-traumatic — natal
6
4
12
2
3
3
3
66
32
3
3
6
9
1
3
2
2
70
44
5
3
9
10
21
3
6
5
5
136
76
5
6
5.8 9.5 7.0
5.5 10.8 8.7
9.3 12.0 10.5
15.0 3.5 11.1
12.5 10.8 11.6
15.8 5.5 11.7
7.8 18.0 11.9
12.9 35.8 14.4
12.0 17.0 14.9
- 15.5 15.5
10.8 14.5 12.6
1
4
2
1
1
3
1
1
1
1
1
7
3
1
17.5 - 17.5
- 32.5 32.5
- 17.5 17.5
11.2 20.8 15.3
15.0 42.5 24.1
- 37.5 37.5
Total
134
148
282
11.7 15.2 13.6
7
7
14
13.2 27.5 20.3
(See Tables 252 and 253 for detail)
Still confining ourselves to the groups containing 10 or more first admissions, we note
that the average admission age is higher for the females in all groups. It is interesting
that the hereditary group (familial), with its many social and economic handicaps,
should succeed in keeping the children out of institutions until such a comparatively
late age.
Table 108. — Clinical Diagnosis of Admissions to Slate Schools, 1939, by School
Walter E.
Clinical Diagnoses
T
3TAL
Belch
ERTOWN
Fernald
Wrh
NTH AM
No.
%
No.
%
No.
%
No.
%
79
26.6
49
39.5
5
7.5
25
23.5
21
7.0
3
2.4
6
9.0
12
11.3
With developmental cranial anomalies .
9
3.0
1
.8
1
1.5
7
6.6
With congenital cerebral spastic infantile
paralyses
11
3.7
—
-
5
7.5
6
5.6
6
2.0
3
2.4
1
1.5
2
1.8
5
1.6
1
.8
2
3.0
2
1.8
Post-traumatic — post-natal ....
3
1.0
2
1.6
-
-
1
.9
With endocrine disorders .....
7
2.3
-
-
3
4.5
4
3.7
With other organic nervous disease
0
1.6
1
.8
—
—
4
3.7
Undifferentiated
143
48.3
62
50.0
40
60.6
41
38.6
7
2.3
2
1.6
3
4.5
2
1.8
Total
296
100.0
124
100.0
66
100.0
106
100.0
P.D. 117
251
Clinical Diagnosis op Admissions to State Schools, 1939, by School
Table 108 presents the clinical diagnoses of admissions to State schools during 1939
by individual schools. Rather marked differences are observed. For example, Belcher-
town places 50% in the undifferentiated group, while the Walter E. Fernald uses this
diagnosis in 60% of admissions and Wrentham in 38% of admissions. Belchertown
places 39% of admissions in the familial group, Walter E. Fernald 7%, and Wrentham
23%. That a selection of certain types for admission is possible is demonstrated by the
figures on mongolism. Belchertown admitted 2% in this diagnosis, Walter E. Fernald
9% and Wrentham 11%. In admissions diagnosed with congenital cerebral paralyses,
Belchertown admitted none, Walter E. Fernald 7% and Wrentham 5%. It should be
remembered that admissions are selected from rather large waiting lists. The urgency
for admission of the various types may vary also in accordance with the population of
the areas served by the respective schools.
Country op Origin of Native Born of Foreign or Mixed Parentage, First
Admissions to State Schools, 1939: Rates per 100,000 Population Aged
0-24 Years of Same Country of Origin
Table 109 gives the country of origin of the native born of foreign or mixed parentage
for first admissions during 1939. As 92% of admissions are under 25 years of age, the
population comparisons are restricted to these ages. Patients with Portugal as the
country of origin show the high admission rate to State schools (53). Canada and Poland
demonstrate rates of 13 and 12, respectively. The low admission rate of 5 is shown for
Greece, Scotland and England. At the bottom of Table 109, we present the admission
rate for the native born of native parentage, 21.6. This rate is higher than the rate of
12.1 for the native born of foreign or mixed parentage.
Table 109. — Country of Origin of Native Born of Foreign or Mixed Parentage, First
Admissions to State Schools, 1939: Rates per 100,000 Population Aged 0-2J/.
Years of Same Country of Origin
Population 0-24
First-
Rates per
Country or Origin
Years, 1930
Admissions
100,000 Same
Census
1939
Country of
Origin
27,841
15
53.8
245,773
34
13.8
Poland
104,464
13
12.4
133,870
16
11.9
Italy
174,969
20
11.4
64,832
7
10.7
16,716
1
5.9
All other Countries
152,822
9
5.8
51,770
3
5.7
19,434
1
5.1
Unknown
-
2
-
992,491
121
12.1
Rate for Native of Native Parentage (155 eases) ■ — 21.6.
1 Includes Newfoundland.
Section H. All Discharges from State Schools for the Mentally
Deficient, 1939
The section following discusses various factors in reference to discharges from State
schools.
Discharges to the Community from State Schools, 1917-1939
Table 110 presents the numbers and rates per 1,000 under care of discharges from
the State schools over the period 1917-1939. With the exception of 1926, the males
have shown a larger number of cases under care than the females from 1917 to 1929.
From 1930 to 1939, however, the females have shown larger numbers under care. In
discharges, the males have shown larger numbers leaving State schools than the females
in every year of the 23-year period with the exception of 1926. The larger number of
male discharges from 1930 onward in the face of a larger number of females under care
is interesting. In the discharge rates, the year 1920 presents the high of 105. The total
rate shows irregularity between 1917 and 1924. After that point a rough trend is dis-
252
P.D. 117
cernible. The years 1925-1927 show discharge rates between 60 and 69. During the
next three years, 1928-1930, the rates drop to between 40 and 49. The years 1931-1934
show a further drop in rates to between 30 and 39. The years 1935, 1936, 1937 and 1938
have shown higher discharge rates with 51, 40, 43 and 43, respectively. The rate drops
to 36 in 1939. In the sexes, the males have shown higher discharge rates in 22 of the
23 years included in this table, the only exception being the year 1926.
Table 110. — Discharges from State Schools, 1917-1939, by Sex: Rates per Thousand
Under Care
Numb
br Under Care
Discharges
Rates
per 1,000 Under
Years
Care
M.
F.
T.
M.
F.
T.
M.
F.
T.
1917 ....
1,808
1,430
3,238
172
80
252
95.1
55.9
77.8
1918
1,824
1,517
3,341
120
37
157
65.7
24.3
46.9
1919
1,925
1,576
3,501
78
52
130
40.5
32.9
37.1
1920
1,941
1,636
3,577
247
129
376
127.2
78.8
105.1
1921
1,863
1,714
3,577
103
56
159
55.2
32.6
44.4
1922
1,908
1,749
3,657
192
120
312
100.6
68.6
85.3
1923
2,086
1,893
3,979
120
40
160
57.5
21.1
40.2
1924
2,236
2,091
4,327
137
65
202
61.2
31.0
46.6
1925
2,254
2,207
4,461
185
102
287
82.0
46.2
64.3
1926
2,235
2,255
4,490
139
154
293
62.1
68.2
65.2
1927
2,270
2,244
4,514
196
99
295
86.3
44.1
65.3
1928
2,324
2,200
4,584
136
79
215
58.5
34.9
46.9
1929
2,322
2,287
4,609
110
76
186
47.3
33.2
40.3
1930
2,365
2,435
4,800
114
80
194
48.2
32.8
40.4
1931
2,441
2,577
5,018
97
69
166
39.7
26.7
33.0
1932
2,492
2,695
5,187
98
69
167
39.3
25.6
32.1
1933
2,628
2,807
5,435
89
79
168
33.8
28.1
30.9
1934
2,733
2,939
5,672
92
86
178
33.6
29.2
31.3
1935
2,805
2,999
5,804
174
126
300
62.0
42.0
51.6
1936
2,836
3,063
5,899
140
97
237
49.3
31.6
40.1
1937
2,950
3,134
6,084
135
131
266
45.7
41.7
43.7
1938
2,911
3,118
6,029
136
127
263
46.7
40.7
43.6
1939
2,878
3,121
5,999
111
106
217
38.5
33.9
36.1
Mental Status and Average Age of Discharges to the Community, 1939
Table 111 outlines the average age of discharges in the various mental status groups.
The 217 patients returned to the community present an average discharge age of 23.6
years, 20.5 years for the males and 26.8 years for the females. The higher discharge
age for the females is partially due to the fact that the females admitted are uniformly
older than the males (see Table 100).
In the idiot group, the 6 cases discharged left the institution at an average age of
20.0 years. The 58 cases in the imbecile group averaged 20.5 years. The 139 cases in
the moron group averaged 24.7 years and the 14 cases in the group not mentally defective
averaged 27.1 years of age at discharge. In the idiot group, the females were 1.7 years
older than the males at the time of discharge and in the imbecile group 2.6 years older.
In the moron group, the females were 8.1 years older and in the group not mentally
defective 3.4 years younger.
Table 111. — Mental Status and Average Age of Discharges from State Schools, 1939,
by Sex: Numbers and Averages
Mental
St
VTUS
Number
Average Age
Discharge
AT
M.
F.
T.
M.
F.
T.
Idiot
3
34
72
2
3
24
67
12
6
58
139
14
19.1
19.4
20.8
30.0
20.8
22.0
28.9
26.6
20
20
24
27
0
5
7
Not Mentally I
1
Total
111
106
217
20.5
26.8
23
6
(See Table 256 for detail)
Age of Discharges Returned to the Community, 1939, by School
Table 112 presents the age distribution of patients discharged from State schools
during 1939. Eighty-nine or 41% of the total discharges were under 20 years of age;
87 or 40% were between the ages of 20 and 29 years and 41 or 18% were 30 years of age
P.D. 117
253
or over. It is apparent that the ages under 30 years are the most favorable for the dis-
charge of patients from State schools.
Table 112. — Age at Discharge of Patients Discharged from State Schools, 1939, by School
and Sex
Age at Discharge
Total
M. F.
Belchertown
M.
Walter E.
Fernald
M.
M.
Under 5 years
.5- 9 years
10-14 years
15-19 years
20-24 years
25- 29 years
30-34 years
35-39 years
40-44 years
45-49 years
50-54 years
55-59 years
60 years and over
Total
Average Age
46
30
12
3
2
1
2
9
17
22
23
13
7
4
1
1
23
15
12
9
4
4
111 106 217
20.5 26.8 23.6
20
38
49
27
70
25.0 26.1 25.7
18.5 25.0 20.8
20.7 28.7
83
24.6
In the sexes we note that the discharge age is younger for boys than for girls. The
average age for all discharges was 23.6 years, 20.5 years for the males and 26.8 years
for the females. Discharges from Belchertown showed the highest average age, 25.7
years, 25.0 years for the males and 26.1 years for the females. Wrentham was second
with an average of 24.6 years, 20.7 years for the males and 28.7 years for the females.
Fernald discharges were the youngest with an average age of 20.8 years, 18.5 years for
the males and 25.0 years for the females. In every school the males discharged are
younger than the females.
Table 113. — Discharges from State Schools, 1989, by School: Numbers and Rates per
1,000 Cases Under Care 1
State Schools
Number Under
Care
NuMBEP. OF
Discharges
Rate per 1,000
Under Care
M.
F.
T.
M. F. T.
M. F. T.
Belchertown
Walter E. Fernald
Wrentham ....
640
1,248
990
930
890
1,301
1,570
2 138
2,291
20 38 58
49 27 76
42 41 83
31. 40. 36.
39. 30. 35.
42. 31. 36.
Total ....
2,878
3,121
5,999
111 106 217
38. 33. 36.
1 Includes discharges irrespective of l.Q. Cases under care are obtained by adding resident population
and patients out on September 30, 1939, and all discharges and all deaths during the year 1939.
Discharges to the Community, 1939, by School: Rates per 1,000 Cases
under Care
During 1939, 217 patients were discharged from the three State schools for the men-
tally defective (Table 113). Of these, 111 or 51% were males and 106 or 49% were
females. While the sexes balance in all schools combined, two of the individual schools
show marked sex differences in discharges. Of the 58 patients discharged from Belcher-
town, 34.4% were males and 65.5% females. Of the 76 discharged from Fernald State
School, 64.4% were males and 35.5% were females. Of the 83 discharged from Wrentham
50.6% were males and 49.3% females.
The rate of discharge per 1,000 cases under care for all schools is 36, 38 for the males
and 33 for the females. Fernald presents a rate of 35; Belchertown and Wrentham
36 each. The discharge rate for females is higher than for males at Belchertown, lower
at Fernald and Wrentham.
Mental Status of Discharges to the Community, 1939, by Age:
Rates per 1,000 under Care of Same Groups
Table 1 14 presents the discharge rates per thousand under care by mental status and
age at discharge. Higher discharge rates are observed in the mental status groups show-
254
P.D. 117
ing the higher intelligence. The idiot group shows a discharge rate of 7 per thousand
idiots under care; the imbecile group a rate of 24; the moron group a rate of 53. The
not mentally defective group is highest with a rate of 92. Higher discharge rates for
the females occur in the idiot and not mentally defective classifications but the males
are higher in the imbecile and moron groupings. In reference to age, the idiots show
their high discharge rate of 17 in the 20-29 year age group. For imbeciles, the high
rate of 41 occurs in the 0-9 year- age group. The morons present a high rate of 66 in the
20-29 year group and the not mentally defective a high rate of 250 in the 40-49 year
age group.
Table 114. — Discharges from State Schools, 1989, by Mental Status and Age at Discharge :
Rates per 1,000 Cases Under Care of Same Mental Status and Age
Mental Status
Sex
Age Distribution
All
Ages
0-9
Years
10-19
Years
20-29
Years
30-39
Years
40-49
Years
50-59
Years
60 Years
and Over
Idiot ....
M.
F.
T.
6.
7.
7.
14.
7.
9.
3.
15.
19.
17.
-
:
-
:
Imbecile
M.
F.
T.
27.
20.
24.
51.
28.
41.
32.
28.
30.
45.
25.
35.
4.
17.
11.
7.
7.
7.
_
-
Moron
M.
F.
T
63.
45.
53.
-
72.
34.
58.
81.
57.
66.
31.
45.
41.
26.
50.
45.
45.
33.
-
Not Mentally Defective
M.
F.
T.
30.
137.
92.
_
23.
120.
58.
178.
142.
100.
142.
250.
250.
250.
_
~
Total ....
M.
F.
T.
38.
33.
36.
25.
11.
19.
46.
30.
40.
54.
46.
50.
12.
32.
24.
15.
32.
26.
14.
8.
-
(See Table 277 for detail)
54
0-9 W -19 20-29 30-39 40-49 50-59
YRS. YRS. YRS. YRS. YRS. YRS.
Graph 12. — Age of Discharges from State Schools,
Rates per 1,000 Under Care of Same Ages
1939:
The discharge rates by age are outlined in Graph 12. Age appears to have a greater
influence on the discharge of males than of females. The males show sharply increasing
discharge rates from 25 in the 0-9 year group to 46 in the 10-19 year group and to 54
in the 20-29 year group. Then they drop to a low rate of 12 in the age group 30-39
P.D. 117
255
years and 15 in the age group 40-49 years. The discharge rates of the females vary from
a low rate of 11 in the age group 0-9 years to the high of 46 in the 20-29 year group and
back to a low rate of 14 in the 50-59 year group.
Clinical Diagnosis of Discharges to the Community, 1939, by Age:
Rates per 100,000 under Care of Same Groups
Table 115 outlines the discharge rates per thousand cases under care by clinical group-
ing and by age distribution. The high discharge rate for the clinical groups, 64, occurs
in the group with other organic nervous diseases (2 cases). Post-traumatic, post-natal
is second with 60 (2 cases) ; and post-infectional and undifferentiated third with 40 (1 1
and 100 cases, respectively). The low discharge rates occur in post-traumatic — natal,
8 (1 case) and with developmental cranial anomalies 12 (2 cases). The age rates across
the bottom of the table show the high discharge rate of 50 in the age group 20-29 years.
The 10-19 group is second with a rate of 40 per thousand under care. The 30-39 and
40-49 groups present discharge rates of 24 and 26, respectively. The familial group
(62 cases) demonstrates the high discharge rate of 56 in the age group 20-29 years and
the low rate of 10 in the age group 10-19 years. The undifferentiated group (100 cases)
offers the high discharge rate of 55 in the 10-19 year age group and the low rate of 7
in the 0-9 year group.
Table 115. — Discharges from State Schools, 1939, by Clinical Diagnosis and Age at
Discharge: Rates per 1,000 Cases under Care l of Same Clinical Groupings and Age
0-9
10-19
20-29
30-39
40-49
50-59
60 Years
Clinical Diagnoses
Total
Years
Years
Years
Years
Years
Years
and Over
Familial ....
33.
15.
10.
56.
37.
34.
20.
-
Mongolism ....
21.
37.
20.
13.
-
-
-
-
With developmental cranial
anomalies
12.
23.
15.
-
—
—
—
—
With congenital cerebral
spastic infantile paralyses
23.
35.
15.
16.
25.
-
-
-
Post-infectional .
40.
52.
63.
26.
20.
—
90.
—
Post-traumatic — natal .
8.
-
15.
_
-
-
-
-
Post-traumatic — post-natal
60.
-
83.
166.
-
-
-
-
With epilepsy — idiopathic
20.
-
32.
37.
-
—
-
-
With endocrine disorders .
25.
-
28.
52.
-
—
-
-
With other organic nervous
disease ....
64.
—
100.
—
—
500.
—
—
Undifferentiated
40.
7.
55.
54.
16.
30.
-
-
Other forms
63.
-
157.
62.
54.
17.
-
-
Total ....
36.
19.
40.
50.
24.
26.
8.
-
1 Cases under care include the resident population and cases out on September 30, 1939, plus discharge
and deaths during the year 1939.
It is interesting to compare the discharge rate of 36 cases per thousand under care
in State schools for mental defectives (88% first admissions) with the discharge rate of
156 per thousand first admissions under care in mental hospitals. While the mental
hospitals discharged one patient out of every 7 under care during 1939, the state schools
discharged but one patient out of every 27 under care.
Economic Status of Discharges to the Community, 1939, by Mental
Status: Rates per 1,000 under Care of Same Groups
Table 116 outlines the economic status of discharges in the various mental status
groups, presenting also the rates per thousand under care of the same groups. There
were no discharges in the comfortable group. The marginal group presents a discharge
rate of 40, 45 in the males and 34 in the females. The group of dependent economic
status shows a rate of 32, 28 in the males and 34 in the females. The imbeciles and
morons show higher discharge rates in the marginal group. The idiot and not mentally
defective groups show the high discharge rates in the dependent group.
Length of School Stay of Discharges to the Community, 1928-1939,
by Mental Status
Table 117 outlines the length of time that discharges remained in residence in State
schools for each year of the period 1928-1939, by mental status. The total column
shows little variation in length of residence over the past twelve years. With the excep-
256
P.D. 117
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P.D. 117
257
tion of the years 1929 and 1930, the average length of school residence has remained
rather consistently around 6 years until 1938 and 1939, which show an increase to 7.5
and 7.2 years, respectively. In nine of the twelve years, the females show a longer school
residence previous to discharge.
Table 117. — Average Length of School Stay during This Admission of All Discharges,
1928-1939, by Mental Status and Sex
A
VERAGES IN
Yeabs
Years
Total
Idiot.
Imbecile
VIoron
Not
Mentally
Defective
M.
F.
T.
M.
F.
T.
M. F.
T.
M.
F.
T.
M.
F. T.
1928 .■■•'.
5.9
7.0
6.3
3.5
7.8
5.6
6.5 7.1
6.8
5.7
7.8
6.4
5.4
7.5 6.2 :
1929 .
4.1
6.1
4.9
7.3
2.1
6.4
3.6 7.7
5.5
4.2
5.8
4.9
2.5
4.3 3.3 j
1930 .
3.9
5.9
4.7
5.0
4.4
4.7
4.7 6.3
5.4
3.7
5.6
4.4
1.1
8.4 5.0
1931 .
6.3
6.0
6.2
9.9
3.3
7.2
6.5 8.7
7.3
5.5
5.5
5.5
4 n
4.9 4.6
1932 .
6.3
5.6
6.0
8.6
4.8
6.7
7.3 4.5
5.8
6.0
6.6
6.2
2.2
5.2 3.5 j
1933 .
4.9
5.8
5.3
7.8
5.3
7.0
5.7 9.3
7.0
3.5
5.1
4.8
3 6
5.3 4.5
1934 .
6.2
6.7
6.5
3.2
10.8
6.2
7.9 5.9
7.0
6.5
5.4
6.0
5.4
9.0 7.5
1935 .
6.2
5.9
6.1
5.4
.3
3.2
7.1 6.6
6.9
7.0
5.8
6.5
4.5
7.1 5.7
1936 .
5.8
5.9
5.8
4.7
5.4
5.1
5.6 5.4
5.5
6.0
6.0
6 0
4.8
6.7 5.8
1937 .
6.2
6.6
6.4
.7
5.7
3.2
5.3 4.4
4.9
6.4
6.4
6.4
7 9
10.7 9.2
1938 .
6.0
9.2
7.5
4.3
10.2
6.4
3.8 10.7
6.4
6.7
8.9
7 8
9.4
8.2 8.6
1939 .
6.3
8.0
7.2
4.3
2.7
3.5
6.4 9.4
7.6
6.3
7.8
7.0
12.0
7.7 8.3
The idiot group showed the longest length of hospital stay in 1931, 7.2 years, and
the shortest residence in 1935 and 1937, 3.2 years. The males remained longer than the
females in six out of the twelve years. The imbecile group showed the longest period of
residence in 1939, 7.6 years, and the shortest hospital stay in 1937, 4.9 years. Again,
we observe considerable irregularity in length of stay. In seven of the twelve years,
the females showed a longer average school residence. The morons presented the high
average stay of 7.8 years in 1938 and the low average of 4.4 years in 1930. This mental
status group showed longer average residences for the females in seven of the twelve
years with the sexes showing the same averages in three other years.
Length of Time on the Books during the Present Admission of Discharges
to the Community, 1939, by Mental Status
Table 118 demonstrates the time spent within institutions and the time spent out on
visit, parole, etc. during the present admission of cases discharged in 1939, by mental
status. All discharges remained in school an average net time of 7.2 years, 6.3 years
for the males and 8.0 years for the females. Time in the community averaged 1.8 years
giving a total time on the books of 9.0 years, 7.6 years for the males and 10.4 years
for the females.
Table 118. — Average Time on Books, Time Spent Out and Net Time Within Institutions
during This Admission of Discharges, 1939, by Mental Status and Sex
Mentai Status
AVebage Time
on Books
Average Time
Spent Out
Average Net Time
Within Institutions
M. . F. T.
M. F. T.
M. F. T.
Idiot ......
Imbecile . .
Moron
Not Mentally Defective .
5.1 2.7 4.3
7.6 10.5 8.8
7.7 10.4 9.0
12.8 10.4 10.7
.8 - .8
1.2 1.1 1.2
1.4 2.6 2.0
.8 2.7 2.4
4.3 2.7 3.5
6.4 9.4 7.6
6.3 7.8 7.0
12.0 7.7 8.3
Total .
7 6 10.4 9.0
1.3 2.4 1.8
6.3 8.0 7.2 •
(See Table 261 for detail)
Apparently, length of school stay is not correlated with intellectual status. The
idiots remained within schools an average of 3.5 years; the imbeciles 7.6 years; the
morons 7.0 years and the group not mentally defective 8.3 years. The group of the
lowest intellectual level is presenting the shortest average stay. It should be recalled
that certain of the higher grade cases (morons) are those showing grave behavior pro-
258
P.D. 117
blems. In the not mentally defective and idiot groups, the males remained longer than
the females. However, in the imbecile and moron groups the females remained longer
than the males.
In reference to the time spent out of school previous to discharge, we notice a positive
correlation with mental status. Here the idiots remained out .8 years; the imbeciles
1.2 years; the morons 2.0 years and the not mentally defective group 2.4 years. The
fact that patients of the higher mental grades constitute the best material for placement
at work in the community accounts for the longer period on the books under supervision.
Many of the patients in the lower mental age groupings are discharged directly to their
families.
Length of School Stay of Discharges to the Community, 1939, by Age
at Admission
Table 119 shows the net time in residence of all cases discharged, by age at admission.
Discarding the age groups over 30 years because of small numbers, we note that the
longest school residence occurs in those admitted under 5 years of age, 15.0 years, with
the admission ages of 5-9 and 25-29 second and third with 8.4 years and 8.3 years,
respectively. Patients admitted in the 20-24 year age group show the shortest residence,
4.8 years. In all age groups the females remain longer within the school than the males,
except in the 25-29 year age group.
Table 119. — Net Time in Residence during This Admission of Cases Discharged during
1939, by Age at Admission and Sex
Age at Admission
Number
Net Time in Residence
in Years
M. F. T.
M. F. T.
25-29 years
2 2
26 10 36
53 36 89
27 34 61
1 11 12
3 7 10
1 - 1
- 4 4
- 2 2
15.0 15.0
8.2 8.9 8.4
6.3 7.5 6.8
4.1 9.4 7.0
.1 5.3 4.8
10.0 7.5 8.3
17.5 - 17.5
6.1 6.1
4.5 4.5
Total
111 106 217
6.3 8.0 7.2
Times out on Visit during This Admission, Discharges to the Community,
1939, by School
Table 120 discusses the average number of times out on visit this admission of all
patients discharged from State schools during the year 1939, by school. The highest
average number of times placed out on visit occurred at Wrentham, 3.7 times. Belcher-
town is next with an average of 3.6 visits before discharge and Fernald is low with an
average of 3.4. For all schools we note an average of 3.6 visits during this particular
admission. The females show an average of 3.6 and the males 3.5 times out.
Table 120. — Times Out on Visit during This Admission, Discharges from State Schools,
1939, by School: Numbers and Averages
State Schools
Number
Average Times Out
M.
F.
T.
M.
F. T.
20
49
42
38
27
41
58
76
83
3.9
3.4
3.5
3.5 3.6
3.4 3.4
3.9 3.7
Total
111
106
217
3.5
3.6 3.6
(See Table 260 for detail)
Capability on Discharge of Patients Returned to the Community, 1939,
by Clinical Diagnosis
Table 121 demonstrates the capability on discharge of cases leaving State schools
during 1939, by clinical groupings. The total shows that 15% of these discharges were
capable of self-support, 43% were capable of partial self-support and 40% were incapable
P.D. 117
259
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260
P.D. 117
of productive work. Fifty-eight percent, more than half the cases discharged, are able
to support themselves either wholly or partially. The females show nearly ten percent
more than the males capable of self-support.
Considering only the diagnoses with 10 or more discharges, we find the familial group
showing the highest percentage capable of self-support, 22%. The group undiffer-
entiated shows 16% of cases falling within this classification. The group post-infectional
shows 9%. It is interesting to see the cases of hereditary mental defect (the familial
group) making such a good showing in this connection. In the cases capable of partial
self-support, we find 58% of the familial, 50% of the undifferentiated and 27% of the
post-infectional. Among those incapable of productive work, the group post-infectional
shows 63%, undifferentiated 34% and familial 19%. The other diagnoses, with less
than ten discharges, show either 50% or 100% incapable of productive work.
Intelligence Quotient of Discharges to the Community, 1939,
by Clinical Diagnosis
Table 122 describes the average intelligence quotient of discharges in the various
clinical groups. Owing to the small number of cases involved in certain of the clinical
groupings, no conclusions can be drawn. All clinical groups together show an average
intelligence quotient- at discharge of .53, .51 for the males and .56 for the females. In
this connection we recall that the male first admissions presented an I. Q. of .46 and the
females an I. Q. of .48 (Table 106). In the clinical diagnosis groups the post-traumatic —
natal, familial and undifferentiated cases show the high average I. Q. of .75, .56 and .56.
The groups with other organic nervous disease and with epilepsy-idiopathic are next
with an average I. Q. of .55 and the group post-infectional follows with .54. Again
referring to Table 106, we note that the group undifferentiated shows the highest admis-
sion I. Q. The lowest average intelligence quotients at discharge are seen in the groups
with congenital cerebral spastic infantile paralyses, .27; mongolism, .29; and post-
traumatic — post-natal, .40.
Age of Discharges to the Community, 1939, by Clinical Diagnosis
Table 123 outlines the average age at discharge of cases in the various clinical groups.
Again the small numbers in certain groups render inadvisable any generalizations. The
highest average age at discharge is seen in the group with other organic nervous disease,
30.0 years. The familial and post-infectional groups are next with average ages of 27.9
and 22.9 years, respectively. The lowest discharge ages are seen in the groups with
developmental cranial anomalies and post-traumatic — natal, 12.5 years. In two groups
the males present the higher discharge ages. In ten groups the females show the higher
average discharge ages.
Table 123. — Average Age of Discharges from State Schools, 1939, by Clinical Diagnosis
and Sex
Average Age
AT
Clinical Diagnoses
Number
Discharge
M.
F.
T.
M.
F.
T.
Post-traumatic — natal ... - .
1
1
12.5
12.5
With developmental cranial anomalies
1
1
2
7.5
17.5
12.5
3
4
7
10.8
15.0
13.2
1
1
2
22.5
12.5
17.5
With congenital cerebral spastic infantile paralyses
3
2
5
14.1
27.5
19.5
With endocrine disorders
l
1
2
22.5
17.5
20.0
58
42
100
20.0
25.8
22.5
Post-traumatic — post-natal
1
1
2
17.5
27.5
22.5
6
5
11
18.3
28.5
22.9
23
39
62
24.0
30.3
27.9
With other organic nervous disease
1
1
2
17.5
42.5
30.0
Other forms
13
8
21
22. 1
24.3
22.9
Total
111
106
217
20.5
26.8
23.6
(See Table 257 for detail)
Length of School Stay during This Admission, Discharges to the
Community, 1939, by Clinical Diagnosis
Table 124 shows the length of residence of discharges during 1939 in the various
clinical groups. All cases discharged reveal an average net length of residence of 7.2
years, 6.3 years for the males and 8.0 years for the females. The group post-traumatic —
P.D. 117
261
post-natal, remained for the longest period, an average of 11.0 years. The group with
congenital cerebral spastic infantile paralyses is second with an average of 9.7 years
and the familial group is third with an average of 9.4 years. The shorter averages are
observed in mongolism, 2.9 years and in developmental cranial anomalies, 2.0 years.
In nine of the twelve groups, the females reveal the longer school stay before discharge.
Table 124. — Length of School Residence during This Admissio?i of Cases Discharged,
1989, by Clinical Diagnosis and Sex
Clinical Diagnoses
Number
M.
T.
Average Residence
in Years
M.
F.
Familial
Mongolism
With developmental cranial anomalies
With congenital cerebral spastic infantile paralyses
Post-infectional
Post-traumatic — natal
Post-traumatic — post-natal
With epilepsy — idiopathic
With endocrine disorders
With other organic nervous disease
Undifferentiated
Other forms
lotal
23
3
1
3
6
1
1
1
1
58
13
39
4
1
2
5
62
7
2
5
11
1
2
2
2
2
100
21
7.9
.6
.6
4.5
6.4
4.5
7.5
4.5
2.5
5.8
8.5
10.3
4.6
3.5
17.5
10.3
3.5
17.5
.3
3.5
12.5
6.6
3.5
9.4
2.9
2.0
9.7
8.1
3.5
11.0
3.9
4.0
7.5
6.2
6.6
106
217
6.3
8.0
7.2
(See Table 262 for detail)
Section J. Deaths in State Schools for the Mentally Deficient, 1939
The following section presents data in reference to cases dying within the three State
schools during the statistical year ended September 30, 1939.
Deaths in State Schools, 1917-1939: Rates per 1,000 under Treatment
Table 125 gives the numbers and rates per 1,000 under treatment of all deaths in
State schools for each year of the period 1917-1939. In the totals the high rate of 50.3
deaths per 1,000 under treatment occurs in 1919 and the low rate of 8.0 in 1931. In
the sexes, the males show higher death rates in sixteen of the twenty-three years. The
females show higher rates in five years and the rates are the same for both sexes in two
years. It is interesting to note these higher death rates in males in view of the fact
that the resident population of State schools shows a younger age distribution for males
than females. In general, there is a slight downward trend in the death rates of State
schools over the twenty-three year period observed.
Table 125. — Deaths in State Schools, 1917-1939, by Sex: Rates per 1,000 Cases under
Treatment
N
cjmber Under
Rates per 1,000
Years
Treatment
Deaths
Under Treatment
M.
F. T.
M.
F.
T.
M. F. T.
1917
1,614
1,350 2,964
23
16
39
14.2 11.8 13.1
1918
1,591
1,398 2,989
40
29
69
25.1 20.7 23.0
1919
1,609
1,412 3,021
99
53
152
61.5 37.5 50.3
1920
1,721
1,513 3,234
22
16
38
12.7 10.5 11.7
1921
1,589
1,554 3,143
20
23
43
12.5 14.8 13.6
1922
1,596
1,595 3,191
15
15
30
9.3 9.3 9.4
1923
1,742
1,714 3,456
30
27
57
17.2 15.7 16.4
1924
1,866
1,846 3,712
30
20
50
16.0 10.8 13.4
1925
1,964
1,965 3,929
33
16
49
16.8 8.1 12.4
1926
1,961
2,044 4,005
26
26
52
13.2 12.7 12.9
1927
2,079
2,060 4,139
31
26
57
14.9 12.6 13.7
1928
2,130
2,062 4,192
38
27
65
17.8 13.0 15.5
1929
2,126
2,061 4,187
36
24
60
16.9 11.6 14.3
1930
2,186
2,216 4,402
22
27
49
10.0 12.1 11.1
1931
2,250
2,365 4,615
18
19
37
8.0 8.0 8.0
1932
2,329
2,467 4,796
26
37
63
11.1 14.9 13.1
1933
2,438
2,566 5,004
33
32
65
13.5 12.4 12.9
1934
2,507
2,688 5,195
40
44
84
15.9 16.3 16.1
1935
2,601
2,768 5,369
28
32
60
10.8 11.6 11.2
1936
2,640
2,795 5,435
39
26
65
14.7 9.3 11.9
1937
2,743
2,836 5,579
38
31
69
13.8 10.9 12.3
1938
2,721
2,831 5,552
38
26
64
13.9 9.1 11.5
1939
2,679
2,824 5,503
27
21
48
10.0 7.4 8.7
262
P.D. 117
Deaths in State Schools, 1939, by School: Rates per 1,000 Cases under
Treatment
A total of 48 cases died in all State schools during the last statistical year; 27 males
and 21 females (Table 126). Wrentham State School showed 23 deaths, Fernald 13
and Belchertown 12.
Table 126. — Deaths in State Schools, 1939, by School: Numbers and Rates per 1,000
Cases Under Treatment l
State Schools
Number Under
Treatment
Deaths
Rate per 1,000
Under Treatment
M. F. T.
M.
F.
T.
M. F. T.
Belchertown
"Walter E. Fernald
Wrentham ....
576 800 1,376
1,195 838 2,033
908 1,186 2,094
4
8
15
8
5
8
12
13
23
6. 10. 8.
6. 5. 6.
16. 6. 10.
Total ....
2,679 2,824 5,503
27
21
48
10. 7. 8.
1 Cases under treatment are obtained by adding the resident population on September 30, 1939, and
discharges and deaths during the year 1939.
To make these figures comparable, we have calculated the death rates per 1,000 cases
under treatment during the year. The death rate for all schools taken together was 8;
10 deaths per 1,000 males and 7 deaths per 1,000 females under treatment. Wrentham
presents the highest death rate of 10. Belchertown is lower with a death rate of 8 and
• Fernald shows the low rate of 6. Sex differences in death rates are observed at the schools.
At Wrentham the rate for the males, 16, is nearly three times that for the females, 6.
At Fernald the male rate is 6, the female 5. At Belchertown the female rate, 10, is
greater than the male rate, 6.
Table 127. — Deaths at State Schools, 1939, by Mental Status and Age at Death: Rates
per 1,000 Cases Under Treatment of Same Mental Status and Age Groups
Age Distribution
Mental Status
Sex
All
0-9
10-19
20-29
30-39
40-49
50-59
60 Years
Ages
Years
Years
Years
Years
Years
Years
and Over
Idiot ....
M.
37.
92.
50.
15.
55.
F.
18.
67.
9.
9.
15.
-
-
_
T.
28.
80.
34.
12.
8.
20.
-
-
Imbecile
M.
6.
20.
5.
6.
5.
_
19.
_
F.
6.
14.
3.
-
14.
-
29.
-
T.
6.
17.
4.
3.
9.
-
25.
-
Moron
M.
.9
_
1.
_
_
_
_
_
F.
5.
-
-
2.
4.
15.
83.
-
T.
3.
-
1.
1.
2.
12.
60.
-
Not Mentally Defective
M.
F.
T.
17.
-
25.
-
-
-
-
-
7.
-
15.
-
-
-
-
-
Total ....
M.
10.
34.
10.
5.
2.
5.
12.
_
F.
7.
28.
2.
2.
9.
6.
43.
-
T.
8.
32.
7.
3.
6.
6.
30.
—
(See Table 277 for detail)
Mental Status of Deaths in State Schools, 1939, by Age: Death Rates
per 1,000 Cases under Treatment of Same Groups
Table 127 shows the age at death of all cases dying during 1939 and the death rates
per 1,000 cases under treatment of the same age and mental status groups. The age
group 0-9 years shows the high death rate of 32. The curve drops to the low of 3 in the
20-29 year group, rises in the next two groups and shows the high death rate of 30 in the
50-59 year group. Deaths in State schools follow the population in showing high rates
in the youngest and oldest age groups. The males show higher death rates in three of
the six age groups. In the general population, the death rates of the males are uniformly
higher than the females in all age groups. Graph 13 presents the death rates per 1,000
under treatment for each age group compared with the death rate in the general popula-
P.D. 117
263
tion during 1939. The mental defectives show vastly higher death rates than the general
population, particularly in the younger ages.
Graph 13. — Death Rates in Mental De-
ficiency (State Schools) Compared with
Death Rates in Massachusetts General
Population, 1939, by Ages
The death rates in the separate mental status groups are studied in Graph^l4.^The
idiots show the highest death rate of 28 per 1,000 under treatment during the year.
The not mentally defective are next with a death rate of 7, the imbeciles show a rate
of 6 and the morons, 3. The death rate of the imbeciles is twice that of the morons.
The rate for the idiots is nine times that of the morons. The males show higher death
rates in the idiots and not mentally defective and the females in the morons. |The rates
are the same in the imbecile group.
es
DEATH PATE PER
/OOO CASES UNDER
TREATMENT ~ OF
SAME MENTAL STATUS.
/D/Or MORON ALL
IMBECILE GROUPS
Graph 14. — Patients Dying in State Schools,
1939: Rates per 1,000 Cases under Treat-
ment of Same Mental Status
264
P.D. 117
Clinical Diagnosis op Deaths in State Schools, 1939, by Age:
Rates per 1,000 under Treatment
In Table 128 we observe the death rates in the various clinical diagnoses by age at
death. In the clinical groups the high death rate of 41 occurs in the group with epilepsy —
idiopathic. Second in order is with other organic nervous disease, 32, while the group
with mongolism is third, 29. The low death rates are observed in the post-infectional
group with 3 and undifferentiated and with congenital cerebral spastic infantile paralyses
with 4. The low death rate of 6 in the hereditary group (familial) is interesting from
the viewpoint of the possible survival of this type of patient. It will be recalled that
this group showed a high discharge rate. Most of the clinical groups tend to show high
death rates under 10 years of age.
Table 128. — Deaths at State Schools, 1939, by Clinical Diagnosis and Age at Death:
Rates per 1,000 Cases Under Treatment l of Same Clinical Group and Age
0-9
10-19
20-29
30-39
40-49
50-59
60 Years
Clinical Diagnoses
Total
Years
Years
Years
Years
Years
Years
and Over
Familial ....
6.
16.
5.
1.
6.
16.
52.
Mongolism ....
29.
38.
21.
41.
-
-
-
With developmental cranial
anomalies
25.
46.
15.
-
47.
-
—
-
With congenital cerebral
spastic infantile paralyses
4.
—
-
-
27.
-
-
—
Post-infectional .
3.
_
10.
-
-
—
-
-
Post-traumatic — natal .
8.
142.
-
-
_
-
-
-
With epilepsy — idiopathic
41.
_
64.
37.
55.
-
—
-
With endocrine disorders .
.25.
200.
28.
_
_
_
-
-
With other organic nervous
disease ....
32.
71.
—
_
_
—
—
—
Undifferentiated
4.
21.
3.
1.
2.
4.
22.
-
Other forms
9.
200.
-
-
-
-
64.
-
Total ....
8.
32.
7.
3.
6.
6.
30.
-
1 Cases under treatment include the resident population on September 30, 1939, plus discharges and
deaths during the year.
Economic Status op Deaths in State Schools, 1939, by Mental Status:
Death Rates per 1,000 under Treatment of Same Groups
Table 129 outlines the economic status of cases dying in State schools during 1939
and the death rates per thousand cases under treatment by mental status. In the totals
the dependent cases show the low death rate of 6 per 1,000, 4 for the males and 8 for the
females. The marginal group is next in order with a rate of nine, 11 for the males and 6
for the females. The comfortable group is third with the high death rate of 26 per 1,000,
36 for males and 14 for females. The males show lower death rates than females in the
dependent group only. It is to be noted that the cases of dependent economic status
show the lowest death rate. This contrasts sharply with the situation in mental diseases
(Table 59) where patients of dependent status have the highest death rate. The idiot
group places the low death rate in the dependent. In the imbeciles, morons and not
mentally defective the comfortable show no deaths.
Mental Status of Deaths in State Schools, 1939, by Age
Table 130 outlines the average age at death of patients dying in State schools during
1939 by mental status. The totals show an average age of 23.7 years at death for all
cases dying, 18.1 for the males and 30.8 for the females. The idiot group showed the
lowest average age at death, 15.1 years. The not mentally defective are next with an
average of 17.5 years and the imbeciles next with 28.5 years. The high average age of
41.2 years is found in the morons. The imbeciles and morons show a higher age at death
among the females.
Age of Deaths in State Schools, 1939, by School
Table 131 presents the age at death of all patients dying during 1939 by school. Of
the 48 deaths, 27 or 56% were under 20 years of age; 6 or 12% were between 20 and
29 years of age and 15 or 31 % were 30 years of age or over. The Wrentham State School
is presenting the larger number of deaths in the younger age groups due to the fact that
this school makes a general practice of accepting younger children. Wrentham presents
the youngest average age at death of 18 years, 14 years for the males and 27 years for
P.D. 117
265
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P.D. 117
the females. Belchertown is higher with an average of 24 years, 17 years for the males
and 28 years for the females. Fernald shows the highest average age at death, 31 years,
26 years for the males and 40 years for the females. All the schools show the females
with higher average ages at death than the males.
Table 131. — Age at Death of Patients who Died in State Schools, 1939, by School and Sex
Age at Death
Total
M.
Belchebtown
M.
F.
Walter E.
Fernald
M.
F.
Wrentham
M.
Under 5 years
5- 9 years
10-14 years
15-19 years
20-24 years
25-29 years
30-34 years
35-39 years
40-44 years
45-49 years
50-54 years
55-59 years
60 years and over
Total
Average Age
27
21
48
18.1 30.8 23.7
17.5 28.2 24.6
8 5 13
26.2 40.5 31.7
14.0 27.5 18.7
Length of School Stay of Deaths in State Schools, 1939, by Mental Status
Table 132 gives the length of school stay during this admission of cases dying in State
schools during 1939 by mental status. The totals reveal that patients dying had re-
mained within the institution an average of 10.9 years previous to death, 8.8 years
for the males and 13.7 years for the females. The shortest average length of stay, 7.3
years, occurs in the idiot group. The imbecile group shows an average residence before
death of 14.6 years and the moron group 15.6 years. In the idiot, imbecile and moron
groups the length of residence for the females is longer than for the males.
Table 132. — Length of School Residence during THIS Admission, Deaths in State
Schools, 1939, by Mental Status and Sex
Mental
Status
Number
Average Net Residence
IN Y EARS
M.
F.
T.
M.
F.
T
Idiot
17
8
1
1
7
7
7
24
15
8
1
7.0
12.9
7.5
7.5
7.9
16.5
16.7
7
14
15
7
3
6
6
Not Mentallj
r Defective
5
Total .
27
21
48
8.8
13.7
10
9
Table 133. — Length of School Residence during ALL Admissions, Deaths in State Schools,
1939, by Mental Status and Sex
Mental Status
Number
Average Net Residence
in Years
M.
F.
T.
M. F.
T.
Idiot
17
S
1
1
7
7
7
24
15
8
1
7.3 7.9
12.9 19.3
7.5 21.7
7.5
7.5
15.9
20.0
7.5
Total
27
21
48
9.0 16.3
12.2
(See Table 266 for detail)
Table 133 gives the length of school residence during all admissions of patients dying
in State Schools during 1939. Here we include all previous admissions. The 48 patients
dying had remained in residence a total of 12.2 years during all admissions previous to
death. The average for the males was 9.0 years and for the females 16.3 years. The
P.D. 117
267
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P.D. 117
morons show the longest school residence previous to death, 20.0 years, 7.5 years for
the males and 21.7 years for the females. The idiots and not mentally defective show
an average of 7.5 years. The imbeciles show a residence of 15.9 years, 12.9 years for
the males and 19.3 years for the females.
Cause of Death of Patients Dying in State Schools, 1939
by Clinical Diagnosis
Table 134 presents the causes of death of patients dying in State schools during 1939
in accordance with the main groupings of the International List, by clinical diagnosis.
The totals show that infectious diseases account for 27% of deaths, diseases of the
respiratory system for 25%, and congenital malformations for 16%. Over 60% of deaths
of mental defectives for 1939 fall in these three groups.
We shall not discuss the clinical groups having less than five deaths. Cases of hered-
itary mental defect (familial) and of mongolism show their highest percentage of deaths
among infectious diseases. The undifferentiated show a high percentage of deaths in
infectious diseases, diseases of the respiratory system and diseases of the circulatory
system. Comparative statistics between the clinical groups are unreliable due to the
small number of deaths for a single year.
Table 135. — Percentage Distribution of Caitses of Death and Mental Status of Patients
Who Died in State Schools during 1989 Compared with Causes of Death of
General Population, 1989
Causes of Death
Percentage
Total
Idiot
Imbecile
Moron
Not
Mentally
Defective
General
Popu-
lation
Infectious and Parasitic Diseases:
Influenza
Dysentery
Tuberculosis of the respiratory system
Disseminated tuberculosis ....
Syphilis
Cancer and Other Tumors:
Cancer and other malignant tumors
Non-malignant tumors
Rheumatic Diseases, Nutritional Diseases, Dis-
eases of the Endocrine Glands and Other
General Diseases:
Other general diseases
Diseases of the Nervous System and of the Organs
of Special Sense:
Meningitis
Other diseases of the nervous system .
Diseases of the Circulatory System:
Endocarditis
Myocarditis
Other diseases of the heart ....
Diseases of the Respiratory System:
Bronchopneumonia (including capillary
bronchitis)
Lobar pneumonia
Pleurisy
Asthma
Diseases of the Digestive System:
Other diseases of the digestive system
Congenital Malformations:
Congenital malformation (still-birth not in-
cluded)
Violent and Accidental Deaths:
Other accidents
All Other Causes
Total
2.0
2.0
18.7
2.0
2.0
2.0
2.0
2.0
4.1
10.4
2.0
2.0
16.6
4.1
2.0
2.0
2.0
16.6
2.0
100.0
4.1
8.3
4.1
4.1
4.1
20.8
8.3
4.1
25.0
40.0
6.6
6.6
6.6
20.0
6.6
13.3
12.5
12.5
37.5
12.5
12.5
100.0 100.0
100.0
100.0
.4
.02
2.9
.001
.4
13.7
.4
.007
3.3
11.9
10.9
3.7
2.4
.1
.1
.1
.3
47.6
(See Table 267 for detail)
Cause of Death of Patients Dying in State Schools, 1939
by Mental Status
Table 135 gives the percentage distribution of the causes of death in the various
mental status groups for 1939. In the totals, the four prominent causes of death are
tuberculosis of the respiratory system, 18.7%, bronchopneumonia and congenital mal-
formations 16.6% each and endocarditis, 10.4%. Adding all causes we find that failure
of the heart or respiratory system is linked with 57% of deaths in mental defectives.
P.D. 117
269
In the idiot group congenital malformation is first, with 25.0%, and bronchopneumonia
second, with 20.8%. In the imbecile group, tuberculosis of the respiratory system is
first with 40.0%, bronchopneumonia second with 20.0%. In the moron group, endo-
carditis was the chief cause of death with 37.5%. Tuberculosis and bronchopneumonia
are prominent in every mental status group.
Owing to the younger ages of the resident population of State schools and the older
ages of the general population, exact comparisons of causes of death are impossible.
However, we note certain diseases are very high in mental deficiency. The infectious
diseases account for 26% of State school deaths and 3% of deaths in the population.
Other significant differences are congenital malformations (State schools 16%, — popu-
lation .7%) and bronchopneumonia (State schools 16%, — population 3%).
Clinical Diagnosis of Deaths in State Schools, 1939, by Intelligence
Quotient
Table 136 outlines the average intelligence quotient of patients dying during 1939
divided into the various clinical groups. The average intelligence quotient of all patients
dying was .27, .22 for males and .35 for females. The average intelligence quotient of
discharges was .53 (Table 122). This shows that patients of higher intelligence are
discharged while those of lower intelligence contribute materially to the deaths. Con-
sidering only the groups with five or more cases, we note that the highest average I. Q.
at death occurs in the familial group with .49. The undifferentiated show an average
I. Q. of .20, the Mongols .18. It will be noted that the females present higher average
I. Q.'s in nearly all of the clinical groups.
Table 136. — Average Intelligence Quotient of Deaths in State Schools, 1939, by Clinical
Diagnosis and Sex
Clinical Diagnoses
Number
M.
F.
Average Intelligence
Quotient
M.
With congenital cerebral spastic infantile
paralyses
Post-traumatic — natal ....
With other organic nervous disease
With epilepsy — idiopathic ....
Mongolism .
Undifferentiated
With endocrine disorders ....
Post-infectional
With developmental cranial anomalies
Familial ........
Other forms
Total
-
.05
.05
05
-
.05
—
.15
.15
15
.20
.17
16
.25
.18
16
.31
.20
25
-
.25
-
.25
.25
31
.15
.27
42
.53
.49
-
.41
.41
27
.35
.27
(See Table 265 for detail)
Table 137. — Average Age of Deaths in State Schools, 1939, by Clinical Diagnosis and Sex
Average Age at
Death
Clinical Diagnoses
Number
IN
Years
M.
F.
T.
M.
F.
T.
Post-traumatic — natal ....
1
1
3.5
3.5
With other organic nervous disease
—
1
1
_
7.5
7.5
2
-
2
12.5
-
12.5
Mongolism .......
7
2
9
17.6
10.0
15.9
With developmental cranial anomalies
3
1
4
19.1
7.5
16.2
Post-infectional
—
1
1
—
17.5
17.5
With epilepsy — idiopathic ....
2
2
4
15.0
27.5
21.2
8
3
11
23.8
30.8
25.7
Familial
4
7
11
15.0
42.5
32.5
With congenital cerebral spastic infantile
paralyses
-
1
1
-
37.5
37.5
Other forms
-
3
3
-
37.8
37.8
Total
27
21
48
18.1
30.8
23.7
(See Table 264 for detail)
270
P.D. 117
Clinical Diagnosis of Deaths in State Schools, 1939, by Age
Table 137 presents the average age of patients dying in State schools by clinical
groupings. The average age at death was 23.7 years, 18.1 years for the males and 30.8
years for the females. The clinical groups showing the highest average ages at death
are with congenital cerebral spastic infantile paralyses, 37.5 years; familial, 32.5 years;
and undifferentiated, 25.7 years. At the other extreme we have the youngest ages at
death in the groups post-traumatic — natal, 3.5 years; with other organic nervous disease,
7.5 years; and endocrine disorders, 12.5 years.
Length of School Stay of Deaths in State Schools, 1939,
by Clinical Diagnosis
Table 138 gives the average length of school stay of the 1939 deaths, by clinical group-
ings. Cases dying in State schools during 1939 had remained an average of 10.9 years
previous to death, 8.8 years for the males and 13.7 years for the females. The longest
time in residence occurs in the groups with congenital cerebral spastic infantile paralyses,
27.5 years (one case) and undifferentiated 14.1 years. The shorter average lengths of
residence are seen in the groups with other organic nervous disease, 1.5 years, and post-
traumatic — natal, 2.5 years (one case each).
Table 138. — Average Length of Residence during THIS Admission of Patients Dying
in State Schools, 1939, by Clinical Diagnosis and Sex
Average Length
OP
Clinical Diagnoses
Number
Residence in Years
M.
F.
T.
M.
F.
T.
Familial
4
7
11
7.2
13.9
11.5
Mongolism
7
2
9
8.9
4 0
7.8
With developmental cranial anomalies
3
1
4
3 2
1.5
2.7
With congenital cerebral spastic infantile
paralyses
-
1
1
_
27.5
27.5
Post-infectional ....
_
1
1
_
12.5
12.5
Post-traumatic — natal ....
1
_
1
2.5
2.5
With epilepsy — idiopathic ....
2
2
4
7.5
20.0
13.7
With endocrine disorders ....
2
-
2
4.0
_
4.0
With other organic nervous disease
_
1
1
1.5
1.5
Undifferentiated
8
3
11
13.8
15.0
14.1
Other forms
-
3
3
.18.3
18.3
Total
27
21
48
8.8
13.7
10.9
Section K. Patients in Residence in State Schools for the
Mentally Deficient on September 30, 1939
The following section is devoted to a discussion of various factors in the resident
population and patients carried on the books of State schools on September 30, 1939.
Patients Resident in Public and Private Schools, 1904-1939
Table 139 outlines the patients in residence in public and private schools for mental
defectives on September 30 of each year from 1904 to 1939, inclusive. The rates per
hundred thousand population are given on the totals for all schools and for the State
schools. The numbers in all institutions for mental defectives increased from 927 in
1904 to 6,002 in 1939. The rate increased from 30 per hundred thousand of the popula-
tion in 1904 to 135 in 1939. This is an increase in rates of 350%. The total rates for the
males increased from 38 in 1904 to 146 in 1939, a rate increase of 284%. The females
increased from a rate of 23 in 1904 to 125 in 1939, an increase of 443%. The residence
rates for the males are higher than those for the females in all years of the period. How-
ever, the greater increases in the females are bringing about a balance between the sexes.
In 1904 the residence rate for the males was 65% higher than that for the females. In
1939 the residence rate was but 16% higher.
In considering the figures for State schools only, we note that the numbers increased
from 847 in 1904 to 5,238 in 1939. The resident rates have increased from 27 in 1904
to 118 in 1939. The males increased from a rate of 34 in 1904 to 118 in 1939, an increase
of 247%. The females increased from 21 in 1904 to 117 in 1939, an increase of 457%.
The males have shown higher residence rates in all years from 1904 to 1921, during the
year 1924, from 1928 to 1930 and from 1937 to 1939. The sexes showed the same rates
in the years 1922, 1923, 1926 and 1927. In 1925 and 1931 to 1936 the females have
P.D. 117
271
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273
shown higher residence rates. Marked increases have been made in bed provision for
females who are mentally defective.
It is interesting to recall that the resident rates for mental hospitals rose from 278
in 1904 to 500 in 1939, an increase of 79%. Over the same period, the resident rates
for State schools rose from 27 in 1904 to 118 in 1939, an increase of 337%. Residence
rates for mental diseases, ten times as high as the residence rates for mental defectives
in 1904, are only four times as high in 1939. Mental defect is gaining on mental diseases
as a major public health problem.
Mental Status of Patients Resident in State Schools, 1939,
by School
Table 140 presents the mental status of cases resident in the three State schools on
September 30, 1939, giving the percentage distributions. Considering the totals, the
idiot group makes up 15.2% of the resident population of all schools, 16.8% of the males
and 13.7% of the females. The imbecile group constitutes 42.1% of the resident popu-
lation, 44.4% of males and 40.0% of females. The morons comprise 40.4%, 36.5%
of males and 44.1% of females. The borderline group makes up 1.6%; with .4% for
the dull normals and .05% for the normals. The males exceed the females in the idiot,
imbecile, dull normal and normal classifications. The females offer a higher percentage
in the moron and borderline cases. Considering the schools separately, Wrentham
has the largest percentage in the idiot group, 17.1%. Wrentham and Fernald each
have 44.0% in the imbecile group. Belchertown has the largest proportion in the moron
group, 46.4%.
Length of School Stay of Patients in Residence, 1939,
by Age at Admission
Table 141 presents material on the age at admission and average length of school
stay of all patients in residence in State schools on September 30, 1939. For all patients
in residence, the average admission age was 13.7 years, 11.9 years for males and 15.3
years for females. The average length of time in residence for all patients within schools
was 11.6 years, 11.7 years for males and 11.5 years for females. A total of 1,572 patients
was admitted between the age of 5 and 9 years; 1,513 between the age of 10 and 14 years;
and 996 between the age of 15 and 19 years. Sixty-five per cent of the resident population
were admitted under the age of 15 years; 91 % under the age of 25 years and 97% under
35 years.
In comparing the sexes we note that the males are higher in the admission age groups
under 5 years, 5-9 years and 10-14 years, a total of 1,952 of the resident males being
admitted during these ages as compared with 1,490 of the females. However, in the
admission ages over 15 years we find the females predominating with 1,207 of the resident
females admitted in these age groups as compared with 589 of the males. Males tend
to be admitted under the age of 15 years (76%). Among the females only 55% fall in
the same ages. In the females the distribution of admission ages show a more uniform
spread throughout all ages.
Table 141. — Average Length of School Residence during This Admission, Patients
Resident in State Schools on September 30, 1989, by Age at Admission and Sex
Age at Admission
Number
Average Length of
Residence in Years
M. F. T.
M. F. T.
10-14 years
20-24 years
25-29 years
55-59 vears
60 years and over
198 159 357
957 615 1,572
797 716 1,513
371 625 996
108 269 377
49 138 187
22 89 111
22 46 68
7 22 29
5 9 14
2 7 9
2 2 4
1 1
8.8 8.0 8.4
11.2 11.1 HI
12.1 11.9 12.0
12.7 10.7 11.4
13.4 13.9 13.8
14 0 12.4 12.8
15.1 13.0 13.4
13.8 11.2 12.0
13.0 9.1 10.0
10.5 13.7 12.5
12.5 117 11.9
5.0 25.0 15.0
.1 - 1
Total
Average Admission Age and Average Length
of Residence ......
2,541 2,697 5,238
11.9 15.3 13.7
11.7 11.5 11.6
274
P.D. 117
In the second section of this table we note that all patients in residence have remained
there an average of 11.6 years. Those admitted under five years or over 60 years of
age have shown a short school stay of 8.4 and .1 years, respectively. The length of stay
increases gradually through the various age groups up to a school residence of 13.8
years in the age group 20-24 years. The 30-34 group also shows a long stay of 13.4
years. The males show a longer period of residence in State schools than females in ten
of the thirteen age periods. The length of stay is remarkably constant whatever the
age at admission.
Length of School Stay of Patients in Residence, 1939,
by Present Age
Table 142 presents the present age and average length of school stay of patients in
residence on September 30, 1939. The average present age of all resident cases was
24.9 years, 23.3 years for the males and 26.4 years for the females. The average length
of residence is 11.6 years, 11.7 years for the males and 11.5 years for the females. In
present age, the 15-19 year group leads with 1,030 cases. The 20-24 year group is second
with 831 cases; the 10-14 year group third with 827 cases; and the 25-29 year age group
fourth with 607 cases. It is interesting to note that we have a total of 256 cases, or 4%
in residence who are over 50 years of age. Sixty-seven are over 60 years of age and 4
are over 70. Only 51 of the resident cases are under 5 years of age. A total of 62% of
resident patients are between the ages of 10 and 30 years. From the age of 20 years
onward, the females offer the larger numbers except in the age group 55-59 years. Up
to 19 years and in the 55-59 year group, the males present the larger numbers.
Table 142. — Average Length of School Residence during This Admission, Patients
Resident in State Schools on September SO, 1939, by Present Age and Sex
Present Age
Number
Average Length of
Residence in Years
M. F. T.
M. F. T.
10-14 years
25-29 years
30-34 years
45-49 years . . .....
65-69 years
30 21 51
186 147 333
495 332 827
571 459 1,030
357 474 831
268 339 607
210 279 489
142 219 361
95 179 274
78 101 179
44 76 120
36 33 69
19 23 42
10 11 21
4 4
1.3 1.3 1.3
2.7 3.1 2.9
4.9 4.9 4.9
6.6 5.5 6.1
11.1 8.4 9.5
14.8 12.6 13.6
18.6 15.6 16.9
21.6 17.9 19.4
24.8 18.8 20.9
28.4 23.3 26.9
30.3 25.2 27.1
32.8 29.6 31.3
34.6 29.3 31.7
32.5 31.7 32.1
36.6 36.6
Total
Average Present Age and Average Length of
Residence
2,541 2,697 5.238
23.3 26.4 24.9
11.7 11.5 11.6
Viewing the average length of time in residence in the second section of Table 142
we note a positive correlation between age and length of residence. Patients under
5 years of age at the present time have remained in schools an average of 1.3 years.
Gradual increases occur until a school stay of over thirty-six years is seen in those who
are 70 years of age. Significant sex differences occur. In eleven of the fifteen age groups
the males have remained within school for longer periods than the females.
If we calculate the maintenance costs, interest on capital investment, depreciation,
etc., we come to an approximate figure of $450.00 per year for the State school care
of each mental defective. The 5,238 cases in residence in our State schools, with an
average stay of 11.6 years, have already cost the Commonwealth the sum of $27,342,360.
Mental Status of Patients Resident in State Schools, 1929-1939 :
Rates per 100,000 of Population Aged 0-44 Years
Table 143 gives the mental status of cases in residence in State schools on September
30 of each year from 1929 to 1939. In comparison with the State population aged 0-44
years (1930 census), the rate for the resident population of State schools increased
P.D. 117
275
from 126 per hundred thousand in 1929 to 168 in 1939, a rate increase of 33% in ten
years, or 3.3% per year. Among the idiots, the rate of 23 in 1929 approximates the
25 of 1939. The imbecile group increases from a low of 46 in 1929 to a high of 70 in
1939. The morons show a less precipitate increase, from 52 in 1929 to 68 in 1939. The
group not mentally defective shows uniformly low rates between 3 and 5 throughout
the years studied. Over the period 1929 to 1939, both the imbeciles and morons show
marked increases, while the idiot and not mentally defective groups show little change.
The accumulation of these various mental status groups within institutions measures,
to a certain degree, both the extent of community demand for provision and the possi-
bility of return to the community of the different types of patients. The idiot group
presents uniform residence rates throughout the ten year period. The imbecile and
moron groups both show conspicuous increases, the trend being more marked in the
imbeciles. The high death rate in the idiot group undoubtedly is a contributing factor
in keeping the residence rates on an even level. The moron group is showing a low death
rate, a high discharge rate and a moderate degree of accumulation. There is less opportun-
ity of placing the imbeciles in the community as parolees and this group is showing a
pronounced accumulation.
Table 143. — Mental Status of Cases Resident in State Schools on September 30, 1929-
1939: Numbers and Rates per 100,000 Population of State 0-44 Years of Age,
1930 Census
Not
Total
I
DIO
Imbecile
Moron
Mentally
Years
Defective
No. Rate
No.
Rat
e No.
Rate
No.
Rat
e No. Rate
1929 ....
3,941 126.
721
23
1,450
46.
1,622
52
148 4.
1930 .
4,159 133.
778
24
1,517
48.
1,737
55
127 4.
1931 .
4,412 141.
821
26
1,623
52.
1,816
58
152 4.
1932 .
4,566 146.
836
26
1,649
52.
1,920
61
161 5.
L933 .
4,771 153.
908
29
1,723
55.
1,961
62
179 5.
1934 .
4,933 158.
699
22
1,978
63.
2,103
67
153 4.
1935 .
5,009 160.
726
23
2,052
65.
2,089
67
142 4.
1936 .
5,133 164.
729
23
2,137
68.
2,141
68
126 4.
1937 .
5,244 168.
771
24
2,216
71.
2,144
68
113 3.
1938 .
5,225 167.
771
21
2,221
71.
'2,128
68
105 3.
1939 .
5,238 168.
798
25
2,208
70.
2,121
68
Ill 3.
Nativity of Patients Resident in State Schools, 1939,
by Admission Age
The average admission age of the resident population was 13.7 years, 11.9 years for
males and 15.3 years for females (Table 144). The native born of the resident population
were admitted 6.4 years younger than the foreign born, 13.5 years for the native born
and 19.9 years for the foreign born. The native born with both parents foreign born
were admitted at an average age of 13.9 years, 12.5 years for males and 15.1 years for
females. The native born with one parent foreign born and the other parent native
born show an average admission age of 13.4 years, 11.6 years for males and 15.1 years
for females. The native born of native parentage were admitted at an average of 13.0
years, 11.5 years for males and 14.5 years for females. It is seen that within the native
born classification, the three parentage groups show admission ages within a year of
each other.
Admission Age, Present Age and Length of School Stay of Resident
Population and Patients out on September 30, 1939
Table 145 gives us the average age at admission, the average present age and the
average length of school stay of patients in residence and patients out on visit, etc. on
September 30, 1939 for the three schools. The Fernald State School shows the highest
average present age of resident patients, 27.4 years. Belchertown is second with an
average of 24.6 years. Wrentham shows the youngest resident age, 22.6 years. All
show older present ages in females than in males. Turning to the third section of this
table, we note that the Fernald State School shows the longest average residence of
14.1 years, 22.4 years for the males and 13.9 years for the females. Wrentham is next
in order with 10.3 years for the resident cases, 9.2 years for the males and 11.2 years
for the females. Belchertown presents an average of 8.3 years, 8.7 years for the males
and 8.0 years for the females.
278
P.D. 117
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The cases out of institutions represent those who are on visit, parole, or escape or
in family care at the end of the year. The present age of these cases is 31.1 years, 27.7
years for the males and 33.3 years for the females. The males out of institutions are
four years older and the females seven years older than those resident within institutions.
The present ages of patients out in the community are 35.1 years for Belchertown, 31.5
years for Fernald and 27.0 years for Wrentham. These cases placed out of institutions
have been under the care of the three schools for 12.7 years, 12.2 years for the males
and 13.0 years for the females. They have been on the books 15.3 years for the Fernald
State School, 13.0 j^ears for Wrentham and 11.0 years for Belchertown.
Table 145. — Average Admission Age, Average Present Age and Average School
Residence of Patients Resident in State Schools, and Out on Visit, etc., on
September 30, 1939, by School and Sex
Cases in Residence
State
Schools
Average Age at
Admission
Average Present
Age
Average Length of
School Stay
M. F. T.
M.
F.
T.
M. F. T.
Belchertown .
Walter E. Fernald
Wrentham
14.5 17.6 16.3
12.0 15.3 13.3
10.3 13.7 12.3
23.2
26.1
19.5
25.6
29.2
24.9
24.6
27.4
22.6
8.7 8.0 8.3
22.4 13.9 14.1
9.2 11.2 10.3
Total
11.9 15.3 13.7
23.3
26.4
24.9
11.4 11.1 11.2
Cases Out of Institution
Belchertown .
Walter E. Fernald
Wrentham
20.9
13.7
12.4
25.6 24.1
18.7 16.2
15.1 14.0
32.3 36.5
26.6 36.4
24.9 28.5
35.1
31.5
27.0
11.4
12.9
12.5
10.9
17.7
13.4
11.0
15.3
13.0
Total
15.5
20.3 18.4
27.7 33.3
31.1
12.2
13.0
12.7
(See Tables 268 and 269 for detail)
Clinical Diagnosis of Resident Population, 1939, by School
Table 146 outlines the clinical classification of cases in residence at the three State
schools on September 30, 1939. Taking the groups in numerical order, we find that the
undifferentiated make up 46% of the resident population at Wrentham, 41% at Fernald
and 30% at Belchertown. The familial group is high at Belchertown with 49%; inter-
mediate at Wrentham with 30%; and low at Fernald with 15%. In the cases of mongol-
ism we find the largest percentage resident at Wrentham, 6%, with 4% at Fernald
and Belchertown. Post-infectional is high at Fernald, 6%, and low at Wrentham, 2%;
Belchertown has 5%.
Clinical Diagnosis in Admissions, Discharges, Deaths, 1939, and in the
Resident Population and Patients out on September 30, 1939
Table 147 presents a comparison of the clinical diagnoses in admissions, discharges,
deaths, resident population and patients out on visit, etc., for the year 1939. It gives
us an excellent opportunity to compare the trends in the various clinical groupings
for the five different classes of patients mentioned. By inspection, we may determine
the tendency of certain clinical groups to predominate in admissions, discharges, deaths
or in the resident population. We note that cases of mongolism made up 7% of admis-
sions, 3% of discharges, 18% of deaths and but 5% of the resident population. These
findings show at a glance that few mongolians are discharged, many of them die, and
few accumulate in the resident population. A similar situation is seen in the groups
with developmental cranial anomalies, with other organic nervous disease, with epilepsy — -
idiopathic and with endocrine disorders. In each of these groups high percentages
among the deaths are observed. Certain groups are high in discharges. The familial
group made up 26% of admissions, and showed an even higher proportion, 28%, of
discharges. This clinical group and the undifferentiated show this tendency to high
proportions among the discharges.
Certain of the clinical diagnoses show a tendency toward retention within State
schools. The familial, although showing a high proportion of discharges, 28%, also show
278
P.D. 117
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P.D. 117
279
a high proportion of cases in residence, 29%. In addition, they make up 41% of cases
out of the institution on visit, parole, etc. The undifferentiated, making up 48% of
admissions and 46% of discharges, are somewhat lower in the resident population, 40%,
and in the cases out on visit, parole, etc. 45%. The two clinical groups, familial and
undifferentiated make up 74% of the discharges and 87% of the cases out of State
schools. Of outstanding interest here is the showing made by the familial group. Super-
ficially, we would not expect the familial group, with its many supposed handicaps,
to constitute such a large proportion of the discharges or cases returned to the com-
munity.
Table 147. — Clinical Diagnosis in Admissions, Discharges and Deaths at State Schools,
1989, and in the Resident Population and Patients Out on Parole, etc., September
30, 1939: Percentages
PEECENr
rAGE DlSTI
UBUTION
Clinical Diagnoses
Cases Out
Admis-
Dis-
Cases in
(Visit,
sions
charges
Deaths
Resi-
dence
Parole,
etc.)
26.6
28.5
22.9
29.5
41.9
7.0
3.2
18.7
5.6
2.0
With developmental cranial anomalies
3.0
.9
8.3
2.9
1.0
With congenital cerebral spastic infantile paralyses
3.7
2.3
2.0
3.8
1.4
2.0
5.0
2.0
4.7
3.0
1.6
.4
2.0
2.1
1.2
1.0
.9
-
.5
.2
With epilepsy — symptomatic ....
-
—
si
.4
-
-
.9
1.7
.2
2.3
.9
4.1
1.4
2
-
-
-
.1
9
-
-
-
.03
-
With other organic nervous disease
1.6
.9
2.0
.5
-
48.3
46.0
22.9
40.7
45.3
2.3
9.6
6.2
5.5
3.2
Total
100.0
100.0
100.0
100.0
100.0
Table 148. — Average Intelligence Quotient of Patients Resident in State Schools on
September 30, 1939, by Age at Admission and Sex
Average
Intelligence
Ntjmbeb
Quotient
Age at Admission
M.
F.
T.
M.
F.
T.
Under 5 years ....
198
159
357
.29
.29
.29
5- 9 years .
957
615
1,572
.38
.35
.37
10-14 years
797
716
1,513
.43
.45
.44
15-19 years
371
625
996
.45
.52
.49
20-24 years
108
269
377
.43
.51
.48
25-29 years
49
138
187
.37
.47
.45
30-34 years
22
89
111
.41
.45
.44
35-39 years
22
46
68
.35
.44
.41
40-44 years
7
22
29
.32
.47
.43
45-49 years
o
9
14
.29
.38
.35
50-54 years
2
7
9
.35
.27
.29
55-59 years
o
9
4
.30
.45
.37
60 years and over
1
-
1
.05
-
.05
Total
2,541
2,697
5,238
.40
.44
.42
Intelligence Quotient of Patients Resident in State Schools, 1939,
by Admission Age
Table 148 shows that patients making up the resident population of State schools
on September 30, 1939 had an average intelligence quotient of .42, .40 for males and
.44 for females. Patients admitted between 15-19 years of age show the high average
I. Q. o" .49. Those admitted between the ages 20-24 years are second with an average
intelligence quotient of .48. Those admitted in the age groups 10-14, 25-29 and 30-34
years show an average intelligence quotient of .44, .45 and .44, respectively. The low
average intelligence quotients are seen in cases coming in at the extremes of the age
distribution. Cases admitted under the age of 5 years show an average I. Q. of .29.
280
P.D. 117
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P.D. 117
281
Present Age of Patients in Residence, 1939, by School
Table 149 and Graph 15 show the number and percentage distribution of present
ages of all patients in residence in State schools on September 30, 1939, by sex. The
age group presenting the highest percentage of resident cases is that of 15-19 years,
with 19.6%. Next in order are the age groups 10-14 years, with 15.7% and 20-24 years,
with 15.8%. We observe that 51% of patients in residence are between 10 and 24 years
of age. The percentages decrease gradually to the oldest age group. Patients in residence
50 years of age or older comprise 4.8%.
The males predominate in the ages up to 20 years. However, in the age groups over
20 years, the females are decidedly in the majority, with the exception of the group
55-59 years. The males have 50.2% under the age of 20 years and 49.0% 20 years or
older. The females have 35.4% under 20 years of age and 64.0% 20 years or older. These
sex differences are revealed in the average present ages. The females (26.4 years) aver-
age 3.1 years older than the males (23.3 years).
Present Age %
■ / /
Under 5yrs. ^ "
50mS4years
S5-59 years B!'?
MALE M 23.3yrs.
FEMALE^ 26.4yrs.
60yrs.&oyer
7.0
\J.3
Graph 15. — Present Age of Resident Population of
State Schools, September 30, 1939, by sex: Percentages
Belchertown shows 38% of the resident population under 20 years of age; Fernald,
38% and Wrentham, 49%. All three schools show larger proportions of males in the
younger ages, but this tendency is most marked at Wrentham.
Length of Stay in State Schools of Patients in Residence, 1939, by
Intelligence Quotient
Table 150 presents the length of school stay of patients in residence by intelligence
quotient. In the totals the I. Q. group .40-.49 presents the largest number of cases in
residence, 1,020. The I. Q. group .50-59 is second with 1,010 patients, the group .60-69
282 P.D. 117
third with 761 patients, the .30-39 group fourth with 656, and the .20-29 group fifth
with 617. Eight hundred sixty-one cases showed intelligence quotients between 0 and
.19. These numbers, of course, do not represent the occurrence of these various intel-
ligence quotient groupings in the community. We have a larger proportion of the existing
cases of lower mental grade admitted to State schools than of those of the higher mental
ratings. In addition, the patients of the lower mental ratings tend to be retained within
institutions. In the sexes, the males show the larger numbers of cases with I. Q.'s between
0 and .49. The females present larger numbers in the I. Q. groups from .50 on. These
differences are reflected in the total average I. Q., that of the females, .44, being four
points higher than that of the males, .40.
In reference to the length of school residence we observe that the I. Q. group .30-39
has remained longest in residence, 13.6 years. (The group .90 and over is excluded
because of small numbers.) Next we find the I. Q. groups .40-49 and .20-29 with
residences of 13.5 and 12.9 years, respectively. The groups from 0-.09 and from .10-19
have each been in residence an average of 12.3 years. In the .50-.59 I. Q. group there is
a decided decrease in length of residence to 10.5 years, a still further decrease in the
.60-.69 I. Q. group to 8.4 years, while the shortest length of residence is observed in the
I. Q. group .70-79 with 6.9 years. In the I. Q. groups 0-.09 and .10-.19 the females
show a longer average school stay than the males. In the I. Q. groups .20-29, .30-39
and .40-.49, the males show the longer school residence. The females show the longer
residence in the groups between .50 and .80. The longer stay of females in these latter
groups is much more marked than in the lower I. Q. groupings.
Population of Place of Residence, Patients within State Schools, 1939,
by Mental Status
Table 151 presents the population of place of residence at time of admission of all
cases within State schools on September 30, 1939, and the resident rates per 100,000
of the same population groups, by mental status.
In the total rates we note that the high incidence of resident patients occurs in those
coming from the villages, 0-2,499 population, a rate of 183 per 100,000. The rates then
gradually decrease from this high point to the low rate of 97 in the population groups
50,000-99,999 and 25,000-49,999. The rates then rise to a second high point of 141 in
the largest population units, 250,000 and over. Mental defectives making up the resident
population of state schools show the highest incidence in the small and large communities
with the low occurrence in the intermediate cities.
The idiot group presents its high rate of 23 in the largest cities and the next highest
rate of 21 in the villages (0-2,499). The imbeciles present the high rate in patients
from the villages, 72, and the largest cities are next with a, rate of 65. The morons present
their high rate of 85 in the villages but show their next highest rate of 58 in the next
population group, the towns. Their lowest rate of 35 occurs in the two groups 25,000-
49,999 and 50,000-99,999 population. Viewing this table as a whole, the moron and
not mentally defective groups tend to show higher rates in the villages and smaller
communities. However, the idiots tend to show higher proportions from the larger
communities.
Clinical Diagnosis of Patients Resident in State Schools, 1939,
by Intelligence Quotient
Table 152 shows the average intelligence quotient of patients resident in State schools
by clinical groupings. The undifferentiated group shows the largest numbers in residence
with 2,137 cases, 1,140 males and 997 females. The familial group is second with 1,547
cases, 602 males and 945 females, and mongolism is third with 294 cases, 159 males
and 135 females.
The average intelligence quotient of all resident cases is .42, .40 for the males and .44
for the females. This is intermediate between the average intelligence quotient of .53
for the discharges and .27 for cases dying during the year. The familial group shows
the highest 1. Q. of .50. The undifferentiated group is second with an average I. Q.
of .43. The group with familial amaurosis is third with an average I. Q. of .42. The
lower average intelligence quotients are noted in the groups with tuberous sclerosis,
.05; with epilepsy — idiopathic, .23 and mongolism,. 24. In eight of the clinical groups
the males present higher average intelligence than the females.
P.D. 117
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Table 152. — Average Intelligence Quotient of Patients Resident in State Schools,
September 30, 1939, by Clinical Diagnosis and Sex
Average
Intelligence
Clinical Diagnoses
Number
Quotient
M.
F.
T.
M.
F.
T.
602
945
1,547
.47
.51
.50
159
135
294
.23
.25
.24
With developmental cranial anomalies .
88
65
153
.32
.23
.28
With congenital cerebral spastic infantile
105
99
204
.32
.30
.31
126
121
247
.42
.41
.41
58
52
110
.31
.32
.31
Post-traumatic — post-natal ....
13
17
30
.41
.39
.40
With epilepsy — symptomatic
5
16
21
.19
.33
.29
With epilepsy — idiopathic ....
43
47
90
.25
.22
.23
With endocrine disorders ....
31
43
74
.40
.34
.36
6
3
9
.51
.25
.42
2
—
2
.05
-
.05
With other organic nervous disease
16
12
28
.33
.39
.36
1,140
997
2,137
.41
.45
.43
147
145
292
.41
.41
.41
Total
2,541
2,697
5,238
.40
.44
.42
(See Table 270 for detail)
Admission Ages and Present Ages of Patients Resident in State Schools,
1939, by Clinical Diagnosis
Table 153 gives the average admission age and the average present age of patients
in residence in State schools by clinical diagnoses. The resident population presents
an average present age of 24.9 years, 23.3 years for the males and 26.4 years for the
females. These same cases at the time of admission averaged 13.7 years with an average
of 11.9 years for the males and 15.3 years for the females. The highest average present
age is seen in the group with epilepsy — symptomatic, 32.8 years. These cases averaged
16.1 years at the time of admission. The group post-traumatic — post-natal has a present
age of 28.6 years. The admission age of this group was 13.1 years. The lowest average
present age is seen in other organic nervous disease, 14.9 years. These cases averaged
11.4 years of age at the time of admission. In the majority of the clinical groups the
females show a higher present age. However, in the groups developmental cranial
anomalies, familial amaurosis, epilepsy — symptomatic and endocrine disorders the males
show a higher present age.
Table 153. — Average Admission Age and Average Present Age of Patients Resident in
State Schools on September 30, 1939, by Clinical Diagnosis and Sex
Average
Average
Clinical Diagnoses
Admission Age
Present Age
M.
F.
T.
M.
F.
T.
11.6
16.0
14.3
21.3
26.9
24.7
9.5
10.3
9.9
16.5
17.3
16.9
With developmental cranial anomalies
10.0
8.7
9.5
19.4
17.4
18.5
With congenital cerebral spastic infantile
11.4
13.2
12.3
24.5
25.7
25.1
Post-infectional
11.6
13.9
12.7
24.0
26.6
25.3
10.6
13.7
12.1
20.7
24.4
22.5
Post-traumatic — post-natal ....
13.0
13.2
13.1
19.7
35.4
28.6
With epilepsy — symptomatic ....
9.7
18.1
16.1
33.3
32.7
32.8
With epilepsy — idiopathic ....
12.4
15.0
13.7
25.9
30.3
28.2
With endocrine disorders ....
12.4
13.6
13.1
24.0
23.7
23.8
13.3
11.1
12.6
33.3
18.8
28.5
With tuberous sclerosis
10.0
-
10.0
20.0
—
20.0
With other organic nervous disease
8.5
15.2
11.4
11.3
19.7
14.9
Undifferentiated
12.5
15.9
14.1
24.6
26.9
25.7
Other forms
14.2
17.7
16.0
31.5
34.9
33.1
11.9
15.3
13.7
23.3
26.4
24.9
Length of School Stay During this Admission, Patients Resident in State
Schools, 1939, by Clinicial Diagnosis
Table 154 presents the average length of stay during this admission of all patients
in residence in State schools by clinical diagnoses. The groups familial amaurosis, 18.6
years; epilepsy — symptomatic, 18.0 years and epilepsy — idiopathic, 14.6 years, show
P.D. 117
285
the longest periods of school residence. The shorter periods of school residence are
viewed in the groups organic nervous disease, 4.3 years ; mongolism, 7.5 years and develop-
mental cranial anomalies, 9.7 years. It will be noted that the males show a longer net
residence than the females in eight of the fifteen clinical groupings.
Table 154. — Average Net Residence during This Admission of Patients Resident in
State Schools on September SO, 1939, by Clinical Diagnosis and Sex
Average
Net
Clinical Diagnoses
Number
Residence iis
Years
M.
F.
T.
M.
F.
T.
602
945
1,547
9.1
11.0
10.6
159
135
294
7.2
7.8
7.5
With developmental cranial anomalies
88
65
153
10.1
9.1
9.7
With congenital cerebral spastic infantile
paralyses
105
99
204
13.3
12.6
12.9
126
121
247
12.3
13.3
12.8
58
52
110
11.8
11.2
11.5
Post-traumatic — post-natal ....
13
17
30
7.3
19.3
14.1
With epilepsy — symptomatic
5
16
21
23.4
16.3
18.0
With epilepsy — idiopathic ....
43
47
90
13.5
15.6
14.6
31
43
74
11.8
10.0
10.8
6
3
9
22.5
10.8
18.6
2
-
2
10.0
-
10.0
With other organic nervous disease .
16
12
28
3.3
5.7
4.3
1,140
997
2,137
12.3
11.2
11.8
147
145
292
17.2
17.2
17.2
2,697
5,238
11.7
11.5
11.6
(See Table 272 for detail)
Table 155. — County of Residence of Admissions, 1939, and Resident Population of
State Schools, September 30, 1939: Rates per 100,000 of Corresponding Counties,
State Population, 1939
Rate per
Rate per
Cases
in Residence
100,000
Cases Admitted
100,000
September 30,
1939
Population
During Year
2
Population
Counties
of Same
County '
of Same
County *
M.
F.
T.
M, F.
T.
Franklin
53
62
115
220.
7 8
15
28.
Hampshire
49
81
130
172.
4 5
9
11.
Barnstable .
20
35
55
137.
2
2
4.
Hampden
230
224
454
136.
10 33
43
12.
Berkshire
64
95
159
130.
8 15
23
18.
Worcester
317
318
635
127.
23 18
41
8.
Suffolk
583
619
1,202
127.
27 24
51
5.
Middlesex
549
536
1,085
110.
24 11
35
3.
Bristol
189
201
390
105.
9 15
24
6.
Plymouth
74
98
172
101.
7 6
13
7.
Essex .
257
248
505
99.
9 7
16
3.
Norfolk
145
166
311
92.
8 10
18
5.
Dukes
2
3
0
79.
2 -
2
31.
Nantucket
_
2
2
59.
- —
-
—
Non-residents
9
9
18
-
3 1
4
-
Total
2,541
2,697
5,238
118.
141 155
296
6.
(See Table 278 for detail)
1 Population of each county estimated for 1939.
2 Does not include transfers.
County of Residence at Time of Admission of Patients within State
Schools on September 30, 1939, and of Admissions, 1939: Rates
per 100,000 of State Population
Table 155 and Graph 16 give the county of residence for all admissions during 1939
and also for all cases in residence on September 30, 1939. The first section of this table
gives the counties of residence of all cases in residence in State schools on September
30, 1939, and also presents the rates per 100,000 of the population of these counties
as of the 1939 estimated population for each county. The counties having the highest
proportionate representation in our State schools are as follows: Franklin, with 220
persons in residence in State schools per 100,000 of the population of the county; Hamp-
286
P.D. 117
shire, 172; Barnstable, 137; Hampden, 136 and Berkshire, 130. Counties presenting
the lowest rates for patients in residence in State schools are: Nantucket, 59; Dukes,
79; Norfolk, 92 and Essex, 99. The rate for the entire State is 118 persons in residence
in State schools per 100,000 of the estimated population of the State for 1939. Here we
observe the tendency for patients from certain counties to be retained in the resident
population.
MENTAL DEFICIENCY-ALL ADMISSIONS- 1939
Graph 16. — County of Residence at Time of Admission, All
Admissions, 1939. and Resident Population in State Schools on
September 30, 1939: Rates per 100,000 Population
P.D. 117 287
In the second section of this table we have calculated rates for the number of persons
admitted to the State schools during 1939 per 100,000 population of the same county
of residence. Dukes, Franklin and Berkshire counties show the highest rates with 31,
28 and 18 persons, respectively, admitted to State schools during 1939 per 100,000 of
the population of these counties. Next in order are Hampden with 12 and Hampshire
with 11. The rate of admission for all counties combined is 6. This rate cannot be taken
as typical of the incidence of mental deficiency or the rate at which mental defectives
are coming to the attention of the authorities. This indicates simply the number of
cases of the greatest urgency that could be admitted to the institutions during the last
statistical year.
Graph 16 presents the patients admitted during 1939 and those resident in State
schools on September 30, 1939, outlined in rates per 100,000 of the population of the
same county. This displays graphically the counties having the largest representations
admitted to and resident within our State schools.
288
P.D. 117
Epilepsy — Non-Psychotic
Section L. General Discussion of Non-Psychotic Epileptic Patients
Under Care at the Monson State Hospital, 1939
For many years the statistics of the Monson State Hospital have been unsatisfactory
owing to the inevitable mixture of epileptics with psychoses and patients who have
epilepsy without an accompanying mental disorder. Some time ago the section on
convulsive disorders of the American Psychiatric Association prepared a separate classifi-
cation of diagnoses for epileptics without mental disorder. Other states used this classifi-
cation and it was deemed advisable that Massachusetts conform to this procedure so
that comparable statistics might be available. As a consequence, from 1937 on the
statistics for the Monson State Hospital have been divided into two sections. The first
section is based on the psychiatric classification and presents data on the epileptic
psychoses using the regular standard tables of the American Psychiatric Association.
These data were included in the regular statistics of mental hospitals as reported in a
preceding section, the Statistical Review of Mental Disorders. A second section is based
upon this new classification of non-psychotic convulsive disorders. These tables are
presented in the following section which is devoted to a statistical review of the epilepsies
"without mental disorder".
Patients under Care, September 30, 1939
Table 156 shows that at the end of the statistical year there were 1,071 patients on
the books of the Monson State Hospital falling in the category of non-psychotic epilep-
tics, 531 males and 540 females. Within the institution were a total of 1,004 patients,
495 males and 509 females.
Table 156. — Epileptics (Non-Psychotic) on Books at the Monson State Hospital on
September 30, 1939, by Sex
N
DMBE8
M.
F.
T.
495.
36
509
31
1,004
67
Total
531
540
1,071
Section M. Admissions of Non-Psychotic Epileptic Patients, 1939
Diagnosis of Non-Psychotic Epileptic Patients in First Admissions, 1939
For the purposes of this report the diagnoses determined by the American Psychiatric
Association are divided into two groups, symptomatic and idiopathic. Symptomatic,
in turn, has the sub-groups toxaemic-exogenous and toxaemic-endogenous and due to
brain disease. Table 157 demonstrates that the largest percentage of first admissions
fell in the group due to brain disease, a total of 53%. The idiopathic group is second
with 31%, followed by the toxaemic-endogenous with 12%. The toxaemic-exogenous
is low, with 1.5%. Males predominate in the due to brain disease. The females present
larger proportions in the other groups.
Table 157. — Diagnosis of First Admissions of Epileptics (Non-Psychotic), 1939, by Sex
Epileptic
Groups
Number
Percent
M.
F.
T.
M.
F.
T.
Symptomatic:
Toxaemic:
3
20
9
1
5
14
11
1
8
34
20
9.3
62.5
28.1
3.2
16.1
45.1
35.4
1.5
12.6
53.9
31.7
Total .
32
31
63
100.0
100.0
100.0
Nativity of First Admissions of Non-Psychotic Epileptic Patients, 1939
Table 158 shows that all but three of the 63 first admissions were native born. The
rate per 100,000 of the population under 25 years of age is 3 for all admissions, 2 for the
foreign born admissions and 3 for the native born. The native born of mixed parentage
P.D. 117
289
show a rate of 5 and the native born of native parentage a rate of 3, and those of foreign
parentage a rate of 1.
Table 158. — Nativity and Parentage of First Admissions of Epileptics (Non-Psychotic),
1939: Rate per 100,000 of Same Nativity Groups Under 24 Years of Age (1930 Census)
Nativity
Number
Rate
3
60
12
17
28
3
3
Foreign Parentage .
Unknown Parentage
1.
5.
3.
Total
63
3
Age of First Admissions of Non-Psychotic Epileptic Patients, 1939
Table 159 compares the ages of first admissions with epilepsy with corresponding age
groups in the general population. The males and females each show a rate of 1 per
100,000 admitted because of epilepsy. Within the individual age groups those under
20 years are admitting the largest proportion of cases with the highest rate, 5, in the
group under 5 years. Rate of 2, 3 and 2 follow for the age groups 5-9 years, 10-14 years
and 15-19 years, respectively. The rates drop in the older age groups.
■Table 159. — Age of First Admissions of Epileptics (Non-Psychotic), 1939, by Sex:
Rate per 100,000 of Corresponding Population (1930 Census)
Age Group
Number
Rate
M. F. T.
M. F. T.
15-19 years .........
20-24 years
25-29 years
30-34 years
35-39 years .........
8 11 19
7 4 11
6 7 13
5 5 10
2 2
2 2
1 2 3
1 1
1 1
1 1
4. 6. 5.
3. 2. 2.
3. 3. 3.
2. 2. 2.
1. .5
1. - .6
.6 1. .9
.6 - .2
.7 - .3
.8 - .4
Total
32 31 63
1. 1. 1.
(See Table 166 for detail)
Section N. Discharges to the Community of Non-Psychotic Epileptic
Patients, 1939
Condition on Discharge of Patients Returned to the Community, 1939,
by Diagnosis
Table 160 shows that of the 28 patients returned to the community during 1939, all
were unimproved. A division by diagnosis places 1 patient in the toxaemic-exogenous
group, 6 patients in the toxaemic-endogenous group, 10 in the classification due to brain
disease and 11 in the idiopathic group.
Length of Hospital Stay During the Present Admission Non-Psychotic
Epileptic Patients Discharged During 1939
Table 161 presents the distribution of length of hospital stay during the present admis-
sion of the patients returned to the community during 1939. The 17 first admissions
discharged had an average institution life of 2.0 years. The 11 readmissions discharged
stayed an average of 1.4 years during their most recent admission, a shorter time than
the first admissions. Twenty-three per cent of the first admissions were in the hospitals
1 to 3 months and 64% stayed less than a year. Of the readmissions, 36% stayed for
one year, 27% for two years.
290
P.D. 117
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P.D. 117
291
Section O. Deaths of Non-Psychotic Epileptic Patients, 1939
During 1939 there was a total of 41 deaths among the non-psychotic epileptic patients,
an increase of 57% from the 26 deaths during 1938.
Duration of Hospital Life of Non-Psychotic Epileptic Patients Dying
1938 and 1939
Table 162 shows that the total duration of institutional life of patients dying during
1939 was 10.0 years. This was somewhat longer than the same average of 9.1 for the
year 1938. In 1939 a total of 6 deaths, or 14% of the total, occurred under one year.
In 1938, 19% of the total died after a hospital stay of under one year. In 1939, 8 patients,
or 19% of the deaths and in 1938, 3 patients, or 11%, had spent 20 years or more of
their lives within institutions. ,
Table 162. — Total Duration of Institutional Life during All Admissions of Epileptics
(Non-Psychotic) Who Died in 1938 and 1939: Percentage Distribution
Duration of Institutional Life
Number
Percent
Number
Percent
Less than 1 month .
1- 3 months ....
4- 7 months ....
8-11 months ....
1 year
2 years
3 years
4 years
5- 9 years ....
10-14 years ....
15-19 years ....
20 years and over
Total
Average Length of Residence
2 4
4^8
4.8
2.4
7.3
7.3
4.8
4.8
19.5
7.3
14.6
19.5
3.8
7.6
3.8
3.8
7.6
7.6
3.8
23.0
11.5
15.3
11.5
100.0
10.04
26
9.17
100.0
(See Table 173 for detail)
Causes of Death in Non-Psychotic Epileptic Patients Dying,
1938 and 1939
In Table 163 epilepsy is given as a cause of death in 36% of patients dying during
1939. Bronchopneumonia and other respiratory diseases are very high, being the cause
in 26% of deaths. Tuberculosis of the respiratory system and accidental suffocation
each account for 9% of the deaths. In the preceding year, 1938, epilepsy was responsible
for 38% of deaths and bronchopneumonia and other respiratory diseases for 34%.
Excluding epilepsy as a cause of death, diseases of the respiratory system of one type or
another are prominent in the causes of death among the epileptics.
Table 163. — Causes of Death of Epileptics {Non-Psychotic) Dying in 1938 and 1939
1939
1938
Causes of Death
Number
Percent
Number
Percent
Tuberculosis of the respiratory system
4
9.7
1
3.8
15
36.5
10
38.5
—
-
1
3.8
Bronchopneumonia and other respiratory diseases
11
26.8
9
34.6
1
2.4
1
3.8
Other diseases of the stomach ....
-
—
1
3.8
-
-
1
3.8
-
-
2
7.7
1
2.4
_
1
2.4
_
_
1
2.4
_
_
Diseases of the nasal fossae and annexae
1
2.4
_
_
1
2.4
_
_
1
2.4
_
_
Accidental mechanical suffocation
4
9.7
-
-
Total
41
100.0
26
100.0
(See Table 171 for detail)
292
P.D. 117
Section P. Non-Psychotic Epileptic Patients in Residence in the
Monson State Hospital on September 30, 1939
On September 30, 1939, there were 701 first admissions classified as non-psychotic
epileptics residents at the Monson State Hospital, 353 males and 348 females. Read-
missions in residence totaled 303 patients, 142 males and 161 females.
Length of Hospital Stay During the Present Admission of All Non-Psychotic
Epileptic Patients in Residencc, September 30, 1939, by Diagnosis
Table 164 shows that of the 701 first admissions in residence, 1 was diagnosed as
toxaemic-exogenous, 167 were toxaemic-endogenous, 255 due to brain disease and 278
idiopathic. The males predominate in the symptomatic, while the females present a
high number in the idiopathic group. In the readmissions in residence, 3 were diagnosed
as toxaemic-exogenous, 84 as toxaemic-endogenous, and 64 as due to brain disease. One
hundred fifty-two placed in the idiopathic group.
The first admissions in residence had remained in hospital a total of 8.9 years at the
end of 1939, an average of 8.1 years for the males and 9.8 years for the females. The
toxaemic-endogenous group had remained the longest with an average of 10.8 years,
and the group due to brain disease the shortest time with 5.9 years.
Table 164. — Average Length of Hospital Residence during the Present Admission of All
Epileptics (Non-Psychotic) , First and Readmissions in Residence on September
30, 1939, by Diagnosis and Sex
First Admissions
Epileptic
Gpotjps
Number
Average Net Hospital
Residence in Years
M.
F.
T.
M.
F.
T.
Symptomatic
Toxaemic:
1
84
139
129
83
116
149
1
167
255
278
7.5
10.8
5.2
9.4
10.7
6.7
11.8
7 5
Due to brain disease
10.8
5.9
10 7
Total ....
353
348
701
8.1
9.8
8 9
Readmissions
Symptomatic
Toxaemic:
3
42
35
62
42
29
90
3
84
64
152
6.8
13.9
9.9
12.1
12.6
7.2
12.6
6 8
13 3
8.7
12.4
142
161
303
12.0
11.6
11.8
The readmissions in residence had remained an average of 11.8 years, 12.0 years for
the males and 11.6 years for the females. In readmissions, also, the toxaemic-endogenous
group had remained longest, an average of 13.3 years. The toxaemic-exogenous had
remained the shortest time, 6.8 years.
P.D. 117
293
Table 165. — Movement of Population of Epileptics (Non-Psychotic), for the Year Ended
September 30, 1939, by Sex
Total
Regular Court
Commitment
Obser-
vation
Voluntary
M.
F.
T.
M.
F.
T.
M
F. T.
M.
F.
T.
Patients on books of institution Sep-
tember 30, 1938 ....
Admissions during year:
First admissions ....
528
32
7
533
31
9
1,061
63
16
181
10
5
203
10
4
384
20
9
1
- 1
347
21
2
330
21
5
677
42
7
Total admissions ....
Transfers from other mental hos-
39
40
1
79
1
15
14
1
29
1
1
- 1
23
26
49
Total received during year .
39
41
80
15
15
30
1
- 1
23
26
49
Total on books during year
567
574
1,141
196
218
414
1
- 1
370
356
726
Discharged from books during year:
As improved
As unimproved
As without psychosis
17
11
28
5
5
10
1
- 1
11
6
17
Total discharged to community
Transferred to other mental hospitals
Died during year ....
17
19
11
22
28
41
5
7
5
8
10
15
1
- 1
11
12
6
14
17
26
Total discharged, transferred and died
during year
36
33
69
12
13
25
1
- 1
23
20
43
Patients remaining on books of hospi-
tal at end of year:
On visit or otherwise absent .
495
36
509
31
1,004
67
171
13
194
11
365
24
-
- -
324
23
315
20
639
43
Total
531
540
1,071
184
205
389
-
- -
347
335
682
Note: During the year one male was changed from the epileptic classification to the psychiatric classi-
fication.
Table 166.
Age of First Admissions, of Epileptics (Non-Psychotic), 1939, by Diagnosis
and Sex
Age Groups
M. F. T.
Symptomatic
Toxaemic
Exogenous
M. F. T.
Endogenous
M. F. T.
Due to
Brain
Disease
M. F. T.
Idiopathic
M. F. T.
Under 5 years
5- 9 years
10-14 years
15-19 years
20-24 years
25-29 years
30-34 years
35-39 years
40-44 years
45-49 years
50-54 years
55-59 years
60 years and over
Total .
- 2
1
1 1
2 -
8 7 15
5 3 8
3 3 6
2 13
20 14 34
294
P.D. 117
Table 167. — Degree of Education of First Admissions, of Epileptics (Non-Psychotic)
1939, by Sex
Degree of Education
Patients 16 Years
and Under
Degree of Education
Patients 17 Years
and Over
M. F. T.
M. F. T.
Less than first grade
First grade
Second grade
Third grade
Fourth grade
Fifth grade
Sixth or higher
16 18 34
2 2 4
2 2
4-4
1 - 1
Illiterate
Reads only
Reads and writes
Common School
High School
College
Unknown .
1 2 3
8 7 15
Total .
23 22 45
Total .
9 9 18
Table 168. — Population of Place of Residence of First Admissions of Epileptics (Non-
Psychotic), 1989, by Diagnosis and Sex
Total
Symptomatic
Population
Toxa
EMIC
Due to
Brain
Disease
Idiopathic
Exogenous
Endogenous
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
1 - 1
7 5 12
5 7 12
7 6 13
3 2 5
5 8 13
4 3 7
1 - 1
2 2 4
2 3 5
2 2 4
12 3
- 2 2
1 - 1
2,500- 9,999
10,000- 24,999
25,000- 49,999
50,000- 99,999
100,000-249,999
500,000 plus
5 3 8
3 3 6
4 4 8
2-2
4 2 6
2 2 4
- 1 1
- 1 1
1 - 1
1 3 4
1 1 2
32 31 63
1 1
3 5 8
20 14 34
9 11 20
Table 169. — Economic Status of First Admissions of Epileptics (Non-Psychotic) , 1939,
by Diagnosis and Sex
Total
Symptomatic
Economic Status
1 OXAEMIC
Due to
Brain
Disease
Idiopathic
Exogenous
Endogenous
M. F.
T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
13 17
17 14
2 -
30
31
2
- 1 1
2 3 5
1 2 3
7 7 14
11 7 18
2-2
4 7 11
5 4 9
32 31
63
1 1
3 5 8
20 14 34
9 11 20
P.D. 117
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296 P.D. 117
Table 171. — Causes of Death in Epileptics (Non-Psychotic) Dying, 1939, by Diagnosis
and Sex
Total
Symptomatic
Idi
Toxaemic
Due to
OPATHIC
Causes of Death
Bbain
Disease
Exogenous
Endogenous
M.
F.
T.
M.
F. T.
M. F. T.
M. F. T.
M.
F. T.
Tuberculosis of the respiratory sys-
2
2
4
—
— —
1 - 1
— — —
1
2 3
Other infectious diseases .
-
1
1
1 1
—
— —
Tumor (non-cancerous)
-
1
1
-
- -
1 1
Cerebral hemorrhage
-
1
1
1 1
Epilepsy
9
ri
15
-
- -
2 1 3
2 2 4
0
3 8
Diseases of the nasal fossae and an-
-
1
1
1 1
Bronchopneumonia (including capil-
lary bronchitis) ....
4
7
11
-
- -
1 1 2
3 3 6
-
3 3
Lobar pneumonia ....
1
-
1
1
1
Pleurisy ......
-
1
1
1 1
-
- —
Diarrhea and enteritis
—
1
1
1 1
Accidental mechanical suffocation
3
1
4
1 - 1
2
1 3
Total
19
22
41
-
- -
4 3 7
6 7 13
9
12 21
Table 172. — Age of Epileptics (Non-Psychotic) at Time of Death, 1939, by Diagnosis
and Sex
Age Groups
Total
Symptomatic
Toxaemic
Exogenous
M. F.. T.
Endogenous
M.
Due to
Brain
Disease
M. F. T.
Idiopathic
M. F. T.
Under 5 years
5- 9 years
10-14 years
15-19 years
20-24 years
25-29 years
30-34 years
35-39 years
40-44 years
45-49 years
50-54 years
55-59 years
60-64 years
65-69 years
70 years and over
Total .
19 22 41
12 21
Table 173. — Total Net Duration of Hospital Life during All Admissions of Epileptics
(Non-Psychotic) Dying, 1939, by Diagnosis and Sex
Duration of Institutional Life
M. F. T.
Symptomatic
Toxaemic
Exogenous
M. F. T.
Endogenous
M. F. T.
Due to
Brain
Disease
T.
Idiopathic
M. F. T.
Less than 1 month
1- 3 months
4— 7 months
8-11 months
1 year
2 years
3 years
4 years
5- 9 years
10-14 years
15-19 years
20 years and over
Total .
1
1
1
1
1 1
1 2
19 22 41
7 13 9 12 21
P.D. 117 21)7
APPENDIX
Detailed Tables
A. Mental Disorders (Tables 174-245)
B. Mental Deficiency (Tables 246-278)
298
P.D. 117
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9 9
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23.42 - 23.42
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646 612 1,258
16 21 37
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2 2
1.18 - 1.18
1 12 13
1.24 12.07 13.31
22 1 23
22 1 23
23.30 1.00 24.30
22.08 1.00 23.08
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18 29 47
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855.55 743.68 1,599.23
821.10 600.41 1,421.51
697 464 1,161
25 38 63
20.49 34.78 55.27
5 5
2 . 58 .01 2 . 59
15 107 122
11.38 108.48 119.86
13 - 13
12 - 12
10.65 - 10.65
10.63 - 10.63
775 542 1,317
30 56 86
15 7 22
2 3 5
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717.13 831.34 1,548.47
661.25 773.26 1,434.51
600 669 1,269
50 63 113
52.15 53.32 105.47
2 1 3
3.73 .42 4.15
3 3
4.34 4.34
43 43
43 - 43
47.50 - 47.50
40.91 - 40.91
596 628 1,224
55 114 169
1
1
Total number of patients actu-
ally in hospitals September 30,
1939
Averages
Daily average population (in-
cluding patients on eScape, on
visit and in family care)
Daily average population (ex-
cluding patients on escape, on
visit and in family care)
Rated capacity of the hospitals
Patients on visit September 30,
1939 •
Daily average number of pa-
tients on visit during year .
Patients on escape September
30, 1939 ....
Daily average number of pa-
tients on escape during year
Patients boarded out September
30, 1939 ....
Daily average number of pa-
tients boarded out during year
Ex-service men on books Sep-
tember 30, 1939 .
Ex-service men in residence Sep-
tember 30, 1939 .
Daily average number on books
during year ....
Daily average number actually
in hospital during year
Support of patient population
(exclusiye of patients on es-
cape and on visit)
Supported by State
Reimbursing
Ex-service patients for whom
pay is received from the
Federal Government
Non-insane patients actually in
hospitals September 30, 1939
Mentally defective
Epileptic ....
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331
Table 192. — Race of First Admissions and Readmissions to Hospitals for
Mental Disorders, 1939, by Sex
First
Admissions
Readmissions
Total
Race
M.
F.
T.
M.
F.
T.
M.
F.
T.
African (black)
78
47
125
22
15
37
100
62
162
African (part black)
5
2
7
1
4
5
6
6
12
American Indian
1
—
1
—
—
—
1
—
1
Armenian .
10
11
21
2
1
3
12
12
24
Chinese
12
-
12
3
-
3
15
-
15
Dutch and Flemish
5
-
5
4
2
6
9
2
11
English
443
359
802
152
156
308
595
515
1,110
Finnish
30
11
41
10
14
24
40
25
65
French
185
144
329
50
49
99
235
193
428
German
45
39
84
16
12
28
61
51
112
Greek
23
12
35
5
9
14
28
21
49
Hebrew
68
88
156
68
79
147
136
167
303
Irish .
595
461
1,056
230
174
404
825
635
1,460
Italian '
194
133
327
68
57
125
262
190
452
Lithuanian
41
20
61
10
9
19
51
29
SO
Magyar
2
-
2
-
-
-
2
-
2
Mexican
—
1
1
-
—
-
-
1
1
Portuguese
56
37
93
20
18
38
76
55
131
Scandinavian 2 .
50
27
77
18
18
36
68
45
113
Scotch
33
36
69
12
10
22
45
46
91
Slavonic 3 .
96
90
186
25
31
56
121
121
242
Spanish
1
1
2
-
1
1
1
2
3
Syrian
4
7
11
2
5
7
6
12
18
Turkish
4
—
4
-
-
-
4
—
4
Welsh _ .
2
1
3
-
-
-
2
1
3
West Indian 4 .
3
1
4
—
—
-
3
1
4
Other specific races
5
4
9
5
1
6
10
5
15
Race Unknown.
60
63
123
13
7
20
73
70
143
Mixed
672
551
1,223
282
240
522
954
791
1,745
Total .
2,723
2,146
4,869
1,018
912
1,930
3,741
3,058
6,799
1 Includes "North" and "South".
2 Includes Norwegians, Danes and Swedes.
3 Includes Bohemians, Bosnians, Croatians, Dalmatians, Herzegovinians, Montenegrins, Moravians,
Pohsh, Russians, Ruthenians, Servians, Slovaks, Slovenians.
4 Except Cuba.
338
P.D. 117
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her types
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P.D. 117
Table 245. — County and City or Town of Residence of Admissions and Cases in
Residence in Hospital for Mental Disorders on September 30, 1989, by Sex
Admissions
Resideni
Population
1939
Sept
30, 193J
County and City or Town
M.
F.
T.
M.
F.
T.
Barnstable
9
8
17
20
17
37
o
-
5
6
3
9
-
1
1
1
1
2
2
2
4
5
4
9
2
2
4
7
5
12
1
-
1
2
_
2
5
1
6
9
10
19
2
5
7
10
14
24
1
-
1
1
2
3
1
3
4
6
12
18
1
1
2
0
4
9
-
_
_
3
3
6
_
_
_
-
3
3
Wellfleet
_
_
_
3
4
7
1
1
2
-
-
Total
30
24
54
78
82
160
Berkshire
4
0
9
36
29
65
Alford
-
1
1
-
_
_
1
1
2
2
1
3
1
_
1
6
1
7
Clarksburg
-
-
-
1
2
3
—
1
1
10
11
21
-
-
-
2
2
4
Florida
—
-
-
1
1
2
Great Barrington
7
6
13
13
17
30
-
-
_
2
1
3
1
1
2
3
2
5
Lee '
3
1
4
13
8
21
-
1
1
11
12
23
Monterey
1
-
1
1
1
2
1
-
1
1
1
9
New Marlborough
-
9
9
4
1
5
North Adams
14
-
14
74
53
127
Otis
_
-
_
3
2
5
Pittsfield
32
20
52
140
98
238
-
-
-
1
1
2
-
2
2
3
3
6
1
_
1
2
2
4
Sheffield
-
1
1
5
3
8
6
1
7
5
6
11
Tyringham
-
-
-
1
-
1
1
-
1
2
—
2
-
—
-
4
1
5
2
4
6
9
15
24
-
-
-
2
2
4
Total
75
54
129
357
276
633
Bristol
-
2
2
8
7
15
21
10
31
79
66
145
-
-
-
1
-
1
2
1
3
14
17
31
2
1
3
8
7
15
3
1
4
8
12
20
10
5
15
22
29
51
Fall River
57
50
107
313
308
621
5
2
7
4
3
7
6
4
10
14
29
43
72
78
150
337
321
658
7
6
13
28
29
57
-
3
3
5
6
11
-
2
2
4
5
9
1
2
3
9
3
12
5
2
7
11
7
18
4
2
6
5
12
17
-
1
1
8
3
11
30
21
51
97
101
198
-
3
3
9
5
14
Total
225
196
421
984
970
1,954
P.D. 117
421
Table 245. — County and City or Town of Residence of Admissions and Cases in
Residence in Hospitals for Mental Disorders on September SO, 1939, by
Sex — Continued
County and City or Town
Admissions
1939
M.
F.
T.
Resident Population
Sept. 30, 1939
M.
Dukes
Chilmark
Edgartown ....
Gay Head ....
Gosnold
Oak Bluffs ....
Tisbury
Total ....
Essex
Amesbury ....
Andover
Beverly
Boxford . . .
Danvers
Essex
Georgetown ....
Gloucester ....
Groveland ....
Hamilton
Haverhill
Ipswich
Lawrence
Lynn
Lynnfield
Manchester ....
Marblehead ....
Merrimac ....
Methuen
Middleton ....
Nahant
Newbury
Newburyport ....
North Andover
Peabody
Rockport
Rowley
Salem
Salisbury
Saugus
Swampscott ....
Topsfield
Wenham
West Newbury
Total ....
Franklin
Ash field .....
Bernardston *.
Buckland
Charlemont ....
Colrain
Conway
Deerfield
Erving
Gill
Greenfield ....
Hawley
Heath
Leverett
Leydon
Monroe . . . . .
Montague ....
Northfield ....
Orange
Rowe
Shelbourne ....
Sunderland ....
Warwick
Wendell
Whately
Total ....
7
13
22
11
4
21
2
1
30
2
40
106
4
4
21
1
3
1
1
15
1
2
23
7
38
81
2
10
3
14
2
3
5
2
7
6
1
20
368 292
11
17
43
1
14
5
1
36
3
3
53
9
78
187
2
18
5
21
2
1
4
17
11
23
9
1
55
2
13
14
1
26
22
49
4
26
6
8
69
5
5
158
10
279
329
6
1
18
7
33
1
2
1
65
12
71
9
4
144
4
30
14
3
1
3
19
30
61
3
21
3
18
46
2
4
125
21
243
284
2
6
19
4
38
3
4
8
37
16
46
16
2
116
2
29
24
1
2
1,425 1,257
1
9
2
3
2
15
1
1
49
1
1
3
3
1
26
7
18
2
3
1
4
1
1
5
1
24
2
1
22
7
14
2
8
2
1
1
35
45
52
110
7
47
9
26
115
7
9
283
31
522
613
8
7
37
11
71
4
6
9
102
28
117
25
6
260
6
59
38
4
3
5
2,682
4
3
20
1
2
73
3
2
3
4
1
48
14
32
4
16
3
1
3
5
29
22
160
422
P.D. 1
Table 245. — County and City or Town of Residence of Admissions and Cases in
Residence in Hospitals for Mental Disorders on September SO, 1939, by
Sex — Continued
Admissions
Resident Population
1939
Sept. 30. 19
County and City or Town
M.
F.
T.
M.
F.
T.
Hampden
Agawam
1
3
4
12
16
28
Blandford ....
1
1
2
Brimfield
_
1
1
1
2
1
6
5
11
16
24
40
128
109
237
East Longmeadow
1
5
6
11
Granville ....
1
_
3
1
_
4
5
9
36
30
66
193
184
377
Longmeadow .
1
3
7
10
4
7
11
18
16
34
Monson ....
9
13
22
Montgomery .
_
_
_
1
26
27
6
7
13
30
29
59
1
2
3
Southwick
_
2
2
8
8
16
Springfield ....
83
87
170
437
473
910
_.
3
3
Wales ....
2
2
_
Westfield ....
12
14
26
56
67
123
West Springfield ....
7
3
10
24
31
55
Wilbraham
1
1
6
8
14
Total
173
178
351
946
1,010
1,956
Hampshire
Amherst
4
6
10
20
25
45
Belchertown
3
1
4
20
9
29 '
Chesterfield
1
1
2
3
3
Cummington .
_
2
5
7 '
Easthampton .
4
8
12
34
33
67
Goshen
_
_
_
1
1
Granby
1
_
1
3
2
5
Hadley
1
_
1
16
4
20 j
Hatfield .
_
2
2
6
7
13
Huntington
1
_
1
1
4
5
Middlefield
_
1
1
Northampton .
24
24
48
92
55
147
Pelham
2
2
1
1
2
Plainfield .
_
_
2
2
Quabbin Reservoir
N \
1
_
1
4
2
6
Southampton .
1
1
2
4
4
8
South Hadley .
3
2
5
17
15
32
Ware
6
2
8
27
18
45
Westhampton .
1
-
1
Williamsburg .
2
_
2
8
6
14
Worthington .
-
-
-
1
-
1
Total . . ... . . .
54
47
101
263
191
454
Middlesex
Acton
2
1
3
7
10
17
Arlington
34
21
55
73
87
160
Ashby
3
_
3
2
3
5
Ashland .
2
_
2
6
6
12
Ayer .
4
4
8
6
11
17
Bedford
2
1
3
3
6
9
Belmont .
20
20
40
39
62
101
Billerica .
5
6
11
12
12
24
Boxborough
1
—
1
Burlington
_
_
_
3
4
7
Cambridge
137
117
254
429
382
811
Carlisle
1
1
2
_
2
Chelmsford
3
4
7
18
22
40
Concord .
8
5
13
16
13
29
Dracut
3
2
5
17
15
32
Dunstable
1
1
1
-
1
Everett
40
24
64
112
101
213
Framingham .
11
15
26
48
79
127
Groton
4
2
6
3
12
15
Holliston .
1
3
4
8
12
20
Hopkinton
1
1
2
6
9
15
Hudson
7
7 •
14
24
19
43
Lexington
4
4
8
22
13
35
Lincoln
1
1
2
4
2
6
Littleton .
1
1
2
6
5
11
Lowell
55
53
108
345
336
681
P.D. 117
423
Table 245. — County and City or Town of Residence of Admissions and Cases in
Residence in Hospitals for Mental Disorders on September SO, 1939, by
Sex — Continued
County and City ok Town
Admissions
1939
F.
T.
Resident Population
Sept. 30, 1939
M.
T.
Maiden
Marlborough ....
Maynard
Medford
Melrose
Natick
Newton
North Reading
Pepperell
Reading
Sherborn
Shirley . . . . i .
Somerville
Stoneham ....
Stow
Sudbury
Tewksbury ....
Townsend ....
Tyngsborough
Wakefield ....
Waltham
Watertown ....
Wayland
Westford
Weston
Wilmington ....
Winchester ....
Woburn
Total ....
Nantucket
Nantucket ....
Total ....
Norfolk
Avon
Bellingham ....
Braintree
Brookline ....
Canton
Cohasset .....
Dedham .....
Dover
Foxborough ....
Franklin
Holbrook
Medfield . . .
Medway
Millis
Milton
Needham
Norfolk
Norwood
Plainville ....
Quincy
Randolph . . . .
Sharon
Stoughton ....
Walpole
Wellesley
Westwood ....
Weymouth ....
Wrentham ....
Total ....
60
11
7
46
l(i
10
55
4
1
5
1
2
82
2
6
2
2
10
38
36
4
1
1
17
37
4
1
11
2
8
4
3
2
11
9
11
1
-10
11
7
38
23
11
48
1
3
1
3
60
4
3
2
1
2
11
26
22
2
2
5
3
3
10
37
4
2
49
5
7
4
4
1
10
4
100
22
14
84
39
21
103
4
2
8
2
5
142
13
3
4
7
4
2
21
64
58
6
3
6
3
144
50
25
114
39
23
120
6
6
20
246
16
4
4
32
5
3
30
117
71
4
4
2
11
161
50
22
124
52
38
151
4
8
16
4
4
259
20
2
3
20
5
2
29
144
59
11
8
5
12
5
27
74
8
3
19
2
13
10
5
2
2
11
21
4
11
2
105
13
1
10
11
7
3
26
9
8
33
88
22
4
35
1
23
24
9
4
10
4
29
26
34
3
129
21
5
27
21
18
4
55
12
4
39
115
20
9
38
1
10
23
8
7
12
3
32
29
5
26
3
166
18
6
20
17
18
5
54
21
305
100
47
238
91
61
271
10
14
36
4
10
505
36
6
7
52
10
5
59
261
130
15
12
7
23
6
18
4
3
10
21
8
53
25
35
33
88
784
629
1,413
2,376
2,494
4,870
6
2
8
14
10
24
13
12
72
203
42
13
73
2
33
47
17
11
22
7
61
55
5
60
6
295
39
11
47
38
36
9
109
33
224 180
404
654
717
1,371
424
P.D. 11;
Table 245. — County and City or Town of Residence of Admissions and Cases in
Residence in Hospitals for Mental Disorders on September 30, 1939, by
Sex — ■ Continued
Admissions
Resident Population
1939
Sept. 30. 1939
County and City oh Town
M.
F.
T.
M.
F.
T.
Plymouth
Abington .
2
3
5
11
11
2°
Bridgewater
8
13
47
22
69
Brockton .
70
47
117
251
177
428
Carver
1
1
7
2
9
Duxbury .
5
1
6
7
10
17
East Bridgewater .
6
3
9
13
13
26
Halifax
4
2
6
2
1
3
10
10
20
Hanson
6
_
6
5
5
10
Hingham ....
6
2
8
15
10
25
Hull .
2
3
5
8
0
13
2
1
3
6
9
15
Lakeville .
1
1
2
2
4
Marion
1
1
2
3
10
Marshfield
2
3
5
5
1
6
Mattapoisett .
1
1
9
2
11
Middleborough
10
18
16
34
Norwell
2
2
4
4
5
9
Pembroke
1
1
8
6
14
Plymouth
8
18
26
43
40
S3
1
1
7
3
10
Rockland .
8
.5
13
21
25
46
Scituate
1
4
8
6
14
Wareham
6
5
11
15
9
24
West Bridgewater .
3
3
6
9
4
13
5
7
12
14
22
36
Total
153
121
274
550
424
974
Suffolk
1,024
903
1,927
3,018
3,229
6,247
61
30
91
145
106
251
Revere
33
30
63
76
80
156
Winthrop
23
14
37
33
44
77
Total
1,141
977
2,118
3,272
3,459
6,731
Worcester
Ashburnham .
3
6
9
7
8
15
Athol ....
9
6
15
28
22
50
Auburn ....
7
1
8
8
10
18
Barre ....
1
4
7
12
Berlin ....
1
1
2
1
2
3
Blackstone
2
7
19
9
28
Bolton
2
2
5
3
8
Boylston ....
1
_
1
2
2
4
Brookfield ....
1
_
1
3
4
7
4
_
4
8
5
13
7
9
16
27
36
63
2
3
6
1
7
4
5
7
10
17
East Brookfield
1
3
2
2
4
27
35
62
128
120
248
10
11
21
51
52
103
4
5
12
10
22
Hardwick
3
_
3
9
9
18
1
_
1
5
1
6
1
2
5
4
9
2
_
2
4
3
7
3
4
3
3
6
9
2
4
6
9
15
4
5
5
9
14
9
14
23
59
44
103
Lunenberg ....
5
2
7
5
4
9
_
_
2
2
Milford
14
4
18
51
34
85
Millbury ....
5
2
7
14
11
25
Millville
1
1
2
9
2
11
New Braintree ....
1
1
Northborough
2
_
2
9
16
Northbridge
5
4
9
26
12
38
North Brookfield .
3
3
4
11
_
4
1
5
Oxford
4
3
7
U
8
19
P.D. 117
425
Table 245. — County and City or Town of Residence of Admissions and Cases in
Residence in Hospitals for Mental Disorders on September 80, 1939, by
Sex — Concluded
County and City or Town
Admissions
1939
F.
Resident Population
Sept. 30, 1939
M.
T.
Paxton
Petersham
Phillipston
Princeton
Quabbin Reservoir *
Royalston
Rutland .
Shrewsbury
Southborough .
Southbridge
Spencer
Sterling
Sturbridge
Sutton
Templeton
Upton
Uxbridge .
Warren
Webster
West borough .
West Boylston
West Brookfield
Westminster
Winchendon
Worcester
Total
Non-Residents
Unknown
Total
Grand Total .
4
1
10
4
1
2
1
2
3
2
7
1
1
1
1
1
2
2
4
2
4
13
6
45
15
2
4
6
19
2
19
11
33
25
2
2
4
1
11
6
33
14
3
5
3
19
S
10
8
26
10
2
1
5
2
3
2
2
6
6
5
24
12
78
29
5
9
9
38
10
29
19
.59
35
4
1
5
176
3
159
8
335
15
565
11
512
26
1,077
400
94
18
320
50
5
720
144
23
1,351
136
116
1,170
47
5
2,521
183
121
112
55
167
252
52
304
3,780 3,098 6,878
12,697 12,234 24,931
* The towns of Enfield, Greenwich and Prescott of Hampshire County and Dana of Worcester County
have been taken over by the building of the Quabbin Reservoir (Chapter 240, 5, Acts of 1938).
Note: — The number of admissions for 1939 is larger than the total First and Readmissions together
because of the fact that the Non-Psychotic (Epileptic) First and Readmissions to the Monson State
Hospital have been added to this table. The same applies to the Resident Population.
426
P.D. 117
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P.D. 117
Table 278. — County and City or Town of Residence of Patients Admitted and
Patients Resident in State Schools on September 30, 1939, by Sex
Admissions
Resident Population
CODNTY AND ClTY OR TOWN
M.
F.
T.
M.
F.
T.
Barnstable
Barnstable
_
_
_
7
4
11
Bourne
_
_
3
1
4
Brewster .
_
1
1
1
1
Chatham .
_
2
2
Dennis
_
1
3
4
Eastham .
_
1
1
2
Falmouth
_
1
1
2
7
9
Harwich .
_
2
3
5
Orleans
_
1
1
Provincetown .
2
4
6
Sandwich .
6
g
Wellfleet .
1
1
Yarmouth
-
-
-
2
1
3
Total
-
2
2
20
35
55
Berkshire
Adams
_
_
_
8
7
15
Alford
_
1
1
2
2
Becket
1
1
2
Cheshire .
...
1
1
2
Dalton
1
_
1
4 .
3
7
Egremont
_
1
1
Great Barrington
1
2
3
2
7
9
Hinsdale .
1
1
1
2
3
Lanesborough
_
2
2
Lee
_
1
1
4
8
12
Lenox
1
1
North Adams .
4
4
8
17
16
33
Otis .
1
1
Peru .
1
1
Pittsfield .
2
3
5
21
29
50
Richmond
1
1
Sheffield .
1
1
1
8
9
Stockbridge
_
1
1
1
2
3
Washington
1
1
West Stockbridge
_
_
1
1
Williamstown .
-
1
1
-
3
3
Total
8
15
23
64
95
159
Bristol
Acushnet
_
1
1
5
5
10
Attleboro .
1
1
14
6
20
Berkley
_
1
2
3
Dartmouth
_
_
1
1
Dighton .
_
1
1
3
2
5
Easton
_
5
3
8
Fairhaven
_
5
3
8
Fall River
2
7
9
60
68
128
Freetown
_
_
4
__
4
Mansfield
I
1
4
3
7
New Bedford .
3
2
5
49
72
121
North Attleborough
1
1
9
4
13
Norton
_
5
1
6
Raynham
_
_
_
1
3
4
Rehoboth
_
_
2
5
7
Seekonk .
1
1
2
Somerset .
1
1
Swansea .
_
1
1
Taunton .
3
2
5
19
19
38
Westport
-
-
-
-
3
3
Total
9
15
24
189
201
390
Dukes
Chi] mark ....
1
_
1
1
1
Gay Head
1
_
1
_
Oak Bluffs
_
1
1
2
Tisbury '
-
-
-
-
2
2
Total
2
-
2
2
3
5
P.D. 117 453
Table 278. — County and City or Town of Residence of Patients Admitted and
Patients Resident in State Schools on September 30, 1939, by Sex — Continued
Admissions
Resident Population
County and City or Town
M.
F.
T.
M.
F.
T.
Essex
Amesbury
1
1
2
10
6
16
Andover
_
5
6
11
Beverly
_
_
_
9
8
17
Boxford
_ -
_
_
1
1
Dahvers .
_
_
_
5
7
12
Essex
_
_
_
1
1
2
Georgetown
_
_
_
1
1
Gloucester
_
1
1
15
15
30
Gfoveland
_
1
1
2
Hamilton .
_
_
_
1
1
Haverhill .
-
_
_
29
36
65
Ipswich
—
_
_
4
3
7
Lawrence .
-
1
1
36
38
74
Lynn
3
1
4
38
45
83
Lynnfiekl .
_
_
3
1
4
Manchester
_
_
_
1
1
2
Marblehead
_
_
_
5
5
10
Merrimac
_
_
1
2
3
Methuen .
_
1
1
9
11
20
Middleton
_
2
2
Nahant
_
_
_
2
1
3
Newbury .
_
_
_
1
1
2
Newbury port
2
_
2
12
8
20
North Andover
_
_
4
4
Peabody .
1
_
1
17
7
24
Rockport .
_
_
5
1
6
Rowley
_
_
_
1
1
2
Salem . i
1
1
2
23
15
38
Salisbury
-
_
1
1
2
Saugus
1
1
2
15
17
32
Swampscott
—
_
3
2
5
Topsfield .
_
_
_
2
1
3
Wenham
-
-
-
1
1
Total
9
7
16
257
248
505
Franklin
Ashfield
_
_
2
2
Bernardston
_
_
2
4
6
Buckland .
1
1
2
4
1
5
Charlemont
1
1
1
2
3
Colrain
_
1
1
Conway
_
_
_
3
3
Deerfield .
1
_
1
3
1
4
Erving
_
_
_
_
2
2
Gill .
_
_
_
_
3
3
Greenfield
2
2
4
17
11
28
Heath
_
_
1
1
Leverett .
_
_
_
_
2
2
Montague
1
2
3
8
12
20
New Salem
_
_
1
\
Northfield
_
_
6
1
7
Orange
-
2
2
3
7
10
Rowe
—
1
1
2
2
4
Shelbourne .
_
3
3
Shutesbury
_
_
_
1
1
Sunderland
_
_
_
1
2
3
Warwick .
1
_
1
1
1
2
Wendell .
_
1
1
Whately .
-
-
-
1
2
3
Total . . . . . \
7
8
15
53
62
115
Hampden
-
1
1
4
3
7
—
_
2
2
_
_
_
4
4
1
3
4
22
21
43
East Longmeadow
_
_
_
2
2
_
_
_
1
1
-
_
_
1
_
1
3
6
9
44
44
88
-
-
3
6
9
—
_
_
3
4
7
—
_
_
5
7
12
_
_
_
4
5
9
_
_
_
2
4
6
-
_
_
3
3
5
17
22
97
97
194
-
1
1 '
2
3
5
454
P.D. 117
Table 278. — County and City or Town of Residence of Patients Admitted and
Patients Resident in State Schools on September 30, 1939, by Sex — Continued
A
DMI88ION8
Resident Population
County and City oh Town
M.
F.
T.
M.
F.
T.
Westfield
1
4
5
21
19
40
-
1
1
10
7
17
-
-
-
2
2
4
10
33
43
230
224
454
Hampshire
Amherst
_
_
_
5
5
10
Belchertown
_
3
3
2
20
22
Curnmington
_
-
-
2
2
1
_
1
o
12
17
_
_
_
_
2
2
_
_
-
1
1
2
-
-
-
2
1
3
Hatfield
_
_
—
1
1
2
_
_
-
3
4
7 ■
Middlefield ....
_
_
_
1
_
1
2
fi
14
12
26
Pelham ....
_
_
_
1
_
1
Plainfield
_
_
_
2
1
3
Quabbin Reservoir *
_
_
_
1
3
4 .
South Hadley ....
_
-
_
6
6
12
_.
_
_
5
1
6
Westhampton
_
_
_
1
1
Williamsburg ....
-
-
_
-
7
7
W orthington ....
-
-
-
-
2
2
Total
4
5
9
49
81
130
Middlesex
Acton ....
_
_
_
2
1
3
_
_
_
16
8
24
Ashby
_
_
_
-
1
1
Ashland
_
_
_
4
_
4
_
_
_
_
1
1
_
_
_
1
2
3
Belmont ....
_
1
1
9
11
20
_
5
1
6
Boxborough
_
_
_
3
-
3
Cambridge ....
2
1
3
61
114
175
Carlisle
_
_
—
2
_
2
Chelmsford
_
_
_
5
4
9
_
_
_
6
1
7
Dracut
1
_
1
5
3
8
Everett
3
-
3
27
26
53
—
3
9
22
31
_
_
_
1
2
3
Holliston
_
_
_
4
2
6
Hopkinton
_
_
_
1
3
4
_
_
_
4
6
10
Lexington ....
_
_
_
1
4
5
_
_
_
3
_
3
2
_
?,
64
55
119
1
4
26
27
53
Marlborough
_
_
_
13
5
18
_
_
_
2
3
5
Medford
1
2
3
19
29
48 ;
Melrose . .
_
_
_
5
7
12
Natick
_
_
_
6
3
9
2
_
?,
33
24
57
North Reading
1
1
9
1
3
-
_
_
3
2
5
Reading
_
_
_
8
18
26
Shirley ....
_
_
_
6
2
8
Somerville
4
1
5
64
45
109
Stoneham
_
_
4
7
11
Sudbury ....
_
_
-
_
2
2
Tewksbury ....
-
2
2
27
33
60
Townsend ....
_
_
_
2
2
4
Wakefield
1
_
1
11
4
15
1
_
1
52
19
71
1
_
1
7
12
19
-
_
_
-
2
2
_
_
_
3
3
6 )
Wilmington . . . ; .
_
_
_
2
2
4
Winchester ....
_
1
1
4
9
Woburn
-
1
1
16
13
29
Total
24
11
35
549
536
1,085
P.D. 117
455
Table 278. — County and City or Town of Residence of Patients Admitted and
Patients Resident in State Schools on September SO, 1989, by Sex — Continued
Admissions
Resident Population
County and City or Town
M. F.
T.
M. F. T.
Nantucket
-
-
2 2
Total
-
-
2 2
Norfolk
Avon
— —
—
1 1
Bellingham
— —
-
3 3
Braintree .
1 1
2
9 8 17
Brookline .
1
1
10 6 16
Canton
- —
-
7 4 11
Cohasset .
- -
-
3 2 5
Dedham .
1 1
2
12 9 21
Dover
- —
-
1 1 2
Foxborough
1
1
1 3 4
Franklin .
1
1
4 10 14
Holbrook .
— —
-
2 2 4
Medfield .
- —
-
3 3
Medwav .
- -
-
2 4 6
Millis
- —
-
1 1
Milton
1
1
8 6 14
Needham .
- -
-
4 2 6
Norfolk .
— —
-
1 1
Norwood
- —
—
8 7 15
Plainville .
— —
—
3 3
Quincy
3 2
5
32 30 62
Randclph
— —
—
2 13
Sharon
2
2
3 9 12
Stoughton
1
1
11 9 20
Walpole
- —
-
4 6 10
Wellesley .
1 1
2
6 25 31
Westwood
— —
-
1 5 6
Weymouth
- -
-
9 7 16
Wrentham
- —
—
2 2 4
Total
8 10
18
145 166 311
Plymouth
Abington .....
1
1
4 7 11
Bridgewater
— —
—
2 4 6
Brockton .
1 3
4
30 35 65
Carver
1
1
2 2
Duxbury
1
.1
2 1 3
East Bridgewater
— —
—
3 3
Halifax
— —
-
2 2
Hanover
- —
—
2 2
Hanson
— —
—
1 1 2
Hingham .
— -
—
2 3 5
Hull
— —
—
1 1 2
Kingston .
1
1
4 1 5
Marion
— —
—
2 2
Mattapoisett
- -
-
2 2
Middleborough
1
1
3 5 8
Norwell
— —
—
1 1
Pembroke
2
2
3 3
Plymouth
- -
-
7 9 16
Plympton
— —
—
112
Rockland .
— —
—
3 4 7
Scituate
1
1
4 2 6
Wareham .
1
1
2 6 8
West Bridgewater
- -
-
1 1
Whitman .
_ ~~
~
4 4 8
Total
7 6
13
74 98 172
Suffolk
Boston ......
24 23
47
527 567 1,094
Chelsea
2
2
26 21 47
Revere ......
— -
—
23 14 37
Winthrop
1 1
2
7 17 24
Total
27 24
51
583 619 1,202
4513
P.D. 117
Table 278. — County and City or Town of Residence of Patients Admitted and
Patients Resident in State Schools on September SO, 1939, by Sex — Concluded
Admissions
Resident Population
County and City or Town
M. F.
T.
M. F. T.
(V orcester
Ashburnham
_ _
_
4 3 7
Athol
_ _
_
10 18 28
Auburn
_ _
_
2 2
Barre
_ _
_
1 1
Blackstone
_ _
_
2 2
Bolton
_ _
_
1 1
Boylston .
_
_
1 1 2
Brookfield
_ _
_
3 2 5
Charlton .
2 1
3
5 4 9
Clinton
1 2 3
Douglas
_ _
_
3 3
Dudley .
_ _
_
2 2 4
East Brookfield
_ _
_
1 1
Fitchburg
3 1
4
26 21 47
Gardner
1 2
3
10 13 23
Grafton
1 1
Hardwick
_ _
_
3 1 4
Harvard
_ _
_
1 1 2
Holden
1 1
2
6 3 9
Hopedale .
_ _
_
2 1 3
Hubbardston .
_ _
_
2 2
Lancaster
_ _
_
2 3 5
Leicester .
_ _
_
4 2 6
Leominster
2
2
13 11 24
Lunenberg
_ _
_
2 2 4
Mendon
_ _
_
1 1
Milford
1 2
3
15 12 27
Millbury .
1
1
3 4 7
Millville .
_ _
-
3 1 4
Northborough .
_ _
_
2 6 8
Northbridge
_ _
_
5 4 9
North Brookfield
Oxford
-
-
5 1 6
2 2
Petersham
_ _
_
2 2
Phillipston
1
1
2 2 4
Rutland
_ _
_
1 1 2
Shrewsbury
- -
-
2 2
Southborough .
— —
-
1 1
Southbridge
1 2
3
14 17 31
Spencer
2
2
2 5 7
Sterling
_ _
—
2 1 3
Sturbridge
1
1
6 2 8
Sutton
1
1
2 3 5
Templeton
2
2
6 5 11
Upton
- -
—
3 5 8
Uxbridge .
- _
—
3 1 4
Warren
_ _
-
2 4 6
Webster .
1
1
8 13 21
Westborough .
- -
-
7 2 9
West Boylston
— —
-
2 1 3
West Brookfield
— -
—
1 2 3
Westminster
_ -
—
2 2
Winchendon
1 2
3
7 9 16
Worcester
7 2
9
109 116 225
Total
23 18
41
317 318 635
Non-Residents
3 1
4
9 9 18
Grand Total
141 155
296
2,541 2,697 5,238
* The towns of Enfield, Greenwich, Prescott and Dana have been taken over bv the building of the
Quabbin Reservoir (Chapter 240, 5, Acts of 1938).
P.D. 117 457
DIRECTORY OF INSTITUTIONS
November 30, 1939
1. Public Institutions:
(a) State Hospitals for Mental Disorders.
(b) State Schools for Mental Defectives.
2. Private Institutions:
(a) For Mental and Nervous Disorders.
(b) For Persons Addicted to the Intemperate Use of Narcotics or Stimulants.
(c) For Mental Defectives.
(d) For Epileptics.
PUBLIC INSTITUTIONS
State Hospitals for Mental Disorders
Boston Psychopathic Hospital (opened 1912 as a Department of the Boston State
Hospital. Became a separate hospital December 1, 1920): —
Trustees: William Healy, M.D., Boston, Chairman; Ohanning Frothingham, M.D.,
Boston; Carrie I. Felch, M.D., Boston; Mrs. Josephine L. Murray, Boston;
Mr. Charles F. Rowley, Boston; Mr. Monroe Kaplan, Boston; Mr. Isaac Kaplan,
West Newton.
Trustees' meetings: Second Thursday of each month.
Medical Director: C. Macfie Campbell, M.D.
Chief Executive Officer: Salomon Gagnon, M.D.
Chief Medical Officer: Gaylord P. Coon, M.D.
Senior Physicians: John P. Powers, M.D.; Harry C. Solomon, M.D.; Oscar J.
Raeder, M.D.; Frank C. d'Elseaux, M.D.; Whitman K. Coffin, M.D.; Howard
E. Weatherly, M.D.; Jane F. O'Neil, M.D.
Assistant Physicians: Mary Palmer, M.D.; Irma Bache, M.D.; H. Jackson DeShon,
M.D.; Kathleen Kilgariff, M.D.; Joseph M. Lesko, M.D.; Lazarus Secunda,
M.D.
Internes : Stanley Peal, M.D.; Bruce R. Merrill, M.D. ; Arthur F. Valenstein, M.D.;
Daniel W. Badal, M.D.
Dentist: Peter J. Dalton, D.M.D.
Head Social Worker: Esther C. Cook, B.A.
Head Occupational Therapist: Alice E. Waite.
Principal of School of Nursing: Mary E. Fitzgerald, R.N.
Treasurer: Anna F. Caulfield.
Staff Meetings: Every day, except Saturdays, Sundays and Holidays, 12 to 1 P.M.
Visiting Days: Every day, 2 to 4 P.M. and 6 to 7 P.M.
Location: 74 Fenwood Road, near corner of Brookline Avenue.
Boston State Hospital (opened 1839) : —
Trustees: Thomas D. Russo, Boston, Acting Chairman; Mrs. Gertrude A. Mac-
donnell, Boston, Secretary; Josephine E. Thurlow, R.N., Winchester; Alexander
M. Sullivan, Boston; Joseph J. Cardillo, Somerville; Harry B. Berman, Newton;
Francis J. Callanan, M.D., Boston.
Regular meetings: Third Wednesday of each month.
Superintendent: Harold F. Norton, M.D.
Assistant Superintendent: Purcell G. Schube, M.D.
Director of Clinical Psychiatry: Ralph S. Banay, M.D.
Senior Physicians: Norris B. Flanagan, M.D.; Peter P. Gudas, M.D.; N. Anthony
Bicchieri, M.D.; Theodore F. Lindberg, M.D.; Daniel J. Sullivan, M.D.; Joseph
P. Thornton, M.D.; Louis S. Chase, M.D.
Assistant Physicians: William J. Clauser, M.D.; Michael A. Grassi, M.D. (Temp.);
John M. Hill, M.D.; Ernst Schmidhofer, M.D.; John F. Sullivan, M.D.; Charles
S. Mullin, Jr., M.D. (L. O. A.).
Pathologist: Naomi Raskin, M.D.
Dentist: Kaen Noonan, D.M.D.
Steward: Charles A. Perry.
Treasurer: Rose J. Siciliano.
Visiting days: 2 to 4 P.M. daily.
Staff meetings are held four times a week.
458 p.D. 117
Location: Administration Building, 591 Morton Street, corner Harvard Street,
Dorchester; East Group, Harvard Street, Dorchester, near Blue Hill Avenue;
West Group, Walk Hill Street, Mattapan; Post Office, Dorchester Center.
Bridgewater State Hospital (opened 1886, 1895) :—
Post Office, State Farm. Railroad Station, South Bridgewater (New York, New
Haven and Hartford).
Supervision of Department of Correction: Arthur T. Lyman, Commissioner.
Medical Director: William T. Hanson, M.D.
Superintendent: James E. Warren.
First Assistant: George H. Maxfield, M.D.
Assistant Physicians: Abraham L. Schwartz, M.D. ; Charles H. MacLaughlin, M.D.
Steward: Thomas W. Hunter.
Treasurer: Fred P. Turner.
Dentist: John H. Hall, D.D.S.
Visiting days: For relatives or friends of patients, every day; for general public,
every day with the exception of Sundays and holidays.
Staff meetings: Two or three times a week at 9:30 A.M.
Location: One-quarter mile from railroad.
Danvers State Hospital (opened 1878) : —
Post Office, Hathorne; railroad station, Danvers (Boston & Maine).
Trustees: S. Herbert Wilkins, Chairman, Salem; James F. Ingraham, Peabody;
Arthur C. Nason, M.D., Newburyport; H. C. McStay, Swampscott; Francis T.
Russell, Dorchester; Annie T. Flagg, Andover; Mary T. O'Sullivan, Lowell.
Regular meetings: Third Thursday of each month.
Superintendent: Clarence A. Bonner, M.D.
Assistant Superintendent: Wm. Charles Inman, M.D.
Clinical Director: Leo Maletz, M.D.
Senior Physicians: Melvin Goodman, M.D.; Doris M. Sidewell, M.D.; Myer
Asekoff, M.D.
Assistant Physicians: Flora M. Remillard, M.D.; Mona C. Mehan, M.D.; Louise
H. Jacob, M.D.; Peter B. Hagopian, M.D.; Samuel H. Marder, M.D.; Francis
X. Sullivan, M.D.; Pasquale A. Buoniconto, M.D.
Pathologist: Salvador Jacobs, M.D.
Resident Dentist: George W. Wheeler, D.M.D.
Treasurer: Miss Hulda Aronson.
Steward: Adam D. Smith.
Visiting days: Wednesdays, Saturdays, Sundays and Holidays, from 9:00 to 11:00
A.M. and 2:00 to 4:00 P.M.
Staff meetings: Daily, except Sundays and holidays, at 8:00 A.M.
Location: Maple and Newbury Streets, Danvers, two and one-half miles from
railroad station.
Foxborough State Hospital (opened 1893. Devoted exclusively to the care of the
insane since June 1, 1914): —
Trustees: E. H. Lewis Harnett, M.D., Dorchester, Chairman; Helen J. Fay, West-
wood, Secretary; Bennet B. Bristol, Foxborough; William H. Bannon, Fox-
borough; William J. Bulman, Brockton; Ethel W. Dodd, Wrentham; Noel C.
King, Holbrook.
Regular meetings: Second Wednesday of each month.
Superintendent: Roderick B. Dexter, M.D.
Assistant Superintendent: Grosvenor B. Pearson, M.D.
Senior Physicians: David Rothschild, M.D.; Morris L. Sharp, M.D.; John T. Shea,
M.D.; Margaret R. Simpson, M.D.
Assistant Physicians: Israel Zeltzerman, M.D.; Carl V. Lendgren, M.D.; Zoe
Ullian, M.D.
Dentist: Edward E. Small, D.M.D.
Treasurer: Harriett S. Bayley.
Steward: Chester R. Harper.
Visiting days: Every day from 9 to 11 A. M. and 2 to 4 P.M.
P.D. 117 459
Staff meetings: Daily, except Sundays and holidays, at 8:30 A.M.
Location: One mile north of Foxborough Center.
Gardner State Hospital (opened 1902): —
Post Office, East Gardner, Mass.; railroad station, East Gardner, Mass.
Trustees: Owen A. Hoban, Gardner, Chairman: Mrs. Margaret X. O'Brien, Wor-
cester, Secretary; John C. Hughes, D.M.D., Gardner; George A. Marshall,
Fitchburg; Miss Margaret E. Hayden, Athol; Edward P. Gilgun, Woburn; Frank
W. Lyman, Fitchburg.
Regular meetings: First Friday occurring on or after the fourth day of each month.
Superintendent: Charles E. Thompson, M.D.
Assistant Superintendent: Frederick P. Moore, M.D.
Senior Physicians: Harold K. Marshall, M.D.; William A. Hunter, M.D.
Assistant Physicians: Paul H. Wilcox, M.D.; Janet S. Barnes, M.D.; Edwin J.
Palmer, M.D.; Solomon M. Haimes, M.D.
Dentist: Joseph N. Carriere, D.M.D.
Treasurer: Gertrude W. Perry.
Steward: Myron L. Marr.
Visiting days: Every day at any hour, including Sundays and holidays.
Staff meetings: Daily 8-9 A.M.
Location: East Gardner, two minutes' walk from East Gardner Railroad Station.
Off route 2 at Westminster and three miles from Gardner.
Grafton State Hospital, formerly Worcester State Asylum (opened 1877) : —
Trustees: Ernest L. Anderson, Worcester, Chairman; Martha Ducey, Shrewsbury,
Secretary; Winslow P. Burhoe, Reading; Frank J. Ludy, North Grafton; Charles
D. Bourcier, Grafton; Rose Herbert, Worcester; Leon Cangiano, Hingham.
Superintendent: Harlan L. Paine, M.D.
Assistant Superintendent: W. Everett Glass, M.D.
Senior Physicians: H. Wilbur Smith, M.D.; James L. McAuslan, M.D.; Benjamin
Cohen, M.D.
Assistant Physicians: Mary Johnson, M.D.; Anna C. Wellington, M.D.; Richard
W. Nelson, M.D.; Soli Morris, M.D.
Treasurer: Susie G. Warren.
Steward: Roy S. Shipman.
Dentist: Edward I. Naiman, D.M.D.
Visiting days: Every day.
Visiting hours: 9:30 to 11:00 A.M.; 1:00 to 4:00 P.M.
Location: The hospital is situated on the main line of the Boston and Albany Rail-
road, between Worcester and Westborough, station, North Grafton. It is about
8 miles from Worcester, and can be reached by bus from there or from the West-
borough or North Grafton Stations of the Boston and Albany Railroad.
Correspondence relating to patients at the Grafton State Hospital should
be addressed to the Superintendent, Grafton State Hospital, North Grafton,
Mass.
Medfield State Hospital (opened 1896) : —
Post Office, Harding. Bus service from Park Square and Forest Hills to Medfield.
Trustees: George O. Clark, M.D., Boston, Chairman; M. James Shaughnessy,
M.D., Framingham, Secretary; Eugene M. Carman, Somerville; Mrs. Louise
Williams, Taunton; John H. Craig, Natick; Mrs. Elizabeth B. Rugg, Kingston.
Regular meetings: Second Friday of each month.
Superintendent: Earl K. Holt, M.D.
Assistant Superintendent: Arthur J. Gavigan, M.D.
Senior Physicians: Vicente A. Navarro, M.D.; Grace T. Cragg, M.D.; Harry M.
Gardiner, M.D.
Assistant Physicians: Edmund M. Pease, M.D.; Nathan Baratt, M.D.; Henry
Benjamin, M.D.; Martin A. Berezin, M.D.
Dentist: Elton V. Faass, D.M.D.
Treasurer: Miss Josephine M. Baker.
Steward: Pascal A. Cantoreggi.
460 RD. 117
Visiting days: Every day.
Staff meetings: Monday, Wednesday and Thursday, at 8:30 A.M.
Location: Two miles north of Medfield Center on Route 27.
Metropolitan State Hospital (opened October 29, 1930): —
Post Office: Waltham, Massachusetts.
Railroad Station: Waverley, Massachusetts.
Trustees: Reverend John R. McCool, Peabody, Chairman; Miss Anna M. Manion,
Waltham, Secretary; Erwin C. Miller, M.D., Worcester; Richard J. Dunn, Esq.,
Newton; Gilbert Horrax, M.D., Chestnut Hill; Miriam C. Regan, Esq., South
Boston; Mrs. J. Haskell Casey, Belmont.
Regular meetings: Third Thursday of each month.
Superintendent: Roy D. Halloran, M.D.
Assistant Superintendent: William Corwin, M.D.
Senior Physicians: Elvin V. Semrad, M.D.; Richard C. Wadsworth, M.D. (Pathol-
ogist).
Assistant Physicians: Clementine McKeon, M.D.; Emerick Friedman, M.D.;
Richard C. Cooke, M.D.; Paul H. Wilcox, M.D.
Resident Dentist: John M. O'Connor, D.M.D.
Treasurer: Cora E. Norris.
Steward: Howard R. Carley.
Visiting days: Every day.
Staff meetings: Daily.
Location: On Trapelo Road, Waltham, about two miles from Waverley Square
(Fitchburg Division and South Division, Boston and Maine or Boston Elevated
from Harvard Square). Bus service from Waverley Square to Hospital.
Monson State Hospital (opened 1898) : —
Post Office and railroad station, Palmer (Boston & Albany).
Trustees: George A. Moore, M.D., Palmer, Chairman; Mrs. Gertrude E. Quinn,
Springfield, Secretary; George D. Storrs, Ware; Joseph L. Simon, Beverly;
Justus G. Hanson, M.D., Northampton; Stuart Winch, Turners Falls; Hannah
Carolynn Simmons, M.D., Worcester.
Regular meetings: First Thursday of each month.
Superintendent: Morgan B. Hodskins, M-D.
Assistant Superintendent: H. Sinclair Tait, M.D.
Senior Physicians: Donald J. MacLean, M.D.; Leon J. Robinson, M.D.; Florence
A. Beaulieu, M.D.
Assistant Physicians: Lucie G. Forrer, M.D.; Benjamin Margulois, M.D.
Dentist: Arthur R. Adam, D.D.S.
Treasurer: Alice C. Haymann.
Steward: William H. Daly.
Visiting days: Every day.
Staff meetings: Every day, except Sundays and holidays, at 8:30 A.M.
Location: One mile from railroad station.
Northampton State Hospital (opened 1858) : —
Trustees: John C. O'Brien, M.D., Greenfield, Chairman; Mrs. Anne O'Keefe
Heffernan, Northampton, Secretary; Samuel Michelman, Northampton; James
H. Benson, Springfield; Albert M. Darling, Sunderland; Allen H. Bagg, Pitts-
field; Mrs. Mary P. Bailey, Northampton.
Regular meetings: Second Thursday of each month.
Superintendent: Arthur N. Ball, M.D.
Assistant Superintendent: Guy C. Randall, M.D.
Senior Physicians: B. Edwin Zawacki, M.D.; Elizabeth Kundert, M.D.; Fernand
Longpre, M.D.; Lee W. Darrah, M.D.
Assistant Physicians: E. Phillip Freedman, M.D.; Helen M. Wiestling, M.D.;
Harry Michelson, M.D.; Phillip Shapiro, M.D.
Pathologist: Ruth Parker, M.D.
Dentist: Lucien H. Harris, D.D.S.
Treasurer: Eva L. Graves.
P.D. 117 461
Steward: Frank W. Smith.
Visiting days: Tuesdays, Fridays and Saturdays on which days members of the
medical staff are in attendance to consult with visitors; but if impossible to come
on those days, visitors may come on any day.
Staff meetings: Every day except Saturdays, Sundays and holidays at 8:30 A.M.
Location: Prince Street, Northampton, one and one-half miles from the railroad
station. (Boston & Maine and New York, New Haven & Hartford railroads.)
Taxi cab service from the station, bus service from Springfield and Holyoke.
Taunton State Hospital (opened 1854) : —
Trustees: Charles C. Cain, Jr., Attleboro, Chairman; Mrs. Elizabeth C. M. Gifford,
Boston, Secretary; Mrs. Mary B. Besse, Wareham; Irving Linley, North Attle-
boro; Gerald O'Sullivan, M.D., Fall River; Lawrence Quinn, M.D., New Bed-
ford; Samuel C. Stone, Attleboro.
Regular meetings: Second Thursday of each month.
Superintendent: Ralph M. Chambers, M.D.
Assistant Superintendent: Roger G. Osterheld, M.D.
Director of Clinical Psychiatry: Abraham M. Stiffle, M.D.
Senior Physicians: Henry L. Hartman, M.D.; Wilfrid Seguin, M.D.; Olga E.
Steinecke, M.D.; Walter W. Jetter, M.D. (Pathology).
Assistant Physicians: Ernest Z. Bower, M.D.; Charles E. Fiman, M.D.; Grace
E. Gillis, M.D.; Eugene S. Gladsden, M.D.; Vincent C. Vielhaber, M.D.
Dentist: Wilfred R. Wilson, D.M.D.
Treasurer: Yvonne B. Patenaude.
Steward: Frederick H. Bradford.
Visiting days: Every day.
Staff meetings: Daily, 8:15 A.M. and 1:00 P.M.
Location: Hodges Avenue, one mile from railroad station (New York, New Haven
& Hartford.)
Mental Wards, Tewksbury State Hospital and Infirmary (opened 1866): —
Post Office, Tewksbury; railroad station, Lowell.
Trustees: Elliott C. Cutler, M.D., Boston, Chairman; William M. Collins, M.D.,
Lowell, Vice Chairman; Mrs. Mary E. Cogan, Stoneham, Secretary; Miss Ida
M. Cannon, Cambridge; William F. Maguire, D.M.D., Randolph; Robert M.
Beirne, Lawrence; James C. Coughlin, D.M.D., Lowell.
Regular meetings: Usually first Friday of each month.
Superintendent: Lawrence K. Kelley, LL.B., M.D.
Assistant Superintendent: Patrick J. Meehan, M.D.
Senior Physicians: Charles L. Trickey, M.D. (Director of Clinical Psychiatry);
H. Spencer Glidden, M.D. (Pathologist); Edward J. O'Donoghue, M.D.; C.
Winthrop Houghton, M.D.; James F. Lawlor, M.D.; Louis W. Stern, M.D.
Assistant Physicians: Charles J. Carden, M.D.; George J. M. Grant, M.D.; Harry
B. Plunket, M.D.; Philip F. Bond, M.D.; Edwin B. Thomas, M.D.; Manuel
Kaufman, M.D.
Dentist: Charles D. Broe, D.M.D.
Steward: Thomas F. Flynn.
Treasurer: Thomas F. McKay.
Principal Clerk: Robert E. Gay.
Visiting days: Every day.
Staff meetings: Tuesday at 1:30 P.M.
Location: About one-half mile from bus line, Lowell to Boston, via Tewksbury
five miles from Lowell; twenty miles from Boston.
Westborough State Hospital (opened 1886) : —
Trustees: N. Emmons Paine, M.D., West Newton, Chairman; Kathrine L. Sullivan,
Canton, Secretary; Sewall C. Brackett, Boston; Thomas F. Dolan, Newton;
John A. Frye, Marlborough; Sadie E. Casey, Milford; Rufus M. Shaw, West-
borough.
Regular meetings: Second Thursday of each month.
Superintendent: Walter E. Lang, M.D.
462 P.D. 117
Assistant Superintendent: Rollin V. Hadley, M.D.
Senior Physicians: Betsy Coffin, M.D.; George E. Peatick, M.D.
Assistant Physicians: Dora E. Brault, M.D.; Sidney Cohen, M.D.: Alexander J.
Mozzer, M.D.; Marlin C. Moore, M.D.
Pathologist: Lydia B. Pierce, M.D.
Dentist: Paul L. Budge, D.D.S.
Steward: P. I. Wiley.
Treasurer: Carrie G. Poor.
Visiting days: Every day.
Staff meetings : Daily.
Location: Two and one-quarter miles from Westborough Station (Boston &
Albany); one mile from Talbot Station (New York, New Haven & Hartford).
Worcester State Hospital (opened 1833) : —
Trustees: William J. Delahanty, M.D., Worcester, Chairman; Mrs. Anna C.
Tatman, Worcester, Secretary; Mrs. Frank Dresser, Worcester; John L. Bianchi,
Worcester; Robert F. Portle, Worcester; Harry Kenney, Boston: Robert Burns,
Auburn.
Regular meetings: Second Tuesday of each month.
Superintendent: William A. Bryan, M.D.
Assistant Superintendent: Walter E. Barton, M.D.
Clinical Director: William Malamud, M.D.
Senior Physicians: Lonnie O. Farrar, M.D.; Embrie J. Borkovic, M.D.; Norman
D. Render, M.D.; William L. Holt, Jr., M.D.; Benjamin Simon, M.D.
Assistant Physicians: Erel L. Guidone, M.D.; S. Harvard Kaufman, M.D.; Hans
B. Molholm, M.D.; Bertram T. Spira, M.D.; Ellsworth F. Waite, M.D.
Pathologist: William Freeman, M.D.
Dentist: Simon G. Harootian, D.D.S.
Steward: Herbert W. Smith.
Treasurer: Margaret T. Crimmins.
Visiting days: Tuesdays, Saturdays, Sundays and holidays from 9 to 11 A.M.
1 :30 to 4:30 P.M.
Staff meetings: Daily.
Location: Belmont Street, Worcester, one and a half miles from Union Station
(Boston & Albany; New York, New Haven & Hartford; and Boston & Maine).
The Summer Street Department is located in the building formerly known as
the Worcester State Asylum, on Summer Street, about five minutes' walk from
the Union Station.
Correspondence relating to patients should be addressed to the Superintendent,
Worcester State Hospital, Worcester, Mass.
Correspondence intended for Steward or Treasurer of the Hospital should be
addressed to the Worcester State Hospital, Worcester, Mass.
State Schools for Mental Defectives
Belchertown State School (for the mentally deficient; opened 1922): —
Post Office and railroad station, Belchertown, Mass. (Central Vermont Railroad
from Palmer or Amherst; Boston & Maine for freight only. Busses from Spring-
field, Holyoke, Amherst and Ware.)
Trustees: James L. Harrop, Worcester, Chairman; Edwin C. Gilbert, M.D., Spring-
field, Secretary; Mrs. Bessie F. Dewey, Northampton; Mrs. Henry F. Nash,
Greenfield; James H. Dillon, Holyoke; Frederick P. Bulman, Athol; Eugene J.
O'Neil, Chicopee Falls.
Regular meetings: Second Thursday of each month.
Superintendent: George E. McPherson, M.D.
Assistant Superintendent: Raymond A. Kinmonth, M.D.
Senior Physicians: Herbert L. Flynn, M.D.; Lois E. Taylor, M.D.;Lulu H. Warner,
M.D.
Assistant Physician: Henry W. Kraszewski, M.D.
Dentist: Arthur E. Westwell, D.M.D.
Steward: John J. Cronin.
Treasurer: Dora B. Wesley.
P.D. 117 463
Visiting days: Every day, except holidays, 9:30 to 11:30 A.M., 1:30 to 4:30 P.M.,
and at other times by special permission.
Staff meetings: Daily at 9:00 A.M.
Location: One-quarter mile from railroad station. On the state road to Holyoke
and one-half mile from the center of the town.
Walter E. Fernald State School at Waltham (opened 1848) : —
Post Office and railroad station, Waverley (Boston & Maine).
Trustees appointed by the Governor: Francis J. Barnes, M.D., President, Cam-
bridge; Mrs. Julia T. Boyle, Secretary, Cambridge; Mrs. Margaret H. Fernald,
Marlborough; Mr. Louis S. Haddad, Marlborough; Mrs. Ray B. Jacobs, Boston,
and Norbert A. Wilhelm, M.D., Newton Centre.
Trustees appointed by the Corporation: Stephen Bowen, Treasurer, Boston; Charles
Francis Adams, Concord, Vice-President; Paul R. Withington, M.D., Milton;
Roger S. Warner, Ipswich; John E. Rogerson, Milton; Warren R. Sisson, M.D.,
Brookline.
Quarterly meetings : Second Thursday of October, January, April and July.
Annual meetings: Second Thursday in December.
Superintendent: Ransom A. Greene, M.D.
Assistant Superintendent: Malcolm J. Farrell, M.D.
Clinical Director: Paul I. Yakovlev, M.D.
Senior Physicians: L. Maude Warren, M.D.; Esther S. B. Woodward, M.D.;
Mary T. Muldoon, M.D.; Fred Vere Dowling, M.D.
Assistant Physicians: John D. Maloney, M.D.; Lawrence P. Bowser, M.D.;
Constance G. Hartwell, M.D.
Dentist: Maurice W. Blumsack, D.M.D.
Treasurer: Emily E. Guild.
Steward: Henry R. Rose.
Visiting days: For the parents or friends of the patients, Wednesday, Thursday,
and Saturday afternoons, and the first Sunday of each month.
Staff meetings: Daily at 9 A.M.
Location: About one mile from Waverley station (Fitchburg Division and Southern
Division, Boston & Maine), or Boston Elevated from Harvard Square.
Wrentham State School (opened 1907) : —
Post Office and railroad station, Wrentham.
Trustees: Albert J. Sargent, Boxboro, Chairman; Mrs. William A. Murray, Milford,
Secretary; Frank J. Nerney, Attleboro; Warren J. Swett, Canton; Judge James
A. Mulhall, Quincy; Francis X. Powers, Worcester; Alice M. Patterson, M.D.,
Marblehead.
Regular meetings : Second Tuesday of every month.
Superintendent: C. Stanley Raymond, M.D.
Assistant Superintendent: Henry A. Tadgell, M.D.
Senior Physicians: Karl V. Quinn, M.D.; Bessie F. Brown, M.D.; Clemens E.
Benda, M.D.; Charlotte A. Mitchell, M.D.; Alcinda de Aguiar, M.D.
Assistant Physicians: John H. F. Connor, M.D.; Anne G. Levingston, M.D.
Dentist: John A. Nash, D.M.D.
Steward: Perry E. Curtis.
Treasurer: Elizabeth Oldham.
Visiting days: Every day 9 to 11 A.M., 1:15 to 4:30 P.M.
Location: Emerald Street, Wrentham, one mile from railroad station, (New York,
New Haven and Hartford railroad). One-half mile from Winter Street stop.
Boston and Providence bus line. Telephone: Wrentham 24.
464 P.D. 117
PRIVATE INSTITUTIONS
For the Care op Mental and Nervous Disorders
Baldpate Inc., George M. Schlomer, M.D., Georgetown.
Bosworth Hospital, George A. Gaunt, M.D., 166 Lancaster Terrace, Brookline.
Bournewood Hospital, George H. Torney, M.D., 300 South Street, Brookline.
Channing Sanitarium, Jackson M. Thomas, M.D., Wellesley Avenue, Wellesley.
Glenside, Mabel D. Ordway, M.D., 6 Parley Vale, Jamaica Plain.
McLean Hospital, For Nervous and Mental Patients (opened 1818): —
Department of the Massachusetts General Hospital.
Post Office and railroad station, Waverley (Boston and Maine R. R.).
President: William Endicott, Boston.
Vice-President: Sewall H. Fessenden, Boston.
Treasurer: Henry R. Guild, Esq., Boston.
Secretary: Reginal Gray, Esq., Boston.
Trustees appointed by the Governor: Miss Betty Dumaine, Groton; Charles J.
Dunn, Esq., Boston; Eben S. Draper, Boston; Michael A. Fredo, Esq., Boston.
Trustees appointed by the corporation: Henry K. Sherrill, Boston, Chairman;
Sewall H. Fessenden, Boston; Phillips Ketcham, Esq., Boston; Hans Zinsser,
M.D., Boston; John R. Macomber, Boston; Francis C. Gray, Esq., Boston;
Lincoln Davis, M.D., Boston; Henry R. Guild, Esq., Boston.
Regular meetings: In the Trustees' Room at the Massachusetts General Hospital
in Boston on Fridays at intervals of two weeks, beginning sixteen days after the
first Wednesday in February.
Superintendent Emeritus: Frederic H. Packard, M.D.
Director: W. Franklin Wood, M.D.
Psychiatrist-in-Chief : Kenneth J. Tillotson, M.D.
Senior Physicians: Rupert A. Chittick, M.D.; David A. Young, M.D.
Pathologist: vacancy.
Director of Laboratories: Elmer H. Stotz, Ph.D.
Resident Physicians: John B. Tompkins, M.D.; Daniel C. Dawes, M.D.; David
Wies, M.D. ; Wolfgang Sulzbach, M.D.; Paul M. Howard, M.D.; Lucie J. Jessner,
M.D.; John E. Harty, M.D.; Beatrice R. Kershaw, M.D.
Roentgenologist: James R. Lingley, M.D.
Dental Surgeon: George O. Bartlett, D.M.D.
Visiting Internist: Wyman Richardson, M.D.
Staff meetings: Wednesdays and Fridays at 11:30 A.M.
The Reeves' Sanitarium, Clarence M. Kelley, M.D., 283 Vinton Street, Melrose
Highlands.
Ring Sanatorium and Hospital, Inc., Curtis T. Prout, M.D., Arlington Heights.
Veterans' Administration Facility, No. 95, Northampton, Mass. (for beneficiaries
of the Veterans' Administration, suffering from nervous or mental diseases;
opened May 12, 1924) :—
Under control of Veterans' Administration, Washington, D.C.
Administrator of Veterans' Affairs: Gen. Frank T. Hines, Washington, D. C.
Assistant Administrator: Colonel George E. Ijams, Washington, D. C.
Medical Director: Charles M. Griffith, M.D., Washington, D. C.
Manager: William M. Dobson, M.D.
Clinical Director: Frederick R. Sims, M.D.
Ward Surgeons: Fred E. Steele, Jr., M.D.; Ralph W. Brown, M.D.; Louis V.
Manley, M.D.; William J. Johnson, M.D.; Darley G. Plumb, M.D.
Pathologist & Chief of Clinical Laboratory: Louis V. Manley, M.D.
Chief of Dental Service: Francis J. Rogers, D.M.D.
Chief of Roentgenology Laboratory: Louis V. Manley, M.D.
Consultant in Ear, Nose and Throat: Joseph D. Collins, M.D.
Consultant in Ophthalmology: Frank E. Dow, M.D.
P.D. 117 465
Consultant in Surgery: Thomas F. Corriden, M.D.
Staff meetings: Mondays, Wednesdays, and Fridays. Time of meetings: 10:30 A.M.
Location: Florence Street, Leeds, Massachusetts. One mile beyond the village of
Florence on the Berkshire Trail. Bus connection from Northampton.
Post Office: Northampton, Mass.
Veterans' Administration Facility, No. 107, Bedford, Mass. (for beneficiaries of
the Veterans' Administration, suffering from nervous or mental diseases, opened
July 17, 1928) :—
Under control of Veterans' Administration, Washington, D. C.
Administrator of Veterans' Affairs: General Frank T. Hines, Washington, D. C.
Medical Director: Charles M. Griffith, M.D.
Manager: Winthrop Adams, M.D.
Clinical Director: Walter P. Burrier, M.D.
Acting Pathologist and Ward Surgeon: Antonino Triolo, M.D.
Senior Physicians: John F. O'Brien, M.D.; Aaron H. Braverman, M.D.; Louis
V. J. Lopez, M.D.
Junior Physicians: William H. Vicary, M.D.; Waldemere G. Richter, M.D.; Irving
I. Ludwig, M.D.
Associate Physicians: Joseph Weber, M.D.; Louis A. Cibelli, M.D.; Raymond E.
Feldman, M.D.
Chief of Dental Service: William E. Sinton, D.M.D.
Consultant in Eye, Ear, Nose and Throat: George A. Leahey, M.D.
Consultant in Roentgenology: John H. Lambert, M.D.
Consultant in Dermatology: C. Guy Lane, M.D.
Consultant in Surgery: Henry C. Marble, M.D.
Consultant in Genito-Urinary Surgery: Sylvester B. Kelley, M.D.
Consultant in Internal Medicine: G. Philip Grabfield, M.D.
Staff meetings: Tuesdays, Wednesdays and Fridays at 10:00 A.M.
Location: Spring Road, Bedford, Mass. One mile in from State Highway. Bus
connection from Arlington Heights, Mass.
Westwood Lodge, William J. Hammond, M.D., Westwood.
Wiswall Sanatorium, Edward H. Wiswall, M.D., 203 Grove Street, Wellesley.
For the Care of Persons Addicted to the Intemperate Use
of Narcotics or Stimulants
Grove Hall Institute, George Colton Moore, M.D., 232 Townsend Street, Roxbury.
Private Hospital, Frederick L. Taylor, M.D., 45 Center Street, Roxbury.
Washingtonian Home, Hugh Barr Gray, M.D., 41 Waltham Street, Boston.
For the Care of Mental Defectives
Clarke School, Miss Edith G. Clarke, 16 Summit Street, Newton.
Elm Hill Private School and Home for the Feeble-minded, George A. Brown,
M.D., Barre.
The Freer School, for girls only, Miss Cora E. Morse, 31 Park Circle, Arlington
Heights.
4611 P.D. 117
The Hospital Cottages for Children, Baldwinsville. Town of Templeton (incorpor-
ated and opened 1882) : —
President: Edward F. Mann, Worcester.
Treasurer: Parker Trowbridge, Worcester.
Clerk: Reverend Baldwin W. Callahan, Gardner.
Trustees appointed by the Governor: Jos. C. Tomasello, Boston; Mrs. Thomas
H. Mahoney, Waban; Mrs. Abner S. McLaud, Greenfield; Fred C. Hailer,
Roslindale; Eli M. Levatinsky, Dorchester.
Trustees appointed by the Corporation: Edward F. Mann, Worcester; J. Sidney
Stone, Boston; John G. Henry, M.D., Winchendon; Mrs. Thomas Allen, Jr.;
Brookline; Donald W. Campbell, Worcester; F. Harold Danield, Worcester;
Mrs. C. S. Dickinson, Baldwinsville; Mrs. Herbert C. Fisher, Worcester; Robert
B. Greenwood, Winchendon; Mrs. Edward H. Hutchins, Boston; Mrs. Edward
G. Iselin, Milton; William G. Lord, Athol; Frederick A. Turner, Boston; Mrs.
John H. Waite, Baldwinsville; Mrs. George R. Wallace, Jr., Fitchburg; Edward
G. Watkins, Gardner.
Quarterly meetings: January, April, July, October.
Superintendent: Alan W. Chadwick, B.S.
Medical Director: E. St. John Ward, M.D., F.A.C.S., D.Sc.
Assistant Physician: Shari Band Gaspar, M.D.
Visiting days: Every day.
Location: Bridge Street one mile from (Boston & Maine) railroad station and
from center of town of Baldwinsville, at junction of routes 68, 32, 202.
Perkins School, Franklin H. Perkins, M.D., Lancaster.
The Pollock School, Morris P. Pollock, 28 Alton Place, Brookline.
Stand ish Manor, Miss Alice M. Myers, Halifax.
For the Care of Epileptics
Woodlawn Sanitarium, Eudora Faxon, M.D., 500 Crafts Street, West Newton.
For the Care of Feeble-minded and Epileptic
The Lila Sanatorium, Richard C. Eley, M.D., 732 Main Street, Woburn.
P.D. 117 467
INDEX
A
Accidents in State Hospitals — (see Casualties)
Acreage — Building sites and grounds, and acres under cultivation, 131
Admissions — Mental Hospitals: 131, 147-176, 224, 236, 298-307, 310-348, 382, 413-
425
State Schools: 131, 239, 244-251, 275, 284, 426-432, 452
Epileptics, Non-Psychotic: 288, 292
Private Hospitals: 142, 309
Private Schooh: 309
Age at Admissions — Mental Hospitals
Admissions: By country of origin of foreign born, 316; by country of origin of native
born, 321; by hospital, 160, 327; by marital condition, 163, 340; by diagnosis,
159, 225, 323; by nativity and parentage, 157, 311
Discharges: By length of hospital stay, 193, 361; by diagnosis, 225, 353
Deaths: By length of hospital stay, 211, 373; by diagnosis, 212, 225, 369
Resident Population: By first and readmissions, 223; by hospital, 229, 397; by length
of hospital stay, 224; by diagnosis, 225, 385, 391*
Cases Out: By hospital, 229, 401 ; by diagnosis, 225, 388, 394
Age at admission — State Schooh
Admissions: By clinical diagnosis, 249, 430; by first and readmissions and rates
per hundred thousand population, 246; by mental status, 245, 429; by nativity
and parentage, 249, 429
Discharges: By length of school residence, 258
Resident Population: By clinical diagnosis, 284; by intelligence quotient, 279; by
length of school residence, 273: bv nativity and parentage, 275; by school,
277, 441
Cases Out: By school, 277, 442
Age at Admission — Epileptics, Non-Psychotic
Admissions: By diagnosis, 293; rates per 100,000 population, 289
Age at Death — Mental Hospitals: By hospital, 214, 367; by diagnosis, 213, 363
State Schools: By clinical diagnosis, 264, 270, 438; by comparison with death rates
in same ages in general population, 262; by mental status, 262, 264, 437, 450;
by school, 264
Epileptics, Non-Psychotic: By diagnosis, 296
Age at Discharge — Mental Hospitals: By hospital, 196, 359; by diagnosis, 194, 349
State Schools: By clinical diagnosis, 255, 258, 433; by mental status, 253, 432, 450;
rates per 1,000 cases under care, 253; by school, 253
Age of Central Registry cases — at examination, 94; by intelligence quotient, 116
Age, Present — Mental Hospitals
Discharges: Rates per 1,000 under care by diagnosis, 179
Deaths: Rates per 1,000 under treatment by diagnosis, 202
Resident Population: By first and readmissions, 228; by hospital, 230, 399; by
diagnosis, 229, 385, 391
Cases Out: By hospital, 229, 401 ; by diagnosis, 388, 394
Age, Present — State Schools
Resident Population: By clinical diagnosis, 284, 447; by length of school residence,
274; by mental status, 450; percentage distribution, 281; by school, 277, 441
Cases Out: By mental status, 450; by school, 277, 442
Alcoholic Habits — Intemperance in Mental Hospital admissions, 1917-1939, 169;
by diagnosis, 168, 335; by economic status, 159
Alcoholic Psychoses, 171
Aliens, 160, 308, 384
Appropriations — compared with expenditures, 26; for maintenance and operation, 27;
special appropriations for construction, permanent betterments, real estate
and furnishings, 32
Assistant Commissioner, D. M. H. — 1
Attorney General Cases, 126
Autopsies in State Institutions, 44-46
468 P.D. 117
B
Baldpate, Inc. — Directory, 464; license issued to George M. Schlomer, M.D., 5
Belchertown State School — Directory, 462
Betterments — special appropriations, 32
Boston Dispensary Child Guidance Clinic, 56-63
Boston Psychopathic Hospital — Directory, 457
Boston State Hospital — Directory, 457
Bosworth Hospital — Directory, 464
Bournewood Hospital — Directory, 464
Brenner, Charles, M.D., Psychiatrist in Division of Mental Hygiene — appointment
of, 2
Bridgewater State Hospital — Directory, 458
Brockton Child Guidance Clinic, 56-63
C
Capability on Discharge — Patients leaving State Schools, 258, 426, 435
Capacity — And overcrowding in State Hospitals and Schools, 135; rated, 299-307
Cases Out — Mental Hospitals: 144, 222-230, 298-307, 382, 388, 394, 401, 413^19
State Schools: 275, 426, 442, 449
Epileptics, Non-Psychotic: 295
Casualties — State Hospitals, 46
Causes of Death — Mental Hospitals: By diagnosis, 377; number and percentage distri-
bution, 215
State Schools: By clinical diagnosis, 268; by mental status, 268, 440
Epileptics, Non-Psychotic: By diagnosis, 296; by year, 1938 and 1939, 291
Central Registry for Mental Defectives — (see Mental Defectives)
Cerebral Arteriosclerosis, 170
Changes in Personnel, 2-3
Channing Sanitarium — Directory, 464; new license granted to Dr. Jackson M. Thomas,
5
Citizenship — Mental Hospitals
Admissions: Rates per 100,000 corresponding population, 162
Resident Population: By country of birth, 384
Cities and Towns — Traveling School Clinic examinations, 104-115
City or Town of Residence — (see County of Residence)
Clarke School — Directory, 465
Clinical Diagnoses — State Schools
Admissions: By age at admission, 249, 430; by intelligence quotient, 249, 432;
percentage distribution, 277; by school, 251
Discharges: By age at discharge, 260, 433; rates per 1,000 cases under care, 255;
by average age at discharge, 260; by capability on discharge, 258, 435; by
intelligence quotient, 260, 434; by length of school residence, 260, 436; per-
centage distribution, 277
Deaths: By age at death, 270, 438; rates per 1,000 cases under treatment, 261;
by cause of death, 268; by intelligence quotient, 269, 439; by length of school
residence, 270; percentage distribution, 277
Resident Population: By admission and present age, 284; by color, 448; by intelli-
gence quotient, 284, 443 ; by length of school residence, 444 ; percentage distri-
bution, 277; b3' present age, 447
Cases Out: By color, 449; percentage distribution, 277
Clinics
Traveling School, 90-115
Child Guidance, Division of Mental Hygiene, 56-63
Color — Mental Hospitals
Admissions: Number by first and readmissions, 413
Discharges: Number by first and readmissions, 413
Deaths: Number by first and readmissions, 413
Resident Population: Number by first and readmissions, 413; by diagnosis and
percentage distribution, 235
Cases Out: Number bv first and readmissions, 413
P.D. 117 469
Color — State Schools
Resident Population: By clinical diagnosis, 448
Case? Out: By clinical diagnosis, 449
Commissioner, D. M. H. — 1, 2. 128
Committee on Care of Institutional Patients — Report of, 5
Committee on Construction — Report of, 6
Committee on Family Care — Report of, 6
Committee on Finance — Report of, 7
Committee on Food — Report of, 7
Committee on Forms and Statistics — Report of, 7
Committee on Legislation and Regulations — Report of, 8
Committee on Mental Hygiene — Report of, 9
Committee on Nurses' Training Schools — ■ Report of, 10
Committee on Personnel and Labor Relations -^Report of, 11
Committee on Public Relations and Scientific Pmilications — • Report of, 11
Committee on Research — Report of, 12
Community Supervision of Mental Defectives — (see Mental Defectives)
Condition on Discharge — Mental Hospitals, 298-307
Discharges: By diagnosis, 357; length of residence, 189; percentage distribution, 188
Epileptics, Non-Psychotic — Discharges: By diagnosis, 289; by legal status, 293
Conferences, 5
Construction at State Hospitals and Schools — Special appropriations, 32
Costs, Per Capita — (see Per Capita Costs)
Costs, Total — (see Total Costs)
Country of Birth — Mental Hospitals
Admissio7is: Number by first and readmissions, 382; by parentage, 310
Discharges: Number by first and readmissions, 382; number and rates per 1,000
under care, 186
Deaths: Number by first and readmissions, 382; number and rates per 1,000 under
treatment, 207
Resident Population: Number by first and readmissions, 382; number and rates
per 100,000 same country of birth, 235: by citizenship, 384
Cases Out: Number by first and readmissions, 382
Country of Birth — State Schools
Ad?nissions: By parentage, 429
Country of Origin — Foreign Born to Mental Hospitals
Admissions: By age at admission, 316; by first and readmissions, rates per 100,000
population of same country of origin, 161; by diagnosis, 313
Country of Origin — Native Born to Mental Hospitals
Admissions: By age at admission, 321; by diagnosis, 218; by first and readmissions,
rates per 100,000 population of same country of origin, 161
— ■ Native Born to State Schools
Admissions: Number and rates per 100,000 population, aged 0-24 years, same
country of origin, 251
County of Residence — Mental Hospitals: Admissions and cases in residence, by city
and town, 420; rates per 100,000 population, same county, 236
State Schools: Admissions and cases in residence, by city and town, 452; rates per
100,000 population same county, 285
Court Commitments — ■ (see Legal Status)
D
Daily Average Population in Residence — Ex-service men, 147; Mental Hospitals,
298-307; State Schools, 426
Daily Average Population on Books — Ex-service men, 147; Mental Hospitals, 144,
298-307; State Schools, 242, 426
Danvers State Hospital — Directory, 458
Deaths — Sudden deaths in State Institutions, 45
Deaths — Mental Hospitals: 198-216, 224, 298-306, 363-383, 413-419
State Schools: 261, 277, 426, 437, 450
Epileptics, Non-Psychotic: 291, 293, 295
470 P.D. 117
Delinquents — (see Juvenile Delinquents)
Deming, Julia A., M.D., Psychiatrist in Division of Mental Hygiene — appointment
of, 3
Dementia Praecox, 172
Dentists — Number resident in each institution, 132
Departmental Statistics, 131-140
Deportations, 13, 125, 308
Diagnoses — ■ Epileptics, Non-Psychotic
Admissions: By age at admission, 293; compared with diagnoses of discharges,
deaths, resident population and cases out, 295; by economic status, 294; by
number and percent, 288; by population of place of residence, 294
Discharges: Compared with diagnoses of admissions, deaths, resident population
and cases out, 295; by condition on discharge, 289
Deaths: By age at death, 296; by^cause of death, 296; compared with diagnoses
of admissions, discharges, resident population and cases out, 295; by length
of residence, 296
Resident Population: Compared with diagnoses of admissions, discharges, deaths
and cases out, 295; by length of residence, 292
Cases Out: Compared with diagnoses of admissions, discharges, deaths and resident
population, 295
Diagnoses — Mental Hospitals
Admissions: By age at admission, 159, 323; by average age at admission compared
with average age at admission of discharges, deaths, resident population and
cases out, 225; by alcoholic habits, 335; compared with percentage distribution
of diagnoses in discharges, deaths, resident population and cases out, 225;
by country of origin of foreign born, 316; by country of origin of native born,
318; by degree of education, 341; by detailed classification, all first and read-
missions, 414; by economic status, 343; by hospital, 329; by legal form of
admission, 153; by marital condition, 338; by number of times admitted, 156,
347; by number and percent classified as intemperate in the use of alcohol,
168; by population of place of residence, 345; by transfers, 155; by transfers
and cases discharged directly from Psychopathic to other institutions, 176
Discharges: By age at admission, 353; by average age at admission compared with
average age at admission of admissions, deaths, resident population and cases
out, 225; by age at discharge, 194, 349; compared with percentage distribution
of diagnoses in admissions, deaths, resident population and cases out, 225;
by detailed classification, all first and readmissions discharged, 414; by dis-
charge rates per 1,000 cases under care, 179; by discharge rates per 1,000 cases
under care and present age, 180; by legal form of admission, 177; by length of
hospital stay, 191; by mental condition on discharge, 187, 357; by number
of times out on visit, 197
Deaths: By age at admission, 369; by average age at admission, compared with
average age at admission of admissions, discharges, resident population and
cases out, 225; by age at death, 212, 363; by cause of death, 377; compared
with percentage distribution of diagnoses in admissions, discharges, resident
population and cases out, 225; by death rates per 1,000 under treatment, 199;
by death rates per 1,000 under treatment and present age, 202; by detailed
classification, all first and readmissions dying, 414; by legal form of admission,
198; by length of hospital stay, 210
Resident Population: By admission age and present age, 385, 391 ; by present age,
229; by average age at admission compared with average age at admission of
admissions, discharges, deaths, and cases out, 225; by color, 235, 413; com-
pared with percentage distribution of diagnoses in admissions, discharges,
deaths and cases out, 224; by detailed classification, all first and readmissions
in residence, 414; by legal form of admission, 218; by length of hospital stay,
231, 405-412; percentage distribution, 219
Cases Out: By admission age and present age, 388, 394; by average age at admission
compared with average age at admission of admissions, discharges, deaths
and resident population, 225 ; compared with percentage distribution of diagno-
ses in admissions, discharges, deaths and resident population, 225 ; by detailed
classification, all first and readmissions out, 414
P.D. 117 471
Directory of Institutions, 457
Discharged Directly to Other Institutions from Psychopathic — And transfers, by
diagnosis, 176
Discharges — Mental Hospitals: 176-198, 224, 298-307, 349-362, 382, 413-419
State Schools: 251-261, 277, 426, 433-437, 450
Epileptics, Non-Psychotic: 289, 293
Division Reports — Financial, 20-38; Mental Deficiency, 90-125; Mental Hygiene,
54-89; Pathology, 39-54; Statistical Research, 128; Statistics, 128-140; Sup-
port, 125-128
Drug Psychoses, 174
Duration of Hospital Residence — (see Length of Residence)
Duties of the Department, 2
E
Economic Status — Mental Hospitals
Admissions: By diagnosis, 175, 430; by number and percent of first and readmissions,
165; by use of alcohol, 159
Discharges: By number and rates per 1,000 cases under care, 184
Deaths: By number and rates per 1,000 cases under treatment, 201
Resident Population: By number and percent, 222
Cases Out: By number and percent, 222
Economic Status — State Schools
Admissions: By mental status, 430; percentage distribution, by mental status, 247
Discharges: By mental status and rates per 1,000 under care, 255
Deaths: By mental status and rates per 1,000 under treatment, 264
Economic Status — Epileptics, Non-Psychotic
Admissions: By diagnosis, 294, 343
Education — Mental Hospitals
Admissions: By diagnosis, 341; number and percentage distribution, by first and
readmissions, 166
— Epileptics, Non-Psychotic
Admissions: By age groups, 294
Educational Program — Division of Mental Hygiene, 72
Elm Hill Private School and Home for the Feebleminded — Directory, 465
Employees — Number in institutions, 132
Environment — Mental Hospital Admissions: Rates per 100,000 population of same
environment, 165
Escapes — Mental Hospitals: General statistics, by hospital, 298-307; number and
percent, 1928-1939, 144; number placed and returned by month, 145
State Schools: General statistics, by school, 426; number and percent, 1910-1939,
241; number and percent, by school, 242
Expenditures — And receipts of Department, 28, 140; of Department and Institutions,
26, 134
Expenses — For maintenance and operation, 27-30
Ex-service men — Number in Mental Hospitals, 298-307; 1928-1939, 147; support
cases, 125
F
Family Care Patients — General statistics, 298-307; number placed and returned,
by month, 145; number under institution trustees, by hospital, 146; number
under institutions and under Department, 1904-1939, 146
Farm and Garden Products — Value, 37-38
Financial Division — Report of, (William I. Rose, Business Agent), 20-38
Foreign Born — Mental Hospital Admissions: By age at admission, 316; by country
of origin, rates per 100,000 population same country of origin, 160; by diagnosis,
313
Form of Admission — (see Legal Status)
Foxborough State Hospital — Directory, 458
Freer School — Directory, 465
Furnishings — Special appropriations, 32
472 P.D. 117
G
Gardner State Hospital — Directory, 459
General Statistics — Mental Hospitals, 298-307; State Schools, 426-428
Glenside — Directory, 464
Graduate Nurses — Number employed in institutions, 132
Grafton State Hospital — Directory, 459
Greenough, Charles W., Second Assistant Commissioner — appointment of, 2
Grove Hall Institute — Directory, 465
H
Habit Clinics — (see Child Guidance Clinics)
Hospital Cottages for Children — ■ Directory, 466
Hospital Life, Duration — (see Length of Residence)
I
Industrial and Educational Department, State Hospitals and Schools — Number
employed, 132
Intelligence Quotient — Central Registry Cases: By age groups, 116
Intelligence Quotient — School Clinic Cases: By examining clinic, first examinations,
94; by examining clinic, re-examinations, 94; by number and percent of first
and re-examinations, 1928-1939, 97; by percentage distribution of first and
re-examinations, 96
Intelligence Quotient — State Schools
Admissions: By clinical diagnosis, 249, 432
Discharges: By clinical diagnosis, 260, 435
Deaths: By clinical diagnosis, 269, 439
Resident Population: By age at admission, 279; by clinical diagnosis, 282, 443;
by length of school residence, 281, 446
Intemperate Use of Alcohol — (see Alcoholic Habits)
Investigations — Pathology Division, 47; Support Division, 126
J
Juvenile Delinquents — Examination of, 3, 4
K
Kemble, Robert P., M.D., Director of Clinical Psychiatry at the Worcester Child
Guidance Clinic — appointment of, 3
L
Lawrence Child Guidance Clinic, 56-63
Legal Status — ■ Mental Hospitals
Admissions: 151-154, 298-307
Discharges: 177, 298-307
Deaths: 198, 298-307
Resident Population: 218
— State Schools
Admissions: 244, 426
Discharges: 426
Deaths: 426
— Epileptics, Non-Psychotic
Admissions: 293
Discharges: 293
Deaths: 293
Resident Population: 293
Cases Out: 293
Legislation — New, 13-19; of general interest in 1939, 19-20
Length of Residence — Mental Hospitals
Discharges: By age at admission, 194, 361; by certain psychoses, 191; by hospital,
193; by diagnosis, 189; by nativity groups, 197
Deaths: By age at admission, 210, 373; by certain psychoses, 210; by hospital, 208;
by number of times admitted, 215, 375; by diagnosis, 208
Resident Population: By age at admission, 224; by diagnosis, 230, 405-412
P.D. 117 473
Length of Residence — State Schools
Discharges: By age at admission, 258; by clinical diagnosis, 260, 436; by mental
status, 255, 436; by mental status and year, 1928-1939, 255
Deaths: By clinical diagnosis, 270; by mental status, 264, 439
Resident Population: By age at admission, 273; by clinical diagnosis, 284, 444; by
intelligence quotient, 281, 446; by present age, 274; by school, 277
Cases Out: By school, 277
Length of Residence — Epileptics, Non-Psychotic
Discharges: By number and percent, 289
Deaths: By diagnosis, 296; by year, 1938 and 1939, 291
Resident Population: By diagnosis, 292
Lila Sanatorium — Directory, 466
Lowell Child Guidance Clinic, 56-63
M
Maintenance and Operation of State Institutions, 26-30, 133, 139
Manic-depressive Psychoses, 172
Marital Condition — Mental Hospitals
Admissions: By age at admission, 164, 340; by diagnosis, 338; number and rates
per 100,000 population same marital condition, 163
Discharges: Number and rates per 1,000 under care of same marital condition, 185
Deaths: Number and rates per 1,000 under treatment of same marital condition, 206
Resident Population: By number and percent, 222
Cases Out: By number and percent, 223
Massachusetts Traveling School Clinic System. 90-115
McLean Hospital — Directory, 464
Medfield State Hospital — Directory, 459
Mental and Physical Examination of Children — Juvenile Delinquents, 3, 4
Mental Condition of Discharges from Mental Hospitals — (see Condition on Discharge)
Mental Defectives — Central Registry, 115-118; community supervision, 120
Mental Deficiency Division — Report of, (Neil A. Dayton, M.D., Director), 90-125
Mental Deficiency — Psychoses With, 173
Mental Examination of Persons Coming Before the Courts, 3
Mental Hygiene Clinics, 56-72
Mental Hygiene Division — Report of, (Edgar C. Yerbury, M.D., Director), 54-89
Mental Hygiene Research Activities, 74
Mental Status — ■ State Schools
Admissions: By age at admission, 245, 429; by economic status, 247, 430; by number
and percentage distribution, 245; by population of place of residence, 430;
by year, 1928-1939, 244
Discharges: By age at discharge, 252, 432; by age at discharge and rates per 1,000
under care, 253; by present age and rates per 1,000 under care, 450; by economic
status and rates per 1,000 under care, 255; by length of school stay, 257, 436;
by length of school stay, 1928-1939, 255
Deaths: By age at death, 264, 437; by age at death and rates per 1,000 under treat-
ment, 262; by present age and rates per 1,000 under treatment, 450; by cause
of death, 268, 440; by economic status and rates per 1,000 under treatment,
264; by length of school stay, 266, 439
Resident Population: By population of place of residence, 282, 444; by present age,
450; by school, 273; by year, 1929-1939, 274
Cases Out: By present age, 450
Metropolitan State Hospital — Directory, 460
Molholm, Hans, M.D., Psychiatrist in Division of Mental Hygiene — resignation of, .2
Monson State Hospital — Directory, 460
N
Native Born Admissions to Mental Hospitals — (see Country of Origin)
Nativity and Parentage — ■ Mental Hospitals
Admissions: By age at admission, 157, 311; rates per 100,000 population of same
nativity groups aged 15 years and over, 1930 Census, 157
Discharges: By length of residence, 197
474 P.D. 117
Nativity and Parentage — State Schools
Admissions: By age at admission, 249, 428; rates per 100,000 population of same
nativity groups aged 0-24 years, 1930 Census, 249
Resident Popidation: By age at admission, 275
Nativity and Parentage — Epileptics, Non-Psychotic
Admissions: Rates per 100,000 population of same nativity groups aged 0-24 years,
1930 Census, 288
New Construction, Permanent Betterments, Real Estate and Furnishings, 26, 32
New England Hospital Child Guidance Clinic, 56-63
Non-Insane Patients — 298-307
North Reading Child Guidance Clinic, 56-63
Northampton State Hospital — Directory, 460
Norwood Child Guidance Clinic, 56-63
Nurses — Number in each institution, 132; training schools, 10
0
Observation Cases — (see Legal Status)
Officers and Employees in State Institutions, 132
Overcrowding in State Institutions, 136
P
Parentage and Nativity — (see Nativity and Parentage)
Paroles at State Schools — Number and percent, 1910-1939, 241 ; by school, 242, 426
Pathology Division — Report of, (Myrtelle M. Canavan, M.D., Pathologist), 39-54
Patients at Small Private Hospitals and Schools, 141, 216, 239, 309
Patients in Residence — Mental Hospitals: 132, 141, 216-238, 298-307, 382-425
State Schools: 132, 141, 239, 270-287, 426, 441-456
Epileptics, Non-Psychotic: 292, 295
Public and Private Hospitals, 1904-1939: 216
Public and Private Schools, 1904-1939: 270
Patients on Books — Mental Hospitals: 144, 298-307
State Schools: 239, 426
Epileptics, Non-Psychotic: 293
Patients on Visit and Escape — Mental Hospitals: 144, 222-227, 298-307, 401, 413-419
State Schools: 241, 426, 442
Epileptics, Non-Psychotic: 293
Patients under Care —Mental Hospitals: 141, 179-189
State Schools: 141, 251, 450
Epileptics, Non-Psychotic: 288
Patients under Treatment — Mental Hospitals: 199-208, 298-307
State Schools: 261, 450
Paying Patients, 36, 125, 134, 138
Payrolls — Analysis of, 31
Per Capita Costs — Stats Hospitals and Schools: According to Massachusetts Standard
of Analysis, 28; by analysis of payrolls, by institution, 31; appropriations and
expenses for maintenance and operations, 27-30; for maintenance and opera-
tion, 1917-1939, 133, 139
Perkins School — Directory, 466
Personal Services, 26, 28
Personnel — State Institutions, 132; Traveling School Clinics, 96
Physicians — Number in each institution, 132
Pollock School — Directory, 466; license issued to Morris P. Pollock, 5
Population of Place of Residence — ■ Mental Hospitals
Admissions: By diagnosis, 345; rates per 100,000 of same population units, 1930
Census, 166
Population of Place of Residence — State Schools
Admissions: By mental status, 430; rates per 100,000 of same population units,
1930 Census, 246
Resident Popidation: By mental status, 282, 444
Population of Place of Residence — Epileptics, Non-Psychotic
Admissions: By diagnosis, 294
P.D. 117 475
Present Age — (see Age)
Private Hospital — Directory, 465
Private Hospitals — Number of patients, 141, 309; in residence, 1904-1939, 216; admis-
sions, 1917-1939, 149
Private Institutions — Changes in, 5
Private Schools — Number of patients, 141, 239, 309
Psychiatrists — Traveling School Clinic, 96
Psychological Service — Division of Mental Hygiene, 64
Psychologists — Traveling School Clinic, 96
Psychoneuroses, 175
Psychoses — (see Diagnoses)
Publications — Division of Mental Hygiene, 80, 87; Division of Pathology, 50
Quincy Child Guidance Clinic, 56-63
R
Race — Mental Hospital admissions, 337
Rates per 100,000 State Population — Mental Hospitals
Admissions: By country of birth of first and readmissions in resident population,
235 ; by county of residence of all admissions and resident population, 236 ; by
citizenship, 162; by environment, 165; first and readmissions, 1917-1939, 149;
foreign born, by country of origin, 161 ; by marital condition, 162; native born,
by country of origin, 161 ; by nativity and parentage of first and readmissions,
480; by population of place of residence, 165; voluntary admissions to public
and private institutions, 1928-1939, 151
Resident Population: By country of birth of first and readmissions in resident popu-
lation, 235; by county of residence of all admissions and resident population,
236; by number and annual increase, 1904-1939, 142; number and rate of all
public and private hospitals, 1904-1939, 217
Rates per 100,000 State Population — State Schools
Admissions: By age at admission, 246; by country of origin of native born, 251; by
county of residence of admissions and resident population, 285; by mental
status, 1928-1939, 244; by nativity and parentage, 249; by number, 1904-
1939, 239; by population of place of residence, 246
Resident Population: By county of residence of admissions and resident population,
285; by mental status, 1929-1939, 274; by mental status and population of
place of residence, 282; by number, 1904-1939, 241; by number and annual
increase, 1904-1939, 142
Rates per 100,000 State Population — Epileptics, Non-Psychotic
Admissions: By age at admission, 289; by nativity and parentage, 288
Rates per 100,000 State Population — Private Institutions: By first and readmissions,
1917-1939, 149; by number and annual increase of resident population, 1904-
1939, 142
Rates per 1,000 State Population — Mental Hospitals
Discharges: By number of this admission, 187; by diagnosis, 179; by diagnosis and
present age, 180
Deaths: By number of this admission, 207; by diagnosis, 199; by diagnosis and
present age, 199
Reading Child Guidance Clinic, 56-63
Real Estate — Special appropriation, 32
Reasons for Referral, School Clinic Examinations, 92-94
Receipts — And expenditures of Department, 26-27; collected from paying patients, 36;
Support Division, 126
Recommendations — Division of Mental Deficiency, 124; Traveling School Clinic
cases, 97-105
Reeves' Sanitarium — Directory, 464
Reimbursing Cases — Board Rates, 36, 127; State Institutions, 126
Religious Instruction in State Institutions — Expenses, 28
Reports — (see Division Reports)
476 P.D. 117
Research Activities — Mental Deficiency, 119; Mental Hygiene (Dr. Thorn), 74; Monson
(Dr. Hoskins), 82; Boston State (Dr. Myerson), 77; Boston Psychopathic
(Dr. Solomon), 76; Worcester (Dr. Angyal), 83; Statistical, 128; Psychiatric
Institute (Dr. Canavan), 76; McLean, 79; Grafton (Dr. Cohen), 80
Residence — (see Length of Residence)
Residence — Of cases examined by Traveling School Clinics, 97-105
Resident Population — (see Patients in Residence)
Retardation — Incidence in public school children of Massachusetts, 106-115
Ring Sanatorium and Hospital, Inc., — Directory, 446; new license granted to Dr.
Curtis T. Prout, 5
Rockefeller Fund, Laura Spelman, 128
Rotation in Service — Persons employed in institutions, 31
S
Schizophrenia — Publications, 87; research, 83
Senile Psychoses, 170
Service Rendered — Child Guidance Clinics, 58
Social Service — Division of Mental Deficiency, 120
Social Workers — Number in each institution, 132; Traveling School Clinic, 96
Sources of Contact — Central Registry cases, 116; Child Guidance Clinic cases, 117
Special Classes — Retarded children in public schools, 106-115
Springfield Child Guidance Clinic, 65-69
Standish Manor — Directory, 466
Statistical Division — Report of, (Neil A. Dayton, M.D., Director), 128-140
Statistical Research Division — Report of, (Neil A. Dayton, M.D., Director), 128
Statistical Review — Mental Disorders, 141-238; Mental Deficiency, 239-287; Epilepsy,
Non-Psychotic, 288-296
Statistics — Departmental, 131-140; Epilepsy, Non-Psychotic, 288-296; Financial,
26-38; General, 298-307, 426; Mental Disorders, 141-238; Mental Deficiency,
239-287; Mental Hygiene Child Guidance Clinics, 60
Sudden Deaths in State Hospitals, 45
Suicides in State Hospitals, 46
Support of Patient Population — State Hospitals, 298-307
State Schools, 426
Support Division — ■ Report of, (Paul A. Green, Supsrvisor), 125-123
Syphilitic Meningo-encephaltis, 170
T
Taunton State Hospital — Directory, 461
Temporary Care Cases — (see Legal Status)
Tewksbury State Hospital and Infirmary, Mental Wards — Directory, 461
Times Admitted — Mental Hospitals
Admissions: 156, 347
Discharges: 187
Deaths: 207, 215, 375
Times Out on Visit, etc., — Mental Hospitals, by diagnosis, 197
State Schools, 258, 435
Total Costs — Estimated for resident population: State Hospitals, 232; State Schools, 274
Transfers — Mental Hospitals
Admissions: General statistics by institution, 298-307; by diagnosis, 135; cases
discharged directly from Psychopathic to other institutions, by diagnosis, 176
Discharges: General statistics, by institution, 298-307; by diagnosis, 178
Transfers — State Schools
Admissions: General statistics by school, 426; number and first and readmissions,
244
Discharges: General statistics by school, 426
Transfers — Epileptics, Non-Psychotic
Admissions: 293
Discharges: 293
Traveling School Clinics, 90-115
Trust Funds, 36
P.D. 117 477
V
Valuation — Land, building and betterments, personal property, farm and garden
products, industrial, 131
Value — Farm and garden products, 37-38
Veterans — Number in mental hospitals, 147, 298-307
Veterans' Administration Facility No. 95 — Directory, 464; new license given to Dr.
William M. Dobson, 5
Veterans' Administration Facility No. 107 — Directory, 465
Visits — Mental Hospitals: General statistics by hospital, 298-307; number and percent,
1928-1939, 144; number placed and returned by month, 145; rates per 1,000
daily average population, by institution, 144
Visits — State Schools: General statistics by school, 426; number and percent 1910-1939,
241; rates per 1,000 daily average population by school, 242; number and
percent by school, 242; number of times by school, 435
Voluntary Care Cases — (see Legal Status)
Voluntary Care Cases — Public and Private Institutions: 1928-1939, 151
W
Waiting Lists of Patients to State Schools, 121-123
Walter E. Fernald State School — Directory, 463
Washingtonian Home — Directory, 465
West End Child Guidance Clinic, 56-63
Westborough State Hospital — Directory, 461
Westwood Lodge — Directory, 465
Wiswall Sanatorium — Directory, 465
Woodlawn Sanitarium — Directory, 466
Worcester Child Guidance Clinic — 69-70
Worcester State Hospital — Directory, 462
Wrentham State School — Directory, 463
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