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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 



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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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P.D. 117 5 

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 



95.8 
100 


21 
41 






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 . . . 



3 

7 

14 




6 
3 

8 




7 
4 
5 
6 



18 
10 


25 


13 







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 



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Steam Lines . ... 
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Dairy Unit and Equipment . 
Refrigeration System Improvei 


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Belchertown Stat 
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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 


+ 


+ 





+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 


+ 





± 


+ 


+ 


+ 


+ 





Toledo 






Equipment 


Scales or 


Incinera- 


His- 




Other 


ation 


tology 


± ttable poor 


+ 


± 





± ttable poor 


+ 


± 





+ 


+ 





+ 


+ 


+ 


+ 


± 


+ 


+ 


± 


± 


+ 


+ 








+ 


+ 





+ 


+ 


+ 


± 


+ 


+ 


Other 





+ 


+ 


+ 


+ 


+ 


± ttable poor 


Other 





± 


+ 


+ 


+ 


+ 


+ 


Other 


± 


+ 


± ttable poor 


+ 


+ 





+ 


+ 


± 


± 


± ttable poor 


+ 





± 



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 



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 Psj r chopathic 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 








49 









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 

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 



159 3 ,V 
108yi 

i032,y* 

92 2 8 
74V 2 
78* 

722,5 

67 1 
54i,ii 
52 5 ,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. 
2 Three accidents to one patient. 
3 Four accidents to one patient. 
4 Two accidents to two patients. 
5 Two accidents to three patients. 
f Two accidents to five patients. 
'Two accidents to six patients. 



"Two accidents to seven patients. 

'Three accidents to two patients. 
10 Aceident prior to admission. 
nTwo accidents prior to admission. 
I2 Nine 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 





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 





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, 

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P.D. 117 51 

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Cottington, Frances and Gavigan, A. J. — Metrazol treatment of depressions. New 

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Flower, B. H. and Cohen B. — The Attention Defect in Schizophrenia, its Grada- 
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on Therapy, p. 63-67, September, 1939. 
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May 1939. 



52 P.D. 117 

Kent, Grace H. — The Use and Abuse of Mental Tests in Clinical Diagnoses. Psychol. 

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in the Paretic Variety. Am. Jour. Syph., Gonorr. and Ven. Disease, 23, 751, 1939. 
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arterial hypertension. Annals Inst. Med. 12: 1213-1222 (Feb.) 1939. 
Loman, J., Rinkel, M. and Myerson, A. — Comparative effects of amphetamine 

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Longpre, Fernand — The Use of Sodium Amytal Combined with Psychotherapy in 

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"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. 
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and schizophrenic subjects by exercise. Am. Jour. Med. Sci. 198: 57, July 1939. 
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the photoelectric colorimeter. Jour. Biol. Chem. 127: 117, January 1939. 
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treatment of acute schizophrenia. V. The blood minerals. Endocrinology 25: 282, 

August 1939. 
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patients). Am. Jour. Med. Sci. 198: 528, October 1939. 
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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 

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Maletz, Leo — Pastoral Psychiatry — John Bonsell. Mental Hygiene, 23, No. 4, 

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Occupat. Therapy, 13, No. 3, May 1939. 
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P.D. 117 53 

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54 P.D. 117 

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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 


"3 


■3*3 

rS'2- 


to 

c 

'•B 


-a 



o 


>> 


-3 


T3 

a 
m 


"s 









53 


is 
o 









'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 
01 

% 






J2 o3 


o 
o 

& 
o 


>> 

o 

a 
'3 


■3 

03 


s 


13 
o 




pq 


PQ 




J 


!< 


!< 


X 


O 1 


« 


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 



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 






. 


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 


. 


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 B 2 deficiency state was produced in pigeons by putting them on a diet of polished 
rice, at the same time giving them injections of vitamin B t . 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 B B 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 C0 2 (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 



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94 P.D. 117 

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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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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105 



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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Bernardston 

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Burlington 



108 



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 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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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 








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 








.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 





9 


- - 


- 


- — 


- 


Bridgewater 


9.72 


- 


7.24 


5 





— — 


- 


1.42 


14.00 


Hosp. Cottages . 


2.43 


1.00 


2.47 


4 


1 


- - 


— 


— - 


- 


Family Care 


- 


- 


- 





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 



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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 




s 4 / / / / //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 Books 1 


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 
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 



145 



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137 144 281 
95 131 226 
8 1 9 
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4 20 24 
7 8 15 
12,493 13,658 26,151 

10.9 10.5 10.7 

7.6 9.5 8.6 


PS 

■< 
p 

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fa 


130 167 297 

214 248 462 

14 9 23 

12 9 21 

4 9 13 

2 7 9 

12,511 13,677 26,188 

10.3 12.2 11.3 

17.1 18.1 17.6 


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366 449 815 

183 248 431 

14 5 19 

13 6 19 

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2 19 21 

12,537 13,672 26,209 

29.1 32 8 31.0 

14 5 18.1 16.4 


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285 368 653 
210 220 430 
11 6 17 
14 3 17 
6 11 17 
2 7 9 
12,493 13,708 26,201 

22 . 8 26.8 24 . 9 

16.8 16.0 16.4 


K 
H 
M 

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O 

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fa 


228 234 462 
146 175 321 

24 3 27 

25 5 30 
4 20 24 
3 11 14 

12,477 13,682 26,159 

18.2 17.1 17.6 
11.7 12 7 12.2 


< 

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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 
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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 

14.2 15.3 14.8 


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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 



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150 P.D. 117 

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 


Total 1 


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 


Total 1 . 


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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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 


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1.9 








39 


43 


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18 


42 


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10 


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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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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 


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 . 
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. 


Canada 1 . 


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. 


Canada 1 . 






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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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 


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 



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P.D. 117 



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P.D. 117 167 

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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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 





.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 


. 


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 


. 


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 


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 


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 


OSPITALS 1 






Number 


Percent 


Number 


] 


5 ercen1 






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 



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184 P.D. 117 

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 


Canada 1 








1,671 


215 


128.6 


Canada 1 








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- 


















order 1 


.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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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 



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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 

Canada 1 . 

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 



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210 



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 



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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 

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.6 

.5 

.4 

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10.9 

3.7 

1.5 

8.9 

2.9 

13.7 

5.7 

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8.6 

2.4 

5.5 

2.9 

.4 

3.1 

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. 7 

1.1 

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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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With syphilitic meningo-en 
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Alcoholic psychoses 
Due to drugs, etc. 
Traumatic psychoses . 
With cerebral arterioscleros 
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With convulsive disorders 1 
Senile psychoses . 
Involutional psychoses 
Due to other metabolic dis< 
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With organic changes of ner 
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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%. 



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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 


Unknown 1 


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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228 



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 
3 r ears. 

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 



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P.D. 117 



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 

Canada 1 . 

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 
County 1 


Admission 








Same 
County 1 


















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 


1935 1 


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 Admissions 1 


100,000 Population 2 










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 


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 





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 







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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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 


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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266 



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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268 



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 


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 



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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 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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