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Full text of "Annual report of the trustees of the Worcester State Hospital"



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Public Document No. 23 



EIGHTIETH ANNUAL REPOET 



THE TRUSTEES 



Worcester State Hospital, 



THIRTY-FIFTH ANNUAL REPORT OF THE TRUSTEES 



WORCESTER STATE ASYLUM AT WORCESTER, 



Year ending November 30, 1912. 




BOSTON: 

WEIGHT & POTTEB PEINTING CO., STATE PEINTERS, 

18 Post Office Square. 

1913. 



Public Document No. 23 



EIGHTIETH ANNUAL EEPOET 



THE TRUSTEES 



OM 



Worcester State Hospital, 



THIRTY-FIFTH ANNUAL REPORT OF THE TRUSTEES 



WORCESTER STATE ASYLUM AT WORCESTER, 



Yeak ending November 30, 1912. 




BOSTON:! 
WEIGHT & POTTEE PEINTING CO., STATE PEiNTEES, 

18 Post Office Square. 
1913. 



Ivua*?^ ((^A^l^ 



Approved by 
The State Board of Publication. 



3 



CONTENT^. 



PAGE 

Report of Trustees, 7 

Report of Superintendent, . . 10 

Laboratory Report, 20 

Products of the Farm, . 28 

Farm Account, 28 

Valuation, 31 

Report of Treasurer, 32 

Statement of Funds, 38 

Statistics, - 41 



OFFICERS OF THE HOSPITAL. 



TRUSTEES. 

SAMUEL B. WOODWARD, Worcester. 

GEORGE F. BLAKE Worcester. 

LYMAN A. ELY, Worcester. 

T. HOVEY GAGE Worcester. 

THOMAS RUSSELL, Boston. 

CARRIE B. HARRINGTON Worcester. 

GEORGIE A. BACON, Worcester. 



RESIDENT OFFICERS. 



ERNEST V. SCRIBNER, M.D., . 
RAY L. WHITNEY, M.D., . 
GEORGE A. McIVER, M.D., 
CORNELIA B. J. SCHORER, M.D., 
FLOYD A. WEED, M.D., . 
HENNING V. HENDRICKS, M.D., 
S. CARLETON GWYNNE, M.D., 
IDA A. McNEIL, .... 
MULFORD H. CENTER, . 
MARY F. DUDLEY, . 
JOSEPH T. REYNOLDS, 



Superintendent. 

First Assistant Physician. 

Assistant Physician. 

Assistant Physician. 

Assistant Physician. 

Assistant Physician. 

Assistant Physician. 

Superintendent of Nurses. 

Steward. 

Matron. 

Farmer. 



NONRESIDENT OFFICERS. 



SAMUEL T. ORTON, M.D., 

HOWARD BEAL, M.D., 
WALTER W. CAMPBELL, D.D.S 
GEORGE E. PARESEAU, . 
GEORGE L. CLARK, . 
JESSIE M. D. HAMILTON, 
JAMES DICKISON, Jr., 



Clinical Director and Patholo- 
gist. 
Consulting Surgeon. 
Dentist. 
Druggist. 
Auditor. 
Clerk. 
Engineer. 



®t)£ Cmnmomoealtf) of ittassartjusettB, 



TRUSTEES' REPORT. 



To His Excellency the Governor and the Honorable Council. 

The trustees of the Worcester State Hospital herewith re- 
spectfully submit their eightieth annual report. The annexed 
reports of the superintendent and treasurer contain details of 
the financial condition of the hospital, and of the commitment, 
discharge, transfer and health of the inmates. 

The new building provided for by the legislative appropria- 
tions of last year will be completed ■ and ready for occupancy 
within the next six months, as will also the additional story to 
the Salisbury ward. 

With its completion a dining room for male attendants will 
.be available, dining facilities for a certain number of patients 
provided, and, to an extent, the deplorable overcrowding of 
the male wards relieved. 

With the completion of the elevator in the Woodward build- 
ing, the weak, the feeble and the aged will be enabled to share 
the advantages now enjoyed by those only who are able to reach 
the enclosed roof space through their own exertions. 

The dining facilities for patients are, and long have been, 
entirely inadequate. The main building, erected thirty-five 
years ago to house and care for 600 patients, contains, with the 
additions, at the present time an average of over 1,300. With 
38 dining rooms, of limited capacity, it is also necessary to 
place permanent tables in the corridors in many places, thus 
diminishing the day space, at the best none too ample, and 
rendering proper service out of the question. 

The distance of many of these dining rooms from the kitchen, 
as well as their multiplicity, makes the service expensive, 
increases greatly the number of employees required (and inci- 
dentally housed and cared for), and makes impossible adequate 
general supervision. 

Alteration of the present laundry building, which is admir- 



8 WORCESTER STATE HOSPITAL. [Dec. 

ably situated for efficient and economical administration, will, 
with the new dining room for male patients, provide room for 
the majority of patients (practically for all) who are in a 
suitable state to enter a congregate dining room; and it is 
conservative to say that in each of the present dining rooms 
thus vacated, from 8 to 10 patients can be provided with sleep- 
ing quarters. 

A new laundry building, to supply the place so converted, 
will provide in its upper story a large room for industrial 
work, which must at present be inadequately and expensively 
accommodated in rooms in various parts of the main building. 

For these purposes the trustees ask for an appropriation of 
$75,000. 

To complete alterations in and to furnish the farmhouse, 
near the cow barn, an appropriation of $4,600 is needed. This 
building, when completed, will house some 20 employees, who 
are now provided for in the neighborhood and outside of the 
hospital limits. 

The full complement of female attendants is 123 ; but 80 of 
these are cared f or, in the nurses' home ; the remainder occupy- 
ing rooms that would otherwise be used by patients. Eight 
thousand dollars expended in finishing the attic of the present 
home will provide for 22 nurses, and the trustees, therefore, 
ask for $8,000 to be so expended. 

To retain in the hospital service married employees has 
always been a difficult matter. Accommodations in the main 
building are lacking, and the trustees ask for $17,350 to be 
expended in the erection of two buildings, in each of which a 
married employee or assistant physician may reside, while 
room will also be provided for from 10 to 12 single persons 
in each building. 

For eight consecutive years the question of the proper dis- 
posal of the hospital sewage has in one form or another been 
before the legislative body. In their seventy-ninth report the 
trustees stated that " The constant growth of the institution, 
the ever-increasing size of the surrounding community, the in- 
stallation of a hydrotherapeutic plant, and the establishment 
of a congregate bath house have made it next to impossible to 
properly care for the consequent drainage." 



1912.] PUBLIC DOCUMENT — No. 23. 9 

What is known as a " septic tank " on the hospital premises, 
not far from a public road, and the flowage of a part of the 
waste water into a neighboring brook, are not proper condi- 
tions to find on the grounds of a Massachusetts State institution. 
The trustees again ask the Legislature for relief, and consider 
that the most satisfactory solution of the matter will be to con- 
nect the hospital system with that of the city of Worcester. 

The purchase of the Curtis land this year materially re- 
duces the expense of constructing proper connections with the 
Worcester system, and to accomplish this the trustees ask for 
an appropriation of $7,500. 

On April 1, 1912, Dr. H. M. Quinby, whose resignation had 
been for some months in the hands of the trustees, but who 
had kindly remained, pending the choice of his successor, was 
succeeded as superintendent by Dr. E. V. Scribner, long in 
charge of the Worcester State Asylum, and who was well 
known to this Board for his efficient and faithful service in that 
capacity. 

At the same time Miss Lila J. Gordon, who had for twenty 
years served as matron, sent in her resignation. 

To Dr. Quinby's long and faithful services the trustees bore 
testimony in their seventy-eighth report; they can now but 
thank him for his willingness to remain during the trying time 
of impending change. 

To the superintendent and members of the staff, and to the 
employees generally, the trustees wish to express their appre- 
ciation of faithful services rendered. 

Respectfully submitted, 

SAMUEL B. WOODWARD. 
GEORGE F. BLAKE. 
LYMAN A. ELY. 
T. HOVEY GAGE. 
THOMAS RUSSELL. 
CARRIE B. HARRINGTON. 
GEORGIE A. BACON. 

Nov. 30, 1912. 



10 WORCESTER STATE HOSPITAL. [Dec. 



SUPERINTENDENT'S REPORT. 



To the Trustees of the Worcester State Hospital. 

I herewith respectfully submit the following report of the 
hospital for the year ending Nov. 30, 1912, it being the 
eightieth annual report. 

There remained at the hospital Oct. 1, 1911, 1,347 patients, 
— 674 men and 673 women. During the year ending Sept. 
30, 1912, there were admitted 605 patients, — 319 men and 
286 women. Six hundred and fifty-two patients — 359 men 
and 293 women — were dismissed from the hospital. Of this 
number, 241 patients — 121 men and 120 women — were dis- 
charged; 142 patients — 86 men and 56 women — died; 138 
patients — 78 men and 60 women — were transferred ; and 
130 patients — 73 men and 57 women — left on visit or escape, 
leaving at the end of the statistical year 1,300 patients, — 634 
men and 6QQ women. Of this number, 1,036 were supported 
by the State, 148 by friends, and 116 as reimbursing patients. 
Of the 370 patients discharged and transferred, 94 (including 
11 habitual drunkards, women) were reported recovered, 71 
capable of self-support, 34 improved and 171 not improved. 
Six men and 3 women were discharged as not insane. Forty- 
nine men and 25 women were transferred by the State Board 
of Insanity to the Medfield State Asylum"; 15 men and 14 
women to the Gardner State Colony; 3 men and 3 women to 
the Boston State Hospital; 2 men to the Danvers State Hos- 
pital; 2 men to the Massachusetts School for the Feeble- 
minded ; 2 men to the Westborough State Hospital ; 1 man and 
3 women to the State Infirmary, Tewksbury; 1 man to the 
Taunton State Hospital; 1 man to Herbert Hall; 1 man to 
the Bridgewater State Hospital; and 1 man to the Monson 
State Hospital. Twenty men and 11 women were removed 
from the State, and 15 women were boarded out. 

There remained at the end of the year 47 patients less than 
at the beginning. The smallest number under treatment on any 



1912.] PUBLIC DOCUMENT — No. 23. 11 

one day was 1,286, and the largest 1,421. The daily average 
number was 1,359.69. 

The percentage of recoveries, calculated upon the number of 
discharged and deaths, was 18 ; calculated upon the number of 
admissions it was 10.6. 

The death rate was 7.3 calculated on the whole number of 
patients under treatment, and 10.4 calculated on the daily 
average number. 

There have been 55 less admissions than during the preced- 
ing year. This, however, cannot be interpreted as indicating 
a lessened insanity rate in the community, but is rather due to 
the fact that during the greater part of the year no cases were 
admitted from Suffolk County, patients from that district hav- 
ing been sent to other institutions. The commitments from 
other counties have maintained their usual average. 

It is of interest to note that the number of acute alcoholics 
has very materially lessened of late. This is no doubt due in 
large measure to the operation of the law which requires that 
cases of delirium tremens shall be cared for in the general 
hospitals. This law seems to be productive of good in that 
while the sufferer still receives entirely adequate attention, the 
insane hospital is freed from a very disturbing element. The 
absence of acute alcoholics from our wards has done much to 
increase the general comfort and quiet. Of the 46 cases of 
manic-depressive psychosis admitted, 36 were women. The 
depressed phase predominated in both sexes. During the year 
98 cases of senile psychosis were admitted, as against 60 of the 
previous year. There appears to be an increasing tendency to 
the accumulation in our wards of the chronic and senile types 
of mental disease. 

In the cases of general paralysis which have been admitted, 
the type of the disease has been more. of a fatuous and simple 
dementing character than of the expansive, exhilarated and 
aggressive type which has been characteristic of some former 
years. It seems quite possible that the type of this psychosis 
is changing, though it can be said that many of the cases ad- 
mitted have been in the terminal paralytic stage. 

One woman was received from the women's prison. The 
Commonwealth has established separate provisions for its male 



12 WORCESTER STATE HOSPITAL. [Dec. 

criminal insane, where they can be properly cared for without 
detriment to the interests of the other insane in institutions. 
Eor the female criminal, however, no special provision has been 
made, and in the event of an inmate of the women's prison 
becoming insane, she is committed to one of the regular insti- 
tutions for the treatment of mental disease, to the serious dis- 
turbance of the discipline of the institution and to the detri- 
ment of its patients. Such an arrangement makes it extremely 
difficult for the hospital to discharge its full duties to each 
class of cases. The innocent patient suffers not only from 
forced association with persons of criminal instincts, but in the 
restriction of personal liberties and privileges incident to the 
necessity for the maintenance of a prison discipline sufficiently 
rigorous to prevent escape. It is to be hoped that this class of 
cases can be given early accommodation elsewhere. 

During the year an effort has been made to improve the care 
and attention given to the acute male service. A special ward 
has been set apart in order to still further assist in classifica- 
tion. This ward has been placed in charge of a female gradu- 
ate nurse. Although this arrangement has been in operation 
for only a few months of the year, the more hospital-like sur- 
roundings, and the greater degree of personal attention made 
possible, have seemed to do much to quiet the patient and to 
allay his suspicions. There is a greater degree of comfort and a 
lessened amount of disorder and violence. In many cases im- 
provement and recovery seem to have been hastened. I am 
very sure that it would be profitable to place other wards of the 
male service under the direction of female nurses. 

The hospital training school is in prosperous condition. The 
attendance of all female nurses is obligatory. The school is 
open to male attendants and they are encouraged to take advan- 
tage of its opportunities, though too few take up the work. 
The present membership of the school is 108. A class of 10 
will soon graduate. The school continues to be a most valuable 
agency in the promotion of intelligent care of the patient and 
a generally broader conception of the duties of a nurse. 

While the number of written applications for employment 
has been rather less than in some former years, there have 



1912.] PUBLIC DOCUMENT — No. 23. - 13 

been more who have made personal application, rendering it 
easier to make a proper selection from the material presented, 
so that perhaps less difficulty than usnal has been experienced 
in securing proper persons for the service. 

A special effort has been made to get as many patients as 
possible out of doors and to encourage them in heathful exer- 
cises and amusements. As a result many cases have shown a 
marked physical improvement; sleep at night has been pro- 
moted, turbulence has been diminished and the general well- 
being materially promoted. Generally ward conditions have 
been improved and a greater degree of contentment is noted. 

While the general health of the house has been good, there 
have been quite a number of cases of dysentery and acute in- 
fectious diseases. The pathologist has made a special study of 
these cases, the details of which are presented in his report. 
Five cases of typhoid fever occurred during the year. The first 
two cases were male attendants, who undoubtedly contracted 
the disease somewhere outside of the institution. NTo new cases 
have developed of late, and it seems reasonably certain that 
no focus for further infection exists on the premises. 

"With the general broadening of the activities of the insti- 
tution, the abolition of restraint, and the giving of greater 
personal attention to patients, I have found it necessary not 
only to increase the number of persons employed, but to change 
somewhat the scope of operations of certain special depart- 
ments. The more purely medical work has been reorganized. 
An assistant is to be furnished to the pathologist, enabling 
him to take up also the direction of the clinical work. This 
will more fully co-ordinate the clinical and the research work 
of the laboratory in a way that will be beneficial to both. Staff 
meetings are held daily at which patients are presented and 
their cases studied. Once each week different persons present 
a review of the recent medical literature bearing on our spe- 
cialty. Once each week the pathologist gives an evening lecture 
in the laboratory. The increased facilities for study and obser- 
vation which will result to the staff, it is believed, will render 
the service more attractive to earnest and capable medical 
men, and it is hoped will to some extent counterbalance the in- 



14 WORCESTER STATE HOSPITAL. [Dec. 

adequate salaries which have hitherto been offered. The higher 
salaries of adjoining communities have created a serious ob- 
stacle to securing and retaining in the service the full comple- 
ment of medical men. This financial defect should be reme- 
died. 

I believe that the medical men of the institution and the 
doctor in general practice have hitherto known too little of 
each other's work. We should come together in frequent con- 
ference which cannot but result in material benefit to both. 
The institution could thus learn more of the general causes 
and of the environment which contributed to the patient's break- 
down. The general practitioner could gain a more intimate 
knowledge of mental disease, perhaps making possible an earlier 
diagnosis of cases which would lead either to an earlier hos- 
pital commitment, when deemed advisable, or to the adoption 
of such treatment at home as might possibly avoid commit- 
ment altogether. 

The institution has not discharged its whole duty to its 
patient with his return into the community, even if recovery 
seems then assured. The further history of the case should be 
followed and the patient and his friends made to feel that the 
institution management continues to have an interest in him 
and his welfare. He should be encouraged to return for ad- 
vice and assistance should he feel the need. In such cases a 
social worker could render great service in after-care and could 
in many other ways be of material aid in furthering the work 
of the institution. Such an officer should be added to the staff. 
Not only should the institution accord a painstaking and in- 
telligent care to its patients, but it should be considerate and 
helpful in its relations to friends and relatives. The greatest 
effort, consistent with the proper care of the patient, is made 
to accommodate the public in the matter of visiting. In a large 
institution it is quite necessary that some regulation should 
exist as to visiting days, in order that the necessary medical 
attention to the patients may be interfered with as little as 
possible. In case of illness friends and relatives are admitted 
at any time. Under ordinary circumstances visitors are re- 
ceived on two week days. Visitors to whom it would be a hard- 



1912.] PUBLIC DOCUMENT — No. 23. 15 

ship to come on other days are admitted on Sundays, when 
special request is made. 

While the services of a dentist have been utilized to a con- 
siderable extent in the past, an arrangement has now been made 
with a local man whereby he comes to the institution and de- 
votes one day of each week to the care of the patients' teeth. 
This service will be extended to meet the needs which develop. 

The high prices of foodstuffs, and the increased fuel con- 
sumption occasioned by the unusual cold of last winter, com- 
bined perhaps with other minor causes, made it evident, early 
in the year, that a financial deficit was impending. In the 
effort to make this deficit as small as possible much very neces- 
sary work of repair and refurnishing has been held in abeyance 
and will have to be accomplished as a part of the coming year's 
operations. 

A great amount of work has been accomplished by male 
patients in out-of-door work in farming, the care of roads and 
grounds, and in the excavation and preparation of the site for 
our new coal pockets. A beginning has been made in out-of- 
door work for women, which it is proposed to enlarge and ex- 
tend as rapidly as seems feasible. The general work of the de- 
partments has continued as before. The patients now, with the 
direction and assistance of paid employees, manufacture all of 
our bed linen, all of the women's cotton underwear, all of the 
women's wrappers and all table linen and towels. In the 
special industrial room a vast amount of fancy work, basketry 
and rugs is produced. In a short time broom, brush and basket 
making and cabinet work will be established as occupational 
diversions for men. In the tailor shop male patients are em- 
ployed in the repairing and manufacture of men's clothing. 
In this same department shoe and harness repairing is done. 
Patients also aid in the manufacture of mattresses and 
draperies. 

This institution was among the pioneers in the industrial 
employment of its patients. About 1882, under the superin- 
tendency of Dr. J. G. Park, patients were very successfully 
and profitably employed in spinning and rug making and other 
industrial pursuits. Much work was done with the hand loom 



16 WORCESTER STATE HOSPITAL. [Dec. 

and patients showed great interest and proficiency in occupa- 
tion. 

Dances and parties have been held in the chapel ; the patients 
have been entertained by the phonograph and in various other 
ways. 

Regular religious services have been held in the chapel by 
Protestant and by Catholic clergymen. 

In considering the physical needs of the institution the 
improvement of the food service is one of the most important. 
Now food is served in small dining rooms, many at considerable 
distances from the general kitchen. Quite a number of these 
rooms are dark and unattractive and lacking in those plumbing 
facilities which are so necessary for satisfactory and efficient 
service. To repair and improve the present rooms would not 
only be an expensive proposition, but would tend to perpetuate 
unsatisfactory and undesirable methods. The feeble and bed- 
ridden people of the infirmary wards, many acute cases, and 
those highly excitable and violent, will obviously continue to 
require the service of food on the ward. The great mass of our 
patients, however, can be better served in a central dining room. 
The building now occupied by the laundry and carpenter shop 
can be remodeled and adapted for use as a general dining room 
for both sexes. This building is situated close to the kitchen 
and is also conveniently located for easy access from the wards 
for both male and female patients. A thousand persons can be 
taken care of here. The ward dining rooms which will be 
vacated will require little more than painting and furnishing 
to fit them for occupancy as dormitories, thus affording addi- 
tional accommodation for the annual increase of the State's 
insane, at a very low per capita cost. 

It is proposed to very largely augment the industrial activ- 
ities of the institution. The present rooms which are avail- 
able for manufacturing purposes are scattered in different parts 
of the buildings. However well adapted each individual room 
may be for its special operations, widely separated units do not 
make for business economy and efficiency in administration. 
The greater the number of industries that can be grouped to- 
gether the less will be the cost of supervision. I recommend to 
your Board that an appropriation of $75,000 be asked from the 



1912.] PUBLIC DOCUMENT — No. 23. 17 

next Legislature for the purpose of erecting a two-story and 
basement building, the basement and first storj to be utilized 
for laundry operations, and the top story for general indus- 
trial purposes. This sum would also suffice for the moving of 
the laundry machinery from its present location to the proposed 
new building, and the adaptation of the present laundry build- 
ing for the purposes of a general dining room. These opera- 
tions are grouped under one request because they are mutually 
dependent upon each other and can best be carried out together. 

It should be our earnest effort to spare no pains to raise the 
standard of service and excellence of administration in our 
institutions that we may better and more intelligently treat the 
unfortunate persons committed to our care. Upon no one 
agency are we more dependent than upon the corps of employees. 
How necessary, then, that we not only secure competent and 
faithful persons, but make the conditions of living such that 
good men and good women will remain in the service. In- 
creased accommodations are needed for both men and women. 
I recommend that an appropriation of $17,350 be asked for 
the erection and furnishing of two cottages for employees, the 
lower story of which in each can be occupied by a man and his 
family, with rooms for other employees on the upper floor. 
Each cottage will furnish accommodation for 10 employees. 

In the female nurses' home is a large and commodious attic, 
at present used only for storage purposes. For $8,000 this 
attic can be finished off into rooms and furnished, providing 
excellent quarters for 22 additional nurses. I recommend that 
the above sum be asked for the purpose specified. 

At the time of the original purchase of the hospital land a 
farmhouse already stood on the premises. This house was 
used for some years and was later removed to a new location 
to make room for a more modern and commodious structure. 
Eor a long time this old building, with some minor additions, 
has been used for storage purposes. I recommend that this 
farmhouse be finished and furnished, giving accommodation for 
20 persons. For this purpose $4,600 will be needed. 

The present method of disposing of the sewage coming from 
this institution is very far from being satisfactory. The sew- 
age now flows into several beds located on the hospital property 



18 WORCESTER STATE HOSPITAL. [Dec. 

and not far from Lake Quinsigamond. The general land for- 
mation there is, fortunately, such that the liquids filter off into 
the ground and disappear without overflow into the lake. The 
agitation concerning the proper disposal of the hospital sewage 
is a matter of long standing, and jour Board has persistently 
requested legislative aid and direction in the solution of the 
problem. It has been proposed that efficient filter beds be con- 
structed not far from the present beds. This doubtless could 
be accomplished and efficient treatment of the sewage obtained. 
The location of these beds, however, would of necessity not be 
very remote from the main highway and a thickly settled por- 
tion of the community. However well cared for it seems prob- 
able that beds so located would at times give off odors and might 
be an offence to neighbors and passers-by. It is my opinion that 
the best and most satisfactory method of disposing of the sewage 
of this institution is to turn it into the sewers of the city of 
Worcester, and to pay the city such compensation therefor as 
may be agreed upon. I recommend that legislation be sought 
authorizing this latter method of sewage disposal, and estab- 
lishing the sum which shall be paid to the city in recompense. 
If this method be adopted it will be necessary to construct a new 
line of sewer pipe connecting the outflow from the hospital 
sewers with the city system. For the construction of this pipe 
line the sum of $7,500 will be required. 

The Hillside farm, located in Shrewsbury, is a valuable, un- 
developed asset of the institution. At present a part of our 
herds are kept there and all of the piggeries. There are great 
possibilities in connection with this property for the develop- 
ment of a farm colony, and in the location for a home for 
convalescents. 

The work of reconstruction and addition to the male wards 
of the institution is progressing rapidly, and will probably be 
completed in the late spring or early summer of next year. 
When this new accommodation becomes available it will add not 
only to the capacity of the institution but to its efficiency as 
well. 

The purchase of the Curtis land has been completed, and this 
tract is now available for hospital use. The Putnam land could 



1912.] PUBLIC DOCUMENT — No. 23. 19 

not be purchased this year, but it may be possible at some 
future date to arrange either a purchase or an exchange of 
holdings with the owners of the property. This matter should 
be kept in mind for future consideration whenever the time 
may seem opportune. 

My long association with your Board as superintendent of 
the asylum, and my earlier service here have combined to make 
me for the moment forget that I am a newcomer here now until 
I turn to consider the changes which have occurred in the medi- 
cal staff. Dr. Quinby, after years of faithful service, has 
resigned. Dr. Hoch accepted a position on the staff of the 
McLean Hospital leaving this institution with the regret and 
best wishes of all his associates. Dr. Whitney was secured as 
his successor. 

The summary of staff changes is as follows : — 

Resignations. 
Dr. William M. Dobson, Jan. 31, 1912. 
Dr. Paul K. Sellew, Feb. 7, 1912. 
Dr. Harry A. Clark, Feb. 29, 1912. 
Dr. Walter M. Crandall, May 6, 1912. 
Dr. Ray L. Whitney, June 7, 1912. 
Dr. Frank M. Lewis, Aug. 31, 1912. 
Dr. Theodore A. Hoch, Aug. 31, 1912. 

Appointments. 
Dr. Floyd A. Weed, June 1, 1912. 
Dr. Frank E. Lewis, June 3, 1912. 
Dr. S. Carleton Gwynne, July 1, 1912. 
Dr. Ray L. Whitney, Sept. 1, 1912. 
Dr. Henning V. Hendricks, Sept. 14, 1912. 

Thanks are again due to the proprietors of the " Worcester 
Evening Gazette " and the " Fitchburg Sentinel " for copies 
of their papers, and to the Worcester Employment Society for 
assistance in sewing. Members of your Board and various other 
friends have given pictures, books and papers. These gifts 
are appreciated. 

E. V. SCKIBNER, 

Superintendent. 
Nov. 30, 1912. 



20 



WORCESTER STATE HOSPITAL. 



[Dec. 



LABORATORY REPORT. 



To the Superintendent of the Worcester State Hospital. 

I herewith submit my report for the work of the laboratory 
for the current year, together with an outline of the plan of 
reorganization of the clinical work in the hospital. 

The summer of 1912 has seen a third recurrence of dysen- 
tery in an epidemic form in this hospital, and a large share 
of the laboratory's activities during this part of the year have 
been devoted to a reinvestigation from the bacteriological stand- 
point of a large series of cases. This investigation is not as 
yet completed, and therefore no definite conclusions can be 
drawn. This year's epidemic consisted of 102 cases with 18 
deaths. This shows a morbidity percentage calculated against 
the daily average population of 7.6 per cent., and a mortality 
percentage calculated against the number of cases of 14.8 per 
cent. 

Comparison with the figures of the two previous years gives 
the following table : — 





Morbidity. 


Mortality. 




Cases. 


Per Cent. 


Cases. 


Per Cent. 


1910, 

1911 

1912, 


136 
99 
102 


9.9 
7.2 
7.6 


22 
14 
18 


16.1 
14.1 
14.8 


Totals 


237 


- 


54 


- 



In recording the latter half of the 1912 epidemic, note has 
been made of the cases of severe diarrhoea which accompany 
the more serious dysentery cases, but these have been ex- 
cluded from the above series, so that the reports for the three 
years should be comparable. Some difficulty has been en- 
countered on account of the lack of an efficient means of re- 
cording the incidence of various diseases. An attempt to 



1912.] PUBLIC DOCUMENT — No. 23. 21 

rectify this has been made in the establishment of a card index 
morbidity record, which will be described more fully in a later 
part of this report. An outline plan of the hospital on a wall 
board is under construction in the laboratory now, and it is 
hoped that the data obtained from the morbidity record when 
recorded on the chart will form a graphic record of the foci of 
spread of various diseases, which may be of value in improving 
intramural sanitation. There is little question that the male 
wing of the hospital has suffered earlier and to a greater extent 
than the female wing, and it also seems that certain wards of 
both sides are more affected than others. The graphic record 
on the board ought to give accurate and convincing data on this 
point. 

The third annual visit of dysentery, with its total of 237 
cases and 54 directly attributable deaths, in three years makes 
this problem one of the most acute ones in the hospital, and 
leaves us in the position of an endemic focus, the potential 
danger of which is effective not only in the institution itself, 
but in all the other institutions and communities of the State 
where patients who have been under our care, or where persons 
who have been in our employ, may find their way. 

The occurrence of any of the acute intestinal infections in 
epidemic proportions is . a 'priori evidence of transmission of 
contagion from the intestinal discharges of one case directly 
or indirectly to the alimentary canal of a susceptible indi- 
vidual. This conception makes of an intestinal epidemic a 
serious commentary on the sanitation of any institution. This 
rests with less weight on an institution for the care of the in- 
sane because of the unavoidable conditions of bad sanitation 
brought about by the filthy habits of certain of the patients. 

The wards where the incidence seems to have been most 
severe are not those for the care of untidy patients and offer 
no obvious departure from inside conditions obtaining in other 
parts of the building. Further data may be obtained which 
will throw more light on this problem. 

In the course of a sanitary inspection of outside conditions, 
stimulated by the dysentery outbreak, several conditions were 
apparent where marked deviations from accepted sanitary ideals 



22 WORCESTER STATE HOSPITAL. [Dec. 

have been in evidence, but which are receiving attention. The 
most prominent of these are outside privies, the fly problem, 
sewage disposal, especially in its relation to the garden, and the 
handling of soiled bedding and clothing both in transit and at 
the laundry. 

The privies located in the gardens and other parts of the 
grounds not reached by sewers have been replaced by the type 
of septic tank described by Lumsden, Roberts & Stiles in the 
United States Public Health Report No. 54. Their operation 
has not been entirely satisfactory on account of too great or 
improper demands on their capacity, and they have not as yet 
stood the test of a cold winter. While they are a marked im- 
provement over the open privies, it is hoped that they can be 
replaced with something still more efficient. 

The fly problem has proven still refractory. Our efforts have 
been followed by a reduction in the pest, but they have still 
been in evidence in large numbers in the wards. The results 
of the summer were, as a whole, rather discouraging, but the 
outlook is still good for an ultimate serviceable reduction of the 
nuisance by means of active and well-directed care of our own 
breeding-places. One probable source of many of our flies has 
not been as yet controlled by experiment or careful observation. 
This is the manure removed by contract from stables in the 
city and hauled to the hospital grounds for use as fertilizer. 
This material is obtained without reference to the care taken 
in shielding it from flies, and is in all probability not only 
heavily seeded with fly eggs, but also badly infested with larvae 
and puparia. When spread immediately on its arrival here 
probably but few of the eggs and only a part of the larvse are 
able to develop under the adverse conditions incident to the 
spreading, but the puparia probably hatch in considerable pro- 
portions. It is hoped that during the next summer some defi- 
nite observations can be made on this point. 

The matter of proper disposal of the hospital's sewage is of 
course a crucial one and is under active consideration, so that 
it need not be discussed here. 

The system of handling the filthy clothing has been far from 
satisfactory, but is receiving attention, and improvements in 



1912.] PUBLIC DOCUMENT — No. 23. 23 

these methods are under way. A steam sterilizer of sufficient 
capacity to accommodate not only the clothing but the con- 
tainers in which the clothing is brought from the wards is 
needed for the safe handling of this material. 

A series of papers offered as a compliment to Dr. Quinby 
on his retirement from the superintendency have been collected, 
under the editorship of the pathologist, from men who have 
been formerly or are at present connected with the staff of this 
hospital. Five of these articles have already appeared in the 
columns of the "American Journal of Insanity," and others 
will appear in ensuing numbers of the same journal. It is 
planned to collect and bind a limited number of reprints from 
these articles into a volume for distribution. The list of con- 
tributors and the titles of their articles are as follows : — 

Peter Bassoe, M.D., Chicago. Unilateral Hypertrophy involving the 
Entire Left Side of the Body. 

Henry W. Miller, M.D., Superintendent, Eastern Maine Hospital for 
the Insane, Augusta, Me. Report of a Case of Pellagra in Maine 
with Remarks upon Recent Work on the Etiology of the Disease. 

Theodore A. Hoch, M.D., Assistant Physician, McLean Hospital, Waver- 
ley, Mass. A Statistical Study of Manic-depressive Insanity, with 
Especial Reference to Physical Illness as an Etiological Factor. 

Isador H. Coriat, M.D., Second Assistant Physician for Nervous Dis- 
eases, Boston City Hospital. The Relation of the Apraxia Problem 
to Psychiatry. 

E. V. Scribner, M.D., Superintendent, Worcester State Hospital. A 
Case of Epilepsy. 

A. M. Barrett, M.D., Director of the Psychopathic Hospital, Ann Arbor, 
Mich.; Professor of Psychiatry, University of Michigan. Diffuse 
Glioma of the Pia Mater. 

E. E. Southard, M.D., Director, Psychopathic Hospital, Boston, Mass.; 
Professor of Neuropathology, Harvard Medical School. A Series 
of Normal-looking Brains (from the Laboratory of the Worcester 
State Hospital). 

R. L. Whitney, M.D., First Assistant Physician, Worcester State Hos- 
pital. A Case of Frontal Brain Tumor. 

Adolf Meyer, M.D., Professor of Psychiatry, Johns Hopkins University. 
1. The Nature of Metastatic Tumors of the Thyroid. 2. New For- 
mation of Nerve Cells in Isolated Part of Nervous Portion of the 
Hypophysis-tumor in a Case of Acromegala with Discussion of the. 
Hypophysis. 



24 WORCESTER STATE HOSPITAL. [Dec. 

Samuel T. Orton, M.D., Clinical Director and Pathologist, Worcester 
State Hospital; Instructor in Neuropathology, Harvard Medical 
School. 1. A Study of the Brain in a Case of Catatonic Hirntod. 
2. Some Technical Methods for the Routine Examination of the 
Brain from Cases of Mental Disease. 

Papers from the laboratory were read during the year at 
the meetings of the American Association of Pathologists and 
Bacteriologists held in Philadelphia, the American Medico- 
Psychological Association and the American Medical Associa- 
tion (section on nervous and mental diseases) held in Atlantic 
City, and the New England Society of Psychiatry and Neu- 
rology held at Danvers Insane Hospital. 

The following articles have appeared in addition to the 
series above recorded : — 

" Further Observations on the Fly Problem at the Worcester 
State Hospital, Massachusetts, 1911," in the " Boston Medical 
and Surgical Journal," Feb. 8, 1912, and "A Report of a Case 
of Extensive Brain Disease from Endarteritis, probably of 
Syphilitic Origin," in the " Journal of the American Medical 
Association," Oct. 5, 1912. 

ISTo changes have occurred in the personnel of the laboratory 
staff during the present year, except the addition of a tem- 
porary assistant to aid in the large amount of bacteriological 
work necessitated by the dysentery epidemic. 

Sixty post-mortem examinations have been performed dur- 
ing the year. Classified according to the psychiatric diagnosis 
the cases were : — 

General paralysis, 15 

Senile psychosis, 12 

Manic-depressive insanity, 9 

Dementia praecox, 8 

Organic dementia, 5 

Alcoholic psychoses, 4 

Imbecility, 4 

Melancholia, 3 

The cases classified by the major anatomical diagnoses 



1912.] PUBLIC DOCUMENT — No. 23. 25 

Acute colitis, 7 

Chronic nephritis, 6 

Broncho-pneumonia, .5 

Exhaustion, 4 

Cardiorenal, 4 

Cardiac, ~T 3 

Pulmonary oedema, 3 

Pulmonary infarct, 3 

Pulmonary abscess, 3 

Tuberculosis, 3 

Hypostatic pneumonia, 3 

Lobar pneumonia, 2 

Neoplasms (except brain tumor), . .2 

Septicaemia, 2 

Aneurysm, 1 

Internal hemorrhagic pachymeningitis, 1 

Intestinal obstruction, 1 

Erysipelas, 1 

Brain tumor, . . .1 

Softening of brain, 1 

Empyema, . . 1 

Subdural hemorrhage, .1 

Typhoid fever, 1 

Food asphyxia, 1 

"No additions of importance have been made to the laboratory 
equipment during the year. 

During the latter part of the current year the direction of 
the clinical work in the hospital has been given into my hands, 
and its reorganization is being attempted along two lines : first, 
more systematic and better methods of record, and second, a 
more co-ordinate plan of study on the part of the medical staff. 
The first effort aims at a thorough and comprehensive series of 
notes taken at regularly specified intervals during the first six 
months after admission of a new case and in cases of longer 
residence, a physical examination and an urinalysis once in six 
months, with a comprehensive note on the mental condition at 
least once a year on every case. This part of the work alone 
makes an almost impossible call on the time of the staff, and 
calls attention sharply to the difficulty in keeping the full 
allotment of medical officers. The present medical staff have 
responded in a most gratifying manner to the additional work, 



26 WORCESTER STATE HOSPITAL. [Dec. 

and their activity and willingness promise well for accom- 
plishments of an exceptional nature. The stenographic force 
has been doubled to aid in the more ready handling of the in- 
creased volume of records, and further simplification of the 
handling of records by means of card indices is planned. 

A morbidity record by means of a card index has been started 
to include data of interest in all cases of infectious and conta- 
gious diseases and some other diseases of questionable etiology. 
These cards in printed form are filled out by the ward physician, 
and are kept on file at the laboratory. As mentioned earlier in 
this report, a wall board with a plan of the hospital is being con- 
structed in the laboratory on which the cases can be indicated 
by means of colored thumbtacks to give visual evidence of the 
foci of occurrence of any disease of an infectious nature under 
consideration. 

The second line of endeavor includes several subheads. 
Staff meetings are held every morning of the week, except 
Saturdays and Sundays, for the consideration of cases of in- 
terest, cases with uncertain diagnosis, and those in which dis- 
charge from the institution is requested or under consideration. 
The time allotted to this work (from an hour to an hour and 
a half) is proving insufficient for the presentation of all cases 
of the above types ; but any increase of the time applied with- 
out concordant increase in the numbers of the staff would prove 
a handicap in the ward work. At these meetings the case his- 
tory is presented in brief abstract, further data being elicited 
from the patient on direct questioning. The diagnosis is not 
stated by the presenting physician, the opinion of the physician 
of the corresponding service of the opposite wing being given 
from the data of the abstract and examination. The direct ex- 
amination and the opinion of each member of the staff is 
recorded by a stenographer and forms part of the case record. 

On Saturday morning the staff meeting hour is given over 
to a literature review. The current medical journals on file 
at the hospital are assigned to individual members of the staff. 
each of whom reports about once a month the articles of inter- 
est in his assignment. 

Twice a week a morning is devoted to a bedside clinic on 
the admission service. These visits alternate between the male 



1912.] PUBLIC DOCUMENT — No. 23. 27 

and female wings, and the staff of the corresponding wing is 
accompanied by the first assistant physician and by the clinical 
director for the purpose of observation of the newly admitted 
cases. 

Evening meetings are being held as formerly once a week 
at the laboratory. Three of these meetings in each month are 
devoted to review of subjects of laboratory interest, — reports 
of post mortems, talks on anatomical, histological or physiolog- 
ical subjects, special laboratory investigations, etc. At pres- 
ent the pathologist is offering at these meetings a formal course 
in the anatomy, histology and histopathology of the central 
nervous system, with illustration by means of microscopic pro- 
jection. The fourth meeting of each month is devoted to a 
symposium on assigned psychiatric topics. At these symposia 
some one of the mental diseases or of its subdivisions is assigned 
to one of the staff, who presents an outline of the characteristic 
features of his assignment which is followed by a general dis- 
cussion. Later these subjects will be repeated with more care- 
ful analysis and dissection of the individual symptoms. It is 
hoped to expand these symposia in time into clinics open to the 
medical profession for the purpose of bringing the work and 
aims of the hospital into more intimate relation with the mem- 
bers of the profession in our district. 

A subject of considerable importance is now under discus- 
sion, and an attempt at its solution is planned for the near 
future. I refer to the reclassification of patients and redis- 
tribution of the medical services to establish an effective acute 
or admission service. All new cases on admission require a 
very much greater amount of individual study, observation and 
appropriate treatment, and to enable this concentration in its 
best form the physicians in charge of these services on the two 
sides of the hospital should be relieved entirely, if possible, of 
the care and observation of the more chronic cases. This should 
in no way discourage attempts at improvement of the chronic 
cases by proper treatment, education and occupation, but merely 
focalize the effort of one medical service on the new cases for 
their more complete understanding and better handling. 

SAMUEL TOBREY ORTON, A.M., M.D., 

Clinical Director and Pathologist. 



28 



WORCESTER STATE HOSPITAL. 



[Dec. 



PRODUCTS OF THE FARM 

On Hand Dec. 1, 1912, and not delivered at the Hospital. 



Apples, barrels, . 


294 


Cucumbers, pickle, pecks, 


528 


Beets, bushels, 


740 


Mangel-wurzels, bushels, 


1,300 


Cabbage, tons, 


37 


Onions, bushels, . 


870 


Carrots, bushels, . 


520 


Parsnips, bushels, 


350 


Celery, boxes, 


190 


Squash, winter, tons, . 


24 


Cauliflower, boxes, 


34 


Turnips, barrels, . 


273 



FARM ACCOUNT. 



Dr. 

Bread, $384 41 

Butter, 1,169 98 

Blacksmith and supplies, 422 61 

Carriage and wagon repairs, 79 90 

Current expenses, 1,003 63 

Fertilizer, 748 62 

Fish, 178 62 

Fuel, 1,191 80 

Furnishings, 1,047 99 

Groceries, 2,467 58 

Harness and repairs, 11 00 

Hay, grain, etc., 10,928 82 

lee, 209 40 

Live stock : — 

Pigs, 12 00 

Meats, 2,347 38 

Milk, 1,981 68 

Repairs, 531 46 

Seeds, 280 77 

Amount carried forward, $24,997 55 



1912.] PUBLIC DOCUMENT — No. 23. 29 

Amount brought forward, $24,997 55 

Sugar, 560 10 

Tools, . . . . 178 67 

Wages, 14,610 50 

Water, - 280 11 

Net gain for year ending Nov. 30, 1912, .... 21,298 84 



$61,925 87 
Cr. 

Apples, 983.5 barrels, $2,458 75 

Asparagus, 29.075 boxes, 116 30 

Beans, Lima, improved, 26 bushels, 45 50 

Beans, shell, 21 bushels, 29 40 

Beans, string, green, 135.5 bushels, 135 50 

Beans, string, wax, 118 bushels, 106 20 

Beef, 2 sides, 664 pounds, 53 12 

Beets, 334.16 bushels, . 233 91 

Blackberries, 1,051 quarts, 157 65 

Cabbage, 21.871 tons, 546 78 

Carrots, 394'.58 bushels, 295 94 

Cauliflower, 41.66 boxes, 52 08 

Celery, 280.66 boxes, 252 59 

Chard, 264 bushels, . . 105 60 

Cider, 1,182 gallons, 141 84 

Citron, 20 pounds, 20 

Corn, green, 1,098.37 bushels, 823 78 

Cucumbers, 110.7 boxes, 83 03 

Cucumbers, pickle, 528 pecks, 158 40 

Currants, 923 quarts, 92 30 

Egg plant, .33 barrel, 66 

Grain bags, 2,400, 49 50 

Hay, 7.437 tons, 163 61 

Hides, 255 pounds, 26 67 

Horse-radish, 110 pounds, 4 40 

Ice, 1,378 tons, 4,134 00 

Kale, 59 bushels, . 14 75 

Lettuce, 482.16 boxes, 216 97 

Live stock : — 

Calves, 45, 450 00 

Cows, 8, . 426 00 

Hog, 1, . . . . • 12 00 



Amount carried forward, ...... $11,387 43 



30 WORCESTER STATE HOSPITAL. [Dec. 

Amount brought forward, $11,387 43 

Manure, 6 cords, 6 00 

Milk, 431,255 quarts, 34,500 40 

Muskmelons, 18 crates, 27 00 

Oats, 590 bushels, 354 00 

Onions, 680.08 bushels, 442 05 

Parsley, 9.75 bushels, 3 90 

Parsnips, 290 bushels, . ■ 217 50 

Peas, green, 116.5 bushels, 174 75 

Peppers, 1 bushel, 60 

Plants, 2,900, 29 00 

Pork, 30,845 pounds, 3,680 90 

Potatoes, 80 bushels, 56 00 

Radishes, 214 dozen bunches, 64 20 

Raspberries, 71 quarts, 10 65 

Rhubarb, 11,840 pounds, . 236 80 

Sand, 77 yards, . 96 25 

Skins, 4, 6 10 

Squash, summer, 20.8 barrels, 17 68 

Squash, winter, 16.54 tons, 413 50 

Scullions, 9 bushels, 3 60 

Spinach, 465 bushels, 162 75 

Straw, .55 ton, 11 00 

Strawberries, 4,669 quarts, 466 90 

Tomatoes, ripe, 1,033.66 bushels, 1,033 66 

Tomatoes, green, 46 bushels, 34 50 

Turnips, 203.18 barrels, • 203 18 

Veal, 211 pounds, 25 32 

Labor of patients, 2,742 days, 2,742 00 

Labor of farm attendants, 1,625 days, 2,437 50 

Teaming, 759.5 days, 3,038 00 

Double harness, . 20 00 

Old wagon, 10 00 

Registration refunded, . . 12 75 

$61,925 87 



1912.] PUBLIC DOCUMENT — No. 23. 31 



VALUATION OF PERSONAL ESTATE. 

Nov. 30, 1912. 



Food, $10,344 22 

Clothing and clothing material, . . . . . . 11,368 31 

Furnishings, 78,114 37 

Heat, light and power, 3,418 41 

Repairs and improvements, 5,297 07 

Farm, stable and grounds, 42,773 42 

Miscellaneous, 14,833 55 

$166,149 95 



32 



WORCESTER STATE HOSPITAL. 



[Dec. 



TREASURER'S REPORT. 



To the Trustees of the Worcester State Hospital. 

I respectfully submit the following report of the finances 
of this institution for the fiscal year ending ISTov. 30, 1912 : — 





Cash Account. 




Balance Dec. 1, 1911, 


Receipts. 


$8,510 86 


Institution Receipts. 






Board of inmates : — 






Private, 


$43,352 76 




Reimbursements, insane, 


21,065 25 




Cities and towns, 


41 32 


$64,459 33 






Sales: — 






Food, 


$1,162 71 




Clothing and materials, 


335 37 




Furnishings, 


4 00 




Heat, light and power, 


6 25 




Repairs and improvements, 


101 59 




Miscellaneous, 


294 58 




Farm, stable and grounds: — 






Cows and calves, 


876 00 




Pigs and hogs, 


12 00 




Hides, 


32 77 




Sundries, . 


188 40 





Miscellaneous receipts : — 

Interest on bank balances, 
Rent, 



$615 54 
420 00 



5,013 67 



1,035 54 



Sale of land, 



68,508 54 
5,000 00 



from Treasury of Commonwealth. 
Maintenance appropriations : — 

Balance of 1911, ...... 

Advance money (amount on hand November 

30) 

Approved schedules of 1912, . $294,074 09 
Less returned, . . . 125 24 



Special appropriations, 



$14,073 75 
13,500 00 

293,948 85 



321,522 60 
45,829 53 



Total, $449,371 53 



1912.1 



PUBLIC DOCUMENT — No. 23. 



33 



Payments. 

To treasury of Commonwealth, institution receipts, . . . $68,508 54 
Sale of land, 5,000 00 

Maintenance of appropriations : — 

Balance November schedule, 1911, ._ . $22,584 61 

Eleven months' schedules, 1912, . . . 293,948 85 

November advances, ..... 5,730 99 

322,264 45 

Special appropriations : — 

Approved schedules, ........ 45,829 53 

Balance Nov. 30, 1912: — 

In bank, $6,383 63 

In office 1,385 38 

7,769 01 

Total, $449,371 53 

Maintenance. 

Appropriation $308,000 00 

Expenses (as analyzed below) , ....... 316,495 20 

Deficit $8,495 20 



Analysis of Expenses. 



Salaries, wages and labor : — 








General administration, . . . . $30,355 14 


Medical service, . 




13,593 36 


Ward service (male) , . 




25,227 03 


Ward service (female) , 




26,452 39 


Repairs and improvements, . 




17,483 16 


Farm, stable and grounds, . 




16,241 43 




df 1 on oro cr-i 


ijuy^jjj O.L 


Food: — 


Butter $15,938 87 


Beans, .... 






1,222 13 


Bread and crackers, 






489 68 


Cereals, rice, meal, etc., 






1,762 23 


Cheese, .... 






1,177 44 


Eggs 






6,635 08 


Flour 






11,892 53 


Fish 






3,701 82 


Fruit (dried and fresh), 






2,353 89 


Meats, .... 






26,481 96 


Milk 






753 46 


Molasses and syrup, 






433 58 


Sugar, .... 






6,529 91 


Tea, coffee, broma and cocoa, 






2,076 70 


Vegetables, 






5,818 47 


Sundries, .... 






2,277 69 


Amount carried forward, .... 


QQ t^A.^ A.A. 


■ ■■ oy,o*±o *m: 


. $218,897 95 



34 



WORCESTER STATE HOSPITAL. 



[Dec. 



Amount brought forward, 








$218,897 95 


Clothing and materials : — 




Boots, shoes and rubbers, .... $1,946 18 




Clothing, ....... 


4,715 50 




Dry goods for clothing and small wares, 


2,262 93 




Furnishing goods, ..... 


219 76 




Hats and caps, ..... 


130 46 




Leather and shoe findings, . 


30 27 




Sundries, ...... N 


53 57 


9,358 67 




Furnishings: — 




Beds, bedding, table linen, etc., . . . $8,758 24 




Brushes, brooms, .... 




609 95 




Carpets, rugs, etc., 




589 73 




Crockery, glassware, cutlery, etc., 




681 27 




Furniture and upholstery, 




803 20 




Kitchen furnishings, ... 




671 00 




Wooden ware, buckets, pails, etc., 




228 19 




Sundries, ..... 




920 16 






13,261 74 


Heat, light and power: — 


Coal $24,031 89 




Gas 391 53 




Oil, 286 69 




Sundries, 117 94 








24,828 05 




Repairs and improvements: — 




Brick $142 38 




Cement, lime and plaster, 




480 31 




Doors, sashes, etc., . . . 




210 94 




Electrical work and supplies, 




1,451 38 




Hardware, ..... 




1,402 89 




Lumber, ..... 




1,347 25 




Machinery, etc., .... 




34 50 




Paints, oil, glass, etc., . 




2,956 82 




Plumbing, steam fitting and supplies, 




1,747 08 




Roofing and materials, 




493 83 




Sundries, ..... 




1,494 49 








11,761^87 




Farm, stable and grounds: — 




Blacksmith and supplies, .... $637 03 




Carriages, wagons, etc., and repairs, 




1,094 53 




Fertilizers, vines, seeds, etc., 




1,153 82 




Hay, grain, etc., . 






12,937 25 




Harnesses and repairs, 






122 44 




Other live stock, 






12 00 




Rent, .... 






250 00 




Tools, farm machines, etc., . 






315 86 




Sundries, .... 






1,557 28 






18,080 21 


Miscellaneous : — 


Books, periodicals, etc., .... $600 83 




Religious services, 






660 00 





Amounts carried forward, 



$1,260 83 $296,188 49 



1912. 



PUBLIC DOCUMENT 



Amounts brought forward. 

Miscellaneous — Con. . 

Entertainment, .... 

Freight, expressage and transportation, 

Funeral expenses, 

Gratuities, .... 

Hose, etc., 

Ice, ..... 

Medicines and hospital supplies 

Medical attendance, nurses, etc. (extra) 

Postage, .... 

Printing and printing supplies, 

Printing annual report, 

Return of runaways, 

Soap and laundry supplies, . 

Stationery and office supplies, 

School books and school supplies, 

Travel and expenses (officials) , 

Telephone and telegraph, 

Tobacco, .... 

Water 

Sundries, .... 



No. 23. 35 

$1,260 83 $296,188 49 



Total expenses for maintenance, 



144 90 


1,109 51 


272 00 


58 24 


329 68 


291 75 


2,692 78 


360 43 


491 18 


321 52 


169 38 


359 80 


2,914 S2 


873 97 


175 41 


540 96 


508 00 


1,355 78 


4,459 53 


1,616 24 




. $316,495 20 



. Special Appropriations. 

Balance Dec. 1, 1911, $12,100 00 

Appropriations for fiscal year ($111,700 plus $101.77 from extraor- 
dinary expenses), ......... 111,801 77 

Total ■ $123,901 77 

Expended during the year (see statement annexed) , $45,829 53 

Reverting to treasury of Commonwealth, . . 12,100 00 

57,929 53 



Balance Nov. 30, 1912, 



$65,972 24 



Resources and Liabilities. 

Resources. 

Cash on hand $7,769 01 

November cash vouchers (paid from advance money), 5,730 99 

Due from treasury of Commonwealth account 

November, 1912, schedule, .... 551 15 



$14,051 15 



Schedule of November bills, 



$22,546 35 



36 WORCESTER STATE HOSPITAL. [Dec. 



Per Capita. 
During the year the average number of inmates has been 1,349.58. 
Total cost for maintenance, $316,495.20. 
Equal to a weekly per capita cost of $4.49+. 
Receipts from sales, $3,013.67. 
Equal to a weekly per capita of $0.0428. 
All other institution receipts $65,494.87. 1 
Equal to a weekly per capita of $0.9305. 

Industries Fund. 
Appropriation, .......... $300 00 

Receipts credited, ......... - 



$300 00 
Expenditures, .......... - 



Balance Nov. 30, 1912, $300 00 

i Sale of land, 85,000, not included. 






1912.] 



PUBLIC DOCUMENT — No. 23. 



37 









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38 WORCESTER STATE HOSPITAL. [Dec. 



STATEMENT OF FUNDS. 



Patients' Fund. 
Balance on hand Nov. 30, 1911, . 

Receipts, 

Interest on bank balance, . 


$5,003 51 

2,275 78 

158 31 


$7,437 60 
3,112 14 


Interest paid to State Treasurer, . 

Refunded, . . 


$158 31 
2,953 83 




$2,000 00 

1,000 00 

1,067 64 

257 82 




$4,325 46 


Investment. 
Worcester County Institution for Savings, . 
Worcester Five Cents Savings Bank, . 
Balance Worcester National Bank, 
Cash on hand Dec. 1, 1912, 


$4,325 46 

$1,540 23 
6 00 


Lewis Fund. 
Balance on hand Nov. 30, 1911, . 
Income, 


$1,481 31 
58 92 


Expended for vault rent, .... 


$926 36 
342 60 
265 27 


American Telephone and Telegraph Company 

Bond, 

Worcester County Institution for Savings, . 
Balance Worcester National Bank, 


$1,534 23 
$1,534 23 






Wheeler Fund. 
Balance on hand Nov. 30, 1911, . 
Income, 


$5,287 27 
234 71 


$5,521 98 
140 56 


Expended for books, 





,381 42 



1912.1 



PUBLIC DOCUMENT — No. 23. 



39 



Investment. 
6 shares Worcester National Bank, 
American Telephone and Telegraph Company 

Bond, 

Worcester County Institution for Savings, 
Worcester Five Cents Savings Bank, . 
Mechanics Savings Bank, 
Balance Worcester National Bank, 



Investment. 
Worcester County Institution for Savings, 



$1,002 00 

712 50 

1,600 00 

1,719 47 

166 86 

180 59 



$5,381 42 

Lawn Fund. 

Balance on hand Nov. 30, 1911, .... $435 14 
Income, 17 56 

$452 70 

Investment. 
Mechanics Savings Bank, $452 70 

Manson Fund. 
Balance on hand Nov. 30, 1911, .... $1,564 65 
Income, . . 63 18 



$1,627 83 



. $1,627 83 



Respectfully submitted, 



E. V. SCRIBNER, 
Treasurer of the Corporation. 



Nov. 30, 1912. 



Worcester, Mass., Dec. 6, 1912. 
I hereby certify that I have this day compared the treasurer's statement of 
funds for the year ending Nov. 30, 1912, with the books kept at the Worcester 
State Hospital, and find it correct. I have also inspected the securities represent- 
ing the investments and find their value is as stated. 

GEO. L. CLARK, 

Auditor of Accounts. 



STATISTICAL TABLES 



[Form prescribed by State Board of Insanity.] 





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ts in the hospital Sept. 
regularly committed, . 
emergency, . 
voluntary, . 
temporary care, . 
ted within the year, . 
by regular commitmen 
emergency, . 
voluntary, . 
temporary care, . 
viz: observation, 
others, 
by transfer, 
from visit, . 

lal admissions for disch 
from visit, .• 

number of cases within 

ised within the year, . 

discharged, . 
as recovered, . 
as capable of self-sup 
as improved, . 
as not improved, 
as not insane, . 

died, . 

transferred, . 

escaped, 

on visit Oct. 1, 1912, . 

lal dismissals for comm 










itien 

Viz: 

luiif. 
Viz: 

omir 
Viz: 

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Viz: 

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44 



WORCESTER STATE HOSPITAL. 



[Dec. 



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03 0S 



1912. 



PUBLIC DOCUMENT — No. 23. 



45 



2. — Insane received on First and Subsequent Commitment. 




Cases committed. 


NUMBER OF THE COMMITMENT. 


Males. 


Females. 


Totals. 


First to this hospital, 

Second to this hospital, 

Third to this hospital, 

Fourth to this hospital, 

Fifth to this hospital, ■ 

Seventh to this hospital, 

Eighth to this hospital 

Eleventh to this hospital, 


217 
29 
3 

2 

1 


202 
21 
3 

4 

1 

1 


419 
50 
6 
4 

2 
1 

1 


Total cases, 

Total persons 

Never before in any hospital for the insane, 


252 
246 
197 


234 
230 

187 


486 
476 
384 



8. — Nativity and Parentage of Insane Persons first admitted to Any Hospital. 





Males. 


Females. 


Totals. 


PLACES OF NATIVITY. 


d 
.2 

P-i 


1 


o 


a 
.2 

fa 


9 
fa 


9 
o 


.2 
fa 


9 

fa 


2 
o 


Massachusetts, .... 


66 


26 


31 


57 


26 


22 


123 


52 


53 


Other New England States, . 


22 


20 


18 


25 


21 


24 


47 


41 


42 


Other States 


10 


6 


5 


9 


5 


4 


19 


11 


9 


Total native, .... 


98 


52 


54 


91 


52 


50 


189 


104 


104 


Other countries: — 




















Armenia 


_ 


_ 


_ 


1 


1 


1 


I 


1 


1 


Austria, 


1 


1 


1 


1 


1 


1 


2 


2 


2 


Azore Islands, 


2 


1 


1 


2 


2 


2 


4 


3 


3 


Belgium, 








1 


1 


1 


1 


1 


1 


Canada 


14 


22 


21 


14 


17 


16 


28 


39 


37 


Cape Breton, 




1 




1 


1 


1 


1 


2 


1 


Denmark, 


1 


1 


1 




1 


1 


1 


2 


2 


England 

Finland 


7 
3 


7 
3 


6 
3 


7 
4 


9 

4 


6 
4 


14 

7 


16 
7 


12 

7 


Germany 


2 


5 


3 


2 


3 


3 


4 


8 




Greece, 


2 


2 


2 


- 




_ 


2 


2 


2 


Ireland, 


23 


40 


44 


26 


48 


54 


49 


88 


98 


Italy, 


4 


5 


4 


3 


3 


3 


7 


8 


7 


Madeira Islands, .... 


1 


1 


1 








1 


1 


1 


New Brunswick, .... 


3 


6 


2 


1 


2 


2 


4 


8 


4 


Newfoundland, .... 






1 


1 




1 


1 




2 


Nova Scotia, 


3 


3 


3 


7 


6 


7 


10 


9 


10 


Poland 


5 


5 


5 








5 


5 


5 


Portugal 










1 


1 




1 


1 


Prince Edward Islands, . 


2 


2 


2 


2 




1 


4 


2 


3 


Russia, 


10 


10 


9 


5 


4 


4 


15 


14 


13 


Scotland 


2 


2 


3 


2 


5 


3 


4 


7 


6 


Spain 


2 


1 


1 


_ 




_ 


2 


1 


1 


Sweden, 


5 


6 


6 


9 


9 


9 


14 


15 


15 


Syria, 


1 


1 


1 








1 


1 


1 


Turkey, 


2 


2 


2 


- 


_ 


- 


2 


2 


2 


Wales, 


1 


1 


1 


_ 


_ 


_ 


1 


1 


1 


West Indies 








2 


2 


2 


2 


2 


2 


Total foreign, .... 


96 


128 


123 


91 


120 


123 


187 


248 


246 


Unknown, 


3 


17 


20 

197 


5 


15 


14 


8 


32 


34 


Totals 


197 


197 


187 


187 


187 


384 


384 


384 



46 



WORCESTER STATE HOSPITAL. 



[Dec. 



4- — Residence of Insane Persons admitted from the Community. 







First admitted 

to Ant 

Hospital. 


Other 
Admissions. 


Totals. 


PLACES. 


. 


















S 


-2 
3 

ft 


1 

H 


S 


S 


1 


"3 


03 

s 


1 



Massachusetts (by counties) : — 




















Bristol, 


1 


- 


1 


1 


- 


1 


2' 


" 


2 


Essex, 




2 


- 


2 


1 


- 


1 


3 


" 


3 


Middlesex, 




64 


64 


128 


10 


13 


23 


74 


77 


151 


Norfolk, . 




- 


3 


3 


- 


- 


- 


- 


3 


3 


Suffolk, . 




19 


10 


29 


7 


3 


10 


26 


13 


39 


Worcester, 




111 


110 


221 


31 


31 


62 


142 


141 


2S3 


Totals, 


197 


187 


384 


50 


47 


97 


247 


234 


481 


Cities or large towns (10,000 or over), 


156 


148 


304 


39 


37 


76 


195 


185 


3S0 


Country distric 


ts (under 10,000), . 


41 


39 


80 


11 


10 


21 


52 


49 


101 



Civil Condition of Insane Persons first admitted to Any Hospital. 





Males. 


Females. 


Totals. 


Unmarried 


82 


64 


146 


Married, 


88 


77 


165 


Widowed, 


21 


39 


60 


Divorced 


4 


3 


7 


Totals, 


195 


183 


378 


Unknown, 


2 


4 


6 


Totals, 


197 


187 


384 



1912. 



PUBLIC DOCUMENT — No. 23. 



47 



6. — Occupation of Insane Persons first admitted to Any Hospital. 



Females. 



Cashier, 1 


School-teacher, 




Clerks, . 








4 


Seamstress, 




Compositor, 








1 


Stenographer, 




Cooks, 








2 


Student, . 




Dressmaker, 








1 


Tailoress, . 




Domestics, 








32 


Waitress, . 




Housekeepers, 








20 


No occupation, 


. .' . 47 


Housewives, 








53 







Laundress, 








1 


Total, 


. . . 183 


Milliner, . 








1 


Unknown, 


4 


Nurse, 








1 







Operatives, 








13 


Total, 


. 187 



Males. 



Agents, 2 


Hackman, . . . . 1 


Baker, 








1 


Hatter, 








1 


Barbers, . 








2 


Hostlers, . 








2 


Bar tender, 








1 


Janitor, 








1 


Blacksmiths, 








3 


Laborers, . 








48 


Cabinet makers 








2 


Letter carrier, 








1 


Carpenters, 








13 


Lithographer, 








1 


Cigar maker, 








1 


Machinists, 








5 


Clerks, 








10 


Mechanics, 








2 


Coachmen, 








3 


Merchants, 








2 


Draughtsman, 








1 


Millwright, 








1 


Electrician, 








1 


Miner, 








1 


Engineer, . 








1 


Musician, . 








1 


Farmers, . 








7 


Operatives, 








28 


Firemen, . 








5 


Painters, . 








4 


Fish cutter, 








1 


Physician, 








1 


Gardener, . 








1 


Printers, . 








3 



48 



WORCESTER STATE HOSPITAL. 



[Dec. 



6. — Occupation of Insane Persons first admitted to Any Hospital — Con- 
cluded. 



Males — Concluded. 



Proofreader, .... 1 


Waiter, ... 


1 


Reporter, . 






1 


No occupation, 


. . 20 


Restaurant keeper, 






1 







Sea captain, 






1 


Total, 


. 192 


Students, . 






4 


Unknown, ' . 


. . 5 


Superintendent, 






1 







Tailor, 






1 


Total, 


. 197 


Teamsters, 






3 







1912. 



PUBLIC DOCUMENT — No. 23. 



49 



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1912.] 



PUBLIC DOCUMENT — No. 23. 



51 



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52 



WORCESTER STATE HOSPITAL. 



[Dec. 



Probable Duration of Mental Disease before Admission. 



PREVIOUS DURATION. 


First admitted to Ant Hospital. 










Males. 


Females. 


Totals. 


Congenital, . 






14 


11 


25 


Under 1 month, 






31 


26 


57 


From 1 to 3 months, . 






30 


21 


51 


3 to 6 months, . 






19 


22 


41 


6 to 12 months, . 






20 


24 


44 


1 to 2 years, 






12 


11 


23 


2 to 5 years, 






24 


30 


54 


5 to 10 years, 






15 


9 


24 


10 to 20 years, 






3 


15 


18 


Over 20 years, 






- 


5 


5 


Totals, . 


168 


174 


342 


Unknown, 






28 


10 


38 


Not insane, . 






1 


3 


4 


Totals, . 


197 


187 


384 


Average known duration (in years), . 


4.23 


4.53 


4.38 



1912. 



PUBLIC DOCUMENT — No. 23. 



53 



■ « 
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A. — First admitted to any hospital: — 

Acute hallucinosis, 

Alcoholic insanity, acute: — 

Alcoholic delirium 

Alcoholic depression, 

Alcoholic hallucinosis, 

Delirium tremens, 

Alcoholic insanity, chronic: — 

Alcoholic deterioration, 

Alcoholic hallucinosis, 

Alcoholic paranoic condition 

Polyneuritic psychosis, 

Constitutional inferiority 

Delirium, acute 

Dementia prgecox, 

Epileptic insanity, 

Exhaustion psychosis, 

General paralysis of the insane, .... 

Huntington's chorea, 

Hysterical insanity 

Imbecility, 

Manic-depressive insanity: — 

Depressed form, 

Manic form, 

Mixed form, . 

Melancholia, senile 

Organic dementia, 

Paranoic condition 

Paranoic condition, senile, 

Paranoic episode, 

Pre-senile psychosis 

Psychoasthenia, 

■Senile dementia 

Toxic insanity, acute: — 

Delirium, 

Hallucinosis 

Traumatic insanity 

Not insane, ........ 


1 



54 



WORCESTER STATE HOSPITAL. 



[Dec. 



< ° a 


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B. — Other admissions: — 

Alcoholic insanity, acute: — 

Alcoholic hallucinosis 

Alcoholic insanity, chronic: — 

Alcoholic deterioration, 

Alcoholic paranoic condition, .... 

Polyneuritic psychosis 

Constitutional inferiority, 

Dementia prajcox, 

Epileptic insanity, ...... 

General paralysis of the insane 

Imbecility, 

Manic-depressive insanity: — 

Circular form, 

Depressed form, ', 

Manic form, ....... 

Mixed form, \ ° 

Melancholia, senile, ' 

Organic dementia, 

Paranoic condition, \ 

Paranoic condition, senile, 

Psychoasthenia, 


Totals 

Aggregate cases, 

Aggregate persons, 



1912.] 



PUBLIC DOCUMENT — No. 23. 



55 





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First to this hospital, 
Second to this hospital, . 
Third to this hospital, 
Fourth to this hospital, . 
Tenth to this hospital, . 
Eleventh to this hospital, 
Sixteenth to this hospital, 


Total cases, 
Total persons, . 
First admitted to any hospital 



56 



WORCESTER STATE HOSPITAL. 



[Dec. 



s 
P 


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1912 



PUBLIC DOCUMENT — No. 23. 



V±£.} X \UAJJ-JXKJ ±SKJ\-j\U±\-LJCJj.y J. 


"1 


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Myocarditis, 

Pericarditis, 

Pericarditis and cardiac aneurism, 

IV. Diseases of the respiratory system: — 

Abscess of lung, 

Broncho-pneumonia, ..... 

Empyema, 

Hypostatic pneumonia, .... 

Lobar pneumonia, 

(Edema of lungs, 

Pulmonary tuberculosis, .... 

V. Diseases of the digestive system: — 
Chronic intestinal obstruction, . 

Colitis, 

Enteritis 

Entero-colitis, 

Tubercular enteritis 

VI. Diseases of the genito-urinary system: — 

Chronic nephritis 

Chronic nephritis and oedema of lungs, 
Pyelo-nephritis, 

VII. Violence: — 

Asphyxiation from food in larynx and bron- 
chi, 


1 



57 



5S 



WORCESTER STATE HOSPITAL. 



[Dec. 



3 

m 
n 

S 


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1 1 1 1 1 1 1 1 1 1 1 1 1 <N 1 


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1 1 1 1 1 1 1 1 I 1 1 I 1 1 1 1 1 1 1 1 1 1 1 oq I 


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52 

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3 61 

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315 


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I. General diseases: — 

Acute peritonitis, 

Carcinomatosis 

Cellulitis of legs, . . . 

Convulsions of general paralysis 

Decubiti, 

Diabetes mellitus 

Exhaustion from general paralysis, 


Pernicious anaemia, 

Septicaemia from abrasion, 

Septicaemia from cholelithiasis, 

Septicaemia from decubiti 

Typhoid fever, 

II. Diseases of the nervous system: — 

Cerebral hemorrhage, ........ 

Exhaustion from manic-depressive insanity, .... 

Exhaustion from senile dementia, 

Internal hemorrhagic pachymeningitis and oedema of lungs, 

III. Diseases of the circulatory system: — • 

Acute dilatation of heart, 

Acute and chronic endocarditis with pulmonary infarct, 

Arteriosclerosis, . 

Chronic valvular heart disease, 

Endocarditis, 

Heart disease, 



1912. 



PUBLIC DOCUMENT — No. 23. 



59 



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III 



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IUJ1 ijiliu 

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60 



WORCESTER STATE HOSPITAL. 



[Dec. 



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A. — Recovered: — 
Under 1 month, . 
From 1 to 3 months, . 

3 to 6 months, . 

6 to 12 months, . 

1 to 2 years, 

2 to 5 years, 
5 to 10 years, 

10 to 20 years, . 
Over 20 years, 


I 

P 


Totals, . . 
Average of known cases (in 
months), .... 



1912. 



PUBLIC DOCUMENT — No. 23. 



61 



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months, . 

months, . 

months, . 

years, 

years, 

years, 

years, 






02 . 
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— Died:- 

Under 1 m 

From 1 to 

3 to 

6 to 

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2 to 
5 to 

10 to 
Over 20 yc 


4% 


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