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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 



EIGHTY-riEST ANNUAL EEPOET 



THE TRUSTEES 



Worcester State Hospital, 



THIRTY-SIXTH ANNUAL REPORT OF THE TRUSTEES 



WOECESTEE STATE ASYLUM AT WOECESTEE, 



FOR THE 



Year ending November 30, 1913. 




BOSTON: 

WEIGHT & POTTEE FEINTING CO., STATE PEINTEES, 

32 DEENE STEEET. 

1914. 



Public Document No. 23 



EIGHTY-FIRST ANNUAL EEPORT 



THE TRUSTEES 



>F0KCE8TER StATE HOSPITAL, 



THIRTY-SIXTH ANNUAL REPORT OF THE TRUSTEES 



WORCESTER STATE ASYLUM AT WORCESTER, 



FOR THE 



Year ending November 30, 1913. 




I 



BOSTON: 

WRIGHT & POTTER PRINTING CO., STATE PRINTERS, 

32 DERNE STREET. 

1914. 






Approved by 
The State Board of Publication. 



If 13 



CONTENTS. 

PAGE 

Report of Trustees, 7 

Report op Superintendent, 11 

Laboratory Report, 21 

Products of the Farm, 25 

Farm Account, 25 

Valuation, 28 

Report of Treasurer, . ' 29 

Statement op Funds, 35 

Statistics, 37 



OFFICERS OF THE HOSPITAL. 



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



woecestee. 
woecestee. 
woecester. 
Boston. 

WoECESTEE. 
WoECESTEE. 
WOECESTEE. 



RESIDENT 

ERNEST V. SCRIBNER, M.D., 
RAY L. WHITNEY, M.D., . 
GEORGE A. McIVER, M.D., 
CORNELIA B. J. SCHORER, M.D 
HENNING V. HENDRICKS, M.D 
WALLACE L. ORCUTT, M.D. 
HAROLD C. AREY, M.D., 
ROY C. JACKSON, 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. 

Assista7it Physician. 

Superintendent oj Nurses. 

Steward. 

Matron. 

Far7ner. 



NONRESIDENT OFFICERS. 



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



Assistant Pathologist. 

Consulting Surgeon. 

Dentist. 

Druggist. 

Auditor. 

Clerk. 

Eyigineer. 



®l)e Ccmmontuealtl) oi ittas^acljiiBCtts, 



TRUSTEES' REPORT. 



To His Excellency the Governor and the Honorable Council. 

The trustees of the Worcester State Hospital herewith re- 
spectfully submit their eighty-first annual report. The reports 
of the superintendent and treasurer are hereto appended, giv- 
ing full details of the admission, transfer and discharge of in- 
mates, and of the finances of the hospital. 

An appropriation of $84,000 granted by the Legislature of 
1912 for a building for 100 men has been nearly expended, 
and the building is substantially finished and partly occupied. 
The purchase of land authorized by the same Legislature has 
been effected, and changes in and finishing off the upper Salis- 
bury ward have been nearly completed. Two elevators, author- 
ized by an appropriation of the same year, have been bought 
and installed. 

With the appropriations granted by the Legislature of 1913, 
the trustees have begun the finishing and furnishing of the old 
farm house and the finishing and furnishing of the attic of the 
female nurses' home. The cottage for employees, authorized by 
the same Legislature, is one-half built. 

The Legislature of 1913 appropriated $7,500 for a new sewer 
pipe line. The act provided that no part of that amount 
should be used or expended until the State Board of Health 
shall certify to the Auditor that the area of filter beds for the 
purification of the sewage of Worcester has been enlarged to 
an extent necessary to filter the sewage to be discharged from 
the hospital, and that in their opinion Worcester has taken or is 
taking such action, in relation to the purification of its sewage, 
that it is desirable from the point of view of the public health 
to connect the hospital with the city's system. As the trustees 
have not received the necessary certificate from the State 



8 WORCESTER STATE HOSPITAL. [Dec. 

Board of Health, no part of the appropriation has been ex- 
pended, and the condition which the appropriation was intended 
to reheve still exists, aggravated by the delay of another year. 

It is now nearly ten years since the question of proper dis- 
posal of the hospital's sewage has been brought to the attention 
of the Legislature by the trustees. The situation calls for some 
action, and the trustees recommend that the most satisfactory 
solution will be to connect at once the hospital system with 
the city's system. In this connection the trustees would call 
attention to the fact that many years ago the Commonwealth 
permitted the city of Worcester to construct certain streets 
over its land in return for permission to enter the hospital's 
sewage into the city's system. We are advised by the Attorney- 
General that the provisions of Statute 1888, Chapter 435, sec- 
tion 1, as amended by Statute 1888, chapter 444, section 1, 
are in full force and effect. While the trustees of the hospital 
have not petitioned the city of Worcester to extend its system 
to the hospital grounds, the city of Worcester nevertheless has 
made such extension and there seems to be no difficulty in 
immediate connection of the two systems, provided the neces- 
sary appropriation is given. The trustees feel that in permit- 
ting the present conditions to continue, the Commonwealth is 
itself doing that which it would not permit any of its citizens 
to do. We therefore again respectfully urge that an appro- 
priation be granted which will enable the sewage of the hospital 
to be turned into the sewers of the city of Worcester. 

We renew our request for an appropriation to provide for 
congregate dining rooms for the inmates of the hospital. Such 
dining rooms will remove from the wards dining rooms which 
are now inadequate in size and equipment, and will relieve the 
ward of the confusion and disorder which results from trying 
to combine dormitory, day room and eating facilities. It will 
also improve service of meals and enable the attendants on the 
wards to devote themselves entirely to the care of their pa- 
tients and of their wards, without the inconvenience of trying 
to serve meals at the same time. We believe in this way that 
the comfort of both patients and attendants will be greatly in- 
creased. The space now occupied by the ward dining rooms 
will become immediately available to relieve the overcrowding 
of the wards and provide sleeping accommodations for patients. 



I 



1913.] PUBLIC DOCUMENT — No. 23. 9 

Plans looking toward this end have already been submitted to 
the State Board, and we ask an appropriation of $100,800. 

We repeat what we have said in the past years about the 
necessity of providing suitable accommodations for the growing 
number of employees. In order to secure and retain competent 
help, we must make adequate provision for their comfort. They 
cannot be expected to live contentedly on the wards, or in 
overcrowded and inadequate quarters. We desire to increase 
the number of married employees, and we therefore ask for 
an appropriation of $19,000 permitting us to build two cot- 
tages, each to contain a tenement for an employee's family and 
dormitory overhead for single employees, and $13,800 for two 
small bungalows, each to contain provisions for an official and 
his family. 

The economical administration of the hospital increasingly 
requires the installation of an adequate cold-storage plant, and 
we ask an appropriation for this purpose of $50,400. 

The superintendent's report contains recommendations con- 
cerning an increase in the number and pay of our employees. 
The trustees desire to indorse these recommendations and es- 
pecially to urge the importance of the following considera- 
tions : — 

1. While the trustees fully appreciate that the hospital must 
receive persons legally committed or transferred to it and the 
great pressure upon the Commonwealth to find provision for 
its insane, they deplore the tendency to overcrowd the hospital. 
They believe that this overcrowding impairs the efficiency, 
both of employees and officers, and does not promote the wel- 
fare of the inmates. 

2. For the reasons already stated we strongly urge provision 
for congregate dining rooms. 

3. We ask for an appropriation which will enable us at all 
times to secure an adequate force of attendants and employees. 

4. We advocate a scale of wages whereby those who remain 
long in the institution can look forward to increased pay. We 
can thus secure permanent help; we also believe that the com- 
pensation of our staff should be increased. 

It will be noticed that all the foregoing recommendations 
look not towards the enlargement of the present plant but to 
perfecting it. 



10 WORCESTER STATE HOSPITAL. [Dec. 

The trustees extend to the superintendent, members of the 
staff, the matron, steward, superintendent of nurses, super- 
visors, nurses, attendants and employees their thanks for faith- 
ful service. 

Respectfully submitted, 

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

Nov. 30, 1913. 



1913.1 PUBLIC DOCUMENT — No. 23. 11 



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, 1913, it being the eighty- 
first annual report. 

There remained at the hospital Oct. 1, 1912, 1,300 patients, 
— 634 men and 666 women. During the year ending Sept. 30, 
1913, there were admitted 728 patients, — 397 men and 331 
women. Six hundred and ninety-eight patients — 372 men 
and 326 women — were dismissed from the hospital. Of this 
number, 261 patients — 149 men and 112 women — were dis- 
charged; 185 patients — 98 men and 87 women — died; 75 
patients — 31 men and 44 women — were transferred; and 177 
patients — 94 men and 83 women — left on visit or escape; 
leaving at the end of the statistical year, 1,330 patients, — 659 
men and 671 women. Of this number, 1,085 were supported 
by the State, 131 by friends, and 114 as reimbursing patients. 
Of the 336 patients discharged and transferred, 75 (including 
1 habitual drunkard, woman) were reported recovered, 68 ca- 
pable of self-support, 42 improved and 69 not improved. Four 
men and 3 women were discharged as not insane. Twenty 
men were transferred by the State Board of Insanity to the 
Gardner State Colonj^; 2 men and 5 women to the Dan vers 
State Hospital; 3 men and 1 woman to the McLean Hospital; 
3 women to the State Infirmary; 1 man and 2 women to the 
Worcester State i^sylum; 1 man to Taunton State Hospital; 
1 woman to the Boston State Hospital; 1 woman to the North- 
ampton State Hospital; 1 woman to the Medfield State| Asy- 
lum; and 1 man to the Westborough State Hospital. Thirty- 
eight men and 16 women were removed from the State, and 
3 men and 30 women were boarded out. 

There remained at the end of the year 30 patients more than 
at the beginning. The smallest number under treatment on 



12 WORCESTER STATE HOSPITAL. [Dec. 

any one day was 1,294, and the largest, 1,384. The daily aver- 
age number was 1,346.75. 

The percentage of recoveries, calculated upon the number 
of discharges and deaths, was 16.8; calculated upon the num- 
ber of admissions it was 10.3. 

The death rate was 9.1, calculated on the whole number of 
patients under treatment, and 13.7, calculated on the daily 
average number. 

Some cases of dysentery have continued to occur during the 
summer, despite the adoption of vigorous sanitary measures. 
The laboratory still has this problem under investigation. A 
few cases of acute contagious disease have occurred, but in 
each instance a rigid quarantine checked any spread of con- 
tagion and no fatalities have occurred from this cause. The 
physicians have been active in medical attention, the record of 
the pharmacy shows an average of over 1,500 prescriptions per 
month. 

In considering the admissions it would seem that we have 
been receiving more cases than formerly where the diagnosis 
was doubtful — more border line cases. The outside physi- 
cians in some localities are becoming more 'alive to the mental 
conditions in the community and realize that the hospital is 
a place for treatment and observation rather than of simple 
incarceration. 

It is interesting to note that more than half of the patients 
admitted were foreign born, and that this ratio is somewhat 
higher than that of last year. Heredity was the greatest prob- 
able cause, with syphilis and alcohol, following in the order 
named, of almost ec|ual importance. When we come to con- 
sider the forms of insanity in those admitted, we find that by 
far the greater number had dementia prsecox, followed by senile 
dementia, alcoholic insanity and general paralysis. 

A liberal policy has been adopted in regard to visits on leave 
of absence. An effort has been made to shorten the hospital 
residence of patients as much as possible. In all cases where 
the mental condition has permitted and opportunity offered 
patients have been allowed to return home on visit. Some have 
had to come back, but the majority have done well. 

Considerable work has been accomplished in the line of in- 



1913.] PUBLIC DOCUMENT — No. 23. 13 

dustrial therapeutics. In our men's industrial room have been 
manufactured the brooms and brushes used in the institution. 
A large amount of furniture has been repaired, baskets made 
and many other articles of domestic use produced. The women 
do work in bookbinding, make rugs, baskets, trim hats, do 
sewing, embroidery and a lot of miscellaneous work. Many of 
these patients have been taken from the disturbed wards and 
an effort is being made to re-educate them in the ways of a 
more orderly method of life. At the last Christmas season a 
large exhibit w^as made here of articles manufactured by patients 
in this and other institutions. This exhibit was visited by over 
a thousand people. 

It is proposed to add to our working staff a director of in- 
dustrial therapeutics. This person, preferably a woman, should 
have charge of the therapeutic industrial activities of the whole 
institution. It should be her duty to lay out and direct the 
work and to inspire in her subordinates a proper and diligent 
application and in her patients an interest and enthusiasm for 
the work. 

But for the drastic cut in our maintenance request for last 
year, a social service worker would be now in service. Con- 
siderable social service work has been done by various members 
of our medical staff, but they have not been able to give suffi- 
cient time to this work to fully meet the needs of the situation. 
A specially trained social service worker should be added to our 
staff as soon as a suitable person can be found to fill the place. 
Since October 1 a eugenics worker, furnished by the Eugenics 
Record Office, Cold Spring Harbor, Long Island, New York, 
has been at the institution and has been prosecuting investiga- 
tions along her special line of work. This woman has been util- 
ized, to some extent, in social service work. 

The more intensive study of the various institution problems 
will add considerably to the numbers of special workers who 
will be required in various lines and will materially increase 
the expense of administration. It is work, however, which must 
be. done if we are to cope properly with the situation. 

For more than a year the institution was entirely without 
restraint or seclusion. Recently, in two instances, it has 
seemed necessarv to break this record. Nonrestraint neces- 



14 WORCESTER STATE HOSPITAL. [Dec. 

sarily implies a greater ratio of nurses and more intensive at- 
tention to excitable cases, not only to give these individuals 
proper care but to protect quiet and inoffensive patients from 
the assaults of the excited and deluded. The general result 
has been good, though there have been more acts of petty 
violence and a greater destruction of property. I should op- 
pose a return to any general use of restraint or seclusion. 

The assignment of female nurses for service in certain male 
wards has given very gratifying results. In every instance 
the welfare of the patients has been promoted and the general 
quality of the nursing service improved. A more active over- 
sight and personal study of cases has resulted. This has made 
it possible in many instances to ward off excitement and vio- 
lence, and to care for certain individuals on the infirmary 
wards who would otherwise have of necessity been classified 
with the disturbed and turbulent. An extension of this nursing 
service is to be desired. 

There is a class of patients in our wards whose presence there 
has a very disturbing influence and for whom some other pro- 
vision should be made at an early date. I refer to the so-called 
defective delinquents. Many of these patients are not suffering 
from an active psychosis but are of defective inheritance and 
seem utterly unable to conform, for any length of time, to the 
requirements and usages of society outside, so that their resi- 
dence in the community cannot be endured. They require in- 
stitutional care of some kind. The proper handling of these 
cases is a very serious problem. Many of these persons are of 
a fairly high degree of intelligence and capable of becoming 
partly, or in some instances wholly, self-supporting, if placed 
in the proper environment. Experiments in boarding out in 
families have met with only a limited degree of success. These 
persons in the wards of an insane hospital react unfavorably 
on the other patients, annoying, provoking excitement and 
often violence. They could well be cared for in farm colonies, 
perhaps connected with some department of the prisons or 
industrial schools, or possibly better in separate establishments. 
Some legislation has already been enacted dealing with these 
cases, but for reasons which I do not understand the provisions 
of the act seem inoperative. If the authorized provision does 



1913.] PUBLIC DOCUMENT — No. 23. 15 

not afford the proper relief, some modification of the act should 
be secured so that the defective delinquents could be removed 
from the wards of our insane hospitals at an early date. 

With hospital buildings of this type of construction, built 
on the block plan and closely associated together, considerable 
difficulty is often experienced in making a satisfactory classi- 
fication of acute patients, inasmuch as the institution can in 
no way limit or regulate the character of the cases admitted, 
but must receive and care for everyone who comes, up to the 
limit of capacity. When too closely associated, excitable cases 
seem sometimes to react upon each other. Still it would seem 
manifestly unfair to disturb the comfort and welfare of quiet 
and orderly patients by thrusting upon them excitable and dis- 
orderly persons. Then again while as much regard as possible 
is paid to the associating together of persons of kindred tastes 
and congenial disposition, quite often the classification has to 
be made largely in accordance with the behavior of the patient. 
I should regard all of our large institutions, built on the block 
plan, as better adapted to the care of chronic and quiet cases 
than to the treatment of the acutely disturbed. At no very 
distant date, in my opinion, this community will demand the 
establishment of a psychopathic unit, the buildings of which 
can well be erected upon these grounds, but at such distance 
from the present structure and with such facilities for classifi- 
cation as will obviate much of our present difficulty. 

So great has been the difficulty in securing and retaining 
suitable persons for the ward service that at times during the 
past year the institution has been seriously embarrassed in its 
work. Every effort should be made to render the service more 
attractive. I believe that some small advance should be made 
in the initial wage and that there should be a more rapid in- 
crease of compensation to a more adequate sum in the case of 
those who prove themselves competent and trustworthy. I 
have long believed that the compensation which the State has 
given to those caring for the insane has been inadequate. The 
general conditions of service should be made such as to attract 
and retain good persons. A substantial increase in the numbers 
of persons employed is to be recommended in order that a 
higher standard of care may be given. In making the estimates 



16 WORCESTER STATE HOSPITAL. [Dec. 

for maintenance for the coming year, a request has been made 
for some increase in the numbers of workers along special lines, 
but, if there is to be any general and radical increase in the ratio 
of the nursing force in our institutions, it should be State wide 
and for this the Legislature must make additional financial 
provision. 

During the year a large amount of general repair has been 
accomplished in various parts of the institution, but much yet 
remains to be done. A force of male patients, working under 
a special man, has aided greatly in the work of renovation in 
the scraping and smoothing of floors. Numbers of wards have 
been painted, adding much to the general cheerfulness of aspect, 
to say nothing of the improved sanitary conditions. 

Good progress is being made on the work authorized by the 
special appropriations of last year, save in the matter of sew- 
age disposal. While connection of the hospital sewers with 
those of the city of Worcester has been authorized and the 
funds granted for the accomplishment of this work, such con- 
ditions were imposed that it has not been possible to make 
even a beginning of this undertaking. No part of this appro- 
priation can be used until the State Board of Health makes a 
satisfactory report concerning the work of the city of Worcester 
in the matter of sewage purification in the Blackstone valley. 
I have no evidence that this report is to be forthcoming on any 
definite date, and it would seem that the institution must in- 
definitely postpone any activity in the matter of sewage dis- 
posal unless some modification can be secured of the restric- 
tions imposed. 

An abundant supply of water is one of the prime necessities 
of an institution not only for ordinary domestic purposes but 
for use in the hydrotherapeutic treatment of patients. With 
the enlargement of the institution, the use of water has steadily 
increased. The coming year a new building will be opened, 
equipped with continuous baths, which will still further add 
to the consumption of water. Under present arrangements 
the water is purchased from the city of Worcester. The finan- 
cial burden is already a heavy one and must increase. In my 
opinion steps should be taken to secure some private source of 
supply. Exploratory wells have been driven in various parts 



1913.] PUBLIC DOCUMENT — No. 23. 17 

of the State property and in only one place has an abundant 
supply of water been found. This is, unfortunately, near to the 
present sewage disposal beds. An analysis of this water shows 
some pollution, probably from this source. With the turning 
of the hospital sewage into the city sewers, this source of con- 
tamination will cease and this water bearing area perhaps could 
be purified and made available as a source of supply. If this 
cannot be done properly, I should advise that other active 
measures be taken for the development of an adequate water 
supply. 

In the last annual report the Legislature was asked for an 
appropriation to provide for the establishment of a central 
dining room for patients. This need was recognized by the 
State Board of Insanity, but the large demands upon the pub- 
lic treasury caused this project to be deferred to another year. 
Now, again I wish to call your attention to the desirability of 
making some change that will provide a more efficient and sat- 
isfactory service of food. In arranging to present this request 
again new estimates of cost were obtained to conform to present 
building conditions. Although no change whatever has been 
made in the plans, there has been a considerable increase in the 
estimated cost of construction. I repeat my recommendation 
of last year that $100,800 "be asked from the Legislature for 
the purpose of erecting a two-story and basement building, 
the basement and first story to be utilized for laundry opera- 
tions, and the top story for general industrial 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 building for the purposes 
of a general dining room. These operations are grouped under 
one request because they are mutually dependent upon each 
other and can best be carried out together." 

Additional accommodations for male patients the coming 
year will be given by the opening of the Quinby building and 
the occupancy of Salisbury 4, the new ward provided by the 
raising of the Salisbury roof. In accordance with the estimate 
of the State Board of Insanity, the institution will be called 
upon to care for 99 more patients than were estimated for the 
past year. The hospital is already crowded in the female de- 



18 WORCESTER STATE HOSPITAL. [Dec. 

partment and greater numbers could not well be cared for there 
without greatly increasing the difficulties of administration. 

With the increased number of patients for the next year 
will come also the need of additional accommodations for offi- 
cers and employees. The building operations which are now 
under way will not make sufficient provision. I recommend 
that your Board ask the coming Legislature for an appropria- 
tion of $19,000 for the erection and furnishing of two cottages 
for employees, following the same plan as that used in the 
building now under construction, each cottage to make pro- 
vision for 10 employees, the lower floor providing a home for 
a man and his family. 

Provision should also be made so that certain members of 
the medical staff may have separate houses on the hospital 
grounds. Such an arrangement would be an additional induce- 
ment for good men to take up hospital work and would tend 
to increase the permanency of the service. For this purpose 
I recommend that your Board request an appropriation of 
$13,800, for the erection and furnishing of two bungalows for 
the use of officers of the institution. 

At the present time the institution is equipped with ordinary 
ice cooled refrigerators. These suffice only for the immediate 
needs of the kitchen service, and are not in any way adapted 
for the long storage of perishable supplies. The experience of 
other institutions indicates that a substantial saving could be 
made in the cost of certain articles of food if they could be 
purchased in large quantities at the time of low prices and 
placed in cold storage for future use. This cold storage can 
best be secured by the use of some form of artificial refrigera- 
tion. The supplies of groceries and other stores used in the 
different departments are now scattered in quite a number of 
different basement rooms. It would seem to be desirable that 
all of the supplies of the institution should, so far as is practi- 
cal, be kept in some central place from which issues could be 
made from time to time in accordance with the various needs. 
To accomplish these desired changes I recommend that your 
Board ask for an appropriation of $50,400 for the erection of 
a general storehouse and for the purchase and installation of 
proper apparatus for artificial refrigeration. 



1913.] PUBLIC DOCmiENT — No. 23. 19 

The members of the medical staff have given faithful and 
intelligent service. With the financial inducements which I 
could offer, I have been unable to keep the members recruited 
to the full complement. I recommend a substantial increase 
in compensation and that the numbers on the staff be increased. 
For several months of the summer two undergraduates of the 
Johns Hopkins Medical School, Mr. Howard S. Colwell and 
Mr. Floyd E. Shaffer, gave material assistance to the staff in 
various ways. The service of these men was very satisfactory. 
I feel that there is a continued field for undergraduate work. 
Staff changes: — 

Resignations. 

Dr. Floyd A. Weed, Dec. 21, 1912. 

Dr. S. Carleton Gwynne, Jan. 14, 1913. 

Dr. Francis A. Taylor, April 10, 1913. 

Dr. J. Abel Thibodeau, Sept. 30, 1913. 

Dr. Samuel T. Orton, Oct. 25, 1913. 

Appointments. 
Dr. Francis A. Taylor, Dec. 23, 1912. 
Dr. J. Abel Thibodeau, Dec. 28, 1912. 
Dr. Mary E. Morse, Jan. 1, 1913. 
Dr. Wallace L. Orcutt, Feb. 7, 1913. 
Dr. Harold C. Arey, July 15, 1913. 
Dr. Roy C. Jackson, Sept. 7, 1913. 

The report of the pathologist gives the details of the labora- 
tory work. During the year Dr. Mary E. Morse has been ap- 
pointed assistant pathologist. Dr. Morse comes to her work 
with a considerable previous experience and is well equipped 
to assist in the working out of our laboratory problems. In 
the latter part of October Dr. Samuel T. Orton resigned his 
position as clinical director and pathologist to accept a similar 
position with the Pennsylvania Hospital for the Insane at Phil- 
adelphia. 

Weekly dances have been held in the chapel. The patients 
have also been amused and entertained by concerts and shows 
of various kinds. The Worcester Asylum kindly gave us an 
evening minstrel show which was greatly enjoyed. Various 
ward entertainments have been given by patients and nurses. 



20 WORCESTER STATE HOSPITAL. [Dec. 

Religious services have been held by Protestant, Catholic 
and Hebrew clergymen. 

I wish to thank the publishers of the "Worcester Evening 
Gazette" and the "Fitchburg Sentinel" for copies of their 
papers. The Worcester Employment Society has also assisted 
us in sewing. Various friends have contributed books, papers 
and puzzles. 

E. V. SCRIBNER, 

Superi7itendent. 
Nov. 30, 1913 



1913.] PUBLIC DOCUMENT — No. 23. 21 



LABORATORY REPORT. 



To the Superintendent of the Worcester State Hospital. 

I herewith submit to you the following report of the clinical 
and laboratory work of the hospital for the current year. 

In my report for the year ending Sept. 30, 1912, there was 
given an outline plan of the methods proposed for the reor- 
ganization of the clinical work. This embraced two main ob- 
jects: first, a more systematic and thorough method of record; 
and second, a more co-ordinate plan of study on the part of 
the medical staff. The first object, that of more thorough 
record, has been hampered somewhat by lack of a full quota 
of staff officers at times, but progress has been made, and for 
this the credit is due to the active interest and energy of the 
members of our staff. The allotted number of staff officers for 
regular duty is so small as to have prevented full accomplish- 
ment of the plan which aimed at a thorough and comprehensive 
series of running notes taken at specified intervals during the 
first six months following the admission of a patient; and in 
cases of longer residence, a physical examination and urinalysis 
at least once in six months and a comprehensive note on the 
mental condition at least once a year in every case. In order 
to systematize the work of keeping track of these records, and 
to prevent the overlooking of notes for long periods on chronic 
cases, a card indexing system has been installed in which record 
is kept on an individual card of each note submitted to the 
stenographers. This card is then filed not by name but by 
the date on which the next examination should be made. By 
this means lists may be readily made of those cases in which 
notes or physical examinations are required, and the time such 
notes or examinations are due, and submitted to the responsible 
physician. 

During the summer months the hospital was fortunate in 
having the services of Mr. Howard S. Colwell and Mr. Floyd 
E. Shaffer of the Johns Hopkins Medical School as volunteer 



22 WORCESTER STATE HOSPITAL. [Dec. 

assistants, and their work in the physical examination and note 
taking on the chronic cases has been of great help in bringing 
many records up to date. 

The morbidity record and wall-board method of graphic reg- 
istration of the occurrence of infectious diseases has proven 
of interest in showing a marked difference in the field of occur- 
rence of the dysentery and diarrhoea cases during the winter 
and summer months. During the winter practically all of the 
cases occurred in wards in which there were many infirm, bed- 
ridden patients, but in the summer the spread was more gen- 
eral, and cases occurred not only among those who ate on the 
wards but from those eating in the employees' dining room and 
even in the officers' dining room, suggesting strongly an epi- 
demiologic factor of general distribution and not due to faulty 
sanitation within the wards or in the general kitchen. This 
factor has not been discovered, but the flies which are still 
present during the warmer months in considerable numbers 
must be considered as one of the possibilities. 

The clinical staff meetings on five mornings of the week and 
the literature review on Saturday mornings have been carried 
out according to the plan outlined in last year's report. The 
literature review falls to the lot of each member of the staff 
once a month, and while at such times it appears in the light 
of a considerable burden, yet it ensures a closer touch with 
the trend of psychiatrical study, and has yielded many inter- 
esting discussions and facts of importance in interpreting symp- 
toms or laboratory findings according to the experience of 
other workers. As reported before, the time allotted to the 
clinical staff meetings has proved insufficient for the presenta- 
tion of all new cases or all cases of uncertain diagnosis or especial 
interest, but practically all cases ready for discharge have been 
presented, and the majority of other classes. 

Evening meetings have been held at the laboratory once a 
week as formerly. 

The work of the laboratory has been carried out along the 
lines laid down in former reports, — aiming at as wide a gen- 
eral review of all cases as possible and at the same time in- 
tensive study of a few of the more interesting ones. To enable 
the maintenance of this standard, further help was required 
at the laboratory and Dr. Mary Elizabeth Morse was appointed 



1913.] PUBLIC DOCUMENT — No. 23. 23 

assistant pathologist on Jan. 1, 1913. A further addition to 
the laboratory staff has been made by the employment of a 
technical assistant, who has charge of the routine urinalysis, 
sputum examination, and spinal fluid work under the direction 
of the pathologist and assistant pathologist, thus relieving the 
staff physicians of the routine work of this type and at the 
same time insuring a uniformity of method in the tests applied. 

The examination of specimems of spinal fluid has been done 
with considerable thoroughness and is yielding information of 
great value for purposes of diagnosis. Samples of blood are 
taken from all new cases, as well as older cases of doubtful 
diagnosis, for examination by the Wassermann method. This 
work is done in the serological laboratory of the department of 
neuropathology of the Harvard Medical School. Our aim is 
to examine the spinal fluid by routine in every case in which 
the Wassermann reaction has been found positive in the blood 
serum, as well as in other cases of especial interest or doubtful 
diagnosis. A part of the specimen of fluid is sent to the sero- 
logical laboratory for a Wassermann test while the rest is ex- 
amined in our own laboratory. This examination includes a 
cell count, Noguchi butyric acid test for globulin, ammonium 
sulphate test for albumins, and an examination and differen- 
tial count of the cell elements by Alzheimer's method. Since 
the establishment of this routine 148 specimens of spinal fluid 
have been examined. 

The series of papers issued in compliment to Dr. Quinby 
have all been published and reprints were bound into volume 
form and are now being distributed. 

During the year 56 post-mortem examinations have been 
performed at the laboratory. These cases classified by the 
psychiatric diagnoses were as follows : — 

Senile psychosis, 20 

General paralysis, 12 

Dementia prsecox, 9 

Organic dementia, 6 

Huntington's chorea, 2 

Manic-depressive insanity, 2 

Unclassified, 2 

Imbecility, 1 

Melaneholiaj 1 

Paranoid condition, 1 



24 WORCESTER STATE HOSPITAL. [Dec. 

The cases classified by the major anatomical diagnoses 
were : — 

Broncho-pneumonia, .13 

(Edema of the lungs, 4 

Chronic nephritis, 3 

Acute cohtis, 3 

Hypostatic pneumonia, 3 

Arteriosclerosis, 3 

Septicsemia, 3 

Septic decubiti, 2 

Cardiorenal, . 2 

Lobar pneumonia, 2 

Aneurysmal dilation of the heart, 2 

Pulmonary tuberculosis, 2 

Chronic pyelonephritis, 

Acute cystitis and pyelonephritis, 

Chronic valvular endocarditis, 

Carcinoma of oysltj, 

Bilateral pleural effusion, 

Exhaustion, 

Rupture of the bladder, 

Empyema, 

Cerebral hemorrhage, 

Encephalomalacia, 

Papillomata of the bladder, 

Acute pancreatitis, 

Septic pneumonia, 

Subdural hemorrhage, 

Before the appearance of this report the writer will have 
resigned his position to accept one — after a short period of 
study in Germany — as clinical director and pathologist to the 
Pennsylvania Hospital for the Insane in Philadelphia, and 
wishes to take this opportunity to express his thanks to the 
superintendent for the courteous treatment accorded him at all 
times and to the clinical staff as well as that at the laboratory 
for their earnest and active co-operation in the work under- 
taken during four years of connection with the hospital. 

SAMUEL T. ORTON, M.D., 

Clinical Director and Pathologist. 



1913. 



PUBLIC DOCUMENT — No. 23. 



25 



PRODUCTS OF THE FARM. 

On Hand Dec. 1, 1913, and not delivered at the Hospital. 



Apples, barrels, 


232 


Mangel-wurzels, bushels. 


400 


Beets, bushels, 


400 


Onions, bushels, . ■ . 


710 


Cabbage, tons, 


13 


Parsnips, bushels, . 


370 


Carrots, bushels, . 


500 


Pumpkins, pounds, 


1,200 


CauUflower, bushels. 


8 


Salsify, bushels, . 


8 


Celery, boxes, 


300 


Squash, winter, tons, . 


10 


Citron, pounds, 


2,200 


Turnips, barrels, . 


320 


Cucumbers, pickle, pecks, 


320 







FARM ACCOUNT. 



Dr. 

Blacksmith and supplies, $261 54 

Bread, 426 58 

Butter, 1,173 88 

Carriage and wagon repairs, 50 30 

Clothing, 404 98 

Current expenses, ". 1,081 67 

Fertilizer, 474 45 

Fish, 228 61 

Fuel, 1,207 69 

Furnishings, 506 66 

Groceries, 2,543 36 

Harness and repairs, '. 188 57 

Hay, grain, etc., 13,269 12 

Ice, 233 76 

Livestock: — 

Calf, buU, 5 00 

Chickens, 42 00 

Meat, 2,400 13 

Milk, 1,830 91 

Repairs, : . . 226 86 

Amount carried forward, . . . . . . . $26,556 07 



26 WORCESTER STATE HOSPITAL. [Dec. 

Amount brought forward, $26,556 07 

Seeds, 243 70 

Sugar, 538 05 

Tools, 476 54 

Wages, 14,792 61 

Water, 369 06 

Net gain for year ending Nov. 30, 1913, 14,429 30 

$57,405 33 
Ck. 

Apples, 460 barrels, $1,380 00 

Asparagus, 41.5 boxes, 166 00 

Beans, Lima, improved, 23 bushels, 39 10 

Beans, shell, 28 bushels, 42 00 

Beans, string, green, 340.5 bushels, 425 63 

Beef, 6 sides, 1,952 pounds, . . . . . . . . 195 20 

Beef, 2 sides, 1,142 pounds, 137 04 

Beets, 855 bushels, ' . . 641 25 

Blackberries, 1,351 quarts, 202 65 

Cabbage, 49.34 tons, 1,381 52 

Carrots, 572 bushels, 429 00 

Calfskins, 2, 2 20 

Cauhflower, 46 bushels, 39 10 

Celery, 388 boxes, 349 20 

Chard, 113 bushels, 45 20 

Chicken, 383.25 pounds, 95 81 

Cider, 831 gaUons, 124 65 

Com, green, 959 bushels, 575 40 

Cucumbers, 103 boxes, 154 50 

Cucumbers, pickle, 320 pecks, . 112 00 

Currants, 128 quarts, 12 80 

Dandehons, 51 bushels, 20 40 

Eggs, 74.16 dozens, . 25 96 

Grain bags, 1,311, 38 60 

Hay, 18.35 tons 385 35 

Hides, 413.5 pounds, 43 06 

Ice, 1,250 tons, 5,000 00 

Kale, 229 bushels, 57 25 

Lettuce, 347.33 boxes, 196 80 

Live stock: — 

Calves, 59, 644 00 

Cows, 4, 93 50 

Hogs, 2, 35 00 

Amount carried forward, $13,090 17 



1913.] PUBLIC DOCUMENT — No. 23. 27 

Amount brought forward, $13,090 17 

Mangel-wurzels, 1,310 bushels, 327 50 

Milk, 423,195 quarts, 27,507 68 

Muskmelons, 59.5 crates, 74 38 

Oats, 652 bushels, ^ 293 40 

Onions, 1,088.5 bushels, 1,034 08 

Parsley, 9.5 bushels, 3 80 

Parsnips, 420.5 bushels, . 315 38 

Peas, green, 188 bushels, 347 80 

I^ork, 32,444 pounds, 3,893 28 

Pumpkins, 900 pounds, . . 18 00 

Radishes, 323 dozen bunches, 129 20 

Raspberries, 279 pints, 33 48 

Rhubarb, 20,032 pounds, 400 64 

Sand, 156 loads, 234 00 

Squash, summer, 94 barrels, 75 20 

Squash, winter, 20.87 tons, 521 75 

ScuUions, 25 bushels, 10 00 

Spinach, 288.5 bushels, 100 98 

Straw, 2.1 tons, 25 20 

Strawberries, 5,303 quarts, 636 36 

Tomatoes, ripe, 467.5 bushels, 467 50 

Tomatoes, green, 46 bushels, .' 34 50 

Turnips, 314.5 barrels, 471 75 

Veal, 85 pounds, 6 80 

Labor of patients, 2,146 days, 2,146 00 

Labor of farm attendants, 1,144 days, 1,716 00 

Teaming, 870 days, 3,480 00 

Registration refunded, 10 50 

$57,405 33 



28 WORCESTER STATE HOSPITAL. [Dec. 



VALUATION OF PERSONAL ESTATE. 



Food, $13,232 10 

Clothing, 10,944 87 

Furnishings, ■ 83,515 69 

Heat, Hght and power, 3,943 42 

Repairs and improvements, 6,609 76 

Farm, stable and grounds, 45,167 36 

Miscellaneous, 12,260 58 



Total, $175,673 78 



I 



1913.1 



PUBLIC DOCUMENT — No. 23. 



29 



TREASURER'S REPORT. 



To the Trustees of the Worcester State Hospital. 

I respectfully submit the following report of the finances of 
this instit^ltion for the fiscal year ending Nov. 30, 1913: — 



Balance Dec. 1, 1912, 



Cash Account. 



$7,769 01 



Institution Receipts. 
Board of inmates: — 
Private, 
Reimbursements, insane, 

Sales: — 

Food, . . . 

Clothing and materials, . 

Furnishings, . 

Heat, light and power, 

Repairs and improvements, 

Miscellaneous, 

Farm, stable and grounds: — 
Cows and calves, . $737 50 
Pigs and hogs, . 35 00 

Hides, . . 45 26 

Sundries, . . 56 10 



Receipts. 



$40,155 35 




21,752 07 






$61,907 42 




$744 28 




121 91 




125 00 




3 70 




92 83 




72 43 





873 



Miscellaneous receipts: — 
Interest on bank balances, 

Rent 

Sundries, 



$660 11 
420 00 
108 98 



Receipts from Treasury of Commonwealth. 
Maintenance appropriations: — 

Balance of 1912 

Advance money (amount on hand November 30) , 
Approved schedules of 1913, . $300,360 15 

Less returned, ... 29 33 



Special appropriations, 
Less returned, . 



2,034 01 



1,189 09 



$9,046 35 
20,000 00 



300,330 82 



$66,346 11 
40 00 



65,130 52 



Industries fund, 



329,377 17 



66,306 11 
62 82 



Total, 



$468,645 63 



30 



WORCESTER STATE HOSPITAL. 



[Dec. 



Payments. 

To treasury of Commonwealth, institution receipts, . . . $65,130 52 

Maintenance appropriations : — 

Balance November schedule, 1912, . , . $16,815 36 

Eleven months' schedules, 1913, . . . 300,330 82 

November advances, ..... 12,649 32 

329,795 50 

Special appropriations : — 

Approved schedules 66,306 11 

Industries fund : — 

Approved schedules, ........ 62 82 

Balance Nov. 30, 1913: — 

In bank, $4,834 25 

In office 2,516 43 

7,350 68 

Total $468,645 63 

Maintenance. 

Appropriation, $335,250 00 

Expenses (as analyzed below) 335,249 15 

Balance reverting to treasury of Commonwealth, ... $0 85 



Analysis of Expenses. 




Salaries, wages and labor: — 






Superintendent, Dr. Ernest V. Scribner, . 


$3,000 00 




General administration, .... 


32,906 82 




Medical service, ..... 


15,636 06 




Ward service (male), .... 


26,198 15 




Ward service (female), .... 


27,916 02 




Repairs and improvements, 


17,155 77 




Farm, stable and grounds, . . 


16,660 41 


$139,473 23 


Food: — 




Butter, 


$16,794 65 




Beans, 


1,579 38 




Bread and crackers, .... 


347 48 




Cereals, rice, meal, etc., .... 


1,649 27 




Cheese, 


1,176 39 




Eggs 


5,636 61 




Flour 


8,686 87 




Fish, 


3,893 24 




Fruit (dried and fresh), .... 


3,257 47 




Lard 


1.402 16 




Meats, 


25,765 14 




Miik 


1,135 00 




Molasses and syrup 


500 46 




Spices, seasonings, salt, etc.. 


639 83 




Sugar 


6,699 06 




Tea, coffee, broma and cocoa, . 


1,898 80 




Vegetables 


5,764 76 




Yeast, 


68 68 




Sundries, 


347 08 


87,242 33 






Amount carried forward. 




$226,715 56 



I 



1913. 



PUBLIC DOCUMENT 



Amount brought forward, 

Clothing and materials ; — 
Boots, shoes and rubbers, 
Clothing, ..... 
Dry goods for clothing and small wares, 
Furnishing goods, .... 
Hats and caps, .... 
Leather and shoe findings, 
Materials and machinery for manufacturing, 
Sundries, ...... 



Furnishings: — 

Beds, bedding, table linen, etc., 

Brushes, brooms, ..... 

Carpets, rugs, etc., .... 

Crockery, glassware, cutlery, etc.. 

Furniture and upholstery, 

Kitchen furnishings, .... 

Materials and machinery for manufacturing, 

Wooden ware, buckets, pails, etc.. 

Sundries, ...... 



Heat, light and power: 
Coal, . 
Gas, 
Oil, 
Sundries, 



Repairs and improvements : — 

Brick, 

Cement, lime and plaster. 

Doors, sashes, etc., 

Electrical work and supplies, . 

Hardware, .... 

Lumber, .... 

Machines (detached), 

Paints, oil, glass, etc., 

Plumbing, steam fitting and supplies 

Roofing and materials, . 

Sundries, .... 



Farm, stable and grounds : — 
Blacksmith and supplies. 
Carriages, wagons, etc., and repairs. 
Fertilizers, vines, seeds, etc.. 
Hay, grain, etc., 
Harnesses and repairs. 
Other live stock, 
Rent, .... 
Tools, farm machines, etc.. 
Sundries, 

Miscellaneous: — 

Books, periodicals, etc., . 
Entertainments, 

Amounts carried forward, 



-No. 23. 


31 


• 


$226,715 56 


$1,676 82 




3,621 72 




1,997 99 




338 06 




154 20 




71 08 




46 89 




69 18 






7,975 94 




$8,597 12 




110 78 




261 15 




1,533 50 




1,088 65 




457 63 




439 78 




72 18 




1,354 75 






13,915 54 




$27,030 65 




404 50 




245 47 




146 13 






27,826 75 




$112 00 




817 77 




115 44 




922 15 




1,315 64 




2,433 89 




1,878 49 




3,593 17 




2,097 54 




66 15 




2,341 46 






15,693 70 




$495 02 




3,231 74 




903 51 




12,459 31 




215 31 




47 00 




216 70 




471 92 




1,019 76 






19,060 27 


$705 98 


169 10 




" $875 08 


$311,187 76 



32 



WORCESTER STATE HOSPITAL. 



[Dec. 



Amounts brought forward. 



$875 08 $311,187 76 



(extra) , 



Miscellaneous — Con. 

Freight, expressage and transportation, 

Funeral expenses, . 

Gratuities, 

Hose, etc.. 

Ice, .... 

Medicines and hospital supplies, 

Medical attendance, nurses, etc. 

Postage, 

Printing and printing supplies. 

Printing annual report, . 

Religious services, . 

Return of runaways. 

Soap and laundrj^ supplies. 

Stationery and office supplies, 

Travel and expenses (officials). 

Telephone and telegraph. 

Tobacco, 

Water, .... 

Sundries, 



Total expenses for maintenance, 



1,280 30 




255 00 




48 45 




48 76 




321 49 




3,954 76 




419 15 




725 00 




547 97 




195 01 




1,156 10 




448 23 




1,886 52 




939 62 




603 41 




769 75 




1,712 46 




5,949 11 




1,925 22 






24,061 39 






$335,249 15 



Special Appropriations. 

Balance Dec. 1, 1912, $65,972 24 

Appropriations for fiscal year, . . . . . . . 29,075 00 

Total $95,047 24 

Expended during the year (see statement annexed) , . . . 66,306 11 

Balance Nov. 30, 1913 $28,741 13 

Resources and Liabilities. 
Resources. 

Cash on hand $7,350 68 

November cash vouchers (paid from advance 

money) , account of maintenance, . . . 12,649 32 

Due from treasury of Commonwealth account 

of November, 1913, schedule, .... 14,918 33 



Liabilities. 



Schedule of November bills, 



$34,918 33 
$34,918 33 



Per Capita. 
During the year the average number of inmates has been 1,351.87 
Total cost for maintenance, $335,249.15. 
Equal to a weekly per capita cost of $4.75 +. 
Receipts from sales, $2,034.01. 
Equal to a weekly per capita of $0.0288. 
All other institution receipts, $63,096.51. 
Equal to a weekly per capita of $0.8951. 



1913.] PUBLIC DOCUMENT — No. 23. 33 

Industries Fund. 

Balance Dec. 1, 1912, $300 00 

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



$300 00 

Expenditures, approved schedules (see statement annexed), . . $62 82 

Balance Nov. 30, 1913, reverting to treasury of Commonwealth, . 237 18 



$300 00 

Industries. 
Expenditures. 
Materials: — 

Leather, . . . . $62 82 



34 



WORCESTER STATE HOSPITAL. 



[Dec. 



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1913.1 PUBLIC DOCUMENT — No. 23. 35 



STATEMENT OF FUNDS. 



Patients' Fund. 
Balance on hand Nov. 30, 1912, .... $4,325 46 

Receipts, 4,102 42 

Interest on bank balance, 159 80 

$8,587 68 

Interest paid to State Treasurer, .... $159 80 

Refunded, 3,813 22 

3,973 02 

$4,614 66 
Investment. ^ 

Worcester County Institution for Savings, . . $2,000 00 
Worcester Five Cents Savings Bank, . . . 1,000 00 
Balance Worcester National Bank, . . . 1,266 11 
Cash on hand Dec. 1, 1913, 348 55 

$4,614 66 

Lewis Fund. "~ 

Balance on hand Nov. 30, 1912, .... $1,534 23 
Income, 58 93 

$1,593 16 

Expended for books and vault rent, 84 30 

$1,508 86 
Investment. "" 

American Telephone and Telegraph Company 

bond, $926 36 

Worcester County Institution for Savings, . . 349 44 

Balance Worcester National Bank, . . . 233 06 

$1,508 86 

Wheeler Fund. ^^~~~^~' 

Balance on hand Nov. 30, 1912, $5,381 42 

Income, 254 27 

$5,635 69 

Expended for books, 279 38 

$5,356 31 



36 



WORCESTER STATE HOSPITAL. [Dec. 1913. 



Investment. 
6 shares Worcester National Bank, . . . $1,002 00 
American Telephone and Telegraph Company 

bond, 

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

Lawn Fund. - 

Balance on hand Nov. 30, 1912, .... $452 70 

Income, 18 26 



712 50 


1,632 00 


1,753 85 


173 58 


• 82 38 



$5,356 31 



$470 96 



Investment. 



Mechanics Savings Bank, 



$470 96 



M ANSON Fund. 
Balance on hand Nov. 30, 1912, . 
Income, 



Expended for entertainments, 



Investment. 



$1,627 83 
65 74 



$1,693 57 
57 00 

$1,636 57 



Worcester County Institution for Savings, $1,636 5"/ 



Respectfully submitted, 



E. V. SCRIBNER, 

Treasurer of the Corporation. 
Nov. 30, 1913. 

Worcester, Mass., Dec. 5, 1913. 
I hereby certify that I have this day compared the treasurer's statement of 
funds for the year ending Nov. 30, 1913, with the books kept at the Worcester 
State Hospital, and find it correct. I have also inspected the securities repre- 
senting the investments and find their value is as stated. 

GEORGE L. CLARK, 

Auditor of Accounts. 



STATISTICAL TABLES. 



[FOEM PRESCKIBED BY StATE BoABD OF INSANITY.] 



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WORCESTER STATE HOSPITAL. 



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1913. 



PUBLIC DOCUMENT — No. 23. 



41 



2. — Insane 



on First and Subsequent Commitment. 



NUMBER OF THE COMMITMENT. 



Cases committed. 



First to this hospital, 

Second to this hospital, .... 

Third to this hospital, 

Fourth to this hospital, .... 

Sixth to this hospital, 

Eighth to this hospital, .... 

Ninth to this hospital, 

Tenth to this hospital, 

Total cases, 

Total persons, 

Never before in any hospital for the insane. 



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





Males. 


Females. 


Totals. 


PLACES OF NATIVITY. 


^• 


S^ 


si 


^ 


i 


^: 


^ 


^ 






.S 


.a 




.2 


£ 


■ •$ 


.2 


M 






Ph 


^ 


S 


£ 


k 


g 


fS 


^ 


S 


Massachusetts, .... 


85 


24 


33 


67 


21 


20 


152 


45 


53 


Other New England States, . 


25 


21 


16 


19 


16 


16 


44 


37 


32 


Other States 


14 


8 


10 


10 


7 


8 


24 


15 


18 


Total native, .... 


124 


53 


59 


96 


44 


44 


220 


97 


103 


Other countries: — 




















Armenia, ...... 


1 


1 


1 


- 


- 


- 




1 


1 


Austria, 


2 


2 


2 


1 


1 


1 




3 


3 


Belgium, 








1 


1 


1 




1 


1 


Canada 


24 


32 


31 


12 


23 


24 


36 


55 


55 


China 


1 


1 


1 










1 


1 


Denmark, 








1 


1 


1 




1 


1 


England 

Finland, ...... 


9 


15 


12 


8 


8 


11 


17 


23 


23 


6 


fi 


6 


3 


3 


3 




9 


9 


France 




1 


1 


1 


2 


1 




3 


2 


Germany, 


2 


4 


4 


2 


4 


2 




8 


6 


Greece 


2 


2 


2 


1 


1 


1 




3 


3 


Holland 


_ 






2 


2 


2 




2 


2 


Hungary, 


1 


1 


1 










1 


1 


Indies, East 


1 


- 


- 


- 


- 


- 




- 


- 


Indies, West 


2 


2 


2 


1 


- 


1 




2 


3 


Ireland, 


37 


fi7 


65 


41 


71 


71 


78 


138 


136 


Italy 


10 


12 


12 


1 


1 


1 


11 


13 


13 




2 


2 


2 


1 


1 


1 




3 


3 




?. 


2 


2 


3 


2 


2 




4 


4 


Newfoundland 








1 


1 


2 




1 


2 


Norway, 


.3 


4 


3 


- 


- 


- 




4 


3 


Nova Scotia, . . . . . 


2 


2 


4 


6 


4 


3 


8 


6 


7 


Poland 


1 


1 


1 


1 


1 


1 


2 


2 


2 


Prince Edward Island, . 
















1 


- 


Russia 


Ifi 


Ifi 


16 


7 


7 


7 


23 


23 


23 


Scotland 


2 




3 


3 


2 


4 


5 


5 


7 


Sweden, 


3 


3 


3 


8 


9 


9 


11 


12 


12 


Syria 


1 


1 


1 








1 


1 


1 


Turkey, 


4 


4 


4 


- 


- 


- 


4 


4 


4 


Total foreign, .... 


134 


185 


179 


105 


145 


149 


239 


330 


328 


Unknown 


2 


22 


22 


- 


12 


8 


2 


34 


30 


Totals 


260 


260 


260 


201 


■ 201 


201 


461 


461 


461 



42 



WORCESTER STATE HOSPITAL. 



[Dec. 



J+. — Residence of Insane Persons admitted from the Community. 





FlBST ADMITTED 

TO Ant 
Hospital. 


Otheh 
Admissions. 


Totals. 


PLACES. 


1 


i 




1 


[S 


1 


1 
1 


(S 


ri 

1 


Massachusetts (by counties): — 
Middlesex, . . . . 

Norfolk 

SuSolk, ...... 

Worcester 


90 

4 

29 

137 


80 
3 
26 
92 


170 

7 

55 

229 


19 

1 

16 
16 


18 

8 
26 


37 

1 
24 
42 


109 

5 

45 

153 


98 

3 

34 

118 


207 

8 

79 

271 


Totals 

Cities or large towns (10,000 or over), 
Country districts (under 10,000), . 


260 
218 
42 


201 
171 
30 


461 
389 
72 


52 
47 
5 


52 
42 
10 


104 
89 
15 


312 

265 
47 


253 
213 
40 


565 

478 
87 



5. — Civil Condition of Insane Persons first admitted to Any Hospital. 





Males. 


Females. 


Totals. 


Unmarried 


118 


77 


195 


Married 


112 


81 


193 


Widowed 


25 


39 


64 


Divorced . 


4 


4 


8 


Totals 


259 


201 


460 


Unknown 


1 


- 


1 


Totals 


260 


201 


461 



1913. 



PUBLIC DOCUMENT — No. 23. 



43 



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



Females. 



Bookkeeper, .... 1 


Proofreader, 


1 


Cashier, . 








1 


Seamstresses, 


. . . 2 


Clerk, 








1 


Tailoress, . 


1 


Cook, 








1 


Teachers, . 


. . . 4 


Domestics, 








29 


Waitresses, 


. . . 3 


Dressmakers, 








3 


No occupation. 


. . . 46 


Housekeepers, 








25 






Housewives, 








50 


Total, 


. 200 


Laundress, 








1 


Unknown, 


1 


Milliner, . 








1 






Nurses, 








2 


Total, 


. 201 


Operatives, 








28 







Males. 



Agent, 

Bakers, 

Blacksmiths, 

Boarding-house keeper. 

Bookkeeper, 

Brakeman, 

Butchers. . 

Carpenters, 

Chauffeur, 

Clerks, 

Collector, . 

Commission dealer. 

Dentist, . 

Electrician, 

Engineers, 

Expressman, . 

Farmers, . 



Florist. 

Foreman, 

Gardeners, 

Gasfitter, 

Janitor, 

Jeweler, 

Laborers, 

Laundryman, 

Machinists, 

Masons, 

Mechanics, 

Molders, 

Operatives, 

Painter, 

Pedlers, 

Plumber, 

Pohceman, 



44 



WORCESTER STATE HOSPITAL. 



[Dec. 



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



Males — Concluded. 



Polisher, ..... 1 


Teamsters, 


5 


Porters, . 








■ 2 


Teachers, . 


2 


Printers, . 








2 


Upholsterer, 


1 


Roofer, 








1 


Waiter, . 


1 


Seamen, . 








2 


No occupation, 


. 26 


Soldier, . 








1 






Stableman, 








1 


Total, 


. 252 


Storekeepers, 








5 


Unknown, 


. . 8 


Student, . 








1 






Tailors, . 








3 


Total, 


. . 260 



1913. 



PUBLIC DOCUMENT — No. 23. 



45 



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46 



WORCESTER STATE HOSPITAL. 



[Dec. 







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Physical. 

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Adolescence, . 
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cence. . 


lilepsy, 

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health. 


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I 



1913. 



PUBLIC DOCUMENT — No. 23. 



47 



1 1 1 1 1 (N 1 




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Bereav 

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nk.a 


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48 



WORCESTER STATE HOSPITAL. 



[Dec. 



Probable Duration of Mental Disease before Admission. 











First admitted to Ant Hospital. 




Males. 


Females. 


Totals. 


Congenital, 








12 


7 


19 


Under 1 month, 








61 


23 


84 


From 1 to 3 months, 








37 


27 


64 


3 to 6 months, 








28 


20 


48 


6 to 12 months, 








IS 


16 


34 


1 to 2 years, 








10 


25 


35 


2 to 5 years. 








31 


42 


73 


5 to 10 years, 








19 


18 


37 


10 to 20 years. 








9 


7 


16 


Over 20 years. 








4 


3 


7 


Totals, . 


229 


188 


417 


Unknown, 








31 


10 


41 


Not insane, . 








- 


3 


3 


Totals, . 


260 


201 


461 


Average known duratic 


n (in 


yea 


rs), . 


3.68 


3.43 


3.57 



1913. 



PUBLIC DOCUMENT — No. 23. 



49 



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A. — First admitted to any hospital: — 

Acute hallucinosis 

Alcoholic insanity, acute: — 

Alcoholic depression, 

Alcoholic hallucinosis, . . . . 

Delirium tremens 

Alcoholic insanity, chronic: — 

Alcoholic deterioration, 

Alcoholic hallucinosis 

Alcoholic paranoid condition, .... 

Polyneuritic psychosis, . . . 

Constitutional inferiority, 

Delirium, acute 

Dementia precox, 

Dementia preecox, allied to 

Epileptic insanity, ...... 

General paralysis of the insane 

Huntington's chorea, 

Hysterical insanity 

Imbecility 

Manic-depressive insanity: — 

Depressed form, 

Manic form, 

. Manic-depressive insanity, allied to, . 

Organic dementia 

Paranoid condition, 

Paranoid condition, senile 

Senile dementia, 

Toxic insanity, acute: — 

Delirium, 

Hallucinosis 

Drug psychosis, 

Traumatic insanity, 

Unclassified 

Not insane 


H 



50 



WORCESTER STATE HOSPITAL. 



[Dec. 



m 


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B. — Other admissions: — 

Alcoholic insanity, acute: — 

Alcoholic hallucinosis 

Delirium tremens, 

Alcoholic insanity, chronic: — 

Alcoholic deterioration, 

Alcoholic hallucinosis 

Alcoholic paranoid condition, .... 

Polyneuritic psychosis, 

Constitutional mferiority, . . . 

Dementia prsecox, 

Dementia prsecox, allied to 

Epileptic insanity, 

General paralysis of the insane, .... 

Huntington's chorea, 

Hysterical insanity, 

Imbecility 

Manic-depressive insanity: — 

Circular form, ....... 

Depressed form 

Manic form, 

Manic-depressive insanity, allied to, . 

Organic dementia, ...... 

Paranoid condition, 

Psychasthenia 

Senile dementia, 

Toxic insanity, acute: — 

Delirium 

Drug psychosis 


Totals 

Aggregate cases, 

Aggregate persons, 



PUBLIC DOCUMENT — No. 23. 



51 





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1 


•siBijox 


i^- ^ cq 1 1 1 1 1 1 1 


S S 5 




•saiBtnaj 


§ -- ' ' 


?5 Si 53 




•sapK 


jH CO cq 1 1 1 1 1 1 1 


?§ ^ § 




;> 


•siB^ox 


CO « I 1 CO 1 « 1 1 1 


s s s 




•saiBraa^ 


- - 1 1 « 1 1 . . 1 


lO lO -H 




•saiBM 


« ^ 1 1 1 1 - 1 1 1 


S; S § 






•siB^ox 


jj cq <N 1 « 1 1 1 1 T^ 


5 5^ 




•saiBHia^ 


^ c ^ , 1 1 1 1 . - 


S § S3 




•sai^H 


g. o ^ , ^ 1 1 , , , 


g g S? 




a 
1 


•emox 


go«-« 1.^^^ 1 


S ?i s 




•S8IBni8j[ 


^ ^ c^ ^ , , ^ ^ ^ , 


^ ^ S3 




•sapM. 


S "= ' ' ^ ' ' ' ' ' 


S-^ ^ 






II 




First to this hospital. 
Second to this hospital, . 
Third to this hospital, . 
Fourth to this hospital, . 
Fifth to this hospital. 
Sixth to this hospital, . 
Seventh to this hospital. 
Eighth to this hospital, . 
Ninth to this hospital, . 
Twelfth to this hospital. 


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



52 



WORCESTER STATE HOSPITAL. 



[Dec. 



'i. 


•smoi 


1 -^ 1 1 1 1 1 1 1 II 1 1 1 1 1 II 1 1 1 1 1 1 


•S9IT3in8^ 


I 'I 1 1 1 I 1 1 1 II 1 1 1 1 1 II 1 1 1 1 1 1 


•sai-BH 


''''''''' ' ' 


M S O 


•emoi 


1 1 1 1 1 1 1 1 1 II 1 1 -H 1 1 1 ,H 1 rt c<i 1 1 I 


•saiBine^ 


1 1 I 1 1 1 1 1 1 II 1 1 1 1 1 II 1 1 ^ 1 1 1 


•sai^H 


1 1 1 1 1 1 1 1 1 II 1 1^ 1 1 1- 1^-11 1 


» H 15 


•SIB^Oi 




•saiBtne^ 


''-'''■''-' ' ' ' '- ' ' ' 


•saiBH 


. 1^1 1 1 1 1 1 ,1 1 1 1 1 1 II 1 1 1 1 1 1 


1^ . 


•SI'BI^OX 


- 1 ^ 1 l-H l-H- 11 1 1 1 1 1 II - 1 1 1 1 1 


•S8I'Bra8j[ 


--'"'"-'-- ' ■ ' ' ' ' ' ' ' ' 


•sai^H 


1 1- 1 1 ' 1 ' ' ' II - 1 1 1 1 . 




•smox 


' '-" ' 1- 1"* ' ' ^^^ 1 ' II ' l^'l 1 1 


•saiBraai[ 


' ' 1 ' 1 '-•- ' 1 11-1111 1 ic,, 1 , 


•S8IBM 


1 ,- 1 1 1 1 1 1 1 , — 1 . II . ,«, 1 1 


■i, 
IS H 
"1 


•slB!^ox 


. 1^, 1 , 1 ,-. ,1 I.C, 1 .1 , IO-.C, - 


•saiBraaj 


I ,«, 1 1 1 ,C , 1 , 1^1 , , 1 , I^O^C, ^ 


•sai^H 


1 1 <M 1 1 1 1 1 ^ II 1 -l<M 1 1 ^ 1 1 1 3 1 1 1 




•SIB^JOi 


IICCIMIIIM l-H lllll II IT^III 1 


•Bai'Braaj[ 


II^ICOIIIM II lllll II lllll 1 


•B81BM 


llC^IOIIIrt l-H lllll II It-HIII 1 


<-0 


•smox 


..o.« 2 -- — -- --S5-" - 


•saiBtnaj; 


rt-^cq 1 COrt^-IO ^1 1 1 (M-HIM 1 1 1 1 ca-icc ^ 


•sai^H 


1 1 OOrtO 1 1 1 CM 1 rt r^«.TH 1 1 -H-H -HNOO 1 1 1 




Eh 

Q 

(in 
O 
OD 

a 

CO 

p 


■■■■I M-- 1 1- 

i .J . . , . . m ■ ■ .'..» 1 . 

1 ■ --s •§ ^« 1 ■ • -las- ■ s 1 ■ ■ -i: -5 ■ 

J.. ?..- .lllll i.ai«il.. H-iki%- 

IIJIUIII Jll .llilil. 

lis lillil ?llllll|i ?i!il i 

a Q Q 



1913. 



PUBLIC DOCUMENT — No. 23. 



53 



1 1 • 1 1 


1 1 1 1 1 <N ! 1 tH 11 III 


^ 





1 1 1 1 1 -^ III II III 


« 


1 > 1 1 1 


1 1 1 1 ,« II- II III 


eo 


1- 1 . 1 


' ' ^ ' "" II. , - J , 1 


2 


, , , , , 




- 


1^11, 


' '-^ ' '- ' ' • 


^ 


1 1 1 1 1 


1 1 IC.,- ,11 11-11 


o 


I 1 1 1 1 


,11-1- III 11-11 


- 


< , , , , 


1 1 1 — 1 , III II III 


« 




— 1 ioth I eq — 1 1 1 , ,11 


s 


1- 1- 1 


■'--'- -' ' ' ' ' • ' 


2 


1 1 I-. 1 


— , CCCO , , III II III 


2 


1111^ 


n , , t~— , 1 , , ,1 1 — 1 


^ 


1 1 1 I- 


1 1 , -K 1 , 1,1 , , III 




< , 1 1 1 




2 


^ 1- 1 1 


^— 1 J2 1 , III — 1 III 


S 


T-. 1 1 1 1 


1— ItOII II, — 1 ,,, 


. 




^ I ICO, , , 1 , ,1 ,11 




, , , , , ^^ ,^^, , ,^ , „ , , ,^ 




lllll llll(MII It^I ^I III 


2 


1 1 1 1 1 rt^ 1 t^tH II III II 1 1 rt 


S 


^CO^C^ ^^^^^^00 — ^ c^ ^^^ 


S 




g 


IC.--.I ^oiooo-'^' 1 ■- II ■ — 


S; 


Chronic myocarditis and arteriosclerosis, . 

Endocarditis 

Mitral stenosis 

Myocarditis, 

Valvular heart disease 

IV. Diseases of the respiratory system: — 


(Edema of lungs 

Pleural effusion with oedema of lungs. 

Pulmonary tuberculosis 

Pneumonia, broncho, 

Pneumonia, hypostatic, .... 
Pneumonia, lobar 

V. Diseases of the digestive system: — 

Acute pancreatitis and cholelithidsis. 

Cholecystitis 

Intestinal obstruction, .... 

VI. Diseases of the genito-urinary system; — 

Acute cystitis 

Chronic interstitial nephritis. 
Gangrenous cystitis and ascending pye- 

lonepliritis, 

Pyelonephritis 

Rupture of bladder, 








54 



WORCESTER STATE HOSPITAL. 



[Dec. 





•SIB^Oi 


1 ,- 1 1 1 1 1 1 ,1 1 1 1 1 1 11 1(111 1 


•SGi'Bniaj 


.,-,1,1,1 ,1 11111 ,1 11111 1 


•saiBpi 


''''''''' ' ' ' ' ' ' ' ' ' ' 


^"1 


•SI■BC^OJ;, 


1 1- 1 1 1 1 1 1 1 1 II ,1,11 , 


•S8I13in8i[ 


1 1- 1 1 1 1 1 1 1 1 1 1 


•saiBjif 




III 


•SIBI^OJ, 




•saiBinaj 




•saiBH 




M 


•ei^^oi 


1,1111,1, 1 , 1-1.1 ,1 ,1,1, 1 


•SGi'Braa^ 




•S91BM 


1 1 1 1 11 1- 1 1 1 




•si^^oi 


,,,1,1.11 .1 ,11-1 , , , , , , , , 


•S3I'BOT9j[ 


11,1,1,1, 1 , ,,,<-<, , , , , , 1 , 1 


•saiBpi 




2 H H 


•SI'E^Oi 




•seiBTnaj 




•eaiBH 




i 

5 


•smox 




•eaiBraaj 




•sqBH 




;? 
nan 

"^1 


•si^^oi 


,1,-1,111 ,1 ,1,1, 1 , , , , , . , 


•seiBraa^ 


,1,1,1,11 , , 1,1,, , , 1,1,1 , 


•saiBpi 


,,,-,,, 1 1 ,1 1,11, , , 1 , , , . , 




W 

-< 
w 

Q 

o 

i 

P 


1 H " 2 i • 

i Au . . 2 -g_ 

i.-l |i| . . I. 1 . 

§ - 1 .' ^u 11 : 
,..j.jiy|..|||..ii...i.;. 

ajiijiiijiiiij&iiiiL 

ii-sigiii'^'ftfi mill ill iirpim 

o s « 



1913.] PUBLIC DOCUMENT 

t 1 1 1 1 1 1 1 1 (M 1 1 III II III 


— > 


1 1 1 1 1 1 1 I 1 ?4 1 1 III II III 


„ 


1 1 1 1 1 1 III II III 




1 1 1 1 1 1 1 III II III 


-- 


' ' ' ' • ' ' .1111 


- 


' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 


■ 


1 1 1 1 1 1^ 1 1 1 1 1 III II III 


-' 


1 1 1 1 1 1 1 1 . 1 1 < 1,1 ,1 , . , 


1 


1 1 1 1 1 1 <-< 1 1 1 1 1 III II III 


-' 


' ' ' ' ' ' ' ' 


^ 


' ' ' ' ' ' ' ' ' ' ' < ' ' < 


1 


1 1 1 1 1 1 1 1 1 1 1 1 III II III 


" 


' ' 1 ' 1 1- 1 1 1 II III 




1 1 1 1 1 1- 1 , 1 1 1 111 : 1 111 


- 




' 


'- ' 'Ill III II III 


-^ 




1 


1- 1 1 1 1 1 1 1 1 1 1 III II III 


- 


1 1 1 1 I 1 1 1 1 <-i 1 i-i III ) 1 III 


- 


1 I 1 1 1 1 1 1 1 1 1- 1 1 r 1 , III 


T-l 


1 . 1 1 1 1111-11 III 11 III 


- 


1 1 1 1 1 1 1 1 1 1 1 1 111 II III 


-' 


.1111 1 1 1 1 1 1 1 II, 1 , 111 


1 


• ' ' ' ' ' ' ' Mill, 


- 


Chronic myocarditis and arteriosclerosis, . 

Endocarditis 

Mitral stenosis, 

Myocarditis 

Valvular heart disease, .... 

IV. Diseases of the respiratory system: — 

Empyema 

CEdema of lungs, 

Pleural effusion with oedema of lungs, 
Pulmonary tuberculosis, .... 

Pneumonia, broncho, 

Pneumonia, hypostatic, .... 
Pneumonia, lobar 

V. Di.seases of the digestive system; — 

Acute pancreatitis and cholelithiasis. 

Cholecystitis, 

Intestinal obstruction, .... 

VI. Diseases of the genito-urinary system: — 

Acute cystitis, 

Chronic interstitial nephritis, 
Gangrenous cystitis and ascending pye- 
lonephritis, 

Pyelonephritis 

Rupture of bladder, 


■f 



55 



56 



WORCESTER STATE HOSPITAL. 



[Dec. 





i 

o 

< 

IS 

< 


lid 

o a H 


•SlU^OT 


1 1 rt ^ t, m (M 1 1 


S ' 


g 2 




■S9I8Uiaj[ 


1 1 « CO cq T« (M 1 1 


s ' 


.-1 CO 




•eoiBjti 


, , , ^ « ., , , , 


CO , 


«> ^ 




1' 


•eiB^ox 


1 1 rt CO lO to « (M 1 


§ ' 






•saiBtno^ 


1 1 ^ CO « ^ CO .M 1 


3 ' 


2 S 
^ 




•S8IBPI 


1 1 1 1 ^ (M rt -H 1 


00 1 


00 M 




►3 

< 

w 
< 



1 
< 


1 


•simox 


to t^ a> N lo cq 1 1 1 


s 


3 5; 




•B8IT3ra9j[ 


.H to ^ to ^ ^ , , , 


?5 ' 


o 




•SSIBpi 


U5 -H iO to rl -H 1 1 1 


§ ' 


lO 




1 

i 

W 


•siB^ox 


O. C, « t, t, ^ , 1 , 


S ' 


S 5 




•saiBtno^ 


rt O CO rt O ^ 1 1 1 


S3 ' 


S3 SS 




•saiBH 


oo 2 « » - ' , , , 


§ ' 


CB ta 




i 

P 




•sinox 


o c. to « ^ ^ 1 1 1 


3 ' 


s § 




•sajBraa^ 


cq CO ^i" ea -H 1 1 1 r 


S3 ' 


S5 § 




•sai^H 


t^ O =. , 1 « , , , 


§ ' 


§ § 




O 






. 




■s 




I 




i i i . . . . i 




A. — Recovered: — 

Under 1 month, . 

From 1 to 3 mont 

3 to 6 mont 

6 to 12 mont 

1 to 2 years 

2 to 5 years 
6 to 10 years 

10 to 20 years 
Over 20 years. 




11 

< 



1913.] 



PUBLIC DOCUMENT — No. 23. 



57 



M-llM!Mrfl(MM(MTt< 


?3 ' 


S3 S 




-H |IN^<M<M-H-HM 


2 ' 






^ ^ , « C , « ^ C 


O 1 


2^§ 
2 




■------"=- 


S3 ' 


05 




, ..< ^ rt 1 « <M N T« 


2 ' 


2 g 




1 1 1 rt T-< ( C^ «, CO 


2 ' 


2 5i 




-°^«'2SSS5=3== 


2 « 


S CO 




' ^-Ht-wj^ooco 


^, "^ 


CO 




-'^'--2---^« 


s ?^ 






SS22g§^^ ' 


S ' 


3 § 

?4 




SSSin'^S^'^ 1 


s 


S K 
^ 




g,ot,^oooc.c , 


5 ' 


5 § 




^?322S^SS^^ 


i s 


s s 




, 2"=°3g»=°-- 


s - 






^ ^ ^ t~ CO ^ a. ,« 


to <M 


00 CO 








. 




1 




a 




B. - Died: - 

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. 




■ & 

11 







iiiSiiiiiii^^^