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Public Document
Cl)e Commonwealth of ^ajBiisacfjiisett^
ANlSrUAL REPORT
OF
THE TRUSTEES
OP THE
Worcester State Hospital
FOR THE
Year ending November 30, 1921
Depabtment of Mental Diseases
BOSTON
WRIGHT & POTTER PRINTING CO., STATE PRINTERS
32 DERNE STREET
Public Document No. 23
Cf)e CommonitJealtJ) of Qia00aci)U0ettg
ANNUAL REPOET
THE TRUSTEES
.Worcester State Hospital (ju.^
FOR THE
Year ending November 30, 1921
Department of Mental Diseases
■/
BOSTON
WRIGHT & POTTER PRINTING CO., STATE PRINTERS
32 DERNE STREET
8T11TE LIBRARY or HOStTTS
JUN16 1922
ST.ME. HOUSE, BOSTQI^
publicatioisr of this document
approved by the
Supervisor of Administration.
•7^
CONTENTS
PAGE
Report of the Trustees 7
Report of the Superintendent 11
Valuation 38
Report of the Treasurer 39
Statement of Funds 46
Statistics 49
OFFICERS OF THE WORCESTER STATE
HOSPITAL.
BOARD OF TRUSTEES
John E. White
John G. Perman, D.D.S.
Ltjther C Geeenleaf .
Caroline M. Caswell, Secretary
Mae Carlson Bemis
William J. Delehantt, M.D.
Edward F. Fletcher, Chairman
Worcester.
Worcester.
Boston.
Northborough.
Worcester.
Worcester.
Worcester.
William A. Bryan, M.D.
Clarence A. Bonner, M.D.
Michael J. O'Meaea, M.D.
Leon E. Duval, M.D. .
Robert B. Harriman, M.D
George F. Caldicott, M.D.
Frankltn p. BoirsQcrET, M.D.
George A. Gaunt, M.D.
Harrison M. Stewart, M.D.
Lloyd E. Byrd, D.D.S.
MEDICAL STAFF.
Superintendent.
Assistant Superintendent.
Director Clinical Psychiatry.
Senior Assistant Physician.
Senior Assistant Physician.
Senior Assistant Physician.
Senior Assistant Physician
(Pathologist) .
Assistant Physician.
Assistant Physician.
Assistant Physician.
Assistant Physician.
Assistant Physician.
Assistant Physician.
Dentist.
HEADS OF DEPARTIMENTS
Elsie I. Richards, R.N.
Maurice Scannell
Jessie M. D. Hamilton
Herbert W. Smith
Lillian G. Carr .
Joseph Reynolds
James Dickison, Jr.
Anton Swenson .
Superintendent of Nurses and
Principal of Training School,
Supervisor, Male Department.
Treasurer.
Steward.
Matron.
Head Farmer.
Chief Engineer.
Foreman Mechanic.
Cl)e Commontoealtf) of ^a00acJ)usett0
TRUSTEES' REPORT.
To His Excellency the Governor and the Honorable Council.
The trustees of the Worcester State Hospital respectfully
submit the eighty-ninth annual report of the hospital, append-
ing a record of the various departments as reported by the
superintendent, Dr. William A. Bryan, and by the treasurer,
Jessie M. D. Hamilton,
In November, 1920, Mr. Edward F. Fletcher of Worcester
was duly elected permanent chairman of the Board, and Miss
Caroline M. Caswell, secretary.
The trustees assisted in helping to make the American
Medico-Psychological Association meeting in Boston the suc-
cess which it was.
In their corporate capacity the trustees voted to present
Washington Allston's picture of St. Peter and the Angel in
Prison, given to the hospital by Dr. R. W. Hooper, to the
Boston Museum of Fine Arts on condition that the original
be replaced by a very fine copy. This gift was made after
careful consideration of the terms of the deed of gift from Dr.
Hooper, and in view of the fact that the original would be of
far greater value as an art treasure to the Art Museum than
to the hospital, w^hile a good copy would give as much pleasure
to the inmates of the Worcester State Hospital.
Believing in co-operation the Board voted to place a sign of
welcome to the city at the junction of Lake Avenue and Bel-
mont Street, at the request of the Chamber of Commerce, and
also voted to grant the city of Worcester permission to erect
a memorial granite shaft for James M. Beatty on the north-
easterly corner of Beatty Square.
Still thinking, as outlined in the 1920 report, that there
8 WORCESTER STATE HOSPITAL. [Dec.
ought to be something definite for all trustees to do to further
the work with which they had become associated, they voted
to give hearty support to the Hospital Trustees Association for
a year. The association has been invited to hold its spring
meeting at the hospital.
One new plan which has worked out very satisfactorily is
the presenting of a full typewritten report by the superintend-
ent to the trustees several days before the monthly meetings.
This report is most comprehensive and gives the trustees time
to consider the various phases of the work in an intelligent
manner.
Repairs on the organ were voted from the private funds held
by the trustees.
The details of improvements in the hospital will be noted by
the superintendent, but the trustees gladly report improved
conditions and steps in advance everywhere. Buildings
painted, installation of new toilets on Washburn I and II,
work begun on the renovation of Lincoln IV and Salisbury III,
a new system of handling garbage, the purchase of necessary
home, farm, medical and dental equipment, the grading and
terracing of the land, and the laying of water pipes at Hillside
— all these activities pointing to progression.
Attention is called to the careful analysis made in the sum-
mary of admissions in the superintendent's report, and to the
result of treatments which, after all, is the most important
feature; also to the resident dentist's report of the dental de-
partment, which shows a very decided increase in work accom-
plished. The excellent achievements in the pharmacy should
be especially noted, showing as they do in the pharmacist
marked thought and interest in the work and capacity for
service. The social service department is as ever impor-
tant in its results and in its bearing upon our usefulness in
the community. An assistant has been at work in this
branch since September 18. The course of six lectures for
the social workers of Worcester in psychiatric social service,
which lectures have been largely attended and thoroughly
appreciated, is also a forward step in the community's under-
standing of hospital service, as well as of much educational
value to the social worker. The out-patient department offers
1921.] PUBLIC DOCUMENT — No. 23. 9
many of the advantages of a psychopathic to the people of
Worcester and vicinity, and will be a most important factor in
acquainting those outside the hospital \dth its desire for help-
fulness. The results of this new work have been most encour-
aging.
The trustees respectfully submit the fact that there is im-
perative need of fireproof stairways; that a new storehouse and
a new system of refrigeration are both very desirable; and that
a plan for a congregate dining room should be made. The use
of the Summer Street department for an up-to-date pscyho-
pathic hospital would greatly increase the value of the Worces-
ter State Hospital in this section of our State. The trustees
again urge upon those in power the necessity of increasing
instead of decreasing salaries and wages for workers in the
different departments, in order that the best brains and service
may be obtained for the hospital.
The trustees can point with no little pride to the advance
which the hospital has made during the past year under the
leadership of Dr. Bryan, appointed superintendent in March,
1921. His keen mentality, united with his love for humanity,
his common sense backed by willingness to work, his vision and
command of others, are qualifications which will make the
Worcester State Hospital most progressive. In all his plans
he has the endorsement and co-operation of the trustees, and
the improvements in the hospital in all its departments are
already perceived. It is most fitting that this, the oldest
hospital in Massachusetts, know^n in the early days for the
heartlessness which characterized the care of the insane, should
now become noted for the incorporation in its remedial work
of the best and most advanced ideas. The improvements in
the wards, making them altogether more desirable, the dining
rooms and sitting rooms planned with a thought of home in
mind, the admission offices designed to impress the patient
favorably, the salvage yard arranged to save all left overs and
to provide proper storage for such goods, the reorganized store
system, the labor-saving devices, which enable Dr. Bryan to
know just what each department is doing and just how many
employees are at their posts — these and various other advanced
steps point to better service and more satisfactory results. The
10 WORCESTER STATE HOSPITAL. [Dec.
clinic at the Summer Street department attended by patients
recommended by doctors, social workers and the schools, the
advice tending toward future amelioration of defects thus dis-
covered, and the schoolroom where those with proper capac-
ity can be taught and thus increase the possibility of cure, are
features of the progressive plans now being made and in which
the trustees rejoice. People and what he can do for them shape
all Dr. Bryan's plans. The Christmas trees in every ward,
that those unable to leave the ward should also have some of
the joys of this glad season, the diversified entertainments,
the careful plans for every one's happiness, show the heart in the
work, the desire to help, the hope that good may come to the
patients, — the patients who are the first and last thought of
Dr. Bryan and his able assistant, Dr. Clarence A. Bonner, also
a new appointee at the hospital.
The trustees would be remiss if in this report they did not
thank all the employees of the hospital for the admirable way
in which they have co-operated with Dr. Bryan in the many
changes he has made, and for the spirit of good fellowship
which exists. Such co-operation with such an able leader can
but make for a most successful new year of service.
Respectfully submitted,
EDWARD F. FLETCHER.
JOHN E. WHITE.
JOHN G. PERMAN.
LUTHER C. GREENLEAF.
CAROLINE M. CASWELL.
MAE CARLSON BEMIS.
WILLIAM J. DELEHANTY.
1921.1 PUBLIC DOCUMENT — No. 23. 11
SUPERINTENDENT'S REPORT.
To the Trustees of the Wo^rester State Hospital.
I herewith respectfully submit the following report of the
hospital for the year ending Nov. 30, 1921, it being the eighty-
ninth annual report.
There remained on the hospital books Oct. 1, 1920, 2,271
patients, — 1,172 men and 1,099 women. During the year
ending Sept. 30, 1921, there were admitted 616 patients, —
382 men and 234 women. Five hundred and twenty patients —
314 men and 260 women — were discharged from the hospital.
Of this number, 265 patients — 166 men and 99 w^omen —
Avere discharged; 241 patients — 138 men and 103 women —
died; and 14 patients — 10 men and 4 women — w^ere trans-
ferred, leaving at the end of the statistical year 2,367 patients,
— 1,240 men and 1,127 women. Two thousand and fifty-eight
patients — 1,048 men and 1,010 women- — were actually in the
hospital. Of this number, 1,852 were supported by the State,
102 by friends, and 104 as reimbursing patients. Of the
patients discharged, 57 were reported as recovered, 157 as im-
proved, and 33 as not improved. Eighteen patients — 12 men
and 6 women — were discharged as not insane. Seven men and
2 women were transferred by the Department of Mental
Diseases to the State Infirmary; 2 women to Herbert Hall;
2 men to the Medfield State Hospital; 1 man to the Boston
State Hospital. Ten men and 4 women were removed from
the State and 15 men and 3 women were deported.
There remained in the hospital at the end of the year 95
more patients than at the beginning. The smallest number
under treatment on any day was 1,976 patients, and the
largest 2,084. The daily average was 1,990.62.
The percentage of recoveries calculated upon the number of
discharges and deaths was 8.87, calculated upon the number of
admissions, 10.63. The death rate w^as 11.9, calculated on the
whole number of patients under treatment, and 8.2 calculated
on the daily average number.
12
WORCESTER STATE HOSPITAL.
[Dec.
Admissions classified by Clinical Groups.
The classification adopted by the American Psychiatric
Association has been followed, and the following summary of
admissions, according to clinical diagnosis, with a brief analysis
of each group, is submitted.
This summary was prepared by Dr. Clarence A. Bonner,
assistant superintendent. Dr. Franklin P. Bousquet, assistant
physician, and Miss Harriet L. Card, superintendent's clerk.
Traumatic PsycJiosis.
Number of cases admitted, one.
Following is a brief abstract of the same: —
Patient is a white male, age 50, single, and a laborer by occupation.
Born in Winchendon, Mass. Admitted to this hospital July 13, 1921,
on regular papers.
Family History. — Negative.
Personal History. — Early childhood essentially negative. Attended
school until he reached the second year of high school, and at sixteen he
went to work.
Onset. — Sudden. He thought that women entered his room at night,
and that they were attempting to persecute him by various methods.
Physical Examination. — Shows ptosis of right upper lid, pupils slug-
gish in action. Wrist shows a condition resembling UTist drop. Blood
pressure, 112 systolic, 70 diastolic. Urinalysis and Wassermann negative.
The injury to his head is said to have occurred when he fell from a high
wall while spraying trees ^\dth a chemical. Apparently after this there
was a progressive weakening of the muscles and the formation of a
psychosis.
Senile Dementia.
Number of cases admitted, 47, — 17 males and 30 females.
Types. — Simple, 30; presbyophrenic, 1; paranoid, 16; total,
47. Average age, seventy-two years.
Results of Treatment.
Males.
Females.
Totals.
Discharged improved
Discharged unimproved
Died
Remaining in hospital
17
30
47
1921.
PUBLIC DOCUMENT — No. 23.
13
Cerebral Arteriosclerosis.
Number of cases admitted, 46, — 31 males and 15 females, —
equal to 5 per cent of the total admissions; fifth decade, 9;
sixth decade, 12; seventh decade, 16; eighth decade, 9.
General Paralysis.
Number of cases admitted, 34, — males, 27, and females, 7, —
or 7 per cent of the total admissions. Average age of men on
admission, fifty years; of women, forty-two. Youngest patient
in this group is twenty-two years of age, and the oldest was
sixty-four.
Twelve patients died, a mortality of 33 per cent.
Results of Treatment.
Males.
Females.
Totals.
Discharged improved
Discharged unimproved
Died . . . .
Remaining in hospital .
Cerebrospifial Syphilis.
Under this classification we have gathered 8 cases which
represent an involvement of the nervous system, varying in de-
gree but exclusive of general paresis. Of these cases 4 have
left the institution and 2 are remaining in the hospital. Both
of the females have been permitted to leave. One of the male
cases responded remarkablj^ well to intensive treatment. This
patient upon entrance exhibited a paralysis of the right arm
and an aphonia. At the time of his leaving the institution
muscular sense was apparently improved to such an extent that
the patient could readily move his fingers. He also recovered
his speech to the point where he was able to make himself
understood. This case is one of the few which stand out as
convincing evidence of the advisability of intensive treatment
of neurosyphilitics, including the paretics.
14
WORCESTER STATE HOSPITAL.
[Dec.
Huntington'' s Chorea.
During the year 1 case was admitted,
this case is as follows: —
A brief abstract on
The case of A. N., admitted to the hospital May 10, 1921. As usual
in these cases we have a previous record of an ancestral case. The father
was a patient in this institution. The patient is fifty-four years of age.
Received a common school education. Has four children and general
health has been fairly good. In October, 1921, patient began to show
unusual signs of nervousness, — ■ became irritable, suspicious, careless in
her habits, and the tj'pical movements associated with Huntmgton's
chorea became evident. Neurological findings: vision very much im-
paired; protrusion of the right eyebaU; general choreic movements, with
a certain amount of voluntary control. Blood pressure: 200 systolic,
110 diastolic. The blood serum was negative.
Hospital liistory finds that patient has been very kindly disposed,
pleasant and tractable; somewhat sensitive, neat in habits and has
assisted greatly in the care of herself. Mentally she is extremely emo-
tional — exaggerates her troubles; occasionally makes rather unreason-
able complaints, but, on the whole, has adopted a rather contented
manner, and is getting along very comfortably at the present time.
Psychosis icith Other Brain or Nervous Diseases.
Four cases were admitted: cerebral embolism, 1; paralysis
agitans, 1; encephalitis, 2.
Results of Treatment.
Females. I Totals.
I
Discharged improved
Died
Remaining in hospital
Alcoholic Psychosis.
Twenty-one cases were admitted, equal to 1 per cent of the
total admissions. Of the total admissions, 2 were discharged
recovered, 1 improved, 1 died and 17 remain in the hospital.
The general run of alcoholic cases shows little change from
1921.
PUBLIC DOCUMENT — No. 23.
15
that of previous years excepting in numbers. There are 7
more alcohohc cases this year than last. In detail, there was
1 case of pathological intoxication, 1 case of delirium tremens,
2 cases of Korsakoff's psychosis, 10 cases of acute alcoholic
hallucinosis, 3 cases of chronic hallucinosis, 1 of the chronic
paranoid t^'pe, and 3 alcoholic deteriorations.
Psychoses due to Drugs.
Psychoses due to drugs came under treatment in 2 cases;
1 was morphine and 1 cocaine. Of this group, 1 escaped from
the hospital and the other is in the institution.
Psychosis with Other Somatic Diseases.
During the year 7 cases were admitted in whom the etio-
logical factor was some physical condition, ■ — post-infectious
psychosis, 1 male, 3 females, total, 4; exhaustion delirium, 3
females.
These cases are interesting and unusual, for the reason that
very definite physical disease is allied with the mental con-
dition. The symptoms are similar to the usual psychoses, but
the basic cause has been attributed to the physical state.
Of these cases above mentioned, 2 directly followed partu-
rition, and 1 followed peritonsillar abscess with resultant ab-
sorption of toxins. One was associated with pulmonary tuber-
culosis, 2 followed periods of exhaustion, and 1 followed chronic
nephritis.
Results of Treatment.
Males.
Females.
Totals.
Dicharged recovered
-
1
1
Discharged improved
-
-
-
Discharged unimproved
-
-
-
Died ....
1
5
In hospital
g
16
WORCESTER STATE HOSPITAL.
[Dec.
Manic-depressive Psychosis .
During the year 32 cases were admitted, — 14 men and 18
women, — equal to 8 per cent of the total admissions for the year.
SUBCLASSIFICATION.
Males.
Females.
Totals.
Manic tj'pe . . • .
3
10
1
14
3
1
17
13
Mixed
2
Resvlts
of Treatment.
Males.
Females.
Totals.
Discharged recovered
Discharged improved
Discharged not improved
Died
4
1
2
7
3
2
13
4
4
4
In the hospital
20
: ■ — ■
14
18
32
Involutional Melancliolia.
During the year 28 cases were admitted, — 14 men and 14
women, — comprising 9 per cent of the total admissions.
Residts of Treatment.
Males.
Females.
Totals.
Discharged improved
Discharged recovered
Remaining in the hospital
1
1
12
14
1
1
26
14
14
28
Dementia Pracox.
Out of 240 cases admitted, 141 were dementia prsecox
cases.
There were 97 males and 44 females, comprising 56 per cent
of the total admissions.
1921.1
PUBLIC DOCUMENT — No. 23.
17
SUBCLASSIPICATION.
Males.
Females.
Totals.
Paranoid
61
25
86
Catatonic
17
13
30
Hebephrenic
10
2
12
Simple
9
4
13
97
44
141
Results of Treatment.
•
Males.
Females.
Totals.
7
1
2
87
2
2
40
9
Not improved ........
1
Died
4
Remaining on books
127
97
44
141
Epileptic Psychosis.
This group is comprised of 4 cases, — 2 men and 2 women, —
all of whom were placed in a subgrouping of deterioration^
The family history could not be obtained in 2 cases. One
case was positive to insanity, the other case was negative.
Results of Treatment.
Males.
Females.
Totals.
Discharged improved
-
-
-
Discharged not improved
-
1
1
Died
1
-
1
Remaining in hospital
1
1
2
2
2
4
Psychoneuroses and Neuroses.
The total number of psychoneuroses cases admitted was
10, — 3 men and 7 women.
Types. — Hysterical types, 4; psychasthenic, 3; neuro-
sthenic, 3.
One was discharged not improved, 3 improved, no deaths^
and 6 remain in the hospital.
18 WORCESTER STATE HOSPITAL. [Dec.
Psychopathic Personality ivith Psychoses.
There were 2 cases diagnosed in this group. These were
both first admissions. One of these was married and the other
single; one a laborer, and the other's occupation was given as
civil engineer. One of these cases remained in the hospital but
a month, when he was permitted to leave on visit. The other
during his stay showed a gradual increase in psychotic
symptoms.
Psychosis ivith Mental Deficiency.
Of the total admitted there w^ere 21 cases classified in this
group, — 14 men and 7 women; the average age was forty
years, the youngest fourteen and the oldest sixty years. Dis-
charged as improved, none; not improved, 2; remaining in the
hospital, 19.
Undiagnosed Psychosis.
Thirty-six cases were admitted during the past year. These
included 22 men and 14 women. Four cases were discharged
as improved, 1 not improved, 3 died, and there are 28 re-
maining in the hospital.
This group of cases at the time of staff presentation could
not be placed in any definite classification according to the
schedule. In the majority of these cases the history was not of
any great help. A few of the cases were incomplete because of
the patient leaving w^ithin a few days after admission, not
giving opportunity for the proper study and observation. From
time to time throughout the year it is planned to inspect and
re-examine cases of this kind, expecting that the symptoma-
tology will offer evidence of a recognized psychosis. Of these
36 cases but 4 had a positive Wassermann and but 1 showed
any symptoms of neurosyphilis.
Without Psychosis.
Six cases were admitted wherein no psychosis could be
found. Of these, 4 were men and 2 women. There was 1 epi-
leptic, 4 psychopathic personalities, and 1 mentally deficient.
Of this group 2 men have been discharged and 4 remain in
the hospital.
1921.
PUBLIC DOCUMENT — No. 23.
19
At the time these cases were presented at staff meeting
their conduct and general reactions had given us no clew as
to the actual type of mental disease. In all the cases there had
been certain abnormal activities which had served to bring
them within the view of the authorities. It not infrequently
happens that patients who have perpetrated conduct disorders
are of the constitutional inferiority or psychopathic classes,
who are capable of self-restraint under disciplinary measures,
but who do not exhibit those gross signs or symptoms which
enable us to properly diagnose according to the present clas-
sification. Of this group the psychopathic personalities pre-
dominated, with 1 case of mental deficiency and 1 of epilepsy
with infrequent convulsive episodes.
Ex-Service Men.
During the past year there were 47 ex-service men admitted
to this hospital, and 15 of that number remained at the end of
the year, making a total of 43 soldiers in the institution. Of
those leaving the hospital 10 are out on a year's trial visit;
7 left without permission; 1 was transferred to another State
hospital; 3 were discharged as recovered, 6 as improved, 4 as
not improved, and 1 as not insane.
These men have been in charge of a special attendant who
is himself a veteran, and the results of this plan have been
most gratifying.
The following table shows the psychoses of these patients: —
Dementia prsecox .
Alcoholic
Manic-depressive .
Psychopathic personality
Mentally deficient
Psychoneuroses
Epileptic
General paralysis .
Cerebral embolism
Unclassified .
Not insane
26
5
3
3
2
1
1
1
1
2
9
20 WORCESTER STATE HOSPITAL. [Dec.
General Health of the Population.
The general health of the institution has been good. Among
the employees 2 nurses suffered from diphtheria and were
cared for at the Isolation Hospital. One female patient,
suffering from dementia prsecox, died from fracture of right
femur, having been pushed by another patient. One woman
suffering from cerebral arteriosclerosis died from multiple in-
juries, due to an accidental fall. One woman, also a case of
cerebral arteriosclerosis, died from asphyxiation, due to food
in larynx and bronchi. One man, diagnosed general paralysis
of the insane, died from punctured ribs, due to an accidental
fall from bed.
These cases were investigated by the medical examiner, and
Dr. Myrtelle M. Canavan of the Department of Mental
Diseases.
Principal Causes of Deaths.
Seventeen and one-half per cent of all deaths were due to
general paralysis of the insane; 15 per cent each to cardio-
vascular renal disease and pneumonia; 10 per cent to general
arteriosclerosis; and 7^ per cent to cerebral hemorrhage.
Staff Changes.
The follovdng changes have taken place on the medical
staff of the hospital : —
Resignations.
Wilham J. Vivian, M.D., resigned Jan. 21, 1921, to go
to the United States Public Health Hospital, West Roxbury,
Mass.
Donald R. Gilfillan, M.D., resigned to go to the National
Sanatorium, Marion, Ind., Jan. 27, 1921.
B. Henry Mason, M.D., acting superintendent, left to
accept a position at the Psychopathic Hospital, Ann Arbor,
Mich., April 17, 1921.
Roy C. Jackson, M.D., resigned July 1, 1921.
Arthur H. Mountford, M.D., resigned Aug. 31, 1921.
Ada F. Harris, M.D., resigned Aug. 31, 1921, to be married.
1921.1 PUBLIC DOCUMENT — No. 23. 21
A2)pointments .
William A. Bryan, M.D., was appointed superintendent, and
assumed charge April 3, 1921.
George F. Caldicott, M.D., was appointed assistant physician
June 1, 1921.
Franklyn P. Bousquet, M.D., was appointed assistant physi-
cian June 1, 1921.
George A. Gaunt, M.D., was appointed assistant physician
Aug. 1, 1921.
Harrison M. Stewart, M.D., w^as appointed assistant physi-
cian Oct. 3, 1921.
Leon E. Duval, M.D., was appointed senior assistant physi-
cian Jan. 1, 1922.
Dr. Clarence A. Bonner was made assistant superintendent
Sept. 13, 1921.
Dr. Michael J. O'Meara was made senior assistant physician
Nov. 23, 1921.
Dr. Lloyd E. Byrd was appointed resident dentist Aug. 15,
1921.
Student Internes.
The staff was materially assisted in the work during the
summer months by a number of student internes from the
Women's Medical College, Philadelphia, the University of
Michigan Medical College, and the Tufts Medical College.
One dental interne from Harvard Dental School served three
months in the dental department. These positions are filled
by second and third year students, and their w^ork consists of
acting as aids to the medical staff in the examination and
treatment of patients, and as assistants in the pathological
laboratory.
It is our intention to give the students a definite formal
course of instruction along specialized lines, and such course is
now being prepared for the next group of internes who come
to the hospital.
22
WORCESTER STATE HOSPITAL.
[Dec.
The following students served as internes for periods of two
to three months: —
Carl P. Benaglia June 1 to Sept. 1, 1921.
Fernand M. Riendeau June 9 to Aug. 1, 1921.
Edward P. A. Vercueil (dental) . . . June 10 to Sept. 10, 1921.
Henry L. Smith June 22 to Sept. 12, 1921.
Walter 0. KHngman June 22 to Sept. 10, 1921.
Mildred Rogers June 30 to Aug. 30, 1921.
Matilda Maerz July 3 to Sept. 16, 1921.
Emily Gardner July 3 to Aug. 30, 1921.
Medical Work.
The estabhshed routine of immediate preliminary physical
examination of all newly admitted cases, Wassermann tests,
typhoid and smallpox vaccines has been followed. Each case
admitted for ten days' observation is brought to the staff con-
ference where the question of commitment is decided. Staff
meetings are held daily at 8 o'clock, each member of the
staff being assigned a definite day when his cases may be pre-
sented. No case is presented until history, physical and
mental examination and all special tests are secured, diagnosis
made and a course of treatment outlined.
The general health of the population has been good during
the year. Two cases of diphtheria have occurred, both of them
being in the nursing group. They were sent to the City
Isolation Hospital; both made a good recovery.
The X-ray department has been in active operation most of
the year. There has been a total of 55 skiagraphs made from
September 1 to the close of the year. The pictures taken are
classified as follows: —
Hip 2
Wrist ....... 10
Foot 1
Head 3
Knee 6
Shoulders . . . . . 4
Chest 6
Hand 11
Ankle 9
Spine ...... 3
The following lesions were found in this group of cases: —
Colle's fracture of wrist.
Compound fracture of humerus above an old fracture.
Compound comminuted fracture of right radius and ulnar bones.
1921.] PUBLIC DOCUMENT — No. 23. 23
Osteoma pereostitis of left tibia.
Falling of ant. arch of right foot.
Fracture of middle third of right humerous.
Dislocation of acromial end of right clavicle.
Double fracture of lower one-third of ulnar.
Three positive cases of tuberculosis.
We have made increased use of electrotherapeutics in treat-
ing certain types of psychoses, and the success attending this
work deserves its further expansion.
Hydrotherapy.
A complete reorganization of the hydrotherapy department
has been brought about in the past year. Considerable new-
equipment, such as pack beds, has been added. Largely as a
result of the increased use of this method of treatment,
restraint and seclusion have been practically eliminated from
the hospital.
Calisthenics, Re-educational Work and Habit Training.
The scope of the re-educational work has been enlarged.
The sale of articles turned out by this department has been
abolished, and the products are now used entirely by the
hospital. This has the eflPect of transferring the interest of the
instructors to the patient. The therapeutic idea is kept in view,
and the instructor is interested in the improvement of the
patient rather than the attempt to turn out beautiful articles
for display or sale.
A beginning has been made in grading the classes according
to the occupation being taught, progressing from the simple to
the complex, and each type of occupation is in a separate room.
In this way the progress of the patient can be accurately
followed. A class of demented patients has been organized
under a physical culture teacher. Small groups of patients are
taken to the chapel and an hour spent in playing games, in
various calisthenic exercises and in marching. We have found
that this is the longest period of time such work can be prof-
itably followed for the same patient, and a different group is
24 WORCESTER STATE HOSPITAL. [Dec.
treated each hour of the day. In this way one teacher can
give her attention to a very large group of patients.
Habit-training classes have been inaugurated on the untidy
wards, and have done much to raise the morale of the patient
population on these wards. Three school classes have been
organized, with patients officiating as teachers, — one class in
English for young Italian girls, a class in conversational
French, and a class in the elementary branches. These classes
have been productive of excellent results, and pupils and
teachers have shown much improvement as a result of them.
An occupational therapy department has been started at
Summer Street, and this work has been enlarged until it is a
very prominent factor in the work of that department.
Staff Luncheons.
A new feature has been initiated during the past year which
has been of much interest and benefit to the members of the
staff. Once in two weeks a staff luncheon is held, at which
time a specialist is secured in some field of general medicine who
discusses with the members the particular phase in which he is
interested. These meetings have been unusually helpful and
stimulating. We are indebted to the following speakers for
their helpful talks: —
Dr. Michael Jordan, "The Relation of the State Hospital to the Neurolo-
gist."
Dr. Ernest Hunt, "Surgical Organization."
Dr. Walter Bieberbach, "Surgery of the Prostate Glands."
Dr. Thomas F. Kenney, "The Relation of the Board of Health to the
State Hospital."
Dr. James Plant, "A Plan for Nurses' Notes."
On December 7 the fifty-second meeting of the assistant
physicians of the State hospitals of Massachusetts was held
here. The program consisted of a ward inspection in the
morning, luncheon at 1 p.m., physicians' meeting at 2, followed
by literary papers and discussion, led by Drs. Bonner and
Gaunt. Calisthenic exercises and occupational activities were
demonstrated.
1921.1 PUBLIC DOCUMENT — No. 23. 25
Laboratory Report.
The work in the pathological laboratory suffered very
seriously by the resignation of Dr. Ada Harris. Since that time
we have had no pathologist in charge, and have only been able
to do the routine work. A pathologist has been secured and
will begin his duties on February 1, at which time it is expected
that a complete reorganization of the pathological work will
take place and the next year be one of productive activity.
Dental Department.
The following report is submitted by Dr. Byrd, the resident
dentist: —
I submit herewith the following report of the dental work
done at the hospital during the year 1921. A full-time dentist
was appointed in June, 1921, and the report will show the
increase in the amount of work carried on following this appoint-
ment.
For the months of June, July, August, September, October and
November the least number of patients treated was 193 and the
greatest number was 267. The least number of prophylactics
was 87, the highest 161. The least number of fillings was 52 and
187 the highest. Treatments throughout this period ranged from
11 per month up to 27. The greatest number of extractions
were performed in November, there being 462.
A full equipment for the dental laboratory has been installed
and four plates have been completed for patients in the hospital.
The work of Miss Thompson, dental hygienist, has been ex-
tremely valuable. She has done much prophylactic work, and
in addition has inaugurated classes in hygiene on the wards.
Attention should be called to the necessity of the new work
with accessories for the use of the dental hygienist, and also a
new dental cabinet and nitrous-oxide machine. The following
table shows, in detail, the work done in the department: —
26
WORCESTER STATE HOSPITAL.
[Dec.
Month.
Num-
ber of
Pa-
tients.
Clean-
ing.
Filling.
Plates.
Treat-
ment.
Teeth
ex-
tracted.
Im-
pacted
Teeth
ex-
tracted.
Plates
re-
paired.
December .
January
February .
March
April .
May .
June .
July .
August
September
October
November
32
48
36
59
39
27
193
235
267
250
262
256
4
15
3
12
6
7
115
112
102
137
87
161
9
6
14
24
9
8
52
82
156
117
187
163
1
3
4
3
8
12
5
10
23
18
26
27
24
11
33
61
34
51
37
12
299
390
434
350
333
462
3
2
3
4
1
Totals .
1,704
761
837
4
171
2,496
12
1
Report of the Out-patient Department.
The following report of the work of the out-patient depart-
ment which was begun at the Summer Street Department in
June, 1921, is submitted by Dr. George F. Caldicott, who has
acted as the head of this phase of the work and has also had
charge of the examination of school children. The personnel
consisted of Dr. Caldicott and Dr. Michael J. O'Meara, Miss
Helen A. Martin, psychologist. Miss Mary W. Howgate and
Miss Jennie A. Harrington, social service workers, Miss
Margaret Medcalfe and Miss Mary Donohue, nurses.
I herewith submit the summary of the work done in the out-
patient department during seven months of the year 1921.
This department was organized in June, the purpose of the clinic
being to offer to the people of this section of the State the
advantages of a psychopathic hospital. At first the idea was
somewhat new to the public, but the opportunity for help
offered by the clinic was soon recognized. Before long, not only
were psychiatric cases presented for diagnosis, treatment and
advice, but also neurological and syphilogical cases; also cases
of children who were retarded in school or who were con-
duct problems. Later the task of examination of school chil-
1921.
PUBLIC DOCUMENT — No. 23.
27
dren in 58 towns came to be placed under this department.
The clinic has available physicians, social workers, a psychologist
and nurses — all training along this line of work. The routine
of examination consists of searching inquiry along lines of
physical examination, family history, personal and develop-
mental history, school progress and tests, practical knowledge,
economic efficiency, social history and reactions, moral reactions,
mental and psychological tests; also the routine taking of blood
for Wassermann tests, together with laboratory examinations,
as indicated.
If needed, such facilities as X-ray, electrical apparatus and
fluroscopes are available for detailed study. From this data a
complete and composite picture is made from which to draw a
conclusive diagnosis. A diagnosis being made, advice on the
disposition of the case is given, and patients who can receive
treatment at the hospital are given attention free of charge.
The following table will show the type of cases handled by
the out-patient department : —
Diagnosis.
No.
Recommendations.
Disposal.
/. Psychotic.
Dementia prsecox .
Senile dementia .
Manic-depressive .
Psj'chosis with cerebral
embolism.
Neurosis
Neurasthenia
//. Feeble-minded.
Simple ....
Delinquent .
With syphilis
With epilepsy
Hospitalization .
Sanatorium treatment
Hospitalization .
Hospitalization .
Electro and hydrotherapeu-
tic treatments, with psy-
choanalysis.
1, electro and hydrothera-
peutic treatment.
2, readmission to hospital .
1, institutional care .
5, special class and manual
training.
2, corrective supervision (at
home).
3, institutional care .
Institutional care
Institutional care and syphi-
litic treatment.
Institutional care
Committed to Worcester State
Hospital.
Relatives carrying out advice.
Committed to Worcester State
Hospital.
Temporary care at Adams Nerv-
ine by relatives; later com-
mitted to Worcester State
Hospital. Condition unim-
proved.
Treatment carried on at
Worcester State Hospital out-
patient department. Im-
provement seen.
1, carried on at Worcester State
Hospital out-patient depart-
ment.
2, in hospital. Condition im-
proved.
Admission pending.
In hands of relatives.
Being carried out.
Advice not followed.
4, admitted to feeble-minded
school.
2, admission pending.
Patient disappeared.
1, advice not followed.
2, patient to report in six months.
3, admission pending.
28
WORCESTER STATE HOSPITAL.
[Dec.
Diagnosis.
No.
Recommendations.
Disposal.
///. Neurological.
Cerebral irritation asso-
ciated with tubercu-
losis.
Post-cerebral hemor-
rhage; paralysis.
1
1
Tubercular hygiene sched-
ule planned for patient
and family, in care of
board of health nurse.
Schedule planned for pa-
tient. Moderate exercise,
modified diet, etc.
Plans being cairied out.
Plans being carried out.
IV. Syphilitic.
Cerebral spinal syphilis
Secondary syphilis
Tabo-paresis
V. Without Psychoses.
4
1
2
Intensive bi-weekly treat-
ments.
Intensive bi-weekly treat-
ments.
Intensive treatment and
hospital care. Out-patient
department to report.
3, treatment carried out at
Worcester State Hospital out-
patient department.
1, patient disappeared.
Treatments carried out at
Worcester State Hospital out-
patient department.
Advice not followed.
Chorea ....
Tonsils and adenoids
plus speech defect.
Hyperthyroidism (ado-
lescent).
1
1
Referred to nose and throat
specialist.
-
Removal of tonsils and
adenoids.
Quiet mode of living, rest,
fresh air, good food, as
scheduled.
Given treatment at Worcester
State Hospital out-patient
department. Condition im-
proved.
Tonsilectomy arranged for at
Memorial Hospital.
Plans being carried out. Con-
dition improved.
Maladjusted :
(a) School .
(b) Home .
1
3
Treatment for ears
Remove patients from pres-
ent homes. Place in good
Ad\'ice given to teacher and
school nurse as to their atti-
tudes toward patient. Con-
dition improved.
Further placement in hands of
Children's Friend Society.
(c) Social .
Conduct problem
1
1
Remove patient from own
home; attention to recre-
ation.
Replacement
Arrangements pending.
Patient in hand of Children's
Friend Society.
Patient in care of Girl's Welfare
Society.
Routine out-patient de-
partment examination .
11
Supervision ; more thorough
study and investigation.
VI. Undiagnosed.
Routine out-patient de-
partment examina-
tion.
1
5
Further investigation; pa-
tient to report to clinic
again in six months.
Patients to report in six
months.
Patient being cared for by Girls'
Welfare Society.
None made.
TTjpe of Cases seen, School Out-patient Clinic.
Feeble-minded.
(a) Simple feeble-
16
Special classes, — training
Arrangements pending for car-
minded.
rlong manual lines and
correction of pathological
conditions.
rying out recommendations.
(b) Feeble-minded re-
1
Institutional care.
-
quiring institu-
tional care.
(c) Feeble-minded po-
2
Special classes, — training
Arrangements pending for car-
tential psychotics.
along manual lines. To
report to Worcester State
Hospital out-patient de-
partment every six
months.
rying out recommendations.
Diagnosis deferred
3
To report in six months for
further study.
- -
Cases in partial state of
27
Pending.
- -
completion.
1921.] PUBLIC DOCUMENT — No. 23. 29
Community Activities.
The following lectures have been given by members of the
staff during the year: —
Clinic for students of Clark University held at
Worcester State Hospital Dr. Bryan.
Lecture on Mental Hygiene before Kosmos Club
of Wakefield Dr. Bryan.
Lecture before Psychology Club of Worcester . Dr. Bryan.
Paper on Mental Hygiene read at meeting of the
Worcester District Medical Association . . Dr. Bryan.
Psychology of Insanity, before medical staff of St.
Vincent's Hospital Dr. O'Meara.
Anatomy of the Nervous System, before nurses of
St. Vincent's Hospital Dr. O'Meara.
Brain and Nervous System, before nurses of
Worcester City Hospital and Rutland State
Sanatorium Dr. O'Meara.
Causes, Classification and Prevention of Mental
Diseases, before the nurses of Worcester City
Hospital and Rutland Sanatorium . . . Dr. O'Meara.
Mental Hygiene, before the nurses of Worcester
City Hospital and Rutland State Sanatorium Dr. O'Meara.
Involution Melancholia, given at a meeting of the
assistant physicians Dr. Gaunt.
Origin and Scope of the Modern State Hospital,
given at a meeting of the assistant physicians Dr. Bonner.
Lecture on Social Service before the Women's Club
of Marlborough Miss Harrington.
The following papers have been published or submitted for
publication during the past year : —
Paresis — Treatment, Arsphenamine, Mercury and
Potassium Iodide Dr. Bonner.
The Origin and Scope of the Modern State Hos-
pital Dr. Bonner.
Adrenahn in Terminal Dementia . . . . Dr. Bonner.
Pathological Changes occurring in Epidemic En-
cephahtis . . Dr. Ada Harris.
Acute Encephahtis . Dr. Ada Harris.
Involution Melanchoha Dr. George Gaunt.
An Experiment with Simple Tests for the Insane Miss Marjory Bates.
A course has been inaugurated to which all social workers,
school nurses and those dealing with the mentally deficient
30 WORCESTER STATE HOSPITAL. [Dec.
were invited to attend. The following is the program of
lectures, the first and second of which have been given at our
Summer Street Department : —
Lecture I. Nov. 9, 1921, by Dr. William A. Bryan.
Introduction, History of Psychiatry. Types of Reaction, Mental
Mechanisms.
Lecture II. Dec. 14, 1921, by Dr. Clarence Bonner.
Methods of Procedure in Caring for Community Patients who need
Psychiatric Treatment. Subtopics: (a) Symptoms which
indicate the need of hospital commitment; (6) factors that
determine the discharge and retention of State hospital
patients; (c) common forms of diagnosis and their social
interpretation. Illustrations.
Lecture III. Jan. 11, 1922, by Dr. Leon Duval.
Types of Conduct Disorder and Character Changes which indicate
the Need of Mental Examination and Treatment. Procedure
— Illustrations.
Lecture IV. Feb. 8, 1922, by Miss Jennie Harrington.
The Relation of the State Hospital to the Social Agenc3^ Sub-
topics: Customs and traditions of the hospital relative to
giving information to outside agencies; nature of information
which hospital may contribute to agencies, and nature of
assistance which hospital may render to such agencies.
Lecture V. March 8, 1922, by Dr. Michael O'Meara.
State Hospital Methods of Caring for Mental Patients. Sub-
topics: Legal relationships; purpose of hospital departments
and their functions ; treatment of patients, clinics, social serv-
ice, out-patient service, etc.
Lecture VI. April 12, 1922, by Dr. William A. Bryan.
Showing forms of mental diseases.
REPORT OF THE SOCIAL SERVICE DEPARTMENT.
To the Superintendent.
For several years the work of the social service department
has been conducted by one worker, but since September 18 the
department has had the services of Miss Mary Wallace Howgate,
a graduate of Smith College and Smith College Training School
for Social Work.
A great deal of the work that a social worker in a State
hospital is called upon to do is of a miscellaneous character.
It is the doing of kind little things, both for the patient and
his family. Looking up patients' clothing, securing his wages,
1921.] PUBLIC DOCUMENT — No. 23. 31
referring his family to various agencies for help, and numerous
other deeds are a part of the work of helping the patient to
recover by relieving his mind from worry.
The social worker studies the patient, his family, his job, his
home surroundings, his recreation, his friends, etc., with a
view to better adjustments of these relationships, so that a re-
covery is more possible and a recurrence less likely. Many
times the irritating influences have been removed by social
service, and the other factors in the environment have been made
helpful. The department is an important connecting link be-
tween the hospital and the community, for many erroneous
impressions of the hospital have been corrected by the workers.
The social work of the hospital may be divided into the
following groups: —
I. Social Case Work. — A social case is one in which there is social
problem needing adjustment.
(o) Environmental and adjustment problems pertaining to home,
work, friends and recreation.
II. History Work. — The social worker goes into the community to
obtain a history in cases where no relatives come to the
hospital, or where there is some social problem involved.
(a) Medical history for medical diagnosis.
(6) Social history for social treatment.
(c) Medical social history for medical diagnosis and social treat-
ment.
III. Investigations. — Made for object of helping patient.
(a) Court investigation.
(6) Home investigation.
(c) Boarding homes investigation.
(d) Complaint investigations.
(e) Miscellaneous.
IV. Supervision.
(a) Patients on visit.
(6) Boarding patients,
(c) Miscellaneous cases.
V. Community Work.
(a) Social agencies.
(6) Linking hospital with community.
VI. Educational Work.
(a) Lectures.
(b) Advice.
VII. Out-patient Work.
(a) Hospital clinics.
(6) School cUnics.
32
WORCESTER STATE HOSPITAL.
[Dec.
Table A. — Reason for Consideration.
Males.
Females.
Medical histories
Medical social histories
Home investigation
Special investigation
Social investigation
Supervision
Family assistance .
Boarding patients .
Venereal disease clinic
Miscellaneous
233
53
23
22
11
22
121
1
25
290
Table B. — Clinic Work.
Males.
Females.
Totals.
Patients interviewed at clinics
Relatives inter\'iewed at clinics
Social cases selected at clinics
34
19
2
38
12
4
72
31
6
55
54
109
f . ,., .. ._. . .. i
Table C. — Service Rendered.
Males.
Females.
Arrangements made for medical care .
Readjustment in home
Readjustment in work . . . . .
Readjustment in recreation . . . .
Readjustment in church . . . .
Arrangements for community supervision .
Referred to relief agencies . . . .
Referred to special agencies ....
Referred to venereal disease clinics
Referred to employment agencies
Legal aid secured
3
16
6
13
2
8
4
5
1
-
15
5
4
2
15
11
1
4
5
3
3
4
1921.
PUBLIC DOCUMENT — No. 23.
33
Table C. — Service Rendered — Concluded.
Males
Females
Totals
Advice to patient
Advice to relatives .....
Boarding patients visited ....
Property cared for ......
Assisting Red Cross with compensation claims
418
It is hoped that with another worker the work of the depart-
ment may be developed along new lines. More efficient work
could be accomplished with the use of a department automobile.
I wish to express my appreciation for the aid and counsel
given me by Miss Hannah Curtis, the director of social work of
the Department of Mental Diseases, and for the co-operation
of the hospital staff and the ready response of help from the
social agencies.
Respectfully submitted,
Jennie A. Harrington,
Social Worker.
Nov. 30, 1921.
TRAINING SCHOOL FOR NURSES.
I herewith submit the following report on the Training School
of the Worcester State Hospital for the year 1921: —
Graduated a class of 14 members, — 13 women and one man.
Present senior class consists of 13 women; present intermediate
class, 9 women; first-year students, 22 women.
Graduation exercises were held September 15. Dr. Myerson
of Boston addressed the class. Miss Caswell, a member of the
Board of Trustees, presented the diplomas. After the exercises
a reception and dance was enjoyed by the graduates and their
friends.
On June 25 the Training School had the honor of entertaining
Miss Linda Richards at an informal tea. She recounted many
interesting incidents regarding her work here while organizing
the Training School in 1903. Our graduates now number 209.
The Alumnse Association has held quarterly meetings at the
hospital, and after the business meeting a social hour is indulged
34 WORCESTER STATE HOSPITAL. [Dec.
in. The Training School has been represented at the various
State meetings and also at the American Nurses Association
Meeting held at Concord, N. H. The Worcester branch of the
Massachusetts State Nurses Association was entertained at the
hospital. During the evening Dr. Wright of Boston State
Hospital gave an interesting talk on hydrotherapy.
The affiliation with Boston City Hospital which had been
ten months was extended to one year. Interest in the Training
School has been stimulated by these various activities, and it is
gratifying to notice an increase in the number of desirable
applicants during the past few months.
Merle B. Malsbury, R.N., assistant superintendent of nurses,
resigned to accept the position of superintendent of nurses at the
Bangor State Hospital. The vacancy has recently been filled by
Florence Wooldridge, R.N.
Elsie I. Richards,
Superintendent of Nii7-ses.
Religious Services.
Religious services have been held regularly each Sunday at
both the main hospital and the Summer Street Department, a
Catholic clergyman oflBciating in the forenoon and a Protestant
clergyman in the afternoon. Response to sick calls and the
rites of their religion to the dying have been faithfully made by
members of the clergy.
Entertainments and Amusements.
Acknowledgment is made to the following individuals and
organizations for entertainments given during the year: —
In February, 1921, an entertainment was provided at the
Summer Street Department by the Knights of Columbus, in-
cluding glee club work, solos and instrumental music.
At the main institution we have been favored, under the
direction of Mrs. Oscar P. Tabor, with a pageant which was
very enjoyable to the patients.
The Auxiliary of the American Legion on two different
occasions entertained the soldiers in the recreation room with
instrumental and vocal music.
One moving-picture entertainment by the Kirk Soap Com-
pany was provided.
1921.] PUBLIC DOCUMENT — No. 23. 35
On November 17, through the courtesy of our storekeeper,
Mr. WilHam Scott, the Kiltie Clan gave an entertainment at
the main hospital, and on the 18th a ver\^ enjoyable entertain-
ment at the Summer Street Department.
On Thursday, December 29, the American Legion and the
Women's Auxiliary gave a most enjoyable program, consisting
of seventeen numbers, for the benefit of the ex-soldiers and
other patients.
On December 28 a number of our talented patients, accom-
panied by several physicians, gave an entertainment to the
patients at Westborough.
During the summer months a baseball team played every
Saturday afternoon and made trips to other hospitals. An
interhospital league has been suggested and would seem to be
an excellent idea.
The weekly moving-picture shows have been productive of
considerable good, and have contributed materially to the
recovery of a certain number of patients, as have also the
weekly dances.
A hospital orchestra has been organized, and it is our in-
tention to make music a very important therapeutic measure.
The various holidays have been observed by special enter-
tainments.
New Consteuction.
General O'perations for the Year.
Many minor repairs have been made in the building during
the course of the year. The cattle barns at the main building
and Hillside have been repainted both inside and out. All the
porches at the main hospital have been painted, the fence at
Summer Street, and three cottages for employees, in addition
to the outside work. Washburn I, which is now used as a
receiving ward, has been entirely renovated and new clothes
rooms built, new toilets put in and the entire ward painted.
The industrial department, under the direction of Mr.
Corkum, has scraped and refinished over a thousand pieces of
furniture during the year in addition to rematting and re-
finishing practically every picture in the hospital. A complete
36 WORCESTER STATE HOSPITAL. [Dec.
reclassification of the wards has been made, the first floor on
each side now being used as a reception service.
A large salvage yard has been completed where articles no
longer in use can be taken and either salvaged, stored in a
proper manner or sold as junk. The utility of this yard has
been shown since it was built.
Comprehensive plans have been made and the work begun
of centralizing the storerooms of the hospital in one corridor.
The work of renovating the laundry has been completed, and
the necessity for this renovation is shown by its increased
efficiency.
Certain changes have been made in the disposition of garbage
which have proven to be in the interest of cleanliness.
All farm implements have been repainted and repaired.
About 200,000 feet of chestnut lumber was sawed during the
early part of the year. The trees had begun to decay, and the
lumber was salvaged before such destruction had progressed
far enough to destroy them.
Much work has been done on the boilers, two of them
having been completely reset.
Needs.
Certain special needs for which an appropriation is requested
are as follows: —
Refrigeration Plant. — This hospital has no adequate means
of refrigeration. The antiquated ice boxes now in use are in-
adequate for our needs, and a great many articles of food are
rendered useless each year because of our inability to maintain
a proper temperature. A combined refrigerating plant and
storehouse, with an ice-making machine of adequate capacity,
would increase our efficiency a great deal. The present ice
house is not large enough for our needs, and each year it is
necessary to go into the market and buy a considerable quan-
tity of ice to care for our needs during the latter part of the
year.
We have sixteen different storerooms, all located in the base-
ment, and this requires a larger force of storeroom employees
than would seem to be necessary if a storeroom was all under
one roof.
1921.] PUBLIC DOCUMENT — No. 23. 37
Congregate Dining Room. — The dining-room facilities for pa-
tients at this hospital are very inadequate, and it is impos-
sible to give the best service in feeding our patients while
they are in use. Each ward has a dining room, in all, 42, and
in no case are these dining rooms equipped for the purpose for
which they are used. A number of them have no facilities for
washing dishes. The construction of a congregate dining room
would enable us to give our patients hot food served in a better
manner which would contribute a great deal to their comfort.
Some attention should also be given to the needs of our
present kitchen. The equipment is almost entirely of wood and
should be replaced by steel equipment. Our kettles are of the
old type with no outlet for the purpose of cleaning. These
should be replaced by modern aluminum kettles. The present
ventilating system in the kitchen is inadequate and does not
take care of the various cooking odors. When certain condi-
tions are present the odor of food can be detected in the
entrance hall.
Fireproof Stairways. — We have at the present time seven
wooden staircases in the main building which make a great fire
hazard. The shafts in which they are built would cause the
flames to spread rapidly from one floor to another. These
wooden staircases should be replaced by iron structures.
iVutomatic sprinklers are needed in the attic of both the
main building and the Summer Street Department. The fire
hazard is very great, and the installation of these would furnish
a protection that can be secured in no other way.
In conclusion I wish to express my grateful appreciation to
the members of the Board of Trustees for their interest and
helpful suggestions in the work of the hospital. They have
supported me in all things, and have been untiring in their
efforts and given freely of their time to assist us in^the care and
treatment of the patients.
To the loyal officers and employees who have so splendidly
co-operated in the work of the year I also wish to express my
grateful acknowledgment.
WILLIAM A. BRYAN,
Sifperintendent.
Nov. 30, 1921.
38
WORCESTER STATE HOSPITAL.
[Dec.
VALUATION
Nov. 30, 1921.
Real Estate.
Land (589 acres)
Buildings .
$416,357 00
2,174,812 76
12,591,169 76
Personal Property.
Travel
Food
Clothing and materials .
Furnishings and household supplies
Medical and general care
Heat, light and power
Farm
Garage, stable and grounds .
Repairs
Real estate
Personal property
Summary.
$872 23
14,936 10
35,062 58
182,097 21
8,869 18
50,193 84
50,986 44
13,238 61
15,103 50
$371,359 69
$2,591,169 76
371,359 69
$2,962,529 45
1921.
PUBLIC DOCUMENT — No. 23.
39
TREASURER'S REPORT.
To the Department of Mental Diseases.
I respectfully submit the following report of the finances of
this institution for the fiscal year ending Nov. 30, 1921: —
Cash Account.
Balance Dec. 1, 1920
$4,092 18
Receipts.
Income.
Board of inmates:
jTrivate .......
Reimbursements, insane
42,997
60
$83,136 84
Personal services:
Reimbursement from Board of Retirement
180 77
Sales:
Travel, transportation and office ex-
penses
$41
69
Food
1.33
10
Clothing and materials ....
173
48
Furnishings and household supplies
1,289
11
Medical and general care
3
78
Heat, light and power ....
9
55
Farm :
Cows and calves . . $310 97
Pigs and hogs . . 24 28
Hides .... 33 81
369
71
06
95
Garage, stable and grounds .
Repairs, ordinary
656
29
2,748 01
Miscellaneous:
Interest on bank balances
$1,096 58
Rent
1,239
62
2,.336 20
88,401
82
Receipts from Treasury of Commonwealth.
Maintenance appropriations:
$60,043 44
Advance money (amount on hand November 30)
48,000 00
Approved schedules of 1921 .
608,835 02
716,878
46
Special appropriations ....
21,058
69
Total
$830,431
15
40
WORCESTER STATE HOSPITAL.
[Dec.
Payments.
To treasury of Commonwealth, institution income .... $88,401 82
Maintenance appropriations:
Balance of schedules of previous year . . . $64,135 62
Eleven months' schedules, 1921 608,835 02
November advances 26,967 28
699,937 92
Special appropriations, approved schedules 21,058 69
Balance Nov. 30, 1921:
In bank $20,361 78
In office 670 94
21,032 72
Total $830,431 15
Maintenance.
Balance from previous year, brought forward $1,299 65
Appropriation, current year 740,400 00
Total $741,699 65
Expenses (as analj'zed below) 677,769 55
Balance reverting to treasury of Commonwealth
$63,930 10
Analysis of Expenses.
Personal services:
B. Henry Mason, acting superintendent . . . $1,061 67
William A. Bryan, superintendent .... 2,380 00
Medical 12,624 85
Administration 20,151 16
Kitchen and dining-room service .... 12,516 14
Domestic 30,800 19
Ward service (male) 65,371 33
Ward service (female) 60,878 34
Industrial and educational department . . . 4,185 21
Engineering department 28,500 84
Repairs 19,759 20
Farm 13,265 99
Stable, garage and grounds 4,469 00
Religious instruction:
Catholic $1,200 00
Hebrew 260 00
Protestant 375 00
Travel, transportation and office expenses:
Advertising $75 43
Postage 475 90
Printing and binding 1,276 05
Printing annual report 257 57
Amounts camed forward $2,084 95
$275,963 92
1,835 00
$277,798 92
1921.] PUBLIC DOCUMENT — No. 23. 41
Amounts hromht forward ,12,084 95 $277,798 92
Travel, transportation and office expenses — Con.
Stationery and office supplies 2,764 90
Telephone and telegraph 2,101 34
Travel 2,045 47
8,996 66
Pood:
Flour $2.3,199 76
Cereals, rice, meal, etc 4,865 37
Bread, crackers, etc 542 54
Peas and beans (canned and dried) .... 3,142 94
Macaroni and spaghetti 1,219 87
Potatoes 4,496 83
Meat 39,472 94
Fish (fresh, cured and canned) 7,172 46
Butter 6,446 05
Butterine, etc 8,934 97
Peanut butter 2 70
Cheese 2,345 31
Coffee 916 61
Coffee substitutes . . . ■ 1,021 69
Tea 547 S8
Cocoa 105 52
Whole milk 129 07
Milk (condensed, evaporated, etc.) .... 1,344 56
Eggs (fresh) 8,114 04
Egg powders, etc 1,021 40
Sugar (cane) 5,807 35
Fruit (fresh) 1,339 53
Fruit (dried and preserved) 9,109 34
Lard and substitutes 1,855 92
Molasses and syrups 1,189 51
Vegetables (fresh) 741 09
Vegetables (canned and dried) 559 81
Seasonings and condiments 1,575 72
Yeast, baking powder, etc 466 91
Sundry foods 731 96
Clothing and materials:
Boots, shoes and rubbers $3,614 29
Clothing (outer) 7,668 96
Clothing (under) 2,770 19
Drj- goods for clothing 2,984 53
Hats and caps 248 64
Leather and shoe findings 188 61
Socks and smallwares 1,651 24
Furnishings and household supplies:
Beds, bedding, etc $12,006 09
Carpets, rugs, etc 1,327 78
Crockery, glassware, cutlery, etc. .... 1,972 90
Dry goods and smallwares 1,394 52
Electric lamps 1,439 95
138,419 65
19,126 46
Amounts carried forward $18,141 24 $444,341 69
42 WORCESTER STATE HOSPITAL. [Dec.
Aynounts brought forward $18,14124 $444,34169'
Furnishings and household supplies — Con.
Fire hose and extinguishers 477 27
Furniture, upholstery, etc 3,865 33
Kitchen and household wares 6,118 10
Laundry supplies and materials 3,225 77
Lavatory supplies and disinfectants .... 2,075 30
Machinery for manufacturing 50 21
Table linen, paper napkins, towels, etc. . . . 2,191 14
36,144 3&
Medical and general care:
Books, periodicals, etc $585 70
Entertainments, games, etc. 2,059 40
Funeral expenses 958 00
Gratuities 17 00
Ice and refrigeration 1,472 99
Laboratory supplies and apparatus .... 274 46
Manual training supplies 113 82
Medicines (supplies and apparatus) . . 5,781 88
Medical attendance (extra) 895 72
Patients boarded out 2,623 22
Return of runawaj^s 151 66
Tobacco, pipes, matches 2,657 46
Water 8,309 26
Sewerage (chapter 165, Special Acts of 1919) . . 2,400 00
28,300 57
Heat, light and power:
Coal (bituminous) i $39,692 14
Freight and cartage 36,681 46
Coal (screenings) 11,811 79
Coal (anthracite) 6,057 33
Freight and cartage 2,322 65
Electricity 263 90
Gas 1,373 65
Oil 556 81
Operating supplies for boilers and engines . . 346 36
Sundries 20 00
99,126 09'
Farm :
Bedding materials $500 24
Blacksmithing and supplies 510 81
Carriages, wagons and repairs 469 50
Dairy equipment and supplies 389 91
Fencing materials 7 56
Fertilizers 995 79
Grain, etc 11,508 77
Hay 8,161 78
Harnesses and repairs 210 04
Cows 83 96
Other live stock . . 725 00
Amounts carried forward $23,563 36 $607,912 71
1 Includes refund of S454.71 on coal which came through care of medical department and did
not go through institution cash.
1921.] PUBLIC DOCUMENT — No. 23. 43
Amounts brought forward $23,563 36 $607,912 71
Farm — Coti.
Labor (not, on pay roll) 66 73
Rent 250 00
Spraying materials 200 65
Stable and barn supplies 98 00
Tools, implements, machines, etc 1,175 23
Trees, vines, seeds, etc 711 58
Veterinary services, supplies, etc. .... 659 81
■ Lime 236 12
.26,961 48
Garage, stable and grounds:
Motor vehicles $1,805 77
Automobile repairs and supplies 5,072 42
Blacksmithing and supplies 105 12
Carriages, wagons and repairs 13 15
Hay 351 99
Harnesses and repairs ....... 4 10
Road work and materials 250 00
Stable supplies 25 08
Tools, implements, machines, etc 246 01
Trees, vines, seeds, etc. 64 42
Veterinary 5 50
Repairs, ordinary:
Cement, lime, crushed stone, etc. .... $1,192 58
Electrical work and supplies 879 04
Hardware, iron, steel, etc 2,999 68
Lumber, etc. (including finished products) . . 3,347 23
Paint, oil, glass, etc. ........ 6,655 69
Plumbing and supplies 2,658 36
Roofing and materials 2,209 96
Steam fittings and supplies 981 09
Tools, machines, etc 572 66
Boilers, repairs 1,902 84
Dynamos, repairs 32 98
Engines, repairs 428 39
Repairs and renewals:
Hand stoker type for two boilers .... $848 10
Corn-shelling machine 264 72
Laundry machinery 8,365 00
Telephone line 449 70
Woodward porches 1,163 78
7,943 56
23,860 50
11,091 30
Total expenses for maintenance $677,769 55
44
WORCESTER STATE HOSPITAL.
[Dec.
Special Appropriations.
Balance Dec. 1, 1920 . $24,874 43
Appropriations for current year 16,000 00
Total $40,874 43
Expended during the year (see statement below) . $21,577 61
Reverting to treasury of Commonwealth ... 5 22
— — — • 21,582 83
Balance Nov. 30, 1921, carried to next year $19,291 60
Object.
Act or Resolve.
Whole
Amount.
Expended
during
Fiscal
Year.
Total
e.xpended to
Date.
Balance
at End of
Year.
Water supply
Chap. 95, Res.
1917.
$11,385 00
S6,580 75
SI 1,207 64
$177 36
Renovating the plumbing .
Chap. 153. Sp.
Acts 1919.
5,500 00
361 53
5,498 46
1 54*
Alterations of buildings.
Chap. 153, Sp.
5,500 00
103 49
5,497 89
2 11*
Hillside Farm.
Acts 1919.
Worcester department, heat-
Chap. 123, Res.
3,758 72
498 67
644 48
3,114 24
ing system. 1
1917.
Alterations to laundry
Chap. 225, Acts
1920.
21,000 00
3,220 36
20,998 43
1 57*
Water supply for fire protec-
Chap. 225, Acts
17,000 00
10,812 81
17,000 00
-
tion.
1920.
Alterations in heating shaft
Chap. 203, Acts
1921.
16,000 00
~
""
16,000 00
?80,143 72
S21,577 61
$60,846 90
$19,296 82
Balance reverting to the treasury of the Commonwealth . . $5 2.^
Balance carried to next year 19,291 60
Total as above
$19,296 82
Resources and Liabilities.
Resources.
Cash on hand $21,032 72
November cash vouchers (paid from advance money),
accoimt of maintenance 26,967 28
Due from treasurj^ of Commonwealth from available appropriation,
account of November, 1921, schedule
Special appropriations
Liabilities.
Outstanding schedules of current year:
Schedule of November bills
Special appropriations
$48,000 00
21,389 24
518 92
$69,908 16
$69,389 24
518 92
$69,908 16
1 Transferred from Grafton State Hospital Dec. 1, 1919.
1921.1 PUBLIC DOCUMENT — No. 23. 45
Per Capita.
During the year the average number of inmates has been 2,027.65.
Total cost for maintenance, $677,769.55.
Equal to a weekly per capita cost of $6.4281.
Receipt from sales, $2,748.01.
Equal to a weekly per capita of $0.0260.
All other institution receipts, $85,653.81 .
Equal to a weekly per capita of $0.812.3.
Net weekly per capita cost, $5.5898.
Respectfully submitted,
JESSIE M. D. HAMILTON,
Treasurer.
Examined and found correct as compared with the records in the office of the
Auditor of the Commonwealth.
ALONZO B. COOK,
Auditor.
46 WORCESTER STATE HOSPITAL. [Dec.
STATEMENT OF FUNDS.
Patients' Funt).
Balance on hand Nov. 30, 1920 . . . $9,340 57
Receipts . . 10,115 09
Interest 329 21
Refunded $8,191 09
Interest paid to State Treasurer . . . 329 21
Inveslment.
Worcester County Institution for Savings
Worcester Five Cents Savings Bank
Worcester Mechanics Savings Bank .
Peoples Savings Bank
Balance Worcester Bank and Trust Company
Cash on hand Dec. 1, 1921 ....
LE"w^s Fui\T).
Balance on hand Nov. 30, 1920 . . . $1,754 32
Income 67 85
$2,000 00
2,000 00
2,000 00
2,000 00
2,996 72
267 85
$19,784 87
8,520 30
$11,264 57
[1,264 57
$1,822 17
Expended for pictures, books, etc 179 38
L,642 79
Investment.
American Telephone and Telegraph Company
collateral trust 4 per cent bond . . . $926 36
Fourth Liberty Loan bonds .... 600 00
Balance Worcester Bank and Trust Company 116 43
L,642 79
1921.1 PUBLIC DOCUMENT — No. 23. 47
Wheeler Fund.
Balance on hand Nov. 30, 1920 . . . $6,539 00
Income 308 82
$6,847 82
Expended for entertainments, magazines, etc. . . . 475 OS
S6,372 74
Investment.
American Telephone and Telegraph Company
collateral trust 4 per cent bond . . . $712 50
Third Liberty Loan bonds 4,000 00
Fourth Liberty Loan bonds .... 1,300 00
Balance Worcester Bank and Trust Company 360 24
$6,372 74
Manson Fund.
Balance on hand Nov. 30, 1920 . . . $1,347 98
Income 50 98
$1,398 96
Expended for entertainments 120 27
$1,278 69
Investment.
Fourth Liberty Loan bonds . . . . $1,100 00
Balance Worcester Bank and Trust Company 178 69
$1,278 69
Respectfully submitted,
JESSIE M. D. HAMILTON,
Treasurer.
Nov. 30, 1921.
N. B. — The values assigned to the above securities are their
respective purchase prices.
STATISTICAL TABLES
AS ADOPTED BY AMERICAN PSYCHIATRIC ASSOCIATION
Prescribed by Massachusetts Department of Mental Diseases
STATISTICAL TABLES.
Table 1. — General Information.
1. Date of opening as an institution for the insane: Jan. 18, 1833.
2. Type of institution : State.
3. Hospital plant:
Value of hospital property:
Real estate, including buildings .... $2,591,169 76
Personal property 371,359 69
Total
2,962,529 45
Total acreage of hospital property, 589.16.
Acreage under cultivation during previous year, 263.75.
4. Medical service:
Superintendent
Assistant physicians
Medical internes
Dentist
Total physicians
5. Employees on pay roll (not including physicians)
Graduate nurses
Other nurses and attendants
All other employees
Total employees
6. Patients employed in industrial classes or in
general hospital work on date of report
7. Patients in institution on date of report (ex-
cluding paroles)
Men. Women. Totals.
1 - 1
7-7
1
1
Men. Women. Totals.
1 16 17
112 100 212
78 77 155
191 193 384
Men. Women. Totals.
543 401 944
1,051 1,042 2,093
Table 2. — ■ Financial Statement.
See treasurer's report for data requested under this table.
52
WORCESTER STATE HOSPITAL.
[Dec.
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PUBLIC DOCUMENT — No. 23.
53
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54
WORCESTER STATE HOSPITAL.
[Dec.
Table 4. — Nativity of First Admissions and of Parents of First Admissions.
Parents
OF
Parents
Patients. I
Male
or Female
Patients.
Patients.
Nativity.
ro
m
IC
_o
M
m
£
m
"cS
S
C3
O
"3
a
O
"S
a
o
s
fe
tn
S
fe
h
S
P4
H
United States
131
71
202
62
57
119
26
29
55
Albania
4
_
4
4
4
8
_
_
_
Armenia
3
3
6
3
3
6
3
3
6
Austria
2
3
5
3
3
6
3
3
6
Belgium
-
-
-
1
-
1
-
-
-
Canada
25
31
56
39
44
83
30
29
59
Central America ....
1
-
1
-
-
-
-
-
-
China
2
-
2
3
3
6
-
-
-
Denmark
1
-
1
1
1
2
-
-
-
England
5
3
8
7
5
12
11
7
18
Finland
4
4
8
4
4
8
4
4
8
France
3
-
3
5
4
9
1
-
1
Germany
6
2
8
10
10
20
3
3
6
Greece
8
3
11
8
8
16
3
3
6
Ireland
20
24
44
39
39
78
38
39
77
Italy
12
9
21
12
12
24
10
10
20
Norway
3
-
3
3
3
6
-
-
-
Poland
8
2
10
11
11
22
2
2
4
Portugal
4
-
4
4
4
8
-
-
-
Russia
8
7
15
9
9
18
12
12
24
Scotland
5
4
9
5
6
11
6
8
14
Spain
2
1
3
2
2
4
1
1
2
Sweden
6
4
10
6
6
12
4
4
8
Switzerland
1
-
1
1
1
2
-
-
-
Syria
-
1
1
-
-
-
1
1
2
Turkey in Asia ....
1
-
1
1
1
2
-
-
-
West Indies
2
-
2
2
2
4
-
-
~
Total foreign born
136
101
237
183
185
368
132
129
261
Unascertained
5
2
7
27
30
57
16
16
32
Grand totals ....
272
174
446
272
272
544
174
174
348
Table 5.
— Citizenship of First Admissions.
Males.
Females.
Totals.
Citizens by birth
Citizens by naturalization
131
17
119
5
71
12
89
2
202
29
208
Citizenship unascertained
7
Totals ....
272
174
446
r . . —
1921.
PUBLIC DOCUMENT — No. 23.
55
Table 6. — Psychoses of First Admissions.
Psychoses.
1. Traumatic, total .......
(o) Traumatic delirium _
(6) Traumatic constitution .....
(c) Post-traumatic mental enfeeblement (de-
mentia) ........
(d) Other types
2. Senile, total .
(o) Simple deterioration .....
(6) Presbyophrenic type
(c) Delirious and confused types ....
(d) Depressed and agitated types ....
(e) Paranoid types ......
(f) Pre-senile type
(g) Other types . ._
3. With cerebral arteriosclerosis .....
4. General paralysis .......
5. With cerebral syphilis ......
6. With Huntington's chorea .....
7. With brain tumor .......
8. With other brain or nervous diseases, total
(a) Cerebral embolism
(b) Paralysis agitans ......
(c) Meningitis, tubercular or other forms (to be
specified) .......
(d) Multiple sclerosis ......
(e) Tabes dorsalis
(/) Acute chorea .......
(fir) Other diseases (encephalitis) ....
9. Alcoholic, total
(a) Pathological intoxication
(6) Delerium tremens ......
(c) Korsakow's psychosis .....
id) Acute hallucinosis _
(e) Chronic hallucinosis .....
(/) Acute paranoid type .....
(g) Chronic paranoid type .....
(h) Alcoholic deterioration . .
(i) Other types, acute or chronic ....
10. Due to drugs and other exogenous toxins, total
(o) Opium (and derivatives), cocaine, bromides,
chloral, etc., alone or combined (to be speci-
fied)
(b) Metals, as lead, arsenic, etc. (to be specified)
ic) Gases (to be specified) . . . . .
id) Other exogenous toxins (to be specified)
11. With pellagra
12. With other somatic diseases, total ....
(a) Delirium with infectious diseases .
(b) Post-infectious psychoses ....
(c) Exhaustion delirium .....
(d) Delirium of unknown origin ....
(e) Cardiorenal disease .....
(/) Diseases of the ductless glands
(g) Other diseases or conditions (to be specified) .
13. Manic-depressive, total
(a) Manic type .......
(b) Depressive type ......
(c) Stupurous type ......
(d) Mixed type .......
(e) Circular type
(/) Other types
14. Involution melancholia ......
15. Dementia prjecox, total . . . .
(a) Paranoid type .......
(b) Catatonic type ......
(c) Hebephrenic type ......
(d) Simple type
(e) Other types .......
16. Paranoia or paranoid conditions . . . .
27
42
28
141
56
WORCESTER STATE HOSPITAL.
[Dec.
Table 6. — Psychoses of First Admissions — • Concluded.
Psychoses.
17. Epileptic, total
ia) Epileptic deterioration
(6) Epileptic clouded states .
(c) Other epileptic types (to be specified)
18. Psychoneuroses and neuroses, total .
(a) Hysterical type ....
(6) Psychasthenic type ....
(c) Neurasthenic type ....
id) Anxiety neuroses ....
^ ie) Other types
19. With psychopathic personality
20. With mental deficiency ....
21. Undiagnosed ......
22. Without psychoses, total ....
(a) Epilepsy ......
(6) Alcoholism
<c) Drug addiction ....
<d) Psychopathic personality
ie) Mental deficiency ....
if) Others
Totals
272 174 446
PUBLIC DOCUMENT — No. 23.
57
aj
H
m
O
a
DUE TO
DRUGS AND
OTHER EX-
OGENOUS
TOXINS.
■s^^ox
I 1 1 1 1 1 '-I 1 1 1 1 -H 1 1 1 1 1 1 1 1 1 1
..
"saiBuia^
1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1
1
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1 1 1 1 1 1 'H 1 1 1 1 M 1 1 1 1 1 1 1 1 1 1
CM
O
w
o
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- , 1 ,« ,o,^, ,o^ , , ,^^ , , ,^^
^
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- 1 1 1 1 1 ^_ 1 1 t^-H 1 1 1 .-^ 1 1 1 -H^
WITH OTHER
BRAIN
OR NERVOUS
DISEASES.
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1 1 1 1 1 1 r-. 1 1 1 Mrt 1 1 1 1 1 1 111-^
^
•sajBuiajf
1 1 1 1 1 1 --I 1 1 1 1 —1 1 1 1 1 1 i 1 1 1 1
«
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1 1 1 1 1 1 1 1 1 1 <-l 1 1 1 1 1 1 1 1 1 1 -H
^
WITH
hunting-
ton's
CHOREA.
•SJB^OX
1 1 1 1 1 1 1 1 1 1 <-! 1 1 1 1 1 1 1 1 1 1 1
-
•saiT3raa^
1 1 1 1 1 1 1 1 ' 1 -- 1 1 1 1 1 1
-^
■sajBj^i
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
1
n s w
^ « &
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OO
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I 1 1 1 1 1 1 1 1 -H 1 1 1 1 -H 1 1 1 1 1 1 1
t-q
■saiBM
IIIIII'-HIIIIIIII'HI'-III rt(M
o
si
•si'b:>ox
.-( 1 T-l 1 CC I CD ^ 1 1 CO CM 1 1 COCM<-H 1 1 1 OOCO
CO
•sajBuia^
■-HI 1 |rt| 1 1 1 |T-lrt| 1 |rt| 1 IICMI
t^
■sa|Bj\[
1 lT-(|(M|Ort| |CNr-l| ICOt-c-hi 1 ICOCO
CM
WITH
CEREBRAL
ARTERIO-
SCLEROSIS.
•SIB'^OX
"-HI 1 iTfl'*! 1 lOI 1 1 «■-< 1 1 1 1 0050
CO
•sa(Binaj[
—"IIICMI-HllllOlllrtllllliol
lO
•saiBi^
llll<MICOIII>OIII -Hrt 1 1 1 1 too
s
J
M
Z
to
•SIBJOX
1 1 1 1 cq i tocM 1 1 ^ 1 1 1 1 -* 1 1 1 1 ooo
CM
•sai3niaj[
I^
•sajBj^
llllllC0^1IC<llllllllll-#ira
■o
Eh
s
<!
PS
■SfBiOX
1 1 1 1 1 1 I 1 1 1 'H 1 1 1 1 J 1 1 1 1 1 1
-
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I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
1
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1 1 1 1 1 1 1 1 1 1 •-< 1 1 1 1 1 I 1 1 1 1 1
-
►J
H
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.— t 1— 1 ^ .— 1 CO
-*
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C^
Race.
-a
o
c
African (black)
Albanian .
Armenian
Chinese .
English .
Finnish
French
German .
Greek
Hebrew .
Irish .
Italian
Lithuanian
Portuguese
Scandinavian
Scotch
Slavonic .
Spanish .
Syrian
Turkish .
Mixed
Race unascerta
13
58
WORCESTER STATE HOSPITAL.
[Dec.
o
O
fi^
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to
»
o
a
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to
to
Z
g
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1 1 1 1 1 1 F 1 -^ 1 ^ 1 1 1 1 1 1 1 J 1 Mi-^
to r
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Cq
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Q
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to
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oq
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l:~
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WITH PSY-
CHOPATHIC
PER-
SONALITY.
•siB^ox
1 1 1 1 1 1 1 1 1 1 1 1 1 1 J 1 1 1 1 1 <M 1
(M
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1
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PSYCHO-
NEUROSES
AND
NEUROSES.
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— illlllrtlicoicqiiiliiiicol
o
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t>-
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6
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C<l
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3
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a
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African (black)
Albanian .
Armenian
Chinese .
English .
Finnish .
French
German .
Greek
Hebrew .
Irish .
Italian
Lithuanian
Portuguese
Scandinavian
Scotch
Slavonic .
Spanish .
Syrian
Turkish .
Mixed
Race unascerta
"3
o
E-i
1921.
PUBLIC DOCUMENT — No. 23.
59
05
<
3
•SIBIOX
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O
•saiBmaj
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03
■sajBi^
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2
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f;
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00
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s
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to
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r.HCCN ^ ^H— ^05 — <(MI^
1 N 1
Psychoses.
Traumatic
Senile
General paralysis
With Huntington's chorea
With brain tumor ........
With other brain or nervous diseases ....
Due to drugs and other exogenous toxins
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Psychoneuroses and neuroses
With mental deficiency
Undiagnosed
Without psychosis
1
o
^HNCO-^iCSOt^OOCSO — NC0*^>O:Ot^000iO — N
60
WORCESTER STATE HOSPITAL.
[Dec.
o
ft^
-^
►J
<
to
<
m
o
«
>
■sib:>ox
1 CO C2 r 1 1 1 1 1 1 I 1 1 1 1 1 1 I 1 1 1 1
cq
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1 oo-H 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 =n
•saiBi\[
1 in oo r 1 1 1 I 1 1 1 1 I 1 1 1 1 1 1 1 1 1
S
•SIB^OX
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CO
•sajBraa^j
1 eocs 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1
l«
•sajBH
l<MifflllllllllIIIII[lll-<l
00
s
g
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i^
•sapraajj
1 o.* 1 I 1 1 1 1 1 1 1 1 1 rt 1 r 1 1 1 -H 1
s
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1 >nm 1 1 1 1 1 1 I I 1 1 I 1 1 1 1 I 1 1 1
o
to
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1 OOO 1 1 1 1 1 CO 1 1 1 1 1 rt 1 1 1 1 1 1 1
N
•saiBmaj
1 QOC<l 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
o
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2
s
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|IMt(<IM^I Irtl 1 1 1 1 iThl 1 1 1-^1 1
s
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1 ^^ 1 1 1 1 1 1 1 1 1 1 I 1 1 1 I I 1 1 1
<M
•sajBiv
l«COIMrt| Irtl 1 1 1 1 1^1 1 1 IrtI 1
2
e
•sp^ox
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CO
•sajBuiaj
I'-lrti-ll 1 1 Irtl 1 1 l—icqlrtl |_rt|
25
"saiB]^
1 1 Tt<.* 1 1 1 1 IM 1 1 1 cq^co 1-^1 1 1 CO 1
§
e
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<M
CO
•sei-eniaj^
1 1 rt.^ 1 rt 1 1 1 1 1 1 CO.*C<l 1 1 1 1 1 rt 1
•sai^j^
1-1 { leO-^l 1 1 1 1 |r-lrt(MCO| I 1 1 Icol
■"
e>
■smox
1 1 1 OOIM 1 1 1 CO 1 1 1 IM-HOO 1 1 CJ 1 -HM< 1
-^
•sa|i3nia^
1 1 1 Ncq 1 1 1 <M 1 1 1 -Hirato 1 1 cq 1 1 cq 1
IM
•sa[i3i\[
1 1 lOl 1 1 l^-ll 1 IMCOCMI 1 1 1— c(M|
s
to
m
i
Traumatic
Senile . . . . _
General paralysis
With Huntington's chorea
With brain tumor
With other brain or nervous diseases ....
Due to drugs and other exogenous toxins
With pellagra
With other somatic diseases
Manic-depressive
Involution melancholia
Paranoia or paranoid condition
Epileptic
Psychoneuroses and neuroses
With mental deficiency
Undiagnosed
Without psychosis
"3
o
T-ICsICO-^iOCOI>-OOa!O^HC<)CO^»^CDt^OD050^C^l
1921.
PUBLIC DOCUMENT — No. 23.
61
•s^ox
[ ^(^n 1 1 1 Irtl JrtMMiOl 1 1 \ ^<CH-I
CD
CD
•sai^niej
1 2'^'^ 1 1 1 1 1 1 1 rt-H 1 lo 1 1 J r 1 COr^
s
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« 'J* 1
1
o
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«
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CO
■S9IBJ^
1 1 --H 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 rt 1
c.
o
■SF^Oi
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t^
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llllll]lllllC<lCJ>OII03llrt|
2
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o
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a
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1 W^ 1 1 1 1 1 (N 1 i rt^ 1 U5 1 ,-, 1 1 coco 1
s
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H
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to
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62
WORCESTER STATE HOSPITAL.
[Dec.
0^
^
•SIB^OJ,
•sa]Btn8j
•sai'Bj^
J I I I I I I 1 I I 1 I 1 I -^ 1 1 I I -^ 1 I
I I I I I I I I I I I I I J I I I I I I I I
1 I 1 I I I I 1 I I I I I I —1 I I I I -^ 1 1
•SJB^OX
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ICOl 1 1 I 1 I I 1 I IMCO— 1"-H|«| I
imto.-il I irtrti 1 I I io>i 1 I 1 icqi
■sib:»ox
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OJ S
p. u
P 0-313
1— lCSCOTt<lOCOI>-OOOOi— '(MCO-^»OCC>I>.OOOiO'-HC<l
PUBLIC DOCUMENT — No. 23.
63
O
fe^
Q
•SIB^OX
1 1 1 1 1 1 1 1 1 1 1 1 1 1 J r 1 1 1 «-H 1
■M
W
Z
<
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f 1 1 1 1 1 1 1 r 1 1 J 1 1 1 1 1 1 1 1 1 1
1
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a
s
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T-Hc^co^iocot^ooa50'-Hcqco^>o=or-.oooio^Hc^i
rtrt— i-H— irtrtr-i— irtcMoqcq
64
WORCESTER STATE HOSPITAL.
[Dec.
a.
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Traumatic
Senile . . .
General paralysis
With cerebral syphilis
With Huntington's chorea
With brain tumor
With other brain or nervous diseases
Alcoholic
Due to drugs and other exogenous toxins
With pellagra
With other somatic diseases
Manic-depressive .......
Involution melancholia
Dementia precox
Paranoia or paranoid condition ....
Epileptic
Psychoneuroses and neuroses
With psychopathic personality ....
With mental deficiency
Undiagnosed
Without psychosis
"3
»-IC^C0'^iCC0t^000i(3'-HCqc0-^iOCOt^0005O^HC^
1921.
is
PUBLIC
•sp^ox
DOCUMENT — No. 23.
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65
66
WORCESTER STATE HOSPITAL.
[Dec.
Table 14. — Psychoses of Readmissions.
Psychoses.
1. Traumatic, total
(a) Traumatic delirium
(6) Traumatic constitution
(c) Post-traumatic mental enfeeblement (de-
mentia) ........
id) Other types
2. Senile, total .
(a) Simple deterioration
(h) Presbyophrenic type
(c) Delirious and confused types ....
id) Depressed and agitated types . . . ' .
(e) Paranoid types
(/) Pre-senile type
Ig) Other types . ._
3. With cerebral arteriosclerosis
4. General paralysis _
5. With cerebral syphilis
6. With Huntington's chorea
7. With brain tumor
8. With other brain or nervous diseases, total
9. Alcoholic, total
(o) Pathological intoxication
(6) Delirium tremens _
(c) Korsakow's psychosis . . . . .
id) Acute hallucinosis _
(e) Chronic hallucinosis
(/) Acute paranoid type
ig) Chronic paranoid type
(h) Alcoholic deterioration . . . .
(i) Other types, acute or chronic ....
10. Due to drugs and other exogenous toxins, total
(o) Opium (and derivatives), cocaine, bromides,
chloral, etc., alone or combined (to be speci-
fied)
(6) Metals, as lead, arsenic, etc. (to be specified) .
(c) Gases (to be specified) . . .
(d) Other exogenous toxins (to be specified)
11. With pellagra
12. With other somatic diseases, total . . . .
(o) Delirium with infectious diseases .
(h) Post-infectious psychosis . . . .
(c) Exhaustion delirium
(d) Delirium of unli:nown origin . . . .
(e) Cardiorenal disease ......
(/) Diseases of the ductless glands
(g) Other diseases or conditions (to be specified) .
13. Manic-depressive, total ......
(a) Manic type
(6) Depressive type
(c) Stuporous type
(d) Mixed type
ie) Circular type
(/) Other types
14. Involution melancholia
15. Dementia pra-cox, total ......
(o) Paranoid type
(6) Catatonic type
(c) Hebephrenic type
Id) Senile type
(e) Other types _ . . _
16. Paranoia or paranoid conditions . . . .
17. Epileptic, total
(a) Epileptic deterioration . . . . .
(6) Epileptic clouded states
(c) Other epileptic types (to be specified) .
24
1921.
PUBLIC DOCUMENT — No. 23.
67
Table 14. — Psychoses of Readmissions — Concluded.
Psychoses.
18. Psychoneuroses and neuroses, total
(a) Hysterical type
(b) Psychasthenic type .
(c) Neurasthenic type .
id) Anxiety neuroses
(e) Other types
19. With psychopathic personality
20. With mental deficiency
21. Undiagnosed ....
22. Without psychosis, total .
(a) Epilepsy .
(6) Alcoholism
(c) Drug addiction
(d) Psychopathic personality
(e) Mental deficiency
(/) Others ....
Totals
WORCESTER STATE HOSPITAL.
[Dec.
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1
1921.
PUBLIC DOCUMENT — No. 23.
69
a
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WITH OTHER
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WITH
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CHOREA.
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General Diseases.
Influenza
Multiple abdominal abscesses .
Arthritis deformans ....
Purpura hemorrhagica ....
Pernicious anemia
Septicemia following infection of left leg
Exhaustion due to manic-depressive in-
sanity
Carcinoma of breast
Diseases of the Nervo^is System.
Encephalitis
Epidemic encephalitis ....
Cerebral hemorrhage
General paralysis of the insane
Cerebrospinal syphilis ....
Tabes dorsalis
Status epilepticus
70
WORCESTER STATE HOSPITAL.
[Dec.
o
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m
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WITH OTHER
BRAIN
OR NERVOUS
DISEASES.
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WITH
hunting-
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Diseases of the Circulatory System.
Cardiovascular-renal disease
Arteriosclerosis ......
Cerebro arteriosclerosis ....
Acute vegetative endocarditis .
Chronic endocarditis ....
Chronic myocarditis ....
Chronic valvular heart disease
Femoral thrombosis
Diseases of the Respiratory System.
Hypostatic pneumonia ....
Broncho-pneumonia
Lobar pneumonia
Pulmonary thrombosis ....
Pulmonary tuberculosis ....
Diseases of the Digestive System.
Acute enteritis
Chronic gastroenteritis ....
Chronic enterocolitis ....
Bacillary dysentery
Carcinoma of intestines ....
Carcinoma of pylorus ....
Carcinoma of stomach ....
1921.
PUBLIC DOCUMENT — No. 23.
71
"l
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1
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■o
II 1 1 1 1 1 1 II 1 1 1 o
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Intestinal obstruction ....
Cirrhosis of liver
Exhaustion (persistent vomiting due to
adhesion of bile duct) ....
Diseases of the Genitourinary System.
Chronic cystitis
Pyelo nephritis
Chronic parenchymatous nephritis .
Carcinoma of bladder ....
Carcinoma of uterus ....
Accidents, Violence and S^ldden Deaths.
Fracture of right femur (pushed by another
patient)
Multiple injuries (accidental fall)
Asphyxiation (due to food in larynx and
bronchi)
Accidental fall from bed (punctured rib)
Dementia pra;cox (sudden death)
m
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Eh
72
WORCESTER STATE HOSPITAL.
[Dec.
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1921.
PUBLIC DOCUMENT — No. 23.
73
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74
WORCESTER STATE HOSPITAL.
[Dec.
ID
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Psychoses.
Traumatic
Senile . . .
General paralysis
With cerebral syphilis
With Huntington's chorea
With brain tumor
With other brain or nervous diseases . . .
Alcoholic
Due to drugs and other exogenous toxins
With pellagra .
With other somatic diseases . . . . .
Manic-depressive
Involution melancholia
Dementia precox ; .
Paranoia or paranoid condition . . . ' .
Epileptic ■ .
Psychoneuroses and neuroses
With mental deficiency
Undiagnosed
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WORCESTER STATE HOSPITAL. [Dec. 1921.
Table 19. — Family-care Department.
Males.
Females.
Totals
Remaining Sept. 30, 1920 ....
Admitted within the year ....
Nominally returned from visit for discharge
Whole number of cases within the year
Dismissed within the year ....
Returned to the institution
Discharged
Died
Visit
Escaped
Remaining Sept. 30, 1921 ....
Supported by State
Private
Self-supporting
Number of different persons within the year
Number of different persons admitted
Number of different persons dismissed
Daily average number
State
Private
Self-supporting
25
10
1
36
14
10
2
2
22
13
5
4
31
6
12
24.11
15.36
4.75
4.00
25
10
1
36
14
10
2
2
22
13
5
4
31
6
12
24.11
15.36
4.75
4.00
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