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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 



Cjbe Commonttiealtl) of ^afimtbii$tm 



ANNUAL REPORT 



THE TEUSTEES 



Worcester State Hospital 



Yeae ending November 30, 1922 



Department of Mental Diseases 




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OFFICERS OF THE WORCESTER STATE 
HOSPITAL. 



BOARD OP TRUSTEES. 



John G. Perman, D.D.S. 
Lttther C. Gbeenleaf 
Caroline M. Caswell, Secretary 
Mae Carlson Bemis . 
William J. Delahanty, M.D. 
Edward F. Fletcher, Chairman 
Howard D. Cowee 



f ^^ 



Worcester. 

Boston. 

Northborough. 

Spencer. 

Worcester. 

Worcester. 

Worcester. 



MEDICAL STAFF. 



William A. Bryan, M.D. 



Michael J. O'Meara, M.D 
Leon E. Duval, M.D. 
George A. Gaunt, M.D. 
Clarence A. Whitcomb, M 

Mervin Fossner, M.D. 
Manley B. Root, M.D. 
John Saucier, M.D. 
Henry P. Wbyler, M.D. 
John P. Powers, M.D. 
Louis Pare, M.D. 

Lloyd E. Byrd, D.D.S. 



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. 
Assistant Physician. 
Dentist. 



VISITING STAFF. 



Ernest L. Hunt, M.D. ] 
John F. Curran, M.D. |- 
C. J. Byrne, M.D. . J 
M. M. Jordan, M.D. . 
Benjamin T. Burley, M.D. 
William F. Holzer, M.D. 
Frank E. Stowell, M.D. 
John W. O'Meara, M.D. 
Phillip H. Cook, M.D. 



Surgeons. 

Neurologists. 

Ophthalmologist. 
Electro-therapist. 
Orthopedist. 
Roentgenologist. 



HEADS OF DEPARTMENTS. 



Florence M. Wooldridge, R.N. 



Maurice Scannell 
Jessie M. D. Hamilton 
Herbert W. Smith 
Lillian G. Carr 
Joseph Reynolds 
James Dickison, Jr. 
Anton Swenson . 
Maude Rose 



Superintendent of Nurses and 
Principal of Training School. 
Supervisor, Male Department. 
Treasurer. 
Steward. 
Matron. 
Head Farmer. 
Chief Engineer. 
Foreman Mechanic. 
Head Occupational Therapist, 






WORCESTER STATE HOSPITAL. [Dec. 

Cfje Commontoealtl) of ^n^smtbn^stm 



TRUSTEES' REPORT. 



To His Excellency the Governor and the Honorable Council. 

The trustees of the Worcester State Hospital respectfully submit the ninetieth 
report of the hospital, appending a record of the various departments as reported 
by the Superintendent, Dr. William A. Bryan, also by the Treasurer, Miss Jessie 
M. D. Hamilton. 

During the year the Honorable John E. White resigned from the Board of Trus- 
tees and Attorney Howard W. Cowee was appointed to fill the vacancy. 

The trustees have studied the needs of both the Belmont and Summer Street 
Hospitals and urgently request that additional funds be provided to meet the de- 
mands of the State and City inspectors, which requirements are specified in the 
superintendent's report. 

We feel assured that the past year has shown a greater development in the surgical 
and medical departments of both hospitals than was ever developed in any previous 
year. The splendid medical and surgical organizations established by Dr. Bryan 
is worthy of great consideration. The trustees heartily co-operate with the superin- 
tendent in the recommendations embodied in his report, kno^ving that same has 
been well thought out. 

It is with a source of great pride that we mention the splendid progress made in 
the medical field. The organizing of a consulting staff composed of well known 
Worcester phj^sicians guiding each specialty, by means of increased facilities for 
diagnosis and treatment, the patients at this hospital have been greatly benefited 
and physical ailments alleviated. The relief of phj^sical distress aids greatly in 
mental recuperation. 

Medical Office. 

During the last year the medical office has been completely renovated, filing 
cabinets have been added and a dictaphone room provided. The comfort and con- 
venience plus the pleasant situation of this room greatly aids the phj^sicians in their 
daily work. 

LiBKARY. 

Among the other attractive changes is that of the library, which has been trans- 
ferred to a large spacious and sunn}^ room with 1,500 volumes readily accessible. 
Adjoining is the medical library where all the new works on medicine are available. 
The patients who are unable to attend the library are supplied daily with books on 
the ward. 

Decorations. 

Over 1,000 new pictures have been placed on the wards. 

We are of the firm belief that our superintendent. Dr. Bryan, has given his utmost 
consideration to every department, working beyond his strength in order to pro- 
mote the best welfare of every inmate confined in both institutions. 

Respectfully submitted, 

EDWARD F. FLETCHER. 
HOWARD W. COWEE. 
JOHN G. PERMAN. 
LUTHER C. GREENLEAF. 
CAROLINE M. CASWELL. 
WILLIAM J. DELAHANTY. 



1 



1922.1 PUBLIC DOCUMENT — No. 23. 



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, 1922, it being the ninetieth annual report. 

There remained on the Hospital books October 1, 1921, 2,367 patients, 1,240 men, 
and 1,127 women. During the j^ear ending Sept. 30, 1921, there were admitted 
611 patients — • 347 men and 264 women. Five hundred and sixty-six patients — 
326 men and 240 women, were discharged from the hospital. Of this number, 301 
patients, 178 men and 123 women — were discharged; 222 patients — 122 men 
and 100 women — died; and 43 patients — 26 men and 17 women — were trans- 
ferred, leaving at the end of the statistical year 2,451 patients — 1,273 men and 
1,178 women. Two thousand and seventeen patients — 1,018 men and 999 women 

— were actually in the hospital. Of this number 1,833 were supported by the State, 
93 by friends, and 91 as re-imbursing patients. Of the patients discharged, 31 were 
reported as recovered, 160 as improved, and 64 not improved. Forty-one patients 

— 27 men and 14 women — were discharged as not insane. Twenty men and ten 
women were transferred by the Department of Mental Diseases to the Gardner 
State Colony; 2 men and 2 women to the State Infirmary; 1 man and 2 women to 
the Boston State Hospital; 1 man to Dr. Channing's Sanitarium; 1 man to Her- 
bert Hall; 1 man to the Bridgewater State Hospital; 1 woman to Dr. Ring's Sani- 
tarium; and 1 woman to the Monson State Hospital. Twenty-two men and 9 
women were removed from the State, and 21 men and 14 women were deported. 

There remained in the hospital at the end of the year 37 less patients than at the 
beginning. The smallest number under treatment on any day was 2,040 patients, 
and the largest 2,110. The daily average was 2,029.46. 

The percentage of recoveries, calculated upon the number of discharges and 
deaths, was 5.45, calculated upon the number of admissions, 5.07. The death rate 
was 7.3, calculated on the whole number of patients under treatment, and 10.9, 
calculated on the daily average number, 

Ex-Service Men. 

During the year, there were 61 ex-service men committed to the hospital, 5 re- 
turned from trial visits, and 14 returned from escape. Thirty-three went out on a 
year's trial visit, 22 left the hospital without permission, 4 died, 5 were transferred 
to other hospitals for the insane, and 13 were discharged. On September 30th 
there were 50 ex-service men remaining in the institution. 

The American Legion has aided us in making the lot of our ex-service men more 
comfortable by entertainments and by the regular visitations of a committee desig- 
nated for this duty. Thej^ have further helped to obtain work for several patients 
and made it possible for them to return to their homes and once more take up their 
usual duties. The Disabled American Veterans have provided entertainments and 
have personally escorted large groups of our ex-service men to amusements and 
suppers in the city. The Red Cross have cheerfully from time to time rendered 
valuable aid. 

Grateful acknowledgment is made to the Societies who have contributed gifts 
to our ex-service men during the year, and provided splendid entertainments at 
frequent intervals. 



WORCESTER STATE HOSPITAL. [Dec. 



General Health of the Population. 

The general health of the institution for the past year has been unusually good. 
I would mention, however, the accidental death by burning of a crippled patient 
at the Summer Street Department who fell into a bon-fire and who died despite 
immediate removal and treatment. Also a female patient at the Summer Street 
Department terminated her hfe by suicide. She was found hanged to death, by 
the Night Supervisor, in the water section. A male patient, who for years had had 
the freedom of the grounds, made his way to the Lake, weighted his pockets with 
stones and jumped into the Lake. His body was recovered, and the Medical Ex- 
aminer attributed the cause of death to drowning. Two other cases of sudden 
death were also reported, and the causative factors determined as self-infhcted. 

On September 28th, during fire-drill, an elderly patient fell down stairway and 
fractured a cervical vertebra, which caused death. An operative case died from 
ether narcosis, following an operation. 

There have been no epidemic diseases occurring among the patients or employees. 

Principal Causes of Deaths. 

Twenty-six per cent of all deaths were due to general arteriosclerosis; 14 per 
cent to general paralysis of the insane; 8 per cent due to cardio-vascular-renal 
disease, and 5 per cent each to chronic myocarditis, broncho pneumonia and pul- 
monary tuberculosis. 

Staff Changes. 

The following changes have taken place on the medical staff of the hospital: — 

Resig7iations. 

George F. Caldicott, M.D., resigned February 14, 1922, to accept internship at 
Worcester City Hospital. 

Franklyn P. Bousquet, M.D., resigned March 15, 1922, to internship at the 
Worcester City Hospital. 

Harrison M. Stewart, M.D., resigned March 25, 1922, to return to United States 
Public Health Service, at Greenville, N. C. 

E. Gwynne Merriweather, M.D., resigned May 1, 1922, to accept a position 
elsewhere. 

Robert B. Harriman, M.D., a physician of very kindly disposition, and extremely 
thoughtful of his patients and associates, passed away June 5, 1922. 

Claude Girardeau, M.D., resigned June 30, 1922, to accept a position elsewhere. 

Clarence A. Bonner, M.D., resigned October 14, 1922, to accept a position as 
Assistant to the Commissioner of the Department of Mental Diseases. 

Henry J. Emanuel, M.D., resigned October 30, 1922, to accept a position else- 
where. 

Appointments. 

Clarence A. Whitcomb, M.D., v/as appointed Senior Assistant Physician (Path- 
ologist) February 2, 1922. 

Mervin Fossner, M.D., was appointed Assistant Physician March 16, 1922. 

E. Gwjame Merriweather, M.D., was appointed Assistant Physician March 29, 
1922. 

Claude Girardeau, M.D., was appointed Assistant Physician May 15, 1922. 

Manley B. Root, M.D., was appointed Assistant Physician May 23, 1922. 

Henry J. Emanuel, M.D., was appointed Assistant Physician June 12, 1922. 

John Saucier, M.D., was appointed Assistant Physician August 1, 1922. 

Louis Pare, M.D., was appointed Assistant Physician September 1, 1922. 

John P. Powers, M.D., was appointed Assistant Physician September 15, 1922. 

Henry P. Weyler, M.D., was appointed Assistant Physician November 13, 1922. 



1922.] 



PUBLIC DOCUMENT — No. 23. 



Student Internes. 

I am desirous of reporting splendid work done by our internes during the past 
summer. Lectures were given by various staff members and each interne prepared 
a thesis upon the subject which proved to be the most interesting to him. One of 
these has been pubUshed in the Boston Medical and Surgical Journal. 

The following students served as internes during the past summer : — 



Merrill R. Fox . 

Charles E. Futch 

A. Dale Kirk 

John F. Sander . 

Esther Closson . 

Helen F. Shrack . 

Omins Von Ostrum (Dental) 



Johns Hopkins University. 
University of Michigan. 
University of Michigan. 
University of Michigan. 
Women's Medical College. 
Women's Medical College. 
Harvard Dental School. 



Medical Routine. 

The usual physical examinations, Wassermann tests and the typhoid-prophy- 
laxis have been practiced and in addition each new patient and many of the old 
patients have had the eyes tested and a complete examination of the nose, throat 
and ears, and abnormal conditions found have been treated. The staff meetings 
have been held regularly and the staff luncheons continued. 

A new system of case work has been inaugurated with an efficient manner ar- 
ranged for preparing of notes and general case formation. The medical work has 
been increased and enlarged to the point where a full staff is kept fully employed. 
The operating room is active daily and consulting specialists in surgery, ophthal- 
moscopy, electrotherapy, orthopedics and Roentgenology have been appointed. 
This has aided us greatly in a more thorough preparation of cases and has shown a 
greatly increased number of physical defects which ordinarily would not have been 
noted and which have been studied in relation to the psychoses. The operating 
room equipment has been largely increased by the purchase of needed instruments. 
A static machine has been installed and has been found useful. The surgical service 
has worked out very nicely and each Saturday finds a number of operative cases 
ready. The visiting staff is apportioned to certain hours of each week and they 
have faithfully co-operated with us and we feel that the medical tone of the institu- 
tion has been raised to the point where the patients are now receiving the benefits 
of the most modern and progressive methods. 

Hydrotherapy. — Hydrotherapy has occupied a very prominent place in our 
treatment and records show that the results on the whole from this measure are 
very important. 

Calisthenics. — Occupational Therapy and habit training — The Occupational 
Department has been increased by the addition of some very excellent workers 
who have established ward classes with the result that wards, especially on the female 
side, formerly very noisy, active and destructive, present a changed appearance. 
The patients, despite very active mental disturbances, enjoy this teaching. Calis- 
thenics and also classes on the male side, have been continued and from time to time, 
as circumstances permitted, re-educational classes of the illiterate have been main- 
tained. 

Medical Report. 

Examination of the Blood. — Routine examinations of 279 R. B. C. and Hemo- 
\ globin Tests by Dare and Tallquist methods show the average Red Count to be 
J 4,471,000 and the average Hemoglobin reading 8L6 per cent. A Red Count should 
I be done on all cases where the Hemoglobin is below 81 per cent. The highest cell 
I count was 6,350,000 and the lowest 1,500,000. 

; Report of the Ophthalmic Service. ■ — In conjunction with the special service re- 

\ cently established an Ophthalmic Service has been organized under the direction of 

Dr. William F. Holzer. The aim of the service is to examine routinely the eyes of 



6 



WORCESTER STATE HOSPITAL. 



[Dec. 



every new patient and to prescribe treatment as indicated. Through the arrange- 
ment accurate refraction is done and glasses procured at a minimum cost. A new 
electro-ophthalmoscopic and trial case has recently been added to this equipment. 
This service has been of great usefulness : 



List of Cases treated. 
Sebaceous cysts of lid 
Inflammation of conjunctiva 
Cataract of lens: 

Mature 

Incipient 
Glaucoma : 

Chronic 

Simple . 
Divergence of eyeball 
Complete blindness 
Optic atrophy 
Plastic iritis 
Trachoma 

Staphyloma of cornea 
Paralysis of eye muscles 
Districhiasis 

Impaired vision, necessitating glasses 
Patients examined but not needing glasses 



1 

7 

5 
1 

2 
1 
3 
1 
1 
1 
1 
2 
1 
1 
32 
22 



X-Ray Examinations of the Teeth. — The following conditions are revealed by 
X-ray examinations of the teeth: Frequently roots are entirely covered by gum 
tissue and often abscesses are concealed in this way. Cystic areas in bone are shown 
and many impacted molars have been revealed. The removal in many cases of this 
abnormality has resulted in a great deal of relief from a painful and irritating con- 
dition. 

The following is the dental record : 



Number of patients 

Cleaning 

Filling 

Plates 

Treatment . 

Teeth extracted 

Repair of plates 

Impacted teeth removed 



3,630 ) 

3,164 

2,043 

27 

131 

2,639 

24 

37 



Report of the X-Ray De/partment. — It is an ob\dous fact that the clinician, and 
since the last decade, the alienist, are gradually getting more dependent upon the 
X-Ray, and, as a matter of fact, their co-operation has proved to be mostly success- 
ful. Let us illustrate with a few examples: 

In bone and abdominal surgery I would venture to say that in almost all cases a 
skiagraph is indispensable and, in fact, is ordered by the surgeon; on the other hand, 
in the presence of an early history of coughing, or slight thoracic pains, at that 
stage when both the stethoscope and the laboratory are unable to decipher the 
mystery, who is the internist who shall refuse the powerful help of the Roentgen 
rays to unravel the intricacies of his problem? 

Even in our apparently limited domain of Psychiatry we have understood the 
necessity of possessing a department of Roentgenology, because both our surgical 
and medical clinics were in need of this valuable element of diagnosis. 

The following figures are a demonstration of what we have done last year (No- 
vember 30, 1921 to November 30, 1922). 



Ankle exposures . . 


14 


Arm ........ 


4 


Chest 


16 


Foot 


6 


Gastro-intestinal ...... 


7 


Hand 


. 28 



1922.1 



PUBLIC DOCUMENT — No. 23. 



Hip . 

Humerus 

Jaw 

Knee . 

Nose exposiu'es 

Leg 

Neck . 

Pelvis . 

Shoulder 

Spine 

Skull 

Wrist 

Thigh 

Rib 

Colon 

Clavicle 



Total skiagraphs 



12 
2 
7 
6 
1 
9 
1 
1 
9 
7 

62 
7 
3 
3 
2 
2 

227 



Surgical Report, December 1, 1921, to December 1, 1922. 

The Hospital is now able to give the best of surgical treatment to patients and 
employees. The operating room is fully equipped and is functioning in a very satis- 
factory manner. Operations of choice are done Saturday of each week; emergen- 
cies are met as they arise. The organization of the surgical department is as fol- 
lows : 

1. Visiting Staff: Two consulting surgeons and four visiting surgeons. 

2. House Staff: One member of the hospital staff. These men serve in rotation, 
the service in each case being three months. 

3. Nurse in charge of the operating room. 

Surgical cases are cared for in the hospital wards and complete clinical records 
are kept. All specimens removed at operation are submitted to the laboratory for 
examination. Full reports of the operation, cUnical course and pathological reports 
are filed in the case records of the patients. 

During the fiscal year jfiifty operations have been performed. Cure of the surgical 
condition has been secured in thirty-three cases; improvement has been secured 
in three cases; no improvement was secured in fourteen cases. No deaths have oc- 
curred which can be accounted for in any way in connection with the surgical con- 
dition. 

Report of Surgical Operations. 

Vaginal repair ............. 3 

Inguinal herniotomy ............ 10 

Gastroenterostomy ............ 1 

Circumcision . . . . . . . . . . . . .1 

Excision of Sebaceous cyst . . . . . . . . . . .2 

Hemorrhoidectomy ............ 3 

Ventral Herniotomy ............ 4 

Resection of prolapsed rectum .......... 2 

! Fixation of uterus . . . . ■ . . . . . . . .2 

' Hysterectomy ............. 1 

Vaginal hysterectomy ............ 1 

Incision of abscess ............ 2 

Appendectomy ............. 4 

Cholecystectomy ............. 1 

Excision of lipoma ............ 2 

Incision of carbuncle ............ 1 

Lengthening of spermatic cord .......... 1 

Excision of fibroma ............ 1 

Amputation of leg ............ 1 

Gastrotomy ............. 1 

Thyroidectomy ............. 1 

Ligation of superior thyroid artery ......... 2 

Radical cure of hydrocele ........... 1 

Dilatation and curettage ........... 1 

Salpingectomy ............. 1 



WORCESTER STATE HOSPITAL. [Dec. 



Report of the Out-Patient Clinics. 

There are at present two separate and distinct clinics. One is the neuro-psychi- 
atric clinic at the Summer Street Department, and consists largely of consultation 
work. The other is the School Clinic, for the examination of retarded school chil- 
dren, and is a traveling clinic operating over a fairly large territory. 

From December 1, 1921, to November 30th, inclusive, the Summer Street Clinic 
examined one hundred and twenty-two cases. No arithmetical or statistical data 
will be given, as it is thought that a review of the types of cases seen, sources of 
inflow to the cHnic, and results obtained is more in order in this report. 

Sources of inflow were Courts (particularly juvenile), welfare organizations, 
(Girls' Welfare Society, Children's Friendly Society, Jewish Welfare Society), other 
hospitals and their dispensaries, private physicians, interested relatives and indi- 
viduals who come on their own initiative. District and School Nurses also sent many 
cases. The largest number of cases from any one source were those of the Girls' 
Welfare, who send all of their cases routinely, and studies of the subsequent liis- 
tories of these girls have shown that the Clinic has helped materially in understand- 
ing their difficulties and helping them in making their readjustments. 

Types of cases were many and varied. Two cases are cited as follows: 

1. Adolescent boy, brought by court officer. Charged with indecent exposure. 
Found to be case of adolescent maladjustment. Recommend removal from school 
and hard physical labor. One year later, no repetition of offence, adjusting well. 

2. Girl, 18, brought by sister. Hebephrenic Dementia PriECox. Committed to 
State Hospital. 

These cases could be multiplied indefinitely, but space forbids. We will pass on 
to the School Clinic work, carried on at the request of and in co-operation with the 
State Department of Education. Two hundred and seventy children were exam- 
ined between December 1, 1921, and November 30, 1922, inclusive. The work 
began in the early part of November, 1921, and approximately three hundred chil- 
dren have been studied to date. One full day per week, during the school year, is 
given to this work, which is carried on by one physician, one psychologist, and two 
social workers, together with assistance from school and district nurses, in the va- 
rious locaUties where the clinics were held. An average of ten to twelve cases were 
examined each clinic day. The clinics are a part of a Statewide survey of backward 
school children, and the examinations are required by a recently-enacted State law. 
The children range from six to sixteen years of age chronologically, and we have 
found a range of mental ages from two and a half or three years up to normal. Some 
of the "retarded" children are found to be cases of maladjustment, due to physical 
disease, unwholesome environment, language difficulties (in foreigners) etc. In one 
town, out of twenty-one children selected as being backward in school, eighteen 
were found to have almost no knowledge of the English language. Physical disease 
as a basis for retardation was commonly found, and endocrine disease has been 
found in a number of well-marked cases. 



REPORT OF THE SOCIAL SERVICE DEPARTMENT. 

To the Superintendent. 

The report of the Social Service Department for the year ending November 30, 1922, 
is herewith submitted. During the year there has been no change in the Social Service 
staff, which consists of two workers. 

Some of the functions of the department are to contribute data relative to the cases 
of patients, to the physician, which may aid in their diagnostic work, to study outside 
conditions which will help in the placing of patients in the community, to visit patients 
who have left the hospital and aid them, if necessary, in securing financial help or em- 
ployment and making known to them the educational and recreational opportunities 
of the commimity. Encouraging, helping, adjusting and advising constitute the four- 
fold work in the homes of the patients. We aim to bring the hospital and commimity 
into closer relationship for the benefit of the patients. 



1922.1 



PUBLIC DOCUMENT — No. 23. 



Table A. — Sources of New Cases. 





Males. 


Females. 


Totals. 


Referred by physicians 

Referred by agencies or hospitals 

Referred by friends of patient 

Referred by initiative of patient 

Selected by social worker 


121 

60 
3 
2 

15 


136 
13 
4 
3 

22 


. 257 

73 

7 

5 

37 




201 


178 


379 



One hundred and eighty-four visits were made to patients who are on visit from the 
hospital and 178 to relatives during the year. There were at the beginning of the year 
25 patients boarded by the hospital in families and at the close of the year 23 were in 
family care. The visits paid to this group of patients during the year was 110. 11 
boarding homes were investigated, 7 proved satisfactory and 2 were unsuitable. 226 
interviews were held for some definite purpose with patients on the ward. 

In April, 1922, in an effort to do some constructive work with the younger girls on 
the wards, a Camp Fire group was started with Mrs. Mary Howgate Caldicott as guar- 
dian and Miss Maude H. Rose, Occupational Therapist, as assistant. The National or- 
ganization authorized and chartered a group of 12 — giving the guardian the privilege 
of having a list of prospective members from whom they could draw when the mental 
condition of a regular member did not warrant her participation in the group activities. 
Due to the constant shifting it has been impossible to build up the correct esprit de 
corps but it is hoped that this lack will become less of an obstacle in time. For group 
activities, the greatest amount of time has been given to out of door work. During the 
winter group attention will be focussed on music and handicraft. It is our aim to make 
the organization a more valuable therapeutic agent for patients eligible for membership. 

Often through the efforts of the Social Workers there is a changed attitude of the 
community towards the hospital and a better understanding of hospital methods and 
purposes. By invitation, we have spoken at the meetings of three organizations explain- 
ing our work. The senior worker has given a series of four lectures in Social Work to the 
seniors in the Nurses Training School. 

In closing the report the department wishes to thank the outside agencies for their 
aid in supervising patients on visit and their help in various ways. We are also glad 
for the spirit of co-operation given us by other departments of the hospital and we are 
grateful to the physicians for their advice and interest in our work. 

Respectfully submitted, 

Jennie A. Harrington, 

Social Worker. 



Report of Laboratory Work during the Year 1922. 

During the year 1922 the Laboratory has co-operated in a more intensive study of 
the physical conditions of the individual patient rather than the study of any par- 
ticular disease process. This has included routine examination of all cases ad- 
mitted to the Hospital. The counting of red blood corpuscles and hemoglobin 
determination have, during the past nine months, been routine on all admissions, 
j During the earlier part of the year a large portion of the time was consumed in 
I the process of rehabilitation which has included the re-organization and increase 
I of the Laboratory staff and in the purchase of new equipment resulting in a sub- 
) stantial increase in the scope of the Laboratory work. 

j During the summer a Benedict metabolism apparatus was purchased by the Hos- 
I pital and this method of study is now available to the clinical staff. Trouble has 
been experienced in obtaining sufficient co-operation on the part of the patient to 
ensure correct determinations. 

, Bacteriological examination of the granulomata attached to the roots of extracted 
i teeth has been made in all suitable cases. In the majority of these no growth on 



10 



WORCESTER STATE HOSPITAL. 



[Dec. 



culture media has been obtained but saprophytic bacteria has been found. In cases 
shomng pathogenic bacteria vaccines have been made. 

Supphes are now at hand and preparatory work is in progress for a quantitative 
chemical determination of the more important constituents of the blood. This 
form of examination will be available for the use of the clinical staff in the near 
future. 

The Laboratory is also being equipped to do Wassermann examination of the 
blood for the detection of syphilis and other serological procedures. 

The staff of the Laboratory has also assisted in the clinical examination and 
treatment of cases. This work has included ear, nose, throat and ophthalmoscopic 
examination and the treatment of patients infected vnth sj^phiUs. 

The following report shows the number of Laboratory examinations made during 
the year 1922. 



Autopsies 

Blood counts, red 

Hemoglobin determinations 

Blood cultures 

Blood groupings 

Bacteriological cultures 

Bacteriological smears . 

Gastric analysis 

Determination of metabolic rate 

Renal functions (phenolphthalein) 

Sputums .... 

Spinal fluid examinations 

Lange colloidal gold examinations (sp. Fl.) 

Shick tests . 

Vaccines 

Urinalysis 

Widal . . . 

Microscopic sections 



48 

396 

396 

6 

8 

54 

75 

5 

68 

86 

43 

88 

76 

3 

15 

694 

2 

157 



Religious Services. 

Religious services have been held regularlj' each Sunday at both the main hos- 
pital and the Summer Street Department for our Catholic, Protestant and Jewish 
patients. Response to sick calls and the rites of their religion to the djdng have 
been faithfully made by members of the clergy. 

Requirements. 

The hospital refrigerator is not satisfactory, and because of the antiquated ice 
box method of storage there is a loss in food stuffs. This could be eliminated by an 
up-to-date refrigerating plant. I would caU attention to the advisability of a con- 
gregate dining room in which food could be served much more efficiently and in a 
more pleasing manner to the patients. 

The recent fire in the Manhattan State Hospital causes us to mention with em- 
phasis the necessity of altering our seven wooden staircases, which increase the 
danger greatly in the event of fire ; also the need of a sprinkler system both in the 
main building and at Summer Street and certain new fire escapes. 

A general store house to care for the large purchase receipts is quite necessary 
since the establishment of the new purchasing department and should be given 
careful consideration. Last year the hospital avenue was made very satisfactory 
by special preparation, but the hard winter mil necessitate further work on this 
roadway. 

Again more attention will have to be given the trees on the grounds which were 
injured so badlj'- in the ice storm of 192L 

On the Phillips Wards of the female side new plumbing is needed to replace the 
old and antiquated style now in use. New plumbing and reconstruction is needed 
at the Summer Street Department to properly prepare the hydrotherapy depart- 
ment for the proposed new function of this institution. New regulators to control 
the inflow of hot water in the hydrotherapeutic department is recommended. 



1922. 



PUBLIC DOCUMENT — No. 23. 



11 



Projects completed. 

Apart from the minor repairs, alterations and usual new constructions, the fol- 
lowing projects have been completed: 

The basement on the female side has been cemented, a new cement floor made 
in the garage. The store rooms have been rebuilt and a new system inaugurated. 
Many of the wards have been renovated and painted. Development of the land at 
the lake corner has begun and a new stone wall started. The main building has 
been partly rescreened. At the Summer Street Department much repairing and 
ward renovating has been carried out, also new plumbing and floor relaying has 
been done. 

Thanks are due to the following physicians for their aid in preparing the special 
parts of this report: Drs. Duval, Gaunt, AVhitcomb, Fossner, Root, Saucier and 
Weyler, and to Miss Harrington for the Social Service Report. 

I desire to express my gratitude to the Board of Trustees for the splendid co-op- 
eration and support given me during the year. They have at all times been ready 
and willing to render valuable advice and assistance and have given freely of their 
time and counsel. In addition I take this opportunitj^ of making public acknowledg- 
ment of the interest and excellent support given me by the officers and employees 
of the hospital. 

WILLIAM A. BRYAN, 

Superinte7ident. 
Nov. 30, 1922. 



VALUATION 

Nov. 30, 1922. 



Real Estate. 



Land (589 acres) 
Buildings 



$41 6,-357 00 
2,170,623 53 

82,586,980 53 



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. 



$8,472 09 
12,999 66 
32,924 58 
235,902 92 
21,864 55 
26,166 31 
25,910 60 
12,420 79 
16,107 67 

8392,769 17 



,586,980 53 
392,769 17 



,979,749 70 



12 



WORCESTER STATE HOSPITAL. 



[Dec. 



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 November 30, 1922: — 



Cash Account. 



Balance December 1, 1921 

Income. 
Board of inmates : 
Private 
Reimbursements, insane 



Receipts. 



$39,418 52 
46,075 97 



Personal services: 

Reimbursement from Board of Retirement . 
Sales : 

Travel, transportation and office expenses . 

Food ... 

Clothing and materials 

Furnishings and household supplies . . . 

Medical and general care 

Heat, light and power 

Farm: 

Cows and calves . . . . $110 00 

Hides 46 33 

Sundries 11 57 



,494 49 
183 29 



Garage, stable and grounds 
Repairs, ordinary 



$0 10 

163 68 

131 59 

187 74 

5 53 

86 00 



167 90 

60 96 

247 20 



Miscellaneous: 

Interest on bank balances 
Rent 



,201 54 
724 20 



1,050 70 



1,925 74 



Receipts from Treasury of Commonwealth. 

Maintenance appropriations: 

Balance of 1921 

Advance money (amount on hand November 30) 
Approved schedules of 1922 



Special appropriations : 
Balance of 1921 
Approved schedules of 1922 



$21,389 24 

96,000 00 

558,453 23 



$518 92 
5,739 89 



Total 



To treasury of Commonwealth: 

Institution income .... 

Maintenance appropriations: 

Ba,lance of schedules of previous year 
Approved schedules of 1922 . 
November advances 
Advanced on October schedule 



Payments. 



$42,421 96 

558,453 23 

18,502 26 

50,736 52 



$21,032 72 



Amount carried forward 



?,654 22 



675,842 47 



6,258 81 
$791,788 22 



$88,654 22 



670,113 97 
$758,768 19 



1922.1 



PUBLIC DOCUMENT — No. 23. 



13 



Amount brought forward 

Special appropriations: 

Balance of schedules of previous year 
Approved schedules of 1922 
November advances .... 
Advanced on October schedule 



Balance, November 30, 1922: 
In bank .... 
In office .... 



$518 92 

5,739 89 

3 98 

237 92 



126,302 86 
216 46 



Total 



$758,768 19 



6,500 71 



26,519 32 
$791,788 22 



Maintenance. 

Balance from previous year, brought forward 
Appropriation, current year 

Total 

Expenses (as analyzed below) 



Balance reverting to treasury of Commonwealth 



$226 36 
692,285 00 



2,511 36 
661,191 87 

$31,319 49 



Analysis of Expenses. 

Personal services 

Religious instruction . 

Travel, transportation and office expenses 

Food 

Clothing and materials . . . . ' . 

Furnishings and household supplies 

Medical and general care 

Heat, light and power 

Farm 

Garage, stable and grounds 

Repairs, ordinary 

Repairs and renewals 



Total expenses for maintenance 



$299,161 98 

1,825 00 

8,783 97 

129,423 04 

16,879 17 

36,457 21 

28,380 41 

61,712 40 

28,447 26 

7,694 82 

27,962 46 

14,464 15 

$661,191 87 



Special Approphiations. 



Balance December 1, 1921 . 
Appropriations for current year 



Total 

Expended during the year (see statement below) 
Reverting to treasury of Commonwealth 



Balance November 30, 1922, carried to next year 



5,982 94 
647 71 



$19,291 60 

$19,291 60 

6,630 65 
$12,660 95 



Object. 


Act or Resolve. 


Whole 
Amount. 


Expended 
during 
Fiscal 
Year. 


Total 

expended to 

Date. 


Balance 

at End of 

Year. 


Water supply .... 
Worcester department, heating 

system 1 . . . 
Alterations in heating shaft . 


Chap 95, Res. 1919 . 
Chap. 123, Res. 1917 . 

Chap. 203, Acts 1921 . 


$11,385 00 
3,758 72 

16,000 00 


$2,643 89 
3,339 05 


$11,207 64 
3,288 37 

3,339 05 


$177 36* 
470 35* 

12,660 95 




$31,143 72 


$5,982 94 


$17,835 06 


$13,308 66 



Balance reverting to treasury of the Commonwealth ...... $347 71 

Balance carried to next year 12,660 95 

Total as above $13,308 66 

1 Transferred from Grafton State Hospital Dec. 1, 1919. 



14 WORCESTER STATE HOSPITAL. [Dec. 



Resoubces and Liabilities. 
Resources. 

Cash on hand $26,519 32 

November cash vouchers (paid from advance money) : 

Account of maintenance . _ $18,502 26 

Account of special appropriations . . . . 241 90 

Account of October schedule 50,736 52 

69,480 68 

$96,000 00 

October schedule 4,736 52 

Due from treasury of Commonwealth from available appropriation account 

November, 1922, schedule 2,002 12 

Special appropriation 243 05 

$102,981 69 

Liabilities. 
Outstanding schedules of current year: 

Schedule of November bills $52,002 12 

Schedule of October bills 50,736 52 

$102,738 64 

Special appropriation: 

November $3 98 

October bills 239 07 

243 05 



$102,981 69 
Per Capita. 

During the year the average number of inmates has been 2,049.01. 

Total cost for maintenance, $661,191.87. 

Equal to a weekly per capita cost of $6.2055. 

Receipt from sales, $1,050.70. 

Equal to a weekly per capita of $0.0098. 

All other institution receipts, $87,603.52. 

Equal to a weekly per capita of $0.8221. 

Net weekly per capita $5.3736. 

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. 



1922. 



PUBLIC DOCUMENT — No. 23. 



15 



STATEMENT OF FUNDS. 



Balance on hand November 30, 1921 
Receipts .... 
Interest .... 

Refunded 

Interest paid to State treasiu-y 



Patients' Fund. 



Investment. 



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 December 1, 1922 



Balance on hand November 30, 1921 
Income ..... 

Expended for entertainments, etc. 



Lewis Fund. 



Investment. 



American Telephone and Telegraph Company collateral trust 
4 per cent bond ........ 

Fourth Liberty Loan bonds ...... 

Balance Worcester Bank and Trust Company 

Wheeler Fund. 
Balance on hand November 30, 1921 . 
Income .......... 

Expended for entertainments and magazines 

Invest7nent. 

American Telephone and Telegraph Company collateral trust 
4 per cent bond ........ 

Third Liberty Loan bonds ....... 

Fourth Liberty Loan bonds ...... 

Balance Worcester Bank and Trust Company 

Manson Fund. 
Balance on hand November 30, 1921 ..... 
Income .......... 

Expended for entertainments ...... 

Investment. 
Fourth Liberty Loan bonds ...... 

Balance Worcester Bank and Trust Company 



$11,264 57 

14,508 62 

373 01 

$16,588 57 
373 01 



$2,000 00 

2,000 00 

2,000 00 

2,000 00 

776 70 

407 92 



L,642 79 
65 54 



$926 36 

600 00 

37 57 



3,372 74 
265 35 



$712 50 

4,000 00 

1,300 00 

115 25 



L,278 69 
46 81 



$1,100 00 
27 50 



$26,146 20 



16,961 58 
$9,184 62 



$9,184 62 



$1,708 33 
144 40 

$1,563 93 



$1,563 93 



3,638 09 
510 34 

5,127 75 



5,127 75 



L,325 50 
198 00 

1,127 50 



1,127 50 



Respectfully submitted, 



Nov. 30, 1922. 



JESSIE M. D. HAMILTON, 

Treasurer. 



N. B. — The values assigned to the above securities are their respective purchase 
prices. 



16 



WORCESTER STATE HOSPITAL. 



[Dec. 



STATISTICAL TABLES. 

as adopted by american psychiatric association. 
Prescribed by Massachusetts Department of Mental Diseases. 



Table 1. — General Infonnation. 

1. Date of opening as an institution for the insane: Jan. 18, 1S33. 

2. Type of institution: State. 

3. Hospital plant: 

Value of hospital property: 

Real estate, including buUdings ..... 

Personal property ........ 

Total 

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. Entiployees 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 (excluding paroles) 



. S2,586,980 53 
392,769 17 

. $2,979,749 70 



Men. Women. Totals. 

1-1 

11 - 11 



1 


- 


1 


13 


- 


13 


Men. 


Women. 


Totals. 


1 

100 

98 


17 
82 
79 


18 

182 
177 


199 


178 


377 


Men. 


Women. 


Totals. 


577 
1,009 


631 
1,015 


1,208 
2,024 



Table 2. — Financial Statement. 
See treasurer's report for data requested under this table. 



PUBLIC DOCUMENT — No. 23. 



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WORCESTER STATE HOSPITAL. 



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1922. 



PUBLIC DOCUMENT — No. 23. 



19 



Table 4. — Nativity of First Admissions and of Parents of First Admissions. 



Nativity. 



United States 



Albania 

Armenia 

Austria 

Belgium 

Canada 

Denmark 

England 

Finland 

France 

Germany 

Greece 

Ireland 

Italy . 

Japan 

New Zealand 

Poland 

Roumania . 

Russia 

Scotland 

South America 

Spain . 

Sweden 

Switzerland 

Syria . 

Turkey in Asia 

West Indies 



Total foreign born 
Unascertained 



Grand totals 



Patients. 



124 

1 
6 



125 
1 



250 



219 

1 
6 
1 



217 
2 



438 



Parents of 

Male 

Patients. 



178 
30 



250 



171 
33 



250 



1 

59 
3 

15 
8 
1 
5 

10 
108 

20 



27 



349 
63 



Parents 
OF Female 
Patients. 



128 
17 



130 
15 



258 
32 



376 



Table 5. — Citizenship of First Admissions. 



Males. 



Females. 



Totals. 



Citizens by birth 
Citizens by naturalization 
Aliens . . . . 

Citizenship unascertained 

Totals . . . . 



124 
26 



20 



250 



188 



219 
44 

147 
28 



20 



WORCESTER STATE HOSPITAL. 



Dec. 



Table 6. — Psychoses of First Admissions. 



1. Traumatic, total .......... 

(o) Traumatic delirium ........ 

(6) Traumatic constitution ....... 

(c) Post traumatic mental enfeeblement (dementia) 

(d) Other types 

2. Senile, total 

{a) Simple deterioration ........ 

(6) Presbyophrenic type 

(c) Delirious and confused types ...... 

{d) 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 .... 

(a) Cerebral embolism 

(6) Paralysis agitans . . • . . ■ • _ • 
(c) Meningitis tubercular, or other forms (to be specified) 

id) Multiple sclerosis . 

ie) Tabes dorsalis 

(j) Acute chorea ......... 

ig) Other diseases 

9. Alcoholic, total . . _ 

(a) Pathological intoxication ....... 

(6) Delirium 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 .... 

(a) Opium (and derivatives) cocaine, bromides, chloral, etc., 

alone or combined (to be specified) .... 

(b) Metals, as lead, arsenic, etc. (to be specified) 

(c) Gases (to be specified) ....... 

(i) Other exogenous toxins (to be specified) .... 

11. With pellagra .......... 

12. With other somatic diseases, total 

(a) Delirium with infectious diseases ..... 
(6) Post-infectious psychoses . . . . . _ . 

(c) Exhaustion delirium ........ 

(d) Delirium of unknown origin ...... 

(e) Cardiorenal disease ........ 

(/) Diseases of the ductless glands ...... 

ig) Other diseases or conditions (to be specified ) 

13. Manic-depressive, total 

(a) Manic type, 

(6) Depressed type 

(c) Stuporous type ......... 

id) Mixed type . 

(e) Circular type ......... 

(j) Other types 

14. Involution melancholia ........ 

15. Dementia Prfficox, total ........ 

(a) Paranoid type ......... 

(b) Catatonic type ......... 

(c) Hebephrenic type ........ 

(d) Simple type 

(e) Other types 

16. Paranoia or paranoid conditions ....... 

17. Epileptic, total 

ia) Epileptic deterioration ........ 

(b) Epileptic clouded states 

(c) Other epileptic types (to be specified) .... 



32 
7 
4 



28 



45 



30 



1922.] 



PUBLIC DOCUMENT — No. 23. 



21 



Table 6. — Psychoses of First Admissions — Concluded. 



18. Psychoneurosis and neuroses, total 

(a) Hysterical type . 
(&) Psychasthenic type 

(c) Neurasthenic type 

(d) Anxiety neuroses 

(e) Other types .... 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed .... 

22. Without psychosis, total 

(a) Epilepsy .... 

(b) Alcoholism .... 

(c) Drug addiction . 

(d) Psychopathic personality . 

(e) Mental deficiency 

(/) Others 



Totals 



1 

20 

104 

12 



438 



22 



WORCESTER STATE HOSPITAL. 



[Dec. 





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Tt< 


5J 


•saiBjf 1 1 "^^ 1 " 1 N-'-*'-' 1 1 1 -1 1 'H 1 1 1 1 t-fo 


CO 
C<1 




:5 A "J 

"* o s 


■%Ye%oj^ 


lilTtiimiiioiill rtco 1 ' 1 1 1 -H>o 


t^ 


.;< 


•saiBTnajf 


I11C0I|]|I(MI1IIIC^I|1II lO-l 


2 




•sajBHj 


III^ICOIIIOOIIII rtrt 1 1 1 1 1 to-* 


■* 




to 


•sib:jox 


f-l [ I IC 1 »« 1 1 1 ^ ^H I 1 1 I i-H 1 1 rH^H 1 C<J-<^ 


T*i 




•sajBraajj 


lll>OIC<llllt-llll|rt|| rtrt 1 OOCO 


?s 


CO 

o 


•saj-Bjf 


rt||||c<oll|i;~<-i|iiiiiiiil^i-i 


I>- 


c/3 


o 

S 
P 

PS 


■siB^ox 


1 1 1 J 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 •-< 1 


- 




•saiBraaj[ 


1 1 J 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


1 


■saj'BH 


' 1 1 1 I J ' 1 1 1 1 1 1 1 I J 1 1 1 1 1 rH 1 


-' 




< 

O 


•siB^ox 


M TP riCirt rt rt CO OtJh 


00 




•sa['Bma^ 


'i'l |co<Mcq^|Tt<-*to|>o|l:~io.-i|— 1— ((MCioo 


OO 


1 


•sai^jf 


rtrtCOOOTf<CJIM>OI:^t^O.-lt~rtt~MCOrt,-lrt 1 OO^ 


o 


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c ^ 

-s c . :% . . .1 

11 itlliliiy 111 itiji 


o 



PUBLIC DOCUMENT — No. 23. 



23 



H 


X 
p 


B 
Z 

<; 

g 

o 


•SIB^OX 


1 1 1 1 1 1 1 1 1 M--I 1 -H 1 'H 1 1 1 1 1 1 TOT« 


22 


■sa|Bui9j; 


llllllllioq^-iiiiiiiiiiiic^ lo 


■saiT3i^[ 


1 1 I 1 1 1 1 1 1 1 1 1 -^ 1 -H 1 1 1 1 1 1 cocq t^ 


d 

P o 

5 


•sjtj:>0X 


, , coo.^-.o«-02--^-" ' ^ ' - ' -JJ22 


■* 


•saj-Buiaj 


1 1 |r-(C^.-H| |COt^^|i-l|.-l|^| 1 1— lO^ 


CO 


• sal's j^ 


1 IM— ic<l>ir2^rtcor-iiffl.-ieo^^lt:^|rtl I.-100 


•0 


--go 


•sib;ox 


1 1 |rt— iccrti— iiol |rt| 1 |,-1| 1 1 lOrt 


•sai-Boiaj[ 


, , ,^ ,0,^ ,^„ , 1^ , , , , , , , ,^ , ^ 


•saiBi\r 


llll'H^lllcMllllllrtllllco-H as 


WITH PSY- 
CHOPATHIC 

PER- 
SONALITY. 


•siB^ox 


1 1 1 1 1 1 1 1 1 ^ 1 1 1 I 1 1 1 1 1 1 1 1 1 1 <-( 


•saiBoiaj 


1 1 1 1 1 1 1 1 1 -H 1 1 1 1 1 1 1 1 1 1 1 1 1 r-l 


■sa[Bj\[ 


1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 


PSYCHO- 
NEUROSES 

AND 
NEUROSES. 


•si^ox 


1 1 1 1 1 1 1 1 1 -H 1 1 1 1 1 1 1 1 1 1 1 <N 1 


CO 


•saiBuiaj; 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .-H 1 


-^ 


•sajB]^ 


1 1 1 1 1 1 1 1 1 ^ 1 1 1 1 1 1 1 1 1 1 1 'H 1 


<N 


6 


■sii5;ox 


Illllllll-HIIIIIIIIIIINI CO 


■sai'8raaj[ 


1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 


•sai^I^ iiii -iiiiii <>ji M 


PARANOIA 
AND PARA- 
NOID CON- 
DITIONS. 


■stnoi 


lllTOlllllrHlllllllllllC^I 


•sajBtnajj 


lll-^lllll'-^lllllllllllll|e<l 


■saiBi\[ 


1II=^IIIIIIII1IIIIIII|(MI ^ 




•siB^ox 


^,^o,c.^^^o^,„,«c.oo^, , ,^>o ^ 


■sajBuia^ 


^1 icqioi 1 lt^-<|rtiM-H— 1| 1 1 I.-ICS1 


-* 


•saiBI\[ 


i lT-«co[c^t-(T-i^o-.,c^[c<]lcq(MI:^^Hl 1 Icoco 


s 


5 ^ 


•s|B^ox 


1 1 1 -^ 1 -^ 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 10 -^ 


00 


■saiBuiaj; 


1 1 1 --I 1 -1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 COrt CD 


■saYBfi 


1 I 1 1 1 1 I 1 1 i 1 1 1 1 1 1 1 1 1 1 1 <Nl 1 cq 


H 
Q 


■s^^ox 




•saiBuiajj 


1 1 IIMI'J'I 1 l<MI IMICOIOl 1 1 «t~CO 


■Sa[BJ\T 


lrtl|rt^|rtC<i^llll„llllll„l eq 


< 


















African (black) 

Albanian 

Armenian 

English . 

Finnish . 

French . 

German . 

Greek 

Hebrew . 

Irish 

Italian 

Japanese 

Lithuanian 

Portuguese 

Scandinavian 

Scotch . 

Slavonic . 

Spanish American 

Syrian 

Turkish . 

West Indian . 

Mixed 

Race unascertained 


"3 



24 



WORCESTER STATE HOSPITAL. 



[Dec. 









-^ 



< 




•sIB:^ox 




1 


1 ^M 1 1 \ n 


1 1 1 rJHMCO-H 1 


1 1 MTOrH 


cc 




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1 1 ,^^ 1 1 ,^ 1 , I^^O^ 1 1 I^O- 


s 


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1 1 1 co-H 1 1 1 crq 1 1 1 1 1 1 1 1 1 1 -Ht^ 1 


" 


t3 


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1 r liol 1 1 icol 1 loiNI 1 1 icqcql 


s 


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lllc^llllllllcoicjllll -Ht^ 1 


lO 


•sa|'Bj\[ 


1 1 ICOl 1 1 ICOl 1 IC^llOI 1 1 |rt.ol 


tM 


1ft 

s 


•S[■BC^ox 


1 1 1 •* 1 1 1 1 CO I 1 rH-# 1 O 1 1 1 1 COCqr-1 


g 


■sajBraa^ 


Illllllllll-H^IQOIIIIC^OII 


-^ 


•sapiM 


IIIt1<IIIIOIIII|C<IIII11CO-h 


o 


eg 


■SIB^JOX 


1 1 irt— 1| 1 icMi irtici>rac<iirt|oiort 


05 


• sal's nia^ 


111— l|||ll|||CO|Tjl||||(MCO^ 


2; 


•saiBpi 


1 1 1 ] — 1 1 I 1 M ] 1 rtCd 1 — l(M 1 rt 1 C<5(M 1 


>o 


i 


■s^ox 


'HI 1 1 1 1 1 1 1 1 1 lOI— l|rtC<lrflMC«3i-l 




•saiBuia^ 


1 1 1 1 1 1 1 1 1 1 1 1 lO 1 I>- 1 1 rt-irtMrt 


OO 


•saii3i\[ 


— 1| 1 1 1 1 1 1 1 1 1 |TJ<|-*|— Ir-lj— IrH.I 




O 


■sib;ox 


lllllillliil'H|oiiil-a<'*ito 


rtH 


•sajBuiaj 


IIIIIIIIIIIIII«III1(MC<1(M 




•sai'Bi\i; 


llllllllllll'-lltOllllC^lN^ 


ira 





•siB^ox 


1 1 I 1 1 I 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 


1 


•sa|Braaj 


1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 


1 


•saiBj\[ 


1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 


1 


►3 
< 
H 

O 


•BIB:>Oi 


^-tlor^O^I 1 l^'HlcOfMOO-^COOOfC— lO-^tM 


00 


•eaiBtaaj 


IOOCOtJH— l| 1 ICOl IrtOCOCOC^Ii-Hrf— [CniO 


oo 


•saiBj^ 


Mr~-a<cOTOi 1 ir-.— l|(^q(^^c^l— i-a<c<3oqicnoi- 


s 


to 

H 
O 

Ph 


1 




With cerebral arteriosclerosis 

General paralysis 

With cerebral syphilis 

With Huntington's chorea 

With brain tumor 

With other brain or nervous diseases 

Alrohnlin 


Due to drugs or other exogenous toxins .... 

With pellagra 

With other somatic diseases 

Manic-depressive 

Involution melancholia 

Dementia pra;cox ......... 

Paranoia or paranoid condition 

Enilentir. 


Psychoneuroses and neuroses 

With psychopathic personality 

With mental deficiency 

Undiagnosed 

Without psychosis 


c 
ir 




-- 


c 


CO ■<*< iO O t^ 00 CT 


0*--(MeO'rf<iOCDI^00050^'M 


11 



1922. 



« 


e 

« 
O 


PUBLIC 

•SIT3^0X 


DOCUMENT — No. 23. 

lOOCOIIIIIlllllllllllICOI 




•sa|T3raaj; 


locjlllllllllllllllllllcq 


•saiBjM 


loo— iiiiiillilililllllMi cq 


oo 


•siB^ox 


I031r~— illlll— Hllllllllllll 


2 


•sa[Buiaj 


1 <cc<i 1 1 1 1 1 1 1 1 i 1 1 1 1 1 1 1 1 1 1 


=» 


•sa['Bj\[; 


Imio— iiiiiirtiiiiiiiilllio 


s 

^ 


•smox 


1 »o<;Or-H I 1 1 1 ^ 1 1 1 1 1 i ^ 1 1 1 1 .rj* ^ Ci 


•saj-Biua^ 


l^c , , , 1 ,- 1 1 , 1 , , , , , , 1 , , 


lO 


■sa|T;i\[ 


ITO^'-HIIIIIIIIIII'HIIII^'-^ ^ 


o 

1 
to 


■siBiox 


IC3COIIII1I1IIII1I1III1MI t~ 


•sap3aiaj[ 


loD-HliiiIliilllllillllI a 


"saiBi^ 


1 T^iO I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 <M 1 00 


to 


■sjujox 


lOTOMI 1 1 ICQI 1 1 |(MCqIrt| 1 lOI 0» 


■sajBuiaj 


IC^'J'llllllllll-illllllll 


t^ 


■saiT3i\r 


It-HOCOI 1 1 IC<11 1 1 l-HC^I— 11 1 |0| (Nl 


o 

CD 


•siB^ox 


IrtcoTtf^l 1 loql 1 |(rqrtrt|,-ii i-hct>| 


g 


•saiBraaj 


II— illlllllllCSIrt— i||||rt(~q| oo 


■saji3j\[ 


1— ic^Tjflrti 1 INI 1 1 1 1 1 |-H| 1 ic^i oo 




■SJB^OX 


1 1 — 1<M 1 1 1 1 <M 1 1 1 ^ 1 TUrt 1 1 1 1 Cd 1 CD 

-I N 


•sa^Braaj 


ll-H|||||||||^|(-5|||||^| _H 


•saiBj\i; 


lllc~)llllcq||iiic^rt|iiiooi lo 


o 
1 


•S[T3;ox 


1 1 ^>0 1 1 1 1 M 1 1 — lOOM^— 1 1 1 1 -HC35— 1 t^ 


•sai^uiajj 


1 1 1 1 1 1 1 1 ^^ 1 1 1 O C^ 1 ^H 1 1 1 1 TlH 1 CO 


■saiBi^[ 


1 l^iOl 1 1 IC^I f— icO^"^l 1 1 1— ^lO— 1 ^ 


O 

s 

p-t 


Traumatic 

Senile 

General paralysis 

With Huntington's chorea 

With brain tumor 

With other brain or nervous diseases 

Alcoholic 


Due to drugs or other exogenous toxins .... 

With pellagra 

With other somatic diseases 

Involution melancholia ....... 

Dementia prascox .... 

Paranoia or paranoid condition 

Psychoneuroses and neuroses 

With psychopathic personahty 

With mental deficiency 

Without psychosis 


o 




— KMCO^iOCOt^OOOa 


0-<(MTO1<>OCDt^00050-HCQ 


II 



25 



26 



WORCESTER STATE HOSPITAL. 



[Dec. 









'^ 



I 

CO 



-I 

6q 



I 

H 
►J 

pq 
<! 







•s^^ox 


I'SicoiOl 1 1 l-dH| 1 II:^I>J3I I 1 l—icol 


^ 




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icq^l 1 1 1 |t-i| 1 i"OI<MI 1 1 i^col 


XO 




•sai-Bjt 


IcslcMOl 1 1 icol 1 l<rq|col 1 1 1 lol 


t^ 




H 

w 

o 
O 


■si^^ox 


1 1 1 1 1 1 1 1 1 1 1 1 cq 1 1 1 1 1 1 1 -1 1 


CO 




■sajBuiaj 


1 1 1 1 1 1 1 1 1 1 1 1 ^ 1 I 1 1 1 1 1 1 1 


-' 




•sajBi^ 


1 1 1 1 1 1 1 1 1 1 1 1 ^ 1 1 1 1 1 1 1 ^ 1 


(M 




O o 

Kg 
m 


■s^ox 


IO(>jT-HiMi 1 1 1 1 1 iTOrtco^l 1 1 icicq 


3 




■saiBraaj 


1 ^^ 1 1 1 1 1 1 1 1 1 -HrHl^~ 1 1 1 1 1 lO'l 


s 




•saii3j\[; 


I(Mt-it-ic<iI 1 1 1 1 1 |(rci|co.-(| 1 1 ll^.-i 


cq 




So 
S o 

s a 


•SfB^OX 


-HCaoOOrtI 1 |t:~^IOJ!0 00-*IM(Sl'-l-^;^CO CO 




•sajBuiajj 


icqoocdl 1 1 1 1 1 |rf05-*ort|rt.-(iooo-*( 


s 




•saj'BX\[ 


^r^OOO^I 1 IW^lrtl^IMrtCOWr-llCOmTtf 


cq 




Cl 


•S[B^0X 


IOOOMtHI I lOOl |rt| 1— lr-l|i-l|xJ<C~rt 


CD 




•sai^uiaj 


|COCOCqr-H| 1 l-ll 1 1 1 l^^l 1 ICsiml 


■0 




•sai-BiM 


|(Mtr~.-i| 1 1 It^l Irtl It^l |i-l|C<IC<lr-( 


TIH 




H 
< 


•siB^tox 


loo^rti I 1 IU3I 1 |th^o|,-i| i^r-1-1 


10 




•sa^Buiaj 


1 -* 1 1 1 1 1 1 -< 1 1 1 Tf-Hrt 1 1 1 1 cooo 1 1 c^ 




. -saiBj^ 


1 Tt<-a<'H llll^lllll'l<l'-l|l rfOi-H 


« 




<• 
O 


•siB^ox 


T-ltOt^O^ 1 1 1 ^** ^ 1 CO Cd 00 ^ ?0 CC OO ^-t O rtH (M 


% 




•sajBraa^ 


I oocO'H'-i 1 1 1 CO 1 1 r-iooco<rq 1 ^^^03113 


1 




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t-(t^^coccl 1 i'-HrHic<i(Mci— *T}Hco(rq|as»f2t^ 

T-H (M (M CS) ^ iO CO 


<M 






p2 


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 and paranoid condition .... 

Epileptic 

Psychoneuroses and neuroses 

With mental deficiency 

Undiagnosed 

Not insane 


"cS 





»-HC<IC0'^>^Ot^0005O'-<(MC0Tt^»OOt^C0O5^'^C<l 
1 r-* ^ ^ ^ T-H ^ ^ r-< ^ rH Cq C^ Cq 





1922. 



PUBLIC DOCUMENT — No. 23. 



27 



ft^ 






a 
P 


•S[T?10X 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 


1 


■sa^Bxua^ 


1 I 1 1 r 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


1 


•sai^H 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


1 


K 


•SITJ^OX 


|t^OT-l| 1 1 1 1 1 1 |c<l(Mt^| 1 1 1 |M(M 


o 


•saiBraai[ 


1 Tt(C<l 1 1 t 1 1 1 1 1 1 C<1!M^ ] 1 1 1 1 M-H 


s 


•sal's j\[ 


IM'S'rtllllllllllCOIIIlIMM 


Tt^ 


< 

K 


•siBCfox 




o 


•sajBmaj; 


C^ 1— 1 C^ CO 1— f CO 


g 


•saiBj^ 


-H^oioco 1 1 1 r^--^ 1 CT <N M oo T»fl CO cq 1 cncoto 


o 


►3 

< 
H 
O 


•siB'^ox 


"2£:S'^ ' ' ' S!'^ 1 CO CJ OO 21 «S CO CO -H o ■* C<1 
■'J'COCO CsJ -^CS C^O"— t 


'^ 


•saiBoia^ 


looco-*i-ii 1 icoi ji-HOtococqirtr-i-Hcnio 


i 


•sajBi^ 


1-H CM cq C^J T— ( *o to 


s 




to 
w 

05 

o 

H 
Ph 


Traumatic 

Senile 

With cerebral arteriosclerosis 

General paralj'sis 

With Huntington's chorea 

With brain tumor 

With other brain or nervous diseases 

Alcohohc 

Due to drugs and other exogenous toxins 

With other somatic diseases 

Manic-depressive 

Involution melancholia 

Dementia pra;cox 

Paranoia or paranoid condition 

Epileptic 

Psychoncuroses and neuroses 

With mental deficiency 

Undiagnosed 

With psychosis 


s 

o 


i-(ccicOTj<ioeot>-ooo5 0^HcqcoTt<u5cot^ooCTio^-'C<J 

.-1MT-Irtrtrt-Hrti-H-I(MC<1C-J 



28 



WORCESTER STATE HOSPITAL. 



[Dec. 



a. 



c^ 



S 



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Bq 







IIIIIIIlT-tlll^-lllllIIICOI 


in 





•sib;ox 






H 








g 














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h 




1 1 I 1 [ 1 1 1 i 1 1 [ ^ 1 1 1 1 1 1 1 C<1 1 




s 


•sajBraa^ 


















2; 




1 1 1 1 1 1 1 ] 1— ( 1 1 1 1 I 1 1 ( 1 1 1 1— t 1 


CM 


P 


• sal's j\r 










|T)<mo5-^i 1 l^^l I icqcoiocdrt^i-HO-* 


CO 




•3l^3^0J^ 




o 














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El 




l-^05ccl 1 1 I 1 1 I ir^^C5^i»^i loocc 




« 

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lO 














o 








O 




1 i-^co»-t| 1 1-<3^I 1 liOi-H^o^^i ;t-ioo»-i 


o 


•sai^K 










\ ccia>t~c<> \ 1 iooT-i|(M»oioo5-*icqc^|r-.oto 


o 




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CM 


1-3 
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ICO-^^^^I I l<MI I IO-^i-<^I 1 IOOOt-h 


o 


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o 


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IMO'^— 1| 1 lOrtlcqifflrtOOCOMcqlt-CMiO 






■sajBjAj 


rt rt T-C T-( CO >0 


t^ 






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CM 




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W 














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^^>i3-*^| 1 1 1 1 1 |<M|t^| 1 1 IrtTtlrt 


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TH10t~0-* 1 1 1 •^'1 1 TOtMOO^OmcOrt O-KIM 


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c 
















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cr 


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ri '! "i ■ ■ ■« 11 ■ ■ ■ 

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T-^C<icC'<J<»COt^00 01O^CqC0"^iO«5t^C00iO'-*C<i 






M rt .-< rH rt rt rH rt — 1 ,-H CM CM (M 





1922.1 



PUBLIC DOCUMENT — No. 23. 



29 



tt. 



Os 



f^ 



S 



•s[b:»ox 



•sajBraaj 



•saiBi\r 



lcqr)<-*cq| I I I I I IO-H-*! IrtlM^rt 



l<Mll^lllllilMIIIII| rtTtl-^ 



l^T»<rt| 1 I I I I IcOi-H^I IrHlrtWI CO 



•siuiox 



•saiBuiaj 



•saiBjt 



-H— ic-jtXI I I l;*l I |T-<|00rt,-il I |(M| 



It-iIt-cII IICOIIIi-(|CO||||1,jh 



-H I (Meo I I I I -; I I I 1 I <Mrf^ I I I 00 I 



•SIBJOX 



■sajBtnaj 



•saiTJi^ 



( lOOlOM I I I 1 rt I 



I OilOlM I I I I I I I I lOTOCD I I I I >r3(MC 



SSS"' ' ' I"-! ''-*"' l=<MC<lrH|COTt<^ 



•S[B^OX 



•sai-Bmaj; 



•S8IBJ\[ 



i>;c^cq I I I I I I I eci lo ■<*< to TO I 

i-H ^ C^ CO 



I COOO— I I I I I I 



H -H CO WC<I I T-H r 



I'-i-*'^! I I I I I I'-i-^rtiOT-HI I liococ 



■STBIOT "^iSElS"*! ' l'*'-llWMOO^COCOCOrtO-*<N 

I T jj Tf< CO CO C^ -* OS (M CD ^H 



•saf-Buiaj 



•S3IBI\[ 



I 00_CO •*'H| I ICOl li-IOCOCOC^IlT-lrH-HCniO 
C-l •-< CO -^ ^^ CO 






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a a, =3 2 «™-fi o g 



C 'm 0) CJ <?3 

siai!^ 



=3:acS 



oJS J Spa =3-2 «?J3j3^j3 H 



30 



WORCESTER STATE HOSPITAL. 



[Dec. 



Oh 





Is 

<l 


■S113;0X 


1 <M 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 cq 1 


^ 






•sa^Buia^ 


1 <M 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 CSI 






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1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 IM 1 


c. 






Q 

u 
K 
O 
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1 1 "-"-1 1 1 1 1 1 1 1 1 1 -^-^ 1^1 1 1 rH 1 


CO 






■saiBraaj[ 


1 1 1 I 1 1 1 1 1 1 1 1 1 ^^ 1 J 1 1 1 1 1 


(M 






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1 1 -1^ 1 1 1 1 1 1 1 1 1 1 1 1 -H 1 1 1 rt 1 


^ 






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% 

H 


•g[T3;ox 


lll'-Hrt|||rt|l|||-(llll||| 


•<*4 






•sa^Braa^ 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 ^ 1 1 1 1 1 1 1 


-^ 






•SajB]^ 


J 1 1 rtrt 1 1 1 ^ 1 1 1 1 1 1 1 1 1 1 1 1 1 CO 






P 
H 

O 

Q 


•SJB^OX 


IroiO^rtl 1 l^rtl liXICOl 1 1 1 ICOl 


t^ 






•sajBrnajf 


1 CDI:~.-I lll|T-l|||Tl<|COIIIl|tO| 


oo 

CO 






■sajBj\[ 


IWQOCO— il 1 IMrtl 1 1 1 1 1 I 1 1 lol 


CO 






S 
S 

B 


■sib;>ox 


100=01 1 1 lol IC50>0-*rf|rt-H-*051 C<1 






•saiBuia^ 


1 coined 1 1 1 1 -H 1 1 Mi~-iOTO 1 1 rtrt^^ 1 








•satBi\[ 


|t-Tt<^l 1 1 lol I^COl-H^I 1 1 liOl 


lO 








•si^^ox 


<-OC<lQ0(M 1 1 1 OJ 1 1 rt 00 M lO lO N IM 1 to !D IM 


53 






■saiBraaj; 


It^rtrtrtl 1 |r-<| 1 lOaliOffdl 1 |1>01U5 


s 






•safBj^ 


rtco«t~.-i 1 1 1 oo 1 1 rt CO oq o CO (M cq 1 rot^t- 








Eh 
O 
H 


•siB^ox 


■-Hiot^OTti 1 1 1 Ti<rt 1 CO irq QO Tfi to CO CO rt o ^ Cd 

•^COCO Cq T}4 Oi cq o ^ 


CO 






•saiBuia^j 


1 OOCO-*^ 1 1 I CO 1 1 rtOCOCOCO 1 -H,-H-<c»»o 
Cq T— ( CO -^ T-H CO 


00 






■sa|'Bi\[ 


T-H^-*tOCOl 1 |r-l,-llNMC<l— iTtlCOCqlCTllOt- 
1— 1 (M c^ C^ 1-^ i^ CO 


g 






H 

O 
« 




'S 

1 


















Traumatic 

Senile 

General paralysis .... 

With cerebral syphihs 

With Huntington's chorea 

With brain tumor .... 

With other brain or nervous diseases 

Alcohohc 

Due to drugs and other exogenous toxins 

With pellagra 

With other somatic diseases 
Manic-depressive .... 
Involution melancholia 
Dementia prtecox .... 
Paranoia and paranoid conditions 

Epileptic 

Psychoneuroses and neuroses 
With psychopathic personality 
With mental deficiency 

Undiagnosed 

Without psychosis .... 






-HC^CO->*l>«t01:^OOC»0— icqco^intOt^QOroOrtlM 





1922. 



PUBLIC DOCUMENT — No. 23. 



31 



Table 14. — Psychoses of Readmissions. 



Psychoses. 



1. Traumatic, total ......... 

(a) Traumatic delirium ....... 

(6) Traumatic constitution 

(c) Post-traumatic mental enfeeblement (dementia) 

id) Other types 

2. Senile, total . 

(a) Simple deterioration ....... 

(6) Presbyophrenic type ....... 

(c) Delirious and confused types 

(d) 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 

(o) Cerebral embolism ....... 

(6) Paralysis agitans 

(c) Meningitis tubercular or other forms (to be specified) 
(<f) Multiple sclerosis ........ 

(e) Tabes dorsalis 

(/) Acute chorea ........ 

ig) Other diseases 

9. Alcoholic, total . 

(a) Pathological intoxication ...... 

(6) Delirium tremens 



(c) Korsakow's psychosis 

id) Acute hallucinosis ....... 

(e) Chronic hallucinosis ....... 

if) Acute paranoid type 

ig) Chronic paranoid type ...... 

ih) 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 specified) .... 
(6) Metals, as lead, arsenic, etc. (to be specified) 

ic) Gases (to be specified) 

id) Other exogenous toxins ...... 

11. With pellagra ......... 

12. With other somatic diseases, total ..... 

(a) Delirium with infectious diseases .... 

(6) Post-infectious psychoses ...... 

ic) Exhaustion delirium ....... 

id) Delirium of unknown origin ..... 

(e) Cardiorenal disease 

(/) Diseases of the ductless glands ..... 
ig) Other diseases or conditions (to be specified) 

13. Manic-depressive, total ....... 

(a) Manic type ......... 

(6) Depressed type 

ic) Stuporous type ........ 

id) Mixed type 

ie) Circular type ........ 

(/) Other types 

14. Involution melancholia ....... 

15. Dementia precox, total 

(a) Paranoid type ......... 

(6) Catatonic type ......... 

(c) Hebephrenic type ........ 

id) Simple type 

ie) Other types 

16. Paranoia or paranoid condition 

17. Epileptic, total 

(a) Epileptic deterioration ....... 

(6) Epileptic clouded states ....... 

(c) Other epileptic types (to be specified) . . . , 



31 



32 



WORCESTER STATE HOSPITAL. 



[Dec. 



Table 14. — Psychoses of Readmissions — Concluded. 



Psychoses. 



18. Psychoneuroses and neuroses, total 

(a) Hysterical type . 
(6) Psychasthenic type 

(c) Neurasthenic type 

(d) Anxiety neuroses . 

(e) Other types .... 

19. With psychopathic personality . 

20. With mental deficiency 

21. Undiagnosed .... 

22. Without psychosis, total 

(o) Epilepsy .... 

(6) Alcoholism .... 

(c) Drug addiction . 

id) Psychopathic personality . 

(e) Mental deficiency 

(/) Others 



Totals 



57 



PUBLIC DOCUMENT — No. 23. 



33 



1^ 



< 

m 

2; 


•SIB^OX 


1 1 1 1 1 1 1 1 1 1 1 1 J 1 1 1 1 1 1 1 1 o 


o 


•saiBaiaj[ 


1 1 1 J 1 1 1 1 1 1 1 J 1 J 1 1 1 1 1 1 1 » 


CO 


•sa['Bi\[ 


1 1 1 1 1 1 J 1 I 1 1 1 1 1 J 1 1 1 1 1 1 l:^ 


t^ 


o 
> 



« 
g 

t:3 


•SJB^OX 


1 1 rt— 1 |«| \ <^ \ 1 iroi— •! 1 1 -a<TOto 1 


g 


■sajBuia^ 


l|.^lllll-H|||lOI-H||| Mr^M 1 


s 


"sai'Bj\[ 


1 1 |-H|-^l I-HI 1 iTtfllOl 1 1 -HtM» I 


CO 
CO 


> 

K 


■spjox 




o 

uO 


■sai^ma^ 


1— I (M 


g 


■eaiBH 


1 lt^-*-H| 1 ILOl 1 loOrtCOMrtlCC-^OI 


s 


6. 

H 
K 

> 

O 


•siBiox 


Illlllllt^-HICOTJI— ,||11|1(M| 


s 


•sajBuiaj 


1 1 1 1 1 1 1 1 rt 1 1 l-Ht^ 1 1 1 1 1 1 1 1 1 


o 


•sajB]^ 


1 1 1 1 J 1 t 1 tOrt 1 T^t^-H 1 1 1 1 1 1 e<i 1 


oo 




•sib;ox 


—I T}< — .O Cq -^ 


>o 


•saiBuiaj^ 


ic<jc^c^i^^l I-<J<1 ic<iiJ5csci-Hrt^-<j*(Mu^ro 


o 


•saiBj^- 


1 ii^>ra— 1— 11 1^— ii«oi>jroc^rt]-*Miqi^ 


5 




s 

» 




"3 








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 

Not insane 


^^CSOO-^W^COt^OOOiO^-HMCO-^iO^Dt^OOOSO^Cl 



34 



WORCESTER STATE HOSPITAL. 



[Dec. 



to 
S) 

o 

K 
o 

to 


S o »J 

W M M 


•siB^ox 


1 1 1 1 III 1 1 1 1 1 1 1 1 I -< 1 1 1 1 1 1 1 1 


•sajBraa^ 


1 1 1 1 III 1 1 I 1 1 1 1 1 1 'H 1 1 1 1 1 1 1 1 


•saiBH 


1 1 1 1 III 1 1 1 1 I 1 1 1 I 1 1 1 1 1 1 1 1 1 


6 

o 
ta 
o 

5 


•siT3:jox 


I I 1 1 111 -Hill me> ll-Hl-Hl llllrHI 


•saiBuiaj; 


1 1 1 1 III -Hill -H 1 1 1 1 1 1 1 1 1 1 1 1 1 


■sai^M 


1 1 1 1 III 1 1 1 1 C^O ll—ll-Hl llll—ll 


WITH OTHER 

BRAIN 
OR NERVOUS 

DISEASES. 


•SIB^Oi 


1 1 1 1 III 1 1 1 -^ 1 1 1 1 1 1 1 1 1 I 1 1 I 1 


•saiBraaj[ 


1 1 1 1 III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


•saj'Bj^ 


1 1 1 1 III 1 1 1 -H I 1 1 1 1 I 1 1 1 1 1 1 1 1 


^2 


■si'B^ox 


1 1 1 1 III 1 1 :^ 1 1 1 1 1 1 1 1 1 1 1 1 1 t 1 


■sajBraajj 


1 1 1 1 III 1 1 <M 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


■saiBM 


1 1 1 1 III 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


J 2 

m J 


•si'b:jox 


1 1 1 1 III ' S ' ' 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


•saiBuiajj 


1111 III I <o 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


•saiBj^ 


1 1 1 1 III 1 CO 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


§2i 

PQ « O 
H W « 
K B S 
H K J 


■si^^ox 


1 -H-H 1 III -* 1 1 1 -HOrH 1 <M I 1 1 !M 1 1 1 1 1 


•sajBuiaj; 


1 1 1 1 III ■* 1 1 1 1 •*-< 1 -H 1 1 1 (M 1 1 1 1 1 


•sapH 


1 — Irt 1 111 1 1 1 1 -HCO" 1 -H 1 1 1 1 1 1 1 1 1 


B 

5 

19 


•SJTJ^OX 


-Hill 1 rt 1 e^ 1 1 1 rtr- 1 1 1 CO 1 1 lo-H^cq i i 


•saiBina^ 


— 1 1 1 1 -H 1 rt I 1 1 rtM 1 1 1 -* 1 1 m-Hrt 1 1 1 


•saiBj^ 


llll III «lll IWIlllMII IIIIMII 




■S[B^OX 


IM-H(M(M 1-1 CS) T-H .^JHCNCqi-H 00 00 »0 -H OO C2 -H -H -H lO -H Cfl O CO 


•saiBuia^j 


Cq 1 tH^ .-I(M-h OCOIM 1 U5 00 Cd -H oo t^ 1 -< -H Ttl -H 1 -*CO 


•sai^Bj^i 


I.-I-HT-I III -^ !S I T-l COOCOI"3cOrt| l—lllMtOI 
Cd T— ( -^ 




X 
E- 

Q 

b 
O 

•< 

o 




General Diseases. 

Facial erysipelas 

Gangrene of foot 

Pernicious anaemia .... 
Inguinal hernia . . . . . ■ 
Exhaustion due to Manic-depressive 

psychosis 

Carcinoma of intestines 
Carcinoma of head of pancreas . 

Diseases of the Nervoiis System. 
Cerebral hemorrhage . . 
General paralysis of the insane . 
Cerebral spinal syphilis 

Diseases of the Circulatory System. 
Cardio-vascular renal disease 

Arteriosclerosis 

Cerebro arteriosclerosis 
Chronic endocarditis .... 
Acute myocarditis .... 
Chronic myocarditis .... 
Fatty degeneration of the heart . 
Aortic regurgitation .... 

Diseases of the Respiratory System. 
Broncho-pneumonia .... 
Lobar pneumonia .... 
Pulmonary gangrene .... 
Chronic bronchitis .... 
Pulmonary tuberculosis 
Acute miliary tuberculosis . 



1922.1 



PUBLIC DOCUMENT — No. 23. 



35 



1 1 1 1 1 1 1 1 1 1 111 


-^ 


1 1 1 1 1 1 1 1 1 1 III 


■" 


1 1 1 1 1 1 1 1 1 1 III 1 


1 1 1 1 1 1 1 '-< 1 1 III 


2 


Jill I 1 1 1 1 1 1 1 1 C<l 


1 1 1 1 1 11-^11 II';:; 


1 1 1 1 1 1 1 1 1 1 1 1 1 -H 


1 1 1 1 1 1 1 1 1 1 III 1 


1 1 1 I 1 1 1 1 1 1 III 


-' 




1 1 1 1 1 '-I 1 1 1 1 III 


CO 


1 1 1 1 1 .1111 . 1 1 1 c. 


1,11 1 - 1 1 1 1 1 1 , i« 

1 




1 1 1 1 1 1 I 1 1 1 III 


CO 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 IS 


1 1 1 1 1 1 1 1 1 1 1 1 1 o 




oo 


1 -Hrt 1 1 1 1 1 1 I III 


^ 


11^1 1 1 1 1 1 1 III 




IIC<1I !M l'-l|ll III 


in 


IIMI <M I-Hlll III 


S 


1 1 1 1 I 1 1 1 1 1 III 


o 


rtrtlOrt to rtrtrtrt—l rtC<i-H 


o 


I «Tt( 1 kO 1 —1 1 1 1 1 (M 1 


CO 


^ 1 „^ ^ „ 1 rt«^ ^ 1 ^ 


- 

2 


Diseases of the Digestive System. 

Acute enteritis 

Gastro enteritis 

Diarrhoea and enteritis 

Dysentery 

Diseases of the Genito-urinary System. 
Chronic intestinal nephritis 

Multiple burns of nearly entire body . 
Fracture of cervical vertebrae 
Intra capsular fracture of r. femur 
Fracture of 1. hip and clavicle 

Cardiac failure 

Self inflicted injury of upper respira- 
tory tract 

Suicide by hanging .... 
Suicide by drowning .... 





36 



WORCESTER STATE HOSPITAL. 



[Dec. 



m 
H 
to 

o 

K 
o 
>< 
m 

PL, 




•SfB^OX 


1 1 1 1 III 1 1 1 1 1 1 1 1 1 '^ 1 1 1 1 1 1 1 1 


•safBuiaj 


1 1 1 1 III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


•sajBi^i 


1 1 1 1 III 1 1 I 1 1 1 1 1 1 '-I 1 1 1 1 1 1 1 1 


IS 
S 


•SIB^OX 


IIII III —'III —ITtlllrtMIl llllll 


•sa[BU3aj 


1 1 1 1 III IIII I 1 1 1 1 1 1 1 llllll 


•sa(Bi\[ 


IIII III -H 1 1 1 «■* 1 1 ^IM II 1 1 t t 1 1 


H ■ 

m 

1* z " 
1- 


■s^ox 


IIII III —IIII <-< 1 1 1 1 I I 1 llllll 


•saiBraaj; 


IIII III rt 1 1 I I 1 I 1 1 1 I 1 llllll 


•sajBH 


IIII III IIII ^ 1 1 1 I 1 1 1 llllll 


p, 

H 


•SJB^OX 


IIII III IIII 1 1 1 1 1 1 1 1 llllll 


•S3[Braaji 


IIII III IIII I 1 1 1 I I 1 1 llllll 


•saiBi\[ 


IIII III IIII 1 1 1 1 1 I I 1 llllll 


PARANOIA 

OR 
PARANOID 
CONDITION. 


"si-B^ox 


IIII l-HI -Hill ^IIIIIII llllll 


•saiBOTaj[ 


IIII i—ii —IIII — iiiiiiii llllll 


•saiBj\[ 


IIII III IIII IIIIIIII llllll 




•sitJ^ox 


1 I — 1 rt 1 1 '^ CO 1 1 1 t>-tM— 1 1 c:j 1 1 1 cq c^ I I t-cq 


•saiBuiajf 


II— 1— 1 II-H —IIII -xc^i-Hiiiii oqoqiico<M 


•sai'Bi\[ 


IIII III (Mill COIIIircilll llll-^l 


o < 

E^ i 5 

> z 


■smox 


IIII III IIII -IIII "^ II 1 'H 1 1 1 1 


•sajBuiaj; 


IIII III IIII -Hill -l-< II 1 -H I I 1 1 


•sajBj^ 


IIII III IIII IIIIIIII llllll 


, > 

H 


■s^ox 


-,||-,,.H|1 -IIII .^.II ^-.c^ 1 -1 CC-H 1 1 0.-H 


•sajBuiaj 




•saii3j\[ 


III— 1 III IIII Mllll— III 1— III— 11 




Q 

03 




General Diseases. 

Facial erysipelas 

Gangrene of foot 

Pernicious antemia .... 

Inguinal hernia 

Exhaustion due to Manic-depressive 

psychosis 

Carcinoma of intestines 
Carcinoma of head of pancreas . 

Diseases of the Nervous System,. 
Cerebral hemorrhage .... 
General paralysis of the insane . 
Cerebral spinal syphilis 

Diseases of the Circulatory System. 
Cardio-vascular renal disease 

Arteriosclerosis 

Cerebro arteriosclerosis 
Chronic endocarditis .... 
Acute myocarditis .... 
Chronic myocarditis .... 
Fatty degeneration of the heart . 
Aortic regurgitation .... 

Diseases of the Respiratory System. 
Broncho-pneumonia .... 
Lobar pneumonia .... 
Pulmonary gangrene .... 
Chronic bronchitis .... 
Pulmonary tuberculosis 
Acute miliary tuberculosis . 



PUBLIC DOCUMENT — No. 23. 



37 



1 1 1 I 1 1 1 I 1 J 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 1 1 1 1 —1 


II-- - 1 1 , -H 1 1 - ■ 


•^ 


ll—l — lllll 1—1 CO 


1 1 1 — 1 1 1 1 — 1 III 


- 


— 1 1 1 1 lllll 1 1 1 eo 


1 1 1 1 1 lllll III 


-' 


— 1 1 1 1 lllll III 


N 


1 1 1 1 — lllll II — 


c 


1 1 1 1 — lllll III 


'- 


1 1 1 1 1 lllll II — 


-^ 


1 1 1 1 — lllll III 


■* 


1 1 1 1 — lllll 1 1 1 1 ■* 


1 1 1 I 1 lllll III I 


CO 


1 1 1 1 1 lllll 1 — 1 


OO 


llll — llll— — lllt^ 


1 1 1 1 1 lllll 1 1 1 1 TX 


llll 1 lllll 1 1 1 Tt< 


llll 1 lllll lllll 


llll 1 lllll III 


^ 


llll 1 lllll III 


;=; 


llll 1 lllll III 


o 


Diseases of the Digestive System. 

Acute enteritis 

Gastro enteritis ..... 

Diarrhoea and enteritis 

Dysentery 

Diseases of the Genito-urinary System. 
Chronic intestinal nephritis 

Multiple burns of nearly entire body . 
Fracture of cervical vertebrae 
Intra capsular fracture of r. femur 
Fracture of 1. hip and clavicle 

Cardiac failure 

Self inflicted injury of upper respira- 
tory tract 

Suicide by hanging .... 
Suicide by drowning .... 


1 



WORCESTER STATE HOSPITAL. 



[Dec. 



!S 



Q 



CO 
< 


1 


■S[T3^0X 


1 1 rtO 1 1 1 1 -H 1 1 1 rtrHN 1 ^ 1 1 1 1 1 


2 


•saiBuiaj 


1 1 ^N 1 1 1 1 1 1 1 1 -Hrtrt 1 -H 1 1 1 1 1 


t^ 


■saiBj^ 


lll-^llll^lllll-Hlllllll 


to 


to ' 


•SIBIfOX 


1 1 1 t- 1 1 1 1 1 1 1 1 1 1 -< 1 1 1 1 1 1 1 


oo 


■sajBuia^j 


1 1 1 C^ I 1 1 1 1 1 1 1 1 1 'H 1 1 1 1 1 1 1 


CO 


•saiBK 


1 1 1 to 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


o 




■gi^^OT ilie<iJiiiill-^-H|-^iiiiiii 


00 


■sajBuiaj[ 


1 1 1 1 1 1 1 1 1 1 1 -H-1 1 <r^ 1 1 1 1 1 1 1 


■* 


■sapi\[ 


1 1 1 CO 1 1 1 1 ! 1 1 1 1 1 C^ 1 1 1 1 1 1 1 


T)fl 


g 


•SIBiOi 


llllMllllllllllM^I^Hllll) 


o 


•saiBmaj; 


1 1 1 ^ 1 1 1 1 1 1 1 1 1 1 C<l 1 1 1 1 1 1 1 


CO 


•saiBj^ 


1 1 1 1 1 1 1 1 CO 1 -1 1 1 1 1 1 


CO 




•siB^ox 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 J 


1 


•sajBraaj 


1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


1 


•saiBM 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


, 


O 


•sitj^ox 


1 1 1 1 1 1 1 1 1 1 1 1 J 1 CO 1 1 1 1 1 1 1 


« 


•sajBuiaj; 


II 1 1 1 1 1 1 1 1 1 1 


1 


• sax's i\i 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 CO 1 1 1 1 1 1 1 


« 


H 
Q 

P 


■si^^ox 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


1 


•saiBuia^ 


1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 


1 


•saiBi\[ 


' ' ' 1,1,1,111 


1 


< 


■sib:jox 


,cooococo, 1— (TO, |.-ir~-*>OTfico, Ico^Urt 


s 


■saiBraaj[ 


1 c^-*tocq 1 1 1 CO 1 1 rt-HT)<oo-*rt 1 1 rtco 1 


C5 


•sai^i^^ 


'g^S-^ ' "^;: ' ' '=° 1^ ■- 1 !«-- 


s 


i 
§ 

a 


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 conditions 

Epileptic 

Psychoneuroses and neuroses 

With mental deficiency 

Undiagnosed 

Without psychosis 


"3 


rtC<lCC-^iOCOI>.OOOiO^COCO-*»OCOt^OOOSO^C^ 





PUBLIC DOCUMENT — No. 23. 



39 



< 


K 

> 
O 




■siB^ox 


IC^ICOIIIIIIIIINI-*— 'IIIICOI 


^ 


•sa^Buiaj 


1 CO 1 1 1 1 1 1 1 1 1 1 c^ 1 <^J-H 1 1 1 1 1 1 


oo 


•sai3i\[ 


1 OJOT 1 1 1 1 1 1 1 1 1 1 1 <M 1 1 1 I 1 m 1 


t-- 


o 
oo 


•siB^tox 


IO00O.-II 1 1 1^1 1 I05I— itMl 1 1 1 1 1 


?! 


•saj'sraa^ 


IrHlOl 1 1 1 li-Hl 1 1— llrtC^I 1 1 1 1 1 


■^ 


•saxBi\r 


|1<«1— lllllllll-Hlllllllll 


o 




•slB:^ox 


l«— ■! 1 1 1 lojl 1 icqi^i 1 1 irtM.-. 


n 


• sal's uiaj[ 


loo 1 1 , 1 , 1 ( , , 1 l« , , , ,- , , 


•^ 




•sai'si\[ 


ICOOl 1 1 1 ICMI 1 |(MI— .1 1 1 1 |M« 


?5 


g 

s 


■siB^ox 


loausl 1 1 1 IIMI 1 liOIOJI 1 i IrtCOl 


S 


•saiBuiajj 


l«" 1 ' ' ' 1 ' ' 1 '^ '- - 1 


Tt* 


■Sa{T3J\[ 


I— tiOl 1 1 1 IIMI 1 |rt|-H| 1 1 |rt(M| 


2 


to 


•si^^ox 


l--itOC<ll 1 1 ICOl 1 lC<l.-ic^rt| 1 IrtCOl 


S 


• sal's uiaj; 


l-Hl^l 1 1 1 1 1 1 |rt-!-Hrt| 1 1 IrtI 


t^ 


•sai'BiM 


1 1 CD-H IIIICTIII-HI-HIIII ^C<, 1 


O 




■siB^ox 


l-HOT^— 1| l^rtl 1 |_l|TtH| 1 1 1 1 1 1 


CO 


•saiBuiajj 


1 ^M 1 -1 ] 1 1 1 1 1 1 1 1 rt 1 1 1 1 1 1 1 




■saiBjM 


1 1 _i^ l||_rt|||rtio7||||||| 


- 




•SJB^OX 


' '---- , , ,^ , , , ,^„ , , 


2 


• sal's uiaj 


1 1 -1 1 --l 1 1 1 1 1 1 1 1 '-"^ 




•sai'Bi\[ 


llllOllllr-Hlllllrtlllllll 


r^ 


o 


•siB^ox 


1 1 l'*'r-i| 1 IMI 1 I.-I— i<MI 1 1 1 icqi 


2 


•sal's uiaj[ 


1 1 1 -H , 1 , ^^^ 1,11,^, 


■o 


•saii3i\[ 


lll-^-HllI—llllllT-llllllrtl 


h 




f 


33 

A 

m 



a 




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 other somatic diseases 

Manic-depressive 

Involution melancholia 

Paranoia or paranoid conditions 

Epileptic 

Psychoneuroses and neuroses ...... 

With mental deficiency 

Undiagnosed 

Without psychosis 


1 

o 


'HMCOTHinOt-OOCnO— i'MTO')>lOtOIr^OOOO'-i(rg 





40 



WORCESTER STATE HOSPITAL. 



[Dec. 






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1. Traumatic 

2. Senile 

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7. With brain tumor 

8. With other brain or nervous diseases 

10. Due to drugs and other exogenous toxins 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive 

14. Involution melancholia 

16. Paranoia or paranoid condition .... 

17. Epileptic 

18. Psychoneuroses and neuroses 

20. With mental deficiency 

21. Undiagnosed 

22. Without psychosis 


"3 



PUBLIC DOCUMENT — No. 23. 



41 





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Psychoses. 


Traumatic 

Senile 

General paralysis 

With Huntington's chorea 

With brain tumor 

With other brain or nervous diseases 

Alcohohc 

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 

Without psychosis 


1 




— icacc-*iraot^ooo30^c<ieo-^tC!Ot^oooso^H(M 





42 



WORCESTER STATE HOSPITAL. 



[Dec. 1922. 



Table 19. — Family-care Department. 



Males. 



Females. 



Totals. 



Remaining Sept. 30, 1921 . 

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 



23 


23 


13 


13 


5 


5 


5 


5 


41 


41 


26 


26 


22 


22 


19.55 


19.55 


10.88 


10.88 


4.74 


4.74 


4.93 


4.93 



Publication of this Document 

approved by the 

Commission on Administration and Finance.