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

3 6 A- 2~M3 



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Public Document _£> No. 23 

Cfje CcmmonoiealtJ) of 6§a00acf)tigett0 



faL. 



ANNUAL REPORT 



THE TRUSTEES 



Worcester State Hospital 



Year ending November 30, 1923 



Department of Mental Diseases 




I Publication of this Document approved by the Commission on Administration and Finance 

i 

C ■■'-.',' 

I 700 3-31-25 Order 1398 s ,"" ' • ,'•■ " '■'" 



OFFICERS OF THE WORCESTER STATE HOSPITAL. 

BOARD OF TRUSTEES. 

Luther C. Greenleaf, Boston. 

Caroline M. Caswell, Secretary, Northborough. 

Anna C. Tatman, Worcester. 

William J. Delahanty, M.D., Worcester. 

Edward F. Fletcher, Chairman, Worcester. 

Howard D. Cowee, Worcester. 

John G. Perman, D.M.D., Worcester. 

MEDICAL STAFF. 

William A. Bryan, M.D., Superintendent. 
Ransom H. Sartwell, M.D., Asst. Superintendent. 

, Director, Clinical Psychiatry. 

Michael J. O'Meara, M.D., Senior Assistant Physician. 

Leon E. Duval, M.D., Senior Assistant Physician. 

George A. Gaunt, M.D., Senior Assistant Physician. 

Clarence A. Whitcomb, M.D., Senior Assistant Physician. {Pathologist). 

Mervin Fossner, M.D., Assistant Physician. 

Manley B. Root, M.D., Assistant Physician. 

John Saucier, M.D., Assistant Physician. 

Henry P. Weyler, M.D., Assistant Physician. 

John P. Powers, M.D., Assistant Physician. 

Paul DeCary, M.D., Assistant Physician. 

Donald B. Cheetham, M.D., Assistant Physician. 

, Assistant Physician. 

Carl A. Oberg, D.M.D., Dentist. 

VISITING STAFF. 

Ernest L. Hunt, M.D. 

John F. Curran, M.D. 

C. J. Bryne, M.D. \ Surgeons. 

William H. Rose, M.D. 

Benjamin H. Alton, M.D. I 

M. M. Jordan, M.D. \ AT , . , 

Benjamin T. Burley, M.D., J Neurologists. 

William F. Holzer, M.D. 

Paul G. Haire, M.D. / 

Frank E. Stowell, M.D., Electro-Therapist. 

John W. O'Meara, M.D., Orthopedist. 

Phillip H. Cook, M.D., Roentgenologist. 

HEADS OF DEPARTMENTS. 

Florence M. Wooldridge, R.N., Superintendent of Nurses and Principal 

of Training School. 
Maurice Scannell, Supervisor, Male Department. 
Jessie M. D. Hamilton, Treasurer. 
Herbert W. Smith, Steward. 
Lillian G. Carr, Matron. 
Joseph Reynolds, Head Farmer. 
James Dickison, Jr., Chief Engineer. 
Anton Swenson, Foreman Mechanic. 
Maude Rose, Head Occupational Therapist. 



> Ophthalmologists. 



^M3 



Cfjc Commontoealtf) of ^as$acftu0ett0 



TRUSTEES' REPORT. 

To His Excellency, the Governor, and the Honorable Council: 

The Trustees of the Worcester State Hospital respectfully submit the ninety- 
first report of the Hospital, with a record of the various departments as given 
by the Superintendent, Dr. William A. Bryan, and a report of the Treasurer, 
Miss Jessie M. D. Hamilton. 

During the year Mrs. Anna C. Tatman of Worcester was appointed as Trustee. 

The Superintendent's comprehensive monthly reports show careful considera- 
tion of the health of the patients, physical as well as mental. Much has been 
done to improve conditions by examination or by treatment, medical or 
surgical. 

A re-organization of medical work for more efficient service to the patient 
has been made. Especially active work has been done by the hydrotherapeutie 
department. Stress has been placed upon the importance of constant employ- 
ment or pleasant, continuous occupation for destructive and disturbed patients; 
also upon the value for all of occupational therapy, gymnastics, the industrial 
department work and that of the group, thought being given as to the result to 
be obtained in the life of the individual employed. 

A training school for occupational teachers, small but enthusiastic, has been 
organized. The out-patient department, hospital, nutrition and habit forming 
clinics have been successful and form an acknowledged bond between the hos- 
pital and social agencies and the general public. The real value of social 
service cannot be overestimated. 

The three years of Dr. Bryan's service at the hospital have been most success- 
ful and he has the confidence of the Trustees as well as their active cooperation 
whenever possible. The budget principle is sound and that of cooperative 
buying, but the Trustees concur in the opinion of many who have given careful 
thought to the matter that, while economy in all State affairs is most desir- 
able, it is to be deplored that the law, intended to be of great value to the 
State, has been cosntrued and acted upon in such a manner that it has worked 
out detrimentally, at least to that part of the State's interests coming under 
the observation of the Trustees. 

The present standards of ivork in Massachusetts cannot be maintained by such 
rigid economy. The care of the patients and the best interests of our institu- 
tion in every way demand that the policies of the institution be formulated 
by those who understand the work, who have been trained in such work and 
knoAv its needs. Cooperation should be the watchword in every advance step 
and special attention should be paid to the building up of the morale of the 
service. This cannot be done on a too limited, biased plan. Men of initiative 
and vision in any direction will not give of their best if there is to be no 
avenue for the Avorking out of those visions, if financial stringency hinders the 
I consummation of ideals and warps initiative. The possibility of being able to 
i carry out constructive plans is necessary to stimulate and give incentive. The 
| best plans, resulting in the best work of not only the Head but of the workers 
l in all departments, can often only be made where expense is necessarily in- 
1 volved. 



4 P.D. 23. 

The trustees also again respectfully call attention to the imperative need of 
consideration of the fire hazard at the Worcester State Hospital. For many- 
years the subject has been reiterated. There is still the same need of added 
fire protection, fire escapes, fireproof stairways and a sprinkler system. 

The Trustees are firm in their belief that the serious break threatened in the 
accomplishment of the best results in the work of the Worcester State Hospital, 
will be averted by quick and decisive action on the part of those in authority. 

Respectfully submitted, 

EDWARD F. FLETCHER. HOWARD W. COWEE. 

WILLIAM J. DELAHANTY. ANNA C. TATMAN. 

JOHN G. PERMAN. CAROLINE M. CASWELL. 
LUTHER C. GREENLEAF. 



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 November 30, 1923, it being the ninety-first annual report. 

There remained on the hospital books, October 1, 1922, 2,447 patients, 1,270 
men and 1,177 women. During the year ending September 30, 1922, there were 
admitted 506 patients — 274 men and 232 Avomen. Six hundred and three 
patients — 311 men and 292 women — were discharged from this hospital. Of 
this number 368 patients — 191 men and 177 women — were discharged ; 213 
patients — 110 men and 103 women, died ; and 16 patients — 9 men and 7 
women — were transferred, leaving at the end of the statistical year 2,579 
patients — ■ 1,372 men and 1,207 women. Two thousand one hundred and thirty 
patients — 1,081 men and 1,049 women — were actually in the hospital. Of this 
number 1943 were supported by the State, 84 by friends and 103 
as reimbursing patients. Of the patients discharged, 45 were reported as 
recovered, 198 as improved and 80 as not improved. Forty-five patients — 25 
men and 20 women — were discharged as not insane. Three men were trans- 
ferred by the Department of Mental Diseases to the State Infirmary, 2 men to 
the Danvers State Hospital, 2 men to the Bi'idgewater State Hospital, 1 man 
to McLean Hospital, 1 man to the Monson State Hospital, 1 woman to Herbert 
Hall Hospital, 2 Avonien to the Medfield State Hospital, 1 AA'oman to the Boston 
State Hospital, 1 Avoman to Glenside Hospital, 1 Avoman to the Gardner State 
Hospital and 1 woman to the School for Feeble-Minded. TAventy-two men and 
13 AA^omen Avere removed from the State, and 17 men and 9 Avomen were deported. 

There remained in the hospital at the end of the year 114 more patients than 
at the beginning. The smallest number under treatment on any day Avas 2,017 
patients and the largest 2,163. The daily aA^erage Avas 2,075.51. 

The percentage of recovei'ies, calculated upon the number of discharges and 
deaths, was 7.46; calculated upon the number of admissions 6.12. The death 
rate Avas 6.69, calculated on the AA T hole number of patients under treatment; and 
10.26 calculated on the daily average number. 

Ex-Service Men. 

During the year, there Ave re 35 ex-service men committed to the hospital, 
24 returned from trial visit, 13 returned from escape, 22 went out on a trial 
visit, 19 left the hospital Avithout permission; 5 died and 11 Avere discharged, 
leaving at the end of the year 66 ex-service men in the institution. 

To all who have contributed gifts and entertainments for the ex-service men, 
I hereby extend my hearty thanks. 



P.D. 23. 5 

Staff Changes. 

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

Resignations. 

Louis Pare, M.D., resigned June 11, 1923. 
Lloyd E. Byrd, D.M.D., resigned June 6, 1923. 

Appointments. 

Dr. Ransom H. Sartwell, was appointed Assistant Superintendent September 
1, 1923. 

Dr. Paul DeCary was appointed Assistant Physician September 10, 1923. 

Dr. Carl A. Oberg was appointed Resident Dentist June 16, 1923. 

Dr. Donald B. Cheetham was appointed Assistant Physician October 16, 1923. 

Student Internes. 
The following served as Internes during the past summer : — 



Benjamin H. Rutledge, Jr 
Charles R. Wilson 
C. Kenneth Cook 
Richard C. Travis 
Elmer Wakefield 
Thomas H. Miller 
Frank R. Smith, Jr 



John Hopkins University. 
University of Michigan. 
University of Michigan. 
University of Michigan. 
University of Michigan. 
University of Michigan. 
John Hopkins University. 



Report of Medical Work. 

A complete re-organization of the medical staff along radically different 
lines has been attempted during the year and while the change has not been in 
effect sufficiently long to be able to say accurately as to whether it is a more 
efficient way of handling the medical work, we do believe that it has already 
resulted in better treatment for our patients. The medical Avork has been 
divided into two distinct divisions — Psychiatric and Medical. Under the old 
plan of organization there were two services in the hospital — male and female — 
each presided over by a senior assistant physician with two assistants. These 
officers were responsible for the entire examination of the patient, both physi- 
cally and mentally. Under the new organization plan a third service has been 
inaugurated, the function of which is the study of the purely physical. This 
service is headed by a senior physician with two assistants and all of the 
physical examinations, both in new cases and patients already in the hospital, 
are carried out by this service. When a patient is admitted to the hospital 
a preliminary physical examination is made by the staff member who receives 
him. On the third day a member of the medical service makes a complete 
physical examination and is responsible for all laboratory procedures and 
other work connected with the study of the physical aspect of the patient. 
After this work is completed the Psychiatric service then makes the psychiatric 
diagnosis, taking into consideration the physical findings. In this way we have 
been able to find many physical conditions which we have been able to remedy. 
While many of these have no bearing upon the psychosis, it seems obvious 
that the first consideration in any mental disease should be to remedy any 
existing physical abnormality. 

The report of the Medical Service will indicate the amount of work done 
on patients entering the hospital. The following medical report is submitted 
by the senior in charge of the medical service, Dr. Henry Weyler : — 

X-Ray Department (No. of Patients). 

Arm, 8; Bladder, 1; Chest, 89; Hand, 35; Leg, 11; Precordia, 1; Skull, 80; 
Toe, 1; Gastro-Intestinal, 16; Elbow, 10; Knee, 11; Ankle, 27; Wrist, 10; 
Fluorascopea, 15; Foot, 18; Hip, 24; Nose, 9; Vertibrae, 1; Ribs, 11; Head, 8; 
Finger, 5; Spine, 11; Jaw, 11; Femur, 1; Arm, 2; Sinuses, 1; Shoulders, 13; 
Tibia, 1; Colon, 5; Mandible, 1; Heart, 1; Thymus, 1. 



6 P.D. 23. 

Surgical Cases. 

Major Operations, 28; Minor Operations, 22. 

Eye Clinics. 
Patients Examined, 76; Examined and Glasses Fitted, 66. 

Neurological Clinic. 
Cases Examined, 23. 

Treatments. 
Arsphenamine, 621; Swift-Ellis, 184. 

Laboratory Report. 

The laboratory work for the year 1923 has largely been of the usual routine 
material. The statistical report gives a fair idea of the amount of work done. 
From the beginning of the year to October 15th, the pathologist, Dr. Clarence 
Whiteomb, had charge also of the syphillis clinic and of the routine examina- 
tions of eyes, nose and throat. The reports of his activities in these other 
lines are, therefore, included in this report, although they are not strictly 
laboratory work. From October 15th to the end of the year Dr. Root has been 
pathologist. He has also had charge of the Out-Patient clinic, not included in 
this report. 

The personnel of the laboratory has consisted of, during the greater part 
of the year, the Pathologist and two assistants. We were fortunate in having 
as one of the assistants a trained chemist who did practically all of the spinal 
fluid examinations and all of the blood chemistry. 

The following is a report of the laboratory work : — 

Autopsies, 53 ; Bacterial Cultures, 33 ; Bacterial Smears, 101 ; Blood Counts, 
61; Blood Counts — Red, 421; Blood Counts — White, 78; Blood Cultures, 9; 
Blood-Haemoglobin Determination, 320; Blood-Count Differential, 39; Blood- 
Urea Nitrogen, 8; Blood Total Nitrogen, 9; Blood Sugar, 9; Blood Creatin, 7; 
Blood Creatinin, 7; Blood Ulric Acid, 6; Animal Inoculations, 2; Gastric 
Analysis, 4; Sputum, 236; Lumbar Punctures, 84; Cistern Punctures, 20; 
Withdrawal of blood for Wassermann Examinations, 280; Withdrawal of blood 
for Spinal Fluid Examination, 267; Renal Function (Phenolphthalein), 53; 
Lamge Colloidal Gold Reaction, 412; Spinal Fluid Cell Count and Protein 
Determination, 501 ; Salvarsan Injections, 573 ; Mercury Injections, 59 ; Swift- 
Ellis Treatment, 184; Ophthalmoscopic Examination, 266; Ear, Nose and 
Throat Examinations, 238; Ear, Nose and Throat Treatments, 123; Urine 
Analysis, 1,491; Feces, 15; Vaccines, 3; Microscopic Sections-Preparation, 833; 
Microscopic Sections Examinations, 20; Lectures, 10; Widal, 17; Spinal Drain- 
age, 5; Saliva Drainage, 1; Blood Chemistry, 79; Erychrocyte Counts, 16; 
Differential Leucocyte Counts, 17; Leucocyte Counts, 21; Blood Bleeding Time, 
1 ; Blood Coagulation Time, 1 ; Blood Fragility Test, 1 ; Scabies Examination, 5 ; 
Albumin and Globulin, 41; Liver Functions, 1; Determination of Metabolic 
rate, 10 ; Throat Culture, 5 ; Vaginal Smears, 2. 

I wish to take this opportunity of expressing my thanks to the members of 
the profession who have rendered such valuable assistance during the year by 
serving on our visiting staff. They have been at all times cooperative and 
have worked assiduously for the best interest of the patient and the hospital. 
I feel very definitely that the organization of any mental hospital depends upon 
the appointment of a large and active visiting staff and it is our purpose and 
plan to add to this visiting staff as rapidly as possible. Our patients have 
received the benefit of a high degree of medical skill and I am sure that it will 
assist us in eventually Avorking out the problem of mental diseases. 

We have continued our study of special conditions during the year. At the 
present time we are using the fluoroscope on the chest as a routine measure in; 
newly admitted cases. It is our custom to take a procedure of this kind andl 
use it as a routine until Ave have accumulated the records of a hundred or two 
hundred cases. We then decide whether a sufficient amount of good has been 
done and information obtained to justify continuing it as a regular thing. 



P.D. 23. 7 

The following report is submitted by our resident dentist, Carl A. Oberg : — 
Number of Patients Examined, 3,511 ; Cleanings, 2,821 ; Fillings, 1,245 ; Plates, 

34; Treatments, 154; Teeth Extracted, 1,245; Repaired Plates, 24; Impacted 

Teeth, 13. 

Training School Report. 

The following report of the training school activities is submitted by Miss 
Florence M. Wooldridge, R.N., Supt. of Nurses : — 

Class Avork for eight seniors and fifteen juniors was carried on with much 
difficulty on account of a shortage of nurse and attendant help. 

Graduation took place on June 29th when eight were presented diplomas, 
seven of this number stayed with us for six months and four are with us still, 
having received promotions. The opening of a diet kitchen under the direction 
of the training school has given our nurses a splendid opportunity. The value 
of the experience in our operating room, X-ray, electrotherapy, hydrotherapy 
and occupational departments, as well as clinics, cannot be overestimated. 

The Alumnae Association has been active, meeting at the hospital every 
three months, having at each meeting a speaker on some of the newer and 
important matters concerning nursing and nurses. The Association has pledged 
a prize of $10.00, called the Linda Richard's prize, to the member of each 
graduating class who writes the best paper on any phase of psychiatric nursing. 
Also a prize of $10.00 to the member of each graduating class who makes the 
highest marks. 

The classes of thirty hours practical instruction for women and men attend- 
ants have been carried on by the training school staff, entailing much work 
with very few staying long enough to finish the course or render better service 
for having taken it. However, we have a more promising class of women 
attendants at the present time. 

It is highly desirous that more intensive instruction be given the probationers. 
This would call for a larger teaching staff. The Worcester branch of the Guild 
of St. Barnabas organized in October, 1922, has been a source of much pleasure 
to our nurses, fifteen of Avhom are members. The training school entertained 
the Guild at the hospital. The school has been represented at all State and 
County meetings. 

I appreciate the willing cooperation on the part of each member of the 
medical staff and heads of departments, who have helped to make the school a 
success. 

Hydrotherapy Report. 

Our Hydrotherapy Department continues to be one of the most important 
departments in the hospital. We have constantly assigned to this department 
a hydrotherapist and eight nurses on the female side and a hydrotherapist and 
two assistants on the male side. We have made some change during the year 
in our pack room in the female wards and have added five continuous bath tubs. 
We now have in operation thirteen continuous tubs, four on the male side and 
nine on the female side. These tubs are in operation 24 hours a day and the 
pack room is used the same. The following report will indicate the amount of 
Avork carried on during the year: — 

Men Women 

Foot Baths as Prep. Treatment 

Foot Baths 

Salt Glows 

Saline Baths 

Electric Light Cabinet Baths 

Fomentations 

Tub Shampoos 

Sitz Baths 

Fan douche 

Needle Spray . 

Hot and Cold to Spine 

Table Shampoos 

Hair Shampoos 



3,101 


1,912 


533 


706 


514 


1,569 


88 


1,050 


451 


938 


- 


945 


407 


839 


- 


614 


2,264 


10,000 


2,388 


9,993 


342 


942 


102 


70 


460 


1,213 





P.D. 23. 


Men 


Women 


60 


393 


- 


342 


- 


726 


20 


323 


- 


4 


- 


5 


- 


3 


- 


8 


- 


4 


250 


827 


276 


984 



Wet Mitt Friction . 

Scotch douche .... 

Rain douche .... 

Jet douche 

Hot Blanket Pack for Class Work 

Wet Drip Sheet 

Throat Compresses . 

Neptune Girdle 

Affusions 

Continuous Baths 

Wet Packs 

The Occupational Therapy Department has developed considerably in many 
ways. Over three hundred patients are enrolled in classes. Some new Avard 
classes have been started and old ones which were more or less intermittent 
have been stabilized by better organization. This has been made possible partly 
by the training school pupils being utilized as assistants to supervise patient 
teachers and pai'tly by hiring more attendants to help with the classes. We 
now have six classes taught by patients under the supervision of a paid worker. 
One patient teacher was added to the pay roll and is doing good work. 

A ward working class for the younger men, largely ex-service men, whose 
psychosis is of the acute type, was formed in May. A definite course of 
instruction was worked out and the class has been very successful. 

The need for more trained workers in a hospital of this size has been heavily 
felt. Partly to meet this need and partly because it seems that occupational 
therapists in mental hospitals should be trained to Avork Avith mental cases, 
a school for training occupational therapists Avas started September 17th. 
The course is comprehensive and broad enough to give the pupils a general 
training Avhich Avill make them useful members of the occupational department 
in a general hospital as Avell as in mental hospitals, should they prefer that after 
graduation. The course occupies a full year, and includes lectures by the medical 
staff, the occupational therapist and the superintendent of nurses. Three pupils 
are enrolled and are making a good record. 

There are four classes Avith employees as teachers on the female service and 
two on the male service. 

The middle of October a class Avas formed composed of the most destructive 
of patients on the female wards. These patients Avere given occupation from 
7 A.M. and 5 p.m. each day, excepting Sunday, until January 12th. A light 
lunch Avas seiwed at ten o'clock and at three each day. During this time the 
amount of destruction AA r as decreased about three-fourths. The total destruction 
of dresses alone during August and September amounted to about three hundred 
and fifty dollars. In December after the class had been in operation about 
six or eight AA^eeks the destruction of dresses amounted to seventy-eight dollars. 

The class Avas discontinued January 12th partly as a test and because there 
Avere not teachers enough to relieve for the long hours. In January the destruc- 
tion of dresses amounted to one hundred and forty-four dollars. This seems 
to prove rather conclusively that occupational therapy has an economic value 
Avhich should appeal Avhere its therapeutic \ r alue is imrecognized. 

With the department groAving at its present rate, better accommodations in 
the way of Avork rooms is a necessity. The class rooms are over-croAvded and 
the equipment for storing and caring for supplies is very inadequate. The 
patients should have a large sunny, airy room in Avhich to AA r ork, made attractive 
by the use of plants, pictures and comfortable furniture. The equipment for 
storing supplies should be such that they can be kept free from dust and in the 
case of the reed much Avaste could be avoided by the proper kind of racks for 
storage. Since occupation is considered one of the most important therapeutic 
measures used in the cure of mental diseases, could funds be used more 
profitably than in procuring modern equipment and an adequate staff of 
trained Avorkers to carry on the Avork of this department? 



P.D. 23. 9 

Psychological Report. 

The following report is submitted by our Psychologist, Dr. Grace Kent : — 
The most obvious and generally recognized function of a psychological de- 
partment in a State Hospital is the application of mental measurement tests to 
selected patients referred to us by the physicians, especially cases suspected of 
mental deficiency, court cases, and various cases in which there is special need 
of making the mental examination as thorough as possible. It is not necessary 
that all incoming patients should be tested, nor would this be possible with our 
present working force. But the psychological test is a routine procedure in the 
Out-Patient clinics and the juvenile and adolescent subjects who are brought 
to these clinics for examination are tested with the utmost care and thoroughness. 

Unfortunately, Ave have no adequate means of mental measurement for insane 
or defective subjects. The Binet scale is fairly satisfactory for testing normal 
children and because of its successful use in schools it has come to occupy an 
important place in public confidence. But when used in the clinic it does not 
yield any such consistent results as are generally attributed to it, and we are 
in great need of a system of mental measurement better adapted to clinical 
requirements. This hospital, including its Out-Patient department, offers ex- 
ceptional opportunities for trying out new methods and the development of a 
system of tests for use in psychological clinics is probably the most valuable 
contribution our department can make to clinical psychology. 

This project is well under way, and it is this opportunity for constructive 
work that makes the position an attractive one. Although it is a research 
proposition that will require several years for its completion, it has already 
been in use for about six months. The system is being built up gradually and 
every new unit that is added to it makes our method of testing more trust- 
worthy and more nearly valid. Two preliminary studies of the plan have been 
presented, one published in the Journal of Applied Psychology and the other 
read at the annual meeting of the American Psychological Association. We 
have received excellent cooperation from various psychologists engaged in the 
development of educational tests, and with their aid we have borrowed several 
thousand records of tests that were made upon school children. The forms we 
have constructed from these records have made three new tests available for 
our use. 

More than half the apparatus used in our laboratory has been made by us. 
Psychological equipment is very high priced because of the limited demand for 
it, and for this reason it has seemed best to make our apparatus as far as 
possible. A set of tools was added to our equipment early in the year, and 
we have not asked for anything that could be made here. Our present perma- 
nent equipment for testing consists of fifteen pieces valued at $121.00 and 
nineteen standard pieces made by ourselves. These home-made puzzles would 
have no considerable value if placed on sale, but they have a replacement value 
of $152.00. 

The work of the department is rich with educational possibilities, and it is 
to be hoped that we shall be able in the future, as this year, to find young 
women who will consider it worth while to spend a few months assisting with 
the routine training which they can receive here. 

In addition to formal psychological work, we have undertaken to make in- 
tensive personality studies of selected patients who are in need of individual 
attention beyond what their physicians can give them. Women patients fre- 
quently feel the need of a close personal friend in whom they can confide 
freely. We make a practice of holding as confidential any information not 
already on record that is given us in confidence, the primary purpose of the 
study being not so much to make the case history complete as to help the 
patient to make the adjustments needed for life in society. In the selection 
of the limited number of patients for this intensive work, preference is given 
to those who give fair promise of being recoverable cases, those who are amen- 
able to reason, and those who are in need of special instruction or of moral 
influence. It is to be expected that most of these patients will leave the hospital 
after a comparatively short stay, and it is not of great importance to shorten 



10 P.D. 23. 

the period of hospital care. Our aim. is rather to give them better preparation 
for community life, and thus diminish the chances of their return to the hos- 
pital. In some cases this work is supplemented by the Social Service. While 
the patient is being trained in our laboratory to understand herself and to 
adapt herself to the conditions of the home, the social worker takes up the 
matter with the other members of the family and helps them to understand 
what adjustments are needed to make the home environment favorable to the 
patient. 

Social Service Report. 

The following report of our Social Service activities is submitted by Miss 
Jennie A. Harrington, Social Worker : — 

In February Mrs. George Caldicott resigned and the work of the department 
was conducted for eight months by one worker. In October the services of 
Miss Theodora Land was secured. Miss Land came to us from the Family 
Welfare Society of Brooklyn, N. Y. She brings to her task much enthusiasm 
and devotion which Ave believe will pi'ove successful in the department. 

The work has been carried on during the year very much as outlined in 
previous reports. Of the 393 cases referred during the year 76 were referred 
for histories, 56 for investigation of conduct disorders, 32 for employment, 
19 for investigation of home conditions, 24 for investigation of patients' state- 
ments, 29 for investigation of statements of others, 125 for supervision, 6 for 
care of patient's family and 25 for personal service. 

The outstanding social problems in the above cases were disease, sex, per- 
sonality, environment, education and legal problems. These problems have 
been solved by obtaining better environmental conditions, both in home and 
industry, bringing about changes in point of view and behavior of the patient, 
adjusting him to his family and community and using every available social 
resource. Much has been accomplished in the homes by educating the patient 
and relatives in the simple principles of hygiene and by giving cheer and 
encouragement. 

There were at the beginning of the year 23 patients boarded in private 
families and at the close of the year 20 were in family care. The visits paid 
to this group of patients during the year were 84. 

A course of four lectures was given to the senior nurses of the hospital, 
one to Clark University students and two to interested community groups. 
The social worker is present at the community clinics. An attempt is being 
made to make some adjustment for this interesting group made up of backward 
or feeble-minded children, constitutionally psychopathic children, juvenile delin- 
quents and behavior problems. Much can be accomplished by home investiga- 
tions, school visits and the cooperation of other social agencies. 

In review of the year's task, the worth-while work is shown in the lives of a 
feAV individuals with whom an intensive work has been done. Through this 
department 26 patients who had no relatives or cooperating friends were re- 
turned to the community and became self-supporting through adjustments made 
by social service. The following table shows the length of hospital residence 
of these 26 patients prior to their visit from the hospital : — 

Number in hospital 12 years or over, 2. 

Number in hospital from 5 to 10 years, 4. 

Number in hospital from 1 to 5 years, 10. 

Number in hospital less than 1 year, 10. 

Aggregate time in hospital of these 26 patients, 77 yrs. 

Cost to State on per capita basis for support of 26 patients for 77 years, 

$698,537.84. 
Number of patients still self-supporting in the community, 21. 
Cost to State of the 21 patients who are not out, remained in hospital 1 year 

more, $7,327.32. 
Approximate cost of Social Service for past year, $1,822.00. 

Therefore, Social Service has saved the State by this work alone $5,505.32. 
It is almost futile to attempt to cover so large a territory or to do the work 



P.D. 23. 11 

in a serviceable way without the use of an automobile and a larger staff of 
workers. 

I wish to express my appreciation for the helpfulness of the medical staff 
and the cooperation received from outside agencies. 

Report of Out-Patient Clinics. 

There are at present three clinics. The personnel of all is identical : — Dr. 
Manly B. Root in charge, Dr. Grace H. Kent, Psychologist, and Miss Theodora 
Land and Miss Jennie A. Harrington, Social Workers. Miss Justine Adams 
and Miss Dorothy Corbett have rendered valuable service assisting Dr. Kent. 
Dr. William A. Bryan, Supt. of this hospital, and Dr. E. C. Sanford, Professor 
of Psychology of Clark University, act in advisory capacity. 

The out-patient clinic at the Summer Street Department of this hospital 
was discontinued August 18, 1923. Patients disliked coming to this hospital, 
which is known all over Worcester as a place for Incurable Insane. The first 
of the new clinics, which Ave call the Mental Hygiene Clinic, was established 
May 3, 1923. It is held each Tuesday at 2 p.m. at the Out-Patient Dispensary 
of the Memorial Hospital, 14 Oak Street. Mrs. Anna Strickland who is in 
charge of this dispensary has kindly placed all its facilities at our disposal and 
on the whole arrangements are quite satisfactory. A nurse is provided to 
assist in the examinations of female patients. Equipment is provided for 
a physical examination. There are several rooms which we use so that two 
or three patients can be seen at once. The main objections to this dispensary 
are the facts that the rooms are not sound-proof and we feel hardly safe in 
leaving valuable equipment there. 

For a Avhile girls from the Girls' Welfare Society were examined at the 
Memorial Hospital. Most of the patients, however, being unmarried mothers, 
were embarrassed and diffident. We, therefore, have for several months gone 
Tuesday mornings to the Girls' Welfare Society's Home and examined the 
girls there. On the whole this arrangement has been more satisfactory. How- 
ever, there are no rooms at this home really suitable for these examinations. 
There is a great deal of distracting noise outside. 

The third clinic is known as the Habit Clinic and was established November 
14, 1923. It is held each Wednesday at 2 p.m. at the Temporary Home and Day 
Nursery, 14 Edwards Street. Miss Charlotte Emerson, Superintendent of this 
home, has kindly placed at our disposal two large rooms which have been 
furnished satisfactorily. The rooms are really too large, however, and there is 
no equipment for physical examinations except a scale and a yard stick. 

In all these clinics we have attempted to make well rounded studies of these 

social, physical, psychological and mental conditions present. It is an accepted 

dictum that proper evaluation prognosis and treatment of cases of delinquency, 

mental deficiency, peculiar conduct, neuroses and psychoses can be made only 

after a complete study. As the statistical report shows, most of the cases have 

been brought in by social workers representing the various charitable organiza- 

I tions. On the whole they have brought in excellent histories taken by our own 

i social Avorkers. We examine most of the patients physically ourselves. The 

{ unmarried mothers and some of the other patients have been examined by other 

physicians before they come to us. Most of the mental examinations consist 

I mainly of getting the patient's story of his or her life and of the particular 

I difficulty. A careful search for incipient neuroses and psychoses is, of course, 

| made. The psychological examination is in the able hands of Dr. Kent. In 

j practically all cases an attempt at an approximate intellectual estimation is 

j made. It has been found impossible in a great many cases to give an accurate 

i " mental age " or " intelligence quotient." Many of the social Avorkers have 

j been trained to expect an exact numerical intelligence report and have expressed 

disappointment at not receiving it. For the sake of pleasing the agencies and 

giving them what they want Ave have attempted to give out mental ages as often 

j as possible. In addition to intelligence estimation some attempt has been made 

| to make vocational tests and to learn of special abilities and disabilities. This 

j function of the clinic can be deA^eloped more and more. The Psychologist, 

j furthermore, assists in a personality study where possible. 



12 P.D. 23. 

The Habit Clinic has problems of its own. Examinations of children is rather 
difficult. The history is, of course, more important in these cases than the 
examination. We have had few eases as the report shows but have been success- 
ful with these. These children are of the pre-school age and have been brought 
by parents. The problems presented here have been bed-wetting, temper 
tantrums, mental deficiency, refusal to eat and epilepsy. The other clinic 
problems have been delinquencies, mental deficiency, neuroses, psychoses and 
peculiar conduct. 

Each Friday at 3 p.m. the cases of the week are discussed in the Director's 
room of the Public Library, the use of which has been very kindly given us 
by Mr. SkaAv, the Librarian. The clinic personnel attends the conferences. 
The social workers of the city agencies are invited and have attended freely. 
Names of patients are withheld and discussion is free and informal. These 
conferences have proven very interesting and helpful. Stenographic notes are 
taken of the conference. 

The report to the agencies is given in the form of a letter. Various types 
of letters have been written. A letter modeled in general after the summary 
in the reports of the Judge Baker Foundation, of Boston, has proven most 
satisfactory. In all letters a summary of the case is given and attempt is made 
to explain causative factors. Prognosis and recommendations are then offered. 
We have seen several cases for further intervieAvs and have actively followed 
a few. An attempt to obtain notes at frequent intervals as to the progress 
of all cases is made. 

Recently thirty-six letters were sent to as many charitable societies explaining 
in some detail the nature of the clinics and asking for further cooperation. 
Replies to some of these letters have been most gratifying. During the coming 
year Ave intend to make the Out-Patient Department a real factor for good in 
the city of Worcester. The director of the clinic will attempt to make more 
and more contacts AAdth agencies, churches, industrial establishments and courts 
Avith the idea of extending our usefulness. The Out-Patient Department will] 
in addition, take over the function noAV in the hands of the social service, of 
supervising hospital patients on visit. Attempts Avill be made to enlist the 
aid of agencies, churches and industrial establishments in providing Avork and 
supeiwision for patients just released from the hospital. In this Avay Ave hope 
to be able to release more patients than formerly. In so far as time permits, 
attempts will be made to study social and industrial conditions in the light of 
their possible relation to the cause and to the relief of mental disease. 

We ha\ T e been greatly handicapped by the lack of a stenographer and it is 
hoped that one can be provided. 

In the near future a clinic Avill be established in the Out-Patient Department 
of the City Hospital. This will receive only adult patients. The age limit will 
probably arbitrarily be set at tAventy-one. The same personnel have charge of 
this clinic. 

Librarian's Report. 

The year 1923 has one outstanding feature, that of opening up the library 
as a center of actiA r ity for both patients and employees. 

We began the year by moving into our neAv " quarters," Avhich consist of one 
large room about 45 X 35 for the general library and tAVO smaller ones for the 
use of the medical staff. The move Avas unquestionably a Avise one, but noAV 
that the usefulness has grown, and the activities of both libraries promise 
further expansion, Ave need more space. This probably would be easily solved 
could Ave procure a large room for the medical staff and library in a nearby 
locality for supeiwision. It Avould also solve the problem of housing magazines 
and journals of value. Our parole patients very quickly found out that they 
had a large bright and cheery Reading Room to AAdiich they could come any 
time of the day and on Sundays. It is Avell patronized by patients and em- 
ployees. We have an average monthly attendance of 263 patients and 314 
employees. The circulation of books has been gratifying, these being the 
average figures for a month : — 

Books and magazines taken from Reading Room, 715. 
Books and magazines distributed on Wards, 226. 
Total, 941. 



P.D. 23. 13 

The general library has about 4,000 volumes, the greater part of which is 
general literature. Our patients do not and will not read books out of date or 
small print. The medical library has about 900 volumes and 300 reprints, 
most of the books having been classified and catalogued within the year, accord- 
ing to the system compiled by Mr. Ballard, Librarian of the Boston Medical 
Library. For the year 1923 we subscribed for 70 magazines : General 29, 
Medical 22, Technical 20. 

In May a few patients and employees met in the libi'ary and organized " The 
Club," the members being all patients and employees using the library — to 
be the center where they can meet for literary and musical recreation. Once 
a month we plan to have an informal entertainment in the Reading Room. In 
November we had a benefit dance for the employees to raise money to buy a 
Victrola for use in the library, at stated times, and also to take to the wards 
when the occasion occurs. We were fortunate in clearing the price of the 
machine and in buying a few records. The machine has proved a source of 
recreation for all and now we need more records as the more varied the music 
is the more enjoyable it is. Occasionally there is a half -hour's dance after lunch. 
One item I ought to have added is the fact that twice a week 12 or 16 
patients from the Industrial Department (Folsom 1) come in and the increased 
interest they find and take in the room is gratifying. Instead of standing still 
and looking rather vacant, they help themselves to reading matter and look at 
magazines. They enjoy the music too. 

Recommendations and Requirements. 

I would again call attention to the necessity for a rearrangement of our 
present method of food distribution. At the present time there is a dining 
room on every ward in the hospital, 42 in all, and the food which is prepared 
in the general kitchen has to be transported to the end of the building for 
some wards and up four floors. It is impossible to serve this food in a proper 
manner. Our food elevators are entirely too small to permit insolated con- 
tainers to be used, although we have been experimenting along this line. A 
congregate dining room would seem to be the only solution of this problem. 

I again wish to mention the necessity for a modern refrigerating plant. 
Our equipment for the storage of food is entirely inadequate and our space 
for general storage is not sufficient to take care of supplies in the quantities 
in which they are being purchased at the present time. 

I again call attention to the necessity of replacing our wooden stair-cases 

with stair-cases of fire proof construction and also the advisability of sprinkling 

systems both at the Main Hospital and Summer Street. There is also an 

urgent need of additional fire escapes, both at the Main Hospital and the 

Summer Street Department. At the Summer Street Department two fire 

escapes lead only to the first floor and allow no egress from there to the ground. 

We should have fire escapes on the following groups of wards at the Main 

Hospital : — Woodward, Hooper Hall, Folsom, Thayer, Gage Hall and Quinby. 

I These points have been covered in the recent inspection of our hospital by the 

j State Department of Public Safety, and certain recommendations have been 

i made which should be carried out. 

Projects Completed. 

During the year all of our continuous tubs and our general bath house have 
! been equipped with power regulators, and additional ones are being installed 
| on all bath tubs, other than the ones mentioned. New lights have been placed 
i in the attic of the Main Hospital. The following wards have been re-painted 
' and renovated during the year : — Washburn 2 and Washburn 3, Salisbury 2, 
[ and we are at present working on Appleton 4. A cement floor has been put in 
1 through the entire male basement and our basement is now cement throughout. 
1 The renovation of the Lincoln toilets is almost complete. The Howe toilets 
j have been completed and are now in operation. A new floor has been put in 
\ the operating room and the entire operating suite renovated and re-painted. 

The minor repairs have been carried on in both departments, but certain 
i things have necessarily had to be neglected on account of the lack of sufficient 



14 P.D. 23. 

money to carry on the work. I refer particularly to the condition of our roofs. 
A complete over-hauling of these roofs is necessary and the longer this matter 
is delayed the more expensive such repairs will be. It will require approxi- 
mately $7,000 to put our roofs in a first class condition and a yearly outlet 
of approximately $2,000 is necessary to keep them in the proper state of repair. 

At the Summer Street Department the principal project of the year was 
the completion of the cement floor in the old heat shaft and the replacement 
of the antiquated kitchen equipment of a more modern type. Two insolated 
food carts have been put into service to supply the male dining room and it is 
our intention to place two more in commission this year. The arrangement 
at the Summer Street Department lends itself very nicely to the use of these 
food carts. 

It seems proper at this time to call attention to the fact that the buildings, 
both at the Main Hospital and at the Summer Street Department are old and 
a considerable sum is needed each year to keep up the minor repairs. If these 
repairs are neglected any one year the expense is much heavier the following 
year. The buildings should be kept in a good state of repair in order to con- 
serve them. The supervision of these repairs under our present repair system 
is excellent and we have begun during the year the installation of a cost system 
on repairs, which will give us fairly accurately the amount of money needed to 
maintain our buildings in first class condition. 

I wish to take this opportunity of acknowledging the splendid loyalty and 
cooperation of the medical staff, heads of departments, officers and employees 
of the hospital. It is very largely through their splendid cooperation and 
ability that we have been able to make such progress as we have. I have 
found at all times a willingness to put aside personal consideration for the good 
of the hospital. I wish to acknowledge the kindness and courtesy of the various 
organizations in the city of Worcester who have contributed so generously of 
their time and energies in the entertainment of our patients. The Veterans' 
organizations have been cooperative, helpful and ready and willing to assist 
us at all times. 

In conclusion, I wish to express my gratitude to the members of the Board 
of Trustees for the support and cooperation given me during the year. I have 
not hesitated to call upon all of them for advice and assistance and they have 
been always ready and willing to give freely of their time and energies in work- 
ing out the problems of this hospital. 

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, 1923. 

Balance December 1, 1922 ' $26,519 32 

Receipts. 
Income. 
Board of inmates: — 

Private S32.54S 99 

Reimbursements, insane . . . . • . . . . 47,184 02 

$79,733 01 

Personal services: 

Reimbursement from Board of Retirement 212 84 

Sales: 

Travel, transportation and office expenses .... $34 07 

Food 206 78 

Clothing and materials 146 33 

Furnishings and household supplies ...... 82 51 

Medical and general care 152 39 

Heat, light and power 123 17 

Farm: 

Hides $29 43 

Sundries 1 48 

30 91 

Repairs, ordinary 408 12 

1,184 28 

Amounts carried forward $81,130 13 $26,519 32 



P.D. 23. 15 

Amounts brought forward SSI, 130 13 $26,519 32 

Miscellaneous: 

Interest on bank balances $1,221 10 

Rent 1,365 00 

2,586 10 

83,716 23 

Other receipts: 

Refunds of previous year $9 15 

Refunds on account of wages unclaimed 38 78 

47 93 

Receipts from Treasury of Commonwealth. 

Maintenance appropriations: 

Balance of 1922 $6,738 64 

Advance money (amount on hand November 30) 40,000 00 

Approved schedules of 1923 576,694 14 

623,432 78 

Special appropriations: 

Balance of 1922 $243 05 

Approved schedules of 1923 (paid by State Treasurer, $4,788.37) . . . 6,851 19 

— 7,094 24 

Total $740,810 50 

Payments. 
To treasury of Commonwealth: 

Institution income $83,716 23 

Refunds on account maintenance 348 00 

Refunds of previous year 915 

Refunds on account wages unclaimed 38 78 

$84,112 16 

Maintenance appropriations: 

Balance of schedules of previous year (November schedule, $52,002.12; less 

advance, $18,502.26) $33,499 86 

Approved schedules of 1923 $576,694 14 

Less returned 348 00 

■ 576,346 14 

November advances 17,977 37 

627,823 37 

Special appropriations: 

Balance of schedules of previous year $243 05 

Approved schedules of 1923 $6,851 19 

Less advances, last year's report 241 90 

— 6,609 29 

6,852 34 

Balance November 30, 1923: 

In bank $21,449 77 

In office 572 86 

■ 22,022 63 

Total $740,810 50 

Maintenance. 

Balance from previous year, brought forward $80 13 

Appropriation, current year 731,489 39 

Total $731,569 52 

Expenses (as analyzed below) 717,484 28 

Balance reverting to treasury of Commonwealth $14,085 24 

Analysis of Expenses. 

Personal services $315,867 80 

Religious instruction 1,840 00 

Travel, transportation and office expenses 8,029 87 

Food 135,145 61 

Clothing and materials 17,674 98 

Furnishings and household supplies 39,652 25 

Medical and general care 31,515 81 

Heat, light and power 95,495 01 

Farm 27,329 57 

Garage, stable and grounds 5,266 34 

Repairs, ordinary 22,332 91 

Repairs and renewals 17,344 13 



Total expenses for maintenance $717,484 28 

Special Appropriations. 

Balance December 1, 1922 $12,660 95 

Amounts from previous year 470 35 

Total $13,131 30 

Expended during the year (see statement below) $12,534 97 

Reverting to treasury of Commonwealth ........ 125 98 

12,660 95 

Balance November 30, 1923, carried to next year $470 35 



16 



Object. 



Remodeling heating system 
Alterations in heating shaft 



Act or 
Resolve. 



Chap. 126, Acts 1922 
Chap. 203, Acts 1921 



Whole 
Amount. 



$3,114 24 
16,000 00 



819,114 24 



Expended 
during 
Fiscal 
Year. 



Total 

expended to 

Date. 



82,643 89 
15,874 02 



818,517 91 



P.D. 23. 



Balance 

at end of 

Year. 



S470 35 
125 9S* 



8596 33 



* Balance reverting to treasury of the Commonwealth . . . . . . $125 98 

Balance carried to next year 470 35 

Total as above $596 33 

Resources and Liabilities. 

Resources. 

Cash on hand • $22,022 63 

November cash vouchers (paid from advance money), on account of main- 
tenance .......■•• 17,977 37 

tenanCe ! $40,000 00 

Liabilities. 
Outstanding schedules of current year: 

Advance money 1923 $40,000 00 

Per Capita. 

During the year the average number of inmates has been 2,113.09. 

Total cost for maintenance, $717,484.28. 

Equal to a weekly per capita cost of $6.5296. 

Receipt from sales, $1,184.28. 

Equal to a weekly per capita of $0.0107. 

All other institution receipts, $82,531.95. 

Equal to a weekly per capita of $0.7511. 

Net weekly per capita $5.7677. 

Respectfully submitted, 

JESSIE M. D. HAMILTON, 

Treasurer. 

Examined and found correct as compared with the records in the office of the Comptroller. 

JAMES C. McCORMICK, 

Comptroller . 

VALUATION. 

Nov. 30, 1923. 
Real Estate. 

Land (589 acres) $416,357 00 

Buildings 2,182,731 49 

$2,599,088 49 
Personal Property. 

Travel, transportation and office supplies $11,164 20 

Food . 19,224 65 

Clothing and materials . ( 31,561 41 

Furnishings and household supplies ' 259,362 68 

Medical and general care 23,747 12 

Heat, light and power 38,335 31 

Farm . . 26,802 43 

Garage, stable and grounds 11,412 71 

Repairs 26,647 59 

$448,258 10 
Summary. 

Real estate $2,599,088 49 

Personal property • • 448,258 10 

$3,047,346 59 



P.D. 23. 17 

STATEMENT OF FUNDS. 

Patient's Fund. 

Balance on hand November 30, 1922 §9,184 62 

Receipts 10,371 58 

Interest 421 49 

$19,977 69 

Refunded $7,122 08 

Interest paid to State treasury 421 49 

7,543 57 

$12,434 12 
Investment. 

Worcester County Institution for Savings $2,000 00 

Worcester Five Cents Savings Bank 2,000 00 

Worcester Mechanics Savings Bank 2,000 00 

People's Savings Bank 2,000 00 

Balance Worcester Bank and Trust Company ' . 4,055 93 

Cash on hand December 1, 1923 378 19 

$12,434 12 

Lewis Fund. 

Balance on hand November 30, 1922 $1,563 93 

Income 65 50 

$1,629 43 

Expended for entertainments, etc 36 00 

$1,593 43 

Investment. 

American Telephone and Telegraph Company collateral trust 4% bond . $926 36 

Fourth Liberty Loan bonds 600 00 

Balance Worcester Bank and Trust Company 67 07 

$1,593 43 

Wheeler Fund. 

Balance on hand November 30, 1922 $6,127 75 

Income 265 24 

$6,392 99 

Expended for entertainments and magazines 5 00 

$6,387 99 
Investment. 

American Telephone and Telegraph Company collateral trust 4% bond . $712 50 

Third Liberty Loan Bonds 4,000 00 

Fourth Liberty Loan Bonds 1,300 00 

Balance Worcester Bank and Trust Company 375 49 

$6,387 99 

Manson Fund. 

Balance on hand November 30, 1922 $1,127 50 

Income 46 75 

$1,174 25 

Expended for entertainments 25 00 

$1,149 25 
Investment. 

Fourth Liberty Loan Bonds $1,100 00 

Balance Worcester Bank and Trust Company 49 25 

$1,149 25 

Respectfully submitted, 

JESSIE M. D. HAMILTON, 

Treasurer. 

Nov. 30, 1923. 

N. B. — The values assigned to the above securities are their respective pur- 
chase prices. 



18 P.D. 23. 

STATISTICAL TABLES. 

As Adopted by American Psychiatric Association". 

Prescribed by Massachusetts Department op Mental Diseases. 

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 S2 ,586,980 53 

Personal property 392,769 17 

Total 82,979,749 70 

Total acreage of hospital, 589.16. 

Acreage under cultivation during previous year, 263.75. 

M. F. T. 

4. Medical service: 

Superintendent ............ 1 - 1 

Assistant physicians ........... 11 - 11 

Medical internes ........... - - 

Dentist 1 - 1 

Total physicians 13 - 13 

M. F. T. 

5. Employees on pay roll (not including physicians) : 

Graduate nurses ........... 2 29 31 

Other nurses and attendants ......... 118 93 211 

All other employees 91 80 171 

Total employees 211 202 413 

M. F. T. 

6. Patients employed in industrial classes or in general hospital work on date 

of report . 733 734 1,467 

7. Patients in institution on date of report (excluding paroles) . . . 1,079 1,066 2,145 

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



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20 P.D. 23. 

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











Parents op 


Parents 




Patients. 


Male 


of Female 










Patients. 




Nativity. 














M. 


F. 


T. 


F.i 


M.2 


Both. 


F.i 


M.2 


Both. 


United States ....... 


103 


112 


215 


39 


40 


79 


51 


49 


100 


Albania ........ 


4 


_ 


4 


4 


4 


8 








Asia ..... ... 


1 


- 


1 


1 


1 


2 


_ 


_ 


_ 


Australia 


- 


- 


_ 


1 




1 


_ 


_ 


_ 


Austria ........ 


2 


3 


5 


2 


2 


4 


3 


4 


7 


Canada ... .... 


27 


26 


53 


35 


31 


66 


32 


34 


66 


Cuba .... 


1 


_ 


1 


_ 


1 


1 








England .... ... 


8 


13 


21 


10 


7 


17 


9 


12 


21 


Finland .... ... 


3 


1 


4 


4 


4 


8 


1 


1 


2 


France 


1 


1 


2 


1 


1 


2 


2 


2 


4 


Germany 


2 


1 


3 


2 


2 


4 


1 




1 


Greece 


6 


- 


6 


6 


6 


12 


_ 


_ 


_ 


Holland 


- 


1 


1 


1 


2 


3 


1 


1 


2 


Ireland 


19 


30 


49 


46 


49 


95 


58 


55 


113 


Italy . 


12 


6 


18 


13 


13 


26 


7 


7 


14 


Norway 


2 


- 


2 


2 


2 


4 


- 


_ 


_ 




1 


- 


1 


1 


1 


2 


- 


_ 


- 


Poland 


IS 


6 


21 


17 


16 


33 


7 


7 


14 


Portugal 


2 


- 


2 


2 


2 


4 


- 


_ 


_ 


Russia ........ 


27 


8 


35 


29 


30 


59 


8 


8 


16 


Scotland ........ 


2 


2 


4 


5 


4 


9 


5 


5 


10 


Sweden ........ 


6 


2 


8 


8 


9 


17 


5 


5 


10 


West Indies 


1 


2 


3 


1 


1 


2 


2 


2 


4 




142 


102 


244 


191 


188 


379 


141 


143 


284 




1 


2 


3 


16 


18 


34 


24 


24 


48 




246 


216 


462 


246 


246 


492 


216 


216 


432 



1 Fathers. 



2 Mothers. 



Table 5. 


— Citizenship of First Admissions. 








M. 


F. 


T. 




103 
25 
91 

27 


112 
14 
57 
33 


215 




39 
148 




60 








Totals .... 


246 


216 


462 







P.D. 23. 



Table 6. — Psychoses of First Admissions. 



21 



Psychoses. 


M. 


F. 


T. 


M. 


F. 


T. 
























15 


24 


39 




10 


18 


28 








Delirious and confused types 


1 


- 


1 










1 


- 


1 








Paranoid types 


3 


6 


9 
















26 


17 


43 










21 


6 


27 










1 


3 


4 


6. With Huntington's chorea ........ 




































2 


_ 


2 




2 


_ 


2 
















45 


2 


47 




2 


- 


2 










7 


_ 


7 










1 


1 











Acute hallucinosis 


18 


_ 


18 










10 


_ 


10 










4 


1 


5 








Alcoholic deterioration ........ 


3 


_ 


3 
















_ 


_ 


_ 




- 


_ 


_ 








11. With pellagra 








_ 


_ 


_ 










2 


12 


14 




_ 


2 


2 










_ 


2 


2 










1 


3 


4 










1 


4 


5 










_ 


1 


1 








Other diseases or conditions (to be specified) .... 


- 


_ 


_ 
















14 


30 


44 


Manic tvpe ......... 


3 


7 


10 










6 


22 


28 








Mixed type ......... 


5 


1 


6 








14. Involution melancholia 








3 


7 


10 










40 


53 


93 


Paranoid type 


17 


29 


46 








Catatonic type ........ 


11 


9 


20 








Hebephrenic type ... ... 


8 


12 


20 








Simple type 


4 


3 


7 
















6 


12 


18 


17. Epileptic, total 








1 




1 




1 


_ 


1 
















2 


6 


8 




2 


2 


4 










_ 


1 


1 








Anxiety neuroses ....... 


_ 


3 


3 
















_ 


_ 


_ 


20. With mental deficiency 








3 


5 


8 


21. Undiagnosed 








50 


34 


84 


22. Without psychosis, total 








15 


5 


20 


Alcoholism .......... 


2 


_ 


2 










7 


2 


9 










5 


3 


8 








Others 


1 


- 


1 








Totals 








246 


216 


462 



22 P.D. 23. 

Table 7. — Race of First Admissions classified with Reference to Principal Psychoses. 



Race. 




Total. 


Senile. 


With 
Cerebral 
. Arterio- 
sclerosis. 


General 
Paralysis. 


With 
Cerebral 
Syphilis. 


With Other 
Brain or 

Nervous 
Diseases. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


M. 


F. 


T. 


M. 


F. 


T. 


African (black) 

Albanian (Turkish) 

Cuban . 

Dutch and Flemish 

East Indian 

English 

Finnish 

French 

German 

Greek . 

Hebrew 

Irish 

Italian . 

Lithuanian . 

Portuguese . 

Scandinavian 

Scotch . 

Slavonic 

Turkish 

West Indian 

Mixed . 

Race unascertained 

Totals . 




5 
4 
1 
1 
1 

14 

3 

22 

2 

7 

10 

51 

12 

10 

2 

10 

4 

28 

1 

1 

45 

12 

246 


5 
1 

1 

13 
1 

22 

1 

3 

57 
8 
4 

5 
6 
10 

1 

61 
17 

216 


10 
5 
1 
2 
1 

27 
4 

44 
3 
7 

13 
108 

20 

14 
2 

15 

10 

38 

1 

2 

106 

29 

462 


1 

1 
5 

1 

7 
15 


2 
2 

9 

1 
2 

7 
1 

24 


2 
3 

1 
14 

2 

2 

14 
1 

39 


1 

3 

4 

2 
6 
3 

1 

6 
26 


6 
1 
1 
1 

6 
2 

17 


1 

3 

4 

2 
12 
3 

1 

2 
1 

12 

2 

43 


1 

2 

1 

1 
1 
3 

5 

1 
1 
1 

4 

21 


1 

5 

6 


1 

2 
2 

1 
1 
3 
5 

1 
1 

1 

9 

27 


1 

1 


1 

1 

1 
3 


1 

1 

1 

1 

4 


1 
1 

2 


- 


1 
1 

2 



Table 7. — Race of First Admissions classified with Reference to Principal Psychoses 

— Continued. 



Race. 




Alcoholic. 


With Other 
Somatic 
Diseases. 


Manic-De- 
pressive. 


Involution 
Melan- 
cholia. 


Dementia 
Precox. 


Paranoia 
and Para- 
noid Con- 
ditions. 




M. 


F. T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


African (black) . 

Albanian (Turkish) 

Cuban . 

Dutch and Flemish 

East Indian 

English 

Finnish 

French 

German 

Greek . 

Hebrew 

Irish 

Italian . 

Lithuanian . 

Portuguese . 

Scandinavian 

Scotch . 

Slavonic 

Turkish 

West Indian 

Mixed . 

Race unascertained 

Totals . 




2 

3 
2 
4 
1 

16 
6 

1 

2 
5 

3 

45 


2 
2 


2 

3 
2 
4 
1 

18 
6 

1 

2 
5 

3 

47 


2 
2 


1 

3 

1 

1 
1 

4 
1 

12 


3 

3 

1 

1 
1 

4 
1 

14 


2 

1 

1 
2 

1 
1 

1 

2 

3 

14 


1 

5 

3 

1 

6 
1 
1 

1 

1 

9 
1 

30 


3 

6 
1 
5 
1 

1 

7 
1 
1 

2 

3 

12 
1 

44 


1 

1 
1 

3 


1 
4 

1 

1 

7 


1 
1 
1 
5 

1 

1 
10 


1 

1 
1 

1 
1 

3 

2 
4 
3 
2 
1 
1 
3 

7 

1 

8 

40 


4 

3 

8 

1 
14 

4 

1 

4 

11 
3 

53 


5 
1 
1 

1 

4 

11 

2 
5 
17 
6 
2 
1 
3 

11 

1 
19 
3 

93 


2 
1 

1 
1 

1 
6 


5 

1 

4 
2 

12 


7 
1 

1 

2 

4 
3 

18 



P.D. 23. 23 

Table 7. — Race of First Admissions classified with Reference to Principal Psychoses 

— Concluded. 



Race. 






Epileptic 
Psychoses. 


Psycho- 
neuroses AND 
Neuroses. 


With 

Mental 

Deficiency. 


Undiagnosed 
Psychoses. 


Not 
Insane. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


African (black) 

Albanian (Turki 

Cuban 

Dutch and Flem 

East Indian 

English 

Finnish 

French 

German 

Greek 

Hebrew 

Irish 

Italian 

Lithuanian 

Portuguese 

Scandinavian 

Scotch 

Slavonic 

Turkish 

West Indian 

Mixed 

Race unascertain 


ih) 

ish 

ed 




1 


- 


1 


1 
1 


1 

1 

2 
1 

1 


1 
1 

2 
1 

1 

1 
1 


1 
1 

1 


1 
1 

1 
2 


2 
2 

1 
1 

2 


1 

2 
4 
2 

10 

1 
3 

2 

8 
1 

10 
6 


1 

2 
1 
5 

1 

4 
1 

1 
1 

2 

1 
10 
4 


1 

1 

4 
1 

9 

2 
1 
14 
2 
3 

.3 

1 

10 

1 

1 

20 

10 

84 


1 
1 
1 
2 

3 

2 
5 


1 

1 

2 
1 


1 
1 

1 

o 
1 

4 

4 
6 


Totals . 


1 


- 


1 


2 


6 


8 


3 


5 


8 


50 


34 


15 


5 


20 



Table 8. — Age of First Admissions classified with Reference to Principal Psychoses. 



Psychoses. 


Total. 


Under 15 
Years. 


15-20 

Years. 


20-25 

Years. 


25-30 

Years. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic ..... 

2. Senile 

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 dis- 

eases ...... 

9. Alcoholic 

10. Due to drugs or other exogenous 

toxins ..... 

11. With pellagra .... 

12. With other somatic diseases . 

13. Manic-depressive .... 

14. Involution melancholia 

15. Dementia pra;cox 

16. Paranoia or paranoid condition . 

17. Epileptic ..... 

18. Psychoneuroses and neuroses 
19 With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed .... 

22. Without psychoses 

Totals 


15 

26 

21 

1 

2 
45 

2 
14 
3 
40 
6 
1 
2 

3 
50 
15 

246 


24 
17 
6 
3 

2 

12 
30 
7 
53 
12 

6 

5 

34 

5 

216 


39 
43 

27 
4 

2 
47 

14 
44 
10 
93 
18 
1 
8 

8 

84 
20 

462 


1 
1 


1 
1 


1 
1 

2 


1 

2 

4 
1 

1 

4 
2 

15 


1 
1 

1 

2 
1 

6 


1 

3 

5 
1 

1 

1 
6 
3 

21 


1 

4 
11 

4 
3 

23 


2 
4 

6 

1 
2 

2 

17 


1 

2 
8 

17 

1 
6 
5 

40 


1 

3 

1 

1 

12 

1 

4 
2 

25 


1 

5 

14 

1 
5 
1 

27 


1 

3 

2 
6 

26 

2 
9 
3 

52 



24 P.D. 23. 

Table 8. — Age of First Admissions classified with Reference to Principal Psychoses 

— Continued. 







30-35 

Years. 


35-40 

Years. 


40-45 

Years. 


45-50 

Years. 


50-55 

Years. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


2. Senile 

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 dis 

eases ..... 

9. Alcoholic .... 

10. Due to drugs or other exogenous 

toxins .... 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia pracox 

16. Paranoia or paranoid condition 

17. Epileptic .... 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed 

22. Without psychoses 

Totals .... 




3 

8 

2 
7 
1 

6 
2 

29 


1 

5 

8 
2 

2 

1 

7 

26 


4 

8 

7 

15 
2 
1 
2 

1 
13 

2 

55 


3 

7 

3 

1 

1 
5 
1 

21 


1 

5 

10 
1 

1 

2 

20 


4 

7 

5 

13 
1 

1 

2 
7 
1 

41 


5 

1 
9 

3 
2 

7 
27 


2 
1 

2 
1 
3 
6 

7 
22 


7 
1 

1 

9 

2 
4 
3 
8 

14 
49 


5 

1 

6 

1 
1 
1 

1 

4 
1 

21 


3 

1 
2 
6 

1 

1 

1 

4 

19 


5 
1 

6 

3 
1 
3 

7 
2 

2 

1 
8 
1 

40 


1 

5 

1 
1 

1 

5 
1 

15 


1 

2 

2 
5 
1 
2 
5 

1 
19 


1 
1 

7 

2 
6 
2 
2 
6 

1 

5 
1 

34 



Table 8. 



Age of First Admissions classified with Reference to Principal Pstjchoses 
— Concluded. 



Psychoses. 




55-60 

Years. 


60-65 

Years. 


65-70 

Years. 


70-75 

Years. 


75 Years 
and Over. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


2. Senile 

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 dis 

eases ..... 

9. Alcoholic .... 

10. Due to drugs or other exogenous 

toxins .... 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia prsecox 

16. Paranoia or paranoid condition 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed 

22. Without psychoses 

Totals .... 




4 
2 

2 

1 
2 

4 
1 

16 


1 

2 
1 
1 

1 
2 
1 

2 

2 
13 


1 
6 
3 
1 

2 

1 
2 
2 

4 

6 
1 

29 


1 

8 
1 

3 

1 
2 

16 


3 
5 

1 

1 

1 
1 

1 

13 


4 
13 

2 

3 

1 

1 
1 

2 
2 

29 


3 

7 
1 

1 
1 

2 
15 


3 
2 

1 

1 

7 


6 
9 
1 

2 
1 

3 

22 


9 
2 

1 

1 

1 

14 


5 
6 

11 


14 

8 

1 

1 

1 

25 


2 
4 

2 
8 


12 

2 

1 
15 


14 
6 

3 
23 



25 





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26 P.p. 23. 

Table 10. — Environment of First Admissions classified with Reference to Principal 

Psychoses. 







Totals. 


Urban. 


Rural. 


Unascer- 
tained. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


2. Senile 

3. With cerebral arteriosclerosis 

5. With cerebral syphilis 

6. With Huntington's chorea 

7. With brain tumor .... 

8. With other brain or nervous diseases 

9. Alcoholic 

10. Due to drugs and other exogenous toxins 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive .... 

14. Involution melancholia 

15. Dementia precox .... 
10. Paranoia or paranoid condition 

17. Epileptic 

18. Psychoneuroses and neuroses 

19. With psychopathic personality . 

20. With mental deficiency 




15 

28 

21 

1 

2 
45 

2 

14 
3 
40 
6 
1 
2 

3 
50 
15 


24 
17 
6 
3 

2 

12 
30 
7 
53 
12 

6 

5 

34 

5 

216 


39 

43 
27 
4 

2 
47 

14 
44 
10 
93 
18 
1 
8 

8 
84 
20 

462 


15 

23 

19 

1 

2 
39 

10 
3 

38 
4 
1 
2 

3 
40 
11 

211 


22 
13 
6 
3 

2 

9 
28 

7 
40 

9 

6 

5 

31 

5 

186 


37 

36 
25 
4 

2 
41 

9 
38 
10 
78 
13 
1 
8 

8 
71 
16 

397 


3 

2 

6 

2 

4 

2 

2 

10 

4 

35 


2 
4 

3 

2 

13 
3 

3 
30 


2 
7 
2 

6 

5 
6 

15 
5 

13 
4 

65 


- 


: 


- 



Table 11. — Economic Condition of First Admissions classified with Reference to 

Principal Psychoses. 







Total. 


Dependent. 


Marginal. 


Com- 
fortable. 


Unascer- 
tained. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


2. Senile 

3. With arteriosclerosis 

4. General paralysis 

5. With cerebral syphilis . 

6. With Huntington's chorea . 

7. With brain tumor 

8. With other brain or nervous dis- 

eases ..... 

9. Alcoholic .... 

10. Due to drugs and other exogenous 

toxins .... 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia praecox 

16. Paranoia or paranoid condition 

17. Epileptic .... 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed 

22. Without psychosis 

Totals .... 




15 

26 

21 

1 

2 
45 

2 
14 

3 
40 

6 
1 

2 

3 
50 
15 

246 


24 
17 
6 
3 

2 

12 

30 

7 

53 

12 

6 

5 
34 

5 

216 


39 

43 

27 

4 

2 
47 

14 
44 
10 
93 
18 
1 
8 

8 
84 
20 

162 


1 

1 
4 

1 

7 


1 

2 

2 

2 

1 
1 
2 

11 


1 

2 

1 
2 

2 

2 
5 
3 

18 


4 
13 
9 
1 

22 

2 
3 
3 
10 

4 
1 
2 

2 
20 

7 

103 


10 
8 
2 
3 

1 

2 
8 
3 

20 
10 

4 

1 
10 

2 

84 


14 
21 
11 

4 

23 

4 
11 

6 
30 
14 

1 

6 

3 

30 
9 

187 


11 

13 
12 

2 
23 

11 

29 
2 

26 

7 

136 


13 

9 
4 

1 

8 
22 

4 
33 

3 

23 
1 

121 


24 
22 
16 

2 
24 

8 
33 

4 
62 

2 

3 

49 
8 

257 


- 


- 


- 



P.D. 23. 27 

Table 12. — Use of Alcohol by First Admissions classified with Reference to Principal 

Psychoses. 



Psychoses. 




Total. 


Abstinent. 


Tem- 
perate. 


Intem- 
perate. 


Unascer- 
tained. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


2. Senile 

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 dis- 

eases ..... 

9. Alcoholic .... 

10. Due to drugs and other exogenous 

toxins .... 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia precox 

16. Paranoia or paranoid condition 

17. Epileptic .... 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed 

22. Without psychosis 

Totals .... 




15 

26 

21 

1 

2 
45 

2 
14 
3 
40 
6 
1 
2 

3 
50 
15 

246 


24 
17 
6 
3 

2 

12 

30 

7 

53 

12 

6 

5 

34 

5 

216 


39 
43 

27 
4 

2 

47 

14 
44 
10 
93 
18 
1 
8 

8 
84 
20 

462 


1 
4 
3 

2 

2 

8 
2 

1 

6 
3 

32 


1 

2 
1 

2 

3 

9 


2 
4 
3 

2 

2 
3 

10 
2 

1 

9 
3 

41 


8 
15 
12 

1 

2 
8 
3 

22 
1 
1 

2 

26 

8 

109 


15 
15 
6 
2 

9 
23 

6 
45 
10 

6 

5 

25 
5 

172 


23 

30 

18 

3 

11 

31 

9 

67 

11 

1 

6 

7 
51 
13 

281 


5 
3 

4 

45 

2 

2 

7 
2 

70 


2 

1 
3 


5 
3 

4 

47 

2 
2 

8 
2 

73 


1 

4 
2 

2 

8 
3 

1 

1 

11 
2 

35 


8 
2 

1 

1 

6 
1 
6 
2 

5 
32 


9 
6 
2 
1 

1 

8 
1 

14 
5 

1 

1 
16 

2 

67 



28 



P.D. 23. 



G3 



^ 












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pq 
< 



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5 H 


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1 N t-< | 1 | 1 | N 1 1 1 N 1 1 1 1 I 1 INI 


| 


» 


fe 


IN||lllllll|N!l||lllNI 


CO 


§ 


1 1 t-t | i | i i eq i i f i i i | i l i l i I 


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d 
m 

K 

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Q 


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[HHH | | | | | | 1 | 1 1^1 i ■•— ■ 1 l-^^H 


o 


&i 


1 1 1 1 1 1 1 1 1 I 1 1 1 ; 1 tH 1 1 — * 1 1 T-i.l 


CO 


s 


I HtHH | | | 1 | 1 | | | | 1 | | 1 1 | COtH 


w 


d 

H 
Eh 

< 

c 
H 
CO 


H 


l|(Mllil|r-H||||||lllil^H| 


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p=; 


1 1 I t 1 1 1 I 1 1 1 I 1 1 1 1 1 1 I 1 tH | 


- 


s 


1 1 <M | 1 1 1 | i-l ]. | | | 1 1 1 [ 1 1 1 I 1 CO 




H 

O 




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1 OO^NiN | | | "* | | MiO'*^'* | I 1 H0O | CO 


fe 


I (Mt>NN | 1 | 1 | I NiCNr-iCO 1 1 1 HiO I 


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s 


1 cOt- | | | | 1^1 | ~h | Cq 1 *H | 1 1 1 « 1 


N 


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I lOWNfH | 1 | 1C | | CO OO »0 05 CM fH rf | CC^DiC 
i-t i-( — i >-i N t-I N 


t>- 


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I HCOCO'-i 1 1 I •— * 1 | «CO^ON | M 1 CONN 
y-i N t-I 


00 


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1 "* o ^ 1 1 1 1 -^ i | i lo^anOi-iH | | -^ co 


s 




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a 

g 
to 


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r-i CM i-H CO ■** i-t O 


fe 


1 ONH | | | | i—i I I INOHHCq | CJ | HWCO 


t-» 


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1 ^io«Ofh i | N-* i l hoj 1 h i I »-t i coOi-h 

N CO COi-l 


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1 OS CO l>* T* 1 ] Nt-- | 1 •* t*< O CO CO »-< 00 1 oo-^o 
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tW 


fe 


I -^NCDCO 1 1 I N i | MONWCN | O 1 ifl^>0 
N i— l i— l CO HO *-• CO 


§ 


a 


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H(NN ^ T-H T}1 lO ^H 




H 
to 
O 

« 

|M 

IB 

CM 


.9 
8-2 

J •§ .2 ■ ■ ■ ■ ■ 

■iviir-- ■!'■■■ 

m tO-S S -a M — "S S <U O ' 

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al^il a i-SI I s " 8.11 1 

g s.-g g.g.g.g.gj s.g.g a > S ?'ft>'.S.Sc.S 


T 
o 




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P.D. 23. 



Table 14. — Psychoses of Readmissions. 



29 



Psychoses. 



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

Traumatic constitution ........ 

Senile, total ........... 

Simple deterioration ......... 

Delirious and confused types ....... 

Paranoid types .......... 

Other types . . ........ 

With cerebral arteriosclerosis ....... 

General paralysis .......... 

With cerebral syphilis ......... 

With Huntington's chorea . . 

With brain tumor .......... 

With other brain or nervous diseases, total ..... 

Alcoholic, total .......... 

Acute hallucinosis ......... 

Chronic hallucinosis ......... 

Chronic paranoid type ........ 

Alcoholic deterioration ........ 

Due to drugs and other exogenous toxins, total 

Opium (and derivatives), cocaine, bromides, chloral, etc., alone 
or combined (to be specified) ....... 

With pellagra .......... 

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

Delirium with infectious diseases ...... 

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

Depressed type .......... 

Stuporous type . ......... 

Circular type .......... 

Other types 

Involution melancholia ........ 

Dementia precox, total ........ 

Paranoid type .......... 

Catatonic type .......... 

Hebephrenic type ......... 

Simple type 

Paranoia or paranoid condition ....... 

Epileptic, total 

Psychoneuroses and neuroses, total ...... 

With psychopathic personality ....... 

With mental deficiency ........ 

Undiagnosed ........... 

Without psychosis, total ........ 

Psychopathic personality ........ 



Totals 



55 122 



Table 15. — Discharges of Patients classified with Reference to Principal Psychoses 
and Condition on Discharge. 







Total. 


Recovered. 


Improved. 


Unim- 
proved. 


Not 
Insane. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic .... 

2. Senile 

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 dis- 

eases ..... 

9. Alcoholic .... 

10. Due to drugs and other exogenous 

toxins .... 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive 

14. Involution melancholia 

15. Dementia prsecox 

16. Paranoia or paranoid condition 

17. Epileptic .... 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed 

22. Without psychosis 

Totals .... 




1 
5 
2 
3 
1 

1 
24 

1 

15 

7 

50 

2 

2 

1 

2 

2 

31 

10 

160 


6 
4 

2 

4 

6 

42 

5 

41 

1 

1 

2 

2 

12 

20 

11 

159 


1 

11 
6 
3 
3 

1 
28 

7 

57 
12 
91 
3 
3 
3 
4 

14 
51 
21 

319 


1 

13 

1 

2 

2 
19 


2 

1 
5 
1 

3 
12 


1 

15 

2 
7 
1 

5 
31 


2 

2 
1 

10 

10 
7 

28 
1 
1 
1 
1 
2 

21 

87 


2 
2 

1 

2 

4 

31 

4 

34 

1 

1 

2 

2 

9 

11 

106 


4 
2 
2 
2 

12 

4 
41 
11 
62 
2 
2 
3 
3 
11 
32 

193 


3 
2 
1 

1 

1 

3 

22 
1 
1 

1 

8 

44 


4 
2 

1 

1 
6 

7 

3 
6 

30 


7 
4 

1 
1 

1 
1 

1 

9 

29 

1 
1 

1 
3 

14 

74 


10 
10 


11 
11 


21 
21 



30 



P.D. 23. 



a? 



S> 



e 

&, 



C 



k a a 

H h CD 

o < < 
2 H 


H 


|HI Ml |H| llll 1 - — 1 1 1 1 1 1 1 t I i 1 CM 1 


fe 


M !■ M.'l 1,1 1 llll 1 — i 1 1 1 1 E 1 1 1 1 ICMI 


g 


1 1 1 1 1 1 1 rH 1 llll 1 1 1 1 1 1 1 1 1 1 1 III 


6 

3 

o 

w 

o 
o 


H 


|«riri | | |-| | llll 1 1 tH 1 | 1 | 1 ■* 1 | ll-H 


fe 


1 1 1 1 1 1 1 1 1 llll 1 1 1 1 1 1 1 1 1 1 1 1 1 H 


g 


1 CM i-h-h 1 1 1 1 ] llll 1 1 -h 1 1 1 1 1 ■* 1 1 III 


With Other 
Brain or 

Nervous 
Diseases. 


H 


rt | 1 | | 1 | | | llll 1 1 1 1 1 1 1 1 1 1 1 III 


ft 


1 1 1 1 1 1 1 1 1 llll 1 1 1 1 1 1 1 1 1 1 1 III 


g 


• — 1 1 1 1 1 I J 1 1 llll 1 1 1 1 1 1 1 1 1 1 1 III 


<) to 
B K j 
h n « 

« B K 
U«2 


H 


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


ft 


1 1 1 1 1 1 1 1 1 1 | CM 1 1 1 1 1 1 1 1 1 1 1 1 III 


g 


1 1 1 1 1 1 1 1 1 llll 1 1 1 1 1 1 1 1 1 1 1 III 


•< en 
H « 


H 


lllllllll 1 -* 1 1 lilt - — ■ t — — • llll l~H<M 


ft 


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 CM 


g 


lllllllll IOII IIII-hI-hIIII I—I 
CO 


^ A *j 

< O t-i 
tt h to 

3 « o 

g B « 


H 


ICMIIIIIII colli 1 1 CM (M 1 1 CO tjh CM 1 1 1 1 CO 


ft 


lllllllll -Hill 1 1 —I 1 1 1 COCM-H II 1 1 CO 


g 


ICMIIIIIII CM 1 1 1 1 MN | | OC1H | | III 


CZ2 


H 
ft 


llllll-Hll i-Hlll HH-HIrn | rttDHH | | f-4 yA -H 


Illlll-Hll —III -H-HCMII— -rtH-Hlll „ _ O 


g 


lllllllll llll IICM-hIICMI-hII | | 7— i 


< 
O 

H 


H 


rtOHHrtrHKlOP] CB^HCOtH HCCHO««OCOtD>HrH rH N C 


ft 


ICO] I -h t— CM CM 1 -HH-*fCNl ^HCOH>tO | CTNWtD | | -h^OCO 


g 


-h-h^-^-hI 1 -h CO CM lOOrtH I [ NM« 1 H^no-<^ ICMCO 


Eh 

«4 

H 

P 

Eh 
O 

a 

CO 

& 
o 








g £ . . . 


» s> ,3> 


S § 3 . . . . o 5... 


B CO § ^ g 

i 1 1 . . . . 1 '1 . . . 


^ Cc3 < -5 S 


to 2 ^-i 1 as 2 o«l- „ 

.2 3 o-^ i £ ® ffl _3 S nm o ° rt to 2 

•S^JScscsca-^ac jSga o g g- S =§ g « t |^ § egg 
•sS-c.S.S.S&il QfeiS' a/H H-p o £ £ s.2'5 o ffl ^ 

CP 1 1 ' ' U tn ^ H H— H^H ^Ht,-^" y^^^JtH^HpHW^ ^ ^Jj Q 

caS«c3c«c3c3j<« e J 0) ft OJ3J3-H O G o o st: O oo h 



P.D. 23. 



31 






•43 x a 

03. S O 

3-d"J3 

,-Bria 

c S m 

o »— 

■ - <* m 

.2 "Sa 

I* S-. C3 

,2 °- Q 






h c 3 

sill 

02 -° 03 



1 3S0 

~S C^ =3 C3 



.2 £ 03 



of _2~ 
" 03 o 



"5 °-5-a g 

^ C3 - O r UIJ 



rhoea 
e ent 
oniti 
oniti 
oniti 
tinal 



2 >> 


icide 

ney. 
enta 
tebrs 
de by 


Diar 
Acut 
Perit 
Perit 
Perit 
Intes 


c 

65 


Horn 
kid 

Accic 
ver 

Suici 



32 



a 
U 



e 

CO 

Oh 



$ 



Eh 05 

o 

B B 

Eh O 

tS * 

S to 


H 


i i i i i i i i i i i i i i i — [ i i i — i i i iii 


fa 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 iril 1 l.lHl.l 1 III 


3 


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


5 H 

a jo 


H 


'« "'-' '""' ' ' ' ' 


fa 


lllllllll r-H||| | rtH | | 1 H [ | | | 1 1 CM 


s 


ICMIIIIIII H-4 1 1— 1 1 1 CM 1 1 1 «-l 1 i-H 1 1 1 1 — 1 


B-l 

g H g 

2 H 

Q 


H 


lllllllll 1 1 1 1 1 1 1 1 1 1 1 1 — 1 1 III 


fa 


lllllllll 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III 


S 


iiiiiiiii i i i i i i i ■ i r I 1 — ■ I 1 III 


With 
Psycho- 
pathic Per- 
sonality. 


H 


lllllllll 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III 


fa 


lllllllll 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III 


a 


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


6 
& 

ft 
H 

ft 


H 


1 1 llll ' 1 1 1- ' "I" 


fa 


lllllllll 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III 


a 


lllllllll 1 1 1 1 1 1 1 [ 1 1 1 L J — i t III 


Paranoia 
or Para- 
noid Con- 
ditions. 


H 


lllllllll —III 1 1 1 1 1 1 1 1 1 1 1 III 


fa 


lllllllll 1 1 1 1 III Ill III 


s 


lllllllll — 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III 


< . 


H 


1 O 1 1 1 — CM 1 CM (Mil— 1— I— I -*H« — I — 1 CM »0 — 1 | — O 


fa 


1 LTD | 1 | h — ■ h — 1 | r — 111 | H | -* 1 H | -(CO 1 ! 1 — "** 


s" 


1 ^. 1 1 1 1 — | w — ii— II— 1 — 1 1 — eci — I ll- 


z 

o , 

Eh Z -<! 

M 3 


E-i 


lllllll 1 1 1 1 1 1 1 1 1 1 1 1 — 1 1 1 1 1 1 CM 


fa 


lllllllll 1 1 1 1 1 1 1 1 1 1 — 1 1 1 1 ll- 


s 


lllllll 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 II — 


9s 

CJ CO 

Z H 


H 


ICOIIIIITKI 1111 llllll— 1— II 1— 1 


fa 


1 CM 1 1 1 1 1 CM 1 llll llllll— 1— II 1— 1 


S 


1 — 1 1 1 1 1 CM 1 llll 1 1 1 1 1 1 1 1 1 1 1 111 


Cause of Death. 






General Diseases. 
Facial erysipelas ..... 
Pulmonary tuberculosis 
Delirium tremens .... 
Carcinoma of liver .... 
Carcinoma of thymus .... 
Carcinoma of bladder .... 
Gangrene of left foot . 
Exhaustion from acute delirium . 
Exhaustion from chronic mental disease 

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

Diseases of the Circulatory System. 
Acute endocarditis .... 
Chronic endocarditis .... 
Chronic myocarditis .... 
Mitral regurgitation .... 
Aortic insufficiency .... 
Angina pectoris ..... 
General arteriosclerosis 
Cerebral arteriosclerosis 
Cardio vascular renal disease 
Infection thrombosis of left leg . 
Aortic stenosis ..... 

Diseases of the Respiratory System. 

Lobar pneumonia .... 
Bronchopneumonia .... 



P.D. 23. 



33 



— < I 1 ■• — ■ ■— ■ ■ II 1 IIU3 


11 1 1 l-l—l 1 l| | | | IO 


' ' ' ' ' ' | ' 


llllll y- i I i— I | | J «r— 


1 1 1 1 1 1 1-» 1 1 1 1 1 1> 


llllll II *-H 1 1 O 


1 '-' 1 1 1 1 II | 1 1 (N 


1111 ' ' | ' 


i" . i i i , , , 


.iiiii i- , , , |_ 


i i p i i i . , , , | , 


1 1 1 1 i 1 1 -. 1 m]h 


111 1 


,,,,,, I , I , , | , 


111 1 " 1 I ~ 


' ' |- 


' ' ' '•' | ' 


' 1 ' |- 


■«*< 


1 1 ^ 1 1 1 II 1 1 | 1 "^ 


1 1 II 1 f— ( II | lit"- 


'!' — |* 


''I'll II 1 « — I *— c \ *& 


iiiiii i , i , , j„ 


' - i i i ■ ii i - i i 1^ 


1 i-< 1 1 1 1 II I | | I oo 


i ii i i i L 


Diseases of the Digestive System. 

Acute enteritis ....... 

Peritonitis following perforation of intestines 
Peritonitis following perforated appendix . 
Peritonitis following gas bacillus infection . 

Diseases of the Genito-urinary System. 

Chronic cystitis 

Urinary obstruction, stricture of ureter 

Accidents, Violence and Sudden Deaths. 
Homicide, fracture of sternum, ribs, ruptured 

liver and right kidney. Hemorrhage, chest and 

abdomen . . . . . 
Accidental fall, probable fracture base of skull, 

and 7th cervical vertebrae and hemorrhage of 

brain .... 
Suicide bv hanging 

Totals 



34 



P.D. 23. 



ftj 



?> 



Oh 



^ 



in °° 
? * 

2 a 


H 


1 1 imi 1 1 l^i I -^ — i —i - — i c— t I I I I — i I 


- 


w 


I 1 1 1 1 1 | 1 1 1 1 I-I.-IT-ITJI | | | | | M | 


CO 


§ 


1 1 1 "5 1 1 1 1 M 1 1 1 I 1 CO 1 1 1 1 1 1 1 


CJ 




H 


1 1 1 IQM | | 1 M 1 1 1 1 1 CO 1 -| I 1 . 1 1 1 


o 


fe 


1 1 1 MM 1 1 1 1 1 1 1 1 1 1-4 .1 1 1 1 1 1 1 


CO 


g 


|I|-3<IIII~H|I!I|CNI|I]IIII 


1^. 


2 H 


H 


III^IIIIIIIIItroiililMi 


00 


fe" 


I I I I I 1 I 1 1 1 I 1 1 1 M | | | | | | | 


- 


§ 


I1|-4*MIIIIIIIII<MIIII|M| 


I>- 


l ■< 


H 


, I IM, , , , , , ,MM,^, ,. , , ,MM 


. 


fe 




CO 


2 


' ' ' ~ M | ICO 1 1 1 1 I'M | 


CO 


in * 

2 s 
cm£ 


H 


1 1 1 1 1 . 1 . 1 1 IM | |.M ,., , , , | 1 


« 


fe 


I 1 1 I 1 1 I 1 1 1 1 M | | M | | | II | | 


« 


§ 


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


1 




H 


'I''' - 1 


~ 


fa 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 M 1 


~ 


s 


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


1 


in 
M . 

aj 
K PS 
H ■< 

q m 


H 


'■'■'.■■''■ ' " 


1 


fa 


1 1 1 ( 1 1 1 1 1 1 t 1 i I 1 1 1 1 1 1 1 t 


1 


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1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ] 1 


1 


J 
O 


hi 


IC^^CTXMI | HO 1 | tDHtfJHHH | HNMO 

CO CCCO H i-l -^ r-l 


(3 


fa 


I -<* -H< CO <M | 1 |H| 1 OOO'*'* | | | | | t>lQ 
<M H CM 


o 

o 


s 


lOOOCOl 1 1 HQ | I rHCVJr-INHr- 1 | H CQ O 1 


o 


03 
H 
0! 



03 
o 

CO 
P4 


8 . j 

1 2 
§ o . 

.2 ro o « ' s 8 "m 
• -S--C3 •§•«■! -■■'3 •§§■■" ■ 

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o 'k o • ^ "3 "& '"o "O ' ad ' " 

£M£0££££^Q££S£Qfa^fag:£P:£ 


13 
o 
H 


HKNMTfiOONOOOO'HMm^iOONCOQOrHiM 



35 



T3 
3 



o 



0$ 



"S3 
Si 






Oh 



533 






HQ 



o H 



-i2 



2 H 
"*!* 



b 3 >>o g.S 
^^?™m1 g 



— --* — MH ^ 

OS g c3 A -PX5 
CD P< Q> §■ 



W C3 O 



if : 



- § 8 



d g 
Q 



M, 



9 o> 



c> g onh-Q o O 

-tJ S +^ -*-* -t-= ^> X 



a> t;^ OJ 






13 5 'w -m 



S s-s . 
B'S ° ■ 

m it* 3 ' 

o ors"^ 

< Nil 

fl 3.3 pjax^. 



2 03 



HCNM'*»CCDNOOOO'-i(McO'1*iOONOOaiO'-^ 



36 
Table 18. 



P.D. 23. 

Total Duration of Hospital Life of Patients dying in Hospital classified 
according to Psychoses. 



Psychoses. 


Total. 


Less than 
1 Month. 


1-3 

Months. 


4-7 

Months. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


m. 


F. 


T. 


1. Traumatic ....... 

2. Senile 

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 . 

9. Alcoholic ....... 

10. Due to drugs and other exogenous toxins 

11. With pellagra ...... 

12. With other somatic diseases .... 

13. Manic-depressive ...... 

14. Involution melancholia .... 

15. Dementia praecox ...... 

16. Paranoia or paranoid condition 

17. Epileptic ....... 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency .... 

22. Without psychosis ..... 


8 
20 
33 

1 
9 

1 
3 

1 

17 

1 

1 

1 

2 
10 


24 
14 
6 
2 

1 

5 

8 

4 

24 

7 
5 


32 
34 
39 

2 

1 

10 

6 
11 

5 
41 

1 

1 

1 
2 

17 
5 


5 
3 

1 

2 

1 

2 

4 
18 


2 
3 

3 
1 

9 


2 
8 
3 

1 

2 

4 
1 

2 

4 
27 


4 
2 

1 

2 
9 


3 
2 
1 

1 

1 
1 

1 
10 


3 
6 
3 

1 

1 
1 
1 

3 
19 


4 
2 
5 

1 

12 


4 
1 

1 
2 

1 

9 


8 
3 
5 

1 

1 

2 

1 


Totals 


108 


100 


208 


21 



Table 18. — Total Duration of Hospital Life of Patients dying in Hospital classified 
according to Psychoses — ■ Continued. 



Psychoses. 


8-12 

Months. 


1-2 

Years. 


3-4 

Years. 


5-10 

Years. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


2. Senile 

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 

9. Alcoholic 

10. Due to drugs and other exogenous toxins 

11. With pellagra 

12. With other somatic diseases .... 

13. Manic-depressive ...... 

16. Paranoia or paranoid condition 

18. Psychoneuroses and neuroses .... 

19. With psychopathic personality .... 

22. Without psychosis 

Totals 


1 
2 
4 

2 

2 
11 


3 
1 
1 

2 

1 

1 

9 


4 
3 
5 

2 
2 

3 

1 

20 


2 
4 
11 

1 
1 

2 
21 


5 
3 
2 
1 

1 
1 

4 
17 


7 
7 

13 
1 

1 
1 

2 

6 
38 


4 

1 
5 


1 
1 
1 
1 

5 
9 


1 
1 
5 
1 

6 
14 


1 

2 
2 

2 

1 

4 
1 
1 

1 
15 


4 
1 
1 

2 
1 
4 

1 

1 

15 


5 
3 
3 

2 

3 
1 
8 
1 
1 

1 
1 
1 

30 



P.D. 23. 

, Table 18. — Total Duration of Hospital Life of Patients dying 
according to Pyschoses — Concluded. 


37 

in Hospital classified 


Psychoses. 


10-15 

Years. 


15-20 

Years. 


20 Years 
and Over. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


2. Senile 

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 . 

9. Alcoholic ....... 

10. Due to drugs and other exogenous toxins . 

111. With pellagra 

12. With other somatic diseases 

13. Manic-depressive ..... 

14. Involution melancholia .... 
, 15. Dementia prsecox ..... 

16. Paranoia or paranoid condition . 

17. Epileptic 

18. Psychoneuroses and neuroses 

19. With psychopathic personality . 

20. With mental deficiency .... 

21. Undiagnosed ...... 

22. Without psychosis ..... 

Totals 


3 
2 


1 

1 




1 

3 

1 

8 


1 

2 

1 
1 


1 

5 
1 


2 
2 

6 

1 
1 


1 

1 
4 

1 


2 

1 

2 

2 


2 

1 

2 
6 

1 
2 


5 


8 


13 


5 


7 


12 


7 


7 


14 


Table 19. — Family Care Department. 




M. 


F. 


T. 


Remaining Sept. 30, 1922 

1 Admitted within the year ........ 

1 Nominally returned from visit for discharge ..... 

I Whole number of cases within the year ...... 

j Dismissed within the year ........ 

Discharged ........... 

Died 

Visit 

Remaining Sept. 30, 1923 

Self-supporting .......... 

Number of different persons within the year .... 

Number of different persons admitted ...... 

Number of different persons dismissed ...... 

j State 

I Self-supporting .......... 


- 


23 
6 

29 
10 
4 

6 

19 
11 

5 

3 
27 

4 

8 
20.69 
11.47 

5.00 

4.22 


23 
6 

29 
10 
4 

6 

19 
11 

5 

3 
27 

4 

8 

20.69 
11.47 

5.00 

4.22