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Public Document
9<£4 No. 23
tytyz (Eommattuiealth, of HSasfiactjuactts
ANNUAL REPORT
OF
THE TRUSTEES
OF THE
ma,, i Worcester State Hospital
YEAR ENDING NOVEMBER 30. 1926
Department of Menial Diseases
Publication of this Document approved p.v the Commission on Finance and administration
300— 9— '27 Order 142
OCCUPATIONAL PRINTING PLANT
DEPARTMENT OF MENTAL DISEASES
GARDNER STATE COLON*
GARDNER MASS
OFFICERS OF THE WORCESTER STATE HOSPITAL.
BOARD OF TRUSTEES
Anna C. Tatman. Secretary, Worcester.
William J. Delehanty, M. D., Worcester.
Edward F. Fletcher, Chairman, Worcester.
Howard W. Cowee, Worcester.
John G. Persian, D. M. D., Worcester.
MEDICAL STAFF
William A. Bryan, M. D., Superintendent.
Lewis B. Hill, M. D., Assistant Superintendent.
Arthur McGugan, M. D., Clinical Director.
Michael J. O'Meara, M. D., Senior Assistant Physician.
Henry B. Moyle, M. D., Senior Assistant Physician.
Francis Sleeper, M. D., Senior Assistant Physician.
Arthur C. Brassatj, M. D., Senior Assistant Physician.
Russel T. Draper, M. D., Assistant Physician.
Byron F. Brown, M. D., Assistant Physician.
Auray Fontaine, M. D., Assistant Physician.
Jacob Goldwyn, M. D., Assistant Physician.
S. Spafford Ackerly, M. D., Assistant Physician.
VISITING STAFF
Ernest L. Hunt, M. D., Surgeon.
John F. Ctjrran, M. D., Surgeon.
William H. Rose, M. D., Surgeon.
Benjamin H. Alton, M. D., Surgeon.
M. M. Jordan, M. D., Neurologist.
William F. Holzk.r, M. D., Ovthalmologist.
Phillip H. Cook, M. D., Roentgenologist.
Oliver H. Stansfield, Internal Medicine.
Lester M. Felton, Genito-Urinary Surgery.
HEADS OF DEPARTMENTS
Herbert W. Smith, Steward.
Jessie M. D. Hamilton, Treasurer.
James Dickison, Jr~, Chief Engineer.
Anton Swenson, Foreman Mechanic.
Wallace F. Garrett, Head Farmer.
Lillian G. Carr, Matron.
Florence M. Wooli>rid£!£, R. N., Superintendent, oj Nurses and Principal of
Training School.
Maurice Scannell, Supervisor, Male Department.
<**■ <v » /w / * \
Sfltc $ommattweaitij of Massachusetts
TRUSTEES' REPORT.
To His Excellency, the Governor, and the Honorable Council:
The Trustees of the Worcester State Hospital respectfully submit the ninety-
fourth annual 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, Miss Caroline M. Caswell of Northborough, resigned as a
member of the Board of Trustees, and her place as Secretary of the Board was
filled by the choice of Mrs. Anna C. Tatman.
During the year, Mr. Luther C. Greenleaf of Boston, a member of the Board
of Trustees, died, after serving the Commonwealth efficiently and faithfully for
many years as a member of this Board. His charming personality had endeared
him to all the members.
The two vacancies in the Board thus caused have not been filled.
The new congregate dining-room is nearing completion, where meals will be
served on the cafeteria plan to patients of both sexes. This method is a great success
in every way, especially from the viewpoint of efficiency and economy, as well as
in the satisfaction and happiness of the patients. This new room is provided in
consequence of the success of the former experimental cafeteria rooms.
The medical work of the hospital is of great importance and requires a high type
of medical officer. To secure the services of the right kind of physicians it is im-
portant to furnish them and their families with confortable and enjoyable living
quarters. To this end it is recommended that cottages be erected for the accom-
modation of the members of the medical staff and their families.
More and more attention is being paid to the physical well-being of patients
and to the subject of the relation of physical troubles to mental disease.
Once more attention is called to the remoteness of the Hillside Farm from the
hospital, and the waste caused by transportation of feed, supplies, and produce.
Soon there must be provided a new farm unit at the main hospital.
Study must be given to the question of transforming the Summer Street De-
partment into a Psychopathic and Receiving Hospital, its location being excellent
for such purposes. This would entail considerable expenses for repairs, alterations,
and the installation of hydrotherapy equipment.
It is important that the Commonwealth should formulate and embark on a
fixed program of doing away with the old wooden floors, which are rapidly wearing
out, in the main hospital, and of replacing them with concrete floors in order to
greatly lessen the fire hazard. It would not be too expensive to provide for
this work at the rate of two wards per year. It would be folly to replace the
outworn wooden floors with wood, when the use of the more permanent concrete
would lessen the danger of fire enormously.
Storage facilities at the main hospital are scattered in such a way as to make
for inefficiency and needless expense for labor. A new store building which would
house most of the stores could be more economically administered.
The trustees wish to take this occasion to register their confidence in the ad-
ministration of Dr. William A. Bryan, Superintendent, and the members of his
staff.
EDWARD F. FLETCHER, Chairman WILLIAM J. DELEHANTY
ANNA C. TATMAN, Secretary HOWARD W. COWEE
JOHN G. PERMAN.
4 P.D. 23
SUPERINTENDENTS 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, 1926, it being the ninety-fourth annual report.
There remained on the Hospital books October 1, 1925, 2,385 patients, 1,131 men
and 1,254 women. Seven hundred and forty-nine patients, 426 men and 323 women
were discharged from the Hospital. Of this number 406 patients, 283 men and
123 women were discharged; 253 patients, 135 men and 118 women died; and 90
patients, 8 men and 82 women were transferred, leaving at the end of the statistical
year, 2,563 patients, 1,280 men and 1,283 women. Two thousand two hundred and
twenty-nine patients, 1,082 men and 1,146 women were actually in the institution.
Of the patients discharged 38 were reported as recovered; 232 as improved and 82
as not improved. Fifty-four patients, 33 men and 21 women were discharged as
not insane.
Two men were transferred by the Departmexit of Mental Diseases to the Fox-
borough State Hospital; 1 man and 29 women to the Gardner State Colony; 1
man and 22 women to the State Infirmary; 1 man to the Medfield; 1 man to the
Bridgewater State Hospital; 1 woman to the Boston State Hospital; 1 woman to
Herbert Hall; 1 woman to the Westboro State Hospital and 1 woman to the
Danvers State Hospital. Four men and eight women were removed from the
State and 11 men and 7 women were deported.
There remained in the hospital at the end of the statistical year, 157 patients
less than at the beginning. The smallest number under treatment on any one day
was 2,225 and the largest 2,408. The daily average was 2,326.30.
The percentage of recoveries calculated upon the number of discharges and
deaths was 5.07; calculated upon the number of admission 7.09. The death rate
was 7.63 calculated on the whole number of patients under treatment, 10.8 cal-
culated on the daily average number.
PftiNCiFAL Causes of Death
Eleven per cent of all deaths were due to pulmonary tuberculosis; 11 per cent
to cerebral hemorrhage, 10 per cent to broncho-pneumonia; 10 per cent to cardio-
vascular renal disease; 7 per cent each to lobar pneumonia and general paralysis
of the insane.
Ex-Service Mkn.
During the year, there were 4 ex-service men committed to the hospital, 6
returned from trial visits, 9 returned from escape, 11 went out on trial visits, 11
left the hospital without permission, 2 died and 2 were discharged, leaving at the
end of the year 58 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.
Staff Changes.
Resignations.
Dr. George A. Gaunt resigned May 15, 1926, to go to the Foxborough State
Hospital.
Dr. Abraham Weidman resigned Dec. 31, 1925, to go into private practice.
Dr. Walford Johnson resigned Jan. 15, 1926, to go into private practice.
Dr. Russell T. Draper resigned Dec. 15, 1926, to accept an Interneship at the
Worcester City Hospital.
Dr. Juanita P. Johns resigned July 31, 1926, to take a Post-Graduate Course at
University of Pennsylvania.
Dr. William J. Curray resigned Jan. 29, 1926.
Dr. Rene Breguet resigned May 19, 1926, to accept a position in Chicago.
P.D. 23 5
Appointments.
Dr. Arthur McGugan was appointed Clinical Director Dec. 18, 1925.
Dr. Henry Moyle was appointed Senior Assistant Physician, Jan. 25, 1926.
Dr. Francis H. Sleeper was appointed Senior Assistant Physician, July 26, 1926.
Dr. Arthur C. Brassau was appointed Assistant Physician, Jan. 4, 1926.
Dr. Byron F. Brown was appointed Assistant Physician, Jan. 18, 1926.
Dr. Auray Fontaine was appointed Assistant Physician, May 24, 1926.
Dr. Jacob Goldwyn was promoted to Assistant Physician, August 3, 1926.
Dr. S. Spafford Ackerly was appointed Assistant Physician, Nov. 8, 1926.
Internes.
Nellie Pelecovitch, July 1 to Jan. 15, resigned.
Max Millman, July 1, to Nov. 20, resigned.
Jacob Goldwyn, Aug. 3, 1926, promoted to Assistant Physician.
Chester L. Glenn, Oct. 29, 1926, to May 25, 1927.
Medical Report
The medical activities of the hospital have been increased very materially
during the year, and some refinements of organization have been worked out
which have enabled us to carry on increased routine, and in addition, some special
projects which are still in progress. The plan of having a separate and distinct
personell to carry on the purely medical and surgical work has been continued.
It is not the intention to make this group an independent organization, but to
give the psychiatrist a department to use to clear up certain physical phases before
he makes a diagnosis and outlines a plan of treatment. We have been able to give
some attention to the correlation between somatic conditions and mental states.
The psychiatric services have utilized the medical service to the fullest extent and
in many cases a different psychiatric problem has appeared following an intensive
physical study of the patient. The phsychiatrist uses the medical and psychological
services and the Social Service Department as so many aids, and he coordinates
the findings of each one to clear up the psychiatric problems involved.
A separate medical service, therefore, is not concerned alone with the incidental
diseases developing in our population, but it enables the psychiatrist to evaluate
the physical findings in certain cases in the light of the psychiatric problem involved.
The hospital is now offering a twelve months' interneship in medicine and
surgery, and during the year four internes were trained on the medical service.
It is obvious that any large mental hospital has a sufficient amount of medicine
and surgery to make it an attractive hospital for interneship, especially where
the medical and surgical staff can be properly organized and where the hospital
is located near a city and an adequate visiting staff can be maintained.
This type of medical organization has enabled the psychiatric service to carry
on, in addition to routine work, two phases of psychiatry.
1. The dissemination of interest in psychiatric viewpoints by means of seminars
has been made available to various groups in the hospital. This work has been
carried on during the year under the direction of Dr. Lewis B. Hill, Assistant
Superintendent. The following groups have been given courses:
a. Internes and Staff members: Six staff meetings weekly, ward walks, and
frequent conferences have enabled us to give a comprehensive presentation of the
different schools of thought in psychiatry to the younger members of the staff and
the internes.
b. Social Service. A series of weekly seminars has been held for hospital social
workers and students, in which a systematic study of the psychiatric facts and
theories of value in social service work was made. A number of outside workers
were in regular attendance at this course.
6 P.D. 23
c. Training School: A regular psychiatric course was given student nurses.
This consisted of lectures, demonstrations, and ward instructions.
d. Occupational Therapy: A course was given for occupational aides and
workers in this department.
e. A short course with demonstrations was given a class in Psychopathology
from Clark University.
/. Theological Students: A group of students from theological schools was
given a seminar in personality studies.
g. Approximately sixty talks and lectures were given by the medical staff and
social service department to outside clubs and organizations. These talks covered
different phases of psychiatry.
2. The second purpose of the psychiatric service is to study the relation be-
tween the soma and the psyche and the following projects have been in progress
during the year.
a. Artificial febrile therapy (Malaria): A group of fifty cases of General
Paresis has been carefully and thoroughly treated by malaria inocculation. The
summary of the report of Dr. Russell Draper, who carried out the study, appears
on page 15, and the need for its continuance.
b. A study has been begun of the effect of the removal of foci of infection in
the upper respiratory tract upon the mental condition of patients suffering from
different psychoses. The records of 70 patients have been carefully worked out,
but this group is too small to permit any conclusions to be drawn. It will be
continued until at least 500 cases have been thoroughly studied. This project
has been carried out under the direction of Dr. Arthur Brassau.
c. Dr. Jacob Goldwyn has been investigating the sedimentation reaction in
the various psychoses, and we are so impressed with the value of this reaction as an
indicator of pathology that the test has been made routine on new patients.
Frequently in non-cooperative patients in whom physical examination is difficult
we have been able to find pathology where the sedimentation reaction time is
increased. A paper by Dr. Goldwyn on this study has been submitted for pub-
lication.
d. In collaboration with Dr. B. I. Walker, of the Evans Memorial in Boston,
Dr. F. H. Sleeper has been investigating the spinal fluid in the different psychoses.
A paper by Dr. Sleeper and Dr. Walker on "Tryptophane of the Spinal Fluid"
has been accepted for publication. This work is also being continued.
e. Dr. S. S. Ackerly has carried on a study of lipoidal uterine injections. A
paper has been submitted for publication on "Visualization of the Uterus as an
Index of Tonus of the Suspensory Ligament."
/. An investigation of the problem of Dementia Praecox from an endocrine
angle was started during the year. This work consists of complete psychiatric and
physical studies, supplemented by certain laboratory procedures. The plans for
this investigation contemplate at least a five year program. Several staff members
are collaborating in this work.
g. A medical seminar was begun during the year. Meetings are held weekly
and interesting problems of diagnosis and treatment from a medical and surgical
standpoint have been discussed. Members of the medical staff have presented
papers bearing upon medical and surgical problems in psychiatric hospitals.
The routine work of the hospital has increased, as the following reports will
show.
Laboratory Report
The laboratory, under the direction of Dr. F. H. Sleeper, has carried an in-
creasing burden during the year. It is obvious that as the medical and surgical
work of the hospital becomes greater, there is a greater demand upon the laboratory.
Much new equipment has been added, and during the year the entire building was
renovated and repainted.
P.D. 23 7
The laboratory report follows:
Autopsies, 64; Bacterial Cultures, 35; Bacterial Smears, 119; Blood Sugars, 176;
Blood Non-protein Nitrogen, 41; Blood Urea Nitrogen, 37; Blood counts — Red,
396;White, 478; Differential, 481; Haemoglobin, 438; Sputum, 112; Spinal Fluid —
Cell count, 221;— Globulin, 240;— Albumin, 176;— Gold Sol, 232; Urinalyses, 2163
Basal Metabolisms, 32; Microscopical sections, 68; Blood Wassermanns, 191
Blood Clotting Time, 139; Urinalyses Quantitative Sugar, 35; Stool Analyses, 58
Renal Function Test, 23; Alveolar Co. Test, 19; Blood Creatinin, 3; Animal
Inocculation, 2;Pla smodia Examination, 19; Animal Autopsies, 1; Vaccines, 1;
Galactose T olerance, 5.
Dental Report
The work of this department has been carried on under the direction of Dr. P.
R. MacKinnon. We have continued our policy of taking a third year dental student
into the department during the summer months. This plan has proven to be very
satisfactory. The following table gives an idea of the year's work in detail.
Patients, 3281; Cleanings, 1672; Fillings, 1055; New Plates, 40; Repairs to Plates,
52; Treatments, 899; Extractions, 1831; Porcelain Jackets, 2; Bridges, 5; Crowns,
(Three quarter veneer), 2; Alveolar ectomy, 1.
Clinics
Our system of daily clinics for patients has been continued. To these clinics
are referred patients from the psychiatric service for examination and treatment.
This method of handling the incidental physical conditions which develop in a
population of this size has proven to be the most efficient method and conserves
the time of the Staff very materially, and gives better service to the patient. During
the year, 233 patients have been referred to the Gynecological clinic and 382 patients
have been referred to the eye, ear, nose and throat clinics.
Surgical Report
The surgical work of the hospital has been under the direction of Dr. F. H.
Sleeper. The amount of work has increased very materially, and the surgical
needs of our population have been cared for by the visiting surgical staff. The
following report gives the details of this work;
Lysis of adhesions for intestinal obstruction, 2; Posterior gastro-enterostomy, 3;
Appendectomy, 8; Herniotomies, 5; Epididymotomy, 1; Incision and drainage
peri-anal abscess, 2; Choi cystectomy and cholidocotomy, 1; Amputation of right
leg, 1; Amputation of left foot, 1; Open reduction right tibia and fibula, fracture,
1; Dilatation and curettage, 1; Thoracotomy, 3; Mastoidectomy, 3; Tonsillectomy,
71; Removal of lipoma, 2; Excision of carbuncle, 4; Excision and curettage of ischio-
rectal abscess, 2; Exploratory laparotomy, tumor of bladder inoperable, 1; Ex-
ploratory laporatomy, pyonephrolithiasis inoperable, 1; Supra-public cystotomy,
3; Curcumcision, 1; Excision of epithelioma, 1; Excision of toe nail, 1; Resection
of rectal fistula, 4; Prostatectomy, 1; Excision of neuromata, 1; Hemorrhoidec-
tomy, 2; Gastrotomy 1; Oophorectomy, 1; Salpingectomy and oophorectomy, 1;
Splenectomy, 1; Sub-mucous resection, 1; Removal of nasal polypi, 4; Thoracen-
tesis, 2; Drainage and irrigation of antra, 2; Cystoscopy, 2; Incision and drainage
of cervical abscess, 2; Plastic operation on stump of amputated foot, 1; Excision
of inguinal gland, 1; Bottle operation for hydrocele, 1.
X-Ray Department
This department, like the other departments in the hospital, has shown increased
volume of work. The following report made by Mr. Pariseau, the technician in
charge of the X-Ray laboratory gives the details of the routine work:
Total number of patients referred from Medical Department, 305; from Dental
8 P.D. 23
Department, 200; Total, 505. Total number of Fluoro-scopic examinations, 45.
Classes of cases referred for examinations: Chest and ribs, 97; Heart, 5; Teeth
and Jaw, 208; Head and head sinuses, 53; Shoulder and clavical, 9; Wrist and
forearm, 16; G. I. Series, 29; Nose, 10; Spine, 17; Hip and Legs, 22; Hand and
elbow, 22; Knee, 4; Ankle and foot, 15; Bladder and kidney, 6; Mastoids, 3;
Abdomen (foreign body), 2.
Hydrotherapy
The hydrotherapy Department has been enlarged and is carrying on a large
amount of work. We have utilized hydrotherapy very extensively, and the
following table, prepared by Miss O'Hara, shows this work in detail:
Electric Light Baths, 180; Salt Glows, 125; Saline Baths, 221; Sitz Baths, 35;
Hot and Cold to Spine, 124; Tub Shampoos, 202; Hair Shampoos, 174; Foot Baths,
193; Fomentations to abdomen, 7; Fomentations to Shoulder, 5; Needle Sprays,
940; Fan Douches, 811; Jet Douches, 91; Foot Baths as Preparatory Treatment,
296.
Wet Sheet Packs: No. of Patients, 690; No. of Packs, 10522; No. of Hours,
39717^.
Continuous Baths: No. of Patients, 710; No. of Baths, 11718; No. of Hours,
93362^.
Local Electric Light Treatments: No. of Patients, 15; No. of Treatments, 171.
Massatherapy: No. of Patients treated, 13.
Instructions (Wet Sheet Packs): No. of Attendants, 158; No. of Lessons, 147;
No. of Hours, 216.
Continuous Baths: No. of Attendants, 115; No. of Lessons, 170; No. of Hours,
323.
Occupational Therapy
The school for occupational therapy which has been in existence for the past
three years was discontinued following the graduation of 3 students in June. The
school was a success and fulfilled the function for which it was organized, namely
the training of occupational therapists along the lines indicated by our own particu-
lar needs. During the year, the hospital has completed plans for affiliation with
the Boston School for Occupational Therapy. The course in the school has been
increased to 18 months, and 6 months of this time will be devoted to hospital
training. The first class will enter in 1927. We have had an average of 8 occu-
pational therapists in the department during the year, and there have been in
operation 9 female and 4 male classes — an average of 241 patients having been
treated in this class.
Social Service Department Report
Statistics are not adequate to present the work carried on by this department.
The following report, made by Miss Theodora E. Land, Head Social Worker,
gives a more vivid picture of what social service represents to the hospital than a
volume of tables could present.
During 1926 the Social Service Department of this hospital handled a total of
509 cases. An average of 233 cases were under the care of this department each
month. Of this number, the larger part, approximately two hundred, were patients
placed on visit, who during their year's visit from the hospital were technically
under the responsibility of the Social Service. Of the other cases, special in-
vestigations and investigation of home conditions prior to visit formed the largest
portion of service to the hospital. About one hundred forty cases were carefully
investigated as to facts regarding the life of the patient before he came to the
hospital. Such investigations are frequently essential to an adequate under-
standing of the patient's present problems. Frequently the diagnosis is dependent
on information obtained from various sources outside the hospital. The relative
coming to the hospital to give the history gives only one picture of the patient's
life, and many times is too close to the tragedy of commitment to give an unbiased
P.D. 23 9
story. From four to fifteen interviews are required, besides information obtained
from letters, in order to obtain sufficient data for the medical social history, so it
can easily be seen that the special investigations form an important part of the
work.
Frequently, when a patient is ready to leave the hospital, the question arises
as to whether or not the home situation is such as to be conducive to continued
mental health. An unstable, quarrelsome wife, herself on the verge of a break-
down,and somehow unable to accept the fact that the patient's former accusations
against her were due to a disordered mind, is hardly the person to whom to send
a patient who, although not fully recovered, is yet able to maintain himself in the
community. An irresponsible father, fond of drink, would not be the best kind
of an associate for a recently recovered alcoholic case. In order not to place
patients where the same factors which were in part responsible for the first break-
down would again play a part in their undoing, 131 home investigations were made.
This means that not only was the home visited, but various other community
sources, such as ministers, priests, physicians, and relatives were seen. When the
home situation is impossible, an effort is made to arrange for the patient's care
elsewhere in the community.
The problems presented in the cases referred to this department are varied and
interesting. They may be grouped as follows:
1. Employment difficulties. Both in incoming and outgoing patients the
question of employment is a serious one. Sixty-six patients, or about 13 % of the
group, were referred because of this problem. In most instances employment had
to be assured before the patients could leave the institution.
2. Ma ital difficulties. 26 patients were involved in marital troubles of one
sort or another.
3. Financial difficulties. Only 21 cases in which financial difficulties were
outstanding occurred in this group. However, in most of the patients for whom
employment was a problem, this was a secondary need.
4. Sex problems. Outstanding difficulties from the social worker's standpoint
occurred so infrequently that they were not tabulated. There were probably a
dozen to fifteen cases. Usually the problem came up in connection with the
group of young psychopaths who, while not belonging literally to a State hospital
population are still frequently sent here because there is no institution to whi ch
they are eligible. When this problem occurred, it was naturally a most difficult one
with which to cope.
5. Friction. In the family or with others, was a factor in 35 cases — sometimes '
very vital one.
6. Unsuitable surroundings. There were 30 instances of this.
7. Alcoholism. This Department is impressed with the large number of al-
coholics coming to its attention. In a special study of 50 cases referred for in-
vestigation, 20 were found to have had alcoholic histories.
The problems growing out of mental disease are many, and it is unnecessary to
tabulate them further.
As to service rendered, the fact that 335 of the 504 cases were referred by
physicians indicates, perhaps, the dependence the doctors feel on social service for
necessary information regarding their patients. A good share of the time is spent
in obtaining this information, for we realize its great importance to the patient.
The very important task of bringing about adjustments between individuals
and their environment, or in their personal relationships was effectually accom-
plished in 46 instances. This, of course, is the most difficult work of the social
worker. To accomplish this, obtaining employment was often a factor. This is
a Herculean task, because of the prejudice of employers against former patients.
For 35 patients work was found. Some ten or twelve of these patients unfortunately
had to be returned, but all were out at least a few weeks, and thus not only saved
10 P.D. 23
hospital expenses, but enjoyed some respite from confinement. Several very
difficult cases are apparently doing well in the community over a period of a year
due to social service supervision.
For most of the other patients on visit a word of advice, consultation at the
Out-Patient Clinic, or the chance to "blow off steam" to a social worker has been
all that was necessary. In a number of instances patients who left the hospital
not recovered were carried along under supervision until the social worker felt
they should be returned. 642 visits were made for the purpose of supervision.
A hospital of this kind should be also an educational center. To this end the
workers have on 14 occasions given addresses and lectures regarding their work.
But the most important contribution to the educational program has come
through the Smith College School for social work, which has this year sent us two
splendid students, who are not only learning the social implications of psychiatry,
but are writing theses which will undoubtedly be of value to us as well as to them.
Yearly Report of the Out-Patient Department
The Out-Patient Department, under the direction of Dr. H. B. Moyle, has
grown during the year, and the following report by Dr. Moyle indicates the scope
of the work carried out.
The Out-Patient work of this hospital has always comprised several rather
distinct lines of activity. The first function of any Out-Patient department is, of
course, the keeping up of contact with the patients who have gone out from the
hospital and in this way to judge to some extent how far the situation is satis-
factory, and when changes should be advised in the environment or when it may
be desirable to return them to the hospital for a period. A second type of service
which has always been offered is that of seeing any adult in the community, who
either presented signs of mental abnormality or where there was a question of
needing institutional care. A third function which has been assumed by the
State Hospitals in Massachusetts has been that of examining the retarded
children in the public schools; each hospital, for this purpose, having a district
and being responsible for serving the schools in this district in this way. A fourth
activity, which has taken recently a rather large place in the Out-Patient work of
this hospital, has been that of the Child Guidance Clinic, dealing with behavior
disorders of all types in children.
The first three of these lines noted above have been carried on during the past
year with little, if any, change in methods. A regular monthly clinic for patients
on visit from the hospital has been held at the Summer St. Department recently
the second Monday in the month and there has been on the average about twenty
patients who have been interviewed at this time. On the whole, these patients
are those who live in or near Worcester, though some often come from surrounding
towns. There is no doubt that these interviews are of real value in keeping in
touch with the progress and situation of the patient and at times of knowing when
a patient needs to return to the hospital. It is also of value to the patients them-
selves in the way of stimulus and encouragement at times of difficulty and this
is fairly evident from the attitude with which they come to the interview and the
freedom and even eagerness with which they discuss their situation. There are,
of course, those who desire to forget their hospital residence as soon as possible,
but there are a considerable number of others, who found in the hospital help and
understanding which they had not known previously and who value the oppor-
tunity to still discuss, after leaving the hospital, their personal problems with one
of the physicians. If for no other reason this type of Out-Patient activity is fully
worth the time and effort involved because of the chance it offers to gain an intimate
glimpse as just to what the hospital residence has meant to many patients.
The second type of service spoken of, that of seeing adults who feel the need of
counsel because of mental difficulty, has not yet been very largely developed for
P.D. 23 11
various reasons. A few patients, however, have been seen at the request of other
hospitals and of charitable agencies, with reference to the particular type of
treatment or help that the individual really requires. These various agencies have
said repeatedly that they find the possibility of such counsel to be a valuable help.
It would certainly seem possible that the scope of this service could be greatly
extended were it possible, for instance, to offer such psychiatric counsel as a part
of the service of a general hospital Out-Patient Department. For obvious reasons
many people have a natural reluctance to come voluntarily to talk with one who
is known as a psychiatrist and therefore, those who need such help often keep that
fact to themselves and interviews are only brought about indirectly.
The department has conducted the examination of retarded school children as
in past years, in response to requests from any school in the district which desires
any such examination. During the year, examinations have been conducted in
the towns of Shrewsbury, Grafton, Blackstone, Millville, Westford, Pepperell,
West Boylston, Jefferson and Holden, and in all about 150 children have been seen.
It is of some interest to note that of these children about 70 % have had one or more
remedial physical defects, such as enlarged tonsils, carious teeth, deafness or
general under-nutrition, oftentimes, several of these occurring together. When
such school surveys are made, the attempt is made, so far as possible, to see the
parents of the child and discuss these conditions with them, and in these cases
usually, there has been marked appreciation of the help offered. Talks have been
given to teachers also in reference to the problems involved with the dealing
with retarded children in school and a great deal of interest has been manifested
in this way. A good deal might be said about the various problems met in such
type of work, but it is sufficient to remark that the schools are increasingly taking
advantage of this type of help and are apparently finding it of real value.
It is probable, notwithstanding the importance of the types of work noted above,
that the most distinctive contribution of this hospital in the Out-Patient field has
been the carrying of the Children's Clinic. This has been in existence now for
about six years and the fact that upwards to 700 children have been brought to
the clinic for advice because of all sorts of problems is proof enough that a real
need exists for such service in this community. Nowadays, however, there is
rarely any argument as to the need but merely as to how it should be met; most
hospitals largely confining their work to the numerous and complicated problems
within their own walls. It is a fact, however, that this hospital is attempting in a
fairly thorough fashion to demonstrate the belief that any psychiatry which does
not reach out into the field of prevention is short sighted and to some extent
sterile. The work of the "Child Guidance Clinic" as it is now designated in con-
formity with the general practice, is a concrete expression of this conviction applied
at a point where it should show some results evident to any informed observers.
Building on the basis of a most cordial relationship with the Memorial Hospital
which generously opens its Out-Patient department for the use of the clinic, the
attempt has been made not only to study as thoroughly as possible the children
who have been brought to the clinic, but also to seek how best to extend the scope
of the work so as to serve the community to the fullest extent. Some results of this
will be noted later.
Any statistical account of work of this nature must of necessity give only a
partial view of what is accomplished. An analysis of the work of the year never-
theless is of real interest. During the past year some 128 different children have
been studied at the clinic, some only coming once, but a number returning regularly
for a considerable period. It is of some interest to note the sources from which
these have come. It is generally recognized that the Juvenile Court presents many
problems for this sort of study and 16 children have come in this way for various
reasons, theft, chronic truancy, running away from home, etc. There is no doubt
this field is a large one and offers considerable scope for further development in
12 P.D. 23
this community. A nearly related group is that of the unmarried mothers in the
care of the Girls' Welfare Society which uses the clinic regularly, 19 girls being
studied during the past year. While a degree of mental deficiency has been found
among these girls, an even more outstanding factor is the lack of home training
and supervision in most cases.
It is becoming increasingly apparent too that the dependent child in foster home3
needs careful study if the best results are to be gotten from the efforts of child
helping societies. Of this group, 10 children have been referred by the Children's
Friend Society for various reasons such as lack of adjustment in foster homes,
various behavior problems, etc., seven children from the Society for Prevention of
Cruelty to Children, three by the Worcester Department of Public Welfare and
three at the request of the State Division of Child Guardianship. Space will not
permit going into the problems involved but here too the field is undoubtedly
expanding.
It is worth noting that twelve children have been studied at the request of the
City and Memorial Hospitals and of private physicians. It is real satisfaction to
speak of the cordial relationship that exists in this connection and the opportunity
of such service will doubtless become greater the more widely the work of the clinic
is known to the profession at large.
Another field that is opening more widely all the time and in importance second
to none is that of the schools. Some thirteen children have come in this way
largely because of behavior difficulties of various sorts and the cooperation and
interest of school authorities and teachers have been most encouraging factors in
the work of the clinic. It is felt that this field offers an almost unlimited oppor-
tunity for future development and a service to the community of a most important
sort.
Another interesting group of patients 26 in number, were brought by their
parents because of various difficulties in home or school. There is no need to enlarge
on the importance of this group or the value of a better understanding by puzzled
parents of the availability of such help without any stigma of inferiority attached.
The remaining 18 children have come from a variety of sources, district nurses,
associated charity workers, etc., where the children were often important factors
in family situations or their needs were discovered in an incidental manner.
It has been demonstrated that an important part of the work of such a clinic is
of an educational sort, both with regard to the workers with children and the
public at large. In an effort to somewhat meet the former need, regular weekly
"Case Conferences" have been held with the discussion of typical problems from
various angles. These have been well attended and frequent expressions of their
value made by the members of the group which incidentally represents a wide
variety of interests from Y. M. C. A. secretaries to hospital social workers.
An effort to inform the community at large more thoroughly about the work
of the clinic and to secure the support of those interested in its objects was made
through the organization of an advisory committee of representative citizens in
October last. Very gratifying response was made by those approached and there
are now some twenty members of this committee, physicians, educators, lawyers
and men and women actively interested in social advancement in this city. Monthly
meetings have been held, reports of the clinic work given and addresses on various
topics related to the work of the clinic have been given by local and outside
specialists. It is felt that the organization of this committee offers a means of both
solidifying the public support of the clinic's work and opening new avenues of
service to the community.
Altogether the Out-Patient physician finds a spirit of cooperation on all sides
which is both encouraging and stimulating. Results cannot be tabulated, but
reports of progress are certainly sufficient to warrant all the expenditure of time,
money and effort possible. Those conversant with the situation feel that the
P.O. 23 13
opportunity for this type of service in the community is steadily widening and the
need becoming more insistent.
The Religious Services
The religious care of our patients has been carried on by Father James Mitchell,
the Reverend Anton Boisson, and Rabbi Abraham Alpert, all of whom are attached
to this hospital as permanent chaplains. The following summary of the report
by Mr. Boisson of the year's work gives an indication of what is being accomplished
in this particular department.
The work of the chaplain falls into five divisions: (1) the conduct of the religious
services on Sunday; (2) personal contacts with patients on the wards; (3) intensive
work with selected cases; (4) a recreational program; (5) educational activities.
The religious services have had an average attendance of 180, with 120 at the
main building and 60 at the Summer Street Department. These services have been
greatly helped by a new service book prepared especially for use in hospitals.
The book provides a compact collection of hymns, prayers and passages of scripture
which are likely to have a comforting, steadying and generally wholesome influence
upon those who are suffering from morbid fears and anxieties, a collection from
which the inapplicable and the disturbing are as far as possible excluded. A
generous subsidy, given by interested churches, has covered the cost of making
the new plates and has made it possible to offer the book at a nominal figure.
The intensive case work is an experiment which has for its purpose to determine
how far particular types of mental disorder may be explained in accordance with
the principles of the psychology of religion and how far the ideas and attitudes
may be modified through the religious approach. It seeks also through the study
of pathological cases to contribute towards the understanding of the psychical
laws which are involved in the more normal types of religious experience. This
project has now been in process for three years. The preliminary conclusions
appeared in the American Journal of Psychiatry for April, 1926, under the title
of "Personality Changes and Upheavals arising out of the Sense of Personal
Failure."
Under the theory that in the functional disorders we are dealing with exaggerated
forms of certain common types of experience with which the religious worker
should be very much concerned, the chaplain is seeking to bring to the attention
of the coming generation of religious workers the problems represented by this
group of sufferers. To this end he is serving three months each fall as special
lecturer at the Chicago Theological Seminary. He also brings to the hospital in
the summer a group of theological students in order that they may get clinical
experience in dealing with maladies of the personality. During the current year
four students served in the hospital, two of them, Mr. Herman Johnson of the
Chicago Theological Seminary and Mr. R. L. Mondale of the Harvard Theological
School served as attendants on the wards. The other two, Mr. E. C. Allen and Mr.
Orlo B. Stewart, both of the Boston University School of Theology, were in charge
of a recreational program. They thus took charge of the base-ball and volley ball
activities, they got out a hospital newspaper and "pictorial" and they held frequent
choir rehearsals and "community sings." For the benefit of these students, special
lectures and conferences were arranged with the help of the medical staff twice each
week.
Special acknowldgment should be made of the help given by All Saints Church
in Worcester and by its rector, Rev. Henry W. Hobson, who has taken charge of
the services once a month in each hospital and has in addition conducted once a
month a special communion service. Mr. Hobson has helped also in many other
ways. Acknowldgment should also be made of the help given by the Massa-
chusetts Home Missionary Society, which contributes six hundred dollars a year
14 P.D. 23
toward the salary of the chaplain and furnishes the sum of ten dollars a month to
be used in the interests of patients.
Training School
The work of the training school of Nursing, under the leadership of Miss Florence
Woodridge, has been carried on as usual throughout the year. Nine nurses were
graduated in June. Three left to go into private nursing, one went to a contagious
hospital in order to get more experience in this specialty, one took charge of an
operating room in a general hospital, and four remained with us, holding positions
of supervisors or head nurses.
A radical change was made in the salary of preliminary students. The remun-
eration for students was placed at $25 per month, and the student's hours were
decreased to 8J^ hours per day, stationery and uniforms being provided by the
school. This change was made after very careful consideration, for the following
reasons:
1. With the larger salary, the student did not put the proper emphasis upon
the education she was receiving as a just reward for her services.
2. There was too little difference between the salary received by student nurses
and that paid a head nurse. This tends to keep our graduates from remaining with
us.
3. We hope to draw to the school the woman who is really interested in nursing
as a profession and who is willing to make financial sacrifices to gain her education.
Plans have been perfected during the year for a three months' course to be
offered student nurses from general hospitals. Two general hospitals have accepted
the affiliation and will send students for the first course on January 1st.
The course for attendants, consisting of thirty hours' instruction, has been
carried on during the year.
General Repair Work
The regular repair work of the hospital has been kept up throughout the year.
During the last half of the year our mechanics gave most of their attention to
the completion of the new dining room, which we expect to open early in 1927.
This work necessarily prevented any larger construction projects from being
completed during the year.
Recommendations
Certain needs to which I have called attention in previous reports still exist
and are becoming more urgent. Perhaps the most important of these is the need
for a new farm unit for our herd, at the main farm. The reasons for this need are
obvious and need not be enumerated here.
Another urgent need is the erection of a number of cottages for members of the
medical staff. In order to attract the highest type of physician into this service,
we must provide adequate quarters where he can have a family and live a normal
life. Five to seven room cottages should be erected upon the grounds for housing
the families of the Staff Members.
I again call attention to the necessity for a continuation of the program for the
elimination of our stairways of wood construction. They are a fire menace and
should be taken out and metal stairways substituted as rapidly as possible.
In concluding this report, I take the opportunity of expressing my sincere thanks
to the members of the visiting staff of the hospital. They have given very freely
of their time and energy and have been ready and anxious to assist at all times.
To the medical staff, officers, and employees of the hospital I wish to acknowledge
my indebtedness. In carrying out the function of the hospital — namely, the
treatment and cure of patients, no success is possible without the loyalty and
cooperation of every officer and employee. This I have had.
P.D. 23 15
I wish to thank the Board of Trustees for the support and encouragement given
me at all times.
Respectfully submitted,
WILLIAM A. BRYAN, Superintendent.
SUMMARY OF THE REPORT ON GENERAL PARESES
by Russell Draper, M. D.
Types of Patients used fob Inoculation jvith Malaria
Patients used were those diagnosed as General Paresis from history, mental,
physical, neurological and serological examination with the exception of two
cases which were under diagnosis of Psychosis with Cerebral Syphilis who were
also inoculated and included in this series. There was no particular choice of
material, those cases being rejected that were considered in the fourth stage and
death so near that the inoculation with malaria would only hasten death. Two
cases were rejected because of severe aortic regurgitation in conjunction with the
Paretic condition.
Method of Inoculation with Malaria
The organism used is a benign form of the Tertian Type of malaria.
Time of Inoculation: The length of time incident to production of chills following
inoculation varies directly v/ith the time in the asexual malarial cycle that the
blood is withdrawn and inoculated. Example of this rule is shown when
blood is withdrawn immediately following a chill and inoculated into another
human, the one inoculated will start to show signs of chills and rise of temperature
much sooner than if the withdrawal and inoculation had been made some hours
after the chill and rise of temperature had subsided. This is probably explained
by reason of the organism being free in the blood stream at the time, and im-
mediately attacks several cells in the human inoculated, wherein if the malaria
organism is already present in red cells when inoculated into another human, the
destruction with beginning of the new process requires a longer time. It has been
observed also that inoculation shortly after chills is followed within a few hours
by a marked rise in temperature without chills which is probably due to protein
reaction. This reaction is not so pronounced when blood is taken and inoculated
late in asexual cycle or at a time when no rise of temperature or chill is present.
Method of Inoculation: Clotting within the needle or the syringe makes it
necessary to use some method by which blood can be kept from clotting during
the transmission from one patient to the other. On both patients the procedure
is carried out under a septic precaution. Green soap and alcohol being used to
prepare the skin over the veins to be used. Syringe and needle being previously
sterilized. 10 cc. of sterile sodium citrate drawn into syringe. Needle placed on
syringe. After preparation of arm and use of tourniquet, the needle is placed in
vein and 2cc. of blood withdrawn and mixed with the lice, sodium citrate. Needle
withdrawn and discarded. New needle placed in vein of patient to be inoculated.
When vein has been entered, syringe attached to needle and few cc. of blood with-
drawn from vein, then very slowly the contents of the syringe are emptied into
the vein. Needle withdrawn and sterile dressing applied. Patient placed on
four hour chart, when any rise of temperature is recorded hourly.
Administration of Quinine in Average Cases: When a sufficient number of chills
have been completed and a termination decided upon, ten grains in capsule three
times daily for the first week followed by ten grains once daily for a week of Quinine
sulphate administered by the month giving a total of 280 grains of Quinine sulphate
over a period of two weeks. This in all cases has been sufficient to efficiently check
the malarial condition. On many occasions the marked rise in temperature with chills
follows in its regular course after first administration, but more than this is un-
common. In several cases even after one week or more there was a rise in tempera-
ture accompanied by chills but was not repeated. It was considered an auto-toxic
16 P.D. 23
condition at first and enemata used with usually an excellent result but in some
cases no enemata used with equally good results, so I feel that the explanation
would be better fitted if this condition might be considered as some malarial
parasites in secluded organs being pushed into the blood stream giving the rise in
temperature and chills. As the blood stream at that time is Quininized those
malarial organisms meet an early fate and the temperature remains normal there-
after unless some other malarial organism is harbored in some secluded spot out
of reach of the Quinine Therapy and are discharged into the blood stream.
Emergency Cases: When for any reason the termination of malaria course
becomes neccessary immediately, the ampules of Quinine Di Hydrochlorid gr
viiss intravenously have been used but always followed by tremendous reaction
immediately following or within a few hours after administration. Temperature
rises far above the average. Chilling temperature and prostration profound,
adding seriously to the already exhaustive condition. This usually subsides and
no further chills or rises of temperature occur. It occasionally becomes necessary
to repeat this intravenous administration but almost invariably the cases have
terminated fatally.
Reactions to Malaria: The general types of patients in reference to reaction
after inoculation were several. First type — Those patients that responded with
typical tertian malaria chart, having chills every other day, Second type —
Those patients starting with typical tertian malaria chart but changing to
daily chills of a more severe intensity. Third type — Those patients starting with
typical tertian malaria chart for period of 3, 4 or 5 chills, then spontaneous re-
mission with no further rises of temperature or a new expression on the patient's
face, a marked change from the paretic type to a decided brightening up. In
some patients, this change did not occur until the administration of Quinine
sulphate and others not until some time after the completion of the entire course.
Only in rare instances was there any medication to check the intensity of the
reaction until it was decided to check the chills. Vomiting was an uncommon thing
but happened occasionally due to the fact that food given was too heavy at time
patient was about to have chill or shortly after chill. Light house diet was used
through the entire course, being withheld at or near time of chilling. Water
given ad lib but was at times followed by regurgitation when given at the height
of the chill.
Jaundice of different grades of intensity were present in every case especially
at the onset of the malaria but generally subsided after first few chills.
Anemia. All cases appeared to be markedly anemic, pale and white with some
loss in weight and strength following the malaria but rapidly regaining strength
and weight. Elix Iron, Quinine and Strychnine being administered, three times
daily after the Quinine sulphate therapy had been completed.
Malaria Paresis
No. of Patients Inoculated: Males, 43; Females, 7; Total, 50 ...
Types— Expansive 24 48%
Depressed 18 36%
Agitated 2 4%
Paranoid 6 12%
Total 50
Average No. of Chills, 12.05; Average period of days, 23.88.
Number— Patients dead 6 12%
Patients improved 40 80%
Patients unimproved 4 8%
Patients Dismissed on Visit 14 2%
P.D. 23
17
Anti-Luetic Treatment
Improved Unimproved
No. PerCent No. Per Cent
Mentally 8 16% 42 84%
Physically 10 20% 40 80%
Neurologically 3 6% 47 94%
Serologically 28 56% 22 44%
Malaria Treatment
Mentally 40 80% 10 20%
Physically 37 74% 13 26%
Neurologically 30 60% 20 40%
Serologically 36 72% 14 28%
Expansive Type
No. of Cases, 24 Improved Unimproved
Mentally 19 5
Physically 17 7
Neurologically 13 11
Serologically 20 4
Depressed Type
No. of cases, 18
Mentally 13 5
Physically 12 7
Neurologically 10 8
Serologically 15 3
Agitated Type
No. of Cases, 2
Mentally 1 1
Physically 2 0
Neurologically 1 1
Serologically 2 0
Paranoid Tyi-e
No. of Cases, §
Mentally 5 1
Physically 5 1
Neurologically 5 1
Serologically 5 1
DEATHS MALARIAL ETEOLOGY
Case No. Primary Cause Contributory Cause Cause
36,804! Myocarditis General Paresis Direct
35,805 General Paresis Tuberculosis Direct
36,440 Lobar Pneumonia General Paresis Indirect
35,493 General Paresis Splenic Hemorrhage Direct
36,216 General Paresis Exhaustion Direct
35,972 General Paresis Septicemia Indirect
Remarks — Six deaths — four considered directly due to malaria; two indirectly
or incidentally to malaria. Autopsies on Nos. 36,440 and 35,493. See autopsy
report under abstract.
Paretic Seizures
No. of Cases, 11—22%
18 P.D. 23
Anli-Luetic Treatment
No. Per Cent
Improved , 2 4%
Not Improved 9 18%
Malaria and Anti-Luetic Treatment
Improved 8 16%
Not Improved 3 6%
Paretic Seizures in the above series, based on history and clinical Signs on ad-
mission were present in 22% of the cases. By means of anti-luetic treatment
there was an improvement in 4% whereas by the use of malaria in conjunction
with anti-luetic treatment there was an improvement in 16%.
Improved
Total number of cases 50
Social adjustments 40 80%
Industrial adjustments 14 25%
Remarks
Social Adjustment is considered as such in patients who were prior to inoculation,
untidy, destructive, ward problems because of resistive and aggressive habits but
followed by recovery or marked improvement of these conditions.
Industrial Adjustment is considered as such in patients wherein there is a complete
remission of mental symptoms, with improvements to such an extent that they
may be dismissed on visit relieving the community of burden of patients hospital-
ization and with partial or complete self-support.
Not Improved
There were only four (4) patients out of the series of fifty (50) that showed no
improvement at all. One patient showed a reversal of mental condition, he being
a depressed type prior to inoculation who changed to an expansive and agitated
type. The remaining three patients continued to progressively deteriorate,
mentally, physically and neurologically.
Clinical Conclusions
(1) That malaria is a valuable adjunct in the treatment of N euro-Syphilis.
(2) That Malaria can be used for any patient in the treatment of Central
Nervous Syphilis, when properly supervised, except in the late cases, and those
patients showing reaction to Quinine or other methods of checking the condition,
but treatment must be carried out in a location so arranged as to prevent the
infection of individuals not receiving treatment by means of Malaria.
(3) That patients having only a small number of chills followed by spontaneous
remission from the chills improve as well as patients having a great number of
chills.
(4) That the death rate is low compared with the incidence and mortality in
untreated cases and in cases treated solely by other methods.
(5) That treatment by means of malaria is valuable from an economic stand-
point insofar as recoveries (termed as social and industrial adjustments), corrections
or even improvement of destructive untidy or assaultive patients are concerned.
(Benefit to patient, friends, hospital management).
(6) That the number of remissions are far more common, with the use of
malaria, than with the use of any other method of therapy in vogue at the present
time.
(7) That by the use of anti-luetic treatment in the form of Arsphenamine and
Sulph-Arsphenamine by Intramuscular, Intravenous and Intraspinous routes
brought about the following results:
P.D. 23 19
Mental Improvement in 16%
Physical Improvement in 20%
Neurological Improvement in 6%
Serological Improvement in 56%
WHEREIN MALARIA in conjunction with the above methods brought about:
Remissions in 26%
Mental Improvement in 80%
Physical Improvement in 74%
Neurological Improvement in 60%
Serological Improvement in 72%
From this series no figures can be offered directly as the results of malarial
therapy because of the factor of Anit-luetic Therapy in combined use.
Note: — Serological improvement means a lowering in the number of cells,
tendency of albumen and globulin to lessen and a distinct change in the gold curve
namely, the curve being lowered and moved to the left.
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, 1926.
Cash Account
Receipts
Income
Board of Patients $109,493.67
$109,493.67
Personal Services:
* Reimbursement from Board of Retirement 244 . 27
Sales:
Travel, transportation and office expenses $2 . 85
Food 774 . 61
Clothing and materials Ill .20
Furnishings and household supplies 60 . 14
Medical and General Care 93 . 57
Heat, light and power 72 . 25
Farm:
Hides $177.02
Vegetables 147 . 89
Sundries, Tools 1 . 00
325.91
Garage, stable and grounds 92 . 98
Repairs, ordinary 217 . 69
Total Sales $1,751.20
Miscellaneous:
Interest on bank balances $1,429. 19
Rent 1,140.00
$2,569.19
Total Income $114,058.33
Maintenance
Balance from previous year, brought forward $4,274.44
Appropriations, current year 793,010 . 00
Total $797,284.44
Expenses (as analyzed below) 756,402 . 14
Balance reverting to Treasury of Commonwealth $40,882 . 30
Analysis of Expenses
Personal Services $377,850.99
Religious Instruction 2,660 . 00
Travel, transportation and office expenses 8,706 11
Food 169,924 '22
Clothing and materials 18,563 . 27
Furnishings and household supplies 40,003 .87
Medical and general care 34,964.38
Heat, light and power 47,655 35
Farm 25,358.25
Garage, stable and grounds 6,377 . 90
Repairs, ordinary 20,109 . 66
Repairs and renewals 4,228 . 14
Total expenses for Maintenance $756,402 . 14
20 P.D. 23
Special Appropriations
Balance December 1, 1925 §155,219.. 08
Appropriations for current year 12,000 . 00
Total $167,219.08
Expended during the year (see statment below) $141,125 . 92
Reverting to Treasury of Commonwealth 1.00
— 141,126.92
Balance November 30, 1926, carried to next year $26,092 . 19
Object
Additional fire pro-
tection
Dining room
Fire Protection, 1925 .
Automatic refrigera-
tion
Equipment for Dining
Room
Acts or
Resolve
Acts 1924, Chap. 510
Acts 1925, Chap. 211
Acts 1295, Chap. 347
Acts 1926, Chap. 79
Acts 1926, Chap. 398
Whole
Amount
$8,000.00
150.000.00
1S,000.00
7,000.00
5,000.00
$188,000.00
Expended
during
Fiscal
Year
$4,989.18
119,237.70
13,178.17
3,580.02
140.85
$141,125.92
Total
expended
to Date
$7,999.00
137,008.80
13,178.17
3,580.02
140.85
$161,906.84
Balance
at end of
Year
1.00*
12,991.20
4,821.83
3,419.98
4,859.15
3,093 J «
Balance reverting to Treasury of the Commonwealth during year (mark item with *) . . 1.00
Balance carried to next year $26,092 . 1 6
Total as above $26,093.16
Per Capita
During the year the average number of inmates has been 2,304.25
Total cost for maintenance, $756,402.14
Equal to a weekly per capita cost of $6.3127, (52 weeks to year).
Receipt from sales, $1,751.20
Equal to a weekly per capita of $.0146.
All other institution receipts, $112,307.13.
Equal to a weekly per capita of $.9372.
Net weekly per capita $5.3609.
Respectfully submitted,
JESSIE M.
D. HAMILTON, Treasurer.
STATEMENT OF FUNDS.
Balance on hand November 30, 1925 .
Receipts
Patients' Fund
Interest.
Refunded
Interest paid to State Treasurer .
Worcester County Institution for Savings.
Worcester Five Cents Savings Bank
Worcester Mechanics Savings Bank
Peoples Savings Bank
Bay State Savings Bank
Balance Worcester Bank and Trust Company .
Cash on hand December 1, 1926
Invesmlent
$14,469.97
9,605.37
530.55
$10,247.26
530.55
$2,000.00
2,000.00
2,000.00
2,000.00
2,000.00
3,456.25
371.83
$24,605.89
10,777.81
$13,828.08
Balance on hand November 30, 1925.
Income
Lewis Fund
,541.16
65.49
Expended for entertainments, etc.
Investment
American Telephone and Telegraph Company collateral trust 4% bond,
Fourth Liberty Loan bonds
Balance Worcester Bank and Trust Company
$926.36
600.00
32.75
$13,828.08
$1,606.65
47.54
$1,559.11
$1,559.11
Balance on hand November 30, 1925 .
Income
Wheeler Fund
Expended for entertainments, etc.
3,132.62
265.29
$6,397.91
252.85
$6,145.06
P.D. 23 21
Investment
American Telephone and Telegraph Company collateral trust 4% bond $712.50
Second Liberty Loan Converted Bonds 4,000 . 00
Fourth Liberty Loan bonds 1,300 . 00
Balance Worcester Bank and Trust Company 132 . 56
$6,145.06
Manson Fund
Balance on hand November 30, 1925 $1,127 . 58
Income 46 . 73
$1,174.31
Expended for entertainment 40 . 90
$1,133.41
Fourth Liberty Loan bonds $1,100.00
Balance Worcester Bank and Trust Company 33 . 41
$1,133.41
Respectfully submitted,
JESSIE M. D. HAMILTON, Treasurer.
Nov. 30, 1926.
N.B. — The values assigned to the above securities are their respective purchase prices.
VALUATION.
November 30, 1926
Land (589 acres) $438,200 . 00
Buildings 2,277,427.73
$2,715,627.73
Personal Property
Travel, transportation and office expenses 7,921 . 01
Food 15,736 . 08
Clothing and materials 32,442 . 97
Furnishings and household supplies 264,820 . 40
Medical and general care 22,119 . 68
Heat, light and power 6,642 . 36
Farm 32,931 .26
Garage, stable and grounds 11,018 . 10
Repairs 25,863 . 23
$419,495.09
Summary
Real Estate $2,715,627.73
Personal Property 419,495.09
$3,135,122.82
22 P.D. 23
STATISTICAL TABLES.
As adopted by American Psychiatric Association.
Prescribed by Massachusetts Department of Mental Diseases.
Table 1. — General Information
1. Date of opening as an institution for the insane: January 18, 1833.
2. Type of institution: State.
3. Hospital plant:
Value of hospital property:
Real estate, including buildings $2,715,627.73
Personal property 419,495.09
Total $3,135,122.82
Total acreage of hospital, 589.16
Acreage under cultivation during previous year, 157.5
Men. Women Totals
4. Medical service:
Superintendent 1 - 1
Assistant physicians 11 - 11
Medical internes .• 1 1 2
Dentist 1 - 1
Total physicians 14 1 15
5. Employees on pay roll (not including physicians) :
Graduate nurses 1 35 36
Other nurses and attendants 118 103 221
All other employees 92 81 173
Total employees 211 219 430
6. Patients employed in industrial classes or in general hospital work on
date of reports 847 646 1493
7. Patients in institution on date of report (excluding paroles) ''.... 1078 1109 2187
Table 2. — Financial Statement.
See treasurer's report for data requested under this table.
P.D. 23
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24 P.D. 23
Table 4. — Nativity of First Admissions and of Parents of First Admissions.
Patients
Parents
of Male
Patients
Parents
of Female
Patients
M.
F.
T.
4
4
1
1
2
34
1
9
2
1
6
29
7
1
1
12
2
19
2
10
2
1
M
54
2
1
1
1
31
1
7
1
2
5
31
8
1
7
2
13
2
6
F.
T.
M.
F.
T.
12
2
1
1
18
1
6
1
5
13
5
1
6
2
13
3
82
2
1
1
16
3
1
1
1
16
2
1
6
6
2
7
2
1
51
2
1
1
1
29
1
8
1
2
5
32
8
1
7
2
13
2
6
105
4
2
2
2
60
2
15
2
4
10
63
16
2
14
4
26
4
12
30
2
1
26
4
1
1
4
1
41
2
1
•6
1
8
2
7
2
1
33
2
1
24
4
1
1
3
1
42
2
1
7
7
1
7
2
1
63
4
2
50
8
2
2
7
2
83
Italy
4
2
13
1
15
3
14
4
2
78
1
69
2
147
3
122
15
122
244
111
12
107
13
218
18 33
25
Grand Totals
191
153
344
191
191
382
153
153
306
Tablb 5. — Citizenship of First Admissions.
Citizens by birth
Citizens by naturalization
Aliens
Citizens unascertained . . .
Totals
112
27
47
5
191
153
194
41
101
344
P.D. 28
Table 6. — Psychoses of First Admissions.
25
Psychoses
13.
Traumatic
Senile, total
Simple deterioration
Presbyophrenic type
Delirious and confused types
Paranoid types
Pre-senile type
Unclassified
With cerebral arteriosclerosis
General paralysis
With cerebral syphilis
With Huntington's chorea
With brain tumor
With other brain or nervous diseases ....
Multiple sclerosis
Tabes dcrsalis
Encephalitis lsthargica
Frederick's ataxia
Undetermined
Alcoholic, total
Rorsakow's psychosis
Acute hallucinosis
Acute paranoid
Chronic hallucinosis
Due to drugs and other exogenous toxins
Morphine
With pellagra
With other somatic diseases, total
Cardio vascular renal
Hypothyrorid
Pulmonary
Gall bladder
General syphilis
Manic-depressive, total
Manic type
Depressive type
Mixed type
Involution melancholia
Dementia praecox, total.
Paranoid type
Katatonic type
Hebephrenic type
Simple type
Mixed type
Unclassified
Paranoia or paranoid conditions
Epileptic, total
Epiletpic deterioration
Psychoneuroses and neuroses, total
Psychasthenic type
With psychopathic personality
With mental deficiency
Undiagnosed
Without psychosis, total
Alcoholism
Psychopathic personality
Mental deficiency
Totals
M.
F.
20
3
2
2
3
16
26
7
11
7
3
21
M
3
21
26
14
2
1
1
5
38
4
5
22
2
26
P.D. 28
Table 7. — Race of First Admissions classified with Reference to Principal
Psychoses — Continued.
Race
Manic-
Depressive
Involution
Melan-
cholia
Dementia
Praecox
Paranoia
or Paranoid
Condition
Epileptic
Psychoses
M.
F.
T.
.M
1
1
F.
T.
M.
F.
T.
M.
1
1
1
1
2
1
F.
T.
M.
F.
T.
African (black)
4
1
4
9
3
1
1
1
4
1
7
1
1
2
8
1
20
1
1
3
1
1
3
1
4
10
1
1
1
4
2
4
3
3
2
1
1
2
1
2
9
1
1
1
1
1
7
2
9
1
1
5
1
1
6
2
1
2
11
2
4
5
12
2
1
1
1
3
1
7
1
1
15
1
1
4
1
1
2
2
1
5
1
1
1
4
1
2
1
3
1
English
-
French
Greek
-
Irish
3
Portuguese
-
Scotch
Slavonic
Turkish
-
Mixed
Race unascertained
1
Total
11
5
5
38
37
75
7
9
16
1
4
Table 7. — Race of First Admissions classified with Reference to Prinicpal
Psychoses — Concluded.
Race
Psycho-
neuroses
and
Neuroses
With
Psycho-
pathic
Pep.sonality
With
Mental
Deficiency
Undiag-
nosed
Psychoses
Without
Psychoses
M.
F.
T.
M.
F.
-
1
1
T.
-
2
2
1
5
M.
1
1
1
o
F.
1
2
1
4
T.
2
1
1
4
1
9
M.
2
6
1
2
2
2
22
F.
1
1
4
1
2
4
2
2
17
T.
1
1
6
1
2
10
1
2
4
9
2
39
M.
2
i
2
F.
1
1
2
T.
African (black)
Armenian
1
1
2
:
:
i
i
2
2
1
1
4
-
Greek
Hebrew
Irish
Italian
Lithuanian
Portuguese
Scandinvian
1
Turkish
2
Race unascertained . . .
Total
1
4
P.D. 28
27
Table 7. — Race of First Admissions classified with Reference to Principal
Psychoses — Continued.
Race
Manic-
Depressivb
Involution
Melan-
cholia
Dementia
Praecox
Paranoia
or Paranoid
Condition
Epileptic
Psychoses
M.
F.
T.
.M
1
1
5
F.
1
1
3
5
T.
1
1
3
1
4
10
M.
1
1
1
4
2
4
3
3
2
1
1
2
1
2
9
1
38
F.
1
1
1
1
7
2
9
1
1
6
1
1
6
T.
2
2
1
2
11
2
4
5
12
2
1
1
1
3
1
7
1
1
15
1
M.
1
1
1
1
2
1
7
F.
1
4
1
1
2
9
T.
1
5
1
1
1
4
1
16
M.
2
1
3
F.
1
1
T.
African (black)
7
1
1
2
1
8
1
20
4
1
4
9
3
1
1
1
4
1
11
German
Greek
-
3
Scotch
Slavonic
Turkish
-
Mixed
Race unascertained
1
Total
37
75
4
Table 7. — Race of First Admissions classified with Reference to Prinicpal
Psychoses— Concluded.
Race
Psycho-
neuroses
and
Neuroses
With
Psycho-
pathic
Personality
With
Mental
Deficiency
Undiag-.
nosed
Psychoses
Without
Psychoses
M.
F.
T.
M.
2
1
1
4
F.
1
1
T.
M.
1
1
1
2
5
F.
1
2
1
4
T.
2
1
1
4
1
M.
2
6
1
2
7
2
F.
1
1
4
1
2
4
2
2
T.
1
1
6
1
2
10
1
2
4
9
2
M.
F.
T.
African (black) 1
Armenian 1
English
Finnish
Greek
Hebrew
1
1
-
1
1
2
2
2
1
5
2
1
1
1
2
-
Lithuanian
Scandinvian
1
Turkish
Mixed
Race unascertaine d . . . .
2
1
Total
2
-
9
22
17
39
2
4
28 P.D. 23
Table 8. — Age of First Admissions classified with Reference to Principal Psychoses.
Total
Undep 15
Years
15-20
Years
20-25
Years
25-30
Years
M.
F.
T.
M.
1
1
F.
T.
1
1
M.
1
3
1
1
1
7
F.
1
2
1
1
5
T.
1
1
5
1
2
1
1
12
M.
1
1
12
2
1
17
F.
3
1
1
5
T.
1
1
15
2
1
1
1
22
M.
1
1
4
1
1
8
F.
1
2
3
1
1
2
5
15
T.
3
21
26
14
2
1
1
5
11
1
9
9
5
38
7
3
2
4
5
22
2
191
25
19
10
1
1
4
6
11
5
37
9
1
1
4
17
2
153
3
46
45
24
3
1
2
5
15
1
15
20
10
75
16
4
2
5
9
39
4
344
2. Senile. ....... .-'.... J
3. With cerebral arteriosclerosis
4. General paralysis. . . •!
1
6. With Huntington's chorea
8. With other brain: or nervous
1
1
10. Due to drugs or other exogenous
11. With pellagra . . . . i
12. With other somatic diseases
13. Manic-depressive
14. Involution melancholia
15. Dementia praecox
16. Paranoia or paranoid conditions. . .
17. Epileptic
18. Psychoneuroses and neuroses
19. With psychopathic personality. . . .
2
7
1
1
2
2
21. Undiagnosed
22. Without psychoses
Total.. .
5
23
Table 8. — Age of First Admissions classified with Reference to Principal
Psychoses — Continued.
Psychoses
30-35
J Years
35-40
Years
40-45
Years
45-50
Years
50-55
Years
M.
F.
T.
M.
3
1
5
3
2
5
19
F.
3
1
1
1
1
1
6
3
17
T.
6
1
2
1
1
1
11
3
2
8
36
M.
1
2
1
3
3
4
1
15
F.
1
1
2
1
2
4
1
2
1
15
T.
1
3
1
1
5
1
5
8
1
3
1
30
M.
1
4
1
1
1
4
2
4
1
19
F.
1
1
3
2
2
2
1
6
1
19
T.
1
2
3
4
1
2
3
3
5
6
2
5
1
38
M.
1
3
1
1
2
3
1
1
1
1
2
17
F.
1
1
1
2
2
7
T.
1
1
1
5
1
1
2
12
1
1
3
14
1
1
1
22
2
1
2
3
19
2
1
3
1
34
1
2. Senile
3. With cerebral arteriosclerosis
4
1
8. With other brain or nervous diseases .
1
10. Due to drugs or other exogenous toxins
-
?.
4
2
3
16. Parnoia or paranoid condition
1
18. Psychoneuroses and neuroses
19. With psychopathic personality
1
4
_
Total
24
.D. 23
Table 8.
29
-Age of First Admissions classified with Reference to Principal
Psychoses — C on eluded.
55-60
Years
60-65
Years
65-70
Years
70-75
Years
75 Years
and over
M.
F.
T.
M.
1
2
2
1
2
1
F.
5
1
T.
1
7
2
1
2
1
1
M.
2
5
1
2
F.
5
5
T.
7
10
1
2
M.
7
7
1
2
1
18
F.
6
1
7
T.
13
7
1
2
1
1
25
M.
10
9
2
21
F.
13
5
.18
T.
1
1
2
3
1
1
3
1
2
1
2
3
1
2
1
1
1
5
3
1
1
1
3
1
2
2
1
3
2. Senile
23
14
-
8. With other brain or nervous diseases .
9. Alcoholic
10. Due to drugs or other exogenous toxins
-
-
16. Paranoia or paranoid conditions
17. Epileptic
-
18. Psychoneuroses and neuroses
19. With psychopathic personality
2
Total ,
IS
7
25
9
6
15
10
10
20
39
30
P.D. 23
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P.D. 23
31
Table 10. — Environment of First Admissions classified with Reference to
Principal Psychoses.
Traumatic
Senile
With cerbral arteriosclerosis
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 preaecox
Paranoia or paranoid conditions
Epileptic
Psychoneuroses and neuroses
With psychopathic personality
With mental deficiency
Undiagnosed
Without psychosis
Total 191
M.
153
T.
344
Urban
M.
184
326
Rural
M. F„
18
Table 11. — Economic Condition of First Admissions classified toith Reference
to Principal Psychoses.
Psychoses
Total
Depen-
dent
Margi-
nal
Comfort-
able
M.
F.
T.
M.
F.
4
1
5
T.
4
1
5
M.
F.
T.
M.
F.
T.
3
21
26
14
2
1
1
5
11
1
9
9
5
38
7
3
2
4
5
22
2
25
19
10
1
1
4
6
11
5
37
9
1
1
4
17
2
3
46
45
24
3
1
2
5
15
1
15
20
10
75
16
4
2
5
9
39
4
2
11
13
3
1
1
2
8
8
3
1
18
4
2
3
5
11
9
5
4
1
4
3
3
3
19
2
1
1
3
8
2
20
18
7
2
1
2
12
11
6
4
37
6
3
4
8
19
1
10
13
11
1
1
3
3
1
1
6
4
20
3
1
2
1
11
2
12
13
6
1
3
8
2
18
7
1
9
2
1
2. Senile
22
3. With cerebral arteriosclerosis
26
17
1
6. With Huntington's chorea
1
1
8. With other brain or nervous diseases
3
3
10. Due to drugs and other exogenous
1
-
12. With other somatic diseases
4
14
6
38
16. Parnoia or paranoid conditions. . . .
10
1
18. Psychoneuroses and neuroses
19. With psychopathic personality. . . .
2
1
1
20
4
Total
191
153
344
96
66
162
95
82
177
TTT>
32
P.D. 23
Table 12.
■Use of Alcohol by First Admissions classified with Reference to
Principal Psychoses.
Psychoses
Total
Absti-
nent
Temper-
ate
Intem-
perate
Unascer-
tained
M.
F.
T.
M.
3
5
1
2
2
1
4
1
1
1
1
22
F.
1
1
1
1
4
T.
4
6
1
2
3
1
5
1
1
1
1
26
M.
3
18
18
12
2
1
1
3
1
6
6
2
27
4
2
2
3
4
13
128
F.
19
16
8
1
1
4
10
5
31
8
1
4
15
2
125
T.
3
37
34
20
3
1
2
3
1
10
16
7
58
12
2
2
4
8
28
2
253
M.
1
1
1
11
1
1
1
3
1
1
1
6
1
30
F.
3
2
4
2
1
1
1
14
T.
3
1
3
1
15
3
1
1
4
21
1
7
1
44
M.
2
1
1
4
1
2
11
F.
2
2
4
1
1
10
T.
3
21
26
14
2
1
. .1
25
19
10
1
1
4
6
11
5
37
9
1
1
4
17
2
153
3
46
45
24
3
1
2
5
15
1
15
20
10
75
16
4
2
5
9
39
4
344
2. Senile
3. With arteriosclerosis
2
4
1
5. With cerebral syphilis
6. With Huntington's chorea .
8. With other brain or nervous
diseases
9. Alcoholic
10. Due to drugs and other ex-
5
11
1
9
9
5
38
7
3
2
4
5
22
2
191
:
12. With other somatic diseases
-
14. Involution melancholia. . . .
15. Dementia praecox
16. Paranoia or paranoid con di-
1
8
1
17. Epileptic
1
18. Psychoneuroses and neu-
19. With psychopathic person-
20. With mental deficiency ....
3
22. Without psychoses
Total
21
33
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P.U. 23
Table 14. — Psychoses of Readmissions.
Traumatic
Senile, total
Paranoid
With cerebral arteriosclerosis
General paralysis
With cerebral syphilis
With Huntington's chorea
With brain tumor
With other brain or nervous diseases ....
Alcoholic, total
Chronic hallucinosis
Paranoid type
Deterioration
Due to drugs and other exogenous toxins
With pellagra
With other somatic diseases total
Parkinsonian's diseases
Exhaustion psychosis
Manic-depressive, total
Manic type
Depressed type
Hypo-manic type
Mixed type
Involution melancholia
Dementia praeeox. total
Paranoid type
Katatonic type
Hebephrenic type
Simple type
Unclassified
Mixed
Paranoia or paranoid conditions
Epileptic
Psychoneuroseo and neuroses
Neurasthenia
With psychopathic personality
With mental deficiency
Undiagnosed
Without psychosis
Total
M.
2
20
40
3
31
1
1
2
3
6
71
P.D. 23 85
Table 15. — Discharges of Patients classified with Reference toPrincipal Psychoses
and Condition on Discharge.
Psychoses
Total
Re-
covered
Im-
proved
Unim-
proved
Not
Insane
7
7
14
1
1
7
8
15
1
3
7
4
24
2
2
8
1
49
4
4
2
1
27
139
2
3
1
1
3
15
4
19
7
1
4
16
76
1
5
10
4
25
3
5
23
5
68
11
4
3
5
43
215
1
1
5
1
4
3
1
22
1
2
2
3
11
57
1
5
1
_
1
1
9
1
1
5
1
4
3
2
27
1
1
2
2
4
12
66
10
10
6
6
1
4
8
9
1
I -
35
2
2
18
2
71
4
1
6
4
4
38
10
220
2
3
1
1
3
16
5
24
8
1
5
17
6
92
1
6
11
9
1
36
3
5
34
7
95
12
1
6
5
9
55
16
312
2. Senile
_
3. With cerebral arterio-
4. General paralysis. . . .
5. With cerebral syphilis
6. With Huntington's
-
7. With brain tumor ....
8. With other brain or
10. Duetodrugsandother
exogenous toxins. . .
12. With other somatic
-
13. Manic-depressive. . . .
14. Involution met'cholia
15. Dementia praecox. . .
16. Paranoia or paranoid .
17. Epileptic
-
18. Psychoneuroses and
19. With psycopathic
20. With mental de-
-
22. Without psychosis . . .
Total
16
16
36
P.D. 23
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Table 17. — Age of Patients at Time of Death,
Psychoses*.
classified with Reference
l3.D. 23
to Principals
Psychoses
Total
Under 15
Years
15-20
Years
20-25
Years
25-30
Years 1
M.
F.
T.
M
F.
T.
M.
F.
1
1
T.
1
1
M.
F.
2
2
T.
2
2
M.
1
1
F.
2
1
3
T.
2
19
29
19
1
5
9
. . 1
16
16
4
2
2
1
2
6
2
47
4
1
1
1
1
10
2
35
45
23
2
1
7
10
1
7
13
3
65
5
3
1
2
4
16
3. With cerebral arteriosclerosis . .
1
5. With cerebral syphilis
6. With Huntington's chorea ....
8. With other brain or nervous
2
1
4
10. Due to drugs and other exo-
5
7
1
18
1
2
1
3
6
12. With other somatic diseases . . .
14. Involution melancholia
16. Paranoia or paranoid condition
18. Psychoneuroses and neuroses .
19. With psychopathic personality
20. With mental deficiency
Total
129
116
245
Table 17. — Age of Patients at Time of Death, classified with Reference to Principal
Psychoses — Continued.
Psychoses
30-35
Years
35-40
Years
40-45
Years
45-50
Years
50-55
Years
M.
F.
T.
M.
2
3
1
6
F.
1
1
T.
2
1
3
1
7
M.
4
1
1
6
F.
2
1
1
4
2
10
T.
6
1
1
1
5
2
16
M.
2
1
2
1
6
F.
1
1
1
2
1
1
7
T.
2
1
1
1
3
2
1
2
13
M.
5
1
1
1
5
1
1
15
F.
1
2
1
3
3
10
T.
6
2
1
1
1
1
8
1
1
3
25
2
1
3
1
4
5
3
5
8
2. Senile
3. With cerebral arteriosclerosis . . .
6 With Huntington's chorea
8" With other brain or nervous
10. Due to drugs and other exo-
12. With other somatic diseases . . .
14. Involution melancholia
16. Paranoia or paranoid condition
18. Psychoneuroses and neuroses. . .
19. With psychopathic personality.
20. With mental deficiency
Total
P.D. 28
Table 17. — Age of Patients at Time of Death, classified with Reference
Psychoses — Concluded.
41
to Principal
Psychoses
55-60
Years
60-65
Years
65-70
Yeaps
70-75
Years
75 Years
AND OVER
M.
1
4
1
2
4
1
1
2
1
1
1
21
P.
2
1
10
1
1
16
T.
1
2
6
1
2
4
1
1
1
12
1
1
1
2
1
37
M.
7
1
2
2
12
F.
4
1
1
1
8
11
1
1
3
3
1
20
M.
7
7
1
1
1
2
1
20
F. T.
- 7
11
- 1
- 1
- 1
- 2
1 1
6 6
- 1
11 31
M
10
8
1
2
2
2
1
26
F.
15
3
9
2
2
31
T.
1
3
2
1
1
1
2
1
1
13
1
3
1
4
1
1
11
1
1
6
2
1
1
1
6
1
2
1
24
2. Senile. . .
25
11
_
8. With other brain or nercous diseases .
1
10. Due to drugs and other exogenous
_
?.
—
11
2
17. Epileptic
_
?,
3
Total
57
Table 18. — 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.
2 1
8 £
1 1
1 -
1 -
2 ]
5 '
F. T.
3
10
2
1
1
L 3
1 9
M.
4
8
2
1
1
16
F.
1
3
1
1
2
8
T.
5
11
2
1
1
2
2
24
M.
1
6
1
2
2
1
13
F.
6
2
1
1
1
1
3
15
T.
2
19
29
19
1
5
9
1
5
7
1
18
1
2
1
3
6
16
16
4
2
2
1
2
6
2
47
4
1
1
1
1
10
2
35
45
23
2
1
7
10
1
7
13
3
65
5
3
1
2
4
16
1
2. Senile
12
3. With cerebral arteriosclerosis
3
3
1
_
8. With other brain or nervous diseases
3
10. Due to drugs and other exogenous
12. With other somatic diseases
-
1
—
16. Paranoia or paranoid condition ....
17. Epileptic
18. Psychoneuroses and neuroses
19. With psychopathic personality
4
Total
129
116
245
20 i
) 29
28
42
P.D. 23
Table 18.-
-Total Duration of Hospital Life of Patients Dying in Hospital
classified according to Psychoses — Continuedl
Psychoses
8- 12
Months
1-2
Years
3-4
Years
5-10
Years
M.
F.
T.
M.
5
6
13
1
1
2
1
1
1
31
F.
3
7
1
1
1
3
1
1
18
T.
8
13
14
2
1
1
3
3
1
1
2
49
M.
1
2
1
1
2
1
F.
1
2
1
6
10
T.
2
2
1
2
1
1
8
1
18
M.
3
1
4
3
3
1
15
F.
3
2
1
8
1
1
16
T.
1
2
1
4
1
1
1
1
1
5
2
2
1
1
1
1
1
9
2. Senile
3
3
1
5. With cerebral syphilis
8. With other brain or nervous diseases ....
4
10. Due to drugs and other exogenous toxins
5
1
15. Dementia praecox
11
17. Epileptic
1
18. Psychoneuroses and neuroses
1
1
22. Without psychoses
Total
31
Table 18.-
-Total Duration of Hospital Life of Patients dying in Hospital
classified according to Psychoses — Concluded.
Psychoses
10-15
Years
15-20
Years
20 Years
and Over
M.
F.
T.
M.
3
3
F.
3
2
5
T.
6
2
8
M.
1
2
6
2
11
F.
19
1
1
1
22
T.
1
1
1
1
2
2
8
7
1
8
1
1
1
1
2
9
1
16
2. Senile
1
10. Due to drugs and other exogenous toxins
?.
25
1
17. Epileptic
1
18. Psychoneuroses and neuroses
-
2
1
Total
33
43
Table 19. — Family Care Department.
P.D. 23
Remaining Sept. 30, 1925
Admitted within the year
No minally 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, 1926
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.
M.
F.
_
17
-
2
_
19
—
8
—
6
-
1
-
1
_
11
-
9
-
1
—
1
-
17
-
2
-
7
-
12.74
-
10.33
-
1.44
-
1.00
11
9
1
1
17
2
7
12.74
10.33
1.41
1.00
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