(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

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

36 & ^M3 

6- 



Digitized by the Internet Archive 

in 2010 with funding from 

University of Massachusetts Amherst 



http://www.archive.org/details/annualreportoftr129worc 



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 

Neurologically 1 1 

Serologically 2 

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 



23 



■* lO LOCO t- 



OS COC- 00 IN CM 



CO tONTJ 



I I-l OS i-l i-H CO CO 00 



(.-iiHi-l I 



■-H COIN 



o 10 10 c co co os as 10 1- X' co 00 10 05 cs o 



CO NHD5 IKiCM I I IO I IHO5C0 O « I t-N I CO I I I I I I I CO CO I 

OS CO lO 



|l-ieJi-4|||T-i||t-ll-<iH IO LO I I 



I I I I I I I HH I 



IN HHNlN<fN I I IS I I IN« "0 00 It-rl I N I I I I I I I N 0J I 

t- r-i JO 

IN IN 







CO no 00 


00OO 


00 C- tC l-O 


00 C- to-"* 


no 


IO 1 1 


1 "#111111111 1 


H 




OSCN 




HKONHr- 


c^ 


O <N 




00 


C-] 






































to 


CO 




























L0 




,_, 


i-i «D ID CO OS IT 


■* 


NiflOO 


<o 


co 1 1 


1 1 1 1 1 1 1 1 1 1 1 
















COH 


00 


CO 




b 
















CO 


co 








CO-* t- 


t-rjt© 


i- COi-" 


,_, 


(OMO-* 


OS 


OS 1 1 


1 V 1 1 1 1 1 1 1 1 1 1 


§ 




IOH 


t- 


t-cet- 


cn h 


N 


b- F-i 


OS 




rM 
















OS 


CI 





-**^LOCSlt-COt-L0 10CCCOOLO 
-fC-.-llNCOOO-'S'T-<'-IC0i-'CS^* 



iH IN "0 OS t- O IN I 

IN .-it- IN IN O 

... CO IN 

CO COIN^ <N 

CD i-c H* 
CO CO CO 



i-OSi-li-l I I 



lOCOCO OS coos 

i-l r-1 r- LO (N 



!OU)HB!e LO I I I HJ1HH | I 



cst-00 n co 



.-I CS ONI 



i-l O r-1 OS ■"# i-l t- t* OS t- O 00 OS It-Tf 

CS'^COrH-'CficNLOrHCOLGi-* IN W CD 
i-H <N NOM rH ri CON 



I I I I I I I I I 



.-H CO LO 



J 41 O r 

.S >>'S B , 

*- CdJ-SS.O ; 

OdEjJ; 
m'C-O-2' 
* 3 cs g. 

8**|j 

"° fl-S 0) 

+> 'S O ^ 

Ph 



CD 



!c3 bo^> 

! -pS 
; S?R o 
: 2*5 






-C rt 3 cy 

« 5 > 

•digo 

> t. 






■2-S a « 



o a- • 

M g. 

,.S 3 B g 

1 id is n l.' 



JS >> 

« +3 p 3 

g> £ 3 e ° 3 

J3.S B M co to 
O-CO 8« J 

^ (0 B S ti '^ 

n- 1 « J£ ^ 5 PJ 
. to O O »wv, 

tire j- 00 

.S ^^ .5 

-cc 2 £ 

cd B-S s 
Qfe.S m 



b ¥ 3 
0) t-j ^3 bfl 

S * M.2.S 

C T.S 3 

£'c:_3 <d s 
•2 '> « 33 '8 

S S--J I 
§1*1:3? 

' ~ -j3 -t-> 0) n! 

- 



c.a.£ £ 
°og,S 

■§■§ « e § 



fcs 5> fe S S g f *■ 

> > > > 3 3 300 






is 

crip- 



c m > h 
.3 o •- m 



.-Og-g 



ft 01 o^ 



g -8 "3 C g -JJ2 



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 



^3 

■x 



I 00 CO rH I i i ih i injiiai I I i in 



W'-l I I I I I I I I I i-< I CN I I I I I 1H 



I CONH | | H | I COr-l I CO I 



H Iri I I I I 



I I I I I I I I I 



I I I I I I I I I 



W y 



■H i r-< | | I | | 



n0=0 I |iH|H I I I CMCX1 I C-IO I n I i-l CO 



I I I I I 



1 i—l I I I 



H I ^"* I I I 1-1 71 I 






3 ° 
S o 

O U 



HnODM In |H I I fflSlTfMMH | 



< CM CO Cn C-3 I nncjH | cO^-n-i-O 



«; 






I en I Ihnhoh | I n-«an. 



I n.;iM I | | | :M | In InIS | | |nl«!i 



hnioh I I I I t- I I IN lun I | | ,« _ | in 



== O 

13 CO 



O CO 



a s 



lion I I I I I n | I n I n CO CO I InHUJ I co 



I I n | | | | | CMC5 I I I I ca I CM 



Nn I | I I I I I I n I nnn I I I HM I n 



coxionjiconc-juoion LOooioto^ci Icncn-^ ■*? 
-ai-^CM n nNnt-rt CO t* 



v '. S :.2 ;.s • ° ■ 5 £ >> 



l--s>>o2.5 
'. & "S ° * 

• "3 13 "g a 3 .a 

• 5 S .o ■§ c t, 

'n | 3 ££ 

U Cd OHH^ O 



•f -o !t) 



: «ss 



2* a. 



« o 



ra S. 5 r; ro 

E C^n CJ rrt 



3 o o, o 



§2 
2 us 






o 0-3*0 >. 

+3.2" 3 n 2 P+> 
2 h S"n- " „ « 2 
Sgs £+3 +3 -35 
5 «5 -«££«£ 



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 

2 1 

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 



Oh 



Ah! 



S2 



«.. 



O 



,0Q 



^3 



o 







1 


















1 








CO 














Ir, 


Q 


H 




















o 
> 




1 1 1 1 1 1 1 1 1 1 I 1 1 1 <H | | | | | | 




fe 














Q 


















1 1 1 1 I 1 1 1 1 1 1 1 1 1 1H | | | .1 | | 






% 










1 1 1 1 1 1 1 M I 1 1 1 1 1 1 Ml 1 


1 -H 


a 


H 






a 

H 














< 








a. 

< 


fc 






a. 
















W 


S 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 | | | | rH | | 


rH 






1 TOON 1 1 1 | 1-1 | INI NNrHrHrH | HN 






H 




■"* 


Q 
W 










1 HOH 1 1 1 1 rH I I I I NMHH 1 1 1 1 




Q 


fe 




TO 


£ 


















1 .-HOrH 1 1 1 1 1 1 1 N 1 1 1 1 1 rH 1 rHN 






fel 










N"tfOSIOTO IrHrHOrH |OH»ifH | IN | C-c 






t-i 


rHrHrH rH rH rH N rH rH 


IO 


5 










1 «0*# — i-f 1 1 1 TO 1 1 if*N<0» 1 1 i—t I 03 c^ 




g 


1* 




CO 


<: 








§ 
















§ 


NOOlOffiN HHt-H 1 tOt>T*00lO 1 | H | 00r 








00 






rHOSCOC- IrHrHTHCr). | COOlNt-^COHNOOOr 






H 


rH "tf N 


"* 


w 

o 






^ 




1 t- iO M 1 1 t— i 1 | | 1 Nt-H0O>j [ | l-tfao 




l* 


' -l 


IO 


w 








a 


HNHHJ | H 1 <*■* | 1 HNHaiNMHN^Nr 


in 




rH N rH 


00 






to ■— > irj tj< co *h n lo m »-t i inoowtD^NiooiaiTj 


^J! 




H 


Tji-rj<N rH HfJHt-rt TO 


TO 


«: 



















llOOOH 1 H | ■* | |tOrH10t>OSrH|rH-*C-Cx 




fo 


NHrH rH CO rH 


o 


Eh 






^ 


a 


Mh«)^nhhu5hh 1 OS O IO 00 t- TO N -<* lO N Cs 






NNh rH TO <M 


a 










































































c 




































































































K 
















































O 














































0) 


H-3 














































S 


DO 

3 


















































































0" 










■c 


C 










c 

o 




>. 























« 


3 


K 


o 






•c 


§3 c« 
p a 












/> 






0/ 

o 










B) 






c 












3 
B 
J 
w 






a 


o 

J3 


u. 


a; 


■5 


a 


T3 


3m. 

C <D O 














h 


2.1B 







u 


ja 





03 J3tr< 

i oT 3 

H 03 (H F 

° ftB a 

•£r5^t 








; 


H 


t 

'Z 

£ 

Eh 


-1 

( 



00 


rr Z?-h bo 3 l, 

rt a rt C +j jZ 

0J- HIM (! -WS 

u £ «;►!■( .a o c 

,a a js .s js .a -5 


c 

C3 
93 ^ 

S J2 
a o 
8* 


« £ 1 8 S 

« Sts ® as 

oSjltft 

. E c a t. 

E ft S3 - ° 

J-S-2-hS S-S 


c 
j: 
c 
> 

P 

-H 

3 

C 

| 












a 














HNCO^i U»S C^OOCTJOrHCJOTHfui'Bt-'oOaJOrHOq 












































(M 


OJ 


(N 


H 





34 



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 



a, 

ft 



O O . c 01 



5 O.K OS 

ija 5 ►« > 7 
JB 2 o £ o 
"OCQ »•" 



J3 C m V 



^: 



13 



+J,0 J- o 
;— ' 0> G> t* 



i-s 



u 



h| 




N r-1 


CO Tf to i-l i-l 03 i-H 
r-( <M 


fe 1 


1 ^HrH | | | W^H^HrtrHrt | | 


OOi-HCO 1 r-llH 


■*H^ | rHiHrH 


s 1 


H| |Hr,M | | | | |r^CO 


©Tf«T(ii-l •qi | 


OiCOOli-l 1 OJ 1 



s-2^ gg :o§ m '| 

§tH 0j -3£t>°'So£tf 

"Blg.slJajfe.SS-s.a 

fe O.I--S £ M-2-E0.3 g « So 

oj ^(50000005^0.^0 
^ u oi""2 tfrJcsaicocJts'F^'S 

3 g.f ££££££"£•-« 

£ S.S.S.S.S.S S £ >-— »S3 
3 '5 i> '5 '5 '3 "S 'S '3 2 .2 bo o j; 



OJ3 a; 



to 



< £-E ^*-J r; 

E8l8|g 

a) <u o c « 
OOOHwO 



=3 O 



■n ? 



a -a 



"3 .'« SI 2 



b .-a S s is g * 

■o £ > a o! u o 
o ,2 -3 E -S o +? 

5fiSOUJ!3 



87 



Ml | M 1 1 1 1 1 1 1 III III M M |H 




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




1 iH | | 1 1 1 1 akfc 1 1 1 1 1 1 1 1 1 III 1 1 1 I '-< 




i-lr-l | i-l | | | | lllrHI ICOI III IIIIIO 




1 1 1 1 1 1 1 1 1 i J - — • 1 III III 1 ! N |rt 




t-ith it-miii iiiii icoi ill iiiiicn 




1 M 1 iH | | 1 | Ill III 1 1 1 1 [ fr- 


i 


ill th | | | I IIIII III III 1 1 1 1 1 IM 




1 co 1 I 1 1 1 1 IIIII III III l l l 1 1 •a 




1 TH | | | | I | IIIII III III 1 1 1 1- j tH 




1 1 I 1 1 1 1 1 lllli III III 1 1 1 1 1 1 




1 t-H 1 1 1 1 1 1 IIIII III III 1 1 1 1 | tH 




r* 1 1 1 1 1 1 1 IIIII III III I I 1 1 1 CM 




rl 1 1 1 1 1 1 1 IIIII III III IIIII, 




1 1 1 1 1 1 1 1 IIIII III III 1 1 1 1 j 1 








CMi-l 1 1 1 1 1 1 IIIII III III 1 1 1 1 1 CO 

CM 




1 1 1 1 1 1 1 1 IIIII III III 1 .' 1 j -f 




CM<-H 1 1 1 1 1 1 IIIII III III IIIIIO 

1 m 








CJCOfr- IIIII r-tllll M 1 1 t-H 1 H | | | IIO 

•<* 




1 i-l CO 1 1 1 1 1 IIIII III 1 i-i I 1 1 1 1 1 <o 

1 — 1 




CMCMTflllll i — i 1111 |i-l| III iH | | | 1 Ol 








CM «5 CO 1 1 1 i-i 1 1 1 1 1 -1 III 1 IM CM I t-i I I 1 in 

,co 




1 ca l l l l n i iiiii ill i i-i— i | I i i 1 «d 




<MT?CO IIIII IIIII III 1 rH 1-1 H | | Id 

r 




1 1 1 1 1 1 1 1 IIIII III III 1 1 1 1 1 IM 




1 1 1 1 1 1 1 1 IIIII III III 1 1 1 1 1 1 




1 1 1 1 1 i I 1 IIIII III III 1 1 1 1 1 CM 








t-L'^OHHHCC 1— I'-Ol— IT-ICM HLQH i-LOW HHHH 1 Ifj E 
iHCMi-ICO T# j 

1 CM 1 




OHCOU 1 Irth 1 CCi ^i rH ,-< III |HIH | | T-t | 1 SO 

i-< CM i-l j 




NlCCOanrt In H i-l 1 1 tH HIOH i-l r-l tH HH |H |'a 
1-liH 1 M j 





5J..S o o j; o o« S 
Sgeo-cpc-c 3 



ss 



s ° 



q <b 



>>>>>>! 



S o " 53 * « ,i S 
h o 2 5 2 2 a S 

O Z ffl 3 3 S-=> 



,2 t) 



<S'~ 



_» CD 

to 3 „ 

■Sg 3 



iJPQO&HMlnOw OhHHO 



^3 *'"5 'S ."tn ^ 

2-2 *■§ c 

ilgOSai 



® O 3 
§*3(D 



J3ii 

>. to 4, 

-O 3 

-a *j « 

§ 2 £ 






.5 * 

MB 2 

iJ-3.sS8.S- 

-Q.fi S 
a o a 

SS'2 
'3 '3 '3 
3 3 3 
www 



3 u 
> 3 



38 



P.D. 23 



u 



.2 S 


^1 


l l 


1 1 


1 


1 


1 


1 


1 


1 ii 


1 


1 


1 


i 


CM 






i 




1 


^ 


1 


1 


1 


1 


^~ 


1 




(=! | 


1 1 1 1 I 1 1 1 1 i-< 1 1 1 1 <M 1 1 1 1 1 1 1 1 1 1 . 1 


S 


s i 


llllllllllllll llllll i-i 1 1 1 1 HH 


With 

Mental 

Mental 

Deficiency 


H 


1 1 1 1 1 1 1 1 1 1 IH 1 1 1 I 1 1 1 1 1 1 1 TH | 1 |. | 


fa 


llllllllllllll llllll 1 1 1 1 1 1 1 


§ 


llllllllllllll i-l 1 1 1 1 1 1 1 i-l 1 1 1 1 


With 
Psycho- 
pathic 
Person- 
ality 


^ 1 


llllllllllllll llllll 1 1 1 1 1 1 1 


fa | 


llllllllllllll llllll 1 1 1 1 1 1 1 


S 


llllllllllllll llllll 1 1 1 1 1 1 1 


Psycho- 
neuroses 

and 
Neurosis 


H 


llllllllllllll llllll 1 1 1 1 1 1 1 


fa 


llllllllllllll llllll 1 1 1 1 1 1 1 


s 


llllllllllllll llllll 1 1 1 1 1 1 1 


X) 

'-J3 

0. 

a 

"ft 

H 


H 


llllllllllllll 1 1 1 1 TO 1 1 1 1 1 1 1 1 


fa 


llllllllllllll 1 1 i 1 i— i 1 1 1 1 1 1 1 1 


a 


llllllllllllll III! CM 1 1 1 1 1 1 1 1 


I 2.| 


H 


llllllllllllll CO 1 1 1 1 1 1 1 1 1 rH 1 1 


Param 

or 
Paranr 
Condit 


fa 


llllllllllllll rH 1 1 1 1 1 1 1 1 1 i-l 1 1 


§ 


llllllllllllll i-H 1 1 1 1 1 1 1 1 1 1 1 1 


.2* 


^ 


llnllllHHllHln lO 1 1 1 N 1 r-inii 1 1 rl 1 


eg 

X> 0) 


fa 


| | 1-h 1 1 1 1 rHH | | rH | | Tf | | | | | nlOJllnl 


a 


llllllllllllln H 1 1 IN 1 1 ii(M 1 1 1 1 


a 

O i 

i rt — 

I 8 


^ 


llllllllllllll llllll 1 1 1 1 1 1 1 


fa 


llllllllllllll llllll 1 1 1 1 1 1 1 


a 


llllllllllllll llllll 1 1 1 1 1 1 1 


a u oi 

c! ft > 

• ^ x>*i 


E^ 


1 1 1 1 1 il 1 1 1 1 1 1 1 1 llllll 1 1 1 r-l 1 1 1 


fa 


llllllllllllll llllll 1 1 1 1 1 1 1 




| | | 1 1 n 1 1 1 1 1 1 1 1 llllll 1 1 1 r-l | | 1 


C ™ 


H 


llllllllllllll llllll 1 HOT 1 I 1 1 


With 

Other 

Somat 

Diseae 


fa 


llllllllllllll llllll 1 H 1 1 1 1 1 


S 


llllllllllllll llllll j r-l CO 1 1 1 1 


w 

K 
H 

«s 

(=3 

Q 

t. 
o 

w 

< 




+■ 

c 
c 

Is 

si 

n 

a 
a 

o 
E 

E- 


a 

c 

oi 
u 

§£ 

c.s 

■* H 1 

Si'" 

n~- 

"C - 

u\ 

x i 

- 

Si 

11 

a c 


£ 

z 



u 

£ 

c 

c 

C 


- 
c 

K 
| 

a 

E 

c 
£ 

e 

c 
u 




c 

"" 



c 

c 

X 
r 


— 

IE 

t- 

c 

ij 

1 

"c 
s 

£ 

c 
C 

f- 

a 


x 
« 

E 

c 

c 

c 

c 

B 

E 
e 
c 

B 


„ 

e 

<- 

i 

»- 
K 


t 
n 

£ 

s 

s 

1 
a 

c 


1 
[ 

I 

8 

5 


> 

X 

c 

c 
« 

: 
x 
= 

c 

•1 

c 

p. 


r 

E 

e 
x 

B 

X 

s 


IE 


» g 

*! 

1 

If 

i 


J 
1 

| 

B 

4 
I- 

a 
C 


a 

c 



c 
a 

X 
"c 

i 

"3 


'5 

K 

"J 

S 
1 

a 

e. 


i 

s 
e 

a 




.2 

IE 

- c 
?> 

« 

a 

X 

c 


1 

Bo 

» ^l 

t- 

K 
t 

C 

| 


4 ff 

1 




c 

a 

1 



t- 
u 

7 

- 
i. 

I 

c 

i 


i 

£ 

e, 
'f 
c 
< 



T 

X 


a 

X 

< 


a 



a 

'r 

4- 
U 
« 

a 

- 
u 
r 

1 

r 

f 
t 

E 
£ 


£ 

a 

i 

1 

* 

5 
1 
EC 





P. D. 28 



39 



I M^-l I rH 



I I I I I to 



-I I N 



I CO 



I r-l 



R..3 O O 

Sg£ O 

3 £ if 

ufti 



Sh o *-. 
d r- <D 
J2 O fi 

o t. ffl 
►JCqO 



o a s :.S 

s O O -w g 

o a, 

« « « „ * 

2 8 2 « § 
JsJ= 6 2,2 

3 3 3J5 t 9 



■ ■ a 

■ o_ 



■ 3 a> 
• u ^ 

iil-i 

2 — s a 



: • § : "5. : 

. " <8 . oi . 

. • » . d . 

:i & :tj : 

•~ =» -'-3 • 

■2 « 



s.S 
ts a) 

*3iZ 



s+3 3-2 
A oi o a 



S * oi 5 s-3o« 
.2 x -m a S« >;3 



§a 



B 3h 

§ _ £ "tare 

-S:i3 oi.ir o 
,g3-' " 



■.•°'<£ 

• d.S 

■ uS 
to a J> 



■ •— o> 

JS o a 

."2 3 3 

goo 

^ £2 



So-g^-g 
fi -3 to >> >> g 



<A£i 



Swa.S.a.S 

r n 3.2 3 3 S 



40 

Table 17. — Age of Patients at Time of Death, 

Psychoses*. 


classified with Reference 


l 3 .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