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

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Public Document No. 23 



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ANNUAL REPORT 



OP 



THE TRUSTEES 



OF THE 



Worcester State Hospital 



FOR THE 



YEAR ENDING NOVEMBER 30, 1929 



Department of Mental Diseases 




Publication op this Document approved by the Commission on Administration and Finance 
500. 9-'30. Order 9938. 



8TI1T[ VM.m ^'F MftSSIGHISETTS 

nc.r 16 'mi 
WORCESTER STATE HOSPITAL. 

BOARD OF TRUSTEES 

Edward F. Fletcher, Chairman, Worcester. 
William J. Delahanty, M.D., Worcester. 
Anna C. Tatman, Secretary, Worcester. 
Howard W. Cowee, Worcester. 
John J. Perman, D.M.D., Worcester. 
Josephine Rose Dresser, Worcester. 
William J. Thayer, Worcester. 

MEDICAL STAFF. 

William A. Bryan, M.D., Superintendent. 
Francis H. Sleeper, Assistant Superintendent. 
S. Spafford Ackerly, Clinical Director. 
Michael J. O'Meara, M.D., Senior Assistant Physician. 
Clifton T. Perkins, M.D., Senior Assistant Physician. 
Arthur T. Whitney, M.D., Senior Assistant Physician 
Morris Yorshis, M.D., Senior Assistant Physician. 
Nathan Barratt, M.D., Assistant Physician. 
Samuel W. Hartwell, Senior Assistant Physician. 
Ruth Thompson, Assistant Physician. 

VISITING STAFF 

Ernest L. Hunt, M.D., Surgeon. 

Benjamin H. Alton, M.D., Surgeon. 

Carleton T. Smith, M.D., Surgeon. 

M. M. Jordan, M.D., Neurologist. 

RoscOE W. Myers, M.D., Ophthalmologist. 

Philip H. Cook, M.D., Roentgenologist. 

Oliver H. Stansfield, M.D., Internal Medicine. 

E. C. Miller, M.D., Internal Medicine. 

Lester M. Felton, M.D., Genitro-Urinary Surgery. 

Joel M. Melick, M.D., Gynecologist. 

Roy G. Hoskins, M.D., Ph.D., Reseaixh. 

Arthur Brassau, M.D., Surgeon. 

Harold J. Gibby, M.D., Ear, Nose and Throat. 

UEADS OF DEPARTMENTS 

Jessie M. D. Hamilton, Trecc^mrer. 

Herbert W. Smith, Steward. 

Mathew N. Masterson, Engineer. 

Anton Svenson, Foreman Mechanic. 

Wallace F. Ga^reit, Hiad Farmer. 

Lillian G. Ca:jz, Matron. 

Anne F. McElholm, R.N., Superintendent of Nurses and 

Principal of Training School. 
Maurice Scannell, Supervisor, Male Department. 



P.D. 23 ' rr ' 3 

TRUSTEES' REPORT 
To His Excellency the Governor, and the Honorable Council: 

The Trustees of the Worcester State Hospital respectfully submit the 
ninety-seventh annual report of the hospital, together 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. 

The Board of Trustees desires to express its opinion of the policy of 
utilizing as much money as is available for the extension of community 
and research work in the hospital. It is the belief of the board that 
this is an important change of policy which will undoubtedly bring results. 
The problem of mental disorder from an economic point of view as well 
as a humane standpoint is a very important one, and the increasing fi- 
nancial burden on the State should make us alert to try new ways of solv- 
ing the problem rather than continuing to add to our facilities for the 
custodial care of patients. 

The board again desires to mention the teaching program which has 
been carried on during the ensuing year in the hospital, and to register 
its approval of this policy. In as much as mental disease is an important 
public health problem it would seem obvious that those working with 
individuals should have a very complete and comprehensive knowledge 
of at least the fundamentals of mental disorder. The dissemination of 
information regarding mental phenomena is an important part of any 
mental hygiene program, and the board believes that the hospital should 
take the leadership for all mental hygiene activities in the community it 
serves. It should be responsible for the mental health of this com- 
munity. Recommendations made in the Superintendent's report for the 
replacement of roofs, floors and porches is heartily concurred in by the 
board. 

The thanks of the hospital are due to the members of the Visiting 
Staff, who have given us freely of their time, and to the oflficers and 
employees for their loyalty and splendid cooperation during the year. 
Respectfully submitted, 

EDV7ARD F. Fletcher, William J. Delahanty, 

Josephine Rose Dresser, Anna C. Tatman, 

HOV^^ARD W. COVi^EE, JOHN G. PERMAN, 

William J. Thayer, Trustees. 

SUPERINTENDENT'S REPORT 
To the Trustees of the Worcester State Hospital: 

I herewith respectfully submit the following report of the hospital 
for the year ending November 30, 1929, it being the ninety-seventh annual 
report : 

There remained on the hospital books October 1, 1928, 2,594 patients, 
1,290 men and 1,304 women. Six hundred and thirteen patients, 352 men 
and 261 women were admitted during the year. Six hundred and forty- 
two patients, 380 men and 262 women were discharged from the hospital. 
Of this number 383 patients, 241 men and 142 women were discharged, 
235 patients, 124 men and 111 women died, and 24 patients, 15 men and 9 
women were transferred, leaving at the end of the statistical year 2,565 
patients, 1,262 men and 1,303 women. 

Staff Changes. 

Promotions. 

Francis H. Sleeper, from Clinical Director to Assistant Superintendent 

January 14, 1929. 
S. Spafford Ackerly, from Senior Physician to Clinical Director January 
14, 1929. 



4 P.D. 23 

Arthur T. Whitney, from Assistant Physician to Senior Physician April 

22, 1929. 
Morris Yorshis, from Assistant Physician to Senior Physician October 

14, 1929. 

Appointments. 

Samuel W. Hartwell appointed Senior Physician August 1, 1929. 
Ruth Thompson appointed Assistant Physician August 20, 1929. 

Internes. 
Kendall B. Crossfield appointed Clinical Assistant July 15, 1929. 
Arthur W. Burckel appointed Clinical Assistant August 1, 1929. 

ResigTiations. 
Jacob Goldwyn resigned to go into private practice September 30, 1929. 
Lyman Orten resigned March 22, 1929. 

Cesareo DeAsis resigned to go into private practice November 19, 1929. 
William F. Finnegan resigned February 21, 1929. 
Bardwell H. Flower resigned March 7, 1929. 

Report of the Psychiatric Service. 
iS. Spafford Ackerly, M.D., Clinical Director 

There are four important phases of the work of the past year which 
deserve mention. First, more intensive therapy for the individual 
patient, second, teaching activities, third, extramural work and fourth, 
publication. Hand in hand with the physical therapy of patients must go 
intelligent psychological treatment. We have found that the old slogan, 
"Too many patients, too few doctors" does not hold, when the psychi- 
atrists are vitally interested in their patient's problems. It is difficult 
for the ward physician to become enthusiastic over an individual patient 
if those above him do not evince this same interest, and show the way. 

Such interest has grown steadily during this past year. At times 
ward physicians have vied with each other to treat certain few patients 
who were the type to benefit by intensive psychotherapy. It is the rule of 
each physician to be carrying a group of patients on an intensive treat- 
ment basis, each patient receiving from ten to fifty hours of treatment.. 
Such cases are presented at a special staff meeting held once a week. 

As part of the individual-treatment-plan the patient is now brought at 
once into the physician's office and is no longer subjected to the confusion 
of the old admitting office where attendants and others are coming and 
going. On the admission service each patient has a chart similar to 
that of a general hospital and his entire treatment recorded. Formerly 
this was only done on the medical service. As soon as the patient is up 
and around, an effort is made to introduce him to a patient who will be 
friendly and congenial. This is difficult to carry out fully but a step in 
that direction has been made. More efficient hydrotherapy is now being 
performed on the male service and the patients under treatment are kept 
on the same ward. The ward physicians have instituted office hours so 
that any parole patient may see a physician if he so desires. 

One of the most important phases of the work during this last year 
has been that of teaching. Teaching is the corner stone of progress. 
Students in the field of medicine, nursing, social service, occupationaJi 
therapy, theology, and general education, are coming to this hospital alj 
through the year for instruction in abnormal psychology and mentai 
hygiene. There is no better place to teach these subjects than in a larg€ 
state hospital. The superintendent has another motive for stressing the' 
teaching program, namely, to recruit desirable personnel into the ranks; 
of state hospital service. Regardless of the latter, however, students 
have been benefited not only personally but also in their understanding 
of what state hospitals are doing for the mental health of its patients; 
and to the community. 



P.D. 23 5 

Students from two medical schools in Boston have been receiving 
instruction in psychiatry during the last two summers. This course 
will be extended this fall to include instructions of senior medical students 
from Tufts' Medical School. Groups of four students will begin a two 
months course at this hospital October first. New groups will come every 
two months during the year. These students are planning their medical 
career this year. It is hoped that their interest may be sufficiently 
aroused by their experience here to influence the right sort of men to take 
up psychiatry. In any event the course is designed to help them in what- 
ever field of medicine they choose to follow. 

The following groups have served on a student basis in the hospital for 
varying periods during the year: 

1. Student nurses from general hospitals. The following hospitals are 
affiliating with us for a three months course : 

Grace Hospital, New Haven, Connecticut. 
Holyoke Hospital, Holyoke, Mass. 
Hahnemann Hospital, Worcester, Mass. 
Memorial Hospital, Worcester, Mass. 
Leominster Hospital, Leominster, Mass. 
Rutland State Sanatorium, Rutland, Mass. 
Framingham Union Hospital, Framingham, Mass. 
Somerville Hospital, Somerville, Mass. 
Hart Hospital, Roxbury, Mass. 
Worcester City Hospital, Woi'cester, Mass. 

2. Senior Medical Students from Tufts College — two months. 

3. Occupational Therapists — Boston School of Occupational Therapy — 
six months. 

4. Psychiatric Social Workers, social worker students — Smith Col- 
lege — nine months. 

5. Theological students representing the following seminaries : 

Union Theological Seminary, New York. 

Yale Divinity School, New Haven, Conn. 

Boston University School of Theology, Boston, Mass. 

Chicago Theological Seminary, Chicago, 111. 

Garratt Biblical Institute, Chicago, 111. 

Extra-mural activities are becoming more important each year. 
The policy of encouraging the staff physician to make contacts with 
other hospitals, thus keeping in touch with what is being done elsewhere 
is a far-sighted one and reacts favorably upon his own hospital. To 
teach properly the teacher must keep in touch with the sources of new 
ideas. Members of the psychiatric staff have been in attendance during 
the past year in both out-patient and in-patient services of several Boston 
and Worcester Hospitals. 

The staff of the hospital has been of increasing service to the com- 
munity. Courses in Mental Hygiene, both elementary and advanced, 
were given to teachers in Worcester and in Webster. A course in the 
psychology of Adolescence was given to the College Club in Worcester. 
Besides these courses about eighty lectures on various phases of Mental 
Hygiene were given before the Parents-Teachers Associations, Boston 
University, Teachers Organizations, Church Organizations and Societies. 
The Superintendent gave a series of radio talks over WTAG. 

Turning to more definite contributions the following articles were pub- 
lished or have been accepted for publication during the past year. 

1. Hypnoidalization — Its Psychotherapeutic Value — Journal of Ab- 
normal and Social Psychology (Dr. Jacob Goldwyn). 

2. Pyromania and Kleptomania (Dr. Jacob Goldwyn). 

3. The Effect of Hypnosis in Basal Metabolism (Dr. Jacob Goldwyn). 

4. Alcoholic Psychosis or Schizophrenia, a case report submitted for 
publication (Dr. Morris Yorshis). 



6 P.D. 23 

5. Differential Diagnosis between Paranoia, Paranoid Condition and 
Dementia Praecox, Paranoid Type, submitted for publication by Dr. 
Morris Yorshis. 

The following work is under way. 

1. Hysterical Paralysis, Treatment by Hypnosis. 

2. The Psychiatric. 

3. Psychosis Associated with Pregnancy. 

4. Cardiovascular Condition in Dementia Praecox. 

5. Follow up studies on Catatonic Dementia Praecox, cases out of the 
hospital five years. 

Report of the Psychological Department 
David Shakow, Head Psychologist. 

The Psychological Department was reorganized in September, 1928, 
when the present director took charge. The few months before the end 
of the previous fiscal year were rather lean ones. Only the essential 
routine, training, etc. were taken care of. 

A review of the work of the last year reveals activities along numerous 
lines. We might be accused of attempting to emulate or even improve 
upon the example of the Leacock hero who sprang to the saddle and rode 
off hastily in both directions. However, further consideration of the 
validity of the criticism that we are attempting many things at once 
lead one to place less importance on it. It is true that we have little in 
the way of concrete results to show, but it is obvious that one cannot 
achieve results as quickly in a number of subjects as one can in con- 
centrating on one. It is hoped, to return to the direction analogy used 
earlier, that the next report will show arrival at least at a few destina- 
tions and considerable progress along others. 

Of course, these remarks refer to the long-period work, largely of 
research nature. Our routine work has gone its way smoothly and well. 
The workers of the department have cooperated excellently and evidenced 
considerable interest in both the routine and research programs. They 
have worked well with little supervision, which has left the director with 
some freedom to spend on special developmental and research work. 

The laboratory was moved from its inadequate quarters on Appleton 4 
to much more satisfactory quarters on Sargent 3, in January, 1929. Its 
present quarters consist of an office, two examining rooms and a shop- 
experimental room, the latter painted black for visual experiments. 

The department is distinguished from other hospital departments in 
that its work is not confined to the house but that a large portion of it 
is out-patient work. The workers in the department have to deal with a 
clientele which shows a very considerable degree of heterogeneity — prob- 
ably as diverse a subject population as can be found in any single organ- 
ization. A listing of the source of cases will give an idea of this great 
variety : 
House: — 

Regular patients (all kinds of psychoses). 

Research cases: Hospital dementia praecox research. 

Own researches: General paretics; alcoholics; various others (infants, 
pregnant women, etc.). 

Employees. 
Out-Patient :- — 

Scholl Clinics, Child Guidance Clinic, Girls' Welfare Society, jail, mis- 
cellaneous (referred by other clinics, other individuals, etc.). 
Other: — 

Normal subjects for standardization purposes. 

Thus we have a clientele which ranges in age from one month to over 
70 years, which covers practically the range of distribution of intelli- 
gence and "normality," which shows a tremendous variability in the 



P.D. 23 7 

presence and degree of physical defect, which runs the gamut of language 
difficulty. For such a group it is obviously necessary to have an exam- 
ining schedule exceedingly varied and of sufficiently wide range to elicit 
interest and cooperation. This we have attempted to assemble. 

Our examining equipment includes a large number of tests in each 
of these groups : Individual language, for general mental ability ; group 
language, for general mental ability; group non-language, for general 
mental ability; performance, of a multiplicity of kinds; special (memory, 
association, apperception, etc.); personality and character; vocational; 
miscellaneous (achievement, etc.). 

Test batteries have been arranged for all kinds of groups. In the 
Child Guidance Clinic it has been found advisable to construct schedules 
which would take into account not only the age of the subject, but the 
thoroughness with which it was necessary to work up the case. The 
subjects have been divided into four groups: Pre-school, 6-12 years, 
12-16,, and 16-over. For each of these groups three schedules have been 
prepared. A, B, and C. The A schedule is the minimum one and takes 
approximately an hour and a half to administer. The B schedule is the 
medium one and takes between three and four hours to administer. The 
C schedule is the maximum one and takes six hours or more to administer, 
(Of course the longer schedules are broken up into a number of examina- 
tion sessions). Each of these schedules is eclectic and contains at least a 
general test and a performance series. 

In the House, a similar principle is followed though it has not been 
worked out so definitely. The schedules are arranged by type of patient 
and by reason of being referred rather than by age. Thus the regular 
patients in the regular routine have the equivalent of the minimum 
schedule, whereas the dementia praecox patients on research have the 
equivalent of the B schedule. 

The routine work of the Psychological Department consists largely of 
the administration of mental tests to patients and out-patients. A short 
statistical report of the routine accomplishments of the year might best 
be presented here. 

In all, 1,169 individuals were examined, falling into the following 
groups: House patients, 361; out-patients, 537; employees, 198; others, 
93; total, 1,169. 

These individuals were given 2,645 tests, viz: Stanford-Binet (or 
Kuhlmann-Binet), 742; group (given individually except in a few 
instances), 370; performance series, 904; memory, 213; association, 221; 
personality, 140; vocational, 53; achievement, 2; total, 2,645. 

The House patients examined consisted of a few distinct groups: 
First, there were the 154 regular patients referred by the medical stalT. 
This group was composed mostly of cases where there was a question of 
mental deficiency. Some were court cases. There were 83 Special Study 
Dementia Praecox patients examined. Fifty of these had second exam- 
inations, and 13 had third examinations — 146 examinations altogether. 

Eighteen general paretics were examined for special study. Besides 
these, there were 86 other patients examined for one reason or another. 
In the Out-Patient Department 303 examinations were made in the 
School Clinics held in various towns. 172 cases were examined in the 
Child Guidance Clinic. (For analysis of cases see the report of the 
Director of Child Guidance Clinic). Thirty-three girls were examined 
at the Girls' Welfare Society, fourteen prisoners at the jail, and there 
were fifteen miscellaneous subjects. 

One hundred and ninety-eight attendants and nurses were examined. 
Of the 93 others the largest part consists of other employees. 

One of the essential functions of a psychological department is to carry 
on research work. A department which is organized on a purely routine 
basis is bound to stagnate and have a hebetating influence upon its 
members, eventually aflfecting that routine work unfavorably. The need 



8 P.D. 23 

for research in psychopathology and related fields is great, the oppor- 
tunities unlimited. The immensity of this field of research for psy- 
chologists might perhaps bear referring to in more detail. Almost every 
specialty in psychology has some field of work in an organization such 
as ours. The child psychologist, the abnormal psychologist, the animal 
psychologist, the experimental psychologist, the applied psychologist, have 
a scope which is only limited by their interest and abilities. 

Research activities, in so far as the patient is involved, fall roughly 
into three groups; therapeutic, diagnostic and theoretical. Of course, 
there is considerable overlapping, but the primary purpose of the research 
is under discussion. 

In the therapeutic field there is considerable scope for work both in 
the determination of the various factors which may have a place in 
therapy (e. g. in relation to occupational therapy; various forms of 
psychotherapy, such as hypnosis) and in working out measures of the 
degree of effect of administered therapy. 

In the diagnostic field lies a tremendous opportunity for the psy- 
chologist. The uncertainty of clinical diagnosis could in many instances be 
decreased if laboratory tests were available which could be used for 
differential diagnosis in a similar way to which the tests of general 
intelligence are used in the diagnosis of feeble mindedness. Tests for 
retardation, affective rigidity, perseveration (to take a few clinical 
symptoms), could be developed if sufficient time and effort were given to 
it. The laboratory would then be of considerable aid in making more 
exact the definitions of various symptoms and supplying objective 
measures of them. 

In the field of theoretical research, the need is obvious. Psychopa- 
thology is in a state where more controlled work of both a qualitative and 
a quantitative nature is essential. The opportunities lie both in the 
test and in the experimental field. An attempt to list these at all fully 
would necessitate an analysis of almost the entire subject of psychopa- 
thology. A mention of a few of the major fields of endeavor, however, will 
suggest the range of possibilities : — 

1. Study of abnormal states in normals — Hypnosis, dreams, sleep, 
hallucinations, etc., suggestion, illusions, hallucinations, etc. 

2. Study of abnormals — both normal and abnormal states, — objec- 
tive observation, studies of memory, association, emotions, sensations, etc. 

3. Abnormal states in animals. Animals offer an unusual field of 
experimentation for psychopathology because of the possibility of con- 
trolling genetic factors and environmental stresses. This field has 
scarcely been touched. Although the application to the human field would 
have to be very cautious, it seems very probable the findings in this 
field will give us valuable time. 

Our department takes its part in the teaching program of the hospital. 
Every group of affiliate nurses is given a twelve hour course in psychology. 
The medical internes are given an eight hour course in psychometrics 
and psychology. Occasional lectures are also given to the Occupational 
Therapy and Social Service Departments. During the summer of 1929, 
a group of school teachers studying here were given an introductory 
course in the principles of psychometrics. A number of papers were 
presented to the staff in seminar and staff meeting. The subjects were, 
"Psychometric technique in the Hospital," "The Ninth International 
Congress of Psychology" (a report of the Congress, attended by the 
director), and "Gestalt Psychology." A few lectures to community 
groups were also delivered. 

Because of the wide range of material at the command of the depart- 
ment this hospital is an exceptionally fine place for training workers in 
psychometrics and clinical psychology. This fact recognized, it is desir- 
able that all who come here shall have the opportunity of working with 
this material. It is, therefore, the policy of the department to make the 



P.D. 23 9 

service a rotating one, in order to cover all the various types of subjects 
at our command. The routine includes attendance at some of the ward 
walks and staff-meetings. 

Although the members of the department are employees rather than 
students, it is to be recognized that as a rule they have had little practical 
experience and that their readiness to come here on meager salary or no 
salary at all implies a desire on their part for training. This places the 
responsibility on us of regarding them as students, which we have tried 
to do. 

We have been called upon a number of times to provide training for 
outside workers. The hospital has been very cordial in its attitude 
towards this work. Miss Jeannette McClure of the Hartley-Salmon 
Clinic of Hartford spent four days with us, and Miss Louise Butler of 
the Lyman School spent two weeks in becoming acquainted with various 
aspects of our technique. 

During the past year one paper was published in association with Dr. 
Grace H. Kent of the Danvers State Hospital. This was, "Group Tests 
for Clinical Studies," The Pedagogical Seminary and Journal of Genetic 
Psychology, 1928, 35, 595-618. Another paper on "Ebbinghaus" was 
accepted by the American Journal of Psychology for April 1930 publica- 
tion. Occasional abstracting was done for Psychological Abstracts. 

The year has been a profitable one in a good many respects. But 
there are still a host of opportunities of which the department is not 
taking advantage. Despite the fact that considerable progress has been 
made in organizing the work so that it is done rather efficiently, we cannot 
take care of ail the routine and as much research as our program had 
intended. Our research plans, broad in scope but integrated in aim, have 
had to be curtailed along various lines because of lack of personnel and 
room. Affiliation with the Psychological Department of some University 
by which some of their students could come here for research and train- 
ing would help the situation considerably. Very little of a laboratory 
research is being done by us with the dementia praecox study group, in 
which there is a great deal to do. 

Report of the Social Service Department 
Eleanor Peck Entorf, Head Social Worker 

It may be of interest to know that the Social Service Department has 
this year made a total of twenty-nine hundred and thirty-three calls. It 
will in some way give an idea of the volume of work carried by it. Total 
number of cases referred to the department during the year numbers nine 
hundred and forty-two. Of this number six hundred and thirty-nine 
were new cases which had not been handled by the department before. 
Two hundred and forty-six histories were secured. This is a decided 
advance over other years and indicates that the staff are more and 
more frequently demanding social service investigations and are seeing 
the value of as full information on cases as is possible to obtain. The 
average number of patients on visit each month was two hundred and 
twenty-one. This means, of course, in addition to the new work of the 
department, social service has been called upon to carry this number of 
cases as a continuous load. 

The Child Guidance Clinic has gradually become an entity in itself and 
this past year none of the regular social workers from the hospital have 
carried any work at the clinic. The clinic now has a full time social 
worker, who assumes entire responsibility for her department, and the 
only contact which the hospital maintains in a social service way is to 
cooperate with the clinic on the matter of the students. 

This past year we have had a special worker in our department who 
has been cooperating with the activities of the Y. W. C. A. It has been 
her particular duty to carry into their organization a mental hygiene 
program. In addition to her work in that organization this worker has 



10 P.O. 23 

been giving five different courses in the community in the field of mental 
hygiene. She has also given various lectures at the request of different 
community organizations. Other workers in the department have given 
lectures at the request of similar institutions in various places. 

In regard to the activities within the hospital the department has 
been working as in previous years. The Smith College School for Social 
Work has continued to cooperate with us in the matter of students and we 
have had four this year. These students come to us for a period of nine 
months and we together with the Child Guidance Clinic work out the 
period of training for them. This past year we had three special 
students during the summer, whose aim it was to discover if they were 
interested in continuing in the field of hospital social work. Another 
student phase has been the advent of medical internes from Boston for 
a period of two months. The Social Service Department has arranged 
to cooperate with the medical staff in giving these students an idea of 
social service. Four hours of lecture work has been prescribed for them, 
and in addition the internes are expected to take at least one complete 
social service history during their stay with us. The lectures to the 
nurses, of course, continue as before. 

During the year the department has also entertained various visitors 
from outside the state and also from outside the country. There have 
been six visitors from England who have been particularly interested in 
the activities of a mental hospital. It has been our pleasure to discuss 
with them our various methods in the hospital, that this would help them 
in their organization work at home. We have also had other visitors who 
have been particularly interested in the working out of Child Guidance 
Clinic in connection with State Hospitals especially as regards the Social 
Service Department. 

It is the feeling of the head worker that a much broader future awaits 
the department because of several things, the most immediate one being 
the cooperation with the Child Guidance Clinic and the rather unusual 
opportunity for training students both at the hospital and at the clinic. 
This offers an almost ideal opportunity for the psychiatric social service 
student, in as much as the clinic itself is just unfolding and is just 
beginning to see its potentialities. There can be no doubt that future 
developments will prove most interesting. There should at all times be 
the closest cooperation by the two departments. 

The work with the medical internes has only just begun but the head 
worker feels that as the medical staff grows in their appreciation of the 
value of social service they will see the important contribution that this 
is in the training of internes. It seems to the head worker that, whether 
or not internes go into psychiatry they must be as fully acquainted with 
the problems of the individual as is possible, and that much of this can 
only come through a full acquaintance with the social situation of 
patients. It is hoped that eventually the work with various agencies in 
the city can be developed more fully. This beginning has just been made 
with one organization and opportunity for doing it with other organiza- 
tions should present itself in the not too far distant future. It would 
seem that the department should carry at least one worker who can make 
this contribution because of training and personality. We have, of 
course, been greatly pleased by an exceptionally well fitted person for this 
work this year. 

The dangers in the department lie in the fact that too much emphasis 
may be placed upon the routine work and this may be allowed to swamp 
the larger perspective. This is, of course, a very natural and easy fault 
to fall into inasmuch as the staff is very likely to demand more and more 
careful investigations both in regard to visit patients and to histories. 
It must be remembered, however, that the aim of any Social Service 
Department and certainly its real strength, lies in the real case work that 
is done. The choice of a few well selected cases on which the various 



P.D. 23 11 

workers can expend their time and skill in an effort to reconstruction and 
readjustment is of vital importance. The pressure of work should under 
no circumstances be allowed to supersede this. 

Report of Nursing Service 
Anne F. McElholm, R.N., Principal of School of Nursing 

In the year 1929 progress has been made by the training school. The 
school has increased to an enrollment of forty students and an affiliation 
of twenty students. 

Framingham-Union Hospital of Framingham and Leominster Hospital 
of Leominster have signed contracts to send two students each every three 
months. Leominster Hospital is so pleased with the affiliation that they 
have asked us to take another student. 

Ten students are at the Boston City Hospital affiliating for one year. 
Two male students are at the Worcester City Hospital for a nine months 
affiliation. 

Nineteen female students were enrolled for training in the class start- 
ing in 1929. 

Four nurses completed their course of training and received their 
diplomas in June. 

Two new, bright, sunny class-rooms, with equipment were opened and 
two graduate registered nurses were installed as instructors. 

A social director now supervises the play-time of the student nurses 
and if is felt that she has done a great deal to help the students adjust 
themselves to' a new environment. 

The Alumni Association gave $75 to the school to start a canteen, the 
profits of which are to be used for the betterment of the training school 
and the nurses home. The canteen is operated in the "Rendez Vous" of 
the nurses home and is a very popular place. 

Report of the Medical and Surgical Service 
Clifton T. Perkiyis, M.D., Senior Physician 
The following is a summary of the various activities of the Medical 
and Surgical Services during the year from December 1, 1928 to 



December 1, 1929. 



Population 







Female. 


Male. 


Total 


. 119 


128 


247 






419 


578 


997 






330 


458 


788 






86 


79 


165 






36 


22 


58 









12 


12 






122 


157 


279 



Patients remaining Dec. 1, 1928 

Admitted .... 

Discharged 

Deaths (Main Hospital) 

Deaths (Summer Street Dept.) 

Escapes .... 

Patients remaining Dec. 1, 1929 

A total of 1,244 patients were cared for on the service, representing 61 
more than the previous year. An analysis of these cases shows that they 
included all of the common medical conditions as well as many varied 
major and minor surgical problems. A comparative few were on the 
medical service only for classification and special study relative to some 
particular system of organs. 

There were 165 deaths in the active medical and surgical wards, with an 
additional 58 deaths at the Summer Street Department, giving a total 
of 223 or 70 less than last year. An analysis of these deaths reveals the 
following general information as to causes : — 

(a) 109 deaths, or 49% of all deaths, were due to those conditions 
incident to advancing years — heart, kidney, and vascular diseases. These 
do not include pneumonia. 

(b) 26 deaths, or 11.5%, were due to tuberculosis, particularly involv- 
ing the lungs. 



12 P.D. 23 

(c) 20 deaths, or 9%, were due to general paresis of the insane, and 
over half of these deaths occurred in conjunction with malarial therapy 
during July, August, and September. This leads us to believe that where 
possible, malarial therapy would be better postponed during the hot, 
exhaustive months except where patients are otherwise in very good 
physical condition. 

(d) 12 deaths, or 5%, were due to some brain disease other than 
arteriosclerosis and syphilis. 

(e) 12 deaths, or 5%, were due to carcinoma. 

(f) 8 deaths, or 3.6%, were due to lobar pneumonia, and of these, all 
but one were beyond middle life. 

(g) The remaining 36 deaths, or 16%, were of varied isolated causes, 
representing no classification of any particular interest. 

As may be noted in the Laboratory Report there were 84 autopsies, 
representing 28% of the deaths. This is 3% less than last year. 

In general the service has been active, the population has been con- 
tinually changing, and at times there is a waiting list for admission to 
either the medical or surgical wards. 

Reports of Clinics 



Wassermann ..... 


857 


Spinal punctures .... 


239 


Eye, ear, nose and throat each . 


639 


Specific treatments .... 


1,834 


Typhoid vaccines .... 


630 


Cold vaccines . . . 


16 


Gynecological examinations 


360 


Small pox vaccinations 


1,073 


Total 


5,648 


r^ . Out-Patient 
Dressings 




Thayer 2 


15,288 


Folsom 2 ..... . 


7,243 



I 



Total 



22,531 



The various clinics maintained an average volume of work. At the 
present time there are 123 luetic patients in the hospital, all of whomf 
are carefully checked and proper treatments administered as indicated. 

The out-patient care and dressings represent a decrease in volume as 
compared with last year. 

On January 14, 15, and 16, 1929, a careful survey was made of all 
patients then in the hospital, and all of those approximately 50 years of 
age or under, were vaccinated against smallpox. Details of this clinic 
have been previously reported. 

A summary of the combined male and female cases follows: — Total 
number of cases vaccinated, 1,001; previously vaccinated, 653, or 65.23% ; 
not previously vaccinated, 348 or 34.77%; show "take", 360, or 36%; do 
not show "take", 641, or 64% ; of the 655 previously vaccinated, 223 or 
34%, showed positive revaccination. 

Surgical Report 
Colecystectomy, 1 ; curettage of right humerus for osteomyelitis, 1 ; 
excision of carbuncle on neck, 1 ; tonsillectomies, 58 ; excision of rectal 
fistula and hemorrhoidectomy, 1 ; removal of finger nail, 1 ; plaster cast 
applied to arm, 1 ; salpingectomy, 1 ; dilatation and curettage, 1 ; cauter- 
ization of endo-cervix, 1 ; excision of Bartholin's cyst, 1 ; perineorrhaphy 
and hemorrhoidectomy, 1 ; perineorrhaphy, 1 ; double inguinal herneor- 
rhaphy, 1 ; appendectomy and laparatomy, 1 ; cystotomy, 2 ; repair of per- 
forated gastric ulcer, 1 ; appendectomy, 2 ; bilateral salpingectomy, 2 ; am- 



P.D. 23 13 

putation of finger, 2; opening and irrigation of antrum of Highmore and 
.partial resection of left turbinate, 1 ; application of splint to right nostril 
for fracture, 1 ; excision of carbuncle, 4 ; suturing laceration of hand, 2 ; 
excision of paronychia, 3 ; trachelorrhaphy, 1 ; repair of umbilical hernia- 
IMayo Op., 1 ; trachelorrhaphy, perineorrhaphy and dilatation and curet- 
Itage, 1 ; excision of chalazion, 1 ; incision of blebs on ankle, 1 ; application 
of plaster cast to shoulder and chest, 1 ; trachelorrhaphy, perineorrhaphy, 
uterine suspension and appendectomy, 1 ; incision and drainage of cellu- 
ilitis of hand, 1; incision of abscess, 11; plaster cast applied to wrist for 
ifracture, 2; lysis of adhesions for sub-acute pancreatitis, chronic hepa- 
|titis with extensive abdominal adhesions, 1 ; trachelorrhaphy and 
perineorrhaphy, 3 ; biopsy of neck, 1 ; application of plaster cast to hip, 1 ; 
iapplication of plaster cast to ankle, 1 ; excision of rectal abscess, 1 ; ice 
Itongs applied to knee for traction, 1 ; perforated gastric ulcer, 1 ; 
'gastrotomy, 1; trachelorrhaphy, perineorrhaphy, Baldi suspension and 
(appendectomy, 1; pan-hysterectomy, 1; radical amputation of left breast, 
1; jejunostomy, 1; supra-cervical hysterectomy, salpingectomy, appen- 
idectomy and hemorrhoidectomy, 2; direct inguinal herniorrhaphy, 1; 
I salpingectomy, suspension (Gilde), appendectomy, trachelorrhaphy and 
: dilatation and curettage, 1; hemorrhoidectomy, 4; herniorrhaphy, 4; 
ileo-cystectomy, 1; excision of fibroma of right breast, 1; posterior gastro- 
j enterostomy, 1; amputation of right foot, 1; cauterization of cervix and 
[perineorrhaphy, 1; excision of cervical polyp and perineorrhaphy, 1; sub- 
total hysterectomy, 1; lysis of adhesions and colostomy, 1; circumcision, 
1 ; cuturing lacerations of knee, 1 ; intravenous injections, concentrated 
salt, solution for varicose veins, 5; trachelorrhaphy, perineorrhaphy 
cauterization of cervix and dilatation and curettage, 1 ; laparotomy, 1 
repair of prolapsed rectum, 1 ; excision of ganglion of left wrist, 1 
removal of sebaceous cyst from scalp, 1 ; Total, 160. 

Although this report represents approximately 100 less operations than 
last year, it does not represent any neglect of necessary surgical care, and 
is consistent with average activity when considered in conjunction with 
the other various activities of the service. 

Many tedious and somewhat dangerous surgical procedures of the 
past have been replaced by less dangerous and what we believe to be 
equally efficient measures. 

Obstetrical Report 

Number of maternity cases delivered between December 1, 1928 and 
December 1, 1929 inclusive: Number of live births, 19; number of still 
births, ; number of deaths of mothers, 1 ; number of deaths of babies, ; 
number of cases of inflamed eyes, 0. 

Although representing nearly 50% increase over last year, this report 
shows a marked drop over the years previous to 1928. The report this 
year is marred by the death of a young mother, 33 years old, occurring 
a few hours after delivery. This was the first child. The mother went 
into labor, rapidly going into an eclamptic state and required immediate 
delivery of her premature baby. Throughout her entire prenatal care 
the mother was very resistive and difficult to manage. 

Dental Report 
Patients, 3,418; examinations, 2,428; cleanings, 1,099; fillings, 1,066; 
extractions, 1,336; treatments, 1,306; gas-ether cases, 27; gas-oxygen 
cases, 6; impactions removed, 29; plates made, 37; repairs, 30; X-ray 
diagnosis, 185; removal of cyst, 1; crowns, 10; inlays, 11; alveolectomy, 
5 ; bridge, 4 ; apiectomy, 1 ; smears and microscopic examinations for 
Vincent's Angina, 49 (37 positive) ; Total 11,048. 

Laboratory Report 
Agglutinins, 102; Alveolar C02, 350; autopsies, 84; bacterial cultures, 
31; blood cultures, 9; bacterial smears, 179; basal metabolism, 457; 



14 P.D. 23 

bleeding time, 5; blood creatinine, 343; blood N. P, N., 441; blood sugar, 
842, blood urea, 326; blood uric acid, 362; blood counts, red, 2288; blood 
counts, white, 2,567; blood counts, diff., 2,390 hemoglobin, 2,285; clotting 
time, 139; galatose tolerance, 594; icteric, 26; liver function test, 102; 
Mosenthal test, 59; mastic test, 12; microscopic sections, 281; nitrogen 
partition, 628; parasites, 5; Platelet count, 2; Plasmodia malaria, 159; 
renal function, 485; spinal fluid, cell count, 277; spinal fluid, gold 273; 
spinal fluid, glob, 279; spinal fluids, sugar 2; sputum, 79; stool, 71; stom- 
ach contents, 2; sedimentations, 3; total chlorides, 1; total nitrogen, 1; 
bloodtyping, 10; urinalysis, 4,715; quantitative sugar, 16; Van den Bergh, 
125; vital capacity, 375; blood calcium, 2; Widal test, 2; total, 21,790. 

The laboratory work has increased in volume 3,000 determinations 
more than last year. The department has been very active in cooperating 
for diagnostic and prognostic purposes with all the various services — 
psychiatric, research and medical. 







X-Ray Report 


Number of 


Number 


Parts Examined Patients. 


of Films 


Arm 18 


30 


Ankle 












20 


25 


Bones 












18 


18 


Chest 












231 


170 


Fluroscopy 












108 





Gall bladder . 












41 


148 


G. I. series 












69 


467 


Hand 












23 


21 


Heart 












7 


17 


Hip 












21 


22 


Humerus 












4 


9 


Knee 












18 


25 


Mandible 












3 


5 


Mastoid 












8 


16 


Neck 












1 


2 


Ribs 












9 


10 


Sella 












54 


74 


Shoulder 












22 


34 


Sinuses 












72 


205 


Skull 












71 


140 


Spine 












15 


25 


Stomach 












3 


10 


Teeth 












122 


270 


Thumb . 












18 


80 


Tibia 












1 


1 


Toe . . . 












4 


4 


Wrist . 












20 


14 


Elbow 












10 


8 


Nose 












5 


7 


Sacro-iliac joint 












1 


1 


Colon 












4 


7 


Leg 












6 


7 


Foot 












5 


8 


Jaw 












16 


19 


Feet and ankles 












12 


12 


Femur 












1 


1 


Skull and sinuses 












9 


36 


Knees and legs 












6 


24 


Kidney . 












1 


2 


Dentals 












115 


325 


Wrist and hand 












7 


7 


Photographs . 












1 


8 



P.D. 23 15 

Number of Number 

Parts Examined Patients. of Films. 

Special . 10 15 

Heel 1 1 

Localization of hip ...... 1 6 

Finger prints ...... 3 48 



Total 1,216 2,384 

Physical Therapy Report 

In order to bridge the gap between medicine and surgery and to act 
as an adjunct to these two methods of maintaining health, a department 
of physical therapy was opened on April 26, 1929. The administration 
of treatments have been under the immediate charge of a single trained 
technician. The department is as yet in its infancy but we are rapidly 
becoming acquainted with the types of mental and physical disorders in 
which physical therapy may form an integral part of the treatment. 

During the past seven months, 192 different patients have received a 
total of 3,414 treatments as listed in the classification below. At the time 
of this report there are over 120 patients on the waiting list for treat- 
ments in this department. 

Employees' Clinic Report 

Physical examinations, 358; treated at clinic, 469; smallpox vaccina- 
tions, 304; typhoid inoculations, 356; Schick tests, 10; total, 1,497. 

This daily clinic, organized July 1, 1928, for the sole purpose of giving 
office examinations and treatments to our employees, has been found to 
be of distinct value to both the hospital and employees. That the clinic 
has been utilized may be noted from the above figures. 

Surgical procedures were necessary on only 24 of our employees, as 
compared with 46 last year. 

Miscellaneous 

In addition to the service rendered to both patients and employees, 
there has been a complete reorganization of the record system of the 
medical and surgical service. From this there has evolved a system of 
standard practice whereby a detailed and rather complete record is main- 
tained for every patient or employee coming within the jurisdiction of 
any of the above departments. This system has been of extreme value, 
not only for temporary purposes and references, but also for statistical 
surveys and relative analyses. 

It has been the earnest endeavor of the medical and surgical service 
to cooperate with the administration, the other hospital services, and 
departments in helping to restore and maintain the health of both patients 
and employees. The relations of the above to the medical and surgical 
service have been very satisfactory during the past year. 

Part 1 — General hiforynation 

Patients are received in this department only as referred cases. They 
may be referred from the patient population through the psychiatric, 
medical and surgical, or research services, and from the employee popula- 
tion they may be referred through any physician. Once referred, the 
responsibility of proper treatment lies, at the present time, entirely in 
the hands of the physician in charge of the medical and surgical services. 

As soon as expedient, after a patient is referred, a diagnosis of the con- 
dition to be treated is made, and physical treatment outlined. This may 
be, and usually is, supplemented by other therapy — mental therapy, drug 
therapy, or by more than one type of physical therapy. This information 
is recorded by the physician, as well as a general statement regarding the 
patient and his condition — whether or not he is cooperative and what is 
hoped to be accomplished by the treatment outlined, etc. 



16 P.D. 23 

With this information at hand, and not until then, the technician is 
allowed to carry on the treatment outlined. In cases where these treat- 
ments are extended over long periods, then rest periods are instituted 
from time to time as indicated. The treatments, although usually 
administered by the technician, are again the immediate responsibility 
of the physician in charge. 

Treatments are discontinued and the case considered as "closed" under 
several conditions: — 

(a) When the optimum effects have been reached by the treat- 
ment outlined. This approaches complete restoration to normal of 
the condition for which treatments were instituted. 

(b) Failure on the part of the patient — failure to cooperate, 
failure to report for treatments, physical condition of the patient 
not warranting continuation of treatments, etc. 

(c) Failure on the part of the type of therapy to produce the 
desired results. 

(d) When a patient does not return for treatments within a week 
— this is usually applicable to the employee population. 

(e) When there has not been complete restoration to normal, and 
further treatments might be of some help, but because of incon- 
venience to the patient, or some other similar reason, it is thought 
best to discontinue further treatments. 

When treatments have been discontinued, and the case considered 
"closed," the physician makes a final note, describing briefly the end- 
results of treatment and classifying this by what we choose to call a 
"Physical Therapy Formula." This formula is modelled after the Moore- 
head Classification for the end-results of fractures in industrial surgical 
work, and is referred to as "P-F." There are three factors in the 
Formula, giving a percentage rating according to the importance of the 
factor: — (1) Symptoms of the condition relieved, 30%. (2) Signs of 
the condition relieved, 30%. (3) Function restored, 40%. Total, 100% 
for complete restoration to normal condition. 

The end-result of treatment for every case is classified according to this 
formula, by the physician in charge. There may be errors in judging 
the results, perhaps too high or too low, but the comparative results 
should be valuable, particularly since they are all judged by one physician 
whose interest is perhaps primarily in physical therapy, but it is no 
more prejudiced in the treatment of pneumonia than it is in the treat- 
ment of alopecia, etc. 

Once a series of treatments have been discontinued and the case 
classified, if the patient returns at a later date for further treatments 
for the same condition or for another condition, he is considered as a 
new case. 

There are still other fields which have not even been touched. Such as 
the use of Physical Therapy in treating gonorrhea, in female pelvic 
conditions, in treating the psychoses and psychoneuroses as such, etc. 
These fields will be opened up during the coming year. 

Report of Research Work 
Frmicis H. Sleeper, M.D., Assistant Superintendent 
The work during the past year has been continued along the lines dis- 
cussed in previous reports. The main project, that of a study of the 
significant endocrine factors in schizophrenia, has been carried out as a 
conjoint research with the Memorial Foundation for Neuro-Endocrine 
Research. Dr. R. G. Hoskins, director of the Memorial Foundation for 
Neuro-Endocrine Research, has continued to serve in the capacity of con- 
sultant in therapeutic research, and as a result of his long experience 
and tremendous industry, the work of the Research Department has 
markedly increased over that of former years. 



P.D. 23 17 

The various problems under study may be enumerated seriatim and 
comments offered on each: 

1. Endocrme Studies m Dementia Praecox — including studies on the 
urine ; basal metabolism ; blood pressure, pulse ; temperature ; respiration ; 
blood morphology; blood chemistry; phenolsulphonthalein output; gal- 
actose tolerance; weight; surface area; vital capacity; urobilinogen in 
the urine; alveolar-carbon dioxide; Van den Bergh tests, direct and in- 
direct; Graham test; bromsulphthalein test; x-ray studies of the chest, 
sella, turcica, and sinuses ; and gastro-intestinal tract series. 

The studies are directed especially toward diagnosis, of endocrine dis- 
order but they aft'ord also many data on the general physical and meta- 
bolic conditions. 

2. An Attempt to subdivide "Schizophrenia" on a Metabolic Basis into 
Valid Sub-Types. 

3. Studies on the Autonomic Nervous System, in Schizophrenia — in 
collaboration with Dr. M. Yorshis. It is planned to make an extensive 
study of the autonomic system in both acute and chronic forms of 
schizophrenia and in the various sub-groups of the disorder. That wide- 
spread disturbances of autonomic functions occur is well known, but 
whether these are primary or secondary manifestations is problematic. 

4. The Effects of Gla^id products on the Mental Symptoms of Schizo- 
phrenia. If the diagnostic studies indicate an endocrine disturbance, 
attempts are made to correct this disturbance in the hope of improving 
the mental condition. There is, seemingly, a close correlation between the 
efficacy of gland products available in each category and the clinical 
results obtained. 

In the past year, even, there has been a tremendous advance in 
knowledge concerning the active principles of various gland products. 
During the past year. Thyroxin, an active principle of the thyroid gland, 
prepared by a new method, has become available. In two cases, we have 
had apparently brilliant results following its administration in 
schizophrenics. 

The posterior lobe extract, through the work of Kamm and his associ- 
ates, has been fractionated into two active components. The relative im- 
portance of each in our therapeutic report remains as yet largely to be 
determined. 

The discovery recently has been made that the anterior lobe produces 
at least two entirely distinct hormones, one of which stimulates the 
growth processes, and one, sexual activity and development. We are re- 
ceiving regular supplies of the sex-stimulating extract from two sources. 

Adrenal cortex medication is frequently encountered in our therapeutic 
work. For several months one concern has been manufacturing an active 
preparation of adrenal cortex that can be administered by mouth. We 
have received one small lot to date, and the results from this lot were 
definitely encouraging. 

Koch and his collaborators have recently evolved a potent extract of 
the male gonads. We hope to test this clinically in praecox within the 
next year. 

5. The effect of Glandular Medication on Physical and Metabolic Con- 
ditions of Man. It will be recalled that a tremendous volume of data is 
accumulated on each individual patient studied, and the effects of medica- 
tion are checked by a complete duplication of the work done at the 
beginning of the study. Here, then, we have the opportunity of checking 
the effects of the various glandular medications on the different studies 
made. 

6. Relative Efficacy of Various Commercial Prepai^ations of Different 
Gland Derivatives. There are numerous commercial firms supplying com- 
peting gland products. In this clinic, we are enabled to check the clinical 
effects of the different commercial preparations, one against the other, 
and note the relative efficacy of the products. 



18 P.D. 23 

The manufacturers are decidedly cooperative, and practically all of the 
larger concerns manufacturing glandular products have supplied us v^^ith 
large quantities gratuitously. 

7. The effects of Vitamine Concentrates on the Symptoms of 
Schizophrenia. As a matter of general policy, the hospital staff is inter- 
ested in determining the helpful possibilities of the various methods 
of treatment other than glandular. The increasing of vitamine intake 
on the patient has been suggested as a promising field of research. Dur- 
ing the past year a new commercial product of vitamine concentrates, 
"Vi-C", has been used in a considerable number of cases in which either 
satisfactory results are not obtained with glandular products now avail- 
able, or in which it was thought that supplementary medication of this 
type might be helpful. At the present stage of the investigation, the pro- 
duct mentioned does not appear to be of any great value in the treatment 
of schizophrenia. 

8. The Effect of Calcium Medication on Nervous Irritability in 
Schizophrenia. There is considerable evidence in the literature of a corre- 
lation between blood calcium concentration and nervous irritability. Con- 
siderable study has been made of the efficacy of calcium gluconate and of 
calcium lactate in the control of tenseness and agitation. In schizo- 
phrenia, calcium medication alone seems to have relatively little efficacy. 
This, however, is a tentative conclusion, as the work is not completed. 

9. The effect of Viosterol on the Efficacy of Ingested Calcium. The 
fact that "Vitamine D" has an important relationship to calcium meta- 
bolism, suggested the desirability of attempting to promote the efficacy 
of calcium by the supplementary use of irradiated Ergosterol. 

10. The Effects of Bile Salts on the Assimilation of Gland Products. 
An outstanding difficulty in endocrine therapy is that of getting the hor- 
mones absorbed effectively when administered by mouth. There is some 
evidence in the literature that absorption of drugs can be promoted by 
the use of bile salts. 

11. The Effects of Insulin on the Symptomatology of Schizophrenia. 
There has been reported in the literature, where it is present, to increase 
the weight of mental patients by the use of Insulin. We have duplicated 
this work and are investigating the possibility that increased weight 
(hence of available energy) would be helpful in schizophrenia. 

12. The Effect of Insulin in Antidoting Certain By-Effects of Thyroid 
Medication. The fundamental purpose in giving thyroid gland material to 
patients is to increase their fund of available energy. We are handi- 
capped to some extent, however, by the toxic effects of thyroid on the 
heart and other organs. The possibility that such by-effects may be offset 
by the use of insulin is being investigated. 

13. The Practical Utility of the Intra-Nasal Route for the Administra- 
tion of Pituitary Extracts. At times it is quite difficult to get certain 
schizophrenics to swallow their medication. There is considerable evi- 
dence to the effect that certain gland products are readily absorbed from 
the nasal mucosa. This research is being carried out as a joint project 
between Dr. Hoskins and Dr. Thompson. 

14. A Study of Practical Cydteria of the Basality in Alleged "Basal 
Metabolism" tests. Determinations of the rate of basal metabolism play 
an important part in our studies and in similar studies. The technic of 
such tests presents several possibilities of errors. There are, however, 
certain objective criteria that aid in the detection of such errors. A 
considerable body of data on such criteria has been collected, and it is 
hoped to offer a quantitative analysis of them soon. 

15. The Effects of Repeated Oxygen-Carbon Dioxide Inhalations on 
the Mental Symptoms of Schizophrenia. Recently Loevenhardt reported 
the discovery that breathing forty per cent of carbon dioxide in pure 
oxygen gas for five minutes has a remarkable effect on mute catatonics. 
The patients suddenly resumed contact with reality and seemed for a 



P.D. 23 19 

brief interval to be nearly or completely free of their psychosis. After 
a few minutes they relapse again into catatonia. This fact seems to 
offer further support to the growing conviction that schizophrenia is 
primarily of organic causation. 

16. The Effects of Manganese Chloride on the Mental Symptoms of 
Schizophrenia. Several investigators have recently reported that man- 
ganese chloride is frequently helpful in this disorder. It is possible that 
the manganese acts by catalyzing the oxidation processes of the brain 
cells. We are making a preliminary study of the possible efficacy of oral 
administration. We have used, to some extent, intramuscular adminis- 
tration of colloidal manganese, also. 

17. The Effects of Sodium Amytal on the Mental Symptoms of Schizo- 
phrenia. At the last meeting of the Association for Research in Nervous 
and Mental Diseases, Lorenz and Bleckween reported very satisfactory 
results in schizophrenics following the use of sodium Amytal. They gave 
the medication intravenously the first day, and thereafter intramuscularly. 
The patients usually slept for several hours, at the end of which they 
were comparatively free from psychotic manifestations for several hours 
longer. We are using the material primarily to relieve the tenseness 
and agitation present in so many catatonics. The work is in too early a 
stage at the present time to discuss results. 

18. Electrocardiographic Studies of Bradycardia Occurring in Schizo- 
phrenia. This is a joint research being conducted by Dr. Ackerly and 
Dr. Halloran, who is the electrocardiographer at the Worcester Memorial 
Hospital. It has been noted for a long time that patients suffering from 
schizophrenia frequently show a marked bradycardia. It was felt that 
electrocardiographic studies might be of great value in giving informa- 
tion as to the etiology of this particular phenomena. 

19. Studies in Malarial Treatment of General Paresis had been con- 
tinued by Dr. DeAsis to the time of his resignation, since which time 
they have been carried along under the direction of Dr. Perkins. 

20. The Use of Diathermy in the Treatynent of General Paresis. Al- 
though the malaria has given us our best therapeutic results in the 
treatment of general paresis, the fact that there is approximately eleven 
per cent mortality from the malaria suggests that some other method of 
treatment might be of value. Spontaneous rupture of the spleen occurred 
in the first one hundred cases given malaria in the hospital. Two of 
them died. It is fairly generally conceded that the general effect from 
malarial therapy is derived from the production of heat in the individual. 
We have run several cases through with diathermy to date under the 
immediate supervision of Dr. Perkins, but it is too early as yet to draw 
any conclusions regarding the therapeutic value of the technic. 

21. Psychological Researches under Dr. D. A. Shakoiv. 
1. Test tvork (Outside of the routine testing). 

A. Administration to Psychotics of: — Perseveration test. Color 
Blindness test. Eyedness test (Parson). Introversion Extroversion test. 
(G. E. A. B. form: Kohlstedt — Neymann) Heilbronner apperception test. 
Ascendance — Submission test (Allport). 

B. Standardization on Normals: — Perseveration test (paper and per- 
formance types). Psychomotor learning. Wells Memory Test (restand- 
ardization). Shakow-Kent Symbol Digit Test. Heilbronner appercep- 
tion test. Kent-Shakow Formboard Series. 

C. Development of Netv Tests: — Perseveration test. Formboard test. 

D. Special Groups Tested: — Elaborate (3-4 hour) examination of 
dementia praecox on research — repeated every three months. Attend- 
ants. Memory in Alcoholics. Association in dementia praecox and 
manic depressive. Elaborate (3-4 hour) examination of general paretics 
before and after malarial treatment. 

E. Analysis of Test Results: — Problem of "Scatter" on the Stanford- 
Binet. Analysis of records of last five years. Effect of time limit on 
achievement in group tests by dementia praecox. 



20 P.D- 23 

2. Experimental: Effect of extra-attentional factors on judgment. 
Effect of rhythmic stimuli on patients in packs. Suggestibility in 
psychotics. 

3. Others: Regular observation of praecox on research in special 
observation room. Survey of employment situation of attendants. 

Projected Research: The effect of isolation on behavior in animals. 
The "Motor-Representation" method (Luria) in psychosis. Rohrschach 
test in psychosis (with Yorshis). Dreams of Psychotics (with Ackerly 
and Yorshis). 

22. Publications: 

1. "The Effect of Ingested Thyroid in the Blood Morphology of 
Man" — Drs. Hoskins and Sleeper. Endokrinologie, 5: 89-103. 1929. 

2. "Basal Metabolism in Schizophrenia" — Drs. Hoskins and Sleeper. 
Arch. Neurol. & Psychiat., 21; 887-900. 1929. 

3. "Endocrine Studies in Dementia Praecox" — Drs. Hoskins and 
Sleeper. Endocrinology, 13: 245-265. 1929. 

4. "A Case of Hebephrenic Dementia Praecox with Improvement under 
Thyroid Medication" — Drs. Hoskins and Sleeper. Endocrinology, 13: 
459-466. 1929. 

5. "Malaria as a Therapeutic Agent for Paresis" — Dr. DeAsis. Arch. 
Neurol. & Psychiat., 22: 752-766. 1929. 

6. "The Effect of Hypnosis on Basal Metabolism" — Dr. Goldwyn. 
Arch. Internal Medicine, Jf5: 109-114. 1930. 

Summary of Endocrine Research in Dementia Praecox 
To date, a total of 129 patients have been significantly studied. Of 
these, 70 cases have been discontinued. In ten cases the patients escaped, 
were transferred or died, leaving 60 complete cases. Of the 60, 24 
patients or forty per cent, have been sent home. An equal number were 
given up as relatively "hopeless", and of the 59 cases now under study, 9 
have not yet been significantly treated. Of the remaining 50, 20 or forty 
per cent, have shown significant degrees of improvement under treatment. 
In one of the 50 have all the therapeutic possibilities been exhausted. 

The problem of schizophrenia presents many aspects imperatively in 
need of study. In this report, a few of these aspects are considered. 

Research work in this institution is carried out on a very broad basis, 
and practically every member of the Staff is responsible, to a greater or 
lesser degree, for all research work emanating from this institution. 

Report of the Out-Patient Department 
S. W. Hartwell M.D., Director of Child Guidance Clinic 

I. The Out-Patient Treatment Clinic: With the cooperation of the 
Social Service Department of the hospital an attempt has been made 
throughout the year to follow and give advice and treatment interviews 
to all patients who are on visit from the hospital. To do this, regular 
monthly clinics have been held on afternoons and evenings the second 
Monday of each month at the Summer Street Department of the hospital. 
These were conducted personally by the physician in charge of the Out- 
Patient-Department. Nearly every patient whose visit expired during 
the year was seen in this way several times, and invariably seen before 
being finally discharged. Others whose visit did not expire, or who for 
therapeutic or other reasons were continued home on visit were seen at 
regular intervals in this clinic. 

It became evident as the year passed that the only day a month plan 
was inadequate to properly serve the increasing number of interviews 
desired by the patients who were on visit. They were frequently coming 
without an appointment and many of them were coming more- frequently 
than they were given appointments for. These patients many of them, 
often expressed the wish that they might see the particular doctor of the 
staff who had treated them in the hospital during their residence there. 



P.D. 23 21 

For these reasons, at the end of the hospital year, a change in this system 
was made. During the next year the plan to be in operation is as follows : 
When the patient is discharged on visit he is given a card giving him 
the name of the member of the staff whom he is to see for treatment and 
follow-up interviews during his visit. The staff member is usually the 
one who has had most contacts with the patient during his period of resi- 
dence in the hospital. He is given the first appointment to return and see 
this particular physician and he is told that he is to feel free to come as 
often as he wishes to make appointments. It is felt that in this way, 
treatment already begun, may be more successfully carried out, that 
patient will feel free to come back and that each physician will have not 
only the opportunity of observing the results of earlier treatment and 
social suggestions given, but he also will be getting the experience of 
extramural psychiatry. 

It is felt, that without a doubt, many patients having been discharged 
on visit during the year, have made better adjustments and have advanced 
toward complete cure more successfully because of the Out-Patient De- 
partment Clinic, as it has been conducted. It is to be hoped that the new 
method will be even more helpful. 

11. Examination of retarded school Children: Under the Ma,ssachus- 
etts Latv: Under the division made by the State this hospital has 
assigned to it fifty-nine towns where clinics are to be conducted annually, 
if necessary. In no one year do all the towns need the examination of 
children two or more years retarded. During the year ending September 
30, 1929, clinics were conducted in the following twenty-four localities : 
Oxford, Southborough, Northborough, Jefferson, Holden, Wayland, 
Cochituate, Sudbury, Boylston, Shrewsbury, Princeton, Westminster, 
Sterling, Millville, Blackstone, Leicester, Clinton, Ayer, Farnumsville, 
Fisherville, Grafton, Saundersville, Paxton, and Holden. 

At the beginning of the school year all the school superintendents in 
these towns are notified by letter of our desire to make advance appoint- 
ments for these clinics and superintendents are requested to report as 
to whether or not they will have children to be examined during the 
school year. This year all superintendents so requested responded either 
by asking for a date or by saying that there would be no children to be 
examined. 

During the year a total of 299 children were examined, 98 of whom 
were found to be technically feebleminded. The staff for these travelling 
school clinics consisted of the psychiatrist (physician in charge of the 
Out-Patient Department), three psychologists and one social worker. 
Usually about eight children, never more than ten are examined in one 
full day by this staff. Following the clinic and staff conference on all 
cases examined, a summary of the findings, both psychological and 
psychiatric are made. An appointment is then made with the superin- 
tendent of the school to meet him, his school nurse and his teachers 
interested, for a general discussion of these cases. At this time final 
recommendations are made. The life of each individual child is discussed 
with his group. It has been found that the members of these groups 
are much interested in the discussion of their problems from a psycho- 
logical and psychiatric angle. Very often opportunities arise to give con- 
structive suggestions along the line of Child Guidance and Mental 
Hygiene as applies to the school teacher and her work. 

We find a number of schools and communities badly in need of special 
classes where none is provided. The superintendent of these school 
systems always report local antagonism at the establishment of such 
classes. This feeling is based, first on the additional cost to the school 
system and second on the general feeling in the community that there 
is "some disgrace" attached to the child and his family if placed in a 
special class. Educational propaganda, to overcom.e these attitudes, is 
badly needed in many of the communities served by the Travelling School 
Clinic. 



22 P-D. 23 

It has been found that an increasing demand on this Travelling Clinic 
is being made to have the psychiatrist see children for other reasons than 
school retardation. Under the law this is possible with the written con- 
sent of the parents and it has been done in a considerable number of 
cases throughout the year. From an educational standpoint this is 
probably a desirable procedure but from the standpoint of giving real and 
constructive advice to those in charge of these children with personality 
problems, we feel that the general practice would not be advisable and of 
course, the type of treatment that a psychiatrist might give the child 
himself in one interview, conducted in a school clinic, is very limited. 
Our feeling is that in communities served by the Child Guidance Clinic 
that behavior and personality problem children, not retarded in school, 
should not be studied in the travelling school clinic. However, the clinic 
does serve a very useful function in regards these cases in that such 
children may be superficially investigated by the social worker and 
psychiatrist at the time of visit to the school and advice given as to the 
wisdom of referring them, for a thorough study, to the child Guidance 
Clinic. 

III. Worcester Child Guidance Clinic: This branch of the Out-Patient 
Department work is now eight years old. From a small beginning it has 
grown steadily until it is now one of the large Child Guidance Clinics of 
the country. 

The Clinic is located in the building of the Out-Patient Department of 
Memorial Hospital. The hospital furnishes quarters, rent, light and 
heat free and the Worcester Welfare Federation contributes materially to 
the expense of the clinic. The chief Social Worker's salary, the office 
supplies and the stenographic help are thus furnished. The Worcester 
State Hospital maintains it in all other expenses. 

During the year the clinic has expanded. Until the first of August the 
psychiatric service consisted in one physician two days a week. Since 
then the director of the clinic has spent his entire time there. In addition 
to this the former director has spent two afternoons a week in Child 
Guidance Work. The remainder of the staff consists in chief Social 
Service Worker, Volunteer Social Service Worker, four Smith College 
students, two of whom are in the clinic at all times, one full and one part 
time psychologist and one stenographer. 

During the year there have been studied 164 new cases. Thirty-two 
old cases have been reopened and seventeen cases were carried through as 
treatment problems from the previous year into this one. The sources 
of these cases are as follows: Schools 24; from parents 26; other hos- 
pitals and clinics 34; social agencies 20; court 22; miscellaneous 38. At 
present the average time spent with each case is approximately thirty 
hours. Counting only such cases as are taken for psychiatric or psycho- 
logical treatment the average time spent is approximately seventy hours. 
In some cases presenting particularly difficult personality problems, in 
which a serious attempt is to be made to alter the mental life of the child, 
much more time is spent. 

We have several cases who have occupied more than two hundred hours 
of the time of the psychiatrist, psychologist and social worker. The aver- 
age for the children seen during this year was between ten and eleven 
years. About twenty per cent of the children seen were borderline or 
lower in their mentality while approximately thirty per cent were classed 
high normal or superior by the psychologists. 

As regards the problems presented by these children we find that, 
roughly by dividing them into groups, the following is the situation. 



Mentality 
Behavior 
Environmental 
Personality 



Chief 


Secondary 


Problem. 


Problem. 


41 


62 


52 


36 


36 


29 


35 


37 



P.D. 23 23 

Four general types of service is given these cases. First the cases that 
are studied only as a diagnostic way. These are largely cases involving 
mental equipment of serious school problems, or of cases of children for 
adoption. In this group also comes a part of the speech defect cases. 
Second those studied and records closed by the clinic after social and 
psychiatric advice has been given to those referring the child. Third, 
children with whom the clinic maintains relations and the case is not 
quickly closed because of social adjustments, only, that must be made for 
the child. Fourth and the largest group are those who are not only 
studied and advice formulated but who are kept as psychiatric treatment 
cases. This group includes all those children who have, as a part of 
their personality problem, traits that are interfering with their good 
adjustment to life or who are thought by the clinic to be indulging in 
mental habits that will later cause trouble of any kind for the child. For 
these children regular and often long continued series of interviews and 
other contacts are arranged for. Very careful case records covering 
both the social and the psychiatric records on the case are kept. 

We feel that this latter group constitutes the more important part of 
the Child Guidance Clinic as its functioning as a part of the Out-Patient 
Department of the Worcester State Hospital but of nearly equally 
importance is the attempt that the members of the staff are making along 
the lines of community education. The psychiatrist, the psychologists 
and chief Social Service Worker are always available to give talks or 
conduct forums for groups of people interested in mental hygiene and 
child guidance. During the past year more than sixty of such talks or 
addresses have been given by the staff and there is a constantly increasing 
demand for this service. 

At present the Child Guidance Clinic is serving and cooperating with 
more than thirty various hospitals, schools, young people's clubs and 
societies and all of the various social agencies organized in the City of 
Worcester. 

The Child Guidance Association Society consists of an executive com- 
mittee, board of directors and general membership. Our executive com- 
mittee meets monthly, the board of directors every three months and the 
entire society annually. Practically the entire membership of these 
various groups attend at the meetings and see dynamic and helpful 
interest taken in all clinics by our executive committee and board. 

It is expected that provision will be made by the legislature at present 
in session for the considerable expansion of the activities of this clinic 
during the year to come. 

General Repair Work 

The regular repair work of the hospital has been kept throughout the 
year, and the buildings are in fairly good condition. The Officers' 
Cottages have been completed and are a valuable addition. They are now 
occupied by the Assistant Superintendent and Clinical Director. 
Recommendations: A program of floor replacements in the hospital 
which will proceed more rapidly than has been the case in the past is 
indicated. The old wooden floors have been in place many years, and 
should be replaced preferably with reinforced cement floors on top of 
which linoleum can be placed. This would make the building absolutely 
fireproof. 

The porches throughout the hospital are in a bad state of repair and 
several of them have been condemned and cannot be used by patients. 
These should be replaced by brick and concrete structures as soon as funds 
will permit. A general over-hauling of both the roofs of the main build- 
ing and Summer Street is imperative at an early date. The Summer 
Street roof should be completely replaced and the roof at the main build- 
ing should have considerable work done on it. 

We have requested this year an appropriation in addition to our regu- 



24 P.D, 23 

lar maintenance for carrying on both research work in the hospital and 
child guidance work in the community. In my opinion the time has 
arrived when some other method of meeting the increasing demands 
upon the State for more housing facilities should be carefully scrutinized 
with the idea of making an attempt to solve the problem in some other 
way. It would seem that some money could be diverted for research into 
the causes and prevention of mental disease, and it is my earnest recom- 
mendation that this program be pursued for a sufficient length of time to 
enable us to ascertain if more patients cannot be returned into the com- 
munity. I believe that the important thing to accomplish this end is a 
personnel. If more patients could be discharged from the hospital and 
adequately supervised in the community it would seem obvious that an 
increase in the force of social workers would be an excellent investment 
for the State. 

In conclusion I wish to express my sincere thanks and appreciation for 
the loyalty and efficiency of the officers and employees of the hospital. 
They have made possible any progress that has been manifested during 
the year in the work of the institution. I also wish to thank the Board 
of Trustees for the support and encouragement the members have given 
me at all times. 

Respectfully submitted, 

WILLIAM A. BRYAN, 

Superintendent. 

VALUATION. 

November 30, 1929. 
Real Estate. 



Land, 589.16 acres 
Buildinsa 



S438,200 . 00 
2,161,914.66 



Personal Property. 



Travel, transportation and office expenses 

Food 

Clothing and materials 

Furnishings and household supplies 

Medical and general care 

Heat, light and power 

Farm ..... 

Garage, stables and grounds 

Repairs ..... 



Real estate 
Personal property 



SUMM-^RT. 



$2,600,114.66 

$6,374.58 
12,286.44 
28,807.77 
281,930.19 
26,146.19 
12,923.06 
41,385.08 
9,957.77 
23,412.44 

$443,223.52 

$2,600,114.66 
443,223.52 

$3,043,338.18 



FINANCIAL 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, 1929. 



Income. 
Board of Patients 



Cash Account. 
Receipts. 



Personal Services: 

Reimbursement from Board of Retirement 



$101,130.00 



$101,130.00 
280 21 



Sales : 



Food 

Clothing and materials . 
Furnishings and household supplies 
Medical and general care 
Heat, light and power . 



$1,557.38 

62.70 

85. 55 

153.48 

25.60 



P.D. 23 

Farm: 

Cows and calves 

Pigs and hogs . 

Hides 

Hay 

Sundries 
Garage, stable and grounds 
Repairs, ordinary- 
Total sales 

Miscellaneous: 

Interest on bank balances 
Rent .... 



Total income ....... 

Maintenance. 
Balance from previous year, brought forward 
Appropriations, current year: 

Maintenance ........ 

Total 

Expenses (as analyzed below) ...... 

Balance reverting to Treasurj of Commonwealth . 

Analysis of Expenses. 
Personal services ..... 
Religious instruction .... 
Travel, transportation and office expenses 

Food 

Clothing and materials 

Furnishings and household supplies 

Medical and general care 

Heat, hght and power 

Farm ...... 

Garage, stable and grounds . 

Repairs, ordinary .... 

Repairs and renewals .... 



25 



Special Appropriations. 



Total expenses for Maintenance 

Balance December 1, 1928 . 

Appropriations for current year .... 

Total . . 

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

Balance November 30, 1929, carried to next year 



$485.53 
48.00 
60.94 
44.00 
23.00 
62.81 
109.92 



,762.34 
501.50 



$12,825.05 



$2,718.91 



2,263.84 
$106,392.96 

$17,758.42 

871,410.00 

$889,168.42 
845,376.61 

$43,791.71 



$417,300.20 

2,620.00 

9,944.71 

170,887.74 

18,669.02 

38,4.59.61 

40,330 . 73 

72,800.53 

30,688.41 

7,791 91 

20,565.22 

15,318.53 

$845,376.61 



$14,394.46 
42,000.00 

$56,394.46 

12,825.05 

$43,569.41 



Object. 


Act 

or 

Resolve. 


Whole 
Amount. 


Expended 

During 

Fiscal Year. 


Total 
Expended 
to Date. 


Balance 
at End 
of Year. 


Boilers ..... 
Water Supply, Hillside Colony . 
Officers' Cottages 
Officers' Cottages, 1929 . 
Cow and Hay Barns 


1927-138 
1927-138 
1928-127 
1929-146 
1929-146 


$42,000.00 

4,500.00 

12,000.00 

12,000.00 

30,000.00 


$4,481.22 

5,400.20 
1,193.17 
1,750.46 


$41,993.07 

11,993.89 
1,193.17 
1,750.46 


$6.93 

4,500.00 

6.11 

10,806.83 

28,249.54 






$100,500.00 


$12,825.05 


$56,930.59 


.$43,569.41 



$43,569.41 
$43,569.41 



Balance reverting to Treasury of the Commonwealth during year (mark item with *) . 
Balance carried to next year .......... 

Total as above ............ 

Per Capita. 
During the year the average number of inmates has been 2,241.89. 
Total cost for maintenance, $845,376.61. 

Equal to a weekly per capita cost of $7.2515 (52 weeks to year). 
Receipt from sales, $2,718.91. 
Equal to a weekly per capita of $.0233. 
All other institution receipts, $103,674.05. 
Equal to a weekly per capita of $.8893. 
Net weekly per capita $6.3389. 

Respectfully submitted, 

JESSIE M. D. HAMILTON, Treasurer. 



26 



STATEMENT OF FUNDS. 

Patient's Fund. 



Balance on hand November 30, 1928 
Receipts ..... 
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, 1929 . 



Investment. 



Lewis Fund. 



Balance on hand November 30, 1928 
Income ..... 



Expended for entertainments, etc. 



Investment. 



Millbury Savings Bank .... 

Worcester Five Cents Savings Bank 

Balance Worcester Bank and Trust Company 



$19,338.13 

27,546.75 

843 . 53 



$25,935.49 
843,53 



$2,000.00 
2,000.00 
2,000.00 
3,000.00 
3,000.00 
8,538.99 
410.40 



$1,562.99 
148 . 35 



$634.26 

1,000.00 

33.38 



P.D. 23 



$47,728.41 



26,779.02 
$20,949.39 



$20,949.39 



$1,711.34 
43.70 



$1,667.64 



1,667.64 



Wheeler Fund. 



Balance on hand November 30, 1928 ....... 

Income ............ 

$6,687 . 70 

Expended for entertainments, etc. .......... 304 . 48 



$6,090.34 
597.36 



Investment. 



Grafton Savings Bank .... 

Millbury Savings Bank .... 

Worcester Mechanics Savings Bank 
Balance Worcester Bank and Trust Company 



M.4NS0N Fund. 



Balance on hand November 30, 1928 
Income ..... 

Expended for entertainments, etc. 



Investment. 



Millbury Savings Bank .... 

Balance Worcester Bank and Trust Company 



Amount of bequest 

Income .... 

Expended for patient's comfort 



Clement Fund. 



Intestment. 



$4,000 . 00 

1,374.22 

1,000.00 

9.00 



$1,170.13 
55.23 



$1,162.80 
23.98 



$1,000.00 
15.94 



$6,383.22 



$6,383.22 



$1,225.36 
38.58 

$1,186.78 



$1,186.78 



$1,015 94 
15.94 



$1,000.00 
$1,000.00 



Worcester County Institution for Savings ........ 

Respectfully submitted, 

JESSIE M. D. HAMILTON, Treasurer 
November 30, 1929. 



P.D. 23 27 

STATISTICAL TABLES. 
As Adopted by the American Psychiatric Association. 
Prescribed by Massachusetts Department of Mental Diseases. 

Table I. General Information. 

1. Date of opening as an institution for the insane; Jan. 18, 1833. 

2. Type of institution: State. 

3. Hospital plant: 

Value of hospital property: 

Real estate, including buildings . . . . . 

Personal property .......... 



$2,600,114.66 
443,223 . 52 



Total 

Total acreage of hospital, 589.16 acres. 

Acreage under cultivation during previous year, 175.00 acres. 

4. Medical service: 

Superintendent .......... 

Assistant Physicians ......... 

Medical Internes .......... 

Dentist ............ 

Total physicians ......... 

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

Graduate nurses .......... 

Other nurses and attendants ........ 

Ail other employees ......... 

Total employ ees ......... 

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

of report ........... 

7. Patients in institution on date of report (excluding paroles) 



Men. 
1 
8 
2 
1 

12 

Men. 

2 

110 

101 

213 

799 
1,113 



$3,043,338.18 



Women. Totals 

1 

1 9 

2 

1 



Women. Totals. 



37 

112 

75 



641 
1,160 



39 
222 
176 



1,440 
2,273 



Note: — The following items, 8-13, inclusive, are for the year ended September 30, 1929. 
8. Census of patient population at end of year: 



Actually in Hospital. 



White: 

Insane 
Epileptics 
Mental defectives 
Alcoholics 
All other cases 

Total . 

Other races: 
Insane 
Mental defectives . 

Total 

Grand Total 



M. 

1,048 

12 
1 

7 

1,068 
31 



31 
1,099 



F. 

1,095 

1 

24 

3 

1,123 



30 
1 



31 
1,154 



Absent from Hospital but 
Still on Books. 
F. 



2,143 
1 

36 
1 

10 



2,191 



62 
2,253 



M. 

157 

3 

1 

161 



2 
163 



142 
4 



3 

149 



T. 

299 
7 
1 

307 



5 

312 



9. Patients under treatment in accupational-therapy classes, including physi 
cal training, on date of report ....... 

10. Other patients employed in general work of hospital on date of report 

11. Average daily number of all patients actually in hospital during year 

12. Voluntary patients admitted during year ..... 

13. Persons given advice or treatment in out-patient clinics during year 



85 129 214 

714 512 1,226 

1,090.92 1,141.62 2,232.54 

8 9 17 

402 316 718 



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



28 



o 

o 

m 

o 

< 
o 

Eh 


M. F. T. 

1,290 1,304 2,534 

294 198 492 
50 34 84 

8 29 37 

352 261 613 

1,642 1,565 3,207 

23 1 24 

93 98 191 
)7 30 127 
28 13 41 

15 9 24 
124 111 235 

380 262 642 

1,099 1,154 2,253 
163 149 312 


CO 

c<r 

CO 

o 
co_ 
1—1 

CO 

t— 1 


Temporary 

Care and 

Observation. 


r' »0 t^i-f 1 00 CO i-*l>OiO 1 1> O ■* (M 
C-liMt^i— 1 OOi— •(Ml— ICO 1— 105 1—1 

1—1 

CO OOCO |i-lrtl i-HC0'*'O5 ICO CO '^i-l 
fe T-l i-( (N CO (M 

k^ r^l O500 It^Ol O-^COCD |t-i t^ Oi-i 
<i 1-1 lO cot^ (M C<) 1-1 CO 1-1 


CO 
1— ( 

lO 

1—1 
1—1 


o 

> 


r* (M CO(M 1 101> 1 O 1 (M II I> 00 1 

C~i 1— 1 1—1 

^- CO iMi-i Icool Icoli-i II Tt^ col 

g'cOr-li-l |C<)00 |(M|i-l 11 CO >OI 


00 
CO 
lO 




M. F. T. 

1,272 1,285 2,557 

234 178 412 
41 30 71 

8 29 37 

283 237 520 

1,555 1,522 3,077 

3—3 
87 92 179 
91 26 117 

1 3 4 

15 9 24 
113 105 218 

310 235 545 

1,084 1,147 2,231 
162 148 310 


1—1 
UO 

c<r 

lO 
05 

(M^ 

1—1 

CO 

(N 

1—1 




Patients on books of Institution Sept. 

30, 1928 

Admissions during year: 

First admissions .... 
Readmissions .... 
Transfers from other hospitals for 
mental diseases 
Total received during year 
Total on books during year 
Discharged from books during year: 
As recovered .... 
As improved .... 
As unimproved .... 
As without psychosis . 
Transferred to other hospitals for 

mental diseases 
Died during year .... 
Total discharged, transferred and died 
during year .... 
Insane patients remaining on books of 
hospital at end of hospital year: 
In hospital ..... 
On parole or otherwise absent 


* 

Oi 

o> 

1—1 

o' 
a> 

a 

<p 

ft 

(D 

O 
O 

PI 

o 
o 



P.D. 23 29 

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











Parents op 


Male 


Parents of Female 


N \TrVITY 


Patients 






P.\TIENTS. 


Patients. 






M. 


F. 


T. 


Fathers. 


Mothers 


Both 
Parents. 


Fathers Mothers. 


Both 
Parents. 


United States. 


139 


104 


243 


60 


53 


48 


57 55 


49 


Austria . 






1 


- 


1 


1 


- 


- 






Canada! 






15 


19 


34 


31 


31 


27 


28 30 


23 


Central America 






1 


- 


1 


- 


_ 


_ 






Czechoslovakia 






- 


1 


1 


- 


_ 


- 


1 1 


1 


England 






4 


2 


6 


11 


7 


6 


5 4 


3 


Finland 






2 


4 


6 


5 


5 


5 


4 4 


4 


France . 






1 


- 


1 


1 


1 


1 


1 




Germany 






2 


2 


4 


5 


5 


5 


6 6 


6 


Greece . 






5 


— 


5 


4 


4 


4 


1 1 


1 


Holland 








1 


- 


1 


2 


2 


2 






Ireland 








13 


17 


30 


34 


41 


34 


33 33 


32 


Italy 








11 


2 


13 


12 


12 


12 


3 3 


3 


Norway 








2 


- 


2 


3 


3 


3 






Poland 








10 


10 


20 


10 


10 


9 


9 9 


9 


Russia 








8 


1 


9 


12 


12 


12 


3 4 


3 


Scotland 






- 


3 


3 


2 


1 


1 


3 4 


3 


South America 






- 


_ 


_ 


- 


1 


_ 






Spain 






- 


- 


- 


- 


1 


- 


_ _ 


_ 


Sweden 






4 


6 


10 


8 


7 


7 


8 8 


8 


Turkey in Europe 






- 


- 


_ 


2 


2 


2 






West indies 2 , 




2 


1 


3 


2 


2 


2 


1 1 


1 


Other countries 






11 


4 


15 


12 


12 


12 


7 6 


6 


Unascertained 






2 


2 


4 


17 


22 


17 


8 9 


7 


Total 


234 


178 


412 


234 


234 


209 


178 178 


159 



' Includes Newfoundland. 



' Except Cuba and Porto Rico. 



30 



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P.D. 23 



Table 5. Citizenship of First Admissions. 



Citizens by birth 
Citizens by naturalization 
Aliens . . . . 

Citizenship unascertained 



Total 



234 



Table 6. Psychoses of First Admissions. 



178 



31 



Males. 


Females. 


Total. 


139 


104 


243 


30 


32 


62 


54 


34 


88 


11 


8 


19 



Psychoses. 



T. 



M. 



F. 



1. Traumatic psychoses . 

2. Senile psychoses 

3. Psychoses with cerebral arteriosclerosis 

4. General paralysis 

5. Psychoses with cerebral syphiUs . 

6. Psychoses with Huntington's chorea 

7. Psychoses with brain tumor 

8. Psychoses with other brain or nervous diseases, total 

Other diseases 

9. Aloohohc psychoses, total 

Delirium tremens . 
Korsakow's psychosis 
Acute hallucinosis . 
Other types, acute or chronic 

10. Psychoses due to drugs and other exogenous toxins, total 

Opium (and derivatives), cocaine, bromides, chloral, 

etc., alone or combined 
Other exogenous toxins . 

11. Psychoses with pellagra 

12. Psychoses with other somatic diseases, total 

Post-infectious psychosis 
Exhaustion delirium 
Cardio-renal diseases 
Other diseases or conditions 

13. Manic-depres.sive psychoses, total 

Manic type ..... 
Depressive type .... 
Other types ..... 

14. Involution melancholia 

15. Dementia preecox (schizophrenia) 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses .... 

18. Psychoneuroses and neuroses, total 

Hysterical type .... 
Psychasthenic type (anxiety and obsessive forms) 
Neurasthenic type ..... 
Other types ...... 

19. Psychoses with psychopathic personality 

20. Psychoses with mental deficiency 

21. Undiagnosed psychoses .... 

22. Without psychosis, total .... 

Psychopathic personality without psychosis 
Mental deficiency without psychosis 

Total 



1 

6 

8 

32 



35 



1 
19 
26 
33 

1 



6 

47 



32 

20 

9 

1 



1 
51 

46 

42 

2 



50 



1 - 1 

12 8 20 



13 



1 11 12 

53 40 93 

7 12 19 

- 2 2 

1 6 7 



234 178 412 



32 P.D. 23 

Table 7. Race of First Admissions Classified toith Reference to Principal 

Psychoses. 



Race. 


Total. 


Traumatic. 


Senile. 


With 
cerebral 
arterio- 
sclerosis. 


General 
paralysis. 


With cere- 
bral syph- 
ilis. 


African (black) 

Armenian 

Dutch and Flemish 

English 

Finnish 

French . 

German . 

Greek . 

Hebrew 

Irish 

Italian 1 

Lithuanian 

Magyar 

Scandinavian 2 

Scotch . 

Slavonic ^ 

Spanish-American 

Syrian . 

Other specific races 

Mixed . 

Race unascertained 




M. 

9 

5 

3 

11 

4 

22 

5 

5 

6 

38 

12 

7 

1 

11 

2 

15 

1 

1 

63 
13 


F. 
5 

5 
4 

23 
5 
1 
5 

33 
3 
5 

8 

4 

10 

1 
58 

8 


T. 

14 

5 

3 

16 

8 

45 

10 

6 

11 

71 

15 

12 

1 

19 

6 

25 

1 

1 

1 

121 

21 


M. F. T. 


M. F. T. 
1 - 1 


M. F. T. 
- 1 1 


M. F. T. 

4-4 
1 - 1 


M. F. T. 


- - - 


2-2 


2 1 3 


3-3 


- - - 


_ _ _ 


3 2 5 
1 2 3 


4 2 6 
1 - 1 


5 3 8 
1 - 1 
1 - 1 


- _ _ 




4 9 13 


5 8 13 
1 - 1 
1 - 1 


3-3 
1 - 1 


1 1 2 


_ _ _ 


- 1 1 

- 2 2 


1 1 
- 1 1 


2-2 


- - - 


2 13 




1 - 1 


























- - - 


5 12 17 
3 4 7 


10 6 16 
2-2 


10 5 15 


- - - 






Total 




234 


178 


412 


1-1 


19 32 51 


26 20 46 33 9 42 


1 1 2 



Table 7. Race of First Admissions Classified ivith Reference to Principal 
Psychoses — Continued. 



Race. 


With Hunt- 
ington's 
chorea. 


With brain 
tumor. 


With other 
brain or 
nervous 
diseases. 


Alcohohc. 


Due to drug 

and other 

exogenous 

toxins. 


With 
pellagra. 


African (black) 

Armenian 

Dutch and Flemish 

English 

Finnish 

French . 

German 

Greek . 

Hebrew 

Irish 

Italian 1 

Lithuanian 

Magyar 

Scandinavian 2 

Scotch 

Slavonic i 

Spanish-American 

Syrian 

Other specific races 

Mixed . 

Race unascertained 




M. F. T. 


M. F. T. 


M. F. T. 
1 - 1 

1 1 2 


M. F. T. 

1 - 1 
1 - 1 
2-2 
2-2 
1 - 1 
1 - 1 


M. F. T. 


M. F. T. 


_ _ _ 


_ _ _ 




- - - 
































12 1 13 
3-3 

4-4 


1-1 


1 - 1 


- - - 


- - - 


1 - 1 


- - - 


- - - 


- - - 


2-2 


- - - 


- - - 






2-2 


5 16 










































1-1 


11 1 12 
2-2 


- 1 1 




- - - 


- - - 


- - - 








6 2 8 


47 3 50 


1 2 3 


1 - 1 











1 Includes "North" and "South." 

2 Norwegians, Danes and Swedes. 

3 Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 



P.D. 23 

Table 7. Race 


of First Admissions Classified with Reference to P 
Psychoses — Continued. 


33 

rincipal 


Race. 


With other 
somatic 
diseases. 


Manic- 
depressive. 


Involution 
melan- 
cholia. 


Dementia 
prsecox. 


Paranoia 

and 

paranoid 

conditions. 


Epileptic 
psychosis. 


African (black) 

Armenian 

[Dutch and Flemish 
] English 

Finnish 

French 

German 

Greek .... 

Hebrew 

Irish . ... 

Itahani 

Lithuanian . 

Magyar 

Scandinavian 2 

Scotch 

Slavonic 3 

Spanish- American 

Syrian 

Other specific races 

Mixed .... 

Race unascertained 

Total . 


M. F. T. 

1 - 1 

- 1 1 
3 2 5 

- 1 ] 

2 1 3 

1-1 
1 2 3 

3 1 4 
1 - 1 


M. F. T. 

- 1 1 

- 1 1 

- 1 1 

1 - 1 

3 2 5 

4 1 5 
2-2 

- 1 1 

1 - 1 

- 1 1 

3 5 8 
1 - 1 


M. F. T. 

- 1 1 

- 1 1 
1 1 

- 2 2 

1 1 2 

- 2 2 

- 3 3 


M. F. T. 

2 2 4 
1 - 1 
1 - 1 
1-1 

3 2 5 
5 7 12 
1 - 1 
3-3 
3-3 

3 8 11 
3-3 
12 3 

4 2 6 

1 - 1 

4 15 

15 13 28 

2 3 5 


M. F. T. 

- 1 1 

1 1 2 

2 2 4 
1 1 2 
1 1 2 
1-1 

1 1 

- 2 2 

1 - 1 

- 2 2 

- 1 1 


M. F. T. 
- 1 1 

1 1 


12 8 20 


15 13 28 


1 11 12 


53 40 93 


7 12 19 


- 2 2 


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


Race. 


Psycho- 
neuroses and 
neuroses. 


With psycho- 
pathic 
personality. 


With 

mental 

deficiency. 


Un- 
diagnosed 
psychoses. 


Without 
psychosis. 


African (black) 

Armenian 

Dutch and Flemish . 

English . 

Finnish . 

French . 

German 

Greek . 

Hebrew 

Irish 

Italian 1 

Lithuanian 

Magyar 

Scandinavian^ 

Scotch . 

Slavonic 3 

Spanish- American 

Syrian 

Other specific races 

Mixed . 

Race unascertained 






M. F. T. 

- 1 1 
1 1 

- 1 1 

- 2 2 

- - 1 
1 - 1 


M. F. T. 

1 1 
1 1 

1 1 

1 1 
1 1 

1 3 4 


M. F. T. 

- 1 1 
1 1 

1 1 2 
1-1 

- 1 1 

14 5 

2-2 


M. F. T. 
1 - 1 


M. F. T. 

1 - 1 

2 1 3 


Total 


1 6 


7 


1 8 


9 


5 


8 13 


1 


- 1 




3 1 4 



1 Includes "North" and "South." 

2 Norwegians, Danes and Swedes. 

3 Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 



34 P.D. 23 

Table 8. Age of First Admissions Classified with Reference to Principal 

Psychoses. 


Psychoses. 


Total. 


Under 
15 years. 


15-19 

years. 


20-24 
years. 


25-29 
years. 


1. Traumatic ..... 


M. 

1 
19 

26 
33 

1 

6 
47 

1 

1 
12 
15 

1 
53 

7 

1 

1 
5 
1 
3 


F. 

32 

20 

9 

1 

2 
3 
2 

8 

13 

11 

40 

12 

2 

6 

8 

8 

1 


T. 

1 
51 
46 
42 

2 

8 

50 

3 

1 

20 

28 

12 

93 

19 

2 

7 

9 

13 

1 

4 


M. F. T. 


M. F. T. 


M. F. T. 
1 - 1 


M. F. T. 


3. With cerebral arteriosclerosis 

4. General paralysis .... 
.5. With cerebral syphilis 

6. With Huntington's chorea . 

7. With brain tumor .... 

8. With other brain or nervous diseases . 










- 1 1 














- 1 1 


2-2 


- - - 


- 1 1 
1 - 1 


10. Due to drugs and other exogenous toxins 

11. With pellagra ..... 

12. With other somatic diseases 

13. Manic-depressive .... 






















1 2 3 

2 2 4 


- - - 


1-1 


12 3 


15. Dementia prsecox .... 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses .... 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis .... 


- - - 


2 4 6 


11 4 15 


12 6 18 
1 1 2 

12 3 








1 1 2 
1 - 1 


- 2 2 

- 2 2 

- 1 1 


- 2 2 


1 - 1 


1 - 1 


- 1 1 


_ _ _ i 


Total 


234 


178 


412 


3 3 6 


6 9 15 


13 12 25 


18 15 33 i 



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



Psychoses. 


30-34 
years. 


35-39 

years. 


40-44 
years. 


45-49 
years. 


50-54 
years. 




M.F. T. 


M.F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis 

5. With cerebral syphilis . 

6. With Huntington's chorea 

7. With brain tumor 

8. W^ith other brain or nervous diseases 

9. Alcohohc ..... 

10. Due to drugs and other exogenous toxins 

11. With pellagra .... 

12. With other somatic diseases . 

13. Manic-depressive 

14. Involution melanchoha. 

15. Dementia prscox 

16. Paranoia and paranoid conditions . 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis 












12 3 
- 4 4 
3-3 










3 1 4 


6 1 7 
- 1 1 


6-6 


6 1 7 


















3-3 


1 - 1 

6 2 8 


1 - 1 

11 - 11 

1 - 1 


10 - 10 


10 1 11 
-11 


2 3 5 


2 4 6 
2 1 3 








3 2 5 


1 1 2 
- 3 3 
5 6 11 
112 


1 2 3 

2 2 4 
1 1 2 


3 4 7 
2 1 3 


8 8 16 
- 3 3 


9 4 13 
- 2 2 


- 2 2 

- 1 1 

1-1 


- 2 2 
2 2 4 


1 - 1 
- 1 1 
1 - 1 


- 1 1 

- 1 1 


- 1 1 

- 1 1 


1 - 1 


- - - 


- - - 


- - - 


Total 


14 12 26 


28 24 52 


33 13 46 


23 15 38 


18 15 33 



P.D. 23 

Table 8. 



35 



Age of First Admissions Classified with Reference to Principal 
Psychoses — Concluded. 



Psychoses. 


55-59 
years. 


60-64 

years. 


65-69 
years. 


70 years 
and over. 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis .... 

5. With cerebral syphilis 

6. With Huntington's chorea 

7. With brain tumor 

8. With other brain or nervous diseases 

9. Alcoholic ..... 

10. Due to drugs and other exogenous toxins 

11. With pellagra .... 

12. With other somatic diseases . 

13. Manic-depressive .... 

14. Involution melancholia . 

15. Dementia prsecox 

16. Paranoia and paranoid conditions . 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed psychosis . 

22. Without psychosis 








4 3 7 

5 2 7 


12 3 
4 1 5 
2 2 4 


5 5 10 
9 3 12 
2-2 


12 23 35 
9 8 17 

1-1 
















1-1 
2-2 

- 1 1 

2 1 3 

- 1 1 

- 1 1 
1 1 2 
2-2 


1 - 1 
2-2 


2-2 


- - - 


1 - 1 
2-2 
3 1 4 

- 1 1 

- 1 1 

- 3 3 


1 - 1 


4-4 


















































Total 








17 10 27 


16 11 27 


19 8 27 


26 31 57 



36 



P.D. 23 



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P.D. 23 



37 



Table 10. Environment of First Admissions Classified with Reference to 

Principal Psychoses. 



PSTCHOSES. 


Total. 


Urban. 


Rural 


Unascer- 
tained. 




M. 

1 
19 
26 
33 

1 

6 
47 

1 

1 
12 
15 

1 
53 

7 

1 

1 
5 

1 
3 


F. 

32 

20 

9 

1 

2 
3 
2 

8 
13 
11 

40 
12 

2 
6 

8 
8 

1 


T. 

1 
51 
46 
42 

2 

8 

50 

3 

1 

20 

28 

12 

93 

19 

2 

7 

9 

13 

1 

4 


M. F. T. 

1 - 1 
18 29 47 
26 20 46 
31 9 40 

1 1 2 

6 2 8 
45 3 48 

1 2 3 

1 - 1 

12 8 20 

15 12 27 

1 9 10 

50 38 88 

7 12 19 
- 2 2 
15 6 
1 8 9 
5 8 13 
1 - 1 
3 1 4 


M. F. T. 


M. F. T. 


2. Senile 

3. With cerebral arteriosclerosis . 

4. General paralysis .... 

5. With cerebral syphilis 

6. With Huntington's chorea 

7. With brain tumor .... 

8. With other brain or nervous diseases 

9. Alcoholic ..... 

10. Due to drugs and other exogenous toxins 

11. With pellagra .... 




1 3 4 


- - - 


2-2 


- - - 


- - - 


_ _ _ 


2-2 


- - - 










13. Manic-depressive .... 

14. Involution melancholia . 

15. Dementia praecox .... 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses 

18. Psyohoneuroses and neuroses . 

19. With psychopathic personality 

20. With mental deficiency . 

21. Undiagnosed psychoses . 


- 1 1 

- 2 2 
3 2 5 


- - - 






- 1 1 


- _ _ 




















Total 




234 


178 


412 


226 169 395 


8 9 17 


- - - 



Table 11. Economic Condition of First Admissions Classified with 
Reference to Principal Psychoses. 



PsTCHOSES. 


Total. 


Depend- 
ent. 


Marginal. 


Com- 
fortable. 


Unascer- 
tained. 


1. Traumatic 

2. Senile .... 

3. With cerebral arteriosclerosis 

4. General paralysis 

5. With cerebral syphilis 

6. With Huntington's chorea . 

7. With brain tumor 

8. With other brain or nervous dis 

eases .... 

9. Alcoholic .... 

10. Due to drugs and other exogenou 

toxins .... 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive 

14. Involution melanchoha 

15. Dementia prsecox 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic personahty 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis 


3 


M. 

1 
19 
26 
33 

1 

6 

47 

1 

1 

12 

15 

1 
53 

7 

1 
1 
5 
1 
3 


F. 

32 

20 

9 

1 

2 
3 

2 

8 

13 

11 

40 

12 

2 

6 

8 

8 

1 


T. 

1 
51 
46 
42 

2 

8 
50 

3 

1 

20 

28 

12 

93 

19 

2 

7 

9 

13 

1 

4 


M. F. T. 

- 2 2 
1 - 1 
1 - 1 

1 - 1 
1 3 4 


M. F. T. 

1 - 1 
14 28 42 
20 20 40 
30 7 37 

\ : I 

6 2 8 
40 3 43 

12 3 

1 - 1 

10 8 18 

14 13 27 

1 10 11 

43 29 72 

6 12 IS 

- 2 2 

1 6 7 

1 6 7 

5 8 13 

1 - 1 

3 1 4 


M. F. T. 


M. F. T. 

5 2 7 
5-5 
2 2 4 
-11 

7-7 

1-1 
1 - 1 
-11 
9 8 17 
1-1 

- 2 2 


Total .... 




234 


178 


412 


4 5 9 


199 157 356 


- - - 


31 16 47 



38 P.D. 23 

Table 12. Use of Alcohol by First Adjnissions Classified with Reference to 

Principal Psychoses. 



Psychoses. 


Total. 


Abstinent. 


Tem- 
perate. 


Intem- 
perate 


Unascer- 
tained. 


1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis 

5. With cerebral syphilis 

6. With Huntington's chorea. 

7. With brain tumor 

8. With other brain or nervovis dis- 

eases ..... 

9. AlcohoHc. .... 

10. Due to drugs and other exogenous 

toxins ..... 

11. With pellagra .... 

12. With other somatic diseases 

13. Manic-depressive 

14. Involution melanchoha 

15. Dementia preecox 

16. Parnaoia and paranoid conditions 

17. Epileptic psychoses . 

18. Psychoneuroses and neuroses 

19. With psychopathic personality . 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis . 


M. 

1 
19 
26 
33 

1 

6 

47 

1 

1 
12 
15 

1 
53 

7 

1 
1 
5 
1 
3 


F. 

32 

20 

9 

1 

2 
3 

2 

8 

13 

11 

40 

12 

2 

6 

8 

8 

1 


T. 

1 
51 
46 
42 

2 

8 
50 

3 

1 

20 

28 

12 

93 

19 

2 

7 

9 

13 

1 

4 


M. F. T. 

1-1 

6 21 27 

7 18 25 
4 8 12 

- 1 1 

3 2 5 

4 6 10 

5 8 13 

1 11 12 
32 33 65 

2 10 12 

- 2 2 
1 6 7 

1 7 8 

2 5 7 
1 - 1 

3 1 4 


M. F. T. 


M. F. T. 


M. F. T. 


5 2 7 
10 - 10 
14 - 14 

3-3 

2-2 
3 2 5 


2 13 

2 13 
12 1 13 

1-1 

47 3 50 

1 2 3 
1 - 1 
2-2 

3 3 6 


6 8 14 

7 1 8 
3-3 

4 2 6 
4-4 


12 3 15 
4 2 6 


7 18 
1 - 1 


2 3 5 














1 3 4 


1-1 


1-1 














Total 


234 


178 


412 


73 139 212 


54 12 66 


80 12 92 


27 15 42 



39 



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40 



P.D. 23 



Table 14, Psychoses of Readmissions. 



Psychoses. 

1. Traumatic psychoses ..... 

2. Senile psychoses ..... 

3. Psychoses with cerebral arteriosclerosis 

4. General paralysis ..... 

5. Psychoses with cerebral syphilis . 

6. Psychoses with Huntington's chorea 

7. Psychoses with brain tumor 

8. Psychoses with other brain or nervoiis diseases 

9. Alcoholic psychoses ..... 

10. Psychoses due to drugs and other exogenous toxins 

11. Psychoses with pellagra .... 

12. Psychoses with other somatic diseases . 

13. Manic-depressive psychoses 

14. Involution melancholia .... 

15. Dementia prsecox ..... 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses ..... 
IS. Psychoneuroses and neuroses 

19. Psychoses with psychopathic personality 

20. Psychoses with mental deficiency 

21. Undiagnosed psychoses .... 

22. Without psj chosis ..... 

Total 



Males. Females. 
1 
1 

3 3 

2 



12 



Total.1 
1 
1 



12 



2 

6 

2 

12 



30 



3 

13 

3 

21 
1 



Table 15. Discharges of Patients Classified with Reference to Principal Psy- 
choses and Condition on Discharge. 





Total. 




Recovered. 


Improved. 


Unim- 
proved. 


M. 


F. 


T. 


M. F 


. T. 


M. 


F. T. 


M. F. T. 


2 
3 
6 
6 
3 


1 

7 
2 
2 

1 


3 
10 

8 
8 
4 


- 


- - 


1 
2 
1 
6 
3 


1 2 
4 6 

2 3 
2 8 
1 4 


1 - 1 
1 3 4 
5-5 


2 

40 

2 


1 
6 


3 

46 
2 


1 
2 


- 1 

- 2 


18 
1 


6 24 
1 


1 1 2 

20 - 20 

1 - 1 


14 
4 

68 
9 
1 
4 
7 

10 


10 

17 

11 

40 

6 

3 

3 

3 

5 


10 

31 

15 

108 

15 

4 

7 

10 

15 


- 


- - 


8 
3 
30 
3 
1 
3 
4 
3 


9 9 
13 21 
10 13 
31 61 

4 7 
1 

2 5 

3 7 

4 7 


-11 

6 4 10 

112 

38 9 47 

6 2 8 
- 3 3 
1 1 2 
3-3 

7 1 8 


1 


3 


4 


- 


- - 


- 


- - 


- - - 


182 


121 


303 


3 


- 3 


87 


92 179 


91 26 117 



1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis 

5. With cerebral syphiUs 

6. With Huntington's chorea . 

7. With brain tumor 

8. With other brain -or nervous diseases 

9. Alcoholic ..... 

10. Due to drugs and other exogenous toxins 

11. With pellagra .... 

12. With other somatic diseases 

13. Manic-depressive 

14. Involution melancholia 

15. Dementia prsecox 
16 Paranoia and paranoid conditions . 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis 

Total 






41 



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42 



P.D. 23 



All other 
psychoses. ' 


rj ICvICOt-III CC-lllfOi-HI^I^C^ ICOl |i-H III 1 CO l"-*! 
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g 1 1 1 1 1 1 lllll 1 1 1 1 1 1 1 11 1 1 III 


1 
1 
1 


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^ 1 lllll 1 1 1 1 1 1 111 II 111 1 1 111 

fa 1 ' 1 ' 1 1 1 1 1 1 1 1 1 111 

§ ' ' ' ' 1 ' 1 ' 1 1 II' II 1 


1 

1 

1 


Epileptic 
psychoses. 


H 1 ■ 1 1 1 1 lllll III- -- III 1 1 i-l 

f^ ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 

i '^' ' ' ' ' '^ ' ' ' ' ' '^' 


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H ' ' ' ' II lllll 1 'II 1 - III 

^ ' ' ' ' ' ' ' ' ' ' 

^' 1 1 1 1 1 1 1 ] I 1 1 1 1 1 1 1 1 III 11 111 1 '-1 III 


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Dementia 
praecox. 


• rt 1 ^^ II .^|,M|| ilMIII TftCCq 'HIM — — II -* 1 — — 
r- llOlll — 1— II IICOlll 00-*— '-^'-< 111 1 ^ 1— — 

g— ICn— 11 COIIII llllll I-HIN— l-rH— — 1 1 1 111 


I-- 

CO 


K 

< 

H 

Q 

6. 
O 

m 

m 
P 


Epidemic, Endemic and Infectious Diseases. 
Dysentery ........ 

Lethargic encephalitis ...... 

Tuberculosis of the respiratory system 

Tuberculosis of other organs ..... 

Purulent infection, septicaemia .... 

General Diseases Not Included in Class I. 
Cancer and other malignant tumors 
Pellagra ...... 

Diabetes ........ 

Alcoholism (acute or chronic) .... 

Other general diseases ...... 

Diseases of the Nervous System. 
Cerebral hemorrhage, apoplexy .... 

General paralysis of the insane .... 

Other forms of mental disease .... 

Epilepsy ........ 

Chorea ........ 

Other diseases of the nervous system 

Diseases of the Circulatory System. 
Endocarditis and myocarditis .... 

Arteriosclerosis ....... 

Other diseases of the arteries ..... 

Diseases of the Respiratory System. 
Bronchopneumonia ..... 

Lobar pneumonia ....... 

Diseases of the Digestive System. 
Hernia and intestinal obstruction .... 

Cirrhosis of liver ....... 

Other diseases of liver ...... 

Other diseases of digestive sj stem (cancer and tuber- 
culosis excepted) . ... 

Non-Venereal Diseases of Genito-Uri^iary System and 

Annexa. 
Nephritis ........ 

External Causes. 
Suicide ........ 

Accidental traumatism ...... 

Other external causes ...... 


o 



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P.D. 23 



47 



Table 19. Family Care Department. 



Remaining in Family Care Oct. 1, 1928 . 
3n visit from Family Care Oct. 1, 1928 . 
Mmitted during year ...... 

Whole number of cases within the year . 

Dismissed within the year ..... 

Returned to institution ..... 

Discharged ....... 

On visit ........ 

Remaining in Family Care Sept. 30, 1929 

Supported by State ...... 

Private ........ 

Self-supporting ....... 

Number of different persons within the year 

Number of different persons dismissed 

Number of different persons admitted 

Average daily number in Family Care during the year 

Supported by State ...... 

Private ........ 

Self-supporting ....... 



Male. 


F'emale. 


Total. 


1 


12 




13 


_ 


3 




3 


1 


15 




16 


— 


5 




5 


- 


5 




5 


1 


10 




11 


- 


6 




6 


1 


3 




4 


- 


1 




1 


1 


14 




15 


- 


5 




5 


— 


3 




3 


1.00 


11. 


33 


12.33 


- 


6 




6 


1 


3 




4 


- 


1 




1