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

I 



3-6 A- 2-M3 



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Public Document 



No. 23 



3lfp fflomntmnuralUf of HaaaarijUBettB 







ANNUAL REPORT 

OF THE 

TRUSTEES 

OF THE 

Worcester State Hospital 

FOR THE 

Year ending November 30, 1930 



Department of Mental Diseases 



MaiTachufetts 



'1 






<<3> 



Tercentenary 



Publication of this Document approved by the Commission on Administration and Finance 
500—6-31. Order 2647. 



OCCUPATIONAL PRINTING PLANT 

DEPARTMENT OF MENTAL DISEASES 

GARDNER STATE COLONY 

GARDNER. MASS. 



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. 

RESIDENT STAFF 
William A. Bryan, M.D., Superintendent. 
Francis H. Sleeper, M.D., Assistant Superintendent. 
Morris Yorshis, M.D., Acting Clinical Director. 
Samuel W. Hartwell, M.D,, Director Child Guidance Clinic. 
Clifton T. Perkins, M.D., Senior Assistant Physician. 
Michael J. O'Meara, M.D., Senior Assistant Physician. 
Auray Fontainjb, M.D., Senior Assistant Physician. 
James R. Linton, M.D., Senior Assistant Physician. 
Harry Freeman, M.D., Senior Assistant Physician. 
Claude Uhler, M.D., Senior Assistant Physician. 
Arthur W. Burckel, M.D., Assistant Physician. 
Nathan Baratt, M.D., Assistant Physician. 
Milton H. Erickson, M.D., Assistant Physician. 
Valdimir T. Dimitroff, Ph;D., Pathologist. 
Alfred J. Normandin, D. M.D. , Dentist. .,.,_ _ 
Dajid Shako w, M.A., [Psychologist. 

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., Research. 
Arthur Brassau, M.D., Surueon. 
Harold J. Gibby, M.D., ^ar, No"-e and Throat. 
Reginald Hunt, Ph. D., Chemist. 

HEADS OF DEPARTMENTS 
Jessie M. D. Hamilton, Trsasvrer. 
Herbert W. Smt^l, SlewGrd.- 
Warren G. Proctor, Engineer. 
Anton Svenson, Foreman Mechanic. 
Wallace F. Garrett, Head Farmer. 
Lillian G. Carr, Matron. 
Anne F. McElholm, R.N., Superintendent of Nurses and Principal 

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



P.D. 23 3 

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

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

The board wishes to again express its complete accord with the policy of carrying 
on extensive research into the cause and treatment of mental disorders. The 
board believes that the research work being done in the hospital and in the Child 
Guidance Clinic will bring immeasurable greater results at the end of a period of 
years than will the policy of neglecting such research and community work, and 
putting the available money into additions to the hospital. 

While it is true that increase in the beds of the hospital is not advisable at the 
present time, it is also true that the buildings of the institution are old, and there 
is a constant need of replacements for the existing structures. The board would 
again call attention to the necessity of money being made available for the repair 
of porches on the building which have become so unsafe as to make it impossible 
for them to be used by the patients. It also concurs in the Superintendent's Re- 
port which calls attention to the necessity for replacement of the present floors, 
the old wooden floors are unsanitary and difficult to care for. They splinter easily 
and make housekeeping very difficult. 

The policy of building cottages for physicians is in the opinion of the board a very 
wise one. Personnel is the most important consideration in the hospital. The care 
and treatment of patients depends not so much upon buildings and equipments as 
it does on the type and character of the people who are doing the work. It would 
seem that anything that would add to the comfort of those in charge of the re- 
sponsibility of caring for the patients and treating them would add much to their 
efficiency. It is to be hoped that other cottages on the grounds will be added as 
fast as funds will permit. 

The radio installation in the hospital is in the opinion of the board one of the 
outstanding accomplishments of the year. This installation was made possible; by 
the use of accumulated funds from several bequests, and it has already proven to 
be a source of much pleasure, and particularly of great benefit to the patients from 
the standpoint of morale. Each ward is now equipped with a loud speaker, and 
these speakers are all regulated from the central control room. 

The thanks of the board are due to the members of the Visiting Staff of the 
hospital who have given so freely of their time, and also to the officers and em- 
ployees for their loyalty and splendid cooperation during the year. 

Respectfully submitted, 

Edward E. Fletcher, William J. Delahanty, 

Josephine Rose Dresser, Anna C. Tatman, 

Howard W. Cowee, 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, 1930, it being the ninety-eighth annual report: 

There remained on the hospital books October 1, 1929, 2,565 patients, 1,262 men 
and 1,303 women. Seven hundred and thirty-seven patients, 427 men and 310 
women were admitted during the year. Six hundred and thirteen patients, 353 men 
and 260 women were discharged from the hospital. Of this number 365 patients, 
216 men, and 149 women were discharged, 221 patients, 119 men and 102 women 
died, and 27 patients, 18 men and 9 women were transferred, leaving at the end of 
the statistical year 2,689 patients, 1,336 men and 1,353 women. 

Staff Changes 
Promotions 
Arthur W. Burckel from Clinical Assistant to Assistant Physician January 6, 1930. 



4 P.D. 23 

Morris Yorshis from Senior Assistant Physician to Acting Clinical Director Sep- 
tember 8, 1930 

Appointments 
Max Littner appointed Assistant Physician January 31, 1930. 
Valdimir T. Dimitroff appointed Pathologist April 15, 1930. 
Milton H. Erickson appointed Assistant Physician April 21, 1930. 
Auray Fontaine appointed Senior Assistant Physician May 21, 1930. 
James R. Linton appointed Senior Assistant Physician July 1, 1930. 
Harry Freeman appointed Senior Assistant Physician July 1, 1930. 
Ladislaus J. Zbranek appointed Assistant Physician October 9, 1930. 
Joseph H. Welch appointed Assistant Physician November 3, 1930. 
Claude Uhler appointed Senior Assistant Physician November 26, 1920. 

Internes. 
Isadore H. Jaffee appointed June 21, 1930. 

Resignations. 
S. Spafford Ackerly resigned to go to Yale Clinic July 30, 1930. 
Kendall B. Crossfield resigned to go to Northampton State Hospital July 31, 1930. 
Arthur T. Whitney resigned to go into private practice July 31, 1930. 
Ruth Thompson resigned to go to Northampton State Hospital August 30, 1930. 
Max Littner resigned to go to Delaware State Hospital October 30, 1930. 
Ladislaus Zbranek resigned to go to United States Public Health Service October 

23, 1930. 
Joseph H. Welch resigned November 25, 1930. 
Isadore H. Jaffee resigned December 31, 1930. 

Report of the Psychiatric Service 
Morris Yorshis, M.D., Clinical Director. 

The prime purpose of the institution is naturally concerned with the treatment 
of the patients sent to it. It has long been felt that once a patient is committed 
to a mental hospital his chance for returning to the community is meagre. The 
prognosis in mental disease may be as favorable as in any other disease, and there- 
fore the outlook for recovery in the majority of cases is encouraging. With this in 
mind, our entire program has benefited by the inculcation of a more optimistic 
note. Specifically, the treatment of patients on disturbed wards has been altered 
so that restraints have been removed, patients have been placed in individual 
rooms which remain unlocked at night, and seclusion has been practically abolished. 
The open wards are filled to capacity. The physicians have offices in these wards 
where the patients may interview them in regard to their personal problems. On 
the admission wards, patients are accorded individual attention so that their stay 
at the hospital need not be protracted unnecessarily. The patient is studied care- 
fully, and he is given a definite daily working schedule which harmonizes with his 
past accomplishments and present desires. It is felt that idleness is responsible 
for the number of chronic patients in a mental hospital, and if institutional inertia 
could be curbed in newly admitted patients, the resultant population would tend to 
diminish rather than increase. 

A comprehensive teaching program is a strong aid in accomplishing this aim. 
Broader perspectives on the part of Staff members and personnel tend to make 
for increased efficiency. This year a series of luncheons was held at which informal 
lectures were given by physicians recognized in their special fields of endeavor. 
They included: Dr. Abraham Myerson, Professor of Neurology of Tufts Medical 
School; Dr. Milton O. Lee, Research Associate in Endocrinology, Harvard Medical 
School; Dr. Tracy Putnam, Associate Neuro-Surgeon at the Boston City Hospital; 
and Dr. Harry Linenthal, Physician-in-Chief, Beth Israel Hospital. Members of 
the Staff made abstracts of current literature in medicine and psychiatry which 
were incorporated in a loose-leaf book kept as a reference in the Medical Library. 
Dr. Hartwell, Director of the Child Guidance Clinic, offered the Staff the oppor- 
tunity for participation at bi-monthly conferences of the Clinic. These conferences 



P.D. 23 5 

were held directly at the hospital. Dr. Perkins gave a 35-hour course of lectures 
and demonstrations in physiotherapy. The Director of Research, Dr. Hoskins, 
presented the lastest aspects of endocrinology. A review of the literature on 
manic-depressive psychosis and dementia praecox was given at evening seminars 
held twice a month. 

The acquisition of a knowledge of fundamental principles in psychiatry is a 
necessary adjuct to all those coming in contact with patients in this institution. 
Consequently all internes, both medical and psychiatric, were given instructions 
in clinical psychiatry. Groups of four students came from Tufts Medical School 
for a two months' course in psychiatry. 

The following is a synopsis of material presented to them: 26 lectures in psy- 
chiatry with demonstrations; 18 clinical psychiatric conferences; 16 research psy- 
chiatric conferences; 9 special staff conferences; 8 syphilis clinics; 8 lumbar 
puncture clinics; 8 medical conferences; 4 lectures on social service; 4 X-ray 
conferences; 4 ophthalmoscopic clinics; 4 Child Guidance Clinic conferences; 
4 lectures by visiting physicians; 4 visits to suburban hospitals and clinics; 4 
clinical neurological conferences; 3 lectures on hospital administration; 2 dem- 
monstrations of psychological tests; 2 demonstrations in pathology, (excluding 
autopsies); 2 evening seminars; 1 lecture on occupational therapy; 1 lecture in 
endocrinology. 

The students seemed to have gained some understanding of mental disorder, as 
well as a certain degree of personal insight. 

In addition to the group of medical students, the hospital maintained its regular 
training school for nurses. At present, the course carries an excess of work in the 
senior year. In order to alleviate this condition, there is being negotiated an 
arrangement for an affiliation with a hospital where the student nurses will receive 
more courses in the junior year. Hospitals accustomed to sending student nurses 
here for training have continued in this connection. A personal advisor was pro- 
vided for these affiliates who assisted them in adapting themselves to work with 
mentally disordered patients. They were encouraged to make observations of 
patients' behavior on the wards. There was interest shown in doing this, and a 
desire for instruction in fundamentals of psychiatry was a natural result. Students 
from the Boston School of Occupational Therapy during their course here demon- 
strated the value of Occupational Therapy in accelerating recovery in patients. 
Seminars held twice a month on practical problems in psychiatric social work were 
given to the students sent here from Smith College. The regular group of theologi- 
cal students were in attendance during the summer months. A member of the 
staff devoted some of his time in aiding these students with questions that arose as 
a result of work with patients. 

The social service department has aided the physicians materially in under- 
standing the reasons for the patient's maladjustment in the community. The 
facts they obtain are extremely valuable as a basis for the complete study of the 
patient. The social service group is composed of very keen, supplementary workers 
who make a careful survey of the situations in which patients break down, and 
therefore they are intensely aware of the constructive and destructive factors in 
the patient's personality. There is need of competent workers to help investigate 
the homes and social situations, as this enables us to learn something of the per- 
sonalities with whom the patients have had previous contact. During the course 
of the year, the members of this department have done splendid work in gathering 
data concerning the home, and they help create an environment of comparative 
stability and adequate supervision, thus facilitating the patient's return to life in 
the community. 

The psychological department has continued its high degree of excellence. 
Psychometric examinations, vocational guidance tests, memory tests, association 
and personality studies have all contributed to the more thorough understanding 
of the case material. 

The occupational therapy workers have contributed to the arousing of the 
patient's interest in his environment, and their cordial visits have considerably 
ameliorated the anxiety of the patients in regard to hospitalization. The present 
department consists of a head worker and two regular assistants, a physical edu- 



6 P.D. 23 

cation instructor, and students from the Boston School of Occupational Therapy, 
who come for six months' affiliation. These students work in the classes with the 
regular workers part of the time and conduct classes themselves at other periods. 
They also change work rooms once a month to give them as wide an experience as 
possible. The regular workers change service at least once in six months, as this 
tends to stimulate their interest and prevents them from slipping into routine. 
Occupational therapy is primarily individual case work and changing class rooms 
helps to keep alert the interest in individuals. This is carried out by craft work 
and progress notes written monthly on each patient. Each girl is assigned a patient 
for a special case study who is her particular problem both therapeutically and for 
study purposes. With the practical experience of working with mental patients, 
the students have lectures in psychiatry and mental hygiene, so that they may 
better understand the personalities with which they are dealing. To balance the 
emphasis on individuals, there is work for special holidays such as the Christmas 
play, or the July 4th pageant. Here, not only the group which actually takes 
part in the play is working as a social unit, but the other classes work on costumes 
and scenery to understand still further the idea of social responsibility and mutual 
help. This phase of the work needs greater stress, particularly as it should include 
the younger type of patients. Such activities would help them to learn to work and 
play in a social unit. Daily classes were held on nine wards, three of these on the 
male service. During the year, two new classes were opened, and several re- 
arrangements were made. A new class was opened on the admission ward on the 
female psychiatric service. The largest average attendance, as well as the largest 
number of patients treated in one month, occurred in August with 209 average 
attendance and 464 total number of patients in class. Physical education classes 
included patients from all the convalescent wards, admission ward and acutely 
disturbed ward, as well as the medical wards. During the year, there have been 
178 patients transferred to the hospital industry and 100 patients sent home on 
visit from these classes. 

In the department of hydrotherapy, the work has been continued during the 
past year with a high degree of excellence. The structure and personnel available 
made it possible to give every patient treatments. All nurses and attendants in 
the hydrotherapy suite were given an intensive course and were only permitted to 
treat patients after such training. The additional pack beds on the male psychia- 
tric service have been utilized to great advantage. It was noted that with the 
careful selection of cases this valuable form of treatment has been very beneficial. 
The staff was given considerable insight into the value of hydrotherapy from a 
course of lectures given by Dr. Rebecca Wright, the Hydrotherapist of the Depart- 
ment of Mental Diseases. The following is a resume of the work accomplished in 
hydrotherapy for 1930: 

Foot baths, 107; foot baths as preparatory treatments, 477; salt glows, 205; 
electric light baths, 145; saline baths, 65; sitz baths, 28; tub shampoos, 202; 
hair shampoos, 271; needle sprays, 990; fan douches, 832; hot and cold to spine, 
49; hot and cold to abdomen, 14. 

Continuous Baths: Number of patients, 511; number of baths, 6,656; number 
of hours, 36,566. 

V/ei Sheet Packs: Number of patients, 535; number of packs, 10,655; number 
of hours, 37,247. 

Instruction: Number of pupils, 201; number of lessons, 269; number of hours, 
316, 

There were special psychiatric staff meetings conducted in connection with the 
research service. Neurological examination form sheets have been printed in con- 
junction with the medical service, and the results of the examination were recorded 
as a part of the case record. A beginning has been made in the scientific study of 
psychotherapy as a distinct form of therapy differing from hydrotherapy, physio- 
therapy, and drugtherapy. At the Out-Patient Treatment Clinic the patients 
met with the particular member of the staff who had treated them during their 
residence at the hospital. These interviews were arranged by appointment. 
Through the employment of this method, the physician established a stronger 
rapport with the patient, and at the same time gave the patient a greater feeling 



P.D. 23 7 

of confidence. The hospitals that sent cases here for observation were submitted 
letters reporting the progress of these patients. In this way these institutions 
gained information concerning patients of this type. 

The following is a brief resume of the activity of the medical library for the year 
extending from October 1, 1929 to September 30, 1930, inclusive: 

Continuing the work started by Dr. Sleeper some two years ago, the former 
medical annex has been completely divorced from the general library, and is now 
situated in a central room close to the medical offices. Efforts are being continually 
made to increase the scope of this library, and to have bound all the current medical 
periodicals. About 400 volumes have been bound during the past year. This 
library now consists of approximately 2,400 volumes. At the close of this record 
year, the medical library has subscribed to 8 journals in psychiatry and neurology; 
14 journals in the other fields of general medicine, surgery and pathology; 8 journals 
in psychology, and 2 in psychoanalysis: 2 journals in mental hygiene, and 2 
journals in the general field of social work. We also have subscribed to 12 different 
journals in special technical fields, such as the field of administration, the field of 
chemistry, occupational therapy, etc. 

Through the generosity of a few of our resident and consulting Staff members, 
the library has received, as gifts, the current issues of many other periodicals, and 
4 private publications have been given to the library. 

During the past year, the medical library has established close contact with 
many other libraries through their inter-library loan departments. Considerable 
use has been made of this loan privilege in dealing with the Worcester District 
Medical Library, Clark University Library, the Worcester Public Library, and 
the Boston Medical Library. 

Our librarian has given very freely of his time in continuing the organization of 
his department, in translating articles written in foreign languages, and in co- 
operating with the various other hospital departments. 

This year a majority of the Staff members have joined either the local District 
Medical Society or the Massachusetts Psychiatric Society. Dr. Sleeper has con- 
tinued his affiliation with the Evans Memorial Hospital in Boston, and the Director 
has been in attendance at the Neurological Out-Patient Department at the Boston 
City Hospital. Radio talks over WTAG on mental hygiene were given by the 
Superintendent, Dr. Bryan. The Director of the Child Guidance Clinic, Dr. Hart- 
well, presented much valuable material to the community by means of a series of 
lectures. 

Through the inauguration of new methods of procedure, a maintenance of co- 
operative inter-dependence among all the services, psychiatric, medical, and 
research, the achievement of the past year has shown progress, and indicates oppor- 
tunities for dynamic growth in the coming year. 

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

The nursing service in the year 1930 added one more school (Grace Hospital, 
New Haven, Connecticut) to its affiliations, making a total of nine hospitals 
sending twenty-one students. 

Holyoke Hospital increased its number of affiliates to four. 

A class of thirty probationers was admitted in the fall of 1930, giving us a total 
of sixty student nurses on duty at the hospital. 

During the past year the male medical and surgical wards came under the super- 
vision of the female nursing service, thus providing an opportunity for student 
nurses to care for male patients. 

Dr. Oscar M. Dudley of the State Department of Public Health has very kindly 
given his services in teaching the nurses hygiene and sanitation, and public sani- 
tation. We are very grateful to Dr. Dudley for his courtesy. 

From the proceeds of a canteen that was started by a fund donated by the 
Alumnae Association, a radio was bought; also a rug, two tables, two lamps, a 
spinet desk, and curtain material, to furnish the reception room in the nurses' home. 
We are very much indebted to the Alumnae Association for the opportunity to 
make this money. Unfortunately the canteen had to be discontinued. 

A dietetics laboratory was started and we are hoping for its completion soon. 



8 P.D. 23 

Report of the Social Service Department 
Helen M. Crockett, Head Social Worker 

The year's activities were handicapped by serious illness among the members of 
the department and an almost complete change of personnel, one position re- 
maining vacant for several weeks. As in previous years, the hospital has benefited 
by the presence of four students from the Smith College School for Social Work, 
who divide their time between the hospital and the Child Guidance Clinic. 

A feature of the year's work is the coming of the two students in September to 
take the course given by the Department of Mental Diseases in State Hospital 
Social Work. These students spend two days per week in Boston attending classes 
in the Simmons College School of Social Work. For five months they spend the 
remainder of their time at the hospital; for three months at the Child Guidance 
Clinic; and for one month at the Worcester Associated Charities. 

We were much stimulated by the coming in September of a social worker from 
Canada to study our organization and methods, before entering upon her adminis- 
trative duties in a mental hospital in Vancouver. 

The routine work of the department was carried on as usual. Although more 
than three thousand calls were made, only about twenty percent of these were to 
patients in the community. At the same time it is interesting to note that although 
449 patients were dismissed on visit during the year, 308 returned to the hospital 
from visit. Too large a proportion of our time was spent in taking 246 histories and 
making 324 investigations. This disproportion is due to the medical staff's appre- 
ciation of the value of our investigatory services. 

Mary E. Richmond in Social Diagnosis, says, "Where disorders within or without 
threaten a man's happiness, his social relations must be the chief means of his re- 
covery." Whe^i the Social Service Department gives its time to investigation to 
the neglect of the social treatment of the situation revealed, it is neglecting its 
major function. 

With an ever higher admission rate in the last five years, there has been no in- 
crease in the number of social workers. We have been compelled to spread our 
efforts over a great number of cases. Meanwhile the standards of psychiatry and 
of social case work require more careful investigations and more intensive social 
case treatment. Although no statistics are available to show whether there is any 
relationship between the amount of social work done, and the length of the patient's 
visit, it is our observation that better case work is usually accompanied by a more 
successful adjustment of the patient to community life. Some research is con- 
templated which will indicate the degree of correlation between amount of social 
work done and the length of time the patient remains in the community. Mean- 
while it will be our policy to leave as much of the history taking as possible to the 
historian, and to reduce the number of investigations as much as seems expedient, 
in order to devote a larger amount of time to case work on visit cases. We believe 
that social case work and social service placement can be a big factor in reducing 
the hospital population, by increasing both the number and the length of visits. 
We anticipate a time when it will be recognized as socially and economically desir- 
able to provide an adequate social service staff. 

We also dream of an out-patient or adult mental hygienic clinic whose function 
in the community shall be the prevention of mental disease by means of psycho- 
therapy and social case work. To such a clinic other social agencies would refer 
cases on which they needed psychiatric advice. Many individuals who do not wish 
to become hospitalized would come voluntarily to an out-patient clinic for treat- 
ment. In the course of a year there are a number of patients discharged as not 
insane, who would profit by both psychiatric and social treatment if it were avail- 
able to them in an out-patient clinic. Only a minimum of such cases can be handled 
with out present facilities. A socially minded psychiatrist connected with such a 
clinic would be of great value to the social service department, if he were free 
enough from other hospital duties to be consulted about convalescent patients in 
the community, or even to call on patients in their homes where that seemed de- 
sirable. 



P.D. 23 9 

In brief, we believe that in its social service department the hospital has an 
instrument whose uses are not yet fully realized. Like the entire social service 
profession, this department is still in its adolescence. 

Report of the Psychological Department 
David Shakow, Head Psychologist 

Although the general progress has remained the same the work for this year has 
increased considerably in scope and quantity over that of last year. 

The increased quarters reported last year soon became woefully inadequate with 
the increase in staff. The large room adjacent to the laboratory was then divided 
up into a number of smaller rooms and added to the laboratory quarters. These 
now consist of nine rooms; four examination rooms, two experimental rooms, one 
shop and two offices. 

With the increased appropriations, which became practically available in July, 
a number of new positions were added in the department. 

Beginning in June 1930 numerous changes occurred. Mr. Paul E. Huston, a 
graduate of Purdue, who has had considerable graduate work in psychology at 
Harvard, where he had also done some tutorial work, joined the staff as research 
associate. Miss Mary Small of Goucher and Bryn Mawr came to take on the house 
assistantship. Miss Margaret Moore was promoted from house assistant to re- 
search assistant and Miss Charlotte Hall from an interneship to a research assistant- 
ship. Miss Frances E. Merrick of Radcliffe came as interne. Miss Dorothy Olsen, 
of Hunter and Clark, held an interneship for the months of July and August, leaving 
then for a position at the University of Chicago. The position is open at present. 

Miss Robina Hirsch left in June for further study at the University of California. 
Miss Florence White left in June for further study at Radcliffe College. 

At the Child Guidance Clinic, the psychologist's position was taken over by 
the head of the department who also remained in the latter capacity. The assis- 
tant psychologist's position was held for July and August by Mr. Robert Young of 
the Harvard School of Education and Boston Psychopathic Hospital. In September, 
Miss Grace Clark of the Universities of Wisconsin and Iowa came to take this 
position. 

Except for a special study of the trade school (see below) the groups we worked 
with this year are very much the same as those reported on in some detail in last 
year's report. The analysis of the examinations given during the year will show to 
some extent the ramifications of our work. 

In all, 1,570 individuals were given psychometric examinations during the year. 
They fall into the following groups; house patients, 664; out-patients, 614; 
employees, 124; others, 68. 

These individuals were given 3,465 tests, viz.: Stanford-Binet (or Kulmann- 
Binet), 821; group (given individually in over half the cases), 667; performance 
series, 1,016; memory, 171; association, 228; personality, 139; vocational, 409; 
achievement, 14. 

The house patients examined consisted largely of a few distinct groups. There 
were 221, largely new admissions, referred by the psychiatric staff where it was 
felt that the psychometric examination would throw some light on the patient's 
diagnosis, etc. There were 65 new cases added to the dementia praecox research 
group. These individuals and those remaining on from last year were given 323 
examinations. Aside from the 65 first examinations there were 67 first, 65 second, 
58 third, 41 fourth, 22 fifth, 4 sixth, and 1 seventh examinations. (See below for 
reexamination program.) There were 20 cases of general paresis examined as part 
of special study. Besides these there were 93 cases of various types of psychosis 
examined as part of special studies of one kind or another. 

In the out-patient department, 250 cases were examined at the Child Guidance 
Clinic (for details see report of Director of Clinic). 120 examinations were made in 
the school clinics. At the Summer Street Jail 42 cases were examined, at the Girls' 
Welfare 22 cases, and there were 24 miscellaneous cases. A special group examined 
this year was the Girls' Trade School group which consisted of 256 invididuals. 

One hundred and twenty-four nurses and attendants were examined. Of the 
68 "others" the larger part consists of other hospital exployees. 



10 P.D. 23 

It might perhaps be best to report the progress of research and developmental 
work during the year by taking each group and telling what progress has been 
made in the work which has actually gone on and to mention some of the projects 
in these groups for the near future. 

In the house there are the following groups: Dementia Praecox Research. — The 
testing schedules arranged over a year ago have been adhered to with a few changes 
and additions. A change is now being made however, in the time of administration 
or re-examinations. Instead of rigid intervals of three months between examina- 
tions, it has been thought more advisable to give the examination during the 
medication control and experimental periods. If for any reason no change is made 
in the status of the patient within four months an examination is attempted under 
any circumstances. 

Considerable data has now been collected on various characteristics of this 
group of psychotics. Motor dexterity, psychomotor learning, form perception, 
group contact, general mental ability, deterioration, are only a few of the character- 
istics which we have begun to analyze from our records. 

Experimentally, work has actually been begun on a study of the effect of emo- 
tional states on voluntary manual responses, involuntary manual responses, blood 
pressure, respiration and association responses. 

In the test field, a study of apperception and color blindness is planned for an 
early date. 

Experimentally, a rather elaborate program has been projected. The time has 
been largely spent in formulating problems and experiments and building apparatus. 
Studies of chronaxie, reflex activity, reaction time, psychogalvanic response, motor 
functions, galvanic sensitivity, motor learning, conditioning, and suggestibility 
are planned. All of these projects should be under way during the next year. 

Manic-D expressive Study. — Material has been gradually accumulating on the 
special studies we are making on the Kent-Rosanoff and General-Electric Associa- 
tion tests, the Neymann-Kohlstedt Scale, and the Allport Ascendance-Submission. 

A study of memory, apperception and color-blindness in this group for com- 
parison with some of the other groups being studied is planned. 

Female Involutional Melancholia — Hebephrenic Dementia Praecox Study. — A 
study made in association with Drs. Hoskins and Thompson was completed and 
gives us some material on the effects of certain therapeutic measures on 19 hebe- 
phrenics and 10 involutional melancholies. 

General Paresis. — A study is being made in association with Dr. Perkins on the 
effects of diathermy treatment. The test schedule is given four days before treat- 
ment, three months after treatment and every three months thereafter while the 
patient is available. To date 7 individuals have been given 14 examinations. The 
cases done previously which had been treated with malaria have been continued 
on the re-examination schedule. 

Experimental study of the ability of paretics to establish conditioned responses 
is planned as an additional part of the schedule. 

Alcoholic and Organic Psychoses. A study of memory in these groups is the 
primary problem of interest to us at present. Besides the gradual accumulation of 
data on these groups a special attempt was made to obtain data on arteriosclerotics. 
For this purpose all the cases of this psychosis which could be located in the house 
were examined. It is hoped to add more cases to these and establish a valid norm 
for this group. The final evaluation of the findings will have to await the standardi- 
zation of our memory tests on normals (see below). 

Mixed Patients, All Psychoses. — All new admissions and as many of the old 
patients as we can arrange to examine are given in writing and drawing task as 
part of a study of this aspect of motor expression in psychotics. Considerable data 
has already been accumulated on this as well as on a test of apperception and 
"perseveration." 

In the Out-Patient Department there are the following: Child Guidance Clinic. — 
With the general emphasis on diagnosis and treatment which is the clinic policy 
our efforts thus far have been in that general direction. As a development of the 
test schedules of a general nature worked out last year, we have this year worked 
out diagnostic schedules for reading and speech disabilities. Considerable time has 



P.D. 23 11 

been given to the correction of these defects in cases which our tests have shown 
need such correction. (For further details see report of Director of Child Guidance 
Clinic.) 

A detailed study of the subject of dominance (hand and eye) has been organized 
and it is hoped that it can soon be made a part of the routine of the clinic. The 
statement has been made that interference with natural dominance often results in 
behavior and personality disorders. A study of the kind which is here mentioned 
should go far to help determine the part that it plays in these difficulties. 

School Clinics. — As part of performance schedule which we give to this group 
we are continuing to give Parson's eyedness test. We are hoping that this will be 
of some correlation value for the more elaborate study we are planning at the Clinic. 

Trade School. In response to a request of the director and trustees of the 
David Hale Fanning Trade School for Girls a survey of the student body was made 
with the idea of determining the general mental level of the group and the possi- 
bility of finding aptitude tests which might be used for selecting girls for specific 
trades. A series of individual and group general and vocational tests were adminis- 
tered to 256 students and recommendations made to the school. For our own 
purposes a considerable body of data was collected which will some time soon be 
worked up for publication. 

Jail. We have continued our work at the jail, having examined 42 prisoners 
in the last year. As soon as we have 100 cases we are planning to analyze our 
findings, as a cursory study of the results seem to show interesting tendencies. 

Normal groups and individuals. — We have continued our rather concerted 
efforts to obtain material on normals for the tests we are using on the psychotics. 
The necessity for standards by which to compare our patients is great. For a great 
many of the tests we use norms are at hand. We have found it necessary however 
to construct new tests for our purposes or modify old ones and it is necessary to 
obtain norms for these. Thus in the last year we have collected a large number of 
records on a memory test which we use very frequently with patients . The problem 
here has been more difficult than usual since we have thought it necessary to 
establish norms for different decades, and certain age groups are difficult to locate. 
It is hoped that the material for this will be finally collected sometime in the next 
year and the findings published. 

Smith College and Harvard College have cooperated with us in giving us an 
opportunity to use some of their students as subjects. We have been able to collect 
a few hundred records from this source on a perseveration test we are using with 
out patients. 

Similar collections of normal records are being made on a number of other tests 
such as psychomotor learning test, the Kent-Shakow Form-Board Series, and the 
Heilbronner Apperception test. 

The testing of attendants has been continued. Although no analysis has been 
made of the mental ratings of the group there ought to be enough cases by the end 
of the next year so that such an analysis could be made. 

A survey of the employment records — the new ones adopted last year on our 
recommendation — showed that there were an insufficient number of cases for 
statistical treatment. It was felt however that there was considerable improvement 
in the nature of the employment records kept and that in a few years there ought 
to be a really worth-while body of material on the attendant employment situation. 

The teaching work of the department has continued, as has also the participation 
in the hospital seminars and literature meetings. 

A paper read before the meeting of the New England Psychiatric Society, by 
the head of the department, April 10, 1930, was republished in the Bulletin of the 
Massachusetts Department of Mental Diseases for April 1930 in somewhat revised 
form. Another paper, on "Hermann Ebbinghaus," was published in the American 
Journal of Psychology, 1930, 42, 505-518. Both Mr. Huston and the head of the 
department have done abstracting for Psychological Abstracts. 

Miss Maryalys Parker, Psychometrist of the Northampton State Hospital, 
spent a little time with us getting acquainted with out schedules and general 
psychometric technique. 

The year has been a profitable one both in the things accomplished and the plans 



12 P.D. 23 

laid. One of the most gratifying features of the work was the increasing coopera- 
tion with the other departments and the general integration of the research program. 
The cooperative research has had a distinctly broadening effect on us which we 
believe has been reflected in our work and in our attitude towards the Hospital. 

Report of Chaplain's Department 
Reverend Anton T. Boisen 

The experiment in religious work among the mentally ill now being carried on at 
the Worcester State Hospital proceeds from the view that in most mental disorders 
of the functional type we are dealing with the unhappy solution of such inner con- 
flicts as the Apostle Paul describes in the Seventh Chapter of Romans, the conflict 
between the law that is in our members and that which we have accepted as our 
own. According to this view there exsits between certain types of mental disorder 
and certain types of religious experience a very important relationship. Both 
arise out of a common situation. They may bring into play common mechanisms 
and perhaps common physiological processes. The difference lies in outcome and 
social value. In the case of religious experience there is release from the burdens 
of fear and from the icy pall of isolation and new access of faith and hope, and 
progress in the direction of inner unification and social adaptation. In the case of 
mental disorder there is temporary or chronic regression toward personal dis- 
integration and social maladjustment. It would follow that only as we study one 
in the light of the other can we hope to understand either. Not only may religious 
insight make important contributions to the understanding and treatment of the 
mentally ill, but much that is important in the understanding and control of the 
normal religious life should result from the experience with the mentally ill. We 
have therefore sought the opportunity to serve in this hospital in the hope of being 
able to make some real contribution to the sufferers assembled here. We have also 
sought it because of the light which an understanding of the disorders of the mind 
may throw upon the laws of the spiritual life. We seek therefore not only to per- 
form the usual pastoral duties of giving comfort and practical help, but to supple- 
ment this by research work and by providing opportunities for clinical experience 
in the service of the mentally ill to representatives of the new generation of religious 
workers. 

This work is now in its seventh year at this hospital. Beginning in 1924 with 
one worker devoting himself to the conduct of the customary religious services, 
and to the friendly contacts on the wards together with intensive work with certain 
selected cases, its growth has been most gratifying. The Worcester State Hospital 
has become the center of a national movement for the clinical training of students 
of theology in the service of the mentally ill. For six years the present chaplain 
has been connected as research associate with the Chicago Theological Seminary 
and for three years he has been a lecturer at the Boston University School of 
Theology. And each summer students from various theological schools do service 
as attendants on the wards of the hospital and help in the conduct of a recreational 
program for the benefit of the patients. Thirteen different theological schools 
have thus been represented by a total of 47 students. Most of these students are 
now trying to carry into their work as pastors the insight gained into normal 
human nature through their study of its disordered forms. 

A few of these students have, however, devoted themselves as specialists to the 
service of the mentally ill, and with their help this work has been extended to 
other institutions. Rev. Donald C. Beatty, who for two years served as musical 
director at the Worcester State Hospital has now for two years been chaplain of 
the Pittsburgh City Home and Hospital at Mayview. Rev. Alexander D. Dodd, 
after two years of part time work in this hospital and a year's special study in 
Edinburgh is now serving in the Rhode Island State Hospital, at Howard, R. I. 
In April, 1930, the movement took on definite form with the organization and 
incorporation under the laws of Massachusetts of the Council for the Clinical 
Training of Theological Students. The incorporators are Dr. Richard C. Cabot, 
President; Rt. Rev. Henry Wise Hobson, Vice-President; Rev. A. T. Boisen, 
Secretary; Dr. William A. Bryan, Dr. William Healy, Rev. Samuel A. Elliott, 
and Rev. Ashley D. Leavitt, members at large. The staff of the council consists 



P.D. 23 13 

of Dr. Helen Flanders Dunbar, B.D., M.D., Ph.D., Director, Rev. Philip Guiles, 
Field Secretary, and Rev. Donald C. Beatty, Rev. Alexander D. Dodd, and Rev. 
Anton T. Boisen of the three cooperating hospitals. An account of this project 
was printed in Religious Education for March 1930 and can be obtained by request 
from the secretary of the council. 

During the present year the chaplain has given much of his time to the study of 
the religious factors in dementia praecox in conjunction with the research work 
now being done at this hospital in the endocrine factors in dementia praecox. He 
has also been engaged in a thorough revision of the Hymnal for Use in Hospitals 
first published in 1926. 

During the present year the chaplain has been ably assisted by Rev. Wayland 
Rice, a graduate of Crozier Theological Seminary with the class of 1929, and since 
September by Rev. Carroll A. Wise, a graduate of the Boston University School 
of Theology with the class of 1930. 

The activities of this department are rather numerous and may be divided into 
three heads, namely, religious services, pastoral work and recreational work. The 
religious services held on Sunday present one of our greatest opportunities to reach 
the patients. It has been the constant aim to base the message given at these 
services upon a true understanding of the patient's problems gained through careful 
study and attempts to help particular cases and upon a wide acquaintance with the 
inmates of the hospital. The entire service, including the hymns, prayers and 
scripture reading, is arranged with the view of applying the fundamental truths 
of religion to the problems of the patients, particularly with the problems arising 
out of the sense of guilt and the feeling of isolation. These services are held in 
Sargent Hall every Sunday morning and in the Summer Street branch every 
Sunday afternoon. They aim not merely to bring comfort and courage but to do 
fundamental therapeutic work. 

Along with these public services, private religious ministration is given wherever 
there is need. Patients on the danger list are visited in an attempt to do as much as 
possible to help them in their last hours. 

The main activity in the pastoral field is that of hospital visitation. All new 
patients are visited by the chaplain shortly after their arrival. The aim of such 
visits is to assure the patient that he is in the care of those who are trying to help 
him, and thus try to remove many fears from his mind, and also to show a personal 
interest in the patient. An attempt is made to meet the needs of each new patient 
and to help him in whatever way possible. Regular visits are made on the eight 
medical wards of the hospital, and the response one meets in these visits is very 
encouraging. Often one finds that he has brought cheer and hope to those whom 
he thought least able to receive and appreciate it. 

Along with the visits the chaplain's department has begun the practice of sending 
flowers to all patients who have undergone an operation. With these flowers is 
sent a suitable card bearing the name of the hospital. They arrive at the patient's 
bedside shortly after he has come out of the ether and bring a message of hope and 
cheer which often cannot be given by the spoken word. This practice of sending 
flowers is extended likewise to employees of the hospital who may undergo opera- 
tions. Other services, such as the providing of reading matter, are much appreciated 
by both patients and employees. 

Along with this pastoral work, the chaplain's department has sponsored and 
distributed a weekly news sheet throughout the hospital. Begun five years ago 
this Hospital Herald has now become an established factor. During the summer 
with the aid of the students the Herald is issued twice a week and it is supplemented 
by a weekly Pictorial which gives hospital news in graphic form. 

The recreational work of the department is most vigorous in the summer months 
when the students are here to assist in the program. Among the activities is the 
conduct of a patients' baseball team. Last summer a squad of thirty patients 
played regularly four times a week. Games with other institutions were arranged 
to provide an incentive for the intramural games. Our own team marked improve- 
ment in its play in the course of the season and it won most of its later games. The 
therapeutic effect upon those patients who take part is often marked. 



14 



P.D. 23 



Another important activity is that of providing an opportunity for those patients 
who are on closed wards to enjoy the fresh air on the beautiful grounds of the 
hospital. 

Musical work has received much attention. The patient's choir meets twice a 
week during the summer and once a week during the remainder of the year. This 
affords an opportunity for a large group of patients to find wholesome self-expres- 
sion. Frequent entertainments and community sings are held and the choir holds 
occasional serenades out on the lawn of the hospital for the benefit of closed ward 
patients. Last summer we were so fortunate as to have in the student group some 
very talented singers who formed a trio and sang twice each week on the wards 
of the hospital for the benefit of those who were too sick or too disturbed to come 
out to the choir practices and community sings. 

For the past five years this department with the aid of the summer students and 
of the other departments has arranged programs for special occasions such as July 
Fourth and Labor Day. 

This expansion of the work in the summer to include many recreational activities 
as well as specific pastoral work is made possible only through the presence in the 
hospital of a group of theological students who spend part of their day working as 
attendants on the wards and part of the time in these other activities. 

Report of the Medical and Surgical Services 
Clifton T. Perkins, M.D., Senior Assistant Physician. 
The following presentation represents a summary of the more important activities 
of the Medical and Surgical Services, during the past hospital year, extending from 
October 1, 1929 to September 30, 1930, inclusive. 

Population 

Patients remaining October 1, 1929 

Admitted 

Discharged .... 
Deaths (Main Hospital) 
Deaths (Summer Street Dept.) 

Escapes 

Births at Hospital . 

Patients remaining September 30, 1930 

The total of 1,137 patients cared for as residents on the above service represents a 
drop of 107 from last year, and a decrease of 47 from the preceding year. This 
figure, however, is consistent with more than average activity, because the decrease 
as compared with previous years, represents a decrease only in numbers of special 
study cases, which have been gradually taken over by the research service. A 
complete ward with a capacity of 31 beds, which has been previously reported as 
of the medical service, was entirely given over to research four months before the 
closing of the records of this year. 

Deaths 

As noted in the above table, there were 221 deaths during the past year, repre- 
senting 2 less than last year, and 72 less than two years ago. Of this total, 60 
deaths occurred at the Summer Street Department, and 161 at the Main Hospital. 
The average age of all deaths was 61.3 years. We believe that the causes of all 
deaths should be very carefully investigated, and as a result of such an examination 
we offer the following analysis of the primary causes of the above 221 deaths: 

(a) 118 deaths, or 53.4%, were due to what we commonly refer to as senile 
changes — pathological conditions of the heart, kidneys, arteries, etc. The average 
age at death in this group was 71.2 years. 

(b) 22 deaths, or 9.9%, were due to tuberculosis. Of these 2 were of the miliary 
type, 1 tuberculous peritonitis, and the remaining 19 were pulmonary. The average 
age at death was 47 years. 

(c) 18 deaths, representing 8.1%, were due to general paresis. Thus we see that 
this disease continued to hold a high place in the causes of death in this institution. 



Female 


Male 


Total 


121 


156 


277 


274 


486 


860 


292 


423 


715 


79 


82 


161 


23 


37 


60 





8 


8 


4 


3 


7 


125 


99 


224 



P.D. 23 



15 



Last year we noted that the majority of these deaths occurred in conjunction with 
the malarial therapy, and during the three exhaustive summer months. This year, 
with the abolition of malarial therapy, the deaths from general paresis have been 
more evenly distributed throughout the year, with February as the heaviest month 
(4 such deaths), and no deaths from this cause during August, May, or April. 
Two deaths have occurred from the diathermy treatment, both on the same day in 
July. Observations lead us to believe that extra care must be taken, even with 
this comparatively safe method of treatment, to eliminate deaths during the ex- 
haustive months. The average age at death caused by general paresis was 48.8 
years. 

(d) 15 deaths, representing 6.8%, were due to pneumonia, all of which were lobar 
except one which was considered a primary broncho-pneumonia in a 35 year old, 
otherwise healthy patient. This death rate seems high and is twice the figure of 
last year. The average age of deaths was 56.2 years. 

(e) 6 deaths, or 2.7%, were due rather directly to fractures of one type or an- 
other. As noted from the fact that the average age at death was 68.3 years, these 
fractures were in elderly patients. 

(f) 5 deaths, or 2.2%, were due to carcinoma. This figure seems rather low 
considering our patient population and total deaths. It represents less than half 
of our deaths from this cause last year. The average age at death was 56 years. 

(g) 5 deaths, or 2.2%, were due to organic heart disease, with a definite history 
of such, and not complicated by the changes of old age. The average age of death 
was 43.2 years. 

(h) 3 deaths, or 1.3%, were due to diabetes mellitus. The average age of death 
was 56 years. 

(i) 2 deaths, or 0.9%, were due to pernicious anemia, with 56 years as the average 
age of death. 

(j) 2 deaths, or 0.9%/ were due to kidney disease, uncomplicated by senile 
changes, with 48 years as an average age at death. 

(k) The remaining 25 deaths, or 11.3%, were due to various causes of no partic- 
ular significance. 

Autopsies 

This year there was a total of 77 autopsies, representing 34.8% of the total 
deaths. This is an improvement of 6.8% over last year, and 3.8% over the previous 
year. From these autopsies we have learned many things regarding the pathological 
processes preceding death. As a new innovation a few months ago we began a 
method of carefully checking post-mortem findings with the ante-mortem diag- 
noses, and rating the physicians accordingly. The formula used is as follows: 

1. If both agree as to primary disease 60% 

2. If both agree as to secondary or contributory disease . . . .30% 

3. If both agree as to anatomical landmarks 10% 

Total 100% 

Thus it may be deduced that the physician whose ante-mortem diagnoses do not 
agree, at least 70% with the post-mortem findings, is missing a great deal and is 
not doing average work. 

Consultation 
Although a large proportion of the diagnostic and therapeutic procedures have 
been carried out by our resident staff, nevertheless we have taken advantage of 
our consulting staff as may be noted by the accompanying table detailing the 
consultations. Our consultants have given freely of their time when called upon, 
and their assistance in every way has been of inestimable value. 

Eye 178 



Ear, nose and throat . 

Gynecological and obstetrical 

General surgical 

Medical . 

Orthopedic . 

X-ray 

Others . 

Total 



6 

125 

208 

8 

2 

370 

897 



16 P.D. 23 

Surgery 

The surgical procedures durng the past year have been 234 and have been carried 
out on 199 different patients. There were 39 more patients requiring surgery this 
year than was the case last year. The operating room suite has been maintained at 
a very efficient and cooperative level. We have been called upon, and it has been 
a pleasure, to cooperate with one of our sister institutions to relieve some of the 
surgical conditions of patients confined there. The itemized account below repre- 
sents only those surgical procedures which were necessary in one or another of our 
operating rooms. There have been many other minor surgical procedures carried 
out in the routine or special clinic of out-patient rooms, and are not included in 
this report: Abdominal paracentesis and drainage, 3; abscesses and carbuncles, 21; 
amputations (minor), 6; amputations (major), 1; appendectomies, 10; cauteri- 
zation of cervix, 3; circumcision, 1; colostomy, 1; colporrhaphy, 1; debrement of 
infected scrotum, 1; dilation and curettage, 8; excision of cervical polyp, 1; 
excision of ganglia and cysts, 5; hemorrhoidectomies, 3; herniorrhaphies, 30; 
hydrocele (repair), 1; hysterectomies (total), 8; hysterectomy (sub-total), 1; 
laparotomies, 3; lysis of adhesions, 1; oophorectomies, 4; orchidectomy, 1; 
osteomyelitis (removal of sequestrum), 1; perineorrhaphies, 7; plaster casts 
(minor), 3; plaster casts (major), 10; prolapsed rectum (repair), 1; salpingec- 
tomies, 5; suspensions (uterine), 3; sutures (major), 3; tonsillectomies and 
adenectomies, 57; trachelorrhaphies, 7; transfusions, 3; varicose veins (injection 
treatments), 20; Total operative procedures, 234; Total operated patients, 199. 

Clinics 

The separate clinics listed below have been utilized more during this year than 
at any previous time. This represents an increase of nearly 2,000 more visits than 
last year to the various clinics. These clinics are maintained within the operating 
room suite. 

The luetic clinic has been exceptionally busy. There have been 5,014 visits to 
this one clinic for examination, treatment, or advice, and there were 1,000 more 
treatments administered than last year. At the end of the year there are 135 
luetics in the hospital, most of whom are general paretics. Of these 79 were admitted 
during the past year. It is difficult to determine whether this increase is an actual 
increase in the paretic admission rate, or whether improved tests and examinations 
have facilitated our ability to diagnose general paresis earlier than has been our 
custom. During the past few months we have utilized the Hinton test and, although 
it is too early to compute from a statistical standpoint, it is our impression that this 
test is much more sensitive than either the Wassermann or the Kahn, and has 
materially aided us in detecting early cases of syphilis particularly attacking the 
nervous system. All of our serological examinations have been carried on in the 
Wassermann Laboratory of the Public Health Department. Six luetics discon- 
tinued treatment prematurely, and 38 were discharged as arrested during the year. 

Malarial therapy was discontinued in February, after a trial of 5 years, and 
seems to have been adequately replaced by the diathermy treatment. The report 
of the clinic work follows: 

Eye examinations, 696; ear, nose and throat examinations, 655; gynecological 
examinations, 411; luetic treatment, 2,957; small-pox vaccinations, 460; spinal 
punctures, 322; typhoid and para-typhoid inoculations, 727; Wassermanns, 
Kahns, Hintons, 1,087; others, 13; Total, 7,328. 

Dressings 

The total number of dressings listed below is somewhat less than the number 
reported last year. The total out-patient dressings, 8,580, represents the dressings 
done in a service room, on the male and female surgical wards, and on patients 
coming from the psychiatric wards who require treatments for minor conditions 
such as boils, burns, etc., but are not sufficiently incapacitated to require resi- 
dence on a medical or surgical ward. This figure justifies a separate clinic away 
from the ward service and it is hoped that this may be arranged at a later date. 

The total of 8,764 ward dressings were on surgical patients. 



P.D. 23 17 

Male out-patient 4,699 

Female out-patient 3,881 

Male ward 5,252 

Female ward 3,512 



Total 17,344 

Obstetrical Service 

Our license for maintaining an obstetrical service consisting of 8 beds has been 
renewed. This service is running at a very low ebb, consisting of only 7 births 
during the past year. There have been no untoward effects to either the mothers 
or the babies. 

Employees 

The usual standard of clinic and hospital treatment for our employees has been 
maintained throughout the past year. Unfortunately statistics on the health of 
these employees for the entire year are not available, and those given below refer 
only to the past 8 months. The centralization of office treatments into a single 
daily clinic in the operating room, suite at 4:00 P.M., and of controlling hospital 
treatments within a few separate rooms on the surgical wards has done a great 
deal to lessen the physicians' responsibility of caring for employees at distant or 
inconvenient places and has also conserved the physicians' time. In general, our 
employee population has been a very healthy one. 

Examined and treated at clinic 778 

Required hospitalization 58 

Required operation 21 

Total number of days on sick wards 383 

Laboratories 

The general amount and quality of the work done in the laboratories during the 
past year is commendable. The figures below represent an increase of 9,000 
determinations over the number done last year. The laboratory force has been 
increased somewhat during the year, and we have again attempted to reorganize 
our department for general pathology. However, we feel the pressing need for 
more work in the special branch of neuropathology. Our consulting chemist has 
contributed much of value to the clinical and chemical laboratories. All of the 
employees in this department have demonstrated their usual cooperation with the 
various hospital services. The report of the laboratory follows: Agglutinins, 29; 
alveolar carbon dioxide, 37; bacterial cultures, 42; bacterial smears, 247; basal 
metabolisms, 738; blood cultures, 11; blood calcium, 23; blood creatinin, 703; 
blood N.P.N., 725; blood sugar, 1,388; blood urea, 711; blood uric acid, 721; 
blood counts (red), 2,837; blood counts (white), 3,238; blood counts, (differential), 
3,240; blood counts (Schilling index), 121; haemoglobin, 2,928; clotting times, 
192; galactose tolerances, 1,170; icteric index, 30; mosenthal tests, 45; nitrogen 
partitions, 991; Plasmodia malaria, 87; renal functions (P. S. P.), 665; spinal 
fluids (cells), 357; Spinal fluids (colloidal gold curves), 375; spinal fluids (globulins), 
375; spinal fluids, (mastics), 5; sputa, 157; stools, 92; tissue sections, 746; urin- 
alysis (routine), 6,544; urine (total chlorides), 33; urine (total nitrogen), 33; Van 
Den Bergh tests, 30; vital capacity, 640; widals, 3; others, 94; total number of 
examinations, 30,403. 

X-ray Department 

This department was somewhat handicapped and operated at a very low scale 
for three months because of a change in personnel. The total of 2,274 plates is a 
decrease of only 54 from last year, but the number of patients examined represents 
a drop of 417. The large increase in dental plates (over twice the number used 
last year) explains the relative increase in total plates. 



18 



P.D. 23 



Parts Examined 









Plates 












Plates 


Abdomen (plain) .... 9 


Knee 41 


Ankle 






54 


Kidney (plain) 








4 


Arm 






46 


Leg . 








26 


Chest 






206 


Mastoid . 










18 


Colon 






17 


Nose 










7 


Elbow 






20 


Ribs. 










14 


Foot. 






31 


Shoulder 










39 


Gastro-intestinal series 






461 


Sinuses . 










48 


Gall-bladder (plain) 






47 


Skull 










117 


Graham test . 






12 


Spine 










82 


Hand 






58 


Teeth 










776 


Heart 






20 


Wrist 










30 


Hip . 






63 


Others 










2 


Jaw .... 






20 




Total plates taken . 








2,274 


Total Patients examined by 


X-r 


ay • 


..... 795 


Finger prints (patients) 






10 


Photographs (patients) 


















134 



Dental Department 
This department has continued to be active throughout the year, as shown by 
the following table: Bridges, 4; cleanings, 1,161; examinations (routine) 2,700 
extractions, 1,434; fillings, 1,048; microscopic examinations, 95; plates, 48 
repairs, 48; treatments (miscellaneous), 1,325; X-ray diagnoses, 163;others, 34 
total examinations and treatments, 8,039; totai patients examined or treated, 3,316. 

Physical Therapy Department 

At the completion of the first full year of active treatments in the physical 
therapy department there was a total of 8,312 treatments on 5,582 patients. 
During the year 312 new patients were treated in the department. These figures 
represent more than an average amount of activity. However, there have been a 
large number of time-consuming research procedures which cannot be properly 
evaluated by simple figures. Although still in its infancy relative to this hospital, 
physical therapeutic measures have proven of considerable value as adjuncts to 
the more usual medical and surgical methods of treatment. This department has 
also cooperated a great deal in the special fields of psychiatry and research. The 
probable fields of usefulness for physical therapy are becoming more apparent and 
more diverse as our research studies progress. Slight reference has been made (see 
Clinics) to the use of biological pyrexia produced by diathermy as a probable 
replacement for the malarial treatment of general paresis. 

It probably would be futile to enumerate the various conditions for which physi- 
cal therapy has been used during the past year. Suffice it to say that the total 
number of different conditions treated is 82. The treatments are: Ultra-violet 
(air-cooled), 3,014; ultra-violet (water-cooled), 1,285; baking, 1,529; massage, 
667; diathermy (medical), 1,249; diathermy (surgical), 68; galvanism, 237 
muscle re-education, 103; sinusoidal, 157; others, 3; total treatments, 8,312; 
new patients during year, 312; total number of patients treated, 5,582. 

Pharmacy 
The increase of activity in medicinal disbursements is rather parallel to the 
combined activities of the hospital services, as demonstrated by the figures below: 



Prescriptions for sedatives 
Prescriptions for narcotics 
Other prescriptions 



Total prescriptions filled 



5,720 
10,760 
12,149 

28,629 



P.D. 23 19 

Miscellaneous 

Although the medical and surgical services have been active and efficient during 
the past year, nevertheless there have been many handicaps. The rapid change of 
personnel in many of the departments has influenced somewhat the amount of 
work done and the turn-over of patients. 

The work of more firmly organizing this service and of extending its usefulness 
has been carried on as in the past. Each year there seems to be a decided general 
improvement over the preceding year. 

Heretofore many infirm and actually ill patients have been cared for at the 
Summer Street Department. It is hoped that during the coming year we may 
com.pletly centralize all of such cases at the Main Hospital. In order to do this, 
it will be necessary to increase our medical service to a capacity of approximately 
375 The present capacity of our active service at the Main Hospital is 285. 

During the year all of the constituent departments of the medical and surgical 
services have demonstrated a fine spirit for work, loyalty and cooperation. The 
cooperation between this service as a whole and the various other hospital services 
and departments has been mutual. 

Rei ort of Research Service 
Francis H. Sleeper, M.D., Assistant Superintendent 

The work during the past year has continued along the lines discussed in previous 
reports. Dr. R. G. Hoskins, Director of the Memorial Foundation for Neuro- 
Endocrine Research, has devoted part of his time to supervising the research in 
this institution. One of the major problems in conducting a cooperative research 
on a scale as large as that planned here is the assembling and training of personnel. 
A large amount of time and effort has been spent in building up the research 
personnel in the past year, with, we believe, excellent results. The following 
additions to the personnel have been made during this period: 

Dr. James R. Linton, B.S., University of Washington, M.D., Harvard Medical 
Schools, 1925, has served as psychiatrist since June. He has had previous research 
experience in physiology with Dr. W. B. Cannon, served an interneship at the 
New Haven Hospital, a psychiatric interneship at the Boston Psychopathic 
Hospital, and had two years' experience at the Iowa Psychopathic Hospital as 
resident physician. 

Dr. Harry Freeman, A.B., Harvard, M.D., Harvard Medical School, 1928, has 
served as internist since June. Dr. Freeman served rotating interneship at the 
Beth Isreal Hospital in Boston, four months as Medical Resident at the Boston 
City Hospital. 

Dr. Milton H. Erickson has been research psychiatrist since April, 1930. Dr. 
Erickson received his A.B., A.M. in psychology and psychiatry and M.D. from the 
University of Wisconsin, served one year as clinical psychologist and two years as 
research psychologist for the Wisconsin State Board of Control, publishing several 
very worthwhile contributions in the field of psychology; served rotating interne- 
ship at the Colorado General Hospital, three months being spend in the Colorado 
Psychopathic Hospital under Dr. Franklin G. Ebaugh. He also took a post- 
graduate course in psychiatry under Dr. Ebaugh. He then became a staff member 
at the Rhode Island State Hospital under Dr. A. P. Noyes, coming from there to 
this hospital as research psychiatrist. 

Dr. Vladimir Dimitroff received his D.Sc. from Johns Hopkins. Prior to coming 
here he was in charge of the laboratories at Hudson City Hospital, Hudson, New 
York. He is in charge of the clinical pathology on the research service. 

Miss Helen Childs, research chemist, received her A.M. in chemistry from the 
University of Illinois, 1930. She is responsible for the chemical work of the research 
service. 

Many of the subjects commented on in the last annual report are still under 
investigation, but because of lack of space only part of the problems under investi- 
gation at the present time will be enumerated seriatim and comments offered on 
each: 

1. Diathermy Treatment for Dementia Paralytica. Although our percentage of 
improvement in cases of dementia paralytica under treatment with malaria was 



20 P.D. 23 

approximately 37%, in the first one hundred cases there occurred three cases of 
spontaneous rupture of the spleen. Many of our cases of dementia paralytica are 
extremely debilitated at the time of hospitalization. To superimpose on the al- 
ready existing luetic process an additional debilitating factor in the form of malaria 
with its consistent accompanying secondary anemia, splenomegaly, jaundice, and 
occasional rupture of the spleen, to enumerate only a few of the complications, 
does not seem to be the ideal form of therapy for this condition. In February, 
1930, Dr. C. T. Perkins, after several months of experimental work on normals, 
started the diathermy treatment of cases of dementia paralytica. On the basis of 
the first twenty-six cases reported, the results are most encouraging. Approxi- 
mately 50 % of the cases treated have made a social recovery, with a mortality rate 
for the series of 7%. Dr. Perkins is also investigating the effects of diathermy on 
the nitrogen partition in urine, blood chemistry, the serology of the blood and the 
spinal fluid, phenolsulphonephthalein output, spinal fluid chemistry and mor- 
phology, the basal metabolism, as well as the clinical changes resulting from the 
treatment. The evidence at the present time indicates that diathermy will prove 
a valuable addition to our therapeutic armamentarium in the treatment of dementia 
praecox. 

2. Comparison of Wasserrncmn, Kahn, and Hinton Tests. For several months 
these three tests have been used routinely in all new admissions and all treated 
luetic cases. It has been found that the relative degrees of sensitivity of the tests 
are in the following ratio: Wassermann, three; Kahn, four; Hinton, six. In 
other words, the Hinton Test, in our cases, has proved 100% more sensitive than 
the Wassermann. This is of a great deal of value in evaluating the treatment of 
luetic cases. This work has been carried out under the supervision of Dr. Perkins. 

3. Stramonium treatment of Parkinson's Syndrome. This research is being con- 
ducted by Dr. C. T. Perkins. The results with this form of therapy have been 
quite satisfactory, resulting in a diminution in the rigidity and salvation in all 
the cases in which it has been used. The strength in many of the cases has in- 
creased. This work will be continued. 

4. The Effects of Gland Products on the Mental Symptoms of Schizophrenia. A 
paper on the ''Thyroid Factor in Dementia Praecox" by Drs. Hoskins and Sleeper 
was read before the annual meeting of the American Psychiatric Association May, 
1930. Among 130 subjects of dementia praecox a group of 18 was diagnosed as 
suffering from thyroid deficiency. Of these 16 received thyroid treatment. Signifi- 
cant mental improvement followed in 14 or 88% of the cases and 5 patients became 
well enough to go home. In a control group of 41 patients receiving similar treat- 
ment the incidence of significant improvement was 34 percent. There was probably 
some degree of thyroid deficiency in various subjects of the control group since 31 
were recorded as showing "endocrine deficiency unclassified." A considerable 
number of the control subjects received other than thyroid medication which 
probably contributed to the improvement shown. In general, cases presenting a 
favorable initial prognosis were excluded from treatment. 

The results of the study are interpreted as indicating that thyroid deficiency 
plays a significant role in more than 10% of State Hospital cases of dementia 
praecox and that in properly selected cases thyroid medication in adequate dosage 
and for a sufficiently prolonged period results in significant improvement. On the 
other hand, relatively little success is to be anticipated from thyroid medication 
in cases selected at random. 

A common picture presented in dementia praecox is reduction of body temper- 
ature, blood pressure, and basal metabolic rate, secondary anemia, and reduction 
of bodily vigor. This picture is suggestive of adrenal deficiency. A report on "A 
Metabolic Study of Desiccated Suprarenal Medication in Man" by Drs. Hoskins 
and Sleeper was published in Endocrinology, Vol. 14, No. 2, March-April, 1930. 
The study of nine adult male schizophrenic subjects has failed to indicate that 
desiccated suprarenal substance administered in large doses by mouth is of any 
significant therapeutic value. While it must be recognized that nine cases are too 
few to justify absolute conclusions, nevertheless under the conditions of these 
experiments any efficacy of the substance sufficient to be of practical clinical sig- 
nificance could hardly have failed in indication. At any rate, these negative results 



P.D. 23 21 

serve further to cast the burden of proof on those who regard the oral adminis- 
tration of desiccated suprarenal substance to adults as other than psychotherapy. 

5. The Effects of Manganese Chloride on the Mental Symptoms of Schizophrenia. 
For the past year we have been investigating the effects of intramuscular injections 
of collosol manganese on the mental symptoms of schizophrenia. The results to 
date have been somewhat conflicting. Part of the patients definitely gain weight 
while under this medication; others remain constant in weight or lose slightly. 
We have not been able to duplicate the results of Dr. English, who used intravenous 
manganese chloride and who reported very good improvement in the mental symp- 
toms of many of his cases. However, we have not used the same preparation 
utilized by Dr. English and therefore no valid comparison may be drawn. 

6. The Effects of Posterior Lobe Pituitary by Mouth on the Water Excretion of the 
Body. This work is not completed as yet, but on a comparatively large number 
of cases the water excretion from patients receiving this form of medication has 
consistently been lowered. With the cooperation of several commercial houses 
this work will be completed in a short time. 

7. The Galactose Tolerance in Dementia Praecox. This study of the galactose 
tolerance is part of a larger study directed toward an attempt to secure further 
light on two major problems: Are there any metabolic peculiarities by which the 
schizophrenic psychosis can be characterized? Within the schizophrenic group 
are there any characteristic metabolic differences among the various sub-groups? 
Such differences, if present, would be of obvious aid in differential diagnosis and of 
possible prognostic value. An article on this subject by Drs. Sleeper and Hoskins 
was published in the Archives of Neurology and Psychiatry, September, 1930, Vol. 
24. The conclusions of this study are as follows: 1. The galactose tolerance was 
determined one or more times in one hundred and thirty-five cases of dementia 
praecox. 2. The tolerance level was constant in fifteen and variable in twenty- 
four of the thirty-nine cases in which multiple determinations were made. Similar 
variability has been noted by others in the blood sugar curves following the in- 
gestion of dextrose. 3. In the series as a whole there was a downward trend of the 
galactose tolerance, averaging approximately 15 per cent. In 8 per cent it was 
below normal. 4. The catatonic group showed the highest degree of incidence of 
normal tolerance and the lowest incidence of depressed tolerance. The hebephrenic 
group showed the lowest incidence of normal tolerance and the highest incidence 
of lowered tolerance. The galactose tolerance test appears to have some value in 
the differential diagnosis of the two types. 5. No relationship between weight, 
age, creatinin output, protein catabolism or initial blood sugar and galactose 
tolerance could be detected. There was some evidence of a decrease of tolerance 
with the increase of the period of hospitalization. 6. A tendency to lowered 
tolerance for galactose is added to the list of characteristics of dementia praecox 
that indicate a depression of functions under endocrine or autonomic control. 

8. Gastro-Intestinal Motility in Schizophrenia. One theory advanced as to the 
etiology of dementia praecox is that toxic substances are absorbed from the gastro- 
intestinal tract, causing pathological changes in the brain. A first step in the in- 
vestigation of this problem was to determine the emptying time of the barium meal 
from the gastro-intestinal tract. The only other work which has been found in the 
literature on this problem was reported by Henry, who states that in 70 per cent 
of acute, actively hallucinating cases of schizophrenia there is a retention of barium 
or of food residue in the colon for periods longer than five days. The following 
tentative conclusions by Drs. Sleeper and Hoskins are made on the study of 86 
male schizophrenic patients. A period of four days or longer to empty the gastro- 
intestinal tract of barium was present in 38.3 per cent of all the cases. Paranoid 
cases had the least tendency to delay in emptying time, only 13.3 per cent showing 
four-day delay. Catatonic cases show the highest incidence of delay, 45.4 per 
cent and require the longest average number of days to empty the tract, 8.3 days. 
This group also shows the poorest degree of activity. The age, weight, period of 
hospitalization, apparently have no significant effect on the time of evacuation. 
Factors which apparently exercise influence on the emptying time of the gastro- 
intestinal tract are ptosis of the transverse colon, degree of activity, thyroid 
deficiency, and deficiency of other glands of internal secretions. At the present 



22 P.D. 23 

time it is rather doubtful if the delayed emptying time is of any marked importance 
in the continuation or etiology of the psychosis. What absorption takes place in 
the intestine probably occurs largely in the proximal colon, and only rarely is there 
any retention of the barium meal in this portion of the intestine. 

9. Blood Pressure in Dementia Praecox. This investigation has been carried out 
by Dr. Harry Freeman with the collaboration of Drs. Hoskins and Sleeper. One 
hundred eighty cases of male dementia praecox were studied. In this group the 
systolic blood pressure averaged 106 mm. The pulse pressure was found to be 
50 mm. As a control group, over 300 freshmen medical students were used. The 
control group statistics were given us through the courtesy of Dr. A. W. Rowe, 
Director of Research, Evans Memorial Hospital, Boston. In this group the 
average systolic blood pressure was found to be 117 mm. and the average pulse 
pressure 45 mm. There was no correlation between the blood pressures and the 
age up to the age of fifty years. There was also no correlation between the nutri- 
tion, the season, the duration of hospital stay, and the total nitrogen excretion. It 
is interesting to note that the paranoid and the simple group had the highest level 
of systolic B.P. — 109. It may be noted here that N. D. C. Lewis found that the 
aplastic circulatory system found in the other groups of praecox was not present 
in the paranoid group. 

10. The Schneider Index. Lewis and Fulstow have reported aplasia of the cir- 
culatory system in schizophrenia. As cardio-vascular inefficiency may conceivably 
play a part in this mental condition, an attempt is being made to study this problem 
by means of the Schneider test, which has been used particularly in the examination 
of aviators. This problem is being studied by Dr. Linton. The data are insufficient 
to warrant drawing any conclusions at this time. 

11. The Oculo-Cardiac Reflex. There is a great deal of evidence pointing to 
involvement of the vegetative nervous system in patients suffering from dementia 
praecox. One test that seems to be of some value in differentiation between 
vagotonia and sympathicotonia is the oculo-cardiac reflex. A method for quanti- 
tating the amount of pressure applied to the eye in terms of millimeters of mercury 
is in use, and a fairly large number of controls and subjects suffering from dementia 
praecox have been studied. Kymograph records of the effects on the pulse are 
made. The data are too few in number to handle statistically at this time. 

12. The Effects of Calcium Therapy on Nervous Irritability in Dementia Praecox. 
The tentative conclusion on this work, subject to revision, is that calcium exercises 
slight beneficial effect on the nervous irritability in these cases. This work is being 
carried out by Dr. Linton. 

13. Prognosis. The problem of prognosis in dementia praecox is of tremendous 
importance in working in this field. A schema on the basis of five divisions has been 
in use for a period of three years, prognosis being figured on the basis of a five-year 
period. The divisions are: A, complete recovery; B, social recovery; C, institu- 
tional social adjustment; D, institutional adjustment; E, deterioration. All Staff 
members go on record as to their ideas on prognosis for the individual case. After 
the five-year period the material will be analyzed and valuable information may 
conceively be forthcoming from this data permitting us to prognose more accurately. 

14. Group Psychotherapy. This is carried out on a group of twelve dementia 
praecox patients by Dr. Bryan. Various psychotic manifestations are discussed 
with the group and explanations, where possible, made. Some of the comments of 
the patients merit further discussion. One of the patients said, "You say that 
spirits cannot talk to the living. How do you account for the fact that Sir Oliver 
Lodge and Sir A. Conan Doyle have gone on record as saying that this is possible? 
Or again, why isn't it possible that these voices which I hear are sent to me by 
means of mental telepathy?" Or another patient comments on being in a theatre 
and having a performer describe accurately an unusual trinket which he carried in 
his pocket without more than three words being spoken by his confederate. It 
is too early to speak definitely regarding the therapeutic value of this experiment, 
but it offers interesting potentialities. 

15. A Simplified Formulation of Dementia Praecox. Dr. Hoskins has written a 
paper which has been accepted for publication by the Journal of the American 
Medical Association on the above subject. According to this formulation, dementia 



P.D. 23 23 

praecox is a defensive reaction to a sense of personal failure. It results from an 
inability to meet one's own personal standards. It is a persistent dream state 
characteristically accompanied by a sense of isolation. It may take the form of 
panic, of despairing acceptance (loss of hope), or evasiveness (with projection and 
grandiose delusions), or simple acceptance of inferiority. Fundamental to the 
psychosis is an intolerable loss of self-respect. The formulation was written for 
the general practitioner with the thought that most of these patients suffering from 
dementia praecox first go to the general practitioner, and theoretically at least, 
the general practitioner should be in a position to do the most for them in the early 
phases of the condition. Embodied in the article are practical suggestions as to 
treatment. 

16. Ward Council. This consists of six Staff members and six patients suffering 
from dementia praecox. It corresponds to the shop council in operation in many 
factories. The meetings are formal; minutes of the meetings are kept, and many 
of the ideas emanating from the patients tending to better their welfare have been 
put in operation. It is felt that for the patient members of the ward council, 
definite benefits have accrued tending definitely to increase their self-respect. 

17. Recreational Therapy. During the past year all the patients on the research 
service have had set hours for recreation, mostly of an outdoor character. This 
has definitely resulted in physical as well as mental improvement in many of the 
cases. 

18. Statistical Survey of the Dementia Praecox Problem. This survey, made by 
Drs. Hoskins and Sleeper, shows that a daily average of more than 141,000 patients 
with dementia praecox are hospitalized and that the daily economic loss to the 
United States as a result of this condition is more than a million dollars a day. 

19. Psychology Department. A large amount of time has been spent by this 
department in developing apparatus for the study of various problems having a 
direct bearing on the larger schizophrenia problem. Apparatus has been developed 
and is in use for the graphic recording of blood pressure, pulse, respiration, tremors, 
and the changes occurring in these as a result of word association stimuli. Appara- 
tus for studying neuromuscular coordination in praecox has also been developed. 
Apparatus for studying chronaxie and various reflexes in praecox are in the process 
of development. A more detailed account of this department may be seen in the 
report of the Chief Psychologist. 

20. Statistical Approach to the Problem. ■ Plans have been formulated for the 
handling of the vast number of data which have been accumulated from a statis- 
tical standpoint. In a research of this magnitude a trained statistician is absolutely 
essential. An effort to compensate for this lack has been made. Six members of 
the research staff are at the present time taking a course in statistics. However, 
production will be greatly facilitated by the addition to the Staff of a trained 
statistician. 

Publications 

"A Metabolic Study of Desiccated Suprarenal Medication in Man," R. G. 
Hoskins and F. -H. Sleeper. Endocrinology, Vol. 14, No. 2 March-April, 1930. 
pp. 109-111. 

"Galactose Tolerance in Dementia Praecox," F. H. Sleeper and R. G. Hoskins, 
Archives of Neurology and Psychiatry, September, 1930. Vol. 24, pp. 550-585. 

"The Boltz (A.A.S.) Test in Cerebrospinal Fluid." A critical Review. B. S. 
Walker and F. H. Sleeper. American Journal of Psychiatry. Vol. X. No. 2, 
September, 1930. 

"The Thyroid Factor in Dementia Praecox." R. G. Hoskins and F. H. Sleeper. 
American Journal of Psychiatry. Vol. X, No. 3, November, 1930. 

"Research in State Hospitals," F. H. Sleeper. Bulletin Mass. Dept. Mental 
Diseases, Vol. XIV, No. 1, 

"Medical and Surgical Service in a State Hospital," C. T. Perkins Bulletin Mass. 
Dept. of Mental Diseases, Vol. XIV, No. 1. 

"The Psychological Department in a State Hospital," D. Shakow, Bulletin 
Mass. Dept. of Mental Diseases, Vol. XIV, No. 1. 

"Community Work in a State Hospital" Samuel Hartwell, Bulletin Mass. 
Dept. of Mental Diseases, Vol. XIV, No. 1. 



24 P.D. 23 

"Teaching in a State Hospital." S. S. Ackerly. Bulletin Mass. Dept. of Mental 
Diseases, Vol. XIV, No. 1. 

"Religious Work in a State Hospital." A. T. Boisen. Bulletin Mass. Dept. 
of Mental Diseases. Vol. XIV, No. 1. 

"Hermann Ebbinghaus," D. Shakow, American Journal of Psychology, 42, 1930, 
505-518. 

Symposium at the 7th Annual meeting of the American Orthopsychiatric Asso- 
ciation. A. "The Psychiatrist." Samuel W. Hartwell. American Journal of 
Orthopsychiatry, Vol. 1, No. 1, October, 1930. 

"A Teaching Program in a Mental Hospital," Olive Caldwell. Occupational 
Therapy and Rehabilitation, Vol. IX, No. 1, pp. 33-38. 

"A Clinical Training for Theological Students," A. T. Boisen, Religious Educa- 
tion, April, 1930. 

Report of the Child Guidance Clinic 
S. W. Hartwell, M.D., Director 

This report covers: first, a statement of the activities of the Clinic in community 
education, developing of agency cooperation, and constructive case record keeping. 
Second, an attempt to evaluate as far as possible what has been actually accom- 
plished for the children, their parents, and the community by the activities of the 
Clinic. 

During the year, over 100 addresses have been given, or meetings held with 
different groups by members of the Child Guidance Clinic Staff. The groups before 
whom we have met in this way have been such as Parent-Teachers Associations, 
Probation Officers, Y.M.C.A.'s, Y.W.C.A.'s, and Boys' Club Workers, Mental 
Hygiene Societies, Church Groups, and Luncheon Clubs. The subjects discussed 
have been largely those dealing with some phase of mental hygiene, psychiatric 
social work, and child guidance. The aim has been to discuss these subjects from 
a practical and constructive angle and to avoid theoretical ideas. The imparting to 
parents, teachers, probation officers, and others, the facts that we seem to learn in 
Child Guidance work, we feei is of great importance, and these meetings have all 
been held with this idea in mind. 

A total of 38 different public agencies have referred cases to the Clinic during 
the year. The workers of these agencies, in nearly every case, have attended the 
conference held in the Clinic regarding the particular children in whom they are 
interested. An attempt has consistently been made throughout the year not only 
to cooperate with the agencies in dealing with the children but to educate their 
workers to the possibilities and limitations of a Child Guidance Ciinic and of the 
practical desirability of having the Clinic closely affiliated with the Department 
of Mental Diseases through the State Hospital. In many cases we have been able 
to establish a more friendly and constructive cooperation between two or more 
other agencies interested in cases that have been referred to us. 

Most of these cases have been treated thoroughly by all our departments — 
psychological, social, and psychiatric — over a considerable period of tjme. We 
have attempted to keep very careful and complete case records. These records, 
will be later of great value in evaluating efforts in Child Guidance and for use in 
research of the causes and treatment of problems of mental health, education, be- 
havior, and personality as they appear in childhood. 

Frequently cases have been referred to the Clinic that in our opinion did not 
seem suitable or necessary to study as regular clinic cases in which our social workers 
have, through the contacts thus established, made helpful and useful suggestions 
and adjustments to the parents or others referring these children. Very frequently 
this adjustment has been the establishing of a friendly, understanding relationship 
between these people and the proper agency to handle their cases. 

During the year, the staff of the Child Guidance Clinic has conducted the ex- 
aminations required by law for children retarded three years, in 19 communities. 
We have examined in these clinics more than 300 children. In each of these com- 
munities, after the examination has been completed and the psychiatric and psy- 
chological report of the children prepared, the Director of the Clinic and the Chief 
Psychologist have held conferences with the teachers, school nurses, and principals 



P.D. 23 25 

having to do with the children examined. Many of these conferences have been 
attended by the entire corps of teachers, and we feel that not only has more con- 
structive and practical advice been possible through the holding of these conferences, 
but that some very excellent educational work along the line of the dynamic ap- 
proach to these problems has been given to a group of people who can utilize these 
ideas to the greatest advantage. 

Our psychological department did a special piece of research and testing work 
for the Worcester Girls' Trade School, testing all the students in the school, both for 
their intellectual equipment and their special abilities and disabilities. 

During the year a new departure in the psychological department has been 
made. We are now treating a small group of speech defect cases and another small 
group of reading disabilities in the Clinic. We hope to extend this work consid- 
erably during the coming year. 

During the year, 30 5 cases were studied in the Clinic. This means the investi- 
gation and often the treatment of more than 1000 individuals who are not actual 
cases. This is true because practically always one or both of the parents and often 
the brothers and sisters of the children, or other relatives, are taken for study and 
treatment, both socially and psychiatrically. More than 600 psychiatric treatment 
interviews with parents or foster parents of our cases have been held. More than 
3,000 social treatment interviews, most of these in the homes of the children, have 
been given by our social workers. More than 500 psychological testings have been 
given. 

Clinical Activities: 305 cases were accepted for treatment in the Clinic; 55 are 
not included in the following summary of results obtained. These 55 represent 
cases too recent for a diagnosis to be made or treatment instituted; those who 
moved from the community after a brief study, temporary cases such as runaways 
referred by the Travelers' Aid Society; those who have become seriously and 
chronically sick and hospitalized soon after the original study, and those whose 
parents refused after the original study to cooperate to any extent with our at- 
tempts to help them. 

In making the following statement of the results of the Clinic's treatment, three 
terms are used: 

"Successful Adjustments" — those that in our opinion all the essential 
aspects of the child's problem have been solved. This means that the 
behavior, mental, and emotional life is at present within normal range 
and that it seems to us and those most intimately acquainted with the 
child that he gives promise of maintaining these normal attitudes towards 
life. 

"Partially Adjusted" — in these, some of the essential problems of the 
child have been solved; that, as a result of what we have done for him, 
some definite improvement has been made, and that we and others believe 
this will be permanent. 

" Unimproved" — where we have not been able to help any of the essential 
problems for which the child was referred, other of course than psychologi- 
cal testing which is always done. 
The cases for this report have been divided arbitrarily into groups according to 
the chief problem presented as we, through out clinic study and investigation, see 
the cases: 

1. Delinquency: This group includes children who have been arrested and 
brought into Juvenile Court for one or more offenses. There are 39 in this group. 
Of these, 18 are fully adjusted and we feel that a large percent of these 18 are out- 
standing successes. 19 of the group are partially adjusted; most of these we are 
still treating in the Clinic. 2 are failures. 

2. Pre-psychotic: 18 of the children referred to the Clinic during the year pre- 
sented symptoms of developing psychoses. 9 of the 18 we feel could be diagnosed 
as psychotic when they were studied. Of this group, 4 are fully adjusted; 13 are 
partially adjusted; in 1 we have been able to accomplish nothing. These cases 
are all still under treatment. A piece of research is being conducted by the Clinic 
staff on this group and we hope in another year to have some interesting material 
to publish. 



26 P.D. 23 

3. Personality and mental conflicts: This is the largest group and represents 55 
cases. Of these, 21 are successfully adjusted. The large percent, 25, have been 
partially adjusted, and in 9 we have been unable to help the child in any way. 

4. Environmental maladjustments and physical problems: This group has 38 
cases, 9 of whom are successfully adjusted, 21 of whom are partially adjusted, and 
8 are failures. This is the group in which social treatment has been the largest 
factor, and represents a very great deal of time spent by members of the staff. 

5. Behavior: 25 of the children, while they have not been apprehended by the 
law, were behaving in an anti-social way. They really represent quite the same 
problem as those of the delinquent group, although of course often the behavior 
was only noticeable in school or in the home. 14 of these children have been 
successfully adjusted; 9 have been partially adjusted, and 2 have been failures. 

6. Educational and vocational problems: This group of 46 represents largely a 
group in which the clinic work is entirely secondary to other agencies, and when 
taken as a total problem probably would not show as good results as when looked 
on solely in the light of what the Clinic may have accomplished in their part of the 
problem. 15 of these children have been successfully adjusted; 25 have been 
partially adjusted, and in 6 cases we felt that we failed entirely to be of any service 
either to the child or to the agency referring him, excepting of course the work of 
the psychological department which is in these cases always of good and definite 
help. 

7. Feeblemindedness: It is the policy of the Clinic not to accept cases of feeble- 
mindedness unless there is some serious social or possible psychiatric problem in- 
volved. The number of children appearing in this group is therefore comparatively 
small as compared with the total number of feebleminded children who are social 
problems in any community. There are 29 of them. When a child is adjusted 
socially in the way we feel is to his own, his family's, and the community's best 
advantage considering his handicaps, we call him successfully adjusted. There 
are 8 of these children that are so classified. In 13 of them we have been able to do 
something that has added constructively to their adjustments and in 8 of them we 
have accomplished nothing. 

Cases Closed and Open 

The time treatment range of these 250 cases is from two to fourteen months. 
As long as the Clinic feels there is need of continued treatment the cases are kept 
active or "open." Often in fully adjusted cases it is thought best to keep the 
cases open for only infrequent social or psychiatric contacts. In unsuccessful 
ones, as long as there seems to be any hope of accomplishing results the case is not 
closed. Some idea of the relative length of treatment may be given by stating 
that 18 of the first 50 of these series are still on the active list and of these 18, 8 
are still being seen for regular psychiatric or social interviews or psychological 
treatment. 

Closed Cases: Out of 116 closed cases, 33 were classified as fully adjusted, 62 as 
partially adjusted, and 21 as unsuccessful. Of the 134 cases still under treatment, 
57 are at present fully adjusted. In these cases we feel for some reason or other 
that Clinic contacts should be maintained, but in the large per cent of them we feel 
that the adjustment is certainly going to be permanent. 62 are partially adjusted, 
and 14 are complete failures up to the present. 

General Repair Work 

The general repairs of the hospital have been kept up. A complete painting 
program of the wards has been carried on and other needed replacements were 
carried out. We have begun the installation of RCA radio equipment. This is 
not yet been completed but will be at a very early date. Every ward in the main 
building will have a loud speaker to be connected by wire with the central control 
board which is located in the balcony of the Chapel. A small broadcasting studio 
is being prepared and it is our intention to broadcast from the hospital itself a 
certain amount of mental hygiene propaganda. 

Recommendations: We have begun the erection of new porches on the Wood- 
ward wards. These will be completed at a very early date. The program of replac- 
ing the porches on the hospital should be carried on as rapidly as possible. The 



P.D. 23 27 

Quimby porches are unsafe and it is impossible to use them, because of this unsafe 
condition. These are old wooden structures and the wood has, through the pro- 
gress of time, rotted to the point where patients cannot be allowed on t^iem. 
Porches are very essential and it is to be hoped that a suitable amount of money 
will be appropriated each year to replace these old wooden structures. 

In accordance with the ten year program previously prepared it would seem 
that some beginning should be made in the general work of bringing the Summer 
Street building up to a better standard. The most imperative need at the present 
time is a complete rearrangement of the kitchen and dining room facilities. A 
suitable plan should be prepared for the installation of a central cafeteria dining 
room for both patients and employees and changing the kitchen to the first floor 
rather than in the basement where it is now located. These changes could be made 
with a comparatively small appropriation and the better food service and saving 
in food would in time compensate for the amount of money spent on it. 

I again wish to express my sincere thanks to the officers and employees of this 
hospital for their loyalty and efficiency during the year. To the members of the 
Board of Trustees for their constant encouragement and support I am also deeply 
grateful. 

Respectfully submitted, 

WILLIAM A. BRYAN, 

Superintendent. 

VALUATION 

November 30, 1930 
Real Estate 

Land, 589.16 acres $467,130.00 

Buildings 2,150,370.13 

$2,617,500.13 
Personal Property 

Travel, transportation and office expenses $5,712.49 

Food . 28,770.10 

Clothing and materials 29,980.61 

Furnishings and household supplies 281,675.65 

Medica 1 and general care 28,517.20 

Heat, l,ight and power 14,264.92 

Farm 46,088.85 

Garage, stables and grounds 11,475.84 

Repairs . 20,331.68 

$466,817.34 
Summary 

Real estate $2,617,500.13 

Personal property 466,817.34 

$3,084,317.47 

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, 1930. 

Cash Account 

Receipts 
Income 

Board of Patients $103,502.14 

$103,502.14 

Personal Services: 

Reimbursement from Board of Retirement 306.55 

Sales: 

Food $2,040.55 

Clothing and Materials 52 . 56 

Furnishings and household supplies 308 . 7 1 

Medical and General Care 141.97 

Heat, light and power 21.34 

Farm: 

Cows and calves . 530.75 

Pigs and hogs 63.08 

Hides 32.90 

Hay 6.00 

Vegetables 25.00 

Tools 2.60 

Garage, stable and grounds 6 . 40 

Repairs, ordinary 32 7.43 

Total sales $3,559.29 



28 P.D. 23 

Miscellaneous: 

Interest on bank balances . $1,667.64 

Rent 480.00 

$2,147.64 

Total Income $109,515.62 

Maintenance 

Balance from previous year, brought forward $21,651.58 

Appropriations, current year: 

Maintenance 860,210.00 

Total $881,861.58 

Expenses (as analysis below) 846,414.44 

Balance reverting to Treasury of Commonwealth ' . . . , $35,447.14 

Analysis of Expenses 

Personal services $430,724.78 

Religious instruction 2,640.00 

Travel, transportation and office expenses 11,502.52 

Food ... 163,260.66 

Clothing and material 19,019.07 

Furnishings and household supplies 38,621.13 

Medical and general care 40,431.33 

Heat, light and power • . . . . 66,783.75 

Farm 31,755.53 

Garage, stable and grounds . 7,563.90 

Repairs ordinary 19,944.14 

Repairs and renewals 14,167.64 

Total expenses for Maintenance $846,414.44 

Special Appropriations 

Balance December 1, 1929 $39,056.37 

Appropriations for current year 23,500.00 

Total $62,556.37 

Expended during the year (see statment below) $38,907.59 

Reverting to Treasury of Commonwealth $38,907.59 

Balance November 30, 1930, carried to next year $23,648.78 



Object 


Act or Resolve 


Whole 
Amount 


Expended 

during 
Fiscal Year 


Total 
Expended 
to Date 


Balance 
at End 
of Year 


Officers' cottages 1929 
Cow and hay barns 
Improvements heating 

system 
New boilers 


Chap. 146, Acts 1929 
Chap. 146, Acts 1929 

Chap. 115, Acts 1930 
Chap. 115, Acts 1930 


$12,000.00 
30,000.00 

10,000.00 
13,500.00 


$26,853.34 

8,411.65 
3,642 . 60 


$1,193.17 
28,603.80 

8,411.65 
3,642.60 


$10,806.83 
1,396.20 

1,588.35 
9,857.40 




$65,500.00 


$38,907.59 


$41,851.22 


$23,648.78 



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

Balance carried to next year $23,648.78 



Total as above $23,648.78 



Per Capita 
During the year the average number of inmates has been 2,268.26 
Total cost of maintenance, $846,414.44. 
Equal to a weekly per capita cost of $7.1760. 
Receipt from sales, $3,559.29. 
Equal to a weekly per capita of $.0294. 
All other institutions receipts, $105,649.78. 
Equal to a weekly per capita of $.8932. 
Net weekly per capita $6.2475. 

Respectfully submitted, 

JESSIE M. D. HAMILTON, 



Treasurer. 



P.D. 23 29 

STATEMENT OF FUNDS 



Patient's Fund 

Balance on hand November 30, 1929 $20,949.39 

Receipts 25,906.93 

Interest 844.66 



Refunded $27,025.72 

Interest paid to State Treasurer 844.66 



Investment 

Worcester County Institution for Savings $2,000.00 

Worcester Five Cents Savings Bank 2,000.00 

Worcester Mechanics Savings Bank 2,000.00 

Peoples Savings Bank 3,000.00 

Bay State Savings Bank 3,000.00 

Balance Worcester Bank and Trust Company 7,468.86 

Cash on hand December 1, 1930 361.74 



$47,700.98 



27,870.38 
$19,830.60 



$19,830.60 



Lewis Fund 

Balance on hand November 30, 1929 $1,667.64 

Income .... 60.31 



$1,727.95 
Expended on books 50.00 

$1,677.95 

Investment 

Milbury Savings Bank $634.26 

Worcester Five Cents Savings Bank 1,000.00 

Balance Worcester Bank and Trust Company 43 . 69 

$1,677.95 



Wheeler Fund 

Balance on hand November 30, 1929 $6,383.22 

Income 296.60 



$6,679.82 
Expended for entertainment, books, etc 461.50 

$6,218.32 
Investment 

Millbury Savings Bank ' . $1,374.22 

Worcester Mechanics Savings Bank 1,000.00 

Balance Worcester Bank and Trust Company 3,844.10 

$6,218.32 

Manson Fund 

Balance on hand November 30, 1929 $1,186.78 

Income 56.24 



1,243.02 
Expended for entertainments, etc 58.03 

$1,184.99 
Investment 

Milbury Savings Bank . $1,162.90 

Balance Worcester Bank and Trust Company 22.19 



Clement Fund 

Balance on hand November 30. 1929 $1,000.00 

Income 50.00 



$1,184.99 



$1,050.00 



Expended for patient's comfort 50.00 

$1,000.00 

Investment 
Worcester County Institution for Savings $1,000.00 

Respectfully submitted, 

JESSIE M. D. HAMILTON, 
November 30, 1930. Treasurer. 



30 P.D. 23 

STATISTICAL TABLES 

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

Table 1. General Information 

Data correct at end of hospital year November 30, 1930 

1. Date of opening as a hospital for mental diseases: January 18, 1833. 

2. Type of hospital: State. 

3. Hospital plant: 

Value of hospital property: 

Real estate, including buildings $2,617,500.23 

Personal property 466,817.34 

Total $3,084,317.57 

Total acreage of hospital property owned: 589.16. 

Additional acreage rented : 400. 

Total acreage under cultivation during previous year: 175. 

4. Officers and employees 

Actually in Service at Vacancies at End 

End of Year of Year 

M. F. T. M. T. T. 

Superintendents 1 - 1 - - 

Assistant physicians 11 11 1 1 2 

Medical internes 1 1 1 1 

j 

Total phsyicians 13 - 13 2 1 3 

Stewards 1 - 1 - - 

Resident dentists 1 - 1 - - - 

Pharmacists 1 - 1 - - 

Graduate nurses 1 38 39 - - - 

Other nurses and attendants . . . . 122 . 105 227 2-2 

Occupational therapists 4 4 - 1 1 

Social workers - 3 3 - - - 

All other officers and employees ... 77 99 176 9 3 12 

Total officers and employees . . . 220 245 465 13 5 18 

Note: — The following items, 5-10 inclusive, are for the year ended September 30, 1930. 

5. Census of Patient Population at end of Year: 

Absent from Hospital 

Actually in Hospital but Still on Books 

White: M. F. T. M. F. T. 

Insane 1,044 1,132 2,176 226 155 381 

Mental defectives 6 7 13 - 3 3 

All other cases 17 20 37 8 2 10 

Total 1,067 1,159 2,226 234 160 394 

Other Races: 

Insane 30 27 57 .5 2 7 

Mental defectives 1 1 - - - 

All other cases 4 4 - - 

Total 30 32 62 5 2 7 

Grand Total 1,097 1,191 2,288 239 162 401 

M. F. T. 

6. Patients under treatment in occupational-therapy classes, in- 

cluding physical training, on date of report .... 52 158 210 

7. Other patients employed in general work of hospital on date of 

report 522 427 949 

8. Average daily number of all patients actually in hospital during 

year . 1,096.65 1,167.85 2,264.50 

9. Voluntary patients admitted during year 1 4 5 

10. Persons given advice or treatment in out-patient clinics during year 60 40 100 

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

Note: — The following tables 3-19, inclusive, are for the Statistical year ended September 30, 1930 



P.D. 23 









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32 P.D. 23 

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











Parents of Male 


Parents of Female 




Patients 


Patients 


Patients 


Nativity 


















Both 


Both 




M. 


F. 


T. 


Fathers Mothers Parents 


Fathers Mothers Parents 


United States .... 


125 


107 


232 


61 55 48 


44 45 34 


Austria 








2 


- 


2 


2 2 2 


1 


Belgium 








- 


1 


1 


_ _ _ 


1 1 


Canada ' 








29 


15 


44 


42 47 40 


23 27 20 


Central America 








- 


1 


1 


_ _ _ 


1 1 1 


Cuba 








- 


2 


2 


_ _ _ 


1 2 1 


England 








9 


4 


13 


12 13 11 


9 8 5 


Finland 








1 


4 


5 


1 1 1 


5 4 4 


France 








- 


- 


— 


_ _ _ 


2 


Germany . 








1 


1 


2 


2 3 2 


5 4 4 


Greece . 








4 


— 


4 


3 3 3 


1 


Holland . 








1 


- 


1 


1 1 1 


_ _ _ 


Ireland 








8 


19 


27 


34 34 29 


46 45 41 


Italy . 








12 


3 


15 


12 12 12 


5 5 4 


Japan . 








- 


1 


1 


_ _ _ 


1 1 1 


Norway 








1 


- 


1 


2 1 1 


_ _ _ 


Poland 








5 


7 


12 


7 6 6 


8 7 7 


Portugal 








2 


1 


3 


1 2 1 


1 1 1 


Russia . 








5 


5 


10 


6 7 6 


7 8 7 


Scotland 








1 


4 


5 


6 4 4 


7 6 4 


Sweden 








5 


6 


11 


7 9 7 


9 9 9 


West Indies 2 








- 


1 


1 


_ _ _ 


1 1 1 


Other countries 








9 


6 


15 


11 11 11 


6 6 6 


Unascertained . 








5 


1 


6 


15 14 14 


7 7 7 


Total 








225 


189 


414 


225 225 199 


189 189 157 



'Includes Newfoundland 



2 Except Cuba and Porto Rico 



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34 



P.D. 23 



Table 5. Citizenship of First Admissions 

Males 

Citizens by birth . . 

Citizens by naturalization 

Aliens . 

Citizenship unascertained 

Total 225 



Females 



Total 



125 


107 


232 


29 


39 


68 


50 


34 


84 


21 


9 


30 



Table 6. Psychoses of First Admissions 



Psychoses 



total 



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 nervous diseases, total 

Multiple sclerosis 
Other diseases 

9. Alcoholic psychoses, total 

Korsakow's psychosis 

Acute hallucinosis 

Other types, acute or chronic 

10. Psychoses due to drugs and other exogenous toxins 

11. Psychoses with pellagra . . 

12. Psychoses with other somatic diseases, total 

Exhaustion delirium .... 
Delirium of unknown origin 
Other diseases or conditions 

13. Manic-depressive psychoses, total . 

Manic type 

Depressive type 

Other types 

14. Involution melancholia .... 

15. Dementia praecox (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 definicency . 

21. Undiagnosed psychoses 

22. Without psychosis, total 

Epilepsy without psychosis 
Psychopathic personality without psychosis 
Mental deficiency without psychosis 
Others 



Total 



M. F. T. 



1 - 
1 1 

2 
2 



- 


1 


1 


10 


1 


11 


24 


1 


25 


2 
1 


2 
1 


4 
2 


6 


6 


12 


1 


6 


7 


8 


12 


20 


- 


3 


3 











M. F. T. 



3 
18 
36 

24 
2 



3 
43 
61 
31 

3 



4 7 11 

34 3 37 



5 8 13 

4 39 83 

8 16 24 

1 3 4 

4 3 7 



2 3 5 

7 2 9 

11 14 25 

4 3 7 



P.D. 23 35 

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



African (black) 

Armenian 

Chinese . 

Cuban 

Dutch and Flemish 

English . 



Finnish . 

French 

German . 

Greek 

Hebrew . 

Irish. 

Italian 1 . 

j apanese 

Lithuanian 

Portuguese 

Scandinavian 2 

Scotch 

Slavonic 3 

Syrian 

Other specific races 

Mixed 

Race unascertained 



Total 



Total 



M. 

4 
1 
1 

1 

15 
1 

30 
2 
3 
5 

40 

13 

6 
1 

10 

4 



225 189 414 



T. 

9 

1 
1 
1 
2 

24 
5 

44 
6 
3 

11 



2 
19 
13 
15 
2 
7 
123 
15 



M. F. T. 



1 - 1 

1 - 1 



1 1 2 
3 10 13 



1 1 
6 3 9 



With cerebral 
arterio- 
sclerosis 



M. F. T. 



3 5 
5 ; 3 



6 12 
1 



25 43 36 25 61 



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

Psychoses — Continued 



Race. 


General 
paralysis 


With cerebral 
syphilis 


With other 
brain or 
nervous 
diseases 


Alcoholic 


With other 
somatic 
diseases 


African (black) 

Armenian 

Chinese . 

Cuban 

Dutch and Flemish 

English . 

Finnish . 

French . 

German . 

Greek 

Hebrew . 

Irish 

Italian 1 . 

Japanese. 

Lithuanian 

Portuguese . 

Scandinavian 2 

Scotch 

Slavonic 3 

Syrian 

Other specific races 

Mixed 

Race unascertained 








M. F. T. 
2-2 


M. F. T. 


M. F. T. 


M. F. T. 
1 - 1 


M. F. T. 
































1 1 2 






1 - 1 
1 1 2 
8-8 


1 - 1 


3 1 4 


1 - 1 


- - - 


2 2 4 


1 - 1 

3 2 5 










- - - 


1 - 1 

1 1 2 


10 1 11 
1 - 1 


1 - 1 
1 3 4 
1.1 2 




























3 14 
1 - 1 


1 1 


1 1 2 


1 - 1 
1 - 1 

3 1 4 


11 


2-2 
8 2 10 


1 - 1 


1 5 6 


1 - 1 
5-5 
1 - 1 


1 1 2 

2 1 3 








Total 








24 7 31 


2 1 3 


4 7 11 


34 3 37 


9 9 18 



includes "North" and "South". . . 

2 Norwegians, Danes and Swedes. 
. includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, .Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 



36 



P.D. 23 



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



Race 


Manic 
depressive 


Involution 
melancholia 


Dementia 
praecox 


Paranoia 

and 
paranoid 
conditions 


Epileptic 
psychoses 


African (black) 

Armenian 

Chinese . 

Cuban 

Dutch and Flemish 

English . 

Finnish . 

French . 

German . 

Greek 

Hebrew . 

Irish 

Italian ' . 

Japanese 

Lithuanian 

Portuguese 

Scandinavian 2 

Scotch 

Slavonic 3 

Syrian 

Other specific races 

Mixed 

Race unascertained 








M. F. T. 


M. F. T. 


M. F. T. 

1 3 4 
1 - 1 
1 - 1 


M. F. T. 
1 1 


M. F. T. 












1 1 
1 1 

1 3 4 

1 4 5 
- 2 2 

2 1 3 
1 3 4 

1 - 1 

3 6 9 


1 1 

1 1 
1 1 

2 1 3 

1 - 1 
1 1 

1 1 

2 2 4 


3-3 

2 1 3 

1 - 1 
1 2 3 
7 6 13 
5 1 6 
1 1 
5 1 6 
1 - 1 

1 3 4 
- 2 2 

2 1 3 
1 1 
1 1 

12 14 26 
1 2 3 


1 - 1 
1 1 
1 1 
1 1 

1 5 6 
2-2 

1 1 2 
3 5 8 


1 2 3 
1 1 


Total 


9 21 30 


5 8 13 


44 39 83 


8 16 24 


1 3 4 



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



Race 








Psycho- 
neuroses and 
neuroses 


With 

psychopathic 
personality 


With mental 
deficiency 


Undiagnosed 
psychoses 


Without 
psychosis 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


Armenian 

Chinese . 

Cuban 

Dutch and Flemish 

English . 

Finnish . 

French . 

German . 

Greek 

Hebrew . 

Irish 

Italian ' . 

Japanese. 

Lithuanian 

Portuguese 

Scandinavian 2 

Scotch 

Slavonic 3 

Syrian 

Other specific races 

Mixed 

Race unascertained 






































- - - 


_ _ _ 


- - - 


1 - 1 
1 - 1 


- - - 


1 - 1 


: : : 


1 1 
1 - 1 


1 - 1 

2-2 


1 1 2 


1 1 
1 - 1 


_ _ _ 


3-3 
1 1 


- 2 2 
1 - 1 


1 - 1 








1 1 2 


















1 1 2 












_ _ _ 


1 2 

1 








- - - 


1 1 


- 


2 2 4 


1 2 3 


2-2 
1 - 1 


3 4 7 
1 1 


2 2 4 


Total 


4 3 7 


2 3 5 


7 2 9 


11 14 25 


4 3 7 



•Includes "North" and "South". 
'Norwegians, Danes and Swedes. 

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



P.D. 23 37 

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



Psychoses 




Total 




Under 
15 years 


15-19 

years 


20-24 
years 


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 . 

14. Involution melancholia 

15. Dementia praecox 

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 


M. 

3 
18 
36 
24 

2 

4 
34 

9 
9 

5 
44 
8 
1 
4 
2 
7 
11 
4 


F. 

25 

25 

7 

1 

7 
3 

9 

21 

8 

39 

16 

3 

3 

3 

2 

14 

3 


T. 

3 
43 
61 
31 

3 

11 

37 

18 
30 
13 

83 
24 
4 
7 
5 
9 
25 
7 


M. F. T. 


M. F. T. 
1 - 1 


M. F. T. 








1 - 1 






12 3 


1 - 1 








1 2 3 


- - - 


6 5 11 


11 6 17 








- - - 


1 2 3 

2-2 
1 1 2 


1 - 1 
1 1 

1 1 2 
2-2 








Total 


225 


189 


414 


2 2 4 


12 8 20 


16 14 30 



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



Psychoses 


25-29 

years 


30-34 

years 


35-39 

years 


40-44 

years 


45-^9 

years 


1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis . 

5. With cerebral syphilis . 

6. With Huntington's chorea . 

7. With brain tumor . 

8. With other brain or nervous 

diseases .... 

9. Alcoholic 

10. Due to drugs and other exo- 

genous toxins 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive . 

14. Involution melancholia. 

15. Dementia praecox 

16. Paranoia and paranoid con- 

ditions .... 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic personal- 

ality 

20. With mental deficiency . 

21. Undiagnosed psychoses 

22. Without psychosis. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 












- - - 


1 - 1 


1 1 
3-3 
1 - 1 


3 1 4 


1 - 1 
7 3 10 
- 1 1 












1 - 1 


1 1 

5-5 


1 1 

8-8 


1 - 1 

2-2 


1 1 2 

7-7 












1 1 
1 1 

7 4 11 

1 1 2 

1 1 

- 1 1 

1 1 
2-2 
3 2 5 
1 - 1 


1 2 3 

8 7 15 

1 2 3 
1 - 1 
1 - 1 

1 - 1 

1 - 1 

2-2 


2-2 

2 6 8 

1 1 

5 5 10 

1 1 2 

1 - 1 

1 - 1 
1 1 

2 2 4 
1 1 


2 4 6 

1 4 5 
1 1 

2 5 7 

-33 
1 1 

1 - 1 
1 1 2 


2-2 
3 1 4 
1 5 6 
1 4 5 

3 3 6 
1 1 

- 1 1 

1 1 
1 - 1 


Total .... 


15 12 27 


22 12 34 


26 19 45 


13 20 33 


27 21 48 



38 



P.D. 23 



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



Psychoses 


50-54 

years 


55-59 

years 


60-64 

years 


65-69 

years 


70 years 
and over 


1. Traumatic .... 

2. Senile ..... 

3. With cerebral arteriosclerosis 

4. General paralysis . 

5. With cerebral syphilis . 

6. With Huntington's chorea . 

7. With brain tumor 

8. With other brain or nervous 

diseases .... 

9. Alcoholic 

10. Due to drugs and other exo- 

genous toxins 

11. With pellagra. 

1 2 . With other somatic diseases . 

13. Manic-depressive . 

14. Involution melancholia. 

15. Dementia praecox 

16. Paranoia and paranoid con- 

ditions .... 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic person- 

ality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis. 


M. F. T. 

2-2 

4-4 
4 2 6 


M F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


2 5 7 
2-2 


2 3 6 
5 4 9 
3-3 
1 - 1 


6 4 10 

7 2 9 
1 1 


10 18 28 
17 13 30 












1 1 2 

2 1 3 










5 1 6 


2-2 


1 1 2 














1 2 3 
1 3 4 

2-2 
3 2 5 

1 4 5 


1 - 1 

1 1 
1 1 2 

1 - 1 


1 - 1 
1 1 

2-2 


1 1 


- - - 


1 1 
















_ 


_ _ _ 


1 - 1 


_ _ _ 


_ _ _ 


- 2 2 


1 1 2 
1 1 


1 1 


- 2 2 


1 1 








Total .... 


21 17 38 


13 10 23 


17 10 27 


14 11 25 


27 33 60 



P.D. 23 



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P.D. 23 



Table 10. Environment of First Admissions Classified with Reference to Principal 

Psychoses 



Psychoses 




Total 


Urban 


Rural 


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 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 . 

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 .... 


M. 

3 
18 
36 
24 

2 

4 
34 

9 
9 

5 
44 
8 
1 
4 
2 
7 
11 
4 


F. 

25 

25 

7 

1 

7 
3 

9 

21 

8 

39 

16 

3 

3 

3 

2 

14 

3 


T. 

3 
43 
61 
31 

3 

11 

37 

18 

30 

13 

83 

24 

4 

7 

5 

9 

25 

7 


M. F. T. 

3-3 
16 24 30 
35 25 60 
23 7 30 

2 1 3 

4 6 10 
33 3 36 

6 9 15 
9 20 29 

5 8 13 
40 38 78 

8 16 24 

1 3 4 
4 3 7 

2 3 5 

6 2 8 
11 13 24 

4 3 7 


M. F. T. 

2-2 
1 - 1 
1 - 1 

1 1 

3-3 
1 1 

3-3 
1 - 1 


M. F. T. 
1 1 

1 - 1 

1 1 2 
1 1 


Total 


225 


189 


414 


212 184 396 


11 2 13 


2 3 5 



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



Psychoses 



Traumatic .... 

Senile 

With cerebral arteriosclerosis 

General paralysis. 

With cerebral syphilis 

With Huntington's chorea. 

With brain tumor 

With other brain or nervous 
diseases .... 

Alcoholic .... 

Due to drugs and other exo- 
genous toxins . 

With pellagra 

With other somatic diseases 

Manic-depressive 

Involution melancholia 

Dementia praecox 

Paranoia and paranoid con- 
ditions .... 

Epileptic psychoses 

Psychoneuroses and neuroses 

With psychopathic person- 
ality 

With mental deficiency 

Undiagnosed psychoses 

Without psychosis 

Total .... 



F. 



De- 
pendent 



M. F. T. 



1 - 1 
- 1 1 



1 - 1 



Marginal 



M. F. T. 



1 

12 

23 

20 

2 



18 

24 

6 

1 



4 
24 



6 

9 

5 8 
33 34 



21 



1 3 4 

5 2 7 

8 10 18 

3 2 5 



414 8 19 167 166 333 1 1 2 49 21 70 



Com- 
fortable 



M. F. T. 



Unascer- 
tained 



M. F. T. 



10 5 15 
1 2 3 



P.D. 23 



41 



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

Principal Psychoses 



Psychoses 


Total 


Abstinent 


Temperate 


Intemperate 


Unascertained 


1. Traumatic . 

2. Senile .... 

3. With cerebral arterio- 

sclerosis . 

4. General paralysis 

5. With cerebral syphilis 

6. With Huntington's 

chorea 

7. With brain tumor 

8. With other brain or 

nervous diseases . 

9. Alcoholic . 

10. Due to drugs and other 

exogenous toxins . 

11. With pellagra 

12. With other somatic 

diseases . 

13. Manic-depressive 

14. Involution melancholia 

15. Dementia praecox 

16. Paranoia and paranoid 

conditions 

17. Epileptic psychoses . 

18. Psychoneuroses and 

neuroses . 

19. With psychopathic per- 

sonality . 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis 


M. 

3 
18 

36 

24 
2 

4 
34 

9 
9 

8 
44 

8 
1 

4 

2 

7 

11 

4 


F. 

25 

25 
7 
1 

7 
3 

9 
21 

8 
39 

16 
3 

3 

3 

2 

14 

3 


T. 

3 
43 

61 

31 

3 

11 
37 

18 
30 
13 
83 

24 
4 

7 

5 

9 

25 

7 


M. F. T. 

1 - 1 

10 22 32 

9 23 32 
5 5 10 
1 1 2 

3 5 8 

4 7 11 

4 17 21 

5 7 12 
23 31 55 

5 13 18 

- 2 2 

1 3 4 

1 - 1 

6 2 8 
4 7 11 

- 2 2 


M. F. T. 

1 - 1 

6 1 7 

9 1 10 
6-6 

1 - 1 

2-2 

3 3 6 

1 1 

9 2 11 

2-2 

1 1 2 

3-3 

- 2 2 

2 3 5 
1 1 2 


M. F. T. 

1 - 1 
2-2 

6 6 
10 2 12 

1 - 1 

- 2 2 
34 3 37 

3 2 5 

2 1 3 

6 1 7 
1 1 2 

1 - 1 
1 - 1 

4 1 5 
3-3 


M. F. T. 

- 2 2 

12 1 13 
3-3 

6 4 10 

- 2 2 

1 1 

1 3 4 


Total . 


235 


189 


414 


82 148 230 


46 15 61 


75 13 88 


22 13 35 



42 



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P.D. 23 



43 



Table 14. Psychoses of Readmissions 

Psychoses 



Males Females Total 



1. Traumatic psychoses , , . ' — 

2. $enile psychoses - 

3. Psychoses with cerebral arteriosclerosis - 

4. General paralysis 

5. Psychoses with cerebral syphilis 1 

6. Psychoses with Huntington's chorea - 

7. Psychoses with brain tumor - 

8. Psychoses with other brain or nervous diseases - 

9. Alcoholic psychoses ............. 8 

10. Psychoses due to drugs and other exogenous toxins - 

11. Psychoses with pellagra ............— 

12. Psychoses with other somatic diseases 1 

13. Manic-depressive psychoses 3 

14. Involution melancholia 3 

15. Dementia praecox 13 

16. Paranoia and paranoid conditions 5 

17. Epileptic psychoses - 

18. Psychoneuroses and neuroses - 

19. Psychoses with psychopathic personality - 

20. Psychoses with mental deficiency . . . . . . . . . ■ — 

21. Undiagnosed psychoses 3 

22. Without psychosis 

Total 37 



1 


2 


15 


18 


1 


4 


22 ; 


35 


: ! 


5 


2 


2 


3 


6 


1 


1 



Table 15. 



Discharges of Patients Classified with Reference to Principal Psychoses 
and Condition on Discharge 



Psychoses 




Total 




Recovered 


Improved 


Uniniproved 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F, 


T. 


M. 


F. 


T. 


1. Traumatic 


























2. Senile 


5 


4 


9 


- 


- 


— 


4 


2 


6 


1 


! 2 


3 


3. With cerebral arteriosclerosis 


4 


3 


7 


- 


- 


- 


2 


2 


4 


2 


1 


3 


4. General paralysis 


7 


5 


12 


- 


- 


- 


5 


5 


10 


2 


- 


2 


5. With cerebral syphilis 


1 


- 


1 


- 


— 


- 


1 


- 


1 


— 


i - 


— 


6. With Huntington's chorea . 


























7. With brain tumor .... 


























8. With other brain or nervous diseases 


4 


1 


5 


- 


- 


— 


3 


1 


4 


1 


— 


1 


9. Alcoholic 


29 


4 


33 


2 


1 


3 


20 


3 


23 


7 


: - 


7 


10. Due to drugs and other exogenous 


























toxins 


- 


3 


3 


- 


- 


— 


- 


3 


3 


— 


I — 


- 


11. With pellagra 


























12. With other somatic diseases 


— 


4 


4 


- 


- 


- 


— 


3 


3 


— 


1 


1 


13. Manic-depressive 


9 


19 


28 


- 


3 


3 


6 


11 


IV 


3 


5 


8 


14. Involution melancholia 


1 


8 


9 


1 


— 


1 


- 


8 


8 


— 


- 


- 


15. Dementia praecox .... 


48 


39 


87 


1 


2 


3 


27 


31 


58 


20 


6 


26 


16. Paranoia and paranoid conditions 


5 


5 


10 


- 


1 


1 


5 


4 


9 


- 


- 


- 


17. Epileptic psychoses .... 


- 


2 


2 


- 


- 


- 


- 


2 


2 


- 


;■ - 


- 


18. Psychoneuroses and neuroses 


1 


3 


4 


- 


1 


1 


1 


2 


3 


— 


- 


- 


19. With psychopathic personality . 


3 


2 


5 


- 


- 


- 


3 


2 


5 


- 


- 


- 


20. With mental deficiency 


2 


6 


8 


- 


— 


- 


2 


6 


9 


- 


- 


— 


21. Undiagnosed psychoses 


1 


1 


2 














1 


1 


2 


22. Without psychosis 


4 


4 


8 




















Total 


124 


113 


237 


4 


8 


12 


79 


85 


164 


37 


16 


53 



44 



P.D. 23 



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50 P.D.23 

Table 19. Family Care Department 



Male Female Tota 

Remaining in Family Care Oct. 1, 1929 , . 1 10 11 

On visit from Family Care October 1, 1929 . - . - 

Admitted during year" ■-•.--- ; — . t ;-■■-—■; . _- -. --■ —.-.-- 7 7 

Whole number of cases within the year . . '- . . . . . . l [li 10 

Dismissed within the year ....- 3 3 

Returned to institution — : 

Discharged ■ ~ 

On visit . j ....;. — " 

Remaining in Family Care September 30. 1930 ... 

Supported by State . — r — . ■-. -. - 

Private . : 

Self-supporting 

Number of different persons within the year . . . . . . ' . I .10 1/ 

Number of different persons dismissed ■ • - '3 3 

Number of different persons admitted , ■ •?„„ 117c it7< 

Average daily number in Family Care during the year 

Supported by State 



6 6 

1 7 8 

1 1 



6 6 



Private • • • ^ 

Self-supporting • • 



1 1