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Public Document
No. 23
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ANNUAL REPORT
OF THE
TRUSTEES
OF THE
Worcester State Hospital
FOR THE
Year ending November 30, 1930
Department of Mental Diseases
MaiTachufetts
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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
0
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
2Except Cuba and Porto Rico
33
03
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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.
Italian1 .
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". . .
2Norwegians, 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
39
c cd
fe I row |
i i i i i i
I lO I I CN I
-i I I I I ro
I I I I I CN
-< I I I I —
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-H I I I -hOOCNOO I
I CO I I HrtfOON
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"^* CN | | NNiO,*lO(^'H^»HtO!
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m cd
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t-i en w iy ~*
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hI^oI^^^p^^:
CS 0. = -
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40
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
3 d
H
to
H
to
N lO O lO IN
■H9)rt<*10rl
y-( MOOfO»H(
■0>OrO t^M |HH llMtN
I OllOrtH
cn
~* r*3 ^H 00 CN CN
^^OOOvvO^fOfOes-^ro
ro 00 "O -^ ^
» OMfl ■* 00 rt -t IN N -I >t
r^ CJ
H
pa
■5"t4ig
g rt g c « £
.a cj.n*:
to
, E
(S o
I- r/i
-J
•si oj a-c
:- 5
)"o O D. O
«j- B .tJ S .t; .ti .ti .ti
~,a
2 c
C wo ,. oj_2
* o) u c .y "0 o m
£^2 £ o 075-0 >,
s.a.a c ^^ §«
coSoftt»5
G L, -rt k^j -4JTJ +j
^^^•JlOONOOaO^fNfO'tlOONOOaO^M
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
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