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Public Document 'P^ No. 23

iAyiAy

ANNUAL REPORT

TRUSTEES

Worcester State Hospital

Year Ending November 30, 1931

1931

Department of Mental Diseases

Publication of this Document approved by the Commission on Administration and Finance
'500. S-'32. Order 6056.

OCCUPATIONAL PRINTING PLANT

department of mental diseases

GARDNER STATE COLONY
GARDNER. MASS,

<k.

WORCESTER STATE HOSPITAL

BOARD ' OF TRUSTEES
Edward F. Fletcher, Chairmart] Worcester. '
William J. Delahanty, M.D., Worcester.
Anna C. Taxman, Secretary, Worcester.
Howard W. Coweb, Worcester.
John J. Perman, D.M.D., Worcester.
Josephine Rose Dresser, Worcester.
George W. Morse, 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 Physician.
Bardwell H. Flower, M.D., Senior Physician.
Lonnib O. Farrar, M.D., Senior Physician.
James R. Linton, M.D., Senior Physician.
Harry Freeman, M.D., Senior Physician.
Nathan Baratt, M.D., Senior Physician.
Arthur W. Burckel, M.D., Assistant Physician.
Milton H. Erickson, M.D., Assistant Physician.
L. Cody Marsh, M.D., Assistant Physician.
Walter E. Barton, M.D., Assistant Physician.
W. Everett Glass, M.D., Assistant Physician.
William H. Freeman, M.D., Pathologist.
John H. Hall, D.M.D., Dentisi.
David Shakow, M.A., Psychologist.

VISITING STAFF
Ernest L. Hunt, M.D., Surgeon.
Benjamin H. Alton, M.D., Surgeon.
Ca:ileton T. Smith, M.D., Surgeon.
M. M. Jordan, M.D., Neurologist.
RoscoE W. Mysrs, M.D., OpHhalmologist.
Philip H. Cook, M.D., Roentgenologist.
Oliver H. Stansfield, M.D., Internal Medicine.
F. C. Millep, M.D., Internal Medicine.
Lester H. Felton, M.D., Genitro-Urinary Surgery.
Joel M. Mei.icr, M.D., Gynecologist.
Roy G. HosKiNs, M.D., Ph.D., Research.
Arthur Brassau, M.D., Surgeon.
Harold J. Gtbpy, M.D., Ear, Nose and Throat.

HEADS OF DEPARTMENTS
Herbert W. Smith, Steward.
Jfs^'Ie M. D. Hamilton, Treasurer.
W/RREN G. Proctor, Engineer.
Anton Svenson, Foreman Mechanic.
Oakleigh Jauncey, Head Farmer.
Lillian G. Carr, Matron.
Anne McE. Normandin, Superintendent of Nurses and Principal of

Training School.
Maurice Scannell, Supervisor, Male Department.

P.D. 23 ' ;,^ •

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

The Trustees of the Worcester State Hospital respectfully submit the ninety-
ninth 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 again expresses its belief in the policy of the hospital as carried for the
past few years, of supporting and furthering research into the cause and prevention
of mental diseases. It is our opinion that efforts along this line should be extended,
even at the expense of interfering with building programs. The board believes
that a systematic and concentrated effort directed towards information as to the
cause and prevention of mental disorder will lead to more progress twenty-five
years from now than will be the case if other policies prevail. The Child Guidance
Clinic has continued to bring the hospital closer to the community, and it is the
opinion of the board that it is the part of wisdom to give as much community
service as is possible to carry on with our present personnel. We thoroughly be-
lieve that the policy of concentrating on personnel is a proper one, and that money
invested in intelligence and brains will do more towards solving this problem of
mental disorder than any other commodity that can be bought.

The board subscribes to the recommendations made in the report of the super-
intendent. If the building is to be kept in the best of repair these replacements
should be made as soon as possible. They are in the interests of the care of the
patient and efficiency.

The opening of the new barn unit has been a great boom to the hospital. It is to
be hoped that with the new arrangement, an increased production of milk will be
possible with a similar number of cattle.

Regular monthly meetings have been held, and the affairs of the institution have
been carefully discussed.

We wish to express our thanks to members of the community who have supported
the institution so loyally. This is particularly true of the visiting staff. These
men have served without compensation, and have been very loyal and diligent in
their efforts to assist the regular personnel in treating and caring for patients.

Respectfully submitted,
Edward E. Fletcher, William J. Delahanty,

Josephine Rose Dresser, Anna C. Tatman,

Howard W. Coweb, John G. Perman,

George D. Morse, Trustees.

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

I herewith respectfully submit the follov/ing report of the hospital for the year
ending November 30, 1931, it being the ninety-ninth annual report:

There remained on the hospital books October 1, 1930, 2,689 patients, 1,336 men
and 1,353 women. Seven hundred and eighty-six patients, 464 men and 322 women
were admitted during the year. One thousand and four patients, 601 men and 403
women were discharged from the hospital. Of this number 506 patients, 321 men
and 185 women were discharged, 233 patients, 134 men and 99 women died, and
265 patients, 146 men and 119 women were transferred, leaving at the end of the
statistical year 2,471 patients, 1,199 men and 1,272 women.

Staff Changes.
Promotions
Nathan Baratt from Assistant Physician to Senior Physician June 22, 1931.

Appointments
Bardwell H. Flower appointed Senior Physician January 1, 1931.
Milton Harrington appointed Senior Physician March 16, 1931.
Lonnie 0. Farrar appointed Senior Physician July 1, 1931.
L. Cody Marsh appointed Assistant Physician July 1, 1931.
Walter E. Barton appointed Assistant Physician July 6, 1931.
W. Everett Glass appointed Assistant Physician September 7, 1931.

4 P.D. 23

Internes
Ruth E. Quigley appointed January 2, 1931.
R. Stuart Roberson appointed February 8, 1931.
Jacob H. Friedman appointed November 19, 1931.

Resignations
Claude Uhler resigned February 14, 1931.
Valdimir T. Dimitroff resigned May 31, 1931.
R. Stuart Roberson resigned July 27, 1931.
Milton Harrington resigned August 17, 1931.
Auray Fontaine resigned August 19, 1931.
Ruth E. Quigley resigned August 31, 1931.
Alfred J. Normandin resigned September 1, 1931.

Deaths.
Michael J. O'Meare, March 29, 1931.

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

The psychiatric objective of the hospital during the year has been to discharge i
as many patients as can possibly get along in the community. Hospitals for mental
diseases have tended to be somewhat indulgent as to the type of patient allowed to i
remain in the institution, but it has been the policy for several years past to gauge ,
efficiency of the psychiatric service by the number of patients who are discharged
back into the community. Stressing the importance of getting patients out of the
hospital has forced the personnel to think in terms of prognosis and treatment
rather than classification and institutionalization. With this in mind a plan for
psychotherapy has been inaugurated, the essence of which has been to make each
person who comes in contact with the patient aware of his personal responsibility
in the discharge of the patient. Much time has been spent in training and educating
the lay personnel along these lines.

We have continued the appointment system for patients who have been released
on visit. This, in brief, consists in giving to the patient at the final interview with
the member of the staif who has been in charge of the patient, an appointment card.
This card bears a date when the patient is to return to the hospital for an examina-
tion. It is in duplicate. One half is given to the patient, the other half is sent to
the head clerk, where it is set ahead to one week before the time for the ajjpointment.
Three days before the patient is to report, the card is taken from the file, and a
form letter sent to the patient reminding him of the appointment, the letter being
signed by the assistant physician. In case the patient does not report at the time
specified, a second appointment is made, and a form letter signed by the Superin-
tendent is sent giving the new date and reminding the patient of the necessity of
keeping his appointments. In case the patient does not appear for this second
appointment the case is referred to the social service. In this Vv^ay we have tried
to have the physician who has treated the patient while he was in the hospital keep
in touch with him in the community. In addition we have continued the custom
of sending a letter of advice to relatives v/hen a patient leaves the hospital on visit.
These methods of procedure tend to bring the hospital closer to the community,
and they make for a more cooperative spirit on the part of the patients' relatives.
We have also followed the custom of forwarding reports of the progress of the
patient to hospitals and physicians who have referred them to us.

The psychiatric service has been consulted very freely by charitable organizations
and other institutions in the community for opinions concerning cases. We have
endeavored in all these requests to give adequate service, and assist these organi-
zations in meeting their mental hygiene problems. The psychiatric service of this
hospital accepts the responsibility of leadership in community mental health
problems.

The standard practice for the study of each newly admitted case has been elabor-
ated. The following factors are stressed:

P.D. 23 5

(1) — Detailed history; (2) — Physical examination; (3) — Mental examina-
tion; (4) — -Personality study; (5) — Neurological study; (6) — Psychological
examination; (7) — Laboratory findings.

Diagnosis has been made only after this data was evaluated. Cases are frequently
considered, but when cases are atypical and a suitable diagnosis could not be made,
they have in all cases been left unclassified. Classification is essential for statistical
purposes, but statistics are of no more value than the data upon which they are
based. Therefore, guessing at a diagnosis or putting a patient into a classification
simply for statistical purposes is not good procedure in our opinion. Therefore,
we have had a rather large group of unclassified psychosis.

There have been more admissions and readmissions to the hospital than any
former years. We admitted 598 persons during the current year, and 152 re-
admissions. Four hundred and seventy-seven men, and 300 women were placed
on visit or discharged from the hospital during the same period of time. More
patients have been discharged or placed on visit during this period than any other
similar time since the hospital was opened.

Attempts have been made to keep the medical staff psychiatrically active during
the year. Doctor Samuel W. Hartwell, Director of the Child Guidance Clinic has
conducted bi-monthly conferences on cases seen in the clinic. This has been of
considerable value to the individual members of the staff. A series of staff luncheons
has been conducted. At each of these luncheons someone of eminence spoke to
the staff upon a subject which was of interest to them. The list of luncheons and
talks will give some indication of the character of the meetings.

October 3. — "Nephritis". William R. Ohler, M.D.

October 17. — "Changes in cerebrospinal fluid during fever." Frank Fremont-
Smith, M.D.

November 7. — "Hypertension." Soma Weiss, M.D.

November 21. — "Recent developments in neurology." Tracey J. Putnam,
M.D.

December 5. — "Research work on the circulation." Hermann L. Blumgart,
M.D.

December 19. — "Research work in medicine." A. W. Rowe, Ph. D.

January 23. — "Normal and abnormal circulation of the brain." Stanley
Cobb, M.D.

February 6. — "Appendicitis." A. R. Kimpton, M.D.

February 20. — "Progress in psychiatry." Dean A. W. Stearns.

March 6. — "Brajn trauma." Timothy Leary, M.D.

March 20. — "Emotions." Prof. W. B. Cannon.

April 3. — "Environment and heredity." Abraham Myerson, M.D.

April 17. — "Medical education." Dean Alexander Begg.
We have continued to take medical students from Tufts Medical School, each
student spending one month in the hospital. These students are given twelve hours
of demonstration, each hour being devoted to one form of mental disease. Cases
are presented and an attempt made to evaluate the case material in a way that the
knov/ledge may be utilized by the general practitioner. The work of these students
is supervised very closely by the senior assistant physician, and indirectly the
clinical director.

The social service students have continued to come to the hospital for nine
months' field work, from the Smith School of Social Work, and the Department of
Mental Diseases. These students were given a course of lecture covering the
following points: —

Marital difficuljties, parent child relation ships, hazard of growing up, iso-
lated personalities, the guilt feeling, projection (paranoia), symbolism, mental

hygiene for children, factors in adult mental hygiene, religion as a factor in

mental health, psychological factors in mental hygiene.
Affiliate nurses from the following schools had been given three months course
;of instruction in psychiatry and allied subjects: — Framingham Union, Leominster
iHospital, Grace Hospital, Memorial Hospital, Hahnemann Hospital, Somerville
jHospital, Hart Private, Worcester City, Holyoke.

The following is an outline of the course: — Psychiatry, 50 hrs.; social service.

6 P.D. 23

10 hrs; mental nursing, 14 hrs.; psychology, 12 hrs.; hydrotherapy, 20 hrs.;
occupational therapy, 26 hrs.; mental hygiene, 4 hrs.; neurology, 10 hrs.

Occupational therapy students from the Boston School of Occupational Therapy
have spent six months in the hospital for their practical training. The students
have been given a course covering the following subjects: — psychiatry, 50 hrs.:
endocrines in dementia praecox, 1 hr.; symbolism, 1 hr.; mental tests, 1 hr.; hyp-
nosis, 1 hr.; dreams, 1 hr.; how to use a library, 1 hr.; adlerian psychology, 1 hr.;
practical demonstration in hydrotherapy, 2 hrs.; clipical demonstration of neuro-
logical cases, 5 hrs.

The report of the training of theological students is covered in the report made
by the chaplain of the hospital. Our hospital training school has been continued,
and there has been an increased number of applicants. It is our plan to raise the
entrance requirements to a full high school education in 1932. Fifteen nurses were
graduated this year.

We have continued to receive psychological students in the hospital. These
young men and women serve a residence under the head psychologist, Mr. David
Shakow. They participate in staff meetings and conferences and are given practical
experience in psychological procedures. We believe that psychology has much to
contribute to psychiatry and the psychological department has been of great benefit
and assistance during the year.

The report of the Social Service Department is appended, and this department
has continued to render excellent service in the psychiatry being carried on by the
hospital. The large number of patients returned to the community is an indication
of the excellent work that has been done.

Community Work. As in previous years the hospital has been called upon to
furnish speakers for community organizations. We welcome the contacts that
this work gives us, and practically all members of the staff have participated in
this activity. Staff members have continued their affiliations with hospitals and
medical schools, and it has been the policy of the hospital to encourage such
affiliations on the part of staff members.

Group Therapy. A number of interesting activities were inaugurated during
the course of the year under the leadership of Dr. Marsh. A brief summary of
these activities is as follows: —

1. The morning rally. Each morning at 8:30 the patients whose conduct ranges
from good to fair are assembled in the hospital chapel for fifteen minutes. This
might be described as the equivalent of a college chapel. The program begins with
one of the patriotic airs accompa,nied by a pipe organ. The song sheets containing
the songs leading to community singing. There is usually a short inspirational
poem read by the patients themselves. Three minutes summary of the current
events of the morning papers is usually read, and a short five minutes inspirational
talk. The program closes with singing. The entire meeting is for the purpose of
improving the morale of the patients for that particular day. The average atten-
dance has been about 350, and much enthusiasm has been roused. These meetings
are now being broadcast to the wards.

2. Disturbed rally. There have been man^ patients who have been too dis-
turbed to go to the first rally. In order to take care of this group they are brought
to a special rally held at 9 A. M. each day. There is an average attendance of 140.
They sing all of the songs, read the same poem the same as the other group, but
the addresses and current events are usually omitted. Music is particularly valu-
able in controlling this group of patients.

3. Juvenile psychotics. We have had approximately eight to ten children in
the hospital during the entire year. Short school session is held each day under
the supervision of the Occupational Therapy Department. Kindergarten methods
are used in training these children.

4. Relatives. One of the most valuable contributions the hospital is making
to the community is the attempt to instruct relatives in how they may cooperate
with the hospital in dealing with psychotic individuals. All who have worked in
psychiatry realize the importance of the relatives in handling psychotics. It is
impossible to discuss matters adequately with individuals. It is necessary to
quiet their doubts and fears, to handle their emotional problems, and to interpret

P.D. 23 7

to them the mental hospital and psychiatry itself. Classes have been instituted
for relatives every Wednesday night and every other Sunday afternoon. The
Sunday afternoon session is a general inspirational meeting, and is for the purpose
of encouraging all to come to the Wednesday night meeting. The course given
on Wednesday evenings consisted of four talks. The Family, Infancy and Child-
hood, Adolescence, The Normal Adult. In these talks they were given help in
order that they might understand themselves as well as their relatives who are
mentally ill. The project has grown very naturally, and is now beginning to assume
an important proportion. Ward physicians and social service workers urge the
relatives to come, and more recently a number of outside members of the com-
munity have taken advantage of these classes.

5. Attendants. The attendant is in a key position to do a good deal of harm or
a good deal of good. During the year an experiment has been made to give both
day and night attendants a course of lectures in psychiatry. One of these deals
with personality studies in order that the attendant might understand something
about his own personality, and a number of other sessions were held in which cases
were presented. We feel that on the whole the reaction has been excellent.

6. Hospital mechanics. The mechanics who direct the work of patients about
the hospital too often have an attitude of rebelHon that they might be assisted by
such incompetent assistants. They accept no responsibility in teaching and train-
ing the patients, but look upon them simply as laborers who must be driven to the
limit of their capacity. It is our feeling that the mechanics directing patients'
work are in every sense occupational therapists. During the year classes of me-
chanics were held, and lectures given on psychiatry and occupational therapy,
and a free discussion on the various problems that come with the use of patient
labor was brought out. Every employee who comes in contact with the patient
shares in the responsibility of getting that patient well, and it is our belief that the
mechanical department of the hospital cannot be absolved from this responsibility.

7. Reorganization of occupational therapy. One of the great needs of the
psychotic is economic rehabilitation and re-education. Working with weaving,
embroidery, and the usual handicrafts of occupational therapy are all wey enough
as an approach to occupation, but in themselves they are not geared to modern
industrial needs. The main stress of the Occupational Therapy Department is
now on the industrial end of occupation. A complete reorganization has been
effected whereby the occupational therapy group maintains a central clearing
office through which the assignments of patients to occupation are handled upon
orders of physicians. The requests for patient labor are brought to this office.
The selection is approved by the senior physician. Patient is taken to the job and
introduced to the foreman by one of the occupational therapy aides. We feel that
this last step is very important. The patient is made to feel at home with those he
works with, and the one under whose direction he is. His job needs are studied
while he works, and his industrial score raised as time goes on. The department
has ma(^e a job analysis of all hospital positions where patients are employed, and
in addition to this an industrial survey is made of every patient coming into the
hospital. The whole matter is an attempt to meet the needs of the patient rather
than meet the economical needs of the hospital.

8. Community council. There is a public health aspect to mental diseases, and
it should be organized as such and tied up with the hospital. The community is
willing to help in spite of prejudices. In order to carry out some public health
plans the Worcester State Hospital Community Council was organized. A meeting
was held, and at least seventy people attended on invitation. An executive group
of fourteen were chosen as the group through which the hospital could reach the
others. This executive committee includes in its personnel a Catholic priest, a
Rabbi, Protestant clergymen, the President of the Junior League, a leading Jewish
clubwoman and other people representing various cross sections of the community.
They have provided visitors for our sick wards, entertainment, books, magazines,
homes and jobs for patients ready to leave the hospital.

9. Radio. We have continued to utilize the radio for mental hygiene propa-
ganda among patients. The report of the chaplain gives more detail as to the
technique and methods used in carrying on these radio programs.

8 P.D. 23

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

The year has been one of adjustment of a nev/ head worker to the duties of the
department. There have been the same number of students as last year, two from
the State course, and four from Smith who divide their time between the hospital 1 1
and the child guidance clinic. This fall we have been fortunate in having a new
second-grade position granted,. Our assistant psychiatric social worker was pro-
moted to the nev/ position, and a well qualified person from the University of
Chicago School of Social Service Administration has come to be our assistant.
The work of the historian has been incorporated in that of this department.

For those interested in statistics, v/e may say that we have held more than four
thousand interviews, but 20 per cent of them with patients in the community. We
have taken over four hundred histories and made more than six hundred investi-
gations, about two-thirds of which had to do with the placement of patients in the
community, either in their own or in foster homes.

The placement v/ork is assuming an increasingly larger proportion of our time,
as the financial depression makes it more difficult to find work for patients, and as
families whose members are out of employment or working only a few days a week
often cannot bear the burden of another mouth to feed. Under such circumstances
most of the relatives are surprisingly eager to cooperate, as is also the Board of
Public Welfare in cases receiving aid from them. We are not always able to expect
as high a financial standard in the homes to which our patients return as in previous
years.

An interesting development this year from which we are hoping for more in
the future, is that of family care. Originally this arrangement was meant for chronic
patients, well enough to get along in the community, but unable to return to their
own homes. We have placed some patients of this type in boarding homes this
year. We are becoming increasingly convinced, however, that foster home place-
ment can be an excellent means of social therapy for certain acute patients whose
own homes are not suitable, or whose families are lacking in understanding of the
patient, and of the nature of the illness. Unless social treatment in the way of
explanation and interpretation is used to change the attitude of the family during ,
the period the patient spends in the hospital and foster home, the placement will
bring only partial results; since most patients of this type will eventually return
to their homes again. Not only must the patient be made strong to face his home
problems, but the problems themselves must be modified.

A series of lectures given by one of the physicians to relatives and friends of the
patients has been of great value from the point of view of this department. Many
relatives received their first insight into the emotional needs of a patient at these
lectures, and some of them developed a real understanding of the part they them-
selves played in the patient's illness and hence, in his recovery.

One of the last projects of the year has been the plan for the organization of the
State Hospital Community Council. The Social Service Departm.ent has had a
small part of this plan in the way of interviewing ministers and others about it.
It is hoped that the council will become an important resource for the placement
and treatment of our patients in the community.

Library Report
H. M. Bosshard, Librarian.

Both the medical and the general library have grown considerably during the
past year. The medical library has thirty-six more journals, than last year. We
now have nineteen journals of psychiatry and neurology, twenty-three journals
in other fields of medicine and pathology, fourteen in general psychology, psychology
of the total personality and mental hygiene, six for social workers, eighteen journals
for special fields, i. e. for dentistry, occupational therapy. The total number of
journals is seventy-nine, not counting several medical magazines sent free of charge
by medical supply companies.

Seven of these journals are gifts of persons connected with our hospital, one
of Dr. Bryan, two of Dr. Hoskins, three of Dr. Hunt, one of Dr. Erickson. One
journal is a gift of the Memorial Foundation for Neuro-Endocrine Research; one
is sent free by the U. S. Treasury Department, and one by the Mass. Society for

P.D. 23 9

Mental Hygierxe. The Memorial Foundation for Neuro-Endocrine Research has
deposited three journals for our use. Twenty journals are of foreign origin, nine
from England and Canada, five from Germany and Switzerland, three from France,
and three from Italy.

The Medical Library has borrowed ninety-four volumes from other libraries for
doctors' use and persons connected with our Research Department. The librarian
has continued translating and psychotherapeutic work, though he could not do
as much of this work as before, because of the rapidly increased demands of the
libraries.

The general library circulated 5,948 volumes during the past year and had
49,149 reading visitors. The library borrowed four times a hundred and fifty
volumes each and about a dozen individual books from the Worcester Public
Library and circulated them among the employees and parole-patients. The
Library has five small sub-branches. Lincoln 1 has a special room stacked with
about twenty books and a variable number of magazines. Washburn 1, Salisbury
1, the Summer Street Department and Hillside Farm have a small number of books
and a variable number of magazines. The librarian has established a few contacts
with churches of Worcester, and private people, who have sent old books and used
magazines for our sub-libraries, and back-ward patients. We have received more
than three hundred books and more than a thousand magazines.

Report op the Medical and Surgical Services
Clifton T. Perkins, M.D.

The following tables with comments sum up the activities of the medical and
surgical services during the past hospital record year, extending from October 1,
1930 to September 30, 1931, inclusive.

Population

Female

Patients remaining October 1, 1930 123

Admitted 479

Discharged 398

Deaths (Main Hospital) 82

Deaths (Summer Street Dept.) 17

Escapes 0

Births at hospitals 5

Patients remaining September 30, 1931 .... 140

The total of 1,106 patients cared for on these services is approximately the same
as was the case last year.

Discharges Detailed as to Physical Condition: Recovered and improved, 693 ; not
improved, 59; not treated, 43; total, 795.

Physical Diagnosis Detailed: Provisional and final agree, 732; provisional and
final disagree, 35; admitted for study only, 28; total, 795.

The above figures indicate in a rough way the medical and surgical efficiency of
the physicians on this service. The items enumerated refer only to the physical
condition for which the patient was transferred to a medical or surgical ward. The
one figure wbich appears to be very low is the number of patients admitted for
study only, which, during the past year is classified as 28. It would seem that with
the physical set-up of the hospital, this figure could be greatly increased in another
year. The majority of these patients who were admitted for study onlj^ are
patients who during the examination for a yearly note, have been found to be
suffering from some physical illness usually involving the kidneys, and which re-
quired more than a casual routine physical examination and urine examination.

Deaths
Total number of deaths -. . . 233

Male

Total

109

232

395

874

289

687

113

195

232

Number of Medico-legal cases

Total number of autopsies

Autopsies confirmed ante-mortem diagnoses (70 % or more)
Autopsies partially confirmed ante-mortem diagnoses (50-70%)
Autopsies refuted ante-mortem diagnoses (less than 50%)
Attendance at autopsies: — students, 286; staff, 359
Total attendance 645

22
106
62
33
11

10 P.D. 23

It will be noted from the above table that approximately 45 per cent of all
deaths in the hospital came to autopsy. It will be noted that 22 of the deaths in
the hospital were referred to the Medical Examiner who claimed jurisdiction. That
would indicate that these cases either died within a year of some accident or that
the cause of death was of such an obscure nature that the hospital did not care to
take the full responsibility as to the cause. One hundred and six autopsies repre-
senting 45 per cent of all deaths were performed, and as will be noted in the above
table, the attendance at these autopsies averaged approximately 6, either students
or staff members, or both. The innovation started a year ago in checking the
post mortem findings with the ante-mortem diagnoses and rating the physicians
accordingly, has served somewhat as a stimulus in perfecting physical diagnoses.
As will be recalled from the report last year, 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 per cent with the post-mortem findings, is missing a great
deal and is not doing average work.

Causes of Death
As will be noted in Table 1, there were a total of 233 deaths during the past year,
and of these 195 were in the Main Hospital, and 38 at the Summer Street Depart-
ment. The average age of death was 59.6 years. An analysis of deaths reveals
the following information:

(a) One hundred and fifteen deaths, representing 49 percent, were due to changes
coincident with advancing years. The average age at death of this group was 69.4
years.

(b) Twenty-nine deaths, representing 12.8 per cent were due to general paresis.
Thus, we see that this disease in a large mental hospital still is one of the most i
important factors to be considered in computing mortality statistics. In past years
our deaths from general paresis were concentrated particularly in the two months i
extending from the middle of July to the middle of September. In fact, it was i
customary to have more deaths from this disease during those two months than |
during any six month period. However, this last year the deaths from general I
paresis occurred primarily during the months of December, February, and March. '
The average age at death in this group was 47.5 years.

(c) Twenty-three deaths, representing 9.8 per cent, were due to tuberculosis.
All of these cases were pulmonary. The average age at death was 50 years.

(d) Ten deaths, representing, 4.2 per cent, were due to carcinoma. Three of
these involved the lower bowel, one the stomach, two the breast, one the brain,
one the face, one the pancreas, and one the lung. The average age at death in
this group was 59 years.

(e) Eight deaths, representing 3.4 per cent, were due to fractures. Of these
eight, six involved the femur, one the skull, and one the humerus. The average
age at death was 69 years.

(f ) Seven deaths, representing 3 per cent, were due to pneumonia. Of these four
were lobar pneumonia, and three were broncho pneumonia and influenza. On the
whole, this represents a rather low mortality as regards pneumonia. The average
age at death was 36.1 years.

(g) Seven deaths, representing 3 per cent, were due to kidney disease not com-
plicated by the changes of old age, and with a definite history of such disease.
The average age at death was 40.9 years.

(h) Six deaths, representing 2.6 per cent, were due to cerebral hemorrhage which
in past years has been classified with senile changes, but we have chosen this year
to make a separate entity of this item. The average age at death of this group was
62.5 years. Thus, the figures in this case would seem to correspond with those which
have been reported during the past year from other organizations, particularly life
insurance organizations. Since the average age of death of those passing away;
from so called senile changes was close to 70 years, and those who died primarily

P.D. 23 11

because of cerebral hemorrhage was nearer 60 years, it would seem as though the
reports from other organizations were strengthened by this report namely that
the dangerous period for cerebral hemorrhage is between the ages of 55 to 65 years,
and that if one reaches the 65 year mark, such danger is much less.

(i) Three deaths, representing 1.2 per cent, were due to organic heart disease,
not complicated by the changes of old age, and with a definite history of such. The
average age of death of these patients was 49 years.

(j) Two deaths, representing .8 per cent, were from diabetes, with an average
age of 59 years.

(k) Two deaths, representing .8 per cent, were from pernicious anemia, and the
average age of death was 55 years.

(1) The remaining 21 deaths, representing 9.4 per cent, were of various causes,
and no particular significance. The average age of this group was 45.3 years.

It might be added that the information given above is merely relative to pri-
mary causes of death.

Consultation

From the following figures it will be noted that the physicians on the consulting
staff of the hospital have been used to a fair degree. Each consultation enumer-
ated below indicates a single consultation on a single patient. If there has been a
second consultation on the same patient, this has been listed as a second consulta-
tion:— Eye, 139; ear, nose and throat, 6; gynecological and obstetrical, 223;
general surgical, 287; medical, 17; orthopedic, 2; x-ray, 549; others, 5; total
1,228.

There have been a total of 186 surgical procedures carried out on 160 patients
during the past year. The following list includes the procedures: Appendectomies,
23; hemorrhoidectomies, 8; herniorrhaphies, (1 scrotal) (1 ventral) 15; chole-
cystectomies, 31; sub-total hysterectomies, 2; pan-hysterectomies, 3; suprapubic
cystostomies, 2; rib resections, 2; gastrotomies, 2; tonsillectomies, 22; removal
of foreign body from deep tissues, 5; fractures, (10 lower extremities, 6 upper
extremities, 1 clavicle) 17; dilatation and curettage, 5; perineorrhaphies, 7; sal-
pingectomies, 3; oophorectomies, 2; hydrocele, 2; abscess incision and drainage,
12; trachelorrhaphies, 6; amputation, (3 toes, 1 leg, 1 finger) 5; laporotomies, 5;
tracheotomies, 2; colostomies, 5; lysis of abdominal adhesions, 2; circumcision,
2; plastics, 2; resections of colon, 2. One each of the following: Excision of nail;
excision of carbuncle; vasectomy; aspiration of chest; abdominal paracentesis;
dacryo cystectomy; excision carcinoma of face; colporrhaphy; entero-colostomy;
uterine suspension; gastrotomy; external meatotomy; excision of new growth
and repair of urethra; rectopexy; excision chalazion; excision cervical polyp;
excision sebaceous gland; orchidectomy; cauterization urethral caruncle; excision
pilonidal cyst.

This represents somewhat less activity than was the case last year, but at the
same time it is felt that the amount of surgery has been adequate. From the ad-
ministrative standpoint it has been necessary to limit surgery of choice, in as much
as the personnel controlling the surgery also controls the various clinics, to be
enumerated later, and these clinics have increased in volume tremendously. It
might also be noted that under this heading of surgery, we report only those sur-
gical procedures for which the surgical suite was used. This does not include the
many minor procedures such as treatments of back, etc., which have been treated
in the various clinic rooms on the wards, themselves.

Clinics
The following figures enumerate examinations done in the various clinics con-
tained within the surgical suite. An elaboration of this report is not necessary as
the figures seem to speak well for themselves. It might be pointed out that there
is a discrepancy of approximately 500 luetic treatments comparing this report with
the report of the venereal clinic. This discrepancy is due to the fact that the luetic
treatments reported here, include all treatments given, whereas those reported in
the table under venereal clinic merely refer to those treatments given to patients
residing in the hospital: Eye examinations, 799; ear, nose and throat examinations,

Male

Female

Total

1,034

292

1,326

505

433

938

374

454

1,090

2,056

3,146

312

384

696

867

126

993

4,206

3,411

7,617

5,657

4,462

10,119

12 P.D. 23

765; gynecological examinations, 395; luetic treatment, 3,897; small-pox vaccin-
ations, 170; spinal punctures, 493; typhoid and para-typhoid inoculations, 562;
Wassermanns, Kahns, Hintons, 1,337; others, 63.

Dressings
The following table enumerates the report of dressings done on the medical and
surgical wards. On the surgical ward on either side, male and female, there is a
small room set apart for so called out-patient dressings, where any patient residing
on one of the psychiatric wards may come for routine treatment, but where his
condition is not such as to necessitate his continued residence on a medical or
surgical ward.

Abrasions and lacerations

Boils and carbuncles.

Burns ....

Infections .

Ulcerations

Others

Total out-patient dressings

Ward dressings .

Total dressings 9,860 7,873 17,733

This report includes the dressings done on the above patients as well as dressings
on patients who have under-gone surgery in the surgical suite. The item listed as
ward dressings refers to these dressings done on surgical patients.

Occupational Therapy
The following figures enumerate the number of patients receiving occupational
therapy while they were residents of medical wards. It has been our feeling that
one of the most appropriate places for the use of occupational therapy has been in
the rehabilitation of patients recovering from severe surgical, or of the more
common medical ailments.

Male Female Total
Patients receiving O. T. on ward .... 547 479 1,026

Patients receiving O. T. outside ward ... 29 228 257

Total medical patients receiving O. T. . . 576 707 1,283

Employees
The employees clinic which is conducted in the operating room suite has func-
tioned to the mutual advantage of both the hospital and employee: Examined
and treated at clinic, 962; required hospitalization, 198; required operation, 35;
total number of days on sick wards, 1,264.

Laboratory
The laboratory has been of inestimable value to all staff m.embers. A rough
estimate of the scope and extent of the work done in this department may be
obtained from the following figures: — Alveolar carbon dioxide, 211; bacterial
cultures, 97; bacterial smears, 271; basal metabolisms, 1,251; blood cultures, 17;
blood creatinin, 742; blood n.p.n., 772; blood sugar, 1,138; blood urea, 890;
blood uric acid, 988; blood counts (red), 2,504; blood counts (white), 3,572; blood
counts (differential), 3,262; haemoglobin, 2,580; clotting times, 145; galactose
tolerances, 893; icteric index, 26; mosenthal tests, 49; nitrogen partitions, 1,103;
Plasmodia malaria, 40; renal functions (P. S. P.), 759; spinal fluids (cells), 512;
spinal fluids (colloidal gold curves), 511; spinal fluids, (globulins), 521; spinal
fluids (sugar), 289; sputa, 324; stools, 800; tissue sections, 1,704; Urinalysis
(routine), 4,944; Van Den Bergh tests, 16; vital capacity, 661; widals, 1; blood
calcium, 13; Schilling's index, 423; reticulocyte count, 7; total chlorides (urine),
42; total nitrogen (urine), 462; quantity sugar (urine), 36; levulose tolerance, 36;
chest and abdominal fluid exams, 6; animal inoculations, 4; stomach contents, 27;
bleeding time, 5; spinal fluid chlorides, 313; spinal fluid protein, 280; spinal fluid
India ink exams, 25; platelette count, 7; spinal fluid benzidine test, 1; spinal fluid

P.D. 23

colloidal carbons, 29; creatinine (urine), 374; vomitus, 2; diacetic acid (urine),
17; occult blood, 3; creatin (blood), 57; liver function, 25; blood cholesterol, 21;
blood gases, 51; milk analysis, 10; Total, 33,869.

It will be noted that there were approximately 4,000 determinations more this
year than was the case last year. The present figure of nearly 34,000 determinations
during the period of a year, surpasses the amount of work done in this department
in any other year of which we have record.

X-ray Department
The X-ray Department has functioned very efficiently during the last year with
a total of nearly 3,000 plates taken, and 1,666 patients examined. The technical
work in this department is taken care of by a full time technician, who in addition
to his immediate duties, also takes the responsibility of such photographs and
motion pictures as is desired for hospital purposes, such as pictures of pathological
specimens, motion pictures for educational work, etc.

Parts

Examined

Plates

Patienis

Patients

Prints

Abdomen (plain)

Jaw 7

Ankle ....

Knee .

Arm ....

Kidney (plain)

Chest ....

374

411

Leg

Colon ....

Mastoid

Elbow

Nose .

Foot ....

Ribs .

Fluroscopy

378

Shoulder

Gastro-intestinal series

166

742

Sinuses

137

280

Gall bladder (plain) .

Skull .

149

299

Graham test

Spine .

120

Hand ....

Teeth .

130

544

Heart ....

Wrist .

Hip ... .

Others

Total ....

1,666

2,945

Finger prints

Photographs

172

576

Dental Department

The Dental Department has continued to serve in a very efficient manner. This
department is controlled by a full time dentist and a dental hygienist.

Apiectomy, 1; bridges, 0; cleanings, 1,591; examinations (routine), 2,129; ex-
tractions, 1,351: fillings, 1,051; microscopic examinations, 78; plates, 56; re-
pairs, 60; treatments (miscellaneous), 1,079; X-ray diagnoses, 139; Others: —
(1) Antrum punctured, 1; (2) Impactions removed, 13; (3) Crowns, 4; (4) Incision
and drainage, 2; Total examinations and treatments, 7,543; total patients ex-
amined or treated, 3,805; total general anaesthetic cases, 40.

Physical Therapy Department

The Department of Physical Therapy has been active during the past year,
not only in doing the usual type of routine treatment but also in doing special
treatments. The fever treatments which we have been giving for the past year,
replacing malarial therapy in cases of general paresis, has been somewhat hazardous.
In view of this, we have limited somewhat the amount of routine work carried on,
and have devoted a great deal of time and energy towards an attempt to perfect
these fever treatments. The figures below, although not so very large, represent a
good degree of activity.

Ultra-violet (air-cooled), 1,480; ultra-violet (water-cooled), 481; baking, 1,410;
massage, 294; diathermy (medical), 710; diathermy (surgical), 58; galvanism, 93;
muscle re-education, 64; sinusoidal, 59; others, 11; total treatments and tasts,
4,732; new patients during year, 241; total number of patients treated, 3,125.

P.D. 23

Pathological Department
The Pathological Department has undergone a great deal of reorganization
during the past year, and consequently has been at a rather low ebb. We had a
pathologist for only 6 months out of the year. During the year there were 106
autopsies. Many of these were done during the absence of a regular pathologist,
by members of the medical and surgical staff. Tissue sections were done on only
62 surgical specimens, and on 1,047 post mortem specimens. We now have a full
time pathologist again, and should be able to look forward to much better results
in the coming 12 months.

Venereal Clinic.
The following table shows roughly the activity of the venereal clinic during the
past year. It will be noted that there were 5,051 visits to this clinic for either
treatment, advice, or examination. At the end of the record year there were 147
patients with syphilis, in the hospital. Perhaps the most out-standing item in this
report is the fact that 155 patients were examined for possible gonorrhea, but during
the year there was not a single patient diagnosed as having this disease. This
hardly seems possible in a community of over 2,000 people such as is represented
by this hospital. A more careful scrutiny of patients admitted will be made in the
future.

1. Total Cases in hospital January 1, 1931

2. New cases diagnosed during year

3. Old cases readmitted during year

4. Total cases (1 plus 2 plus 3)

5. Total cases closed

(a) Discontinued hospital treatment without permission

(b) No longer require treatment

(d) Released on other clinic or doctor ....

6. Total cases in hospital at end of year (4 less 5)

7. Total number of treatpients

(a) Arsenicals

(b) Others

Total number of laboratory testa

(a) Blood, Wassermann

(b) Blood, Kahn ....

(d) Spinal, Wassermann

(e) Others

Syphilis.

M. F. Total

83
38

125

19
13
91

Pos.

202
335
456
168

Neg.

876
743
622
262
80

130

195

147

3,357

660

2,697

Total.

3,745
1,078
1,078
1,078
431
80

Gonorrhea.

M. F.

Pos.

Neg.

Total

9. Total visits to clinic for treatment, examination, or advice 5,051

(7 plus 8 (a) plus 8 (d) plus 8 (e) for Gonorrhea)

10. Number of social service connections: To Contacts To Delinquent

Visits 42 33

Letters 21 23

11. Total number of patients in hospital last day of year 2,166

Obstetrical Service
We have continued to have a license to operate an obstetrical service consisting
of 8 beds. This has been adequate for our purposes. During the record year 10
children have been delivered on this service. One new born infant died soon after
birth. He was a premature baby and was one of twins. One mother died soon
after giving birth to a child. She was eclamptic and mentaly was a rather de-
structive general paretic.

Pharmacy
The pharmacy has under-gone a rather drastic re-organization during the past
year, primarily in an attempt to eliminate waste, and in a further attempt to
control such items as are purchased for the general medical and surgical care of
patients. During the past year there were 2,414 narcotic prescriptions, 5,814
prescriptions for sedatives, and 11,504 of the so called regular prescriptions, making
a total of 19,732 prescriptions filled by the pharmacist.

P.D. 23 15

Miscellaneous

The medical and surgical service have on the whole been active, and operating
at a fairly efficient level. Many knew changes have been innovated, and we believe
that these changes all lead towards more efficiency.

The amount of record work coincident vdth a patient on one of our medical or
surgical wards is much greater than would be the case of a patient in a general
hospital, where a patient's condition is not complicated by a mental illness, in
addition to a physical illness. We feel that our records are satisfactory and are
not to be ashamed of, but we hope to improve them a little more each year.

The service as a whole with its various accessory departments, we have tried to
run on a basis of optimum efficiency rather than trying to attain maximum figures.

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

The work on schizophrenia has been conducted along the lines described in
previous reports with certain additions and changes which will be commented on.

As a result of preliminary work, certain problems have arisen which obviously
demanded immediate attention and which could not be solved by the technic in
operation during the earlier years of the work.

Up until July, 1931 the research work was primarily directed toward making
endocrine diagnoses and checking the effects of therapy on the patients. The
necessity for quantitative methods for the determination of regression and improve-
ment has been apparent from the start. Because of financial limitations, however,
this aspect of the problem has had to be treated very inadequately. With the
addition of certain funds from the Memorial Foundation for Neuro-Endocrine
Research, which became available in April, it became possible to employ additional
personnel to care for the development of quantitative methods.

A statistical service was organized, and we have been fortunate enough to obtain
the services of Mr. E. Morton Jellinek as chief statistician. Mr. Jellinek brings to
bear on the problem many years' experience in biometrical research and notable
adaptability to the various needs of such a comprehensive research.

A committee was appointed, under the chairmanship of Mr. David Shakow,
chief psychologist, which has evolved a methodology for the purpose of quantitating
psychiatric symptomatology. Mental symptomatology is graded on a five-point
scale, is checked three times during a seven-month period, following which various
types of therapy will be tried and results noted. A great deal of labor on the part
of the committee members has been necessary and the original plan has already had
to be revised to fit working conditions. The probabilities are great that further
revision will be necessary from time to time. Accurate definition of terms has been
necessary and unanimity of opinion on the part of all the psychiatrists has been
arrived at as to the meaning of the psychiatric terminology employed.

Another problem is the determination of types of patients who shall be con-
sidered by the entire staff to be suffering from dementia praecox, and therefore,
be included in the study. We routinely exclude all patients over the age of fifty,
patients having marked language handicaps, patients having any demonstrable
disease as shown by routine methods and which, therefore, might influence physio-
logy, and all patients on whom adequate histories cannot be obtained. We feel
that we are securing an adequate cross-section of dementia praecox in a fairly pure
culture, exclusive of cases with co-exisiting organic disease. We have had to
exclude surprisingly few cases because of co-existing physical disease demonstrable
by the usual clinical and laboratory methods and feel therefore that our selection
of cases is fairly representative of dementia praecox as accepted in the best clinics.
We use dementia praecox and schizophrenia as synonymous terms.

We feel that it is necessary to study patients with schizophrenic episodes as well
as cases which have gone on to so-called "deterioration." We do not like the term
"deterioration" because of the fact that we have seen many of our patients earlier
labelled "deteriorated" who have shown striking improvement. We find that in
many of the so-called "deteriorated" cases, it is impossible to determine a sub-
group falling under the major classifications in use in this country, namely catatonic,
hebephrenic, paranoid, and simple types. We find frequently, also, that many of
the cases demonstrate symptoms of apparently equal importance which would

16 P.D. 23

make a case fall in two sub-types. Commonly we also see a catatonic case regressing
to a hebephrenic level. In such cases, when the catatonic symptomatology is
predominant, the case is labelled "mixed catatonic-hebephrenic, catatonic pre-
dominant." Wherever possible, two diagnoses are recorded; the patient who on
the basis of the history was a "catatonic" early in the psychosis may have gone
on to so-called "deterioration." Such a case would be labelled "early diagnosis^
catatonic; present diagnosis — late indeterminate."

At the present time we are making correlations between psychiatric diagnosis
evolved on t|ie above basis and physiological and psychological data which has
accumulated. It may be possible, by securing data from the psychiatric, physio-
logical, and psychological methodologies simultaneously on the same patients,
to bring order out of the classification chaos which exists in the field of schizoph-
renia at this time. It will be remembered from earlier reports that the more exact
delimitation of the disease was one of the fundamental purposes of the research.

We must know the variations which occur in the psychiatric, physiological, and
psychological pictures without therapeutic variables of any sort being interjected.
For this reason we have had in operation since August 4, 1931, the so-called "seven
months' plan." This plan of approach takes into consideration most of the major
theories as to the etiology of dementia praecox. A standard practice has been
evolved, and the practicality of such a program of cooperative research has been
demonstrated. It lends itself to inclusion of other tests which may be of value.
The possible statistical permutations of such a scheme are obvious and should lead
to the solution of many major and minor problems facing the investigator in the
field. An outline of the seven-month plan is appended. It will be noted that
psychiatric notes are frequent and are so planned as to permit correlations between
the psychiatric and physiological states.

Spatial limitations preclude a detailed report of the projects being carried out
on the research service. A somewhat inadequate idea may be obtained by refer-
ence to the appended "seven-month plan." The psychological aspects are cov-
ered in the report of the chief psychologist, Mr. Shakow.

Seven Month Sch.edule
First Week:

Monday — 9:00 A.M., Psychometrics; 1:00 P.M. Physical and psychiatric.

Tuesday — 1:00 P.M., Physical and psychiatric.

Wednesday — 9:00 A.M. — Psychometrics if necessary; 1:00 P.M., Physical
and psychiatric.

Thursday — 7:30 A.M., Basal metabolism, bl. chem., and phytotoxic index,
9:30 A.M., Breakfast; 1:00 P.M., Psychiatric examination.

Friday— 7:30' A.M., Basal metabolism, 9:30 A.M., breakfast; 1:00 P.M.,
Admitting staff, psychiatrist's note.

Saturday — 7:30 A.M., Basal metabolism; P.M., Mental note.

Second Week:

Sunday — A.M. and P.M. Rest.

Monday — 9:00 A.M., Experimental psychology; 1:00 P.M., Psychiatric wd.
obs.; 3:00 P.M., Photography.

Tuesday — 9:00 A.M., Experimental psychology; 1:00 P.M., Psychiatric wd.
obs.

Wednesday — 9:00 A.M., Experimental psychology if necessary; 1:00 P.M.,
Psychiatric wd. obs.

Thursday— 8:00 A.M., Oculocardiac test; 9:30 A.M., Breakfast; 1:00 P.M.,
Psychiatric wd. obs.; 1:30 P.M., Dental examination and x-ray.

Friday — A.M., Blood vol., plasma vol., hemoglobin, weight pH., surface area,
blood gases, blood morph.; 3:00 P.M., Schneider test. Psychiatric wd. obs.

Saturday — 8:00 A.M., Rest period, Recheck Friday if necessary; P.M. Rest.

Third Week:

Sunday. — 7:00 A. M., Start 24 hour urine collection; P. M. Urine collection.

Monday. — 7:00 A. M., Finish urine collection; 8:30 A. M. inject P.S.P. collect
specimens.

P.D. 23 17

Tuesday. — 7:00 A. M. Start collection of 24 hour urine, 7:30 A. M., Basal
metabolism, V. C, Alv. CO2, B. P., Wt., etc., 9:30, Breakfast; 1:00 P. M., psy-
chiatrist's note.

Wednesday. — 7:00 A.M., Complete 24 hour urine collection; 8:30 A. M., Inject
P. S. P., collect specimens.

Thursday. — 5:00 A. M., Gal. tol. control, 6:30 A. M., Blood chemistry and
phytotoxic index., blood morph.; 7:00 A. M., Gal. tol. test; 1:00 P. M., Psy-
chiatrist's note.

Friday. — 5:00 A. M., Repeat gal. tol. test; 1:00 P. M., Psychiatrist's note.

Saturday. — 5:00 A. M., Repeat gal. tol. test; 1:00 P. M., Psychiatrist's note
if gal. tol. positive or done.

Fourth Week:

Sunday. — A. M. and P. M. rest

Monday. — 8:00 A. M., G. I. series, psychiatrist's note. Physical status;
internist's note; P. M., G. I. series.

Tuesday. — A. M., G. I. series psychiatrist's note.

Wednesday. — G. I. series, 8:30 A. M., blood sedimentation test, bromsulph-
thalein test. Psychiatrist's note.

Th;ursday. — G. I. series. P. M. Psychiatrist's note.

Fifth Week

Sunday. — Rest.

Monday. — 8:00 A.M., Pharmacodynamic studies, adrenalin.

Friday. — 8:00 A. M., Pharmacodynamic studies, ergotamine.

Sixth Week:

Tuesday. — 8:00 A. M., Pharmacodynamic studies, atropin.
Saturday. — 8:00 A. M., Pharmacodynamic studies, physostigmine.

Seventh Week:

Thursday. — Bromide solution three times daily.
Friday. — Bromide solution three times daily.
Saturday. — Bromide solution three times dally.

Eighth Week:

Sunday. — Bromide solution three times daily.

Monday. — Bromide solution three times daily.

Tuesday. — 8:00 A. M., Lumbar puncture, (Brom. perm, test and cerebrospinal
fluid Wassermann.)
Additional Personnel:

The following additions to the personnel have been made during the year:

J. M. Looney, A. B., M. D. Harvard, v/as appointed director of laboratories in
July, 1931. Dr. Looney was instructor in chemistry in the Harvard Medical
School following graduation, was chief of laboratories at the Shepard & Enoch
Pratt Hospital for several years, and was acting professor of physiological chemistry
at Jefferson Medical School prior to accepting his present appointment. He has
completely reorganized the laboratory and it is operating at a high level of efficiency
under his administration. Dr. Looney has published several articles on the bio-
logical chemistry of mental disease, as well as evolving several new methods in
biochemistry.

Hugh T. Carmichael, A M. University of Minnesota, M. D., Queens University,
was appointed psychiatrist September 16, 1931. Dr. Carmichael served as interne,
JRegina General Hospital, Regina, Sask., 1923-24; interne, Grace Hospital, New
j Haven, Connecticut, 1926-27; assistant superintendent. Northern Maine Sani-
(tarium, Fresque Isle, Maine, 1927; fellow in neurology. Mayo Clinic, October 1927
to September 1930; fellow in neuro-psychiatry and instructor in neuropathology,
jAlbany Medical School and associate neuro-psychiatrist, Albany Hospital, 1930-31.

Joseph C. Rheingold, A. M. University of Illinois, M. D., University of Illinois,
I'was appointed psychiatrist July 15, 1931. He has served as interne in the Research
jand Educational Hospital, Chicago, in the Kankakee and Elgin State Hospitals
as well as resident psychiatrist in the Illinois Psychiatric Institute.

18 P.D. 23

Camille Killian, A. B. Hiram, M. S. S. Western Reserve, 1929, was appointep
psychiatric social worker, September 21, 1931. Miss Killian also took a one year
course in hospital psychiatric service at Western Reserve leading to a certificate
as psychiatric social worker.

E. Morton Jellinek, M. Ed. University of Leipzig, was appointed chief statistician
May 1, 1931. Mr. Jellinek has been statistician to the Prime Minister of Hungary,
biometrician for the research departments of the firms of R. Pariser and Elder
Dempster and Co. (West Africa), assistant director of agricultural research. United
Fruit Company (Central America). Various publications in ethnology and
biometry.

Executive conferences are held every Wednesday attended by approximately
twenty members of the organization. At these meetings, department heads
familiarize the entire group with the workings of their respective departments.
This is tending to increase definitely the cooperation between departments.

Diagnostic staff meetings are held every Friday afternoon.

A statistical seminar is held each Wednesday night, which has an attendance of
about twelve members of the research group.

A seminar on dementia praecox is held each Monday afternoon. This seminar
has proved to be exceedingly popular and the average attendance has been forty.
It is planned to continue these seminars for a period of one year.

The relationship between the Foundation and the hospital administration could
not have been better. The research service is an integral part of the hospital.

Dr. Hoskins and Dr. Sleeper had an exhibit at the American Medical Association
Meeting in Philadelphia, June, 1931 on the general subject of dementia praecox.
At the same meeting, Dr. Hoskins gave a paper on "An Analysis of the Schizo-
phrenia Problem from the Standpoint of the Investigator" which was published
in the Journal of the American Medical Association, September 5, 1931, vol. 97,
pages 682-684. A paper on "Dementia Praecox.. a Simplified Formulation" by Dr.
Hoskins appeared in the Journal of the American Medical Association, April 11,
1931, vol. 96, pges 1,209-1,211.

A paper on " Grading of Patients in Mental Hospitals as a Therapeutic Measure "
by Dr. M. H. Erickson and Dr. R. G. Hoskins appeared in the American Journal
of Psychiatry, Vol. 11, No. 1, July, 1931.

Dr. Sleeper attended the meeting of the American Psychiatric Association in
Toronto and reported the meeting to the entire staff.

The Meeting of the American Psychological Association was attended by Mr.
Shakow and Mr. Huston, who reported this meeting to the staff. In September a
paper by Dr. Hoskins and Dr. Sleeper was presented by the former before the
American Chemical Society in Buffalo on "The Endocrine Treatment of Psychoses."

The spirit of cooperation demonstrated by the entire research group is tremen-
dously gratifying, proving as it does that cooperative research with its consequential
increase in productivity and reliability is possible in studying mental disease, if
such a plan is carried out in an institution with a sympathetic administration.

Report of the Psychological Department.
David Shakow, Head PsychologisL

There is little to say about the general state of the department except that it
has functioned quite smoothly. The policy of giving each new member an oppor-
tunity to work with the many groups with v/hich we have contact and the policy
of having each individual responsible for at least one research project has worked
out very well. Even the routine work has not taken on the characteristics usually
associated with it.

During the year little change was made in the physical structure of the labora-
tory. The shop was divided in two to give us a stenographic-clerical room, in
addition to the shop, and one of the rooms previously used for living quarters was
returned for Laboratory use; so that now the quarters consist of eleven rooms.

In addition to the number of groups mentioned in previous reports two new
groups were added during the past year. An arrangement was made with the
Children's FViend Society by which four children a month were to be examined for
them. The probation nurses have been added to the nurse-attendant group which
is examined.

Number

Number of

Individuals

tests given

181

1,049

387

2,905

192

1,441

258

1,341

114

182

256

237

609

1,388

7;,897

P.D. 23 19

In all, 1,388 individuals were examined or re-examined during the year. These
were distributed as follows:

House
Regular patient
Dementia praecox research
G. P. and other

Out Patient Department:
Child guidance clinic
Girls' Welfare Society

Jail

School clinic and other
Employees ....

Totals

The details of the work done at the child guidance clinic will be found in the
report of the director of the clinic. It might, however, be mentioned here that a
considerable part of the time of one of the psychologists has been given over to
corrective work in the fields of speech and reading disabilities. Very fine results
have been obtained in a number of cases and the work seems worth while continuing.

Very marked progress has been made on the research program during the past
year. The work of the department has been so organized that practically all of
the routine work becomes part of some research project. A system has been set
up in such a way that most of the material becomes automatically organized for
analysis. Practically all of the work going on is of a cooperative nature not only
among the present members of the department who take part in most projects
together but also in the continuation of projects started by previous members of
the department.

There are approximately one hundred projects under way in the laboratory,
about one-third to one-half of which are directly related to the dementia praecox
research. The work in progress falls into a number of distinct classifications. A
few examples of each type will be given after its proper heading for purposes of
clarification.
a. Testing Research.

1. Standardization of developed tests.

a. On normals:

(1) — K-S formboard series — A formboard series which was developed by
the head of the department in cooperation with Dr. G. H. Kent, of Danvers State
Hospital. This test is one of the most valuable ones in our schedule, but needs
more standardization on normals. This is at present being done in various parts
of the country as well as in our own laboratory.

(2) — S-K symbol digit — An ideational learning and "perseveration"
test worked out here in cooperation with Dr. Kent. We have already obtained
approximately 500 records on normals and we shall probably get an equal additional
number by using students at Smith, Harvard, and other schools.

b. On psychotics:

(1) — Heilbronner apperception — A very interesting and potentially
profitable test which has never been standardized. This has been modified to fit
our needs. We are collecting norms on this gradually.

(2) — Wells memory test — A memory test which we are re-standardizing
on normals by decades. We are using it on all types of patients in order to establish
more adequate criteria as to the memory function in these groups.

2. Development of new tests.

a. "Guinea pigs" formboard — A new formboard worked out by the writer
which involves a definite principle.

b. Worcester 2C — The most difficult board of the old Worcester series
which has been adopted for use as a psychomotor learning test.

3. Analysis of established tests given on various groups.

a. The analysis of tests given over the last three years to dementia praecox
patients. A wealth of material is at hand which is slowly being analyzed.

20 P.D. 23

b. The analysis of the records of house patients of different types of psychoses
which has been collecting for a long time.

4. Development of new techniques — An attempt is continually being made to
develop techniques which are particularly applicable to the types of individuals
we have here. Practically all of it is pioneer work.

a. 20 versus 30 minute time limit in the Otis — A comparison of the effect of
time on the score obtained in this test.

b. "Perseveration" — Development of tests to study this characteristic
commonly found in psychotics, particularly schizophrenics.

b. Experimental research.

1. Application of established experimental techniques to psychotics.

a. Study of patellar tendon reflex — A study of latent times and refractory
phase particularly in dementia praecox.

b. Galvanic threshold — A study of galvanic sensitivity in dementia praecox.

2. Development of new experimental technique —

a. Luria — A modification of the technique used by luria for getting at
"complexes".

Some of the new projects taken on during the year are the following: —

1. Patellar tendon reflex — mentioned above.

2. Galvanic threshold — mentioned above.

3. "Lewinische" experiments — A study of the total responses of the individual
in situations where "psychic tensions' ' are set up. The techniques worked out by
Lewin of the University of Berlin are being followed by Doctor Riekers of his
laboratory, now a member of our department. A study is being made of the effects
of interruption of activity, substitution of activity, etc. An observation experi-
ment is also being conducted along similar lines.

4. Hypnosis-intelligence — A study of the effects of hypnotic suggestion on the
intelligence level of individuals, in cooperation with Doctor Erickson.

5. Pack room study — An observational study of the behavior of patients in
the pack room, and the effects of music, suggestion, etc., on their behavior.

6. Learning and General Paralysis. — A study of the learning ability of general
paretics on a maze.

The projects mentioned in last year's report are with very few exceptions being
continued this year. Still in the imminent stage in the study of chronaxie. Al-
though the constituent parts of the apparatus are finally at hand, the extreme
"busyness" of the head of the department has prevented the actual assembling and
experimentation. It is hoped that he can get to work on it very shortly.

Since August, most of the time of the department has been given to the Seven
Months' Study of Dementia Praecox. Practically all of the first three days of the
week of all the members of the department is given over to these patients. The
other patients on research, however, are not being neglected. They are being
examined every four months unless there is a reason for examining them within
that period.

Other projects which are of a research and developmental nature may be men-
tioned here. The time of the head of the department for the latter part of the year
has been largely spent in work on the development of a rating scale technique for
mental examinations. The second experimental form is now in use after consider-
able revision of the first form. The project is probably one which will take years
before it is satisfactorily completed but progress is undoubtedly being made. The
attitude of the psychiatrists who have to bear the brunt of the work has been
splendid and whatever progress has been made depends to a great extent on them.

An innovation in the department is the development of a reprint and abstract
system. The method of keeping reprints and abstracts has been entirely revised,
and it is hoped that v^hen it is finally in working order it will be of considerable
service to other departments in the hospital.

The development of testing schedules for various types of cases continues. We
now have schedules arranged for practically all of the major types of problems,
both here and at the clinic. In the process of completion is a rating scale technique
for psychometrics reports very much like that used in the mental status rating

P.D. 23 21

scale. It is for use primarily on dementia praecox research patients and it is
hoped that it will be of considerable aid to the psychiatrists in filling out their
rating forms.

The course in psychology given the nurses has been continued during the past
year. The occasional lectures to occupational therapy students and social service
students have also been very much the same. The head of the department talked
once to the Harvard Psychological Colloquium on the "The Experimental Approach
to Psychopathology" and to the Harvard Psychological Clinic on "Language in
Schizophrenia".

Visits were paid to the Institute of Human Relations and the Psychiatric Institute
of New York. Both visits were very stimulating and resulted in a number of
suggestions which were of considerable help in the development of our research
program.

Three members of the department Mr. Huston and Dr. Rickers, besides the
writer, attended the American Psychological Association meeting at Toronto.
This meeting was exceedingly profitable to all. A report on the papers read was
later made to the Staff.

No papers were published from the department during the year, altho data for
quite a number were being collected. A considerable amount of abstracting was
done for psychological abstracts by Mr. Huston and the writer.
Report of Chapla/n's DeparTxMent
Reverend Carroll Wise

During the past year this department has continued many of its routine activities
and has branched into new ones, always with the aim of making its distinctive
contribution to the patients and to the hospital as a whole. Conducting religious
services is of course, a primary task, and one to which much thought and effort
is given with the purpose of making the services as helpful and therpauetic as
possible. Along with the regular morning services, there is also an evening vesper
service which is broadcast to each ward in the hospital, thus reaching those who are
unable to come to the chapel.

General pastoral work in the hospital is another routine and primary task of the
religious worker. Each new patient is seen shortly after his admission. In this
case the aim is to establish a friendly contact and to minister to the patient as his
needs and desires may require. Regular visits are made on the sick wards of the
hospital, and on the psychiatric wards also. Each patient whose name is placed
on the danger list is seen immediately, in an attempt to bring some peace and
security in his last hours. Flowers are sent to each patient who is operated on.
With these flowers is sent a card bearing the good wishes of the hospital. This
practice often meets with unexpected responses, even on the part of somewhat
deteriorated patients. Along with these activities, more intensive work is carried
on with a selected number of patients with the double purpose of therapy and
learning more about the religious factor involved in mental disorder.

The patients in the hospital enjoy reading local news and this department pub-
lishes a weekly news sheet, called THE HOSPITAL HERALD which is mimeo-
graphed and distributed to the wards. We also edit and publish a monthly paper
THE HOSPITAL MESSENGER which is mailed to relatives of patients and
others who are interested in the problems of the hospital. The aim of this paper
is to acquaint people with some of the hospital problems, to teach them some of the
basic facts of mental disorder, and mental hygiene and to establish a better basis
of understanding and cooperation between the hospital and the community which
we serve.

The department has also cooperated with Dr. Marsh in the organization of the
Community Council (details of which will be found elsewhere in the annual report)
and in the conducting of the morning rallies in the chapel. Among the new activities
in which we have engaged this year is the supervision of the newly installed hospital
radio. A report of this follows.

Radio Department

Every morning at six-thirty, the patients of this hospital hear a "good-morning"
program over our radio. This is the beginning of the day's program from station
WSH, which continues at intervals all day until nine o'clock at night. While

22 P.D. 23

other institutions have radios for the entertainment of the patients, for the past
year the radio at this hospital has been in operation for definite therapeutic
purposes and experiments made so far have indicated real results and tremendous
possibilities in such therapeutic use of it.

The radio system consist of a nine-tube superheterodyne receiving set, with
facilities for amplification and rebroadcasting, a broadcasting studio and phono-
graph attachment of our own and some fifty loudspeakers, scattered throughout
the hospital. The entire set is a double one; that is, two programs can be broad-
cast at once. Programs suitable for certain wards only can be sent to them while
the rest of the hospital receives a different program. All programs are very care-
fully selected, and sent to certain wards for definite purposes.

The work is planned and supervised by a member of the chaplain's department
who is also employed in conducting surveys and experiments to determine just
what results are being obtained. Three patients are used in tending the radio,
and many other patients have the opportunity from time to time of broadcasting
musical programs which they do very creditably.

Some of the radio programs are simply received and broadcast from the Vfor-
cester stations WTAG, and WORC. But the most important programs from the
therapeutic angle originate in our own studio. One constant aim we have had is
to give the patients the feelings that they are not locked up and forgotten that we
are interested in their recovery, and that the situation is not at all so hopeless as
many of them seem to feel. News broadcasts, therapeutic lectures, and so on — all
are planned with a view to the ultimate recovery of as many patients as possible.

The musical programs from outside are very carefully chosen. From time to
time musicians from in or near Worcester have donated their services to WSH,
and have been very welcome. One musical program per week comes from the
employees of the hospital. We have some six hundred phonograph records, which
of course, make it possible to have just the program we want at just the time we
want it. The records are used especially in experimental work. Most important
of all, one or more musical programs each week are given by patients themselves.
These last are the most popular, and many patients send in requests for musical
numbers they would like to hear. And many of these patients' programs compare
very favorably with the progress of any commercial broadcasting station.

Perhaps the most direct therapeutic work done over the radio is in the thera-
peutic talks that are given. Every day we have a fifteen minute news broadcast,
from which all items which might be upsetting are excluded, but which serves
to keep patients in touch with the world. At 6:30 every morning there is a short
"good-morning" program, consisting of a little lively and cheerful music, and a
cheery two-minute talk. The radio day ends with a "good-night" program, of
soothing music and quieting suggestions. New patients are helped by Dr. Bryan's
weekly radio talk to the admission wards, which serves to explain the hospital and
the patient's own situation to him, and to reassure him as to our interest in his
recovery. Other talks, given to the entire hospital, include the following: a weekly
health talk; Dr. Bryan's weekly talk on mental disease, the organization of the
hospital, methods of treatment and other such subjects; Dr. Marsh's weekly talk
on mental hygiene, which is made inspirational as well as informative; talks given
by the social service department, explaining their work; library talks; a weekly
question box conducted by the chaplain; and the Sunday evening radio vesper
service which includes besides the very practical and helpful talk at least half an
hour of good organ music from our own pipe organ. Nurses' programs, occupa-
tional therapy programs, interviews with various members of the staff, and many
other such programs, complete the schedule.

Many patients in mental hospitals have the idea that their case is hopeless
because they think that no one ever gets well enough to be discharged from such a
hospital. Once a week, therefore, we report over the radio the names of those who
have been given parole, and the patients who have been discharged. A brief de-
scription of the patient's trouble and his progress accompanies each note of dis-
missal. Along with each report is a certain amount of direct as well as indirect
suggestion to the effect that what one patient has done another can do also, and
that many more could get well if they would make the effort.

P.D. 23 23

Besides these regular programs, test programs are being carried on from time
to time. Preliminary experiments have indicated that an evening of the right
kind of music may add as much as an hour a night to the sleep of certain patients,
and we are in the process of further experiments to substantiate and elaborate our
results. The psychology department has spent several months conducting an
experiment to determine the effect of soft music on disturbed patients who are
receiving hydrotherapy in the form of "packs". Music is being used to facilitate
the work in the kitchen, the scullery, the cafeterias and so on, and experiments
are being carried on to determine just what its effects are.

While the above account is incomplete, it will give you some idea of the sort of
program that is being carried on. A pioneer project, our radio is still in a more
or less experimental stage, but more and more definite results are being obtained
all the time, and it has already proved to be of definite therapeutic value in many
ways.

Part of the work of this department may be classed as teaching. Working in
cooperation with the council for the clinical training of theological students, a
group of fourteen students from eight different theological seminaries were brought
to this hospital last summer for a three months' period of training. This training
consists in actual experience in the capacity of an attendant, case studies and class-
room work. The aim is to give the student an understanding of the psychological
basis of personality, insight into how a personality may become upset or mal-
adjusted, and a method of approach to human experience which he may carry with
him into his church work. No attempt is made to turn the students into psychia-
trists; on the other hand the purpose is to help the student to become a more
sympathetic and understanding and hence, a more helpful minister.

The summer students also make a contribution to the hospital in return for
what they receive. Each student spends half of each day working on the wards
as an attendant. Along with that work, each student has other duties. Last
summer a Hospital Pictorial, protraying the news of the hospital by pictures, was
published weekly by a student. The Hospital Herald was issued twice weekly.
Organized recreation was conducted daily for locked ward patients. This recrea-
tion consisted in hikes, tennis, swimming and baseball. The work of the women
students with female patients was especially valuable. These students were
assigned to patients who needed special attention by the physician in charge and
under his direction, much effective work was accomplished. During their spare
time a group of the students built a miniature golf course for the patients use. A
student quartette broadcast radio programs twice weekly and were ably assisted
in these programs by "Ralph and Rastus", two students who very effectively
imitated the "Amos and Andy" idea. These student musicians also furnished
music for all the church services, where their work was much appreciated by the
patients. The students assisted in the fourth of July program, and took the initia-
tive in the development and execution of the Labor Day celebration.

Another new activity which may be classed as teaching has been the cooperation
with Dr. Marsh in the conducting of a seminar for local ministers. The aim of
this seminar is to introduce the ministers to the problems which are found in the
hospitals, and to enable them to deal with such problems more intelligently as
ministers. Along with this the chaplain has given lectures in the Boston University
School of Religious Education and at present is giving a course in the Boston
University School of Theology.

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

The annual meeting was held October 28, 1931 at which time the director sum-
marized the year's work in the clinic and explained some of its activities. At the
end of this report are included stenographic notes on the verbal report given at
that time, incorporated as part of this report.

The clinic has functioned throughout the year five and one-half days a week.
During the year there has been added one assistant psychiatrist, and several
psychiatrists have spent in training with the clinic.

During the latter part of the year the social service department has been operating
with one less worker than was planned. This was made necessary by the fact that

24 P.D. 23

the money provided in the budget would have been exhausted had this plan not
been adopted.

During the year a total of 180 cases have been accepted as new cases, and 32
cases have been reopened. There were open, at the end of last year, 141 cases the
treatment of which was carried over into this year making a total of 361 children
served during the clinic year of 1931.

An attempt was made to roughly classify the cases as to the chief and secondary
problems presented by the total number of cases. The following table gives a sum-
mary of the new cases accepted during the year classified in this way:

Primary Problems

Secondary Problems

Educational and mental

. 31%

Environmental

. 48%

Personality ....

. 30%

Personality ....

. 23%

Behavior ....

■ 26%

Behavior ....

■ 17%

Environmental

. 13%

Educational and mental

. 12%

The Worcester Child Guidance Clinic has in the past year continued to function
as a full study and treatment clinic as has been our poHcy in the past. While the
case load is not heavy compared to other clinics, the proportion of cases on which
a large amount of work is done is very high when compared with almost any other
clinic in the country.

While the clinic staff is divided into three departments — psychiatric psycho-
logical and social — the work of these departments interlays in nearly every case.
Where cases are referred to us by other agencies who have social workers, our
social service department functions only in an advisory capacity at the time the
child is seen and at the conference, unless at the conference it is decided that the
clinic should carry the case as a full study and treatment one.

The Psychological Department: This department gives full tests to all new eases.
Frequently, whenever it seems wise and helpful in advising the schools or for other
reasons, they retest old cases regularly or occasionally as is indicated. Some
research work is done in the psychological department. At present work is done in
the psychological department. At present this is taking the direction of dominance
tests to determine right and left handedness, etc. The psychological department
has made a new departure this year in giving limited psychological service to the
Worcester Children's Friend Society. This service is for children who present no
known behavior or personality difficulties but about whom the society wishes to
know the intellectual abilities. These cases are not included, of course, in the
report of the clinical cases.

The Social Service Department: This department has been somewhat handicapped
this year because of the fact that due to budget difficulties one social worker, who
resigned because of an approaching marriage in the summer, was not replaced.
Since the psychiatric department has been well staffed because of student workers,
extra heavy work has been carried by the regular social workers, and the students
in that department. We feel well satisfied with the training we have been able to
give the Smith students during the past year. We feel that a longer period of
training would undoubtedly be better for these students and we are hoping that
this may be arranged next year.

During the year our social workers has 1,369 study interviews and 2,566 treat-
ment interviews. When one realizes that many of these interviews concern several
children, and often the problems of one or both of the parents, one gets some idea
of the importance of this part of the clinic work. The treatment of some of our
cases is almost entirely with the parents. Sometimes a child will be seen only two
or three times but the social worker will, during several months, interview the
mother or father of both every week. If one were to try to even sketch the various
types of problems that our social workers help families of children to meet or the
ways in which we attempt to change unhealthy attitudes in family situations, he
would need an entire evening.

The Psychiatric Department: During the year has been added a regular assistant
psychiatrist. Dr. L. O. Farrar, who, in addition to his work in the clinic to which
he is able to give most of his time, acts as assistant superintendent in charge of the
Summer Street Department of the State Hospital. During the year we have had
several psychiatrists who have spent from two to five months with us. We should

P.D. 23 25

especially mention Dr. Julia Hill of DesMoines who added much to the clinic with
her excellent, faithful and painstaking work as volunteer assistant in training, and
Dr. Eugene L. Swan, who came to us from the National Social Hygiene Society for
two month's period of observation and work in the clinic. We feel that this close
contact between mental hygiene and social hygiene is a very constructive and
useful thing. During the year, 1,060 psychiatric interviews were held with children
and 238 interviews by the psychiatrist with parents. Original interviews with
children are usually one and one-half hours to two hours long, and the later inter-
views about one hour.

Our New Home: At the beginning of this year we had only recently moved into
the house at 21 Catherine Street. It has proved to be an even more delightful
place to work than we anticipated it would. An effort has been made to keep it
with the atmosphere of a home and our friends are kind in saying that we have
succeeded in this. We now use all of the house excepting three back rooms on the
lower floor which are occupied by the caretaker and his family. Three of the
rooms need redecorating badly and we still need some furniture though our friends
have given liberally of furniture and other useful articles during the year.

Agency Cooperation: The clinic is proud of the fact that we are serving so many
different agencies and that we seem to have a very friendly and understanding
relationship with these agencies. We also feel that none of the agencies are failing
to mark constructive use of the advice and help we are able to offer.

The Juvenile Court Situation: During the year a new law was passed requiring
psychiatric and psychological examination of every child committed to a state
institution. This work was divided among the various state hospitals of the state,
and the clinic is assuming the duty of giving this service for the courts assigned
to the Worcester State Hospital. This in no way effects the work we were already
doing with the cases from the Worcester Juvenile Court. These cases are referred
in ample time for full study. Nearly every child who, in the judge's opinion, shows
a personality problem is referred whether commitment is considered or not, and
all cases in which commitment is being considered have been referred to the clinic
for several months before the law was passed. It is different with the outlying
courts where they understood almost nothing of what the clinic is trying to do.
These cases come to us without adequate family history, with no reports of the
personalities of those directly concerned with the child, and in many of these out-
lying communities few or no social agencies are available to carry out constructive
work we might suggest. The result is that we cannot give the type of service to
the children referred to us under the law from outside courts. The clinic is trying
to do educational work along this line, and we hope that by the time of the next
annual report we will be able to say that we feel we are doing something constructive
for these cases.

Our Board: Throughout the year our Board have been most faithful in attending
monthly meetings and most helpful in giving suggestions and in many other more
concrete ways. The staff of the clinic appreciates this cooperation and help most
sincerely.

Report of Laboratory.
Joseph M. Looney M. D. Director

The type of tests carried out in the laboratory vary from the relatively simple
routine qualitative examination of urine to the more compHcated determination
of the oxygen and carbon dioxide content of blood by the manometric Van Slyke
apparatus. Of the tests, approximately one-half are performed for the research
service in dementia praecox, one quarter for research work in the regular house
service, and the rest routine diagnostic procedures for the medical and surgical
services. The laboratory aids in the control of the purity of the milk supply by
frequent bacterial counts of the raw and pasturized milk, and also by examination
of throat cultures taken from the men who handle the milk.

During the past year a great mass of data has been accumulated much of which
has been used as the basis for several papers submitted for publication by members
of the hospital and research staff and part is now in the process of analysis for
further papers, which will undoubtedly be published during the coming year.

Since assuming control of the laboratory in August, the time of the Director has

26 P.D. 23

been occupied chiefl,y in blending together the personnel of the laboratory into a
smoothly and harmoniously functioning organization, training the workers in new
methods of analysis, and in developing new apparatus and methods for further
attack on the problem of dementia praecox.

From his previous experience in the field, the director feels that there is presump-
tive evidence of the presence of a toxic factor in certain psychotic states and that
this toxine belongs in the class of nitrogenous compounds designated as amins.
Evidence to uphold this assumption is being sought by the use of phytotoxic index
of Macht, and in possible variations in the undetermined nitrogen of the blood.
The phytotoxic index may be definited as the ration of the growth of the roots of
lupinus albus seedlings in experimental solutions to that in control solutions. Ex-
periments are being carried out on both blood and urine. The presence of a toxic
nitrogenous compound might be shown indirectly by an increase in the unde-
termined nitrogen fraction of the blood. A method for estimating these amins
directly would be an extremely valuable weapon of investigation. The director
has already spent five years of investigation for such a method without any success,
but will endeavor to tackle the problem again if time permits.

Investigation into the relative degree of oxidation in the tissues is being carried
on through a determination of the gaseous exchange and the total blood volume.

The attack on the problem from the physical chemical aspect is of the utmost
importance. The entire field of colloid chemistry of the cells in health and disease
has been barely touched and there is good reason to believe that much valuable
information can be obtained from such a study. This method of attack will be
inaugurated very shortly along the lines suggested by the work of Bancroft and
Ludlum.

One of the most pressing needs of the laboratory when the director assumed
control was the expansion of the working space to relieve the over-crowded condi-
tion of the main laboratory and the subsequent loss in the efficiency of the staff.
This situation will be remedied by the installation of new work desks in two of the
rooms. One of these rooms has already been equipped for use of the director and
one end of the corridor has been partitioned off for an office. The work of equipping
the second room is progressing and should be completed within a short time.
Additional space has also been made available by the building of a storeroom for
records in the basement. With the completion of this work and the renovation of
the remaining space, the hospital authorities will have a laboratory of which they
may well be proud.

A study of the distribution of protids in the blood of dementia praecox cases is
desirable in order to coordinate the findings with those obtained from the physical
chemical determinations. The present methods used for obtaining this information
are very cumbersome and time consuming. The director has in mind a new method
of attack on this problem which he feels will simplify the determinations so that
they can be added to the present program.

The work now being carried on by the laboratory staff is very close to the limit
of the capacity of the workers. Some increase in efficiency will undoubtedly be
obtained with the installation of the new laboratory equipment, but it would be
unwise to add much to the present duties of the staff, for in case of illness of one
of the principle members, the burden might be so great on the remaining members
as to cause a disruption of the entire study.

The addition to the staff of a well-trained chemist who has made a specialty of
physical chemistry and has demonstrated his ability as an investigator should
receive serious consideration.

The working space will be ample for the present staff on the completion of the
changes already initiated but certain pieces of equipment are urgently needed.

The director would be remiss if he did not add a word of praise for the excellent
spirit of cooperation manifested by the members of his staff.

General Repair Work

The general repairs of the hospital have been kept up throughout the year.

The painting program has been carried on and every ward in the hospital has been

painted within the past two years. Radio installation was opened during the year

and later reports will give a more complete discussion of the way in which this

P.D. 23 27

installation is being utilized for therapeutic purposes. A new porch was completed
on the Woodward wards and is of great benefit to the patients. The new cowbarn
for which an appropriation was made two years ago was completed during the
year and forty-five cattle are now housed in this new unit. The barn is strictly
modern in every way, and has a number of features which are distinctly out of the
ordinary. The average bacteria count for milk in pasteurization is approximately
three thousand. Weekly counts are made, and the bacterial content are checked
constantly.

The following recommendations cover changes that are imperative in keeping
up the buildings and grounds: — (1) New dining room arrangements at Summer
Street. The present dining room arrangement at Summer Street is very inadequate
and wasteful. At an early date an architect should study this situation with the
view of establishing a central dining room of the cafeteria type, and eliminating
the two dining rooms which are now being used. These dining rooms could be
converted into wards for patients, and increase the capacity of the institution by
at least one hundred beds.

(2) The program of replacing the present porches should be continued as rapidly
as funds permit. The new Woodward porch is a substantial brick structure which
will stand for many years, and was built at a very small cost by our own labor.
The Quinby porches are unsafe, and we cannot permit patients to use them. There
are many patients on closed wards of the hospital whose only chance of getting
out of doors is in this way and one or two porches should be completed each year,
and new ones added. The Thayers and Folsoms are in very bad condition, and at
as early date as possible these porches should be rebuilt and made larger.

(3) The present salvage yard which was built out of lumber cut on the premises
has served its purpose admirably, but has now become too large for our needs. It
has also been in a very dilapidated condition due to the fact that part of it was
destroyed by fire some time ago. The space which it now occupies could be used
for the storage of coal. A new salvage yard should be established utilising cement
block structures and a wire fence. The present farm house must be renovated very
soon. The wooden porches are in a dilapidated condition, and the cost of repairing
them is prohibitive. The new porches of brick and cement should replace the
present wooden structures, and the new porches should be carried to the second floor
of the building. In addition to this, the farm house which houses only thirty-five
patients could be utilized for married couples. Our housing facilities for this
group are very limited. The thirty-five patients could be very well housed in the
main hospital, and this farm house converted into a dormitory for married couples
and physicians. New main roads on the hospital grounds are imperative at an
early date. It is to be hoped that sufficient money will be available for the cement
road at least on the main avenue entrance. A program of securing expert advice
in attention to the trees on the hospital grounds is indicated. The ice storm a number
of years ago did considerable damage to the trees on the hospital grounds, and it
would seem that some expert assistance would be of value in preserving the wonder-
ful trees that are scattered over the entire hospital premises.

My sincere thanks are due to the officers and employees of the hospital for their
splendid loyalty and cooperation during the year. They have continued to give
excellent service and without this cooperation, no progress could have been made.
To the members of the Board of Trustees, I am deeply grateful for their constant
encouragement and support.

Respectfully submitted

WILLIAM A. BRYAN

Superintendent.

VALUATION

November 30, 1931
Real Estate

Land, 589.16 acres $467,130.00

Buildings 2,143.727.23

$2,610,857.23

28' P.D. 23

Personal Property

Travel, transportation and office expenses $6,583.63

Food 27,227.45

Clothing and materials 27,702.96

Furnishings and household supplies 277,986.99

Medical and general care 31,638.77

Heat, light and power - . . 6,254.78

Farm 54,198.94

Garage, stable and ground 10,478.54

Repairs _ 19,533.11

$461,605.17

Summary

Real estate ^ $2,610,857.23

Personal property ' 461,605.17

$3,072,462.40

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, 1931.

Cash Account

Receipts
Income

Board of Patients $94,055.30

Personal Services:

Reimbursement from Board of Retirement 310.97

Food $2,015.25

Clothing and materials 18.25

Furnishings and household supplies 42 . 50

Medical and general care 181.67

Heai, light and power 36.50

Farm:

Cows and calves 354.16

Pigs and hogs 80.00

Hides 32.36

Vegetables 56.12

Garage, stable and grounds .90

Repairs, ordinary 258.25

Total sales $3,075.96

Miscellaneous:

Interest on bank balances $1,162.67

Rent 948.50

2.111.17

Land ' 1 . 00

Total Income $99,554.40

Maintenance.

Balance from previous year, brought forward $20,459.15

Appropriations, current year:

Maintenance 830,620.00

Total $851,079.15

Expenses (as analyzed below) 803,114.60

Balance reverting to Treasury of Commonwealth $47,964.55

Analysis of Expenses

Personal services 439,274.95

Religious instruction 2,440.00

Travel, transportation and office expenses 10,460.11

Food 134,303.96

Clothing and materials 15,280.44

Furnishings and household supplies 33,976.28

Medical and general care 44,090.91

Heat. light and power 62,835.05

Farm 28,308.10

Repairs ordinary 17,815.28

Repairs and renewals 9,189.78

Total expenses for MSiint^nance $803,114.60

Special Appropriations

Balance December 1, 1930 $23,648.78

Appropriations for current 42,000.00

Total $65,648.78

Expended during the year (see statement below) $55,706.11

Reverting to Treasury of Commonwealth 51.37

■ 53,757.48

Balance November 30, 1931, carried to next year $11,891.30

P.D. 23

Expended

Total

Balance

Object

Act or Resolve

Whole

during

Expended

at End

Amount

Fiscal Year

to Date

of Year

Cow and Hay Barns .

Chap. 146, Acts 1929

S30,000.00

$1,344.83

$29,948.63

.$51.37*

Officers' Cottages 1929

Chap. 146, Acts 1929

12,0000.00

Chap. 1, Acts 1931

7,000.00

16,400.89

17,594.06

1,405.94

Improvements, Keat-

ing System

Chap. 115, Acts 1930

10,000.00

1,570.85

9,982.50

17.50

New Boilers

Chap. 115, Acts 1930

13,500.00

8,043 54

11,686.14

1,813.86

Equipment Dairy and

Cow Barns

Chap. 14, Acts 1931

20,000.00

19,924.68

75.32

Renovating Heating .

Chap. 245, Acts 1931

12,000.00

6,064.37

5,935.63

Furnishings 0.=ticers'

Cottages .

Chap. 245

3,000.00

356.95

2,643.05

3107,500.00

v<$53,706.11

$95,557.33

$11,942.67

Balance reverting to T

reasury of the Commom

wealth during year (mark item with *)

$51.37

11,891.30

Total as above .

$11,942.67

Per Capita
During the year the average number of inmates has been 2,197.06.
Total cost of maintenance, $803,114.60.
Equal to a weekly per capita cost of $7,029.
Receipt from sales, $3,075.96.
Equal to a weekly per capita of $.027.
All other institution receipts, $96,478.44.
E.iual to a weekly per capita of $.844.
Net weekly per capita $6,158.

Respectfully submitted

Jr]SSIE M. D. HAMILTON

STATEMENT OF FUNDS

Patients' Fund

Balance on hand November 30, 1930

Receipts

Interest

Expended

Interest paid to State Treasurer

Worcester County Institution for Savings
Worcester Five Cents Savings Bank
Worcester Mechanics Savings Bank

Peoples Savings Bank

Bay State Savings Bank

Balance Worcester Bank and Trust Company
Cash on hand December 1, 1931

Invesl'incnts

Balance on hand November 30, 1930
Income

Lewis Fund

Expended

Treasurer.

819,830.60
33,110.46

677.80

$36,386.58
677.80

$2,000.00
2,000.00
2,000.00
3,000.00
3,000.00
4,181 .51
372.97

$1,677.95
64.02

$53,618.86

$37,064.38
$16,554.48

$16,554.48

$1,741.97
$407.67

$1,334.30

Worcester Five Cents Savings Bank

Balance Worcester Bank and Trust Company

Balance on hand November 30, 1930
Income

Expended

Wheeler Fund

Worcester Mechanics Savings Bank

Balance Worcester Bank and Trust Company

$1,300.00
34.30

$6,218.32
109.95

$1,000.00

78.32

1,334 30

$6,328.28
5,249.96

$1,078.32

Balance on hand November 30, 1930
Income

Manson Fund

Expended

$1,184.99
33.66

$1,218.65
123.03

$1,095.62

Investments

Millbury Savings Bank $1,000.00

Balance Worcester Bank and Trust Company 95 . 62

Balance on hand November 30, 1930
Income

Clement Fund

$1,000.00
47 . 50

Expended

Worcester County Institution for Savings

Investment

P.D. 23

$1,095.62

$1,047.50
47.50

$1,000.00
$1,000.00

Novembor 30 1931.

Respectfully submitted

JESSIE M. D. HAMILTON

Treasurer.

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, 1931

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 . $2,610,857.23

Personal property 461,605.17

Total $3,072,462.40

Total acreage of hospital property owned: 589.16
Additional acreage rented: 400

Total acreage under cultivation during previous year: 175.
Officers and Employees:

Superintendents
Assistant physicians.
Clinical assistants

Actually

in Service at End
of Year

F. T.
1
11
1

Vacancies at End

of Year

M. F. T.

11
1

1 1
1

13
1
1
1

38 39

129 236

5 9

4 4

75 172

1 2

107

1 1

2 13

225

251 476

4 16

Total physicians ....

Stewards

Resident dentists ....

Pharmacists

Graduate nurses ....
Other nurses and attendants .
Occupational therapists ,

Social workers

All other officers and employees .

Total officers and employees
Note: — The following items, 5-10 inclusive, are for the year ended September 30, 1931
5. Census of Patient Population at end of year:

Absent from Hospital
Actually in Hospital but Still on Books.

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

White:
Insane 1,007 1,112 2,119 159 135 294

Alcoholics
AH other cases

Total
Other Races:
Insane

Total

1,014
19
19

Grand Total 1,033

1,113
20
20

1,133

2,127

39
2,166

Males
78

160

166

Females

461

137

139

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

cluding physical training, on date of report ....

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

report 686

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

year 1,047.35

9. Voluntary patients admitted during year 6

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

year 110

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, 1931.

297

305
Total
175
1,147

1,131.71
5

2,179.06
11

170

P.D. 23

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32 P.D. 23

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

Patients

Parents of Male
Patients

Parents of Female
Patients

Nativity

Both

Fathers Mothers Parents

United States

158

112

270

66 68 59

59 58 48

Austria .

1 2 1

- - -

Canada i

42 40 34

31 37 27

China

_ _ _

1 1 1

Denmark

_ _ _

- - —

England .

7 9 6

9 5 4

Finland .

3 3 3

4 4 4

France .

3 1 1

Germany

5 2 2

6 3 3

Greece .

1 1 1

Ireland .

52 54 48

34 34 30

Italy

10 10 10

4 5 4

Norway .

1 1 1

Philippine Islands

_ _ _

Poland .

10 12 10

7 8 7

Porto Rico

- - —

Portugal

3 3 3

2 2 2

Russia

9 7 7

5 5 5

Scotland

1 1

3 3 3

Sweden .

13 13 13

8 8 7

Turkey in Europe

1 1 1

- - —

West Indies 2

1 1 1

- - —

Other countries

10 10 10

8 10 8

Unascertained

17 15 14

5 5 4

Total

254

191

445

254 254 224

191 191 159

^Includes Newfoundland.

^Except Cuba and Porto Rico.

UTS

1 1 1 r^ 1 1 1 1 1 ! 1 1 1 1

9r. ^

s.s

1 1 1 1 1 1 1 1 1 1 1 1 1 1

n ca

'P*'

1 1 1 f-) 1 1 1 1 1 1 1 1 1 1

'J)

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1 lt^ooio<Kco — Ti<(vi — r ^1

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ca >

i l-tr^r-Ost-roOM/i-^Oool

« C/l

0 "

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H Q

i 1 ro U-; 00 Cv — ' 30 i/^ t^ t^ r^ f^ 1

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% 0

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1 1 1 -f 1 1 1 1 1 1 1 1 1 1

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1 1 1 •H 1 1 1 1 1 1 1 1 1 1

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P.D. 23

Table 5. — Citizenship of First Admissions.

Citizens by birth .

Citizens by naturalization

Aliens

Citizenship unascertained

Total 254

158

112

270

Table 6. — Psychoses of First Admissions.

Psychoses

F. T.

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

........

- 2

1
18

55
25

2
34

5
44
9
2
2

7
23

44
12

1
4

5
9

1
46
86
30

other diseases .... . . .

9. Alcoholic psychoses, total .......

Korsakow's psychosis .

1
32

3 35

Acute hallucinosis

Other types, acute or chronic

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

, alone o

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

Other exogenous toxins

11. Psychoses with pellagra ....

12. Psychoses with other somatic diseases total

Exhaustion delirium

' 6
9
4

1
1

1 1

- 3
6 10

"s' ii'

12 21
6 10

"4 "4'

- 1
1

Cardio-renal diseases ....

Other diseases or conditions
13. Manic-depressive psychoses, total .

(a) Manic type

(b) Deoressive type ....

14. In7jVu.ti»n melancholia ....

15. Dementia praecox (schizophrenia) .

16. Paranoia or paranoid conditions

17. Epileptic psychoses

18. Psychoneuroses and neuroses, total

Hysterical type

Psychasthenic type (anxiety and obsessive
Other types

19. Psychoses with psychopathic personlaity

forms) .

20. Psychoses with mental deficiency .

21. Undiagnosed psychoses ....

22. Without psychoses, others

Total

254

191

445

P.D. 23 35

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

Race

African (black)

Armenian

Chinese .

English .

Finnish .

French .

German .

Greek

Hebrew .

Irish

Italian i .

Lithuanian

Portuguese

Scandinavian

Scotch .

Slavonic '

Spanish .

Syrian

Ocher specific races

Mixed

Race unascertained

Total

12
3

30
3
1
3

10
8
3

14
2

14
1
2
1

79
9

3
1

8
4

23
5
1
3

32
5
3
2
S
7
6

254 191 445

20
7

S3
8
2
6

11
5

22
9

152

M. F. T.

Senile

M. F.

1 3

- 2

7 12 19
1 2 3

1 18 28 46 55 31 86

With cerebral
arterio-
sclerosis

M. F. T.

1
11 6
2 -

20 11
1 1

General
paralysis

M. F. T.
1 - 1

1 2
1

2 5
1
1

25 5 30

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

Race

African (black)

Armenian

Chinese

English

Finnish

French

German

Greek

Hebrew

Irish

Italian '

Lithuanian

Portuguese

Scandinavian

Scotch

Slavonic '

Spanish .

Syrian

Other specific races

Mixed

Race unascertained

Total

With cerebral
syphilis

M. F. T.

- 3

With other
brain or
nervous
diseases

M. F. T.

1 1

Alcoholic

M. F. T.

Due to drugs

and other

exogenous

toxins

With

other

somatic

diseases

M. F. T.

1 - 1

- 1 1

1 - 1

1 1

2-2

3 5

7 7 14

'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

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

African (black)

Armenian

Chinese . .

English .

Finnish .

French .

German .

Greek

Hebrew .

Irish

Italian ' .

Lithuanian

Portuguese

Scandinavian

Scotch

Slavonic ^

Spanish .

Syrian

Other specific races

Mixed

Race unascertained

Total

Manic-
depressiv!

M. F. T.

7 7 14
1 1

Involution
melancholia

M. F. T.

Dementia
praecox

1 - 1

10 18 28

1 - 1

Paranoia

and
paranoid
conditions

M. F. T.

- 2
1 3
1 1

Epileptic
psychoses

M. F. T.

2 1 3

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
psj'choses

Without
psychoses

M. F. T.

Armenian
Chinese .
English .
Finnish .
French .
German .
Greek
Hebrew .
Irish

ItaUan ' .
Lithuanian
Portuguese
Scandinavian
Scotch .
Slavonic '
Spanish .
Syrian

Other specific
Mixed .
Race unascert

race
aine

s
d

1 1

1 - 1

- - -

1 1

- - -

1 - 1

- - -

3 3 6

- 2 2

- - -

1 1
1 - 1

1 - 1

3 2 5

1 - 1

- - -

1 - 1

- - -

1 1
1 - 1

4 3 7
1 1

1 - 1

4 6 10
1 - 1

2 3 5

2-2

Total

2 4 6

7 5 12

12 9 21

7 7 14

3-3

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

2 Includes Bohemian, Bosnian, Broatian, Dalmatian, Her^egovinian, Montenegrin, Moravian, Polish,
Russian, Rutheifian, Servian, Slovak, Slovenian.

P.D. 23 37

Table 8. — Age of First Admissions Classifi-ed with Reference to Principal Psychoses.

Traumatic

Senile

With cerebral arteriosclerosis
General paralysis ....
With cerebral syphilis .
With Huntingtoii's cnorea .
With braia tumor ....
With other brain or nervous diseases

Alcoholic

Due to drugs and other exogenous toxins
With pellagra ....

With other somatic diseases
Manic-depressive ....
Involution melancholia.
Dementia praecox
Paranoia or paranoid conditions .
Epileptic psychoses
Psychoneuroses and neuroses
With psychopathic personality .
With mental deficiency.
Undiagnosed psychoses
Without psychosis.

Total

Under

15 years

M. F. T.

1 - 1

-22

15-19

years

4 6 10
1 - 1

20-24
years

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

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 or paranoid con

ditions

17. Epileptic psychoses
l.S. Psychoneuroses and neuroses

19. With psychopathic person-

ality

20. With mental deficiency

21. Undiagnosed psychoses

22. Without psychosis

Total ....

25-29
years

M. F.

1
1 1

30-34
years

M. F. T.

19 10 29 22 17 39

35-39

years

M. F. T.

1 1

- 4

40-44

years

45-49
years

M. F. T.

2 1 3
1 1 2

22 11 33

38 P.D. 23

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

Psychoses

50-54
years

55-59
years

50-64

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 larain 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 praeco.x

16. Paranoia or paranoid condi-

tions

17. Epileptic psychoses

18. Psychoneurose and neuroses
19 With psychopathic person-
ality

20. With mental deficiency

21. Undiagnosed psychoses

22. Without psychosis

M. F. T.

3 7 10
10 7 17

15 21 36

30 16 46

1 - 1

2 3 5
2-2

9 2 11
1 - 1

4 3 7

3-3

1 1

1 - 1
1 - 1

6-6

3-3

1 1 2

1 - 1

1 1 2
.5 5 8

1 - 1

2 4 6

1 - 1

1 1 2
1 - 1
1 1 2

- 1 1

1 - 1
1 - 1

1 1 2

- - -

1 3 4

- 1 1

_ _ _

1 - 1

1 1

2 1 3

1 - 1
1 - 1

1 1

1 1 2

Total ....

14 14 28

22 6 28

IS 7 22

15 18 33

48 38 86

Q::

IvOCOvOI I 1 |f-l 1 |i^|iO-<l 1 Icsrol

iTft-lllllllllMirO—llll— 1

C rt

IOJ~<^OI 1 1 ir-l 1 l^lrMI 1 1 |(Mrs|

1 1 — 1 1 1 1 1 1 1 1 1 f^-iO 1 -rt 1 -. 1 1 1

1 1 1 1 1 1 1 1 1 1 1 1 1 —M 1 — 1 1 1 1 1

'I'

II— lllllllll-^l^lll—lll

iCOOOlOCMl 1 ICS-<|-*Pr)— •OOtMlTj'— irol

r-i

tH W-*

r-.

•^'9.

|r<^vO!Nr-Jl 1 1 1 1 |~5ool— i-H|rOi ItMl

>-w

ll/^r^r^l 1 1 |(N-<l-.l/-, — t^— I-.-.I-.1

— r-l — O-H 1 1 ^. f 1 1 t^O>— iro-*-.r^)0<MI^<N

cs -t — 1 ■— rvj — lo ^M -^ —

go
E o

If^rv^ro^l l-^I 1 1-^Or^OOOl— lO'Ofrjl

— . -H — (M

— lOO^f^l 1 I'^lt^ i|r00-*t^\0— 1— iiot^'iCiN

■i-

les^— 1 1 i 1^1 1 1— |(^(N| 1 1— 1— .

t-^

C-

ea m

m "^

1 c~] w 1 1 1 1 1 1 1 1 1 -H 1 1 — 1 1 1 1 1 1

1 1—— 1 1 1 lTt<l 1 1 1 |ro-.| 1 Iwirt

Ir-OcMl 1 1 1(^1 Irorolf^tN— 1 I'O— 1

{"OvOI 1 1 1 |rr>l 1 ItSlr^— 1| 1 ItC— i|

1— OrJl 1 1 |-*l IrOI 1— -^—1 Itsl 1

(>q

— NO^Orf) 1 1 (^t--r^ 1 •^ojrooO-Hr'iNOeN — Tt^ro

1/5

■^OO'O !~0 — 1T)<-HCX>IM — <(N— 1

■*
■*

"rt

100— ilOf^l 1— tOl It^rDOO'ftN— i-*LOCM^I

„4

tN ^0 (N ^ -<

WOOIOIOI 1 ICNTftNlt^OMO-^CitMfNt^r^t^fO

— 1/; !N tr, — •* «

t/i

m O

u
>•

. . ■- c .2 . ^

m "o ' oj ' ' ■ ■ ■ 5 r? ' ■ ■

8 ^ = 2 £ "n m'3

• -fc • -S -g -S -S • • ■§ ■£§•■•

.2 n:" r t5 ■a-Q-o-'^c.sS
E„u£uffix)oooaoi;Sgg^oaag>g

— fsro^io>dr~^o6a^'o — (Nt<^-*ioOl^odOvo' — r-j

rt — »-•— i-H-H— i^w-HC-jMr^

40 P.D. 23

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

Psychoses.

1. Traumatic

2. Senile

3. With cerebral arteriosclerosis

4. Genera! 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 or paranoid conditions .

17. Epileptic psychoses

18. Psychoneuroses and neuroses

19. With psychopathic personality

20. With mental deficiency ....

21. Undiagnosed psychoses ....

22. Without psychosis

Total

1
46
86
30

Urban

15 27 42

S4 31 85

25 5 30

- 3 3

2 1

34 3
2

254 191 445 244 185 429 10 6 16

Rural

M. F. T.

- 1

1 1

2 4

Ta,ble 11. — Economic Condition of First Admissions Classified idth Reference
to Principal Psychoses.

Psychoses

Total

De-
pendent

Marginal

Com-
fortable

Unascer-
tained

1. Traumatic

2. Seqile ....

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 nerv-

ous diseases

9. Alcoholic ....

10. Due to drugs and other

exogenous toxins.

11. With pellagra .

12. With other somatic dis-

eases ....

13. Manic-depressive .

14. Involution melancholia .

15. Dementia praecox .

16. Paranoia and paranoid

conditions

17. Epileptic psychoses

18. Psychoneuroses and neu-

roses ....

19. With psychopathic per-

sonality

20. With mental deficiency .

21. Undiagnosed psychoses .

22. Without psychosis .

1
18

55
25

2
34

7
19

5
44

9
2

7
12

7
3

5
3

1
3

7
23

8
44

5
9

1
46

14
42
13

21
3

M. F. T.

- 2 2

5 1 6
2-2

1 - 1

2 1 3

1 - 1

2 - 2

1 - 1

2 1 3

3 1 4
1 1 2
1 - 1

M. F. T.

1 - 1
IS 23 38

42 23 65
19 5 24
-33

1 1 2
26 2 28

2-2

6 7 13

17 22 39

5 8 13

38 39 77

9 12 21

1 1 2

2 4 6

5 4 9

7 8 15

6 6 12
1 - 1

M.F. T.

- 1 1

M. F. T.

3 3 6

8 6 14

4-4

6-6

1 1 2

4 4 8

2-2
1 - 1

Total.

254

191

445

22 7 29

203 168 371

- 2 2

29 14 43

P.D. 23

Table 12.

Use of Alcohol of First Admissions Classified with Reference to
Principal Psychoses.

Psychoses

Total

Abstinent

Temperate

Intemperate

Unascertained

1. Traumatic .

2. Senile ....

3. Wi th 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

-30

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 psyhcoses .

"■

Total .

254

191

445

146

237

P.D.

CD C
55

I I I I
I I I I
I I I I

I ^ ;s fs
I I I I

I ^ eN CN

I I ff) I -H

I I -, I -,

I I CN I i

I OOt^ I I

rt 00 T)i«) ■M
i r^ 00 lO tN

-H -H O !^ I

rtOOirjir) I

— I

-I 1

I I i I I lO oj 1^ •* I « r^ O I I

f^ ^ ^ ^ OO CN ^ CN ^

" fO I I f^ r*^ 00 ^ CS *-( ■^ lO OM^ I

c! C

0) rt rt C +j ^

^H ^^ L- —

M (

• - ■ £ a Ji § '

O o O Oi o

2 ■=!

3g^„

S c S o Ji
o Q c g

&II2J5-&

■r; cJ .y Ji S? u c ■"
" S" •i-" j-iT) 4->

s\Or^CO^O»-Hr]f^'^u-)*OI^OOO\0^<

P.D. 23

Table 14. — Psychoses of Read missions.

Psychoses

Males Females Total

1. Traumatic psychoses -

2. Senile psychoses 1

3. Psychoses with cerebral arteriosclerosis 5

•i. General paralysis 3

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 1

9. Alcoholic psychoses 8

10. Due to drugs and other exogenous toxins -

11. With pellagra

12. Psychoses with other somatic diseases 1

13 Manic-depressive psychoses 8

14. Involution melancholia I

15. Dementia praecox 23

16. Paranoia and paranoid conditions 3

17. Epileptic psychoses 1

18. Psychoneuroses and neuroses -

19. Psychoses with psychopathic personality 2

20. Psychoses with mental deficiency 2

21. Undiagnosed psychoses ............ —

22. Without psychoses ^ . . . -

Total 60

Table 15. — Discharges of Patients Classified with Reference to Principal Psychoses
and Condifiofi. on Discharge.

1. Traumatic

2. Senile

3. With cerebral arteriosclerosis

4. General paralysis

5. With cerebral syphilis

6. With Huntington s chorea

7. With bram tumor .

8. With other brain or nervous diseases

9. Alcoholic

10. Due to drugs and other exogenous

toxins

1 1. 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 personality

20. With mental deficiency .

21. Undiagnosed psychoses .

22. Without psychosis . ' .

Total

4
12
18

190

140

330

Recovered

M. F. T.

8 8 16

Improved

M. F. T.

2 4
7 3
15 4
2

4
16
2
37
8
1
3
2
4

4t
11

144 111 255

Unimproved

34 19 53

P.D. 23

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lr^oo<r^-<l If^OI l-*rt-HO.— 'csl— iou-j|

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<

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50 P.D. 231

Table 19. — Family Care Department.

Male
Remaining in Family Care October 1, 1930 . .,.,;.., • . . 1
On visit from Family Care Otcober 1, 1930 . . . . . . . -

Admitted during the year . . . . . . . . . . .2

Whole number of cases during the year . . . . ' . . . .3

Dismissed within the year 1

Returned to institution . . . • ; • ■ . ; .; , . . .1

Di.scharged -

On visit . . -

Remaining in Family Care September 30, 1931 2

Supported by State . . -

Private 2

Self-supported -

Number of different persons within the year . . .... . .3

Number of different persons dismissed. . . . . . . . . 2

Number of different persons admitted 1

Average daily number in Family Care during the year . . : . . .015

Supported by State -

Private . - . . ' . 2

Self-supporting . -

Female

Total

.165

.18

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