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

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Public Do cument No. 23 

©ire (Enmmanxupaltli of ilaasarliita^ttfi 



ANNUAL REPORT 



TRUSTEES 



Worcester State Hospital 



Year Ending November 30, 

1932 

Department of Mental Diseases 



xH^iL^i 



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Pi BLICATION OF THIS DOCUMENT APPROVED BY THE COMMISSION ON ADMINISTRATION AND FINANCE 

500. 9-33. Order 9296. 



OCCUPATIONAL PRINTING PLANT 

DEPARTMENT OF MENTAL DISEASES 

GARDNER STATE COLONY 

EAST GARDNER. MASS. 



DEO 14 i^^^ WORCESTER STATE HOSPITAL 

[P. O. Address — Worcester, Mass.] 

STATE HOUSE BCii^l J ' board of trustees 

Edwaed F. Fletcher, Chairman, Worcester. 
William J. Delahantt, M.D., Worcester. 
Anna C. Taxman, Secretary, Worcester. 
Howard W. Cowee, Worcester. 
John J. Perman, D.M.D., Worcester. 
Josephine Rose Dresser, Worcester. 
George W. Morse, Worcester. 

RESIDENT STAFF 
William A. Bryan, M.D., Superintendent. 
Clifton T. Perkins, M.D., Assistant Superintendent. 
Morris Yorshis, M.D., Clinical Director. 
Samuel W. Hartwell, M.D., Director Chilli Guidance Clinic. 
Francis H. Sleeper, M.D., Senior Physician. 
Bardwell H. Flower, M.D., Senior Physician. 
LoNNiE O. Farrar, M.D., Senior Physician. 
James R. Linton, M.D., Senior Physician. 
Harry Freeman, M.D., Senior Physician. 
Hugh Carmichael, M.D., Senior Physician. 
Nathan Baratt, M.D., Senior Physician. 
Joseph M. Looney, M.D., Senior Physician. 
Arthur W. Burckel, M.D., Assistant Physician. 
Milton H. Erickson, M.D., Assistant Physician. 
Walter E. Barton, M.D., Assistant Physician. 
W. Everett Glass, M.D., Assistant Physician. 
Minna Emch, M.D., Assistant Physician. 
James A. Willie, M.D., Assistant Physician. 
William H. Freeman, M.D., Pathologist. 
David Shakow, M.A., Psychologist. 

VISITING STAFF 
Ernest L. Hunt, M.D., Surgeon. 
Benjamin H. Alton, M.D., Surgeon. 
Carleton T. Smith, M.D., Surgeon. 
M. M. Jordan, M.D., Neurologist. 
Roscoe W. Myers, M.D., Ophthalmologist. 
Philip H. Cook, M.D., Roentgenologist. 
Oliver H. Stansfield, M.D., Internal Medicine. 
E. C. Miller, M.D., I nts'-nal Medicine. 
Legteh M. I'elton, M.'D.,Gjnitc-U'>-lnary Surgery. 
Joel M. Melick, M.D., Gynecologist. 
Roy G. Hoskins, M.D., Ph.D., Research. 
Arthur Brassau. M.D., Surgeon. 
HAnoLr J. GiBBY, M.D., Ear, Nose and Throat. 

HEADS OF DEPARTMENTS 
Herbert W. Smith, Steward. 
Margaret T. Crimmins, Treasurer. 
Warren 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 ,a^^^ . 3 

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

The Trustees of the Worcester State Hospital respectfully submit the one- 
hundredth annual report of the hospital together with the report of the Superin- 
tendent, Dr. William A. Bryan, and report of the Treasurer, Miss Margaret T. 
Crimmins, and other statistical information. 

Attached to this report is a more detailed report of Dr. William A. Bryan, Super- 
intendent of the hospital, to which the Board has given careful attention. We 
endorse the recommendations of that report. 

For a number of years, recommendations have been made for certain changes 
in the hospital which will decrease the ever present menace of fire. The main 
building of the hospital is forty-five years old, and the Summer Street Department 
has been in existence one hundred years. In these two buildings, we have fire 
hazards which are very dangerous. The wooden construction of the attics, the 
wooden floors, the obsolete type of wiring, the lack of fire escapes, and the wooden 
staircases, all constitute a great danger. The board has called attention in the 
annual reports of the need of a program of improvement which would replace the 
wooden floors in both the main hospital and Summer Street, modernize the electric 
wiring, and put in additional enclosed fire escapes where needed and change the 
roof to a fire-proof type of construction. We again call attention to this situation 
and would urge Your Excellency to take immediate steps to remedy the conditions 
which now exist. The responsibility of the State is very grave in this matter, and 
the Board of Trustees of this hospital cannot carry the burden of responsibility 
alone. If a fire were to break out in the attic of the hospital, the results would be 
disastrous both from destruction of property and possible loss of life. 

The condition of the roads in the hospital grounds is very bad, particularly the 
main avenue road. This road carries a great deal of traffic and has never been pro- 
perly surfaced. It is the recommendation of this board that a suitable sum of money 
be appropriated immediately to lay a concrete surface on the avenue road extending 
from the garage to the main entrance. It is no credit to the State, that roads on 
property belonging to this Commonwealth be permitted to remain in the condition 
that the hospital roads are in. 

The board would again respectfully call attention to the imperative need at the 
main hospital of suitable porches for patients. The present Quinby and Thayer 
porches are in such a dilapidated condition that they cannot be used. It is unsafe 
to permit patients on them. The porches are of wooden construction, and have 
gradually rotted away. The board recommends that suitable enclosed porches be 
built as quickly as possible on the Thayer and Folsom wards, the Quinby and 
Woodward ward together with one story porches for the two admission wards, 
Salisbury One and Washburn One. 

The board desires to register its approval and recommendation that the work 
going on, dealing with the investigation as to the cause of mental disorder, be 
continued. The results have not been startling, but there is a steady gain in our 
knowledge of the causation of mental disorder. Research should be encouraged 
by the appropriation of suitable amounts of money to attract good men, and it is 
to be hoped that the Commonwealth will continue the policy of appropriating 
each year a suitable amount to carry on these investigations. 

The work of the Child Guidance Clinic has been of inestimable value to the 

community, and the board recommends that the Commonwealth continue to 

support this worthy project. 

I The board desires to call attention to the fact that personnel is the important 

j! thing to be considered in the treatment of patients. Quality and quantity of 

,: personnel are important in maintaining a high recovery rate from any hospital. 

I The greater number of high grade employees and officers we have in this hospital, 

the larger number of patients we will be able to restore and return to their homes. 

! Therefore, it is imperative that a sufficiently high wage be inaugurated to attract 

! the best type of personnel, and that sufficient money be appropriated to employ 

I an adequate number in order that more patients may be restored to mental health. 

In this way the economic burden of the state can be lowered. 

The resignation of Miss Jessie M. D. Hamilton has been accepted with reluctance. 



4 P.D. 23 

Miss Hamilton has been the Treasurer of this hospital since 1902 and her faithful- 
ness, loyalty and efficiency have made her a valuable member of the hospital or- 
ganization. Her resignation was accepted with regret. 

It is a pleasure to the board to acknowledge the indebtedness of the hospital 
to the members of the visiting staff. They have served faithfully and have been 
of great assistance in the work of the institution. The thanks of the board are 
due to the officers and employees of the hospital who have given freely of their 
loyalty and cooperation during the year. 

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

Josephine Rose Dresser, Anna C. Tatman, 

Howard W. Cowee, John (.i. Perman, 

George D. Morse, Trustees. 

SUPERINTENDENT'S REPORT 
To the Trustees of the V/orcester State Hospital: 

I herewith respectfully submit the following report of the hospital for the year 
ending November 30, 1932, it being the one-hundredth annual report: 

There remained on the hospital books October 1, 1931, 2,471 patients, 1,199 
men and 1,272 women. Eight hundred and twenty-three patients, 489 men and 
334 women were admitted during the year. Seven hundred and fifty-two patients, 
446 men and 306 women were discharged from the hospital. Of this number 452 
patients, 278 men and 174 women were discharged; 234 patients, 129 men and 
105 women died, and 66 patients, 39 men and 27 women were transferred, leaving 
at the end of the statistical year 2,542 patients, 1,242 men and 1,300 v/omen. 

Staff Changes 
Promotions 
Clifton T. Perkins from Senior Physician to Assistant Superintendent, July 11, 
1932. 

Appointments 
Minna Emch appointed Assistant Physician February 15, 1932. 
James A. Willie appointed Assistant Physician September 3, 1932. 

Internes 
George R. Lavine appointed March 22, 1932. 
Jack L. Troupin appointed August 15, 1932. 

Resignations 
L. Cody Marsh resigned May 31, 1932. 
Jacob H. Friedman resigned June 23, 1932. 
Jack Troupin resigned October 1, 1932. 
John H. Hall, Dentist, resigned October 13, 1932. 

Report of Psychiatric Service 
Morris Yorshis, M.D., Clinical Director 
The past year has effected many changes in the clinical work, the teaching, and 
out-patient treatment. The medical staff, although considerably hampered by 
shortage of resident staff, continued to keep pace with the goals of the institution, 
namely to make a perceptible decrease in the incidence of mental disorder in the 
general community, discharging more patients, and to be an active teaching and 
research center. 

I. Changes in Hospital Procedure and Psychiatric Services. 

The most direct change in psychiatric procedure has been the elimination of 
presenting patients to staff conferences; the facts of each case are given in the 
presence of only those who are familiar v/ith the problem at hand. Then the 
patient is seen in his own environment on the ward. The most beneficial effect 
noted was the lessening of the tension on the part of the patient, and the increase 
in confidence that the patient had for his or her physician. 



P.D. 23 5 

The admission routine of patients was changed so that interviews and physical 
examinations were only carried out after the patient was made comfortable on the 
admission ward. Four hour charts were kept on all new patients. All medication 
or other orders were written by physicians and signed on the therapeutic sheet, 
recorded uniformly with the time and initials of administering nurse given. Orien- 
tation examinations were conducted by physicians only unless specific orders were 
given to nurse. Behavior notes written every three days by nurses were objective 
only. Interviews concerning life history and mental content were conducted by 
the Staff. The privilege of reading the records on these patients was controlled 
by the physician on the case. 

Insofar as possible, an attempt was made to regroup patients on the basis of: 

A. Absence of organic brain involvement with consequent deterioration. 

B. Age. 

C. Degree of intelligence as manifested by history prior to onset of psychoses. 

D. Type of psychosis. 

This has resulted in certain ward changes. The principal attack was on the back 
wards, the aim being to isolate the more acute from the chronic disturbed, keeping 
in mind especially the duration of illness, and the assets of the patient, especially 
onset of illness and precipitating factors. 

All patients having seizures at any time were examined neurologically. x\ll 
luetic patients especially of the C. N. S. Type were treated in the same way so 
that a closer check could be made between serology and organic involvement 
and clinical course. A short statement giving the estimate of improvement as 
noted by physician was incorporated in the record of the patients receiving hydro- 
therapy and physiotherapy. 

The patients residing on the medical service received more psychiatric obser- 
vation. The nurses on these wards reported regularly on their charts objective 
behavior of the patients, and progress noted by physicians included summary 
statements about the patient's mental content and progress, thus allowing for a 
better understanding of the correlation between the psyche and the soma. 

To facilitate case work and insure unity of effort, a unit system was inaugurated. 
This consists of an actual physical plant of communicating offices wherein are con- 
centrated all the persons interested in the welfare of the patient in that particular 
division of the hospital. ThUs, psychiatrists, social workers, occupational thera- 
pists and psychologists are found in such a unit of offices; it is in close proximity 
to the admission office, nursing supervisor's office, clothing supervisor and the 
wards themselves. The psychiatrist confers directly with the social worker, thus 
eliminating all indirect referrals and concentrating responsibility. All social 
service referrals are checked once a month by the psychiatrist and the social worker 
in charge. The unit system has enhanced the efficiency of the personnel, in that 
it has afforded the co-workers to get more insight about themselves. With this 
newer knowledge, the personal equation became more estimable and the work pro- 
duced was more objective. 

II. Teaching and Educational Activiiies in Hospital: 

Teaching has been the greatest stimulus during the past year. An affiliation with 
the Boston University School of Medicine was responsible for the addition of seniors 
from the medical school to the increasing student group at the hospital. A definite 
teaching program for these undergraduates was arranged and a synopsis of the 
course is given herewith: — 

1. Introductory conference with clinical director. 

2. Schedule for the month. 

A. Visit to admission wards where students do most of their clinical work. 

B. Visit to medical and research wards. 

G. Arrangements for visits to special clinics. Lumbar puncture, ophthal- 
moscopic, roentgenologic, anti-luetic, and laboratories, both patho- 
logical and psychological. Attendance at autopsies compulsory. 

D. Conference with chief social worker. 

E. Visit to occupational and industrial departments. 

F. Case conference with director of Child Guidance Clinic and visit to the 

Clinic. 



6 P.D. 23 

3. Study of Massachusetts commitment laws and forms. 

4. Arrangement of the day and week. 

A. Student's time off similar to the medical staff. 

B. Visit through each psychiatric service once a week with resident staff. 

C. Staff conferences on psychiatric services. 

D. Administrative staff conferences with the Superintendent. 

E. Clinico-pathological conference. 

5. Special conferences. 

1. With Chief Psychologist. 

2. With Director of Research. 

3. With Assistant Superintendent. 

4. With Director of Clinical Psychiatry. 

Psychiatry to this group is no longer a medical curiosity. The various comments 
made by individual students show conclusively that this phase of medicine has 
given them a better understanding of their role as physicians and keener insight 
into the relationship between patients and themselves. 

Doctor Lalkaka of Bombay, India, faithfully completed a fifteen month's period 
of study at the hospital. During this time he made a place for himself in the 
memory of those who worked with him, such as no previous member had. He was 
held in high esteem both by his patients, and by the whole community. He was 
enthusiastic in the privileges that were extended to him; he applied himself dili- 
gently in his work and made excellent use of the opportunities that were available, 
not only in this hospital but throughout this section of the country. We were all 
sorry to see him leave us to return to India because of the many pleasant hours he 
injected into the day's work of those who were associated with him. 

A concentrated effort in contacting all groups dealing with patients to enable 
them to understand the thoughts of the medical staff led to the inculcation in the 
teaching program, classes in dynamic psychology with supervising and graduate 
nurses, both on medical and psychiatric wards. The group of probationers as well 
as the junior class of the Nurses' Training School were given similar instruction 
along more fundamental lines dealing concretely with individual patients under 
their care on the wards. The Occupational Therapy group was also initiated into 
this program of increasing the efficiency of the hospital by giving them practical 
demonstrations of the role they play as psychotherapists, and how it could 
fit in with the aim of the psychiatrist in planning adjustments of a patient. 
The various department heads were seen from time to time by the psychiatrist 
and regularly by the occupational therapy workers for the purpose of elucidating 
the newer and more definite approach of industrial therapy. The following outline 
was devised for this purpose. 

Outline for Industrial Reports of Patients 

1. Adaptability of patient toward hospital. 

A. Appearance. 

1. Age. 

2. Clothing. 

3. Physical Index. 

B. Activities: 

1. Overproductiveness of speech. 

2. Restless energy or lack of it. 

3. Response to work. 

a. Kind and amount — beds, swabbing, kitchen. 

b. Patient's attitude toward supervision by nurse or patient, that 

is, supervision in a prodding or general way. 

c. Social response. 

C. Hospital History — Medical Service — Length of time transfers. 

2. Job assigned and reason for placement. 

A. Home industrial history. 

1. Any previous industrial accidents. 

2. Time unemployed before entering hospital. 

B. Doctor's reasons for placement. (Prescription, if not in line with former 

occupation, why?) 



P.D. 23 7 

3. Department assigned to in hospital. 

lib. A. Attitude of patient toward foreman. 

W B. Attitude of patient toward fellow workers. 

C. Responsibility assumed. 

D. Apparent physical improvement. 

E. Attitude towards job. 

a. Mechanical response, interest in production, initiative, efficiency of 
movement. 

1. Foreman's report on patient's ability and attitude. 

2. Patient's report on job. 

3. Patient is observed by therapist, in a casual way. 

4. Change in position. 

A. Length of time in former position. 

B. Reasons for change. 

1. Psychiatric implications. 

2. Circumstances. 

3. Response to new department. 

a. Efficiency. 

5. Attitude toward leaving the hospital. 

A. Patient's attitude toward parole or home. 

6. Patient's account of his Industrial History in the hospital. 

The following is a brief account of an industrial history: 

Mr. M. was admitted to this hospital last October following a period of 

worry and depressed spirits. He was a middle-aged man, scrupulously neat 

and clean, very meek and quiet on the ward. He would eat very little and 

gave the appearance that all the cares and troubles of the world were his own. 

The worrying and mental strain caused him to lose weight. He was transferred 

to the medical service after he lost ten pounds. He was placed on a strict diet. 

Following three weeks care, he regained weight, felt better, and wanted to work. 

While working with an outside group, he resented the authority of the 

people in charge of him, and contributed very little to the work of the group. 

Gradually his work diverted his attention from the worries which had been 

bothering him. The chaplain spent a good deal of time with him in order to 

reassure and make clear certain religious problems which had been troubling 

him. The social service worker helped to clear up some misunderstandings 

in the home which had caused some of his mental depression. The psychiatrist 

was able to change the patient's attitude toward life, an attitude which had 

been hopeless and full of despair. With the combined efforts of these three 

departments, plus the industrial work, Mr. M. showed marked improvement. 

He was then placed in the carpenter shop where he improved so rapidly that 

he returned to his home the first of the year. 

Social Service students from Smith College, and Simmons were given a course 

in clinical psychiatry with special emphasis on the case material assigned to them. 

Theological students, in addition to being supervised by ward psychiatrists, 

were enrolled in the bi-weekly seminar comprised of various physicians on the staff, 

including the director of the Child Guidance Clinic and the superintendent. A 

group of ministers from Worcester, and neighboring towns attended regularly a 

course in dynamic psychology given by the superintendent and the Staff. 

Classes for relatives of patients continued as in previous years. 

III. Visits, Discharges, Family Care, Community Activities and Out-Patient Work. 
Owing to the increased number of new admissions and dismissal rates, more 
patients have reported to the hospital for follow-up treatment; psychotherapy 
with accessible and recovering patients was considered of utmost importance. The 
difficulty in sending patients out has made it necessary to give more thought to 
family care patients with the result that during the past year there were more 
patients boarded out than any previous year. A definite policy regarding this 
procedure was adopted. Before any patient was released, the likelihood of patient's 
ultimate discharge from the hospital was considered of major importance, thus 
doing away with the old custom of simply keeping patients whose assets were such 



8 P.D. 23 

that with an improvement in the economic situation they would easily make an 
adjustment in the community. With the record number of patients sent out of 
the hospital this way, it was necessary to assign a social worker to devote her full 
time to seeing such patients. A regular system of visitations by the medical staff 
was inaugurated. 

Again, the discharge rate was the highest in the state, and the number of cases 
discharged as "without psychosis" reached another record figure. The director, 
with the aid of the staff, is gathering evidence pertinent to the need for the estab- 
lishment of an adult psychiatric clinic. This would reduce the number of patients 
committed to a minimum, and would help lessen the stigma of being hospitalized 
in a state institution. 

The community continued to call upon the hospital from time to time for psy- 
chiatric advice, and the medical staff responded with generosity to the frequent 
calls made by the Board of Public Welfare, Young Women's Christian Association, 
Associated Charities, and also the Belmont and Rutland Hospital for Tuberculosis. 

The added interest in autopsy material inspired by the pathologist and internist 
resulted in a high percentage of autopsies. The attendance at these examinations 
by the medical staff, although not compulsory, was representative. The cases 
selected for the monthly clinico-pathological conferences by the pathologist, in- 
ternist and director were conducted by the chief of the medical service, who, from 
time to time, would call upon the consulting staff to discuss the case presented. 

In addition to the research activities reported by Dr. Sleeper, the chief of the 
female psychiatric service has been carrying on a project on menstrual disorders. 

The literature contains many references to periodic changes in mental attitudes, 
emotional response and physiological functions of women in relation to the men- 
strual cycle. There are also references to disturbances of the cycle of amenorrhea 
during one course of a psychosis, with the suggested possibility that return of 
menstruation presages mental improvement. Objective studies are few and some- 
what indefinite in purpose, so that in most instances the conclusions drawn might 
be considered in the nature of opinion rather than verified observation. In order 
to study this problem, records have been kept on a group of more than one hundred 
patients in regard to menstrual periods (dates, duration, amount), with a view to 
establishing a norm for a psychotic group, and from this to expand the study so 
that gross changes in behavior and other manifestations of psychosis might be 
studied in their relation to the menstrual function. 

The director has continued with the study of blood groups in intact families 
especially in Schizophrenia. 

In conclusion, the director wishes to express his appreciation for the excellent 
cooperation the employees rendered to the medical staff in aiding them to carry 
out the goals of the hospital; also, to the individual staff members and to the 
administrative officers for their kindliness and tireless efforts in maintaining an 
esprit de corps that enhanced the efficiency of the clinical work. 

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

The Social Service Department has worked on nearly 1,800 cases during the past 
year, holding more than 5,000 interviews, taking 657 histories of incoming patients 
and making 739 investigations for placement at home, at work or elsewhere made 
up the bulk of our work. There were investigations of conflicting statements of 
patients and relatives, investigations of reported misconduct of patients, cases 
carried for supervision in the community and for extensive case work on patient 
and family. 

The personnel of the department has shown little change except that the social 
worker for the Research Service had to be given up because of lack of funds. We 
feel fortunate in having been able to carry on our work without interruption. 

The Student Training Program doubled this fall. The Smith College School for 
Social Work sent us four students who are to work at the hospital during the entire 
nine months of their training, other students being assigned to the Child Guidance 
Clinic. We believe this to be a more satisfactory arrangement than the former 
division of time with the Clinic, since the students remain long enough to follow 



P.D. 23 9 

some cases through every case work process, from the time the patient enters the 
hospital with an acute psychosis until he is on the way to a social recovery. Three 
students from other states, two of them daughters of state hospital superintendents, 
are taking the Department course. For the first time, we have a student from the 
Simmons College of Social Work, a Fellowship student, who will receive her Mas- 
ter's Degree in June. 

The financial depression has made our work more difficult in two respects. The 
results of our attempts to find work for patients have been so meagre — only a 
half dozen patients so located this year — that we are not justified in spending 
time in this way. Many families, whose wage earners have long been unemployed, 
hesitate to support an additional member, now in the hospital, out of rapidly 
dwindling savings. We have had the finest cooperation from various boards of 
public welfare, but especially from the Worcester organization in increasing the 
allowance of dependent families when a patient member returns home. The effect 
of financial worries or dependence, upon the returning patient, has not proved to 
be so disastrous as we had anticipated, partly because he recognizes his own situ- 
ation as universal. 

In ^pite of these financial handicaps, the usual number of patients have been 
placed through the increased use of Family Care. Sixty-nine patients have been 
placed in boarding homes during the past year. Of these, 36 had to be returned 
before the end of the year, usually because their physical or mental condition made 
it impossible for them to remain. Several of those remaining out are younger 
patients for whom there is hope that, after a period in a boarding home, they will 
be able to take their place in industry or to make some adjustment to their own 
homes again. In some cases work is being done with the families to this end. 

The new organization of the medical staff (described elsewhere in this report) 
has been of great advantage to the social service department. The head social 
worker now has charge of student training and administrative duties. One social 
worker is in charge of all work on the male service, another of all work on the 
female service, and a third of Family Care and the placement of babies born in the 
hospital. The student workers are divided between the two services, and the 
historian continues her duties as usual. There is now a closer working relationship 
with the doctors of the respective services, because it is definitely known for whom 
to expect each type of service, and because of the proximity of the offices makes 
frequent consultation possible. Our new offices offer ample space and give 
opportunity for more privacy in interviewing. Since we are located on the wards, 
patients drop in more readily to consult us about their problems so that a close 
rapport is more apt to exist before the patient leaves the hospital, giving impetus 
to social treatment. These changes have helped to make the past year an unusually 
good one for this department. 

Report of Occupational Therapy 
Olive Caldwell, Head Occupational Therapist 

In November of 1931, the work of the Occupational Therapy Department was 
completely reorganized. Believing that all patients occupied in any form of work 
should be part of the occupational therapy program, whether they were in the 
conventional craft shop or in the laundry, all the occupational therapy classes 
were closed with the exception of those on the medical and research services. An 
industrial office was established to consolidate the working activities of the entire 
patient population. Consequently, an industrial analysis was made by the therapist 
of every job in the hospital, each and every angle of the job being carefully studied 
by observation and actual work in the job. These analyses prove very valuable 
in acquainting the doctors and new workers with the type of work available for 
patients and the job environment. 

An industrial survey of the entjre population was made giving all the information 
which might be useful in placing a patient in work most suitable to his social and 
industrial abilities. On this card there is opportunity to rate the patient on a score 
of sixteen points which show his industrial progress while in the hospital. 

All requests for patient labor and transfers from one job to another are sent in 
writing to the industrial office daily. Each morning these requisitions are tabulated, 
and copies are delivered to the physicians-in-charge, thus acquainting them with 



10 P.D. 23 

the vacancies in the hospital industries. The physician prescribes work for the 
patient with reference to the therapeutic needs of the patient and secondly with 
reference to the industrial needs of the institution. 

The number of working patients has not increased greatly, averaging about 71% 
for the men and between 45 and 50% for the women. These figures are important 
as they mean patients actually employed in industrial activity. The total number 
of placements in the main hospital during the year was 584 women and 61fi men, 
thus showing the large turnover in industrial population, due to patients' leaving 
the hospital for home or as boarding-out cases. 

After the job survey was completed, ward classes were reopened on some of the 
wards, particularly the admission and acute services on the women's side because 
of the need to reach these people before they became hospitalized. 

With this program we are establishing a system of graduation of work for the 
patient from ward activity through work which approaches the norm of industrial 
life, thus preparing the patient to take his place in the community. 

Religious Services 

The regular religious services have been held throughout the year. Mass was 
celebrated on Sundays and Holidays both at the Main Hospital and the Summer 
Street Department by Rev. Charles Duffy and Rev. George F. Dacey for the 
Catholic patients. The clergy have responded faithfully to calls for the sick 
and have administered the last rites to the dying. 

In addition monthly services have also been held for our Episcopalian and 
Jewish patients by their respective chaplains. 

Report of Chaplain's Department 
Reverend Carroll A. Wise 

The work of the Chaplain's Department falls conveniently under the following 
heads: religious services, pastoral work, musical activities including the operation 
of the hospital radio, teaching and miscellaneous activities. In this work the 
chaplain has been assisted by Mr. Wallace F. Searle, a splendid musician, and by 
Mr. Sheridan W. Bell, Jr., a theological student. 

Each Sunday morning during the year, a Protestant service was held at the Sum- 
mer Street branch of the hospital, and at the Main hospital. These services are 
in every way planned to meet the particular needs of the patient to whom we 
minister. The sermons are short and seek to show the bearing of religion on the 
problems of mental health. A vesper service is broadcast to the wards each Sunday 
evening, and observations indicate that a large number of patients listen to them. 

A number of activities are included in pastoral work, the main one being ward 
visitation. Routine visits are made to each ward — some wards being visited 
more frequently than others. Each new patient is seen shortly after admission. 
A visit is made to each patient who is placed on the danger list. Flowers are 
brought to each patient who undergoes a surgical operation. Selected patients 
are taken out for walks. In cooperation with the ward physician, intensive work 
is carried on with individual patients who are carefully selected. In addition to 
our own pastoral work, the chaplain cooperates with local ministers who visit 
the hospital to see members of their particular church and frequently notifies 
ministers when patients from their church desire to see them. In cooperation with 
the Worcester Federation of Church Women's Clubs, regular visiting on the medical 
wards of the female side has been done by twenty carefully chosen local women. 
The effect of this visiting is noticed in the increased cheerfulness of the patients, 
and in the feeling that the community has not forgotten them. This regular 
visiting is now being expanded to some of the psychiatric wards. 

A Chaplain who spends his full time in a mental hospital has an opportunity, 
not only to serve, but also to learn a great deal from the Staff, and from his 
contact with patients. Along with this there comes the further opportunity of 
speaking to groups on the outside on subjects relating to mental health and religion. 
The chaplain may become one channel through which the hospital is interpreted to 
the community. During the past year the chaplain has spoken to over thirty 
outside groups, including churches, women's clubs, men's clubs, the Y. W. C. A. 
and young people's groups. He has given a course dealing with psychopathology 



P.D. 23 11 

and religious experience at the Boston University School of Theology. In coopera- 
tion with hospital physicians he has organized and conducted three seminars at 
the hospital for local ministers. A total of twenty-five ministers have attended 
these seminars, six of whom have attended all three. 

During the past summer the course in clinical training for theological students 
was given for the eighth consecutive summer. This course is given in cooperation 
with the Council for the Clinical Training of Theological Students. Twelve students 
from six theological seminaries spent the summer months at the hospital. Part 
of the time they served as attendants on the wards, part in some special activity 
such as music, athletics, dramatics for the patients, and part in study under the 
direction of the physicians and the chaplain. A seminar was conducted two even- 
ings each week. This training course, which began in Worcester eight years ago, 
has now spread to four other state hospitals, one prison and a general hospital. 
Mr. Boisen, who began the work here, left the first of this year to go to the Elgin 
State Hospital, Elgin, Illinois, where he has initiated similar work. Besides 
spreading in state hospitals, the idea of clinical training for theological students is 
gradually growing in favor among the faculties of theological seminaries and in 
many churches. 

First among the miscellaneous activites of this department may be mentioned 
an open forum which was conducted by the chaplain over the hospital radio. 
Questions sent in by patients were answered. A series of talks on the various re- 
ligions of the world is at present in progress. Once a week during the year, and 
twice a week during the summer, the department issues the Hospital Herald, 
a news-sheet, which is distributed to the patients. With the help of the students 
in the summer a Hospital Pictorial, showing in picture form persons and incidents 
of interest to the patients, was issued weekly. 

In February of this year the first issue of the Hospital Messenger made its 
appearance. This four-page paper, which is sent to relatives of patients and 
friends of the hospital, has been issued monthly since February and has a circulation 
of almost one thousand. Its purpose is to create a better understanding between 
the community and the hospital, and also to disseminate mental hygiene ideas. It 
is edited by the chaplain. 

In April the chaplain published an article in Zion's Herald entitled "The Church 
and Mental Disorder." 

Radio Department 

Mr. Searle has given his full time to the radio and musical activities. Therapy 
by means of radio is possible and is being demonstrated from day to day at this 
hospital. To have a well-functioning radio department in a State Hospital requires 
three very definite things: a suitable and well-planned equipment which will ade- 
quately serve the radio needs of the hospital; thorough supervision and over-seeing 
of every program that emanates from this radio system; and sufficient observing on 
the wards, consultations with the doctors and nurses and conversations with 
patients either to confirm pre-conceived plans concerning programs or to insure 
justification for changing them. 

Our radio equipment is well planned and is adequate for our needs. To cite the 
complete equipment would be superfluous. Suffice it to say that we have facilities 
which enable us to receive the Blue, Red and Columbia networks; to broadcast 
programs from our station WSH; to play Victrola records. Our amplification 
system enables us to send programs to every ward in the hospital, the cafeterias, 
the chapel, the reception-hall for visitors, the sewing-room, tailor-shop, weaving 
room, scullery, and other places where patients work. A distinct advantage for 
daily check-ups is the fact that there is installed in the Superintendent's quarters 
a loudspeaker which presents to him any program he may wish to hear. By means 
of an auxiliary input system we can send hospital-originated programs to the 
hospital. In other words, a doctor can speak to one or all of the wards. An artist 
can sing or play to a single ward or the entire hospital. Features of this type can 
be broadcast from the studio, the control room, or the hospital chapel. Thus a 
single individual who is in charge of the control-board may broadcast from the 
place where he is working. An artist, speaker or small group can broadcast their 
programs from the studio. A choir, chorus or large group are able to send their 



12 P.D. 23 

programs from the chapel. Perhaps the most advantageous aspect of our equip- ; 
ment is what is known as the double channel. By means of this we can be sending j 
two programs to the hospital at the same time — for example: a football game to ; 
the male side while the female wards are having music. 

Program making is far from haphazard. It involves many hours of searching 
bulletins of outside stations, culling out the cream of the programs, eliminating | 
most talking features, including those features which patients unanimously vote j. 
for, avoiding too much repetition, discriminating back-ward programs from parole, I 
making an effort during cafeteria hours to give 'dinner music' and not screeching | 
sopranos (who are disturbing to patients) and most important of all, checking up 
all programs which include much advertising. However, program-making does 
not end here. It involves securing outside talent for our evening broadcasts. I 
believe the most note-worthy achievement in the radio department this year is 
the cataloging of musicians of Worcester and vicinity, classifying them as to their 
respective talents, securing their cooperation, inciting their interest in our station 
and having them leave us with the attitude that they wish to perform for us again. 
To personalize, to dignify and to heighten the standards of our station means much 
to patients, and has also helped to secure the definite interest of many Worcester 
musicians. To hear a program from our own station is emphatically better than an 
outside program provided the talent is good. The tonal production is better, and 
most important of all when patients hear, "This is WSH your own station" they 
know someone has come several miles to favor them with a program — obviously 
the interest is greater than in some vague outside program. Since September 1, 
1932, there have been over a hundred programs given to the hospital by vocalists 
and instrumentalists from Worcester and Boston over our Station, WSH. Since 
January 1, 1932, we have sent 1,940 programs to the hospital from our own studio. 

Of these programs I mention a few of outstanding significance. Once a week 
the Superintendent speaks to the admission v/ards giving a series of four talks as 
follows: "On Entering the Hospital," "The Legal Aspects of Mental Disease," 
"The Treatment of Mental Disease," and "On Leaving the Hospital." Twice 
during the year the superintendent has also given a series of talks on the various 
types of mental disease. A series of talks on the Religions of Mankind were 
presented by the hospital chaplain. A series of short talk6 "On the Care of your 
Teeth" was featured by the hospital dentist. The head of the medical department 
presented several programs dealing with the care of the body. The occupational 
therapists for eight weeks told of various phases of their work and asked "What 
did you do today?" The Social Service students, in a series of eight talks, pre- 
sented in brief the history, habits and customs of different countries. Special 
national music and folksongs were presented in these programs. In many cases 
the songs were sung in their native tongues. 

Every morning at 6:30 we present a "Good Morning Program" which is a short 
"|cherio" and serves to stimulate, awaken and refresh. At night the opposite type 
of program is offered to close the day, the effect being sedative. Request programs 
have been featured, playing numbers requested by patients, and announcing their 
nlames over the radio. A short series of musical appreciation talks were presented. 
Daily current events are read to the wards which are selected by the radio director, 
thus eliminating the undesirable features of the outside news bulletins. Progress 
notes telling of those patients who have received parole, those who have been 
sent home, and those who have received promotions on research wards are read 
weekly to all wards. A number of fifteen minute piano recitals featuring the 
works of different composers were given by the radio director. This by no means 
enumerates the complete list of programs we have presented. 

It has seemed prudent to lessen the hours of continuous radio which go to the 
wards. It has been decided that at no time during the day the wards receive 
more than an hour of radio at a time. This keeps radio from ever becoming mono- 
tonous and revives new interest when it is resumed. It is an interesting fact that 
no program can be turned on or off from any ward. The entire controlling is done 
from the main control-room and in order to have a program put on or off it must 
be by order of a doctor or someone in authority — thus preventing various em- 
ployees from depriving patients of the radio because of their personal prejudice. 



P.D. 23 13 

The correct time is given to the wards every half hour. This as well as the station 
announcement, is a helpful bit of orientation. 

The control-room is in complete charge of patients under the supervision of the 
radio director. This control-room is active almost constantly from 6:30 A. M. 
until 9 P. M. Announcing the time; feeding the outside stations into the hospital; 
reading the news; giving the good morning and good night programs; controlling 
programs broadcast from the hospital; calling doctors in the staff dining room at 
meal hours; the care of victrola records; meeting and escorting talent from the 
reception hall to the studio — these are only a few of the activities performed by 
patients. Since January first, there have been twelve patients working in this 
department. Five returned home and four are working at present. The normal 
environment, the atmosphere which is decidedly not hospitalike, the meeting of 
many people, the having to do a definite thing at a definite time is exceedingly good 
therapy for neurotic and psychotic patients as results have shown. 

Musical work in the hospital, other than that which is presented over the radio, 
is of three types: collective work with groups of patients, individual work with 
specific patients and musical activities among the employees. 

During the past year scores of private lessons have been given to patients on the 
piano and the pipe-organ. This work has been done at the request of a physician, 
occupational therapist or the patient himself. In most instances, the patient has 
had musical training before entering the hospital. In several instances these 
patients have refused to do any other kind of work, but through their interest in 
music they became interested in other activities. Since many patients have made 
requests for lessons, this work will be greatly expanded during the coming year. 

Frequent ward rallies, socials, musicales and get-togethers have been conducted, 
these varying from the most deteriorated male ward in the hospital to the most 
disturbed ward on the female side. In this particular, disturbed female ward 
morning rallies were conducted daily for several months. These rallies, which were 
about fifteen minutes in length, consisted in group and individual singing, dancing, 
reading responsively and instrumental music. Many times when foreign-born 
patients were unable to sing in English, they could be influenced to sing heartily 
when some native folk-song was played. It was our fortune to have several theo- 
logical students during the summer who contributed a great deal musically to the 
hospital. A harpist and a male trio should be specially mentioned here for their 
work on the medical wards. 

Three musical experiments were conducted with patients, the last of these being 
with both patients and employees. In each instance a short program of unfamiliar 
classic music was played on the piano and listeners were asked to write at the close 
of each number what that particular music meant to them. The response proved 
that these particular patients (forty in number) sensed the prevailing mood of the 
composition as well as the normals in the group. 

During the year a patients' choir for Sunday morning church services has been 
conducted with rehearsals once a week. A nurses' glee club has been organized 
with bi-weekly rehearsals. A group of occupational workers has been trained 
and has rendered several programs for the patients. 

Each morning there is held in the hospital chapel what is known as the" Morning 
Rallies." One is held for the better patients; another for the distrubed patients. 
These rallies give the majority of the patients an opportunity to go somewhere and 
to hear something every day. To many, this is the one big event of the day. 
Music is an important feature of these rallies, especially in the rally for the disturbed 
patients. 

Music can be stimulating or sedative, invigorating or lulling, it can stimulate 
the memory and imagination, increase or lower the blood pressure, make the heart 
beat faster, make one work faster or slower. Knowing this, we hope in the coming 
year to continue our musical activities by doing more research with music in the 
pack-rooms, more experiments to determine the value of music in promoting sleep, 
more entertaining programs for the senile wards, more music of a stirring type for 
youthful schizophrenic patients, more sedative music in the disturbed wards. 



14 P.D. 23 

Report of Training School 
Anne McE. Normandin, R. N. 

In the past year there have been no great achievements brought about, but steady 
progress has been made. 

Nine students received diplomas from the School. The usual prizes were 
awarded. Miss Ruth MacGeoch received the prize given by the Alumnae Asso- 
ciation for the highest average maintained during three years of training, also the 
Linda Richards prize for the best Essay on Psychiatric Nursing. Miss Anna 
Fremont won the prize given by Doctor Bryan for the best suggestion for an im- 
provement beneficial to the patients' welfare in the Hospital. 

For the first time the Graduation Exercises were held in the Garden in the rear 
of the Nurses' Home. The day was ideal and the setting beautiful. 

Miss Elsa Benson, Assistant Principal of the School resigned in June, and Miss 
Gretchen E. Nind accepted this position. 

Being cognizant of the over-supply of nurses we decided to admit but one class 
a year, raising the entrance requirements from one year of High School to High 
School Graduate. Twenty-nine students were enrolled. 

Sixty-six students affiliated for three months. 
Framingham-Union Hospital . 6 Leominster Hospital ... 7 



Grace Hospital 
Hahnemann Hospital 
Hart Private Hospital 
Holyoke Hospital . 



8 Memorial Hospital ... 6 

10 Rutland Hospital .... 2 

6 Somerville Hospital ... 6 

15 

Beacuse of the confusion of a complete turnover in the student body every three 
months, it was proposed that Affiliating Schools send students through the summer 
months and that students report every six weeks rather than every three months. 
This proposal has been accepted most graciously by the schools affiliating with us, 
and is to go into effect January, 1933. We are grateful for the cooperation we 
have received. 

Weekly conferences have been held by Doctor Bryan with the entire graduate 
nurse group. Doctor Perkins has also held weekly conferences with the Nursing 
Staff. It is felt that these conferences have been most beneficial in helping the 
nurse realize the policy, ideals and problems of the Hospital Administration. 

Our thanks are offered to the Medical Staff for the very able help it has given us 
and the interest shown in the Training School. 

Report of the Medical and Surgical Services 
Clifford T. Perkins, M.D. 

The following tables and comments comprise a report of the activities of the 
medical and surgical services for the past hospital record year, extending from 
October 1, 1931 to September 30, 1932, inclusive. 

Movement of Population 

Male Female Total 

Remaining October 1, 1931 140 92 232 

Admitted 435 446 881 

Discharged 350 345 695 

Deaths 88 114 202 

Deaths (Summer St. Dept.) 17 16 33 

Escapes 2 - 2 

Births 2 10 12 

Remaining Sept. 30, 1932 134 79 213 

In general, the distribution and movement of population, as it has affected the 
medical and surgical services, compares very favorably with the reports of the 
past few years. A total of 1,113 patients were cared for on these services with an 
average continual census of approximately 230. 



Male 


Total 


306 


606 


8 


12 


31 


77 



Female 


Male 


Total 


. 11 


12 


23 


. 62 


95 


161 


. 49 


76 


126 


s 

. 11 


15 


26 


. 2 


4 


6 

68.59 



P.D. 23 15 

Discharges Detailed as to Physical Condition 

Female Male Total 

Recovered and improved 305 299 604 

Not improved 12 9 21 

Not treated 33 37 70 

Total 350 345 695 

In the above table, with comparisons of previous years, there may be noted a 
steady decrease in the total number discharged from the service as "not improved." 

Physical Diagnosis Detailed {Based on Discharges) 

Female 

Provisional and final agree 300 

Provisional and final disagree 4 

Admitted for study only 46 

Of particular interest in this table is the marked increase in the number of patients 
admitted to the service for study only. Such an admission presupposes a vague 
physical disorder and such conditions seem to be steadily increasing in our general 
hospital population. 

Deaths Detailed 

Number of Medico-Legal Cases 

Total number of autopsies 

Autopsies confirmed ante-mortem diagnoses (70% or more) 
Autopsies partially confirmed ante-mortem diagnoses 

(50S7c-70%) 

Autopsies refuted ante-mortem diagnoses (less than 50%) 

Percentage Autopsies 

Attendance at Autopsies: 

Students: 802; Staff: 862 1664 

The re-organization of the pathological department during the past year has 
brought many new, healthy influences to bear on the morale of the resident staff 
and students. The above table summarizes the immediate effects of some of these 
influences. The autopsies percentage has greatly increased (22%) over last year. 
The attendance at autopsies is likewise tremendously increased (over 150%), 
which means increased interest and enthusiasm on the part of the staff, and which 
in turn will inevitably lead to continued increased autopsy percentages in the future. 
Furthermore, the constant check of ante-mortem diagnoses by post-mortem 
examination in such a high percentage of the cases has been an incentive of in- 
estimable value to the staff. 

Analysis of Deaths 

As may be noted in the first table, there was a total of 235 deaths during the year, 
of which 33 occurred at the Summer Street Department and the remaining 202 
at the Main Hospital. This total number is parrallel to that of recent past years. 

The average age of all deaths was 62.7 years. A detailed analysis of all deaths 
gives the following information, based only on the primary causes of death. 

(a) Eighty-four deaths, or 36%, were due to changes coincident to advancing 
years — generalized arteriosclerosis, cardio-vascular-renal disease, etc., but exclud- 
ing cerebral hemorrhage. The average age of death was 72 years. 

(b) Forty-three deaths, or 18.2%, were due to pneumonia. Of this number, 8 
were lobar, and the remaining 35 were broncho-pneumonia. The average age of 
death of this entire group was 66.9 years. The most recent classification for deaths 
requests that if a broncho-pneumonia is the actual immediate cause of death in an 
elderly individual, it should be so recorded as primary, and not secondary. In past 
years such a death might be attributed to generalized arteriosclerosis with broncho- 
pneumonia as secondary. This change in classification accounts for the increase 
(15%) in the number of deaths in this group, and the decrease (13%) of deaths in 
the senile group as compared with last year. It also accounts for the increased age 
of death from pneumonia reported here (66.9 years) as compared with the age re- 
ported for pneumonia deaths last year (36.1 years). 



16 P.D. 23 

(c) Fifteen deaths, or 6.3%, were due to dementia paralytica. It is interesting 
to note that, following our impressions of a year and two years ago and observing 
extra precautions during the hot, exhaustive months, this death rate has been 
nearly halved. Last year it comprised 12.8% of the entire number of deaths. The 
average age of death of this group was 48 years — identical to that of past years. 

(d) Fourteen deaths, or 5.9%,, were due to tuberculosis. This, again, is approxi- 
mately half the figure it was a year ago. Of these cases 2 were miliary and the re- 
maining 12 were pulmonary. The average age at death was 48 years. 

(e) Nine deaths, or 3.8 %, were due to carcinoma in different forms, and involving 
8 different organs as the primary site. The average age at death was 64.5 years. 
These figures run very parellel to those of last year. During this year we have begun 
to take more active advantage of the cooperation offered by the Department of 
Public Health in utilizing the facilities of the Pondville hospital for additional diag- 
nostic help and for radium and x-ray treatments. 

(f) Eight deaths, or 3.4 %, were due to fractures, most of which occurred in elderly 
patients, as the average age of 71.7 years would indicate. 

(g) Eight deaths, or 3.4%, were due to kidney disease, with a definite history 
of such, uncomplicated by senile changes. The average age at death was 47.3 years. 

(h) Four deaths, or 1.7% were due to diabetes mellitus, with an average age of 
68 years. 

(i) Three deaths, or 1.2%, were due to heart disease (2 acute bacterial endo- 
carditis and 1 acute dilatation) uncomplicated by senile changes. The average 
age at death was 42 years. 

(j) Only 2 deaths, or 0.8%, were attributable to cerebral hemorrhage, with an 
average age of 59.5 years. 

(k) The remaining 45 deaths, or 19.3%, were due to many isolated causes of no 
particular significance. The average age at death in this group was 53 years. In 
this group there were 2 deaths (0.8%) recorded for each of the following causes: — 
peptic ulcer, cholecystitis, hypertrophied prostate, alcoholism, typhoid fever, and 
C. N. S. lues. 

Consultations Detailed 



Eye 


134 


Medical 


15 


Ear, Nose, and Throat . 


40 


Orthopedic 


9 


Gynecological and Obstetrical 


250 


X-Ray . . . 


. 1199 


General Surgical 


160 


Others 


10 


Total 






. 1817 



As the years progress and our medical and surgical problems become increasingly 
difficult and complex, we recognize and appreciate more and more the valuable 
assistance given us by our consultants. The above table summarizes the individual 
consultations on individual patients, and represents an increase of 50% over last 
year's figure, and an increase of 125% over two years ago. 

S^irgery Detailed 

Amputations: of breast, 2; of foot, 2; of leg, 1; amputation minor, 3; appen- 
dectomies, 15; aspirations: gall-bladder, 2; hydrocoele, 1; biopsy, 3; cataract 
extraction, 1; circumcision, 2; cholecystectomies, 2; colporrhaphies, 1; cysto- 
tomies supra-pubic, 1; dilatation and curettage, 5; excisions minors, 9; fulgura- 
tion urethral neoplasms, 2; gastrotomies, 2; herniorrhaphies, 19; hysterectomies: 
sub-total, 2; total, 3; ileostomy, 1; incision and drainage minor, 23; injections 
for varicose veins, 52; iridectomy, 1; laparotomies exploratory, 9; ligation of 
severed blood-vessels, 1; lysis of adhesions, 1; lysis of urethral stricture, 1; mas- 
toidectomies, 2; myringotomies, 2; oophorectomies, 4; orchidectomy, 1; para- 
centesis abdominal, 12; perineorrhaphies, 6; plaster casts: minor, 9; major, 13; 
plastic repairs, 1; proctoscopic examinations, 1; removal of foreign bodies, 4; sal- 
pingectomy, 1; splints applied, 20; suspension uterine, 2; suturing tendons, deep 
lacerations, etc., 11; tonsillectomies and adenectomies, 10- thoracentesis, 2; 
trachelorrhaphies, 5; transfusion, 1; turbinectomy, 1. Total surgical procedures, 
257; total patients, 251. 

The surgical procedures of the past year represent an increase in number of about 
50% over last year, and likewise about 50% more patients involved. Many of our 
former usual surgical procedures are cared for in other ways (physical therapeutic, 



P.D. 23 



etc.) yet there is this definite trend towards an increase in surgical procedures. The 
preceding table enumerates and classifies such procedures as were carried out last 
year. 

Clinics Detailed 

Eye examinations, 813; ear, nose and throat examinations, 748; gynecological 
examinations, 425; luetic treatment, 3,736; small-pox vaccinations, 149; spinal 
punctures, 676; typhoid and para-typhoid inocculations, 884; Wassermanns, 
Kahns, Hintons, 1,431; others, 18. Total visits to clinics, 8,880. 

The number of visits to the routine clinics, as noted in the above table, is very 
parallel to the number reported last year (8,801). This is due, to some extent, to 
administrative control of volume, which, it was felt, was necessary in order to assure 
efficiency. These routine clinic examinations form a very valuable part of the 
medical care of our patients. The volume is more or less equally distributed 
throughout the year, and is not concentrated in certain months. 

Venereal Clinic 



1. Total Cases in hospital first of year 

2. New cases diagnosed during year 

3. Old cases re-admitted 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 

(c) Died 

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

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

7. Total number of treatments 

(a) Arsenicals 

(b) Others 



Total number of laboratory tests. 

(a) Blood, Wassermann. 

(b) Blood, Kahn . . . . 

(c) Blood, Hinton . . . . 

(d) Spinal, Wassermann 

(e) Others 



91 

66 

4 

161 

44 

1 

1 

19 

23 

117 

2,585 

409 

2,176 



Pos. 

1,417 
291 
377 
524 
225 



56 

25 

4 

85 

24 

1 

2 

4 

17 

61 

1,233 

211 

1,022 

Neg. 

3,360 

1,113 

1,027 

880 

340 



147 

91 

8 

246 

68 

2 

3 

23 

40 

178 

3,818 

620 

3,198 

Total 

4,777 

1,404 

1,404 

1,404 

565 



Gonorrhea 



M. 



- 2 2 

1 1 

80 80 

80 80 

Pos. Neg. Total 

3 95 98 



95 



98 



9. Total Visits to Clinic for Treatment, Examination, or Advice 5,885 

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

10. Number of Social Service Connections: To Contacts To Delinquents 

Visits 39 39 

Letters 39 53 

11. Total number of patients in hospital last day of year 2,181 

Again, this year as last, in analyzing the report of the venereal -clinic we are 
particularly impressed with the small number of cases of gonorrhoea diagnosed 
during the year. The staff members have been keenly aware of the apparent rela- 
tive absence of gonorrhoea in our population and have exerted every effort to make 
certain that this absence is not only apparent, but is actual. As noted in the table, 
there were only 3 cases diagnosed during the year (all women) and only one remain- 
ing in the hospital at the close of the record year. 

The number of patients having syphilis, diagnosed during the year, was 91, and 
at the end of the year there were 178 such patients in the hospital. The most of 
these patients were suffering from syphilis of the central nervous system, primarily 
dementia paralytica. Thus, approximately 8% of our population has syphilis, 
whereas available figures indicate that only about 1.5% of the general community 
population has venereal disease (syphilis or gonorrhoea). There were 50% more 
patients admitted to this clinic this year than was the case in the preceding two 
years. Of these cases, approximately 85% were referred by private physicians 
(primarily because of some type of mental illness). This is interesting inasmuch as 



18 P.D. 23 

Drs. Nelson and Scamman of the Massachusetts Department of Public Health re- 
ported in March, 1931, that by far the majority of venereal cases reported to that 
department came from public clinics rather than from private physicians. The 
discrepancy is remarkable and worthy of analysis. 

It may be noticed that only 3 cases were closed as not requiring further treat- 
ment. Our criterion for this particular classification has been that a patient must 
have persistent negative examinations of the blood (3 each of Wassermann, Kahn, 
and Hinton) and 1 negative spinal fluid Wassermann, extending over a period of at 
least a year after the complete cessation of all anti-luetic therapy. We do not feel 
that age or debility enter into this criterion, although treatments might be tem- 
porarily suspended in such cases. 

As indicated in the table, the majority of treatments given were not arsenicals. 
Bismuth in various forms has been used extensively, as has fever treatment by 
diathermy — with and without other anti-luetic therapy. The time has been too 
short to evaluate these latter treatments. 

The total of 5,885 visits to the clinic for treatment, examination, or advice is an 
increase of about 15% over the figure of the last two years. 

Employees Detailed 

Examined and treated at clinic, 1,383; required hospitalization, 221; required 
operation, 30; Total number of days on sick ward, 1,464. 

The employees' clinic, which has been successfully functioning for several years, 
has become a very valuable part of the hospital administration. Of particular 
interest in the above table is the fact that 1,464 sick days (based on discharges) 
were spent in the employees' sections of our medical wards. This represents only 
approximately 0.7% of all employee-days. June was the lightest month in this re- 
gard, and the Fall months of September, October, and November were likewise 
very light. March and August were the heaviest months for oflice treatment for 
employees at the clinic. The number of clinic visits represents an increase of 50% 
over last year. 

Dressing Detailed 

Out-Patient Males Females 

Abrasions and lacerations 1,285 440 

Boils and carbuncles 846 290 

Burns 691 153 

Infections 2,672 2,193 

Ulcerations 257 338 

Others 1,647 221 

Total Out-Patient dressings 7,398 3,635 

Ward dressings 11,873 12,203 

Total dressings 19,271 15,838 

Grand Total 35,109 

The above table enumerates and classifies the dressings that were done on the 
medical wards and in the out-patient clinics on these wards during the year. It 
represents 100% increase in activity over last year. 

Dental Department 

Cleanings, 1,297; examinations (routine), 3,175; extractions, 1,670; fillings, 
1,217; microscopic examinations, 4; plates, 37; repairs, 37; treatments (mis- 
cellaneous), 1,256; x-ray diagnoses, 47; others, 10; Total examinations and treat- 
ments, 8,778. Total patients examined or treated, 5,369; total general anesthetic 
cases, 16. 

The above table, detailing the activities of the dental department, represents an 
increase of 16% in the total number of treatments given, and an increase of 40% 
in the number of patients treated. Much of this increase is due to the fact that in 
August of this year the dental department of the Main Hospital took over the 



P.D. 23 



19 



complete dental work at the Summer Street Department. Heretofore, this latter 
work was done by a private dentist whose records were not included in the report 
of this department. 





X-Ray Department 














Parts E 


x;amined 






Plates 




Plates 


Patients 


or 


Patients 


or 






Prints 




Prints 


Abdomen (plain) 


21 


33 


Jaw 16 


31 


Ankle 


29 


48 


Knee . 






28 


68 


Arm ...... 


65 


93 


Kidney (plain) 






5 


10 


Chest 


418 


518 


Leg 






19 


28 


Colon .... 


3 


7 


Mastoid 








6 


22 


Elbow 


11 


16 


Nose . 








18 


39 


Foot .... 


18 


21 


Ribs . 








8 


17 


Fluoroscopy 


1,801 





Shoulder 








33 


48 


Gastro-Intestinal Series 


297 


920 


Sinuses 








46 


106 


Gall Bladder (plain) 


30 


75 


Skull . 








95 


232 


Graham Test 


100 


283 


Spine . 








21 


58 


Hand .... 


45 


49 


Teeth . 








47 


218 


Heart .... 


16 


21 


Wrist 








28 


47 


Hip ... . 


48 


75 


Others 








11 


28 


Total .... 






3,283 


3,111 


Finger prints 






29 


36 


Photographs 














80 


152 



The foregoing table represents an increase of over 90% in the number of patients 
of patients on whom x-ray examinations were carried out, with only an increase 
of 7% in the number of plates used. In our endeavor to economize, we have en- 
couraged the staff to use fluoroscopic examinations (rather than to take roent- 
genograms) v/herever such a substitution is feasible. The above comparisons show 
the results. 

Physical Therapy Department 
Classification of treatment and tests 

Ultra-violet (air cooled) 1,936 

Ultra-violet (water cooled) 514 



Baking . . . , 
Massage . . . , 
Diathermy (medical) 
Diathermy (surgical) 
Galvanism . . . . 
Muscle re-education 
Reaction of degeneration. 
Sinusoidal . . . . 



1,901 

463 

753 

45 

27 

47 

6 

17 



Total treatments and tests 5,709 

New patients during year 312 

Total number of patients treated 3,864 

The physical therapy department was moderately active during the year, and 
there is a general increase of about 25% in the activity as determined by total 
patients treated and the total number of treatments given. 

The work on fever treatments in dementia paralytica, referred to in the report 
of the venereal clinic, has progressed satisfactorily. Our investigations in this 
regard have broadened somewhat, to include other types of diseases, and to include 
a more thorough understanding of the general effects of heat and fever on the 
human body. 



20 P.D. 23 

Pharmacy 

The pharmacy, as a source for storing and dispensing medical and general supplies 
for immediate therapeutic use, has filled its usual important niche in the hospital. 
During the record year there were filled, 5,134 narcotic prescriptions, 16,973 pre- 
scriptions for hypnotics and sedatives, and 25,125 regular prescriptions and refills. 
A total of 47,232 prescriptions were filled, an increase of about 75% over last year. 
The regular prescriptions have more than doubled over last year, those for sedatives 
and hypnotics have tripled, whereas, those for narcotics are less than half the 
number filled last year. Some of this general increase in volume is due to closer 
administrative control where the policy has been to discourage the storing of large 
amounts of drugs and supplies on the wards. This, obviously, has resulted in more 
frequent prescriptions for smaller amounts, with the storage burden on the phar- 
macist. 

The above tables, which form the essential part of this report, have been enum- 
erated somewhat in detail and have been scrutinized rather carefully so that by 
means of this hindsight, or by means of an interpretation of thiife past history, we 
may note the important trends and more carefully budget our expenditures and 
control our medical activities. The ultimate results of such procedures, we hope, 
will be increased efficiency — medical, economic and administrative. 

Hydrotherapy Report 
Harold Murphy 

West Sheet Packs: Total number of patients, 534; total number of packs, 5,398; 
total number of hours, 16,39934- 

Continuous Baths: Total number of patients, 721; total number of baths, 7,339; 
total number of hours, 29,261,12- 

Tonic Baths: Foot bath as preparatory treatment, 190; foot baths, 229; tub 
shampoos, 27; hair shampoos, 28; salt glows, 190; sitz-baths, 7; E. L. baths, 1; 
needle sprays, 450; fan douches, 450; jet douches, 122. 

Colonic Irrigations: Number of patients, 377; number of hours, 1,696; number 
of treatments, 1,755. 

Instructions 

Wet Sheet Packs: Number of pupils, 175; number of hours, 104; number of 
lessons, 193. 

Continuous Baths: Number of pupils, 173; number of hours, 125; number of 
lessons, 114. 

Tonic Baths: Number of pupils, 122; number of hours, 33; number of lessons, 
20. 

Colonic Irrigations: Number of pupils, 70; number of hours, 49; number of 
lessons, 48(. 

Report of Child Guidance Clinic 
S. W. Hartwell, M.D., Director 
The Child Guidance Clinic Department of the Worcester State Hospital has 
been carrying a very heavy load during the year of 1932. There is a constantly 
increasing demand for our service, both from agencies who refer cases to us and 
from parents who consult us about their children. We have found it impossible to 
accept all cases referred, preferring to carry out our policy of making a complete 
study of each case taken and giving the treatment which appears advisable to us, 
rather than accepting a large number of children on whom we can do only a diag- 
nostic service. At the same time, we are doing this service for many of the Juvenile 
Court problems and for the unmarried mothers cared for by the local agency. 
More than 75% of the cases studied entirely by the clinic staff (and not handled 
cooperatively through social workers in other agencies) are taken for long-time treat- 
ment. The geographical area from which our cases come is increasing. The clinic 
accepts cases from all parts of the district which the Worcester State Hospital 
covers. Because of the handicap of distance, it is difficult to do intensive treat- 
ment on cases in the outlying towns and this frequently influences our plans in 
individual cases. However, this extension of the work has increased materially 
the telephone and travel expense of the Clinic. Other expenses have been curtailed 



P.D. 23 21 

in every way during the year in order that the budget might be balanced despite 
this very considerable and necessary increase. 

The cases accepted for study and treatment within the year have, in general, 
been those presenting serious problems. Among them have been a considerable 
number of mildly psychotic, pre-psychotic or psychoneurotic children. Several 
of these children have been referred to us from the State Hospital, where they were 
patients on observation. In all such cases referred during the year we have been 
able to carry on such treatment as has kept the child adjusted in the community. 
The director of the clinic and the other staff members are particularly interested in 
the problem of the child who is presenting serious mental deviations and a large 
percent of the cases on which the most time has been spent are in this group. 

The seriously introverted and withdrawing child has been the object of a special 
study that has been going on over the past two years, and it is our plan to continue 
this particular line of study and treatment during the coming year. 

The psychological department has put special emphasis during the year on the 
treatment of a group of children who stutter or stammer. These have obtained 
special training in relation to their speech handicap and also for their personality 
difficulties. Miss Grace Clark, of the clinic staff, attended Dr. Smiley Blanton's 
summer school for speech work and will be on the staff of this school in the summer 
of 1933. Through the psychological department, a number of special reading and 
arithmetic disabilities are being studied and treated. 

The various members of the staff have been active during the year in community 
education. More than 200 addresses and talks before groups of parents and others 
interested in mental hygiene have been given by members of the clinic staff. We 
have covered almost the entire state in doing this work, groups in more than 40 
towns having been reached in this way. Our plans for the coming year include 
even greater activity in this line. Since practically all of this work is done in the 
evening it has not been necessary for the work of the clinic to be in any way curtailed. 

During the year a total of 225 new cases were studied and treated in the clinic. 
The open case lot of the clinic usually averages about 400 children, from which we 
realize that a large proportion of the clinic cases are open and active over a long 
period of time. Attention may be called to the fact that with each child taken for 
full study and treatment, many other individuals come to be dealt with actively by 
the psychiatrist, psychologist, and social worker. Very frequently much more time 
is spent in trying to change the attitudes of parents or interpreting to them their 
own part of the problem than is spent with the child, himself. Therefore, in 
dealing with these 225 new children, it is a safe estimate to say that we have con- 
tracted and in most cases tried to help probably more than 1,000 individuals. 

The clinic is gratified at the very free use all the agencies operating in this com- 
munity have made of us, and we are particularly gratified with the cooperation 
given us through following our suggestions and seeing that the child came to the 
clinic for treatment when indicated. We particularly mentioned the school systems 
of Worcester and Worcester County, the Boston Children's Aid Association, the 
Worcester Children's Friend Society, the District Nursing Society, the Travelers' 
Aid Society, and probably most important, the Juvenile Courts, especially the 
Juvenile Court of Worcester. From this court we get complete and very intelligent 
cooperation, both in obtaining information in the cases referred under the new law, 
and in helping us carry out treatment of delinquent children. 

The staff members of the State hospital and the clinic are gratified at the report 
of the Rockefeller Foundation issued after the investigation made by them of all 
the child guidance clinics in the United States. In this report the clinics were scored 
on the point of service to the community. Our clinic was given the highest score 
of all in the United States, having 13 points more than our nearest competitor. 

For the coming year we are planning to continue our work as we are now doing it. 
The case load will undoubtedly increase. All members of the staff are thoroughly 
enthused with the past, and we feel that, while the work will be undoubtedly heavier 
next year than it has in the past, we will be able to carry it on without any additional 
budget appropriation. 



22 P.D. 23 

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

The dementia praecox project has been carried out during the past year as a 
joint undertaking of the Division of Mental Hygiene, the Worcester State Hospital, 
and the Memorial Foundation for Neuro-Endocrine Research. The work has con- 
tinued under the immediate direction of Dr. F. H. Sleeper of the Worcester State 
Hospital, and Dr. R. G. Hoskins of the Memorial Foundation for Neuro-Endocrine 
Research. 

During the year, the "seven month ' ' plan was completed and certain of the results 
have been analyzed. It is evident that patients with reaction types included under 
the heading of schizophrenia suffer from a disordered homeostasis. Many of the 
patients show an extremely labile type of response to various tests when these tests 
are repeated without the patient's receiving medication. On certain days, the 
patient gives a normal response, on others, a depressed finding. This accounts to 
a large extent for the contradictory findings so common among research workers in 
this field. The plan has demonstrated a fluctuating organic background to the 
psychosis, which is not necessarily associated with changes in the mental picture. 

A resume of some of the more important results obtained during the year will 
be given. 

A commercial glycerin extract of adrenal cortex was found to be effective in ele- 
vating the blood pressure when given by mouth. This observation held true in 
100% of ten cases to whom the medication was administered. In the majority of 
cases there was a slight increase in body weight under this treatment. It was also 
found to have a mildly stimulating effect on the haematopoietic system. The 
mental symptoms in these patients were not altered by the medication given over 
a period of ten weeks. An article on the complete study by Drs. Hoskins and Free- 
man, giving details, was accepted for publication by "Endocrinology" and will 
appear early in 1933. 

In oculocardiac studies, which have been completed by Dr. H. Freeman, pressure 
was applied in terms of millimeters of mercury to each eye separately and to both 
eyes. In normal controls, for each 25mm. change in pressure, there was a change 
of four beats in the pulse rate. In cases of dementia praecox the average change 
was two beats, but the findings were not consistent. This suggests a disturbance 
in the vagal regulatory mechanism of the heart. 

Study of the sedimentation rate was carried out on 50 normal controls and 50 
subjects. There was essentially no difference in the rate between the schizophrenic 
and normal subjects when infections were definitely ruled out. Repeated tests 
seemed to show characteristic rates for each individual in the absence of infection, 
utilizing a special technic modified from Rourke's procedure. It has been possible 
to further simplify the test whereby fewer readings have to be made with conse- 
quent saving in labor. 

Utilizing the Weiss technic for studying blood velocity, our schizophrenic subjects 
show definite stasis in comparison with Weiss's hospital controls. The average time 
for our cases in the first series studied was 25 seconds from the arm to the carotid 
sinus whereas in Weiss's controls the time was 15 seconds. 

The study of blood velocity is merely one of a battery of tests by means of which 
we hope to determine definitely whether insufficient oxygenation of the tissues plays 
a significant role in the etiology of the psychoses. Many of our findings, the low- 
ered oxygen consumption, the failure of bilirubin obtained by duodenal drainage 
to be oxidized to biliverdin, the secondary anaemia, suggest that the tissues do not 
obtain sufficient oxygen. 

Pharmacodynamic studies have been only partially analyzed. Preliminary in- 
dications are that the autonomic nervous system in schizophrenic subjects re- 
sponds differently from that in normal subjects. Schizophrenics respond less to 
adrenalin and more to atropine than normal controls. No final conclusions regard- 
ing these results will be drawn until the effects of the administration of eserin and 
ergotamine have been analyzed. All these drugs were given intravenously and 
repeated at three-month intervals. 

The ability of the patients to utilize sugar is markedly lowered and tends to 
fluctuate markedly. Fully half of the patients show this lowering of carbohydrate 



P.D. 23 23 

tolerance. This is one of the most complicated fields of human physiology and a 
conclusive explanation of the phenomenon cannot be offered at this time. Several 
projects are under way for the further investigation of the subjects. 

Secondary anemia is present in 66% of the cases. In 88% we have been able 
to definitely increase the red count by means of thyroid medication. A paper on 
"Studies in Thyroid Medication — Some Conditions Determining the Haemato- 
poietic Effects" by Hoskins and Jellinek appeared in Endocrinology, Vol. 16, No. 5., 
September-October 1932, Pages 455-486. It was discovered that a diphasic effect 
resulted upon the administration of thyroid substance. In the case of 52 patients 
initially anemic, the red cell count first increased, and then decreased as the dosage 
was raised. There is, therefore, an optimal dosage for this substance. The bene- 
ficial effect of a given dosage decreased with age. A more pronounced effect was 
obtained in patients in normal nutrition than in underweight or overweight 
patients. Results are non-specific. They indicate that thyroid medication is of 
general utility for the treatment of secondary anemia, and that age, nutritional 
status and the basal metabolic rate, as well as dosage and duration of treatment, 
are significant factors in determining the degree of effect obtained. 

In schizophrenia a common observation is an increase in the white cells of the 
blood. During the year the effect of posture on the count was investigated partially. 
There is an average increase of 2,000 cells brought about by merely having the 
patient sit up for five minutes. It is planned to further investigate the liability of 
the white count in these patients. In only one or two of our cases with a high white 
count was there a shift in the Schilling index which would suggest infection as a 
cause for the leucocytosis. 

The blood volume in dementia praecox subjects differs very slightly from that of 
normal controls. 

An interesting observation that has come from the work of the past year is the 
fact that the venous oxygen content is markedly lowered in approximately 75% 
of the cases. We have been unable to explain this phenomenon to date. 

A new and simpler technic for the collection and handling of blood samples for 
gas analyses was developed during the year by Dr. Looney. 

A rather complete investigation of the liver, by means of various carbohydrate 
tests, the icterus index, the Van den Bergh test, bromosulphalein tests, McClure 
tests, and Ehrlich's tests, and the examination of blood and urine for aromatic sub- 
stances after the ingestion of tyrosine, shows that the liver is involved in a fair 
percentage of the cases. The material is so complex that it does not lend itself to a 
report of this kind. Suffice it to say that there is very little correlation between 
the tests, as is to be expected, because of the partial functions that the liver sub- 
serves and because of its numerous functions. It is a well-known clinical fact that 
one function of the liver may be seriously damaged, and the others remain intact. 

The gastro-intestinal emptying time is delayed in approximately two-thirds of 
our cases. This has been shown to be due in most patients to relative physical 
inactivity which is frequently correlated with ptosis of the transverse colon and a 
lowered oxygen consumption, the latter possibly not of primary significance, how- 
ever, in its etiology. 

In fully two-thirds of our patients, the urinary output is much greater than in 
our normal controls, many of the patients voiding as much as six litres per day. 
This is definitely suggestive of lesions in the vicinity of the pituitary gland or the 
hypothalamus. Investigations of this condition are under way. 

In a paper on "Blood Pressure in Schizophrenia'"' by Drs. Freeman, Hoskins 
and Sleeper, Archives of Neurology and Psychiatry, February 1932, Vol. 27, pages 
333-351, in which 180 schizophrenic patients were studied, the mean systolic pres- 
sure of the patients was shown to be 11.2 mm. lower than the normal control sub- 
jects and the diastolic pressure 16.7 mm. lower than controls. The psychiatric 
groups vary but slightly in their mean systolic pressure — the paranoid group has 
the highest and the catatonic the lowest reading. 

Preliminary studies on the amount of male sex hormone excreted in the urine 
of these patients indicate that in a fairly high percentage there is a lack of this 
hormone. This function again fluctuates from month to month. Our studies 
are too few in number to draw conclusions but are suggestive in the need for much 
more work along this line. 



24 P.D. 23 

A paper "Endocrine Therapy in the Psychoses" by Drs. Hoskins and Sleeper, 
appeared in the American Journal of Medical Sciences, August, 1932, No. 2, Vol. 
184, Page 158. In this paper, the statement was made that in all probability the 
psychoses are influenced in a variety of ways by the endocrine status of the subjects. 
There is abundant justification for elaborate and long-continued diagnostic and 
therapeutic studies of the significance of endocrine factors. Successful results 
from endocrine medication in a variety of psychiatric cases have been reported but, 
in general, control subjects have been inadequate or totally lacking. 

During the year a constant temperature room was constructed for our investi- 
gations on skin temperature necessary in association with our studies on water 
metabolism and the autonomic nervous system. We have purchased a Benedict- 
Collins skin temperature apparatus for the same study. Equipment for cardiac 
output studies by the Grollman technic was also purchased, as well as a Douglas 
bag. We now have equipment for the investigation of the specific dynamic action 
of protein and further nutrition studies. Our patients, in spite of their lowered 
oxygen consumption and relatively heavy diets, are on an average 15% under- 
weight which points to malassimilation of foodstufxs. 

We have been able to evolve a preliminary yardstick for measuring improvement 
or regression from a psychiatric standpoint. We feel that there are approximately 
32 mental characteristics for these patients which can be measured quantitatively 
on a five point scale. 

The mental age of schizophrenic subjects as determined by the Otis and Stanford 
Binet tests fluctuates from time to time and seems to be of value in determining 
regression and improvement. 

Some of the Psychology tests have given us leads as to what type of employment 
we should utilize for our patients. 

During the year a Miles Pursuit meter and an oscillograph have been constructed 
by the Psychology Department workers. 

In this department, the following projects have been completed or are practically 
completed at the time of this report. Because of lack of space we will merely enum- 
erate the subjects, amplifying slightly only a few of them. 

1. Color Blindness in schizophrenia and the psychoses. 

2. Motor Learning in schizophrenia and normals as meastired by the Ferguson 
V Formboard. 

3. The Worcester 2C Formboard as a measure of learning in schizophrenia 
and Normals. 

4. The effect of sex on Kent-Rosanoff Association and Results. 

5. "Motor Representation" in schizophrenia and in normals. 

6. Observation Experiments in Schizophrenia — The Application of Lewin 
Technics to schizophrenia. 

7. Reaction time in schizophrenia — The individual variations discovered 
may possibly be of value as a measure of "Attention" in this group. 

8. "Steadiness" in schizophrenia — Achieved on a Dunlop steadiness test. 

9. First report on mental tests in schizophrenia — ■ First analyses of data 
collected for four years on various mental tests. 

10. Certain aspects of neuro-muscular coordination in schizophrenia. Results 
obtained show significant differences between Schizophrenics and normals and 
consistent differences between sub-types of Schizophrenia. 

11. Latent time and refractory phase of the knee-jerk in schizophrenia as 
measured by the method of muscle thickening. Preliminary study to oscillo- 
graphic study, which indicates that latent time is greater in schizophrenics and 
that high correlation of time and height found in normals is absent in schizo- 
phrenics. This finding, which has been reported before, opens up interesting 
possibilities for attempts at varying the time therapeutically and for further 
investigation of the cause of the phenomenon. 

12. The Heilbronner test in schizophrenia and other psychosis. 

13. The Heilbronner test in normals. 

14. Preliminary analysis of mental status project — Preliminary analysis of 
attempt to quantify the mental status examinations on a rating-scale basis. 



P.D. 23 25 

. The Psychology Department has presented the following papers during the year: 

1. David Shakow — -"Experimental Psychopathology and the Worcester 
Schizophrenia Study." Brown University, February 8, 1932. 

2. Paul E. Huston — "Some Psychological Experiments of the Schizo- 
phrenia Study." Brown University, February 8, 1932. 

3. Maria Rickers — "The Application of Lewin Techniques in Psycho- 
pathology." Brown University, February 8, 1932. 

4. Maria Rickers — "Lewinische Psychologie" — Harvard and Clark 
Psychological Group, State Hospital, February 11, 1982. 

5. David Shakow — " Certain Aspects of Neuro-Muscular Coordination 
as Measured by the Prod Meter." American Psychological Association, 
September 1932. 

6. Paul E. Huston — "Certain Aspects of Neuro-Muscular Coordination 
as Measured by the Pursuit Meter." American Psychological Association, 
September 1932. 

7. David Shakow — "Certain Problems in Learning in Schizophrenia." 
Clark University, October 26, 1932. 

During the ensuing year, we plan to direct our eflforts primarily to individual 
projects which demand immediate attention. The question of oxygen utilization, 
the investigation of various hormones in the urine and blood, the investigation of 
the cause of polyuria in a majority of the cases are a few of the physiological aspects 
of the problem. Certain therapeutic leads will be followed. Further analysis of 
the correlations between the many psychiatric, physiological and psychological 
leads will be made. The purely psychiatric aspects of the problem are the most 
difficult to handle quantitatively in a given case. We feel that we have made real 
progress in this aspect of the work but that it must be greatly amplified. Many 
papers covering different parts of the work are ready for publication and during 
the next year particular emphasis will be given to laying the results of the research 
before the psychiatric profession. 

The cooperation between all workers has been extremely gratifying. Esprit de 
corps is excellent. Most of the staff have worked together from three to five years 
and excellent team play is thereby possible. 

During the year, we lost two physicians and one social worker because of financial 
stringencies. 

Report of the Psychological Department 
David Shakow, Head Psychologist. 

There were a number of changes in personnel in the Department during the year, 
in harmony with the policy of using the Hospital as a teaching center. Miss Minnie 
Radner left in January, 1932, to take a position as psychometrist at the Foxborough 
State Hospital, and was replaced by Miss Marion Zerbe. Miss Marcella Sachs of 
Wellesley joined the Department in January, 1932, and remained through June 
as a student. Miss Helen Lasker resigned in August, 1932, to take up graduate 
study at the University of Chicago. Miss Sylvia Hazelton of Smith replaced Miss 
Sachs for the summer, and in turn was replaced by Miss Frances Spessard of 
Randolph-Macon Women's College in September. Mr. Irving Knickerbocker of 
Harvard and Mr. Howard Laskey of Boston University joined the Department 
for the summer. Mr. Frank Howard joined the Department in July to work at 
the child guidance clinic. Miss Harriet Lange resigned in August, 1932, to take 
a position at the New Hampshire State Hospital as psycholgist. Dr. Tamara 
Dembo and Dr. Eugenia Hanfmann came to the Department in September as 
special research assistants to work on psychological problems connected with ward 
situations. Dr. Kenneth Braly also joined the Department at this time, as a re- 
search interne, to work on experimental problems connected with Schizophrenia. 

With the growth of the personnel and the work done by the Department, 
especially the experimental work, the need for more room became imperative. To 
meet the situation a suite of rooms in the basement of Gage Hall, known as the 
Psychological Annex, was developed. This met our needs very satisfactorily. Space 
is available for a shop for the research service, which it is hoped will be built up 
shortly. 



26 P.D. 23 

The following table gives the statistical account of the work done by the Depart- 
ment for the past year: 

Psychometrics and Interviews 

Number of Number of 

Individuals tests or sessions 
House: 

Regular patients 196 709 

Schizophrenia research 360* 1,704 

Other special groups 475 899 

Out-Patient Department: 
Child guidance clinic — 

a. Regular patients 260 1,171 

b. Special disability and other therapeutic inter- 

views 72 440 

Girls' Welfare Society 22 88 

Jail . 52 202 

School clinic and others 327 1,274 

Employees 250 687 

2,014 7,174 
Experimental and Other Research 

Patients 554 2,767 

Normals 121 604 

Totals 2,689 10,545 

*Includes repeated examinations on the same individual. 

As will be seen from the above table, 10,545 individual tests, interviews, and 
experimental sessions were held, and 2,689 subjects were examined. A few words 
might be said about one of the items — research data. Most of the others have 
been discussed in previous reports. 

Because of the complexity of the problem with which the psychologist has to 
deal, and the necessity for control of innumerable factors, a tremendous amount 
of data, especially of a control nature, has been accumulated. A disproportionately 
small amount of this has been thoroughly analyzed, however. Thus, at this date, 
there is an accumulation of some 16,000 items of research data on some 40 different 
research projects. It is hoped that very shortly the opportunity will offer for enter- 
ing into a thorough analysis of some of this invaluable store of data. The analysis 
of the data obtained during the ' 'Seven-Month Study" on the Pursuit-and-Prod- 
meter, which indicated significant differences between normal and Schizophrenic 
individuals, encourages us to hope for considerable from the approaches we have 
used. The patellar tendon reflpx study commenced last year was completed in so 
far as it could be with the old apparatus. The necessity for electrical recording 
of the reflex response was recognized and a new apparatus — an oscillograph — has 
been constructed and is at present practically completed. 

One of the important things accomplished during the year was the revision of 
the "Department Practice," now a volume of some 140 typewritten pages. This 
contains detailed information on the standard practice of the Department and the 
hospital, and is invaluable in the training of students which is undertaken by the 
Department. We have had a considerable demand for the manual from other 
institutions. 

Four members of the Department attended the American Psychological Associa- 
tion meetings at Cornell University in September, 1932. At this meeting a paper 
on, "Certain Aspects of Neuro-Muscular Coordination as Measured by the Prod- 
Meter" was read by the head of the Department, and another paper on, "Certain 
Aspects of Neuro-Muscular Coordination as Measured by the Pursuit-Meter" 
was read by Mr. Huston. Other papers presented by members of the department 
during the year were: A symposium on "Experimental Psychopathology" at 
Brown University, participated in by Dr. Rickers, Mr. Huston, and the writer, 
and one talk by Dr. Rickers on "Lewinische Psychologie" to a group of psycholo- 
gists from Harvard and Clark Universities, which met at the State Hospital. 



P.D. 23 27 

Although no articles were published during the year, one is ready for publi- 
cation — that on the "Direct Current Threshold," and a number of others are in 
process of preparation. The abstracting done by various members of the Depart- 
ment for "Psychological Abstracts" increased in amount over last year. 

We were highly honored during the year by a few days' visit from Professor 
Kurt Lewin of the University of Berlin. While here he delivered a talk on some 
aspects of his psychology to the Staff. 

A number of additional members of the Department have become associate 
members of the American Psychological Association, which makes six at the 
present time. 

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

The work of the laboratory has progressed very satisfactorily for the past year. 
The total number of tests increased from 33,869 to 49,611 which is almost fifty 
percent more than ever before. The various tests are enumerated in the table 
appended to this report. 

The work of equipping the large room for the chemical work was completed early 
in January. This permitted all of the pathology, bacteriology and blood morphology 
to be carried out in the smaller room, and all the chemical work in the new labor- 
atory. 

The effect of this increasing the working space was immediately reflected by an 
increase in the efficiency of the personnel, and a decrease in amount of breakage 
of laboratory glassware. 

A course in training for laboratory technicians has been instituted and three 
girls have been admitted. The need of adequately trained technicians has fre- 
quently been commented on by workers in this field, and it is our aim to supply 
technical assistants, thoroughly trained and capable of carrying on research work 
under supervision. In order to accomplish this we admit only college graduates 
who have the necessary basic experience in chemistry and biology. 

Regular instruction in chemistry, pathology and bacteriology has been given the 
nurses by Doctor Freeman and myself. In addition to this teaching, Clinico- 
pathological Conferences are held once a month, at which all the members of the 
medical staff are expected to be present. Frequently physicians specializing in 
some special field are invited to be present to discuss cases of particular interest 
to them. These conferences have been extremely valuable adjuncts for the train- 
ing of our staff members. The Director has held weekly seminars in biochemistry 
which have been attended by members of the laboratory and medical staffs. 

Of the 235 patients who died during the year, post-mortem examinations were 
performed on 161, or 68.5 per cent. This is the highest autopsy percentage ever 
obtained in the institution and great credit must be given to the members of the 
medical service for this very excellent showing. These autopsies were viewed 921 
times by members of the staff, and 894 times by medical students. 

The laboratory was included in the list of those approved by the American 
Medical Association by the recognition of the Director as a specialist in this field. 

In September, Dr. S. R. Feldman was appointed pathological interne, and has 
been of material assistance to Dr. Freeman. Mr. H. O. Carlson, a graduate of 
Worcester Polytechnical Institute, and Mr. F. C. Stratton have served as volunteer 
assistants since April. In addition to these workers, students from Harvard Med- 
ical School, Tufts Medical School, and Boston University School of Medicine have 
come for training during the summer, and one student from Antioch College served 
for ten weeks as part of his continuation work. 

The Director attended the annual meeting of the Federation of American 
Societies for Experimental Biology in April, at Philadelphia, and presented a paper 
entitled, "A New Method for the Determination of Albumin and Globulin in Blood 
Serum". This paper was published in the Journal of Biological Chemistry, 96 
XXVI, 1932. In November, he gave a paper with Dr. Sleeper on "Liver Function 
Studies in Schizophrenia". 

In addition to these, the following papers were published: "The Pathologist's 
Duty in Obtaining Permission for Autopsies"; Bull. Mass. Dept. Mental Diseases, 
XVI 15, 1932, by Dr. William Freeman. 



28 P.D. 23 

"Oxygen Consumption in Schizophrenia", by Hoskins, R. G. and Walsh, Anna 
I. Archives of Neurology and Psychiatry 28. 1346, 32. 

Work on the installation of a new refrigerating system for the mortuary has 
been started, and the completion of this essential unit will give the hospital a 
modern morgue which has been very badly needed. 

As in the past, most of the time of the laboratory force has been utilized in 
determinations needed for the investigations in schizophrenia. A great deal of 
material has been gathered, which, it is hoped, will shortly be ready for publication. 

Total Nu mber of Examinations 
Autopsies, 159; bacterial cultures, 426; bacterial smears, 444; basal metabolism, 
1,120; bleeding times, 8; blood gases, 530; blood cholesterol, 487; blood cultures, 
34; blood creatinine, 1,311; blood N.P.N., 1,331; blood creatines, 515; blood 
sugars, 1,713; blood ureas, 1,037; blood uric acids, 1,588; blood counts (red), 
2,736; blood counts (white), 5,045; blood counts (differ), 3,330; hemoglobins, 
4,830; Schilling's index, 1,356; clotting times, 119; galactose tolerance, 686; 
icteric index and Vandenberg, 280; Mosenthal tests, 204; nitrogen partitions, 
3,225; liver function tests, 197; renal function test (P.S.P.), 408; spinal fluids 
3,390; sputa, 330; stools, 326; stomach contents, 36; tissue sections, 728; urin- 
alysis, 6,563; vital capacity, 555; urine creatinine, 222; milk analyses, 249; blood 
amino acids, 490; vomitus, 14; Widal tests, 48; empyema fluid, 2; platelet counts, 
14; blood volumes, 212; blood grouping, 45; reticulocyte counts, 16; abdominal 
fluid, 10; blood fragility test, 4; diacetic Acid test, 6; spinal fluid (differ), 3; urine 
(quant, sug.), 28; urine (bacteriology), 40; blood chloride, 12; stool (creatinine), 
1; stool (fat), 1; P. H. studies, 257; blood calcium, 1; spinal fluid (bact.), 1; 
fluid from bursitis, 1; fluid from cervical glands, 1; Ascheim-Zondek test, 14; 
lead determinations, 9; fluid from cavity, 2; blood hematocrits, 265; sedimentation 
tests, 179; phytotoxic index, 369; bromide permeability, 154; Duodenal drainage, 
744; blood tyrosie studies, 432; urine tyrosie studies, 432; urine (androitim), 16. 
Total number of examinations, 49,611. 

Library Report 
George L. Banay, Ph.D., Librarian 
I. Medical Library: 

The library is primarily a tool for research, therefore it stresses the value of 
periodicals. The Medical Library has fifteen more journals than last year. We 
now have 24 periodicals in neurology, psychiatry, and mental hygiene; 11 in 
psychology and psychoanalysis; 14 in general medicine; 18 in internal medicine, 
surgery, obstetrics, and pathology; 8 in physiology and chemistry; 6 in physical 
medicine and radiology; 1 in legal medicine; 2 in hospital administration; 7 in 
social service; 1 in occupational therapy; 2 in nursing; altogether 94 periodicals. 

Of this number the hospital subscribes to 67, 2 are paid by the Foundation for 
Neuro-Endocrine Research, 13 donated by Dr. Hoskins, 5 by Dr. Hunt of the 
Evans Memorial, 1 by Dr. Erickson, and 6 coming in free from the U. S. Govern- 
ment and medical supply companies. 

Five of these periodicals are in French, seven in German, three in Italian, and 
seventy-nine in English. 

The Medical Library circulated 500 volumes last year. 

The librarian established close contact with other medical libraries and borrowed 
187 volumes of medical periodicals from 8 libraries, that is: Boston Medical 
Library, 142; Clark University Library, 20; New York Academy of Medicine, 10; 
Army Medical Library, 5; Harvard University, School of Medicine, 6; Harvard 
University, School of Business Administration, 2; Mass. Institute of Technology, 
1; Smith College for Social Work, 1. 

Pursuing a vigorous policy in completing the back-files of our medical periodicals, 
we were able to complete (either by purchase from second-hand dealers or by ex- 
change from dealers or from other medical libraries) the following periodicals: 
Journal of Experimental Medicine, American Journal of the Medical Sciences, 
Index Catalogue Surgeon General's Library, Index Medicus, Psychological Bulletin, 
Medical Clinics of North America, and through the generosity of the Research 
Service, Zentralblatt fur die gesamte Neurologie and Psychiatrie, of which we now 



P.D. 23 29 

have a complete set of sixty volumes. To accomplish more along these lines, the 
Medical Library became a member of the American Medical Library Association, 
which facilitates exchange of duplicates among the member libraries. 

We have received 51 volumes of books and periodicals as donations from various 
members of the staff. Dr. Hoskins donated ten volumes of three medical periodicals 
formerly deposited in the library (Schweizer Archive, fur Neurologie and Psychia- 
tric, Archivio Generale, Rivista di Pat. Nerv. e Mentale). Dr. Jacob Goldwyn, 
formerly of the Worcester State Hospital, donated thirteen volumes of the Collected 
Papers of the Mayo Clinic. Dr. Sleeper and Mr. Shakow presented some old 
medical periodicals to be used for exchange. 

We bought eighty new books and about a dozen good dictionaries to facilitate 
reading of the foreign periodicals. A library committee of ten staff members has 
been appointed to pass on all requests for new books. 

We bound 381 volumes during the year, including 250 volumes of old medical 
periodicals stored in the basement, so that we are up to date now with our binding. 

By November 30, 1932 the Medical Library had: 1,971 bound volumes of peri- 
odicals; 1,284 bound volumes of books. Total, 3,255 volumes, not counting the 
reprints and pamphlets. 

The Medical Library gives the following services for the benefit of the staff: 

a. Current bibliography. A list of articles of special interest to the hospital 
(schizophrenia, endocrine therapy, etc. ) is compiled by the librarian and circulated 
ueekly among the staff members. 

b. Abstracts. Abstracts of the most important articles of the week are circulated. 
The average number of the weekly abstracts is about twenty-five. 

c. Special bibliographies. 

d. Translations of foreign articles. As requested from time to time, for "c" and 
"d". 

Recataloguing. As the original cataloguing has been done on a general cataloguing 
scheme, we have to extend our system gradually, especially in psychiatry and 
psychology, as most of our books come under these headings. We have to re- 
catalogue all our books which will require a considerable amount of time. 

More Shelf Room. We add about 200 bound volumes of periodicals and 100 books 
yearly to our accession-list, so we need more shelf room very badly. Our present 
library is so small that no additional shelves could be accommodated and yet leave 
sufficient space for the readers. When the next opportunity arises, we would need 
a more spacious room with good lighting and ventilating facilities. 
//. General Library: 

The number of books in the library has been increased by many donations and 
purchases. The general library now has about three thousand books and forty 
current magazines and newspapers. One-third of the books is fiction, the rest 
religion, history, biography and poetry. Six hundred new books (mostly light 
fiction)were added to the library last year to bring it as much up to date as possible. 

The library is well patronized by patients and employees. The average monthly 
attendance is 1,969 patients and 2,055 employees. The circulation of books and 
magazines is gratifying. Here are the mean monthly figures: Books and magazines 
taken out, 574; books and magazines distributed on wards, 200. 

Besides this, the library borrows 150 books every three months from the Wor- 
cester Public Library to circulate among the parole-patients and employees. 

For the patients on the closed wards we have five sub-branches: Lincoln I, 
Washburn, 1, Salisbury I, Summer Street Department, and Hillside Farm. The 
Occupational Therapists take books and magazines to the wards regularly; they 
work constantly with the patients, so they know their wishes better than anybody 
else. 

For our blind patients we borrow ten books in Braille every month from the 
Perkins Institution for the Blind, Watertown, Massachusetts. 

All in all, the library circulated six thousand volumes last year, and had about 
50,000 reading visitors. 

A few churches of Worcester (First Church of Christian Scientist, St. John's 
Episcopal Church, All Saints' Church), the Roosevelt Pubhc School, and the 
Worcester Public Library send old books and magazines regularly to the library; 



30 P.D. 23 

so we received during the year sixty books and more than a thousand magazines. 
From our own staff, Dr. Erickson and Miss Hamilton donated their old magazines 
from time to time. We express our hearty thanks to all who have given books 
and magazines to the library. 

General Comments. 
In accordance with previous custom this annual report is made up of the reports 
of different medical department heads. These reports give a sketchy picture of 
the activities carried on by the hospital during the year. The work of the modern 
hospital must be judged in terms of patients. The real criterion of efflciency of 
the mental hospital is how many patients are being turned back into the community. 
In order to justify the complex medical and assisting staffs that the hospital of 
today carries we must answer three questions: 

1. Are we discharging more patients back into the community than we do 

with a more simple type of organization? 

2. Are we shortening the time spent in the hospital? 

3. Are we prolonging the time the patients spend at home between attacks? 
Unless we can answer these three questions in the affirmative, we are not accom- 
plishing much even if our systems and records are the finest in the world. 

There are three points of attack upon the problem of mental disease that must 
be carried on by the mental hospital if any real impression is to be made upon the 
incidence of mental disorder. The mental hospital which confines its responsi- 
bilities to the four walls of the institution is not making much of a return on the 
investment. The continuance of the policy of constantly building more buildings 
to house more patients is not the best policy for the State to pursue. The solution 
of these problems is not to be found with bricks and mortar but with brains. There- 
fore personnel is the important thing to be considered. What the mental hospital 
needs is the best brains that can be found in order than constructive work may be 
done getting at the causation of the different mental disorders. Therefore, the 
points of attack that promise a rich return on the investment of time and money 
in the years to come are: — 

1. Good Psychiatry. By this I mean a real, dynamic psychiatry which is more 
than a mere pigeon-holing of the patient's disease. Furthermore, if the maximum 
of effort is to be rewarded by discharging more patients there must be a broad 
catholic policy towards the representatives of other disciplines who may have 
important contributions to make to this problem. It would seem that the study 
of the patient from many points of view would offer more in the way of results 
than a single approach by a medical psychiatrist alone. The medical man will 
always be the leader of the team, but the ramifications of a psychiatric case are 
entirely too wide for him to carry on the best type of work without the proper 
assistance of specialists in other lines. Therefore, the mental hospital should 
welcome to its organization all those who have valid contributions to make in the 
field of psychiatry. There is too little understanding as to the causation of mental 
disease for any one school of thought to pronounce the last word on the matter. 

This kind of psychiatry would include careful physical work by internes and 
surgeons. It is our belief that proper medical work in mental hospitals can only 
be done by full time internists who are concerned primarily with the physical side 
of the patient. The interpretation of their findings and their place in the psy- 
chiatric condition should, of course, be the work of the psychiatrist, but to ask the 
psychiatrist to be the internist too is in our opinion too great a burden to lay on his 
shoulders. 

2. Teaching. One of the most important functions of the mental hospital is its 
teaching activities. The teaching hospital is the best hospital, and in such an 
institution patients receive better care, and the results as judged by discharged 
patients are superior to that hospital where no teaching is carried on. These 
teaching activities are important from two points of view: 

a. The presence of a number of young and enthusiastic students in the organi- 
zation does much to improve the morale of the entire organization. Their thirst 
for knowledge and their constant inquiries as why this is so and would this not be 
better, is the best antidote for institutional stasis. 



P.D. 23 31 

b. The representatives of the medical, nursing and other professions go into 
general work with a better understanding of the mental hospital and pyschiatry 
than could possibly be the case if they had not spent some time in the hospital 
organization. 

3. Research. The research program of this hospital has been carried on through- 
out the year through funds furnished by the Commonwealth and the Neuro-Endo- 
crine Foundation. Dr. R. G. Hoskins has continued to act as the Head of the 
Research Consulting Staff, and our thanks are due him for the enthusiastic cooper- 
ation which has been given. The report of the resident director of research will 
indicate that some results have been attained. Research is essential if the economic 
burden of mental disease to the world is ever to be lightened. To continue housing 
patients and caring for them without making an effort to find an adequate cause or 
methods of prevention is a foolish policy. States might very well emphasize the 
matter of research, even at the sacrifice of other material things for a period of a 
few years. If this were done, it is our opinion that much more would be accona- 
plished than would be the case if only a program of increasing accommodationsfiis 
carried on. 

Recommendations: The Worcester State Hospital is in many respects a veritable 
fire trap. Both the Summer Street Department and the Main Hospital are badly 
constructed. All of the floors are wood, the electric wiring is in many places' ex- 
posed, and the roofs and attics are of the flimsiest kind of wooden construction and 
very old and dry. A number of staircases in the main hospital are of wooden 
(ronstruction. The responsibility of the personnel in the prevention of fire is a 
great one. If a fire started in either of these buildings, great destruction of pro- 
perty would ensue, and what is even more important, loss of life would probably 
be the result. Therefore, I cannot recommend too strongly the immediate appro- 
priation of a sufficient amount of money to correct and improve this condition 
which makes the buildings of the hospital unsafe to house patients in. Adequate 
fire escapes should be placed on all parts of the building where either patients or 
employees are housed. In the nurses and attendants home, each housing one 
hundred employees and nurses, there are only wooden staircases, and no outside 
fire escapes. This obviously is a condition which should be remedied immediately. 
All buildings should have sprinklers installed in the attics at once. -i 

The porches for patients are in very bad condition. In the first place, we have 
no adequate sized porches for certain types of patients to get out into the open air. 
Those we have, small as they are, have been used until fairly recently when they 
became so unsafe that the use of them had to be stopped. They are all of wooden 
construction, arid have become so rotten that they cannot be repaired. The 
Folsom and Thayer wards need these porches very badly. In these wards are 
housed patients who are physically ill. Everything that will contribute to the 
quick recovery of a physically ill patient is important from an economic point of 
view. It costs more to care for a patient on our general hospital wards than it 
does on the psychiatric wards. Therefore, the shortening of a patient's stay on 
these wards by even one day is a real economic saving. Our tubercular patients 
who are housed on the fourth floor would be much benefited by the opportunity 
to get out into a suitable porch. The fire hazard on these wards is particularly bad. 
There is only one entrance from the main building, and there are no exits on the 
opposite end. By building these porches, a fire escape could be placed on the end 
of the building furnishing an exit which would be enclosed. Open fire escapes are 
not so good on wards caring for this type of patient as in other kinds of buildings. 
There is always the possibility of escape, and where fire escapes are enclosed this 
is minimized. 

New porches are needed on Quinby and Woodward wards. 

One of the greatest fire risks in the entire institution is in the Washburn wards, 
where the disturbed class of women patients are housed. It would be exceedingly 
difficult to get these patients off the ward without numerous exits. Fire escapes 
could be incorporated into porches on the Woodward and Washburn wards which 
would render our responsibility much less than it is at the present time should fire 
break out. 



32 P.D. 23 

The piece of land adjacent to the Summer Street Hospital which is used to raise 
asparagus on should be fenced as soon as possible. The depredation of small boys 
in the community make it advisable for a proper metal fencing to be installed. 

I would again recommend a study of the Summer Street Department, and an 
inauguration of some plan for its future development. Two courses might be con- 
sidered. First, the establishment of an admission service or a Psychopathic 
Hospital. This building would lend itself very nicely to this particular type of 
development. It would enable us to take patients from the community into the 
hospital, and discharge them directly from that building without being sent to the 
Main Hospital. If this were done, it would mean rather extensive changes. The 
building of a suitable hydrotherapy equipment would be imperative and in order 
to do this the floors of the building should be strengthened preferably by tearing 
out the wooden floors, and substituting concrete slabs. A rearrangement of the 
dining facilities would have to be made. There is the possibility for the installa- 
tion of a cafeteria food service which would be a tremendous saving in the future 
appropriations of the hospital. 

A second plan of development which might be considered would be to convert 
this institution into a Children's Department. There is throughout the state a 
need for a department or a hospital where children who are conduct problems can 
be taken for study and treatment. If this development were brought about for 
the Summer Street Department it would mean some changes, but perhaps not as 
many would be necessary to convert it into an admission building. The increased 
expense of the Children's Department would come largely in increased personnel. 
It is to be hoped that some careful thought will be given to the future of this 
historical building which fundamentally is in fairly good condition. 

Requests have been made from time to time for an appropriation to renovate 
the present farm house and convert it into an employees' building. There are several 
reasons why this should be done. It is expensive to maintain twenty patients in 
a separate building. They could be housed in the main hospital fully as well as 
they could be where they are at the present time. There is a second reason why 
this should be done. The volume of work and number of activities falling on the 
medical service, and particularly in operating room suite, have increased many 
fold in the past few years. During the past year, over 15,000 patients were cared 
for in the operating suite alone — all coming for some surgical procedure or for 
other treatment, examination or advice in one of the various clinics conducted 
there. In addition, the adjacent suites (x-ray, dental, and physical therapy) have 
been visited by approximately another 12,000 patients. This volume and variety 
of activities result in some confusion at times, and a great deal of duplication of 
work in set-ups, etc. More efficient production would result if the facilities and 
space available could be enlarged. Such an arrangement could readily be brought 
about if the present farm house were equipped with rooms for employees, thus 
freeing the rooms (now occupied by employees) adjacent to the operating room, 
for clinical use. Such space would also provide ample room for a centralized out- 
patient department for dressings, etc., eliminating from the medical wards some 
10,000 visits a year. Under this plan, with some reorganization and perhaps a 
little additional personnel, it is estimated that the operating and clinic suites could 
efficiently care for over 40,000 patient-visits per year. 

Our roads are in very bad condition and some attention should be paid at once 
to the proper surfacing of these roads. The main avenue road is in a very poor 
state of repair, and it would be my recommendation that a proper concrete surface 
be laid on this avenue road extending from the garage to the main gate. 

The repairs of the hospital have been kept up throughout the year. Keeping 
up buildings as old as the main hospital which is forty-five years old, and the 
Summer Street Department which is one hundred years old, becomes an increasing 
burden, and is increasingly costly each year. Most of the plumbing in the Main 
Hospital, and to some extent in the Summer Street Department, has had to be 
replaced, and this program is continuing. The Hooper Hall wards have been 
renovated during the year. 

The new cow barn has been functioning well and has more than proved its 
worth. The present wing houses forty-five cattle. I would recommend the 
addition of a new wing as soon as possible together with a horse barn which would 



P.D. 23 33 

enable us to do away with the unsightly old barn in which we now house our horses. 
This barn is located on the main highway between New York and Boston, and is a 
very unsightly structure. It would not pay to put very much into repairs for it. 
It is also a very serious fire risk. 

I again call attention to the necessity of giving much thought to personnel which 
is the most important factor in increasing the recovery and discharge rate of any 
hospital. The number of patients discharged from the hospital are in direct pro- 
portion to the number and quality of the personnel which is carrying on the work 
of the institution. We need more graduate nurses and better trained graduate 
nurses than we have had in the past, we need a larger medical staff, we need more 
social workers, and we need more well-trained attendants on the wards. It is a great 
mistake to be economical in this particular regard. If the hospital is to fulfill its 
function, which is the treatment and recovery of patients, it must have an adequate 
number of people to carry on. The ratio of one ward employee to eight patients 
is not an adequate one. This, of course, does not mean at all times every eight 
patients have an employee in charge of them. This includes supervisors and other 
supervising officers. It includes the night force, and out of this is to come the 
time off for our employees. I would urge that considerable thought be given to 
increasing the number of our personnel. 

I again wish to express my sincere thanks to the officers, and employees of the 
hospital for their loyalty and efficiency during the year. To the Board of Trustees, 
I am deeply grateful. Their constant encouragement and support have been a 
.source of great strength and they have been at all times ready to give freely of their 
time and experience. 

Respectfully submitted, 

WILLIAM A. BRYAN, 

Superintendent. 

VALUATION 

November 30, 1932 
Real Estate 

Land, 589.16 acres $467,130.00 

Buildings 2,096,495.46 

$2,563,625.46 

Personal Property 

Travel, transportation and office expenses 8,155.04 

Food 19,484.24 

Clothing and materials 30,023.10 

Furnishings and household supplies 276,238.52 

Medical and general care 48,453.67 

Heat and other plant operation 3,598.90 

Farm 58,077.4 

Garage and grounds 11,673.16 

Repairs 18,732.86 

$474,436.89 
Summary 

Real estate $2,563,625.46 

Personal property . . . _ ......... . . 474,436.89 

$3,038,062.35 

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, 1932. 

Cash Account 
Receipts 
Income 

Board of Patients $81,246.09 

Personal Services: 

Reimbursement from Board of Retirement 293.83 

Food $1,586.10 

Clothing and materials 17.55 

Furnishings and household supplies 18.45 

Medical and general care 147.37 

Heat and other plant operation 36.98 



34 



P.D. 23 



Farm: 

Cows and calvjs 200.62 

Pigs and hogs 128.00 

Hides 14.22 

Vegetables 18.85 

Repairs, ordinary 9.55 

Total sales $2,177.69 

Miscellaneous: — 

Interest on bank balances $344.35 

Rent 1,078.00 

1.422.35 

Total income $85,139.96 



M.-VINTENANCE 

Balance from previous year, brought forward . $44,028.80 

Appropriations, current year: Maintenance 774,700.00 

Total $818,728.80 

Expenses (as analysed below) 752,602.45 

Balance reverting to Treasury of Commonwealth $66,126.35 

Analysis of Expenses 

Personal services $433,721.11 

Religious instruction 2,540.00 

Travel, transportation and office expenses 9,786.77 

Fo'od 112,227.02 

Clothing and materials 16,665.30 

Furnishings and household supplies 27,354.04 

Medical and general care 21,587.75 

Heat and other plant operation 75,527.28 

Farm 22,906.52 

Garage and grounds 4,620.54 

Repairs ordinary 15,388.22 

Repairs and renewals • 10,277.90 

Total e.xpenses for Maintenance 752,602.45 

Special Appropriations 

Balance December 1, 1931 $11,891.30 

Appropriations for current year - 

Total $11,891.30 

Exp.ended during the year (see statement below) $11,548.99 

Reverting to Treasury of Commonwealth 56.36 

11,605.35 

Balance November 30, 1932, carried to ne.xt year 285.95 



Object 


Act or 

Resolve 

Chap. Act 


Whole 
Amount 


Expended 

during 
Fiscal Year 


Total 

Expended 

to Date 


Balance 
at End 
of Year 


Officers' apttages 1929 .... 

Improvements, heating system . 

New boilers 

Equipment dairy and cow barns 
Renovating heating system 
Furnishings officers' cottages 


146-1929 

1931 
115-1930 
115-1930 
14-1931 
245-1931 
245-1931 


$19,000.00 

10,000.00 
13,500.00 
20,000.00 
12,000.00 
3,000.00 


$1,405.43 

1,775.00 

32.90 

5,890.07 

2,445.59 


$18,999.49 

9,982.50 
13,461.14 
19,957.58 
11,954.44 

2,802.54 


.51 

17.50* 
38.86* 
42.42 
45.56 
197.46 




$77,500.00 


$11,548.99 


$77,157.69 


$342.31 



Balance reverting to Treasury of the Commonwealth during year (mark item with *) . . $56.36 
Balance carried to next year 285.95 



Total as above $342. .31 

Per Capita 
During the year the average number of inmates has been 2,216.38. 
Total cost of maintenance, $752,602.45. 
Equal to a weekly per capita cost of $6.5301. 
Receipt from sales, $2,177.69. 
Equal to a weekly per capita of $.0189. 
All other institution receipts, $82,962.27. 
Equal to a weekly per capita of $.7199. 
Net weekly per capita $5.7913. 



Respectfully submitted, 

MARGARET T. 



CRIMMINS, 

Treasurer. 



P.D. 23 35 

STATEMENT OF FUNDS 

Patients' Fund 

Balance on hand November 30-, 1931 $16,554,48 

Receipts 18,468.61 

Interest 454.33 

$35,477.42 

Expended 24,875.95 

Interest paid to State Treasurer 454.33 

25,330.28 

$10,147.14 
Investments 

WorcJester County Institution for Savings 1,500.00 

Worcester Five Cents Savings Bank . . 1,500.00 

Worcester Mechanics Savings Bank . 1,500.00 

Peoples Savings Bank 2,000.00 

Bay State Sa'vings Bank . 2,000.00 

Balance Worcester Bank and Trust Company 1,465.52 

Cash on hand December 1, 1932 181.62 

■ $10,147.14 

Canteen Fund 

Balance on hand July 12, 1932 $1,924.95 

Receipts 4,952.04 

$6,876.99 

Expended 5,693.42 

$1,183.57 
Inveslvients 

Worcester Bank and Trust Company $937.17 

Cash on hand December 1, 1932 246.40 

$1,183.57 

Lewis Fund 

Balance on hand November 30, 1931 $1,334.30 

Income 52.00 

. — $1,386.30 

Expended 33.05 

$1,353.25 
lyiveslments 

Worcester Five Cents Savings Bank $1,300.00 

Balance Worcester Bank and Trust Company 53 . 25 

$1,353.25 

Wheeler Fund 

Balance on hand November 30, 1931 $1,078.32 

Income 46.55 

— • $1,124.87 

Expended 112.51 

$1,012.36 
InvesiTnenls 

Worcester Mechanics Savings Bank $1,000.00 

Balance Worcester Bank and Trust Company 12.36 

$1,012.36 

Manson Fund 

Balance on hand November 30, 1931 $1,095.62 

Income 20.02 

$1,115.64 

Expended 90.49 

$1,025.15 
Investments 

Millbury Savings Bank $1,020.00 

Balance Worcester Bank and Trust Company 5.15 

$1,025.15 

Clement Fund 

Balance on hand November 30, 1931 $1,000.00 

Income 39.98 

$1,039.98 

Expended , 39.98 

$1,000.00 
Investm.ents 
Worcester County Institution for Savings $1,000.00 

Respectfully submitted, 

MARGARET T. CRIMMINS, 

Treasurer. 
November 30, 1932. 



36 P.D. 23 

STATISTICAL TABLES 

As Adopted by the American Psychiatric Association 

Prescribed by the Massachusetts Department of Mental Diseases 

'■■ ' ■ Table 1. — General Information 

Data correct at end of hospital year November 30, 1932 
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 $2,563,62.'5.46 

Personal property 474,436.89 

Total $3,038,062.35 

Total acreage of hospital property owned: 589. 16. 

Additional acreage rented: 400. 

Total acreage under cultiviation during previous year: 175. 

4. Officers and employees: 

Actually in Service Vacancies at End 

of End Year of Year 

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

Superintendent 1 - 1 - - - 

Assistant physicians 11 1 12 - - - 

Clinical assistants ......1 - 1 1 - 1 

Total physicians 13 1 14 1 - 1 

Stewards 1 - 1 - - — 

Resident dentists ....... - - 1 - 1 

Pharmacists 1 - 1 - - - 

Graduate nurses - 38 38 1 - 1 

Other nurses and attendants ... 98 131 229 - 33 

Occupational therapists - 5 5 - - - 

Social workers - 4 4 - - - 

All other officers and employees . . . Ill 72 183 10 1 11 

Total officers and employees . . . 224 251 475 13 4 17 

Note: — The following items. 5-lOinclusive, are for the year ended September 30, 1932 . 

5. Census of patient population at end of year. 

Absent from Hospital 
White: Actually in Hospital but Still on Books 

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

Insane 1,026 1,057 2,083 183 217 400 

Alcoholics 3 - 3 - - - 

All other cases 6 5 11 2 - 2 

Total 1,035 1,062 2,097 185 217 402 

Other Races: 

Insane 21 18 39 1 3 4 

Total 21 18 39 1 3 4 

Grand Total 1,056 1,080 2,136 186 220 406 

M. F. T. 

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

cluding physical training, on date of report 103 95 198 

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

report 688 442 1,130 

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

year 1,070.12 1,112.55 2,182.67 

9. Voluntary patients admitted during year 3 3 6 

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

year 183 132 315 

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, 1932. 



P.D. 23 



37 



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38 P.D. 23 

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











Parents of Male 


Paren 


TS OF Female 


Nativity 


P 


\TIENTS 




Patients 




Patients 










Both 




Both 




M. 


F. 


T. 


Fathers Mothers Parents 


Fathers 


Mothers Parents 


United States 


156 


150 


296 


76 72 61 


76 


72 59 


Austria . 






2 


- 


2 


2 2 2 


— 


- - 


Belgium . 






- 


- 


- 


1 1 1 


- 


- - 


Canada i 






26 


17 


43 


36 40 32 


39 


34 28 


Denmark 






- 


2 


2 


_ _ _ 


2 


2 2 


England . 






S 


5 


10 


10 9 5 


6 


8 5 


Finland . 






2 


5 


7 


2 2 2 


6 


5 5 


France . 






1 


- 


1 


4 2 2 


2 


1 1 


Germany 






2 


2 


4 


4 3 3 


4 


1 1 


Greece 






2 


1 


3 


2 2 2 


1 


1 1 


Holland . 






1 


- 


1 


1 1 1 


— 


- - 


Ireland . 






16 


15 


31 


48 48 42 


32 


41 31 


Italy 






13 


7 


20 


16 18 16 


11 


11 11 


Norway . 






2 


- 


2 


2 2 2 


- 


- - 


Philippine Islands 






- 


- 


- 


- 2 - 


1 


2 


Poland . 






11 


8 


19 


11 10 10 


9 


8 8 


Portugal . 






3 


4 


7 


4 4 4 


4 


5 4 


Russia . 






6 


6 


12 


12 11 11 


8 


9 8 


Scotland 






6 


1 


7 


7 7 6 


2 


2 1 


Sweden . 






11 


5 


16 


14 12 12 


10 


10 9 


Turkey in Asia 






1 


1 


2 


_ _ _ 


1 


I 1 


Turkey in Europe 






- 


1 


1 


- - - 


1 


1 1 


Wales . 






- 


- 


- 


1 1 1 


- 


- — 


West Indies^ . 






2 


- 


2 


3 2 2 


- 


- - 


Other countries 






10 


3 


13 


10 11 10 


4 


4 4 


Unascertained 






2 


- 


2 


14 18 12 


4 


5 4 


Total 






280 


223 


503 


280 280 239 


223 


322 184 



'Includes Newfoundland 



^Except Cuba and Porto Rico. 



39 



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1 1 — 1 1 -H 1 1 1 1 1 1 


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




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a 


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to 


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to 




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0) 




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O 


ro 


't 




fc 


^_H_roin— —ctN^w 


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tvi 






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o 


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S 


"'"'"""'"'"'"'"""" 


rf 


00 


^ 




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a 




o 

o 






03 


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"^ >>>,>,>,>.>>>.>.>,>. >,t 


O 


pa 

■a* 






o;0^•^tC^tl^C^Tt•O^Tt>C^Tt^O^ ? 

S 1 1 1 1 1 T 1 1 1 1 1 >■ 
►^lOOuiOulOiOOioOiOO 


fc H 




a 






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1 



40 



P.D. 23 



Table 5. — Citizenship of First Admissions 



M. 

Citizens by birth 156 

Citizens by naturalization 52 

Aliens 51 

Citizenship unascertained 21 

Total 280 



F. 


T. 


140 


296 


28 


80 


30 


81 


25 


46 



Table 6. — Psychoses of First Admissions 



M. F. T. M. F. 



10. 



Traunatic psychoses 

Senile psychoses .... 

Psychoses with cerebral arteriosclerosis 

General paralysis .... 

Psychoses with cerebral syphilis 

Psychoses with Huntington's chorea 

Psychoses with brain tumor 

Psychoses with other brain or nervous diseases, total 

Multiple sclero-sis 

Other diseases 

Alcoholic psychoses, total. 

Delirium tremens 

Acute hallucinosis 

Other types, acute or chronic 
Psychoses due to drugs and other exogenous 

toxins 

Psychoses with pellagra .... 
Psychoses with other somatic diseases, total 

Post-infectious psychosis 

Other diseases or conditions 
Manic-depressive psychoses, total . 

Manic type 

Depressive type 

Other types 

Involution melancholia .... 
Dementia praecox (schizophrenia) . 
Paranoia or paranoid conditions 

Epileptic psychoses 

Psychoneuroses and neuroses, total 

Hysterical type 

Psychasthenic type (anxiety and obsessiv( 

Neurasthenic type .... 

Other types 

Psychoses with psychopathic presonality 
Psychoses with mental deficiency . 
Undiagnosed psychoses .... 
Without psychosis, total .... 

Mental deficiency without psychosis . 

Others 



toxins, other exogenou 



forms) 



4 
44 
20 



It 

34 

6 

3 



7 
41 
18 

1 
15 



3 
35 
S7 
34 
10 



6 10 16 

34 8 42 



1 1 

- 2 2 
12 17 29 



13 IS 28 



11 
85 
38 
1 
20 



7 
21 
23 
10 



Total 



280 223 503 



P.D. 23 41 

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



African (black) 

Armenian. 

Dutcli and Flemisli 

English 

Finish 

French 

German 

Greek 

Hebrew 

Irish 

ItaUan' 

Lithuanian 

Pacific Islander 

Portuguese 

Scandinavian ^ 

Scotch 

Slavonic ' 

Syrian 

Turkish . 

Other specific races 

Mixed 

Race unascertained 

Total 



Total 



2 
1 

10 
2 

31 
2 
2 
7 

49 

17 
5 
2 
4 

14 
7 

14 

1 

3 
92 

7 



T. 



3 
9 

25 
8 

25 

1 

3 

3 

179 

12 



503 



Traumatic 



Senile 



M. F. T. 



1 3 4 

2 1 3 



1 1 

2-2 



9 5 14 
1 3 4 



With cerebral 
arterio- 
sclerosis 



M. F. T. 



.^ - 3 
3 - S 
2-2 



20 13 33 
1 - 1 



53 34 87 



General 

paralysis 



M. F. T. 



- 2 

- 2 



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



Race 



African (black) 

Armenian . 

Dutch and Flemish 

English 

Finnish 

French . 

German 

Greek . 

Hebrew 

Irish 

Italian i 

Lithuanian . 

Pacific Islander 

Portuguese . 

Scandinavian 2 

Scotch 

Slavonic ' . 

Syrian 

Turkish 

Other specific races 

Mixed . 

Race unascertained 

Total . 



With 
cerebral 
syphilis 



M. F. T. 



1 - 1 
1 - 1 



1 - 1 

3 2 5 



With other 
brain or 
nervous 
diseases 



M. F. T. 



1 1 

-22 
1 1 



Alcoholic 



M. F. T. 



34 



Due to drugs 

and other 

exogenous 

toxins 



M. F. 



With 
pel'agra 



M. F. T. 



With 

other 

somatic 

diseases 



M. 



F. T. 
1 1 



1 1 

1 5 



^Includes "North" and "South." 
^Norwegians, Danes and Swedes. 

^Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravin, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 



42 



P.D. 23 



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



Race 



Manic- 
depressive 



Involution 
melancliolia 



Dementia 
praecox 



Paranoia 

and 
paranoid 
conditions 



Epileptic 
psychose 



African (black) . 

Armenian 

Dutch and Flemish 

English 

Finnish . 

French . 

German 

Greek . 

Hebrew 

Irish 

Italian i 

Lithuanian . 

Pacific Islander . 

Portuguese . 

Scandinavian - 

Scotch . 

Slavonic ' 

Syrian . 

Turkish 

O.ther specific races 

Mixed . 

Race unascertained 

Total . 



M. F. T. 



M. F. T. 
1 1 



M. F. T. 
2-2 



M. F. T. 
1 - 1 



M. F. T. 



1 2 
3 3 
1 6 



1 1 

3 3 6 

1 1 

1 1 



2 5 
4 12 

3 5 



1 

1 1 



1 - 1 

2 4 6 
1 - 1 

3 2 5 



1 1 
2-2 
1 - 1 

1 1 



1 

4 3 



13 21 34 
3-3 



44 41 85 



20 18 38 



- 1 1 



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



Race 


Psycho- 
neuroses and 
neuroses 


With 
psychopathic 
personality 


With mental 
deficiency 


Undiagnosed 
psychoses 


Without 
psychoses 


African (black) 

Armenian . . . . 
Dutch and Flemish 

English 

Finnish 

French 

German 

Greek 

Hebrew 

Irish 

Italian 1 

Lithuanian . . . . 
Pacific Islander . . . 

Portuguese 

Scandinavain 2 . . . . 

Scotch 

Slavonic ^ . . . . . 

Syrian 

Turkish 

Other specific races 

Mixed 

Race unascertained 


M. F. T. 


M. F. T. 


M. F. T. 
1 - 1 


M. F. T. 
1 - 1 


M. F. T. 












1 2 3 


_ _ _ 


1 - 1 

2 1 3 


1 - 1 
1 - 1 

1 2 3 


1 1 






















1 1 
1 - 1 


_ _ _ 


1 1 2 
1 1 2 


2-2 
1 - 1 


2-2 
1 1 












11 
1 1 2 










1 1 














1 1 


- - - 


1 1 


- 2 2 


1 - 1 




















2 8 10 
1 1 


3 2 5 
1 1 


4 7 11 


5 6 11 
1 - 1 


1 2 3 


Total 


5 15 20 


3 4 7 


10 11 21 


13 10 23 


4 6 10 



'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 43 

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



Psychoses 



Traumatic 

Senile 

Witli cerebral arteriosclerosis 

General paralysis 

With cerebral syphilis .... 
With Huntington's chorea . 

With brain tumor 

With other brain or nervous diseases . 

Alcoholic 

Due to drugs and other exogenous 

toxins 

With pellagra 

With other somatic diseases . 

Manic-depressive 

Involution melancholia. 

Dementia praecox .... 

Paranoia and paranoid conditions 

Epileptic psychoses .... 

Psychoneuroses and neuroses 

With psychopathic personality . 

With mental deficiency. 

Undiagnosed psychoses. 

Without psychosis 



Total 



Total 



280 223 503 



T. 



Under 15 
vears 



M. F. 



15-19 

years 



20-24 
years 



M. F. 



5 17 21 13 34 



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



Psychoses 



Traumatic 

Senile .... 

With cerebral arteriosclerosis 

General paralysis . 

With cerebral syphilis . 

With Huntington's chorea 

With brain tumor 

With other brain or nervous 

diseases 
Alcoholic 
Due to drugs and other exo 

genous toxins 
With pellagra 

With other somatic diseases 
Manic-depressive . 
Involution melancholia 
Dementia praecox 
Paranoia and paranoid con 

ditions 
Epileptic psychoses 
Psychoneuroses and neuroses 
With psychopathic person. 

ality .... 
With mental deficiency . 
Undiagnosed psychoses 
Without psychoses 

Total 



25-29 
years 



M. F. 



6 5 11 

2-2 



30-34 
vears 



25 14 39 



3.5-39 
years 



10 



4 0-44 
years 



M. F. T. 



1 4 5 

3 3 6 
1 2 3 
1 9 10 

4 7 11 



45-49 

years 



M. F. T. 



2 4 6 

2 1 3 

1 1 

- 2 2 



21 14 35 



44 



P.D. 23 



Table 8. — Age of First Admissions Classified with Reference to Princi-pal 
Psychoses — Concluded 



Psychoses 


50-54 
years 


55-59 
years 


60-64 
years 


65-69 
years 


70 years 
and over 


1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis . 

5. Witii cerebral ovphilis . 

6. With Huntington's chorea . 

7. With brain tumor 

8. With other brain or nervous 

diseases .... 

9. Alcoholic .... 
10. Due to drugs and other e.xo- 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


2 2 4 
4 2 
1 1 2 


6 9 15 

2-2 
1 1 2 


1 1 2 
11 5 16 

2-2 
1 1 2 


2-2 
9 6 15 


18 13 31 

25 12 37 












2 A 

5 16 


- 2 2 
1 1 2 


- 2 2 
2-2 


- - - 


- 1 1 
1 - 1 


11. With pellagra 

12. With other somatic diseases. 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia praecox 

16. Paranoia and paranoid con- 

ditions .... 

17. Epileptic psychoses 

1 8. Psyclioneuroses and neuroses 

19. with psychopathic person- 

ality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. With psychosis 












1 2 3 

2 2 4 

1 4 5 

2 1 3 


3 1 4 

1 - 1 

2 3 5 
1 1 2 

1 3 4 


1 - 1 
1 - 1 


3 1 4 
1 - 1 


_ — _ 


3-3 


1 - 1 


1 - 1 


1 - 1 


1 - 1 


- 2 2 


- - - 


- - - 












_ _ ■_ 


2 2 4 
1 - 1 


2 2 4 


1 - 1 

- 2 2 


4 3 7 
1 1 


Total .... 


21 17 38 


22 23 45 


24 13 37 


17 10 27 


49 30 79 



45 









I^OC^-^i ICS^I IPOI tf^CMI l^C*^\OCN 


X 






H 


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1 -iTO 1 1 i 1 ^ 1 1 1 fO 1 1 M-H 1 1 -i-wrq-H 


o 




D 


^ 


Iior-<M--| 1 I'rfl 1 1 1 |U-)-H| 1 |-H-*-H 


X 






H 


1 r-fv) 1 -H Ill -H-, 1 ^ 1 1 1 1 


X 




V 








tn 














1— l^l'-clllllljll-^'^l—llill 


o 




^ 


b 








o 










U 








CO 




^ 


1 I ^ 1 1 1 1 1 i 1 1 1 1 1 1 1 1 -^ 1 1 1 1 


!M 


<» 








C/3 


















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1 '^CO'^'-^ 1 1 (N<M^^wr<:^^^0 1 rr^ r*^ | r^*-* 




li 




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a. 


t/) o 


fe 


I—-*! 1 1 l^l-^-rtlO — — r^lrotNlco-H 




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l<MTfrO-<l 1— iMI |rtt^« — rPl l-<l I 1 


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r^iOOOioOl |OvC>l''-tTt*^Q0^i^— ^'rfMr^'MO 


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1 vo— <OCN 1 1 OiO 1 ^LOC^O-*^^— ^ 1 00-^^ 


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tin 


IINtKI I 1 1 1(NI |-M|tNr^| 1 1— -H-H 


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fOLOt--Tt<0 1 lO'^J^OJO'X-^u", 00^Or--^'^O 


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CO 




H 


fn X ro w ^^ CM CN *- X fO C^ CN CM ^ 


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1 -^-^OrO 1 1 OX«r.lr^Lcr^ — X-HLO^rtOvO 


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b 


« ro — . _^ ^ — c « wrt 


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^v* 






f^-iroxr~l lO-rfl l^lro-CTfOlu^c^O'O-* 


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(NIO^ ro -- rt"-^ — — 












o 










s 










o 










•r^ 




















e 










u 










s 










-e 










fe) 










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o 










<» 










<u 










>~ 










C)> 










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Q 


w 




"S 

S 2 




oi 


i 




S ■§ 2 • 




W 


u 




.......^.|. ...:l..^... 




>J 


>■ 






pq 


fc 




S s o S ^ •-« ca 




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• • fe • • £i • > ■ ^ • S • • ■ S ■ S i 
■^ '^° S 1 ;s = ^ Ste&i 

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46 



P.D. 23 



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

Psychoses ' \ 



Traumatic . ; 

Senile . . . . .' 
With cerebral arteriosclerosis 
General paralysis . .• . . . 
With cerebral syphilis .... 
With Huntington's chorea 

With brain tumor 

With other brain or nervous diseases 

Alcoholic 

Due to drugs and other exogenous to.xins 
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 



Tota' 280 



Total 



M. 

3 
21 

53 
28 



16 
42 

1 

2 
29 
28 
11 
85 
38 

1 
20 

7 
21 
23 
10 



Urban 



3 

19 
50 

27 

7 



12 

33 

6 

3 



5 
33 



12 
13 
4 
44 
20 

5 
3 
9 
12 
3 



1 

17 
15 

6 
40 
18 

1 
14 

4 
11 

9 

6 



503 269 213 482 U 10 2 



Rural 



M. F. T. 



2 4 i 

1 4 1 

1 I 



Table 11. — Economic Condition of First Admissions Classified with Reference 

to Principal Psychoses 



Psychoses 


Total 


Dependent 


Marginal 


Com- 
fortable 


Unascer- 
tained 


1. Traumatic 

2. Senile .... 

3. With cerebral arterio- 

sclerosis 

4. General paralysis . 

5. With cerebral syphilis . 

6. With Huntington's chorea 

7. With brain tumor . 

8. With other brain or nerv- 

ous diseases 

9. Alcoholic .... 

10. Due to drugs and other 

e-xogenous toxins . 

11. With pellagra . 

12. With other somatic dis- 


M. 

3 
21 

53 
28 

6 
34 

12 

13 

4 

44 

20 

5 

3 
10 
13 

4 


F. 

14 

34 
6 

3 

~ 

10 
8 

1 

17 

15 

7 

41 

18 
1 

15 

4 
11 
10 

6 


T. 

3 
35 

87 
34 
10 

16 

42 

1 
2 

29 
28 
11 
85 

38 
1 

20 

21 
23 
10 


M. F. T. 

5 3 8 

6 3 9 
2-2 
1 - 1 

3 2 5 
1 - 1 

1 1 

5 1 6 

6 2 8 

1 1 

1 1 2 

2 1 3 
1 - 1 
1 2 3 


M. F. T. 

3-3 
15 10 25 

46 30 76 

24 6 30 

5 3 8 

3 8 11 
31 8 39 

1 1 

- 2 2 

12 16 28 

13 15 28 

4 7 11 
37 39 76 

13 15 28 
1 1 

5 14 19 

2 3 5 

8 10 18 

9 8 17 

3 4 7 


M. F. T. 


M. F. T. 

1 1 2 

1 1 2 
"> - 2 
1 - 1 


- - - 


2-2 










13. Manic-depressive . 

14. Involution melancholia . 

15. Dementia praecox . 

16. Paranoia and paranoid 

conditions . 

17. Epileptic psychoses 

18. Psychoneuroses and neu- 










1 - 1 


1 1 2 
1 1 2 






19. With psychopathic per- 

sonality 

20. With mental deficiency . 

21. Undiagno.t-ed psychoses . 

22. Without psychoses 






_ _ _ 


3 2 5 






Total. 


280 


223 


503 


34 17 51 


233 200 433 


1 - 1 


12 6 18 



P.D. 23 



47 



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

Principal Psychoses 



Psychoses' 




Total 




Abstinent 


Temperate 


Intemperate 


Unascer- 
tained 


i 


M. 


F. 


T. 


M. 


F. 


T. 


M. F. T. 


M. 


F. 


T. 


M. 


F. T. 


1. Traumatic 


3 


_ 


3 


2 


_ 


2 


1 - 1 


_ 


_ 


_ 


_ 


_ 


2. Senile 


21 


14 


35 


7 


10 


17 


7-7 


2 


- 


2 


5 


4 9 


3. Witli cerebral arterio- 


























sclerosis 


53 


34 


87 


14 


28 


42 


23 3 26 


10 


- 


10 


6 


3 9 


4. General paralysis . 


28 


6 


34 


7 


3 


10 


14 3 17 


5 


- 


5 


2 


2 


5. With cerebral syphilis 


7 


3 


10 


- 


1 


1 


2 2 4 


3 


- 


3 


2 


2 


6. With Huntington's 


























chorea . 


- 


- 


- 


- 


- 


- 


_ _ _ 


— 


- 


- 


- 


- - 


7. With brain tumor . 


- 


- 


- 


- 


- 


- 


_ _ _ 


- 


- 


- 


- 


— — 


8. With other brain or 


























nervous diseases . 


6 


10 


16 


3 


8 


11 


2 1 3 


1 


1 


2 


- 


- — 


9. Alcoholic . 


34 


8 


42 


- 


- 


- 


_ _ _ 


34 


8 


42 


- 


- — 


10. Due to drugs and 


























exogenous toxins 


- 


1 


1 


- 


1 


1 


- - - 


— 


- 


- 


- 


- — 


11. With pellagra . 


- 


2 


2 


- 


1 


1 


- - - 


- 


1 


1 


- 


— — 


12. With other somatic 


























diseases. 


12 


17 


29 


7 


14 


21 


5 1 6 


- 


1 


1 


- 


1 1 


13. Manic-depressive . 


13 


15 


28 


4 


12 


16 


7 3 10 


2 


- 


2 


- 


— — 


14. Involution melan- 


























cholia . . 


4 


7 


11 


2 


7 


9 


2 - 2 


- 


- 


- 


— 


- — 


15. Dementia praecox . 


44 


41 


85 


25 


31 


56 


10 8 18 


3 


1 


4 


6 


1 7 


16. Paranoia or paranoid 


























conditions . 


20 


18 


38 


6 


14 


20 


8-8 


3 


- 


3 


3 


4 7 


17. Epileptic psychoses . 


- 


1 


1 


- 


1 


1 


_ _ _ 


- 


- 


- 


- 


- - 


18. Psychoneuroses and 


























neuroses 


5 


15 


20 


1 


12 


13 


4 2 6 


- 


1 


1 


- 


— — 


19. With psychopathic 


























personality . 


3 


4 


7 


2 


2 


4 


1 1 2 


- 


1 


1 


- 


— - 


20. With mental defi- 


























ciency . 


10 


11 


21 


5 


7 


12 


1 2 3 


3 


- 


3 


1 


2 3 


21. Undiagnosed psy- 


























choses . 


13 


10 


23 


5 


9 


14 


3,-3 


3 


- 


3 


2 


1 3 


22. Without psychosis . 


4 


6 


10 


2 


4 


6 


- - 


1 


- 


1 


1 


2 3 


Total . 


280 


223 


503 


92 


165 


257 


90 26 116 


70 


14 


84 


28 


18 46 



48 







H 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 r<^ 1 1 1 1 1 1 1 


I^J 




St3 










O 11 










s-s 


tii 


1 1 1 1 I 1 1 1 1 I [ 1 1 1 1 ] 1 1 1 1 1 1 






c 5 




















^ 


S 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 rO 1 1 1 1 1 1 1 


(^ 






H 


liMrs"(Mi 1 \ ^ \ l^l-^rot^lcsl |-H| 


rj 




TJ 




CN 














U 










o 


fe 


1 l-HltNl 1 1 1 1 I^I^^OII^I 1 I 1 


Cv 




> 










s 


S 


ICN— — 1 1 1 1^1 1 1 1 icq— |w| |-H| 


12 


K 










<» 










cc 






1 1 1 1 1 1 l^^l ICN^I^^I^I^I 1 


0\ 


O 


T3 


H 








CTj 








Si 


Gl 


fc 


1 1 1 1 1 1 l--^-"! I<N1 1— 1 l-Hl— 1 1 


'"^ 


(1, 


c. 








,^ 


w 


S 


1 1 1 1 1 1 i 1 1 1 1 1 -rt 1 1 -H 1 1 1 1 1 1 


rj 


e 










fi, 










•^ 




H 


|00I^'O-H 1 l—Tji 1— lo^tN^T). |rt 1— VCIN 


c> 


tj 


•T3 






_S 


V 










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^ 


o 


fc 


l-^^-il 1 l-H| I'rfrt — «rN!N|— 1— LCr^ 


I^ 


Ds 


•a 


-- 


Ti- 


o 


S 


It^ro^— 1 1 1^1 l^l-<|o)l 1 1 1— 1 


ro 
















1 -nO — Ti" 1 1 ^0«-<— iTtt^OOOO — Ot^Csl'H — 


lO 




H 


-rt">l M «-H -H-i -H « 


o 


T3 






CN 


.'^ 


.i; 








'^ 


t: 


fe 


1 <N ts -j. -1 1 1 (V)r^ — 1 w 1/^ OV -^IfllO -<>0 N-H •*— • 


CC 


D= 










-g 


1§ 


|C\00t^r^l I'rtC-l lOOr^, forol'*-^ — t^l 


;:; 


•^ 










g 
























^^T)>00=^-OI ICt^l IC — — 00O)|-O-*t^lOt^ 


lO 




H 


_ „ „ „ 1/5 rt _ 


00 


!5 


V 


















CO 


C 


fc 


1— 't^— 1 1 ItOI 1 |iotn — r-lo>|>OCSCO-HrO 




C 


M 








O 




S 




o 




















O 






rOLor^-fC 1 1 VD ^ — c (MC. CO — LO 00-rt o t^ — ■roO 


t^ 


05 




h 


"5 00 ro — ■« ^ (-<icq— ■OOfO (N INr)"-! 


o 
in 


CO 










•cO 












"rt 




1 TfrfO^. 1 1 OOC— tNt^lOt^-HOO— H/5'<1<'-'0>0 


fo 


■TS 


o 


fc 


— ~; — — — rf — — — -H 


(S 


^ 


H 






M 


CO 




(V5 — ~5oor~.( lO-tl |!Mro-*'*0|iO<*)0<»>Tt 


o 


r*: 




i 


(Nl/^OJ ro -Hrt^eN — -H 


CO 




















o 










CO 










S 










o 










•<s> 




















•^ 










•TS 










s 










o 










O 










3 










•^ 










*- 










e 






„ 




:§ 


H 

o 




C 

... >< 

m ■ O 

M §•-••• 

• -7. • • • -g -g -^ ■ ■ -^ -8:= • • • 




CO 
1—1 

H 

PQ 


a; 
o 
>■ 






Eh 






^ »2 g fc .2 .2 -o g£>.S 
g^o2" = -° ooocoiSgo^oaEMg 










2 
o 




'«' CS r^ ■* in O t-^ «' ol d -J oj ro -+ lO O t-' CO Ov O — " «N 








— rt — „rt— .^rt — _IMC^(^J 





P.D. 23 



49 



Table 14. — Psychoses of Readmissions 



Psychoses 



M. 



1. Traumatic psychoses 1 

2. Senile psychoses 1 

3. Psychoses with cerebral arteriosclerosis 4 

4. General paralysis 4 

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. Psychoses due to drugs and other exogenous toxins - 

11. Psychoses with pellagra " 

12. Psychoses with other somatic diseases 1 

13. Manic-depressive psychoses 9 

14. Involution melancholia 1 

15. Dementia praecox 20 

16. Paranoia and paranoid conditions 4 

17. Epileptic psychoses - 

18. Psychoneuroses and neuroses "" 

19. Psychoses with psychopathic personality 1 

20. Psychoses with mental deficiency 1 

21. Undiagnosed psychoses - 

22. Without psychosis " 

Total 57 




Table 15. 



Discharge of Patients Classified tuith Reference to Principal Psychoses 
and Condition on Discharge 



Psychoses 




Total 


Recovei 


ed 


Im 


pro\ 


ed 


Unimproved 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic 


_ 


_ 


_ 


_ 


_ 


_ 


- 


- 


- 


- 


- 


- 


2. Senile 


7 


9 


4 


- 


- 


- 


1 


1 


2 


1 


1 




3. With cerebral arteriosclerosis . 


9 


6 


15 


2 


- 


2 


7 


6 


13 


- 


- 


- 


4. General paralysis .... 


4 


1 


5 


- 


- 


- 


3 


1 


4 


1 


- 


1 


5. With cerebral syphilis 


- 


1 


1 


- 


- 


- 


- 


- 


- 


- 






6. With Huntington's chorea 


- 


- 


- 


- 


- 


- 


- 


- 


- 


— 


- 


~ 


7. With brain tumor .... 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


8. With other brain or nervous diseases 


1 


1 


3 


- 


- 


- 


1 




3 


- 


- 


- 


9. Alcoholic ...'... 


32 


6 


38 


/ 


2 


9 


24 


4 


28 


1 


- 


1 


10. Due to drugs and other exogenous 


























toxms 


1 


- 


1 


1 


- 


1 


- 


- 


- 


- 


- 


- 


11. With pellagra 


- 


_ 


_ 


- 


- 


- 


- 


- 


- 


- 


- 


~ 


12. With other somatic diseases . 


4 


.■) 


9 


-> 


2 


4 


2 


2 


4 


- 


1 


J 


13. Manic-depressive .... 


20 


29 


49 


2 


3 


5 


15 


20 


41 


3 


- 


3 


14. Involution melancholia 


5 


4 


9 


- 


- 


- 


3 


4 


7 




- 




15. Dementia praecox .... 


41 


31 


72 


2 


1 


3 


31 


29 


61 


V 


1 


8 


16. Paranoia and paranoid conditions . 


9 


9 


18 


4 


1 





4 


5 


9 


1 


3 


4 


17. Epileptic psychoses .... 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


18. Psychoneuroses and neuroses . 


5 


8 


13 


1 


2 


3 


3 





8 


1 


I 




19. With psychopathic personality 


8 


11 


19 


2 


3 


5 


4 


7 


11 




1 


3 


20. With mental deficiency 


10 


4 


14 


- 


2 


2 


8 


1 


9 


2 


1 


■i 


21. Undiagnosed psychoses . 


1 


1 


2 


- 


- 


- 


1 


1 




- 


- 


- 


22. Without psychosis .... 
Total 


3 


5 


8 


- 


- 


- 


- 


- 


- 


-" 


~ 


~ 


155 


125 


280 


23 


16 


39 


lOS 


94 


202 


21 


10 


31 



50 



II — ^ 






tsro — < I 



a ca 
OS 












I I 

I — 



re vo u^ I 



. ^H »-< r^ ^H CN ^— r 



1 c^l r- irj I I I ^ « I 




s l-[ ^ 



EO 



■w'3'5. 

Ro o ^ 
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03 o O >3- 

>> D 3 >; 
HHHw 



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C2 S P 



0.5.2 



^ ^ 



OJ 






« o aj -w 



^- 2^ 



CC _j sn .^ ^ 
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c:S-goS 









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s g 
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P.D. 23 



51 









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a; 







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nj 


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a 


c 


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56 ' P.D. 23 

Table 19. — Family Care Department 

Male Female Total 

Remaining in Family Care September 30, 1931 2 18 20 

On visit from Family Care September 30, 1931 . - , - - 

Admitted during the year ' 13 

Whole number of cases during the year . . , . ._ . . . . . 15 

Dismissed within the year 9 

Returned to institution 7 

Died 1 

On visit 1 

Remaining in Family Care September 30, 1932 6 

Supported by State 4 

Private 1 

State and Private . . . . . .1 

Self-supporting - 

Number of different persons within the year 14 

Number of different persons dismissed 8 

Number of different persons admitted 12 

Average daily number in Family Care during the year . . ,. . .7.50 

Supported by state 12 

Private 3 

Self-supporting - 



64 


70 


25 


34 


24 


31 


- 


1 


1 


2 


39 


45 


22 


26 


17 


18 


- 


1 


40 


54 


23 


31 


42 


54 


33.17 


40.67 


37 


49 


27 


30