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

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University of Massachusetts Amherst 



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1333 

Public Document No. 23 *** 



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ANNUAL REPORT 



TRUSTEES 



vuaju. • Worcester State Hospital (, 



FOR THE 

Year Ending November 30, 

1933 

Department of Mental Diseases 



i A a '*a 



Publication of this Document approved by the Commission on Administration and Finance 
500. 4-'34. Order 1063. 



OCCUPATIONAL PRINTING PLANT 

DEPARTMENT OF MENTAL DISEASES 

GARDNER STATE COLONY 

GARDNER. MASS 



K 



JUL 6 M Jr)^. Of, 

FE HOUSE BOSTON 

WORCESTER STATE HOSPITAL 

Post Office Address : Worcester, Mass. 

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

RESIDENT STAFF 
William A. Bryan, M.D., Superintendent. 
Clifton T. Perkins, M.D., Assistant Superintendent. 

Psychiatric Service 
Morris Yorshis, M.D., Clinical Director. 

Minna Emch, M.D., Psychiatrist in Charge Women's Department. 
Walter E. Barton, M.D., Assistant Physician. 
Nathan Baratt, M.D., Psychiatrist in Charge Men's Department. 
Arthur W. Burckel, M.D., Assistant Physician. 

Medical and Surgical Service 
Bardwell H. Flower, M.D., Director. 
George R. Lavine, M.D., Assistant Physician. 
W. Everett Glass, M.D., Assistant Physician. 
William Freeman, M.D., Pathologist. 

Research Service 
Roy G. Hoskins, Ph. D., M.D., Director. 
Francis H. Sleeper, M.D., Resident Director. 
Joseph M. Looney, M.D., Director of Laboratories. 
James R. Linton, M.D., Psychiatrist. 
Hugh T. Carmichael, M.D., Psychiatrist. 
Milton H. Erickson, M.D., Psychiatrist. 
Harry Freeman, M.D., Internist. 
David Shakow, M.A., Head Psychologist. 
E. Morton Jellinek, Med. Biometrician. 
George Ban<.t, Ph. D., Medical Librarian. 

Oui- Patient Department 
Samuel W. Hartwell, M.D., Director of Child Guidance Clinic. 

Summer Street Department 
Lonnie O. Fa prap, Medical Director. 

Visiting staff 

Ernest L. Hunt, M.D., Surgery. 

Arthur Brassau, M.D., Surgery. 

Franklyn Bousquet, M.D., Surgery. 

Joel M. Melick, M.D., Gynecology and Obstetrics. 

Donald K. McClusky, M.D., Gynecology and Obstetrics. 

Lester M. Felton, M.D., Genito Urinary Surgery. 

John O'Meara, M.D., Orthopedic Surgery, Roentgenology. 

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

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

Michael M. Jordan, M.D., Neurology. 

Julius J. Tegelberg, M.D., Oto-laryngology. 

Roscoe W. Myers, M.D., Ophthalmology. 

Philip H. Cook, M.D., Roentgenology. 

George Dix, M.D., Dermatology. 

Oscar Dudley, M.D., Epidemiology. 



1935 

P.D. 23 3 

SPECIAL WORKERS IN RESEARCH 
Andre Angyal, Ph.D., M.D., Psychology. 
Earl F. Zinn, M.A., Psychoanalysis. 
Harold C. Taylor, M.S., Psychology. 

HEADS OF ADMINISTRATIVE DEPARTMENTS 
Herbert W. Smith, Steward. 
Margaret T. Crimmins, Treasurer. 
Warren G. Proctor, Engineer. 
Anton Svenson, Foreman Mechanic. 
Oakleigh Jatjncey, Head Farmer. 
Lillian G. Carr, Matron. 
Anne McE. Normandin, Superintendent of Nurses and 

Principal of Training School. 
Margaret Diamond, R.N., Supervisor Women's Department. 
Maurice Scannell, Supervisor Men's Department. 
Helen M. Crockett, Director of Social Service. 

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

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

It is the duty of the members of the board to again call to the attention of 
your Excellency certain imperative needs of the hospital. Chief among these is 
the matter of fire protection. The costly fire which occurred this year in the 
roof of the Lincoln building has brought out a fact that has been repeatedly stressed 
in these reports. More effort should be made by the Legislature to make the 
Worcester State Hospital buildings safe for the housing of patients. This fire, 
which destroyed the entire roof of one building and cost the State $40,000, was 
caused by defective wiring, and could have been prevented had steps been taken 
to correct a condition that has existed for many years. The wiring of the main 
hospital is in a deplorable state. Much of it is exposed in an open attic, and the 
wood construction of the roof constitutes a fire menace that may cause a catas- 
trophe some day, which will not only mean costly repairs, but may mean the 
loss of one or more lives. The Board therefore recommends that measures be 
immediately taken to correct all of the conditions which go to make up this situa- 
tion. In offering to your Excellency a complete program looking towards the 
elimination of fire hazards, your board is not unmindful of the economic situation. 

j But the responsibility is with us, nevertheless, and it would seem that if a be- 
ginning be made, at least the State would have recognized and made some effort 

[ to meet what is a real emergency. It would be impossible to do all the necessary 

j things in a short period of time. The program that we offer would be carried 
on over a period of at least ten years, but it is our earnest hope that such a plan 

i of betterment can be agreed upon and start at once. If a definite plan could be 

[ outlined with the understanding that a portion of the money be appropriated each 
year, the entire situation could be corrected with a minimum drain on the financial 
resources of the Commonwealth. We therefore recommend to your Excellency 

i the following proposals which are, in our opinion, essential in making this hospital 

ja proper place in which to house the mental patients who are committed to the 

j care of the Commonwealth. 

1. Replacement of Wood Floors Throughout the Main Hospital with Concrete. 

I This project alone would bring the hospital a long ways toward the goal of com- 

jplete safety. It would be impossible to do more than one, or possibly two, buildings 
at a time. If two could be done each year it would require five years to complete 
the entire project, but at the end of that time we would have a fireproof building 

I which would stand for all time. The relative cost of this would not be great. 

(The floor joists of each floor could be cut and the entire floor lowered to use as 
a form for the concrete. There are only a few places in the building where the 

;span is greater than ten feet, therefore, beams would not be essential except in 



4 P.D. 23 

these particular places. This project would also include the renovation of the 
wiring and the installation of all wires in proper conduits. 

2. Re-placement of all Wood Stairways by Fireproof Stairways. The Main 
Hospital is a four-story building and in it are a large number of stairs constructed 
of wood. These should be replaced by fireproof construction without delay. If 
a fire broke out near one of these stairways it would be impossible to get the 
patients out of the building. The project is a necessary part of any program to 
correct fire menace. 

3. Fire Alarm System. At the present time there is no way of giving a signal 
to employees in the different parts of the hospital to inform them of the location 
of a fire. The only way the information can be sent is by means of the telephone 
system. This installation should be connected with the fire alarm system of the 
city of Worcester and would automatically notify the Department where, in the 
institution, the fire was. It is an important part of the fire equipment of any 
hospital. 

b. Installation of Suitable Ducts with Fans to connect all Heat Shafts in the Attic 
This hospital has an indirect system of heating by which the warm air is carried 
from the radiators in the basement to the four floors through ducts which open 
in the attic. These open ducts form flues through which fire can spread from one 
floor to another. They should all be tied into pipes in the attic, and a suitable 
fan installed in each building. This would not only remove a real fire risk, but 
would give the hospital a better system of ventilation. 

5. Renovation of the Summer Street Department along the lines indicated by the 
four projects noted above. This department of the hospital is one hundred years old, 
and while the building is in excellent condition, it needs certain changes to make 
it safe for patients. The wood floors should be replaced by concrete, the electric 
wiring renovated, and the heat ducts which open into the attic tied up in a system 
of pipes as described in project number four. 

The board earnestly feels that this program should be started at the earliest 
opportunity, and it recommends to your Excellency your thoughtful consideration 
of the entire matter of fire protection at the Worcester State Hospital. 

It is also the desire of the Board to direct your attention to another matter 
which has a direct bearing upon the welfare of the patients, and even more than 
this upon the money invested by the Commonwealth in the hospital plant. For 
a number of years, due to the economic conditions which have prevailed, repairs 
on the buildings have not been kept up in the way they should have been. This 
is due to no fault of any one, but is caused by the diminishing income of the State, 
and yet your Trustees would be remiss in their duty if they did not point out 
to your Excellency the direction in which we are heading as a result of a continuance 
of this policy. The main hospital building is fifty-six years old, and the Summer 
Street Department has been in operation one hundred years. The battle to keep 
these two buildings in the best state of repair is an increasingly difficult one. 
The appropriations which the hospital has received yearly for the past few years 
have not been sufficient to do what is vitally necessary. Essential repairs have 
had to be deferred year by year because of insufficient funds, until there has 
developed an accumulation of needed things which is beginning to seriously affect 
the efficiency of the institution. 

As a case in point, the roofs of both the Main Hospital and Summer Street 
Department have had to be left with only a minimum amount of work done on 
them, until it will now require a considerable sum of money to put them into 
condition to even keep out the weather. 

Both buildings need repointing. Surely, after the years of service these buildings 
have seen, it is fair to assume that rather extensive repointing should be done 
as soon as possible. 

The present dining-room facilities at Summer Street may have been, and probably 
were at one time, adequate, but the old dining-rooms have outlived their usefulness. 
More modern methods of cafeteria service should be substituted. Alterations of 
this kind would produce a distinct saving to the State because of the better food 
supervision and the elimination of waste. 

The windows of both buildings need to be completely overhauled. We are 
wasting many tons of coal each year because of loose window casings and windows. 



P.D. 23 5 

An expenditure of money, even though it may seem large, would pay for the 
project within a short time in the amount of coal saved. 

Other alterations which have a direct bearing upon the care and treatment of 
patients will be mentioned in the report of the Superintendent, but the Board 
desires to impress upon your Excellency the need for additional funds for repairs 
as quickly as the financial condition of the State will permit. An appropriation 
of approximately $1,000 per month is a small amount of money to keep buildings 
as old as these are in a state of good repair. 

The Board recommends that the salary cut of the hospital personnel be re- 
stored as soon as possible. In the lower grades of the service the remuneration 
is now so low that it seriously interferes with the efficiency of the hospital. 
Questions such as this must be thought of in their relation to the treatment and 
cure of patients. Surely any investment will be profitable that will increase the 
discharge rate of the hospital, and it seems obvious that personnel is the important 
factor in accomplishing this. The more patients discharged to their homes, able 
to carry on their work in the world, the less the economic burden on the taxpayers. 
It would also add much to the efficiency of the hospital if the present personnel 
quotas were abolished. To arbitrarily decide that a certain number of a parti- 
cular class of workers is needed for a hospital, is decidedly uneconomical, and 
does not lead to efficiency. Hospitals are dynamic organizations, and the loads 
carried vary from time to time. To say that the quota of ward workers required 
should be the same at all times, regardless of the kind of patients that happen 
to be in the hospital, is shortsighted. The uniform wage scale should, of course, 
be maintained. To set this aside would invite much competition between hospitals. 
Grades and uniform salaries should be continued as at present, but it is our recom- 
mendation that a careful survey be made to ascertain whether it would not be 
possible to appropriate a lump sum for personal service and leave the decision 
as to the numbers of each grade to the hospital officials. This would give flexibility 
to the service which would increase efficiency. It would seem that those dealing 
with the problems should know the needs of the individual hospital better than 
any one else. 

In conclusion, the Board wishes to call the attention of your Excellency to the 
loyalty and cooperation of the officers and employees of this institution during 
the troublesome times we are passing through. They have continued to carry on 
in spite of many difficulties. We also wish to again register our satisfaction with, 
and approval of, the policies of extending the work of the hospital to include re- 
search, preventive work and teaching. The hospital has many responsibilities to 
the community it serves, and it is the recommendation of this Board that these 
activities be broadened and amplified as rapidly as can be done. 

Respectfully submitted, 
Edward E. Fletcher William J. Delahanty 

Josephine Rose Dresser Anna C. Tatman 

Howard W. Cowee John G. Perman 

George D. Morse Trustees. 

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

I herewith respectfully submit the following report of the hospital for the year 
ending November 30, 1933, it being the one hundred and first annual report. 

There remained on the hospital books October 1, 1932, 2,542 patients, 1,242 
men and 1,300 women. Seven hundred and ninety-nine patients, 433 men and 
366 women were admitted during the year. Seven hundred and forty-five patients, 
399 men and 346 women were discharged from the hospital. Of this number 
478 patients, 254 men and 224 women were discharged; 233 patients, 123 men 
and 110 women died, and 34 patients, 22 men and 12 women were transferred, 
leaving at the end of the statistical year 2,596 patients, 1,276 men and 1,320 women. 

The past two years have been particularly trying to hospital administrators. 
To maintain proper standards of care and treatment on the curtailed budgets 
that have been necessary by the decreased income of the state have presented 
problems that were well nigh insurmountable. No administrator could possibly 
meet this situation alone. It is only through the united efforts of all members 



6 P.D. 23 

of the hospital organization that we have been able to keep up the volume of 
work on the money available. 

This period of retrenchment and the careful scrutiny of expenditures that it 
necessitated has been good for us. Many leaks have been corrected and more 
efficient methods of doing things have been devised. The entire program has 
been built around the idea that waste was the logical place to attack the problem. 
To make any impression it was felt that the idea of watching the waste must be 
sold to everyone in the organization. To do this an organized campaign for all 
employees was carried on through the year. In this campaign new ways of elim- 
inating waste were constantly stressed. The response of the personnel was ex- 
cellent. Each member of the organization has become waste conscious and each 
one has made a real effort to contribute something. Careful supervision of ex- 
penditures has been necessary. There is a real danger that in the enthusiasm of 
cutting down one item of the budget another will be increased. For instance 
in the report of the medical and surgical service and comparing it with similar 
reports of past years one cannot help but notice the yearly general increase in 
activity of the medical and surgical services. This increase is both in the volume 
and variety of activities. In other words, the need for general medical and surgical 
care is not only present in this hospital, but it becomes more apparent and even 
more necessary from year to year. In view of this need, our present standards 
for medical and surgical care must not be lowered the slightest. To lower them 
would have far-reaching effects on the welfare of our patients. It is obvious that 
in order to do the operations and dressings noted above, a tremendous amount 
of gauze is necessary, it is necessary to replace and repair instruments, supply 
medicinal solutions, etc. To medically examine and treat the patients, medicines 
and laboratory supplies must be provided, upkeep of x-ray and physical therapy 
apparatus is necessary, etc. A further relative curtailment in expenditures for 
such items is bound to result in lowered medical and surgical standards to the 
final detriment to the patient. 

As has been the custom of former years the details of the medical, psychiatric, 
research and preventive work of the hospital are embodied in the reports of the 
several directors of these services. Therefore, any elaborate discussion of them 
would be superfluous. But there are certain points to which I wish to call at- 
tention. In the report of the clinical director it will be noted that the visit and 
discharge rate of the hospital has been higher than in previous years. This is 
probably due in part to the constant stress that has been put upon discharging 
patients. It is my belief that this is the true record of achievement of any hospital. 
It is of small importance whether the records are well kept, whether the systems 
used are good and whether good custodial care is maintained unless they lead 
directly to the discharge of more and more patients. Unless this is made the 
aim and end of psychiatry it becomes little more than an academic thing. The 
real test of the importance of the psychiatrist is in this result and in no other. 

The increase in the number of cases under family care is in the nature of an 
experiment. This State has had family care for many years but it has only been 
in the past two years that it has been expanded to the point where the influence 
of it is really felt in the hospital population. The whole movement is in a trans- 
itional stage. The goal to be worked for is to utilize family care for the convales- 
cent patient and make the home a half-way station between the artificial environ- 
ment of the hospital and the comparative freedom of the community. 

An adult clinic should be the next step in the work of the hospital along the 
lines of mental hygiene. In my opinion the future of the mental hygiene move- 
ment is in the hands of the State hospital. If mental hygiene is to make any real 
progress in the prevention of mental disease it must be done largely by the State. 
This is the only agency that is sufficiently large and powerful to treat the psychoses 
as a real public health problem. Therefore, it is to the State hospital that mental 
hygiene must turn to carry on. A full time adult clinic would be a wise and far- 
seeing investment for the Commonwealth and such a clinic would pay handsomely 
in the years to come. 

I am more and more impressed by the necessity of staff members following up 
their own patients who leave the hospital. With this in mind an appointment 



P.D. 23 7 

system has been worked out and fully 50% of our patients on visit return, at 
regular intervals to see the psychiatrist. The social worker cannot carry on alone 
any more than any other technician can. The staff member who is not sufficiently 
interested in the results of his own psychiatric treatment to follow up his patients 
is not making the best contribution to the hospital. Certain careful studies have 
been made by the social service department the results of which are not yet available 
but will be reserved for the 1935 report. These studies indicate that patients 
leaving the hospital under social service supervision remain well longer than those 
who leave without suc.h supervision. The influence is obvious. If social service 
supervision will prevent patients from having to be returned to the hospital it 
would be economically sound to double or treble our number of social workers. 

This hospital continues to stress the need of a proper kind of religious minis- 
tration. The clergy has a real contribution to make both in the actual hospitalized 
mental patient and in the field of prevention. The teaching efforts of the Chaplain's 
department have all been directed towards the goal of making the undergraduate 
theological student more understanding of the problems of the human being. In 
order to serve people, clergymen must have a real understanding of their mental 
processes, and the factors which motivate their behavior. 

As one of the treatment resources of the hospital the radio system continues 
to fill a real need. It is not only a diversion but is therapeutic. It is of great 
assistance in keeping up the morale of patients. Used as a means of disseminating 
indirect and direct suggestion to patients, it is a valuable aid in group therapy. 
It is important that everything be done to maintain as good a rapport between 
patient and hospital as is possible in order that the psychiatrist may not be 
handicapped in his attempts at individual psychotherapy. The administrative 
routine of every mental hospital should be carefully studied in its relationship 
to the patient. This routine is the foundation upon which individual therapeutic 
results are achieved. 

The emphasis which has been placed upon research for the past five years has 
been continued and strengthened. To go on erecting more buildings to house 
more patients is, in my opkiion, a short sighted policy. It would be better to 
let the crowded condition continue for a period and put the money that would 
be used for additional accommodations for patients into personnel and equip- 
ment for treatment and research. Surely continuous effort to get at causes will 
reap a rich reward in the end. The community must be patient while this research 
is progressing. To expect results in a short time is to ask the impossible. Psychi- 
atric research has been neglected so much in the past that it will take many years 
to throw much light upon the psychoses but results will come if the policy of 
encouraging research in State hospitals is continued. 

A well organized psychological service is a valuable adjunct to any mental 
hospital. The psychologist has many important contributions to make to 
psychiatry. In this connection it might be pointed that the real attack on the 
problems of psychiatry can only be made by the concerted efforts of all disciplines. 
To say that any one profession can handle the situation alone is to speak without 
knowing the facts. The sooner quibbling over trivial non-essentials, such as to 
what group the work belongs, is stopped and a real cooperative effort by all groups 
working in harmony is begun the sooner we will achieve results. 

The increasing importance of biochemistry in the study of the psychoses has 
been recognized by the installation of additional facilities. Increased personnel 
has made it possible to do more careful research. In my opinion the biochemist 
has an important contribution to make in the search for the causes of many of 
the psychoses. 

Our autopsy rate is the highest in the history of the hospital. But it should 
be pointed out that mere numbers of autopsies mean nothing. The important 
thing is whether they serve to throw more light on the problems of the psychiatrist. 
This percentage of autopsies reflects the scientific interest of the staff. In addition 
it is to some extent an indication of the better relationship existing between the 
hospital and the public it serves. It is my belief that the autopsy rate of any 
hospital is an indication of the amount of good will that has been built up between 
the hospital and relatives during the period of the patient's illness. 

We have stressed the importance of attendance at autopsies and have kept 



8 P.D. 23 

accurate records in order to check the interest of staff members in following their 
cases into the autopsy room. The monthly clinico pathological conference is 
one of the most important staff meetings in this hospital. It serves to corelate 
the clinical and pathological in a way that nothing else could. 

We have continued to give much time and thought to the expansion of our 
library facilities. It will be noted in the librarian's report that not only is this 
expansion in the form of additional books and periodicals but in better service 
to the medical staff. A medical library without a well trained librarian is like 
a ship without a rudder. It is not everyone who knows how to use a library with- 
out assistance. The service rendered in abstracting and translation work by the 
trained librarian is an invaluable contribution to the hospital. Research could 
not be carried on without this important department. 

I am more and more impressed by the importance of the State hospital working 
with children. Childhood is the golden age for mental .hygiene and if any real 
preventive work will achieve results this is the time when it must be applied. 
But I cannot refrain from pointing out a real danger. To make the clinic only 
a classification mechanism is to defeat its purpose. Treatment must follow in 
all cases if it is to make a real contribution to mental hygiene. Another danger 
is the casual way in which such clinics are organized. In the first place skillful 
and continuous work in the community is needed to get the proper interest in 
the work. In the second place the personnel cannot have divided duties. Child 
guidance is a real specialty. To expect a psychiatrist to spend one half his time 
dealing with the problems of the adult psychotic and one half considering the 
problem of the child is asking more than the human mind is capable of. 

Psychiatric Service 
Morris Yorshis, Clinical Director 
Hospital Procedure 
The teaching and research programs have been the incentives to a more pro- 
gressive psychiatry in the last twelve month period. The changes effected by 
these stimuli involved many systems especially the hospital case record and a 
few examples of its modifications will be given in detail. 

1. Abstaining from the usual state hospital vocabulary and in its place stressing 
"content of thought" and psychiatrists' attitude toward the presenting problem. 

2. The challenge of a progress note. By this is meant a very detailed analysis 
of factors operating in a patient's protracted stay in the hospital. This was 
accomplished by contacting every individual in the patient's immediate environ- 
ment such as supervisors, nurses, foremen in industry, other patients and most 
important, a careful scrutiny of the frequency and number of visitors. The 
necessity for this last procedure, although obvious, was woefully neglected in the 
past but owing to the increasing number of new admissions the medical staff 
could ill afford to allow patients to become institutionalized. Wherever relatives 
had been slack in their attention to the needs of a particular patient a letter from 
the Superintendent helped tremendously in awakening interest. 

3. The effect of hydrotherapy was periodically recorded. 

4. With the growing interest in therapy and recording of the interviews made 
the case record more "alive". 

5. The diagnostic summary was revised and the formulations were arranged 
in the following order: 

1. The complaint or problem 8. Laboratory data 



2. 


The present illness 


9. 


Consultations 


3. 


Past history 


10. 


Progess note — Clinical course 


4. 


Personality 


11. 


Etiology 


5. 


Family history 


12. 


Differential diagnosis 


6. 


Mental status 


13. 


Prognosis 


7. 


Physical status 


14. 


Treatment 



Clinical Facilities 
This has proven helpful in analysis of clinical material. 

The introduction of encephalographic technique to clinical psychiatry although 
not new has been formally added to the aymementarium at the hospital and with 



P.D. 23 9 

the new x-ray equipment the possibilities are manifold. Spinal punctures are 
performed with more precision, care being given to manometric readings; the 
chemistry and cytology of the fluid undergoes careful analysis. The excellent 
service supplied by the laboratory has made it easier for more thorough case study. 

The psychological department as in the past has rendered excellent service in 
examining patients presenting complex clinical problems. The Rohrsdsch Test 
as given by Dr. Rickers in addition to the psychometric examinations given by 
others of the department have been of inestimable value to the clinical psychiatrist. 

The social service department continued to provide data without which the 
medical staff would have found itself seriously handicapped. The anamensis, an 
important part of the case record was taken, in each case under the direction of 
this department. Summarizing each history into a chronological account has 
facilitated analysis. 

The occupational therapists during the past year made ward rounds with the 
resident psychiatrists — thus bringing this technical group more in contact with 
different types of patients and making the psychiatrists conscious of the possibilities 
of industrial therapy. Their case reports at the staff conferences about each 
patient considered at the time depicted an aspect of the behavior of the patients 
which aided the psychiatrists to correlate these observations with their own clinical 
impressions. 

The nursing services have made forward strides in their careful notations of 
ward behavior on the newly admitted and also the acutely ill. The advantages 
of this service to the physician in attendance is too obvious to need any more 
extensive amplification. 

Both treatment suites, the physio and hydrotherapy have increased in scope. 
In the former with the aid of added personnel more patients were treated for 
various conditions and in the latter the addition of colonic irrigation equipment 
had made it convenient to treat a larger number of acute psychiatric cases. 

The medical library has supplied the medical staff abundantly with abstracts 
from the literature both on current medical topics and those of interest to each 
individual physician. 

The medical service has investigated the serious and more puzzling problems 
dealing with the psychotic. More neurological examinations were done than in 
any previous year — the total exceeding 125. 

Clinical Material 

The economic situation has changed the economic status of our newly admitted 
patients. More patients were committed to the hospital from poor farms — and 
other such institutions. The hospital still continues to receive patients from Boston 
and also from Worcester County but the Boards of Public Welfare in and about 
the county have utilized the resources of the State hospital to a greater degree 
than in previous years. There has been no perceptible increase in any one type 
of mental disorder such as dementia praecox, general paresis or manic depressive 
psychoses. What has been noticed was a slow rise in the number of reactive 
depressions and in the number of personality problems — psychoneuroses, and 
without psychosis. More patients have asked to be allowed to remain in the 
hospital — ■ owing to the economic insecurity in the community. The increase 
in rate of cerebral arteriosclerosis and senile psychoses has been gradual. Of the 
165 autopsies performed during the year, approximately 45% were on seniles and 
arteriosclerotics. The total number of general paretics coming to autopsy was 
about 10%; psychosis with somatic disease, 10%; and dementia praecox about 15%. 

It is encouraging to note that only one case of dementia paralytica had to be 
readmitted during the course of the year among the 20 that were discharged. 
This is an example of the strides that psychiatry has made in the treatment of 
this organic brain condition. Among the psychoses with somatic diseases a single 
patient returned to the hospital — although there were twenty-nine admitted. 

A goodly number of patients were referred by agencies in and about Worcester 
and from clinics in Boston for out-patient department treatment. A growing need 
for the establishment of psychotherapeutic clinics is definitely indicated if the 
amount of extra-mural work that was referred to this hospital in the past year 
is an index. It has been the director's observation that the incidence of such 
referrals has been gradually but steadily increasing in the past few years. 



10 



P.D. 23 



Admissions, Visits and Discharges 
(Oct. 1, 1932 to Oct. 1, 1933) 
Out at 
Admissions Visits End of Month '. 

2 932 Per cent 

Oct. 

Nov. 

Dec. 

1933 

Jan. 

Feb. 

Mar. 

Apr. 

May 

June 

July 

Aug. 

Sept. 

Total 

In a resume of the total admissions, visits and discharges over the past ten 
years — the visit rate of 1933 exceeds that of any previous year. 75% of the 
patients released on indefinite visit still were out at the end of the year. The 
discharge rate per 100 admitted was 63.4%. This was .2% better than for the 
full calendar year of 1932. 
Disposition At End of One Year of Committed First Admissions Exclusive of Deaths 



65 


39 


84.6 


50 


46 


73.9 


55 


72 


80.6 


62 


27 


74.1 


59 


46 


71.7 


55 


36 


77.8 


55 


50 


68.0 


69 


62 


74.2 


76 


60 


73.3 


78 


66 


75.7 


72 


39 


84.6 


68 


59 


69.5 


64 


602 


Av. 75.6 



charges 


Discharge rate 
Per 100 admitted 


37 


56.9 


36 


72.0 


47 


85.4 


39 


62.9 


32 


54.2 


42 


76.3 


37 


67.2 


47 


68.1 


43 


56.5 


44 


56.4 


28 


38.8 


45 


66.1 


177 


Av. 63 . 4 



First Court 
Admissions 



Remaining in 
Institution 



1932 
Oct. 
Nov 
Dec. 



Discharged 



Out of 
Institution 



40 100% 17- 

30 100%, 10- 

27 100% 



5 12.5% 

7 23.3% 

3 11.1% 



9 22.5% 

13—43.4% 

13 48.2% 



42.5% 
33.3% 

11 40.7% 

Patients Discharged from Visit 

A more careful scrutiny of patients to be discharged from visit was carried out 
during the year. Those patients who in the opinion of the psychiatrist and social 
worker were adjusting well were given their discharge: the others wherever possible 
were returned to the hospital and after a few days residence the visit was renewed. 
In this way only will it be possible to reduce the number of readmissions and 
avoid unnecessary inconveniences on the part of relatives, patients and hospital. 

Family Care 

Up to 1931 the chief use of boarding homes in this state as well as in this hospital 
was to care for chronic patients who were sufficiently well to leave the hospital, 
but who had no relatives to care for them. Since then a policy has been formu- 
lated whereby boarding homes are made a stepping stone to mental health, in- 
dependence and self-support. The idea of mental patients being cared for in 
private homes is an old one but using such homes in a therapeutic way is new. 
The goal in the past year and in the years to come will be to place patients in 
homes with the view of helping them to recover from their illness and take their 
place in society. 

Before any patient is released from the hospital to family care — the following 
data is critically studied: 1. Reasons for commitment. 2. Assets — Physical, 
Mental. 3. Clinical course during hospital stay. 4. Reasons for placement. 
5. Possibilities of discharge. 

One social worker has given all her time to the placing of patients and supervision 
of these homes. The success or failure of this new therapeutic approach depends 
upon placing the patient in the right situation. In that caretakers assume some 
responsibility in this method of handling convalescent patients, the following was 
devised as a guide. 

Instructions to Caretakers 

1. Your patients should be treated as members of your family and made to 
feel at home so far as possible. 



P.D. 23 11 

2. Study the dispositions of your patients, but do not discuss or encourage 
their peculiarities or fancies. Their habits should be observed and any wrong 
tendencies discouraged. 

3. Keep careful oversight of your patients. Some responsible person must al- 
ways be with them. 

4. Never threaten your patients or lock them in their rooms. Every form of 
punishment is strictly prohibited under all circumstances. 

5. Patient's failure to eat enough should be reported at once, unless good 
reason is obvious. Take notice whether they are gaining or losing weight. See 
that patients' bowels move daily. 

6. More than one patient must never be allowed to sleep in one bed, nor 
should sleeping rooms be above the second floor unless special permission be 
obtained. 

7. Patients should be encouraged to do suitable work, according to their 
strength, but never beyond it. Light outdoor occupation, such as gardening, 
caring for hens, and so forth, is suitable for women patients. 

8. All clothing must be kept clean and in good repair and subject to the in- 
spection of the visitor. When patients are removed, all clothing belonging to 
them must be taken with them. 

9. Patients should have a thorough bath at least once each week. 

10. For State boarding patients. Payments for board are made monthly, as 
soon after the first of the month as bills can be approved. Bills are made up to 
the beginning of the month and not up to the time when you receive payment. 
Private patients will be paid for according to agreement with relatives. 

11. No bills, except in emergencies, should be contracted or expenditures made 
without authority from the superintendent. 

12. Be self-reliant in dealing with emergencies; act promptly in accordance 
with your best judgment as you would for yourself and then report as soon as 
possible to the hospital. Do not allow a continuance of anything which seems 
wrong to you without calling it to the attention of the visitor from the hospital. 
Try to foresee difficulties and seek advice beforehand. 

13. If a patient is ill, report this at once to the hospital. In case of death, 
telephone or telegraph to the hospital. In an emergency call a local physician 
and then the hospital. 

14. If a patient escapes, search for her. If she cannot be found, immediately 
notify the local police and the superintendent. 

15. If a patient becomes dangerous or unmanageable, notify the hospital at 
once. If necessary in order to care for her safely, call on the local authorities to 
assist you until the hospital responds. 

16. Patients must not visit friends at a distance without permission from the 
superintendent. They must not be removed to another house, family or town 
without approval from the superintendent. 

17. The visitors of the hospital will expect to see each patient alone, to inspect 
her room and clothing thoroughly and to make such other examination as may be 
necessary. Please do not be sensitive nor regard this as any reflection on you 
or your care of the patient. The visitor is required to do it as a part of her duty 
in all cases. 

18. Record in ink, any important information especially dates of visits of 
friends, or of the patient to friends. Note change of habits and of mental or 
physical condition of the patient. 

19. We must be kept informed of any additions to the boarding family, i.e., 
if they take any convalescent cases from other hospitals, especially general hospitals, 
if they take children to board, etc. Would be better if we knew about these things 
before the actual changes took place as the Department does not generally approve 
of mixing mental with other types of patients. 

20. These patients will from time to time be seen by a physician from the 
hospital. 

Boarding homes for women patients were more easily found than for men, al- 
though the experience in this hospital for the past few years has been that more 
men are discharged than women. Why this is true is not yet clear. 

In addition to medical students serving in the capacity of clinical clerks during 



i 



12 P.D. 23 

the school year, art affiliation was arranged with the Worcester City Hospital 
whereby the internes would spend at least two months on a psychiatric service. 
Although this is wholly voluntary on the part of the individual more than half 
of the newly appointed internes have made arrangements to serve in the capacity 
of psychiatric internes. This is another milestone in the history of the modern 
state hospital. 

During the coming year there are indications that the number of encephalograph- 
ies, personality studies and psychotherapeutic cases will increase. There is a vital 
need for electro-cardiographic and neuropathological investigations. The medical 
and surgical service should be equipped with hydrotherapeutic apparatus and a 
colonic irrigation apparatus on the male psychiatric wards is essential. 

Eventually with the increase in out-patient department cases a special extra- 
mural staff will have to be organized. 

There is an increasing demand on the part of the community for extra mural 
psychiatry. Inasmuch as any mental hygiene program must include an adult 
clinic it would seem that sooner or later the hospital should add to its personnel 
sufficient physicians and social workers to attack this most promising and im- 
portant field of prevention. 

Social Service 
Helen M. Crockett, Head Social Worker 

This year the social service department worked on more than 1,800 cases, on 
which they held nearly 6,000 interviews. Although we believe that no statistics can 
give a correct evaluation of the extent or the value of social case work, since 
some interviews accomplish many times as much as others, yet a few tendencies 
seem to be indicated. The number of cases is only slightly larger than last year 
yet the number of interviews has increased by more than a thousand. Although 
no statistics are available, it is our impression that the interviews themselves 
tend to be longer. All this seems to indicate that cases are becoming more in- 
tensive. It was our purpose to make them so, when it was decided, in consultation 
with the clinical director, to give routine supervision to only an occasional patient 
released from the hospital, but to spend more time on those cases where social 
treatment was indicated. This change is possible because a larger number of 
patients "on visit" are reporting to the psychiatrists at the hospital. The type 
of treatment most suitable in a particular case is often a matter of staff consider- 
ation, the point of view of both psychiatrist and social worker being presented. 

When we compare the statistics of 1933 with those of 1929 we find about 50% 
more cases referred while the number of interviews has more than doubled. In 
the past four years we have had one additional psychiatric social worker, making 
a total of four social workers and one historian. Instead of four students dividing 
their time with the child guidance clinic, we now have five students giving full 
time to hospital work. Considering the amount of supervision required, the 
work of the three additional students would be equal to that of one paid social 
worker. Besides the larger case load due to a larger staff, some of the increase 
in the amount of interviewing may be explained by the fact that more and more 
clients are seen at the hospital so that much of the time formerly spent in travel 
is saved. We have come to realize that the physical environment of the home 
has less significance to the patient than has the attitude of the family. Attitudes 
and relationships can be explored as easily in an office interview as in the home. 

The number of investigations, 1,854, is more than twice as large as in 1932. 
Most of these are concerned with home conditions and the placement of patients. 
A recently completed statistical study of patients who left the hospital in 1931 
shows a close correlation between the success of the visit and the amount of social 
service preparation for the patient's return. We believe, therefore, that much of 
our time can wisely be spent in this manner. 

Another feature of the year's work has been the increased use of family care, 
sometimes because the patient has no other resources, and frequently as a temporary 
step in his social re-adjustment: — 

Forty-four remained in family care from the previous year of whom 4 were 
changed to visit and 1 was discharged. One hundred and two were placed during 
the year of whom 55 are still out; 36 returned to the hospital; 4 escaped; 6 went 
on visit — 4 to relatives and 2 to jobs; 1 died. 



P.D. 23 13 

Ninety-four patients remained in family care at the end of the year, of whom 
64 were supported by the state and 30 by relatives or guardians. 

Of the 26 who returned to the hospital 24 were mentally sick; 5 were physically 
sick; 4 were dissatisfied and preferred hospital life; 3 were returned because 
homes were given up. Before they were returned to the hospital, one was tried 
in three different homes and three in two homes. 

An average of ten visits were made to each patient by social workers and one 
and one half by doctors. Twenty-two patients were returned to the hospital for 
more extensive medical examinations and treatment and later replaced in the 
same home. 

A study of individual cases seems to indicate that a very hopeful group of 
boarding patients are the younger ones, many of whom are in school, and all of 
whom have shown remarkable improvement through this type of treatment. We 
have learned that certain deteriorated patients if placed in family care require a 
disproportionate amount of time in supervision, without showing much improve- 
ment. Although the placement may be a failure and the patient returned to 
the hospital, the effect upon the relatives is sometimes adequate reward for our 
efforts. If the patient were well enough to be given a trial, the case seems to 
the family less hopeless and their interest is quickened. For example, one father 
gave a Christmas party to the patients on his daughter's ward for the first time 
this year, although she has been in the hospital several years. She is not well 
enough to adjust to the simplest type of home and our family care placement 
was a failure. A family who had been asked repeatedly to take a patient from 
the hospital, made no move to do so, but accepted her quite willingly from a 
boarding home. Another family who had refused for two years to take a patient 
home felt it was their duty to take her when she had been in a boarding home 
for one year. At the present time little more expansion in boarding home activities 
is possible because we have not enough social workers to supervise any more 
patients than have already been placed. 

There has been a great improvement in our follow-up on luetic patients and 
their families. Recently we have been re-checking all luetics now in the hospital 
no matter how long ago they were admitted, and have written letters and made 
calls to see that all members of their families have had Wassermanns and treat- 
ment as indicated. 

Chaplain's Department 
Rev . Carroll Wise — Protestant Chaplain 
Religious work in a mental hospital may be carried on merely as formal activities 
which in a blind way aim to bring comfort and inspiration to the patients. Or 
they may be carried on more intelligently, that is, they may proceed from an 
understanding of the experiences through which the patients have gone and are 
going, and of the psychological relation of these experiences to certain kinds of 
valid religious experience. This type of religious work requires of the worker that 
i he be trained, not only in the disciplines of religion, but also with those dealing 
! with the social and psychological aspects of the development of both normal and 
abnormal types of personalities. This incidently is a type of training which is 
not being adequately given in any theological seminary in the country today. 

It is from the second viewpoint that we are endeavoring to carry on the re- 
I ligious work in this hospital. The aim of the chaplain is not to seek miraculous 
! cures through religion — a feat which many people seem to expect of him but 
I rather to integrate the religious activities into the hospital organization so that 
i they may take their proper place as part of the total situation in which the patient 
! finds himself. In this way the chaplain's department takes its place along side 
i of the other departments in making its contribution to the main purpose of the 
I hospital, — the recovery and welfare of the patients. The close cooperation existing 
; between this and the other departments also serves in making the religious activities 
! an integral part of the hospital program rather than an isolated activity. 

In the main, the religious activities assume the conventional patterns, but these 
\ are controlled by the understanding attitude mentioned above. Thus the worship 
i services on Sunday morning, and the vesper service broadcast over the hospital 



14 P.D. 23 

radio on Sunday evenings seek to bring to religiously minded patients an under- 
standing of their own experiences in terms which they can comprehend. They 
proceed from the belief that religion, rightly understood and accepted, is one of 
the ways in which men may find a satisfactory adjustment to their total environ- 
ment and to themselves. The resources and techniques of religion, and the 
personal attitudes which make them affective provide the themes for the sermons. 
Emphasis is always placed on the positive rather than the negative aspects of life. 
A specially prepared hymnal and order of worship for use in mental hospitals is 
used in these services. Special services are held at appropriate seasons of the 
year, such as Easter and Christmas, and a baccalaureate service for the Nurses 
Training School is conducted each spring. 

In his pastoral work the chaplain does not force his attentions on any patient, 
but rather seeks to make himself available for any patient who desires to see him. 
Visits are made to the medical wards, and to some of the psychiatric wards very 
frequently. Individual patients are seen more or less frequently according to 
their condition, their needs and their desires. Each new patient is seen shortly 
after admission in an attempt to establish friendly contacts and where possible to 
allay fear and bring reassurance. Patients whose names are put on the danger 
list are seen immediately. 

Part of the function of a trained chaplain in a mental hospital is to assume his 
share of the hospital's obligation to the community at large. This obligation, in 
so far as he is concerned, usually takes the form of educational activities. During 
the past year the chaplain has made over twenty talks to various types of organiza- 
tions, such as churches, men's clubs, women's clubs, and young people's organiza- 
tions. These talks dealt with various aspects of mental health, and personality 
development. A number of groups of students were brought to the hospital for visits 
and lectures. During the year a seminar for ministers was conducted on Monday 
afternoons for sixteen consecutive weeks. This seminar, which was attended by 
twelve clergymen dealt with various problems arising in personality development 
and mental disorder, particularly as they relate to the work of the minister. It 
was organized and conducted by the hospital chaplain with the assistance of 
several hospital physicians. 

A feature which combines hospital visiting with community education has been 
the continuance of a group of women visitors organzied last year by the social 
service committee of the Worcester County Federation of Church Women's Clubs. 
This group makes regular visits to the female wards which are greatly appreciated 
by the patients. Monthly meetings are now being held by this group in which a 
member of the staff talks about some phase of hospital life. 

In addition to these teaching activities the chaplain gave a course in psycho- 
pathology at the Boston University School of Theology during the year. 

It is felt that the greatest progress made by the department during the past year 
was in regard to the summer course for the clinical training of theological students. 
The first endeavor to give theological students clinical training occurred at this 
hospital in 1925. A few years later several other institutions had started this type 
of work, and a group of interested individuals incorporated the Council for the 
Clinical Training of Theological Students, for the purpose of fostering and devel- 
oping it. Dr. Richard C. Cabot was president of this group for several years, but 
at present is headed by Dr. Earl Bond of Philadelphia. The training of theological 
students at this hospital is carried on in cooperation with this Council, and the revised 
program as used last summer follows briefly. For the first two weeks each student 
spent half of each day on the wards working as attendant. In a very natural way 
this introduced him to the hospital routine and also to the patients. After that 
period each student was assigned to a small group of patients with whom he was 
required to spend a definite amount of time each day. This work was carefully 
supervised by the ward physician and the chaplain. Careful notes were required 
of each student. Along with this definite clinical program, a carefully arranged 
teaching program was carried out which aimed at giving the student as thorough 
an understanding as possible of the physical and psychological aspects of person- 
ality development and of the pathologies of personality. Every attempt was made 
to relate their experiences and knowledge to the work of the minister in dealing 
with the infirmities of mankind. The work of the minister was carefully differ- 



P.D. 23 15 

entiated from that of the psychiatrist. Problems regarding the adjustment of per- 
sonality through religion were carefully considered. Methods and techniques which 
the minister might use were carefully considered, as were methods and techniques 
which belong properly to specialized groups, such as psychoanalysis and which 
therefore he should not try to use. The value of the experience for one of the 
students may be seen from his statement which follows: 

"There are a good many points in my work at the church where I'm finding 
application for some of the summer's training ... As the weeks go along I 
can say emphatically that the summer's work was by all odds the most valu- 
able experience I have had for my work in the church and for the future of my 
ministry . . . You ask us to tell you what difference the summer has made 
in our personal religious lives. As I look on religion in general, it has made me 
more critical and at the same time more appreciative. I am better able to 
understand, and evaluate religious experiences, to see when they are of signifi- 
cance and when not, to grasp what they mean in terms of the total personality 
picture. In regard to my personal practice — I can't say as there's been much 
change. My views of God, sin, prayer, etc., are about as they were before, 
only more so, and much more clearly so. Worship is increasingly vital and 
probably more intelligent, as I can understand now a good many of my moods 
and caprices, and am better able to see the details of my life in perspective, 
objectively." 
Another student who found a great deal of personal value in the summer's ex- 
perience writes: 

"I am amazed that the summer's work among broken lives should have had 
such a powerful integrative force on my own. It's far from completed, and 
that's why I wish I could stay on there longer." 
These statements speaK for themselves and indicate some of the values to be gained 
by theological students through a well-planned course of clinical training. 

In addition to the above, the chaplain engages in a few miscellaneous activites, 
the most important of these being the editing of The Hospital Messenger, a four 
page pamphlet which appears monthly. The purpose of this pamphlet, which has 
a circulation of almost a thousand each month, is to acquaint the relatives of 
patients, and other interested people with the work of the hospital, and to spread 
information regarding mental disorder and mental hygiene. Enthusiastic comments 
from people who read it indicate that it is filling a need in the community. 

Before closing this report I wish to acknowledge gratefully the financial support 
received during the year from the Massachusetts Congregational Conference and 
Missionary Society. 

Music and Radio 
Frederick Searle — Musical Director 

Each year will necessarily bring about many changes in the manner of treat- 
ment of the mentally ill by music. Much experimentation has been carried on in 
the past with music and its relation to organic and psychic changes in normal per- 
sons. A great deal of this type of research will have to be done with abnormal 
persons before too definite musically therapeutic methods can be utilized. How- 
ever, there have been sufficient indications that music does exert a therapeutic 
influence upon the mentally afflicted. 

Our musical work with disturbed patients during the past year has not been 
entirely void of results. For several months we conducted daily experimental 
sessions musically, with a disturbed female group of about fifty patients. These 
sessions were about eight minutes in length. They consisted of five definite features 
each session: Group singing (1 min.); group reading (1 min.), group singing (1 
min.); four minutes of music (instrumental or vocal ) in which patients were not 
participating but were expected to Listen to; finally, group singing of one minute. 
An observer checked minute by minute upon the motor disturbances of individuals 
in the group such as talking to self, shouting, waving arms, etc. The following 
chart shows the trend of motor disturbance during these eight minute sessions for 
a period of three weeks. Reading from left to right we see the motor disturbance 
for each session minute by minute. Reading from top to bottom we see the 
difference in disturbance in some particular minute day by day. 



16 



P.D. 23 





1st 


2nd 


3rd 


4th 


5th 


6th 


7th 


8th 




Min. 


Min. 


Min. 


Min. 


Min. 


Min. 


Min. 


Min. 


Day 1. . ." . 


11 






9 


9 


11 


11 




Day 2. 






3 


3 


1 


5 


3 


3 


6 


3 


Day 3. 






2 


1 


- 


8 


7 


6 


5 


5 


Day 4. 






3 


6 


7 


7 


8 


5 


6 


- 


Day 5. 






4 


7 


6 


8 


12 


7 


13 


- 


Day 6. 






7 


7 


- 


7 


6 


11 


6 


2 


Day 7. 






3 


1 


1 


7 


7 


4 


3 


3 


Day 8. 






5 


- 


8 


8 


8 


6 


8 


- 


Day 9. 






4 


5 


4 


7 


9 


7 


7 


5 


Day 10. 






6 


6 


5 


3 


2 


2 


1 


6 


Day 11. 






5 


7 


5 


13 


8 


11 


10 


7 


Day 12. 






7 


5 


6 


14 


8 


8 


13 


5 


Day 13. 






2 


1 


4 


5 


8 


7 


5 


3 


Day 14. 






3 


3 


4 


12 


5 


3 


4 


2 


Day 15. 






6 


6 


5 


9 


10 


9 


4 


3 


Day 16. 






3 


3 


5 


8 


7 


5 


5 


8 


Day 17. 






2 


3 


4 


4 


7 


7 


6 


3 


Day 18. 






- 


2 


5 


3 


3 


2 


3 


1 


Day 19. 






8 


9 


8 


11 


5 


5 


7 


- 


Day 20. 






7 


8 


7 


5 


8 


6 


4 


3 


Day 21. 






1 


2 


3 


6 


5 


4 


1 


3 


Total . 






92 


91 


88 


159 


145 


129 


128 


62 



The outstanding points of interest concerning this chart are: First, the consistent 
lowering of disturbance during the first three minutes while the patients were par- 
ticipating; Second, the extraordinary motor increase when the music started; 
third, the consistent lowering of disturbance during the succeeding minutes until 
the final moment was more quiet than the first moment of the experiment. It 
is hoped that we may be able tocontinue these experiments over a longer period 
of time, and also to prolong the musical period in each session to seven or eight 
minutes thereby trying to ascertain if the seeming therapeutic influence will con- 
tinue over a longer period and the disturbance fall to a still lower level. 

The planning and engineering of all the musical and radio activities of the hospital 
are done by the musical director. However, it would be impossible for any one 
man to attend to the mechanics of these varied activites. It is so arranged that 
about eight patients lend almost their entire time in assisting in carrying out the 
many details connected with the musical department. A patient, being a piano 
tuner by profession has kept every piano in the institution and Doctor's cottages in 
perfect tune; a female patient broadcasts bi-weekly on the organ to the hospital 
as well as assisting in accompanying various musical features. Three patients 
alternate on a fifteen-hour schedule in the control room of our radio broadcasting 
station WSH. They announce features, call doctors, follow a set programme for 
the day, and control a very intricate board quite as accurately as one would at any 
commercial station. The control-room is entirely in their charge, under the super- 
vision of the musical Director. Many improvements have been inaugurated on our 
control body, the two most advantageous being the installation of equipment which 
enables us to send at a given minute any programme to any segregated section of 
wards: male, female, locked, medical, parole, or industrial shops, special equip- 
ment for making our own recordings has been added. 

In program making over our radio station we are making more effort to eliminate 
advertising and sundry commercial announcements and in its place to utilize 
educational methods via radio for both our patient and employee population. Thus 
announcements about movies, dances, church services, entertainments, waste, 
choir, etc., are given; progress notes of patients leaving the hospital on trial visits; 
the reading of patient promotions in the research wards; therapeutic and hygienic 



P.D. 23 



17 



suggestions and time signals — some one of these reach our wards every half hour. 

Radio programmes by staff members have been carefully planned and carried 
out. There has been a series of talks relative to the various types of psychoses 
presented by the psychiatric department; another series explaining the functioning 
of the medical department by the head of that department; The chaplain has 
presented a weekly feature. At the present time there is in progress a series of 
talks by various staff members on definite subjects that are of interest to the hospital. 
Many local musicians have generously lent us their talents in broadcasting and it 
has been quite evident by several requests to broadcast to our wards that public 
approbation and interest is increasing. Also by the fact that many requests have 
come to the hospital for the musical director to speak at Rotary, Kiwanis and 
other clubs concerning the musical work at the hospital. 

The coming year we plan to have some blood-pressure equipments with music 
as well as compile a manual of general practice for the operation of the radio equip- 
ment and the supervision of musical activities based on the experience of the past 
three years. 



Medical and Surgical Service 
Clifton T. Perkins, Assistant Superintendent 
The following tables summarize briefly the chief activities of the medical and 
surgical services during the past hospital record year, extended from October 1, 
1932 to September 30, 1933, inclusive. 



Movement of Population 


Female 


Male 


Total 


Remaining October 1, 1932. 


. 134 


79 


213 


Admitted 


. 512 


434 


946 


Discharged 


. 415 


338 


753 


Deaths 


. 117 


117 


234 


Escapes 


. 


- 


- 


Births 


6 


5 


11 


Remaining September 30, 1933 . 


. 114 


58 


172 



No particular comments are necessary relative to the distribution and movement 
of population on the medical and surgical wards. A total of 1,159 patients were 
taken care of on these services during the year, and at the end of the year there is 
an appreciable drop in the number remaining on the service, as compared with past 
years. It is particularly gratifying to know that of the 946 patients admitted during 
the past year, 102, representing 10.7% of these admissions, were primarily for study 
only. That is, the physicians on the psychiatric wards felt that these patients 
should undergo very thorough physical examinations and tests, even though obvious 
physical illnesses were not apparent. They were therefore referred to the medical 
service for these physical check-ups. A further study of the table below, relative 
to physical condition at time of discharge from the medical service reveals that 
half of these patients so referred actually did have some vague physical illness 
which were helped by the physicians on the medical service, and the remaining 
half, or 51 patients, were discharged from the service as having no discernible 
physical illness, and therefore not treated. The use of the medical and surgical 
services for such "study" cases referred by physicians from other services in the 
hospital, is very valuable, and is to be encouraged. 

Discharged Detailed as to Physical Condition Fe; 

Recovered and improved I 

Not improved 

Not treated 

Total < 

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 (50- 

70%) ... 

Autopsies refuted antemortem diagnoses (Less than 50%) 
Attendance at autopsies (10 months): — students, 754; staff, 803. 
Autopsy percentage of deaths — 68.8% 



nale 


Male 


Total 


80 


307 


687 


9 


6 


15 


26 


25 


51 


15 


338 


753 


11 


12 


23 


84 


77 


161 


62 


56 


118 


15 


16 


31 


7 


5 


12 



18 P.D. 23 

The above table merely summarizes certain information relative to deaths and 
autopsies during the past record year. Additional comments may be found in the 
combined report of the laboratories and pathological departments. 

Analysis of Deaths 
Of the 234 deaths noted in the first table, 22 occurred at the Summer Street De- 
partment and the remaining 212 at the main hospital. The figure for total number 
of deaths runs remarkably constant from year to year. As may be seen in the first 
table, the deaths are equally divided between the sexes — 117 of either sex. This 
is an unusual coincidence, since for several years there have been from 10 to 15 
percent more women than men, die in the hospital. The average age of all deaths was 
61.7 years. The following is a more detailed analysis of these deaths, based only 
on the primary cause of death in each case: 

(a) Sixty-four deaths, representing 27.3%, were due to the physical disorders 
coincident to old age, primarily arteriosclerosis and cardiovascular-renal disease. 
The average age of death of this group was 72.4 years. The age factor remains 
fairly constant in this group from year to year, but there is a decided decrease in 
the percentage of the total number of deaths represented by this group. 

(b) Fifty-two patients, representing 22.2% died from pneumonia. As noted 
in the report last year, we now include in this group many deaths which heretofore 
had been included in the first group. This change on our part was due to a wide- 
spread change in classification of deaths from the statistical standpoint. The 
average age of deaths of this entire group was 66.8 years. Of the total number in 
the group 14 died from lobar pneumonia, and the average age of this sub-group 
was 62 years. 

(c) Twenty patients, or 8.5%, died from general paresis. Again, as has been 
noted year after year, the greater number of this group die in the hot, exhaustive 
summer months extending from the middle of June to the middle of September. 
The average age of death of this group was 45.5 years. 

(d) Nineteen deaths, representing 8.1% were due to carcinoma. This death 
rate is more than double that which we have ever before experienced, and cancer 
this year leads tuberculosis as a cause of death in this hospital. The average age 
of death of this group was 59.3 years. Of the total number, twelve primarily involved 
the gastro-intestinal tract, the stomach being the primary seat, three originated 
in the breast, two in the uterus, one in the bladder, and one in the testicle. We have 
continued to take full advantage of the facilities offered us by the Public Health 
Department and its Pondville Hospital for treatment and advice relative to our 
patients suffering from cancer. 

(e) Seventeen deaths, or 7.2% were due to tuberculosis. Of this number, all 
were of the pulmonary type except one which was renal, and one involving the 
bones. The average age of death was 42.7 years. 

(/) Eight deaths, representing 3.4% were due to kidney disease, uncomplicated 
by senile changes. The average age of death was 53.5 years. 

(gr) Eight deaths, representing 3.4% were due to heart disease uncomplicated 
by senile changes. Three of these were cases of acute bacterial endocarditis. The 
average age of death was 57.4 years. 

(h) Six deaths, or 2.5% were due to diabetes mellitus. The average age of 
death was 68.1 years. 

(i) Five deaths, representing 2.1% were due to fractures. The average age of 
death was 70.4 years. The percentage which this group represents of the total 
deaths has steadily declined in recent years. 

(J) Three deaths, representing 1.2% were due to cerebral hemorrhage, with an 
average age of 62.3 years. 

(k) The remaining 32 deaths, representing 13.6 years, were due to a variety of 
causes which have no particular statistical significance. The average age of death 
of this unclassified group was 54.7 years. 



P.D. 23 19 

Consultations Detailed 

Eye 155 Medical 16 

Ear, nbse and throat ... 73 Orthopedic 11 

Gynecological and obstetrical 170 X-ray 1,108 

General surgical .... 194 Others 8 



Total 1,735 

The above table indicates roughly the extent to which our consultation service 
has been utilized. 

Obstetrical Service 
We continue to carry our license for an obstetrical service of eight beds. Pre- 
natal care is carefully managed and the follow-up care after delivery is maintained 
in necessary cases for a period of six months or until such time as the infant is 
weaned. As may be noted from the first table in this report, there were eleven 
deliveries last year. One birth was a still-born. 

Surgery Detailed 

Amputations, major, 3; minor, 3 ; antrum, radical, 1; appendectomies, 22; as- 
pirations, 1; biopsy, 4; cataract excision, 1; circumcision, 2; colphorrhaphies, 
2; craniotomy, 1; cystoscopy, 3; cystotomy, supra-public, 3; dilatation and 
curettage, 2; dislocation reduced, 1 ; excisions, minor, 16; enterostomy, 2; figur- 
ation, 1; gastrostomy, 1; gastro-enterostomy, 2; hemorrhoiddectomy, 2; her- 
niorrhaphy, 9; hysterectomy, 5; incision and drainage, minor, 55; injection vari- 
cose veins, 64; iridectomy, 1; laporatomy, 6; laryngoscopic examination, 1; 
ligation of large blood vessels, 1; lysis of adhesions, 4; mastoidectomy, 2; myotomy 
1; myringectomy, 2; oophorectomy, 1; orchidectomy, 1; osteotomy, 2; para- 
centesis, 7; perineorrhaphy, 3; plaster casts, major, 16; plaster casts, minor, 6; 
plaster repairs, 5; proctoscopic examinations, 9; removal foreign body, 4; sal- 
pingectomy, 2; splints applied, 4; submucous resection, 3; suspension of uterus, 1; 
suturings, 42; tonsillectomy and adenectomy, 4; thorocentesis, 2; trachelorrhaphy, 
2; trephine, minor, 4. 

There were a total of 358 surgical procedures carried out on 337 different patients 
in the surgical suite. A great deal of this increase in actual procedures is accounted 
for by the fact that many of the larger suturing procedures, and the more important 
cases requiring incision and drainage have been done in the surgical suite itself 
rather than in the ward treatment rooms as was the custom in the past. The 
amount of work represents a good degree of activity. 

Clinic Detailed 

Eye examinations, 861; ear, nose and throat examinations, 826; gynecological 
examinations, 567; luetic treatment, 2,731; small pox vaccinations, 169; spinal 
punctures, 382; typhoid and para-typhoid inoculations, 1,796; Wassermanns, 
Kahns, Hintons, 1,389; others, 41. Total, 8,762. 

Again, the attendance at various clinics indicates a fair degree of activitiy, and 
is rather comparable to past years. There were approximately 5,000 visits to the 
luetic clinic alone, for treatment, examination or advice. 

Employees Detailed 

Examined and treated at clinic, 2,614; required hospitalization, 171; required 
operation, 32; total number of days on sick wards, 1,322. 

There has been a tremendous increase in routine clinic examination and treat- 
ment of employees. The figure of 2,614 given above indicates 100% increase over 
the volume last year. The majority of these attended the clinic during the winter 
and early spring. Fifty less employees have required hospital care this year than 
was the case last year. This is a decrease of 30%. There likewise has been the 
decrease of 150 days of sickness requiring hospitalization. 



20 



P.D. 23 



Dressings Detailed (Out-Patient) 



Abrasions and lacerations 
Boils and carbuncles. 

Burns 

Infections .... 
Ulcerations 

Others 

Total out-patient dressings 
Ward dressings . 

Total dressings . 
Grand total 



Male 


Female 


739 


903 


535 


331 


110 


112 


1,273 


1,558 


155 


316 


1,421 


693 


4,365 


4,329 


17,034 


14,860 


22,399 


19,518 


41,917 



The figures given above indicate an increase of 17% in activity over last year. 
This increase is general, and is found in both the out-patient dressings as well as 
in the ward dressings. It becomes increasingly urgent from year to year that we 
establish a centralized system for out-patient dressings. This could be best carried 
out in conjunction with our present surgical suite, but such is not possible under 
the present physical layout of this suite, and its adjoining rooms. 

Dental Department 
Bridges, 2; cleanings, 1,309; examinations (routine), 2,202; extractions, 1,124; 
fillings, 1,136; plates, 33; repairs, 60; treatments, (miscellaneous), 825; x-ray 
diagnosis, 58; others, 7. Total examinations and treatments, 6,756. Total patients 
examined or treated, 3,986. Total general anaesthetic cases, 16. 







X-Ray Department 














Pa 


rts Examined 






Patients 


Plates 


Patients 


Plates 


Abdomen (plain) 


19 


22 


Jaw 12 


23 


Ankle .... 


25 


31 


Knee 






11 


16 


Arm 




17 


22 


Kidney (plain) 






5 


11 


Chest . 




289 


308 


Leg 






18 


23 


Colon . 




11 


12 


Mastoid 








14 


28 


Elbow 




8 


9 


Nose . 








23 


43 


Foot . 




20 


24 


Ribs . 








14 


24 


Fluoroscopy 




66 





Shoulder 








32 


50 


G astro-intestinal series 


55 


298 


Sinuses 








10 


21 


Gall-bladder (plain) . 


2 


3 


Skull . 








131 


386 


Graham test 


17 


53 


Spine . 








34 


68 


Hand .... 


41 


42 


Teeth . 








84 


232 


Heart .... 


11 


14 


Wrist . 








25 


28 


Hip ... . 


54 


73 


Others . 








13 


32 


Total .... 






1,061 


1,896 


Finger or foot prints. 








18 


Photographs 








1,865 


Lantern Slides 


















224 



Although this report indicates a decrease in some of the regular x-ray work, it 
represents a tremendous increase in the making of lantern slides and photographs. 
These latter two functions of the technician are very important from the teaching 
standpoint. It is not expected that this volume of photographs and lantern slides 
will continue proportionately. 

Physical Therapy Department 
Classifications of Treatment and Tests 

Ultra-violet (air-cooled) 3,279 

Ultra-violet (water-cooled) . 897 

Baking 1,812 

Massage 610 



P.D. 23 21 

Diathermy 550 

Others 654 

Total treatments and tests 7,802 

New patients during year 382 

Total number of patients treated 5,330 

The report of this department indicates a general increase in activity of approxi- 
mately 40% over that of last year. This increase is in the total number of patients 
treated as well as in the total number of treatments and tests given. 

Research Service — Psychiatry and Internal Medicine 
F. H. Sleeper, Resident Director Research 

Because of the emphasis placed on the evaluation of data already obtained with 
a consequential slight diminution in experimental work below that of the preceding 
year, the curtailment of financial support did not too seriously affect the operation 
of the service. However, if productivity on a comparable scale is to be continued, 
additional financial support from the State should be made available. 

During the period covered by the report a rather crude constant temperature 
room was constructed. As a result of preliminary experiments conducted in this 
room sufficient data of a positive nature were obtained by Drs. H. Freeman and 
J. Gottlieb to warrant expansion of the work and more elaborate construction to 
eliminate technical errors which cannot be avoided in the present room. 

New equipment purchased during the year consisted of a muffle furnace for the 
laboratory; a "silk scale" for measuring insensible perspiration; a Boas cardio- 
tachometer which will be used for the study of emotional changes as reflected by 
the pulse rate and the effects of graded work on the pulse rate; and a Benedict- 
Collins metabolism apparatus. 

Publications 

Particular emphasis has been placed on preparation of accrued material for 
publication. During the fiscal year the following articles have been published, 
excerpts from the summaries and conclusions are given: 

1. "Oxygen consumption (Basal Metabolic rate) in Schizophrenia." R. G. 
Hoskihs, Arch. Neur. and Psychiat. 28: 1346, December 1932. 

The rate of oxygen consumption under conventionally satisfactory conditions 
was determined in 214 male schizophrenic patients. The average was 88.3% of 
standard normal. One to 15 readings were made per individual patient. The 
average lowest reading in the series was 81.1%. Evidence is given that this more 
nearly represents the true basal rate than the 88.3 figure. The average sub-group 
rates were — catatonic 87.9%, hebephrenic 89.4%, paranoid 87.9%, indeterminate 
88.8%, and simple 95.0%. Schizophrenia is characterized by a systematic down- 
ward displacement of the oxygen consumption rate. 

Further work on this problem will be carried out during the ensuing year. Work 
directed toward ways and means of normalizing the lowered rate has been reported 
in previous years. 

2. "The Effect of Habituation on Blood Pressure in Schizophrenia." H. 

Freeman, Arch. Neur. and Psychiat. 2.9: 139, January, 1933. 

A study was made of the systolic and diastolic blood pressures in 50 cases of 
schizophrenia, in three periods, three months apart. The mean values of the 
systolic pressures in the three periods were 105.2, 99.6 and 100.3 mm. hg. respec- 
tively. Diastolic pressures were 65.5, 55.5 and 60.8 mm. respectively. Season, 
nutrition, anemia and oxygen consumption rates were excluded as factors causal 
in the production of the lowered pressures. Sedentary life was probably not a 
significant factor. The fall in systolic pressure on repeated determinations is 
ascribed to habituation to the environmental situation. The observations serve 
further to emphasize vascular hypotension as a characteristic of schizophrenia. 
The mechanism of its production presents a problem for further research. Ex- 
periments are under way at this time for further elaboration of this finding and will 
be continued. 

Inasmuch as hypotension has been definitely shown to be a characteristic of 
schizophrenia, methods for treating the condition had to be devised. The following 
communication is the direct result of part of our therapeutic research plan. 



22 P.D. 23 

3. "Some Effects of a Glycerin Extract of Suprarenal Cortex Potent by- 
Mouth." R. G. Hoskins and H. Freeman, Endocrinology 17: 29, Jan. -Feb. 
1933. 

Ten schizophrenic patients, initially presenting low blood pressure, were treated 
for 10 weeks with glycerin extract of adrenal cortex. Dosage was gradually in- 
creased from an equivalent of about 100 grains to 450 grains of fresh gland substance 
per day. The average initial systolic pressure was 105.7 and the final pressure 132.5 
mm. hg. Similarly, the diastolic pressure was increased from 69 to 84 mm. There 
was an irregular increase in weight from an average of 62.6 kg. at the beginning to 
65.4 kg. at the end of treatment. There was also a fairly consistent increase in 
the red cell counts of about 300,000 on the average per patient. At the end, the 
increase had fallen to about 150,000 cells above the initial level. There was evi- 
dence of early stimulation of renal function with later return toward initial levels. 
Investigation is to be extended. 

Noto, an Italian investigator, has reported that the ingestion of 1 gram of ty- 
rosine by schizophrenic patients resulted in the production of aromaturia and 
aromatemia, which in turn was attributed to a defective liver. We have repeated 
this work. 

4. "The Effect of the Ingestion of Tyrosine on the blood phenols and the 
blood uric acid as determined by the methods of Folin and Benedict." J. M. 
Looney, Jour. Biol. Chem., May 1933. 

Results of this study on 48 schizophrenic patients indicated that the two methods 
are not measuring absolutely identical substances, as Benedict's method is 
affected by changes in phenols as well as by changes in uric acid. No association 
could be shown between changes in blood phenols and the increases in tyrosine in 
the blood. The excretion of phenol in the urine could not be correlated with the 
phenol content of the blood. 

The above paper, dealing with the technical phase of the subject, did not show, 
as actually happens, that in schizophrenic patients of the period of hospitalization 
with which we are dealing, no phenols were present in sufficient amounts in either 
the blood stream or the urine to have had a toxic action. However, we were dealing 
with longer hospitalized patients than the Italian investigator and this phase of 
the work remains to be done with some technical variations. 

5. "Organic Functions in Schizophrenia." R. G. Hoskins, and F. H. 
Sleeper. Arch. Neur. and Psychiat. 30: 123, July, 1933. 

An epitomized account is given of the results of the study of physiologic func- 
tions in schizophrenia as brought out by repeated tests on 57 male subjects over a 
period of seven months. Patients were on the average 16 per cent under weight, 
showed a high incidence of poor circulation in the skin, irregularities of the pupils, 
abnormal reflexes, poor teeth and depression of the blood pressure, oxygen con- 
sumption and to a slight extent, the pulse rate. The level of protein metabolism 
showed no significant correlation with the rate of oxygen consumption as it did in 
a control series. Total urinary volume was twice that of normal controls, which 
suggests abnormal functioning of the diencephalon, or of the posterior lobe of the 
pituitary gland. There was a high incidence of moderate secondary anemia, and 
leucocytosis. The average red and white cell counts were 4,957,000 and 10,477 
respectively; differential counts were normal; sedimentation rate and Schilling 
index were commonly normal. In individual cases, venous oxygen was strikingly 
low, but the average was substantially normal. The functional efficiency of the 
liver tested in a variety of ways, indicated a variably inconsistent inefficiency in a 
considerable proportion of the cases. Nearly all the functions studied showed high 
individual variability. The ability of the body to maintain a "steady state" in 
schizophrenia is diminished. Some functions are basically displaced in an upward 
others in a downward direction. 

6. "A Cooperative Research in Schizophrenia." R. G. Hoskins, F. H. 
Sleeper, D. Shakow, E. M. Jellinek, J. M. Looney and M. H. Erickson. Arch. 
Neur. and Psychiat. 30: 388, August, 1933. 

This paper describes the Worcester project in several aspects. The functions of 
the laboratories devoted to organic and psychologic features of the research are 
outlined. The methods by which psychiatric observations were made are discussed. 
The recording and handling methods used in dealing with the data are recounted. 



P.D. 23 23 

The project has proved to be practicable and productive. 

7. "Blood Cholesterol in Schizophrenia." J. M. Looney and H. M. Childs. 
Arch. Neur. and Psychiat. 30: 567, September, 1933. 

Approximately 50 men with schizophrenia were studied over a period of seven 
months at intervals of two weeks and three months. The mean cholesterol values 
were: for the first period, 146 mg.; second period, 161 mg.; third period, 166 mg. 
The mean value for 26 normal men was 175 mg. Both schizophrenic patients and 
the controls showed great variability in cholesterol values, the former having a 
standard deviation of about 20 mg., and the latter about 27 mg. No correlation 
could be shown between the blood cholesterol and the basal metabolic rate or the 
emotional status. Schizophrenia seems to be characterized by a slight degree of 
depression of the cholesterol content of the blood. 

8. "The Fasting Blood Sugar in Schizohprenia." William Freeman, M.D., 
Am. Jour. Med. Sc. 186; 621, November 1933. 

Six samples taken from 59 male schizophrenic patients, making a total of 347 
determinations, form the basis of this report. The conclusion is drawn that schizo- 
phrenia is characterized by normal fasting blood sugar levels, but the individual 
variability is somewhat greater than in normal subjects. Thirty-one normal sub- 
jects acted as controls for this study. 

9. "Schizophrenia from the Physiological Point of View." R. G. Hoskins, 
M.D. Annals of Int. Med. 7: 445, 1933. Read before the American College 
of Physicians at Montreal, Quebec, February 9, 1933. 

This paper emphasizes the marked variability from one functional test to an- 
other. In most regards, the average functional level was essentially normal. The 
galactose tolerance averaged 22 grams as compared with a reported normal average 
of 30 grams. The motor functions of the colon were retarded. The complex of 
functions centering about oxygen metabolism was found to be characteristically 
abnormal. There are suggestions that pituitary deficiency may play an important 
role. It is suggested that further studies as to how these abnormalities are brought 
about may throw significant light on the cause of the psychosis. 

Several papers have been accepted for publications. 

1. "The concomitance of organic and psychologic changes during marked 
improvement in schizophrenia." M. H. Erickson, Am. Jour. Psychiat. 

Three distinct psychiatric states, namely stupor, recovery from stupor, and a 
condition of apparent recovery from psychosis were found, for each of which a 
physiologic cross-sectional study was made. During the stuporous state, the 
patient was underweight, had diminished oxygen consumption, reduced body tem- 
perature, polyuria, and delayed colonic emptying time. During the second period, 
the patient had recovered from the stupor, had gained weight, had a still further 
slight decrease in his oxygen consumption rate, slight increase in body temperature 
mild secondary anemia, low venous and arterial oxygen content. Other findings 
were normal. During the third period, the patient had gained weight, normal oxy- 
gen consumption rate was recorded, normal body temperature and except for a 
marked plyuria and low venous oxygen content, there was no significant deviation 
from normal. There is evidence suggested of pituitary deficiency, manifested at 
about puberty and also during the first and third periods of the study. However, 
the fluctuations noted could likewise be attributed to an abnormal function of the 
hypothalamus. Coincidental with the changes in the psychiatric and psychological 
spheres, there have been corresponding or opposite fluctuations and variations in 
the organic sphere. When more studies of this nature have been made possibly 
an answer to the question of functional interdependence may be achieved. 

2. "Blood Sedimentation Rate in Schizophrenia." H. Freeman. Arch. 
Neur. and Psychiat. 

A study was made of 50 normal and 47 schizophrenic men in whom selection was 
made on the basis of relative freedom from detectable infectious processes. In 
the normals, the mean sedimentation rate. was 0.26 mm. per minute; of these, 
20 percent had rates more rapid than the conventional normal limit of 0.35 mm. 
In the schizophrenic subjects the determinations were made on three occasions in 
seven months. The mean values for the rates were 0.32, 0.24, and 0.29 mm. per 
minute. These were all within normal limits and were not significantly different 
from one another. Sub-classes showed no significant differences in the sedimenta- 



24 P.D. 23 

tion reaction. The sedimentation rate in noninfected subjects showed a mean 
variation of only 0.09 mm. per minute over a seven-month period and seemed to 
be a characteristic feature of each person. There was no diurnal variation of the 
sedimentation reaction. Infection being excluded, schizophrenia is characterized 
by normal blood sedimentation rate. 

3. "A Comparison of the Methods for Collection of Blood to be Used in the 
Determination of Cases." J. M. Looney and H. Childs. Jour. Biol. Chem. 

A new method for collecting and handling blood for gas analysis, using a capped 
syringe, is described and is shown to be superior to the methods now in use in 
preventing error caused by the diffusion of the gases through the oil layer used in 
the ordinary method. 

4. ''The sensory threshold to direct current stimulation in schizophrenic 
and normal subjects." P. E. Huston, Arch. Neur. and Psychiat. 

As a check upon the statement that high faradic current thresholds are found in 
about 50 per cent of dementia praecox patients, a technic of direct current stimula- 
tion was employed. This revealed no significant differences between the schizo- 
phrenic group and a comparable normal one in the means of the two groups, the 
scatter about the mean, the mean variation within individuals, the intervale be- 
tween the ascending and descending series and the course of the threshold. Reasons 
for the failure to confirm Grabfield's results are advanced. 

5. "Manganese Treatment in Schizophrenia." R. G. Hoskins, Jour. 
Nerv. and Ment. Dis. 

This paper points out the relative inadequacy of colloidal manganese in the 
treatment of schizophrenia. 

6. "Further Studies on a Glycerin Extract of Adrenal Cortex Potent by 
Mouth." H. Freeman, F. E. Linder, and R. G. Hoskins, Endocrinology. 

This is a complete confirmation of the results of the preceding study mentioned. 

7. "The relation between oral and rectal temperatures in normal and 
schizophrenic subjects." H. T. Carmichael and F. E. Linder, Am. Jour. 
Med. Sci. 

Schizophrenic subjects have a mean difference between oral and rectal temper- 
atures, taken simultaneously, of 0.54 F as contrasted with the figure of 0.95 F 
for normal subjects. Normal subjects individually showed more variation than 
did the individual patients. While the difference between the two groups may in 
part be accounted for by greater activity of the normals, results suggest that the 
heat regulating mechanism in the schizophrenic subjects may be different than in 
the normals. 

8. "A Biometric Study of the Relation between Oral and Rectal Tempera- 
tures in Normal and Schizophrenic subjects." F. E. Linder and H. T. Car- 
michael, Human Biology. 

In a biometric study of the relationship between oral and rectal temperatures of 

25 schizophrenic patients and 24 normal subjects, 24 simultaneous oral and rectal 
temperature measurements were made on each. Analysis of the data showed essen- 
tially the same mean oral and rectal temperatures for the two groups. But signifi- 
cant differences found in the degree and manner of the relation of oral to rectal 
temperatures indicate that the organization of the temperature regulating mechan- 
isms in schizophrenia is different than in our normal controls. 

9. "The Schizophrenic Personality with Special Regard to Psychological 
and Organic Concomitants." R. G. Hoskins and E. M. Jellinek. 

Invitation to present this paper before the Association for Research in Nervous 
and Mental Diseases has been received. 

A comparison of variation from individual to individual in schizophrenics with 
the variation amongst normal controls gives evidence of the heterogeneity of the 
schizophrenic group. The authors believe that no theory can be advanced until 
strict separation of the various diseases classified as schizophrenia has been accom- 
plished. However, on the basis of studies of the variation within given individuals 
and of studies of correlations within these individuals, but chiefly based on the 
investigation of blood pressure relationships as indices of autonomic integration, 
they predict that in the major part of the group the essential etiology will prove 
to be defects of integration rather than primary organic abnormality. They ex- 
tend Bleuler's label to include "split physiology" as well as "split mentality." 



P.D. 23 25 

The following papers have been submitted for publication but no formal accep- 
tance has yet been received. 

1. "Studies on the Phytotoxic Index." I. Results in 68 male schizophrenic 
subjects. William Freeman and Joseph M. Looney. 

2. " Arm-to-Carotid circulation time in normal and schizophrenic individuals." 
H. Freeman, M.D. 

3. "The effect of dinitrophenol on the metabolism as seen in schizophrenic 
patients." J. M. Looney, M.D. and R. G. Hoskins, Ph. D., M.D. 

4. "The gas content of arterial and venous blood of schizophrenic patients." 
J. M. Looney, H. Freeman and E. M. Jellinek. 

Psychological phases of the research are covered in the report of the chief psy- 
chologist, D. Shakow. 

A total of 28 addresses were given by members of the research service during 
the year. 

The year has been notable chiefly for definite increases in our knowledge of the 
physiology of schizophrenia. The concept of inefficiency of integrative physio- 
logical mechanisms has been applied to the group. The general problem has been 
clarified to a greater degree than heretofore as a result of the analysis of accrued 
material. 

Plans for the next year contemplate emphasis on the gathering of control data, 
the possible establishment of a ward exclusively for therapuetic purposes and 
projects directed toward evaluation of autonomic efficiency in these patients. 
Sufficient work has been done on the psychiatric evaluation of various traits of 
the patients to tell us which traits can be quantitated. This information is of 
vital interest. The accumulation of such data is tremendously time-consuming 
and requires a greater personnel than we have available to carry on as far as we 
would wish. Work on this project will be continued, however. It is hoped that 
hormonal assays on the blood may be carried out on a systematic basis. Other 
plans for the year are alluded to in the body of the report. 

Research activities of the hospital are in no sense limited to the research service. 
During the year, Dr. Perkins has continued his investigations of the physiological 
effects of diathermy in the treatment of dementia paralytica, Dr. Yorshis his 
studies on blood groups in schizophrenic patients and their relatives, Dr. Emch 
her work on menstrual abnormalities in psychotic women, Dr. Levine on special 
neurological and endocrine case studies. 

It would be emphasized that the personnel of the research service is both anxious 
and willing to be of assistance to the other services in planning new projects, pro- 
viding special facilities which may be available and helping staff members to avoid 
mistakes which have been made on the research service in investigations. 

Research Service Psychological Laboratory 
David Shakow, Director. 

In general the department went along the even tenor of its way except that more 
time was given this year to analysis as opposed to the accumulation of data. 

As an inevitable result of the policy of using the hospital as a training center, the 
year saw numerous changes in the personnel. Miss Rosaline Goldman, a graduate 
of the Worcester State Teachers' College, came in December as externe. Miss 
Judith Israelite, M.A., of Columbia and the Judge Baker Foundation, came as 
interne in February and stayed through August. She has since gone to the Caswell 
Training School at North Carolina as psychologist. Miss Marjorie Page left in 
July to continue her graduate work and take a position at the Iowa Psychopathic 
Hospital. Miss Marion Greenham, M.A., (University of Minnesota) came as 
interne in July. Messrs. Irving Knickerbocker and Douglas MacGregor of Harvard 
came for special experiment work during the summer, as did Mr. Lorrin Riggs of 
Dartmouth. 

In September there were a number of changes. Dr. Braly and the Misses Merrick 
Bail and Spessard left; Miss Bail for the position of psychometrist at Foxorough 
State Hospital, Miss Spessard for a position in Virginia, and Dr. Braly for a position 
at the University of Minnesota. Miss Margaret Gifford of Wellesley and the 
Harvard School of Education and Miss Jennie Kauffman from Cornell came to take 
two of the positions thus vacated. 



26 P.D. 23 

A statistical analysis of the work done by the Department shows the following. 
Psychometrics and Interviews 

House: Individuals Tests 

Regular patients 299 1,050 

Schizophrenia research 138* 759 

Other special groups 88 352 



525 2,161 
Out-Patient Department: 
Child Guidance clinic: 

Regular patients 219 1,095 

Special disability and other therapeutic interviews 60 1,256** 

School clinic 296 888 

Girls' Welfare Society 18 72 

Jail 32 126 

Other 7 38 

Employees 191 503 

823 3,978 
Experimental and Other Research 

Patients 510 1,525 

Normals 305 706 

815 2,231 

Grand Total 2,163 8,370 

♦Includes repeated examinations on the same individual. 
♦♦Interviews or session^. 

Among the research projects completed during the year are the following: 

1. Study of psychological ".condition" in schizophrenia and normal controls 
by means of the Miles pursuitmeter. 

2. Oscillographic study of the patellar tendon reflex in schizophrenia and normal 
controls. 

3. Reaction-time under varying preparatory intervals in schizophrenia. 

4. The Kent-Rosanoff association test in schizophrenia. 

5. Simple auditory and simple and choice visual reaction time in schizophrenia 
and normal controls. 

Some of the major projects still in progress are: 

1. The response of schizophrenic patients to the interruption of presented tasks. 

2. The response of schizophrenic patients to substituted activities. 

3. Memory in psychotic subjects — particularly in schizophrenia. 

4. The psychological stiuation of a patient in a mental hospital. 
II. The progress of hospitalization. 

Two papers are about ready for publication: 

1. A study of hypnotically-induced complexes by means of the Luria technic. 

2. The response of newly-admitted patients to Dr. Bryan's informational letter 
to them. 

One paper has been accepted for publication by the Archives of Neurology and 
Psychiatry — "The Sensory Threshold to Current Stimulation in Schizophrenic 
and Normal Subjects." 

Some of the papers in an advanced stage of writing which should be submitted 
during the course of the year are: 

1. A series on motor and learning phenomena in schizophrenia, based on studies 
with the prodmeter, the pursuitmeter, and the steadiness meter. 

2. " Scatter" in the Stanford-Binet in schizophrenia. 

3. Psychomotor learning as measured by the Ferguson V and the Worcester 2C 
Formboards. 

4. The psychological situation of patients in a mental hospital. I. First contacts 
with the hospital and the different types of response to it. 

Papers published, based on work done at Smith College, by members of the 
department during the year are the following: 



P.D. 23 27 

1. Hanfmann, E.: Some experiments in spatial position as a factor in children's 
perception and reproduction of simple figures. Psychol. Forsch. 17, 1933. 

2. Hanfmann, E. and Dembo, T.: Intuitive halving and doubling of figures. 
Psychol. Forsch. 17, 1933. 

In the course of the year the following papers were read at meetings: 

1. Houston, P. E. — A study of hypnotically-induced complexes by means of 
the Luria technic. American Psychological Assn., (Ithaca), Sept. 1933. 

2. Houston, P. E. — A Study of hypnotically-induced complexes by means of 
the Luria technic. Harvard Psychological Colloquium, December 1933. 

3. Huston, P. E. — A study of hypnotically-induced complexes by means of 
the Luria technic. Massachusetts Psychiatric Assn., December, 1933. 

4. Rickers, M. — The response of schizophrenic patients in a "free" situation. 
American Psychological Assn., (Ithaca), September, 1933. 

5. Rickers, M. — The Lewin theory of feeblemindedness. Harvard Psycho- 
logical Clinic, February, 1933. 

6. Rickers, M. — The response of normal subjects in a "free situation" 
Harvard Psychological Clinic, July, 1933. 

7. Hanfmann, E. — Theory of Association. Harvard Psychological Clinic, 
February, 1933. 

Considerable new apparatus was developed during the year largely because of 
the aid of the mechanic made available to the Research Service. Among these 
might be mentioned, a modification of the Miles pursuitmeter, a new reaction-time 
apparatus, the completion of the oscillograph, and a multiple choice apparatus. 

During the course of the year two seminar courses were held — one for department 
members and the other made available for the hospital staff. In the first, meetings 
were held weekly from November through February. At regular meetings members 
of the department presented reports on their research projects. At special meetings 
outside speakers were invited to discuss some psychological subject of interest. 
Among the outside speakers were Doctor Wells, Willoughby, Hunter, and Hoag- 
land. The other seminar held was in the nature of a course on "Mental Adjust- 
ments" given by Dr. F. L. Wells of the Boston Psychopathic Hospital. This 
consisted of two-hour sessions held once a week during March and April. 

Plans for the coming year involve primarily the analysis of the immense body of 
material collected in our work for the past years. However, because of the promise 
of a number of our experimental studies, we are planning particularly to continue 
some of them. These include various aspects of learning in schizophrenia; the 
Luria studies on the nature of conflict, especially in patients; the mental status 
studies; and various of the Lewing studies. 

Research Service — Biochemistry and Pathology 
Joseph M. Looney, M.D. — Director of Laboratories. 

As will be seen from the attached summary, the total number of tests performed 
in the laboratory for the past year has been maintained at a high level — a total of 
48,830 as compared with a total last year of 49,611. 

The work of installing a new refrigerator in the mortuary was completed early 
in January. This unit has proven of inestimable value throughout the year, and is 
of ample size to care for all our routine requirements. In order to complete the 
renovation of the pathology department, a new autopsy table is necessary, as the 
present one is in very poor condition. 

The training course in laboratory technique has been continued, and a new 
student has been admitted to replace one of the girls who had completed the work 
and secured employment. Mr. H. O. Carlson, who served as a volunteer assistant 
in the laboratory, left in September, and has since secured employment as a 
chemist. 

Dr. S. R. Feldman, pathological interne, resigned on June 1 to enter private 
practice in Springfield. His place has been taken by Dr. J. C. Drooker who will 
serve as pathological interne for six months while awaiting his general internship 
at the Boston City Hospital. 

During the summer the same policy of admitting medical students to work in 
the laboratories has been followed out and this year two students from Boston 
University Medical School worked in the pathology department and one student 



28 P.D. 23 

from Harvard Medical School, and one from John Hopkins Medical School worked 
in the Chemical Department. 

The instruction to the student nurses in bacteriology, pathology and chemistry 
by Dr. Freeman and myself has been carried out as usual. The pathological con- 
ferences, which are held monthly, have proven to be both profitable and instructive. 

During the year the name of Dr. Freeman was added to the list of specialists in 
the field of clinical pathology approved by the American Medical Association. It 
might be noted that of the four physicians residing in Worcester on the list two are 
on the staff of this hospital. 

The total number of autopsies performed during the year amounted to 165, 
which is 74% of total of 233 deaths which occurred during the year. This is a 
most excellent record and is due to the close cooperation between the medical 
service, and the pathologist. These were attended by 1,061 visits from members 
of the medical staff, and 1,033 visits from among the medical students, or an 
average attendance of 13 per autopsy. 

The director attended the annual convention of the American Society of Bio- 
logical Chemists in Cincinnati, Ohio in April and presented a paper on "The 
Effect of the Ingestion of Tyrosine on the Blood Phenols and Blood Uric Acid as 
Determined by the Methods of Folin and Benedict." This was published in the 
June number of the Journal of Biological Chemistry. 

In March he gave an address to the Knights of Columbus in Somerville, Massa- 
chusetts, on " What the State is doing for its insane." 

Dr. Freeman has continued his connection with the Boston University School 
of Medicine as instructor in the Department of Pathology. He also presented two 
papers during the year; the first entitled, "Bone Marrow Studies in Primary 
Blood Dyscrasias" was given at a staff meeting of the Worcester Hahnemann Hos- 
pital in April, and the second before the annual cancer clinic of the Worcester 
District Medical Society on "Grading the Degree of Malignancy of Cancerous 
Tumors in Relation to Prognosis and Treatment" in September. 

In addition the following papers have either been published or accepted for 
publication during the year. 

Pathologist's Duty in Obtaining Permission for Autopsy. Am. Journ. Clinical 
Pathology, 3, 211, 1933. William Freeman. 

Preparation and Use of Colloidal Carbon Solutions. J. M. Looney and F. C. 
Stratton. Accepted by Jour. Lab. and Clinical Medicine. 

A Comparison of the Methods for the Collection of Blood to be Used in the 
Determination of Gases. J. M. Looney and H. Childs. Accepted by J. Biol. Chem. 

Bone Marrow Studies in Primary Blood Dyscrasias. William Freeman. Staff 
of Worcester Hahnemann Hospital. 

Grading the Degree of Malignancy of Cancer Tumors with its relation to the 
Prognosis and Treatment. Read before the Annual Cancer Clinic of the Worcester 
District Medical Society. 

A number of other papers have been completed and are ready for publication. 

The research work has progressed satisfactorily; during the year definite indi- 
cations for future studies have crystallized out of the completed investigations. 

It is hoped that future investigations will proceed along the line of therapy and 
a number of substances have been or are in the process of being utilized for such 
studies. 

Total Number of Examinations 

Androitin test . 
Urine (bacteriology) 



Bacterial cultures 






•249 


Bacterial smears 






287 


Basal metabolisms 






1,084 


Blood cultures . 






50 


Blood creatinine 






1,576 


Blood N.P.N. . 






1,626 


Blood sugars 






2,210 


Blood urea 






1,579 


Blood uric acid . 






1,638 


Blood counts 






2,802 


Blood counts (W) 






4,420 


Blood counts (D) 






3,556 



Glucose tolerance 
Blood gases 
Blood sedimentation 
Pituitary hormone 
Blood lactic acid 
Luminescent bacteria 
Blood glutathione 
Stomach contents 
Blood fragility . 
Blood P.H. 



12 

16 

10 

485 

29 

7 

448 

175 

624 

94 

103 

104 



P.D. 23 



29 



Haemoglobins . 






4,329 


Dopa Stains 




Clotting time 






119 


Gastric lavage . 




Galactose tolerance . 






186 


Blood pressures 




Icteric index 






240 


Fluid (hydrocele) 




Mosenthal tests . 






335 


Urine (prolan) . 




Nitrogen partitions 






1,056 


Blood (prolan) . 




Plasmodia malaria . 






3 


Blood oestrin 




Renal function . 






195 


Urine oestrin 




Spinal fluids (cells) . 






372 


Manganese analysis , 




Spinal fluids (gold) 






370 


Stool (fat contents) . 




Spinal fluid (chlor.) . 






369 


Stool (creatinine) 




Spinal fluid (diff.) 






19 


Acid analysis 




Spinal fluid (glob.) 






371 


Toxicological exam. . 




Spinal fluid (sugar j 






370 


Vomitus 




Spinal fluid (prot.) 






371 


Enema exam 




Stools . 






534 


Peroxidase stain . 




Sputa . . . . 






614 


Cranial fluid (prot.) . 




Tissue sections . 






3,576 


Cranial fluid (chlor.) 




Urines (routine) 






7,859 


Blood clot retractibility 




VandenBergh tests 






172 


Spinal fluid culture . 




Vital capacity . 






459 


Fluid (wound) . 




Widals. 






15 


Blood sp. gravity 




Bleeding time . 






14 


Ascitic fluid 




Urines (quant, sugar, 






342 


Platelet fragility 




Milk analysis 






141 


Water analysis . 




Blood typing 






12 


Blood serum protein 




Fluid (pleura) . 






1 


Exudate (leg) 




Ascheim-Zondek test 






19 


Animal inoculation . 




Blood phophorus 






10 


Urine (urobilen) 




Blood calcium . 






18 


Urine (urobilinogen) 




Fluid (abdomen) 






4 


Phytotoxic index 




Blood chloride . 






7 


Liver function test . 




Colonic irrigations 






372 


Blood phenol 




Platelet count . 






43 


Blood tyrosine . 




Reticulocyte count 






42 


Urine phenol 




Blood amino acids 






63 


Urine tyrosine . 




Blood cholesterols 






484 


Urine hematin . 




Blood creatine . 






63 


McClure's tests 




Blood volumes . 






44 


Urine music acid 




Schilling's indices 






393 


Milk P.H. . 




Blood hematocrits 






210 


Stool (tot. nitrogen) . 




Water metabolism 






298 


Stool (tot. solids) 




Stool (lead) 






1 


Stool (saline suspension) 




Urine (lead) 






1 


Stool (broth suspension) 




Fluid (abscess) . 






1 


Fluid (gland) 




Autopsies . 






165 


Total of Other examinations . 


Grand Total 













Research Service — Medical Library 
George L. Banay, Ph.D., Librarian. 

Medical Library 
The past year represents a year of marked expansion in the history of the medical 
library. The increase in the number of our periodicals, our policy of immediate 
binding, the exchanges received from the Medical Library Association, and the 
reorganization of our reference library necessitated the installation of new shelves 
in the Library. By putting in twelve new racks (some of them especially adapted 
for the display of periodicals) we increased the shelf -room capacity about 50%. 
The new floor and desk lamps in the reading room enhance the attractiveness of 
the reading-room considerably. But, because at the end of the year almost all of 
the additional shelf-room has been used up, the necessity of increasing the facilities 
of the medical library is as great as ever. 



30 P.D. 23 

To indicate the increased activities and the progress in the development of the 
library, I quote the following details: 

Periodicals: The medical library had 11 more journals than last year. We now 
have 26 periodicals in neurology, psychiatry and mental hygiene; 17 in psychology 
and psychoanalysis; 16 in general medicine, 19 in internal medicine, surgery, 
obstetrics and pathology; 8 in physiology and chemistry; 5 in physical medicine 
and radiology; 1 in legal medicine; 2 in hospital administration; 5 in social 
service; 1 in occupational therapy; 2 in nursing; 9 in education and child guidance; 
altogether 105 periodicals. 

Of this number the hospital subscribes to 78: 2 are paid for by the Foundation 
for Neuro-Endocrine Research, 13 are donated by Dr. Hoskins, 2 by Dr. Sleeper, 
1 by Dr. Perkins, 2 by Dr. Carmichael, 1 by Dr. Erickson, and 6 come in free 
from State and Federal authorities and medical supply companies. 

Of these periodicals six are in French, seven in German, five in Italian, and 87 
in English. 

Circulation. The Medical Library circulated 483 volumes last year. 

Inter-Library Loans. The Librarian maintained close contact with other medical 
libraries and we borrowed 217 volumes of periodicals from 8 libraries, that is: Bos- 
ton Medical Library, 138; New York Academy of Medicine, 26; Clark Univeristy 
Library, 21; Army Medical Library, 13; Harvard College Library, 11; Providence 
Public Library, 5; Harvard Medical Library, 2; Iowa State College Library, 1. 

Medical Library Exchange. Continuing our policy of completing the back files 
of our medical periodicals, we were able to complete many items during the year 
either by purchase from second-hand dealers or by exchange from other libraries. 
(Boston Medical and Surgical Journal, Medical Clinics of North America, and 
others.) As a member of the Medical Library Association, we received 92 volumes 
and we gave in exchange 38 volumes to 27 medical libraries. The Association is 
of the greatest benefit to all medical libraries in helping to shape a general policy 
for the administration and care of the medical libraries and by maintaining the 
exchange. The librarian attended the annual convention of the association held 
in Chicago, June 19-21, 1933. 

Dr. William J. Delahanty donated to us about 60 volumes of old medical periodi- 
cals to be used for exchange. Dr. Looney presented to us 35 volumes of chemical 
periodicals. 

New Books. We have received 16 books as donations from various members of 
the Staff. Besides this, we bought 123 new volumes to bring our reference library 
more up-to-date. 

Binding. We bound 589 volumes during the year, including the ones received 
from the exchange, so that we are up-to-date now with our binding. 

Present State. By November 30, 1933 the medical library had 2,809 bound 
volumes of periodicals, 62 unbound volumes of periodicals, and 2,254 volumes of 
books. Total, 5,125 volumes, not counting the reprints and the pamphlets, an 
increase of 728 volumes during the year. 

Services. The librarian continued to circulate the weekly bibliography and ab- 
stracts, prepared many special bibliographies, and translated about 60 foreign 
medical articles. 

After circulation the abstracts are returned to the medical library and are class- 
ified under subject headings. We now have about 2,000 abstracts on file. 

Plans for the Future. A great many of our books are old and have only historical 
value. As soon as there is more shelf-room available it is intended to separate the 
volumes of historical interest and make a special historical collection in glass-doored 
book-cases. 

Cooperating with the department of research, we intend to compile a complete 
bibliography of schizophrenia and abstract all the important articles as soon as 
we can afford to have permanent help in the medical library. 
II. General Library 

The number of books in the library has been increased by many donations and 
purchases. The general library now has 3,663 books and takes about 40 current 
magazines and newspapers. One-third of the books are fiction, the rest religion, 
history, biography and poetry. One hundred seventy-five new books (mostly light 
fiction) were added to the library to bring it as much up-to-date as possible. 



P.D. 23 31 

The library is well patronized by patients and employees. The average monthly 
attendance is 1,500 patients, and 300 employees. The circulation of books and 
magazines is gratifying. Here are the mean monthly figures. 

Books and magazines taken out 598 

Books and magazines distributed on the wards . . . . . 200 

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

We maintained the five sub-branches on the closed wards as before (Lincoln I, 
Washburn I, Salisbury I, Summer Street Department and Hillside Farm.) The 
occupational therapy department cooperated with us in the most helpful way by 
taking books and magazines to the patients regularly, as they know their wishes 
better than anybody else. 

All in all, the library circulated 7,180 volumes last year and had 21,752 reading 
visitors. 

A few churches of Worcester (First Church of Christ. Scientist, St. John's 
Episcopal Church, All Saints' Church) and the Worcester Public Library send to 
us old books and magazines regularly, so we received during the year about 500 
books and 1,500 magazines. We express our hearty thanks to all who have 
given books and magazines to the library. 

After long years of faithful service, Miss Cushing, the patient in charge of the 
general library, died at the end of the year, and shortly afterwards her successor, 
Miss Garbitt, too. Their deaths upset the routine work of the library for a period 
until we again found suitable personnel. 

Outpatient Service — Child Guidance Clinic 
S. H. Hartwell, M.D., Director. 
I. Report of Case Load: 

A. Carried Cases: Boys Girls Total 

1. Cases carried over from last year 452 

2. Intake a. New cases accepted .... 146 55 201 

b. Old cases reopened: 

(1) last closed before present year . 5 3 8 

(2) last closed within present year. 1 - 1 

3. Total cases open at sometime in this year 662 

4. Cases taken from service 116 70 186 

5. Cases carried forward to next year 476 

B. Closed cases followed up (not reopened) 31 

C. Applications rejected 10 

D. Withdrawn cases 29 

II. Type of Service Classification: 

A. New Accepted Cases: 

6. Full service a. Clinic staff cases 96 

b. Cooperative cases 42 

c. Full service cases not (a) or (b) .... 35 

7. Special service 31 

8. Mental health study 6 

9. Total new cases accepted 210 

B. Total Cases Open at Sometime in this Month: 

10. Full service a. Clinic Staff cases 427 

b. Cooperative cases 110 

c. Full service cases not (a) or (b) . . . . 68 

11. Special service 50 

12. Mental health study 7 

13. Total cases open at sometime this year 662 

C. Cases Taken from Service: 

14. Full service a. Clinic staff cases 87 

b. Cooperative cases 48 

c. Full service cases not (a) or (b) . . . . 21 

15. Special service 26 

16. Mental health study 2 

17. Total cases taken from service 186 



32 

III. Sources Referring New Accepted Cases: 



P.D. 23 



VI. 











Mental 








Full 


Special Health 


Total 


18. 


Agencies a. Social 


. 43 


13 


- 


56 




b. Medical . 


. 5 


1 


1 


7 


19. 


Schools a. Public 


. 18 


4 


- 


22 


20. 


Juvenile court 


. 66 






66 


21. 


Private physicians 


1 


7 


4 


12 


22. 


Parents and relatives . 


. 40 


6 


1 


47 



23. Total new cases accepted .... 173 
IV. Summary op Work With or About Patients: 

A. By Psychiatrists: 

1. Interviews with patients a. for examination 

b. for treatment . 

2. Interviews about patients 

3. Physical examination by clinic staff members. 

B. By Psychologists: 

1. Interviews with patients a. for examination 

b. for re-examination 

c. for treatment 

2. Interviews about patients 

C. By Social Worker: 

1. Interviews in clinic 

2. Interviews outside clinic 

3. Telephone calls 

D. Number of Cases given Initial Staff Conference: 

1. Full service a. Clinic staff cases 

b. Cooperative cases . 

2. Special service 

3. Mental Health study 

V. Personnel Report: (Average staff during year) 



31 



210 



Total 
201 

1,159 
318 
193 

197 
30 

492 
86 

961 
1,521 
1,325 

72 
83 

57 
7 



A. 


Regular Staff: a. Psychiatrists 




b. Psychologists . 




c. Social workers . 




d. Clerical workers 


B. 


Staff in Training: a. Psychiatrists 




b. Social workers 


C. 


Volunteers: a. Clerical workers 




b. Research . 


Operating Schedule: 


A. 


Schedule of clinic days and hours: 




9:00 to 5:00 daily 




9:00 to 12:00 Saturdays. 


B. 


Schedule of attendance of psychiatrists 




9:00 to 5:00 daily. 




9:00 to 12:00 Saturday. 



Full Time 
2-3 
3 
3 
2 
1 
2 



Part time 
1 



1-2 

1 



Cases Carried Over from Last Year 
At the beginning of the year 1933, we were carrying 452 open cases. Approxi- 
mately 50% of these cases were cases that were in the stage of active treatment. 
By this is meant that the children, as the patients, or their parents, or other im- 
portant people in their lives, were being seen by some member of the staff for inter- 
views or other contacts regularly and frequently. Most of the cases represented 
by the other 50% of this group are cases which have been active in the clinic for 
two or three years, and are held open because the child or his parents still occasion- 
ally wish to come to the clinic or to see the workers. Some of these children or their 
parents need very definite psychiatric advice and help occasionally. Others wish 
to have the contact continued because of the fact that they have been helped and 
get security from knowing that the staff members are still their friends, and are 



P.D. 23 33 

people who can appreciate their successes and adjustments. The year 1934 opens 
with 476 open cases. This slight increase is very gratifying since it means that the 
staff is now at least carrying the same volume of work that it did a year ago despite 
the fact that the average size of the staff throughout the year has been somewhat 
smaller than it was the year previous. 

By comparing the average case load which is 450 and dividing by the average 
number of cases received during any year, one sees the average time a child is carried 
as a treatment case in the clinic is two years. 

Intake 

The total number of new cases accepted during the year was 201, and 9 cases 
were reopened. This last item requires considerable explanation. It is the policy 
of the clinic to consider three points when accepting cases. There are many more 
cases that are (in one way or another) referred to the clinic than is represented by 
the figure of those accepted. When parents or agencies ask to have a child accepted 
by the clinic, the first thing that is done is to have the parents or the agency worker 
come to the clinic, with the child's record, if one is available, and discuss the problem 
with our chief social worker or her assistant. 

Three factors are weighed when the case is being considered for acceptance by 
the clinic: 

First. Does the child or its parents need the kind of service which we offer? 
In other words, is a part of the problem based on the mental health, the personality, 
the emotional experiences or attitudes of the various people in the family situation, 
who are accountable for a considerable part of the problem? 

Second. Is the child's environmental situation such that, if these problems are 
dealt with, the child or his parents can benefit by a change in their mental life; or 
can our social worker, or in agency cases their social work, change the environmental 
situation, if it is so pernicious or abnormal that the clinic treatment alone could not 
be expected to accomplish results? 

Third. Is the need for help that a child guidance or mental hygiene clinic can 
bring great enough to warrant the making of a full study, conducted as it always 
is in our clinic, with the idea that treatment will probably be necessary? 

When the answer to any of these three questions is definitely in the negative the 
case is not at that time accepted for study and treatment in the clinic. However, 
the clinic does give service to the unaccepted cases during the referral interviews. 
For the first group we attempt to help the parents or others referring the child to 
see what the problem is, and often can give advice, such as environmental changes 
or methods of dealing with the child in habit training or disciplining, which if 
carried out will solve or partly solve the problem. The second group, those where 
in our opinion the situation is too pernicious and too undesirable for successful 
treatment, we can often refer the case to some other agency such as a child placing 
agency or the S. P. C. C, where the problem may be more constructively dealt 
with. Quite frequently, such cases come back to us later and are accepted. In 
the third group, those in which the problem is comparatively simple, we are very 
often able to do as much for the child in one or two interviews with the parents, 
as we would were the child to be accepted for full study and treatment, thus 
avoiding unnecessary work and use of the time of various members of the staff. 
Notes of these interviews are kept. Quite frequently the referring person comes 
back later for further advice. Sometimes the cases is accepted later, and these notes 
are very useful to us. They do not appear in the statistical report of our work al- 
though they do represent in our opinion a considerable part of the actual construc- 
tive work we do. 

As will be seen later in the report, we deal with a large number of agencies. 
We accept all the cases referred to us from a very few of these agencies. Chief 
among them we should mention the juvenile courts. Because of the law requiring 
a compulsory examination of all children before being committed as wayward or 
delinquent, and since the Child Guidance Clinic is the only agency at present 
equipped to make this examination in this community, it is necessary for us to do 
this. The small group of cases with whom we have no opportunity to do a thorough 
study or treatment, because of the fact that they are to be committed no matter 
what advice we give, are the most unsatisfactory group of cases with which we deal. 



34 P.D. 23 

None of these come from the Worcester Juvenile Court where the judge and pro- 
bation officers are always ready to continue a case or put the child on probation if 
we say at the time of the initial examination that we think the case may be dealt 
with through clinic and probation treatment, or placing by a child placing agency. 
Some of the outlying courts do not take this attitude. Cases referred by child 
placing and family welfare agencies are all accepted. These agencies have trained 
workers who can be relied on to use excellent judgment as to whether or not the 
case is an appropriate one for us. 

Old Cases Reopened: 

The number of old cases reopened is small. This is accounted for by the fact 
that it is the policy of the clinic not to close a case if we feel that the child or the 
parents would like to have occasional contacts with us, even if in the ordinary 
meaning the case has been adjusted successfully. This policy decreases the number 
of new cases that may be accepted, but we feel that a very definite part of our goal 
should be the understanding of the results, whether they are good or whether the 
case ends in failure, by the people who have worked with the case. In the last 
analysis, unless we can come to this understanding we are not progressing in 
technique nor will we be helped to establish or discredit any ideas that preventative 
psychiatry is advancing. 

The clinic is particularly interested in a group of children who have been con- 
sidered psychotic or borderline psychotic, and whom we have been able to handle 
as treatment cases. The results of treatment in some of these cases have been ex- 
tremely satisfactory but we feel they present a special problem for the clinic since 
they must be observed carefully over a long period, even though they seemingly 
are now well adjusted. 

Recommendations 

The usual repairs to the operating plant have been carried out during the year 
insofar as our limited appropriations would permit. Because of economic condi- 
tions during the past few years, the amount of money for the maintenance and 
upkeep of the buildings has been inadequate. Our buildings are old and require 
an ever increasing amount of money to keep them in good condition. Necessary 
repairs have piled up to the point where a considerable amount is needed to restore 
the hospital to its former condition of efficiency. The roofs and windows are in 
need of a considerable outlay to prevent waste of coal and to keep out the weather. 
There are many changes and alterations that need to be made to bring the buildings 
up to the point where patients can be properly treated in them. For after all, all 
construction must be thought of in terms of patients. To spend great amounts of 
money on changes in buildings to modernize them simply to house patients is one 
thing but to modernize old buildings in order to improve treatment facilities which 
in turn lead to the recovery of more patients, is another. Some of the changes 
recommended deal directly with the recovery of patients and others lead to in- 
crease efficiency on the business side of the institution and of course indirectly to 
the recovery of patients. In the first group of needed changes — those which have 
a direct bearing on the recovery rate of patients the following may be noted: 

Cafeteria Equipment for the Quinby, Woodward, Washburn and Salisbury Wards 

On each side of the hospital there are from 75 to 100 patients who are disturbed, 
noisy and untidy and cannot be taken to the regular cafeteria for obvious reasons. 
For this group and also to supply tray service for the two admission wards, cafeteria 
equipment is needed for a small dining room on each side. Any rearrangement 
which will permit closer supervision and the service of better food of greater variety 
and proper temperature will not only assist in getting patients well but will actually 
save money by eliminating waste. 

Changes in the Thayer and Folsom Wards: 

The Thayers and Folsoms are the medical and surgical wards of the hospital. 
They are ideal, in many ways, for this purpose. They permit proper classification 
and are easy of access for administrative purposes. But they are not performing 
their functions properly until certain changes are made so that better care and 
treatment may be given patients. One of the important needs on these wards is a 
passenger elevator in which patients may be transferred from one floor to another 
with the least possible delay. Patients must be transported to and from the 



P.D. 23 35 

operating suite for surgery and it is difficult to do this efficiently without elevators. 

The food service on these wards is not only inefficient but is very wasteful. It 
is impossible to prepare special diets for physically ill patients or for those who 
need extra nourishment and get it to them in a palatable condition. Unpalatable 
food always makes waste. If each diet kitchen could be moved to the basement 
under the wards it served, all trays could be prepared under direct supervision 
and sent directly to the ward by a subveyor system. All food would be taken off 
the wards and all dishwashing would be removed to the diet kitchen. The result 
of these changes would be that the patients would get better food and with the 
elimination of the waste we now have with our 'present system money could be 
saved. 

Installation of A Cafeteria at the Summer Street Department 

This is a much needed change which would both benefit patients and save money. 
There are 500 patients at this department. They are served in two dining rooms, 
one for men and one for women. These rooms are in the basement and are in a very 
bad state of repair. It would be a great improvement if one cafeteria could be in- 
stalled in the center of the building, serving both men and women. Such central 
food service would permit us to give a greater variety, serve the food in a more 
palatable condition and thus lead directly to an actual saving of money. 
Installation of Surgical Equipment for Folsom and Thayer Wards 

A glance at the medical and surgical section of this report will at once show how 
important this need is. We do not have the proper equipment for taking care of 
our physically ill patients. We need more sterilizers, more utensils such as bed 
pans, blanket warmers, Gatch beds, bedside tables, chart holders and other im- 
portant articles for the efficient care of the sick. 

Men and Women's Bath Houses 

The bathing facilities at this hospital consists of one central bath house which 
is used on alternate days by both sexes. It is located some distance from the 
wards and it is necessary to take the patients out of doors to bathe them. This is 
a decided hardship at any time but in the winter it is positive cruelty. This con- 
dition should be remedied at once by the erection, on each side, of a combined 
general bathing and tonic and sedative bathhouse, which will be connected with the 
main building. A central bath suite for each sex permits better supervision and 
more frequent bathing than will equipment on each ward. 
Conversion of the Roofs of the Woodward and Quinby Wards into Tubercular Wards. 

This could be done with very little expense. The roofs are now used for patients 
to walk about on but they would be much more useful if they could be used for 
tubercular patients where they could receive the maximum amount of air and 
sunshine. This would give additional accommodations for about fifty patients on 
both wards. 

Acoustical Treatment of Patient's Cafeteria and Chapel. 

When the present cafeteria was built, the treatment of wails by acoustical material 
was not as far advanced as it is today. The result is that the cafeteria is noisy. In 
many ways this noise affects patients and nullifies the good therapeutic affect the 
dining room has. 

The installation of sound picture equipment makes it absolutely essential that 
something be done to deaden the echos in the amusement hall. The maximum 
amount of therapeutic affect cannot be attained until better acoustics are secured. 
Tunnel to Patient's Cafeteria 

The present route followed by male patients to and from the dining room is 
not satisfactory. They travel the same route that service carts use in delivering 
supplies to the wards. The employees use the same corridor to go to their dining 
room. This crossing of traffic is very unsatisfactory and at slight expense a tunnel 
could be built leading from the Lincoln wards to the sub-basement near the cafe- 
teria. 

Patients' Exercise Yard 

This is a badly needed improvement which will permit disturbed patients to 
spend most of their time out of doors in good weather with a minimum amount of 
supervision. Occupations can be carried on in this yard, playground apparatus 
can be installed and much benefit can be accomplished for the women who are on 
continued treatment wards. This yard would be exclusively for women. 



36 P.D. 23 

Alterations to Farmhouse 

The building which is commonly known as the farmhouse is in a bad state of 
repair. It now houses thirty patients who would be more comfortable at the main 
building. This building could be converted into a staff and employees' home at 
little expense and this would take care of the crowded situation among employees 
and physicians which is not conducive to good work. It would also enable us to 
get badly needed additional room for our surgical and treatment suite and permit 
physicians to give better care to the patients coming there for treatment. An 
examination of the surgical report will reveal how badly this room is needed. 

In the second group of much needed improvements which would add to the 
business efficiency of the hospital I list the following: 
New Engines — Main Hospital 

The light and power of the hospital is supplied by three old Ames engines directly 
connected to generators of the direct current type. These engines are over 30 
years old and they use an excessive amount of steam for the power they deliver. 
Because of their age it is difficult to get repair parts for them. The generators are 
worn, the insulation is brittle and the commutators have been turned down many 
times. We are limited on production because of the decreased capacity of the 
generators. The Commonwealth would save money if this old equipment were 
replaced by two large unit generators each capable of carrying the entire load and 
one small unit which could carry a small load. 

New Engines — Summer Street 

The engines at the Summer Street Department are 33 years old. They have 
had hard service. The current shaft of the small engine is sprung and the con- 
necting ring of the large unit should be replaced. The generators are in poor con- 
dition. The commutator on the small engine has been turned down many times 
and the generator on the large engine has been damaged by lightning. They should 
be replaced by two new 50 horse power machines directly connected to generators. 

New Laundry 

The laundry building at this hospital is a menace to patients and employees 
both from the standpoint of fire hazard and health. It is a single large room located 
on the first floor of a two story building, dark and without any ventilation except 
from the windows. Part of the room is one story with a tar and gravel roof and 
skylight. This latter condenses the steam as fast as it rises and in the winter it 
falls back into the room in a deluge. It is absolutely inhuman to require either 
employees or patients to be in any room where such conditions prevail. 

Alterations in Present Laundry Building for Proper Storage Facilities 

The facilities at this hospital for the storage of goods is entirely inadequate. The 
store rooms are in separate rooms in the basement. They are scattered, and hard 
to supervise. Improper ventilation, dampness and darkness make it impossible 
for the hospital to properly take care of the considerable stock of goods we must 
carry at all times. The present laundry building would make an ideal storehouse. 
It is located in the center of the institution, easily accessible to all parts and ade- 
quate for all our needs. 

Renovation of "Strawbarn" 

The old barn which is locally known as the "strawbarn" from the fact that it 
was used many years ago for the storage of straw to fill the straw ticks upon which 
the patients slept, is now used for the storage of plumbers and engineers supplies. 
It could easily be transformed into an excellent industrial building where industrial 
therapy can be given to male patients under conditions that are much more com- 
fortable than is the case at the present time. 

Renovation of Toilets in Nurses and Attendants Home 

The toilets in both the attendants and nurses homes are obsolete, unsanitary 
and entirely inadequate to the number of people who are housed in these structures. 
The Board of Registration of Nurses requires one toilet and one lavatory for every 
six nurses, and one shower or tub for each ten nurses. We are not able to comply 
with these requirements at the present time. This project contemplates only the 
replacement of unsanitary, obsolete fixtures for more modern ones. The structural 
changes necessary to enable us to install these additional fixtures are not extensive. 



P.D. 23 37 

Repaving Main Avenue and Adjoining Roads 

The condition of the Worcester State Hospital roads is disgraceful. These roads 
have good bases and when originally built it was contemplated that surfacing would 
be carried out later. This has never been done. The result is that the roads are 
rutty, uneven, and some of them washed out by rain storms. This project contem- 
plates new curbing, a gutter on each side and a properly surfaced road. 

Completion of Cow Barn 

Two years ago we completed a new barn of the pen type and the results of this 
experimental barn have been such as to justify the completion of the project as it 
was worked out before the present wing was built. This would include other wings 
to the barn and also the erection of a new horse barn. This latter is particularly 
important because our present wooden structure, which was here when the hospital 
was built, is in a state of extreme dilapidation and will not last very much longer. 
It does not seem to be good business procedure to keep valuable horses in a struc- 
ture of this kind. These changes should also include very important changes in 
our facilities for vegetable storing which are entirely inadequate at this hospital. 

It is obvious that all of these changes cannot be made at one time but a portion 
of the work could be done each year and it would not take many years to 
get this hospital in first class condition. I have included these specific matters 
in this report in order to make it perfectly clear that in my opinion an attempt should 
be made to begin the modernization at a very early date. The reason for this 
modernization is that it will enable us to be more efficient in the care and treatment 
of patients and as a result of increased efficiency I firmly believe that more patients 
could be discharged from the hospital. 

Words are quite inadequate to express my feelings of gratitude toward the Board 
of Trustees and the officers and employees of this hospital for their constant support 
and cooperation during this strenuous period. Members of the Board have been 
unfailing in their encouragement and support and I am deeply grateful for this. 
The officers and employees have worked diligently and to a common end towards 
the progress of the hospital and it is with much pleasure that I make this public 
acknowledgement to both of these groups. 

Respectfully submitted, 

WILLIAM A. BRYAN, 

Superintendent. 

VALUATION 

November 30, 1933 
Real Estate 

Land, 589.16 acres $467,130.00 

Buildings 2,042,646.68 

$2,509,776.68 
Personal Property 

Travel, transportation and office expenses $7,950.87 

Food 12,590.12 

Clothing and materials 27,401.05 

Furnishings and household supplies 274,990.24 

Medical and general care 55,738.54 

Heat and other plant operation 3,845.53 

Farm 57,697.15 

Garage and grounds 12,284.17 

Repairs 17,216.54 

$469,714.21 
Summary 

Real estate $2,509,776.68 

Personal property 469,714.21 

$2,979,490.89 

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, 1933. 

STATEMENT OF EARNINGS 

Board of patients $74,665 . 22 

Personal Services: 

Reimbursement from Board of Retirement 263.14 



38 P.D. 23 

Sales* 

Food . . . . . . . " • $1,393.62 

Clothing and materials 149.80 

Furn. and household supplies 21.12 

Medical and general care 204.71 

Heat and other plant operation 63 . 50 

Garage and grounds 2.50 

Repairs ordinary 154.95 

Repairs and renewals - 

Arts and Crafts sales - 

Misc. — junk - 

Farm (itemize) Cows and calves $142.04; hides, $21.71; vegetables, $2.03; 

sundries, $3.00 168.78 

Total Sales $2,158.98 

Miscellaneous: — 

Interest on bank balances $335.68 

Rents , • 906.97 

Sundries 52.80 

Total, miscellaneous $1,295.45 

Total Earnings for the year • ■ $78,382.79 

Maintenance Appropriation 

Balance from previous year, brought forward $39,941.10 

Appropriation, current year 707,800.00 

Total $747,741.10 

Expenditures as follows: 

1. Personal services $394,038.31 

2. Food 106,079.36 

3. Medical and general care 29,040.96 

4. Religious instruction 2,446.00 

5. Farm 22,888.56 

6. Heat and other plant operation 82,717.58 

7. Travel, transportation and office expenses 9,086.32 

8. Garage and grounds 5,841.69 

9. Clothing and materials 13,615.61 

10. Furnishings and household supplies 25,259.15 

11. Repairs ordinary 13,372.21 

12. Repairs and renewals 2,456.49 

Total Maintenance expenditures $706,842.24 

Balance of Maintenance appropriation, Nov. 30, 1933 $40,898.86 

Special Appropriations 

Balance December 1, 1932, brought forward $285.95 

Appropriations for current year 41,000.00 

Total $41,285.95 

Expended during the year (see statement below) $32,808.23 

Reverting to Treasury of Commonwealth *119.57 

(Star balances below that are reverting) ■ 32,92 7.80 

Balance November 30, 1933, carried to next year $8,358.15 



Appropriation 


Act or 
Resolve 
Ch. Year 


Amount 
Appro- 
priated 


Expended 

during 
Fiscal Year 


Total 

Expended 

to Date 


Balance 
at end 
of Year 


Officers' Cottages, 1929 . 

Equipment for dairy .... 
Equipment for cow barn . 
Renovating heating system 
Furnishings Officers' cottages . 
Roof repairs and fire protection . 


146-1929 
245-1931 

14-1931 
245-1931 
245-1931 
371-1933 


$19,000.00 

20,000.00 

12,000.00 

3,000.00 

41,000.00 


$166.38 
32,641.85 


$18,999.49 

19,957.58 

11,954.44 

2,968.92 

32,641.85 


$.51* 

42 . 42* 
45.56* 
31.08* 
8,358.15 






$95,000.00 


$32,808.23 


$86,522.28 


$8,477.72 



Per Capita 
During the year the average number of patients has been 2,235.60. 
Total cost of maintenance, $706,842.24. 

Equal to a weekly per capita cost of (52 weeks to year), $6.0303. 
Total receipts for the year, $78,382.79. 
Equal to a weekly per capita of, $.6743. 

Total net cost of maintenance for year (Total maintenance less total receipts) $628,459.45. 
Net weekly per capita, $5.4060. 



Respectfully submitted, 
MARGARET T. 



CRIMMINS, 

Treasurer. 



P.D. 23 



STATEMENT OF FUNDS 

Patient's Funds 



Balance on hand November 30, 1932 

Receipts 

Interest 



$10,147.14 

6,947.65 

301.85 



Expended 8,273.05 



39 



$17,396.64 



Interest paid to State Treasurer 



301.85 



Worcester County Institution for Savings 
Worcester Five Cents Savings Bank 
Worcester Mechanics Savings Bank 
Peoples Savings Bank 
Bay State Savings Bank . 
Balance Worcester Depositors' Corp. 
Balance Mechanics National Bank 
Cash on hand December 1, 1933 



Investments 



1,300.00 

1,300.00 

1,300.00 

1,800.00 

1,800.00 

211.02 

994.99 

115.73 



Balance on hand November 30, 1932 
Receipts 



Expended 



Canteen Fund 



$1,183.57 
14,510.56 



Investments 
Worcester Depositors' Corp. (Class A Certificate) 

Mechanics National Bank 

Cash on hand December 1, 1933 



$310.98 
854.43 
154.89 



Balance on hand November 30, 1932 
Income 



Lewis Fund 



$1,353.25 

48.75 



Investments 
Worcester Five Cents Savings Bank $1,300.00 



Balance Worcester Bank & Trust Co. 
Balance Mechanics National Bank 



Balance on hand November 30, 1932 
Income 



61.75 
40.25 



Wheeler Fund 



$1,012.36 
37.50 



Expended 



Worcester Mechanics Savings Bank 
Balance Worcester Bank & Trust Co. 



Investments 



$1 ,000.00 
21.06 



Balance on hand November 30, 1932 



$1,025.15 



Manson Fund 

Expended 4.32 

Investments 



Millbury Savings Bank 

Balance Worcester Bank & Trust Co. 



$1,020.00 
.83 



Clement Fund 

Balance on hand November 30, 1932 $1,000.00 

Income 37 . 50 

Expended 



8,574.90 
58,821.74 



$8,821.74 

$15,694.13 
14,373.83 

$1,320.30 

$1,320.30 

$1,402.00 

$1,402.00 

$1,049.86 
28.80 

$1,021.06 
$1,021.06 

$1,020.83 
$1,020.83 



$1,037.50 
37.50 

$1,000.00 
Investment 
Worcester County Institution for Savings $1,000.00 

Respectfully submitted, 

MARGARET T. CRIMMINS, 
Treasurer. 
November 30, 1933. 



40 P.D. 23 

STATISTICAL TABLES 

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

Table 1. General I nformation 

Data correct at end of hospital year November 30, 1933 

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 $2,509,776.68 

Personal property 469,714.21 

Total $2,979,490.89 

Total acreage of hospital property owned, 589.16 

Additional acreage rented, 400 

Total acreage under cultivation during previous year, 177 

4. Officers and employees — November 30, 1933 

Actually in Service Vacancies at End 

at End of Year of Year 

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

Superintendents 1 1 - - - 

Assistant physicians 11 1 12 - 

Clinical assistants - - - 2 - 2 

Total physicians 12 1 13 2 2 

Stewards 1 - 1 - 

Resident dentists 1 - 1 - - 

Pharmacists 1 1 - - - 

Graduate nurses - 37 37 - 1 1 

Other nurses and attendants ... 98 131 229 1 1 2 

Occupational therapists - 5 5 - - 

Social workers - 4 4 - - 

All other officers and employees ... 115 73 188 617 

Total officers and employees ... 228 251 479 9 3 12 

Note: — The following items, 5-10 inclusive, are for the year ended September 30, 1933. 

5. Census of patient population at end of year: 

Absent from Hospital 

Actually in Hospital but Still on Books 

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

Insane 1,052 1,075 2,127 194 217 411 

Mental defectives 1 3 4 - - - 

Alcoholics 1 1 - - - 

All other cases 6 2 8 

Total 1,060 1,080 2,140 194 217 411 

Other Races: 

Insane 21 20 41 1 3 4 

Total 21 20 41 1 3 4 

Grand Total 1,081 1,100 2,181 195 220 415 

Males Females Total 

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

cluding physical training, on date of report 101 81 182 

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

report 665 387 1,052 

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

year 1,071.52 1,073.52 2,144.59 

9. Voluntary patients admitted during year 8 9 17 

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

year 248 108 356 

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

Note: — The following tables 3-20, inclusive, are for the Statistical year ended September 30, 1933. 



P.D. 23 



41 









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42 P.D. 23 

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





















Parents of Male 


Parents of Female 




Patients 




Patients 


Patients 


Nativity 






















Both 


Both 




M. 


F. 


T. 


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Mothers Parents 


Fathers Mothers Parents 


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150 


124 


274 


72 


70 63 


61 62 49 


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35 


39 32 


34 35 30 


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1 1 


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1 


2 


2 


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1 1 1 


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1 


3 


4 


4 


4 2 


9 6 5 


Finland 












2 


3 


5 


2 


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3 3 3 


France 












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- - 


1 


Germany 












2 


5 


7 


6 


4 4 


5 5 5 


Greece. 












2 


3 


5 


2 


2 2 


3 3 3 


Hungary 












- 


- 


- 


- 


- 


1 


Ireland 












22 


29 


51 


51 


50 47 


51 51 43 


Italy . 












10 


9 


19 


11 


11 11 


11 10 10 


Norway 












- 


- 


- 


- 


1 


1 


Poland 












9 


7 


16 


11 


11 11 


10 9 9 


Portugal 












3 


1 


4 


4 


4 4 


1 1 1 


Russia . 












8 


1 


9 


9 


9 9 


3 2 2 


Scotland 












1 


1 


2 


4 


2 2 


1 3 1 


Sweden 












7 


6 


13 


12 


12 11 


11 11 11 


Switzerland 










- 


1 


1 


- 


- - 


1 1 1 


Turkey in Europe 








1 


- 


1 


2 


3 2 


- - - 


Other countries 








14 


4 


18 


15 


15 15 


6 6 6 


Unascertained . 








1 


1 


2 


16 


18 14 


8 118 


Total .... 


262 


222 


484 


262 


262 234 


222 222 189 



'Includes Newfoundland. 



43 



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44 



Table 5. Citizenship of First Admission 



P.D. 23 



Males 

Citizens by birth 150 

Citizens by naturalization 40 

Aliens 42 

Citizenship unascertained 30 

Total 262 



124 


274 


23 


63 


45 


87 


30 


60 



Table 6. Psychoses of First Admissions 



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



Traumatic 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 

Tabes dorsalis ....... 

Otner diseases 

Alcoholic psychoses, total 

Korsakow's psychosis 

Acute hallucinosis 

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

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

Other exogenous toxins 
Psychoses with pellagra . 
Psychoses with other somatic diseases 

Post-infectious psychosis 

Cardio-renal diseases 

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

Manic type 

Depressive type .... 

Other types 

Involution melancholia 
Dementia praecox (schizophrenia) . 
Paranoia and paranoid conditions . 
Epileptic psychoses .... 
Psychoneuroses and neuroses, total. 

Hysterical type .... 

Psychasthenic type (anxiety and obsessive 

Neurasthenic type .... 

Other types 

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

Alcoholism without psychoses 

Mental deficiency without psychosis 

Others 



forms) 



alone or 



1 




1 


1 


- 


1 




1 


1 


2 


1 


2 


3 


8 


9 


17 



5 6 
1 1 
3 4 

6 7 



2 
14 
60 
28 

2 



3 
43 
11 



38 

31 

14 

5 



46 

15 

2 

15 



2 

52 
91 

42 

7 



7 6 13 
45 9 54 



3 
89 
26 

2 
18 



Total 



262 222 484 



P.D. 23 45 

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





















With cerebral 




Race 




Total 




Traumatic 




Senile 


arterio- 


General 




















sclerosis 


paralysis 




M. 


F. 


T. 


M. 


F. T. 


M. 


F. 


T. 


M. F. T. 


M. F. T. 


African (black) 


3 


5 


8 


- 


- 


- 


2 


2 


_ 


1 1 2 


Armenian 








6 


1 


7 














1 - 1 


Chinese . 










2 


- 


2 
















English 












6 


12 


18 


- 


- - 


- 


3 


3 


2 2 4 


- - - 


Finnish 












- 


3 


3 
















French 












23 


19 


42 


- 


- - 


1 


1 


2 


7 3 10 


3 2 5 


German 












3 


5 


8 


- 


- - 


- 


3 


3 


2-2 


- - - 


Greek 












2 


3 


5 


- 


- - 


- 


1 


1 


- - - 


1 - 1 


Hebrew 












9 


4 


13 


— 


- - 


— 


- 


- 


3-3 


- - - 


Irish 












43 


45 


88 


_ 


- - 


1 


9 


10 


15 12 27 


4 2 6 


Italian 1 












10 


10 


20 


- 


- 


- 


1 


1 


1 2 3 


1 1 2 


Lithuanian 










10 


3 


13 


1 


1 


— 


- 


- 


1 - 1 


- - - 


Magyar . 










1 


- 


1 














1 - 1 


Portuguese 










4 


2 


6 


- 


— - 


- 


1 


1 






Scandinavian 


2 








13 


12 


25 


- 


- - 


1 


1 


2 


3 1 4 


1 1 2 


Scotch 










3 


1 


4 


- 


- - 


— 


- 


- 


1 - 1 


1 1 


Slavonic 3 










14 


9 


23 


- 


- - 


- 


1 


1 






Turkish . 










1 


- 


1 
















Other specific races 






2 


1 


3 


- 


- 


- 


- 


- 


1 - 1 


- - - 


Mixed 






101 


81 


182 


1 


1 


11 


13 


24 


20 10 30 


15 6 21 


Race unascertained 






6 


6 


12 


- 


- 


- 


2 


2 


4 1 5 


_ _ _ 


Tota 


1 










262 


222 


484 


2 


2 


14 


38 


52 


60 31 91 


28 14 42 



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



Race 


With cerebral 
syphilis 


With other 
brain or 
nervous 
diseases 


Alcoholic 


Due to drugs 

and other 

exogenous 

toxins 


With 
pellagra 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


Armenian 
Chjinese . 
English . 
Finnish . 
French . 
German . 
Greek 
Hebrew . 
Irish 
Italian 1 . 
Lithuanian 
Magyar . 
Portuguese 
Scandinavian 
Scotch 
Slavonic 3 
Turkish . 


2 










- - - 


1 - 1 


- - - 


- - - 


- - - 


- - - 


1 1 2 


1 - 1 






1 1 
1 1 


- 2 2 
1 1 2 
1 - 1 


3 1 4 
1 - 1 


j_ 


- - - 


12 2 14 
1 - 1 
3 1 4 


: _ _ 


1 1 


1 1 


_ : : 


1 - 1 
2-2 
1 - 1 
8 2 10 


- - - 


- - - 


1 - 1 
1 2 3 










Mixed 

Race unascertained 


3 2 5 


12 3 15 


2-2 


_ _ _ 












Total 












2 5 7 


7 6 13 


45 9 54 


2-2 


1 1 



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

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



46 P.D. 23 

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



Race 



With 

other 

somatic 

diseases 



Manic- 
depressive 



Involution 
melancholia 



Dementia 
praecox 



Paranoia 

and 
paranoid 
conditions 



African (black) 

Armenian 

Chinese 

English 

Finnish 

French 

German 

Greek 

Hebrew 

Irish 

Italian ' 

Lithuanian 

Magyar . 

Portuguese 

Scandinavian 

Scotch 

Slavonic 3 

Turkish . 

Other specific races 

Mixed 

Race unascertained 



Total 



M. F. T. 



M. F. T. 



M. F. T. 



2 3 5 
1 - 1 
2-2 



1 - 1 

3 2 5 
1 1 2 



M. F. T. 



1 - 1 

1 3 4 



1 1 
1 



17 19 36 
1 1 2 



43 46 



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



Race 


Epileptic 
psychoses 


Psycho- 
neuroses and 
neuroses 


With 
psychopathic 
personality 


With mental 
deficiency 


Undiagnosed 
psychoses 


Without 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 

1 2 3 
1 - 1 


M. F. T. 


M. F. T. 


Armenian 
Chinese 
English . 
Finnish . 
French . 
German. 
Greek . 
Hebrew 
Irish 
Italian • 
Lithuanian 
Magyar 
Portuguese 
Scandinavian 
Scotch . 
Slavonic 3 
Turkish 


2 




- - - 


- - - 


- - - 


- - - 


1 1 


2 2 


1 1 














1 1 


- - - 


3-3 


- - - 


- - - 


: : : 


1 1 
1 1 

- 2 2 
1 - 1 

- 2 2 










: : : 


1 1 
1 - 1 
1 - 1 


- - - 


_ _ _ 










i i 


- - - 


_ _ _ 


1 - 1 


- - - 


- - - 




































: : : 


1 1 

2 5 7 










Mixed . 

Race unascertained 


3 1 4 

1 1 


3 2 5 
1 - 1 


1 - 1 


1 1 


Total 






2 2 


3 15 18 


3 3 6 


12 5 17 


1 - 1 


-33 



includes "North" and "South". 
2 Norwegians, Danes and Swedes. 

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



P.D. 23 47 

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



Psychoses 



Total 



Under 15 
years 



15-19 
years 



20-24 
years 



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 

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 



262 ! 222 484 



M. F. T. 



M. F. T. 



2 1 3 
9 6 15 



1 4 5 
1 - 1 



11 12 23 



13 13 26 



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



Psychoses 


25-29 
years 


30-34 
years 


35-39 

years 


40-44 
years 


45-49 

years 


1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis . 

5. With cerebral syphilis . 

6. With Huntington's chorea . 

7. With brain tumor . 

8. With other brain or nervous 

diseases .... 

9. Alcoholic .... 

10. Due to drugs and other exo- 

genous toxins 

11. With pellagra 

12. With other somatic diseases. 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia praecox. 

16. Paranoia and paranoid con- 

ditions 

1 7. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic person- 

ality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis 


M. F. T. 
1 - 1 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 




















1 1 


2 4 6 
1 1 


7 3 10 


5 2 7 
1 2 3 


5-5 
1 1 2 












2 1 3 


1 - 1 
1 1 2 

1 - 1 


- 2 2 
6-6 

1 - 1 


2 1 3 
6 3 9 


2-2 
6 2 8 


- 2 2 

- 2 2 


1 1 
1 3 4 


1 2 3 

2 3 5 


3-3 
2 3 5 


1 2 3 
3 2 5 


13 5 18 
1 - 1 


6 13 19 
1 1 


6 3 9 

4 1 5 


4 2 6 
- 2 2 


1 6 7 

2 3 5 


- 4 4 

1 - 1 
3-3 


-33 
3 1 4 


1 1 

3 1 4 


2-2 
1 - 1 


1 1 

1 1 
1 1 












Total .... 


21 15 36 


15 28 43 


30 16 46 


26 15 41 


22 22 44 



43 



P.D. 23 



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



Psychoses 


50-54 

years 


55-59 

years 


60-64 

years 


65-69 

years 


70 years 
and over 


1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis 

5. With cerebral syphilis . 

6. With Huntington's chorea . 

7. With brain tumor. 

8. With other brain or nervous 

diseases .... 

9. Alcoholic .... 

10. Due to drugs and other exo- 

genous toxins 

11. With pellagra 

12. With other somatic diseases. 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia praecox 

16. Paranoia and paranoid con- 

ditions .... 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic person- 

ality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychoses 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


1 1 

2 3 5 

3 2 5 
1 1 


1 1 
7 3 10 
3-3 


- 5 5 
8 4 12 
1 1 2 


1 9 10 
8 6 14 


13 22 35 
35 13 48 




















1 - 1 
11 1 12 


5-5 


1 2 3 
3 1 4 


4-4 


1 - 1 


1 - 1 

2 1 3 

1 - 1 
-33 

2 2 4 
1 1 
1 1 


1 1 
1 1 2 
3 1 4 

1 - 1 
-33 

2 1 3 








1 1 2 
1 - 1 


1 1 


- - - 


- 2 2 

- 4 4 


1 1 


_ _ _ 


1 1 














- - - 


- - - 


1 - 1 


- - - 


- - - 


1 1 


















Total .... 


23 17 40 


22 12 34 


16 20 36 


13 17 30 


49 35 84 



49 






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P.D. 23 



51 



Table 11. Economic Conditions of First Admissions Classified with Reference to 

Principal Psychoses 























Unascer- 


Psychoses 




Total 




De 


pendent 


Marginal 


tained 






M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 




2 


_ 


2 


_ 


_ 


_ 


2 


- 


2 


- 


- 


- 


2, Senile 


14 


38 


52 


5 


8 


13 


7 


27 


34 


2 


3 


& 


3. With cerebral arteriosclerosis 


60 


31 


91 


11 


8 


19 


43 


22 


65 


6 


1 


7 


4. General paralysis .... 


28 


14 


42 


1 


2 


3 


26 


12 


38 


1 


- 


1 


5. With cerebral syphilis 


2 


5 


7 


- 


- 


- 


2 


4 


6 


- 


1 


1 


6. With Huntington's chorea 


























7. With brain-tumor .... 


























8. With other brain or nervous diseases 


7 


6 


13 


2 


- 


2 


5 


6 


11 


- 


— 


— 


9. Alcoholic 


45 


9 


54 


6 


1 


7 


38 


8 


46 


1 


- 


1 


10. Due to drugs and other exogenous 


























toxins 


2 


- 




1 


- 


1 


1 


- 


1 


— 


— 


— 


11. With pellagra 


- 


1 


1 


- 


- 


- 


- 


1 


1 


_ 


_ 


— 


12. With other somatic diseases . 


10 


12 


22 


4 


1 


5 


6 


11 


17 


- 


— 


— 


13. Manic-depressive .... 


16 


17 


33 


- 


- 


- 


15 


16 


31 


1 


1 


2 


14. Involution melancholia . 


3 


- 


3 


- 


— 


- 


3 


- 


3 


- 


— 


— 


15. Dementia praecox .... 


43 


46 


89 


1 


6 


13 


34 


39 


73 


2 


1 


3 


16. Paranoia and paranoid conditions . 


11 


15 


26 


4 


1 


5 


7 


12 


19 


- 


2 


2 


17. Epileptic psychoses 


- 


2 


2 


- 


- 


- 


- 


2 


2 


- 


- 


~ 


18. Psychoneuroses and neuroses 


3 


15 


18 


- 


1 


1 


3 


14 


17 


- 


— 


— 


19. With psychopathic personality 


3 


3 


6 


1 


2 


3 


2 


1 


3 


- 


- 


— 


20. With mental deficiency . 


12 


5 


17 


3 


2 


5 


8 


3 


11 




— 


1 


21. Undiagnosed psychoses . 


1 


- 


1 














i 


- 


1 


22. Without psychoses .... 


- 


3 


3 


- 


2 


2 


_ 


1 


1 


" 






Total 


262 


222 


484 


45 


34 


79 


202 


179 


381 


15 


9 


24 



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

Psychoses 





























Unascer- 


Psychoses 




Total 




Abstinent 


Temperate 


Intemperate 


tained 




M. 


F.. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


1. Traumatic 


2 


_ 


2 


1 


_ 


1 


- 


- 


- 


1 


- 


1 


- 


- - 


2. Senile 


14 


38 


52 


13 


27 


40 


1 


3 


4 


- 


1 


1 


- 


7 7 


3. With cerebral arter- 






























iosclerosis . 


60 


31 


91 


24 


25 


49 


15 


5 


20 


10 


— 


10 


11 


1 12 


4. General paralysis . 


28 


14 


42 


13 


8 


21 


7 


5 


12 


5 


1 


6 


3 


3 


5. Cerebral syphilis . 


2 


5 


/ 


- 


3 


3 


2 


1 


3 


- 


- 


- 


- 


1 1 


6. With Huntington's 






























chorea . 






























7. With brain tumor . 






























8. With other brain or 






























diseases 


7 


6 


13 


3 


5 


8 


1 


- 


1 


2 


1 


3 


1 


1 


9. Alcoholic 


45 


9 


54 














45 


9 


54 


- 


- - 


10. Due to drugs and 






























exogenous toxins 


2 


- 


2 


- 


- 


- 


1 


- 


1 


1 


- 


1 


- 


— ~~ 


11. With pellagra. 


- 


1 


1 


- 


1 


1 


















12. With other somatic 






























diseases 


10 


12 


22 


3 


11 


14 


1 


- 


1 


5 


- 


5 


1 


1 2 


13. Manic-depressive . 


16 


17 


33 


6 


15 


21 


5 


2 


7 


4 


- 


4 


1 


1 


14. Involution melan- 






























cholia . 


3 


- 


3 


3 


— 


3 


















15. Dementia praecox. 


43 


46 


89 


28 


37 


65 


7 


5 


12 


4 


2 


6 


4 


2 6 


16. Paranoia and para- 






























noid conditions . 


11 


15 


26 


5 


13 


18 


3 


1 


4 


2 


- 


2 


1 


1 2 


17. Epileptic psychoses 


- 


2 


2 


- 


1 


1 


- 


1 


1 












18. Psychoneuroses and 






























neuroses 


3 


15 


18 


2 


9 


11 


1 


2 


3 


- 


3 


3 


- 


1 1 


19. With psychopathic 






























personality . 


3 


3 


6 


2 


2 


4 


1 


- 


1 


- 


- 


- 


- 


1 1 


20. With mental de- 






























ficiency 


12 


5 


17 


8 


5 


13 


- 


- 


- 


2 


- 


2 


2 


2 


21. Undiagnosed psy- 






























choses 


1 


- 


1 




















1 


- 1 


22. Without psychosis. 


- 


3 


3 


- 


1 


1 


- 


- 


- 


_ 


2 


2 


~ 


— — 


Total 


262 


222 


484 


Ill 


163 


274 


45 


25 


70 


81 


19 


100 


25 


15 40 



52 





1 


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1 




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13 


£ 


--' 1 1 1 1 •* 1 1 1 1 1 1 « | | | | | | | 


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1-4 

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1 ** 1 1 J 1 1 e<q | | | | »h | h | | j | | ' | 


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P.D. 23 



53 



Table 14. Psychoses of Readmissions 

Psychoses Males 

^Senile psychoses 1 

Psychoses with cerebral arteriosclerosis 3 

:General paralysis .... 

; Psychoses with other brain or nervous diseases 2 

lAlcoholic psychoses 6 

Psychoses due to drugs and other exogenous toxins 1 

Psychoses with otl er somatic diseases - 

iManic-depressive psychoses 9 

Involution melancholia 1 

[Dementia praecox 16 

iParanoia and paranoid conditions 4 

iPsychoneuroses and neuroses . 3 

[Psychoses with psychopathic personality 1 

iPsychoses with mental deficiency .......... 5 

jWithout psychosis - 

Total 52 



Females 


Total 


5 


6 


6 


9 


1 


1 


1 


3 


2 


8 


- 


1 


1 


1 


18 


27 


1 


2 


21 


37 


3 


7 


3 


6 


1 


2 


3 


8 


1 


1 



ITable 15. Discharges of Patients Classified with Reference to Principal Psychoses 

and Condition on Discharge 



Psychoses 



Total 



Recovered 



Improved 



Unimproved 



(Traumatic 

(Senile 

IWith cerebral arteriosclerosis 

[General paralysis 

With cerebral syphilis .... 
(With other brain or nervous diseases . 

(Alcoholic 

Due to drugs and other exogenous toxins 
IWith other somatic diseases . 

IManic-depressive 

Ilnvolution melancholia .... 
[Dementia praecox -r 
Paranoia and paranoid conditions 
Epileptic psychoses .... 
Psychoneuroses and neuroses 
With psychopathic personality 
With mental deficiency .... 
Undiagnosed psychoses .... 
Without psychosis 

Total 



M. 

2 

2 

18 

16 

1 

2 

31 

2 

4 

20 

1 

39 

13 

3 
2 
5 
1 
1 



M. F. T. 



M. F. T. 



3 
1 
4 
3 
1 
8 

15 
3 

43 
9 
2 
7 
2 
7 



163 169 332 19 20 39 117 121 238 26 22 48 



54 



P.D. 23 



Table 15-a. Hospital Residence During This Admission of First Court Admissions 

Discharged during 1933 



Number 



Average Net 

Hospital Residence 

in Years 



Traumatic 

Senile 

With cerebral arteriosclerosis 

General paralysis 

With cerebral syphilis .... 

With other brain or nervous diseases 
Alcoholic ....... 

Due to drugs and other exogenous toxins 
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 
Without psychoses 

Total 



T. 



2 


_ 


2 


1.00 


- 


1.00 


2 


8 


10 


.50 


.63 


.61 


16 


9 


25 


.48 


1.28 


.76 


13 


1 


14 


.74 


1.50 


.80 


1 


2 


3 


.50 


.50 


.50 


1 


5 


6 


.50 


1.17 


1.06 


26 


6 


32 


.53 


.54 


.53 


2 


1 


3 


.31 


.50 


.37 


4 


7 


11 


.99 


.79 


.86 


13 


11 


24 


.59 


.74 


.66 


1 


2 


3 


.50 


2.50 


1.83 


28 


36 


64 


1.31 


2.13 


1.76 


9 


13 


22 


.78 


.69 


.73 


— 


2 


2 


- 


.50 


.50 


2 


9 


11 


.50 


.45 


.47 


2 


4 


6 


.25 


1.55 


1.12 


3 


7 


10 


1.83 


2.83 


2.54 


1 


3 


4 


.50 


.23 


.30 


127 


126 


253 


2.01 


2.35 


2.18 



55 



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P.D. 23 



61 



Table 19. Average Length of Hospital Stay During the Present Admissions of All 
Cases in Residence on September 30, 1933 



Number 



Average Length of 
Residence in Years 



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 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 psychoses 



S 
31 
66 
92 
12 



18 

148 

2 



42 

20 

497 

35 

8 

5 

12 

72 



1 

64 

52 
35 



17 
21 

1 

16 
80 
38 
583 
67 
10 
18 
16 



6 

95 
118 
127 

20 



35 

169 

2 

1 

24 

122 

58 

1,080 

102 

18 

23 

28 

140 

13 



M. 

4.49 
3.13 
2.93 
4.23 
3.49 



3.54 
8.74 

.45 

2.11 
7.01 
7.70 

11.61 
6.68 

11.88 
1.07 
6.40 
8.56 

.83 



F. 

7.50 
3.69 
3.04 
5.11 
5.86 



4.66 
6.15 

.45 
4.74 
6.66 
7.24 
10.65 
7.80 
7.29 
3.36 
8.12 
8.53 

.45 



4.99 
3.51 
2.98 
4.47 
4.44 



4.08 

8.42 

.45 

.45 

3.86 

6.78 

7.39 

11.09 

8.01 

9.33 

2.87 

7.38 

8.55 

.68 



Total 1,081 1,100 2,181 



8.67 8.51 8.59 



Table 20. Family Care Department 



Males Females Total 



Remaining in family care September 30, 1932 6 

On visit 2 

Admitted during the year 41 

Whole number of cases during the year 47 

Dismissed within the year 30 

Returned to institution 23 

Died 1 

On visit 3 

On escape 3 

Discharged - 

Remaining in family care September 30, 1933 17 

Supported by State 11 

Private 6 

State and private 

Self-supporting 

Number of different persons within the year 33 

Number of different persons dismissed 26 

Number of different persons admitted 33 

Average daily number in family care 18 

Supported by State 38 

Private 9 

Self-supporting 



39 


45 


- 


2 


75 


116 


14 


161 


44 


74 


37 


60 


5 


8 


1 


4 


70 


87 


46 


67 


23 
1 


29 
1 


61 


94 


38 


64 


61 


94 


57 


75 


78 


116 


36 


45