(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

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

i 



I 



I 



6 



Digitized by tine Internet Arciiive 

in 2010 witii funding from 

University of iVIassaciiusetts Amiierst 



littp://www.arcliive.org/details/annualreportoftr137worc 



Public Document No. 23 

^ ' O — ^ 1:3;,. -. 



ANNUAL REPORT 

OF THE 

TRUSTEES 

^\.as<§, : or THE 

Worcester State Hospital^; 



MS^T) 



FOR THE 

Year Ending November 30, 

1934 

Department of Mental Diseases 



% 




Publication of this Document approved by the Commission on Administration and Finance 
500. 9-'3S. Order 4661. 



OCCUPATIONAL PRINTING PLANT 

department of mental diseases 

GARDNER state HOSPITAL 
EAST GARDNER. MASS. 



tim vmmi if iMi®»:m 

WORCESTER STATE HOSPITAL 

Post OflBce Address: Worcester, Mass. . . 

Board of Trustees 
Edward F. Fletcher, Chairman, Worcester. 
William J. Delahanty, M.D., Worcester ii 
Anna C. Tatman, Secretary, Worcester. 
Howard W. Cowee, Worcester. :;, ?>^ <'>>'¥'iOTA.I^ 

John J. Perman, D.M.D., Worcester. 
Josephine R. 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. 
George R. Lavine, M.D., Assistant. 

Walter E. Barton, M.T)., Psychiatrist in Charge of Men's Department. 
Arthur W. Burckel, M.D., Assistant. 

Medical and Surgical Service 
W. Everett Glass, M.D., Director. 
Henry R. Craig, M.D., Assistant. 
Embrie J. BoRKOvic, M.D., Assistant. 
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. 
Hugh T. Carmichael, M.D., Psychiatrist. 
Wilbur R. Miller, M.D., Psychiatrist. 
Milton H. Erickson, M.D., Psychiatrist. 
Andras Angyal, Ph.D., M.D., Psychiatrist. 
Harry Freeman, M.D., Internist. 
Jacques S. Gottlieb, M.D., Internist. 
Charles M. Krinsky, M.D., Clinical Assistant 
David Shakow, M.A., Chief Psychologist. 
E. Morton Jellinek, M.Ed., Biometrician. 
George Banay, Ph.D., Medical Librarian. 

Out-Pati3nt Department 
Samuel W. Kahtwell, M.D., Director of Child Guidance Clinic. 

SifMMER Street Department 
Lonnie Oi Farrar, M.D., Medical Director. 

Special WoRK.i:Re in Research 
Earl F. Zinn, M.A., Psychoanalysis. 
Joseph M. Hunt, Ph.D., Psychology. 

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, Roentgenelogy . 
Oliver H. Stansfield, M.D., Internal Medicine. 
Erwin C. Miller, M.D., Internal Medicine. 
Michael M. Jordon, M.D., Neurology. 



Julius Tegelberg, M.D., Oto-laryngoWgyi 
RoscoE W. Myers, M.D., Ophthalmology. ' 
Philip H. Cook, M.D., Roentgenology. 
George Dix, M.D., Dermatology. 
Oscar Dudley; M.D., Epidemiology. 

HEADS OF ADMINISTRATIVE DEPARTMEN^TS 
Herbert W. Smith, Steward. 
Margaret T. Crimmins, Treasurer. 
Warren G. Proctor, Engineer. 
Anton Svenson, Foreman Mechanic. 
Oakleigh Jauncey, Head Farmer. 
Lillian G. Carr, Matron. 

Katherine McLean Stkeve, Superintendent of Nurses. 
Margaret Diamond, Supervisor, Women's Department. 
Maurice Scannell, Supervisor, Men's Department. 
Helen 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 102nd 
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. 

In the annual report of 1933 certain specific recommendations were made leading 
to improvements which would improve the situation at this hospital so far as fire 
risk is concerned. Since that report was made certain changes have been brought 
about which have taken care of some of these matters. The work of rewiring the 
hospital was begun during the present year, also the replacement of wooden stair- 
cases by fireproof construction. Your board again calls attention to the desira- 
ability of beginning a program of replacement of wooden floors in the institution 
which would make the building fireproof throughout. There is also the imperative 
need of an adequate fire alarm system in order to permit proper organization of the 
employees in case of fire. These changes are very necessary if the risk of fire is to 
be cut down. The board feels that the particular need is the replacement of the 
wooden floors and earnestly requests that some steps be taken to carry out this 
program as soon as possible. Such a program would necessarily extend over a 
period of years, perhaps five, but when it is completed the fire hazard which con- 
tinues to exist in this hospital because of these wooden floors would be practically 
eliminated. 

The board again directs your attention to the need of a more liberal appropriation 
for the minor repairs of the hospital and also a more liberal amount of money for 
actual medical and general care of patients. It is only a question of time until 
these minor repairs become larger ones, and the cost is proportionately greater. 

In the matter of our need for actual medical care of patients it is pointed out that 
in an attempt to get away from pure custodial care, actual intensive treatment 
must be carried out on the patients who are committed here. There is an impera- 
tive need for a well organized general hospital to serve the mental population, and 
this naturally requires a greater per capita cost than the institution as a whole. 
While a great deal of the cost comes from the general per capita, the budget is such 
that the amount of money allotted for this particular purpose is entirely inadequate. 
Modern medicine has given us many therapeutic weapons, new equipment, and new 
methods of treatment, and the hospital would be remiss if it did not progress in 
this particular respect. 

It is to be hoped that a more liberal policy will be adopted in the future for both 
repairs and medical and general care. 

The board continues to emphasize its recommendation that an increase in the 
number of ward personnel would probably be reflected in an increase in the dis- 
charge rate. We believe that such recovery rate is proportionate to the number 
and kind of personnel. 



1 



4 P.D. 23 

We would respectfully recommend that some thought be given to an increase 
in the number of medical officers and nurses with the hope that this will be repaid 
by an increased discharge rate of patients. 

In conclusion the board wishes to call the attention of your Excellency to the 
loyalty and cooperation of the hospital employees during the past year. We also 
wish to again register our satisfaction with, and approval of, the policies of ex- 
tending work of the hospital to include research, preventive work and teaching and 
we urge that as rapidly as possible this work be extended. 

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, 1934, it being the one hundred and second annual report. 

There remained on the hospital books October 1, 1934, 2,596 patients, 1,276 men 
and 1,320 women. Eight hundred and thirty-one patients, 429 men and 402 
women were admitted during the year. Seven hundred and seventy patients, 419 
men and 351 women were discharged from the hospital. Of this number 472 
patients, 268 men and 204 women were discharged to the community; 268 patients, 
140 men and 128 women died; and 30 patients, 11 men and 19 women were trans- 
ferred to other mental hospitals, leaving at the end of the statistical year, 2,657 
patients, 1,286 men and 1,371 women. 

The past year has again been a trying period for the hospital administrator. 
The endeavor to keep up the quality of the work of the hospital and to inaugurate 
such expansions as are essential if an organization is to progress, and not go back- 
ward on the curtailed budget, is a well nigh insurmountable task. It has required 
the united efforts of every member of the organization. The administrator finds 
that his particular function in the organization is to be in integrator and co- 
ordinator of the whole group. To cut down activities without impairing morale 
is the real problem. Well trained and enthusiastic members of the organization 
resist attempts to keep them from doing the things for which they see the need, and 
it requires careful judgment during these troublous times to perserve a proper 
balance. 

We have given much thoughtful consideration during the year to a concrete 
declaration of principles for the hospital. Every organization, if it is to be in- 
tegrated to a common end, must have some goal to which it is working, and this 
goal must be well known to every member of the organization. The medical group 
has made an attempt to put down in black and white the exact principles for which 
this hospital stands. These principles are rather broad general ones, but they do 
furnish a goal idea. It is a well known fact in administration that the principles 
and policies of any organization must be kept actively before every member of 
the organization in order to coordinate the efforts of the entire group towards a 
common end. Furthermore, these principles and policies must fit in and be har- 
monious with the personal aims and objects of the individuals. This is the real 
problem of administration. The following statement of principles has been the 
product of many members of the organization, and is an attempt to put into con- 
crete form the real goal of the hospital group. 

A. To make a perceptible decrease in the incidence of mental disorder in the 
general community. 

1. By rendering a real service to the community and making the hospital the 
place to which individuals turn for a settlement of their troubles and 
difficulties. 

2. By enlisting the people of the State in this campaign and getting them to 
share the responsibility for the better understanding of the problem of mental 
disorders. 



P.D. 23 5 

3. By disseminating information about mental disease and health as rapidly 
as it is accumulated, and teaching people that many of these disorders may 
be prevented. 

4. By developing the entire hospital as a research center and making a sub- 
stantial contribution to the sum total of our knowledge of the etiology of 
mental disease, its prevention and treatment. 

5. By enlarging the present clinic facilities for the study and treatment of 
adults and children in the community who show abnormal behavior reactions. 

B. To discharge more and more patients into the community, to decrease the time 
spent by each patient in the hospital, and to increase the time spent outside by 
those who may have to return. 

1. By constantly keeping before each member of the organization the true 
measure by which an individual's efficiency must be judged — i.e., the 
recovery of patients. 

2. By making a continuous effort to integrate the entire group towards this 
common goal. 

3. By thinking always in terms of human beings instead of bricks and mortar. 

4. By making the administrative routine of the hospital a real therapeutic 
factor which is concerned primarily with the recovery of the patient and 
the prevention of mental disease. 

C. To make the hospital a center of activity for all who may have an interest in 
the mental problem of human beings. 

1. By welcoming all sound new thought in psychiatry. 

2. By inviting representatives of the social sciences and other disciplines to 
utilize the facilities of the hospital, and to permit them to make such con- 
tributions to our program as may be possible. 

3. By constantly exemplifying the fact that the sensible approach to the 
problems of psychiatry in the present state of our knowledge is a coordi- 
nated one — a matter of team work. 

D. To prove that psychiatry has a contribution to make to general medicine. 

1. By carrying on a teaching program for medical students and graduates which 
is designed to show that the illnesses of human beings are mental as well as 
physical. 

2. By teaching general nurses that the patient is a human being as well as a case. 

3. By carrying on a high type of medical and surgical work and contributing 
facts regarding the relationship between the psyche and the soma. 

E. To carry out these purposes with due consideration for the economic cost and 
with the rights of the community constantly in mind. 

1. By keeping the costs of the hospital as low as is consistent with the type 
of service needed to carry out this program. 

2. By constantly utilizing new ideas from whatever source they may come in 
an effort to lower the costs of maintenance. 

3. By endeavoring to get State governments to see the real solution of this 
problem is in personnel and not in buildings. 

As in former years the greater part of this report has been prepared by the chiefs 
of the various services, and only a small portion of it will deal with a discussion of 
these various reports. In the report of the Clinical Director the attempt to empha- 
size therapy should be noted. The tendency of most hospitals in the past has been 
to put greater stress upon the problems of diagnosis rather than on detailed treat- 
ment. In my opinion one of the greatest needs of the mental hospital is to make 
a careful analysis of the therapeutic resources of the institution. This necessitates 
records showing exactly what was done for the particular patient. We use the 
term treatment rather loosely without understand'irtg exactly what we all mean by 
this. I refer to such things as occupational therapy, psychotherapy, etc., that 
cover a wide range of possibilities. Just what kind of psychotherapy is practiced 
in a hospital for mental disorder, precisely what kinds of occupation accom- 
plish what results, and so on in every possible therapeutic facility. We should be- 
gin to accumulate a body of knowledge by which we will be able to say with some 
degree of certainty that a particular kind of therapy is indicated in a particular kind 
of case. How much does the hospital routine itself contribute to the patient's 



6 P.D. 23 

recovery? An analysis as to why patients do recover would throw considerable 
light upon the part the hospital itself plays. The emphasis on these problems will 
continue and be made stronger as time goes on. 

We have elaborated and emphasized more strongly than ever our teaching pro- 
gram during the year. Considerable thought and deliberation has been given to 
the whole question of the training school for nurses. It is our opinion, as a result 
of these deliberations, that the time has come when the special hospital should 
devote itself largely to post-graduate teaching. The specialty of psychiatry 
must be built upon a foundation of general knowledge and training in all 
the social sciences. It is quite true that the individual in the undergraduate period 
profits by an exposure to psychiatric patients, particularly in the fields of medicine 
and nursing, but it is doubtful if the mental hospital should be in the field of 
training general nurses. This is a modification of our policy of former years, and 
has come only as the result of greater experience and more careful study of the 
general nursing situation. It is our intention next year to embark upon a post- 
graduate course for nurses of nine months, with an optional additional three months 
for advanced psychiatry and administrative training. In addition to this, we will 
continue our affiliation with the general hospitals taking their senior nurses for a 
period of three months. The type of training given the affiliates has been changed. 
The affiliating hospitals send all of those who are to go to the Worcester State 
Hospital to us for their theoretical lectures. These are all given at the hospital 
itself, and this enables us to confine the teaching of the affiliate on the ward to 
bedside nursing and a practical application of this theory. The report of the 
Principal of the Training School discusses this question at great length. We are 
hoping to build the entire nursing of patients around the graduate nurse. 

The report of the director of the radio system gives an idea of the manner in 
which the radio system functions therapeutically. It should be noted that the 
effect of these radio programs is not measurable except through impressions ob- 
tained through conversation with patients. It enables us to spread mental hygiene 
propaganda throughout the hospital, and while it is impossible to say any one period 
of this has any particular result, we do feel that it adds a great deal to the morale of 
the patients themselves, builds up a better attitude towards the hospital itself, and 
makes the work of the psychiatrist very much easier. The psychiatrist must 
have a rapport with the patient before anything can be accomplished, and this 
rapport depends considerably upon the rapport the patient has with the hospital 
itself. The psychiatrist goes to him as a representative of the hospital, and if the 
patient has no confidence in the institution, and is antagonistic to it, no matter 
what the personal relationship between physician and patient is little can be 
accomplished. Therefore, we believe the radio to be a very effective agent in a 
therapeutic program. 

The report of the occupational therapy director stresses the need for a close 
personal relationship between therapist and individual patient. It furthermore 
seems rather obvious that if the production of the hospital is to be measured in terms 
of recovered patients that every one in the organization should have as a goal the 
improvement of the patient. It is our hope that within a short time we will be able 
to incorporate in an occupational therapy program a complete industrial program, 
and make every workman or other employee in the hospital carry a definite re- 
sponsibility for the improvement of the patients. 

We have continued to stress the boarding out of patients. It should be pointed 
out that in any program of boarding out some attempt should be made to utilize 
these boarding homes as therapeutic agents, and not purely as custodial homes. 
There are two classes of patients that should be considered in any family care 
program. First, the convalescent patient who for one reason or another should not 
be sent directly from the hospital to his own home. Such patients will frequently 
be benefited by a sojourn in a supervised situation for a period of several months. 
The boarding home is a transition between the rather rigid discipline of the hospital 
and the comparative freedom of one's own home. During the year we have sent 
fifteen patients from boarding homes to their own homes, and changed their status 
to that of visit. Seven have become self-supporting, having found positions. The 
details of this will be found in the report of the social service department. 



P.D. 23 7 

The medical and surgical service has continued to function as a separate service, 
and each year we believe more firmly that this type of organization gives the best 
service to the patient. The psychiatrist uses the medical and surgical service as 
he would any technical service. Even though the patient is transferred for medical 
study, the psychiatrist continues to carry the responsibility, and the report of the 
service is given to him for utilization. The great amount of medicine and surgery 
that is carried on indicates the need of still more medical and nursing personnel, 
and better facilities for the accurate treatment and study of physicial ills in a mental 
population. 

As in the past few years research has occupied a good deal of our time and thought. 
The report of the director of research will give the details of what has been carried 
on. As one of our major goals this occupies a very important part of the program 
of any mental hospital. It is essential that we proceed as quickly as possible to a 
comprehensive program of coordinated research in psychiatry. This phase has been 
neglected for many years, but with the tremendous investment of money in or- 
ganizations, and plants maintained by every state, there seems to be no reason why 
every state hospital should not have the facilities and means to carry out some work 
which might lead to an increase of our knowledge relative to mental disorder. In_^ 
this connection I would call attention to a research project carried out by the" 
head farmer of this hospital. This report will be found in the body of the report. 
It is an experimental project dealing with herd control, and it has been worked out 
in a very comprehensive way with the idea of giving us a better milk production. 

It should also be noted that research in mental hospitals is not necessarily a 
matter of psychiatry or medicine alone. Other departments could contribute a 
great deal to the administrative organization of mental hospitals by carrying on 
research projects. This institution for the past two years has been carrying on 
some experimental work in the matter of freezing vegetables. This has been 
done under the direction of the steward, Mr. H. W. Smith, and out of this work 
we have been able to develop a technique of handling these vegetables, both in 
the field and in the kitchen after they were taken from storage. Research is not 
necessarily a matter of medical research. Studies of laundry routine are research 
problems that would benefit many mental hospitals immeasurably. A healthy 
spirit of skepticism and an unwillingness to accept things because they are tradi- 
tional is a valuable spirit in any organization. 

The report of the psychological department will indicate how important we 
believe the psychologist's contribution to psychiatry to be. It is our belief that 
the problems of psychiatry will be solved through the coordinated approach of 
many disciplines rather than the approach of only one. The psychologist, the 
sociologist, the physical chemist, biochemist, and many other specially trained 
individuals have their contributions to make, and it would seem that they should 
be a part of the personnel of every mental hospital. 

Our laboratory continues to function with a very heavy load. The necessity 
for careful physiological studies seems to be obvious, and a well equipped and well 
organized laboratory must be an essential part of every progressive hospital for 
mental diseases. 

We continue to give much time and thought to the enlargement and development 
of our medical library. The amount of research that has been carried on makes 
this library a very important part of the organization. 

The patient's library continues to function, and the Librarian's report indicates 
the popularity of this particular department. 

I must again emphasize the importance this hospital attaches to the Child Guid- 
ance Clinic work. Every mental hospital should be carrying on five major func- 
tions: 

1. Psychiatry 

2. Medicine and Surgery 

3. Teaching 

4. Research 

5. Prevention 

In carrying out the last named function, it would seem obvious that work with 
children occupies a prominent position. No well organized mental hygiene com- 



8 P.D. 23 

munity program can hope to get along without the state hospital as a very promi- 
nent factor, and the sooner the hospital recognizes its responsibility for the mental 
health of the community it serves, the sooner we will be able to get organized to 
meet that responsibility. 

It should again be emphasized that the cure and discharge of patients from a 
mental hospital is in direct proportion to the number and quality of hospital per- 
sonnel, and particularly in the medical and professional group. The highest 
percentage of recoveries of psychotic patients occurs during the first six months 
of their residence. The curve goes down gradually for the second six months, and 
drops very abruptly at the end of the year. If personnel quotas were based upon 
admission rate, plus resident population, rather than resident population alone, 
the increased number of physicians, nurses, and social workers, would give an 
opportunity for more intensive and concentrated therapy during the early months 
of a patient's residence in the hospital. It seems obvious that the real criterian 
of hospital efficiency must be the number of patients discharged back to the 
community. 

Psychiatric Service 
Morris Yorshis, Clinical Director 
The past year has been marked by a complete evolution in the practice of psy- 
chiatry at the hospital. Every department was carefully scrutinized and wherever 
tradition was in vogue a broad and dynamic approach was substituted. 
Table I. Admissions, Visits and Discharges 
(Oct. 1, 1933 to Oct. 1, 1934) 
First Admissions Readmissions Total Discharges Visits 

540 158 698 430 525 

In the past twelve month period 47 fewer patients were admitted than in 1932-33. 
The readmission rate was approximately 15% lower than the preceding year (158). 
There were, however, 430 patients discharged, an increase in total of 18 over 1932, 
and a percentage increase of 7. 

Table II. Disposition at end of One Year of Committed First Admissions^ 

Court Remaining in Out of 

1932-33 Commitments Institution Discharged Institvtion 

October 40 17 42.5 5 12.5 9 22.5 

November 30 10 33.3 7 23.3 13 43.4 

December 27 11 40.7 3 11.1 13 48.2 

19 33-3 It 

January 29 10 34.5 4 13.8 15 51.7 

February 32 9 28.1 5 15.6 18 56.3 

March 24 7 29.2 5 20.8 12 50.0 

April 28 11 39.3 3 10.7 15 50.0 

*The statistics for the months of May to September have not been determined. 
The above table shows that 66% of the admissions in 1932-33 have left the hospital. 

Approximately ten patients were regularly committed from general hospitals 
in a moribund condition, and all except two died within twenty-four hours after 
admission. It is gratifying to report that the incidence of such commitments has 
decreased in frequency during the past year. The superintendents of the various 
general hospitals about Worcester have been very alert to prevent such practice. 

As in the previous year, a rigid follow-up of all cases dismissed on visit from the 
hospital just prior to consideration for discharge led to the renewal of visits in twenty- 
two cases. This is an effective means of curbing the rise in the readmission rate, a 
factor that must of necessity be controlled because of the increasing demands on 
the part of the medical staff. 

Several years have elapsed since the policy of supervising only those cases that 
offered splendid opportunities for thorough case work and social-psychiatric 
treatment. At the present time thirty-four cases are on visit. Supervision of 
the favorable cases by the hospital is possible if the staff is large. Neither staff, 
the medical nor the social service possess the personnel to adequately study in any 
detail the first admissions, yet patients on visit, and those in family care offer 
many problems. The policy, therefore, has been to supervise a minimal number 
of patients on visit and to refer as many patients to either the family physician 
or to the committing psychiatrists, or the referring agency. 



P.D. 23 .9 

Therapeutic Resources ; 

I. — Case Record: 

The new psychiatric classification of mental diseases adopted by the American 
Psychiatric Association early in the year made it necessary to review every record 
in the active files. With this painstaking review of each case record — a strongly 
positive attitude toward the recording of treatment resulted. Therapy or the 
specific plans of treatment especially for each new patient is just as important as 
accurate classification. All first admissions have specially planned treatment 
schedules. Progress notes on every patient stress 
(Ij Mental and physical status. 

(2) Interpretation. 

(3) Therapy. 

A concrete example of this type of thinking can best be demonstrated by presenting 
a short abstract from the summary of two recent admissions. 

Case No. 42 919 — Diagnosis — Dementia Praecox, Paranoid Type. 

(1) Introvert personality. 

(2) History of odd and strange behavior. 

(3) Multiple delusions — unsystematized — changeable. 

(4) Auditory hallucinations. 
Treatment: 

1. Since admission: 

a. Interjection of as many interesting personalities as possible — attractive 

women, theological students — people in the various fields of work he has 
been introduced to. 

b. Occupational Therapy — Farm. Industrial room and psychology experi- 

mental laboratory — all refused. 

c. Hydrotherapy — Continuous tubs because of dejection — caused no change. 

d. To avoid monotony of environment has been taken out walking by theological 

students which he enjoyed. 

e. To discover any endocrine disfunction; B.M.R. normal. 

f. Interviews to gain his confidence. 

2. Further recommendations in treatment. 

a. Dr. Bryan should see patient because of his constant desire to speak to the 

superintendent. 

b. Transfer to research service because: 

1. Can be studied more thoroughly. 

2. Will receive more individual psychiatric treatment. 

3. Time can be planned to avoid his falling into faulty habits and developed 

tuberculosis. 

c. Have social service investigate more thoroughly the milieu in which psychosis 

developed. 

d. Obtain abstract on maternal aunt at Grafton State Hospital. 

e. Use of a sex stimulating hormone, anterior, pituitary, to note effect on 

personality therein. 

f. Because of familial history of tuberculosis should be carefully checked for 

evidence of the disease. 

g. Keep up nutrition. 

Case No. 42 902. 

Differential Diagnosis: In view of his history of chronic alcoholism; initial 
onset of present illness with tremor; the presence of auditory and visual hallu- 
cinations with the urinary findings and elevateti blood pressure, the diagnosis offered 
is Chronic Nephritis and hypertension with superimposed acute alcoholic hallu- 
cinosis. 

Etiology: 1. Patient's constitutional weakness to face difficult situations with 
reactionary flight to escape reality by use of alcohol, (a) Marital situation. Death 
wishes against wife. 

2. Chronic Alcoholism. 

Prognosis: In view of underlying constitutional makeup of patient it is unlikely 
that he will be cured of his alcoholism permanently. The outlook for recovery from 



10 P.D. 23 

the present psychosis is favorable but patient will no doubt have to remain in the 
hospital for some months and should be committed. 
Treatment: 

1. High carbohydrate, low protein, salt free diet. 

2. Elimination through emunctories by 

a. Warm tub baths (elimination thru skin). 

b. Catharsis (epsom salts daily in small amounts). 

c. Flushing kidneys by forcing fluids. 

3. Relief from increased intra-cranial pressure by lumbar puncture. 

4. Minimum of sedation (altho he has required paraldehyde at times). 

5. Prevention of acidosis by use of carbohydrate diet and alkali medication -citro- 

carbonate). 

6. Occupational Therapy has been unsuccessful because of patient's confused state. 
Recommendations : 

1. Continue treatment as above outlined. 

2. Careful investigation of patient's home environment, and personality toward 

elimination of factors causing alcoholism. 

3. Regular commitment in order to control patient should he recover from his 

present psychosis and be dismissed. 

4. Have detailed study of marital situation. Patients has been married for 14 years 

no children. 

II. The Physician: Heretofore the practice has been to train the younger men on 
the staff by assigning them directly to the psychiatric admission wards — studying 
new cases — Although this is a very desirable method yet during the past year an 
approach utilized in some degree with medical students was applied to the interne. 
He was directly in charge of all new patients to the Infirmary service. In this way 
the recent graduate from an active medical and surgical internship could be made 
to think of the patient as a whole. 

III. Social Service Department: This department of the mental hospital is one 
that few physicians utilize intelligently. This is due because (1) the average 
medical man is not trained to think in terms of social medicine and (2) the social 
worker had little realization of her limitations. 

Formerly social service workers acted largely in the capacity of investigators and 
parole officers (with 750 admissions and 350 visit cases annually — no other type 
of work was possible.) With the added training and the change in policy of the 
hospital towards supervision of cases the workers have proven themselves capable 
of — 

(1) Gaining significant data about medical history — psychiatric and social in- 
formation. 

(2) Recognizing and analyzing such data for the use of the psychiatrist. 

(3) Approaching therapeutically those attitudes and emotional reactions con- 

ditioning the patient and family. 
To be able to carry out the above intensive case work is a forward step in pre- 
vention and treatment of mental disorder. With only four full time workers the 
need for additional trained personnel in this department is imperative. 

IV. FawMy Care: One of the four social workers is a full time case worker on 
the family care patients. Seventy-seven patients were released from the hospital 
by this method — during the year, the total number of patients in family care for 
the year — 183. 

Number of patients returned to the hospital 57 

Number of patients dismissed on visit from family care . . . . 22 

Number of patients discharged 7 

In the preceding year only six patients were dismissed on visit. The sharp rise in 
number of visits from family care confirms the belief that convalescence is rendered 
more favorable in an atmosphere away from the mental hospital. The type of case 
dismissed in family care this year varied a great deal in many instances from that 
of the previous year. There were fewer custodial cases. This is as it should be. 
Boarding homes should preferably be for hopeful cases — especially in those 
instances when the state has to pay for it. It is obvious that with such a large 



P.D. 23 11 

number of patients out of the hospital it needs more than one full time social 
service worker. This department should be directly supervised by one psychiatrist 
and two social service workers. In the present arrangement members of the 
medical staff visit some patients with regularity and other at periods ranging from 
one month to six. To place inexperienced internes in psychiatry in charge of this 
phase of extra mural psychiatry is asking him to shoulder a responsibility far 
beyond his capacity. 

V. The Psychological Department: This department has continued to give its 
diagnostic help with the same high degree of competence. It has been of special 
value in the detailed study of complicated cases such as that of aphasia. 

VI. Occupational Therapy: Just as in the other departments of the hospital allied 
to psychiatry the traditional functions of this department have been transformed 
into a more therapeutic and dynamic approach. O. T. to mean anything must be 
definitely prescribed and guided. The activity is just like a drug — it is either po- 
tent for good or ill — dependent as for the degree of intelligence with which it is 
prescribed and administered. The indications and applications of 0. T. are many. 
During the year more of the case work approach as outlined in the 1933 report was 
attempted with a moderate degree of success. 

VII. Hydrotherapy, Physiotherapy and Pyrotherapy : In all of these treatment 
suites the goal was to note carefully the patient's reactions to the various types of 
treatment. The wet sheet packs were used less extensively — Pryotherapy during 
the humid months was found to be contraindicated. The tonic effect of ultra 
violet proved very beneficial in cases of the malnourished and disturbances — in the 
function of the skin. The value of each technician as a psychotherapist in many 
instances proved to be as beneficial as the treatment itself. 

VIII. The Chaplain's Department. As a liaison worker — between patient and 
psychiatrist he has been able to accomplish a great deal in mitigating conflicts 
of a religious nature. The sermons bordered mainly on mental hygiene themes. 
He has been able to furnish the staff information concerning the community through 
his association with various agencies such as church organizations — clubs and 
the ministers of the congregations of the county. The theological students aided 
greatly by disseminating the aims of the psychiatrists to the patients. 

IX. The Nursing Service. Standard practices were formulated on all acute 
wards. Head nurses were chosen on the basis of their ability (1) as personalities 
having psychotherapeutic ability (2) as nurses trained to care for the mentally ill. 

X. The Radio. The music director demonstrated that the radio as a therapeutic 
adjunct was on par with any of the empirical approaches. By carefully selected 
programs — responding to requests of patients enlightening various wards from 
time to time of movement of patient population — he has been able to build up 
an excellent response. 

XI. Psychoanalysis: Mr. Earl Zinn has been able to treat several patients the 
past year. These were selected by the staff. His results have been gratifying from 
the point of view of technique of handling psychotics. 

XII. Special Techniques: (a) Encephalograms and ventriculograms were per- 
formed in several cases of suspected and confirmed brain tumor cases. Drs. Horrax 
and Poppen of the Lahey Clinic gave their time freely and were very kind to dem- 
onstrate these procedures to the staff, (b) Pneumothorax utilized for the past 25 
years in the treatment of tuberculosis was added to the armamentarium by the 
medical service under the direction of Dr. Glass. These treatments heretofore had 
not been given at this hospital. The results to date have been entirely satisfactory. 

Pathological Material 
Table III. Autopsy Data 
Clinical Diagnosis Causes of Death 

Psychoneurosis 2 1 Case of dystonia musculorum 

1 Suicide. Patient had previously at- 
tempted suicide approximately 75 
times. 



12 

Unclassified 

Involutional Melancholia 
Paranoid Condition . 



General Paresis . 



Manic Depressive 



Psychosis with Somatic Disease 3 



Psychosis with Mental Deficiency . 4 



20 



Psychosis with Epilepsy ... 1 
Psychosis with organic brain disease 1 

Dementia Praecox .21 



Alcoholic Psychosis .... 9 
Senile and Arteriosclerosis . .86 



P.D. 23 

1 suicidal attempt prior to commitment 
with success. 

1 died of tuberculosis 

2 died in senile period. 

2 died of heart disease (sudden) 
1 died of cancer of vulva 
1 died in senium 

1 died of toxic hepatitis 
1 died of rheumatic heart 
1 died of eclampsia 

1 died of tuberculosis 

2 died of nephritis and uremia 
1 died of fecal impaction 

1 died of scalding 

1 died of catheterization 

2 died of burns 

1 died of gastric ulcer 
1 died of cerebral arteriosclerosis 
1 died of septic pulmonary infection 
1 died of pulmonary tuberculsois 

1 died in convulsive state 
Luetic cirrhosis 

7 died of tuberculosis 
1 suicide 
1 volvulus 

4 sudden deaths: 1 cerebral edema; 3 
cerebral hemmorhage 



Total 169 

The above table is of considerable interest. In the two cases of psychoneuroses 
— one an unrecognized case of dystonia musculorum that had been hospitalized 
for years — showed the necessity for a fundamental understanding of neurology 
in clinical psychiatry. The paranoid group had a preponderance of organic path- 
ology. The deaths in the somatic group were among patients who were com- 
mitted and died shortly after admission. Thirty-three and one third per cent of 
the deaths of the Praecox group were due to tuberculosis. 

Over 50 % of the autopsies were on cases of senile dementia or cerebral arterio- 
sclerosis. 



Table IV 

1. Rheumatic Heart Disease 
Acute Rheumatic Fever 
Toxic softening of the brain 

2. Dural Endotherioma 

3. Undiagnosed Intestinal Tuberculosis 

4. Benign Nephrosclerosis 
Malignant Hypertension 

5. Death following Avertin Anaesthesia 



Pulmonary tuberculosis (unrecog- 
nized) Suspected cancer of stomach. 
Unrecognized Gangrenous Appen- 
dicitis with Generalized Peritonitis. 
Hypoendocrinopathy 
Complete fibrosis of thyroid, pitui- 



Clinico Pathological Conferences 

Schizophrenic reaction 



Committed as arteriosclerotic. 
Manic Depressive. 

Committed as Involutional Melan- 
cholia. 
Committed 4 days post-operative. 
Death five days after admission. 
Alcoholic Psychosis 



Psychosis — probably Alcoholic. 



P.D. 23 13 

tary and adrenal glands. No pathology in 

Pancreas. 
The above table is a succinct description of the type of case discussed monthly: 
all of them unusual and of clinical interest. The need for such conferences is best 
examplified by the number of unrecognized conditions ante-mortem. 

Publications 

1. Yorshis, M. and Gottlieb, J.: The Genetic Relationship of Blood Groups and 

Schizophrenia. Amer. Jour. Psy. Vol. XIII, No. 6, May 1934. 

2. Barton, W. E. and Freeman, W.: Pericardial Hemorrhage complicating Scurvy. 

A case Report N. E. Jour, of Med. Vol. 210, No. 10, Mar. 8, 1934. 

Papers 

1. Yorshis, M.: The Mechanism of Recovery of a Paranoid — Boston Society of 

Psychiatry and Neurology, — January 1934. (Abstracted — Arch. Neur. 
and Psy. November 1934.) 

2. Horrax, G., Yorshis, M. and Lavine, G.: Calcified Intradural Cholesteotoma 

of Unusual Size in a Patient Showing Manic Depressive Symptoms. 
Boston Society of Psychiatry and Neurology — February 1934. American 
Neurological Assn. June 1934. 

3. Gottlieb, J. and Lavine G. — A Case of Tuberose Sclerosis with Unusual Bony 

Lesions — Boston Society of Psychiatry and Neurology — April, 1934. 

4. Bryan, W. A. — State Hospitals as a Training Centre, — American Psychiatric 

Assn. Division of Psychiatric Education — May 1934. This paper was 
discussed by the director. 

Exhibit 
For the February meeting of the Worcester District Medical Society the hospital 
activities and functions were demonstrated in graphic form. Booths were con- 
structed for the following departments: 

1. Psychiatric Services including the Social Service, Psychological, O. T., 

Hydrotherapy, Chaplain, and Music. 

2. Medical and Surgical, which included the pathological and physio-therapy. 
8. Research. 

4. Child Guidance Clinic. 

5. Teaching. 

This exhibit was open to all lay groups in the community and over 2,000 people 
came to see it. 

Teaching 
Students: 

1. Medical — Seniors from Tufts and (1) All these groups received didactic 

B. U. and practical instructions. 

2. Social Service — from Smith and (2) The stimulus to the various mem- 

Simmons bers of the staff was a constant one, 

constructive in nature and bene- 

3. Psychological ficial to all concerned. 

4. Occupational Therapists > 

5. Affiliating Nurses (3) The presence of such young alert 

minds encourages an investigative 
spirit, — promotes thinking and 
eradicates inertia. 

6. Student Nurses 

7. Technicians 

8. Theological 

9. Statistical 

10. Seniors from Holy Cross 

11. Clark University Group 

The time involved to teach these groups, however, handicapped the medical 
staff immensely and for this reason a complete reorganization of all the teaching 
activities is in progress. 



14 P.D. 23 

Items of Note 

The Government of Mysore, India deputed Dr. Govindo Swamy to devote a 
year to study American Psychiatry. Thru the Department of Mental Diseases — 
Dr. Swamy came to this hospital and altho his study was cut short to seven months 
he received full credit toward his diploma in psychological medicine in London. 

Internes from the Worcester City Hospital commenced their affiliation with the 
hospital for training in psychiatry. Dr. Knowlton D. Stone the first interne — 
joined the Staff here on September 15, 1934. 

Future Plans and Recommendations 

With the increasing number of admissions and readmissions and the more 
detailed and individual approach — it is very essential that some action be taken 
to increase the number of physicians on the wards. Eight resident physicians are 
not sufficient to properly care for 1,600 patients. It would seem that just as it is 
important for foundations to support Research projects — that similar plans 
should be adopted to teaching in mental hospitals. If this were taken care of by 
additional personnel — the resident staff could devote its full time to the treat- 
ment of patients. 

The whole teaching program is to undergo reorganization. The affiliating courses 
are only to be given once — the training school of the hospital is to be closed and 
the teaching burden of the individual staff men is to be lessened. 

Post-graduate instruction to nurses and organized instruction to internes — 
are contemplated during the coming year. 

Nursing Department 
Katherine McLean Steele 

The year 1934 has proved an important one in nursing because during this year 
the final reports of the Committee on the Grading of Nursing Schools have been 
published. These two publications are worth anyone's time, An Activity Analysis 
of Nursing and Nursing Schools Today and To-morrow. There has seldom been 
a more searching and thorough investigation of any profession carried on. The 
future problem is to carry out the suggestions offered and make this piece of work 
worth the labor it has necessitated in the results obtained. 

We may briefly outline the general recommendations made in these reports as 
follows: 
What ails nursing? 

1. Overproduction of nurses. Massachusetts has a ratio of 1 nurse to every 162 

persons. 

Worcester has a ratio of 1 nurse to every 124 persons. 

2. Under-education. 

3. Nursing schools have been found to be of 3 types: 

A few very good; 
A few very poor: 
Many neither very good nor very poor. 

4. Nursing schools need public endowment. 

5. Hospitals do not employ enough graduate nurses. 
What's to be done? 

1. Stop overproduction by 

(1) Closing mediocre and poor training schools 

(2) Make better training schools. There should be a state license required 
to allow a hospital to have a training school. 

(3) Employment of graduate nurses in hospitals. Enforced registration. 

(4) Post-graduate courses for nurses. 

In applying these principles and recommendations to the particular situation in 
existence at the Worcester State Hospital it seemed necessary to think seriously 
about whether the training school should be carried on or whether it would be more 
advisable to concentrate all our energy in teaching an affiliate and post-graduate 
course. The special problems to be considered in the individual situation were: 

1. Is not training nurses in a mental hospital taking "the cart before the horse?" 
Is it not better to teach a foundation in general nursing before any of the specialties 
are taught? 



P.D. 23 15 

2. Mental hospitals lack clinical facilities. 

3. In a specialized hospital the students must have at least one years' affiliation 
in a general hospital. 

4. The student body at present consists of: Preliminary students, 4; second 
year students in affiliation at Boston City Hospital, 5; senior students, 10. 
Does: 

5. The small number of students justify the expense of maintaining the training 
school or the heavy teaching load on the hospital staff. 

For the consideration of all these problems it was felt that we would be greatly 
helped and our thinking clarified by expert advice. Sa we asked the Committee 
on Mental Hospital Relations of the National League of Nursing Education to 
visit us December 5 and 6, 1934. Of this Comm.ittee Miss Anna K. McGibbon, 
Superintendent of Nurses, Butler Hospital, Providence, R. I. is chairman and the 
members are Miss Effie J. Taylor, Dean of the Yale School of Nursing and Miss 
May Kennedy who is Associate Director and Director of Pedagogy of the New 
York Hospitals. 

The Training School Committee of W. S. H. after several hours discussion with 
these nursing leaders decided to discontinue the training school. With the dis- 
continuance of the training school it was decided to transfer the four preliminary 
students where they would wish to go. They will be accepted for transfer by the 
Worcester Hahnemann Hospital to enter there January 1, 1935. 

The second year students we would attempt to transfer to an accredited training 
school where they would receive as much credit as possible for the time they have 
already spent in the training school. This transfer has not as yet been effected. 

The seniors would complete their course at the Worcester State Hospital and 
be graduated in the fall of 1935. 

The Committee from the N. L. of N. E. feel it is the duty and privilege of mental 
hospitals to offer affiliation in psychiatry and psychiatric nursing to nurses from 
general hospitals in their community. The training school committee felt that the 
teaching of the affiliation course four times a year, every three months, makes too 
great a load on the hospital staff. Therefore it was decided that we would give 
the theoretical work, a course of thirty hours, four hours a week, in the spring 
quarter of the year to all the third year students from any of the hospitals in 
Worcester. And that all the students who would be coming to the hospital for the 
three months practical affiliation for the year, April 1, 1935 to April 1, 1936, would 
receive their lectures in psychiatry and psychiatric nursing at this time. 

It was also decided that we would plan a post-graduate course in psychiatric 
nursing to be offered beginning the fall of 1935. This course would be twelve 
months in length and maintenance would be furnished but no salary. The students 
accepted for this course would pass the requirements of a complete high school 
education and be graduates of an accredited school. 

The course would be outlined so that it could be approved by the Department 
of Mental Diseases and if possible by the School of Nursing of Simmons College, 
Boston, so that the nurses might receive credit toward a degree. 

It is our hope to concentrate on the present staff of nurses and give them every 
opportunity to improve their educational qualifications. 

Radio Department 
Frederick Searle, Musical Director 
Because we wished to confirm our convictions that a correct utilization of 
radio in a mental hospital has a therapeutic value we have made a detailed 
study of the reactions of our patient population to this particular type of 
stimuli. Out of the copious information we gathered, the following facts 
seemed to be outstanding: 
1. Improves the general morale of patients. 

A. Lessens antagonism of patients to hospital 
Every patient cannot be reached by the Superintendent or even by some of the 
staff members individually, but they can be reached collectively, by means of the 
radio. In view of this fact, the superintendent gives four talks to new patients, 



16 P.D. 23 

the first talk being entitled, "The Keys to the Hospital." This talks acquaints the 
patients with the institution, makes them feel comfortable, and eradicates the idea 
they are in a prison, emphasizing at all times, that they are in a hospital. This 
talk takes up such details as the explanation of the Protestant, Catholic and Jewish 
services. It explains that there is a Library in the hospital which patients have 
access to; that patients can write two letters a week at the expense of the hospital. 
Such details as these reaching each new patient, serves as a helpful bit of orientation. 
The second talk in this series deals with the legal aspects of mental disease. It 
explains simply but thoroughly the Committment laws of the State of Massa- 
chusetts, and the three ways that a patient can or does enter a State hospital. If 
this talk seems too obtuse and opaque for the average patient, may we cite an in- 
stance of a man who asked his father when he began to realize that he had some 
mental disease, to which his father replied, "When I heard Dr. Bryan's talk on 
the Legal Aspects of Mental Disease." Another talk, dealing with the various 
types of treatment in an institution of this sort, is included in this series. This 
tells simply and clearly what hydro-therapy, occupational therapy, physio-therapy, 
and the various types of therapy are, and the way they are used in this institution. 
The last of this series explains what the patient must do, and what progress he must 
make before he can receive parole, and leave the hospital. 

Any sort of technique in running a radio in a mental hospital that will make 
patients feel that they have some part in this programme, and some voice in its 
management, will tend to lessen antagonism against it. If it is run in a too die- 
to rial fashion with no voice of patients in the matter, it will not accomplish the same 
purpose. We have several questionaires concerning radio programmes that have 
been circulated among patients. These questionaires asked what types of music 
they liked best; if they liked talking or musical features; if they preferred hospital 
to outside programmes, etc. The patient feels that he has at least an infinitesimal 
possession in this radio equipment when he can voice an opinion or ask for some 
particular programme. Many announcements are made during programmes asking 
the patients to write letters with suggestions in regard to changes or additions in 
the radio programmes, and the efficacy of these announcements has been proved 
. by many letters, that have come to the radio room with valuable suggestions. For 
example, one patient suggests that we make announcements concerning our hospital 
library, give book reviews, tell of new magazines and newspapers, and so on. Some 
contests have been held offering prizes for the best letters containing suggestions 
and these contests have brought in a great many interesting and sometimes very 
valuable patient letters. 

B. Disseminates Information about the work of the Hospital 
In place of advertising that comes in commercial programmes from the outside, 
we are able to utilize these moments to disseminate information concerning various 
departments of the hospital. The hospital is a definite community. A good citizen 
takes an interest in something outside of himself and lends some assistance and 
co-operation to the community. 

A good patient will take an interest in the community that he is in, and the more 
he knows about the various forms of treatment; what the various departments 
'are doing therapeutically, the better hospital citizen he will be. Short minute briefs 
on the departments of occupational therapy, social service, research, pathology, 
bio-metrics, psychology, and industrial are broadcast. Short snatches about these 
interesting aspects of the hospital, serves to create an interest, and the interest 
becomes a community one, rather than an old fashioned one. 

C. Makes patients feel that he is a part of the group 
The talks on various departments; on various types of therapy by various staff 
members, — all of this is indicatory that one is not alone in a hospital as large as 
ours, and that one is not suffering alone; that there are some 2,200 other people 
in similar circumstances and all of these 2,200 people can in their small way, help 
to rehabilitate themselves. The right kind of group therapy will lessen the patient's 
parading his paranoid ideas upon other patients and will increase his desire for 
co-operation with the hospital programme, and will enable him to assist his fellow 
patients in rehabilitation. 



P.D. 23 17 

D. Keeps up the interest of the patient in the outside world 
The fact still remains, and we cannot get away from it, that in a mental hospital 
there are bars on the windows, the doors are locked, and some rules are rigid. All 
of this may be a contributing factor psychologically, to the added sense of isolation 
that a patient entertains after commitment. Before the days of Radio, the only 
connection with the outside world was an occasional visit from a relative or an 
occasional concert by philanthropic outsiders. Today, there is hardly an important 
event in the outside world that is is not possible to bring to the most disturbed 
ward in the hospital — if that programme is therapeutic for these particular wards. 
It is hoped that the patient does not enter the institution with a complete annihi- 
lation of outside interests and that church, politics, town, civic, state, national 
interests, or clubs and sports, still contain an atom of interest for him. Church 
services may be of vital importance therapeutically to certain patients. They may 
possibly listen to a service from their own church or to some well known and well 
liked clerical speaker, such as Father Coughlin, or S. Parkes Cadman. An emphatic 
indication of the interest of these types of programmes was manifested by a petition 
gotten up by male patients and signed by some 40 or 50 parole and locked patients, 
asking to have the weekly talk of Father Coughlin. Political events of state or 
national importance, such as a speech by the Preisdent of the United States, or the 
Governor of Massachusetts, should interest any normal individual, and the facts 
that such events can be broadcast to wards is an emphatic declaration that in one 
sense of the word they are no more isolated than their relatives who are in their 
homes listening to the same programmes. Certain privileges have been denied 
these patients, but other privileges have been most emphatically retained, and are 
even encouraged. 

2. Information disseminated about Mental Hygiene. 

For centuries, mystery, witchery, and ignorance has existed in regard to mental 
disease. The various organizations of Mental Hygiene in our country are doing 
much to educate lay groups as to the cause and cure of mental disease. Each season, 
over our radio system, we have one of the chief psychiatrists deliver a series of ten 
or twelve talks to the patients relative to mental disease. These talks are ten 
minutes in length, simply worded and are given in informal manner. They are not 
read, but are given from notes. Each year, this series is slightly changed to meet 
the needs of the hospital and also to introduce variety. For example, one series 
will deal exclusively with the psychoses, telling simply but plainly, just what de- 
mentia praecox or general paresis is. It seems only logical that this type of talk to 
200 patients and employees should be in the common vernacular, as if the psychi- 
atrist was replying to Annie's mother, when she asks '"You say my daughter has 
dementia praecox. What do you mean by that?" Obviously, the psychiatrist 
cannot pour forth an avalanche of technicalities in this situation. All types of 
psychoses are represented in our hospital. There are very few epileptics and too 
few of this diagnostic phase to warrant a talk on that particular psychosis. All 
of the others, however, were taken up. Another series of purely psychiatric talks 
deal with such subjects as "mental mechanics," "nervous exhaustion," "subli- 
mation," "projection," and so on. None of these talks are too involved for a 
"Prep" student to understand, nor too rudimental for a mature person to enjoy. 
The positive proof that patients DO enjoy, benefit from, and appreciate, this type 
of talk, is manifested once again by their verbal comments, and their letters which 
come either to the superintendent or the radio director. Several patients have been 
so specific as to mention the fact that they have been benefited by these talks and 
gotten a better understanding of themselves. 

There are two types of advertising. The first being more lengthy, costly, showy, 
impressive; the other being very brief, to the point, and more frequent. This has 
been called the ' 'Hammer" type of advertising. It eventually makes an impression 
by its constant persistance and dogged determination. Respecting both of these 
psychological approaches to influence groups, we use them both in our mental 
hygiene radio technique. The former, more lengthy type has been explained 
above. The latter and perhaps just as efficacious is utilized in the following 
manner. Every fifteen minutes during the broadcasting periods (which are staged 
hourly throughout the day) the correct time and correct date are given. This is 



18 P.D. 23 

at least a helpful bit of orientation. These announcements will not run over two 
minutes at the most and most of them are about one minute in length. These 
hygienic tid-bits are so diversified and versatile that over a period of a few weeks 
one could compile a rather thick book of mental hygiene hints, brief explanatory 
bits on occupational therapy, the psychoses, and various types of therapy. 

3. Recreation. 

The radio is almost a necessity for the majority of human beings in this country. 
It is a source of pleasure to many people and even educational at times. A mental 
hospital, at its very best, with all modern types of therapy, equipment, and instal- 
lation, is still a House of Sighs and Sorrows. Anything that can serve to attenuate 
any of this unhappiness, discontentment, and phlegmatitude, should be utilized. 
Entertainment, in one sense of the word, is therapeutic, but even if we divorce it 
from its therapeutic side, we still have assets in its utilization. Many hours a week, 
many weeks a year, and several months of the year, are made more bearable, more 
happy, more interesting to the male patients of the hospital, just by listening to 
the base-ball gam.es. This one feature alone is serving a triple purpose. It is 
providing positive entertainment. It is emphatically socializing the patients' 
mind and interest, — being taken away from himself, and transferring it to even 
cities beyond his State, and the happiness, temporal normalcy, and delightful en- 
joyment that the patient gleans from these "sports" events, are indeed therapeutic. 

Humor is hygienic, and one seldom sees, even from the physical side, a man with 
a jolly disposition and keen sense of humor who is a dyspeptic. Probably a glint of 
humor has never played upon the faces of a large majority of psychotics. Perhaps 
their situation in life has never permitted them to harbor humor as a close ally. 
The right type of humor sketches over this Radio may do much to even turn the 
search-light of absurdity upon some Hypochondriac. A letter from a patient at 
this hospital mentioned the "healthy humor" of Amos 'n Andy. The prevalent 
forms of ward entertainment, in the early evening are friendly games, and listening 
to the radio. The mere fact of a patient whistling a tune with the radio, while he 
is keenly interested in a game of pool, testifies that unquestionably he is enjoying 
and quite in rapport with the melody at hand, even though this be an unconscious 
enjoyment. 

4. Self-expression. 

This word, really, cannot be overworked. If individuals express themselves 
truly and honestly, they are not only completely and harmoniously adjusted, but 
they are happy individuals. There always has been and always will be, a minority 
of patients in mental hospitals, who are musical and who receive great satisfaction 
from expressing their musical ability before an audience. The mechanical fascina- 
tion of a microphone psychologically, gives even normal individuals a tenseness; 
it calls for great mental discipline; its demand is even more accurate and dogged 
than the glassy eyes of an audience. Performing then over the radio can become 
a therapeutic situation both for the patient performer and the patient listener. 
Performances over the radio by a female patient formed a large part of the thera- 
peutic programme which eventually released her from the hospital. Mental dis- 
cipline, a happy medium between the manic and depressive moods, sublimation, 
and fulfillment, are all involved in radio broadcasting for patients. 

5. Request Programes. 

One only has to study the radio situation in the outside world to note the psy- 
chological technique used in programme making. Whether we listen to the 
Philadelphia Symphony, Dick Liebert, Lawrence Tibbett, or Abram Chasins, 
we are conscious of their desire to please the public by the request numbers given. 
In many instances, the names or initials of "requestees" are announced over the 
Radio. When the U. S. Marine Band plays number so and so for "M. T. " from 
such and such a city, the chances are probably that " M. T. " will remain a devotee 
of the Marine Band forever. 

Many request programmes have been given over our station for patients with 
the announcements of the numbers and whom they are played for. This is a project 
which we are still building upon. 

6. Racial Programmes. 

The Worcester State Hospital has a large foreign population, many of whom 



P.D. 23 19 

speak the English language very poorly or not at all. A thousand musical numbers 
or speeches in English would not equal one single sentence in their mother tongue 
to these individuals. The most logical procedure in presenting racial programmes 
is to utilize well-known folk songs. A list of foreign patients in that tongue should 
be obtained and their respective wards called so that they would be sure and hear 
that particular programme. The word '"tak" (yes) does more for my senile Polish 
friends on Ward "D" than could an impassioned address in our own language. 
A Polish Folk Song will bring forth more reaction from this Slavish woman than 
would a symphonic poem. 

Occupational Therapy Department 
Olive M. Caldwell, Head O. T. 

The outstanding feature of our program throughout the year 1934 has been a 
stronger emphasis upon the individual treatment of the patients and a closer 
relationship with the psychiatrist who, through this closer relationship, has a 
clearer picture of the patients' response in a work and social environment. 

Classes have been held regularly on the treatment wards of the female psys- 
chiatric service where our groups are small in numbers as it is only in small groups 
that one can reach the individual and develop in her a feeling of security upon which 
she may build. Neither the creation of an article nor the development of a hobby 
is important in these classes where the real object in view is the initial reintegration 
of the patient. As quickly as is possible she is moved out to a larger social environ- 
ment where more normal situations and demands provide a chance for further 
reintegration on a higher level. Intensive work along these lines is done by the 
students with individuals from this group who are assigned by the psychiatrist in 
consultation with the head of the department, on the basis of personal contribution 
each student may give to the patient. Work with these "specials" consists of 
any activity carried on at any time during the day irrespective of any class activity 
in which the patient may be participating. The foundation of this work is a 
personal, friendly relationship directed by the psychiatrist's entire program of 
treatment for the particular patient. Once a week progress notes by the students 
on patients with whom they have worked both in class and individually are sub- 
mitted to the psychiatrist who is thus kept in close contact with the reaction of her 
patients to this form of therapy. These notes are promptly returned to the students 
with suggestions from the psychiatrist for any change in activity or approach to 
the patient. An important adjunct to this form of therapy has been in the use of 
the flower gardens and greenhouses for a dual purpose; first, of stimulating those 
patients who have recently gone onto parole to reach out for the mild social respon- 
sibility which this work affords for their leisure time; and second, of helping the 
acutely ill patient who may be having other forms of therapy such as hydrothreapy 
for half a day to find a milieu in which she may take the first steps of reintegration. 

A few male patients have been taken down to the Thayer O. T. shop for special 
reintegrative therapy as prescribed by the psychiatrist. Most men respond more 
readily to a larger field of activity such as is furnished by industrial therapy but 
there are patients from time to time who need the smaller environment and the 
closer individual treatment. 

On the medical services therapy of an almost purely palliative or diversional 
nature has been carried on, one student dividing her day between the two services. 

A new project is well under way whereby occupational therapy of a palliative 
nature may be carried on by the nurses on the locked wards which are not other- 
wise reached by occupational therapy. The occupational therapist provides 
materials, gives suggestions for projects, directions, methods of approach, and acts 
in a general supervisory capacity in whatever way the nurses may need her. This 
service not only benefits the patients but also strengthens the feeling which has 
been increasingly evident during the past year of a common purpose held by nurses 
and occupational therapists together. 

Recreational therapy has been extended to meet the needs of prolonged treat- 
ment wards, as well as acute treatment wards. Group games and singing through 
the winter months have been arranged for Philip III while more individual games 
and singing meet the needs of the acutely ill on Washburn IV. The classes in 
eurythmics from the treatment wards respond more readily in the environment of 



20 P.D. 23 

the new recreation room on Philip I where there are no distracting influences such 
as they had to contend with while having class on the ward. The piano and recent 
magazines on the reading table provide an interest for those patients who otherwise 
had to wait around idly while the slower patients in the class changed their costumes. 
This means that the spirit of recreation is kept intact until the whole group dis- 
bands. The informal walks, the bridge parties, the holiday dances all contribute 
to the spreading of the realization that recreation is an important feature of an 
active therapy program. Individual music or dancing lessons as prescribed by the 
psychiatrist are given by Miss Marble for special reintegrative therapy. 

As in the other branches of the department the keynote of progress in industrial 
therapy has been the recognition by ward attendants, supervisors, and foremen 
of the aim of the department in emphasizing the work as the treatment for the 
individual. Through this grov/ing spirit of cooperation new sources of therapy for 
special individual cases have been opened such as typing in the Steward's office, 
tracing in the Statistical department, technician in the X-Ray room, and so forth. 
The reorganization of the library is well under way to provide more opportunities 
for closely supervised work in mixed groups and graded to various levels of physical 
and mental activity. A new stimulus for patients assigned to ward work is being 
provided in a weekly class held by a supervisor on the female service in which the 
patients are taught standard methods of bed making and ward procedure. It has 
become routine procedure that the physician visits with the occupational thera- 
pists at regular intervals the shops and industries where the patients are working. 
This means a closer tie-up between patient at work and physician; a deeper reali- 
zation on the part of the foremen that they are therapists helping in the treatment 
of patients and first hand knowledge on the part of the psychiatrist of the situations 
and personalities to be considered in prescribing this form of treatment. 

A system of records regarding patients progress in industrial therapy has been 
inaugurated whereby such information is in the psychiatrist's hands at the time 
when his notes are due in the case record. 

A change in the organization of the department has been made to coordinate 
both services so that one person plans with the psychiatrist for the industrial 
treatment of the patient and evaluates such treatment, while the other member 
is responsible for the details of carrying out the psychiatrist's prescription. This 
makes for greater efficiency in the work. 

Student training is planned on a dynamic basis and is aimed to meet the re- 
quirements of the above program. The responsibility of writing notes is most 
important in this program and the ability to observe, understand, and record 
patients' attitudes is stressed as one of the most important factors in the newer 
and larger concept of occupational therapy. 

Social Service 
Helen M. Crockett, Head Social Worker 

There has been little change in the personnel or policies of the social service 
department during the past year, although we trust we have made progress in our 
thinking about the social problems for which we are responsible. It has seemed 
desirable that the work of historian be handled by regular workers of the social 
service department. Although this means an increase in case load without any 
increase in personnel, we believe this to be a step in the right direction. 

During the summer there was an exchange of social workers between the male 
and female services. This had two advantages; the workers have had the oppor- 
tunity to transfer those cases on which they had not had full success and the stimulus 
of undertaking a new group of problems. At the same time the two services have 
profited by the varied talents of two different workers. 

This year all our students come from schools of social work. The three from the 
Smith College School for Social Work assigned to this hospital are having the first 
year of their field experience. It is our impression that beginners adjust more 
readily to the leadership of a state hospital psychiatrist than do the more advanced 
students whose concepts of case work have already been formed in a less specialized 
setting. One of the three students from the Simmons College School of Social 
Work has dropped out because of personal plans making the total number of student 
at the present time five, the same as last year. 



P.D. 23 21 

Although we discredit the value of statistics in social case work, except as they 
show general trends, the quality of the interviews and the skill of the social worker 
being more important factors than the number of calls made or the number of 
cases carried, we believe that certain trends can be indicated. We dealt with a 
total of 2,041 cases this year, about 250 more than in 1933, with no increase in the 
number of social workers or students. The case load per month varied between 
five and six hundred, of which an average of one hundred were carried by students. 
The remaining were carried by three workers, whose efforts were too scattered to 
insure us the quality of service which the standards of this hospital should lead 
us to expect. Some measures are indicated, either to increase the number of social 
workers, or to cut down the volume of v/ork. If the latter plan is followed, it would 
seem that the administrative tasks to which we give so large a part of our time 
might be transferred to some other department of the hospital. 

This year we are beginning to see some of the results of our efforts to make 
family care placement a step toward adjustment to community life. One hundred 
and ninety-three different patients have spent some time in our boarding homes 
during the past year. Of these, 77 were new placements, 5 were replacements, and 
12 patients for many years in boarding homes under the supervision of the Depart- 
ment of Mental Diseases were transferred to our care, 101 remain in boarding homes 
at the end of this year, although the monthly average was only 96 plus. The 
average patient was visited ten times by a social worker and once by a physician. 
Fifteen patients have gone from Family Care to their own homes, "on visit" 
status, and seven have found employment and become self-supporting, three have 
been discharged as recovered and four have died, 43 have been returned to the 
hospital because of poor physical condition, and five because the caretaker was 
compelled to give up the work and suitable places have not yet been found. 

Since the family care patient spends a longer period under the supervision of 
the hospital, some of our most intensive cases for social treatment are to be found 
in this group, work with the family and with the patient often progressing simul- 
taneously. 

Case I. Sally became ill while in high school. She had felt much responsibility 
for her mother and younger brothers, and had long been her mother's confidante, 
although she still did not fully understand all that she was told and spent much time 
worrying about it. When she became well enough to leave the hospital, it seemed 
desirable for her to finish high school in a different town, because her mother 
worries might again react unfavorably, although she had had opportunity to discuss 
them with her psychiatrist and to understand them better. The mother, mean- 
while, has had many talks with the social worker and is gradually developing more 
stability and serenity. Sally goes home for holidays, and although not fully re- 
covered, the normal home life she is experiencing in the boarding home is preparing 
her to take up again the responsibilities which had to be dropped at the beginning 
of her illness. 

Case II. Anna, 19, was never really loved by her parents, whom she reminded 
of an unhappy time in their own lives. They would never have admitted this, 
even to themselves, for they were constantly making sacrifices to give her nice 
things they could not afford. When Anna had sufficiently recovered from a 
schizophrenic episode, she was placed in a boarding home, where she gradually 
learned to be a part of the household. The caretaker helped her to share her keen 
wit and humorous way of looking at life with her foster family although usually 
a silent person with a group, she has made real progress in keeping up her end 
of a conversation. Over a period of two years, her family were seen frequently 
by a social worker, until they felt free to discuss their own feelings. At all times 
it was emphasized that the way they felt about Anna was more important than 
what they did for her. In time the mother began to discover for herself how 
Anna felt about herself, her home, and her family and took pleasure in making some 
important changes before she asked to have Anna come home to stay. Anna has 
steadily improved since her return home. 

Case III. Bertrand, at 17, had his first psychotic episode, although he had been 
known to psychiatrists and social workers for many years. They had been pre- 
vented by technicalities from placing him in a foster home about eight years earlier. 



22 P.D. 23 

and it seemed as if our placement might be a little too late. He has made a heroic 
effort to become one of his new family. At first he enjoyed the instantaneous 
popularity which his good looks and easy social manner won for him among the 
young people of the rural community where he was placed. He talked about 
wanting to be a psychiatrist like the friend who had helped him for so many years, 
but was satisfied merely to talk about it. V/hen the first opportunity for work came, 
he was the more inexperienced in the gang that was preparing railroad ties. The 
first week he blistered his hands and froze his feet, but earned only 65 cents. He 
persisted, however, until he has become a respected workman, now pays his own 
board, and is saving something toward carrying out his ambitions. His caretaker 
writes, " Bertrand is doing remarkably well now. Many of the little problems that 
have been pestering me have vanished into thin air and I believe the rest will too." 

Case IV. Mrs. Mortan, a pleasant, gray-haired woman had been in the hospital 
for many years, her son being unable to care for her, and her strength being unequal 
to the task of earning her living. Although she adjusted in the boarding home to 
which she was assigned, she always longed to get back to the community in which 
?he had formerly lived. Her excellent adjustment in the home convinced not only 
the staff but the Board of Public Welfare of her home town that she could get 
along in the town farm. The patient herself was glad to make the change. 

Case IV indicates that even for the elderly patient without resources the boarding 
home may be a stepping stone toward community life. We feel more and more 
strongly that the most economical use of Family Care is to provide a helpful environ- 
ment for the patient during the period of convalescence. The task of the social 
worker is not finished until the patient has became a self-sustaining member of 
society, her contact often continuing after the patient has been discharged from 
the hospital books. 

We believe that changing trends in social work in mental hospitals have made 
some revision of our reports to the trustees desirable. Since the emphasis through- 
out the hospital is on the treatment of the patient, we hope to dispense with the 
fine classification of investigations, and add the number of cases carried for social 
treatment, the number of intensive cases, and the amount of time spent on them. 
The most important and the most needed service a social case worker has to offer 
in a mental hospital, we believe, is social case work, not history taking and inves- 
tigation. There is no point to discovering a limiting or hindering social situation 
unless we can do something about it. 

Medical and Surgical Service 
Clifton T. Perkins, Assistant Superintendent 

The following report is designed to summarize briefly the more important activ- 
ities of the medical and surgical service, during the past hospital record year, 
. extending from October 1, 1933 to September 30, 1934, inclusive. 
(1 ) Movement of Population on the Service 

During the past year there were a total of 1,285 patients cared for on this service. 
This is an increase of 126 more patients than were on the service during the previous 
year. There were 113 patients admitted during the year. It has been contended 
that one of the greatest values of such a service comes from its utilization by the 
psychiatrist as an adjunct in the study and treatment of the more vague physical 
illnesses which so frequently complicate the detailed study of mental disorders. 
To this end the service has been used for the special study of 148 patients, in 
addition to the usual run of patients suffering from obvious physical infirmities. 
After the study was completed, all but 31 of these 148 patients were found to have 
physical illness and were improved under treatment. It is hoped that such cases 
for study will increase from year to year, that they will tend to more closely har- 
monize the psychiatrist with the internist and the surgeon, and that eventually 
from such studies will come increased knowledge of the relationship between the 
psyche and soma. 

The turnover of patients on the medical and surgical service was satisfactory 
during the year. There were a total of 922 patients discharged from the service 
either to go to one of the other services in the hospital or to go home. This indicates 
an average monthly turnover of 77 patients. A study of these discharges indicate 
that the months of December, January, February, and April are the most active 



P.D. 23 23 

throughout the year. Because of certain construction work, the activity of the 
service was somewhat curtailed during the summer months and during September 
with only 45 discharges, the service was working at approximately only 60% 
efficiency. 

The discharges from the service, detailed as to physical condition, may be sum- 
marized as follows: — 

Female Male Total 

Recovered and improved 510 356 866 

Not improved 9 16 25 

Not treated 15 16 31 



'.male 


Male 


Total 


129 


140 


269 


83 


82 


165 


17 


14 


31 



Total 534 388 922 

(2) Deaths 
The following table, with comments and analysis gives us much valuable infor- 
mation relative to deaths occurring among our patients during the past year. 

Total number of deaths 

Total number of autopsies 

Total number of medico-legal cases 

Autopsies confirmed ante-mortem diagnoses (70% or 

more) 66 61 127 

Autopsies partially confirmed ante-mortem diagnoses 

(50-70%) 12 17 29 

Autopsies refuted ante-mortem diagnoses (less than 

50%) 5 3 8 

Autopsy percentage of deaths — 61.3% 

Attendance at autopsies (10 months) — Students, 616; Staff, 816; Total 1,432. 

Although the total number of autopsies alone was higher than any previous 
year, the autopsy percentage of deaths was 7.5% less than last year. 

Of the 269 total deaths, 25 (12 women and 13 men) were at the Summer Street 
Department, and one elderly lady died in a boarding home. It has been a policy 
of this hospital to transfer all patients critically ill to the Main Department where 
more adequate care for physical ailments can be administered. Under existing 
conditions because of lack of adequate ambulance and elevator facilities, it is 
not always advisable to adhere strictly to this polity. 

An analysis of deaths in relation to season, shows that the highest death rate 
occurred in the months of November, December, May, and September. The 
lowest death rate was in August, with January, March, and June also having a 
low death rate. These monthly variations are of particular interest when com- 
pared with the months of increased activity on the service as noted under the 
caption "Movement of Population." 

A survey as to the ages and primary causes of death reveals the following in- 
formation: — 

(a) Seventy-four deaths, representing 27.5% were due to pneumonia. Again, 
the latest classification of causes of death requests that those deaths following the 
infirmities of old age, complicated by pneumonia, be classified as pneumonia deaths. 
Hence the increase in this division during the past two years. Of these deaths, all 
were bronchopneumonia except three (one 18 year and one 25 year old patient, 
each having bilateral lobar pneumonia and one 70 year old patient with unilateral 
lobar pneumonia). This is a decided decrease in the number of lobar pneumonia 
deaths, but an increase of 5% in the total number pneumonia deaths. The average 
age of death ot the group was 67.4 years. The month of May was by far the heaviest 
for bronchopneumonia deaths, and January for lobar pneumonia. 

(b) Sixty-seven deaths, representing 25%, were due to the infirmities of ad- 
vancing years, such as arteriosclerosis, cardiovascular-renal disease, etc. This 
is a decrease of 2% over last yfear. April was the outstanding month for deaths 
from the infirmities of old age. The average age of death was 70.4 years. 

(c) Twenty-three patients, representing 8.5%, died from general paresis. The 
percentage is exactly as last year, and remains rather constant from year to year. 
The average age at death, 46.6 years represents an increase of one year. June con- 



24 



P.D. 23 



tinues to be the heavy month for deaths from paresis, and there were none in May 
or August. 

(d) Twenty-two patients, representing 8.1% died from tuberculosis. All were 
pulmonary except two, one of which involved the spine, and the other was miliary. 
November was the heaviest month. The average age at death was 48.5 years, 
which is an increase of 6 years. 

(e) Eleven deaths, representing 4%, were due to carcinoma. This is i% less 
than last year, and the average age at death, 67.7 years, representing an increase 
of 8 years over last year's report, is very encouraging. We are not equipped in 
this hospital to give adequate treatment to all patients suffering from the various 
types of cancer, but we continue to take full advantage of the resources of the 
Pondville Cancer Hospital for the treatment of these patients. Of the cancer cases 
above reported, the primary site of the disease was as follows — 1, the face, 4, 
the stomach; 1, the colon; 2, the breast; 2, female pelvic organs; and 1, the tongue. 

(f) Eight deaths, or 3 %, were due to fractures, and the average age of death was 
72 years. Seven of these eight deaths were due to fractures of the femur. 

(g) Eight deaths, or 3% were due to diseases of the genito-urinary tract, pri- 
marily in men, and usually complicated by the changes coincident to advancing 
years. Such diseases as hypertrophied prostate, pyelonephritis, and purulent 
cystitis comprise this group. The average age at death was 65.4 years. 

(h) Five deaths, representing 1.9 '^"c were due to diabetes mellitus. The average 
age of death was 70.4 years, an increase of 2 years. 

(i) Five deaths, or 1.9% were due to cerebral hemorrhage. The average age of 
death was 67 years. 

(jj Five deaths, or 1.9% were due to syphilis of the central nervous system 
(exclusive of general paresis), and the average age of death was 45.2 years. 

(k) Four deaths, or 1.4% were due to primary heart disease, uncomplicated by 
senile changes. The average age of death was 39 years. Although this is a decided 
decrease in the number of such deaths, the age of death is 18 years younger than 
that reported last year. 

(1) Three deaths, or 1.1% were due to primary kidney disease, uncomplicated by 
senile changes, and the average age of death was 39.3 years. As in the case of pri- 
mary heart disease, there is a marked decrease in the number of deaths from primary 
kidney disease, but the age of death is 14 years younger than that reported last year. 

(m) Two deaths, or 0.8% were due to peptic ulcer, and the average age of 
death was 52 years. 

(n) Two deaths, or 0.8% were due to intestinal obstruction, and the average 
age of death was 45 years. 

(o) The remaining 30 deaths, representing 11.1%, were due to a wide variety of 
causes, having no particular significance. Such single, isolated causes of death as 
brain tumor, otitis media, osteomyelitis, paralysis from drinking Jamaica ginger, 
pulmonary embolus, etc. comprise this group. The average age of death of the 
group was 51.3 years. 

(p) The average age of all deaths was 62.2 years. The age is quite constant from 
year to year. 

(3) Consultations 

The following table summarizes the extent to which the members of the service 
called upon our consultants. Although the total number of consultations is some 
300 more than last year, the increase is not spread throughout the entire list; there 
were nearly 400 more X-ray consultations this year as compared to last year, and 
the gynecological and obstetrical consultation were 43% less. 

Eye 107 



Ear, nose, and throat . 
Gynecological and obstetrical 
General surgical . 

Medical 

Orthopedic .... 

X-ray 

Others . . . . 



90 
96 
184 
18 
39 
1,502 
20 



Total 



2,056 



P.D. 23 



25 



(4) Obstetrics. Detailed 

As has been our custom for several years, we continue to maintain a small, 
regularly licensed obstetrical ward of eight beds. Although our demands on this 
department are not great, nevertheless we endeavor to provide adequate pre-natal 
and post-natal care for mothers, and give satisfactory medical and nursing care to 
the infants born, until they are 3-6 months of age. During the years of economic 
depression we have experienced increasing difficulties in finding proper placement 
for such infants even by the time they are six months old. It is preferable that 
they have proper placement even at 3 months. Although we are equipped to care 
for these infants as noted above, we strongly feel that it is not proper for an infant 
of over 6 months to be brought up in the environment of a ward of this hospital. 

There were 7 female and 6 male children born during the past year. One infant 
died shortly after birth. 



(5) Surgery Detailed 



Amputations (major) 


2 


Amputation (minor) 


1 


Appendectomies 


8 


Biopsies 


5 


Bronchoscopic Examinations 


5 


Cataract excision . 


1 


Cauterization of cervix 


5 


Cholecystectomies. 


4 


Circumcisions 


2 


Colostomy .... 


1 


Colporrhaphy 


1 


Craniotomy .... 


1 


Cystographies 


2 


Cystoscopies .... 


5 


Cystotomy (supra-pubic) 


1 


Dacryocystostomy 


1 


Dilatation and currettage . 


4 


Encephalographies 


9 


Enucleation of eye 


1 


Excisions (miscellaneous, minor) 


18 


Fistulectomies 


4 


Fulgerations .... 


8 


Gastro — enterostomy 


1 


Hemorrhoidectomies 


4 


Herniorrhaphies 


31 


Hydrocelotomies . 


o 


Hysterectomies 


5 


Incisions and drainage (miscel 


- 


laneous, major and minor) 


115 


Injections of hemorrhoids . 


2 


Injectionsof varicose veins . 


18 


Laparotomies 


11 


Mastoidectomies . 


3 



Miscellaneous procedures (minor) 

Myomectomy 

Myringectomies 

Osteotomies . 

Oophorectomies 

Orchidectomy 

Osteotomies 

Paracentesis . 

Perineorrhaphies 

Plaster Casts (Major) . 

Plaster Casts (Minor) . 

Plastics miscellanoues, major and 

minor) 

Pneumolysis 

Pneumothorax treatments . 
Proctoscopic examinations . 
Prostatectomies .... 
Pyelographies .... 
Removal of foreign bodies . 
Salpingectomies .... 
Sigmoidectomy 
Splints applied (miscellaneous, 

major and minor) 
Suspension of uterus 
Suturings (miscellaneous, major 

and minor) .... 

Tonsillectomies and adenectomies 

Thorocentesis 

Thyroidectomy .... 
Transfusions ..... 

Varicotomy 

Ventriculographies 



1 
4 
3 
2 
1 
3 
3 
8 
21 
11 



1 
163 
17 
3 
2 
3 
2 
1 

6 
1 

119 
32 

7 
1 
8 
1 

4 



As may be noted above the total surgical procedures carried out during the past 
years was 722. This figure cannot in any way be compared with the reports of 
past years because of administrative changes in more closely associating the surgical 
suite with the department caring for more minor "out-patients" procedures. Thus, 
for example, there are reported this year nearly three times as many suturings as 
last year, and over twice as many incision and drainages, although these actual 
procedures were approximately the same both years. In general, it may be said 
that the report indicates a fair degree of activity. 

Among the procedures listed above there may be noted certain ones that are not 
designed primarily as therapeutic, but rather as diagnostic, such as ventriculo- 
graphies, pyelographies, bronchoscopic examination, etc. These, however, may 
well be rated as surgical procedures of major importance. 



26 P.D. 23 

It may also be noted that there are several new procedures which have not been 
reported in past years and which have been utilized to great advantage during the 
past year. We refer particularly to pneumothorax, pneumolysis, encephalography, 
and ventriculography. The use of artificial pneumothorax has been extended in 
this hospital primarily through tiie unceasing efforts of Dr. (Jlass. During the past 
year eleven patients suffering from pulmonary tuberculosis were given these treat- 
ments with excellent results. They have been given as often as necessary, some- 
times as frequently as three times a week. Three of these eleven patients had 
bilateral pulmonary tuberculosis. One had an operation for pneumolysis. All 
patients improved both mentally and physically following treatments, although 
the time is too short to evaluate permanent results. Two patients suffering from 
lobar pneumonia were also successfully treated by pneumothorax. It is hoped 
that this work may be extended during the coming year. 

The use of encephalography and ventriculography as diagnostic aids in the 
detailed study and understanding of brain tumors and other diseased conditions 
of the brain has been invaluable. The procedures have been furthered primarily 
through the eff'orts of Dr. Lavine, and have been used on thirteen different occasions 
during the past year. Present plans call for continued and more wide-spread use 
of these procedures. 

In reports of past years we have commented upon the necessity of closely allying 
the general dressing room for out-patient dressing and minor surgery with the main 
surgical suite. This has seemed most desirable from the standpoint of efficiency and 
centralized control -- primarily for better supervision of procedures and distri- 
bution of supplies, to conserve personnel and time, and to minimize duplication of 
equipment. Although our ideal goal in this detail is far from being reached, a step 
in that direction was taken this year by combining the two dressing and minor 
surgery rooms into one, now located on Howe II ward. It is hoped that in the not 
too distant future arrangements may be made for employees now housed in rooms 
adjacent to the surgical suite to be maintained elsewhere, and that all clinics, "out 
patient" dressings and minor surgical procedures may be cared for in those rooms, 
under the immediate control of those having charge of the surgical suite. 

Work in the surgical suite has been somewhat handicapped during the last six 
weeks of this record year, due to various construction projects. It has been possible 
to carry out only surgery of an emergency nature during this temporary period. 

(6) Clinics Detailed 

l']ye examinations 750 

Kar, nose and throat examinations 720 

Gynecological examinations 546 

Luetic treatments 4,733 

Small-i)ox vaccinations 162 

Spinal punctures 266 

Typhoid and para-typhoid inoculations 2,021 

Wassermann, Kahn, and Hinton tests 1,250 

Others 33 

Total 10,480 

These clinics, as in past years, (continue to be run in conjunction with the general 
surgical suite and the report indicates a good degree of activity. The total clinic 
procedures is approximately 2,000 more than reported last year. There were 2,002 
more luetic treatments given than last year, but eye examination, ear, nose and 
throat examination, spinal punctures and blood tests, each run nearly 100 less 
than last year. 

The luetic clinic continues to Ije (^uite active, and this year there were approxi- 
mately 7,000 visits to that clinic alone for examination, treatment, or advice. 

For the past few years we have been comparing the Wassermann, modified Kahn, 
and llinton tests on the blood for their relative ellicacy in detecting syphilis and in 
guiding the physician in his treatment and pronouncement of a cure in such an 
illness. We are not yet ready to publish the detailed report of these comparisons. 
For the moment, suffice it to say that further (comparisons do not seem necessary 
and we have completely forsaken the blood Wassermann and modified Kahn tests 



Male 


Female 


902 


1,142 


499 


195 


349 


477 


. 1,118 


1,802 


339 


591 


899 


1,518 


. 4,106 


5,725 


. 18,106 


17,200 



P.D. 23 27 

for the Hinton test. This latter test seems to be much more sensitive than the 
others, and a safer guide for the physician dealing with neurosyphilis. 

During the coming year additional thought will be given to the question of these 
clinics. The luetic clinic is in need of reorganization. The illnesses of some of our 
patients indicate the possible need of additional clinics. 

(7) Dressings Detailed 

Abrasions and lacerations 

Boils and carbuncles. 

Burns 

Infections . 

Ulcerations 

Others 

Total "out-patient" dressings 
Ward dressings 

Total dressings . . 22,212 22,925 

Grand Total 45,137 

As noted under the caption "Surgery Detailed" fur the past several months 
the "out-patient" dressings have been concentrated in one room, rather than 
distributed in special dressing rooms on the various wards. It is hoped that in 
time we may centralize these dressings even more. 

The total number of dressings is approximately 8', more than last year. This 
increase is made up mostly by the increase of ward dressings on the female wards. 

A study of dressings from year to year is of particular interest because it repre- 
sents fairly closely the need and use of gauze. Except for the relatively small 
amount of gauze used in the actual surgical procedures, and in the clinics, practically 
all other guaze used in the hospital is represented in dressings. A brief comment 
of comparison of the amount of gauze used in the past two years might be apropos. 
In 1933 a total of 14,300 yards of gauze were used. This was of a good grade. In 
1934, making due allowances for inventory of gauze, both in package lots and in 
made-up dressings, a total of 28,000 yards was used. This was of a fair grade. 
Being waste conscious and noting the tremendous increase (100 T^j) in gauze used 
with but slight increase indicated in dressings we looked into the discrepancy. It 
was found that a large percentage of the good grade of gauze purchased in 1933 
could be salvaged and utilized two and sometimes three times, whereas the poorer 
grade purchased for us in 1934 rapidly deteriorated in laundering and sterilizing, 
and very little could be salvaged. 

(8) Employees 
As in past years we have continued to conduct a clinic for employees every day 
except Sunday. This clinic is held in a special room in the surgical suite and is 
held between 4-5 o'clock. The clinic, conducted by the physicians on the medical 
and surgical service, offers the usual type of physician's office service to our em- 
ployees. During the year 1,388 visits from male employees, and 1,607 from 
female employees, a total of 2,995 visits. This is 350 more visits than last year. 
The months of October, November, December, January, and April were the 
heaviest months for activity in this clinic. September was the lightest with 120 
visits, whereas October was the heaviest single month with 440 visits. During the 
year 26 men and 21 women, a total of 47 employees, required operation. In 
general the health of our employees has been quite satisfactory. 

(9) Denial Departments 

Main 
Hospital 

Cleanings 1,301 

Examinations (routine) .... 2,290 

Extractions 1,646 

Fillings 1,528 



Summer 




Street 




Dept. 


Total 


240 


1,541 


693 


2,983 


732 


2,378 


267 


1,795 



28 



P.D. 23 



Impactions removed 


9 


1 


10 


Miscellaneous treatments 


880 


110 


990 


Plates 


46 





46 


Repairs . . . . 


5 


62 


67 


X-ray diagnoses 


79 


1 


80 



Total examinations and treatments 7,784 2,106 9,890 

Patients examined or treated . 4,090 1,617 5,707 

The above table reporting the activities of the dental department for the past 
year is most satisfactory. The total of 9,890 diagnostic or therapeutic procedures 
is 3,000 more than last year and represents roughly a 50% increase. This indicates 
more activity than has ever been reported from this hospital, and is 1,800 procedures 
higher than our previous high year (1930), as carried out by our resident dentist 
and dental hygienist. The total number of patients examined or treated (5,707) 
is likewise approximately 50% higher than last year, which was our previous high 
year. There were 1,800 patients more this year than last. 

Although the general dental and mouth hygiene of our patients is fairly satis- 
factory, there continues to be the ever-present problem of control of tooth brushes 
and teeth cleaning materials on the wards, with reasonable assurance that our 
patients cleanse their own teeth at proper intervals. The resident dentist and 
dental hygienist are now conducting a survey of this problem and undoubtedly will 
soon be in a position to make definite recommendations for action. 
(10) X-Ray Department 

Parts Examined 
Abdomen (plain) 
Ankle . 
Arm 
Chest . 
Colon . 
Elbow 
Foot . 
Fluoroscopy 
Gastro-Intestinal series 
Gall-bladder (plain) . 
Gall-bladder (Graham test) 
Hand . 
Heart . 
Hip 
Jaw 
Knee 

Kidney (plain) 
Leg 

Mastoid 
Nose . 
Ribs 
Shoulder 
Sinuses 
Skull . 
Spine . 
Teeth . 
Wrist . 
Others 

Total .... 

Finger or foot prints (sets) 

Photographs 

Photographic films used . 

Lantern slides 

Cine films used (feet) 





Plates 


Patients 


Used 


21 


23 


17 


21 


10 


10 


347 


348 


5 


5 


11 


14 


22 


26 


130 





35 


265 


3 


5 


9 


27 


57 


60 


17 


20 


52 


61 


4 


9 


17 


24 


4 


7 


22 


37 


11 


23 


7 


12 


19 


33 


26 


88 


41 


72 


81 


207 


38 


66 


111 


298 


29 


31 


61 


237 


1,206 


1,968 


19 




2,082 




523 




198 




400 





P.D. 23 



29 



The above table indicates a good degree of activity, with a continued increase 
in photographic work. The taking of X-rays is expensive. During the past few 
years we have stressed the importance of curtailment in this regard and have en- 
couraged the substitution of fluoroscopy for roentgenograms where such sub- 
stitution has been possible. The time has come, however, when we will again have 
to take X-rays more freely (^ut not wastefuUy) in order to maintain satisfactory 
medical standards for the care of our patients. 

For a more efficient use of this department we should be equipped with a timer 
for our present X-ray apparatus. This would materially lessen the loss of expensive 
plates through variations on technique. We also should be equipped with a portable 
X-ray unit which might be carried to the wards and to the various outlying hospital 
buildings rather than subject certain types of patients to the dangers attendant 
on moving them to our present X-ray suite. 

(11) Physical Therapy Department 
Ultra-violet (air-cooled) 3,444 



Ultra-violet (water cooled) 

Baking 

Massage . 

Diathermy (medical) 

Diathermy (surgical) 

Muscle re-education 

Others 



Total treatments and tests 
New patients during the year 
Total number of patients treated 



536 

1,768 

896 

554 

69 
800 

58 

8,125 

537 

5,919 



This report indicates a slight increase in the number of treatments and tests 
administered and an 11% increase in the number of patients treated. It indicates 
good activity. Many of the treatments given (such as biological fevers and muscle 
re-education) as well as some of the tests (such as reaction of degeneration) are 
very time-consuming and require close application on the part of the technician. 
Amoi^ the 58 tests listed as "others", there were 9 tests for reaction of degeneration. 

We have continued to use biological fevers produced by medical diathermy as 
a therapeutic measure in general paresis. It also has been used somewhat with 
varied results in other types of illnesses. With a variation of our former technique 
and by the use of special electrodes we seem to have eliminated many of the unto- 
wards effects formerly experienced in giving these treatments. 

During the past year we have maintained cordial relations with the Department 
of Physiology at Clark University and have been of mutual assistance in attempting 
to understand more fully the physiological and pathological effects of heat as 
produced by high frequency currents. 

Research Service 
F. H. ShEEPETii, Resident Director of Research 

The research activities on the problem of schizophrenia have continued as a joint 
responsibility of the Memorial Foundation for Neuro-Endocrine Research, the 
Division of Mental Hygiene, and the Worcester State Hospital, under the direction 
of Drs. R. G. Hoskins and F. H. Sleeper. 

During the fiscal year the Rockefeller Foundation granted a substantial subsidy 
to the Trustees of the hospital for the furtherance of two major problems. (1) 
The construction of a regulated temperature and humidity laboratory. This was com- 
pleted early in November at an approximate cost of $7,500. Experimentation was 
started immediately by Drs. H. Freeman, F. Linder, and R. Nickerson. The 
laboratory is so constructed that a temperature range from 50° dry bulb to 120° 
dry bulb and relative humidity from 20% to 90% and any combination of these 
factors may be obtained. Temperature, humidity, and air velocity can be con- 
trolled to a degree of accuracy not heretofore possible in our experimentation. 

This laboratory lends itself to an infinite variety of experiments, only two of 
which will be considered at this time. It has been postulated that schizophrenic 
patient? frequently present a condition of physiological clumsiHess, that there is a 
rigidity of certain mechanisms and undue lability in others; that there is present 



30 P.D. 23 

an inability to maintain a steady state of the internal milieu: in short a disordered 
homeostasis, to use Cannon's terminology for this condition. With this new equip- 
ment we plan to test this hypothesis by studying the reaction of patients and 
control subjects to changes in temperature and humidity, with special attention 
to functional integration. 

We also plan to investigate weight loss due to insensible perspiration, comparing 
the metabolism rates as determined by this method with those obtained by the 
Benedict Collins apparatus. 

(2) The investigation of normal control subjects living under the same conditions 
as schizophrenic subjects. 

This project is directed toward the solution of a problem of major importance. 
For example, to what extent will normal individuals placed in an environment similar 
to that in which schizophrenic subjects live develop physiological changes com- 
parable to those present in the schizophrenic subjects. Normal subjects are 
selected after a careful physical examination which includes the usual clinical and 
laboratory tests as well as serological studies, psychological tests, and psychiatric 
interviews. Patients and normal subjects are studied as matched pairs over a 
period of two months. Practically all variables under investigation are repeated 
during the two-month period at least once, and in certain instances four times or 
more. The data are needed not only in the evaluation of our work but for the 
understanding of work done in other institutions on such topics as the endocrine 
and metabolic characteristics of delinquents, the aged, prisoners, etc. This inves- 
tigation was started July 30 this year. Nearly all of the research staff collaborated. 

The following papers were published during the current year by members of the 
research staff and give a partial idea of the activities of the service. Where they 
lend themselves to such discussion, excerpts from the summaries and conclusions 
are given in those papers not discussed in the previous report. 

The Sedimentation Rate of the Blood in Schizophrenia. H. Freeman. Arch. 
Neurol, and Psychiat. 30: 1928, December, 1933. 

Further Studies of a Glycerin Extract of Adrenal Cortex Potent by Mouth. H. 
Freeman, F. E. Linder, and R. G. Hoskins. Endocrinology 1 7:677, Nov-Dec. 1933. 

The Manganese Treatment of ''Schizophrenic Disorders." R. G. Hoskins. Jour. 
Nerv. and Ment. Dis. 79: 59, January, 1934. 

A Comparison of the Methods for Collection of Blood to be used in the Determina- 
tion of Gases. Joseph M. Looney and Hazel Childs. Jour. Biol. Chem. iO^: 53, 
January, 1934. Describes a method of collecting and handling blood for gas 
analyses in a capped syringe. This method prevents error from exchange of blood 
gases with the air. Blood kept in 10 cc. portions for 3^ to 2 hours under a layer of 
oil 5 cm. deep was found to lose CO^ and absorb oxygen from the air. It was also 
shown that the effect of stasis on the gas content of the blood could be avoided by 
allowing one minute to elapse after removing the tourniquet before drawing the 
blood. 

The Effect ofal% Solution of Silver Nitrate on the Growth of Gonorrhoeal Organisms 
in Vitro. Julius Gottlieb and William Freeman. Jour. Maine Med. Asso. 25: 
28, February, 1934. 

Sensory Threshold to Direct Current Stimulation in Schizophrenic and Normal 
Subjects. P. E. Huston, Arch. Neurol, and Psychiat. 31: 590, March, 1934. 

Pericardial Hemorrhage Complicating Scurvy. Walter E. Barton and William 
Freeman. N. E. Jour. Med. 210: 529, March, 1934. 

Arm-to-Carotid Circulation Time in Normal and Schizophrenic Individuals. H. 
Freeman. Psychiatric Quarterly 8: 290, April, 1934. The arm-to-carotid cir- 
culation time was determined in 26 normal subjects and 73 male schizophrenic 
patients, free from organic disease. For the patients under basal conditions the 
mean circulation time was 25.6 seconds. In a second series of 52 of the same 
patients four months later the mean basal circulation time was 27.9 seconds. In 
45 of these a third series of tests was made on the afternoon of the same day. In 
these the mean arm-to-carotid time was significantly decreased to 23 seconds. In 
the normal individuals the mean basal circulation time was 21.9 seconds, a sig- 
nificantly faster rate of blood flow than was found in the second and more reliable 
of the schizophrenic series. Under non-basal conditions the mean circulation time 
showed a practically indentical value of 21.4 seconds. In the normals the cor- 



P.D. 23 31 

relation coefficient between the basal and non-basal series was +.73, a value sig- 
nificantly higher than that of the schizophrenics, which was +.15, and which, 
coupled with the similarity of the mean values in the circulation time, seemed 
indicative of a greater individual stability. It was concluded that schizophrenia 
is characterized by an abnormal slowing of the circulation time and by an ab- 
normally high-intra-individual variability in the rate of blood flow. 

Mental Hospitals may profitably take up Ediccational Programs. W. A. Bryan and 
F. H. Sleeper. Hospital Management 57: 24, April, 1934. 

The Pathologist' s Duty towards Obtaining Permission for Autopsy. William Free- 
man. Am. Jour. Clin. Path. 3: 211. May, 1934. 

The Concomitance of Organic and Psychologic Changes during Marked Improve- 
ment in Schizophrenia. A Case Analysis. Milton H. Erickson. Am. .Jour. Psy- 
chiat. 13: 1349, May, 1934. 

The Effect of Dinitrophenol on the Metabolism as seen in Schizophrenic Patients. 
J. M. Looney, and R. G. Hoskins. N. E. Med. Jour. 210: 1206, June 7, 1934. 
In order to study the effect of raising a low metabolic rate which is consistently 
found in schizophrenic patients by the use of dinitrophenol, this drug was admin- 
istered to 10 patients in doses of 3 to 4 mgm. per kilo, for a period of 49 days. Each 
week analyses were made on blood for complete nitrogen partitions, sugar, choles- 
terol, lactic acid, glutathione, carbon dioxide, oxygen, and pH. Nitrogen partitions 
were made on urine, as well as routine quantitative analyses. It was found that 
there was an increase in the basal metabolic rate of approximately 50 per cent with- 
out any concurrent change in blood pressure, pulse rate, or temperature. At first 
there was a gradual increase in the non-protein-nitrogen, urea nitrogen, and uric 
acid nitrogen, which again receded to normal as the treatment continued. Blood 
cholesterol and lactic acid showed considerable variation, but no consistent trend. 
Patients lost about 2 to 3 kilograms in weight, but no deleterious effects were noted. 
It was concluded that this drug could be used to increase the rate of oxygen con- 
sumption without great loss of weight, especially if the energy intake is augmented 
by supplemental feedings. Within the limits of dosage employed, the drugs is 
apparently harmless. It was found that in dosages up to 4 mgm. per kilo, the drug 
was without significant effect on temperature, blood pressure, pulse pressure, or 
pulse rate. There was a suggestion that the medication might prove to be of some 
therapeutic value, but the data were not sufficiently extensive to permit accurate 
judgment on this point. 

The Relation between Oral and Rectal Temperatures in Normal and Schizophrenic 
Subjects. Hugh T. Carmichael, and Forrest E. Linder. Amer. Jour. Med. Sci. 
188: 69, July, 1934. 

A Study of Hypnotically Induced Complexes by Means of the Luria Technic. P. 
E. Huston, D. Shakow, and M. H. Erickson. Jour. Gen. Psych. 11: 65, July, 
1934. In an attempt to test the validity of the Luria method of detecting affective 
conflicts, one of his experiments was repeated. A complex was induced hypnoti- 
cally. Verbal, voluntary, involuntary, and respiratory responses were studied. 
Four male and eight female subjects were used. The results obtained and thfe 
interpretations suggested are the following: 

1. There was evidence that nine subjects accepted the story told them as some- 
thing they had done and that it produced a profound reaction in them. 

2. In six of these nine subjects some non-verbal (motor) aspect of the Luria 
technique revealed the presence of the conflict in either the hypnotic or waking 
states. These subjects in the hypnotic states tended, in general, to give verbal 
responses definitely related to the conflict with relatively few non-verbal dis- 
turbances. In the waking state the relative importance of the non-verbal distur- 
bances increased over the verbal. The hypothesis is suggested that there may be 
"levels of discharge''' so that if excitation created by the conflict is not discharged 
verbally there is a spread to voluntary and involuntary motor levels. An implica- 
tion of this hypothesis is that the motor aspects of the Luria tecHlnique sometimes 
may not reveal the presence of the conflict. 

3. In the three other cases, those of subjects who accepted the story suggested 
to them, the evidence that the Luria technique revealed the existence of a conflict 
was lacking or was of a dubious character. These three cases are discussed with 
special reference to the effect of the artificial conflict upon their verbal responses. 



32 P.D. 23 

4. The results from the three subjects who refused to accept the complex suggest 
that the reproachable act must be of such a nature that the subject can plausibly 
conceive of his participation. 

5. Data collected from repeated sessions on the same subject indicate that there 
is a "shock" effect which appears chiefly in the first session as a large number of 
motor disturbances and declines upon repetition. This "'shock" effect must be 
evaluated properly before valid conclusions in this type of experiment can be 
drawn. 

6. Repeated experimental sessions on the same individual while he had the 
conflict showed a gradual decline in motor disturbances from day to day, pointing 
to an "abreactive" factor or a forgetting factor. 

7. Certain other theoretical implications of the experiment are discussed and a 
list of problems which may be approached by the Luria technique are included. 

The Effect of Dinitrophenol on Circulation Time. H. Freeman. Jour. Pharm. 
and Exper. Ther. 51: 477, August, 1934. The administration of dinitrophenol to 
schizophrenic patients as a means of counteracting the apparent sub-oxidation in 
that disease was discussed above. In nine male healthy schizophrenic patients 
the administration of dinitrophenol over a seven weeks' period in amounts sufficient 
to raise the oxygen consumption rates a mean of 28 points resulted in a significant 
mean decrease in the circulation time of 6.2 seconds. Having reached a new level, 
no further variation in the circulation time was observed with an increase in the 
oxygen consumption. 

Phytotoxic Index. I. Results of Studies with 68 Male Schizophrenic Patients. 
William Freeman, Joseph M. Looney, and Rose Small. Arch. Neurol, and Psychiat. 
32: 554, September, 1934. In an effort to test the hypothesis of a toxic genesis of 
the schizophrenic psychosis, the inhibitory effects of 1 and 2 per cent solutions of 
defibrinated whole blood in a 50 per cent solution of nutrient Shive solution on the 
growth of the roots of Lupinus albus seedlings were studied simultaneously with 
male schizophrenic patients and normal male subjects, all free of any perceptible 
organic disease. The technique used was a modification of Macht's original pro- 
cedure. A total of 68 patients and 21 normal subject was thus tested. Some of 
these had one or more re-tests. A 2 per cent solution of diluted urine was likewise 
tested. In each instance the total 24-hour urinary output was diluted to 10 litres. 
Sixty-eight patients and 25 normal subjects constituted this series. No significant 
differences were found in the inhibitory action of whole blood in strengths of either 
1 or 2 per cent between the male schizophrenic patients and the normal male 
controls. Likewise no abnormal inhibitory action on the growth of these seedlings 
was demonstrable by using a 2 per cent solution of diluted urine. It was concluded 
that neither the blood nor the urine of male schizophrenic patients showed any 
abnormal phytotoxicity demonstrable by the Lupinus albus test. No significant 
differences in phytotoxicity were found between the more acute cases and the 
chronic cases of either blood or urine. 

Comparative Sensitiveness of Schizophrenic and Normal Subjects to Glycerine 
Extracts of Adrenal Cortex. H. Freeman and R. G. Hoskins. Endocrinology 18: 
576, October, 1934. A glycerine extract of adrenal cortex was administered to 
healthy male schizophrenic and normal subjects in a daily dosage representing 
approximately 450 grains of cortical substance. Combining two series of patients 
and controls studied, consisting of 17 normal controls and 19 patients, 18 pet cent 
of the normal subjects as compared with 79 per cent of the schizophrenic patients 
showed a pressor reaction. In the first series of patients the mean rise in systolic 
pressure for the group was 17 mm. and in the second series 13.6 mm., these changes 
being statistically significant. The findings raised several questions that demand 
further study. To what extent and how consistently does adrenal deficiency figure 
in the schizophrenic picture? Is the deficiency — if it actually exists — a cause, 
effect, or a concomitant of the psychosis? With more accurate grading of the 
dosage could the pressor reaction be used as a pathognomonic diagnostic criterion 
between the schizophrenic and the normal subject.^ Is the reaction shared by other 
tyt)es of psychotics? What is the mechanism underlying the exaggerated reaction 
to cortical extract that is seen in the schizophrenic? What is the practical thera- 
peutic value of the extract we are using? These problems are being investigated. 



P.D. 23 33 

Studies on the Phytotoxic Index. II. Menstrual Toxin C'menotoxin"'). William 
Freeman and Joseph M. Looney. Jour. Pharm. and Exper. Ther. 52: 178, October, 
1934. In this study Macht's original technique was modified to eliminate certain 
sources of error and to check Macht's assertion that women in their menstrual 
periods have a toxin circulating in the blood. The modified technique was used on 
22 normal, healthy women in their catamenia. One sample of blood from each 
was obtained in one of the first three days of the menstrual period and another 
sample two weeks later. No difference in the mean "phytotoxic index " of the two 
groups was obtained. In 13 subjects there was an increased intra-menstrual index 
and in 9 instances there was a decreased intra-menstrual index. The conclusion 
arrived at was that normal healthy women do not show an increased phytotoxicity 
to the Lupinus albus seedling during their intra-menstrual cycle. 

Cardiovascular System in Schizophrenia studied by the Schneider Method. J. R. 
Linton, M. H. Hamelink, and R. G. Hoskins, Arch. Neurol, and Psychiat. 32: 
712, October, 1934. The Schneider test that is alleged to measure cardiovascular 
fitness was administered to 25 members of the hospital staff and to 99 schizophrenic 
patients. The mean score of the patients was 11.9 and of the controls 13.4. Arbi- 
trarily correcting the score of the patients in relation to the initial lower pulse 
rate would reduce their score to 11.3, a value 19 per cent below that of the controls. 
The pulse rates and the systolic blood pressure were slightly lower in the patients 
than in the controls, but the ranges among individuals were notably greater, as 
were also the Schneider scores. The different sub-types of schizophrenia showed 
substantially equal scores. The Schneider score indicates a significant lowering of 
physiological fitness in the schizophrenic patient but apparently mirrors the degree 
of physical activity rather more than the intrinsic degree of normality. 

Treatment of Varicose Ulcer by Genetian Violet. Charles M. Krinsky. N. E. 
Jour. Med. 211: 803, November, 1934. 

The Lactic Acid and Glutathione Content of the Blood of Schizophrenic Patients. 
Joseph M. Looney, and Hazel M. Childs. Jour. Clin. Inves. 13: 963, November, 
1934. The theory that schizophrenia is due to a deficient oxidation of body tissues, 
particularly in the hypothalamic region of the brain, has been the starting point for 
a number of investigations. It has been shown that the rate of oxygen consumption 
of these patients is significantly lower than that of normal subjects and that the 
decreased intake of oxygen is not infrequently accompanied by lowering of the 
venous oxygen content of the blood. It has been shown that when normal indi- 
viduals are subjected to a lower oxygen tension for a short time, they tend to react 
in a manner very similar to schizophrenic patients. It was felt that a study of the 
lactic acid content and also of the oxidative enzymes of the blood might shed further 
light on the problem. Even though sufficient oxygen were made available, a de- 
ficiency in the amount of glutathione which is a general cell catalyst that facilitates 
oxidation-reduction reactions might interfere with the utilization of this oxygen 
by the tissues and thus lead to an accumulation of lactic acid. Thirty-seven 
schizophrenic patients and 18 normal subjects were studied. The mean value for 
the Lactic acid content for the venous blood of the patients was found to be 14.27 + 
0.72 mgm. per cent, while that for the control subjects was 10.28+0.57 mgm. per 
cent. The mean of reduced glutathione for the patients was 34.99+0.68 mgm. per 
cent, while that for the normal subjects was 38.23+1.20 mgm. per cent. The 
authors state that they cannot consider that they have demonstrated a statistically 
significant lowering in the reduced glutathione of the patients. Since the lactic 
acid level was independent of the amount of oxygen supplied to the tissues, the 
high value must be ascribed to some local factor which interferes with oxidation. It 
was concluded that lactic acid is not removed from the tissues of the schizophrenic 
patients in the basal state as readily as it is from normal subjects, and this failure 
may be due in part to a decrease in the content of reduced glutathione. 

The Schizophrenic Personality with Special Regard to Psychologic and Organic 
Concomitants. R. G. Hoskins and E. M. Jellinek. Proceedings of the Association 
for Research in Nervous and Mental Disease. December, 1933. Published 1934. 

Preparation and Use of Colloidal Carbon Solutions. Joseph M. Looney, and 
Frank C. Stratton, Jour. Lab. and Clin. Med. 19: 996, June, 1934. 

The Problem of Mental Disorder. Chapter XV. Psychological Avenues of Approach 



34 P.D. 23 

to Schizophrenia. David Shakow. Publisher: McGraw, Hill. Editors, Madison 
Bentley and E. V. Cowdry. 1934. 

The Problem of Mental Disorder. Chapter XI. Endocrinology. R. G. Hoskins. 
Publisher: as above. 

The Cyclopedia of Medicine. Chapter — Psychoses and the Internal Secretions. 
Pp. 549-579. R. G. Hoskins. Publisher: F. A. Davis Co. Editor: Piersol. 1934. 

The Cyclopedia of Medicine. Chapter — Endocrine Glands. Neuro-Endocrin- 
ology. Pp. 169-176. R. G. Hoskins. Publisher: as above. The last three articles 
represent Dr. Hoskins' views on the role of endocrinology in relationship to mental 
disorder and neurology. The article by Mr. Shakow depicts the role of psychology 
in the general attack on the problem of schizophrenia at this hospital. 

In addition to the research activities represented in the above papers, certain 
other projects should be briefly discussed. 

The necessity for considering the effects of institutionalization as such in evalu- 
ating our physiological studies has been discussed. Seasonal variations also need 
consideration. Dr. Looney has completed a study of the seasonal variation of 
blood cholesterol. A group of patients were individually tested at monthly inter- 
vals for over a year. It appeared that there is a statistically valid change in the 
cholesterol level at different times of the year. This information is of particular 
value to our group as we have been investigating the thyroid factor in schizophrenia 
for several years and the relationship of cholesterol metabolism to thyroid activity 
is receiving considerable attention by many workers at this time. 

The increase in oxygen consumption by dinitrophenol resulted in no significant 
mental improvement in the patients. A possible explanation for this failure may 
be that the drug acts on liver and muscle metabolism whereas the defective oxid- 
ation in the schizophrenic patient presumably involves the brain. 

There is a suggestion that the metabolic picture presented by schizophrenic 
patients may be due to defective functioning of the hypophysis. It has recently 
been claimed that pituitary insuflSciency may be recognized by abnormal responses 
to the ingestion of a fatty meal. This hypothesis is being tested. 

The possibility that schizophrenia may be due in part to defective metabolism 
of certain mineral salts such as calcium, phosphorus, and potassium is being 
investigated. 

The ratio of albumin and globulin is being determined as part of an investigation 
of water metabolism. 

The state of the circulatory apparatus is being further determined by studies 
of venous pressure and of rate of output of blood from the heart (minute-volume) 
in normal and schizophrenic subjects. 

The "specific dynamic action of protein " has been under investigation in normal 
and schizophrenic subjects for the past six months. These studies are particularly 
difficult of evaluation because of the erratic nature of basal metabolic rates which 
form part of the experiment. 

Comparative studies of the effect of exercise on the blood lactic acid of normal 
and schizophrenic subjects have followed the discovery by Looney that the lactic 
acid level of the schizophrenic is higher than that of the normal subject. The 
high lactic acid level indicates a failure of oxidation in the tissues, which may be 
due to the presence of an interfering substance or the absence of some necessary 
substance by which the oxidation processes are regulated. Studies are being 
continued on the blood serum as influencing biological oxidation, using cultures 
of vibrio phosphorens for the purpose. 

Attempts are being made to isolate the active principle of the adrenal cortex 
preparation having a pressor effect on schizophrenic patients with two objectives 
in vievv^, the ability to secure adequate supplies of potent inexpensive material and 
a more adequate determination of the metabolic effects of the product. 

Further studies of the "galactose tolerance" are being made in an attempt 
to improve the technique. In previous studies we reported that the tolerance to 
this sugar was lowered in schizophrenic subjects. With our present technique 
quantitative studies are made on both blood and urine, reducing substances other 
than galactose being fermented off by the use of yeast. This new technique will 
give a much better comprehension of the metabolism of sugar than we have 
hitherto had in this psychosis. 



P.D. 23 35 

An analysis of several factors which might influence the polyuria so frequently 
encountered in schizophrenia was completed and seemed to indicate a higher degree 
of emotional activity present in the patients showing polyuria. 

An elaborate biometric analysis is being made on the large mass of accumulated 
basal metabolism data. This study is indicated for purposes of orientation and 
interpretation, both as regards individual subjects and as regards the psychosis 
itself. Excellent progress has been made on this investigation. 

Drs. Leo Alexander and J. M. Looney made a substantial start on an investi- 
gation of effects of hydration and dehydration on the brain, which was suspended 
when Dr. Alexander left to assume a position in Boston. This study was partially 
subsidized by the Rockiefeller Foundation. 

Dr. Andras Angyal has concerned himself particularly with investigation of the 
mechanisms operative in the production of delusions and hallucinations. His 
excellent training both in psychology and psychiatry has already resulted in 
excellent contributions to this very difficult field. 

The Biometrics department has been very productive. The development of 
new methodologies or application of old methodologies to our special problems has 
been gratifying. These include the application of the "Chi Squared", method 
an adaptation of Pearson's "Generalized Probable Error Method" for diagnostic 
purposes, and adaptation of the "Analysis of Variance" technic to our type of 
problem. A very important function of the department has been a critical analysis 
of several of the technical methodologies in use on the service. This has resulted 
in the elimination of certain of these methods which have been somewhat generally 
accepted by the medical profession. The department has evolved a biometric 
technic for the study of the relationship of functions in the individual patient as 
contrasted with defects in functions. 

Somewhat elaborate studies upon experimental therapeutics have been carried 
out during the year under the immediate supervision of Dr. Hoskins. A variety 
of different substances has been administered to patients in the hope of finding 
some that would have a clean-cut influence upon the clinical picture. This repre- 
sents the initial phase of the study. It is planned as potent agents become available 
to administer them to patients and make detailed studies of the effect throughout 
the metabolic, psychologic, and psychiatric spheres. In the study thus far thyroid 
substance has seemed to be the most effective glandular preparation at our dis- 
posal. The study has two primary purposes, (a) to improve the treatment of 
schizophrenia, and (b) to throw further light upon the mechanism of the psychosis. 

Psychology research activities are considered in the report of Mr. Shakow and 
will receive no further discussion in this section. 

Again it is gratifying to record that research activities are not limited to the 
research service. This year, of the 35 publications credited to the hospital, three 
came from the Child Guidance Clinic, five from staff members not on the research 
service, three were collaborative studies, and the balance were written by research 
staff members. During the coming year every indication points to an increase in 
publications from staff members not on the research service. 

The following papers were presented during the year before medical societies. 
A total of 22 addresses was made during the year to various organizations. 

December 13. An Ekjcperimental Study of Hypnotically Induced Complexes. 
Huston, Shakow, and Erickson. Massachusetts Psychiatric Association, Boston. 

December 13. Arm-to-carotid Circulation Time in Normal and Schizophrenic 
Individuals. H. Freeman. Massachusetts Psychiatric Association, Boston. 

December 29. The Schizophrenic Personality with Special Regard to Psychologic 
and Organic Concomitants. R. G. Hoskins and E. M. Jellinek. Association for 
Research in Nervous and Mental Diseases, New York. 

March 29. The Lactic Acid and Glutathione Content of the Blood of Schizophrenic 
Patients. J. M. Looney and H. M. Childs. American Society of Biological 
Chemists, New York. 

May 31. An Investigation of Polyuria in Schizophrenia. F. H. Sleeper. American 
Psychiatric Association, New York. 

May 31. The Therapeutic Use of Dinitrophenol and Dinitro-Ortho-Cresol in 
Schizophrenia. J. M. Looney and R. G. Hoskins. American Psychiatric Associ- 
ation, New York. 



36 P.D. 23 

June 4. Organic Trends and Functional Integration in Schizophrenia. R. G, 
Hoskins and E. M. Jellinek. Psychopathic Association, Atlantic City, N. J. 

June 12. Dr. Hoskins served as Chairman of a '' Panel Discussion of Endocrinology 
in Relation to Pediatrics," given before the American Academy of Pediatrics, 
Cleveland, Ohio. 

Oyctober. 26. Chemical Fiactors in Personality — A Consideration of the Endocrine 
Glands. R. G. Hoskins. Judge Baker Guidance Center, Boston. 

In addition to the projects now under way, an organized effort to investigate 
homeostasis seems indicated. The necessity for additional psychiatrists still ob- 
tains. To carry to completion certain projects which have been inaugurated will 
require the services ot at least four thoroughly trained research psychiatrists. The 
type of psychiatrist we have in mind should receive salaries considerably higher 
than those in vogue in the state service. We hope financial aid will be forthcoming 
for this very essential part of our research program. 

The service is operating efficiently. Cooperation has been the keynote of the 
organization. The thanks of the directors is extended to all who have made this 
state of affairs possible. 

Psychology Department 
David Shakow, Director 

Despite the numerous changes in personnel, both because of the emphasis on 
training and the low salary scale, the work of the department has been gratifying. 
Considerable progress has been made in bringing some of our material to publi- 
cation and in the improvement of the quality of the routine work. 

The personnel changes during the year were: Miss Helen Irvine (A. B. Hollins, 
M. A. Columbia) came to take Miss Kauffman's internship in October, 1933 and 
stayed until June 1934. In December Dr. Anne Roe (A. B. Denver, Ph. D. 
Columbia) came to replace Mrs. Millard in the Psychometrist's position. She 
stayed until October 1934, when she was replaced by Dr. A. J. Harris, (A. B., Ph, 
D. Harvard) who had had a number of years teaching experience at Purdue and 
Simmons. In July Dr. Saul Rosenzweig (A. B., Ph. D. Harvard) came as Research 
Assistant, after some time spent at the Harvard Psychological Clinic. Mr. George 
R. Brush (A. B, Vermont, University of Mame) and Miss Geraldme Denison 
(A.B. Holyoke) came as internes in July for a year's stay. For special work during 
the summer we had Miss Elsa Siipola (A. B., M. A. Smith), Mr. Lorrin Riggs 
(A. B. Dartmouth M. A. Clark) and Mr. Frederick Davis (A. B. Bridgewater, 
T. C, M. A. Harvard Scho->l of Ed.) In September Miss Goldman left and Miss 
Margaret Murray (A. B., Holyoke, M. A. Stanford) and Miss Marjorie Ballou 
(A. B. Smith) came. 

A statistical analysis of the work done by the Department during the year 
ending September 30, shows the following: 

Psychometric Examinations 
House Individuals Tests 

Regular Patients 275 1148 

Schizophrenia Research 153 519 

General Paresis Research 31 151 

459 1818 
Out Patients* 

School Clinic - 258 468 

Jail 21 94 

Other 8 22 

Employees and other normals 361 609 

648 1193 
Experimental Research 

Patients . 165 503 

Normals 120 237 

285 740 

Totals 1392 3751 

*For Child Guidance Clinic Work see report of Child Guidance Clinic. 



P.D. 23 37 

Among the major researches in progress might be mentioned: 

(1) The response to the interruption of tasks in schizophrenia (2) The response 
to substituted activities in schizophrenia. (3) The use of personality schedules 
in psychosis (4) The memory function in psychosis (5) Repetition-choice in 
schizophrenia (6) The theoretical significance of the Rorschach and some aspects 
of its application to psychosis (7j Continuous reaction in schizophrenia (8) Re- 
standardization of the K-S Formboard Series (9) The attitude of long-hospitalized 
patients to the hospital (10) The drawings of schizophrenic patients. 

Among the completed researches on which considerable progress in analysis has 
been made and in some cases on which papers are in process of preparation are: 
(1) Acessibility of schizophrenic patients and normal controls to environmental 
influences (2) Reaction time studies in schizophrenia and normal controls (3) 
Motor learning in schizophrenia (4) '"Scatter" in the Stanford-Binet — its measure 
and significance (5) The Heilbronner Test in psychotic patients and normal 
controls (6) The effect of the sex and personality of the examiner on Kent Rosanoff 
Association Test results in normal subjects (7) A study of a case of agnosia and 
aphasia (8) The speed of movement in schizophrenia as measured by a tapping 
device (9) The problem of frustration tolerance (10) A test for types of reaction 
to frustration. Among the major pieces of research on which the collection of 
data has been completed during the year is that on the Wells- Worcester Memory 
Test. We now have over 500 records on normal subjects of both sexes ranging 
in age from 20 to 90 years. 

During the course of the year a number of papers have been published or accepted 
for publication. These are: 

1. Sensory threshold for direct current stimulation. Arch. Neurol and Psychiat. 
31, 1934, 590-596 (Huston). 

2. A study of hypnotically induced complexes by means of the Luria technique. 
J. Gen. Psychol. 11, 1934, 65—97. (Huston, Shakow, Erickson). 

3. Psychological avenues of approach to schizophrenia. In the "Problem of 
Mental Disorder" M. Bentley and E. V. Cowdry, Eds. N. Y.: McGraw Hill, 1934. 
pp. 308— 313. (Shakow). 

4. A suggestion for making verbal personality tests more valid. Psychol. Rev. 
41, 1934, 400—401 (Rosenzweig). 

5. Types of reaction to frustration. J. Abn. and Soc'I Psychol. Nov. 1934. 
(Rosenzweig). 

6. Apparatus for the study of continuous reaction. J. Exp. Psychol. Dec. 
1934. (Huston and Hayes). 

7. The value of an orientation letter for newly-admitted patients. Psychiat. 
Quart. Oct. 1934. (Dembo and Hanfmann). 

8. A note on color-blindness in some psychotic groups. J. Soc. Psychol. 1935. 
(Millard and Shakow). 

9. The patellar tendon reflex in schizophrenic and normal subjects. J. Gen. 
Psychol. July, 1935. (Huston). 

10. A psychometric study of 150 adult delinquents. J. Soc. Psychol. 1935. 
(Shakow and Millard). 

11. The psychological situation of patients in a hospital for mental diseases. 
Amer. J. Psychol. 1935. (Dembo and Hanfmann.) 

The following papers were presented at meetings: 

1. E. Hanfmann. — The psychological situation of newly admitted psychotic 
patients. Howard State Hospital, April 16, 1934. 

2. M. Rickers — The accessibility of schizophrenic patients as manifested in 
a "free" situation. Howard State Hospital, April 16, 1934. 

3. M. Rickers — An experimental study of social responsiveness. Harvard 
Psychological Clinic, June 1934. 

Various members of the Department attended the meetings of the American 
Psychological Association in New York in September, the meetings of the Am- 
erican Orthopsychiatric Association in New York in February and those of the A. 
A. A. S., in Boston in December. 

New apparatus added to our laboratory equipment were an electrically con- 
trolled tachistoscope, a cardiochronograph, a further modified continuous-re- 
action apparatus, a " Phi" phenomenon apparatus and a Young maze C. All these 



38 P.D. 23 

pieces were made in the laboratory shop, except for the amplifier on the cardio- 
chronograph. 

Three members of the Department, Dr. Rickers, Dr. Hanfmann, and Dr. Dembo 
were fortunate in obtaining grants-in-aid for their research projects from the 
Social Science Research Council. The paper on " 'A Study of hynotically induced 
complexes by means of the Luria technique" received the second prize in the 
competition of the New England Psychiatric Society. 

The Department Seminar was again started this year. The general topic is 
''Methodology in Psychopathology." In addition to papers by seminar members, 
a number of outside speakers representing distinct viewpoints in psychopathology 
have been invited to discuss their approaches. 

In addition to the training and teaching within the Department the course of 
Psychology to nurses has been continued and a course on " Psychometrics in 
Psychiatry" for staff members has been initiated. 

Plans for the coming year include the continued attack on the accumulated 
data in order to bring more of it into analyzed form. In this connection the Kent- 
Rosanoff studies in schizophrenia and the Stanford-Binet studies in psychosis 
should receive special mention. Continuation of the Luria, Rorschach, Inter- 
ruption and Substitution studies are distinctly indicated because of their promise. 
Among projected studies might be mentioned one of schizophrenic thinking and 
speech. 

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

The past year has been a very productive one from the view point of the director. 
The laboratory has functioned very efficiently and as may be seen from the at- 
tached summary the number of procedures has reached a new high level of 52,877. 

The policy of admitting suitably qualified college graduates for training in 
laboratory has been continued and new candidates are admitted as vacancies arise. 
Two of the girls have been placed in positions. 

Mr. Stratton who spent two years in the laboratory as a volunteer assistant 
was appointed in February to the position ot chemist to the Boston Police De- 
partment. Dr. Silver, also a volunteer worker holding a Ph. D. degree in organic 
chemistry from Yale, secured employment and left in March. This vacancy was 
filled in September by the appointment of Mr. M. C. Darnell, Jr. who received an 
M. A. degree from Mass. State College in June. 

Dr. Leo Alexander came to the laboratory in January from the department of 
Neurology of the Peiping Union Medical College, Peiping, China. He received 
his training in the field of neuropathology in the Laboratories of Kleist and of 
Marburg, and was particularly well qualified for investigation along these lines. 
He was given a grant from the Rockefeller Foundation to carry on his investi- 
gation with us, but his talents were soon recognized by others and in October he 
resigned to accept an appointment in the Department of Neurology at the Harvard 
Medical School and the Boston City Hospital. During the year the following 
men served as pathological internes: Dr. J. C. Drooker from Dec. 1, 1933 to 
May 1, 1934. Dr. C. M. Krinsky from Jan. 1, 1934 to June 30, 1934, Dr. Zolov 
from May 7, 1934 to October 1, 1934 and Dr. Arthur Stern from Oct. 8, 1934 to 
date. It is hoped that in the future we may be able to obtain suitable men to 
spend a year in the department of pathology. 

During the summer two students from the third year class of John Hopkins 
Medical School worked in the laboratory and also a graduate nurse who came for 
special training in laboratory technique. 

Instruction to the nurses in the training school was given in bacteriology, 
chemistry and pathology by Dr. Freeman and myself. The monthly conference 
in clinico-pathology have been continued and are a potent factor in keeping the 
clinical work of the members of the staff at a high level of excellence. 

The total number autopsies performed during the year amounted to 169 which 
is 62.6 per cent of the total of 270 deaths occurring during the year. These autopsies 
were attended by 1,020 visits from members of the staff and 797 visits from among 
the medical students, or an average attendance of 11 per autopsy. 



P.D. 23 39 

The following papers were published during the year by members of the 
laboratory staff: 

(a) The Effect of Dinitrophenol on the Metabolism as Seen in Schizophrenic 
Patients. J. M. Looney and R. G. Hoskins. N. E. J. Med. 210, 1906, 1934. 

(6). Comparison of Methods for the Collection of Blood to be Used in the 
Determination of cases. J. M. Looney and Hazel M. Childs. J. Biol. Chem. 195, 
53, 1934. 

(c) The Lactic Acid and Glutathione Content of Blood of Schizophrenic 
Patients. Preliminary Report. J. M. Looney, Hazel M. Childs, J. Biol. Chem. 
195, 53, 1934. 

(d) The same. 2. Clinical Investigation. 13,963, 1934. 

(e) The preparation and Use of Colloidal Carbon Solutions. J. M. Looney 
and F. C. Stratton. J. Lab. and Clin. Med. 19, 996, 1934. 

(/) Studies on Phytotoxic Index. I. Results in 68 Male Schizophrenics. Wm. 
Freeman, J. M. Looney, Arch. Neur. and Psych. 32, 544, 1934. 

(g) II. Menstrual Toxin, Wm. Freeman, J. M. Looney. J. Pharm. and Exp. 
Ther. 52, 179, 1934. 

(h) The Effect of a one per cent solution of silver nitrate on the growth of 
gonorrheal organism in Vitro. Dr. Wm. Freeman, J. Maine Med. Asso. Feb., 1934. 

(t) Pericardial Hemorrhage Complicating Scurvy. W. E. Barton, Wm. Free- 
man, New Eng. J. of Medi. 210, 529, 1934. 

The following papers have been accepted for publication: 

(j) Acute Rupture of the Esophagus in Syphilis. W. E. Glass, Wm. Freeman. 
Am. J. Med. Sci. 

(k) The Therapeutic Use of Dinitrophenol and 3.5 Dinitro-ortho-cresol in 
Schizophrenia. J. M. Looney and R. G. Hoskins. Am. J. Psychiat. 

The following papers have been submitted for publication: 

(0 Gas Content of Aj-terial and Venous Blood or Schizophrenic Patients. 
J. M. Looney, H. Freeman, E. M. Jellinck. 

(m) The Blood Volume in Normal Subjects and Schizophrenic Patients. J. M. 
Looney, H. Freeman. 

The following meetings were attended by the director. The American Associ- 
ation for the Advancement of Science, December 1933, at which the Paper on the 
Efifect of Dinitrophenol on the Metabolism was presented before Section C. 

(a) The Federation of American Societies for Experimental Biology. Paper was 
presented at this meeting, which was held in New York City March 28 — 31, 1934. 

(6) The Association for the Study of Internal Secretions. Cleveland, Ohio. 
June 11—12, 1934. 

(c) The Annual Convention of the A. M. A., Cleveland, Ohio, June 13—15, 1934. 

(d) A paper listed as K above by J. M. Looney and R. G. Hoskins was given 
by the latter at the Annual Meeting of the American Psychiatric Association. 

(e) The Annual Meeting of the Massachusetts Medical Society, June, 1934. 
Dr. Freeman attended the following meetings: Annual Meeting, Massachusetts 

Medical Society, June, 1934. Annual Meeting American College of Surgeons, 
Boston, October, 1934. He was elected a fellow of the American Society of Clinical 
Pathologists at their annual meeting. 

During the year Dr. Freeman gave an address before the Worcester District 
Meeting of the Massachusetts Medical Society in April on the Grading of Malign- 
ancy of Carcinomata with Relation to the Treatment and Prognosis, and to the 
Nurses' Alumni Association of the Worcester Hahnemann Hospital on Recent 
Advances in Pathology. 

0<n December 4, Dr. Looney addressed the Chemist Club of Worcester on the 
subject, "Promoters of Personality," the effect of the Endocrine Glands. 

The research activities have progressed favorably and the work on lactic acid 
metabolism gives promise of leading to some definite results. Work upon the 
isolation of the principle of the adrenal glands responsible for the pressor actions 
on the blood pressure of schizophrenic patients is under way and is hoped that 
the coming year will be very fruitful in this regard. 

The director would be remiss if he did not again show his appreciation of the 
excellent work of the laboratory force by publicly acknowledging their cooperation 
throughout the year. 



40 



P.D. 23 



193^ 

Total for 
Fiscal Year 
Blood creatine . 
Blood volumes . 
Schilling's index . 
Blood hematocrits 
Water metabolism 
Autopsies 
Stomach contents 
Vomitus 
Urine (bact.) 
Blood fragility 
Blood gases 
Liver Function 
Blood P. N. 
Urine (Urobil.) 
Blood glutathione 
Blood lactic acid 
Blood sp. gravity 
Blood viscosity . 
Urine (bile) 
Urine (chlor.) 
Autogenous Vaccines 
Milk blood plates 
Photos path. spec. 
Blood sedimentation 
Urine (blood) 
Glucose tolerance 
Blood (hanging drop) 
Blood magnesium 
Plates (udders of cows) 
Toxicological exam. . 
Animal inoculation . 
Blood potassium 
Blood albumin . 
Blood Lipoids 
Blood cholesterol esters 
Blood total P. N. 
Blood acetone 
Blood hydroxylretyric acid 
Blood minute volumes 
Dopa Stains 
Stool Fat Contents . 
Peroidase stain 
Spinal fluid culture . 
Ascetic fluid 

Stool (soap, fibers, starch) 
Urine (typhoid) 
Luminescent bacteria 
Spinal fluid smear 
Urine (Dinitrophenol) 

Medical Library 
George L. Banay, Ph.D., Librarian 
The past year represents a year of further 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 new 
additions to the reference shelves necessitated the installation of new shelves in the 
library. By putting in six new racks we increased the shelf-room capacity, but at 
the same time we reached the limit of any further expansion. The medical library 









Year of 


Total for 


Fiscal Year 


Bacterial cultures . . 256 


Bacterial smears 






323 


Basal metabolisms 






1,336 


Blood cultures . 






70 


Blood creatinine 






1,778 


Blood N. P. N. . 






2,022 


Blood sugar 






3,210 


Blood urea 






1,787 


Blood uric acid . 






1,789 


Blood counts (R) 






3,213 


Blood counts (W) 






3,886 


Blood counts (D) 






3,720 


Haemoglobin 






3,825 


Clotting times . 






157 


Glactose tolerance 






88 


Icteric index 






80 


Mosenthal tests 






165 


Nitrogen partitions 






2,058 


Plasmodia malaria 






4 


Renal function (PSP 


) 




85 


Spinal fluids (cells) 






267 


Spinal fluids (gold) 






262 


Spinal fluids (chlor.) 






251 


Spinal fluids (diff.) 






5 


Spinal fluids (glob.) 






260 


Spinal fluid (sug. ) 






260 


Sputa . 






1,306 


Stools . 






1,328 


Tissue sections . 






2,804 


Urines (routine) 






7,442 


Van den Bergh Test 






80 


Vital capacity 






467 


Widals. 






2 


Bleeding Time . 






93 


Spinal Fluid (prot.) 






251 


Urine (quant, sug.) 






623 


Milk analysis 






58 


Blood typing 






42 


Fluid (pleura) 






17 


Ascheim Zondek test 






20 


Blood Phosphorus 






82 


Blood Calcium . 






186 


Fluid (abdomen) 









Blood chloride . 






163 


Colonic irrig. 






608 


Platelet count 






33 


Retic. count 






42 


Blood amino acids 






1 


Blood cholesterols 






780 



P.D. 23 41 

as it is now is nothing but a stockroom closaly lined with shelv^es. There is hardly- 
enough room left to squeeze in a table and a few chairs to accommodate six 
readers. As the new shelves block the only window in the room, there is not enough 
light and even less air in the room (especially during the hot summer months), 
making it very stuffy and gloomy for the greater part of the year. 

Fortunately the Trustees' Room, converted into a pleasant reading room, relieves 
somewhat the crowded situation but offers no possibility for further expansion. 
We earnestly hope that the addition of the Treasurer's Office to the present medical 
library can be accomplished this year so that the additional facilities will take care 
of the regular yearly increase for a number of years to come. In case the change is 
made, it will be worth while to make the new library more fire-proof by installing 
a safer floor (inlaid linoleum over a cement foundation) and by substituting steel 
book-racks for the wooden ones. The present wooden ones could be used in the 
reorganized general library to replace the dilapidated old ones. As the medical 
library represents a replacement value of $50,000, every precaution should be 
taken to safeguard its contents. 

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

Periodicals. Fully realizing the value of medical periodicals in connection with 
research, we added a few new ones to our subscription list. We have now 28 
periodicals in Neurology, Psychiatry, and xVIental Hygiene; 20 in Psychology and 
Psychoanalysis; 19 in General Medicine; 20 in Internal Medicine, Surgery, 
Obstetrics, and Pathology; 11 in Physiology and Chemistry; 5 in Physical Medi- 
cine and Radiology; 1 in Medical History; 2 in Hospital Administration; 4 in 
Social Service; 1 in Occupational Therapy, 2 in Nursing, 6 in Education and Child 
Guidance; 14 more than in the previous year — altogether 119 periodicals. 

Of this number the hospital subscribes tc 87; two are paid for by the Memorial 
Foundation for Neuro-Endocrine Research; 15 are donated by Dr. Hoskins; 1 
by Dr. Sleeper; 1 by Dr. Perkins; 3 by Dr. Carmichael; 1 by Dr. Linder; 1 by 
Miss Crockett; and 8 come in free from State and Federal authorities and Medical 
Supply Companies. 

Of these periodicals, 6 are in French, 12 in German, 5 in Italian, and 96 in English. 

Circulation. The Medical Library circulated 543 volumes last year. 

Inter-Library Loans. The Librarian maintained close contact with other Medical 
Libraries and we borrowed 198 volumes of periodicals from six libraries, that is: 
Boston Medical Library . 159 Harvard Business School . . 2 

New York Academy of Medicine . 23 Clark University Library . . 1 
Harvard College Library . 12 Columbia University Library 1 

Medical Library Association Exchange. The Medical Library Association is of 
the greatest benefit to all Medical Libraries in supplying them with missing and 
out-of-print material for the nominal charge of the postage. During 1934 we re- 
ceived 86 volumes from the Association and gave in exchange 64 volumes to 42 
Medical libraries. 

The librarian attended the annual convention of the Association held in Balti- 
more May 21-23, 1934, and on this occasion visited the following libraries: Uni- 
versity of Maryland Medical School, Johns Hopkins LTniversity; Enoch Pratt 
Public Library, Henry Phipps Psychiatric Clinic, William H. Welch Medical 
Library in Baltimore, and the Army Medical Library in Washington. 

Back Files. 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 (Journal of Laboratory 
and Clinical Medicine, Transactions Medico-Psychologic Association, and others). 

Donations. Dr. E. L. Hunt of our visiting staff donated 68 volumes of valuable 
old medical periodicals to the library. 

New Books. During the year 131 new volumes have been added to the shelves, 
some of them to the library of the Child Guidance Clinic. 

Binding. We bound 308 volumes during the year, including the ones received 
from the Exchange, so that we are up-to-date with our binding. 

Present State. By November 30, 1934, the Medical Library had: 
3,187 bound volumes of periodicals 



42 P.D. 23 

95 unbound volumes of periodicals 
2,420 bound volumes of books 
49 unbound volumes of b:oks 

Total 5,751 volumes, an increase of 626 volumes over the previous year. 

Some of our books are old and have only an historical value. As soon as there is 
more shelf room available, I intend to separate the volumes of historical interest 
in a special historical collection in separate book-cases — eliminate the obsolete 
old textbooks and reclassify and re-catalogue the remainder, using a new classi- 
fication scheme. 

Services. The librarian continued to circulate the weekly bibliography and ab- 
stracts, prepared many special bibliographies, and translated 40 foreign medical 
articles. The abstracts and translations are filed in the medical library. We now 
have more than 3,000 classified abstracts and two volumes of translations. 

Exhibit. On the occasion of our scientific exhibit in February, 1934, the medical 
library had a booth, exhibiting some of our features. The bibliographic and ab- 
stracting services were very favorably commented upon by many visitors. 

Worcester District Medical Society Library. During the year negotiations were 
started to consolidate our medical library with the Worcester District Medical 
Society Library, containing 12,000 volumes. The combined libraries would have 
had about 15,000 volumes at the disposal of the medical profession of the city of 
Worcester. Due to legal technicalities, the negotiations failed. 



As may be seen from the above report, the various activities of the library point 
to the great need of clerical help in order to put the services on a more efficient basis. 

Gexeral Library 

The Re-organization of the General Library. It has been pointed out more than 
once in the librarian's reports that the General Library was badly in need of re- 
organization. The patients in charge changed constantly and were unable or 
unwilling to follov/ instructions; most of the time we were unable to secure ade- 
quate personnel to carry on the work. Our plan to put a graduate library student 
in charge did not materialize, as the prospective candidates secured permanent 
employment during the negotiations and did not consider it worth while to take 
temporary positions at the hospital. After due consideration it has been decided 
to put the library under the immediate supervision of the occupational therapy 
department. This would create new activities formany patients (cleaning, dustings 
simple repairs), and under the guidance of the occupational therapy department 
the patients will learn to carry out the library routine more efficiently. 

At the present time the occupational therapy department is working on the re- 
organization of the library. It seemed advisable to eliminate all the dilapidated, 
obsolete, and dead material (a small library in good working condition is more 
useful than a large one in a dilapidated condition ) ; to re-classify and re-catalogue 
the remainder; and to make the room itself more cheerful and m_ore attractive. 

That the greatest benefit may be derived from the library, it is considered highly 
desirable to move to larger and better ventilated quarters, to install new shelves, 
and to provide a few easy chairs and writing desks for the use of the readers. To 
replace the eliminated material we would need a few hundred new books. If the 
above-mentioned changes could be effected, within a few months we would have a 
small but highly satisfactory library for our purposes. 

Before the re-organization, the library had: 
74 volumes of serials 
48 volumes of reference books 
27 volumes Bibles and prayer books 
54 volumes of bound magazines. 
3,671 

Total 3,874 volumes 

Of this material, about one-half will be retained after the re-organization. 
Forty-eight current periodicals and daily newspapers are subscribed to by the 
hospital. 

Besides this, the library borrows 150 books every three months from the Worcester 



P.D. 23 



43 



Free Public Library to circulate among the patients and employees. 

The library is well patronized by patients and employees. The average monthly 
attendance is 1,700 patients and 400 employees. 

During the year the library circulated 7,282 volumes, and had 23,662 reading 
visitors. 

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 in a most helpful way by taking books 
and magazines to the patients on the closed wards. 

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



Worcester Child Guidance Clinic 
Annual Service Report 

I. Report of Case Load: 

A. Carried Cases: 

1. Cases carried over from last year 

2. Intake a. New cases accepted 

b. Old cases reopened 

(1) last closed before present year 

(2) last closed within present year 

3. Total cases open at sometime in this year 

4. Cases taken from service .... 

5. Cases carried forward to next year . 

B. Closed cases followed up (not reopened) 

C. Applications rejected 

II. Type of Service Classifications: 

A. New Accepted Cases: 

6. Full service a. Clinic staff cases 

b. Cooperative cases 

c. Full service cases not a or b 

7. Special service 

8. Mental Health study 

9. Total new cases accepted . 

B. Total Cases Open at Sometime in this Year: 

10. Full service a. Clinic staff cases 

b. Cooperative cases . 

c. Full service not a or b 

11. Special service 

12. Mental Health study 

13. Total cases open at sometime this year 

C. Cases Taken from Service: 

14. Full service a. Clinic staff cases 

b. Cooperative cases 

c. Full service not a or b 

15. Special service 

16. Mental Health study 

17. Total cases taken from service 

III. Sources Referring New Accepted Cases: 



Boys Girls 



145 



228 



53 



99 



18. Agencies a. Social 

b. Medical 

19. Schools a. Public 

20. Juvenile Court 

21. Private physicians 

22. Parents and relatives 



Full 
46 

3 
13 
63 

9 
56 



Special 
6 
1 
2 

4 
3 



Mental 
Health 



Total 
476 
198 



662 

327 

355 

33 

7 



83 

105 

2 

16 



206 

422 

166 

49 

40 

5 

682 

145 

145 

15 

22 



327 



Total 
52 
4 
15 
63 
13 
59 



23. Total new cases accepted 



190 



16 



206 



44 



P.D. 23 



IV. Summary of Work with or about Patients: 

A. By Psychiatrists: 

1. Interviews with patients a. for examination 

b. for treatment 

2. Interviews about patients .... 

3. Physical examinations 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 Workers: 

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): 



A. Regular Staff: a. Psychiatrists . 

b. Psychologists . 

c. Social Workers 

d. Clerical Workers 
Staff in Training: a. Social Workers 



Full 
time 
1-2 
1-3 
2-3 
2-3 
2-3 



Total 
195 

1,071 
263 
180 

196 

21 

643 

125 

921 
1,030 

1,281 

55 

84 

14 

2 

Part 
time 
1 



B. 

C. Volunteers: a. Psychologists 
VI. 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 psychiatirsts: 

9:00 to 5:00 daily 
9:00 to 12:00 Saturdays 
Educational Services: 

Number of lectures and courses giveji by Dr. Hartwell, 4; Mr. Howard, 2; 
Mr. Toy, 2; Miss Wyman, 2; Mrs. Huston, 2; Miss Rabinovits, 3; Miss Spiegel, 
1. Total, 88. 
Publications: 

See written material on following sheets for this information. 
Committee Meetings and Conferences Attended by Staff Members: 

Occasion 
Orthpsychiatric meeting, Chicago, 111. 
Hampden County Training School Conferences 
Juvenile Delinquent Committeee, Boston 
Mass. Parents Council Meeting 
American Psychiatric Meeting, New York 
Smith College, Supervisors Meeting 
Mass. Conference of Social Workers, Wellesley 
Other than Interested in Individual Patients: 
a. Number from city, 17; b. Number from outside city, 21. 
Dr. Lott, R. I. State Psychiatrist. 
Dr. Lawton, Providence, R. I. 
Dr. George Stevenson, Exec. Sec. Society for Mental Hygiene. 

Worcester Child Guidance Clinic 
Samuel W. Hartwell, M.D. Director 
The work of the Worcester Child Guidance Clinic has continued in a general 



Number 


Month 


1 


February 


3 


April 


1 


April 


1 


May 


1 


May 


3 


August . 


1 


September 


Visitors 


TO Clinic — 



P.D. 23 45 

way the same as the previous year. No line of work has been given up although 
our staff has at present four less people on it than it did a year ago. The case load 
has been practically the same and the percentage of intensive treatment cases 
has remained as high. 

There have been a number of changes in the staff. In June 1934, Mr. Frank 
M. Howard, who had been with us for two years in the psychological department, 
and who during the last year had carried very successfully a considerable number 
of cases for psychotherapy, resigned to take a position as psychological consultant 
in the Lyman School. No one has taken his place in the clinic. Due to a ruling of 
the Department of Mental Disease that Summer Street State Hospital should at 
all times be covered, it became impossible for Dr. L. O. Farrar who for three years 
has given us half of his time as psychiatrist in the clinic, to continue his work at 
the clinic. This created a very difficult situation for us both because of the case 
load that he was carrying which had to be taken over by others or closed because 
they were not appropriate cases to transfer to some other psychiatrist, and because 
of the fact that it added a considerable load on myself and Dr. Hill. This change 
came during the middle of the year and must be adjusted in some way if the clinic 
is to continue as it has in the community. 

Miss Goldie Rabinovitz, one of our social workers, resigned from the clinic to 
accept a position in New York the first of October. Because of the difficulties arising 
through civil service regulations, it has been impossible for us to fill her position. 
This has thrown much extra work on the other social workers, and has seriously 
handicapped us in our work during the past two and a half months. Miss Roberta 
Frank, following her course in graduate work at Western Reserve, remained at 
the clinic for three months on a maintenance basis. She also left us the first of 
October. 

The result of all these workers leaving and not being replaced has been that 
during the past three months the clinic staff has been eKcessively overtaxed in work 
and has been unable to accept the usual number of cases. At the same time we 
have had a steady increase of court cases referred, so that at present we have avery 
large number of agency-referred cases, as well as family-referred cases, that we 
have been unable to do any more than promise that we will see them as soon as we 
can. Many cases that we feel could have been helped have been rejected. The 
agencies and families are looking at this situation as a temporary thing but unless 
some increase in staff can be provided it will not be temporary. A.lso unless the 
clinic should change the policy which it has adhered to very strictly during the 
last five years, of accepting only such cases as it could study and treat adequately, 
the clinic is going to be unable to maintain its place in this community as a service 
available to all who need it. 

We feel that the standard of psychiatric service that we have rendered our clients 
has continued at at least as high a standard as it was last year. Play Technique 
for younger children has been stressed more this year and has, we feel, shown 
excellent results in the cases treated and we feel that our technique along this line 
is being perfected. Many older children who were early cases have come or have 
been brought to the clinic and have had their cases and treatment reopened. This 
has been done even though many of these children were adjusting well. The idea 
of evaluating our work and finishing any part of treatment still needed has been well 
received. It is useless to try to evaluate cases for success or failure, but I myself 
am convinced that most of our long-time treatment cases have received considerable 
benefit, measured in terms of their adjustments in life and mental health through 
the treatment in the clinic. 

The psychia.tric treatment is always adjusted to fit the child. "While most of 
the treatment is carried out in formal interviews, the method of seeing the child 
in his home or interviewing him while riding in a car is frequently used. Well 
along in treatment the child himself is allowed to determine the frequency with 
which interviews are to be held. We think this is a good plan in most cases. 

The psychiatric service that is possible to give the court cases is uncertain, first 
because only a very small percentage of them come with any degree of cooperation 
on the parents' part, and second, because many of them are not seen until they are 
so seriously delinquent that they are at once committed. During the year an 



46 P.D. 23 

analysis was made of court cases covering a period of three years, and it was found 
that approximately fifty percent of the court cases seen have been taken for treat- 
ment or suggestions have been given in the social treatment of the child by other 
agencies, with the result that they have not as yet been committed to the reform 
school. This, I believe, is a considerable higher percentage than has occurred in 
any other juvenile court in the State. A part of this good record is accounted for 
however by the fact that our probation ofRcers do sometimes ask for an official 
report as though the boy were being considered for commitment when it would 
not be done did they not believe that the clinic would not recommend commitment. 
The agencies have been most cooperative in helping the psychiatrists at the 
clinic carry out intensive treatment on cases referred by them, and in carrying out 
suggestions made by the psychiatric and social departments that would help in this 
treatment. Among those that have been especially cooperative should be men- 
tioned — The Associated Charities; the Board of Public Welfare; the Children's 
Friend Society; the Y. M. C. A., the Worcester State Hospital; the Worcester 
District Nursing Society; Memorial Hospital; City Hospital; the Boston Chil- 
dren's Aid Society; and the New England Home for Little "Wanderers. 

Social Work Department: 

The social work department has two major tasks; first the carrying out of the 
psychiatric treatment on the clinic cases, and second the training of our Smith 
and Simmons students. As has been mentioned, the social workers have been 
greatly handicapped by a low personnel. However, they have been able to keep 
up the treatment case load very satisfactorily throughout the year. At present, 
the task is becoming increasingly difficult and unless an additional social worker 
can be obtained soon, some of the cases that are under treatment and should be 
active will necessarily have to be closed. The student training situation has been 
most satisfactory during this year. The two students whose training period finished 
in June were both excellent students and we felt were well trained in cfiild guidance 
social work when their period of training was finished. In September we admitted 
three new students, two from Simmons School for Social Work, and one from Smith 
School for Social Work. These girls are all fitting in very nicely with the clinic and 
we feel will be of great help to us, as well as will prove to be good students and will 
develop into good social workers. The training of social workers is an important 
part of our task, first because it stimulates our own social workers to better work; 
second it helps the clinic because the girls, after the first few weeks of training, are 
useful and efficient in social treatment; and third because the task of any child 
guidance clinic is in part educational and the training of social workers helps to 
disseminate the things we may learn in the clinic, that social workers, teachers and 
parents should know. 

Psychological Department 

In the Worcester Child Guidance Clinic, the psychologists, after a few months of 
orientation in clinic procedure, obtained wnile they are doing only testing of the 
children, are used in treatment of cases. Miss Grace Clark who has been with us 
several years has spent most of her time tnis year as she did last in the treatment of 
special disabilities, especially reading disabilities and stuttering and stammering. 
Since these things are very frequently emotional manifestations, the treatment in 
many of these cases takes on the nature of straight psychiatric treatment. Miss 
Clark, we feel, has had a considerable measure of success in this work. Under the 
reduced staff, this work will of necessity be curtailed next year. This is unfortunate 
since it is one of the best things that is being done in the clinic and one of the things 
that gets us recognition from the outside clinical groups. 

Mr. Charles Toy who has been with the clinic for more than two years, receiving 
a low salary because his work has been considered a period of training, has func- 
tioned at a much higher level than a psychologist in training and has carried the 
treatment of a number of cases. He will resign, February 1, to enter the study of 
medicine. The clinic will suffer loss here both in what he as an individual has been 
able to add to the clinic and because he has carried considerable burden of the 
testing. 

The statistical details of the work of the year are closely comparable to those 
of 1933, about 400 cases being carried forward on the open case load. The plan 



P.D. 23 47 

for 1935, includes in its foundation the carrying on of the work of the Clinic as it 
has been done in previous years. Cases referred for psychiatric consultation, ad- 
vice, recommendation, and treatment by the social agencies, medical and health 
agencies, schools. Juvenile court, and the private physicians will be handled, and 
treatment of the psychiatric problems and family situations involved is the fun- 
damental purpose of the Clinic program. 

Certain groups of cases will be especially emphasized in the treatment work. 
There has been an increasing tendency toward the referral of very young children 
presenting subtle problems of personality malformation in fairly early stages. 
This is undoubtedly a result of the program of community education in relation to 
the foundations of mental health which has been carried on for the last few years 
by the Clinic as well as by other departments of the Worcester State Hospital. 
Dr. Julia Hill, Assistant Psychiatrist, is to carry the major responsibility for treat- 
ment work with these young children through the use of Play Technique. She 
finds that a comparatively small amount of psychiatric treatment of the child and 
interpretation to the parents of the formation of the mechanisms which have led 
to the child's problems yields gratifying results in healthy development in what 
might otherwise have been a diseased mind. 

Miss Grace Clark, Head Psychologist of the Clinic, is hoping to do intensive 
treatment of a group of conflict and neurotic patients who show problems of 
stuttering, stammering and special educational disabilities such as in reading and 
arithmetic, if sufficient psychological help is available for general clinic work. Miss 
Clark has done similar work in Dr. Smiley Blanton's Stammering School during 
the last two summers and has proven her ability to treat these problems in children 
coming to the Clinic. 

Members of the Social Work department have been asked for an increasing 
amount of consultation service they have, given to Worcester social agencies em- 
ploying non-psychiatrically trained social workers. This consultation consists in 
the guidance of work with severe adult personality problems in parents and in 
several instances has made it possible to avoid hospitalization where treatment by 
local psychiatrists was either not available to the social agency or not acceptable 
to the patient. The service of members of the Social Work staff on the Difficult 
Case Committees of these agencies has brought us in touch with this service and 
has proved valuable. A special discussion group of mothers is planned by the 
Associated Charities of Worcester, to be led by the head social worker of the Clinic. 
The purpose of the course will be the discussion with the mothers of the problems 
they meet in the development and training of their children. 

The community education program will continue as in earlier years. Large 
demands are made by the community for the help of the Chnic in furnishing 
speakers for meetings and in planning discussion groups. Every member of the 
staff participates in this program. Social work students are being trained for the 
psychiatric course at the Smith School for Social Work and the Simmons School 
for Social Work. Because of the urgent need throughout the country for the 
training of people who will do professional work in child guidance and other mental 
hygiene programs, it is necessary for the Worcester Child Guidance Clinic to devote 
considerable time to the training not only of individual students in each department 
who spend some time in the Clinic, but also of workers in other agencies who wish 
to add an understanding of mental mechanisms to the work they are doing in other 
fields. The Worcester Clinic has accepted this responsibility and is frequently 
visited by people who come for short or long periods to learn about the work. 

There are several important problems now facing the clinic. These problems 
must be met in some way. The basic factor in this situation is that the Worcester 
Child Guidance Clinic, one of the largest clinics in the country at present, has 
always been staffed by people who were receiving a considerably lower salary in 
their respective fields tha'n those working in other comparable child guidance 
clinics. The opportunities of association with the State Hospital, the cooperation 
of the Department of Mental Disease and the State Hospital with the clinic, and 
the policy of allowing the Clinic to work in an unhampered fashion has held these 
people in the Clinic and almost without exception the members of the staff have 
frequently refused positions offered them that carried with them a higher salary 



48 P.D. 43 

than they were receiving because of their loyalty to the Clinic and the personal 
satisfaction they had in working with the group. This is an intangible asset and 
can only be kept by the continuation of this feeling of satisfaction and cooperation. 

The problem of court referred cases is a serious problem as it affects the general 
average of the type of work the Clinic can do. The number of court cases is 
gradually increasing. At present several of the outlying court cases assigned by 
area allotment to the Worcester State Hospital for examination are evading the 
law about compulsory examination in one way or another. Were all the cases to 
come to the Clinic that the law when drafted intended to come, and were the 
Clinic to continue to spend time in the examination and reports as it now does on 
the court cases, more than one half of all the Clinic's activity would be expended 
in this way. Good psychiatric work with children is only done when the parents 
are or can be made to be cooperative in psychiatric as well as social treatment. A 
large percentage of court parents do not fall in this class. Therefore our work with 
this group is not as productive of good results for the children, and from it we learn 
but little that will help us in real psychiatric advance and increased knowledge 
about psychiatric problems of children. 

As the situation now stands, we must urge other agencies to refer only their 
most serious problems. This is especially true of the schools because of the fact 
that our time is so much taken up with court cases that we cannot find time to 
deal with any but the most serious problems. It is impossible for a group of clinical 
child guidance people to touch these unhappy boys and girls who are in serious 
trouble without having an intense desire to help them, and we are able to help 
some of these children but not nearly as large a percentage as we could were we 
not to have serious court cases, those that are being considered for commitment. 
Were we to take a comparable number of mildly delinquent children who were out 
of court cases or came to us as school behavior problems, or children referred to 
us from S. P. C. C, we would be able to help a larger number. I foresee during 
the next year, with the reduced staff, that an even larger percentage of the staff's 
time is going to be consumed with court cases, and since they are more difficult 
and more discouraging, I feel that there is grave danger that the number of suc- 
cessful cases treated in the Clinic will fall considerably. The juvenile probation 
officers in the Boys division of the Juvenile Court are cooperative and do all they 
can to help the Clinic carry out psychiatric treatment, or to follow out the Clinic's 
suggestions for probationary treatment. We have had but very few girls referred 
to us from the court this year. The Girls' probation officer does not as readily 
accept the ideas back of mental hygiene and has not been as active in cooperation 
with the Clinic as we might wish. 

This is really a serious situation for the Clinic to face at the same time that it is 
reorganizing the staff, as it will be following my resignation, and as it is facing a 
decrease in personnel. There is danger that the Clinic's work will be criticized 
or less highly evaluated on the basis of this change when the real fault might easily 
be the situation that has arisen out of the law requiring these compulsory examin- 
tions. I personally believe that the law is a good thing. No provision was made 
for the increase of a state hospital staff to take care of it in an adequate way, 
however, and since there is little reason to believe this will be made, I personally 
would be in favor of the repeal of the law, which in itself would be a step backward. 

There is one possible solution, difficult I know for the State Hospital. This 
would be for the State Hospital to dp the routine examinations as is dpne by the 
other State hospitals in the state, and refer to the clinic only the cases as the 
psychiatrist and psychologist at the hospital would in their brief and rapid exam- 
ination feel were appropriate for the Clinic to study. The hospital could make out, 
as is done in the other hospitals, very brief reports about the findings of the child. 
I dislike to make this suggestion, both because I know it increases the duties of 
the already overburdened staff of the State Hospital, and it jeopardizes the rather 
enviable record that the Worcester Child Guidance Clinic has in dealing with 
seriously delinquent children. But, in the face of this serious concrete situation 
thlat now faces the Clinic, I think that it is something that should be thought of, 
at least should be remembered as a possible solution of the problem if it becomes too 
difficult. 



P.D. 23 49 

Farm Department 

Oakleigh Jauncey, Head Farmer 

Worcester Herd Control 

As our fiscal year of 1934 drew near and plans for herd improvement were being 
assembled, a need was felt for some daily check of each individual animal in 
regard to milk production, breeding and feed consumption, in order to maintain 
the maximum efficiency of each animal and pave the way toward a 15,000 pound 
milking average per cow per year or better; this is one of the goals among others 
we desired to obtain. 

It was felt that it was not enough to visit our two herds as often as possible, 
and to go through herd books for records, in order to maintain herd efficiency, 
but a concise and up-to-the-minute source of information was needed that could 
tell at a glance just what each individual animal milking and not milking was 
doing toward her part of plans as laid down. 

A series of charts were created that accommodated the entire milking herd, dry 
cows and young stock to be bred and to freshen during the year 1934. 

The following is a very brief description of the key to the herd control chart. 
Every one has a different idea of how a milking herd should be managed. The 
writer is not attempting in his description of the working of the key to the control 
chart to make one accept statements such as made. They can be taken for what 
they may be worth, and are merely beliefs and practices executed in a successful 
herd. 

1. Date When Calving is Expected. 

Assures the herd manager of the approximate date the animal is to freshen. 

2. Date to Examine by Veterinary. 

Twenty-one days after freshening, the animal's uterus should be contracted, and 
an examination should be made by a competent veterinary, to assure normalcy 
for conception and, if not, remove any obstructions that may lay in the path of 
efficient breeding. 

3. Date Bred. 

This indicates when the animal was bred and how many times. 
If. Date Female and Male Calf Born. 
The above are self explanatory. 

5. ■ Date When Animal Should Be Bred. 

There is a certain time after an animal freshens that she should have been bred 
and conceived. This depends upon certain conditions. If one is launching a cow 
on a 365 day official test, the breeding should be held off so that the animal would 
not freshen before her official test was completed. When one wishes a cow to 
have a calf every 365 days and have a 60 day rest period before another lactation 
period, the cow should have conceived 60 days after freshening. 

In case of a heifer being placed on the chart, her first breeding date would 
depend on her breed, size and age. It would not be good animal husbandry to 
breed an animal under sized or aged and also vice versa. 

6. Examined by Veterinary. 

Three months after an animal's last breeding, she should be examined so as to 
determine if she is pregnant, and if not, to determine the cause of her not con- 
ceiving and at the same time, remedy the trouble. 

7. Date in Heat and Not Served. 

If an animal is normal after calving she should be in heat in about 21 days. 
It is not good practice to breed on this first heat, but to wait until the second 
period, which assures one upon conception and if breeding efficiency is maintained, 
that the animal will milk ten months of the year, have her 60 day rest period 
before calving and have her calf all inside of the desired 365 day period, providing 
one is conducting this program. 

8. Daily Milk Production Per Cow. 

This indicates any rise or fall in the animal's total daily milk production If 
a sudden decrease in milk is indicated the one in charge can at once investigate and 
determine or correct the source of trouble. If a special feed is being used, its 
influence can be noted on the individual being fed. Also the weather and many 
other influential factors that deal with milk production. 



50 P.D. 23 

9. Daily Grain Consumption. 
Daily Hay Consumption. 

This indicates the amount of each fed to the animal, any change in feed at any 
time, the relation of hay and grain to milk production and at the end of a lactation 
period, the total amount fed to animal per year, can be figured as cost against the 
total amount of milk produced during the animal's lactation period. This can 
also be figured by the day, week or month or any period that may be desired. 

10. Abortion. 

Indicates the date aborted. 

11. Animal Transferred from Hillside to Home Farm. 

12. Animal Transferred from Home Farm to Hillside. 

Eleven and twelve indicates the influence of the move on milk production and 
also the date of removal. 

13. Total Milk Production Hillside. 

Shows the rise and fall in milk production at the different months of the year, 
and also the influence of weather and feeds on the milk production line. The 
number of cows maintained at this plant and number of calvings at different 
periods of the year, will show their influence also on production. 
l^.. Herd Average Daily per Cow Hillside. 

This indicates the daily milking average per cow per day in this herd. 

15. Herd Average Yearly per Cow Hillside. 

This is one of the outstanding accomplishments in maintaining an efficient herd. 
One must maintain a high herd average and all factors of herd management have 
their influence on this one line one way or another. 

16. Total Milk Production Daily Home Farm. 

17. Herd Average Daily per Cow Home Farm. 

18. Herd Average Yearly per Cow Home Farm. 

Same explanation for the above as that given previously for 13, 14 and 15. 

19. Date Animal is to be Dried Off. 

This is extremely important. A cow should have a good rest period before 
calving. The length of this period may vary, but 60 days is reasonable and a cow 
should have every day of it after a hard year's work. 

20. Date Animal Died. 

Date animal died is indicated on the milk line or space on chart set aside for 
individual merely as a matter of record. 

21. Animal Slaughtered. 
For record only. 

22. Fair, Cloudy, Showers and Snow. 

These are very influential factors on milk production. There is not very much 
that one can do in regard to the adjustment of the weather except in extreme 
cases of heat and cold, and that is to make the animal as comfortable as possible. 

23. Total Milk Production Daily Combined Herds. 

In the successful management of milk production, the total milk produced per 
day, month or year, is no doubt, the thing we are most interested in. This is es- 
pecially true in maintaining two herds. It is this line that spells success and profit 
and must forever be watched and studied and all phases of good and bad manage- 
ment, has its effect on this factor more so than any one previously mentioned. 
2^.. Total Daily Average Milk Production per Cow Combined Herds. 

Not so important perhaps, but nevertheless it indicates how the herd is doing 
by the day. 

25. Total Weekly Yearly Average per Cow Combined Herds. 

A little more important than a daily average. It gives one a better insight how 
the herds are producing and gives one a better understanding of how the herds 
are doing toward a yearly average. 

26. Total Yearly Average Milk Production per Cow Combined Herds. 

This along with total yearly average milk production per cow, combined herds, 
are the most important factors we are seeking in herd management. Everything 
that is executed in the combined herds for or against the best welfare of the animals, 
show its influence the greatest in these two averages. These are "The Top" of 
successful dairy husbandry. 



P.D. 23 51 

The results of the herd control chart have been very gratifying and very valuable 
and have more than served the purpose for which it was designed. It has pointed 
out, that it is absolutely possible to manage a herd of any size without going ne^r 
the premises of the herd except for inspection of sanitation of buildings, personal 
and visible conditions of animals. The real value of the control chart is not in 
the first year of its operation, but in the ensuing years where close daily contact 
with the individuals in the herd will bring about efficiency in breeding and feeding 
and where truly lies the fruits of high milk production, high average and herd 
improvement. 

I would be remiss in my duty if I did not again call attention to, the fact that 
the physical plant of the hospital has not been kept up to a high state of efficiency 
the past few years because of the necessary curtailment of the budget for repairs. 
The Commonwealth has a large investment in the buildings and equipment of a 
hospital, and it is only good business judgment to protect this investment by keeping 
repairs up. The main hospital is fifty years old and the Summer Street Department 
over one hundred years old. To keep buildings of this age in good serviceable 
condition requires a much greater outlay of money each year than has been ex- 
pended during the period of depression. To permit buildings to deteriorate through 
lack of minor repairs is to depreciate the investment, and such a policy will be ex- 
tremely costly eventually. 

In the Annual Report of 1933 I made recommendations for extensive repairs 
and betterments. I refer again to these sstjne recommendations only to emphasize 
their increased importance. It would be an unnecessary waste of space to enumer- 
ate these needed changes each year, but a start should be made on a comprehensive 
program of changes and betterments, that will make the plant more modern and 
better able to function as a hospital according to our present standards and needs. 

Again it is my duty and pleasure to record the able support given me by the 
Board of Trustees of the hospital. The members have at all times given freely of 
their time, and the hospital owes them individually and collectively a debt of 
gratitude for their services. 

To make an adequate acknowledgment of the loyalty of officers and employees 
would be impossible in a limited space, but it is this interest and loyalty to the ideals 
and purpose of the institution that makes progress possible. 

Respectfully submitted, 

William A. Bryan 

Superintendent. 

VALUATION 

November 30, 1934 

Real Estate 

Land, 589. 16 acres $467,130.00 

Buildings and betterments 2,100,798.29 

$2,567,928.29 

Perso-val Property 

Travel, transportation and office expenses $9,631.62 

Food 13,864.03 

Clothing and materials 28,511.75 

Furnishings and household supplies 269,697.11 

Medical and general care 64,989.32 

Heat and other plant operation 1,276.84 

Farm 57,514.10 

Garage and grounds 8,352.84 

Repairs 23,228.05 

$477,065.66 

Summary 

Real estate $2,567,928.29 

Personal property 477,065.66 

$3,044,993.95 



52 P.D. 23 

FINANCIAL STATEMENT 
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, 1934. 

Statement of Earnings 

Board of Patients $69,198.57 

Personal Services: 

Reimbursement from Board of Retirement 261.00 

Sales: 

Food $1,531.28 

Clothing and materials 16.50 

Furnishings and household supplies 18.45 

Medical and general care 107.38 

Heat and other plant operations 17.00 

Garage and grounds 4.06 

Repairs ordinary 244.50 

Farm (itemize) 346.68 

Total Sales $2,285.87 

Miscellaneous: 

Interest on bank balances $225 . 75 

Rents 1.690.75 

Com. on Pay Station Telephone, etc 131.58 

Total miscellaneous 2,048.08 

Total earnings for the year 73,793.52 

Total cash receipts reverting and transferred to the State Treasurer 73,730.52 

Accounts receivable outstanding December 1, 1933 - 

Accounts receivable outstanding November 30, 1934 $63 . 00 

Accounts receivable increased. 63.00 

Maintenance Appropriation 

Balance from previous year, brought forward $22,939.20 

Appropriation, current year 750,430.00 

Total $773,369.20 

Expenditures as follows: 

Personal services $388,669 . 46 

Food 124,819.25 

Medical and general care 33,879 . 34 

Religious instruction 2,433.97 

Farm 25,469.55 

Heat and other plant operation 82,016.53 

Travel, transportation and office expenses 9,374 94 

Garage and grounds 6,351.70 

Clothing and materials 15,444.59 

Furnishings and household supplies 31,103.03 

Repairs ordinary 16,291.05 

Repairs and renewals 2,721.39 

Total maintenance expenditures 738,574.80 

Balance of maintenance appropriation, November 30, 1934 34,794.40 

$773,369.20 

Special Appropriations 

Balance December 1, 1934, brought forward $8,358.15 

Appropriations for current year 502,000.00 

Total $510,358.15 

Expended during the year (see statement below) $112,840.96 

Reverting to Treasury of Commonwealth 112,840.96 

Balance November 30, 1934, carried to next year $397,517.19 



Appropriation 


Act or 
Resolve 
Ch. Acts 


Total 

Amount 

Appropriated 


Expended 

during 
Fiscal Year 


Total 

Expended 

to date 


Balance at 
end of 
year 


Roof repairs and fire protection, item 

458A 

Alterations for fire protection M.S.P. 

M-20, PWA D. 6243 
Standpipe M.S.P. M-39, PWA. D. 

4640 

Fireproof balconies, M.S.P. M-48 

PWA. D 4465 

Sprinklers and rewiring, M.S.P. M-49 

PWA. D. 5308 

Hydrotherapy Building, M.S.P. M-50 

PWA. D. 4657 


371-1933 


$41,000.00 
90,000.00 
42,000.00 
138,000.00 
111,000. 00 
121,000.00 


$8,250.30 
38,514.97 

6,399.79 
40,720.47 

7,421.91 
11.533.52 


$40,892.15 

38,514.97 

6,399.79 

40,720.47 

7,421.91 

11,533.52 


$107.85 
51,485.03 
35.600.21 
97,279.53 
103,578.09 
109,466.48 



P.D. 23 53 

Per Capita 
During the year the average number of patients has been, 2,299.89 
Total cost of maintenance, $738,574.80 

Equal to a weekly per capita cost of (52 weeks to year), $6.1756 
Total receipts for the year, $73,730.52 
Equal to a weekly per capita of $.6165 
Total net cost of maintenance for year, $664,844.28 
Net weekly per capita $5.5591 

Respectfully submitted, 

Margaret T. Ceimmins, 

Treasurer. 

STATEMENT OF FUNDS 

Rockefeller Research Project 

Received July 16, 1934 $4,000.00 

Received October 23, 1934 8,000.00 

$12,000.00 

Expended to November 30, 1934 4,040.78 

Balance on hand November 30, 1934 $7,959.22 

Investments 
Balance Worcester County Trust Co $7,959.22 

Lewis Fund 

Balance on hand November 30, 1933 $1,402.00 

Income 42.25 

$1,444.25 

Expended 110.06 

$1,334.19 

Investments 

Worcester Five Cents Savings Bank $1,300.00 

Balance Mechanics National Bank 34.19 

$1,334.19 

Wheeler Fund 

Balance on hand November 30, 1933 $1,021.06 

Income 32.50 

$1,053.56 

Invest'ments 

Worcester Mechanics Savings Bank $1,000.00 

Balance Mechanics National Bank 53.56 

$1,053.56 

Manson Fund 

Balance on hand November 30, 1933 $1,020.83 

Investments 

Millbury Savings Bank $1,020.00 

Balance Mechanics National Bank .83 

— $1,020.83 

Clement Fund 

Balance on hand November 30, 1933 $1,000.00 

Income 32.50 

$1,032.50 

Expended 32.50 

$1,000.00 

Investments 
Worcester County Institution for Savings $1,000.00 

P.\tients' Fund 

Balance on hand November 30, 1933 $8,821.74 

Receipts 6,475.20 

Interest 225 . 75 

$15,522.69 

Expended 8,459.08 

Interest paid to State Treasurer 225.75 

8,684.83 

$6,837.86 
Investments 

Worcester County Institution for Savings $1,000.00 

Worcester Five Cents Savings Bank 1,000.00 

Worcester Mechanics Savings Bank 1,000.00 

Peoples Savings Bank 1,500.00 

Bay State Savings Bank 1,500.00 

Worcester County Trust Co. (Class A Certificate) 106.00 

Balance Mechanics National Bank 480.04 

Cash on hand December 1, 1934 251.82 

$6,837.86 

November 30, 1934. 



54 P.D. 23 

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

Table 1. General Information 

Data correct at end of institution year November 30, 1934 
Date of opening as a hospital for mental diseases, January 18, 1833 
Type of hospital : State. 
Hospital plant: 

Value of hospital property: 

Real estate, including buildings $2,567,928.29 

Personal property 477,065 . 66 

Total $3,044,993.95 

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

Total acreage under cultivation during previous year 177 
Officers and employees: 

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 1 - 1 

Clinical assistants 2 - 2 - - - 

Total physicians 14 1 15 1 - 1 

Stewards 1 - 1 - ~ - 

Resident dentists 1 - 1 - - - 

Pharmacists 1 - 1 - - ~ 

Graduate nurses - 41 41 - 1 1 

Other nurses and attendants .... 102 118 220 1 - 1 

Occupational therapists - 5 5 - - - 

Social workers - 4 4 - - - 

All other officers and employees .... HI 71 182 819 

Total officers and employees . . .230 240 470 10 2 12 

Classifiration by Diagnosis September 30, 193 tt 
Census of Patient Population at end of year. 

Absent from Hospital 

Actually in Hospital but Still on Books 

White M. F. T. -4. F. T. 

Insane 1,071 1,085 2,156 183 246 429 

Mental defectives 2 1 3 

Epileptic and Mentally Defective . . - 1 1 _ _ _ 

Alcoholics 3 - 3 - - - 

' All other cases 2 7 9 - - - 

Total 1,078 1,094 2,172 183 246 429 

Other Races: 

Insane 24 27 51 1 4 5 

Total 24 27 51 1 4 5 

Grand Total 1,102 1,121 2,223 184 250 434 

M. F. T. 
Patients under treatment in occupational-therapy classes, including 

physical training, on date of report 112 140 254 

Other patients employed in general work of hospital on date of report 501 351 852 

Average daily number of all patients actually in hospital during year. 1,087.50 1,116.75 2,204.50 

Voluntary patients admitted during year 2 7 9 

Personsgivenadviceor treatment in out-patient clinics during yaar . 251 160 411 



23 



55 



J 5 



5 K 



« t < 



I 0-. — O I o o 



I ^ t^ 3< I I 0-. 
I IM Tl- vc I I O 



1-r <i 1 f ~ 



(Si lOC^^^^|t^c^ loi^n^-i—ior^ so'oo 



M f^ CO ^ 

O i^, -J I ^ 00 ir^ 
LC ts X « 00 '^ 



— — 00 o — — 



; — C^ I -t-^^ O I 



O O X 1 \o •* 






■ — IC T)< 0^ — 



; O S' OS- TfC: ■* 






__ o ^ "TN o a- X X 

— -. ro C -< tN 



>0 O X X ro — t 
lO ir-, -^ \o -^ 00 rf 



— X C'l -^ rsC X-O -~2-*t^ 
" 1-^ CO -C r^ re ro <J^ 



-, <OX"*0)fN XC — "^■*C-X— — iS-^ 



^ coOOvOOCN ro »— -^ CO O -^ c 
CO CN (N ^ ■* t^ 



— CO — CN CO 



lOinO^w^i^ coX'-^OX^-OC- ^-ctO 
OO^O^^I^<lO T)i— ^XvO — t— OXX 






CO M 2 

o'C-S 

s =• <« 

c coE 
o c-o 

m O tS 






E gij-o 

".Ig'S'^E 
g^2.o52"S 

w cd M ^ Oe« "^ 



5' 2 



O cti 



o^ o 
> i^ — ,— o 



■2-S - 



; Ej: 






-- o t^ 



™ OJ ■ 



■^2 c^ 



[„-*lO -<ox 
CI CN t^ -^ O O 

JJro-H « 



O- O — O X 
3 0\ »0 ^ lO u~- 

— CNt^ O -^ O 
"■ "OX 01>0 

JO — 



^ t^ ^ r-1 ^ O '- ^ t 



rtxxrs-o^ CO -o ^ 



a c 
ox; 

>-3 



= ^^ .1i ca «• 



1' 


- 






ca 


c 


t: 


c 






rt 


n 


o 


o 










j3 


> 


H 


fr 



jE . 

3^ > 












<I> 



■ c ••« 



5 > ' 



c fe « 



O 01 

E ^ ° iJ 

'S !< !■ <5 



■ ft 2 
• c5sE 



O . i; - '" 

a ° >,u 

ft u '- S 'Zi 
3 ii'- CD ft p 

E 



56 P.D. 23 

Table 3. Nativity of First Admissions and of Parents of First Admissions 











Parents of Male 


Parents of Female 


Nativity 


Patients 


Patients 


Patients 




















Both 


Both 




M. 


F. 


T. 


Fathers Mothers Parents 


Fathers Mothers Parents 


United States i . . . . 


148 


120 


268 


75 76 66 


61 59 52 


Austria 


1 


4 


5 


1 1 1 


4 3 3 


Canada 2 


24 


21 


45 


40 39 35 


29 29 24 


China 


1 


- 


1 


1 1 1 


- - - 


England 


5 


5 


10 


10 8 7 


11 9 7 


Finland 


- 


2 


2 


- - - 


3 3 3 


France 


- 


- 


- 


2 - - 


1 


Germany 


1 


- 


1 


4 4 3 


3 2 2 


Ireland 


9 


11 


20 


29 34 27 


29 31 28 


Italy 


14 


9 


23 


14 14 14 


11 12 11 


Norway 


- 


2 


2 


- - - 


2 2 2 


Philippine Islands . 


- 


- 


- 


1 


- - — 


Poland 


3 


5 


8 


6 6 6 


10 10 10 


Portugal 


— 


2 


2 


_ _ — 


3 3 3 


Russia 


3 


1 


4 


4 4 4 


3 2 2 


Scotland 


1 


1 


2 


2 1 1 


2 1 1 


Sweden 


10 


4 


14 


13 13 13 


5 5 5 


Turkey in Asia .... 


1 


- 


1 


1 1 1 


- - - 


Turkey in Europe . 


3 


- 


3 


3 3 3 


- - - 


West Indies ' . . . . 


- 


2 


2 


- - - 


1 2 1 


Other Countries 


6 


3 


9 


7 7 7 


8 8 8 


Unknown 


1 


2 


3 


18 19 17 


8 13 8 


Total 


231 


194 


425 


231 231 206 


194 194 170 



1 (Persons born in Hawaii, Porto Rico and the Virgin Islands should be recorded as born in the U. S.) 
^Includes Newfoundland. ^Except Cuba, Porto Rico and Virgin Islands. 



P.D. 23 



57 



oq 



CO 



B^ 



^ 



O 









H 


1 1 1 1 1 1 1 -- 1 1 1 1 — 1 1 1 


CN 




> o 












•5 c 






1 1 1 1 1 1 1 — 1 1 1 1 -^ ' 1 1 

1 1 1 1 1 1 1 1 1 1 1 ! 1 1 1 1 


1 






c 




1 l-Hi^^woi^^rol-Hl 1 1 


CN 






& 


H 




^-1 






o 
c 












[i-. 




lO 


"^ 




c 




^^ 








^' 


fr; 


II ||_-^^||r^||||| 


t^ 




z 












o 






1 isci/^'Oor^jC'-^trjr^icJO'. tH^O 


o 




m 


)_ 


H 


-H T— CN ^H ^^ ,-H T-H 


PO 






S OJ 










2 


tS > 












o o 




1 l■3^'^^^^^vco■*Mu-. --fri-cNoo — ^ 


■* 




<J 


til 




M3 






u~, c 










K 


— C3 


^^■ 


1 1 CVrC'rpr/^\C<>O^CC0000t^vC 1 C^ 


M 




e; 




<5 








o 












w 


'^ en 


H 


1 1 -^ 1 —-1 1 1 1 1 i 1 -1 1 1 1 


^ 


o 


(/I 
W 




fc 


1 1 1 1 1 " 1 1 1 1 1 : -^ 1 1 1 


IN 


> 


■J} 




S 


1 1 — 1 '- 1 1 1 1 1 I 1 1 1 1 1 


IN 










H 


a 
w 
i- 


m 


H 


1 :—— 1 1 1 1 1 1 1 1 1 1 1 1 


IN 


< 

2; 


li-, o 


fc 


1 1 "< 1 1 1 1 1 1 1 1 1 1 1 1 1 


- 




U> 




<; 


1 1 1 -^ 1 1 1 1 1 1 1 1 1 1 1 1 


'^ 




z 














ui 


H 


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


r-, 




« 


li 










s 


fc 


1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 


1 




H 


c ^, 












Hj 


^ 


1 1 1 1 1 1 1 -I 1 1 1 1 1 1 1 1 


'^ 








1 1 0< vO 00 -- r^ IT. r~l -t uo CM rf ^ rt VO 


in 






" 


H 


































o 


fe 


1 |u^fNPCt-\Cu~, f^'«O-*':t*-^00^'^ 








H 




t^ 








i^ 


1 l-*'*u^Tfi-~occvoo"«:i^'0|r.i 


i^ 








-< 


""* 


00 






c 


H 


1 rtw 1 „_rt 1 wr^^^Tfuo^rt 1 


O 






o 












C 


^ 


1 1 1 1 1 1 1 1 — i 1 1 <^^-H 1 


r^ 






"c 










■ 


D 


S 


|„w|^,. „| icvi-^ — rol 1 


fO 




H 


1 fr>J^rC'-^ir;\cr^iTtH-^CMfNfsi ! ^ | 


IN 










^ 






"^ 
























_>< 


t 


I'H-^-l— -f-H^-nrol— —1 1 1 


Cv 
















w 


rS; 










w 




j_j 


ICSr^rr; |V-ir, ir^^-fS — ^^H |^H ! 


fO 




< 




^ 








y. ' 










o 


bJ 




H 


^r ^Ot^cioctr, fo^TjiTl-^rCTf^ 


00 


« 




n 


^ ^ — < 


00 


2: 


1^ 


o 


fc 


«^OvC--t^^ro ^--.-r^ 1 


Tf 






t. 








S 






k^^ 


1 rou-. Tf>CtC'*^^lu^'MrOwM— i-H 


V3 


Ci 






^ 




■* 


o 












fc 






H 


■^00^-JC0C^yDCNt^O^^^^<50^^^^f^ 


CO 




























_> 












a 


fc 


■^r^ir^l\Or^iLcir;r^iY^T-.i--^pOLO(v^^ 


s 






Z 














^ 


1 \OOiMr^'^r^'^i^>f^^Or'l^D(Nr/5CN 


>o 


- 






^ 


"■ 


>o 






H 


(M3s-<^0C'*t^Tt<00>COOt^l/5M'*' 


CO 








«r^cN— itNCM^'rH-HCNrt^^-^ 


vo 




r 














fe 


^r^c.l^^>CC00OC)iOO\rC«0Ct^-H 


o 




c 










E- 








— 








S' 


1 r^lO'ON'i^Xi'^O^^t^ONt^iOfO 


00 










■* 




















H 


<NO>Ol^vOinO<»OOlO<MCTO\POO 


to 








■^•?ftNCNrO-^CN'^r*:;r^CN(MCN*-iw 






(8 
M 








-* 






• 


CNr^r^-^r^rcvC-^w^r^r^fr^vOOOio 


-* 








k^ 




Ov 




Of. 












<;■ 




*^ 


1 (Nf^rOO, ^l^-*OM3>oqir, \Oroir;lo 


_^ 








<, 


r-cc-J^^ — (Nw.rf«CS«— ,— , 


ro 




w & « 






u 

— l-rt<MCNC«5r<5-*'*>OU^>OVOt^t^OO S 
111111111111111° 


"ca 








o 
H 








^tNCSr^rryTj*^l/^u-3\O^C!t^i^0000 





58 



P.D. 23 



Table 5. Citizenship of First Admissions 

Males 

Citizens by birth 148 

Citizens by naturalization . 25 

Aliens 32 

Citizenship unknown . . . ., ■ . . 26 



emales 


Total 


120 


268 


15 


40 


30 


62 


29 


55 



Total 



231 



425 



Table 6. Race of First Admissions Classified with Reference to Principal Psychoses 





Race 






Total 


With 
syphilitic 
meningo- 
encephalitis 


With other 
forms of 
syphilis 


With 

epidemic 

encephalitis 


With other 
infectious 
diseases 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (blacl 
Armenian 


.) ■ 

2 

races 






6 
3 
1 
9 

28 

4 

1 

29 

15 

5 

12 

1 
10 

9 

88 
15 


7 
3 

_ 

11 
3 

19 
1 

2 

28 

12 

5 

2 

7 

4 

11 

1 
73 

5 


13 
6 

1 
20 

3 
47 

5 

3 
57 
27 
10 

2 
19 

5 
21 

3 

161 

20 


3-3 


- 3 3 


_ _ _ 


_ _ _ 










English 

Finnish 

French 

German 

Hebrew 

Irish 

Italian • 

Lithuanij 


in 


1 1 
3 2 5 
2-2 

1 1 
- 2 2 
1 1 2 


- 2 2 


- - - 


- - - 


- - - 


- - - 


1 - 1 








_ _ _ 


1 - 1 


-33 
1 1 


Scandinavian 
Scotch . 
Slavonic 3 
Syrian 
Turkish . 
Other specific 
Mixed 


1 - 1 


1 - 1 


- - - 












9 4 13 

2 1 3 


1 - 1 

1 2 3 


1 - 1 


- - - 










Tota 


1 








231 


194 


425 


22 12 34 


3 7 10 


2-2 


1 5 6 



Table 6. Race of First Admissions Classified with Reference to Principal 
Psychoses — Continued 



Race 




Alcoholic 
psychoses 


Due to 
drugs, etc. 


Traumatic 
psychoses 


With 
cerebral 
arterio- 
sclerosis 


With other 
distrubances 
of circulation 


With 
convulsive 
disorders 
(epilepsy) 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) . 


_ _ _ 


_ _ _ 


_ _ _ 


1 - 1 


_ _ _ 




Chinese 

English . 

Finnish . 

French . 

German 

Hebrew 

Irish 

Italian' 

Lithuanian 

Portuguese 

Scandinavian 

Scotch . 

Slavonic 3 

Syrian . 

Turkish 


2 ' 


- - - 


- - - 


- - - 


1 - 1 

2-2 


2-2 












2-2 


- - - 


3-3 


5 2 7 


2-2 


- - - 














7 - 7 
2-2 
1 - 1 


_ _ _ 


_ _ _ 


11 7 18 
3-3 


2 2 4 
1 - 1 


- - - 












3-3 
3 1 4 


- - - 


- - - 


3 1 4 
1 - 1 
2-2 


- - - 


: : I 


























Mixed . 
Race unknown 


7 1 8 
1 - 1 


2 1 3 


1 - 1 


13 11 24 
4-4 


1 - 1 


1 - 1 


Total 




26 2 28 


2 1 3 


4-4 


46 21 67 


8 2 10 


1 1 2 



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

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



P.D. 23 



59 



Table 6. Race of First Admissions Classified with Reference to Principal 
Psychoses — Continued 











Due to 


With organic 










Senile 


Inv 


olutional 


other 


changes of 


Psych 


■>- 


Manic- 




psychoses 


psychoses 


metabolic 


nervous 


neuroses 


depressive 


Race 








diseases, etc. 


system 






psychoses 




M. F. T. 


M. 


F. T. 


M. F. T. 


M. F. T. 


M. F. 


T. 


M. F. T. 


African (black) 


1 1 






1 1 








1 1 


Armenian 


_ _ _ 


_ 


_ _ 


_ _ _ 


1 - 1 


_ _ 


_ 




Chinese 


_ _ _ 


_ 


_ _ 


_ _ _ 




_ _ 


_ 


_ _ _ 


English . 


1 5 6 


_ 


_ _ 


_ _ _ 


1 1 


_ _ 


_ 


1 1 


Finnish . 


_ _ _ 


_ 


1 1 


_ _ _ 




1 


1 




French . 


3 3 6 


1 


1 


1 2 3 


1 1 


1 


1 


1 - 1 


German 


_ _ _ 


_ 


1 1 










1 - 1 


Hebrew 


1 1 


_ 


_ _ 


_ _ _ 


_ _ _ 


_ _ 


_ 




Irish 


4 5 9 


_ 


_ _ 


1 - 1 


1 1 


1 


1 


- 2 2 


Italian > 


1 1 2 


- 


2 2 


1 - 1 




2 - 


7 




Lithuanian . 


_ _ _ 


_ 


1 1 


1 - 1 


_ _ _ 






- 2 2 


Portuguese . 


_ _ _ 


- 






-- _ _ 


- _ 


_ 




Scandinavian - 


1 1 


- 


1 1 


1 1 2 


_ _ _ 


1 


1 


1 - 1 


Scotch . 


- 2 2 


_ 


_ _ 


_ _ _ 


_ _ _ 








Slavonic ^ 


1 1 


- 


2 2 


_ _ _ 


1 1 


1 


1 


1 1 


Syrian 


- - - 


- 


- - 


1 - 1 


- - - 


- - 






Other^pecific races 


_ _ _ 


_ 


_ _ 


1 1 


_ _ _ 


1 - 


1 




Mixed . 


6 14 20 


3 


4 7 


4 4 8 


1 1 


4 3 


7 


4 3 7 


Race unknown 


3 2 5 


- 


- - 


- - - 








1 - 1 


Total . 


18 36 54 


4 


12 16 


10 9 19 


1 5 6 


10 5 


15 


8 10 18 



Table 6. Race of First Admissions Classified with Reference to Principal 
Psychoses — Concluded 



Race 




Dementia 
praecox 


Paranoia 

and 
paranoid 
conditions 


Witli 
psychopathic 
personality 


With 

mental 

deficiency 


Undiagnosed 
psychoses 


Witliout 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) 


s 


1 2 3 


2-2 
1 - 1 


'_ _ _ 


_ _ _ 


- 1 1 


_ _ _ 












English . 
Finnish . 
French . 


1 - 1 

3 5 8 
1 - 1 
1 - 1 

1 5 6 

2 4 6 

2 2 4 
- 2 2 

1 1 
1 1 

3 4 7 


1 2 3 
1 1 2 


1 - 1 


1 - 1 
1 2 3 


- - - 


1 1 














Irish 
Italian i 


1 1 
1 1 


1. - 1 


2-2 
1 1 


_ _ _ 


1 1 2 


Portuguese 
Scandinavian '-' 












1 1 2 


- - - 


1 1 


_ 


- - - 












2-2 


Syrian 






















Other specific race 
Mixed . 
Race unknown 














19 15 34 
3 1 4 


4 2 6 
1 1 


_ ^ _ 


7 6 13 
1 - 1 


1 1 


1 1 2 


Total 




37 42 79 


10 9 19 


2-2 


12 10 22 


- 2 2 


4 3 7 



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

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



60 P.D. 23 

^ Table 7. Age of F(irst Admissions Classified with Reference to Principal Psychoses 



Psychoses 


Total 


0-14 
years 


15-19 

years 


20-24 
years 


25-29 

years 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


With syphilitic meningo- 

encephahtis 
With other forms of syphilis 
With epidemic encephalitis 
With other infectious diseases 
Alcoholic psychoses 
Due to drugs, etc. 
Traumatic psychoses . 
With cerebral arteriosclerosis 
With other disturbances of 


22 
3 
2 
1 

26 
2 

46 

8 

1 

18 

4 

10 

1 
10 

8 
37 

10 

2 
12 

4 


12 

- 
.5 
2 

1 

21 

2 

1 

36 
12 

9 

.5 

5 

10 

42 

9 

10 

2 


34 

10 
2 
6 

28 
3 
4 

67 

10 

2 
54 
16 

19 

6 

15 
18 
79 

19 

2 
22 
"2 

7 


_ _ _ 


_ _ _ 


2-2 


1 1 2 










- - - 


1 1 2 


- 2 2 


3-3 


- - - 


- - - 


1 - 1 


















With convulsive disorders 
(epilepsy) .... 

Senile psychoses . 

Involutional psychoses 

Due to other metabolic 
diseases, etc. 

With organic changes of ner- 
vous system 

Psychoneuroses 

Manic-depressive psychoses 

Dementia praecox 

Paranoia and paranoid con- 
ditions .... 

With psychopathic person- 
ality 

With mental deficiency 

Undiagnosed psychoses 

Without psychoses 


























- - - 


- - - 


1 - 1 


- 2 2 


1 1 

1 1 


1 2 
7 4 11 


1 3 4 

2 3 5 
13 7 20 


1 1 2 

1 1 

3 8 11 

9 9 








1 - 1 
? - 2 


- - - 


2 1 3 


3 1 4 


- - - 


1 - 1 


1 1 


- - - 


Total .... 


231 


194 


425 


- 2 2 


12 7 19 


23 17 40 


13 14 27 



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





30-34 


35-39 




40-44 




45-49 




50-54 




55-59 


Psychoses 


years 


years 




years 




years 




years 


T. 


years 




M. F. T. 


M. F. 


T. 


M. F. 


T. 


M. F. 


T. 


M. F. 


M. F. T. 


With syphilitic men- 






















ingo-encephalitis 


3 2 5 


2 3 


5 


2 2 


4 


3 1 


4 


4 2 


6 


3 1 4 


With other forms of 






















syphilis 


_ _ _ 


2 


2 


_ 2 


2 


1 


1 


- 


- 


3-3 


With epidemic en- 






















cephalitis . 


_ _ 


- - 


- 


2 


2 


- 


- 


- - 


- 


- - - 


With other infectious 






















diseases 


_ _ _ 


- - 


- 


1 


1 


- - 


- 


- - 


- 


- — - 


Alcoholic psychoses 


3 1 1 


2 - 


2 


4 - 


4 


5 - 


5 


3 1 


4 


1 - 1 


Due to drugs, etc. . 


_ _ _ 


- - 


- 


- - 


- 


- — 


- 


1 


1 


- - — 


Traumatic psychoses 


_ _ _ 


1 


1 


1 


1 


— - 


- 


- - 


- 


1 - 1 


With cerebral ar- 






















teriosclerosis 


_ _ _ 


1 


1 


— - 


- 


- - 


- 


3 1 


4 


7 5 12 


With other distur- 






















bances of circula- 






















tion 


_ _ _ 


1 


1 


- - 


— 


1 - 


1 


- - 


- 


- - — 


With convulsive dis- 






















orders (epilepsy) 


1 - 1 


1 


1 


- 


- 


- 


- 


- 


- 


- - - 


Senile psychoses . 


- - - 


- - 


- 


- - 


- 


- - 


— 


- - 


- 


- - — 


Involutional psy- 






















choses . 


_ _ _ 


1 


1 


3 


3 


- 3 


3 


2 4 


6 


1 1 2 


Due to other meta- 






















bolic diseases, etc. 


_ _ _ 


1 


1 


1 


1 


- - 


- 


4 2 


6 


2 2 4 


With organic changes 






















of nervous system 


_ _ _ 


- - 


- 


1 1 


2 


1 


1 


2 


2 


- — — 


Psychoneuroses 


2 - 2 


1 1 


2 


1 


1 


.■) - 


3 


- — 


- 


- — - 


Manic-depressive 






















psychoses . 


- 1 1 


2 3 


5 


- - 


- 


1 


1 


1 


1 


1 - 1 


Dementia praecox 


9 3 12 


1 7 


8 


3 4 


V 


- 2 


2 


1 5 


6 


- — - 


Paranoia and para- 






















noid conditions . 


1 - 1 


1 


1 


5 1 


6 


1 1 


2 


_ 2 


2 


- 2 2 


With psychopathic 






















personality 


_ _ _ 


- - 


- 


- - 


- 


- 


- 


- - 


- 


- — — 


With mental defi- 






















ciency 


_ _ _ 


1 2 


3 


2 1 


3 


- 4 


4 


1 1 


2 


- - - 


Undiagnosed psy- 






















choses . 


_ _ _ 


- - 


- 


1 


1 


- — 


- 


- - 


- 


- - - 


Without psychoses 


- - - 


1 


1 


2 - 


2 


- 1 


1 


- 


- 


_ _ _ 


Total 


19 7 26 


12 23 


35 


24 16 


40 


14 14 


28 


19 21 


40 


19 11 30 



P.D. 23 

Table 7. Age of First Admissions Classified tvith Reference to Principal 
Psychoses — Concluded 



61 



Psychoses , 


60-64 

years 


65-69 
years 


70-74 

years 


75-79 
years 


80-84 
years 


85 years 
and over 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


With syphilitic meningo- 
encephalitis 

With other forms of 
syphilis 

With epidemic encepha- 
litis . . , . 

With otlier infectious 
diseases 

Alcoholic psychoses 

Due to drugs, etc. . 

Traumatic psychoses 

With cerebral arterio- 
sclerosis 

With other disturbances 
of circulation 

With convulsive disorders 
(epilepsy) 

Senile psychoses . 

Involutional psychoses. 

Due to other metabolic 


2-2 
1 1 
































1 1 
3-3 

11 4 15 
2-2 

- 3 3 
1 - 1 

1 1 

1 1 
1 - 1 












2 - 2 

6 1 7 
2-2 

3 3 6 










1 - 1 
114 15 

3 9 12 


5 4 9 
3-3 

5 11 16 


1 - 1 

2 2 4 
- 1 1 

2 5 7 


5 5 10 


1 1 2 


] - 1 








diseases, etc. 
With organic changes of 








nervous system ■. 












Manic-depressive psy- 












choses .... 


- 1 1 

1 - 1 

1 - 1 

1 1 












Paranoia and paranoid 


1 1 2 




1 1 






conditions 
With psychopathic per- 






sonality . : 
With mental deficiency . 
Undiagnosed psychoses 






















- 1 1 




















Total 


22 13 35 


15 7 22 


16 13 29 


13 16 29 


5 8 13 


5 5 10 



62 



P.D. 23 









■* 1 1 1 I/-. 1 1 ri r^ 1 i^ f, f, — 1 fN ir; ■* 1 f^l -H 1 


-N 




a 
> 


H 




■b 




o 




1 1 1 1 1 1 i'N— 1|— 'rrjCM— ■l-H(NCSI |-^l 


V5 




M 


fc 




CM 




a 










•D 


S 


•*i 1 l>Ol IO<M|VOI— 1 l-.rOCN|(NI 1 










1 1 1 I'^ll 1 l-<|~5l— |-*|fO-<l 1 1 1 


\r, 






H 








CJ 










M 










_ai 




[ 1 1 1 1 1 i [ 1 i tS 1 w 1 j 1 1 t 1 I 1 1 


<r> 






fc 








O 










^ 


1 1 1 irsl 1 l-^l— ■! 1 l^|r<;'H| i 1 1 


CM 


CO 
O 












OCfllfN'OI-'OI IVOf^vCtN — VOOtNl l^-l 


^ 




H 


CM 


t^ 


-a; 


^="3 








« 


bfl O 




— CNItM— 1| IrJI lie— <*5rMlr*50— 1| \ -"^ 


ID 


s> 




fei 




rs 


w 


S^ 








a. 


C/2 


i 


■^■--1 1^11— i-*l 1— r^l'^l— <^C>— 1 1 1 1 


O 


,^^ 






t^ 


e 
a 














00^-«-t(N^»^^0^-;'^y^^Ot^^C^-^000^^'H^NCO 1 •* 


r^ 


'e* 




H 


rt •« wr iM .«,j.„rt 


CN 


sj 


C 








•«?» 


2o 
s o 








*. 




0^\r, |r-^,-_ |r-5.rt |-fiy-. OJ — invC**© l<0 1-^ 


ro 


^ 


fe 


_ — <N 


O 


o 




o>(N^« — tNiroC'J'-<>OM"*--'^'*0>>OCNt^ ! rr: 


O 


<» 
o 




^ 


— CM -- 


Z^ 


S£ 
















CM 1 1 1 ^. 1 1 — 1 1 1 -H — 1 1 1 M ^ 1 rt 1 1 


CM 


<)i 




H 




*H 


"^ 








G^ 


-o> 


fc 


CMIIIIIIIIII— — lll-<ll«ll 


^0 


^ 










•| 


Pi 


^ 


llllr^ll—llllllll— --llll 


O 


13 


>, 




1 1 1 1 1 1 1 ^ 1 1 1 1 1 i 1 1 ^ 1 1 1 1 1 


c^ 


<» 




H 






^ 


o 






CO 

to 


13 


fc 


i 1 1 1 1 1 1 — 1 1 1 1 1 1 1 1 -^ 1 1 1 1 1 




O 


(S 


^ 


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


1 


cc 














H 


CM|-^|rOI |Tf->--iOOCMCM--C-l|lOI l>CI<N 


O 


CO 


0) 


fc 


1 1 1 1 1 1 If^l—Tl-CMI— 1 I'tl I n ] „ 


e> 


TS 


1"^ 


s 


CM 1 -- 1 ^0 1 1 — -< I'^ICMICMI-cl ircl-. 


^H 


^ 






ro 


CO 






Tf<OcM>000''5T}<r^OCM-*»00>>OlOOOOvOv01CMCMr^ 


1/5 






H 


r^ T-1 cq ^^ ir; ^ '— ^ ^ r^ ^ CM 


'^ 


&H 


5 








o 




^I^ |u-;^— 1— ?N— VCCMOMJ-. lOOr^Ov lOc^lPO 


^ 


c 
H 


b 


" CM ro— „^ „ 


O 
- 






c^irOCM — vOCMTtOOC — X'*'©— 'OOOI^OCJCM I ■* 








i 


^ CM •* _ _< „ f^ _ „ 


CM 


s 










:« 










c^q 
























<» 




























<» 










Q 




















p 




00 






c . . a 

0) O^ (J to 




1^ 






■z; ■z>. ii >, 




h3 


7) 

w 








< 


o 

u 








>> 

[/) 

a, 




!lil...llg. !M.i . 

illll^=liili-4iS5.fr|is 


















o 








■S-5-S50 <u g-S-S-£ = 'o iJ'S^S E g'5'S;5-S 





P.D. 23 



63 





i 

c 
c 


H 

fc 
S' 


1 1 1 1 1 1 -- 1 1 1 — 1 1 1 -H-,^ 1 1 1 1 1 
1 1 1 1 1 1 1 1 1 1 — 1 1 1 1 — 1 1 1 1 1 1 

1 1 1 1 1 1 -H 1 1 1 1 1 1 1 — 1 ^1 1 1 1 : 1 






+ 

§ 

o 
o 
o 


H 
fe 
§ 


r^'-l I—I IVOI 1 — 1— Ir^lM — tNI 1 1 1 


•* 
-o 

o 


in 

CO 
K 

o 


1 

O Ov 

o •* 
— <-^ 




W-. — |ir;^i— |ro — — <^r-i-*Tt'T!H — (V1-* i-# — rsi 

u- — ^J 1 1- ^1 — O U-, 1 CN — ^ — "-. "-. '^ ^ — ^ 1 <^ 


00 


eg 




— lllllllll'Nill— — -^l— — II 

-<IIIIIIIIIMIIII'-III— II 
llllllllllllll— I'^l-Hlll 


o 


5l> 

s 
O 

K 

s 

o 

W 
CO 
•■SI 






1 1 ir-l—l |iM| 1— [— 1— lir;— Ir-ll 1 
ll!<N|||||l— l-Hllll— I--1' 

1 1 1 1 -- 1 1 oq 1 1 1 1 1 1 -H 1 i/~, 1 1 rt 1 1 


o 


is 

2^ 




r^— 1— r^[-H>C— lTt"*| 1 1— t^iMjIMI 1 
1 — 1 1 1 1 1 M — 1 M ro [ i 1 1 1/-, rl 1 -- 1 1 
IM 1 1 — ~5 1 — ^ 1 1 IM — 1 1 1 — (M 1 1 — 1 1 


OO 


1 _, 




^— 1| l">l lO^-- — CM^fNI-HtX-^lu^ — -H 
{N«| 1 1 1 Ir', 1 |i/-, U-, -H|— -^rcHlw—l 
Ml 1 1 "-. 1 i \C — — ^ M — 1 1 1 U-, rr. I ■*' 1 — ' 




"c? 


1 
c 




1— 1 l"l-HTfM|rnMTl-| |«ir;«|-.| 1 
1 1 1 1 1 1 1 !^1 1 1 — IM M 1 1 -< rr^ 1 1 — 1 1 
1— 1 1— 1— OjrNIOllMl 1 ItN—l 1 1 1 


V3 




H 


-*C M^Oc5C^c•i■^-Crs|■*OC^»Ou-lOO<^O^MlMO^l^ 




S 


o 


fc 


Mr- 1 U-, M « 1 — 1 M — ■ O ri CN "-- 11^ O CN 0> 1 C CN r^ 

— M ~-, — -< -* -H 








i 


IM'CM«'OM-f<50C-H0C-*O--HO00t^OCMCS 1 ■* 






c 

X 
o 
>■ 

Oh 






o 


C5 

n 


B 

c ■ • • -S 

= t3°?..«^'^'...m.... 

n'S aj n =" • m'C 5.2 ■ 2-° M ■ S • C ,, <u ° „, 

!is|||li|T,lf|„|i|ll||. 

:S£-S'Sg<^s5-£-£^Po'Si^cEg-S'5=5'5 



64 



P.D. 23 



Table IQ. Economic Condition of First Admissions Classified with Reference to 

Principal Psychoses 







Total 




Dependent 


Margins 


1 


Ur 


known 


Psychoses 




























M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


With syphilitic meningo-encephalitis . 


■79 


12 


34 


6 


2 


8 


14 


10 


24 


2 




2 


Withother forms of syphilis . 


3 


7 


10 


1 


1 


2 


2 


6 


8 


- 


- 


- 


With epidemic encephalitis . 


2 


- 


2 




- 


- 


1 


- 


1 


1 


- 


1 


With other infectious diseases 


1 


5 


6 


- 


- 


- 


1 


4 


5 


- 


1 


1 


Alcoholic psychoses 


26 


2 


28 


6 


- 


6 


18 


2 


20 


2 


- 


2 


Due to drugs, etc 


2 


1 


3 


1 


- 


1 


1 


T 


2 


- 


- 


- 


Traumatic psychoses .... 


4 


- 


4 


1 


- 


1 


3 


- 


3 


- 


- 


- 


With cerebral arteriosclerosis 


46 


21 


67 


15 


3 


18 


27 


17 


44 


4 


1 


5 


With other disturbances of circulation . 


8 


2 


10 


1 


— 


1 


6 


2 


8 


1 


- 


1 


With convulsive disorders (epilepsy) 


1 


1 


2 


- 


— 


- 


1 


1 


2 


- 


- 


- 


Senile psychoses 


18 


36 


54 


3 


5 


10 


9 


23 


32 


4 


8 


12 


Involutional psychoses .... 


4 


12 


16 


- 


- 


- 


4 


9 


13 


- 


3 


3 


Due to other metabolic diseases, etc. 


10 


9 


19 


4 


- 


4 


5 


8 


13 


1 


1 


2 


With organic changes of nervous system 


1 


5 


6 


- 


1 


1 


1 


3 


4 


- 


1 


1 


Psychoneuroses 


10 


S 


15 


3 


- 


3 


7 


3 


12 


- 


- 


- 


Manic-depressive psychoses . 


8 


10 


18 


- 


2 


2 


7 


7 


14 


1 


1 


2 


Dementia praecox 


37 


42 


79 


4 


5 


9 


29 


36 


65 


4 


1 


5 


Paranoia and paranoid conditions 


10 


9 


19 


2 


2 


4 


8 


5 


13 


- 


2 


2 


Psychoneuroses 


10 


5 


15 


3 


- 


3 


7 


5 


12 


- 


- 


— 


With psvchopathic personality 


2 


- 


2 


1 


- 


1 


1 


- 


1 


— 


- 


— 


With mental deficiency .... 


12 


10 


22 


3 


3 


6 


9 


/ 


16 


- 




— 


Undiagnosed psychoses .... 


- 


2 


2 


- 


- 


- 


- 


1 


1 


- 


1 


1 


Without psychoses 


4 


3 
194 


/ 


2 


3 


5 


2 


-" 


2 


~ 


~ 


~ 


Total 


231 


425 


55 


27 


82 


156 


147 


303 


20 


20 


40 



Table 11. Use of Alcohol by First Admissions Classified with Reference to Principal 

Psychoses 







Total 




Abstinent 


Temperate 


Intemperate 


Unknown 


Psychoses 
































M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


With syphilitic meningo- 




























encephalitis . 


22 


12 


34 


7 


3 


10 


6 


5 


11 


6 


2 


8 


3 


2 5 


With other forms of syphi- 






























lis 


3 


/ 


10 


I 


4 


5 


- 


2 


2 


1 


1 


2 


1 


- 1 


With epidemic encepha- 






























1 itis .... 


2 


- 


7 


- 


- 


- 


9 


— 


2 


- 


- 


- 


— 


— — 


With other infectious dis- 






























eases .... 


1 


3 


6 


1 


5 


6 


- 


- 


- 


- 


- 


- 


— 


- — 


Alcoholic psychoses 


26 


9 


28 


- 


- 


- 


- 


- 


- 


26 


2 


28 


- 


- - 


Due to drugs, etc. 


-> 


1 


3 


2 


- 


2 


- 


- 


- 


- 


1 


1 


- 


- — 


Traumatic psychoses 


4 


- 


4 


7 


- 


2 


2 


- 


2 


- 


- 


- 


- 


- - 


With cerebral arterio- 






























sclerosis .... 


46 


21 


67 


22 


19 


41 


10 


1 


11 


7 


- 


V 


7 


1 8 


With other disturbances of 






























circulation 


8 


2 


10 


1 


9 


3 


4 


- 


4 


1 


- 


1 


2 


2 


With convulsive disorders 






























(epilepsy) 


1 


1 


2 


1 


1 


2 


- 


- 


- 


- 


- 


- 


- 


- — 


Senile psychoses 


18 


36 


54 


8 


22 


30 


- 


6 


6 


4 


1 


5 


6 


7 13 


Involutional psychoses 


4 


12 


16 


- 


7 


V 


2 


2 


4 


2 


1 


3 


- 


2 2 


Due to other metabolic 






























diseases, etc. 


10 


9 


19 


3 


6 


9 


3 


2 


5 


3 


- 


3 


1 


1 2 


With organic changes of 






























nen-ous system 


1 


5 


6 


1 


4 


5 


- 


- 


- 


- 


- 


- 


- 


1 1 


Psychoneuroses . 


10 


5 


15 


6 


2 


8 


3 


2 


5 


1 


- 


1 


- 


1 1 


Manic-depressivepsychoses 


8 


10 


18 


3 


6 


9 


1 


1 


2 


4 


9 


6 


- 


1 1 


Dementia praecox . 


37 


42 


79 


20 


32 


52 


9 


8 


17 


4 


1 


5 


4 


1 5 


Paranoia and paranoid con- 






























ditions .... 


10 


9 


19 


4 


6 


10 


4 


- 


4 


- 


2 


2 


2 


1 3 


With psychopathic person- 






























ality .... 


2 


- 


2 


- 


- 


- 


2 


- 


2 


- 


- 


- 


- 


— - 


With mental deficiency . 


12 


10 


22 


9 


8 


17 


- 


- 


— 


2 


- 


2 


1 


2 3 


Undiagnosed psychoses 


- 


2 


2 


- 


2 


2 


- 


- 


- 


- 


- 


- 


- 


- 


Without psychoses . 


4 


^ 


7 


- 


1 


1 


1 


2 


3 


3 


- 


3 


- 


_ _ 


Total .... 


231 


194 


425 


91 


130 


221 


49 


31 


SO 


64 


13 


77 


27 


20 47 



P.D. 23 



65 



I — I : I I 

I -H I I I I 

I I I I I I 

I — I — (M i 

I — I I ^1 I 
111—11 

I — — I 1 I 
111—11 



— I I I c/: — I oc IN M — I 

— ir, — -f-^i- <^. '^-t — f^O — f^oc 00 .oc t 

oor^ I -*rs— I o^ — — XX>^^)r-)^-*' 
r*^ rN — 1 O \ f^. -^ f^j I li-, fN O — O -^ ■* L 



^ ^ ^ ^ uo ■— 

c-1 — 1 I I I : ^ \ 11- r-: 1 fn O ir. -o I O 1 — 

t^ — — — (^1^ [sOCM — r^ — c^5 Ir^-^C^f^CMO I — 






ir^rvl^ 1 *-*(N — O'NO^i^-vr; Cr^Ov i 0*N^ 



o 



;rNi — vC^J-^^X — x-tC— Cooi^; 






(u ^ z; oj 



K c 0) O 

•-; u. o i-< C, :3 , , _iD 
cnoa-ooOpo 



>." 



c 2 



?3-- o o S 



?_.2-^ S Q • 



.t: .„ .t; -t; o 3 g .- 



J2 C m 2 o 

■" o an r 

° " Q 3 o 

:S:S=°o 









' c -^ 



^s 



^ 5 M 
T3 x: .S m 5 i- ti 

ii S c Ki o 



66 



P.D. 23 



I I I 
I I I 



VO I — — « 
I I — I f^ 
M3 1 I — tr. 



I I 

I I 

I I 



fee 



i — 1 OlfO 



1 I I I 'f 



U-. — I pq o 



I I 

I I 
I I 



tN — — 1^ I 



T t- Tf m CO 



-I I I i I 



^ ■* — a^ O CC 



— I t--o I 



I ir> \C ^ <— 



— - I II 



w w r^ cN 






I — I I I I 
"; — I I I I 



I I I I r^ 
I I I I I 



I I II "TO 

II II — "O 
I I II ■* I 



1 I — I <N 






I I I I 

II II 
I I I I 



lO 



II II 

I I I I 

I I I 



I I~ I 

I I I 

I >- I 



— — -< ro 



_H rt -<fO <^ 



feS 



I I I 
I I I 



-* — 1/-, CN I 



vO — 



r-J „^ LO I 



t — 'c; >" = 2 

2 ^-s-r '" ■'SSJqS 






A i; == o) c 

: a « 2 S « .ii ■:= ^ 



.2 c3 Si 
.s .r; -c « ■ ~ 

;S S oj m S .5 
o P - 

d ^ CJ - 



E a.: 



t^j.-H rt _ *-■ Cl — fiTj^*-* ^ 

mC 2f ^ &^ a o c « o 
S; " ■^. ~ ~ -" o 0) 



I I II r^ I 

I 1 II •* i 

1 I II 00 I 

-- w ^ — . ■-. — r-i 00 rs 

I I - I I II j^-* 



;= X! ^ S i 



.Ci a 



o •■ 



• -^ O ra U, 4J ^ r- 






<n -w^^. 



-O.^ 



0, 



£, ft. 



^? 



P.D. 23 



67 



III Tfllll-llt^l— ||(MII II-*- _<|||-. Il^l^ 
III rollll— 1— — II— II II -t —III— llll^ 
III _|||| 11- 111^ II II 1 1 III 1 ||_|| 


1— 1| r^lllroOM— —ll'^l 11 1— f*-} 1 III <M IICJMiO 
1— 1 r<->lll'^vOP-ll— III 11 II ^1 1 lllr^ l|(M-H'<^ 
III lllll^l— II|!M1I i_— 1 III 1 III— pj 


IT, \ r^ O — — r-5~-, lOU^IM 111^ II II •* 1 II— 1 — |r/5— 1 
— 1— \0 — — 'IfO— -^P-l Ill's* II II ^ 1 II— 1 — llll 

Tfl— -Thllf^l-*- 1 llll II II— 1 III 1 ll-n- i 


3 5 8 

2 1 3 

16 31 47 

- 2 2 

- 3 3 

- 6 6 
9 13 22 

7 17 24 
5 5 

3 8 11 

2 1 3 

1 - 1 
2 2 

5 4 9 

2 - 2 
1 1 2 

4 4 8 
1 1 

- 1 1 
1 - 1 

- 2 2 
1 - 1 


III — 1— lltNjI llll II II— 1 III 1 lllll 
III 11-11— II llll II II- 1 III 1 lllll 
III — 1 1 1 1 — 1 1 llll II II 1 1 III 1 lllll 


1 1 

18 30 48 

1 2 3 

2 1 3 

.5 - 3 
1 1 

1 - I 

7 6 13 

1 1 
1 1 

5 5 


III III — - -II III- II II- — — II 1 lllll 
III III — — III III- II 11- -,-,1 1 lllll 
III 1 ; 1 1 1 - 1 ) llll II II 1 1 III 1 lllll 


^111 t^ 1 ■* 1 1 so — 1 -111-- 11 — -N in -V) III r^ 1 PO — — o 

-III -Jfli^ll '^— 1 — ll-Th II — ^r-l r-i III O |(M|— (N 

— 11 r<^l— l|fOII lll'O 11 11 f^ 1 111— 1— — |f^ 


111 ^|„-i| III -III II 11- --,11- -i-r-,1 
111 li-ii III— III II II- — — II T — II— 1 
III ^,11—1 III llll II II 1 1 1 1 1 — 1 1 — — - 1 


2 1 3 

16 29 45 

2 1 3 
-33 

3 4 7 

3 9 12 

1 1 

1 2 3 

1 1 2 
10 8 18 

1 I 

1 1 2 
4 4 

- 4 4 

1 - 1 
1 - 1 

1 1 
10 3 13 


Psychoses Due to Convulsive Dis- 
orders (Epilepsy): 
Epileptic deterioration 
Epileptic clouded states . 
Other epileptic types 
Psychoses Due to Disturbances of 
Metabolism, Growth, Nutrition or 
Endocrine Function: 
Senile Psychoses: 
Simple deterioration 
Presbyophrenic type 
Delirious and confused types 
Depressed and agitated types 
Paranoid types 
Involutional psychoses: 

Melancholia .... 
Paranoid types 
Other types .... 
With diseases of the endocrine 

glands 

Exhaustion delirium 
With pellagra .... 
With other somatic diseases 
Psychoses Due to New Growth: 
With intracranial neoplasms , 
With other neoplasms 
Psychoses Due to Unknown or Her 
editary Causes, hut Associottd 
with Organic Changes: 
With multiple sclerosis 
With Huntington's chorea 
With other brain or nervous 

diseases 

Disorders of Psychogenic Origin or 
Without Clearly Defined Tangible 
Cause or Structural Change: 
Psychoneuroses: 
Anxiety hysteria 
Conversion hysteria: 
Anesthetic type 
Hyperkinetic type 
Autonomic type 
Mixed hysterical psycho- 
neurosis .... 
Psychasthenia or compulsive 
states: 

Obsession .... 
Mixed compulsive states . 
Neurasthenia 
Hypochondriasis . 
Reactive depression 



68 



P.D. 23 



- :0; 




H 


<M ^, — -^ -. ^ 1 ! Tf 


-H c^ VC 1^ r-l — — ro 


w i>j Lc -J 00 1 1 - 1 1 1 1 1 1 


, .h" 


•c O 










s 


4^ m 


fc 


•M — r^ r- «-^ 1 i ir; 


1 I/-, — • t^ •-(■ — O <M 


-^l^woO II 1 llll 1 


> 


^1 










O 


§ 


1 rq •* ts 1 1 1 1 rt 


— ■* lO 1 OC 1 U-, .- 


1 r^- II II 1 llll 1 


H 












^ 


Uj 


H 


t^l '^ C- — !N -< -1 1 1 


r-l(NCNCMO0(NCf^ 


w*^~| li 1 llll 1 


o 


C 




— — tSCN <M 




if 


_^_o 










H 

y. 


u en 


b 


« p', lo r- (S — -. 1 1 


(NO^C^P^CSfNCS — 


— PT— - 1 II 1 1 r 1 1 1 










u 


Eg 










< 

a, 


T3 


S 


— 1 -* Tf 1 1 i 1 1 


1 f;r^ 0\0 1 OC CN 


1 — PC 1 1 II 1 llll 1 






H 


r>i 1 1^ CM — ■ IT, — 1 cs 


— i^00Or~(v;(N — 


U-, o< (N r^ — ■ 11 1 llll 1 


,, 


en 


c<5 '- 


C^fO X 'CO cs — 


*-H f*^ 




• C 










d 


■sl 












fc 


_ 1 ir'.w. — r<:\ 1 Tt 


O vC t^ — Ov ". ir, i-^ 


TOl^'tl II- 1 llll 1 


a-' m 




CtJ-.O^rf — 




^1 






"" 




a 


w 


^^ I rs r^ 1 fs ^- 1 lA 


Ul — . .- CM» 1 t- ■* 


•- O- 1/-, PC '- II 1 llll 1 


B. 




»^ 




^ P^ (V-, -^ ir, 




o. 












Oh 


















I U-. w; C 1 U-, — 1 l^ 


oc«ai^"*-#cM^ 


WPO'tPC— t«5 1 •- — ■CSP^ 1 1 










ts (N 00 — or. 1/; — 


p*^ Tf '- 


z 


c 


H 




-H CN .— 




u 


*j.2 










g 












!fl 


•t^ -2 




1 fN t^ <^ 1 u", -H 1 ^- 


O — •* — LC, r/^C-c^ 


■"tOtNt--— 1 1 1 1 -<CStS 1 1 


u 


fc c 


1^ 




X ir. -^t- n 


PN CS 


»; 


XI 






■" 






< 


^ 


1 f^ ^t^ 1 1 1 1 O 


c-lt^u-, oa— COC 


•tP', r)vCI PCI — ll—l 1 








(M ^ c; O O ^ 


■^ (N 










^H *« 






m 


H 


!■- ^« , 1 1 1 - 


tS U-, Tf U-, r^ 1 CS 1 


1 11 l«. 1 llll 1 


C/) 


■^2 

Si 


fc 


1 -^ 1 1 1 1 1 1 1 


— -t r'. -'-, re 1 r-) 1 


1 -H- II 11 1 llll 1 


a 


^E 










s- 






— — — <N 1 1 1 1 


1 1 1 1 1 1 — ' 1 llll 1 


< 




i< 








K 












Q ■ 




















' 


|W.H-<C II 1 llll 1 


J 


c 


H 








_l 


^ o 
































1 -H 1 1 O II 1 llll 1 






U< 










ES 












•o 


S 


II 1 fS 1 1 1 1 1 


^1 — ~5 ^ M 1 — .— 


II— — -* II 1 llll 1 






H 


— 1 tN"* 1 1 1 1 —■ 


fO CN ro t^r^ 1 «\0 


l-H10l<N SCI 1 ir-ifNI 1 




1 c 














fel 


II O. r»5 1 1 1 1 — 


•^ ^ — (M rrj 1 rt(^ 


1— "tl— — 1 1 1—— 1 1 


o 


Pi-s 










< 


E 


^ 


•^1 f'/ — 1 1 1 1 1 


<M 1 r^ — rt 1 1 ro 


II — 1— t^l 1 1—— 1 1 


m 


H 


r^p*" OC 1^^^- 


O 1/-. — X — I •* 't 


1 -C 00 PC ^1 C ", 1 1 — Ov — — 


Q 


C 

o 


" 




t^l 














.J 


i2 m 


fc 


-- •*«: 1 -- 1 •* 


~- i>l tr. ir: -^ \ \C rr, 


1 1/^ C'J IM ^1 — <^1 1 ll—l 1 


"^ 


Ee 












•o 

< 


^ 


r-q ^ rN X 1 1 [ — r-i 


ir. ~-, O 1^ O 1 » — 


1— -o— 1 0-. — 1 1— 00- — 






H 


1 CN Tj. CN 1 — 1 1 c-l 


Ol CO f^ 00 "7 1 -IT 


C-IPCPCI— Ol 1 IPCIN- — 




«} 










< c 












•o o 










•A 
y. 




ta 


II t- 1 1 1 1 1 1 


— P^ -H :^ C; 1 — (^1 


(N PC t^l 1 1 — 1 1 1 tN 1 1 1 


o 


^■i 










c^ 


^ 


1 r^i T'. f^j 1 »-H 1 1 r^] 


— 4 ly-, r^I ^H vC 1 1 P^l 


1 1 - j - O 1 1 1 -rs- - 


w 




^ 
































c 


M 


H 


iMro tvi o i 1 1 1 rr 


U-. « O 0» P'. -H 00 CS 


(MaapctN opc — — — ai- 1 


< 


c 










_o 










i^ 














" m 






IMP^P^C'* 1 On I 


C-IVOCS- 00 — IN 1 — IPCI 1 


< 


feE 


Wh 










73 

< 


s 


(N (N IC ■* 1 1 1 1 — 


p^iOP^CM^'-HONf^l 


IPCt^lM-* 0-— — 1— >OI 1 












>. a, 








i 


>> 


■ ■ c ■ 5"° 




w 

Q 




. . <u G 

•It -: 


15 

c 

o •• 

g& 


H • ..§s ■ ■ ■ 

E ^'S- 

oj .ti o 2 
• • • ■ . • -S -"m E o ■ • 








2- . ^ 


^ s?| 


?^ G S '^ E 




.-1 

Id 




i)0.> So p-g 8 


*- C CJ *-• w dJ 

iiG.° 2 OJ-O >.o 

•• a?:i rt c5 Soo qE 
2.5 5i« S^ S gj5J= 


sill §~5S'S-Ei5^.S §2.2 
1?|<QQ P, WS 








S 














:§^ 



P.D. 23 



69 



II II II 
II II II 
II II II 


o 

<o 

o 


II II II 
II II II 
II II II 


o 

CO 


II -H 1 II 

-- 1 II II 


0^ 
00 


1- - 1 - 1 




II 1 1 II 
II II II 
II II II 


o 


II II II 


00 


1 lO lor^ II 

1 ^ ^ro 1 1 
1 -* ■ f 11 


o 

<J-> 

->• 


1 - 1 

6 1 7 

17 12 29 
12 6 18 

1 1 
1 - 1 




4 1 5 

3 4 7 
6 3 9 

95 63 158 


3-3 

14 13 27 
9 6 15 

- 2 2 
1 - 1 


O 

d 

fO 


Imbecile 

Epilepsy and mental deficiency : 
Other non-psychotic diseases or 

conditions .... 
No other condition . 
Priviary Behxiior Disorders: 
Primary behavior disorders in 

children: 

Conduct disturbance . 

Neurotic traits 


5 
o 

C 

2 

o 



70 



P.D. 23 



Table 14. Discharges of Patients Classified with Reference to Principal Psychoses 

and Condition on Discharge 







Total 




Recovered 


Improv 


;d 


Unimproved 


Psychoses 
















































M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. F. 


T. 


With syphilitic meningo-encephalitis 


7 


9 


16 




2 


2 


- 


y 


14 






With other forms of syphilis . 


3 


2 


5 


2 


- 


2 


1 


1 


2 


1 


1 


With epidemic encephalitis 




1 


- 


1 


- 


- 


— 


1 


- 


1 


- - 


- 


With other infectious diseases 




1 


- 


1 


- 


- 


- 


1 


- 


1 


- - 


- 


Alcoholic psychoses 




28 


4 


32 


8 


3 


U 


20 


1 


21 


- — 


— 


Due to drugs, etc. 




1 


2 


3 


1 


1 


2 


- 


1 


1 


- - 


- 


Traumatic psychoses 




5 


- 


5 


- 


- 


- 


4 


- 


4 


1 


1 


Witli cerebral arteriosclerosis 




14 


13 


27 


1 


2 


3 


12 


g 


21 


1 2 


3 


With con\rulsive disorders (epileps 


^') 


- 


1 


"l 


- 


1 


1 


- 


- 


- 


- - 


- 


Senile psychoses 




4 


9 


13 


- 


— 


- 


3 


7 


10 


1 2 


3 


Involutional psychoses . 




4 


4 


8 


- 


- 


- 


3 


4 


7 


1 


1 


Due to other metabolic diseases, etc. 


3 


6 


Q 


_ 


1 


1 


3 


5 


8 


- - 


- 


With organic changes of nei-vous system 


3 


6 


9 


- 


3 


3 


3 


3 


6 


- - 


— 


Psychoneuroses 


7 


11 


18 


5 


3 


8 


2 


8 


10 


- - 


— 


Manic-depressive psychoses . 


14 


30 


44 


9 


7 


9 


12 


20 


32 


- 3 


3 


Dementia praecox 


43 


33 


76 


5 


2 


7 


33 


28 


61 


5 3 


8 


Paranoia and paranoid conditions 


8 


7 


15 


2 


1 


3 


6 


6 


12 


- — 


- 


With psychopathic personalitj- 


3 


6 


9 


1 


4 


5 


2 


2 


4 


- - 


- 


With mental deficiency .... 


9 


13 


22 


4 


.S 


9 


S 


8 


13 


- — 


- 


Undiagnosed psychoses .... 


- 


1 


1 


- 


- 


— 


- 


- 


- 


1 


1 


Without psychoses .... 


4 


3 


7 


- 


- 


- 


- 


- 


- 


- 


- 


Total .... 




162 


160 


322 


31 


35 


66 


118 


110 


228 


9 12 


21 



P.D. 23 



71 



Table 15. Hospital Residence during This Admission of Court First Admissions 

Discharged during 193^ 











Average Net 






Number 




Hospital Resid 


ence 


Psychoses 










n Years 






M. 


F. 


T. 


M. 


F. 


T. 


With syphilitic meningo-encephalitis 


4 


8 


12 


.97 


2.37 


1.90 


With other forms of syphilis 










2 


2 




25 


.17 


.21 


With epidemic encephalitis 










1 


_ 




.20 




.20 


With other infectious diseases . 










1 


_ 




.12 


_ 


. 12 


Alcoholic psyi_hoses 










21 


3 


24 


.71 


.75 


.71 


Due to drugs, etc 










1 


2 




04 


16 


. 12 


Traumatic psychoses 










S 


_ 




.70 




.70 


With cerebral arteriosclerosis 










13 


12 


25 


.50 


.50 


.50 


With convulsive disorders (epilepsy) 










_ 


t 






.20 


.20 


Senile psychoses 










4 


7 


U 


.29 


.55 


.45 


Involutional psychoses .... 










4 


4 


8 


.68 


1.01 


.85 


Due to other metabolic diseases, etc. 










3 


5 


8 


.20 


3.63 


2.34 


With organic changes of nervous system 










3 


.5 


8 


1.15 


.45 


.71 


Psychoneuroses 










6 


10 


16 


.3.^ 


1.20 


.87 


Manic-depressive psychoses 










11 


17 


28 


.51 


1,33 


1.01 


Dementia praeco.x 










34 


24 


.58 


1.49 


2.62 


1.96 


Paranoia and paranoid conditions . 










S 


6 


14 


.33 


.42 


.37 


With psychopathic personality . 










1 


3 


4 


47 


.75 


.68 


With mental deficiency .... 










8 


<> 


17 


.29 


1.69 


1.03 


Without psychoses 








3 


I 


4 


.12 


.12 


.12 


Total 










133 


119 


252 


.76 


1.46 


1.09 



72 



P.D. 23 





>. 




— II II 1 III 1 1 lilcsll r^ll III 
III II 1 III 1 1 1 1 1 -< 1 1 — 1 1 III 
—11 II 1 III 1 1 lii^ll OJII III 




:S O 

C 




-111 II 1 — II l-H|||fOll ■O- 1 - 1 1 

1 1 1 — 1 1 111 1 1 1 -H rr; Tf 1 -- r- 1 1 III 


CO 

o 

CO 


> £ >. 

■~ :3 a V 
> > or= 




III 11 1 1 ] -< 1 1 1 1 1 1 1 1 III III 
III II 1 1 I 'H 1 1 1 1 1 1 1 1 III III 
III II 1 III 1 1 1 1 1 1 1 1 III III 




dj O 
•5 




— 1 |- 1 111 1 1 11—111 —11 III 

— 1 1 II 1 III 1 1 1 1 1 1 1 1 III III 
III II 1 III 1 1 1 1 - 1 1 1 — 1 1 III 


o rt -';o 




(Mil C^M CN — -Ml 1 1 rtrt—t^ll f^ll III 
III II CN III 1 1 II — - II Oil III 




O o • 
It 

< G 


fa 


C^l 1 1 II 1 III 1 1 1 1 1 1 1 1 f \ \ III 

— 1 1 II 1 III 1 1 1 1 1 1 1 1 — 1 1 III 

— 1 1 II 1 III 1 1 1 1 1 1 1 1 C', 1 1 III 


CO 
CO 


r- 1^ 5 S 

t: a! .2 ", 

>'^ '-> ^ 




1 ' 1 II i 111 1 1 1 1 1 1 1 1 — 1 1 III 
III II 1 III 1 1 1 1 1 1 1 1 III III 
III II 1 III 1 1 1 1 1 1 1 1 - 1 1 III 


O 

CO 






II"-, 11 1 1 -H 1 1 1 1 1 1 1 1 1 III III 
1 1 fO 1 1 1 1 — 1 1 1 1 1 1 1 1 1 III III 
1 1 (N 1 1 1 III 1 1 1 1 1 1 1 1 III III 


■Si 


.y 6-- 


fa 


II— 11 1 — Ol 1 1 llllll llfT) III 
111 II 1 1 t- 1 1 1 llllll 1 1 — 1 1 1 
11-11 1 — ^ . 1 1 llllll 1 1 f^ 1 1 1 






H 


— — l^ OC— ^ o — — — — I/-, r-lOC — rvj COf^** CNCN — 

r-1 tN r-) vO 


CO 


fal 




c^j^r.-, lOI ■« r-irol rt 1 tNCN'i'N — — ' CCIO -HCN-< 


H 

m 
< 

Eh 


H 

Q 



w 

D 

< 




is '.1? - 111 ■§ ss ■"!! "1 II' 's^lg ■ 

in ii!;i-piiinrirn.j 1 

^.2 -.^gloiJio .^^^1 .^a;^ -§ -53^0 .^QiggEsiq^SS^ 
.2 S eilS PI g-1| 1 S-g S^S g 1 S § 1 g|-£ ll 1 nil i Sg| 



P.D. 23 



r^ fN fO 'H 



fS ^ M CN ^ w O 



r^ r^ I rt N w -H I I I 



I I -I I II — (M-.«r-5 



eC "■§ 



CO nf 



;3 " 






m o 2 



.O 



J= "3 2 m -r 



.Q 



•s> 






i ii D SOqCQ 

3 XI J3 te^ to 

S ■ ■^ ■ " I- ? .e ■ • *^ 

S'o Kta w^-i tr'^*'-' >» ^ 
aj(i;a)D(DOS°"Se -S 
3*-to*-'m„SSH o, 
uanlQcag.^ggo :i„ 



• ' V rr, ^ 

to a --2 (J-* 

O C C y 

.2 "^ 5— • 
o c 2 g 



rt oj rt 4-> 



'^ --z:- 



, e bo B 

j u nj a> 



« _ 



:i'o S ox; 

3 O O O ^ 



74 



P.D. 23 





o 2 
> a 




III II < II 1 1 1 1 1 1 1 1 -^1 
III II 1 III 1 1 1 1 1 1 1 1 II 
111 II 1 III 1 1 1 1 1 1 1 1 —I 


T3 


, "6 
-^ ft 


H 

fc 
S 


III II 1 III 1 1 1 1 1 1 1 1 II 


C 
O 

o 

o 

so 


•a 




— 1 1 II 1 III 1 1 1 1 1 1 1 1 -- 1 
^11 II 1 III 1 1 1 1 1 1 1 1 II 


o , 

>■ £•■■? 

^ a 


h 
fc 

^ 


111 II 1 III 1 1 1 1 1 1 1 1 II 
III II 1 III 1 1 1 I I 1 1 1 II 




.2 "^ c (_" 


lll-l 1 III — IllltSII II 

1 1 1 — 1 1 III 1 1 1 1 1 Ol I 1 II 

III II 1 1 1 1 — 1 1 1 1 1 1 1 II 




H 
fa 


c^— 1 <S— 1 0)ll 1 ir^lll— 1 lO — 
i^ll I-" 1 (Nil 1 ItNIIIII (N- 


o 


■ill 

cd o u 

l; ft 

t3 


£_; r-i 1 1 II 1 III 1 1 1 1 1 — 1 1 ---^ 

J^- III II' 1 III 1 1 1 1 1 1 1 1 1 — 
g' ^11 II 1 III 1 1 1 1 1 - 1 1 — 1 




6 S' H 


I : 1 II 1 III 1 1 1 1 1 1 1 1 — 1 
III II 1 III 1 1 1 1 1 1 1 1 — 1 
III II 1 III 1 1 1 1 1 1 1 1 II 


e 
O 

s 

■to 


ni tr = = 

Pf 4J o S 

■£ 2 c « 


j_; 11—11 1 — II 1 !— liil— — 1 
jj/ II— II 1 — II 1 l — llli— — 1 
^ III 11 1 ■ r"T t 1 1 1 1 1 1 1 1 II 


c 

til 


fa 


III II 1 III 1 1 1 t 1 1 1 1 <-< 1 
III II 1 III 1 1 1 1 1 1 1 1 "1 
III II 1 III 1 1 1 1 1 1 1 1 II 




•5 


fa 


rs 1 1 Ol 1 tN III 1 1 1 1 — 1 1 1 CN 1 

III r^l, - III 1 III— III II 

^11 II — III 1 lllllll <NI 


S 

O 

< 


G 

b 
C 

w 
(/; 

3 




iliiil 'IW\s^,''m-- 

5|l^».i^|i. 1 ii ill i\l 11 

lliss? iS^I ^1^ i 1 ■ o sill- ll . Ii ll 1 

|||2 K ^ § S i -^ i ».•£ S !• £ >. 1 S g 2 fc - M fc 1 d 2 5 



P.D. 23 






S E 



^ S 2.2 



■-S % 



5.1 E 



£ o. =^ X S 

.s» § 5 -a 2 . 'S 
>J2 ™ <u o .^ 

S ^ £ tj *-> ~ 
.s o^ y:~-^ v£ 






ts t^ _ ^ 

c ij~ „ S i; Q o'**^^ 

e a7-5^.2.2 3 s o 
Szo aQ.Sa.g 



:XO 





e 




CT3 
n c 


E 


a 


m 


^ 




'5 


nj 


cd 


"a 








c 










's; 
























li 










ffi 


















•~E 




■a 




ta. 






K O 




T) 




■c 






■s s 


o 


ij 


C 


ux: 
















SO 


so 


J} 


<u<o 


cot- 













76 



P.D. 23 





45-49 
years 




CM 1 1 1 1 -< 1 1 1 1 1 1 i i IN« 1 -^ 1 1 
1 1 1 1 1 1 1 1 1 1 1 1 1 1 — 1 1 — 1 1 
CS 1 1 1 1 « 1 1 1 1 1 ! 1 1 rt-H 1 1 1 1 












•^ll-lllllllllloji-ii; 


00 


05 

eo 
O 

5s 

w 

U 

s 






Ml 1 1 :tsi 1 i—ci— — -Htsi 1 1 1 1 
<M- 1 1 1 J 1 1 1 1 1 1 1 1 « 1 1 — 1 1 


o 


1 ts 
6 ij 




!>)"!— Illllllll— Mlllll 
tN 1 1 1 1 1 1 1 1 1 1 1 1 1 -< 1 1 1 1 1 

1 — 1 — 1 1 1 1 ; 1 1 1 1 — -- 1 1 1 1 1 




s 


1 ca 

u^ OJ 




lllllllll'-l— l-H«l||l| 

lllllllll'-l-^l'-llllli 
1 1 1 1 1 1 1 1 1 1 1 1 1 1 -I 1 1 1 1 1 




■* CO 

1 a 




- 1 1 1 1 1 1 1 1 1 1 1 1 1 '' 1 1 1 1 1 
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 'H 1 1 


m 




« >, 




1 1 - 1 1 1 1 1 1 1 1 1 1 1 <N 1 1 1 1 1 

1 1 1 1 1 1 1 1 1 1 ! 1 1 1 — 1 1 1 1 1 

1 1 — 1 1 1 1 1 1 1 1 1 1 1 — 1 1 1 1 1 




•^ 


H 


rs ^ u^ « u"^ ^ f*^ 


•» 




"to 
o 
H 


fc 


OiO 1 r', OO'O — 'OtSvO^^OriiNO^"* |c«5CM | 


o 




s 






•5^ 




s 
u 
>• 
1/1 

a. 






^ 




o 




5a 




-^ 








n 
< 


s 

c S 

CO . . . . O^ . . ,• . t^ 

3 0! CO ct CO 

■§.■;• 'h| • 1 o •■ '.s^. •• ■ 

g|§ -s-^ • -^ -fc •£ -^i • • • 

OjSci liOCD "3 C to oC 

•S^g ogo So S >. oacg 

.ill ^51 ill lis- say II 
|ll.?-£|||.|sli|.s^|£ ! 

^oSoSoS^SooSj-ggoSEls 



P.D. 23 



77 





CO ^ 


H 


1 1 1 1 1^' 1 1 X 1 1 1 1 1 1 1 1 1 1 1 1 


ro 




;-. ID 










a > 










V o 


(li 


1 1 1 1 tN 1 1 ■* 1 1 1 1 1 1 1 1 1 1 1 1 


^0 




•a 










^ c 










CO (3 


S 


1 1 1 1 "5 1 1 ^ 1 1 i 1 1 1 1 1 1 1 1 1 


f^ 






H 


lll!^^-||Ollllil-.|,||| 


- 




•^ m 










00 b 










1 OJ 
00 >> 


di 


1 1 1 1 ^ - 1 t^ 1 1 1 1 1 1 - 1 1 1 1 1 


— 


T3 










3 




S 


1 1 1 1 o 1 1 f^ 1 i 1 1 1 1 1 1 1 1 1 1 


1 


U 








J 


Q 




H 


Ill—OO^IxOllllil— .l|||_^ 


o 


O 










1 


1 n) 


fe 


1 1 1 1 '■'5 1 I C^ 1 1 1 1 i 1 1 1 1 1 1 1 


cs 




lO iJ 






1 


t- >. 








60 
SO 




i 


1 1 l---:'~J|r-l 1 1 1 1 1— 1 1 i 1^ 


^ 


O 
So 














1 1 l—OI IC^wl 1 1— irjl ] 1 1 1 


f^ 




t^ >. 










S 


1 1 1 ^ t^ 1 1 r^ ^ — 1 1 I ^ r-i 1 1 1 1 1 


VO 














H 


1— •lc^^o^rN|-^■•.-— 1 1 |«P0rt| 1 1 1 


1/^ 


a. 












1 CO 


fe 


i-H|tNrOi In 1—1 1 1 ICN-hI I 1 1 




o 


lO 11 








>o >. 








s 




S 


IllivCr-Jli^—llll— — lllll 


f«5 


S 










ito 
















f, — 1 "5 CC n 1 r^, — -, 1 r^ 1 1 rrj 1 1 1 — 1 
I — 1 1 -1 1 1 r-5 — — 1 ro 1 1 -1 1 ; 1 — i 


CO 


-< 


\o >. 








•cO 




1,-^ 


~5 1 1 ro o r-1 1 1 1 1 1 i 1 1 cs 1 1 1 1 1 


O 


s 




(< 








Ov CO 


H 


(N— IMi/11 1 l—rol 1 1— -tl 1 1 1 1 


Ov 


'e^ 


lO i^ 










1 ? 

IT) u 


fa 


-"- 1 1 n 1 1 1 1 — 1 1 1 1 "^ i 1 1 1 1 


00 


e 


lO >i 






„ 






S 


— 1 loif^l 1 l—^l 1 1— -Hi 1 1 1 1 


^ 




H 


COINI— — 1 1 1 |io— 1— -"~or-ll 1 1 1 


S 


Q 


■* en 








<*-> 




fc 


"I'NI-Hl 1 1 1 |w— |_|(MCsl| 1 1 1 


CO 


o 


lO >> 








5» 




^_I 


'^lll—llll-*!!!— —Itlll 


„ 






r^ 




-" 


f-l 




"~l 






e 










K> 




















s 










<» 










■cO 










B 










Oh 










"^ 










<» 












Ui 

O 
S 
U 
> 




c 3 








5 ... .3 &..„-. 2 ... c ... 
Q to ^^ ^ ■2>. 

s-l -^'3.^ ■ .s .^ .. .^1 . . . 




pq 

< 


£ 












•p u- 3 .2 S ° S 2 <" 5? o a c S 
S St^ ot 3^„ 5!,^; S 2 i:qi3.5«>.m 

„pajj3ca*j^aJmSO-?to.Syot;<i.'»'C> 
.SSo°--ga^>^c5g33Q.^cJ-S-mS, 

ax:x:.Sjj;x:cg'o-ScSji»i.5rt>. Sg 


"cS 








>.'-'"— njj-'oaTi'-i^^^.- CO „c-" 










■ mOOouOO^OOOO,' C0C=M3 


o 






1 


H 



P.D. 23 



I I I — "5 I 



CN I ] —rf \ 



^« I rt ^ 



-- I I 'I'C i 






— I I I 't 



r-) I I — ■* I 



— I I 



o 



a: 



5 5 



-* I ^ I I 






:^ — sc^'-'Ofsr^^irj^^i';^^'-' 



;OCr<^— 'r/^^lvC — OtSCNO.'* I rr^cs 



■Ol — ?[^r^ I oc-tt^ LI I i/vio.-i^<N I — 



m 

n 

<! 
Eh 






o o 



■ ■v'-~ 



2 c o 






c e o o k. 3 



t; a^ in ^ fj 

r* u ^ 



o > 



o o q 



o u 



in " ■ ° 
CO O 4j 

-C CC ^ c 

C o C M g 

3 o o o o 
-* 3 3 •— ;? 



!S o^ 



S o a c 
a Cy.jj^^ 

., X 2-3 " u a, 

> o 5 ti »J " ° 

S b'S o-t;i3 >. 
I. a c _jj « D J' 

Ci -* ^ u f^ 5 a 

"O w " M ^ C *^ 

' c o a E M = 
■ii ij c _ _, 2 2 



.2 5 H 



79 



(U O 

o c 
tN a 



i — I I 
I ^ I I 
I I I I 



U 



55, 



^ 



O 



!U 



5r 



&^ 






S °.2 



O ?JT3 
O C o 

>■ ai-o-2 
aj2 ir 



&2 



E > 



m O O 
III 



o o o o 



O G d g 
X t^-d " <-J I' 

ts ;^ 5 c ^ ^ Ci c_£. ™ o s 
o (u (b-S ^ p S 2'S5-3'S 



80 



P.D. 23 



Table 19. Average Length of Hospital Residence during the Present Admission of 
All First Admission Cases in Residence on September 30, 193 U 



Psychoses 



Number 



Average Net 

Hospital Residence 

in Years 



T. 



With syphilitic meningo-encephalitis 
With other forms of syphilis 
With epidemic encephalitis 
With other infectious diseases 

Alcoholic psychoses 

Due to drugs, etc. 

Traumatic psychoses . . . . . 

With cerebral arteriosclerosis 

With convulsive disorders (epilepsy) 

Senile psychoses 

Involutional psychoses . . . . 
Due to other metabolic diseases, etc. 
With organic changes of nervous system 

Psychoneuroses 

Manic-depressive psychoses 

Dementia praecox 

Paranoia and paranoid conditions . 
With psychopathic personality . 
With mental deficiency . . . . 
Undiagnosed psychoses . . . , 

Without psychoses 

Primary behavior disorders 

Total ... . . . 



67 
6 
8 
1 
104 
1 
6 

52 
5 

2.S 

10 
8 



4.S 

6 

55 

30 



7 6 

19 17 

319 327 



42 
9 

53 
1 
7 
1 



93 
14 
14 

3 
109 

1 

7 
97 
11 
80 
40 
15 
12 
13 
36 
646 
63 
17 
98 

1 
13 

1 



4.93 
2.83 



3.99 
4.50 
9.19 
.45 
1.48 
2.88 

12.09 
4.13 
8.99 
2.23 
5.64 
1.04 
7.55 

12.57 
5.63 
9.24 
8.26 

4.30 



6.49 
6.36 
6.50 
3.98 
11.30 



11.35 

10.00 

9.83 

8.21 

7.50 

.45 

.45 



.36 
.84 
.06 
15 
.29 
.45 
.34 
,76 
8.40 
3.93 
6.87 
2.74 
4.40 
4.24 
7.60 
11.95 
8.54 
9.55 
8.23 
7.50 
2.23 
.45 



725 659 1,384 



9.05 



8.97 



Table 19a. Average Length of Hospital Residence during the Present Admission of 
All Readmission Cases in Residence on September 30, 193 1^ 









Average Net 




Number 




Hospital Residence 










n Years 




M. 


F. 


T. 


M. 


F. 


T. 


37 


6 


43 


4.05 


5.15 


4.20 


4 


_ 


4 


6.49 


- 


6.49 


7 


1 


3 


.98 


2.50 


1.48 


42 


8 


50 


9.18 


10.99 


9.47 


1 


1 


2 


1.50 


17.50 


9.50 


3 


_ 


3 


7.50 


- 


7.50 


13 


8 


21 


3.40 


4.49 


3.81 


5 


2 


7 


6.50 


8.98 


7.21 


7 


11 


18 


3.34 


5.31 


4.54 


3 


7 


12 


7.30 


12.50 


10.33 


_ 


4 


4 


_ 


7.24 


7.24 


9 


3 


5 


4.50 


.80 


2.28 


5 


3 


8 


4.48 


3.15 


3.98 


27 


38 


65 


6.37 


7.35 


6.94 


184 


309 


493 


10.51 


9.41 


9.82 


7 


18 


25 


9.07 


6.60 


7.30 


4 


7 


11 


6. 75 


3.19 


4.48 


27 


35 


62 


10.02 


7.17 


8.40 


1 


1 


2 


7.50 


.45 


3.98 


1 


- 


1 


12.50 


- 


12.50 


377 


462 


839 


8.60 


8.56 


8.58 



With syphilitic meningo-encephalitis 
With other forms of syphilis 
With epidemic encephalitis 

Alcoholic psychoses 

Due to drugs, etc 

Traumatic psychoses 

With cerebral arteriosclerosis 

With convulsive disorders (epilepsy) 

Senile psychoses 

Involutional psychoses . . . . 
Due to other metabolic diseases, etc. 
With organic changes of nervous system 

Psychoneuroses 

Manic-depressive psychoses 

Dementia praecox 

Paranoia and paranoid conditions 
With psychopathic personality . 
With mental deficiency . . . . 
Undiagnosed psychoses . . . . 
Without psychoses 

Total 



Table 20. Family Care Statistics for the Year Ended September 30, 193 ^ 

Males Females Total 

Remaining in Family Care September 30, 1933 17 70 87 

On Visit from Family Care September 30, 1933 2 24 26 

Admitted to Family Care during the year 15 78 93 

Whole Number of Cases within the year 32 148 180 

Discharged from Family Care within the vear: 12 75 87 

Died ■ 1 3 4 

Discharged - 4 4 

From Family Care to Escape Status 2 2 4 

From Family Care to Visit Status 1 22 23 

Returned to Institution 8 44 52 

Returned to Institution from Escape - 1 1 

Returned to Institution from Visit - 6 6 

Remaining in Family Care September 30, 1934 20 73 93 

On \'isit from Family Care September 30, 1934 1 14 15 

Average Daily Number in Family Care During Year 20 76 96 

Supported by State 15 52 67 

Private 5 20 25 

Self-supporting - 1 1