Public Document No. 23^
ANNUAL REPORT
TRUSTEES
MOF THE
Worcester State Hospital
/T--
FOK THE
Year Ending November 30,
1935
Department of Mental Diseases
■/
Publication of this Document approved by the Commission on Administration and Finance
500. 9- '36. Order 7583.
OCCUPATIONAL PRfNTING PLANT
DEPARTMENT OF MENTAL DISEASES
GARDNER STATE HOSPITAL
EAST GARDNER. MASS.
WORCESTER STATE HOSPITAL
Post Office Address: Worcester, Mass.
Board of Trustees
William J. Delahanty, M.D., Chairman, Worcester.
Anna C. Tatman, Secretary, Worcester.
Howard W. Cowee, Worcester.
John G. Perman, D.M.D., Worcester.
Josephine R. Dresser, Worcester.
George W. Morse, Worcester.
John L. Bianchi, Worcester.
Resident Staff
William A. Bryan, M.D., Superintendent.
Clifton T. Perkins, M.D., Assistant Superintendent.
Psychiatric Service
Morris Yorshis, M.D, Clinical Director.
Arthur J. Gavigan, M.D., Psychiatrist in charge Women's Department.
Benjamin Simon, M.D., Assistant.
Walter E. Barton, M.D. , Psychiatrist in charge of Men's Department.
Paul Haun, M.D., Assistant.
Eleanor Edgar, M.D., Interne.
Hildegard Waasa, M.D., Interne.
Joseph L. Goldstein, M.D., Interne.
Morris C. Beckwitt, M.D., Interne.
Medical and Surgical Service
W. Everett Glass, M.D., Director.
Embrie J. BoRKOvic, M.D,, Assistant.
William Freeman, M.D., Pathologist.
Joseph N. Finni, D.M.D., Dentist.
Research Service
Rot G. Hoskins, Ph.D., M.D., Director.
Francis H. Sleeper, M.D., Resident Director.
Joseph M. Looney, M.D., Director of Laboratories.
Wilbur R. Miller, M.D., Psychiatrist.
Louis H. Cohen, Ph.D., M.D., Psychiatrist.
Eilhard von Domarus, Ph.D., M.D., Psychiatrist.
Andras Angyal, Ph.D., M.D., Psychiatrist.
Harry Freeman, M.D., Internist.
Joseph H. Fierman, M.D., Clinical Assistant.
David S^akq-w^^M-^A,, Chief ^syphologist,. .
E. MoRToJf irjEEiii^Ekl M.Ed.,' p. Sc., Chief Biometrician. ^
George -Li '"Bakay*,' rFMT.' t)., M-edical iitbMHan.
Outrl*ATIENT DEPARTMENT
Milton E. Ki-rkvatkick,' M.D. , Director, ChildGuidanceClinic.
Jvh^A\^liV,^.:D.'^As;sfstax.t,'\ '[i'^l ,';
Summer Street Department
LoNNiE O. Farrar, M.D., Medical Director.
Special Workers in Research
Conrad Wall, M.D.
D. EwEN Cameron, M.B., D.P.M.
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.
Scb
i^ '?M'S
P.D. 23 1*535" 3
Donald K. McCluskey, MtD.7 Gynecology and Obstetrics.
Lester M. Felton, M.D,, Genito-Urinary Surgery.
John O'Meara, M.D., Orthopedic Surgery, Roentgenology.
Oliver H. Stansfield, M.D., Internal Medicine.
Erwin C. Miller, M.D., Internal Medicine.
Michael M. Jordan, M.D., Neurology
Jacob Goldwyn, M.D., Neurology.
Julius Tegelberg, M.D., Oto-laryngology.
RoscoE W. Myers, M.D., Ophthalmology.
Philip H. Cook, M.D., Roentgenology.
George Dix, M.D., Dermatology.
Oscar Dudley, M.D., Epidemiology.
Hudson Hoagland, Ph.D., Neurophysiology.
Melvin a. Clevett, Physical Education.
Heads of Administrative Departments
Herbert W. Smith, Steward.
Margaret T. Crimmins, Treasurer.
Warren G. Proctor, Engineer.
Anton Svenson, Foreman Mechanic.
Oaklbigh Jauncey, Head Farmer.
Lillian G. Carr, Matron.
Katharine McLean Steele, B.S., R.'i^., Superintendent of Nurses.
TRUSTEES' REPORT
To His Excellency the Governor, and the Honorable Council:
The Trustees of the Worcester State Hospital respectfully submit the 103d 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.
One of the most forward looking steps that has been taken in the Massachusetts
State Hospital System is the inauguration of an eight-hour day for ward employees.
Work with mental patients is a constant strain upon the patience and spirit of kind-
ness of the individual. Shorter hours make possible a higher standard of service
to the patient than could possibly be the case when ward personnel is on duty ten
hours. The Commonwealth will undoubtedly save more than the cost of the
additional people needed in the eventual increase in the discharge rate of patients.
The eight-hour day has proven to be very satisfactory in this hospital, and will in
time fully justify the additional amount of money needed to effect it.
The ratio of ward personnel has been held at one to eight for some time past.
If this meant that the actual number of employees on duty was one to eight patients,
it would be an adequate number but when vacations, sickness, and days off are
taken out, it leaves our wards with an insufficient number of employees. This
board earnestly recommends that some special provision be made for relief on those
necessary days off.
A second innovation to which your board wishes to call attention and of which
it desires to record its approval, is the centralization of the nursing service of the
hospital under one head. The net result of this has been to equalize the standard
of care of both men and women. A further development of this plan which the
board approves enthusiastically, is the substitution wherever possible of specially
trained graduate nurses for attendants in the care of our patients. This, in our
opinion, is a progressive step which brings the hospital to a higher level of nursing
care. In this connection the board would point out that all graduate nurses are
not qualified by temperament or education to carry on successful mental nursing.
The graduate from the general hospital is not competent to do such nursing until
she has had special experience. Therefore, the board believes that the policy of
hiring graduate nurses who have had mental experience wherever they may be
found, is for the best interests of our patients.
The appropriations for repairs have been so inadequate for several years past
that the buildings have not been kept up to the highest stage of efficiency. A
policy of retrenchment along these lines will sooner or later build up a liability for
4 P.D..23
the Commonwealth which will cost much more than if the repairs were properly-
taken care of as the need develops. The State has a substantial investment in
this hospital, and a sufficient amount of money should be appropriated for paint,
construction materials and labor to protect this investment. If this is not done it
will prove costly in the end.
Certain improvements have been completed during the year which are particu-
larly gratifying because they lessen the fire hazard. The installation of a stand
pipe with a capacity of 1,000,000 gallons will give additional volume of water when
needed for fire protection. Fireproof stairways have been installed, the rewiring
of the hospital has been completed, a sprinkler system installed in the attics of the
main building and Summer Street. There are a number of other projects urgently
needed which would give additional protection.
This board has called attention to the condition of the floors of the hospital and
in 1935 an appropriation was granted by the legislature to renovate the Quinby
wards. This money is being used for replacement of the wood floors by cement
construction. With this beginning the program should be continued until all
ward floors in the institution are fireproof. A fire alarm system is badly needed.
Under our present conditions we have no way of calling the employees on duty
and designating the location of a fire.
The board respectfully calls the attention of Your Excellency to the urgent need
of a laundry at this hospital. The present equipment is so old and antiquated that
it is impossible for it to adequately carry the load and some relief should be given
through the erection of a new building and new machinery.
The board wishes to again call the attention of Your Excellency to the loyalty
and cooperation of the employees during the last year and we again register our
approval of the policies and principles that have governed the operation of the
institution for the past several years.
Respectfully submitted,
William J. Delahanty John G. Perman
Anna C. Tatman John L. Bianchi
Josephine Rose Dresser George D. Morse
Howard W. Cowee 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, 1935, it being the one hundred and third annual report.
As in former years the bulk of this report has been prepared by the Chiefs of the
Services. The Superintendent's Report will deal with only certain phases of the
individual summaries of the year's work. The most significant change in policy
that has been inaugurated during the year is the direct result of the forty-eight
hour week law. In my opinion this was a progressive step towards better service
for the patient. It attracts to the service a better trained and more competent
type of individual than we were able to do under the old regime. Eight hours is
sufficiently long for any employee to remain on a ward of psychotic patients, and
retain his poise and emotional balance. With an eight hour day increased demands
for better treatment and more activity among the patients can be enforced. Out
of this came the policy of the substitution of a graduate nurse for the attendant, at
least so far as the charge positons are concerned. It is our belief that the graduate
nurse from the general hospital with a special training in psychiatry, makes a better
ward administrator than the individual without this educational background.
Unemployment for nurses antedates the depression, and members of this profession
may be attracted to psychiatric nursing if places were made for them in mental
hospitals. I believe they would contribute a great deal in the process of raising
the hospital from a custodial to a treatment level of care.
In line with this policy another innovation was made in that all nursing through-
out the hospital was centralized under one head, the Director of Nursing. It has
been a traditional custom in mental hospitals to have the women's wards in charge
of the Superintendent of Nurses, who is required to be a graduate nurse. The men's
wards were entirely independent of her supervision and were administered by a
male supervisor. It is our belief that this violates two very important adminis-
P.D. 23 5
trative axioms. There can only be one individual in charge of any group the
members of which do the same type of work. It is an administrative absurdity
to have a dual headed nursing service such as has been the custom in the past.
Again it is not good psychiatric practice to have a double standard of care. If
women require the service of graduate and student nurses, men are entitled to the
same type of care.
A rating system for head nurses and charge attendants was inaugurated during
the year. Through this system an attempt is made to evaluate the ability of each
individual in charge of a ward. The ratings are made at six-month intervals and
represent the combined estimate of several superiors of the individual who is being
rated. Rating is made in conference, the employee is shown the grade and the
deficiencies discussed with her. This promises to be an excellent method by which
we can estimate the value of each employee in charge of an administrative nursing
unit, which in this hospital, is the ward.
A continuation and elaboration of the policy of incorporating all industrial
activity into the occupational therapy program was carried on during the year. It
is our belief that all occupation, whether in the classroom or hospital industry, is
a part of occupational therapy. The policy has also been developed of charging
the nursing personnel with the responsibility of certain parts of this occupational
therapy program. Psychiatric nursing should include certain phases of this kind
of therapy. The nurse on the ward is responsible for all ward classes, of house-
keeping activity as it relates to the therapy of the patients, and in fact everything
dealing with occupation up to the time the psychiatrist sends the patient to the pre-
industrial shop. The occupational therapist acts in the capacity of technical advisor
to the nurse, she furnishes supplies and assists the nurse in devising new occupational
and recreational outlets.
The policy of boarding-out patients has been continued throughout the year.
This hospital is more impressed by the good results of this social method of treat-
ment than ever before. In the report of the Social Service Department, it is noted
that 17% of the total number of patients who were placed in boarding homes during
the year were either discharged or their status changed to visit. Used as a social
case work tool, family care adds a powerful weapon to the armamentarium of the
psychiatrist.
The outstanding contribution of the medical and surgical service this year has
been the inauguration of a cross index of disease, both physical and psychiatric.
When this is completed it will enable us to make better use of our records than has
been the case in the past. I would also call your attention to the autospy rate of
63 % which has been maintained during the year. I take considerable pride in this
record as being not only one of scientific achievement but on the basis that it repre-
sents in some degree the relationship of this hospital with the community it serves.
A high autopsy rate usually indicates that the insitution has made a special effort
to build up a good rapport between itself and those who are using it.
We have continued to utilize the radio installation as a psychotherapeutic me-
dium, and it is with increased interest in its possibilities that we review the ex-
perience of several years. The constant hammering home of mental hygiene
propaganda undoubtedly affects the patients, although it cannot be mathemati-
cally checked. During the year two interesting research projects were carried on
by the radio personnel. These are noted in the report of the director.
In the laboratory the year has been marked by the official recognition of the
laboratory, by the American Society of Clinical Pathologists as a qualified training
school for technicians. Our clinical pathological conferences have continued and
as a teaching medium they have proven to be most valuable.
The details of the research projects are noted in the report of the resident director
but attention should be called to certain administrative changes that we believe
will make for efficiency and more rapid progress. An emphasis has been placed
upon individual projects rather than the regimented approach which we have used
up to this time. This project method will be further elaborated as the work goes on.
This does not by any means indicate that an individual can work on a problem
regardless of whether it h within the limits of the interest of the institution or not
but it means that, within the broad limits of the approach we are making to the
6 P.D. 23
problems of the schizophrenic, he can elect to take any particular method in which
he is interested. Before this is finally decided upon a complete protocol must be
worked out by the individual doing the research, and it must be approved by the
Research Committee.
Our Editorial Board continues to function and every publication going out of
the hospital is passed upon by that group.
In the Psychological Department the outstanding piece of work that was carried
on during the year was a study of the play technique of schizophrenics. The record
of publications during the year will indicate the broad interest maintained by this
department.
It is with a great deal of gratification that we have been able to enlarge the
Medical Library, which had become so crowded that additional room was necessary.
This was gained by utilizing the office of the Treasurer, that office being removed
to a better location. This change also enabled us to give the patients' library
better facilities than it has had in the past. The patients' library is a very important
adjunct to psychotherapy but like all libraries is of much less value without a well
qualified librarian. Bibliotherapy can be made more than a name.
I would call your attention to the report of the Protestant Chaplain of the
hospital. This institution has had full time chaplains for a number of years and it
is our opinion, as a result of this experience, that well trained theologians have an
important place in the work of a mental hospital. This is true for two reasons:
first, the contribution that an experienced clergyman can make to the patients, and
secondly in the teaching program of the hospital; students from theological semin-
aries derive great benefit from such an experience.
In the Child Guidance Clinic a considerable amount of time has gone to reviewing
and re-establishing the policies of the clinic from the standpoint of therapy, teach-
ing, research and public education. It has been necessary for us to define very
definitely the importance of each of these phases and to decide what amount of
time should be given to each. The result of these deliberations is that therapy
occupies the dominant position and everything must be subservient to this.. The
intake of the clinic is held down to two hundred new cases each year in order that
proper treatment may be given each case. The second most important activity is
teaching. We feel a definite responsibility in training new personnel for child
guidance work. The third activity in point of importance is research, and it is
the belief of this hospital that research is also one of our responsibilities. As the
clinic grows in importance and prestige the need for public education proportion-
ately decreases and instead of being the first consideration as has been the case in
former years, it now becomes a matter of least importance.
This report includes reports of certain members of the organization who have
carried on particularly interesting work during the year. I would call your atten-
tion to the report of the steward relative to the course in laundry processing, which
he has conducted throughout the year. We believe these courses dealing with
special skills should be carried on to the very fullest extent that time will permit.
The installation of a conveyer system in the cafeteria clean-up room has been a
most amazing innovation. Hospital administrators would find such method of
handling dishes of great importance both in the therapy of patients and in the
actual efficiency of a cafeteria.
The chief engineer has inaugurated a very interesting rating system for the
employees in his department which has the effect of improving the morale of his
group.
The foreman mechanic has devised a system of handling keys in which the entire
responsibility is placed on one individual, and all keys in the institution pass through
him.
The head farmer makes a very brief report regarding our experience in freezing
vegetables and with a planting chart. This hospital has been carrying on an ex-
periment in freezing vegetables for a number of years and with increasing success.
It has many advantages over canning methods.
P.D. 23 7
Psychiatric Service
Morris Yorshis, M.D.
The intensive treatment of new admissions and organized instruction to all
student groups were the main activities of the psychiatric staff.
In that more mental patients leave the hospital during their first year residence
than at any other period, greater emphasis was placed on intensive therapy on all
first admissions. The following tables give a resume of the movement of population
among the new admissions.
Admissions, Discharges, Visits, and Family Care Placement, 193^-1935
Table I. — Male
Remain 1
1934 Admissions Discharges Visits Family year
Care Later
October ..,..-.... 33 8 10 1 8
November 21 7 6 - 8
December 37 15 7 - 7
1935
January 42 11 18 - 16
February ......... 39 7 12 - 13
March 44 10 18 1 12
April 40 5 9 - 17
May ....... i .. 38 13 7 - 9
June ... 34 IS , 6 - 8 .
July .....:.... 31 6 7 - 14
August ......... 39 14 5 - 16
September, ......... 20 4 2 - 10
Total— Male 418 115 107 2 138
Table II. — Female
Remain 1
1934 - Admissio7}s Dicharges Visits Family year
Care Later
October 22 7 7 5 6
November ........ 27 6 14 2 3
December 18 2 9 22 4
1935
January 25 4 6 2 1 1
February ... 22 6 6 2 8
March ......... 24 5 3 1 8
April .......... 29 6 9 3 8
May 32 6 10 2 12
June .......... 28 10 6 3 6
July 26 8 5 - 9
August 35 5 6 1 15
September 30 5 5 1 14
Total— Female ...... 318 70 86 24 104
Table III. — Total Statistics of Male and Female Population
Remain 1
Admissions Discharges Visits Family years
' ■ Care Later
Male ..'........ 418 115 107 2 138
Female 318 70 86 24 104
Total 736 185 193 26 242
There were just 100 more male admissions than female. The outright discharge
rate (i.e. the patients discharged from observation) was considerably higher also
among the male patients. Family care placement was found, however, to be more
definitely indicated in the convalescent female patient group and this accounts for
the great difference in the number of placements between the two services, — 2 on
the male and 24 on the female service.
There were 184 readmissions during the past twelve month interval; 260 patients
were discharged from visit and family care, and with the 185 patients discharged
outright within the observation commitment period, a total of 445 discharges were
made for the year. Seven patients v/ere discharged from family care and 27 patients
were placed on visit, indicating that the boarding out of patients is not a static
procedure. Patients do improve in an environment away from a mental hospital.
Organization of Therapeutic Activities
The ward psychiatrist aims to practice psychotherapy but because of the in-
creasing number of admissions and few physicians it is most important that all
the resources that have any therapeutic value be so organized as to render them
8 P.D. 23
available to the individual patient. The following changes were inaugurated on
the two psychiatric services to meet the above goals.
1. Male Psychiatric Wards:
Classification of patients on the basis of level of social adjustment was made.
Competent trained nurses aided much in creating a hospital atmosphere. The
added employment of female nurses on the male wards was made available on all
wards. The presence of nurses served to reinforce repressions and encouraged some
restraint, and improved social conduct. The development of a kindly and sym-
pathetic attitude was fostered from the time of admission of the patient to the
admission service. An organized ward program awaited him.
Habit training was begun at once. Every patient was impressed with the fact
that everyone must work. The busy person has less time to think of his mis-
fortunes. Jobs were selected according to the ability and needs of the patient.
Those who couldn't work outside were taken out for daily walks when the weather
permitted. Those who had to remain indoors spent this time in marching to music
and exercises on the ward. Group contacts were stimulated. The cafeteria did
much to assist in this respect. Patients were taught to assist in the care of others.
Industrial placements were made early and the patient advanced in accordance
with the improvement made. The chaplain's department assisted in special
problems. At intervals ward parties were held, often with mixed groups, which
had a distinct socializing value. The patients were encouraged to make all the
arrangements whenever possible thus stimulating initiative. Bridge and beano
were the most popular games.
Evenings were devoted to concerts, to movie?, a variation of the traditional
hospital dance with groups selected from those in whom social contacts were
particularly desirable. On other nights ward activities such as pool, pingpong,
cards, and table games were directed by the nurse. The library truck made avail-
able books and magazines and all were encouraged to read. Books were often
prescribed as to particular needs of patients.
The radio, in use all day, served an added function at night. During the evening
hours patients were congregated to hear special broadcasts by members of the staff
of mental and physical illnesses and other phases of hospital activities. Lowell
Thomas was a particular favorite. His program assisted us greatly in keeping
up the patients' interest in world events.
On one ward of selected patients, group therapy was conducted in the classroom
manner with mental hygiene talks at regular intervals.
Records of all these varied activities were correlated in a central record room.
This accumulated data was tabulated and filed in the individual case records.
The physician serves in the capacity of director of the patient in his various
activities. Until such time as it is possible to have sufficient psychiatrists to give
personal attention to the patient, it would seem that such a plan as outlined is the
only alternative.
2. Women's Psychiatric Service:
An attempt was made to organize the time of the physicians' activities in order
to increase their efficiency. Such a plan was made possible by the addition of three
internes to the service. Each interne under the close supervision of the senior
physician was held responsible for the care and treatment of one-third of the pat-
ients. The severity of the illness of the patients resident in the wards assigned
varied from the acutely disturbed to the convalescent. The efficiency of such a
system was enhanced by the cooperation of the nursing service in appointing a
supervisor in charge of each section assigned to the interne. Supervision and guid-
ance of the internes' activities were furnished by the junior and senior phsyicians
who made ward rounds daily, and discussed the problems which were present on
their respective divisions. Such an organization has made possible not only a more
intimate knowledge of the details of the patients' illness, but also has placed the
treatment on a more specific and intensive basis. The internes have profited greatly
by this plan, in that their sense of personal responsibility has been increased, and
the latter has stimulated them to greater effort.
In conjunction with the above change, the method of recording data gathered
by the nurses was altered because it was felt that the intelligent application and
P.D. 23 9
direction of therapy depended to a great extent upon the knowledge of the patient's
behavior and her reactions to treatment. In order to obtain this information the
form of ward chart was altered to consist of the following specific information:
1. The behavior chart which contained data regarding not only the mental but
also the physical symptoms of the patients.
2. A progress chart which furnished a chronological account of the various
activities of the patient.
Autopsy Data
With 257 deaths, a 63% autopsy rate was obtained and some interesting con-
clusions can be drawn from the data. Among the 22 schizophrenics 6 deaths
were due to tuberculosis, 4 died of carcinoma, 9 of these patients were 70 years of
age and 5 were over 60. It is planned to determine what the actual psychiatric
status was of this group in their seventh and eighth decades, contrasted with that
at the time of admission.
A patient with a diagnosis of paranoid condition died of carcinoma of the face.
This is in keeping with the concept of White and Freeman who have stated that
there is some relationship between the projection mechanism and neoplasm.
A carcinoma of the head of the pancreas was found in a patient diagnosed
psychoneurosis.
Twenty-one paretics came to autopsy. All with the exception of one had died
of pneumonia, the other death was caused by carcinoma of the rectum. This
condition is uncommon as a cause of death in Paresis, having occurred only twice in
a series of over 60 successive autopsies among patients with dementia paralytica.
In some instances of lues it was noted that although the spinal fluid had been
negative and the gross brain findings were typical of paresis, yet the clinical picture
did not show this to be true.
Carcinomatosis was the cause of death in two cases of involutional melancholia.
Seventy-nine autopsies were performed on the senile and arteriosclerotic group.
Teaching
The mental hospital must be an institution for instruction and investigation.
By training internes in psychiatry, student social workers, occupational therapy
students, medical students, theological students, post-graduate nurses and affilia-
ating nurses, the hospital provides the means to practice preventive psychiatry.
This must go hand in hand with therapeutic endeavors. Just treating patients and
not carrying on any preventive measures is poor economy. All student groups
eventually return to their own activities in the community and with the experience
gained at the mental hospital plus the organized instruction which they have re-
ceived are in a better position to render service along mental hygiene lines.
Another excellent reason for carrying on an extensive teaching program is that
the psychiatrist is able to take the nurse, O. T. Worker, social worker, industrial
foreman, family caretaker and all others who have daily contact with patients
completely into his confidence and thereby make a coordinated team, the members
of which have detailed knowledge of his therapeutic aims and can render invaluable
aid in the successful attainment of the goals of the hospital getting patients well
and keeping them well.
This was the first year that the hospital undertook to train psychiatric internes
for a period of twelve months. The Peter Bent Brigham Hospital sent its first
interne for training in clinical psychiatry for a period of four months. This is to be
a regular procedure and a worth while venture.
The following is the list of courses that were given to the psychiatric internes:
1. Clinical Psychiatry. 7. Neuropathology.
2. Seminar in Psychoanalysis. 8. Fever Therapy.
3. Administrative Psychiatry. 9. Endocrines in Psychiatry.
4. Biopsychiatry. 10. Research in Methodology.
5. Juvenile Psychiatry. 11. Psychometrics in Psychiatry.
6. Psychiatric Social Service. 12. Biometrics.
Publications
State Hospitals as Training Centers. W. A. Bryan. Mental Hygiene, 19: 405,
July, 1935.
10 P.D. 23
The Role of Occupational Therapy in Modern Psychiatry. Minna Emch. Am.
Jour. Psych. 92: 207, July, 1935.
A Reorientation for State Hospital Psychiatry. Minna Emch. Mental Hygiene,
19: 586, October 1935.
Nursing Service
Katherine M. Steele, Superintendent of Nurses.
This year I find the task of preparing an annual report of the Nursing Service
stimulating and difficult. It is a story of rapid growth and of several major changes
that we believe to be important and lasting in their influences on the care of patients
in this hospital.
The increase in the number of graduate nurses has been gratifying. Last year
we had sixty-six graduate nurses. We now have a total of one hundred and twenty-
one. This means that we now have a ratio of one graduate nurse to every eighteen
and five-tenths patients.
There are many advantages in having graduate nurses caring for mental patients.
Some of the outstanding ones are:
First, it is not necessary to spend as much time teaching the graduate nurse.
She comes to us already trained in nursing techniques. This year we have been
able to secure many graduates with special training in psychiatry. This means that
they are more mature and therefore of more value. For the positions of assistant
superintendent of nurses and director of nursing education, we have women with
college training and exceptional professional experience.
Second, with a large number of graduates, adequately prepared, the standards
of the nursing care of patients are raised from the level of custodial care to the
constructive teaching of the patient the principles of good physical and mental
health. She can also be of help to the patient in his social rehabilitation.
The more intelligent the notes and observations the nurse makes about the patient
the more value she can be to the psychiatrist. Nurses have learned much about
administration during their training. They are accustomed to the ward as the
unit of administration. If they are in the position of head nurse, they are prepared
to assume the responsibility for the work of all the employees on the ward for the
twenty-four hours. These abilities are difficult for the untrained person to acquire.
The centralization of the administration of the nursing service has become
effective this year. The usual type of organization of the nursing service in state
hospitals, where there is a complete separation of the male and female services, was
built up because it was not thought advisable to have women nurses caring for male
patients. The two organizations were top heavy. Ther sevice was the unit of
administration rather than the ward. Supervisors were doing much detail work
and not true supervision.
With the constant increase in the number of graduate nurses on the male wards,
it has seemed advisable to change the plan of administration. We now put emphasis
on the ward as the administrative unit and the entire nursing service is centralized
under one head.
The results obtained have been that the service is coordinated. There can be a
uniformity of procedure over the entire hospital. Routine work can be cut down
to a minimum because of lack of duplication and this means more time spent with
patients. All the work of the nursing service becomes more effective.
Nursing Education:
In January 1935, nine senior students remained in the training school, the other
students having been transferred to general hospital schools in accordance with the
suggestions made by the National League of Nursing Education. These nine stu-
dents were graduated from the Worcester State Hospital in September 1935, and
with one exception, have remained on the Nursing Staff as general duty nurses.
A change of program for the affiliating students was made early in 1935. In
April and May, thirty lectures were given to a group of forty-eight students from
the Hahnemann, Memorial and St. Vincent's Hospitals, Worcester. The instructors
were members of the medical and nursing staffs of this hospital and the lectures
were designed to give the students a comprehensive, although necessarily brief
view of the fields of psychiatry and psychiatric nursing. The students who take
this course may elect a three month period of practical experience at the Worcester
P.D. 23 11
State Hospital, if they wish. During 1935, there were twenty-nine affiliating
students coming in groups of eight for three months each. During their period at
this hospital, they are given further work in psychiatric nursing, one hour each
week, four lectures in social service, four in Occupational Therapy, eight lectures
in Hydrotherapy and an opportunity to attend ward conferences held by the
physicians. The interest shown by the student nurses in this branch of work is
very encouraging and several of them have expressed a desire to take up post-
graduate work in psychiatry upon completion of their general training.
In September and October, with the large addition to the nursing staff, all new
employees, nurses and attendants alike, were given a series of talks by the admin-
trative staff, telling them the aims and purposes of the hospital, emphasizing
important details such as fire rules, escapes, precautions, and so forth, thus giving
them from the start, a sense of responsibility to the hospital and an appreciation
of their importance as members of the hospital personnel. This orientation course
proved very valuable and was repeated often enough so that all new employees
received the benefit of it. New attendants have had a series of classes in routine
procedures by the chief supervisor.
The post-graduate course in psychiatric nursing is commencing this fall. Four
students are enrolled for the first class. Although considerable publicity has been
done during August and September by advertising in the American Journal of
Nursing, and by distributing folders describing the course to training schools, the
small response is probably due to the fact that these efforts were necessarily started
too late in the year.
The aim of this post-graduate course is to give graduate nurses a thorough knowl-
edge of psychiatric nursing and allied subjects. It has been set up with more hours
of theoretical work than most graduate courses and ability and desire to study and
learn are prerequisites. The course includes Psychiatry, Psychiatric Nursing,
Psychology, Sociology, Mental Hygiene, Neurology, Endocrinology, the special
therapies, Hydrotherapy, Occupational Therapy and Physical Therapy, Psychiatric
Social ''Work, Juvenile Psychiatry and special lectures. The Sociology course will
be given by Professor Balsam of Clark University, and in addition to giving the
students some idea of social backgrounds and the various forms of social dis-
organizations which contribute to the problems of patients, it serves as a valuable
connection with the university. All the other courses will be taught by members
of the hospital staff. In the classes on psychiatric nursing, emphasis will be placed
on the patient as a total personality and on the social or public health problems
involved.
The affiliate students and post-graduate students will, except for special lectures,
be taught in separate groups. In addition to the regular courses, the students will
attend staff conferences and ward rounds, and have access to the case histories.
Classes and conferences will occupy approximately twelve hours, or three days a
week. The clinical experience will obviously be a very valuable part of their
teaching, and for this experience the students will spend three days each week on
the wards.
For their practical experience, the students will follow the plan of their theoreti-
cal work as nearly as it is possible, that is, when they are studying the senile
psychoses they will have their practical work on the wards where the majority of
the patients are included in this group. We feel it important that they will have
their experience on the admission wards toward the end of their eight months'
course. For it is on these wards that we wish to concentrate our active therapy
and therefore the nurses caring for these patients should be well prepared to take
their part in that active therapy.
The need for such a course as this is very evident to anyone interested in the
care of the psychotic patients, or in psychiatric nursing; and the Worcester State
Hospital, because of its wealth of clinical material and interest in teaching, is an
excellent field for this undertaking.
With the addition of 135 new positions, making it possible for the employees in
the State institutions to work forty-eight hours a week, our ratio of patients to
ward employees has changed from 8.5 patients to one employee to a ratio of 6
patients to one employee. However, this has not increased the actual time spent
12 P.D. 23
with patients because each employee is working two hours less each day. This
increase makes it possible to cover the wards if everyone is on duty, but it gives no
leeway for vacations and illness. If we were to have an additional quota of twenty
positions, we could then distribute vacations evenly throughout the year, and still
have a small surplus to allow for illnesses. We would, however, have no housing
facilities for this additional quota as the two homes are at present overcrowded.
There is no question but that the shorter day has made for more efficient work
and for better satisfied and more interested employees.
As a means of developing some system whereby we might rate Supervisors, head
nurses and charge attendants, a personnel committee was formed. It consists of
the Superintendent of the hospital, the two senior physicians on the psychiatric
services, the two chief supervisors and the Superintendent of Nurses. This com-
mittee meets once a week. Several days before the meeting there has been sent
to five people who know the work of the employee to be rated, a sheet with questions
on it. These questions are scored 0-1 or 2 or left blank if the one rating feels he
cannot grade the employee in that respect. This rating is done independently.
At the weekly meetng these reports are read, the averages reached and recorded
on a scoring sheet. After the rating is completed, the employee is shown his rating
with explanations.
We believe the advantages to this system are that it is as near an objective grade
as we are able to reach. It lifts the responsibility of rating from one person and it
enables the employee to evaluate his own work in the light of group opinion without
personal bias.
The superintendent of the hospital has had classes in ward administration for
this same group which have aided markedly in the establishment of routine through-
out the hospital.
Ward Activity Charts:
Because of the large number of patients in contrast to the number of doctors,
nurses, occupational therapists and other personnel, the daily routine of the hospital
must of necessity be part of the therapeutic treatment of patients in State hospital.
The ward activity charts are an attempt to analyze the content of that therapy.
They are a daily record of the general care, the physical activity and the recreation
which the patients received and how many patients are engaged in each type of
activity. To be effective, these charts must be checked every day and closely
supervised. They illuminate the needs and weaknesses on the wards and give a
picture of how time is spent. An ever increasing effort is made to put the emphasis
on the patient and on keeping him busy.
OCCUPATIONAL THERAPY DEPARTMENT
Dorothea W. Cooke, Chief Occupational Therapist.
With the advent of a new director in June, 1935, the Occupational Therapy
Department started reorganization.
The personnel of the department consists of a chief occupational therapist and
three trained assistants. In January and July of each year, the Boston School
of Occupational Therapy sends us eight students for their training in occupational
therapy as applied in a mental hospital.
The chief occupational therapist functions as an administrator of the department
and directs student training. One trained assistant directs the Male Industrial Ther-
apy another the Female Industrial Therapy, and a third supervises the pre-industrial
shops for men and women. Students are rotated each month between the two
services.
The aim of Occupational Therapy is to assist in strengthening and restoring
the impaired faculties of normal mentality; namely, productivity, sociability and
normal community interest. To accomplish this, pre-industrial shops have been
instituted and industrial therapy further developed.
Occupational therapists have made a survey and analysis of the available jobs
in the hospital to acquaint the physician with the occupational possibilities and
their therapeutic advantages.
Our next objective has been to educate the workman or industrial therapist
in charge of patients to maintain a therapeutic supervision, to make his chief
interest the patients' improvement rather than the amount of work accomplished
P.D. 23 13
With this type of supervision, we find that the patient makes a more rapid adjust-
ment and that production increases both in quantity and quality.
All assignments are made by the physician whose prescription includes not only
results desired but also precautions to be observed by the industrial therapist.
The occupational therapist introduces all patients to new jobs. It is also her
duty to see that the physcian's prescription is understood by the industrial therapist,
thus making the occupational therapist the interpreter or liaison agent between
the physician and the industrial therapist.
A daily report sheet has been instituted, on which are recorded grades with regard
to the behavior and adjustment of the patient while working. This report sheet
is made out by the industrial therapist, sent to the occupational therapist, who in
turn presents it to the physician, enabling the latter thereby to have a daily
knowledge of the patient's progress.
For purposes of orientation and the determination of therapeutic need, pre-
industrial shops have been organized for new patients.
With this information at hand, the therapeutic placement of the patient in
industry is thereby placed on a more rational and specific basis.
Patients not adjusted to industrial placement are kept occupied in ward classes
in charge of the ward nurse. These are guided indirectly by the Occupational
Therapy Department, a therapist giving material, suggestions and advice to the
nurse in charge three days a week at specified hours. Ward games and ward
parties are also the nurse's responsibility, the occupational therapist acting in-
directly as a source for materials and suggestions.
Community recreational activities, holiday programs, dances, community sing-
ing, activities including all the patients in the hospital remain the responsibility of
the Occupational Therapy Department.
Social Service Department
Barbara Estes, Head Social Worker
The Social Service Department during the past year has worked on more than
1,800 cases, holding approximately 5,000 interviews and taking 524 histories.
Three new students from Smith and one from Simmons came to the hospital in
September for the winter term. On September 30, Miss Alice Paine, social worker
on the male service, left to accept a position at the Boston Psychopathic Hospital.
Her place was filled in October by the appointment of Miss Anne Hecht.
During the year several changes in the policies of the Social Service Department
have been made in order to increase its efficiency. Registration of all cases with
the Central Index has been made the responsibility of the clerical office, thus re-
lieving the department of considerable routine work and expediting its contact
with other agencies.
During the past the Social Service Department has found it impossible with its
present staff to secure histories on all new patients admitted to the hospital, and
at the same time carry on any amount of intensive social treatment. With the
addition of long time internes to the staff, much of this important work has been
delegated to them, to the benefit of all concerned. All cases in which a social
problem appears or cases in which it is impossible to secure histories in the hospital,
are referred immediately to social service. Because of fewer demands for histories,
we are able to spend more time on those referred to us. More sources of information
can be contacted, more time can be given to the families of patients.
The latter point seems to us particularly important as it may develop later into
specific treatment of the family with the aim of future return of the patient to
the home. A diagnosis of mental illness in one member of the family group may
result in trauma to other members of the household. Such conditions may be
discovered at the time of taking the history and therapy started immediately.
When we have time to listen we find that many families wish to talk over their
troubles, bringing a variety of problems for our advice.
Discussion of any treatment leads naturally to a consideration of family care.
During the past year, 91 placements in boarding homes were made. Of these, 13
were men and 78 women. December 1, 1934, there were 101 patients in family care;
during the year 81 cases were closed, leaving a total of 111 patients in boarding
homes on November 30, 1935. While statistics usually are dull, we believe that a
14 P.D. 23
vivid picture of the necessary supervision and treatment of these patients may be
secured from the following figures. During this period, 44 patients were returned
to the hospital, 7 were discharged and 27 were transferred from family care to
visit. Visits made to these patients totalled 903, of which 793 were made by the
social worker and 110 by physicians.
Since the depression, our applications from families who wish to board patients
have increased. The number of such requests which come in from homes of a
poorer type has risen, bringing, as a result, the need of more careful investigation
to insure the welfare, mental, as well as physical, of our patients. This has increased
the burden of the social worker in charge of family care, and if continued, may
result in one of two things — either fewer patients on family care, or lessened
investigation and consequently, poorer homes. It may be that in the future it
will be found expedient to divide the work of this particular part of the Social
Service Department, delegating to one worker the investigation of applications for
boarding homes and to another the supervision and treatment of the patients
involved. If we are to consider our boarding homes as of definite psychotherapeutic
value in the treatment of our patients, intensive investigation and supervision is
essential.
Report of the Radio Department
Wallace Searle, Director
During the year this department has functioned the same as usual, except that
additional experience has rendered the service of more value to the hospital.
Practically all of the advertising at the beginning and end of radio programs has
been eliminated. In its place we give short talks on mental hygiene, therapeutic
suggestions, hospital information, and various news events. News broadcasts
which are carefully selected are given on an average of three times daily, only
news that would be of general interest to most of the patients being presented.
Critical reviews of outside radio programs are being compiled with a view to
finding out how they should be utilized, if at all, in this hospital.
From a therapeutic standpoint the operation of the radio station has been
utilized to better advantage this year than ever before. Young men are assigned
to work on the control boards entirely from the standpoint of its therapeutic
value. A large waiting list of patients has accumulated who desire this type of
occupational therapy. We feel that much has been accomplished during the past
year in this respect. Requests for special programs have increased, which definitely
indicates marked interest on the part of the patients in this type of entertainment
and education.
Several plays were presented to the patients during the year under the direction
of this department in which patients had major parts. There is a definite suggestion
that this method of expression on the part of the patients may, in selected cases,
have a definite therapeutic effect.
During the year two interesting research projects were conducted by this de-
partment. An attempt was made to study the cardiac and respiratory rates
under musical stimuli. Music was furnished by victrola records broadcast through
the radio system to the research room. Normal subjects who were sophisticated
musicians of the same sex and having approximately the same musical background
and training were utilized as controls. The cardiac rate was higher at the be-
ginning of each musical number, rapidly adjusting itself to normal. The same
music will be played to musically unsophisticated employees and to patients,
and comparisons made. One hundred patients have been given the Seashore Test.
It is hoped to correlate these findings with the norms of Seashore and see if there
is any radical difference between mentally normal and mentally abnormal people
in any of these six tests. The data are not sufficiently analyzed to offer any con-
clusions at this time.
Medical and Surgical Service
W. Everett Glass, Director
The following report summarizes briefly the activity of the medical and surgical
service from October 1, 1934 to September 30, 1935.
P.D. 23 15
(I ) Movement of Population on the Service
There were 919 cases admitted to the service during the record year, which is
a decrease of 366 cases over the number admitted last year. As in past years the
number of study cases is maintained, 144 cases being admitted during the year.
Of these all but 25 were found to be suffering from various types of physical dis-
orders. This figure represents 15% of the total cases admitted to the service and
indicates that the psychiatric service is using the medical service to the advantage
of the patients by referring to the medical service such cases requiring further
study to obtain an accurate physical diagnosis. Seven hundred fourteen cases were
discharged from the service during the year, being approximately equally divided
as to male and female patients. This represents a monthly turnover of 59 cases
which is less than the monthly turnover of 77 cases of the preceding year. As
usual, the peak months for discharges were January, March, April, and August,
the same seasonal variation shown each year with but slight changes. Discharges
from the service detailed as to physical condition shown in the following table: —
Female Male Total
Recovered and improved 322 345 667
Not improved .10 12 22
Not treated .......... 14 11 25
Total .346 368 714
(2) Deaths
During the fiscal year 257 patients died, as compared with 269 of the preceding
twelve months.
Total number of deaths ....
Total number of autopsies ....
Total number of medico-legal cases
Autopsies confirmed ante-mortem diagnoses
(70% or more)
Autopsies confirmed partially, ante-mortem
diagnoses (50 to 70%) ....
Autopsies refuted (less than 50%)
Autopsy percentage of deaths 63%
Attendance at autopsies — staff, 661; students, 435; total, 1,096.
Of the total number of deaths, 15 men and 20 women died at the Summer
Street Department. This represents an increase of 10 deaths at that department
over the figures of the preceding year. This is probably without any significance.
The autopsy percentage is 0.3% higher than the last year, although six less
autopsies were done. It may be pointed out that this relatively high percentage
of autopsies indicates in a rough way a feeling of good will between the relatives
of the patients and the hospital staff, otherwise relatives would not give autopsy
permission.
A survey of the deaths reveals that, as usual, pneumonia was given as the
primary cause of death in the largest number of deaths — 68, or 22.1%. All of
these deaths were listed as bronchopneumonia except 5, which were lobar in dis-
tribution.
The average age of the entire group was 70.5 years. This represents an increase
of 3.1 years in this group and a decrease in the total number of pneumonia deaths
over last year by 5.4%.
Fifty-six persons, or 21.7%, died as a result of changes of a senile nature. The
average age in this group was 71.8 years. The two most common causes of death
in this group were generalized arteriosclerosis and cardiovascular renal disease.
Thirty-five, or 13.5%, died of general paresis. The average age of death in this
group was 37.9 years. These figures represent an increase in the percentage of
deaths of 5%. The average age of death is less by 8.7 years when compared with
the preceding year.
Twenty-four, or 9.3%, died of pulmonary tuberculosis. The average age in this
group was 51.4 years. All of the deaths listed as pulmonary tuberculosis except
^emal
3 Male
Total
131
126
257
-
-
163
-
-
29
-
-
141
_
_
20
-
-
2
16
P.D. 23
one, which was intestinal. This represents an increase of 1.2% over the figures
given last year, but the total age has increased from 48.5 to 51.4. This is a con-
sistent rise as compared with the average age of 42.5 two years ago and probably
represents the result of concentrated treatment with pneumothorax.
Thirteen cases, or 5%, died from cancer. The average age in this group is 63.6
years. Eight of these cases of cancer originated in the gastro-intestinal tract and
one each in the bladder, ovary, cervix, breast, and face. We have continued to use
the facilities of the Pondville Cancer Hospital as an aid of treatment of our cancer
cases.
Ten deaths, or 3.8%, were due to fractures during the year. The average age
of this group was 67.7 years, which is essentially the same figure as given last year.
Primary kidney disorders accounted for 7 deaths, primary heart disease for 5
deaths, cerebral hemorrhage for 4, diabetes 2, and primary genito-urinary disease 1.
The remainder of the deaths — 31, or 12% — with an average age of 58.2 are
widely scattered as to causes of death and not worth analyzing.
(3) Consultations
The following table represents the extent to which the consultant staff has been
used in the hospital. The figures given show an increase in X-ray consultations of
480, while the others show a decrease corresponding in genera to the reduction
of total cases handled on the service during the year.
Eye 100
Ear, nose, and throat 61
Gynecological and obstetrical 75
General surgical 110
Medical 20
Orthopedic 8
X-ray . 1,982
Others 62
Total
2,418
(I) Obstetrics Detailed
This service continued as in the past but the total number of deliveries seems
to be gradually getting less. This year there were 9 deliveries, 6 male and 3 female,
as compared with 13 the year before. During the past year the delivery room has
been taken over by the operating room force in an attempt to centralize supplies
and personnel.
Considerable difficulty is still experienced in the placement of the children after
birth, in many cases nine or ten months being required to find a settlement for
them, and this is a deplorable condition. We feel that in general all children should
be placed in homes at the end of three months at the very latest.
Adenoidectomy .
Amputations (major)
Amputations (minor)
Appendectomy .
Artificial pneumothorax
Biopsies
Blood transfusion
Breast amputation
Cataract excision
Chest aspiration
Cholecystectomy
Circumcision
Colostomy .
Cystoscopic examination
Cystogram .
Cystotomy, suprapubic
Dilatation and currettage
Deliveries . . . .
(5)
Surgery
Detailed
. 2
Hemorrhoidectomy
10
. 2
Herniorrhaphy ....
.9
. 5
Hydrocelectomy . .
1
. 6
Hysterectomy . . . .
6
126
Injection of varicose veins .
9
. 13
Intestinal obstruction volvulus .
2
. 1
Mastoidectomy ....
9
. 2
Myringectomy ....
4
. 1
Nasal operations ....
2
. 8
Oophorectomy and salpingectomy
8
. 4
Parotid tumor excision . .
1
. 3
Perineorrhaphy . . . .
14
. 1
Plastic repairs . . .
1
. 2
Pneumolysis
1
. 3
Proctoscopic examinations .
14
. 2
Skin tumors — excision
10
. 7
Spinal manometries . . .
62
. 9
Surgical diathermy
4
. 2
. 3
. 1
Suturing (miscellaneous)
Suspension of uterus . . * .
Teeth extraction under anaesthesia
91
1
26
. 2
. 1
. 2
. 26
. 3
Tendon repairs ....
Thyroidectomy . . .
Tonsillectomy ....
Ventriculogram ....
2
1
14
1
P.D. 23 17
Dislocations (reduction)
Encephalogram .
Enterostomy
Epulis removed
Fistulectomy
Fracture, open reduction
Fracture, closed reduction
Gastrostomy
During the year 629 operations and proceedings were done in the surgical suite.
This is 98 less than the preceding year. In general the list of operations corresponded
with the list given last year in variety and number.
(6) Clinics Detailed
Eye examinations 695
Ear, nose, and throat examinations 627
Gynecological examinations 645
Luetic treatments 6,456
Small-pox vaccinations 157
Lumbar punctures 514
Typhoid and para-typhoid inoculations 3,168
Hinton Tests 1,478
Others . . , 47
Total 13,787
Last year 10,480 examinations and treatments were given, which was an increase
of 2,002 over the preceding year. The figure given this year represents a further
increase of 3,307 treatments and examinations given. The luetic treatments
accounted for an increase of 2,000 more than the preceding year. This is explained
by a change in the system of treatment of syphilis. Treatment as given now is
continuous without the former "rest periods." A closer check in the progress of
those treated accounted for an increase in the number of Hinton tests and lumbar
punctures. The policy of repeating the typhoid inoculation on our patients in
the hospital longer than three years accounts for the increase in this figure of
over 1,000 treatments.
(7) Dressings Detailed
Abrasions and lacerations 3,286
Boils and carbuncles 642
Burns 386
Infections 2,324
Ulcerations 764
Others 2,800
Total "out-patient" dressings 9,911
Total "ward" dressings 37,040
Grand Total 46,951
This figure represents a further increase this year by approximately 1,700
dressings.
(8) Employees
This year 2,015 were examined in the employees' clinic. As in past years, this
service is offered to the employees daily from 4 to 5 o'clock. Out of the number
examined in the clinic, 133 were hospitalized, with a total loss of work of 828 days.
Twenty-seven employees required operations of various types. In general the
health of the employees has been satisfactory.
18
P.D. 23
Summer
Main
Street
Hospital
Dept.
Total
4,079
701
4,780
2,524
460
2,984
1,220
138
1,358
1,679
251
1,930
1,869
438
2,298
1,001
139
1,140
52
4
56
73
8
81
79
3
82
25
2
27
16
2
18
5
0
5
142
0
142
372
0
372
63
0
63
(9) Dental Departments
Number of patients .
Examinations (Routine)
Cleanings
Fillings ....
Extractions .
Miscellaneous treatments
New Dentures made .
Dentures repaired
X-ray Diagnosis .
Ether, Anesthetics
Impactions Removed
Bridges
Dentures Numbered .
Dentures Cleaned
Dentures Adjusted
Totals 9,117 1,445 10,562
The dental service shown by preceding chart was rendered by the resident
Dentist, Dental Hygienist, and two dental Internes engaged for the months of
June, July, and August. The figures given are essentially the same as those in the
preceding years and represent an increase of 672 in the total number of examinations
and treatments.
All new patients admitted to the hospital have had their oral conditions charted
on dental charts, and careful records have been made, with recommendations which
have been carried out. A semi-annual re-examination of all patients has been made
where possible and necessary dental work performed.
During the past year a survey was made of the problem of the control of tooth
brushes and teeth cleaning materials on the wards. A regular teeth cleaning period
has been instituted on each ward and each patient is recorded as to the number of
times teeth have been cleaned throughout the month. This record is kept on suit-
able charts furnished wards by the dental department. The mouth hygiene of the
patients has definitely improved under this system. Tooth powder which is made
in the hospital pharmacy is distributed to the wards for the patients. This results
not only in saving time but also in better mouth hygiene. The entire supervision
of the distribution of tooth brushes and tooth powder has been taken over by the
Dental Department. Publication: "Excessive and rapid formation of dental
calculus." Joseph N. Finni and Jacques Gottlieb, Dental Cosmos, December, 1935.
(10) X-Ray Department Analysis
The X-Ray department showed an increase in the number of plates and patients
examined by 822 and 470 respectively. There was a decrease in the photographic
work from 2,082 to 539.
X-Ray plates used 2,790
Patients examined 1,676
Foot and finger prints (sets) 14
Photographs 539
Lantern Slides 109
During the past year the hospital obtained an X-Ray Timer and also a portable
X-Ray unit, both of which were much needed. With the help of the timer it is
proposed to standardize our technique and turn out more uniform X-Ray work,
which in turn will tend to decrease the waste of expensive X-Ray Plates.
(11) Physical Therapy Department
Ultra-violet (air-cooled) 3,100
Ultra-violet (water-cooled) 483
Baking 1,842
Massage 1,298
P.D. 23 19
Diathermy (medical) 600
Diathermy (surgical) 34
Muscle re-education 1,177
Others 145
Total treatments and tests 8,679
Total number of patients treated 5,442
These figures represent an increase in the number of treatments and tests by 554,
with a slight decrease in the total number of patients treated. It is hoped that in
the coming year we shall be able to treat more general paretics by diathermy. This
will be done by assigning one person to help the nursing care of the patients during
the diathermy treatment. The above figures indicate a good activity in this depart-
ment.
(12) The following publications appeared from this department:
Spontaneous Rupture of the Esophagus in Syphilis. W. Everett GJass and William
Freeman. Am. Journ. Med. Sci., 189: 80, January, 1935.
Some Temperature Characteristics in Man. Hudson Hoagland and Clifton T.
Perkins. Jour. Gen. Physiology, 18: 399. January, 1935.
Tuberose Sclerosis with Unusual Lesions of the Bones. Jacques S. Gottlieb and
George R. Lavine. Arch. Neur. and Psych., 33: 379, February, 1935.
Labobatory Report
Joseph M. Looney, M.D., Director
The work of the laboratory has continued to increase during the past year so
that the total number of procedures carried outduringthe year amountedto 56,123,
as shown in detail below. This is about the maximum which can be performed with
the present equipment. The next year should witness a substantial decrease in
the total number of tests performed as the result of a change in the type of work
carried on for the research service to that of a more experimental nature.
The work of training qualified college graduates in laboratory procedures has
continued as in the past and all of the students who completed the course have been
placed in other laboratories. During the year the laboratory was officially recog-
nized by the American Society of Clinical Pathologists as being qualified to train
technicians.
The Clinico-pathological conferences have been held on the last Friday of the
month in the afternoon instead of at night, with a resulting increase in the atten-
dance. They have served as one of the most valuable means of teaching, especially
to students and internes.
The number of autopsies performed during the year, 163, is somewhat lower than
the number for the previous year, 169; but with a decrease in deaths from 269 to
2'57 the ratio of autopsies to deaths is practically unchanged; 63.0 per cent as
compared with 62.7 per cent for 1934.
During the year the following papers were published :
Galactose tolerance as measured by the Folin micro and macro blood sugar methods.
J. M. Looney and E. M. Jellinek, J. Biol. Chem. 109: Ivii, 1935.
The Therapeutic Use of Dinitrophenol and 3.5 Dinitro-Ortho-Cresol in Schizo-
phrenia. J. M. Looney and R. G. Hoskins, Am. J. of Psychiat. 91: 1009, 1935.
The Volume of Blood in Normal Subjects and in Patients with Schizophrenia. J.
M. Looney and H. Freeman, Arch. Neurol, and Psychiat. SJ^: 956, 1935.
The following meetings were attended by the Director:
a. The Federation of the American Societies for Experimental Biology, at which
the paper on the Galactose Tolerance was presented, April 10-13, in Detroit.
b. The annual meeting of the Massachusetts Medical Society.
c. The fifteenth International Physiological Congress, Leningrad and Moscow,
August 8-18, as a delegate from the American Society of Biological Chemists.
During February and March he gave four postgraduate lectures on Recent
Advances in Endocrinology under the auspices of the New Jersey State Medical
Society and Rutgers University at Trenton and neighboring cities.
Dr. Freeman attended the annual meeting of the American Society of Clinical
Pathologists at Atlantic City, June 7-10, and read a paper entitled, Bone Marrow
20
P.D. 23
Studies in Glandular Fever {Infectious Mononucleosis) .
He also attended the annual meeting of the Society for the Study of Internal
Secretions, and the annual meeting of the American Medical Association, both of
which were held at Atlantic City, June 10-14.
He read a paper entitled. Grading the Degree of Malignancy of Carcinomata in
relation to Treatment and Prognosis, at St. Vincent's Hospital, Bridgeport, Conn.,
June 18.
During the year he was elected to membership in the American Society of
Pathologists and Bacteriologists and the American College of Physicians.
At the present time the research work of the laboratory has been drected along
the lines of individual projects of a more experimental nature. In line with this
policy there is now in progress a project to determine the chemical constituents of
various regions of the brain of normal and schizophrenic patients. An attempt is
being made to assay the activity of the thyroid gland in our patients by injecting
iodine and following the level of iodine in the blood and the excretion of this sub-
stance in the urine.
The study on the rate of lactic acid production during exercise has been continued
and sufficient evidence has accumulated to state that there is a higher production of
lactic acid for a given amount of work in the schizophrenic patients than in the
normals.
The work on the isolation of the blood pressure raising principle of the adrenal
gland has been carried on and will be pushed even more vigourously next year as a
result of a grant from the Armour Company to finance the investigation. If a
highly purified potent principle can be isolated, it might possibly be of tremendous
benefit to general medicine in preventing the fatal fall in blood pressure sometimes
occurring under spinal anesthesia.
Laboratory Tests for Fiscal Year
October 1
, 1934 —
September 30, 1935
Bacterial cultures . . . 241
Blood gases 844
Bacterial smears .
1,046
Blood pH ....
283
Basal metabolisms
1,300
Blood glutathione
779
Blood cultures
61
Blood lactic acid .
1,283
Blood creatinine .
1,551
Blood magnesium
17
Blood N. P. N. .
2,252
Blood potassium
193
Blood sugar .
3,179
Blood albumin
189
Blood urea .
1,562
Blood lipoids
206
Blood uric acid .
1,669
Blood cholesterol esters
204
Blood counts red
3,001
Blood total prot.
190
Blood counts white
3,986
Blood acetone bodies .
583
Blood counts diflf.
3,955
Blood hydroxbut. acid
345
Haemoglobins
3,684
Blood minute volumes
69
Clotting times
92
Milk analysis
25
Galactose tolerance
99
Milk blood plated
10
Icteric index .
69
Ascetic fluid
21
Mosenthal test .
240
Colonic irrigations
185
Nitrogen partition
2,253
Platelet count
10
Plasmodia malaria
7
Reticulocyte count
103
Renal function .
81
Schillingrams
341
Spinal fluid cells .
505
Blood fragility
8
Spinal fluid gold .
503
Stomach contents
278
Spinal fluid chlor.
494
Vomitus
5
Spinal fluid diff. .
11
Urine bacteria
20
Spinal fluid glob.
. 500
Urine bile
531
Spinal fluid sugar
502
Urine urobil.
526
Spinal fluid prot. .
498
Urine chlorides .
167
Sputa .
1,604
Urine blood .
10
Stools .
1,121
Urine typhoid
6
Tissue sections .
. 2,375
Animal inoculation
8
Urine, routine
8,000
Photos path. spec.
22
VandenBergh test
60
Autogenous vaccines
17
P.D. 23
21
Vital capacity
Widals .
Bleeding time
Urine quant, sugar
Blood typing
Ascheim-Zondek test
Blood phosphorus
Blood calcium
Blood chloride
Blood cholesterol
Blood volume
Blood hematocrits
Blood sedimentation
Total number of examinations
Number of autopsies
Grand total
509
8
88
805
8
34
152
307
192
260
70
81
81
Toxicological exam.
Peroxidase stains .
Glucose tolerance
Spinal fluid uric ac.
Spinal fluid N. P. N.
Urine Diacetic Acid
Water analysis
Spinal fluid (T. B.)
7
2
7
3
2
15
12
1
56,123
163
56,286
Report of Research Service
Francis H. Sleeper, Resident Director of Research
As in the past year, the research on schizophrenia has been subsidized by the
Division of Mental Hygiene of the Massachusetts Department of Mental Diseases,
the Worcester State Hospital, the Memorial Foundation for Neuro-Endocrine Re-
search, and the Rockefeller Foundation. It has continued under the direction of
Drs. R. G. Hoskins and F. H. Sleeper.
During the fiscal year twenty-five schizophrenic patients and twenty-five normal
men were studied in parallel, as outlined in the previous report, the control subjects
living on the wards and undergoing the same tests as the patients. The schizo-
phrenic patients represented a somewhat earlier stage of the psychosis than those
previously studied, and the paranoid sub-type was more frequently represented
in the sample. The data have been tabulated and the material is being prepared
for publication. With this survey the general orientation phase of the research will
probably be concluded and future efforts will be directed largely to individual pro-
jects, although the cooperative nature of the research will continue to be empha-
sized.
During the year a thorough critical survey of the previous eight years' work was
made and methods of improving the service were given special consideration.
Certain changes in administrative procedure were adopted. A Research Council
was appointed, consisting of the key men of the organization. This council holds
weekly meetings, when all major matters of policy are discussed. It has proved
to be a highly effective means of improving coordination within the service.
A different method of inaugurating new research projects was adopted. The
research worker advancing a project works out a protocol, discusses the pertinent
literature orienting the problem, the possible means of solution, the possible sources
of error and means of combatting these. A detailed estimate of total expenses and
of the time involved concludes the protocol. A comittee is appointed to consider
each protocol in detail. The directors and Chief Biometrician are ex-oflicio members
of all committees. The plan provides for thorough initial critical appraisal of the
project and serves to bring to bear on it all the expert counsel available in the group.
The plan has proved valuable even to the more experienced investigators on the
service. The Editorial Board of five members continues to pass each communication
before it is submitted for publication.
The following papers from the Research Service may be discussed briefly:
A Biometric Study of the Relation between Oral and Rectal Temperatures in Normal
and Schizophrenic Subjects. Forrest E. Linder, Ph. D. and Hugh T. Carmichael,
M.D., C. M., M. S. Human Biology, 7: 24, February 1935.
The paper gives an account of the oral and rectal temperatures obtained in 25
schizophrenic patients and 25 normal control subjects together with a biometrical
analysis of the data. There is no important difference in the temperatures of schiz-
ophrenic and normal subjects. In neither group is there a very close relationship
between temperatures taken at the two sites. The schizophrenic shows less than
normal lability in local adaptivity to temperature regulations. As a result of this
22 P.D. 23
study it is concluded that important differences found in the degree and manner of
relation of the oral to rectal temperatures indicate that the organization of the tem-
perature regulating mechanisms in the schizophrenic is different than in normal
subjects.
The Reflex Time of the Patellar Tendon Reflex in Normal and Schizophrenic Sub-
jects. Paul E. Huston. Journal of General Psychology. 13: 3, July 1935.
It has been the general plan of the Psychology Department to study the simplest
type of response to stimulation at one extreme to complex reactions to the environ-
ment on the other. It has been postulated that defects in reflex responses (knee
jerk) are present in schizophrenia. This study was carried out with meticulous
attention to detail and it has been shown that there is no difference between the
response in the schizophrenic as compared with that of the normal.
A Pharmacodynamic Investigation of the Autonomic Nervous System in Schizo-
phrenia. I. Effect of Intravenous Injections of Epinephrine on the Blood Pressure
and Pulse Rate. H. Freeman, M. D. and H. T. Carmichael, M. D. Arch. Neur. &
Psychiat. 33: 342, February 1935.
The reactions of schizophrenic and normal subjects to various drugs having
characteristic selective actions upon the sympathetic and parasympathetic com-
ponents of the autonomic nervous system have been studied. This paper discusses
the results obtained in the use of adrenin in 72 schizophrenic and 24 normal subjects.
Significant differences between the two groups were obtained. The blood pressure
and pulse rate did not react as freely in the schizophrenic as in the control subjects.
Prior to the injections of adrenin, a fairly close relationship between the systolic
and diastolic blood pressure was found, but after the injections the association was
almost totally disrupted. The schizophrenic has less than normal sympathetic
reactivity. A study of the correlation between systolic and diastolic blood pressure
affords a practical criterion of such reactivity.
The Therapeutic Use of Dinitrophenol and 3.5 Dinitro-Ortho-Cresol in Schizo-
phrenia. J. M. Looney and R. G. Hoskins. American Journal of Psychiatry. 91:
1,009, March 1935.
Both of these drugs significantly increased the rate of oxygen consumption of
schizophrenic patients but were without significant therapeutic value in regard to
the mental manifestations.
Investigation of Polyuria in Schizophrenia. Francis H. Sleeper, M. D. American
Journal of Psychiatry. 91: 1019, March 1935.
An attempt was made to explain the polyuria occurring in schizophrenics on
physiological grounds. There was some reason to believe that the hypothalamic
area might be especially involved. The evidence did not warrant this assumption,
but rather seemed to point to psychological reasons for the condition.,
Body Temperatures of Persons with Schizophrenia and of Normal Subjects. Effect
of Changes in Environmental Temperature. Jacques S. Gottlieb, M. D. and Forrest
E. Linder, Ph D., Archives of Neurology and Psychiatry. 33: 764, April 1935.
This is part of a larger study of homeostasis in schizophrenia. Findings were
interpreted as indicating the thermohomeostasis is defective.
The Bromide Permeability Test in Schizophrenia. Hugh T. Carmichael, M. D.,
C. M., Joseph Rheingold, M. D., and Forrest E. Linder, Ph. D. Journal of Nervous
and Mental Disease. 82: 125, August 1935.
It has been claimed that the schizophrenic patient can be shown to be somewhat
abnormal in regard to the interchange of bromide between brain tissues and the
circulating blood. It was found that considerable variability in the partition exists.
In this series the schizophrenic showed no characteristic peculiarity nor was there
any relationship between changes in the coefficient and changes in the clinical
condition of the patient.
The Effect of Changes in the Environmental Temperature on the Blood Pressure and
Pulse Rate in Normal Men. Jacques S. Gottlieb, American Journal of Physiology.
113: 181, September 1935.
This paper also reports on a problem which was a part of the investigation of
the broad problem of homeostasis. In this case the effect of increase in the environ-
mental temperature on blood pressure and pulse rate was investigated. An increase
in the environmental temperature cause a significant increase in the pulse rate and
the diastolic blood pressure but not in the systolic pressure.
P.D. 23 23
Volume of Blood in Normal Subjects and in Patients with Schizophrenia. Joseph
M. Looney, M. D. and Harry Freeman, M. D. Archives of Neurology and Psy-
chiatry. SJ^: 956 November, 1935.
We have been specially interested in the oxygen metabolism of schizophrenic
patients. It was necessary to consider the efficiency of the mechanisms for the
transportation of oxygen. This depends in part upon blood volume. It was found
that the blood volume of the schizophrenic when referred to the surface area was
less than normal. In work reported last year, it was shown that the speed of cir-
culation of the blood was also less than in normal individuals. Presumably with
both these factors operating there might be a reduced efficiency of circulation in
the brain. This effect may be one of the causal factors of the psychosis.
This article received an Associated Press release coming from Chicago where the
Journal is published.
Progress and Problems in Endocrinology. R. G. Hoskins, Ph. D,., M. D., Journal
of the American Medical Association. 105: 948, September, 1935.
This is a resume of endocrinology up to the date of publication and was the subject
of an Address to the Section on Pediatrics of the American Medical Association at
their annual meeting.
Psychiatry is primarily concerned with the abnormal behavior of the individual,
and how it can best be altered for better adjustment. Psychiatric research, there-
fore, has its emphasis placed on why certain individuals behave in a psychotic way.
It aims at being able to evaluate all of the physiogenic, psychogenic, neurogenic,
constitutional and other data in terms of the patients' behavior. Since our means
of delimiting schizophrenia from other mental diseases is limited to differences in
mode of behavior (thinking, feeling, acting), it becomes evident that if one uses this
concept for delimiting the problems for research, the final evaluation is a psychiatric
one.
Through a grant by the Rockefeller Foundation, we have finally been able to
augment our psychiatric research staff to a point where the psychiatric case load
allows more investigative work to be carried on. In May, 1935, Dr. Eilhard von
Domarus, who received his training at the University of Jena and Yale University,
joined our staff. His special field of investigation is in thinking disturbances in
dementia praecox.
In July 1935, after spending a year at Guy's Hospital in London, Dr. Louis Cohen
came to us from the Institute of Human Relations at Yale University. At present
he is cantaring his interest chiefly in the problem of deterioration as it occurs in
schizophrenia.
Dr. D. Ewen Cameron, who is Physician in Charge of the Reception Service of
the Provencial Mental Hospital at Brandon, Manitoba, and the author of "Objec-
tive and Experirnental Psychiatry," spent three months this Fall on the Research
Service. During this period, he undertook the study of the relation of the systolic
to the diastolic blood pressure in a group of emotionally unstable patients. Previous
investigators in this hospital have shown that study of this relationship in the
schizophrenic group indicates that the sympathetic nervous system is considerably
less active in this disorder than in normal individuals. Statistical analysis of Dr.
Cameron's findings is being carried out and so far indicates that we may expect
to find that the sympathetic nervous system is unduly active in the emotionally
unstable group.
During the year. Dr. Andras Angyal has continued his investigations in certain
symptom complexes occurring in schizophrenia. He has observed that certain
schizophrenics present a number of symptoms which are not likely to occur alone
in patients, but only in association with each other. The consistent association of
these symptoms seems to be indicative of the presence of a particular syndrome.
The principal components of the symptom-complex are: (a) Disturbances of self-
awareness (alter ego, depersonalization, etc.); (b) Experience of motor influences
and automatism; (c) Certain somatic "delusions"; (d) Auditory hallucinations
with endosomatic localization; (e) Phenomena resembling Lilliputian hallucina-
tions (this is not constant) ; (f ) In the more severe cases, a certain type of activity
disturbances. The following paper deals with a single aspect of this symptom-
complex:
24 P.D. 23
The Perceptual Basis of Somatic Delusions in a Case of Schizophrenia. Andras
Angyal, M. D. Archives of Neurology and Psychiatry. S^: 270, August 1935.
The somatic delusions of a schizophrenic patient were analyzed. The perceptual
basis of such delusions proved to consist of certain tactile and kinesthetic phenomena
which under certain conditions also appear in normal persons. One of these
phenomena consists in the projection of a movement produced by the organism itself
(by arterial pulsation, respiratory movements or activity of the skeletal muscles)
into an external object which is in contact with the moving part of the body. As
another source of somatic delusions were found certain peculiar kinesthetic after-
sensations which arise when, without the knowledge of the subject, pressure is
removed from a muscle group (for example, by diminishing gradually the weight of
an object resting on a certain muscle group) . The kinesthetic after-sensation which
arises under such conditions consists in an impression that a substance is emanating
from the particular region of the body from which the pressure was removed. The
frequent occurrence of such phenomena in this patient seems to be due to severe
disturbances of self-awareness.
Dr. Cohen has been engaged in carrying out the folllowing projects:
1. Deterioration in schizophrenia with special reference to the significance of
stupor. This is a long term project in which an attempt is being made to describe
and evaluate the factors involved in personality deterioration. The first factor
which is under consideration is stupor and its associated characteristics.
2. Cardiochronographic reactions to pain in schizophrenic patients, (with M.
Patterson). This is a study of heart-rate changes to painful stimulation in schizo-
phrenics, including a group in schizophrenic stupor.
3. The effects of hyperthyroidization on deteriorated schizophrenics, (with J.
H. Fierman). A study of the physiological and psychiatric changes induced by
massive thyroid ingestion is in progress on patients in whom deterioration is extreme.
Dr. von Domarus has continued his investigations on the study of Thinking
Disturbances in Dementia Praecox. Patients have been interviewed daily over ex-
tended period. Their productions have been reported literally and the material
studied as to possible laws not yet discovered, but governing the thought processes
of schizophrenia. Interpretation of the productions has shown that benign and
malignant thinking disturbances may be distinguished. Benign thinking distur-
bances are defined as those which show correctibility and less strange productions
and also go together with a good prognosis. Malignant thinking disturbances
show incorrectibility, are para-logical and the prognosis is poor. At the same time,
the question has arisen as to whether the thinking disturbances are caused by a
disease process or whether they are primary — setting up further destructive pro-
cesses.
Dr. Miller's approach has been chiefly centered about psychosomatic relation-
ships.
A paper. Psychogenic factors in the Polyuria of Schizophrenics, was read at the
annual meeting of the American Psychiatric Association, May, 1935, and is accepted
for publication in the Journal of Nervous and Mental Disease. A summary of
the contents follows.
A previous study by Sleeper and a more recent study by Sleeper and Jellinek
revealed a high percentage of polyuria in the schizophrenic population. Exhaustive
physiological and biochemical investigations gave no clue for the high fluid intake
and output. It was then decided that the motives for the ingestion of large amounts
of fluid should be studied. It soon became apparent that the high polyuria group
was composed of individuals in whom the drinking of water and other fluids had
a high symbolic value. As a group they showed many strongly fixed oral interests,
without the development of disguising delusional symptoms. On the other hand,
patients from the group with a low output of urine volume appeared to have de-
veloped feelings of guilt if oral preoccupation were present. They developed most
often paranoid delusions of poisoning or ideas concerning the ingestion of noxious
and harmful substances. Consequently the taking of food and fluids by mouth
was greatly restricted.
Under the stimulus of Hoskins' use of endocrines in schizophrenia, the utilization
of these products as tools for bringing about clinical variability in the psychoses
P.D. 23 25
has been emphasized. We believe we have shown that alterations in basis energy
distribution can be brought about by the use of thyroid, male sex hormone (and-
rostine) and adrenin. By studying the shifts in the behavior pattern, one is better
able to evaluate the means at the disposal of the partici^lar patient for handling these
shifts. This would appear to offer us a valuable tool for approaching the problem
of research in psychiatry. The methods by which the individual psychotic can
make readjustments to shifts in the balance of his tensions, as brought about by the
use of hormones and related drugs, give the investigator an opportunity to study
psychodynamics in process. There have been many indications from our previous
physiological-biochemical investigations that the homeostasis of the organism is
disturbed in schizophrenia. Psychoanalytic and dynamic psychiatry has long
pointed out the significance of the instinctual tensions in the formation of person-
ality and its deviations.
Another study of psychosomatic relationships has been made with the use of
the cardiochronograph for the study of affectivity in lelationship to the content of
the psychotic reaction. Patients were interviewed under varying stipulated con-
ditions while a continuous record of the heart beat was being recorded. Synchron-
nously with this a verbatim stenographic record was made so that fluctuations in
the heart rate could be recorded accurately with the content. Present indications
are that this method may give a clue to what experiences are significant in the life
of a schizophrenic.
Progress this year has been maintained at a satisfactory level. Cooperation be-
tween individuals and departments has been most cordial. During the coming year
individual research efforts will be emphasized.
Report of the Psychology Department
October 1, 1934 — September 30, 1935
David Shakow, Director
I. Introduction:
S^nce the routine activities of the Department run along smoothly with minor
changes from year to year I shall say little about this aspect of the work. In this
report rather, the opportunity will be taken to present part of a research program
on schizophrenia originally presented to the Research Council of the JHospital.
The program has been worked out with the purpose of integrating past, present,
and projected psychological work within the Department and in relation to the
researches of other departments.
II. Statistical Report:
A statistical analysis of the work done by the Department during the year reveals
the following:
Psychometric Examinations
Individuals Number of
House Examined Tests Given
House patients 267 1,379
Schizophrenia research patients 40 381
Out-Patient
School clinic 290 495
Jail 14 60
Other patients 38 79
Employees and other normal subjects .... 131 622
780 3,016
Experimental Research
Individuals Number of
Examined Tests Given
Patients 50 57
Normal Controls 29 29
79 86
Totals 859 3,102
26 • P.D. 23
III. Psychological Program:
There has been considerable advance made during the yeai in integrating the
program of psychological research on schizophrenia. The program at the more
immediate theoretical level is organized about the concept of needs and their satis-
faction. In the normal person the characteristic pattern (all the patterns here pre-
sented are, of course, much simplified for purpose of exposition) in the process of
satisfaction of needs is considered to be:
1. Need -> Disequilibrium Attempt to Direct
(without anxiety) reestablish-^ Satisfaction ->- Equilibrium
equilibrium
or frequently:
2. Need — >• Disequilibrium Attempt to Continued
(without anxiety)— >-reestablish->-Frustrationdise -> quilibrium
equilibrium without anxiety
Indirect
satisfaction -> Equilibirium
at mature
level (e. g.
sublimation)
In the psychotic, especially the schizophrenic, the characteristic pattern of the
satisfaction process is different, and is of the nature of the following:
1. Need Disequilibrium Attempt to Continued
(without anxiety) reestablish Frustration disequilibrium
equilibrium with anxiety
Regression Satisfaction Equilibrium
The major distinction which is made between normal and psychotic persons is
that whereas the normal person's way of reachieving equilibirum is by means of
reality-serving devices, that of the psychotic is through regression (reversion to a
channel of expression belonging to a phase of development earlier than that indi-
cated by the chronological status of the individual). It must be understood, too,
that the pattern of behavior suggested is the characteristic type of behavior — not
the invariable type of behavior — and that the difference between a psychotic and
a normal individual lies in the prevalence of this behavior. It is also probable
that, biographically, behavior of type 3 follows on types 1 and 2. If in the process
of attempting to establish reality-contact the frustrations are too many and too
oiten repeated for the organism to bear, behavior of type 3 may become habitual.
A consideration of the various aspects of the reaction-pattern of the psychotic
will enable one to follow the organization of the research program more adequately.
It may be divided into three sections: 1. Needs; 2. Attempts at satisfaction;
3. Actual ways of final satisfaction. These divisions are, of course, artificial but
for our present purposes are fairly satisfactory.
With regard to the needs and their associated disequilibrium states, an obvious
question arises: Is there any difference in the innate strength, extent of, and nature
of needs between a schizophienic and a normal person? Until evidence to the con-
trary is given it seems more reasonable and fruitful to assume that there is the same
distiibution of need strength in the psychotic as in the normal. Some of the ques-
tions which need answer in so far as the nature of needs is concerned are : What are
the needs shown? What situations arouse needs? What is the strength oi needs?
What is the speed with which the organism becomes sensitive to need stimulation?
What is the nature of disequilibrium states before attempts to reestablish equili-
librium are made? With regard to the attempts at reestablishing equilibrium one
is especially interested in the effort expended at direct satisfaction.
Assuming that the fundamental needs of the human organism are, have been, or
are potentially, present, then the difficulty in achieving satisfaction of these needs
in the normal way may be due to either or both of two kinds of defect:
1. Low capacity. The organism is below par in its potentialities. It starts,
relatively, with a handicap in its intellectual and motor functions which pre-
sumably it can never overcome, even under optimum conditions. The defect is
primary.
P.D. 23 27
2. Inability to achieve capacity level. Despite the presence of approximately-
average capacities, something prevents the organism from reaching these capacity-
levels. This defect is secondary and may be due to either or both of these factors:
immatmity and disintegration. (These may be present independently and are not
synonymous.)
a. Immaturity — The subject is unable to react to situations consistently at a
level of development to be expected from the "ideal" person of that chrono-
logical (and mental) age. The immature response may be due to either:
1. Retardation or fixation in the process oi maturation.
2. Regression — reversion to a channel of expression belonging to a phase of
development earlier than that indicated by the chronological and mental
age of the individual.
b. Disintegration (or, perhaps better, lack of integrity) — a condition of inhar-
monious -working of the organism, in which there is a lack of coordination and
organization as a totality. (Terms such as dissociation, sejunction, individua-
tion [Coghill], etc. are more or less synonmous.) One is concerned not only
-with the problem of the quality of the integration but also with that of the
stability of the integration.
At this stage of the process of satisfaction of needs one would want to know
whether the unsuccessful attempts of the schizophrenic person to obtain direct
satisfaction or indirect satisfaction at a high level is due to a fundamental incapacity
which does not permit him to meet relatively complicated situations or to inter-
fering factors which do not permit of adequate use of capacities. One is largely
concerned here with the immediate "whys" of frustration.
The latter stages of the satisfaction process may be considered under the heading
of actual ways of satisfying needs. This involves the subject's way of handling the
results of his attempts to manipulate reality. These attempts result in frustration
with the tensions remaining — there is continued disequilibrium, but now probably
involving anxiety. In the schizophrenic this tension seems to be released by adopt-
ing predominantly earlier modes oi response, which result in satisfaction and re-
establishment of equilibrium. Some of the obvious questions at this level are:
What is the mechanics of tension release in schizophrenia? What is the extent of
anxiety in schizophrenia? When does it appear? When not? What is the nature
of the equilibirium state?
It is about this pattern that previous and present studies have been organized.
The space will not, however, be taken to list these. It seems desirable, however,
to describe to some extent some of the projected studies in relation to this program.
These studies cannot all be undertaken at once but the plan is to get to them in an
order determined largely by available resources.
A. Studies involving the nature of needs, etc.
1. Reactions to "free" situations in the playroom. — A logical development of
our earlier observation experiments. In this setting will be available
materials which permit easily of symbolic manipulation and for that reason
seem more likely to bring out reactions connected with the "core" of the
personality. x\n opportunity will here also be given to study the kinds of
things which get behind the "autism" of the schizophrenic and some aspects
of the "object-relationships" which he establishes.
2. Suggestion-negativism — A study of the nature of suggestibility and nega-
tivism in the schizophrenic with its implications for the determination of his
receptiveness to social simulation.
B. Studies connected with attempts at need satisfaction, etc.
There are two major groups of studies which come under this heading. Studies
involving capacity and those involving integration. Besides, there are a few
which involve mainly the analysis of the nature of the poor performance of
the schizophrenic person.
1. Capacity studies — These studies attempt to get behind the poor performance
of schizophrenics to determine whether capacity level is any different from
what it is in normal subjects.
a. Prodmeter, protracted study. The indications of a preliminary experiment
done a few years ago indicated that when schizophrenics are kept at a
28 P.D. 23
learning task for a long time the existing differences between them and
the normal subjects disappear. This present study is intended to follow
this up in detail.
b. Reaction time, protracted study. An experiment with the same rationale
as the above. Both experiments attempt to determine capacity level by
a kind of "battering" process.
c. Effects of motivation on achievement. Use of rewards and punishment as
devices for speeding up the process of approaching- the normal level in
learning situations.
d. Effects of competition on achievement. Use of rivalry or competition —
more socialized stimulation — for speeding up the process of approaching
the normal level in learning situations.
2. "Integration" studies. — Aimed at determining in a limited way certain
aspects of the integrative capacity of the schizophrenic individual.
a. Transfer of training. A study of the speed and quality of transfer of a skill
acquired by one side of the body to the other.
b. Associated movements. As a correlative study to the above, the investiga-
tion of established associated movements (synkinesis). This is a desirable
complement to the previous study since it is approaching the problem at
a simpler and somewhat different level.
c. Psychological profile, self-correlation and variation. The use of these statis-
tical devices on the accumulated psychological material for the light it can
throw on the problem of integration.
d. Conditioned Reflex. An early study by us of the patellar tendon reflex
latent time showed no difference between normal and schizophrenic sub-
jects. The next logical step was to see what would be the effect of bringing
cortical processes more definitely in. For the present the pupillary reflex
has been selected since it would involve a study of the pupil per se as well
as a study of the conditioning. It is a logical link in the chain of experi-
ments planned for a long time which range from simple behavior at the
reflex level through the complicated behavior involved in learning.
3. Analysis of factors involved in poor performance of schizophrenics.
a. Persistent attention study. V/ith a new pursuitmeter built here the analysis
of the attention difficulties shown by the schizophrenic in a very simple
task is planned.
b. Reaction time, effect of preparatory interval. This study is a follow-up of
a previous study which gave some suggestions as to the way in which
schizophrenics broke down in situations requiring consistent attitudes or
"sets."
c. Reaction time, perseverative effects. A follow-up on a previous study which
gave promising leads on the nature of perseveration in schizophrenia.
This study and the above are closely interrelated.
C. Studies connected with the ways in which needs are satisfied.
1. Tension-release mechanisms.
a. Substitution study. A continuation of the previously reported study with
the use of substitute tasks when the original task is interrupted. It is an
attempt to study the adequacy of the schizophrenic in finding indirect
ways of expression for accumulated tensions.
b. Repetition-choice and types of reaction to frustration. Studies especially
concerned with the types of reaction shown when the subject is frustrated
and the way in which the accumulated tensions are released.
c. Levels of tension release. Whereas the previous experiments were con-
cerned with the macroscopic aspects of tension release, the present study
is interested in it microscopically. It is a natural outgrowth of our Luria
technique study where an hypothesis of levels of tension release was
presented. Discrete and continuous free association technics will be used.
Besides the verbal material, reaction time, heart rate (cardio-tachometer),
respiration, weight change (Sauter scale*, movements and perhaps some
other indicators of tension will be used. In an associated experiment
voluntary and involuntary movements of the hand will be used. The
P.D. 23 29
major purpose of the experiment is to determine the presence of tension
in relation to presumably affective situations and the ways in which
schizophrenics get rid of it when present.
d. Autistic gestures and expressive movements. The use of involuntary move-
ments and expressive movements as tension release mechanisms and in-
dicators of personality qualities is to be studied.
e. Nature of the equilibrium state — Comparison of normal and schizophreni
subjects over a long period to determine whether the relative equilibrium
state is more nearly an equilibirum state in schizophrenics than in normals.
The technique to be used includes the cardio-tachometer, movements
device, etc.
2. Language and thought studies. The use of various technics for getting at the
nature of the thought processes both as to content and formal properties.
a. Healy P. C. II.
b. Aphasic-schizophrenic relationships. — Use of tests found valuable with
aphasics.
c. Errors in Alpha and Otis Tests. Analysis of errors in these multiple choice
tests.
d. Tachistoscopic studies. Exposure of vague pictures to determine apper-
ceptions.
3. Analytic play technique.
a. A series of experiments using materials which offer themselves readily
for symbolization of childhood situations. The purpose is to use this
technique as an entree into the conflicts of the patient especially when
they are not verbalized (cases of mutism) and to determine the validity
of the technic for getting at very early material which according to some
theories is supposed to play an important part in the etiology of schizo-
phrenia. For the present, the major technic planned is the use of the
construction of dramatic situations in the life of a child.
IV. Papers published, accepted, read, etc.
A. Papers published:
1. A note on color-blindness in some psychotic groups. J. Soc. Psychol,
1935, 6, 252-256. (M. S. Millard and D. Shakow).
2. The reflex time of the patellar tendon reflex in normal and schizophrenic
subjects. J. Gener. Psychol. 1935, 13, 3-41 (P. E. Huston).
3. A psychometric study of 150 adult delinquents. J. Soc. Psychol, 1935,
6, 437-457. (D. Shakow and M. S. Millard).
4. The patient's psychological situation upon admission to a mental
hospital. Amer. J. Psychol, 1935, 47, 381-408. (T. Dembo and E.
Hanfmann).
5. Freud vs. the Libertine. Modern Thinker, 1935, 6, No. 3., 13-19 (S.
Rosenzweig).
6. Outline of a cooperative project for validating the Rorschach test.
Amer. J. Orthopsychiat., 1935, 5, 121-123. (S. Rosenzweig).
7. A test for types of reaction to frustration. Am. J. Orthopsychiat. Oct.
1935 (S. Rosenzweig).
8. Apparatus for the Study of Continuous Reaction. Jour. Exper. Psychol.
17: 885, December 1934. (P. E. Huston and J. G. Hayes).
9. Types of Reaction to Frustration. An Heuristic Classification. Jour.
Abn. and Soc. Psychol. 29: 298, December 1394. (S. Rosenzweig).
10. Social Structure of a Group of Kindergarten Children. Amer. Jour, of
Orthopsychiat., 5: 407-410, 1935 (Oct.) (E. Hanfmann).
The following papers were accepted for publication:
1. Resumption of interrupted activities in schizophrenia. J. Gener. Psychol.
(M. Rickers).
2. Motor Functions in schizophrenia: I. Speed of Tapping. J. Gener. Psychol.
(D. Shakow and P. E. Huston).
3. Motor Functions in schizophrenia: II. Reaction time. J. Gener. Psychol.
(P. E. Huston, D. Shakow, L. Riggs).
30 P.D. 23
4. Accessibility of schizophrenic and normal subjects to environmental in-
fluences. J. Gener. Psychol. (M. Rickers).
5. A study of the Hering phenomenon. Psychol. Forsch. ( E. Hanfmann).
The following papers were presented at meetings:
1. The social structure of a group of kindergarten children. Amer. Orthopsy-
chiatric Assn., February 1935, New York. (E. Hanfmann).
2. The personality structure of schizophrenic patients. Lewin Group, January,
1935, Ithaca. (M. Rickers).
3. An experimental study of social responsiveness. Harvard Psychol. Clinic,
March 1935, Cambridge. (M. Rickers).
4. A test for types of reaction to frustration. Amer. Orthopsychiatric Assn.,
February 1935, New York. (S. R.osenzweig.)
5. Program for a cooperative project for validating the Rorschach test. Amer.
Orthopsychiatric Assn., February 1935, New York. (S. Rosenzweig).
6. Therapy by psychologists. Conn. Valley Assn. of Psychologists, May 1935,
New London. (S. Rosenzweig).
7. Research opportunities in a State Hospital. Amer. Psychol. Assn. Sept.
1935, Ann Arbor. (N. Goldman).
V. Miscellaneous: . .
Various members attended the meetings of the Americari Psychological Assn.,
American Orthopsychiatric Assn. and of other groups. The abstract work for
Psychological Abstracts continued as usual, being partaken in by various members
of the department. Two members. Dr. Rickers and Dr. Hanfmann, obtained re-
newals of their grants-in-aid for research projects from the Social Science Research
Council. The Department seminar in " Methodology in Psychopathology " was
very successful and a new one to discuss projects and work in progress was started
this September.
The plans for the coming year include besides the initiation of some of the pro-
jects discussed in the program, the continued analysis of the accumulated data
with the purpose of getting material ready for publication.
LiBHARY Report
George L.Banay, Ph.D., Librarian ■
/. Medical Library
Medical science as we know it today is based on experiment and research, and the
library, in this connection, is almost as useful a tool as the laboratory. In addition
to its primary purpose of curing sick people, this hospital is an institution for re-
search, so the library is built around the periodicals. However, for the benefit of
the interns, medical and other students, we keep a well-stocked reference shelf,
and the most important textbooks in all the subsidiary sciences are available. The
presence of the students creates a lively atmosphere and the library is a busy place
throughout the whole year. ^
To indicate the various activities of the library, I quote the following details:
Periodicals. — Although we could not add any new periodicals to our subscription
list this year, we had all the important magazines at our disposal. Here is a classi-
fied list: 22 periodicals in Neurology and Psychiatry; 19 in Psychology and Psycho-
analysis; 21 in General Medicine; 13 in Internal Medicine, Pathology, Surgery,
and Dermatology; 15 in Physiology and Physiological Chemistry; 5 in Physical
Medicine and Radiology; 2 in Dentistry; 2 in Medical History; 2 in Hospital
Administration; 6 in Social Service; 1 in Occupational Therapy; 2 in Nursing; and
5 in library Science and Statistics — altogether 115 periodicals, 4 less than the
previous year.
Of this number, the hospital subscribes to 79, 2 are paid for by the Memorial
Foundation for Neuro-T^ndocrine Research, 18 are donated by Dr. Hoskins, 2 by
Dr. Bryan, 1 by Dr. Sleeper, 1 by Dr. Perkins, 1 by Dr. Looney, 1 by Dr. Car-
michael, 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, 4 are in French, 10 in German, 4 in Italian, and 97 in English.
Circulation. — The Medical Library circulated 643 vplumes last year.
P.D. 23 31
InterAihrary Loans. — The Librarian maintained close contact with other
Medical Libraries, and we borrowed 155 volumes from seven libraries, namely:
Boston Medical Library 108
New York Academy of Medicine . . . • . . 28
Harvard College Library 11
Clark University Library 3
Worcester Polytechnic Institute ..... 3
Harvard Medical School 1
Columbia University Library 1
On the other hand, we lent 9 volumes to the U. S. Veterans Hospital in North-
ampton, Massachusetts.
Medical Library Association Exchange. — Our library is a member of the Medical
Library Association. This 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 1935 we received 114 volumes from the Association
and gave in exchange 79 volumes to 53 medical libraries.
Back Files. — Continuing the policy of completing the back files of the more
important 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.
New Books. — Eighty-six new volumes have been added to the shelves, some of
them to the library of the Child Guidance Clinic.
Binding. — We bound 318 volumes during the year (including the ones received
from the exchange) so that we are up to date with the binding.
Present State. — On November 30, 1935, the Medical Library had:
3,420 bound volumes of periodicals
14 unbound volumes of periodicals
1,267 bound volumes of books
— unbound volumes of books
1,140 old books (used for exchange)
613 catalogued reprints and pamphlets
Total 6,454 items, an increase of 364 volumes over the previous year.
The old textbooks and other obsolete material have been taken off the shelves
and the worn but valuable volumes rebound, so that the library is in an excellent
working condition.
Services: — The Librarian continued to circulate the bibliographies and abstracts,
prepared many special bibliographies, and translated 15 forgein medical articles.
The bibliographies, abstracts, and translations are filed in the Medical Library. We
now have more than 3,000 classified abstracts and two volumes of translations.
ERA Projects. — Three projects submitted by the Medical Library were approved
by the Federal Government and seven stenographers were assigned for the work.
We started to recatalogue our books, to compile a full bibliography on schizo-
phrenia, and to complete our abstracts on schizophrenia up to 1932, when our
present abstract service was begun. Due to unfortunate financial complications,
after three weeks' work the projects were dropped and there is very little hope that
there will ever be enough money avilable to complete them. All three projects
were meant to increase the value and usefulness of the Medical Library.
//. General Library
Under the guidance of the Occupational Therapy Department, we started to re-
organize the General Library. As the first step, all the obsolete material has been
eliminated and the still valuable but shopworn books rebound. The shelves look
rather depleted at the present, but we shall build up the library systematically and
hope to have it in a fairly good condition in the near future. An Occupational Ther-
apy student is in constant attendance to help the patients to select their reading
material and at the same time to safeguard the contents of the library. The
students change every month, and the situation, although far from being ideal, is
much better than when we had to depend entirely on the patients.
Included in the equipment for the new porches were two new book-trucks. Twice
a week trips are made to the male and female wards in the evening hours to provide
32 P.D. 23
reading material for the bedridden and non-parole patients. These trips are very
popular and are eagerly awaited.
To replace the eliminated material we bought 150 new books, and we intend to
buy 100 new books every three months during the coming year.
We hope to secure the services of a library student who will be in charge of the
General Library.
On November 30, 1935, the General Library had:
2,084 volumes of books
176 volumes of bound magazines •
27 Bibles and prayer-books ,
Total 2,287 volumes.
Forty-eight current periodicals and daily newspapers are subscribed to by the
hospital.
In addition to this, the Library borrows 150 books every three months from the
Worcester Free Public Library to circulate among the patients and employees.
Arrangements have been made with the Public Library to send 100 volumes every
three months to the Summer Street Department. Besides this we send to the Sum-
mer Street Department 100 books every three months from the General Library
at the Main Hospital.
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.
The library is well patronized by patients and employees. The average monthly
attendance is 1,600 patients and 300 employees.
During the year the library circulated 6,496 volumes and had 22,774 reading
visitors.
A few churches of Worcester (First Church of Christ, Scientist, St. John's
Episcopal Church, All Saints' Church) and the Worcester Public Library sent to
us old books and magazines regularly. We express our hearty thanks to all who
have given books and magazines to the library.
Chaplain's Department
Carroll S. Wise, D.D., Chaplain
Many of the duties of a chaplain in a mental hospital are specific and do not
change from year to year. One of these is, of course, the conducting of religious
services. These have continued during the past year much the same as during
previous years, but several advances have been made. The attendance at these
services during the past year has been more than doubled. Patients are not forced
to attend services, but more positive encouragement is being used on the part of
the nurses. Along with this a method has been worked out through which the
chaplain contacts patients who do not attend services and whose condition is such
that they may attend. Another improvement in the program of religious services
has been the monthly observance of Holy Communion. A special service for use
in a mental hospital was prepared for these occasions. The patients have always
responded in a way which indicated that they appreciated the service, and it is our
belief that it has a definite place and value in a mental hospital.
Preaching in a mental hospital presents its peculiar problems, but these are not
insurmountable. The usual procedure is to preach on some innocuous subject
which has no meaning or value to the patients. Such a method grows out of a
failure to understand the problems and the patients. Mental patients on the whole
have the same religious needs and problems which ordinary people have. On
the wards of a mental hospital may be found individuals who are going through
experiences very similar to those which religious leaders have gone through, and
for which these leaders found a solution in their religion. All of the religious
problems, and more, which come to any minister in the community are to be found
within the walls of a mental hospital. It is true that a minister cannot always ren-
der the same degree of service to a mental patient as he can to someone who is not
in a condition which requires him to be in a hospital. This is due, however, only
to the extremity of the patient's condition, and not to any essential difference in
P.D. 23 33
the problems. When this situation is understood and faced honestly it gives
religious services and preaching in a mental hospital a quite different aspect than is
usually seen. Such activities, then, become an opportunity rather than a formality.
The opportunities for pastoral work in a mental hospital are also large for the
properly trained pastor or chaplain, but they are small for a pastor who is not
specially trained. Not infrequently something is said in a sermon which brings a
request from a patient for a conference. New patients are seen regularly and sys-
tematically by the chaplain in an endeavor to establish a friendly relationship with
them. The medical wards of the hospital are also visited regularly, and the
chaplain is notified when the name of a patient is put on the danger list. Doctors
and nurses frequently call the chaplain requesting that he see a patient. A trained
pastor in a mental hospital can spend just about as much time as he has at his
disposal in seeing patients who might profit in one way or another by such minis-
trations.
Many of the activities of the chaplain of this hospital may be called educational.
The most important of these is the supervision of a group of theological students
who study here for twelve weeks during the summer in cooperation with the
Council for the Clinical Training of Theological Students, Inc. A separate report
has been made on this work which is available for anyone who wishes it. During
the past summer a group of eight students and five ministers participated in the
course. The ministers were present because they were conscious of problems in
their respective parishes which they did not know how to meet. In this course we
endeavor to give the student a first-hand contact with mental patients, a thorough
knowledge of mental pathology, a knowledge of the approach and contribution of
the various specialists in the field of personality problems, and also some under-
standing of his own approach and contributions as a minister in the solution of such
problems. Students and ministers attending this course represent all denomin-
ations. The interest in such training is growing rapidly, and each summer many
more students apply for admission than we are able to take.
Another educational activity of the chaplain during the past year has been to
conduct a course during the fall months for local ministers. These ministers came
to the hospital one morning each week for eight weeks and joined in a discussion of
personality problems and the minister's relation to them. At the end of the course,
the group asked that it be continued as they felt it was of great value to them.
Along with these courses the chaplain has also continued to teach a course in
the Boston University School of Theology. He has also made over fifty talks to
various groups in the community on mental hygiene subjects. These talks have
been given to church groups of various types, Y. M. C. A. groups. Women's
Clubs, Men's Clubs, and other such groups.
A project which was begun several years ago in cooperation with the Worcester
County Federation of Church Women's Clubs has been continued very successfully
during the past year. This organization has sponsored a plan of systematic visiting
by a group of sixteen women of the community to certain wards on the women's
side of the hospital. These visits are very much appreciated by the patients, and
many look forward to them from week to week. During the Christmas season a
number of Christmas parties were arranged by this visiting committee, to the
great pleasure of the patients. This group has met once a month during the winter
and at each meeting a talk was given by the chaplain on some phase of hospital life.
In closing this report grateful acknowledgment should be made for the continued
interest and support of the Massachusetts Congregational Conference and Mission-
ary Society, without which this work could not have been carried on.
Child Guidance Clinic
Milton E. Kirkpatrick, Director
The activities of the Child Guidance Clinic should always be considered from a
qualitative standpoint, and quotation of figures in such categories as total cases
accepted, cases treated, cases closed, number of interviews, etc. should not receive
primary consideration. This Clinic has constantly adhered to the principles of
therapy and has carefully avoided any procedure which would incline toward
strictly diagnostic work. Treatment of the individual child is and will continue
to be our chief objective. The freedom which has been accorded the Clinic in
34 P.D. 23
limiting its intake to the number consistent with good therapeutic endeavor is
greatly appreciated by the entire staff. As at present organized, this should not
exceed 200 new cases each year.
The training of personnel is secondary in importance to therapy. During the
past year two students from Simmons College and one from the Smith College
School for Social Work were given their field training at the Clinic. The theses
which they prepared by the aid of Clinic material for qualification for their degrees
in social work will be discussed later. The Director feels that this program is very
important and should be continued. We would like to see our students remain in
Massachusetts and we hope that in the near future some of them will be absorbed
in the social agencies of Worcester.
The case records at the clinic contain a wealth of material which could be used
for research purposes. The Director intends that the staff of the clinic shall make
increasing use of this material. Each year has seen some new research completed.
We hope that in the near future something outstanding will be developed.
Community education, which is so important in the early years of any Child
Guidance Clinic, occupies a position of lesser importance. So much has been done
in this direction that we feel it no longer essential; the time of staff members can
be used to a much greater advantage in the treatment of children. Our case load
most be carefully selected. There are always a number of cases wanting service.
In view of this situation the Director advises careful discrimination in the accep-
tance of popular speaking engagements.
Reference to the Statistical Table above shows that 559 children received service
at the Clinic during the fiscal year ending November 30, 1935. It is the Director's
opinion that each case treated reaches on the average of three other interested
persons, either parents, teachers or brothers and sisters. Full service cases num-
bered 340. An additional 140 cases were handled on a cooperative basis between
the clinic and local social agences. Special service cases of an advice nature num-
bered 79. During the year 400 cases were closed. This figure is abnormally high
and needs some explanation. The change in personnel necessitated by the resigna-
tion of four permanent staff members whose aggregate period of service to the
clinic totals 19 years, resulted in the closing of more than the usual number of cases
and also in the reduction of the number of new cases accepted.
In regard to the source of referrals, we note that social agencies are consulting
the clinic with much greater frequency. We take this as an indication that the
clinic is useful in their program. The increasing number of agency workers who
are able to do good cooperative case work with the clinic is most encouraging. The
Juvenile Court referred 56 children during the year. The Director is definitely of
the opinion that we are not getting these cases early enough. One of our most
valuable treatment adjuncts, that of foster home care, is little used. Only four
boys referred by the Court last year were placed in foster homes — the remainder
were too old or too steeped in chronic delinquency patterns to make placement a
wise or potentially satisfactory plan.
The clinic is vitally interested in four community projects which promise much
for mental hygiene in this vicinity.
1. We are furnishing both psychiatric and social work service to the newly
organized Shrewsbury School Clinic under the direction of Dr. Farrar.
2. The Superintendent of the County Training School for Boys, at Oakdale,
has asked for and is receiving a very thorough service for the school. This is a most
unusual opportunity. Probably never before has a clinic been accorded such a
high degree of cooperation in a correctional institution and we regard it as an
extremely challenging situation.
3. The Director of the Worcester Girls Club has asked that a psychiatric social
worker be assigned to the club on a basis of two hours, two afternoons a week. She
hopes to be able to obtain from her Executive Board consent to add a psychiatric
social worker permanently to her staff on the basis of the service a part-time worker
can render in her organization.
4. Through the Simmons College School for Social Work, four workers from local
agencies are being supervised by staff members in order that they may complete
their qualifications for membership in the American Association of Social Workers.
P.D. 23
35
These four workers are key people in their organizations and we expect them to be
very valuable to us in future relationships.
Research completed during the year includes three theses by Social Work students
in training. "A Study of Children Referred by the Juvenile Court to the Worcester
Child Guidance Clinic with special Reference to Those for Whom Clinic Treatment
was Recommended" by Miss Josephone Parker of Smith College, "Study and
Treatment of Cases at the Worcester Child Guidance Clinic" by Miss Dorothy K.
Howerton of Simmons College, and "Forty-two Delinquent Boys with Special
Attention to Their School Placement" by Miss Elizabeth B. Rose of Simmons
College. "Some Factors in Truancy" begun elsewhere but completed during the
year was published in the October issue of Mental Hygiene by the Director and
an associate. "The Contribution of Child Guidance Theory to the Treatment of
Behavior Problems in the Field of Probation" was presented by the Director be-
fore the National Conference of Social Work, in Montreal.
Research in progress at the present time includes a thesis on Referrals and
another on Treatment. Miss Clark is beginning to evaluate the cases of speech
defects that she has treated at the Clinic during the past four years. Mr. Brush is
making a detailed comparison of personality types and their relationship to different
intelligence tests. The Director expects to complete a study of "One Thousand
First Offenders", begun elsewhere, sometime during the year.
Staff members have participated actively in the teaching program at the Hospital.
Lectures have been given to the theological students, medical students and nurses.
Once each month a Child Guidance Clinic case is presented before the Hospital
Staff. We expect to continue the policy of carefully integrating the work of the
Clinic with that of the Hospital and make it a vital part of the serrvice being
rendered to the community.
The statistical report for the Department for fiscal year is appended.
Worcester Child Guidance Clinic
Annual Service Report
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 ....
D. Applications withdrawn ....
II. Type of Service Classification:
A. New Accepted Cases:
6. Full service a. Clinic staff cases, 4 reopened
b. Cooperative cases, 6 reopened
c. Full service not a or b
7. Special Service (Advice) 6 reopened
8. Mental Health study ....
9. Total new cases accepted .
B. Total Cases Open at Sometime in the Year:
10. Full service a. Clinic staff cases
b. Cooperative cases
c. Full service not a or b
11. Special service (Advice)
12. Mental Health Study ....
13. Total cases open at sometime this year
Total
355
188
11
5
559
400
159
55
25
68
63
81
4
56
0
204
340
120
38
79
0
559
36
P.D. 23
III.
IV.
C. Cases taken from Service:
14. Full service a. Clinic staff cases
b. Cooperative cases
c. Full service cases not a or b
15. Special service (Advice) . . .
16. Mental Health Study
17. Total cases closed during this year .
Sources Referring New Accepted Cases:
Full
18. Agencies a. Social.
b. Medical .
19. Schools a. Public
20. Juvenile Court
21. Private physicians
22. Parents and relatives
51
1
4
33
2
57
148
(7 reopened)
(2 reopened)
(1 reopened)
(10 reopened)
Special
12
3
23
(4 reopened)
18 (2 reopened)
56 (6 reopened)
23. Total new cases
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 services a. Clinic staff cases
b. Cooperative cases
2. Special service
E. Number of Open Cases given Service during year by Workers:
Approximately
Referral Interviews (June to December 1, 1935) approximately
V. Personnel Report (Average Staff during year) ;
A. Regular Staff:
Part
time
1
1
2
2
1
266
78
19
37
0
400
Total
63
1
7
56
2
75
204
Total
213
714
151
107
181
25
513
61
851
728
976
55
90
17
450
75
Full
time
2
2
2-3
2
2-3
a. Psychiatrist
b. Psychologist .
c. Social workers
d. Clerical workers
B. Staff in Training: a. Social workers
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 psychiatrists:
9:00 to 5:00 daily
9:00 to 12:00 Saturdays
Educational Services:
Number of lectures and courses given by Dr. Kirkpatrick, 18; Miss Walton, 4;
Dr. Hill, 5; Dr. Hartwell, 4; Miss Wyman,l; Mrs. Huston, 2; Mr. Toy, 2.
Committee Meetings and Conferences attended by Staff Members:
Number Month Occasion
1 February A.A.S.W. Delegate Conference, Washington D. C.
5 February Amer. Orthopsychiatric meeting, New York.
P.D. 23 37
5 May. . . Child Welfare Conference, Cambridge, Mass.
1 May . . American Psychiatric Association
3 June . . . National Conference of Social Workers, Montreal
1 July . . Supervisors Meeting, Smith College, Northampton
5 September . Social Work Conference, Wellesley.
Visitors to Clinic — Other than Interested in Individual Patients:
a. Number from city, 23 b. Number from outside city, 28.
Dr. Doris Sidwell, Danvers State Hospital
Dr. Helen Witmer, Smith College
Dr. Douglas A. Thom, Boston, Mass.
Miss Mary Augusta Clark, National Committee for Mental Hygiene
Miss Harriet Parsons, Family Welfare Society, Newton, Mass.
Dr. George Stevenson, National Committee for Mental Hygiene.
Dr. Clarence Hincks, National Committee for Mental Hygiene.
Miss Annette Garrett , Smith College School for Social Work.
Dr. Everett Kimball, Smith College School for Social Work.
Farm Report
Oakleigh Jauncey, Head Farmer
Seasonal variations in crop production with periods of over-production on one
hand and underproduction on the other necessitate careful planning on the part
of the institutional farmer if the best interests of the institution are to be served.
With this fundamental idea in mind, for the past few years we have developed
and used at this hospital a planting chart which permits the farm manager to lay
out a program of planting and harvesting whereby he can supply the hospital with
fresh vegetables in season and store in the farm and freeze in cold storage enough
vegetables to supply the hospital until the following season's crops are ready for
harvest.
Prior to the planting season each year the steward, chef, and farm manager
determine the variety and amounts of vegetables needed by the hospital.
The planting chart is figured on a weekly basis and is so devised that space is
given horizontally for 52 weeks and vertically for the variety of vegetables. In the
horizontal spaces are inserted in black the desired weekly delivery of farm produce
and in red the actual delivery as the crops come to harvest. From the planting
chart the farm manager makes up his seed list and orders the seed in advance of
the planting season, taking into consideration the seed which is best adapted to the
soil to be planted and the amount necessary for crops which can profitably be util-
ized by the institution. The use of the chart facilitiates the purchase of seed
maturing at different harvesting seasons. The earlier varieties of seeds are planted
first and the planting is so planned as to arrange for efficient weeding and harvesting
to avoid flooding the institution market. In practice it has been found that the
estimated delivery of farm crops compares favorably with the actual deliveries.
Naturally this follows only when the weather is favorable and all other things are
equal. The steward, chef, and farm manager all know far in advance just what
vegetables are to be expected and will be available at any time throughout the year,
with an average season. It eliminates the possibility of delivering vegetables to
the institution which cannot be utilized and which would result in an economic
waste to the hospital. If a freezing program is in effect in a given institution, by
the use of this chart the additional labor necessary for preparation of the various
foodstuffs can be arranged for in cooperation with the physicians of the hospital.
It affords an easy method of calculating seed purchases and acreage to be planted,
eliminating guesswork to a considerable degree.
Steward's Report
Herbert W. Smith, Steward
The laundry of the mental hospital has always been an administrative problem.
Too much responsibility is placed on the head laundryman and too little knowledge
of laundry practice and processing is known by those administering it. The results
are usually unsatisfactory. In January of 1935 we started an intensive study of
laundry procedure at this hospital which we are still pursuing and from which we
have derived much valuable knowledge and also improved the quality of work
38 P.D. 23
done. The study has been carried on with two main objectives in mind — first,
to obtain clean white linen; second, to do this with the least injury to tensile
strength of the fabric.
The vital part of any laundry is the wash wheels. What goes on within them
during a laundry process has been the better part of our study. Great damage can
be done by the improper washing of clothes and this in turn can make replacement
cost high. Formulas are built in a great many instances by the "Trial and error"
method, and in our study of this subject we found that there are control methods,
which although they may not be absolute, can be applied satisfactorily in a prac-
tical way. We are working along these lines and find that the knowledge applied
aids us considerably in knowing what is going on inside of the wash wheel.
There are several factors that are absolutely essential to good laundry practice
such as thermometers for registering proper temperature, accurate devices for
measuring water levels, proper cold and hot water inlet valves to wash wheels,
etc., that all are important when considering the objectives we are striving for.
These we do not possess at this time, but thus far have brought our standard of
work up to a great deal higher level than it was in January of 1935.
This study would be of no practical value unless it was applied, and to do this,
we have stimulated interest in the minds of our laundry employees, and during
the past winter months have held weekly classes after working hours to pass on
the information we have gained relative to the control system of running wash
wheels. This has been attended by all of the male erhployees in the laundry who
have shown great interest in the subject and it has been reflected in their work.
We feel that by the end of the course we will have made several good washers out
of young men who originally came into the laundry with no other purpose than to
fill a job.
The cafeteria system of feeding patients and employees was started in this
hospital in October of 1927. Various factors pertaining to this service that were
not entirely satisfactory at the beginning have been ironed out and made to run
smoothly.
One factor in particular that has given more trouble than all others combined,
was the proper handling of trays and dishes left at a central clean-up room after
the patients were through with them. Here it was necessary to scrape the table
waste from plates and trays and return them to the dish-washer to be cleansed and
put back into circulation. This clean-up room has been one of our greater problems
on account of the noise and confusion together with the messy condition brought
about by the method employed in handling the dishes coming into this room.
We often thought of an endless belt or conveyor system to be used in connection
with this problem, but never felt that we had the money to invest for such a
purpose. Conditions did not improve, so in the latter part of 1935 we designed an
endless conveyor belt which was built at the institution by our own mechanics
and put into operation.
There are one or two startling results that have been obtained from the use of
this mechanism. First, the room is no longer noisy or messy; and second, while
previously it had been necessary to have 10 men take care of the dishes coming into
this clean-up room, we now find that with the belt, we can do the work very readily
with five. It has also reduced the crockery breakage at this point to a minimum.
Report of Foreman Mechanic
Anton Svenson, Foreman Mechanic
During the year a new system of handling keys was started. Under the old
system a considerable number of keys were lost or mislaid. With several people
handling keys, the responsibility for their loss could not always be placed. A key
cabinet was built with space for storing all the keys of the hospital and special
spaces for the separate buildings so arranged and numbered that keys for individual
rooms could be quickly obtained. The cabinet is located in the carpenter shop
storeroom. New employees get their keys here when employed and turn them in
at the same place when leaving the service. Broken keys must also be turned in
for replacement. The treasurer of the hospital is notified that all keys are accounted
for before final payment can be made. Since the installation of the system, the
hospital has had no financial loss as a result of lost keys.
P.D. 23 39
Recently a key machine was purchased which permits the manufacture of all
types of keys very rapidly. Inasmuch as many of our keys and locks are old and
worn necessitating much repair work, it is estimated that the key machine will
pay for itself in time saved in less than six months.
Engineer's Report
Warren G. Proctor, Chief Engineer
During the past year each man in the department has been rated as to efficiency
according to a plan developed by an operating engineer. Eighteen major character-
istics were considered. At regular intervals each member of the crew was given
his rating by the chief engineer, his deficiencies explained and recommendations
for improvement emphasized. When improvement resulted commendation was
given. Not only has this system proved beneficial to the hospital but it has helped
the individual men. All the men in the department have been continually urged
to improve themselves by study in order to qualify for the next higher position
in the department. Several of the men are attending night classes at the Worcester
Trade School, another has been taking a course in mechanical engineering at the
Y. M. C. A. Two of the attendants in charge of patients in the boiler room during
the winter months obtained their second class firemen's licenses. During the year
one man has received his first class engineer's license, one has advanced a grade to
a first class firemen's license and another has received his second class fireman's
license.
While it is realized that we may lose some of these men to other institutions, the
additional knowledge these men have obtained and are using in the plant should
eventually result in an increased efficiency which will mean a definite saving to the
hospital in diminished operating costs.
I would not be carrying out my duty to the patients of the hospital and their
relatives in the community, did I not call the attention of the Trustees to the
entirely inadequate appropriations that have been the rule for a number of years
for the physical upkeep of the buildings of this hospital. These appropriations have
been cut to a point where the physical plant has suffered. As an illustration I take
the one item of paint. Certainly paint is an excellent investment for any landlord.
The wards of a hospital of this kind get a greater wear and tear than would be the
case in any other kind of a building that one can think of. Frequent painting would
add a great deal to the length of life of the buildings, to say nothing of the improved
environment of the patient.
There are many improvements and betterments that should be seriously con-
sidered at a very early date. The program of new floors, changes in the medical
service through the installation of elevators and new diet kitchens, would all add
to our service to patients and it is to be hoped would eventually result in an increase
in the discharge rate.
I submitted a complete program of improvements in 1933. It would be useless
to go over these same projects again but I respectfully call your attention to my
report of that year. The need for these betterments is even greater at this time
than it was at that time. The outstanding need of the hospital is a new laundry
and additional accommodations for employees, if we are to continue to house our
working personnel. The machinery in our present laundry will not last much longer.
It is entirely inadequate and the result is destruction of clothing, inordinate wear
and tear on our linens and a general lowering of morale due to irritation on the part
of both employee and patient.
If we are to continue to house employees in the hospital, the increased number
entering the service because of the eight hour day, makes it imperative that addi-
tional accommodations be considered. The renovation of the present farm house
and an addition to the nurses home, will have to be seriously thought of in the
very near future.
In conclusion I wish to call the attention of the board to the splendid spirit
that has prevailed throughout the hospital during the entire year. Officers and
employees have worked unceasingly towards the goal that has been set for them,
and I would indeed be remiss in my duty if I did not acquaint the board with this
40 P.D. 23
fact. My personal acknolwedgment to the Board is a pleasure and duty. It has
greatly lightened the labor that comes upon any administrator during the changing
times in which we live, to know that he has the support and approval of a group of
citizens such as constitute the membership of the board. I make grateful acknow-
legment of your interest, and the time and energy you have expended in helping
me solve the various problems that have come up during the year.
Respectfully submitted,
William A. Bryan,
Superintendent.
VALUATION
November 30, 1935
Real Estate
Land, 589.16 acres $444,570.00
Buildings and Betterments 2,346,178.40
$2,790,748.40
Personal Property
Travel, transportation and office expenses $9,315.46
Food 9,941.71
Clothing and materials 27,887.12
Furnishings and household supplies . 272,010.28
Medical and general care . . . 54,867.65
Heat and other plant operation 8,632.09
Farm 53,461.86
Garage and grounds 10,647.58
Repairs 18,018.89
$464,782.64
Summary
Real estate $2,790,748.40
Personal property 464,782.64
$3,255,531.04
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, 1935.
Statement of Earnings
Board o! Patients $72,058.71
Personal Services . 268 00
Sales:
Food ' $3,747.81
Clothing and materials 15.00
Furnishings and household supplies 43.90
Medical and general care . . 82.08
Heat and other plant operations 23.46
Garage and grounds 9.10
Repairs ordinary 20.03
Farm ■ 355.72
Total sales $4,297 . 10
Miscellaneous:
Interest on bank balances . ' . $180.00
Rents 1,546.55
Commission on Pay Station Telephone 121.76
Reimbursements on account of Patients' Boarded Out 322.75
Total miscellaneous $2,171.06
Total Earnings for the year $78,794.87
Total cash receipts reverting and transferred to the State Treasurer . . . . . 78,812.87
Accounts receivable outstanding Dec. 1, 1934 . . . . . . $63.00
Accounts receivable outstanding Nov. 30, 1935 45.00
Accounts receivable increased $18.00
Maintenance Appropriation
Balance from previous year, brought f orvi^ard $30,063 . 53
Appropriation, current year 869,570.00
Total $899,633.53
Expenditures as follows:
1. Personal services $451,509.24
2. Food 151,578.42
3. Medical and general care 37,815.77
4. Religious instruction 2,638.67
5. Farm 27,869.31
6. Heat and other plant operation 95,102.76
7. Travel, transportation and office expenses 9,077.05
8. Garage and grounds; garage, $3,788.03, grounds, $1,633.79 . . . 5,421.82
9. Clothing and materials 15,706.60
10. Furnishings and household supplies 29,578.13
11. Repairs ordinary 15,507.15
P.D. 23
41
12. Repairs and renewals 10,104.46
Total maintenance expenditures $851,909.38
Balance of maintenance appropriation, Nov. 30, 1935 47,724.15
Balance December 1, 1935 brought forward
Appropriations for current year
Special Appropriations
$899,633.53
$397,517.19
52,100.00
Total
Expended during the year (see statement below)
Reverting to Treasury of Commonwealth
$298,775.03
107.85
5449,617.19
298,882.88
Balance November 30, 1935 carried to next year $150,734.31
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, MSP
M-20, PWAD 6243 . .
Standpipe, MSP M-39, PWAD 4640
Fireproof balconies, MSP M-48;
PWAD 4465
Sprinklers and rewiring, MSP M-49;
PWAD 5308
Hydrotherapy building, MSP M-50;
PWAD 4657
Window calking and weather strips
Roof repairs
Quimby ward building renovation .
Mechanical refrigeration
371-1933
$41,000.00
90,000.00
42,000.00
138,000.00
114.000.00
125,000.00
5,000.00
7,700.00
18,000.00
14,400.00
$50,070.24
30,266.89
60,659.75
92,092.04
65,686.11
$40,892.15
88,585.21
36,666.68
101,380.22
99,513.95
77,219.63
$107.85*
1,414.79
5,333.32
36,619.78
14,486.05
47,780.37
5,000.00
7,700.00
18,000.00
14,400.00
Per Capita
During the year the average number of patients has been 2,306.77.
Total cost of maintenance, $851,909.38.
Equal to a weekly per capita cost of (52 weeks to year), $7.1020.
Total receipts for the year, $78,812.87.
Equal to a weekly per capita of $.6570.
Total net cost of Maintenance for year (Total maintenance less total receipts), $773,096.51.
Net weekly per capita, $6.4450.
Respectfully submitted,
Margaret T. Crimmins,
Treasurer.
STATEMENT OF FUNDS
November 30, 1935
Canteen Fund
Balance on hand November 30, 1934 $735.56
Receipts 16,696.17
$17,431.73
Expended 16,517.40
$914.33
Investments
Worcester Depositors Corp $160.00
(Class A Certificate)
Mechanics National Bank 734.57
Cash on hand November 30, 1934 19.76
$914.33
Patients' Fund
Balance on hand November 30, 1934 $6,837.86
Receipts 7,659.37
Interest 180.00
$14,677.23
Expended $6,629.90
Interest paid to State Treasurer 180.00
■ • 6,809.90
$7,867.33
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
Worcester Depositors Corp. (Class A. Certif.) 100.00
42 p.D. 23
Bay State Savings Bank 1,500.00
Balance Mechanics National Bank 1,340 !q4
Cash on hand December 1, 1935 [ [ '427^29
' — — $7,867.33
Rockefeller Research Project
Balance on hand November 30, 1934 $7,959.22
Receipts to November 30, 1935 12,610.60
$20 569 82
Expended to November 30, 1935 18'898!21
Balance on hand November 30, 1935 $1,671.61
Investments
Worcester County Trust Co $1,671.61
Clement Fltnd
Balance on hand November 30, 1934 $1,000 00
Income ' 3o'oO
$1,030.00
Expended 30.00
$1,000.00
Investments
Worcester County Institution for Savings $1,000.00
Lewis Fund
Balance on hand November 30, 1934 $1,334.19
Income _ 39 00
„ ^ , ' ' — $1,373.19
Expended 41 . 20
$1,331.99
Investments
Worcester Five Cents Savings Bank $1,300.00
Balance Mechanics National Bank ". '31.99
' '■ — $1,331.99
Manson Fund
Balance on hand November 30, 1934 $1,020.83
Income . ' 41.90
'■ — $1,062.73
Investments
Millbury Savings Bank $1,061.90
Balance Mechanics National Bank ] .83
'- — $1,062.73
Wheeler Fund
Balance on hand November 30, 1934 $1,053.56
Income ' 30.00
„ , . $1,083.56
Expended 81.64
$1,001.92
Investments
Worcester Mechanics Savings Bank $1,000.00
Balance Mechanics National Bank ' 1 . 92
'■ — $1,001.92
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, 1935)
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 $2,790,748 40
Personal property [ '464,'782.64
Total §3 255 531 04
Total acreage of hospital property owned, 589.16
Additional acreage rented, 75
Total acreage under cultivation during previous year, 177
Officers and employees: November 30, 1935
Actually in Service Vacancies at end
at End of Year of Year
M. F. T. M. F. T.
Superintendents 1 - 1 _ _ _
Assistant physicians ..:...ll - 11 1 - i
Clinical assistants - 1 1 1 _ i
Total physicians 12 1 13 2 - 2
Stewards 1 _ 1 _ _ _
Resident dentists 1 - 1 _ _ _
Pharmacists 1 - j _ _ _
Graduate nurses 1 60 61 - 4 4
P.D. 23 43
Other nurses and attendants .... 128 150 278 3 7 10
Occupational therapists - 5 5 - - -
Social workers - 3 3 - 1 1
All other officers and employees .... 140 85 225 11 4 15
Total officers and employees . . . 284 304 588 16 16 32
Census of Patient Population at end of year (Classification by Diagnosis, September 30, 1935):
Absent from Hospital
-Actually in Hospital but still on Books
White: M. F. T. M. F. T.
Insane 1,068 1,090 2,158 178 211 389
Epileptics - - - 1 - 1
Mental defectives 3 - 3 - - -
All other cases 6 5 11 3 7 10
Total 1,077 1,095 2,172 182 218 400
Other Races:
Insane 27 25 52 2 4 6
Mental defectives 1 1 2 - - -
Total 28 26 54 2 4 6
Grand Total 1,105 1,121 2,226 184 222 406
M. F. T.
Patients under treatment in occupational-therapy classes, including
physical training, on date of report 84 193 277
Other patients employed in general work of hospital on date of report 425 263 688
Averagedaily number of all patients actually in hospital during year 1,100.02 1,112.62 2,212.64
Voluntary patients admitted during year 6 7 13
Persons given advice or treatment in out-patient clinics during year 270 225 495
44
P.D. 23
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P.D. 23 45
Table 3. Nativity of First Admissions and of Parents of First Admissions
Parents of Male
Parents of Female
Patients
Patients
Patients
Nativity
Both
Both
M.
F.
T.
Fathers Mothers
Parents
Fathers Mothers Parents
United States i
154
121
275
65 57
43
53 58 46
Africa
—
_
_
1
—
_ _ _
Canada 2
20
31
51
36 42
29
42 38 32
Czecho-Slovalcia
_
_
_
1
_
1 1 1
Cuba
1
—
1
1 1
1
_ _ _
Denmark
1
—
1
. 1 1
1
_ _ _
England .
10
4
14
12 13
7
7 4 3
Finland .
1
4
5
2 2
2
6 6 6
France .
—
—
_
1
-
_ _ _
Germany
1
—
1
7 6
5
2 2 2
Greece .
4
—
4
6 5
5
_ _ _
Ireland .
10
17
27
31 33
24
36 36 32
Italy
13
5
18
19 18
18
6 6 6
Norway .
_
1
1
- —
—
1 1 1
Poland .
7
3
10
12 11
11
6 6 6
Portugal
1
-
1
1 1
1
2 2 2
Russia .
2
—
2
5 6
5
1 - -
Scotland .
2
1
3
3 5
3
4 4 3
South America
—
—
_
1
—
_ _ _
Sweden .
7
6
13
11 11
11
6 6 6
Turkey in Asia
1
-
1
1 1
1
■ _ _ _
Other Countries
11
3
14
13 13
13
4 4 4
Unknown
3
-
3
21 21
18
19 22 18
Total
249
196
445
249 249
198
196 196 168
'Persons born in Hawaii, Porto Rico and the Virgin Islands should be recorded as born in the U. S.
^Includes Newfoundland.
46
P.D. 23
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P.D. 23 47
Table 5. Citizenship of First Admissions
Males Females Total
Citizens by birth 154 121 275
Citizens by naturalization 26 5 31
Aliens 43 37 80
Citizenship unknown 26 33 S9
Total 249 196 445
Table 6. Race of First Admissions Classified with Reference
to Principal Psychoses
Race
Total
With
syphilitic
meningo-
encephalitis
With other
forms of
syphilis
With other
infectious
diseases
Alcoholic
psychoses
M.
F.
T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
African (black)
Cuban .
English .
Finnish .
French .
German .
Greek
Hebrew .
Irish
Italian! .
Lithuanian .
Portuguese .
Scandinavian 2
Scotch .
Slavonic '
Syrian
Other specific race>
Mixed
Race unknown
9
1
13
2
30
5
5
6
35
19
10
1
12
5
12
2
2
70
10
2
8
6
33
2
3
40
7
4
2
7
3
4
61
14
11
1
21
8
63
7
5
9
75
26
14
3
19
8
16
2
9
131
24
3-3
_ _ _
_ _ _
3-3
3 1 4
1 - 1
- - -
1 - 1
1 1 2
2 1 3
6 6 12
2-2
1 - 1
2-2
2 1 3
6-6
1 1
- - -
- - -
1 - 1
1 - 1
1 1
9 1 10
1 - 1
1 - 1
- - -
- - -
1-1
3-3
1 - 1
6 4 10
2-2
- 1 1
1 1
1 1
6 1 7
1 - 1
Total
249
196
445
35 13 48
3 2 5
- 2 2
28 4 32
Table 6. Race of First Admissions Classified with Reference to Principal
Psychoses — Continued
Race
Due to
drugs,
etc.
With
cerebral
arterio-
sclerosis
With
other
disturbances
of circulation
With
convulsive
disorders
(epilepsy)
Senile
psychoses
Involutional
psychoses
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T
African (bla
Cuban
English
Finnish
French .
German
Greek .
Hebrew
Irish
Italian 1
Lithuanian
ck) .
- - -
1 - 1
1 - 1
1 1 2
- - -
- 1 1
_ _ _
3 1 4
- 1 1
_ _ _
6 4 10
1 - 1
1 - 1
1 1
4 6 10
-33
1 - 1
1 - 1
-33
1 - 1
1 - 1
1 - 1
- 2 2
8 9 17
2-2
1 1
1 - 1
- - -
1 - 1
2 12 14
2-2
Scandinavian - .
Scotch
Slavonic ' .
Syrian
Other specific races
Mixed .
Race unknown .
- - -
3 1 4
3-3
1 - 1
_ _ _
- 1 1
- 2 2
2 2 4
1 1 2
2-2
1 - 1
IS 6 21
1 3 4
3 10 13
4 1 5
Total
2-2
42 27 69
3-3
- 2 2
15 37 52
13 11 24
'Includes "North" and "South."
^Norwegians, Danes and Swedes.
^Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish,
Russian, Ruthenian, Servian, Slovak, Slovenian.
48
P.D. 23
Table 6. Race of First Admissions Classified with Reference to Principal
Psychoses — ■ Continued
Race
Due to
other
metabolic
diseases, etc.
Due to
new
growth
With organic
changes of
nervous
system
Psycho-
neuroses
Manic-
depressive
psychoses
Dementia
praecox
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
1 - 1
English
Finnish
French .
German
Greek .
Hebrew
Irish
1 - 1
- - -
- - -
1 1 2
1 - 1
- 2 2
1 2 3
5 7 12
1 1 2
2-2
1 1 2
S 9 14
4 2 6
2 2 4
1 1 2
1 2 3
1 - 1
1 2 3
1 - 1
16 17 33
3 3 6
- 1 1
- - -
2-2
1 1 2
1 1 2
1 - 1
1 - 1
2 3 5
1 2 3
Lithuanian
Portuguese
Scandinavian 2 .
Scotch
Slavonic 3 .
Syrian
Other specific races
Mixed .
Race unknown .
1 - 1
- - -
- - -
1 - 1
1 - 1
1 1
- - -
1 - 1
- - -
1 - 1
1 - 1
4-4
1 - 1
1 - 1
1 2 3
3 6 9
5 7 12
2 1 3
Total
7 2 9
1 - 1
5 2 7
8 14 22
14 14 28
46 51 97
Table 6. Race of First Admissions Classified with Reference to Principal
Psychoses — Concluded
Race
Paranoia
and
paranoid
conditions
With
psychopathic
personality
With
mental
deficiency
Undiagnosed
psychoses
Without
psychoses
Primary
behavior
disorders
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
African (black)
1 2 3
English .
Finnish .
French .
German
Greek .
Hebrew
Irish
Italian i
Lithuanian .
Portuguese .
Scandinavian 2
Scotch .
Slavonic 3
Syrian .
Other specific races
Mixed .
Race unknown .
1 - 1
- 2 2
- 2 2
2-2
1 - 1
2 2 4
_ _ _
3-3
1 - 1
1 - 1
1 - 1
1 - 1
: : :
- - -
- - -
1 - 1
- - -
- - -
- - -
2-2
1 - 1
- - -
1 1 2
- - -
1 - 1
1 - 1
1 4 5
4-4
1 - 1
Total .
8 10 18
6-6
7 2 9
2-2
3 2 5
1 1 2
ilncludes "North" and "South".
^Norwegians, Danes and Swedes.
^Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish,
Russian, Ruthenian, Servian, Slovak, Slovenian.
P.D. 23 49
Table 7. Age of First Admissions Classified with Reference to Principal Psychoses
Psychoses
Total
0-14
years
15-19
years
20-24
years
25-29
years
30-34
years
M.
F.
T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
With syphilitic men-
ingo-encephalitis
With other forms of
syphilis
With other infectious
diseases
Alcoholic psychoses
Due to drugs, etc. .
With cerebral arter-
iosclerosis .
With other distur-
bances of circula-
tion
With convulsive dis-
orders (epilepsy)
Senile psychoses
Involutional psycho-
ses
Due to other meta-
bolic diseases, etc.
Due to new growth
With organic changes
of nervous system
Psychoneuroses
M anic-depressive
psychoses .
Dementia praecox
Paranoia and para-
noid conditions
With psychopathic
personality
With mental de-
ficiency
Undiagnosed psy-
choses .
Without psychoses
Primary behavior
disorders .
35
3
28
2
42
3
15
13
7
1
5
8
14
46
8
6
7
2
3
1
13
2
2
4
27
2
37
11
2
2
14
14
51
10
2
2
1
48
5
2
32
2
69
3
2
52
24
9
1
7
22
28
97
18
6
9
2
5
2
- - -
- 1 1
2-2
1 - 1
4 2 6
1 - 1
2-2
- 1 1
_ _ _
_ _ _
1 - 1
_ _ _
_" _ _
1 - 1
1 2 3
1 1 2
18 5 23
1 - 1
1 4 5
2 4 6
7 4 11
- - -
1 - 1
1 2 3
5 2 7
10 5 15
- - -
5 5 10
1 - 1
2-2
1 - 1
1 - 1
1 1 2
- 1 1
2-2
1 - 1
1 1 2
1 - 1
1 1 2
_ _ _
_ _ _
_ _ _
Total
249
196
445
1 - 1
11 8 19
26 9 35
15 14 29
24 12 36
50
P.D. 23
Table 7. Age of First Admissions Classified with Reference to Principal
Psychoses — Continued
Psychoses
35-39
years
40-44
years
45-49
years
50-54
years
55-59
years
60-64
years
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
M. F. T.
With syphilitic men-
ingo-encephalitis
With other forms of
syphilis
With other infectious
7 3 10
- 1 1
1 1
2-2
6 2 8
2 3 5
7 1 8
2 1 3
3-3
1 - 1
Alcoholic psychoses
Due to drugs, etc. .
With cerebral arter-
iosclerosis .
With other distur-
bances of circula-
6 1 7
1 - 1
- 1 1
5 1 6
1 - 1
1 - 1
5 1 6
2 1 3
2-2
1 3 4
2 2 4
7 5 12
1 - 1
With convulsive dis-
orders (epilepsy) .
Senile psychoses
Involutional psy-
choses .
Due to other meta-
bolic diseases, etc.
Due to new growth
With organic changes
of nervous system
Psychoneuroses
Manic-depressive
psychoses .
Dementia praecox .
Paranoia and para-
noid conditions .
With psychopathic
personality
With mental defici-
ency .
Undiagnosed psy-
1 1 2
3 3 6
2-2
1 1
- 2 2
1 1
1 2 3
2 2 4
5 2 7
1 1 2
1 - 1
- 1 1
1 - 1
1 - 1
1 - 1
1 1 2
1 3 4
2 10 12
1 - 1
1 - 1
1 - 1
1 - 1
1 2 3
1 - 1
1 - 1
1 - 1
- 2 2
1 2 3
1 13 14
-33
2 3 5
1 - 1
1 - 1
- 4 4
2 3 5
6 2 8
- 2 2
2 1 3
2 1 3
2 2 4
2 2 4
2-2
- - -
- - -
- - -
Without psychoses .
Primary behavior
disorders
1 - 1
1 1
Total
19 19 38
22 26 48
15 15 30
27 16 43
15 18 33
22 9 31
Table 7. Age of First Admissions Classified with Reference to Principal
Psychoses — Concluded
Psychoses
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.
With syphilitic meningo-encephalitis
With other forms of syphilis
With other infectious diseases .
Alcoholic psychoses
2-2
1 - 1
_ _ _
_ _ _
_ _ _
3-3
- - -
- - -
- - -
- - -
With cerebral arteriosclerosis .
9 3 12
2-2
11 8 19
5 3 8
5 1 6
1 1 2
With convulsive disorders (epilepsy)
Senile psychoses
Involutional psychoses ....
Due to other metabolic diseases, etc.
Due to new growth
With organic changes of nervous system
1 10 11
3 8 11
1 7 8
3 6 9
1 2 3
1 - 1
1 1 2
Manic-depressive psychoses
- - -
1 - 1
- - -
- - -
- - -
Paranoia and paranoid conditions .
With psychopathic personality
With mental deficiency ....
Undiagnosed psychoses ....
Without psychoses
Primary behavior disorders
1 - 1
Total
20 14 34
16 16 32
6 10 16
8 7 15
2 3 5
P.D .23
51
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P.D. 23
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P.D. 23
53
Table 10. Economic Condition of First Admissions Classified with Reference to
Principal Psychoses
Psychoses
Total
Dependent
Marginal
Comfortable
Unknown
M.
F.
T.
M.
F.
T.
M.
F.
T.
M. F. T.
M. F. T.
With syphilitic meningo-
encephalitis
35
13
48
1
10
11
32
3
35
_ _ _
2-2
With other forms of
syphilis
3
2
5
2
1
3
1
—
1
_ _ _
1 1
With other infectious
diseases
—
2
2
_
—
—
—
2
2
_ _ _
_ _ _
Alcoholic psychoses
28
4
32
2
—
2
25
3
28
_ _ _
1 1 2
Due to drugs, etc.
2
—
2
—
-
—
2
-
2
_ _ _
_ _ _
With cerebral arterio-
sclerosis
42
27
69
8
21
7.9
30
-
30
- 2 2
4 4 8
With other disturbances
of circulation
3
_
3
—
_
_
3
-
3
_ _ _
_ _ _
With convulsive dis-
orders (epilepsy)
-
2
2
-
-
-
-
2
2
Senile psychoses .
15
37
52
3
27
30
11
—
11
- 2 2
1 8 9
Involutional psychoses .
13
11
24
2
9
11
10
—
10
_ _ _
1 2 3
Due to other metabolic
diseases, etc.
7
2
9
-
—
-
7
1
8
_ _ _
1 1
Due to new growth
1
-
1
1
-
1
—
—
-
_ _ _
_ _ _
With organic changes of
nervous system
5
2
7
2
1
3
3
1
4
_ _ _
- _ _ _
Psychoneuroses
8
14
22
-
10
10
8
3
11
_ _ _
1 1
Manic-depressive psy-
choses
14
14
28
—
9
9
11
2
13
1 1 2
2 2 4
Dementia praecox .
46
51
97
8
37
45
34
4
38
- 3 3
4 7 11
Paranoia and paranoid
conditions .
8
10
18
—
2
2
8
6
14
_ _ _
- 2 2
With psychopathic per-
sonality
6
—
6
1
—
1
5
—
5
_ _ _
_ _ _
With mental deficiency .
7
2
9
—
1
1
7
1
8
Undiagnosed psychoses
2
—
2
1
—
1
1
—
1
Without psychoses
3
2
5
2
1
3
1
1
2
_ _ _
_ _ _
Primary behavior dis-
orders
1
1
2
1
1
2
-
-
-
- - -
- - -
Total
249
196
445
34
130
t:64
199
29
228
1 8 9
15 29 44
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 .
35
13
48
9
3
12
12
10
22
10
—
10
4
- 4
With other forms of syph-
ilis
3
2
5
—
—
-
1
—
1
2
1
3
—
1 1
With other infectious dis-
eases ....
—
2
2
—
2
2
-
—
—
—
—
—
—
— —
Alcoholic psychoses .
28
4
32
—
—
—
—
—
—
28
4
32
—
— —
Due to drugs, etc.
2
—
2
1
—
1
1
—
1
—
—
-
—
— —
With cerebral arterio-
sclerosis ....
42
27
69
8
7
15
12
19
31
11
—
11
11
1 12
With other disturbances of
circulation
3
—
3
2
—
2
—
—
—
1
—
1
—
— —
Withe convulsive disorders
(epilepsy)
—
2
2
—
1
1
—
—
-
-
-
-
—
1 1
Senile psychoses
15
37
52
8
9
17
2
23
25
1
-
1
4
5 9
Involutional psychoses .
13
11
24
2
—
2
7
10
17
3
-
3
1
1 2
Due to other metabolic dis-
eases, etc.
7
2
9
—
2
2
3
—
3
3
-
3
1
1
Due to new growth .
1
—
1
1
—
1
—
—
—
-
-
—
—
— —
With organic changes of
nervous system
5
2
7
5
1
6
—
1
1
-
—
—
—
— —
Psychoneuroses .
8
14
22
2
2
4
3
12
15
3
—
3
—
- —
Manic depressive psy-
choses ....
14
14
28
1
—
1
7
13
20
3
-
3
3
1 4
Dementia praecox .
46
51
97
25
10
35
11
40
51
6
-
6
4
1 5
Paranoia and paranoid
conditions
8
10
18
3
4
7
2
5
7
3
-
3
—
1 1
With psychopathic per-
sonality ....
6
—
6
1
—
1
1
-
1
2
-
9
2
- 2
With mental deficiency .
7
2
9
6
2
8
1
—
1
—
-
-
—
— -
Undiagnosed psychoses .
2
-
2
1
-
1
-
-
—
1
-
1
—
— —
Without psychoses .
3
2
5
1
1
2
1
—
1
1
-
1
-
1 1
Primary behavior disorders
1
1
2
1
1
2
-
-
-
-
-
-
-
-
Total . . .
249
196
445
77
45
122
64
133
197
78
5
83
30
13 43
54
P.D. 23
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58
P.D. 23
Table 14. Discharges of Patients Classified with Reference to Principal Psychoses
and Condition on Discharge
Psychoses
Total
Recovered
M. F. T.
Improved
Unimproved
M. F. T.
With'syphiliticmeningo-encephalitis
With other forms of syphilis .
With epidemic encephalitis .
With other infectious diseases
Alcoholic psychoses .
Due to drugs, etc. .
With cerebral arteriosclerosis
With other disturbances of circulation
With convulsive disorders (epilepsy)
Senite psychoses ....
Involutional psychoses .
Due to other metabolic diseases, etc.
Due to new growth
With organic changes of nervous system
Psychoneuroses ....
Manic-depressive psychoses .
Dementia praecox ....
Paranoia and paranoid conditions
With psychopathic personality
With mental deficiency .
Without psychoses ....
Primary behavior disorders .
Total
10 4
2 2
1
3
30 6
1 1
5 1
3 4
5
12
22
7
1
4
3
6
3
2
10
20
30
9
3
4
158 144 302 24 11 35 113 117 230
19 IS 34
P.D. 23
59
Table 15. Hospital Residence during This Admission of Court First Admissions
Discharged during 1935
Psychoses
Number
M. F. T.
Average Net
Hospital Residence
in Years
With syphilitic meningo-encephalitis .
With other forms of syphilis .
With epidemic encephalitis .
With other infectious diseases
Alcoholic psychoses ....
Due to drugs, etc
With cerebral arteriosclerosis .
With other disturbances of circulation.
With convulsive disorders (epilepsy) .
Senile psychoses
Involutional psychoses ....
Due to other metabolic diseases, etc. .
Due to new growth
With organic changes of nervous system
Psychoneuroses
Manic-depressive psychoses .
Dementia praecox
Paranoia and paranoid conditions
With psychopathic personality
With mental deficiency ....
Without psychoses
Primary behavior disorders .
4
2
1
32
1
18
1
1
4
2
1
5
11
2.3
6
2
2
4
5
11
1
1
3
5
1
1
7
9
27
9
1
1
1
1
Total
116 94 210
.68
.49
.20
.95
.20
.34
.12
2.50
.32
.33
.04
.25
1.02
1.38
.21
.29
.16
.83
.48
.45
.20
.16
.90
.20
.38
.16
1.50 4.50
.23 .23
.28
.41
.16
.59
.45
.20
1.19
.94
.29
.43
.65
.04
.20
.70
.80
.42
.04
.29
.36
.85
1.03 1.19
.68 .47
2.50 2.50
. 54 . 37
.12
.20
.77
60
P.D. 23
With
other
disturbances
of circulation
III 1 III 1 1 1 1 1 II 1 1 -< 1 1 1 1 1 1 1
III 1 II 1 1 1 1 1 1 II lllll 1 1 1 1 1
III 1 II 1 1 1 1 1 1 II 1 1 -< 1 1 1 1 1 1 1
With
cerebral
arterio-
sclerosis
- 1 1
1 - 1
2 1 3
1 1
1 - 1
1 1
1 - 1
1 - 1
3 1 4
11 9 20
1 1
1 - 1
u to
II
3 <J
III 1 II 1 1 1 1 1 1 II lllll 1 1 1 1 1
u
St
3 60
Q2
T3
III 1 II 1 1 1 I 1 1 II lllll 1 1 1 1 1
III 1 II 1 I 1 1 1 1 11 lllll 1 1 1 1 1
III 1 II 1 1 1 1 1 1 II lllll 1 1 1 1 1
It
CNll rt II 1 IIII 1 l—l lllll III" 1
With
other
infectious
di.seases
III 1 II I IIII 1 II lllll IIII 1
III 1 II 1 IIII 1 II lllll IIII 1
III 1 II 1 IIII 1 II lllll IIII 1
With
epidemic
encepha-
alitis
H
fc
S
III I II 1 IIII 1 II lllll IIII 1
III 1 II 1 IIII 1 II lllll IIII 1
III 1 II 1 IIII 1 II lllll IIII 1
With
other
forms of
syphilis
11^ 1 II 1 II-I I II lllll -Hill 1
I 1 -H 1 II 1 1 1 -1 1 1 II lllll IIII 1
1 1 " 1 II 1 IIII 1 II lllll -H 1 1 1 1
With
syphilitic
meningo-
encephalitis
H
fc
S
'-il'-HtN II I llrjl 1 II lllll rt'rtil 1
-Hi" 1 II 1 IIOI 1 II lllll IIII 1
lllrvi II 1 llvoi 1 II lllll ""11 1
IN
H
O " lO fO " CN CN CO fO f^ " (N 00^ " 00 O CN " On Tt* *H CS "
"(3
o
to
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§
t^|(N>0 II 1 CN">OI 1 rO" |c«2iO"-H rO"CN"
K
H
<;
w
Q
b
O
w
<
U
Infectious and Parasitic Diseases:
Tuberculosis of the respiratory system
Tuberculosis of other organs ....
Syphilis (non-nervous forms) ....
Cancer and Other Tumors:
Cancer and other malignant tumors
Rheumatic Diseases, NutritionalDiseases, Diseases
of the Endocrine Glands and Other General
Diseases:
Acute rheumatic fever
Diabetes
Diseases of the Blood and Blood-Making Organs:
Leukemias and pseudo-leukemias .
Diseases of the Nervous System and Organs of
Special Sense:
Cerebral hemorrhage
Cerebral embolism and thrombosis .
General paralysis of the insane
Epilepsy
Diseases of the organs of special sense (eye,
ear and mastoid)
Diseases of the Circulatory System:
Chronic endocarditis (valvular disease) .
Diseases of the myocardium ....
Diseases of the coronary arteries and angina
pectoris
Other diseases of the heart ....
Arteriosclerosis
Other diseases of the arteries ....
Other diseases
Diseases of the Respiratory System:
Bronchopneumonia (including capillary bron-
chitis)
Lobar pneumonia
Asthma
Other diseases (tuberculosis excepted)
Diseases of the Digestive System:
Other diseases of the stomach (cancer excepted)
P.D. 23
61
1 1 1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 II 1 1 1 1 1 1
1 1 1 1 1 1 II 1 1 1 1 1 1
1
1 - 1
2 8 10
2 1 3
o
1 1 1 1 1 1 II 1 1 1 1 1 <-'
1 1 1 1 1 1 II 1 1 1 1 1 1
1 1 1 1 1 1 II 1 1 III'-'
1
1 1 1 1 1 1 II 1 1 1 1 1 1
1
1 1 I 1 1 1 II 1 1 1 1 1 1
1 1 1 1 1 1 II 1 1 1 1 1 1
1 1 1 1 1 1 II 1 1 1 1 1 1
1 'H 1 1 1 1 II 1 1 1 1 1 1
1 1 1 1 1 1 II 1 1 1 1 1 1
1
1 1 1 1 1 1 II 1 1 1 1 1 1
1 1 1 1 1 1 II 1 1 1 1 'H 1
1
1 1 1 1 1 1 II 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 'I 1 1 1 1 1 1
1 1 1 1 1 1 II 1 1 1 1 'H 1
O
r*5
.rt-H-* 1 1 -^ VO-I -H -< (S 1 O 1
1 1 1 <N-H 1 0> 1 1 1 1 'HI^ (N
O
Diarrhea and enteritis
Appendicitis
Hernia, intestinal obstruction ....
Cirrhosis of the liver
Biliary calculi and other diseases of the gall
bladder and biliary passages ....
Diseases of the Genito-Urinary System:
Nephritis (acute, chronic and unspecified)
Diseases of the bladder (tumors excepted)
Diseases of Pregnancy, Child-birth and the Puer-
peral State:
Diseases of the Bones and Organs of Locomotion:
Other diseases of the bones (tuberculosis ex-
cepted)
Violent and Accidental Deaths:
Suicide
Confiagration and accidental burns .
Accidental traumatism
Other external causes
2
O
62
P.D. 23
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68 P.D. 23
Table 19. Average Length of Hospital Residence during the Present Admission of
All First Ad'missio7is in Residence on September 30, 1935
Psychoses
Average Net
Sfumber
Hospital Residence
in Years
M.
F.
T.
M.
F.
T.
65
23
88
5.33
7.31
5.84
4
7
11
4.00
4.77
4.49
8
6
14
5.33
8.33
6.60
1
1
2
7.50
7.50
7.50
101
7
108
9.56
8.34
9.48
2
—
2
.97
-
.97
2
1
3
2.00
7.50
3.83
54
42
96
2.88
4.19
3.46
2
_
2
.45
-
.45
5
6
11
13.40
4.49
8.54
22
53
75
3.29
3.65
3.54
16
26
42
5.72
7.14
6.60
8
4
12
2.45
5.48
3.48
10
3
13
4.38
3.15
4.10
7
12
19
1.47
3.55
2.78
19
18
37
5.95
4.98
5.48
314
330
644
12.90
11.65
12.26
21
48
69
6.47
9.26
8.41
10
9
19
8.48
10.27
9.33
45
52
97
9.00
8.82
8.90
6
4
10
4.30
.97
2.97
722
652
1,374
9.22
9 07'
9.15
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 other disturbances of circulation
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 . . . .
Without psychoses ......
Total
Table 19a. Average Length of Hospital Residence during the Present Admission of
All Readmissions in Residence on September 30, 1935
Psychoses
Average Net
Number
Hospital Residence
in Years
M.
F.
T.
M.
F.
T.
33
6
39
4.17
5.50
4.37
3
—
3
8.83
—
8.83
2
1
3
2.00
3.50
2.50
1
1
—
1.50
1.50
43
6
49
9.60
10.50
9.71
—
1
1
—
22.50
22.50
3
_
3
7.83
_
7.83
14
7
21
4.13
4.63
4.30
_
1
1
—
.45
.45
5
2
7
7.90
9.50
8.35
6
15
21
4.82
4.08
4.29
5
6
11
7.09
14.33
11.04
_
1
1
_
7.50
7.50
2
6
8
5.00
1.47
2.35
4
5
9
6.25
4.89
5.49
33
41
74
6.39
8.70
7.67
188
308
496
10.48
10.59
10.55
9
26
35
8.83
7.18
7.60
3
6
9
11.50
4.65
6.93
27
28
55
11.64
10.00
10.80
1
_
1
.45
—
.45
2
2
4
6.47
.45
3.46
383
469
852
8.94
9.55
9.27
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 other disturbances of circulation .
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 Year Ended September 30, 1935
Males Females Total
Remaining in Family Care September 30, 1934 20 73 93
On Visit from Family Care September 30, 1934 3 23 26
Admitted to Family Care during the year 20 82 102
Whole Number of Cases within the year 40 155 195
Discharged from Family Care within the year 17 75 92
Died - 1 1
Discharged 2 4 6
From Family Care to Escape Status - 3 3
From Family Care to Visit Status 5 20 25
Returned to Institution 10 47 57
Returned to Institution from Escape - 1 1
Returned to Institution from Visit 1 7 8
Remaining in Family Care September 30, 1935 23 80 103
On Visit from Family Care September 30, 1935 3 23 26
Average Daily Number in Family Care during year 23 75 98
Supported by State 18 62 80
Private 5 18 23
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