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

Public Document No. 23 






TRUSTEES 



OP THE 



Worcester State Hospital 



KT 



Year Ending November 30, 
1936 

Department of Mental Diseases 




Publication of this Document approved ry the Comi^ission on Administration and Finance 
550. 7-'37. Order 141. 

OCCUPATIONAL PRINTING PLANT 

DEPARTMENT OF MENTAL DISEASES 

GARDNER STATE HOSPITAL 

EAST GARDNER, MASS. 



Worcester'^ iTAT:£^ hospital 

Post Office Address: Worcester.Mass. 

Board of TRUSTE^^SiS' OrrHiiAlA 
William J. Delahanty, M.D., Chairman, Worcester. 
Anna C. Taxman, Secretary, Worcester. 
John G. Perman; D.M;D.-, Worcester. 
Josephine R. Dresser, Worcester. 
John L. Bianchi, Worcester. 
Robert R. Portle, Worcester. 
John T. McManus, Webster. 

Resident Staff , 

William A. Bryan, M.D., Superintendent. 
Francis H. Sleeper, M.D., Assistant Superintendent. 

Psychiatric Service 
Morris Yorshis, M.!)., Clinical Director. 

Arthur J. Gavigan, M.D., Psychiatrist in charge of Women's Department. 
Benjamin Simon, M.D., Assistant.' 

Walter E. Barton, M.D., Psychiatrist in charge of Men's Department. 
Conrad Wall, M.D., Assistant. 
Elizabeth D. Kane, M.D., Interne. 
Ethel L. Hieronymus, M.D., Interne. 

M;bdical and SurgSical Service 
W. Everett Glass, M..D., Director. 
Embrie J. BoRKOvic, M.D., Assistant. 
Thomas O. Murray, M.D., Assistant. 
William Freeman, M.D., Pathologist. 
Joseph N. Finni, D.M.D., Dentist. 

Research Service 
Roy G. Hoskins, Ph.D., M.D., Director. 
Joseph M. Looney, M..D., Director of Laboratories. 

D. EwEN Cameron, M.B., D.P.M., Psychiatrist. 
Louis H. Cohen, Ph.D., M.D., Psychiatrist. 
Andras Angyal, Ph.D., M.D., Psychiatrist. 
Robert Fuch.s, M.D., Clinical Assistant. 
Harry Freeman, M.D., Internist. 

David Shakow, M.A., Chief Psychologist. 

E. Morton Jellinek, M.Ed., D.Sc, Chief Biometrician. 
George L, Ban ay, Ph.D., Medical Librarian. 

" Vi '/. •"- ;''^OuT"PATIBNi' 'DEPARTMENT 

Milton E". JtiRkpAVRick, M. if., Director, Child Guidance Clinic. 
Paul Jordan, M.D. 't^A&'slstant. 

, ^ •.'.. SP¥IJtBR STREipX, DeB^^^TMENT 

LojjJfil; O. Far&ar; •M.'D^/Mad!c»?^.Mrei?t^d?. 

Visiting Staff 
Ernest L. Hunt, M.D., Surgery. 
Arthur Brassau, M.D., Surgery. 
Franklyn Bousouet, M.D., Surgery. 
Joel M. Me-lick, M.D., Gynecology and Obstetrics. 
Donald K. McCluskey, M.D., Gynecology and Obstetrics. 
Lester M. Felton, M.D., Genitb-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. ^ 



^J- 



62.ai^5 



^3 "\A/92.r 

Julius Tegelberg, M.D., Otolaryngology. 
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 Administrativ:e Departments 
Herbert W. Smith, Steward. 
Margaret T. Crimmins, Treasurer. 

Warren G. Proctor, Engineer. , 

Anton Svenson, Foreman Mechanic. 
Oakleigh Jauncey, J7ead i^armer. 
Lillian G. Carr, Matron. 
Katharine McLean Steele, B. S. , R.N., SMpenwfendeni 0/ iVwrses. 

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

The Trustees of the Worcester State Hospital respectfully submit the i04th 
annual report of the hospital together with the report of the Superintendent, Dr. 
William A. Bryan, and report of the Treasurer, Miss Margaret T. Crimmins and 
other statistical information. 

It is the duty of this Board to direct the attention of your Excellency to certain 
fundamental considerations that have influenced the management of the hospital 
during the year. The discussion of details will be found in the report of the Super- 
intendent. We heartily endorse his statements and subscribe to his recommenda- 
tions. It has been and is now the opinion of the Board, that the citizens of the 
Commonwealth want a hospital in fact as well as name. By this we mean a 
hospital where the first consideration is treatment which will tend towards early 
and permanent recovery. It seems obvious that such a policy will eventually 
bring the State to the point where there will be need for fewer mental hospitals, 
whereas a policy of considering the work of the institution on the sole basis of low 
per capita cost will create an ever increasing demand for greater bed capacity^ 
Your Trustees have conducted the hospital with this policy ever in mind. We 
believe in the principles of active and skillful medical work with patients, in the 
continuance of educational activities, the constant raising of the qualifications of 
personnel, and increase in the number of graduate nurses, further extension of the 
research program, increase in the number of patients in boarding homes and the 
enlargement of child clinic facilities. We believe in these principles because, in 
our opinion, they will lead to better results than would a less aggressive method of 
handling the mental disease problem. These results will not only become apparent 
in money but in the sum total of human happiness. 

In carrying out such policies the hospital has been under a great strain during 
the past five years because of insufficient funds. Your Board recognizes the 
necessity that has caused this condition of affairs but it cannot refrain from pointing 
out the consequences of a continuation of the policy. The Board does not wish to 
be held responsible for the maintenance of a higher standard of care and treatment 
than is possible to achieve with the money granted. We believe in high standards 
for the reasons given but they are impossible of, attainment without some invest- 
ment of funds. If such standards will lead to an increased recovery rate the invest- 
ment will be amply justified. But it is a self-evident fact that a twentieth century 
hospital cannot be successfully carried on at nineteenth century costs. The Board 
can only bring standards as high as the appropriations allotted will. permit. 

The attention of Your Excellency is also directed to the fact that increased 
appropriations alone will not solve the problem. This money must be expended 
wisely and w'th due regard for the financial load that taxpayers have to bear. To 
do this requires the services of personnel that is experienced in the management of 
mental hospitals. Hospital administration is a highly specialized branch of medi- 
cine and men have to be trained in all of its intricacies. The restrictions that come 
with the requirement that personnel must be selected from the Commonwealth 



4 P.D. 47 

make it exceedingly difficult for officials to secure a sufficient number of properly 
experienced individuals who are competent to carry on these treatment policies. It 
is our opinion that a hospital is no better than the people who are employed to 
manage it. Buildings will not function by themselves nor can wards be controlled 
properly without good nurses. Therefore, in addition to more liberal appropriations 
the question of more and better trained personnel must be considered. 

We have been particularly concerned about the matter of food for both patients 
and personnel. In the opinion of the Board the method of computing the food 
budget on the basis of patient population alone is unsound. We recommend that a 
basic ration be established, the cost of this to be ascertained at the current prices 
and the total budget figured on the total population, including patients, employees 
and special students who are in the hospital for a temporary period. 

The attention of Your Excellency is directed to the question of building main- 
tenance. The money appropriated during the past five years has been insufficient 
to keep the buildings up to a proper standard of efficiency. It is recommended that 
a simple cost system for minor repairs be established in order that the sum for 
these essential repairs to the physical plant be allotted on a basis of the actual 
needs ot the institution. 

The Board desires to express its appreciation of the work of the officers and 
employees of the hospital during the trying period through which we have passed. 
They have been diligent and loyal and have served the Commonwealth faithfully 
and well. We again register our satisfaction with the policies that have been 
continued throughout the year of making the working goal of the institution the 
discharge of patients. We believe in the principle of utilizing the resources of the 
hospital for education of students in mental hygiene, for research in the various 
forms of mental disorder and hope that there will speedily come an extension of 
the out-patient facilities for both adults and children in order that widespread 
preventive work may be done. 

Respectfully submitted, 
William J. Delahantt John T. McManus 

Anna C. Tatman John L. Bianchi 

Josephine Rose Dresser Robert R. Portle 

John G. Perman 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, 1936, it being the one hundred and fourth annual report. 

As has been the custom in former years the bulk of this report is made up of the 
reports from the several departments of the hospital. They cover the work of the 
year in considerable detail and any elaborate discussion of them would be super- 
fluous. The medical service continues to function as a separate unit of the hospital. 
By this I mean that the responsibility of the medical service is delegated to a special 
group of internists and nurses. It is not in any sense isolated but is a tool for the 
use of psychiatrists in studying the relationship between the mind and body. In 
addition to this, the care and treatment of acute illness among patients and em- 
ployees is an important function. 

Our facilities for carrying on efficient medical and surgical work are still quite 
inadequate although some improvements have been made during the year. The 
nursing personnel should be increased on the medical S3rvice to a ratio of one nurse 
to five patients. This ratio should be maintained at all times and sufficient per- 
sonnel added to allow time off duty and vacations. 

Renovation of these sick wards is imperative in the interest of better care of 
physically ill patients. B3tter provisions for the treatment of tubercular patients 
should be made. The facilities for food service leave much to be desired. An 
elevator should be installed to permit the transfer of patients from one floor to 
another, in addition to the transportation of food carts. Medical equipment of a 
modern type is needed, and the entire operating suite needs renovation. The 
amount of work carried on by this service is enumerated in the detailed report, 
and is an excellent index of the medical needs of the patients in a mental hospital. 



P.D. 47 5 

One of the important needs of psychiatry is a comprehensive evaluation of the 
treatment facilities that are afforded by the mental hospital. There is a tendency 
to get into a rhythm in doing certain things and continue to do them simply from 
an historical point of view. It is our opinion that every administrative process 
of the mental hospital should be carefully and thoroughly studied in order that 
we may actually evaluate the usefulness of each department in the treatment and 
recovery of patients. The entire program of the hospital is becoming more and 
more a therapeutic one with the recovery of the patient as the ultimate end. 

The program of placing all the industrial work of the hospital in the category of 
occupational therapy has been continued with what is believed to be increasing 
success. As our experience has accumulated it is possible to better fit the patient 
to the job and keep the assignment on the basis of the need of the patient for the 
occupation rather than the necessity of the institution for the patient s labor. The 
beginning of occupational therapy is on the ward itself, and more and more respon- 
sibility for preliminary training which leads later to industrial activity has been 
placed on the nursing personnel. The occupational therapist steps in when the 
preliminary ward training has been completed. 

The family care program of the hospital has been increased during the year. 
After a considerable experience with a large number of patients in boarding homes, 
I am more impressed than ever by the possibilities of a continuation of this partic- 
ular method of handling individual patients. These patients naturally fall into 
two distinct groups. In the one case boarding homes are utilized as a transitional 
step between the rigid discipline of the hospital and the comparative freedom of 
the patient's own home. It is a trial period and enables the psychiatrist to estimate 
just what the patient is able to accomplish under the stress and strain of community 
conditions. On the other hand, there are a group of custodial patients who are 
much better off in the environment of a home, and can get along perfectly well. 
The first group is, in our opinion, the most important one, and the increasing use 
of boarding out or family care as a social case work tool will come in the near future. 
This is one of the means by which the overcrowded condition of mental hospitals 
can be relieved without the tremendous investment in capital construction. 

The centralization of the nursing service has been continued, and it is our opinion 
that such centralization has been productive of a considerable degree of efficiency. 
There can be no justification for different standards of nursing service in the same 
hospital. In order to prevent such a condition it is necessary that all nursing be 
concentrated under one head. The old problem of nursing is a very important 
matter. It seems to be obvious that if we wish to have hospitals, the nursing 
service must be under the control of properly trained graduate nurses, and it is my 
recommendation that every effort be made to increase the number of graduate 
nurses working in the field of psychiatry. Hospital psychiatry should be a recog- 
nized specialty of the nursing profession, and I am convinced that the members 
of the profession would be attracted to it if a proper recommendation of their 
service could be given. 

Research has, as in the past, occupied an important position in our program. 
There are so many questions to be answered in psychiatry and in the adminis- 
tration of the men'al hospital, that it seems imperative that a concentrated sys- 
tematic effort be made to find the answers to some of the confusing and perplexing 
questions that are constantly arising. A concentration of effort on this particular 
point will bring forth rich results. It is a short sighted policy to continue to house 
and care for mental patients without making a determined effort to get at the cause 
of the condition, and take steps to find some way of either preventing or combating 
the mental disorder. An indispensable part of a research service is a medical 
library. During the year our library has been extended and the quarters increased 
in size. The library now consists of approximately eight thousand volvmes. It 
has been the policy to build this library around the current periodicals and at the 
present time the hospital subscribes to a large number of psychiatric journals. We 
have also improved the patients' library. It has been moved into new quarters 
and many new books have been added. 

The details of the work of the laboratory will be found in the report of the 
Director, Dr. J. M. Looney. Cne of the most important contributions the labor- 



6 P.D. 47 

atory is making to the hospital itself is the clinical pathological conferences. These 
have continued at monthly intervals. A journal club and a medical history club 
have also functioned as in previous years. 

Attention is called to the report of the head farmer, which discusses the question 
of the planting chart and the freezing process for vegetable conservation. 

The report of the Child Guidance Clinic shows that a considerable amount of 
preventive work has been done during the year. It is our opinion that prevention 
and research will do more towards cutting down mental disorder than anything 
else. 

Psychiatric Service 
Morris Yorshis, M.D., Clinical Director 
During the past twelve months a special effort was made to determine what the 
factors were that helped patients leave the hospital. In the frank organic psychoses, 
particularly in the early psychoses due to syphilis, treatment of the underlying 
somatic pathological condition was of significant value as one would expect. When 
one considers the amount of individual attention which physicians in state hospitals 
can give to patients we are forced to the conculsion that the healing power of nature 
must play a significant role. While we find it extremely difficult to evaluate the 
actual curative value of our efforts it is much less difficult to evaluate palliative 
measures. Patients suffering from psychoses with cerebral arteriosclerosis and 
senile dementia who are completely unmanageable in their homes, disrupting 
entirely the morale of the household, by means of habit training firmly yet kindly 
applied, become changed individuals in many cases in a comparatively short space 
of time. 

Only about sixty percent of the new admissions leave within the first year but, 
it must be remembered that 25 or 30% of the admissions are cases of Senile De- 
mentia and Arteriosclerosis and the recovery rate from this group is very insignifi- 
cant. The paretics that are committed in many instances have had extended 
courses of treatment, and commitment was necessary apparently because no im- 
provement resulted. With such patients it is quite impossible to bring about com- 
plete recovery although the condition may be arrested. Detailed study of the 
psychiatric aspects of the paretics have shown that not only is the early recognition 
of the disease important in the prognosis, but that a well integrated prepsychotic 
personality seems to have a determining influence. 

The survey of the data has led us to conclude that the personality assets and 
liabilities, the physical status, and the social situation are the three important 
facts to study in every patient. It seems that what this hospital offers in applica- 
cation of this appraisal is the effective forcing of patients to live in certain patterns. 
These patterns are varied, certainly, and only loose adherence is required of the 
patients which implies tolerance, sympathy with and understanding of the indi- 
vidual. The understanding is not a conscious psychological one. It is rather a 
knowledge, secured empirically, of what a given patient likes and dislikes, of what 
he can do or will try to do in work, organized play or casual contacts. The hospital 
situation, if carefully controlled, can bring about improvement in the patients' 
condition in a rather short time. In that it is impossible to do any comprehensive 
psychotherapy or at least psychotherapy that can be given regularly by the 
physician, it is incumbent upon the medical staff to devise some means to arrange 
for a suitable environment that will tend to ameliorate the mental illness so that 
repair can go, on unhampered. Just what this should constitute has been a matter 
of debate. The program here for the past year has been very carefully organized, 
and varies with the individual patient, but as a group most of them are on the 
following program: 

Every patient must have the general care that is given to the patient in a general 
hospital, attention to the skin, teeth and physical needs. Forcing patients to 
brush their teeth or to bathe may in many respects create difficulties, especially 
if the milieu from which they come makes no such demands. It is here that the 
physician has to individualize. The same thought must necessarily be given to 
cases that are assigned work. Many patients react very satisfactorily to the work 
situation but respond poorly to the other patients at work at the same job; with 
careful selection of groups of patients and the type of foreman supervising the pa- 



P.D. 47 7 

tients, irritations can be avoided. The occupational therapy department has done 
remarkably fine work in lessening the tensions that have heretofore been very 
prevalent in the various industrial situations prescribed for patients. The inertia 
that existed on many wards, especially after working hours, has been in most in- 
stances done away with due to the extensive recreational activities that have been 
prescribed for all wards. Special radio broadcasts with games, dances, and other 
entertainments have continued to increase group interest, and have a definite 
psychotherapeutic value, especially where the ward personnel through lack of time 
has been unable to give each individual patient the stimulation that he needs. 

While medical treatment is given, especially hydrotherapy treatments, it is 
difficult to say that the tub or the pack or the tonic bath has led to recovery, and 
the same can be said about sedative drugs. Experience has not shown that the 
drug is responsible for the cure, but it does definitely lessen tensions and in many 
cases if this can be done with hydrotherapy or with manipulation of the hospital 
environment it certainly is preferable to do the latter than to resort to the use of 
sedatives. It would seem, therefore, that by lessening the irritations of a mental 
hospital through a carefully arranged industrial and recreational program, many 
patients can be helped. 

Careful study by the Social Service Department of the resources in the com- 
munity and supervision of the environmental stress in a given situation may lead 
to permanent adjustment without necessary recurrence of the disorder. This 
has been found to work. very satisfactorily in the past. We plan to continue this 
survey in the hope that we may conclusively determine the most important thera- 
peutic factors in the hospital situation. We have found that keeping relatives 
away from certain disturbed patients, especially of the manic type, has been a 
considerable help to these patients. We have also found that many of these 
patients do very badly when visited or treated by members of the opposite sex. 
Particular points of this nature are being revealed as detailed studies of individual 
patients who have resided in the hospital for a year have been made. 

This survey has demonstrated that text-book criteria for prognosis are by no 
means sound, and that only after thorough study of large groups of new admissions 
will we be able to make prognoses in individual cases with a high degree of reliability. 
Succinctly, individual psychotherapy in the major psychoses, while it may be 
important, with the present ratio of physicians to patients, certainly cannot be 
given at the State Hospital to any appreciable number of patients. Something 
else, therefore, must be done to obviate this deficiency. We believe that a care- 
fully worked out therapeutic program which includes general care, occupational 
and recreational activities plus medical treatment will tend to lessen tensions in 
the various situations which patients will encounter and will be the major means 
by which patients will leave the hospital sufficiently well to adjust to the com- 
munity. 

Nursing Department 
Katherine M. Steele, R.N., Superintendent of Nurses 

The work of the nursing department for the current year has been concentrated 
in an attempt to develop, improve, and stabilize programs that were instigated in 
1935. In January, 1936, a vacation schedule was put into effect distributing va- 
cations evenly throughout the entire year as near the date of employment as 
possible. With this even distribution of vacations the shortage is at least a con- 
stant factor though the need for an additional quota of twenty employees for 
relief, for vacation and illness is very great. 

Since June, 1936, it has become increasingly difficult to find graduate nurses for 
floor duty. The condition exists throughout the country and in all branches of 
nursing. Whereas, last year at this time, we had 121 graduate nurses on the staff, 
we now have 103. 

The centralization of the administration of the nursing service at the Summer 
Street Department became effective this year; this has been accompanied by an 
increase in the number of female graduate nurses on the male serviee as head 
nurses and supervisors. Mrs. Myrtle Fuller, as Superintendent of Nurses, Summer 
Street Department, has increased her supervision to include the male service. The 
results obtained in the co-ordination of the nursing service of the entire institution 



8 P.D. 47 

have been gratifying, though certain problems arise because no part of the nursing 
service is now an independent unit. Quotas of the ratio of nursing personnel to 
patients have had to be decided upon for each service and redistributions made. 

With the additional personnel necessary for the forty-eight hour week, there 
was an increase in the staff of barbers from two to four. New equipment and 
extra facilities have been furnished so that where last year male patients had one 
or two shaves a week, they now have three shaves every week. Haircuts have 
been increased to one in every three weeks. An electric razor was purchased for 
the male medical wards so bed patients can now have shaves more often. 

The four students from the Training School, who took their senior year affiliation 
at Springfield, completed their training in the fall of 1936. They will return to this 
hospital to be prepared for the Commissioner s examinations. 

Affiliations have continued with the Hahnemann, Memorial and St. Vincent's 
Hospitals of Worcester. A total of twenty-eight students from these hospitals 
have completed a three months affiliation. A course of thirty hours in Psychiatry 
and Psychiatric Nursing was given to a group of sixty student nurses from these 
same hospitals in January and February, lg33. The oiientation course for all 
new employees has been given at intervals throughout the year by members of the 
administrative staff. 

Miss Margaret Diamond has continued to instruct all new attendants in a thirty 
hour course in practical nursing and the routine of the hospital. All student 
nursing groups and all new attendants have had instruction in hydrotherapy. 

Two students were graduated from the post graduate course in May, 1936. 
One has been retained on the staff of this hospital as a head nurse. The other 
accepted a staff position at the Payne Whitney Clinic in New York City. Five 
students are enrolled for the present post-graduate course. 

Occupational Therapy Detartment 
Dorothea Cooke, O. T., Reg., Chief Occupational Therapist 

During the past year this department has continued the program as outlined in 
the re-organization of the previous year, developing and branching out, always 
with the aim of enlarging our scope and perfecting a set-up which will include 
practically the entire patient population. Due to the formation of a continued 
treatment service, which necessitated an additional industrial office, we have 
transferred one of the Summer Street assistants to the main hospital for the time 
being. This leaves one assistant in the Summer Street Department to carry on 
the routine work there. Other than this change our department personnel remains 
the same. Sixteen students from the Boston School of Occupational Therapy have 
completed their field work in mental hospital occupational therapy training. 

Our two shops, one for the Male Service, and one for the Female S9rvice are 
primarily orientation and evaluation centers, where the newly admitted patients 
are sent as soon as possible after admission. The activities in the shop are of 
necessity of handicraft nature. 

We have kept them as practical as possible and confined the work to hospital 
needs. Baby clothes, surgical dressings, bookbinding and repairing, mending, 
knitted jackets, table runners, and pillows for the wards and simple laundry have 
been included. Patients have been prescribed to the shop for two weeks' obser- 
vation periods. During that time the therapist has made complete notes of the 
education, vocational and avocational interests, or lack of them, their capabilities 
and aptitudes for each patient. These findings have been presented to the physician 
and take their place with reports on the patients' condition and progress that go 
to the physician from other departments, thus enabling him to plan a re educational 
and rehabilitative program for each patient. 

The main stress in the department has been Industrial Therapy. This is the 
therapeutic use of hospital industries for the benefit of the patient, through work 
activities. It does not indicate Just any work in contrast to idleness, but work 
intelligently prescribed by the physician for its physical demands, its emotional 
effects, its social influence, its mental stimulus, and its integrating power in relation 
to the individual patient. Craft work is primarily an individual occupation and 
for the normal person it often becomes a hobby in which is found surcease from 
conflicts and responsibilities of every day life. Through placing patients in normal 



P.D. 47 9 

hospital tasks we have endeavored to return these factors of normal activity that 
have been lost; namely, productivity, social, and community interests and re- 
sponsibilities. 

An analysis of each particular task in the hospital has been made, using the 
following form as guide: 

Name of job 

Attitude of department head 

Attitude of division head 

Attitude of industrial therapist 

Description of work 

Environment 

Supervision 

Industrial hazards 

Requirements of the job: 

a. physical 

b. psychological 

c. social 
Hours of work 
Socializing factors. 

In making this analysis, we obtained detailed information regarding personality 
characteristics, physical status, special training, and intelligence required for a 
patient to fill capably the needs of each task. 

One of the facts we have discovered is that keeping a patient too long on one 
job is not effective therapy; thus the grading of jobs with a plan of promotion has 
been important in our program. Charts with jobs graded as to behavior and 
intelligence requirements have been our latest steps in attempting to achieve 
scientifically supervised occupation. 

Nurses ward classes started last year have greatly improved. By means of 
informal guidance at regular intervals the nurses have gained a broader under- 
standing of possible projects, materials, design, color and practical application, 
resulting in an increased effectiveness in their stimulation and guidance of the 
patients work interest. The quality and output has Improved, whereas last year 
burlap raveling was predominate, this year patient's mending has been the chief 
activity. 

Ward games and recreation have continued to be the nurses responsibility, the 
occupational therapist acting indirectly as a source of equipment and advice. A 
program for outdoor recreational activity was instituted this summer, consisting 
of tennis, croquet, volley ball, shufEe board, and ring toss. Several base-ball teams 
were organized among the male patients using a special type of soft play-ground 
base-ball. Plans were drawn up and the foundation laid for an outdoor dancing 
floor for use during the summer holidays. 

Community recreational activities have been dances, movies, W.P.A, plays, 
community sings, and during the summer months band concerts. 

So'::;tal Sebvice De-'artvent 
Birb-ira Edes, MA., Chuf S:cial Worker 

During the past year there have been several changes in personnel in the Social 
Service Department. Miss Helen Crockett, head worker, resigned in November, 
1935 to accept another position. In the absence of a civil service list a provisional 
appointment was made in January 1936, becoming permanent in November. 
Miss Anne Hecht, social worker on the male service, left on September 31, 1936 to 
be replaced by Miss Helen Hollander on October 14. The hospital was granted a 
special worker for a period of three months for an intensive study of Family Care. 
Mrs. Addienne Wise, who had been connected with the hospital for some time as a 
volunteer worker was appointed for this study on September 21. We are hoping 
that this appointment will be made permanent so that we may have two full time 
workers for this branch of the service. 

We have had eleven student social workers and one volunteer worker during the 
year. From September 1935 to June 1936 we had three students from the Smith 
College and one from Simmons College School of Social Work. During the 
summer we had th3 S2rvic3s part tim3 of one young woman taking the summer 



10 P.D. 47 

course for theological students and one volunteer worker. The latter had had 
training at the New York School of Social Work, and both were of great service to 
us during the summer months when the staff was cut by vacations. Fall again 
brought us students from Smith and Simmons, three from each school. One of the 
latter group left after a few weeks, however, leaving us five for the winter months. 
Despite their lack of training in hospital work, they have adjusted well, and carry 
a fair share of the work. 

Statistics for the year are as follows: 1,453 new cases were referred to the de- 
partment including 434 histories and 495 requests for special investigations. In- 
terviews held with patients, relatives, friends, etc., totaled 5,027 including 1,060 
interviews on, and in regard to. Family Care patients. Of the 200 patients in 
Family Care during the year, 99 were new placements. Thirty-six patients were 
transferred from Family Care to Visit during the year. 

The department has sought to strengthen the spirit of cooperation between it 
and the other hospital departments, attempting to give the type of service most 
needed by the staff. Intensive cases have been referred in staff meetings and the 
type of treatment determined by psychiatric and social service. Such treatment 
has then been carried on in close consultation with the psychiatrist on the case. 
This has, we believe, developed a keener appreciation in both service of the special 
abilities and limitations of each. Through such cooperative efforts, with all services 
working together for the patient's best interests, the highest type of therapy can 
be carried out. 

The department has continued its part in the training program of the hospital. 
This includes not only the intensive work with the social service students, but also 
lectures to nurses, summer theological students, and monthly lectures to each new 
group of medical students. We have had many visitors from other state hospitals 
who were particularly interested in this phase of the work. In addition there have 
been others particularly interested in the aims of Family Care. We appreciate 
their interest, and are always glad of the new ideas, suggestions and helpful criticism 
which they bring us. 

Radio Department 
Wallace F. Seirle, Director 
For the purpose of clarity this report will be divided into three parts. The first 
will deal with the statistical details of the department, the second will explain 
individual therapy as administered to patients working in the department, mis- 
cellaneous activities will be compiled in the third part. 

Statistics 

There were 1,931 programs broadcast from studios of WSH. These include 
news bulletins, turntables. Dramas, Doctor's calls, talks by physicians and staff 
members, piano, organ, vocal and violin programs by patients, and programs by 
employees. 

Four hundred twenty-eight turntables were broadcast to wards. These turn- 
tables consist of electrical recordings which we are able to use when we are un- 
able to procure what we wish from the outside. 

Eight hundred ninety-three doctor's calls were made in the staff dining room. 
By retaining a loudspeaker in the staff dining room we are enabled to call physicians 
during meal time and greatly accelerate phone service during those periods. 

Eight hundred sixty-four news bulletins were broadcast from our own station 
either by the radio director or patients assigned to the radio department. By a 
careful statistical study of outside local news bulletins we discovered that over 
50 per cent of the news was of an undesirable sort for patients. By carefully cen- 
soring the news we are able to give news which we believe to be beneficial to the 
patient population. Two general news bulletins are presented by patients and a 
feature entitled, "Notables in the News" by the director each day. 

Ninety-four WPA Band and Orchestra concerts have been broadcast to the 
wards. The advertising continuity we interpolate between musical numbers deals 
with mental hygiene and hospital information. 

Three-hundred sixty-six daily WSH Radio Programs were typed and lined. 
Each day it is necessary to cull from the various advance programs of net work 



P.D. 47 11 

stations what is best to re-broadcast as well as to include the daily or special 
programs from our own station. This means tabulating each feature for every fifteen 
minutes during the entire day and to draw lines to the respective wards that each 
particular feature should be broadcast to. 

Occupational Therapy and Special Positions 
In our department of Occupational Therapy there has been inaugurated a system 
of graded positions for patients with positions ranging from D to A. Up and 
beyond even the A positions are a few outstanding hospital positions that are 
classified as "special positions". The radio department is included in these special 
positions. When a patient needs to have a position that requires much initiative, 
keen concentration, and a bolstering of his self esteem he is assigned either to 
clerical work in the radio department or to work on the radio control board. 
During the past year among the many patients assigned to this work have been a 
world war veteran, a postman, a first class machinist, a prominent lawyer, a 
registered nurse, a research chemist, an insurance agent with an all high record for 
insurance sales in the Commonwealth, a brick-mason, a concert violinist, a house 
wife and four high school boys. Usually the type of patients assigned to this de- 
partment are convalescent. This entails constant teaching of departmental 
activities as well as radio techniques. In many instances patients have been taught 
radio techniques by other patients. A two fold bit of therapy is accomplished 
thereby for the teacher senses a feeling of superiority, and the pupil entertains 
respect for his fellow patient and enters with a sprit of competition so as to try 
and eventually operate better than his teacher. 

Miscellaneous Activities 

Weekly choir rehearsals with patients convene for preparation for the Sunday 
services. 

A vested choir of employees and patients sing under the direction of the musical 
director for all Catholic and Protestant services. 

Many lectures relative to music in institutions have been delivered to community 
groups. These are all in response to requests from. the outside and are an infin- 
itesimal aide in bringing community interest to the institution. 

All dramatic and musical WPA units have been supervised by this department. 
Three WPA dramatic performances are staged weekly for our patient population 
by a. residing WPA unit. These plays are presented both at the main hospital and 
at the Summer Street Department. ■ 

A questionnaire relative to radio in mental institutions has been circulated to 
all mental hospitals and, sanatoriums in the United States and Canada. We are 
vitally interested to. find out to what extent a radio system in a mental hospital 
can be used therapeutically. Because of this, we are anxious to discover what 
other institutions have done along this line and to profit by their experiences and 
findings. 

A racial index, of the patient population has been compiled. This will aid us in 
preparing racial programs. 

A radio drama in serial form and especially designed for therapeutic ends was 
written by a member of the WPA unit under the supervision of the department. 
These radio plays depicted the onset of a neurosis in a young boy while living at 
home. Through dramatic scenes he was taken through the hospital routine until 
he convalesced and returned home mentally healthy. The proof that patients 
listened to and benefited by these plays were the scores of letters they sent in to 
the superintendent. 

Medical and Surgical Service 
W. Everett Glass, M.D., Director 
The following report summarizes briefly the activities of the medical and surgical 
service from October 1, 1935 to September 30, 1936. 
(1 ) Movement of population on the service: 

There were 955 cases admitted to the service during the past year which is an 
increase of 36 cases over the figures given last year. The largest number of cases 
were admitted during the months of April, May, June and August, about the same 
seasonal variation as last year. Of these cases 184 were admitted for study only. 



12 P.D. 47 

an increase of 40 over the previous year. Four hundred and twenty-eight male and 
339 female cases were discharged in this same period. The monthly turnover 
averaged 64 and is an increase from 59, the figure last year. Discharges from the 
service detailed as to physical condition are shown in the following tables: — 

Table I 

Female Male Total 

Recovered and improved 368 304 672 

Not improved 17 18 35 

Not treated 27 17 44 



Total 412 339 751 

(2) Dejihr. 

During the fiscal year 204 patients died as compared with 257 the preceding 12 
months. The following table gives the details of the deaths and autopsies: — 

Table II 

Female Male Total 

Total number of deaths 108 96 204 

Total number of autopsies 124 

Total number of medico-legal cases . ..... 21 

Autopsies confirmed ante-mortem diagnoses (70% or more) 101 

Autopsies confirmed partially, ante-mortem diagnoses (50 

to 70%) . 17 

Autopsies refuted ante-mortem diagnoses (less than 50%) . 6 

Autopsy percentage of deaths — 60 . 7 % 

During the year 24 patients died at the Summer Street Department. 

The autopsy percentage is 60.7%, a decrease of 2.3% from last year. A total 
of 124 autopsies were done as compared with 163 in this same period. 

A survey of the deaths reveals that as usual, pneumonia caused the largest 
number of deaths — 68, or 33%. The number of deaths in this group is exactly 
the same as last year although the percent is greater. There were only four cases 
of lobar pneumonia the past year. The average age in this group is 68.2 years, a 
slight decrease from last year. 

Thirty-two persons died as a result of changes of a senile nature. This is 15.6% 
of the total deaths. The average age in this group was 71.7. The most of these 
were classified as cardiovascular renal disease and generalized arteriosclerosis. 

Twenty-one or 10.7%, died from general paresis. The average age of this group 
is 46.4. This represents a decrease both in the total number and in the percentage. 
The average age of the group is increased by almost 9 years, when compared with 
this group last year. 

Seventeen or 8.3% died from pulmonary tuberculosis. The average age was 
54.7. The age in this group continues to rise. It was 48.5 in 1934, 51.4 in 1935, 
and now 54.7 this year. We believe that the pneumo-thorax treatments given these 
patients have caused the increase in the ages of this group. 

Cancer was the cause of death in 8 cases or 3.9%. This is a decrease over the 
figures of last year. 

Cerebral hemorrhage caused the death of 10 persons, pulmonary thrombosis 4, 
primary kidney disease 5, primary heart disease 9, diabetes, intestinal obstruction, 
and C.N.S. syphilis accounted for three each. 

Six or 2.9% died directly as a result of fractures. 

Fifteen or 7.3% died of miscellaneous causes. The average in this group was 
45.3 years. 
{3) Consultations: 

The following table represents the extent to which the consultant staff was used 
during the year. 

Table III 

Eye . 110 

Ear, nose and throat 17 

Gynecological and obstetrical . . 57 



P.D. 47 13 

General surgical 93 

Medical 12 

Orthopedic . 

X-Ray . 1,573 

Others 42 

Total 1,904 

There is no significant change in this part of the medical service. There was a 
decrease of about four hundred cases seen by our X-ray consultant. This is 
approximately the amount of last year's increase, and probably is a return to 
normal. 

(J^) Obstetrics: 

There was a slight increase in the activity in this department the past year. A 
total of 12 babies were born during the year, as compared with 9 the preceding year. 
It is still our feeling that some legal means should be found to enable us to place 
the children who are born here without watiing for the whims and fancies of persons 
responsible for the placement of these children. During the past year at least two 
children had to remain in this hospital until they were almost able to walk. 



(5) Surgery Detailed: 



Table IV 


. Operations Performed 










Amputations major . 


1 


Hemorrhoids 3 


Amputations minor . 


2 


Herniorrhaphies 




6 


Appendectomies 


6 


Hysterectormies 




5 


Bimanual exams, (anaes.) 


1 


Incision and drainage 




122 


Biopsies 


7 


Injections of varicosities 




97 


Blood transfusions . 


6 


Intestinal obstruction 




3 


Bronchoscopies 


2 


Ionizations of cervix 




8 


Caesarian section 


1 


Iridectomy. . . 




1 


Cataract removal ... 


1 


Paracentesis 








1 


Cervical repairs 


11 


Perineal repairs 








12 


Chest aspirations 


6 


Plastic repairs 








4 


Closed drainage 


3 


Pneumothorax 








335 


Cholecystectomy 


2 


Prostatectomy 








1 


Circumcision .... 


2 


Pyelogram 








1 


Colostomy .... 


1 


Ramstadt operation 




1 


Curettage of bone . 


2 


Removal of toe-finger nails 




6 


Cystoscopic exams ... 


5 


Rib resection .... 




1 


Cystotomies (suprapubic) 


3 


Proctoscopies 




5 


Dilatation and curetage . 


7 


Saphenous veins ligation 




5 


Dilatation of rectal sphincter 


1 


Sigmoidoscopies 




3 


Deliveries 


14 


Skin tumors 




7 


Dislocations .... 


4 


Spinal manometries 




35 


Encephalograms 


13 


Surgical diathermy . 




1 


Enterostomy .... 


1 


Suspension of uterus 




1 


Epididiotomy .... 


1 


Suturing .... 




61 


Exploratory laporotomy 


3 


Teeth extraction (anaes.) 




25 


Fistulectomy (vesico-vag.) 


1 


Thoracotomy . . 




2 


Foreign body removal 


8 


Tonsillectomies 




8 


Fractures, open reduction 


1 


Vulvectomy 




1 


Closed 


25 





Gastric lavage 


1 


Total 904 


Gastrotomy .... 


1 




(6) Clinics Detailed: 






Table \ 


^. — Clinics Deatiled 


Eye examinations 




. . 849 


Ear, nose and throat examinations 




770 


Gynecological examinations 




617 


Luetic treatments 










1 


7,527 



14 



P.D. 47 



Small-pox vaccinations 

Lumbar punctures .... 

Typhoid and para-typhoid inoculations 

Hinton tests 

Others 



580 

578 

3,548 

1,764 

44 



Total 16,177 

There were about 2,600 more treatments and examinations given this year. This 
represents a steady increase from year to year in this particular part of the medical 
service. 



(7) Dressings Detailed: 

Table VI. 
Abrasions and larcerations . 
Boils and carbuncles . 
Burns . . 



Dressings Detailed 



Infections 

Ulcerations 

Others 

Total "out-patient" dressings 
Total "ward" dressings . 



Grand Total 



1,892 

575 

123 

13,063 

517 

3,090 

7,562 

27,208 



54,030 

This is a decrease of about 1,200 in the total number of dressings done during 
the year. 

(8) Employees: 

During the year 3,370 examinations and treatments were given. This is an 
increase of 1,300 over last year. Forty-eight males and eighty-four females were 
hospitalized during the year. The total number of working days lost by hospital- 
ization was 995, an increase of 167 days over the preceding year. 



(9) Dental Department: 



Cleanings .... 

Examinations (routine) . 

Extractions 

Fillings .... 

Impactions removed 

Miscellaneous treatments 

Plates .... 

Repairs 

X-Ray diagnoses 

General anesthetic cases 



Table VII. — Dental Report 



Main Summer 
Hospital St. Dept. 



Total examinations and treatments 
Total patients examined or treated 



1,554 

2,446 

1,822 

1,672 

47 

1,061 

52 

99 

71 

28 

8,852 
4,249 



162 

271 

189 

156 

2 

64 

4 

16 



864 
420 



Total 
1,716 
2,717 
2,011 
1,828 

49 
1,125 

56 
115 

71 

28 

9,716 
4,669 



(10) 



X-Ray Department Analysis 



X-Ray Department: 

Table VIII. 

X-Ray plates used 2,606 

Patients examined 1,494 

Foot and finger prints (sets) 41 

Photographs 222 

Lantern Slides 122 

There was no significant change in the activity in this department. Additional 
equipment was obtained during the year which has improved the scope of fiuoro- 
scopic work that can be done. 



P.D. 47 



15 



{11) Physical therapy Department. 

Table IX. — Physical Therapy Department 

tntra-violet (air-cooled) 1,980 

Ultra-violet (water-cooled) 421 

Baking 1,833 

Massage . ... . . . . . 1,453 

Diathermy (medical) . . . . 620 

Diathermy (surgical) . . ... 63 

Muscle re-education 1,366 

Others 118 

Total treatments and tests . . . . ... . . 7,854 

Total number of patients treated 4,978 

There has been a decrease in the amount of work done in this department during 
the year, by about 800 treatments. A surgical knife was purchased during the year 
and this added equipment will enable our surgeons to do work which before they 
were unable to do. 

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

The total number of determinations for the past year decreased to 45,700 as 
shown in detail below. This decrease was predicted in last year's report and was 
occasioned by a change in the type of work carried on for the research service from 
a descriptive to a more experimental and exploratory nature. During the year 
there were 204 deaths and of these 124 were autopsied. The decrease in deaths 
noted last year was even more marked for this year, 55 less deaths being noted. 
The ratio of autopsies to deaths remained about the same, 61 % as compared with 
63 % for the previous year This percentage though very creditable could probably 
have been raised somewhat if we had been able to keep the position of pathological 
interne filled. 

The work of training suitable college graduates as technicians in clinical, path- 
ology has been continued and one of the girls who completed her course last year 
has been able to secure employment. The laboratory was one of the four located 
in Massachusetts placed on the first list of accredited training schools for technicians 
approved by the Americal Medical Association. 

The Clinico-pathological conferences have been held monthly as in previous 
years. The value of these conferences in the training of medical students and 
internes is readily apparent to those attending them. 

During the year the following papers were published: 

Bone Marrow Studies in Glandular Fever (Infectious Mononucleosis). Am; J. 

of Clinical Path. 6: 185, 1936. Wm. Freeman. 

The Blood Pressure Raising Principle of Adrenal Cortex Extracts, J. Biol. Chem. 

IH: Lxii. 1936. J. M. Looney and M, A. Darnell, Jr. 

The following papers are in the hands of the Publishers: 

The Oxygen and Carbon Dioxide Content of Arterial and Venous Blood of Normal 

Subjects. J. M. Looney ^nd E. M. Jellinek. To be published in The American 

Journal of Physiology. 

The Oxygen and Carbon Dioxide Content of the Arterial and Venous Blood of 

Schizophrenic Patients. J. M. Looney and Harry Freeman. 

The Seasonal Variation of Cholesterol. E. M. Jellinek and J. M. Looney. 

The director presented a paper with Dr. Glass before the Worcester County 
Medical Society at the Hospital in February entitled: The Effect of Duodenal 
Extracts in Diabetes Mellitus He also gave lectures before the student bodies of 
Holy Cross College, Worcester State Teachers College, and gave addresses before 
the Boston University Alumni Association, The Brown University Alumnae, the 
Worcester City Hospital Alumnae Association, and the Rotary Clubs of Marlboro 
and Walpole and the Shrewsbury Grange. He attended the annual meeting of the 
American Society of Biological Chemists in Washington March. 23-27, where he 
gave the paper on adrenal cortex noted above. He also attended the Annual 
meeting of the Massachusetts Medical Society in Springfield in June and the 
scientific conference of the Harvard University Tercentenary in September. 



16 



P.D. 47 



Dr. Freeman presented a paper, Studies on Bacterial Flora of the Normal and 
Abnormal Mouth, in March to the Worcester District Dental Society. He gave a 
paper entitled: Studies on Adrenal Cortex Therapy in the Pernicious Vomiting 
during Pregnancy, to the Staff of the Boston Lying-in-Hospital on March 19. He 
gave talks on the Research Work of the Hospital to the Junior Auxiliary for the 
Home for th9 Jewish Aged of Worcester, to the Webster-Dudley-Southbridge Med- 
ical Club and to the Exchange Club of Worcester. During the year he attended the 
Annual Meeting of the American Association of Pathologists and Bacteriologists 
at Boston, on April 9-10, and the Connecticut Medical Congress, at New Haven, 
September 22-24. 

The work of determining the chemical constituents of various regions of the 
brain has continued during the past year, and methods for handling the material 
have been perfected. 

The investigations into the oxidative processes in schizophrenic patients have 
been continued and certain definite deiSrences between them and normal subjects 
have been found out. This work is being continued by a further study on the 
utilization of sodium lactate when injected and by a study of the mechanisms in- 
volved through the use of the Warburg apparatus. In these experiments the 
changes in oxygen utilization which animal tissues undergo when blood and spinal 
fluid of normal and schizophrenic subjects are added to the system will be studied. 

The work on the isolation of the blood pressure raising principle of the adrenal 
gland has been carried on by a grant from the Armour Co. A number of potent 
fractions have been prepared but as yet efforts to purify and isolate the substance 
responsible has been unsuccessful. The work will be continued for the coming year. 



Total Number of Laboratory 


Tests for Fiscal Year Ending 




September 30, 1936 




Bacterial cultures . 


206 


Urine (urob.) . . . . 


130 


Bacterial smears 


1,038 


Urine (chlor.) . . . . 


164 


Basal metabolisms 


1,102 


Urine (blood) . . . . 


9 


Blood cultures .... 


89 


Blood typing . . . . 


56 


Blood creatinine 


1,075 


Blood calcium 


111 


Blood N.P.N. .... 


2,089 


Blood chloride . . . . 


129 


Blood sugar .... 


2,813 


Blood cholesterol 


241 


Blood urea .... 


1,020 


Blood hematocrits . 


158 


Blood uric acid 


1,117 


Blood sedimentation 


127 


Blood counts (red) 


2,667 


Blood gases 


111 


Blood counts (white) 


3,376 


Blood Ph . . . 


101 


Blood counts (diff.) 


3,270 


Blood glutathione . 


117 


Haemoglobins 


3,279 


Blood lactic acid 


522 


Clotting times 


70 


Blood phosphotase 


3 


Bleeding times 


66 


Blood phosphorus . 


54 


Icteric index 


88 


Blood capacity 


608 


Yan den Bergh Test 


69 


Blood widals . 


3 


Spinal fluid (cells) 


589 


Nitrogen partitions 


2,584 


Spinal fluid (gold) . 


580 


Plasmodia malaria 


3 


Spinal fluid (Chlor.) 


565 


Platelet count 


8 


Spinal fluid (glob.) 


578 


Reticulocyte counts 


73 


Spinal fluid (sugar) 


578 


Schillingrams . 


363 


Spinal fluid (prot.) 


572 


Blood fragility 


15 


Spinal fluid (diff.) . 


7 


Ascetic fluid 


168 


Sputa .... 


879 


Colonic irrigations . 


24 


Stools .... 


448 


Animal inoculations 


9 


Tissue sections 


1,290 


Ascheim-Zondek tests . 


22 


Urines .... 


8,281 


Stomach contents . 


265 


Mosenthal test 


78 


Autogenous vaccines 


4 


P.S.P. 


22 


Glucose tolerance . 


33 


Urine (quant, sugar) 


457 


Galactose tolerance 


25 


Urine (bact.) . . 


10 


Toxicological exam. 


2 


Urine (bile) 


133 


Urine (diacetic acid) 


1 



P.D. 47 



17 



Blood serum protein 


35 


Milk analysis . 


6 


Milk blood plated . 


6 


Liver function test 


1 


Blood amino acid . 


10 


Blood albumin 


26 


Blood bromide 


14 


Phytotoxic index 


36 


Congo red test 


1 


Blood potassium 


84 


Peroxidase stains . 


1 


Blood sodium . 


70 


Urine sodium . 


140 


Urine potassium 


150 



Spinal fluid (bromide) . 

Blood creatine. 

Blood vitamin " C " 

Urine vitamin " C " 

Takata-Ara test 

Urine (qualitative sug.) . 

Blood iodine 

Skin test (undulant fever) 

Urine protein . 

Urine (cell count) . . 

Blood volumes 

Blood lipoids . 

Blood cholesterol esters. 

Blood minute volumes . 



Grand total (minus autopsies) 
Autopsies 



4 

5 

261 
o 

3 

25 

3 

1 
2 
2 
6 
28 
28 
5 

45,700 
126 



Research Department 
F . H. Sleeper, M.D., Assistant Superintendent 

During the past year we have continued our investigations of the disordered 
homeostasis present in schizophrenic patients. We have utilized to advantage our 
regulated temperature and humidity laboratory for this purpose. Early in the 
experiments it was discovered that control observations on normal individuals as 
revealed by the literature were either lacking or inadequate. Inasmuch as Dr. H. 
Freeman wished to investigate temperature control in schizophrenics, we found it 
necessary to obtain our own control data for normal individuals on skin temperature, 
oxygen consumption rate, body temperature, oral and rectal, and the rate of 
excretion of insensible perspiration. 

The difference in skin temperature between the right and left sides in nine 
symmetrically located areas were studied in twenty normal and twenty schizo- 
phrenic individuals at half-hour intervals for three and one-half hours, with environ- 
mental conditions at 24° C. and twenty per cent relative humidity. The schizo- 
phrenic patients showed less than normal ability to maintain bilateral symmetry 
of temperature but the two sides of the body are sufficiently similar to obviate 
the necessity of measuring both sides in future studies. 

Twenty normal subjects and twenty schizophrenic patients were studied, nude, 
in the basal state at a room temperature of 24° C. and humidity at twenty per cent 
for three and one-half hours. Skin temperatures were taken seven times during 
this period at nineteen skin points. It was found that the adaptation of the skin 
and body temperatures to this cool condition of the schizophrenic patients differs 
from the normal, in certain levels of skin temperature, the extremities cool more 
rapidly, the temperatures of certain parts of the body decrease by a less consistent 
pattern, skin temperatures are more affected by changes in air velocity. These 
differences afford further evidence of defective adaptation in the schizophrenic 
subject. Similar studies were carried out at a warm temperature (32° C.). It 
was found that the schizophrenic in his adaptation to heat is as abnormal as in his 
adaptation to cold. 

Studies have been made of the oxygen consumption rate and rate of excretion 
of insensible perspiration at 30° C. and twenty per cent relative humidity, with 
simultaneous studies of skin and body temperatures. It is now possible to determine 
the effect of basality as well as of environmental conditions on these various char- 
acteristics. These studies, as well as investigations on the effect of humidity, of 
cold, of heat, and of thyroidization on the variables mentioned above, have not 
been sufficiently analysed to make final conclusions, but we believe the results 
will prove highly meaningful. 

During the last year schizophrenic patients and paired normal control subjects 
had their blood lactate determinations made after ruraning up and down stairs, 
and the lactic acid, oxygen and carbon dioxide, and hydrogen-ion concentration 
of the blood determined before exercise. It was found that for a given amount of 
work, the patients accumulated a greater amount of lactic acid than do the controls. 



18 P.D. 47 

Furthermore, patients required a longer period of rest than did the normals for 
the lactate to reach a normal level. This discrepancy is regarded as a fundamentally 
important datum. 

The oxidation problem has been further studied by determining the oxygen and 
carbon dioxide content of venous and arterial blood of patients and normal sub- 
jects under comparable conditions of basality. Previous studies had shown that 
the volume of blood in the schizophrenic is somewhat less than normal, and that 
when the patient is in a basal state the passage of blood through the tissues is 
abnormally slow. Without going into details, we may say that under basal con- 
ditions in normal subjects the use of oxygen was determined entirely by metabolic 
factors in the tissues. In schizophrenic patients, however, we found that the more 
oxygen that was supplied, the more was used, and vice versa. The abnormal 
relationship between the blood gases was submerged during exercise, but the relative 
rigidity of the carbon dioxide itself was maintained. The schizophrenic in this 
regard reacts more like a physical-chemical mechanism than like a finely controlled 
organism. 

Dr. Looney has continued his investigations on the glutathione content of the 
blood in normal and schizophrenic subjects in relationship to the lactate content 
of the blood. Preliminary studies are under way by Dr. Nickerson with the 
ultimate object of determining the oxidative capacity of isolated bits of living tissue 
obtained at operation, and also blood serum and cerebrospinal fluid. 

Dr. H. Freeman, in a regulated temperature humidity laboratory, is making 
an investigation of the specific dynamic action of the amino acid glycine. Studies 
directed toward the refractoriness to oxidative stimulation in schizophrenic sub- 
jects have been made and will be discussed in the ensuing report. 

For the past three years observations have been made upon the influence of a 
commerical glycerine extract of adrenal gland. We reported previously that in 
most schizophrenic subjects this material caused a rise in blood pressure. Hoskins 
and Freeman have shown that the weight of the normal subject is not significantly 
influenced by such extract in standard dosage, but that of the schizophrenic is 
definitely increased. The systematic differences brought out by these studies 
between the schizophrenic and normal individuals are a challenge. The material 
we have used has a tendency to correct the depressed circulation and to improve 
the nutrition of the patients. An understanding of the mechanisms of these effects 
might aid significantly in a better understanding of the physiology of the psychotic. 
Dr. Looney for the past year has been attempting to isolate the active pressor 
principle in this material. Several active preparations have been obtained, but 
it has not yet been possible to get them consistently. 

Two studies of the influence of thyroid medication are being made. The first 
of these investigations of the thyroid hormone as a factor in psychodynamics 
was started two years ago. Several patients have now been studied at length, and 
the results will soon be published. During the past year eight deteriorated patients 
were placed on prolonged heavy dosage of desiccated thryoid substance by Dr. 
Cohen and Dr. Hoskins. Careful psychiatric observations were made and a large 
volume of data accumulated. It has been discovered that the chronic deteriorated 
type of schizophrenia is characterized by a remarkably high tolerance to thyroid 
substance, as measured either by physiological or by psychiatric changes. It is 
apparent that the high tolerance is not due to defective absorption but possibly 
is due to low reactivity of the body tissues, as thyroxin by vein must be administered 
in large doses to get any significant physiological response. The possibility of a 
humoral thyroid antagonist is being investigated as an explanation of the phenome- 
non. In connection with other thyroid studies Drs. Hoagland and Rubin of Clark 
University are investigating the effects of thyroid substance on encephalograms. 
We have at our disposal ample supplies of the maturity principle of the anterior 
pituitary gland and a polyvalent extract presumably containing most or all of the 
anterior pituitary principles. We are making moderately intensive investigations 
of the effect of this material on schizophrenic subjects. 

Last March Dr. D. Ewen Cameron started the treatment of schizophrenic 
patients with large doses of insulin. To our knowledge, this is the first time that 
this treatment was used in the United States. Preliminary results are definitely 



P.D. 47 19 

promising, and we are giving increased attention to it. We are not satisfied with 
the explanation of its action, and are making intensive studies directed toward a 
more satisfactory evaluation of the effect of this treatment. Dr. Hoagland and Dr. 
Rubin have been investigating the Berger rhythm in these patients also. 

In the Annual Report for last year Mr. Shakow, the Chief Psychologist, outlined 
an integrated program designed to test the functional capacity of schizophrenics 
throughout the gamut ranging from the simple knee jerk at one end to complex 
mental and behavioristic activities at the other. This program has been continued. 
During the current year researches have been completed which deal with the effect 
of varying the warning interval on reaction time. It was shown that whereas the 
normal subject can get "set" for a given activity and hold the "set" for a consider- 
able period in spite of distracting circumstances, the schizophrenic has notably 
less capacity. A study was also made of the comparative ability of schizophrenic 
and normal subjects to adapt to disturbing situations. In this connection the so- 
called psychogalvanic reaction was used as an index, noises as the disturbing 
factor. Adaptation in the patients was shown to be much impeded. Schizophrenic 
and normal subjects were also compared in their reactivity to disagreeable skin 
stimulation, using cardiotachometer readings as an index. 

The Biometrics department has prepared analyses and interpretive memoranda 
for various members of the research group. The major analyses include those of 
blood gas data, variations of circulation time, reactions to disagreeable stimuli, 
bilateral symmetry of skin temperatures, effects of environmental variables upon 
skin temperatures, reaction to adrenal cortex medication, topographical distri- 
bution of skin temperatures, effects of hyperthyroidization on physiological and 
metabolic functions, analysis of imagery of schizophrenic patients, and analyses of 
reactions to the Rorschach test. Many minor tabulations and analyses were 
completed. Original researches included a variety of biometric analyses and a 
considerable amount of technical theoretical work as applied to the schizophrenic 
problem. 

By the use of special techniques it is now definitely established that the schizo- 
phrenic subject as compared with the normal individual shows excessive variation 
in the following features: all nitrogenous constituents of the blood and urine, blood 
cholesterol, lactate, potassium, potassium-calcium ratio, sugar, blood pressure 
and circulation time, skin temperature, and body weight. On the other hand, 
blood calcium and the carbon dioxide of the blood are found to be held within 
abnormally rigid limits. Presumably these findings indicate adaptational diffi- 
culties. 

During the past year Dr. A. Angyal has been interested particularly in empirical 
syndromization, and he has been able to isolate a certain symdrome which occurs 
in approximately 12 per cent of the schizophrenic population studied. The patients 
all showed a variety of somatic complaints which included sensation of lightness 
or heaviness of the body, sensation of levitation, an impression of expansion or 
shrinking of the body, and of an airy substance passing through and emenating 
from the body. The normal person has, as a part of his conception of Mmself as 
an individual, a mental picture of his own body as a totality. This picture includes 
the posture of the various parts. Under the influence of the unnatural sensations 
mentioned above, the patients perception of his "postural model" disintegrates. 
Dr. Angyal has been able to throw considerable light on the sensory-neurological 
basis of the somatic complaints. 

During the last few months Dr. Angyal has been working on plans for a com- 
prehensive integrating study of the data that have been and are being secured by 
the Research Service as a whole. He has made for several years a broad survey of 
the field of psychiatry, and has attempted to revise and clarify basic concepts and 
devise a method of synthesis which will allow the unification of physiological, 
psychological, and sociological data in a common scheme. 

Another major project in the psychiatric department is Dr. Cohen's study of 
schizophrenic deterioration. From a psychological point of view, special attention 
has been given to the matter of imagery in a group of twenty-one patients and a 
comparable group of normal controls investigated under similar experimental 
conditions. The first step of the physiological approach to the problem of deteri- 



20 P.D. 47 

oration was to study the effects of thyroid given in large doses to a selected group 
of patients. The deteriorated patient was characterized by low responsivity. De- 
tails will be reported shortly in the literature. 

The following articles were published during the year on the Research Service: 

1. Psychopathic Personalities. Eugen Kahn, Lloyd J. Thompson, and Louis H. 
Cohen. Practitioner's Library of Medicine and Surgery, Vol. IX: Chapt. III. 
pp. 57-104, D. Appleton-Century Co. 1936. 

2. Schizophrenia. Eugen Kahn and Louis H. Cohen. Ibid. Chapt. XLVI. pp. 
1145-1192, 1936. 

8. Psychological Government and the High Variability of Schizophrenic Patients. 
J. McVicker Hunt, Ph.D. Am. Jour. Psych. ^5; 64, January, 1936. 

4. An Endocrine Approach to Psychodynamics. R. G. Hoskins. Psychoanalytic 
Quarterly. 5: 87, January, 1936. 

5. A Method of the Estimation of Average Heart Rates from Cardiochronographical 
Records. E. Morton Jellinek and John W. Fertig. Jour, of Psych. 1: 193, 
February, 1936. 

6. Peripheral Venous Blood Pressure in Schizophrenic and in Normal Subjects. 
Charles M. Krinsky and Jacques S. Gottlieb. Arch. Neur. & Psychiat. 35: 
304, February, 1936. 

7. 7s the Pressor Effect of Glycerin Extract of Adrenal Glands due to Epinephrine? 
R. G. Hoskins and J. S. Gottlieb. Endocrinology, 20: 188, March, 1936. 

8. Physiological Factors in Personality. R. G. Hoskins. Occupations, The Vo- 
cational Guidance Magazine. Sec. 1, May, 1936. 

9. The Blood Pressure-Raising Principle of Adrenal Cortex Extracts. Joseph M. 
Looney and Matthew C. Darnell. Jour. Biol. Chem. Proc. Am. Soc. Biol. 
Chem. 11I^: Ixii, May, 1936. 

10. Endocrine Factors in Behavior. R. G. Hoskins, Ph.D., M.D. Journal-Lancet, 
56: 249, May, 1936. 

11. A Comparative Physiologic, Psychologic, and Psychiatric Study of Polyuria 
and Non-Polyuric Schizophrenic Patients. Francis H. S|leeper, M.D. and E. 
M. Jellinek, M.Ed. Jour. Nerv. & Ment. Dis. 83: 557, May, 1936. 

12. The Experience of the Body-Self in Schizophrenia. Andras Angyal, M.D., 
Ph.D. Arch. Neur. & Psychiat. 35: 1029, May, 1936. 

13. Relationship of the Systolic to the Diastolic Blood Pressure in Schizophrenia: The 
Effect of Environmental Temperature. Jacques S. Gottlieb, M.D. Arch. 
Neur. & Psychiat. 35: 1256, June, 1936. 

14. Measurements of the Consistency of Fasting Oxygen Consumption Rates in 
Schizophrenic Patients and Normal Controls. E. Morton Jellinek. Biometric 
Bulletin, 1 : 15, June, 1936. 

15. The Use of Interaction in the Removal of Correlated Variation. John W. Fertig. 
Biometric Bulletin, 1: 1, June, 1936. 

16. The Relationship of muscle tonus changes to vibratory sensibility. Louis H. 
Cohen and Stanley B. Lindley (in " Psychological Studies of Human Variability 
in Honor of Professor Raymond Dodge, edited by Walter Miles). Psychol. 
Monog. A7: No. 212, 83, 1936. 

17. The way of experiencing as a psychiatric concept. Eugen Kahn and Louis H. 
Cohen. Ibid. Psychol. Monog., ^7: No. 212, 381, 1936. 

18. Phenomena resembling Lilliputian hallucinations in schizophrenia. Andras 
Angyal. Arch. Neur. & Psychiat. 36: 34, July, 1936. 

19. Studies of Motor Function in Schizophrenia. I. Speed of Tapping. David 
Shakow and Paul E. Huston. Jour. Gen. Psychol, i 5; 63, July, 1936. 

20. Speech Perseveration and Astasia-Abasia following Carbon Monoxide Intoxi- 
cation. Louis H. Cohen, M.D. Jour. Neur. & Psychopath. 1 7: 41, July, 1936. 

21. Weight Changes Following the Use of Glycerin Extract of Adrenal Cortex. R. G. 
Hoskins and H. Freeman. Endocrinology. 20: 565, July, 1936. 

22. Some Implicit Common Factors in Diverse Method of Psychotherapy. Saul 
Rosenzweig. Am. Jour. Orthopsychiat. 6: 412, July, 1936. 

23. Pacemakers of Human Brain Waves in Normals and in General Paretics. Hudson 
Hoagland. Am. Jour. Physiol. 116: 604, August, 1936. 



P.D. 47 21 

24. A Method Facilitating the Application of the "Chi Square" Test to Certain 
Problems Arising in Social Psychology. Forrest E. Linder and Margaret V. 
Leary. Jour. Soc. Psycho. 7; 363, August, 1936. 

25. On a Method of Testing the Hypothesis that an Observed Sample of n Variables 
and of Size N ghas been Drawn from a Specified Population of the Same Number 
of Variables. John W. Fertig. Annals of Mathematical Statistics. 7: 113, 
September, 1936. 

26. Psychogenic Factors in the Polyuria of Schizophrenia. Wilbur R. Miller, M.D. 
Jour. Nerv. & Ment. Dis. 8^: 418, October, 1936. 

Psychology Department 
David Shakow, M.A., Director 
A statistical analysis of the work done by the Department during the year reveals 
the following: 

Psychometric and Experimental Studies 

Number 

Individuals of Tests 

House Examined Given 

House Patients 321 1,308 

Schizophrenia Research Patients 147 210 

Out-Patients 

School Clinic 273 309 

Adult Delinquents 14 32 

Other Patients 42 66 

Employees and Other Normal Subjects .... 79 129 



876 2,054 

During the course of the year the following papers were published, accepted or 
prepared for publication: 

A. Published : 

1. Rosenweig, S. Some implicit common factors in diverse methods of psycho- 
therapy. Am. J. Orthopsychiat., July, 1936. 

B. Accepted: 

1. Cohen, L. H. and Patterson, M. Heart-rate reactions to pain stimulation. 
J. Gen. Psychol. 1937. 

2. Rosenzweig, S. Schools of psychology: a complementary pattern. Phil, of 
Sci. January, 1937. 

3. Harris, A. J. and Shakow, D. The clinical significance of measures of scatter 
in the Stanford-Binet. Psychol. Bull. 1937. 

4. Rosenzweig, S. and Shakow, D. Mirror behavior in schizophrenic and normal 
subjects. J. Nerv. and Ment. Dis. 1937. 

5. Rosenzweig, S. The experimental measure of types of reaction to frustration. 
For book to be published by Harvard Psychological Clinic in 1937. 

6. Rosenzweig, S. and Shakow, D. Play technique in schizophrenia and other 
psychoses. I. Rationale. Am. J. Orthopsychiat. January, 1937. 

7. Shakow, D. and Rosenzweig, S. Play technique in schizophrenia and other 
psychoses. II. An experimental study of schizophrenic constructions with play 
material. Am. J. Orthopsychiat. January, 1937. 

C. Prepared: 

1. Wegrocki, H. J. Masochistic motives in the literary and graphic art of Bruno 
Schulz. 

2. Wegrocki, H. J. The ethnological approach to personality: a critique. 

3. Goldman, R. and Shakow, D. The vocabulary of normal subjects. 

4. Radio, G. Competitive and cooperative behavior in schizophrenics. 

5. Altman, C. H. and Shakow, D. A comparison of the performance of matched 
groups of schizophrenic patients, normal subjects and delinquent subjects on 
some aspects of the Stanford-Binet. 

At meetings the following papers were presented by members of the Department: 
American Psychological Association, Hanover, N. H., September 2-5 1936. 
1. D. Shakow — Mental sets in schizophrenia studied in a discrimination re- 
action setting. » 



22 P.D. 47 

2. M. Rickers — The Reaction of schizophrenics to interrupted tasks. 

3. E. Hanfmann — A concept formation test in schizophrenia. 

4. S. Rosenzweig — The preferential repetition of successful and unsuccessful 
activities. 

5. E. Rodnick — A comparison of the development of delayed and twice con- 
ditioned responses. 

Brown University, May 20, 1936 — S. Rosenzweig — Experimental study of 
personality mechanisms. 

American Orthopsychiatric Association, Cleveland, Ohio, February 20, 1936 — 
S. Rosenzweig and D. Shakow — Play technique in schizophrenia. 

Among the new pieces of apparatus developed during the course of the year were 
one for the galvanic skin reflex, a new calibration device for the cardiotachometer, 
and a rebuilding of the chronoscope and auxiliary equipment for reaction-time 
study. 

Plans for the coming year include the continuation of the experiments using play 
technique with schizophrenic patients, continuation of the reaction-time experi- 
ments, further work with devices studying tension release, and further study of the 
adaptive and integrative capacities of the schizophrenic. 

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

The year of 1936 is one of marked expansion in the history of the Medical Library . 
By reorganizing the offices in the Executive Building we were fortunate to obtain 
the use of the former Treasurer's Office adjoining the Medical Library. After 
removing the partition that separated the two rooms, we were able to double the 
floor and shelf space in our library. The new quarters are roomy, well lighted and 
well ventilated and accommodate eighteen readers instead of six, as formerly. In 
addition to this we use the Trustees' Room for a reading room as in other years and 
are now able to accommodate thirty-six readers. All new furnishings are of light 
oak and match the shelves, giving a pleasing impression to the nev/ quarters. 

With the aid of a special appropriation voted by the Legislature last year, we 
were able to remodel the old library annex in the basement and equip it with modern 
fireproof steel shelves. By keeping duplicate, old, and little-used material in the 
basement, we shall have enough shelf room in the main library for years to come. 

Keeping in step with the physical development, the library continued to grow. 
To indicate the various activities, the following items are cited: 

Periodicals. — Although we could not add any new periodicals to our subscription 
list this year, we had all the important magazines at our disposal. We have 106 
periodicals in 1936 as compared with the 115 of the previous year. 

Of this number the hospital subscribes to 92, 2 are paid for by the Memorial 
Foundation for Neuro-Endocrine Research, 3 are donated by Dr. Bryan, 3 by Dr. 
Hoskins, 2 by Dr. Sleeper, 2 by Dr. Looney and 2 come in free from the Federal 
Government. 

Of these periodicals, 4 are in French, 9 in German, 2 in Italian and 91 in English. 

Circulation. — The Medical Library circulated 692 volumes last year. 

Inter-library Loans. — The Librarian maintained contact with other libraries 
and we borrowed 182 volumes from 8 libraries, as follows: 

Boston Medical Library • 122 



New York Academy of Medicine . 

Harvard College Library 

Clark University Library .... 

Smith College Library .... 

Yale University Library .... 

Columbia University Library 

University of Minnesota Library . 

Medical Library Association. — We maintained our membership in 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 



32 

17 
7 
1 
1 
1 
1 



P.D. 47 23 

charge of the postage. In 1936 we received 98 volumes from the Association and 
gave in exchange 64 volumes to 48 medical libraries. 

New Books. — - 88 new volumes have been added to the shelves, some of them to 
the Child Guidance Clinic Library. 

Binding. — ■ We bound 165 volumes during the year including the' ones received 
from the exchange. 

Present State. — On November 30th, 1936, the Medical Library had: 
8,626 bound volumes of periodicals 

99 unbound volumes of periodicals 
1,589 bound volumes of books 

13 unbound volumes of books 
1,033 catalogued reprints and pamphlets 
1,041 old books 
431 lantern slides 



Total 7,832 items 
This is an increase of 1,378 items over the previous year and is accounted for chiefly 
in the classifications "reprints" and "slides". 

Services. — The Librarian continued to circulate the bibliographies and abstracts, 
prepared many special bibliographies and translated about 15 foreign medical 
articles. The bibliographies, abstracts and translations are filed in the Medical 
Library. We now have more than 3,000 classified abstracts and 2 volumes of trans- 
lations. 

W.P.A. Projects. — Three projects submitted by the Medical Library were 
approved by the Federal Government and six stenographers were assigned for the 
work. Projects accepted were recataloguing of books, compilation of a complete 
bibliography on Schizophrenia, and the suupplementing of cur abstract collection 
on Schizophrenia, comprising publications from 1917 to 1932 when our abstract 
service was started. All three projects are practically completed at this date. We 
have recatalogued the books and reprints in the Medical Library, in the Labora- 
tories, and at the Child Guidance Clinic. The bibliography and abstract cards 
are typed and it remains only to classify these under subject headings. After this 
work is done, we shall have a complete file of bibliography and abstracts on the 
subject of "Schizophrenia". 

II. General Library: 

The General Library moved into new quarters in 1936. We were given the use 
of the former Steward's Office, a large, well-lighted and well-ventilated room, 
opposite the Staff Dining Room. Twenty-three new bookcases, 18 Windsor arm 
chairs, 3 settees and a new desk for the Librarian complete the new equipment. 
After last year's general reorganization, when we eliminated all the torn and obso- 
lete books, the shelves look rather empty at the present, but we shall build up the 
Library systematically and hope to fill up the new shelves in the not too remote 
future. From January to August, 1936, Miss Helen M. Gale, a graduate of the 
Simmons College Library School, was in charge of the General Library. Under her 
guidance the Library progressed very satisfactorily. It is hoped that in January, 
1937 an Occupational Therapy student will be assigned to the library to help with 
the routine work and to take the book truck to the closed wards twice a week with 
books for the patients who are unable to come to the Library. 

In 1936, we added 501 volumes to the shelves. 

On November 30, 1936 the General Library had: 

Fiction and Non-Fiction 2,639 



Serials .... 
Reference books . 
Bound magazines . 
Bibles and prayer books 
Stereoscope slides . 



74 
48 
54 
37 
100 



Total 2,952 items 

Forty-eight popular magazines and six daily newspapers are subscribed to by 
the Hospital. 



24 P.D. 47 

In addition to this the Library borrows 150 books every three months from the 
Worcester 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. In addition, 100 books 
are sent every three months from the General Library in the main Hospital, and 
ten popular magazines and newspapers are subscribed to for this Department. 

As in other years, five sub-branches on the closed wards were maintained. The 
Occupational Therapy Department cooperated in the most helpful way by taking 
books and magazines to the patients on these wards. 

The Library is well patronized by patients and employees, the average monthly 
attendance being 1,054 patients and 273 employees. 

During the year the Library circulated 7,117 volumes and had 11,723 reading 
visitors. 

A few churches of Worcester and the Free Public Library sent to us old books 
and magazines regularly. We express our thanks to all who have given books and 
magazines to the Library. 

Chaplain's Department 
Carroll A. Wise, D.D., Chaplain 

During the past year the religious services for the patients have been held 
regularly each Sunday, with a service at the main hospital and one at the Summer 
Street Department. These services have been planned with the needs and problems 
of the mental patient in mind, and the hymnal used is one that was edited especially 
for use in mental hospitals. The sermon, which is always brief, is prepared with a 
background of knowledge of the needs and condition of the patients, and seeks to 
present healthy and constructive religious ideas and attitudes and to stimulate within 
the patients a desire for improvement. Care is taken not to reinforce unhealthy 
religious ideas in patients. The monthly communion service, which was instituted 
in the previous year, has been continued regularly because of the splendid response 
of the patients to this type of service. 

During the year the Chaplain made regular weekly visits to the various wards 
of the hospital, including the wards on the medical services. Special attention was 
given to new patients, and to patients referred by members of the staff. The cooper- 
ation of the nurses in this work has been excellent. In many instances, the Chaplain 
communicated with ministers in the community whom patients requested to see. 

The demand on the Chaplain for talks to groups in the community in regard to 
the work of the hospital was very heavy during the past year, as can be seen by 
the fact that a total of seventy talks were made and a large number referred to 
other members of the hospital organization. These talks were given to various 
types of clubs, church groups, young people's organizations and school groups. 
The subjects included the following: Handling Inner Tensions, Casting Out Devils, 
Religion and Mental Health, Problems of the Pastor, and Problems in Personality 
Development. 

In addition to these talks the Chaplain also conducted a twelve week course for 
local ministers. The course met one morning each week at the hospital, and was 
attended by twelve clergymen. In this course we discussed some of the psycho- 
logical aspects of mental disorder, together with problems involved in the relation 
■of mental hygiene and religion and the work of the pastor. 

During the year the systematic visitation of eight of our women's wards by a 
:group of women representing the Worcester County Federation of Church Women's 
Clubs was continued as in past years under the supervision of the Chaplain. The 
-visits of these women to the wards was greatly enjoyed by many of the patients. 

In cooperation with the Council for the Clinical Training of Theological Students, 
Inc., a group of ten theological students participated in the clinical course for 
theological students during the summer of 1936. These students came from various 
seminaries and represented a number of denominations. The purpose of this 
course is to give theological students a first hand contact with individuals who are 
maladjusted in life, to enable them to study first hand some of the problems of life 
adjustment, to acquaint them with the techniques and aims of the various specialists 
such as the psychiatrist and social worker so that they, as ministers, will be able 
to cooperate intelligently with these specialists in the community, and to study the 



P.D. 47 25 

needs and problems of mental hygiene from the viewpoint of the religious worker. 
In no sense do we try to make these students into psychiatrists, but rather to train 
them so that they may make their contribution as ministers to the solution of the 
problems of life adjustment in their parishes. Further information in regard to 
this work is available to any who are interested. 

In addition to this course, which extends for twelve weeks during the summer, 
the chaplain also gave lectures to other student groups in the hospital, such as the 
social service and occupational therapy students. These lectures dealt with the 
religious problems involved in mental disorder. 

Child Guidance Clinic 
Milton E. Kirkpatrick, M.D., Director 

During the year past, the Child Guidance Clinic has rendered service to 349 
children. This includes much more service than is implied in the total number of 
cases which have been handled. In every case the parents have been interviewed, 
some of them many times and it is often the case that they are in need of much 
more treatment than their children. There has been a reduction in the total 
number of children seen throughout the year due to the large number of cases which 
were closed in 1934-1935 (400) due to changes in the professional staff. It is 
unwise and often impossible to transfer children from social workers and psychia- 
trists who are leaving the Clinic to other staff members who are replacing them. 
The intake is practically the same — 188 cases in 1935 and 182 cases in 1936. 
Many more cases have been carried over into 1937. There are several reasons for 
this, chief among which is the better selection of the material with which we are to 
work. The staff recognizes that treatment techniques have as yet not been devised 
which will be equally applicable to all types of cases. We must frankly face the 
fact that same situations in light of our present knowledge are untreatable and 
that mora research is necessary before these children can be helped. In some cases 
there is little demand on the part of parents; they come to the Clinic in response 
to pressure excited by the school or some social agency. 

Two research projects have been completed. In the closing of cases, we often 
think in terms of the problems presented at the time the child was referred and 
the eventual outcome. "Case Closing: A Retrospective Study in Treatment" 
is an intensive study of 35 cases and it has already been of value to the staff in 
the selection of its material. The second study, "First Interviews as a Guide to 
Treatment" has been of similar value. Retrospective studies of success and failure 
will eventually make possible a more thorough treatment. 

A total of 45 children were referred from the Juvenile Court. A new plan has 
been inaugurated whereby the Juvenile Court Probation Officer has done an in- 
tensive piece of case work with a selected group of boys under the supervision of 
the Chief Social Worker at the Clinic. It has been unnecessary to commit any of 
these boys to a correctional institution. This confirms our opinion that probation 
should be good social case work — no more or less — and that when intelligently 
applied it becomes an extremely useful method of controlling anti-social behavior. 

In community relationships, the Clinic has continued to render service to the 
Oakdale Training School for Boys, the Worcester Girls' Club, the Children's 
Friend Society, and the Associated Charities. The weekly treatment clinics at the 
Shrewsbury and Sterling public schools have been well supported and children who 
otherwise would be more or less neglected have had the advantage of clinic study. 
As soon as this type of school service can be intelligently extended without inter- 
fering with the clinic program, we would like to do so. 

The training of psychiatric social workers for the child guidance field is being 
continued with little change. We have four students in social work sent here for 
field work from Smith College and Simmons College. Members of the staff have 
participated actively in the teaching program at the hospital in courses given for 
nurses and occupational therapy workers. There has been a decrease in the number 
of public lectures given by staff members and this is in keeping with the clinic 
policy of giving this service where it will do the most good. In order that the 
community may have a better understanding of the activities of the Clinic, a 
motion picture, "Just Children", has been filmed and favorably received when- 
ever shown. This picture depicts the child in conflict v/ith his parents, his accep- 



26 



P.D. 47 



tance, study and treatment at the Clinic. It answers a long felt need for a better 
method of acquainting people with the work of the Clinic. 



Annual Service Report 

I. Report of Case Load: 
A. Carried Cases: 

1. Cases carried over from last year 

2. Intake a. New cases accepted 

b. Old cases reopened 

(1) last closed before present year 

(2) last closed within present year 

3. Total cases open at sometime in this year 

4. Cases taken from service 

5. Cases carried forv/ard 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 staflf cases . 

b. Cooperative cases 

c. Full service not a or b 

7. Special service (Advice) 

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. Total cases open at sometime this year 

C. Cases taken from Service: 

13. Full service a. Clinic staff cases . 

b. Cooperative cases 

c. Full service not a or b 

14. Special service (advice) .... 

15. Mental Health Study 

16. Total cases closed during this year 
III. Sources Referring New Accepted Cases: 



IV. 



17. Agencies a. Social . 

b. Medical 

18. Schools, public 

19. Juvenile Court 

20. Private physicians . 

21. Parents, Relatives . 

22. Total new cases accepted 
Summary of Work with or about Patients: 
A. By Psychiatrists: 



Full 

25 

4 

4 

4 
48 

85 



Special 

18 

4 

1 

45 

7 

22 

97 



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 . . 



Total 
159 
182 

7 

1 

349 

31 

318 

49 

4 

10 



87 

95 







182 

149 

129 

29 

42 
349 

19 

12 







31 

Total 

43 

8 

5 

45 

11 

70 

182 



Total 

194 

599 

181 

14 

184 
15 

480 
66 



P.D. 47 27 

C. By Social Workers: 

1. Interviews in Clinic 823 

2. Interviews outside Clinic . 484 

3. Telephone calls 879 

D. Number of Cases given Initial Staff Conference 

1. Full service a. Clinic staff cases 92 

b. Cooperative cases 64 

2. Special service 12 

E. Number of open cases given service during year by workers, approx. 500 

F. Referral Interviews 103 

V. Personnel Report (Average staff during year) 

Full-time Part-time 

A. Regular Staff a. Psychiatrists .... 2 

b. Psychologists .... 2 

c. Social workers .... 2-3 

d. Clerical workers .... 2 1 

B. Staff in Training 

a. Social workers .... 2-4 

VI. Operating Schedule: 

A. Schedule of Clinic days and hours: 9 to 5 daily; 9 to 12 Saturday 

B. Schedule of Attendance of Psychiatrist: 9 to 5 daily; 9 to 12 Saturday 
Educational Services: 

Number of lectures and courses given by Dr. Kirkpatrick, 17; by Miss 
Walton, 6; by Dr. Hill, 3; by Miss Clark, 7. 

Committee Meetings and Conferences Attended by Staff Members: 
Number Month Occasion 

1 February American Orthopsychiatric Meeting, Cleveland, Ohio. 

5 March Psychiatric Round Table. 

1 May American Psychiatric Meeting, St. Louis. 

1 July International Conference of Social Work, London, Eng. 

1 July International School of Social Work, London, Eng. 

1 July-Aug. Smith College School for Social Work. 

Visitors to Clinic — Other than Interested in Individual Patients: 

a. Number from city, 45; b. Number from outside, 24. 
Miss Bertha Reynolds, Smith College School for Social Work. 
Col. Edgar Erickson, Oakdale School. 

Mr. Evsrett Kimball, Smith College School for Social Work. 
Dr. Burham Jones, Clark University. 
Dr. Eugene Walker, Springfield Hospital. 

Dr. George Stenvenson, National Committee for Mental Hygiene. 
Miss Mildred Scoville, National Committee for Mental Hygiene. 
Mrs. Converse, Brookfield, P. T. A. 

The Institutional Freezing of Vegetables 
Oakleigh Jauncey, Head Farmer 

In growing vegetables for a market that demands a frozen product, there must 
exist a relation between acreage planted and the consuming market. 

In the case of institution markets the farm manager must work in close touch 
with the steward. The steward knows what his demands are and it would be folly 
for the farm manager to go ahead and plant crops with no idea of how he is going to 
market them. The steward can give the farm manager a schedule depending on 
when the crops begin to mature, that will enable him to know how much seed to 
order and how many acres to plant. In other words the farm manager knows just 
how much and everything else being equal, just what results he may expect. 

A good steward will have variety in his vegetable menus and will have menus 
containing only vegetables that are palatable. In having a variety, waste is cut 
down to a minimum and this goes also for palatability. 

During the fresh vegetable season the demands on the farm should be spread 
over as long a period as possible. All the beans should not be planted at once 
because when the crop comes into bearing, the market for same would be flooded. 
A series of plantings should be made so that labor for harvesting can be spread out 



28 P.D. 47 

as well as the product and a better utilization of all vegetables by the fresh and 
frozen market will be maintained. This spreading out of plantings also helps the 
labor of weeding. Instead of having weeding all coming in at once it is spread out 
and better work can be accomplished. 

The harvesting of crops in relation to frozen vegetables is very important. Crops 
should be planted so that they all can be picked in their prime, but this, owing to 
so many uncertain conditions, is imposslbe. One must gauge the harvesting 
operations so that the crop if it cannot be picked in its prime, should be started 
before its prime so that a large bearing crop will carry through the before prime, 
prime and just a little past the prime period. This practice renders a pretty fair 
product. 

There must be sufficient labor at hand so that when a crop is ready for harvesting 
it can be handled in as little time as possible. Labor must be able to work in groups, 
the best labor being used in the preparation room where very important work is 
carried on. Work can always be found for the harvesting groups when not picking, 
such as weeding, cleaning and many other tasks about the farm. 

The delivery from the field to the preparation room must be efficient. The de- 
livery system is one of the most important factors in successful frozen products. 

In the preparation room goes on the very important task of processing the 
products. Tiie appearance of the packages depends in a good measure upon the 
work that is done in the preparation room. 

Have labor in this room that is dependable and is interested in turning out a 
good product. Have the preparation room attractive. Whitewash or paint the 
walls, use some colored paint where possible. The addition of plants lends a great 
deal to the pleasantness of the seat of such an important operation. A radio is 
the greatest addition that can be made because it swings all labor into a rhythm of 
surprising production and interest of work that is very gratifying. 

Design working benches that will systematize the work to a degree of high 
efficiency. Bring the work to the workers and not the workers to the work. Have 
a person responsible for all production and this person should be one with a good 
personality and one interested in the work to be done. At times it is necessary to 
work with knives and sharp instruments but no great difficulty has been experienced 
in this method if thought is given to labor. 

The washing, ice baths and packing room are of great importance. Some 
vegetables are washed as they come from the field before being sent to the tables 
for other processes of preparation. As low a temperature as possible in the ice 
baths should be maintained. Just above freezing, if possible, but this is difficult 
to maintain with natural ice. As soon as products are run through the ice baths 
they should be run through the cutting machine or packed as the case may be. 
Great care should be exercised in packing so that the maximum ia packed into the 
boxes. The layers of ice between the vegetables are very important as it is this ice 
that maintains the low temperature en route to the freezing plants, and holds the 
low temperature until the sub-zero temperature in the freezer has done its work. 
As soon as possible, deliver packed products to the freezer and these trips cannot be 
made too often so long as a pay load can be made. 

Pick out a good storage plant with rooms large enough to be assigned to the 
production for freezing. The room for holding and freezing vegetables should be 
clean and well ventilated as poor sanitary conditions and poor ventilation will 
impart foreign tastes to the products and render them useless for food. 

Maintain as low a temperature as possible in the freezer. This is usually about 
12 to 14 degrees below zero in the ordinary plant. These temperatures must be 
steady and not fluctuating as fluctuating temperatures have a very detrimental 
effect on the keeping and physical qualities of the products. 

The cost per unit must be such that economical storage of products can be 
accomplished from one bearing season to another. As the holding time in storage 
progresses, so does the natural market for vegetables and a balance must be main- 
tained between storage and when fresh products arrive in the market again. 

A schedule of drawing products out of storage should be in vogue. Vegetables 
must be withdrawn for palatability and variety. The produce placed in storage 
first should be withdrawn first. The market for storage products should be known 



P.D.. 47 29 

and the withdrawing of products is just a matter of calculation of the demands 
over the storage period. 

Upon withdrawing vegetables from storage, a good system of delivery to the 
point of consumption is as important as delivery into storage. As soon as delivery 
is made, the vegetable should be cooked. Frozen vegetables can be placed in 
boiling water with very little change in cell structure of the vegetable, but if allowed 
to remain to defrost before cooking, with very little exception, the product will 
be injured very greatly by cell structure change. 

Some vegetables can be defrosted before cooking such as peppers and some 
fruits, but they are more the exception than the rule. 

Fruits can be frozen about the same as vegetables. In the freezing of fruits they 
lose much of their sugar content and a simple syrup is added to the packing before 
freezing. All frozen fruits should be packed in liquid tight containers for obvious 
reasons. 

In the successful freezing of vegetables, there are many varieties and types to 
consider, all of which present a special problem for the proper processing due to 
their physical make up. There is the leaf type, which has to be removed from the 
field as soon as possible, so that it will not wilt too much, and upon being received 
at the preparation room, has to go through a series of tap water and ice water baths 
so that they can be made to look fresh, of good color and crisp so that they will 
retain these qualities upon being frozen. 

The solid type of vegetables such as carrots, cabbage, etc., are a cool vegetable 
as they come from the field. The ice water baths play no important part until 
after the vegetables are cut up and are ready to pack. Upon being prepared for 
washing, the cut up vegetables are run through a rinse water and a bath of ice 
water to bring them down to the coldest temperature possible before sending to 
the freezer. 

Semi solid types such as tomatoes and peppers are transported from the field 
as soon as possible, although there is no need for transportation as soon as picked 
because these types do not deteriorate quickly in the field and are simply run 
through the sorting tables and washed with ordinary tap water and packed for 
storage according to quality demanded in the pack. 

The pod type of vegetable is a little more effected by heat in the field than the 
solid or semi solid type. The aim should be for frequent transportation of these 
types of vegetable^ from the hot fields and run through the processing tables at 
once, through the tap water and ice water baths and finally through the machine 
for cutting. The delivery of packed boxes should be as soon as possible so that the 
enzymes in the juices of these vegetables do not get a chance for reaction due to 
high temperatures thus causing a poor product after being taken out of storage for 
cooking. 

Shell type of vegetables are not affected by field heat. As soon as delivered to 
the preparation room, they should have the hard skin removed if they are not tender 
and then cut up as desired and not washed after being cut up as washing has a 
great tendency to remove valuable juices of palatability. All washing should be 
done as the product comss from the field before going to the preparation room. 

All vegetables are packed with layers of ice except the semi-solid type and upon 
being placed in the freezer, allow the cold air to circulate and bring about effective 
freezing. 

In the freezing of vegetables and fruit, there is much to accomplish and it is 
study and painstaking operations that will bring the assurance of satisfactory 
results. In time a great increase of vegetables will be frozen for consumption as; 
it is a matter of delivery and education of the consumers to the value of frozen 
products as compared to canned goods. The color and palatability is certainly 
maintained to a higher degree in most cases than in canning. It is cheaper and less 
loss is suffered from spoilage. The loss in institution freezing over a period of five 
years has been about nothing compared to the hundreds of thousands of pounds 
frozen. 

Presented are the figures showing the amounts of products frozen since 1930 and 
also varieties. 



2.250 


1,825 


2,500 


— 


— 


24.300 


25.657 


26.056 


39.438 


41.916 


— 


7,920 


8,460 


14.340 


11.640 


— 


20,083 


7.920 


20,580 


— 


— 


2.700 


7.640 


6,600 


8.040 


— 


5.415 


10.410 


18,225 


18,760 


— 


— 


— 


24,960 


24,015 


— 


— 


— 


760 


— 


15,900 


41.200 


34.580 


12,380 


— 


— 


— 


— 


200 


— 


2,184 


— 


1.600 


1,600 


— 


3.820 


3.460 


6,620 


4,760 


6.280 


— 


— 


— 


350 


— 


— 


— 


— 


8,190 


5.015 


— 


4,320 


3,820 


4,520 

60 

77,650 


4.880 


46.600 


44,250 


29,850 


17.600 


1.560 


3,149 


385 


1.204 


— 



30 P.D. 47 

Varieties and Pounds of Vegetables Frozen: 

Variety 1930 1931 1932 1933 1934 1935 

Asparagus — 

Beans, string 22,257 

Beet greens — 

Cabbage — 

Celery — 

Chard — 

Carrots — 

Cauliflower — 

Corn 750 

Egg plant — 

Peas 60 

Peppers 11,134 

Kale — 

Spinach — 

Summer squash — 

Broccoli — 

Tomatoes 28.500 

Strawberries — 

Fakm Planting Chart 
Oakleigh Jauncey, Head Farmer 

In most institutions there exists in a large measure, an overproduction and an 
underproduction of farm crops at certain periods during the planting and harvesting 
season. During the overproduction periods the institution is flooded with huge 
masses of vegetables which it cannot possibly hope to utilize with any degree of 
economy. Also at times there is underproduction which results in the necessity of 
going on the open vegetable market and procuring the vegetables which the farm 
is unable to supply. Such practice as mentioned results in large losses financially 
to the Commonwealth. 

In the past few years there has been devised and is in use at the Worcester State 
Hospital a planting chart. This planting chart enables the farm manager to lay 
out a program for planting and harvesting whereby he can supply the hospital 
with fresh vegetables in season and store at farm and freeze in cold storage enough 
vegetables to supply the hospital until the following season's crops are ready for 
bearing and harvest. 

In order to have a planting chart mean anything, the institution steward, chef 
and farm manager should have a conference sufficiently advanced of the planting 
season to determine the amounts of vegetables the hospital needs. This conference 
should be held every year as varieties and types of vegetables change from time to 
time. The planting chart is figured on a weekly basis. The chart is so devised 
that space is given horizontally for fifty-two weeks and vertically for variety of 
vegetables. In the horizontal spaces are inserted in black the estimated figures of 
desired delivery of farm produce by the week, and in red, the figure of actual 
delivery as the crops come into bearing and harvest. 

From the planting chart, the farm manager makes up his seed list and orders 
same in advance of the planting season. Also from the planting chart is taken into 
consideration, the variety of seed that can be used which is best adaptable to the 
soil in question and the amounts of seed required for planting, as the purchase of 
seed above requirements is costly and absolutely unnecessary. In the purchase of 
seed the varieties for maturity at different periods of seasonal planting must be 
considered and this data can all be studied from the planting chart. 

After the requirements for the planting chart are established the farm manager 
plants according to his chart when the proper seasons are at hand. The earlier 
varieties of seeds are planted first and are not all planted at the same time but 
each crop is divided into several plantings for efficient harvesting, weeding and to 
avoid flooding the institution market. 

When the different crops are harvested and sent to the institution the weekly 
amounts are recorded on the planting chart in red in horizontal spaces according 
to weeks as the actual delivery of farm crops. The figures in red must compare 
as near as possible with the estimated delivery of farm crops and will with all 
things being equal and the weather being rather considerate. 

By the use of the planting chart the steward, chef and farm manager know far 
in advance just what vegetables are to be expected and available at any time 



P.D. 47 31 

through the year with an average season. This system eliminates the possibility 
of the farm manager delivering vegetables to the institution that cannot be con- 
sumed and thus wasted. It spreads the planting of all seeds over a period not only 
for efficient harvesting but for efficient weeding of crops. 

The planting chart is very flexible if a freezing program is decided upon, the 
extra purchase of seeds and acres planted can be calcultated with no difficulty and 
will eliminate any guess work. The requirements for the storage of frozen products 
can be determined and allowances made in addition to the regular fresh vegetable 
consumption. 

Steward's Department 
H. W. Smith, Steward 

The department has functioned very satisfactorily during the year 1936. There 
have been very few changes in personnel — none in the key positions except the 
Head Storekeeper, Mr. W. H. Daly, Jr., who was appointed to the Steward's 
position at the Monson State Hospital in December, 1935. 

The maintenance appropriation granted this hospital for 1936 was properly ex- 
pended and recorded, and the closing of the year's business showed no overdrafts. 

The feeding of the patients and employees during the year has not been satis- 
factory. This was due partly to increased prices but more particularly to the 
restrictions of the ration allowance. This ration is heavy on farinaceous food and 
deficient in milk, eggs and fresh fruit. It does not permit the wide variety which is 
essential for a well balanced diet. A careful and thorough study of the nutritional 
problems of the hospital is indicated. The basis of the food service, the ration, 
should be revised in line with modern developments in knowledge of food. The 
cafeteria service and kitchens have run smoothly during the past year, although 
replacement of equipment has not been properly attended to because of lack of 
funds. 

The store room facilities at this hospital are inadequate to care for the needs of 
approximately 3,000 persons. Lack of proper space for the storage of dry goods 
and perishables necessitates the duplication of supply orders at too frequent inter- 
vals. This condition increases the paper work of the hospital considerably and 
causes many other inconveniences. A new store house is badly needed for this 
hospital. 

In the early part of 1935 the entire lot of laundry machinery we are using today 
was disassembled, repaired and put back into service. If this had not been done, 
nearly every piece of it would be in the junk heap today. It was old and anti- 
quated then, and is worse now. During 1936 we put 2,065,389 pounds of dry clothes 
through this laundry and have done this by continually "babying" every piece of 
machinery in the building. In 1937 the new hydrotherapy building will be opened 
and operated which will throw an additional load on this laundry equipment. 
Something will have to be done during 1937 to correct this condition or the 
Worcester State Hospital will be without laundry facilities in the not too distant 
future. 

Report of Some of the Work Accomplished during 1936 
Anton Swenson, Foreman Mechanic 

1. Salisbury 2, walls, ceilings and woodwork repaired and painted. 

2. Appleton 1, walls, ceilings and woodwork repaired and painted. 

3. Folsom 1, walls, ceilings and woodwork repaired and painted. 

4. Howe 1, walls, ceilings and woodwork repaired and painted. 

5. Gage Hall 1, water section, new concrete floor and tile, new plumbing and 
painting. 

6. Lowell Home 1st floor, walls, ceilings and woodwork repaired and painted. 

7. Large portion of doors and windows painted. 

8. New Treasurer's Office and Steward's Office constructed in Sargent Building. 

9. Quimby Building. Wooden floor removed. New concrete floor, new lino- 
leum and new plumbing installed. 

10. Nurses Home. All old plumbing removed and new plumbing installed. 

11. Lincoln 3 and Philip 1. Two new clothing rooms (new shelves and coat 
racks) installed. 



32 P.D. 47 

Engineer's Report 
Warren G. Proctor, Chief Engineer 

The years 1936-1937 will mark the third major change in the power plant at 
this hospital. 

The first power plant occupied a space that is now used as a stock room and was 
installed about 1870. In 1902 the present boiler room was built. This year has 
seen the beginning of a change which is to modernize the equipment and result 
in a more compact installation with greater efficiency of service. 

The present engine room will be taken over for a machine shop and the space 
formerly occupied by the boilers will be used for the turbines and the engine. A 
much larger boiler will be installed in the space made available beside our present 
boilers. 

The new plant will, when complete, consist of two turbines designed to deliver 
300 K. W. each of electricity, and one engine which will deliver 300 K.W. Thus 
there will be available for the hospital 900 K.W., a value three times as great as 
was delivered by the old engines. 

The new boiler will be rated at 500 H.P., which is 150 H.P. greater than any of 
our boilers now in service. The total boiler H.P. will be 1544. 

The current will be changed from direct to alternating which will enable us to 
transmit the power to a greater distance and all of the cottages and the farm 
group will be supplied from our own power plant. 

The refrigeration plant will also be modernized; the use of ammonia will be 
discontinued and an odorless non-poisonous gas will be used for a refrigerant. 

The old square stack installed for the first power plant has been removed and 
' many of the old bricks were used to raise the roof of our present boiler and engine 
room. This stack passed up through the center of our industrial building and oc- 
cupied space which now becomes available for the enlarging of shops and work 
rooms. 

The fuel for boilers has been changed from coal to oil. The old coal pit has been 
divided into four compartments. One contains three 25,000 -gallon tanks for oil 
supply, another provides space for oil pumps and hot water storage tanks. The 
other two compartments are reserved for coal if at an5^ time it should prove to be 
more economical to return to that fuel. 

It is estimated that the larger power units will enable us to furnish power and 
lights with one engine, instead of three, and one boiler, instead of two, a change 
which will materially decrease the yearly consumption of fuel. 

Recommendations 

Recommendations for replacements in the physical plant have been made in 
former years, and it is imperative that some of this be done at a very early date. 
Perhaps our greatest need is a new laundry. In 1933 I submitted a recommendation 
for a program which embraced the construction of a new laundry, conversion of 
the present laundry building into a store house, and renovation of the present straw 
barn into an industrial building. Our present laundry is entirely inadequate, and 
the machinery is so old and antiquated that we live in constant apprehension that 
it will break down and completely paralyze the institution. The destruction of 
clothing, ordinary wear and tear on our clothes and general lowering of morale due 
to irritation on both the part of employee and patient is the inevitable result of a 
condition of this kind. 

The facilities this hospital has for the storage of supplies is costly, inefficient and 
leads to a considerable loss because of spoilage. The present laundry building would 
make an ideal store house, both from the standpoint of location and construction. 
It could be changed to meet the needs with a minimum cost and the second stage 
in this program would be the construction of a store house in the present laundry 
building. 

The hospital is badly in need of a fire alarm system which will notify the em- 
ployees that there is a fire in the building. This hospital is under the protection of 
an organized, efficient city department. Therefore, the business of the hospital 
personnel is to remove the patients from the scene of the fire, and to keep them 
comfortable while the firemen are taking care of the matter of fighting the fire. 
Without an alarm system, it is impossible to adequatley fulfill this function and 



P.D. 47 33 

unless something is done about installing such a system we may have a loss of life 
due to our inability to get our employees to the scene of the fire. 

The Summer Street Department of the hospital cares for five hundred patients. 
The facilities for food service are entirely inadequate and should not be tolerated 
any longer than is necessary to provide funds for improving them. The patients 
are fed. in two basement dining rooms, entirely unsuited for the purpose they are 
used for. If one cafeteria could be installed on the first floor, in the space now 
occupied by the occupational therapy room, and the employees dining room and 
the kitchen placed on the same level it would add .a great deal to the efficiency of 
the food service. 

I again call attention to the need for carrying on a program of floor replacements. 
The floors of the main hospital are old, badly splintered, and it is almost impossible 
to keep them clean and in good condition. They constitute a bad fire risk. If one 
building was renovated each year in a period of ten years the entire building would 
be converted into a sanitary and fire proof structure. This program could be 
carried on with relatively small expense. The Quimby wards have already been 
changed and the improvement is remarkable. 

Renovation of Thayer and Folsom Wards. — These are the medical and surgical 
wards of the hospital, and if they were modernized and proper facilities installed 
for the transportation of patients and service of food, they v/ould be ideal for the 
purpose. Tney permit proper classification of patients and are of easy access for 
administrative purposes, but in their present condition the hospital works under 
a tremendous handicap. There are no means by which the patients may be 
transported from one floor to another except by hand litters. The food service is 
very inadequate, inefficient and wasteful. I recommend that elevators be installed 
in these wards so that the patients may be transported from one floor to the other 
on litters and the same elevators can be used for the transportation of food trucks 
from one floor to another with the diet kitchen in the basement. 

It seems obvious that many of these changes should be made to bring the hospital 
plant up to the point of efficiency and modernize it in every way. This is not only 
desirable from an investment point of view, but it will contribute much to the 
treatment of patients. 

In conclusion, I wish to express my gratitude to the Board of Trustees and the 
officers and employees of the hospital for their constant support and cooperation 
during the year. Board members have been unfailing in their encouragement, and 
I am deeply grateful for this. The officers and employees have v/orked diligently 
and to a common end towards the progress of the hospital, and it is with much 
pleasure that I make this public acknowledgement to both of these groups. 

Respectfully submitted, 

William A. Bryan, 

Superintendent. 

VALUATION 

November 30, 1936 
Real Estate 

Land. 589.16 acres ... $444,570.00 

Buildings and betterments 2,370,652.31 

$2,815,222.31 
Personal Property 

Travel, transportation and office expenses $10,166.74 

Food 16,633.76 

Clothing and materials 26.438.02 

Furnishiings and household supplies 270,630.07 

Medical and general care 58,749.47 

Heat and other plant operation 8,700.82 

Farm 47,268.72 

Garage and grounds 9,546.09 

Repairs 19,016.44 

$467,150.13 
Summary 

Real estate $2,815,222.31 

Personal property 467,150.13 

$3,282,372.44 



34 P.D. 47 

FINANCIAL STATEMENT 

To the Department of Mental Diseases: 

I respectfully submit the following report of the finances of this institution for 

the year ending November 30, 1936. 

Statement of Earnings 

Board of Patients |6S,139.70 

Personal services 245 . 00 

Sales: 

Food $2,225.04 

Clothing and materials 29.84 

Furnishings and household supplies . , 51.48 

Medical and general care 112.91 

Heat and other plant operations 10.50 

Garage and grounds 2.55 • 

Repairs ordinary 93.55 

Farm: (horse, $6; cows, calves and pigs, $1,073.30; hides, $33.57; vegetables 

bags, etc., $19.80) 1,132.67 

Total Sales 3,658.54 

Miscellaneous: 

Interest on bank balances $165.00 

Rents 1,232.92 

Com. on Pay Sta. Telephone 133.80 

Miscellaneous 26.33 

Total miscellaneous 1 ,558 . 05 

Total earnings for the year, November 30, 1936 70,601.29 

Total cash receipts reverting and transferred to the State Treasurer 70,616.79 

Accounts receivable outstanding December 1, 1935 45.00 

Accounts receivable outstanding November 30, 1936 29.50 

Accounts receivable increased $15.50 

Maintenance Appropriation 

Balance from previous year, brought forward $30,508.57 

Appropriation, current year 1,030,215.00 

Total $1,060,723.57 

Expenditures as follows: 

Personal services . . $572,606.26 

Food 168,077.65 

Medical and general care 37,360.72 

Religious instruction . . ... . 2,780.00 

Farm 25,788.77 

Heat and other plant operation 87,530.30 

Travel, transportation and ofifice expenses 9.653.38 

Garage and grounds (garage, $4,743.93; grounds, $1,008.70) . . . 5,752.63 

Clothing and materials , . 15,534.36 

Furnishings and household supplies . 36,061.59 

Repairs ordinary 16,055.06 

Repairs and renewals 15,268 90 

Total maintenance expenditures $992,469.62 

Balance of maintenance appropriation, November 30, 1936 68,253.95 

$1,060,723.57 

Special Appropriations 

Balance December 1, 1935, brought forward $151,872.69 

Appropriations for current year 285,500.00 

Total $437,372.69 

Expended during the year (see statement below) $94,256.06 

Reverting to Treasury of Commonwealth 94,256.06 

Balance November 30, 1936, carried to next year $343,116.63 



P.D. 47 



35 





Project 


Total 


Expended 


Total 


Balance at 


Appropriation 


and Chap. 


Amount 


during 


Expended 


end of 




Acts 


Appropriated 


fiscal year 


to date 


year 


Alterations for fire protection, 












M.S.P.M.-20; PWA D. 6243 . 




$90,000.00 


$819.66 


$89,404.87 


$595.13 


Standpipe M.S.P.M.-39; PWA 












D. 4640 




42,000.00 


4,299.45 


40,966.13 


1,0.33 87 


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












PWA D. 4465 




136,000,00 


8,324.89 


109,705.11 


28,294.89 


Sprinklers and rewiring, M.S.P. 












M.-49; PWA D. 5308 . 




115,138.38 


14,483.68 


113,997.63 


1,140.75 


Hydrotherapy Building. M.S.P. 












M.-50; PWA D. 4657 . 




125,000.00 


34,362.92 


111,582.55 


13,417.45 


Window calking and weather 












strip 


249-1935 


5,000 00 


1 ,605 . 75 


1 ,605 . 75 


3,394.25 


Roof repairs .... 


249-1935 


7,700.00 


7,697.38 


7,697.38 


2.62 


Quimby Ward Building renova- 












tion 


249-1935 


18,000.00 


14,994.55 


14,994.55 


3,005.45 


Mechanical refrigeration . 


249-1935 


14,400.00 


- 


— 


14,400.00 


Porch — Administration build- 












ing 


304-1936 


5,500.00 


.67 


.67 


5.499.33 


Plumbing — Summer St. Hos- 












pital 


304-1936 


10,000.00 


5,682.98 


5,682.98 


4,317.02 


New boilers, stokers, etc. . 


304-1936 


270,000.00 


1,984.13 


1,984.13 


268,015.87 




$840,738.38 


$94,256.06 


$497,621.75 


$343,116.63 



Per Capita 
During the year the average number of patients has been, 2,400.09. 
Total cost of maintenance, $992,469.62. 

Equal to a weekly per capita cost of f52 weeks to year), $7.9521. 
Total receipts for the year, $70,616.79. 
Equal to a weekly per capita of, $.5658. 
Total net cost of Maintenance for year, $921,852.83. 
Net weekly per capita, $7.3863. 

Raspactfully submittad, 
Margaret T. 



STATMENT OF FUNDS 

November 30, 1936 
Canteen Fund 

Balance on hand November 30, 1935 

Receipts 



Crimmins, 

Treasurer. 



$914.33 
18,506.10 



Expended 

Cash on hand November 30, 1936 

Investments 
Worcester Depositors Corp. (Class A Certificate) 

Mechanics National Bank 

Cash on hand November 30, 1936 



$19,420.43 
18,527.63 



$136.00 
565,33 
191.47 



Balance on hand November 30, 1935 

Receipts 

Interest 



Patient's Fund 



$7,867.33 

11,077.91 

165.00 



Expended 

Interest paid to State Treasurer 



10.060.53 
165.00 



$892 . 80 



$892 . 80 



$19,110.24 
$10,225.53 



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

Peoples Savings Bank 

Bay State Savings Bank 

Worcester Depositors Corp. (Class A. cert.) 
Balance Mechanics National Bank 
Cash on hand December 1, 1936 



Investments 



3,884.71 



ROCKEFELLLER RESEARCH PROJECT 

Balance on hand November 30, 1935 

Receipts to November 30, 1936 

Expended to November 30, 1936 

Balance on hand November 30, 1936 

Worcester County Trust Co. . 



$1,000.00 
1,000.00 
1,000.00 
1,500,00 
1,500.00 
85.00 
2.408.67 
391.04 



$1,671.61 
16,291.62 



,884.71 



$17,963.23 
15,462.11 



Balance on hand November 30, 1935 
Income 



Investments 
Clement Fund 



$2,501.12 

$2,501.12 



$1,000.00 
27.50 



Expended 

Balance on hand November 30, 1936 



$1,027.50 
27.50 



$1,000.00 



36 P.D. 47 

Investments 
Worcester County Institution for Savings $1,000.00 

Lewis Fund 

Balance on hand November 30, 1935 $1,331.99 

Income 43.75 

$1,375.74 

Expended 39.77 

Balance on hand November 30, 1936 $1,335.97 

Investments 

Worcester Five Cents Savings Bank $1,300.00 

Balance Mechanics National Bank 35.97 

$1,335.97 

M.4NSON Fund 

Balance on hand November 30, 1935 $1,062.73 

Income 24.36 

$1,087.09 

Investments 

Millbury Savings Bank $1,086.26 

Balance Mechanics National Bank .83 

$1,087.09 

Wheeler Fund 

Balance on hand November 30, 1935 $1,001.92 

Income 27.50 

$1,029.42 

Investments 

Worcester Mechanics Savings Bank $1,000.00 

Balance Mechanics National Bank 29.42 

$1,029.42 

STATISTICAL TABLES 

As Adopted by the American Psychiatric Association Prescribed by 

THE Massachusetts Dbpart.ment of Mental Diseases 

Table 1. General Information 

(Data correct at end of institution year November 30, 1936) 

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 $2,815,222.31 

Personal property 467,150.13 

Total $3,282,372.44 

Total acreage of hospital property owned, 589.16. 
Additional acreage rented, 75. 

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

Actually in Service at Vacancies at End 

at End of Year of Year 

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

Superintendents 1 - 1 - - - 

Assistant physicians 10 - 10 2 - 2 

Clinical assistants - 2 2 - - - 

Total physicians 11 2 13 2 - 2 

Stewards 1 - 1 - - - 

Reiident dentists 1 - 1 - - - 

Pharmacists 1 - 1 - - - 

Graduate nurses 2 71 73 - - - 

Other nurses and attendants .... 124 155 279 5 6 11 

Occupational therapists - 4 4 - 1 1 

Social worker - 4 4 - - — 

All other officers and employees . . . . 144 75 219 9 3 12 

Total officers and employees .... 284 311 595 16 10 26 

Classification by Diagnosis September SO, 1936 
Census of Patient Population at end of year: 

Absent from Hospital 

White: Actually in Hospital but still on Books 

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

Insane 1,133 1,150 2,283 192 228 420 

Mental defectives 1 3 4 - - - 

Alcoholics 1 - 1 - - - 

All other cases 5 3 8 1 7 8 

Total 1,140 1,156 2,296 193 235 428 

Other Races: 

Insane 26 30 56 3 4 7 

Total 26 30 56 3 4 7 

Grand Total 1,166 1,186 2,352 196 239 435 

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

physical training, on date of report 86 149 235 

Other patients employed in general work of hospital on date of report 525 592 1,117 

Average daily number of all patients actually in hospital during year. 1,134.68 1,160.49 2,295.17 

Voluntary patients admitted during year 4 1 5 

Persons given advice or treatment in out-patient clinics during year 240 190 430 



P.D. 47 



37 



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32 



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38 P.D. 47 

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 > 


157 


139 


296 


66 71 56 


66 72 59 


Austria 




2 


— 


2 


1 2 1 


1 


Canada ^ 








19 


31 


50 


37 34 30 


41 42 38 


China 








- 


— 


— 


1 1 1 


_ _ _ 


Denmark 








— 


- 


- 


1 


1 1 1 


England 








5 


3 


8 


10 13 7 


10 7 6 


Finland 








3 


2 


5 


4 5 4 


3 3 3 


France 








— 


2 


2 


1 1 1 


2 3 1 


Germany 








- 


2 


2 


3 - - 


5 4 4 


Greece 








4 


1 


5 


4 4 4 


1 1 1 


Holland 








— 


— 


— 


1 1 1 


_ _ _ 


India 








_ 


1 


1 


_ _ _ 


_ _ _ 


Ireland 








11 


18 


29 


45 43 38 


44 42 40 


Italy . 








12 


6 


18 


17 17 17 


12 12 12 


Norway 








2 


— 


2 


4 2 2 


_ _ _ 


Poland 








5 


5 


10 


8 8 8 


6 6 6 


Portugal 








1 


1 


2 


1 1 1 


2 1 1 


Russia 








2 


2 


4 


3 3 3 


4 4 4 


Scotland 








1 


6 


7 


1 1 


7 9 7 


Sweden 








9 


4 


13 


11 11 11 


8 8 8 


Turkey in Asia 




3 


— 


3 


3^3 


_ _ _ 


Other Countries 




13 


8 


21 


14 15 14 


8 8 8 


Unknown 




- 


2 


2 


14 12 10 


13 9 9 


Total 








249 


233 


482 


249 249 212 


233 233 208 



'Persons born in Hawaii, Porto Rico and the Virgin Islands should be recorded as born in the U. S. 
^Includes Newfoundland. 



P.D. 47 



39 







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' 



40 



Citizens by birth 
Citizens by naturalization 
Aliens .... 

Citizenship unknown 



Table 5. Citizenship of First Admissicns 





P.D. 47 


iicns 






Males 


Females 


Total 


157 


139 


296 


24 


12 


36 


38 


43 


81 


30 


39 


69 



Total 249 233 482 

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



Race 




Total 




With 
syphilitic 
meningo- 
encephalitis 


With 

other 

forms of 

syphilis 


With 

epidemic 

encephalitis 


With 

other 

infectious 

diseases 


Alcoholic 
psychose 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


Africaii (blk) 


2 
4 

1 
1 

1 

24 

4 

35 

1 

4 

5 

52 

18 

4 

1 

14 

10 

3 

4 

53 

8 


4 
3 

15 
3 

28 
3 
1 
6 

55 

12 
5 
1 

10 
8 
5 

58 
16 


6 

7 
1 

1 

1 
39 

7 
63 

4 

5 

11 

107 

30 

9 

2 
24 

8 
15 

3 

4 
111 

24 


- 1 1 


















Bulgarian 






















Dutch and 
Flemish 
English . 
Finnish . 
French . 
German. 
Greek . 
Hebrew 
Irish 
Italian!. 
Lithuanian . 
Portuguese . 
Scandinavian 2 
Scotch . 
Slavonic 3 
Syrian . 
Other specific 












- 1 1 








4-4 








8-8 
- 1 1 


- 1 1 


- - - 


- - - 


4-4 




















1 2 3 
3-3 
- 1 1 
1-1 
1 1 


1 - 1 


- - - 


1 1 2 


16 1 17 
1 - 1 
1 - 1 




















4-4 
















3-3 










1 - 1 
1 4 5 


1 - 1 
1 1 2 








Mixed . 
Race unknown 


1 1 


1 1 


3-3 












Total 


249 


233 


482 


15 11 26 


3 2 5 


1 1 


1 2 3 


36 2 38 



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



Race 


Due to 
drugs, etc. 


Traumatic 
psychoses 


With 
cerebral 
arterio- 
Eolerosis 


With 

other 
disturbances 
of circulation 


With 
convulsive 
disorders 
(epilepsy) 


Senile 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) . 

Armenian 

Bulgarian 

Chinese 

Dutch and Flemish 

English . 

Finnish . 

French , 

German 

Greek 

Hebrew 

Irish 

Italian! 

Lithuanian . 

Portuguese . 

Scandinavian ^ 

Scotch . 

Slavonic ^ 

Syrian 

Other specific races 

Mixed . 

Race unknown 


_ _ _ 


_ _ _ 


1 1 2 

2 2 4 
































- - - 


- - - 


1 - 1 

7 5 12 


_ _ _ 


_ _ _ 


3 2 5 


- 1 1 


1 - 1 


8 7 15 
1 1 
2-2 
2 2 4 
12 10 22 
2 2 4 
1 1 2 


1 - 1 


4-4 


- 1 1 

- 1 1 


1 - 1 


1 1 2 


2 6 8 


- - - 


- - - 


- 1 1 


- - - 


_ : : 


5 2 7 

- 2 2 

- 1 1 
1 - 1 




















- - - 


- - - 


- - - 


_ _ _ 


2-2 


19 10 29 
4 7 11 


1 - 1 


1 - 1 


5 3 8 
1 - 1 


Total . 


1 1 


3 - 3 


67 53 120 


3-3 


6 1 7 


11 14 25 



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

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



P.D. 47 



41 



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







Due to 






With organic 










Involutional 


other 


Due to 


changes of 


Psyche 


- 


Manic- 




psychoses 


metabolic 


new 


growth 


nervous 


neuroses 


depressive 


Race 




diseases, etc. 






system 






psychoses 




M. F. T. 


M. F. T. 


M. 


F. T. 


M. F. T. 


M. F. 


T. 


M. F. T. 


African (black) 












_ 


_ 


_ 


Armenian 


_ _ _ 


— — — 


— 


— - 


1 - 1 


- - 


- 


- - - 


Bulgarian 


_ _ _ 


_ _ _ 


- 


- - 


- - - 


- - 


- 


— - — 


Chinese 


_ _ _ 


- — — 


- 


- - 


— — — 


- — 


— 


1 - 1 


Dutch and Flemish 


_ _ _ 


_ _ _ 


- 


- - 


- — — 


- - 


- 


— - - 


English . 


- 1 1 


_ _ _ 


1 


- 1 


- - - 


1 


1 


3-3 


Finnish . 


_ _ _ 


_ _ _ 


- 


1 1 


— - - 


- - 


- 


- - - 


French . 


- 5 5 


- 1 1 


- 


— - 


- 1 1 


2 1 


3 


4-4 


German 


_ _ _ 


1 - 1 


- 


- — 


- - - 


- - 


— 


- — - 


Greek . 


_ _ _ 


1 1 


- 


— - 


_ _ _ 


— — 


- 


- — - 


Hebrew 


_ _ _ 


_ _ _ 


— 


- - 


_ _ _ 


1 


1 


- 1 1 


Irish 


1 3 4 


1 - 1 


- 


— — 


_ _ _ 


2 1 


3 


4 5 9 


Italian i 


- 2 2 


1 2 3 


_ 


— - 


1 - 1 


1 1 


2 


1 1 2 


Lithuanian 


1 1 


_ _ _ 


1 


- 1 


_ _ _ 


— - 


- 


— - - 


Portuguese . 


_ _ _ 


_ _ _ 


- 


- - 


- - - 


- - 


- 


- - - 


Scandinavian ' 


_ _ _ 


_ _ _ 


- 


— - 


- — - 


1 


1 


- — - 


Scotch . 


1 1 


_ _ _ 


- 


— - 


_ _ _ 


— — 


- 


- - - 


Slavonic ' 


_ _ _ 


- 1 1 


— 


— - 


_ _ _ 


— — 


- 


1 - 1 


Syrian . 


_ _ _ 


_ _ _ 


- 


- - 


_ _ _ 


- - 


- 


- - - 


Other specific races 


_ _ _ 


- - - 


- 


— - 


- — - 


- — 


- 


— - — 


Mixed . 


1 4 5 


2 2 4 


- 


— - 


- 1 1 


1 3 


4 


4 11 15 


Race unknown 


- 1 1 


- 1 1 


- 


- 


- - - 


- 1 


1 


- 3 3 


Total . 


2 18 20 


5 8 13 


2 


1 3 


2 2 4 


8 8 


16 


18 21 39 



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



Race 


Dementia 
praecox 


Paranoia 

and 
paranoid 
conditions 


With 
psychopathic 
personality 


With 

mental 

deficiency 


Undiagnosed 
psychoses 


Without 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) 

Armenian 

Bulgarian 

Chinese 

Dutch and Flemish 

English . 

Finnish . 

French . 

German 

Greek . 

Hebrew 

Irish 

Italian • 

Lithuanian . 

Portuguese . 

Scandinavian ^ 

Scotch . 

Slavonic ' 

Syrian . 

Other specific races 

Mixed . 

Race unknown 


1 1 2 
112 






















- - - 


- - - 


1 - 1 


- - - 


- - - 














6 5 11 
3 2 5 
3 8 11 












1 - 1 
1 3 4 


























2-2 
2 2 4 

7 20 27 

8 2 10 
1 - 1 












- 1 1 
1 1 










- 1 1 


1 1 2 


- - - 


1 1 


1 1 














- - - 




3 7 10 
- 4 4 
5 3 8 

1 - 1 

11 15 26 

1 2 3 


- - - 


- - - 


1 - 1 




1 - 1 
1 - 1 
1 - 1 
1 2 3 










- - - 


1 - 1 


- - - 


- - - 


1 - 1 








- - - 


1 - 1 


- - - 


Total 


55 72 127 


6 8 14 


1 1 2 


4 2 6 


1 - 1 


- 5 5 



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

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



42 P.D. 47 

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 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


With syphilitic meningo- 
encephahtis 

With other forms of syphilis 

With epidemic encephalitis . 

With other infectious diseases 

Alcoholic psychoses 

Due to drugs, etc. 

Traumatic psychoses . 

With cerebral arteriosclerosis 

With other disturbances of 
circulation 

With convulsive disorders 
(epilespy) .... 

Senile psychoses . 

Involutional psychoses 

Due to other metabolic dis- 
eases, etc. 

Due to new growth 

With organic changes of nerv- 
ous system .... 

Psychoneuroses 

Manic-depressive psychoses 

Dementia praecox 

Paranoia and paranoid con- 
ditions .... 

With psychopathic person- 
ality 

With mental deficiency 

Undiagnosed psychoses 

Without psychoses 


15 
3 

1 
36 

3 

67 

3 

6 

11 

2 

5 
2 

2 

8 

18 

55 

6 

1 
4 
1 


11 
2 
1 

2 
2 

1 

53 

1 
14 
18 

8 

1 

2 

8 

21 

72 

8 

1 

2 

5 


26 

5 

1 

3 
38 

1 

3 
120" 

3 

7 


- 1 1 








1 - 1 


- 1 1 

- 1 1 


1-1 














1 - 1 
















_ _ _ 


1 - 1 


1 - 1 


2-2 


20 

13 
3 

4 

16 

39 

127 

14 

2 
6 
1 
5 










_ _ _ 


_ _ _ 


- 3 3 


1 2 3 


- 1 1 
1 - 1 


1 - 1 
4 2 6 


- 1 1 

1 4 5 

14 10 24 


- 1 1 

2 1 3 

1 - 1 

17 9 26 










- - - 


- - - 


- 1 1 


- - - 


_ _ - 


- 1 1 


- - - 


- 2 2 


Total .... 


249 


233 


482 


1 2 3 


7 3 10 


16 21 37 


25 16 41 



P.D. 47 



43 



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



Psychoses 


30-34 

years 


35-39 

years 


40-44 
years 


45-49 
years 


50-54 

years 


55-59 
years 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


With syphilitic 
meningo-enceph- 
alitis . 

With other forms of 
syphilis 

With epidemic en- 
cephalitis . 

With other infec- 
tious diseases . 

Alcoholic psychoses 

Due to drugs, etc. 

Traumatic 
psychoses . 

With cerebral ar- 
teriosclerosis 

With other distur- 
bances of circula- 
tion 

With convulsive 
disorders (epil.) 

Senile psychoses . 

Involutional psy- 
choses 

Due to other meta- 
bolic diseases, etc 

Due to new growth 

With organic 
changes of nerv- 
ous system 

Psychoneuroses . 

Manic-depressive 
psychoses . 

Dementia praecox 

Paranoia and para- 
noid conditions 

With psychopathic 
personality 

With mental de- 
ficiency . 

Undiagnosed psy- 
choses 

Without psychoses 


2-2 


2 2 4 


2 2 4 
1 1 


2 3 5 
- 1 1 


3 1 4 
1 - 1 


3 2 5 










4-4 


4 1 5 


6-6 
- 1 1 

1 - 1 


7-7 


1 - 1 
6-6 


- 1 1 

4-4 


12 3 


1 3 4 
1 - 1 


3 7 10 


- 1 1 


1 - 1 


1 - 1 














- 6 6 

- 1 1 

2-2 

2 2 4 

- 1 1 

3 6 9 

- 1 1 


1 5 6 

1 - 1 

1 - 1 

7 1 8 
3 8 11 

2 3 5 


- 3 3 
1 - 1 

2-2 

1 1 2 

- 2 2 

- 2 2 


- 1 1 

- 2 2 

1 2 3 
7 9 16 

2-2 

2 1 3 


- 1 1 
1 - 1 

1 1 2 

5 7 12 

6 12 18 

- 1 1 


- 1 1 

1 2 3 

- 13 13 

1 - 1 
1 - 1 
1 - 1 


- - - 


1 - 1 


- - - 


- - - 


- 1 1 


- 1 1 














Total 


18 16 34 


20 26 46 


14 24 38 


17 23 40 


29 21 50 


14 18 32 



44 



P.D. 47 



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



Psychoses 



60-64 

years 



M. F. T. 



65-69 

years 



M. F. T. 



70-74 
years 



M. F. 



75-79 
years 



M. F. T. 



80-84 
years 



M. F. T. 



85 years 
and over 



M. F. T. 



With syphilitic meningo- 
encephalitis 

With other forms of 
syphillis 

With epidemic encepha- 
alitis .... 

With other infectious dis 
eases .... 

Alcoholic psychoses 

Due to drugs, etc. 

Traumatic psychoses . 

With cerebral arterio- 
sclerosis 

With other disturbances 
of circulation 

With convulsive disorders 
(epilepsy) . 

Senile psychoses 

Involutional psychoses 

Due to other metabolic 
diseases, etc. 

Due to new growth 

With organic changes of 
nervous system . 

Psychoneuroses 

Manic-depressive psy- 
choses .... 

Dementia praecox 

Paranoia and paranoid 
conditions . 

With psychopathic per- 
sonality 

With mental deficiency . 

Undiagnosed psychoses 

Without psychoses 

Total 



6 9 IS 
1 - 1 



1 1 2 

1 - 1 

20 6 26 



17 15 32 



12 3 15 
1 - 1 



6 6 12 



- 1 1 
-11 



-33 
1 - 1 



2 4 6 



2 5 



1 1 

1 3 4 



14 16 30 



25 10 35 



11 6 17 



2 13 



3 3 6 



P.D. 47 



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P.D. 47 47 
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 

With other forms of 
syphilis. 

With epidemic encepha- 
litis .... 

With other infectious 
diseases 

Alcoholic psychoses 

Due to drugs, etc. . 

Traumatic psychoses 

With cerebral arterio- 
sclerosis .... 

With other disturbances 
of circulation 

With convulsive disorders 
(epilepsy) 

Senile psychoses 

Involutional psychoses . 

Due to other metabolic 
diseases, etc. 

Due to new growth 

With organic changes of 
nervous system . 

Psychoneuroses 

Manic-depressive psy- 
choses .... 

Dementia praecox . 

Paranoia and paranoid 
conditions 

With psychopathic per- 
sonality 

With mental deficiency . 

Undiagnosed psychoses. 

Without psychoses 


15 
3 

1 
36 

3 

67 

3 

6 
11 

2 

5 
2 

2 
8 

18 
55 

6 

1 
4 

1 


11 
2 
1 

2 

2 

1 

S3 

1 

14 
18 

8 
1 

2 
8 

21 

72 

8 

1 
2 

5 


26 

5 

1 

3 

38 

1 

3 

120 

3 

7 
25 
20 

13 
3 

4 
16 

39 

127 

14 

2 
6 

1 
5 


4 2 6 

- 1 1 

9-9 

22 14 36 

1 - 1 

2-2 
4 2 6 

2-2 

1 1 2 

- 4 4 
4 12 16 

1 1 

1 12 

- 3 3 


10 9 19 

3 1 4 

1 1 

1 2 3 

26 1 27 

1 1 

3-3 

42 34 76 

1 - 1 

4 1 5 
7 12 19 

2 18 20 

3 8 11 

1 1 2 

2 2 4 
7 6 13 

17 16 33 
47 59 106 

6 6 12 

1 1 2 

3 1 4 
1 - 1 
- 2 2 


- - - 


1 - 1 

1 1 2 

3 5 8 
1 - I 


- 1 1 

1 - 1 

- 1 1 


1 - 1 

- 1 1 
4-4 

- 1 1 


Total 


249 1 233 


482 


50 41 91 


187 182 369 


1 2 3 


11 8 19 



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

Psychoses 



Psychoses 


Total 




Abstinent 


Temperate 


Intemperate 


Unknown 


M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


With syphilitic meningo- 
encephalitis 

With other forms of 
syphilis. 

With epidemic encepha- 
litis .... 

With other infectious 
diseases 

Alcoholic psychoses 

Due to drugs, etc. . 

Traumatic psychoses 

With cerebral arterio- 
sclerosis 

With other disturbances 
of circulation 

With convulsive disorders 
(epilepsy) 

Senile psychoses 

Involutional psychoses . 

Due to other metabolic 
diseases, etc. 

Due to new growth 

With organic changes of 
nervous system . 

Psychoneuroses 

Manic-depressive psy- 
choses .... 

Dementia praecox . 

Paranoia and paranoid 
conditions 

With psychopathic per- 
sonality 

With mental deficiency 

Undiagnosed psychoses. 

Without psychoses 


15 
3 

1 

36 

3 

67 

3 

6 
11 

2 

5 
2 

2 
8 

18 
55 

6 

1 
4 
1 


11 

2 

1 

2 
2 
1 

53 

1 
14 
18 

8 
1 

2 
8 

21 

72 

8 

1 
2 

S 


26 
5 

1 

3 

38 

1 

3 

120 

3 

7 
25 
20 

13 
3 

4 
16 

39 

127 

14 

2 
6 
1 
5 


5 7 12 

1 - 1 

1 1 

1 1 

18 40 58 
1 - 1 

4 1 5 

5 12 17 

1 12 13 

2 7 9 
1 1 2 

1 2 3 
5 8 13 

2 15 17 
15 55 70 

1 5 6 

1 1 

2 2 4 
1 - 1 
-33 


5 4 9 
2 1 3 


5-5 


- 1 1 


_ _ _ 


1 1 2 
36 2 38 


- 1 1 


1 - 1 

31 6 37 

1 - 1 

4 1 5 

1 4 5 

2 1 3 

1 - 1 
3-3 

11 3 14 

27 14 41 

4 2 6 

1 - 1 
2-2 


2-2 
10 1 11 

1 - 1 

1 1 

1 - 1 

5-5 
10 1 11 

1 - 1 


8 6 14 
2-2 

2 1 3 
1 1 

1 - 1 

-33 

3 2 5 

- 1 1 


- 1 1 


- - - 


- 1 1 


Total 


249 


233 


482 ' 65 173 238 1 96 37 133 


72 6 78 


16 17 33 



48 



P.D. 47 





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2-2 

34 22 56 
4-4 

- 1 1 


H 
O 

< 
X 

u 

(5 




E 


6 1 7 

- 1 1 

1 - 1 
2-2 

- 1 1 
2-2 

10 1 11 

- 1 1 
,1 - 1 


^ o 

< 


E 


9-9 
2-2 

- 1 1 

- 2 2 

3 1 4 
5-5 
3 1 4 
8-8 
15 1 16 

- 1 1 

1 - 1 

12 13 25 
1 - 1 

- 1 1 
1 1 2 


lA 

z 



00 

s 

c 

<; 
< 


•si 


E 


r* N 1 1 1 1 1 ,H 1 ts 1 -nm II 1 1 II O, 1 1 1 111 

-H-<|||||-H llll-H II 1 1 II -4<lll III 
fO -H 1 1 1 1 1 1 1 «S 1 -H-* II 1 1 II lO 1 1 1 III 


c 

Ee 

< 


E 


16 11 27 

1 - 1 

2 2 4 

- 1 1 

- 1 1 
1 - 1 

- 1 1 

- 1 1 
5 1 6 
3-3 
7 1 8 

28 1 29 

- 1 1 
1 - 1 

1 - 1 
2-2 

71 54 125 

4-4 
1 - 1 

3 1 4 
3-3 




en 

b: 
u 

Q 
g 

Q 

i; 

z 

u 




Psychoses Due to or Associated with 

Infection: 

Syphilis of the Central Nervous 
System : 
Meningo-encephalitic type 

(general paresis) 
Meningo-vascular type (cere- 
bral syphilis) 
With intracranial gumma . 
Other types .... 

With epidemic encephalitis 

With acute chorea (Sydenham's) 

With other infectious disease . 

Post-infertiou.s psychoses. 
Psychoses Due to Intoxication: 

Due to Alcohol: 

Pathological intoxication 
Delirium tremens . 
Korsakow's psychosis . 
Acute hallucinosis 
Other types .... 

Due to Drugs or Other Exoge- 
nous Poisons: 

Due to gases .... 
Due to other drugs 
Psychoses Due t > Trauma: 

Traumatic delirium . 

Posttraumatic personality dis- 
orders 

Post-traumatiic Mental deterio- 
ration 

Other types .... 
Psychoses Due to Disturbance of 

Circulation: 

With cerebral arteriosclerosis . 

With cerebral embolism . 

With cardio-renal disease 

Other types .... 
Psychoses Due to Convulsive Dis- 
orders (Epilepsy): 

Epileptic deterioration 

Epileptic clouded states . 

Other epileptic types 



50 



P.D. 47 



o 






05 

CO O 



o 



05 CO 



CO "^ 



Q&Q 



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u 

H 
H 
H 
5) 

> 

o 


•si 


fa 

i 


lllll IIMMIMII lllc< 1 IM MM 

lllll llMMll II IIIM 1 1 1 II 


o 

z 
u 

< 


a 




M 1 1 csM oOMin Micsii lllTti tslto II 
1 1 1 Mcs vOM^ llMii IIIr; eslts II 

M 1 1 MM CSlMMlMll IIIM | |m|| 


z 

o 

H 

< 
-1 

D 

11. 

o 

&- 

H 

z 

w 

B 
in 
H 

ai 


^1 
^6 




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COM 1 1 •* 1 TjtCS llMit MlllO MMl II 
•*I|CS|CSMM|||M| IllfO II 1 II 


c: 
o 




r^ r-< rf rT) \o vo 00 m (S 't fO II M m »* t^ m | | m 1 
ro CS CS M M 

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■*l|M<^O|l0MM00 II MMCSO 1 1 1 Ml 


H 


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^ 1 1 1 M 1 1 1 1 1 1 1 1 1 1 1 1 III II 
1 1 1 1 M 1 1 1 1 1 1 1 1 1 1 1 1 III II 
M 1 1 1 1 III III II till 1 1 1 II 


Q" 
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< 






OOMIOO'* loll llt^Ml M||(«5 1 I 1 II 
MM10M-* c<illllr«5ll IIICS III II 

t^llCSlMll 1|-*M| MllM 1 1 1 II 


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to -a 




MllICSMll llMll IIIM 1 IM II 
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1 1 1 1 1 1 1 1 i 1 1 1 1 1 1 1 1 1 1 M II 


E'e 

< 




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M 1 1 1 CS OOCSCS IICNIM llll WJiM II 
rOlll<N|M(NllMM| IIIM 1 1 1 Ml 


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fa 


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lOMCSMio 0>'0r»; Irovo |M, IIICS Mil II 
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in 

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P.D. 47 



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csesio^ .-I CS ri ^rt 

>OTJ<CS00fOl00<-( l^rtl I CS I CS-HWl ItJ< PO'l" rt -r-n-l 

rt —I ro 

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52 



P.D. 47 



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

and Condition on Discharge 



Psychoses 



Total 



Recovered 



M. F. T. 



Improved 



M. F. T. 



Unimproved 



M. F. T. 



With syphilitic meningo-encephalitis 
With other forms of syphilis 
With other infectious diseases . 
Alcoholic psychoses .... 

Due to drugs, etc 

With cerebral arteriosclerosis . 
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 .... 
Paran ia and paranoid conditions . 
With psychopathic personality 
With mental deficiency 
Without psychoses .... 
Primary behavior disorders 



Total 



155 



17 



14 1 15 

2 13 

1 1 

18 2 20 



1 1 

3 8 

4 14 
16 28 

1 5 

3 2 

4 3 



1 



2 - 



281 52 17 69 



83 93 176 



18 11 29 



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

Discharged during 1936 



Psychoses 



Number 



Average Net 

Hospital Residence 

in Years 



M. 



With syphilitic meningo-encephalitis . 
With other forms of syphilis . 
With other infectious aiseases 
Alcoholic psychoses .... 

Due to drugs, etc 

With cerebral arteriosclerosis. 

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 denciency .... 

Without psychoses 

Primary Dehavior disorders . 

Total 



12 
1 
5 
3 
2 
1 
1 
6 
11 
25 
3 
5 
3 
1 
1 



1 
2 
2 
1 

12 
2 
3 

12 
2 
1 

10 

10 

21 

4 

3 

4 



.40 
2.00 

2.06 

.26 
.29 
.73 

1.60 
.33 
.04 
.29 
.34 
.52 

1.16 

1.33 
.61 

1.06 
.29 
.29 



1.50 
.33 
.41 
.04 
.42 

2.00 
.34 

1.34 
.33 
.20 

.25 

.43 

.47 

3 34 

6.73 
.18 



.40 

1.83 
.33 

1.95 
.04 
.34 

1.43 
.58 

1.40 
.33 
.12 
.29 
.28 
.48 
.84 

2.47 
.61 

3.90 
.20 
.29 



118 90 208 



1.05 



.98 



P.D. 47 



53 



With 
convulsive 
disorders 
(epilepsy) 




1 i 1 1 1 >-> 1 II till 1 1 1 1 1 III III 1 

1 1 1 1 1 II II IIII 1 1 1 1 1 III III 1 


With 

other 
disturbances 
of circulation 




1 1 1 1 1 II II IIII 1 1 1 ^ 1 III 1 1 1 (N 
1 1 1 1 1 II II IIII 1 1 1 i 1 III III 1 
1 1 1 1 1 II II IIII 1 1 1 X 1 III 1 1 1 cs 


With 
cerebral 
arterio- 
sclerosis 




1 - 1 
1 - 1 

1 - 1 

2-2 

2 2 4 

1 - 1 

- 1 1 

3 2 5 

13 12 25 

- I 1 

2-2 
5 5 10 


II 

3 O 
CS >> 

HO. 




1 1 1 1 1 II II 1 1 1 1 'H 1 1 1 1 III III 1 
1 1 1 1 1 II II IIII 1 1 1 1 1 III III 1 
1 1 1 1 1 II II 1 1 1 1 ^ 1 1 1 1 III III 1 


P 




lllllesi II l-ill irtirti ^11 111^ 
1 1 1 1 1 II II IIII 1 1 1 1 1 III III 1 
lllllcsl II l^ll l^l^l ^11 tii^ 


.2 

.^ tusi 
>t3 a 
^aS 

11 




I'Hiii II II ^111 l^lll III III 1 
1 1 1 1 1 II II 'rt 1 1 1 111(1 III III 1 
("Hill II II IIII 1 '^ 1 1 1 III III 1 


With 

other 

forms of 

syphilis 




1 1 1 1 ^ 1 1 II IIII 1 1 1 1 1 >« 1 1 III 1 
1 1 1 1 1 II II IIII 1 1 1 1 i III III 1 
1 1 1 1 iH 1 1 II IIII 1 1 1 1 1 ^ \ i III 1 


With 
syphilitic 
meningo- 
encephalitis 




1 1 1 1 1 II II 1 1 O 1 1 '^ 1 1 1 III III 1 
1 1 1 1 1 II II 1 1 00 1 1 1 1 1 1 III III 1 

1 1 1 1 1 II II 1 1 CN 1 1 >H 1 1 1 III III 1 


<: 

H 

o 


H 




fe 




IS 


I^M^'rtCS ro-H tol liots.,^ rtioliOrt Ol-H lesl fs 

-H cs ^ 


X 
H 
< 

Q 

b 
O 

U 

(A 



< 




Infectiius and Parasitic Diseases: 

Erysipelas 

Lethargic encephalitis (epidemic) . 

Tuberculosisof the respiratory system . 

Disseminated tuberculosis .... 

Syphilis (non-nervous forms) 
Cancer and Other Tum rs: 

Cancer and other malignant tumors 

Tumor (non-cancerous) 

Rheumatic Diseases, Nutritional Diseases, Dis- 
eases 'fthe Endocrine Glands and Other General 

Diseases: 

Diabetes 

Other diseases 

Diseases </ the Nervous System and Organs of 

Special Sense: 

Meningitis 

Cerebral hemorrhage 

General paralysis of the insane 

Other diseases of the ner\ ous system . 
Diseases if the Circulatory System: 

Acute endocarditis 

Diseases of the myocardium .... 

Other diseases of the heart .... 

Arteriosclerosis 

Other diseases of the arteries 
Diseases if the Respiratory SyHem: 

Bronchopneumonia (including capillary 
bronchitis) 

Lobar pneumonia ...... 

Other diseases (tuberculosis excepted) . 
Diseases of the Digestive SyHem: 

Diseases of the buccal cavity and annexa and 
of the pharynx and tonsils (including ade- 
noid vegetations) 

Hernia, intestinal obstruction . 

Cirrhosis of the li\er 

Diseoses rfthe Genit -Urinary System: 

^ Nephritis (acute, chronic and unspecified) . 



54 



P.D. 47 



With 
convulsive 
disorders 
(epilepsy) 




II 1 1 1 1 1 


1 


With 

other 
disturbances 
of circulation 






1 


With 
cerebral 
arterio- 
sclerosis 




1 , . 1 I-. 


•>* 
cs 


II 
3 O 

Ha 




II 1 1 1 1 1 
II 1 1 1 1 1 


1 


.2S 

"o o 

•§■5 




II 1 1 1 1 1 


CO 

1 

00 


u'-S 
.ti vjs 




II 1 1 1 I 1 
II 1 1 1 1 1 




With 

other 

forms of 

syphilis 




II 1 1 1 1 1 
II 1 till 


1 


With 
syphilitic 
meningo- 
encephalitis 




II 1 1 1 1 'H 
II 1 1 1 1 1 
II 1 111^ 


00 




H 


<N« ^ ^rtt^rt 


IT) 


< 


fc 


— •« 1 « 1 vO 1 


i 




i 


^ 1 W 1 -<THrt 


o 


H 
< 
H 
Q 
lit 

o 
Ifl 

M 

» 
u 




Other diseases of the kidneys and ureters 
(puerperal diseases excepted) 
Diseases cf the F-kin and Cellular Tissue: . 
Diseases (f the Bones and Organs cf Lccomction: 

Osteomyelitis 

Vii lertand Accider.tal Deaths: 

Conflagration and accidental burns 

Accidental traumatism 

Other external causes 

Ill-Defined Causes cf Death: .... 


"3 

o 
H 



05 



o 



o 



.tic. a 

> (U <J 

> C« 




1 1 1 1 1 II 1 >< 
1 1 1 1 1 II 1 M 


Paranoia 

and 
paranoid 
conditions 




1 1 1 1 1 II II 
1 1 1 1 1 II It 


II 
i3» 




^ 1 Ort 1 •N 1 II 

^ 1 a 1 1 »H 1 II 


1 > V 

ta S; cj 
•a o. 




1 1 1 1 1 II II 
1 1 1 1 1 II II 
1 1 1 1 1 II 11 


With organic 

changes of 

nervous 

system 




1 1 1 1 1 It II 


Q M 




1 1 1 1 1 1 -< II 
1 1 1 1 1 II II 


Due to 

other 

metabolic 

diseases, etc. 




1 1 <S 1 1 II ^1 

1 1 ^ 1 1 II . •^ I 


1 OJ 

5'(3 o 

O C3j3 
> O o 




1 1 1 1 '^ II II 

1 1 1 1 'X II II 
1 1 1 1 1 II II 


0) m 
go 

a 




1 1 tS 1 1 'Hi II 

1 1 M 1 1 ■^ \ II 
1 1 1 1 1 II II 


-< 
w 
Q 

O 




I^^ ' ' 

» E& 3 21 

1 -1^1111111 •• 

iJlliiiJ 

„ (U OC g -3 .2 s I, ■_ -S r^ £ ^ 

5-E_^ J! J!-H ° O g 1 ^_g j; 

•S>.5-2wa»65S^rt5 

ot-.(ii3— '>.«C33^.**—**^ 

^W^HQwgOHl'S'JO 



P.D. 47 



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56 



P.D. 47 







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P.D. 47 



57 



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P.D. 47 







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P.D. 47 



Table 19. Average Length of Hospital Residence during the Present Admission of 
All First Admissions in Residence on September SO, 1936 



Psychoses 









Average Net 




Mumber 


Hospital Residence 










n Years 




M. 


F. 


T. 


M. 


F. 


T. 


65 


25 


90 


5.36 


5.25 


5.33 


8 


9 


17 


3.10 


4.15 


3.66 


6 


4 


10 


6.16 


8.75 


7.20 


1 


2 


3 


7.50 


3.97 


5.15 


99 


8 


107 


9.39 


8.73 


9.34 


1 


— 


1 


1.50 


— 


1.50 


5 


1 


6 


1.47 


7.50 


2.47 


78 


60 


138 


2.14 


3.66 


2.80 


2 


— 


2 


.97 


— 


.97 


7 


5 


12 


10.55 


6.09 


8.69 


22 


45 


67 


4.03 


4.17 


4.13 


15 


30 


45 


7.16 


5.78 


6.24 


10 


9 


19 


2.68 


2.80 


2.73 


10 


3 


13 


4.69 


3.83 


4.49 


5 


7 


12 


2.88 


7.06 


5.42 


21 


22 


43 


6.00 


4.11 


5.03 


333 


370 


703 


12.96 


11.00 


11.93 


26 


49 


75 


6.30 


8.96 


8.04 


8 


10 


18 


11.12 


12.39 


11.83 


45 


47 


92 


10.81 


10.32 


10.56 


4 


3 


7 


.96 


1.13 


1.03 


771 


709 


1.480 


9.17 


8.74 


8.96 



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 dsturbances 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 dehciency . . . , 
Without psychoses 

Total 



Table 19A. Average Length of Hospital Residence during the Present Admission of 
All Readmissions in Residence on September 30, 1936 



Psychoses 









Average Net 


Number 


Hospital Residence 










n Years 




M. 


F. 


T. 


M. 


F. 


T. 


37 


8 


45 


4.48 


5.98 


4.75 


3 


1 


4 


9.16 


.45 


6.98 


2 


1 


3 


3.00 


4.50 


3.50 


- 


1 


1 


— 


2.50 


2.50 


48 


6 


54 


8.82 


10.83 


9.04 


— 


1 


1 


— 


22.50 


22.50 


2 


_ 


2 


6.00 


— 


6.00 


15 


7 


22 


3.95 


4.62 


4.16 


— 


1 


1 


— 


.45 


.45 


3 


1 


4 


10.83 


17.50 


12.50 


6 


13 


19 


5.66 


5.19 


5.34 


4 


6 


10 


6.00 


14.50 


11.10 


— 


1 


1 


— 


7.50 


7.50 


1 


_ 


1 


.45 


— 


.45 


3 


7 


10 


3.81 


2.20 


2.69 


4 


5 


9 


7.00 


4.89 


5.82 


35 


42 


77 


6.77 


9.18 


8.08 


189 


311 


SOO 


12.12 


10.37 


11.03 


6 


22 


28 


10.83 


8.90 


9.31 


4 


7 


11 


9.48 


3.91 


5.94 


30 


33 


63 


10.95 


9.16 


10.01 


3 


3 


6 


.45 


.45 


.45 


395 


477 


872 


9.58 


9.48 


9.53 



With syphilitic meningo-encephalitis . 
With other forms of syphilis . 
With epiaemic 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. . 
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 dehciency .... 
Without psychoses 

Total 



Table 20. Family Care Statistics for Year Ended September 30, 1936 

Males Females Total 

Remaining in Family Care September 30, 1935 23 80 103 

On Visit from Family Care September 30, 1935 3 23 26 

Admitted to Family Care during the Year 21 84 105 

Whole Number of Cases within the Year 44 164 208 

Discharged from Family Care within the Year: 20 78 98 

Died - 1 1 

Discharged 1 2 3 

Transferred - 1 1 

From i<amily Care to Escape Status - 1 1 

From Family Care to Visit Status 7 37 44 

Returned to Institution 12 36 48 

Returned to Institution from Escape - 1 1 

Returned to Institution from Visit 3 14 17 

Remaining in Family Care September 30, 1936 24 86 110 

On Visit from Family Care September 30, 1936 4 21 25 

Average Daily Number in Family Care during Year: 21.33 83.17 104.50 

Supported by State 18 62 80 

Private 6 24 30