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. ^
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62.ai^5
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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 . 0
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
0
0
0
182
149
129
29
42
349
19
12
0
0
0
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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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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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
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t^ I -OCO CS
<■* Oro -H M I
I W5 IOCS I I I
•rHW>VOT-l-< O\00 I ■* I I
I CSIOCSOO 00lO^»-< I "^
0OCSO0^OO|-*CS rtrtT)<l-H O ^ CSCO-*CS tH»h rtO T-l Olrt
csesio^ .-I CS ri ^rt
>OTJ<CS00fOl00<-( l^rtl I CS I CS-HWl ItJ< PO'l" rt -r-n-l
rt —I ro
COOOvOfOlOl^Ow ^IrOl-H 00 w ICSCOCS rtt~ OQvO | »-i|
O, Ji a) oJ HI o
Er?
OS —
E E
■« '^
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a,a,*s
S25SD
■a a,E
4-> (U^
iicE
S £E-H
^^t
° !r, IS
o
t- ^ y at
-t-j 3>--i ra ---
o >- o. Pis
,-,0 1= So
a-
3 o o
o <u
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
0
<
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
-<
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» E& 3 21
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P.D. 47
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59
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60
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
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