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

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

Public Document No. 23 



QI1|F OIottmumttYFaltii of MuBsntlpxstUB 



ANNUAL REPORT 



OF THE 



TRUSTEES 



Worcester State Hospital 



;a^ 



Year Ending November 30, 
1937 




Publication of this Document approved by the Commission on Administration and Finance 
550. 4- '38. Order 3761. 

i OCCUPATtONAL PRINTING P1.ANT 

DEPARTMENT OF MENTAL D1SBA.SES 
V SAAONER STATE HOSPtTAL 

EAST OARONER, MASS. 






5iHlL lIdIiMiI Ui' MAo^Mu'uOlI Ivi 



"-n. 



WORCESTER sSTAT^ HOSPITAL 

(Post OMce Address: Worcester, Mass.) 

Board op Trustees 
William J. Delahanty, M.D., Chairman, Worcester. 
Anna G. Tatman, Secretary, Worcester. 
John G. Perman, D.M.D., Worcester. 
JosEPHii?E"^.'-I!)^1gsSEtiV^(^rcester;— -' — --^'-^•^■'"m.mtm 
John L. Bianchi, Worcester. 
Robert R. Portle, Worcester. 
Harry Kenney, Boston. 

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

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

Arthur J. Gavigan M.D., Psychiatrist in charge of Women's Dept. 
Frances Cottington, M.D., Assistant. 
James Watson, M.D., Assistant. 

Walter E. Barton, M.D., Psychiatrist in charge of Men's Dept. 
Clifford Halvorsen, M.D., Assistant. 
Maurice Greenhill, M.D., Interne. 
Gregory Rochlin, M.D., Interne. 

Medical and Surgical Service 
Embrie J. BoRKOvic, M.D., Acting Director. 
William Freeman, M.D., Pathologist. 
Joseph De Marco, M.D., Assistant. 
Edward J. Kelley, M.D., Assistant. 
Simon G. Harootian, 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, Executive Officer. 
Harry Freeman, M.D., Internist. 

Louis H. Cohen, Ph.D., M.D., Psychiatrist. 
Andras Angyal, Ph.D., M.D., Psychiatrist. 
Conrad Wall, M.D., Psychiatrist. 
Robert Fuchs, M.D., Internist. 
Louis S. Chase, M.D., Clinical Assistant. 
David Shakow, M. A., Chief Psychologist. 

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

Out-Patient Department 
''MtLioir B^XiSKPATRrcK^jM^p,,; Director, Child Guidance Clinic. 
*jt*Aai,y/oBKASj^ M.D., A^sii^ta'vi. ; •'* 

•■. S^ujMMER Street Department 
Lonnie 0. FARnf^k,:M.T>., Medical Director. 

'■'f*:* '•*»•• : ' • •.*■, • .ViSiTIIfG .ST/.FF 

' ! S RKkES-r: L*.* JHJjjJT, iM,* £> • » Surgery. '^ •. ; : 
Arthur *BRASs'Atr**M.D.VS!iTg'ery.^ ' • 
Franklyn Bousquet, M.D., Surgery. 
Joel M. Melick, M.D., Gynecology and Obstetrics. 
Donald K. McCluskey, M.D., Gynecology and Obstetrics. 
Lester M. Felton, M.B., Genito-Urinary Surgery. 
John O'Meara, M.D., Orthopedic Surgery, Roentgenology. 
Oliver H. Stansfield, M.D., Internal Medicine. 
Erwin C. Miller, M.D., Internal Medicine. 
Michael M. Jordan, M.D., Neurology. 
Jacob Goldwyn, M.D., Neurology. 



P.D. 23 



"362, 2j'^ 



Julius J. Tegelbekg, M.D., Oto-Laryngology. 
RoscoE W. Myers, M.D., Ophthalmology. 
Philip H. Cook, M.D., Roentgenology. 
George A. Dix, M.D., Dermatology. 
Oscar A. Dudley, M.D., Epidemiology. 
Hudson Hoagland, Ph.D., Neurophysiology. 
Melvin a. Clevett, Physical Education. 

Heads op Administrative Departments 
Herbert W. Smith, Steward. 
Margaret T. Crimmins, Treasurer. 
Warren G. Proctor, Engineer. 
Anton Svenson, Foreman Mechanic. 
James Mistark, Head Farmer. 
Lillian G. Carr, Matron. 
Katherine McLean Steele, B.S., R.N., Superintendent of Nurses. 

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

In the management of a mental hospital a Board of Trustees can be of great 
service to the Commonwealth in two ways: 

1. Through frequent consultations with hospital officials and the Department, 
professional and financial policies can be established that will enable the institution 
to function efficiently and at the same time protect the interests of both patients 
and taxpayers. It is our belief that a Board of Trustees should not participate in 
the actual administration of these policies. It is a board responsibility to select a 
competent administrator who has shown executive ability and set up such checks 
and balances as are needed to know that the standards as agreed upon by both 
board and executive are being carried out. Boards should be policy-forming, fact- 
finding agencies. In the day by day operation of the hospital the members find 
themselves in difficulty because they have not been trained in the intricacies of 
institutional management. Executive decisions, when made by a group will 
inevitably be slow, wasteful and cumbersome. 

2. One of the important responsibilities of the trustees is to correctly interpret 
the hospital to the citizens of the community. Such interpretation should be based 
upon an accurate knowledge of the guiding policies of the institution and partic- 
ularly upon a confidence in the ability of the administrator in charge of the organi- 
zation. In spite of the excellent educational work that has been going on in the 
community over a long period of time there is a great deal of misunderstanding 
regarding the purpose and function of the mental hospital. The idea of disgrace 
in connection with mental disease is still the governing factor in establishing the 
mental attitude of many citizens. Fear and apprehension are still present in the 
minds of many people. A Board of Trustees made up of men and women who have 
a certain degree of prestige in the community is a powerful aid in building up public 
confidence. 

Your board wishes to reiterate its belief in the policies of the hospital such as 
are mentioned in previous reports. These policies are: 

1. Active treatment for all patients in the hospital. The idea of the mental 
hospital as a custodial institution dies hard. If the best interests of the public are 
to be considered every mental hospital must be a real treatment center and patients 
must be promptly discharged when they have recovered. This is, in our opinion, 
the way to an eventual decrease in the cost of mental disease. Such treatment 
must include the care of physical disease. It is our belief that the mental hospital 
should be as well-equipped and manned for the treatment of physical illness as the 
best general hospital. 

2. Research is an important part of this hospital and we believe that it is sound 
policy to support it to the limit of our resources. If the efficiency of the institution 
is to be judged on the basis of the number of patients cured and discharged, new 
methods of treatment should be developed as soon as possible. Every effort must 
be made as rapidly as funds will permit to try new avenues of approach to the 
problems of mental disease. 



4 P.D. 23 

3. We feel that the policy of teaching young men and women of the medical and 
allied professions something about the difficulties of this great public health problem 
is proper. The tremendous changes that our country is going through and the 
necessity for the individual to readjust his thinking and emotional life to these 
changes, make it imperative that those who are fitting themselves to minister to 
human beings be famiUar with the rocks on which lives are wrecked. Nowhere 
can this be learned more readily than in work with patients who have failed to 
make satisfactory social adjustments. 

4. We believe it is a proper activity of the hospital to work in the field of pre- 
vention and it seems to be commonsense to say that the favorable time for such 
preventive measures is in childhood. The work of the Child Guidance Clinic shows 
that many children are already laying the ground work for future mental dfficulties 
through bad emotional adjustment and every effort should be made to study and 
help these children before a worse condition develops. 

This is the program and policy of the hospital and your board thoroughly be- 
lieves in its soundness. But to carry it out more than a program is required. 
Finances and personnel are important considerations and the extent to which these 
policies can be carried is limited by the other two factors. The program cannot 
proceed faster than finances will permit and personnel of the quality and number 
to make an advance in the march towards the goal is dependent upon the amount 
of money available. Your board believes that expenditures of money for equip- 
ment and personnel to futher the program of treatment, research, teaching and 
prevention will earn rich dividends for the Commonwealth, not only in decreased 
cost but in increased human happiness among our citizens. The dreadful toll that 
mental disease takes in the community is appalling and it is the firm belief of this 
board that constructive and vigorous measures should be taken to combat it on a 
large scale and along a considerable front. 

The report of the superintendent and other officers of the hospital gives the 
details of work done during the year. We wish to express our satisfaction with 
the general activities of the institution and to register our belief that both officers 
and employees have been diligent and active in carrying out these policies of the 
Board. 

Respectfully submitted, 
William J. Dblahanty, Chairman John L. Bianchi 

Anna C. Tatman Robekt R. Portle 

Josephine Rose Dresser Harry F. Kenney 

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, 1937, it being the one hundred and fifth annual report. 

The annual report of any hospital is an account of the stewardship of those 
charged with the responsibility of rendering certain services to the community and 
expending the money appropriated by the legislature for this service. This report 
is designed to enumerate the professional services carried on for the benefit of those 
who have been committed to our care during the year. It is likewise a record of 
the return to the Commonwealth on the financial investment. 

The practice of judging hospital efficiency on the sole basis of per capita cost 
is misleading. This cost can be cut to a point at which the purpose for which the 
institution was built is defeated. The hospital with the highest per capita cost 
may be getting more for the money expended than the one which is maintained at 
a low rate. It is important in the comparison of hospitals that both quality and 
quantity of professional work be taken into consideration. Admission and dis- 
charge rates are important. The standard of custodial and therapeutic care 
established by the hospital, and the degree of success with which these standards 
are carried out governs the cost. The investment return and to some extent the 
real index of hospital performance must be based on the number of patients returned 
to the community thus relieving the State of the responsibility of further care. It 
is only when these factors are studied in conjunction with per capita cost that con- 
clusions can be drawn regarding hospital efficiency. 



P.D. 23 5 

Mental hospital administration has passed beyond the one-man stage and entered 
into a period of large scale production. Cooperation, in the best sense of that mis- 
used term is essential if these complicated organizations are to function as inte- 
grated machines. The administrator must ever keep in mind the triad of factors 
that motivates every hospital policy. These factors are: Program, finances, 
personnel. These are so interwoven and intermingled that it is impossible to 
consider one to the exclusion of the others. 

There is both a professional and business side to the administration of the mental 
hospital exactly as there is a technical and business aspect to most industrial 
activities. The two viewpoints are not antagonistic but supplementary. Like 
everything in the institution, the finances are a tool for the psychiatric administrator 
to use in the treatment of patients. But he must know something of its possibilities 
and what it can accomplish. He must be the master and not the slave of finances. 

When the professional group in the hospital can grasp the simple fact that they 
could not exist without those who carry on the business activities and the latter 
group realize that the professional work is the only justification for their existence, 
the entire matter of mental hospital administration will be simplified. If each group 
will broaden its viewpoint and take in the entire horizon instead of a small segment, 
the resulting integration would lead to increased efficiency. 

The most important factor in the operation of any organization is the people 
who make up the group. Hospitals are not made of bricks and mortar but of 
human beings, patients and employees. The progress the institution makes in its 
advance towards a given goal is dependent, in a large measure, upon the paid 
personnel. The several aspects of this personnel problem may be outlined briefly 
as follows: 

Number of Personnel. — The present quota of employees in many departments 
of the hospital is inadequate. The ward service is an outstanding example of this 
fact. When vacations, days off and sickness are taken into consideration the 
number actually on ward duty at any given time is entirely too small to permit 
the very highest standard of psychiatric care and treatment. Increased super- 
vision of patients will mean more treatment, fewer accidents, less destruction and 
higher standards of care. 

A recent study made on the medical and surgical service of this hospital shows 
the time devoted to bedside nursing care per patient in twenty-four hours to 
average approximately one hour and twenty-five minutes. The nursing care per 
individual patient on some of the psychiatric wards is as low as nine minutes per 
patient for twenty-four hours. The top is one hour and fifty-one minutes on 
the reception and insulin wards. If the hospital is to maintain what we believe 
the proper standards of psychiatric treatment more personnel is an absolute 
necessity, and to carry on special therapies such as Insulin and Metrazol treatment 
a still further increase in personnel must be forthcoming. 

The number of physicians on the medical staff is inadequate to give the close 
personal supervision to small groups that is essential to good therapy. I am con- 
vinced that there will always be a limit to intense psychotherapy with individual 
patients. The future of psychiatric treatment for psychotics in mental hospitals 
must be built around group therapy. Small groups of individuals must be treated 
by physicians rather than dealing with the individual alone, but there is not a 
sufficiently large medical staff to carry out this procedure properly, and to the point 
where it will give maximum results. I, therefore, make the following recommen- 
dation: 

There are certain special positions that are given to all hospitals regardless of 
size and admission rate. The professional administration of the hospital requires 
a certain number of individuals whose duties prevent them from actively treating 
patients. Their positions are highly specialized and contribute to the patients 
only indirectly and these should not be a part of the general ratio. It is my recom- 
mendation that the following positions be considered exclusive of the quota: 
Superintendent Director of Out-Patient Clinics 

Assistant Superintendent Dentist 

Clinical Director Psychologist 

Director of Laboratory 



6 P.D. 23 

I would suggest the following for establishing a quota of medical officers for the 
hospital: 

1. One physician for each 125 patients admitted yearly. 

2. One physician for each 250 patients in the resident population. 
This would be equally divided between the Senior and Junior physicians. 

What I have said in regard to the ward service is equally true of other depart- 
ments. I call attention particularly to the clerical staff, and the maintenance 
group. As treatment increases and the professional load is added, record keeping 
becomes more complicated, and it adds to the burden of the clerical group. A 
careful study and survey should be made and repeated at frequent intervals to 
determine the proper amount of personnel to handle the clerical side of the adminis- 
tration, both financially and professionally. 

The Summer Street Department of this hosptial is 104 years old. The main 
hospital was completed in 1878. Both are very old buildings and their maintenance 
in a high stage of efficiency becomes increasingly difficult each year. The quota 
of maintenance workmen is entirely insufficient to keep the building up in the way 
it should be to protect the investment of the state. I also recommend that a cost 
accounting system be established with the goal of bringing about a more equitable 
adjustment of the quota of maintenance personnel. 

Some flexibility in regard to number would be a great advantage to the admin- 
istrator in assigning available employees and would concentrate nursing energies 
during peak loads of the day. 

Quality of Personnel. — The selection of ward and other personnel is a part of 
this problem. Well trained and experienced ward nurses and physicians are in- 
dispensible in maintaining high standards of professional care. It is our opinion 
that the nursing personnel should be built around the graduate nurse rather than 
untrained attendants. There are many reasons why this should be so, and there 
will be no dearth of graduate nurses if the field of psychiatry is open to them, and 
if the salaries paid are commensurate with the investment required for special 
training. We need an additional classification for nurses to make the service more 
flexible. The grade required is comparable to that of charge attendant, but being 
a salary one step higher than the latter. Such nurses should be called floor duty 
nurses. This would add a great deal to the present service. 

The problem of building morale and integrating the organization in the direction 
of better care and treatment is always with the administrator. The eight hour day 
has been of inestimable value in this particular regard. It is our belief that eight 
hours is sufficiently long for anyone to spend with psychotic patients and keep up 
a high standard of ward administration. Our experience with this system proves 
to us that it is a forward step in improving the service to the patient. 

As an expedient for gaining improved morale, we have found it preferable to 
handle the disciplinary problems with employees through a group of medical officers 
and supervisors presided over by the Superintendent or Assistant Superintendent 
rather than to charge one person with the responsibility of making a decision which 
penalizes an employee. The employee is protected from the emotional reactions 
and prejudices that are inseparable where these matters are handled by one person. 

Training Personnel. — While higher qualifications required for ward nurses and 
attendants are useful, they do not take the place of actual training in the specific 
problems of the particular hospital where they are employed. We have carried 
on during the year a limited training and educational program for ward personnel. 
We feel that it is deficient in that the employee is not required to fit himself for 
the job before he or she actually goes on duty. It is our opinion that every new 
employee regardless of the department he is employed in should be given a mini- 
mum training period to acquaint him or her with the problems of the particular 
institution, and preferably this training should be given before they take the 
position. Unfortunately, the number of employees allowed does not permit this 
to be done. 

Therapy. — The emphasis upon therapy has more and more permeated the 
organization during the past year. It is my opinion that the mental hospital will 
never attain real prestige in the community until it is organized on the basis of a 
therapeutic approach, rather than upon a policy of mere humane and kindly care. 



P.D. 23 7 

While a high standard of custodial care is the foundation for all psychiatric treat- 
ment, this in itself is not sufficient. Therapy means the difference between a hos- 
pital and the custodial institution. Perhaps the most significant therapeutic 
development has been the work with Insulin and Metrazol in Schizophrenia. There 
can be no question that these methods of treatment have brought about changes in 
the system of individual patients that cannot be explained away as fortuitous in 
character. The hospital has kept in mind constantly the necessity for caution in 
the evaluation of results, and is not prepared, even after a considerable experience, 
in drawing any sweeping conclusions, and only time and careful research work will 
determine the place in psychiatry of these methods of treatment. 

Work has been carried on with the Narcosis treatment, Vitamin B and Photo- 
dyne. No definite conclusions can be given, as they are being scrutinized from the 
research point of view. 

It is not my purpose to elaborate on the individual reports. They show in some 
detail the work of the various departments of the hospital, and a perusal of these 
reports will give a fair indication of the amount that is being carried on. 

Construction Recommendations 
These may be considered seriatim. It is understood that all of these recom- 
mendations cannot be carried out at once. Each recommendation is considered in 
order of importance: 

A. Main Hospital 
/. Laundry Building 
This is the first step in a program of development that will lead to better efficiency 
on the business side of the hospital. The present laundry is entirely inadequate 
for handling the load required in the maintenance of proper standards of patient 
care. It cannot be adapted to present-day needs. It is proposed to erect a new 
laundry building with modern equipment on the site of the present garage. The 
building will be one story but because of the conformation of the land a basement 
is necessary. This will be adequate to care for the garage needs of the institution 
so far as the state owned cars are concerned. The laundry will be planned to take 
care of the future needs of the institution. 

//. Conversion of Present Laundry Building into a Storehouse 
The present storeroom facilities are wasteful and inefficient. The storeroom of 
a hospital is the neck of the bottle through which all materials and supplies should 
be received and issued on requisition. When the facilities are so limited that this 
cannot be done, waste inevitably results. The present laundry building is an ideal 
location for a storeroom. It is the center of the institution, easily accessible from 
all points. With a comparatively small expenditure of money the building can be 
converted into an excellent storeroom with adequate facilities for the proper storage 
of all supplies. 

///. Conversion of the Present Strawbarn into an Industrial Building 
The building located in the rear of the institution known as the "strawbarn" 
is now an adjunct to the storeroom and is used for the storage of heavy materials. 
If and when the storeroom is moved to the present laundry building this material 
will be in the central store. The present second floor of the so called "industrial 
building" will be needed for storage of supplies and the present industrial shops 
will have to be moved. The sewing room must also be relocated. It is proposed to 
renovate the present "strawbarn" and convert it into industrial shops, including 
a sewing room. 

IV. Replacement of Floors 

A program of floor replacement in the Main Hospital is an important part of a 
developmental plan. There are two reasons why this should be done. In the first 
place these old splintered wood floors, soaked with oil and wax are a dangerous 
fire risk. In the second place they increase the difficulty of keeping down vermin 
of all kinds. This program will require at least ten years to complete. Only one 
building can be completed each year. 

Floor replacements will also include certain changes that are essential for the 
proper classification of patients. Dividing the large wards, Washburn, Phillips, 



8 P.D. 23 

Lincoln and Salisbury would enable us to segregate disturbed patients and care for 
them in smaller units. To make this division of wards additional toilet sections 
must be built. 

V. Modernization of Medical and Surgical Service 

A. Improvement of Feeding Facilities. — A complete renovation of the facilities 
for supplying food to the patients on these wards is badly needed. A basement 
diet kitchen on each service will permit a centralization of the food service which 
will tend to lower the cost and increase the efficiency. Trays will be prepared in 
the kitchen and sent to the ward. They will be returned to the diet kitchen to be 
washed and no dishes will be kept on the wards. This will relieve the ward per- 
sonnel of the duty and responsibility of food preparation and permit them to 
utilize the time in other necessary service to the patients. All tray preparation 
and dish washing will be centralized in these diet kitchens. Centralization means 
economy. 

B. Installation of Elevators. — A general hospital of four floors without passenger 
elevators is laboring under a great handicap. Sick patients must be carried up 
and down stairs. A passenger elevator sufficiently large to take a bed should be 
installed in each service. 

C. Surgical Suite. — The number of examinations, special treatments and surgi- 
cal procedures carried on by this hospital calls for a better lay-out than we have 
at the present time. If the present quarters of the Superintendent could be used, 
a modern surgical and diagnostic suite could be established. The space on the 
second floor of the Sargent building now occupied by employees could be utilized 
and an excellent surgical ward for patients would be arranged. 

D. Tubercular Wards. — The facilities for the care of tuberculosis are entirely 
inadequate at this hospital. There are several ways in which this problem can be 
dealt with. A new building is not indicated but changes can be made in the existing 
structure which will improve the present way of caring for these tubercular patients. 

VI. Employee Housing 
If the present policy of employees living in the hospital is to be continued, ad- 
ditional accommodations must be furnished in the very near future. An addition 
of at least 100 beds to the present Nurses' Home is indicated and the present farm- 
house should be converted into a building for physicians and employees. Additional 
cottages for physicians should also be erected at an early date. 

VII. Porches 
Additional porches should be built for the Salisbury, Lincoln, Appleton, Wood- 
ward, Howe and PhilUp wards. The porch on Quinby ward should be demoUshed 
and rebuilt. This will permit additional day space. 

B. Summer Street Department 
The future development of the Summer Street Department should call for 
careful and serious consideration. There are three possible ways in which the 
present institution can be planned. 

1. Continue to use the building for quiet, chronic patients. 

2. Convert it into a receiving service for the main hospital and a psychopathic 

hospital for the City of Worcester. 

3. Convert it into a psychiatric research institute. 

Arguments for and against each of these courses may be made but no matter 
what the future use of the building is to be certain improvements should be made. 

/. Replacement of Floors 
The need for floor replacement is as acute at Summer Street as it is at the Main 
hospital. The building has the same kind of wooden floors. These constitute a 
decided fire risk. 

II. Improved Dining Facilities 
The need of this improvement is more urgent every year. The present method of 
feeding patients is wasteful and results in poor food for those patients who are 
housed there. The present dining room should be used for other purposes and a 
modern cafeteria system installed in the center of the building on the first floor. 



P.D. 23 9 

If the building is to be used for either the second or third purpose, certain other 
changes will have to be made. 

//. Porches 
Porches should be built on the front of the Summer Street buildings to provide 
day space and eliminate the over-crowding in this department. 

C. Farm 
I. Completion of Present Farm Unit, in Order that the Herd may be brought together 

The present farm unit should be completed in order that the herd may be brought 
together. The present separation is expensive and adds to the cost of milk pro- 
duction. This improvement is, of course, based upon the continuation of the policy 
of mental hospitals producing their own milk. This is a question that should re- 
ceive serious and careful study. In my opinion, any utilitarian procedure that 
cannot be defended on the basis of lessened cost or treatment of patients should be 
eliminated from every institution. The herd can only be defended on the basis of 
lower costs. It has little importance in the actual treatment of patients in an 
industrial community like our own. 

The matter of food conservation should receive early consideration and records 
should be installed that will permit an accurate estimate as to whether canning on 
a commercial scale should be continued in the institutions. Other methods of food 
conservation should be given more thought and attention than has been the case 
in the past. A freezing plant for all institutions might be seriously considered. 
Gardening should always be retained because of its value in patient therapy, but 
canning or freezing have no such value and must be judged solely on the basis of 
economy. 

In conclusion may I record my sincere appreciation to the Board of Trustees for 
their continued enthusiastic support. Their aid and counsel has definitely lightened 
my administrative burdens. I also wish to express my thanks for the loyal co- 
operation I have received during the year from the officers and employees of the 
hospital. It is a real pleasure to publicly commend their efforts to improve the 
service rendered by the Worcester State Hospital. 

Staff Changes 

Appointments. — Dr. James Watson — appointed assistant physician, January 
4, 1937, Psychiatric Service; Dr. Beatrice Kershaw — appointed assistant phy- 
sician. April 3, 1937, — Medical Service; Dr. Joseph De Marco Jr., appointed 
assistant physician, September 27, 1937 — Medical Service; Dr. Frances Cotting- 
ton promoted from interne to assistant physician, November 1937; Dr. Edward J. 
Kelley appointed assistant physician — November 8, 1937 — Medical Service. 

Resignations. — Dr. Thomas C. Murray appointed assistant physician December 
19, 1935, resigned December 17, 1936, to continue studies in pediatrics. Dr. 
Beatrice Kershaw resigned September 25, 1937, to teach in Boston. Dr. Benjamin 
Simon, Senior Physician, was given leave of absence for one year to study at 
Queen's Square Hospital in London, September 16, 1937. 

Psychiatric Service 
Morris Yorshis, M.D., Clinical Director 
Movement of Population 
During the year there were 540 first admission patients received — 44 less than 
the previous year but there were 34 more patients readmitted. The total number 
received was 800. The total number discharged was 402; patients discharged as 
recovered, 134; patients discharged from the hospital as improved, 167; patients 
out of the hospital on visit or otherwise absent, 489. 
Diagnosis of the patients admitted: 

General paresis 31 

Suffering from psychosis with cerebral arteriosclerosis or senile de- 
mentia 139 

Dementia praecox 123 

Without psychosis 70 



10 P.D. 23 

Among the discharges: 

General paresis . 17 

Psychosis with cerebral arteriosclerosis 20 

Dementia praecox 106 

Without psychosis 101 

The increase in the number of patients with arteriosclerosis presents a very 
difficult problem since these patients rarely recover — 20 such patients being dis- 
charged from the hospital during the fiscal year. Thus the age of the hospital 
population is definitely increasing, necessitating more personnel and more wards 
to be devoted to debilitated senile patients. The number of patients admitted and 
discharged as without psychosis shows the frequency with which various agencies 
and local hospitals are making use of the hospital as a diagnostic and treatment 
facility. During the year, 27 patients were discharged from family care and placed 
on visit; 4 patients were discharged outright as recovered. There were 108 
patients that remained in family care on September 30, 1937. 

In order to further the opportunities for intensive treatment, the psychiatric 
service was divided into male and female reception units and a continued treat- 
ment service. 

The reception service because of its greater concentration on therapy necessitated 
increasing the ratio of employees to patients. Prior to the segregation of the 
chronic patient from the acute, the ratio on the psychiatric services was one em- 
ployee to twelve patients. Now it is one to eight thus enabling the physicians on 
each acute service to arrange carefully worked out therapeutic programs. 

Insulin and metrazol therapy, sodium amytal narcosis and encephalography are 
all now part of the daily ward work. 

Remodeling of the Quimby building made it possible to include into it a portion 
of the admission ward. This combination unit has provided single rooms for the 
acutely disturbed patients immediately adjacent to the renovated hydrotherapy 
unit. 

During the year the new therapeutic approaches to schizophrenia were instituted 
on the female service. Courses of insulin and metrazol treatment were carried out 
with encouraging results. The use of endocrine preparations in certain patients 
suffering from involutional melancholia was undertaken and the results obtained 
warrant continued employment of this form of treatment. 

During the past year the new hydrotherapy building for female patients was 
opened for use. This event greatly increased our therapeutic facilities and resulted 
in the availability of this form of treatment for a much larger number of patients. 
The utilization of the newest mechanical devices in the various hydrotherapeutic 
procedures reduced to a minimum the factors that were not conducive to optimal 
results. The addition of the new cafeteria for disturbed patients enabled one to 
feed the patients without interrupting the hydrotherapeutic treatment. Even 
the most disturbed patients could, after a period of re-education, conduct them- 
selves at the table in a decorous manner. 

The completion and use of an out-door enclosure for disturbed female patients 
made outdoor exercise available for a greater number. Furthermore the enclosure 
greatly increased the efficiency with which such patients could be cared for. 

Psychotherapy 

Dr. Conrad Wall has continued along the usual lines of psychotherapy, persu- 
asion and symptomatological analysis being the chief weapons of attack. With 
psychoneurotics attention has been devoted to methods of approach. Verbal 
methods were tried entirely with the exception that unfruitful attempts were rnade 
to interest several schizophrenics in finger painting. In general, the indirect 
approach was better, that is, more productive than a direct question and answer 
method. It was found that a fairly good rapport could be obtained with some 
patients who had been non-productive by the usual methods of investigation. 
The conduct of some of these could be changed but there was no evidence that the 
essential psychosis was affected. 

During the latter half of the year some attention was devoted to psychological 
interference with cases under insulin treatment. As a patient approached a stage 
when his contact with the outer world seemed to be increasing, he was interviewed 



P.D. 23 11 

at length one or more times. Attention was devoted to explaining anything which 
was puzzling him and persuading him that his psychotic symptoms, e.g., auditory 
hallucinations, might be coming from him. This seed of doubt as to the source of 
his symptoms having been planted, at a later date direct persuasion was attempted. 
Although the results were not conclusive and could not be separated from the 
effects of the insulin, this procedure seemed to be of definite value. Attempts at 
suggestion while the patient was emerging from a hypoglycemic state were com- 
pletely unsuccessful. Whether the suggestions were related or not related to the 
psychosis made no difference. 

Reckeational Facilities 

The traditional hospital dance was discontinued and in its place a "therapeutic 
dance" substituted. These affairs were usually held on the eve of a holiday. 
Special decorations were planned to fit the occasion. A select group of patients 
were picked by the psychiatrists. 

Improved facilities made possible by the addition of a second motion picture 
projector provided more enjoyment of the weekly pictures with a definite reduction 
of disturbance among patients who have been ill long periods. 

Outdoor recreational opportunities were increased. Concerts on the lawn, a 
new outdoor dance pavillion, a skating rink and soft ball games were some of the 
specific privileges extended to patients under active therapy. 

Continued Treatment Wards 
The continued treatment wards first under the direction of Dr. Benjamin Simon, 
and now headed by Dr. William Holt, is for the first time a separate division of the 
psychiatric service. Most of the patients on this service have been in the hospital 
over one year or are in the senium. Despite this, therapy was instituted at once 
among a group of chronic disturbed patients. Amytal narcosis, metrazol, endocrine 
preparations, have all yielded results, thus making chronic untidy uncooperative 
patients more agreeable, working, and institutionally adjusted. Chemical sedation 
is much less utilized, and seclusion and hydrotherapy can be more carefully pre- 
scribed. In the re-classification of patients, all luetics under active treatment were 
placed on wards nearest to the luetic clinic. 

Family Care and Extra-Mtjral Psychiatry 
The year 1937 saw the provision of a physician to devote his full time to family 
care patients and Out-Patient Department problems. This was most urgently 
needed and hope is expressed that many of the community problems can thus be 
handled — without requiring hospitalization. Dr. James Watson, the physician, 
has recommended the discharge of a few of the patients in family care. By con- 
tacting these patients much oftener than had been possible heretofore he has been 
able to dispose of cases that otherwise would have been allowed to becom.e chronic 
and difficult to discharge ultimately from the hospital. 

Certification in Psychiatry 
This year the hospital executives became certified by the American Board of 
Psychiatry and Neurology. The medical staff is especially grateful to Drs. Leo 
Alexander and Paul Yakovlev, both of whom gave freely of their time instructing 
the staff in neuroanatomy and neuropathology. Dr. Theodore Von Storch contri- 
buted by his illustrative lectures on neuro-roentgenology. All of the senior staff 
made application to take the board examinations in December. 

Staff Luncheons 
For some years it has been the custom to have men from various research centers 
visit the hospital and address the staff on subjects allied to psychiatry. This year 
we were very fortunate in having Dr. Stanley Cobb discuss phases of the cerebral 
circulation. Dr Tracy Putnam reviewed some of the research activities of the 
Neurological Unit at the Boston City Hospital. Dr. Houston Merritt spoke about 
neurosyphihs. Dr. JuHus Loman spoke on "Intracranial Hydrodynamics." 
The above papers, in addition to the added stimulus of the reviews of the liter- 
ature by various staff members at the journal club and the increased knowl- 



12 P.D. 23 

edge disseminated by the instructors in neuroanatomy, neuropathology and neuro- 
roentgenology all helped to raise the level of the staff conferences, which in the 
past year have emphasized "what can we do for the patient." 

With a newly equipped neuro-roentgenological outfit and surgical instruments 
and a consultant neurosurgeon the hospital is in an excellent position to carry out 
remedial measures not available heretofore. 

During the past year a definite quota of students has been established for the 
hospital. In 1937 approximately 60 senior medical students from Tufts College 
Medical School and Boston University School of medicine were in residence, in 
addition to the other students in disciplines allied to psychiatry. 

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

With the increased emphasis on therapy at the Worcester State Hospital, the 
problems involving the nursing care of these patients have increased. 

In the early months of 1937, it became necessary to go over the ratio of personnel 
to patients on the different services and redistribute some of the personnel in order 
to have the highest quota on the services where the most treatment was done. 

For the medical and surgical service, the ratio established at this time was one 
employee to four patients. On the research service, where insulin and metrazol 
treatment of schizophrenics has become a part of the routine, the quota is one 
employee to 4.5 patients. On the acute psychatric service, which includes the 
admission wards, the wards for the acutely disturbed newly admitted patients and 
the treatment wards, the ratio established was one employee to nine patients. The 
continued treatment service and the Summer Street Department, where the more 
chronic cases are placed, have a ratio of one employee to thirteen patients. These 
ratios were figured, of course, on the number of positions now assigned to the 
nursing service and the personnel quota is far too low to give adequate nursing 
care to any of these groups of patients. The ratio on the medical and surgical 
service and research, we believe, should be one to three; on the acute psychiatric, 
one to six; and on the continued treatment service, one to ten. This would mean 
a coverage of the wards during vacations and sickness and would make available 
a concentration of nursing personnel during emergency situations. At present, 
the coverage of the wards is adequate only when all personnel is on duty. Every 
employee has one day off each week which means that one-seventh of all em- 
ployees are off each day. Vacation of two weeks is granted each employee during 
the year. These vacations are distributed as evenly as possible throughout the 
year. Approximately fourteen employees are on vacation at one time. Illness 
varies with the season, two to ten employees being sick at one time. Thus, at a 
glance, it is obvious that the number on duty every day is much less than 382, the 
total nursing payroll. 

The type of personnel necessary is another important consideration. The 
graduate nurse personnel has been concentrated on the research, medical and acute 
psychiatric services with about twice as many nurses on these services as on the 
continued treatment services and the increase necessary is entirely for graduate 
nurses' position, not for attendant positions because the therapy used is demanding 
more expert nursing skill and knowledge. 

The patients being treated with insulin and metrazol must be most carefully 
watched during treatment and it is essential for nurses to be trained in these 
techniques and the observations of the reactions of these patients. 

The rating of head nurses and charge attendants has continued to be a very useful 
and fair method of summarizing a nurse's ability and usefulness. These individual 
rating slips are given to the physician in charge of the service, the supervisors on 
the service, and anyone else who has immediate supervision and knowledge of the 
person's work. This group of individuals, with the superintendent of the hospital 
and the superintendent of nurses, evaluate the individual ratings with comments. 
The person rated is then shown the result with suggestions as to how she can im- 
prove her work and efficiency. The system is invaluable to the administration when 
promotions are to be considered. As a rule, an individual is rated automatically 
every six months, but a special rating may be held at any time for consideration 
of promotion or unsatisfactory work. This relieves any one person of the entire 



P.D. 23 13 

responsibility for an employee's standing and gives the employee a feeling that 
his rating is not due to judgment of one or two people. 

When mistakes of a serious nature are made by ward personnel, statements by 
those concerned are submitted to the nursing office. A conference is then held 
of the same group that rates the individual. The persons under criticism are given 
an opportunity to present their side of the story. The decision as to handling the 
case and the punishment is made by the majority of the group in conference. 

The ward therapy charts continue to be valuable in maintaining the standard 
of nursing care at a high level. It is a method for checking the number of bed 
baths, shavesj hair cuts, entertainments, recreation and occupation given the 
patients each day of the month and is summarized and criticized by the physician 
in charge of the service, the supervisor and the administration. 

Nursing Education 

Miss Evelyn Pettee, a graduate of Peter Bent Brigham Hospital, who received 
her B. S. in nursing, June, 1937, at Teachers College, Columbia University, and 
who has been a member of the nursing staff for several years, is the present Edu- 
cational Director. 

Worcester Hahnemann Hospital, Memorial, and St. Vincent's Hospitals have 
continued to send 7 of their students to us every three months for psychiatric 
affiliation, 28 students being taught during the year. The lecture course was given 
to the large group of nurses from these hospitals for whom a psychiatric affiliation 
could not be provided. 
Curriculum for Affiliates: 

Therapeutic Approaches 

Hours Hours Hours 

Psychiatry . . .20 Hydrotherapy . 8 Music — radio . . 2 

Psychiatric nursing . 23 Occupational therapy . 3 Psychotherapy . 1 

Ward Clinics . 20 Social service 4 Recreational . 4 

Four staff conferences; and excursions to the State School for Feeble-minded, 
the Child Guidance Clinic, and the Worcester Court. 

There have been a number of requests for affiliation from general hospitals this 
year which could not be granted because of inadequate housing facilities and due 
to the student quota permitted by the Department of Mental Diseases. 

Five post-graduate nurses were graduated in May, 1937, All of these nurses 
have continued in psychiatric nursing, one in a private mental hospital in New 
York State, two at this hospital and two returned to their native country, Panama, 
to assist in conducting a hospital for mental patients there. Four students were 
enrolled in the class of 1937. We feel that as these nurses have all stayed in psy- 
chiatric work, the course is Vt^ell worthwhile and pays for itself in improved care 
of mental patients. 
Curriculum for Post-Graduates: 

Hours Hours 

Psychiatry 30 Psychiatric Nursing ... 30 

Dynamic Psychology of Behavior 15 Development Behavior of Children 5 

Sociology 15 Ward Clinics 40 

Neuro-Anatomy .... 10 Therapeutic Approaches . . 61 
Endocrinology .... 5 
Sixty Staff Conferences. 

This includes occupational therapy, recreational therapy, physiotherapy, re- 
ligion, music and radio. 

Visitations: 

State School for Feebleminded Lancaster School 

Child Guidance Clinic Baldwinsville Hospital Cottages for Children 

Worcester Court Florence Crittendon Home 

Lyman School Norwood School Project. 

Miss Margaret Diamond has continued to instruct all attendants and new em- 
ployees in the hospital routine and the essentials of the care of mental patients. 



14 

Curriculum for Attendants: 



P.D. 23 





Ho 


urs 




Hours 


Orientation Series 




6 


Practical Nursing . 


. . 16 


Laboratory . . . . 




1 


Hospital Routine . 


4 


Hospital Housekeeping 




2 


Hydrotherapy 


4 


Routine Reports 




1 


0. T 


2 


Total .... 








. 36 



Occupational Therapy Department 
Dorothea W. Cooke, 0. T. Reg. Director 

For the past year the occupational therapy department has devoted all its 
abilities toward the further development of a program that will provide therapeutic 
activity for the greatest number of patients. Realizing that the present ratio of 
occupational therapists to patients makes individual treatment impossible for more 
than a small percentage of the total patient population, we have aimed at a more 
comprehensive program whereby the trained registered occupational therapist 
shall direct others in the carrying on of a daily therapeutic program for all patients. 

The occupational therapy department is responsible for the supervision of the 
three following services, directly and indirectly: 

I. Nurses' Ward Classes 

This is the first indirect service under the direction of occupational therapy. 

The department is responsible for a supply room, which is open three times a 
week at regular hours for the nurse to obtain craft articles, materials, patterns, 
instructions, and advice for projects to be carried out on the ward under her super- 
vision. This type of occupational activity has been started for the senile, the 
infirm, the disturbed, and all patients who are unable to adjust to industrial or 
work therapy, due to physical and mental contra-indications. The policy of this 
hospital states that the psychiatric nurse has a very distinct and definite respon- 
sibility in any program of occupation designed as a treatment measure. Ward 
housekeeping and the simpler handicrafts are all introductory types of work that 
serve to prepare the patient for the next step in his or her rehabilitation, namely, 
industrial therapy. 

It is the responsibility of the occupational therapist to guide, to stimulate, and 
to assist the nurse through teaching and suggestions of various kinds of activity 
best suited to the patient, but the therapist's efforts during this period should be 
directed, not towards the patient (except indirectly) but towards the nurse herself, 
in order to obtain the best and most effective results for the greatest number of 
patients. 

II. Pre-Industrial Shops for Men amd Women 
These shops are located on each service and are directly supervised by a registered 
graduate therapist. 

1. Male Shop. — Classes are pre-industrial in nature for the physically hand- 
capped patient who has progressed beyond the nurse's ward class. We find as a 
rule that male patients adjust to industrial placement without a period of orienta- 
tion in the shop. 

2. Female Shop. — There are two types of classes in this shop. 

{1 ) Morning Class. — For further re-education and habit training of the con- 
tinued-treatment patient who has progressed in the nurse's ward class to a point 
where she is potentially a candidate for hospital industry. 

{2) Afternoon Class. — For orientation and determination of the therapeutic 
needs of the newly admitted patient. We have found that some sort of work, how- 
ever limited in the beginning, makes it easier for the newly admitted patient to 
adjust to the new circumstances of Uving in the hospital. A summary of the 
patient's occupational, avocational, and educational hsitory with her aptitudes, 
interests, and capabilities is presented by the therapist to the senior physician at 
a weekly clinic for consideration of an occupational program. The ultimate aim is 
a therapeutic placement in industry as soon as possible, in an endeavor to restore 
the patient to economic and social adequacy. 



P.D. 23 



15 



III. Industrial Therapy 

This is the therapeutic use of hospital maintenance industries for the benefit of 
the patient through work activities. It does not indicate just any work in contrast 
to idleness, but work prescribed by the physician for its physical demands, its 
emotional effects, its social influences, its mental stimulus, and its integrating power 
in relation to the individual patient. 

We consider industrial or work therapy an indirect service which necessitates 
the following responsibilites of the occupational therapist: 

1. The therapist shall introduce the patient to the job, following the physician's 
industral assignment based on the patient's needs. 

2. The therapist shall guide, stimulate, and instruct employees who are directing 
the work of the patient in the hospital maintenance industries. 

3. The therapist shall act as a liaison between the physician and the industrial 
supervisor, interpreting the physician's therapeutic aims in adapting a patient to 
a particular task, so that the employee's supervision shall be intelligent and thera- 
peutic and his knowledge of the characteristics and peculiarities of the patient 
shall be thorough. 

During the past year patients have been placed in the various services as follows: 

Female Psychiatric Treatment Service {Main Hospital) 
Industrial Office: Monthly Average 

Total industrial placements by prescription 109.7 

Adjustments and promotions 90.8 

Promotions from pre-industrial shop 18.9 

Patient Census: 

Total Patient population 372.8 

Patients in industry 268.8 

Patients in pre-industrial shop . 32.9 

Patients occupied in nurses' ward classes as able 71.1 

Male Psychiatric Treatment and Research Service (Main Hospital) 

Industrial Office: 

Total adjustments by prescription 101.3 

Adjustments and promotions 71.1 

Placements of newly admtted patients directly in industry 24.9 

Promotions from pre-industrial shop 5.3 

Patient Census: 

Total patient population 319.5 

Patients in industry 264.0 

Patients in pre-industrial shop 200 

Patients occupied on ward as able 35.5 

Female Continued Treatment Service {Main Hospital) 

Total industrial placements by prescription 39.4 

Patient Census: 

Total Patient population 

Patients in industry 

Patients in pre-industrial shop 

Patients occupied in nurses' ward class as able 



Male Continued Treatment Service {Main Hospital) 

Total industrial placements by prescription 

Patient Census: 

Total Patient population 

Patients in industry 

Patients occupied in ward classes as able 

Summary {Main Hospital) 



Total monthly average number of patients in hospital 
Total monthly average per cent of patients in pre-industrial 

shop 

Total monthly average per cent of patients in industry 



Female 
861.5 

3.8% 
55.5% 



. 367.7 

. 210.0 

14.4 

. 143.3 

52.5 

. 470.1 

. 390.0 

80.1 

Male 
895.4 

2.23% 
73.04% 



16 P.D. 23 

For the remaining patient population, ward classes on the medical and psychiatric 
services were conducted by nurses, under the supervision of the Occupational 
Therapy Department. The number of patients varied, as was to be expected, due 
to the physical and mental condition of the patient. 

We are fully cognizant of the fact that a well-balanced program of occupational 
therapy should have organized recreational activity. We are looking forward to 
the time when a well-trained experienced recreational director will be a member of 
our department. Until such a time recreation on the wards is limited to the nurses' 
initiative and ablity to promote ward parties, simple table games, pool, ping pong, 
and marching. Community recreational activity is the responsibility of occupa- 
tional therapy and this past year included dances, community singing, holiday 
celebrations, and all social activity for the general patient population. 

Social Service Department 
Barbara Estes, M.A., Chief Social Worker 

At the time of our last annual report the Social Service Department had on a 
temporary basis Mrs. Adriene Wise to work with Miss Harrington on Family Care. 
Many applications were investigated during the six months period from September 
21, 1936, to April, 1937, in an attempt to find more boarding homes, thus enabling 
us to place more patients on this basis. It was found that because of the rise in 
food prices, it was extremely difficult to find families willing to accept patients for 
the $4.50 per week paid by the State for boarding patients. Several homes were 
found which would take patients at $7 per week and up, but for the same economic 
reason, few of our families felt themselves able to pay even that sum for their 
relatives. Consequently, we were unable to place the number of patients deemed 
essential for the maintenance of two workers on family care and when her second 
appointment of three months was concluded Mrs. Wise was not reappointed. We 
feel that it is impossible for one worker to supervise over a hundred patients 
scattered over such a large area, and in addition, to have the burden of finding and 
investigating new boarding homes. 

Our routine work has progressed smoothly during the year. Statistics include 
the following: 

Histories taken .... 407 Patients placed in Family Care . 82 
Investigations made . . 905 Patients status changed from 

Interviews held . . . 3,175 family care to visit ... 24 

As in previous years, certain cases have been selected by the staff for intensive 
follow-up work by the Social Service Department. Many of these have involved 
close cooperation with outside agencies to whom we wish to express our sincere 
appreciation for their insight and aid. 

Educational Work 

We have had, as usual, during the past year, social service students, three from 
Smith College and two from Simmons College, Schools of Social Work. They carry 
on well their share of the work of the department and are of value to the permanent 
workers as they serve to keep us acquainted with the latest theories and trends in 
the field of social work as taught by their respective schools. 

Our part in the training program of the hospital has continued with lectures to 
medical students and nurses, as well as the special program arranged for our own 
students. Lectures have been given by the different workers in the department to 
clubs or other interested groups outside the hospital. We welcome always the 
opportunity to explain the role of the social worker in a mental hospital. Two 
workers attended the conference for supervisors at Smith College in July, while 
the State Conference of Social Work, held in Boston in November, was attended 
by all members of the department. 

Several projects in research have been suggested to us by other departments, 
which would be of value to both services. With our present staff of four paid 
workers, we are unable to carry on efficiently anything more than the essential 
routine work. We believe that two additional paid workers, one to be assigned to 
family care, would enable us to cooperate more fully with other departments in 
the hospital and would increase markedly the efficiency of our service. 



P.D. 23 ■ 17 

Radio Department 
Wallace F. Searle, Director. 
Routine Activites 
After seven years of experimentation and careful study we have found that the 
radio system does definitely contribute to the happiness and health of patients. Be- 
cause of this fact we make an effort to run the "station" along commercial lines 
with as careful attention to details as would be paid in any network station. An in- 
creasing effort has been made to increase the responsibility of patients working in 
the department giving them every opportunity to manifest new thought, new 
ideas, initiative, and originality. 

The activities of the radio director can be divided into the following items: 

1. Teaching newly assigned patients to operate and announce over the radio. 

2. Operating and announcing when patients are ill or discharged until another 
patient is assigned. Sometimes this is for a period of weeks for only a certain type 
of patient can be assigned to the department. 

3. Minor repairs and trouble finding on the radio system. This includes relay 
troubles, "shorts", loose connections and trouble that is not of a highly technical 
nature. 

4. It is the business of the radio director to announce all important programmes 
such as staff members, local talent from Worcester, W.P.A. bands etc. 

5. When either patients, employees, or outside talent perform over W.S.H., it 
is necessary for the radio director to rehearse their program, accompaning them on 
the piano if necessary, taking microphone tests and playing and announcing the 
feature when broadcast. 

6. Several features a year are presented over the radio by the Director including 
daily news bulletins, and reading of papers prepared by staff members. Both 
piano and organ recital series have also been presented. 

7. During the year many lectures and talks have been given by the radio director 
to outside groups including clubs, church groups, study groups, etc. A series of 
lectures is also given to different nursing groups and to the occupational therapy 
department. 

8. The musical end of church services is under supervision of the Radio Director 
who also presides at the organ at the main hospital and "fills in" at the Summer 
Street branch when necessary. 

9. Several community sings throughout the year are conducted in the chapel 
for patients. 

10. All activities in the chapel are indirectly under the supervision of the radio 
department. 

11. All typing of records, reports, indices, requisitions, orders, notes, programs, 
etc. are done by the director. 

New Features 

After having written to all state hospitals in the country requesting them to 
fill out a questionaire relative to music and radio in their institution it was necessary 
to compile the information we received. This information is so complete that we 
know practically how many loud speakers there are in every state hospital; how 
many hours a day they operate; if they have a centralized installation; if they 
use the radio for therapeutic purposes; the cost of their equipment. It is an in- 
teresting fact that one State Hospital allows their most musical patients to go down 
once a month to the local broadcasting station and put on a program. It is not 
hard to imagine the amazement of the public upon hearing good musical programs 
broadcast by mental patients. 

With the installation of A. C. current many vital changes were necessary with 
the radio equipment. About a 1,000 feet of copper shielded wire were installed in 
the rear of the radio panel to prevent leakage, feedbacks, etc. Two splendidly 
constructed rheostat volume controls were installed in microphone and master 
panels. All low level lines were isolated from high level lines in lead conduit. A 
tapering battery charger was installed to take care of the signal system. Elimina- 
tion of four amplifiers were made possible by feeding the receiving set directly from 
our new 20-watt power amplifiers. New acoustically treated material similar to 



18 P.D. 23 

Celotex was installed both in the control-room and studio. This insures better 
quality, less echo, and has a tendency to make both rooms sound-proof. 

From year to year new demands are being made upon our radio system. Among 
some of these is our present system of march recordings to the wards. The wards 
both on the male and female side call the radio when they wish their patients to 
exercise. We in turn play about 10 minutes of march music, and they march the 
patients up and down the wards. Request programs from various wards con- 
tinually come to the radio room. Sometimes these are numbers which we have in 
our victrola list of recording and again it may be for some program from the outside. 

A plan is under way which will in about five years give us a fairly complete index 
of victrola recordings but also a complete replacement of radio loud speakers. 
The plan is to purchase one new album of records a month and also replace one 
speaker a month until the entire hospital is equipped with permanent magnete 
speakers. 

Medical and Surgical Service 
W. Everett Glass, M.D., Director 

The following report summarizes briefly the activities of the medical and surgical 
service from December 1, 1936 through November 30, 1937. 

1 . Movement of population on service: 

There were 1,082 cases admitted to the service during the past year: this is an 
increase of 127 cases over the figures of last year. One hundred and thirty six 
cases were admitted for study only. The largest number of cases were admitted 
during the months of December, January, February, March and April. During 
the year 402 males and 403 females were discharged. Discharges from the service 
detailed as to physical condition are shown in the following tables: 

Table I 

Male 

Recovered and improved 365 

Not improved 13 

Not treated 24 

2. Death : 

During the fiscal year 268 patients died as compared with 204 the preceding 
fiscal year. The following table gives the details of the deaths and autopsies. 

Table II 

Total number of deaths 

Total number of autopsies 

Total number of medico-legal cases 

Autopsies confirmed ante-mortem diagnoses (70% or more) 
Autopsies confirmed partially ante-mortem diagnoses (50 

to 70%) 

Autopsies refuted ante-mortem diagnoses (less than 50 %,) . 
Autopsy percentage of deaths, 48.9. 

During the year 12 patients died at the Summer Street Department. 

The autopsy percentage is 48.9%, a decrease of 11.68% from last year. A 
total of 131 autopsies were done as compared with 124 during the last fiscal year. 

The survey of the deaths reveals that as usual pneumonia caused the largest 
number of deaths, 110 or 41.03%. This is an increase over last year and is directly 
related to the pneumonia epidemic at this hospital during the year. 

In this group there were 31 lobar pneumonia which is equivalent to 29.47%. 
There is a marked increase over last year. The average age of the pneumonia group 
is 69.82 years, a sHght increase over last year. 

Seventy-two patients died as a result of senile changes. This is 26.86% of the 
total deaths. The average age of this group is 73.46 years, a slight increase over 
last year's figures. 

Twenty-one or 7.83% died from general paresis. The average age of this group 
is 51.86 years. This is an increase of 5.46 years when compared to this group last 
year. 



'.male 


Total 


373 


738 


12 


25 


18 


42 



Male 


Female 


Total 


155 


113 


268 


79 


52 


131 

26 

123 

7 
1 



P.D. 23 



19 



Sixteen of 5.97% died from pulmonary tuberculosis. The average age is 54.93 
which is about the same as it was last year. 

Cancer was the cause of death in 8 cases or 2.98%. This is practically the same 
figure as last year. 

Eight patients died directly or indirectly as a result of fractures, 2.98%. The 
average age of this group is 76.6 years. 

Six patients or 2.23% died as a result of chronic nephritis; the average age was 
51 years. 

Twenty-seven patients or 10.12% died of miscellaneous causes. 





Table III 


Consultations: 

Eye 

Ear, nose and throat 
Gynaecology and Obstetrics 
General Surgery 


. 104 Medical . 
17 Orthopedic 
23 X-ray 

47 Others . 



. 13 

6 

.1,361 

31 

There is no significant change in this part of the medical service. There was a 
decrease of 46 surgical consultations and about 212 X-ray consultations. 



Obstetrics: 

There was a decrease in the activity in this department during the past fiscal 
year. A total of 4 babies were born during the year, as compared with 9 the pre- 
ceding year. Two of these babies were premature and died soon after delivery. 



Table IV 




4 Spinal manometries 


. 37 


3 Suturing ... 


. 79 


1 Teeth extrac. (anaes.) . 


12 


8 Thoracotomy 


2 


4 Tonsillectomies 


4 


4 Suprapubic cystotomy an 


1 re- 


3 moval of urethral stone 
1 


1 



Surgery Detailed: 
Amputation, minor 
Appendectomies . 
Bimanual exams (anaes.) 
Biopsies .... 
Blood transfusions 
Chest aspirations . 
Cauterization of cervix 
Cholecystectomy . 

There has been a considerable increase in the number of encephalograms done. 
A very convenient encephalogram chair was designed and constructed at the 
hospital. During the year new surgical instruments have been added to our present 
equipment and we now have a quite complete set of instruments for neurosurgery. 



Circumcision .... 


1 


Skin Grafts 


2 


Cystoscopic examinations . 


1 


Reparing vesico vaginal fistula . 


1 


Dilatation and curettage . 


2 


Injection and ligation of vari- 




Deliveries 


3 


cosities 




Dislocations .... 


1 


Reduction of volvulus . 




Encephalograms . 


30 


Excision of ingrown toenail 




Enterocolostomy . 


1 


Dlivery, episiotomy with repair 




Exploratory laporatomy 


2 


Suspension of uterus 




Foreign body removal . 


4 


Chalazion .... 




Fracture closed, reduction . 


37 


Reduction of volvulus, 1st stage 




Hemorrhoids .... 


1 


colostomy .... 




Herniorrhaphies 


7 


2nd stage colostomy . 




Hydroceles .... 


3 


Aspiration of Bursitis . 




Hysterectomies 


3 


Thoracotomy and rib — resectior 




Incision and drainage . 


125 


Removal of corn 




Injection of varicosities 


39 


Prolapsed rectum repair 




Intestinal obstruction . 


3 


Ventral hernia 




Perineal repairs 


1 


Sigmoidoscopic, reduction of vol 


- 


Pneumothorax 


8 


voulus .... 


1 



20 



P.D. 23 



Proctoscopic examination 
Rib resection 
Saphenous vein ligation 
Sigmoidoscopes 



1 Manipulation of fracture, nasal 

2 bones 

1 Salpingoophorectomy . 

11 Oophorectomy .... 
Excision of new growth 



Total 479 



There has been a considerable decrease in the amount of work done in this item. 
The decrease is due mainly to the decreased number of pneumothoraces done. 
This year 8 were done as against 335 last year. 



Clinics Detailed: 

Table V 
Eye examinations .... 

Ear, nose, and throat examinations . 
Gynecological examnations . 
Luetic treatments .... 

Small-pox vaccinations 
Lumbar punctures .... 
Typhoid and para-typhoid inoculations 

Hinton tests 

Others 

Pneumococci-antigen injections . 



Total 



748 
422 
412 

8,515 
564 
521 

1,987 

1,358 
107 

2,076 

16,710 



There were about 2,000 less treatments and examinations given this year; the 
total was boosted by the pneumococci-antigen injections making this year's total 
about the same as last year. There were 1,561 fewer typhoid and para-typhoid 
inoculations this year. This accounts mainly for the drop in the total figure ex- 
clusive of pneumococcic antigen injections. 



Dressings Detailed: 

Abrasions and lacerations 

Boils and carbuncles 

Burns 

Infections 

Ulcerations 

Others 

Total "out patient" dressings 

Total " ward " dressings 



Table VI 



Total 

There is no significant change in this figure over last year. 



2,102 

770 

506 

2,922 

1,259 

3,359 

10,618 

31,906 

53,442 



Employees. — During the year 2,499 examinations and treatments were given. 
There were 1,264 males and 1,235 females in this group. This is a decrease of 871 
over the last fiscal year. Sixty-two males and 89 females were hospitalized during 
the year. Thirteen males and 17 females required operations. The total number 
of working days lost by hospitalization was: males 371, female 657, a total of 
1,028, an increase of 33 days over the preceding fiscal year. During January 12 
farmers and milk handlers were given physical checks and during February 6. 



P.D. 23 

Dental Report: 



Alveole ctomy 

Bridges .... 

Cleanings 

Examinations (routine) 

Extractions 

Fillings .... 

Microscopic examinations 

Plates .... 

Repairs .... 

Treatments (miscellaneous) 

X-ray diagnosis 

Others .... 

General anasthetic cases 



Total examinations and treatments 



Total patients examined or treated 



Table VII 



Main 

Hospital 

5 

1 

1,420 

3,505 

945 

810 

1 

22 

22 

1,541 

69 

2 

14 

8,357 

4,018 



Summer 
St. Dept. 



94 
244 

75 
76 



1 

1 

130 

4 



626 



290 



21 



Total 

5 

1 

1,514 

3,749 

1,020 

886 

1 

23 

23 

1,671 

73 

2 

15 

8,983 

4,308 



There has been no significant change in this department in spite of the fact that 
we were without a dentist and dental hygienist during the month of March. 

Table VIII 
X-ray Department Analysis: 
X-ray plates used 2,080 



Patients examined 
Foot and fingerprints (sets) 
Photographs . . . . 
Lantern slides 

Total 



1,163 

36 

226 

152 

3,528 



The work in this department would probably have been greatly increased over 
last year had it not been for the fact that we were without a technician for a short 
period. 

Table IX 
Physical Therapy Department: 

Utra-violet (Air-cooled) 1,850 

Ultra-violet (water-cooled) 195 



Baking 
Massage . 

Diathermy (Medical) 
Diathermy (Surgical) 
Muscle re-education 
Others 



Total number of treatments and tests 
Total number of patients treated 



1,690 

1,054 

283 

63 
1,021 

94 

6,250 
3,936 



There has been a decrease in the amount of work done in this department during 
the year; this is probably due to the fact that there has been a change in the method 
of treatment of paretics. With the old method a paretic's temperature was raised 
to 104° F. and then allowed to fall to normal; ten such treatments were given. 
Under the new treatment the temperature is raised and held between 105° F. and 
106° F. for a period of five hours; six such treatments are given making a total of 
30 hours at a temperature of about 106° F. 



22 



P.D. 23 



LA.BORATORY RePORT 

Joseph M. Looney, M.D., Director 

The total number of determinations carried out in the laboratory was 47,534 as 
shown in detail below. It will be noted that one item records 2,816 determinations 
for chemical analyses of brain. These resulted from the duplicate analyses of 8 
brains for 22 different constituents in each of 8 different regions. Inadvertently 
this item was omitted from last year's report which should have listed the analyses 
of 11 brains. During the year there were 284 deaths and 137 autopsies. There 
was a marked fall in the ratio of autopsies to deaths, only 48% being obtained as 
compared with 61 % for last year. This fall in percentage can be in large measure 
ascribed to the increased demand on the medical service during the pneumonia 
epidemic last winter and the fact that the service did not have its full complement 
of physicians. Considerable more pathological work could be carried on if it were 
possible to have a pathological interne at all times. Under the present arrange- 
ment of a definite assignment of a place for such an interne it is expected that ■^e 
will be able to procure suitable men with less difficulty: We have asked for approval 
of the A. M. A. for the laboratory for training of pathological internes. 
- It should be pointed out that only 840 tissue sections were cut during the past 
year. These were chiefly from the surgical specimens and from the tissues studied 
for the clinico-pathological conferences. There has accumulated a large amount 
of histological work which should be cleared up, and which would occupy the full 
time of another technician. It is hoped that some arrangement may be brought 
about which will permit us to add a full time histological technician to our staff. 

The training of college graduates as laboratory technicians has been carried on 
as in the past. Many more requests for technicians have come to the laboratory 
than could be filled. In October five of the technicians took the examinations given 
by the American Society of Clinical Pathologists and were approved. 

The monthly clinico-pathological conferences have continued to exert their 
educational and stimulating action on the staff members and students. 

Doctor Freeman with Doctor Glass presented a paper before the Worcester 
County Medical Society in February, entitled the Relation of Adrenal Glands at 
Autopsy to Blood Vitamin C. Since September he has been conducting a course in 
pathology weekly for the Worcester County Dental Society. He attended the 
annual convention of the American Society of Clinical Pathologists, and the 
American Board of Pathology at Philadelphia May 30 to June 5. There he took 
the examination of the Board and was certified as a specialist in Pathology. He 
also served for two months as pathologist at the Worcester Cancer Clinic. 

The Director, with Doctor Randall, attended the annual meeting of the American 
Society of Biological Chemists in Memphis, April 21-24. He also attended the 
annual meeting of the Association for the Study of Internal Secretions, and the 
Annual Convention of the American Medical Association June 6-12 at Atlantic 
City. He talked before the student body of Holy Cross College in February on the 
"Chemistry of the Living Cell". 

The work on the investigation of the physiological changes brought about by 
insulin in schizophrenia, and also the study of the oxidative mechanisms in these 
patients has been carried on during the year. Preliminary work on the assay of 
various hormones has been started and will be pushed vigorously the coming year. 



Bacterial cultures 


193 


Bacterial smears 


453 


Basal metabolisms 


836 


Blood cultures . 


67 


Blood Creatinine 


925 


Blood N. P. N. . . 


. 1,840 


Blood sugars 


. 3,412 


Blood urea 


625 


Blood uric acid . 


904 


Blood counts (red) . 


. 2,938 



Laboratory Report 
Year Ending September 30, 1937 
Vital capacities . 
Nitrogen partitions 
Plasmodia malaria 
Platelet counts . 
Reticulocyte count 
Schillingrams 
Blood fragility . 
Ascitic fluid 
Animal inoculation 
Ascheim-Zondek tests 



630 
1,663 

4 

9 
56 
69 

2 
30 
11 

7 



P.D. 23 



23 



Blood counts (white) 






. 3,350 


Stomach contents . 


Blood counts (diff.) . 




3,085 


Autogenous vaccines 


Haemoglobins 






3,300 


Glucose tolerance 


Clotting times 






11 


Galactose tolerance . 


Bleeding times . 






10 


Toxicological exam. . 


Icteric index 






40 


Blood total prot. 


Vandenbergh test 






19 


Blood bromide . 


Spinal fluid (cells) . 






500 


Blood globulin . . . 


Spinal fluid (gold) 






. 487 


Blood potassium 


Spinal fluid (chlor.) 






480 


Blood Creatine . 


Spinal fluid (gold) 






487 


Blood potassium . 


Spinal fluid (glob.) 






488 


Blood lipoids 


Spinal fluid (sugar) 






488 


Blood vitamin ' C ' . 


Spinal fluid (prot.) 






484 


Blood choles, free 


Spinal fluid (diff.) 






5 


Milk (bact. count) . 


Sputa . 






865 


Milk (broth cultures) 


Stools . 






264 


Milk (blood plated) . 


Tissue sectons . 






840 


Milk (occult blood) . 


Urines 






7,562 


Phytotoxic index 


Mosenthal tests 






27 


Agglutinins. 


P. S. P. 






3 


Pneumococci typing 


Urine (quant, sug.) 






372 


Skin Test (undul. fever) . 


Urine (bact.) 






4 


Blood glutathione 


Urine (bile) 






10 


Blood acetone 


Urine (urobil.) . 






10 


Urine (qualit. sugar) 


Urine (blood) 






3 


Bang abortus test 


Blood typing . 






25 


Milk alkalinity test . 


Blood calcium 






177 


Haldane basal metabolism 


Blood chloride . 






130 


Water analysis . 


Blood cholesterol 






804 


Choline-esterase Study . 


Blood hematocrits 






274 


Blood phosphotase 


Blood sedimentations 






203 


Blood sodium 


Blood gases 






230 


Blood albumin . . . . 


Blood Ph . 






142 


Urine Ph . . . . 


Blood lactic acids 






759 


Blood CO . . . 


Blood magnesium 






1 


Douche (parasites) . 


Blood phosphorus 






163 


Skin test (trichiniasis) 


Chemical analyses of 8 brains. 2,816 




Total 











Autopsies 



345 

18 

78 

7 

1 

6 

77 

1 

166 

40 

166 

611 

930 

592 

4 

30 

11 

483 

120 

2 

191 

4 

80 

1 

43 

3 

56 

48 

9 

326 

1 

2 

1 

16 

1 

1 

1 



44,718 
2,816 

47,534 
137 



Research Department 
D. Ewen Cameron, M.D. 

The activities of the Research Department during the last year can readily be 
divided into two periods During the first of these the work of the research per- 
sonnel was largely devoted to individual projects, and during the second the 
emphasis was placed on cooperative studies. 

During the first part of the year a considerable amount of work was carried out 
by the Psychology Department under Mr. Shakow on the concept of adaptation. 
This represented a continuation of work started in the previous year. It is con- 
sidered that one of the ways in which the schizophrenic patient deviates most 
markedly from the normal is in his lessened capacity to carry out adaptation either 
at the psychological or physiological level. The work on this topic has taken three 
main directions: 

A. The study of mechanisms of adaptation in dynamic situations, e.g., 
reaction-time experiments; 

B. A study of the personality, e.g., Rorschach, tautophone, thinking ex- 
periments; 



24 p.D. 23 

C. A study of the genetic factors which may be responsible for maladapta- 
tation, e.g., play experiments. 

During the same period the laboratories, under the direction of Dr. Joseph M. 
Looney, carried out extensive investigations of the effects of the insulin treatment 
of schizophrenia. In particular the glucose tolerance of patients before and after 
treatment was studied, and a comparison of the blood gases and blood minerals at 
the same time intervals was made. Dr. Randall carried out work on the effects 
of the treatment on the blood lipids and the blood choline esterase. From studies 
of the latter substance it is anticipated that we shall be able to obtain more precise 
data in regard to the behavior of the vegetative nervous system. 

In the psychiatric group Dr. Angyal was engaged in writing a monograph on the 
psychology of personality. He also carried out studies on the relationship between 
the pre-psychotic personality and the type of schizophrenia. Dr. Cohen investi- 
gated the type of imagery found in schizophrenic patients and contrasted this with 
what was found in a group of normal individuals. In addition, work on the effects 
of high doses of thyroid in schizophrenia, which had been initiated in the previous 
year, was carried to completion. Dr. Cameron carried on further research into 
the action of insulin in schizophrenia. In particular this action on lipid metabolism, 
on other endocrine glands, and on tissue oxygenation was studied. In association 
with Drs. Hoagland and Rubin, the effects of insulin treatment on the brain wave 
patterns were considered, and changes in the pattern which concurred with clinical 
improvement were discovered. 

Dr. H. Freeman continued his work on the mechanisms involved in heat regula- 
tion. The insensible perspiration was separated into its two components, that from 
the skin and that from the lungs. Simultaneously basal metabolic determinations 
were made with the idea of determining with which phase of the insensible perspira- 
tion this physiological function would correlate to the higher degree. The fraction- 
ation of the insensible perspiration has not been done before with any accuracy, 
and from this point alone the work is unique. Its ultimate importance remains 
to be determined when the analysis of the data has been completed, but it should 
shed a new light on many of the mechanisms involved in the temperature regu- 
lation of the body. Studies are also being made upon the effects of preventing the 
loss of moisture from the lungs by having both patients and normal controls 
breathe air having a high humidity and a high termperature. Preliminary results 
show that schizophrenics are not so capable of making readjustments to this situ- 
ation as are normals. This seems to indicate a sluggishness of the autonomic 
mechanisms. 

Dr. Fuchs has been studying the effects of adrenalin upon the heart rate and 
blood pressure of normals and schizophrenic patients. The response of the heart 
rate in both groups showed little difference. The blood pressure response of the 
patients was, however, significantly reduced. This difference disappeared in re- 
sponse to a second injection. These results appear to indicate that the peripheral 
mechanism of autonomic reactivity is not imparled in schizophrenia. 

During the second part of the year plans were set up for a cooperative attack 
upon a central project. It had been felt for some time that as we had now estab- 
lished the fact that certain functions in the schizophrenic patient showed definite 
deviations from normal, it would be desirable to study what happened to these 
abnormalities as the patient either improved or grew worse. In this way we antici- 
pate that we shall be able to obtain a better idea as to which are the primary 
abnormalities and as to how the abnormalities are interrelated. Accordingly a 
program was set up in which abnormalities of O2 metabolism, of the vegetative 
nervous system activity, and of the function of integration were studied both in 
patients in whom spontaneous remission occurred and in patients who were treated 
with insulin. By means of this closely integrated program it is anticipated that 
we shall obtain not only the above-mentioned information but also we shall be 
able later to assess insulin treatment more adequately, and shall also be able to 
obtain more precise information as to its underlying principle. Furthermore, data 
are being gathered at the same time in regard to what constitutes the most favorable 
type of case for treatment, and efforts are being made to establish objective indices 
of treatment. In this regard the relationship of the systolic-diastolic pressures 



P.D. 23 25 

has previously been found to be much more rigid in schizophrenics than in normals, 
and we are investigating the question of whether this becomes modified as treat- 
ment progresses. Further studies of the changes which occur in the personality 
formation as clinical improvement or recession occurs are being carried out by Dr. 
Angyal. The delta index and the percentage of the time during which the alpha 
wave is present in the brain wave pattern are receiving further study by Drs. 
Hoagland and Rubin. The latter is also carrying out an extensive mapping pro- 
gram of the wave pattern shown by the schizophrenic brain, and in association with 
Dr. Angyal is endeavoring to map the areas of brain atrophy. The clinical picture 
presented by patients showing these areas of atrophy has already been reported 
by Dr. Angyal. The brain wave work has been much advanced by the acquisition 
of a two-channel apparatus and complete shielding of the experimental room. 

Apart from the central projects, certain other investigations are being carried 
out. Dr. Cohen is investigating the recently introduced convulsive treatment of 
schizophrenia. His investigations not only include evaluation of the therapeutic 
aspects of the method in recent and chronically disturbed patients, but cover in 
addition the study of the effects of the drug used, metrazol, on memory and on 
cognition. 

In September Dr. Franics H. Sleeper, who had been Resident Director of Re- 
search since the establishment of the department ten years ago, and to whose 
energy and capacity for organization the Research Department owes much of its 
present development, resigned to devote full time to his duties as Assistant Super- 
intendent. He was succeeded by Dr. D. Ewen Cameron. At the same time the 
psychiatric group, which had been brought up to strength by the appointment of 
Dr. L. S. Chase and Dr. C. Wall, was established as a department under the 
direction of Dr. A. Angyal. Dr. Chase is engaged upon the study of the effects of 
vitamin Bi. Previous work in this department has shown that there is reason to 
suspect that the schizophrenic patient is deficient in O2 catalysts, and consequently 
it is felt that a study of the action of known catalysts may well be significant. In 
addition he is conducting a study of doubt as it constitutes a factor in the schizo- 
phrenic psychosis. Dr. Wall is engaged upon an analysis of the personality factors 
in a group of patients who have been treated with insulin. The laboratories, under 
Dr. J. M. Looney, in addition to carrying on the extensive work on the O2 meta- 
bolism and the vegetative nervous system involved in the central project and 
vitamin Bi investigations, have attempted to establish methods of assaying certain 
of the endocrine products which are used in clinical investigations. The material 
in various dosages has been injected into sexually immature rats and the uterus, 
ovaries, and tubes weighed. The vagina is checked for histological findings. The 
testes, prostate, and epididymis of the male rats are also weighted. Variation is 
such that it is necessary to use more than five rats for each experiment in order 
to evaluate the results. At present the laboratory is working with animals of 
constant age and later will endeavor to run a series in which the weight factor is 
kept constant. Dr. Randall has just completed a preliminary report of brain 
chemistry studies which he has carried out in both normal controls and patients 
over a period of several years. Until now, comparatively little of an exact nature 
has been published in regard to this very important field. The Psychological De- 
partment, under Mr. Shakow, has taken an active share in the central project and 
in the Bi studies. In addition, work has been carried out on the thinking of 
schizophrenics, and cooperative studies with other departments have been carried 
on. Dr. Rosenzweig has studied the personality effects of sex hormones in asso- 
ciation with Dr. Hoskins, and Mr. Shakow and Dr. Rodnick have worked on the 
problem of integration in association with Dr. H. Freeman. Further studies of 
the value of the play technique as a means of approaching inaccessible patients 
were carried out by Mr. Shakow and Dr. Rosenzweig. 

To the Biometric Department under Mr. Jellinek has fallen the task of integra- 
tion and evaluation of the data afforded by the various research projects. The 
major analyses of data during the past year comprised brain chemistry data, brain 
wave data, insensible sweating, skin temperature, skin resistance, reaction time, 
adrenalin reactions, phytotoxic index, mitotic index, revision of the basal metabolic 
data, and the effects of social situations on the performance of schizophrenic 
patients. Special work was devoted to improvements in the analysis of variance 



26 P.D. 23 

and to the comparability of the degrees of heterogeneity in two samples. At present 
the Department is much interested in theorems and techniques which can be 
applied to the evaluation of single individuals, and to expressions of total variability 
of an individual, as well as in other descriptive indices of the physiological status. 
Production of satisfactory methods of evaluation of progress and regression in 
individuals is of the greatest moment for further investigation, particularly of 
therapeutic agents. By this means it may be confidently anticipated that the 
errors which arise from subjectivism can be greatly reduced. 

The papers pubUshed by the members of the Research Staff are incorporated in 
the complete list of publications from the hospital. 

Publications from the Worcester State Hospital 
December 1, 1936 — November 30, 1937 

Books 

1. Administrative Psychiatry. William A. Bryan. Published by W. W. Norton, 

New York, December 1936, 349 pp. 

2. Psychiatric Nursing. Katherine McL. Steel. Published by F. A. Davis, 

Philadelphia, 1937, 370 pp. 

Papers 

1. A pharmacodynamic study of the autonomic nervous system in normal men. The 

effects of intravenous injections of epinephrine, atropin, ergotamine and physo- 
stigmine upon the blood pressure and pulse rate. Harry Freeman and Hugh T. 
Carmichael. Jour. Pharm. & Exper. Ther. 58: 409, December 1936. 

2. Estimates of intra-individual and inter-individual variation of the erythrocyte and 

leukocyte counts in man. E. Morton Jellinek. Human Biology 8: 581, 
December 1936. 

3. Studies in seasonal variation of physiological functions. 1 . The seasonal varia- 

tions of blood cholesterol. E. Morton Jellinek and Joseph M. Looney. Bio- 
metric Bulletin 1: 83, December 1936. 

4. The testing of certain hypotheses by means of lambda criteria with particular 

reference to physiological research. Part I. The drawing of one or more samples 
from completely or partially specified populations John W. Fertig. Bio- 
metric Bulletin 1: 45, December 1936. 

5. The bilateral symmetry of skin temperature. Harry Freeman, Forrest E. Linder 

and Ralph F. Nicherson. Journal of Nutrition. IS: 34, January 1937. 

6. The pressor effects of prolonged administration of glycerin extract of adrenal 

cortex. R. G. Hoskins and J. H. Fierman. Endocrinology 2i : 119, January 
1937. 

7. Play technigue in schizophrenia and other psychoses. I. Rationale. II. An 

experimental study of schizophrenic constructions with play materials. Saul 
Rosenzweig and David Shakow. Amer. Jour. Orthopsychiat. 7: 32, Jan. 
1937. 

8. Studies of Motor Function in Schizophrenia. II. Reaction Time. Paul E. 

Huston, David Shakow and Lorrin A. Riggs. Jour. Gen. Psych. 16: 39, 
January 1937. 

9. Studies in the personality structure of schizophrenic individuals. I. The acces- 

sibility of schizophrenics to environmental influences. II. Reaction to inter- 
rupted tasks. Maria Rickers-Ovsiankina. Jour. Gen. Psych. 16: 153, 
January 1937. 

10. An improved technic for the determination of insensible prespiration. Ralph F. 

Nickerson. Jour. Lab. & Clin. Med. 22: 412, January 1937. 

11. Schools of Psychology: A Complementary pattern. Saul Rosenzweig. Phil, of 

Sci. i: 96, January 1937. 

12. The oxygen and carbon dioxide content of the arterial and venous blood of normal 

subjects. Joseph M. Looney and E. Morton JelHnek. Am. Jour. Physiol. 
118: 225, February 1937. 

13. Can the Biochemist produce lifel Joseph M. Looney, M.D., Hormone 19: 

17, February 1937. 



P.D. 23 27 

14. Psychiatric manifestations associated with disease of the central nervous system 

with special reference to multiple sclerosis. A point of view. Louis H. Cohen 
and Arthur J. Gavigan. Jour. Nerv. & Ment. Dis. 85: 266, March 1937. 

15. The clinical significance of numerical measures of scatter on the Stanford-Binet. 

Albert J. Harris and David Shakow. Psychological Bulletin, Sit: 134, March 
1937. 

16. Electrical brain waves in schizophrenics during insulin treatments. Hudson 

Hoagland, Morton A. Rubin and D. Ewen Cameron. Jour, of Psych. 3: 
513, April 1937. 

17. Suprarenal cortex therapy in vomiting of pregnancy. II. The results in 78 cases. 

William Freeman, J. M. Melick and D. D. McClusky. Amer. Jour. Obs. 
& Gyn. 33: 618, April 1937. 

18. A method for the study of concept formaion. Eugenia Hanfmann and Jacob 

Kasanin. Jour, of Psych. 3: 521, April 1937. 

19. These complex living cells. Joseph M. Looney, M.D., Science Digest I ; May 

1937. 

20. The effect of artifically raised metabolic rate on the electroencephalogram of 

schizophrenic patients. Morton A. Rubin, Louis H. Cohen and Hudson 
Hoagland. Endocrinology. 21: 536, July 1937. 

21. The encephalograms of schizophrenics during insulin treatments Hudson Hoag- 

land, D. Ewen Cameron and Morten A. Rubin. Amer. Jour. Psychiat. 9^: 
183, July 1937. 

22. Some significant factors in juvenile recidivism. Milton E, Kirkpatrick, M.D. 

Jour, of Orthopsychiat. 7: 349, July 1937. 

23. Mirror behavior in schizophrenic and normal individuals. Saul Rosenzweig and 
David Shakow. Jour. Nerv. & Ment. Dis. 86: 166, August 1937. 

24. The "delta index" of the electro-encephalograms in relation to insulin treatments 
of schizophrenia. Hudson Hoagland, D. Ewen Cameron and Morton A. Rubin. 
Psych. Rec. i : 196, August 1937. 

25. The experimental study of psychoanalytic concepts. Saul Rosenzweig. Char- 
acter and Personality 6: 61, September 1937. 

26. Experiences in the insulin-hypoglycemia treatment of schizophrenia. D. Ewen 
Cameron and R. G. Hoskins. J. A. M. A. 109: 1246, October 16, 1937. 

27. Some observations on Sakel's insulin-hypoglycemia treatment of schizophrerda 
D. Ewen Cameron and R. G. Hoskins. Schweizer Archiv. fur Neur. u. 
Psychiat. 39: 180, October 1937. 

28. The effect of prolonged insulin therapy on glucose tolerance in schizophrenic 
patients. Joseph M. Looney and D. Ewen Cameron. Proc. Soc. Exp. Biol. 
37: 253, October 1937. 

29. The effect of pain on the heart rate of normal and schizophrenic individuals. 
Louis H. Cohen and Mervin Patterson. Jour. Gen. Psych. 17: 273, October 
1937. 

30. Disturbances of activity in a case of schizophrenia. Andras Angyal, M.D. 

Arch. Neur. & Psychiat. 38: 1047, November 1937. 

31. The electro-encephalogram of schizophrenics during insulin hypoglycemia and 
recovery. Hudson Hoagland, Morton A. Rubin and D. Ewen Cameron. Amer. 
Jour. Physiol. 120: 559, November 1937. 

32. A comparison of the performance of matched groups of schizophrenic patients, 
normal subjects and delinquent subjects on some aspects of the Stanford-Binet. 
Charlotte Hall Altman and David Shakow. Jour. Ed. Psych. 2S: 519, October 
1937. 



28 P.D. 23 

Psychology Department 
David Shakow, M.A., Director 
Statistically the records for the year indicate the following as to the patients 
and other subjects worked with in the Psychology Department. 

Psychometric and Experimental Studies 

Individuals Tests 

House Examined Given 

House patients 216 732 

Schizophrenia research patients . 128 293 

Out-Patients 

School clinics 370 435 

Adult delinquents 16 51 

Non-patients (inc. employees) 184 557 



Total 914 2,068 

Besides the routine psychometric work with patients the above figures include 
the work done with patients on various established research projects. Among 
these were the comparative reactions of schizophrenics and normal subjects to: 
situations involving aspiration; different length warning intervals in a reaction- 
time setting; startle stimulation in respect to adaptation as shown by the galvanic 
skin response, insensible perspiration and pulse rate; adrenalin and atropin as it 
effects the galvanic skin response; indistinct sound patterns as presented by the 
tautophone. The effects of sex hormones on the behavior and mental content of 
a patient studied daily is also included. 

A number of other projects which are in earlier stages of development are, how- 
ever, not included. Among these may be mentioned: a study of the relative 
abilities of schizophrenics and normal subjects to handle material in social, personal 
and impersonal settings; a revision of an optionary (typeof questionaire) to frustra- 
tion reactions; a comparison of group and individual presentation of vocabulary 
tests. 

The papers from the Department during the year were as follows: 

A. Published: 

All papers published from the Psychology Department for the year are included 
in the hospital list of publications. 

B. Accepted for Publication: 

1. Rosenzweig, S. and Shakow, D. Mirror behavior in schizophrenic and normal 
individuals. J. Nerv. & Ment. Dis. 1937. 

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

3. Harris, A. J. and Shakow, D. Scatter on the Stanford- Binet in schizophrenic, 
normal and delinquent adults J. Abn. & Soc. Psychol. 1938. 

4. 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. J. Educ. Psychol. 1938. 

5. Rickers-Ovsiankina, M. The Rorschach test as applied to normal and schizo- 
phrenic subjects. Brit. J. Med. Psychol. 1938. 

6. Kasanin, J. and Hanfmann, E. An experimental study of concept formation 
In schizophrenia. 1 . Quantitative analysis of the results. Am. J. Psychiat. 
1938. 

7. Shakow, D. and Goldman, R. The effect of age on the Stanford-Binet vocabu- 
lary score of adults. J. Educ. Psychol. 1938. 

8. Hanfmann, E., Rickers-Ovsiankina, M. and Goldstein, K. A psychological 
study of a case of post-traumatic dementia. Brit. J. Med. Psychol. 1938. 

C. Prepared for Publication: 

1. Hanfmann, E. A study of thinking in schizophrenia by means of the Healy 
P. C. II. 

D. Read at meetings: 

1. Radio, G. Aspiration behavior in schizophrenic patients. Meeting of Lewin 
psychologists. Harvard, December 1936. 



P.D. 23 29 

2. Rosenzweig, S. Application of experimental method to psychoanalysis. 
Psychol. Colloquium of Brown & Yale Universities, January 1937. 

3. Rosenzweig, S. Frustration as a co-ordinating concept for experimental psy- 
chopathology N. R. C. Conference on Experimental Neuroses, Washington, 
D. C, April, 1937. 

Considerable progress has been made on the analysis of three extended studies, 
two on memory, one of normal subjects and the other on different diagnostic groups 
of psychotic subjects, and the other on the intellectual level of different groups of 
psychotic subjects as measured by the Stanford-Binet. An attempt was also made 
to integrate the results of the psychological studies of a period of some eight years. 
Although this was primarily done for a report for Dr. Gregg of the Rockefeller 
Foundation it was the basis of various reports and discussions at the hospital. 

Dr. Rosenzweig has been carrying the major part of the teaching load outside 
the Department. He has, in the last year, given courses in psychology to our post- 
graduate nurses and to the nurses at Memorial Hospital. 

Members of the Department attended various scientific meetings among which 
were the Lewin meetings in Cambridge, December 1936, the meeting of the Ameri- 
can Orthopsychiatric Association in New York, February 1937, and the meeting 
of the American Psychological Association in Minneapolis, September, 1937. 

On the whole, the year was a productive one from the standpoint of papers 
published and experimental projects completed. There is still a great deal of 
accumulated project material to be analyzed, however, and it is one of the main 
goals of the Department to make an even more concentrated attack upon this 
while continuing with the prosecution of new projects. 

Library Report 
George L. Banay, Ph.D., Librarian 
I. Medical Library 
The past year represents a year of further expansion in the history of the Medical 
Library. To indicate the activities and the progress in the development of the 
library, the following details are quoted: 

Periodicals. — We had 117 periodicals in 1937 as compared with the 106 of the 
previous year. Of this number the hospital subscribed to 94, 2 were paid for by 
the Memorial Foundation for Neuro-Endocrine Research, 3 were donated by Dr. 
Bryan, 5 by Dr. Hoskins, 3 by Dr. Sleeper, 2 by Dr. Looney, 1 by Dr. William 
Freeman, and 7 come in free from scientific organizations. 

Of these periodicals, 3 are in French, 6 in German, 4 in Italian, and 104 in English. 

Circulation. — The Medical Library circulated 696 volumes last year. 

Inter-Library Loans. — The Librarian maintained contact with other libraries, 

and we borrowed 164 volumes from 4 of these as follows: Boston Medical Library, 

119; New York Academy of Medicine Library 35; Harvard College Library, 8; 

Harvard Medical School Library, 2. 

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 
charge of the postage. In 1937 we received 78 volumes from the Association. 

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

Binding. — We bound 275 volumes during the year, including the ones received 
from the Exchange. 

Present State. — On November 30, 1937, the Medical Library had: 

Bound volumes of periodicals 3,715 

Unbound volumes of periodicals 56 

Bound volumes of books 1,836 

Unbound volumes of books 6 

Old books 869 

Catalogued pamphlets 1,269 

Lantern slides 431 

Total items 8,182 



30 P.D. 23 

This is an increase of 353 volumes over the previous year. 

Services. — The Librarian continued to circulate the bibliographies and abstracts 
prepared many special bibliographies, and translated foreign medical articles for 
the use of the Staff. The bibliographies, abstracts, and translations are filed in the 
Medical Library. 

W. P. A. Projects. — We completed work on the 3 projects approved by the 
Federal Government, that is, re-cataloguing of books, compilation of a complete 
bibliography of schizophrenia, and bringing up to date our abstract collection on 
schizophrenia. The books are re-catalogued. The bibliography and abstract cards 
are typed and filed under subject headings. 

//. General Library 

The General Library was moved into new quarters in 1936. At the same time it 
was re-organized, the worn and obsolete material being eliminated. The shelves 
still look somewhat empty at the present time, but we shall build up the library 
systematically and hope to fill up the shelves in the not too remote future. 

During 1937 one of the W. P. A. workers was in charge of the library and the 
Occupational Therapy students took the book trucks to the closed wards twice a 
week with books for the patients who were unable to come to the library. 

We added 208 volumes to the shelves during the year. 

On November 30, 1937, the General Library had: 
Books (fiction and non-fiction) 2,103 Bibles and prayer books . . 25 

Serials 67 Reference books ... 80 

Bound magazines . . . 168 Lantern slides .... 100 



Total 2,543 

Fifty popular magazines and 6 daily newspapers are subscribed to by the hospital. 

In addition to this, 150 books are borrowed every 3 months from the Worcester 
Public Library to circulate among the patients and employees. 

Arrangements have been made with the Free Public Library to send 100 volumes 
every 3 months to the Summer Street Department. In addition, 100 books are 
sent every 3 months from the general library in the main hospital, and 10 popular 
magazines and newspapers are subscribed to for this department. 

The library is well patronized by patients and employees, the average monthly 
attendance being 922 patients and 70 employees. 

During the year the library circulated 7,445 volumes and had 11,066 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 
Carrol A. Wise, D.D., Chaplain 

The activities of the protestant Chaplain of this hospital fall conveniently under 
the headings of (1) religious services, (2) ward visitation, (3) education and (4) 
community service. 

Religious services are held each Sunday morning at the main hospital and at the 
Summer Street Department. During the past year the attendance at these services 
has averaged well over three hundred. An endeavor is made to conduct a worship 
service which is milding stimulating, and in which a mental hygiene emphasis is 
made. A hymnal especially prepared for use in mental hospitals is used in this 
service. The sermon is brief, and seeks to indicate the value of religion for the 
emotional needs of the patients. These services offer one form of normal exper- 
ience which many of the patients had on the outside of the hospital, and for which 
they feel a continuing need after admission to the hospital. 

Routine visits are made to the admission wards so that all new patients are seen 
within a week after their admission to the hospital. The medical and other psy- 
chiatric wards are visited regularly, and individual patients are seen at any time 
when a visit is desired or indicated. Patients are frequently found who have 
unhealthy religious attitudes, and in whom a process of religious re-education may 
contribute to their general mental health. 



P.D. 23 31 

The educational program of the chaplain's department centers chiefly in the 
training of theological students. In this work, the hospital is affiliated with the 
Council for the Clinical Training of Theological Students. While no actual training 
was done in this hospital during the past year, plans were made for developing this 
type of training into a six months rather than a three months course. The demand 
for such training on the part of seminaries and students is increasing, and its value 
is being increasingly appreciated in many sections of the church. 

During the year the chaplain gave a series of four lectures on Religion and Mental 
Disorder to two groups of occupational therapy students, and to one group of 
nursing students, and another course of six lectures to another group of nursing 
students. 

The community service of the chaplain consists largely in speaking before various 
groups on subjects related to the hospital and its work. During the past year the 
chaplain made thirty-five such talks. The Hospital Messenger, a paper primarily 
published for relatives, was issued monthly, partially under his supervision and 
editorship. 

In September, 1937, the chaplain attended a conference on Christianity and 
Mental Hygiene which was sponsored by the National Committee on Mental 
Hygiene, the Federal Council of Churches, and the National Council on Religion 
in Higher Education. He is a member of the committee which is arranging for a 
similar conference during the coming year. In October he read a paper entitled 
"The Experience of Frustation in the Ministry", before the annual conference of 
the Council for the Clinical Training of Theological Students, in New York. 

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

Treatment of the individual child whose behavior deviates significantly from 
that of his group has always been the primary objective of the Worcester Child 
Guidance Clinic. In reviewing the figures of this report, one will note a significant 
number of cases which were accepted on an advice basis. This does not represent 
any departure from our treatment program, but rather indicates the development 
of certain trends in this community which make it possible for persons other than 
those associated with the Child Guidance Clinic to do something for the child. 
There is an implication running through the mental hygiene movement to the 
effect that if physicians, nurses, teachers, and other professional groups become 
sufficiently indoctrinated with mental hygiene principles, we can expect eventually 
a diminution in the maladjustments of childhood. During the past three years 
more educational work with professional groups has been done in Worcester, not 
only by members of the staff of this Clinic, but by other agencies. It is now possible 
for agency workers who consult us about children to carry on intelligent treatment 
not directly under our close supervision. 

Each year an attempt is made to discover the effects of Child Guidance Clinic 
procedure on certain selected groups of children, although no attempt has yet been 
made to evaluate what has happened to the total number of children seen during 
the past ten years. It is the opinion of the director that such research is valuable 
from two points of view. It makes a contribution to the general field of study of 
behavior problems in children and at the same time reveals the shortcomings as 
well as the strong points in our therapeutic approach. During the past year the 
following research projects were completed. The director published "Some 
Significant Factors in Juvenile Recidivism", which is a statistical evaluation of 
social and economic factors in the lives of first offenders. We also made an ex- 
haustive analysis of a large series of cases referred to the Child Guidance Clinic by 
the Worcester Associated Charities. The findings of this research have pointed 
the way toward a better working relationship between the two agencies. We have 
alwyas been confronted with the problem of the personality encountered in the 
mother as well as the personality of her child whom she brings to us for treatment. 
"A Retrospective Study of the Relationship Between Personality Characteristics 
of Mothers and the Outcome of Treatment" indicates that the capacity of the 
mother to carry out Clinic recommendations in spite of her previous shortcomings 
is the most important, single factor in her child's improvement. There has been 
an increasing number of adolescent children referred to the Clinic. We have also 



32 



P.D. 23 



completed a study, "The Relationship Between Adolescent Personality and 
Problem with Respect of the Outcome of Treatment". The findings, of course, 
are specific only to this Clinic, but they indicate very clearly the ability of an in- 
dividual therapist to carry on successful treatment with a certain type of adoles- 
cent problem. 

We are continuing to exert most of our efforts in community education in the 
direction of professional groups. During the past year an interesting project was 
undertaken in the public school system of Webster, Massachusetts. Four members 
of the Clinic staff have been going to Webster one afternoon a week, studying two 
cases and reporting their findings at a conference of the teachers later in the after- 
noon. This project has been very successful and has branched out until at the 
present time it includes the following: (1) a seminar on mental hygiene conducted 
once each month and attended by all the teachers in the public school system of 
Webster; (2) a mental testing program supervised by the psychologist at the Child 
Guidance Clinic and administered to groups of children by the teachers, which is 
the first attempt to provide such supervision in the Webster schools; (3) individual 
counseling, whereby teachers may consult with Clinic staff members about problems 
they encounter in the classroom; (4) monthly conferences on difficult cases which 
have been prepared for presentation by the teachers and school nurses with the 
assistance of Clinic staff members. It has been the purpose of this co-operative 
relationship with the Webster schools to make them aware of the existence of 
mental hygiene and child guidance problems, and at the same time show them what 
they, as teachers and nurses, can do about it. 

Community support continues to be very fine, financially as well as in other less 
tangible ways. We have more children referred than we can adequately care for. 
A conscientious attempt is made to select those cases with which we can be success- 
ful and whenever possible to refer the remainder to other sources wherein they might 
find some alleviation for the presenting problem. The physical aspects of the clinic 
are quite good. During the coming year we anticipate no changes in either our 
organization or our general method of procedure. 



Service Report 

I. Report of Case Load: 

A. Carried Cases: 

1. Cases carried over from last year 
2 Intake a. New cases accepted 
b. Old cases reopened 

(1) last closed before present year 

(2) last closed within present year 

3. Total cases open at sometime in this year. 

4. Cases taken from service 

5. Cases carried forward to next year 

B. Closed cases followed up (Not reopened) 

C. Applications rejected .... 

D. Applications withdrawn 

II. Type of Service Classification 

A. New Accepted Cases: 

6. Full service a. Clinic staff cases 

b. Cooperative cases 

c. Full service not a or b 

7. Special service (Advice) 
9. Total new cases accepted 

B. Cases taken from Service: 

10. Full service a. Clinic staff cases 

b. Cooperative cases 

11. Special service (advice) 

12. Total cases closed during this year 



Total 
318 
227 

7 

3 

555 

268 

287 



10 

15 



124 

103 





227 

98 

164 

6 

268 



P.D. 23 



33 



III. Sources Referring New Accepted Cases: 



IV. 



13. Agences 

14. Schools 



Social . 
Medical 
Public 
Private 



15. Juvenile Court 

16. Private physicians 

17. Parents, relatives . 

18. Total new cases accepted 
Summary of Work With or About Pa 
A. By Psychiatrists: 



Full 
48 
2 
6 



5 

77 
138 



Special 
3 
2 
1 
1 
7^ 

10 

89 



tents: 



D. 



E. 
F. 



1. Interviews with patients a. for examination . 

b. for treatment 

2. Interviews about patients 

3. Physical examinations by clinic staff members 
By Psychologists: 

1. Interviews with patients a. for examination 

b. for re-examination 

c. for treatment 

2. Interviews about patients 

By Social Workers: 

1. Interviews in clinic 

2. Interviews outside clinic 

3. Telephone calls 

Number of Cases given initial Staff Conference: 

1. Full service a. Clinic staff cases 

b. Cooperative cases 

2. Special service 

Number of open cases given service during year by working, approx 
Referral Interviews 



Total 
51 

4 
7 
1 

72 
5 

87 
227 



Total 

294 

748 

237 

46 

261 

9 

624 

39 

1,104 
579 
297 

45 

30 

3 

600 

132 



V. Personnel Report (Average staff during year) 

A. Regular Staff a. Psychiatrist 

b. Psychologists . 

c. Social workers 

d. Clerical workers 

B. Staff in Training a. Social workers 

VI. Operating Schedule 

A. Schedule of clinic days and hours: 9 to 5 

B. Scheudule of attendance of psychiatrists: 



Full-time Part-time 
2 
2 
3 

2 1 

4 



daily; 9 to 12 Saturday. 

9 to 5 daily; 9 to 12 Saturday. 



The Steward's Department 
Herbert W. Smith, Steward 

This Department has functioned during the fiscal year 1937 without any unusual 
developments. Again we bring to light the absolute necessity of proper storeroom 
and laundry accommodations if the work of this hospital is to go on successfully. 
Each year adds to the demands set upon these two vital parts of the Steward's 
department and it is to be hoped that the necessity for prompt action to change 
present conditions will be recognized in the near future. 

Our present storeroom facilities are not adequate to properly handle the material 
a hospital of this size demands, either for proper storage or quantities to be kept on 
hand. This necessitates a duplication of orders at shorter intervals than should 
be which in turns adds to the clerical work of storeroom accounting. Therefore, 
viewed from all angles, a relocation of our present storeroom is badly needed if a 
reasonable degree of efficiency is to be maintained. 

So much has already been written and spoken about the laundry connected with 
this hospital that there is little left to comment on. The physical condition of the 
plant is not improving and it is remarkable that the machinery is standing up the 
way that it is. The possibihty of a bad breakdown increases with each days use. 



34 p.D. 23 

Working conditions are far from satisfactory and it is conceded by all those who 
should know that a new laundry, both building and machinery, is needed to meet 
the demands of this hospital. 

It is to be hoped that something can be done during 1938 to correct both the 
storeroom and laundry conditions in the Worcester State Hospital. 

Farm Report 
James Mistark, Head Farmer 

The motorization of the farm has continued during the past year. The number 
of horses has been reduced to two and a 1-12 and two F-12 tractors were added to 
the equipment. This has enabled the farm to increase the acreage by the develop- 
ment of new land. An area of approximately eight acres has been added to the 
land under cultivation. This new land will be used to produce green hay the first 
part of the season of 1938 and later will be planted with garden crops. 

One new and one rebuilt silo were added to the dairy barn this year. Ensilage is 
an important factor in keeping the milk production on a constant level. When 
only green feed is used the flow of milk becomes irregular. The ensilage can be 
used during the first six months of 1938 and will mean a considerable saving in 
purchased feed such as beet pulp and hay. 

With the addition of the silos the acreage of land used for the production of hay 
can be reduced. This will permit a better rotation of crops. Old hay land can be 
given a rest through plowing and cropping it with turnips. Such land will probably 
give a heavy yield. Proper rotation means better production on a smaller area and 
relative freedom from weeds. This farm has always been troubled by the weed 
problem but the prospects are better for a clean and weed-free land through such 
a system of crop rotation. 

One of the important improvements made during the year is the installation of 
the first section of an irrigation system. The control of moisture will undoubtedly 
permit a greater crop production with a smaller area and such crops can be brought 
to maturity from 10 to 15 days earlier with artificial irrigation than under Nature's 
system of watering. It is planned to continue the installation of sections of the 
system until the entire garden area is so treated. 

One of the problems that confronts every head farmer in a mental hospital is 
the question of reconciling the occupational and industrial therapy for patients 
with the need for continued production. Certain demands are laid upon the farm 
for food production and at the same time there is a demand for patient occupa- 
tion. The farm personnel has accepted both responsibilities during the year 
and it is my opinion that these two points of view can be adequately met by 
constantly impressing upon those who are in charge of farm work as well as those 
who are in charge of patients, the necessity for properly teaching each patient to 
work efficiently. It is my observation that work carried on in an orderly, systematic 
manner with the patient carefully instructed in the best way to work with a mini- 
mum amount of exertion, is better treatment than work which is performed accord- 
ing to the pecuUar ideas of the individual patient. Work planned in this way 
improves efficiency and speeds up production. 

Engineer's Report 
Warren G. Proctor, Chief Engineer 

Four major changes have taken place at the power plant during the last year: 
Structural changes; electrical modernization; new type of refrigeration; addition 
and replacement of steam equipment. 

The structural changes consisted of raising the roof of the old boiler room, roofing 
over the old coal pocket, removing the old square chimney, building a new engine 
room in the old boiler room, partitioning the old coal pocket into four rooms, one 
for oil storage tanks, one for coal storage, a utility room and a small coal prepara- 
tion room. 

The old machine shop was divided into three rooms, one room to house the new 
boiler, feed water heater and receiving tank, another room for a new engineer's 
office which overlooks the boiler room and engine room, and the rest of the space 
for switch-board and electrical controls. 



P.D. 23 35 

The new plant is now very compact. A new cement floor has been laid in the 
boiler room and steel stairs and walks over the boilers which will make all parts of 
the room easily accessible. 

Electrical modernization. — Consisted of changing from direct to alternating 
current. 

Three new generators were installed each one of which is capable of generating 
as much current as our six old generators. These generators are connected by gears 
to turbines except one which is directly connected to an engine. 

All motors throughout the hospital have been replaced except in the laundry 
which are now supplied with direct current from a motor generator set. 

Electric clocks are being installed which will be operated by the new current. 

By means of transformers the current can be sent longer distances without drop 
in voltage which has made it possible to supply the farm group and also the cottages 
on Belmont Street from our plant. 

All wires in the sub basements are now in conduit which is much neater in 
appearance and eliminates a fire hazard. 

Much more electrical equipment can now be installed at the hospital at less 
expense to the State due to the adoption of alternating current. 

Due to the installation of new wires in conduit several leaks have been eliminated 
where the current had been discharging into the ground. 

New type of refrigeration. — Our old refrigeration system was very inefficient, a 
large amount of power being necessary to produce the required results. 

Five small electrically driven compressors with automatic controls are now 
doing the work. 

A new type of refrigerant "freon " has been used in place of anhydrous ammonia, 
the new gas is odorless and therefore much more safe than ammonia and due to this 
fact it can be used direct to the ice boxes. 

The cooling units are now placed in the top of the ice boxes instead of on the 
sides and this alows for more storage space. 

As there are several machines it is possible to operate boxes at controlled tem- 
peratures over a wider range for instance, meat boxes will be kept at 32° F while 
vegetable boxes will be kept at 40° F and ice making tanks at 10° F. Great care 
has been taken to prevent the loss of gas, all joints are sealed and the operating 
cost of the new units should be much lower than with the old equipment. 

Many additions and changes have been made to the steam generating equipment 
by the installation of a new five hundred horse power boiler, boiler feed water 
heater, new boiler feed pump, circulating pumps for return water, and oil burners. 

For the first time in many years the hospital has ample boiler capacity, this 
insures steady heat, light and power, with one or more boilers ready for service at 
any time. 

As a result of the installation of this new equipment we have been able to release 
twenty patients who have been wheeling in coal and removing ashes. 

The allowable working pressure of the boilers has been raised from 110 to 150 
lbs. New steam pipes from boilers to engines and turbines have been installed and 
the loop system used which will enable the operators to remove pressure from certain 
sections of the steam pipe for purposes of change or repair without interruption 
of service. 

Two new hot water tanks for domestic supply to the hospital have been placed 
in the utility room. These tanks are copper lined and are equipped with twice the 
heating capacity of our old tanks. 

Two turbines and one engine have been installed to drive generators. These 
units are very compact and will use much less steam than our old units while 
generating an equal amount of current. 

The educational program has been continued, several men are studying for higher 
licenses and one man, Mr. Harney passed the examiation for second class fireman. 



36 



P.D. 23 



Report of Maintenance Department 
Anton Svenson, Maintenance Foreman 
The maintainence and repair work of a mental hospital can be classified under 
several headings: — 

1. The ordinary day by day work of making the small repairs of the hospital. 
This is a never ending task. 

2. Carrying out larger construction projects which represent radical changes 
made in the interest of increased efficiency. 

3. Supervising projects which are being built under special appropriations 
granted by the legislature. 

4. Inspection of work being done by contractors to see that the specifications 
are complied with. 

The ordinary maintainence repair work has been carried on during the year as 
rapidly and completely as the limited mechanical personnel permitted. The up- 
keep of buildings from sixty to more than one hundred years old which are occupied 
by mental patients many of whom are deliberately destructive means more in time, 
money and labor than would be the case in an ordinary building. During the year 
the painters replaced 6,000 panes of glass. We used 5,000 feet of window cord, 500 
gross of screws and 25 kegs of nails. All of this material went into the routine 
maintainence of the building. 

The painting program has been increased through W. P. A. labor. Fifteen wards 
have been completely redecorated and the work will proceed at the same rate in 
1938. 

The range of special maintainence projects carried on during the year is a wide 
one. Many of them occupied the time of one or two men for two or three days 
but in the aggregate they make up a tremendous total. 

Special projects during the year were the renovation of the Quinby wards and 
rebuilding the porch on the administration building. These were carried out 
with outside labor but under the direction of the maintainence foreman. 

The establishment of better stock storage facilities has resulted in a considerable 
saving. The stock man is now directly in charge of the foremen and the stock for 
each job is issued directly by him. This system will later be extended to include a 
system of planning and dispatching the work and the incorporation of a simple 
cost system which will facilitate budget preparation. 



Land, 584.95 acres . 
Buildings and Betterments 



VALUATION 

November 30, 1937 
Real Estate 



Travel, transportation and office expenses 

Food 

Clothing and materials 
Furnishings and household supplies 
Medical and general care . 
Heat and other plant operation 

Farm 

Garage and grounds 

Repairs 



Personal Property 



Real estate . 
Personal property 



Summary 



$389,507.00 
2,548,944.53 

$2,938,451.53 

$9,429.76 
13,984.07 
27,664.50 
285,710.14 
67,672.31 
3,848.39 
51,018.72 
10,014.82 
20,769.96 

$490,112.67 

$2,938,451.53 
490,112.67 

$3,428,564.20 



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, 1937. 

Statement of Earnings 

Board of Patients 

Personal Services 

Sales: 

Food $2,248.19 

Clothing and materials 45 . 80 

Furnishings and household supplies 

Medical and general care 



$71,597.26 
275.59 



73.05 
107.66 



P.D. 23 



37 



Heat and other plant operations 84.00 

Garage and grounds .50 

Repairs ordinary 310.90 

Farm (horses and harness, $26; cows, calves and pigs, $605.03; hides, $98.95; 

vegetables and tools, S78.50) 808.48 

Total Sales 3,678.58 

Miscellaneous: 

Interest on bank balances $137.50 

Rents 1,496.09 

Soil conservation 276.00 

Tel. Com. (S116.80) Misc. (S65.38) 182.18 

Total Miscellaneous 2,091.77 

Total earnings for the year $77,643.20 

Total cash receipts reverting and transferred to the State Treasurer $77,617.70 

Accounts receivable outstanding December 1, 1936 $29.50 

Accounts receivable outstanding November 30, 1937 55.00 

Accounts receivable increased $25.50 

Maintenance Appropriation 

Balance from previous year, brought forward $25,595.37 

Appropriation, current year 1,079,887.00 

Total $1,105,482.37 

Expenditures as follows: 

Personal services $594,944.61 

Food 198,811.60 

Medical and general care 42,530.98 

Religious instruction 2,960.00 

Farm 28,945.88 

Heat and other plant operation 92,949.36 

Travyel, transportation and office expenses 10,385.41 

Garage and grounds (garage, $6,341.15; grounds, $657.91) .... 6,999.06 

Clothing and materials 21,540.86 

Furnishings and household supplies . 37,339.94 

Repairs ordinary 16,442.32 

Repairs and renewals 15,940.55 

Total maintenance expenditures $1,069,790.57 

Balances of maintenance appropriation, November 30, 1937 35,691.80 

$1,105,482.37 

Special Appropriations 

Balance December 1, 1936, brought forward $317,726.07 

Appropriations for current year 9,000.00 

Total $326,726.07 

Expended during the year (see statement below) $242,464.65 

Reverting to Treasury of Commonwealth (Star balances below that are reverting) * 229 . 63 

$242,694.28 

Balance November 30, 1937, carried to next year $84,031.79 





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, PVVA D. 6243 




$89,404.87 


_ 


$89,404.87 


— 


Standpipe, M.S.P.M.-39, PVVA 












D. 4640 




40,966 . 13 


- 


40,966.13 


— 


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












48, PWAD.4465 . 




109,765.03 


$59.92 


109.765.03 


- 


Sprinklers and rewiring, M.S. P. 












M.-49, PWA D. 5308 . 




115,138.38 


1,140.75 


115,138.38 


— 


Hydrotherapy building, M.S.P. 












M.-50, PWA D. 4657 . 




127,173.41 


14,722.37 


126,304.92 


$868.49 


Window calking and weather 












strip 


249-1935 


5,000.00 


3,172.07 


4.777.82 


222.18* 


Roof repairs .... 


249-1935 


7,700.00 


- 


7,697.38 


2.62* 


Quimby Ward building renova- 












tion 


249-1935 


18,000.00 


3,000.62 


17.995.17 


4.83* 


Mechanical refrigeration . 


249-1935 


14,400.00 


4,543.32 


4.543.32 


9,856.68 


Porch — Administration build- 












ing 


304-1936 


5,500.00 


5,147.83 


5,148.50 


351.50 


Plumbing — Summer St. Hos- 












pital 


304-1936 


12,300.00 


6,554.88 


12,237.86 


62.14 


New boilers, stokers, etc. . 


304-1936 


270,000.00 


204,122.89 


206,107.02 


63,892.98 


Fire alarm system 


304-1936 


9,000.00 


- 


- 


9,000.00 




$824,347.82 


$242,464.65 


$740,086.40 


$84,261.42 


*Less Reverted .... 










229.63 




$64,031.79 



38 P.D. 23 

Per Capita 
During the year the average number of patients has been, 2,453.1. 
Total cost of maintenance, $1,069,790.57. 

Equal to a weekly per capita cost of (52 weeks to year) $8.3864. 
Total receipts for the year, $77,617.70. 
Equal to a weekly per capita, $.6084. 
Total net cost of maintenance for year, $992,172.87 
Net weekly per capia, $7,778. 

Respectfully submitted, 

Margaret T. Crimmins, 

Treasurer. 

Financial statement verified. Geo. E. Murphy, 

Approved Comptroller. 

STATEMENT OF FUNDS 

November 30, 1937 

Patients' Fund 

Balance on hand November 30, 1936 $8,884.71 

Receipts 9,244.44 

Interest 137.50 

$18,266.65 

Expended $10,932.59 

Interest paid to State Treasurer 137.50 

11,070.09 

$7,196.56 

Investments 

Worcester County Institution for Savings $1,000.00 

Worcester Five Cents Savings Bank 1,000.00 

Worcester Mechanips Savings Bank 1,000.00 

Peoples Savings Bank 1,000.00 

Bay State Savings Bank 1,000.00 

Worcester Depositors Corp. (Class A Cert.) 70.00 

Balance Mechanics National Bank . . . 1,904.15 

Cash on hand December 1, 1937 222.41 

$7,196.56 

Canteen Fund 

Balance on hand November 30, 1936 $892.80 

Receipts 20,806.75 

$21,699.55 

Expended 20,740.95 

Cash on hand November 30, 1937 $958.60 

Investments . 

Worcester Depositors Corp. (Class A Cert.) $112.00 

Mechanics National Bank 702.40 

Cash on hand November 30, 1937 144.20 

$958.60 

Wheeler Fund 

Balance on hand November 30, 1936 $1,029.42 

Income 25.00 

$1,054.42 

Investments 

Worcester Mechanics Savings Bank $1,000.00 

Balance Mechanics National Bank 54.42 

$1,054.42 

Clement Fund 

Balance on hand November 30, 1936 $1,000.00 

Income 25.00 

$1,025.00 

Expended 25.00 

Balance on hand November 30, 1937 $1,000.00 

Investments 
Worcester County Institution for Savings $1,000.00 

Lewis Fund 

Balance on hand November 30, 1936 $1,335.97 

Income 32.50 

$1,368.47 

Investments 

Worcester Five Cents Savings Bank $1,300.00 

Balance Mechanics National Bank 68.47 

$1,368.47 

Manson Fund 

Balance on hand November 30, 1936 $1,087.09 

Income 25 . 12 

$1,112.21 

Investments 

MUlbury Savings Bank $1,111.38 

Balance Mechanics National Bank .83 

$1,112.21 



P.D. 23 39 

Rockefeller Research Project 

Balance on hand November 30, 1936 $2,501.12 

Receipts to November 30, 1937 15,403.29 

$17,904.41 

Expended to November 30, 1937 16,048.11 

Balance on hand November 30, 1937 $1,856.30 

Investments 
Worcester County Trust Co . $1,856.30 

Insulin Treatment for Dementia Praecox 

Check Received March 10, 1937 $1,000.00 

Expended 994.46 

Balance on hand November 30, 1937 $5.54 

Investm,ents 
Worcester County Trust Co $5.54 

STATISTICAL TABLES 

As Adopted by the American Psychiatric Association Prescribed by 

THE Massachusetts Department op Mental Diseases 

Table 1. General Information 

(Data correct at end of institution year November 30, 1937) 

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 $2,993,514.52 

Personal property 490,112.67 

Total $3,483,627.19 

Total acreage of hospital property owned, 589.16. - - ^ 

Additional acreage rented, 75. 

Total acreage under cultivation during previous year, 177. 
Publication of this Document approved by the Commission on Administration and Finance 
550. 4- '38. Order 3761. 
Officers and employees: 

Actually in Service at Vacancies at End 

End of Year of Year 

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

Superintendents 1 - 1 - - - 

Assistant physicians .......11 1 12 2 - 2 

Clincal assistants 2 - 2 - - - 

Total physicians 14 1 15 2 - 2 

Stewards 1 - 1 - - - 

Resident dentists 1 - 1 - - - 

Pharmacists 1 - 1 - - - 

Graduate nurses 5 72 77 - 2 2 

Other nurses and attendants .... 138 156 294 _ _ _ 

Occupational therapists - 4 4 - 1 1 

Social workers - 3 3 - 1 1 

All other officers and employees . . . .141 86 227 7 18 

Total officers and employees . .301 322 623 9 5 14 

Classification by Diagnosis, September 30, 1937 
Census of Patient Population at end of year: 

Absent from Hospital 

Actually in Hospital but still on Books 

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

Insane 1,115 1,156 2,271 228 251 479 

Mental defectives - 3 3 - 1 1 

All other cases 1 3 4 - 6 6 

Total 1,116 1,162 2,278 228 258 486 

Other Races: 

Insane 26 29 55 2 1 3 

Mental defectives - 1 1 - - - 

Total 26 30 56 2 1 3 

Grand Total 1,142 1,192 2,334 230 259 489 

M. F. T. 
Patients under treatment in occupational-therapy classes, including physi- 
cal training, on date of report 108 273 381 

Otherpatientsemployedingeneral work of hospital on date of report . 561 483 1,044 

Averagedajly number of all patients actually in hospital during year .1,160.43 1,181.48 2,341.91 

Voluntary patients admitted during year 9 2 11 

Persons given advice or treatment in out-patient clinics during year . 165 120 285 



40 



P.D. 23 



OS b <! 



I t^clO I OO 



I PO I OfO I I m I 

I I I cs cs I I cs I 

I 1^ I 00»H I I « I 

CS « rt CO "1 I VO -rt I 

"-I CN 

»H rt CS •* 00 I f»3 »H I 

'H I CS Tjl t~ I C*5 O I 

♦-<00^VOCv|«*rr5 CS 



CS 



t^O 



< CS 



■rtCT(Q I O 



CN mcscNvcm !«« 



00 f»5 CNiO I ioc»5 



irt CNOoOf^fioo — < to (K) t^ rt CN ■* r» CNd'-i 

-100rt'*>OCN ~ 



t^ ^ ^H»0 O ^ 



P*0 lO C^^ 00 CN lO 
CN OOt^O CNOi.»-H 
't ^ CN CN t^ 



CN t^ OnOIO H-f ro 



a\oo ^ pot^ w^ »o ^o^o 

M rt CN rt CN-* 



llOOOC*500lOd, CN th©.-< 



Or*t^f^Ot>» ^ t^ *o ^ OOCN '^ -^ 
Tj* ^ lO Tji O 00 ro O f*^0 PO^ OOO 
lr)CN^~ oo>o "-H rt ^ri< csr~ 



IT) t^Ot^OOlOO >0 c«5 r* \o CO t^ Tjl Ov CN 0\ '-I 

CN CNON'^CN'^I^ >* Ov i-i c^ 00 "-I th rn CMO IT) 

^_CNroc<5t>^ ■-iT-<f»;^-icNTi< 

CN t^^^O"^"^^- Oi"* cnuiOioOio cnOcn 




H 00 PC •H CO 

CN CN 



?> •>* 00 1/5 r-l O 
Ji>OT(ICNOiO 

E^00 00t~ 



•^OOtSINOO'* '*p»5 



Ocv 

li 
cd 
n; 
>. 

C 

3 

O . 

o 

X! 

u c 

11 

:°i 
-SI 

E-S 
«.B 




iO 

^o 

1t^ CSO 

" 9. 
■o" • ■ 

CO 

u 
. 4, . . 
X! 

E 

• lU . ■ 

a 

0) 

• W . ■ 

a 

.2 E 

> 

c o 

■ « ■ '^ 

.| . .2 
.5 "J 

.E .£ 
*" >. 

■« ■ '.'H 
3 ca 

■S . ■» 

« C 

•q ■ -.S 
0) a 'g oj 


>Oo 
CN, 

b^ 

CO 

o\ 
o" 

CO 

OJ 
£ 

a 

OJ 

w 

(J 
>. 

£ • 

q ■ 

q • 

a 
a ■ 


non-insane patients in hospital at end of institution year: ' .' 
' defective 

. . ." .' 1 



M 3 ta > 



J'> O 41. OS 
J3 )- u, -y 1- Cfl £ 

/I. l'.^ — rt -J- '3 D -^ 






P.D. 23 41 

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 » 


210 


135 


345 


101 101 87 


54 60 47 


Austria . 






3 


- 


3 


3 3 3 


_ ■ _ _ 


Canada 2 






31 


28 


59 


59 59 48 


37 40 33 


China . 






_ 




_ 


1 1 1 




Czecho-Slovakia 






— 


1 


1 


_ _ _ 


1 1 1 


England . 






6 


7 


13 


9 8 7 


13 8 8 


Finland . 






2 


3 


5 


3 3 3 


4 4 4 


France 






1 


— 


1 


_ _ _ 


_ _ _ 


Germany 






1 


- 


1 


3 2 2 


1 1 1 


Greece . 






2 


- 


2 


2 2 2 


1 1 1 


Holland . 






— 


1 


1 


_ _ _ 


1 1 1 


Ireland . 






11 


21 


32 


45 40 37 


40 37 34 


Italy 






8 


6 


14 


14 15 14 


12 11 11 


Norway . 






— 


1 


1 


_ _ _ 


2 1 1 


Poland . 






4 


5 


9 


8 7 7 


10 10 10 


Portugal 






— 


1 


1 


_ _ _ 


1 1 1 


Russia 






5 


1 


6 


12 13 11 


4 4 4 


Scotland 






2 


3 


5 


3 5 3 


4 4 3 


Spain 






— 


- 


- 


_ _ _ 


1 1 1 


Sweden . 






14 


6 


20 


18 19 18 


9 10 9 


Turkey in Asia 






4 


1 


5 


3 3 3 




Wales . 






— 


— 


- 


_ _ _ 


1 


Other Countries 






9 


6 


15 


14 15 13 


9 9 9 


Unknown 






- 


1 


1 


15 17 12 


23 22 20 


Total 






313 


227 


540 


313 313 271 


227 227 199 



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



42 



P.D. 23 



CO 



0:J 



ttj 



.'*?. 







^i 




h 


1 1 1 1 1 1 1 1 1 1 1 1 '^ 1 1 




rt 






— r o 
















' ■- S 




fe 


1 1 1 1 1 1 1 1 1 1 1 !<-< 1 1 




,_, 






■y-M 




















§■ 


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




1 








c 
















^ 


H 


1 f 1 1 1 *-< 1 i i-< 1 1 tH*M ^ 1 




ui 








o 
















c 


fc 


1 1 1 1 1 1 1 1 -H 1 1 1 — 1 1 




fs 






z ' 


c 














o 


D 


S' 


1 if 1 1 -1 i i 1 1 1 'H f-. 1 ' 




f»> 






H 


1 «rt«p»50\r^'-i0v>00v>0f^NO 


t^ 


O 






CO *-• 


•rtCN'rti-l»-l»-lCNi-lr-l 




r^ 






Q 


IH 11 














< 


rt > 














1) o 


fe 


l»H| icspo'*t~ovt~a>>'5'>*>oui 


<ri 


>0 






W 


^--a 






(^ 






a 


lO c 














s 

w 

cq 

M 
H 


-^ ca 


§ 


1 1 rt-H-^vOO'*00\0'-<cX)^OiO 


■* 


m 












a 




a; 


1-1 »-• 


H 


1 |fSrt(NW5| |rt|«| 1 1 1 




o 




O 

m 


<! 
H 


1 « 

2^ 


fe 


1 1 «-HtN(N 1 1 « 1 'H 1 1 1 1 




00 




Z 


Q 




:§■ 


1 1 '- 1 1 rt 1 1 1 1 1 1 1 1 1 




CN 




O 














hH 






H 


llleslll-Hiil-Hiii 




^ 




Pi 


2 












' D 


=^2 


te 


lll'Hlll«lll'-'lll 




fO 




o 


z 


■"Si 










fe 






S 


1 1 1 tH 1 1 1 1 1 1 1 1 1 1 1 




'^ 






m 


H 


1 1 -Hrt-H 1 1 1 1 1 1 ^ 1 rt 1 




lO 






H 


li 
















to 


III— lllllll«l«l 




fO 








^ >. 
















12 


§■ 


1 1 - i - 1 1 1 1 1 1 1 1 1 1 




fS 








H 


1 »H'*m>omfotN'rtvooo\(n'<to 


t>. 


T)< 










•-l<-ICNCS'H04rt<v)'-(>-l 




On 








"rt 


to 


1 rt rt fo "* UT* 00 « t^ O t^ lO t^ lO 


c^ 


^ 








o 






o\ 








H 


















§ 


1 1 r«5 cs CS 00 0> •* O On O CS 00 t^ lO 


'^ 


f^ 










,_j rH — -H 




O 










H 


1 M O) M ro ro ■* "-H CN ts —1 >-< ro CN "-1 


^ 


O 








s 






ro 








^ 
















o 


to' 


l-H-^tSCNtSCSlCNl |T-ltST-l-H 


1 


^ 








c 
















D 


S" 


1 |rt«MrtCNl»H|CS-l|THM| 


^~* 


ro 








CSOMMrOt~OOCNOO>OOOOOCS'*IO 


fS 


■* 










H 






ro 








01 

> 
















to' 


ltrmrri\o^rtirr>e^ Irofoui Ics 


tN 


t^ 

■* 




o 


H 

z 

w 


z 


§ 


tN'<l«OvO'-<-*>0 0>OiOiOiot^'*r<5 


1 


00 






H 


1 CNr«5iO'*'*t«5incNTH— 1 «rt 1 


1 


o 




m 


< 

fc 














w 




to 


1 |(S'*CNM»H(N(NI«I IthI 


1 


t^ 




> 




i 


S 


|(M«MtSCS(N«l»H| I -^ \ 1 


1 


ro 




< 


















H 


«f5vO>C r^OO CNOt^O (NOOr^ 1 


f^ 


^ 














lO 








C 
















M 
















'S 


to 


1 0^ u^t^ O '^ ^^ P*^ CS »H 1 f^ »0 1 


^ 


lO 








O 

to 
















i 


•rt rf »-( Ov 1^ ts vo "1 1~ in 0\ tN >0 cs 1 


CN 


t^ 










« w« 




On 








H 


f^u^f^I^t^PCl^-CNCNloOi-tTt^T^vO 


>o 


■O 










CNrOrCTt<f^tNCSCNMCN>-<CN— 1 




•* 








_ 








r^ 








rt 


to' 


1 i/)-i\o>0'*'-iO\OCS'0'*Ot^o 


fo 


lO 








o 






r<5 








H 


















S' 


fOOCS'-i-HO.'OrOPOr«5>nt^'tf^f<^ 


f«2 


O 










iH CS tN r«5 "-1 "-I "-I •-< '-I '1 '-' 




*-H 
















cs 












fOOI^tSroOO-*fo-HOOoOoOO 


r^ 


o 






ID 




H 


csr<T*iOTf*"*'>*fO'*r^'*(N«-< 




■* 






S, 










•o 






bo 




to' 


1 >0 CN 0\ O Oilil t~ O CMO -H >0 ■* 00 


O 


t^ 






£. 




« rt W CS rl TH M CVl »-H«CS»-l 










bo 










cs 








S' 


c«50ir)f<5rci^iOt^MCNioO\cS'*oo 


t^ 


fTl 








-H(NCNr»5tNCS(NCNtN04'-ICN« 




n 






H 1 


^ 






U( 


"m 




c 






w IS c 

<< 


<l 




^O\^O\^0n^Cn^0\^0^^0\^ n 


01 


o 
H 










>-i— iCNtNrOro-^TjiiOlO'OvOl^f^OO 

1 111 1 111 1 IJ-llll 


> 

o 












T-icscsr«5r»>'#'*io>oO>Ot^t^oooo 







P.D. 23 

Table 5. Citizenship of First Admissions 

M. 

Citizens by birth - V- ; < . .- - . v ,---,...,.., , . 210 

Citizens by naturalization . . '. . . 42 

Aliens '. . . 26 

Citizenship unknown . . . . . . . . . . ■. . . \35 

Total . ... . . . . . . . . . . . . 313 



43 



F. 


T. 


135 


345 


11 


53 


25 


51 


56 


91 



540 



Table .6. Race of First Admi 


ssions Classified with Reference to Principal Psychoses 


Race 


Total 


With 
syphilitic 
meningo- 
encephalitis 


With 

other 

forms of 

syphilis 


With 

other 

infectious 

diseases 


With 
Alcoholic 
psychoses 


Due to 
drugs, etc. 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) . 
Armenian . 
Chinese 
Dutch and 

Flemish . 
English 
Finnish 
French 
German 
Greek . 
Hebrew 
Irish 
Italian 1 
Lithuanian 
Portuguese 
Scandinavian 2 . 
Scotch 

Slavonic^- \ •: 
Other specific 


3 
5 

1 

15 

3 

39 

1 

4 

12 

57 

IS 

9 

18 
5 

-»■ 

1 

108 

9 


3 

2 

1 
15 

4 
32 

2 

2 

4 
40 
12 

7 

1 

9 

4 
-14- 

65 
10 


6 

7 
1 

1 
30 

7 
71 

3 

6 
16 
97 
27 
16 

1 
27 

9 
—22- 

1 

173 

19 


2 - 2 
1 - 1 


















1 - 1 


- - - 


- - - 


- - - 


- - - 


- - - 


- - - 


•1 - 1 


- - - 


6 - 6 


- - - 


1 - 1 


6-6 


- - - 


1 - 1 
2-2 
4-4 
1 -.1 
1 1 2 


















- - - 


- - - 


7-7 


- - - 


^ ■_"----■ 


- "- "-' 


2 1 3 


_ _- :: 


1 - 1 
1 - 1 


,_.- 


I . Z I 


1 - 1 
1 1 2 
3 3 


1 .1 I 


Mixed 

Race unknown . 


8 1 9 
1 - 1 


- - - 


2-2 


10 - 10 


2 1 3 










Total . 


313 


227 


540 


29 2 31 


1 - 1 


3-3 


31 2 33 


2 1 3 



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



Race 


Traumatic 
psychoses 


With 
cerebral 
arterio- 
sclerosis 


With 

other 
disturbances 
of circulation 


With 
convulsive 
disprders 
(epilepsy) 


Senile 
psychoses 


Involu- 
tional 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 




— _ — 


- 2 2 
1 - 1 










Armenian 

Dutch and Flemish 

English . 

Finnish . 

French . . 

German 

Greek . 

Hebrew . . " 

Irish 

Iialian.i.„,.,, . ,.„.,_,,,. 

Lithuanian . 

Portuguese . 

Scandinavian 2 

Scotch . 

Slavonic ^ 

Other specific races 

Mixed 

Race unknown 


- 


- - - 


- - - 


- 1 1 


- - • - 


- - - 


5 5 10 






2 2 4 










. 1 - .L„ 


4 7 11 

1 - 1 

1 1 

1 - 1 

11 14 25 


1 1 2 


- - - 


5 3 8 


1 - - 


3-3 


- - - 


1 - 1 

1 12 13 

,--r_.,l-..J 


4-4 










_ _ _ 


4 - . 4 
2-2 
- 1 1 


3 1 4 
1 - 1 


- - - 


1 3 4 

- 1 1 

- 1 1 


- 1 1 

- 1 1 

- 1 1 


_ _ _ 


27 16 43 
- 5 5 


1 1 2 
3-3 


1 2 3 


1 2 3 

2 1 3 


1 2 3 


Total . 




1 - 1 


57 53 110 


12 3 15 


1 2 3 


13 27 40 


6 7 13 



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

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



44 



P.D. 23 



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



Race 


Due to 

other 

metabolic 

diseases, etc. 


Due to 
new growth 


With organic 

changes of 

nervous 

system 


Psycho- 
neurosis 


Manic- 
depressive 
system 


Dementia 
praecox 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) 

Armenian 

Dutch and Flemish 

English . 

Finnish . 

French . 

German . 

Greek 

Hebrew . 

Irish. 

Italian 1 . 

Lithuanian 

Portuguese 

Scandinavian 2 

Scotch . 

Slavonic ^ 

Other specific races 

Mixed 

Race unknown 


1 - 1 
1 - 1 




















2 1 3 










1 - 1 
- 1 1 








- 2 2 


1 3 4 

2 2 4 
6 14 20 


1 - 1 






1 - 1 


1 1 2 


2-2 












1 1 2 
4 3 7 
9 6 15 
6 3 9 
2-2 


3 3 6 


- - - 


- - - 


2-2 
1 2 3 


- 1 1 

1 2 3 

2 2 4 






- - - 


- - - 


- - - 


- 1 1 


1 - 1 


- - - 


- - - 


2-2 


- 1 1 


3 1 4 
1 - 1 
1 3 4 


1 - 1 


- - - 


- - - 


1 1 2 


- - - 


1 2 3 


1 - 1 


1 1 2 


5-5 


4 8 12 


19 21 40 
1 4 5 


Total 


9 6 15 


2-2 


2 1 3 


12 8 20 


9 17 26 


58 65 123 



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



Race 


Paranoia 

and 
paranoid 
conditions 


With 
psychopathic 
personality 


With 

mental 

deficiency 


Undiagnosed 
psychoses 


Without 
psychoses 


Primary 
behavior 
disorders 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) . 

Armenian 

Chinese 

Dutch and Flemish 

English . 

Finnish . 

French . 

German 

Greek . 

Hebrew 

Irish 

Italian i 

Lithuanian . 

Portuguese . 

Scandinavian ^ 

Scotch . 

Slavonic ^ 

Other specific races 

Mixed . 

Race unknown 


















































2 1 3 


1 - 1 




- - - 


2 1 3 


- - - 








- - - 


5 5 10 












1 - 1 
1 - 1 


1 - 1 
1 - 1 


- - - 


1 - 1 


1 - 1 

1 - 1 

10 1 11 

4 3 7 
3-3 


_ _ _ 


1 - 1 


- - - 


- 1 1 


- - - 


- - - 


1 - 1 


- - - 


- 1 1 


- - - 


1 1 2 


- - - 


- 1 1 

4-4 


1 - 1 


1 1 2 
3-3 


- - - 


- 5 5 

17 7 24 
1 - 1 


1 1 2 


Total . 


10 2 12 


4-4 


4 5 9 


1 - 1 


45 25 70 


1 1 2 



ilncludes "North" and "South". 
^Norwegians, Danes and Swedes. 

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



P.D. 23 



45 



Q^ 



O 





H 


^ 1 — -^o^ 1 -H 1 1 1 1 rsw 1 ojrsON 1 — 1 00 1 




5S2 








fe 


•Hi 1 l-Hl-ll 1 1 1^1 1 1 cs^o 1 1 — 1 tN 1 


lO 


-* >. 










S' 


f^ 1 'HTj<^ 1 1 1 1 1 1 'H« 1 cs 1 ^cs 1 1 1 vo 1 


lO 




H 


^1 Irol 1 ICN— 1|— 1| l-H-Ht^00rt| Irtvol 


\o 






•* 


a (0 








1 rt 


fe 


lllllll—ll—ll-ll <*0 1 1 1 1 CN 1 


a 


lO 4J 






r»5 >. 










S 


TJH| lf.^1 1 iTHrtI 1 1 1 IrtPOOOrtI \ ■^t t 


cs 




H 


<ri \ |vOI 1 1 l-H| l-H| 1 r^iOOO-H 1 -H 1 rO« 


f5 




vH ^H 


ui 


•* m 








O (U 


fe 


1 1 1 1 1 1 : 1 — 1 1 -H 1 1 -irvia 1 1 1 1 ■* — 


O 

CN 


r<5 >i 










S 


f^l loi 1 1 1 1 1 1 1 i itstsa'Hi^iovl 


CO 




H 


!N| ICSl-Hl 1^1 |rt|Jrr>CS-H|-H| loOl 


CN 




cs 


■* 


0> to 

1 ca 








fe 


-III— llll'-'llllll — (N 1 1 1 1 c«5 1 


a 


lO n 






o) >. 










§■ 


-H| |rt|rt| 1 1 1 |,H| 1 r*2-Ha 1 -H 1 1 lO 1 


CO 




H 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 i^^ — p^ 1 ^m 1 t^ 1 


CO 


'^ m 








CN ti 








1 rt 


fc 


llllllllllllll<N-HVOl|-H|(Nl 


cs 


O m 




^^ 


<N >. 










§■ 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 t-. 1 — (>g 1 m 1 


lO 




H 


lllltllllllll|rO'*C>l-H(Mlt~| 


CN 


Ov m 


















fe 


1 1 1 1 1 1 1 1 I 1 1 1 1 1 fO<NlO 1 1 !N 1 •* 1 


>o 


^ >> 










S' 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CN-* 1 rt 1 1 r., 1 


o 




H 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CSrt 


CO 


t " 








1 0) 


b 


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


1 


o >. 










§■ 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 (N-H 


CO 






■rt'rHp«)f»)f*5T-(Oior'>Ot»5U^CNroO>Or»5tN'*0\«OtS 


O 




H 


r<^ rr, rt -H •* « -( CSCSCN-H (^ 


•>* 


►J 


—1 rt 


lO 








< 




tNl ItN'rtlrOrOtSt^t^vOI'HOOI^lOeSllOllO — 


t^ 


H 
O 


fc 


>0 <N -(O (N 




H _ 












CN'rHrC-HtNrtt.c^'-<rovOO\CNCNtsaoOO-*Tj<rtiil— 1 


CO 




s 


CN CO U^ •-* —^ i-i lO'H Tt 


CO 






6 












O 
X 
u 
>• 








U5 

a, 




0.2m m^vji S t- m'a^ 

11 2 oj Sop si^mqC S 

1 ;l s Jill -III =-!. 1511 s! 














c?OOOOpoOo"3OOoO'COaEb03C 


"rt 












o 








H 



46 



P.D. 23 



'^ 



fc. 



CO u 

u V 

n > 
V o 

^ « 

00 c3 




1 1 1 1 1 1 vOtH 1 VO 1 1 1 1 1 1 1 1 1 1 1 1 1 
1 1 1 1 1 1 r^ 1 1 f^ 1 1 1 1 1 1 1 1 1 1 1 1 1 
1 1 1 1 1 1 ro-- 1 re 1 1 1 1 1 1 1 1 1 1 1 1 1 


t«5 


■* 0] 
00 >> 




IllllloOr-ll^lllllllllllll 
1 1 1 1 1 1 ^ 1 1 rC 1 1 1 1 1 1 1 1 1 1 1 1 1 
llllll'«l<'-i|rolllllllllllll 


00 
00 


0\ TO 

1 rt 

IT) <LI 




1 1 1 1 1 1 r^-" 1 0\ 1 1 1 1 1 I 1 1 1 1 1 -< 1 
1 1 1 1 1 1 00 1 1 vo 1 1 1 1 1 1 1 1 1 1 1 1 1 
1 1 1 1 1 1 C-i 1 m 1 1 1 1 1 1 1 1 1 1 1 « 1 


00 


■* to 

1 CS 




llllll'*csla>l'illlllllllcsl 
1 1 1 1 1 1 ifjcs 1 ■* 1 "H 1 1 1 1 1 1 1 1 1 1 1 


00 
CM 


1 rt 




1 1 1 1 1 1 >0 1 1 r<5 1 1 1 1 -H^-H 1 1 1 1 1 1 1 

tNI 1 1 1 lf-4| 1 ItNI-HJ 1 1— 1 1 1 |rH| 


o 

2 


"* CO 




1 1 1 1 1 1 ^O'H lOlillll^llll^l 


o 


0> CO 

IT) 1-, 

1 a 




rt| |10.-I|1/^10| |r»5rt| |»-I|10CS| 1 I(N| 
1 1 1 1 1 1 CN-H 1 1 — -H 1 1 1 1 ro-H 1 1 1 1 1 
T-l| |lOrt|<*)'*l ICSl 1 l»H|CS'-l| 1 Icsi 


cs 

CN 


■* CO 




1 1 1 1 1 1 ^ 1 1 1 ■*" 1 1 1 fOlO-H 1 1 1 (N 1 
Ov i (N-* 1 1 1 1 1 1 1 <-! 1 1 rt 1 rtTH,^rt 1 CN 1 


5 

o 


1 a 




rH| 1001 1 liHl |(Nrc|tsrOrt — rolwlool 
1 1 1 -H 1 1 1 1 1 1 «(N 1 1 ^ 1 00 1 1 « 1 ro 1 
-.1 It^l 1 t -^ \ |-Hrt|CN<N-rtrorcl 1 liDl 


CS 


7) 

« 

o 

o 
> 














E 

■B -S^- -ii -S 

~ CO « 11 to CO 

1 s^. -s -i • • •!>. 

■E^SS £-2|g Ji^gJ 1 g^g|„| 

11 M|lirtiil.lii| ill 

mmmmmmmM 

&o^goSS^8^3ooS|^g|aE^g& 


"(3 

O 



P.D. 23 



47 









-Hi \ rr, \ |«Ov|r^--H-H>H|(S(N-* -1 l-HO^I 


CO 




a 


H 


xjl .pH tH 


0-. 




& 










o 


fe 


1 1 1 1 1 1 u,^ 1 O^TH 1 1 1 tNOv 1 1 1 1 Tl" 1 


cs 




Ci 




lO 




J4 










C 
O 


S' 


^1 1 rr> 1 1 >Ooo I-*! I-H|cs|ir>l 1 1 -HIT) 1 










1 Iw^l |<-irt|rt| 1 1 I-hIvOI I 1 1—1 


n 




<u 


H 




■^ 




M 










_aj 


fe 


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


fi 




■q 










O 












i 


1 lrtrtl l«rtlwi 1 1 1 1 \ •* \ 1 1 I-Hl 


o 


C/3 






■^ 




H 


V) Irtcsrc ll^rt i^fs^t 1— ivoOroCNro 1 IOth 


es 


o 




-ri T-, 


OS 


-< 


J3 








U 


to o 




I 1 1 1— |u^— |«-H|^|— roOC^I 1 1 l^--( 


■* 


S5 


r:43 


fe 




•* 


M 


ffi,^ 








tt, 


w 


§■ 


lOI— (CNCMICSI 1 ItNf^l |rO'*^CSfOI l>Ol 


00 


"e 










Si. 






0\ 1 1 CN 1 wr<lf<lr^'rtt^a-H-'00Ol>O>O-H'* 1 •*'-i 


CN 




H 


•H c-l -^Ji rt . -HU1 r^ 


CN 


•e* 






1 




^ 


fc 


CSl |rt| rOrt<NOvc«5-*| I^'300C^■^|1N|O^I 


t^ 


(1, 


§■5 




00 


o 


o^ 




1^1 |rt|-HOtS--ICS'*<0'H'-'U^TJ<t^U^rt(N|U1-H 


■o 


^ 




S 


■rt CS ro CS CN 


lO 


5J 
S 


















^ 


•a 




«5rt^io| :t-.| ro-H'-Hl I'rtts — (NicslrsI 


lO 


i. 
^ 


H 




>o 


Cd (L) 








isy 






i 1 1 -H 1 1 •* 1 1 ro-H 1 1 1 -H-<^ 1 1 ,« 1 .* 1 


o 


M 


•a> 


hX4 




cs 






S' 


!*>-H-H'* 1 1 r^ 1 1 fO 1 -< 1 1 1 -Ht^cs 1 « 1 00 1 


1/^ 

CO 


s 






















H 


1 II II 1 n 1 1 ■-< 1 1 1 -H 1 : -H 1 \ -^ \ 1 1 


t^ 


<*^ 


O 








•e^ 






1 1 1 1 1 1 — 1 I 1 1 1 1 1 1 1 1 I 1 — 1 I 1 


CN 


CO 




fc 








•d 








^ 


ta 










OJ 


§■ 


IIII[|CS|I*~I|||— llwjjiiit 


lO 


o 


Oi 






V) 










s 




H 


t^: 1 1 1 lOO'Tllt-CNl 1 ICSlCSCNIOAl'*! 


fo 


o 


(U 




CO 


CO 


a 

u 

Si 


fc 


1 1 1 1 1 liol |lO<N! 1 I 1 Its— |«|rol 


2 


s 


jS 










""^ 


i 


to 1 1 1 1 1 fO— ICSl 1 1 |(M| I—I— |-H| 


•^ 








«««2rr]r<^-HOiOr<70rciDtNroOvOfOCS<#0\ — OCS 


O 




H 


fO fO — — -^jl w^ CN CS CN — i^ 


lO 


&H 










►J ' 








^ 


< 




ts 1 Its- |for»5tst^t^>0 1— oot~-iocs |io |io — 


t^ 


H 




fe 


lO CN — ^O CN 


CN 
CN 


?^ 


H . 








o 




0\ — c*^ — CN — t^CS — rOOO\CSCNCSO\OOOTi<TjH — IO- 


CO 


e 




S' 


CS ro lO— — — <o— 'ii 


CO 


O 










^ 










-e 










I^ 










*<--, 










o 










«i 










^ 










t~ 










c» 










(a 










Q 






c 




CO 






c s 

5 ■3->, ^ S 




H 


in 






m 

< 







;:? cam.-(U. ">••■„ 

a » fc;^ S o •2>. 




H 






j;»K ■ • ■.SoS ■ 's •£ •„ '^sS ■ • ■ ■ 

i-Sw ■ ■ ■Sr,,':' ■ '^ •— 'O -oO • • -4^ 






in 








CL, 




























o 








^*j= iu^-M-M_x;.ii!uc rtOco 


H 



















48 



P.D. 23 





a 
1 , 




1 1 1 1 1 1 -H- 1 1 1 1 1 1 1 1 C«3 1 1 1 -HrH 1 
1 1 1 1 1 1 'H 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 

1 1 1 1 1 1 1 - 1 1 1 1 1 1 1 1 rn 1 1 1 -H- 1 






+ 

§ 


0" 

10 


h 
fc 
§ 


•01 1^1 ICSl 1— 1 1 1 1 «SIOO\-HCS 1 1 •* 1 

1 1 1 -I 1 1 1 1 1 -H 1 1 : 1 ^^^ 1 1 1 1 CS 1 
<o 1 1 1 1 1 CN 1 1 1 1 1 1 1 wcNto-Hcs 1 1 es 1 


cs 

00 


o 

Si 

an 




H 

fc 

i 


00 -H CS -< CS •■I wj t~ —I t»3 Oi "-I »-i »-i CN r«5 yO — >-< 1 ■* -h 
>-< CS >0 est-i T-(rt>o fO 

CSl 1^1 ImcSlt^vO'*! |POt^T-..Hl 1 IcS'rt 

vo»-icsOcs-HcioiOT-i>o-*iO'H-Htio>ocsm'-n-i 1 cs 1 

■>H CS CS I»> CS 


00 

cs 


Pi. 








cs 1 1 1 1 1 CS 1 1 1 1 1 1 1 1 csro 1 1 1 1 -H 1 

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CS(N 1 1 1 1 -H 1 
MlllllCSlllllllll-Hllllll 


O 








'^ 1 1 --< 1 1 O-H 1 -^ 1 — 1 1 -H — 00 1 1 r«5 1 ro 1 

1 1 1 1 1 1 (N 1 1 1 1 1 1 1 — -HW) 1 1 CO 1 « 1 


cs 


CO 


2- 


to 


1 1 1 1 1 ll^l |rf>^| I-Hrtciool |T-,|ioi 
CNI^IO |-*CSl!N<Nl l-H-Hl^illwl IVOI 


o 

CO 





W 
CO 

1 


Si 


h 
fe 
§■ 


rtl |Tj<w|-r-.r»5CNO>l'Ol |eNf»500'!t<|-*l'-i-< 
1 1 1 IrtlvC— ItNiOI'Hl l-H'-lCS'-llrtlCOl 

-Hi !■*! luicslcolcNl l-HCN-oir)lroloo-< 


00 
CO 




H 
fe 
S 


'||||ICSllll-<ll'H|f«5llll-H| 
^1 1 ,H 1 1 irirt 1 w 1 ■^•,-^ 1 .H 1 ■^-H 1 1 I •* 1 


cs 

00 
CN 


S 


J - 



f-; 


rtrtr«rOr<T-iOirir/50r»5iOCSfr>0>0<r>CS'*CN'rtOcs 


o 





fe 


fS 1 1 CS-H ImrcJCSt^t^^ l-rtOOt^>OCS Im \ ITf^ 
10 cs "-lO CN 


cs 
cs 


1 


s 


r«rtr»3'HCN'<<^CS'Hf<)-CO\CSCSCNCv00O'*-*«->O'-< 

cs CO ■O'rt —1 -^ ■O'-i ■* 


CO 

CO 


Oi 




> 






"(3 
o 
H 


< 


s 

•2 -S^- -ii -^ 

g «^ . . .-s " " • -S . £: -co .=3- . ■ ■ „ 

C«aJ o"*- m JJ u eg JO 

V5| sSg ^ ^ 8| ^ 
•5"^ S°So SS S s? oaeg .2 

lll?l|^liyill 1? |l 5! 

&oooo|go8^^ooooigoaEM|^ 
.ti .t; ._ cj a pj •- .t; -t; c > 3 3 .- >> t« S is •- ■" c L- t: 



P.D. 23 



49 



Table 10. Economic Condition of First Admissions Classified with, Reference to 

Principal Psychoses 



Psychoses 


Total 


Dependent 


Marginal 


Comfort- 
able 


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 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 dis- 
eases, etc 

Due to new growth 

With organic changes of 
nervous system 

Psychoneuroses . 

Manic-depressive psychoses 

Dementia praecox 

Paranoia and paranoid con- 
ditions .... 

With psychopathic person- 
ality 

With mental deficiency 

Undiagnosed psychoses 

Without psychoses 

Primary behavior disorders . 


29 

1 

3 

31 

2 

1 
57 

12 

1 

13 

6 

9 
2 

2 
12 

9 
58 

10 

4 
4 
1 

45 

1 


2 

2 
1 

53 

3 

2 

27 

7 

6 

1 

8 

17 

65 

2 

5 

25 

1 


31 

1 
3 
33 
3 
1 
110 

15 

3 
40 
13 

15 

2 

3 

20 

26 

123 

12 

4 
9 
1 
70 
2 


6-6 
1 - 1 

7-7 
16 14 30 

4 8 12 
3-3 

1 1 2 

1 1 2 
9 6 15 

2-2 

2-2 

2 3 5 

14 5 19 
1 1 2 


23 2 25 


_ _ _ 


_ _ _ 


3-3 

24 2 26 

2 1 3 

1 - 1 

38 31 69 

5 3 8 

1 2 3 

7 15 22 

6 6 12 

6 6 12 

1 - 1 

2 1 3 
9 7 16 

8 16 24 
48 54 102 

8 2 10 

2-2 
2 2 4 

28 19 47 


- 1 1 


3 8 11 
7-7 

2 4 6 
- 1 1 

1 - 1 

2-2 
1 4 5 

1 - 1 

3 1 4 


Total .... 


313 


227 


540 


69 39 108 


224 169 393 


- 1 1 


20 18 38 



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

Psychoses 







Total 




Abstinent 


Temperate 


Intemperate 


Unknown 


Psychoses 






























M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


With syphilitic men- 






























ingo-encephalitis . 


29 


2 


31 


8 


2 


10 


13 


— 


13 


7 


— 


V 


1 


- 1 


With other forms of 






























syphilis 


1 


— 


1 


1 


- 


1 


- 


— 


- 


— 


- 


- 


— 


— — 


With other infectious 






























diseases . 


3 


— 


3 


1 


- 


1 


1 


— 


1 


1 


— 


1 


— 


— — 


Alcoholic psychoses . 


31 


2 


33 


— 


— 


— 


— 


— 


— 


31 


2 


33 


— 


— — 


Due to drugs, etc. 


2 


1 


3 


— 


1 


1 


1 


— 


1 


— 


— 


— 


1 


- 1 


Traumatic psychoses 


1 


— 


1 


- 


- 


— 


— 


- 


— 


1 


— 


1 


— 


— — 


With cerebral arterio- 






























sclerosis . 


57 


53 


110 


14 


29 


43 


22 


5 


27 


11 


3 


14 


10 


16 26 


With other disturbances 






























of circulation . 


12 


3 


15 


2 


2 


4 


2 


— 


2 


2 


— 


2 


6 


1 7 


With convulsive dis- 






























orders (epilepsy) 


1 


2 


3 


— 


2 


2 


1 


— 


1 


— 


— 


— 


— 


— — 


Senile psychoses 


13 


27 


40 


5 


18 


23 


4 


— 


4 


2 


6 


8 


2 


3 5 


Involutional psychoses 


6 


7 


13 


2 


5 


7 


3 


1 


4 


1 


— 


1 


— 


1 1 


Due to other meta- 






























bolic diseases, etc. . 


9 


6 


15 


3 


3 


6 


4 


2 


6 


2 


— 


2 


— 


1 1 


Due to new growth 


2 


— 


2 


— 


- 


— 


1 


— 


1 


- 


- 


— 


1 


- 1 


With organic changes 






























of nervous system . 


2 


1 


3 


— 


— 


— 


1 


— 


1 


1 


1 


2 


— 


— — 


Psychoneuroses . 


12 


8 


20 


3 


7 


10 


4 


1 


5 


4 


— 


4 


1 


- 1 


Manic-depressive psy- 






























choses 


9 


17 


26 


3 


11 


14 


6 


3 


9 


— 


1 


1 


- 


2 2 


Dementia praecox 


58 


65 


123 


14 


43 


57 


26 


9 


35 


14 


1 


15 


4 


12 16 


Paranoia and paranoid 






























conditions 


10 


2 


12 


3 


2 


5 


6 


— 


6 


1 


- 


1 


- 


- - 


With psychopathic per- 






























sonality . 


4 


- 


4 


1 


— 


1 


1 


- 


1 


2 


- 


2 


- 


— — 


With mental deficiency 


4 


5 


9 


2 


5 


7 


2 


- 


2 


— 


- 


— 


- 


— — 


Undiagnosed psychoses 


1 


- 


1 


— 


— 


- 


- 


— 


- 


1 


- 


1 


- 


- - 


Without psychoses 


45 


25 


70 


10 


11 


21 


15 


7 


22 


17 


4 


21 


3 


3 6 


Primary behavior dis- 






























orders 


1 


1 


2 


1 


- 


1 


- 


1 


1 


- 


- 


- 


- 


- 


Total . 


313 


227 


540' 


73 


141 


214 


113 


29 


142 


98 


18 


116 


29 


39 68 



50 



P.D. 23 



I ts 



?!, 



•H I I 00 I 



es 



^ IN 



— — cs I 

11 — 1 






m<-<THW)ts I >-i rt rt o^ vo 'I" «s cs o lo CM 00 






-HTJl 



Tt<« — r-i»-i I in 00 I lo fi 00 cs r-< rf r<5 cs t~ 

irt « cs -H 



^ 



— rt »-l « rtrtt^ fj 

I I I I I I 00 I -Hoocs I I I vomt^ I I CO I O-H 

•- I CS« I »-l rt CS >H •* cs <-l I -< lO lO O »H >* Tjl .-H t^ « 



cs I |cs»H Imotst^t^o Irtoot^iocs |io |io»h 



fe* 



S 

o 



n e u 



CO O O 

J3 4; J3 

IIS 






-s; B> D 
o C o 



- w ® S '" - — 

O -Sx! ti 3 ID m >,'5 
JSUOcO-j-iftlcLimp 

S aj 1) -u o a"3 



•a>' 



2 » F o •- 



oooAcoaEofgi- 



P.D. 23 



51 



u 
« 

H 

35 
> 
2 








^ 1 rtrt-. 1 1 1 — ^ 1 to^; II 1 -^ "-"-^ o 1 1 1 III 

tn 1 1 M-^ III 1 1 1 1 1 II 1 1 II ^111 III 

— 1 rt 1 1 1 1 1 -H— 1 fO'* II 1 « 'Hrt (N 1 1 1 III 


o 

H 

z 

S 

H 

a. 


SI 


E 


oo»hI|«III Mwcsiom I'" 1 1 II relics |»-irt 

•H ^ CO 

CNIIIIIII Ill—I II 1 1 II 2'!' ' '^'^ 
a. -H 1 1 "I 1 1 1 csrtcs-^io l-H 1 1 II colics III 


2 

O 
H 

D 
O- 


■si 


E 


V) MlCSt^liil TjOHCSTh^O Its 1 rr> II CO'HII Ov-H^^ 
m ■* po 

00 « 1 -HCS l«l ll^lrt ICN 1 1 II 00« 1 1 "TH | 

r»csl<-iiolll Tj<rtrt'*cs II 1 fo II mill >oi>-i 
ts •* « 


H 

z 

w 

Q 


^ o 
El 

Ee 

•o 
< 


E 


CS O — OOt^ltSI Ullt-'^vo "HCS W5 « — rt OICS«-l ^l»< 

r<) — 1 mm III II tsi^to 1 rt rt 1 II r) 1 t 1 es 1 1 
tN 'O 

Ov tS»Hr<5T)<|NI IO|lOW>f»5 «'-l CM '-< '^'-1 00ltS»H csl-< 






E 


« -H 1 1 — fq II ^i^im II 1 1 II 21*^1 I'l 

1— IIIINll lllll II 1 1 It '^tll III 

m III— III —I — im II 1 1 II ovl—l III 


< 


Eg 
< 


E 


t^— ICSllltS CNIICNCS II 1 1 —1 OOIOI lies 
tH CO ^h 

n ll—lll— lllll 11 1 1 11 Oviesi III 

CO 

■^ „ 1 n 1 1 1 ^ Nil tNN II 1 I—I OvIOOl lltS 


t/i 

u 
u 

< 


^1 


E 


00 — 1 — — 1 1 — — — IIJO 1— 1 1 II "till II — 

- 1 1 -- 1 1 - 1 1 1 1 - II 1 1 II cs 1 1 1 II- 

t^ — 1 1 1 1 1 1 — — ii^; 1— 1 1 II csiii III 


in' 

Q 
<5 


a 

< 


E 


o col 1 1 — cs— iocslo\a II 1 1 II 00—1— 1 MCN 

CO cs 1 1 1 — 1 — — — III II 1 1 II 00 1 1 — 1 — — 
vO— llllMl ■*— laOv II 1 1 II O— II 1— — 


o 
5! 

S- 

Q 
< 


is 

^E 


E 


lo — 1— cslll ICO — csr~ Its 1 ts — — "^l- 1 ——1 
— II— llll lllll 1— 1 1 II OvIII 1— 1 

»*— IICSlll |C0 — (Nt^ 1— 1 cs«— lOI— 1 — II 


m 

c 
-U.2 

trL CO 

Ee 

■a 
< 


E 


— II— lies— — — COOOO ICO 1 — II OlcotS Icol 
CS 1 1 1 1 1 1 1 II — — 1 1 — 1 1 1 1 CO 1 CS— 1 (N 1 
0\ 11—11 (S— — — tSOvOO 1 CS 1 — II C^ 1 — — 1 — 1 

CS — ir> — 




CO 

b: 

H 
Q 

« 
o 
en 

P 

z 
a 




1 1 Ml -^ pm ls|| 5 lia" i 1 l|l i iU 
il|t|^|^|ill|3 i :|i||i! §11 i ^pm mm iilll 



Oi jn 



52 



P.D. 23 



u 

H 

H 
55 
> 
1 


ii 


E 


thIIII roles ll|rt»^| csll ■* to III cs II 
lllllcNics Mil II tsllts w:lll»H 11 
•Hiiii^ll iii^^i IIIN 1 lll'H II 


o 

H 
Z 
M 
H 

<: 


c 

El 
•a 

< 


E 


tr, \ \ ■^•^ t^rr^XT) |CS-4(N l-H III -H -< III 1 II 
roll— ■<tl'5«5!N ItSlfN II III "I "I III 1 II 
CNlll|(N|fOll-l| l-H III 1 1 III 1 II 


o 

< 
D 


ii 


E 


cs — rttsoo lor-fo lllcsll -Hirtoo 1 I'hI | — il 

00rt»H|t^«vOCN IIItH II III •* 1 l-ll 1 Ii 
■* 1 1 CS« T(l — — III— II — 1— .^ 1 III 1 — 1 


^1 

H 
2 

a 
w 


e'e 
< 


E 


CO — — \ot^ •>*t^o> — — csO 1! Ilesoo lilies II 

a> — — •*— t^t^m — 1 r^tr> II llcscs llll— II 
o \ 1 (Nvo t-I'd'l—lt^ll lli>o 1 III— II 


a; 

H 

M 

Q 

<; 


ii 


H 
E 


fn 1 — 1 1 III 1 1 1 1 II III 1 i III 1 II 
ro 1 — 1 1 III 1 1 1 1 II III 1 1 III 1 II 
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 II 


E E 
•a 
< 


E 


00 1 »0 1 00 lO 1 — — 1 <Nt~ II 1 1 — CS 1 1 1 1 1 II 
00 1 lO 1 •* — 1 1 II — r^ II 1 1 1 1 1 1 1 1 1 II 
O 1 — 1 ■* •* 1 — — 1 — ■* II 1 1 — ts 1 1 1 1 1 II 




< 

X 
u 

Q 
J 


^6 


E 


lllll II— <Nll— II 1— 1 — 1 II—'-' ■^ \ 
lllll 111-11— II lll>— 1 III— — 1 
lllll II--III II l-l 1 1 II- 1 II 


-u-2 

1-4 M 

E'e 

< 


E 


— 1 1 — — ■* — (N — — lO— 1 IIICN 1— II— II 
lllll fO — (N 1— |(Mll IIIlN 1— III II 
rt 1 1 — — — IJrtll^- 1 III 1 1 III— II 


U5 

o 
tfl 


•si 

^E 


E 


(NiCNIWJIMll llll Ii 111^ 1 III 1 II 
lllll III llll II IIIIN 1 II— — II 


< 


*j.2 

Ee 

•a 

< 


E 


tsl'5*iro— OIro 11^——— ^|w— 1 — II — II 

■*|rOCN00T>|tN ll(N"* II — II 1 1 — II 1 II 
001— — fOlrtI— lltst^— — II— — 1 III — II 




a 

w 

Q 
ei 

g 

Q 

i 

H 
Z 




ll ,.-s| J. ^ ill §1 .J« o^i .. s t 

|ilJf|li.„^3,.i|i|iiiife.iS.,iii, J ,. 
%mm^M iii3igis-"ip ifiititieiil s 

iiiaiiiili ilUllfill il|l!s:.i|l l||^-=^-' °|ssl 



P.D. 23 



53 



1 1 

- 1 1 
1 1 

- 1 1 

6-6 

8 16 24 
1 8 9 
1 1 2 

1 - 1 

3-3 

7 6 13 

7 11 18 

10 19 29 

12 17 29 

3 7 10 

1 4, 5 

4 3 7 

- 1 1 

- 6 6 


CS 


- 1 1 

- 1 1 
1 1 

1 1 2 

1 - 1 

5 2 7 

6 2 8 

2 3 5 
1 - 1 

4 4 8 

5 11 16 

6 8 14 
12 31 43 

9 11 20 

- 1 1 

7 6 13 
2-2 

1 1 
4 1 5 

- 1 1 

- 1 1 


CO 
CO 

CO 


4-4 
1 2 3 

1 2 3 

15 26 41 
13 7 20 

2 1 3 
1 4 5 

1 - 1 

2 4 6 

13 5 18 
49 115 164 
34 63 97 
71 107 178 
74 51 125 

- 5 5 
7 19 26 

3 6 9 

4 4 8 

14 14 28 
19 18 37 

2 3 5 

1 - 1 

1 1 

- 1 1 

- 1 1 

- 1 1 


OS 

o> 
in 

CO 

in 


- 1 1 

1 1 
1 1 

3 2 5 

2 8 10 

4 14 18 

- 5 5 
7 1 8 

15 9 24 
52 84 136 
43 55 98 
103 129 232 
94 58 152 

- 2 2 
24 41 65 

5 8 13 

2 2 4 

9 18 27 

20 18 38 

4 7 11 

- 1 1 

- 1 1 

- 1 1 


lO 

CO 
cO_^ 

I^ 
lO 

•o 

00 


llllll CN-H|||rt CSfOC<5t^lO|rt| ICNCSlI II 1 1 llll II II 1 1 
1 1 1 1 1 1 -H-, llll -HOJCN'*'* III 1 1 1 1 1 III 1 llll II II 1 1 
llllll -H|lll'-< M««f<^,-<|TH| ICSCNII II 1 1 llll II II 1 1 


CO 


llllll CO-*!— Ill — CNCO^OI-H| ||.^.,H| II 1 1 llll II II 1 1 
llllll —"-I 1 -H 1 1 rtrtCNt^'* 1 -H 1 1 1 1 1 1 II 1 1 llll II II 1 1 
llllll CNfOllll l«-H^^^OIII ||.rH.H| II 1 1 llll II II 1 1 


o 

CN 

00 

CO 
CO 


-Hllcoico ooiol>ol>-H «oOTi<i^ioloocN llcoll t^-i 1 1 r-ml'H co-h ■^cn »-i I 
ll|rolcst~--*lcsll liocot^t^lvol llcsll CNl 1 1 l^CNII col II 1 1 

-hIIIItH .rt-H|ro|rt «CO-H|00|CNCN II-h|| uth I I |^|.h |rt ^CN —1 1 


c» 
lO 

lO 

t^ 

CO 

00 


3 1 4 
5 5 10 
2-2 
3 1 4 

3 8 11 

3 2 5 

- 1 1 

1 - 1 

2 1 3 
2 7 9 

10 5 15 
8 16 24 

11 6 17 

2 2 4 
2-2 

1 2 3 
1 1 2 

1 - 1 

11 2 13 

- 1 1 

2-2 
1 - 1 

1 6 7 

2 1 3 
4-4 

1 1 

- 2 2 
5 3 8 

20 5 25 

4 1 5 

- 1 1 
1 - 1 


o 

00 
CN 

CO 
t^ 


1 - 1 

1 1 

- 1 1 

6-6 

6 12 18 

2 6 8 

1 1 
1 - 1 

3-3 
10 4 14 

5 9 14 
15 13 28 
13 5 18 

1 - 1 

- 1 1 

1 - 1 

3 2 5 

5 2 7 
1 - 1 

- 5 5 
1 1 2 

1 - 1 

- 3 3 

3 1 4 
2-2 

1 - 1 


CN 

o 


2 2 4 

3 5 8 

1 - 1 
5-5 

5 7 12 

2 6 8 

1 4 5 
1 - 1 

1 2 3 
9 5 14 

12 14 26 
23 37 60 

13 7 20 

10 2 12 

4-4 

-33 

4 1 5 
1 1 

1 - 1 

10 2 12 

- 1 1 

2-2 
1 - 1 

1 6 7 

2 1 3 
4-4 

- 2 2 

-33 

5 4 9 

16 5 21 
4 1 S 

- 1 1 
1 - 1 


o 
■* 

lO 

CN 
CN 

CO 

CO 


Mixed compulsive states . 

Neurasthania 

Hypochondriasis . 

Reactive depression 

Anxiety state 

Mixed psychoneurosis . 
Manic-depressive Psychoses: 

Manic type .... 

Depressive type 

Circular type 

Mixed type .... 

Perplexed type 

Other types .... 
Dementia praecox (schizophre- 
nia): 

Simple type .... 

Hebephrenic type . 

Catatonic type 

Paranoid type 

Other types .... 

Paranoia 

Paranoid conditions . 

With psychopathic personality 

With mental deficiency: 

Idiot 

Imbecile 

Moron ..... 

Unknown .... 
Undiagnosed Psychoses: 
Without Psychosis: 

Alcoholism .... 
Drug addiction .... 
Disorders due to epidemic en- 
cephalitis .... 
Psychopathic personality: 

With pathological sexuality 

With pathological emotion- 

ahty 

With asocial or amoral trends . 
Mixed types .... 

Epilepsy 

Mental deficiency: 

Imbecile 

Moron 

Other non-psychotic diseases or 

conditions .... 
No other condition . 
Primary Behavior Disorders: 
Simple adult maladjustment . 
Primary behavior disorders in 

children: 

Conduct disturbance 


o 
H 

a 
O 



^ c 



54 



P.D. 23 



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

and Condition on Discharge 



Psychoses 



Total 



M. 



Recovered 



M. F. T. 



Improved 



M. F. T. 



Unimproved 



M. F. T. 



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

Due to drugs, etc 

With cerebral arteriosclerosis . 

With other disturbances of circulation 

With convulsive disorders (epilepsy) 

Senile psychoses .... 

Involutional psychoses 

Due to other metabolic diseases, etc. 

Due to new growth .... 

With organic changes of nervous system 

Psychoneuroses 

Manic-depressive psychoses . 
Dementia praecox .... 
Paranoia and paranoid conditions . 
With psychopathic personality 
With mental deficiency . 
Undiagnosed psychoses . 
Without psychoses .... 
Primary behavior disorders 

Total 



17 
5 
1 
5 

42 
1 

22 
2 
5 
3 
8 

11 
1 
4 

32 

47 
103 

12 
4 
8 
1 
101 
3 



12 - 



3-3 



1 - 1 
- 1 1 



10 



19 



- 1 1 

2-2 

- 6 6 
3 2 5 



1 2 3 

7 8 15 

15 10 25 

18 9 27 



4 - 
1 3 
1 



19 37 
2 7 



188 438 89 45 134 74 93 167 22 14 36 



4 

2 

20 

3 



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

Discharged during 1937 



Psychoses 









Ave 


;rage Net 


Number 


Hospital Residence 








in Years 




M. 


F. 


T. 


M. 


F. 


T. 


6 


3 


9 


1.44 


.34 


1.08 


1 


2 


3 


4.50 


1.56 


2.54 


2 


2 


4 


.12 


.41 


.26 


23 


2 


25 


2.11 


.20 


1.96 


10 


8 


18 


.48 


.74 


.59 


1 


1 


2 


.04 


.04 


.04 


2 


2 


4 


.12 


.20 


.16 


3 


6 


9 


.26 


1.67 


1.17 


1 


— 


1 


.37 


— 


.37 


5 


3 


8 


.92 


.20 


.65 


1 


— 


1 


.04 


— 


.04 


— 


2 


2 


— 


.16 


.16 


14 


8 


22 


.21 


.10 


.17 


7 


11 


18 


.51 


1.20 


.85 


33 


35 


68 


.60 


.44 


.52 


2 


2 


4 


.20 


.16 


.18 


2 


— 


2 


.20 


- 


.20 


2 


3 


5 


.20 


.34 


.28 


1 


- 


1 


.46 


— 


.46 


50 


22 


72 


.07 


— 


.07 


1 


1 


2 


.12 


.12 


.12 


167 


113 


280 


.63 


.49 


.57 



With syphilitic meningo-encephalitis 
With other forms of syphilis 
With other infectious diseases 
Alcoholic 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 deficiency 
Undiagnosed psychoses 
Without psychoses. ..... 

Primary behavior disorders . 

Total 



P.D. 23 



55 



With 

other 
disturbances 
of circulation 




1 1 1 1 1 1 1 1 1 1 1 1 II 1 II 1 1 '^ 1 1 1 1 1 1 1 1 
1 1 1 1 1 1 1 till I II 1 II 1 1 1 1 1 1 1 1 1 1 1 
1 1 1 1 1 1 1 1 1 1 1 1 II 1 II 1 1 » 1 1 1 1 1 1 1 1 


With 
cerebral 
arterio- 
sclerosis 


i 


- 1 1 
1 - 1 

1 1 2 

- 1 1 

1 - 1 

1 - 1 
1 2 3 

1 - 1 

8 3 11 
1 - 1 
1 - 1 

- 1 1 

1 - 1 

23 20 43 
6 1 7 


3 O 
CO >> 




1 1 1 1 1 1 1 1 1 1 1 1 II 1 II 1 1 1 1 1 1 1 'H 1 1 1 
1 1 1 1 1 1 1 1 1 1 1 1 II 1 II 1 1 1 1 1 1 1 1 1 1 1 
1 1 1 1 1 1 1 1 1 1 1 1 II 1 II 1 1 1 1 1 1 1 •« 1 1 1 


.as 

oS 

o 




llfOll l-H llll 1 II I^I-HICSIJI 1 tSTj< 1 1 
lllll l-H llll 1 II l-l ll-tlll 1 llll 

llroll 1 1 llll 1 II 1 II— l-illl 1 INTJ< 1 1 


With 

other 

infectious 

diseases 




lllll 1 1 llll 1 II 1 II 1 1 1 1 1 1 1 ^H 1 1 1 
lllll 1 1 llll 1 II 1 II 1 1 1 1 1 1 1 llll 
lllll 1 1 llll 1 II 1 II 1 1 1 1 1 1 1 -H 1 1 1 


.a .5 

>T3 a 




1 •H 1 1 1 1 1 llll 1 II 1 II 1 1 1 1 1 1 1 llll 
lllll 1 1 llll 1 II 1 II 1 1 1 1 1 1 1 llll 
1 •H 1 1 1 1 1 llll 1 II 1 II 1 1 1 1 1 1 1 llll 


With 

other 

forms of 

syphilis 




llllwl 1 llll 1 tsl 1 II 1— llll 1 llll 

lllll 1 1 llll 1 -H 1 1 II 1 -H 1 1 1 1 1 llll 
1 1 1 1 -H 1 1 llll 1 X 1 1 II 1 1 1 1 1 1 1 llll 


With 
syphilitic 
meningo- 
encephalitis 




lllll 1 1 llll 1 -H 1 1 II 1 1 1 1 1 1 1 llll 

lllll 1 1 llll 1 rn 1 1 II 1 1 1 1 1 1 1 llll 

lllll 1 1 llll 1 00 I 1 II 1 1 1 1 1 1 1 llll 




H 




<! 
H 
O 

H 


fc 


«|(NII 1 vO -HlCNl 1 ■*! rtrtCS IrtOOII'" 1 «<NI-( 

roT-H 




S' 


|«\0-<M -^ -H l^lrt -» 0\-H 1 f»5(S ,»)W)rr5-H«l — moO«l 


K 
H 
<! 

Q 

§ 

in 

< 
U 




Infectious and Parasitic Disec^es: 

Erysipelas 

Lethargic encephalitis (epidemic) 

Tuberculosis of the respiratory system 

Tuberculosis of other organs 

Syphilis (non-nervous forms) 

Purulent infection, septicaemia (non-puer- 
peral) 

Cancer and Other Tumors: 

Cancer and other malignant tumors. 
Rheumatic Diseases, Nutritional Diseases, 

Diseases of the Endocrine Glands and Other 

General Diseases: 

Chronic rheumatism, osteoarthritis . 

Pellagra 

Diabetes 

Other diseases 

Diseases of the Blood and Blood-making Organs 

Hemorrhagic conditions .... 
Diseases of the Nervous System and Organs of 

Special Sejise: 

General paralysis of the insane . 

Other diseases of the nervous system 

Diseases of the organs of special sense (eye, 

ear and mastoid) 

Diseases of the Circulatory System: 

Chronic endocarditis (valvular disease) . 

Diseases of the myocardium 

Diseases of the coronary arteries and an- 
gina pectoris 

Other diseases of the heart. 

Arteriosclerosis 

Gangrene 

Other diseases of the arteries . 

Other diseases 

Diseases of the Respiratory System: 

Bronchitis 

Bronchopneumonia (including capillary 
bronchitis) 

Lobar pneumonia 

Pleurisy 

Other diseases (tuberculosis excepted) 



56 



P.D. 23 



With 

other 
disturbances 
of circulation 




8 2 10 




With 
cerebral 
arterio- 
sclerosis 




II 00 -H 1 1 1 VO 1 
II O II 1 1 00 1 

II 00 -H 1 1 1 to 1 


o 

00 


3 O 

ca >> 




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


1 


2 o 

-S-B 
O o 

<a 




II 1 II 1 1 1 1 


NO 

r<5 


With 

other 

infectious 

diseases 




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


1 


^•a a 
a cj 

0) 




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


1 


With 

other 

forms of 

syphilis 


fi,' 


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




With 
syphilitic 
meningo- 
encephalitis 




II 1 II 1 1 'H 1 
II 1 II 1 1 1 1 
II 1 II 1 1 TH 1 


c^ 




H 




•* 
w 

CN 


< 

H 
O 

H 


fc 


CNfS ■* II « 1 lo-H 


•* 


S 


« 1 >0 -H« 1 «t^ 1 


o 


w 
Q 

in 
< 




Diseases of the Digestive System: 

Diarrhea and enteritis 

Hernia, intestinal obstruction 
Diseases of the Genito-Urinary System: 

Nephritis (acute, chronic and unspecified) 

Other diseases of the kidneys and ureters 
(puerperal diseases excepted) . 

Diseases of the prostate .... 
Violent and Accidental Deaths: 

Suicide 

Accidental traumatism . . '. . 

Other external causes 

Ill-defined Causes of Death: .... 


"a 



H 



fti 



:*?. 



o 



>> 

-« o 

J3 <5 3 

> U (J 

> 3« 

3 1) 

•a 




1 1 <o 1 1 1 1 

1 1 1 1 1 1 1 

1 1 t«5 1 1 1 1 


Paranoia 

and 
paranoid 
conditions 




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






1 1 00 1 1 1 CN 
1 1 IM 1 1 1 CS 
1 1 O 1 1 1 1 


V CO 

1 > CI 

III 

ca c o 

5 a>. 

•o a 




1 1 (S 1 1 1 1 
1 1 1 1 1 1 1 
1 1 ^ 1 1 1 1 


With organic 

changes of 

nervous 

system 




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


Due to 

other 

metabolic 

diseases, etc. 




1 1 CS 1 1 -H 1 

1 1 1 1 1 1 1 

1 1 l>) 1 1 <-! 1 


O w 
■rl O 

3-g 
"o >> 




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


0) 

g-g 

a 




1 1 1 1 1 1 (N 
1 1 1 1 1 1 <N 
1 1 1 1 1 1 1 


With 
convulsive 
disorders 
(epilepsy) 


H 
ta 

i 


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


Causes of Death 




Infectious and Parasitic Diseases: 

Erysipelas 

Lethargic encephalitis (epidemic) 
Tuberculosis of the respiratory system 

Syphilis (non-nervous forms) .... 
Purulent infection, septicaemia (non-puerperal) 
Cancer and Other Tumors: 

Cancer and other malignant tumors . 



P.D. 23 



57 



llll 1 II 1 11 1 1 1 1 1 1 1 llll III "II llll 

1— II 1 II 1 II ll-Hlll l-Hlll II 1 II llll 


1 


llll 1 II 1 II 1 'H 1 1 1 1 1 „ 1 1 1 II 1 II llll 
llll 1 II 1 II 1 1 1 1 1 1 1 'H 1 1 1 II 1 1 1 1 1 1 1 
llll 1 II 1 1' 1 1 'H 1 1 1 1 1 llll II 1 II llll 


M 


- 1 1 

1 - 1 
1 - 1 

1 - 1 

12 3 

6 4 10 
3 8 11 

1 - 1 
1 1 

- 1 1 

- 1 1 

2 5 7 

- 1 1 


o 

tri 

00 
cs 


1 1 1 —1 1 II 1 II -H 1 i 1 1 1 1 -HtN 1 1 »H>^ CS II •rt 1 1 1 
1 1 1 1 1 II 1 II 1 1 1 1 1 1 1 -^-^ \ 1 1 ^ « 1 1 '•H 1 1 1 
111^ 1 II 1 II -<lllll 1 l-Hll -Hi -^ II llll 




llll 1 l-H 1 II lllllll ^111 Ml 1 II ll-Hl 
llll 1 II 1 II 1 1 1 1 1 1 1 1 1 1 1 <H 1 . 1 1 1 1 1 1 1 
llll 1 l-Hl II llllll iMlll II 1 II ll-Hl 




-l-l 1 II 1 II l-Hllll 1 -,-H II II « II llll 
'^l-Hl 1 II 1 II llilll 1 llll ll-Hll llll 
llll 1 1 1 1 1 1 1 -H 1 1 1 1 1 . „ M 1 1 II 1 II llll 




llll 1 II 1 II llllll 1 r^cs 1 1 II TH II llll 
llll 1 II 1 II llllll 1 1 -H 1 1 II 1 II llll 
llll 1 II 1 II llllll 1 <N« 11 1 1 _ 1 1 llll 


<* 


1 - 1 

1 2 3 

5 10 15 
1 1 2 

5 5 10 
1 - 1 

1 - 1 

- 2 2 


CM 

CN 


llll 1 II 1 II llllll 1 1 M 1 1 II 1 II 1 1 -H 1 
llll 1 II 1 II llllll 1 llll II 1 II llll 
llll 1 II 1 II llllll 1 1 -H 1 1 II 1 II 1 1 » 1 


1 


Rheumatic Diseases, Nutritional Diseases, Diseases 

of the Eyidocrine Glands and Other General Diseases: 

Chronic rheumatism, osteoarthritis 

Pellagra 

Diabetes 

Other diseases 

Diseases of the Blood and Blood-making Organs: 

Hemorrhagic conditions 

D'iseases of the Nervous System and Organs of Special 

Sense: 

General paralysis of the insane .... 

Other diseases of the nervous system 

Diseases of the organs of special sense (eye, ear 

and mastoid) 

Diseases of the CircuUitory System: 

Chronic endocarditis (valvular disease) 

Diseases of the myocardium .... 

Diseases of the coronary arteries and angina 
pectoris 

Other diseases of the heart 

Arteriosclerosis 

Gangrene ........ 

Other diseases of the arteries .... 

Other diseases 

Diseases of the Respiratory System: 

Bronchitis 

Bronchopneumonia (including capillary bron- 
chitis) 

Lobar pneumonia 

Pleurisy 

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

Diarrhea and enteritis 

Hernia, intestinal obstruction .... 
Diseases of the Genito-Urinary System: 

Nephritis (acutp, chronic and unspecified) 

Other diseases of the kidneys and ureters (puer- 
peral diseases excepted) 

Diseases of the prostate 

Violent and Accidental Deaths: 

Suicide 

Accidental traumatism 

Other external causes 

Ill-defined Causes of Death: 


"a 
o 



58 



P.D. 23 









cs^l I'pHi |rt| 1 |r«:|-«csi« 


cs 






H 




^H 




Ov to 












fe 


l^llllllllleNll— II 


^ 




Tji >. 












§■ 


CNI 1 l-H| l-l I 1--: T--^ 1 « 


00 






H 

fe 


tsl 1 1— 1 1— 1 1 1 1 1 ICSIlS 


00 






1 1 1 1 'H 1 1 1 1 1 1 1 1 1 ^ 1 1 


cs 




tC >, 












S 


tNllllll—llllll-HltN 


VD 








ni 1 1 1 1 1— «l 1 l<N-<tNl 1 


0\ 


w 




H 






«i 


O to 








K 


1 ? 

IT) V 
fO >» 






lO 




b 






ft. 




S 


-lllllll-lll'Hl-ll 


•* 










"e 




H 


'H 1 1 1 1 1 1 1 1 1 1 1 1 1 '^ 1 1 


cs 


a 


■>* to 






1 




1 t9 
O ^ 


fe 


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




$i 


ro >» 








ft. 




S 


-f 1 1 1 1 1 1 1 1 1 1 1 1 1 -< 1 1 


ts 


p 






ll^llllllllr^ll^ll 


m 


■^^ 




H 








0> to 

1 ta 


(li 


1 1 1 1 1 1 1 1 1 - 1 1 


« 


'U 


to ^ 








»- 


(S >. 








05 




§ 


M-lllllllltNll-Hll 


•* 










.^ 




H 


rH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


■^ 












■(oa 


•<* m 








S 


1 rt 


fe 


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


1 


T3 


O V 










§■ 


rt 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


"^ 






rOTtlrt.rtVO»H'H'H(Nt^lOa.'*CSOtS« 


■* 




H 


(N TH Oth r<^ -HIO 


00 


O 


►J 




«N 


^ 




r»;(Nl |r»)l<*)CSlcs-HfO«>noo«l 


■* 


"e 


H 
O 


fc 


• M. cs IN 


^ 




H 






















0\(S»H — Cl-HOOOvCSUT^Omt^CN-HO 


o 


^ 
^ 
g 




§ 


« « 1/5 « CS 


t» 






"c-a 






^ 






e 






K 






s 






<» 






•c* 












e 






ftn 






"t-. 






o 






<u 






55s 






^ 






t-^ 


to 




1— 1 


u 




w 


en 

o 


E 


ij 


u 


to 2^ • • o M 


m 


>< 


■■3 ^ ^ -ti S? 


< 


I/l 


S t« w in « to 

^ 1^- ■£§ ■ -I • • 

a to !-Q " S ^ 

S"- ^ . .-"-5 ■ -Ss" -^ • ■ 

A-S;S°' S to fc ^^ o y 

.5d.2 moCo moojgj o a 

E£SoS|t;5^to^s^s;8S'? 

&?&S|iS?8^3oS^£oE o 
































^^^^<Ei:^^^c^«Q^SQ£^ 


1 



P.D. 23 



59 









1 1 1 1 1 1 OO-H 1 -H 1 1 1 1 —rt-H 


fo 






H 




ts 




I-. V 










nj > 










D 


fe 


llllllt^llmlillwli 


o 




^13 










lO c 










CO Gj 


§■ 


1 1 1 1 1 1 lO-H 1 O 1 1 1 1 1 -l-H 


•* 






H 


1 1 1 1 1 1 'O-H 1 00 1 1 1 1 r^ 1 1 


00 








^-1 




■* m 








■^3 
T3 


00 t. 

1 "J 

C30 >> 


bi 


IIIIIICSIIlOllll-Hll 


00 




S' 


1 1 1 1 1 1 ■* « 1 fn 1 1 1 1 ts 1 1 


© 


13 




H 


1 1 1 1 -H 1 (N 1 1 OOtS 1 1 1 \0 1 TH 


© 


o 
O 


1 ca 

JO « 


b 


1 1 1 1 1 1 a 1 1 >Ort 1 1 1 ■* 1 1 


0\ 






S 


1 1 1 1 »-< 1 ro 1 1 t^-H 1 1 1 (N 1 •-H 


r^ 










O 
-Si 






i 1 1 1 ro 1 ■*(S 1 CO 1 1 1 <»JO. 1 1 

1 1 1 |«|«| Iml 1 1 It^l 1 








S 


1 1 1 1 tS 1 0>(N 1 f«5 1 1 1 fO'C 1 1 


r«5 












s 






^w I 1 rt -rt t^ 1 1 es ^H 1 1 *-ioo^H^ 


m 




H 




ro 




O^ to 








Qh 


\0 iH 


fe 


l-H| 1 1 I^OI ICNl 1 1 «\0»H 1 


;:; 


o 


VD >. 








■fc-a 




S' 


« 1 1 1 ^^rt 1 1 1 rH 1 1 1 (S 1 « 


00 










8 










<£> 




H 


ro«N 1 liolvOl'HitsiN'rtfO'*! 1 


o> 


!~ 






cs 


•^ 


O K 








5^ 


fe 


1 1 1 1 -H 1 (N 1 1 1 1 1 1 -<W5 1 1 


t^ 


^ 




S' 


tf>6> \ |T)<|'*l-H|tS(N-H{N»H| 1 


cs 


■| 


















13 




H 


r»5 1 1 1 <N 1 t^-* 1 1 1 1 1 CSt~ 1 1 




^ 










CO 


Ov to 
to k. 

1 m 


fe 


-<lllll>o«lllll (Nin 1 1 


•* 




■o >. 










S 


CS| 1 ICSICNr^l 1 1 1 1 Icsl 1 


,H 


O 






*^ 


.;« 




H 


t^l |«(N|>-l| 1 1 ItSTH^IOl 1 


O 


e 






cs 


■» 


■* to 








Q 


1 OJ 


fci- 


-<|I|||th||||«1I»h|| 


^ 


'S' 


O 11 








§ 


CI 1 1 «CS 1 1 1 1 1 1 -H-HMTt 1 1 


NO 


^ 




























•eo 










&H 










e 










tii 










-ti^ 










S 










« 










•eo 










"e 










a. 










•> 










o 










«:> 










Ol 










^ 


s 




.'■"I"'" 

.2 .S-r- ■ ■ OP ■ ■ ■ ■ 

!■■.■■ 11 -■si-1' 

gto ^ .SoS- g£;„ ;3 

•S^aS 1?,°B° MoSfe- OR 

^iait^^>^ till Sal 




•1— 1 


tn 

O 

u 
> 
I/I 






< 






















■3 








mO<UOOgoOo7;300(^C10e 



















^^^^<f^^^^c^«Q^SQ£^ 





60 



P.D. 23 









■*l 1 I'rtlvOI |iol»-<l Icslcs 


^ 






H 




CS 






fe 


lllll|r<^l|iollll-<ll 


a 






S 


^1 1 1— IfOl 1 1 l-H| l«|f^ 


cs 








t^-<| IrtlOl |«rt(»)»HTilrt| 1 


O 




H 




lO 


CO 


O} 










CN 1- 

1 ta 


fa 


-HllllllOllOOlll 0)»H 1 1 


t^ 


ft. 




§■ 


\Dth| l^liol |r»5rtro-<ts| 1 1 


r»5 






H 


1 1 1 1 1 1 »0 1 1 »-<-H 1 1 1 tD 1 1 


« 


■?; 


"5 








li 
g 


T S 


fe 


1 1 1 1 1 1 (S 1 1 1 1 1 1 1 fO 1 1 


lO 


•^ 


*i 








<^ 








fts 
o 




S' 


1 1 1 1 1 1 ■* 1 1 -H« 1 1 1 1 1 1 


-o 






mrti 1 irt^l |'#'-(f/5|rtr»5»-<l 


^ 


Oi 




H 


(N 


■* 


s 


J3 








^ 


1 C 


fe 


(>)«|-| 1 IO.I |f^l-H|-HCN«| 


O 


s~ 


•* o 








o 


E 








o 




S 


in \ 1 1 1 ^IN 1 1 ■r^rtCN 1 1 ■rt 1 1 




5J 






CS 


^ 

'Q 

^ 












H 


CSr-c| iTHlt^Wl'rtOOl l'-l»H| 1 1 




^ 


^•S 










7-S 


(!<■ 


1 1 1 1 1 I'^wlPOl I'H-Hl 1 1 


o 


M 


^ o 








^ 


B 










§■ 


(Mrt 1 1 rt 1 fOIN rllO 1 1 1 1 1 1 1 


lO 


O 






cs 


'e 






^1 1 rt 1 1 I^QO 1 ■* 1 CN 1 -^ 1 1 1 


o 


•r^ 


Sj3 


H 


CS 


■* 




■" o 

V 




IIIIIIvOi-hIIIcsIIIII 


Ov 


o 


fe 






^ 








S 


►J'^ 


;§ 


rt 1 1 tH 1 1 t^t^ 1 ■* 1 1 1^1 1 1 


CN 


"•ji 










S 






c^^<#rt-H^O'H«rtc^^t~loo^■*csO(^^^o 


•<* 




H 


fS w O —1 c«5 '-I'O 


00 
CS 


;s5 


-J ■ 








Q 




ficsl \rn\nt»tr^^r<^-^'n»-^l 


■* 


CO 


H 

o 


fe 


Tt CS tN 


" 


s 


H 








aj 









•co 






O\CN,-^^^f^^H00a^M»n ^ \0 fO t^ CS -TH o 


o 


"e 




;§■ 


•rH rt lil -H CS 


t^ 


0^ 


















o 










^ 










^--. 










•cS> 










v^ 










2 




















•<*3 










55, 










03 










o 










tej 










«<-. 










O 










s 










o 










'■S 










"e 










^ 


i/i 








s 










P 


O 








^ 


^ 




•S ■2^- -iil- ■ ■ ■ 




o 


cu 




2 13J m C I" 03 




E^ 






^ g&- -gS • •§ • 




00 






liliililllltllll 












< 








H 






2 








&^©^-o|So8»3ofe^goE 


o 



















P.D. 23 



61 



o 



^ 



o 



tci 



'^t* CO 



OS m 

V P. 






CS^m Rj 



■3 >> 



C o 



I to rt rt cs 

I -^O I 1 

I « 00 1 cs 

I I t^ I I 

I -HIT) I tS 

I -« 1 1 

I I I I I 

I — -H I I 

"1 I I 

Tl< I I 

•H I I 

^ I I 

I I I 

-H I I 

cs I i 

ts I I 

I I I 

re I I 

IN I I 

-H I 1 



cu o 



, o 









- C d U 
(J C (Ll 

to o 0) o 



(U 



u to >, OJ 

> 0) 5? c 

- to rv C 

a O u 
= >? S ■" 






C X F^ u 



o ' c o E 

.y 4) c _ 



- 2 



'.2 o ' 

SSI's ;^j 



62 



P.D. 23 



Table 19 Average Length of Hospital Residence during the Present Admission of 
All First Admissions in Residence on September 30, 1937 











Average Net 






Mumber 


Hospital Residence 


Psychoses 










n Years 






M. 


F. 


T. 


M. 


F. 


T. 


With syphilitic meningo-encephalitis 


79 


23 


102 


4.71 


7.62 


5.36 


With other forms of syphilis 


6 


6 


12 


7.50 


4.08 


5.79 


With epidemic encephalitis 


4 


3 


7 


5.50 


7.50 


6.35 


With other infectious diseases ....... 


2 




2 


3.97 




3.97 


Alcoholic psychoses 


86 


6 


92 


9.41 


10.15 


9.46 


Due to drugs, etc 


?, 


1 


3 


1.47 


.44 


1.12 


Traumatic psychoses 


.S 


1 


6 


2.28 


7.50 


3.15 


With cerebral arteriosclerosis 


,S8 


62 


120 


2.59 


4.16 


3.06 


With other disturbances of circulation 


.S 




3 


.98 




.98 


With convulsive disorders (epilepsy) 


3 


2 


5 


10.83 


12.50 


11.50 


Senile psychoses 


17 


46 


63 


5.37 


4.37 


4.62 


Involutional psychoses 


11 


29 


40 


6.12 


6.45 


6.36 


Due to other metabolic diseases, etc 


8 


6 


14 


2.09 


4.31 


3.04 


With organic changes of nervous system .... 


6 


4 


10 


2.15 


5.75 


3.59 


Psychoneuroses 


4 


6 


10 


1.72 


6.65 


4.68 


Manic-depressive psychoses 


1.-? 


28 


41 


5.95 


3.56 


4.32 


Dementia praecox 


,^07 


335 


642 


13.16 


11.64 


12.36 


Paranoia and paranoid conditions 


24 


43 


67 


5.99 


10.43 


8.83 


With psychopathic personality 


.S 


8 


13 


14.48 


15.12 


14.88 


With mental deficiency 


.-^.s 


45 


80 


11.52 


10.20 


10.78 


Without psychoses 


- 


3 


3 


- 


.64 


.64 


Total 


678 


657 


1,335 


9.43 


9.21 


9.32 



Table 19A. Average Length of Hospital Residence during the Present Admission of 
All Readmissions in Residence on September 30, 1937 











Average Net 




Number 


Hospital Residence 


Psychoses 










n Years 






M. 


F. 


T. 


M. 


F. 


T. 


With syphilitic meningo-encephalitis 


27 


8 


35 


6.31 


7.37 


6.55 


With other forms of syphilis 


3 


2 


5 


1.83 


4.50 


2.90 


With epidemic encephalitis 


5 


2 


7 


4.30 


6.00 


4.78 


With other infectious diseases 




1 


1 


_ 


12.50 


12.50 


Alcoholic psychoses 


52 


5 


57 


7.94 


10.10 


8.13 


Due to drugs, etc 


_ 


2 


2 


- — 


12.00 


12.00 


Traumatic psychoses . . . 


3 




3 


2.66 


_ 


2.66 


With cerebral arteriosclerosis 


IS 


18 


33 


4.50 


3.50 


3.95 


With other disturbances of circulation 




1 


1 




2.50 


2.50 


With convulsive disorders (epilepsy) 


7 


4 


11 


6.50 


5.75 


6.22 


Senile psychoses 


7 


17 


24 


10.92 


6.08 


7.50 


Involutional psychoses 


6 


9 


15 


7.50 


8.33 


8.00 


Due to other metabolic diseases, etc 


1 


1 


7. 


7.50 


7.50 


7.50 


With organic changes of nervous system 


6 


4 


10 


6.66 


3.50 


5.40 


Psychoneuroses ■ 


7 


5 


12 


6.21 


6.70 


6.41 


Manic-depressive psychoses 


34 


42 


76 


7.91 


8.76 


8.38 


Dementia praecox 


241 


,341 


582 


10.90 


10.31 


10.56 


Paranoia and paranoid conditions 


7 


24 


31 


13.14 


8.79 


9.77 


With psychopathic personality 


3 


6 


9 


12.50 


8.00 


9.50 


With mental deficiency 


39 


39 


78 


10.06 


9.44 


9.75 


Without psychoses 


1 


4 


5 


3.50 


1.50 


1.90 


Total 


464 


535 


999 


9.24 


9.32 


9.28 



Table 20. Family Care Statistics for Year Ended September 30, 1937 

Males Females Total 

Remaining in Family Care September 30, 1936 24 86 110 

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

Admitted to Family Care during the year 40 63 103 

Whole Number of Cases within the Year 64 149 213 

Discharged from Family Care within the Year 38 67 105 

Discharged Outright from Family Care 2 2 4 

From Family Care to Escape Status 3 2 5 

From Family Care to Visit Status 8 19 27 

Returned to Institution 25 44 69 

Returned to Institution from Escape 3 2 5 

Returned to Institution from Visit 3 13 16 

Remaining in Family Care September 30, 1937 26 82 108 

On Visit from Family Care September 30, 1937 5 6 11 

Average Daily Number in Family Care during Year 29 84 113 

Supported by State 18 58 76 

Private 8 24 32