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

56:2, J2iM 

Public Document No. 23 



©tjr Olomntottuipaltlj of iHasaarijuBrtts 



ANNUAL REPORT 

OF THE 

TRUSTEES 

OF THE 

Worcester State Hospital 

FOR THE 

Year Ending November 30, 

1938 

Department of Mental Health 



4i 




Publication of this Document Approved by the Commission on Administration and Finance, 
550. 7-'39. Order 7827. 

OCCUPATIONAL PRINTING PLANT 

DEPARTMENT OF MENTAL HEALTH 

GARDNER STATE HOSPITAL 

EAST GARDNER. MASS. 






WORCESTER STATE HOSPITAL 

(Post Office Address: Worcester, Mass.) 

Board of Trustees \ti( 
William J. Delahanty, M.D., Chairman, Worcester. 
Anna C. Taxman, Secretary, Worcester, rrn *» 
Josephine R. Dresser, Worcester. sitB 20 1940 

John L. Bianchi, Worcester. 
Robert R. Portle, Worcester. 

Harry Kenney, Boston. STA^'E HOUSE, BOSTON 

Robert Burns, Auburn. 

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

Psychiatric Service 
Morris Yorshis, M.D., Clinical Director. 
LoNNiE D. Farrar, M.D., Medical Director Summer Street Dept., Supervisor School 

Clinics. 
Arthur J. Gavigan, M.D., Psychiatrist in Charge of Female Reception Service. 
Frances Cottington, M.D., Assistant. 
Joseph B. Furst, M.D., Clinical Assistant. 

Walter E. Barton, M.D., Psychiatrist in charge of Male Reception Service. 
Maurice Greenhill, M.D., Assistant. 
Harvard Kaufman, M.D., Clinical Assistant. 
Norman D. Render, M.D., Psychiatrist in charge of Continued Treatment Service. 

Medical and Surgical Service 
Embrie J. Borkovic, M.D., Director. 
William Freeman, M.D., Pathologist. 
Robert Fuchs, M.D., Assistant Male Medical Wards. 
Ellsworth F. Waite, M.D., Assistant Female Medical Wards. 
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., Resident Director of Research. 
Harry Freeman, M.D., Internist. 

Louis H. Cohen, Ph.D., M.D., Psychiatrist. 

Andrus Angyal, Ph.D., M.D., Psychiatrist. 

Conrad Wall, M.D., Psychiatrist. 

Morton A. Rubin, Ph.D., Neurophysiologist. 

Geza Roheim, Ph.D., Psychoanalyist and Anthropologist. 

David Shakow, M.A., Chief Psychologist. 

E. Morton Jellinek^ M-Ed., D.Sc., Chief Biometrician. 
George L. BaAa'Y, Fh.T^.yMSd}cai,LibrcM'lqn.;- "■. ' '^; 

*' ' "OtJT' PAtiENl'*DEpkRl'MENT 

Milton E. Kirkpatrick, M.D. y-Ifhector, Child Guidance Clinic. 
William L. Holt, Jr., M.D., Assis^tixnt Physician. 

James Watsdn, ,M-D.„F,R.C.5., ,Z>;i>ecior Adult Mental Hygiene Clinic and Supervisor of 
Family^Caie. *• •'.•' .';.,' "• »■".• ] • '„- '', . *; 

..'.".• • Nursing D^pXrtment 

Katherine M. Steele, B.S., R.N., Superintendent of Nurses. 
Katherine R. Dick, B.S., R.N., Assistant Superintendent of Nurses. 
Evelyn A. Pettee, B.S., R.N., Educational Director. 

Consultants 
Ernest L. Hunt, M.D., Surgery. 
Arthur Brassau, M.D., Surgery. 
Franklyn Bousquet, M.D., Surgery. 
Joel M. Melick, M.D., Gynecology and Obstetrics. 
Donald K. McCluskey, M.D., Gynecology and Obstetrics. 
Lester M. Felton, M.D., Genito- Urinary Surgery. 
John O'Meara, M.D., Orthopedic Surgery, Roentgenology. 






P.D. 23 c^^■^^- 3 

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. 

John T. Carmody, Neurosurgery. 

Julius Tegelberg, M.D., Oto-laryngology. 

RoscoE W. Myers, M.D., Ophthalmology. 

Philip H. Cook, M.D., Roentgenology. 

Theodore VonStorch, M.D., Encephalo graphic Roentgenology. 

George A. Dix, M.D., Dermatology. 

Oscar A. Dudley, M.D., Epidemiology. 

Hudson Hoagland, Ph.D., Neurophysiology. 

Heads of 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. 

Dorothea Cooke, O.T.Reg., Director of Occupational Therapy. 
Barbara Estes, M.S.S., Head Social Worker. 

TRUSTEES' REPORT 

To His Excellency the Governor and the Honorable Council: 

The Trustees of the Worcester State Hospital respectfully submit the 106th annual 
report of the hospital together with the report of the Superintendent, Dr. William A. 
Bryan and report of the Treasurer, Miss Margaret T. Crimmins and other statistical 
information. 

The board again wishes to record its approval of the policies of the hospital as they 
relate directly to patients. The emphasis upon treatment, research, teaching and pre- 
vention will, we hope, eventually bring substantial return on the money invested in the 
form of a reduced hospital population. The cure and discharge of patients, as a criterion 
of hospital efficiency, is so obvious as to need no comment and in measures that will 
increase the recovery rate will prove economical in the end. The board has viewed with 
alarm the constantly rising per capita cost of maintenance for our patient population 
over a period of years. As a result of a study of this situation we have arrived at the 
conclusion that the only way to reduce costs and at the same time maintain proper 
standards of care and treatment, is through more efficient fiscal administration of both 
hospital and commonwealth. Better control over finances and inventories within the 
institution, more careful budgeting and increased eificiency in purchasing supplies and the 
application of sound principles of business administration will do much to reduce operat- 
ing costs without affecting the standard of care. 

Thousands of dollars worth of paint, lumber, plumbing supplies, repair parts, etc., 
are purchased annually by the institution. Under the present system of accounting 
these supplies are entered on the stock book and immediately issued as expense items. 
No further records are kept as to their distribution and use. Such methods are an in- 
vitation to waste and extravagance. A better check on distributed supplies and ma- 
terials would undoubtedly result in substantial savings. 

The delays attendant on the purchase and delivery of supplies to the institution make 
it difficult to keep inventories down to a level that is consistent with sound business 
procedure. There is no necessity for carrying large stocks of goods when markets are 
accessible and transportation so readily obtained. Yet the time required to put through 
the central purchasing bureau an order for goods and secure delivery is so great that 
serious inconvenience to patients frequently results. The purchase of yearly supplies 
of dried fruit, canned goods, etc., with the resulting danger of spoilage and shrinkage is 
not, in the opinion of the board, a sound business practice. 

The board recommends to your Excellency that a careful study of these business pro- 
cedures be made in the interest of a more economical administration of the institution. 
Over centralization of routine does not lead to a decrease in per capita cost. On the 
contrary it adds to the overhead of administration. Certain measures which the board 
hopes will lead to economy have already been put into effect and others will be inaugu- 



4 P.D. 23 

rated from time to time. A system of financial control for monthly expenditures is 
functioning smoothh^ and efficiently. A daily balance sheet of bills paid and bills pay- 
able compared with the monthly budget allowance enable the Superintendent to keep 
well within the budget allowance for the month. 

The policy of keeping down inventories to a value of one-half of the total expenditures 
for the month has already been established. Rapid turn-over of inventory should prove 
to be as profitable to the state as it is to private industry. 

Study of the distribution of materials and supplies used for building maintenance is 
is in progress. A stock room is now functioning. It is a part of the store system under 
the control of the steward and with an assistant store keeper in direct charge. Materials 
for each job are issued to workmen on requisition. A cost sj'stem for both labor and 
materials will eventually be worked out. 

The board hopes that the active interest and cooperation of the entire personnel can 
be enlisted to conserve the finances of the Commonwealth. Each member of the or- 
ganization must appreciate his or her responsibility in financial matters. The loyalty 
of every officer and employee during the past year has been most gratifying. Each has 
made a contribution and it is a pleasure to make acknowledgment of this fact. 

Respectfully submitted 
William J. Delahanty, Chairman Robert R. Portle 

Anna C. Taxman, Secretary Harry Kenney 

Josephine R. Dresser Robert Burns 

John L. Bianchi Trustees. 

SUPERINTENDENT'S REPORT 
To the Trustees of the Worcester State Hospital: 

In accordance with custom, a detailed account of the activities of the hospital are em- 
bodied in the reports of the several department heads. A careful perusal of these will 
give a summary of the work carried on during the year. 

The emphasis of all hospital activity has been on therapy. One of the criteria of 
psychiatric efficiency is the number of patients discharged. Many have received the 
newer forms of treatment and the results are shown in the report of the Clinical Director. 
It is my belief that the mental hospital must be organized around therapy rather than 
mere custody if it is to justify its existence. 

The shortage of properly trained personnel in psychiatry creates an inescapable re- 
sponsibility for the mental hospital in an educational program. The policy of bringing 
students into the institution for actual contact with psychotic patients is one of the 
methods by which this responsibility may be carried out. The teaching program has 
continued to be an important activity and we are constantly endeavoring to revise and 
improve our pedagogical methods and techniques. The students admitted for training 
at Worcester represent many disciplines and allied professions. 

The report of the Director of Nursing shows the attempts we have made to formulize 
psychiatric nursing techniques into concrete ward procedures. This is based on the 
theory that every patient must be surrounded by an atmosphere of reality which presses 
on him at all times and on all sides. It is created by an active and systematic ward 
nursing routine. 

An interesting phase of the report is a study of illness among ward personnel. Sick 
leave has been granted this year. This study is an analysis of the results of the first 
few months. 

In our social structure a complete change of relationship between worker and em- 
ployer is going on. Traditional methods of dealing with workers have been discredited 
in favor of more democratic methods. Many hospitals have accepted the general situa- 
tion. The eight hour day, sick leave, vacations with pay, and general recognition of 
the rights of individuals are entirely of this. Experiments along the line of greater 
democracy in organization are in line with the modern trend of industry. Real coopera- 
tion between employees and administration rather than mere order-giving and order- 
taking is rapidly coming into industrial administration and will inevitably come into the 
mental hospital. We should therefore be in the forefront in recognizing this trend. 

Devices to promote this improved relationship have been tried. Disciplinary prob- 
lems have been considered by group conferences. House committees have been or- 
ganized for the nurses and employees homes Ward personnel has been rated and their 
grades discussed with them. While these methods are still in crude form and on an ex- 
perimental basis, they are attempts to meet the changing conditions of society. 



P.D. 23 5 

Reports of other years have discussed the question of numbers of personnel. Most 
of these comments were based upon impressions. This year a study of actual nursing 
hours per patient has been started and is still being carried on by the Assistant Director 
of Nursing. While the survey is not complete, it already reveals the fact that the nursing 
time per patient for certain groups is inadequate for even a high standard of custodial 
care. The full report will be published when complete. 

We have continued to emphasize the responsibility of the nurse in the Occupational 
Therapy program. Through ward classes and ward work, she makes the first approach 
to the occupational interest of the patient. Occupational therapy is an important phase 
of psychiatric nursing. The policy of industrial placement as a responsibility of the 
occupational therapist has been continued. The placement is carried out through evalu- 
ation clinics presided over by the physician. They seek to place the patient in accord- 
ance with his psychological needs. 

Family care of patients has been continued and extended through the addition of a 
social worker. As a tool for social case work, family care continues to grow in impor- 
tance. It offers a medium for reducing overcrowding and eliminates the need of addi- 
tional construction for housing patients. 

The medical and surgical service has been active during the year. This service is a 
valuable tool for the psychiatrist. Through it he can study the psycho-somatic rela- 
tionships of the patient. From the standpoint of better care during acute illness, a 
separate medical service has proven to be of great value. The patient receives better 
nursing and medical care when the personnel of the ward is primarily interested in physi- 
cal disease. 

The quantity of work carried out by the adjunct services, X-Ray, Dental, Physical 
Therapy, Laboratory, etc., indicate the medical activity during the year. 

A complete reorganization of the pharmacy was affected during the year. The 
theory upon which the reorganization was based is that the pharmacy is a part of the 
stores system and as such it should be a responsibility of the steward so far as stock- 
keeping and recording are concerned. The stock of drugs and supplies has been re- 
duced and a perpetual inventory installed which will give better control. The new sys- 
tem has already improved the service and reduced the cost of operation. 

Research continues to be a major activity. The lines along which this research has 
developed is indicated by the report of the Research Service. Research is the hope for 
the psychiatry of the future. Money invested in these investigations can only bring a 
return in the years to come. To handle the problem of mental disease without an or- 
ganized and systematic approach to its problems has already proven to be a costly policy 
in many states and will be more expensive in the years to come. 

The policy of community activity has been continued through the Worcester Child 
Guidance Clinic and the more recently organized Mental Health Clinic. The latter has 
been made possible through an affiliation with the Welfare Department of the City of 
Worcester. The Department furnishes office space and clerical assistance and the hospi- 
tal furnishes the director. This is the type of united effort which, I believe, will give the 
greatest amount of service at the least possible cost. A development of the same type 
of united effort has been organized in conjunction with the W ebster School System. The 
Webster Child Guidance Clinic is a joint product of the Worcester Child Guidance Clinic 
and the City Schools of Webster. 

The reports of the psychology, library, chaplain and radio departments are indicative 
of the important place they occupy in our hospital. The volume of work carried on by 
each is an index to the number of patients who are reached by direct and indirect psy- 
chotherapy. 

The business affairs of the hospital have been carried on during the year with greatest 
attention to the details of administration than at any previous time. The problems of 
governmental economy are intimately related to the efficient administration of the 
hospital. Two main goals present themselves. One is the improvement of efficiency 
in service to the patient within the institution. The other is economy of operation. 
These two objectives may be but are not necessarily in opposition. The harmony be- 
tween them is greatest when economy is not arbitrary but is itself governed by efficiency. 
The problem is how to raise the standard of care and treatment of patients without in- 
creasing the cost of operation. This can only be done through the application of these 
sound, fundamental principles of business control that have proven to be so profitable to 
private enterprise. It is through these means that we can save funds to be applied to the 
furtherance of our professional program. 



P.D. 23 



Psychiatric Service 
Morris Yorshis, M.D., Clinical Director 
Movement of Population 
During the year there were 542 new patients received, two more than the previous 
year but there were nineteen fewer patients readmitted. The total number received 
was 761. The total number discharged was 443, an increase of 41 patients over 1937; 
patients discharged as recovered, 124; patients discharged as improved, 181; patients 
out of the hospital on visit or otherwise absent, 532. Eight patients were discharged 
from family care and nineteen patients were placed on visit. 
Diagnosis of patients discharged among the more common reaction types: 



Psychoneuroses .... 23 

Manic Depressive Psychoses . . 46 
Dementia Praecox . . . .122 
Without Psychoses . . . . 69 



Syphilitic Meningo-encephalitis . 7 

Alcoholic Psychoses .... 44 
Cerebral Arteriosclerosis ... 38 

Senile Psychoses U 

Involutional Psychoses ... 14 

It is of considerable interest to those studying Shock Therapy to observe that 122 
schizophrenics were discharged from the hospital during the past 12 month interval. A 
majority of these patients were either recovered or improved. 
Disposition at End of One Year of Committed First Admissions: 



1936-37 



Admitted 



November 34 

December .... 34 
1937-38 

January 29 

February ! 34 

March 28 

April 49 

May ; 31 

June 30 

July 52 

August . . . . . . . .45 

September 25 

October 31 



Remaining 
Number % 



17 
12 

14 

12 
13 
15 
17 
11 
23 
11 
10 
17 



50 
35.3 

48.2 
35.3 
46.4 
30.6 
54.8 
36.7 
44.2 
24.4 
40.0 
54.8 



Discharged 
Number % 
5.9 



On Visit 



20.6 

13.9 

14.7 
10.9 
30.6 
12.9 
26.7 
15.4 
26.7 
24.0 
3.2 



Number 
15 



11 
17 
12 
19 
10 
11 
21 
22 
9 
13 



% 
44.1 
44.1 

37.9 
50.0 
42.7 
38.8 
32.3 
36.6 
40.4 
48.9 
36.0 
41.9 



422 172 75 175 

Of the 422 committed court admissions, 175 patients were dismissed from the hospital 
and 75 were discharged. 

Summary of Special Therapeutic Activities 





Number of 


Treatment 




Patients 


Days 


Insulin 


55 


900 


Metrazol 


311 


4,355 


Narcosis 


8 


80 


Photodyne 


10 


440 


Vitamin 


34 


599 



During the past year emphasis on metrazol insulin and vitamin therapy has yielded 
beneficial results. Most patients on treatment received metrazol; best results were ob- 
tained in the affective reaction types. A physician was put on full time in charge of 
the treatment wards and hardly any complications arose. Insulin was given to patients 
who did poorly with metrazol and the results were encouraging. Relapses with both 
methods of treatment were noted among the group that were chronic. Two patients 
died as a result of metrazol and the post mortem studies failed to discover any gross 
visible pathology. The use of vitamins were of great value in the alcoholic group. 
Photodyne and narcosis therapy although utilized in the beginning of the year have now 
been replaced by metrazol and insulin. Photodyne (hematoporphyrin) was felt to be 
of no value in depressions as none of the test cases showed any improvement. When 
metrazol was administered hysterical manifestations disappeared in nearly all instances. 

Wet sheet pack treatments were given to 666 patients; 1,862 were given continuous 
tub treatments; 645 were given tonic bath treatments; and 324 students received 281 
hours instruction. Despite the use of the special treatments the number of patients re- 
quiring the wet sheet pack has not been decreased in contradistinction to the experience 
of others. 

Male Reception Service 

On the male reception service in keeping with current trends in psychiatry, the inajor 
emphasis was placed on insulin and metrazol. Thirty patients received 1,238 days 



P.D. 23 7 

treatment with insulin and 82 patients had 937 metrazol injections. Results were 
sufficiently encouraging to continue their use. 

Narcosis therapy, utilizing sodium amytal was tried in 6 cases, after a nursing group 
was trained in techniques — three patients showed marked improvement. One ex- 
tremely excited manic became profoundly depressed and remained so for some time. 
One patient, a chronically disturbed patient received no effect from the drug. It was 
concluded from this brief trial and reports in the literature that in certain selected cases 
of manic excitement, narcosic therapy was of value in shortening hospital stay and in 
prompt amelioration of symptoms. The maintenance of an efficient well-trained staff 
of 4 nurses was required for each 6 patients treated. This cost and the lack of personnel 
was a bar to its continuation. 

■ Female Reception Service 

Thirty-one patients were given both metrazol and insulin treatments and 23 of these 
patients were released from the hospital after such medication. Seventy-two patients 
received metrazol only, and half of this group left the hospital after this treatment. Two 
patients died as a result of metrazol injections. 

Neuropathological data has as yet not been completed. The main emphasis of the 
metrazol treatment during the past year was given to a group of depressed patients con- 
sisting of 20, classified as involutional and manic depressive psychoses. This was prin- 
cipally done by Drs. Cottington and Gavigan. The age range was 28 to 59 years and 
the patients had been ill from two months to five years. Treatments were administered 
three times weekly, beginning with a dosage of 3 cc 10% aqueous of metrazol, which was 
increased as necessary to obtain typical grand mal seizures, and were discontinued when 
remission or considerable improvement had taken place. In this series, 17 patients un- 
derwent full remission of symptoms and were discharged. Three manifested definite 
improvement. 

Continued Treatment Service 

1. Occupational Therapy. An average of 267 male patients (53%) and 167 female 
patients (45%) were industrially employed throughout the year. There was a rise in 
employment from 288 males working in September 15, 1937 to 313 males working Sep- 
tember, 1938 and from 231 female patients working in industry September 15, 1937 to 
296 recorded September 15, 1938. Effort was made to find new work outlets, especially 
for female patients, in housekeeping and sewing groups. 

2. Recreation consisted of ward games, ward marching, and nurses' ward classes in 
leisure time for sewing and light O.T. projects and the use of the outdoor playground 
group walking outdoors. During the summer months, eight dances were held for pa- 
tients on the service during the year, and motion pictures were shown once a week. 

3. A special effort was made to encourage church attendance among patients. 

4. Hydrotherapy: 82,919 hours continuous baths, 10,455 hours wet sheet packs, 4,888 
tonic suite, colonics and special treatments were given to patients. There has been an 
increase of such prescriptions to combat destructiveness and excitement of patients dis- 
turbing the wards at rest hours. 

5. Habit Training, with special attention to the senile and deteriorated patients, was 
instituted to bring about regularity in toileting, meals, exercise and rest hours. 

6. Metrazol was begun in March 1938 on this service. Nine hundred and sixty-nine 
injections of this drug were given to female patients and 478 to male patients on alternate 
days. Six patients received a combination of metrazol and intravenous sodium amytal 
treatment experimentally at the beginning. Metrazol in chronic disturbed patients 
had a definite effect in improving ward adjustments, reducing feeding problems and un- 
toward behavior, making the patients accessible to occupational therapy and ward ac- 
tivities. In connection with this treatment. Dr. Holt undertook a survey of the effects 
of metrazol upon the spinal fluid, making 269 personal examinations. 

7. A special study of patients with seizures as a presenting symptom was undertaken. 
Twenty encephalograms were made; cranial exploration was done upon one patient. 

8. Intravenous sodium amytal was given for therapeutic purposes to 8 patients. 

9. Prolonged narcosis therapy with sodium amytal and sodium alurate was under- 
taken on four occasions, the patient, a psychopath with pathological emotionality, re- 
sponding by better rapport and therapeutic contact. 

10. Female sex hormone therapy was supplied for two patients in melancholia without 
appreciable benefit to the mental status. 



Hours 




Hours 


. 245 


Social Service Students . 


. 85 


. 180 


Attendants . . . . 


. 30 


. 115 


Psychology Internes 


. 25 


. 110 


Grey Ladies A.R.C. . 


. 25 


. 100 


Graduate Nurses 


. 20 


20 







8 P.D. 23 

11. Epileptics under treatment averaged 5 female and 11 male patients. Pheno- 
barbital was the standard drug used, latterly with the addition of benzedrine to counter- 
act undesirable side effects with large dosage. 

In the treatment of any mental illness the approach to the patient must be through 
his illness and infections, through his altered chemistry, through his endocrines, through 
his mechanical changes, through more purely psychological methods. No single line of 
attack will meet the multiple effects of causative factors. There is rarely a case in which 
a treatment cannot be directed to more than one aspect of it. It is frequently difficult to 
trace the primary and leading cause of the breakdown and to decide which is to be the 
first like of attack. Therefore, with the use of insulin, metrazol, vitamin, narcosis or 
any other special form of therapy the combined efforts of the nurse, occupational thera- 
pist, psychologist, social worker and other disciplines were utilized to enhance recovery. 
Their ancillary services have made it possible to bring about a quick adjustment on the 
part of the patient. 

Teaching 
Instruction was given to graduate internes, to Peter Bent Brigham internes and medi- 
cal students; to social service, occupational therapy, psychology and statistical students, 
to post graduate nurses and affiliating nurses. 

Hours of Instruction: 

Post Graduate Nurses 

Internes 

Occupational Therapy Students 
Affiliate Nurses. 
Peter Bent Brigham Internes 
Miscellaneous Groups 

Psychiatric internes were given, in addition to experience in clinical psychiatry, 
guidance in neuroanatomy and neuropathology, an introduction to research methodology 
a period of orientation in social service and occupational therapy and a month at the 
Child Guidance Clinic. 

Extra Mural Activities 
Much demand has been made on the hospital for extra mural instruction. A list of 
some of the groups receiving instruction follows. 
Boston City Hospital Undergraduate Nurses 
Boston University School of Medicine (Sophomore Class) 
Central Baptist Church — Southbridge 
Central District Medical Society of Connecticut 
Chaffin's Parent Teachers Association 
Department, University Extension 
First Universalist Church Mission Club 
Fitchburg Federation of Pastors 
Girl Scouts, Temple Emanuel 
Grafton State Hospital 
Hall Club 

Institute Human Relations, Yale 

Ladies Aid, Adams Square, Congregational Church, Worcester 
Ladies Aid, Congregational Church, Framingham 
Leicester Grange 
Lincoln Square Baptist Church 
Lowell Parent Teacher's Association 
L. H. R. Business Girls of Wesley Church 
Marlborough Daughters of the American Revolution 
Marlborough Forum Group 
Married Couples Club, Spencer, Mass. 
Massachusetts League of Nursing Education 
Massachusetts State Nursing Association. District No. 2 
Mothers' Club, Wesley Church, Worcester, Mass. 

New England Conservatory of Music, Alumni Association of Worcester County 
New England Deaconess Hospital 



P.D. 23 9 

Neurological Supper Club, Harvard 

National Jewish Council of Women 

Open Hearth Club, Worcester, Mass. 

Oxford Church Group 

Psychological Colloquium, Brown and Clark University 

Radio Talk, Worcester Federation Churches 

Republican New Voters Unit 

Smith College School of Social Work 

Social Service Case Workers of Worcester 

Staff of Worcester Schools 

Stoneham Congregational Church 

Sutton Men's Club 

Teachers Webster- Dudley School System 

Tufts Medical School (Junior Class) 

Uxbridge Rotary School 

Wheaton College Seniors 

Whittenagamot Club 

Worcester District Dental Society, Study Club 

Worcester Girls' Club Leaders 

Worcester Hahneman Hospital Undergraduate Nurses 

Worcester Memorial Hospital Undergraduate Nurses 

Worcester St. Vincent Hospital Undergraduate Nurses 

Worcester Young Men's Christian Association 

Papers 
On May 18, 1938, a symposium on therapy was held at the hospital and many in- 
teresting papers were read by members of the Staff of the various mental hospitals. Dr. 
Walter E. Barton gave a concise treatise on the use of narcosis therapy. The director 
read a paper at the American Psychopathological Association entitled, "Psychiatric 
Manifestations of Mucous Colitis. A Case Report." 

Certification in Psychiatry 
This year all the Staff members eligible to be examined by the American Board of 
Psychiatry and Neurology were certified. Eight men now hold certificates as specialists. 
The medical staff is especially grateful to Dr. Paul Yakolev and his colleagues for the 
comprehensive instruction given in the fundamentals of neuroanatomy, neuropathology 
and neurophysiology and roentgenology. 

Recommendatio7is 
It is hoped that in the ensuing year it will be possible to extend the training period 
of the internes in psychiatry for a period of two years and thereby give them the op- 
portunity to get instruction in other institutions. Instruction is to include a temporary 
interneship at the criminal insane institution, at a school for the feeble minded and at an 
epileptic colony. More emphasis will be placed on the social aspects of psychiatry to 
afford the interns an opportunity to realize the resources of the community. A course on 
hospital administration and the legal aspects of psychiatry will round out the period of 
training. 

Nursing Department 
Katharine McLean Steele, Superintendent of Nurses 
Standards of Nursing Care: 

One of the important functions of the nursing service in a mental hospital is to or- 
ganize the nursing care of patients on a level higher than "custodial" care. Part of the 
treatment of patients is to adjust them to a well organized, smooth running environment 
with an orderly routine in which they participate, either voluntarily or through persua- 
sion. For help in establishing such a treatment situation, the therapy chart has proved 
of great benefit. 

To be of value, the chart must be kept up to date and must be carefully and conscien- 
tiously filled out every day. At the end of the month, it is sent to the nursing office from 
each ward. The administration studies it, compares it with previous months' records, 
makes comments and criticisms and sends it bacK to the ward. 



10 



P.D. 23 



Capacity 24 patients 

Ward Hooper Hall; Month December 1938 



Therapy Report 
Nurse Helen Adams 



Day of Month 



I 1 I 2 I 3 I 4 I 5 I 6 I 7 18 | 9 I 10 | 11 I 12 I 13 I 14 I 15 



General Care 



Wash Face 


48 


48 


48 


48 


50 


50 


56 


48 


46 


44 


44 


57 


54 


54 


56 


Brush Teeth 






48 


48 


48 


48 


50 


50 


56 


48 


46 


44 


44 


52 


54 


54 


56 


Bath . 






24 


24 


24 


24 


75 


25 


78 


74 


73 


77 


77 


76 


77 


77 


78 


Trim Nails 






8 


5 


3 


5 


9 


4 


1 


70 


6 


8 


10 


17 


10 


5 


6 


ToenaQs 






10 


6 


9 


6 


7 


4 


1 


11 


9 


10 


7 


11 


9 


7 


9 


Shave . 




































Haircut 




































Untidy — Bowels 








1 


1 


























Urine 






I 


1 


? 


























Toileted — Bowels 








7 


? 






? 


1 


















Enema 












1 


3 


? 


6 


1 




3 






3 


7 


5 


Menstruation . 






1 


1 


1 


1 


1 


1 


7 


4 


7 


1 


1 


1 


1 


1 


1 


Beauty Parlor . 








10 




6 




13 




12 






6 




14 




5 



Physical Activities 



Out of Doors 


20 


19 


24 


5 


17 


R 


15 


7 


R 


R 


70 


21 


27 


6 


77 


Marching Ward . 


17 


20 


20 


12 


16 


26 


24 


24 


72 


77 


16 


17 


20 


74 


72 


Calesthenics 


19 


20 


20 


19 


70 


20 


20 


70 


8 


9 


10 


11 


10 


8 


70 


Dancing, Ward . 


20 


18 


16 


15 


10 


8 


9 


8 


16 


11 


12 


12 


9 


6 


18 















Recreational Activities 
















Ward Games 


15 


18 


20 


20 


22 


20 


70 


70 


70 


18 


70 


71 


19 


70 


77 


Group Singing 








17 


16 


24 


17 


20 


18 


14 


15 


73 


71 


17 


18 


11 


17 


16 


Group Reading 








20 


19 


10 


16 


17 


14 


10 


10 


15 


16 


19 


20 


2 


10 


19 


Special Radio 








24 


24 


24 


24 


25 


28 


26 


24 


73 


72 


71 


18 


8 


78 


78 


Library 








11 


1 


2 


7 


3 


7 


5 


4 


4 


4 


5 


6 


6 


7 


11 


Books Given 








12 


14 


4 


6 


4 


14 


10 


5 


20 


18 


10 


11 


5 


10 


14 


Church 














14 








17 






IS 










Dance . 






































Entertainment 






















14 












71 




Party . 







































Occupational Therapy 



Hospital Work — Cafe . 


3 


3 


3 


3 


3 


3 


3 


3 


3 


3 


3 


3 


3 


3 


4 


B. Parlor . . 


2 


2 


2 





7 


2 


7 


7 


7 


7 





7 


1 


1 


2 


Sewing Room N. Home 


2 


2 


2 





2 


2 


2 


2 


7 


7 





7 


3 


3 


3 


Industrial 


1 


1 


1 





1 


1 


1 


1 


1 











1 


1 





M. Room 


3 


3 


3 





3 


3 


3 


3 


3 


3 





7 


7 


7 


7 


Dining Room . 
































Engineer 
































Outside .... 


2 


2 


2 


2 


2 


2 








3 


2 


2 


1 


1 


1 


1 


Others .... 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 



Ward Work 



Bed Making . 
Sweeping . 
Dusting . 
Toilets . 
Bathroom 
Wash Windows 
Polishing. 
Swabbing 
Linen 



. 


21 


20 


22 


19 


20 


22 


24 


23 


20 


21 


20 


21 


21 


21 






17 


19 


19 


19 


17 


17 


17 


8 


8 


9 


10 


10 


10 


10 






11 


12 


12 


17 


18 


19 


19 


2 


2 


3 


4 


4 


4 


4 






2 


3 


4 


3 


3 


3 


3 


3 


1 


1 


2 


2 


2 


2 






3 


4 


4 


4 


4 


4 


4 


2 


2 


3 


3 


3 


3 


3 






2 


2 


2 


2 


2 


2 


1 


1 


1 


1 


1 


1 


1 


1 






1 


1 


1 


1 


1 


1 


1 


1 


1 


1 


1 


1 


1 


1 






2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 


2 






5 


4 


4 


4 


4 


4 


4 


2 


2 


2 


2 


2 


2 


2 



Class Work, Ward 


Sewing .... 


18 


16 


10 


17 


16 


18 


16 


8 


8 


9 


9 


10 


10 


10 


12 


Mending 


9 


10 


2 


10 


12 


15 


12 


4 





3 


3 


3 


8 


8 


6 


Arts and Crafts 
































Other Work . 


























3 


3 


3 


O. T. Center 


10 


10 





10 


10 


11 


13 


9 


3 


3 





16 


9 









Comments on Therapy Chart — Hooper Hall One — November 1938: 

General care of patients this month is satisfactory. A daily bath for each patient. 
This is quite commendable. Toe nails and finger nails seem to have been given 
sufficient care. 

I am glad to note that you have checked the incontinence in the one patient. The 
result of habit training undoubtedly. Your beauty parlor report is an excellent 
one. It shows that each patient visited the beauty parlor at least four times during 
the month. 

Recreational and occupational reports are very good. 

It shows that your patients are continually engaged in some form of therapy. 

A ward party for your patients. This is good. 

You have no accidents recorded for the month. Is this correct? 

Your report in general is an excellent one. It is the kind of report I like to see, 
especially on the admission ward. 



P.D. 23 11 

This kind of treatment should aid greatly in the ultimate recovery of these 
patients. 

Monthly averages of such items as baths, beauty parlor treatments, shaves, haircuts, 
have been summarized for the year, 1938. The following figures will show to what ex- 
tent the nursing service is able to rise above the minimum standards which have been 
set. 

Minimum Standards Averages for 1938 
per month per patient per month per patient 

Baths 12 22.9 

Beauty Parlor Treatments .... 2 2.4 

Shaves 12 12.8 

Haircuts 1 1.6 

Ward parties 3.0 

General care is of first importance and as part of the physical care of patients' habit 
training, deserves emphasis. There is no group of deteriorated, untidy patients whose 
habits and appearance cannot be greatly improved on a ward where all the personnel con- 
scientiously carries out a program of habit training with regularity of toileting, exercise, 
eating, sleeping, and bathing. 

On a large ward on the continued treatment service, the simple procedure of washing 
hands and face and brushing the hair and teeth becomes a difficult task unless the patients 
are trained to take part in these activities in a systematic and orderly manner at the 
same time each day. Some patients are able to assist in the supervision of other patients, 
making the procedure somewhat simpler. 

The therapeutic effect of frequent shaves, haircuts, manicures and beauty treatments 
is well known. Minimum standards should be set for these treatments and a vigorous, 
effort made on the part of the nursing personnel to rise above these standards. Again> 
patients can do a very large part of the work in the beauty parlor and barber shop un- 
der the supervision of trained employees. This placement in the industrial program 
has the advantage of being excellent therapy for the working patient. 
Physical Activities: 

All patients need to get outdoors every day that the weather permits. It gives them 
a new perspective and at the same time keeps them in touch with reality. This is an 
activity that drops to a minimum unless there is constant insistence of its importance. 
The daily report from each ward is sent to the administration, with census of the ward, 
the number of working patients, the number of infirm patients, the length of time they 
were outdoors. We believe more benefit is derived from a small group than from the 
large formal marching groups. 

Marching on the ward is done daily when possible after dinner, and after supper, 
with the windows of the ward open. By calling the radio room, martial music is played. 
Active participation is gained even on the part of the schizophrenic, who is withdrawn 
and preoccupied, and though the response may be mechanical, the activity and fresh 
air are beneficial. The nurse organizes a group of patients for calesthenics early in the 
day before other activities start. Dancing to music from the radio may be done with 
individual patients at any time during the day when the patients seem to have slumped 
into inactivity. 
Recreational Activity: 

Many nurses do not seem to have experience in organizing recreational activities. 
Classes taught by the Recreational Director of the Y. M. C. A. have been found to be 
very stimulating and helpful. There is an endless variety of games that can be used on 
the wards such as beano, bridge, checkers, ring toss, soft ball or bean bag throwing, jig- 
saw puzzles, all types of solitaire, etc. 

Group activity singing, reading, listening to the radio, ward parties furnish a variety 
of occupation for patients in the evening. It is the recording of all these activities on 
the therapy chart and the commenting upon them monthly by the administration that 
stimulates competition and enthusiasm. 
Occupational Therapy: 

The industrial activities are taken care of and reported upon by the occupational 
therapy department, but it is the responsibility of the ward personnel to see that patients 
are ready for their job and interested in it. The housekeeping on the ward can be made 
into a therapeutic activity, patients can get pleasure in being taught to make a bed cor- 



12 



P.D. 23 



rectly, cleaning windows, washing floors and polishing, if pride in the appearance of the 
ward is built up. 

When the nursing personnel is made responsible for all the occupational therapy that 
is done on the ward, either in class work or individually, cooperation between the nurs- 
ing service and the occupational therapy department is essential. The O.T. depart- 
ment furnishes the material, stimulation and advice, and the nursing department carries 
out the activity. 

Summary of the Sick Leave Program in the Worcester State Hospital for 1938 — Katherine 
R. Dick, R.N., Asst. Supt. of Nurses: 

1. Desirability — The hospital favors the practice of continuing sick employees on the 
payroll for a time. Health hazards exist in an institution over which the employee has 
no control. We therefore believe that sickness acquired in line of duty should not be 
an occasion to penalize the employee. A few simple rules cover the compensation for 
time lost due to illness. 

2. Who is eligible to receive benefit? All employees who have been in the service of 
the hospital six months or longer. 

3. Method — (1) Group one constitutes all employees working on a per diem basis 
or forty-eight hours a week. The maximum time for which sick leave with pay will be 
granted in any one year is twelve working days. (2) Group two comprises the adminis- 
tration staff and heads of departments. Persons in this group are available for duty any 
hour of the day or night. More sick leave than indicated in (1) may be considered ad- 
visable for group (2). The superintendent is the judge when such exceptions arise. 

(3) In order to secure sick leave with pay, the employee must consult a physician of 
the medical staff of the Worcester State Hospital in the employees' clinic, or a physician 
in practice in the community, 

(4) Employees hospitalized under the direction of the Worcester State Hospital 
physician will receive compensation from the first day of illness. 

(5) Employees who elect to remain home will not receive sick leave with pay until 
the third day of illness unless after that time they produce the required certificate duly 
signed by a physician practicing in the community. 

(6) A sick report card is kept on file, properly filled out on each employee absent by 
reason of illness. 

The sick leave program was instituted June 1, 1938. The following study, from June 
1, 1938 to December 1, 1938, was made from the daily time sheets and the sick report 
cards for the nursing service of the main hospital. 

89 employees were ill 454 days: 

50 of the 89 were in service 6 months or longer, were ill 335 days. 

41 of the 50 were ill 295 days, illness certified, paid for 214 days. 

There were 90 surgical days: 

3 appendectomies 76 days , . . paid 36 days 

2 tonsillectomies 14 days . . . paid 12 days 



The following were out six days or longer: 
1 pyelitis 
1 gout . 

1 facial neuralgia 
1 furunculosis 
1 abscess soft palate 
3 acute infections 



90 days 



23 days 

13 days 

8 days 

8 days 

6 days 

23 days 



48 days 

paid for 11 days 
paid for 11 days 
paid for 6 days 
paid for 7 days 
paid for 6 days 
paid for 20 days 



81 medical days 



The following were injured in line of duty: 

1 fracture rib 9 days 

1 fracture finger 10 days 

1 fracture metacarpal .... 6 days 

1 fracture toe . . , . . . 4 days 



paid for 61 days 



paid for 
paid for 
paid for 
paid for 



8 days 
6 days 
5 days 
4 days 



29 fracture days 
In the nursing service in the main hospital: 

17 persons ill as listed lost 200 days, paid for 124 days. 



paid for 15 days 



P.D. 23 13 

6 persons ill for less than six days each, these persons lost through illness 95 days 
and were paid for 90 days. 
The following is a summary of time lost for the entire hospital through sick leave, cover- 
ing persons in the service six months or longer: Employees off, 80; days off, 619; days 
paid, 514. 
Recommendations : 

1. That one year of service be required before an employee is eligible to receive 
compensation. 

2. That employees who elect to remain at home may receive compensation from 
first day of illness upon presentation of a doctor's certificate. 

Nursing Education 
Evelyn H. Pettee, Director of Nursing Education 

The work of the department has continued substantially the same as in the past year. 

Four students completed the eight months postgraduate course in psychiatric nursing 
in May, 1938. All of these nurses have continued in psychiatric nursing, two as head 
nurses at this institution, one at the Neuro-Psychiatric clinic in Ann Arbor, Michigan, 
and one at the Westchester Division of the New York Hospital in White Plains, New 
York. 

Two students were enrolled in the postgraduate course for 1938-39. In spite of this 
small enrollment, we feel that the course which is still in its infancy should be continued. 
Considerable interest, as well as an evident need for such a course, has been manifest. 
We feel that the enrollment will increase after the prestige of the course becomes es- 
tablished, in large part, through its graduates. 

Worcester Hahnemann, Memorial and Saint Vincent hospitals have continued to 
sent seven of their students to us every three months for a psychiatric afifiliation until 
October, 1938, when we were authorized to utilize unused postgraduate "blocks" 
for additional affiliate nurses. This raised our affiliate quota to twelve every three 
months and made it possible for us to accept students from the Burbank Hospital in 
Fitchburg. 

The twelve student blocks are filled as follows: Burbank Hospital, 2; Worcester Hahne- 
mann Hospital, 2; Worcester Memorial Hospital, 5; Worcester Saint Vincent Hospital, 3. 

A thirty-three hour lecture course in psychiatry and psychiatric nursing was given to 
a large group of student nurses from the previously mentioned Worcester hospitals for 
whom a psychiatric affiliation could not be provided. 

All new employees continue to receive orientation lectures and all new attendants a 
course which deals with hospital routine and the essentials of the care of mental patients. 

A course for a group of Grey Ladies of the American Red Cross was organized in 1938 
and a series of thirteen lectures given. After successfully completing the course, a 
certificate was awarded and the Grey Ladies assisted in the escorting of visitors. 

During the past year, monthly reports have been instituted, new student report 
forms adopted and a new postgraduate course outline printed. 

The nursing service has also contributed in small part toward the community educa- 
tion program through speaking engagements. 

The department of nursing education has co-operated with the other departments of 
education in the hospital so that in many subjects the nurses have had classes in con- 
junction with students from the other departments. 

We believe this is very stimulating and hope for even more contact with other de- 
partments in the future. 

Occupational Therapy Department 

Dorothea W. Cooke, 0. T. Reg. Director 

The present program of Occupational Therapy has been functioning for four years. 

During the past year much of this program has crystallized to the point where it has 

become a decided factor in the improvement and recovery of patients in the hospital. 

Our aims have been : 

I. lo ever-increase the scope of organized therapeutic activity to include the 
entire patient population, namely: — a. Newly admitted group, b. Con- 
tinued-treatment group, c. Medical and surgical group, 
ii. 1 o educate hospital personnel in the essentials of the role they must enact and 
in ttieir responsibilities in such an inclusive program. 



14 P.D. 23 

The newly admitted group are sent to the two pre-industrial occupational therapy 
shops, unless there are contra-indications, mental or physical. Handicraft activity, in 
which individual endeavor is combined with the experience of working with others, 
predominates. Concentration and coordination are important in the patient's adjust- 
ment. The ability to accept and follow directions and instructions and to take criticism 
is emphasized, and also the necessity of adapting to and facing reality. To the occu- 
pational therapist in charge of the shop falls the responsibility of finding an adequate 
form of occupation that will drive the patient out of his pleasant state of unreality 
to take the first step in facing the real situations of life. 

Treatment equals the relationship between the therapist and her patient, plus the 
activity, plus the environment; and so we find that it has been very important to make 
our shops as colorful and attractive as possible. Neatness and orderliness also play an 
important part in the re-education and re-establishment of a normal behaviour pattern. 

We find, however, that the craft type of occupation is not rooted in reality and tends 
to keep a patient so inclined away from reality, if continued too long. Thus we have 
been developing Industrial or Work Therapy until it has become the focusing point 
of our entire program, and as rapidly as possible patients are promoted from the shops 
to Industrial Therapy. 

For the newly admitted group and the continued-treatment group Industrial Therapy 
presents the next step in rehabilitation. This service has two primary purposes: it may 
help the individual to find a niche for himself within the hospital community, or it may 
be a stepping-stone in the necessary adjustment he must make in order to return to the 
normal workaday world. In prescribing this form of treatment for patients only such 
tasks are chosen as may have treatment or training value and are within the mental and 
physical capacities of the individual patient. Cooperation, patience, and a certain 
amount of initiative are important if one is to work with ten or twelve others. Self- 
control and tact become essentials if harmonious relations are to be maintained in a 
group-work situation, such as the serving counter in the cafeteria, and we find that a 
patient held up to these demands soon benefits. 

Our ultimate aim is, of course, the return of the patient to his own community with a 
new grip on life and a new confidence in self. However, if this is not possible, he is much 
better off in being a responsible member of the hospital community, participating in 
useful activity and in becoming an economic asset within the institution. 

For the medical and surgical group, classes on the ward are the responsibility of the 
ward nurse, who in turn is guided by the occupational therapist. The occupational 
therapy department has charge of a Supply and Preparation Room, open three times a 
week at regular hours, where the nurse may obtain handicraft projects prepared for com- 
pletion, materials, instructions, and advice. 

In the continued-treatment group, ward classes supervised by the nurse, supplementing 
Industrial Therapy, have been developed for the deteriorated, disturbed, and senile, and 
also for any patients who may temporarily be unable to adjust to the demands of a daily 
task and for whom the occupational therapy shops can not care, due to the lack of time, 
space, and personnel. 

For the past year patients have received treatment under Occupational Therapy as 
follows : 

Main Hospital Male Female 

Total monthly average number of patients in hospital 901 883 

Total monthly average number of patients receiving 

treatment in occupational therapy shops (chiefly 

newly admitted and insulin and metrazol patients) 49 or 5.44% — 79 or 8.95% 
Total monthly average number of patients working in 

maintenance industries (placed by physician's 

prescription) 598 or 66.37%— 407 or 46.09% 

The remainder of the patient population : 

Medical and Surgical patients 128 or 14.21%— 142 or 16.08% 

Continued treatment and newly admitted patients 

unable to adjust to industry 126 or 13.98%— 255 or 28.88% 

The last two groups are kept occupied on days they are able to work in ward classes 
supervised by the ward nurse, the Occupational therapist being responsible for the 
preparation and supplying of materials with which to work. 



P.D. 23 15 

Recreational Therapy is also a part of our therapeutic program. A continuous schedule 
is carried on for all types of patients, graded as to the demands of the groups. 

Until such time as we are able to include a well-trained recreational director as a 
member of our department, the parties, daily marching, and games on the ward are the 
responsibility of the ward nurse. Community recreation, holiday celebrations, dances, 
community singing, and the providing of recreational equipment are all the responsibility 
of the director of occupational therapy. 

Our dances are different from those in most mental hospitals. We try to have them 
coincide with holidays to permit attractive decoration. They are held at irregular 
intervals rather than weekly. The list of patients is carefully selected by the physician 
for purely therapeutic reasons. Each patient is held to a high standard of conduct and 
appearance. The dances have all the aspects of normal social affairs, presided over by 
the occupational therapist. One important rule is that no one shall attend in uniform. 

For the continued-treatment group, who often exhibit bizarre conduct and eccentric 
dress and behaviour, occasional dances are also arranged. 

Education — The success of this entire program depends upon the intelligence and 
understanding of the hospital personnel in cooperating with the occupational therapy 
department. For their guidance certain responsibilities have been outlined by our 
superintendent, and it has become our responsibility to broadcast these in daily contacts 
to: a. New physicians joining the staff, b. Nursing group, c. Department heads, 
d. Industrial therapists (personnel directly supervising patients in maintenance tasks). 

Occasional formal talks and question periods are arranged for the nursing supervisors. 
Weekly visits to the Supply and Preparation Room offer an excellent opportunity for a 
better understanding between the ward nurse and the occupational therapist. 

Attendants, newly admitted to the hospital are given a lecture on the occupational 
therapy program and what their responsibilities are. 

Afiftliate nurses from General Hospitals attend lectures and spend one week in each 
shop, with the added experience of being responsible for a ward class. 

Postgraduate nurses receive sixteen hours in lectures on theory of occupational therapy 
and one month's experience in practice. 

Few medical schools devote time to occupational therapy except in passing reference. 
Yet, although a knowledge of our technique is not necessary, an appreciation of it is 
essential. Therefore all medical students are taken on Industrial Rounds to see the 
activities prescribed and the patients actually at work. 

Special internes here for one year spend two days in the department observing the 
different services. 

Lectures are given to the group of Family Caretakers, pointing out how they may con- 
tinue this treatment in their homes with the patients in their care. 

Included also in our educational program are sixteen students each year from the 
Boston School of Occupational Therapy. These students come to us for six-month 
periods of practical experience in the mental field. Their curriculum provides thirty 
hours of lectures on the Practice and Principles of Occupational Therapy in this field. 

With all these groups our aim is the constant promotion of a better understanding of 
the breadth of this unified program and of the facilities of the occupational therapy 
department, which may be developed to the advantage of every patient. 

Social Service Department 
Barbara Estes, M.S.S., Head Social Worker 

One of the major concerns of the Social Service Department might be stated as fol- 
lows: "Referred to the Social Service Department, John Jones and Mary Smith to be 
placed in Family Care. Vacancies in Family Care home, — 2 for men, 1 for a woman; 
waiting list of patients referred for Family Care, — 5 men, 3 women." The problem 
appears obvious and simple of solution, — namely, (1) accept the applicants and place 
those referred to the department and, (2) fill all vacancies from the waiting list. The 
problem, however, cannot be so simply solved. 

In September 1938 we were granted an additional worker, Mrs. Hildur Ekdahl, on 
a one year appointment to work on Family Care problems with Miss Harrington. 
During the year 93 patients were placed in Family Care homes, of whom 39 or about 
42% were placed during the last three months, or since the appointment of a second 
worker. During the first nine months 10 boarding homes were investigated. During 
the last three months 54 homes were investigated. An indication of the time consumed 



16 P.D. 23 

in such investigations and the difficulty in finding suitable homes is revealed in the fact 
that of these 54 homes, only 9 were finally accepted. The reasons for this are varied, 
including unsatisfactory references, distance from the hospital, unsuitability of the 
family, (e.g. a single woman wanting to board male patients and unable to accept women 
because she has a male boarder) or, more commonly, the final decision of the family that 
they cannot accept patients at state rates of $4.50 per week. There is no question but 
that we could place at least twenty more patients if we could guarantee $7 or even $6 
per week. Many applicants withdraw with the explanation that they can get elderly 
people who are receiving Old Age Assistance of $2S-$30 per month and who are, after 
all, much less care than mental patients. It is a tribute to the sincere interest of our 
many caretakers that they accept their responsibility so adequately and so cheerfully. 
The second problem, the co-existence of vacancies and a waiting list, similarly, is not 
so simple of solution. Mary Brown has to be placed in a home near a Catholic Church 
and the vacancies for women are all in the country far from such possibilities. Or John 
Smith, a young man, needs to be with an understanding family so situated that he may 
have opportunities to look for a job, while Robert Jones, an elderly man of culture and 
refinement, wants to be near a library where he can indulge his fondness for reading. 
Neither of these men will fit into the present vacancies which are most suitable for middle 
aged men who enjoy simple farm tasks. That it does not pay to try to force square pegs 
into round holes has been clearly demonstrated in certain instances. A young woman 
placed in a home which did not suit her, became so prejudiced against Family Care that 
she had to be returned to the hospital and refused ever to consider placement in another 
home. She also spread stories which influenced other patients against boarding out. 
Also the placement of a patient in a home in which he is not happy, may so irritate him 
that he upsets the household, and in the case of a new caretaker, may discourage her and 
influence her to give up the project. Human beings are not all square pegs to be fitted 
into the square holes of boarding homes; rather, like the pieces in a psychological form 
board, they must be placed in the environment in which they best fit. 

It has been a great help to the workers this year, to have Dr. Watson assigned to the 
care of boarding out patients. Much time is saved and more efficient medical and psy- 
chiatric service can be given when the patients are under the supervision of one physician 
who knows them well. During the year 364 calls were made on Family Care patients 
by the physician and 1,225 calls by social workers. 

Statistics for the department as a whole include the following: 

New cases assigned 1,963 

Histories taken 367 

Supplementary information contributed on other cases 715 

Investigations made 1,927 

Interviews held 5,236 

Patients placed in Family Care 93 

Patients status changed from Family Care to visit 20 

Patients discharged from Family Care 8 

During the past year we have had our customary students, three from the Smith 
College School of Social Work and two from Simmons College School of Social Work. 
We have had, in addition, a student from Boston University School of Religious and 
Social Work, a young man who lives nearby and does not, therefore, require maintenance. 
We are very glad to accept our first student from Boston University and hope that the 
present pleasant relationship may continue. 

The head social worker attended the National Conference of Social Work in Seattle, 
Washington. The opportunity to visit two state hospitals in Washington and to talk 
with workers from Vancouver and Victoria, as well as from other western hospitals, was 
a valuable experience. Two workers attended the supervisors conference at Smith 
College in July, and the Massachusetts State Conference of Social Work held in Boston 
in November was attended by the entire department. 

Lectures have been given as usual to medical students, nurses and occupational ther- 
apy students, as well as to our own social service students. Several lectures or more in- 
formal talks were given by members of the department to outside groups, the most 
distant being to the staff of the Western State Hospital near Tacoma, Washington. 

We feel that the general efficiency of our work has improved this year and we are 
grateful for the fine cooperation from all other departments in the hospital which con- 



P.D. 23 17 

tribute to the smooth operation of our department. We again end the year with an 
urgent request for the permanent appointment of an additional worker for Family Care. 

Research Department 
Andras Angyal, M.D., Resident Director of Research 

A great part of the activity of the Research Service during the last year was the con- 
tinuation of the investigations on the effects of insulin treatment of schizophrenia and, 
less elaborately, of metrazol. While the work was primarily oriented toward thera- 
peutic results, a number of subsidiary problems were studied with a view to determining 
the mechanism of the effects and to learning under what conditions favorable results may 
be obtained. 

In addition to other activities the Psychology Department, under the direction of Mr. 
David Shakow, devoted considerable time to the study of the behavior and mental 
activities of patients in the various phases of insulin and metrazol treatment. The 
activity of this department is reported in greater detail separately. 

The insulin work was supervised by Dr. D. Ewen Cameron and was shared by all the 
departments. Twenty-two of the more acute cases were treated. Ten patients had a 
good remission and twelve did not respond favorably to insulin treatment. When the 
group of recovered and non-recovered patients had been compared, distinct differences 
in the physiology became evident: 

1. Recovered patients had a low blood pressure before treatment as contrasted 
with a group of non-recovered patients who originally had a normal blood pressure. 
After treatment the recovered patients showed a significant increase in their blood 
pressure. 

2. The recovered patients showed initially an entire lack of constant relationship 
between free cholesterol and ester cholesterol of the blood, while in this respect 
the non-recovered patients were normal. After cessation of the insulin treatment in 
the recovered patients it became stabilized. 

3. The inorganic phosphorus of the blood was originally super-normal in all of 
the patients and decreased significantly in the recovered patients only. 

4. The recovered patients were underweight before treatment, while the non- 
recovered patients were of normal weight. Under treatment the weight of the re- 
covered patients increased. 

5. Only the recovered patients showed an increase in pulse rate; the non- 
recovered patients remained unchanged in this respect. 

6. The recovered patients showed a more marked increase in blood circulation 
time than did the non-recovered patients. 

On the basis of the foregoing evidence the hypothesis is offered that there is one sub- 
group of schizophrenics whose psychosis is significantly determined by initial depression 
of the adrenal-sympathetic apparatus. It is this group which responds favorably to 
insulin, and the behavioral effect may be due to improvement of the adrenal-sympathetic 
functions. 

In addition to the insulin study Dr. Cameron continued his investigations in associa- 
tion with Drs. H. Hoagland and M. A. Rubin upon the effects of emotion upon the brain 
wave picture, leads being taken not only from the cortical regions but from an area in the 
neighborhood of the hypothalamus. In view of the fact that the insulin results indicated 
that the adrenal activity, particularly of the recovered cases, was much increased, Dr. 
Cameron, in association with Dr. Rubin, studied the effects of adrenalin injections upon 
the brain wave picture. In association with Mr. R. Moore of the Psychology Depart- 
ment the effects of the same drug upon certain personalitj' traits were studied. As a 
further test of the activity of the sympathetic-adrenal system Dr. Cameron investigated 
the use of the so-called ice-water test. Immersion of one extremity in ice-water has been 
found to cause a greater rise in blood pressure in individuals with abnormal sympathetic 
activity. He also carried out a study on the early symptoms of schizophrenia with a 
view to making possible earlier detection and hospitalization of such cases. 

In November, 1938, Dr. Cameron left the Worcester State Hospital to assume pro- 
fessorship in psychiatry and neurology at the Albany Medical College. He was suc- 
ceeded by Dr. A. Angyal. 

In previous publications Dr. Angyal reported on a group of schizophrenics character- 
ized by the presence of a particular clinical syndrome, (depersonalization, experience of 
motor influences, auditory hallucinations with endo-somatic localization and disturbance 



18 P.D. 23 

of psychomotor activity.) It was inferred that the syndrome might be due to atrophy in 
certain sections of the parietal cortex. In order to test this hypothesis pneumoencephalo- 
graphic studies were carried out on a number of schizophrenic patients having this 
syndrome. In order to obtain a further objective check the same patients were also 
studied b}' Dr. Rubin by the electro-encephalographic method. The evidence points 
to the fact that a rather close correlation exists between the syndrome and parietal 
atrophy. 

Dr. Angyal also devoted considerable time and effort to the completion of a mono- 
graph entitled "Foundations for a Science of Personality." The monograph was written 
to afford an interpretational background for physiological as well as for psychological 
facts. Two sections have already appeared as articles in scientific journals. 

During the past year Dr. L. H. Cohen has devoted his energies almost exclusively to 
the metrazol project. The primary purpose of this study was to determine the thera- 
peutic efficacy of the drug and the best way of utilizing it. In all, 153 schizophrenic 
patients were treated and a number bearing other psychiatric labels were used as con- 
trols. In patients treated early in their psychosis the results were excellent. In more 
chronic cases the degree of improvement was in general less striking, but in a high pro- 
portion of the chronic cases in which over-activity and excitement were outstanding 
features, a marked quieting effect was obtained. Two outstanding results of administer- 
ing metrazol in the conventional method are convulsions and anxiety. Whether the 
convulsions are necessary to therapeutic success was studied by giving to a group of 
patients enough of the drug to evoke anxiety but not convulsions. The therapeutic 
results were less marked than with the conventional treatment. The same problem was 
approached in another way, namely, by giving sufficient amounts of a sedative drug 
(sodium amytal) to prevent convulsions. It seemed to have the general effect of lessen- 
ing the efficacy of the metrazol, and in this measure to detract from therapeutic results. 
Another method of using the drug was to give it in relatively large doses intramuscularly 
rather than by vein. The patients were thus brought into a condition where repeated 
convulsions occurred. No particular advantage of this method could be seen and since 
it added to the dangers of toxic injury it was discontinued. 

A study was made by Dr. Cohen in association with Dr. W. Freeman on the effect of 
metrazol on the various organs of rats. Also in collaboration with Dr. W. Freeman, 
post-mortem examinations have been made on three patients who had at some time been 
on metrazol treatment, and no pathological findings were obtained which could be re- 
garded as metrazol effects. 

Dr. Cohen is carrying out a study in association with Dr. L. Randall on the serum 
lipid values of excited and calm schizophrenic patients. 

Dr. C. Wall made an attempt to find common characteristics in a small group of 
schizophrenic patients who had responded to insulin treatment and to contrast these 
with a group who did not respond. The two groups showed suggestive differences in 
addition to the difference in duration of psychosis. The patients who responded showed 
in general a rapid onset, or an acute episode in a gradual onset. In contrast with the 
other group, they were capable of a considerable amount of "normal" emotion. Follow- 
up observations have been made on the above patients throughout the year. In another 
study data on the behavior of patients during hypoglycemia were correlated with the 
therapeutic success and an explanation of the correlation was attempted. Dr. Wall also 
made a study of pathological reflexes in schizophrenia. Reflex abnormalities in schiz- 
ophrenia have been reported by several other writers. Dr. Wall checked the results of 
these reports on 50 schizophrenics and 20 normal subjects. Only 2 of the numerous 
reflexes proved to be at all instructive, namely, those of Schrijver-Bernhard and Pio- 
trowski. However, these reflexes were found also in 2 of the 20 normal subjects, hence 
they are not of absolute diagnostic value. In conjunction with Dr. Rubin, Dr. Wall 
made a study on the effect of metrazol on the electrical activity of the brain in 11 patients. 

Dr. H. Freeman, in collaboration with Dr. Rodnick, studied the effects of a "thermal 
stress" situation upon various cardio-vascular and respiratory mechanisms in 20 normal 
and 20 schizophrenic subjects. The lesser response of the patients in blood pressure, 
heart rate and respiratory rate and depth seems to indicate that the schizophrenic 
patients as a group have a diminished reactivity. Dr. Freeman studied the arm-to- 
carotid circulation time in 22 acute schizophrenic patients who received insulin treat- 
ment. The mean circulation time was decreased by the insulin treatment by approxi- 
mately 3 seconds. Of these patients, 10 improved and the others showed no change. 



P.D. 23 19 

Both groups showed more stability in this function both within and among individuals as 
a result of the treatment, but the group which improved exhibited a greater change in 
this respect than the others. In collaboration with Dr. Rubin, Dr. Freeman studied the 
effect of NaCN on the brain waves. NaCN was used because of the apparent similarity 
of its respiratory effects to those of subconvulsive doses of metrazol. In 22 patients, 
0.7 cc. NaCN accentuated whatever brain rhythm was present previous to the injection. 

Dr. Freeman has been experimenting with a new therapeutic technic. By the use of 
cyclopropane he is producing rapid changes in the state of consciousness. In six chronic 
cases no satisfactory results were obtained, but in two acute cases being studied at 
present the results are encouraging. 

Dr. M. A. Rubin investigated the spontaneous electrical activity of the cerebral 
cortex as a whole, rather than in terms of its separate parts. The resultant distribution 
curves of alpha activity along the head from both cerebral hemispheres of normal indi- 
viduals yielded information of considerable neuro-physiological interest. Application of 
this "mapping" technic uncovered a new method for localizing cortical atrophy. The 
method is based mainly on the differences observed in alpha activity of corresponding 
areas in the two cerebral hemispheres when atrophy is present. 

Studies of the electro-encephalogram in "emotion" were also carried on in collaboration 
with Drs. Cameron and Hoagland. One of these studies was concerned with the relation 
between slow (delta wave) activity in the cerebral cortex and "emotion." In both 
normal and schizophrenic subjects, the delta wave activity increased with an "emo- 
tional" response to verbal stimulation. It seemed that the electro-encephalogram is a 
better index of "emotion" than the electro-cardiogram. In the other study (with the 
assistance of Dr. J. J. Tegelberg) simultaneous electrograms from the cerebral cortex and 
from a region near the hypothalamus brought out certain differences in the activity of the 
two organs. When an "emotional" response was evoked, delta waves appeared under 
the "Hypothalamic" electrode before they were recorded from the cortical lead. 

The effect of adrenalin on the cortical electrogram was studied in collaboration with 
Dr. Cameron. It was found that intravenous adrenalin was entirely without effect 
while when administered subcutaneously it altered the per cent time alpha in schiz- 
ophrenic patients but was without effect on normal controls. 

In collaboration with Dr. Wall the effects of metrazol on electrical activity of the brain 
have been studied. Simultaneous records from the head and from the musculature of 
the left arm confirmed the conclusions that the metrazol convulsions were of central 
nervous origin. 

Dr. Rubin also co-operated on the various therapeutic projects studying the changes in 
the electro-encephalogram before, during, and after treatment. 

During the year the biochemical laboratory, under the direction of Dr. J. N. Looney, 
has collaborated on studies on the effect of insulin on schizophrenic patients. Calcium, 
phosporus, potassium, lactic acid, blood gases and glutathione were determined twice 
weekly for the two weeks before the insulin treatment and for two weeks after the com- 
pletion of the therapeutic program. Blood lipids and choline esterase were done once a 
week. In addition lactic acid, pH, blood gases, and sugar determinations were made 
at intervals during the period of coma and one hour after glucose was administered. 

As a part of an extensive study of the sex hormone factor in schizophrenia, con- 
siderable attention has been paid to assay methods. The "characteristic curves" for 
gonadotropic material (Armour's maturity factor) have been fairly well established in 
immature male and female rats, using several organs as indicators. Similarly, con- 
siderable progress has been made in establishing the curves for testosterone propionate. 

The work on isolation of gonadotropic substances from the adrenal glands as reported 
last year has been continued by Dr. Looney and Miss Howe. Fractions were made 
according to the technique of Pottenger and also of Hofl'man. This showed only 
slight evidence of activity. Several fractions have been made by use of dibutyl ether 
and also by the use of dioxane. In preliminary tests suggestions have been obtained 
that the aqueous-alkaline fractions made from these solvents have a female stimulating, 
male-depressing effect. Ether soluble residue from the sodium NaOH treatment has 
given some evidence of a male gonado-tropic effect. Miss Howe has also worked with 
the colorimetric detail of gonadogens extracted from the urine of the schizophrenic 
patients by the benzol extractor of Koch. 



20 P.D. 23 

In a group of patients who are to receive testosterone, determinations are being made 
of the androgens and estrogens as well as the pregnandiol glucuronidate output of the 
urine. 

In collaboration with Dr. Cohen, Dr. Randall and Mr. Romanoff have studied the 
effect of metrazol on lipid and choline esterase of schizophrenic patients and also in 
excited as compared with calm patients. 

Dr. William Freeman and Miss Ruth Kennedy have carried out an investigation on 
the effect of metrazol convulsion on the various organs of rats, including the brain. 

The insulin study provided a large portion of the work performed by the Biometric 
Department under the direction of Mr. E. M. Jellinek. There was first the continuous 
recording of this data, next the preliminary analysis, and lastly a detailed final analysis. 
The most outstanding results have been referred to already in connection with the insulin 
study. 

The experiments of Dr. H. Freeman relating to insensible perspiration, oxygen con- 
sumption, and skin and body temperature under various conditions were subjected 
to exhaustive analysis. 

The results of Dr. Cameron's ice-water test as well as his eserin and adrenalin studies 
received preliminary statistical analysis. Special studies pertaining to oxygen consump- 
tion were performed. 

Dr. Lengyel has been making a study of spontaneous remission rates in schizophrenia. 
This was based on the records of the hospital starting with the year 1910. It is hoped 
that upon completion of this study control material will be available for evaluating re- 
mission rates in various therapeutic procedures. As a by-product of this study mortality 
tables in schizophrenia will be produced. 

On the theoretical side, Lamda techniques have been perfected now to such a degree 
that they have become available for practical application. 

Numerous small analyses have been prepared pertaining to various physiological and 
psychological studies. 

The papers published 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, 1937~November 30, 1938 

1. Protamine Insulinate in the Treatment of Diabetes in Psychotic Patients. Joseph M. 

Looney and W. Everett Glass. Am. J. M. Sc. 194: 810, December, 1937. 

2. Oxygen Metabolism in Schizophrenia. R. G. Hoskins. Arch. NeuroL & Psychiat. 

38: 1261, December, 1937. 

3. Some Uses and Abuses of Statistical Method in Psychiatry. E. Morton Jellinek. 

Biometric Bull. /; 97, December, 1937. 

4. The Use of Fiducial Probability in the Interpretation of Inclusive Experiments. 

Robert Dorfman. Biometric Bull. 1: 97, December, 1937. 

5. A Test of a Sample Variance Based on Both Tail Ends of the Distribution. John W. 

Fertig with the assistance of Elizabeth A. Proehl. Annals of Mathematical 
Statistics. 8: 193, December, 1937. 

6. Scatter on the Stanford- Binet in Schizophrenic, Normal and Delinquent Adults. 

Albert J. Harris and David Shakow. J. Abnorm. & Social Psychol. 33: 100, 
January, 1938. 

7. Studies in Vibratory Sensibility. L. H. Cohen and S. B. Lindley. Am. J. Psychol. 

51: 44, January, 1938. 

8. Understanding the Parent. Milton E. Kirkpatrick. Understanding the Child. 

6: 3, January, 1938. 

9. He is My Child, Too. Esther C. Whitman. Understanding the Child. 6: 19, 

January, 1938. 

10. Further Experiences in the Insulin-Hypoglycemia Treatment of Schizophrenia. 

D. Ewen Cameron. J. Nerv. & Ment. Dis. 87: 14, January, 1938. 

11. The Early Diagnosis of Schizophrenia by the General Practitioner. D. Ewen Cam- 

eron. New England J. Med. 218: 221, February, 1938. 

12. Oxygen and Carbon Dioxide Contents of Arterial and Venous Blood of Schizophrenic 

Patients. J. M. Looney and H. Freeman. Arch. Neurol. & Psychiat. 39: 
276, February, 1938. 



P.D. 23 21 

13. The Defi7iition of Ambivalence. Saul Rosenzweig. Brit. J. M. Psychol. 17: 

223, March, 1938. 

14. Relations of the Adrenal Glands at Autopsy with Clinicopathological Findings and 

with Blood Vitamin C. William Freeman and W. Everett Glass. Am. J. Clin. 
Pathol. 8: 197, March, 1938. 

15. Variability of Circulation Time in Norman and in Schizophrenic Subjects. H. 

Freeman. Arch. Neurol. & Psychiat. 39: 488, March, 1938. 

16. The Rorschach Test as Applied to Normal and Schizophrenic Subjects. Maria 

Rickers-Ovsiankina. Brit. J. M. Psychol. 17: 227, March, 1938. 

17. Imagery and Its Relations to Schizophrenic Symptoms. Louis H. Cohen. J. Ment. 

Sc. 84: 284, March, 1938. 

18. Electroencephalograms in Schizophrenia. (Abstract only.) Hudson Hoagland. 

J. Nerv. & Ment. Dis. 87: 337, March, 1938. 

19. Electrical Brain Waves in Relation to Insulin Treatment of Schizophrenics. Hudson 

Hoagland, D. Ewen Cameron, and Morton A. Rubin. M. Rec. 147: 293, April, 
1938. 

20. The Effect of Age on the Stanford- Binet Vocabulary Score of Adults. David Shakow 

and Rosaline Goldman. J. Educ. Psychol. 29: 241, April, 1938. 

21. Metabolic, Cardiovascular, and Biochemical Changes Associated with Experimentally 

Induced Hyperthyroidism in Schizophrenia. Louis H. Cohen and J. H. Fierman. 
Endocrinology 22: 548, May, 1938. 

22. An Internship Year for Psychologists {With Special Reference to Psychiatric Hos- 
1 pitals). David Shakow. J. Consult. Psychol. 2: 73, May, 1938. 

23. Changes in Blood Lipids during Insulin Treatment of Schizophrenia. Lowell O. 

Randall, D. Ewen Cameron, and Joseph M. Looney. Am. J. M. Sc. 195: 802, 
June, 1938. 

24. Skin and Body Temperatures of Normal Individuals under Cold Conditions. H. 

Freeman and R. F. Nickerson. J. Nutrition 15: 597, June, 1938. 

25. Observations on the Convulsant Treatment of Schizophrenia with Metrazol. Louis H. 

Cohen. New England J. Med. 218: 1002, June, 1938. 

26. An Initial Depression of Heart Rate in Response to Epinephrine in Human Subjects. 

Robert T. Fuchs. J. Pharmacol. & Exper. Therap. 63: 143, June, 1938. 

27. The Distribution of the Alpha Rhythm over the Cerebral Cortex of Normal Man. 

Morton A. Rubin. J. Neurophysiol. 1: 313, July, 1938. 

28. Chemical Topography of the Brain. Lowell O. Randall. J. Biol. Chem. 124: 481, 

July, 1938. 

29. Loss of Temporal Localization as a Manifestation of Disturbed Self-Awareness. 

Louis H. Cohen and Gregory N. Rochlin. Am. J. Psychiat. 95: 87-95, July, 
1938. 

30. A short Note on a Child's Drawing. William H. Stavsky. Am. J. Orthopsychiat. 

8: 560-561, July, 1938. 

31. The Transition from Intuitional to Social Adjustment. Elizabeth Anne Proehl. 

Am. Sociological Rev. 3: 534, August, 1938. 

32. The Concept of Bionegativity. Andras Angyal. Psychiatry, i; 303, August, 1938. 

33. The Early Effects of Metrazol Therapy in Chronic Psychotic Over-Activity. Louis H. 

Cohen. Am. J. Phychiat. 95: 327, September, 1938. 

34. A Note on the Method for Finding Variance Formulae. Robert Dorfman. Bio- 

metric Bull. 1: 129, September, 1938. 

35. Analysis of the Effects of High Humidity on Skin Temperature. B. A. Lengyel and 

H. Freeman. Biometric Bull. 1: 139, September, 1938. 

36. A Variability Study of the Normal and Schizophrenic Occipital Alpha Rhythm: I. 

Morton A. Rubin. J. Psychol. 6: 325, October, 1938. 

37. Emotion in Man as Tested by the Delta Index of the Electro-Encephalogram: I. 

Hudson Hoagland, D. Ewen Cameron, and Morton A. Rubin. J. Gen. Psychol. 
19: 227, October, 1938. 

38. Emotion in Man as Tested by the Delta Index of the Electro-Encephalogram: II. 

Simultaneous Records from Cortex and from a Region near the Hypothalamus. 
Hudson Hoagland, D. Ewen Cameron, Morton A. Rubin, and Julius J. Tegelberg. 
J. Gen. Psychol. 19: 247, October, 1938. 



22 P.D. 23 

39. A Basis for the Improvement of Personality Tests with Special Reference to the M-F 

Battery. Saul Rosenzweig. J. Abnorm. & Social Psychol. 33: 476, October, 
1938. 

40. Explorations in Personality — Experimental Studies of Repression {Chapt. XVIII). 

Experimental Measurement of Types of Reaction to Frustration {Chapt. XXIV). 
Saul Rosenzweig. (Book edited by Henry A. Murray). Published by Harvard 
Psychological Clinic. 1938. 

41. Physiochemical Properties of Brain, Especially in Senile Dementia and Cerebral 

Edema: Differential Ratio of Skull Capacity to Volume, Specific Weight, Water 
Content, Water-Binding Capacity and pH of the Brain. Leo Alexander and 
Joseph M. Looney. Arch. Neurol. & Psychiat. 40: 877, November, 1938. 

42. The Electroencephalogram in Bromide Intoxication. Mortan A. Rubin and Louis H. 

Cohen. Arch. Neurol. & Psychiat. 40: 922, November, 1938. 

43. The Influence of Cyanide on Brain Potentials in Man. Morton A. Rubin and 

Harry Freeman. J. Neurophysiol. 1: 527, November, 1938. 

44. Early Schizophrenia. D. Ewen Cameron. Am. J. Psychiatry 95: 567, November, 

1938. 

45. A Dynamic Interpretation of Psychotherapy Oriented Towards Research. Saul 

Rosenzweig. Psychiatry 1: 521, November, 1938. 

Medical and Surgical Service 
Embrie J. Borkovic, M.D., Director 

The following report summarizes briefly the activities of the medical and surgical 
service for the fiscal year of 1938. 
(/) Movement of population on service: 

There were 1,229 cases admitted to the service the past year. This is an increase of 
137 cases over the figures of last year and 264 over figures for the fiscal year of 1936. 
One hundred and twenty-five cases were admitted for study only. The largest number 
of cases were admitted during the months of Dec, Jan., Feb., March, May and August. 
485 males and 465 females were discharged. Discharges from the services detailed as to 
physical condition are shown in following tables. 

Table I 

Male Female Total 

Recovered and improved . 405 410 815 

Not improved 14 8 22 

Not treated 34 31 65 

The figures in the not treated group have increased due to the fact that many were 
scarlet fever suspects or "post-encephalogram" study cases observed on the medical 
service. During the year there was an outbreak of scarlet fever which assumed the pro- 
portions of a mild epidemic. Twelve patients and twelve employees contracted the 
disease. There were no deaths or serious complications. The epidemic began in 
January and continued through the month of May at which time the peak was reached. 
{2) Deaths: 

During the fiscal year 222 patients died as compared with 268 the preceeding fiscal 
year. The following table gives the details of the deaths and autopsies. 

Table II 

Male Female Total 
Total number of deaths . . . . . . . . 121 101 222 

Total number of autopsies . 78 56 134 

Total number of medical legal cases . . . . . . 17 11 28 

Autopsy percentage of deaths this year was 60.3 per cent, an increase of 11.4 per cent 
over last years figure. A total of 134 autopsies were performed, the same number as 
last year. Three patients died at Summer Street Department. Since the policy regard- 
ing the infirmary has changed there have been no deaths at the S.S.D. All physically 
ill patients who were expected to be sick more than 24 hours were transferred to the 
main hospital (that is where it was believed the patient would remain in bed more than 
24 hours). 



P.D. 23 



23 



Clinical Diagnosis 
Traumatic psychosis 

Encephalitis lethargica . 

Friedreich's ataxia 
Meningitis .... 
Huntington's chorea 
Chronic alcoholic hallucinosis 
Alcoholic pseudoparanoia 
Reactive depression 

Psychoneurosis — anxiety state 

Dementia praecox . 
Dementia praecox paranoid 



Dementia praecox . 
Dementia praecox . 
Dementia praecox . 
General paresis 
Paranoid condition 



Paranoid condition 
Involutional melancholia 
Manic Depressive — depressed 
Senile and cerebral arteriosclerosis 



Pathological Material — Autopsy Data 

Causes of Death 
1 Primary multiple carcinomata of Aeso- 

phagus with metastasis. 
1 Primary cyst adenoma of pituitary with 

hemorrhage. 
1 Friedreich's ataxia-bacteremia. 
1 Acute pneumococcic meningitis. 
1 Huntington's chorea-broncho-pneumonia. 
1 Subdural and intra-ileum hemorrhage. 
1 Carcinoma of lung and spine. 
1 Mycosis fungoides. 

Chronic nephritis. 

1 Fractured pelvis — ^associated with in- 
ternal hemorrhages — (Suicide). 

3 Bilateral pulmonary tuberculosis. 

2 Carcinomatosis — cancer of stomach — 
cerebellum, dural endothelioma. 

1 Asphyxiation (Suicide). 

1 Diabetes. 

1 Duodenal ulcer with obstruction. 

1 Dural endothelioma of brain. 

1 Primary carcinoma of gall bladder with 

metastasis. 

Primary adeno carcinoma of colon. 

Chronic duodenal ulcer with obstruction. 

Suicide by asphyxiation. 



1 

1 

1 

69 



I. 

n. 

HI. 

IV. 

V. 

VI. 

VII. 

VIII 



General paresis 
Korsakoff's psychosis 
C.N.S. syphilis 
Essential hypertension 
Alcoholic pseudo paranoia 
Manic depressive, depressed 
Manic depressive, manic 
Manic depressive, manic 



The above table is an indication of the variety of concomitant organic pathology 
among the psychotic population. As usual, the paranoid group had a preponderance of 
neoplastic lesions. There were 3 deaths by asphyxiation. 
Clinico Pathological Conferences: 

Dural endothelioma 
Peupheral polyneuritis pellagra 
Undiagnosed ruptured gastric ulcer 
Benign nephrosclerosis 
Intradural and intra-ileum hemorrhages 
Scurvy 

Ruptured kidney with hemorrhages (unrecognized) 
Subdural hematoma 

The above is a description of the type of case discussed monthly. At these meetings 
the internes were given the opportunity to present the clinical material and a member of 
the Senior Staff was chosen to discuss the case. This was followed by the presentation 
of the pathological data. Many unrecognized conditions were thus brought to the atten- 
tion of the entire staff. Records of these conferences have been bound and are kept in 
the medical library. 

A survey of the deaths reveal that the largest number of deaths, 73, resulted from 
senile changes. This is 32.88 per cent of the total deaths, and over half the autopsies 
were performed on this group. There were 13 lobar pneumonia and 51 broncho-pneu- 
monia, a total of 64 pneumonias. The total percentage for the two combined is 28.8 
per cent. Eleven or 4.95 per cent died as a result of Tuberculosis. Fifteen or 6.75 per 
cent died as a result of dementia paralytica. Eleven or 4.95 per cent died as a result of 
cancer. Three or 1.3 per cent patients died as a result of fractures. Eleven or 4.95 
per cent of patients died as a result of Pyelonephritis and nephritis. Thirty-four or 15.3 
per cent patients died from miscellaneous causes. Four of these were associated with 
diabetes mellitus. 



24 P.D. 23 

Table III 
Consultations: 

Eye 88 Medical ...... 6 

10 

9 

1 

10 



16 Orthopedics . 

32 Genito-urinary 

19 Electro cardiograms 

104 Encephalograms . 
13 



Ear, nose and throat . 
Gynecology and obstetrics 
Pondville Cancer Hospital 
General Surgery . 
Neurology 
Obstetrics: 

The number of deliveries increased from 4 last year to 10. There were no premature 
births and no infant mortality. 

Table IV 
Report — Dec. 1, 1937 to Nov. 30, 1938 
Major Surgical Procedures: 

Amputation of breast 2 

Appendectomy 7 

Application of body cast 4 

Cholecystectomy 1 

Colostomy 1 

Craneotomy 4 

Cystotomy I 

Deliveries . 10 

Discission of eyes 2 

Gastrostomy 1 

Hip Nailing 3 

Herniorrhaphy It 

Hydrocele 1 

Hysterectomy 5 

Ligation and injection of saphenous veins . 11 

Nepherectomy pelvotomy 1 

Open reduction of fracture (Clavicle-olecranon) 2 

Pyelotomy . .1 

Rectopexy 1 

Transection of stomach t 

Thyroidectomy 2 

Total 72 

Minor Surgical Procedures: 

Adenoidectomy • • • -2 

Artificial pneumothorax . . . • ■ • . ii 

Aspirations (knee-5) (neck-1) . , . . . . . . ■ • .6 

Application of plaster cast • • ^^ 

Biopsies 7 

Blood transfusions ... . . . • . 8 

Chest aspirations . . . • ■ • • • .37 

Circumcision 

Curetage (Bone of heel) 2 

Coagulation of cervic . • .3 

Cystoscopic exams 4 

Dilatation and curetage 2 

Encephalographies 45 

Esophogoscopy . 1 

Electrodessication 3 

Fulgeration of caruncle 3 

Hemorrhoidectomy . . . . . ■ . . 1 

Incision and drainage 213 

Injection of varicose veins 226 

Manipulation of leg under anesthesia 1 

Myringotomy 1 

Perineorrhaphy 5 

Phlebotomy . 2 



P.D. 23 25 

Partial tuxbinectomy . . . . ; - 1 

Passage of urethral sounds 1 

Removal of — (Cervical polyp-1) (strip out pillar-1) (needle from back- 1) (foreign 
body in spine-1) (wens-3) (finger and toe nails-4) (small tumor in mouth-1) . 12 

Reductions of dislocations : ^ 

Rib resection .1 

Sigmoidoscopies : . 5 

Spinal manometries 441 

Suturing of lacerations . . . . . . 142 

Teeth extractions under anesthesia 7 

Tonsillectomy . . . . 8 

Varicocele Tap . .2 

Valpeau bandage to fractures of clavicle 2 

Vena puncture 1 

Total 1,309 

The major and minor operations are listed separately. A very definite increase in the 
number of both major and minor operations over last year have taken place. This year 
there were 72 major operations, compared to 41 in 1937, and 1,325 minor procedures as 
compared to 454 the last fiscal year. 

The increase in the number of minor operations was due in part to the increase in 
number of spinal manometric readings, the injection of varicose veins and of the use of 
artificial pneumothorax. The out patient dressing room has been moved from Howe 
two ward building to the operating suite for two reasons — (a) the present room is larger 
and (b) the central location is more convenient to surgical room supplies in time of 
emergency. 

A clinic was established for the treatment of hernia, varicose veins and hemorrhoids. 
New patients are examined routinely and old patients at opportune intervals. Elective 
repair of chronic ailments undoubtedly adds something to the patient's sense of well- 
being. 

All intravenous solutions are now being made and sterilized at the hospital. This 
eliminates the purchase of intravenous solutions and results in a substantial saving of 
money. 

The service has requested a "peritoneoscope" to facilitate intra abdominal diagnosis. 
When a laporotomy is indicated, there often is considerable risk to the patient. The 
peritoneoscopic examination minimized this risk in many cases by permitting the inser- 
tion of the scope through a puncture opening for purposes of diagnoses. 

We would also like to own a cystoscope. There is adequate need for this instrument. 

The hospital should have some sort of an efficient mechanical resucitator to be used 
in case of emergencies during surgical operations, following asphyxiation (after suspen- 
sion, drowning, or any other cause). 

Table V 
Report— Dec. 1, 1937 to Nov. 30, 1938 
Clinics Detailed: 

Eye examinations 663 

Ear, nose and throat examinations . 540 

Gynecological examinations 604 

Luetic treatments 9,445 

Small-pox vaccinations 533 

Lumbar punctures 498 

Typhoid and para-typhoid inoculations 1,904 

Hinton tests 1 .171 

Others 96 

Hernia, hemorrhoid and varicose veins exams 249 

Total . 15,703 

There has been no particular change in these figures over last year. 



26 P.D. 23 

Table VI 
Dressings detailed: 

Abrasions and lacerations . 3,093 

Boils and carbuncles 972 

Burns . 1^211 

Infections 3,858 

Ulcerations 2,493 

Others 2*192 

Unna boots 160 

Total . 13,979 

Total clinic dressings 13,819 

Total ward dressings . 23,605 

Grand total dressings 37,424 

Table VII 
Employees: 

1980 employees were examined. This number is less than in the previous report 
because of the typhoid inoculations and small pox vaccinations done last year. 

Employees examined at clinic 1,980 

Employees required hospitalization male 65 

female 83 148 

Employees required operation . . male 26 

female 23 49 

Total number of days on sick ward male 531 

female 570 1,101 

Farmers and milk handlers physical exam, and throat cultures employees 55 

patients 68 
Table VIII 
Dental Report — 1938: Main Hospital: 

Fractures immobilized . 5 

Bridges . 

Cleanings 1,852 

Examinations 4,837 

Extractions 1,847 

Fillings . 1,292 

Microscopic examination 5 

Plates . 31 

Repairs 34 

Treatments . . 4,078 

X-Ray diagnosis 564 

Others 

Total examinations and treatments . , . .... . . . 15,345 

Total patients examined and treated ,; . 4,837 

Total general anasthetic cases > .. 6 

Plates numbered . 217 

Alveolectomy , . .... 3 

Sutures . 10 

X-rays taken 564 

Summer Street Department: 

Bridges : , . 

Cleanings 199 

Examinations 706 

Extractions . . . . ... 422 

Fillings 79 

Microscopic exam 

Plates . . , . . . . vv . 1 

Repairs 10 

Treatments 605 

X-Ray diagnosis 35 



P.D. 23 



27 



Others 

Total examinations and treatments 

Total patients examined and treated 

General anasthetic cases 

X-rays taken 

Table IX 
X-Ray Department Analysis: 

Patients examined 

X-Ray plates used . . . . . 4,136 

Foot plates used . . . '. 22 

Foot and fingerprints 71 

Photographs 322 

Prints 66 

Lantern slides 





1,894 

706 



35 



2,224 



Total 6,841 

The department did more work than during the preceeding year. 
Work will be greatly facilitated after the new X-ray equipment now provided for is 
installed. Particular difficulty is encountered at present with the old machine, as 
precise fleuroscopic detail is impossible to obtain. 
Physical Therapy Analysis: 

Table X 
A.C. ultra violet .... 2,286 Medical diathermy ... 514 

W.C. ultra violet .... 123 Muscle re-education . . 856 

Baking 2,729 Others 325 

Mass 1,572 

Total treatments and tests 8,405 

Total patients treated 1,943 

The physio therapy department remains very active. The work of this department 
requires one or two new short wave penetrating heat units. The present machines are 
of obsolete long wave type. There is a constant heavy demand for fever therapy of 
paresis and allied conditions. The present equipment must shortly be replaced in order 
to maintain the efficiency necessary to treatments. Care must be exercised in applying 
electrodes of the long wave type especially over bony irregular surfaces. This detracts 
considerably from the applicability of the units in the treatment of joint conditions. 



Laboratory Report 


FOR THE Year from October 1, 1937 to Sept. 30. 1938 


Basal metabolisms .... 367 


Urine pH 


37 


Blood bromide . 






91 


Tissue vitamin 'C . . . " 


. 192 


Blood calcium 






. 477 


Tissue respiration studies 


. 85 


Blood chloride . 






. 24 


Urine Bence- Jones protein 


5 


Blood cholesterol 






. 1,265 


Blood sp. gravity 


6 


Blood albumin . 






3 


Animal inoculations 




. 2,091 


Blood cholesterol free 




. 1,216 


Ascetic fluid 




. 44 


Blood choline esterase 




. 1,369 


Bacterial cultures 




764 


Blood creatinine 




. 658 


Blood cultures . 




89 


Blood gases 






. 809 


Feces pus . 




1 


Blood globulin . 






3 


Feces bile 




14 


Blood glutathione 






. 1,420 


Feces occult blood 




196 


Blood lactic acid 






. 1,173 


Feces ova and parasites . 


63 


Blood lipoids 






. 1,216 


Milk bacterial count 


304 


Blood N. P. N. . 






. 2,211 


Milk occult blood 


630 


Blood phosphorus 






. 491 


Milk pathogenic bacteria 


56 


Blood potassium 






. 442 


Bacterial smears 


923 


Blood phosphotase 






6 


Sputum T. B. . 




532 


Blood pH . 






. 87 


Neufeld typing 




474 


Blood sodium 






4 


Vaccines 




9 


Blood sugar 






. 3,298 


Bleeding time . 




31 


Blood total protein 






5 


Clotting time 




31 


Blood urea . 




. 643 


Blood count differential . 


3,673 


Blooc! uric acid 






'•''S 


^'onH count erythroc 


ytes 


3,671 



28 

Blood vitamin 'C 
Galactose tolerance . 
Gastric analysis free HCL 
Gastric analysis comb. HCL 
Gastric analysis total HCL 
Gastric anal^^sis organic ac. 
Gastric anal^'sis blood 
Gastric analysis bile . 
Gastric analysis bacteria 
Gastric analysis bromide 
Glucose tolerance 
Spinal fluid cells 
Spinal fluid chlorides 
Spinal fluid gold curve 
Spinal fluid globulin 
Spinal fluid protein . 
Spinal fluid sugar 
Spinal fluid total N 
Spinal fluid N. P. N. 
Spinal fluid bromide . 
Toxicological examination 
Urine routine 
Urine chloride 
Urine Mosenthal test 
Urine nitrogen partition 
Urine renal function 
Urine qualitative sugar 
Urine bile 

Urine quantitative sugar 
Urine bromide . 
Urine diacetic acid 
Urine blood 



P.D. 23 



1,020 


Blood count hemoglobins 


4,023 


1 


Blood count leucocytes . 


3,706 


140 


Blood count platelets 


6 


140 


Blood count reticulocytes 


88 


140 


Blood schillingrams 


14 


138 


Blood fragility .... 


8 


140 


Blood hematocrit 


1,179 


137 


Blood sedimentation 


US 


25 


Blood typing .... 


85 


3 


Icteric index .... 


46 


69 


Plasmodia malaria . 


51 


932 


Vanden Bergh 


30 


572 


Agglutination tests . 


12 


745 


Undulant fever tests 


6 


728 


Blood widals 


7 


1,071 


Feces Dysentery 


4 


751 


Feces typhoid and para typhoid 


17 


14 


Feces T. B 


5 


14 


Feces fat 


2 


2 


Darkfield examination 


1 


1 


Semen examinations 


4 


8.799 


Urine typhoid and para typhoid 


9 


1 


Water B. coli .... 


1 


3 


Androgenic studies . 


76 


158 


Bio-assay of sex hormone 


194 


10 


Pregnandiol determinations . 


36 


141 


Adrenal gland extracts 


72 


12 


Tissue sections routine 


602 


4 


Tissue sections research . 


650 


1 


Tissue sections serial 


83 


3 


Endocrine hormone assays 


557 


6 


Autopsies 


127 



Grand Total 



62,356 



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

The number of examinations carried out by the laboratory during the past year showed 
a marked increase to an all time high of 62,229 as given in detail in the accompanying 
table. 

The laboratory has been approved by the Council on Medical Education and Hos- 
pitals of the A.M.A. for the training of internes in pathology. This should be very helpful 
in keeping these positions filled in the future. 

The training of well qualified college graduates as technicians has continued with the 
approval of Registry of Clinical Pathologists and the A.M.A. Two girls were given 
certificates and have found employment, and their places have been taken by two other 
students. 

The main research work of the laboratory has been centered on the physiological 
changes occurring during insulin and metrazol therapy. In addition a study is under 
way as to the eflfect of diathermy treatment on brain metabolism. A study of the rela- 
tionship between fever and vitamin C and glutathione levels of the blood has been 
completed and is now being prepared for publication. Further studies on hormones 
have been carried on by the help of two technicians who are being supported by the 
Armour Fund. The increase in hormone investigations are indicated by the various 
items at the bottom of the table. Further progress on the utilization of tissue respira- 
tion experiments by means of the Worburg apparatus has been made and future develop- 
ments should yield valuable information as to abnormal oxidative processes in schizo- 
phrenics. 

The following papers were published: 
1 . The effect of exercise on the blood gases, pH and lactic acid content of the blood of normal 
and schizophrenic subjects. J. Biol. Chem. 123: Ixxvi. 1938. 



P.D. 23 29 

2. Physico-chemical properties of brain especially in senile dementia and cerebral edema. 

Arch. Neurol. & Psychiat. 40: 877. 1938. 

3. Changes in Lipid Composition of Nerves from Arteriosclerotic and Diabetic Subjects. 

J. Biol. Chem. 125: 723. 1938. 
In press: 

1 . Changes in lactic acid, pH, and gases produced in the blood of normal and schizophrenic 

subjects by exercise. Am. J. Med. Science. J. M. Looney. 

2. Histo pathology of senile dementia and related conditions. Arch. Neurol. & Psychiat. 

J. M. Looney and L. Alexander. 

3. Tyrosine determination. Science. J. M. Looney. 

4. The determination of spinal fluid protein with the photoelectric colorimeter. J. Biol. 

Chem. Jan. 1939. J. M. Looney and A. J. Walsh. 

5. The determination of serum phosphatase and its clinical significance. New England 

J. Med. J. M. Looney. 

The director and Dr. Randall attended the annual meeting of the Federation of 
American Societies for Experimental Biology March 30 to April 2, 1938 at Baltimore. 
He also attended monthly meetings of the Northeastern Section of the American Chemi- 
cal Society, the Boston Society of Biologists, and regular meetings of the Harvard 
Chapter of Sigma X. 

Dr. Freeman attended the annual meetings of the American Association of Pathologists 
and Bacteriologists in Atlantic City in June and the American College of Physicians at 
New York in April. He also attended the regular meetings of the New England Patho- 
logical Society. Both Dr. Freeman and the director attended the annual meeting of the 
Mass. Medical Society in June. 

The following meetings were addressed by members of the staff: 

1. Endocrine aspects of personality. Presented before the student body of Holy Cross 

College, April, 1938. J. M. Looney. 

2. The Physicians view of Russia. Worcester Rotary Club, May, 1938. 

3. Determination of phosphatase and its clinical significance. Worcester Medical 

Society, October 12, 1938. J. M. Looney. 

4. The endocrine aspects of dentistry. The Worcester County Dental Hygienists and 

Assistants. J. M. Looney. 

5. Further studies on central necrosis of the adrenal glands. New England Pathological 

Society, April 21, 1938. W. Freeman. 

6. How postmortem examinations help me. Webster Rotary Club, September 12, 1938. 

W. Freeman. 

7. Some thoughts on old medicine and new medicine. Worcester District, Massachusetts 

Nursing Association. W. Freeman. 

8. The chemical topography of the brain. Federation of American Societies for Ex- 

perimental Biology. L. O. Randall. 

Worcester Child Guidance Clinic 
Ruth Walton, Head Social Worker 

One cannot think of a Child Guidance Clinic without its relationship to the community 
as a whole. The function of such a clinic includes a number of services, available for the 
use of the home, the school, and the social agency within the community in helping to 
adjust behavior and personality problems indicative of conflict within the individual 
himself or with his environment. The statistical report shows that 529 children received 
some types of service from the clinic during the year. Obviously this many children 
could not receive intensive service over a long period of time, nor is such service fre- 
quently desired. We cannot think of the child as an isolated unit any more than we can 
think of the Clinic in this way. We think of the child in the sense of a total personality 
affected by the various factors in his environment. For this reason, a diagnostic or 
consultation service given to a school, an agency or a parent does not end there, but is 
part of a treatment process which is continued for the child, although it may not be 
within the Clinic. 

A Child Guidance Clinic because of its psychological and psychiatric facilities, is able 
to offer a unique service in helping with problems of individual maladjustment. There 
are many children who present difficulties of such an intrinsic nature, that a more ade- 
quate adjustment can be reached only by changes brought about within himself. This 
necessitates intensive therapy for a period of time, the length depending upon the nature 



30 P.D. 23 

of the problem, the desire and the capacity of the child and the parent to use the therapy 
offered by the Clinic. It is seldom that intensive therapy with the child, or with the 
parent alone, creates the most helpful results. A treatment plan which includes both 
the child and the parent, as well as the school, or other agencies as in a co-operative case, 
affords a better opportunity for progress in the total situation depending, of course, upon 
individual differences. Of the 214 new cases accepted during the past year, eighty-five 
cases were carried intensively, and it will be noted that fifteen of these were co-operative 
cases. This seems a large enough number to indicate a growing awareness on the part of 
social agencies of personality difficulties which can be treated at a Child Guidance 
Clinic. Intensive therapy may mean, a child and a parent are seen regularly at the 
Clinic for one, two or three therapeutic hours a week, for a period of six months or a year 
or longer, again depending upon the nature of the problem. 

The value of speeches in the community, as a part of an educational program, has been 
questioned. This year twenty-one talks were made in the community upon the request 
of various clubs, schools, and social agencies, and a number were refused because of lack 
of time available. It seems evident that the community still feels the need of education 
by this means. 

Although there have been changes in our staff members and we have had a reduced 
staff at various times during the year, we have continued with our usual clinic activities 
both in the community and within the clinic itself. The demonstration clinic in con- 
nection with the Webster schools, begun in January, 1937, was continued. Some of the 
cases studied during the first year and still in need of treatment were carried throughout 
the year, and a few emergent new situations were dealt with. The chief work of 1938, 
however, was a study of twenty-five children of average intelligence, or above, in the 
early grades, who were markedly retarded in reading. This was a problem which con- 
cerned the school system, and it was hoped that out of this study might come some com- 
mon observations which might be related to the general problem of difficulty in reading. 
The schools gave careful reports on these children as they saw them, and tested ears and 
eyes, while the clinic secured social background, gave tests for dominance and diagnostic 
reading tests and examined the children psychiatrically. The Director made a general 
report on the results of the study to all of the teachers in the school system. The social 
workers saw the various parents again to give them specific suggestions for use with their 
own children. And the teachers of the twenty-five non-readers were given reports and 
recommendations for the individual children, culled from the findings of the psychiatrist, 
the psychologist, and the social worker. It is our opinion that one of the most valuable 
by-products of this study has been the absolving of the teacher of blame for all of her 
reading failures, with the result that she has attacked the problem with added energy. 

This has been the third year that our social worker. Miss Burnell, has been doing some 
work in connection with the Worcester Girls' Club in an effort to learn how the clinic 
might best be of service to such a recreational agency. At first children who were 
alread}'^ disciplinary problems were interviewed, but this was given up as the children 
regarded her as just another disciplinarian. Then, at the request of the club, the parents 
of these children were visited and attempts made to have the parents make use of the 
Child Guidance Clinic. These, too, were unsuccessful. It was decided that the 
Clinic's service probably lay more in the educational and preventive field, and the work 
during 1938 has been in this area. The social worker met with the Club leaders for a 
series of lectures and discussions having to do with psychology and behavior. The 
leaders have found these helpful in their dealings with the girls, and the Club Director 
has asked that they be continued in 1939. In connection with another course being 
given at the Club, there were discussions with adolescents on the bases of behavior. 
These are to be continued in 1939 as electives in the Club program, under the name of 
"Personality Clubs." 
Psychology Department 

There has been no change in the routine of psychometric examinations. During this 
year 180 children were examined by a psychologist in this Clinic. In practically all 
cases a "general intelligence" scale was utilized and in a great many cases special tests, 
educational achievement scales with stress on reading ability, aptitude tests, and scales 
for the measurement of personality. 

In the clinic in Webster, Massachusetts, 26 children were examined by a psychologist. 
Of these 25 were given a reading test as part of a research project. 



P.D. 23 31 

Psycho-therapy is also a part of the work of this department. Intensive treatment 
was carried on with 34 children. Of these, 13 children were seen individually by Mrs. 
Whitman, 10 by Dr. Stavsky, and 11 children were treated in the "play group". 

Research has been carried on mainly to determine the value of "group therapy" with 
young children. For one morning a week a small group (not over 6 children) are organ- 
ized much as a nursery school group except that the first hour and a half is given over to 
free play. This play which is supervised by the psychologist is considered to have a 
two-fold purpose. It serves not only as a medium for the expression of his conflicts but 
the group may serve either as a check on his activity or may ser/e as a means for fuller 
expression of his difficulties. 

Careful records of their activities through a one-way screen and of their conversation 
by means of a recently installed amplifier makes possible fairly accurate estimations of 
of outstanding behavior variables. These ratings are to be evaluated in relation to the 
problems which they present, and we may then be able to determine to what extent 
such a method of treatment is useful or at least determine its limitation. 

Our research program has become a particularly important factor during the past year 
not only in our study and analysis of therapeutic techniques but also in further study of 
the type of personality and of the problem which responds to clinic treatment. This has 
included a study of the personality traits of a group of 25 adolescents, who broke treat- 
ment of their own volition, and of 27 mothers with personality traits of a dominating 
and aggressive nature. The mothers were treated simultaneously with the treatment 
of the child, and with only partial success. Emphasis was also laid upon the treatment 
of a particular problem in another study, including the analysis of the present adjust- 
ment of 36 children who were treated for speech defects. More than two-thirds of these 
children showed improvement. A study of the source of referral in 45 cases seen at the 
Clinic during the year 1937-1938 revealed that although the source may or may not 
have been of an authoritative nature, the real outcome of the case depended upon the 
parents' desire for, and acceptance of treatment. 

In August the staff members started to organize a follow-up study of 300 children who 
had formerly been treated at the clinic to determine their present adjustment and the 
value of clinic treatment in this adjustment. There has already been a great deal of 
progress made in this study under the supervision of Dr. Shakow of the Worcester State 
Hospital. 

The training program has continued with three social work students and one psycho- 
logical student. Miss Frances Jenney and Miss Betty Baum from the Smith School of 
Social Work, and Miss Mary Walker, of the Simmons School, joined the staff in Septem- 
ber. Miss Mildred Henrich from the Bryn Mawr School joined the psychological 
department as a student in October. 

The Clinic has felt keenly the loss of various staff members during the past year. Dr. 
Paul Jordan resigned in March to take a position in the psychiatric division of the 
Medical School of the University of Michigan. He was replaced by Dr. William Holt, 
of the Worcester State Hospital, in September, and the latter returned to a position on 
the Hospital staff in November. Dr. Stavsky of the psychology department left the 
Clinic in October to take a positon as psychologist with the new Children's Center in 
Wilkes-Barre, Pennsylvania. He has not yet been replaced. Dr. Kirkpatrick resigned 
as Director of the Clinic in November, 1938, to take a position in Lansing, Michigan, as 
organizer of new child guidance clinics in connection with the Couzen's Fund. The 
members of the staff are appreciative of Dr. Kirkpatrick's leadership at the Clinic, and 
sincerely regret his leaving. We have been ably assisted by Dr. Cobliner since October, 
1938. She has been kindly loaned to us from the Worcester State Hospital staff. We 
have been able to carry on our usual Clinic program only through the valuable interest 
and assistance of Dr. Bryan, while awaiting the appointment of a new director. 

Annual Service Report 
I. Report of Case Load: 

A. Carried Cases: ' Total 

1. Cases carried over from last year 315 

2. Intake a. New Cases Accepted 192 

b. Old Cases reopened 

(1) last closed before present year 21 

(2) last closed within present year 1 



32 



P.D. 23 



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 oj Service Classification 

A. New Accepted Cases: 

6. Full service a. Clinic staff cases (7 reopened) . . 

b. Cooperative cases (3 reopened) 

c. Full service not a or b 

7. Special and Diagnostic service (Advice) (12 reopened) 

8. Total new cases accepted 

B. Cases taken from Service: 

10. Full service a. Clinic staff cases . . ... 

b. Cooperate cases . . . . . 

11. Special service (advice) 

12. Total cases closed during this year 

III. Sources Referring New Accepted Cases: 

Full Special 

13. Agencies a. Social . . .. .. 11 17 

b. Medical 1 3 

14. Schools a. Public 9 24 

b. Other (tutor) .... 1 

15. Juvenile Court - 56 

16. Private physicians 1 3 

17. Parents, relatives 57 26 

18. Others (Church, friend,) (Pres. of C. G. Assoc.) 5 



IV. 



19. Total new cases accepted 
Summary of Work With or About Patients: 
A. By Psychiatrists: 



85 



129 



1. 



for examination 
for treatment . 



Interviews with patients a. 
b. 

2. Interviews about patients 

3. Physical examinations by clinic staff members . 

B. By Psychologists: 

1. Interviews with patients a. for examination 

b. for re-examination . 

c. for treatment 

2. Interviews about patients 

C. By Social Workers: 

1. Interviews in clinic . . 

2. Interviews outside clinic . . . . ... 

3. Telephone calls 

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 workers 
Referral Interviews 



D 



E. 
F. 



529 

293 

236 

48 

12 

16 



70 

15 



129 

214 

121 

44 
128 
293 

Total 
28 

4 
33 

1 
56 

4 
83 

5 

214 



Total 

173 

571 

103 

33 

169 
14 

861 
17 

991 
397 
709 

53 

14 

18 

2,109 

145 



V. Personnel Report (Average staff during year) 



A. Regular Staff a. Psychiatrists 

b. Psychologists 

c. Social Workers . 

d. Clerical workers 

B. Staff in Training a. Social workers 

b. Psychologist 



Full-time 
2 
2 
3 
2 
4 
1 



Part-time 



(3 beginning 9-1-38) 
(Beginning 9-38) 



P.D. 23 33 

VI. Operating Schedule: 

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

B. Schedule of attendance of psychiatrists: 9 to 5 daily; 9 to 12 Saturday. 
Educational Services: 

Month and Staff Member 

January: Walton, Y.M.C.A.; A.A.S.W. 

February: Whitman, Jewish Council of Women; Y.W.C.A. Parents Education. 

February: Burnell, Girls' Club Leaders. 

February: Kirkpatrick, Unitarian Church; Committee on Delinquency; Y.M.C.A. 
Parents Education. 

February: Walton, Whitman, Kirkpatrick, State Teachers College. 

March: Burnell, Chaffin Parent-Teacher Assoc; Girls' Club Leaders. 

April: Walton, Y.W.C.A. 

April and May: Burnell, Girls' Club Leaders; Girls' Club (Assistant Leaders); Girls' 
Club Leaders. 

November: Whitman, National Jewish Council. 

November: Burnell, Girls' Club Group; Women's Union, Baptist Church. 

The Mental Health Clinic 

James Watson, M.D., Director 

The "Mental Health Clinic" was organized during the month of January, 1938. It is 
an outgrowth of the desire to link the State Hospital more closely with the community 
and to make the Hospital truly the center for Mental Hygiene activities in the com- 
munity. Before making this step, the psychiatrists in private practice in the city were 
interviewed. They were unanimous in stating the need for a clinic and gave their 
encouragement toward its organization. Valuable hints as to procedure were obtained 
from them. Next the heads of the welfare agencies in the city were interviewed and they 
were found enthusiastic in their welcome to the idea and in their offers of cooperation. 
For years they had felt the need of psychiatric advice and assistance in welfare work. 

The clinic was opened as a cooperative enterprise of the State Hospital and the Board 
of Public Welfare. Dr. J. Watson, who had been assigned to the Family Care depart- 
ment of the W.S.H., was to give part of his time to the work of the clinic and the Welfare 
Board agreed to furnish office space, the stenographic and social service assistance, 
janitor, etc. This agreement has worked out satisfactorily. It now appears that 
through this cooperation the Mental Health Clinic is a permanent asset of the com- 
munity and the opinion prevails that in the near future steps should be taken to enlarge 
its personnel and equipment that it may more adequately meet the demands made upon 
it. The first advance should be a full-time psychiatrist, a part-time psychologist, a 
part-time psychiatric social worker, and a full-time stenographer. Later, plans should 
be made for a complete unit as recommended by the National Committee for Mental 
Hygiene such as now functions so adequately in the Child Guidance Clinic. 

The types of problems referred to the clinic are quite varied. Many patients are 
afflicted with some type of Psychoneurosis (Phobias, Hysteria, Compulsions, Hypo- 
chondriasis, Anxiety states. Obsessions, etc.) Others have mild forms of the Psychoses. 
Naturally once in a while an individual who is frankly psychotic is brought in. Among 
the problems are many cases of family disharmony, mental abilities, and behavior 
difficulties of adolescents. 

Among the Referring Agencies are: Board of Public Welfare; Associated Charities; 
Children's Friend Society; Girls' Welfare Home; Swedish Charities; Worcester Boys' 
Club; Society for Prevention of Cruelty to Children; Child Guidance Clinic; Physicians 
and Clergymen. Only referred patients are taken. 

Four types of appointrntnts are made. ,1 i^valuation interviews of one hour each in 
which an attempt is made to learn the patient's problem and to decide whether the clinic 
can be of assistance to him. {2) Therapeutic hours for planned psychotherapy. (3) Ad- 
visory consultations given to social case workers, who wish to consult with a psychiatrist 
relative to problems arising in their work. (4) Out patient follow up of patients on visit 
from the Worcester State Hospital form a part uf this group. Occasionally adolescent 
boys and girls who have been in difficulties and have been helped are allowed, upon 
request of the referring agencies, to come . ; f^r a few aimutes once a month to report 
how they are getting along, in this ivav .i.- .sapervi.^ion is maintained. When new 
difficulties are detected they are assign ,■ 1 > jxt available therapeutic hour. 



34 P.D. 23 

The director of the clinic endeavors to keep in close contact with the referring agencies 
and to understand their needs. Reports are sent frequently and when a case is closed a 
complete statement is sent in with such constructive suggestions as are available. A 
course of twenty lectures in "Clinical Psychiatry" was given last spring to the social 
case workers of the city. This fall a class in "The Psychology of Personality" is being 
conducted. The facilities of the State Hospital, particularly the SociaF Service, the 
Nursing, and the Psychology Departments have been very cooperative. The general 
hospitals of the city have cooperated fully. All the referring agencies have appreciated 
the service. 

Statistics for the complete fiscal year are of course not available, but the figures for 
the last three months of the fiscal year may be taken as fairly representative. However, 
the load thus indicated has been found too heavy for the present personnel in that it does 
not allow sufficient time for the completing of records and the adequate study of anam- 
nestic material. 

Summary of Monthly Reports of September, October and November: 

Clinic consultations . . .120 Total patients 70 

Advisory consultations ... 55 Referring agencies .... 10 
New patients 37 Lectures and addresses given . . 22 

Report of the Psychology Department 
David Shakow, M.A., Chief Psychologist 
During the year the number of patients with whom the department had contact was 
as follows: 
Psychometric and Experimental Studies: 

Individuals Number of 

House Examined Tests Giveti 

House Patients 180 614 

Schizophrenic Research Patients 216 851 

Out-Patient 

School Clinic 429 478 

Adult Delinquents 13 33 

Non-Patients (Employees, etc.) 236 ' 591 



1,074 2,567 

These figures include, as far as the psychometrics are concerned, work done with over 
fifty different tests. The experimental studies refer to a variety of projects, the major 
ones of which are discussed below. 
I. Researches completed during year: 

A. Insulin program — ^A battery of tests and a series of experimental procedures were 
followed out with the insulin group studied by the research service as a whole. In the 
analysis of the findings two types were especially looked for: (1) those in which re- 
covered patients distinguished themselves from non-recovered patients before medication 
and (2) those in which the medication had differing effects in the two groups despite 
similarity of response before medication. It is gratifying that indications of both 
kinds were found. At present, it appears that various aspects of the Stanford-Binet, 
the Kent-Rosanoff , the pursuitmeter and the galvanic skin reflex offer the most promising 
possibilities. 

B. Respiratory stress — This experiment done by Dr. Rodnick in association with 
Dr. H. Freeman is reported upon in detail elsewhere. 

C. Tautophone — An experiment carried out collaboratively by Dr. Rosenzweig and 
Mr. Shakow was concerned with the responses of patients and normal controls to auditory 
stimulus patterns. Different profiles of response appear for the normal, hebephrenic, 
and paranoid groups. The normal profile includes a relatively greater proportion of 
responses which have sentence structure, which follow the stimulus pattern closely, and 
meaningful and have ego-reference. The hebephrenic reactions, although consisting 
largely of meaningful responses in sentence structure, are relatively remote from the 
stimulus pattern and are frequently coudhed in a foreign language. The paranoid 
profile gives prominence to syllables and exhibits a tendency towards a later assignment 
of meaning to the originally non-meaningful responses. The results thus offer material 
significant for diagnostic purposes and is to be used as a regular test procedure in the 
testosterone schedule. ' 



P.D. 23 35 

D. Adrenalin association experiment — Mr. Moore, in association with Dr. Cameron, 
completed a study of the effect of the administration of adrenalin on higher integrative 
mental functions. "Organization" responses and. reaction-time were found to be the 
most effected. Most important seems to be the centripetal effect of adrenalin, viz., the 
tendency for characteristics already evidenced by the subjects to become more marked 
ifter adrenalin has been injected. 

II. Research in Progress: 

1. Effect of sodium cyanide and cyclopropane — In this experiment, being done by Dr. 
Rodnick in collaboration with Drs. H. Freeman and Rubin, the problems are primarily 
physiological. The details can be obtained in the reports of the latter two workers. 
Due to the importance of the galvanic skin reflex in emotional experiments generally, it 
was felt wise to take advantage of the experimental procedure set up to include the 
g.s.r. Opportunity is here offered to get some light on the central representation aspects 
of the g.s.r. 

2. Analytic play technique — We have continued the intensive study of an 11-year 
old who was markedly immature in speech development and showed considerable 
asocial behavior. Some progress has been evidenced in both speech and general 
behavior. 

3. Thematic apperception test — An intensive study of the thematic apperception test 
from the standpoints of validity and general usefulness for clinical purposes has been 
undertaken. 

4. Aspiration in psychopathic personality — A continuation of the aspiration studies 
heretofore done with schizophrenic and normal subjects is being extended to psycho- 
pathic personalities. 

III. Analytic Work in Progress — Work has continued on the analysis of various bodies 
of material collected, particularly on memory functions in normal subjects of various 
age levels and in the different psychotic groups, on Stanford-Binet results in the various 
psychoses and on Kent-Rosanoff Association Test results in schizophrenia. 

IV. Published Papers: — All papers published from the Psychology Department are in- 
cluded in the general list of publications to be found in the report of the Research 
Department. 

V. Papers in Press: 

1. Rosenzweig, S., et al. Frustration as an experimental problem. Charac. and 
Person. 1938. 

2. Shakow, D. and Pazeian, B. Adult norms for the K-S Clinical Formboards. \. 
Appel. Psychol. 1939. 

3. Shakow, D. The psychologist in the State Hospital. J. Consult. Psychol., 1939. 

4. Hanfmann, E. Thought disturbances in schizophrenia as revealed by a picture 
completion test. J. Abn. and Soc. Psychol., 1939. 

VI. Scientific meetings attended: — Dr. Rodnick, Dr. Rosenzweig, Mr. Moore, Mr. 
Rotter and Mr. Shakow attended the American Psychological Association Meetings at 
Columbus, September, 1938. Mr. Shakow also attended the meetings of the American 
Association for Applied Psychologists at Columbus. 

The experimental program for the next j'ear consists primarily of the continuation of 
most of the present projects and the initiation of a few others connected with metrazol, 
insulin and testosterone administration. In addition the analysis of the accumulated 
data and the clinical application of our psychological findings are ever present goals. 

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 various activities and the progress, the following details are 

quoted : 

Periodicals: The library had 126 periodicals in 1938 as compared with the 117 of the 
previous year. Of this number the hospital subscribed to 106, 2 were paid for by the 
Memorial Foundation for Neuro-Endocrine Research, 2 were donated by Dr. Bryan, 
5 by Dr. Hoskins, 3 by Dr. Sleeper, and 1 by Dr. William Freeman, and 7 came in free 
from institutions and scientific organizations. 

Of these periodicals 9 are in German, 6 in French, 4 in Italian, and 107 in English. 
Circulation: The medical library circulated 818 volumes in 1938. 



36 P.D. 23 

Interlibrary Loans: The librarian used the facilities of other near-by libraries and during 
the year the library borrowed 154 volumes from 8 libraries, as listed below: 
Boston Medical Library . .110 Harvard Medical School Library . 4 

N. Y. Acad, of Medicine Library . 23 Harvard Business School Library 5 

Brown University Library ... 1 Harvard Law School Library . . 1 
Harvard College Library ... 9 Harvard Arboretum Library . . 1 
Medical Library Association: Our library maintained the 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. Sixty-four volumes were received from the Exchange of the Association during 
the year. 

The librarian attended the meeting of the Association, held in Boston, June 28-30, 
1938, working on various committees and taking part in the discussions. 
New Books: Sixty-two new volumes have been added to the shelves, not including the 
newly bound volumes of periodicals. 

Binding:— T\^o hundred and two volumes were bound during the year, mostly current 
issues of medical periodicals. 
Present State: — On November 30, 1938 the medical library had: 

Bound volumes of periodicals 4,067 

Unbound volumes of periodicals 85 

Bound volumes of books 1,796 

Old books (mostly neurology and psychiatry) . . . 1,288 



Total books (an increase of 264 volumes) . . . 7,236 

Catalogued reprints and pamphlets, 6,888; Abstracts, 5,541; Lantern slides, 634. 
Services: — The librarian continued to circulate the bibliographies and abstracts, pre- 
pared 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: — Three stenographers continued to work on the projects approved 
by the Federal Government, i.e. recataloguing of the books in the library and in the 
departments, compilation of a bibliography of schizophrenia, and completing the col- 
lected abstracts on schizophrenia. 

Needs of the Library: — A stairway is needed in the very near future to connect the stock- 
room (just below the library) with the reading room to facilitate shifting of the old and 
little used material. 

//. General Library 

The general library was moved into its new quarters in 1936. At that time it was 
reorganized, 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 1938 one of the W. P. A. workers was in charge of the library and the Occu- 
pational 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 313 volumes to the shelves during the year. 

On November 30, 1938, the general library had: 
Books (fiction and non-fiction) . . 2,663 Bibles and prayer books . 18 

Serials 477 Reference books . . . 166 

Bound magazines 113 

Total books . . . 3,437 
Stereopticon slides 100 

Fifty eight popular magazines and 6 daily newspapers are subscribed to by the hospital. 
In addition to our stock 150 books are borrowed every three months from the Worcester 
Public Library to circulate among the patients and the employees. 

Arrangements have been made with the Free Public Library to lend 100 volumes 
every three months to the Summer Street Department. In addition to this 100 volumes 
are sent to Summer Street every three months from our general library in the main 
hospital, and 10 popular magazines and newspapers are subscribed to for this depart- 
ment. 

The library is well patronized by patients and employees, the average monthly at- 
tendance being l,2ol patients and 272 employees. 



P.D. 23 37 

During the year the library circulated 13,163 volumes and had 13,473 reading visitors. 

A few churches of Worcester and the Free Public Library send to us old books and 
magazines regularly. We express our thanks to all who have given books and mag- 
azines to the general library. ' • 

Chaplain's Department 
Carroll A . Wise, Chaplain 

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

Attendance at the religious services, which are held each Sunday morning at the main 
hospital and at the Summer Street Department, has averaged three hundred each 
Sunday. These services are approximately thirty-five minutes in length. The hymns 
and liturgy used in these services are from the hymnal, "Hymns of Hope and Courage", 
a book edited for use in mental hospitals. The sermon is brief, and seeks to relate 
religion to the emotional needs and problems of the patients. These services offer one 
form of normal experience which many of the patients found helpful before their ad- 
mission to the hospital, and for which they feel a continuing need after admission. 

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 psychiatric 
services 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. 

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, Inc. During the past year plans for a year's 
course in clinical training have been developed, and it is hoped that such a course will 
begin during the year of 1939. The demand for such training on the part of seminaries 
and students is increasing, and its value is being recognized in many sections of the 
church. 

During the year the chaplain gave a series of four lectures on Religion and Mental 
Disorder to a group of Occupational Therapy Students, and a series of five lectures to a 
group of nursing students and social service 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 gave twenty such talks. Many requests for talks were referred to other 
members of the staff. In September, 1938, the chaplain attended a conference on 
Christianity and Mental Hygiene which was sponsored by the National Committee on 
Mental Hj'giene and the Federal Council of Churches of Christ in America. He served 
as a member of the committee arranging this conference. 

Perhaps the most significant work carried on by the chaplain during the past year, 
judging from the community standpoint, was that which resulted in the formation of a 
Department of Religion and Health in the Worcester Council of Churches. The pur- 
pose of this new department is "to study into the problems of health, particularly those 
of mental health and life adjustment, as they exist in the churches and the community; 
to cooperate with existing health agencies, including especially psychiatric agencies, so 
that the mutual interests of the churches, the agencies and the community as a whole 
might be better served, and to develop and sponsor practical programs, such as educa- 
tional and research projects, designed to meet these ends." The enthusiasm and interest 
with which this proposal was received by the churches, and its immediate acceptance, is 
itself evidence of the value and effectiveness of the work of community education carried 
on by the hospital for a number of years. One project which this new Department has 
under consideration is the setting up of a consultation service through which clergymen 
may get professional advice in dealing with parish problems. 

This report would not be complete without grateful acknowledgment of the financial 
support given by the Massachusetts Congregational Conference and Missionary Society 
to the work of this department during the past year. This support is much needed and 
greatly appreciated. 



38 P.D. 23 

Radio Department 
Wallace F. Searle, Director 
Routine Activities: 

The routine activities of the department have been carried on as in past years includ- 
ing: 

1. Clerical work — A. Typing of daily radio programs. B. Tabulating WSH pro- 
grams in yearly book and preparation of monthly reports. C. Indexing of phonograph 
records. D. Continuity preparation for therapeutic radio programs. 

2. Church services — Organ and piano accompaniments for Protestant and Episcopal 
Church services at Main and Summer Street Hospitals. 

3. Broadcasting by radio director — A. News Bulletins — "Notables in the News". 
B. Announcing of special features. C. Accompanist for patients and employees 
musical programs. 

4. Repairing and maintenance of radio equipment — Testing of tubes and minor repairs 
and trouble finding. 

5. Educational activities — A. Lectures to Post-Graduate nurses; affiliates; and occu- 
pational therapists. B. Lectures to community organizations. 

6. Patients' Contribution to Radio Department — A. Announcing and controlling of 
radio programs. B. Paging physicians. C. Typing miscellaneous records. 

Musical Research with Excited and Depressed Patients: 

Over a period of eight weeks a detailed study was made to learn the reaction of excited 
and depressed music upon excited and depressed patients. Sixteen musical sessions were 
held. In eight, by phonograph records. Each session occupied thirty minutes with a 
twenty minute musical period preluded and postluded by a five minute silent period. 
Musical programs designed to excite and depress were played for both excited and de- 
pressed patients. The programs were staggered in such a way that neither a memory 
nor monotony factor would enter in. At no time did both depressed and excited patients 
listen to the same program at the same time. Careful observations were made by trained 
observers who tabulated on charts the slightest change in affectivity and motor activity 
of patients during these sessions. Some of the interesting findings as revealed by the 
graphs later compiled relative to this study were : 

1. No reaction or change in responsiveness to environment was manifested by the 
depressed patients at any time during either orchestra or phonograph programs; neither 
did they respond to differences in types of music, depressed or excited. 

2. Motor activity in excited patients invariably decreased at the beginning of the 
music. This decrease remained at a slightly lower level during the musical periods, then 
climbed to a new high in motor activity after the music had ceased. The hallucinatory 
activity of this group was slightly attenuated during the musical periods and noticibly 
increased after the music was concluded. 

3. An interesting comment of a depressed patient who had been totally inactive during 
these sessions, after she had had metrazol shocks was, "I must have been too ill to remem- 
ber having listened to the music." 

New Projects in the Radio Department: 
"Airways to the Mind" 

A series of weekly radio programs especially planned for the patients at this hospital 
entitled, "Airways to the Mind" has proven very successful. They were designed to 
desseminate mental hygiene, to emphasize important facts about the hospital, to stress 
mental health rather than mental disease; to entertain and to educate. The programs 
as outlined were as follows: 

1. Station announcement and opening theme song. 

2. Opening announcements explaining the program and its purpose. 

3. Musical appreciation (explaining some interesting aspects of short symphonic 
selections). 

4. Therapeutic hospital drama (depicting in dramatic form a typical hospital "lesson" 
such as a patient receiving parole, a staff meeting, etc.) Hospital patients and employees 
comprise the cast. 

5. Patient performance: Patients who played instruments well or sang were featured 
in a dignified way on these programs. 

6. Paroles granted: Paroles, promotions, discharges, and trial visits were read. 



P.D. 23 39 

7. Weekly travelogue: Each week a staff member was interviewed on some tour or 
cruise he had experienced. This was done in an informal manner with a minimum of 
written material. Some of the travelogues were "The romance of Quebec"; "My trip 
around the world"; "Flying to Alaska"; "Around the Great Lakes"; "My home is in 
Washington, D.C."; "Hospitals and Hospitality in England"; "The romance of Venice." 

8. Continuity: All material was typewritten with the exception of the travelogue. A 
theme song was interwoven between the various features. Various phases of Mental 
Hygiene were stressed during the program. Proof that the patients listened to and 
enjoyed these programs were the many letters of comment written to the radio room by 
patients. After one travelogue over 50 letters came in. We believed the patients 
would be interested in hearing about the travels and personal experiences of some of the 
physicians and heads of departments; that this would be more interesting than a "cut 
and dried" paper, and also that the staff members themselves would accept more readilj' 
this idea. Both of these suppositions proved to be true. This program is from 45-60 
minutes in length. Generally speaking this is too long for the sustained attention of 
mental patients but because of the variety and the expectancy of the "Travelogue" 
their interest is fairly well retained, especially on locked wards. This is the most suc- 
cessful series of programs we have presented. 

Paging Physicians: 

During the month of December we experimented in the matter of paging physicians 
via radio. This has never been done before at our hospital except during meal-time. 
After a study was made relative to the efficiency of this system as well as the reaction 
of the staff and patients the following facts were outstanding: A. Staff -members were 
located much quicker than with the old bell system. B. All physicians and department 
heads prefer being called via radio than by bells. C. Many times patients will tell 
physicians when they are being paged. D. Several times patients have commented 

about calls such as, "Dr. must be a busy man, etc." E. Some hallucinated 

patients have shown less agitation at the paging than the bells. F. According to 
supervisors, nurses, and attendants no patients have complained of this system. G. As 
most patients are in industry during the day time (calls cease after 6 P. M.) this does not 
interfere with evening programs. H. 1888 calls were made during the last three weeks 
in December. 

The Steward's Department 
Herbert W. Smith, Steward 

A revised and completed system of financial control, the planning for smaller inven- 
tories and controlled stock distribution were the outstanding contributions of the 
Steward's Department during the past year. Changes in personnel were not excessive 
and on the whole results obtained in 1938 were satisfactory. 

We again stress the need for new storeroom and laundry facilities, and continually 
live in hopes that each year will see favorable action taken on the plans and specifications 
as laid out. For several years we have called attention to the deplorable state of our 
present inadequate laundry. The building is dark, dingy and poorly ventilated and 
working conditions are bad. Machinery is antiquated and mechanical breakdowns of 
serious nature are imminent. 

Under our present system of handling and storing merchandise, which amounts to 
approximately $450,000 each year, there is bound to be a wastage, and there always will be 
until it can be brought under proper physical and financial control. The use of space for 
storerooms that was originally intended for sleeping purposes is not conducive to good 
supervision of supplies. It is almost impossible to account properly for the use of 
merchandise where perpetual inventories are not required. The present specified system 
of accounting is carried on in a so-called "Expense Ledger" that means nothing, proves 
nothing, and cannot be considered of any value as a control factor. 

We believe all merchandise should be controlled by perpetual inventories and when 
this is not practiced, waste and loss is bound to creep into the results obtained. Although 
no pressure has been brought to bear on us to make material changes in the system now 
in use, it is our intention to do so just as soon as they can be properly assimilated and 
efficient systems devised to bring them under control. 

There are several angles to inventories as they apply to the operation of any hospital. 
Inventories covering the storage of undistributed supplies are no more important than 
are the inventories covering certain classifications of supplies after their distribution to 
the various wards and departments of the hospital. In either case, surplus material can 



40 P.D. 23 

accumulate on shelves and in closets that results in merchandise in excess of demands 
and proper inventories. This procedure can freeze assets that, in some cases, are never 
thawed out. 

The hospital pharmacy has been reorganized with its stock placed directly under the 
supervision of the steward's department. A perpetual inventory was established and it 
was soon found that no detriment to medical service ensued from a great reduction in 
variety and quantity of drugs, and almost complete abolition of stocks from which com- 
pounding is done. Insofar as possible ward supplies of drugs were held within a two 
days supply. The success of this reorganization is apparent to all concerned. 

Another example of controlled inventory established during the year under this depart- 
ment is the sheet control system. A quota of two sheets per bed forms a basic inventory, 
and all other sheets used are obtained at central control points, that operate on a loan 
system. This method eliminates accumulated surplus and defines loss without adding 
any great burden to the time factor involved. 

All these matters have a direct bearing on operating cost which, in the last analysis, 
affects the patient weekly per capita cost rate. The trend of this rate has been upward 
for several years past, and it will only turn when good business management is applied 
to each individual hospital. This means good accounting and control of finances, inven- 
tories and distribution of supplies. 

During this year, it will be the endeavor of this department to apply such management 
to this hospital, and we are now laying plans to put it into effect as soon as possible. In 
time it should reflect itself in the downward trend of patient per capita cost without 
lowering in any particular the hospital standards as they exist today. 

Farm Report 
James Mis tar k, Head Farmer 

A carefully planned planting program was inaugurated at the beginning of the garden 
season. Each field of soil had been carefully tested for calcium, nitrates, phosphorus 
and potash. Consideration was given to what each particular crop needed in the line 
of plant food, soil type, drainage and location. Fields which showed acidity were cor- 
rected by the use of agricultural lime to suit the requirements of the particular crop. 

The idea in mind was to get a larger yield per acre, using less land and reaping a larger 
yield, which would mean fewer rows to weed, cultivate and spray, and to keep down 
unnecessary surplus vegetables that can be quite a problem. This idea fits in well with 
our rotation program. 

This routine brought us an abundant crop of early vegetables, with a remarkable yield 
and the fewest weeds in history. The heavy rains during the latter part of July reduced 
the yield of many of the later crops as much as 40-60 per cent. We hope to continue 
planned planting, fertilization and crop rotation next year. 

Hay yielded very heavily, producing enough hay to carry us through the entire year, 
supplying dry stock, heifers, bulls and horses. The hay was harvested early in June 
before the rainy weather set in. This early harvesting gave us a fine crop of second 
cutting hay. To ease the harvest a hay carrier and hoist was installed in the large barn, 
Home Farm, saving very much hard manual labor and eliminated the dangerous heights 
for hand pitching. 

The Ensilage corn crop produced heavily, filling three silos. This fed out very well 
and with the home produced hay we reduced the cost of producing milk considerably. 

Swamp reclaiming progressed with unusual vigor, adding at least seven acres of fine 
virgin land that shall help out a great deal in our rotation program. 

One crawler tractor, obsolete, was traded in towards a new F-30 tractor, heavy duty 
rubber tires. This tractor not only replaced the crawler type but travels to our Hillside 
Farm on its own power, and saves the loading into a truck as was necessary with the 
crawler tractor. 

The correlation of patient therapy and production demand continues to be a problem. 
Many of the garden, dairy and miscellaneous farm jobs require some certain skill. It is 
not always possible to have an adequate number of patients with the abilities necessary 
to production pressure. 

The non-parole groups that do most of the weeding, cultivating and harvesting have 
dropped in effiiciency. Many members need closed supervision to prevent unnecessary 
loss by destruction of plants during weeding and harvesting. We believe it necessary 
for the attendant to spend a great deal of time teaching his workers. A closer check 
should be given the attendant as to his method of teaching. 



P.D. 23 . 41 

With the aid of our Pathologist we have practically stamped out all chronic mastitis. 
A large number of heifers freshening during the year have added considerably to the 
milking herd. We are commencing to reap the fruit of a well planned breeding program. 

Some of the newly added features during the past year are : 

A soil tester which gives us a detailed analysis. In past years it was necessary to 
deliver soil samples to the State College. 

Electric Fencing: This unit with but one wire, charged with a low voltage, keeps cows 
in a restricted area very well. With this we were able to give our cows a summer pas- 
turage, so essential to a milking herd, the first since the location of the new barn at the 
Home Farm. 

All dump carts and farm wagons have been converted to rubber tires to keep in pace 
with our rubber tractor equipment. 

The rear of the Male Home has been graded and landscaped, making a very attrac- 
tive lawn. 

The old baseball site was lengthened, regraded and reseeded and a retaining wall built 
on the South side. This should be a fine ball park next year. 

At the end of a four day heavy rain storm, September 21, at 4 o'clock in the afternoon 
a terrific gale-hurricane wind uprooted more than half of the many fine shade trees at 
Summer Street and the Main Hospital. We estimated over 5000 trees were uprooted, 
broken down beyond repair. Most of these trees were in perfect shade condition, as a 
result of a pruning and fertilizing program put into effect about four years ago. It will 
take about four years to prune and rejuvenate the remainder of these storm damaged 
trees and about fifty years to re-establish the grounds to proper shape. 

Much damage was done to farm crops, shredding late sweet corn, late spinach, beans 
and turnips. We were fortunate to have had harvested all but two acres of fine silage 
corn. Many crops in the low areas were flooded with water. 

A few of the farm buildings were also damaged. 

Engineer's Report 
Warren G. Proctor, Chief Engineer 

The plant has been operating on oil since January 1, 1938 and during that time we 
have burned 1,389,856 gallons of "Bunker C" oil at an average cost oi 3}/2 cents per 
gallon which would make a total fuel bill for the year of approximately $48,644.96. 
This quantity of oil is comparable to 7,619 tons of coal at the main plant from 1928 to 
1938. Coal at $7 per ton would cost approximately $53,333. 

The advantages of oil are : — 

1. Ease of handling. The oil is fed to the burners by pumps. This eliminates the 
labor of an attendant and twenty-five patients who wheeled in from twelve to forty tons 
of coal each day and removed from eight to thirty tons of ash each week. 

2. Cleanliness. Coal must be shoveled many times and during each operation coal 
dust passes off into the air. This made it hard to keep the boiler room clean. The coal 
dust was also carried into the Hospital creating a housekeeping problem. 

3. Boiler maintenance. The surfaces of the boilers exposed to combustion have been 
much cleaner, thus increasing their efificiency. Stoker repairs and upkeep have been 
eliminated. This has always been a costly item. Furnace walls and brick work are in 
excellent condition and their care and proper maintenance is much easier and less 
expensive. Due to the installation of a large boiler we are able to operate most of the 
time on one boiler and maintain a steady steam pressure. This again is a more efficient 
operation. 

The new turbines and engine have been giving excellent service. Each one of the 
new generators is capable of carrying the entire load which was beyond the capacity of 
our old plant. During the year of 1938 we generated 1,414,600 K.W., and in 1930 we 
generated 392,830 K.W. 

This shows an increase of 360% in the use of electricity. The additional electric load 
is accounted for by the installation of fans in our attics which are operated by large 
motors also motor driven fans in new Hydro. 

Suitable illumination promotes cleanliness and prevents accidents. 

During the September hurricane the Engineer's department suffered only slight 
damage. Two panes of glass were broken in a sky light, a branch broke a wire on line 
leading to farm and a tree fell on wires near cottage, but in the main hospital service was 
maintained without interruption as it also was at the Summer Street Department. 
Many other places suffered the loss of light, power, and even fire protection. 



42 P.D. 23 

New refrigerating apparatus has been installed which is more efficient with a wider 
range of temperature where required and greater economy in operation. 

New machinery has been purchased for our machine shop that is of great assistance in 
making repairs, throughout the hospital. 

Engineers are continuing to study and work for higher licenses. One second class 
engineer passed the examination for a first, and three other second class engineers are 
working to improve their knowledge and to receive certification. One fireman has ad- 
vanced from second to first class. 

A request has been made to change the rating of this plant from second class to first 
class. 

A fire alarm system designed by the Gamewell Company has been placed in service. 
The telephone operator is able with one signal to notify the entire Hospital of a fire and 
its location. When an alarm is given each group has assigned duties to perform : Doctors, 
nurses and attendants to care for the patients, mechanics to fight the fire and others to 
police the grounds and direct traffic. 

The buildings are frequently inspected by members of the Worcester Fire Department 
and also by engineers from the Department of Mental Health. 

Many recommendations made by these inspectors have been carried out; others 
demand a special appropriation to fulfill. 

Maintenance Department 
Anton Svenson, Maintenance Foreman 

In all maintenance and repair work we have attempted to combine results with 
economy in hospital operation. Special emphasis has been laid upon proper planning 
and layouts as the best method to insure permanent results. The manner of repairing 
and altering buildings may vary according to an individual's ideas and with the require- 
ments of each undertaking. Unlike most other buildings, the mental hospital is occu- 
pied by patients, many of whom at times are destructive. Repairs are especially fre- 
quent as some buildings are more than one hundred years old. The range of main- 
tenance projects carried on during the year is a wide one. It includes the inspection of 
work done by contractors to see that their work is completed in accordance with plans 
and specifications; ordinary maintenance; and to them has been added this year the 
burden of hurricane and storm damage. 

The painting, plastering, masonry, and carpentry work has been increased through 
W.P.A. labor. The interior of nineteen wards has been completely repaired and re- 
decorated; also the exterior stone and brick masonry of many buildings has been painted. 

Special projects during the year were the temporary and permanent protection of 
buildings damaged by hurricane, the addition of an insulated tar and gravel roof over 
the kitchen and laundry through the installation of fans or ventilators to remove foul air 
and reduce humidity; complete air changes are possible now in these buildings; the in- 
stallation manually operated window controls in the kitchen; the installation of a 
modern plumbing system in the Sargent building and in part of the Male Employees 
Dormitory. 

This past year, owing to effects of the hurricane, glazing became a major item in all 
buildings, including the greenhouse. A great amount of time, labor and materials were 
necessary to complete this item as the painters replaced 20,000 panes of glass. The 
carpenters replaced 10,000 feet of window cord and in other work used 600 gross of 
screws and 30 kegs of nails. The masonry repairs included brick, stone, and concrete 
work at various buildings both interior and exterior. Many concrete walks have been 
repaired or replaced, and over 2 carloads of cement have been used in this work. 

Copper base — and counter-flashing, moreover, have been installed on the roof, and in 
the parapet walls of Woodward building; thereby eliminating the penetration of the 
moisture to plastered walls and ceilings. The extensive effects of the September hurri- 
cane necessitated many repairs to slate, tar and gravel roofs. 

Certain outstanding needs of the hospital have been requested in other reports. It 
seems useless to reiterate these needs each year. They are increasingly important with 
the passage of time and the longer they are delayed the more the cost. 

My personal appreciation is due to all officers and employees of the hospital who have 
rendered faithful and cooperative service during the year. Such loyalty is the im- 
portant factor in the progress of any organization. 

William A. Bryan, Superintendent, 



P.D. 23 43 

VALUATION 

November 30, 1938 

Real estate — Land, 584.95 acres $ 389,507.00 

Buildings and betterments 2,443,598.50 

$2,833,105.50 

FINANCIAL REPORT 

To the Department of Mental Diseases: 

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

fiscal year ending November 30, 1938. 

St.\tement of Earnings 

Board of Patients $66,687.29 

Personal Services 314.43 

Sales ' 

Food $1,693.67 

Clothing and materials 23.10 

Furnishings and household supplies 105.95 

Medical and general care 200. 90 

Heat and other plant operations 72.00 

Repairs ordinary 327.13 

Farm: 

Cows, calves, pigs and bulls 2,407.61 

Hides 21.85 

Vegetables, tools, etc. . . . . 237.66 

Total Sales 5,089.87 

Miscellaneous: 

Interest on bank balances $112.50 

Rents 1,315.14 

Court fees; $39.50; lectures $90; Tel. Com. $136.26; Patients' valuables, 

$204.22; P & D Frt. $21.78; Misc. $63 554.76 

Total Miscellaneous 1,982.40 

Total earnings for the year $74,073 . 99 

Total cash receipts reverting and transferred to the State Treasurer $74,121.32 

Accounts receivable outstanding December 1, 1937 $55.00 

Accounts receivable outstanding November 30, 1938 7.67 

Accounts receivable decreased • *'i7 . 3i 

Maintenance Appropriation 

Balance from previous year, brought forward $7,852.15 

Appropriation, current year 1,105,150.00 

Total $1,113,002.15 

Expenditures as follows: 

Personal services $620,521.50 

Food 201,693.71 

Medical and general care ■ 42,714.00 

Religious instruction v 2,860.00 

Farm 23,887.06 

Heat and other plant operation . . . 83,857.73 

Travel, transportation and office expenses 11,897.64 

(Garage, $4,903.46; grounds, $1,319.52) 6,222.98 

Clothing and materials 22,817.80 

Furnishings and household supplies . . ' . 35,957.25 

Repairs ordinary 16,286.87 

Repairs and renewals 31,454.40 

Total maintenance expenditures $1,100,170.94 

Balances of maintenance appropriation, November 30. 1938 12,831.21 

$1,113,002.15 
Special Appropriations 

Balance December 1, 1937, brought forward $84,031.79 

Appropriations for current year 268,350.00 

Total $352,381.79 

Expended during the year $110,325.44 

Reverting to Treasury of Commonwealth 110,325.44 

Balance November 30, 1938, carried to next year $242,056.35 



44 



P.D. 23 





Act or 


Total 


Expended 


Total 


Balance at 


Appropriation 


Resolve 


Amount 


during 


Expended 


end of 




Chap.— Yr. 


Appropriated 


fiscal year 


to date 


year 


Hydrotherapy Building, 












M.S.P.M. 50, PWA D. 4657 




$127,173.41 


$842.67 


$127,147.59 


$25.82 


Mechanical refrigeration 


234-1937 


14,400.00 


9,357.61 


13,900.93 


499.07 


Porch — Administration Bldg. 


304-1936 


5,500.00 


349.15 


5,497.65 


2.35 


Plumbing — Summer Street 












Hospital 


234A-1937 


12,300.00 


61.12 


12,298.98 


1.02 


New boilers, stolcers, etc. . 


304-1936 


270,000.00 


60,557.88 


266,664.90 


3,335.10 


Fire alarm system 


934-1937 


9,000.00 


8,543.27 


8,543,27 


456.73 


X-ray equipment 


356-1938 


8,000.00 


- 


- 


8,000.00 


Medical equipment . 


356-1938 


5,000.00 


- 


- 


5.000.00 


Bake ovens 


356-1938 


6,550.00 


.46 


.46 


6,549.54 


Electric wiring . 


356-1938 


10,000.00 


- 


- 


10,000.00 


Plumbing — Summer Street 












Hospital . . ' . 


356A-1938 


12.300.00 


11,167.25 


11,167.25 


1,132.75 


Renovation of plumbing — 












Employees' Bldg. . 


234-1937 
304-1936 


10,500.00 


10,120.80 


10,120.80 


379.20 


Hurricane and flood damage 


507-1938 


216,000.00 


9,325.23 


9,325.23 


206,674.77 






$706,723.41 


$110,325.44 


$464,667.06 


$242,056.35 



" Per Capita 

During the year the average number of patients has been, 2,467.36. 

Total cost of maintenance. $1,100,170.94. 

Equal to a weekly per capita cost of $8.5748. 

Total receipts for the year. $74,121.32. 

Equal to a weekly per capita of $.5777. 

Total net cost of maintenance for year, $1,026,049.62. 

Net weekly per capita, $7.9971. 

Respectfully submitted, 

Margaret T. Crimmins, 



Treasurer. 



Financial statement verified. Geo. E. Murphy, 

Approved Comptroller. 

STATEMENT OF FUNDS 

November 30, 1938 
Insulin Treatment for Dementia Praecox 

Balance on hand November 30, 1937 $62.38 

Expended to November 30, 1938 48,31 

Balance on hand November 30, 1938 . . $14.07 

Investment 

Worcester County Trust Co • ,$14.07 

Canteen Fund 

Balance on hand November 30. 1937 $958.60 

Receipts to November 30. 1938 20,744.14 

$21,702.74 

Expended to November 30, 1938 19,916.54 

Cash on hand November 30, 1938 . . . . . . . . . . • ■ . $1,786.20 

Investments 

Worcester Depositors Corp. (Class A Certificate) $96.00 

Mechanics National Bank 1,548.14 

Cash on hand November 30, 1938 142.06 

$1,786.20 

Patient's Fund 

Balance on hand November 30, 1937 $7,196.56 

Receipts 7,157.38 

Interest 112.50 

$14,466.44 

Expended $8,972.77 

Interest paid to State Treasurer 112.50 

9,085.27 

Balance on hand November 30, 1938 . . $5,381.17 

Investments 

Worcester County Institution for Savings $1,000.00 

Worcester Five Cents Savings Bank 500 . 00 

Worcester Mechanics Savings Bank 500.00 

Peoples Savings Bank 1,000.00 

Bay State Savings Bank 1,000.00 

Worcester Depositors Corp. (Class A Cert.) 60.00 

Balance Mechanics National Bank 1,128.20 

Cash on hand November 30, 1938 192.97 

$5,381.17 



P.D. 23 45 

Rockefeller Research Project 

Balance on hand November 30, 1937 $1,856.30 

Receipts to November 30, 1938 16,018.32 

$17,874.62 

Expended to November 30, 1938 16,264.28 

Balance on hand November 30, 1938 $1,610.34 

Investment 
Worcester County Trust Co $1,610.34 

Wheeler Fund 

Balance on hand November 30, 1937 $1,054.42 

Income to November 30, 1938 25.00 

$1,079.42 

Expended to November 30, 1938 61.41 

Balance on hand November 30, 1938 $1,018.01 

Investment 

Worcester Mechanics Savings Bank $1,000.00 

Balance Mechanics National Bank 18.01 

$1,018.01 

Clement Fund 

Balance on hand November 30. 1937 $1,000.00 

Income to November 30, 1938 25 . 00 

$1,025.00 

Expended to November 30, 1938 25.00 

Balance on hand November 30, 1938 $1,000.00 

Investment 

Worcester County Institution for Savings $1,000.00 

Lewis Fund 

Balance on hand November 30, 1937 $1,368.47 

Income to November 30, 1938 32.50 

$1,400.97 

Expended to November 30, 1938 84.72 

Balance on hand November 30. 1938 $1,316.25 

Worcester Five Cents Savings Bank , $1,300.00 

Balance Mechanics National Bank 16.25 

• $1,316.25 

Manson Fund 

Balance on hand November 30. 1937 $1,112.21 

Income to November 30. 1938 26.03 

$1,138.24 

Expended to November 30. 1938 .83 

Balance on hand November 30. 1938 $1,137.41 

Investment 
Millbury Savings Bank $1,137.41 

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

Table 1. General Information 
(Data correct at end of institution year November 30. 1938) 
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 $2,833,105.50 

Personal property 478.420.48 

Total $3,311,525.98 

Total acreage of hospital property owned. 584.95. 
Additional acreage rented, 40. 

Total acreage under cultivation during previous year, 180.79. 
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 1 - 1 

Clinical assistants 2 - 2 - - - 

Total physicians 14 1 15 1 - 1 

Stewards 1 - 1 - - — 

Resident dentists 1 - 1 - - - 

Pharmacists 1 - 1 - - - 

Graduate nurses 3 67 70 1 - 1 

Other nurses and attendants 141 160 301 112 

Occupational therapists - 4 4 - 1 1 

Social workers - 4 4 - - - 

All other officers and employees .... 139 90 229 9-9 

Total officers and employees .... 300 326 626 12 2 14 



46 



P.D. 23 



Classification by Diagnosis September 30, 1938 
Census of Patient Population at end of year: 

Absent from Hospital 

Actually in Hospital but still on Books 

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

Insane 1.134 1,169 2,303 229 293 522 

Mental defectives - 1 1 - i \ 

Alcoholics 1 - 1 - - - 

All other cases 4 3 7 - - - 

Total 1,139 1,173 2,312 229 294 523 

Other Races: 

Insane 25 27 52 4 4 8 

Mental defectives - - - - 1 i 

Total 25 27 52 4 5 9 

Grand Total 1,164 1,200 2.364 233 299 532 

M. F. T. 

Patients under treatment in occupational-therapy classes, including 

physical training, on date of report 188 168 356 

Other patients employed in general work of hospital on date of report 504 647 1.151 

Average daily number of all patients actually in hospital during year 1.153.38 1.202.40 2.355.78 

Voluntary patients admitted during year 10 1 11 

Persons given advice or treatment in out-patient clinics during year . 1 30 1 65 295 



P.D. 23 



47 



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Table 3. 



P.D. 23 

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^ 


215 


155 


370 


97 95 78 


70 74 59 


Austria 






— 


1 


1 


_ _ _ 


2 3 1 


Canada^ . 






20 


22 


42 


52 49 42 


36 38 32 


China 






1 


- 


1 


1 


- — _ 


Czecho-Slovakia 






1 


- 


1 


1 1 1 


_ _ _ 


Denmark 






1 


— 


1 


1 2 1 


1 


England . 






3 


8 


U 


7 10 4 


13 12 9 


Finland . 






3 


2 


5 


6 6 6 


3 4 3 


France . 






_ 


1 


1 


1 


1 2 1 


Germany 






1 


1 


2 


6 5 4 


2 3 2 


Greece 






4 


— 


4 


6 5 5 


1 1 1 


Holland . 






1 


- 


1 


1 1 1 


_ _ _ 


Hungary . 






1 


— 


1 


1 


_ _ _ 


Ireland 






23 


12 


35 


56 59 49 


31 30 29 


Italy 






6 


4 


10 


13 13 13 


9 9 9 


Norway . 






- 


- 


- 


_ _ _ 


1 1 1 


Poland . 






12 


8 


20 


19 19 19 


16 14 14 


Portugal 






- 


1 


1 


_ _ _ 


1 1 1 


Russia 






3 


1 


4 


5 6 5 


3 3 2 


Scotland 






2 


2 


4 


3 4 1 


5 5 4 


South America 






1 


- 


1 


_ _ _ 


_ _ _ 


Sweden . 






7 


5 


12 


9 9 9 


11 9 9 


Switzerland 






- 


- 


- 


2 1 1 


_ _ _ 


Turkey in Asia 






4 


2 


6 


5 5 5 


2 2 2 


Other Countries 






4 


2 


6 


6 6 6 


5 4 4 


Unknown 






1 


1 


2 


18 16 13 


15 13 12 


Total 


314 


228 


542 


314 314 263 


228 228 195 



'(Persons born in Hawaii, Porto Rico and the Virgin Islands should be recorded as born in the United 
States.) 

'Includes Newfoundland. 



P.D. 23 



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-50 



P.D. 23 



Table 5. Citizenship of First Admissions 



Citizens by birth . . . 
Citizens by naturalization 
Aliens . . . 
First papers .... 
Citizenship unknown 

Total ... 

Table 6. Race of First 


Admissions Classified 


with Ref 


erence to 


M. F. T. 
216 156 372 

31 14 45 
29 23 52 

6-6 

32 35 67 

314 228 542 

Principal Psychoses 


Race 


Total 


With 
syphilitic 
meningo- 
encephalitis 


With 

other 

forms of 

syphilis 


With 
epidemic 
encepha- 
litis ■ 


With 

other 
infectious 
diseases 


Alcoholic 
psychoses 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 




6 

5 
1 

1 

4 

6 

35 

4 

6 

5 

52 

13 

6 

10 

1 

19 

1 

1 

124 

14 


1 

13 
3 

24 
3 
1 
5 

33 
9 
2 
1 

10 
4 

15 
1 
1 
2 

89 

11 


7 
5 
1 
1 

17 
9 

59 
7 
7 

10 

85 

22 
8 
1 

20 
5 

34 

2 

1 

3 

213 

25 


2 1 3 
2-2 










Armenian 

Chinese . 

Dutch and Flemish 

English . 

Finnish 

French . . 

German . 

Greek 

Hebrew 

Irish 

Italiani . 

Lithuanian 

Portuguese 

Scandinavians 

Scotch . 

Slavonic' * 

Syrian 

Turkish . 

Other specific races 

Mixed 

Race unknown 


















































4-4 








5-5 








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
























10 - 10 
1 - 1 


1-1 


- - - 


- 1 1 










11 








1 1 2 








1 - 1 








3 1 4 




























9 3 12 


3-3 


1 1 2 


- 2 2 
1 - 1 


21 1 22 
2 1 3 








Total 




314 


228 


542 


27 5 32 


4-4 


1 1 2 


1 4 5 


43 4 47 



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



Race 


Due to 

drugs, 

etc. 


Trau- 
matic 
psychoses 


With cerebral 
arteriosclerosis 


With other 
disturbances 
of circulation 


With 
convulsive 
disorders 
(epilepsy) 


Senile 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) 

Armenian 

Chinese .... 

Dutch and Flemish 


- _ _ 


- - - 


2-2 


- - - 


_ _ _ 


2-2 












- - - 


- - - 


2 4 6 




1-1 


2 2 


Finnish 

French 

German 

Greek 

Hebrew 

Irish 

Italiani 








1 1 
- 5 5 
1 - 1 

4 4 8 

2 2 


- 1 1 

1 1 2 


1 - 1 
1 - 1 

1 - 1 


9 7 16 

1 - 1 
18 14 32 


1 - 1 
1 1 










Portuguese 
Scandinavian^ 
Scotch .... 
Slavonic' ^ . . . 
Syrian .... 
Turkish .... 
Other specific races 
Mixed .... 
Race unknown 


















4 1 5 


1 - 1 
1 - 1 


_ _ _ 


1 1 






2 2 


- - - 


1 - 1 


2 1 3 


1 - 1 


























1 1 2 
- 1 1 


1 1 2 


10 19 29 
5 3 8 


- - - 


2-2 
1 1 2 


6 11 17 
1 2 3 


Tota 


. 


2 4 6 


5 1 6 


53 51 104 


3 2 5 


4 1 5 


15 31 46 



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

^Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 
^Undiagnosed psychoses, 1 Female. 



P:D. 23 



51 



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



Race 




Involutional 
psychoses 


Due to 

other 

metabolic 

diseases, etc. 


Due to 

new 
growth 


With organic 

changes of 

nervous 

system 


Psycho- 
neuroses 


Manic- 
depressive 
psychoses 




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' 

Lithuanian 

Portuguese 

Scandinavian^ 

Scotch 

Slavonic^ ^ . 

Syrian 

Turkish 

Other specific races 

Mixed 

Race unknown . 




_ _ _ 


_ _ _ 


_ _ _ 


1 - 1 


- - ' - 


_ _ _ 


























- - - 


1 - 1 


- - - 


- - - 


1 1 


- -. - 


_ " _ _ 


- 1 i 








1 - 1 


- - - 


1 - 1 


- - - 


1 1 2 
- 1 1 


- - - 


- - - 


1 - 1 


2 1 3 


- 1 1 










1 - 1 


- - - 


- - - 






- 2 2 
1 1 


1 - 1 


: : : 


: : : 


1 - 1 


1 1 
1 1 












4 4 8 


1 - I 

3 1 4 
1 - I 


- 1 1 


1 1 2 
1 - 1 


4 4 8 


3 6 9 


Total . 




5 9 14 


8 2 10 


- 1 1 


5 1 6 


7 7 14 


5 12 17 



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



Race 


Dementia 
praecox 


Paranoia 

and 
paranoid 
conditions 


with 
psychopathic 
personality 


with 

mental 

deficiency 


Without 
psychoses 


Primary 
behavior 
disorders 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 




1 =- 1 
1 - 1 
1 - 1 












Armenian 

Chinese 

Dutch and Flemish 

English . 

Finnish 

French 

German 

Greek 

Hebrew 

Irish . 

Itahan' 

Lithuanian 

Portuguese 

Scandinavian^ . 

Scotch 

Slavonic' * 

Syrian 

Turkish 

Other specific races 

Mixed 

Race unknown . 


































- 5 5 

3 1 4 
8 9 17 

1 3 4 

2 1 3 
1 4 5 
5 5 10 

4 2 6 
1 1 2 








1 - 1 

3 , - 3 
5-5 




1 1 2 


- - - 


1 - 1 


_ _ - 


- 1 1 


- - - 


2 2 4 
1 - 1 


1 - 1 

1 - 1 

5-5 

2 - 2 

3 1 4 


1 - 1 










3 5 8 
- 1 1 
7 7 14 
1 - 1 
1 1 


1 - 1 


- - - 


- - - 


1 - 1 


- - - 


1 1 


- - - 


- - - 


1 1 2 
























27 21 48 
1 2 3 


2 2 4 


1 1 2 


2 3 5 


23 4 27 
1 1 2 


- 2 2 










Total 




67 68 135 


4 5 9 


1 1 2 


6 6 12 


47 8 55 


1 3 4 



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

^Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 
'Undiagnosed psychoses, 1 Female. 



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56 P.D. 23 

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

Principal Psychoses 



Psychoses 



Total 



M. 



Dependent 



M. F. T. 



Marginal 



M. 



Comfortable 



M. F. T. 



Unknown 



M. F. T. 



With syphilitic meningo- 
encephalitis . 

With other forms of 
syphilis 

With epidemic encepha- 
litis .... 

With other infectious 
diseases 

Alcoholic psychoses 

Due to drugs, etc. . 

Traumatic psychoses 

With cerebral arterio- 
sclerosis 

With other disturbances 
of circulation 

With convulsive disorders 
(epilepsy) 

Senile psychoses 

Involutional psychoses 

Due to other metabolic 
diseases, etc. 

Due to new growth 

With organic changes of 
nervous system . 

Psychoneuroses 

Manic-depressive psy- 
choses .... 

Dementia praecox . 

Pananoia and paranoid 
conditions . 

With psychopathic per- 
sonality 

With mental deficiency 

Undiagnosed psychoses 

Without psychoses 

Primary behavior dis- 
orders .... 

Total 



32 

4 

2 

5 

47 

6 

6 

104 

5 

5 
46 
14 

10 
1 

6 

14 

17 
135 



11 1 12 



18 



- 2 



16 
4 
1 

33 
1 
5 

26 

3 

1 
6 
4 



4 
50 



2 

32 

1 



11 15 
56 106 



1 1 

4 6 

1 1 

6 38 



1 1 



36 



1 - 1 
3 2 5 
- 1 1 



8 17 



1 1 
1 - 



81 37 118 



204 167 371 



Table 11. Use of Alcohol by First 



A dmissions 
Psychoses 



Classified with Reference to Principal 



Psychoses 




Total 




Abstinent 


Temperate 


Intemperate 


Unknown 
































M. 


F. 


T. 


M. 


F. 


1'. 


M. 


F. 


r. 


M. 


ir-'. 


r. 


M. 


F. T. 


With syphilitic meningo- 






























encephalitis 


27 


5 


32 


4 


— 


4 


9 


5 


14 


13 


— 


13 


1 


- 1 


With other forms of 






























syphilis 


4 


- 


4 


— 


— 


— 


2 


- 


2 


2 


— 


2 


— 


— — 


With epidemic encepha- 






























litis .... 


1 


1 


2 


1 


— 


1 


— 


1 


1 


— 


— 


— 


— 


— — 


With other infectious 






























diseases 


1 


4 


5 


— 


3 


3 


1 


— 


1 


— 


1 


1 


— 


— — 


Alcoholic psychoses 


43 


4 


47 


- 


- 


- 


- 


- 


- 


43 


4 


47 


- 


- - 


Due to drugs, etc. . 


2 


4 


6 


— 


2 


2 


— 


1 


1 


2 


— 


2 


— 


1 1 


Traumatic psychoses . 


5 


1 


6 


3 


1 


4 


— 


— 


- 


2 


— 


2 


— 


— — 


With cereoral arterio- 






























sclerosis 


53 


51 


104 


15 


30 


45 


11 


7 


18 


13 


— 


13 


14 


14 28 


With other disturbances 






























of circulation 


3 


2 


5 


— 


2 


2 


2 


— 


2 


1 


— 


1 


— 


— — 


With convulsive disorders 






























(epilepsy) . 


4 


1 


5 


2 


— 


2 


1 


— 


1 


— 


— 


- 


1 


1 2 


Senile psychoses 


IS 


31 


46 


5 


18 


23 


6 


1 


7 


3 


1 


4 


1 


11 12 


Involutional psychoses . 


5 


9 


14 


2 


8 


10 


2 


1 


3 


1 


— 


1 


— 


— - 


Due to other metabolic 






























diseases, etc. 


8 


2 


10 


3 


1 


4 


1 


— 


1 


3 


— 


3 


1 


1 2 


Due to new growth 


- 


1 


1 


— 


— 


— 


— 


— 


— 


— 


— 


— 


— 


1 1 


With organic changes of 






























nervous system . 


5 


1 


6 


2 


1 


3 


— 


— 


- 


2 


— 


2 


1 


- 1 


Psychoneuroses 


7 


7 


14 


3 


5 


8 


1 


2 


3 


3 


- 


3 


- 


- - 


Manic-depressive psy- 






























choses .... 


5 


12 


17 


I 


7 


« 


3 


5 


8 


1 


— 


1 


— 


— — 


Dementia praecox . 


67 


68 


135 


32 


38 


70 


16 


18 


34 


15 


2 


17 


4 


10 14 


Paranoia and paranoid 






























conditions . 


4 


5 


9 


— 


2 


2 


2 


— 


2 


2 


— 


2 


- 


3 3 


With psychopathic per- 






























sonahty 


1 


1 


2 


1 


— 


1 


— 


1 


1 


— 


- 


— 


— 


~ ~ 


With mental deficiency 


6 


6 


12 


4 


6 


10 


— 


— 




2 


— 


2 


— 


— — 


Unaiagnosed psychoses 


- 


1 


1 


— 


— 


— 


- 


— 




— 


1 


1 


— 


— — 


Without psychoses 


47 


8 


55 


11 


4 


15 


11 


2 


13 


24 


2 


26 


1 


1 


Primary behavior dis- 






























orders . . . . 


1 


3 


4 


- 


1 


1 


1 


1 


2 


- 


- 


- 


- 


1 1 


Total 


314 


228 


542 


89 


129 


218 


69 


45 


114 


132 


11 


143 


24 


43 67 



P.D. 23 



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OOt^lOOm 1 CNtS 1 W510 II \0 « « (NMCN 1 1 f«5TH 1 rt 1 
(NOsOO-jO 1 -<Ov 1 m 1 1 1 1 1 1 — 1 1 II II 1 II 

'Ooot^O>>ol'-ico llioll >0 « <-i >-i— ir^ II r<5-H 1 >H| 


00 

o- 



-W.2 

E'e 
< 


E 


>-irOO>OiOlOvCN iir^TtlTH \r> rt lO tOr«5tS -hoO (Sio <N »ith 
iOO\-*r^t^|ir).rt lio^lrt rH 1 1 cs^l 1^ <r>| (N |.-< 
"CtvOrooO 1 Tj<..H rttNro I I •* .i lO t-i ts cn rtt^ CMo 1 i-i 1 


00 
"5 




en 

w 
o 

o 
Q 

$ 
z 
u 




£ .^ , ■ ^i i ■ ■ ■= ■ ■ ■- • • 

1 1 S .^^.2 .^ . . .| . ...£S . . 

a a..2>'S». =5 g,-S ?>-s; -^ -2^ -gg k^^oE> -SS 

^ ^i^:;i ill -^ -i^IeM^I IBI^ -lislllH?^ 
I4ls iill 1 i ,1 il i^lll|5^l||5S 2 iilt s ^l|l 

1:3^ a; 


•a 

c 

2 




P.D. 23 



61 



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

and Condition on Discharge 



Psychoses 



Total 



Recovered 



Improved 



M. F. T. 



Unimproved 



M. F. 



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

Due to drugs, etc 

Traumatic psychoses 

With cerebral arteriosclerosis . 

With other disturbances of circulation 

With convulsive disorders (epilepsy) 

Senile psychoses .... 

Involutional psychoses 

Due to other metabolic diseases, etc. 

Due to new growth .... 

With organic changes of nervous system 

Psychoneuroses 

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

Total 



7 

2 

2 

44 

6 

3 

38 

1 

4 

11 

14 

8 

2 

2 

23 

46 

122 

11 

14 

11 

69 

3 



1 2 

- 28 

1 6 

4 11 

1 

1 1 
3 4 

2 4 



2 


2 


4 


1 


2 


3 


1 


- 


1 


- 


1 


1 


14 


- 


14 


2 


- 


2 



3 3 

1 2 
14 15 

- 2 

2 1 
1 



269 174 443 82 42 124 95 86 181 34 35 69 



Table 15. Hospital Residence During This Admission of First Admissions Discharged 

During 1938 



Psychoses 



Number 



M. 



Average Net 

Hospital Residence 

in Years 



M. 



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 diseases, etc. 
Due to new growth .... 

Psychoneuroses 

Manic-depressive psychoses 

Dementia praecox 

Paranoia and paranoid conditions 
With psychopathic personality . 
With mental deficiency 

Without psychoses 

Primary behavior disorders . 

Total 



2 


2 


4 


.45 


.33 


.39 


1 


— 


1 


.12 


— 


.12 


1 


1 


2 


.12 


.12 


.12 


25 


- 


25 


2.08 


— 


2.08 


3 


1 


4 


.06 


.12 


.08 


1 


- 


1 


.20 


- 


.20 


23 


8 


31 


.73 


.27 


.61 


1 


— 


1 


.20 


— 


.20 


2 


1 


3 


.08 


.04 


.06 


3 


7 


10 


.66 


.76 


.73 


3 


7 


10 


1.01 


.86 


.91 


3 


4 


7 


.06 


.55 


.34 


1 


— 


1 


.12 


— 


.12 


5 


2 


7 


.18 


.04 


.14 


13 


6 


19 


.70 


.21 


.55 


27 


41 


68 


1.20 


.43 


.73 


4 


3 


7 


1.38 


.86 


1.16 


3 


1 


4 


.23 


.12 


.20 


3 


3 


6 


.20 


1.48 


.84 


44 


9 


53 


.09 


.12 


.09 


1 


1 


2 


.12 


.04 


.08 


169 


97 


266 


.76 


.45 


.65 



62 



P.D. 23 





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1 


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00 1 — vo— cs 1 II cscN-H— ' ts 1 ir)»o!N 1 rnm-^ II — ■* i —cs — 


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ID— 1 >OI — — — — TflltSl «5 tSlOCOl — OOOI f^CN m — —( fOCSI 


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i2g S §3 -§11 5 g .^.S^c^l"' ^ ^ ^ l^-S^^SlsSl 

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11^ S ^ III 2 §-S 2i^ r§ &I ^^-S S g 2 S S ||-n g S 1 g o|| £ .-5 2^1 SS^3|^ 


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si 
1-2 

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to 


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III II 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III It 1 II III 
III II 1 1 'H 1 1 1 1 1 1 1 1 1 1 1 III II 1 II III 


1 






III II 1 1 1 1 1 -H 1 1 1 1 -H 1 1 1 III II 1 II III 


10 

M 


Paranoia 

and 
paranoid 
condi- 
tions 




lllt^l 1 1 tlllll 1 llll—'Hll II 1 II III 
1 1 1 "^ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III II 1 II III 
III II 1 1 1 1 1 1 1 1 1 1 1 1 1 'H .H 1 1 1 1 1 II III 


M 


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i 


0*ll ^ \ --t 1 IIIII*^ 1 ll^^l 1 irj-Hrs-^l M II ^I^H 

t-ll-^l 1 1 lllll— 1 llll 1 fO»H(N II _ II 11^ 
Mil —1 rH 1 llllll 1 ll-H| 1 (Nil — 1 ^ II .^11 


00 
M 

00 






to' 


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III 11 1 1 ll-lll 1 lll-l l-Hl II 1 11-11 
III II 1 1 llllll 1 II— 1 |(Sll 11 — 11— II 






to" 


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11—11 1 1 llllll 1 1— II 1 III II 1— 1 1 — 1 
III II 1 1 llllll 1 llll 1 111 II 1 II 111 


•* 

1 


With or- 
ganic 
changes 
of nerv- 
ous 
system 


to' 


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III II 1 1 llllll 1 1 1 1 — 1 III II 1 II til 

III II 1 1 1 — 1 1 1 1 1 llll 1 <N 1 1 II 1 II III 


•<* 


O JS 


to' 


III 1 — 1 1 llllll 1 llll 1 111 II 1 II III 
III 1 - 1 1 1 1 1 1 1 1 1 llll 1 III II 1 II III 
III II 1 1 llllll 1 llll 1 III II 1 II III 


1 


Due to 

other 

metabolic 

diseases, 

etc. 


to 

i 


— II II 1— llllll 1 llll 1 III 1— — II 111 
III It 1 1 llllll 1 llll 1 III 11 — 11 111 

— II II 1— llllll 1 llll 1 III 1—1 II III 




1 ^ 
2"^ o 

" a 


to 


III II 1 1 llllll 1 II — 1 1 1 — 1— 1 — II 111 
III II 1 1 llllll 1 llll 1 III II 1 II III 
III II 1 1 llllll 1 II — 1 1 1 — 1— 1 — II III 


1 


II 

Q, 




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III — 1 — 1 II— III — IIOvl 1 001— II PO II III 
III — 1 1 1 llMlll 1 I1W5I 1 MMl II 1 II III 


10 

to 

10 

M 




With 
convul- 
sive dis- 
orders 
(epilepsy) 


to 


III II 1 1 llllll 1 llll 1 — 1 1 II 1 II III 
III II 1 1 llllll 1 llll 1 — 1 1 II 1 II III 
III II 1 1 llllll 1 llll 1 III II 1 II III 


1 


X 
r* 

<: 
Q 

(1. 
o 

a 
in 

< 




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"^i -l-i ^ " .s ...... ^S .=5 . . 

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ll'-s s V 1 §1 ° i^ H^ rs &fc-s^ § g 2 g i s fe-£ g 2 ^ g-5 s fc 2 --a 2|_s ss|^ s^ 
^•3 g5 g S 3 1 ^.^.2 gSg^sasfegs s.2.2 o-st.2 s o-g-g^ 3 s - 3 g.^32|.|5;| 


3 



64 



P.D. 23 



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P.D. 23 



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P.D. 23 






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2°5.yg§^§ 



68 P.D. 23 

Table 19. Average Length of Hospital Residence During the Present Admission of All 
First Admissions in Residence on September 30, 1938 



Psychoses 



Number 



T. 



Average Net 

Hospital Residence 

in Years 



M. 



F. 



T. 



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

Alcholic psychoses 

Due to drugs, etc 

Traumatic psychoses . . . . 

With cerebral arteriosclerosis . 
With other disturbances of circulation . 
With convulsive disorders (epilepsy) 

Senile psychoses 

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

Psychoneuroses 

Manic-depressive psychoses 

Dementia praecox 

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

Without psychoses 

Primary behavior disorders 

Total 



26 
6 
3 
1 
8 
1 
1 

61 

3 

52 

29 

5 

4 

6 

22 

328 332 

21 43 

4 8 

42 45 

1 

3 1 

2 



83 
5 
2 
1 

93 
1 
6 

62 
4 
4 

24 

11 
7 

10 
2 
9 



109 

11 

5 

2 

101 

2 

7 

123 

4 

7 

76 

40 

12 

14 

8 

31 

660 

64 

12 

87 

1 

4 

2 



4.76 
8.08 
6.00 
7.50 
9.46 



1.87 

3.97 

7.61 

12.69 

7.01 

20.00 

10.95 

.44 



7.37 
6.00 
7.50 

.44 
6.86 

.44 

12.50 

2.94 

12.50 

3.82 

6.97 

5.70 

4.50 

7.32 

5.72 

12.27 

10.96 

16.50 

10.85 

.44 

2.50 

.44 



5.38 
6.94 
6.90 
3.97 
9.25 
1.97 
4.19 
2.71 
1.47 

10.77 
3.62 
6.86 
4.24 
2.62 
6.48 
6.27 

12.48 
9.66 

17.66 

10.90 
.44 
.95 
.44 



722 660 1,382 



9.24 9.58 9.40 



Table 19A. Average Length of Hospital Residence During the Present Admission of All 
Readmissions i?i Residence on September 30, 1938 



Psychoses 



Number 



Average Net 

Hospital Residence 

in Years 



M. F. 



M. 



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

Due to drugs, etc 

Traumatic psychoses .... 
With cerebral arteriosclerosis 
With other disturbances of circulation 
With convulsive disorders (epilepsy) 

Senile psychoses 

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

Psychoneuroses 

Manic-depressive psychoses . 
Dementia praecox . . ._ 
Paranoia and paranoid conditions 
With psychopathic personality 
With mental deficiency .... 
Without psychoses 

Total 



26 
3 
6 



5 

5 

1 

4 

6 

30 

237 

8 

3 

32 

2 



7 
3 
3 
1 
4 
1 

19 
1 

2 

14 

12 

2 

4 

4 

44 



349 586 

21 29 

9 12 

38 70 

2 4 



7.19 
3.50 
5.83 

8.10 

7.50 
4.02 

7.37 

5.90 

6.30 

7.50 

10.00 

7.00 

8.36 

11.54 

12.56 

12.50 

11.21 

2.50 



7.78 

3.50 

10.83 

12.50 

9.25 

22.50 

3.81 
3.50 
3.50 
4.07 
8.00 
4.00 
4.00 
6.75 
8.77 
10.63 
9.83 
6.16 
9.89 
3.50 



7.31 
3.50 
7.50 

12.50 
8.19 

22.50 
7.50 
3.91 
3.50 
6.60 
4.55 
7.50 
5.16 
7.00 
6.90 
8.60 

11.00 

10.58 
7.75 

10.50 
3.00 



442 540 982 



9.94 9.62 9.77 



Table 20. Family Care Statistics for Year Ended September 30, 1938 

Males Females Total 

Remaining in Family Care September 30, 1937 26 82 108 

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

Admitted to Family Care During the Year 40 42 82 

Whole Number of Cases within the Year 66 124 190 

Discharged from Family Care within the Year: ^^ 49 82 

Discharged outright from Family Care: 3 5 8 

From Family Care to Escape Status 1 2 3 

From Family Care to Visit Status 7 16 23 

Returned to Institution 22 26 48 

Returned to Institution from Escape -1 2 3 

Returned to Institution from Visit 2 4 6 

Remaining in Family Care September 30, 1938 33 75 108 

On Visit from Family Care September 30, 1938 5 12 17 

Average Daily Number in Family Care During Year: 31 76 107 

Supported by State 25 54 79 

Reimbursing - } \ 

Private . . . 8 21 2y