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

Public Document No. 23 

l&tyt (JJommonttiFaltlj of MnBanttyxxarttB 



ANNUAL REPORT 



TRUSTEES 



Worcester State Hospitalism 



FOR THE 

Year Ending November 30, 

1939 

Department of Mental Health 







Publication of this Document appeoved by the Commission on Administration and Finance 
550,-9-40. Req. P. 126. 

OCCUP>.TK'N/>L PRI^JT.hG PLA^T ' ' 

DEPARI'MilNT DF MDN7A1 HEA..TII i i 

GARDNER STATE HOSPITAL 
EAST GARDNER. MASS. 

it 



TESTER S 



WORCESTER STATE HOSPITAL 

Post Office Address: Worcester, Mass. 

ST Board oF PCR©#Si&N 
William J. Delahanty, M.D., Chairman, Worcester. 
Anna C. Tatman, Secretary, Worcester. 
Josephine R. Dresser, Worcester. 
John L. Bianchi, Worcester. 
Robert R. Portle, Worcester. 
Harry F. Kenney, Boston. 
Robert A. Burns, Auburn. 

Resident Staff 
William A. Bryan, M.D., Superintendent. 
Walter E. Barton, M.D., Assistant Superintendent. 

Psychiatric Service 
William Malamud, M.D., Clinical Director. 
Lonnie 0. Farrar, M.D., Medical Director Summer Street Dept., Supervisor School 

Clinics. 
William L. Holt, Jr., M.D., Psychiatrist in Charge of Female Reception Service. 
Bertram T. Spira, M.D., Assistant. 
Harold Greenberg, M.D., Clinical Assistant. 

Benjamin Simon, M.D., Psychiatrist in Charge of Male Reception Service. 
S. Harvard Kaufman, M.D., Assistant. 
Martin Dollin, M.D., Clinical Assistant. 

Norman D. Render, M.D., Psychiatrist in Charge of Continued Treatment Service. 
Erel Guidone, M.D., Assistant. 

Medical and Surgical Service 
Embrie J. Borkovic, M. D., Director. 
William Freeman, M.D., Pathologist. 
Hans Molholm, 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. 
Andras Angyal, Ph.D., M.D., Resident Director of Research. 
Joseph M. Looney, M.D., Director of Laboratories. 
Harry Freeman, M.D., Internist. 
Conrad Wall, M.D., Psychiatrist. 
Otto Kant, M.D., Psychiatrist. 
Nathan Blackman, M.D., Psychiatrist. 
Mortin A. Rubin, M.D., Neurophysiologist. 
David Shakow, M.A., Chief Psychologist. 
George L. Banay, Ph.D., Medical Librarian. 

Out Patient Department 
Robert Kemble, M.D., Director Child Guidance Clinic. 
Phyllis D. Schaefer, M.D., Assistant Physician. 

James Watson, M.D., F.A.C.S., Director Adult Mental Health Clinic and Supervisor of 
Family Care. 

Nursing Department 
Katharine 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 Bosquet, M.D., Surgery. 
Joel M. Melick, M.D., Gynecology and Obstetrics. 
Donald K. MeCi/usKEY; M.D., Gynecology, amd Obstetrics. 
Lester M/FeltQ^, M.D; kxeriito-Unnprfj.Surgety. 
John O'Meara,' M!D.; (JrlKo'pedic Surgery, Roentgenology. 
Oliver H. Stansfield, M.D; internal Medicine. 
Erwin C. Miller, M.D., In\ennal Medicine. 



WW* 

P.D. 23 3 

Jacob Goldwyn, M.D., Neurology. 

John T. Carmody, M.D., Neurosurgery. 

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

Roscoe W. Myers, M.D., Ophthalmology. 

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

Theodore Von Storch, M.D., Encephalographic Roentgenology. 

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

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

Hudson Hoagland, Ph.D., Neurophysiology. 

Heads op Administrative Departments 

Herbert W. Smith, Steward. Anton Svenson, Foreman Mechanic. 

Margaret T. Crimmins, Treasurer. James Mistark, Head Farmer. 

Warren G. Proctor, Engineer. Lillian G. Carr, Matron. 

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

Wanda Misbach, O.T.Reg., Director of Occupational Therapy. 

TABLE OF CONTENTS Page 

Trustees' Report 4 

Superintendent's Report 5 

Changes in the Staff 6 

Movement of Population 7 

Psychiatric Activities 7 

Report of the Clinical Director ...... .... 8 

Shock Therapy Unit 8 

Hydrotherapy Report 10 

Occupational Therapy Report 11 

Nursing Department .13 

Chaplain 15 

Social Service Department 16 

Radio Department .18 

Medical and Surgical Activities 19 

Report of the Medical and Surgical Division 19 

Out Patient and Clinic Treatments 21 

Physical Therapy Report 22 

X-Ray Department - 22 

Dental Department . . . . .22 

Laboratory Report 23 

Research 25 

Research Department ....'.' 25 

Psychology Department . . 29 

Library Report 32 

Publication List . " . 34 

Scientific Assemblies 36 

Educational Activities 37 

Student Training . 37 

Teaching Appointments 37 

Nursing Education 38 

Community Service - 39 

Prevention 39 

Child Guidance Clinic 39 

Mental Health 42 

School Clinics 43 

Division of Public Relations 44 

Administrative Activities . . . . 45 

Stewards' Department .45 

Farm Report . . " 46 

Engineers' Report . . . . . . , 47 

Maintenance Department 48 

Industrial and Sewing Rooms 49 

W. P. A. and N. Y. A 49 

Treasurers' Report 50 

Statistical Tables 53 



4 P.D. 23 

TRUSTEES' REPORT 

To His Excellency the Governor and the Honorable Council: 

The Board of Trustees of the Worcester State Hospital respectfully submits the 
annual report of the hospital for the period of the year 1939. 

This report will deal principally with the question of the imperative need for certain 
physical improvements in the institution. While the Board is thoroughly familiar 
with the necessity for economy in state government, it also recognizes the need for 
a proper protection of the investment which has been made by the Commonwealth in 
buildings and equipment. It would be derelict in its duty if it did not invite the atten- 
tion of your Excellency to certain specific improvements which are needed to prevent 
deterioration and loss. 

Before making these recommendations, the Board has considered each of them in the 
light of three main objectives: 

1. Will the desired outlay contribute directly or indirectly to the recovery of patients? 

2. Will this outlay protect an existing investment? 

3. Will the expenditure result in direct saving for the Commonwealth? 

Each of these recommendations has been measured by this rule of three and in each 
case the answer is in the affirmative. 

Laundry Building 

The need for a new laundry building and equipment grows more acute with each 
passing year. The machinery deteriorates and is more difficult and expensive to keep in 
repair. A new building will contribute directly to the recovery of patients because 
laundry work is one of the most important forms of occupational therapy in the hospital. 
Standards of personal care of patients will also be raised through the elimination of delay 
in the return of body clothes now brought about by inadequate laundry facilities. 
The unhygienic conditions under which patients work in the present quarters reflect 
no credit upon the Commonwealth. 

A new laundry will protect the existing investment which the hospital has in linen 
and clothing. Anything that lessens the wear and tear on textiles and prolongs their 
life will protect the money invested in them. 

Similarly a new laundry will lead to an actual saving in wear on clothing and linen 
and in labor. There will be a direct saving in laundry supplies. 

Storehouse 

This is a section of a long-range program. When a new laundry is completed it would 
be economical to utilize the present building for the storage of goods. This can be 
easily done with a few changes such as cement floors, carrying the second story over the 
entire building and the installation of refrigeration and elevators. 

Such a project would result in a direct saving to the Commonwealth. The hospital 
stores thousands of dollars worth of materials and supplies each year. The loss on these 
through improper storage is great. Increased efficiency with reduction of time of hand- 
ling goods would result from the establishment of a central storehouse. 

Floor Replacement 

A long-term program of floor replacement should be begun as soon as funds permit 
as part of a fire prevention program. Both the main building and Summer Street are 
fire hazards because of the wood floors. It would not be prohibitive in cost to tear out 
the floors in one building each year and substitute cement and linoleum floors. 

This would be a direct contribution to patients through the reduction of the fire hazard. 

Renovation op Thayer and Folsom Medical Wards 
This is an improvement that is badly needed. It is a sound investment because it will 
make a direct contribution to patient recovery. 

It is proposed to install an electric elevator in the Thayer and Folsom buildings for 
the purpose of conveying patients from one sick ward to another. It is difficult to ima- 
gine a general hospital that must carry sick patients from one floor to the next by litter 
bearers. Moving seriously ill patients by hand up steep drafty staircases is a hazardous 
procedure that should be eliminated. These wards comprise a general hospital and to 
carry patients from one floor to another is an antiquated procedure that should be 
corrected. 

Conditions on these wards are unsatisfactory in regard to food service. At present 
it is impossible to serve hot foods at the bedside. It is proposed to establish a centra 



P.D. 23 5 

diet kitchen in the basement and distribute food in electrically heated carts which can 
be carried directly to the bedside by means of the proposed elevators. 

These recommendations can be carried out as a five year program of betterment. 
It would be entirely impractical to attempt more than one at a time, but we would 
strongly urge that a start be made towards correcting the obvious deficiencies of the 
plant. 

The Board wishes to again testify to its belief in the soundness of those policies of 
administration which place the major emphasis upon patient treatment, teaching, re- 
search and prevention. We believe that anything that will make these activities more 
efficient will return substantial dividends in the form of more patients recovered and 
discharged into the community. 

The Board congratulates each and every employee of the organization for the loyalty 
and enthusiastic cooperation with the administration during the year. The high standard 
of integration amd coordination of the personnel indicates the fine quality of leadership 
given by the Superintendent, Dr. Bryan. 

Respectfully submitted, 
William J. Delahanty Robert H. Burns 

John L. Bianchi Josephine R. Dresser 

Harry F. Kenney 

Trustees. 

SUPERINTENDENT'S REPORT 

To the Trustees of the Worcester State Hospital: 

As has been the custom for many years, the details of this report have been prepared 
by those members of the staff who have had the responsibility of supervising the several 
departments of the hospital. This procedure is the logical development of the plan of 
organization which has been characteristic of the institution many years. The delegation 
by the chief executive of responsibility and authority makes for a democratic spirit and 
a sense of partnership which serves to integrate the organization into one harmonious 
unit. 

The department head and medical councils have functioned as advisory groups to the 
superintendent. These councils have met weekly for free discussion of hospital prob- 
lems including the selection of new personnel. The appointment of committees for the 
purposes of handling routine problems and studying special projects has lead us further 
along the line as a true participative democracy. Studies are now being made regarding 
the feasibility of the creation of an employees' council. The membership of this council 
would be elected by the group of employees and it would act in an advisory capacity 
to the superintendent. 

All of these changes in management of personnel follow the trend which is developing 
rapidly throughout the world. The relationship between management and worker is 
constantly undergoing readjustment and hospital organizations must recognize and meet 
this situation by the inauguration of a more liberal form of administration. 

The policies of this hospital have been built around five major activities. These are: 

1. Psychiatric Treatment. 4. Research 

2. Medicine and Surgery. 5. Prevention. 

3. Teaching. 

The reports of the clinical director shows the general line along which treatment has 
been carried out. The staff is constantly alert to the necessity of keeping abreast of the 
times in the matter of new therapies. As a time-saving device the Journal Club which 
has been in existence for five years is useful. Staff meetings and ward rounds have been 
increased in number and the emphasis is constantly upon the therapeutic program for the 
individual patient. Every activity of the hospital is organized around this theme and 
the result of these efforts in the form of patients discharged is an important criterion of 
the professional efficiency of the staff. 

The detailed report of the chief of the medical and surgical service indicated the vast 
amount of work carried on. It is becoming increasingly apparent that the relationship 
between the psyche and soma is of the greatest importance in elucidating the problems 
of psychiatry. 

We have completed the first year of an organized system of sick leave for employees. 
Our plan has been to grant twelve days of sick leave to each employee who acquired ill- 
ness in line of duty who had been employed more than a year. The total cost to the 



6 P.D. 23 

hospital for a year of operation was $4,114.09. The expenditure has been justified 
because the good feeling engendered by the privilege has reflected itself in the relation 
of employee and patient. It is a direct contribution to patient recovery. 

The educational program of the hospital has been elaborated and systematized during 
the year. In general this educational work has been confined to post-graduate instruc- 
tion. The best contribution of the special hospital to all disciplines is in this field. 
Specialization should be built upon a basis of general education. Mental hospitals have 
an important contribution to make in the fields of medical, social service, nursing, 
psychological and occupational therapy education. To make the contribution worth- 
while the institution must have a real interest in education. This interest will find 
its expression in a well organized, formal system of instruction rather than merely per- 
mitting students to browse about the hospital to pick up what they can. 

In the field of research the hospital has continued to work towards a better under- 
standing of the causes and treatment of mental disease. The details of this work will 
be found in the report of the director of research. During the year fifty-two papers 
have been published. These papers sum up the results of the year's work. 

To those philanthropic agencies which have supported these research projects finan- 
cially, I offer my sincere appreciation and gratitude. Their support has made possible 
many lines of inquiry that could not possibly have been followed had this support not 
been available. 

An organized, systematic approach on a broad basis to the problems of psychiatry 
will net rich returns in the form of better understanding of human behavior. Mental 
hospitals must take their part in this movement. 

In the field of prevention, the hospital has developed a number of additional clinics 
during the year. The Child Guidance clinic has continued to function and the report 
of the director will indicate the volume of activity and the trend of the work. 

The affiliation with the Worcester Welfare Department has been cemented into a 
worthwhile arrangement. The city department furnishes office quarters, clinical assist- 
ance and social workers. The hospital contributes the director, psychologist and social 
service leadership. The report of the director gives the scope of the activities. 

A further development of preventive work has been the establishment of a mental 
health clinic at the Worcester City Hospital. Inasmuch as this is in the embryonic 
stages no report can be offered, but it promises to become a potent factor in the preven- 
tive policy of the hospital. 

The community educational work carried on by the hospital is best illustrated by the 
fact that over 400 talks were given by members of the staff to lay audiences. A bulletin 
of speakers was prepared during the year and has been most useful in arranging for 
addresses and talks before lay organizations. 

In conclusion, I wish to thank the Board of Trustees for the constant support and 
encouragement given me. I also wish to thank the officers and employees of the hospital 
for their constant loyalty and enthusiasm in carrying out the principles and policies of 
the institution. Finally I offer my sincere appreciation to the citizens of Worcester for 
their faith in the hospital and the unfailing support they have given. 

Changes in the Staff 

In the past year the following changes have been made in the resident staff : 
Physicians who left: 

Francis H. Sleeper, Assistant Superintendent to Assistant to the Commissioner, 
Inspector of Hospitals, the Department of Mental Health. 

Dr. Ewen Cameron, Resident Director of Research to Head of the Department and 
Professor of Psychiatry Albany Medical College. 

Morris Yorshis, Clinical Director to private practice of pychiatry in Haverhill. 

Milton E. Kirkpatrick, Director of Child Guidance Clinic to Secretary of the National 
Committee for Mental Hygiene, New York. 

Arthur J. Gavigan, Senior Physician to Assistant Superintendent at Medfield State 
Hospital. 

Louis H. Cohen, Senior Research Psychiatrist to Clinical Director Manteno (Illinois) 
State Hospital. 

Maurice Greenhill, Assistant Physician to Massachusetts General Hospital. 

Frances Cottington, Assistant Physician to Bellevue Hospital, New York. 

Robert Fuchs, Assistant Physician to private practice in Baltimore, Maryland. 



P.D. 23 7 

Joseph *B. Furst, Clinical Assistant to Iowa Psychopathic Hospital. 

E. Morton Jellinek, D.Sc. Biometritian, to private consultation practice in New York 
City. 
Promotions: 

Andras Angj^al, Senior Research Psychiatrist to Resident Director of Research. 

Walter E. Barton, Senior Psychiatrist to Assistant Superintendent. 

William L. Holt, Jr., Assistant in Child Guidance to Senior Physician in charge of 
Female Reception Service. 

S. Harvard Kaufman, Clinical Assistant to Assistant Physician. 
New Appointments: 

William Malamud, Professor of Psychiatry Iowa State University Medical School 
to Clinical Director. 

Benjamin Simon on leave of absence to National Hospital, Queen Square, London, 
returned to become Senior Phychiatrist in Charge of Male Reception Service. 

Otto Kant, Associate Professor of Psychiatry — University of Tuebingen, Germany, 
to Senior Research Psychiatrist. 

Erel Guidone, Medfield State Hospital to Assistant Physician. 

Bertram Spira, Manteno State Hospital (Illinois), to Assistant Physician. 

Hans Molholm, Habit Clinic, Department of Mental Health and Massachusetts 
General Hospital, Out Patient Department, to Assistant Physician. 

Phyllis D. Schaefer, Greystone Park State Hospital to Assistant in Child Guidance. 

Harold Greenberg, Private Practice Minneapolis, Minn., to Clinical Assistant. 

Martin H. Dollin, Michael Reese Hospital, Chicago, to Clinical Assistant. 

Alex A. Dickson, 3rd Class Engineer, retired on Dec. 22, 1938. 
Dead: 

Michael M. Jordan, Consultant in Neurology and Psychiatry. Died September 30, 
1939. 

Movement in Population 
In 1939, 552 patients were admitted for the first time to a mental hospital. This was 
10 more than were admitted on the same status in 1938. 221 patients were readmitted, 
an increase of 23 over last year. There were 516 discharged to the community, an in- 
crease of 53, more patients returned to their homes than in the past year. 100 of these 
were recovered, 283 were discharged as improved, 42 unimproved, 91 were without 
psychosis. 22 patients were transferred to other hospitals during the year. At the end 
of the year 2,419 remained in the hospital and 556 patients went on visit or otherwise 
absent. 

The following mental disorders were most frequently seen amongst those admitted 
for the first time : 

Psychosis with Cerebral Arteriosclerosis, 130 Syphilitic Meningoencephalitis, 33 
Dementia Praecox, 124. Senile Psychosis, 23 

Alcoholism with Psychosis, 38 Manic Depressive Psychosis, 14 

Without Psychosis, 14 Involutional Melancholia, 10 

Psychoneurosis, 35 

Patients who were discharged came chiefly from the following groups : 
Dementia Praecox, 82 Manic Depressive Psychosis, 20 

Alcoholism with Psychosis, 36 Syphilitic Meningoencephalitis, 14 

Psychoneurosis, 30 Involutional Melancholia, 9 

Cerebral Arteriosclerosis, 23 

Psychiatric Activities 
In the following report the activities of the clinical psychiatric staff are presented as 
they are grouped under a series of primary functions leading toward one main goal. 
This goal may be described in a general way, as an effort directed toward combatting 
mental disease, not only in the individual patient with his particular disease process 
but in relation to the problem of personality maladjustments as one meets them in the 
community in general. This broadens the field of clinical psychiatry outside of the 
confines of the state hospital to include such problems as research into the nature and 
causes of these diseases, the preparation of suitably trained workers in the field and the 
institution of measures directed towards the prevention of ikich. diseases. With this as 
the goal, the psychiatric activities have proceeded along the following lines. 



8 P.D. 23 

I. Adequate Care; Treatment, and Adjustment of the Patients Admitted to this Hospital. 
— The proper procedure along this line starts with an attempt to understand the nature 
and causes of the particular diseases which have necessitated the admission of the pa- 
tients to the hospital. For this purpose, daily ward rounds are conducted on the various 
services of the hospital by the Clinical director, the regular staff of physicians on that 
particular service, the residents, internes and student internes in cooperation with social 
workers, occupational therapists and others who are concerned in the understanding 
and treatment of the patients. At these rounds all newly admitted patients are seen 
shortly after admission, a provisional diagnosis is made and some form of treatment is 
suggested on the basis of the apparent etiology. Further more intensive lines of investi- 
gation into the case are also indicated. 

Twice a week, staff conferences are held for the discussion of cases presenting problems 
of particular interest, difficulties in diagnosis, teaching opportunities or research possi- 
bilities. The whole clinical staff and representatives of the nursing, psychology, social 
service, laboratory and other departments are present and are encouraged to participate 
in the discussion. Twice a week diagnostic conferences are held on the acute service 
to determine final diagnosis, and treatment or disposition of patients that have been in 
the hospital for three weeks. At these conferences the same group participates as on 
ward rounds. Four times a week conferences are held on the different services with 
regard to patients who have reached a point where changes in their hospital status 
or in the form of treatment must be made in view of the progress that has taken place 
in the course of the treatment. 

Methods of treatment are instituted and administered wherever possible in relation- 
ship to the particular factors that have contributed to the development of the disease. 
The main trend is to prefer such methods as have been proven by experience to do most 
good and to subject the patient to the least danger. At the same time, however, the 
clinical staff is alive to new methods of treatment that are being introduced and applies 
these judiciously wherever they are indicated. Of the methods most frequently prac- 
ticed, psychotherapy in its various forms, adequate medical and surgical treatment 
wherever needed, proper diet and hygiene are still proving to be of great benefit. In care- 
fully selected cases the use of metrazol in the treatment of tension and stupor states and 
insulin in cases where the patients show a tendency toward reality distortion, has been 
of great benefit and is considered as worthjr of continuation. Social therapy and Occupa- 
tional therapy have come into prominence not only as auxiliary procedures in relation- 
ship to investigation and adjustment of the patient to the hospital, but also with a view 
toward the socialization of the patient and a preparation for his readjustment when he is 
ready to leave the hospital. The personality of the individual patient and his social 
background are taken as the most reliable criteria to determine what method or methods 
of treatment are to be used. Frequent consultations of the various members of the 
clinical staff and the other workers are held to determine new steps to be taken as the 
patient's condition changes in the course of his stay in the hospital. 

II. Educational Activities. 

III. Research Activities. 

IV. Prevention of Mental Disorders. — The three essential psychiatric objectives 
listed above are properly within the sphere of influence of the Chief of Staff and have 
been carried out under his direction. They have been described in detail below under 
main sections of this report together with the work of related hospital departments. 

Shock Therapy Unit 

On August 7, 1939, a "Shock Therapy Unit" was established in what was the female 
occupational therapy shop in Folsom basement. This entire ward was turned into an 
insulin treatment room consisting of fourteen beds separated by a partition so that seven 
male and seven female patients could be treated simultaneously. The adjacent rooms 
were converted into a dressing room, store room, and dining room respectively. 

The staff consisted of (1) a Junior Assistant Physician in Charge, (2) a Resident 
Physician, (3) two female nurses (one charge), (4) two male attendants. The charge 
nurse and one of the physicians made up the team that daily went to either the male or 
female wards to give metrazol therapy. Insulin was given every day except Saturday 
and Sunday. Metrazol was given on alternate days, three times weekly. 

A course of metrazol consisted of from 15 to 20 convulsions with the rate and degree 
of improvement determining the number of treatments. In insulin therapy, a course 



P.D. 23. 



9 



consisted of from 30 to 50 comas with the rate and degree of improvement again deter- 
mining the total number of treatments. Exceptions, where patients received less treat- 
ments than the minimum required were rare. 

All patients treated with insulin had schizophrenia and we find the following facts : 



Male — 17 

34 
22 
50 
27 
40 
15 
units of insulin 
units of insulin 
units of insulin 
119.5 units of insulin 
45 
235 
5 — 30% of all patients 
5 — 30% of all patients 
intravenous glucose 

4 (36.4% of completed cases) 
1 (14% of those in hospital) 

5 (45% of cases completed) 
1 (25% of patients out of 



190 

75 

290 



Female — 18 

35 
10 
54 
22 
47 
4 
116 units of insulin 
55 units of insulin 
350 units of insulin 
79 units of insulin 
20 
160 
6 (33 K% of all patients) 

6 (33 M% of all patients) 
Sucrose intubation into stomach 

7 (52% of completed cases) 
2 (33 y 3 % of those in hospital) 
5 (39% of completed cases) 
1 (14% of patients out of hospital) 



Average number of treatments per 

patient 

o. Least number per patient 

6. Greatest number per patient 
Average number of comas 

a. Most for single patient . 

6. Least for single patient . 
Average maximum dose . 

a. Smallest maximum dose 

6. Largest maximum dose . 
Average constant coma dose . 

a. Smallest constant coma dose 

6. Greatest constant coma dose 
Part coma delirious .... 
Convulsions ..... 
Primary method of relief of coma 
Out of Hospital ... 

Advanced to parole ward 
Same status .... 
Relapse of patient out of Hospital 

hospital) 

The method of treatment for both male and female patients was approximately 
constant and this is borne out by the statistics. However, the average maximum insulin 
dose and the constant coma producing insulin dose was higher in the males than in the 
female patients even though the extreme of dosages were greater in the women. Mild 
complications convulsions and deliria showed no sexual variation (30 to 33V3%). In the 
greatest number of male cases coma was relieved by intravenous glucose, while in the 
women sucrose intubation was sufficient. More women recovered or improved (over 
one half out of the hospital and one third of the remaining on open wards) than the male 
patients (a little over one third out of the hospital and only one was transferred to an 
open ward). One male and one female patient suffered a relapse after leaving the 
hospital. 

Since the advent of the centralized "therapy unit," 81 female patients have been 
put on metrazol therapy and 74 males. This makes a total of 155 patients for four 
months or an average of 38.75 new patients per month as compared to 24.6 new patients 
per month during the first eight months of the fiscal year. The 155 patients were com- 
posed of 8 manic depressive manics, 2 manic depressive depressed, 6 involutional melan- 
cholies, and the rest schizophrenics. On December 1, 1939, there were 15 female and 
14 male patients still on therapy with their courses incompleted. 

Tabulation of the results of the Metrazol Treatment brought out the following 
interesting fact : 

Number Treated 
Average number of treatment per patient 

Least number of treatment per patient 

Greatest number of treatment per patient 
Average number of convulsions per patient 

Least number of convulsions per patient 

Greatest number of convulsions per patien 
Average maximum dose 

Smallest maximum dose 

Largest maximum dose 
Fractured Spines 
Fractured Hips . 
Cardiac complications 
Major dislocations 
Pulmonary complications 
Out of hospital . 
Advanced to parole ward 
Relapse of patients out of hospital 

Method of therapy was kept constant as much as possible in both male and female 
patients but the female patients (as a group) received less than the minimum number of 
treatments established. The average number of seizures per female patient was 14 x /i 
including a prolonged case of 63 seizures. It is interesting to note, with this in mind, 
that although the same number of male and female patients left the hospital, twice as 
many female patients returned after a relapse. Further, 28% of the remaining male 
patients were placed on a parole ward, whereas, only l /s of the remaining female patients 
were advaned to open ward privileges. 

As for complications, only one was noted among the female patients (a slight edema 
of the ankles with no cardiac findings) of the 74 male patients, 8 received compression 



Male 




Female 


74 




81 


21.3 




22.2 


2 




3 


15 




14.5 


1 




2 


30 




63 


9.4 cc. 




7.4 cc. 


4 cc. 




3 cc. 


15 cc. 




12 cc. 


8 







2 







2 




1 


















18-30% 


18- 


-27% 


13 (28% of remaining) 


9 


(20% of remaining) 


1-5H% 


2- 


-11% 



10 P.D. 23 

fractures of the vertebrae, 2, fractured hips, and 2, acute cardiac decompensation 
syndromes. 

There were no deaths from insulin or metrazol shock therapy. 

Because of the multiple injuries to the back of the male patients the springs were 
removed from army style cots and the patient received treatment while lying on the flat 
mattress on steel slats. The hips were held to the mattress, the arms to the patient's 
sides, and the shoulders held to the mattress. 

In conclusion, it is stated that during the year, 376 patients were treated with metrazol 
convulsive therapy, 155 or 41% during the last four months by the newly established 
treatment unit. 

Because of the centralization of treatments, a greater number of patients may be 
treated and the physicians and nurses on the acute service are able to spend more time 
in personal care of patients on the ward. Too, efficient and concentrated observation 
is made on all shock therapy patients as a group, changes made and accidents guarded 
against. It is felt, also, that the results obtained indicate continuation of the unit 
because (1) "shock therapy" is not specific treatment but utilized only when indicated. 
(2) Since the establishment of the unit the acute service have increased their number of 
parole beds (3) it affords a centralized teaching unit for physicians and nurses, and 
(4) it enhances opportunities for research. 

Recently metrazol convulsions have been given to patients in insulin coma. The 
course of this new form of therapy is not completed, but in the cases so treated good 
results are beginning to be seen where there had been no improvement during insulin 
or metrazol therapy alone. Five patients have been maintained on an improved level 
by weekly metrazol convulsions. 

Plans are being made to start giving insulin to a picked number of cases by the intra- 
venous method. It is hoped that this will shorten the length of the morning's course and 
reduce the general expense. 

Insulin has been used in this hospital as shock therapy since March 1936. 50 patients 
have received this treatment alone. 33 or 66% are now at home. Metrazol has been in 
use since October 1937. 376 patients have received this treatment alone. 154 or 43% 
are now at home. Many of those who received the treatment were old and chronic 
cases. These remain in the hospital. Metrazol and Insulin both have been given to 
81 patients and 52 or 63% of these are at home. Therefore 48% of the 507 cases who 
have received shock therapy are no longer in the hospital. These results are encouraging 
but are of administrative interest only as understanding of them awaits careful scientific 
scrutiny now in progress. 

As a general principle insulin is being given to cases of dementia praecox of paranoid 
or hebephrenic type. Metrazol finds its greatest use in depression, manic excitements, 
involutional agitations and in Catatonic Dementia Praecox. 

Hydrotherapy Report 

The female hydrotherapy department is situated on second floor of the Hydrotherapy 
building. In the hydrotherapy suite we have 2 tub rooms, 2 pack rooms, a colonic room 
and a room for tonic treatments. 

In the large tub room the treatment hours are from 8:30 to 11 a.m., 1:30 to 4 p.m., 
and 6:30 p.m. to 6 a.m. There are 12 tubs in this room, averaging 36 baths a day. 

In the small tub room, the treatment hours are from 6:30 a.m. to 6:00 p.m. and from 
6:30 p.m. to 6:00 a.m. There are 6 tubs in this room, averaging 12 baths a day. In all 
1,279 female patients received 18,902 baths and spent 105,793 hours in the tubs. 

Patients remaining in continuous baths all day are fed while in treatment. Patients 
in baths all night are rubbed with oil before entering tub. 

There are 10 pack beds in the Pack Room. Patients go into pack at 8:30 a.m. and 
are returned to wards at noon. The afternoon patients are enveloped after dinner, and 
removed from pack at 4:00 p.m. 

The night packs are put in at 6:30 p.m. until 6:00 a.m. They are repacked every four 
hours. Noisy patients are separated from quiet patients and removed to other pack 
room. 440 women received 5,359 wet sheet packs during the year and 13,010 hours of 
treatment. 

In the colonic room we average 10 enemas and 5 colonics a day. The yearly total was 
2,944 enemas and 1,107 colonic irrigations to 524 women. 

The tonic suite consists of an electric light cabinet, vapor room, sitz tub and a large 
bath tub for various treatment such as tub shampoos, saline bath, immersion baths, etc. 



P.D. 23 11 

There is a pack bed which is used for pack demonstrations for students. This bed is also 
used for hot and cold applications to spine, and wet mitten friction. There are 3 pails for 
foot-baths. There is a control table, for the needle spray, rain, fan, scotch and jet 
douches, tub and sitz bath, and wave spray. 327 women received 2,042 various types 
of tonic bath treatments. 

Three ice-makers are in constant use. The ice is used for cold compresses to forehead 
on noisy, talkative patients. Ice collars, which are filled with a 5% solution of glycerine, 
are kept in ice-makers to freeze them. 

The Male Hydrotherapy Suite is located on the first floor, and is separated from 
Quimby I disturbed admission ward by locked doors. 

There are 2 tub rooms and 1 pack room. Each tub room, contains 4 continuous bath 
tubs and a control table for regulating the temperature of the water. Treatment hours 
are approximately from 7:45 a.m. to 11:00 a.m. as all patients are removed for dinner. 
Patients are returned to baths about 12:30 p.m. and removed at 4:00 p.m. In the 
evening patients enter bath at about 5:45 p.m. being removed at 11 :00 p.m. No treat- 
ments are given after this hour. The usual daily quota is 24 baths. Last year 432 men 
had 7,617 baths for a total of 20,503 hours of treatment. 

The pack room, located on the same floor contains 6 pack beds with rubber covered 
mattresses. Wet sheet pack treatments are given within the same hours as the con- 
tinuous baths. Patients are packed in the evening only in emergency. The average 
number of treatments daily is 12 to 14. Last year 269 men received 3,176 pack treat- 
ments for a total of 6,745 hours. 

A shower bath is located in the main corridor for use of patients upon removal from 
treatment and at other times. 

The Male Tonic Bath Suite is located in basement of male bath-house. It consists 
of 2 rooms. In the first room is located an electric light cabinet, 2 reclining beds, for use 
of patients after treatments, also facilities for undressing and dressing patients. In the 
second room, there is a large bath tub for use in giving such treatments as Saline Baths, 
Tub Shampoos, Immersion Bath, etc. There is a large table covered with a rubber 
covered mattress, for use in giving such treatment as Hot and Cold Applications to 
Spine and Wet Mitten Friction. Also a Sitz-Bath Tub. There is a control table for the 
Needle Spray, Fan Douche, Jet Douche and Rain Douche. All ice used is brought from 
the icehouse to Tonic Suite. Last year 140 patients received 68 tonic bath procedures 
of various types. 

With improvised equipment for the administration of Colonic Irrigations, 129 enemas 
and 26 colonics were given last year. 

Occupational Therapy Department 

The past year has witnessed an almost entire change of personnel in this department. 
After four years as director, Miss Dorothea Cooke, left in August to become a member 
of the Staff at the Boston School of Occupational Therapy, and was succeeded by 
Miss Wanda A. Misbach. Miss Margaret Cullen and Miss Eleanor Sturtevant resigned 
to be married. Miss Marion Easton went to Louisville, Ky., to become Director of 
Occupational Therapy in Louisville City Hospital. Miss Alice Hussey, Miss Eleanor 
Perkins, and Mrs. Pearl Beaton Fielding filled resulting vacancies. 

In spite of adjustment such widespread changes have necessitated the new personnel 
has carried on with the following goals in mind. 

a. Concentrated treatments for patients newly admitted or receiving shock and 
other therapies. 

b. Concerted effort to keep every patient possible engaged in some activity — 
the activity to be suited to the patient's needs and capabilities, and promotions to 
ensue as the patient is ready for them. 

c. More activities of a recreational nature to make for a more normal and better 
balanced program of work and play. 

d. Education of hospital personnel and students in our own and allied depart- 
ments, or the Nursing Service. 

1 . Concentration of effort to newly admitted, and shock treatment patients 
has been facilitated on the female side by removal of the O. T. shop from 
Folsom basement to Washburn porch. This has meant that the approach 
to the shop is pleasanter, patients can be moved to and from shop with less 
risk of escape, aid is at hand in the event of any delayed reaction on the part of 



12 P.D. 23 

treatment, patients are stimulated to interest in the shop by virtue of its 
visibility through ward windows and nurses find it easier to bring patients 
to a shop so located, hence attendance is more regular. 

Classes have not been limited entirely to new admission or special treatment 
and research patients but have included, when prescribed, those from other 
wards on the Reception Services who needed the supervision and special atten- 
tion such a class affords. 

Promotion of the patient from the point at which he can be stimulated to 
productive activity, no matter how simple, to more difficult tasks as his powers 
of attention, concentration, coordination, judgment and responsibility increase 
has its beginning in the shop laboratories. 
In the female shop classes an average of 82 patients were enrolled and 30 were pro- 
moted each month to responsibilities of an industrial placement. The male Occupational 
Therapy shop had an average monthly enrollment of 60 patients and promoted 19 to 
industrial jobs. 

2. The principle of work fitted to the needs of the patients, as followed for 
the past five years, has been adhered to this year not only in shops but in 
making industrial placements. 

In this weekly conference of the director and therapists from the Occupational 
Therapy Industrial Offices with the Assistant Superintendent have been 
valuable as a coordinating force between the administration and our depart- 
ment, and as aid in training new personnel. 

An improved record system of line graphs showing number of patients in 
industry, pre-industrial centers or ward classes month by month and mounted 
in front office has helped in keeping physicians aware of their responsibility 
and in giving them a picture of what has happened on their respective services. 
Pre-industrial centers for those patients, particularly on continued treat- 
ment service, who are not ready to meet the demands of an industrial place- 
ment, but who do not require supervision of a graduate therapist in a shop, 
have been added to and expanded. In these groups under direct supervision 
of ward personnel, with suggestions, advice and help from this department, 
the goal is to establish working habits and induce productive activity looking 
toward promotion to industrial placement. 

Such classes have been maintained on W2, P3, P4, Q2, and S4. The P3 class 

is now being reorganized as a Sanitary Goods Assembly Unit with P4 taking 

over more responsibility as a mending class. Specially constructed tables have 

been built for the P3 class, arranged in a hollow square to facilitate distribution 

of raw material and supervision of work. Sanitary pads, sponges and mouth 

gags will be made in this class with patients working in the manner of factory 

assembly line, receiving a stimulus from one side, performing her part of the 

task and passing it on to the next. It is hoped that we will thus make the 

withdrawn patient increasingly aware of others and the need of working with 

others. 

Throughout the year on the Male service 70% of the men were in industrial positions; 

5% were in the Occupational Therapy shop or pre-industrial center; 11% were occupied 

in nurses ward classes and about 14% were in ward classes on the medical service. 

On the female service 50% of the women were in industry, 10% in Occupational Therapy 

shop and pre-industrial centers, 24% in nurses ward classes and 16% in medical ward 

programs. 

There were 3 pre-industrial centers on the female service. Patients were prescribed 
to attend class by the physician largely from the group unable to make an adjustment 
off the ward. It was possible to promote from 2 to 10 patients a month into industry 
each month. W2, a disturbed ward, produced 14,945 completed articles on an average 
of 1,245 pieces each month. P3, a continued treatment ward for luetics, produced 
54,494 complete articles, a substantial portion of them sanitary napkins. P4, a continued 
treatment ward for very deteriorated patients, organized a group in October and averaged 
1,118 pieces a month. 

In July, 2 centers were established in male wards. Q2 averaged 274 articles a month 
and S4 sanded an average of 11 pieces of furniture a month. 



P.D. 23 13 

Ward classes are conducted by ward personnel for those patients who are unprescribed 
to industry, Occupational Therapy shops, or other pre-industrial centers. Indirect 
supervision and materials are supplied through and records kept by this department. 

It is the purpose here to stimulate activity and adjustment to work situations with 
promotion to pre-industrial centers or to industry. 

A study made of these classes this year on the female wards shows a downward trend 
in amount of destructions as the amount of work goes up. This study will be continued 
in the next year. 

An enlarged program of recreation is still needed. Until a recreational director can be 
added to the staff, this department continues to be responsible for dances, outdoors in 
summer and in Sargent Hall in winter. During the summer months one therapist and 
a student made rounds of ward groups outside helping organize games and other group 
activities. Teas and parties are given in the shops and approximately one afternoon 
a week is spent in group games instead of crafts. Calisthenic classes have been newly 
organized with patients prescribed to it by physicians. Two classes, one for men, one for 
women, each meet twice weekly under direction of a patient who has had experience and 
training in physical culture. Attendants or nurses from each service and a member of 
the Occupational Therapy Department help guide activity of class members. 

This department has cooperated also with the music department in the art classes 
which have been held weekly and with the nursing service and librarian in bringing to 
the library in the evening groups of patients who are off the ward when the book truck 
makes rounds. 

Education of hospital personnel is carried on through exhibits, charts and graphs, and 
lectures to residents, medical students, attendants and social service students. Each 
affiliate nurse spends a week in the department after instruction through lectures and 
demonstration, in conducting ward classes. Post-graduate nurses spend a month in 
the various branches of the department learning through lectures, observation and 
practice how they may use Occupational Therapy as nurses and cooperate with us for 
the ultimate gain of the patient. 

Fifteen students from the Boston School of Occupational Therapy trained in the 
department during the past year. 

Summary of Industrial Placements Through the Occupational 
Therapy Department 



Total Placements . 
New Patients Assigned 



Female 


Female 


Male 


Male 


Reception 


Continued 


Reception 


Continued 




Treatment 




Treatment 


1,462 


919 


1,316 


1,072 


436 




467 





Nurses ward classes on Female wards of the Reception Service completed 18,042 
articles and on the Continued Treatment Service, 12,513 and Medical Service, 10,129 
individual pieces. 

Summer Street Department 

One therapist runs the shop and makes the placements in industry at the Summer 
Street Branch. Only parole patients work in the shop because this therapist must be 
absent frequently on other duties. 

Of the 582 average number of patients in residence at this branch, an average of 294 
are assigned in industry, 117 work on the ward, 11 are in the Occupational Therapy Shop. 
The remainder fall into groups infirm or idle, of these about 40 are occupied to some 
extent in ward classes. 

Nursing Department 
Efforts were continued during the past year to continue a high standard of personal 
and psychiatric care for the patient. Daily detailed reports were examined by the 
Superintendent and carefully checked to insure accuracy. Each male patient averaged 
3 shaves a week and a hair cut once every 2}^ weeks. A total of 180,524 shaves and 
26,643 hair cuts in the main and Summer Street division were necessary to give this 
service to an average of 1,180 male patients. A total of 1,225 females got 14,980 hair 
cuts and 11,399 waves at both departments, or an average of a hair cut a month and a 
wave every 53^ weeks. 



14 



P.D. 23 



Housekeeping: 

The housekeeping supervisor has thoroughly housecleaned every ward in the hospital 
and the Hillside dormitory this year. This has aided the program of cleanliness and 
orderliness of the wards. 
Ratings of employees: 

The efficiency rating record sheets for graduate nurses and charge attendants have 
been revised to fit more satisfactorily those qualities we desire in people caring for 
mental patients. All employees on the nursing service continue to be rated once in 
six months. 
Outside maintenance: 

There is still need for an increase in the allowance for outside maintenance to relieve 
the overcrowding in the nurses and attendants homes. 
Continued Treatment Service: 

A marked decrease in the number of idle patients on this service has been accomplished 
with the continuance of the P3 industrual room, the establishment of a similar project 
on P4 and the chair caning project on the male service. These classes are conducted 
by the nursing service with suggestions and material from the Occupational Therapy 
service. 
Nursing staff activities: 

Staff nurses as a group have shown increased interest in professional activities outside 
the hospital. Large groups have attended district and State meetings. There have been 
a number of visits to other institutions and not only has the staff shown interest in these 
excursions but has related the knowledge gained to the nursing care of patients in this 
hospital. 

Six of the staff nurses have taken courses in the Department of Nursing Education 
of Boston University. One has taken the course in public health at Simmons College. 
Recreation and physical therapy: 

Two very creditable entertainments were given this year in which the patients took 
a most active part. There were 255 ward parties held for the entertainment of patients, 
an average of 21 each month. 

Calisthenics classes under the direction of a patient well trained in physical therapy 
have been conducted on the grounds during the summer and in the chapel in the fall 
with both male and female patients. 

A literary club, organized among the patients on the Research Service, publishes a 
monthly newspaper which has proved of great interest to employees and patients. 
The stimulation of news gathering, the responsibility for organization and contact with 
others in selling the finished product has done much to bring the schizophrenic patient 
into a more healthy relationship. 



Analysis 

Nursing Service Payroll Dec, 1938 
R. N. — Registered Nurse. Att. — Attendant. 

Resigned Discharged LWON* 



Nov. 30, 1939. 



R.N. Att. 



January 

February 

March 

April . 

May . 

June 

July . 

August 

September 

October 

November 

December 

Total 



R.N. Att. 

- 1 
1 

- 4 



42 86 



*L.W.O.N. Left without notice. 



Resigned 
Discharged 
L. W. O. N. 
Other . 

Total . 



R.N. Att. 

- 9 

- 1 

- 7 

- 6 

- 4 

- 5 

- 6 

- 4 



Other 

R.N. Att. 

1 

1 

1 

1 3 



Appointed 
R.N. Att. 



Transfer Promoted 
R.N. Att. R.N. Att. 



5 24 



43 



Appointed 



R.N. 
42 

5 



1 
48 

48 



1 8 



Att. 



24 
43 



161 
159 



48 139 



Total 

128 

29 

43 

9 

209 



10 



197 



P.D. 23 15 

Summer Street Division 

The Summer Street Department has cared for about 585 patients with 107 employees, 
including 12 Registered Nurses, during the past year. 

"Continued Treatment" type of patients are cared for with the main objective being 
the best nursing and medical care, occupational and industrial therapy possible to give 
with available personnel. 

About 80 % of our patients have been engaged in industrial and occupational therapy, 
including a small class in the O. T. room for special training, and about 140 in daily ward 
classes. 

A class in "Push Therapy" was started during the early summer, selected from 
patients who, because of apathy, inability, or for other reasons, were unoccupied. 
This group was given marching exercises and calisthenics with gradual induction into 
useful occupation. An employee was chosen as instructor with some assistance from the 
Occupational Therapist and Supervisors. Though he was untrained in occupational 
therapy, he has shown ability in interesting apathetic type of patients in occupation. 

Twenty-nine different patients, some of whom were destructive of clothing and more 
or less untidy, have been in the class. One very destructive patient has been scraping 
furniture and has improved from his destructive tendencies. Another sews buttons on 
clothing, and another has taken up weaving which was his occupation years ago. Some 
have recently shown interest in looking at magazines, etc., all of which indicates that the 
most lethargic may be awakened with the right kind of persistent effort. 

Recreational Activities 

In addition to daily exercise in the yard for those not enjoying parole privileges, and 
exercise provided in "Push Therapy" class, three wards in the male and female depart- 
ments enjoy yard parole from among whom many are given city permits signed 
individually. 

Dances have been held at intervals, six in all, including special features at holiday 
seasons. Nineteen band concerts have been given by the W. P. A. Band; thirteen 
entertainments were held by our Director of Music, and one each by St. Joseph's Choir 
Boys, and a group from the Lancaster Advent School. About 86 patients have been 
taken to moving pictures weekly during the moving picture season. 

Religious Instruction 

Services have been held weekly by our Protestant and Catholic clergy and more 
recently services have been held by the Hebrew Rabbi weekly with much satisfaction 
to our patients and employees. 

Chaplain 

The activities of the Protestant Chaplain may be conveniently classified under the 
following headings: (1) religious services, (2) ward visitation, (3) education, (4) com- 
munity services. 

Religious services are held each Sunday morning at the main hospital and at the 
Summer Street Department. The average attendance at these services is 300. A hymnal 
which has been especially prepared for use in mental hospitals is used in this service. 
The sermon, which is brief, seeks to relate religion to the needs and problems of the 
patients. These services offer a form of normal experience to which many of the patients 
were accustomed before entering the hospital and for which they feel a continued need 
after admission. Such services have a real value for many of the patients. 

The admission wards of the hospital are visited routinely and new patients are seen 
shortly after their admission. The medical and other psychiatric wards are also visited 
routinely and individual patients are seen at any time when a visit is desired or indicated. 
Unhealthy religious attitudes are at times a factor which retards the recovery of a 
patient, and therefore, a process of religious re-education may contribute to the health 
of the patient. 

The educational program of the Chaplain's Department is carried on both inside and 
outside the hospital. During the past year, five series of lectures, each series numbering 
five lectures, were given to various student groups in the hospital, such as the Occupa- 
tional Therapy, Social Service, and nurses. These lectures were on the general subject of 
"Religion and Mental Health." 

Closer working relationships were developed between the hospital and a nearby 
theological seminary and approaches have been made to certain foundations for support 
of a program for training of theological students in the hospital. It is our hope that this 
program may begin during the coming year. 



16 P.D. 23 

The Chaplain has been active throughout the year building up the relationship of the 
hospital with the community groups, particularly with churches. He has acted as 
Secretary of the Department of Religion and Health of the Worcester Council of 
Churches, and is also a member of the Department of Religion and Health of the 
Federal Council of Churches, and of the Committee on Institutional Ministry of the 
Massachusetts Council of Churches. In cooperation with the Worcester Department of 
Religion and Health, the chaplain arranged and conducted two courses for clergymen 
at the hospital. One of these courses covered the general field of mental health; the 
other was in the area of marriage adjustments and mental health. Each course was well 
attended by clergymen from Worcester and vicinity. His community relationships have 
also included the Worcester Y. M. C. A. and Y. W. C. A. and the Worcester County 
Federation of Churches Women's Clubs. This latter organization, through its social 
service committee, has been active in visiting on the wards of the hospital, and a series 
of lectures was arranged for this group by the chaplain. 

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 was much needed 
and was greatly appreciated. 

Social Service Department 

For the first time in several years the Social Service Department has had no changes 
in its staff during the year. The effect of this unusual stability has been felt in an in- 
crease in efficiency, a smoother functioning of all parts of the work. More emphasis has 
been placed on improving techniques and on student training, since less attention had 
to be given to routine functions with which all were familiar. The necessary element of 
change, of new interests, new theories and practice was supplied as usual by the students. 

These have come to us from the following schools: — Boston University, School of 
Religious and Social Work, one student during the winter, and one for two months in the 
summer; Simmons College School of Social Work, two students; Smith College School of 
Social Work, three students. Theses contributed by these students included a study of 
the history of psychiatric social work, and a study of patients placed in Family Care. 

Two innovations have been made in the program of student training in the hospital. 
These include evaluation clinics for the social service students and a social service seminar 
on community resources. The evaluation clinics give the students and staff an oppor- 
tunity to present cases from the point of view of social problems, to discuss them more 
freely and at greater length than can be done in the larger staffs. We also believe that 
the clinics will prove of educational value to members of the staff outside of the social 
service department, by giving them a clearer and more detailed picture of the case from 
the community's viewpoint. 

The seminar on community resources is held in the evening and has been opened to 
medical students and internes, occupational therapists and nurses, on the theory that 
a wider knowledge of the community would be of value to all groups. Social service 
students in other agencies in the city have been invited to these meetings and have 
shown a great interest in them. At each meeting a worker from a local agency discusses 
the work of her particular field stressing particularly the ways in which a mental hospital 
may be of service to her clients, as well as how her agency may aid our patients. 

In addition to these special classes for our own students, the educational work of the 
department has included forty-two lectures to nurses, medical students, occupational 
therapists and other groups. The Massachusetts State Conference of Social Work was 
attended by the entire staff, and the National Conference by one worker. Two workers 
attended the supervisors' conference at Smith College in July. 

Statistics for the department are as follows: 
New cases assigned . . . 1,899 Interviews held .... 4,605 

Histories taken .... 314 Patients placed in family care 152 

Supplementary information secured Patients status changed from family 

on other cases . . . . 1,732 care to visit .... 24 

Investigations made . . . 1,896 Paients discharged from family care 12 
Family Care: 

The work of this division has shown a steady growth : if at times it has seemed slow, 
we believe that such progress was the best course, as homes must be selected with great 
care and placements made after an exhaustive study of all factors in the case. 



P.D. 23 17 

In analyzing the work we find that there are many details which take more time than 
one would suspect. Each patient referred must be interviewed, each case abstracted, 
relatives contacted, dental work arranged for to be completed before patient leaves the 
hospital and clothing ordered through clothing office. The physical and mental condi- 
tion of the patient as well as what symptoms to be aware of are explained to the prospec- 
tive caretaker before the actual placement is made. The best placement for a particular 
patient in light of the facilities and the problems involved is often difficult and sometimes 
seems impossible of solution. 

Five of our 52 homes are located 45 miles from the hospital, the others are within a 
28 mile radius. During the past year 132 homes were investigated, out of which 26 were 
accepted. About 10 more applications were received which were not investigated 
because they located outside of our hospital jurisdiction and would involve the expendi- 
ture of too much time and money. 

The reasons for the rejection of so many homes are varied — such as — not adequate 
quarters, unsatisfactory references, lack of real interest and understanding of applicant, 
other boarders or state wards in the home, and often the demand for more than $4.50 
for patient's board and room. Although the legislature has recently passed a bill to 
increase patient's board from $4.50 to $6 a week, we have been unable to comply with 
this ruling because at present no appropriation has been made to allow for this increase. 

For every home investigated there are at least three personal calls made, interviews 
with other social agencies to whom applicant may be known and numerous letters sent. 
The home is visited several times before it is accepted and after the first placement 
frequent visits are made to the new home. To secure our new homes advertisements 
have been inserted in the daily papers of Worcester and surrounding towns. Several 
lectures have been given by the workers to organizations and clubs stressing the needs 
of family care homes and their value to patients, hospital and community. 

Supervision is carried on regularly at least once a month, when workers make a careful 
study of the patient and his adjustment. In addition there are special visits made at 
the request of either caretaker or patient when some problem has arisen in which advice 
and guidance is needed. Many times it is necessary to return the patient for appoint- 
ments with the dentist, chiropodist, or to different clinics. 

When the status of a patient is to be changed from family care to visit or discharge 
the worker first investigates all possible resources and determines what plans in her 
judgment will be best for the patient. 

Visits made during the year by the social workers are 1,863 to patients, 113 to relatives, 
264 to others in connection with family care homes — total 2,240. 

There were 113 patients under state care and 33 on private care as of November 30, 
1939; and 49 changes of status in patients placed prior to 1939 were made as follows; 
16 were returned for exacerbation of mental symptoms, 21 for physical illness; 3 were 
released on visit; 1 to relatives ; and 2 found work. Seven patients were discharged, — 
1 to old age assistance, 3 to public relief agency supervision, 2 to own families, and one 
into own care. Two patients escaped. 

Of the 152 patients placed in 1939, 49 were returned to the hospital, 33 for mental 
conditions and 16 for physical disease. 21 were released on visit, 8 to relatives, one to 
own care and a job, 12 to public relief agencies. Five patients were discharged, one to 
family, two to relief agencies, one to own care and one to another hospital. There was 
one escape. 

Ages of Family Care Patients 

Number of patients between ages of: 

Years Number Years Number 

20-30 12 50-60 40 



12 


50-60 


13 


60-70 


30 


70-80 



30-40 13 60-70 31 

40-50 30 70-80 20 

Total 146 

Diagnoses of Family Care Patients 

General paresis 4 

Alcoholic psychosis 7 

Psychosis with cerebral arteriosclerosis 7 

Psychoses with epilepsy 1 



18 P.T). 23 

Senile psychosis 4 

Involutional psychosis 4 

Psychoses with organic brain disease 2 

Psychoneuroses 3 

Dementia praecox . . . . . . .76 

Simple, 36 

Catatonic, 4 

Paranoid, 25 

Hebephrenic, 11 
Manic depressive psychoses . . . 19 

Manic, 5 

Depressed, 6 

Circular, 1 

Mixed, 7 

Paranoia and paranoid condition 7 

Psychoses with psychopathic personality 1 

Psychoses with mental deficiency 7 

Mental deficiency without psychosis 3 

Undiagnosed psychosis 1 

146 
Radio Department 
Radio Activities 
Music for Church services; community sings at the main Hospital and Summer Street 
Department; musical assistance at ward parties and entertainments; musical instruction 
to individual patients on the recommendation of the physician; instruction to patients 
on how to operate the control board of our radio station WSH; the preparation and 
presentation special WSH programs including, "Notables in the News," "Airways to 
the Mind," and many other local features in which employees and patients participated, 
as well as Mental Hygiene propaganda; educational work consisting of lectures to 
various hospital groups, and visitations of outside groups to the Radio department; 
The supervision of patients who work there in the capacity of cleaning, typing, etc.; 
special radio features presented by the Radio Director, all these are routine activities 
of the Department which have been carried on this year as in previous years. 

New Projects 
Art Class 

With the aid of Mr. Paul Morgan, Jr., of Worcester and the cooperation of the 
Worcester Art Museum, we have been able to conduct an art class each week for pa- 
tients. Over a hundred patients have had opportunity to express themselves through 
this channel. Because of the space needed for this class, with twenty to thirty patients 
working at easels, it was held in the Chapel. After an eight month experimental period, 
we were able to make some evaluations. Some of the therapeutic benefits derived from 
the Art class seemed to be, 1. the manifestation of an initiative (Shall I, or shall I not 
come to class? What shall I draw? What medium shall I use in drawing?) 2. The 
privilege of choice, (What easel shall I use? Shall I do still life or copy?) 3. The creation 
of a social situation where both the sexes meet, work, enjoy and at times lose themselves 
in their work. Self expression and the joy at creation of a creditable product were 
additional gains. 

An exhibition was held of the more than 100 sketches done in class. It was attended 
by Art Museum heads and Hospital trustees and occasioned much favorable comment. 
Physician Calls 

Prior to this year Physicians and Staff members have been located in our Hospital 
by means of noisy bell signals. This year we have inaugurated the system calling 
doctor via radio. This system has proven very efficient. We estimated that we make 
between 400,000 and 500,000 calls per year. 

The outside activities of the Radio Director have increased this year so that the 
present finds the Director as President of the Worcester Chamber of Music and Con- 
ductor of the Worcester County Light Opera Company. The musical demands from the 
outside toward our musical department is yearly increasing. This is encouraging because 
it proves that we are overcoming gradually that "bug bear" of the past, isolation. Calls 



P.D. 23 19 

for the Director to administer the sea shore test for musical appreciation to outside 
problem children, are increasing. 

Planned Projects 

A standard practice manual for the Department is now in the making. This manual 
will be complete in every respect relative to the Radio and Music Department. It will 
contain detailed instruction for the radio equipment, its use, its maintenance, and for 
future plans. It will contain detailed instruction for other activities of the Department 
as well as a five year plan. Other added features: New radio loud speakers are being 
monthly installed in our wards. At the close of approximately two years time, all old 
loud speakers will be replaced with new magnetic loud speakers. 

Monthly additions to our phonograph record library will eventually give us a good 
standard collection of usable musical records. 

During the coming year, a microphone will be installed with its necessary pre-amplifier 
in the Superintendent's office. This will enable the Superintendent to issue reports and 
special messages to the Hospital in times of need and emergency. 

Plans are in progress to inaugurate rhythm bands on several of our disturbed and 
deteriorated wards. Once these are organized by the Musical Director, they will be 
conducted by ward attendants and nurses and even at times by some musical patients. 

Medical and Surgical Activities 

This hospital is equipped with a separate medical and surgical unit of 287 beds for the 
study and treatment of physical diseases. The service is composed of ten wards; five 
male and five female; each ward reserved for a particular type of disease. For instance, 
one ward is reserved for infections, such as erysipelas, cellulitis carbuncles, furuncles, 
upper respiratory infections, pneumonias, etc.; another ward is reserved for surgical 
cases, for fever therapy, study cases, etc. One ward is reserved for tuberculosis. All 
diabetics and degenerative conditions are grouped on a fourth ward and finally one ward, 
is reserved for the terminal debilities of old age and organic brain disorders. 

Other medical activities under this division of the report are the various diagnostic 
and therapeutic clinics for patients and employees, the X-Ray and physical therapy 
departments, the dental department and the hospital laboratory. 
Movement of Population: 

There were 1,192 cases admitted to the service during the past year. The greatest 
number of cases were admitted during the months of February, March, April and May. 
During the year 477 males and 53 females were discharged from the service. Discharges 
from the service detailed as to physical condition are shown below. 

Table I 

Male Female Total 

Recovered and improved ....... 452 510 962 

Not improved 15 9 24 

Not treated 10 14 24 

Admitted for study 65 64 129 

Deaths: 

There have been 192 deaths during the year; an average of 16 deaths per month. 
The average age of death is 68. Deaths in the younger age group were mostly due to 
tuberculosis and dementia paralytica, the remaining few from various diseases. In spite of 
the fact that the incidence of infections (carbuncle, furuncles, erysipelas, etc.) is high, 
it has not been a major factor in our mortality. This is also true of the older group of 
patients. There have been 47 deaths due to bronchopneumonia, all in elderly patients 
who showed various degrees of arteriosclerosis. In 34, arteriosclerosis was the principal 
cause of death. Other patients listed as dying as the result of coronary sclerosis, coronary 
thrombosis, cerebral hemorrhage, cerebral thrombosis, hypertensive heart disease, 
chronic nephritis (not pyelonephritis) rupture of abdominal aorta, etc., could be in- 
cluded as deaths due to arteriosclerosis. There were 11 deaths, or 5.7% of the total 
group, resulting from lobar pneumonia. This is a very satisfactory figure especially 
since many patients were quite old. One was below 60 years of age (56), few were in 
their 60th years, and the rest, comprising the majority of the group, were in their 70th 
and 80th years. There were 16 deaths from general paresis and their average age was 
55.5 years. Malignant growth, grouped under cancer, was responsible for 10 deaths. 



20 



P.D. 23 



There were 5 deaths due to tuberculosis and these comprise our younger age group. 
There were 6 deaths due to pyelonephritis. Coronary occlusion and coronary thrombosis 
were responsible for 4 and 3 respectively; generalized arteriosclerosis was an important 
factor in these cases. The remaining deaths were due to various causes in many of which 
generalized arteriosclerosis was a contributing factor. There were 101 (52.6%) autopsied 
cases during the year; and 32 medico-legal consultations held during the year. 

From November 1st, 1938 to November 1st, 1939, the following Clinico-Pathological 
Conferences were held: 

Medical Disease 

Benign nephrosclerosis 

Subdural and intra-ileum hemorrhages. 

Diabetes mellitus 

Gamma streptococcic bacteremia. 

Syphilis 

Hydromyelia 

Hemolytic streptococcic bacteremia. 

Pulmonary and renal abscesses 

Staphylococcic bacteremia. 

Generalized arteriosclerosis. 

Bronchopneumonia with empyema. 

Cystadenoma of pituitary with intra-neoplastic 
hemorrhage. 

Hypostatic pneumonia. 

Repeated cerebellar-pontine hemorrhages. 

Bronchopneumonia. 

Fractured skull with subdural hemorrhage and 
operation therefor. 

Bronchopneumonia. 
Consultations: 
The following table lists the number of examinations made by consultant specialists. 



Psychosis 
I. Acute alcoholic 

II. Friedreich's ataxia 

III. Catatonic dementia praecox 



IV. Alzheimer's disease 



V. Huntington's chorea 



VI. Acute encephalitis 



VII. Paranoia 



VIII. Traumatic psychosis 



Eye . . . 
Ear, Nose, Throat 
Gyn and OB 
General surgery . 
Neuro surgical . 



Table II 




86 Medical 


9 


38 Orthopedic ..•.-. 


15 


20 X-Ray 


1,890 


50 To Pondville Cancer Hospital 


14 


19 Others 


11 



Obstetrics: 

During the fiscal year there were 7 deliveries, this includes one set of twins. There 
were 6 female and 2 male infants. In this group there were no premature babies and 
there were no infant or maternal deaths. 
Surgery: 

During the year as tabulated below 87 surgical operations and 1,020 minor surgical 
procedures were carried out. 



Table III 
Major Surgical Operations 



1. Craniotomies 

2. Hernia repairs (uncomplicated and strang- 

ulated) 

3. Saphenous vein ligations .... 

4. Hemorrhoidectomies 

5. Mastoidectomies 

6. Hip nailing 



13 



7. Hysterectomy and other female surgery 5 

8. Cataract surgery 4 

9. Exploratory laparotomy .... 4 

10. Appendectomies 4 

11. Amputations 3 



Other Types: 

Ventriculogram, 1 ; abortion, 1 ; removal cervical stump, 1 ; cystotomy, 1 ; fixation of 
tendon leg, 1 ; removal foreign body in stomach, 1 ; patella suture, 1 ; resection rectum, 
1; removal of recto sigmoid and colostomy, 1; rib resection, 1; perineal repairs, 2; 
nasal sinus surgery, 2. Total, 87. 



P.D. 23 21 

Table IV 
Minor Surgery 

1. Lumbar punctures with readings 189 

2. Injection of varicose veins 277 

3. Incision and drainage . 186 

4. Suture of lacerations 171 

5. Removal of foreign bodies 9 

6. Encephalograms 21 

7. Excision of tissue 20 

8. Examinations (sigmoidscopic, bronchoscopic, etc.) ....... 17 

9. Immobilization of limbs 36 

10. Biopsies 5 

11. Dental extraction under anesthesia 5 

12. Reduction of fractures and dislocations 7 

13. Tonsillectomies 4 

14. Aspirations (joints, hydrocele and abdomen) ....... 15 

15. Artificial pneumothorax 50 

Olher Types: 

Dilatation and curettage, 1 ; phlebotomy, 1; removal hip nail, 2; reopening wounds, 
1; transfusion, 1; repair of tendon sheath, 1; cystoscopic and pyelogram, 1. Total, 
1,020. 

Table V 
Surgery on Employees 

During the past year, 40 surgical procedures were carried out on employees as follows : 
Incision and drainage . . . . 7 Suture of lacerations .... 3 
Reduction and immobilization of Lumbar punctures . . . . 6 

fractures 6 

Aspiration of body cavities . 4 

Others: 

Appendectomy, 1; avulsion of nail, 1; circumcision, 1; dilatation and curettage, 2; 
sinus, 1; hemorrhoidectomy, 1; myringotomy, 1; mastoidectomy, 2; removal of 
foreign bodies, 2; tonsillectomies, 2. 
Employees: 

Tabulation of the medical and surgical attention given to employees is listed below. 

Table VI 

Examined and treated at clinic 1,437 

Required hospitalization 109 

Required operation 40 

Total number of days on sick wards . 702 

Farmers and food handlers examinations 125 

Out Patient and Ward Dressings: 

12,937 dressings and treatments were handled by the nurse in charge of the outpatient 
clinic under the supervision of medical service physicians. All ambulatory patients 
receive this care in a central room that is a part of the operating room suite. Table VII 
details the procedures carried out during the year. 

Table VII 

Abrasions and lacerations . . 2,558 Unna's Boots 155 

Furuncles and carbuncles . . 1,237 Burns 1,163 

Infections 3,161 Miscellaneous .... 2,710 

Ulcerations 1,953 

12,937 

29,705 dressings were done on the medical and surgical service to patients in residence 
there in addition to the above number. 
Special Clinics: 

To facilitate diagnoses, special clinics are held by physicians of the Medical Depart- 
ment to examine the eye, ear, nose and throat and also pelvic examinations are made on 
female patients. To effect economy of time and effort certain diagnostic procedures, 
namely, Wassermann and spinal tests are also handled in clinic style. In all 17,824 
examinations and treatments were given in special clinics listed below : 



22 P.D. 23 

Table VIII 

Eye examinations 899 

Ear, nose, and throat examinations . 933 

Gynecological examinations . . 1,102 

Luetic treatments 8,829 

Spinal punctures 585 

Wassermann tests 1,393 

Hemorrhoid, Hernia, and Varicose Vein examinations and treatments . . 1,176 

Smallpox vaccines . . . . 379 

Typhoid vaccines 2,467 

Others . 61 

17,824 
Physical Therapy Department: 

Mr. Charles Keslake physical therapist left the hospital at the end of September and 
was not replaced by a Civil Service appointee during the remainder of the year. This 
curtailed greatly the work of the department. In November the very latest model fever 
cabinet and a diathermy machine was purchased to replace an antiquated apparatus 
that had been in constant use for 10 years in the fever treatment of mental disorders. 
During the year, a new sinusoidal and faradic generator was also secured to replace 
an obsolete model. 

Treatments carried out in the department are given below: 

Baking 

Diathermy (medical) 

Diathermy (surgical) 

Massage 

Muscle Reeducation 

Ultra Violet (air cooled) 

X-Ray Department: 

An entirely new and modern X-Ray installation was made during the year. This 
necessitated closing the department for seven weeks beginning June 10th. 

A rearrangement of the suite with attractive decoration now provides a waiting room, 
office and plate reading room, dressing room, and lavatory, operating room and a dark 
room. The very latest model X-Ray machine and dark room equipment as well as other 
accessories now make this department one of the finest in the State. The photographic 
section of this department has been moved to new quarters in the Howe building. 

Mr. Edward Day left the department on August 3rd and on September 11th was 
replaced provisionally by Mrs. Sarah Simon former technician at the Massachusetts 
Memorial Hospital. To insure uninterrupted service and quality of help it is regarded 
as essential that the salary level of X-Ray technician be raised to the equal of that of 
laboratory or physical therapy technician in the hospital. 

One student received training in X-Ray during the year. The report of the depart- 
ment's activities during the year, curtailed by the changes made appears below : 

Table X 
Patients examined .... 1,890 Photographs patients ... 60 

X-Ray films used . . . . 2,575 Films 116 

Finger prints . . ... 49 Lantern Slides 15 

Foot prints . . . . . 7 

Dental Department: 

Simon D. Hairootian, D.M.D., assisted by a full time dental hygienist and three 
months during the summer by two dental internes, has administered efficiently to the 
dental needs of all patients. Examinations are made on all new patients and yearly 
check of all old patients. The department also controls dental supplies and insures 
dental hygiene through supervision on the wards of the hospital. This department has 
excellent equipment. 



Table IX 




2,551 


Ultra Violet (water cooled) 


169 


500 


Others 


38 


20 


Total treatments and tests 


5,878 


724 


New patients during year 


396 


438 


Total number of patients treated 


919 


1,438 







P.D. 23 23 

Table XI 

Total examinations and treatments 19,306 

Total patients examined and treated 5,810 



Cleanings . 

Examinations 

Extractions 

Fillings 

Plates 



2,114 X-Rays 631 

5,810 Dentures numbered . . . 321 

1,805 Sutures 28 

1,512 Fracture immobilized ... 1 

47 



The Podiatrist saw an average of 73 men and 51 women each month. Corns, cal- 
louses, ingrown and thick nails and bunions were the chief ailments he treated. 

Laboratory Report 

The work of the laboratory has been maintained at approximately the same level as 
for last year with nearly 5,000 examinations per month being carried out. The exact 
figure is 59,409 and some of the more interesting tests are given in the table below. 
During the year there were 192 deaths and 101 autopsies giving a percentage of 52.6. 
This percentage is somewhat lower than in some of our previous reports but is still 
a creditable showing. The monthly clinic-pathological conferences have been continued 
as in the past and have been well attended and have led to changes in procedures as 
a result of the information gained. 

The work of training suitable students in clinical laboratory techniques has been 
continued and the graduates of the course have all been able to obtain positions. The 
school has received widespread acknowledgment and applications are received from all 
parts of the country. . 

The laboratory has been accredited by the American Medical Association for the 
training of pathological residents, and physicians who take their training in pathology 
here will now be able to receive credit by the various specialists' boards who require 
training in pathology as one of the essentials for admission to examinations. 

Emphasis has been placed upon the question of disturbances in the metabolism of the 
sex hormones, and preliminary investigations appear to show that the patients are 
significantly different from normals, in that they do not excrete greater amounts of 
androgens after testosterone administration. A number of studies on the physiological 
changes produced by insulin and metrazol therapy in schizophrenic patients have been 
carried out, and also an investigation on the effects of diathermy on brain metabolism. 
This material is now being prepared for publication. 
Work completed during the year: 

1. A description of a new and improved method for determining spinal fluid protein. 
The method is simpler and more accurate than previous methods. 

2. A paper obtained incidental to the introduction of phosphatose determinations, 
gives in condensed form the variations usually found in serum phosphatose. 

3. A summary of the forty biochemical variables obtained on normal subjects during 
our investigations. It is the only compilation of its kind, giving values and variability, 
and should be helpful to investigators in general who use normal values. 

4. This investigation was concerned with the lactic acid metabolism of 35 schizo- 
phrenic patients and 35 normal subjects. It shows that the patient is not as efficient 
as the normal subject since he produces a significantly greater amount of lactic acid 
per unit of work than the normal man. It also shows that the acid base equilibrium 
of the patient is not different from the normal, and that this line of investigation is not 
a profitable one to pursue. It also appears that the patients approach the normal in 
their carbon dioxide mechanisms as the result of exercise. 

5. The changes in phosphorus mentioned earlier in this report. 

6. A new method for making Globulin and Albumin determinations in blood serum 
with a comparison of the older method. The determinations are more reliable, can be 
run on as little as 0.2 ml of serum and take much less time than previous methods. 

7. A critical evaluation of the Phytotoxic Index with reference to depressed patients 
and pointing out its limitations and defects. It was carried out in order to evaluate the 
test previously performed with schizophrenic patients. 

8. The serum liped levels of "calm" schizophrenic patients are lower than those of 
"excited patients" or normal subjects. 



24 



P.D. 23 



9. The results of the increase in serum liped values as the result on insulin therapy. 
The "recovered" patients maintain their gains but the "non-recovered" patients tend to 
fall back to the initial level which was significantly lower than the control subjects. 

10. A significant rise in Choline esterase occurs after insulin. The function becomes 
much more stable in the "recovered" patients but more unstable in the "non-recovered" 
group. 
Papers Accepted for Publication: 

1. Sex Factors of the Adrenal Gland — J. M. Looney, Endocrinology. A review 
paper pointing out the close relationship between sexual functions and the Adrenal 
Gland. 

2. The Treatment of Pituitary Dwarfism with Growth Hormone. J. M. Looney, 
Endocrinology. This paper shows the effect of medication on growth and illustrates 
how personality traits may be altered by remedying the factors that single out a child 
as different from other children. 

3. The Effect of Insulin on Serum Lipeds and Choline Esterase Activity in Schi- 
zophrenia. J. Lab. and Clin. Med. L. O. Randall. 

Essentially the same as above. 

4. The Liped Composition of Intracranial Tumors — L. O. Randall. 

5. The Chemical Pathology of the Brain — ■ L. O. Randall. 

6. The Effect of Testosterone on Serum Lipeds in Schizophrenia — L. O. Randall, 
J. Biol. Chem. This has been described above. 

7. The Effect of Repeated Insulin Type Glycemia on Liped Composition of Rabbit 
Tissues. Insulin treatments produced a small but statistically significant decrease in the 
phospho liped and neutral fat content of the nervous tissues but no change in cholesterol. 
The adrenal glands were hypertrophied and showed a percentage decrease in ester- 
cholesterol and increase in neutral fats. The other components remained constant. 

8. Influence of Insulin on Experimental Neoplasms. M. O. Lee, R. G. Hoskins, 
W. Freeman. Given at the Annual Meeting Asso. Study Int. Secretions, May 1939. 

Extensive alterations of the ground floor rooms of the laboratory have begun in order 
to give more working space and relieve the over crowding. This was accomplished by 
taking one room in Washburn Ward and one Lincoln Ward room for Basal Metabolism 
rooms and by converting the old basal rooms into two large laboratories. 

During the year a new research chemist was added to the staff, Dr. Alan Mather from 
Dr. Doisy's laboratory in St. Louis. He received his doctor's degree for work in the 
biochemistry of the sex hormones and will continue investigations in this field. Dr. 
Randall has resigned to take effect December 1, 1939, to accept a research appointment 
with Burroughs and Welcome Co., N. Y. 



Laboratory Tests for 

Abstract of some tests from the 

Pathology: 

Autopsies 

Rat autopsies .... 
Tissue sections, post mortem . 
Tissue sections, research . 
Tissue sections, frozen 
Tissue sections, surgical . 

Feces, blood .... 
Feces, ova and parasites . 
Feces, typhoid and paratyphoid 
Feces, dysentery 
Feces, mucous and starch 

Blood, differential counts 
erythrocyte counts 
leucocyte counts . 
platelet counts 
reticulocyte counts 
hemoglobin . 



Year Oct. 1, 1938 to Sept. 30, 1939. 
grand total of 59,409 tests made. 





fragility 






6 


101 


Typings 


135 


288 


bleeding and clotting times 


83 


. 1,501 
. 1,023 


Endocrine Hitio, Bioassy Rats 


636 


. 753 


Bacteriology: 




. 228 


Smears for bacteria . 


1,063 




Bacterial cultures 






655 


. 175 


Blood cultures . 






70 


48 


Sputa for T.B. . 






285 


37 


Neufeld typings 






1,693 


9 


Vaccines 






30 


6 


Plasmodia malaria 






32 




Agglutination undulant fever 


7 


. 3,416 


Animal inoculations Guinea pig 


15 


. 3,297 


Rabbit 


41 


. 3,445 


Rat . 


2,292 


24 


Bacterial milk count 


360 


19 


Occult blood .... 


690 


. 332 


Special bacteria 






77 



P.D. 23 



25 



Chemistry: 










Uric acid .... 


211 


Urine : 


Vitamin C . . . . 


385 


Urinalyses 8,828 


Phosphatose .... 


518 


Nitrogen partitions 






1,328 


Spinal Fluid: 




Quantitative sugar 






89 


Cell count .... 


637 


Blood: 








Gold curve .... 


642 


Albumin 






145 


Protein 


644 


Bromides 








217 


Sugar 


436 


Calcium . 








330 


Bromide . . ■ . 


10 


Chloride 








81 


Gastric Analyses 


107 


Cholesterol 








1,613 


Blood . . 


110 


Cholesterol free 








1,592 


Bile 


109 


Choline-esterase 








694 


Bromide .... 


7 


Color index . 








1,392 


Special Tests: 




Creatinine 








179 


Glucose tolerance 


94 


Gases 








344 


Ascetic fluid cell count . 


26 


Globulin 








145 


Icteric indices .... 


102 


Glutathione . 








264 


Vandenbergh .... 


99 


Lactic acid 








312 


Basal metabolism 


205 


Lipoids . 








1,592 


Tissue respiration studies 


325 


Magnesium . 








456 


Hormone extractions 


147 


N.P.N. . 








2,248 


Androgenic BioAssay 


17 


Phospho-lipoids 








1,592 


Haldane gas determinations . 


29 


Phosphorus . 








602 


Adrenalin determinations 


34 


P.H. 








87 


Kidney stone analyses 


15 


Total protein 








240 


Schneider index 


13 


Specific gravity 








78 






Sugar 








3,225 


Takata-Ara-Test 


4 


Thiocyonate . 








3 


and many others. 




Urea 








159 







Research 
Psychiatry, as medicine in general, is still and perhaps always will be in the process 
of development toward a better understanding of the causes and treatment of disease. 
From this point of view research activities form an important and integral part of the 
work in clinical psychiatry. Systematic attempts are being carried out in the study of 
various aspects of this branch of medicine. Members of the staff are encouraged to 
proceed along some line of investigation at the same time as they are carrying on their 
daily routine duties. A number of such studies have been published and will appear 
in the bibliography attached to this report. At present a series of problems are being 
investigated. Some of the members of the clinical staff are working in close cooperation 
with those of the research division. Others are carrying on independent projects in the 
various phases of psychiatric medicine. Among these we mention a few of the more 
important ones : (1 ) the causative factors of involutional mental diseases ; (2) the psycho- 
pathological and neuro-physiological effects of drugs; (3) therapeutic and physiological 
studies in patients treated with insulin and metrazol; (4) the blood-cerebrospinal fluid 
barrier; (5) the effects of small doses of thyroid in treatment of chronic patients; 
(6) sodium chloride in the treatment of acute excitements; (7) the nature and etiologic 
factors in the psychoses of the aged; (8) language and thought disturbances in schizo- 
phrenia. The importance of such investigations as factors enhancing the progress of 
psychiatry cannot be emphasized too strongly, but they can only be satisfactorily fol- 
lowed under suitable conditions. There must be the necessary funds to obtain the 
apparatus and personnel, and there must be sufficient time for the members of the staff 
to apply themselves adequately to such work. In the latter case the increasing number 
of residents has been of great help in that it has released some of the more experienced 
clinical workers from some of their routine duties. 

Research Department 
A considerable part of the activity of the Research Service during the last year was 
devoted to the study of the effects of sex hormones in schizophrenia. This work is 
being carried out under the direct supervision of Dr. R. G. Hoskins, and all depart- 



26 P.D. 23 

ments are contributing their share to this study. The endocrine preparation on which 
most work has been done during this year is Testosterone Propionate. The schedule 
consists of three six-week periods, one before, one during, and one following medication. 
The program includes the study of the following biochemical and physiological items: 
sex hormone assays on 24-hour-amount urine samples; basal oxygen consumption rate; 
glucose tolerance; uric acid and adrenalin determination in the blood; blood lipids; 
hematocrit determination; blood morphology; basal blood pressure and pulse; and tests 
for autonomic reactivity with nicotine, adrenalin, and cyanide. Continued observations 
on the behavior and mental status of the patients are recorded by the psychiatrists, and 
also a standardized rating is filed weekly by the psychiatrists. The battery of psycho- 
logical tests used with the patients on the Testosterone study includes the Army Alpha, 
Thematic Apperception, Attitude-Interest, Play Procedure, Drawing, Aspiration, Social 
Situation, and a special association test containing sex-loaded words. The effect of the 
latter is studied by means of the galvanic skin response as well as the actual associations. 
In suitably cooperative patients electroencephalograms are obtained by Dr. Rubin. 
The biochemical studies, which form the greater part of this program, are reported in 
connection with the work of the biochemical laboratory. 

Hormonal preparations other than Testosterone Propionate, the effects of which on 
schizophrenic patients are being studied, include various pituitary preparations, pregnant 
mare serum extract, and Stilboestrol. 

Another group study which has been carried out is that in connection with the insulin 
and metrazol treatments. The purpose of the study is to discover prognostic and differ- 
ential therapeutic indicators which would allow the prediction of the type of patient 
most likely to respond favorably to insulin or metrazol treatment respectively. A further 
aim of this study is to utilize the therapeutic responsiveness as one of the means of 
dividing the schizophrenic group into more meaningful sub-groups than the conven- 
tional sub-type classification. Each patient is subjected to two weeks' intensive study 
before and after medication. The clinical observations on the insulin cases are made by 
Dr. C. Wall and on the metrazol cases by Dr. B. Simon. The program includes studies 
of the following biochemical and physiological variables: blood minerals and choline 
esterase, hematocrit and blood lipids, blood morphology, blood circulation time, daily 
basal pulse rate, and tests with intravenous adrenalin. The main items of the psychologi- 
cal test battery in this study are the Stanford-Binet, K-R Association Test, Aspiration 
and Play Procedure. 

Another cooperative study under the direct supervision of Dr. Hoskins was under- 
taken in order to determine how far an ameliorative therapeutic program may be worked 
out for old schizophrenic patients. Twelve patients around sixty years of age are the 
subjects of this study. The schedule includes a metabolic check-up of two weeks' dura- 
tion, followed by a six-week period of treatment with such therapeutic agents as are 
indicated in the results of the tests. After the six-week medication period another 
metabolic recheck is done, after which the therapeutic plans are reconsidered. It is 
planned that the duration of study in each case should be about a year, consisting of 
alternate six-week treatment and two-week test periods. Psychiatric observations and 
weekly behavior ratings are made by members of the psychiatric department. The 
psychological examinations consist mainly of tests on memory and deterioration. 

Besides the aforementioned collective studies, a number of individual investigations 
have also been carried out by the various members of the Research staff. Dr. Andras 
Angyal, in collaboration with Dr. Blackman, has studied the nystagmic response to 
rotatory and caloric stimulation of the vestibular organ in 58 schizophrenic and 20 
normal persons. The variables studied were absolute number and average frequency 
of nystagmic beats 

(Number of nystagmic beats). 

(Total duration of reaction) 
In response to rotatory stimulation they found a 21 per cent reduction of the absolute 
number and a 26.2 per cent reduction of the nystagmis frequency in the patients as com- 
pared with normal controls. In response to caloric stimulation the schizophrenics showed 
a 38.8 per cent reduction of nystagmic frequency and a 48.3 per cent reduction of abso- 
lute number of nystagmic beats. Besides the general reduction of vestibular reactivity 
a small group with particularly low responsiveness has been detected. It is noteworthy 
that all the patients who have the clinical syndrome previously described by Angyal 
belong to this very low group. 



P.D. 23 27 

In previous years in a number of studies from our Research Service a distinct reduc- 
tion of responsiveness to various physiological stimuli has been observed. Dr. Angyal, 
in collaboration with Dr. Freeman and Dr. Hoskins, made a theoretical evaluation of 
this fact, connecting these physiological features with the clinical symptoms of with- 
drawal. 

Dr. Conrad Wall continued his follow-up studies on the adjustment of patients who 
recovered following insulin treatment and who were discharged from the hospital. 
Preliminary evaluation of the data gives promise that this work will be particularly 
informative as to the permanency of insulin recovery. Dr. Wall, in collaboration with 
Dr. Hoskins, studied the effects of Testosterone in a homosexual individual with acute 
psychotic episodes. The effects of the Testosterone were best revealed in the patient's 
phantasies which, concomitantly with the medication periods, turned in a more or less 
obviously heterosexual direction. Dr. Wall also studied the therapeutic effects of 
Diethyl-stilboestrol in 8 female patients suffering from involutional melancholia. In the 
majority of cases a more or less marked improvement in mental and physical condition 
was noted, and the results seem encouraging for the continuance of this experiment. 

Dr. Otto Kant carried out an intensive catamnestic study on a large group of schizo- 
phrenic patients who have recovered and who have been living outside of the hospital 
for at least the last five years. Two hundred fifty such cases were contacted by letter 
and Dr. Kant succeeded in examining personally about 100 of these patients, in addition 
to collecting the information which could be obtained from the patients' relatives, 
friends and from various social agencies. The material has not been finally evaluated 
as yet, but various significant conclusions can already be made. It appears that a 
schizophrenic heredity definitely decreases the chance for recovery, while a manic- 
depressive heredity increases it. Extroverted pre-psychotic personality and psychogenic 
precipitating factors are favorable for the prognosis. Simple, hebephrenic, and paranoid 
types of schizophrenia are associated with an extremely poor prognosis. Dr. Kant also 
completed a study on the problem of differential diagnosis in schizophrenia. The signifi- 
cance of the various schizophrenic symptoms is discussed in the light of Dr. Kant's theory 
of stratafication of personality structure. 

Dr. Nathan Blackman made an interesting experiment in group therapy with schizo- 
phrenic patients. As a result of this a literary club has been organized by the patients 
themselves, partially through their own initiative and partially through Dr. Blackman's 
encouragement. The group edits a monthly publication, "The Current," of which, 
to date, four issues have appeared, and several hundred copies of each issue have been 
sold by the patients. This method of occupational therapy, which lays particular 
emphasis on fostering the patient's initiative, is definitely useful in the process of 
socialization. 

Dr. Blackman is also studying the capillaries of the nail-bed in schizophrenic patients 
and normal controls. The morphology of the capillaries as well as the rate of flow of 
blood are being observed. The results are not conclusive as yet but in some cases in the 
patients quite marked abnormalities have been observed. 

Dr. Harry Freeman has been studying the respiratory sensitivity to varying per- 
centages of C0 2 (2% to 6%) to determine whether this function is altered in schizo- 
phrenia. Ten normal and ten schizophrenic subjects were tested. The factors investi- 
gated were respiratory rate, respiratory volume, heart rate, and skin temperature. 
Contrary to the findings of Golla, Dr. Freeman's data on preliminary analysis seem to 
indicate no difference between patients and normals. 

Dr. Freeman, in another study in collaboration with Dr. Neustatter, aimed to remove 
the metrazol-produced fear reactions by preliminary induction of anesthesia with 
cyclopropane and nitrous oxide. The anesthetic agent completely removed fear of the 
treatment in the five patients so treated and did not seem to affect adversely the con- 
vulsive threshold. 

Dr. Morton A. Rubin has been working on an encephalographic method of detection 
of cortical atrophy. The results obtained with this method are in fair agreement with 
the findings obtained by pneumoencephalography and thus this method, if perfected, 
may prove to be of considerable practical value. Dr. Rubin, in collaboration with 
Dr. Freeman, studied the effects of intravenously administered sodium cyanide on the 
brain wave pattern in a case of catatonic stupor and in a patient with narcolepsy. 
In these cases slow rhythms were found. This was attributed to depressed cortical 
activity, presumably present in this type of patient. Consequently an attempt was 



28 P.D. 23 

made to produce such a cortical state experimentally. Anesthesia is known to depress 
cortical function and to produce slow-wave activity. Cyclopropane was chosen for the 
anesthetic, since it has a rapid [induction period and recovery from its effects is also 
rapid. Sodium cyanide was given to 7 schizophrenic patients during light cyclopropane 
anesthesia, expecting to obtain the same regular, slow rhythms as in the stuporous 
catatonic and the narcoleptic under the influence of cyanide alone. In most experiments 
the cyanide was without effect. In those cases, however, in which it was possible to 
evoke a cortical response to sodium cyanide during anesthesia there was, contrary to 
expectations, an increase in the number of fast waves. These findings would indicate 
that slow rhythms do not necessarily imply depressed cerebral activity, but that the 
slow rhythm is a product of various factors at present not understood. 

Working with the hypothesis that certain disturbances of affectivity in schizophrenia 
might be related to dysfunction of the hypothalamus, Dr. Rubin, following the sugges- 
tion of Dr. Hoskins and in collaboration with Professor John Fulton of Yale, has under- 
taken a study of the effects of surgically produced lesions of the hypothalamus in mon- 
keys. These animals with bilaterally placed lesions of the anterior hypothalamus 
exhibited marked behavioral changes. They became "shy" and much easier to handle 
after operation, and once caught they made no attempt to escape. In one of three 
monkeys a clear-cut adiposito-genital syndrome developed. In another animal marked 
atrophy of the ovaries and adrenals was found on autopsy. The third animal had 
lesions in the posterior hypothalamus, and, in contrast with the other two monkeys, 
showed no atrophy of the gonads. Electroencephalographic tracings obtained from 
these monkeys before and after operation are still in the process of analysis. 

On the basis of reports from the Armour Company of a hypothalamic extract which 
produced a state similar to catatonia in rats, at Dr. Hoskins' suggestions Dr. Rubin 
undertook to investigate the experimental potentialities of such an extract. So far, 
however, the tests have been confused by the action of the preservative that was used 
in the extract, hence no evaluation is possible. 

During the year the biochemical laboratory, under the direction of Dr. Joseph M. 
Looney, has collaborated on the sex hormone study, the insulin-metrazol study, and in 
the study on old schizophrenic patients. Various chemical methods were tried for the 
estimation of estrogens but none of these were found to be sensitive enough to be used 
on the small amounts occurring in male urine. The method of chemical estimation has 
therefore been held in abeyance and the method of assay using spayed mice is being 
utilized. The use of the photoelectric colorimeter has been compared with the Oesting 
technique and this method has been adapted for use. For large concentrations it is 
more accurate than the Oesting method but it will not serve for very small amounts. 
Dr. Looney has also modified slightly the Oesting procedure so that it gives somewhat 
better results. 

Miss Howe has been determining the androgen output of schizophrenic patients and 
normal control subjects before and after giving Testosterone. The results so far indicate 
a marked difference between patients and controls, the former not increasing their 
androgen output after medication while the latter do. 

Dr. Mather has taken up the work of utilizing the photoelectric colorimeter for 
andorgen assays and also is continuing the study of better methods of extraction. 
This investigation promises to be a valuable contribution to the sex-hormone field and 
to offer a basis of more certain methods for separating the various hormones. He is 
also making estimations of the estrogen output in the two groups, using the spayed mouse 
as the test object. 

Dr. Randall has carried on a number of investigations of changes in body lipids under 
various experimental conditions. The results of these studies indicate that the lipid 
metabolism may be significantly related to the schizophrenic process. There is an in- 
crease in all lipid fractions except free cholesterol in patients when they are treated with 
insulin or metrazol. Further, these levels are maintained in the recovered patients but 
not in the non-recovered group. In the Testosterone-treated patients there is also 
an increase in the lipid fractions. Dr. Randall has also studied the changes in fat 
distribution on prolonged treatment with insulin, using rabbits for this experiment. 
A similar study of the organs of pituitary-treated and pregnant rabbits has been com- 
pleted in collaboration with Dr. Graubard of Clark University. 

Miss Small has carried on investigations on the effect of Testosterone on the organ 
weights of immature male and female rats. The uterine weight changes give a good 



P.D. 23 29 

means of assay. A comparison with Oesting color units was not successful. Apparently 
the action of the color component is not the same as that of Testosterone. A further 
study is contemplated, therefore, of the effect of Androsterone rather than Testosterone. 
In connection with the general problem of vigor, she has also carried out an investigation 
of the effects of Stilboestrol on the activity of rats. A significant increase in activity was 
found during the period of injection. 

Dr. Looney has devised a new method for the determination of serum albumin and 
serum globulin which has greatly simplified the methods of analyses now used, increase 
their accuracy, and cut the time required for an analysis from four to five hours to about 
ten minutes. The method makes use of the photoelectric colorimeter to measure the 
turbidity produced when a protein precipitant is added to serum. A protective colloid 
is added which holds the precipitate in colloidal suspension and gives a stable opalescent 
solution well adapated to measurement by the photoelectric cell. The total protein is 
measured by precipitating all the proteins with sulfosalycylic acid and the globulin 
estimated separately by precipitation with one-half saturation with ammonium sulfate. 

Miss Walsh studied the comparative efficiency of the old and new methods for the 
determination of albumin and globulin. She has also made all analyses dealing with 
lactic acid, blood sugar, uric acid, and glucose tolerance tests in connection with the 
therapeutic studies. 

Miss Dyer has been carrying out the determination on blood gases, and the determin- 
ations of total nitrogen, creatine and creatinine on the patients on Testosterone medica- 
tion. She has also modified the method for the determination of magnesium so that it 
can be carried out using the photoelectric colorimeter. Using this method, she is 
investigating the magnesium metabolism of normal and schizophrenic subjects. 

Mr. Romanoff has been carrying out estimations of choline esterase, which doubtfully 
suggest that Testosterone causes some increase in the choline-esterase content of the 
blood of patients under treatment but not in the normal subjects. He has also been 
studying the effect of Testosterone on the tissue respiration of rat organs. 

All the analyses for such studies as required statistical treatment have been carried 
out in the Statistical Department which is at present under the direction of Mrs. 
Hazel Stone. 

The activity of the Psychology Department which is under the direction of Mr. 
David Shakow is reported separately. 

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

Psychology Department 
During the current year the number of subjects studied and procedures pursued with 
them is given in the following table : 

Psychometric and Experimental Studies 

Number of Number of 

Hospital Subjects Procedures 

House Patients 327 1,030 

Schizophrenic Research Patients 200 682 

Out-Patient 

School Clinic 268 279 

Adult Delinquents 21 66 

Non-Patients (including Employees) 191 316 



1,007 2,373 

In the above figures is concealed work done with a variety of subjects and procedures. 
Besides the routine school clinic examinations and the psychometric investigations of 
new patients, there are included studies of nursing, attendant and occupational therapy 
personnel, and various out-patient groups such as prisoners coming under the Briggs law. 
Rotary scholarship applicants, under-age applicants for first grade. Experimental and 
therapeutic studies using many different techniques with special groups of patients 
selected by diagnosis, age or special conditions make up the balance. The latter studies 
will be discussed in more detail in the body of the report. 



30 P.D. 23 

Researches completed during year 

A. Thematic Apperception — Three researches on "Studies in the Use and Validity 
of the Thematic Apperception Test with Psychotic Subjects" were completed — two by 
Dr. Harrison and one by Mr. Rotter. The first — "Method of analysis and clinical 
problems" investigated the general clinical usefulness and validity of the test and 
reports the use of a semi-objective method of analysis which determined attitudes and 
conflicts as well as prevailing characteristics with' a fairly high degree of validity. The 
second and third studies— attempts at quantitative validations against case history 
material and by the method of 'blind analysis' — corroborated the findings of the first 
study in a more quantitative way. 

B. Validity of Imagery Testing — A study by Mr. Snyder who reorganized the items 
in the imagery test used by Dr. Cohen and examined 30 additional schizophrenics and 
15 normals. The results of the previous study art. not corroborated and it was felt that 
this device was not a valid diagnostic measure. It appeared rather to measure the degree 
of confusion of the associative processes and the patients' ability to concentrate. 

C. Aspiration — A study of a group of normal subjects as control data for the deter- 
mination of the relationship between responses in a new aspiration situation and 
personality characteristics. Relationships were found with position in family and 
various personality traits. 

D. Tautophone — A study by Dr. Wood of a group of Schizophrenic patients and 
normal subjects with another set of stimuli for the tautophone. Some of the patients 
were from the original study. The effects of repetition after a short interval and the 
difference in pattern of response between the groups are in process of analysis. 

E. Special case studies — Several cases were given intensive study during the year: 
among these was a 12-year old encephalitic boy with marked obsessive characteristics 
and a young men with mixed obsessive and schizophrenic characteristics. 

Researches in Progress: 

A . Insulin-Metrazol — There are two groups of studies in progress connected with the 
effect of these drugs. 

1. Test battery — Continuation with the new insulin-metrazol group of the major 
items of the battery used for the last two years in the investigation of the effects of the 
drug: Stanford-Binet, K-R Association, Aspiration, Play Procedure. These items were 
found the most valuable in an analysis of the previous results for the prognostication 
before treatment of improvement. In separate analyses of two previous groups it was 
found that scores on these procedures above and below certain critical points prognosti- 
cated fairly accurately those who did and those who did not improve. The present study 
was intended as a further check on the results of the previous ones and should determine 
finally the validity of the findings which indicated that early deterioration seemed to be 
a factor of primary importance with relation to prognosis. 

2. Metrazol and experimentally induced habit systems — An attempt by Dr. Rodnick 
to determine whether metrazol has a greater disrupting effect upon a more recently 
acquired habit system than on an incompatible older habit system. On the basis of 
14 metrazol and 5 control subjects thus far obtained, the results indicate a greater effect of 
metrazol on the more recently acquired habit system. 

B. Testosterone — In connection with this drug three major studies we?e carried out 
during the year: 

1 . Test battery — A revised battery of the tests used with testosterone patients during 
the last few years was adopted for the present group. This consists of: Army Alpha, 
Thematic Apperception, Attitude-Interest, Play Procedure, Drawing, Aspiration, Social 
Situation, and a special association test containing sex-loaded words. The effect of the 
latter is studied by means of the galvanic skin response as well as the actual associations. 
It is still too early to make any generalization about the findings for this battery. 

2. Special Case Studies — Dr. Rosenzweig has continued work with five patients in 
which he follows personality changes closely during the periods of medication and rest. 

3. Photoscope— Work has been started by Dr. Rosenzweig with a device which exposes 
pictures of varying degrees of sexual content. An experimental program has been 
organized from which it is hoped to be able to evaluate this device for measuring changes 
in sexual interest and the effectiveness of sex hormone medication. 

C. Frustration and Aggression — Dr. Rodnick and Mr. Rotter have completed a 
preliminary study of eight normal subjects on the reactions to an experimentally in- 
duced frustrating situation. The reactions to the situation were studied by means of 



P.D. 23 31 

the responses to the Thematic Apperception Test after success and failure. The results 
thus far indicate an increase in aggression after failure. It is now planned by Dr. Rod- 
nick to continue the study with a group of schizophrenics. 

D. Substitution — A study, in the preliminary stages, by Miss Bennett in which the 
attempt is made to determine whether interrupted ego activities are completed whether 
directly or by substitutes. This is to be compared with the trend found in previous 
studies of schizophrenics that they did not complete peripheral activities or did not 
accept substitutes for uncompleted activities. 

E. Old Schizophrenics — A battery of tests is being given to old schizophrenics to 
determine present status and changes under treatment. In this connection the studies 
on memory and deterioration discussed below are of special significance. 

F. Memory — A special study, part of the larger study of memory in the various 
psychoses, of memory in senile, arteriosclerotic and general paretic patients. Some 
additional cases of the former two are being added by Miss Ballou to the already existing 
material. This will make available data for comparison with the schizophrenics of 
long standing. 

G. Behavior Disorders in Rats — Some preliminary studies of behavior disorders 
which follow on simultaneous rotation and noise. At present there are indications that 
the strain of the rat is important. If a strain where the disorder is more prominent 
becomes available, it may be desirable to pursue the experiment further. 

H. Development of new devices for study of personality functions — Various workers 
of the department continued to interest themselves in the further development of 
objective devices for the study of personality. (This is aside from the work already 
mentioned on the Thematic Apperception Test.) There are: . 

1. Non-verbal Absurdity — Mr. Shakow and Miss Ballou have done some preliminary 
work on a test which seems to have potential value for the study of thinking disturbances. 

2. Maze and Block Tests — Two tests of the performance type which Mr. Leverett 
has been particularly interested in developing. They are concerned primarily with the 
intellectual aspects of personality. 

3. Frustration Test — A revision of De. Rosenzweig's F-Optionary, being an attempt 
to devise an easily available behavioral test of personality. 

4. Test Battery for Brain Injury Cases — Mr. Klebanoff has been assembling the 
literature on the psychological phenomena in relation to brain injury with the purpose 
of organizing a battery of tests for diagnostic purposes. 

5. K-R Association Norms — Mr. Berkeley has been experimenting with a new scoring 
system for the association test. This gives promise of more adequately distinguishing 
between schizophrenic and normal responses. 

Analytic Work in Progress: 

Work has continued on the tabulation and analysis of previous studies. The major 
advances which have been made during the year are : 

A. Memory studies — Data on memonic functioning in schizophrenia and other 
psychoses, and in normal subjects of various age levels, has been tabulated and exten- 
sively analyzed. 

B. Stanford-Binet — (1) The trends in a selected group of patients who had more 
than ten Stanford-Binet examinations over a period of ten years or so have been 
analyzed; (2) Tabulation of the qualitative responses on certain parts of the Stanford- 
Binet for purposes of comparison with normal subjects. 

Research and Analytic Work Planned for 1939-1940: 

For the coming year, besides the continuation of those projects already in progress 
the following program has been projected. The program is obviously too extensive for 
completion within a year but it is hoped to make substantial progress during this period. 
Three major fields of activity are involved: A. Typing of schizophrenia; B. Study of 
the effects of drug treatment; C. Study of individual variability in schizophrenics. 
A. Typing of Schizophrenia (Selection of Syndromes). 

1. Selection by symptoms and characteristics — Two major avenues of attack are 
possible here: By way of a study of (a) Therapeutic efficacy; (b) Functional 
profiles. 

a. Therapeutic efficacy — Here schizophrenics will be separated according to the 
therapeutic efficacy of drugs such as insulin and metrazol in relation to the 
predictive power of the devices mentioned earlier, viz., Stanford, Aspiration, 
K-R, etc. 



32 p.D. 23 

b. Functional — These profiles are profiles of performance determined from a 
variety of psychological and psychophysiological characteristics studied 
during the present and in the past. They include performances on psycho- 
physiological (galvanic skin response, autonomic stress), motor (speed, re- 
action time and reaction time set, learning), intellectual (Stanford-Binet, 
Alpha, Otis), and personality (Rorschach, Thematic, Tautophone, Associa- 
tion) functions. 
2. Development of devices for the objective study of symptomatology — As part 
of the problem of the determination of the fundamental constituents of schizo- 
phrenia we have recognized the need for the development of objective psycho- 
logical devices for determining symptoms and characteristics. The projected 
program in this respect includes two different aspects: (a) the continued study 
and development of devices for personality analysis; (b) the detailed study of the 
deteriorating process by objective means. 

a. Objective devices — Work has been and will continue to be. done on the 
development of the thematic apperception, tautophone, aspiration and 
photoscope because of their promise in this direction. In addition a study of 
brain waves in conflict situations is under consideration. 

b. "Deteriorating" process — A rather comprehensive program of deterioration 
has been started which will consider, besides current material, the material 
collected over a period of ten years or so on the same patients. With respect 
to intellectual functioning the various psychometric data and the various 
studies of the thinking process (Ach-Sacharov, Wegrochi tests, etc.) will 
be used. With respect to emotional and motivational deterioration the 
work on aspiration-frustration and the various Lewin studies will be used. 

B. Study of the Effects of Drug Treatment — It is planned to continue the studies 
already described (under Researches in Progress) which are part of the insulin-metrazol 
and testosterone investigations. In the case of the latter it is planned to carry an addi- 
tional patient in some form of psychoanalysis while he is being treated with testosterone. 

C. Individual Variability — Over the period of years there has accumulated a con- 
siderable body of psychological data about the same patient. Since, in relation to the 
study of deterioration, a good deal of this material will necessarily be gone over it is 
hoped to utilize the material for a detailed investigation into certain aspects of the prob- 
lem of psychological variation in schizophrenia. 

D. Studies of Old Age — In relation to the studies of long-hospitalized schizophrenics 
a number of studies on the aged is in progress. Besides those already mentioned, a study 
of deterioration in non-schizophrenic patients of long standing is being undertaken. 

Library Report 
/. Medical Library 
Brief history of the Medical Library: 

The origin of the Medical Library goes back to 1833, the date of the founding of the 
Hospital. The first superintendent, Samuel B. Woodward, who was also the founder and 
the first president o the American Psychiatric Association, was a lover of books. From 
the foundation year on we find scattered reports of donation of books to the Hospital. 
However, no effort was made to organize a medical library (as we understand the term 
today) until 1896 when Dr. Adolf Meyer, the present incumbent of the Chair of Psychia- 
try at the Johns Hopkins University School of Medicine, was Clinical Director at this 
Hospital. Dr. Meyer gave the medical library considerable attention and it was at that 
time that it began to take shape along organized scientific lines. Through his efforts 
valuable files of German, French and Italian periodicals on psychiatry and neurology 
were acquired. These have formed the nucleus for the present medical library. This 
impetus carried over for some years after Dr. Meyer left and although the growth of 
the library was slow, steady progress was maintained until 1914 when the World War 
interrupted subscriptions to foreign journals and the library as a whole was somewhat 
neglected for quite a few years. 

In the early 1920's, the progressive and efficient policies initiated by Dr. Bryan 
received considerable favorable attention and in 1927 the Hospital was chosen for 
establishment of a research unit by the Memorial Foundation for Neuro-Endocrine 
Research. In 1930 the Commonwealth of Massachusetts appropriated a special sum for 
research in Dementia Praecox to be carried out in conjunction with the Memorial 



P.D. 23 33 

Foundation, and in 1934 the Rockefeller Foundation granted aid to the hospital for the 
continuation of this work. 

Coincident with the growth of the research unit has been the reorganization of the 
medical library under direction of a full-time librarian. Dr. F. H. Sleeper, former 
Director of the Research Service, is primarily responsible for the reorganization. He was 
instrumental in collecting, collating and rebinding many hundred volumes scattered in 
the various departments of the Hospital. After the establishment of the Medical 
Library as a central unit, the monograph collections and periodical files continued to 
grow and many gaps have been filled as the years have gone by. In 1933 the library 
joined the Medical Library Association acquiring thereby a steady source of exchange 
material. The importance of the library as a tool of research is well recognized and it is 
believed that the present support will be continued. 
Activities during the year: 

Periodicals: Fully realizing the value of medical periodicals in connection with prob- 
lems confronting the staff, the current policy is to maintain this division of library 
service at the highest level possible with resources available. We had 131 periodicals in 
1939 as compared with the 126 of the previous year. Of this number the Hospital sub- 
scribed to 109, 2 were paid for by the Memorial Foundation for Neuro-Endocrine 
Research, 2 were donated by Dr. Bryan, 5 by Dr. Hoskins, 1 by Dr. Barton, 2 by 
Dr. Looney, 1 by Dr. William Freeman, and 9 came in free from institutions and scientific 
organizations. 

Of these periodicals, 9 are in German, 6 in French, 5 in Italian and 111 in English. 

Circulation: The Medical Library circulated 817 volumes in 1939. Most of the 
periodicals and the bound volumes are consulted in the library so the circulation figure 
is only a partial indication of the use of the library. 

Interlibrary loans: The librarian used the facilities of other libraries and during the 
year the library borrowed 99 volumes from 5 libraries as listed below : 
Boston Medical Library ... 55 Harvard Business School Library . 4 
N. Y. Academy of Medicine Library 13 Clark University Library ... 3 
Harvard College Library ... 24 

Our library lent 48 volumes to three libraries as follows : 
Worcetser District Medical Society Brown University Library ... 1 

Library 46 Boston State Hospital ... 1 

Medical Library Association: The library maintained the membership in the Medical 
Library Association. The 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. Fifty-six volumes were received from the Exchange of the Association during 
the year. The librarian attended the meeting of the Association held in Newark, N. J., 
June 27-29, 1939, working on various committees and taking part in the discussions. 

New Books: 135 new volumes have been added to the shelves in 1939, not including 
the newly bound volumes of periodicals. 

Binding: 301 volumes were bound during the year, mostly current issues of medical 
periodicals. 

Present state: On November 30, 1939, inventory of the library shelves showed — 

Bound volumes of periodicals 4,579 

Unbound volumes of periodicals 20 

Bound volumes of books 1,939 

Old books (mostly historical in neurology and psychiatry) . 1,376 

Total books ... 7,914 

(This number represents an increase of 678 volumes over the 
previous year.) 

Catalogued reprints 7,047 

Abstracts 5,872 

Bibliographic cards 10,530 

Lantern slides 634 

Services: The librarian continued to circulate to the staff bibliographies and ab- 
stracts, prepared many special bibliographies, and translated foreign medical articles 
for the use of the staff. The bibliographies, abstracts and translations are filed in the 
library. 



34 p.D. 23 

W. P. A. Projects: Two stenographers continued to work on the projects approved 
by the Federal Government, i.e. compilation of a bibliography of schizophrenia and 
completing the collected abstracts on schizophrenia. 

II. General Library 

To patients in this hospital, many of whom are here for extended periods, the General 
Library is a great boon. In a modern hospital, library service is considered one of the 
important functions as it offers an easy and simple way to make available to all patients 
news of outside activities, and the interest aroused by reading is a familiar tool for "chang- 
ing the thoughts." 

Observation of the reading-interest within the institution reveals trends about the 
same as in any urban community. Fiction is the most popular; biography, history and 
travel rank next in order, and even scientific literature is called for in about the ratio of 
its demand from the general public. The selection of books is made with a view to pro- 
viding new literature for the varied demand, introducing new subjects to the readers 
and replacing on the shelves new editions of old and favorite classics. 

Employees as well as patients are at liberty to use the facilities of the library and 
their appreciation of this service is indicated by the circulation figures quoted. 

In the first half of the year one of the W.P.A. workers gave part time assistance in the 
library and the Occupational Therapy students took the book truck to the closed wards. 
On September 1st, a full-time attendant was appointed for the library, with a division 
of her time between the desk and the ward service. 

The book-truck service to the wards has been placed on a regular schedule — twice 
a week to the male wards, twice a week to the female wards, and weekly to the Summer 
Street Department, Hillside Farm and the Farmhouse (in rotation). In this way a good 
selection of books and magazines is available to patients who cannot come to the library. 

We are now experimenting with an "Evening Hour" (6:00-7:00) keeping the library 
open at that time to give patients an opportunity to read the evening papers. This also 
gives working-patients an opportunity to use the library. 

During the current year 246 new books were added to the shelves. 

On November 30, 1939, the General Library had: 
Books (fiction and non-fiction) . 2,528 Bibles and prayer books . . 18 

Serials 325 Reference books .... 94 

Bound magazines . . . . 112 

Total books . . . 2,977 

Stereopticon slides 100 

In addition to our stock, we borrow 150 books every three months from the Worcester 
Public Library. 

Fifty-one popular magazines, 12 technical periodicals and 6 daily newspapers are 
subscribed to by the Hospital. 

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 from our General Library in the Main Hospital and 10 
popular magazines and newspapers are subscribed to for this Department. 

The library is well patronized by patients and employees, the average monthly 
attendance being 1,041 patients and 172 employees. 3,904 patients' and 3,298 em- 
ployees' charge slips are on record for the year. The library circulated 14,049 volumes 
and had 15,147 reading visitors. 

A few of the churches of Worcester and the Free Public Library send us used books 
and magazines regularly. We express our thanks for all such donations. 

Publications from Worcester State Hospital 
December 1, 1938— November 30, 1939. 

1. Histologic changes in senile dementia and related condictions studied by silver 

impregnation and microincineration. Leo Alexander and Joseph M. Looney. 
Arch. Neur. & Psychiat. 40: 1075, December, 1938. 

2. The significance of frustration as a problem of research. Saul Rosenzweig. 

Character and Personality 7: 120, December, 1938. 

3. General outline of frustration. Saul Rosenzweig. Character and Personality 7: 

151, December, 1938. 



P.D. 23 35 

4. Cost in relation to standard of State Hospital care. William A. Bryan. Am. 

Ass'n Adv. Sci., Mental Health, No. 9: p. 174, 1939. 

5. The function of biometric methodology in psychiatric research. E. M. Jellinek. 

Am. Ass'n Adv. Sci., Mental Health, No. 9: p. 48, 1939. 

6. The determination of spinal fluid protein with the photoelectric colorimeter. 

Joseph M. Looney and Anna I. Walsh. J. Biol. Chem. 127: 117, January, 1939. 

7. The structure of wholes. Andras Angyal. Phil, of Sci. 6: 25, January, 1939. 

8. The effects of high humidity on skin temperature at cool and warm conditions. 

H. Freeman and B. A. Lengyel. J. Nutri 17: 43, January, 1939. 

9. The care of the aged. Arthur J. Gavigan and Evelyn H. Pettee. Am. J. Nurs. 39: 

150, January, 1939. 

10. Function of the Psychologist in the state hospital. David Shakow. J. Con. Psych. 

3: 20, January, 1939. 

11. Electroencephalographic localization of atrophy in the cerebral cortex of man. 

Morton A. Rubin. Proc. Soc. Exp. Biol. & Med. 40: 153, February, 1939. 

12. Brain wave frequencies and cellular metabolism. Effects of dinitrophenol. Hud- 

son Hoagland, Morton A. Rubin and D. Ewen Cameron. J. Neurophysiol. 2: 
170, March, 1939. 

13. The return of cognitive conscious functions after convulsions induced with 

metrazol. Louis H. Cohen. Arch. Neur. & Psychiat. 41:. 489, March, 1939. 

14. Effects of vitamin Bi in schizophrenia. Louis S. Chase. Am. J. Psychiat. 95: 

1035, March, 1939. 

15. A critique of cultural and statistical concepts of abnormality. Henry J. Wegrocki. 

J. Abnorm. & Soc. Psych. 34: 166, April, 1939. 

16. Thought disturbances in schizophrenia as revealed by performance in a picture 

completion test. Eugenia Hanfmann. J. Abnorm. & Soc. Psych. 34: 248, 
April, 1939. 

17. The determination of serum phosphatase and its clinical significance. Joseph M. 

Looney. N.E.J. Med. 220: 623, April, 1939. 

18. The pharmocologic antagonism of metrazol and sodium amytal as seen in human 

individuals (schizophrenic patients). Louis H. Cohen. J. Lab. & Clin. Med. 
24: 681, April, 1939. 

19. Brain potential changes in man induced by metrazol. Morton A. Rubin and 

Conrad Wall. Br. J. Neur. & Psychiat. 2: 107, April, 1939. 

20. A qualitative analysis of the Healy Pictorial Completion Test II. Eugenia 
Hanfmann. Am. J. Orthopsychiat. 9: 325, April, 1939. 

21. An easily made apparatus for use in "Closed System" pneumoencephalography 

with notes on technic for its use. William L. Holt and Robert S. Schwab. 
Arch. Neur. & Psychiat. 41: 1021, May, 1939. 

22. Factors involved in the stability of the therapeutic effect in the metrazol treat- 

ment of schizophrenia. (A report of 146 cases). Louis H. Cohen. N.E.J. 
Med. 220: 780, May 11, 1939. 

23. Some principles of psychiatric classification. E. M. Jellinek. Psychiatry 2: 

161, May, 1939. 

24. Statistics on some biochemical variables on healthy men in the age range of 20 to 

45 years. E. M. Jellinek and J. M. Looney. J. Biol. Chem. 128: 621, May, 1939. 

25. The therapeutic significance of fear in the metrazol treatment of schizophrenia. 

Louis Cohen. Am. J. Psychiat. 95: 1349, May, 1939. 

26. The effects of insulin on serum lipids and choline esterase in schizophrenia. (Pre- 

liminary Report). Lowell O. Randall. J. Biol. Chem. 128: lxxxii, June, 1939. 

27. Prima Donnas on the payroll. William A. Bryan. National Safety News. 39: 

51 and 80-81, June, 1939. 

28. Metrazol treatment of depressions. Frances Cottington and Arthur J. Gavigan. 

N.E.J. Med. 220: 990, June 15, 1939. 

29. Serum lipids in schizophrenia. Lowell O. Randall and Louis H. Cohen. Psychiat. 

Quart. 13: 441, July, 1939. 

30. Changes in lactic acid, pH and gases produced in the blood of normal and schizo- 

phrenic subjects by exercise. Joseph M. Looney, Am. J. Med. Sci. 198: 57, 
July, 1939. 



36 P.D. 23 

31. A variability study of the normal and schizophrenic occipital alpha rhythm. 

II. The electro-encephalogram and imagery-type. Morton A. Rubin and 
Louis H. Cohen. J. Ment. Sci. 85: 779, July, 1939. 

32. Psychiatric changes associated with induced hyperthyroidism in schizophrenia. 

Louis H. Cohen. Psychosomatic Medicine 1 : 414, July, 1939. 

33. The relationship of male sex hormone to the level of bodily vigor in senility. 

R. G. Hoskins, H. M. Levene and S. Bevin. Endocrinology 25: 143, July, 1939. 

34. Physiological studies in insulin treatment of acute schizophrenia. I. Methods. 

E. M. Jellinek. Endocrinology 25: 96, July, 1939. 

35. Physiological studies in insulin treatment of acute schizophrenia. II. Pulse rate 

and blood pressure. E. Ewen Cameron and E. M. Jellinek. Endocrinology 25: 
100, July, 1939. 

36. Physiological studies in insulin treatment of acute schizophrenia. III. The 

serum lipids. Lowell O. Randall and E. M. Jellinek. Endocrinology, 25: 105, 
July, 1939. 

37. Physiological studies in insulin treatment of acute schizophrenia. IV. The choline 

esterase activity of the blood serum. Lowell O. Randall and E. M. Jellinek. 
Endocrinology 25: 278, August, 1939. 

38. Physiological studies in insulin treatment of acute schizophrenia. V. The blood 

minerals. J. M. Looney, E. M. Jellinek and Cora J. Dyer. Endocrinology 25: 
282, August, 1939. 

39. The art of understanding. Ethel Jeanne Schwager. Pac. Coast J. Nurs. 35: 474, 

August, 1939. 

40. Adult norms for the K-S Clinical Formboards. David Shakow and Bessie Pazeian. 

J. App. Psych. 23: 495, August, 1939. 

41. Racial differences in the neurosis and psychosis. GezaRoheim. Psychiatry, 2: 375, 

August, 1939. 

42. Significance of behavior during hypoglycemia. Conrad Wall. Mass. Dept. 

Ment. Health, Symposium on Therapy, p. 21, September, 1939. 

43. Narcosis treatment in the psychoses. Walter E. Barton. Mass. Dept. Ment. 

Health, Symposium on Therapy, p. 41, September, 1939. 

44. Studies on the Phytotoxic Index. III. (An evaluation of the method with 

reference to depressed psychotic patients). Joseph M. Looney, William Freeman 
and Rose R. Small, Am. J. Med. Sci. 198: 528, October, 1939. 

45. Skin and body temperatures of schizophrenic and normal subjects under varying 

environmental conditions. H. Freeman. Arch. Neur. & Psychiat. J+2: 724, 
October, 1939. 

46. The determination of globulin and albumin in blood serum by the photoelectric 

colorimeter. Joseph M. Looney and Anna I. Walsh. J. Biol. Chem. 130: 634, 
October, 1939. Ibid. (Preliminary report) 128: lx, 1939. 

47. Psychotherapy for the poor. A state-city cooperative enterprise in the field of 

mental hygiene. James Watson. Ment. Hyg. 23: 558, October, 1939. 

48. The social and cultural implications of incest among the Mohave Indians. George 

Devereaux. Psychoanalytic Quat. 8: 510, October, 1939. 

49. The electroencephalogram of schizophrenic patients during administration of 

Vitamin Bi. Morton A. Rubin. Proc. Soc. Exp. Biol. & Med. 42: 440, Novem- 
ber, 1939. 

50. Psychopathy, psychosis and internal secretions. R. G. Hoskins and L. H. Cohen. 

Cyclopedia of Medicine, Vol. 5: Chap. IX, pp. 646-690, F. A. Davis & Co., 1939. 

51. Neuro-endocrinology. L. H. Cohen and R. G. Hoskins. Cyclopedia of Medicine, 

Vol. 5: Chap. X, pp. 690-713, F. A. Davis & Co., 1939. 

52. The Mental Hospital as a Social Service Training Center. Barbara Estes. Proc. 

National Conference of Social Work, 1939. Columbia University Press, 
New York, pp. 409-415. 
Scientific Meetings Addressed by Members of the Staff: 

Dr. Bryan, National Conference of Social Work in Buffalo. 

Dr. Hoskins, Annual meeting of the Association for the Study of Internal Secretions; 
the Marcus A. Rothschild Memorial Lecture at Beth Israel Hospital (N. Y.); Round 
Table New York Acedemy of Medicine. 

Dr. Angyal, Round Table and presentation of paper at American Psychiatric Associa- 
tion, Chicago. 



P.D. 23 37 

Dr. Kemble, Massachusetts Medical Society Annual Meeting, Worcester. 

Dr. Rosenzweig, British Association for the Advancement of Science, Dundee, 
Scotland. 

Dr. Rodnick and Dr. Rotter, Eastern Psychological Association, Bryn Mawr. 

Mr. Wise, American Association for the Advancement of Science, Richmond, Va., 
Michian Society for Mentral Hygiene, Grand Rapids and Conference on Mental Hygiene 
and Pastoral Relations, New York City. 

Miss Estes, National Conference for Social Work, Buffalo. 

Educational Activities 

The future of psychiatry is directly dependent upon the training and preparation of 
new workers in its field. Residents, internes and students are encouraged to come to 
the hospital for periods of training or special lecture courses that will enable them to 
prepare themselves for future independent work in this field. On the clinical service 
we have at present seven residents who are serving a one-year period of training in the 
field of psychiatry and three internes of the Peter Bent Brigham Hospital who come 
for a four months' intensive training in clinical psychiatry intended to give them a grasp 
of psychiatric implications in general practice. Fourth year medical students from 
Tufts Medical School and the Boston University School of Medicine serve a four weeks' 
interneship intended to provide them with a good grasp of clinical psychiatric knowledge 
essential in the practice of medicine. The teaching of all of these is organized by the 
clinical director and shared by the members of the staff, social workers, nurses, occupa- 
tional therapists, psychologists, etc. The clinical director in the capacity of clinical 
professor in the two schools prepares the students for this work by courses in the earlier 
years of the students training. The director and the staff also cooperate in the teaching 
of students and internes trained in other departments. Courses in applied psychiatry 
and demonstrations are given to students in psychiatric social work, occupational 
therapy, psychology, and psychiatric nursing. One of the most profitable methods of 
instruction is that given by means of "evaluation" seminars with student groups from 
two or more departments. In these seminars carefully selected patients are presented 
and an attempt is made to determine the interrelationship of activities and the results 
of cooperative therapeutic efforts. 

The state hospital provides a vast laboratory for the study of mental disorders. 
It supplies both case material and the specialists who can best interpret it. It is not 
surprising then that those interested in abnormal psychology and adjustment problems 
should turn to this source for clinical instruction. 

Students from Wheaton, Holy Cross, Simmons, Middlesex and Norwich College, 
Babson's Institute and many other students in professional fields allied to psychiatry 
have met with us for special instruction and clinic demonstrations to outline those 
phases of psychiatric experience that can be of benefit to them in their work in the 
community at large. 

There are 59 students in training at Worcester most of the time. The quota as it 
stands includes: 
Medical Student Internes . 
Graduate Medical Residents 
Graduate Pathology Residents . 
Dentral Internes (for 3 months) 
Psychiatric Social Service Students : 

Smith College .... 

Simmons College 
Psychology Students . 
Occupational Therapy Students 
Laboratory Technicians 

The following staff members held teaching appointments during the year : 

Dr. William Malamud, Clinical Professor of Psychiatry at Tufts and Boston Univer- 
sity Medical Schools. 

Dr. Walter E. Barton, Instructor in Medicine and Clinical Psychiatry, Smith College 
School for Social Work. 

Dr. William Freeman, Instructor in Pathology at Boston University Medical School 
and Worcester Hahnemann Hospital. 

Dr. J. M. Looney, Special Lecturer in Endocrinology at Holy Cross, Clark and 
Boston College. 



7 

. 6 

2 


Child Guidance Clinic Research Quota : 
Psychology Student ... 1 
Social Service Students: 


2 
3 


Smith College .... 2 
Simmons College .... 1 
Graduate Medical Residents and 


2 


Biometrics Students ... 4 


5 


Affiliate Student Nurses ... 12 


8 
2 


Post Graduate Nurses ... 2 



38 P.D. 23 

Dr. S. Rosenzweig, Instructor in Dynamic Psychology at Clark University. 
Dr. E. Rodnick, Instructor in Psychology at Mt. Holyoke College. 
Mr. Carroll A. Wise, Instructor in Abnormal Psychology and Psychology, Boston 
University School of Religion and Social Work. 

Nursing Education 

The activities of the Nursing Department under Evelyn H. Pettee, B.S., R.N., can be 
roughly classified as postgraduate, affiliate, staff, and extra mural education. 

Two students completed the eight-month postgraduate course in psychiatric nursing 
on May 31, 1939, and two students were enrolled in the post graduate course for 1939- 
1940. 

The postgraduate curriculum has been organized with as many courses as possible 
on a thirty-two semester hour basis, so that students working for a college degree may 
receive maximum credit for their work. This has been accomplished by combining short 
related courses. 

The postgraduates have attended one hundred and fifty-two lectures by physicians 
(this includes staff conferences), forty and one half hours by nurses, and seventy-three 
hours by special therapists. The postgraduate students provided the hospital with 
1,894 hours of nursing service. 

Sixty-one student nurses will have completed a three months' affiliate course in psy- 
chiatric nursing in the year ending December 31, 1939. Forty-eight of these students 
have been in residence and the remainingt hirteen commuted. 

The nursing school distribution is as follows : 

School of Nursing Location Number 

Beth Israel Hospital .... Boston, Mass 1 

Hahnemann Hospital 
Burbank Hospital 
Worcester Memorial Hospital 
Saint Vincent Hospital 



20 
24 



Worcester, Mass. 
Fitchburg, Mass. 
Worcester, Mass. 
Worcester, Mass. 

Affiliate experience in the occupational therapy department was previously confined 
to the shop. At present students are assigned to the department for one week. Each 
student is given the responsibility for a two hour class in diversional therapy on one of the 
medical wards each morning. The two students who are in the department at the same 
time conduct such a class for two hours in the afternoon on a disturbed female ward. 
During the interim, the student prepares material for use in her classes. This arrange- 
ment has proved most satisfactory in that it enables the student to return to the general 
hospital with a better idea of the value and techniques of diversional therapy for the bed 
patient. It has fostered self reliance and initiative as well as provided experience with 
disturbed patients and developed an insight into the relationship of occupational therapy 
and nursing. It has made it possible to increase the number of patients who participate 
in occupational therapy projects on active wards. 

During the year the affiliate nurses have attended one hundred and ninety lectures 
(including staff conferences which they have attended) by physicians, one hundred and 
eighty-five by nurses and sixty-four by special therapists. It is interesting that affiliating 
students have rendered 29,773 hours of service to the hospital in 1939 in spite of the fact 
that classes are included in their eight hour duty day and that their practical experience 
is assigned upon the basis of student need rather than administrative convenience . 

All new employees receive seven orientation lecture hours and all new attendants 
thirty hours in psychiatric nursing. 

Dr. Wright of the Department of Mental Health spent the month of September at the 
hospital and conducted a series of lectures in hydrotherapy for four groups within the 
hospital: physicians, female nurses and attendants, student nurses, and male nurses. 

Enthusiasm for psychiatric nursing has been evident among the student group as four 
former postgraduate students and fourteen former affiliate student nurses have returned 
for employment as graduate nurses during the past year. The demand for affiliation in 
psychiatry is steadily increasing and it will probably be necessary to increase quotas 
to meet this need within the near future. 



P.D. 23 39 

Community Service 

It is our belief that the hospital's obligations to the community is not discharged 
solely through the modern care and treatment of its citizens afflicted with mental disease. 
It has an obligation to use its resources and experienced personnel to discover new and 
better ways to treat illness and to train others in this special field of medicine. Still 
another obligation for service lies outside the hospital walls. Dissemination of knowledge 
about mental hygiene, and the opportunity for the study of incipient or minor mental 
disorder must exist if lasting reduction in the incidence of mental illness is to be achieved. 
Prevention: 

The ultimate goal of psychiatry is to establish measures that will prevent the occur- 
rence of mental diseases. The most important requisite for the development of such 
measures is a thorough understanding of the causes of these diseases and their recognition 
and treatment before the patient has reached a point where hospitalization is necessary. 
To make progress in this direction it is necessary that the psychiatrist be given an 
opportunity to contact personality maladjustments at their early stages. With this in 
view a clinic is being organized at the Out-Patient Department of the Worcester City 
Hospital whose main functions will be to provide psychiatric help and investigation for 
those patients who come for help to the City Hospital. Such patients may be either 
frankly personality problems, personality problems developing in reaction to physical 
disease, or symptoms which develop on the basis of personality problems but stimulate 
somatic diseases. 

Maladjustments of this type may be found among the ambulatory cases in the out- 
patient clinic or among the patients who, for one reason or another, have been admitted 
to the hospital as in-patients. This clinic is to be under the supervision of the clinical 
director working in cooperation with assistants both from the Worcester State Hospital 
and the Worcester City Hospital. The staff of this clinic will also include social service 
workers and a psychologist. It is primarily intended to investigate and treat early 
personality maladjustments and to prevent resulting serious involvements. In addition 
to this, however, it will provide excellent opportunities for the teaching of internes and 
students of both hospitals. 

The Worcester Child Guidance Clinic 

The Worcester Child Guidance Clinic has taken as a definition of its function, "The 
treatment of behavior problems in the emotional and social growth of children and 
adolescents." Developments of the past year have brought the clinic to a better realiza- 
tion of this function, and viewing these developments in retrospect affords evidence of 
this accomplishment. 

The year was opened under difficulties. Dr. Kirkpatrick had just resigned from the 
directorship and there was no psychiatrist attached to the staff until May, 1939, when 
Dr. Robert Kemble began as Director. During this time, psychiatrists from the 
Worcester State Hospital gave their services to the Clinic. In September, Dr. Phyllis 
E. Shaefer began her duties as assistant psychiatrist, and Miss Alice Fleming filled the 
position of psychometrist. Miss Ethel Burnell, one of our social workers, left at the end 
of June to become Chief Social Worker of the Colorado Springs Child Guidance Clinic. 
The year was thus one of staff reorganization which had to be accomplished in the face 
of increased demands for Clinic services. 

Fewer cases could be accepted for treatment, but the statistics show that cases were 
given more service. The total number of interviews per case was greater, and the 
emphasis in these additional interviews was directed toward getting cases started on 
a treatment basis, as contrasted with the more diagnostic type of service. Cases have 
been approached with the idea of helping them, rather than merely knowing or studying 
them, and the treatment process has been scrutinized with an eye to the dynamic factors 
influencing change and growth. 

Thus the movement or progress of a case has become the focus of attention. This has 
led an interest in the factors which bring a case to the Clinic and those which tend to 
continue bringing him there. These factors lie partly in the individual and his problems, 
and partly in the Clinic and the therapist, together they are important to the relation- 
ship through which treatment must operate. This relationship and its factors need not 
be vague or mysterious, they can be approached and investigated just as any other 
processes or happenings. It is obvious that for growth and change to be seen and helped 
there must be continued interviews over a period of time. This will explain the aim of 



40 P.D. 23 

the Clinic in approaching each case with the idea of its continuing, instead of merely 
studying and appraising it. In those cases that do continue the Clinic has been of 
greatest service, therefore, the emphasis has been on getting them to continue rather 
than merely be studied and then left to their own devices. 

The difference this makes can best be seen in the form of the application interview. 
The application could be an elaborate and exhaustive collection of information about a 
case, with investigation of every factor that seems significant. On the other hand, it can 
be directed simply to the elements that decide whether the case will continue or not: 
does this mother want the help the Clinic offers, can she be given an understanding of 
how treatment is carried or by regular appointments over a period of time, can she make 
the necessary arrangements? This is an important shift in emphasis, and in making it 
we have seen gratifying improvement in the continuity of treatment. 

This is but one example of how attention to the dynamics of treatment adds to the 
value of treatment and affords insight and perspective to the therapeutic process. 
Similarly, an awareness of the therapeutic situation and the relationship between 
patient and therapist is used to clarify and strengthen the relationships that the child 
must make in his everyday life. 

The Clinic has fulfilled and extended its other responsibilities to the community. 
The number of talks to community groups was more than tripled in the past year. 
A program of service to the public schools of Webster has been continued, with constant 
examination into how that service can be made most effective. In the difficult problem 
of delinquency, new approaches are being tried. Here the probation officers of the 
Worcester courts have been most helpful with suggestions and cooperation. 

The uses of group therapy in the form of a play group are being studied from the 
material of the group completed in May, 1939. Another group is being formed to con- 
tinue investigating this form of treatment, which seems to have some interesting possi- 
bilities. 

Miss Burnell continued her program at the Girls' Club, placing her emphasis this year 
upon her work with the leaders, and discussion groups with the older girls in the Club. 
She gave a series of lectures on the emotional development of the child, at the same time 
affording an opportunity for the discussion of problems of particular concern to the 
leaders. 

In the training of workers in this field, the Clinic continues to afford a year's work to 
three student social workers, and a student psychologist. One psychiatrist is in training 
for the whole year, and in addition the resident psychiatrists of the Worcester State 
Hospital each receive three months of training at the Clinic. The training program has 
been given more form and substance through the use of weekly seminars in each of the 
three phases of work: therapy, social work, and psychological testing. 

The critical evaluation of the Clinic's work is being continued in the follow-up study, 
the goal being approximately three hundred follow-up visits on cases that were carried 
on a treatment basis. Though no predictions can be made concerning the form the 
statistics will take, the staff has already learned a great deal from the individual reports. 
This is an arduous and difficult task and it is expected to be completed during 1940. 

In all, the Worcester Child Guidance Clinic seems definitely accepted by the commun- 
ity as a valuable resource. More cases come to us than we can handle at all times, and 
this is perhaps the best indication that our services are appreciated. The Clinic is taking 
up its next responsibility, the critical evaluation and improvement of the qualitv of the 
services it gives. 

I. Re-port of Case Load: 

A. Carried Cases: Total 

1 . Cases carried over from last year 205 



B. 
C. 
D. 



2. Intake a. New cases accepted . 

b. Old cases reopened 

(1) last closed before present year 

(2) last closed within present year 

3. Total cases open at some time in this year 

4. Cases taken from service 

5. Cases carried forward to next year . 
Closed cases followed up (not reopened) 

Applications rejected 

Applications withdrawn .... 



172 

24 

1 

402 

169 

233 

220 

10 

9 



P.D. 23 



41 



II. Type of Service Classification: 
A. New Accepted Cases: 

6. Full service a. Clinic staff cases (9 reopened) 

b. Cooperative cases (7 reopened) 

c. Full service not a or b 

7. Special and Diagnostic service (advice) (9 reopened) 



78 

26 



93 



8. Total new cases accepted . . 197 

B. Cases raken from service : 

9. Full service a. Clinic staff cases 45 

b. Cooperative cases 15 

10. Special service (advice) 109 



1 1 . Total cases closed during the year 
III. Sources Referring Neio Accepted Cases: 



12. Agencies a. Social 

b. Medical 

13. Schools a. Public 

b. Other 

14. Juvenile Court 

15. Private Physicians 

16. Parents, relatives, self 

17. Others (friend) 



169 



Full 


Special 


Total 


19 


14 


33 


3 


4 


7 


6 


3 


9 





7 


7 


7 


49 


56 


3 


2 


5 


65 


14 


79 


1 





1 



18. Total new cases accepted .... 104 93 197 
IV. Summary of Work With or About Patients: 

A. By Psychiatrists: 

1. Interviews with patients a. for examination . . . . 183 

b. for treatment 591 

2. Interviews about patients 33 

3. Physical examinations by clinic staff members .... 2 

B. By Psychologists: 

1. Interviews with patients a. for examination 175 

b. for re-examination . . . . 17 

c. for treatment 546 

2. Interviews about patients 12 

C. By Social Workers: 

1. Interviews in clinic 994 

2. Interviews outside clinic 300 

3. Telephone calls 833 

D. Referral Interviews 151 

V. Service to Webster Schools: 

A. 1. Cases carried over from last year 31 

2. New cases 9 

3. Cases closed 29 

4. Number of cases receiving service 40 

B. 1. Social workers' interviews with patients, parents, teachers, and 

others 145 

2. Psychiatrists' interviews with patients, parents, teachers, and 
others 33 

3. Total number of interviews in Webster schools . . . . 178 
VI. Number of Interviews Given by Staff Members 3,402 

VII. Number of Educational Lectures Given by Staff Members to Community 

Organizations 75 



42 P.D. 23 

VIII. Personnel Report (Average staff during year) : 

Full-time Part-time 

A. Regular Staff: 

1. Psychiatrists ....... 2 

2. Psychologists 2 

3. Social Workers . . . . . 3 1 (vol) 

4. Clerical Workers 2 1 

B. Staff in Training: 

1. Social Workers 3 

2. Psychologist ...... 1 - 

3. Psychiatrists . . . . . . Five different internes, each for 

three month periods. 
IX. Operating schedule: 

A. Schedule of clinic days and hours: B. Schedule of attendance of psychiatrists 
9 to 5 daily 9 to 5 daily 

9 to 12 Saturdays 9 to 12 Saturdays 

Mental Health Clinic 
The hospital also operates with the cooperation of the Worcester Department of 
Public Welfare, a clinic at 58 Front Street, Worcester, Massachusetts, for the treatment 
of mild mental disorders in adults. The director of this clinic serves also as medical 
supervisor of all cases placed in family care. 



Statistics: 

Number of lectures and addresses Worcester State Hospital 

given 



Clinic consultations 

Advisory Consultations 

New Patients 

Total Patients for the year 

Number of types of new cases 

Number of Agencies referring cases 



36 
9 
5 
4 
3 
3 
2 
2 
2 
2 
1 
1 
1 



69 Associated Charities 

586 W.P.A. . . 

208 Probation Officer — Worcester . 

132 Clergyman . . . . 

292 Church 

35 Physician 

18 Probation Officer — East Brookfield 
Girls Welfare Home 

Agencies in Order of Number of Cases District Nurses Association 

Referred: Children's Friend 

Board of Public Welfare: S.P.C.C " . 

District 1, 2, 3, 4 . .40 Worcester Boys' Club . 

Aid to Dependent Children . 19 
Old Age Assistance ... 1 
Home Economics ... 1 

61 

The above analysis of the activities of the Mental Health Clinic shows that a large 
part of the cases referred came from but a few of the many agencies that used the Clinic 
during the year. This fact should be taken into consideration in a report on the probable 
future activities of the Clinic. 

Of the 132 new clients, 61 were referred by the Board of Public Welfare. This ex- 
tensive use of the Clinic by this agency was to be expected as the Board of Public Welfare 
helps maintain the Clinic by supplying the office used and also the stenographic assist- 
ance required. 

Next in order of number of cases referred came the Worcester State Hospital with 
36 patients. They should be referred only for fairly intensive psychotherapy and not 
merely for "follow-up" observation; and those selected for such therapy should have 
a fairly good prognosis in terms of the interest and ability of the director as well as in 
terms of the patient's particular "total situation." 

Of the 18 agencies that referred cases, 7 have been characterized as "Special Agencies" 
as they do a specific kind of work in which psychological factors are often of paramount 
importance. It seems to me that the scope of the Clinic can be increased, not by taking 
complete charge of all cases referred by these agencies, but by consulting with a particular 
agency about a case and attempting to have the agency treat the case under the super- 
vision of the Clinic. In the first place the Clinic can supervise the treatment of more 



P.D. 23 43 

cases than it can treat by itself. Such a procedure will not only have an immediate 
utility by increasing the number of cases that can be treated, but it will give individual 
workers supervised training so that they will gradually grow in their ability, as well as 
in their confidence to treat cases in which psychological factors are important. In the 
second place the services offered by special agencies can be better integrated, if there is 
a central agency working with all of them that may draw several of them into the treat- 
ment. In this way each agency will come to know more than it does at present about 
what the others are doing, and thus see how the particular services offered by some other 
agency can be used in treatment. In general it seems to me that the future of the Mental 
Health Clinic lies in its gradually becoming a counselling center where agencies or indivi- 
duals can receive advice on psychological problems, and where any decision reached will 
arise out of the consultation, and not be handed down by the psychiatrist. This state- 
ment does not mean that the director would not continue to do psychotherapy with a 
number of selected patients. 

Some steps have already been taken to make the clinic into a counselling center. 
A weekly case conference has been started at the Associated Charities and two weekly 
case conferences at the Board of Public Welfare. These two agencies are especially 
pleased with this extension of the activities of the Clinic. The Board of Public Welfare 
will provide more space so that the counselling aspect of the Clinic can be emphasized. 

School Clinics 

The state school clinic functions under regulations made jointly by the Department 
of Education and the Department of Mental Health for the "Determination of the 
number of children retarded in mental development" with amendments which added 
permission for the Superintendent of Schools to "present for examination any child ap- 
pearing to be retarded less than three years." 

Reports on every child examined are made to the statistical department of the Depart- 
ment of Mental Health. Personnel of the school clinics from the various state hospitals 
and feeble minded schools consists of psychiatrist, psychologist and social worker from 
each hospital and state school. The school system personnel consists of the school 
superintendent, school nurse or visiting teacher and a teacher assigned by the superin- 
tendent to give school tests. 

The psychiatrist does a physical examination, limited in scope, which might be well 
made by the school physician of each town, who should be brought into the conference 
and study of the children. 

Dates for holding clinics are made as far in advance as possible, but in many cases, 
owing to lists of pupils to be examined and lateness of the work in completing the 
histories and school tests, result in our inability to make dates far in advance. School 
superintendents are urged annually to submit their lists of children to be examined early 
in the school year, but many fail to do this. 

Dates for holding clinics are in general set on Tuesdays and Thursdays, reserving 
Wednesday afternoons for conference of completed work. 
Clinic Operation: 

1. Lists for children for examination are submitted to the Superintendent of the 
hospital conducting the clinic. . 

2. The required history and school test forms are forwarded to the school superin- 
tendent and preferably the hospital social worker should confer with him and the school 
nurse relative to procedure in acquiring histories, and with the assigned teacher relative 
to giving school tests and marking them. 

3. Histories and school tests are completed by the nurse and teacher and forwarded 
to the psychiatrist. 

4. Clinic examination is made of the children. 

5. Records are studied by the psychiatrist and psychologist and recommendations 
made for each child. 

6. Conference is held after school hours between the combined staffs of the school 
and clinic with interested teachers, with the idea of making the best recommendations 
for the child in the physical, educational, psychiatric and social fields. 

7. Parents of children are interviewed by the psychiatrist at the invitation of the 
School Superintendent. 

8. Detailed written reports of the examinations with recommendations are made 
to the school superintendent and a prescribed report is made to the Director of the 
Statistical Department of the Commission of Mental Health, on each child. 



44 P.D. 23 

The School Clinic examined 257 children from 20 towns during the year ending 
November 30, 1939. 

Partial analysis indicates the primary reason for referral was Retardation in 134 cases. 
119 cases were found to be School, Behavior or Personality Problems, who were not as 
easily provided for. 

Special class recommendations were made for about 48% in whom some Personality, 
School and Behavior Problems were included but in dull minds whose treatment must 
be a long time job. 

About 6 % were recommended for psychiatric treatment and full child guidance clinic 
treatment. Many recommended for guidance clinic study from nearby towns may 
receive such treatment but practically all from more distant towns have no clinic 
facilities. 

A gradually increasing larger number of children of fair to good intelligence are being 
referred. Those needing such treatment came from about half of the towns examined. 

A noteworthy finding was 21 cases of serious Birth Difficulty, some instrumental and 
113 cases with known poor hereditary environment were recorded, which indicates 
a rather large percent for whom not too much may be expected from either the clinic 
or school. 

Each school superintendent was given, in addition to a conference with the school 
staff on all cases examined, a card bearing certain statistical information regarding the 
child to which is appended our recommendations; a Correlation Chart graphically in- 
scribed with the child's age, mental age, grade in which he should be against the grade 
he is achieving in each school subject. 

This past year, in addition to a report of our brief psychiatric examination, a report 
of the child's physical examination, important points in anamnesis, school history and 
personality traits found by both the school and the clinic, with a brief theoretical explana- 
tion of how the child became a problem with mechanisms was given. This addition has 
met with general favor by the school superintendents. School superintendents have been 
asked to designate the problem cases who seem to have fair to good intelligence to enable 
us to know whom to pay special attention. 
Recommendations: 

I. Clinic staff should be provided with a psychiatric social worker whose duty would 
be to confer with each nurse in assisting her to understand how to get an adequate his- 
tory. 2. Conference with the special teacher chosen by school superintendent to give 
school tests to acquaint her with how tests should be administered and scored to enable us 
to understand the child's achievement academically and make correct correlation charts. 
This latter conference would be of great help to our psychologists who make the charts. 
3. Social worker should make arrangements for a place for clinic to be held. 

II. The small yet increasing number of children of fair to good intelligence referred 
with problems should be given further treatment to towns so far removed from guidance 
clinic centers as to make it possible for them to get adequate treatment. (19 cases this 
year). 

III. Some member of our psychological staff should be allowed time to give reading 
tests for suitable cases, particularly those with a fairly good intelligence whose basic 
problem is Reading Difficulty. 

IV. School Staffs should be brought into general conference when some good speaker 
should address them and someone should give them further information on aims and 
methods of school clinics. 

Division of Public Relations 
To meet the need of dissemination of mental hygiene information, the hospital issues 
a booklet listing members of the staff with short biographical sketches and thumb nail 
abstracts of the topics they are prepared to discuss. Booklets are sent to civic organi- 
zations in order that health talks may be included in their educational programs. 



P.D. 23 



45 



The widespread popularity of this service is attested to by the following summary of 
talks given outside the hospital in 1939. 



Name of Speaker 

Lonnie O. Farrar, M.D. 
Barbara Estes 
William Freeman, M.D. 
Benjamin Simon, M.D. 
Andras Angyal, M.D. . 
Louis H. Cohen, M.D. . 
S. Harvard Kaufman, M.D. 
Phyllis E. Schaefer, M.D. 
Norman Render, M.D. . 
Helen Hollander 
David Shakow 



Number 
of Talks 

5 

4 

3 

3 

2 

1 

1 

1 

1 

1 

1 

470 



Name of Speaker Number 

of Talks 
Walter E. Barton, M.D. . 104 

Carroll A. Wise . . . .101 
Esther Whitman .... 65 
William A. Bryan, M.D. . .43 
James Watson, M.D. . . . 42 

Esther Burnell 35 

Robert Kemble, M.D. . . . 15 
Katherine M. Steele . . .15 
Joseph M. Looney, M.D. 9 

Wallace Searle .... 7 
HildurEkdahl .... 6 

Ruth Walton 6 

Total for year 1939 

Administrative Activities 

The hospital has still another obligation to the people it serves, that of sound business 
management. The wise use of funds appropriated for annual expenses, the elimination 
of waste and extravagance and planned economy are objectives within the realm of 
achievement. We are constantly striving to introduce into the business side of the 
hospital new ideas and practices that will result in more efficient use of public funds 
or even a reduction of expense without a sacrifice of either personnel standards or medical 
program. 

The Steward's Department 

Through the cooperation of the Steward's and Treasurer's Department, the books 
for the year 1939 were closed in good order with inventories low and under control, 
with standards maintained and small unspent appropriation balances. This reflects 
the good results that can be obtained, even in a year of reduced budget and general 
saving, with the daily financial accounting methods in use in the hospital. We are firm 
believers in the daily balance sheet that correlates available moneys with expenditures 
and commitments as well. 

We have tried to introduce even closer supervision and control of distributed hospital 
supplies. Records have been devised to provide greater accuracy and accountability 
that should increase efficiency and reduce waste. 

This year we have put into operation a new system of repairs that will for the first 
time place at our disposal information concerning the cost of repairs. At the same time, 
it will put our so called "expense material" on a perpetual inventory basis that is bound 
to effect economy in the near future. 

The method consists in a division of repairs into those that can be completed with less 
than 16 hours labor and another group requiring more work called projects. A secretary 
lists repairs by number on a daily sheet to each maintenance division. The worker 
enters on a time card the hours spent on each numbered repair. Any materials issued 
for use, also bear on the requisition slip the repair number. A recap sheet can then be 
made to relate job, labor and material for ready calculation of cost. 

Projects are graded as to urgency, given a number and are handled in precisely the 
same fashion. 

It seems unnecessary to again call attention to the conditions of both our storeroom 
and laundry. These very essential departments of the hospital are certainly not im- 
proving with age. They are getting more and more expensive to operate each year and 
they are most inefficient. Inside cylinders of our wash wheels are badly patched, all 
leak and require continual repair. The tumblers are in an almost useless condition, 
Extractors are dangerous, presses are about gone and the general safety is inadequate. 
The demand on the laundry has not decreased, and this, together with poor working 
conditions, chiefly atrocious ventilation and crowding, brings about a demoralizing effect 
on the operatives. Although committed to an eight hour day the almost daily break- 
downs produce emergency demands that make it necessary to work certain employees 
half a day on Sunday and also three nights each week to keep up with the work. 

About 3,000 pounds of laundry are handled daily by the laundry or nearly 18 tons 
in a week. 



46 P.D. 23 

In our 1938 report we discussed the storeroom situation as it existed, and there are 
no further comments to make except that for a hospital of this size, it is our opinion that 
the present facilities are both inadequate and expensive to operate. 

The perpetual inventory introduced in the pharmacy last year has functioned satisfac- 
torily to give complete control of purchasing. No complaints have been registered by 
the Medical Staff because of lack of drugs or service. Expenses were not lowered but 
no unexpended reserve was allowed to accumulate. 

During 1940 it will be our endeavor to further apply good business management to 
the operation of this hospital in its various departments. This will be carried out just 
so far as it is possible with clerks that can be made available to handle the detail and 
information derived from its application. We have about reached the saturation point 
of our present clerical force with detail of the various activities we have taken on in 
excess of regular routine, but it is not our intention to ask for more until it can be defin- 
itely determined that the savings derived will fully warrant the increased personnel 
expense. 

Farm Report 

In spite of a severe drought throughout the latter part of the summer the farm has 
produced an abundant supply of vegetables, silage, and hay. For this success, a great 
deal of credit must be given to a carefully designed and systematic program of soil 
analysis, crop rotation, choosing a proper soil type for each particular crop and correct- 
ing soil acidity by applying lime wherever necessary. This program proved advantageous 
because in many cases crop yields increased greatly per acre. 

Old run-out pasture lands responded very well to a somewhat similar program. 
During the past winter all brush and low growing shrubbery has been cleaned off of 
open pasture areas. In the spring a heavy bush harrow loosened up the hard mossy 
surface, this was followed by an application of lime and phosphate and finally reseeded 
to a Ladino clover and grass mixture. The old pasture area was then divided into four 
parts by fencing and cows were allowed to feed in each area eight to ten days. This plan 
gave each pasture a chance to regain its natural growth before cows were allowed to 
pasture it again. 

Grass silage was introduced into our farm program and worked out very successfully. 
In the past we experienced difficulty in curing our first crop of hay due to poor curing 
weather. Grass silage has the following advantages: 

A. Earlier cutting — giving a better second crop. 

B. May be harvested during wet and poor weather; in fact the more moisture 
the better the feed. 

C. Molasses is used as a preservative — no fear of spontaneous combustion. 

D. Required only one week of tractor and man labor to harvest enough feed to 
carry throughout summer. 

E. Old method of greenfeed cutting required a gang and tractor four hours of each 
day throughout the summer year. 

F. No chance for heating and spoilage. 

G. A steadier milk flow. 

We found that the cows relished this grass silage and kept in better condition. 

A new 14' x 30' silo was added to the Hillside colony dairy barn. It is believed that 
this shall help to further reduce milk cost by giving us a better silage food and should 
reduce cost and bother of transporting ensilage from the main farm. 

A new cattle Heredity Chart was developed at the farm office. We find it very helpful 
in maintaining a high producing herd of cattle. It contains all the past five or six 
generations of pedigrees, recorded in milk production and butter fat in such a concise 
form that one may at a glance make a comparison of daughter against dam or grand-dam. 
It was necessary to compute all past herd records and by using daily standard factors to 
bring every individual of a family group of several generations back to an equal basis 
on a 305 day mature lactation. These family groups are classified according to their 
ability to transmit milk and butter fat to their offspring. We can thereby easily tell 
when a new offspring arrives whether or not it shall remain in the herd for future use. 
It is believed that by this chart it shall be possible to greatly improve the herd in years 
to come. 

Artificial insemination has been practiced in the dairy herd in a small way for a three 
month period. A veterinarian was hired to do the work, which started last March. 



P.D. 23 



47 



The first results were only fair and we are again trying to further the work along this 
line a second time, taking advantage of past experience. It is too early to predict any 
results on the second trial. 

One tractor was traded in for a new Model H tractor which has a top road speed of 
twenty miles per hour. This is a great help in speeding up the farm operations, especially 
on long road hauls. 

The patient labor continues to give us a problem especially during the rush season of 
harvesting. We experienced difficulty in harvesting certain crops at their peak of ripe- 
ness because of so much other necessary work. We believe the transferring of the outside 
supervisor and outside attendants to the farm jurisdiction improved efficiency a great 
deal. 

During the past year nearly ten acres of new land have been reclaimed in the swamp 
area. This brings the swamp to full cultivation. Many feet of rock drains have been 
laid throughout the area during the past summer. We believe that we can have this 
swamp completely in seed this coming year. 

A large parking area was built in front of the main administration building to 
accommodate the overflow of visitors' cars. 

Many square feet of lawn area had to be reseeded because hurricane reconstruction 
damaged the lawn in many places. 

Removal of all hurricane stumps has been completed and a program of reforestation 
carried on where these trees have been removed. A great deal of tree pruning and 
surgery work has been done by our own grounds force. 

Statistics 

Dairy: There were at the end of the year, 72 mature cows, 42 heifers over 1 year, 
27 calves under 1 year and 3 bulls. 16,560 hours of employee and 41,563 hours of 
patient labor resulted in production of 929,590.5 lbs. of milk at 4c a pound. This was 
valued at $37,183.60. 

Pork: It took 4,040 hours of employee and 14,781 hours of patient labor to produce 
38,744 lbs. of pork valued at 12c a pound for a total of $4,649.28. There were 4 Dure 
Jersey Boars, 8 brood sows and 210 Spring shoats. 

Farm: 34,035 hours of labor by employees and 221,574 hours of patient labor was 
put into work on the farm; 72.29 acres were in garden crops; 56.3 tons of fertilizer was 
purchased in addition to 589.5 loads of manure used; 1,047,935 lbs. of vegetables valued 
at $14,978.56 were raised. 





Pounds 


Pounds 


Asparagus 


1,234 Corn, sweet . 


. . 73,007 


String beans 


74,662 Onions . 


62,529 


Beets .... 


31,344.5 Spinach 


23,203 


Cabbage 


. . . 60,501 Squash . 


. . 131,127 


Carrots 


. 117,983 Tomatoes 


. 128,167 


Celery .... 


31,366 Turnips 


. 95,627 


35 acres produced 825,78 


lbs. of ensilage corn valued at $3,716 


01. 15 acres were 



planted in green feed and yielded 67,150 lbs. 40.5 acres of hay yielded 757,106 lbs 

Engineer's Report 
Plumbers: 

The plumbing repairs were kept up and eight obsolete toilets were replaced, anti- 
syphon valves were installed on the fourth floor. 

Bubblers of new design were placed in many wards, new flushometer valves were 
placed on toilets in the Lincolns. 

A new copper cold water supply line was run from Main Hospital service to the 
Lowell Home. 

Acid proof plumbing was installed in the Laboratory and gas lines were changed. 

New sinks were built for the kitchen to replace worn out sinks. 
Electricians: 

Repairs were kept up and many projects completed. Wiring was installed for new 
X-Ray equipment. Much time has been spent on servicing motors. In many places 
obsolete wiring has been replaced. Several new street lights have been connected to 
improve the lighting of the grounds. One building of the farm group was wired. 
Changes were made at Hillside which improved the service. The kitchen at Summer 
Street Department was rewired. 



48 P.D. 23 

Machinst: 

Two machines of unique original design were built in the machine shop for use in the 
laundry. One counts articles received and the other folded laundered goods. 

Several medical wheel chairs of special design were made. 

All machinery in laundry, kitchen, bake shop and throughout the hospital was ser- 
viced and repaired from machine shop. Elevators were checked each day as an insurance 
for safety. 

Steam leaks were repaired, steam traps cleaned, boilers and machinery and equipment 
were kept in good order. Eleven boilers in cottages and farm buildings were cleaned 
and placed in good condition for winter operations. New covering was placed on steam 
pipes. The machine shop was renovated and remodeled to bring it to the appearance 
and efficiency standard of the adjacent new power house. An old lathe was over-hauled 
and new punches were made for pipe cutting and threading machines. 
Engineers and Firemen: 

The engine and boiler rooms and their equipment were kept at a high peak of 
cleanliness. 

From November 30, 1938 to November 30, 1939 the Main Plant used 1,406,724 gallons 
of Bunker "C" oil. During this same period, 1,429,600 kilowatts of electricity were 
generated for lighting and power on the grounds. 

We believe a steady gain in economy and efficiency has taken place. 

A request has been made that the rating of our plant be changed from second to 
first class as it fully meets the requirements for an advanced standing. Several men are 
studying to improve themselves and for the purpose of gaining a higher license. Rooms 
adjoining the engine rooms have been improved which has added to the appearance of 
the Power Plant. Pipes have been painted to comply with a color chart. New steps 
and doors have been placed at the rear as an entrance to a new locker room built for the 
Power Plant employees. 

Maintenance Department 
The maintenance and repair work of a mental hospital can be classified under several 
headings. 

1. The ordinary day by day work of the never ending small repairs in the hospital. 

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

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

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

The ordinary maintenance repair work has been carried on during the year as rapidly 
and completely as the limited mechanical personnel permitted. The upkeep of buildings 
from sixty to more than one hundred years old which are occupied by mental patients 
many of whom are deliberately destructive means more in time, money and labor than 
would be the case in an ordinary building. 

One of the largest repair items of the hospital is the replacing of glass; in 1939 we used 
5,800 panes of glass, 4,500 feet of window cord, 500 gross of screws, and 25 kegs of nails. 
We also used 15,000 ft. of lumber, 1,200 gals, of paint, 1,,100 bags of cement, 250 bags of 
plaster, 300 bags of lime, 25 bbls. of plaster paris. All of this material went into the 
routine maintenance of the building. 

The painting program included the repainting of several wards and cottages, also 
wards and dining halls at the Summer Street Department. 

Considerable repairs were also done at the Hillside dormitory and caretaker's quarters. 

A complete change, including new counters, new sinks, etc., using carpenters, masons, 
painters, was done at the laboratory. 

In the X-Ray Department, a complete renovation, including the moving of partitions, 
and the installing of others, new counters, new linoleum and floors, was done. 

New hardwood floors were laid in the chapel, stage, and two adjoining rooms. 

The front porch at the Summer Street Department was completely renovated. 
This was done with outside labor under the direction of the maintenance foreman. 

The administrative offices were remodeled as were the offices of the chief clerk. 
A new record and file room was created out of a front corridor. 



P.D. 23 49 

Projects 

A few of the major projects completed during the year show hours of labor and cost $ 
exclusive of materials used. 

Total Cost of 

number of labor 
hours 
Project 

1. Erection of a partition in the locker room adjacent to machine shops. . . 263% $205.73 

2. Painting of radiators on Howe 3 and 4, Phillip 3 and 4, and "Washburn 3 and 4 . 39 30.42 

3. Laying of cement walk to Quimby, Lincoln and Salisbiiry doors .... 60 46 . 80 

4. Remove wax covering and paint, repainting shuffle board 31% 24.57 

6. Burying scales in floor ' 64 49.92 

7. Cover boiler at dairy with asbestos 23% 17.94 

8. Laboratory Reconstruction: plumber and electrician; carpenter; painter . . 891% 695.57 

9. Special locks on rooms and shutting off 3 sections in Salisbury, Phillip and 

Washburn basements 39% 30.61 

10. Erection of roof on silo at Hillside Colony 8% 6.26 

12. Repairs to rear porch at Prospect Cottage 8% 6.26 

15. Repainting in Mr. Smith's apartment 333% 259.93 

16. Install new street light — West wall of garage 8% 6.63 

17. Two street lights installed on concrete walks Administration building to Avenue 

Cottage No. 2 9% 7.41 

18. Erection of partitions in office of Dr. Barton 370% 289.19 

19. Carpenter, painter, and to laying of new floor in Miss Riddell's office . . 801 624.78 

21. Repairs to chimney on house, Plantation Street 24 18.72 

22. Carpenter work on Stonehouse, Hillside Colony 78% 61.03 

24. Necessary repairs — Superintendent's apartment 269% 210.41 

25. Repairs to roof and wall of hay barn . 13% 10.34 

26. Installation of pressure regulator for water — Quimby Base .... 12% 9.85 

27. Relaying slate floor in shower room 38% 30.23 

28. Necessary repairs to plaster, ceiling and stone in Folsom 3 32% 25.15 

29. Painting as required in Cafeterias — Patients' and Employees' .... 95 74 . 10 

31. Repairing roof leaks in Engineer's Dining Room 3% 2.73 

32. Repairs to roof of cow-barn 2 1 . 56 

33. Repairs to porch corner in Washburn 1 8 6.34 

34. Plumbing repairs in Sargent basement 15% 12.29 

35. Removal of screens from E. B. windows 11% 8.97 

36. Laboratory reconstruction installing counters and shellacing .... 147% 115.22 

37. Removal of screens at Hale Home 8 6.34 

38. Removal of screens at Lowell Home 7% 5.85 

39. Removal of screens — Sargent building 14 10.92 

41. Renovation of Dr. Banay's apartment. Carpentry, cleaning and painting as 

specified 356% 278.07 

42. Painting radiators, Employees' Cafe 123 95.94 

43. Plumbing — Woodward 1 and 2 145% 113.27 

44. New floor in Chapel 94% 73.89 

45. Duplicate keys for telephone office 53% 41.73 

46. Christmas tree stands 37% 29.25 

48. Furnishing "No Parking" signs 33 29.04 

49. Carpentry — table in Laboratory 26 20.28 

50. Removing tops of wall cabinets in Pathological Laboratory . .- 33% 25.74 

52. Plumbing repairs 4th floor — Male and Female sides, each ward. . . . 20% 15.99 

53. Construction of brackets with pole to hold wrapping paper in clothing offices . 16% 12.68 

54. Construction of tables for Philip 3 57% 44.65 

56. New table tops — male cafeteria 39% 30.81 

58. Plumbing and electrical work, Male wards first floor 22% 17.92 

59. Fabrication and erection of new sinks — main kitchen 25% 20.09 

62. Repair of dormitory doors 19 14.82 

64. New panels door — stairway Salisbury 2 11 8.58 

67. Elevator and Plumbing repairs — Male reception service 2nd floor ... 6 4 . 68 

77. Painting walls and ceiling Apartment H-2 140% 109.77 

The Industrial Department under F. R. Proctor carried out many useful projects. 

Mimeograph, 194,535 copies of various record forms and papers. 

Furniture, repaired and painted 1,612 articles. 

New goods made: 

Rag rugs 482 Leather slippers . . 276 pairs 

Brushes 429 Toweling . . . . 1,115 yards 

Men's suits 376 

Pressing, 3,000 coats and 4,460 pants. 

Shoes repaired, 1,100 pairs. 

Dictaphone records, 4,377 shaved. 

New mattresses made 450, new pillows 156, mattresses retuffed 3,966. 

Chairs and sofas upholstered 68. 

Many other items such as bedside guards, rubber sheets, slip covers, fracture straps, 
laundry bags, window shades, and baseball bases were made. 

The many activities of the Matron's Department under Miss Lillian G. Carr are re- 
flected in part by these brief reports. 

The mending room repaired 10,415 dresses, 10,252 suits of underwear, 12,566 shirts, 
and 7,395 sheets. The varied items coming for repair is suggested by noting tablecloths, 
slippers, shawls, barber gowns, uniforms, blankets, scarves, and flags. 



50 P.B. 23 

The sewing room made many thousands of new items such as cafeteria and waitress 
uniforms to coffee bags and sofa pillows. 6,582 ward towels, 1,174 sheets, and 4,282 
Indian Head napkins were manufactured, as well as 1,662 men's shirts and 2,625 
women's dresses. 

W. P. A. 
Cataloguing and Research Project 

Official Project No. 665-14-3-210 
Work Project No. 17026 

This project consisted of transcribing, cataloguing, typing and cross-indexing records 
for the State Hospital to be used primarily for research purposes. The work was carried 
on by a group of fourteen girls : one supervisor, three cataloguers and ten typists. 

In the Medical Library about 3,000 bibliographic cards were typed on Schizophrenia. 
Around 1,000 articles on the subject of Schizophrenia including English, French, Ger- 
man, and Italian were collected and typed. Both these sets of cards are kept in special 
files. 

In the Pathology Department autopsy protocols and cross-index files (both major 
and minor) have been completed from 1895-1935. The data are now being studied to 
compare the findings peculiar to types of insanity. 

In the Psychology Department a body of data collected over a period of ten years 
on different types of abnormal persons was brought into analyzable form. The filing 
system was reorganized; the results from 500 Clark-Thurstone Personality Inventories, 
the results from 1,000 Kent-Rosanoff Association Tests, the results from 250 examina- 
tions of General Paretics, the results from the Stanford-Binet Tests of 450 Dementia 
Praecox patients were tabulated. Manuscripts and articles were copied to be used 
in connection with this psychological research. 

In the Statistical Department tabulations of the medications administered to one 
hundred Dementia Praecox patients on the research service, tabulations of the incidence 
of physical diseases in mental diseases, and the physiological factors over long time 
ranges in these patients were made. 

The Worcester State Hospital and Clark College sponsor official project number 
665-14-3-726. It is a study of Hormone metabolism in normal and pathological human 
beings to discover the relation of the metabolism of the female sex hormones to health 
and disease. Sex hormones in the urine of patients were determined quantitatively and 
variations in output measured and the nature of the output after administration of 
chemically known hormone. 

Dr. Gregory Pincus supervises twelve W. P. A. workers. 
National Youth Administration (N. Y. A.) 

Late in the year the National Youth Administration placed twelve girls in three 
groups in the business offices for special training. Supervisors were impressed with the 
enthusiasm and ability of the workers. This program promises to be popular enough to 
warrant extension into the training of boys in mechanical skills. 

VALUATION 

November 30, 1939 

Real estate — Land, 584.95 acres $389,507.00 

Buildings and betterments Z,ooZ,o\)Z.67 

$2,942,009.37 

FINANCIAL REPORT 

To the Department of Mental Health: 

I respectfully submit the following report of the finances of this institution for the 
fiscal year ending November 30, 1939. 

Statement of Earnings 

Board of Patients * 58, qf«"nr» 

Personal Services 6bb • uu 

Sa Food $1,834.21 

Clothing and materials ^8.00 

Furnishings and household supplies 7 J . 95 

Medical and general care £j>U . 88 

Heat and other plant operations ^ y 1 • 5U 

Garage and grounds "^ 

Repairs ordinary • • • 4dl.»o 

Farm: (Cows, calves and pigs, $1,997.33; bags and vegetables, $211.01; 

horses, $1) . 2,209.34 

Total Sales $5,227.94 



P.D. 23 

Miscellaneous : 

Interest on bank balances 

Rents 

P & D Frt., $31.48; Tel. Com., $134.30; Auto claims, $24.55; Simmons 
College, $50; Court fees, etc., $63.03 



$100.00 
1,154.50 



303.36 



Total Miscellaneous 



Total earnings for the year 

Total cash receipts reverting and transferred to the State Treasurer 

Accounts receivable outstanding Dec. 1, 1938 

Accounts receivable outstanding Nov. 30, 1939 



$7.67 
50.40 



51 



$1,557.86 



65,926.58 
$65,883 . 85 



Accounts receivable increased 

Maintenance Appropriation 

Balance from previous year, brought forward 

Appropriation, current year 



Total 

Expenditures as follows: 
Personal services . . 

Food 

Medical and general care .... 

Religious instruction 

Farm 

Heat and other plant operation 
Travel, transportation and office expenses 
Garage, $2,994.99; and grounds, $1,783.53 
Clothing and materials .... 

Furnishings and household supplies . 

Repairs ordinary 

Repairs and renewals 



$42 . 73 

$286.36 
1,074,749.95 

$1,075,036.31 



$628,372.08 

198,522.92 

50,226.56 

2,930.00 
21,857.70 
74,245.90 
10,669.52 

4,778.52 
21,561.61 
33,459.51 
15,413.32 

9,219.05 



Total maintenance expenditures .... 
Balances of maintenance appropriation, Nov. 30, 1939 



Special Appropriations 
Balance December 1, 1938, brought forward . 
Appropriations for current year 



Total 

Expended during the year 

Reverting to Treasury of Commonwealth . 

Balance November 30, 1939, carried to next year 



$188,480.03 



$1,071,256.69 

$3,779.62 

$1,075,036.31 

$241,098.20 
8,500.00 

$249,598.20 

188,480 . 03 

$61,118.17 





Act or 


Total 


Expended 


Total 


Balance at 


Appropriation 


Resolve 


Amount 


during 


Expended 


end of 






Appropriated 


fiscal year 


to date 


year 


Hydrotherapy Building, 












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




$127,173.41 


$25 . 82 


$127,173.41 


_ 


Plumbing — Summer Street 


Chap. 234 


12,300.00 


- 


12,298.98 


1.02 




1937 

Chap. 356 

1938 










Plumbing — Summer Street 


Chap. 309 


17,300.00 


758.35 


11,925.60 


5,374.40 




1939 










New boilers, stokers, etc. . 


Chap. 304 
1936 


270,000.00 


2,192.82 


268,857.72 


1,142.28 


X-Ray equipment 


Chap. 356 
1938 


8,000.00 


7,763.98 


7,763.98 


236.02 


Medical equipment . 


Chap. 356 
1938 


5,000.00 


4,617.72 


4,617.72 


382 . 28 


Bake ovens .... 


Chap. 356 
1938 


6,550.00 


6,534.77 


6,535.23 


14.77 


Electric wiring .... 


Chap. 356 
1938 


10,000.00 


9,909 . 08 


9,909.08 


90.92 


Renovating plumbing, em- 


Chap. 309 


14,000.00 


201.08 


10,321.88 


3,678.12 


ployees Bldg. 


1939 








50,198.36 


Hurricane and flood . 


Chap. 507 


216,000.00 


156,476.41 


165,801.64 




1938 














$686,323.41 


$188,480.03 


$625,205.24 


$61,118.17 



Per Capita 
During the year the average number of patients has been, 2,532.86. 
Total cost of maintenance, $1,071,256.69. 
Equal to a weekly per capita cost of, $8.1335. 
Total receipts for the year, $65,883.85. 
Equal to a weekly per capita of, $.5002. 
Total net cost of maintenance for year, $1,005,372.84. 
Net weekly per capita, $7.6333. 

Respectfully submitted, 

Margaret T. Crimmins, 



Treasurer. 



Financial statement verified. 
Approved: 



Geo. E. Mtjrphy, 
Comptroller 



52 

STATEMENT OF FUNDS 

November 30, 1939 
Patients' Fund 

Balance on hand November 30, 1938 $5,381 . 17 

Receipts 8 '°££-££ 

Interest 100-00 

Expended $7,457.92 

Interest paid to State Treasurer 100.00 

Balance on hand November 30, 1939 

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.) 50.00 

Balance Mechanics National Bank 1,697.13 

Cash on hand November 30, 1939 221.78 

Wheeler Fund 

Balance on hand November 30, 1938 $1,018.01 

Income to November 30, 1939 25.00 

Expended to November 30, 1939 

Balance on hand November 30, 1939 

Investments 

Worcester Mechanics Savings Bank $1,000.00 

Balance Mechanics National Bank 15.51 

Clement Fund 

Balance on hand November 30, 1938 $1,000.00 

Income to November 30, 1939 25.00 

Expended to November 30, 1939 

Balance on hand November 30, 1939 

Investment 
Worcester County Institution for Savings 

Lewis Fund 

Balance on hand November 30, 1938 $1,316.25 

Income to November 30, 1939 32.50 

Expended to November 30, 1939 

Balance on hand November 30, 1939 

Investments 

Worcester Five Cents Savings Bank ^^'^S? "99 

Balance Mechanics National Bank 21.25 

Manson Fund 

Balance on hand November 30, 1938 $1,137.41 

Income to November 30, 1939 27.25 

Balance on hand November 30, 1939 : 

Investment 

Millbury Savings Bank 

Canteen Fund 

Balance on hand November 30, 1938 IJ/I 8 ^ 2 , , 

Receipts to November 30, 1939 22,082.27 

Expended to November 30, 1939 

Balance on hand November 30, 1939 

Investments 

Worcester Depositors Corp. (Class A Certificates) $80 . 00 

Mechanics National Bank 806 . 66 

Cash on hand November 30, 1939 2 o 2 ■ 95 

Rockefeller Research Project 

Balance on hand November 30, 1938 fi'fi2'lf 

Receipts to November 30, 1939 15,555.33 

Expended to November 30, 1939 

Balance on hand November 30, 1939 

Investments 

Worcester County Trust Co 

Insulin Treatment for Dementia Praecox 

Balance on hand November 30, 1938 *}f-°J 

Expended to November 30, 1939 14 -0< 



P.D. 23 



$13,526.83 

7,557.92 
$5,968.91 



$5,968.91 



$1,043.01 
27.50 



$1,015.51 



$1,015.51 



$1,025.00 
25.00 



$1,000.00 
$1,000.00 



$1,348.75 
27.50 

$1,321.-25 



$1,321.25 

$1,164.66 
$1,164.66 



$23,868.47 
22,718.86 

$1,149.61 



$1,149.61 

$18,165.67 
16,420.18 

$1,745.49 

$1,745.49 



P.D. 23 



53 



STATISTICAL TABLES 
As Adopted by the American Psychiatric Association Prescribed by the 
Massachusetts Department op Health 
Table 1 . General Information 

(Data correct at end of institution year November 30, 1939) 

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 $2,942,009.37 

Personal property 468,094.85 

Total $3,410,104.22 

Total acreage of hospital property owned, 584.95. 
Additional acreage rented, 45. 

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 12 - 12 1 - 1 

Clinical assistants 2 - 2 - - 

Total physicians 15 - 15 1 - 1 

Stewards ......... 1 - 1 - - - 

Resident dentists 1 1 - 

Pharmacists 1 - 1 - - 

Graduate nurses 1 61 62 - 1 1 

Other nurses and attendants .... 146 163 309 167 

Occupational therapists - 5 5 - - 

Social workers - 5 5 - - 

All other officers and employees ... 134 87 221 8 3 11 

Total officers and employees . . . 299 321 620 10 10 20 

Classification by Diagnosis September SO, 1939 
Census of Patient Population at end of year: 

Absent from Hospital 
Actually in Hospital but still on Books 

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

Insane 1,178 1,176 2,354 248 300 548 

Mental defectives - 2 2 - 2 2 

Alcoholics - 1 1 - - - 

All other cases 8 2 10 2 2 

Total 1,186 1,181 2,367 248 304 552 

Other Races: 

Insane 27 25 52 2 2 4 

Total . 27 25 52 2 2 4 

Grand Total . . . . . . . 1,213 1,206 2,419 250 306 556 

M. F. T. 

Patients under treatment in occupational-therapy classes, including 

physical training, on date of report 40 66 106 

Other patients employed in general work of hospital on date of report 816 720 1 ,536 

Averagedaily number of all patients actually in hospital during year 1,181.62 1,201.04 2,382.66 

Voluntary patients admitted during year 10 4 14 

Persons given advice or treatment in out-patient clinics during year 96 101 197 



54 



P.D. 23 









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P.D. 23 

Table 3. Nativity of First Admissions and of Parents of First Admissions 



55, 











Parents of Male 


Parents of Female 






Patients 




Patients 


Patients 


Nativity 


















Both 


Both 




M. 


F. 


T. 


Fathers Mothers Parents 


Fathers Mothers Parents 


United States 1 


218 


156 


374 


93 101 75 


83 70 60 


Austria 






— 


1 


1 


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1 1 1 


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31 


18 


49 


56 52 45 


34 37 25 


China 






2 


1 


3 


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_ _ _ 


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- 


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1 1 1 


111 


Denmark 






— 


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_ _ _ 


1 


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3 


8 


11 


9 6 5 


10 11 7 


Finland . 






3 


1 


4 


7 6 6 


2 2 2 


France . 






1 


- 


1 


1 1 1 


1 


Germany 






- 


2 


2 


1 1 1 


5 6 5 


Greece 






1 


- 


1 


2 2 2 


_ _ _ 


Ireland . 






16 


14 


30 


51 50 44 


35 41 33 


Italy 






9 


7 


16 


19 18 18 


12 12 12 


Norway . 






- 


- 


- 


1 


_ _ _ 


Poland . 






9 


11 


20 


17 18 17 


17 16 16 


Portugal 






1 


- 


1 


2 3 2 


_ _ _ 


Russia 






5 


1 


6 


10 8 8 


5 5 5 


Scotland 






3 


1 


4 


4 6 3 


1 2 1 


Spain 






1 


- 


1 


1 1 1 


_ _ _ 


Sweden . 






5 


3 


8 


10 10 9 


5 6 4 


Turkey in Asia 






2 


- 


2, 


2 2 2 

1 
1 1 1 


1 1 1 


Wales 

West Indies 3 . 






_ 


_ 


_ 


_ _ _ 


Other Countries 






10 


8 


18 


16 16 16 


9 9 9 


Unknown 






- 


- 


- 


16 13 11 


9 12 9 


Total . 






320 


232 


552 


320 320 269 


232 232 191 



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

includes Newfoundland 'Except Cuba, Porto Rico and Virgin Islands. 



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P.D. 23 

Table 5. Citizenship of First Admissions 

M. 

Citizens by birth 219 

Citizens by naturalization ............ 35 

Aliens 36 

First Papers 9 

Citizenship unknown 21 

Total 320 



57 



F. 


T. 


157 


376 


17 


52 


26 


62 


3 


12 


29 


50 



552 



Table 6. 


Race c 


f 


First Admissions Classified 


with Reference to 


Principal Psychoses 


Race 


Total 


With 
syphilitic 
meningo- 
encephalitis 


With 
epidemic 
encepha- 
litis 


With 

other 

infectious 

diseases 


Alcoholic 
psychoses 


Due to 

drugs, 
etc. 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 




5 

2 

2 

8 

7 

30 

1 

3 

9 

46 

20 

13 

2 

9 

3 

20 

1 

1 

129 

9 


4 
3 

7 

2 

18 

3 

6 
33 

12 
7 

4 

1 

15 

1 

108 

8 


9 

5 

2 

15 

9 

48 

4 

3 

15 

79 

32 

20 

2 

13 

4 

35 

1 

1 

1 

237 

17 


1 1 2 






































English 

Finnish 

French 

German 

Greek 

Hebrew 

Irish 

Italian 1 

Lithuania 


n 


1 - 1 

1 1 

4 15 


- - - 


- 1 1 


2-2 
11 2 


- - 1 

- 1 - 






1 - 1 

2-2 
2-2 










- - - 


- - - 


1 - 1 
8 1 9 
1 1 2 
3 2 5 


- - - 


1 - 1 
1-1 


- - - 


_ _ _ 


Scandinavian 2 

Scotch 

Slavonic 3 

Spanish . 

Syrian 

West Indian 4 

Mixed 






















4-4 


- - - 


- 1 1 


2 1 3 


- - - 






















7 7 14 
1 - 1 


1 1 2 


- 1 1 


8 2 10 
1 1 2 


1 .4 5 










To 


tal 








320 


232 


552 


23 10 33 


3 1 4 


- 3 3 


27 11 38 


1 5 6 



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



Race 


Trau- 
matic 
psychoses 


With cerebral 
arteriosclerosis 


With other 
disturbances 
of circulation 


With 
convulsive 
disorders 
(epilepsy) 


Senile 
psychoses 


Involutional 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) 
Armenian 
Chinese 
English . 
Finnish . 
French . 
German 
Greek . 
Hebrew 
Irish 
Italian 1 . 
Lithuanian . 
Portuguese . 
Scandinavian 2 
Scotch . 
Slavonic 3 
Spanish 
Syrian . 
West Indian 4 
Mixed . 
Race unknown 






_ _ _ 


1 - 1 


_ _ _ 


1 - 1 


- 1 1 


- 1 1 


: : : 


2 4 6 

1 - 1 

13 6 19 

- 2 2 


1 - 1 


- - - 


1 1 2 
3 1 4 


- 3 3 










2-2 


1 1 2 
19 17 36 
4 2 6 
3 2 5 


1 1 


_ _ _ 


14 5 


2 13 










1 - 1 


2-2 
1 1 2 
1 3 4 


1 - 1 


1 - 1 


- 1 1 


1 - 1 


- - - 


- - - 


1 - 1 


- - - 


























_ _ _ 


20 18 38 
3 3 6 


- 2 2 


- 1 1 


2 6 8 
2 1 3 


1 4 5 


Total 


3-3 


71 59 130 


2 3 5 


2 1 3 


10 15 25 


4 10 14 



58 



P.D. 23 



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



Race 






Due to 

other 

metabolic 

diseases, etc. 


Due to 
new 

growth 


With organic 

changes of 

nervous 

system 


Psycho- 
neuroses 


Manic 
depressive 
psychoses 


Dementia 
praecox 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) 






- - - 


- - - 


1 - 1 


1 - 1 


- - - 


■ - 1 1 
- 1 1 
1 - 1 
3-3 
2-2 
3 1 4 
1 - 1 


Chinese 

English 

Finnish 

French . 

German 

Greek . 

Hebrew 

Irish 

Italian 1 

Lithuanian 


















: : : 










1-1 






2 2 4 










1 1 
- 1 1 

1-1 


_ _ _ 


1 - 1 
1 1 


3 2 5 
2-2 
1-1 
1-1 


i - i 

1 1 2 
1 1 


2 2 4 

3 5 8 
2 6 8 
- 3 3 
2-2 
2 13 


Scandinavian 2 

Scotch 

Slavonic 3 

Spanish 

Syrian 

West Indian 4 

Mixed . 

Race unknown 


_ _ _ 


- - - 


- - - 


1 - 1 


- - - 


1 - 1 
1 - 1 


- - - 


1 1 


1 1 2 


12 3 


5 5 10 






















1 - 1 
38 28 66 

2 3 5 


2 5 7 


1 1 2 


- - - 


7 8 15 


2 5 7 












Total 








6 7 13 


1 1 2 


2 2 4 


19 16 35 


5 9 14 


67 57 124 



Table 6. Race of First Admissions 
Psychoses — 



Classified with Reference to Principal 
Concluded 



Race 






Paranoia 

and 
paranoid 
conditions 


With 

psychopathic 

personality 


With 

mental 

deficiency 


Undiagnosed 
psychoses 


Without 
psychoses 


Primary 
behavior 
disorders 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) 






- - - 


- 1 1 






2 13 


- - - 


Chinese 

English 

Finnish 

French. 

German 

Greek . 

Hebrew 

Irish 

Italian 1 

Lithuanian 




- - - 


- - - 


1 - 1 


- 1 1 


1 - 1 
1 - 1 
2-2 
1 1 2 


_ _ _ 


1 - 1 


_ . _ 


1 - 1 


_ _ _ 


_ - _ 


- - - 


2-2 


: : : 


2-2 
2 13 
1 - 1 


_ _ _ 


4 1 5 
5-5 
3-3 


_ _ _ 


Scandinavian 2 

Scotch 

Slavonic 3 

Spanish 

Syrian 

West Indian 4 

Mixed . 

Race unknown 


- - - 


- - - 


1 - 1 


1 1 


1 - 1 
1-1 
2-2 


1-1 


























1 1 


13 4 


5 16 


- - - 


30 9 39 


3 1 4 














Tota 








3 1 4 


1 4 5 


13 2 15 


- 2 2 


53 12 65 


4 1 5 



includes "North" and "South". 
2 Norwegians, Danes and Swedes. 
3 Includes Bohemian, Bosnian, Croatian, Dalmatian, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 
4 Except Cuba. 



Herzegovinian, Montenegrin, Moravian, Polish. 



P.D. 23 



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P.D. 23 



P.D. 23 

Table 10. 



63 



Economic Condition of First Admissions Classified with Reference to 
Principal Psychoses 









Total 


Dependent 


Marginal 


Comfortable 


Unknown 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


With syphilitic meningo 

encephalitis . 
With epidemic encepha 

litis 
With other infectiou 

diseases . 
Alcoholic psychoses 
Due to drugs, etc. . 
Traumatic psychoses 
With cerebral arterio 

sclerosis . 
With other disturbance 

of circulation . 
With convulsive disorder 

(epilepsy) 
Senile psychoses 
Involutional psychoses 
Due to other metaboli 

diseases, etc. 
Due to new growth . 
With organic changes o 

nervous system 
Psychoneuroses . 
Manic-depressive psy 

choses 
Dementia praecox . 
Paranoia and paranoic 

conditions 
With psychopathic per 

sonality . 
With mental deficiency 
Undiagnosed psychoses 
Without psychoses 
Primary behavior dis 

orders 


3 

S 
3 


f 

1 


23 
3 

27 
1 
3 

71 

2 

2 

10 
4 

6 
1 

2 
19 

5 
67 

3 

1 
13 

53 

4 


10 
1 

3 

11 
5 

59 
3 

1 

15 
10 

7 
1 

2 
16 

9 
57 

1 

4 

2 

2 

12 

1 


33 

4 

3 

38 

6 

3 

130 

5 

3 
25 
14 

13 
2 

4 
35 

14 
124 

4 

5 
15 

2 
65 

5 


6 2 8 

1 - 1 

7 3 10 
2-2 

29 26 55 

- 1 1 

- 1 1 
6 3 9 

- 1 1 

2 2 4 

- 1 1 

6 5 11 

1 1 
18 12 30 

2-2 

- 3 3 

6 1 7 

1 1 

17 6 23 

2 1 3 


15 7 22 

1 1 2 

— 3 3 

19 6 25 

15 6 

1-1 

29 26 55 

2 1 3 

2-2 

1 9 10 

4 7 11 

2 5 7 
1 1 2 

1 - 1 
13 11 24 

5 8 13 

44 42 86 

1 1 2 

1 1 2 

5 1 6 

1 1 

30 4 34 

2-2 


1 - 1 


2 1 3 
1 - 1 

1 2 3 

13 7 20 

- 1 1 

3 3 6 

- 2 2 

2-2 
1 1 2 

5 3 8 

2-2 
5 2 7 


Total 


320 


232 


552 


104 70 174 


180 140 320 


1 1 


35 22 57 



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

Psychoses 



Psychoses 




Total 


Abstinent 


Temperate 


Intemperate 


Unknown 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


With syphilitic meningo- 




























encephalitis . 


23 


10 


33 


- 


5 


5 


18 


3 


21 


3 


- 


3 


2 


2 4 


With epidemic encepha- 






























litis 


3 


1 


4 


1 


1 


2 


1 


_ 


1 


1 


„ 


1 


_ 


— — 


With other infectious dia- 






























eases 


— 


3 


3 


— 


3 


3 


















Alcoholic psychoses 


27 


11 


38 


- 


- 


- 


- 


_ 


_ 


?7 


11 


38 


- 


- - 


Due to drugs, etc. . 


1 


5 


6 


— 


4 


4 


1 


1 


2 




_ 




_ 


- - 


Traumatic psychoses 


3 


- 


3 


1 


- 


1 


- 


- 


- 


2 


_ 


2 


- 


- - 


With cerebral arterio- 






























sclerosis . 


71 


59 


130 


22 


34 


56 


31 


14 


45 


10 


1 


11 


8 


10 18 


With other disturbances 






























of circulation . 


2 


3 


5 


- 


3 


3 


1 


_ 


1 


1 


_ 


1 


- 


— - 


With convulsive disorders 






























(epilepsy) 


2 


1 


3 


- 


1 


1 


1 


_ 


1 


1 


_ 


1 


- 


— - 


Senile psychoses 


10 


15 


25 


3 


8 


11 


3 


3 


6 


1 


1 


?, 


3 


3 6 


Involutional psychoses . 


4 


10 


14 


2 


5 


7 


1 


3 


4 


- 


- 


- 


1 


2 3 


Due to other metabolic 






























diseases, etc. 


6 


7 


13 


- 


4 


4 


2 


2 


4 


4 


_ 


4 


- 


1 1 


Due to new growth . 


1 


1 


2 


- 


1 


1 


- 


- 


- 


1 


- 


1 


- 


- - 


With organic changes of 






























nervous system 


2 


2 


4 


1 


1 


2 


1 


- 


1 


— 


- 


— 


— 


1 1 


Psychoneuroses . 


19 


16 


35 


V 


10 


17 


8 


4 


12 


4 


2 


6 


- 


- - 


Manic-depressive psy- 






























choses .... 


5 


9 


14 


1 


7 


8 


2 


2 


4 


?, 


— 


2 


— 


— — 


Dementia praecox . 


67 


57 


124 


21 


27 


48 


30 


22 


52 


13 


4 


17 


3 


4 7 


Paranoia and paranoid 






























conditions 


3 


1 


4 


- 


1 


1 


2 


— 


2 


1 


_ 


1 


- 


- - 


With psychopathic per- 






























sonality .... 


1 


4 


5 


— 


— 


— 


— 


4 


4 


1 


— 


1 


— 


— — 


With mental deficiency . 


13 


2 


15 


6 


2 


8 


5 


- 


5 


2 


- 


2 


- 


- - 


Undiagnosed psychoses . 


- 


2 


2 


- 


1 


1 


- 


1 


1 












Without psychoses . 


53 


12 


65 


10 


4 


14 


22 


4 


26 


21 


3 


24 


- 


1 1 


Primary behavior dis- 






























orders .... 


4 


1 


5 


- 


1 


1 


4 


- 


4 












Total . 


320 


232 


552 


75 


123 


198 


133 


63 


196 


95 


22 


117 


17 


24 41 



64 



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Neurasthenia .... 
Hypochondriasis 
Reactive depression . 
Anxiety state .... 
Mixed psychoneurosis 
Manic-depressive Psychoses: 
Manic type .... 
Depressive type. 
Circular type .... 
Mixed tj'pe .... 
Perplexed type .... 

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

Simple type .... 

Hebephrenic type 

Catatonic type 

Paranoid type 

Other types .... 

Paranoia 

Paranoid conditions . 

With psychopathic personality 

With mental deficiency: 

Idiot 

Imbecile 

Unknown .... 
Undiagnosed Psychoses: 
Without Psychosis: 
Alcoholism .... 
Disorders due to epidemic en- 
cephalitis .... 
Psychopathic personality : 
With pathological sexuality 
With pathological emotion- 
ality 

With asocial or amoral trends 
Mixed types .... 

Mental deficiency: 

Other non-psychotic diseases or 
conditions .... 
No other condition . 
Primary Behavior Disorders: 
Simple adult maladjustment . 
Primary behavior disorders in 
children: 
Conduct disturbance . 
Neurotic traits 


"cj 

o 

H 

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68 



P.D. 23 



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

Condition on Discharge 



Psychoses 



With syphilitic meningoencephalitis 
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 

T\ ith 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 284 



M. 



F. 



T. 



18 
2 
3 
3 

49 

11 
5 

28 
2 
3 
6 

17 
7 
1 
5 

38 

44 
143 

17 
9 
9 

91 



516 



Recovered 



M. F. T. 



11 11 

4 14 

5 9 
1 

- 2 

1 2 



-11 
- 2 2 
2 13 



Improved 



M. F. T. 



3 15 

2 

1 2 

1 2 

1 27 

2 4 
3 

11 21 

1 

3 

5 

15 

4 

1 

5 

15 

25 



45 62 107 



44 56 100 146 137 283 20 22 42 



Unimproved 



M. F. T. 



2 1 3 
- 1 1 
1 1 2 
-33 



1 - 1 

- 1 1 
12 10 22 

- 2 2 



Table 15. Hospital Residence During This Ad?nission of First Admissions Discharged 

During 1939 



Psychoses 



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. . 
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 









Average Net 


Number 


Hospital Residence 








in Years 


M. 


F. 


T. 


M. 


F. 


T. 


11 


3 


14 


.48 


1.05 


8.46 




- 


1 


.54 


— 


.54 


2 


1 


3 


4.10 


.29 


2.83 




2 


3 


7.50 


.12 


2.58 


31 


5 


36 


.52 


.08 


.46 




7 


8 


.62 


.16 


.22 




1 


2 


1.50 


.20 


.85 


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P.D. 23 75 

Table 19. Average Length of Hospital Residence During the Present Admission of 
First Admissions in Residence on September 30, 1939 



Psychoses 



Number 



M. 



Average Net 

Hospital Residence 

in Years 



M. 



F. 



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

Alcoholic psychoses 

Due to drugs, etc 

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

Senile psychoses 

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

Psychoneuroses 

Manic-depressive psychoses . 

Dementia praecox 

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

Without psychoses 

Primary behavior disorders 



33 
6 
3 
2 



118 

11 

6 

2 



1 

7 

73 

4 
5 

22 
12 
6 



13 102 
1 



70 143 

4 



3 

51 

35 

5 



7 2 

8 16 
377 398 775 

20 40 60 



5 
53 



13 

101 
1 
5 
2 



5.61 
8.70 
3.14 

10.64 

4.50 

2.34 

2.52 

2.23 

7.88 

3.93 

6.82 

3.15 

3.63 

1.44 

11.74 

12.22 

9.21 

18.50 

10.17 

.70 

.44 



6.76 
8.50 
9.16 
.97 
4.94 

12.50 
2.96 

8.48 

4.48 

7.97 

7.67 

5.98 

13.97 

8.30 

12.69 

12.47 

13.49 

12.08 

.44 

.44 

.44 



5.93 

8.59 

6.15 

.97 

9.91 

4.50 

3.61 

2.74 

2.23 

8.11 

4.32 

7.68 

5.21 

4.80 

4.23 

9.45 

12.46 

11.38 

15.41 

11.08 

.44 

.65 

.44 



Total 



795 745 1,540 



9.40 10.21 9.79 



Table 19A. Average Length of Hospital Residence During the Present Admission of 
Readmissions in Residence on September 30, 1939 



Psychoses 









Average Net 


Number 


Hospital Residence 










n Years 




M. 


F. 


T. 


M. 


F. 


T. 


26 


8 


34 


7.07 


7.12 


7.08 


- 


3 


3 


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5.50 


5.50 


4 


3 


7 


5.00 


10.83 


7.50 


_ 


2 


2 


- 


6.50 


6.50 


44 


3 


47 


7.43 


10.83 


7.64 


_ 


1 


1 


_ 


22.50 


22.50 


1 


1 


2 


12.50 


.50 


6.50 


14 


18 


32 


6.35 


4.50 


5.31 


8 


3 


11 


7.25 


3.83 


6.31 


3 


12 


15 


5.83 


5.58 


5.64 


6 


12 


18 


5.33 


6.75 


6.28 


1 


- 


1 


12.50 


- 


12.50 


_ 


1 


1 


- 


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.50 


4 


5 


9 


8.25 


2.90 


5.27 


5 


4 


9 


4.50 


7.00 


5.61 


25 


37 


62 


8.42 


9.25 


8.91 


232 


289 


521 


11.10 


10.95 


11.02 


5 


17 


22 


10.50 


9.85 


10.00 


4 


6 


10 


6.50 


7.66 


7.20 


32 


33 


65 


10.40 


10.74 


10.57 


4 


3 


7 , 


2.25 


2.83 


2.50 


418 


461 


879 


9.60 


9.85 


9.73 



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 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 

Total 



Table 20. Family Care Statistics for Year Ended September 30, 1939 

Males Females Total 

Remaining in Family Care September 30, 1938 33 75 108 

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

Admitted to Family Care During the Year 64 117 181 

Whole Number of Cases within the Year 97 192 289 

Discharged from Family Care within the Year: 53 95 148 

Discharged outright 3 8 11 

From Family Care to Escape Status 4 2 6 

From Family Care to Visit Status 15 29 44 

Returned to Institution 31 56 87 

Returned to Institution from Escape 4 2 6 

Returned to Institution from Visit 5 16 21 

Remaining in Family Care September 30, 1939 44 97 141 

On Visit from Family Care September 30, 1939 8 12 20 

Average Daily Number in Family Care During Year: . . . . 42.33 89.42 131.75 

Supported by State 37 69 106 

Reimbursing - 1 1 

Private 7 27 34