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 y3% 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
0
2
0
2
1
0
0
0
0
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
0
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 C02 (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
0
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
0
7
7
7
49
56
3
2
5
65
14
79
1
0
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
0 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
SaFood $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/I8^2,0,
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 2o2 ■ 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 States1
218
156
374
93 101 75
83 70 60
Austria
—
1
1
_ _ _
1 1 1
Canada2 .
31
18
49
56 52 45
34 37 25
China
2
1
3
1 2 1
_ _ _
Czecho-Slovakia
-
-
-
1 1 1
111
Denmark
—
-
-
_ _ _
1
England .
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 Indies3 .
_
_
_
_ _ _
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.
50
P.D. 23
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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
Italian1
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
- - -
_ _ _
Scandinavian2
Scotch
Slavonic3
Spanish .
Syrian
West Indian4
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
Italian1 .
Lithuanian .
Portuguese .
Scandinavian2
Scotch .
Slavonic3
Spanish
Syrian .
West Indian4
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
Italian1
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
Scandinavian2
Scotch
Slavonic3
Spanish
Syrian
West Indian4
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
Italian1
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
_ _ _
Scandinavian2
Scotch
Slavonic3
Spanish
Syrian
West Indian4
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".
2Norwegians, Danes and Swedes.
3Includes Bohemian, Bosnian, Croatian, Dalmatian,
Russian, Ruthenian, Servian, Slovak, Slovenian.
4Except Cuba.
Herzegovinian, Montenegrin, Moravian, Polish.
P.D. 23
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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
0
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
P.D. 23
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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
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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
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.46
7
8
.62
.16
.22
1
2
1.50
.20
.85
11
12
23
.36
.44
.40
1
2
.54
.71
.62
1
2
.20
.20
.20
—
3
3
—
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.80
2
13
15
1.48
1.36
1.38
5
2
7
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.65
—
1
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1
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1
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16
14
30
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5
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31
51
82
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1.09
1.08
9
5
14
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1
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3
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1
2
3
1.50
.33
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52
12
64
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3
2
5
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187
156
343
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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
_
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
-
.50
.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
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