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

Public Document P. D. 23 



ANNUAL REPORT 



TRUSTEES 



iass.WORCESTER STATE HOSPITAL 



Year Ending November ^0, 
1940 

Department of Mental Health 




Publication of this Document approved by the Commission on Administration and Finance 
550— 9-41— Req. P-243 



OCCUPATIONAI- PRINTING PLANT 

DEPARTMENT OF MENTAL HEALTH 

GARDNER STATE HOSPITAL 

EAST GARDNER, MASS. 



»94 



-1-^ n--*3u 



WORCESTER STATE HOSPITAL 

Post Office Address: Worcester, Mass. 

BoAKD OF Trustees 
William J. Delahajstty, M.D., C/iairv?wm». Worcester. 
Anna C. Taxman, Secretary, Worcester. 
Josephine R. Dressek, Worcester. 
John L. Bianchi, Worcester 
Robert R. Portle, Worcester 
Harry F. Kenney, Boston 
Robert A. Burns, Auburn 

Resident Staff 
Walter E. Barton, M.D., Acting Superintendent. 

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

Clinics. 
Paul S. Wolfe, M.D., Psychiatrist in charge of Female Reception Service. 
Harold Greenberg, M.D., Assistant. 
Joseph M. Zucker, M.D., Clinical Assistant. 

Benjamin Simon, M.D., Psychiatrist in charge of Male Reception Service. 
Edmund F. Walker, M.D., Assistant. 
Lincoln Lebeaux, M.D., Clinical Assistant. 

S. Harvard Kaufman, M.D., Psychiatrist in charge of Continued Treatment Service. 
Stanley Peal, M.D., Assistant. 

Medical and Surgical Service 
Embrie J. BoRKOVic, M.D., Director. 
William Freeman, M.D., Pathologist. 
Bertram T. Spira, M.D., Assistant Male Medical Wards. 
Martin Dollin, M.D., Assistant Female Medical Wards. 
SiAiON 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. 
William L. Holt, Jr., M.D., Psychiatrist. 
Otto Kant, M.D., Psychiatrist. 
Nathan Blackman, M.D., Psychiatrist. 
Morton A. Rubin, Ph.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. 

Erel Guidone, M.D., Director Adult Mental Health Clinic and Supervisor of Family 
Care. 

Nursing Department 
Katherine R. Dick, B.S., R.N., Superintendent of Nurses. 
Mary L. Weston, RS.., R."M.,, Assistant Supo>rintendcp.i of Nurses. 
Anna V. Kaska**, B:'^.;'ll.N„.Etly.catiional Director. 
' * ' Consultants 

Ernest L. Hunt, M.D., Surgery. ' 
Arthur Brassau, M.D., Surgery. ' 
Franklyn Bosqtjet, ^T>., Surgery. ... 

Joel M. Melick, M.D., Gij-rtecology^and Obstetrics. 
Donald K. McCluskey,* M.D., Gyne'cology und Obstetrics. 
Lester M. Felton, M.D., Genito-Urinary Surgery. 
John O'Meara, M.D., Orthopedic Surgery, Roentgenology. 
Oliver H. Stansfield, M.D., Internal Medicine. 
Erwin C. Miller, M.D., Internal Medicine. 
Jacob Goldwyn, M.D., Neurology. 
John T. Carmody, M.D., Neurosurgery. 
Julius Tegelberg, M.D., Oto-laryngology. 



194D 

P.D. 23 A 

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 of Administrative Departments 
Joseph P. Moynihan, Acting Steward. 
Margaret T. Crimmins, Treasurer. 
Warren G. Proctor, Engineer. 
Anton Svenson, Forman Mechanic. 
James Mistark, Head Farmer. 
Lillian G. Carr, Matron. 
Marion C. Ely, Head Social Worker. 

Mary B. Beach, O.T.Reg., Director of Occupational Therapy. 

TABLE OF CONTENTS 



Trustees' Report . 
Superintendent's Report 
Changes in the Staff 
Movement of Population 
Psychiatric Activities 

Report of the CUnical Director . 
Nursing Department 
Social Service Department 
Occupational Therapy Department 
Hydrotherapy Report 
Chaplain's Department 
Radio Department 
Medical and Surgical Activities 

Report of the Medical and Surgical Service 
Outpatient and Clinic Treatments 
Physical Therapy Report 
X-Ray Report . 
Dental Department 
Dietitian's Report 
Laboratory Report 
Research Activities 
Research Department 
Psychology Department 
Library Report 
Publication IJst 
Scientific Assemblies addressed 
Educational Activities 
Student Training 
Teaching Appointments of Staff 
Nursing Education . 
Community Service 
Child Guidance Clinic 
Mental Health Clinic 
School Clinics . 
Division of Public Relations 
Business Activities 
Steward's Department 
Farm Report 
Engineer's Report 
Maintenance Department 
Hospital Industries 
W.P.A. and N.Y.A. . 
Treasurer's Report 
Statistical Tables 



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4 P.D. 23 

TRUSTEES' REPORT 

To His Excellency the Governor and the Honorable Council: 

The trustees of the Worcester State Hospital respectfully submit the 108th annual 
report of the hospital, appending a record of the various departments as reported by the 
acting superintendent, Walter E. Barton, M.D. and the report of the treasurer, Miss 
Margaret T. Crimmins, together with other statistical information. 

It was with regret that on May 14, 1940 the trustees accepted the resignation of 
Dr. Wm. A. Bryan, Superintendent of the Worcester State Hospital for the past 19 j-^ears. 
He left to become Superintendent of Norwich State Hospital in Connecticut. Under 
the able leadership of Dr. Bryan the hospital was recognized as one of the most progres- 
sive of psychiatric institutions. The trustees took immediate steps to effect a continuity 
in policy and named Walter E. Barton, Assistant Superintendent, and for nine years a 
member of the staff of the hospital, to fill the position. As the fiscal year ended this 
appointment had not been confirmed by the Commissioner of the Department of Mental 
Health. 

It is our hope that this important post will soon be filled as a settled administrative 
poUcy is desirable where far-reaching reorganization has been necessitated through staff 
changes. 

The resignation of the Steward, Herbert D. Smith, after 33 years of honorable service 
to the State by reason of ill health, has left another gap of great importance in the 
organization. The trustees, after a careful search, selected Joseph P. Moynihan, 
Assistant Steward to take this place. Higher State authorities have not taken any 
action toward the filling of this post of business manager. It is difficult to see how the 
hospital can operate without satisfactory business management. 

We urge the Department of Mental Health to cooperate with the trustees in building 
an organization as capable as the last one in the field of progressive psychiatry. 

The following projects, completed during the year, added to the efficiency of operation 
or protected existing investments. New piazzas were constructed at the farm house, 
dormer windows and doors were painted, tunnels cemented and new linoleum laid. 
Plumbing was improved at Summer Street Division and in the Male Home. The water 
supply at the Hillside Farm was made safe by connecting to Shrewsbury city supply. 
The hurricane-damaged cow barn at Hillside was torn down and the main barn re- 
modeled to accommodate the milking herd. 

The laundry which was so badly needed two years ago is an even greater need today. 
Constant breakdowns of dilapidated machinery keep repair crews busy, destroy linen 
and clothing, — divert needed money from other repairs, and cause employees to work 
overtime almost daily. Occupational hazards from exposed machinery and unhealthful 
surroundings are such as to nullify much of the therapeutic value of work here by 
patients. 

Kitchen equipment requested two years ago and not approved now is an absolutely 
imperative need. Ovens are rusted through and steam kettles and warmers so inadequate 
as to make the daily preparation of food for more than 3,000 eaters a trial of patience 
and ingenuity. 

It is still difficult to supply hot food to the medical and surgical ward patients. Patients 
also must be carried by litter from floor to floor. Heavy oxygen tanks and expensive 
equipment have to be carried by hand as there are no elevators. We need elevators in 
our medical building to move patients, food and equipment. 

Fire protection should be extended during the year. If possible a building a year 
should be remodeled with reinforced concrete floors and fire-proof ceilings to make these 
old buildings safe. An extension of kalomine doors and sprinklers is desired. Buildings 
require repointing and window repairs. 

A central store house would conserve personnel now spread over the many basement 
storage points and bring about a more complete control over distributed supplies that in 
time would undoubtedly result in material savings. This might be built in the present 
laundry building without new construction. 

There has been a trend of late in this state toward greater centralization of authority 
for expenditures, and blanket covering-orders. Many are for an entire year's supply of 
goods. Under this trend responsibihty is not transferred to the state departments along 
with control over money and purchases. This greatly increases the burden upon the 
individual hospital. The difficulties of budgeting and financial control have mcreased 
many times, and more than ever, the control of distributed supphes becomes important. 



P.D. 23 5 

Foodstuffs — dishes — doth and many suppUes are to be purchased for an entire year in 
advance yet the hospital has not been furnished the means of control, nor the necessary 
facilities for storage. It becomes easy to see the danger of costs mounting without 
improving standards. 

The board wishes to acknowledge the spirit of cooperation and loyalty of all the 
employees of the hospital who made possible continued high standards of care and 
treatment of patients during this trying period of transition and change. 

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

Anna C. Tatman, Secretary Harry Kenney 

Josephine R. Dresser Robert Burns 

John L. Bianchi 

A fit ^t^^S 

SUPERINTENDENT'S REPORT 

To the Trustees of the Worcester State Hospital: 

The year 1940 was marked by far reaching changes in the administration of the 
hospital. The resignation of the Superintendent, Dr. William A. Bryan, the Steward, 
Mr. Herbert Smith, the Superintendent of Nurses, Mrs. Katherine Steele, the Head 
Occupational Therapist, Miss Wanda Misbach, as well as important members of the 
medical staff, all within a few short months, necessitated much rebuilding. At the time 
of this report the two most important posts of superintendent and steward are still 
unfilled. 

It is under these circumstances that we are proud to be able to report considerable 
progress after all. 

Steps toward improved employee morale, so essential to good patient care, were taken 
first through the extension of employees' representation. The committee, intrusted with 
ruling on eligibility for sick leave compensation, was reorganized to include all employee 
groups. The Graduate Nurses Club and the "Mutual Benefit Society," the latter estab- 
lished to provide nursing care and other benefits to sick employees, provided organiza- 
tional contacts; a program of social activities contributed to improved employee spirit. 
The Summer Street Social Club — the Graduate Nursing Club and Mutual Benefit 
Societies all held numerous parties. Each time patient dances were held the orchestra 
was available for an employee party following. A basket ball team from the attendant 
group was followed through a remarkably successful season by a large group of interested 
persons. Seminars were held in the evening for general staff education. Student groups 
particularly used these opportunities. Thirdly, sick-leave compensation was found to be 
worth while. Compensation for 12 days of illness in a single year was allowed to persons 
who had 12 months of service. During the year December 1, 1938 to November 30, 1939, 
299 employees (45% of the 665 employed) were sick. 200 quahfied under the sick- 
leave plan. The cost of the protection was $4,214.55. Although there seemed to be a 
general increase in illness, the security of income and satisfaction in the job increased. 

The world crisis has depleted our employee ranks, and salary advantage in private 
industry has diminished the number of applicants. The efforts to achieve employee 
contentment became more important at this time than before. 

Worcester has had a high rate of accidents reported to patients that could not be ex- 
plained entirely on the basis of greater completeness of reporting and thoroughness of 
examination. It was only logical that an attempt should be made to lower the rate of 
injury through education, improved patient supervision, and removal of hazards. 

On the female side accidents fell from a peak of 232 in one month to a low point of 116 
and on the male service 140 became 88, through concentrated effort. 

During the year 1939 an average of 670 patients had 39,415.7 hours of seclusion and 
460 patients had 15,599.65 hours of restraint. It was possible to reduce this figure to 
67 patients in seclusion 1,061.28 hours and 338 patients in restraint 7,027.1 hours. 
Seclusion was permitted for short periods and only in exceptional instances. With 
adequate ward coverage it could be abolished entirely. The use of restraint was confined 
solely to the confused patient on the medical ward and to the patient under insulin 
shock. This reduction was accomplished with a decrease in the use of hydrotherapy, a 
decrease in the accident and injury rate but an increase in the activity and ward program. 

Food seroice was improved throughout the hospital. The institution of a weekly 
control sheet was made possible checking of food stuffs used with ration allowance and 
tended to stabilize costs at a lower level. It also became evident that with improved 



6 P.D. 23 

supervision of patient workers, and elimination of waste, further improvements in the 
dietary could be achieved. 

Kitchen hygiene was stressed. To accomplish this, pan-scouring details, replacement 
of worn out tins and kettles, and a new three compartment sink were installed at both 
the Main and Summer Street divisions. Our kitchens and cafeterias, the first, and once 
the finest in the state, now lag behind many of the others. Rather extensive moderniza- 
tion should be undertaken in the near future. 

Emphasis on the neat appearance of patients has led to an extension of clothing 
purchases to bring up inventories to a reasonable minimum. A campaign to encourage 
relatives to furnish clothing was undertaken. This needs intensification as the goals 
have not yet been achieved. Until the queer and absurd appearing patients, the man 
with the "high water" pants and a coat too long, is a thing of the past, our task will 
be incomplete. 

The recreational program was greatly extended. A director of recreation, John 
Cronan, was appointed from the attendant group. Patients were all taken out of doors 
during the summer and fall and arranged in groups according to social adjustment in the 
hospital. Appropriate outdoor activities and games made these periods interesting and 
health building. Trips to the circus, museums, swimming parties, picnics and outings 
were made, on a scale hitherto not possible, through a provident gift fund. The energies 
of the recreational director have introduced physical activities and games on all wards 
during fall and winter months as well. 

Lastly — an articulate standard practice has become a reality in the publication of a 
number of manuals which make it easy to secure accurate information about policies 
and procedures. This was done with the help of the W.P.A. 

We believe employee morale has been strengthened (in spite of the uncertainty of 
changing administrations), patient appearance improved, and hazards reduced, while 
standards of treatment have been kept at their previously high level. 

Changes in the Staff 

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

Dr. William A. Bryan, Superintendent, to Superintendent, Norwich State Hospital, 
Norwich, Connecticut. 

Dr. Norman Render, Psychiatrist in charge of Continued Treatment Service, to 
Clinical Director, Cherokee State Hospital, Cherokee, Iowa. 

Dr. Hans Molholm, Assistant Physician to Cleveland Child Guidance Clinic, Cleve- 
and, Ohio. 

Dr. Ellsworth F. Waite, Assistant Physician, to private practice, Wheelersberg, Ohio. 

Dr. Conrad Wall, Senior Research Psychiatrist, to private practice in Worcester. 

Dr. Phyllis D. Schaefer, Assistant in Child Guidance Clinic, to private practice in 
Summit, New Jersey. 

Dr. James Watson, Director Adult Mental Health Clinic and Supervisor of Family 
Care, to Director, Division of Mental Hygiene, State of North Carolina. 
Promoiions: 

Dr. Walter E. Barton, Assistant Superintendent, to Acting Superintendent. 

Dr. WiUiam L. Holt, Psychiatrist in charge of Female Reception Service, to Senior 
Psychiatrist, Research Service. 

Dr. S. Harvard Kaufman, Assistant Physician, to Senior Psychiatrist in charge of 
Continued Treatment Service. 

Dr. Harold Greenberg, Clinical Assistant, to Assistant Physician. 

Dr. Martin DoUin, Clinical Assistant, to Assistant Physician. 

Dr. Erel Guidone, Assistant Physician, to Director Adult Mental Health Clinic and 
Supervisor of Family Care; 

Katherine R. Dick, Assistant Superintendent of Nurses, to Superintendent of Nurses. 

Mary B. Beach to Director Occupational Therapy Department. 
New Appointments: 

Dr. Paul S. Wolfe, Clinical Director, Colorado State Hospital, to Senior Psychiatrist 
in charge of Female Reception Service. 

Dr. Selwyn Brody, Resident in Psychiatry, Mount Zion Hospital, San Francisco, to 
Clinical Assistant. 

Dr. Max A. Sherman, Assistant Alienist, Bellevue Psychopathic Hospital, to Junior 
Psychiatrist, Research Service. 



P.D. 23 7 

Dr. Edmund F, Walker, Senior Physician, Middletown, Conn., State Hospital, to 
Junior Physician. 

Dr. Joseph M. Zucker, Fellow in Neuropathology, Mount Sinai Hospital, New York 
City, to Clinical Assistant. 

Dr. Lincoln Lebeaux, Interne, Worcester City Hospital, to Clinical Assistant. 

Marion C. Ely to Director of Social Service Department. 

Mary Weston to Assistant Superintendent of Nurses. 
Retirements and Resignations: 

Herbert W. Smith retired on October 16, 1940 from the position of Chief Steward. 

Charles Nord retired on April 17, 1940 from the position of carpenter. 

Joseph Pichette, an attendant at Summer Street Department, retired on June 24, 
1940. 

Elizabeth J. Ward, a housemaid, retired on August 1, 1940. 

Mary Martin, a housemaid, retired on March 19, 1940. 

Katherine M. L. Steele resigned as Superintendent of Nurses, February 10, 1940 to 
become Director of Nurses at the Hospital Municipal Psiquiatrico, Caracas, Venezuela. 

Wanda Misbach resigned as Director of Occupational Therapy, July 27, 1940 to be- 
come Director of Occupational Therapy at the Hospital Municipal Psiquiatrico, Caracas, 
Venezuela. 

Barbara Estes resigned as Director of the Social Service Department, June 8, 1940. 
Deaths: 

Maurice Scannell, Chief Male Supervisor died on March 5, 1940. 
Movement in Population 

A total of 531 patients were admitted for the first time to a mental hospital in the 
year 1940. This is 21 less than in 1939 and 11 fewer than in 1938. Readmissions num- 
bered 229, an increase of 8 over last year. There were 519 discharges to the community, 
an increase of 386 were classified as recovered, 311 were discharged as improved, 27 
unimproved and 95 were without psychosis. Transferred to other hospitals were 30. 
At the end of the year 2,401 remained in residence at the hospital and 437 patients went 
on visit or were otherwise absent. Of these latter 140 were in familj'- care. 

Among first admission, the following mental disorders were the most common: 
Dementia Praecox, 94 Involutional Melanchoha, 37 

Senile Psychosis, 80 Manic Depressive Psychosis, 31 

Psychosis with Cerebral Arteriosclerosis, 55 Psychoneuroses, 30 
Alcoholism with Psychosis, 38 Syphilitic Meningo Encephalitis, 19 

Discharged patients came chiefly from the following types of psychoses: 
Dementia Praecox, 87 Alcoholism with Psychosis, 40 

Psychosis with Cerebral Arteriosclerosis, 28 Psychoneuroses, 23 
Manic Depressive Psychosis, 21 

Psychiatric Activities 

The activities of the clinical staff are presented under a series of functions which con- 
verge onto the main goal of the psychiatric department, namely, the care and treatment 
of those who suffer from personality maladjustment and the prevention of the develop- 
ment of such disorders in the community at large. Broadly these functions can be 
described as consisting of the following: (1) Care and treatment of patients admitted to 
this hospital; (2) Investigation into the general nature of these maladjustments, leading 
to a better understanding of their causes and improvement of their treatment; (3) 
Education of workers who wish to be trained in psychiatry, education of medical men 
in the general field and education of community at large; (4) The organization of plans, 
and measures leading toward a program of preventive medicine. 

I. Adequate care, treatment and adjustment of the patients admitted to this hospital. — 
The procedures leading to this function have been organized during the last year into a 
smoothly working plan which aims at the proper diagnosis and understanding of the 
patients admitted, institution of the most adequate forms of treatment and a study of 
the course of progress with a view to making the most advisable disposition. Daily 
ward rounds are conducted on the various services by the Clinical Director and the staff 
of the respective services at which all new patients are seen shortly after admission and 
a plan of study and treatment is organized. At the end of three weeks after admission, 
these patients are seen again and a final diagnosis as well as review of the plan of treat- 
ment and disposition are thoroughly discussed. Some of these cases that present greater 
problems in arriving at a conclusion and who are particularly suitable for instruction are 



8 P.D. 23 

presented at general staff conferences in which not only the clinical staff but also other 
workers such as nurses, psychologists, social service workers and occupational therapists 
are present. Frequent consultations are carried on with individual members of the staff 
on various problems relating to the care and treatment of individual patients or other 
problems arising on the various services. Of specific methods of treatment that have 
been carried on through the year we would emphasize especially psychotherapeutic 
measures, metrazol and insulin treatment, anti-luetic and other forms of treatment of 
the organic diseases, social therapy and occupational treatment. Some of these and 
their results are submitted in detail. 

The Administration of metrazol and insulin shock treatment has been continued with 
very little change since the Special Therapy Unit was set up in July, 1939. Responsi- 
bility for administration of these therapies was placed in the hands of the Junior Physi- 
cian on the Continued Treatment Service. An effort was made to preserve close contact 
with the physicians on the Admission Services as 86% of the metrazol patients and all 
of the insulin treated patients were on the Admission Services. 

The selection of treatment to be given was decided by Clinical Director in consultation 
with the physicians of the Staff. Uniform standards for study of the physical condition 
were set up in order to minimize the physical risks. Before the patient is accepted for 
Shock Therapy it must be recommended in a Staff note, an x-ray of spine and chest must 
be negative for tuberculosis and bone disease, the blood pressure and heart must be 
normal, and relatives must have approved the treatment. 

Fractures of the vertebrae have been reported by aU physicians doing extensive work 
with metrazol who have taken x-rays of the spine after treatment. We have taken 
x-rays of every patient's spine both before and after treatment and whenever back pain 
was complained of during the course of metrazol therapy. Whereas others report 10% 
to 40% vertebral fractures, we encountered only 5% as a result of special effort to 
prevent their occurrence. No fractures were encountered in 50 male patients treated 
on a new modification of the Bennett fracture board which prevented by hperflexion of 
the spine. 

In spite of careful selection of physically healthy patients, one insulin treated patient 
died while in treatment. Three metrazol treated patients died but in only one case 
could the death be directly related to the treatment, the others dying 6 and 9 months 
after treatment was stopped (of tumor of the kidney and pneumonia respectively). 

Results of Shock Therapy continue to be good. Of 80 male patients treated with 
metrazol 82.5% improved and 59% were able to leave the hospital. Of 135 female 
patients treated with metrazol, 79% improved and 55% left the hospital. Of the 56 
insulin treated patients 79% improved and 68% went out of the hospital. Of the 
metrazol patients sent out 5% returned and of the insulin patients 14% returned. 
Insulin treatment was suspended during hot weather and again when insufficient per- 
sonnel were available. For this reason the average number of insulin comas given was 
only 14 per patient instead of 25 as had been given in the preceding year and is generally 
recommended. The average number of metrazol convulsions given was cut from 15 the 
preceding year to 7. The better selection of patients given insulin and metrazol therapy 
is reflected in the higher number now sent home after completion of treatment; 60% in 
the past year as compared to 49% in the preceding year. 

Our experience with these methods of treatment justifies the conclusion that in certain 
types of mental diseases they exert a definitely good effect even if in some of these it is 
only temporary. The best results with metrazol treatment were obtained in patients 
showing behaviour disturbances, tension, excitement or mood deviation regardless of 
diagnosis. Insulin seemed to be most helpful in patients who showed disturbances in 
thought content, paranoid trends and associative defect. Psychotherapy in terms of 
exploration, education and guidance was utilized with preference where psychogenic 
factors were evident in the etiology. Drugs, such as Sodium Amytal, which facilitate 
contact with patients who are reticent in the discussion of their problems were very 
useful as aids in psychotherapy. A number of other medications that have been sug- 
gested by some observers were tried but without any great effect. This applies to such 
methods as sulphur in oil, deep narcosis, silbesterol in the involutional psychoses, and 
others. 

In the treatment of alcoholic psychoses where in the pathology of which food de- 
ficiencies play a major role, the use of vitamin therapy has proved to be of the highest 
value. In the treatment of the epileptic syndromes the use of phenobarbital and sodium 



P.D. 23 9 

dilantin has met with satisfactory results. Of the methods of treatment related to the 
purely medical techniques we would stress as particularly helpful the judicious and 
systematic application of the various forms of hydrotherapy, occupational therapy 
and recreation. The last has become particularly well organized under the guidance of 
our new recreational director. Games, sports, exercises all help to give new zest and 
interests to patients who tend otherwise to withdraw into themselves and isolate them- 
selves from the outside world. With our increased rate of admission, however, and the 
constant influx of new patients these activities require a higher quota of well trained 
personnel and we would urgently recommend that this be given serious considerationn. 
The increased admission rate also brings in the urgent need. 

Summer Street Department 

The Summer Street Department cares for 260 Male and 325 Female patients with 
110 employees, including 72 who work on the ward. These patients are classed as 
continued treatment cases, are relatively quiet and do not require specialized treatment, 
such as hydrotherapy or intensive medical treatment. FiA^e patients have been dis- 
missed on visit and three placed in family care. 

A well equipped barber shop and personnel hygiene parlor are manned by skilled 
workers, assisted by patients. The men are given three shaves weekly and a hair cut 
monthly and proper attention is given to the ladies' hair. 

The male industrial department cares for about 12 patients under the supervision of 
an instructor and they prepare furniture for painting and do general carpentry and 
repair work. An outside group of 30 men care for the grounds and flower gardens. 
They spend some time during inclement weather making concrete blocks for building 
pm-poses. They made 423 wreaths for the holiday season in addition to shovelling snow. 

Occupational therapy continues to be our main therapeutic approach and results in 
better morale and appearance of our patients, as well as a tendency toward recovery or 
prevention of rapid mental deterioration. 

The occupational therapy department, during this year, has supervised the patients' 
monthly dances, community singing once a month, band concerts twice a month, and 
plays in the chapel. The O. T. Department has charge of the personnel for industrial 
therapy, getting workers for the different departments and keeping the workers on their 
jobs. 

Library books and magazines are in charge of the O. T. Department. Library books 
are given out on the wards once a week to the back ward patients. The parole ward 
patients come to the O. T. office, where the library is maintained, for their books and 
magazines. 

NuKsiNG Department 
General Care: 

Each year a report is made of nurse-patient ratio. The nursing care is limited because 
of restricted ward personnel. The following data covers the average care per patient 
in this hospital for twenty-four hours: 

1. Service for the Physically 111, 1 hour, 9 minutes. 

2. Acute Psychiatric Service, 40 minutes. 

3. Continued Treatment Service, 30 minutes. 

This is a quantitative study and the administrative and extra-nursing duties are 
included with the nursing care. 

The Division on Nursing of the American Hospital Association and National League 
of Nursing Education, with approval from the American College of Surgeons, recommend, 
that average bedside nursing care in each twenty-four hours should be: 
Physically III Adult: 

Medical and Surgical — 3 to 3j'2 hours. 
Obstetrical: 

Mothers and Babies — 2H to 3 hours. 

This is a quaUtative study dealing with bedside nursing care. The National League 
of Nursing Education through the Committee on Mental Hygiene and Psychiatric 
Nursing, has recommended that one interesting activity during the coming year would be: 

"B. Patient care in state institution, the number of hours of care per patient, the 
number of graduates and attendants giving the care."^ 

1 Forty-sixth Annual Report of the League of Nursing Education, 1940, p. 108-11. 19-20. 

A gross study of this nature was made two years ago in this hospital and has been 
reviewed and placed up to date each year. 



10 



P.D. 23 



Personal hygiene and ward hygiene has not decreased although there has been an 
increase in patient census. 

Nurses continue to supervise ward classes in sewing and various other O. T. activities 
such as painting, wood working, etc. 

There have been many changes in the nursing personnel during the year. The follow- 
ing table portrays the number of persons entering the service; the number leaving the 
service; the number ill; the number on vacation and days spent on vacation. The fact 
that 46% more employees left the hospital payroll than in the preceding year reflects 
the improved industrial opportunities for employment. 

A plan for the rotation of supervisors on evening and night duty was established. The 
supervisors elected to spend two months' time on the 7:00 p.m. to 3:30 a.m. and the 
11:00 P.M. to 7:00 a.m. duties. 

The aim of this plan was to provide broader experience for the nurses on the medical 
and psychiatric wards. Every week, two or three persons were to receive the change 
so that patients and ward routine would not be disturbed. 

The hospital is now covered with graduate nurse supervisors for the entire twenty-four 
hours. 

Month 
December, 1939 
January, 1940 . 
February, 1940 
March, 1940 
April, 1940 
May, 1940 
June, 1940 
July, 1940 
August, 1940 
September, 1940 
October, 1940 . 
November, 1940 

Total for 12 months . . 311 306 431 2,561 241 2,313 

The orientation lectures were increased from six hours to twelve hours in order to 

include all hospital routines. 

A program in staff education has been set up. The nurses submitted the subjects 
they wished to have presented. A course in nursing arts was outlined. 

Every two head nurses selected a topic to present to the class. The general duty 
nurse takes turns in demonstrating procedures to the class. Each procedure is amended 
and adopted for use in the Worcester State Hospital. These procedures should be of 
great assistance in establishing uniform nursing technique throughout the hospital. 
Through this method an attempt was made to provide opportunity for group expression 
and to create a desire to participate. 

Social Service Department 
By way of introduction for this year's report pertinent statistics are recorded as a 
basis for the analysis and the evaluation of the work of the Social Service Department. 



Employees Employees 










Services 


Services 


Employees 


Days 


Employees 


Days 


Began 


Ended 


III 


III 


Vacation 


Vacation 


12 


15 


29 


137 


3 


36 


17 


13 


40 


150 


10 


114 


17 


19 


50 


215 


14 


144 


21 


20 


28 


207 


13 


114 


27 


27 


31 


184 


17 


160 


18 


21 


17 


147 


15 


141 


36 


40 


27 


183 


29 


288 


28 


22 


55 


342 


40 


472 


36 


45 


46 


257 


49 


499 


31 


34 


46 


220 


23 


191 


30 


28 


25 


187 


10 


79 


28 


22 


47 


252 


J8 


75 



New Referrals .... 1,833 
Cases carried forward from Nov. 

1939 349 

Total number of cases . . 2,182 
Histories taken .... 242 
Supplementary information ob- 
tained 1,109 

Investigations made . . 1,970 

Interviews with patients on wards 732 

All other interviews . 4,271 



Patients placed in Family Care 

during year .... 109 
Patients placed in Family Care 

at beginning of year . . 145 

Patients placed in Family Care 

at end of year . . . 132 

Patients discharged from Family 

Care ..... 5 

Patients transferred from Family 

Care to visit .... 30 



Last year there were 66 more referrals. This year the number of histories decreased 
(72 less) as well as the service of obtaining supplementary information (623 less) yet 
there was an increase of 398 interviews. 

All statistics indicate that the services and function of the department evolve around 
short-term cases; the number of intensive cases is negligible. Yet we recognize, from a 
psychiatric point of view, that individuals need time to work through their problems, 
both individually and when under treatment; we are aware that immediate conflicts 
readily expressed are not always the basic problems; we appreciate that reUeving en- 



P.D. 23 11 

vironmental stress and strain does not help all individuals in their adjustment. The 
following case exemplifies the service which can be offered by intensive treatment. 

There have been 1,833 referrals during this year and 349 cases were carried over from 
the previous year or a total of 2,182 cases was carried actively by the staff. Assuming 
that each of these nine workers in the department, five of which are students, carried 
full caseloads on a yearly basis, the individual worker would have responsibility for 242 
cases annually. 1,970 cases were investigations, 242 cases were histories; a total of 
2,112 cases or 96.7 per cent of the cases known to Social Service were short-term prob- 
lems. Only 70 of 2,182 cases were not included under histories or investigations, how- 
ever, the statistics do not indicate what specific problem or problems existed in these 
instances. A total of 5,003 interviews illustrates that each case would average approxi- 
mately two interviews, and the statistics do not indicate whether the greater number 
of interviews were held in the hospital or in various communities. 

Thoughtful study of these figures delineates the function of the department and at this 
time we are able to conclude whether the present work is directly related to the specific 
skill and knowledge of the psychiatric social worker who "is concerned with the release 
of resources in the immediate environment and capacities in the individual, which may 
give him a fuller and more satisfying life."^ 

Mr. X was admitted to the hospital in 1932, when he was twenty-two years old, 
because he had failed to make an adequate adjustment in his home. He was diagnosed 
Psychopathic Personality and remained in the hospital a number of years since he was 
unwilling to return to his home and likewise his family refused to care for him. Later 
in making two attempts to adjust to the community he led a "hit and miss" life, took 
odd jobs, only to be rehospitalized. This fall before being discharged he talked to a 
social worker who helped him make the arrangements he wished. An agency in a nearby 
city agreed to aid him until he found work. Immediately Mr. X took the initiative in 
applying for an apprenticeship which would result in his gaining employment in a skilled 
trade in spite of a physical handicap. The worker has continued seeing the patient 
weekly, giving him an opportunity to talk over his difficulties and plans with an under- 
standing person. Mr. X has been out of hospital 4 months, and has been working all 
but two weeks of this period. He has met his expenses, saved some money and bought 
himself clothing. His interest in vocational guidance continues. He is now living with 
his sister who is delighted with his present achievements and he has made several friends, 
whereas in the past he was not a sociable person. 

Statistics show that 190 new cases were referred to Family Care and 145 cases were 
already placed in Family Care homes, i.e., a total of 254 cases was known to Family 
Care during the year. In this given period 5 patients, (1.9 per cent of the total number 
of the patients) were discharged; 30 patients (11.8 per cent of the total number of 
patients) were transferred to visit, while 132 patients remained under Family Care at 
the end of the year. In 1939, 12 patients were discharged and the status of 24 patients 
was changed to visit, which does not emphasize any significant change in work 
carried on this year. These figures raise the question as to whether more patients 
could be helped, through case work treatment, to make a more adequate adjustment 
in society. Will the recent appointment of another worker in the department and 
the increase in board money paid by the State, make it possible to discharge more 
patients each year? Do these present figures indicate that the emphasis of the 
value of Family Care needs to be refocused? 

To suEomarize, the work of the department is now focused on short-term services,, 
although it is recognized that many patients need more intensive case work treatment. 
In attempting to meet this situation there is a need to revise our present statistics so 
that we may have more adequate data. We do not have specific information about the 
types of requests made to the department or the types of problems referred. Nor can we 
determine the problems presented in the intensive cases now carried, such as financial 
difficulties, marital difficulties, school problems, sex problems, vocational guidance, etc. 
No material is available about the number of office interviews versus interviews in the 
community. Ob\'iously, a greater number of office appointments will mean better use 
of time and reduction of expenses. (Within the last two months we have been able to 
use a state car for out of town calls which conserves much of our time.) Every effort 
should be made to reduce office routine to a minimum with an optimum of efficiency. 
We should emphasize inter-agency cooperation so that patients receive the services of 

1 Hamilton, Gordon, "Theory and Practice of Social Case Work," page 12. 



12 P.D. 23 

the organization which is best set up by society to meet his needs. Such cooperation 
will make it possible for more patients to receive case work treatment geared to help 
them to make more satisfactory adjustments in the community. 

Occupational Therapy Department 
During the past year the aims of the Occupational Therapy Department have con- 
tinued to be the following: 

1. To increase the facilities for organized therapeutic activity for the entire patient 
population and get as many patients as possible participating in them. These facilities 
now fall into three groups: the O. T. Shops and pre-industrial centers, the hospital 
industries, and the ward classes conducted by the nurses. 

2. To plan events for special holidays and to cooperate with other departments in 
providing recreational activities throughout the year for all patients. 

3. To educate the hospital personnel in the part they play and their responsibilities 
in such a program. 

Since September this department has been without one staff member due to the read- 
justment of the payroll blocks. To meet this difficulty and take care of the needs of the 
patients, we have placed one therapist in charge of both male and female occupational 
therapy shops and the male and female nurses' supply rooms. Thus she can spend only 
half the day in each shop and depends on the occupational therapy students to run the 
shops alone when she is not there. We feel that this is taking care of the situation 
temporarily, but that this arrangement should not be permanent, since the patients need 
to be guided by a trained therapist during their entire time in the O. T. shops and the 
occupational therapy students also need more supervision. Because of this load of work 
on one therapist, we cannot carry on such close contacts with the nurses in their ward 
classes as we would wish. 

The pre-industrial center on Washburn 2 has not been re-organized this fall because 
of the shortage of ward personnel. There is a need for this class. 

In the past year we have seen an increase in the number of old people being admitted. 
In the present set-up of this department there is no place particularly suited to keep 
these people as active as possible. In the O. T. Shops are the newly admitted patients 
and those on special treatment. The industries are at such a distance from the wards 
on which the older people have lived they are unable to walk to and from work, yet are 
capable of doing more activity than provided by nurses' ward classes. Many of these 
patients could go a short distance to an industrial or pre-industrial center. The creation 
of such shops should be carried out in the next year for both women and men. 

For more than a year a chart has been kept of the amount of articles completed on the 
female wards in nurses' ward classes, the number of patients in these classes, and the 
amount of destruction done during the same period, in order to see if there is a correlation 
between constructive and destructive activities. From the results it would seem justifi- 
able to conclude that generally, as the amount of articles completed rises, the number of 
dresses, blankets, dishes, etc., destroyed dropped. We must, therefore, aim toward 
further cooperation with the hospital staff in drawing into constructive activity every 
patient possible. 

This fall the affiliate nurse working on Washburn 3 has been conducting a special 
class with untidy patients using modeling clay in an attempt to sublimate the patients' 
desires for smearing. The results so far indicate that this is possible and suggest that 
this is one step toward constructive activity. 

In the past year 70% of the men and 49% of the women were working in hospital 
industries, and 10% were in the O. T. Shops. Twenty-three per cent of the women par- 
ticipated in ward occupational classes conducted by the nurses, while only 8% of the 
men were so occupied. Of the remainder 15 % were physically ill and so not kept busy. 
Mr. John Cronan, a member of the nursing personnel, was assigned as recreational 
director in this hospital. Under his guidance and with the cooperation of the nursing 
staff, patients were supervised in playing ball, games and calisthenics. The patients 
were less disturbed, slept better and appetites improved following this exercise. 

During inclement weather, the patients follow the program established for ward 
recreation. This includes dancing, ward parties, group reading, special radio programs, 
marching, calisthenics, the weekly moving picture, and the attendance to religious 
duties. To this list may be added the season's festive days which are celebrated with 
special programs and parties. 



P.D. 23 13 

This department has planned special talks for the patients and nature walks given by 
the staff of the Natural History Museum of Worcester. We cooperate with the music 
department in evenings of community singing and with the weekly art classes. 

During the next year we aim to develop the facilities of this department along the lines 
suggested above so that it will be better able to meet the needs of all the patients. 

Hydrotherapy Report 
In the past year the number of wet sheet packs given showed a considerable increase 
though the number of patients receiving this form of treatment was only slightly greater 
than last year. A total of 722 patients received 28,906 hours of pack treatment compared 
to 19,755 hours the preceding year. The use of continuous tub baths declined in the 
same period. Only 1,251 patients received 70,818 hours of baths compared with 1,711 
patients receiving 126,203 hours the year before. This change is probabty related to 
the increasing value of shock therapy and occupational therapy in meeting the problems 
of the disturbed patient previously treated with hydrotherapy. Some 489 patients 
received 7,654 treatments in the tonic suite where colonic irrigations, electric light baths, 
vapor baths, sahne baths, salt glows, scotch douches, needle sprays, fan douches, foot 
baths, sitz baths and tub shampoos are given. 

Chaplain's Department 

The activities of the Protestant Chaplain during the year may be roughly divided into 
those dealing directly with patients and those in the area of religion and health, though 
not directly concerned with the patients. Past reports have dealt more in detail with the 
work directly with the patients. The bulk of this report will deal with the other type 
of activity, though this does not mean that the work with and for patients has been 
neglected during the past year. 

The work directly with patients centers in religious services and in personal visits with 
patients. Services were held each Sunday morning at both the Main Hospital and at 
the Summer Street branch, the average attendance at these being three hundred. 
Individual patients have been seen on the ward through a system of routine visits, 
through requests by members of the staff or the patient's relatives or clergyman, or 
by request of the patient. The value of such visitation varies of course from patient 
to patient, and it is the task of the chaplain to discover those patients to whom he can 
render a significant service. 

On the more popular level of education, two courses dealing with problems of adjust- 
ment in marriage were given. One of these sponsored by the Y. M. C. A., the other by 
three Worcester churches. In addition to these, seventy-two talks were given to various 
groups in the community, twenty-two sermons were delivered in churches in the com- 
munity and two sermons given on a local radio station. For a period of three months 
the chaplain conducted the Sunday morning services in the Tatnuck Congregational 
Church in the absence of the minister. He also gave a paper on the task of the clergyman 
in the area of mental health before the Massachusetts Mental Hygiene Conference at 
Springfield. 

Another type of activity in the broader field of religion and health has been that of 
maintaining a working relationship between the hospital and the community organiza- 
tions. He has served as secretary of the Department of Religion and Health of the 
Worcester Council of Churches; he has also been a member of the Committee on Religion 
and Health of the Federal Council of Churches. He has served as a theological super- 
visor and member of the Board of Governors of the Council for Chnical Training, a 
national organization which trains theological students in hospitals and prisons. He 
has been a member of the Committee on the Institutional Ministry of the Massachusetts 
Council of Churches. Working relationships between the Worcester Y. M. C. A. and 
the Worcester Y. W. C. A. have been established and maintained by the chaplain. 

There has also been some activity in the matter of publications. An article "Mental 
Hygiene and the Clergy" appeared in the Mental Hygiene Bulletin of the Michigan 
Society for Mental Hygiene, December, 1939. Short articles entitled "Religion and 
Health" were published in seven issues of the Pilgrim Slate News, a Congregational 
Church paper. An article, "Our Ministry to the 111" appeared in Zion's Herald, October 
16, 1940. Another paper, "The Clergy and Community Education for Mental Hygiene" 
has been accepted by Mental Hygiene for publication early in 1941. 

Through the Council for Clinical Training, the Committee on Religion and Health 
of the Federal Council of Churches, and the Department of Religion and Health of the 



14 P.D. 23 

Worcester Council of Churches the chaplain received a grant from the Josiah Macy, Jr. 
Foundation to defray expenses incident to the preparation of a manuscript of book 
length on the problems of religion and health. This work has progressed during the 
year, and will be completed during 1941. 

In conclusion, we wish to express our gratitude to the Massachusetts Congregational 
Conference and Missionary Society for their continued support of this work during 
the past year. 

Radio Department 

After ten years' experimentation with our radio equipment in which we have tried to 
utilize its possibilities to the utmost advantage we have eventually arrived at the point 
where most of the radio activities are of a routine nature. However, if we compare a 
1932 daily program with one of 1940, it will be easy to see that the equipment is carrying 
quadruple the load that it carried eight years ago. The largest single addition to this 
load is the paging of staff members. This system, inauguated last year, has proven so 
successful that it has been continued. Another additional daily feature is the playing 
for two hours daily recorded march music for purposes of marching and exercising on 
disturbed wards. Summed up briefly the radio programs that emanate from Station 
WSH consist of the following items: 1. Programs from the outside that are picked up on 
our heavy duty antennas and re-broadcast. 2. Hospital programs, consisting of news 
bulletins, therapeutic programs, patient programs, recorded programs and marching 
programs for disturbed wards. 3. Doctor's calls, escape calls and announcement of 
clinics. 

During the past year an excellent arrangement has been made with the WPA musical 
units in which we were to get a musical unit once a week throughout the year. The 
WPA Orchestra alternated with the WPA Band. In the fall and winter months these 
concerts are held in the chapel with mental hygiene propaganda being read via radio 
between numbers. During the summer months the units play out-of-doors. 

The weekly drawing classes mentioned in last year's report have been continued with 
decided success. For three weeks in August the Worcester Art Museum sponsored an 
exhibition of "Drawings and paintings by Patients at the Worcester State Hospital" in 
three of their main galleries. This exhibition was hung on its artistic merit and not 
featured on a psychotic basis. Over four thousand people from the community attended 
this exhibition. A paper has been written on this project and is to be published in one 
of the psychiatric journals. 

Expense of the Department 

The total expense of the department for the year amounted to $404.49. This includes 
purchase of radio equipment, labor by the consulting engineer, art material, victrola 
records, and some outside entertainment. It is interesting to note that the entire 
expenditure of the radio and its upkeep for the year amounted to orily $197.17 or 54 cents 
a day. This figure included the purchase of a few dynamic speakers to replace the old 
magnetics. 

Recommendations 

The plan to replace all 100 RCA magnetic speakers with modern dynamic types 
should continue. A system of lights could be installed in the control room and in the 
telephone office enabling the operator to push a button for a certain doctor rather than 
call the radio room by phone. Thought should be given to the eventual purchase of a 
complete new control board as much of the present equipment is now obsolete. When- 
ever a part time worker or voluntary worker could be procured for the radio department 
this should be done. Because of the routine reports, clerical work, maintenence and 
care of the radio equipment, the radio director has little or no time to devote to patients 
that might benefit by private instruction or musical aide. In past years we have been 
fortunate to have voluntary workers from the community as well as "loans" from the 
Occupational Therapy Department. This year there was no such aide. 
Medical and Surgical Activities 

This hospital has a separate medical and surgical unit of 287 beds for the study and 
treatment of physical disease. The service is composed of ten wards : five male and five 
female; each ward reserved, as much as is possible for a particular group of diseases and 
is administered by three physicians. 

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 and Dietician. 



P.D. 23 



15 



Movement of Population 
There were 1,474 cases admitted to the service during the past year. The greatest 
number of cases were admitted during the months of January, February, March and 
April. During the year 563 males and 690 females were discharged from the service. 
Discharges from the service detailed as to physical condition are shown below : 

Table I 

Male Female 
Recovered and improved ....... 508 616 

Not improved ......... 38 32 

Not treated 17 20 

Admitted for study ........ 49 51 

Deaths: 

There were 222 deaths during the year; the average age at death was 66. The principal 
cause of death in 75 was generalized arteriosclerosis; in 17, chronic nephritis; in 17, 
death was associated with some type of fracture (this includes cases dying within a year 
of a fracture). In 16, broncho-pneumonia was a principal cause of death occurring mostly 
in elderly arteriosclerotic individuals; in 8 the principal cause of death was listed as 
lobar pneumonia; dementia paralytica accounted for 10 deaths; 5 died as a result of 
coronary occlusion and 3 as a result of coronary sclerosis; 11 patients died as a result 
of pulmonary tuberculosis; death associated with some type of cancer occurred in 10 cases. 
The remaining deaths were due to various causes in many of which generalized arterio- 
sclerosis was a contributing factor. 

There were 138 (62.2%) autopsied cases during the year; 22 of this group were medico 
legal cases. 

This is an increase of 10% in autopsy rate. 

Table II 
Consultations: 

The following table list the number of examinations made by consultants: 
Eye ... 

Ear, Nose, Throat 
Gynecology and Obstetrics 
General Surgery 
Medicine . 
Pondville (cancer) 
Orthopedics 
Obstetrics: 

During the fiscal year there were 9 deliveries; in the group there was one stillbirth. 
There were no deaths of live births, and there was no maternal mortalitv. 





77 


Neuro Surgical . 






10 




24 


Genito Urinary . 






7 




30 


Dental 






2 




48 


Pediatrics . . 






2 




7 


Electrocardiograms 






4 




16 


Dermatology 






1 




15 


X-ray 






50 



Major Surgical, Operations 
Deliveries ....... 

Hernia Repair uncomplicated and strangulated 

Hysterectomies and other female Surgery 

Blind Hip Nailing 

Hemorrhoidectomies 

Exploratory Laporatomy 

Appendectomies . 

Saphenous Vein Ligations 

Mastoidectomies . 

Cholecystectomies 

Cystoscopies and Pyelograms 

Mastectomies Simple and Radical 

Perineal repair 

Suprapublic cystotomy 



Table III 



9 
6 
6 
6 
5 
4 
4 
3 
3 
3 
3 
2 
2 
2 

One each of the following: Colostomy and resection of volVulos, rib resection, removal 
of cancer of nose, enucleation of eye, resection and lateral anastomosis of jejunum, 
dilatation and curetage, resection of complete prolapse of rectum, sub muccous resection, 
ventriculogram, repair of evisceration, removal of hip nail, Leahy's colostomy first stage, 
removal of foreign bodies from abdomen, omentopexy, tonsillectomy, amputation, 
craniotomy. 
Total 77 



16 



P.D. 23 



Minor Surgery Table IV 
Lumbar punctures with pressure readings 
Suture of lacerations .... 

Incision and drainage .... 

Injection of Varicose Veins . 

Reduction of fractures and dislocations . 

Immobilization in plaster casts 

Aspirations — joints, hydrocele, abdomen, chest. 

Artificial pneumothorax 

Dental extractions under anesthesia 

Excision of Tissue .... 

Blood Transfusions .... 

Examinations — sigmoidoscopic, bronchoscopies, 
Encephalograms ..... 

Biopsies ...... 

Implantation of Testosterone propionate 

Removal of foreign bodies 

Fulguration of tissue .... 

Myringotomy ..... 

One each of the following: Incision and curetage, removal of nasal polyps, 
of urethra, insertion of radium. 
Total 



etc. 



etc. 



177 
144 
143 
57 
58 
42 
34 
21 
15 
11 
11 
12 
10 
6 
5 
3 
3 
2 
dilitation 

. 757 



Table V 
Tabulation of the medical and surgical attention given to employees is listed below: 
Examined and treated at clinic 1,175 Farmers and food handlers ex- 

Required hospitalization . 163 aminations .... 183 

Required operations ... 35 New employee physicals . . 367 

Total number of days on sick ward 929 

Table VI 

This table details the procedure carried out at our Out Patient Clinic for ambulatory 
patients. This is held in a part of the Operating Room Suite. 

Abrasions and lacerations . 1,918 Burns ..... 797 

Furuncles and carbuncles 1,415 Unnas Boots .... 91 

Infections .... 6,698 Miscellaneous . . . - . 3,909 

Ulcerations .... 2,340 

There has been no permanent clinic nurse since August because of a shortage of nurses. 
As a consequence the number of patients treated since that time in the clinic had fallen 
to one third of any previous month. 

To facilitate diagnosis, special clinics were held by physician of the Medical Depart- 
ment to examine eye, ear, nose and for pelvis examinations on female patients. To effect 
economy of time and effort diagnostic procedures are handled in clinic style. In all 
19,110 examinations and treatments were given in special clinics listed below: 



Table VIII 



Eye examinations 

Ear, nose and throat examinations 

Gynecologic examinations . 

Luetic treatments 

Spinal punctures 

Wassermann tests 

Hernia, hemorrhoid and varicose vein 

Small-Pox vaccinations 

Typhoid Vaccines 

Others ..... 



examinations 



783 

757 
1,127 
8,996 

428 
1,405 
1,506 

403 
3,415 

113 

18,933 



Total 

Physiotherapy Department: 

Miss Dorothy Miller, graduate of Boston University Sargeant School, was appointed 
physio-therapist at the end of December, and has efficiently operated this department 
with one assistant during the remainder of the year. 



P.D. 23 



17 



Treatments carried out are given below: 

Baking 

Diathermy (medical) . 

Diathermy (surgical) 

Massage . 

Muscle re-education . 

X-Ray Department: 

Mr. Vincent Nutt was appointed in March to the position of Technician and increased 
the efficiency of operation markedly over last year. 

Table IX 



. 1,994 


Ultra Violet (air cooled) 


1,162 


488 


Ultra Violet (water cooled) . 


84 


22 


Fever therapy . 


230 


660 


Total treatments and tests . 


5,453 


813 


Total number of patients treated 


639 



Photograph of patient 

Films 

Lantern Slides . 



Patients examined . . . 2,380 

X-Ray Films used . . . 3,670 
Finger Prints .... 35 

Foot prints .... 6 

Derdal Department: 

Simon D. Harootian, D.M.D. continues to direct the activities of this department. 
A full time dental hygienist and two dental internes during the summer administer to 
dental needs of all patients. All new* patients have dental examinations, and all patients 
are examined j^early. An effort is made to keep mouths in good condition. Dental 
supplies and dental hygiene on wards is under supervision of the dentist. 



Cleanings .... 


2,211 


Examinations 


5,398 


Extractions 


1,263 


Fillings .... 


1,142 


Microscopic Exam. 


1 


Plates .... 


36 


Repairs .... 


9 


Treatments — miscellaneous 


3,343 


X-Ray and Diag. 


886 


General Anesthesia 


23 



Table X 

Plates Numbered 

Alveoectomy 

Sutures 

Case Records Taken 

Case Records Dictated 

Sutures removed 

Surgical extractions 

Impactions 

Ligatures removed 

Fractures Immobilized 



326 

146 

660 

833 

1 

12 

2 

11 

5 



Total examinations and treatments ........ 16,164 

Total number of patients treated ........ 5,398 

The Grand Total report for 1938-39 exceeds the figures for 1939-40 due to the presence 
of a dental interne from January, 1939 to June, 1939 aside from the usual two dental 
internes for the summer months. 

If a comparison of this year's report (1939-40) is made with 1937-38 figures, it will be 
noted that an actual gain has been made this year. (App. 900 dental operations). 
Dietary Department: 

There have been two definite changes in the Dietary service in the past year. 

The majority of the special trays were cancelled, retaining only such special diets as 
were deemed absolutely necessary by the doctor, such trays as diabetics, nephritics, 
peptic ulcer cases, and sick employees. This necessitates the preparation of from twenty 
to twenty-five special diets daily. Additional fruit, fruit juices, vegetables, egg nogs, 
and chocolate milk have been supplied to supplement the house diets. The diet personnel 
now go to the Medical wards at every meal and serve and supervise tray service and 
dish washing. 

The dietitian assumes the responsibility for correct tray service, dish washing and 
cleanhness of ward kitchens. She also has charge of replacement of dishes and silver- 
ware when needed on medical wards. The dietitian consults with the chef daily on the 
type of food and the quantity to be served to the medical wards. 

The dietary department also serves a full noon meal to all insulin patients on treat- 
ment days. There are from eight to fourteen patients. 

There are approximately 270 people receiving meals under the dietary department. 

Laboratory Report 

The total number of laboratory procedures for the past year has shown a drop of 
approxmately 6,000 from that of the previous year, the total being 53,379 as against 
59,409. The greater part of this drop is accounted for by a decrease in the number of 



18 



P.D. 23 



routine blood chemistry determinations made. This change appears to be due to the 
fact that each service is responsible for the obtaining of blood samples on their own 
patients. Coincident with this change in policy the number of requests for blood chemi- 
cal examination diminished. As an example only 1,491 N. P. N. determinations were 
made this year as opposed to 2,248 last year. 

The total number of autopsies performed during the year was 139, an increase of 37 
over last year. The number of deaths was 222 so that the percentage of autopsies was 
62.2 or 10% higher than last year. 

During the year the laboratory has continued the course in medical technology and 
at the present time there is a greater demand for our graduates than we are able to 
supply. All our previous graduates have been placed and we have been able to call 
back to the laboratory two of our students for permanent positions. We have likewise 
continued to train physicians in pathology but have experienced considerable difficulty 
in finding suitable candidates to fill our two positions. 

The clinico-pathological conferences have been held regularly on the last Thursday 
of the month and have been well received and attended. Every effort is made to choose 
the type of case presented so that some new lesson can be learned at each session. 

It is hoped that during the coming year the plans formulated two years ago for the 
refinishing of the laboratory can be completed. The upper laboratories are greatly in 
need of painting and the floors need covering. 

Laboratory Examinations 
1939-1940 
Abstract of some of the tests from the total of 53.379. 



Laboratory Examinations 



1939-1940 
Pathology 

Autopsies: . . . . 139 

Tissue Sections . . 1,890 

Feces examinations ova, parasi- 

tis, etc. ..... 185 

Bacteriology: 

Animal Inoculations . . 2,053 

Ascitic Fluid .... - 

Sp. Gr 4 

Cells 19 

Bacterial Cultures . . . 779 

Blood Cultures ... 35 

Feces Bile .... 15 

Blood .... 102 

Ova 35 

Parasites .... 33 

T. B 

Fit 

Milk Count .... 306 

Occult Blood ... 633 

Pathological Bacteria . . 63 

Bacteria Smears . . 1,003 

Sputum . .198 

Neufeld Typing . . 2,644 

Vaccines .... 6 

Blood 

Bleeding time ... 33 

Clotting time ... 33 

Differential counts . 3,615 

Erythrocytes counts . 2,465 

Leucocytes counts 3,724 

Platelet counts ... 22 

Reticulocyte counts . . 43 
Hemoglobin . . .3,178 

Malaria .... 3 



Schilling index 

Fragility 

Hematocrit 

Icteric Index 

Sediment 

Typing 

Vandenberg 

Color Index 
Agglutination 

Sp. Bacteria 

Undulant Fever 

Widal Tests 
Feces Typhoid 

Dysentery . 
Skin Undulant Fever 
Skin Test Trichinosis 

Chemistry 
Blood: 
Albumin 
Bromide 
Calcium 
Chloride 
Cholesterole 
Cholesterole Free 
Cholineesterase 
Creatinine 
GlobuUn 
Glutathione . 
Lactic Acid 
Lipoids . 
N. P. N. 
Phospho. Lipids 
Phosphorus 
Potassium 
Magnesiums 
P. H. . 



180 

2 

190 

34 

15 

82 

27 

2,294 

1 

4 
7 
192 
90 
1 
2 



538 

86 
107 

11 
502 
488 
571 

16 
532 
330 

32 

488 

1,491 

488 

431 

406 
6 



P.D. 23 



19 



,701 


Spinal Fluid 


- 


554 


Bromide 


9 


398 


Cell count 


1,103 


9 


Chloride 


1 


152 


Gold Curve . . 


636 


419 


Protein .... 


636 


26 


Sugar .... 


636 


56 


Special tests: 




31 


Tissue Respiration . 


222 


159 


Hormone Extract . 


1,049 


118 


Adrenaline Determinations 


170 


.75 


Haldane Gas Determinations 


24 


75 


Insulin Tolerance 


82 


75 


Spinal Fluid Differential . 


103 


10 


Spinal Fluid Thiocyanate 


85 




Urine Chlorides 


2 




Spinal Fluid Bilirubin 


1 



Sugar 

Table Protein 
Sp. Gravity 
Urea 
Uric Acid 
Phosphotase 
Vitamin C. 
Glucose Tolerance 
Sulphanilamide 
Sulphapyradine 
Thiocyanate . 
Gastric Analyses 
Blood . 
Bile 
Bromide 



Research Activities 
During the year a number of projects have been in progress carried on by a clinical 
staff, some of them in cooperation with the research department. These included sub- 
jects of a chnical nature, specific methods of treatment, investigations into the etiologies 
of various types of disturbances, the care and management of patients both in and out- 
side of the hospital. The cUnical staff emphasized the following: (1) a study of the course 
and prognosis of the psychoneuroses, a report of which was presented at the American 
Psychiatric Association; (2) studies on the problem of old age, reports of which were 
presented at a symposium sponsored by the Massachusetts Society for Research in 
Psychiatry; (3) a Study of the Socio-psychiatric factors in the development of Involu- 
tional Psychoses to be presented at the next meeting of the American Psychiatric Asso- 
ciation; (4) An investigation into the neurophysiological and psychiatric effects of drugs, 
to be presented at the American Neurological Association meeting; (5) the results of 
shock therapy and (6) a survey of hyperthermic methods of treatment in syphilitic 
diseases of central nervous system. Other projects which are carried on in collaboration 
with the research department are mentioned below in the report by that department. 

Research Department 
The Research Department has, as in previous years been subsidized by the Division 
of Mental Health, the Worcester State Hospital, the Memorial Foundation for Neuro- 
Endocrine Research, and the Rockefeller Foundation. In addition, a grant from the 
Armour Company to Dr. R. G. Hoskins has been used for a special stipend and materials 
for study of the biochemistry of sex hormones. 

As in the preceding year, a great part of the activities of the Research Service 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 departments 
are contributing to the undertaking. The organization of this project has been de- 
scribed in some detail in the preceding year's report. 

Dr. Harry Freeman, in collaboration with Dr. Saul Rosenzweig, undertook an investi- 
tion to determine whether any psychologic changes were apparent after the administra- 
tion of a combination of male sex hormone (testosterone) and anterior pituitary gonado- 
tropic factor (Maturity Factor — Armour). Ten schizophrenic patients were given 
anterior pituitary material intramuscularly daily for ten days. Ten other schizophrenic 
patients were gi\ en similar amounts of placebos identical in appearance with the endo- 
crine material. The selection of patients for the blank or potent materials was made 
by Dr. Hoskins and remained unknown to anyone else. The patients were given psy- 
chiatric examinations and photoscope tests (pictures of varying degrees of sexual interest) 
before and after the medication and three weeks later. In 90% of the patients the 
medication produced considerable mental changes, mainly of the nature of the greater 
tension with greater sexual interest, or of reactivation of old conflicts. 

Dr. R. G. Hoskins and Dr. Saul Rosenzweig followed one patient very closely for 
several months to observe the effects of various sex hormones on behavior. It appeared 
that significantly observable effects were produced by some of the medications, but the 
results were not always beneficial nor were they more than transitory. From the stand- 



20 P.D. 23 

point of psychodynamics, the findings are of interest since it was possible to show 
through the intensification of certain drives what were the underlying patterns in the 
behavior of the patient. 

In another study Dr. Hoskins and Dr. Rosenzweig made an attempt to study the 
possible effects of sex hormones in a case of homosexuality of long standing. The patient 
in question was notorious for his feminine behavior and it was therefore thought useful 
as a control project to see what changes, if any, could be produced in him by medication. 
Various sex hormones were administered at the prescription of Dr. Hoskins and inter- 
views were made by Dr. Rosenzweig. The results of the project were negative and it 
seemed reasonable to conclude that this could be attributed to the long-standing char- 
acter of the homosexual behavior, which represented a firm crystallization of the person- 
ality which was no longer amenable to modification by hormone administration. 

Dr. Harry Freeman treated a normal 45-year-old male who complained of impotence 
with testosterone and anterior pituitary material. Marked improvement was noted in 
two weeks which persisted throughout the period of medication when anterior pituitary 
and testosterone were given together throughout the period of treatment. The study 
is interesting in that it seems to indicate that the combination of medicaments was more 
effective than either one alone. The combination seems to be worth a trial in schizo- 
phrenia, a condition in which depressed gonadal activity has been claimed for a long 
time as a possible etiological factor. 

Dr. Joseph Looney has continued the investigations on methods for the identification 
and estimation of the androgens excreted in the urine of schizophrenic patients. The 
pooled extracts from the urine of patients receiving testosterone were fractionated and 
showed the presence of diocholane 3 x-ol 17 one, and etioallocholane 3 x -17 diol. A 
similar fractionation of the extracted steroids from the urine of normal subjects after 
testosterone medication failed to yield these compounds, though Callow has shown the 
presence of the first in the urine of a man receiving 100 mgm. daily of testosterone. Dr. 
Looney also continued the investigation of the use of the polarograph or dropping mer- 
cury electrode for the determination of sex hormones. The manually operated instru- 
ment which he has used has been improved by the addition of an oscilloscope. An 
amplifier was built to enable him to use this instrument in connection with the polaro- 
graph. By its use a visual standing sine wave is impressed on the voltage curve of the 
dropping mercury electrode. A distortion of this sine wave is obtained at the points of 
inflection as the voltage through the dropping mercury cell is changed and this gives a 
rapid means of identifying the compounds present in the cell. With this improvement 
in technique, it is hoped that more rapid progress can be made in the identification of 
the steroid compounds isolated from the urine. 

Dr. Alan Mather has been working with new methods for the isolation and deter- 
mination of sex hormones. He has been making a study of a new reagent, potassium 
guaiacolsulphonate, for the estimation of androgens. By the use of our spectro-photelo- 
meter, he has prepared absorption curves of the products produced by adding this 
reagent to sex hormones under various experimental conditions. The work so far has 
been promising. He has also been studying the question of the solubility of the various 
sex hormones when partitioned between two immiscible solvents. The methods seem 
to be entirely practicable for separating the various hormones. 

A co-operative project relating to insulin and to metrazol treatments has been com- 
pleted. Dr. Conrad Wall compared a group of patients who did well after insulin treat- 
ment with a group who reacted poorly to this medication. He was able to establish 
certain clinical criteria which may have considerable prognostic value for insulin treat- 
ment. A similar study on metrazol-treated cases is nearing completion by Dr. Benjamin 
Simon. 

Data relating to the functions of the vegetative nervous system such as blood pressure, 
pulse rate, circulation time, reaction to adrenalin before and after insulin and metrazol 
treatments are being analyzed by Dr. Harry Freeman. The data on the biochemical 
variables are in process of analysis by Dr. Joseph Looney and other members of the 
Biochemical Department. 

Previously Dr. Andras Angyal and Dr. Nathan Blackman studied the vestibular 
reactivity in schizophrenic patients and normal persons. They found a strong reduction 
of this function in the schizophrenic group. Following this lead several studies of 
vestibular function are being carried out on the Research Service. Dr. Angyal and Dr. 
Blackman studied the nystagmic reaction of patients and normal persons under the 



P.D. 23 21 

influence of increased CO2 tension, hyperventilation, and ingestion of alcohol. The 
reaction of the patients was found to be not only quantitatively different from that of 
the normal subjects but it was, paradoxically, in an opposite direction, (a) Under the 
influence of alcohol the normal subjects showed an increase, the patients a decrease, in 
the number and frequency of nystagmus, (b) Increased CO2 tension depressed the 
nystagmic reaction in normals; in 40% of the patients it caused an increased reaction, 
45% showed no change, and only 15% behaved somewhat similarly to the normals, 
(c) Hyperpnea caused an increase in the normals and a decrease in the patients. 

In order to clarify the causation of abnormal vestibular findings in schizophrenia, it 
seemed desirable to examine separately the various sections of the vestibular nervous 
connections. Dr. Max Sherman compared the optokinetic nystagmus of schizophrenic 
and normal individuals. He found no significant difference between the patients and 
normal subjects and hence he concludes that the pathway from the conjugate center of 
the ocular movement in the mid-brain to the extra-ocular muscles is not primarily related 
to the diminished nystagmus observed following vestibular function. At present Dr. 
Andras Angyal and Dr. Max Sherman are engaged in the investigation of the general 
postural reactions to vestibular stimulation. The indicators used for the measurement 
of changes in the skeletal muscle tonus are past-pointing and deviation of gait. 

Dr. Nathan Blackman is engaged in studying the problem of whether or not the 
abnormalities of vestibular function found in schizophrenia are correlated with the 
duration of illness. For this purpose a group of schizophrenic patients with recent 
onset of illness is being compared with another group of long duration of illness. Dr. 
Blackman is studying the nystagmic reaction of caloric stimulation in persons affected 
with psychoses other than schizophrenia. This study should clarify whether the ab- 
normal findings in schizophrenia are specific to this disease or whether they are common 
to psychoses in general. 

Drs. Harry Freeman and Eliot Rodnick have been measuring the steadiness of 
schizophrenic and normal persons before and after vestibular stimulation by rotation.. 
The amount of swaying is measured by a suitable arrangement and is recorded on a 
drum of the kymograph. The preliminary analysis of their findings revealed that as a 
result of rotation the patients increased in unsteadiness 54% and the normal subjects 
105%. Thus these results are a further confirmation of reduced vestibular reactivity 
in schizophrenic. 

Besides the afore-mentioned collective studies a number of individual investigations 
have also been carried out by the various members of the Research Staff. 

Dr. Otto Kant has examined a group of schizophrenic patients who have been dis- 
charged from the Worcester State Hospital as recovered and have been out of the hospital 
for a period of at least 5 years. After a personal examination he found 39 completely 
recovered cases (6.95%) of the total admissions during the 3-year period that he was 
studying. Dr. Kant studied this group of patients in relation to a comparable group 
of deteriorated patients. The outstanding characteristics in the recovered group were 
acute onset, apparent psychogenic precipitation, presence of clouding of consciousness, 
some manic-depressive admixtures, extraversion and pyknic physique. The de- 
teriorated group showed opposite tendencies. Significant differences were found also 
in the hereditary background of these patients. The manic-depressive psychosis was 
5 times as frequent in the hereditary background of recovered patients as in that of the 
deteriorated patients. Conversely, incidence of schizophrenia was 5 times as frequent 
in the hereditary background of the deteriorated group as in that of the recovered group. 
Dr. Kant studied also a comparable group of highly-improved patients and he found 
that they are midway between the recovered and deteriorated group with respect to 
the above-mentioned characteristics. 

In several of our schizophrenic patients a fairly consistent high eosinophilia count has 
been observed in the past. Dr. Andras Angyal has selected 11 schizophrenic patients 
who have shown in the past a high eosinophile count. Weekly determinations of blood 
morphology were secured on these patients. Examinations of their stools failed to 
reveal parasites in any of these patients. At present Dr. Angyal is testing the hypothesis 
that a poisoning with histamine or similar toxic derivaties may be the cause of the 
eosinophilia. A Winthrop preparation, Torantil, for which a neutrahzing effect of 
histamine and histamine-hke amino derivatives is claimed, is being administered to the 
patients. The results of the experiment are not as yet conclusive. 



22 P.D. 23 

Dr. William Holt is studying the problem of whether the sub-clinical pathology of the 
central nervous system can be revealed under a physiological stress. He is carrying 
out careful neurological examinations of patients kept under low oxygen tension (9% 
oxygen). 

Dr. Nathan Blackman and Dr. Walter Barton have made a survey of intra-mural 
publications of mental institutions in the United States. The data from this survey will 
serve to formulate plans for the more effective use of hospital publications in stimulating 
socially acceptable forms of behavior in mental patients. 

In a previous study with a glycerin extract of adrenal cortex (Glycortal — Schiefflin), 
it was found that the response in blood pressure to the oral administration of this ma- 
terial was greater in patients than in normal subjects. In view of this indication of 
adrenal dysfunction Dr. Harry Freeman undertook a study on one patient with synthetic 
adrenal cortical hormone. The patient was given desozycorticosterone acetate (Per- 
corten — Ciba) intramuscularly every other day for a month, then daily for another 
month. The patient showed no appreciable change mentally except for marked decrease 
of tension and agitation. Physiologically, he showed an increased reaction to the 
administration of adrenalin, a lessened tolerance to glucose, and a greater stabilization 
of the blood sugar level in the glucose-insulin tolerance test. This may indicate greater 
sympathetic reactivity. Other physiological functions such as blood pressure, circula- 
tion time, B. M. R., and blood chemistry were unchanged. 

Dr. Morton A. Rubin studied the electrical activity of the brain in a group of aged 
schizophrenic patients. The electroencephalograms were not different from those of 
the younger schizophrenic patients or normal control subjects in respect to occipital 
alpha frequency, per cent time alpha, or delta index (amount of slow potential changes). 
There are, however, three outstanding features of the senile schizophrenic's EEG when 
compared to that of a younger patient or normal control subject: (a) a tendency for 
an equal distribution of per cent time alpha over the entire head; (b) a tendency for 
alpha frequency to become progressively lower passing rostrally from the back of the 
head; (c) in the majority of the senile group, fast (20-30 per sec.) waves are numerous, 
especially in the frontal regions. The only interpretation that can be made of these 
data at present is that in this group of senile schizophrenics there is less than normal 
relative independence of the various architectonic regions of the cerebral cortex, with 
the net result that they have become more or less equal in their production of electrical 
energy. 

Dr. Morton Rubin studied the encephalographic tracings of schizophrenic and normal 
persons under the influence of hyper ventiliation. In the majority of the cases in the 
normal control group, large slow waves appear in the EEG as a result of overventilation. 
Of the group of schizophrenic patients none has shown slow waves. Most of them had 
an increased per cent time alpha and a few no change at all. 

Dr. Morton Rubin, Dr. William Malamud, Dr. Justin Hope, and Dr. EHzabeth 
Schneidhuber are studying the psychologic changes and the change in the brain activity 
as measured by the EEG in schizophrenic patients under the influence of sodium amytal, 
benzedrine, and cocaine. The data as yet available do not allow any definite conclusions 
to be stated. 

Dr. Joseph Looney has completed studies on the albumin-globulin ratios of schizo- 
phrenic patients and normal control subjects. The results bear out our earlier impression 
that there is a fall in albumin and a decrease in the albumin-globulin ratio in the patient 
group. 

Several studies which have been carried out on the Research Service in the past 
strongly indicate that the oxidative processes in schizophrenia are defective. Mr. 
Elijah Romanoff has undertaken to investigate this problem with the Warburg tech- 
nique. It is hoped that this technique will allow the detection of the lack of necessary 
metabolites or of obnoxious material which interferes with normal metabolism. This 
technique will further allow the study of hormonal influences on metabolism. Explora- 
tory work by the use of the standard poison technique with iodo acetate indicates that 
the uterine muscle will serve best for the dual purpose — detection of poisons and study 
of the influence of hormones. It has been found that the enzyme system involved in 
the metabolism of the uterine musculature differs from that of the skeletal muscles in 
that it is more sensitive to poisons and thus may be a better indicator of toxic material 
in the serum. 



P.D. 23 23 

Dr. Bela Lengyel has made a survey of the recovery, discharge, and mortality rates 
for schizophrenic patients admitted to the Worcester State Hospital during the period 
January 1, 1910 through December 31, 1936. The analysis of these data has required 
statistical treatment and was furnished by the personnel of our Statistical Department. 

Psychology Department 
During the current year a statistical analysis of the work done includes the following: 
Psychometric and Experimental Studies 

Number oj Number of 
Hospital Subjects Procedures 

House Patients 451 1,025 

Schizophrenic Research Patients ..... 314 917 

Out-Patient 

School Clinic 359 378 

Adult Dehnquents 14 36 

Non-Patients (including Employees) .... 298 359 



1,436 2,715 

The above figures conceal psychometric and experimental investigations on a great 
variety of subjects — mentally disordered, borderline and normal, besides school clinic 
examinations and psychometric studies of nurses, attendants, occupational therapists 
and other personnel. Experimental research investigations on various types of patients 
make up the greater portion of the balance. 
I. Research Completed During Year. 

A. Electro-physical treatment of schizophrenic patients. — This project represented an 
attempt to test the therapeutic and psychodynamic significance of a combination of 
mild electric shock and rapid rotation on selected cases of schizophrenia. Approximately 
20 individuals served as subjects, but only about half of these were treated for any con- 
siderable length of time because in the other cases there were contra-indications. 

(a) It may be tentatively concluded that the experiences to which the patients were 
subjected had beneficial effects as related to remission of symptoms in a number of 
cases. Successful results were achieved in such individuals as would probably have 
benefited from metrazol or insulin treatment, i.e., early and acute cases. 

(b) From the standpoint of psychodynamic significance — one of the chief aims of 
the study — it was possible to make observations which tend to bear out the view that 
the psychological effect of the treatment is of paramount importance. 

B. The effect of metrazol shock upon habit systems. — This study was carried out on a 
group of 21 schizophrenics undergoing metrazol therapy; another group of 21 other 
schizophrenics not undergoing pharmacological therapy serving as controls. Two con- 
flicting habits patterns were established. On the critical trials following the metrazol 
shock, the direction in which the subject moved, whether toward Habit I or Habit II 
was noted. The results showed that a single metrazol shock had a significantly greater 
weakening effect upon newer acquisitions than upon older learned material. This 
phenomenon was obtained even when the difference in age of the two habits was rela- 
tively slight. 

C. Ada.ptation to sound in the schizophrenic as measured by the Galvanic skin response. — 
This investigation, carried out on ten schizophrenic and ten normal subjects, indicated 
that the schizophrenic responded significantly less to an anticipatory signal for a loud 
sound than did normals, even though the reaction to the noise itself was of essentially 
the same magnitude. The results indicated that the ability of the schizophrenic to 
mobilize an anticipatory set was at fault, rather than the physiological capacity to react. 

D. Insulin-Metrazol Studies. — Completion of the study on the group of patients 
used in the insuhn-metrazol series. 

Test battery — The major items of the battery used in the investigation were: Stanford- 
Binet, K-R Association, Aspiration, Play Procedure. These items were found the most 
valuable in the analysis of the previous results for the prognostication of improvement. 
In separate analyses of two previous groups it was found that scores on these procedures 
above and below certain critical points prognosticated 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 investigations 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. 



24 P.D. 23 

E. Substitute behavior in interrupted ego tasks. — A study on a group of patients, schizo- 
phrenic and other diagnoses, and normal controls of the method of release of tension 
created by interrupting a task which presumably has considerable ego value for the 
subject. The results are in process of analysis. 

F. Leverett Maze Tests. — A series of Maze tests intended for the study of intellectual 
and other personahty characteristics was published and put into general circulation 
with instructions, and norms. 

II. Research in Progress. 

A. Test for types of reaction to frustration. — This project represents an attempt to 
construct an instrument which will give a behavioral measure of typical ways which a 
subject adopts in reacting to situations of frustration. The test includes some seven 
sub-sections, each of which attempts, like the various sub-tests of the Binet, to tap one 
or another kind of level or type of frustration behavior. Thus far, the test has been 
administered to six groups of subjects, including mainly normal individuals but also 
containing a small sample of psychotic and neurotic patients. Approximately 200 sub- 
jects have been tested. The results are promising, particularly because of the very 
great reliability of the results when groups are compared. 

B. Reactions to experimentally induced frustration. — In this investigation a moderately 
strong frustration is induced by blocking the drives of financial gain and maintenance 
of ego status. After enjoying some success on a simple game of skill, in which the score 
is controlled surreptitiously by the experimenter, the subject is frustrated by making 
him obtain low scores. Immediately after the frustration, the reactions to frustration 
are measured by two techniques: the pursuitmeter and thematic apperception tests. 
The main purpose of the study is the determination of differences in the patterns of 
reactions to frustration, on the one hand, between schizophrenic and normal subjects, 
and on the other hand, between acute and chronic patients. In the former case the 
objective is the determination of the relationship between the pattern of the reactions 
to frustration and the psychiatric picture which the schizophrenic presents. The com- 
parison of the latter groups of subjects should shed light on the progressive changes that 
occur with increase in chronicity of the disorder. 

C. Autonomic and respiratory reactions to changes in intra-pulmonary atmosphere. — 
This investigation is an extension of a study published earlier. Acute and chronic 
schizophrenics are being compared for purposes of studying the phenomenon of deteriora- 
tion. The inclusion of other psychoses as well is planned. The original apparatus was 
redesigned and simplified in order to improve its ease of operation and portability, 
with a view toward standardizing its use as a test instrument of autonomic function 
under stress. In the earlier investigation it was found that when the inspired air was 
heated above body temperature and saturated with moisture, a fairly marked autonomic 
reaction occurred in normal subjects. In schizophrenics, however, the reaction was 
comparatively slight. The measures used were heart rate, blood pressure and respira- 
tory rate and amplitude. In the present modification, in which both temperature and 
humidity of the inspired air is automatically controlled, the same autonomic and re- 
spiratory measures except for respiratory rate will be employed. Thus far only pre- 
liminary results have been obtained. 

D. The effect of hyperventilation upon the galvanic skin response. — This minor study 
merely a preliminary control for the experiment which has just been described, in order 
to determine whether the effect of the respiratory stress might be a result of hyper- 
ventilation. 

E. Effects of testosterone on psychological functions. — This project is continuing with 
special emphasis being placed on the use of the Thematic Apperception and Rorschach 
Tests. 

F. Psychological functions in cases cf brain damage. — A continuation of work on the 
study of patient with organic brain damage by means of a battery of pschological tests. 
The literature on the psychological effects of brain damage has also been worked up. 

G. K-R Association Test Norms. — Continuation of the work done on developing a new 
and more adequate scoring system for the Association Test. 

H. Deterioration Studies. — -Preliminary to a major project on the deterioration process 
in schizophrenia the literature on deterioration has been collected and to a considerable 
extent abstracted. 

I. A study of sibling deaths in the pre-psychotic history of schizophrenic patients as a 
factor in etiology. — -A study, mainly statistical, on this problem. 



P.D. 23 



25 



III. Analytic Work in Progress. 

A. Memory studies. — Data on the mnemonic functioning in the various psychoses 
(some 900 cases) is still in process of rescoring by a new scoring system based on one 
developed for control group of normal subjects. The data on the latter (192 cases) are 
in the process of statistical analysis. 

IV. Research and Analytic Work Planned for 1940-41- 

Besides the continuation and completion of the researches stiU in progress the follow- 
ing are planned for the coming year: 

A. Deterioration. — A comprehensive study of the process of deterioration as indicated 
in the disturbance of psychological function has already been started in a preliminary 
fashion. Those patients are being used on whom data are available for a period of ten 
years or so. From these data it is hoped to determine the different varieties of deteriora- 
tion and make comparisons with non-deterioration cases. 

B. Responsivity in schizophrenics as compared with normal and psychoneurotics. — In 
connection both with the development of devices which may be of use in the national 
emergency and the continuation of projects of interest to us on our schizophrenia 
research a certain integration of projects already planned and some new projects into a 
general project will be part of a larger schedule to be participated in by the Research 
Service as a whole. The plan is to work with groups of schizophrenics, normals and 
psychoneurotics on the following program: 

1. Adaptation to sound as measured by the galvanic skin response (Described above). 

2. Reactions to experimentally produced frustration. (Described above). 

3. Autonomic and vestibular reactions to rotational stimulation. (Described above). 

4. Tautophone. Use of a simplified form of the test which has been found of value in 
distinguishing between schizophrenic and normal subjects. 

Library Report 
I. Medical Library 

The Medical Library is constantly expanding with an average yearly accession of 300 
bound volumes of periodicals and 100 medical monographs and textbooks purchased 
from current funds. Also, we receive donations from the Medical Library Association 
Exchange and from members of the staff. 

To relieve the congested condition in the main library, an additional stock room has 
been made available for the old and little-used material. The library now has two 
connecting basement stock rooms which are reached by way of a new stairway leading 
directly from the reading-room. This is an improvement which has long been advocated 
and has proved its value in bringing the entire resources of the library within easy reach 
of the readers. 

The activity and usefulness of the medical library are indicated by the following 
details: 

Periodicals: Realizing the importance of medical periodicals in the advancement of 
research, we try to maintain this section of the library at the highest level possible with 
the resources available. Issues of 123 periodicals were received in 1940. Of this number, 
the Hospital subscribed to 104, 2 were paid for by the Memorial Foundation for Neuro- 
Endocrine Research, 3 were donated by Dr. Hoskins, 3 by Dr. Barton, 1 by Dr. Malamud, 
2 by Dr. Looney, 1 by Dr. W. Freeman and 7 came in free from institutions and scien- 
tific organizations. Due to the war, our foreign periodicals ceased to arrive after March, 
1940 and it is intended to eliminate these from our next year's subscription list. 

Circulation: The Medical Library circulated 809 volumes in 1940. Most of the 
periodicals and the reference books are consulted in the library so the circulation figure 
is only a partial indication of the use of the library. 

Inter-Library Loans: The librarian contacted other medical Libraries and during the 
year borrowed 126 volumes from 5 libraries as listed below: 

Boston Medical Library ........ 80 



New York Academy of Medicine Library 
Harvard College Library .... 
Clark University Library .... 
Library of Congress ..... 
Our library lent 38 volumes to three libraries as follows 
Worcester Medical Library .... 
Norwich State Hospital .... 
Rutland Sanitarium ..... 



27 

13 

4 

2 

36 
1 

1 



26 P.D. 23 

Medical Library Association: The library maintained 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. Forty-eight volumes were received from the Exchange of the Association 
during the year. 

New Books: In addition to the newly bound volumes of periodicals, 139 other new 

books were added to the shelves in 1940. The library is used extensively by the affiliate 

nurses and for their benefit a considerable number of textbooks were purchased during 

the year. 

Binding: 185 volumes were bound during the year, mostly current medical periodicals. 

Present State: On November 30, 1940, the inventory of the library shelves showed — 

Bound volumes of periodicals ...... 4,796 

Unbound volumes of periodicals ..... 23 

Current books 2,094 

Old books (mostly historical) ...... 1,416 



Total Volumes 8,529 

This is an increase of 615 volumes over the previous year. 

Catalogued reprints ........ 7,452 

Abstracts .......... 6,104 

Bibliography cards 12,227 

Lantern slides ......... 64 

Services: The librarian continued to circulate bibliographies and abstracts, prepare 
special bibliographies, and translate foreign medical articles for the use of the staff. The 
bibliographies, abstracts and translations are filed in the library. 

W. P. A. Projects: The two projects approved by the Federal Government, namely 
compilation of a bibliography of schizophrenia and continuation of the file of collected 
abstracts on this subject, have been completed during the year. This work has enabled 
us to assemble a comprehensive and highly valuable special section in the library for the 
use of the staff working on schizophrenia research under special grants to this hospital. 

At present writing, no W. P. A. workers are assigned to library projects. 

A^. Y. A. Workers: Through the Federal Agency for training of young people, three 
workers have been assigned to the libraries of this hospital, each giving eight days' 
service per month. Their help in the routine administration of the libraries has been 
considerable and without their assistance it would be extremely difficult to cover all the 
clerical work necessary. 

Recommendations: Due to the greatly increased activities of the Library a telephone 
and some permanent clerical help are urgently needed. 

II. General Library 

A library maintained for the benefit of the patients, plays an important role in a mental 
hospital. Bibliotherapy is one of the avenues of approach in the rehabilitation of the 
patients. In the hands of a competent librarian, weU-acquainted with books and used 
to the ways of mental patients, the library may safely be described as affording the 
patients an environment and social situation very similar to that available in the com- 
munity. 

Unfortunately, the high aims of an aggressive library policy cannot be attained in our 
library under the present arrangements. The library room itself is pleasant and the 
furniture attractive; the choice of current magazines and newspapers is adequate for a 
hospital of this type. Although funds for the purchase of new books are limited, we are 
able to acquire the most important recent books. Where we are less successful is in the 
matter of personnel to administer the collection. During the last ten years, we scarcely 
ever have had a librarian qualified for the task. We have experimented with patients, 
W. P. A. and N. Y. A. workers, attendants and volunteer help (some years as many as 
five or six persons being in charge of the desk). The primary cause for the constant 
change in personnel has been the lack of an appropriation for a qualified employee. All 
personnel so far supplied have been "loaned" from a project or another department 
which has first lien on the individual's services. This division of interest and supervision 
is incompatible with efficient administration. 

In the first half of the year. Miss Jeannette Belliveau was in charge of the library, 
taking care of the desk and making regular trips to the wards — twice a week to the male 
wards, twice a week to the female wards, and once each week to the Summer Street 



P.D. 23 



27 



Department, Hillside Farm and the Farmhouse in rotation. Through this system, a 
good selection of books and magazines was made available to the patients who cannot 
come to the main hospital library. After Miss Belliveau's resignation on July 1, 1940, 
Mr. William Foxhall took over the duties. Unfortunately in October, his services were 
required for ward duty. Since that date, three N. Y. A. girls have helped in the Library. 
This had made it possible for the library to be open certain hours during week-days. 
With a regular employee in charge, it is our plan to keep the library open in the evening 
and at weekends so that working patients may have an equal opportunity with others 
to use the library. Since October, the ward service and the evening reading hours have 
had to be discontinued. 

During the fiscal year we added 119 new books to the shelves. On November 30, 1940 
the General Library had: 

Books (fiction and non-fiction) . . . . . . 2,182 



Serials 

Bound magazines . 
Bibles and prayer books 
Reference books . 



212 
95 
36 
73 



Total books 2,598 

In addition to our stock, we borrow 100 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 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 every three months and 10 popular 
magazines and 4 newspapers are subscribed to for this department. 

The Library is well patronized by patients and employees. The circulation figures 
for the year are quoted below: 

Fiction 6,257 



Non-fiction . 
Magazines . 
Ward service 

Total circulation: 
Patients' book charge slips 
Employees' book charge slips 
Reading patients . 
Reading employees 



1,667 
2,308 
5,498 

15,730 
6,195 
2,206 

12,601 
1,250 



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

List of Publications for Worcester State Hospital 
December 1, 1939 — November 30, 1940. 

1. Angyal, Andras with Nathan Blackman. Vestibular Reactivity in Schizophrenia 

Arch. Neur. & Psychiat. 44; 661, September, 1940. 

2. Angyal, Andras with Harry Freeman and R. G. Hoskins. Physiologic aspects of 

schizophrenic withdrawal. Arch. Neur. & Psychiat. J+Jf. 621, September, 1940. 

3. Blackman, Nathan. Experiences with a Literary Club in the group treatment of 

schizophrenia. Occ. Ther. and Rehab. 19: 293, October, 1940. 

4. Bryan, WilUam A. How to obtain necropsy permits? Mod. Hosp. 51^: 44, April, 



1940. 

5. Bryan, William A. 

6. Devereux, George. 

December, 1939. 

7. Devereux, George. 



Mental patients in small towns. Mod. Hosp. 51^: 77, May, 1940. 
Maladjustment and social neurosis. Am. Soc. Rev. 4.- 844, 



Social Negativism and Criminal Psychopathology. J. Criin. 

Psychopath. 7.- 322, April, 1940. 
Freeman, Harry. Heat-regulatory mechanism iii normal and in schizophrenic 

subjects. (Under basal conditions and after the administration of dinitrophenol.). 

Arch. Neur. & Psychiat. 43; 456, March, 1940. 
Freeman, Harry with Eliot H. Rodnick. Autonomic and respiratory responses to 

changes of intra-pulraonary atmosphere. Psychosom. Med. 2: 101, April, 1940. 



28 P.D. 23 

10. Greenhill, M. H. with M. Yorshis. Prognostic criteria in dementia paralytica. 

Am. J. Psychiat. 57; 167, July, 1940. 

11. Hoskins, R. G. with Rose Small. The influence of diethyl stilboestrol on the spon- 

taneous activity of male rats. Endocrinol. 27: 452, September, 1940. 

12. Kant, Otto. Differential diagnosis of schizophrenia in the light of the concept of 

personahty stratification. Am. J. Psychiat. 97: 342, September, 1940. 

13. Kant, Otto. Types and analyses of the clinical pictures of recovered schizophrenics. 

Psychiat. Quart. Ij: 676, October, 1940. 

14. Lee, Milton with William Freeman. Liver growth in rats treated with anterior 

pituitary growth hormone. Endocrinol. 26: 493, March, 1940. 

15. Looney, Joseph M. The treatment of pituitary dwarfism with growth hormone. 

Endocrinol. 26: 163, January, 1940. 

16. Looney, Joseph M. Sex factors of the adrenal gland. Endocrinol. ^7.- 511, Septem- 

ber, 1940. 

17. Looney, Joseph M. The effects of pregnant mare serom on spermatogenesis in man. 

Endocrinol. 27: 753, November, 1940. 

18. Looney, Joseph M. with Elijah B. Romanoff. The effect of testosterone on the 

serum lipids of normal subjects. J. Biol. Chem. 136: 479, November, 1940. 

19. Randall, Lowell O. Effects of repeated insulin hypoglycemia on the lipid composi- 

tion of rabbit tissues. J. Biol. Chem. 133: 129, March, 1940. 

20. Randall, Lowell O. Effects of Testosterone on serum lipids in schizophrenia. J. 

Biol. Chem. 133: 137, March, 1940. 

21. Randall, Lowell O. The effects of insulin on serum lipids and choline esterase in 

schizophrenia. J. Lab. & CUn. Med. 25: 1,025, July, 1940. 

22. Rodnick, E. H. with D. Shakow. Set in the schizophrenic as measured by a com- 

posite reaction time index. Am. J. Psychiat. 97: 214, July, 1940. 

23. Roheim, Geza. The Garden of Eden I. Psychoanal. Rev. 27: 1, January, 1940. 

24. Roheim, Geza. The Garden of Eden II. Psychoanal. Rev. 27: 176, April, 1940. 

25. Roheim, Geza. Freud and Cultural Anthropology. Psychoanal. Quart. 9: 246, 

April, 1940. 

26. Roheim, Geza. Society and the Individual. Psj'^choanal. Quart. 9: 526, October, 

1940. 

27. Rotter, Julian B. Studies in the use and vaUdity of the Thematic Apperception 

Test with mentally disordered patients. I. Method of analysis and clinical 
problems. Char. & Person. 9: 18, September, 1940. 

28. Rubin, Morton A. with Harry Freeman. Brain Potential Changes in Man During 

Cyclopropane Anesthesia. J. Neurophysiol. 3: 33, January, 1940. 

29. Rubin, Morton A. Electroencephalography in the Psychoses: Localization of 

Cerebral Atrophy. Am. J. Psychiat. 96: 861, January, 1940. 

30. Shakow, David with Saul Rosenzweig. The use of the Tautophone ("Verbal 

Summator") as an auditory apperceptive test for the study of personality. Char, 
and Person. 8: 216, March, 1940. 

31. Shakow, David. One psychologist as analysand. Jour. Ab. & Soc. Psych. 35: 198, 

April, 1940. 

32. Snyder, William U. with Louis H. Cohen. Validity of imagery testing in schizo- 

phrenia. Char. & Person. 9: 35, September, 1940. 

33. Wall, Conrad. Observations on the behavior of schizophrenic patients undergoing 

insulin shock therapy. J. Nerv. & Ment. Dis. 91: 1, January, 1940. 

34. Wegrocki, Henry J. Generalizing ability in schizophrenia. (An inquiry into the 

disorders of problem thinking in schizophrenia.) Arch, of Psychology 35: 254, 
July, 1940. 

35. Wise, Carroll A. Mental Hygiene and the Clergy. Mental Hygiene Bull, of the 

Michigan Soc. of Mental Hygiene, December, 1939. 

36. Wise, Carroll A. Our Ministry to the 111. Zion's Herald, October 16, 1940. 

Scientific Assemblies Addressed by Staff Members 
Andrus Angyal, M.D., with Nathan Blackman, M.D. American Psychiatric Associa- 
tion, Cincinnati, May 20-24, 1940. "Paradoxical Vestibular reactions in Schizophrenia 
under the influence of alcohol, of hyperpnea and carbon dixoide inhalation." 

Boston Society of Psychiatry and Neurology, Boston, Mass., March 21, 1940 with 
Nathan Blackman, M.D. "Vestibular reactivity in Schizophrenia." 

Walter E. Barton, M.D., American Hospital Association, Boston, Mass., September 
19, 1940. "Sick Leave." 



P.D. 23 29 

With Hans Molholm, M.D., American Psychiatric Association, Cincinnati, May 
20-24, 1940. "Family Care; a community resource in the rehabihtation of mental 
patients." 

Massachusetts Society for Research in Psychiatry, Taunton, October 11, 1940. 
Exhibit — Vasodilator Bed in treatment of arteriosclerotic psychoses. 

Mary B. Beach, Reg. O. T., American Occupational Therapy Association, Boston, 
September, 1940. "Evaluation Clinic." 

Nathan Blackman, M.D., American Psychiatric Association, Cincinnati, May 24, 
1940, "Experiences with a Literary Club in the group treatment of Schizophrenia." 

WiUiam Freeman, M.D., Massachusetts Society for Research in Psychiatry, Taunton, 
October 11, 1940. Exhibit — "Pathology in the aged Psj'chotic." Discussant — "Vitamin 
C Studies on the Aged." 

Otto Kant, M.D., Boston Society of Neurology and Psychiatry, Boston, November 
21, 1940. "A comparative study of a group of deteriorated and recovered schizophrenic 
patients." . 

Joseph Looney, M.D., The Association for the Study of Internal Secretions, New 
York, June, 1940. "The effect of the administration of testosterone proprionate on 
normal and schizophrenic subjects." 

William Malamud, M.D., American Psychiatric Association, Cincinnati, May 20-24, 
1940. "Prognosis in Psychoneuroses." 

American Neurological Association, Rye, N. Y., June 6-8, 1940. Discussant paper by 
Lindermann and Finesinger. 

Massachusetts Society for Research in Psychiatry, Taunton, October 11, 1940. 
"Current trends and needs in research on problems of the aged." 

Worcester District Medical Society, February 14, 1940. "The Treatment of the 
Neuroses." 

Conference on Psychological Methods for Personality Selection. National Research 
Council, Philadelphia, November 23-24, 1940. "Clinical Psychiatric Examinations." 

Eliot H. Rodnick, Ph.D., American Psychological Association, State College, Perm- 
sylvania, September, 1940. "The effect of metrazol convulsions upon habit systems." 

Saul Rosenzweig, Ph.D., Eastern Psychological Association, Atlantic City, April, 1940. 
"Need-persistive and ego defensive types of reaction to frustration." 

Worcester District Medical Society, February 14, 1940. "Experimental Neuroses." 

J. B. Rotter, Midwestern Psychological Association, Chicago, 111., May, 1940. "Re- 
actions to experimental induced fustration." 

Benjamin Simon, M.D., with S. Harvard Kaufman, Massachusetts Society for Re- 
search in Psychiatry, Taunton, October 11, 1940. "Psychiatric Problems of the Aged." 

Conrad Wall, M.D., American Psychiatric Association, Cincinnati, May 20-24, 1940. 
"Some prognostic criteria for the response of schizophrenic patients to insulin treatment." 

Educational Activities 

The programs in this field have been carried on both in the hospital and outside of it. 
These have been concerned primarily with the training of members of the staff, especially 
of the residents. In addition to the instruction given at rounds and conferences, lectures 
on various phases of this field were given by the clinical director, members of the staff, 
psychologists, etc. As in previous years, fourth-year medical students from Tufts 
Medical School and from Boston University Medical School served one month interne- 
ships at the hospital and special programs of instruction were carried on by the staff 
for them. Evaluation clinics for occupational therapy students and social workers were 
continued throughout the year with case discussions and the formulation of plans for 
treatment. 

There were 59 students in training in the hospital most of the time last year divided 
into groups listed below: 
Medical Student Internes (for 1 month) 5 Laboratory Technicians ... 2 



Graduate Medical Residents 
Graduate Pathology Residents . 
Dental Internes (for 3 months) . 
Psychiatric Social Service Students 

Smith College 

Simmons College . 

Boston University 
Psychology Students 
Occupational Therapy Students 



6 Child Guidance Clinic 

2 Psychology Student . . . 1 

2 Social Service Students . 3 
Medical Residents and Special 

3 Students ..... 4 
1 Affiliate Student Nurses (3 months) . 13 
1 Postgraduate Nurses . 3 
5 . — 
8 5'9 



30 



P.D. 23 



Teaching appointments held by the staff members were as follows: 

Dr. R. G. Hoskins, Professor of Endocrinology, Harvard Medical School. 

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. 

Lectures Clark University. 

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

Dr. Saul Rosenzweig, Instructor in Psychology, Clark University. 

Mr. Carroll A. Wise, Instructor in Psychology, Boston University School of Religion 
and Social Work. 

Drs. Malamud, Looney and Mr. Shakow served as instructors in course on Neurology 
and Psychiatry at the Metropolitan State Hospital. 

Nursing Education Department 

In 1940 the Nursing Education department made a consistant effort to increase the 
amount and quality of ward teaching and experience of the student nurses in the clinical 
situation. This necessitated greater expenditure of time by the instructors and head 
nurses. Individual instruction and instruction of small groups seems to have shown 
that there was more enthusiasm and initiative and better learning on the part of the 
students. In order to help students to anticipate and prepare for nursing situations, 
rotation schedules were made for the students' entire period of service in the hospital. 
An attempt was made to create situations which would help the students integrate all 
their activities into a skiUful ability to adjust better to their future personal, social and 
professional Ufe. 

Post-Graduate Instruction: — In May two students completed the Post-graduate 
Course and in October three students were enrolled. 

It was necessary to grade the type of experience planned for each student because of 
background, desires and expectations from the course. Changes were made in the 
Course of Study to pattern it to those in institutions of higher learning. It is hoped 
that sometime soon the revised Course of Study will be accepted and credited by a 
coUege or university near Worcester as part of a degree program. 

Special attention was given to sequence and chronological order in which courses were 
presented to ensure a logical and more easily assimilated development. Major changes 
were as follows: 

Psychotherapy increased ....... 9 hours 

Psychiatric Nursing increased ....... 13 hours 

Throughout the Psychiatric Nursing Course emphasis was placed on planning and 
executing the best possible type of nursing care and on the principles and methods of 
ward supervision, management and teaching. 

It was planned for the first time to give beauty parlor experience and out-patient 
department experience. Whenever possible conventions and meetings were attended in 
an attempt to broaden the students' knowledge and interest in their own and other jfields. 

The Nursing Education Department was expecially fortunate in having Mrs. Mala- 
mud plan and teach the Sociology Course. It is different in that applications are made 
to psychiatric hospital and nursing situations and is, therefore, more functional. 

On request of the students and because it seemed to be in the best interest both of 
the hospital and the health of the nurses a forty-four hour week including classes was 
established in December. 

Affiliate Nursing Instruction Program: — Affiliate nurses came from the following 
hospitals in 1940: 

Burbank Hospital, Fitchburg 12 students 



Worcester City Hospital 
Worcester Hahnemann Hospital 
Worcester Memorial Hospital 
Worcester St. Vincent's Hospital 



12 students 

8 students 

23 students 

21 students 



Total .76 students 

About six students commuted from their own hospitals during the year except in the 
winter. Some of the affiliates have joined our staff upon graduation; others plan to do 
so; while still others plan to return as post-graduate students. 



P.D. 23 31 

Special classes in clay modeling were conducted for the untidy patients and there was 
found to be a noticeable decrease in destruction and soiling in this group of patients 
when they were occupied in this class. 

In July a revised course of study was instituted upon the suggestion of the State De- 
partment. The major changes were the introduction of three subjects: 

Psychology, including psychometrics ..... 20 hours 

Sociology . . . . . 4 hours 

Neuroanatomy, including autopsies . 10 hours 

Since the students had previously attended at least four hours of autopsy the increase 
by the addition of these subjects is thirty hours. Most of the students have had neither 
Psychology nor Sociology before they come here so these subjects are necessary in 
order to give a better basis for psychiatry and psychiatric nursing. However the 
Curriculum Guide for Schools op Nursing^ recommends that these two subjects 
be taught in the first year of the nurse's education. This would mean that these subject 
should be prerequisites to their affiliation. If this were so, there would be more time 
for the student to get experience in the clinical situation than is possible under the 
present plan. 

: Staff Education Program: — A Staff Education Program was planned and begun with 
the cooperation of the entire nursing staff and opportunity was provided for active 
participation by every member. Procedures, new treatments and medications, and the 
principles of ward administration and teaching were to be discussed. The first step 
of this program is the evaluation and reconstruction of nursing procedure. It is hoped 
that this program will stimulate the nursing staff to be progressive while they are in 
our organization and to prompt them to seek further study so that they will give the 
best scientific nursing care. 

Community Service 

In an attempt to reach out into the community for the purpose of treating the milder 
forms of personality maladjustment and also to prevent the occurrence of more severe 
deviations and to keep in contact with the psychosomatic problems as they are met with 
in the field of general medicine an outpatient clinic at the Worcester City Hospital was 
carried on with the help of a social worker and a psychologist. Most of the patients seen 
there were treated at that clinic although some who presented more severe problems 
were referred for admission to the State Hospital. Statistics concerning this service are 
still not available. 

The Worcester Child Guidance Clinic 

Emphasis at the Worcester Child Guidance Clinic during the year has been on treating 
cases rather than mere diagnostic service, hence the number of interviews per case has 
been increased. 

The demand for this type of service is also increasing, and because these cases take a 
longer time and more frequent interviews, the clinic has had to establish a waiting list. 
At the end of the fiscal year, this list stood at twenty-one children waiting for treatment. 
This nuinber has since been materially reduced. 

Keeping children and parents waiting for treatment has a somewhat detrimental 
effect on therapy. The continuity of our contacts is interrupted for one or two months 
and this serves in the long run to make treatment even longer. Sometimes it seems that 
the clients are discouraged and do not return at all when we finally re-establish contact 
with them. 

The training program for psychiatrists, social workers, and psychologists has continued 
as before. The clinic has increased its communication with the community. Two 
pamphlets were issued during the year, describing the work of the clinic, and sent to a 
mailing list of fifteen hundred community people. An "Open House" was held during 
May for two nights and many attended to learn first-hand of the clinic's work. Ninety 
talks were given to various organizations by members of the clinic staff. 

With the pressure of demand for work on cases, it has been difficult to bring our follow- 
up study near to completion. However, this is nearing the final phase of its work, and 
a report will be made on three hundred treatment cases during a period of seven years. 
A real diflHculty has been sensed in the keeping of notes and statistical records. There 
is need for a system that will coordinate records, statistics, follow-ups, community work, 
research time, and time spent in classes and seminars. The clinic has been working out 

1 National League of Nursing Education, New York, 1937. 



32 



P.D. 23 



forms which should make all of this relatively simpler than it has been heretofore. The 
allocation of the working time of staff members needs some consideration. It may be 
roughly budgeted, but in order to budget, some estimate must be first made of where it 
is going now. Monthly reports should, therefore, include as far as possible, the various 
avenues in which any staff worker directs his time, whether administration, classes, 
effective time with cases, community work, or anything else. An attempt is being made 
to summarize these various points and to evaluate them for relative effectiveness. 

The clinic feels the need for another stenographer to handle all the work of ten staff 
members and students. The clinic at present has one stenographer and one "Attendant 
Nurse," who must handle clients and telephone calls in the waiting room. The addition 
of another would help materially toward clearing up the waiting list and adding to the 
efficiency of the clinic. 



Report of Case Load: 

A. Cases Carried During the Year: 

1. Cases carried over from last year 

2. Intake: 

a. New Cases Accepted: 

Ages: 12 3 

Number of boys - - 1 3 
Number of girls - 1 - 1 



Boys Girls Total 



233 



8 11 



14. Others 
19 38 
4 8 



143 
60 

11 

447 

368 

79 

86 

303 

209 

1,617 



447 
13 



52 
26 

49 
11 
20 
31 

1 



b. Old cases reopened from previous years 

3. Total cases open at some time in this year 

4. Cases closed during the year 

5. Cases carried forward to next year 
B. Closed Cases Followed Up but Not Reopened 

II. Clinic Service: 

6. Number of clinic sessions . 

7. Number of children attending clinic . 

8. Number of visits to clinic by children . 
III. Types of Service Classification: 

Total Cases Open at Some Time in This Year: 

9. Diagnostic cases 

10. Treatment cases 

11. Unassigned to service classification 
IV. Sources Referring New Cases: 

12. Children's agency 

13. Clinic staff 

14. Community education 

15. Court 

16. Family agency 

17. Former client . 

18. Friend or relative 

19. Health agency . 

20. Physician. 

21. School . 
33. Self. 
23. Others . 

Mental Health Clinic 

During the year this Clinic has had three directors. As a consequence, this report 
cannot have the quality of cohesiveness. The present director has been in charge for 
three months and has in general continued the work so ably set up by the clinic's founder, 
Dr. James Watson. From time to time modifications have been added and improve- 
ments made in the quality and number of services rendered by the Clinic. Clinic func- 
tions are manifold and consist primarily of two types of services, first, to patients and 
second, to the various agencies referring patients. Included are the broader types of 
services arising from the many relationships enjoyed with the community at large. The 
general purpose is the furthering of the ideals of mental hygiene, to the general end of 
improving the state of our people. 

Services to Patients 

Referral of Patients: Patients are referred to the Clinic by the various social agencies 
in the city, by private physicians, by hospitals in the city or elsewhere in the State, by 
private persons. Occasionally the patients themselves make applications for service. 
Usually, the case is first presented by, and discussed with, the worker or group of workers 
or by the referring agent. At this preliminary presentation, decision is made as to 
whether clinic services are available to the patient in question. The patient is then seen 
and treatment instituted as may be required. Appendix B shows referring agencies and 
number of patients each referred. 

Statistical Data: During the year, 101 individual patients were seen for a total of 515 
hours. This number does not include those patients, the subject of conferences with 
workers, who never appeared for a first interview. The average time devoted to each 
patient was 5.66 hours. 



P.D. 23 33 

Therapy: Results of treatment are on the whole gratifying, considering the essential 
hopelessness of so many of the cases seen. 

Every effort has been made through conferences with workers and through investiga- 
tion by the director to arrive at an understanding of the patients' problems by reference 
to his cultural background. The Director made several visits in company with workers 
to homes of non-patients in the Welfare Districts in order that a feeling for the culture 
of people on Welfare and in the lower income levels could be had. This endeavor was 
of definite value towards establishing a more sympathetic orientation on the patients' 
problems. 

Treatment has in virtually all cases utilized both psychotherapy as well as the resources 
of social agencies of all kinds, for carrying out of psychotherapeutic procedures is not 
often possible without the aid of a complementary agency. This fact abides in the 
external factors which so frequently contribute to the establishment of the situation for 
which patient comes to the Clinic, and has reference to the economical and sociological 
forces at work in both the immediate and remote background. 

Diagnostic Classification: The types of disorder met with include the whole range of 
morbidity from frank psychosis to conditions wherein no psychiatric problem exists. 
They are tabulated in Appendix C. 

Services to Agencies 

General Considerations: Two broad types of services are rendered the agencies; first, 
professional, and second, educational. These cannot always be clearly separated, for 
contacts effected by agencies for purposes of bringing patients to the Clinic invariably 
are handled from a psychiatric point of view with the definite purpose to instruct workers 
psychiatrically, and so to clarify the problem for which help is sought. The general idea 
is to help the workers to a better understanding of the people they are handling and to 
train them as far as possible in the recognition of morbid states. 

Individual Contacts: As has been indicated, when the worker discovers a case which 
she thinks might benefit by psychiatric treatment, she usually calls at the Clinic and 
describes the situation in her own terms. During this interview discussion is free and 
all angles are examined carefully both by the director and under his direction by the 
worker. The interview always furnishes an opportunity for explanation to the workers 
of the possible psychiatric implications. This feature of the worker-physician relation- 
ship is emphasized by the physician who considers it important to ignore no opportunity 
to carry on the teaching work of the Clinic. 

Group Contacts: At frequent intervals conferences are held with groups and between 
agencies. Each district of the Welfare Division meets regularly at the Clinic. The case 
is discussed, psychiatric impHcations gone into, and an appointment made to see the 
patient. The practice of reviewing all cases that the particular group has referred has 
been established for the purpose of keeping abreast of the progress of the case and to 
exchange reports. These conferences are informal and the workers are encouraged to 
ask questions on any phase of a problem which may occur to them. This practice has 
resulted in animated discussions which indicate a growing interest on the part of the 
workers. The subject matter of the discussions is not always purely psychiatric, but 
utilizes as well the sociological disciplines in all human relationships. 

Teaching Activities 
Clinics: Teaching activities are widely varied and consist of formal lectures and 
clinics, given regularly, and of the informal instruction dispensed at all meetings with 
workers or groups of workers. During the final two months of the fiscal year, four 
clinics for workers of the various agencies were held at the Worcester State Hospital. 
All agencies were invited by letter. The Clinics were well attended and appeared to 
have been of some value in the precise sense for which they were designed, namely, to 
show the workers the more obvious types of psychotic reaction. Practically all the 
workers attended one or more of these clinics. It is planned to continue clinics regularly 
at given intervals, perhaps twice a year, and in addition to hold clinics on request of 
authorized bodies. Thus, the course of lectures at the Girls' Club will be concluded by 
a clinic at the Worcester State Hospital. 
1. Lectures: Board of Public Welfare: 

A course of lectures was organized under the auspices of the Board of Public Welfare. 
These lectures are given on alternate weeks and will extend throughout the academic 
year. Attendance is not limited to welfare agents, but the members of all agencies have 
been invited to attend. 



34 



P.D. 23 



2. Girls' Club: 

Not all agencies have been able to attend at the given hour, and as a result a parallel, 
course has been designed and will be begun early in January for the benefit of the 
workers in the Girls' Club. This latter arrangement was felt to be peculiarly rich in 
possibilities because of the adolescent material this organization deals with. 

3. Worcester State Hospital — Affiliate Nurses: 

One course of four lectures on Mental Hygiene has been given to affiliate nurses at 
the Worcester State Hospital and a second series will be given early in January. 

4. Memorial Hospital — Class of Nurses: 

At the invitation of the Director of Education at the Memorial Hospital, a course of 
14 lectures on Psychology will be begun in January. 

Miscellaneous Activities 

No rigid rules exist for seeing patients. If a patient is too feeble to come to the Clinic, 
physician willingly calls at the home, and the facilities of the Clinic are open out of hours 
to persons whose working hours preclude their coming in during the course of the working 
day. 

Meetings are attended whenever they are accessible. This year Director attended a 
Conference of Social Workers in Boston, a meeting of the Massachusetts Society for 
Mental Hygiene in Salem, the annual meeting of the Worcester Associated Charities 
and the annual meeting of the Travelers Aid Society in Worcester. 

Appendix A 
Tabular Summary for the Year 
December, 1939-November, 1940 



Total Consultation 

With Workers 

Singly 

Groups 

Individual groups . 

Inter-Agency groups 

With Patients 

Individual Patients seen 

New Patients 

Average Time per Patient 

Lectures Given 

Clinics Given 

Visits to Districts . 

Miscellaneous Meetings Attended 



669 



54 
100 



89 
11 



154 



515 



Appendix B 
Referring Agencies 



Advisory Council 

Aid to Dependent Children 

Associated Charities 

Board of Public Welfare 

Childrens' Friend Society 

Clergymen 

Other patients. 

Private individuals 

Private physicians 

Self-referred . 

Society for Prevention of Cruelty to Children 

Swedish Charities 

Worcester State Hospital 

W.P.A. Certifying Office 



101 
91 

5.66 hours 
12 

4 

3 

5 



Number 
referred 

1' 
19 
10 
37 

1 

5 

1 

2 

2 

1 

4 

2 

3 

1 



Appendix C 
Case Types of New Patients 



Psychopathic Personality 



P.D. 23 



35 



Simple adult maladjustment ....... 47 

Dipsomania .......... 1 

Homosexual 
Unclassified 
Psychoneurosis 

Anxiety Hysteria 
Anxiety State 
Hysteria, unclassified 
Neurasthenia 
Obsessional neurosis 
Psychasthenia 
Schizophrenia . 
Mental Deficiency 

With Juvenile Delinquency 
Without Psychosis 
Psychosis with Cerebral Arteriosclerosis 
Manic-Depressive Psychosis, hypomanic 
No Problem .... 
Paranoia and Paranoid Conditions 

Paranoid State, type undetermined 
Marital Discord, Paranoia . 
Alcoholic, unclassified 
Behavior Disorder, unclassified . 
Conduct Disturbance, unclassified 
Family Discord, Rejection and Overprotection 
Primary Behavior Disorder in Children 

School Clinic Repokt 
The School Clinic made 274 examinations of children from 22 towns during the year 
ending November 30, 1940. 

Analysis reveals about 50% were referred because of Retardation; 38% referred 
because of School Problems, of which Reading DiflSculty was predominant; about 9M% 
were Behavior or Personality Problems, and about 2K% were referred whose pre- 
dominant problem was in the physical realm. 

We annually find an increasing percentage of Reading Difficulty Problems, which are 
difficult for the clinic and unsatisfactory to the school, in part because of our inadequate 
study of the causative factors involved and ability to ofi'er proper remedial teaching. 
Very few schools have Remedial Teachers, or even teachers reasonably well versed in 
handling Reading Problems. 

Practically the same percentage of mentally retarded and borderline intelligence cases 
were referred as last year, namely about 77% of cases examined. 

Recommendation for treatment in Child Guidance Clinic was made in about l]4,%, 
of whom very few may be expected to receive such study. About 1 % were recommended 
for Psychiatric treatment, in the school, as compared with 3% last year of whom very 
few could be seen more than once because of lack of time. 

Special Class treatment was recommended for 50%, practically the same as last year. 
Special Classes are functioning in about 50% of the towns in which examinations were 
made, which compares very favorably with 10% eight years ago. Most School Super- 
intendents, if not all, are well aware of the need but are holding back because of lack of 
room or other economic reasons. There appears to be a scarcity of well trained teachers 
with the right personality for the job, and lack of proper equipment in the room. 

Willing co-operation was given by most school staffs but in several towns new school 
nurses had been appointed, and without a little training in acquiring histories much 
failure was apparent in acquiring information pertinent to much understanding of the 
problems involved. Likewise some teachers had difficulty in properly giving and scoring 
school achievement tests resulting in extra work for our psychologists, and in some cases 
incomplete correlation charts for presentation to the school superintendent with a Jist 
of recommendations. The number of Special Classes is slowly increasing. 

Conferences with the school staff by the psychiatrist was offered in all towns and 
accepted in most with excellent co-operation and interest shown. In a few towns, how- 
ever, the superintendent has not seen the value of calling interested teachers in for the 
conference. 



36 



P.D. 23 



School superintendents have in many cases expressed satisfaction in receiving a brief 
resume of the case with findings and recommendations. On several occasions they have 
been asked to enumerate on their list of pupils submitted for examination those with 
adequate intelligence, but there are a few who continue to fail to recognize the value to 
the clinic of this information. 

Letters are written to school superintendents quoting the law under which the clinic 
functions, listing the minimum requirements for conducting a clinic, containing a distinct 
statement to the effect that until the basic requirements are complied with, children 
will not be examined. The letter also contains a few basic reasons explanatory of our 
demands. 
RecovimendatiGns: 

1. The clinic staf¥ shall be provided with a psychiatric social worker whose duty shall 
be to confer with each school nurse assigned to acquire histories and assist her in acquir- 
ing a proper history as far as available, and confer with a special teacher assigned 
to give school achievement tests to assist her in understanding our requirements and 
scoring the blanks. The social worker shall also attend the final conference with the 
school staff to assist in bettering their understanding of environmental problems involved. 

2. Some member of the psychological staff should give reading tests to proper cases 
and be prepared to confer with the child's teacher regarding the type of reading problems 
involved and ways of meeting the situation. 

3. The small number of children recommended for psychiatric study should have an 
opportunity for at least a few interviews from the psychiatrist, and the family should be 
interviewed by the social worker. Likewise those recommended for study in a Child 
Guidance Clinic, who are unable to get to a clinic, should have the same treatment, as 
required, though in most cases over a longer period. In either type the chief problem 
is in educating parents and school in understanding problems involved and handling 
them. 

4. School staff should be brought into general conference at least annually, at which 
time some good speaker should address them on educational or personality problems, 
and they should have the opportunity to discuss the problems confronting them. 

5. School clinic staffs should meet in general conference annually to discuss general 
problems. (This was formerly carried out with Dr. Walter E. Fernald, and has been in 
session twice since Dr. Fernald's death, with Dr. Dayton). 

Division of Public Relations 

Believing that prevention of mental disorder can be achieved through the prompt 
recognition of incipient disorder the hospital has carried on a program of mental health 
education. This service also aids in building a better understanding of the work of the 
hospital by the community. 

A descriptive booklet listing speakers is sent to community organizations inviting 
them to include a mental health program during the year. 

Twenty-four staff members gave 238 talks to 12,261 people. 

Total Number of Talks Given for the Year 
Dec, 19&9 through Nov., 1940 



Name 






Number 


Name 








Number 


of Talks 


of Talks 


Dr. Angyal. ... . .4 


Dr. Render .... 6 


Dr. Barton 






95 


Dr. Rosenzweig 






1 


Dr. Blackman 






3 


Dr. Schaefer 






3 


Dr. Bryan 






19 


Mr. Searle 








3 


Mrs. Ekdahl 






2 


Mr. Shakow 








3 


Dr. Farrar . 






1 


Mrs. K. Steele 








4 


Dr. Wm. Freeman 






3 


Dr. Wall . 








2 


Dr. Kaufman 






8 


Miss Walton 








6 


Dr. Kemble 






8 


Dr. Watson 








1 


Dr. Looney 






3 


Mrs. Whitman 








52 


Dr. Malamud 
Miss Misbach 






2 
4 


Mr. Wise . 


. 71 








Dr. Molholm 






3 


24 Total 








248 



P.D. 23 37 

Business Activities 
Sound business management is still another obligation of the hospital administration 
to the Commonwealth. The wise use of funds, the elimination of waste and planned 
economy of more than ordinary proportions returned to the state large unexpended 
balances in accordance with the program of the Department of Mental Health. 

Steward's Department 

Mr. Smith's resignation was a severe shock to the Worcester State Hospital and 
especially to the Steward's OfEce. In the more than twenty years of his connection 
with this hospital, Mr. Smith has left marks that will always remain. His poUcy in 
delegating responsibility to his assistants has proven indispensable in this emergency. 

During the past year an accrual system of financial control was introduced in this 
state. It was very confusing at the start, but has now settled down to more or less 
of a routine. This accrual system is a step in the right direction. It is very gratifying 
to know that the need of definite financial control was anticipated by this hospital over 
five years ago. 

It seems unnecessary to again caU attention to the deplorable condition of the present 
laundry. The store room is the next department need that demands attention. When 
one -considers that our present store room facilities are a series of basement rooms 
scattered about the various Ward Buildings, it can be seen that if a perpetual card 
inventory sj'stem were not in operation inventories would be impossible to control. 
This is a very essential department of the Hospital and it is hoped that upon completion 
of the new laundry, no time will be lost in renovating the present laundry building into 
a storehouse. 

The personnel of the Department, aside from the resignation of Mr. Smith and a few 
minor changes, remains the same. Such will not be the case in the coming j'^ear. For 
with the surrounding shops working to full capacity and the prospects of higher wages 
in combination with the National Guards and Draftees leaving for Military Service, it 
will mean that the turnover of help in this hospital, especially in the lower salaried 
market, will be increased considerably. 

During 1941 the tentative program of the Steward Department will be: 

1. To consolidate the department under the Steward's Office. 

2. To install a system of Flat Work control. 

3. To attempt to devise ways and means to put the cafeteria employees on straight 
time. 

4. To check menus and food cost more closely; so that a varied diet without increase 
in cost can be obtained. 

Farm Report 

The spring season opened with hay fields coming through in fine conditions, thanks to 
the heavy snow fall last winter. Large crops of alfalfa and timothy hay were harvested 
as a result. We continued a systematic program of soil analysis, crop rotation and added 
soil conservation to the program. All three of these practices helped greatly in growing 
an exceedingly heavy crop of squash, beans, peppers, and turnip. 

Soil conservation is here to stay. It proved itself at our Hillside colony, where nearly 
all the land is situated on from five to twenty per cent grades and in previous years heavy 
rain storms usually ruined and washed a great many crops. This conservation work 
requires the practice of planting all cultivated crops in strips fifty to seventy-five feet 
wide across the general slope with an alternate strip of land. This practice never allows 
the water to converge in large quantities, thereby preventing gullying and erosion. The 
sod area remains in sod for a three year period; after that it is alternated with cultivated 
strips. 

A new 16' x 38' silo was added to the main hospital. This allows a greater storage 
space for ensilage, either grass or corn, and now supplies us the entire year with good 
roughage. 

The renovation of the main cow barn removed all but twelve of the forty-five pens 
and placed two rows through the middle of the barn, in chain tie-up system. This gave 
us room for the entire herd of milking cows and saved a great deal of cattle transporting. 
Formerly each cow had been transported two months before calving to Hillside and ten 
days after calving back to the main barn. Also the milk parlor has been eliminated. 
Under this new system one man was eliminated from the care of cattle to a badly needed 
tractor driver. We have operated under this new system for three complete months 



38 



P.D. 23 



and like it very much. This renovation made it possible to demolish the Hillside hay- 
barn which had been badly damaged by the hurricane two years ago. This barn area 
was regraded and reseeded to hay. 

A new manure pit was erected at the Hillside Colony which is large enough to accom- 
modate all manure from swine, horses, and young stock. There are several advantages 
in storing manure in a pit versus the pile in the field method, such as follows : 

a. Saves leaching of valuable plant food and ammonia from the manure. 

b. Saves hauling every day from barn to pile. 

c. Eliminates unsightly pile in field. 

d. Needs moving only once in the spring and once in the fall. 

Artificial insemination was again carried on in the dairy herd. This was the third 
trial by two different veterinarians in two years. The first two trials did not prove to 
be a paying proposition because conception occured only in a small percentage of the 
attempts. Natural physical breeding showed about sixty percent conception whereas the 
third trial completed in October gave about forty percent conception. The conclusion 
drawn from these three trials is as follows: 

a. The technique of the veterinarian must be improved. 

b. Proven herd sires must be used in order to improve the herd more rapidly through 
artificial insemination. 

c. Proven herd sire must be used to help off-set the added veterinarian expense. 

d. The veterinarian must get as high a conception rate as does the physical method. 
Further study has been carried on in controlling mastitis. The use of sulfanilamide 

has proved to be of great value. This medication has cured almost all cases save the 
chronic which had been previously infected and continue to recur. An additional, new 
medication was used to control the chronic cases. It produced better than fifty-percent 
cures in chronic cases. This material was given us for trial purposes by a large drug 
concern. 

The Heredity Herd Control Chart introduced in 1939 continues to prove worthy. 
Each year as a cow finishes her lactation it is added to her record until she finally leaves 
the herd. At that time an established record remains for years to come, as her offspring 
continues to make records, passing on the milking abilities down through the generations. 
We are now proving three young herd sire? via daughter-dam milk and butter fat com- 
parison. Through this system we expect to have at least two proven soon. If their 
daughters show a substantial gain in milk and butter fat — then artificial insemination 
should prove its worth and veterinarian fees could be overlooked. 

A new Diesel trac-tractor was purchased to replace the old T-20 and it suits the needs 
of the farm much better. The fuel cost and operating expense for the first six months 
were about one-third of those of the T-20 when that was new. Moreover a badly needed 
snow plow was purchased to attach on this diesel job and this plow did very well during 
the last heavy storm the day before Thanksgiving. 

The old coal pocket and cinder dump has been regraded and reseeded, thereby im- 
proving a very unsightly area west of the hospital near the new ball field. 

One more tennis court was added to the premises giving us ample space to take care 
of all patients interested in this game. 

Nearly a half mile of road was patched and resurfaced with asphalt. Also a mile of 
road was regraded and graveled to improve the wearing surface. 

The swamp reclaiming work has been finished and now completely cultivated, adding 
a great deal of land for rotation purposes. 

Statistics— 1940 
Some of the farm products raised were: 





Pounds 




Pounds 


String beans . 


. 40,429 


Onions . 


62,698 


Cabbage 


75,329 


Spinach . 


22,984 


Carrots . 


. 111,540 


Squash, summer 


12,682 


Celery 


17,168 


Squash, winter 


. 117,600 


Corn, sweet 


34,283 


Tomatoes 


. 120,169 


Lettuce . 


15,122 


Turnips . 


. 176,232 



The dairy herd of 64 cows produced 914,149 lbs. of milk. 

The total heard of 64 cows and 73 heifers and calves consumed 138,359 lbs. of home 
produced hay, 601,825 lbs. of ensilage corn. 



P.D. 23 39 

The total value of 64 cows $14,705.00; 73 heifers valued at $6,450.00 and 5 bulls at 
$1,660.00. 

There were 227 spring pigs born valued at $2,89G.C0. These hogs when slaughtered 
dressed off 48,524 lbs. of pork valued at $3,881.94, besides selling to other institutions 
for breeders, 22 sows, 6 shoats, 6 pigs and 13 boars. 

The grand total value of all farm produce and milk for the year was $66,745.00. 

Engineer's Report 

The winter of 1940 was unusually cold and the engineering department was kept very 
busy trying to keep patients and employees comfortably warm. 

We find on windy days of comparable temperature that it costs $25.00 more for fuel. 
This is mostly due to lack of weather proofing. 

A few storm windows have been installed on cottages, and carpenters have tightened 
a few windows in the hospital. 

Plans have been made and money appropriated to automatically control the heat in 
Lowell and Hale Homes. This is to eliminate window temperature control now used. 

The cost of Fuel Oil and Coal during the fiscal year of 1939 was: 

The amount of oil used during 1939 was: 40,147.27 

The amount of coal used during 1939 was: 

Bit. —8,055.151 

Scr. — 699.46^11,050.68 

Anth.— 2,296.07] 

The cost of Fuel oil and Coal during the fiscal year of 1940 was: 

The amount of oil used during 1940 was: 50,541.87 

The amount of coal used during 1940 was: 

Bit. —9,190.091 
Anth.— 1,578.57 ^10,913.25 
Scr. — 144.59] 
Electricity 

Plans have been made to rewire Hale and Lowell Homes. The present wiring is old 
(not inclosed in conduit) and constitutes a fire hazard. 

We have rewired the kitchen and bake shop and rooms adjoining. 

The fluorescent lighting in the bake shop is a great improvement also over the sink 
near tin toom. 

This new type of lighting gives us much better illumination with less current consump- 
tion. 

The old wiring in kitchen at Summer Street Department was also renewed. 

Plumbing repairs have been kept up and much old plumbing improved. 

Plans are under way to renovate the plumbing in Folsom wards as this is our oldest 
and most out-of-date water section. 

Hillside is now supplied with water from the town of Shrewsbury; this is better water 
and due to the increased pressure assures us of better fire prevention. 

The brass pipe at Hillside is not suitable for the water and has been replaced by copper 
tubing. 

The old six inch steel service main under Main Hospital is rusting away and will 
shortly be replaced by copper tubing, also the 3" steel water main at Summer Street. 

New stainless steel sinks have been installed in kitchens of Main Hospital and at 
Summer Street. 

The plumbing at Lowell Home is progressing very slowly. We have not seen any 
significant action for two years toward completing the third and fourth floors. 

Summer Street Department: The W. P. A. project for plumbing renovation was con- 
tinued with the modernization of toilet facilities for patients on Wards 5, 11, 17, Sewing 
Room and Laundry. Employees' facilities were provided in the Industrial Room. 
Employees' facilities were renovated in the Laundry Building quarters and the fourth 
floor of the Administration Building. The painted plaster wall in the female patients' 
shower room proved to be unsatisfactory and was replaced with tile. The obsolete and 
deteriorated coal stoves in the kitchen were removed and gas stoves were installed in 
their place, resulting in a much cleaner kitchen. 

In order to provide a steady source of hot water, a new 1,500 gallon domestic hot water 
heater was provided to take the place of our old heater's exceedingly limited capacity. 
The obsolete and unsatisfactory wiring and fixtures were replaced in the gereral kitchen 
with modern type materials. 



40 P.D. 23 

The iron fence fronting on Summer Street, which suffered great damage during the 
1939 hurricane, has been completely repaired. 

Two new electrically heated food trucks have been placed in operation. This insures 
having the patients' food served in a hot and savory condition. 

Fire Prevention 

One thousand feet of unlined linen fire hose was used to replace old fire hose in the 
Administration buildings. 

Plans are underway to install sprinklers in the Industrial building. 

Fire drills have been held each week. Regular inspections have been made of fire 
fighting equipment. 

Fire alarm box has been tested each week. 

Fire extinguishers are charged each year. A request has been approved to change the 
sprinklers at Summer Street from a wet to a dry system. 

We hope the Washburn building will be next on the renovation program to be fire 
proofed by removing the old wooden floors and replacing them with cement. 

The Department of Mental Health has changed the rating of our plant from Class B 
to Class A; this has given our engineers a higher rate of pay for which we are grateful. 

One engineer, Mr. Manning passed the examination for first class engineer. 

From the data submitted from the Department of Mental Health we are lowering 
our cost per patient each year for heat, light and power. 

Maintenance Department 

The ordinary maintenance repair work has been carried on during the year as rapidly 
and completely as the 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. 

During the year the painters replaced 5,000 panes of glass. We used 4,000 feet of 
window cord, 400 gross of screws and 25 kegs of nails. All of this material went into 
routine maintenance of the building. 

Three years ago all the wards in the Institution were painted by W. P. A. project. 
Due to a great deal of damage since that time, the wards have been thoroughly repaired 
and retouched by our own mechanics. All the wards are now in good condition. 

We have also repaired and repainted some employees' living quarters. 

The Bake Shop has been repaired and repainted, including all machinery. 

At the Summer Street Branch, five wards have been repaired. This includes plaster- 
ing ceilings, repair to base board and windows, and painting. Some painting has also 
been done to the employees' living quarters. 

In the spring a repair program was started on the outside. This includes new doors 
where needed, and repair and painting doors and windows. It also includes all fire 
escapes. This program will continue in the spring. 

Temporary repair work, including new woodwork, painting and replacement of glass 
was done to the greenhouse. 

Owing to the small force of mechanics it is necessary to have the aid of outside me- 
chanics. The following jobs were completed with the aid of outside help: — 

One completely new brick porch at Farm House, and remainder of old wooden one 
thoroughly repaired and repainted. 

Approximately forty-five dormers of Main Hospital were repaired and repainted. 

The floors of the tunnels underneath the employees and patients' cafeterias, were 
cemented. 

W. P. A. Project Report 

Works Project Number 65-1-14-523 consists of transcription, tabulation, and statistical 
treatment of data obtained from psychological examinations accumulated over a period 
of years; and of data obtained from post-mortem examinations of sane and insane 
patients; recording historical facts and progress of fever treatments of patients; typing 
a cross-index of somatic and functional disturbances; typing material and preparing 
standard practice booklets for guidance in treatment and handUng of patients; typing 
abstracts and bibliographies for the use of research workers; typing material assembled 
under the project to be used by doctors for purposes of analyses and for publication in 
scientific journals. 

In the Psychology Department 7,237 test-items were recorded and checked and 
statistics computed on them; 7,550 pages were typed in connection with this research. 



P.D. 23 41 

In the Medical Library 1,468 cards were typed on literature dealing with subjects 
under research. 

In the Pathology Department 8,252 autopsy findings have been recorded and statistics 
computed on this data. A total of 3,684 cards have been typed for the pathological 
cross-index file. 

Historical facts about 1,320 patients and records of their treatment have been tabu- 
lated; statistics on one-fourth of this tabulation data have been computed. 

About three thousand medical records and charts were filed preparatory to typing a 
cross-index file of mental and physical illnesses. This filing system contains about one 
thousand cases thus far. 

In the Administrative Department 201 booklets have been made which entailed 
typing 2,799 pages, cutting 201 stencils, assembling 35,450 pages and covering material 
with loose-leaf covers. 

In the Statistics 1,488 pages have been typed and 1,403 cards containing abstracts of 
articles for a manual of tests for a study to be made by the Research Psychologist on 
"The Impairment of the Cerebral Cortex." 

This work has been carried on by thirteen workers: one supervisor, seven typists and 
five clerks. 

National Youth Administration: We have participated in the training of Youth in 
actual business settings under the National Youth Administration. Girls have served 
as clerks and typists in the clerical and business offices. Boys have been apprenticed in 
storerooms, engineers and carpenter and paint shops to skilled workmen. 

Hospital Industries 

Matron's Department: This department not only supervises the housekeeping but also 
directs the Mending Room and the Sewing Room both of which employs an average of 
45 patients and 7 employees. The Mending Room repaired 52,883 articles and the 
Sewing Room darned an additional 9,124 stockings and socks. The Sewing Room made 
56,485 new articles, all the linen and most of the clothing worn by the patients. The 
above figure includes 768 new pieces which were made in the Sewing Room of the 
Summer Street Department. 

Laundry: The Laundry with old equipment needing frequent repairs has added new 
counting equipment. A total of 1,905,983 lbs. of clothing were laundered during the 
year by 61 patients and 15 employees. The monthly total of work done has shown a 
30% increase during the twelve months. The addition of a new mangle made this 
possible but new washers are urgently needed. 

Male Industrial Department: Male Industrial Shops employ 40 men with 5 employees 
doing shoe repairing, furniture upholstering, tailoring, printing, rug making, and making 
brushes. 

Among the various items of work accomplished in the Male Industrial Department 
during year 1940, 6,154 dictaphone records shaved, 3,919 mattress retuffed, 1,539 articles 
of furniture repaired, 365 mens suits made by our tailor, 983 pair of shoes repaired. 

VALUATION 

November 30, 1940 

Real Estate — Land, 584.95 $ 343,273.00 

Buildings and betterments ......... 2,498,973.51 

$2,842,246.51 

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, 1940. 

Statement or Earnings 

Board of Patients $60,130.05 

Sales: 

Food $1,945.61 

Clothing and materials ......... 93.42 

Furnishings and household supplies ...... 44.25 

Medical and general care ........ 227.57 

Heat and other plant operations ....... 106.00 

Garage and grounds ......... 6.00 

Repairs ordinary .......... 133.90 

Farm: (Cows, calves and pigs, $2,104.44; vegetables and tools, 8238.32; 

and pump house, $1.00) 2,343.76 

Total Sales 4,900.51 



42 

Miscellaneous: 

Interest on bank balances ....... 

Rents ........... 

P & D freight, $20.64; Tel. Com., $123.10; Court Fees, $12.40; Sim 
mons Col., $30.00; P. O. Keys, $16.38; Births, etc., $6.00 

Total Miscellaneous ....... 

Total earnings for the year ....... 

Total cash receipts reverting and transferred to the State Treasurer 

Accounts receivable outstanding Dec. 1, 1939 .... 
Accounts receivable outstanding Nov. 30, 1940 .... 

Accounts receivable decreased ....... 

Maintenance Appbopbiation 
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, $3,691.18; grounds, $1,353.74 

Clothing and materials ........ 

Furnishings and household supplies ..... 

Repairs ordinary ......... 

Repairs and renewals ........ 

Total maintenance expenditures ..... 
Balances of maintenance appropriation, November 30, 1940 

Special Appropriations 
Balance December 1, 1939, brought forward .... 
Appropriations for current year ...... 

Total 

Expended during the year ....... 

Reverting to Treasury of Commonwealth ..... 

Balance November 30, 1940, carried to next year 



$95.00 
891.12 



208.52 



$50.40 
20.03 



P.D. 23 



1,194.64 
$66,235.20 
66,255.57 



$30.37 



$3,037.06 
1,089,401.55 



. $1,092,438.61 



$621,109.80 
195,913.32 
52,216.23 

2,920.00 
22,084.34 
82,047.80 

9,987.95 

5,044.92 
20,943.04 
33,874.42 
14,187.27 

5,663.53 



$12,908.05 



$1,065,992.62 
26,445.99 

$1,092,438.61 

$61,118.17 

$61,118.17 

12,908.05 

$48,210.12 



Appropriation 


Act or 
Resolve 


Total 

Amount 

Appropriated 


Expended 

during 
fiscal year 


Total 

Expended 

to date 


Balance 

at end of 

year 


Plumbing — Summer Street Hospital 

Plumbing — Summer Street Hospital 

New Boilers, Stokers, etc. 

X-Ray Equipment 

Medical Equipment 

Bake Ovens .... 

Electric Wiring — Employees' 

Building ..... 
Renovation Plumbing . 

Hurricane and Flood Damage 


Chap. 234 

1937 
Chap. 309 

1939 
Chap. 304 

1936 
Chap. 356 

1938 
Chap. 356 

1938 
Chap. 356 

1938 
Chap. 356 

1938 

Chap. 497, 

309 

1938-39 

Chap. 507 

1938 


$12,300.00 
17,300.00 

270,000.00 
8,000.00 
5,000.00 
6,550.00 

10,000.00 
14,000.00 

216,000.00 


$5,010.88 
351.04 

958.14 
6,587.99 


$12,298.98 
16,936.48 

268,857.72 
7,763.98 
4,968.76 
6,535.23 

9,909.08 
11,280.02 

172,389.63 


$1.02 

363.52 

1,142.28 

236.02 

31.24 

14.77 

90.92 
2,719.98 

43,610.37 




$559,150.00 


$12,908.05 


$510,939.88 


$48,210.12 



Per Capita 
During the year the average number of patients has been 2556.623 
Total cost of maintenance, $1,065,992.62. 
Equal to a weekly per capita cost of $8.0183. 
Total receipts for the year, $66,255.57. 
Equal to a weekly per capita of $.4913. 
Total net cost of Maintenance for year, $999,747.05. 
Net weekly per capita, $7,527. 

Respectfully submitted, 
Margaret T. Crimmins, 



Financial statement verified. 
Approved : 



Treasurer. 



Walter S. Morgan, 
CcnnptroUer 



P.D. 23 



43 



STATEMENT OF FUNDS 

November 30, 1940 
Patients' Fund 



Balance on hand November 30, 1939 
Receipts ..... 

Interest ..... 

Expended ..... 
Interest paid to State Treasurer 

Balance on hand November 30, 1940 



Investments 



Worcester County Institute for Savings . 
Worcester Five Cents Savings Bank 
Worcester Mechanics Savings Bank 
Peoples Savings Bank ..... 
Bay State Savings Bank .... 

Worcester Depositors Corp. (Class A Certificate) 
Balance Mechanics National Bank . 
Cash on hand November 30, 1940 . 

Canteen Fund 
Balance on hand November 30, 1939 
Receipts to November 30, 1940 .... 

Expended to November 30, 1940 .... 

Balance on hand November 30, 1940 

Investments 
Worcester Depositors Corp. (Class A Certificate) 
Mechanics National Bank ..... 

Cash on hand November 30, 1940 . 



Balance on hand November 30, 1939 
Income to November 30, 1940 

Expended to November 30, 1940 

Balance on hand November 30, 1940 

Worcester County Institute for Savings 

Balance on hand November 30, 1939 
Income to November 30, 1940 

Expended to November 30, 1940 

Balance on hand November 30, 1940 

Worcester Five Cents Savings Bank 

Balance on hand November 30, 1939 
Income to November 30, 1940 



Clement Fund 



Investments 
Lewis Fund 



Investments 
Manson Fund 



Expended to November 30, 1940 

Balance on hand November 30, 1940 

Millbury Savings Bank . 

Balance on hand November 30, 1939 
Income to November 30, 1940 



Investm,ents 
Wheeler Fund 



Investments 



Expended to November 30, 1940 

Balance on hand November 30, 1940 

Worcester Mechanics Savings Bank 
Balance Mechanics National Bank . 

Rockefeller Research Project 
Balance on hand November 30, 1939 
Receipts to November 30, 1940 

Expended to November 30, 1940 

Balance on hand November 30, 1940 

Worcester County Trust Co. . 



Investments 



$5,968.91 

9,950.68 

95.00 

9,972.14 
95.00 



1,000.00 
500.00 
500.00 

1,000.00 

1,000.00 
37.50 

1,689.01 
220.94 



$1,149.61 
522,633.42 



$60.00 
987.32 
420.86 

$1,000.00 
22.50 



$1,321.25 
32.50 



$1,164.66 
28.45 



$1,015.51 
25.00 



$1,000.00 
.26 



$1,745.49 
15,761.58 



116,014.59 

10,067.14 
$5,947.45 



$5,947.45 

$23,783.03 
22,314.85 
$1,468.18 

$1,468.18 

$1,022.50 

22.50 

$1,000.00 

$1,000.00 

$1,353.75 

53.75 

$1,300.00 

$1,300.00 

$1,193.11 

$1,193.11 
$1,193.11 

$1,040.51 

40.25 

$1,000.26 

$1,000.26 

$17,507.07 
15,156.72 
$2,350.35 
$2,350.35 



44 



P.D. 23 



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

(Data correct at end of institution year November 30, 1940) 
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 ......... 

Personal property ........... 



Total 

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

Total acreage under cultivation during previous year, 180.79. 
Officers and employees: 

Actually in Service at 

End of Year 
M. F. T. 

Superintendents 

Assistant physicians ..... 13 - 13 

Clinical assistants ..... 2 - 2 



Total phj'sicians 
Stewards. . . . 

Resident dentists 
Pharniacists 
Graduate nurses 
Other nurses and attendants 
Occupational therapists 
Social workers 
AH other officers and employees . 

Total officers and employees 



15 



15 



1 


. - 


1 


1 


— 


1 


4 


65 


69 


130 


152 


282 


5 


5 


10 


- 


3 


3 


135 


92 


227 



291 



317 



608 



82,842,246.51 
401,243.72 



$3,243,490.23 



Vacancies at End 

of Year 

M. F. T 

1-1 



Classification by Diagnosis, September SO, 194-0 
Census of Patient Population at end of year: 

Actually;Jn Hospital 

White 
Insane. 
Epileptics 
Mental defectives 
All other cases 

Total 
Other Races: 
Insane. 

Total 
Grand Total 

Patients under treatment in occupational-therapy classes, including physical 
training, on date of report. . ' . i j- ' 

Patients in occupational therapy classes, including physical training, and em- 
ployed also in general work of hospital ....... 

Patients employed in general work only. ....... 

Voluntary patients admitted during year _. . _ . 

Persons given advice or treatm.ent in out-patient clinics during year . 



16 



Absent from Hospital 
but still on Books 



M. 


F. 


T. 


M. 


F. 


T 


1,132 
1 
5 
6 


1,197 


2,329 
1 
7 
9 


250 


318 


568 


2 
3 


- 


2 
2 


2 
2 


1,144 


1,202 


2,346 


250 


322 


572 


28 


27 


55 


1 


4 


5 


28 
1,172 


27 
1,229 


55 
2,401 


1 

251 

M. 


4 

326 

F. 


5 

577 
T. 



40 



34 



74 



733 590 1,323 

693 556 1,249 

11 5 16 

236 192 428 



P.D. 23 



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48 



P.D. 23 



Table 5. Citizenship of First Admissions 



M. 


F. 


T. 


191 


180 


371 


38 


20 


58 


17 


26 


43 


4 


— 


4 


22 


33 


55 



Citizens by birth . . . • • • 

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

Aliens ......••••••• 

First papers .....-■•■••• 

Citizenship unknown , , , . • • • • 

Total ............ 272 259 531 

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



Race 




Total 


With 
syphilitic 
meningo- 
encephalitis 


With other 
forms of 
syphilis 


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. 


African (black) . 




6 5 11 
2 13 
5-5 
1 - 1 
5 9 14 
1 3 4 
17 21 38 

- 3 3 
4 1 5 
9 5 14 

38 42 80 
19 12 31 

10 8 18 

1 - 1 

11 10 21 

2 4 6 
14 10 24 

- 1 1 

3 — 3 
116 112 228 

8 12 20 


1 1 2 
1 - 1 


- - - 


- - - 


1 - 1 


- - - 


Armenian . 

Chinese 

Dutch and Flemish 

English 


1 - 1 


- - - 


- - - 


- - - 


- - - 


- - - 


- - - 


1 - 1 


- - - 


Finnish 


2 1 3 


1 1 








French 








German 


2-2 










Greek 










Hebrew 








4 1 6 
2-2 
2-2 




Irish 

Italian^ 

Lithuanian 


2 1 3 


1 - 1 


1 - 1 


- - - 


Portuguese 






I ]^ 


1-1 




Scandinavian^ 










Scotch . .; 
Slavonic^ . 


- - - 


- - - 


- - - 


1 - 1 


- - - 


Welsh 


1 - 1 
5 16 
- 1 1 










Other specific races 

Mixed 

Race unknown . 


1 2 3 


1 1 


18 6 24 
- 1 1 


13 4 


Total . 




272 259 531 


14 5 19 


3 3 6 


1 2 3 


30 8 38 


1 4 5 



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



Race 






Traumatic 
psychoses 


With 
cerebral 
arterio- 
sclerosis 


With other 
disturbances 

of 
circulation 


With 
convulsive 
disorders 
(epilepsy) 


Senile 
psychoses 


Involutional 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 












2 2 




African (black) 
Armenian 






- - - 


1 - 1 


- - - 


- - - 




- - - 


Ohinese 

Dutch and Flemish 












I I 


- - - 


1 1 2 
- 1 1 
3 4 7 






2 1 3 
1 - 1 

7-7 
1 I 




English . 
Finnish . 
French . 


_ _ _ 


_ _ _ 


- 4 4 


German 
Greek . 
Hebrew 
Irish 


- - - 


1 - 1 
10 9 19 


1 - 1 


- 1 1 


1 - 1 
5 11 16 

2 1 3 
1 - 1 


- 1 1 

- 6 6 
4 4 


Italian' . 
Lithuanian 


- - - 


1 - 1 


- - - 


- - - 


- 4 4 


Portuguese 
Scandinavian^ 
Scotch . 


- 1 1 


1 - 1 
- 2 2 

2 1 3 


- - - 




2 2 4 
- 1 1 
1 - 1 


112 


Slavonic' 








Welsh . 














Other specific races 
Mixed . 
Race unknown 


- - - 


8 6 14 
1 2 3 


- 1 1 
1 1 


- - - 


20 16 36 
2 13 


4 11 15 


Total 






- 1 1 


29 26 55 


1 2 3 


1 1 


44 36 80 


6 31 37 



P.D. 23 



49 



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) 

Armenian 

Chinese 

Dutch and Flemish 

English . 

Finnish . 

French . 

German 

Greek . 

Hebrew 

Irish 

Italian! . 

Lithuanian 

Portuguese 

Scandinavian^ 

Scotch . 

Slavonic' 

Welsh . 

Other specific races 

Mixed . 

Race unknown 






- - - 


- - - 


1 - 1 


- - - 


1 1 


1 1 2 


1-1 










2-2 










- - - 


- - - 


1 - 1 


- - - 


- 2 2 


- 5 5 


- 1 1 






1 1 2 


1 1 2 


1 4 5 
















1 1 2 
4-4 

2 4 6 

3 4 7 

4 2 6 








1 - 1 
3 1 4 


1 2 3 

3 2 5 

1 1 






2 3 5 
1 - 1 


- - - 


- - - 












1 1 2 


- - - 


1 - 1 
1 1 2 


- 3 3 


- - - 


3 2 5 








2-2 


3 5 8 






















- 2 2 
1 - 1 


1 - 1 


6 3 9 
1 - 1 


5 9 14 
1 4 5 


6 9 15 


10 25 35 
- 2 2 


Total 






3 4 7 


1 - 1 


14 7 21 


11 19 30 


13 18 31 


34 60 94 



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



Race 






Paranoia 

and 
paranoid 
conditions 


With 

psycho- 
pathic 
personality 


With 

mental 

deficiency 


Un- 
diagnosed 
psychoses 


Without 
psychoses 


Primary 
behavior 
disorders 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (Black) 

Armenian 

Chinese 

Dutch and Flemish 

English . 

Finnish . 

French 

German 

Greek ,. 

Hebrew 

Irish 

Italian! . 

Lithuanian 

Portuguese 

Scandinavian^ 

Scotch . 

Slavonic' 

Welsh . 

Other specific races 

Mixed . 

Race unknown 






- - - 


- - - 


- - - 


- - - 


2-2 


- - - 


- - - 


- - - 


- - - 


- - - 


1 - 1 


- - - 


























- - - 


- 1 1 


- 1 1 


- - - 


2 1 3 


- - - 






















2 2 4 
6 1 7 
5-5 
1 1 2 
1 - 1 
2-2 
1-1 
1 - 1 




2-2 


1 1 2 


1 2 3 




- - - 


- 1 1 






1 - 1 


- - - 




- - - 


1 - 1 


1 - 1 


- 1 1 


1 - 1 










1 - 1 
25 9 34 


1 - 1 

2 2 4 


1 1 2 


- 2 2 


4 3 7 
1 - 1 


_ _ _ 


Total 






3 1 4 


2 5 7 


7 6 13 


- 3 3 


50 15 65 


5 2 7 



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

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



r)0 



P.D 23 





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1 1 I 00 1 1 1 1 1 1 1 1 1 I 1 -I.-I 1 1 <N 1 00 1 
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O* coco 1-1 1-1 CD 1-1 

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P.D. 23 



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1 1 1 1 1 1 C<l 1 1 ^ 1 1 1 1 1 1 1 1 1 1 1 1 1 

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1 I 1 I 1 1 1 1 1 '^ 1 1 : 1 -H I 1 1 1 1 1 1 1 

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1 1 rt 1 1 1 CO'H 1 Tl<(N(M 1 rt 1 CO^^ 1 1 1 1 1 
1 1 1 -^ 1 1 O I 1 TtHCa 1 1 (Nrt 1 1 1 1 1 1 ■* I 


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P.D. 23 



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54 



P.D. 23 



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



Psychoses 



Total 



M. F. T. 



Dependent 



M. F. T. 



Marginal 



M. F. T. 



Comfortable 



M. F. T. 



Unknown 



M. F. T. 



With syphilitic meningo- 

encephahtis 
With other forms of syphilis . 
With other infectious diseases 
Alcoholic psychoses 
Due to drugs, etc. 
Traumatic psychoses . 
With cerebral arteriosclerosis. 
With other disturbances of 

circulation 
With convulsive disorders 

(epilepsy) 
Senile psychoses . 
Involutional psychoses . 
Due to other metabolic dis- 
eases, etc. 
Due to new growth 
With organic changes of ner- 
vous system 
Psychoneuroses . 
Manic-depressive psychoses . 
Dementia praecox 
Paranoia and paranoid con- 
ditions .... 
With psychopathic personality 
With mental deficiency 
Undiagnosed psychoses 
Without psychoses 
Primary behavior disorders . 

Total 



44 



3 

1 

14 
11 
13 
34 

3 
2 

7 

50 
5 



1 4 

- 1 

29 26 



1 1 

36 80 

31 37 

4 7 
1 

7 21 

19 30 

18 31 

60 94 



15 65 
2 7 



272 259 531 



21 
1 



18 



12 7 19 



23 



8 31 
3 3 



1 1 
16 32 
26 31 



7 3 10 

10 14 24 

11 16 27 
25 53 78 



84 51 135 



3 
1 
5 

31 
2 



167 188 355 



4 10 



6 6 
1 



20 20 40 



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

Psychoses 



Psychoses 


Total 


Abstinent 


Temperate 


Intemperate 


Unknown 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


With syphilitic meningo- 
encephalitis . . . 

With other forms of syphilis. 

With other infectious diseases 

Alcoholic psychoses 

Due to drugs, etc. 

Traumatic psychoses . 

With cerebral arteriosclerosis 

With other disturbances of 
circulation 

With convulsive disorders 
(epilepsy) 

Senile psychoses . 

Involutional psychoses. 

Due to other metabolic dis- 
eases, etc. 

Due to new growth 

With organic changes of ner- 
vous system 

Psychoneuroses . 

Manic-depressive psychoses . 

Dementia praecox 

Paranoia and paranoid con- 
ditions .... 

With psychopathic personality 

With mental deficiency 

Undiagnosed psychoses. 

Without psychoses 

Primary behavior disorders . 


14 5 19 
3 3 6 
1 2 3 

30 8 38 

1 4 5 

1 1 

29 26 55 

1 2 3 

1 1 
44 36 80 

6 31 37 

3 4 7 

1 - 1 

14 7 21 
11 19 30 
13 18 31 
34 60 94 

3 1 4 

2 5 7 

7 6 13 
— 3 3 

50 15 65 
5 2 7 


- 5 5 
1 1 2 

- 2 2 

- 3 3 

- 1 1 
7 19 26 

- 1 1 


7-7 
2 2 4 
1 - 1 

1 1 2 


6-6 
30 8^ 38 


1 - 1 


10 5 15 


4-4 


8 2 10 
1 1 2 


16 27 43 
3 20 23 

- 3 3 


19 5 24 
3 7 10 

3 1 4 


5 1 6 
- 2 2 


4 3 7 
- 2 2 

1 - 1 

2 1 3 
1 1 2 

1 1 2 
2 


4 4 8 

2 15 17 

3 14 17 
10 43 53 

- 1 1 
2 2 4 

4 5 9 

- 2 2 
21 8 29 

2 1 3 


4 1 5 
4 3 7 
9 3 12 
19 16 35 

2-2 
- 3 3 
1 1 2 
1 1 
11 3 14 
3-3 


4 1 5 
4-4 
1 1 2 

4-4 

1 - 1 


2-2 

17 3 20 
- 1 1 


1 1 2 


Total 


272 259 531 


75 177 252 


99 52 151 


78 17 95 


20 13 33 



P.D. 23 



55 






I (M i 
I I I 
I <N I 



I I I .H 1 IN 



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I I I I 
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I ^ I 
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I I I 
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I I I I 



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-53 



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T 


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Tl 


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§ 


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S 


B 




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5 




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J3 


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a) 




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£ 


+^ 


■2. 


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bC ft 


"3 


.a 


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o 
S3 


"3 

C 

o 


2 fe 


tt) 


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CD 
J3 


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j2 




























n 




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■gJ=-^ 


"o 


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■*-' 


-^ 


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tusC 



56 



P.D. 23 



Table 13. Mental Disorders of All Admissions, All Discharges, 

September SO, 194-0, by Status 





All Admissions 


All Discharges 


Mental Disordebs 


First 












First 














Admissions 


Readmissions 




Admissic 


)ns 


Readmis 


sions 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


Rate 


M. 


F. 


T. 


Rate 


Psychoses Due to or Associated with 






























Infection: .... 


18 


10 


28 


5 


— 


5 


7 


8 


15 


79.3 


4 


— 


4 


65.5 


Syphilis of the Central Nervous 






























System: .... 


17 


8 


25 


5 


- 


5 


7 


5 


12 


68.9 


4 


- 


4 


71.4 


Meningo-encephalitic type (gen- 






























eral paresis) 


14 


5 


19 


5 


- 


5 


6 


4 


10 


64.1 


2 


— 


2 


46.5 


Meningo-vascular type (cere- 






























bral syphilis) 


1 


- 


1 


— 


— 


- 


- 


— 


- 




1 


— 


1 


333.3 


With intracranial gumma 


— 


- 


— 


- 


- 


- 


— 


— 


- 




- 


— 


- 


— 


Other types .... 


2 


3 


5 


— 


- 


- 


1 


1 


2 


153.8 


1 


— 


1 


111.1 


With epidemic encephalitis . 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


With acute chorea (Sydenham's) . 


— 


— 


- 


— 


— 


- 


— 


— 


- 


- 


- 


— 


— 


— 


With other infectious disease 


1 


2 


3 


- 


- 


— 


— 


3 


3 


600.0 


— 


- 


- 


- 


Post-infectious psychoses 


— 


— 


— 


- 


- 


- 


— 


- 


— 


- 


- 


- 


- 


— 


Psychoses Due to Intoxication: 


31 


12 


43 


9 


5 


14 


36 


8 


44 


248.5 


9 


1 


10 


142.8 


Due to Alcohol: 


30 


8 


38 


9 


3 


12 


35 


5 


40 


23.8 


9 


— 


9 


134.3 


Pathological intoxication . 


3 


- 


3 


- 


- 


- 


4 


- 


4 


235.2 


- 


- 


- 


- 


Delirium tremens . 


10 


- 


10 


1 


— 


1 


9 


2 


11 


785.7 


— 


- 


- 


— 


Korsakow's psychosis 


2 


4 


6 


1 


- 


1 


2 


— 


2 


125.0 


1 


- 


1 


500.0 


Acute hallucinosis . 


2 


2 


4 


1 


- 


1 


5 


2 


7 


291.6 


2 


- 


2 


333.3 


Other types .... 


13 


2 


15 


6 


3 


9 


15 


1 


16 


164.9 


6 


- 


6 


109.0 


Due to Drugs or Other Exogenous 






























Poisons: .... 


1 


4 


5 


- 


2 


2 


1 


3 


4 


444.4 


— 


1 


1 


333.3 


Due to gases .... 


- 


- 


- 


- 


- 


— 


- 


— 


- 


- 


— 


— 


— 


— 


Due to other drugs . 


1 


4 


5 


- 


2 


2 


1 


3 


4 


500.0 


- 


1 


1 


333.3 


Psychoses Due to Trauma: 


- 


1 


1 


1 


— 


1 


3 


— 


3 


250.0 


- 


— 


- 


— 


Traumatic deUrium . 


— 


- 


— 


— 


— 


— 


— 


— 


- 


— 


— 


— 


- 


— 


Post-traumatic personaHty dis- 






























orders ..... 


— 


— 


— 


1 


— 


1 


2 


— 


2 


666.6 


— 


— 


- 


— 


Post-traumatic mental deteriora- 






























tion ..... 


— 


— 


— 


— 


— 


— 


1 


— 


1 


250.0 


— 


— 


— 


— 


Other types .... 


- 


1 


1 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


Psychoses Due to Disturbance of Cir- 






























culation: .... 


30 


28 


58 


4 


4 


8 


14 


17 


31 


128.6 


1 


5 


6 


133.3 


With cerebral arteriosclerosis 


29 


26 


55 


4 


4 


8 


12 


16 


28 


120.6 


1 


4 


5 


113.6 


With cardio-renal disease . 


1 


2 


3 


- 


- 


- 


1 


— 


1 


166.6 


— 


— 


- 


- 


Other types .... 


- 


- 


- 


- 


- 


- 


1 


1 


2 


666.6 


- 


- 


- 


- 


Psychoses Due to Convulsive Disorders 






























(Epilepsy): .... 


- 


1 


1 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


Epileptic deterioration 


- 


- 


— 


— 


- 


- 


— 


— 


— 


— 


— 


— 


- 


— 


Epileptic clouded states 


- 


1 


1 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


Other epileptic types . 


— 


— 


— 


— 


— 


— 


- 


— 


- 


- 


— 


- 


- 


— 


Psychoses Due to Disturbances of 






























Metabolism, Growth, Nutrition 






























or Endocrine Function: 


53 


71 


124 


7 


10 


17 


9 


21 


30 


107.9 


1 


6 


7 


116.6 


Senile Psychoses: 


44 


36 


80 


2 


4 


6 


3 


8 


11 


69.6 


- 


- 


- 


- 


Simple deterioration 


30 


24 


54 


1 


1 


2 


1 


4 


5 


55.5 


— 


- 


- 


— 


Presbyophrenic type 


4 


4 


8 


— 


1 


1 


1 


1 


2 


153.8 


— 


- 


- 


— 


Delirious and confused types . 


2 


1 


3 


1 


- 


1 


— 


— 


- 


- 


- 


— 


- 


— 


Depressed and agitated types . 


5 


2 


7 


— 


- 


— 


1 


3 


4 


210.5 


— 


— 


- 


— 


Paranoid types 


3 


5 


8 


— 


2 


2 


- 


— 


— 


- 


— 


— 


- 


- 


Involutional psychoses: 


6 


31 


37 


4 


6 


10 


5 


9 


14 


142.8 


1 


6 


7 


200.0 


Melancholia .... 


6 


16 


22 


4 


4 


8 


4 


6 


10 


172.4 


— 


5 


5 


238.0 


Paranoid types 


- 


9 


9 


- 


1 


1 


- 


2 


2 


95.2 


- 


1 


1 


100.0 


Other types .... 


- 


6 


6 


- 


1 


1 


1 


1 


2 


105.2 


1 


- 


1 


250.0 


With diseases of the endocrine 






























glands ..... 


— 


— 


— 


- 


— 


- 


- 


- 


— 


- 


- 


— 


— 


- 


Exhaustion delirium . 


— 


— 


— 


- 


- 


— 


1 


- 


1 


500.0 


— 


— 


- 


— 


With other somatic diseases 


3 


4 


7 


1 


- 


1 


— 


4 


4 


210.5 


— 


— 


- 


— 


Psychoses Due to New Growth: 


1 


- 


1 


- 


1 


1 


- 


- 


- 


- 


- 


2 


2 


1000.0 


With intracranial neoplasms 


1 


- 


1 


- 


1 


1 


— 


- 


— 


— 


- 


2 


2 


1000.0 


Psychoses Due to Unknown or Hered- 






























itary Causes, but Associated with 






























Organic Changes: 


14 


7 


21 


2 


1 


3 


1 


1 


2 


54.0 


1 


- 


1 


58.8 


With multiple sclerosis 


- 


— 


— 


1 


- 


1 


- 


1 


1 


1000.0 


— 


- 


- 


— 


With paralysis agitans 


1 


- 


1 


- 


- 


- 


— 


— 


- 


— 


— 


— 


- 


— 


With Huntington's chorea . 


2 


1 


3 


- 


- 


- 


— 


— 


- 


- 


— 


— 


- 


— 


With other brain or nervous diseases 


11 


6 


17 


1 


1 


2 


1 


- 


1 


33.3 


1 


— 


1 


71.4 


Disorders of Psychogenic Origin or 






























Without Clearly Defined Tangible 






























Cause or Structural Change: 


70 


109 


179 


64 


82 


146 


75 


72 


147 


107.9 


53 


60 


113 


111.3 


Psycho neuroses: 


11 


19 


30 


3 


8 


11 


10 


13 


23 


469.3 


7 


6 


13 


419.3 


Anxiety hysteria 


1 


5 


6 


- 


2 


2 


1 


3 


4 


500.0 


- 


1 


1 


500.0 


Conversion hysteria: 






























Anesthetic type . 


- 


- 


- 


- 


1 


1 


- 


- 


- 


- 


- 


1 


1 


1000.0 


Hyperkinetic type 


1 


— 


1 


— 


- 


— 


1 


— 


1 


1000.0 


— 


- 


- 


- 


Paresthetic type . 


- 


1 


1 


- 


- 


- 


- 


1 


1 


1000.0 


- 


~ 


- 


~ 



P.D. 23 



57 



All Deaths, 1940, All Cases in Residence and All Cases Out on 
of Admission and Sex 



All D 


EATHS 


Resident P 


OPULATION 


Patients Out 


ON Visit, etc. 


Firs 
Admiss 


t 
ons 


Readmis 


sions 


First 
Admissions 


Readmiss 


ions 


First 
Admissions 


Readmissions 


M. F. 


T. 


Rate 


M. 


F. 


T. 


Rate 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


12 5 


17 


101.1 


3 


1 


4 


76.9 


90 


46 


136 


30 


14 


44 


17 


4 


21 


5 


4 


9 


12 4 


16 


104.5 


3 


- 


3 


62.5 


85 


40 


125 


30 


11 


41 


17 


4 


21 


5 


3 


8 


12 4 


16 


116.7 


2 


- 


2 


55.5 


79 


32 


111 


24 


8 


32 


15 


4 


19 


5 


2 


7 


- - 


- 


- 


- 


- 


- 


- 


3 


1 


4 


1 
5 


1 


1 

1 
2 
7 


1 


- 


1 


- 


1 


1 


- - 


- 


- 


1 


1 


1 
1 


111.1 
333.3 


3 

4 


7 
4 
1 

1 
13 

11 


10 

8 

1 

1 

1 

100 

96 

11 

2 

8 

10 

65 


2 
2 


1 


- 


1 


- 


- 


- 


- 1 


1 


600.0 


- 


- 


- 


- 


1 


- 


1 


1 


- 


- 


- 


- 


1 
1 

1 


1 
13 
13 

1 

1 

1 

10 


5 - 
5 - 
1 - 


5 
5 
1 


33.5 
35.4 
62.5 


2 

2 


- 


2 
2 


35.0 
37.0 


87 
85 
11 
2 
4 
8 
60 


37 

37 

2 


8 
6 


45 

43 

2 


19 
19 
1 
1 
2 
4 
11 


9 
8 


28 
27 
1 
1 
6 
6 
13 


12 
12 

1 
1 

1 
9 


1 - 
3 - 


1 
3 


55.5 
35.7 


2 


: 


2 


44.4 


4 
2 
5 


3 
32 


1 
5 


1 

3 

37 


4 
2 
2 


1 


- - 


- 


- 


- 


- 


- 


- 


2 
1 
1 

4 


2 


4 
1 
3 
5 
1 


- 


2 


2 


- 


1 


1 


- 


- 


- 


1 - 
1 - 


1 

1 


111.1 
500.0 


- 


- 


- 


- 


2 

1 
1 


1 
1 


2 

1 


2 
2 

1 


2 

1 


1 
1 


1 
3 

1 


1 

1 


- 


1 
1 


40 24 

38 22 

1 2 

1 - 


64 

60 

3 

1 


284.4 
277.7 
500.0 
333.3 


3 
3 


5 
5 


8 
8 


190.4 
195.1 


3 
1 

63 

61 

2 


67 
67 


3 
1 

130 

128 

2 


12 
12 


1 

16 
16 


1 

28 

28 


1 

6 
6 


1 

10 
10 


2 

16 
16 


1 
1 


2 
2 


3 
3 


1 1 
1 - 

- 1 


2 
1 

1 


222.2 

142.8 

1000.0 


- 


1 
1 


1 
1 


66.6 
200.0 


5 

4 

1 


2 
2 


7 
6 

1 


9 

7 

2 


5 
3 

2 


14 
10 

4 


- 


1 
1 


1 

1 


- 


_ 


_ 


26 20 

23 18 

17 11 

1 3 

1 1 

2 2 
2 1 


46 
41 
28 
4 
2 
4 
3 


193.2 
275.1 
325.5 
363.6 
1000.0 
222.2 
93.7 


1 

1 
1 


6 
5 
4 
1 

1 
1 


7 
6 
5 
1 

1 
1 


148.9 
272.7 
416.6 
500.0 

43.4 
83.3 


61 
38 

24 
2 

5 
7 
17 
13 

4 


101 

59 

29 

3 

5 
22 
39 
19 
11 

9 

1 
1 

1 


162 

97 

53 

5 

10 
29 
56 
32 
11 
13 

1 
1 
7 


11 
4 
3 

1 

5 
3 
1 

1 


22 
12 
4 

1 

7 
10 
3 

6 

1 


33 

16 

7 

1 

1 

7 
15 
6 
7 
2 


5 
3 
2 

1 

2 
1 

1 


35 
6 
2 
2 

1 
1 
26 
15 
8 
3 


40 
9 
4 
2 
1 
1 
1 
28 
16 
8 
4 


5 

5 
5 


8 

1 
1 

7 
4 
2 
1 


13 

1 
1 

12 
9 
2 

1 


3 2 
1 - 
1 - 


5 
1 

1 


312.5 
1000.0 
1000.0 


_ 


- 


- 


- 


6 


2 


- 


2 


- 


3 


3 


- 


- 


_ 


4 7 


11 


323.5 


- 


1 


1 


76.9 


16 


5 


21 


6 

2 


5 


11 
2 


1 


2 


3 


- 


4 


4 


- 2 
4 5 


2 
9 


400.0 
333.3 


- 


1 


1 


100.0 


1 
2 
13 


1 

4 


1 
3 

17 


4 


1 

4 


1 
8 


1 


2 


3 


- 


4 


4 


13 20 
1 - 


33 

1 


29.4 
30.3 

- 


8 


13 


21 


25.0 


426 
4 

1 


516 
5 

1 


942 
9 
2 


302 
5 


402 
4 


704 
9 


111 
5 


129 
11 
2 


240 
16 
2 


66 
2 


111 

7 

1 


177 
9 

1 



58 



P.D. 23 



Table 13. Mental Disorders of All Admissions, All Discharges 

September SO, 1940, by Status 





All Admissions 


All Discharges 


Mental Disorders 


First 












First 














Admissions 


Readmissions 


Admissions 


Readmissions 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


Rate 


M. F. 


T. 


Rate 


Mixed hysterical psychoneu- 




























rosis .... 


— 


— 


- 


- 


— 


— 


— 


2 2 


666.6 


— 


— 


— 


— 


Psychasthenia or compulsive 




























states : 




























Obsession .... 


1 


1 


2 


- 


— 


— 


— 


- — 


— 


— 


— 


— 


— 


Phobia .... 


1 


— 


1 


— 


— 


— 


1 


- 1 


1000.0 


— 


- 


- 


— 


Mixed compulsive states 


- 


- 


- 


- 


- 


- 


- 


- - 


- 


- 


- 


- 


- 


Neurasthenia. 


— 


— 


— 


- 


- 


- 


— 


— - 


- 


— 


- 


— 


— 


Hypochondriasis 


— 


— 


- 


- 


— 


- 


- 


— — 


- 


— 


1 


1 


333.3 


Reactive depression 


3 


7 


10 


2 


3 


5 


2 


6 8 


615.3 


2 


2 


4 


4.44: A 


Anxiety state . 


— 


- 


— 


- 


— 


- 


- 


— - 


— 


2 


— 


2 


666.6 


Mixed psychoneurosis 


4 


5 


9 


1 


2 


3 


5 


1 6 


352.9 


3 


1 


4 


4:44: A 


Manic-depressive psychoses: 


13 


18 


31 


20 


20 


40 


9 


12 21 


262.5 


13 


21 


34 


223.6 


Manic type .... 


3 


7 


10 


10 


14 


24 


2 


4 6 


315.7 


6 


)0 


16 


188.2 


Depressive type 


3 


6 


9 


7 


4 


11 


3 


7 10 


294.1 


4 


9 


13 


302.3 


Circular type .... 


— 


2 


2 


— 


— 


— 


— 


— - 


— 


— 


— 


- 


— 


Mixed type .... 


2 


1 


3 


2 


1 


3 


1 


1 2 


181.8 


1 


1 


2 


166.6 


Perplexed type 


— 


- 


— 


- 


— 


— 


- 


— - 


- 


- 


— 


- 


— 


Other types .... 


5 


2 


7 


1 


1 


2 


3 


- 3 


230.7 


2 


1 


3 


333.3 


Dementia praecox (schizophrenia) : 


34 


60 


94 


31 


43 


74 


46 


41 87 


85.7 


29 


27 


56 


80.8 


Simple type .... 


1 


5 


6 


5 


3 


8 


2 


- 2 


43.4 


3 


1 


4 


111.1 


Hebephrenic type . 


3 


6 


9 


3 


5 


8 


10 


3 13 


60.7 


5 


3 


8 


46.5 


Catatonic type 


10 


13 


23 


4 


4 


8 


9 


11 20 


115.6 


2 


7 


9 


84.9 


Paranoid type 


7 


29 


36 


10 


21 


31 


18 


16 34 


91.6 


9 


11 


20 


92.1 


Other types .... 


13 


7 


20 


9 


10 


19 


7 


11 18 


85.7 


10 


6 


15 


92.5 


Paranoia ..... 


- 


- 


— 


— 


— 


— 


— 


— — 


— 


— 


— 


— 


— 


Paranoid conditions . 


3 


1 


4 


2 


- 


2 


3 


2 5 


75.7 


1 


2 


3 


100.0 


With psychopathic personality 


2 


5 


7 


5 


8 


13 


1 


1 2 


90.9 


2 


3 


5 


200.0 


With mental deficiency: 


7 


6 


13 


3 


6 


6 


6 


3 9 


71.4 


1 


1 


2 


24.3 


Idiot . . . ■ . 


„ 


1 


1 


— 


— 


— 


1 


1 


90.9 


— 


— 


— 


— 


ImbecUe .... 


3 


1 


4 


- 


2 


2 


3 


- 3 


68.1 


- 


1 


1 


35.7 


Moron ..... 


4 


4 


8 


3 


1 


4 


2 


3 5 


81.9 


1 


- 


1 


23.2 


Unknown .... 


— 


— 


- 


— 


- 


— 


— 


— 


- 


— 


- 


- 


— 


Undiagnosed Psychoses: . 


-■ 


3 


3 


— 


— 


— 


- 


1 1 


250.0 


— 


— 


- 


— 


Without Psychosis: 


50 


15 


65-- 


26 


8 


34 


46 


16 62 


861.1 


26 


7 


33 


785.7 


Alcoholism .... 


7 


3 


10 


3 


1 


4 


8 


3 11 


1000.0 


4 


1 


5 


1000.0 


Drug addiction .... 


- 


2 


2 


- 


- 


- 


1 ~ 


2 2 


1000.0 


- 


- 


- 


- 


■ Disorders due to epidemic en- 




























cephalitis .... 


— 


- 


— 


— 


- 


- 


— 


— - 


- 


— 


— 


- 


— 


Psychopathic personality: . 


19 


2 


21 


14 


2 


16 


18 


2 20 


909.0 


13 


2 


15 


833.3 


With pathological sexuality . 


1 


— 


1 


- 


— 


— 


1 


1 


500.0 


— 


— 


- 


— 


With pathological emotionality. 


6 


1 


7 


5 


— 


5 


6 


1 7 


1000.0 


5 


- 


5 


833.3 


With asocial or amoral trends . 


5 


— 


5 


3 


1 


4 


4 


- 4 


800.0 


3 


1 


4 


1000.0 


Mixed types .... 


7 


1 


8 


6 


1 


7 


7 


1 S 


1000.0 


5 


1 


6 


750.0 


Epilepsy ..... 


1 


- 


1 


2 


- 


2 


1 


- 1 


1000.0 


1 


— 


1 


500.0 


Mental deficiency: 


11 


4 


15 


5 


4 


9 


7 


5 12 


705.8 


4 


3 


7 


636.3 


Idiot 


- 


1 


1 


- 


— 


- 


- 


1 ] 


1000 . 


— 


— 


- 


— 


Imbecile .... 


2 


- 


2 


1 


2 


3 


- 


- 


- 


1 


1 


2 


500.0 


Moron ..... 


9 


3 


12 


4 


2 


6 


7 


4 1] 


785.7 


3 


2 


£ 


714.2 


Other non-psychotic diseases or 




























conditions .... 


7 


4 


11 


1 


1 


2 


7 


4 11 


846.1 


3 


1 


4 


1000.0 


No other condition 


5 


— 


5 


1 


— 


1 


5 




833.3 


1 


- 


] 


1000.0 


Primary Behavior Disorders: . 


5 


2 


7 


— 


- 


— 


6 


2 i 


i 888.8 


— 


— 


- 


— 


Simple adult maladjustment 


3 


2 


5 


- 


- 


- 


4 


2 e 


) 857.1 


- 


- 


- 


- 


Primary behavior disorders in 




























children : 




























Conduct disturbance 


2 


- 


2 


- 


- 


- 


2 


^ 


1000.0 


- 


- 


- 


~ 


Grand total 


272 


259 


531 


118 


Ill 


229 


197 


146 34; 


i 143 . 3 


95 


81 


17f 


) 132.3 



Note: — Admissions and discharges dc not include transfers. 



P.D. 23 



59 



All Deaths, 1940, All Cases in Residence and All Cases Out on 
of Admission and Sex — Concluded 



All Di 


:aths 


Resident P 


OPULATION 


Patients Out on Visit, etc. 


First 










First 












First 










Admiss 


ons 


Readmissio 


ns 


Admissions 


Readmissions 


Admissions 


Readmissions 


M. F. 


T. 


Rate 


M. F. 


T. 


Rate 


M. F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


- - 


- 


- 


- - 


- 


- 


1 - 
1 


1 

1 


1 

2 

1 


1 
2 


1 

2 
2 
2 


1 


1 

1 

1 
2 


1 

1 

1 
1 
3 


1 


- 


1 


1 - 


1 


100.0 


_ _ 


_ 


_ 


- 1 


1 


1 


1 


2 


3 


— — 


- 


— 


— — 


— 


— 


- 


— 


— 


- 


- 


- 


— 


- 


- 


1 


1 


— - 


- 


- 


— — 


— 


— 


2 2 


4 


1 


1 


2 


3 


4 


7 


- 


3 


3 


- 2 


2 


37.7 


3 2 


5 


46.2 


9 21 


30 


27 


42 


69 


12 


15 


27 


16 


28 


44 


— — 


- 


- 


1 1 


2 


33.3 


1 5 


6 


15 


27 


42 


3 


4 


7 


9 


16 


25 


- 1 


1 


43.4 


1 1 


2 


64.5 


5 7 


12 


7 


9 


16 


3 


8 


11 


5 


7 


12 


— — 


- 


— 


- — 


— 


— 


- 2 


2 


- 


1 


1 


_ 


1 


1 


— 


1 


1 


- 1 


1 


125.0 


1 - 


1 


125.0 


- 5 


5 


2 
1 
2 


3 


5 
1 
4 


2 


1 


3 


- 


4 


4 


_ _ 


_ 


_ 


_ _ 


_ 


_ 


3 2 


5 


2 


4 


1 


5 


2 


_ 


2 


9 14 


23 


26.9 


5 9 


14 


23.8 


345 397 


742 


226 


292 


518 


74 


88 


162 


43 


62 


105 


1 1 


2 


52.6 


- — 


— 


— 


19 15 


34 


16 


7 


23 


3 


5 


8 


8 


1 


9 


3 2 


5 


26.4 


- 5 


5 


32.8 


70 101 


171 


43 


96 


139 


8 


17 


25 


7 


13 


20 


2 4 


6 


41.0 


- 2 


2 


21.9 


49 71 


120 


32 


48 


SO 


13 


14 


27 


11 


4 


15 


3 5 


8 


27.3 


2 1 


3 


16.0 


106 144 


250 


70 


94 


164 


37 


42 


79 


8 


22 


30 


- 2 


2 


10.6 


3 1 


4 


30.5 


101 66 


167 


65 


47 


112 


13 


10 


23 


9 


22 


31 


— - 


- 


— 


— - 


- 


- 


- 5 


5 


— 


2 


2 




— 


— 


— 


— 


— 


- 1 


1 


18.1 


- 2 


2 


71.4 


14 35 


49 


7 


16 


23 


8 


3 


11 


— 


2 


2 


- 1 


1 


66.6 


— — 


— 


— 


5 7 


12 


5 


9 


14 


2 


o 


7 


1 


5 


6 


3 2 





45.8 


- — 


— 


— 


49 46 


95 


32 


37 


69 


10 


7 


17 


4 


7 


11 


2 - 


2 


181.8 


— — 


— 


- 


4 4 


8 


2 


2 


4 


— 


_ 


— 


_ 


1 


I 


1 2 


3 


73.1 


— — 


- 


- 


15 20 


35 


11 


14 


25 


2 


1 


3 


1 


1 


6 


— — 


— 


- 


- — 


— 


— 


26 16 


42 


17 


18 


35 


8 


fi 


14 


3 


4 


7 


- - 


- 


- 


- - 


- 


- 


4 6 

1 

7 1 


10 
1 

8 


2 


3 


5 


- 


2 

1 


2 
1 


- 


1 


1 


1 - 


1 


14.0 


- - 


- 


- 


5 


3 


8 


- 


- 


1 


1 


- - 


- 


- 


- - 


- 


- 


2 - 
1 - 

1 - 

4 - 


2 
1 

1 
4 


1 
2 

1 


1 


1 
3 

1 


- 


- 


- 


- 


- 


- 


_ _ 


- 


- 


- - 


_ 


- 


1 
1 
1 


1 
2 


2 
1 
3 


- 


1 


1 


- 


1 


1 


_ _ 


_ 


_ 


_ _ 


_ 


_ 


2 - 


2 


_ 


2 


2 


_ 


_ 


_ 


_ 


_ 


_ 


- - 


- 


- 


- - 


- 


- 


2 - 


2 


1 


- 


1 


- 


1 


1 


- 


1 


1 


1 - 


1 


76.9 


- - 


- 


- 


- 1 
1 - 


1 

1 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- - 


- 


- 


- - 


- 


- 


- 


- 


- 


- 


- 


- 


1 
1 


1 

1 


- 


- 


- 


104 77 


181 


88.8 


17 27 


44 


39.6 


759 753 


L,512 


413 


476 


889 


161 


195 


356 


90 


131 


221 



60 



P.D. 23 



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

Condition on Discharge 





TOTAI 




Recovered 


Improved 


Unimproved 


Psychoses 


























M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F- 


T 


With syphilitic meningo-encephalitis 


8 


4 


12 








8 


4 


12 








With other forms of syphilis . 


3 


1 


4 


— 


- 


— 


3 


1 


4 


- 


— 


— 


With other infectious diseases 


— 


3 


3 


- 


- 


- 


— 


3 


3 


— 


— 


— 


Alcoholic psychoses .... 


44 


5 


49 


20 


2 


22 


23 


3 


26 


1 


— 


1 


Due to drugs, etc .... 


1 


4 


5 


- 


3 


3 


1 


1 


2 


— 


— 


— 


Traumatic psychoses .... 


3 


— 


3 


1 


- 


1 


2 


- 


2 


— 


— 


— 


With cerebral arteriosclerosis . 


13 


20 


33 


— 


1 


1 


11 


18 


29 


2 


1 


3 


With other disturbances of circulation 


2 


2 


4 


— 


— 


— 


2 


2 


4 


_ 


— 


— 


Senile psychoses ..... 


3 


8 


11 


1 


1 


2 


1 


3 


4 


1 


4 


6 


Involutional psychoses .... 


6 


16 


21 


3 


4 


7 


3 


11 


14 


— 


- 


— 


Due to other metabolic diseases, etc 


1 


4 


5 


- 


1 


1 


1 


3 


4 


— 


— 


— 


Due to new growth .... 


— 


2 


2 


- 


- 


— 


— 


2 


2 


— 


— 


- 


With organic changes of nervous system . 


2 


1 


3 


1 


- 


1 


1 


1 


2 


— 


— 


- 


Psychoneuroses ..... 


17 


19 


36 


7 


7 


14 


9 


11 


20 


1 


1 


2 


Manic-depressive psychoses . 


22 


33 


55 


5 


4 


9 


16 


28 


44 


1 


1 


2 


Dementia praecox .... 


75 


68 


143 


10 


7 


17 


56 


58 


114 


9 


3 


12 


Paranoia and paranoid conditions . 


4 


4 


8 


- 


1 


1 


4 


3 


7 


— 


— 


— 


With psychopathic personality 


3 


4 


7 


— 


2 


2 


2 


2 


4 


1 


- 


1 


With mental deficiency .... 


7 


4 


11 


1 


1 


2 


6 


3 


9 


— 


- 


— 


Undiagnosed psychoses .... 


— 


1 


1 


-. 


— 


- 


— 


- 


— 


— 


1 


1 


Without psychoses .... 


72 


23 


96 


- 


— 


— 


- 


- 


- 


— 


— 


— 


Primary behavior disorders 


6 


2 


8 


3 


- 


3 


3 


2 


6 


- 


- 


- 


Total 


292 


227 


619 


52 


34 


86 


162 


159 


311 


16 


11 


27 



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

During 1940 











Under 1 




1-3 






4-6 






7-n 




Total 


Month 


Months 


Months 


Months 


Mental Disorders 






























M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


With syphilitic meningo-encepha- 






























litis ..... 


6 


4 


10 


- 


- 


— 


3 


3 


6 


- 


1 


1 


1 


1 


With other forms of syphilis 


1 


1 


2 


— 


— 


— 


— 


- 


- 


- 


1 


1 


1 


- 1 


With epidemic encephalitis 


- 


- 


- 


— 


— 


- 


— 


- 


— 


— 


— 


- 


— 


— — 


With other infectious diseases . 


- 


3 


3 


— 


1 


1 


- 


— 


— 


- 


2 


2 


— 


— — 


Alcoholic psychoses 


35 


5 


40 


13 


2 


15 


11 


1 


12 


4 


1 


6 


4 


- 4 


Due to drugs, etc. 


1 


3 


4 


- 


1 


1 


- 


2 


2 


- 


— 


- 


1 


- 1 


Traumatic psychoses 


3 


— 


3 


— 


— 


- 


2 


- 


2 


1 


- 


1 


— 


— - 


With cerebral arteriosclerosis 


12 


16 


28 


4 


1 


5, 


6 


8 


14 


1 


- 


1 


1 


2 3 


With convulsive disorders (epi- 






























lepsy) .... 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


Senile psychoses 


3 


8 


11 


1 


3 


4 


- 


2 


2 


1 


2 


3 


— 


1 1 


Involutional psychoses 


6 


9 


14 


- 


1 


1 


2 


2 


4 


1 


2 


3 


1 


3 4 


Due to other metabolic diseases, 






























etc. ..... 


1 


4 


5 


- 


1 


1 


1 


2 


3 


— 


— 


— 


— 


— - 


Due to new growth 


- 


— 


- 


- 


- 


— 




— 


— 


— 


- 


— 


— 


— — 


With organic changes of nervous 






























system .... 


1 


1 


2 


- 


— 


— 


1 


1 


2 


— 


— 


— 


— 


— — 


Psychoneuroses 


10 


13 


23 


6 


6 


11 


4 


6 


9 


— 


2 


2 


1 


1 


Manic-depressive psychoses 


9 


12 


21 


1 


- 


1 


4 


7 


11 


1 


2 


3 


- 


1 1 


Dementia praecox 


46 


41 


8/ 


2 


1 


3 


18 


IV 


36 


13 


9 


22 





7 12 


Paranoia and paranoid conditions 


3 


2 


5 


- 


- 


- 


2 


1 


3 


- 


- 


- 


- 


1 1 


With psychopathic personality . 


1 


1 


2 


- 


- 


- 


1 


1 


2 


— 


- 


— 


- 


- - 


With mental deficiency 


6 


3 


9 


— 


- 


- 


4 


1 


5 


— 


1 


1 


1 


1 2 


Undiagnosed psychoses 


— 


1 


1 


— 


— 


— 


- 


— 


— 


- 


1 


1 


- 


— — 


Without psychoses . 


46 


16 


62 


20 


8 


28 


24 


8 


32 


2 


- 


2 


— 


— — 


Primary behavior disorders 


6 


2 


8 


5 


- 


6 


1 


2 


3 


- 


- 


- 


- 


- 


Total .... 


197 


146 


343 


51 


26 


76 


86 


64 


160 


24 


24 


48 


16 


16 32 


Average Hospital Residence in 






























Years ..... 


.76 


.70 


.73 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- - 



P.D. 23 61 

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

During 1940 — Concluded 



Mental Disorders 


1 
year 


2-4 
years 


5-9 
years 


10-19 

years 


20 Years 
Plus 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


With syphilitic meningo-encepha- 

litis 

With other forms of syphilis 
With epidemic encephalitis 


2-2 


_ _ _ 


_ _ _ 




























Alcoholic psychoses 


1 1 2 








2-2 








Traumatic psychoses 
With cerebral arteriosclerosis 
With convulsive disorders (epi- 
lepsy) .... 
Senile psychoses 
Involutional psychoses 
Due to other metabolic diseases, 












- 3 3 


- 1 1 


- - - 


- 1 1 


- - - 


1 - 1 










1 1 2 
- 1 1 














Due to new growth . 
With organic changes of nervous 
system .... 
Psychoneuroses 
Manic-depressive psychoses 
Dementia praecox 
Paranoia and paranoid conditions 
With psychopathic personality . 
With mental deficiency 
Undiagnosed psychoses 
Without psychoses . 
Primary behavior disorders 








1 - 1 
6 3 9 


2 2 4 
1 2 3 
1 - 1 


_ _ _ 


- - - 


: : : 


- 2 2 


_ _ _ 


1 - 1 


- - - 


1 - 1 


- - - 


- - - 


_ _ _ 
































Total .... 
Average Hospital Residence in 


11 7 18 


6 7 13 


- 2 2 


- 1 1 


3-3 















62 



P.D. 23 



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P.D. 23 



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Erysipelas ......... 

Tuberculosis of the respiratory system .... 

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Cancer and Other Tumors: 

Cancer and other malignant tumors ..... 

Tumor (non-cancerous) ....... 

Rheumatic Diseases, Nutritional Diseases, Diseases of the Endo- 
crine Glands and Other General Diseases: 

Diabetes ......... 

Diseases of the thyroid and parathyroid glands . 
Diseases of the Blood and Blood-Making Organs: 

Other diseases of the blood and blood-making organs . 
Diseases of the Nervous System and Organs of Special Sense: 

Meningitis ......... 

Cerebral hemorrhage ....... 

Cerebral emboHsm and thrombosis ..... 

Epilepsy ......... 

Other diseases of the nervous system ..... 

Diseases of the organs of special sense (eye, ear and mastoid) 
Diseases of the Circidatory System^: 

Chronic endocarditis (^'alvular disease) .... 

Diseases of the myocardium ...... 

Diseases of the coronary arteries and angina pectoris . 

Arteriosclerosis 

Diseases of the veins ....... 

Other diseases ......... 

Diseases of the Respiratory System: 

Bronchopneumonia (including capillary bronchitis) 

Lobar pneumonia ........ 

Pleurisy ......... 

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

Ulcer of the stomach and duodenumi ..... 

Hernia, intestinal obstruction ...... 

Other diseases of the intestines ..... 
Diseases of the Genito-Urinary System: 

Nephritis (acute, chronic and unspecified) .... 

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

Violent and Accidental Deaths: 

Other external causes ....... 


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P.D. 23 





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"3 



P.D. 23 



75 



Table 21. Family Care Statistics for Year Ended September SO, 1940 



Remaining in Family Care September 30, 1939 
On Visit from Family Care September 30, 1939 
Admitted to Family Care During the Year 
Whole Number of Cases within the Year 
Discharged from Family Care within the Year 

Discharged outright 

From Family Care to Escape Status 

From Family Care to Visit Status 

Returned to Institution 

Returned to Institution from Escape . 

Returned to Institution from Visit 
Remaining in Family Care September 30, 1940 
On Visit from Family Care September 30, 1940 
Average Daily Number in Family Care During Year 

Supported by State .... 

Private ...... 



ilales 


Females 


Total 


44 


97 




141 


8 


12 




20 


51 


68 




119 


95 


165 




260 


49 


71 




120 


4 


— 




4 


2 


1 




3 


11 


16 




27 


32 


54 




86 


2 


1 




3 


8 


7 




15 


46 


94 




140 


3 


9 




12 


46.33 


96. 


17 


142.50 


43 


73 




116 


3 


21 




24