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Full text of "Annual report of the Worcester State Asylum at Worcester"

THIRTY-SIXTH ANNUAL REPORT 



WORCESTER STATE ASYLUM 



WORCESTER, 



Year ending November 30, 1913. 



CONTENTS 



Report of Trustees, . . 65 

Report of Superintendent, 70 

Report of Treasurer, 82 

Statistics, 91 



Digitized by the Internet Arciiive 

in 2010 with funding from 

University of IVIassachusetts Amherst 



http://www.archive.org/details/annualreportofwo115worc 



OFFICERS OF THE ASYLUM. 



TRUSTEES. 

GEORGE F. BLAKE, Worcester. 

LYMAN A. ELY, Worcester. 

THOMAS H. GAGE, Worcester. 

THOMAS RUSSELL, ■. Boston. 

CARRIE B. HARRINGTON, . . . . . . Worcester. 

GEORGIE A. BACON, Worcester. 

SAMUEL B. ¥/OODWARD, Worcester. 

RESIDENT OFFICERS. 

H. LOUIS STICK, M.D., . . . Superintendent and Treasurer. 

HIRAM L. HORSMAN, M.D., . . Assistant Physician. 

ARTHUR E. PATTRELL, M.D., . Assistant Physician. 

DONALD R. GILFILLAN, M.D., . Assistant Physician. 

GEORGE K. BUTTERFIELD, M.D., Assistant Physician. 

EFFIE A. STEVENSON, M.D., . . Assistant Physician. 

ABBIE S. FAY, Matron. 



NONRESIDENT 


OFFICERS. 


GEORGE L. CLARK, . . . 


. Examiner. 


SUSIE G. WARREN, . . . 


. Clerk. 


FREDERICK H. BAKER, M.D., 


. Pathologist 


FOREST A. SLATER, . . . 


. Engineer. 



CONSULTING SURGEON. 

LEMUEL F. WOODWARD, M.D., Worcester. 

JOHN McRAE, Business Assistaiit. 

THOMAS 0. LONG, .... Colony Supervisor. 
ALICE L. Lx\KE, Superintendent of A'urses. 



®l)e iHommonrDealtl) oi ii\asmtl)mtttB. 



TRUSTEES' REPORT. 



To His Excellency the Governor and the Honorable Council. 

The trustees of the Worcester State Hospital, having in 
charge the Worcester State Asykim, herewith respectfully pre- 
sent their thirty-sixth annual report. The reports of the 
superintendent and treasurer are hereto appended, giving full 
details of the health, admission, transfer and discharge of 
inmates and of the finances of the asylum. 

In view of the anticipated removal from Worcester to the 
Grafton colony, no special appropriation is asked for in 
Worcester. 

The appropriation granted by the Legislature in 1911 pro- 
vided for two buildings for 50 patients each and for a store- 
house. The buildings for patients are substantially completed 
and are occupied, and the storehouse is in use and will be com- 
pleted by the expenditure of the balance of the appropriation. 

The appropriation granted by the Legislature in 1912 pro- 
vided for two buildings for 50 patients each and both the 
buildings are nearly completed and can soon be occupied. 

Of the appropriation of $400,000, providing for the removal 
of the asylum from Worcester to the Grafton colony, about 
$200,000 has been already expended in the erection of ten 
buildings and additions to the bakery, laundry and power 
house. In the preparation of plans for these buildings the 
trustees were advised by the State Board of Insanity as to the 
class of inmates for whom provision must be made, and the 
plans were worked out with the co-operation of the State Board 
of Insanity and were submitted to and received the approval 
of the Governor and Council in accordance with the provisions 
of the act. The trustees believe that these buildings will be 
completed before Jan. 1, 1915. 



66 WORCESTER STATE ASYLUINI. [Dec. 

The Legislature of 1913 made a special appropriation for the 
asylum amounting to -1208,000. This appropriation provided 
for the construction of a male nurses' home, a female nurses' 
home, a new kitchen and dining room at colony No. 2, repairs 
on the old farmhouse at colony No. 2, filter bed enlargement, 
water supply and reservoir, an additional boiler at the power 
plant, a motor generator, and a service building at colony 
No. 4. All the foregoing buildings and improvements have 
been started with the exception of the repairs on the old farm- 
house, which cannot be undertaken until the house is vacated, 
and the service building at colony No. 4. 

This service building at colony No. 4 was planned somewhat 
after the service building at the Pines. The contractor who 
built the building at the Pines was asked to estimate the cost 
of the proposed building, and upon his estimate an appropria- 
tion of $48,000 was granted by the Legislature. When the 
building was put upon the market for bids, the lowest bid for 
the completed building was $55,000. This is the only instance 
in the appropriations of 1911, 1912 and 1913, involving an ex- 
penditure of over $700,000, in which the trustees have found it 
impossible to construct a building in accordance with the plans 
submitted and within the appropriation asked for. In-as- 
much as the construction of this service building at colony 
No. 4 was essential to the removal of the asylum from Worces- 
ter to Grafton, the trustees brought the matter to the attention 
of the State Board. Two courses were open: either the plans 
could be modified to permit the building to be built within the 
appropriation, or the matter could await the action of the 
Legislature of 1914. The State Board declined to approve the 
modification of the plans, and the building has not been started. 
New estimates for its construction have been obtained which 
amount to 862,000, which is $14,000 more than the original 
estimate and $7,000 more than the bid of 1913. The trustees 
regret that the original estimate upon which the appropriation 
was based has proved unreliable. They are informed that the 
reasons for the increase of $7,000 over the bids of 1913 are, 
the general rise in price of labor and material and the increased 
expense which is always incurred in erecting a single building. 
The estimate of $55,000 in 1913 was received from contractors 
whose plant was on the ground and who had labor immediately 



1913.] PUBLIC DOCUMENT — No. 23. 67 

available. In order to complete the service building at colony 
No. 4, therefore, the trustees respectfully request an additional 
appropriation of $14,000. 

The trustees renew their repeated request for better accom- 
modations for employees. The colony is to a degree isolated, 
and it is impossible to secure the best and most efficient help 
without providing them with reasonable conveniences. We 
believe, also, that it will add to the permanence of the service of 
employees if some provision can be made for families of em- 
ployees. We therefore ask for an appropriation of $16,000 to 
build two cottages for employees and $10,000 to build two 
bungalows for employees. 

We renew the request for an appropriation of $10,000 with 
which to purchase the Sinclair farm, so called, and urge again 
the reasons set forth in last year's report. The buildings on 
this farm, close to our No. 1 group, will furnish us with a horse 
barn and dormitory for employees, for both of which we have 
urgent need, and we cannot build them for the price asked for 
the entire property. 

With the completion and occupation of all the new buildings 
at colony No. 3 a new boiler must be added to the heating 
plant, and we ask an appropriation of $2,500 with which to 
piu-chase, equip and set such boiler. 

The trustees in their last report asked for an appropriation 
with which to build a cow barn at colony No. 1, and we 
respectfully renew the request for an appropriation of $9,000 
with which to build such barn. 

We believe that the efficient and economical administration 
of the colony requires the installation of a cold-storage plant 
and request an appropriation of $16,000 therefor. The store- 
house recently built was planned to permit a refrigerating 
system to be added to it. 

In their last report the trustees called attention to the needs 
of extending the sewage filtration plant, and that, after the 
removal to the colony of the patients now in Worcester, a 
further extension would be necessary. The trustees therefore 
now ask for an additional appropriation of $25,000 with which 
to extend the filter beds, to meet the demands occasioned by 
said removal. 

The recent rapid growth of the colony requires some extension 



68 WORCESTER STATE ASYLUM. [Dec. 

and enlargement of the hot water system, especially at colonies 
No. 1, No. 3 and No. 4, and an appropriation of $4,000 is 
asked for this purpose. 

The asylum at present has no hydrotherapeutic outfit. If 
the institution is to provide its inmates with that care and 
treatment which modern scientific methods demand, we be- 
lieve that an outfit for this purpose should be installed in the 
infirmary building and ask for an appropriation of $5,000 for 
that purpose. 

The present service building at the Pines was erected in 1910 
and was to care for 400 patients. The kitchen, scullery and 
storerooms were considered at the time hardly adequate and 
part of the room designed as a dining room has been used for 
these purposes. With the increased patients at this group all 
dining room facilities T\'ill be needed and additional space must 
be secured for kitchen and other purposes. In order to enlarge 
the present service building, so as to secure more kitchen 
accommodations, to rearrange the storerooms, pantries and 
sculleries, and on the second floor to provide a separate dining 
room for nurses and employees, we ask an appropriation of 
820,000. 

In order to comply with the requirements of the Commis- 
sioner of Public Records concerning the proper custody of the 
asylum's records, it v\'ill be necessary to fireproof certain rooms 
in the administration building and provide the same with 
steel cases and desks. For this purpose we ask an appropria- 
tion of S4,000. 

The colony at present has no central place in which religious 
serA'ices or entertainments can be held. Upon the completion 
of the buildings now in the process of construction and upon 
the removal of the asylum from Worcester, the population of 
the colony, inmates and employees, will be about 1,700, and 
it seems highly important that there should be a hall centrally 
located capable of accommodating from 1,200 to 1,400 people. 
We believe that the basement under such a hall ought to pro- 
vide opportunities for patients, nurses and employees in the way 
of gymnasium and recreation space. We therefore ask an appro- 
priation of .$75,000 with which to construct such a building. 

The details of these various requests have already been sub- 
mitted to the State Board of Insanity. 



1913.] PUBLIC DOCUMENT — No. 23. 69 

The trustees regret that there are committed to this asylum 
so many custodial and terminal cases. The colony was estab- 
lished to give patients the benefits of outdoor work and occupa- 
tion. The caring of custodial cases is a departure from the 
purposes of the colony and should, we believe, be discouraged 
as much as possible. We believe, also, with the growth of the 
institution it is desirable that it be made a reception hospital 
and not an asylum, to the end that it may receive its quota of 
acute cases to be helped by the opportunities which colony 
life affords. 

We also wish to enter our protest against the overcrowding 
of our dormitories and other buildings. We do not believe 
that satisfactory care can be taken of patients, or that em- 
ployees can give satisfactory care to patients, when the con- 
ditions under which they are housed and work are overcrowded. 

The trustees have asked for a maintenance appropriation on 
the basis that has heretofore prevailed. It is for the Legislature 
to determine what is to be the standard of support for the 
wards of the Commonwealth. We believe that a more generous 
scale of salaries and wages to those who care for the insane 
would encourage competent people to enter upon and remain 
in this field of work and do much to make the management of 
the institution more efficient. Salaries by other States are 
larger than those received in this Commonwealth, and we are 
constantly losing valuable officials who leave to enter the 
service elsewhere. 

To the superintendent, members of the staff, matron, super- 
visor of the colony, nurses, attendants and employees the 
trustees express their thanks for faithful service. 

Respectfully submitted, 

GEORGE F. BLAKE. 
LYMAN A. ELY. 
THOMAS H. GAGE. 
THOMAS RUSSELL. 
CARRIE B. HARRINGTON. 
GEORGIE A. BACON. 
SAMUEL B. WOODWARD. 



WORCESTER STATE ASYLUM. [Dec. 



SUPERINTENDENT'S REPORT. 



To the Trustees of the Worcester State Hospital, acting for the Worcester 
State Asylum. 

I respectfully present for your consideration the thirty-sixth 
annual report of the Worcester State Asylum and its colony. 

On Oct. 1, 1912, 1,150 persons were inmates of this institu- 
tion; of this number 546 were men and 604 were women. Dur- 
ing the year there were admitted 270 cases, — 106 men and 
164 women, • — making a grand total of 1,420 cases under treat- 
ment for the year, — 652 men and 768 women. Of this num- 
ber 3 men and 6 women were discharged into the community; 
10 women were transferred as boarding out cases and to other 
institutions; 2 men escaped; 2 men and 2 women went out on 
visit; 27 men and 38 women died. On Sept. 30, 1913, there 
remained in this institution 618 men and 712 women, — 1,330 
persons. The total number leaving the institution by death, 
transfer and discharge was 84, 14 more than last year. One 
man and 1 woman were discharged as capable of self-support, 3 
women as improved and 4 as not improved, although able to 
get along outside of an institution. 

Of the different forms of mental disease, primary dementia 
with its different forms, as last year, stands first, then alcohol- 
ism, imbecility, chronic delusional and manic-depressive in- 
sanity, senile dementia, epilepsy, involutional melancholia, con- 
stitutional inferiority, puerperal insanity and organic dementia, 
in the order named. Last year epilepsy and imbecility stood 
second and third while this year alcoholism is second in num- 
bers, and senile dementia stands sixth as against seventh last 
year. A greater number of the cases admitted were of a more 
intelligent class compared to the very large number of imbeciles 
received preceding last year. The average age of all cases 
admitted is lower than the previous year, and the duration of 
disease before admission to this institution is verv much 



1913.] PUBLIC DOCUMENT — No. 23. 71 

shorter. ]Many of the cases have been in a hospital less than 
six months, and more than a score less than ninety days. The 
patients admitted are of the violent, destructive and turbulent 
class, making it much more difBcult to care for them with the 
same number of attendants and nurses. 

The death rate is about one-half of one per cent, higher than 
last year. Of the whole number of patients treated 4.50 per 
cent, have died, while of the daily average number of patients, 
5.31 per cent., which is 1.25 per cent, higher than last year. 
Tuberculosis again, as last year, stands first as the cause of 
death, there being 11 cases; pneumonia stands second; the 
deaths from tuberculosis were 2 more than last year; from 
pneumonia the same number as last year. The number of 
deaths in the cases admitted was greater than in the older cases 
of the institution. 

During the early part of the year we had 4 cases of erysipelas 
among the patients at the colony, and in October 2 cases of 
measles occurred among the employees at the asylum. In 
June we had 10 cases of a bad type of dysentery at the Birches, 
in July 8 more cases at the Pines, and in August 4 more were 
noted at the Larches. The blood of all these cases was exam- 
ined for malaria and typhoid. One of the nurses at the Willows 
contracted the disease in July and was critically ill for about 
eight weeks, but has made a complete recovery and is now 
recuperating. Four of these cases died, all of whom were 
advanced in years. We did 19 typhoid vaccinations among the 
nurses and employees who came in immediate contact with 
the patients. A number of them had marked reaction for a 
few days. There were no marked cases of dysentery on the 
male side. 

The social work of the institution has been conducted by a 
member of our medical staff. She has made numerous visits 
to the homes of relatives and friends to ascertain the general 
conditions of the different families who were contemplating 
taking home an inmate who had become much improved; and 
if the surroundings were found suitable the patient was sent 
home on visit. Her visits to the different homes, no doubt, 
have been very beneficial to the homes as well as to the in- 
stitution in creating a better feeling towards the institution. 



72 WORCESTER STATE ASYLUM. [Dec. 

The rotation of employees has been greater than in any pre- 
vious year, a little more than three times. Their surroundings 
have been improved, the general instruction has been more 
varied, and more has been done for them than ever. However, 
the changes on the nursing staff have been a little less the past 
few months than during the early part of the year. The open- 
ing last year of the female nurses' home at the colony has had 
some staying effect and has made it more pleasant for the 
nurses, who after their hours of duty can leave the immediate 
environment of the patients. Our course of training has been 
still more varied. A course of lectures has been started for 
the male attendants, all of whom are compelled to attend. In 
this way we hope to be able to give instruction to all the 
different attendants and nurses who come in immediate con- 
tact with the patients. Lectures on social work and eugenics 
have been added to this course. I still believe that an increase 
in compensation for the attendants and nurses should be made, 
but I do not believe this will wholly solve the problem. 

We had 270 admissions during the year or 225 more than 
last year, so that the institution is filled to its capacity. We 
have had a large number of boarding out cases sent to us, but 
the greatest number have been received by transfer from the 
other institutions. The type of patient has greatly changed. 
Instead of receiving an average number of quiet and semi- 
industrious cases, we are receiving end results in the form of 
violence, turbulence and destructiveness, and the care of this 
class of patient becomes more trying and exacting in order to 
prevent accidents and violence. The character of the patients 
admitted has slightly reduced the percentage of occupation, so 
that the per cent, of persons at work or occupied in some form 
of industry has dropped from 74.11 last year to 68.9 per cent.; 
yet our actual number of patients working was materially 
larger than the previous years. I strongly urge that the old 
custom of transferring patients from the hospitals to the 
asylums should be discontinued and that all the institutions 
should be made reception hospitals, so that the patient might 
be admitted to the institution located in his district and remain 
there. I believe that if the State could be redistricted and a 
psychopathic hospital located in the central district, namely, 



1913.] PUBLIC DOCUMENT — No. 23. 73 

Worcester county, and one in the western district, in Spring- 
field, all of the central district could be taken care of in the 
two Worcester institutions and Gardner. 

To reduce the amount of violence on the wards we should 
consider smaller units. I belicA^e that a strong building of 
fireproof construction to care for not more than 20 or 25 
patients should be erected in each of our custodial groups, 
male and female, so that the violent, homicidal and the moral 
imbecile could be removed from the larger wards where they 
are and have always been a disturbing element. I believe that 
this would greatly reduce the amount of violence and accidents 
on our large and overcrowded wards. 

The work out-of-doors at the colony has progressed. INIore 
female patients have been working out-of-doors than last year. 
They have accomplished more and are doing better work, which 
is of much benefit to the institution and to the patient as well. 
We still more strongly urge taking excitable and turbulent 
cases from the wards, thereby reducing the ward disturbance 
greatly. 

The garden work started last year was still more successful 
this year, many of the patients occupying all of their time in 
improving their small plots and helping those nurses who 
entered into the plan with much interest. More than fifty 
bushels of the different kinds of vegetables were raised, of 
cucumbers alone more than fourteen. All of these vegetables 
were allowed the patient or nurse who prepared the same for 
her own use, or placed them in the kitchen where they were 
prepared for other patients as well. Because their work was 
so successful the past year, a still larger area will be prepared 
this coming year. We shall attempt to have a more uniform 
plot for each patient and nurse. A number of patients working 
in this garden were recruited from the out-of-door working 
crew. The largest number of female patients working out-of- 
doors during any one day was 33. 

The industrial work of the institution has been progressing. 
The sewing room at the colony has been a success. It has in- 
creased the efficiency of the patient who has been taken from 
the industrial rooms after her work has become more intelligent. 
]\Iuch clothing that heretofore was bought in the open market 



74 WORCESTER STATE ASYLUINI. [Dec. 

has been made during the year. Much work is being done on 
the ward with the assistance of the nurses, many of whom Hke 
to encourage the patients to do something whereby their minds 
may be occupied. 

The work done in the male department at the colony has 
been more pronounced this year than last, — a larger number of 
men were gotten out to work on the farm and in the barrow 
crews, grading and filling about the buildings. Much more 
work has been done in our Oaks group, this being purely for 
the colony type of patient who has been taken from the 
custodial class both from the asylum and the Elms group at 
the colony. The transfer of a patient from a closed ward ta 
the farm industrial group appeals to most of them very strongly. 
More roads and paths have been built about the Elms, also at 
the Oaks. The ice pond at the Willows has been enlarged a 
fourth over that of last year and the material excavated used 
for grading about the new buildings of this group. 

The work in the male industrial rooms at the asylum has 
been a great success. During the year about 400 chairs have 
been caned and reseated; about 135 rope mats have been 
made; 100 old laundry baskets have been repaired and more 
than 20 new ones constructed, all the brooms used in the in- 
stitution have been made; almost 600 hair and straw mattresses 
have been made here and at the colony; and about 400 hair 
and feather pillows, and also many other valuable necessaries. 
We have made several gross of new shoes and slippers and re- 
paired dozens of pairs of old ones in our cobbler shop. Most 
interesting work has been done in our industrial rooms at the 
asylum as well as at the colony. Although we may not make 
as much usable material in these places, yet the wisdom of 
getting certain patients to do something and of re-educating 
them has been fully demonstrated. This form of labor has 
greatly helped to reduce the amount of noise, destruction and 
turbulence on the different wards by providing occupation. 

We have added about 10 more acres to our cleaned land and 
4 more to our tillage. This amount is not as great as we antici- 
pated because we had so much digging, grading and general 
work for the patients to do. Much valuable work on the farm 
has been accomplished by patients' help. The farm products 
this year have been the largest in the history of the institution. 



1913.] PUBLIC DOCUMENT — No. 23. 75 

The yield of hay, corn and other farm products has been in- 
creased very materially. We raised more corn on one-half the 
acreage than was raised two years ago. 

We have been testing our herd for tuberculosis every six 
months instead of yearly as was our custom. No reactions 
were noted among the cows, but five yearlings gave a positive 
reaction. These calves, as last year, were placed in the open 
pasture in April and remained there until the latter part of 
September when they were again tested with tuberculin, and 
all were negative. The entire herd was examined with but one 
positive reaction, a cow that had been bought in the open 
market about five months ago. 

Numerous improvements have been made about the colony. 
But little repairing was necessary at the asylum because of the 
splendid upkeep of the same in previous years. At the colony 
we have made an addition to the dormitory portico at colony 
No. 1, giving us an extra room for clothing for the patients at 
this colony. The telephone booth has been finished and 
occupied most of the year. The cow barn had to be repaired by 
shoring. The horses had to be removed on account of the 
dangerous condition of the underpinning. The roof had to be 
temporarily covered before we could put in our new crop of 
hay. The old horse barn was renovated and the old bins re- 
moved to make room for the horses taken from the cow barn. 
The remaining structure of the old barn at colony No. 2, the 
Willows, has been removed. This lumber will be used to re- 
build the small barn at the Rhodes cottage, which was de- 
stroyed by a heavy wind storm during the early part of the 
year. Ten new hen pens have been added to the farm de- 
partment. The parts of the old pig shed removed last spring 
have been used to rebuild in a new location, giving us an 
added capacity for about 200 more pigs. 

The two-colony type of dormitories of 1910, for 50 patients 
each, at the Willows and the Oaks, are fully occupied. The 

1911 dormitories at colony No. 2 and the Oaks have been 
finished and are now occupied. The female nurses' home has 
been finished except the basement, and is fully occupied. This 
home is greatly appreciated by all. The two dormitories of 

1912 are about finished and are soon to be occupied. 

The new buildings to be erected on account of the removal of 



76 WORCESTER STATE ASYLUM. [Dec. 

the asylum to its colony, made mandatory by an act passed by 
the Legislature May 29, 1912, have all been started and are 
well along. 

There are nine buildings in this group, namely, an administra- 
tion, one infirmary, two strong buildings, — one for 100 men 
and one for 100 women, — one service and dining room with 
dormitory, a dormitory for 50 men at the Oaks, one for 50 
women at the Willows, one employees' cottage at colony No. 
1, one carpenter shop, and the boiler house addition. All of 
these buildings were put on the market in April and by the 
end of May the contracts were awarded and the agreements 
signed, so that the actual work began in June. 

Twenty new wells have been sunken near the old well on the 
Valley farm, all of which have been piped and attached to our 
present water system. This water was tested several times 
by the State Board of Health and found to be excellent. Al- 
though we have been frequently using more than 400,000 
gallons per day during the months of July, August and Sep- 
tember, yet the water in these wells was not lowered to any 
appreciable degree. 

About one-fourth of the excavation for the new reservoir, 
located on land recently procured north and west of the 
Willows, has been done and about 900 feet of the new 8-inch 
pipe has been laid. The reservoir is to be finished not later 
than June, when we shall possess a water supply not easily 
exhausted. All of the new buildings have been fully connected 
with our water system. 

The new boiler has been purchased, installed and will soon 
be ready for use. 

The new electrical generator and engine were purchased. 
The foundation is now being prepared to set them in alignment 
with the old generators. When these three machines are fully 
synchronized, we shall be able to produce all the electricity 
necessary for a number of years to come. 

The entire Willows group is now being heated from the 
central boiler house, which is one of the most successful ac- 
complishments at the colony. 

Other than for maintenance, no special appropriations will be 
asked for at the asylum this year. 



1913.] PUBLIC DOCUMENT — No. 23. 77 

Most of the appropriations I recommend to your Board this 
year are necessary to provide accommodations for our em- 
ployees and patients. 

The need of the Sinclair farm of 83 acres is more urgent than 
ever for the following reasons : — 

The colony horses are, at present, housed in a patched-up 
annex to the cow barn at No. 1. This is no longer adequate, 
and is also in a dilapidated condition. A new horse barn would 
cost about S7,000. For $10,000 the Sinclair farm can be 
purchased, with 83 acres of good land worth about $3,000, a 
house in excellent condition, which is capable of caring for 
from 22 to 24 persons with very slight changes, and an excellent 
barn suitable for 22 horses. To care for 22 employees, build- 
ings costing approximately $14,000 would be needed. This 
land was desired, largely on account of its buildings, at the 
time the colony was established, but the owner would not sell. 
I would recommend your Board to ask for $10,000 to purchase 
these buildings and the land as described. 

When the service building at colony No. 4 was put upon the 
market for bids, the lowest bid was in excess of the appro- 
priation of 1912. I therefore recommend that your Board ask 
for an additional appropriation of $14,000 with which to build 
said building. 

We shall be greatly in need of two employees' cottages to 
care for the increased number of employees needed at the 
colony. We shall have to provide new accommodations for 
employees who are now working at the asylum but room out- 
side of the institution, 42 in number. These cottages are of 
the same type and style as those now built and being built, 
only somewhat larger than the original plans of 1909. One of 
them should be located in or about our colony No. 1 group 
and the other at the Oaks group. They will care for 22 to 
24 employees. The first story is to be occupied by a married 
couple, the woman to take care of the building in compensa- 
tion for the rent. It has been estimated that the cost of 
building and furnishing these cottages will be $16,000. I 
would recommend your Board to ask for this amount. 

The Colony has two small houses that are occupied by single 
families. It seems to be very desirable that our employees 



78 WORCESTER STATE ASYLUM. [Dec. 

who are married or who have families and now live in North 
Grafton, Westborough or Worcester can remain nearer the in- 
stitution. We would be better served and it would tend to 
lessen the yearly rotation that seems so pronounced in our 
institution at present. I believe that we should have a number 
of small cottages for this purpose. One of these cottages should 
be located in the No. 3 or Oaks group, which will be occu- 
pied by the man and his wife who are in immediate charge or 
the physician and his family, who will later be at the head of 
this group. Several cottages could be located along the main 
highway leading from North Grafton to Westborough. I 
would recommend that your Board ask for $10,000 for build- 
ing, heating and furnishing these cottages. 

At present we have no central building to hold church or 
chapel services, entertainments, or other gatherings for social 
or educational purposes. This building should be large enough 
to care for at least 1,200 or 1,400 persons and centrally lo- 
cated, so that it would be easily accessible from all parts of 
the colony. The basement should be furnished for a recrea- 
tion hall, gymnasium or other athletic or calisthenic class work, 
or educational purposes for the patients, attendants, nurses 
and employees, and for a semi-storage place for furnishings 
and necessary material for work among the patients. The 
main auditorium would be used for chapel or church services 
and entertainments in general. I would respectfully recom- 
mend your Board to ask the coming Legislature for the sum 
of S75,000 to build, heat, light and furnish the same. 

The heating capacity at our colony No. 3, or the Oaks, is 
overtaxed at present and, with the addition of three new build- 
ings, it will be absolutely necessary to enlarge the same. I 
would recommend your Board to ask for S2,500 to purchase, 
erect and fully equip a boiler. 

The old cow barn at our colony No. 1 has about served its 
usefulness and is in a deplorable condition. It has been re- 
paired several times to tide us over from year to year, but 
now it is beyond repair unless a larger sum of money be ex- 
pended than is justifiable. A new and modern structure should 
be erected at some distance from the present farm buildings. 
The present structure is too small to care for the number of 



1913.] PUBLIC DOCUMENT — No. 23. 79 

cows necessary to produce the required amount of milk. I 
therefore recommend your Board to ask the Legislature for 
the sum of $9,000 to erect and equip this barn according to 
the plans and specifications used in the erection of the cow 
barn at our colony No. 3, in 1906, but to accommodate 64 
instead of 50 cattle. 

The storage building has been built for two years. It will 
be necessary to equip the same the coming year with a refrig- 
erating system so as to have it ready for use by the end of 
1914. It is estimated that to complete this insulation, finish 
rooms, purchase the machinery and erect the same the sum 
of $16,000 is needed. I recommend your Board to ask for 
the above sum. 

Our present filter beds are overtaxed. They take care of 
but one-half of the sewage. When the new beds are completed 
they will not even care for the new buildings now under con- 
struction, so that we shall have to add at least twice the 
amount of filter-bed surface. However, I do not believe that 
we should ask for more than half the amount this year. We 
are still caring for the colony No. 1 group by surface drainage 
in fields near the railroad. We were requested by the State 
Board of Health to discontinue the same four years ago, but 
have not done so because of the lack of funds to comply with 
this request. I therefore recommend your Board to ask the next 
Legislature for the sum of $25,000 to build 10 more filter beds. 

It will be necessary to extend our hot water system to fully 
equip the new buildings at our colonies No. 1 and No. 4, the 
Oaks and the Willows. For this extension $4,000 will be re- 
quired. I would urgently recommend your Board to ask the 
next Legislature for this sum to purchase the pipe, dig the 
trenches and install the same. 

A new hj^driatric outfit should be installed in our new infirm- 
ary building now under construction, so that we can give a 
more scientific and up-to-date treatment. This apparatus and 
the arrangement of the same should be placed in the base- 
ment of the infirmary building, so that it may be easily acces- 
sible by being centrally located. I recommend your Board to 
ask the coming Legislature for the sum of $5,000 to purchase 
and install such an apparatus. 



80 WORCESTER STATE ASYLUM. [Dec. 

Ill order to care for the increased number of patients in the 
Pines group the service building there must be increased, and 
I therefore recommend that your Board ask for an appro- 
priation of $20,000 with which to enlarge the service building 
to give increased kitchen, scullery and store space and provide 
for more suitable dining rooms for nurses and employees. 

To comply with a request made by the Commissioner of 
Public Records, who examined our plans and specifications for 
the new administration building now under construction at our 
Grafton colony, it will be necessary to fireproof all rooms con- 
taining our public records. It will be necessary to place iron 
doors on these rooms, iron shutters on the windows, to enlarge 
the vaults and make heavier walls of the same. I would recom- 
mend your Board to ask for a sum of $4,000 to comply with 
this request. 

Our training school has been in existence for more than ten 
years. We give a two years' course consisting of lectures, and 
class and ward demonstrations in connection with the daily 
work on the wards. The probation period extends over a 
period of three months, during which time the nurses receive 
special instruction and at the end of the two years, or June of 
the second year, having passed the final examinations, they 
take a six months' course in a general hospital. We are now 
affiliated with two general hospitals, — the Boston City Hos- 
pital and the Burbank Hospital in Fitchburg. All of our 
nursing force, no matter what their duties, have been com- 
pelled to take the training. This year we have made it man- 
datory for all attendants to take lectures both here and at 
our colony. This year 15 nurses graduated from our training 
school. 

Several changes have taken place on our staff. Dr. B. 
Henry Mason resigned the first of November to take up pri- 
vate practice in Portland, Me. Dr. H. L. Horsman was pro- 
moted to this position. Dr. George K. Butterfield, who has 
been an assistant in the Taunton State Hospital since 1902, 
was appointed to fill this last made vacancy. 

With the exception of the summer months we have had our 
regular weekly dances at the asylum and at our colony, and 
a monthly entertainment of some kind usually given by local 



1913.] PUBLIC DOCUMENT — No. 23. 81 

talent. In October we had a minstrel show, gotten up by a 
recovered patient, which was so successful that, after two per- 
formances at the asylum and colony, it was presented at one 
of the other institutions. This work is made more easy by 
the encouragement of the nurses and attendants who have 
charge of the social work among the patients and employees. 
Several berrying parties were made to our colony on the auto 
truck. These trips were very popular. On July 4 we had a 
regular field day at our colony which was attended by more 
than 200 patients, nurses and employees. The usual number 
of patients attended the different circuses and the New Eng- 
land Agricultural Fair. 

The ofiicers of the institution have given me cordial assist- 
ance and support throughout the year. The employees in gen- 
eral have been loyal in the performance of their duties. The 
procuring of the most efficient help has been trying. I am in- 
deed especially indebted to your Board for your many kind- 
nesses and assistance in aiding me in my many duties. 

We are indebted to the publishers of the "Worcester Eve- 
ning Gazette" and to the "Boston Journal" for copies of their 
daily papers; to the Hospital Society for books, pamphlets, 
magazines, and Christmas cards; to the Worcester Employ- 
ment Society for a large amount of sewing for the institution; 
to Miss Frances Lincoln for books, magazines and papers; to 
Mrs. Kinnicutt for books, magazines and pictures; and to the 
several members of your Board for most generous contribu- 
tions. 

H. LOUIS STICK. 

Worcester, Mass., Nov. 30, 1913. 



82 



WORCESTER STATE ASYLUM. 



[Dec. 



TREASURER'S REPORT. 



To the Trustees of the Worcester State Hospital acting for the Worcester 
State Asylum. 

I respectfully submit the following report of the finances of 
this institution for the fiscal year ending Nov. 30, 1913: — 

Cash Account. 
Balance Dec. 1, 1912, $13,569 33 

Receipts. 
Institution Receipts. 
Board of inmates : — 

Reimbursements, insane, .... $8,067 59 

Sales: — 

Food $225 98 

Clothing and materials, . . 400 14 

Repairs and improvements, . 17 09 

Miscellaneous, ... 243 98 

Farm, stable and grounds: — 
Cows and calves, $1,364 97 
Hides, . . 9 40 

1,374 37 

Total sales, 2,261 56 

Miscellaneous receipts : — 

Interest on bank balances, . $218 79 

Sundries, .... 7 57 • 

From Retirement Association, . 56 85 

283 21 

10,612 36 

Sales account of industries fund, ..'..... 10 55 

Receipts from Treasury of Commonwealth. 
Maintenance appropriations: — 
Balance of 1912 ($799.29 less returned $12.10), . $787 19 

Advance monej' (amount on hand November 30), 20,000 00 

Approved schedules of 1913, . $264,968 38 

Less returned, ... 27 27 

264,941 11 

285,728 30 

Special appropriations, ........ 213,643 49 

Industries fund : — 

Approved schedule, ........ 1 50 

Total, $523,565 53 



1913.1 



PUBLIC DOCUMENT — No. 23. 



83 



Payments. 



To treasury of Commonwealth : — 
Institution receipts, 
Industries fund, 



$10,612 36 
10 55 



Maintenance appropriations : — 
Balance November schedule, 1912, 
Eleven months schedules, 1913, 
November advances. 



Special appropriations: — 
Approved schedules. 
Less advances, last year's report. 



$213,643 49 
713 48 



November advances. 



$15,070 00 

264,941 11 

6,399 16 



$212,930 01 
1,089 38 



286,410 27 



214,019 39 

Industries fund : — 
Approved schedules, ........ 1 50 

Balance, Nov. 30, 1913: — 

In bank, $12,126 05 

In office, 385 41 

12,511 46 

Total . . $523,565 53 

Maintenance. 

Appropriation $290,900 00 

Expenses (as analyzed below) . 290,81131 

Balance reverting to treasury of Commonwealth, . . . $88 69 



Analysis of 
Salaries, wages and labor: — 
H. Louis Stick, superintendent. 
General administration, . 
Medical service, 
Ward service (male), 
Ward service (female). 
Repairs and improvements. 
Farm, stable and grounds. 



Food: — 

Butter, . 
Beans, . 
Crackers, 
Cereals, rice, meal, etc., 



$3,000 00 


37,736 54 


6,736 23 


19,549 60 


20,144 52 


10,288 48 


19,519 83 


©lie n-TC on 




$13,319 68 


1,236 69 


593 75 


1,366 28 



Amounts carried forward, 



$16,516 40 $116,975 20 



84 



WORCESTER STATE ASYLUM. 



[Dec. 



Amounts brought forward. 



$16,516 40 $116,975 20 



Food — Con. 






Cheese 


817 05 




Eggs 


1,439 77 




Flour, 


8,142 63 




Fish 


2,632 94 




Fruit (dried and fresh) 


2,924 46 




Lard 


861 59 




Meats 


21,840 16 




Milk 


4,735 59 




Molasses and syrup 


289 75 




Spices, seasonings, salt, etc., . 


290 37 




Sugar 


3,131 92 




Tea, coffee, broma and cocoa, . 


2,335 00 




Vegetables 


4,292 00 




Yeast 


114 88 




Sundries 


486 23 


70,850 74 






Clothing and materials : — 






Boots, shoes and rubbers, 


$2,013 17 




Clothing, . . . . 


9,090 68 




Dry goods for clothing and small wares, . 


2,037 06 




Furnishing goods, 


89 57 




Hats and caps, 


164 43 




Leather and shoe findings. 


258 27 




Materials and machinery for manufacturin 


g, . 105 93 




Sundries, 


469 89 


14,229 00 






Furnishings: — 






Beds, bedding, table linen, etc., 


$9,548 83 




Brushes, brooms 


356 50 




Carpets, rugs, etc 


86 60 




Crockery, glassware, cutlery, etc., 


912 38 




Furniture and upholstery. 


464 10 




Kitchen furnishings, . . . . 


587 70 




Materials and machinerj' for manufacturin 


?, . 617 21 




Wooden ware, baskets, pails, etc.. 


95 59 




Sundries, 


1,673 96 


14,342 87 






Heat, light and power: — 






Coal, 


$23,653 17 




Freight on coal 


4,791 85 




Gas 


9 79 




Oil 


350 08 




Sundries, ...... 


633 49 


29,438 38 






Repairs and improvements: — 






Cement, lime and plaster, 


$107 60 




Doors, sashes, etc., . . . . 


23 60 




Electrical work and supplies, . . 


593 77 




Hardware, 


1,619 67 




Lumber, 


1,238 26 




Machines (detached), . . . . 


442 50 




Amounts carried forward, 


$1,025 40 


$245,836 19 



1913. 



PUBLIC DOCUMENT — No. 2.3. 



85 



Amounts brought forward, 



$4,025 40 $245,836 19 



Repairs and improvements — Con. 
Paints, oil, glass, etc.. 
Plumbing, steam fitting and supplies. 
Roofing and materials, 
Sundries, . . . . . 



Farm, stable and grounds: '■ — 
Blacksmith and supplies. 
Carriages, wagons, etc., and repairs, 
Fertilizers, vines, seeds, etc. 
Hay, grain, etc., 
Harnesses and repairs. 



Cows, . 

Other live stock. 

Tools, farm machines, etc, 

Sundries, 

Religious services, 



Miscellaneous : — 

Books, periodicals, etc., . 
Entertainments, .... 

Freight, expressage and transportation, 
Funeral expenses, .... 

Hose, etc., ..... 

Ice, ...... 

Medicines and hospital supplies. 
Medical attendance, nurses, etc. (extra). 
Postage, ..... 

Printing and printing supplies. 
Printing annual report, . 
Return of runaways. 
Soap and laundry suppUes, 
Stationery and office supplies, . 
Travel and expenses (officials). 
Telephone and telegraph. 
Tobacco, ..... 

Water, 

Sundries, ..... 



Total expenses for maintenance, 



1,848 89 




2,422 70 




258 65 




1,021 31 






9,576 95 




$348 3^ 




4,084 23 




1,828 92 




9,126 60 




229 47 




950 00 




1,050 24 




287 48 




218 37 




1,258 74 






19,382 43 




• 


954 00 


$452 76 




559 55 




2,454 36 




433 00 




126 47 




46 25 




1,195 98 




60 00 




366 43 




116 39 




140 33 




151 72 




2,668 04 




1,186 52 




384 46 




639 00 




841 97 




1,523 78 




1,714 73 






$15,061 74 






$290,811 31 



Special Appropriations. 

Balance Dec. 1, 1912, $452,399 21 

Appropriations for fiscal year, ....... 208,500 00 

Total $660,899 21 

Expended during the year (see statement annexed) , $213,643 49 

Reverting to treasury of Commonwealth, . . 1 72 

213,645 21 



Balance Nov. 30, 1913, 



$447,254 00 



86 WORCESTER STATE ASYLUM. [Dec. 



Resources and Liabilities. 
Resources. 

Cash on hand, $12,511 46 

November cash vouchers (paid from advance 
money) : — 
Account of maintenance, . $6,399 16 
Account of special appropria- 
tions 1,089 38 

7,488 54 



Due from treasury of Commonwealth account of 

November, 1913, schedule 5,870 20 



$25,870 20 



Liabilities. 
Schedule of November bills $25,870 20 



Per Capita. 
During the year the average number of inmates has been 1,256.45. 



Total cost for maintenance, $290,811.31. 
Equal to a weekly per capita cost of $4,439. 
Receipt from sales, $2,263.56. 
Equal to a weekly per capita of $0,034. 
All other institution receipts, $8,348.80. 
Equal to a weekly per capita of $0,127. 



Industries Fund. 

Balance Dec. 1, 1912, 

Receipts credited, ...... 



Expenditures, approved schedules (see statement annexed), 

Reverting to treasury of Commonwealth, 

Balance Nov. 30, 1913 



$300 00 
10 55 


$310 55 

$1 50 

298 50 

10 55 



310 55 



Industries. 
Expenditures. 



Materials: — 
Reed for baskets, ......... $1 50 



1913.1 



PUBLIC DOCUMENT — No. 23. 



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WORCESTER STATE ASYLUM. [Dec. 1913. 



INMATES' FUND. 



Cash on hand Dec. 1, 1912, 13,830 42 

Received from inmates, $1,211 25 

Interest, Worcester Trust Company, . . 34 23 

Interest, Mechanics Savings Bank, . . . 98 10 

1,343 58 



S5,174 00 
Cash refunded inmates, ........ 717 09 



Balance (Worcester Trust Company, $1,913.97; Mechanics 

Savings Bank, $2,527.04; drawer, S15.90), .... $4,456 91 

Worcester, Dec. 20, 1913. 

I hereby certify that I have made a monthly examination of all bills and pay 
rolls representing the current expenses of the Worcester State Asylum for the year 
ending Nov. 30, 1913 ($290,811.31), and have found them properly scheduled and 
correctly cast. 

I also find in the hands of the treasurer $4,456.91 belonging to patients. 

GEORGE L. CLARK, 

Examiner. 



Statistical Tables 



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92 



WORCESTER STATE ASYLUM. 



[Dec. 



— • Received on First and Subsequent Admissions. 



NUMBER OF ADMISSION. 


Cases admitted. 


Males. 


Females. 


Totals. 


First (to this asylum), 

Second (to this asylum). .... 
Third (to this asylum), 


100 
2 


156 


256 
2 


Total cases, 

Total persons, 


102 
102 


156 
156 


258 
258 



3. — Ages of Insane at First Attack and Death. 





Died. 




AT FIRST ATTACK. 


AT TIME OP DEATH. 




Males. 


Females. 


Totals. 


Males. 


Females. 


Totals. 


Congenital, .... 


_ 


_ 


_ 


_ 


_ 


_ 


15 years and less, . 


2 


- 


2 


- 


- 


- 


From 15 to 20 years, . 


1 


1 


2 


- 


- 


- 


20 to 25 years, . 


4 


3 


7 


- 


1 


1 


25 to 30 years, . 


- 


3 


3 


- 


1 


1 


30 to 35 years, . 


3 


3 


6 


3 


1 


4 


35 to 40 years, . 


2 


3 


5 


1 


4 


5 


40 to 50 years, . 


5 


4 


9 


8 


8 


16 


50 to 60 years, . 


1 


4 


5 


3 


7 


10 


60 to 70 years, . 


1 


3 


4 


8 


5 


13 


70 to 80 years, . 


- 


- 


- 


3 


9 


12 


Over 80 years, 


- 


- 


- 


1 


2 


3 


Unknown, .... 


8 


14 


22 


- 


- 


- 


Totals, .... 


27 


38 


65 


27 


38 


65 


Total persons, 


- 


- 


- 


- 


- 


- 


Mean known ages (in years), 


32.84 


39.66 


36.65 


54.33 


56.42 


55.55 



1913. 



PUBLIC DOCUMENT — No. 23. 



93 





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A. — First admitted to any hospital when received 
by institution from which transferred: — 
Alcoholic insanity, acute, .... 
Alcoholic insanity, chronic, .... 
Chronic delusional insanity, 
Constitutional inferiority with dementia, . 

Dementia, chronic 

Dementia prsecox, 

Dementia praecox, catatonic form. 
Dementia praecox, manic type, . 
Dementia precox, paranoid form. 

Dementia, senile, 

Epilepsy, 

Epilepsy with dementia, .... 

General paresis 

Imbecile, 

Imbecile, moral 

Imbecile with dementia, .... 

Inebriate, 

Involutional melancholia 

Manic-depressive insanity 

Organic dementia, 


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94 



WORCESTER STATE ASYLUM. 



[Dec. 



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B. — All other admissions: — 

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Alcoholic insanity, chronic. 
Chronic delusional insanity. 

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mentia 

Dementia, chronic, 

Dementia prjecox, 

Dementia precox, paranoid form, 

Epilepsy, 

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General paresis, 

Imbecile with dementia, .... 

Imbecile, 

Imbecile with traumatic epilepsy. 
Involutional psychosis, .... 
Manic-depressive insanity, . . . . 

Organic dementia, 

Puerperal insanity, infectious. 


Totals B 

Aggregate cases, 

Aggregate persons, 



1913.1 



PUBLIC DOCUMENT — No. 23. 





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Nervous system : — 

General paresis, 

General paresis, heart disease, .... 
Status epilepticus 

Circulatory system: — 

Arteriosclerosis 

Cardiovascular renal, senility 

Cerebral hemorrhage, arteriosclerosis, . 
Cerebral hemorrhage, diabetes, .... 
Chronic endocarditis, arteriosclerosis, . 
Chronic endocarditis, myocarditis, hydrothorax, 

chronic passive congestion of kidneys. 
Chronic valvular heart disease, .... 
Chronic valvular heart disease, senility. 

Endocarditis 

Endocarditis, hypostatic pneumonia, . 

Heart disease 

General system: — 

Acute enteritis 

Acute enteritis, arteriosclerosis 

Acute enteritis, multiple sclerosis, 

Acute enteritis, obesity, 

Cancer of face 

Chronic hephritis, malaria, 

Chronic intestinal tuberculosis 

Exhaustion, fracture of thigh, .... 



1913.1 



PUBLIC DOCUMENT — No. 23. 



97 



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Facial erysipelas, 

Facial erysipelas, acute enteritis, .... 

Fractured skull and jaw, 

Heat exhaustion, arteriosclerosis 

Killed on railroad, 

Respiratory system: — 
Bronchitis, acute, myocarditis, arteriosclerosis, . 
Bronchitis, chronic, asthma, .... 
Chronic bronchitis, chronic myocarditis, 
Pneumonia, broncho, arteriosclerosis, chronic 

malaria, 

Pneumonia, lobar, 

Pneumonia, lobar, endocarditis, .... 
Pneumonia, lobar, fracture of thigh. 

Pulmonary tuberculosis, 

Pulmonary tuberculosis, acute enteritis. 







WORCESTER STATE ASYLUM. 



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Nervous system: — 
General paresis, . . ... 
General paresis, heart disease, .... 
Status epilepticus, 

Circulatory system: — 

Arteriosclerosis 

Cardiovascular renal, senility, .... 

Cerebral hemorrhage, arteriosclerosis. 

Cerebral hemorrhage, diabetes, .... 

Chronic endocarditis, arteriosclerosis, . 

Chronic endocarditis, myocarditis, hydrothorax. 

Chronic passive congestion of kidneys. 

Chronic valvular heart disease, .... 

Chronic valvular heart disease, senility, 

Endocarditis, 

Endocarditis, hypostatic pneumonia, . 

Heart disease 

General system: — 

Acute enteritis, 

Acute enteritis, arteriosclerosis 

Acute enteritis, multiple sclerosis. 

Acute enteritis, obesity, 

Cancer of face 

Chronic nephritis, malaria, 

Chronic intestinal tuberculosis, .... 



1913 



PUBLIC DOCUMENT — No. 23. 






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10 to 20 years, . 
Over 20 years, .... 


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