r ;. THIRTY-SEVENTH ANNUAL EEPOKT WORCESTER STATE ASYLUM WORCESTER, FOK THE Year ending November 30, 1914. CONTENTS. PAGE Report of Trustees, . . . . . . . . . . 61 Report of Superintendent, 66 Report of Treasurer, ' . . 83 Statistics, 91 Digitized by the Internet Archive in 2010 with funding from University of IVIassachusetts Amherst http://www.archive.org/details/annualreportofwo117worc OFFICERS OF THE ASYLUM. TRUSTEES. ELLEN A. SHEEHAN, Worcester. GEORGIE A. BACON Worcester. TIMOTHY J. FOLEY, Worcester. RESIDENT OFFICERS. H. LOUIS STICK, M.D., . . HIRAM L. HORSMAN, M.D., . ARTHUR E. PATTRELL, M.D., DONALD R. GILFILLAN, M.D., GEORGE K. BUTTERFIELD, M.D. MARY JOHNSON, M.D., . . MINNIE SCHRIBER, . Superintendent and Treasurer. Assistant Physician. Assistant Physician. Assistant Physician. Assistant Physician. Assistant Physician. 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, . . THOMAS O. LONG, ROBERT S. SAWYER, Business Assistant, Colony Supervisor. Practical Farmer. ^\)t (HommontDealtt) of itla00ac()usettB, TRUSTEES' REPORT. To His Excellency the Governor and the Honorable Council. The trustees of the Worcester State Hospital, having in charge the Worcester State Asylum and its Gra^fton colony, herewith present their thirty-seventh annual report, and, for a detailed statement concerning the patientS; employees, farm- ing and building operations, and other activities incident to the life of the institution, as well as its immediate needs, would respectfully call your attention to the appended reports of the superintendent and treasurer. The year ending Nov. 30, 1914, has witnessed the comple- tion of various things authorized by the Legislature of 1912, 1913 and 1914, namely, two dormitories for 50 patients each; a male nurses' home; a female nurses' home at colony No. 2; a service and dormitory building at the same colon}-, made possible by addition to and alterations in the original dormi- tory; the setting of three boilers (one at the central heating plant, the others in the boiler house at colony No, 3); the in- stallation of an additional motor generator; the construction of a reservoir with a storage capacity of at least 2,000,000 gallons; and an appreciable addition to the sewage filtration system. In addition to the above, a service building at the Oaks, a building of the custodial type at the Elms, to provide for 100 male patients^ and one at the Pines group for 100 female patients, also an infirmary building at the Elms, have been completed. The administration building, two dormitories (one for 50 male and the other for 50 female patients), the carpenter shop, and a cottage for employees are well under way. All of these were authorized as a result of the legislative act of 1912 62 WORCESTER STATE ASYLUM. [Dec. for the removal of the asylum to Grafton, and for which an appropriation of $400,000 was granted. As the number of patients under treatment annually has in- creased from 1,194 in 1910 to L511 in 1914, and as the State Board of Insanity has given the number to be cared for in 1915 as 1,575, the trustees are perplexed and troubled regarding adequate accommodations. The appropriation granted for the removal of the asylum will provide for the housing of only 400 patients. The number at the present time at the asylum is 627, at the colony, 773. The older custodial buildings at the colony are already over- crowded, the service building at the Pines has reached its utmost limit, and the failure to secure a sufficient appropriation to erect a service building at the Elms has made conditions there almost intolerable. Until these conditions can be reme- died and other buildings necessary for the care, treatment and diversion of the patients can be erected, it seems neither wise nor possible to comply with the provisions of the removal act. The Legislature of 1914 granted an extension of time, and a further extension will be necessary. Before the new custodial and infirmary buildings can be opened three things are imperative : — 1. An extension of the heating and hot-water system. For this we ask an appropriation of $5,000. 2. The erection of a service building at the Elms. The Leg- islature of 1913 granted an appropriation of $48,000 for this purpose. This was based upon the estimate of a reputable contractor, but fell short of the actual figures submitted by the lowest bidder. Last year the trustees asked for an additional appropriation of $14,000, the sum necessary to build in accord- ance with the plans approved by the State Board of Insanity. We renew this request for an appropriation of $14,000. 3. The enlargement of the service building at. the Pines. This building now provides for the preparation and serving of food to 322 patients and 57 employees. To secu''e the neces- sary additional space, we renew our request of last year for an appropriation of $20,000. With each increase in the number of patients, with the open- ing of new buildings, and with the extension, of farming opera- 1914.] PUBLIC DOCUMENT — No. 23. 63 tions comes a corresponding increase in the number of employees. To provide for this increase and to furnish accommodations that will counteract the lure of the city and make for the most wholesome living, we renew our request of last year for an appropriation of $16,000 to build two cottages for employees. We also ask for an appropriation of $20,000 to construct four cottages of the bungalow type, these to be occupied by single families. Ever since the inception of the colony the trustees have been eager to own what is known as the Sinclair farm. Two years ago they secured an option on it, and requested an appropria- tion for its purchase. This request was renewed last year, but not granted. The condition of the old barn at colony No. 1 is a disgrace to the State; patched, propped, it is unsafe for man or beast, and further expenditure for its renovation would, in our opinion, be unwarranted. The purchase of the Sinclair farm would relieve this situation, and, with slight changes, provide not only a horse barn but accommodations for 20 to 25 employees. The land would make available considerable acreage for farming purposes. We therefore ask for the third time for an appropriation of $10,000 to purchase and alter this property. With the present accommodations it is impossible to house and care for all our stock properly and to provide for a larger herd, which must be maintained if the institution is to produce the necessary amount of milk. We therefore renew our request of the past two years for an appropriation of $9,000 to build a cow barn. To provide for the care and distribution of the quantity of supplies necessary to maintain the larger institution, the store- house at the colony, which was built by means of an appro- priation granted by the Legislature of 1911, will be altogether too small. At the time of its construction it was so arranged that a refrigerating system could be installed later on. That system is much needed at the present time. To enlarge the present structure and equip it for cold-storage purposes, we ask for an appropriation of $47,500. Hydrotherapy has proved an effective agent in the treatment of insanity. At three different times the trustees have asked 64 WORCESTER STATE ASYLUM. [Dec. for an appropriation to provide the means for such treatment at the colony. Again we renew the request and ask for the sum of $5000 to install a hydriatric outfit in the new in- firmary. To minister to the spiritual needs and to relieve the tedium of confinement and exacting occupation, the institution must provide religious services, educational opportunities and varied entertainment. The only available place at the colony for this purpose is a day space in one of the custodial buildings. This location is inconvenient, its use is a disturbing factor to many of the inmates of this particular building, and its capacity is much too small even now. To provide adequate accommoda- tions for present and future needs, we renew our request of last year and ask for an appropriation of $75,000. The appropriation requested last year for further extension of the sewage filtration plant was only granted in part, there- fore we ask for $6,000 this coming year that we may more easily approach the amount of filtration deemed necessary by the State Board of Health. Last year an appropriation for fireproofing certain rooms in the administration building, now in process of construction, was not granted. The building itself being fireproof, it seems best to postpone a renewal of this request. Certain minor repairs are much needed at the asylum proper, but no special appropriation is asked for at this time. During the year the trustees have met with a real mis- fortune in the resignation of a majority of their members. The interest, the zeal, the knowledge of past conditions and the realization of future needs which they brought to their work have made their places difficult to fill. Another resignation, which the trustees accepted with regret, was that of Miss Abbie S. Fay, w^ho, on account of ill health, has retired to private life after thirty-one years of conscien- tious, devoted service as matron of the institution. The faithfulness with which the superintendent, the members of the staff and the employees have performed their several duties merits our appreciation and thanks. In closing, we again express our regret at the large number of custodial and terminal cases that are committed to our care. 1914.] PUBLIC DOCUMENT — No. 23. 65 We renew our belief that a change in the nature of the in- stitution should be made, — that it should become a reception hospital. We register, for the first time, our protest against the aban- donment of the asylum buildings. The cry of the times is economy in city, State and national government; the burdens of taxation are becoming greater each succeeding year; a reverence for the past and the preservation of historic sites are being considered more and more; and the prevention of disease, even more than its cure, is the aim of the medical profession. The asylum, through the dignity of its construction, is a tribute to the architectural development of the past. The first institution maintained by the State for the care of the insane, it is of more than passing worth; its destruction will lessen the available accommodations for the mentally sick and be a loss to the State of hundreds of thousands of dollars. Its location is ideal for a much needed psychopathic hospital in this vi- cinity. It is our desire that it be retained. Respectfully submitted, ELLEN A. SHEEHAN. GEORGIE A. BACON. TIMOTHY J. FOLEY. WORCESTER STATE ASYLUM. [Dec. SUPERINTENDENT'S REPORT. To the Trustees of the Worcester State Hospital, acting for the Worcester State Asylum. Ill obedience to the laws of the Commonwealth, I have the honor to submit to you for your consideration the thirty-seventh annual report of the Worcester State Asylum and its colony. On Oct. 1, 1913, 1,330 persons were inmates of this institu- tion, — 618 men and 712 women. During the year there were admitted 181 cases, — 100 men and 81 women, — making a grand total of 1,511 cases under treatment for the year, — 718 men and 793 women. Of this number, 12 men and 9 women were transferred to .boarding out or to other institu- tions; during the year 36 patients were allowed home on visit, — of this number 11 were discharged from visit, 16 were returned for institution care, and on Sept. 30, 1914, 8 patients, — 4 men and 4 women, — were still on visit; 40 men and 36 women died. On Sept. 30, 1914, there remained in the institution 648 men and 737 women, — 1,385 persons, — which is 55 more than the pr'evious year. The total number leaving the institution by death, transfer and discharge was ll3, 29 more than last year. Three men and 1 woman were discharged as recovered; 5 men and 3 women as capable of self-support; 2 men and 2 women as improved; and 2 men and 3 women as not improved, though able to be cared for in homes outside of an institution. Of the different cases admitted, primary dementia, as last year, stands first, alcoholism, second, chronic delusional insan- ity, imbecility, general paresis, manic-depressive insanity, senile dementia, epilepsy, constitutional inferiority, chronic dementia, arteriosclerosis, defective delinquent, puerperal in- sanity and idiot, in the order named. We received 181 admissions during the year, which is 88 less 1914.] PUBLIC DOCUMENT — No. 23. 67 than last year. A larger number of boarding-out cases were received than the year before, but the largest number of ad- missions was by transfer from other institutions. The average age of all cases admitted this year was a little higher than last year. A smaller number of imbeciles and con- stitutional inferior cases, and but one idiot, were admitted. The patients admitted during the year were even more turbu- lent, destructive and violent than last year. Among those admitted were three badly homicidal and a large number of suicidal cases, which makes it still more difficult to care for them properly with the small number of attendants and nurses at hand. Figured on the whole number of patients treated, the death rate was 4.99 per cent., or .37 per cent, higher than last year; while figured on the daily average number of patients, the death rate is 5.49 per cent., which is .18 per cent, higher than last year. Tuberculosis was the cause of the largest number of deaths, there being 15 oases this year against 11 of last year, acute enteritis was second, cardiorenal third, valvular heart disease and cerebral hemorrhage were equal in number, and pneumonia takes fifth place instead of second as last year. The asylum population Nov. 30, 1914, consists of 1,400 cases with the following analysis : — Cases. Chronic alcoholic insanity, 160 Chronic delusional insanity, 272 Primary dementia, 489 Primary delusional insanity, 5 Senile dementia, 28 Epilepsy, .111 Manic-depressive insanity, 64 General paresis (dementia paralytica), . . . . . . .16 Imbecile (different grades), 188 Constitutional inferiorit}'', . . 38 Constitutional psychopathic, 1 Defective delinquent, 1 Idiot, 5 Involution melancholia, 11 Puerperal insanity, 3 Organic dementia, 2 Arteriosclerotic insanity, 3 Syphilitic insanity, 3 68 WORCESTER STATE ASYLUM. [Dec. The hospital residence of the above cases ranges from forty- seven years to less than one year. We have a number of cases which were here when the asylum became an institution for the temporary care of the insane in 1877. During the early part of the year we had two sporadic cases of typhoid fever, one at the asylum and one at the colony. The patient at the asylum died as a result. As a matter of precaution, 27 nurses were treated with typhoid vaccine. During the past four years 174 cases have been treated. At the asylum during the months of July, August and Sep- tember, we had 6 cases of erysipelas, with no fatal results. At the colony we had 1 case of German measles during the month of July. On March 1 a nurse at the asylum developed a severe attack of diphtheria. She was immediately isolated, and several thousand units of diphtheria antitoxin were given when she was sent to the Worcester Isolation Hospital, where she grad- ually improved. She apparently was convalescing when she developed a paralysis the third week of April, and died on the 23d. The usual precaution was taken and 14 nurses who had come in immediate contact with the nurse were given antitoxin treatment. We had from 40 to 50 sporadic cases of tonsillitis, both mild and severe. These cases were entirely among the attendants and nurses, and seemed to have developed soon after they came to the institution. In July, 4 night nurses of the female custodial group de- veloped a severe attack of dysentery. Three of them were in a critical condition for about five weeks, but all made a grad- ual recovery when they were sent elsewhere for recuperation. They have since returned to their different duties. Soon after this we had a number of cases develop in July, August and September among the patients. There were 13 on the female side and about 40 on the male side in the Elms group. Five deaths resulted from this disease. An attendant contracted the disease during the latter part of September. He became critically ill, it being necessary to have him under constant observation for more than two weeks, during which time he developed an articular infection of both knees and ankles. 1914.] PUBLIC DOCLMENT — No. 23. 69 He is now recuperating, but is unable to resume his duties. The blood and dejecta of nurses and attendants were ex- amined several times to demonstrate the typhoid or para- typhoid germ, but the cultures proved it to be the dysentery germ instead. This infection was first noticed among the nurses and attendants rather than among the patients, which would almost demonstrate the fact that it was originated outside of the colony. The epidemic we had last year de- veloped during the latter part of May and the early part of June, while this year no evidence was noted until the latter part of July. We had no cases at the asylum. A case of pellagra was discovered on the female wards at the asylum last July. The patient rapidly grew worse and was confined to her bed until relieved by death three months later. She was a native of Ireland and came to the United States in 1875. She was admitted to the Worcester State Hospital the first time in 1893 for acute alcoholism, and a few weeks later was discharged. In 1895 she was again committed, when her hospital residence became permanent. She came to the asylum in 1902. A marked mental change had been noticed for the past fourteen months. From a garrulous, semi-violent person she became quiet, tractable and agreeable, though her grandiose delusions always remained. In 1909 she weighed 145 pounds, and this gradually diminished until just previous to her death her weight was but 89 pounds. The left upper lobe was in- fected presumably with tuberculosis. The Wassermann blood test was negative. Wassermann blood tests were made of the different patients of the institution to the number of 1,355. One thousand one hundred and eighty specimens were negative, 105 positive and 70 doubtful. A spinal puncture was made in most of the posi- tive cases to determine the cellular count of the spinal fluid. This examination has cleared up doubt as to the cause of the psychosis in some cases. The number of positive cases among the imbecile and epileptic class was much smaller than had at first been anticipated. The whole number of positive cases is low, but 75 per cent, more prevalent among the male than the female. Of the positive cases, 16 have been diagnosed as cases of dementia paralytica. A complete analysis of these 1,355 70 WORCESTER STATE ASYLUIVI. [Dec. cases, as to age, sex, habits, residence (rural or urban), occu- pation and mental psychosis, will be published later. I again strongly urge that the custom of transferring patients from the hospitals to the asylum should be discontinued. The Medfield Asylum has been made a reception hospital. This asylum should not only be made an institution for acute cases but it should be made into a psychopathic hospital. Worcester is the logical place for the second or central district, where the acute cases can be brought and cared for, and where the general public can receive advice and treatment at all times. I most strongly urge that the Legislature be petitioned to create a law to this effect. The asylum was used for an acute hospital for forty-five years. It has many features that are not duplicated in any of the more recently built hospitals. The reduction of violence on the wards at the asylum and colony can only be accomplished by a larger nursing force and classification of cases into smaller units. I would again strongly urge smaller units for not more than 20 to 25 patients. These could be erected in our custodial groups, and would relieve the larger wards from violence, turbulence and acute excitements. Out-of-door work at the colony has been carried on more extensively than in former years. More patients have been working, — about 55 per cent, of the men and about 15 per cent, of the women. They have done more and better work than in previous years. This greatly benefits the patient as well as the institution. The many ward disturbances are more easily and effectively reduced by the open-air agrarian occu- pations. The work done in our garden was more effective this year than ever, more patients and nurses took part in the outdoor occupations, and more have spent all of their time in the open air. The garden area was enlarged; the individual plots were more intensively cared for; the crops were larger and more prolific. The vegetables were used by the patients and nurses, who took much pride in preparing the same for their own use or for others who were less fortunate than themselves. We shall make strenuous efforts to double our acreage and the number of patients taking part in this open-air occupation the coming year. A large per cent, of these patients was trans- ferred from our out-of-door crew. 1914.] PUBLIC DOCUMENT — No. 23. 71 A much larger number of male patients has been working- out-of-doors this year than last. The wheelbarrow and grading crews were enlarged, but the number immediately occupied in actual farming was not increased because of the type of these patients. Much grading has been done in the Willows, Oaks and Elms groups. The number of transfers of closed ward patients to the Oaks has been larger. The reservoir has been wholly excavated, and the ice pond at the Willows enlarged. The industrial work has been progressing under the instruc- tion of our new industrial teacher, who has introduced many new ideas and ways of occupation for the indolent ward pa- tients. The nurses, as well as the patients, receive instruction. The nurse is taught in class, and the knowledge thus obtained is used in encouraging the patients to do something whereby their minds may be occupied in useful ways. This has resulted in a larger number of patients assisting with the mending and in making new clothing, all of which greatly reduces the large amount of work done in the sewing rooms. In September we had an exhibit at the Worcester County Fair of work done in the industrial departments. The general public was invited to see how the patients' time is occupied, and what the institution is doing in general for their care. The industrial work on the male wards has been more di- versified and- much more has been accomplished, so that at present all of our brooms, baskets, rope mats and most of our brushes are of our own manufacture. Most of the chairs, which in previous years were repaired in the carpenter shop, are now looked after in the industrial shops at the asylum and colony. All chair caning is done herC; and all straw and hair mattresses, all pillows, and many other articles valuable to the institution are made. In the cobbler shop 165 pairs of shoes and slippers were made and about 1,800 pairs were repaired; 123 harnesses were repaired and many other small repairs were made. This form of labor has been of assistance in reducing ward disturb- ance, destructiveness and violence. More than 20 acres of land have been redeemed during the past two years, and about 5 added to the farm for tillage. The farm has become more productive, and more intensive farming has been accomplished. Our apple crop was very large and our vegetables almost double. 72 WORCESTER STATE ASYLUM. [Dec. The social work of the institution was conducted by the female assistant physician of the staff. About the same number of families were visited, and all homes were visited before patients were allowed to go home for a visit or before their discharge. The number of patients sent out on visit has been the largest in the historj^ of the institution. There is no doubt but what the visits of the social worker have produced a better feeling among the public, relatives and friends. The rotation of employees has been about 2.7 times, which is less than last year. The stability seems better, and the type of nurses and attendants seems a little higher. The male nurses' home at the colony has been opened, and this, with the opening of the female nurses' home, has made it more pleasant and agreeable for the employees by getting them away from the wards after their hours of duty. Our training school for nurses was established eleven years ago. To date we have had 71 graduates, 20 of whom are still in our employ. The course of study covers a period of two years with a probation period of three months, after which the candidate, if satisfactory, is required to wear the standard uniform of the school. At the end of the two years' course those who successfully pass the final examinations are given a diploma. The nurse must then take a post-graduate course of from six to twelve months in a general hospital with which we are affiliated. At present one of our graduates, who has taken a year's course at the Boston City Hospital, is at the Boston Lying-in Hospital, and two are at the Burbank General Hospital at Fitchburg. All nurses are compelled to take the training, and must give satisfactory evidence that they will remain the full two years. More studies have been added, and the lectures and demonstrations are more varied; a course in dietetics has been prepared by Miss Schriber, our matron; a course in industrial occupation will be given by our industrial instructor; and a course in surgical technique by our visiting surgeon. A course of 12 lectures has been added for the male nurses which is obligatory, so that all nurses and attendants who come in contact with the patients receive instruction. All nurses are required to do a certain amount of collateral reading, which it is hoped will help to broaden their general 1914.] PUBLIC DOCUMENT — No. 23. 73 knowledge. We also have a number of attendants taking the regular course of training with the nurses. A kindly and sympathetic spirit on the part of the public will help very materially to raise the general standard of our nursing force. A slight increase in compensation may help, but environment with a higher standard of requirements is of the greatest importance. An out-patient department was opened at the asylum October 9 for Friday evening of each week from 7 to 9 o'clock; also, since November 16 on Friday from 2 to 4 p.m. We tested our herd twice during the year, once in April and again in October, for tuberculosis. We had one reaction in the spring and two this fall. The one reacting in the spring was killed, the other two will be observed for a few months longer, after which time a third test will be made. Last spring four of the young stock reacted. As in previous years these were turned loose in the open pasture in April and allowed to re- main there until October, when they were brought in and a second test made with negative results. Of the five calves that reacted in the spring of 1913, all gave a negative reaction to both tests made this year. Our herd is much improved. The average production of milk per cow for the year has been 8;358.5 pounds, which is about 78.02 pounds higher than the previous year. Eight of the cows had their first calf this year. We have disposed of all cows giving less than 4,000 pounds per year. We have 20 thoroughbred cows, 28 heifers and 5 bulls, so that in the course of a few more years our herd will consist of only registered stock. I think much of this improvement in our herd is due to the constant attention in the care and feeding of them by those now in charge of this department. We have made many improvements at the colony, but little repairing has been done at the asylum. The addition to the portico of the colony No. 1 dormitory has been completed. The cow barn at colony No. 1 again had to be reshored and propped up on the north side and east end to keep it from falling to pieces. This is a constant source of expense and anxiety, which can only be obviated by replacing it with a new structure. Several small sheds were built in 74 WORCESTER STATE ASYLUM. [Dec. which the gardener keeps his tools and vegetables. The wagon . shed is being enlarged for the automobile truck. Colony No. 1 has been connected with the new heating lines, the old one being discontinued. The old line leading from Maple cottage to dormitory 1 has to be replaced. At the Oaks the hen house is being enlarged. Twelve new hen pens for about a dozen chickens have been built. The two-colony type dormitories of 1912 have been com- pleted and are now occupied. The male nurses' home has been completed and occupied since August. The matron's cottage will soon be finished. The infirmary and 100 men's building have been completed since October, but as we have no central dining room these buildings could not be occupied because of lack of dining space. No appropriation for heating these two buildings was granted last year, so that local plants were established within the buildings to protect them from the elements. The new administration building is nearing completion. The new dining room and service building at the Willows is about completed and has been partly occupied since November 24, when the patients were moved from the old farmhouse preparatory to eating their Thanksgiving dinner in the new home. The new female nurses' home has been completed and will soon be heated, when it will be partly occupied. The Cedars or 100 women's building has been finished, but is not occupied because of inadequate dining space. An addi- tion to the service building in this group will be absolutely necessary before this building can be occupied. The addition to the old boiler house has been finished and occupied since the early part of May. The carpenter shop is rapidly nearing completion. The service building at the Oaks is completed except for the floors in the dining rooms, scullery and kitchen, which are rapidly being put in. The new boiler house is completed, and the two new boilers of 1912 and 1913 have been purchased and installed. The two dormitories of 1913 at the Willows and the Oaks are under roof, lathed and ready for plastering in the spring. The reservoir, which is connected by an 8-inch pipe with the 1914.] PUBLIC DOCUMENT — No. 23. 75 main water system, has been completed and is now in use. This will give us a storage capacity of about 2,000,000 gallons, and ample fire protection for all of the buildings at the colony. The new motor generator has been placed and in use since May. We are now able to take care of any emergency which is liable to occur, for a long time to come. The entire group at the Willows is being heated from the central boiler plant. The whole system has been fully installed, the hot-water heater and storage tank changed, and a new pump placed to circulate and feed the four boilers now in use. The filter beds, for which an appropriation was granted in 1913, have been completed and are in use. The three new beds authorized in June of this year are rapidly being constructed. When these beds are finished we shall have about four-fifths the amount of filtration surface recommended by the State Board of Health. No special appropriation will be asked for the asylum this year, excepting for maintenance. Most of the appropriations I recommend to your Board are made necessary by the failure of the Legislature to grant the same last year, so that we shall not only be compelled to ask for the same appropriations, but the amounts in several in- stances will be considerably larger. These appropriations are most urgent and very necessary. I have recommended the purchase of the Sinclair farm and buildings for the past two years, and feel that the need of this place is more imperative to us than ever. As stated in my report last year, the horses and cows at colony No. 1 are poorly housed and should be properly cared for in up-to-date buildings, if not to uphold the dignity of the State, for the general welfare and hygienic improvement of these animals. The old barn is now being propped up and shored to keep our animals from being injured. I feel that the money which has been expended on these buildings has been, in a sense, wasted. The farm with its different buildings can be purchased for $10,000. The house will give the same accommodations as two of our present em- ployees' cottages, which cost us about $14,000. The barn will give us accommodations to care for our horses, now poorly housed. This farm of 83 acres of good land will produce more 76 WORCESTER STATE ASYLUM. [Dec. than $3,000 worth of hay and other products the first year. By purchasing this property, I feel that the State would make one of the very best investments and procure more adequate accommodations for our employees and horses, while the farm will give us the proper location for a new cow barn which is most urgent. I would recommend that $10,000 to purchase this farm and buildings be asked for by your Board. I would suggest four bungalows this year instead of two, the number asked for last year, these to care for single families, which will make homes for employees who haA^e families and who cannot, at present, live at the colony because we are not so situated that we can give them this accommodation which, as you well know, will mean more stability and efiiciency with our help. At present such employees are compelled to live in North Grafton or Westborough, and I believe that if they could remain nearer the institution, we would be better served and it would tend to lessen the yearly routine of help. The sum of 120,000 will be necessary to build, heat, light and partly fur- nish the same. I recommend that your Board petition the Legislature for the above sum.. We are in need of two employees' cottages of the same type as we have been building and of the same size as the matron's cottage located in the administration group. Both of these buildings are needed for the employees necessary to care for the farm, gardens and grounds, and the night watches of these different groups. The sum of $16,000 will be necessary for the erection, heating, lighting and furnishing of the same, which sum I would recommend your Board to ask for this coming year. The colony has no central place of gathering, no recreation hall, no place of amusement and no chapel for religious serv- ices. A chapel and recreation hall should be so located that it will be in about the center of the colony geographically, as well as the center of the different groups of buildings, especially the custodial groups. If the colony is to be developed to a capacity of 1,600 cases by Jan. 1, 1916, and to 2,000 later, this building should accommodate at least 1,200 to 1,400 persons. This building should be of fireproof construction and so ar- ranged as to have services and entertainments in the main •auditorium. The basement or ground floor should be so ar- 1914.] PUBLIC DOCUMENT— No. 23. 77 ranged as to care for special classes in calisthenics for patients, attendants and nurses, as well as classes of all kinds for the patients. It would also be used for the social gatherings of the attendants, nurses and other employees. All entertainments for the patients, weekly dances and other gatherings are now held in the day spaces of the Birches or Pines, making it necessary to remove the patients to another part of the building, causing congestion, or to another building, which causes much dis- turbance among the excitable and turbulent patients. The pa- tients who sleep in the dormitory part of the building above these day spaces must necessarily be disturbed. Should we fail to receive the appropriation for this building, our class gradua- tions and entertainments for the patients or employees must of a necessity take place in the already overcrowded buildings. It has been estimated that for the erection of the same, heating, lighting, plumbing and grading, a sum of $75,000 will be necessary. I would recommend that your Board petition the Legislature for this amount. Extension of our Heating and Hot-water System. — This ex- tension of the heating and hot-water system is to connect fully the new buildings now completed at our colony No. 1 and the Elms, the new administration group, the new service building, infirmary, 100 men's building and dormitory at the Oaks. All of these buildings are erected and completed, but, as an appro- priation for this extension was not granted last year, they must of a necessity stand without heat this winter or a temporary local heating plant must be erected to prevent deterioration from the elements. The heating capacity of colony No. 3, or the Oaks, is overtaxed at present, and you may readily see that the new dining room and service building and the new dormi- tory now under roof and about to be plastered cannot be heated with the present equipment. Two new boilers have been purchased and are now fully installed in the new heating plant of this group, yet we have no way of transmitting the heat to and from the boiler house to the other buildings. It has been estimated that to purchase all the material, dig the trenches, lay the pipes and cover the same, the sum of S5,000 will be necessary, for which sum I recommend that your Board ask the pending Legislature. 78 WORCESTER STATE ASYLUM. [Dec. We are in greater need of a cow barn this year than at any time, because of the increased size of our herd necessary to pro- duce the required amount of milk, and because of the. extremely dilapidated condition of the present barn. During the last two summers the underpinning gave way several times, so that we have been compelled to remove some of the horses and place them in a shed or part of the horse shed used for storing grains and feed. At one time this past summer the south side of the floor dropped over 14 inches. This had to be jacked up and underpinning put in. We must do the same thing again be- cause of the poor, decayed condition of the girders and old underpinning. It is indeed unsafe to keep cattle in such a structure. We were compelled to prop two sides of the building to keep it from spreading any more by heavy bulging. The roof had to be repaired in order to keep the cattle and hay dry. To date we have spent a little over $1,300, which amount should have gone- towards the erection of a new barn. A new and modern barn must be erected, and should be located at a much greater distance from the present dormitories, kitchen and administration center. The size of the building should be such as to take care of at least 65 to 70 cows. The type and construction would be similar to the one at the Oaks, with the exception that it would have the modern improvements. The milk room should be large and farther away from the main structure. A basement should be located in the main part of the barn to take care of the manure, or a manure shed should be erected some distance away. There should be a basement under the milk room where a furnace can be maintained to heat this part of the building and to supply the hot water necessary. This building should be located on the Sinclair farm. I therefore recommend that your Board ask the Legisla- ture for the sum of $9,000 to erect and equip this barn accord- ing to the plans and specifications used in the erection of the cow barn at the Oaks, built in 190G, but to accommodate 65 instead of 50 cattle. Storehouse and Cold Storage. — -.The storehouse at the colony, w^hich is to be used for our cold storage, has been erected for three years, but on account of the removal scheme, it will be absolutely necessar\- to have a larger building for this purpose bv Jan. 1, 1916. To care for all the material necessary at the 1914.] PUBLIC DOCUMENT — No. 23. 79 present time and allow for an increase in our stock, the present building will need to be enlarged by at least 75 feet, 50 feet to be added to the west end towards the railroad and 25 feet to the east end. The west end will be used for general storage pur- poses, while most of the old part and the east end will be oc- cupied by the cold-storage outfit, rooms to keep meat, eggs, butter and cheese, fowl, fish, apples, other fruits, and vegetables. The first floor will be used for the storage of flour, sugar, beans, dried fruits and other bulky material, such as molasses, syrup, salt, oils of all kinds, heavy hardware and supplies for the farm, and garden implements. I therefore would recommend your Board to ask for an appropriation of $47,500 to erect this addition, purchase and install machinery and insulate the different rooms. Our filter beds are now more than overtaxed. x\t present we are filtering but one-half of our sewage on the old beds. When our present filter beds are completed and connected with the old beds, we will have sufficient filter surface to care for most of the sewage, but will not be able to give these beds the rest necessary to good filtering. At present our colony No. 1 is surface-drained, • — not a single new building has been added. When these beds are finally completed, we have been advised by the State Board of Health to discontinue the field drainage. The sewage from our power house and laundry building, cold storage and carpenter shop is taken care of by the Assabet valley beds. , These beds are also to be discontinued and the sewage is to be put into the new beds. To do this it will be necessary to pump the same, which will require the erection &f a pumping station. However, we shall have to put in one or two more beds. To build these new beds will require about $8,000, but as we will have to connect all the new buildings with the present system and finish the grading of our old beds, it has been estimated that to build the beds, purchase and place the pipe, a sum of from $16,000 to $20,000 will be necessary. However, I feel that it would be better to connect the new buildings and rearrange the old sewage pipes this year and make the other extension of beds next year. I therefore recommend that your Board ask for a sum of $6,000, the amount necessary to do this work. Two years ago we asked for an appropriation to build, fur- 80 WORCESTER STATE ASYLUM. [Dec. nish and complete a new service building, with a dormitory, in the Elms group. This request was granted, and the sum asked for was appropriated by the Legislature of 1913. When the building was put on the market, it was found that among the number of different contractors the lowest bid was about $8,000 higher than the estimate made for this building, namely, $48,000. The estimate was made by a local contractor who made a mistake in his figures, which was the real cause. Had we been able to build two years ago, an amount of $7,500 would have been sufficient to complete the same, but as this was not sanctioned by the Commission on Economy and Effi- ciency, the same was not granted. It has been estimated that to erect this building an additional sum of $14,000 will be necessary. This building is absolutely necessary before we can open two of the new buildings, the infirmary and 100 men's building, now finished. It is also most essential before the asylum population can be moved to the colon\^ I therefore recommend that your Board ask the Legislature for $14,000 in addition to erect, fully equip and furnish this building. We should have a new hydriatric outfit for this institution. The same should be installed in our new infirmary building now completed, in order that we may care for our patients by more scientific and up-to-date methods. At present we have no facihties for caring for our patients who should have con- tinuous tub, spray or shower baths, or any of the hydriatric measures necessary for so many mental and nervous cases. This apparatus, with the arrangement of the same, together with the preparation of the room in the basement of the new infirmary building, will require a sum of $5,000, for which I recommend that your Board ask the coming Legislature. I would again renew the request for an addition to our pres- ent service building at the Pines group. When the building was erected in 1910, it was to care for 400 patients, and at that time we had less than 300. The kitchen, scullery and storerooms were considered small at that time. The new build- ing for 100 women, the Cedars, is now completed, but we can- not occupy this structure until we have a place to feed the patients. It is very necessary to secure other space for this purpose, and this can only be done by making an addition to 1914.] PUBLIC DOCUMENT — No. 23. 81 the present kitchen department. This space can be obtained by extending the kitchen department 24 feet, which will necessi- tate the rearrangement of the cold-storage room, the pantries and scullery facilities, this to be on the ground floor. The second story is to be used for a nurses' and employees' dining room. This same appropriation was asked for last year and passed upon by the State Board of Insanity. A sum of $20,000 has been estimated as necessary to erect this addition. I there- fore recommend that your Board ask the Legislature for the above sum to erect and complete this new addition. Miss Abbie S. Fay, who was matron of the asylum since 1893 and previous to this was assistant matron at the Worcester State Hospital for over ten years, resigned in October. Through her resignation I consider that the State has lost one of the most faithful, energetic and industrious servants. The success of the institution was her constant thought. Miss Minnie Schriber has been secured to fill this vacancy. Dr. Effie A. Stevenson resigned in August to take up work in an acute private institution in Connecticut. Dr. Mary Johnson has been secured to fill this vacancy. Miss Alice L. Lake, superintendent of nurses, resigned in June and since has taken a position in an acute hospital in Detroit, Mich. Miss Elsie C. Hartshorne has been secured as our industrial in- structor. Regular monthly staff meetings have been held throughout the year at which meetings a paper is presented by a member. Numerous conferences have been held, and all patients who are candidates for discharge or for trial visit are discussed in staff meetings. At this time the patient is examined, and the fitness of his or her condition is determined as well as the home surroundings, a report of which has previously been made by the social worker. I recommend that another physician be secured to take charge of the dispensary and laboratory work, which latter work should become more acute than it has been. He would also relieve on the wards when necessity demanded it. I would also recommend a second female physician, who would devote her whole time to the social service problem and eugenics. Because of her medical knowledge she should be 82 WORCESTER STATE ASYLUM. [Dec. able to investigate homes and draw conclusions from a medical and mental point of view in a better way than the lay mind or the nonmedical social service worker. She can also be called upon to assist with a certain amount of medical work as well. During the year the regular weekly dances at the asylum and colony have been held, monthly entertainments have been given by local talent both here and at the colony, and a regular monthly entertainment has been given by outside talent. Such entertainments have been arranged for the coming year as well. The work this year has been carried on by the industrial instructor. Several trips were made by the patients to the colonj^ to pick berries. These outings, though perhaps not profitable, were very popular, as they usually meant an auto- mobile ride. The regular field day on July 4 was the most successful of any we have had. A corn roast, which was a real success, was given the female patients near Long Pond in the Willows group in September. The usual number of patients attended the different circuses and the New England fair. The officers of the institution have given me their assistance and hearty support during the year. The employees have apparently been more loyal in the performance of their differ- ent duties. The resignation of the older members of the Board has been a great loss to our institution, as only by their unselfish assist- ance, guidance and constant supervision have we made such advancement in the treatment and care of the insane. We are indebted to the "Boston Journal" and the "Worces- ter Evening Gazette" for copies of their daily papers; to the Hospital Society of Boston for books, pamphlets, magazines and Christmas cards; to the Worcester Employment 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 contributions. Respectfully submitted, H. LOUIS STICK, Superinte7ide7it. Worcester, Mass., Nov. 30, 1914. 1914.1 PUBLIC DOCUMENT — No. 23. 83 TREASURER'S REPORT. To the Trustees of the Worcester State Hospital acting for the Worcester State Asyhmi. I respectfully submit the following report of the finances of this institution for the fiscal year ending Nov. 30, 1914: — Balance Dec. 1, 1913, Cash Account. $12,511 46 Receipts. Institution Receipts. oard of inmates : — ■ Reimbursements, insane, lies: — Food $139 70 Clothing and materials, . 455 23 Furnishings, . 20 Repairs and improvements. 14 84 Miscellaneous, 329 24 Farm, stable and grounds: — ■ Cows and calves, $190 00 Pigs and hogs, . 16 00 Hides, . . 26 17 ),362 36 Miscellaneous receipts : — Interest on bank balances, Sundries, Board of Retirement, $282 68 100 80 38 61 Sales account of industries fund, . Wages refunded account of 1913 expenses, 10,955 83 82 81 7 98 Receipts from Treasury of Commonwealth. Maintenance appropriations : — • Balance of 1913, Advance money (amount on hand November 30), Approved schedules of 1914, . $301,626 07 Less returned, . . . 16 86 Special appropriations. Industries fund. $5,870 20 13,483 35 320,962 76 362,168 69 61 24 $706,750 77 84 WORCESTER STATE ASYLmi. [Dec. Payrnents To treasury of Commonwealth: — Institution receipts, . . . . Industries fund, ..... Wages refunded account of 1913 expenses. $10,955 83 82 81 7 98 Maintenance appropriations: — Balance November schedule, 1913, Eleven months schedules, 1914, November advances, Special appropriations : — Approved schedules, Less advances, last year's report, November advances. $362,168 69 1,089 38 $19,471 04 301,609 21 4,544 27 $361,079 31 7 43 325,624 52 361,086 74 Industries fund : — Approved schedules, ........ 61 24 Balance, Nov. 30, 1914: — In bank, $8,626 57 In office, 305 08 8,931 65 Total, $706,750 77 Maintenance. Appropriation, $315,000; from 1913, $88.69, $315,088 69 Expenses (as analyzed below), ....... 321,053 56 Deficit, . . $5,964 87 Analysis of Expenses Salaries, wages and labor: — H. Louis Stick, M.D., 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. Cheese, Eggs, . Floiir, . Fish, . Amounts carried forward, $3,000 00 43,556 14 7,226 67 24,176 40 24,280 94 8,215 55 23,466 58 $133,922 28 $11,615 34 982 33 628 33 1,133 48 945 78 1,492 39 10,427 49 2,911 26 $30,136 39 $133,922 28 1914. PUBLIC DOCUMENT Amounts brought forward, •No. 23. 85 $30,136 39 $133,922 28 Food — Con. Fruit (dried and fresh) 3,015 81 Lard, . 1,124 80 Meats, 22,546 77 Milk, 7,206 86 Molasses and syrup 370 63 Spices, seasonings, salt, etc.. 348 26 Sugar, 4,178 93 Tea, coffee, broma and cocoa, ... 3,043 96 Vegetables 6,420 98 Yeast, 146 77 Sundries, ...'... 643 89 79,184 05 Clothing and materials : — Boots, shoes and rubbers. $2,349 71 Clothing, 8,805 46 Dry goods for clothing and small wares. 1,807 44 Furnishing goods, ..... 92 80 Hats and caps, 47 69 Leather and shoe findings. 267 69 Materials and machinery for manufacturing. 465 52 Sundries, ...... 266 66 14,102 97 Furnishings : — Beds, bedding, table linen, etc.. $9,003 05 Brushes, brooms, ..... 415 38 Carpets, rugs, etc., .... 130 58 Crockery, glassware, cutlery, etc.. 1,512 62 Furniture and upholstery, 533 74 Kitchen furnishings 1,113 74 Materials and machinery for manufacturing. 872 84 Wooden ware, buckets, pails, etc., . 128 51 Sundries, ...... 1,965 25 15,675 71 Heat, light and power: — Coal, $27,049 37 Freight on coal, ..... 6,918 53 Gas, 14 81 Oil, 325 58 Sundries 647 43 34,955 72 Repairs and improvements : — • Cement, lime and plaster. $313 16 Doors, sashes, etc., .... 12 65 Electrical work and supplies, . 1,292 89 Hardware, ...... 2,696 11 Lumber, ...... 749 22 Machines (detached), ..... 379 22 Paints, oil, glass, etc., .... 1,665 18 Plumbing, steam fitting and supplies. 3,420 25 Roofing and materials 120 60 Sundries, ...... 1,046 34 11,695 62 Amount carried foward, $289,536 35 WORCESTER STATE ASYLUM. [Dec. Amount brought forivard, Farm, stable and grounds: — ■ Blacksmith and supplies, Carriages, wagons, etc., and repairs. Fertilizers, vines, seeds, etc.. Hay, grain, etc.. Harnesses and repairs. Horses, .... Other live stock, Tools, farm machines, etc., Sundries, $289,536 35 $208 47 1,307 05 2,447 97 6,770 99 69 25 285 00 52 80 902 94 1,064 48 13,108 95 Religious services. 1,419 25 Miscellaneous : — Books, periodicals, etc., . Cuspidor supplies, .... Entertainments, .... Freight, expressage and transportation, Funeral expenses, .... Hose, etc., ..... Ice, ...... Medicines and hospital supplies, Medical attendance, nurses, etc. (extra). Printing and printing supplies. Printing annual report, . Return of runaways. Soap and laundry supplies. Stationery and office supplies, . Travel and expenses (oflRcials), Telephone and telegraph. Tobacco, . . . . Water, . . . . , Sundries, . . . . Total expenses for maintenance, . Wages refunded account of 1913 expenses, Balance Dec. 1, 1913, Appropriations for fiscal year, $492 62 19 49 825 35 3,108 20 478 00 201 02 22 13 1,410 79 244 36 338 15 513 39 139 71 213 40 2,699 34 577 77 404 18 797 08 959 50 1,085 20 2,467 31 16,996 99 $321,061 54 7 98 $321,053 56 RIATIONS. $447,254 00 22,500 00 Total, $469,754 00 Expended during the year (see statement annexed), $362,168 69 Reverting to treasury of Commonwealth, . . 1 30 362,169 99 Balance Nov. 30, 1914, $107,584 01 1914.1 PUBLIC DOCmiENT — No. 23. 87 Resources and Liabilities. Resources. Cash on hand, ....... November cash vouchers (paid from advance money) : — Account of maintenance, . $4,544 27 Account of special appropria- tions, .... 7 43 Due from treasury of Commonwealth balance of appropriation, ...... Schedule of November bills, $8,931 65 4,551 70 4 11 $13,487 46 $19,452 33 Per Capita. During the year the average number of inmates has been l,c Total cost for maintenance, $321,053.56. Equal to a weeldy per capita cost of $4.51. Receipt from sales, $1,171.38. Equal to a weekly per capita of $0,016. All other institution receipts, $9,784.45. Equal to a weekly per capita of $0,137. Industries Fund. Balance Dec. 1, 1913, Receipts credited, ....... Expenditures, approved schedides (see statement annexed), Balance Nov. 30, 1914 $10 55 82 81 $93 36 $61 24 32 12 Industries. Expenditures. Instructors, Materials: — Booth at fair, $20 00 Cotton waste, 8 30 Doilies, patterns, cotton, etc.. 13 14 Electricity at fair, . ' . 1 60 Expenses to and from fair, 4 85 Shpper soles, . 25 Yarn 40 $12 80 $61 24 WORCESTER STATE ASYLUM. [Dec. -§1 *l 05 t^Ot^ OO (O-^OOOSC O "5 rt°fcSFi lo Oi en os^-H t^u:) t-H o ooot^coc^ 3 O 050 OS o ooo s § §s o o oooooo o o oooooo o o oooooo o o OOOCOOiO 5 OS OHM OS OC ftftnaaD.D,ag.aaafts - -3 g-3 d J.S-S 3 ^ O ^ £ £o5 ^ c3 O c3 g 'g-i M'^ o ^ H bH m zn P ►■"] a ffi ■5 !2; 'S > Ph 1914.1 PUBLIC DOCUMENT — No. 23. INMATES' FUND. Cash on hand Dec. 1, 1913, $4,456 91 Received from inmates, $1,267 13 Interest, Worcester Trust Company, . . 41 04 Interest, Mechanics Savings Bank, . . 102 08 — 1,410 25 $5,867 16 Cash refunded inmates, . 869 30 Balance (Worcester Trust Company, $2,327.94; Mechanics Savings Bank, $2,629.12; drawer, $40.80), .... $4,997 86 Worcester, Dec. 19, 1914. 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, 1914 ($321,053.56), and have found them properly scheduled and correctly cast. I also find in the hands of the treasurer $4,997.86 belonging to patients. GEORGE L. CLARK, Examiner. STATISTICAL TABLES [Form prescribed by State Board of Insanity.] >'^Tt<QO-^iO'y30»OCOiOC r ^s^ !t2S" ^? ) »0 CO T-H --^ CO »0 I ^Ht^OOr 1 O O -# ■# 00 o fl a S o s ^ I o-d II 3as-§^^-£S.i§ 2 2 2 0'^ =0 10 m m M w-S-t^ » S g S" 5 ca-S g g g g § ■S,3-cl i i i i o ■" a o, ft a a ■"11 Si' ^PQ^ 3 a c3 a c a (D (U (B 01 o ^^^to^ (D a ^ ^ 0) 0) S o » ^ >M ft S a a a a a ":^^ 3 3 3 3 3 ca> 94 WORCESTER STATE ASYLUM. [Dec. 2. — Received on First and Subsequent Admissions. NUMBER OF ADMISSION. Males. Females. Totals. First (to this asylum), 98 76 174 Second (to this asylum), - 3 3 Third (to this asj^lum), - - - Total cases, 98 79 177 Total persons, 98 78 176 3. — Ages of Insane at Fii'st Attack and Death. Died. AT FIRST ATTACK. AT TIME OP DEATH. Males. Females. Totals. Males. Females Totals. Congenital, .... _ 2 2 15 years and less, . 3 1 4 - - - From 15 to 20 years, . 1 1 2 - _ - 20 to 25 years, . 2 3 5 - 2 2 25 to 30 years, . 2 4 6 1 1 2 30 to 35 years, . 3 3 6 1 1 2 35 to 40 years, . 4 1 5 3 6 9 40 to 50 years, . 7 2 9 10 3 13 50 to 60 years, . 2 5 7 11 5 16 60 to 70 years, . 1 2 3 6 7 13 70 to 80 years, . - — - 8 7 15 Over 80 years, - - - - 1 1 Unknown, .... 15 11 26 - 2 2 Totals, . . . 40 35 75 40 35 75 Total persons. 40 35 75 40 35 75 Mean known ages (in years). 34.56 34.08 34.32 53.92 51.31 52.70 1914.] PUBLIC DOCUMENT — No. 23. 95 M •s[B^ox 1 •* 1 OO 1 '^;*-< 1 <MC^-H-* 1 -^M-<:0 1 s ■sajBraa^ 1 rt 1 TH 1 -HOO 1 1 <N-( 1 r-< 1 rHCq-^CO 1 J5 •saiBK 1 CO 1 -* 1 1 O^ 1 1 ^^CO 1 1 ^ 1 CO 1 ?§ i Q ■siB^oi ,0 ICO I^;h^ |o,<^.^^ l^oo^co 1 ^ •saiBraaj[ 1^ 1^ ,^=o 1 ic^ 1^ I^O,^^ 1 S •sai^K S < a •sib;ox ''''''"''''' CO ■eaiBraa^ 1 1 1 1 . 1« , 11 1 1 1 1 1 11 1 1 c. ■saiBjv 1 1 1 1 1 1 -( 1 1 1 1 1 1 1 1 1 1 1 1 " Q •SIB:^ox 1- 1 1 1 1 1 1 1 1 1 1 1 1 1 ,, 1 1 - •sajBTOa^ 1 1 1 1 1 1 1 1 1 1 1 > 1 1 1 1 1 1 1 1 ■sapK '^'111 1 1 1 1 1 1 -^ si •sp^oX '-^' ''''■'' ' "' ^ •saiBraaj[ - •saiBK 1 - 1 1 1 1 1 1 1 1 1 1 , 1 1 , , o. , CO i P5 •siB^ox '"' .1111111,11 c •sapuia^ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 •saiBH 1 =^ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 a i •sp;ox '--^S--?™;:— -- i •sapraa^ 1- lO^ l« 1 |« ,«^ lo.^ 1^^ s •sapM ,«^0= I^C.^^ lO, ,0^=0^ l« , s s s 1 1 'aS-ij . ... g£ A. — First admitted to any hospital whe by institution from which trans Alcoholic insanity, acute. Alcoholic insanity, chronic, . Arteriosclerotic insanity. Chronic delusional insanity. Constitutional inferiority, . Dementia, chronic. Dementia prrecox. Dementia prsecox, paranoid form Dementia, presenile, . Dementia, senile, . Epilepsy, .... Epilepsy dementia. General paresis, . Idiot Imbecile, .... Imbecile dementia. Involutional psychosis. Manic-depressive, . Puerperal insanity, 96 WORCESTER STATE ASYLUM. [Dec. •si^^oi |mMCO|.OTt<rHC-)|-*rt| INCOIC S; § § •sai^ma^ 2 S 5 •sapH 1 ^^^ 1 CNN^^ 1 CO 1 1 1 1 -HCO 2 S S o Q 1 •siB^ox S5 S S •sajBuia^ 1 1 ,-irt 1 m^ 1 -1 1 rt^ 1 1 -HM 1 2 i§ S •sai^H 1 TXrt,-! 1 C^C<1 1 ^ 1 (M I 1 1 1 rt 1 3 § § d < Q Is •sp^ox '''''''■'' '~ C. u, ^ ■saiBoia^ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 -^ rt CO N •saiBpf 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ^ rt (M C^ i > •sp^ox ' 1 1- 1 ' 1- ' 1 ' ^ CO .. •saj'Buiaj; 1 1 1 - 1 1 1 ' 1 1 ^ - , ■saiBH 1 1 1 1 1 1 1 ^ 1 1 1 1 1 1 1 1 1 ^ c. o, n 5 < 3 •si^^ox l-l ^,,,^1^ ^ CO CO •saiBuia^ 1 ^ 1 1 1 1 1 1 1 1 1 1 1 1 - 1 1 « CO CO •saiBj^ 1 1 1 1 1 1 1 1 1 1 -. 1 1 1 1 1 ^ ■^ "" "= > •sib:^ox , c. ^ ^ •saiBraa^ 1 1 1 1 1 1 1 1 1 1 '- ^ ^ ^ •saiBK 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TH ^ CO oo d i Q ■siB^ox ,e.^co^,>o,^-^,^^-|u. ^ g s ■sai^raa^ ,^^„^,«,„^, , ,^^,00 s g g ■saiBjv- s § s H p O g B. — All other admissions: — Alcoholic insanity, acute Alcoholic insanity, chronic, .... Chronic delusional insanity. Constitutional inferiority, .... Constitutional psychopathic. Dementia, chronic, Dementia prajcox, Dementia praecox, paranoid form, Dementia, senile, Defective delinquent, Epilepsy, P^pilepsy dementia, General paresis Imbecile Imbecile, moral, Imbecile dementia, Manic-depressive, Totals B Aggregate cases, Aggregate persons, 1914.1 PUBLIC DOCUMENT — No. 23. 97 ■sF^ox § T:t^ T-f § S ^ •saiBtaaj ^ CO T-H CO H •saiBpi lo -H 1 ?? •siB^ox t- CO -— 1 ,^ •sa^Bniaj; co CO ^ CO ^ ►j:; •saiBpi ^ 1 1 ^ ^ ■siB^ox ^ ^ 1 »o CO rjj a i II •sapuia^ CO 1 1 CO c^ 1 •saiBjn ^ -H 1 c^ *-* '^ ■s^ox CO 1 1 CO ^ s m o o •sapmaj •-< 1 1 ^ ' s g •sapH cq 1 1 (M ^ ^ §«■ •si'b:jox GO 1 1 00 -* 'tS H S !■ ?} •saiBniaj CO 1 1 CO " 1 "eg •sai^JK »o 1 1 »Ci CO •sib:>ox ^ 1 1 T*H <M i^s •sa^Bina^ " ' ' '"* 1 "^ •sai^H CO 1 1 CO c^ i= •?s t^.X-r^ ^ S"^ ^ o « ^ 7 o 5"^-^ Ki "^ 2 Q fa O 1 1 i 1 H H kn S H WORCESTER STATE ASYLUM. [Dec. < i 1" •si^^oj, •saiBuiaj llll 1^,1,1^1 lllll^lllll •sajBH -■III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 •SIB^Oi III, , 1 , IC , , ,,,,,, ,^, ,^ .-saiBinaj •S9i^K llll 1 1 1 lO, , 1 1 1 , 1 1 , , 1 , 1 ,-H 1 •sp^ox llll 1 1 1 N 1 1 -H-< 111^. „ •saiBTn9j[ llll 1 1 1 « 1 1 «-H 1 1 1 -1 1 1 1 1 1 1 1 •SSIBJV llll 1 1 1 -^ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 » m •SlB^Oi ,11, 1 , ^^ , ^^ , , ^ •sajBraaj ■S8IBI\[ 1 1 1 1 1 1 1 1 1 - 1 1 1 1 1 1 1 1 1 1 1 1 1 III ■SJB^OX •S9IBni9J llll 1 1 1 1 1 1 1 1 1 1 1 - 1 1 1 , 1 1 1 •S91BK llll ^,^,„,,, , ,0. 1 1 , , , > , ill •sp^ox llll 1 1 1 1 1 1 1 1 111111111,1 ■s9IBniej llll 1 1 1 1 1 1 1 1 111111111,1 •S9IBH llll 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 i O § < •sib:>ox •S9IBin9J , ^ , „ , ^„^ , , CO« 1 ^ 1 M. 1 -H^-,^ , , •S9IBH i. o 1 . . . s _, 1 1 . . . i|- %■■■■! i'l ,lipi1li|-,r:iW-i 1 111 niMi b Jl llll ill! 1111 Hi. 1 ^liiiiiillli iiiil lllilllli If llllillil 1914.] PUBLIC DOCUMENT — No. 23. 99 1 1 1 . 1 1 1 1 1 1 < , . < 1 , 1 f . ^ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 " 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 -^ ,^^,^,^, „^, , ,^,^. , , , 2 , , , 1^1 , , ^, , , ,^^, , , , CO 1 rt-H III^I l^lll^lllll QO 1 1 1 1 1 1 1 1 II 1 1 1 1 O 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ^ ' ' ' ' ' ' ' ' ' ^ 1 1 1 1 1 , 1 1 1 |«^ 1 1 ,,^^ 1^ 2 - 1 1 1 1 1 1 1 o 1 1 1 1 1 1 1 1 1 1 -H 1 1 1 1 ^^ 1 ^ « ^111, III ^,,,,„,|,^| 2; 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 -^ -.11,1111 ^|,,|„|,|^| 2 11,11111 1 1 1 1 1 1 1 1 1 1 1 1 ' ' ' 1 1 1 1 , 1 1 1 1 1 ' ' ' ' ■ ' ^^^ « ^^ K 1,1, ^^^^ ^ 1 , ^^o« 1 1 1 1 J§ ^„^„ , ,,^ , ^^^ ,^=o 1^^^^ § volvulus, . icute tubercular, 3, chronic heart disease, s, acute enteritis, s, chronic endocarditis, s, ischiorectal, . liary, .... Intestinal obstruction, Pernicious anemia, Peritonitis, Peritonitis, shock, . Tubercular enteritis. Typhoid fever. Uremia, acute. Uterine carcinoma. Respiratory system: — Asphyxia, Pneumonia, broncho. Pneumonia, bronch,o, Pneumonia, hypostati Pneumonia, lobar, Pulmonary tuberculos Pulmonary tuberculos Pulmonary tuberculos Pulmonary tuberculos Tuberculosis, acute m Tuberculosis, general, 100 WORCESTER STATE ASYLUM. [Dec. 11 •SIb:jox 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 «^ 1 ■saiBtnaj: 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 rH 1 1 •saiBH I'll 1 II 1 1 ,,,,., 1-1 ft'"' •smox , , , , ,,,,,,-, , , ,^, ,^, , , , •saiBuia^ , , , , < 1 1 . 1 > 1 . , , 1^1 ,^, , , , ■saiBH 1 1 1 '-I 'I'll u •sib;ox ,.., ,,,,,,,, ,,-,,,,,,,,, •sa|Bniajj 1- ,,,,,,,,,,, •saiBH , ^^ , -,,,,,,,, ,.,,,,,,.,, 1^" •siB^ox •saiBiuaj; •saiBH j 1 s •sib:jox , , , , 1 , ,-H^, , , ^, ,^, , , , , , , ■saiBtuaj[ , , , , , , 1^1 , , , , , 1^1 , , , , , , •saiBM 1 ■SIB^OX , , ,^ , , ,^, , ,^ , ,^1 ,,,,,, , •saiBTnaji , , ,^ , , ,^, , ,^ ,,,,,,.,,,, •saiBH P m H O Nervous system: — Ascending disseminated sclerosis. General paresis, General paresis, general septicemia, . Status epilepticus, Circulatory system: — Arteriosclerosis, endocarditis, .... Arteriosclerosis, general Cardiorenal, Cardiorenal, vascular, Cerebral hemorrhage, Cerebral thrombosis, Chronic valvular heart disease Heart disease General system : — Carbuncle, ^ . . Carcinoma of breast Dysentery, Enteritis, acute, Enterocolitis, acute Enterocolitis, chronic Enteritis, chronic, Exhaustion following maniacal excitement, Gastroenteritis Heat exhaustion, Intestinal obstruction, acute, .... 1914.] PUBLIC DOCUMENT — No. 23. 101 i I , , , , , ,,,,,,,,,,, c " ' ' ' ' ,,,,,.,, - ,,,,,,,, ,,,,,,,,>,, ^ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 V ,,,,,,,, ,,,,,,,■:., ' ' ' ' ,,,,,,,,,, - 1 1 .--i 1 1 1 I.I. .1 " " " " " - ' ' ^ ,,,-,,,, 1 < < . 1 1 , 1 1 < 1 . .,,,,. ,^ ,,,,,,,,,,, - ,,,,,, ,^ ,,,:,,,,,,, - , , , , 1^^, , , , ,^^, , , , , - 1 i . . .-- ^^, . , , , o 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 - I < < , < 1 , < ■ , , , ^., , , , , , - CO .,,,,,,, ,,,,..,,,,, ^ i 1 . g ill III J ■ fe 3 >.>: Respiratory system: — Asphyxia, ....... Pneumonia, broncho, acute tubercular, Pneumonia, broncho, hemiplegia abscess, . Pneumonia, hypostatic, chronic heart disease. Pneumonia, lobar, Pulmonary tuberculosis, .... Pulmonary tuberculosis, acute enteritis. Pulmonary tuberculosis, chronic endocarditis. Pulmonary tuberculosis, ischiorectal, . . , Tuberculosis, acute miliary. Tuberculosis, general, .... 1 102 WORCESTER STATE ASYLUM. [Dec. i < SI 1 <; ii O tJ is •SIB^OX , ,^,^, , , , c, , •S9iBraaj ^ ■ - ;: •sai^H ,,.,,,,,. ^ , •^ Ii ^ a Si •siB^oi , 1^,^, , , , . , IM 03 •S8|BUia^ . , , ,^, , , , -H 1 rH T)< g •sai^H , ,^, , , , , , « . 5~ O B 1 « H si f! o i i (5 o 1 •sits^ox ,,,,,,,,, , . .. , •sajBoia^ 1 1 1 1 1 1 1 1 1 ■ 1 1 1 •sai^H ■ " , . C. , 1 -<1 •sib:jox .. . "^ S •S8IBUI9j[ 1 1 1 , ^ •S9I^K C. , « S :3 O is Q ■siu^ox , c. § ^ '♦i^. •saiBoiaj 1 1 1 1 1 1 1 1 1 1 1 ' • •sai^H , . (M 1 C c t p Jfllll: 1 a 4 o < 1914.1 PUBLIC DOCUMENT — No. 23. 103 1 1 1 1 -HC^t~O5 00 S^ ' ^ i 1 1 1 1 ^^nmio S ' CO ° ■* 1 1 1 1 1 1 1 ^coto ^ S 1 1 1 1 1 1 ,-(MCO CO ro la ^ i 1 1 1 1 '^^^'^^ g 2 § CD to g CO S , .^^=o..o. o s ^ § 1 1 1 rt(M«t^C0tO - ' 1 1 T-fl 1 ■* <N 0= t> CO § ' 2 OtHIMCO'UMM-h 1 g s ^s WCO 1 «M<MM 1 1 CO CO s 1 — -' s s ^8 B. — Died: — Under 1 month. From 1 to 3 months, 3 to 6 months, 6 to 12 months, 1 to 2 years, . 2 to 5 years, . 5 to 10 years, . 10 to 20 years, . Over 20 years, .... Totals Average of known cases (in months).