Annual report of the Worcester State Asylum at Worcester

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;.

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

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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.

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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

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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

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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.

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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

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[Dec.

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1914.] PUBLIC DOCUMENT — No. 23.

99

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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

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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

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c

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-

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g

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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

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1914.1

PUBLIC DOCUMENT — No. 23.

103

1 1 1 1 -HC^t~O5 00

S^ '

^ i

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■* 1

1 1 1 1 1 1 ^coto

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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).