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Public Document ^ No. 23
^t)e Commontoealtf) of iWasgacfjusiettjs
ANNUAL REPORT
THE TRUSTEES
.^ t ^Worcester State Hospital iju^,,^
YEAR ENDING NOVEMBER 30, 1927
Department of Mental Diseases
Publication of this Document approved by the Commission on Finance and Administration
7-'26. Order 6083
OCCUPATIONAL PRINTING PUANT
DEPARTMENT OF MENTAL DISEASES
GARDNER STATE COLONY
PRINTERS
'\
OFFICERS OF THE WORCESTER STATE HOSPITAL
BOARD OF TRUSTEES
Edward F. Fletcher, Worcester, Chairman.
William J. Delahanty, M. D , Worcester.
Anna C. Tatman, Worcester, Secretary.
Howard W. Co wee, Worcester.
John G. Perman, D. M. D., Worcester.
MEDICAL STAFF
William A. Bryan, M. D.,, Superintendent.
Lewis B. Hill, M. D., Assistant Superintendent.
Francis H. Sleeper, M. D., Acting Clinical Director.
Michael J. O'Meara, M. D., Senior Assistant Physician.
Henry B. Moyle, M. D., Senior Assistant Physician.
Arthur C. Brassau, M. D., Senior Assistant Physicijan.
S. Spafford Ackerly, M. D., Senior Assistant Physician.
AuRAY Fontaine, M. D., Assistant Physician.
Chester L. Glenn, M. D., Assistant Physician.
Jacob Goldwyn, M. D., Assistant Physician.
Sarah M. J. Ching, M. D., Assistant Physician.
Olive N. Ehrenclou, M. D., Assistant Physician.
Reginald P. McKinnon, D. M. D., Dentist.
VISITING STAFF
Ernest L. Hunt, M. D., Surgeon.
John P. Curran, M. D., Surgeon.
William H. Rose, M. D., Surgeon.
Benjamin H. Alton, M. D., Surgeon.
M. M. Jordan, M. D., Neurologist
William F. Holzer, M. D., Ophtalmologist.
Philip H. Cook, M. D., Roentgeneologist.
Oliver H. Stansfield, Internal Medicine.
Lester M. Felton, Genito-Urinary Surgery.
HEADS OF DEPARTMENTS
Herbert W. Smith, Stezoard.
Jessie M. D. Hamilton, Treasurer.
James Dickison, Jr., Chief Engineer.
Anton Swbnson, Foreman Mechanic.
Wallace F. Garrjtt, Head Farmer.
Lillian G. Carr, Matro:i.
Florence M. Woolridge, R. N., Superintendent of Nurses and Principal of
Training School.
Maurice Scannell, Supervisor, Male Department.
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I tirfje Commontoealt!) of jlMas^s^acfiUigettsJ
TRUSTEES' REPORT
I To His Excellency the Governor, and the Honorable Council:
The Trustees of the Worcester State Hospital respectfully submit the ninety-
fifth annual report of the hospital, for the year ended November 30, 1927, together
with a record of the various departments as given by the Superintendent, Dr.
William A. Bryan, and a report of the Treasurer, Miss Jessie M. D. Hamilton.
Two vacancies in the Board mentioned in the last preceding annual report
existed throughout the year.
The trustees wish again to record their satisfaction with the conduct of the
complicated affairs of the hospital under the administration of Dr. William A.
Bryan and his loyal assistants. Furthermore, they are pleased to note the forward
steps taken by the inauguration of wholly new, effective and economical methods
under Dr. Bryan's progressive lead.
The outstanding development of the year was the completion of the new dining-
room at the main hospital and the inauguration on October 24 of the cafeteria
service of food to patients of both sexes. Experimental work in this line in this
hospital had shown the desirability of this radical innovation, and its success was
immediate, and complete. By this method patients are permitted a greater variety
of menu and the power of choosing food for themselves, which not only gives them
exercise for their minds and a real interest in something they are doing, but makes
them better contented as a natural result. The elimination of waste by thus letting
the individual choose what he wants to eat instead of serving him something that
he will not consume is actual and surprisingly large. Aside from this saving of food,
the therapeutic value to the patients is ample to justify the system. The compara-
tive freedom of the dining-room and the responsibility of making choices of food is
of great and peculiar value in the mental rehabilitation of the patients. The
inauguration of this experiment of cafeteria service was at first subject to con-
siderable skeptical comment, but its success has instantly been the object of great
interest throughout the state and country.
During the year a Personal Hygiene Department was established. This, again,
has proven to be a therapeutic measure of considerable importance. It helps the
morale of the patients; it improves their appearance; and it was one of the im-
portant additions to the hospital.
The hospital has inaugurated a separate record system for the medical and
surgical service. These records are following the forms advocated by the American
College of Surgeons, and give a complete record of every patient and employee who
is treated in the medical and surgical service.
The Child Guidance Clinic operated in connection with the hospital has been
an increasingly valuable contribution to the welfare work of Worcester. The
work of the clinic has increased during the year, and is more and more being utilized
in the study of behavior problems among children by parents, social agencies, and
teachers.
The following changes are urged as needed by the hospital, and as all are con-
sidered as necessary, the order of their mention is not of significance as to their
relative importance.:
1. The replacement of all remaining wooden staircases by suitable structures
of metal construction. Some of these have been replaced, but there are a number
remaining which should be replaced at the earliest opportunity. They constitute
a very serious fire risk. The project of installing fire doors throughout the insti-
tution was completed this year. At an early date an adequate sprinkling system
should be installed in the attics of the main building and the outlying buildings.
Summer Street should also be protected in this way.
IH'-
4 P.D. 23
2. The erection of a new cow-barn is an imperative necessity. The herd is now
located at Hillside in dilapidated barns. This is bad from an economic point of
view, dnd costly. It necessitates the transportation of milk two miles and a half,
and feed and fertilizer the same distance. It would be wise to begin the develop-
ment of a new farm unit at the main farm building, at least two wings and the
dairy building, as soon as possible. The completed structure should have two
wings for milch cows, one wing for young stock and calves, and one wing for horses,
with a hay barn connecting the four wings.
3. At Summer Street a careful survey and study of the needs of the Summer
Street Department to change it into an acute receiving hospital should be made.
This would necessitate rather extensive alterations, and a careful study would show
what these alterations should be. New engines must be installed at Summer Street
within a short time.
4. There should be a continuation of the building of cottages for the medical
staff of the hospital. There is an increasing need for more adequate quarters for
married men desiring to take up this specialty of m.edicine. Good medical men
are attracted by three things — first, active medical and surgical work and an
active service in psychiatry. Second, proper living quarters for themselves and
their families. Third, salary. The hospital is active from the medical standpoint,
and offers an excellent service. Salaries have been increased to the point where
they are attractive, and it only remains to comply v^ith the other requirement,
namely, adequate and proper housing. This will enable us to retain in the service
men of high calibre who will adopt psychiatry as a career.
5. We wish to call attention to the development of teaching various groups
in the hospital. This very definitely improves the morale of the nurses, attendants,
and medical staff, and throws an entirely new light upon the mental hospital to
a large group of individuals in the community. It is of value as an expression of
the ideals of the institution and the things for which the hospital and all connected
with its administration stand.
EDWARD F. FLETCHER, Chairman WILLIAM J. DELAHANTY
ANNA C. TATMAN, Secretary HOV/ARD W. COWEE
JOHN G. PERMAN
P.D. 23 5
SUPERINTENDENT'S REPORT
To the Trustees of the Worcester State Hospital:
I herewith respectfully submit the following report of the hospital for the year
ending November 30, 1927, it being the ninety-fifth annual report:
There remained on the hospital books October 1, 1926, 2,563 patients, 1,280
men and 1,283 women. Five hundred and seventeen patients, 273 men and 244
women, were discharged from the hospital. Of this number, 285 patients, 152 men
and 133 women, were discharged; 209 patients, 112 men and 97 women, died; 22
patients, 6 men and 16 women, were transferred, leaving at the end of the statis-
tical year 2,630 patients, 1,328 men and 1,302 women. Two thousand two hundred
and eighty-eight patients, 1,114 men and 1,174 women, were actually in the
institution. Of the patients discharged 19 were reported as recovered; 170 reported
as improved; and 57 as not improved. Thirty-nine patients, 28 men and 11 women
were discharged as not insane.
Three men and 2 women were transferred by the Department of Mental Dis-
eases to the Danvers State Hospital; 1 man and 1 woman to Westborough; 1 man
and 2 women to Northampton; 1 man and 2 women to Tewksbury; 2 women to
Gardner State Colony; 1 woman to Foxborough; 1 woman to Medfield; 2 women to
Dr. Ring's Sanatarium; 1 woman to Dr. Reeve's Sanatarium; 1 woman to McLean
Hospital; and 1 man to the State Infirmary. Eight men and one woman were
removed from the State, and 7 men and 3 women were deported.
There remained at the hospital at the end of the statistical year 59 patients more
than at the beginning. The smallest number under treatment on any one day
was 2,191 and the largest 2,298. The daily average was 2,242.52.
Principal Causes of Death
Fifteen percent of all deaths were due to pulmonary tuberculosis; 12 percent
to generalized arteriosclerosis; 9 percent to lobar pneumonia; 8 percent to cardio
vascular renal disease; and 6 percent to broncho pneumonia.
Ex-Service Men
During the year there were 33 ex-service men admitted to the hospital. Nine-
teen went out on trial visit, 7 were discharged, and 1 died, leaving at the end of
the year 64 ex-service men in the institution.
To all who have contributed gifts and entertainments for the ex-service men,
I hereby extend my hearty thanks.
Staff Changes
Resignations
Dr. Chester L. Glenn resigned May 28, 1927.
Appointments
Dr. Sarah M. J. Ching appointed Clinical Assistant January 22, 1927.
Dr. S. Spafford Ackerly promoted to Senior Assistant Physician March 2, 1927.
Dr. Sarah M. J. Ching promoted to Assistant Physician April 8, 1927.
Dr. Chester L. Glenn promoted to Assistant Physician April 8, 1927.
Dr. Jacob Goldwyn promoted to Senior Assistant Physician April 25, 1927.
Dr. Francis Sleeper promoted Acting Clinical Director June 1, 1927.
Dr. Olive Ehrenclou appointed Assistant Physician June 17, 1927.
6 P.D. 23
Internes
Nathan Baratt appointed interne May 24, 1927.
Julius Tegelberg appointed interne June 15, 1927.
M. Yorshis appointed interne June 24, 1927.
A. T. Whitney appointed interne July 1, 1927.
Medical Report
The medical work of a hospital for mental diseases very naturally falls into five
divisions. The line between these divisions is not in any sense clear-cut, but for
purposes of analysis they offer a convenient method of differentiating various
kinds of work. They are as follows: 1. Psychiatry. 2. Medicine and Surgery.
3. Teaching. 4. Research. 5. Community work.
All five of these divisions of the work of a mental hospital have received atten-
tion during the year.
Psychiatry
Modern psychiatry is a study of the individual case. Naturally, the admission
service is the point at which this type of psychiatry begins. It is our purpose to
have each staff physician take on a small group of patients for individual study
and therapy. In this personal work, all aspects of the case are taken into considera-
tion, and all departments of the hospital utilized under the direction of the psychi-
atrist, in gathering data and assisting in the work of treatment. While mass-
treatment has not been neglected, we feel that more and more emphasis should
be placed upon personal therapy, going as far in this direction as the size of the
personnel will permit.
The routine of staff meetings was changed during the year for the purpose of
securing more time for the study of early and hopeful cases, and the consideration
of their treatment. Instead of having a daily staff meeting, which was attended
by all members of the medical staff, we have inaugurated daily ward walks, at which
the large number of cases received and being released on visit are seen and con-
sidered by the clinical director and members of the medical staff on the service
from which the patient comes. The ward walks are on alternate sides, and are
under the direction of the assistant superintendent, or clinical director. Bedside
demonstrations are a part of these ward walks. On two days a week, Tuesdays
and Thursdays, an eleven o'clock staff meeting is held, at which time only one or
two cases are thoroughly and carefully discussed.
During the year, a reclassification was made on the female service whereby the |
number of parole patients has been increased from sixty, which is the average
number of several years past, to over two hundred. The population on the con-
tinued treatment wards has shown a decrease, and the wards are not as crowded
as they were formerly. It should be the policy of a hospital to give as much free-
dom to individual patients as they are capable of having. And while, as a result
of this policy, accidents may occur, it would seem that with a careful selection
of patients, and a proper sympathy with the ideals of the hospital on the part of
the nursing service, that the parole system within the hospital could very easily
be extended.
Hydrotherapy
Hydrotherapy, one of the important aids to the psychiatric service, has been
extensively utilized and has been of great benefit. The following report will indicate
the scope of the work aild the amount done.:
Electric light baths, 312; sahne baths, 320; salt glows, 286; hot and cold to
spine, 67; foot baths, 267; sitz baths, 49; needle sprays, 1,294; f^n douches, 1,018;
foot baths as preparatory treatment, 363; tub shampoos, 219; jet douches, 785;
P.D. 23 7
drip sheet rub, 44; wet mitten friction, 19; Swedish shampoo, 28; wet sheet rub,
11; scotch douche, 6.; fomentations to abdomen, 8; hair shampoo, 53; rain douche,
20.
Wet sheet packs: number of patients, 527; number of packs, 7,726; number of
hours, 30,489.
Continuous baths: number of patients, 693; number of baths 10,407; number of
hours, 62,665.
Instructions (continuous baths): number of attendants, 111; number of lessons,
129; number of hours, 244.
Wet sheet packs: number of attendants, 92; number of lessons, 94; number of
hours, 159.
Occupational Therapy
Occupational Therapy is of equal importance in psychiatric therapy. We have
constantly increased our personnel, and have established affiliations with the
Boston School of Occupational Therapy. The following are the number of patients
receiving instructions in the different classes: number of patients in all Occupa-
tional Therapy classes 3,230; number of patients in the Physical Education classes
1,449; total both classes, 4,679.
Perhaps one of the most important changes during the year from the standpoint
of therapy was the opening of a new dining-room, utilizing cafeteria service for the
patients. The transition to this service has been made without accident or dis-
turbance and with a surprising general expression of approval by the patients.
From the psychiatric point of view, the cafeteria offers a splendid means of psycho-
therapy. It has been observed that women patients in particular are more careful
in their appearance and conduct, and that there is a minimum of quarreling, push-
ing and disorder as a direct result of the comparative freedom which maintains
in this dining room. The readiness with which disturbed wards have accepted
cafeteria service has been surprising to many observers. The exercise of a choice
of food is sin excellent beginning for the patient in regaining self-direction and a
normal attitude. It may seem surprising to many that I include a mention of this
in a discussion of the psychiatric work of the hospital, but the entire personnel
has been impressed by the pure therapeutic results that have come with the open-
ing of this dining room.
This outline of the objective happenings of the psychiatric service seems to be
rather a meagre showing, but the intangible developments are well worth while.
In terms of morale, of freedom, of disciplinary problems, and of cooperation between
Individuals and departments, the developments of the year have been gratifying.
It has been possible to build up a staff of congenial, intelligent and competent
individuals, the influence of which has been felt throughout the hospital. The
patients on the wards have expressed themselves as having sensed the change
which they show in terms of more understanding, more desire to help, greater
tolerance, and less institutionalization. It is interesting to note that the psychia-
tric staff has been through the year without vaca,tncies.
Social Service Department
The year 1927 has shown definite progress in the development of social service
at Worcester State Hospital. The implications of the work have been more clearly
recognized, and new lines of activity have opened up. There has been a growing
sense of the interdependence of medical staff and this department, which has been
reflected in the more thorough study and treatment of those patients under the
care of social service. At present the staff consists of head worker and two assis-
ta:nts, besides four students from the Smith College School of Social Work.
8 P.D. 23
This year the department handled 788 cases, as against 509 last year. These
figures, of course, include cases previously known to social service, but being re-
ferred for a different type of service. The monthly case load averaged 261, as
compared with 233 of the previous year. Without doubt, this increase in cases
under care has been made possible through having the Smith students, who are
getting their practical field training in this department.
During the past year a new method of selecting cases has been worked out.
Every day the head worker goes over the cbmmitrrient records of the new admis-
sions and decides which cases are to have thorough social service histories and
investigations. In this way the worker anticipates the doctor's needs and there
is more time to secure adequate information before the case comes to staff meeting
for diagnosis. The effort is also made to have at least an office interview with
each patient and his relatives at the time the patient leaves the hospital. In this
way the subsequent supervision visits of the workers are better understood and
apt to be more welcome.
This year there has been a notable increase in the number of social histories
taken and investigations made before cases are presented for diagnosis. There
were approximately 200 of these. Undoubtedly more thorough psychiatric work
has been possible because of these more adequate pictures of the social background
of patients which these histories present.
Even greater has been the number of investigations of employment and of
home situations. This year there were 213 of these. Such investigations are for
the purpose of determining the conditions under which the patient would have to
live, were he released. Since a large number of patients leaving the hospital are
though improved, still mentally ill, it is of greatest importance to know just what
the stress and strain in their environment would be. 155 of these cases have
been analyzed and it is interesting to note that 121 are at present still in the com-
munity, 18 having been returned, and the home situation of the remaining 16
was such as to make the hope of adjustment impossible. Undoubtedly, the re-
maining 58 cases would follow in the same proportion. Frequently relatives
besiege the phsyicians to allow patients to return, patients who are in no condition
to get along except under ideal conditions. It is essentially important for the
physician to know whether or not the patient is to return to a situation in which
financial need, lack of employment, or incompatible personalities will play a part
before the doctor can risk sending the patient out.
From home investigations revealing unfavorable home situations comes that
phase of the work termed intensive case work. Where possible, home conditions
were changed; where this could not be done other living arrangements could
sometimes be made. Through the additional help of the students, considerably
more intensive cases could be carried, with gratifying results. At present, one
young foreign girl of very pleasing personality, who would have had to take work
which would give no scope for her emotional needs, is being trained in a nearby
school for social work with her own people. Similar cases of readjustment on the
basis of careful study of the psychiatric and social needs of the individual show
the value of this work.
The general supervision of cases not needing intensive case work shows an
increase in visits.
The types of problems found in the cases referred show 50 in which there were
employment problems, 36 with financial problems, 48 with sex difficulties, 64 in
which friction and quarreling with relatives played an important part, 45 v/ith
martial troubles, 36 who came from an unsuitable home invironment, and 42 with
anti-social habits. This last group was chiefly alcoholic.
This year the work of the out-patient department has grown to such an extent
that the Golden Rule Fund (Community Chest) has voted to pay the salary of j
a psychiatric social worker. In previous years, the cases came largely from
P.D. 23 9
agencies, but last year, besides a host of agency cases, there were so many referred
by the school and by parents that for half the year a student gave her full time
under supervision of the head worker, to these cases, and since September, two
students have been needed for this work.
As before mentioned, the Smith College School of Soc'^il Work has used this
hospital as a training qenter for field work. Last year we had two students, and
in September, four were sent to us. It is difficult to estimate just how much these
students mean to the progress of the work. It has been amply demonstrated
above that the output of work has materially increased with the advent of the
students, so that the amount of time spent in teaching and in supervision has
been more than repaid. The preser^-ce of students has also served to hold up
the standard of the regular work. Their interested questions and valuable criti-
cisms have served to spur us on to greater effort. The theses prepared by the
students are a worth-while contribution to the hospital. Last year one student
wrote on the cases committed to the hospital followijig criminal actions. The
other wrote on the Children of Psychotic Parents. The latter had some particu-
larly interesting conclusions, especially of value to the work of the out-patient
clinic.
Under the stimulating leadership of Dr. Hill, the assistant superintendent, a
two-hour seminar has been held weekly for the workers and students of the de-
partment. These sessions have been held in the evenings, and although attendance
is not required, the group has shown great interest in the meetings. Various types
of psychoses were studied week by week and the social, as well as the psychiatric
implications of the psychoses were discussed following Dr. Hill's lectures. Illus-
trative cases were used as a basis for discussion and occasionally special reading
was assigned. The general problems of the department were discussed during the
first half-hour of the session.
Medicine and Surgery
The total number of admissions to the medical and surgical service for the
year was 877 patients — 415 female, and 462 male. The turn-over of patients is
comparatively slow, due largely to the fact that a large number are suffering
from somatic diseases. A detailed report of the surgery during the past year is
appended. Our visiting surgeons and consultants have given freely of their time
and have been of great value to the hospital.
Report of Surgery Performed for Year Endii^g
November 1, 1927
Tonsillectomy, 141 ; submucous resection, 8; removal nasal polypi, 3; drainage
and irrigation of antra, 10; suturing tonsillar pillars, 2; mastoidectomy, 3; curet-
tage mastoid cells, resuturing of wound, 1; turbinectomy, 2; appendectomy, 10;
cholecystectomy and appendectomy, 1; cholecystectomy, 1; laparatomy, per-
forated gastric ulcer, 1; lysis of adhesions and appendectomy, 1; lysis of adhesions,
intestinal obstruction, 1; gastrotomy with cauterization multiple gastric polypi,
1; suturing perforated duodenal ulcer, 1; posterior gastro-enterostomy, 4; splenec-
tomy, 1; excision fistula, in ano, 2; hemorrhoidectomy, 4; proctoscopic examina-
tions, 3; incision- curettement pilo-nidal cyst, 1; removal necrotic tissue cervix
uteri, 1; dilatation and curettage, 2; cauterization cervix uteri, 1; removal ovarian
cyst with ventral suspension, 1; removal ovarian cyst, 2; pan-hysterectomy and
appendectomy, 2; partial hysterectomy and appendectomy, 2; partial hysterec-
tomy, 3; pan-hysterectomy, 1; left salpingectomy and oophorectomy, 1; trachelorr-
haphy, 1; perineorrhaphy, 1; trachelorrhaphy and perineorrhaphy, 1; dilatation
and currettage and trachelorrhaphy, 1; dilatation and curettage and trachelorr-
haphy, perineorrphaphy, 3; nephrectomy, 1; excision lipoma, 2; excision inguinal
gland, 1; excision toe-nail, 1; incision paronychia, 1; removal of cyst from thumb,;
10 p. D. 23
1; removal cyst of neck, 1; excision carbuncle, 4; incision and drainage ischio-
rectal abscess, 1; incision and drainage abscess dorsum of foot, 1; incision and
drainage cervical abscess, 2; incision and drainage cellulitis left arm, 1; incision
and drainage carbuncle, 2; incision and drainage abscesp abdomen and face, 1;
incision and drainage infected finger, 1; incision and drainage inguinal abscess, 1
incisioli and drainage periurethral abscess, 1; incision and drainage tendon sheath
infection right hand, 1; incision and drainage multiple breast abscesses, 1; incision
and drainage breast abscess, 3; incision and drainage celluHtis of neck, 3; incision
and drainage curettement post auricular cyst, 1; debridement carbuncle, 1; de-
bridement decubitis, 1; suturing laceration two fingers right hand, 1; suturing
laceration third finger left hand, 1; resuturing abdominal incision, 1; suturing
laceration hand ligation arteries, 1 ; suturing laceration of head, 1 ; suturing lacera-
tion upper eye-lids, 1; suturing multiple lacerations of wrists, 1; double inguinal
herniorrhaphy, 3; inguinal herniorrhaphy, 2; herniorrhaphy (inguinal) and ap-
pendectomy, 1; femoral herniorrhaphy, 2; inguinal herniorrhaphy and orcheietomy,
1; ventral herniorrhaphy, 2; cystoscopic examinations, 8; urethrotomy, 1; meato-
tomy and curettement of perineum, 1; hydrocelectomy, 2; prostatectomy, 1; epi-
dydemectomy, 2; circumcision, 5; paracentesis hydrocele, 1; paracentesis abdom-
inalis, 11; thoracentesis, 6; paracentesis, bursa, 1; excision epithelioma of hand,
1; amputation breast, 1; amputation left leg, 1; amputation right leg, 1; reduction
dislocation left shoulder, 1; application plaster cast to leg, 3; application plaster
cast to hand, 1; application plaster cast to arm, 3; thoracotomy, 1; the total number
of operations, 330.
Clinics
The system of clinics has been continued, with much satisfaction. All new
patients admitted to the hospital attend the eye, ear, nose and throat clinic, and
555 patients were examined in this clinic in the past year. All new female patients
admitted, attend the Gynecological clinic for examination and treatment if in-
dicated. A total of 733 patients were examined and received treatment in this
clinic. All employees and patients received paratyphoid inoculations, and a
total of 1,893 inoculations were given.
During the year, a clinic was opened for the treatment of employees, which has
proven to be very satisfactory. A doctor is in his office in the treatment suite
each d^y from 4:00 to 5:00. Employees report at this time and are given careful
physical examinations. A system of record-keeping for the work done for em-
ployees has been inaugurated, and is a very valuable part of our medical records.
Obstetrical Ward
During the year an obstetrical ward was opened on Folsom III. A delivery
room and nursery in connection with it enables us to care for all of the obstetrical
cases within the institutions under the jurisdiction of the Department of Mental
Diseases. During the year we have had 20 deliveries, with two infant mortalities.
One was a seven-months baby which weighed less than four pounds at birth and
lived only four days. The other was a case of placenta praevia, in which podalic
version was done, the child being still-born.
Malarial Therapy
The work of malarial therapy in general paresis of the insane has been con-
tinued during the year, about 100 cases having received the treatment. The results
have been definitely encouraging. In the series there have been two cases of
spontaneous rupture of the spleen. One case was diagnosed postmortem, in the
other case a diagnosis was made, and spleenectomy performed. He is now eleven
months post-operative. The patients receiving malaria are followed up by try-
parsamide and other forms of syphilitic therapy. A total of 2117 specific treat-
ments were given during the year in addition to malarial therapy.
P.D. 23 11
Autopsies
A determined effort has been made during the year to get more autopsies and
correlate the pre-mortem and post-mortem findings. The percentage of autopsies
for the year was 39.7%.
Laboratory
The detail of the work carried on by the laboratory during the year is as follows:
Autogenous vaccines, 1; animal inoculations, 3; alveolar C02, 25; autopsies,
77; bacterial cultures, 97; bacterial smears, 323; basal metabolisms, 187; blood
cultures, 3; blood creatinin, 153; blood N. P. N., 264; blood sugars, 391; blood
urea, 295; blood uric acid, 166; blood counts, red, 879; blood counts, white, 942;
blood counts, differential, 941; blood hemoglobin, 1044; clotting time, 208; galactose
tolerance test, 95; microscopical sections, 19; nitrogen partitions, 121; malarial
Plasmodia in the blood, 57; spinal fluid, albumin, 17; spinal fluid, cell count, 266;
spinal fluid, gold curve, 337; spinal fluid, globulin, 324; sputum, 81; stools, 56;
urea curves, 59; urinalysis, 2675; quantitative sugars, 171; icteric index, 6; van
den Bergh, 2; stomach analysis, 3; mastic test, 34; P. S. P. test, 87; vital capacity,
20; Widal test, 4; Mosenthal test, 4; Kahn test, 1; sedimentation, 21; blood fragility,
0; spinal fluid, sugar, 2; parasites, 3.
Dental Department
Following is the report of the Dental Department of the hospital:
Patients, 4,230; cleanings, 2,079; fillings, 1,848; extractions, 3,587; plates (new),
65; repairs to plates, 72; examinations, 1,043; X-rays, 176; impactions, 10; pyorrhea
treatments, 843; abscess and socket, 409; alveolarectomy, 22; bridges, 7; crowns,
8; inlays, 8; fractured jaws wired and set, 2.
X-Ray Department
The following is a detailed report from the X-Ray Laboratory:
Number of Number of
Patients Films
Chest 133 149
Leg 2 2
G. I. Series 35 286
Ankle 9 11
Abdomen 1 1
Sinuses 35 131
Shoulder 13 16
Skull 46 100
Ribs 7 12
Nose 3 3
Toe 1 1
Head 2 8
Knee 8 13
Elbow 3 5
Wrist 9 10
Thorax 1 2
Heart 12 12
Spine 14 23
Foot 8 12
Hip 14 18
Hand 15 16
Jaw 6 8
Mastoids 8 16
Arm 5 10
12 P.D. 23
Gall Bladder 10 48
Thigh 2 3
Sella Turcica 2 6
Finger 2 2
Throat 1 1
Clavicle 4 4
Kidney 5 11
Appendix 1 1
Teeth 6 50
Sacro-Iliac X-Ray Plate 1 1
Total 424 992
Teaching Activities
Perhaps the major eflfort of the psychiatric organization during the year has
been a definite effort to avoid institutional inertia. Our most effective means
of favoring this aim has been the utilization of hospital resources and material
for teaching purposes. Our teaching policy has had three direct goals:
First, to stimulate the stable, regular hospital staff, giving them an active
interest in work by a refreshing contact with younger workers. It has appeared
that a number of persons of unusual ability can be retained and made happy
with this added stimulus who without it might seek other fields of endeavor.
Second, to take a part in the work of carrying on mental hygiene propaganda.
For this purpose it has seemed wiser to turn out in the Commonwealth each year
a considerable group who know something practical about mental health and
disease, and what the State is doing in caring for the mentally ill. Taking these
students into the hospital and simulating them for a greater or less period of time
seems to be more important than to deliver a number of brief and casual lectures
to a large group, the members of which are unqualified by education and experience
to understand the problem.
Third, though not least in value, is the goal to bring to our patients a group of
enthusiastic workers of excellent educatipnal background who will take a keen
personal interest in the patient, and will be able to give a personal touch to their
work.
During the year this teach^,ng activity has expanded to a considerable extent.
This expansion has been due to an increasing demand for admission to our student
group. We are now receiving the following groups of individuals:
1. Medical and surgical internes for a twelve months' internship.
2. Students of the psychiatric social service school maintained by Smith
College who spend nine months doing field work.
3. Undergraduate nurses from five general hospitals who are at the hospital
for three months of the year.
4. Students from the Boston School of Occupational Therapy spend six months
at the hospital getting their practical work.
5. Students from various theological seminaries are invitfed into the hospital
for three months for instruction in abnormal psychology.
6. The Training School of the hospital has been carried on in keeping with the
standards set by the Board of Registration of Nurses. Six nurses were granted
diplomas, three of whom have taken their exa^ninations for registered nurse. At
present we have six students in our senior class, two intermediates, and fourteen
preliminary students. Our graduate nurses and attendants have been satisfac-
torily permanent durjpg the past year.
To the hospital which desires to do this kind of work, a great field is offered,
but it should be pointed out that it is a time-consuming process and means a con-
siderable amount of work for the medical staff in actual teiaching. It is not sufficient
P.D. 23 13
to turn these students loose in the hospital to get what they can, but the hospital
must feel its responsibility in giving adequate instruction in a formal way.
7. Classes for men and women attendants were carried on during the months
of January, February and March.
Community Work
During the year a total of 98 lectures were given by doctors of the staff of the
hospital to various community groups.
Out-Patient Reiort
The work of the department falls into three distinct settings, and will so be
reported.
1. An attempt was made to keep in touch with as many as possible of the
patients who go out froim this hospital on visit. For this purpose a regular monthly
clinic is held the second Monday of each month at the Summer Street Department,
and through the Soci,al Service Department the patients who are in the vicinity
of Worcester are notified of the clinic and asked to report and see the physician.
During the pajpt year the number of patients reporting this way has varied to some
extent. The average has been about twenty.
Three points seem to stand out quite definitely in connection with this work of
supervising visit patients, and are, perhaps, worth mentioning with some degree
of emphasis. Firstly, the great majority of patients who are asked to come to
clinics feel that the chance to talk over things with the physician and with one
of the social service workers is a real help to them, and are accordingly very appre-
ciative. This is, of course, particularly true when friendly contact with the home
has been made during the patient's residence in the hospital. Secondly, it has
been clear, as indicated, that through cooperation of this sort between the social
service department and out-patient physician and clinic consultations, that it is
possible to know much better tha-n any other way how far patients are making a
satisfactory adjustment, and when, as someti^mes happens, that patient should
return to the hospital. From the physician's point of view, also, it gives a very
helpful insight into the way in which various types of people do or do not assimilate
the fact of a mental illness. Thirdly/ there is no doubt whatever that a group
Q:f patients are able to be out in the community when under such supervision
who otherwise could not be sent out at a;ll.
2. Examination of retarded school children: This being one of the largest of
the State Hospftals, Worcester, naturally, has a father extensive territory in which
the schools look to the Out-Patient Department for examination of retarded chil-
dren. There a^e now some fifty-nine towns divided into th^fty-one school unions
in the district assigned to this hospital. For vaj-ious reasons, a comparatively
small percentage of these towns ask for examinations of children in any one year.
Twhoe a year letters are sent out to eac^ superintendent and he is asked whether
he desires this examination otjnducted in his schools, and how many children are
to be seen.
During the year past, examinations were conducted in the schools in the fallow-
ing plaices: Pepperell, Jefferson, West Boylston, Boylston, Rutland, Paxton,
Littleton, Carlysle, Bolton, Spencer, Northborough, Fisherville, Ashland, Hbp-
kinton, Sudbury, Wayland, Cochituiate, Dover, Oxford, and Shrewsbury. In
October of this year, alfeo, children were examined in Ayer, Shirley and South-
borough. All in all, some 409 children were examined, the chief problem being
that of school retardation, though in some cases school principals requested the
physician to see children who are problems for other reasons. It is of some interest
to note that of this number some 148 children fall into the class technically known
^s feebleminded, that is, those who have an Intelligence Quotient of under 70.
14 P.D. 23
Some 27 of the whole number, just about 7%, are children who really need the
particular care and training which they can only get in an institution such as
State Training Schools. The crowded condition of these institutions makes it
very unlikely that any considerable number of these children can be admitted.
Some 257 children, that is about two-thirds of the entire number, had well-defined
physical defects, such as badly carious teeth, enlarged tonsils, defective vision, or
marked malnutrition, which would have a good bit to do with their ability to do
good work in school. There appears to be an increasing sense of importance of
this work on the part of the school authorities, though many are handicapped by
the difficulty of providing for special classes in an already crowded building, or
of persuading school committees to undertake new expenditures of this kind.
It is also a question of some difficulty where superintendents have a small number
of children who are in need of this ungraded class with the special educational
work, but where there is not a sufficient number to make it mandatory to establish
such a class. There is no question, however, that all the time more is being done
all over the State to meet the needs of the child for whom the regular class work
is not suitable.
3. Behavior Clinic for Children in Worcester: There have been, on the whole, some
very satisfactory developments in the work of this clinic during the past year.
The clinic has been making closer contacts, particularly with the schools in the
city, and also increasing number of requests for advice have come from parents
in private homes. The total of 122 cases have been seen, including some 27 girls
seen at the home belonging to the Girls' Welfare Society. Other sources from
which these children have been referred are as follows: Children's Friend Society,
13 children; city schools, 12 children; Juvenile Court, 5 children; District Nursing
Society, 5 children; children under the Department of Public Welfa^re of the City
of Worcester, 3; S. P. C. C, 2 children; Associated Charities, 3 children; Division
of Child Guardianship, 3 children. There have been also 10 children referred
from courts and other agencies in outside towns, and 36, the largest number of any,
came from private homes.
About one-third of the children have been referred to the clinic primarily because
of the difficulties arising from some degree of mental retardation. These diffii-
culties were both school maladjustments and conduct difficulties in the home,
where the difficulty of management was chiefly due to their lack of mental capacity.
In some cases the deficiency was sufficiently marked to make it necessary for the
child to receive the type of training and discipline which can only be gotten in
one of the State Schools for Feebleminded. In most of the other cases the child's
needs can be met by changing the school regime or the type of training that is
being given. There were 24 children all together with whom delinquency of greater
or less degree was the problem. In two cases the delinquency had been of such
long standing and the response of the child so poor that it seemed necessary for
them that they should have the type of discipline that could only be gotten in o ne
of th'e schools at Lancaster or Westborough. In many of these cases the difficulty
was due to deficiency in the home from the loss of one parent or other similar
cause. It has been sought to make contacts for these children with wholesome
group life, and to keep up shich a friendly supervision as will be of help to them
and to the home. It is of some interest, also, to note the age grouping in these
cases. The largest group of all, some forty children, fall in between the ages of
twelve to fifteen, to whom the home authority is naturally somewhat failing and
less efficient, and the temptations of the world outside becoming stronger. The
next largest group, thirty children, were in the age group of nine to twelve years.
There were seventeen children between six and ten years of age, nine under six
years of age, seven between fifteen and eighteen years of age. This division is
consistent of what one would expect in considering the social and personal factors
involved in the maladjustment of childhood.
P.D. 23 15
As there is an increasing number of children coming to the clinic for whom it
is necessary thjat the contact be kept up with the home and with them over pro-
longed periods, h is a great satisfaction tha,t the Golden Rule Fund of Worcester
has voted $21560 to pay for the salary of a trained social worker to be attached
entirely to the Child Guidance Clinic. As well as being a promise of greater effi-
ciency in the work of the clinic in the future, this seems to be a sign of the confidence
of the community in the necessity and value of the clinic's work.
A word should be said in regard to the educative side of the clinic's work during
the past year. During the fall, winter and spring there have been monthly meet-
ings of the Advisory Committee, which was organized first in October, 1926. The
May meeting of 1927 of this committee took the form of a dinner and a public
meeting addressed by Dr. Macfie Campbell of Boston Psychopathic Hospital, on
"The Understanding of Childhood". This meeting was well attended and was
an evidence of the increasing interest of the public in the understanding of the
problems of childhood.
There also have been regular weekly meetings of the case conference held by
the clinic staff with a steadily increasing interest by those attending. This year
the meetings are held in the Young Women's Christian Association, and it is fair
to say that the conference is becoming a forum for the discussion of problems o
childhoood in the community. f
It may be added that the out-patient physician delivered a course of four lectures
on "Problem Children" before the V/'orcester Teachers' Association in March,
1927, and has lectui^ed twice to other groups. Finally it is a source of great satis-
faction to mention the increasing cooperation from all agencies in the community
and an increasing interest in the work being done by the cliniC,
New Construction
General operations for the year. The repairs of the hospital have been kept up
as well as possible with the small number of workmen on the payroll. The largest
project which was carried on during the year was the erection of the new congre-
gate dining room. This has taken up almost our entire time in spite of the fact
that we have hired outside workmen, but it was completed in October, and has
been in use since that time.
Recommendations
I have previously called attention to certain needs that exist at this hospital.
Perhaps one of the most important is the erection of a new farm unit. At the
present time our herd, which is an accredited herd, is housed at the Hillside Farm .
The transportation of milk, and the danger of infection after pasteurization, makes
it an expensive and cumbersome method of production. A farm unit at the main
farm is an imperative need.
A continuation of the program for the elimination of the stairways of wood con-
struction is essential. We have a number of these stairways in the hospital and
they constitute a serious fire menace.
I wish to express my sincere thanks to the members of the visiting staff of the
hospital who have given so freely of their time and energy to further the work of
the hospital. To the medical staff, officers, and employees, I gratefully ackowledge
my appreciation of their loyalty and support. Without this loyalty and coopera-
tion, no progress could be made in any organization.
I wish also to thank the Board of Trustees for the constant support and encour-
agement given me at all times.
Respectfully submitted,
WILLIAM A. BRYAN, Superintendent.
16 P.D. 23
TREASURER'S REPORT
To the Department of Mental Diseases:
I respectfully submit the following report of the finances of this institution for
the fiscal year ending November 30, 1927.
Cash Account
Receipts
Income
Board of Patients $111,430. 57 $111,430. 57
Personal Service:
Reimbursement from Board of Retirement 282 . 37
Sales:
Travel, Transportation and Office Expenses $ .75
Food 201.61
Clothing and Materials 56 . 50
PMrnishings and Household Supplies 66 .40
Medical and General Care 31.24
Heat, Light and Power 116.30
Farm:
Pigs and hogs $6.16
Hides 144 . 50
Vegetables 27 . 36
Sundries (empties) 4.00
182.02
Garage, Stable and Grounds 41 . 00
Repairs, Ordinary 185 .,46
Total sales 881 .28
Miscellaneous:
Interest on bank balance $1,545 . 78
Rent 1,020 . 00
$2,565.78
Total Income $115,160.00
Maintenance
Balance from previous year, brought forward $32,659 . 74
Appropriations, current year 811,085.00
Total $843,744.74
Expenses (as analyzed below) 822,271 . 10
Balance reverting to Treasury of Commonwealth $21,473 . 65
Analysis of Expenses
Personal services $395,938 . 66
Religious instruction 2,585 . 00
Travel, transoortation and office expenses 8,492 .69
Food ." 161,751.31
Clothing and Materials 18,735.00
Furnishings and household supplies 38,223 . 75
Medical and general care 36,959 . 92
Heat, light and power 98,438 .45
Farm 28,036 .73
Garage, stable and grounds 5,660 . 31
Repairs ordinary 18,377 . 40
Repairs and renewals 9,071 . 88
Total expenses for Maintenance $882,271.10
Special Appropriations
Balance December 1, 1926 $26,092 . 16
Appropriations for current year 46,500 . 00
Total $72,592 . 16
Expended during the year (see statement below) $45,695.93
Reverting to Treasury of Commonwealth 94 . 84
45,790.77
Balance November 30, 1927, carried to next year $26,801 .39
Object
Act or
Resolve
Whole
Amount
Expended
during
Fiscal
Year
Total •
expended
to Date
Balance
at end of
Year
Chap. 211, Acts 1925
Chap. 347, Acts 1925
Chap. 79, Acts 1926
Chap. 79, Acts 1926
Chap. 138, Acts 1927
Chap. 138, Acts 1927
$150,000.00
18,000.00
7,000.00
5,000.00
42,000.00
4,500.00
$12,899 . 18
4,819.01
3,292.62
4,743.73
19,941.39
$149,907.98
17,997.18
6,872.64
4,884 . 58
19,941.39
$92 . 02*
Fire Protection, 1925
Automatic Refrigeration
Equipment for Dining
2.82*
127.36
115.42
22,058.61
Water Supply, Hillside
4,500.00
$226,500.00
$45,695.93
$199,603.77
$26,896 . 23
P.D. 23 17
Balance reverting to Treasury of the Commonwealth during year (mark item with *) . . 94 . 84
Balance carried to next year 26,801 . 39
Total as above $26,896 . 23
Per Capita
During the year the average number of inmates has been 2,261.39.
Total cost for maintenance, $822,271.10
Equal to a weekly per capita cost of $6.9925 (52 weeks to year).
Receipt from sales, $881.28.
Equal to a weekly per canita of $ . 0074.
All other institution receipts, $114,278 72.
Equal to a weekly per capita of $.9718.
Net weekly per capita, $6.0133.
Respectfully submitted,
JESSIE M. D. HAMILTON, Treasurer.
STATEMENT OF FUNDS
Patient's Fund
Balance on hand November 30, 1926 $13,828 . 08
Receipts 16,327.81
Interest 578 . 48
— $30,734 . 37
Refunded $14,266.83
Interest paid to State Treasurer 578 .48
14,845.31
$15,889.06
Investment
Worcester County Institution for Savings $2,000.00
Worcester Five Cent Savings Bank 2,000 . 00
Worcester Mechanics Savings Bank 2,000 . 00
Peoples Savings Bank 3,000 . 00
Bay State Savings Bank 3,000.00
Balance Worcester Bank & Trust Company 3,466 .96
Cash on hand December 1, 1927 422.10
$15,889 . 06
Lewis Fund
Balance on hand November 30, 1926 $1,559 . 11
Income 87,00
$1,646.11
Expended for entertainments, etc 38 . 71
$1,607.40
Investment
American Telephone and Telegraph Company collateral trust 4% bond $926.36
Millbury Savings Bank 634 .26
Balance Worcester Bank and Trust Company 46 . 78
$1,607.40
Wheeler Fund
Balance on hand November 30, 1926 $6,145 . 06
Income 311.82
$6,456.88
Expended for entertainments, etc 259 . 87
$6,197.01
Investment
American Telephone and Telegraph Company collateral trust 4% bond $712.50
Grafton Savings Bank 4,000 . 00
Millbury Savings Bank 1,374 . 22
Balance Worcester Bank and Trust Company 110.29
$6,197.01
Manson Fund
Balance on hand November 30, 1926 $1,133 .41
Income 86 . 17
$1,219.58
Expended for entertainments, etc 48 . 05
$1,171.53
Investment
Millbury Savings Bank $1,162 . 80
Balance Worcester Bank and Trust Company 8 . 73
$1,171.53
Respectfully submitted,
JESSIE M. D. HAMILTON, Treasurer.
November 30, 1927.
N. B. — The values assigned to the above securities are their respective purchase prices.
VALUATION
November 30, 1927
Real Estate
Land, 589 acres $438,200 00
Buildings 2,230,344.36
$2,668,544.36
18 P.D. 23
Personal Property
Travel, transportation and ofBce expenses $9,762 . 66
Food 20,430.59
Clothing and materials 19,924 . 83
Furnishings and household supplies 246,207 . 78
Medical and General care 20,186.46
Heat, light and power 31,938.49
Farm 38,146 . 10
Garage, stables and grounds 9,723 . 35
Repairs 25,039 . 99
$421,360.25
Summary
Real Estate : $2,668,544.36
Personal Property 421,360 . 25
$3,089,904.61
STATISTICAL TABLES
As adopted by American Psychiatric Association.
Prescribed by Massachusetts Department of Mental Diseases
Table 1. — General Information
1. Date of opening as an institution for the insane: January 18, 1833.
2. Type of institution: State.
3. Hospital plant:
Value of hospital property:
Real estate, including buildings $2,668,544.38
Personal property 438,344 . 36
Total $2,668,544 . 36
Total acreage of hospital, 589.16.
Acreage under cultivation during previous year, 137.5.
Men Women Totals
4. Medical service:
Superintendent 1 — 1
Assistant physicians 8 2 10
Medical internes 4 - 4
Dentist 1 - 1
Total physicians 14 2 IS
5. Employees on pay roll (not including physicians):
Men Women Totals
Graduate nurses 1 35 36
Other nurses and attendant 106 101 207
All other employees 96 78 174
Total employees 203 214 417
Men Women Totals
6. Patients employed in industrial classes or in general hospital work
on date of report 762 616 1378
7. Patients in institution on date of report (excluding paroles) 1124 1166 2290
Table 2. — Financial Statement
See treasurer's report for data requested under this table.
19
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20 P.D. 23
Table 4. — Nativity of First Admissions and of Parents of First Admissions
Patients
Parents of
Male Patients
Parents of
Female Patients
Nativity
Fathers
Mothers
Both
Parents
Fathers
Mothers
Both
Parents
M.
F.
T.
M.
F.
T.
M.
F.
T.
United States
Armenia
125
1
22
1
10
1
1
5
11
6
8
15
2
3
1
101
1
1
14
4
4
1
3
22
6
1
3
1
6
8
1
226
1
2
36
1
14
5
2
8
33
12
1
11
1
21
2
11
1
1
60
1
1
27
11
1
1
3
5
43
7
11
17
5
7
1
11
65
1
1
30
15
1
3
5
37
7
10
17
4
5
1
10
125
2
2
57
28
2
1
6
10
80
14
21
34
9
12
2
21
43
2
1
20
12
4
1
3
46
8
1
4
1
7
2
10
1
11
45
2
1
22
8
4
1
3
38
10
1
6
1
6
1
12
1
15
88
4
2
42
Denmark
20
Finland
8
2
6
Ireland
Italy
84
18
2
Poland
10
Portugal
2
13
Scotland
3
22
Turkey
2
{West Indies
Unascertained
26
Total
212
177
389
212
212
424
177
177
354
* Includes Newfoundland % Except Cuba and Porto Rico
Table 5.
— Citizenship of First Admissions
M.
F.
T.
128
46
33
5
97
46
33
1
225
92
Aliens
66
6
Total
212
177
389
Table 6. — Psychoses of First Admissions
10.
11.
12.
13.
Psychoses
Traumatic psychoses
Senile psychoses
Psychoses with cerebral arteriosclerosis
General paralysis ,
Psychoses with cerebral syphilis
Psychoses with Huntington's chorea
Psychoses with brain tumor
Psychoses with other brain or nervous diseases — total . . . .
Encephalitis lethargica
Undetermined
Alcoholic psychoses — total
Acute hallucinosis
Chronic hallucinosis ,
Other types — acute or chronic
Psychoses due to drugs and other exogenous toxins, total .
Psychoses with pellagra
Psychoses with other somatic diseases, total
Pulmonary
Cardio-renal diseases
General syphilis
Other diseases or conditions
Manic-depressive psychoses, total
Manic type
Depressive type
Involution melancholia
Dementia praecox
Paranoia and paranoid conditions
M.
F.
M.
F.
1
60
18
29
4
11
38
1
20
11
9
97
10
P.D. 23
Table 6 — Psychoses of First Admissions — Concluded
21
17. Epileptic psychoses
18. Psychoneuroses and neuroses, total. ...''...
Psychasthenic type
19. Psychoses with psychopathic personality
20. Psychoses with mental deficiency
21. Undiagnosed psychoses
22. Without psychosis, total
Epilepsy without psychosis
Psychopathic personality without psychosis
Mental deficiency without psychosis
Undetermined
Total
M.
F.
M.
212
T.
2
4
5
11
50
8
177 389'
Table 7. — Race of First Admission classified with Reference to Principal Psychoses
Total
Traumatic
Senile
With
Cerebral
Arterio-
sclerosis
General
Paralysis .
M.
F.
T.
M.
1
1
F.
T.
1
1
M.
5
3
7
1
6
1
23
F.
1
6
7
2
3
1
17
37
T.
1
5
9
14
2
4
1
23
1
60
M.
1
1
5
4
11
F.
1
1
1
2
1
1
7
T.
2
2
1
7
1
5
18
M.
2
2
1
4
1
11
1
22
F.
1
1
2
3
7
T.
2
1
15
1
23
4
5
42
8
10
5
3
15
1
73
4
212
4
1
10
4
14
2
3
2
38
8
2
1
12
6
1
67
2
177
6
2
25
5
37
6
8
2
80
16
12
1
17
3
21
1
1
140
6
389
_ ■
American Indian
Armenian
3
Finnish
3
-
Greek
1
—
6
Italian*
-
—
Portuguese
-
Scotch
-
1
Turkish .
-
14
Race unascertained
Total
1.
29 '
Table 7. — Race of First Admissions classified with Reference to Principal
Psychoses — C ontinued
Race
With
Cerebral
Syphilis
With Other
Brain or
Nervous
Diseases
Alcoholic
With
Pellagra
With Other.
somatic
Diseases -
M.
F.
T.
M.
1
2
1
2
6
F.
1
1
3
5
T.
1
1
1
2
1
5
11
M.
2
1
10
3
6
1
8
6
37
F.
1
1
T.
~
2
1
11
3
6
1
8
6
38
M.
F.
-
1
1
T.
1
1
M.
1
1
1
3
F.
1
2
1
5
1
1
6
17
T.
4
4
-
4
4
_ ■
American Indian
. -
1
_
?.
Greek
1
fi
—
_
_
1
Scotch
?.
Turkish
—
7
Race unascertained
Total
20
22 P.D. 23
Table 7. — Race of First Admissions classified with Reference to Principal
Psychoses — Continued
Manic-
Depressive
Involution
Melan-
cholia
Dementa
Praecox
Paranoia
AND Paranoid
Conditions
Epileptic
Psychoses
Race
M.
F.
T.
M.
1
1
F.
1
1
1
1
1
1
2
8
T.
1
1
1
1
1
1
3
9
M.
1
1
2
6
3
4
6
2
1
2
1
20
2
51
F.
2
1
2
11
3
3
18
46
T.
3
1
3
2
7
4
5
17
3
2
1
3
5
1
38
2
97
M.
1
1
2
2
6
F.
4
4
T.
1
1
2
6
10
M.
F.
1
1
2
T.
1
1
1
2
5
1
1
1
2
1
6
2
1
1
1
2
1
3
11
_
American Indian
-
_
_
1
Greek
_
_
_
1
_
_
_
_
_
Turkish
_
West Indian"
_
_
Race unascertained
Total
2
Table 7. — Race of First Admissions classified with Reference to Principal
Psychoses — C oncluded
Race
Psycho-
neuroses
AND Neuroses
With
Psychopathic
Personality
With
Mental
Deficiency
Undiagnosed
Psychoses
Without
Psychoses
M.
F.
T.
M.
1
1
2
4
F.
1
1
T.
1
1
3
M.
1
3
1
5
F.
1
1
3
1
6
T.
1
3
1
1
1
3
1
11
M.
1
1
1
2
5
2
1
1
2
9
25
F.
1
2
1
2
1
7
1
2
1
6
1
25
1
T.
M.
1
2
1
2
6
F.
1
1
2
T.
1
1
2
1
1
2
1
1
2
4
2
3
2
4
1
12
2
2
3
3
15
1
50
_
American Indian
-
_
_
1
Greek
_
_
2
?.
_
_
_
Scotch
_
_
Turkish
_
_
3
Race unascertained
Total
8
* Includes "North" and "South." t Norwegians, Danes and Swedes. J Includes Bohemian, Bosnian
Croatian, Delmatian, Herzegovinian, Montenegrin, Moravian, Polish, Russian, Ruthenian, Servian
Slovak, Slovenian. ° Except Cuba.
P.D. 23 23
Table 8. — Age of First Admissions classified with Reference to Principal Psychoses
Total
Under
15 Years
15—19
Years
20—24
Years
Psychoses
M.
F.
T.
M.
F.
1
1
2
T.
1
1
2
M.
1
5
1
1
1
9
F.
5
1
1
7
T.
1
10
1
2
2
16
M.'
1
1
1
9
4
1
17
F.
2
1
3
2
1
9
T.
1. Traumatic
2. Senile
1
23
11
22
4
6
37
3
5
1
51
6
2
4
5
25
6
212
37
7
7
5
1
1
17
6
8
46
4
2
2
1
6
25
2
177
1
60
18
29
4
11
38
1
20
11
9
97
10
2
4
5
11
50
8
389
-
3. With cerebral arteriosclerosis
4. General paralysis
-
6. With Huntington's chorea
-
8. With other brain or nervous diseases .
9. Alcoholic
10. Due to drugs and other exogenous
toxins
11. With pellagra
3
1
12. With other somatic diseases
13. Manic-depressive.
2
15. Dementia praecox
16. Paranoia or paranoid conditions
17. Epileptic psychoses
18. Psychoneuroses and neuroses
19. With psychopathic personality
12
2
5
1
Total
26
Table 8. — Age of First Admissions classified with Reference to Principal
Psychoses — C ontinued
25—29
Years
30—34
Years
35—39
Years
40—44
Years
45—49
Years
Psychoses
M.
F.
T.
M.
4
7
10
1
1
1
1
25
F.
2
1
1
3
8
2
1
1
3
22
T.
6
1
7
1
3
18
2
47
M.
4
2
2
8
1
7
1
1
2
1
29
F.
1
1
1
9
1
13
T.
5
2
2
8
1
2
16
1
1
42
M.
5
7
1
5
1
1
2
22
F.
2
3
3
4
1
1
1
4
19
T.
7
-
7
3
1
3
9
1
1
1
2
6
41
M.
1
6
3
1
3
1
3
18
F.
1
2
2
3
5
1
1
15
T.
1
1
10
1
1
4
1
1
20
1
2
1
6
1
11
2
1
2
1
16
1
1
5
1
1
31
1
2. Senile
1
3. With cerebral arteriosclerosis
6
8. With other brain or nervous diseases .
8
10. Due to drugs and other exogenous
?.
a
14. Involution melancholia
3
H
16. Paranoia or paranoid conditions
1
18. Psychoneuroses and neuroses
19. With psychopathic personality
1
4
22. Without psychosis
Total
33
24
P.D. 23
Table 8. — Age of First Admissions classified with Reference to Principal
Psychoses — C on eluded
Psychoses
50—54
Years
55—59
Years
60—64
Years
65—69
Years
70 Years
AND Over
M.
F.
T.
M.
1
1
5
1
1
1
4
14
F.
5
1
1
2
9
T.
6
1
5
2
1
I
1
4
23
M.
1
1
1
1
2
1
1
2
F.
1
2
1
1
2
2
T.
2
3
1
1
1
3
2
1
2
1
2
19
M.
2
2
1
1
6
F.
7
1
1
3
12
T.
9
3
2
3
1
18
M.
19
8
1
1
1
2
1
33
F.
23
3
5
31
T.
2
2
2
3
9
1
1
1
2
2
1
10
18
1
2
2
1
1
4
2
1
13
27
_
2. Senile.
4?.
3. With cerebral arteriosclerosis .
11
1
6, With Huntington's chorea
8. With other brain or nervous diseases
1
10. Due to drugs and other exogenous
_
1
13. Manic-depressive
15. Dementia praecox
16. Paranoia or paranoid conditions
18. Psychoneuroses and neuroses
-
7
1
Total
64
I I rt 1 -HIM I I I I I rt
25
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ts
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rHWrHN'^l l<Ot-| lmU3rHrHtCIN'^'ffllO«D
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26 P.D. 23
Table 10. — Environment of First Admissions classified with Reference to
Principal Psychoses
Psychoses
1. Traumatic
2. Senile
3. "With cerebral arteriosclerosis . .
4. General paralysis
5. With cerebral syphilis
6. With Huntington's chorea
7. With brain tumor
6. With other brain or nervous diseases
9. Alcoholic
10. Due to drugs and other exogenous toxins
11. With pellagra
12. With other somatic diseases
13. Manic-depressive
14. Involution melancholia
15. Dementia praecox
16. Paranoia or paranoid conditions
17. Epileptic psychoses
18. Psychoneuroses and neuroses
19. With psychopathic personality
20. With mental deficiency
21. Undiagnosed psychoses
22. Without psychosis
Total
Total
M.
212 177 389 211 172 383
M.
Rural
M. F.
Table 11. — Economic Condition of First Admissions classified with Reference
to Principal Psychoses
Psychoses
1. Traumatic
2. Senile
3. With cerebral arteriosclerosis ....
4. General Paralysis
5. With cerebral syphilis
6. With Huntington's chorea ,
7. With brain tumor
8. With other brain or nervous diseases
9. Alcoholic
10. Due to drugs and other exogenous
toxins
11. With pellagra
12. With other somatic diseases
13. Manic-depressive
14. Involution melancholia
15. Dementia praecox
16. Paranoia or paranoid conditions. .
17. Epileptic psychoses
18. Psychoneuroses and neuroses
19. With psychopathic personality ....
20. With mental deficiency
21. Undiagnosed psychoses
22. Without psychosis
Total 212 177 389 11 12 23
Total
M. F. T.
Depen-
dent
M. F
Marginal
F.
T.
Comfort-
able
M.
T.
i
P.D. 23 27<
Table 12. — Use of Alcohol by First Admissions classified with Reference to
Principal Psychoses
i
1
Absti-
Temper-
Intem-
Unascer-
t, Psychoses
Total
nent
ate
perate
tained
1
M.
F.
T.
M.
F.
T.
M.
1
F.
T.
1
M.
F.
T.
M.
F.
T.
1. Traumatic
1
_
1
-
2. Senile
23
37
60
2
16
18
12
17
29
5
4
9
4
-
4
3. With cerebral arteriosclerosis . . .
11
7
18
3
2
5
5
5
10
1
—
1
2
-
2
4. General paralysis
22
7
29
4
2
6
13
2
15
5
2
7
-
1
1
4
_
4
1
_
1
V
_
2
1
_
1
_
—
—
6. With Huntington's chorea
-
-
-
-
-
-
7. With brain tumor
-
_
-
-
-
-
-
-
-
-
—
-
-
-
-
8. With other brain or nervous dis-
eases
6
5
n
1
5
6
3
-
3
1
-
1
1
-
1
9. Alcoholic
37
1
38
-
-
_
—
_
_
37
1
38
-
-
-
10. Due to drugs and other exogen-
ous toxins
-
-
-
-
-
-
-
-
-
-
—
-
-
-
-
11. With pellagra
_
1
1
-
-
_
-
_
-
—
1
1
-
-
-
12. With other somatic diseases ....
3
17
20
-
6
6
3
9
12
-
2
2
-
-
-
13. Manic-depressive
5
6
11
1
6
7
2
-
2
2
-
2
-
-
—
14. Involution melancholia
1
«
9
-
3
3
1
3
4
-
1
1
-
1
1
15. Dementia praecox
51
4fi
97
12
20
32
26
19
45
10
3
13
3
4
7
16. Paranoia or paranoid conditions
6
4
10
1
2
3
4
1
5
-
-
-
1
1
2
17. Epileptic psychoses
-
2
2
-
1
1
—
1
1
-
-
-
-
-
18. Psychoneuroses and neuroses . . .
2
2
4
1
-
1
1
2
3
-
-
-
-
19. With psychopathic personality. .
4
1
5
1
-
1
3
1
4
-
-
—
-
20. With mental deficiency
5
(i
11
3
3
6
2
3
5
-
—
—
-
-
21. Undiagnosed psychoses
25
25
50
6
11
17
9
12
21
8
2
10
2
-
2
22. Without psychosis
6
2
8
1
2
3
3
-
3
2
-
2
-
~
"
Total
212
177
389
37
79
116
90
75
165
72
16
88
13
7
20
28
P.D. 23
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P.D. 23
29
Table 14. — Psychoses of Readmissions
Psychoses
Males
Females
Total
1. Traumatic psychoses
2. Senile psychoses
3. Psychoses with cerebral arteriosclerosis
4. General paralysis
5. Psychoses with cerebral syphilis
6. Psychoses with Huntington's chorea
7. Psychoses with brain tumor
8. Psychoses with other brain or nervous diseases ....
9. Alcoholic psychoses '
10. Psychoses due to drugs and other exogenous toxins
11. Psychoses with pellagra
12. Psychoses with other somatic diseases . .
13. Manic-depressive psychoses
14. Involution melancholia
15. Dementia praecox
16. Paranoia and paranoid conditions
17. Epileptic psychoses
18. Psychoneuroses and neuroses
19. Psychoses with psychopathic personality
20. Psychoses with mental deficiency
21. Undiagnosed psychoses
22. Without psychosis
Total
40
11
5
32
2
1
1
3
4
7
3
86
Table 15. — Discharges of Patients classified with Reference to Principal Psychoses
and Condition on Discharge
Psychoses
Total
Re-
covered
Im-
proved
Unim-
proved
Not
Insane
M.
F.
T.
M.
6
2
8
F.
2
3
1
1
7
T.
6
2
5
1
1
15
M.
1
4
3
7
2
1
2
2
20
2
3
1
1
49
F.
1
1
2
1
2
4
17
2
24
4
1
1
9
6
80
T.
1
5
4
9
1
4
1
4
19
4
44
6
4
3
5
9
6
129
M.
1
2
1
1
1
3
8
1
1
2
1
22
F.
3
1
1
3
4
12
T.
4
2
2
2
1
3
3
12
1
1
2
1
34
M.
2
1
17
20
F.
T.
1
5
5
8
1
11
1
7
2
28
2
1
4
2
3
18
99
4
1
3
1
1
2
6
20
5
28
4
1
3
4
10
6
99
1
9
6
11
1
2
13
1
6
27
7
56
6
1
5
5
7
10
24
198
2. Senile
3. With cerebral arteriosclerosis . .
-
5. With cerebral syphilis
6. With Huntington's chorea
-
8. With other brain or nervous
•>
10. Due to drugs and other exogen-
11. With pellagra
12. With other somatic diseases . . .
-
14. Involution melancholia
15. Dementia praecox
16. Paranoia or paranoid conditions
17. Epileptic psychoses
18. Psychoneuroses and neuroses . .
19. With psychopathic personality
20. With mental deficiency .......
21. Undiagnosed psychoses
1
17
Total
90
30
P.D. 23
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34 P.D. 23
Table 17. — Age of Patients at Time of Death, classified with Reference to Principal
Psychoses
Psychoses
Total
Under
15 Years
15—20
Years
20—25
Years
25—30
Years
M.
F.
T.
M.
F.
T.
M.
1
1
F.
1
1
T.
1
1
2
M.
F.
2
2
T.
2
2
M.
3
3
F.
1
1
.T
17
16
11
1
2
7
4
3-
3
26
3
1
I
10
18
12
4
1
1
10
7
1
24
1
2
12
1
35
28
15
1
1
2
7
1
14
10
4
50
4
1
1
4
22
1
2. Senile
3. With cerebral arteriosclerosis . .
-
5. With cerebral syphilis
6. With Huntington's chorea
-
8. .With other brain or nervous
10. Due to drugs and other exogen-
11. With pellagra
12. With other somatic diseases. .
-
14. Involution melancholia
4
16. Paranoia or paranoid conditions
18. Psychoneuroses and neuroses. .
19. With psychopathic personality.
20. With mental deficiency
-
Total
107
94
201
4
Table 17. — Age of Patients at Time of Death, classified with Reference to Principal
Psychoses — Continued
Psychoses
30—35
Years
35—40
Years
40—45
Years
45—50
Years
50—55
Years
M.
F.
T.
M.
2
4
6
F.
1
1
2
4
T.
2
1
1
4
2
10
M.
1
1
1
1
1
1
6
F.
_
5
5
T.
1
1
6
1
1
1
11
M.
4
1
1
3
1
10
F.
2
3
1
6
T.
6
1
1
6
1
1
16
M.
1
1
1
2
3
8
F.
1
1
2
3
7
T.
3
1
4
1
1
1
2
5
1
1
3
1
3
9
2. Senile
3. With cerebral arteriosclerosis . . .
1
6. With Huntington's chorea
7. With brain tumor
6. With other brain or nervous dis-
eases
9. Alcoholic
10. Due to drugs and other exogen-
ous toxins
11. With pellagra
1
1
12. With other somatic diseases, . . .
1
14. Involution melancholia
1
4
16. Paranoia or paranoid conditions.
17. Epileptic
18. Psychoneuroses and neuroses . . .
19. With psychopathic personality. .
20. With mental deficiency
6
Totals
15
P.D. 23 35
Table 17. — Age of Patients at Time of Death, classified with Reference to Principal
Psychoses
— Concluded
1
■ Psychoses
55—60
Years
60—65
Years
65—70
Years
70—75
Years
75 Years
AND Over
M.
F.
T.
M.
1
1
1
1
1
1
2
8
F.
2
2
1
2
4
1
1
13
T.
2
3
2
1
2
4
1
2
1
3
21
M.
2
2
1
1
2
1
9
F.
4
2
1
1
2
1
11
T.
6
4
1
1
1
3
3
1
20
M.
5
8
1
1
1
4
1
1
1
23
F.
3
1
1
1
6
T.
8
9
1
1
1
5
1
1
1
1
29
M.
10
4
1
2
1
1
2
21
F.
8
5
3
1
1
2
20
T.
1
3
1
3
8
1
2
3
1
5
1
13
1
3
3
1
3
1
8
1
21
_
2. Senile.
18
3. With cerebral arteriosclerosis . . .
9
_
6. With Huntington's chorea
-
8. With other brain or nervous dis-
eases
9. Alcoholic
10. Due to drugs and other exogen-
ous toxins
11. With pellagra
12. With other somatic diseases ....
13. Manic-depressive
14. Involution melancholia
15. Dementia praecox
16. Paranoia or paranoid conditions.
17. Epileptic
18. Psychoneuroses and neuroses . . .
19. With psychopathic personality. .
20. With mental deficiency
1
5 :
2
2 ;
4
22. Without psychosis
Totals
41
Table 18. — Total Duration of Hospital Life of Patients dying in Hospital
classified according to Principal Psychoses
Psychoses
Total
Less than
1 Month
1—3
Months
4—7
Months
M.
F.
T.
M.
2
1
1
1
9
14
F.
3
2
3
6
14
T.
5
3
3
1
1
15
_
28
M.
5
3
6
1
1
1
1
18
F.
1
2
1
2
T.
6
5
6
1
1
1
1
3
24
M.
2
4
1
1
1
9
1
F.
3
1
2
1
1
8
T.
17
16
11
1
2
7
4
3
3
26
3
1
1
2
10
18
12
4
1
1
10
7
1
24
1
_
J
1
35
28
15
1
1
2
7
1
14
10
4
50
4
1
1
4
22
1
_
2. Senile
5
3. With cerebral arteriosclerosis
4
1
1
6. With Huntington's chorea
8. With other brain or nervous dis-
1
1
10. Due to drugs and other exogenous
toxins
12. With other somatic diseases
13. Manic-depressive
2
_
15. Dementia praecox
l'
16. Paranoia or paranoid conditions. .
17. Epileptic psychoses
18. Psychoneuroses and neuroses
19. With psychopathic personality. . .
21. Undiagnosed psychoses
1
22. Without psychosis
Total
107
94
201
17
36 P. D. 23
Table 18. — Total Duration of Hospital Life of Patients Dying in Hospital
classified according to Principal Psychoses — Continued
Psychoses
8—12
Months
1—2
Years
3—4
Ye.\rs
5—10
Years
M.
F.
T.
M.
6
2
3
1
1
13
F.
4
2
1
1
1
2
2
13
T.
10
4
4
2
1
3
2
26
M.
1
1
1
1
1
5
F.
4
2
4
1
1
12
T.
5
2
1
1
5
1
1
1
17
M.
3
1
2
9
1
1
1
18
F.
1
1
1
4
3
1
9
1
1
22
T.
1
2
2
5
1
4
1
6
2
6
I
2
1
11
2 Senile
1
3. With cerebral arteriosclerosis
3
2
5. With cerebral syphilis
6. With Huntington's chorea
1
8. With other brain or nervous diseases
-
10. Due to drugs and other exogenous
11. With pellagra
_
12. With other somatic diseases
6
3
1
18
16. Paranoia or paranoid conditions
1
1
18. Psychoneuroses and neuroses
19. With psychopathic personality
1
2
_
Total
40
Table 18. — Total Duration of Hospital Life of Patients Dying in Hospital
classified according to Principal Psychoses — Concluded
Psychoses
10—15
Years
15—20
Years
20 Years
and Over
M.
F.
T.
M.
3
3
6
F.
1
1
2
T.
1
3
1
5
10
M.
2
1
6
2
11
F.
T.
1
1
1
4
1
8
1
2
5
1
9
1
1
1
3
9
2
17
_
2 Senile
_
_
_
_
_
_
_
?.
10. Due to drugs and other exogenous toxins
11. With pellagra
_
1
6
?.
18. Psychoneuroses and neuroses
-
—
_
_
Total
11
P.D. 23
37
Table 19. — Family Care Department
T.
Remaining September 30, 1928
Admitted within the year
Nominally returned from visit for discharge
Whole number of cases within the year
Dismissed within the year
Returned to the institution
Discharged
Died
Visit
Escaped
Remaining September 30, 1927
Supported by State
Private
Self-supporting
Number of different persons within the year
Number of different persons admitted
Number of different persons dismissed
Daily average number
State
Private
Self-supporting
13
1
12
13
2
11
3
12.33
10.33
2
1
2
12
14
3
12.68
10.33
2.35
1
I
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