Public Document

IDl1e Qlommottwrultl1 of iWlussurl1usrtta 1:-51 tt. )

ANNUAL REPORT

OF THE

TRUSTEES

OF THE

=fuss,',WESTBOROUGH STATE HOSPITAL /lVlS?ln

FOR THE

YEAR ENDING NOVEMBER 30,

1938

DEPARTMENT OF MENTAL HEALTH

PUDLICATIOS OF THIS DOClJ1\.tENT APPROVED BY THE COMl\HSSION ON ADMINISTRATION AND FINAN( E 550. ~. 7-·39. Order 7843.

OCCUPATIONAL PRINTING PLANT DEPARTMENT OF MENTAL HEALTH GARDNER STATE H OSPI TAL EAST GARDNER. MASS WESTBOR SPITAL (Post Office Address: Westborough. Mass.) S~ ~J:~~..E.ES N. EMMONS PAINE, M.D., 'e1ilii~e n. KATHRINE L. SULLIVAN, Secretary, Cant SEWALL C. BRACKETT, Boston. SS. OFFlaALS THOMAS F. DOLAN, Newton. JOHN A. FRYE, Marlborough. JOHN T. NEARY, D.D.S., Southborough. SADIE E. CASEY, M ilford. RESIDENT OFFICERS WALTER E . LANG, M.D., Superintendent. ROLLIN V. HADLEY, M .D., Assistant Superintendent. LYDIA B. PIERCE, M.D., Senior Physician, (Pathology). BETSY COFFIN, M.D., Senior Physician. GEORGE E. PEATICK, M.D., Senior Physician. HOWARD T. FIEDLER, M .D ., Assistant Physician. HARRY M. GARDINER, M.D., Assistant Physician. WILLIAM J . HORNYAK, M.D., Assistant Physician. FRANK S. ROZANSKI, M.D., Assistant Physician. DORA E . BRAULT, M.D., Assistant Physician. PAUL L. BUDGE, D.D.S., Resident Dentist. ELISABETH C. DANIEL, R.N., P rincipal of School of Nursing. P. I. WILEY, Steward. CARRIE G . POOR, Treasurer. CONSULTING BOARD FRED P. BATCHELDER, M .D., Internist. SOLOMON C. FULLER, M .D., Pathologist. CLIFFORD D. HARVEY, M .D., Surgeon. ELMON R. J OHNSON, M.D., Laryngologist. HOWARD MOORE, M.D., Orthopedist. W. D. ROWLAND, M.D., Ophthalmologist. JOHN P. SUTHERLAND, M.D., Internist. CONRAD WESSELHOEFT, M.D., Internist. DEWITT G. WILCOX, M.D., Gynecologist. SAMUEL N . VOSE, M .D ., Urologist. VISITING STAFF M. GENE BLACK, M.D., Diseases of the Chest. HENRY M. EMMONS, M .D ., Ophthalmologist. HARRY F. FRIEDMAN, M.D., Roentgenologist. RUDOLPH JACOBY, M .D., Dermatologist. LEIGHTON F. JOHNSON, M.D., Rhinologist and Laryngologist. RICHARD H. NORTON, D .D.S., Oral Surgeon. ROLAND O. PARRIS, M .D ., Rhinologist and Laryngologist. EDWIN W . SMITH, M.D., Gynecologist. CHARLES SZIKLAS, M.D., Surgeon. MYRON J . HAHN, M.D., Urologist. REPORT OF THE TRUSTEES To His Excellency, the Governor, and the Honorable Council: The Trustees of the Westborough State Hospital present this, their fifty-fourth annual report. Another year of successful operation of this hospital has passed. We have observed the orderly procedures of management and conduct that have been developing during the half-century of its existence. We have been impressed many times by the vast amount of labor and thought that are given to the routine duties of an institution having patients and employees to the number of approximately two thousand. And we have felt gratified by the constant efforts to relieve suffering, and to return to their homes all those whose ailments have not passed beyond the possibility of human aid. That these efforts have been recognized and approved by the community is the reward in which all share. P.D.30 3 No new buildings have bepn added this year, as in recent years, but it is our hope, ex­ pressed by us two years ago, "That another well considered plan will include an admis­ sion building, where all patients will be received, studied, treated, and then transferred to suitable departments: a home for !llale employees; a building for disturbed women patients ; and additional quarters for physicians." There is also need of new construc­ tion of the main building. Much of it was built about three quarters of a century ago; and it is now a fire hazard. One portion of it was vacated in 1932, when the chapel was removed to the new assembly building. Another portion formerly occupied by the con­ gregate dining room and kitchen, is now an open space since these departments are now located in the rear centre, which was fin ished in 1936. T hese and other needs of the hospital have been detailed by the superintendent in former years, and have been recom­ mended by the t rustees for the proper care of patients and employees. We ask for a well-balanced development of t he institution in the year upon which we are just entering. The unique event of the year occurred on the twenty-first of September, when a hurri­ cane tore through this part of t he country. People living here were unacquainted with such a phenomenon; but history records that a simi lar terror had struck New England more than a century before, on the twenty-third of September, 1815. The recent wind­ storm caused great damage to this institution: portions of the roof coverings were torn off; trees were uprooted; and some of the smaller, frame buildings were dislocated and demolished. Communicat ion by telephone and telegraph stopped here as elsewhere in New England, when poles were overthrown and wires were on the ground and broken. Millions of people resorted to candles and kerose ne lamps, as of a century ago, when the electric current was no longer passing through disconnected wires. Fallen trees blocked highways and railroads for hundreds of miles. The storm was so devastating that a de­ scription of its immediate fury and the damage done to this property, the disruption of service, and some of the problems that followed, will be omitted here but will be included in the report of t he Superintendent, Dr. Lang. Action this year without precedent was the unionization of employees in the State hospitals. When this step was contemplated, one requirement, insisted upon by the governor, was that there should be no strikes and interruption of service in the care of the sick and helpless in the institutions. The Westborough Continuous Bath Control has proved its superiority another year over other forms of temperature regulation since its perfection by Dr. Lang and its installation five years ago. No other treatment has proved so efficacious and beneficial in abnormal activity and sleeplessness. Another year of helpful service to our patients has been rendered by the two groups of specialists, the Consulting Board of Physicians and Surgeons, and the Visiting Staff. The Consulting Board was established by the trustees 43 years ago, in January, 1895. None of the ten original members continues to serve on this board, but Dr. John P. Sutherland was appointed to fill a vacancy the following year, in 1896; was reappointed for 5 years in February of this year and is now the senior member with 42 years of service. The other member of the Consulting Board, who was also reappointed for 5 years in February of this year, is Dr. DeWitt G. Wilcox, whose first appointment to this board was in 1923, following 3 years of helpfulness on the Vi siting Staff. Three other present members of the Consulting Board who have ser ved long and well, are Elmon R. Johnson, since 1915; Howard Moore, since February 1917; and Solomon C. Fuller, since March, 1920, who had been previously the pathologist of the hospital for 23 years, from July, 1897. The second group of 11 specialists, the Visiting Staff, was appointed by Dr. Lang and approved by the trustees, in September, 1920. Seven of them continue to give their skill and experience to the hospital after 18 years, although 3 of them have become mem­ bers of the Consulting Board in the intervening years. T he devotion of the members of these 2 boards of specialists is indicated by the number of operations and examinations they have made, as included in the report of the superintendent. We thank them one and all. When visit ing the wards recently, a male patient became of special interest. He ap­ peared to be well and strong physically, but it was reported t hat he had been controlled by a delusion and had been unwilling to eat in the normal manner. The result was that for 3 years he had been given food twice a day, through a nasal feeding tube, and the daily ration consisted of 8 eggs, 2 quarts of milk, 6 ounces of orange juice, 6 ounces of tomato juice, and one tablespoonful of sugar. An interesting fact was that he always claimed the tube after his meal, and then satisfied himself of its cleanliness by washing it himself. 4 P.D.30 In our annual report for 1934, some facts were included concerning the establishment of this hospital, on June 3,1884, a half-century before, with a review of some of the efforts of our predecessors, during that first year, to comply with the law. In our report for 1935, an account was given of the difficulties encountered by the trustees, during the year of 1885, in getting possession of the property, and starting the work of reconstruction for hospital purposes of the old buildings of the State Reform School. Then, in our report for 1936, we traced the progress made by the trustees of 1886, in remodelling and furnish­ ing the several departments of the institution, until the task was completed, on the 30th of November, and the governor had issued a proclamation opening this hospital for the reception of patients on the next day, the first of December, 1886. Some of the events and developments that have followed in later years will be restated now and thereby perpetuate certain facts that were known at the time but are generally unknown now, and other facts that were included in early reports, reports that have become scarce and practically unobtainable. The first patient admitted was a resident of Westborough. The day was the 6th of December, 1886. He had been retained for a few days, so that the officer, the patient, and the village should all have the honor of presenting, and of being, the first inmate, a resident of the home town. The interest of the fully organized institution of doctors, nurses, and other employees was concentrated upon him until the next day, when a car­ load of 41 women came from the \\Torcester State Hospital, and other transfers followed during the year until 204 of the chronic class of patients relieved the crowded wards of the other state hospitals. As the total number of admissions was 432, and as 204 of them were transferred from other institutions, the balance of 228 were direct admissions during the ten months of that first fiscal year, ending September 30, 1887; and 309 was the number remaining in the hospital on that date. Of the 228 direct admissions, 19 were not insane but were committed under a two-year old law entitled "An act concerning hospital treat­ ment for certain persons subject to dipsomania or habitual drunkenness." This provision for the care of victims of alcohol was a well-intentioned experiment, but the mingling of sane alcoholics with the insane was uncomfortable for the officers, the attendants, and both classes of patients. In that same report for 1887, the trustees state that the number of weeks of this abridged year was 42~; the daily average number of patients was 248r'ilf ; and the average weekly cost was $5.62. Also, that the legal rate for patients sup­ ported by the state, cities and towns was $3.25 per week. To those accustomed to the present methods of lighting and communication illumina­ tion by gas produced by the evaporation of gasolene, and the speaking tubes to the wards, indicate that the establishment of the hospital was at the time when electric lighting an<~ the telephone were undeveloped and unsatisfactory. As the General Electric Company has stated recently, only "a few 1,000 Mazda lamps were sold in 1888, and only a few houses were wired" in that year. The use of gas was unsatisfactory, as shown by the report of the trustees in 1889, when they declared it to be "dirty and dangerous" and the superintendent announced that "on two occasions already patients have been prevented with difficulty from setting fire to the building by putting their mattresses in the flame of the gas jets." With passing years, the trustees noted the improvement and economy of electric lighting, and requested its introduction into the hospital until, in 1895, their hopes for better illumination were satisfied. An effort to increase the knowledge of mental diseases, in 1888, the second year of hospital life, resulted in two clinics, when "The students of the graduating class of the Boston University School of Medicine visited the hospital once in the fall and again in the spring." Also in 1889, "About 30 students, most of them from the graduating class, visited the hospital on five different days during the fall months of last year. They be­ came familiar with all the ordinary manifestations of mental disease through the large number of cases presented to them, and are thereby better prepared for practice in the community. Their visits were also highly appreciated by the patients themselves, who took the opportunity for reciting their troubles and delusions to sympathetic strangers." From the beginning, those having the care of patients have been given much thought and sympathetic interest by the trustees and the superintendents. It was on the 9th of December, 1886, three days after the first patient was admitted, that the trustees "Voted: To substitute the word Nurse for the word Attendant whenever it occurs in the Rules and Regulations of the hospital now under consideration." In the report of the superintendent for the same year, that of 1887, he states that "nurses are required to adopt a uniform. Female nurses wear white caps and white aprons. The men wear brass P.D.30 5 buttons on the coat and vest, which bear the arms of the State; and blue flannel suits are preferred, but they are not obligatory." In the second year, that of 1888, two of the assistant physicians "spent many evenings with the nurses, explaining to them the rules and regulations of the hospital, and instructing them in their duties. We have not yet organized a training school for nurses, but a step in that direction has been taken." In 1889, the third year, the trustees urge that provision be made for CIa hall or room for the use of nurses and attendants when resting from their labors." At that time most of the nurses occupied rooms on the wards, as was customary in the architectural arrangement of institutions. The hours of duty were long and tiresome for them during the days and the hours of wakefulness continued into the nights, when they were disturbed by the sounds about them and still more when they were called upon to assist the night nurses in their duties. It was in the same year, in November that "a majority of the nurses became interested and formed a class for further study." In 1890, the fourth year, the trustees state:-"Much pains is taken by the superintendent in the careful training and instruction of the nurses, both male and female, regular class instruction being given weekly and text books provided for intermediate study.... At the close of the regular course certificates of efficiency will be given to the deserving." Also in this year, an un­ usual step was taken. "The student nurses have had the further advantage of private nursing outside of the hospital." Physicians of the neighborhood were invited to engage these nurses for their surgical and obstetric cases and to give them instruction in their duties. "In such cases, the pay has been greater than the usual hospital wages." "The change of work from the routine of the hospital to the dissimilar conditions of private nursing has proved to be a benefit to the nurses. The change itself has been a relief; and they have returned with a much pleasanter feeling toward the hospital, and with a stronger determination to do good work among their patients." In 1891 the trustees state:-"The condition of the hospital as to the care of patients and the efficiency of the corps of nurses appears to us to have steadily improved since its opening. Much in this direction is attributable to the efficient training of the nurses which has been established during the last two years, and which so far receives our commendation that the school is now considered a permanent feature of the hospital, and we concur with all that is claimed for it in the superintendent's report." In this year a further step forward was taken "when none were admitted to the nursing staff of the hospital who did not apply for admission to the school; and continuance in the hospital depended as much upon satis­ factory progress in their studies as upon proper work in the wards." On the 4th of November 1891 the first class, consisting of 3 men and 7 women was graduated and they were given diplomas and the distinguishing badge of the school. The annual report of that year contains this statement:-"A regular scale of wages has also been adopted. Female nurses receive $14 a month for the first 3 months: $16 a month for the next 3 months and $18 a month after the fi rst half year. Male nurses $20 a month; $22 and $25 at corresponding intervals. $1 a month is added after the first year for each additional year of service." During the intervening 47 years changes have made the nurses' life more attractive ... For instance, the salaries have been standardized by the Department of Administration and Finance for a ll institutions, and inexperienced female attendants begin their duties at $45 per month with an annual increase of $5 a month until $60 a month is reached. Graduate nurses receive $85 a month for the first year with an annual increase of $5 a month until the maximum of $100 a month is reached. With this showing of the difference in salaries of nurses that has taken place in the half-century it may be of interest to compare the salaries of physicians and nurses. In 1888, the graduate in medi­ cine, becoming an assistant physician or pathologist in this hospital received a salary of $30 a month in comparison with the $20 a month of the untrained male attendant; and the medical superintendent's salary then was $2,500 a year, in comparison with approxi­ mately the same salary now of the principal of the school of nursing. Another change for the better was made when the hours of duty were lessened by act of the legislature, effec­ tive on the 23rd of October, 1935 when "the hours of labor of ward attendants and ward nurses ... shall not exceed 48 in each week. But the greatest benefit was the home for female nurses, approved in 1933, to be four stories in height, providing single rooms for 135 persons, at a cost of more than $250,000. This building was erected in 1934: the interior was finished in 1935: furnished in 1936; and on the 13th of June, " jubilant nurses took possession of their beautiful home." In this building the female nurses are removed from the wards when off d uty, but there is protected communication with the main building through an underground passageway. The following is an abstract from the 6 P .D.30 minutes of the meeting of the trustees held on July 9th, 1936: "Mr. Dolan after an in­ formal introduction concerning the deep interest and the distinguished service which the institution has had from Dr. Paine, presented the following resolution: That the new building which has recently been completed for use as quarters for women employees, shall hereafter be known as 'Paine Hall,' in recognition of the services of Dr. N. Emmons Paine, who during the past 50 years has served as superintendent, member of the Con­ sulting Board and Chairman of the Board of Trustees. With Dr. Neary acting as tem~ porary chairman, the resolution was adopted." The course of study in the tni.ining School has been lengthened from 2 years to 3 years, of which time 1 year is spent in an affiliated general hospital; and the result has been that the graduates have shown a high rating in the examinations conducted by the Department of Mental Health, and by the State Board of Registration in Nursing. It was in their new home that the graduating nurses received their friends and guests, after the 48th annual graduation exercises of the school, on the 13th of October. The 7 recipients of diplomas had been addressed by Dr. Alex­ ander S. Begg, Dean of Boston University School of Medicine. The exercises were of special interest to Mr. Frank W. Forbes, of Westborough, who was present, and who was treasurer of the hospital when the first class was graduated in 1891, after their 2 years of study and experience. During the intervening years of the half-century, radical changes have taken place in the duties and responsibilities of trustees. Certain of their former duties are shown in their first report where the trustees state that:-"By the act approved June 3,1884, ... the trustees were required to submit to the governor and council plans for such altelations in the buildings as might be deemed necess<\ry to fit them 'for the residence of 325 pa­ tients, and of the physicians and other officers and attendants who shall care for such patients'; and upon the approval of such plans by the governor and council, the trustees were directed 'to proceed at once to rriake contracts with the lowest responsible bidders for the alteration and repair of the buildings aforesaid and for necessary additions thereto, to an amount not exceeding $150,000.' " The trustees prepare plans no longer for building operations and they make no contracts, although they have been required to approve perfected plans when presented to them. The trustees, in the earlier days, fixed the salaries of certain officers and approved or were acquainted with the wages of employees as determined by the superintendents; while the present standardization by the Depart­ ment of Administration and Finance of all positions and their several remunerations, in the state institutions has been a development of subsequent years. In recent years the trustees make no purchases, they pay no bills, and they are not acquainted with expendi­ tures. There are no more conferences as formerly at the state house or at the hospitals, between the trustees and the governor, the legislative committees, or the Department of Mental Health. It was customary 50 years ago, for the Secretary of the Commonwealth to notify the Board officially of appointments to its membership. The trustees' records show that '3uch notices were presented at their meetings on March 2 and on December 13, 1887, and on March 7, 1888. As the years have passed so have names. When reading the first report of the trustees, they state that this institution was established by the Legislature as the Westborough Insane Hospital; while their 25th report, that for the year of 1909, shows that the same authority had substituted the word State for Insane, and it became the Westborough State Hospital. Fifty years ago the words insane and hospital were regarded as modern and preferable to the older words lunatic and asylum, which had acquired an unpleasant connotation in the minds of people. Then too, that portion of the State government, known as the State Board of Lunacy and Charity, when this hospital was established, had existed for 5 years with that title since the 7th of June 1879 with a membership of 9 persons. This organization became the State Board of Insanity in September, 1898, with 5 members, at which time Col. Charles R. Codman be<;ame one of them, who had been a member of the first board of trustees of this hospital, and its chairman for 14 years until he resigned to become a member of the new State Board. Another change was made eighteen years later, on August 1, 1916, when the Massachusetts State Board of Insanity was abolished, and the Massachusetts Commission on Mental Diseases was established, with a "director and 4 associate members." By the recent action of the legislature, effective on the 7th of October, 1938, the last change has been made, when the "name of the department of mental diseases is hereby changed to the department of mental health," and "there shall be a commissioner of mental health who shall have the exclusive supervision and control of the department." P.D.30 7 Mr. Thomas F. Dolan, of Newton, was reappointed by Governor Hurley in May of this year, after 23 years of d~voted and valuable service, having been appointed a trustee in 1915, by Governor Walsh. Mrs. Sadie E. Casey of Milford was appointed a trustee on the 9th of March, to succeed Miss Flora L. Mason, who had been a trustee and secre­ tary of the Board since her appointment in 1916. In closing, we wish to express our appreciation of the efforts made to relieve the suf­ fering bodies and minds of all who have come for help to this household. The physicians have' studied and striven to apply such measures as would be most beneficial for each individual. The heads of the several departments have cooperated for the success of the whole. The devotion and labor of our employees in the making of emergency repairs at the time of the. hurricane deserve warm commendation, and we do not fail to recognize and to be thankful for the helping hands of hundreds of our patients in all parts of this great establishment. But above all, we have watched for nineteen years, the efforts the Superintendent, Dr. Lang, has made for the harmonious and profitable conduct of this institution; and we hope that his skill and increasing experience may continue to be devoted to the further successes of this one of the "cities of refuge" of this 'Common- wealth, . N. EMMONS PAINE, Chairman JOHN A. FRYE KATHRINE L. SULLIVAN, Secretary J OHN T. NEARY SEWALL C. BRACKETT SADIE E. CASEY THOMAS F. DOLAN Trustees. REPORT OF THE SUPERI NTENDENT To the Board of Trustees of the Westborough State Hospital: I a'm submitting the fifty-third annual report of the Superintendent of the Westborough State Hospital. The statistical tables which follow relate to the period' of 12 months ending September 30, 1938, but all other matters have reference to the fiscal year which terminated November 30, 1938. . MOVEMENT OF PATIENT POPULATION At'the end of t he statistical year there were in the hospital 682 male and 908 fe'male patie~ts, a total of 1,590. There were on' parole or otherwise absent but still u nd~r com­ mitment 282 patients, making a total of 1,872 persons in the care of the hospital on that date. The daily average number of patients actually in the hospital during the statistical year was 1,521.77 and for the fiscal year 1,543.40. Admissions. - There were 597 new admissions of whi¢h 401 were first admissions, 170 readmissions, and 26 transfers from other mental hospitals. Discharges. - There were discharged from the hosp{tal d uring the year 495 patients. Of these 125 were considered recovered, 95 improved, 21 ' unimproved and 47 without psychosis. Fift'y-eight Were transferred to other mental hospitals and 149 died. MAI NTENANCE T he total expenditure for maintenance'was $675,482.95. This was $9,064.39 less t han the sum used for the same purpose during the previous year. The weekly per capita cost was $8.4164. Income from all sources was $1 15,456.26 or $1.4385 per capi'ta per week . . The net' weekly per capita cost was $6.9779. The table which follows shows an analysis of the 'weekly 'per capita cost for the cUrrent year and a comparison with similar costs' for several preceding years. It will be noted t hat the cost for personal services which includes all salaries and wages has been mounting steadily and now amounts to 58.35 per cent of the total expenditure.

WEEKLY PER CAPITA COST . , " 1933 1934 1935 1936 193'7 1938 Personal services . . . $3.5824 $3.4702 I $4.0796 S4.7476 $4 . 8455 $4.9113 Travel. transportation and office .0729 .0779 ,0820 .0757 .UB61 :8090 Food .8381 ,9973 I 1.2114 1. 3517 1 .4765 1. 3496 , Religious I~st r uctio~ .0179 .0173 .0193 ,0188 .0196 ,0180 Clothing and materials .1486 . 1907 ,2208 .21 13 ,2362 .2230 Furnishings and househoid su'ppli~s .2407 ,2821 .2996 .2794 .3480 .2914 Medical and general care .1071 .1393 .1551 .1694 . 1590 .. 1779 Heat and other Plant ope r ati~n .5009 ,5198 ,77'39 .6861 .7913 .6194 Farm. .2222 .. 2668 · .2954 ,3141 .3646 .2857 Garage and gro~nd" ,0597 .0757 .0917 ,0626 .0813 .1028 Repairs ordinary . ,1485 .1553 .1675 : 1514 . 1689 , 1462 Repalrs and renewals .0657' ,0598 .1708 . 1466 .1522 ,2094 $5.9507 S6,25n $7 .5671 $8,2147 $8.7292 I $8.4164 8 P.O. 30 SPECIAL ApPROPRIA TlONS Expenditures for Special Appropriations amounted to $34,590.50. This sum was spent for the following purposes: Development of Rear Center. $ 650 . 16 Renovation of Richmond San- Nurses Home 154 .50 itarium . $4,626.57 Resurfacing sewer beds 5,293 . 23 Completion of Garage 1,561 . 72 Painting Main Group 3,570.00 Refrigerator boxes and com- pressors 7,501 . 11 Hurricane and flood damage. 11,233 . 21 REPAIRS AND RENEWALS The following is a list of the Repairs and Renewals with the expenditure for each indicated: Rearrange plumbing, Male Wd. 1A $178.16 Tile showers, Cod man 200.61 Tile work, Male Wards 93 .59 Renewing of fire mains, Main Group 338.08 Showers, Farm Dormitory 88.78 Re-wiring Male Ward 3 236.81 Emergency air compressor 162.50 Replacement plumbing, Home 1 1,224 .31 Heating equipment, Greenhouse 759.08 Bakery equipment 2,545 . 06 Vacuum breakers and flush valves. 341. 04 Replace slop sinks, Main Building. 319.87 Electric ref rigera tors 370.56 Gas equipment, Dietetic Laboratory 102.30 Pressure equalizing valves 308.38 Non-return valves, Power House 264 .60 Scales . 312.24 Recording thermometers for Butcher Shop 162.50 Repairs to triplex pump 879.95 Lathing and plastering, Home 1 2,198.00 Sewage pump, Power House 729.20 Circulating pump, Laundry 146.74 Trusses and ceiling, Male Ward 3 2,912 . 16 Laundry machinery, 48" x 84" washer 1,929.45 SPECIAL ApPROPRIATIONS REQUESTED FOR 1939 Special Appropriations have been requested of the 1939 Legislature for the following purposes: A new boiler house for heating buildings at Richmond Colony; an Admission Building for 110 male and 110 female patients, with quarters for 14 sick employees; a building for disturbed women patients; 3 cottages for officers; a new dairy barn unit; a hay barn; horse barn and wagon shed unit; remodeling of storeroom building; painting of the exterior of 13 wooden buildings, and a sum for fire protection to be used for addi­ tional water mains and hydrants, a sprinkler system and fireproof stair towers for Dewson Building, Richmond Colony, Codman, Childs and Talbot Buildings, female wards 2 and 4 and male wards 1 and 3. MEDICAL SERVICE The Medical Service of the hospital has differed little from previous years with the exception that the use of metrazol has been introduced, but its real value has not yet been determined. Some patients have given evidence of marked improvement following its administration, others have shown moderate improvement, and in others no apparent change in the mental condition has been noted. The use of photodyne in depressed cases, of antigen H, of typhoid vaccine for the production of artificial fever in cases of general paralysis and theelin in treatment of involution melancholia has been conducted with encouraging results in some cases, but no effect whatever in others. As heretofore all new patients when admitted are cared for in bed for a period of at least a week during which time intensive study is made, which includes careful physical, neurological, laboratory and psychiatric examinations. Treatment is promptly instituted to correct any abnormal physical conditions. Hydrotherapy, particularly continuous baths, wet sheet packs and colonic irrigations, is used extensively. Our study of tuberculosis has continued under the direction of Dr. M. Gene Black of our Visiting Staff. P.D.30 9

CONSULTING SERVICE Our Consulting Service has been very active. Members of the Consulting Board and Visiting Staff have responded promptly and cheerfully to all of our calls for service. They performed 50 operations, and made 944 special examinations. The above figures do not include the work of the Podiatrist who has visited the hospital weekl y and has treat ed hundreds.of patients, much to their satisfaction and comfort.

L ABORATORY S ERVICE Dr. Lydia B. Pierce has continued in charge of our Laboratory and X-Ray Department and has given supervision to the Physiothera py service. Her report follows. The number of clinical tests performed in the labora tory during the past year was 9,543. These included spinal fluid examinations and many urinalyses and blood counts. Schil­ ling indices were estimated when these were indicated, and there were sedimentation rates and hematocrit determinations in selected cases when these procedures were of diagnostic value. Blood chemistry tests included determinations of blood sugar, non­ protein nitrogen, urea, potassium, calcium a nd cholesterol. Bacteriological work con­ sisted , for t he most part, of throat cultures, cultures from infections a nd blood cultures. There has been no occasion for bacteriological examination of stools, as the hospital has been free from gastro-intestinal infections. E xaminations of faeces a nd sputa have been made. A very few reticulocyte counts were done early in the year. A number of tissue specimens were cut and stained . These were from material obtained at the autopsies, and all specimens obtained from operative cases were sectioned and diagnosed. Frozen sections were made when they were required . Animal inoculations were made under the direction of the consulting urologist for diagnosis of renal tuberculosis. There were 33 a utopsies performed a nd some of these were of unusual interest. At 10 day intervals throughout the year samples of milk from the hospital dairy were cultured a nd bacterial counts were made. There was also a monthly estimate of butter fat from each cow and from a mixed sample representing the herd. Teaching of the student nurses in the Training School included 44 hours in chemistry, 22 of which were lectures and 22 were laboratory sessions. There were also 26 hours in pathology, 4 hours of lectures in urinalysis, a nd 2 hours of lectures about the X-Ray. Instruction was also given at t he autopsies which students are required to attend. These classes were conducted by the Pathologist. There was also a total of 10 hours for each student in urina lysis, which was conducted by the la boratory technician; each nurse being given individual attention and an opportunity to gain experience in making the routine chemical tests. Late in the year a study of the chemistry of the blood in patients who are receiving treatments with metrazol was begun. The treatments, under the direction of Dr. Hadley, a re conducted in series, a definite number of convulsions being induced in each series, at intervals of from 1 to 3 days. The blood study was begun by this department, and specimens are collected from the basilic vein, one immediately before the metrazol is given, a second, immediately after the patient has recovered from the convulsion, and a third four hours later. This is done several times during the series of 20 convulsions. The blood is tested for sugar, non-protein nitrogen, cholesterol, calcium and potassium. Leucocyte and differential leucocyte counts and Schilling indices are estimated. The greatest change observed has been in blood sugar, which in each instance is much in­ creased immediately after the convulsive seizure, a nd returns to normal before the end of the four hour interval. There is no cha nge in non-protein-nitrogen or in calcium. Potassium figures a re low in some instances, but so far the results a re not consistent. Cholesterol, in some cases is lower in the last specimen. The following is a complete list of t he tests performed during the year : Animal inocu­ lations, 7; a utopsies, 33; Babcock milk tests, 610; basal metabolism tests, 10; blood chemistry: calcium, 12; cholesterol, 12; non-protein nitrogen, 23; potassium, 12; sugar, 458; urea, 3; uric acid, 3; Blood counts: erythrocyte, 335; leucocyte, 858; haemaglobin, 810; differential counts, 495; Schilling indices, 78; reticulocyte counts, 3; blood sedimen­ tation rates, 61; bloods typed for transfusions, 11 ; bacterial cultures, 277; bacterial counts, milk, 50; bacterial smears examined, 317; faeces examined, 8; gastric a nalyses, 1; Hinton tests, 11; hydrogen-ion concentration, 3; icteric indices, 3 ; renal function, 3; spinal flu id examinations, including all counts, albumin and globulin contents and gold sol. 30; tissue sections, mounted, 239; frozen sections, 23; urinalyses, 4,682; Van den Bergh test, 1. 10 P.O. 30 PHYSIOTHERAPY AND X-RAY In the physiotherapy department there were 2,742 treatments given during the year. The following is a complete list of these: ultra-violet, 363; infra-red, 1,162; massage, 666; Morse wave, 523; diathermy, 15; autocondensation, 13; coagulations, 2. The n umber of patients and employees treated was 175; of these 125 were women and 60 were men. In the X-Ray department there were 727 roentgenograms taken. Of these 531 were for patients in the hospital, 192 for employees, and 4 for the Lyman School. There were 236 radiographs of chests for diagnosis of heart or lung pathology. The above figures include the usual number of films taken for diagnosis of fractures of the extremities, hips, spines and skulls. There were 16 mastoid films, 22 of nasal bones or frontal and acces­ sory sinuses, 65 dental films, and 12 of the lower jaw. There were a number of gastro­ intestinal series, barium enemata, Graham tests and pyelograms. There were 832 fluoroscopic examinations made, - 337 of these were by Dr. Black, 302 by Dr. Pierce, and 193 by Dr. Fiedler. DENTAL SERVICE As heretofore the Dental Department personnel consists of the Dentist and a Dental Assistant. They made 3,936 examinations, cleaned and scaled 1,256 cases, extracted 269 teeth, did 901 fillings, filed 65 teeth, treated gums in 1,153 cases, and gave oil of clove treatment in 140. Bridgework was removed and cleaned in 3 cases and set and fitted in 2. Crowns were set or re-set in 9 cases. Plates: impression, bite and shade, 43; fitted and filed, 132; repaired and re-set, 29; 429 plates were cleaned; 18 X-Rays were taken. EXTRAMURAL SERVICE Dr. Betsy Coffin has conducted this service in a very able manner. Her report follows. This department has continued on the lines already established. The following statistics do not speak for what values are served nor for the standards and goal of the work, but are given for what they may convey to various readers. They include a glimpse into the dimensions of the task and the problems involved in the hospital's attempt to act as counsellor and backer of those who leave its doors to try again to fill a productive place in life or to adjust as best they can in the role of one who cannot join those ranks. T. M. F. Case total of indefinite visit patients 422 189 233 Total of patient interviews. 1,297 499 798 Case total of others 49 14 35 Total interviews with others 104 35 69 Total discharged patients . 26 10 16 Total discharge patient interviews 69 24 45 Relatives total number 171 64 107 Relatives total interviews . 388 168 220 School clinics have been carried on as before: 157 children - 50 girls, 107 boys were examined. The routine findings and recommendations were given as required; but in addition to these a separate summary with explanations, remarks and suggestions was written in the case of each child for the use of the superintendent of schools and the par­ ticular teacher or teachers having to do with that child. The scope of helpfulness here is necessarily limited but the short summary has been appreciated and somewhat helpful. Juvenile Court cases are examined from time to time. 12 cases, 7 boys and five girls have been examined this year. Suggestions as to the disposal of the case are made to the courts who desire them and most of them do. An authoritative attitude or recommenda­ tion is avoided due to the short period of study and observation allowed both to social service worker and to psychological and psychiatric observers. The court is often much better acquainted with situation and child than they are, except for the strictly technical findings in regard to mental status. Only a limited number of children have been studied and treated in the outpatient clinics at Framingham and Westborough. There have been a few cases which were urgent and which could not be put into the hands of psychiatrists in clinics somewhat too distant for these particular cases. A trend noted last year has been even more active this year. Reference is made to the return of discharged patients for counsel and for psychotherapy as well as for renewal of friendly contact. One discharged patient brings her sister because she and the family are acquainted and feel at home in this clinic. P.D.30 11 Another discharged patient still in need of psychotherapy continues to come though discharged a few months ago. Still another dropped in after a year to tell of his progress. It is true that those who are ready for planned, regular psychotherapeutic interviews are few; and that still fewer are those who can be thus served. Infrequency of opportunity for interviews with the exception of Boston and Westborough Clinics is the greatest reason and in addition to this factor, there is the limitation of time. The other inter­ views consume of course the most of the physician's time. However, there is being built up a foundation for a future organization which can provide for more intensive treatment as the demand for it grows, year by year, among the patients released for an indefinite period; also among those who have been discharged at the end of their visit year and are financially unable to procure such services elsewhere.

FRAMINGHAM CLINIC - 3S SESSIONS Total Male Female 1. Total of patients on indefinite visit (male and female) during statistical year. 53 18 35 2. Total of indefinite visit patients who have attended an outpatient clinic dur· ing statistical year . . . 38 14 24 3. Number of new indefinite visit cases ...... 24 15 9 4. Number of discharged patients attending an outpatient clinic. 1 1 0 5. Number of new discharged patients . . . . 0 o 0 6. Number of other patients attending a n outpatient clinic 11 3 8 7. Number of new other patients . . . . . 2 o 2 8. Number of relatives interviewed at an outpatient clinic 35 11 24 9. Number of new relatives interviewed . . 9 4 5 10. Number of indefinite visit patient interviews 153 66 87 11. Number of discharged patient interviews 6 6 0 12 . Number of all other patient interviews 52 25 28 13. Total patient interviews 211 96 115 14. Total relative interviews 53 23 30

LOWELL CLINIC - 12 SESSIONS 1. Total of patients on indefinite visit (male and female) during statistical year. 5D 19 31 2. Total of indefinite visit patients who have attended an outpatient clinic during statistical year . . . . 35 15 20 3. N umber of new indefinite visit cases ...... 19 7 12 4. Number of discharged patients attending an outpatient clinic. 5 3 2 5. Number of new discharged patients . . . . 3 2 1 6. Number of other patients attending an outpatient clinic 5 5 o 7. Number of new other patients . . . . . 1 1 o 8. Number of relatives interviewed at an outpatient clinic 16 8 8 9. Number of new relatives interviewed. . 11 7 4 10. Number of indefinite visit patient interviews 103 28 75 11. Number of discharged patient interviews 13 10 3 12. Number of all other patient interviews 2 2 o 13. Total patient interviews 11 8 40 78 14. Total relative interviews 55 27 28

HOSPITAL CLINIC - 10 SESSIONS 1. Total of patients on indefinite visi t (male and female) during the statistical year...... 104 50 54 2. Total of indefinite visit patients who have attended an outpatient clinic during the statistical year. . . . 80 39 41 3. Number of new indefinite visit cases ...... 35 15 20 4. Number of discharged patients attending an outpatient clinic. 1 o 1 5. Number of new discharged patients . . . . 0 o o 6. Number of other patients attending an outpatient clinic 2 1 1 7. Number of new other patients . . . . . 1 1 o 8. Number of relatives interviewed at an outpatient clinic 27 14 13 9. Number of new relatives interviewed . . 13 5 8 10: Number of indefinite visit patient interviews 139 60 79 11. Number of discharged patient interviews 2 o 2 12. Number of all other patient interviews 2 1 1 13. Total patient interviews 143 61 82 14. Total relative interviews 65 26 39

WALTH."M CLINIC - 34 SESSIONS 1. Total of patients on indefinite visit (male and female) during the statistical year ...... 102 40 62 2. Total of indefinite visit patients who have attended an outpatient clinic during the statistical year. . . . 78 34 44 3. Number of new indefinite visit cases ...... 34 12 22 4. Number of discharged patients attending an outpatient clinic. 1 1 o 5. N umber of new discharged patients . . 1 1 o 6. Number of other patients attending an outpatient clinic 3 1 2 7. Number of new other patients . . . . . 2 o 2 8. Number of relatives interviewed at an outpatient clinic 35 12 23 9. Number of new relatives interviewed. . 18 7 11 10. Number of indefinite visit patient interviews 215 97 118 11. Number of discharged patient interviews 1 1 o 12. N umber of all other patient interviews 8 2 6 13. Total patient interviews 224 100 124 14. Total relative interviews 68 35 33 12 P.D.30

BOSTON CLIN IC - 95 SESSIONS Total Male Female 1. Total of patients on indefinite visit (male and female) during the statistical year ...... 229 104 125 2. Total of indefinite visit patients who have attended an outpatient clinic during the statistical year ...... 191 87 104 3. Number of new indefinite visit cases . . . . . 66 27 39 4. Number of discharged patients attending an outpatient clinic 17 4 13 5. Number of new discharged patients . . . . . 7 3 4 6. Number of other patients attending an outpatient clinic 28 4 24 7. Number of new other patients . . . . . 13 3 10 8. N umber of relatives interviewed at an outpatient clinic 58 19 39 9. Number of new relatives interviewed . . . . 29 9 20 10. Number of indefinite visit patient interviews 514 189 .325 11. Number of discharged patient interviews 47 7 40 12. Number of all other patient interviews 40 6 34 13. Total patient interviews . 601 202 399 14. Total relative interviews . 147 57 90

T OTAL OF ALL CLINICS 1. Total of patients on indefinite visit (male a nd female) during the statistical year ...... 538 23 1 307 2. Total of indefinite visit patients who have attended an outpatient clinic during the statistical year . . . . 422 189 233 3. N umber of new indefinite v isit cases ...... 178 76 102 4. N umber of discharged patients attending an outpatient clinic. 26 10 16 5. Number of new discharged patients . . . . 11 6 5 6. Number of other patients attending an outpatient clinic 49 14 35 7. N u mber of new other patients . . . . . 19 5 14 8. Number of relatives interviewed at an outpatient clinic 171 64 107 9. Number of new relatives interviewed . . 80 32 48 10. Number of indefinite visit patient interviews . 1.124 440 684 It. Number of discharged patient interviews 69 24 45 12. Number of all other patient interviews . 104 35 69 13. Total patient interviews . 1,297 499 798 14. T otal relative interviews 388 168 220

SCHEDU L E OF OUTPATIENT CLINICS Boston Clinic Massachusetts Memorial H ospitals, 82 East Concord Street Tuesday 9 A.M.-2 P.M. and 4- 5 P .M. by appointment. 2-4 P.M. without appoint­ ment. \Vednesday, 9- 12 is reserved for Massachusetts Memorial Hospitals cases only. Wednesday, 1- 5 P.M. by appointment. (W. S. H . cases.) Framingham Clinic Board of Public H ealth Rooms. Memorial Building. Third Monday of month, 6:30 P.M. Framingham U nion H ospital. 1-5 P .M . M onday. by appointment. Hospital Clinic Westborough State Hospital . First Sunday of month, 3- 5 P .M. 9 A.M. to 3 P .M . by appointment only . L owell Clinic St. J ohn's H ospital, 14 Bartlett Street First M onday of Montb at 6:30 P .M. Afternoon by appointment. Waltham Clinic Board of Public Welfare Rooms, City H all F irst Wednesday and Second and Fourth Monday at 6:30 P .M. SOCIAL SERVICE D EPARTMENT The Social Service Department has been under the direction of Mrs. Eda W. Ander­ son, Head Social Worker. She has for her assistants a Social Worker and an Assistant Social Worker. Her report follows. This year ends the second full year during which all histories, those taken in the hospital as well as outside of it, have been compiled by this department. The total for the past year, 454, showed an increase of 62 over the number secured during the preced­ ing year. It was anticipated that as time went on a larger percentage of histories would be taken in the hospital, thus leaving more time available for investigation and other services leading to placement of patients who were sufficiently improved to leave the hospital. A considerable amount of effort was devoted to perfecting the system whereby rela­ tives and friends would be interviewed at the hospital and in as short a time as possible after the arrival of each new patient. To an encouraging degree this has been accom­ plished. However, comparison of the percentage of histories taken this past year in the hospital, shows the figure to be slightly below that of the year before, 69% as compared with 71 % in 1936-7. However, it is recalled that the hurricane of 1938 and t he severe winter weathe'r of 1937-8 prevented many visits by outsiders to the hospital over a period of several weeks. This might very logically account for the lower fig ure for this past year. P.D.30 13 Our tabulations of time spent and services accomplished during the year, in investiga­ tions, placement and miscellaneous services to patients show an increase over the previ­ ous year. As we review the list of problems dealt with, feeling that our accomplishment is an improvement over the preceding year, it is not out of order to regard as successful those efforts to plan our time so as to give more of it to these types of referrals while still fulfilling our obligations in regard to the routine history taking. Comparison of the services rendered during the past year, with that of the previous year indicates that the total number of patients placed or adjusted to environmental or employment relation­ ships this year has increased 68 %, the number of reports as to condition of patients in the community showing a n increase of 110%, over the same types of service performed the preceding year. To balance this increased activity, however, services in the School Clinic and in supervision of family care patients has decreased somewhat since the preceding year. This year we have in our table separated the referrals for placement (28 such cases) from the investigation classification covering such referrals last year, because it appears and greatly to our satisfaction so, that the number thus referred will become a substantial figure in time. The referra ls which come to this department are in type almost as varied as there a re numbers of cases referred. We will not refer here to investigations called for by the medica l staff in order to add to its understanding of what is wrong with its patients, contributions to history in other words. Such investigations may require, it is true, pa instaking search for help from various sources in the community and may con­ sume much of the worker's time. But we do want to enumerate a few of the types of investigation which perhaps starting out in a small way, gather momentum a nd lead to the accumulation of a great deal of entirely fresh information, much of it of value in formulating and carrying out plans for the restoring of patients to active useful lives. Not a ll persons referred to our department continue on as our responsibility after a plan, based on a more or less thorough investigation, has been started . It should be made clear that the majority of t hose patients whom the social service department has attempted to help to a greater or less degree toward a return to community life, become the responsibility of the outpatient physicia n, reporting at regular interva ls at clinic. The opportunity thus offered to the patient to benefit by the services of a psychiatrist over a period of months after leaving the hospital is a factor of the fi rst importance in looking toward restoration to health for the patient. The services of the social worker a re not required excepting in such cases as wo uld not benefit by clinic attendance or are for some reason incapable of attending the clinic. In referring a patient for placement the hospital physician must feel that there is a possibility that despite the care a nd treatment given in the hospital with the apparent recovery of the patient, t here is a n element of doubt as to whether t he improvement is definitely present. One of the functions of the social service department therefore is to prepare a so-called experimental field in which the patient may demonstrate that he has benefited by the services of the hospital. Such environment should provide a practical and a safe opportunity to adjust to out-of-the-hospita l conditions. For the social worker and for the hospital too, this experimental fie ld should be a carefully selected one, well scrutinized from all sides to bring out any factors which would make it unsuited fo r the particular need we have for our patient. The arrangement of the field should be altered repeatedly to correspond with the need of t he individual case. We should be quite as enthusiastic in our approach to those placement problems which offer the least apparent likelihood of success as to the so-called more promising referrals, since the value of repeated attempts in behalf of the patient may produce a much more comprehensive picture of the problems a nd present new ways to utilize resources tried out less success­ fully in earlier practice. T hus the socia l worker has the opportunity to present a fresh point of view to old problems, often dropped because the well known but perhaps some­ what worn out sources of help have fai led. In this connection the young girl who has been given two or more earlier placements and has not too successfull y come through a nyone of them, did reveal in these earlier, a nd we now feel experimental placements, those favorable qualities which may event ually become dominant a nd lead to another a nd more successful placement in the future. Her way is now being cleared for the fresh experiment and t he worker has renewed confidence, based on her experience with the failures in this girl's former experience to select the setting which shall be satisfying to everyone concerned. 14 P.O. 30 The hospital social worker with her knowledge of the resources of the community, its health and its social agencies may be of great assistance to the individual who has left the hospital behind him and in time faces the handicaps of poverty, unemployment, sickness and not least of all the need for encouragement. This set of problems, dealt with ef­ fectively during the past year by our department is duplicated in some respect or other by numerous patients living in the community. One other illustration taken from the work during the past year will serve as an ex­ ample of the character and variety of problems which are referred. In this particular case what started out as a comparatively simple investigation developed into a placement problem having many interesting angles offering opportunity for various types of service. We were asked to look up the relatives of a patient to learn of their attitudes toward our patient and perhaps secure their cooperation in regard to her release on trial visit. Our patient had several children all but one wards of the State and our initial contact with her came as a result of her desire to know about her children. When her husband died a few years earlier an Employers' liability allotment was made to her and to her children. Our patient had but a clouded, impractical grasp on her financial circumstances. As the investigation proceeded the relatives were found to be unwilling to assume any responsibility for our patient's future. We found her income to be sufficient to cover her living expenses for several years to come, located a reliable and understanding person of her own race who agreed to take her into her home and later arranged to provide her with suitable employment at fairly good wages. Inasmuch as the outpatient physician advised community supervision by the social worker rather than clinic attendance, this responsibility was assumed. The children were all located and with the permission of the State Department caring for some of them, the patient, after the worker had once taken her to see them in their foster homes, regularly repeated these visits, properly accompanied. The patient has a little furniture stored away which was returned to her. She saved her money. The trial year passed and the social worker thereafter saw but little of the patient. What happened to return the patient to the hospital some few months after her final discharge from it, may perhaps have been inevitable. However, one ventures to express regret that another year of standing by on the part of the worker, might not have been possible. In this instance the collapse of a definite progr.am planned by the social worker with the cooperation of community resources, left the patient with­ out any props whatever. Her mental symptoms shortly returned to the end that she is now back in the hospital. We have given but three examples out of the many, of persons referred to our depart­ ment, our service varying from that of freshly outfitting a girl from top to toe and speeding her on her way to her relatives, to the carefully worked out plan to secure both employment and a home for a man who has neither. That the plan failed completely in a few weeks and the man returned to the hospital after trying his wings in a later plan of his own, does not indicate that neither plan should have been tried. During the year 15 lectures each, in sociology and social work were given the Senior nurses besides one lecture to a similar group in the Framingham Union Hospital. Miss Dorothy F. Smith who came to the department on June 13, 1932, resigned on April 30, to take a course in social work in Chicago. Miss Annie M. Heal came to us from the Social Service Department of the Taunton State Hospital on May 23. With sincere regret we parted from Miss Smith. We were fortunate, however, in securing Miss Heal's services. In closing we hope that our skill will increase with added experience and more under­ standing. Neither can be developed without failure in greater proportion than our success. To serve the hospital well is our goal.

SOCIAL SERVICE STATISTICS YEAR ENDING NOVEMBER 30, 1938 Male Female Total Cases remaining December 1, 1937 28 26 54 New cases referred during year 228 237 465 Cases renewed from previous years 30 50 80 Cases renewed within the year 18 46 64 Total number of patients dealt with during year 303 359 662 Cases closed during year 291 323 614 Cases remaining Nov. 30, 1937 13 36 49 P.D.30 15 A nalysis of year's work: 1. Purposes for which cases were referred: Histories 449 Investigation 75 Placement (separated this year from miscellaneous) 28 Supervision 24 Miscellaneous services . 38 2. Outstanding problems in cases referred: Disease, mental 535 Disease, physical 35 Environmental 44 Personality . 102 Miscellaneous problems 10 3. Services rendered: A. Histories, total number taken 454 Taken in the hospital 313 On patients regularly committed (inc. vol.) 148 On patients admitted for observation or temporary care 162 On patients Juvenile Court or Child Guidance Cases 3 Histories taken in community 92 On patients regularly committed . 42 On patients admitted for observation or temporary care 44 On Juvenile Court or Child Guidance Cases 6 Histories taken both in the hospital and the Community 49 On patients regularly committed . 17 On patients admitted for observation or temporary care 31 On Juvenile Court or Child Guidance Cases 1 B. Investigation of home conditions prior to visit 24 C. Investigation of condition of outpatients 44 D. Arrangements for medical assistance 1 E. Adjustment of patients, to: Environmental and personal relationships 33 Employment 14 F . Advice given to: Patients 21 Relatives or others 26 G. Connecting patients with other social agencies 13 H. Assistance to families of patients 1 I. Personal services . 21 J . Psychometric Examinations 8 K. No service rendered 3 Visits made by workers: To patients in hospital 214 To patients on visit 160 To relatives or friends 501 To social agencies 443 To others 413 Family Care: Number in family care during year 38 Number of visits to patients in family care 225 Social Clinic Services: Histories taken 65 Psychological tests (by social worker) 4 TRAINING SCHOOL FOR NURSES The Training School for Nurses has been under the direction of Mrs. Elisabeth C. Daniel, R.N., Principal of the School of Nursing. We have continued to meet the con­ stantly advancing requirements and standards recommended by the Board of Registra­ tion in Nursing, which are necessary for the recognition of a School of Nursing whose graduates are eligible to take the State examination for Registered Nurses. This course 16 P.D.30 covers a priod of 3 years, one year of which is spent in affiliation at the Boston City H ospital where the students receive extensive training in surgical, pediatric a nd ob­ stetrical nursing. Mrs. Daniel a nd her assistants have also given a 75 hour course of instruction to at­ tendants. The Graduation exercises were held in the Assembly Ha ll on October 13, 1938, a nd were followed by a reception and tea at Paine Hall. Diplomas were awarded to Ma rtha A. Davis, Alta C. J ones, Phyllis C. Salmon, Marie H . Short, Ma rgaret R. Stevens, Eileen E. Wallace, and Juliet A. Yoksas. The Alumnae prize of $10 was awarded to Martha A. Davis, with honorable mention to Phyll is C. Salmon.

O CCUPATIONAL THERAPY DEPA RTMENT This department has continued to give valuable assistance in the treatment of our mental patients. Classes conducted in Childs a nd Codman Buildings where new patients are admitted have given an opportunity for the early use of this therapy in the treatment of new comers. Classes have also been held at our Colonies, where continued treatment cases are cared for. The Occupational Therapy Room in the Main Building dra ws patients both from the Main Group and from the admission service. During the sum­ mer patients from this department have assisted in garden work and in the canning of fruits and vegetables. The furniture, broom a nd mattress shop and the shoe repair shop have occupied the time of a number of patients to their advantage and to that of the Institution. A very large number of pieces of furniture have been repaired a nd refinished. All the brooms and practically all of the mattresses used in the hospital have been made, a nd a large number of shoes repaired.

ENGINEERrNG DEPARTMENT Mr. Timothy F. Kiely has conducted this department with his usual hi gh degree of skill and efficiency. Coal consumption for the year was 5,918 tons, which was 30 tons less than the preceding year. Electric current generated was 631,110 K.W. hrs. Cur­ rent purchased for kitchen purposes 322,730 K.W. hrs. and for general purposes 120,980 KW. hrs., ma king a total of 1,074,820 KW. hrs. This was a n increase of 13,030 KW. hrs. over the previous year. In addition to the routine operating procedures the per­ sonnel of this department renewed the heating mains in the basement of female wa rd 7, installed a new heating boiler at the greenhouse, installed 500 feet of 4 inch and 300 feet of 3 inch fire main in the basement of the Main Group; a new 4 inch sewage pump at the power house; a l Yz inch circulating pump in the laundry, a cascade washer iJl the laun­ dry, new copper hips and ven,tilator hoods on West Wing; barber shop equipment in Codman Building; personal hygiene equipment ; plumbing in treatment room at Cod man ; floor drains and sink connections in the basement of Rear Center ; transformers, pump and motors in the irrigation pumping station wired, and new refrigeration in Rear Center and service building, and wall drain in the La undry. They also overhauled the Gould Triplex Pump at the Metropolitan Pumping Station, renewed the fire wall coping on roofs of male a nd female wards, renewed the metal troughs at the piggery, relocated and lined hot wa ter storage tank at Codman, reloca ted Bakery equipment, rewired male ward 3 a nd Richmond Sanitarium, extended the fire alarm system to Childs Building and female ward 3 and reconstructed the pole lines at the Colonies following the hurri­ cane.

FARM R EPORT As for many years past, Mr. Raymond L. Whitney has had charge of the farm and grounds. His report follows. Due to circumstances beyond our control, the 1938 season was somewhat of a disap­ pointment. Had it not been for some extra help secured for the summer, the very wet season would have been more disastrous. Weeds were hard to control, and many items were rotted out and had to be reseeded. At t imes large sections of so me fields were under water. We have been unable to work on some fields for the past three years be­ cause of moisture conditions being excessive. The hay crop was very large. Considerable of it had to be stored in stacks outside the buildings; 120 tons were disposed of to other institutions. Ensilage corn also yielded well, and there was ample for feed through the year. The garden yield was somewhat disappointing. Milk production was about as usual, while pork production was cur" tailed on advice of the Department. P.D.30 17 T he hurricane damaged crops that were not harvested a nd made considerable extra work for the farm . Production for t he year included (in pounds) milk 726,785, beef 3,554, pork 65 ,478, ensilage 712 ,520, garden vegetables 365,506, hay 625,645, oat hay 18,670, green hay for green feed 376,240, green rye 15,765, millet 49,960, oats a nd peas 127,785, rowen 115,600, a pples 125,255, pears 500, stra wberries 4,800. G ROUNDS T he Grounds were given the usual attent ion during t he summer, a nd to September 21 were a source of prid e. T he hurricane on that date changed the whole a ppearance of the place. Large nUlTIbers of trees a nd shrubs were either uprooted or laid down, a nd as one looked about it seemed t hat utter destruction had ta ken place. Fa miliar la nd­ marks have disappeared, new vistas are open a nd the whole landscape is different. Where possible t he trees have been cut into logs. M uch of the debris has been removed, roads a nd other da mage repaired . Considerable work was done by a contractor in t he wooded sections in removing the fi re hazard that existed on account of the hurricane. There is still a great deal of work t o be done in t he wooded sections, and there will be considera ble timber to be sawed into lumber. T he greenhouse a nd outdoor gardens have produced a bount iful supply of plants a nd blooms, which has been a source of joy a nd added ha ppiness to the patients a nd vi s i to r ~ . With the expenditure of a reasonable a mount of money for a few years most of the unsightly places will be obscured, a nd the grounds will present a good appeara nce. ENTERTAINMENT T he entertainment program of the hospital has consisted of t he talking motion pictures afternoon a nd evening weekly during eight months of the year, da nces for the patients about mont hl y d uring the same period, Field Days with sports on t he 4t h of July a nd Labor Day, baseba ll and soft ba ll during the summer and tennis for those fe w who are acquainted with t he game. The usual extensive Christmas holiday program gave much pleasure to ma ny. The hospital orchestra has contributed much in playing for the pa­ t ients' dances. We are indebted to T he American Legion a nd The American Legion Auxiliaries as well as to other serv ice organi zations, for entertainments, Christmas boxes and ma ny gifts to our former Soldiers. C HANGES IN P ERSONNEL On Ma rch 27, Dr. Anthony J. Vola nte resigned to enter the Government Service, as did also Dr. Ralph S. Belmont, on May 26. Drs. Willia m J. H ornyak a nd Frank S. Rozanski took up their d uties as assistant physicians on July 11, 1938.

THE H URRICAN E No report of t his year would be complete wit hout mention of the hurrica ne which visited us on September 21. It occurred in the late afternoon and early evening, reaching its greatest intensity about half past six. Fort unately both patients a nd employees sought shelter early a nd consequent ly, no persons were injured. Hundreds of trees were destroyed a nd ma ny others so seriously injured t hat they could not be saved . The da m­ age to buildings was principally to roofs and windows. One whole section of the roof of the main building was blown a way, and a ll other sections of it were denuded of la rge areas of slate. Skylights were broken or blown away, chimneys destroyed. Tin roofs were rolled up over large a reas a nd others were punctured in hundreds of places by bits of fl ying sla te a nd other debris. The ta r and gravel roof on the ell of Childs Building was rolled up a nd carried hundreds of feet away into t he field. The roof of Talbot Building was da m­ aged in ma ny places. Spear a nd Dewson Buildings were stripped of la rge a reas of sla te. At the Farm Dormitory t he e'K ha ust ventilator over t he kitchen was blown a way, a nd a large hole broken in the roof. At the old Heath Farm House t he chimney was blown down, shingles were stripped from the roof and part of the eaves ca rried away. The Heath barn doors were destroyed, cla pboards were blown from the siding and t wo large calf sheds were picked up and dropped, t otally destroyed, a hundred feet a way. The vegetable storage building lost many shingles, and t he piggery was stripped in la rge areas. T he apartment house roof sufre red particularly, as a great part of the asphalt shingles was carried a way. La rge a reas of t he roof of Paine Hall were ent irely denuded. T he windows of Home 1 were blown in. The 65-foot chimney at Warren Colony heating plant was destroyed. The blacksmith shop and horse barn roofs suffered greatly, a nd t he wagon shed was blown down t he hill to t he lake. T he boat house was ent irely destroyed . The roofs a t Durfee Colony were seriously damaged, and one of the porch stairways was destroyed by fa ll ing trees. 18 P.D.30 The electric service of the New England Light and Power Company was interrupted for eleven days, but by running both of our generators, and by shifting the load by oper­ ating the bakery at night, we managed to supply current sufficient for our urgent needs. Telephone service was interrupted entirely for several days and was intermittent for a week or two afterward. The pole lines around the lake were severely damaged, and it was five days before emergency lighting was established at Richmond and the Warren Col­ onies. Emergency repairs were started immediately, and I cannot speak too highly of the loyalty and devotion of all classes of employees in meeting the emergency situation. Men of the Engineer's Department and the maintenance force worked from daylight to dark, seven days a week, for three weeks. To remove fire hazards which had developed in our wooded areas, a contract was made by the Department and this work went forward during October and November. Damage to the buildings alone has resulted in a contract for its repair in the sum of over fifty-six thousand dollars. It is estimated that the logs sawn from felled or damaged trees will produce in excess of one hundred and fifty thousand board feet of lumber. Stump re­ moval and grading will require the expenditure of several thousand dollars more.

CONCLUSION A review of the year 's activities and the ' parts played in them by physicians, depart­ ment heads, and other employees causes me to have a great sense of gratitude to them all for the assistance they have given in carrying on the affairs of the hospital and I wish to share with them any credit which may be due for our accomplishments. To the members of your Board I am greatly indebted for your interest, encouragement and support. Respectfully submitted, WALTER E. LANG, M.D., Superintendent. VALUATION November 30, 1938 REAL ESTATE Land. 763.93 acres. . $60.830 .00 Buildings and Betterments 1,707,059.85 $1.767,889 .85 FINANCIAL REPORT To the Department of Mental Health: I respectfully submit the following report of the finances of this institution for the·fiscal year ending November 30, 1938. STATEMENT OF EARNINGS Board of Patients $110,588.62 Personal Services 232.50 Sales: Travel, transportation and office expenses 38.97 Food . . . . 1,989.56 Clothing and materials . . 25.96 Furnishings and household supplies 65.82 Medical and general care 3.25 Garage and grounds 6.22 Repairs ordinary...... 391.46 Farm: (Hides, etc., $18.29; cows and calves, $1,170.78; bags and barrels, $83.15; all other, $283.61) 1,555 .83 Total Sales $4,077 .07 Miscellaneous: Interest on bank balances (Patients') $154.00 Rents . . . 415.44 Services in accidents 12.00 Total Miscellaneous 581.44 Total Earnings for the year $115,479.63 Total cash receipts reverting and transferred to the State Treasurer $115,456.26 Accounts receivable outstanding December 1, 1937 . $5400 Accounts receivable outstanding November 30, 1938 77 . 37 Accounts receivable increased $23 37 P.D.30 19

MAINTENANCE ApPROPRIATION Balance from previous year, brought forward . $4,169.78 Appropriation. current year (Chap. 356, Acts 1938) 691,060 . 00 Total . $695,229 . 78 Expenditures as follows: Personal services $394,166 .75 Food . . . . 108,3 16 . 92 Medical and general care 14,271 .09 Religious instruction 1,510.08 Farm . 22,927.72 Heat and other plant operation . . 49,715 . 09 Travel, transportation and office expenses 6,492.96 Garage, $7,925.56; grounds, $326.86 8,252.42 Clothing and materials 17,903 .25 Furnishings and household supplies 23,383 . 49 Repairs ordinary 11,739 .61 Repairs and renewals 16,803 .57 Total maintenance expenditures $675,482 .95 Balances of maintenance appropriation. November 30, 1938 19,746.83 $695,229 .78 SPECI AL ApPROPRIATIONS Balance December 1, 1937, b rought forward $41,714.53 Appropriations for current year 115,200. 00 Total $156,914 .53 Expended during the year . . . Reverting to Treasury of Commonwealth 29,307.64 Balance November 30, 1938, carried to next year $127,606.89

Act or Total Expended Total Balance at ApPROPRIATION Resolve Amount during Expended end of Ch. Year Appropriated fiscal year to date year

Laundry Bldg. M-18-973 . 365- 1933 $60,860 .53 - $60,841 .33 $19 . 20 Development of Rear Center M -19- 1034 365-1933 285,107.97 $650 . 16 285,107 . 97 - N urses' Home M-:i5-2067 365-1933 261,632.00 154. 50 261,632.00 - Resurfacing sewer beds 497-1938 15,000 . 00 5,293.23 9,996.46 5,003.54 Painting Main Group 234-1937 10,000.00 3,570.00 7,424 .25 2,575.75 Renov. Richmond San. 497-1938 16.900.00 4,626 . 57 4,626.57 12,273.43 Completion of Garage 234-1937 2.500.00 1,561 . 72 2,413.57 86.43 Fire protection . . 356-1938 15,000 . 00 - - 15,000.00 Refrigerator boxes and com- pressors 234-1937 11,400 .00 7,501.11 7,501. 11 3,898.89 Hurricane and fi a'od damage 507-1938 94,700 .00 5,950 . 35 5,950 . 35 88,74,9.65 Totals $773,100.50 $29,307.64 $645,493 . 61 $127,606.89

PER CAPITA During the year the average number of patients has been, 1,543.409. Total cost of maintenance. $675,482.95. Equal to a weekly per capita cost of $8.4164. Total receipts for the year, $115,456.26. Equal t o a weekly per capita of $1.4385. Total net cost of maintenance for year, $560,026.69. Net weekly per capita, $6.9779. Respectfully submitted, CARRIE G. P OOR, Treasurer. Financial Statement Verified. GEORGE E. MURPHY, Approved. ComptToller. 20 P.D.30

STATISTICAL TABLES As ADOPTED BY THE AMERICAN PSYCHIATRIC ASSOCIATION PRE SCRIBED BY THE MASSACHUSETTS DEPARTME NT OF MENTAL HEALTH

TABLE 1. General Information (Data correct at end of institution year November 30, 1938) Date of opening as a hospital for mental diseases, December I, 1886. Type of hospital: State. Hospital plant: Value of hospital property: Real estate, including buildings $1,767,889 .85 Personal property 500.357 .01 Total ...... 52,268,246 .86 Total acreage of hospital property owned, 763.93. Total acreage under cultivation during previous year, 382. Officers and employees: Actually in Service Vacancies at End at End of Year of Year M . F. T. M . F . T. Superintendents 1 1 Assistant physicians. 6 3 9 Total physicians 7 3 10 Stewards . . 2 2 Residen t dentists . 1 1 Pharmacists . 1 1 Graduate nllrses . . . 38 38 Other nurses and attendants 98 85 183 Occupational therapists 2 8 10 Social workers . 3 3 All other officers and employees 102 72 174 3 3 T otal officers and employees . . . 212 210 422 5 5 Classification by Diagnosis September 3D, 1938 Census of Patient Population at end of year: Absent from Hospital Actually in Hospital but stiU on Books WHITE: M . F. T . M . F. T. Insane 663 893 1,556 108 172 280 Epileptics 1 1 Mental defectives: 1 1 Alcoholics 4 4 All other cases 4 4 8 Total 673 897 1,570 108 172 280 OTHER RACES: Insane 9 11 20 Total 9 11 20 Grand Total 682 908 1,590 108 174 282 M. F. T. Patients under treatment in occupational-therapy classes, including physical training, on date of report ...... 190 190 Other patients employed in general work of hospital on date of report 307 301 608 Average daily number of all patients actually in hospital during year 636 . 200 885 .579 1,521.779 Voluntary patients admitted during year ...... 6 1 7 Persons given advice or treatment in out-patient clinics during year 189 233 422 TABLE 2. Movement of Patient Population for the Year Ended September 30,1938 ~ (Data in all of the fo llowing tables are based on the Statistical Year, October 1, 1937 to September 30, 1938) o REGULAR COURT TOTAL COMMITMENT OBSERVATION TEMPORARY VOLUNTARY CN (INSANE) CARE o M. F. T. M. F. T. M . F. T. M. F . T. M . F . T. Patients on books of institution September 30, 1937 767 1,003 1,770 762 999 1,761 1 1 2 - - - 4 3 7 Admissions during year; First admissions. 192 209 401 147 185 332 40 22 62 2 2 4 3 - 3 Readmissions 75 95 170 54 88 142 16 4 20 2 2 4 3 1 4 Total admis;ions 267 304 571 201 273 474 56 26 82 4 4 8 6 1 7 Transfers from other mental h~spita l s 8 18 26 8 18 26 ------Total received during year 27 5 322 597 209 291 500 56 26 82 4 4 8 6 1 7 Total on books during year 1,042 1.325 2,367 971 1. 290 2,261 57 27 84 4 4 8 10 4 14 Discharged from books during ye'a r : As recovered 64 61 125 51 48 99 13 13 26 -- - - - "- As improved 48 47 95 48 46 94 - 1 1 ------As unimproved 8 13 21 7 12 19 - - - 1 1 2 -- - As without psychosis 36 11 47 - -- 28 6 34 3 3 6 5 2 7 Total discharged to c~mm~nity 156 132 288 106 106 212 41 20 61 4 4 8 5 2 7 Transferred to other mental hospitals 26 32 58 26 32 58 ------Died during year . . . . : : : 70 79 149 63 75 138 7 4 11 ------TotalCiischarged, transferred and died during year 252 243 495 195 213 408 48 24 72 4 4 8 5 2 7 Patients remaining on books of hospital at end of year: In hospital 682 908 1,590 670 903 1,573 9 3 12 - - - 3 2 5 On parole or' oth~rwi5~ ab~ent 108 174 282 108 174 282 ------Total 790 1,082 1,872 778 1,077 1,85 5 9 3 12 -- - 3 2 5 NOTE: The total males in the Voluntary and Insane groups will not balance through September 30, 1938, owing to the fact that 2 males had a change of legal status during the year from Voluntary Sane to Section 51. (Court Commitment.) SUPPLEMENTARY DATA M. F. T. Average daily number of patients on books during year 157.45 1,043 .40 1,800 . 85 Actually in institution during year 636 .20 885.57 1,521.77 In family care . 12 . 06 16.45 28.51 On visit 103 .97 138 .62 242 .59 On escape ...... 5.22 2.76 7.98 Number of patients actually remaining in institution September 30, 1938 : State. . 584 704 1,288 Reimbursing ...... 98 202 300 Ex-service patients paid by Federal Government . 2 2 Number of patients in family care September 3D, 1938: 11 16 27 State. . 5 5 Reimbursing 11 11 22 Self-supporting Private ...... Number of non-insane patients in hospital at end of institution year: Mentally defective 1 Epileptic 1 N Others 4 12 22 P.D.30

TABLE 3. Nativity of First Admissions and of Parents of First Admissions

PARENTS OF MALE PARENTS OF FEMALR PATIENTS PATIENTS PATIENTS NATIVITY Both Both M. F. T. Fathers Mothers Parents Fathers Mothers Parents

United States! 134 131 265 73 79 65 59 62 S3 Canada2 . 16 26 42 32 30 2S 37 37 32 England. 4 4 8 6 8 4 13 8 7 Finland 1 1 2 3 2 1 1 1 Germany 1 1 1 2 2 2 Greece 2 1 3 2 2 2 1 1 1 Ireland 12 26 38 45 41 38 57 57 53 Italy 6 9 15 12 11 11 14 14 14 Norway 1 1 1 Poland 3 5 5 5 5 6 6 6 Portugal . 5 6 5 S 5 1 1 1 Russia 2 3 2 2 2 4 4 4 Scotland : 1 3 1 1 1 3 4 3 Sweden 1 2 1 2 1 2 2 2 Turkey i~ Asi~ 1 1 1 1 Turkey in Europe 1 1 1 1 Wales 1 1 West Indies' : 1 2 1 Other Countries 3 4 3 3 5 5 Unknown 2 1 Total 192 209 401 192 192 164 209 209 187

!(Persons born in Hawaii, Porto Rico and the Virgin Islands should be recorded as born in the United States.) 'I neludes Newfoundland. 'Except Cuba, Porto Rico and Virgin Islands. "1j o w o

TABLE 4. A ge of First Admisswns Classified with Reference to Nativity. and Length of Residence in the United States of the Foreign Born

NATIVE BORN FOREIGN BORN

PARENTAGE TIME IN UNITED STATES DEFORE ADMISSION AGE AT Aggregate AOMISSfON T otal T otal Uncler 5-9 10-14 15 years Foreign Mixed Native Unknown 5 years years years and over Unknown

M. F. T . M. F. T . M. F. T . M . F. T . M. F. T . M .F. T. M . F. T. M . F . T. M .F. T . M . F . T . M . F . T . M.F. T .

0- 14 years 1 1 2 1 I 2 ------1 I 2 ------15- 19 years 4 7 11 4 7 11 - 5 5 - - - 4 2 6 ------20-24 years 24 17 41 23 17 40 13 10 23 5 I 6 5 6 11 - - - 1 - I ------1 - I ------25-29 years 20 17 37 18 12 30 8 4 12 4 3 7 6 5 11 - - - 2 5 7 - - - 1 2 3 - 3 3 - - - 1 - 1 30- 34 years 18 23 41 15 18 33 4 10 14 3 2 5 8 6 14 - - - 3 5 8 - - - - 1 1 2 2 4 I 2 3 - - - 35-39 years 14 15 29 11 8 19 5 6 11 1 - I 5 I 6 - I 1 3 7 10 - 1 I - - - - 1 I .3 5 8 - - - 40--44 years 23 15 38 16 12 28 5 5 10 2 - 2 9 7 16 - - - 7 3 10 ------2 - 2 4 3 7 1 - I 45-49 years 14 20 34 9 12 21 4 6 10 2 1 3 3 4 7 - I I 5 8 13 ------1 - I 4 8 12 - - - 50- 54 years 13 18 31 7 10 17 2 4 6 I 3 4 4 3 7 - - - 6 8 14 ------1 - 1 5 8 13 - - - 50- 59 years 10 19 29 5 11 16 - 4 4 2 - 2 3 7 10 - - - 5 8 13 ------5 8 13 - - - 60--64 years 9 9 18 6 4 10 3 1 4 I 1 2 2 2 4 - - - 3 5 8 ------3 5 8 - - - 65-69 years 11 12 23 4 6 10 - - - - 2 2 4 4 8 - - - 7 6 13 ------7 6 13 - - - 70-74 years 11 17 28 4 6 10 1 3 4 1 - I 2 3 5 - - - 7 11 18 ------1 - I 6 11 17 - - - 75-79 years 11 7 18 7 2 9 2 2 4 - - - 5 - 5 - - - 4 5 9 ------4 5 9 - - - 80--84 years 7 9 16 2 3 5 - 2 2 - - - 2 1 3 - - - 5 6 11 ------5 6 11 - - - 85 years a nd over 2 3 5 2 2 4 - I 1 - - - 2 I 3 - - - - 1 1 ------1 1 - - - Total 192 209 401 134 131 26:; 47 63 110 22 13 35 65 53 118 - 2 2 58 78 136 - 1 1 1 3 4 8 6 14 47 68 11 5 2 - 2 - _ ._-

N C/_ 24 P.O. 30

TABLE 5. Citizenship of First Admissions M . F. T. Citizens by birth 134 133 267 Citizens by nat urali zati~ n 14 11 25 Aliens 44 64 108 First papers I I T otal 192 209 401

TABLE 6. Race of First Admissions Classified with R eference to Principal Psychoses

With With syphilitic other Alcoholic Due to Traumatic TOTAL memngo- infectious psychoses drugs, etc. psychoses RACE encephalitis diseases ---- M. F. T. M. F. T . M. F. T. M. F. T. M. F. T. M . F. T .

Africa n (black) 2 2 Armenian I 1 English. 66 68 134 4 8 Finnish. 2 1 3 French. 13 14 27 German. I 3 4 Greek 2 I 3 H ebrew 1 4 5 Irish 70 73 143 5 6 14 5 19 Italian' 12 14 26 1 1 2 2 Lithuanian 2 2 4 Portuguese 5 1 6 Scandinavian' 2 4 S CO lch 2 2 4 1 1 Slavonic 3 7 7 14 4 4 Spanish I 1 Turkish 2 Other specifi~ races. 1 1 Mixed 10 17 4 - - -- T otal 192 209 401 10 5 15 3 1 8 39 2

TABLE 6. Race of First Admissions Classified with R eference to Principal Psychoses - Continued

With Due to With With other With Senile Involutional other organic cerebral disturb· convulsive psychoses psychoses metabolic changes of RACE arterio- ances of disorders diseases, nervous sclerosis circulation (epilepsy) etc. system

M . F. T. M. F .T. M . F.T. M . F. T. M. F . T. M . F. T . M. F. T.

African (black) Armenian. English 14 18 32 4 6 4 6 - 2 Finnish 1 1 French 1 4 5 - 1 3 - 1 German 1 1 2 Greek H ebrew I Irish. 10 17 27 3 8 3 3 Italianl 1 I 1 3 3 Lithu anja~ Portuguese . 3 3 Scandinavian2 . 1 1 2 Scotch 2 2 Slavonic3 1 1 Spanish Turkish Other s pe~i fic races Mixed T otal 32 44 76 4 9 12 21 4 11 15 4 - 2

' Includes "North" and " South" . 2Norwegians, Danes and Swedes. 3I ncludes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian. Montenegrin, Moravian, Polish, Russian, Ruthenian, Servian, Slovak, Slovenian. P.D. !30 25

TABLE 6. Race of First Admissions Classified. with R eference to Principal Psychoses - Concluded

Paranoia With Manic- and psycho- With Psycho- depressive Dementia paranoid pathic mental Without RACE neuroses psychoses praecox conditions personali ty deficiency psychoses

M . F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. ·

Af·rican (black) - - 1 1 Armenian 1 1 English 4 3 5 17 22 13 11 24 2 - 2 - - 3 3 9 12 Finnish 1 1 2 French 3 3 5 2 7 German : 1 1 1 1 Greek 1 Hebrew 2 2 2 2 Irish 2 - 4 15 19 13 20 33 3 13 3 16 Italianl 2 2 4 3 6 9 1 2 - 2 Lithuanian 1 2 3 1 1 Portuguese . 1 2 Scandinavian! Scotch Slavonic' 3 4 3 Spanish 1 Turkish . 1 Other specific races Mixed 3 4 3 T otal 8 3 11 12 46 58 41 56 97 2 - 3 - 3 3 8 11 28 9 37

'Includes "North" and "South". 2N orwe~ians, Danes and Swedes. ~Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravain. Polish. Russian, Ruthenian, Servian, Slovak, Slovenian.

TABLE 7. Age of First Admissions Classified with R eference to Principal Psychoses

0-14 15- 19 20--24 25-29 TOTAL years years years years PSYCHOSES ---- M. F. T. M . F. T. M. F. T. M . F. T. M. F. T. With syphilitic meningo-en- cephalitis 10 5 15 With other infectious diseases 2 2 1 Alcoholic psychoses 3 1 8 39 3 Due to drugs. etc. 1 1 Traumatic psychoses 2 2 With cereb$l arteriosclerosis. 32 44 76 With other disturbances of cir- culation ; 2 4 With convulsi;'e' di so~ders' (epii.) 1 1 Senile psycsoses . 9 12 21 I nvolutiona, psychoses 4 11 15 Due to other metabolic di~eas~s, etc . . 2 4 With organ'lc changes of 'nerv~ ous system 2 2 1 1 Psychoneuroses: . . 8 3 11 1 1 1 1 Manic-depressive psychoses 12 46 58 1 1 3 6 9 1 7 8 Dementia praecox 41 56 97 2 4 5 10 8 18 12 8 20 Paranoia and paran ~i d c·ondi~ tions 2 2 With p s y c h ~pathic p~rso';ality 3 3 I With mental deficiency 3 8 11 1 I 2 Without psychoses --28 --9 37 3 5 6 4 4 Total 192 209 401 4 II 24 17 41 20 17 37 26 P .D . 30

TABLE 7. Age of First Admissions Classified with Reference to Principal Psychoses - Continued

30-34 35-39 40-44 45-49 50-54 55- 59 years years years years years years PSYCHOSES M. F . T. M. F . T . M . F. T . M. F. T. M . F . T . M. F . T . With syphilitic meningo-enceph- alitis . 2 - 2 4 - 4 3 3 With other infecti~us diseases - 1 1 Alcoholic psychoses 3 1 4 4 - 4 6 3 9 4 - 4 4 - 4 4 Due to drugs. etc. Traumatic psychoses . \Vith cerebral arteriosclerosis . 4 6 With other disturbances of circu- lation - 1 With convulsive disorders (epil.i Senile psychoses I - 2 2 · Involutional psychoses . . 3 - 3 3 6 2 - 2 Due to other metabolic'diseases. etc. \Vith organic'c h a~ges of nei-vou~ system - I Psychoneuroses. . . 2 1 I 1 2 2 - 2 1 Manic-depressive psychoses 1 7 8 - 4 4 3 5 8 - 8 8 3 4 4 6 Dementia praecox . . . 6 10 16 6 8 14 3 3 6 - 5 5 4 5 - 4 4 Paranoia and paranoid conditions 1 1 I With psychopathic personality. 1 With mental deficiency 1 - 3 3 1 I 1 - 2 Without psychoses 3 8 1 3 - 3 4 2 6 1 Total 18 23 41 14 15 29 23 15 38 14 20 34 13 18 31 10 19 29

TABLE 7. Age of First Admissions Classified with Ref erence to Principal Psychoses - Concluded

60-64 65- 69 70-74 75-79 80-84 85 years years years years years years and over PSYCHOSES M . F. T. M . F. T . M . F . T. M . F . T . M . F . T. M . F. T .

With syphilitic meningo-enceph- alitis - I With other infecti~us diseases Alcoholic psychoses 2 Due to drugs, etc. Traumatic psychoses . . \Vi th cerebral arteriosclerosis . 4 4 8 9 16 3 12 15 9 4 13 8 15 - 3 3 With other disturbances of circu- lation With convulsive disorders (epil.i Senile psychoses 2 3 - 2 2 4 6 2 2 4 - I 2 - Involutional psychoses - I 1 Due to other metabolic d is~ases', etc. - 2 With orga nic'ch a ~ges of ne~vous system 'J . Psychoneuroses. . . Manic-depressive psychoses Dementia praecox Paranoia and paranoid'conditio~s With psychopathic personality . With mental deficiency Without psyc\>oses - 1 Total 9 9 18 11 12 23 11 17 28 11 7 18 9 16 3 5 :-t' o w o

TABLE 8. Degree of Education of First Admissions Classified with Reference to Principal Psychoses

Reads and Common High TOTAL Illiterate Writes &hool &hool College PSYCHOSES --·--·--1----,------M. F. 2:.:....IM. F . T·IM. F. T·IM. F . T . 1M. F . T · IM. F . T .

With syphilitic meningo-encephalitis 10 5 15 4 4 8 1 4 4 3 With other infectious diseases 2 2 2 2 Alcoholic psychoses 31 8 39 2 21 4 25 10 Due to drugs, etc. . I I I I Traumatic psychoses . . 2 2 2 2 With cerebral arteriosclerosis . . 32 44 76 3 4 4 6 20 IS 2 With other disturbances of circulation 2 2 4 2 29I 4913 4 11I I With convulsive disorders (epiJepsy) 1 I I Senile psychoses . . 9 12 21 I 4 6 6 12 3 3 Involutional psychoses. . . 4 11 IS 2 2 3 3 6 4 5 Due to other metabolic diseases, etc .. 2 2 4 1 2 3 With organic changes of nervous system 2 2 2 2 Psychoneuroses . . . 8 3 11 5 2 2 I 3 Manic-depressive psychoses . 12 46 58 2 4 23 2771 6 IS 21 6 Dementia praecox . . . . 41 56 97 1 26 32 58 IS 20 35 2 Paranoia and paranoid conditions 2 2 2 2 With psychopathic personality 3 3 3 3 With mental deficiency 3 8 11 2 2 6 8 Without psychoses. 28 9 37 4 4 15 7 22 1 6 --,--1--1------1---- Total 192 1 209 1 401 12 1 12 11 23 1116 122 238 1 48 59 107 I 11 10 21

~ -r Iv (Ye

TABLE 9. Environment of First Admissions Classified with R ef erence to Principal Psychoses

2,500- 10,000- 25.000- 50,000- 100,000- T OTAL 0-2,499 9,999 24,999 49.999 9 9,999 ,249,999 I 500,000+ I Unknown PSYC HOS ES I-- -- M. F. T . M. F. T. M. F . T . M. F. T . M . F. T. M. F . T. M . F . T. M . F . T I M . F . T . ---- .. With syphilitic meni ngo-encephalitis 10 S 15 - --- 1 1 1 3 4 1 1 2 1 - 1 4 - 4 2 - With other infectious di seases 2 2 ------2 2 ------Alcoholi c psychoses 31 8 39 1 - 1 6 - 6 8 2 10 3 1 4 2 - 2 8 4 Ii 3 1 4 Due t o drugs, etc. 1 1 ------1 1- Traumatic psychoses 2 2 ------2 - 2 Vvith cerebral arterioscierosis 32 4.4 76 2 3 5 7 7 14 5 3 8 3 9 12 5 7 12 10 11 21 I - 3 With other disturbances of ci rc ui at i o ~ 2 2 4 ------1 i ------1 1 2 With convulsive disorders (epilepsy) 1 1 1 - 1 ------Seni le psychoses. . 9 12 21 - 1 1 1 3 4 1 4 S 1 .- 1 1 - 1 :5 4 9 Involutional psychoses 4 11 15 - 1 1 1 - 1 - 3 ,~ 1 1 2 - 2 2 2 4 6 Due to other metaboli c dise:ases: etc. 2 2 4 - - - 1 - 1 - 1 1 ------1 1 2 \Vith organic changes of nervous system 2 2 -- - 1 - 1 1 - 1 ------Psychoneuroses 8 3 11 - - - 1 1 2 3 - 3 - 1 1 --- 2 1 2 - 2 Manic-depressive psychoses 12 46 58 1 3 4 4 7 11 3 6 9 1 8 9 1 8 9 1 12 1 2 3 D ementia praecox 41 56 9 7 3 2 5 5 3 8 5 4 9 6 9 15 5 5 10 12 25 31 ~7 I 2 8 10 - 3 Paranoia and paranoid 'co nciiti o ~ s 2 2 ------1 - 1 ----- 1 - 1 With psychopathic personality 3 3 1 - 1 ------2 - -- With mental defi ciency 3 8 11 - 1 1 1 1 2 - 1 1 1 1 2 - 1 1 1 2 j I -- - I - I. Wit hou t psychoses --28 --9 37 1 2 3 2 - 2 8 2 10 5 1 6 5 - S 6 2 8 T otal 192 209 40 1 10 13 23 30 23 S3 35 3 2 67 23 32 S5 20 23 43 57 68 125 I 12 16 28

'i::I b w o P.D.30 29

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

TOTAL Dependent Marginal PSYCHOSES ------1-----1------M. F. T. M. F . T. M. F. T.

With syphilitic meningo-encephalitis 10 5 15 9 5 14 With other infectious diseases 2 2 2 2 Alcoholic psychoses . 31 8 39 31 8 39 Due to drugs. etc. . 1 1 1 1 Traumatic psychoses 2 2 2 2 With cerebral arteriosclerosis . 32 44 76 31 43 74 With other disturbances of circulation 2 2 4 2 2 4 With convulsive disorders (epilepsy) 1 1 1 1 Senile psychoses 9 12 21 9 12 21 Involutional psychoses 4 11 15 4 11 15 Due to other metabolic diseases. etc. 2 2 4 2 2 4 vVith organic changes of nervous system 2 2 2 2 Psychoneuroses . 8 3 11 8 3 11 Manic-depressive psychoses 12 46 58 12 46 58 Dementia praecox. . . 41 56 97 41 56 97 Paranoia and paranoid conditions 2 2 2 2 With psychopathic personality 3 3 3 3 With mental deficiency 3 8 11 3 7 10 Without psychoses 28 9 37 28 9 37 ------1-----'------Total 192 209 401 2 2 4 I 190 207 397

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

TOTAL Abstinent Temperate Intemperate P SYCHOSES I ----I M. F. T . M. F. T. M. F. T. M. F. T. - - - - With syphilitic meningo-encephalitis 10 5 15 5 5 10 2 - 2 3 - 3 With other infectious diseases - 2 2 - 2 2 ------Alcoholic psychoses 3 1 8 39 ------3 1 8 39 Due to drugs, etc. - 1 1 - 1 1 ------Traumatic psychoses 2 - 2 - - - 1 - 1 1 - 1 With cerebral arterioscle'rosis' 32 44 76 27 37 64 3 6 9 2 1 3 With other disturbances of circuh~.tion· 2 2 4 2 1 3 - 1 1 -- - With convulsive disorders (epilepsy) 1 - 1 - - - 1 - 1 - - - Senile psychoses 9 12 21 6 9 15 2 3 5 1 - 1 Involutional psychoses 4 11 15 4 10 14 - 1 1 - -- Due to other metabolic diseases. etc . . 2 2 4 2 1 3 - 1 1 - - - With organic changes of nervous system 2 - 2 2 - 2 ------Psychoneuroses . . 8 3 11 5 2 7 2 1 3 1 - 1 Manic-depressi ve psychoses 12 46 58 9 40 49 3 4 7 - 2 2 Dementia praecox 41 56 97 25 44 69 7 12 19 9 - 9 Paranoia and paranoid c'ondit ion~ 2 - 2 1 - 1 -- - 1 - 1 With psychopathic personality 3 - 3 1 - 1 - - - 2 - 2 With mental deficiency 3 8 1! 2 8 10 1 - 1 - - - Without psychoses . 28 9 37 10 6 16 6 - 6 12 3 15 -- T otal 192 209 401 101 166 267 28 29 57 63 14 77 1 w TABLE 12 . Marital Condition of First Admissions Classified with Reference to Principal Psychoses o

T OTAL Single Married Widowed Divorced Separated Unknown PSYCHOSES --'--1--1------______..:...... _..:...... _ I~I~I..2:..-I-M-.------F . T . IM. F . T . IM. F. T.IM. F. T.IM------. F. T.IM. F . T. With syphilitic meningo-encephalitis 10 5 15 9 2 11 I - 3 3 With other infectious diseases 2 2 2 2 Alcoholic psychoses 31 8 16 10 4 14 3 Due to drugs, etc. . 1 3~ 115 Traumatic psychoses . 2 2 2 2 With cerebral arteriosclerosis . 32 44 76 3 10 13 17 14 31 112 20 32 With other disturbances of circulation 2 2 4 1 1 2 1 1 2 With convulsive disorders (epilepsy) 1 1 1 Senile psychoses . 9 12 21 4 6 5 5 10 Involutional psychoses .. 4 11 15 2 2 4 8 12 Due to other metabolic diseases, etc. . 2 2 4 2 1 3 With organic changes of nervous system 2 2 1 1 .1 1 Psychoneuroses . . 8 3 11 3 3 5 2 Manic-depressive psychoses 12 46 58 4 13 17 8 24 327 1 - 51 4 4 Dementia praecox . . . 41 56 97 37 27 64 4 26 30 I. Paranoia and paranoid conditions 2 2 2 2 With psychopathic personality 3 3 2 2 With mental deficiency 3 8 11 2 6 8 1 1 2 Without psychoses 28 9 37 15 3 18 13 4 17 -,-,-1------Total 192 I 209 1 401 1 88 66 154 1 82 94 176 I 20 38 58 8 3 4

TABLE 13. Mental Disorders of All Admissions, All Discharges, All Deaths, 1938, All Cases in Residence and All Cases Out on September 30, 1938, by Status of Admission and Sex

ALL ADMISSIONS ALL DISCHARGES ALL DEATHS R ESIDENT POPULATION IP ATIENTS OUT ON VISIT, ETC. MENTAL DISORDERS ---I 1---- First Read­ First Read­ First Read­ First Read­ First Read­ Admissions missions Admissions missions Admissions missions Admissions missions Admissions missions M. F. T . IM. F. T.IM. F. T.IM. F. T . IM. F. T.IM. F. T.IM. F. T.IM. F. T.IM. F. T . IM. F . T . P sychoses Due to or Associated with I nfection: Syphilis of the Central Nervous System: Meningo-encephalitic type (gen- eral paresis) . . . . I 10 15 6 16 6 22 8 10 3 Meningo-vascular type (cere- bral syphilis) . 3 3 "tl Other types . . With epidemic encephalitis . 2 3 2 2 b With acute chorea (Sydenham's) 1 w With other infectious disease o Psychoses Due to Intoxication: ~ Due to Alcohol: tJ Pathological intoxication 2 2 2 I 2 2 2 3 2 3 Delirium tremens. '. II10 - 10 2 9 9 4 4 2 3 3 1 1 w Korsakow's psychosis 2 3 5 1 639 2 1 3 o Acute hallucinosis 8 3 11 1 1 5 6 8 1 9 2 2 4 2 6 Other types , , , , 10 1 1l 3 4 4 4 26 1 27 6 6 2 3 5 Due to Drugs or Other Exogenous Poisons: Due to opium and derivatives Due to other drugs , 2 3 Psychoses Due to Tra'lttna: Traumatic delirium . . . Post-traumatic personality dis- orders...... Post-traumatic mental deteriora- tion ...... Psychoses Due to Distltrbance of Cir­ culation: With cerebral arteriosclerosis I 32 44 76 4 4 8 4 6 10 29 36 65 6 8 39 67 106 8 15 23 4 With cerebral embolism 1 1 2 1 1 With cardio-renal disease 1 1 Other types, , , , , 1 1 Psychoses Due to CotUJulsive Disorders (EPilepsy): Epileptic deterioration 2 2 9 II 4 5 9 Epileptic clouded states 4 224 2 2 4 2 3 Other epileptic types , , , 1 1 Psychoses Due to Disturbances of Metabolism. Growth. Nutrition, or Elldocri1le Function: Senile Psychoses: Simple deterioration I 3 459 3 Presbyophrenic type , 1 1 1 1 1 Depressed and agitated types 4 2 6 1 2 7 8 15 3 4 1 Paranoid types 4 8 12 3 5 14 22 36 5 6 2 2 3 Involutional psychoses: Melancholia , 4 6 10 4" 5 2 3 3 6 10 19 29 6 11 17 3 5 8 4 5 Paranoid types , 5 5 2 3 3 2 11 13 2 4 6 4 4 1 1 Other types , I 1 With diseases of the endocrine glands, , ' , , With other somatic diseases Psychoses Due to Unknown or H ered­ itary Causes but A ssociated with Organic Changes: With multiple sclerosis With paralysis agitans With Huntington's chorea, ' With other brain or nervous dis- eases 3 3 w.... W N

TABLE 13. Mental Disorders of All Admissions, All Discharges, All Deaths, 1938, AU Cases in Residence and AU' Cases Out on September 30, 1938, by Status of Admission and Sex - Concluded

ALL ADMISSIONS ALL DISCHARGES ALL DEATHS RESIDENT POPULATION IPATIENTS OUT ON VISIT. ETC. MENTAL DISORDERS First Read­ First Read­ First Read­ First Read­ First Read­ Admissions missions Admissions missions Admissions missions Admissions missions Admissions missions M, F. T' I M. F, T'IM. F. T ' IM, F, T.IM. F. T ' IM, F. T'I~~ I M. F. T·IM. F. T' I M, F. T. Disorders of Psychogenic Origin or Without Clearly De,fined Tangible Cause or Stru.ctural Change: Psychoneuroses: Anxiety hysteria 3 Conversion hysteria: Amnesic type . . . Psychasthenia or compulsive states: Obsession Phobia, , . ' Mixed compulsive states Neurasthenia . H ypochondriasis 1 Reactive depression 4 3 3 3 Anxiety state . Mixed psychoneurosis Manic-depressive Psychoses: M anic type 8 25 33 14 19 33 7 9 16 5 13 18 2 3 I 2 15 29 44 23 33 56 6 14 20 9 18 27 Depressive type 3 14 17 6 16 22 10 14 24 7 10 17 4 5 4 6 12 21 33 18 36 54 6 13 19 4 11 15 Circular type 2 2 1 1 2 2 2 2, Mixed type 5 6 4 9 1 I 6 7 8 10 3 3 4 Perplexed type , 1 3 1 Stuporous type, , , ' Dementia praecox (schizophrenia) : Simple type 8 3 11 1 1 2 1 1 3 3 1 9 7 16 8 6 14 i 4 6 1 1 Hebephrenic type 13 9 22 5 6 11 8 2 10 2 3 5 4 2 86 61 147 64 78 142 6 5 11 7 8 15 Catatonic type 7 18 25 6 11 17 8 I I 19 6 7 13 4 4 40 88 128 32 64 96 3 10 13 4 13 17 Paranoid type 12 26 38 4 10 14 8 12 20 2 2 4 I 2 51 98 149 43 84 127 5 12 17 5 7 12 Other types 1 1 1 1 1 1 1 1 Paranoia . . 2 2 1 1 Paranoid conditions 2 2 3 1 1 With psychopathic personality 3 4 3 5 10 11 With mental deficiency: ~ Idiot , 1 4 4 1 1 t:I Imbecile 2 2 1 11 5 16 3 5 8 Moron 6 8 3 11 19 17 36 7 13 20 4 4 w o Without Psychosis: ;tl Alcoholism . . . 8 6 6 4 S S S 3 3 o Psychopathic personality: With pathological sexuality . 5 4 4 w With pathological emotionality 1 1 1 1 o With asocial or amoral trends 1 1 1 3 Mixed types 1 1 1 Epilepsy . 2 1 1 Mental deficiency: Imbecile 1 1 1 1 2 Moron . , . . 4 3 448 Other non-psychotic diseases or conditions. . 426 4 4 4 4 No other condition 224 2 4 Grand Total 192209401 1 75 95 1701112 81 193 1 44 51 95 1 54 62 1161 16 17 331417512929 1265 396 661 1 62 95 157 146 79 125

N OTE: - Admissions and discharges do not include transfers.

W ~J 3-1 P.D.30

TABLE 14. Discharges of Patients Classified with R ef eref!-ce to Principal Psychoses and Condition on Discharge

PSYCHOSES ____ TOTAL1_____ 1__ R__ ec_o_v_e_r_ed __ .I __I_m_p_r_o_v_e_d __ .l _u__ ru_.~ __ p_ro_ · v_e_d_ M . F. T. M . F. T. M . F. T . M. F. T. 1 ------,------I ------I ------I ----~-- With syphilitic meningo-encephalitis 2 2 With other forms of syphilis 1 1 - 1 With epidemic encephalitis 1 2 3 1 1 1 2 Alcoholic psychoses 23 3 26 17 1 18 2 7 Due to drugs. etc. 1 3 4 1 2 3 Traumatic psychoses . . 1 1 1 1 With cerebral arteriosclerosis . . 5 8 13 4 8 12 With other disturbances of circulation 2 2 1 1 Senile psychoses 2 2 1 1 Involutional psychoses 2 6 8 1 3 4 1 2 Psychoneuroses . . 5 3 8 4 3 7 1 1 Manic-depressive psychoses 33 53 86 25 37 62 7 14 21 1 2 3 Dementia praecox . . . 38 37 75 10 12 22 24 19 43 4 6 10 Paranoia and paranoid conditions 1 1 1 1 With psychopathic personality 2 2 4 1 1 1 2 With mental deficiency 4 1 5 3 2 2 Without psychoses 36 11 47 ------+ ------'1------1------'·.:..· --- Total 156 132 288 I 64 61 125 48 47 95 I 8 13 21

TABLE 15. Hospital R esidence during This Admission of First Admissions Discharged during 1938

Average Net Number Hospital Residence PSYCHOSES in Years

M. F. T. M. F. T.

With syphilitic meningo-encephalitis 2 2 . 66 .66 With other forms of syphilis 1 1 7.50 1.50 With epidemic encephalitis i 1 2 .62 . 46 .54 Alcoholic psychoses 20 2 22 . 42 1.02 .48 Due to drugs, etc. 1 1 2 .04 . 12 ·. 08 Traumatic psychoses . 1 1 . 29 .2.9 With cerebral arteriosclerosis. . 4 6 101 ..12 . 50 .75 With other disturbances of circulation 1 1 .04 .04 Senile psychoses 2 2 .74 .74 Involutional psychoses 2 3 5 1.22 .37 .71 Psychoneuroses . . 5 3 8 .20 .26 .22 Manic-depressive psychoses 21 28 49 1.09 . 91 ·.99 .Dementia praecox . . . 25 25 50 1.23 .86 1.04 Paranoia and paranoid conditions 1 1 - 23 .0023.00 With psychopathic personality 1 1 2 4.50 4 .50 4.50 With mental deficiency 3 1 4 1.86 .29 1.46 Without psychoses 23 8 31 .09 .09 .09 T otal 112 81 193 .83 1.02 .91 ~ TABLE 16. Causes of Death of Patients Classified with Reference to Principal Mental Disorders o With With - With vJ syphilitic I Alcoholic cerebral cenvulsive Senile o TOTAL meningo- psychoses arterio- disnrders psychoses - CAUSES OF DEATH encephalitis sclerosis (epilepsy) --,--,--I------i---- M. F. ~IM. F. T·IM. F. T·IM. F. T ·I M . F. T'IM. F. T. ltJjectious and Parasitic. Diseases: Tuberculosis of the respiratory system 3 3 Syphilis (non-nervous forms) . . . 4 5 2 Purulent infection. septicaemia (non-puerperal) 1 Cancer and Other Tumors: Cancer and other malignant tumors 12 1 Tumor (non-cancerous) ...... , 1 Rheumatic Diseases. Nutritional Diseases. Diseases of the Endocrine Glands and Other Gen­ eral Diseases: Diabetes...... ,. Diseases of the Blood and Bloodmaking Organs: Pernicious anemia . . . . Chronic Poisonings and Intoxications: Alcoholism (acute or chronic) . . . . . Diseases of the Nervous System and Organs of Special Sense: Other diseases of the spinal cord . 2 Cerebral hemorrhage . . 10 15 8 5 13 General paralysis of the insane . 2 4 4 Other diseases of the nervous system 1 Diseases of the Circulatory System: Chronic endocarditis (valvular disease) 4 4 3 3 Diseases of the myocardium 13 17 30 9 8 17 3 5 Other diseases of the heart 1 9 10 1 4 5 1 1 Arteriosclerosis 5 16 21 2 11 13 3 5 Other diseases .. 1 1 1 1 Diseases of the Respiratory System: Bronchopneumonia (including capillary bronchitis) 8 4 12 6 3 9 Lobar pneumonia . . 2 3 5 Diseases of the Digestive System: Ulcer of the stomach and duodenum Hernia. intestinal obstruction , ...... Biliary calculi and other diseases of the gall bladder and biliary passages Diseases of the GenUa-Urinary System: Nephritis (acute. chroni'c and unspecified) 3 4 1- Violent and Accidental Deaths: Suicide. . 1 1 Other external causes 5 3 8 4 Ill-Defined Causes of Death: --'--1--1------1---- Total 70 79 1 149 3 6 4 4 1 35 38 73 3 6 8 14

W VI W TABLE 16. Catlses of Death of Patients Classified with Reference to Principal Mental Disorders - G:oncluded 0-

I I Due to With other organic Ma nic- Wltb CAUSES OF DEATH I Involutional metabolic changes of depressIve Dementia mental psycbose. diseases. nervous psychoses praecox deficiency etc. system M. F. T . M . F. T . M. F. T. M . F. T. M. F. T . M. F. T . I nfectious and Parasitic D£seases: Tuberculosis of the respiratory system . ------3 Syphilis (non-nervous forms) . . . . ------:: 1 1 Purulent infection, septicaemia (non-puerperal) . : I Cancer and Other Tttmors: Cancer and other mali gnant tumors -I 1 1 -I 1 I 3 Tumor (non-cancerous) ...... Rheltmatic Diseases, Nlttritional Diseases, Diseases of the Endocrine Glands and Other General Diseases: Diabetes Diseases of th~ Blo~d a~d Bioodl~aki~g Organs: Pernicious anemia...... Chronic Poisonings and Intoxications: Alcoholism (acute or chronic) . . . . . Diseases of the Nervolts System and Organs of Special S ense: Other diseases of the spinal cord Cerebral hemorrhage . . General paralysis of the insane . Other diseases of the nervous system Diseases of the Circulatory System: Chronic endocarditis (valvular disease) 1 Diseases of the myocardium . 3 3 3 Other diseases of the heart . -I -I -I 1 1 1 Arteriosclerosis 1 Diseases of the ResPirat~ry Systet~: . . . , Bronchopneumonia (including capillary bronchitis) Lobar pneumonia . . . . . 1 -I -I -I - I 3 4 Diseases of the Digestive System: Ulcer of the stomach and duodenum Hernia. intestinal obstruction Biliary calculi and other diseases of the'gall 'bladder and biliary pa~sage~ Diseases oj the Genito-Urinary System: N ephri tis (acu te, chronic and unspecified) Violent and Accidental Deaths: Suicide - 1 Other external c~ uses 2 3 Ill-Defined Causes of Death: - :-0 Total 3 3 :1 :1 :1 5 11 1: I 9 9 1~ I 2 2 4 0 W 0 o~ w TABLE 17. Age of Patients at Time of Death Classified with Reference to Principal Psychoses o

20-24 25-29 30-34 35-39 40-44 45-49 50-54 PSYCHOSES TOTAL years years years years years years years ______IM:"""I~I~ I M. F . T. IM. F. T. , M. F. T., M. F. T., M. F. T. , M. F . T . , M .. F. T.

With syphilitic meningo-encephalitis 3 3 6 1 Alcoholic psychoses 4 4 1. With cerebral arteriosclerosis . . 35 38 73 With convulsive disorders (epilepsy) 1 2 3 Senile psychoses . 6 8 14 Involutional psychoses . . . 3 3 6 Due to other metabolic diseases. etc. 1 1 2 With organic changes of nervous system 1 2 3 Manic-depressive psychoses 5 11 16 1 3 Dementia praecox . 9 9 18 3 With mental deficiency 2 2 4 --'--1--1------:------' Total 70' 79 I 149 3 3 3 3 8 4 5 4 6

55-59 60-64 65-69 70-74 75-79 80-84 85 years PSYCHOSES years years years years years years and over M . F. T. 1M . F . T . 1M . F. T. 1M. F. T. 1M. F . T. 1M. F. T. 1M. F . T.

With syphilitic meningo-encephalitis 2 2 Alcoholic psychoses . . 2 2 With cerebral arteriosclerosis . 3 4 7 11 18 5 9 14 6 6 1~ 111 16 3 4 With convulsive disorders (epilepsy) Senile psychoses . 3 4 Involutional psychoses . . . Due to other metabolic diseases. etc. '" With organic changes of nervous system Manic-depressive psychoses 1 Dementia praecox . 3 With mental deficiency 2 Total 10 4 12 16 28 8 16 24 I 13 11 24 I 13 6 19 6

W '"-l ~

TABLE 18. Total Duration of Hospital Life During All Admissions of Patients Dying m Hospital Ctass·ijied According to Principal Psychoses

Less than 1-3 4-7 8-12 1- 2 PsYCHOSES ----TOTAL 1 month months months months years M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. ----- Wi th ' yphilitic meningo-encephalitis 3 6 1 Al coholic psychoses . . . 4 4 2 2 \Vith cerebral arteriosclerosis . 35 38 73 8 ·11 ·19 8 15 -3 8 11 3 3 61 6 4 10 ' With convulsive disorders (epilepsy) 1 2 3 1 1 Senile psychoses. . . 6 8 14 . 1 2 Involutional psychoses . . . 3 3 6 I Due.to <>the r metabolic diseases. etc. 1 1 2 With organic changes of nervous system 1 2 3 Manic-depressive psychoses . 5 11 16 - 3 4 Dementia praecox . 9 9 18 -I 1 1 1 Wi th mental deficiency 2 2 4 ------Total 70 79 149 III 15 26 12 13 25 6 11 17 4 9 10 11 21

3-4 5-6 7-8 9-10 15-19 20 years PSYCHOSES years years I years years years and over M. F. T. M. F. T. IM. F. T. M. F. T. M. F. T. M. F. T . ------I With syphilitic meningo-encephalitis Alcoholic psychoses . . With cerebral arteriosclerosis . . 3 5 4 2 With convulsive disorders (epilepsy) 1 1 1 Senile psychoses, . . . . 1 1 Involutional psychoses Due to other metabolic dise'ases: etc. With organic changes of nervous system Manic-depressi ve psychoses 3 3 Dementia praecox . 4 3 7 With mental deficiency : 1 2 2 4 Total 12 4 4 :1 6 II 5 :1 8 IS "1j 0 VJ 0 P.O. 30 39

TABLE 19. Average Length of Hospital Residence during the Present Admission oj All First Admissions in Residence on September 30, 1938

Average Net Number Hospital Residence PSYCHOSES in Years M. F. T. M. F. T.

With syphilitic men in go-encephalitis 16 6 22 2 . 66 2.47 2.60 With other forms of syphilis. . 3 - 3 12 . 50 - 12 . 50 With epidemic encephalitis . 2 1 3 7 . 50 7.50 7.50 With other infectious diseases - 1 1 - 1.50 1.50 Alcoholic psychoses 45 6 51 7.48 9 .63 7 . 73 Traumatic pSy'choses ~ 2 - 2 3 . 97 - 3.97 With cerebral arteriosclerosis 39 67 106 3 . 91 4.35 4 . 19 With other disturbances of circula'tion 1 3 4 3 . 50 3.48 3 . 48 With convulsive disorders (epilepsy) 4 11 15 4 . 23 7 . 13 6 . 35 Senile psychoses . . . . 25 36 61 3 .80 4 .40 4 . 15 Involutional psychoses. . . . 12 31 43 3 . 23 3.00 3.07 Due to other metabolic diseases, etc, . 1 1 2 1.50 . 44 . 97 With organic changes of nervous system 4 1 5 1.97 4 . 50 2 . 47 Psychoneuroses . . . 4 4 8 2.61 5.00 3 .80 Manic-depressive psychoses . 28 59 87 3 . 37 3.93 3 . 75 Dementia praecox .. 187 254 441 10. 10 9 . 72 9 .88 Paranoia and paranoid conditions 1 4 5 .44 32.50 26.08 With psychopathic personality 2 3 5 . 44 17 . 50 10. 67 With mental deficiency 34 22 56 9 . 99 5.80 8 . 34 Without psychoses . 7 2 9 1.44 .44 1.22 Total . 417 512 929 7.44 7.32 7.37

TABLE 19A. Average Length of Hospital Residence during the Present Admission oj All R eadmissions in Residence on September 30, 1938

Average Net Number Hospi tal Residence PSYCH OSES I in Years M. F. T. M. F. T.

With syphilitic meningo-encephalitis 8 2 10 6.87 3 . 00 6 . 10 With epidemic encephalitis. . 2 - 2 7 .50 - 7 .50 With other infectious diseases - 1 1 - 1.50 1.50 Alcoholic psychoses 10 2 12 4 .90 9 . 50 5 . 66 Due to drugs. etc. 1 - 1 7.50 - 7.50 Traumatic psychose~ 1 - 1 2.50 - 2.50 With cerebral arteriosclerosis 8 15 23 6 . 37 4 .30 5.02 With other disturbances of circulation 2 - 2 4 . 50 - 4.50 With convulsive disorders (epilepsy) 7 7 14 3 . 64 5.35 4.50 Senile psychoses . . . . 3 10 13 4.16 4 .00 4 . 03 Involutional psychoses 8 15 23 3.00 3.76 3 . 50 Due to other metabolic disea~es, ~tc. 1 - 1 1.50 - 1.50 With organic changes of nervous syste;n 1 - 1 7.50 - 7.50 Psychoneuroses . . . 5 2 7 5 .50 15 .00 8 .21 Manic-depressive psychoses . 45 78 123 4.45 6 . 11 5 .50 Dementia praecox . 148 232 380 10.32 9.97 10. 11 Paranoia and paranoid conditions - 2 2 - 32 .50 32.50 With psychopathic personality 1 10 11 12 .50 3.50 4 . 31 With mental deficiency 11 18 29 12 . 50 8 . 66 10. 12 Without psychoses 3 2 5 .50 12 .00 5 . 10 Total 265 396 661 8.17 8.39 8.31 ----

TABLE 20. Family Care Statistics for Year Ended September 30, 1938 M . F. T. Remaining in Family Care September 30, 1937 12 18 30 On Visit from Family Care September 30, 1937 5 5 Admitted to Family Care during the Year 5 12 17 Whole Number of Cases within the Year. . 17 30 47 Discharged from Family Care within the Year: 6 14 20 From Family Care because of Death 1 1 From Family Care to Visit Status . 10 10 Returned to Institution. . . . . 6 3 9 Remaining in Family Care September 30, 1938 11 16 27 On Visit from Family Care September 30, 1938 . 6 6 Average Daily Number in Family Care During Year: 12.065 16 .455 28 . 520 Supported by State 4 . 580 4.580 Private 12 . 065 11.875 23 .940