Public Document No. t7

mlft QJ.nmnutltUtta1t1f of aassadlltllftts

ANNUAL REPORT

OF THE

TRUSTEES

OF THE

J~ss:. FOXBOROUGH STATE HOSPITAL(I;,sdoe

FOR THE

Y E AR ENDING NOVEMBER 30

1939

D E PARTME NT OF M E NTAL HEALTH

PUBLICATION OF THIS DOCUMENT APPROVED BY THE COMMISSION ON ADMTNISTllA1l0N AND FINAN( Ii: 500--7-4~Req. P - 1l4

OC:CUPAnONAL ""INTI"'" ~NT O~AfltTME.NT OF MENTAL HEALTH ClA.ltDNIER STATE HOSPrTAL ."'aT GlA .. DNIi ... MA ••. I ~ " ... '\ ~ .," • Il, . . ( ~ . ." .... FEB Ll 1Q4

FOXBOROUq,-H, ST~&E WITAL (Post Office Address: Foxborough, Mass.)

BOARD OF TRUSTEES DR. E. H. LEWIS HARNETT, Chairman, Dorchester MRS. HELEN J. FAY, Secretary, Westwood MRS. ETHEL W. DODD, Wrentham MR. WILLIAM H. BANNON, Foxborough MR. BENNET B. BRISTOL, Foxborough MR. WILLIAM J. BULMAL'<, Broakton MR. NOEL C. KING, Holbrook

OFFICERS OF THE HOSPITAL DR. RODERICK B. DEXTER, Superintewlent DR. GROSVENOR B. PEARSON, Assistant Superintewlent DR. DAVID ROTHSCHILD, Senio.r Physician, Patho.lo.gist DR. MORRIS L. SHARP, Senio.r Physician DR. JOHN T. SHEA, Senio.r Physician DR. MARGARET R. SIMPSON, Senio.r Physician DR. ISRAEL ZELTZERMAN, Assistant Physician DR. CARL V. LENDGREN, Assistant Physician DR. ZOE ULLIAN, Assistant Physician DR. ARTHUR E. BURKE, Resident in Psychiatry DR. EDWARD L. SMALL, Dentist MR. CHESTER R. HARPER, Steward MISS HARRIETT S. BAYLEY, Treasurer

CONSULTING STAFF DR. IRVING J . WALKER, Surgery DR. ARTHUR B. DONOVAN, Surgery DR. LAURENCE J. LOUIS, Surgel'y DR. E. PARKER HAYDEN, Surgery Lo.wer Abdo.men and Pro.cto.lo.gy DR. OTTO J. HERMANN, Ortho.pedic Surgery DR. RUSSELL F. SULLIVAN, Ortho.pedic Surgery DR. CHARLES B. MCCL"'N, Gyneco.lo.gy and Obstetrics DR. WILLIAM J. McDoNALD, Gyneco.lo.gy and Obstetrics DR. JOHN J. THORNTON, Gyneco.lo.gy awl Obstetrics DR. AUGUSTUS J. RILEY, Genito.-Urinary Surgery DR. CHESTER S. KEEFER, Internal Medicine DR. W. RICHARD OHLER, Internal Medicine DR. CADIS PHIPPS, I nternal Medicine DR. CALVIN B. FAUNCE, Oto.lo.gy - Larnygo.lo.gy - Rhino.lo.gy DR. WILLIAM T. HALEY, Oto.lo.gy - Larnygo.lo.gy - Rhino.lo.gy DR. JAMES J. REGAN, Ophthalmo.lo.gy DR. WALTER A. GRIFFIN, Pulmo.nary Diseases DR. ARIAL W. GEORGE, Ro.entgeno.lo.gy DR. RALPH D. LEONARD, Ro.entbeno.lo.gy DR. FRANK A. DUNBAR, Patho.lo.gy DR. HAROLD J. MORGAN, Oral SUlgery

HEADS OF DEPARTMENTS MR. WILLIAM W. WHITE, Chief Engineer MR. CHARLES F. THURSTON, Head Farmer MR. GEORGE CLARK, Maintenance Fo.reman MISS ILA P. JACKSON, R.N., Supt. o.f Nurses and Principal o.f Training Schaal MISS ELIZABETH L. MOSELEY, Head Psychiatric So.cial Wo.rker MISS MILDRED J. SHANNON, Principal Clerk and Steno.grapher MISS VERONICA 1. CAVANAUGH, Head Occupatio.nal Therapist MISS CATHERINE MULLANE, Head Institutio.nal Ho.usekeeper MR. ALBERT D. KELLY, Chief Male Superviso.r . .. ' .. ... " P.D.47 3 TRUSTEES' REPORT To His ExceUency, the Governor, and the Honorable Council: The Trustees of the Foxborough State Hospital have the honor to submit herewith the forty-eighth annual report covering the fiscal year ending ovember 30, 1939. Meetings were held regularly with a majority of the members present at each meeting. Frequent visits to the wards and other parts of the institution were made and con­ ferences were held with the superintendent pertaining to maintenance and the further development of the institution. During the year particular attention has been given to having the affairs of the hospital administered as economically as pos ible and at the same time maintain the necessary tandard in the care of the patients. In the report submitted by the Superintendent and to be found el ewhere, a description in detail is given covering the work of the institution throughout the year and of the new construction considered to be necessary. In 1939 the sum of $7,500 was granted as a special appropriation for the completion of Ward Building E and it is expected that the project will be completed early next year. In 1938 the sum of $15,000 was appropriated for the purchase of property bordering along Payson Road. By the close of 1939 title had been acquired to six parcels of land, leaving one yet to be purchased. It is hoped that in the near future Payson Road will be abandoned as a public highway and thus elinlinate the menace which has existed because of the large amount of vehicular traffic. The high pei'centage of over-crowding has continued to make difficult the satisfactory care of the patients. In order to keep up with the continuous growth of the hospital, an increase is needed in the medical and other personnel, besides alterations to some buildings and construction of others. Particularly urgent is the remodelling of the E wing of Ward Building 0 and the construction of an addition thereto for the use of patients of the disturbed type. The second floor of Ward Building C is now occupied by employees with patients on the floor below and in the adjOining buildings. This building should be completely remodelled to increase the fire protection and used exclusively for patients with accommodations provided elsewhere for the employees. The kitchen, dining room, and bakery facilities are taxed beyond their capacity and to meet this need the service building should be remodelled and such additional improve­ ments as are necessary to furnish adequate dining room space. A medical and surgical building is needed to take care of the hospital and infu'm patients and of sick employees. As previously recommended, it seems necessary to purchase two additional parcels of land along the southern boundary of the hospital at an approximate cost of 6,000 to provide a site for the relocation of Chestnut Street and a suitable formal entrance to the hospital grounds. Other needs are the installation of a sprinkler system in two buildings occupied by employees, the con truction of a hospital garage, and of a hen house at the Colony Farm, the remodelling of the old assembly building for vegetable storage, and the installation of a grounds lighting system. These alterations and additions would increase the capacity of the institution and make for a more economical and atisfactory administration. Respectfully submitted, E. H . L EWIS HARNETT BENNET B . BRISTOL WILLIAM J. B ULMAN ETHEL W. DODD OEL C. KING H ELEN J. FAY WILLIAM H. BANNON Trustees. SUPERI TENDENT'S REPORT To the Trustees of the F'oxborough tatc Hospital: The forty-eighth annual report of the Superintendent of the Foxborough State Hospital for the year ending November 30, 1939, is herewith respectfully submitted. The statistical tables contained herein are for the year ending September 30, 1939. MOVEMENT OF POPULATION On September 30, 1938, the census of the hospital was as follows: On the wards, men, 649; women, 756; total, 1,405 ; on parole or otherwise absent, men, 52; women, 67; total, 119. The total number of patients in the care of the Hospital was 1,524, of whom 701 were men and 823 women. 4 P.D.4'1 On October 1, 1938, there were on the books of the hospital 701 men, 823 women, total, 1,524. First admission by regular court commitment as insane, 105 men, 76 women; for temporary care, 8 men, 4 women; for observation care 21 men, 13 women. Voluntary, 0 men, 2 women. The total of all first admissions were 134 men, 95 women. Readmissions, by regular court commitment, 40 men, 32 women; by voluntary commit­ ment, 1 man, 0 women; for temporary care, 1 man, 1 woman, for observation care, 6 men, 4 women. Total of all readmissions were 48 men, 37 women. Transfers from other hospitals for mental diseases, by regular court commitment, 2 men, 7 women. Total of all transfers were 9. There was a total of 323 patients received during the year. The average daily number of ex-service patients was 41.500.

MEDICAL STENOGRAPHIC DEPARTMENT The work of the statistical and medical stenographic department has been carried on by Miss Mildred J. Shannon, Principal Clerk. In the final section of this report there is complete information concerning the move­ ment of population and statistical tables as adopted by the American Psychiatric Association, prescribed by the Massachusetts Department of Mental Health.

MEDICAL SERVICE Changes in Personnel.-Dr. Aznive A. Ner&essian who had been a member of the hospital staff from November 11, 1933 until May 1, 1939, resigned to enter general practice. Dr. Zoe Ullian was appointed to fill this position. Dr. Mary Hammond, Senior Physician, who had been a member of the hospital staff from September 1, 1937, resigned on September 1, 1939. Dr. Margaret R. Simpson was appointed Senior Physician on October 22, 1939 to fill this vacancy with the special assignment of Director of Traveling School Clinic. Dr. Simpson came as a transfer from the Boston State Hospital where she had been a member of the staff from 1935. Employees.-At the close of the fiscal year the personnel consisted of 323 employees. During the year a total of 112 left the service and a total of 107 were appointed.

MEDICAL AND SURGICAL CARE The consulting and visiting staff continued the same as in the previous year. The service rendered has been very prompt in providing the necessary expert medical and surgical care in major cases. Many minor operations were performed by members of the resident staff. Besides these the following major work was done: Laparotomy and appendectomy; simple appendectomy; cholecystectomy; cholecystotomy and chole­ lithiosis; herniotomy, right; supra-cervical hysterectomy; radical mastoidectomy, left; simple mastoidectomy, right; radical mastectomy, left; simple mastectomy, left; repair of volvulus with ilio-colotomy, incision and drainage; blood transfusion - indirect method; tonsillectomy; closed reduction of fractures under anesthesia, applications of plaster casts. Additional procedures were as follows: Basal metabolism rates, 50, blood chemistry, 480, inoculations, 412, anti-luetic treatments, intravenous, 895, intramuscular, 742, first aid and surgical dressings in operating room, 438, gynaecological clinics, 25, physical examinations of applicants for positions, 81.

MEDICAL LIBRARY During the year a considerable number of new books was added and the work of reclassification and cataloging was begun as a project under the Works Progress Ad­ ministration. The library is considered adequate to meet the needs of the institution and a great deal of use is made of it by the members of the medical staff and social service department. DENTAL DEPARTMENT Resident Dentist.-Dr. Edward Small; Dental Hygienist: Miss Pearl Vincent. Patients were treated as follows: Number of patients treated, 2,743; operations performed, 1,940; fillings, 310; cleanings, 485; extractions, 645; dentures made, 32; denture repairs, 37; gold crowns, 8; bridgework, 6.

PHYSIOTHERAPY, X-RAY Until June 24, 1939, Miss Mary V. Villone as technician supervised the work of this department. On that date she resigned to accept a position in the Veterans Facilities. She was for ten years in the service of the hospital. The position was temporarily filled P.D.47 5 by a provisional appointment, under civil service, until the permanent appointment of Miss Rose A. Connolly was made on ovember 15, 1939. Treatments were given as follows: Total, 1,104; radiant heat, 304; massage, 277; mechanotherapy, 25 ; infra-red, 94; ultra-violet, 75 ; diathermy, 1 ; des ication, 24; galvani m, 8; dressings, 32. Total number of individuals treated, 74 ; total number of patients, 55; male, 12; female, 43; employee, 19. X-ray: Individuals worked on, 832. pecial attention was given to the use of X-ray in examination of chest as an aid to diagnosis. Total number of patients, 679; male, 327; female, 353; employees, 146 ; outside patients, 6.

PODIATRY Podiatrist. - Dr. Henry G. Campbell. The special attention given to the care of the feet has unquestionably resulted in marked benefit to the patients. Work has been systematically carried out and has included the fitting of shoes especially in the very difficult cases where cooperation is lacking. The work of the clinic i summarized as follows: Patients examined, male, 447, female, 500; patient treated, male, 307, female, 432; treatments given, male, 500, female, 486; hours of treatment given: male, 160, female, 160. Type of cases treated were as follows: Di eases of the skin, lesions of the skin, di eases of the nail, diseases of the ebaciou glands, mechanical condition .

HYDROTHERAPY On the Male ervice MI'. George Hennessey continued in charge. Miss Anna Hable re igned as charge of the Women's Department. Her place has been filled by Mi Annie Fraser who i a graduate nurse and who had received special training in hydro­ therapy. Men Women Number of patients given wet- heet packs . 119 99 Number of packs admini tered 5,5 5 9,423 Number of hours of treatment given in wet-sheet packs 15,478 24,000 umber of patient given continuous baths 71 114 umber of bath treatments given 1,3 2 3,397 umber of hour of continuous bath treatments ,0 0 15,470 umber of colonic irrigation patients . 4 19 umber of colonic treatments given 22 136 umber of hours of treatment of colonic 18 119 umber of tonic bath patients 32 25 umber of treatments 2,925 962 Observations were carefully made and recorded indicating the progres made in each case with special reference to type of psychosis. Lectures and demonstrations were given to nurses in the training school and to attendant nur es.

OCCUPATIONAL THERAPY Head Occupational Therapist: Miss Veronica Cavanaugh. Because of the small num­ ber of workers it has been difficult to carryon as much work as would seem advantageous in thi department especially among the more disturbed patients. As much time as possible has been devoted to carrying out a program of instruction for juvenile cases. Except during the summer months motion pictures and dances were held weekly. During the summer the patients were given as much opportunity as po sible for game and exercises in the open. An unu ual amount of interest was shown in oft ball in which a considerable number of the patients participated and furni hed entertainment for a fairly large group. Because of daylight aving it was po ible for games to be played after upper. The usual Field Day was held on July Fow·th and in addition to competitive games an entertainment was furni hed by a traveling circus. The recreation room formerly used by employees was brought into use and made it po sible for group of patients to gather there for evening recreation who had been chiefly otherwi e occupied during the day. The work was begun on the new recreation field and it i expected this will be com­ pleted early in the pring of 1940. The patients and employees continue to show a marked interest in the library and the total circulation was approximately 7,000 volumes for the year. The practice of 6 P.D.47 having the library and reading room open daily for the selection of books to both em­ ployees and groups of patients has been found of great advantage. Articles were manufactured in the Department as follows: 32 braided rugs, 1 dozen napkin rings, 5 pairs bed socks, 6 dozen bibs, 73 fancy pillows, 3 dozen IN-OUT signs, 21 dozens face cloths, 3 desk pads, 87 tray cloths, 2 hot pads, 2 wall hangings, 1 key cord, 22 dozens table runners, 1 pool rack, 25 dozens towels, 1 pool rake, 6 shoulderettes, 1 shuffle board set, 8 pairs bookends, 1 bulletin, 1 dozen pot holders, 1 couch cover, 2 desk signs, 1 lamp and shade, 71 pairs curtains, 1 crocheted chair set, 57 pairs tie­ backs, 1 doll's chair, 25 valances, 1 doll's cradle, 19 rugs, 1 woven runner, 3 dozen doilies, 1 sweater.

PATHOLOGICAL AND RESEARCH Director: Dr. David Rothschild. Charge of Laboratory, Mr. Charles N. Hamberg, assisted by a laboratory technician and two students in laboratory technique. Pathological Department: During the course of the year, 43 autopsies "'ere per­ formed, constituting 38.7 per cent of the deaths occurring in the hospital. The psy­ chiatric diagnoses in these cases were as follows: psychosis with cerebral arteriosclerosis 11; dementia praecox, paranoid type, 6; dementia praecox, Hebephrenic type, 4; de­ mentia praecox, catatonic type, 2; senile psychosis, 4; general paresis, 3; psychosis with cardiorenal disease, 2; alcoholic psychosis, Korsakow's type, 2; psychosis with other brain or nervous diseases, type undetermined, 2; psychosis with other infectious diseases, 2; manic-depressive psychosis, depressed type, 2; psychosis with epilepsy, 1; psychosis with chronic epidemic encephalitis, 1; paranoid condition, 1. The causes of death in these cases were as follows: Pulmonary Tuberculosis, 6; senile psychoses, 3; generalized arteri osclerosis, 2; cerebral arteriosclerosis, 2; generalized arteriosclerosis with gangrene of foot, 1; arteriosclerotic heart disease, 2; cardiorenal disease, 3; cardiorenal disease with lung abscess, 1; hydronephrosis, pyelitis, and cystitis, 2; bronchopneumonia, 2; chronic progressive vascular nephritis, 1; arteriosclerotic kidneys, 1; general paresis, 1; general paresis and therapeutic malaria, 1; aplastic anemia (syphilitic), 1; multiple abscesses of lung, 1; abscesses of lungs and pericardial effusion, 1; acute encephalitis, 1; streptococcus septicemia, 1; gangrene of foot with streptococcus septicemia, 1; fibromyoma of rectovaginal septum with acute cystitis and pyelitis, 1; negacolon and acute colitis, 1; lobar pneumonia, 1; asphyxiation by suspension, 1; aortic valvular disease, 1; carcinoma of stomach, 1; carcinoma of lung, 1; carcinoma of gall bladder, 1; chronic epidemic encephalitis Parkinsonism, 1. The routine sectioning of all brains has been continued in spite of the increasing work entailed, owing to the increase in number of autopsies, this year's total representing the largest number for many years. Some of the most interesting cases were presented at clinicopathological conferences.

CHEMICAL, BACTERIOLOGICAL AND SEROLOGICAL DEPARTMENT In all new cases, complete blood counts, five urinalyses and determinations of the sugar and non protein nitrogen content of the blood ·were performed, and other tests were carried out at the request of the medical staff. During the year, 3,600 urinalyses and 874 blood counts were made. The work in blood chemistry included the following: Sugar 670 determinations, non protein nitrogen 600, cholesterol 20, creatinine 15, uric acid 13, phosphorus 11, chloride 11, calcium 11, quantitive bromide 4, and urea 3 de­ terminations. Procedures for quantitive tests of the blood for alcohol and sulfanilamide were established during the year and are now being performed whenever requested. In the work on spinal fluid, 134 specimens were examined. Cell counts and colloidal gold tests were performed in all instances. The total protein was determined in 133 cases, the sugar content of the spinal fluid in 129 cases, the non protein nitrogen content in 129 cases; and the distribution ratio of bromide between blood and spinal fluid in 68 cases. The basal metabolic rate was determined in 36 cases, the icterus index in 18 cases, and the blood sed,imentation rate in 70 cases. Thirty-two examinations of feces, 6 of gastric contents, and 12 Van Den Bergh tests were performed. The blood was typed in 17 cases. Sugar tolerance curves and kidney function tests were carried out on request, and the Friedman modification of the Ascheim-Zondek test was performed in 5 cases. P.D.47 7 The bacteriological work included examinations of 111 specimens of sputum and 275 miscellaneous specimens, such as: throat smears and cultures, smears for gonorrhea, blood cultures, etc. The laboratory has been established as a recognized station for pneumonia typing, caring for its own needs and those of two nearby state institutions. During the year, 20 specimens of sputum were typed for pneumonia. In addition to the foregoing work, the following procedures were performed on em­ ployees: 71 blood counts, 53 urinalyses, 10 basal metaboli m tests, and 7 examinations of sputum; 11 blood non protein nitrogen, 1 uric acid, and 10 sugar determinations; and 56 miscellaneous bacteriological examinations. The yphilitic treatment clinics have been held twice weekly. During the course of the year, 27 patients were given 717 intravenous injections of tryparsamide, 53 patients were given 792 intramuscular injections of bismuth, and 12 patients were given 158 injections of neoarsphenamine. No paper was published during the year, but one article has been submitted for publication. This paper, entitled "Dementia Paralytica Accompanied by Manic­ Depressive and Schizophrenic Psychoses" by D . Rothschild, was read at the 95th Annual Meeting of the American Psychiatric As ociation in Chicago, May, 1939. An­ other paper on problems of diagnosis in senile and arteriosclerotic psychoses is being planned for the immediate future. Metrazol shock treatment has been continued in a group of patients. Over 50 pa­ tients have now received this form of therapy. In October, 1939, the results of treat­ ment in 50 cases were summarized and discussed at a clinical conference. Among teaching activities with the hospital staff, clinical and clinicopathological conferences were held once or twice monthly during the winter, fall, and spring months, a course of psychiatric lectures was given to the newer members of the Medical Staff and the Social Service group, and practical instruction in neuropathology to the resident in p ychiatry. Plans are being made to engage in a number of research projects with several members of the staff. BROCKTON NEUROPSYCHIATRIC CLINIC This i under the direction of Dr. David Rothschild. The out-patient clinic is held on Wednesday afternoons. Dr. Rothschild was assisted during the early part of the year by Dr. Mary Hammond and after that by Dr. Margaret R. Simpson, two social workers and a psychometrist. The Brockton Clinic has continued its weekly out-patient work every Wednesday afternoon at the Brockton Hospital. Because the Clinic is now restricted to persons thirteen years of age or older, the number of patients has decreased from last year's record figures, but approximately equals or urpasses tho e of earlier years when patients of all ages were accepted. During the year there were 192 new cases, consisting of 110 male and 82 female patients. Of this number, 37 were under the age of 16 years. Twenty-one cases were re-opened, and 20 continued from the previous year, making a total of 233 patients seen in the Clinic. These patients made 531 visits to the Clinic during the period under review. Eighty-four patients were referred to the Clinic by physicians of Brockton and the nearby communities, and 25 by the Brockton Hospital. Social agencies accounted for 21 cases, and school authorities for eight cases. Twenty-six cases were sent to the Clinic by police or court authorities, including nineteen referred under Chapter 215 of the regulations governing juvenile delinquents. Fourteen patient were referred by the staff of the Foxborough State Hospital. Twenty-four cases (exclusive of the juvenile delinquent group referred by the courts) were diagnosed as conduct disorder in adolescents whose intelligence was above the feeble-minded level. Five patients were of borderline intelligence, 11 of dull normal, and 8 of normal intelligence. Generally, unruly behavior, sometimes combined with stealing, was the commonest type of difficulty. Sexual difficulties were the chief problem in 3 cases, and enuresis in 1 case. In 4 cases, mal-adjustment at school was the chief complaint. There were 19 additional cases of conduct disorder referred under Chapter 215 of the regulations governing juvenile delinquents. Among thi group, 1 patient was mentally deficient, 4 were of borderline, 7 of dull normal, 5 of normal, and 2 of high intelligence. Stealing was the commonest problem, although it was sometimes combined \vith unruly behavior in school or at home. In 1 case, sexual difficulties were the chief complaint . 8 P.D.47 In addition to these cases, 5 patients previously seen at the clini c were referred as juvenile delinquents by court authorities, making a total of 24 patients examined under Chapter 215 during the year. A diagnosis of mental deficiency was made in 6 cases (exclusive of the case mentioned in the preceding paragraph); 1 patient was classified as an idiot, and 5 as morons. In most of these cases the chief problem was backwardness, although more general mal­ adjustment was noted in two cases. In 28 cases a diagnosis of neurosis or psychoneurosis was made. Most of these cases were not classified as to type. Several of them were selected for more detailed psycho­ therapy, and beneficial results were usually obtained. Psychoses of various types were definitely diagnosed or strongly suspected in 26 cases, and an additional group of 12 cases was referred to the clinic by the hospital for follow-up work. In most cases the type of psychosis was left undiagnosed; in a con­ siderable .number, care or observation in a mental hospital was advised. In some of the milder cases, repeated visits were made to the clinic for further study and psycho­ therapy. Four cases were classified as examples of simple adult mal-adjustment, and 2 as psychopathic personality. In 70 cases, the chief problems were of a neurological nature. There were 12 cases of head trauma, and 8 of trauma to the peripheral nervous system. Non-traumatic nerve or plexus lesions occurred in 6 cases, including 2 cases of Bell's palsy. Among a variety of other conditions, one might mention 6 cases of cerebral arteriosclerosis, 4 of paralysis agitans, 2 of acute chorea, 1 of Meniere's syndrome, one of Huntington's chorea, and 1 of acute encephalitis. Epilepsy was definitely diagnosed in 2 cases and strongly suspected in 2 cases. The psychological department of the Foxborough State Hospital, which has con­ tinued to give great help in the work of the clinic, examined a total of 75 patients; 65 Stanford tests, 6 school tests, 2 Kent-Oral tests, 1 performance test, and 1 deterioration study were performed during the year. The Social Service Department under the supervision of Miss Mosely has continued to aid greatly in the work of the clinic, and various social agencies of Brockton and the surrounding communities have been helpful as in previous years. During the course of the year, 60 patients were seen in consultation on the wards of the Brockton Hospital. In closing this report, we wish to express appreciation to Dr. Hollister and the staff of the Brockton Hospital for the cooperation extended. SCHOOL CLINIC Director: Dr. Mary Hammond, psychiatrist, was in charge until her resignation on September 1, 1939. Since October 23, 1939 Dr. Margaret R. Simpson has been in charge assisted by Miss Lillian Shapiro, psychometrist. The clinic histories were obtained by the local school nurses who cooperated with interest and understanding. The school tests are for the most part done by the psy­ chiatrist although in nearly half of the towns this year substitute or regular grade teachers have given the tests in advance of the clinic. The school superintendents, principals, and teachers have been most cooperative. There have been conferences with the superintendents of schools, principals, and teachers, and a few parents, thus promoting better understanding of the child and the clinic's function both in the school system and in the community. All the towns visited have made arrangements for providing school work to the capacity of the backward children. However, special classes and manual training are not available in all of the towns. The school superintendents are now referring behavior problems and personality problems to the clinic. Some of these have been passed on to Child Guidance or Mental Hygiene clinics with excellent results. During the year the school clini c has examined children in the towns of Bellingham, Braintree, Bridgewater, Cohasset, East Bridgewater, Foxborough, Hull, Mansfield, Milton, Needham, Norton, Norwood, Plainville, Sharon, Stoughton, Walpole, Wellesley, Weymouth and Wrentham. The total number of children examined during the past year was 360; 270 boys and 90 girls. The majority of these were referred because of retardation, a small percentage as behavior or personality problems. Pre-school tests were given. The total number found to be feebleminded was: 60; 43 boys, 17 girls. Of these 57 fell into the moron P.D.47 9 group and 3 were classed as imbeciles. The remaining consisted of borderline, dull normal or normal groups. Five children were found to be of superior intelligence. A high pe'rcentage were failing because of reading disabilities of varying degrees of severity. Remedial reading was often recommended as many towns have had their teachers take courses in this subject. The psychiatrist's work included, in addition to the traveling school clinic, the weekly Brockton europsychiatric CliniC, the monthly out-patient clinic at the Boston Psycho­ pathic Hospital and duty as Senior Physician at the Ho pital. The psychometrist's work includes the Traveling School Clinic, Brockton Clinic, Brigg's Law Cases and selected hospital clinics. The total number of cases, not in­ cluding the traveling clinic cases, was 245. At the hospital 98 patients were examined, often more than once. The following lists the types of tests given: Hospital patient, 98 cases: Stanfords, 54; Kent oral tests, 20; deterioration studies, 37; performance tests, 22; memory tests, 3; Otis written te ts, 1. Brockton clinic cases, 69: Stan fords, 65; performance tests, 1; school tests, 6; Kent oral tests, 2; deterioration studie, 1; Brigg's law cases, 23; Stan fords, 21; performance tests, 2; deterioration studies, 1; practical knowledge tests, 6; Kent oral tests, 3.

SOCIAL SERVICE Director: Mis Elizabeth L. Moseley. During the year since December 1, 1938, this Department has dealt with a total of 850 cases (464 male and 387 female). Of these, 505 (291 male and 214 female) were referred to this Department for the first time. This total number divides itself into two main group: first, those patients under commitment to the hospital, which number for the year wa 604 (317 male and 287 female) and those persons dealt with in the community not under commitment, which number for the past year was 246 (146 male and 100 female). Of those patients under commitment to the hospital 281 were cases of new admi sions, and as usual were automatically taken by this Department for a social history and investigation. Of this number 157 were males and 124 females. At this point, it is interesting to note again the large number of acute cases that have been coming to the hospital in the past few years in increasing numbers; for instance, of the 53 new admissions to the hospital during the last 2 months of the past fiscal year - namely, October and November - only 13 were cases of regular commitment; there were 23 admitted under ten-day temporary care papers, 16 for 35-days' observation, and 1 under Section 100 - Observation papers from the court. During the past year another important factor has been the larger number of cases admitted under Section 100 for a period of observation from the court, and a study of those for the past fiscal year shows that there were 19 uch admissions (17 male and 2 female). Their ages ranged from 19 to 82 years. In all of these cases, a very careful and intensive social investigation was made, and it was found that the behavior in all the cases had been such as to warrant observation for the mental condition, although a few of these patients were discharged eventually as" ot Insane" and returned to the court. Several, how­ ever, were committed, either here or to the Bridgewater State Hospital, and one was eventually sent to the Wrentham State School. There have been during the year, a total of 188 patients dismissed from the hospital on prolonged visit, and 10 women in Family Care, all under the supervision of this Department. Of the placements on visit, 84 were men and 104 women (in addition to the 10 under Family Care). Of the Family Care patients, 1 was boarded privately, but the others were all self-supporting, working in private families found through the Social Service. Two of these patients were discharged outright during the year. This hospital has never boarded any such patients in private familie , but plans are being made to do 0 in the next fiscal year, and this Department has investigated a number of homes with this in view. One has been already selected, and we are planning to place 6 women patients there at the beginning of the new year, the State to pay their board. All of these patients in these two groups have been under the general supervision of this Department, and have been seen either by visits made to their home or at one of our Out-Patient CliniCS, or while reporting at this hospital, and frequently both methods have been employed. Thirty-four (34) such patients on visit have been report­ ing to our evening clinic held monthly at the Boston Psychopathic Hospital, where there has been a total of 73 vi its. One member of thi Department always attends 10 P.D.47 this clinic with the psychiatrist, and has held there a total of 85 interviews, 52 with patients and 33 with relatives or friends accompanying them. These interviews are in addition to those held by the physician and deal especially with the social situation in each case. Some of the problems involved in these cases include such things as the question of additional relief needed in the family, the placement of a child, or, perhaps, the return of the children to the home who may have been placed out during the mother's hospitalization, the finding of employment, etc. The question of the patient's adjustment to the ordinary problems of life is, of course, of paramount importance, and much can be done by the social worker in helping him to face his problems, and thus make a satisfactory adjustment so that he will be able to remain out of the hospital. In a few cases, the patient's return to the hospital for a short period of observation has been advised, and we have helped to bring this about. Of the Community cases, not under commitment to the hospital, the largest group has been that of patients coming to our Brockton Neuropsychiatric Clinic, which at least one and usually two members of this Department attend each week. There were in the past year 196 such patients dealt with in this clinic (116 male and 80 female), and a total of 344 interviews was held, 106 with patients and 238 with other interested individuals accompanying them, sometimes relatives and quite often, social workers or nurses, who were interested in the patients and their families. In this Clinic group we have studied the cases of 24 Juvenile Delinquents referred to us from the local district courts as in the past few years. In this group, there were 21 boys and 3 gills; their ages ranged from 1072 to 17, most of them being under 17. One of these, a boy of 16 had been seen in our Clinic in 1938 for the same kind of offense which he was now in court again -namely, breaking and entering in the night-time. Most of the offenses were some kind of stealing, combined usually with breaking and entering; a few were for truancy; one, that of a l4-year old boy, was a sex charge and one, that of a boy of 11, was for assault and battery. Of the cases of the 3 girls, one was 13, one 14, and one 1772. In two of these cases, as might be expected, the de­ linquencies had been chiefly along sex lines, but in the case of the l4-year old girl, the charge was larceny. This leaves a balance of 50 other community cases dealt with. Twenty-nine (29) of this number were cases of retarded school children in the town of Bellingham, who were being seen by our School Clinic, and we were asked to secure histories from the families of these children. This was the only town where we were asked this year to do any of the school clinic work, the histories in the other towns being secured by the local school nurses. Seventeen (17) of the community cases were those of certain prisoners awaiting trial, who were being examined for their mental condition and in regard to whom we were asked to make a social investigation as in recent years. In all of these 17 cases, an intensive investigation was indicated. The balance of 4 cases were either those of patients treated in our hospital Out-Patient Department or, as in two cases, former hospital patients, now discharged, who returned to the social worker for advice. The total number of interviews required for this work during the year was as follows: Interviews at hospital with interested individuals 837 Interviews with patients on the ward . 93 Visits to patients out on visit from the hospital 144 Visits to relatives of patients 451 Visits to social agencies . 260 Visits to other interested individuals (employers, etc.) 1,220 Interviews at Brockton Clinic 344 Interviews at Boston (Psychopathic Hospital) Clinic 85 Interviews in School Clinic Work 46

A total of . . 3,480 TRAINING SCHOOL FOR PSYCHIATRIC NURSING Principal: Miss TIa P. Jackson, R.N., Assistant Principal, Miss Margaret M. Moynihan, R.N. On October 2, 1939, a class of 8 women and 7 men was enrolled. On October 11, diplomas were awarded to 4 women and 3 men. The class of 1940 has an enrollment of 7 women and 4 men, 2 women and 1 man having withdrawn during the year. P.D.47 11 In the attendants' class 12 women and 7 men completed the first year work. The present first year group began with an enrollment of 10 women and 8 men, and 4 women have since withdrawn. In the econd year group 20 women and 12 men completed the course. The present enrollment of the second year attendants comprises 13 women and 4 men, 2 women having withdrawn. Instruction Hrs. Practice Hrs. Lectures and demonstrations 368 In the Occupational Therapy Dept. 198 Recitation periods. 60 In the Continuous Bath Suite .1,565 Examinations . 42 In the Pack Room .2,604 Pack lessons . 31 In the Tonic Bath Suite 221 Continuous Bath lessons 23 In the Drug Room 220 In the Physiotherapy 4 Wks. In the Diet Kitchen 19

RELIGIOUS SERVICES The work of carrying on the religious services was done by clergymen from the town of Foxborough. In addition to conducting the u ual services on Sunday and Christmas D ay they made frequent visits to the Wards and as isted in every way possible in admini tering to the needs of the patients.

MEN'S I NllUSTRIAL Director: Mr. Henry A. Turner. During the year work in the shop was devoted largely to making repairs and the manufacturing of certain new articles. Manufactured: 208 corn brooms, 57 long handle scrub brushes, 129 number 12 window shades, 6 wood horses, 1 table, 1 typewriter table, 1 set desk partitions, 4 shuffle board desks, 1 marking machine bench, 2 ladders, 1 exercisor, 1 arm exercisor, 1 X-ray support, 25 fiy screens, 20 barrels, 2 barrel pungs, 2 paddles, 24 plug , 2 bulletin boards, 3 name boards, 2 carving boards, 1 card box, 9 shuffieboard packs, 1 shelf, 8 delivery boxes, 16 sand bags, 4 indestructible mattresses, 4 strong mattresses, 45 indestructible mattress covers, 44 mattress ticks, 188 pillows, 637 yards of toweling. Repaired: 730 shoes nailed soled, 200 shoes stitched soled, 878 shoes heeled, 516 shoes patched, 91 window sha.des, 4 screens, 2 bed side screens, 102 brushes, 304 handles, 37 desks, 2 book cases, 16 benches, 19 tables, 926 chairs, 207 chairs scraped, 212 chairs recaned, 31 clocks, 11 drawers, 10 dishwasher trays, 111 mop pails, 48 bed feet turned, 1 batter mixer rehandled, 48 trays, 24 cups, 2 double mattresses, 439 mattresses, 3 box springs, 12 chairs uphol tered, 2 couches uphol tered, 1 suite furnitw·e uphol tered, 2 office chairs upholstered, 252 leather articles, 31 spectacles, 29 scissors sharpened, 1 lock, 1 laboratory sli cing machine, 1 miscroscope case, 1 camera bellows installed, 8 saws sharpened, 1 tIUSS, 4 pictures framed, 1 bass violin, 1 card file, 1 exercisor, 2 lawn edgers sharpened, 1 garden shears rehandled, 1 stretcher cart, 1 pencil sharpener in­ stalled, 2 rugs rebuilt, 806 pes. clothing pressed, 749 pes. clothe. Canned: 3,172 cans string beans, 5,799 cans tomatoes.

WOMEN'S INllUSTRlAL Charge of Sewing: Mrs. Theresa Boyden. The usual amount of manufacturing was done from new materials which are needed in great variety for distribution throughout the institution. The following articles were made in this industry: 27 dozen waitress aprons, 12Y2 dozen coveralls, 2 dozen oil cloth, 4 collar cuff and apron sets, 8 dozen bed bags, 4 bra sieres, 8 book bands, 54 dozen bedgowns, 8 tea bags, 12 bottle bags, 6Y2 dozen I aundry bags, 9 2/3 dozen canvas bags, covers, 22 hydro; 18 hammocks, 3 dozen cover straps, 4Y2 dozen bread covers, 4 dozen screen covers, 10 extractor covers, 11 Y2 dozen ironing board covers, 5 dozen bed pan covers, 8 dozen bw·eau covers, 3 bed puff covers, 2 couch covers, 28 pairs sash curtains, 10 pairs shower curtains, 106 pairs drapery curtains, 29U dozen combinations, 12%: dozen kitchen coats, 54 dozen dresses, 26Y2 dozen strong dresses, 12 dozen pa.irs garters, 20 dozen mattress ticks, 48Y2 dozen night dresses, 9Y2 dozen pillow ticks, 7Y2 dozen pan holders, 335Y2 dozen pillow cases, 240Y2 dozen sheets, 4 dozen pack sheets, 11 dozen draw sheets, Y2 dozen restraint sheets, 24 dozen tie sheets, 20Y2 dozen shroud sheets, 6 1/3 dozen rubber sheets, 1Y2 dozen laparotomy sheets, 73 dozen shirts, 2 dozen surgeons and dentist gowns; surgical supplies; 1 dozen mayo covers, 1 dozen sculitus binders, 8 instrument covers, 2 masks, 5 rubber 12 P.D.47 pillows, 3 dozen isolation gowns, 1 dozen smocks, 6172 dozen dress slips, 8%; dozen table cloths, 15 table pads, 413 dozen bath towels, 174 dozen hand towels, 238 dozen dish towels, 74 dozen dentist towels. Charge of Mending: Miss Mellow MacMillan. Articles mended are as follows: 3,180 aprons, 326 smocks, 1,394 blankets, 1,958 slips, 117 strong blankets, 5,014 shirts, 456 bath robes, 2,969 undershirts, 1,835 bloomers, 514 sweaters, 379 combinations, 419 table cloths, 595 coats, 9,045 stockings, 450 covers-hydro, 77 screen covers, 244 board covers, 26 baker covers, 107 extractor covers, 1,549 trousers, 689 towels, 121 rugs, 4,489 drawers, 155 curtains, 6,291 dresses, 1,987 strong dresses, 790 unionsuits, 58 kimonos, 214 scarfs, 714 laundry bags, 1 altar cloth, 262 mattress ticks, 4 couch covers, 6,840 nightdresses, 4 flags, 246 overalls, 4 rubber sheets, 215 pajamas, 26 pillow tops, 844 pillow cases, 4 napkins, 6,572 sheets, 7 doilies, 1,989 spreads, 8 pillow ticks. Charge of Marking: Miss Josephine MacMillan. Nearly all manufactured articles require marking before distribution and all articles of wearing apparel whether home furnished or provided by the hospital are marked for the individual patient to whom they are furnished. LAUNDRY Charge of Laundry: Mrs. Ina F. Veno. Approximately 3,592,612 pieces were laundered during the year. The new building and additional facilities have contributed greatly to the satisfactory operation of the plant.

POWER PLANT Chief Engineer: Mr. William W. White. Under maintenance many minor changes have continued to be made in the power plant to ensure a more efficient and more economical operation. The relatively smaller amount of fuel consumed during the year showed a decided increase in efficiency. In 1938 a Special Appropriation was obtained for the installation of steam lines along Baker Street to provide heat for an employees' home and several cottages. The amount was insufficient to complete the work during that year but a small additional sum was obtained as a Repair and Renewal and the installation was completed in time to be put in operation in the early fall. This change has proven to be very satisfactory and it is expected that it will result in a marked economy in fuel and labor. During the Spring thaw and heavy rains water reached the settings of one of the boilers from beneath and caused considerable damage which had to be repaired. It is believed that to provide permanently against such recurrence it will be necessary to install a rather extensive drainage system about the power house and vicinity. The new turbine engine has continued to operate very satisfactorily. Much time was devoted towards centralizing storage of supplies but this is considered something well worth while as it has now made possible a much more rapid distribution of materials and supplies. Additional radiation was installed in the industrial shop, ward dining room of the E. Building, sewing room, temporary vegetable storage room, new employees' dining room, dairy and at various points in the ward buildings. A new boiler was installed in the dairy. New reducing valves, traps and pipes were installed in the heating system in buildings B, D, and E. Sewage beds at the Colony Farm were put in operation in the early summer. Thus far they have been very satisfactory in their operation and appear to be adequate to meet the present and future needs of the Colony. By use of the acetylene welding machine and facilities afforded by the machine shop and blacksmith shop many things were manufactured and repaired with the almost exclusive use of salvage materials which would otherwise have been a loss. Fire Protection: Additional fire extinguishers, some of special type, were purchased and installed where needed. All hose outlets were tested for pressure and locks were installed on reserve and main valves. The systematic inspection gives a monthly record of the condition of all apparatus. Fire drills were carried on routinely and participated in by both patients and em­ ployees. ENTERTAINMENT As much time as possible was devoted to the entertainment of patients in the open air during suitable weather. Several croquet sets were placed on the lawn. Many games of soft ball were played by both male and female patients. Having a number of P.D.47 13 these games at twilight made it possible to have teams from outside come to the hospital and on such occasions as many patients as possible were permitted to witness the games. The ho pital orchestra composed mostly of employee personnel has continued to provide good music for many occasions including the weekly dances. Other functions as conducted by the Occupational Therapy Department will be found elsewhere in the report of that Department.

REPAIRS Maintenance Foreman: Mr. George P. Clark. In addition to the routine work of maintenance this department was able to carry out a number of projects. The major portion of the work of rebuilding the stone crusher was done in the previous year under a P.W.A. project but it was carried to completion by our own repair department in the year 1939. Many thousand feet of lumber obtained as a result of the hurricane were planed and prepared for use. Under a repail' and renewal job a cobble stone garage was constructed at Cottage E. The land to the rear of the main buildings was surveyed and the major portion of grading was completed in the development of the new recreation field. Under the supervi ion of this department and a W.P.A. project grading and seeding at Cottages Band E and the rough grading at the Assembly Building was completed. In addition, groups of patients working outside prepared a great deal of loam for grading.

FARM Head Fanner: Mr. Charles Thurston. The farm was unusually productive during the year in spite of unfavorable weather conditions during part of the season. The yield in squash and onions was particularly good. The apple crop was fair and the straw­ berry crop unusually large. Total profits for the year after all cost of labor and materials had been deducted amounted to $16,213.66. The production as sununarized was as follows: Milk produced, 614,445.1Ibs., milk fed calves, 5,137.7Ibs., milk spillage, 9,941.1 (more than 50% till'own away on account of sickness); cows freshened, 39; cows sold, 8; cows destroyed, 2; heifers freshened, 17 ; heifers aborted (No. 309), 1; calves raised, 14; calves old, 41; calves died, 3; calves destroyed, 2; calves transferred to bulls, 1; calves transferred to heifers, 13; eggs produced, 131,364; hens killed, 774; hens killed unfit for food, 17; hens died, 152; chicks purchased, 1,220; chicks died, 111; chicks killed, 158; chicks transferred, 951. Hay and Green Feed Production: Green alfalfa, 43,970 lbs.; clover hay No.2, 9,650 Ibs. ; corn fodder, 75,370 lbs.; green hay, 136,400 Ibs.; meadow hay, 725 lbs.; millet, 62,110 lbs.; oats and peas, 15,230 Ibs.; rowen, 1,200 Ibs.; Timothy No.1, 9,570 Ibs.; Timothy No.2, 6,850 Ibs.; chicken, 431%, lbs.; fowl, 3,40172 lbs.; broilers, 416 Ibs. Fruit and Vegetable Production: Apples No.1, 12,230 Ibs.; apples o. 2, 6,731 Ibs.; pears, 235 Ibs.; quince, 80 Ibs.; raspberries, 36~ lbs.; strawberries, 11,706~ Ibs.; asparagus, 1,75872 Ibs.; shell beans, 1,702 Ibs.; string beans, 28,774 Ibs.; beets, 24,685 lbs.; beet greens, 6,256Ibs.; broccoli, 889Ibs.; cabbage, 47,952Ibs.; carrots, 27,852Ibs.; cauliflower, 74972 lbs.; swiss chard, 6,320 Ibs.; sweet corn, 27,721 Ibs.; cucumbers, 25,34772 Ibs.; dandelion, 5,692Ibs.; egg plant, 1,84072 Ibs.; lettuce, 8,840 Ibs.; onions, 19,179 Ibs.; parley, 272 lbs.; parsnips, 14,066 Ibs.; green peas, 1,395 Ibs.; peppers, 5,258 Ibs.; pumpkins, 10,835 lbs.; radish, 285 Ibs.; rhubarb, 5,568 Ibs.; scullions, 1,148 Ib .; spinach, 14,303 Ibs.; summer squash 18,859 Ibs.; winter squash, 102,62572 Ibs.; tomatoes, 86,278 Ibs.; turnips, 44,266Ibs.; onion sets, 2,650 Ibs.; brussel sprouts, 23572 Ibs.; vegetable tops, 13,930 Ibs.

REPAIRS AND RENEWALS The sum of money appropriated for use under Repairs and Renewal for 1939 was allocated as follows: Stair grill and window guards, $357.92; fire protection, $581.31; cement mixer, $781.06, kitchen equipment, 1,344.66; operating room window and balcony glas , $162.52; X-ray equipment, 183.26; medical equipment, $128.62; par­ tition between toilet and wash-room, $352.38; tray trucks, 700; brooder house, $3,279.45; laundry machine, $3,519.86; completion steam lines, 1,000. By the close of the year these projects were mostly completed. 14 P.D.47 SPECIAL ApPROPRIATIONS The sum of $7,500 was appropriated for the completion of the Hydro-therapeutic Suite in the basement of ward building E. When this project is completed, this suite and the one completed in the previous year in the basement of ward building 0 will provide adequate facilities for this highly important form of treatment for both men and women patients. In 1938 the sum of $15,000 was appropriated for the purchase of property bordering along Payson Road. During the latter part of 1938 and the early part of 1939 title was acquired to six pieces of land leaving only one yet to be purchased. It is hoped that in the near future the hospital will come into possession of the highway known as Payson Road and thus eliminate a serious menace which has existed because of the large amount of vehicular traffic and provide additional space for the recreational life of the patients. The large portion of the hen house at the main hospital which was destroyed in the hurricane of 1938 has not yet been replaced. Inasmuch as the building formerly used as a piggery and now as a hennery is not well suited for its present purpose, it is hoped that an appropriation can be secured in the near future to build a suitable hennery at the Colony Farm to be used in conjunction with the brooder house constructed there under a Repair and Renewal granted in 1939. In order to provide adequate facilities for the proper classification of disturbed patients and for medical and surgical treatment of sick patients and sick employees, alterations and additions to certain buildings are necessary and a new medical and surgical building must be constructed. The resulting increase in accommodations for patients would bring up the capacity to 1,600. A larger institution could be administered more economically and more satisfactorily. Twenty-six women employees are still housed on the second floor of ward Building C where they are subjected to the noise of disturbed patients on either side. The interior of the building is of wooden con­ struction and the plumbing is obsolete. We believe that it is necessary that this build­ ing be reconstructed, taken for the use of patients in its entirety and recommend that the project be combined with that of the remodelling of Building 0 which taken together can provide beds for ninety-two patients additional at an estimated cost of approxi­ mately $157,000.00. This would make it necessary for the employees to be given lieu of maintenance and reside in the community. The increase in the number of patients and employees has made greater demands on the facilities afforded by our Kitchen and Dining Room Service than they are able to meet and it is impossible to satisfactorily and economically prepare and serve food. We recommend that the Kitchen and Dining Room Building be remodelled and an addition constructed for the installation of a cafeteria system which has proven so s::.tisfactory in other institutions. This would include a remodelling or relocation of the bakery which is poorly located, small, and inadequate and the installation of addi­ tional equipment in the kitchen which is very greatly needed. Estimated cost $150,000. Cottage A and Cottage C are of wooden construction and used as quarters for em­ ployees. A sprinkler system should be installed ~n these buildings at an estimated cost of $1,000. . The hospital garage is small and quite inadequate to properly care for the motor vehicle equipment and at the same time provide adequate facilities for the storage of the fire engine and the other fire fighting equipment. It is proposed to locate a new garage building in the rear of the main bUilding at an approximate cost of $13,000 and use the present garage for fire equipment. For several years the old assembly building has been made use of for the purpose of vegetable storage. In order that undue loss may be prevented and the vegetables served in the best possible condition, certain changes should be made in the building and apparatus installed. To fully meet the requirements of the Department of Public Safety, certain changes and additions should be made in Cottage C which is occupieq. by employees. Alterations to the barn at the Colony Farm are needed and a grounds lighting system should be installed. We believe that two additional parcels of land should be purchased at an estimated cost of $10,650 along the southern boundary of the hospital to square up the land now owned by the institution and at the same time make possible a site for the relocation of Chestnut Street with the elimination of passing of a public highway through the grounds and dangerous high speed traffic. P.D.47 15

ACKNOWLEDGMENTS In the work of conducting our activities outside the hospital such as out-patient clinics, traveling school clinics, a great deal of as istance has been obtained from welfare workers, the Brockton Hospital and the Superintendents of Schools of the various districts to which the clinic was assigned. We would take this opportunity of expressing our appreciation of the courtesy and assistance extended to us. Throughout the year the American Legion and the American Legion Auxiliary, the Veterans of Foreign Wars and the Veterans of Foreign Wars Auxiliary have continued to make regular visits to the Ex-Service men. In addition to providing confectionery and other delicacies, they have arranged programs for the entertainment of the veterans on each visi t. M'any magazines and books have been contributed by persons interested in the hospital and have tended to greatly increase our circulation of books and periodicals. I would take this opportunity of expressing my appreciation for the assistance rendered by the hospital per onnel in carrying on the work of the institution and the members of the Board of Trustees for their helpful advice and upport. Respectfully submitted, RODERICK B. DEXTER, Superintendent. VALUATION November 30, 1939 Real E.tate, Land 350.56 acres . . 37,685.00 Buildings and betterments 2,322,812.49 2,360,497.49 FI ANCIAL REPORT To the Department of Mental Health: I respectfully submit the following report of the finances of this institution for the fiscal year ending ovember 30, 1939.

STATEMENT OF EARNINGS Boa rd of patients 858,062.99 Personal services 206.39 Sales: Food. . . . . 5-17.51 Clothing and materials . . . l.00 l!'urnishings and household supplies 48.96 Medical and general care . . 79.02 Heat and other plant operations. l.00 Garage and grounds 4.65 Repairs ordinary . 422.34 Miscellaneous: Junk ...... l.00 Farm: (vegetables, 53.65; calves, 266.05; bags, 8.86; cows, 477.08; wood, 150; harrow, 81) 956.64 Total Sales 2,062.12 Miscellaneous $4.50 Rents, House 240.00 Rents, Garage . . . . . 52.16 Tew England Tel. & Tel. Co., Comm. 64.52 Total Miscellaneous 361.18 Total earnings for the year ...... 60,692.68 Total cash receipts reverting and transferred to the State Treasurer 60,702.48 Accounts receivable outstanding Dec. 1, 1938 . 8182.58 Accounts receivable outstanding Nov. 30, 1939 . 172.78 Accounts receivable decreased . 9.80 MA;NTE~AN~E A~pno'pnIATloN' Balance from previous year, brought forward 1,420.62 Appropriation, current year 588,192 .74 Total . . $589,613.36 Expenditures as follows: Personal services 5341,536.69 Food. . . . . 102,452.79 Medical and general care 13,012.84 Religious instruction 1,360.00 Farm . . . . . 16,728. 34 Heat and other plant operation. . 45,045.23 Travel, transportation and office expenses 6,665. 70 Garage, $3,388.70 ; and grounds, 8396.24 3,784.94 Clothing and materials. . . 12,433.64 Furnishings and household supplies 22,683.93 Repairs ordinary 8,737.48 16 P.D.47 Repairs and renewals 8,519.17 Total maintenance expenditures $582,960.75 Balances of maintenance appropriation, Nov. 3D, 1939 6,652 . 61 $589,613.36 SPECIAL ApPROPRIATIONS Balance December I, 1938, brought forward $60,377 .05 Appropriations for current year . . 7,500 . 00 Total ...... $67,877.05 Expended during the year (see statement belo.v) $44,190 . 90 Reverting to Treasury of Commonwealth . *96.18 44,287.08 Balance November 30, 1939, carried to next year $23,589.97

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

Laundry building and equipment, M.S.P. M-8 . . . . $104,987.77 540 . 00 5104,932.78 1\54 . 99 A ..embly building and tunnel, M.S.P. M-31 131,232.59 - 130,046.90 1,185 . 69 Relocation "E" B~ildi~g toilets . 1937 8,000.00 - 7,903.82 *96.18 Completing and equipping hydro- therapeutic suite . . . 1937 2,430.67 65 .82 2,409.36 21.31 Relocating Hydrotherapeutic suite 1938 17,500.00 1,562.46 9,979.84 7,520.16 Sprinkler system e..l(tension . . 1938 3,000.00 2,108.64 2,127.44 872.56 Purchase of land. . . . 1938 15.000.00 12,128.19 12,136.29 2,863.71 Sewage disposal, Hersey Farm . 1938 14,000.00 3,858.09 13,975.71 24.29 Renovation of Rteam and hot water lines 1938 9,500.00 786.97 9,195.53 304 .47 Hurricane and floo"d da~ag~ 1938 34,600.00 23,640.73 23,857.21 10,742.79

PER CAPITA During the year the average number of patients has been 1,440.910. Total cost of maintenance, $582,960.75. Equal to a weekly per capita cost of (52 weeks to year), $7.7803. Total receipts for the year, $60,858.92. Equal to a weekly per capita of $0.8122. Total net cost of maintenance for year, $522,101.83. Net weekly per capita, $6.9681. Respectfully submitted, HARRIET S. BAYLEY, Treasurer. Financial statement verified. Approved: GEO. E. MURPHY, Comptroller.

STATISTICAL TABLES As ADOPTED BY THE AMERICAN PSYCHIATRIC ASSOCIATION, PRESCRIBED BY THE MASSACHUSETTS DEPARTMENT OF MENTAL HEALTH TABLE 1. General Information (Data correct at end of institution year November 30, 1939) Date of opening as a hospital for mental diseases: August, 1914. Type of hospital: State. Hospital plant: Value of hospital property . $37,685.00 Real estate, including buildings 2,322,812.49 Personal property . 372,177.20 Total ...... $2,732,674.69 Total acreage of hospital property owned, 352.4. Additional acreage rented, 23.5. Total acreage under cultivation during previous year, 170.5. Officers and employees: Actually in Service Vacancies at End at End of Year of Year M . .1<'. T. M . F. T. Superintendents . 1 1 Assistant physicians 6 2 8 Clinical assistan ts . 1 1 Total physicians 8 2 10 Stewards. . 1 1 Resident dentists 1 1 Pharmaciste . 1 1 Graduate nurses . . 7 33 40 Other nurses and attendants 77 61 138 7 7 Occupational therapists 2 2 1 1 P.D.47 17 Social workers . . . 3 3 All other officers and employees 73 54 127 Total officers and employees 168 155 323 8 9 Classification by Diagnosis September 30, 1939 Census of Patient Popuintion at end of year: Actually in Hospital M.. F. T. WHITE: Insane 622 722 1,344 52 67 119 Total 622 722 1,344 52 67 119 OTHER RACES: Insane 29 20 49 Total 29 20 49 Grand Total 651 742 1,393 52 67 119 M. F. T. Patients under treatment in occupational-therapy classes, includiD~ physical training, on date of report ...... 49 18 67 Other patients employed in general work of hospital on date of report 305.547 188.834 494.381 Average daily number of all patients actually in hospital during year 664.369 759.569 1,423.938 Voluntary patients admitted during year ...... 1 2 3 Persons given advice or treatment in Qut-p:ltient clinics during year 153 124 277 >-' 00 TABLE 2. Movement of Patient Population for the Year Ended Septembel' 30, 1939 (Datn in all of the following tables are based on the Statistical Year, October I, 1938 to September 30,1939)

I REGULAR COURT T E MPORARY TOTAL COMMITMENT OBSERVATION CARE VOLUNTARY (INSANE)

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

Patients on books at the beginning of t he year : In h ospital . . . 649 756 1,405 647 751 1,398 2 2 4 - 2 2 - 1 1 On visit or otherwise absent 52 67 119 52 67 119 ------Total 701 823 1,524 699 818 1,517 2 2 4 - 2 2 - 1 1 Admissions during ye~r: First admissions 134 95 229 105 76 181 21 13 34 8 4 12 - 2 2 Readmissions . 48 37 85 40 32 72 6 4 10 1 1 2 1 - 1 Total admjss i o~s 182 132 314 145 108 253 27 17 44 9 5 14 1 2 3 Transfers from otber me'ntal'hospitals 2 7 9 2 7 9 ------T otal received during year . . 184 139 323 147 115 262 27 17 44 9 5 14 1 2 3 T otal on books during year . . 885 962 1,847 846 933 1,779 29 19 48 9 7 16 1 3 4 D ischarged from books during year : As recovered. . . . . 23 23 46 13 15 28 7 7 14 3 - 3 - 1 1 As improved. . . . . 34 43 77 30 33 63 3 5 8 1 3 4 - 2 2 As unimproved . . . . 10 3 13 4 3 7 6 - 6 ------As without psychosis . . . 13 8 21 - 1 1 12 5 17 1 2 3 - - - Total discharged to community 80 77 157 47 52 99 28 17 45 5 5 10 - 3 3 Transferred to other menta l hospi tals 40 34 74 40 34 74 ------Died during year ...... 62 42 104 58 39 97 - 1 1 4 2 6 - - - Total discharged, transferred a nd died during year . 182 153 335 145 125 270 28 18 46 9 7 16 - 3 3 Patients remaining on books of hospital at end of year : I n hospital . . . 651 742 1,393 649 741 1,390 1 1 2 --- 1 - 1 On visit or otherwise absent 52 67 119 52 67 119 ------Total 703 809 1,512 701 808 1,509 1 1 2 - - - 1 - 1

-- -~------

SUPPLEMENTARY DATA Male Female Total Average daily number of patients on books during year 717.13 831. 34 1,548.47 Actually in institution during year. . . . . 661. 25 773 . 26 1,434 .51 In family care 4.34 4.34 On visit 52.15 53.32 105 .47 On escape ...... 3.73 .42 4.15 Number of pa tients actually remaining in institution September 30, 1939: State . 596 628 1,224 Reimbursing ...... 55 114 169 1-0 N umber of patients in family care September 30, 1939 3 3 Self-supporting . 3 3 t:J H'­ --l P.D. 47 19

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

PARENTS OF lVI ALE PARENTS OF FEMALE PATIENTS PATIENTS PATIENTS NATIVITY Both Both M. F. T. Fathers Mothers Parents Fathers Mothers Parents United States 98 75 173 64 55 49 42 37 31 Austria ' - 1 1 - - - 1 1 1 Belgium 1 - 1 1 1 1 - - - Canada! 10 10 20 13 19 10 12 17 10 Cuha - - - - 1 - - - - England - 1 1 2 3 1 4 6 3 Finland - 1 1 - - - 1 1 1 France - 1 1 - - - 1 1 1 Germany - - - 1 1 1 1 1 1 Ireland 10 3 13 27 25 22 16 15 12 Italy. 7 - 7 11 11 11 6 5 5 Poland 1 1 2 4 4 4 1 1 1 Portugal 4 - 4 5 6 5 - - - Russia - - - I 1 1 1 1 1 cotlnnd - - - 1 - - 3 4 2 Sweden 2 1 3 2 2 2 2 1 1 Other CountrieS 1 1 2 1 1 I 1 1 1 Unknown . - - - I 4 1 3 3 1 Total 134 95 229 134 134 109 95 95 72

1 (Persons born in Hawaii, Porto Rico and the Virgin 1 lands should be recorded as born in the United States.) 2 Includes Newfoundland. t>:) o T ADLE 4. A ge of First Admissions Classified with Reference to Nativity, and Length of Residence in the United S tates 0/ the F01'eign Born

NATIVE BORN FOREI GN BORN

PARENTAGE TIME IN UNITED STATES BEl<~ ORE AGE AT Aggregate ADMISSION A DMISSI ON Total Total Foreign Mixed Native Unknown Under 10- 14 15 years Unknown 5 years years and over 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 1 2 ------1 1 2 ------15-19 years . 7 6 13 7 5 12 3 - 3 1 1 2 3 3 6 - 1 1 - 1 -1 ------1 1 --- 20- 24 years . 6 6 12 6 5 11 2 1 3 -- - 4 4 8 -- - - 1 1 -- - - 1 1 ------25-29 years . 10 11 21 8 11 19 5 5 10 1 2 3 1 4 5 1 - 1 2 - 2 ------2 - 2 - - - 30- 34 years . 9 9 18 7 8 15 1 4 5 3 3 6 3 1 4 - - - 2 1 3 - 1 1 1 - 1 1 - 1 - - - 35- 39 years . 11 11 22 10 10 20 4 2 6 - 4 4 5 3 8 1 1 2 1 1 2 - --- 1 1 1 - 1 - - - 40-44 years . 11 11 22 9 7 16 2 2 4 4 1 .5 3 3 6 - 1 1 2 4 6 ------2 4 6 --- 45-49 yeltrs . 10 5 15 5 4 9 1 1 2 2 1 3 2 2 4 - - - 5 1 6 -- - - 1 1 5 - 5 --- 50- 54 years . 12 7 19 9 5 14 2 1 3 3 1 4 4 2 6 - 1 1 3 2 5 -- - 1 - 1 2 2 4 - - - 55-59 years . 12 1 13 8 1 9 1 - 1 1 - 1 5 1 6 1 - 1 4 - 4 ------4 - 4 - - - 60-64 years . 7 4 11 4 4 8 2 1 3 - -- 1 3 4 1 - 1 3 - 3 ------3 - 3 - - - 65- 69 years 8 6 14 4 4 8 1 2 3 - -- 3 2 5 - - - 4 2 6 - - - 1 - 1 2 2 4 1 - 1 70- 74 years . 13 6 19 7 4 11 2 2 4 1 1 2 4 - 4 - 1 1 6 2 8 ------6 2 8 -- - 75-79 years . 5 4 9 4 2 6 - 1 1 2 - 2 2 1 3 - - - 1 2 3 ------1 2 3 - - - 80- 84 years . 9 5 14 7 3 10 1 2 3 - - - 6 1 7 - - - 2 2 4 ------2 2 4 - - - 85 years and ave; 3 2 5 2 1 3 - 1 1 --- 2 - 2 - - - 1 1 2 ------1 1 2 --- Total 134 95 229 98 75 173 27 25 52 18 14 32 49 31 80 4 5 9 36 20 56 - 1 1 3 3 6 32 16 48 1 - 1

------

TABLE 5. Citizenship of First Admissions Males Females 'fota l Citizens b y birt h . 99 75 174 Citizens by naturalization 21 11 32 Aliens . 11 6 17 F irst papers . . 2 2 Citizenship unknown . 3 1 4 'lj Total 134 95 229 ~ .... --I P.D. 47 21

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

With syphilitic With With With With TOTAL meningo- other epidenlic other Alcoholic cerehral RACE encepha- forms of encepha- infectious psychoses arterio- litis syphilis litis di eases sclerosis

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

African (hlack) 2 2 Dutch and Flemish 1 1 1 - English 15 15 30 7 2 9 Finnish 1 1 French 5 7 12 1 - German 1 1 Hehrew 1 1 2 lri,h 34 19 53 1 1 7 8 7 5 12 Italiani 11 6 17 2 - 2 1 1 2 Lithuanian 1 1 Portuguese 3 3 2 - 2 Sca,ndinavian2 2 1 3 ~ catch 5 5 Siavonic3 3 1 4 Other speCific races 1 1 Mixed 51 36 87 2 - 2 3 4 8 9 Race unkno'wn 4 2 6 1 1 Total 134 95 229 5 - 5 2 2 14 3 17 27 10 37

T ABLE 6. Race of First Admissions Classified with Reference to Principal Psychoses - Continued

With With other With Involu- Due to organic disturh- convulsive Senile tional other changes of Psycho- ances of disorders psychoses psychoses metabolic nervous neuroses RACE circula- (epilepsy) diseases, system tiOD etc. M. F.T. M.F.T. M. F. T. M. F. T. M.F.T. M . F. T. M.F.T.

African (black) Dutch and Flemish English 2 2 Finnish French 2 1 - German Hehrew - 1 1 Irish . 2 4 6 2 3' 5 3 3 2 Italianl 2 - 2 Lithuanian Portuguese Scandina vian2 1 - Scotch Slavonic'. . 1 - Other specific races ~/llxed . 1 2 2 7 9 3 4 2 5 2 7 2 2 Race unknown 1 - 1 Total . 3 4 4 5 4 15 19 6 4 10 2 13 3 16 3 2 5

J Includes "North" and "South." 2. Norwegians, Danes and Swedes. :I Includes Bohemian, Bosnian, Croatian, D almatian, Herzegovinjao, Montenegrin, :h1oraviao, Polish, Russian, Ruthenian, Servian, Slovak, Slovenian. 22 P.D. 47

T ABLE 6. Race of First Admissions Classified with Reference to Principal Psychoses - Concluded

With Manic- Paranoia psycho- With Primary depressive Dementia and pathic mental Without behavior RACE psychoses praecox paranoid person- deficiency psychoses disorders conditions ality

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

African (black) Dutch and F lemish English 2 2 4 2 3 2 2 4 Finnish. French . 2 3 German Hebrew 1 1 Irish 2 2 4 5 5 2 3 4 Italian l : 2 3 1 2 2 1 2 Lithuanian 1 - 1 Portuguese 1 - Scandinavia~2 Scotch 1 1 Slavonic' 1 2 1 - Other specifi~ rac;" - 1 1 Mixed 4 5 9 13 8 21 1 2 - 2 2 2 3 5 6 Race unkno~n 1 1 2 - 2 1 1 Total 9 11 20 25 17 42 5 5 10 - 3 3 4 6 10 12 6 18 - 1

1 Includes "North" and "South." 2 Norwegians, Danes and Swedes. 3 Includes Bohemian, Bosnian, Croatian, Dalmatian, HerzegoviniaD, Montenegrin, Moravian, Polish Russian, Ruthenian, Servian, Slovak, Slovenian.

T ABLE 7. Age of First Admissions Classified with Reference to Principal Psychoses

0-14 15-19 20-24 25-29 TOTAL years years years years PSYCHOSES ------1---1----1----1---- M. F. T. M.F.T. M.F. T. M.F. T. M. F. T.

With syphilitic meningo-encephalitis . 5 5 With other forms of .yphillis 1 1 2 With epidemic encephalitis. 1 1 With other infectioUfl diseases 1 1 2 Alcoholic psychoses . . 14 3 17 With cerehral arteriosclerosis . . 27 10 37 With other disturbances of circulation 3 1 4 With convulsive disorders (epilepsy) 1 4 5 Senile psychoses . 4 15 19 I nvolutional psychoses . . 6 4 10 Due to other metabolic diseases, etc. 1 1 2 1 1 With organic changes of nervous system 13 3 16 1 1 Psychoneuroses . . . 3 2 5 1 1 Manic-depressive psychoses . 9 11 20 1 1 1 1 1 1 Dementia praecox . . . 25 17 42 4 3 7 4 3 7 5 4 9 Paranoia and paranoid conditions 5 5 10 W ith psychopathic personality 3 3 With mental deficiency . 4 6 10 2 3 1 - 2 2 Without psychoses . . 12 6 18 1 1 1 - 4 1 5 Primary behavior disorders 1 1 - ---1- - ·1---1-- - -1- - - - 1----- Total 134 95 229 2 7 6 13 6 6 12 10 11 21 P.D.47 23

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

With syphilitic meningo-enceph- alitis. . . . . 2 - 2 2 - 2 With other forms of syphilJis 1 - With epidemic encephalitis With other infectious diseases Alcoholic psychoses. . 1 - 3 4 3 4 2 3 2 - 2 1 - With cerebral arteriosclerosis . 1 With other disturbances of circu- lation . . . . . 1 - With convulsi,'e disorders (epil.) 1 - Senile psychoses. . . . Involutional psychoses . . - 1 2 3 2 - 2 3 - 3 Due to other metabolic diseases, etc...... \Vith organic changes of nervous system . 1 2 1 - 1 1 - 1 1 - 2 - 2 Psychoneuroses. . . 1 1 2 1 - 1 Manic-depressive psychoses 1 2 224 1 2 2 2 4 2 - 2 Dementia praecox . . . 426 235 224 3 3 Paranoia and pa ranoid conditions 1 2 3 - 2 2 1 - 1 2 With psychopathic personality 1 1 1 1 1 With mental deficiency . 1 1 1 Without psycho es . . 1 - 3 3 3 4 1 - Primary behavior disorders 1 Total 1--9---9--18- 1 -1-1--1-1-2-2- 1 --l-l -1-1--22-I-l-~---~-I-~-1 --12--7--1-9- --12----1-3-

T ABLE 7. Age of First Admissions Classified with Reference 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 . With other f~rms' of syphiWs With epidemic encephalitis 'Vith other infectious diseases 2 - 2 ~f~hh ~ ~~eb~it~~:::ios~ lero;is 4 5 3 2 5 9 2 11 3 2 5 8 9 With other disturba nces of circ';- lation 2 - 2 With convulsivedlsorcters (~p il. i 1 1 Senile psychoses . . . . - 2 2 - 2 2 - 4 4 2 2 4 4 5 2 Involutional psychoses . . Due to other metabolic diseases, etc. Wit h organic' c h a~ges ~f ne~vou~ system 2 - 2 2 - 2 3 - 3 PsychODeu r~es Manic~depressive' PSY~hose"s 2 - 1 Dementia praecox . . . Paranoia and paranoid conditions With psychopathic personality With mental deficiency . Without psychoses . . Primary behavior disorders

Total 7 4 11 8 6 14 13 6 19 5 4 9 9 5 14 3 2 5 ::;e

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

Reads and Common High TOTAL Illiterate Writes School School College PSYCHOSES --,--1--11----;------M. F. T . 1 M. F. T. 1 M. F. T. 1 M. F. T . 1 M . F . T. 1 M. F. T. --'--1--1---- With syphilitic tneningo-encephalitis . 5 5 3 3 2 2 With other forms of syphilis 1 1 2 1 1 With epidemic encephalitis 1 1 1 With other infectious diseases 1 1 2 1 1 2 Alcoholic psychoses . . 14 3 17 2 3 G 2 8 3 3 2 2 With cerebral arteriosclerosis . . 27 10 37 4 5 IG 7 23 426 2 2 With other disturbances of circulation 3 1 4 2 2 1 1 1 1 With convulsive disorders (epilepsy) 1 4 5 1 2 3 2 2 Senile psychoses . 4 15 19 2 4 6 2 10 12 1 1 Involutional psychoses . . . 6 4 10 2 2 3 1 4 3 4 Due to other metabolic diseases, etc. . 1 1 2 1 1 With organic changes of nervous system. 13 3 16 7 8 426 Psychoneuroses . . . 3 2 5 1 1 224 Manic-depressive psychoses 9 11 20 5 7 12 325 2 3 Dementia praecox . . . 25 17 42 2 2 3 4 7 1 10 7 17 9 6 15 1 Paranoia and paranoid conditions 5 5 10 1 1 2 2 2 2 4 3 3 With psychopathic personality 3 3 2 2 1 1 With mental deficiency 1 6 10 358 1 2 Without psychoses 12 6 18 1 1 2 3 1 5 4. 9 4 5 P ri mary behavior disorders 1 1 1 1 Total - 134 '% 1 229 1 10 7 17 1 20 11 31 I 65 48 113 1 33 27 60 I 528

~ ~ ~ ---l --= t:J >I:. -..j

TABLE 9. Envil'onment of Fil'st Admissions Classified with Reference to Principal Psychoses

2,500- 10,000- 25,000- 50,000- 100,000- TOTAL 0-2,499 9,999 24,999 49,999 99,999 249,999 500,000+ Unknown }'SYCn08EB M.I F. I T·I M. F. '1'. 1M. F. T' I M. F. T., M. F. '1'., M. F. T'I M. F. T. 1M. F. 1'1M. F . T.

With syphilitic meningo-encephalitis 5 5 2 2 2 2 With other forms of syphilis . 1 I 2 With epidemic encephalitis I 1 1 1 With other infectious diseases 1 I 2 1 1 2 Alcoholic psychoses . . . 14 3 17 718 2 2 1 1 2 2 4 1 1 With cerebral arteriosclerosis . . . 27 10 37 7 5 12 5 6 2 2 7 4 11 3 3 3 3 With other disturbances of circulation. 3 1 4 2 2 1 1 2 With convulsive disorders (epilepsy) 1 4 5 1 1 1 1 1 2 3 Senile psychoses . 4 15 19 1 7 8 7 7 2 1 3 I nvolutional psychoses . . . 6 4 10 224 1 213 Due to other metabolic diseases, etc. . 1 1 2 1 1 1 1 With organic changes of nervous system 13 3 16 5 5 3 1 4 314 2 3 Psyohoneuroses . . 3 2 5 J 1 1 1 2 2 2 l\laruc-depressive psychoses 9 11 20 224 4 1 5 2 1 1 1 2 3 134 Dementia praecox. . . 25 17 42 10 8 18 7 29 639 1 1 224 Paranoia and paranoid conditions 5 5 10 224 1 1 2 1 1 2 2 With psychopathic personality 3 3 2 2 1 1 With mental deficiency . 4 6 10 145 1 1 2 2 Without psychoses. . 12 6 18 325 3 3 628 2 2 Primary behavior disorders 1 1 - 1 1 --'--1--1 2 3 40 85 1-2-7-1-6-4-3+------Total 134 95 1 229 145 527 1342054 7 7 14 1 14 6 20 2 3

1-,;) Con 26 P.D.47

TABLE 10. Economic Condition of First Admissions Classified with Refe:rence to Principal Psychoses

TOTAL Dependent Marginal Comfortable PSYCHOSES ------1---1------1------1------M . F. T. M. F . T. M . F. T. M. F. T. ------1------W ith syphilitic meningo-encephalitis 5 5 1 2 - 2 2 2 With other forms of syphilis 1 1 2 2 With epidemic encephalitis 1 1 With other infectious diseases 1 1 2 1 1 2 14 3 17 8 1 9 6 2 8 ~itohh~~i;eb~~t~~;ioscier08is . . 27 10 37 13 4 17 10 6 16 4 4 With other disturbances of circnlation 3 1 4 1 1 1 1 2 1 1 W ith convnlsive disorders (epilepsy) 1 4 5 1 1 2 2 2 1 1 Senile psychoses . . . . 4 15 19 3 3 6 9 9 3 4 Involutional psychoses . . 6 4 10 1 1 2 4 2 6 1 2 Due to other nletabolic diseases, etc. . 1 1 2 1 1 2 With organic changes of nervous system. 13 3 16 6 6 7 1 8 2 2 Psychoneuroses . . . 3 2 .; 3 1 4 1 1 Manic-depressive psychoses 9 11 20 2 2 4 7 8 15 1 1 Dementia praecox: . . . 25 17 42 11 6 17 13 10 23 1 2 Paranoia and paranoid conditions 5 5 10 5 1 6 3 3 1 1 With psychopathic personality 3 3 2 2 1 1 With mental deficiency 4 6 10 2 3 5 1 2 3 1 2 Without p,ychoses . 12 6 18 8 3 11 4 3 7 Primary behavior disorders 1 1 1 1 ------11 ------1------·1------TotaJ 134 95 229 63 26 89 60 55 115 11 14 25

T ABLE 11. Use of A lcohol by First Admissions Classified with Refe:rence to Principal Psychoses

TOTAL Abstinent Temperate Intemperate Unknown PSYCH OSES --- --M. F. T . M. F. T. M. F. T. M . F. T. M. F . T. - - Witb syphilitic meningo-encepb- alitis...... ; - 5 1 - 1 3 - 3 1 - 1 - - - With other form. of syphilis 1 1 2 1 1 2 ------With epidemic encephalitis - 1 1 - 1 1 ------With other infectious diseases 1 1 2 - 1 1 1 - 1 ------Alcoholic psychoses. . 14 3 17 ------14 3 17 - - - ,\\"ith cerebral arteri osclerosis 27 10 37 7 7 14 13 3 16 6 - 6 1 - 1 With other disturbances of cir~ culation 3 1 4 1 - 1 2 1 3 ------With convnlsive d'isorcters (epil.i 1 4 5 - 3 3 1 1 2 ------Senile psychoses. . . . 4 15 19 - 13 13 3 2 5 1 - 1 - - - Involutional psychoses . . 6 4 10 2 3 5 3 1 4 1 - 1 - - - Due to other metabolic diseases, etc. 1 1 2 - 1 1 1 - 1 - - -. - - - With organic'cha~ges ~f ne~vou~ system 13 3 16 2 3 5 3 - 3 8 - 8 - - - Psychoneuro~es 3 2 5 - 1 1 1 1 2 2 - 2 - - - Manic-depressive 'psy~hos~ . 9 11 20 3 9 12 1 - 1 5 2 7 - - - D ementia praecox . . . 25 17 42 12 10 22 9 5 14 3 1 4 1 1 2 Paranoia and paranoid conditions 5 5 10 - 4 4 2 1 3 3 - 3 - - - Wit h psychopathic personality - 3 3 - 2 2 - - - - 1 1 - - - W ith mental deficiency . 4 6 10 4 6 10 ------Without psychoses . . 12 6 18 2 4 6 1 - 1 8 2 10 1 - 1 Primary behavior disorders - 1 1 - - - - 1 1 ------Total 134 95 229 35 69 104 44 16 60 52 9 61 3 1 4 '"d b ..... -I

TABLE 12. Marital Condition of First Admissions Classified with Reference to Principal Psychoses

TOTAL Single Married Widowed Divorced Separated Unknown PSYCHOSES - ' - ~ -- I 1----1 1-- M. F. T. I M. F. T. I M. F. T. I M. F. T. I M. F. T. I M. F. T. I M. F. T.

With syphilitic meningo-encepbalitis 5 5 4 4 With other forms of syphilis 1 1 2 2 With epidemic encephaHtis 1 1 With otber infectious diseases 1 1 2 1 2 Alcoholic psychoses . . 14 3 17 5 5 7 3 10 1 1 1 1 \Vith cerebral arteri osclerosis . . 27 10 37 4 2 6 9 2 11 10 6 16 3 3 With other disturbances of circulation 3 1 4 2 1 3 1 1 With convulsive disorders (epilepsy) 1 4 5 1 2 3 2 2 Senile psychoses . 4 15 19 1 3 4 3 3 2 9 11 Involutional psychoses . . 6 4 10 3 2 5 325 Due to otber metabolic diseases. etc. 1 I 2 1 1 1 1 With organic changes of nervous system 13 3 16 3 1 4 6 2 8 2 2 2 2 Psychoneuroses . . . 3 2 5 1 1 2 1 1 1 1 1 Manic-depressive psyohoses 9 11 20 3 4 7 4 6 10 1 2 1 Dementia praecox . . . 25 17 42 20 9 29 4 6 10 1 Paranoia and paranoid condi tions 5 5 10 2 2 336 2 2 With psychopathio personality 3 3 1 1 1 With mental deficienoy 4 6 10 4 5 9 1 1 Without psychoses . 12 6 18 6 3 9 426 2 Primary behavior disorders 1 1 1 1 -·--1--1------,---- Total 134 95 I 229 I 56 35 91 I 47 36 83 I 19 19 38 9 4 13 2 2 2

~ -.J to.:) 00

TABLE 13. Mental Disorders of All Admissions, All Discharges, All Deaths, 1939, All Cases in Residence and All Cases Out on September 30, 1939, by Status of Admission and Sex

ALL ADMISSIONS ALL DISCHARGES ALI, DEATHS RESIDENT POPULATION PATIENTSOUTONVISIT,ETC.

First Read­ First Read­ First Read­ First Read­ First Read­ MENTAL DISORDERS Admissions miAsions Admissions misFlioDS Admissions missions Admissions missions Admissions missions M. F. T . I M. F'. T. I M. F. T. I M. F . T. I M. F. T. I~ F. T. I M. F. T. I M. F. T. I M. F. T. I M. F. T.

Psychoses D1le to or Associated with Infection: - Syphilis of t,he Central Nervous System: Meningo-encephalitic type (general paresis). . . 5 5 2 4 4 30 7 37 11 3 14 2 2 Meningo-vascular type (cere- bral syphilis). . . 2 2 5 6 2 2 With intracranial gumma 1 1 Other types . . 1 1 Wit,h epidemic encephalitis 1 2 2 2 With other infectious disea!Se 2 1 Psychoses Due to Intoxication: - Due to Alcohol: Pathological intoxication 2 2 2 2 Delirium tremens . 5 5 2 2 3 3 2 2 1 1 Korsakow's psychosis 3 3 1 9 1 10 3 4 Acute hallucinosis 2 1 3 3 3 2 3 3 3 2 2 617 2 2 Other types .. 2 2 4 4 4 1 1 1 1 1 23 6 29 11 2 13 2 3 2 2 P sychoses Due to Trauma: - Traumatic delirium . . . Post traumatic menta1 deteriora- tion . . Other types. . . . . Psychoses Due to Disturbance of Cir­ culation:- With cerebral arteriosclerosis I 27 10 37 2 3 3 4 2 2 24 7 31 29 22 51 5 4 9 3 3 With cardio-renal disease. . 3 1 4 1 2 3 3 Psychoses Due to Convulsive Disorders (Epilepsy): - ~ Epileptic deterioration 1 1 2 2 2 8 ]0 7 2 9 Epileptic clouded states 2 3 2 2 336 1 2 3 b Other epileptic types . 1 1 2 1 2 3 .... -..1 '":j Psychoses Due to Di.turba"ces 0/ M etabolism, Growth, Nutrition or t; Endocrine Function: - Senile Psychoses: ~ Simple deterioration 2 5 7 2 2 6 17 23 224 Presbyophrenic type .. 3 3 3 3 4 4 " Delirious and confused types . 1 1 Depressed and agitated types 5 5 2 2 1 4 5 Paranoid types. .. 2 2 4 1 3 7 [a 3 3 Involutional psychoses: Melancholia . . . . 6 4 10 2 2 3 4 14 24 38 2 9 11 3 3 .: With diseases of the endocrine glands . . 2 2 Alzheimer'S disease With pell agra . . . With other somatic diseases . I 2 Psychoses Due to New Growth:- With other neoplasms. . . Psychoses Due to Unknown or lJ eredi­ tary Causes, but Associated 'U'ith Organic Chanties:- With multiple sclerosis . ' Vitb Huntington's chorea. . Wi th other brain or nervous rus- eases...... I 13 3 ] 6 3 4 3 3 5 2 7 2 3 I 25 13 38 8 10 ]8 2 2 4 Disorders oj Psychogenic Origin OT Without Clearly Defined Ta1lyible Cause or Structural Chanye: - Psychoneuroses: Anxiety hysteria Conversion hyst.eria: Hyperkinetio type . . 2 2 3 3 Psychasthenia or compulsive states : Obsession 2 2 Phobia . 1 Neurasthenia . 2 3 2 2 2 2 Hypochondriasis 1 1 1 1 Reactive depre..sioll . I 2 2 3 4 2 3 2 2 224 2 3 Anxiety state . . 1 1 1 1 1 1 1 Mixed psychoneurosis . 2 1 2 1 :Manic-depressive Psychoses: Manic t.ype . I 6 2 8 4 8 12 5 7 12 2 3 1 1 2 2 2 1 12 13 25 25 31 56 G 2 8 4 8 Depressive type . 3 5 8 6 2 8 2 5 7 7 7 4 2 6 2 3 16 17 33 17 10 27 2 2 4 6 7 Mixed type . 2 2 1 1 1 1 2 2 2 2 1 1 Stuporous type. . . . 2 2 2 2 D ementia praecox (schizophrenja): Simple type . . . . I 2 2 4 ] ] ] 1 9 8 17 347 2 2 1 Hebephrenic type . . . 7 4 11 3 1 4 4 4 3 3 3 3 6 I 76 87 163 61 71 [32 ] 2 3 4 [ 5 Catatonic type. . . . 4 4 8 .1 5 10 5 2 7 2 4 6 1 129 2958 21 36 57 7 5 12 2 7 !)

t-:) co o~ TABLE 13. Mental DiS01'ders of All Admissions, All Discharges, All Deaths, 1939, All Cases in Residence and All Cases Out on September 30, 1939, by Status of Admission and Sex - Concluded

ALL ADMISSIONS ALL DISCHARGES ALL DEATHS RESIDENT POPULATION P .... TIENTsOUTONVrsIT ,ETC.

First Read­ First Read­ First Read­ First Read­ First Read­ MENTAL DISORDERS Admissions missions Admissions missions Admissions missions Admissions m iRs ions AdmissioDs missions M. F. T. I M. F. T. I M. F. T. I M. F . T. I M . F . T. I M. F. T. I M. F. T. I M . F. T. I M. F. T. I M. F. T.

Paranoid type 9 2 11 3 5 8 2 3 2 3 2 6 8 59 76 135 32 59 91 1 2 Other types 3 5 8 2 2 1 1 1 1 3 9 12 224 3 4 Paranoia . . 1 1 2 2 1 1 Paranoid conditions . . 4 5 9 1 1 3 3 2 2 4 12 18 30 6 11 17 1 2 2 With psychopathic pprsonality 3 3 2 3 3 3 1. 2 3 358 369 2 2 2 4 With mental deficiency: Idiot . 1 1 2 8 10 3 3 Imbecile 2 3 5 I 1 1 13 28 41 4 8 12 1 1 2 Moron 1 3 4 2 2 2 3 2 3 5 12 17 4 10 14 2 3 1 Unknown. . 1 1 Without Psychosis:- Alcoholism . . . 4 5 5 Psychopathic personali ty: With pathological sexuali ty . 1 1 1 1 With pathological em otionality 2 2 2 2 With asocial or amoral trends 2 2 4 2 2 4 Mixed types . 1 1 1 1 Mental deficienoy: Idiot . 1 1 2 Moron . . . . 2 2 3 Other non-psychotio diseases or conditions. . . . 2 2 Primary Behavior Disorders:­ Simple adult maladjustment

Grand Total 134 95 229 1 48 37 85 1 57 15 102 1 23 32 55 1 51 26 77 1 11 16 27 1409 446 855 1242 296 0538 1 33 32 65 I 19 35 54

NOTE: Admissions and disoharges do not include transfers.

"':i ~.... --l P.D. 47 31

TABLE 14. Discharges of Patients Classified with Reference to Principal Psychoses and Condition on Discharge

TOTAL Recovered Improved Unimproved PSYCHOSES --~- 111. F. T. 111. F. T. 111. F. T. M. F. T. ---- With syphilitic meningo-eucephalitis 1 1 2 -- - 1 1 2 --- Alcoholic p"ychoses. . . 12 2 14 10 2 12 2 - 2 -- - Witb cerebral arteriosclerosis. 5 I 6 - - - 3 1 4 2 - 2 With other disturbances of ciroula.tion : 1 1 2 - 1 1 1 - 1 - - - With convulsive disorders (epilepsy) 2 - 2 1 - I 1 - 1 -- - Senile psychoses . . . . 1 - 1 ------1 - 1 1m'01lltional p ychoses. . . I 5 6 - - - 1 4 5 - 1 1 Due to other metabolic diseases, etc. 1 I 2 - 1 1 1 - 1 - -- With organio changes of n.ervous syste~ 4 - 4 - -- 3 - 3 1 - 1 Psychoneuroses . . . 4 12 16 3 2 5 1 10 11 --- 1\1anic-depressive psychoses. . 9 21 30 5 11 16 4 10 14 - - - Dementia praecox . . . . 19 10 29 - 1 1 14 8 22 5 1 6 Paranoia and paranoid conditions . 2 5 7 - - - 1 5 6 1 - 1 ,'l' itb psychopathic personality 1 5 6 1 2 3 - 3 3 -- - W ith mental deficiency . 4 4 8 3 3 6 1 - 1 - 1 1 Vi ' ithout psychoses. . 13 8 21 ------P rimary behavior disorders - 1 1 - - - - 1 1 ------Total 80 77 157 23 23 46 34 43 77 10 3 13

TABLE 15. Hospital Residence during This Admission of First Admissions Dischm'ged during 1939

Average Net Number Hospital Residence PSYCHOSES in Years

M. ]? T. 111. ·F. T.

With syphilitic meningo-encephalitis I 1 2 1.50 1.50 1.50 A lcoholic psychoses. . . . 7 2 9 .08 .25 .12 With cerebral arteriosclerosis . . 3 1 4 .06 .12 .08 With other disturbances of circulation: 1 1 2 .12 .20 .16 With convulsive disorders (epilepsy) 2 2 .29 .29 Senile p ychoses . . . . 1 1 .04 .04 I nvolu tional psychoses. . . 2 2 1.14 1.14 Due to other metabolic diseases, etc. . 1 1 2 .37 .29 .33 ,\Vith organic changes of nervous system 3 3 .74 .74 Psychoneuroses . . . . . 4 6 10 . 18 .57 .41 Manic-depressive psychose 8 12 20 .82 .74 .77 Dementia praecox . . . 12 3 15 .86 1.15 .92 Paranoia and paranoid conditions 3 3 . 26 .26 With psychopathic personality 3 3 .09 .09 With mental deficiency . 2 2 4 1.02 .08 .55 Without ~sychoses. . 12 7 19 .07 .08 . 07 Primary ehavior disorders 1 1 .04 .04 Total 57 45 102 .46 .50 .47 ~ tv TABLE 16. Causes of Death of Patients Classified with Reference to Princip.:::a:.-I.::.M.::.e.::.n.::.tal:....::D...:.i:..:so:.:.r::.d:..:er,:s___ --:- ___-:- ___ 7 With With With With With With syphilitic other other Alcoholic cerebral other dis­ convulsive TOTAL meningo­ forms infectious psychoses arterio­ turbances disorders CAUSES Ol~ DEATH encephali tis of syphilis diseases sclerosis of circu- (epilepsy) lation M.I F . 1 T. 1 M. F. T. 1 M. F. T . I M. F. T. I M. F. T. I M. F. T. I M. F. T . I M. F. T. I nfectious and Pa'r'as£tic Diseases: Erysipelas . . . . . Lethargic encephalitis (epidemic) . 1 \11 Tuberculosis of the respiratory system 7 I 2 9 2 - 2 Syphilis (non-nervous forms) . . . . 1 - 1 1 - Purulent infection, septicaemia (non-puerperal) 1 Cancer and Other Tumors: Cancer and other malignant tumors...... 4 1 5 1 - Rheumatic Disea8es, Nutritional Diseases, Diseases of the Endocrine Gla11ds and Other General Diseases: Diabetes...... Diseases 0/ the N erVOUB System and 0,.oan8 0/ Special Sense: Encephalitis (non-epidemic) 1 1 1 - Cerebral hemorrhage . . 7 3 10 1 - 5 - 5 General paralysis of the insane. . 5 5 4 4 1 - Dementia praecox and other psychoses 1 1 Other diseases of the nervous system 4 2 6 Diseases 0/ the Circulatory System: Chronic endocarditis (valvular disease) 134 1 Dispases of the myocardium . . . . . 10 7 17 7 - 7 Diseases of the coronary arteries R. nd angina pectoris 1 1 Other diseases of the heart 3 1 4 - 1 1 2 - 2 1 - Arteriosclerosis . . . 4 3 7 415 Diseases of the Respiratory System: Bronchopneumonia (including capillary bronchitis) 3 2 5 2 - 2 Lobar penumonia . . . . . 3 3 6 'I - Other diseases (tuberculosis excepted) 1 1 - 1 Diseases 0/ the Digestive Sy.,tem: Hernia, intestinal obstruction . Disea ses oj the Genito-Urinary System: Nephritis (acute, chronic and unspecified) . . . . . 3 8 325 Otber diseases of the kidneys and ureters (puerperal diseases excepted) 1 - 1 Dise ases 0/ the Skin and Cellular Tissue: 5 I 1 1 1 Con(Jenital Malformations: 2 2 Senility: . . . . 1 1 Violent and Accidental Deaths: Suicide ...... Conflagration and accidental burns r-o Other external causes 1 - ~ Total 62 1 42 1104 5 5 2 - 2 1 - 3 1 4 24 7 31 3 - 3 1 - ... -.j '"U TABLE 16. Causes of D eat~~ Patients Classified with Reference to Princi1Jal M ental Disol'ders - Concluded ~ Due Lo ... Invo- other Due to orWigatnih c I ]\1nnic- I IPar aanond ia -..J Senile I lutional metabolic new changes of depressive Dementia paranoid I Without CAUSES OF DF.ATH psyohoses psychoses diseases, growth nervous psyohoses praecox condilions psychoses eLc. system M . 1'. T. M. F . T . M. F. T . M . F . T . M . F. T . I i\I. F. T. I M. }'. T. I M . F. T . I M. F. T. Tn/ectiotl8 and Parasitic Diseases: Erysipelas . . . . Lethl\rgic encerhnlitis (epidemic) . Tuberculosis 0 the respiratory system 2 4 5 Syphilis (non-nervous forms) . . . . Purulent infection, septicl\emia (non-puerperal) Cancer and Other 7"umors : Cancer and other malignant tumors...... Rheumatic D iseases, Nutritional D-iscases, D iseases oj the Endocrine Glands and Other General DiseaBes: Diabetes...... 1 - DiseaBes of the N or"OUS System and Organs of Special Sellse: Encephalitis (non-epidemic) Cerebral hemorrhage . . - 2 2 I 1 - General paralysis of the insane . . Demeo tia praecox and other psychose8 ~I Other diseMes of the nervnuR system . - 1 3 1 4 DiseaBes of the Circulatory SYBtern: Cbronic endocarditis (valvula r disease) 1 2 Diseases of tbe myocardium . . . . . - 4 4 1 - - - I - - - 1 - -- I J - 1 3 4 1 - Diseases of t he coronary arteri es and angina pectoris 1 - 1 Other diseases of the heart . Arteri osclerosis . . . Diseases of the Respiratory System: Bronohopneumonia (including capillary bronchitis) 1 - - 2 2 Lobar penurnonia. . . . . 1 1 2 - 2 2 Other diseases (tuberculosis excepted) Diseases of the Digestive System: HE"Tni ll , intestinal obstruct.ion . 1 - Diseases of the O."ito- Urinary System: Nephritis (acute. ohronio a nd uns pecified) . . . . . 1 - Other diseases of the kidneys a nd uret.ers (puerperal diseases excepLed) Diseases of the Ski" and Cellular Tis8ue: Congenital },falformations: Senility: . . . . Violent and Accidental Deaths: Suicide ...... Conflagration and accidental burns 1 - Other external causes Tota l 7 8 2 - 2 7 4 11 6 7 13 6 12 18 2 c.J c.J CJ.:) >+- TABLE 17. Age of Patients at Time of Death Classified with Reference to Principal Psychoses

Less than 1-3 4-·7 8-12 1- 2 3-4 PSYCHOSES TOTAL 1 month months months months years years M. F. T. 1M. F. T.I M. F. T. I M. F. T. 1 M. F. T. 1 M. F. T. 1M. F. T. With syphilitic meningo-encephalitis Ii 5 2 2 ~i~~ ~~~~~ i~f:~i~~:~~:~,ses : 1 1 314 1 1 ~ff~~~~eb~~lc~~:::ios~lero~is '. . 24 7 31 7 8 6 6 3 4 4 4 527 With other disturbances of circulation 3 3 2 2 1 With convulsive disorders (epilepsy) 1 1 Senile psychoses. . 178 2 2 2 I nvolutional psychoses . , . 1 1 Due to other metabolic diseases, etc. 2 2 Due to new growth. . . . . 1 1 With organic changes of nervous system 7 4 11 2 2 2 2 I 2 Manic-depressi ve psychoRes 6 7 13 1 2 2 2 2 1 3 Dementia praecox . . . 6 12 18 2 3 Paranoia and paranoid conditions 1 1 2 Without p"ychoses 1 1 Total 62 42 104 I 11 3 14 8 2 10 5 6 11 9 10 I 10 8 18 4 5

5-6 7-8 9- 10 11- 12 13- 14 15- 19 20 years PSYCHOSES years years years years years years and over M. F. T. I M. F. T. I M. F. T. I M. F. T. I M. F. T. I M. F . T. I M. F. T . With syphilitic rneningo-encephalitis ~:~~ ~~~~~ i~f~~i~~:~~~~~es : Alcoholic psychoses. . . 2 2 With cerebral arteriosclerosis. . With other disturbances of circulation With convulsive disorders (epilepsy) Senile psychoses. . Involutional psychoses . . . Due to other metabolic diseases, etc. Due to new growth . . . . . With organic changes of nervous system 2 2 Manic-depressive psychoses . . . I 1 1 1 Dementia praecox . . . 2 2 2 2 2 448 Paranoia and paranoid conditions >-ci Without psychoses b Total 235 347 3 2 .5 2 3 2 3 4 4 6 10 ..... -1 I-C T ABLE 18. Total Dumtion of Hospital Life of Patients Dying in FioS1)ital D'uring All Admissions Classified Acc01'ding to Principal Psychoses t:J H'- 25-29 30- 34 35-39 I 4(}-44 I 45-49 I 50-54 PSYCHOSES TOTAL I years years years years years years "" M. Ie. T. M. F. T. M. F. T. M. F. T. M. F . T. M. F. T. M. F. T. With syphilitic meningo-encephalitis 5 5 With other fo rms of syphiJi, . 2 2 With other infectious diseases . 1 1 3 1 4 ~ithh~~~eg~ilc~~~::i os~ l ero.~ i s 24 7 31 With other djsturbsnces of cil'c~l l at i ~n 3 3 With convulsive disorders (epilepsy) 1 1 Senile psycho.~es. . 1 7 8 Involutional pRychoses 1 1 Due t.o other metaboUc di;easeS, etc. 2 2 Due to nel't' growth. . . . . 1 1 With organic changes of nervous system 7 4 - - - - 2 - I M anic-depressive psycbose.~ 6 7 13111 1 1 1 I Dementia praecox . . . 6 12 18 -I I 2 ~ I -I ~ 2 2 Paranoia nnd pa ranoid conditions 1 1 2 Wi thou t pRyc hoses 1 1 Tolal 62 42 104 1 I 2 2 I 4 4 I - 1 I 2 3 5 I 2 5 7

55- 59 60-64 65- 69 70- 7'1 75-79 80-84 85 years PSYCHOSES I years years years years I years I years I and over M. F. T . M. F. T . M . F. T . M. F . T . M. F. T. M. F. T. M . F. T. With syphilitic meningo-encephali tis 3 - 3 With otber forms of syphilis . . 1 - 1 With other infectious diseases . - - - Alcoholic gsycl:ioses. . - - - 1 - 1 - 1 1 2 - 2 \Vi th cere ral arteriosclerosis - - - 4 - 4 - - - 6 3 8 3 4 - 2 2 With other disturbances of c irc~ l at i ~11 ------1 - - - - - 2 2 With convulsive disorders (epilepsy) ------Senile psychoses. . . . . ------1 1 2 l ~ I- 2 - 2 2 Involutional psychoses . . . ------~ I - 1 1 Due to other metaboli c diseases, etc. il ------Due to new growth - - - - 1 1 Wi th 0d;anic cbanges 'of n~r vo t; s sy~te m ' 1 - 1 3 1 1 - 1 - 1 1vJanic- epressive psychoses . . . - - - - 2 2 1 - 3 3 Dementia praecox . . . 1 1 2 1 4 - 2 2 1 3 Paranoia and paranoid conditions - - - - 1 - - ~I 1 - 1 Without psycho..es ~I

Tolal G 7 I 10 9 19 I 4 8 I 13 8 21 I 10 6 16 I 4 2 6 I 4 3 7 WC,. . 36 P.D.47

TABLE 19. Average Length of Hospital Residence dUj"ing the pj'esent Admission of First Admissions in Residence on September 30, 1939

Average Net Number Hospital Residence PSYCHOSES in Years

M. F. 1'. 1\1. F . T.

With syphili tic meningo-encephalitis 30 7 37 7.09 8.92 7.44 With other lorms 01 syphilis . 6 2 8 7.33 3.97 6.49 With epidemic encephalitis . 1 1 2 4.50 7.50 6 .00 With other inlectious disease.. 1 1 .44 .44 Alcoholic psychoses 40 8 48 8.51 12.24 9.13 'rraumat.ic psychoses . . 3 3 4.16 4.16 With cerebra l arteriosclerosis. . 29 22 51 2.78 3 .48 3.08 With convulsive disorders (epilepsy) 6 13 19 4.65 5.40 .'.16 SenilP. psychoses 10 33 43 2.98 3. 78 3.59 Inyolutional psychoses. . . 14 24 38 2.68 3. 74 3.35 Due to other metabolic diseases, etc. . 1 2 3 7.50 17.50 14.16 With organic changes of nervous system 26 14 40 3.75 3.41 3.63 Psychoneuro es . . 2 4 6 2.-17 7.50 5 .82 Manic-depressi ve psychoses 28 34 62 4.63 4 . 63 4.63 Dementia pra.ecox. . . 176 209 385 9.17 13.14 10.62 Paranoia and paranoid conditions 14 18 32 4.62 4 . 21 4. .39 With psychopathic personality 3 5 8 5.16 7.70 6. 75 With mental deficiency 20 49 69 7.73 8.06 1.97 Total 409 446 855 7.04 8.50 7.80

TABLE 19A. Average Length of Hospital Residence during the Present Admission of Readmissions in Residence on September 30, 1939

Average Net Number liospital R""idence PSYCHO ES jn Years

l\1. F. 1'. M. F. T.

With syphilitic meningo-encephalitis 11 3 14 6.50 6.50 6.50 With other lorms 01 syphilis . 2 - 2 7 .50 - 7.50 Alcoholic psychoses. . . 17 3 20 10.44 4.16 9.50 With cerebral arteriosclerosis . . 5 4 9 5 . 90 4.50 5.27 With convulsive disorders (epilepsy) 8 4 12 5.50 6.50 5.83 Scnile psychoses . 2 5 7 7.50 9.10 8.64 l nvolutional psyrhoses . . . . 2 9 11 4.50 5.72 5.50 'Yitb organic changes of nervous system 8 10 18 7.12 5.50 6.23 Psychoneuroses . . 8 5 13 3.00 1. 70 2 . 50 Manic-depressiYe psychoses 42 43 85 7.07 8 . 05 7.57 Dementia praecox . . . 119 172 291 9.53 11.25 10.55 Pa.ranoia and paranoid conditions 7 11 18 4.92 6.77 6.05 With psychopathic personality 3 6 9 4.50 7.16 6.27 With mental deficiency 8 21 29 10.37 7.54 8.32 Total 242 296 538 8.28 9.44 8.92

T ABLE 20. Family Cm'e Statistics for Year Ended September 30,1939 Males Females Total Remaining in Family Care September 30, 1938 . 5 5 Admitted to Family Care During the Yea r 8 8 Whole umber of Cases within the Year. . 13 13 Discharged from Family Care within tbe Year: . 10 10 Dis. Outright Irom Family are 2 2 From Family Care to bscape Status 1 1 Returned to I nstitution ...... 7 7 Remaining in Family Care September 30, 1939. . 3 3 Average Daily umber in Family Care During Year: .0356 .0356 elf-supporting 13 13