Public Document No. 84

&i)e Commontoealtf) of Jfflaasacfiusetts ws. ANNUAL REPORT ocs. OLL.

TRUSTEES

Boston State Hospital

Year Ending November 30,

1940

The Ninety-ninth Annual Report of the Hospital Founded in 1839 by the City of Boston

Publication op this Document approved bt the Commission on Administration and Finance

OCCUPATIONAL PRINTING PLANT DEPARTMENT OF MENTAL HEALTH GARDNER STATE HOSPITAL EAST GARDNER, MASS. BOSTON STATE HOSPITAL

(Post Office Address: Dorchester Center, Mass.) Board of Trustees Alexander M. Sullivan, Chairman, Boston Thomas D. Russo, Boston Joseph J. Cardillo, Somerville Harry B. Berman, Newton Dr. Charles C. Lund, Brookline Mrs. Anna CM. Tillinghast, Secretary, Cambridge Miss Josephine E. Thurlow, R.N., Winchester

Consulting Physicians Edward J. O'Brien, M.D., Genito-urologist Boris E. Greenberg, M.D., Genito-urologist Lduis Curran, M.D., Medical Culsultant Hyman Morrison, M.D., Medical Consultant Samuel Proger, M.D., Medical Consultant John F. Casey, M.D., Medical Consultant Donald Macdonald, M.D., Laryngologist, Rhinologist and Otologist Vincent J. DeMento, M.D., Laryngologist, Rhinologist and Otologist Victor Baer, M.D., Laryngologist, Rhinologist and Otologist Harold F. Downing, M.D., Orthopedist Matthew V. Norton, M.D., Orthopedist Thomas H. Peterson, M.D., Orthopedist John S. Kelley, M.D., Orthopedist William J. McDonald, M.D., Gynecologist Fred J. Lynch, M.D., Gynecologist J. Edward Flynn, M.D., Surgical Consultant Lawrence J. Louis, M.D., Surgical Consultant A. J. A. Campbell, M.D., Surgical Consultant Arch. McK. Fraser, M.D., Surgical Consultant Francis P. McCarthy, M.D., Dermatologist Milton Glodt, M.D., Dermatologist W. A. Noonan, M.D., Anaesthesist Charles H. Thorner, Podiatrist James E. Gibbons, D.M.D., Dentist Hugh C. Donahue, M.D., Ophthalmologist Abraham Myerson, M.D., Neurologist Tracy Putnam, M.D., Neurosurgeon H. L. McCarthy, M.D., Roentgenologist D. Monroe, M.D., Brain Surgeon John A. Foley, M.D., Tuberculosis Consultant Chaplains Rev. Robert Pierce Rev. Moses L. Sedar Rev. Frank H. Stedman Rev. Charles J. Foley

Officers of the Hospital Harold F. Norton, M.D., Superintendent Purcell G. Schube, M.D., Assistant Superintendent Ralph S. Banay, M.D., Diiector of Clinical Psychiatry Theodore F. Lindberg, M.D., Senior Physician Naomi Raskin (Pathologist) M.D., Senior Physician N. Anthony Bicchieri, M.D., Senior Physician Joseph P. Thornton, M.D., Senior Physician Louis S. Chase, M.D., Senior Physician Charles S. Mullin, Jr., M.D., Senior Physician William M. Shanahan, M.D., Senior Physician

, Senior Physician Elizabeth A. O'Leary, M.D., Assistant Physician Dorothy C. V. Heinz, M.D., Assistant Physician Leo Berman, M.D., Assistant Physician Eleanor C. Beamer, M.D., Assistant Physician P.D. 84 3

Harold L. Stratton, M.D., Assistant Pnhysician Samuel Silverman, M.D., Assistant Physician

, Dentist Charles A. Perry, Steward Frieda Kaplan, Acting Treasurer Mary Alice McMahon, R.N., Princival of School of Nursing TRUSTEES' REPORT To His Excellency the Governor and the Honorable Council: The Board of Trustees of the Boston State Hospital respectfully submit the Annual Report for the year 1940 as follow: (a) During the statistical year ending September 30, 1940, the institution admitted 1,165 patients, representing the highest admission rate in the history of this hospital or that of any other similar institution in the State. Even with the old C and D Buildings still not used, there is no overcrowding. (b) It is the policy of the Superintendent to send letters to the nearest relative or friend of every patient who is discharged, goes on visit, or dies while in the hospital. Periodically he writes to relatives of certain groups of patients within the institution. These letters concern the care and treatment given to the patients. The responses have been gratifying and indicate the type of service we are rendering to the public of Boston. The Board of Trustees approved this procedure of contacting periodically the relatives of the patients. (c) The Board of Trustees regrets that the appropriation which was requested for the building of a tunnel under Morton Street, which separates the two groups of the hospital, was not approved. It is necessary for large groups of patients, in order to pass from one group of the hospital to another, to cross over this busy highway. This situation is hazardous and does not lend itself to the efficient operation of the institution. (d) The only large Auditorium available in the hospital is one that was built as a kitchen and dining room in 1888. It has a seating capacity of less than 500, while there are approximately 2,300 patients in residence. Much benefit has been derived from the extensive recreational programs which we have provided. Such programs, in our opinion, have aided in the high discharge rate of patients to the community. These programs could be made available to many more of our patients if we had a sufficiently large auditorium to hold at least 2,500 patients. (e) Stony Brook should be covered. It is a menace to the health of our patients.

(/) During the past year all cooking for the hospital has been done in one large kitchen. There were formerly five kitchens. This centralization of cooking has done much to improve the quality of the food served and to eliminate waste. Through the death of Dr. Francis J. Callanan on April 14, 1940, the Board of Trustees lost a valued member who had planned to work harmoniously and effectively with his associates on the Board and with the Superintendent to further the best interests of the patients and employees of the institution. In closing, the Board of Trustees wishes to commend the Superintendent, physicians, department heads, and all other employees for their splendid co-operation and efficient service throughout the year. Following is the detailed report of Dr. Harold F. Norton, Superintendent. Respectfully submitted, Alexander M. Sillivan Harry B. Berman Thomas D. Russo Charles C. Lund Joseph J. Cardillo Anna CM. Tillinghast Josephine E. Thurlow REPORT OF THE SUPERINTENDENT To the Board of Trustees of the Boston State Hospitoi: The following is a report of the activities of the hospital for the statistical year ending September 30, 1940, and the fiscal year ending November 30, 1940. Founded by the City of Boston, in 1839, this marks the completion of its 101st year as a hospital for mental illness, and the thirty-second year of its history as a State institution. Movement of Population The census of the hospital on September 30, 1939, was as follows: in the wards, men, 1,013, women, 1,309, total, 2,322. There were admitted during the year, 614 men, and 551 women, a total of 1,165. There were discharged to the community 264 men and 4 P.D. 84

194 women, a total of 458. Thirty-one men and 9 women were transferred to other institutions. There were 298 deaths during the year, 136 men and 162 women. There were remaining on the books on September 30, 1940, 2,748 patients, of which number 2,372 were residing in the hospital, and 376 on visit or otherwise absent. Personnel Daniel J. Sullivan, M.D., left the service as Senior Physician on December 6, 1939. John M. Hill, M.D., left the service as Assistant Physician on December 25, 1939. Norris B. Flanagan, M.D., left the service as Senior Physician on December 31, 1939. Dorothy C. V. Heinz, M.D., was appointed Assistant Physician on January 3, 1940. Volta R. Hall, M.D., was appointed Senior Physician on Janury 4, 1940. Maier I. Tuchler, M.D., was appointed Assistant Physician on March 18, 1940. Maier I. Tuchler, M.D., left the service as Assistant Physician on May 23, 1940. John F. Sullivan, M.D., was promoted from Assistant Physician to Senior Physician on April 8, 1940. Samuel Silverman, M.D., was appointed Assistant Physician on June 3, 1940. Michael A. Grassi, M.D., left the service as Assistant Physician (Temporary) on June 13, 1940. Elizabeth A. O'Leary, M.D., was appointed Assistant Physician on June 24, 1940. Volta R. Hall, M.D., left the service as Senior Physician on June 30, 1940. Timothy L. Curran, M.D., was appointed Assistant Physician (Temporary) on July

1, 1940. Harold L. Stratton, M.D., was appointed Assistant Physician on July 15, 1940. William J. Clauser, M.D., left the service as Assistant Physician on July 22, 1940.

Charles J. Hart, M.D., was appointed Assistant Physician on August 1, 1940. Peter P. Gudas, M.D., left the service as Senior Physician on August 3, 1940. John F. Sullivan, M.D., left the service as Senior Physician on August 15, 1940. Ernst Schmidhofer, M.D., left the service as Assistant Physician on August 26, 1940. William M. Shanahan, M.D., was appointed Senior Physician on September 2, 1940. Ralph S. Banay, M.D., left the service as Director of Clinical Psychiatry on September 7, 1940. Charles S. Mullin, M.D., Assistant Physician, returned from a leave of absence and was promoted to Senior Physician on September 10, 1940. Timothy L. Curran, M.D., left the service as Assistant Physician (Temporary) on September 28, 1940. Charles J. Hart, M.D., left the service as Assistant Physician on October 21, 1940. Eleanor H. Beamer, M.D.. was appointed Assistant Physician on November 7, 1940. Leo Berman, M.D., was appointed Assistant Physician on November 18, 1940. During the year the following relatively important changes took place in the adminis- trative personnel which should be recorded: Mrs. Rose J. Siciliano, Institution Treasurer, resigned on November 9, 1940. Mrs. Grace L. Broe, Assistant Dietitian, resigned on June 19, 1940. Miss Violet Koskela was appointed to the position of Dietitian on July 29, 1940. Kaen A. Noonan, D.M.D., left the service as Dentist on May 21, 1940. Joseph P. Fleming, D.M.D., was appointed Dentist on May 22, 1940, and resigned on August 19, 1940.

Netjropsychiatric Service This division of the institution has continued to function in the same pattern as it has for the past three years. The fundamental purpose of this pattern is to return the patient to the community as rapidly as possible. In order to do this, the neuropsychiatry service embraces a program which includes not only the physician, but the total personnel of the institution and all of its equipment and ingenuity. The patient, therefore, becomes the hub of the pattern, with the spokes and rim of this same pattern being the various branches of the hospital bringing pressure to bear on him to get well and to go home. Thus, the patient receives not only the benefit of psychotherapy, pharmacotherapy, and other special therapies such as insulin, metrazol, and electric shock by the medical staff, but the benefit of physical therapies offered by other hospital departments. When an individual enters this institution as a patient, he, as a matter of course, re- ceives an intensive neuropsychiatric and phj^sical analysis in the Reception Building. As soon as this is completed and his problem analyzed for treatment the hospital as a unit brings its pressure to bear on him to get well. This pressure is not perceived as :

P.D. 84 5 such by the patient, but it is there, nevertheless, pushing him and urging him to recover so that he may return to his home. If the institution could talk to him, he would un- doubtedly hear it saying, "You are sick; we know it; you probably do not. You are sick. That is why you are here. We are here for that reason, too—we are here to get you well and to send you home—better for your sickness—better than you were before. We are going to get you well." The patient does not hear this but the forces of recovery are at work. From the kitchen, food of good quality, well prepared and of pleasing appearance, is given him to eat. He must be cleared of any deficiency symptoms due to poor dietary habits. From the laundry are sent clean bed linen and clothing. He must keep his person clean so he is bathed regularly, and showered, and his hair cut. If the individual is a woman, she receives additional attention to her hair and fingernails. The patient is urged to be clean and tidy, to dress attractively, and to keep his bedding in order. His sleep is facilitated at night in blue lighted rooms and if he is disturbed during the day, he is kept in blue lighted rooms to decrease the irritating influence of sharp, slashing light. He is urged to occupy himself at some type of occupation in industry wherein he can give vent to his creative urges. He is given physical exercsie and long walks outside. For the summer he is kept out-of-doors as much as possible to get all of the benefits of sun and fresh air. Entertainment of all types is provided for him. If he cannot leave his building, music, and other entertainment is provided on the ward. If he can leave it, movies, music, singing, vaudeville, and such are provided on the grounds or in an auditorium. He may be taken with groups of other patients to baseball games, hockey games, football, basketball, circuses, theatres, or on sleigh rides in the hills, boat trips on the ocean, beach parties, or bicycle trips. It is in this manner that he is urged to get well—to go home. He is continually under the pressure of one group or another to be remembered. He is not forgotten and he is not peimitted to think that he is. He is not permitted to become a "backwards" individual. It is this type of mass therapy that has been functioning in this institution with results that are reflected in hospital releases. In order to maintain a high degree of interest in neuro-psychiatric progress, the medical library has continued to obtain important current books and journals. These are constantly available to the staff. Twice a month the medical staff meets as a Journal Club wherein one member presents the interesting articles published and following which there is a general discussion. At irregular intervals speakers of note have been invited to the hospital to give talks in their special fields. At other irregular intervals, and as they are required, members of the staff have gone into the community to give talks on psychiatric problems. They have likewise given planned lecture courses to affiliate nurses. Four clinical psychiatric conferences, one pathological conference, and one neurological conference are held every week. It is felt that the program of mass therapy, individual selective therapy, and progressive staff stimulation, has done much in this past year to crystallize a progressive program of intra-hospital relationships which has only one aim, i.e., the return of the patient to the community the better for his experience here. If this is accomplished, and I feel that it is, the hospital is serving the community as it was originally designed to do. If in its enthusiasm to return the patient to the com- munity, it makes errors, these are forgivable, because it, by virtue of these errors, becomes progressive and serves its community in an honest and reliable manner. Dental Service The dental activities at the hospital were conducted under the direction of Kaen A. Noonan, D.M.D., until his resignation on May 21, 1940. During the period May 22, 1940, to August 19, 1940, Joseph P. Fleming, D.M.D., was in charge of the dental service. A vacancy existed in this position from August 20, 1940, until the end of the fiscal year. During the year, the following work was performed

Examinations. . . 6,194 Restorations .... 48 Extrations .... 1,067 Prophylaxis .... 1,383 Fillings 322 Social Service Department The Social Service Department has continued under the supervision of Mrs. Lillian S. Irvine, Head Social Worker, assisted by Mrs. Isabel C. Cunningham, Psychiatric Social Worker, and Miss Martha Wolk, Assistant Psychiatric Social Worker. There 6 P.D. 84

were several changes in the personnel of the department. Miss Esther Coleman, who had served as Assistant Psychiatric Social Worker for several years, resigned to attend the Smith College School for Social Work. Miss Mary Dolan was appointed as worker to fill this vacancy. Miss Dolan received a B.S. degree at the Worcester State Teachers' College in 1937 and a M.A. degree at Clark University in Worcester in 1938, and had eight summers' experience at Worcester State Hospital. Miss Margaret L. Kelly also resigned to accept a position as social worker at the Boston City Hospital. During the summer there were five volunteer workers in the department. Miss Mary Wessling, a senior at Regis College, performed valuable work for the department as a volunteer. It was due to her reports that the department received commendation from the South Boston Court. Miss Dorothy Jones came to us from Simmons College from which she had graduated. She had previous experience at the Boston Dispensary and the Children's Hospital. Miss Eileen A. Kelley was a senior at Emmanuel College and returned to college. She had done volunteer work at the Massachusetts Memorial Hospital. Miss Margaret Walsh was also a student at Emmanuel College and Miss Laura M. Kelly was a student at Pembroke College. This group of volunteer workers, with very slight previous training, rendered the department inestimable service. They worked faithfully and conscientiously. The follow-up program of the hospital is ever increasing its scope. The Social Service Department made 400 visits to patients on trial visit from the hospital and at least 1,000 visits were made by patients to the Out-Patient Department. Patients were aided in their social, vocational, and educational adjustments. The workers offered a word of encouragement, and advised and helped them in their social problems, in an effort to promote good mental hygiene. They assisted with job findings and made home conditions as congenial as possible. In several instances, patients who had been discharged, contacted the Social Service Department for aid in solving their individual problems. Family friction, lack of

satisfactory employment, and ill health were but a few of such problems. The patients in Family Care, with whom intensive follow-up work is carried on, are kept occupied with household chores in their foster homes. For instance, one knits for the Red Cross; another makes beautiful patchwork quilts and a third is writing her autobiography. Two young people are attending school and making good progress and are prominent in extra-curricular activities. The adjustments of several of these patients are so adequate that they are soon to be discharged from the hospital jurisdiction. During the year the Social Service Department obtained 1,214 histories and made 178 full investigations of observation and criminal observation cases. Two-thirds of the histories were obtained at the hospital and one-third outside of the hospital. For several months nearly the entire time of one worker has been taken up with obtaining histories on patients who have no visitors or who have died or have been discharged. In many of these cases much time is spent in locating relatives or friends of these patients. Numerous cases were referred for burial responsibility and in several of these many hours of work were required to index the case, chase down minor clues, and make numerous telephone and personal calls before the responsibility for burial could be correctly placed. The department feels that its work would be more constructive and effective if there were two more workers. The following is a summary of the Social Service cases for the year: Male New Cases .... Renewed Cases from Previous Years

Renewed Cases within the Year . Continued Cases from Previous Years

Closed During Year . Cases Continued to Following Year Physical Therapy Department This department has functioned under the supervision of Miss Roslind M. Gibbs, a graduate of the Sargent School of Boston University. The following is a summary of the work of this department for the year: Number of individual patients treated ..... 145 Number of individual employees treated ..... 34 Number of different conditions treated ..... 58 : :

P.D. 84

Total number of conditions treated 649 Total number of patients actually treated 2,898 Total number of treatments actually gi /en 5,368 Number of patients discharged from Physiotherapy 131 X-Ray Department At the beginning of the year, the X-Ray Department was under the supervision of Miss M. Claire Gagen. On May 22, 1940, she left the service of the hospital, and from May 28, 1940, to June 13, 1940, the work was carried on by Mrs. Nina Timchenko. Miss M. Hilda Hayes was appointed to the position of X-Ray Technician on July, 5, 1940. X-Ray examinations and fluoroscopic examinations on patients and employees are ordered by the staff physicians. X-Ray plates are read by Dr. Humphrey L. McCarthy, consulting roentgenologist. Employees working in contact with food or with patients having tuberculosis are X-Rayed at regular intervals. During the year, the following work was performed:

X-Ray taken .... 2,525 Patients X-Rayed . . . 1,854

Fluoroscopic Examinations . 21 Employees X-Rayed . 497 Pathological Laboratory The work of the pathological laboratory has continued under the supervision of Dr. Naomi Raskin. It is felt that two technicians are inadequate for the amount of work necessary for the proper function of this department. During the year the following work was completed Autopsies 153

Urinalysis . Blood Counts: White blood counts Red blood counts Differential counts Hemoglobin estimations Blood sugar determinations Non-protein nitrogen Spinal fluids Bacteriological slides Stool for occult blood Blood cultures Milk analysis Icteric indices Van Den Bergh Psychological Service This department is comprised of two Psychometrists. For the proper functioning of this department, there should be, in addition, a Psychologist, but as yet we have been unable to obtain this position. The work of the School Clinic has been conducted under the supervision of Dr. Dorothy C. V. Heinz, Assistant Physician. The statistics of the routine work done by this Department are as follows 635 8 P.D. 84

School Clinic Number of children tested:

Somerville District ...... 227 Everett District 177 Occupational Theeapy Department During the year several changes were made in the location of the Occupational Therapy Shops and classes. The Furniture Refinishing Shop was moved from the West Center Building to the first floor of the C Building which offered better facilities for the work and for storage. The classes held in the K Building were moved in September, 1940, to a large shop adjoining the Employees Club. This new shop offers a large, airy, and attractive room for the Occupational Therapy activities. Patients from the B, G, and K Buildings, female, attend classes there and the H-9 Occupational Therapy Shop is devoted entirely to classes for male patients. A new shop for the repairing of furniture was opened on the second floor of the C Building where patients, under the direction of an Occupational Therapist, repair broken furniture. The other shops, East, H-9, were continued during the year. Classes at the Reception Building were held on the male and female wards, with a small shop in the basement used by the worker as an office and a place to prepare work. Patients in the O Building are visited once a week and quiet games are organized, and books and magazines given out. Light handwork, such as sewing and knitting, is left on the wards for the patients to do under the direction of the nurses. Patients in the infirmary wards and those on other wards who are physically handicapped in the B Building are also left light handwork. During the summer months, when the patients are out-of-doors, a concerted effort was made to have all patients kept busy at some productive occupation. Large groups of patients were kept busy cleaning the brush out of a wooded section to be used as a camp site for recreational activities for paitents. Other groups, male and female, pulled weeds, raked hay, cleaned sections of the grounds of stones and other debris and mowed lawns and weeded flower beds. Those patients unable to do active work shined aluminum trays from the cafeterias and kitchens; other pulled the sterilized hair apart getting it ready for the picking machine. Some of the female patients mended clothing and other light handwork. With the exception of the very feeble, the acutely ill, and those patients on infirmary wards, and about 250 patients who refused to participate, all patients were engaged in some productive activity during the day. Occupational Therapists directed this activity with the cooperation of the Nursing Service. The Occupational Therapy Department continued to take active part in all the re- creational activities for the patients, accompanying groups of patients on their outings outside of the hospital grounds—the picnics at the Blue Hills, the boat trips, trips to the

zoo, baseball games, auto races, horse races, etc . Field Days on special legal holidays were organized and directed by the Occupational Therapists with games and competitive races for the patients. They also assisted with the decorating for special holidays and social functions. Nine issues of the Boston State Hospital News were written, edited, and mimeo- graphed under the direction of the Occupational Therapy Department. The Boston State Hospital News has grown from a small newspaper of a few pages to a much larger issue with a circulation of 1,200. An exhibition of the work done in the Patients' Art Class was opened on January 25, 1940, in the Auditorium of the Reception Building. This exhibit has received a great deal of notice and favorable comment from artists, psychiatrists, and the general public and articles about the exhibit have appeared in the Boston newspapers. The Industrial Therapy program, placing of patients in the different hospital industries on a therapeutic basis, has continued to grow and the number of patients working full time in hospital industries has increased. There have been few changes in the personnel of this Department, with only one re- signation during the year. The members of the department, with the permission of the Superintendent, attended a series of lectures given at the Boston Public Library by Dr. Stanley Cobb on "The Borderlines of Psychiatry." These lectures were most interesting and informative. During the year, 22,879 garments were mended; 979 key cords were made for the use of employees; 308 games were made; 1,604 articles were laundered; 10,065 sponges were P.D. 84 made for the operating room. 6,091 miscellaneous articles were made, 5,927 pieces of furniture were painted, refinished, and sent to the wards. Following is a summary report of classes and attendance for the year: Number of classes ...... 3,819 Total hours 11,953 Total attendance ...... 79,875 Total different patients in classes ...... 1,051 Hydrotherapy Department The Hydrotherapy Department is under the direct supervision of the nursing service and supervised by Miss Mary A. Bresnahan, R.N. Following is a summary of the department for the year: The number of patients in wet sheet packs—141. The number of packs—6,095, and the number of hours of packs—5,324:27. The number of patients in continuous baths—275. The number of baths—9,540, and the number of hours —68,431:46. Nursing Service Miss Mary Alice McMahon, R.N., Principal of the School of Nursing, has had charge of the nursing service of the hospital. The following is a census of the nursing service for the year ending September 30, 1940: The hospital was accredited for the training of affiliate nurses and thirteen affiliate nurses from the Mercy Hospital, Springfield, the Henry Heywood Memorial Hospital,

Garnder, and the Boston City Hospital, Boston, reported for duty on October 1, 1940, for a course in psychiatric nursing. dale Superintendent of Nurses Assistant Superintendent of Nurses Supervisors—Chief Hospital Supervisors—Assistant (Days) Supervisors—Assistant (Nights) Head Nurses—Registered Head Nurses-—Graduate Hydrotherapists Physiotherapists Barbers Charge Attendant Nurses Attendant Nurses Psychiatric Nurses Graduate Head Psychiatric Nurses Graduate Psychiatric Nurses Senior Psychiatric Nurses Employed During Year Assistant Superintendent of Nurses Registered Nurses Head Graduate Psychiatric Nurses Graduate Psychiatric Nurses Hydrotherapists Charge Attendants Physiotherapists Barbers Attendant Nurses Left Durtng Year Assistant Superintendent of Nurses Registered Nurses Charge Attendant Nurses Hydrotherapists Head Graduate Psychiatric Nurses Graduate Psychiatric Nurses Physiotherapist Barbers ..... Attendant Nurses Classes Conferences for Supervisors Lectures (Special) for Head Nurses—Head Graduate Psychiatric Nurses and Charge Attendant Nurses Classes for Attendant Nurses (Male and Female)

Special Introductory Classes—Registered Nurses . Special Introductory Classes—Head Graduate Psychiatric Nurses Special Introductory Classes—Attendant Nurses (Male and Female) 10 P.D. 84

1. New individual refrigerating units were installed in East Kitchen and in the Bakery. 2. A new air compressor was installed in the Laundry. 3. The 8-inch water main under the new retaining wall in the East Group was relocated. 4. Outside lights were installed over the fire escapes on West E and F Cottages. 5. New blowoff lines, both branches and mains, were installed in the Powerhouse from all boilers to blowdown tank outside. 6. The transformers in the East Kitchen were replaced with a temporary electric supply, line in the West H Building. 7. A new toilet was installed in the Occupational Therapy Department. 8. New Lighting fixtures were installed in the East Employees' Dining Room. 9. A new hot water storage tank was installed in the basement of the West H Building. 10. A steam kettle was installed in the basement of the old center office building for the mixing of water wax. 11. A food mixer was installed in the West Kitchen. 12. The electric stove was replaced in West H-8. 13. The new shower room in the West I Building was completed. 14. A broken shaft on a laundry extractor was replaced. 15. A new underground cable was laid on the Recreation Field. 16. All the necessary piping for the new 1,000 gallon gasoline tank was installed at the storehouse. 17. One 20-inch and six 35-inch ventilating fans were installed in the West Kitchen and Cafeterias. 18. New electric cables supplying Storehouse, Bakery, and East Kitchen were laid under the new retaining wall in the East Group. 19. A new expansion joint was installed in the 8-inch steam main on the East Group at the brook. 20. The ice machine at the West Kitchen was overhauled and new expansion coils, new thermostatic valves, and new condensor tubes were installed. 21. The transformers in West A, B, and H Buildings were checked and filled with oil where needed. 22. Fryolators were installed at the West Kitchen. 23. A coffee urn and table was installed in West H-l. 24. A new K. V. A. transformer was installed in the West Kitchen. 25. A steam coffee urn was installed in East Employees' Cafeteria. 26. A chrome plated railing was installed outside the serving bar in the West A Cafeteria. 27. The installation of new steam mains from the Powerhouse to the West Group was started in August. 28. New bed pan sterilizers were installed in the East O Building. 29. Connections were made in the Powerhouse to supply new steam main. 30. The transformer at the carpenter shop was removed from the side of the building and placed in a new concrete vault and connected. 31. The domestic water line at the East carpenter shop was cut off due to new road construction and a new main was connected. 32. The food kettles in the West Kitchen were changed and piped up. 33. Six new radiators were installed in the West B Building. 34. A motor and wax heater was installed in the West Industrial Shop for the shoe repair machinery. 34. The usual repairs and renewals to the heating system, plumbing system, and the electric system, were carried on during the year. 35. The boilers in the Powerhouse were cleaned Tnd inspected at intervals during the year. 36. New stationary pegs were installed in No. 3 pulverizer and the worn parts in the other pulverizers were replaced as needed. 37. The gasket on the main stop valve of No. 3 boiler was renewed. 38. The transformers in the Powerhouse were checked and new oil added as needed. 39. The lubricating oil in No. 3 turbine was replaced with new oil and the tank cleaned out. P.D. 84 11

40. The valve gear on No. 2 turbine was cleaned and repacked. 41. Other maintenance work in the Powerhouse was carried on as necessary. General Operations In December, 1939, construction of a new retaining wall between the East Patients' Cafeteria and Storehouse, was started. The road building project continued in the East Group. In January, 1940, the D Building started functioning as an Occupational Therapy Center. The A Cafeteria started to function as a feeding center for disturbed men as well as women and as a result of this it was possible to close the G and I Cafeterias and to bring about further centralization of feeding. A Domestic Science suite was established in the site of the old East Kitchen. On March 7, 1940, Dr. Arthur H. Ruggles, Superintendent, Butler Hospital, Secretary- Treasurer of the American Psychiatric Association, and President of the National Com- mittee for Mental Hygiene, visited the hospital. On March 19, 1940, the hospital was inspected by Dr. Huston K. Spangler, Field Representative, American College of Surgeons, for the purpose of acceptance of the hospital by the American College of Surgeons. In April, 1940, two Wurlitzer Music Machines were purchased for use in the Hydro- therapy Department in the treatment of our disturbed patients. A Recordak photo-copying unit was installed for the purpose of creating complete photographic files on 16mm. film of all of the valuable records. The retaining wall between the Storehouse and the East Kitchen was completed. On April 19, 1940, Dr. Clifton T. Perkins, Commissioner, Dr. Bardwell H. Flower, Assistant Commissioner, Dr. William C. Gaebler, Dr. Francis H. Sleeper, Dr. Edgar W. Yerbury, Dr. Neil A. Dayton, Mr. C. W. Greenough, Mr. William I. Rose, from the Department of Mental Health, visited the hospital, accompanied by eight hospital superintendents from Canada. In May, 1940, four W. P. A. Metropolitan District Commission trained recreational directors were assigned to the hospital for the summer months to care for the patients out-of-doors. A Tree Pruning Project was employed in caring for the trees on the grounds of the institution. In July, 1940, work on the installation of the new steam lines was started. In September, 1940, with the aid of the United States Postal Authorities, all alien patients within the institution, were finger-printed and registered. Work on the new entrance to the East Group from Morton Street was started. Local Draft Board, No. 29, Ward 14, Precincts 11 to 20, under the chairmanship of Judge David I. Rose, established headquarters at the Administration Building. The following improvements and repairs were made during the year: West A Building—Plaster baseboards were installed in the day halls. East L Building—Porches screened in rear of building. East M Building—Cement floor laid at front entrance. Partitions installed from day hall to each corridor, Wards 1 and 2. East N Building—Roof repaired. East O Building—Roof repaired. Partition installed in basement. Reception Building—Steps were built from the back porch to the yard in rear of the building. Grills were installed on outside doors. West Nurses' Home—Roof repaired. West Kitchen—Red Quarry Tile laid in scullery. Office built for dietitian. Asphalt tile was laid in the following buildings: West A Building—Wards, 3, 4, 5, 6, tub room on Ward 1. West B Building—Wards 3 and 4. Diet Kitchen. West E Cottage, West F Cottage, G Building. West H Building—Wards 1, 2, and 7. West I Building—Small rooms on Wards 3 and 4. West J Building—Second floor. East L Building—Small rooms on Wards 1 and 2. East N Building—Small rooms in rear of Ward 1. :

12 P.D. 84

The following were painted West A Building—Cafeteria and stairways. West B Building—Wards 1, 2, 3, and 4. West H Building—Wards 1, 2, 5, 6, and stairways. East L Building—Day halls and stairways. East M Building—Day halls and corridors. The West kitchen. Repairs to locks, windows, doors, screens, and plaster, were made whenever necessary, also to the laundry trucks. Thirty-six polishing blocks were made, 12 coat racks built, 1,000 pieces of furniture repaired, 35 door checks repaired and rebuilt, and a wooden fence built around Recrea- tion Field, by the Maintenance Department. Clothing and Bedding: Much valuable work was done by the workers in the Sewing Room, in conjunction with a W. P. A. Project, and the following articles were produced during the year: Bedgowns, 1,855; Curtains (Pairs), 1,917; Dresses, 3,288; Pillow Cases, 4,655; Sheets, 6,114; Shirts, 1,612; Slacks, 1,811; Slips, 2,552; Spreads, 1,505; Towels, 14,112. Many miscellaneous articles were also produced by this department. A total of 71,449 miscellaneous articles of clothing and bedding were mended. The following is a summary of the articles produced by the Industrial Shop during the year: Mattresses, 1,476; Pillows, 300; Window Shades, 1,094; 1,927 miscellaneous articles were also produced by this department, and renovations and repairs made on various articles of furniture, shoes, beds, springs, and mattresses. Recreational Therapy The Recreational Programs have continued on an extensive scale and much benefit has been derived by the patients from this form of therapy. The following is an analysis of this program for the year: Art Exhibit: Art Exhibit by Patients. Tea. Visitors to Hospital. Relatives and friends of patients. 3,000 visitors. Reception Building Auditorium. Auxiliaries: American Legion.—52 Visits, 7 distribution of delicacies and smokes, 12 Dancing Parties, refreshments, entertainment. 52 Luncheons. Mrs. Mary Mc- Laughlin, Chairman. Veterans of Foreign Wars:—52 Visits—Herbert J. Wolfe Post, distribution of Goodies and smokes. Louis D. Brandeis Post; 12 dancing parties, refreshments, entertainment. Lotta Crabtree Post, Passover celebration, Jewish holidays; United Service, Rabbi Moses L. Sedar. Bands and Orchestras—American Legion.— 10 Concerts, courtesy, Commanders and Directors. Catholic Youth Organizations.—15 Concerts, courtesy, Reverend Directors. Firemen's.— 12 Concerts, courtesy Comm. William A. Reilly. Policemen's.—12 Concerts, courtesy Comm. Joseph F. Timilty. Salvation Army.—10 Concerts, courtesy Col. Edmund Hoffman and Major Leroy Stockman. Works Progress Administration.—-250 Concerts, courtesy Massachusetts Music Project —State Supervisor William Haddon. Baseball Games.—"Bees", 5 games, courtesy of J. Robert Quinn, President. "Red Sox", 4 games, courtesy of Mr. Thomas Yawkey. St. Brendon's, 2 games, courtesy of Rev. Fr. Donovan. Old Harbor Village. 2 Games—courtesy of Supervisor John Meade. Birthdays.—Birthday Party of the Month. Music, dancing, entertainment, refresh- ments. 12 Parties, Mrs. Herbert Channing Huntress, Hostess. (Chairman, Gray Ladies, American Red Cross.) Circus.—Policemen's Circus, courtesy of Joseph F. Timilty, Boston Garden, Boston, Mass. Ringling Brothers Circus, courtesy of Ringling Brothers, Boston Garden, Boston, Mass. Christmas Carollers.—St. John's and St. Hugh's, Roxbury; St. Leo's, Dorchester; St. Andrew's, Forest Hills; Holy Trinity, Boston; Parkway Community Church, Milton; courtesy—Rectors of Churches. Christmas Concert.—Dorothy Clarke, Director. . —

P.D. 84 13

Christinas Dancers.—Gertrude Dolan Studios; courtesy of Gertrude Dolan. Christmas Play.—Colored Centre of Boston; courtesy of Mother Marie Therese. Christmas Concert.—Choir of St. Andrew's; courtesy of Rev. Charles J. Foley, Chaplain. Choral Singing.—Daily Singing, 365 days; patients. Field Days.—Memorial Day, Bunker Hill Day, Independence Day, Labor Day, Columbus Day. Recreational Grounds, bands furnished by W. P. A. Courtesy of William A. Haddon, State Supervisor. Sports, refreshments. Football Games.—Boston College—Anselm; Boston College—Manhattan. Courtesy of John P. Curley, Graduate Manager of Athletics, Boston College. Games.—Beano, Bridge, Chinese Checkers, Cribbage, Dominoes, Parchesi, Whist 700 games. Glee Clubs.—American Legion, Suffolk County Auxiliary, All Women. Courtesy of John J. Madden, Director. Hikes.—Arnold Arboretum, 15 trips. Franklin Field, 10 Trips. Bowling on Green, Tennis, Tournaments. Courtesy of William P. Long, Park Commissioner. Holidays (dancing parties):—New Year's, Lincoln's Birthday, St. Valentine's, Wash- ington's Birthday, St. Patrick's Day, Patriot's Day, Memorial Day, Bunker Hill Day, Independence Day, Labor Day, Columbus Day, Hallowe'en, Armistice Day, Thanks- giving Day, Christmas Day. Orchestra and Entertainment furnished by W. P. A. Dancing, favors, refreshments. Hockey.—Hockey Games, Boston Garden; 3 trips. Courtesy of Mr. Weston Adams, President. Horse Show.—Horse Races, Suffolk Downs. Courtesy of Suffolk Downs. Keith's—RKO.—Motion Pictures, vaudeville; 6 visits. Courtesy of Mr. John Granara, Publicity Manager. Library.—Boston Public Library, Bowdoin Square Branch. Weekly visits. Movies.—Best Motion Pictures of the Year. 110 showings. Plays. Armistice Week. "You Can't Beat the Irish", Holy Trinity Players of Boston. Courtesy of Rev. H. C. MacLeod, S.J., Holy Trinity Church, Boston. Museum.—Children's Museum, Boston Art Museum, Gardner Museum. 14 visits. Picnics.—Picnic Suppers and Bus rides. Boy Scout Encampment. 16 trips. Blue Hills. Quartettes.—American Legion, John J. Madden, Director. Immaculate Conception Church, Dorothy Clarke, Director. Salvation Army, Major Leroy Stockman, Director. Radio.—All Wards—Cafeterias and Hydrotherapy Suites. Hourly, Daily Newscasts. Daily Weather Reports. Daily Concerts (9:00 a.m. and 9 :00 p.m.) Wurlitzer Recordings —"Music They Want." Radio Skits.—Visits—Entertainment. George and Dixie, Georgia Mae, Jimmie and Dick, Ruth Moss. Courtesy of WNAC, Boston. Recitals.—Organ. 50 Recitals. Soap Box Derby.—Sight-seeing trips. Box luncheon. Suffolk Downs. Sports.—Seasonal and Daily. Recreational Grounds, East and West Groups. Bicy- cling, hop-scotch, hoop rolling, kite flying, marbles, quoits, rope jumping, sliding, skating (ice and roller) Shore:—Bus Trips, Nantasket, Pemberton, Hull: Sail, Nantasket, Pemberton, Hull; courtesy of Nantasket Steamboat Company, Mr. Robert Greene, Mrs. Herbert Channing Huntress, Hostess. Chairman, American Red Cross, Gray Ladies. All Day Sail Provincetown; courtesy of Cape Cod Steamship Company. Mr. L. L. Day, Manager. Show.—Fruit and Flower Show. Horticultural Hall, Boston. Swimming.—Male and female patients (4 times a week). Curtis Hall Gymnasium, Jamaica Plain; courtesy of Commissioner William P. Long. Research Laboratory During the past year the Research Division of the Boston State Hospital carried out researches which are classified as follows: I. Human Autonomic Pharmocology and Allied Subjects. II. Biochemistry of Alcohol. III. Neuropathological Studies. IV. Sex Hormone Stucijs. V. Heredity Studies. 14 P.D. 84

VI. The "Total Push" Method of Chronic Schizophrenia. VII. Organization Activities. I. Human Autonomic Pharmacology and Allied Subjects: The main activity in this field has been to evaluate new drugs and new methods of administering well known drugs. (1) We have concluded our work on furfuryl trimethyl ammonium iodide (Furnethide) and our two papers, "The effect of furfuryl trimethyl ammonium iodide on various autonomic functions in man," and "Ocular pharmacology of furfuryl trimethyl am- monium iodide, with special reference to intraocular tension," have appeared on this subject. This drug is parasympathetic in most of its effects and seems to have a valuable field in the treatment of diseases of the eye. (2) We have been particularly occupied with the slow absorption of drugs. In this connection we have used the drip method on certain of the adrenergic and cholinergic drugs. (a) The work indicates that by the drip method one may raise the blood pressure, using adrenergic drugs, to a desired level and keep it there by manipulating the rate of administration. This seems to us a valuable method for the treatment of shock and allied conditions. (b) The parasympathetic drugs may be used in similar fashion to induce sweating and to lower the blood pressure, which would seem to indicate that there is a field for their use in the treatment of kidney disease where both increased excretion and a drop in blood pressure are valuable. (c) Of particular interest to the labortory has been the use of gelatin as a solvent for drugs, in order to slow up the absorption rate and to give an effect comparable to the natural production of chemical substances within the body. This has been found to be of particular value in the use of amphetamine sulfate. The undesirable side-effect of blood pressure raise presented by amphetamine sulfate in watery solution can be largely avoided by the use of amphetamine sulfate in gelatin, and other effects can be greatly prolonged. Thus, the gastrointestinal relaxation lasts far longer than when the drug is administered in an aqueous solution, and the relaxation of rigidity in Parkinson's disease is prolonged into clinical usefulness. (d) In this connection we have been carrying on experiments on Parkinson's disease of encephalitic origin and have found the combination of scopolamine in gelatin and amphetamine sulfate in gelatin of great value, giving results not equalled by any other method of treatment. This work is still going on and, in fact, is in its beginnings. (3) Studies on pyruvic acid: This chemical has lately come into great prominence because of its production as one of the important phases of carbohydrate metabolism. It has been definitely established that vitamin Bi is instrumental in regularing the amount of pyruvic acid in the organism. We carried on, therefore, experiments of the following types: (a) To see whether pyruvic acid in excess can produce multiple neuritis. Our experiments indicate definitely that this is the case. This is a new approach to the prob- lem of the production of neuritis. (6) Given in small doses, it seems to increase the weight of pigeons. In large doses, it acts as a toxic substance, producing severe damage to the organism. (c) The relationship of this chemical to the use of sugar, insulin, and other sub- stances is as yet quite confused. Our experiments have not yet been successful in elucidating the exact relationship of the quantity of pyruvic acid to the metabolic activities. (4) Brain metabolism: During the past year three studies on the metabolism of the brain were carried out, two of which were completed and one almost completed. (a) The first study concerned itself with the effect of insulin on the changes in oxygen and sugar of the brain and arm with special reference to these changes following the administration of insulin. It was shown that the brain lags behind the arm in recover- ing its use of oxygen and sugar. This finding refutes the widely held theory that the improvement following insulin shock therapy is due to increased oxygen and sugar consumption by the brain. (b) The second study concerned itself with the changes in oxygen, carbon dioxide and sugar contents of the arterial and internal jugular venous blood following metrazol convulsions. This study may be summarized as follows: There is no evidence that cerebral anemia initiates metrazol seizures. During the progress of the convulsion, a P.D. 84 15 change occurs in cerebral blood flow dependent upon the altered relationship of blood gases and changes in blood pressure. Any change in cerebral blood flow following the convulsion is temporary, as indicated by the return of blood gases to original levels shortly after the convulsion . There is no similarity between insulin hypoglycemnia and the metrazol convulsion as regards changes in relationship of dextrose and oxygen. So far as these data are concerned, changes in mental states following metrazol convulsion and insulin hypoglycemia cannot be explained on the basis of any common alteration in either cerebral chemistry or cerebral blood flow. (c) The third study concerns the comparative effects of nicotinic acid on the cerebral blood flow in the arm as shown by observations of the superficial and deep blood flow of these parts. Differences in oxygen content between the arterial and venous bloods were measured and studies of the cerebrospinal fluid pressure and examination of the retinal vessels were made. It was shown that the marked changes in blood flow occur in the arm in contrast to the cerebral blood flow. Marked changes in oxygen differences between the arteries and veins of the arm occur, while little or no change occurs in the uptake of oxygen by the brain. Furthermore, no change occurs in spinal fluid pressure at the height of the action of nicotinic acid, nor do any changes in diameter of the retinal vessels result following the administration of the drug. It can be concluded from this study that in contrast to the peripheral circulation, the cerebral circulation appears very resistant to changes in the blood flow following the use of nicotinic acid. II. Biochemistry of Alcohol: The study of the absorption of alcohol has been one of the main problems which we have attacked during this past year. We have definitely established the fact that the adrenergic substances significantly lower the rate of alcohol absorption from the gastro- intestinal tract, and of special interest in this connection is the use of amphetamine sulfate. This is in line with the clinical observations made by others that this drug is valuable in the treatment of acute and chronic alcoholism and, in fact, gives a rational basis for its use. We are carrying out work on pigeons concerning the effect of alcohol and the treatment of alcoholism. Apparently pigeons become drunk and also develop a tolerance for alcohol very much as human beings do. This gives us an opportunity, which we are going to explore through the next year, to study the relationship of other chemicals to the effects of alcohol. III. Neuro-pathological Studies: During the past year the work of the neuropathological division concerned itself with three main studies: (1) the reproduction of Wernicke's disease in experimental animals; (2) the circulation of the basal ganglia, particularly of the strio-pallidum; and (3) the pathology of athetosis and paralysis agitans. (1) The reproduction of Wernicke's disease in experimental animals: The identity of the lesions produced experimentally by Bi avitaminosis in pigeons with Wernicke's hemorrhaic polioencephalitis occurring in chronic alcoholism and other conditions in men was proven by a thoroughgoing study of the topographical distribution and of the morphological and histological characteristics of these lesions. In conjunction with other findings published in previous years, this work may be summarized as follows: (a) Wernicke's hemorrhagic polioencephalilis can be produced with significant regularity in pigeons deficient in vitamin Bi as a complication of beriberi if large supplies of other vitamins (A, B2, C and D) are fed. (b) If the pigeons are kept on an entirely vitamin-free diet the resulting beriberi will only rarely be complicated by lesions of the Wernicke type. (c) Wernicke's disease cannot be produced in pigeons receiving crystalline vitamin Bi (thiamin), although they may be deprived of all other vitamins, or of any one other vitamin for a period of over six months. (d) These observations suggest that vitamin Bi possesses antiangiodegenerative properties, in addition to antineuritic properties, and that smaller amounts of vitamin Bi are sufficient to act as an antiangiodegenerative agent than are necessary for anti- neuritic action. (e) The administration of high doses of vitamins A, B2, C or D in vitamin Bi deficiency probably raises the vitamin Bi requirement of the tissues, and angiodegenera- tion manifests itself soon after the onset of the neuronal degeneration. (2) The circulation of the basal ganglia was studied by means of postmortem injec- tion according to a method previously published by us. The results of this study showed .

16 P.D. 84 that the so-called lenticulo-striate arteries actually supply only the striatum and parts of the internal capsule adjacent to it. They arise from the middle cerebral artery and some of them from the anterior cerebral artery. The globus pallidus and that part of the internal capsule which is posteriorly adjacent to it are supplied by the so-called anterior choroidal artery which, in addition, also supplies the ammonshorn of the hippocampal gyrus. This artery is a direct branch from the carotid artery, runs posteriorly over a considerable stretch along the basal surface of the brain crossing the optic tract twice, finally enters the brain laterally to or per- forating through the posterior end of the optic tract; the part nourishing the pallidum branches off there and recurves anteriorly within the brain substance. Since on the basis of previous studies, we have found that any artery's susceptibility to thrombosis

, Undivided length, can be expressed by the equation:] =-: this artery can be considered as particularly prone to undergo thrombosis in conditions which favor clotting, such as circular disturbances, carbon monoxide poisoning, etc. (3) The pathology of athetosis and paralysis agitans: A careful study of a fairly large number of cases of athetosis reveals a surprising new fact, namely, that the so-called "Marble disease" (status marmoratus, etat marbre) of the striatum is not due to a structual lesion such as could be caused by a birth injury, as has been frequently assumed, but due to abnormal course and termination of the fronto-pontine tract (Turck's bundle) In athetosis and torsion dystonia, the fronto-pontine tract enters the striatum instead of the pons, i.e., it connects the frontal lobe with the striatum instead of with the pons. The over-supply of myelinated fibers to the striatum is thereby explained as nothing else but the normal fibers of the fronto-pontine tract which, however, take an abnormal course into the striatum instead of continuing downwards into the pons where they normally belong and where they are missing in cases of athetosis and torsion dystonia. This pathologic finding probably explains the asynergic ponto-cerebellar component in the motor disturbances of athetoid and dystonic patients. It furthermore elucidates the "extra striatal factors" which the Vogt's assumed in spite of their own discovery of the local striatal abnormality. Furthermore, it fits in well with Wilson's physiological con- ception that the origin of the athetoid and dystonic disturbance would have to be looked for in the frontal lobes. And, again, it explains the fact of Klemme's outstanding success of curing athetosis by operations in the region of the frontal lobes. The most interesting result of the work relating to paralysis agitans is the time factor. In a series of thoroughly studied clinico-pathologic cases, the fact was established that considerable time elapses between the completion of the lesion and the appearance of Parkinsonian symptoms. This time may vary from three months to two years, the aver- age being about one year. The cause of this time lag was not found to be progression of active inflammatory or other changes. A noteworthy fact, the significance of which is, however, still quite problematic, is the observation of typical post-encephalitic pathology in patients who during life presented symptoms characteristic of catatonic schizophrenia. Although this observation may mean nothing beyond the fact that a diagnostic error had been made, in one of these cases it can be stated with absolute certainty that no tremor or true rigidity had been present during life. We feel that the study of brains from schizophrenic patients should be reopened on a larger scale than it has been possible up to the present time. IV. Sex Hormone Studies: During the past year the main emphasis of the sex hormone division of the laboratory has been to determine the quantitative relationships of male and female hormones, especially in regard to male homosexuality, as well as its relationship to other conditions. (1) In regard to male homosexuality it may be stated that there are three general tj'pes; First, the true male homosexual who has no heterosexual desire and who is active in his homosexual drive. This individual tends to have a low male hormone content in his urine and a high female content. In several of our patients the female content has been far above that of the average woman. The second type of male homosexual has hetero- sexual desire, and this is his main avenue of sexual activity. Homosexuality appears incidental to confinement or to character disturbance. Such individuals have normal male and female hormones. A third type of individual is low in sexual drive, often pre- sents endocrinal stigmata, and has a low male and female hormone content. (2) The general trend in cases of impotence is towards a low male and female hormone content in his urine. P.D. 84 17

(3) Masturbation appears to present no special deficiency and, in fact, is often asso- ciated with a high content of both male and female hormones. (4) Certain interesting findings refer to the hormones of children. It appears quite certain that the hormone content follows the overt sexual development; that is, it is low in infancy, gradually increases through early childhood, takes a sudden spurt in puberty, reaching its height in early adult life. This is in direct contradiction to the Freudian hypothesis of a very active sexual fife or active sexual constitution in infancy and child- hood. (5) In certain physical conditions the sexual hormone content seems to be very directly involved. In Mongolism the content is almost nil. In serious thyroid disease, both of the hypo- and hyperthyroid type, there is marked loss of hormones. Similarly with such diverse conditions as scleroderma and diabetes insipidus. This work is continuing. Recently we have made a contact with the Massachusetts Reformatory in Concord which has furnished us with a great deal of valuable material, and the help of Sing Sing Prison has also been enlisted in this research. V. Heredity Studies: These have been going on mainly at the McLean Hospital and as part of the work of the Committee on Heredity and Eugenics of the American Neurological Association. A first paper is in press which relates to the heredity of members of distinguished families at the McLean Hospital. A control study was made of the members of distinguished families of whom we have no knowledge whatsoever to begin with as to their heredity. A third group of studies concern themselves with the heredity of non-distinguished families whose genealogies are accessible. Certain important results can be recorded: (1) The family name is very misleading since the name may go on generation after generation, but the stock changes after each admixture. (2) The family history as given in hospitals is entirely inadequate and never embraces the total amount of mental disease or abnormality in the immediate genealogy, if the term "immediate" includes brothers, sisters, parents, first and second counsins, great uncles, great aunts, as well as grandparents. (3) If such a spread of individuals is considered, mental disease is found almost equally in our three groups of individuals. It appears that mental disease is omnipresent in the community. Here and there it becomes more marked for one or two generations, then it appears to spread again. Generally speaking, there are no normal family trees if the genealogy of the immediate collaterals as well as the siblings, parents and grand- parents is carefully studied. (4) Finally, there appears to be no real relationship between distinction and mental disease, since it appears conspicuously in all walks of life irrespective of attainment or of social achievement and failure. VI. The "Total Push" Method in Chronic Schizophrenia The total push method, introduced by the director, has been tried for a year in certain of the state institutions and at the McLean Hospital. The results vary according to the energy put into the project. Certain of the state hospitals reported no particular change except some improvement in conduct. Other state hospitals and the McLean Hospital reported a very marked improvement in the condition of the patient, general betterment in the tone of the institution, and some increase in the recovery rate. On the whole, it seems certain that the total push method does not cure schizophrenia, although it ameliorates it. It appears further that the method probably has value in the acuter psychosis of all types. VII. Organization Activities: (1) The director was elected to membership in the National Research Council of the National Academy of Sciences to represent psychiatry. (2) The director was appointed chairman of the Committee on Research of the American Psychiatric Association. (3) The director is now a member of the Research Council of the Surgeon General of the United States Public Health Service and has attended conferences and meetings of this group. The director and staff wish to acknowledge with thanks the collaboration and co- operation of the Works Progress Administration, Projects No. 180888 and 21176. 18 P.D. 84 Papers Published 1. The attitude of neurologists, psychiatrists, and psychologists towards psycho- analysis. Am. J. Psychiat. 95:623-641, (Nov.) 1939. (A. Myerson) 2. The social psychology of alcoholism. Diseases of the Nervous System 1:1-8, (Feb.) 1940. (A. Myerson) 3. Errors and problems in psychiatry. Ment. Hyg. 24:17-35, (Jan.) 1940. (A. Myerson) 4. Total Push Method. III. Schema for the recording of certain important attitudes in chronic schizophrenia. Am. J. Psychiat. 9^:935-943, (Jan.) 1940. (A. Myerson). 5. Wernicke's Disease. Identity of lesions produced experimentally by Bi avita- minosis in pigeons with hemorrhagic polioencephalitis occurring in chronic alcoholism in man. Am. J. Pathol. i5':61-69, (Jan.) 1940. (L.Alexander). 6. "Pigeon Dermatitis", A vitamin B deficiency state with anemia. Am. J. Med. Sci. .799:518-539, (Apr.) 1940. (W. Dameshek and P. G. Myerson.) 7. Metrazol convulsions: Changes in oxygen, carbon dioxide and sugar contents of arterial and of internal jugular venous blood. Arch. Neurol. & Psychiat. 46:682-692, (Apr.) 1940. (J. Loman, M. Rinkel and A. Myerson.) 8. Alcohol: A study of social ambivalence. Quart. J. Studies on Alcohol 1 13-20, (June) 1940. (A. Myerson.) 9. Neuroses and alcoholism amongst the Jews. Medical Leaves 3:104-107, 1940. (A. Myerson.) 10. The effect of amphetamine sulfate (benzedrine sulfate) and paradrine hydro- bromide upon sodium amytal narcosis. New England J. Med. 221:1015-1019 (Dec. 28) 1939. (A. Myerson, J. Loman, M. Rinkel, and M. F. Lesses.) 11. The synergism of phenobarbital, dilantin sodium and other drvgs in the treat- ment of institutional epilepsy. J. A. M. A. 1^:480-484, (Feb. 10), 1940. (B. Cohen, N. Showstack and A. Myerson. 12. The effect of furfuryl trimethyl ammonium iodide on various autonomic func- tions in man. J. Pharmacol. & Exper. Therap. 68-476-481, (Apr.) 1940. (A. Myerson, M. Rinkel, J. Loman and W. Dameshek.) 13. Pharmacology of cholinergic and adrenergic drugs. Bulletin of New England Medical Center 2: 127-130, (Apr.) 1940. (J. Loman.) 14. The rationale of amphetamine (benzedrine) sulfate therapy. Am. J. Med. Sci. 199:729-737, (May) 1940. (A Myerson.) 15. Effect of iontophoresis on the eye with special reference to intraocular tension. Arch. Ophth. ^--761-764 (Oct.) 1940. (W. Thau and A. Myerson.) 16. Ocular pharmacology of furfuryl trimethyl ammonium iodide, with special reference to intraocular tension. Arch. Ophth. #4:758-760. (Oct.) 1940. (A. Myerson and W. Thau.) 17. Psychosomatics and somatopsychics. Psychiat. Quart. 14-665-675 (Oct.) 1940. (A. Myerson.) 18. Quantitative sex hormone studies in homosexuality, childhood, and various neuropsychiatric disturbances. Am. J. Psychiat. 97:524-551 (Nov.) 1940. (R. Neustadt and A. Myerson.) Papers in Press 1. Sugar and oxygen metabolism of the brain during and after insulin hypoglycemia. (J. Loman) Arch. Neurol. & Psychiat. 2. Pharmacological studies in experimental alcoholism. I. The effect of sympatho- mimetic substances on the blood-alcohol level in man. (M. Rinkel and A. Myerson). J. Pharmacol. & Exper. Therap. 3. Intravenous drip administration of autonomic drugs. (A. Myerson and J. Loman.) New England J. Med. 4. Experience with electric shock therapy in mental disease. (A. Myerson, L. Feldman and I. Green.) New England J. Med. 5. The incidence of manic-depressive psychosis in certain socially important families. Preliminary report. (A. Myerson and R. D. Boyle.) Am. J. Psychiat. Papers Read 1. Alcoholism as a major public health problem. (Read by A. Myerson before the Research Council on Problems of Alcohol. (A.A.A.S.) New York City December 6, 1939. 2. Pharmacology of cholinergic and adrenergic drugs. (Read by J. Loman before the Boston Dispensary, Janury 25, 1940. . .

P.D. 84 19

3. Recent advances in the treatment of epilepsy and schizophrenia. (Read by A. Myerson before the Greater Boston Medical Society, January 2, 1940.) 4. The effects of alcohol on the nervous system. (Read by L. Alexander before the Boston State Hospital, January 3, 1940. 5. The mechanism of motion. (Read by A. Myerson before the Boston State Hospital, January 10, 1940.) 6. Metabolism of brain in insulin hypoglycaemia as demonstrated by internal jugular puncture method. (Read by J. Loman before the Boston Society of Psychiatry and Neurology, January 18, 1940.) 7. Results of total push method. (Read by A. Myerson, K. Tillotson, L. Maletz, W. Corwin before the Boston Society of Psychiatry and Neurology, January 18, 1940.) 8. Human autonomic pharmacology and eye signs. (Read by A. Myerson before the Boston City Hospital, Neurological Staff, January 26, 1940. 9. Psycho-physiological approach to the psychoneuroses. (Read by A. Myerson before the Metropolitan State Hospital, March 4 and 11, 1940.) 10. Mental Hygiene. (Read by A. Myerson before Tufts College, March 8, 1940. 11. Medical ethics. (Read by A. Myerson at the George Washington Gay Lecture, Tufts College Medical School, March 15, 1940.) 12. Heredity. (Read by A. Myerson before Harvard Medical School, Psychiatric Seminar, March 20, 1940.) 13. Study of the sex hormones in the urine in various neuropsychiatric conditions. (Read by R. Neustadt and A. Myerson before the Boston Society of Psychiatry and Neurology, March 21, 1940.) 14. Red and green lights of activity. (Read by A. Myerson before the American Association of Health and Physical Education, Boston, March 27, 1940.) 15. The incidence of manic-depressive psychosis in certain socially important families Preliminary report. (Read by A. Myerson and R. D. Boyle before the Massachusetts Psychiatric Society, April 5, 1940.) 16. Clinical uses of pharmacological drugs. (Read by J. Loman before the St. Joseph's Hospital, Lowell, April 11, 1940.) 17. Divergent social attitudes of husbands and wives. (Read by A. Myerson before the New York State Conference on Marriage and the Family, New York City, April 13, 1940.) 18. Eugenical sterilization and the inheritance of mental disease. (Read by A. Myer- son before the Boston Lying-in-Hospital Journal Club, April 16, 1940.) 19. Somato-psychics (and psycho-somatics): a critical re-appraisal and restatement of the body-mind (and mind-body) problem. (Read by A. Myerson at the thirthieth annual metting of the American Psychopathological Association, Cincinnati, Ohio, May 19, 1940.) 20. Sex hormones in the urine of the child. (Read by A. Myerson and R. Neusadt at the sixty-sixth annual meeting of the American Neurological Association, Rye, New York, June 7, 1940.) 21. Sugar and oxygen metabolism of the brain during and after insulin hypoglycemia (Read by J. Loman at the sixty-sixth annual meeting of the American Neurological Association, Rye, New York, June 7, 1940.) 21. Sugar and oxygen metabolism of the brain during and after insulin hypoglycemia. (Read by J. Loman at the sixty-sixth annual meeting of the American Neurological Association, Rye, New York, June 7, 1940) 22. Theory and practice of human autonomic pharmacology. (Read by A. Myerson at the round table on "The Allergic Constitution" of the American Society for the Study of Allergy, New York City, June 11, 1940.) 23. Total Push. (Read by A. Myerson before the American Occupational Therapy Association, Boston, September 17, 1940.) 24. Psychiatry and its relation to dental problems. (Read by A. Myerson before Oral Surgery Staff, Boston City Hospital, at Harvard Club, November 4, 1941.) 25. Pharmacological studies in experimental alcoholism. (Read by M. Rinkel before the Massachusetts Society for Research in Psychiatry, Westborough State Hospital, on November 14, 1940.) 26. The male homosexual: hormonal and clinical studies. (Read by A. Myerson, R. Neustadt, and I. P. Rak before the Boston Society of Psychiatry and Neurology, November 1, 1940.) :

20 P.D. 84

27. The study of the urinary sexual hormones with special reference to male homo- sexuality. (Read by A. Myerson before the Beth Israel Hospital, November 23, 1940.

Financial Statement The appropriation for maintenance for the past year was $1,143,221.04, plus an amount of $335.13, brought forward from 1939, making a total of $1,143,556.17. The expenditures amountea to $1,110,395.51. The difference between the expenditures and the appropriation represent the proportion of the $200,000.00 cut in the Mental Health allowance allocated to this institution, giving a weekly cost per patient of $9,097. This was for an average of 2,347.24 patients. The estimate for maintenance for 1941, based on a patient population of 2400 is as follows Personal Services $ 635,000.00 Travel, transportation and office expenses 10,450.00 Food .... 237,138.00 Clothing and materials 31,600.00 Religious instruction 2,080.00 Furnishings and household supplies 34,500.00 Medical and general care 28,000.00 Heat and other plant operations 118,311.00 Farm Garage and grounds 8,535.00 Repairs ordinary 16,100.00 Repairs and renewals 22,590.00

$1,144,304.00 Recommendations To continue the efficient functioning of this institution, and to provide adequate care and treatment for the patients, the following improvements should be made. A serious menace to the health and safety of the patients is an open stream which passes through our property. The stream drains unclean areas in addition to the ceme- tery, and from this point of view is dangerous to the health of the patients. The water is deep enough to drown in. It is my opinion that this stream should be completely covered over on the hospital property. The cost of this would be approximately $100,000.00. There are five stucco buildings on the hospital grounds, all designed to house patients. Three of them are being used for this purpose at the present time. The buildings have adequate fire escapes and water sprinkling systems, but a hazard remains in the old electrical wiring which cannot be repaired. All of this wiring should be removed from these buildings and new wiring installed. The cost of this will be approximately $50,000.00. The entire electrical system of the hospital is fed by one power plant. The interruption of the flow of electricity from the power plant shuts down all electrical lighting, machin- ery, and appliances. If this happens at night, the entire hospital is thrown into total darkness. I feel that the most vulnerable part of this system should be protected, i.e., the power lines from the power plant should be placed underground. They are now strung overhead. The cost of placing these lines underground would be approximately $40,000.00. The hospital property is divided by an arterial highway, which creates a serious hazard relative to the movement of the patient population across it. This movement of the patient population is necessary because of the location of our industries, the presence of an auditorium on one side of the street, and the recreation field upon the other. In order to eliminate the danger from the automobile traffic, I feel that a tunnel should be bored under Morton Street and a passageway made there under to handle the hospital traffic. The cost of this would be approximately $60,000.00. With the exception of a few buildings in the East Group, none of the buildings in the hospital are connected with each other or with the patients' dining rooms. This means that the patients must go out of doors to their meals, regardless of the weather. This movement of patients is euqally true of the transfer from one building to another. It is my opinion that this movement can be handled in only one manner, i.e., the erection of tunnels inter-connecting buildings and connecting buildings with the dining rooms. The cost of this work would be approximately $85,000.00 P.D. 84 21

The entertainment program at this hospital for the benefit of the patients is carried out on an extensive scale. The only large auditorium available is one which has a seating capacity of less than 500, located in the East Group. This necessitates a long walk for the patients from the West Group who attend the entertainments, and it is also necessary for them to cross the dangerous intersection at Morton and Harvard Streets. A large auditorium should be erected in the West Group. This building would cost approxi- mately $192,000.00. In view of the fact that the admission rate of this institution has increased from 777 patients in 1933, at which time the last physician was added to the hospital staff, to 1,165 during the year of 1940, and because one of the ward physician positions, namely that of a Senior Physician, was converted to that of a Director of Clinical Psychiatry, there is very definitely a disproportion between the number of hospital physicians and patients today as compared with 1933. At that time this institution conformed to the standards of the American Psychiatric Association relative to the ratio between physi- cians and patients. In order to bring the present physician-patient ratio within the standards of the American Psychiatric Association, the importance of which is only too obvious, it is my feeling that there should be added to the Medical Staff one Senior and three Assistant Physicians. The necessity is made even more obvious when it is considered that we have established in this institution a night physician whose entire time is taken up with work at night, an out-patient department which during the year of 1940 saw over a thousand patients, and the fact that there has been a material increase in the number of juvenile delinquent examinations which we are requested to do. Furthermore, the type of neuropsychiatry work which has been performed in the past several years has been of a more meticulous nature and of greater volume than ever before, thereby increasing the load on the existing staff physicians tremendously. Although the load on the stenographic department handling the records, correspond- ence, etc., relative to patients has been proportionately increased with the increase in admissions, juvenile delinquents, school clinic examinations, more detailed neuropsy- chiatry examinations, admission routines, etc., over a period of years, there has not been an addition to the stenographic force in this particular field since 1936. It is not necessary to call attention to the fact that the addition of this stenographer in 1936 was not suffi- cient to satisfy the existing need at that time and had been requested for several years previously. When one considers the volume of work that must be turned out by an individual in the stenographic department it at once becomes quite obvious that the load is entirely out of proportion with any one stenographer's capacity in this respect. Al- though it was formerly possible for one clerk to carry on all of the statistical work con- nected with the patient population, this has now become an impossibility and requires two or even three clerks. Since we do not have help enough to supply these extra clerks the statistical work is continually falling behind, thus retarding other departments who depend on these reports. It is my opinion that four Junior Clerks and Stenographers should be added to the stenographic force. Never in the history of this institution has there existed a position for a Psychologist although the need for one has always existed. The present force of two psychometrists is entirely occupied with the psychometric examinations of patients, juvenile delinquents, and the testing of children in the School Clinic. Proper psychological evaluation of of patients is impossible under the present system and the need for a trained psychologist is great. A large majority of our 735 employees are residents of the City of Boston, and many of them live within a short distance of the hospital. It is unfair to give them maintenance at this hospital which they are unable to accept because of the nearness of their homes. It is my impression that these employees should be given money in lieu of maintenance. Such an arrangement would make several new buildings available for the use of the patients. In this manner the eight years' required residence in Boston could be lowered. These buildings, with very little expense, could be converted for the use of patients. Conclusion I wish to extend my thanks to the members of the Board of Trustees for their co- operation helpfulness all and at times during the past year and to assure them that it has been appreciated by me. The death of Dr. Francis J. Callanan of the Board of Trustees, on April 14, 1940, was a great loss. 22 P.D. 84

I wish also to thank the medical staff, the various department heads, and all of the employees for all they have contributed to the health and happiness of our patients during the past year. Respectfully submitted, Habold F. Norton, Superintendent. VALUATION November 30, 1940 Real Estate Land, 224.66 acres $ 974,100.00 Buildings and betterments ...... 3,821,613.20 $4,795,713.20 FINANCIAL REPORT To the Department of Mental Health: I respectfully submit the following report of the finances of this institution for the fiscal year ending November 30, 1940. Statement of Earnings Board of Patients $ 76,115.65 Personal Services ...... 324.27 Sales: Food $392.74 Furnishings and household supplies ...... 17.83 Medical and general care ...... 8.00 Garage and grounds ...... 3.00 Repairs ordinary ...... 242.61 Miscellaneous ...... 82.06 Total Sales $746.24 Total earnings for the year ...... $77,186.16 Total cash receipts reverting and transferred to the State Treasurer .... 77,193.16 Accounts receivable outstanding Dec. 1, 1939 ..... $7.00 - • Accounts receivable, decreased ...... 7.00 Maintenance Appropriation $335 13 Balance from previous year, brought forward ...... Appropriation, current year ...... $1,143,221.04 Total $1,143,556.17 Expenditures as follows: Personal services ...... $629,865.04 Food . 229,228.13 Medical and general care ...... 29,995.33 Religious instruction ...... 2,080.00 Heat and other plant operation ...... 105,727.49 Travel, transportation and office expenses ..... 10,091.33 Garage and grounds ...... 6,434.43 Clothing and materials ...... 31,206.88 Furnishings and household supplies ...... 34,400.42 Repairs ordinary ...... 15,599.48 Repairs and renewals ...... 15,765.98 Total maintenance expenditures ...... $1,110,394.51 Balances of maintenance appropriation, Nov. 30, 1940 ...... 33,161.66 Special Appropriations $81,564.86 Balance December 1, 1939, brought forward ...... Appropriations for current year ......

Total $81,864.86 Expended during the year ...... $45,258.80 Reverting to Treasury of Commonwealth ...... 45,258.80 Balance November 30, 1940, carried to next year ...... $36,306.06 P.D. 84 23 Per Capita During the year the average number of patients has been, 2,358.02. Total cost of maintenance, $1,110,394.51. Equal to a weekly per capital cost of $9,0557. Total receipts for the year, $77,193.16. Equal to a weekly per capita of $.6295. Total net cost of maintenance for year, $1,033,201.35. Net weekly per capita, $8.4262. Respectfully submitted, Frieda Kaplan, Treasurer. Financial statement verified. Approved: Walter S. Morgan, Comptroller. STATISTICAL TABLES As Adopted by the American Psychiatric Association, Prescribed by the Massachusetts Department op Mental Health Table 1. General Information (Data correct at end of institution year November 30, 1940) Date of opening as a hospital for mental diseases, December 11, 1839.

Type of hospital: State. >-; Hospital plant: Value of hospital property:

...... Real estate, including buildings , . $4,795,713.20 Personal property ...... Not valued Total $4,795,713.20 Total acreage of hospital property owned, 224.66. Officers and employees: Actually in Service Vacancies at End at End of Year of Year M. F. T. M. F. T. Superintendents 1 - 1 Assistant physicians 10 4 14 Clinical assistants 1 - 1

Total physicians 12 Stewards Resident dentists Pharmacists

Graduate nurses . Other nurses and attendants Occupational therapists Social workers All other officers and employees

Total officers and employees 24 P.D. 84

In P.D. 84 25

Table 3. Nativity of First Admissions and of Parents of First Admissions 26 P.D. 84

Table 4. Age of First Admissions Classified with Reference to Nativity, and Length of Residence in the United States of the Foreign Born-—Continued FOREIGN BORN

Time in United States before Admission Age At Nativity Admission Total Unknown

5-9 years 10-14 years 15 years and over Unknown

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

0-14 years 15-19 years 1 1 20-24 years 2 1 25-29 years 4 4 1 - 30-34 years 5 3 35-39 years 8 8 16 40-44 years 11 2 13 45—49 years 15 14 29 15 14 29 50-54 years 18 15 33 18 15 33 55-59 years 14 12 26 14 12 26 60-64 years 20 20 40 19 20 39 65-69 years 21 13 34 20 H 31 70-74 years 24 17 41 22 14 36 75-79 years 17 18 35 16 14 30 80-84 years 8 10 18 7 10 17 85 years and 3 5 8 3 5 8

Total 170 143 313 5 6 11 158 130 288 6 7 13

Table 5. Citizenship of First Admissions M. Citizens by birth Citizens by naturalization Aliens First papers

Citizenship unknown .

Total 432 363 795

Table 6. Race of First Admissions Classified with Reference to Principal Psychoses P.D. 84 27

Table 6. Race of First Admissions Classified with Reference to Principal Psychoses—Continued

Race 28 P.P. 81

Table 6. Race of First Admissions Classified with Reference to Principal Psychoses—Concluded

Race P.D. 84 29

Table 7. Age of First Admissions Classified with Reference to Principal Psychoses—Continued

Psychoses 30 P.D. 84

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Table 13. Mental Disorders of All Admissions, All Discharges, Out on September 30, 1940, byStatus of P.D. 84 37

All Deaths, 1940, All Cases in Residence and All Cases Admission and Sex—Concluded 38 P.D. 84

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