Annual Report of the Trustees of the Taunton State Hospital

Public Document No. 22

e Commontoeal-tJ of spasgacfuigettg do c s '. ^ COLL*. ANNUAL REPORT

Year ending November 30, 1923

Department op Mental Diseases

. ,

Publication of this Document approved by the Commission on Administration and Finance OFFICERS. TRUSTEES. Arthur B. Reed, Chairman, Abington. Philip E. Brady, Esq., Attleboro. Charles C. Cain, Jr., Taunton. Simeon Borden, Jr., Esq., Fall River. Julius Berkowitz, New Bedford. Margaret C. Smith, Taunton. Elizabeth C. M. Gifford, Secretary, Cambridge. RESIDENT OFFICERS. Ransom A. Greene, M.D., Superintendent. Roderick B. Dexter, B.A., M.D., Assistant Superintendent. John J. Thompson, M.D., Senior Assistant Physician. Fannie C. Haines, M.D., Senior Assistant Physician. Samuel Tartakoff, M.D., Assistant Physician. Charles A. DeCary, B.S., M.D., Assistant Physician. Clarence M. Kelley, M.D., Assistant Physician. Rodolphe M. Richard, M.D., Assistant Physician. Wilfred H. Baines, M.D., Pathologist. George A. Harris, D.M.D., Dentist. Linda A. J. Richards, R.N., Superintendent Nurses Emerita. James W. Flynn, Engineer. Stephen F. Tracy, Steward. Fred. Gullon, Farmer. Frank W. Boynton, Treasurer.

Cije Commontoealtf) of ®$ft$mthumt$ TRUSTEES' REPORT.

To His Excellency the Governor and the Honorable Council. The trustees of the Taunton State Hospital present herewith their seventieth annual report, together with the Superintendent's report, Treasurer's report and the annual statistics. During the past year the only work remaining on special appropriations for the hospital to complete was the Mill River Dam which has now been finished, and at the time of writing this report the course of the Mill River has been changed and is running over new spillway constructed. For many years there has been an urgent need at this institution for the expenditure of funds based upon a program for the better care of inmates by reason of over-crowded conditions, and also on basis of safety as to fire protection. As time goes on the need for granting these requests is more and more manifest. The installation of a sprinkler system in attics and basements of the main building is of paramount importance. The program as so far outlined, includes in its scope as preliminary steps, the construction of a storehouse and cold storage plant. It has been necessary for a number of years to utilize day halls and certain corri- dors for purposes of sleeping quarters by an arrangement of movable beds. It is most certainly necessary to increase the dormitory space in the main building. This can be accomplished in various ways, but it seems more advisable and a special request has been made upon the basis that this purpose could best be carried out together with the increasing of dining room space by the following method, viz., the construction of a storehouse and cold storage plant in conjunction with extension of spur track now in existence. The present storage capacity is inadequate, inconvenient and space now occupied for storage in the rear of the main building together with cold storage which unless practically renewed will have to be immediately considered as a problem for reconstruction and in P.D. 22. 3 conjunction with storehouse will lend us space in the main building for another part of our program, which is, a later request for the revamping and building of additional kitchen and culinary department as well as furnish space for construction of a congregate dining room of such capacity as to relieve the present much over-crowded dining rooms, and dining rooms so relieved throughout the hospital may then be converted into dormitory wards. Now that the Mill River Dam has been constructed it seems wise that the second part of construction program be requested, namely; bridge, which upon completion will give direct entrance for a great many of the visitors to the hospital and be of great convenience to those employed, rendering the institution more accessible; this project lending itself very admirably to the improvement of grounds as well as facilitating communication. As it is becoming increasingly difficult to obtain physicians for staff it is urgently a necessity that living quarters for married physicians be made an inducement for entering the psychiatric field of work, and a program for construction of such quarters is proposed, beginning with a request for Superintendent's house. Such construction also to be on the basis of relieving over-crowded quarters and dining room space at the present time used in the main building of the hospital. There has been received at the time of making up this report a very beautiful sentiment expressed in the message of His Excellency, Governor Channing H. Cox, which was incorporated in the Christmas programs of the calendar year of 1923, and this Board desires to express to relatives and friends of patients in this hospital the sentiment contained in the Governor's Message. We feel that the work of the hospital will be carried on much easier through the public visitation and familiarity with our problems and needs and a sympathetic understanding of the difficulties encountered in the care of pur unfortunate inmates ; also assist us in the economies that are justly and rightly used, and testify that the expenditure of special appropriations from time to time is most essential to progressive, scientific and humanitarian care of our patients. The hospital has felt many losses in the heads of departments during the past year. The sudden death of Miss Elizabeth Best who served in the capacity of head matron for many years is deeply to be regretted. The position has been filled by Mrs. Elizabeth Fulton. The Board feels that this report should contain a record of their appreciation of the services of officers of the hospital resigned by retirement in the past year. The chief engineer, Mr. James C. Flynn, spent within a few months of fifty years of service at this institution, giving his entire time whole-heartedly and most efficiently. The head carpenter, Mr. Benjamin G. Cobb, also having spent nearly half a century in the service of the Commonwealth resigned by retirement. The most workmanlike and conscientious construction at various points of the institution will testify and be a monument to the type of service which he has for so many years rendered. The loss of Mr. William S. Hiltz through retirement on account of physical disability was very keenly felt. Other changes that have taken place in the personnel of the hospital are: the resignations of Charles J. Bolton, M.D., as Assistant Physician; Frederick A. Parker, M.D., as Pathologist; Joseph V. Chatigny, M.D., as Assistant Physician, who was able to obtain a more advanced position in another hospital of the Com- monwealth. We feel deepest regret that the hospital has lost the services of David Mackler, M.D., who died, at the age of twenty-eight years, while in the service of this hospital, having been ill for several months. The Doctor had been most loj^al to the hospital and on account of his temperament and most amiable disposition as well as the character of his work was most fitted for medical care of the unfortunates. His loss was keenly felt. Additions to the Staff made during the year are as follows: There has been appointed to the position of chief engineer, James W. Flynn, and to the position of foreman mechanic, George S. Hollingworth. Rodolphe Richard, M.D., has been appointed to the position of Assistant Physi- cian. Wilfred H. Baines, M.D., as Pathologist. Clarence M. Kelley, M.D., as Assistant Physician. 4 P.D. 22. The Training School has been continued under difficulties. Employment of attendant nurses, both male and female, seems difficult, and to secure women with the required qualifications for entry into our regular training course is increasingly hard. At the present time we have in our Junior Year but four students, eight are taking their course with the affiliated training class at the Boston City Hospital, and only six students are in the coming graduating class. The Trustees cannot close the year without expressing their fullest appreciation of the able service and loyalty given by the entire staff and of the distinguished service given by our Superintendent, Ransom A. Greene, M.D., who has by prac- tice as well as precept inculcated a new era of progress in the hospital's history. Under his direction, the hospital administration has been made highly efficient and a high standard has been established which should assure the hospital of continued progress in the care of its patients. We, the undersigned, respectfully submit the above report. ARTHUR B. REED, Chairman. PHILIP R. BRADY. ELIZABETH C. M. GIFFORD. SIMEON BORDEN. 1 CHARLES C. CAIN, Jr. JULIUS BERKOWITZ. MARGARET C. SMITH. SUPERINTENDENT'S REPORT.

To the Trustees of the Taunton State Hospital. I respectfully submit the seventieth report of the superintendent covering the fiscal year ending November 30, 1923. The Statistical covers the period included between October 1, 1922 and Sep- tember 30, 1923. Movement of Population.

On October 1, 1923, patients in the hospital and family care numbered 674 men and 741 women, total, 1,415, — 31 more than on the corresponding date of previous year. The total number under treatment during the year was 983 men and 1,038 women, total 2,021. The daily average number of all patients actually in the institution during the year was 768.0231 men and 826.0493 women, — total 1,594.0724. Transfers by the Department of Mental Diseases numbered 8 and were as follows: 1 to Foxborough State Hospital, 1 to Bridgewater State Hospital, 1 to Wrentham State School, 1 to McLean Hospital, 1 to Medfield State Hospital, 2 to the State Infirmary at Tewksbury, and 1 to Wiswall Sanitarium. 10 patients were deported, and 8 sent to other States during the year. In Family Care we now have 14 patients, — 2 men and 12 women. Medical Administration.

The position of pathologist has been filled the greater part of the year but is, at the time of making up this report, vacant. That this position should be filled and work continued is very urgent and I will use every effort to encourage the occupation of this vacant position by some one at the earliest opportunity. X-ray equipment has been established in connection with the laboratory and a great deal of the routine laboratory work is being carried on, even in the absence of pathologist, by the laboratory assistant which position was filled during the past year. There has also been added to the laboratory work, a photographic department which is at present equipped so that records of all patients are made more complete by the addition of patient's photograph. Examination of blood and spinal fluid specimens together with anti-syphilitic treatment is being carried on as during previous years. Report of Pathological Laboratory.

Autopsies performed, 53. Chemical examinations (total, 1,179), Blood, chemical determinations^; Spinal fluids, 146; Urinalyses, 1,031.

1 Deceased. : : :

P.D. 22. 5 Microscopic examinations (total, 112), Bloods, 45; Cultures, 10; Feces, 1; Smears, 14; Sputums, 41; Widal, 1. Bloods for Wassermann test, 646; Spinal punctures, 146; Salvarsan injections, 476; Mercurial injections, 421. Out-patient Clinic and School Clinic.

For some years, clinics to supervise the progress of extra-mural cases have been conducted by this hospital once a month in both Fall River and New Bedford. In April of this year, a Mental Hygiene Clinic, operating weekly, and differing from the old type of clinic in that any community cases might be presented to it for examination and treatment was opened under the direction of this hospital in New Bedford. The personnel of this Clinic, which also operates once a month in Fall River and examines cases which are brought to the main hospital for examination without the formality of commitment, consists of one physician, two social service workers and one psychologist. The purpose, as is the purpose of any specialized general hospital out-patient clinic, is to accept for examination all of those cases presented to it which fall within its scope; to differentiate those cases which are suitable to be cared for in the community from those which should properly be hospitalized, and to institute in the former group therapeutic measures of a physical, psychiatric, or social nature which would tend to modify or entirely eradicate those symptoms which made it necessary for them to be presented for examination, in order that they be enabled to remain more comfortably in the community. There have been seen during the year a total of 150 different patients, of these 63 were male and 87 female. The total visits numbered 316, of which 125 were male and 191 female.— The sources of the cases examined at the clinic have been as follows :

Out-patient Department, February 1, 1928, to November 80, 1923 — Source of Cases.

(a) Children's Aid Society, 37 (g) Taunton State Hospital, 32 (b) Family Welfare Society, 25 (h) Public Schools, 5 (c) Society for Prevention of Cruelty to (i) Private physicians, 5 Children, 11 (j) Instructive Nursing Asso., 3 (d) International Institute, 3 (k) Tubercular Clinic, 1 (e) Self or immediate family, 26 (I) St. Luke's Hospital, 1 (/) Courts, 1

1. New Bedford: 2. Fall River: 3. House cases: (a) New cases (a) New cases (a) New cases Male, 48. Male, 10. Male, 5. Female, 69. Female, 14. Female, 4. Total, 117. Total, 24. Total, 9. (6) Total visits: (b) Total visits: (b) Total visits: Male, 91. Male, 22. Male, 12. Female, 154. Female, 28. Female, 9. Total, 245. Total, 50. Total, 21.

Male cases seen (new), 63. Female cases seen (new), 87. Total new cases, 150. Male visits to clinics, 125. Female visits to clinics, 191. Total visits to clinics, 316.

School Clinics, Dec. 1, 1922-Nov. 30, 1923. M. F. T. New Cases referred for examination 61 33 94 New Cases completed 30 11 41 New Cases incomplete 31 22 53 Re-examination 13 3 16 :

6 P.D. 22. Dental Wohk.

Bridgework: Preparation for, 6; Removed, 8. Crowns: Davis set, 7; Gold reset, 2; Gold set, 1; Gold removed, 4; Cleaning and scaling, 87; Examination and charting, 577; Extractions, 1,311. Fillings: Amalgams, 647; Cement, 74; Root Canal, 8; Synthetic, 4; Temporary, 7; Zinc Oxide and Eugenol, 181; X-rays taken, 42. Inlays: Preparation for, 2; Carved, 2; Set, 2. Plates: Im- pressions for, 49; Made, 38; Adjusted, 150; Repaired, 14; Cleaned, 111. Treat- ments: For pyorrhoea, 1; Formo-Creosol, 14; Gums, 48; Howe's Silver Nitrate, 10; Oil of Cloves, 6; Post Operative, 143; Guaol, 6; Root Canal, 3; Pulp Re- moved, 2.

Number of visits, 2,220 Number of operations, 3,567 Average operation per patient, 1 .60% Percentage of patients with work completed, 87% Percentage of patients unable to receive dental attention, 5.89% Percentage of patients with work to be done, 7.11% Social Service Report.

The following is the report of the Social Service Department for the year ending on November 30, 1923. As usual there have been two full time workers. The scope and limitations of the work have remained about the same as in previous years with the exception of the clinic work, which has been increased. As in the past it seemed to be impossible for the school authorities to obtain the proper type of histories for the children referred to the School Clinic, it was decided during this last year that the social service department should assist the school nurse in gathering information. The following plan was attempted. On one day the nurse acted as guide to the worker, conducted her personally to the homes of the children, observed the method of asking questions, and then was left for several weeks to complete the histories. A second appointment was then made when the hospital worker reviewed the data and collected whatever additional information seemed to be necessary. In some instances, this was a good method but in others it was not satisfactory. During the following year, the social service department will take all histories with the nurses acting as escorts. The Community Clinic described elsewhere in the report, has offered an opportunity to the department to become acquainted with many interesting social and psychiatric cases. At the clinics, where always one worker and usually two are present, the social workers act as clinic directors and historians. From the relatives and agents representing various social organizations, a full family and personal history is obtained before the patient sees the physician. Whenever psycho- metric tests and physical examinations are desired, arrangements are made for these. The workers also interpret the scope and purposes of the clinic to visitors and agents coming for the first time and instruct them in the type of information needed by the physician for the giving of the best advice. During the time not occupied by the above, the social workers discuss in an informal manner social problems that bother either the agent or the relative, hoping in this mannerto maintain the morale of the clinic and break the monotony of the long wait which of necessity occurs before it is time to see the physician. Following are the yearly statistics P.D. 22. 7

Social Service Yearly Statistics, Dec. 1, 1922, to Nov. 30, 1923.

I. Numerical Summary of Cases: 8 RD. 22. IV. Service Rendered — Concluded. 2. Social:

(«) Adjustments for Patients f 49 { —&, (b) Adjustments for Patients in industry, 22 (c) Adjustments for Patients in recreation, 10

f To relatives, 86

(d) Advice I To patients, 93

[ To others, 59 (e) Connecting with Agencies, 47; with individuals, 12

f Legal, 3

(/) Family assistance { Financial, 18

[ Miscellaneous, 22

( 2 V. Supervision Work: 1. No. Patients on visit last day previous year, 231 No. Patients on visit last day current year, 166.

( To Patients on ward, 71 visit, | To Patients on 142

Visits I To Relatives or Friends, 270 To Social Agencies, 105 I

[ To Others, 97 No. Patients in care of Other Agencies, 87 2. Family Care Patients: (a) No. Patients visited, 18 (d) No. Patients returned, 5 (6) No. Patients placed, 1 (e) No. Patients Discharged, 1 (c) No. Patients replaced, 4 (/) No. Boarding Homes investi- gated, 1 VI. Clinic Work: f No. clinics attended, 17

' Purviews with patients, 47 1. Hospital^ Clinics g No. interviews with relatives, 23 I

[ No. social cases selected, 10

f No. attended, 5 a Histories, 36 2. School Clinics gNo. Psychological Tests, 3

[ Miscellaneous Work (Instruction of nurse), 4 No. Attended, 28 [ No. interviews with Patients, 145 I

3. Community Clinics ( No. interviews with Others, 109 No. cases selected, 2 I

[ No. cases referred to local agencies, Training School Statistics. Men Women Graduates in 1923 - 10 Senior Class - 6 Intermediate Class - 6 Junior Class - 4 Number in Boston City Hospital - 8 Number during year in Boston City Hospital - 12 Farm.

During the latter part of the year the work of the farm has been somewhat interrupted by the loss of Mr. William S. Hiltz, Head Farmer, through illness and necessary retirement. However, during the year we have been able to acquire by elimination, a herd of cattle free from tuberculosis, and have established the P.D. 22. 9 entire milk herd dairying industry of the hospital at the Borden Colony, instead of maintaining a duplicate herd at the barns of Main Hospital and Lovering Colony. The pasteurizing outfit completed last year is now functioning efficiently. Re-establishment of poultry plant has met with fair success, and a sub- stantial addition to this branch as a department of the farm is anticipated in the coming year. Occupational and Industrial Departments.

The work of the occupational and industrial departments has been very satisfactory during the past year; the occupational department being an additional armament to our therapeutic care of patients. On the present staff of the occupational department there are three women employed. This department has accomplished the making of many articles to beautify and decorate the wards together with many useful articles. The production of this department, however, is not considered so essential or important a factor as the fact that this department has interested patients with such mental conditions that would be unable otherwise to be occupied and greatly assisted in their recovery, and I am certain that this form of occupation has decreased the length of residence of many of the patients, because of its assistance in hastening their return to mental balance. In the industrial department there has been no changes. The work has continued most satisfactorily and efficiently. This department includes the making of shoes, making and repairing of harness, tailor shop, broom shop, tin shop, basket shop, and furniture, mattress and upholstering shop. In the sewing department the head seamstress and seamstress have been established in large and commodious quarters, and the output of this department has been greatly increased and many additional patients are employed in this work.

Entertainments. .

We were unfortunate the greater part of the last winter, being unable to hold regularly our entertainments because of an epidemic of scarlet fever afflicting forty-two patients and employees, necessitating quarantine from November 25, 1922 to April 14, 1923. This, however, has been made up as far as possible during the summer months by ball games and outdoor picnics, and during the fall regularly having at weekly intervals moving pictures, dances, and additional entertainments furnished by various organizations who have been most kind in visiting the hospital and giving their services. Religious Services.

Religious services have been conducted regularly each Sunday; Catholic clergy- man officiating in the morning, and Protestant services being held in the after- noon. Services were also conducted regularly at the colonies. As in the past, the clergymen have been always available and most anxious to administer the rites of the various religions to the critically ill, as well as visit the patients of the hospital at frequent intervals. They have also been of great assistance to us in the care of our patients. General Repairs of the Institution.

I am glad to report that repairs of the institution have been going on very satisfactorily. Considerable has been accomplished in the way of repairs and renewals necessitating quite a number of changes in construction in the main office to provide space for records, installation of dictaphones and space for the stenographic force. Quarters have also been provided by alteration in the industrial building for the department of occupational workers. Some changes in construction were necessary so that a twenty-four hour telephone service could be maintained. Toilet facilities have been increased at the Borden Colony. Wagon shed and barn have been erected at the Borden Colony and an old abandoned barn acquired at time of purchase of Borden Colony property has also been removed. The electric lighting of the Lovering Colony has been completed and is very satisfactory. At this Colony there has also been completed, painting and an addition of molding for hanging pictures, which have been provided. The male 10 P.D. 22. and female homes have been completely repainted and plastered. Roof of piggery renewed. Garage capacity increased and fully equipped, and quite complete automobile equipment installed. The roofs of the main building have had to have quite extensive repairs, as also has the refrigeration plant. Certain changes have been made in the laundry department. While decreasing the personnel of this department with the establishment of a new system, we are increasing the capacity and efficiency of the laundry. Watchmen have been added to our quota of employees and this has been very satisfactory in the protection of property against depredations by pilfering of gardens and grounds. A regular fire organiza- tion has been established among the employees, and a whistle for drills has been installed. A modern fire alarm box has been installed in the immediate proximity of the telephone exchange. Medical Work.

The Staff is at present following closely the outlines of classification recom- mended by the National Committee of Mental Hygiene. Staff conferences are held daily for the consideration of diagnosis and disposition of patients, and at regular intervals, social service problems, research and special medical problems are considered. A marked interest is also exhibited in the discussion of our Out- Patient Clinic as to its extra-mural patients. In our study we have been im- pressed by the following facts as regards the type of mental disease classified under the heading of Alcoholic Psychosis. —

P.D. 22. 11 TREASURER'S REPORT.

To the Department of Mental Diseases. I respectfully submit the following report of the finances of this institution for the fiscal year ending November 30, 1923:

Cash Account. Balance December 1, 1922 $15,508 65

Receipts. Income. Board of inmates: Private $23,799 47 Reimbursements, insane 35,676 76 — $59,476 23 Personal services: Reimbursement from Board of Retirement 180 95 Sales: Travel, transportation and office expenses .... $17 02 Clothing and materials 216 46 Furnishings and household supplies 2 09 Medical and general care 5 60 Farm: Cows and calves $228 28 Pigs and hogs 14 00 Hides 277 71 Sundries 49 53 — 569 52 Garage, stable and grounds 2 10 Repairs, ordinary 414 92 Repairs and renewals 25 00 1,252 71 Miscellaneous: Interest on bank balances $533 33 Rent 297 08 Sundries 184 00 1,014 41 Board of employees 778 72 62,703 02 Other receipts: Refunds of previous year 73 81

Receipts from Treasury of Commonwealth. Maintenance appropriations: Balance of 1922 $15,868 32 Approved schedules of 1923 463,393 07 — 479,261 39 Special appropriations: Balance of 1922 $817 31 Approved schedules of 1923 11,395 26 12,212 57

Total . . $569,759 44

Payments. To treasury of Commonwealth: Institution income $62,703 02

Refunds, account of maintenance, $267.98; account of special, $208.02 . 476 00 Refunds of previous year 73 81 $63,252 83 Maintenance appropriations: Balance of schedules of previous year (Nov. schedule, $47,868.32; less adv., $16,423.90) $31,444 42 Approved schedules of 1923 $463,393 07 Less returned 267 98 463,125 09 494,569 51 Special appropriations: Balance of schedules of previous year $817 31 Approved schedules of 1923 $11,395 26 Less returned 208 02 $11,187 24 Less advances, last year's report 67 45 11,119 79 — 11,937 10 Total $569,759 44 Maintenance. Balance from previous year, brought forward $204 04 Appropriation, current year 502,344 03

Total $502,548 07 Expenses (as analyzed below) 487,017 55

Balance reverting to treasury of Commonwealth $15,530 52 12 P.D. 22. Analysis of Expenses. Personal services $212,064 48 Religious instruction 1,620 00 Travel, transportation and office expenses 6,500 15 Food 89,085 82

Clothing and materials . 18,527 58 Furnishings and household supplies 31,620 95 Medical and general care 18,584 83 Heat, light and power 47,710 82 Farm 20,971 74 Garage, stable and grounds 7,778 25 Repairs, ordinary 15,373 94 Repairs and renewals ' 17,178 99

Total expenses for maintenance $487,017 55 Special Appropriations. Balance December 1, 1922 $13,674 60 Expended during the year (see statement below) $13,533 76 Reverting to treasury of Commonwealth 47 13,534 23

Balance November 30, 1923, carried to next year $140 37

Object. P.D. 22. 13 STATISTICAL TABLES AS ADOPTED BY AMERICAN PSYCHIATRIC ASSOCIATION. PRESCRIBED BY MASSACHUSETTS DEPARTMENT OF MENTAL DISEASES.

Table 1. — General Information.

1. Date of opening as an institution for the insane, 1851. 2. Type of institution: State. 3. Hospital plant: Value of hospital property: Real estate including buildings 3825,452 65 Personal property 188,807 31

9 6 Total . $1,014,259 Total-acreage of hospital property owned, 336. Additional acreage rented. Total acreage under cultivation during previous year, 137. 4. Officers and employees: Actually in Service Vacancies at End at End op Year. of Year.

M. F. T. M. F. T. - Superintendents 1 1 Assistant physicians 7 1 8 2 1 3 Medical internes ...... - - - Clinical assistant ......

Total physicians 8 1 9 2 1 3 - - ~ Stewards 1 1 - Resident dentists 1 - 1 Graduate nurses ...... 2 18 20 - Other nurses and attendants ..... 64 61 125 7 9 16 Teachers of occupational therapy ..... 3 3 6 Social workers ...... 2 2 All other officers and employees 59 46 105 9 15 24

Total officers and employees 138 131 269 18 25 43

5. Census of patient population at end of year: Actually in Absent from Insti- Institution. tution but still on Books. M. F. T. M. F. T. White: Insane 661 726 1,387 103 90 193 Epileptics - Mental defectives ...... - - - - Alcoholics ...... - - - Drug addicts ...... - - - Neurosyphilitics (without psychosis) ... ------All other cases

Total 661 726 1,387 103 90 193 Colored: Insane 15 9 24 2 2 ~~ - Epileptics ...... - - - - _ Mental defectives - - - - - Alcoholics ...... Drug addicts ...... - Neurosyphilitics (without psychosis) ... - - All other cases ...... - - - - -

Total 15 9 24 2 2

Grand total 676 735 1,411 103 92 195

M. F. T. 6. Patients employed in industrial classes or in general hospital work on date of report 473 418 891

7. Average daily number of all patients actually in institution during year . 648.0039 705.9147 1,353.9186 8. Voluntary patients admitted during year ...... 1 1 9. Persons given advice or treatment in out-patient clinics during year . . 63 96 158

Table 2. — Financial Statement.

See treasurer's report for data requested under this table. 14 P.D. 22.

Opq P.D. 22. 15 Table 4. — Nativity of First Admissions and of Parents of First Admissions for the Year ending September 30, 1923. 16 P.D. 22. Table 6. — Psychoses of First Admissions for the Year ending September 30, 1923.

Psychoses. P.D. 22. 17 Table 7. — Race of First Admissions classified with Reference to Principal Psychoses for the Year ending September 30, 1923 — Continued.

Race. 18 P.D. 22. Table 7. — Race of First Admissions classified with Reference to Principal Psychoses for the Year ending September 30, 1923 — Concluded.

Race. P.D. 22. 19 Table 8. Age of First Admissions classified with Reference to Principal Psychoses for the Year ending September 30, 1923 — Continued. 20 P.D. 22.

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R 24 P.D. 22. Table 14. — Psychoses of Readmissions for the Year ending September 30, 1923.

Psychoses. M.

Traumatic psychoses

Senile psychoses . . .

Psychoses with cerebral arteriosclerosis .

General paralysis . . Psychoses with cerebral syphilis .... Psychoses with Huntington's chorea

Psychoses with brain tumor . Psychoses with other brain or nervous diseases

Alcoholic psychoses . . . . . • _ . Psychoses due to drugs and other exogenous toxins

Psychoses with pellagra . . Psychoses with other somatic diseases Manic-depressive psychoses 12 Involution melancholia

Dementia pracox . Paranoia and paranoid conditions .... Epileptic psychoses . Psychoneuroses and neuroses Psychoses with psychopathic personality Psychoses with mental deficiency .... Undiagnosed psychoses Without psychosis

Total 26 38

Table 15. — Discharges of Patients classified with Reference to Principal Psychoses and Condition on Discharge for the Year ending September 30, 1923. P.D. 22. 25

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Psychoses. 30 P.D. 22. Table 18. — Total Duration of Hospital Life of Patients dying in Hospital classified according to Principal Psychoses for the Year ending September SO, 1923 — Concluded.

Psychoses. Public Document No. 22

ASS . OCS. ®f)e Commontoeaitfj of jUlasteadmactte OLL.

ANNUAL REPORT

OF THE TRUSTEES

OF THE TAUNTON STATE HOSPITAL

FOR THE

Year ending November 30, 1924

Department of Mental Diseases

Publication- or this Document approved by the Commission on Administration and Financs S00 9-10-25 Ordpr No. 2708 OFFICERS Trustees Arthur B. Reed, Chairman, Abington. Philip E. Brady, Esq., Attleboro. Charles C. Cain, Jr., Taunton. Julius Berkowitz, New Bedford. Asa A. Mills, Fall River. Margaret C. Smith, Taunton. Elizabeth C. M. Gipford, Secretary, Boston.

Resident Officers Ransom A. Greene, M.D., Superintendent. Roderick B. Dexter, B.A., M.D., Assistant Superintendent. Clarence M. Kelley, M.D., Senior Assistant Physician. Fannie C. Haines, M.D., Senior Assistant Physician. Samuel Tartakoff, M.D., Senior Assistant Physician, Pathology. Harry M. Baker, M.D., Assistant Physician. Charles A. Decary, B.S., M.D., Assistant Physician. Rodolphe Richard, M.D., Assistant Physician. Fernand Longpre, M.D., Assistant Physician. George Revenelle, M.D., Assistant Physician. George A. Harris, D.M.D., Dentist. Linda A. J. Richards, R.N., Superintendent Nurses Emerita. James C. Flynn, Engineer. James F. O'Neil, Steward. Frank W. Boynton, Treasurer. George S. Hollingworth, Foreman Mechanic. Fred Gullon, Farmer.

W&t Commontoealtf) of Jffla&sarimtfetts; TRUSTEES' REPORT

To His Excellency the Governor and the Honorable Council: The trustees of the Taunton State Hospital present herewith their seventy- first annual report, together with the superintendent's report, financial report and statistical tables. In the past year no special appropriation approved by the General Court remained for the trustees' expenditure. The work of other special appropriations was completed the previous year. In the past year, however, a small special appropriation was made on basis of report of building inspector from Department of Public Safety by an act of the General Court for expenditure previous to June 6, 1926, of the sum of $3,600 to be divided among the following items: fire escape; additional water supply to infirmary; a continuation of stairways to basement of main building for fire protection. The first two items have already been completed. We have had no construction since 1914 when accommodations for 100 women were made at Lovering Colony. At that time there were 1145 patients cared for in the hospital. At the end of present statistical year, 1421 patients are cared for, an increase of 24% in population without any construction for enlarging housing facilities. Over-crowding was spoken of in report of 1917 and there has been an effort made ever since that time to bring to the attention of the General Court the necessity for increasing facilities for the care of our patients. Plans of construction have been submitted and last year a definite program was laid out but no action was P.D. 22. S taken. This year we are again submitting a program for increasing capacities for care of our unfortunates which includes store house, acquiring property on Albro Avenue, and superintendent's house; the latter is requested as a means for relieving congestion of officers' quarters and dining room facilities; the Algro Avenue property to be a means of housing employees and making room for patients' care; the storeroom as a means for revamping an ancient and inadequate kitchen with the construction of a congregated dining room, thus releasing present dining room space for dormitory purposes. After a considerable study it is estimated that the proposed changes of utilizing space now used for dining rooms would make an increase in dormitory space for the accommodation of about 250 beds. At the Department of Mental Diseases estimated cost of construction, namely, $1,500 per capita, this would warrant an expenditure of at least $375,000 for the projects proposed.

There is a great necessity for sprinkler system for fire protection, a bridge to connect Albro Avenue property, and the acquiring of Rogers' property to adequately complete our farm unit at the Borden Colony, Raynham, so that we may have pasture, there being no pasture facilities whatever at present. In our 1924 budget there has been expended from a sum of $61,544.41 for repairs and renewals all but a sum of $277.51. Of this total, a sum of $25,000 was appropriated for renewal of roof of original building completed in 1853. This work has been done on such a basis that by means of careful expenditure and judicious care of money the whole original building has been covered with Monson slate, copper ridges, valleys, metal skylights replacing wooden ones, at about two-thirds of original estimated cost of work. We are requesting a considerable sum of money for the coming year for continuation of repairs, as repairs and renewals are urgently needed to maintain a structure that is old and of necessity must have a great deal done in the way of repairs, not only to modernize our plant but to maintain such appurtenances as must be replaced from the consequences of wear of time and weather.

Our hospital quota of mechanics is only sufficiently large to carry on the work of maintenance of repairs. Any special appropriations or repairs and renewals that have to be added to the regular work of our force is a burden that is carried to the neglect of our ordinary maintenance repairs, and we urgently request that money appropriated for repairs and renewals and special work be sufficiently large and as estimated so that we may be able to employ labor for this work outside our regular force. This Board desires that your attention be called to the matter of care of female group of mental cases classified as defective delinquents. A considerable group of these cases are regularly committed to this hospital, 25 or more cases having been inmates in the last year. This group is a problem that is a menace and a danger to the Schools for Feeble-Minded. They, for obvious reasons, are distinctly a foreign problem to the strictly mental hospital as well, and we urge the necessity of plans for their segregation under a disciplinary institution suitable to their needs and separated from an institution of our type. The death of our associate, Mr. Simeon Borden, who died on January 16, 1924, having been a trustee and valuable advisor since his appointment by His Excellency, Governor Eben S. Draper in 1909 is a serious loss. For fifteen years, he gave unsparingly from his busy life a sufficient time to master the many details of the hospital work, to investigate each matter brought to his attention and to suggest improvements in the work being carried on. His judgment was valued by his co-workers; his interest in the Board's labors rendered his service noteworthy, and the State of Massachusetts no less than this hospital lost a valued official in his passing. To succeed him has been appointed, Mr. Asa A. Mills of Fall River. There has been lost to the Staff by resignation, John J. Thompson, M.D. and Fannie C. Haines, M.D., Senior Assistant Physicians, Wilfred H. Baines, M.D., Pathologist, and Mr. Stephen Tracy, Steward. There has been appointed to the Staff during the past year, Harry M. Baker, M.D., Fernand Longpre, M.D., George Ravenelle, M.D., as Assistant Physicians. 4 P.D. 22. Mr James O'Neil was appointed as Steward. Clarence M. Kelley, M.D., has been promoted to Senior Assistant Physician and Samuel Tartakoff, M.D., to Senior Assistant Physician, Pathology. We, the undersigned, respectfully submit the above report. ARTHUR B. REED, Chairman. CHARLES C. CAIN, Jk. JULIUS BERKOWITZ. PHILIP E. BRADY. MARGARET C. SMITH. ASA A. MILLS. ELIZABETH C. M. GIFFORD.

SUPERINTENDENT'S REPORT

To the Trustees of the Taunton State Hospital; ' I respectfully submit the seventy-first annual report for year ending November 30, 1924. The Statistical tables cover the period included between October 1, 1923, and September 30, 1924. Movement of Population

On October 1, 1924, patients in the hospital and family care numbered 1428, — 688 men and 740 women, — an increase of 13 patients over the corresponding date of previous year. There are 108 men and 105 women on visit and escape. During the year there were admitted, by first admission 188; by readmission 84; by transfer from other institutions 5; making a total received of 422. There have been discharged during the year 385 as follows: as recovered 27, as improved 112; as not improved 45; as not insane 20; transfers to other institutions under the supervision of the Department of Mental Diseases 22; by death 159. The total number under treatment during the year was 2,027, — 1016 men and 1011 women. The daily average number of all patients actually in institution during the year was 1400. 1922, — 678.1153 men and 722.0769 women. In family care we now have 13 patients, 2 men and 11 women. In the past year it has been increasingly obvious that a difficulty in finding and classifying properly a group of patients to be boarded out is becoming more and more marked. I question the advisability of having boarding out patients except in rare instances, inasmuch as this hospital is so situated and so constructed that it has two dependent colonies where only such patients as can be allowed full parole can be cared for. One of these colonies is for men and one for women and the facilities for caring for such patients is sufficiently large so that it is even now difficult to find the type of patient which can be properly classified in such colonies. It is only from this group that we would select boarded out patients. It seems to me much better to care for them at the Colonies than boarded out, especially when we consider the expense attached to the travel and transportation not only for placing such patients but for their visitations afterwards, and in case of illness or difficulty their removal from place of boarding out and return to the hospital, and in cases of acute illness the necessity of requiring the care of some local physician especially in the winter season when travelling is such that we cannot reach or care for them by our own physicians. I am firmly convinced that any money that can be apparently saved as a bookkeeping entry if considered practically would have no argument in favor of boarding out, and it is my intention in the coming year to have less instead of more boarded out patients. Medical Administration In the past year we have constantly had Staff Conferences each morning at which Conferences, problems concerning patients are settled, the Superintendent presiding at these meetings. The purposes of the Conference is to cover the following points: All new patients admitted are presented for diagnosis and disposition from the various forms of commitment on admission to the hospital. The various physicians of the Staff present their cases from the various services for consideration of treatment, trial visit or discharge whenever a patient presents such symptomatology that disposition can be considered. Conferences are also used on an average of once a month for the presentation of some special medical :

P.D. 22. 5 question of interest to us as a problem that concerns psychiatry or general medicine. An occasional Staff meeting is also devoted to Social Service problems. Staff Conferences have been greatly enhanced in the past year by the advantage obtained from a completely functioning laboratory with pathologist in charge, so that cases presented can be considered with full physical and laboratory findings as well as mental examination. A properly functioning x-ray laboratory with additional room for a developing of x-ray and photographic plates has also added a stimulus to scientific work together with the fact that equipment has been provided for work in blood chemistry and metabolism. Cases are now coming to Conference with clinical and laborator}' findings very completely elaborated in the case record. The case record also includes a photograph of each patient for purposes of iden- tification and comparison at a later date. The Staff has apparently accepted the stimulus of advantage obtained by such facilities and our Conferences have had an increasing interest from a scientific as well as utilitarian point of view, and the disposition of cases for discharge or trial visit has been increased.

Report of Pathological Laboratory Urinalyses 937, spinal fluids 192, white blood counts 23, complete blood counts 104, smears 93, cultures 64, sputa 62, feces 12, autopsies performed 48. During this present fiscal year certain accomplishments merit mention. With the exception of a very few patients incapacitated by physical or mental infirmity, all patients have been photographed and their photographs entered as a part of their hospital record. Spinal fluid examinations have been made more complete by the incorporation as routine measures of two tests, definitely of diagnostic value in certain cases. These tests are (a) The Acetic Anhydride Sulphuric Acid Test and (6) The Mastic Test. An apparatus for the determination of the Basal Metabolic rate has been instituted, and the metabolism determinations are now being made in all cases presented by the clinical services. During the year a method was instituted in the Operating Room whereby all cases with findings indicative of syphilis received treatment. The arsphenamine used was changed to sulpharsphenamine, this being administered intravenously, intramuscularly and subcutaneously. The figures recorded in the table below indicate the activity of the Venereal Clinic together with some interesting results from the point of view of ihe serological changes produced. In April, 1924, a group of luetic patients was chosen at random and each treated with sulpharsphenamine. Their serology was determined at the onset and again late in November of this year. The entire group remains under treatment at present. The findings are of interest in that in approximately 50% of the cases was a change produced in the blood Wassermann; in 20 cases a positive was reduced to a negative or a doubtful reaction, while in only 2 cases was a negative blood changed to a positive. The following table refers to blood Wassermann reactions

1. Cases negative in April — still negative 9 2. Cases positive in April — still positive 16 3. Cases positive in April — now negative 16 4. Cases negative in April — now positive 2 5. Cases positive in April — now doubtful 4

The addition of x-ray to our fist of procedures has been of decided advantage to both medical and dental services. Both services utilized this opportunity freely. The deaths during the fiscal year numbered 158, of which 90 were male and 68 female. There were 48 autopsies. The following table gives number of deaths, autopsies and percentage autopsies. Deaths Autopsies % Autopsies Male 90 General average, 35 38.9 Female 68 30.3% 13 19.1

These figures show an increase in autopsy percentage over that of the few preceding years, even though during the fiscal year ending in November, 1923, there .

6 P.D. 22. were 53 autopsies as compared to 48 this year, for these were based on figures representing 23 more deaths than in a corresponding period of time ending in November, 1924. In general, the services of the laboratory have been utilized to a greater extent than during the previous year, as indicated by an increase in the number of operations carried out.

Out-Patient Clinics New Cases

New Bedford Fall River House Total 1924 1923 1924 1923 1924 1923 1924 1923 Male .... 54 48 5 10 9 5 68 63 Female 73 69 3 14 2 4 78 87

Total. . 127 117 8 24 11 9 146 150 Total Visits Male .... 142 91 15 22 21 12 178 125

Female . . 267 154 28 28 5 9 300 191

Total. . 409 245 43 50 26 21 478 316

Sources of Cases 1924 1923

By Children's Aid Society ' 43 37 By Family Welfare Society 19 25 By Society Prevention of Cruelty to Children 21 11 By International Institute 2 3 By self or immediate family 18 26 By courts 2 1 By Taunton State Hospital 17 32 By private physicians 3 5 By Instructive Nursing Association 6 3 By St. Luke's Hospital 3 1 From other sources 12 6

146 150 Conclusion 1. Considering the report of 1923 as covering a period of time equal to that in 1924, we find an increase in the cases seen in New Bedford and at the hospital and a decrease in those seen in Fall River. 2. Disregarding ex-hospital cases, one finds that there were 129 community cases seen in 1924 as compared to 118 in 1923. 3. The total visits in all clinics during the year exceeded those of the preceding year by 162. 4. In New Bedford alone, the visits of this year exceeded those of last year by 164. 5. During the year, the clinic, augmented in its personnel by the different hospital staff members in rotation, has, we feel certain, continued to maintain its firm contact with the community, no greater evidence of which is necessary than the figures recorded above.

School Clinic Department M. F. T. 1. New cases referred for examination 21 10 31 2. New cases completed 8 5 13

• 3. New cases incomplete . . 13 5 18 4. Old cases completed 26 20 46 5. Re-examinations 27 4 31

The above figures represent work in four towns : that is, all of those towns from which a request to examine children was received. 3

P.D. 22. 7 As 47 towns are in this hospital district, but %}/%% of the authorities made requests for examination. By letter the authorities in all towns were informed about the project. In 3 towns by letter and by personal interview. Those in 3 other towns were especially informed about the project. None of these availed themselves of the services of the hospital clinic, emphasizing the necessity for the Department of Education to encourage the work if further work is to be done. X-Ray Work -

There has been done in the past six months since the x-ray room has been in operation the following number of operations: Medical Operations: Male, 72; Female, 40; Total, 112. Dental: Male, 305; Female, 122; Total, 427.

Operating Room In the operating room we have a very inadequate outfit for the care of such surgical cases as may occur in an approximate population of 2,000 persons. We have added to this equipment in the past year a fairly satisfactory set of instruments that we may do any laparotomy or ordinary surgical procedures. We have also purchased a gas oxygen machine. Our methods of sterilization are very inadequate. The quarters are very cramped and light is very poor. In the coming year I hope to alter these quarters to make some improvement but until construction is made either in the form of new building or additions are made to the present building, a really adequate and suitable operating room cannot be provided. The larger part of our work in the operating room is in the nature of dressings and the administration of arsenical preparations to our specific cases of which there have been the following treated: M. F. Salvarsan injections 440 Mercurial injections 448 Bloods for Wassermarrn 327 Lumbar punctures 100 Greatest number of patients under treatment during any one month 80 Smallest number of patients under treatment during any one month 63 Average number of patients per month 73.

Dental Report

Bridgework: Preparation for, 3; Removed, 9; Set, 1. Cleaned and scaled, 743 Examined and charted, 682; Extracted, 1331. Fillings: Amalgam, 535; Cement, 27 Root canal, 15; Gold, 1; Silicate, 12; Temporary, 10; Zinc Oxide and eugenol, 226 Inlay: Preparation for, 4; Carved, 3; Set, 2. Plates: Impressions, 43; Made, 22 Adjusted, 125; Repaired 17; Cleaned, 108. Treatments: Formo-crebsol, 11; Gums, 38; Howe's silver nitrate, 9; Pulp removed, 4; Post operative, 110.

Number of patients receiving dental treatment 3024 Number of operations performed on these patients 4518

Average number of operations per patient 1 . 46 Percentage of all patients with work completed 90. 06% Percentage of all patients unable to receive dental attention 4. 16%

Percentage of all patients with dental attention needed 5 . 78%

Hydrotherapy

The new entrances to the hydrotherapeutic rooms have been completed and having been able in the last year to complete the building of cabinet baths, elec- trically heated, this added armament to the treatment of mental diseases by hydrotherapy has been greatly improved. Because of inaccessibility of entrances previous to construction of new ones the hydrotherapeutic work was practically nil but at the present time a considerable use is being made of this department as indicated in figures listed below, and we hope to have an increase in this treatment next year. :

8 P.D. 22. M. F. T. Hot foot baths 825 656 1,481 Salt glows 733 712 1,445 Hot and cold to spine 226 559 785 Sitz baths 242 249 491 Swedish shampoos 545 510 1,055 Needle sprays 2,572 2,733 5,305 Fomentations to abdomen 2 2 Hair shampoos 406 415 821 Fan douches 2,052 2,235 4,287 Pail douches 48 48 Saline baths 13 13 Number Continuous Baths Number of hours Males 727 4,968% Females 1,803 12,597M

Totals 2,530 17,566^

Wet Sheet Packs: Males 167 500^ Females 2,675 10,640

Totals 2,842 15,640^ Social Service Because the question arises frequently as to the purely economic value of a social service department in a mental hospital, statistics, this year, were compiled to show the amount of money saved the hospital through the special activities of the social service department. In addition to the routine work of taking histories from relatives who cannot come to the hospital, conducting investigations which aid in the making of correct diagnoses, and visiting the patient on trial from the hospital, all of which increases the general efficiency of the hospital and makes existence a little more comfortable for many patients, there are certain duties performed by the social service workers which could not be done as efficiently by any other department in the hospital and which do reduce the annual expense account. For instance, relatives apply for the discharge of a patient. The patient is not well or only slightly improved. Unless home conditions are especially favorable, the physicians do not feel that it is advisable to send the patient away from hospital care. Social workers can go into the community to see the home conditions, to advise changes, to smooth over difficulties, and to make arrangements which enable the patient to leave several months earlier than he could otherwise. During this last year, fourteen patients were released under the above mentioned conditions. By counting the per capita cost of hospital maintenance as one dollar a day, it is estimated that this dismissal saved the hospital about $2,000.00. In several other cases, where there had been no request for discharge, the hospital authorities decided that the patients were well enough to leave. The social service department then got into communication with relatives, who either had lost interest in the patient or thought because he had been in the hospital a long time that he would always need institutional care, and made arrangements for them to care for the patients in their homes. If there were no relatives, the social workers found homes and places of employment. Over $3,000.00 was saved in this way. Patients on trial would frequently have to return to the hospital if there were no social workers to .visit them, to interpret their difficulties to their families, and to act as safety valves for their pent up feelings. By counting only those where it is known definitely that the possibilities of social service supervision caused the relatives to delay return, it was found that $6,000.00 was saved. In two other cases, the patients were discharged as "not insane" becouse the outside investigation showed that they had foundation for their apparently paranoid ideas. P.D. 22. 9

As the total amount saved is considerably more than the expenses and salaries of the department, it does seem as though social service is of economic value. The above statements are made on the basis of a purely financial point of view. The humanitarian and routine advantage of Social Service is not here considered, and the above is not written in defense for the existence of Social Service but to bring out the point that there is financial advantage as well as humanitarian use- fulness in a hospital of this kind for an increase in Social Service work in the near future, as well as reason for requesting, upon the basis of increase of population, an additional Social Service worker to the Staff.

SOCIAL SERVICE MONTHLY STATISTICS

I. Numerical Summary of Cases: .

10 P.D. 22. IV. Service Rendered: 1. Medical: (a) Contribution of information re: Medical History, 316

(b) Contribution of information re : Home Conditions, 78 (c) Contribution of information re: Condition of Out Patients, 285 (d) Arrangements for Medical Assistance, 11 2. Social:

(a) Adjustments for Patients { ^SSS^tSns, 51 (b) Adjustments for Patients in Industry, 24 (c) Adjustments for Patients in Recreation, 14

f To Relatives, 167

(d) Advice \ To Patients, 165

I To Others, 52

(e) Connecting with Agencies, 21 ; with Individuals, 7 Legal, [ 12 (/) Family assistance i Financial, 8

I Miscellaneous, 19 (g) Arrangements for further study or training. 9 (h) Personal Services: Placement Work { g^ 12 V. Supervision Work: 1. No. Patients on visit last day previous month, No. Patients discharged from visit during month,

( To Patients on ward, 88

I To Patients on visit, 218

Visits \ To Relatives or Friends, 29S

I To Social Agencies, 77 } To Others, 75 No. Patients in care of Other Agencies, 16 2. Family Care Patients: (a) No. Patients visited, 11 (d) No. Patients returned, 4 (6) No. Patients placed, 3 (e) No. Patients discharged, 1 (c) No. Patients replaced, 2 (/) No. Boarding Homes investi- gated, VI. Clinic Work: / No. clinics attended, 5 C

• ) interviews Patients, 1 tj -4. i ™- No. with 10 1. Hospital Climes \ No Interviews with Relatives, 9

I No. social cases selected, No. attended, f

• Histories, 18 o q„i i i No. 2. School dimesm- Nq Psycholo^ical TestS;

I Miscellaneous Work, No. attended, 47 C

I No. interviews with Patients, 178

3. Community Clinics \ No. Interviews with Others, 229 No. cases selected, I No. cases referred to local agencies, 2 VII. Miscellaneous:

( School or Community Clinic

1 Amount of Expense Account \ Work, $10.21

I Hospital Work, $267.01 No. days in Hospital, f

, , . No. days outside Hospital, o A T J 2. Account of Time ' \ No _ D^yg gpent in gc£ool CUnic w?rk>

I No. days spent in Community Clinic Work, Special Features: Lectures: Papers: Special Studies: Conferences attended: Visits to Other Institutions: P.D. 22. 11 Training School An arrangement has been made in the past year through the Superintendent of Schools, with the approval of the School Committee of the City of Taunton, who have very graciously co-operated, providing a course in the night high school, giving upon completion of such course a certificate of the first year of high school work. According to a law recently passed it is necessary that a nurse present with her diploma of graduation, a certificate indicating that she has had one year of high school training or its equivalent. There are many pupils available for training as nurses who have not had this preliminary education and we feel very grateful to the Taunton School Authorities for their co-operation in providing such facilities and a goodly number of our attendants have availed themselves of this privilege and are taking this course at the present time which will enable them to qualify as graduate and registered nurses. M. F. Graduates in 1924 — 5 Senior class — 5 Intermediate Class — 3 Junior Class — 12 Number in Boston City Hospital — 3 Number at Boston City Hospital during year — 8

Farm and Greenhouse During the past year the work on the farm has been carried on very successful^ by Mr. Fred Gullon, head farmer. During the year we have maintained a herd of cattle free from tuberculosis and have purchased additional stock for increasing our milk production. A new boiler has been installed for pasteurizing purposes and within a reasonable time we hope to have sufficient home milk supply from farm so that there will not have to be any outside purchase of milk. Our crops have done reasonably well, although certain items were affected by the severe drought in July and August. Our poultry plant has been increased and has been profitable so far, and it is hoped that an additional increase will be made to the plant in the coming year. From our greenhouse there has been produced an increasing amount of potted plants and flowers for distribution on wards. Much satisfaction is expressed by patients as well as visitors to our wards in appreciation of the appearance of halls because of this added attractiveness.

Occupational Therapy Department In our occupational department we have increased our facilities to some extent and are working on plans for its further extension. We have already, through this department, increased the property of our wards with such products as are of advantage for purposes of decoration and utility. The department has a quota of three women rated as occupational therapists and they are assisted by several ward etaployees. We are maintaining a regular course for both men and women in the industrial building, also conducting classes upon the wards. These classes have increased and a great percentage of patients who are disturbed or indifferent will be provided with occupation for its therapeutic value and the advantage of this has already been made apparent in the improvement of this group of patients as to their mental and physical welfare. In many instances I am certain that we have been able through this Department to shorten the duration of hospital res- idences of many patients and also in many cases improved their mental status to a point where they have been able to take up industrial work in the hospital that is purely utilitarian rather than therapeutic, even though their condition does not warrant their leaving hospital care.

Industrial Department In our industrial departments there has been accomplished a very satisfactory amount of work, particularly in that part of the shops which covers the manufacture of mattresses, brooms, brushes and metal articles. Our shoe shop has produced all the shoes necessary for wear by our male patients and a large percentage of 12 ' P.D. 22. shoes worn by our women. In our tailor shop there has been a new stimulus, in addition to the rug weaving and ordinary repair of clothing there has been a considerable manufacture of men's suitings. In our sewing room there has been a greatly increased production of bed linen and ward supplies, and there has been made also suitable dresses as well as underclothing for the women. A large and much complimented exhibit of our products was on display at Brockton Fair.

Entertainments We have been able to hold regularly our dances each week, also moving pictures, and have been able to procure a very satisfactory type of picture which apparently is very pleasing to the patients. On holidays and at various other times we have provided special entertainments, especially in the summer when we have been able to have ball games and other outdoor affairs. At one of these entertainments on the Fourth of- July, 1,184 of our patients participated, being out of doors for the greater part of the day, and a very satisfactory picnic lunch was provided for every one. The various organizations have also provided entertainments for our soldier patients as well as the regular inmates of the hospital.

Religious Services Religious services have been conducted regularly each week by the Protestant, Hebrew and Catholic clergymen. We are particularly grateful to these clergymen for their services in cases of serious illness, their co-operation in answering our calls, and their attendance and visitation to our patients. I wish to express my appreciation to all the clergy" who have been so considerate and whom I know 'at times have attended to our needs at a great sacrifice.

Employees In the past year our employees have formed an association and by means of committee have established a post-exchange. They have had at regular intervals, entertainments and gatherings for their own benefit and have most satisfactorily participated in the entertainments and affairs for amusement that have been conducted for the benefit of patients. The principle involved in their maintenance of the post-exchange is that, First, There may be provided for employees a convenience for obtaining candy, tobacco and small articles without the necessity of leaving hospital grounds ; Secondly, That there may be an income from the sale of such articles to be used for the benefit of the Association and plans are made and well on their way toward execution for provision of quarters suitable for their own gatherings. It may be of considerable interest to you to study the statistical facts as to employment in the various services of the hospital as indicated in the table below. It is obvious that there is a tremendous turnover in the employment of personnel for such an institution as this. By far the greatest turnover is in the ward service. I respectfully submit these figures for 3^our study and consideration and if there is any solution to this problem I am anxious for assistance, and I assure you it involves much more than is apparent on the surface. Number employed Full % of during year Quota Re-employment Medical 17 12 41% Administration 27 24 8 Kitchen 29 19 52 Domestic 68 36 88 Ward, Male 259 77 236 Ward, Female 189 82 130 Industrial 9 6 50 Engineering 19 18 3 Repairs 12 12 Farm 26 17 52 Garage 6 4 50

661 307 115% P.D. 22. 13 General Repairs and Improvements Construction of salvage shed, and yard surrounded by riot fence and gate. Sheathing in cow barn, brick cottage for patients. Kenney House, and root cellar shingled with asphalt shingles. Hay barn and carriage shed completed. Brick barn has had repairs to roof, walls and eaves. The roof of main hospital building has been reslated. The paint shop has been tinned for fire protection. Terrazzo floors installed in lavatories of Nurses Home and plumbing renovated. New entrances to the hydrotherapeutic rooms have been constructed. Electric trans- mission line to these rooms was reconstructed. Bathroom built for officers'; quarters. Service building at Borden Colony has had a cement basement with toilet facilities for patients' convenience installed, making a place for their convening before and after meals. The congregated dining rooms have been screened). Fire escapes have been added to the rear of main building and fire escape repaired on Industrial Building. Outside trimmings of the main buildings and guards have been painted. Under repairs ordinary, several wards have been entirely renovated, lavatories of male side have had terrazzo floors laid and plumbing modernized with installation of flush valves, and three wards on female wings similarly treated. Outside street lights were installed over doorways. Cement sidewalks added to rear of main building and from Male Home to Male Infirmary. Garage has had tool room and equipment added, and repair cost on cars has been reduced 50%. A grain room has been made from an abandoned farm building. This room is vermin proof and has a capacity of five carloads. An additional dining room has been made in rear centre by utilizing space previously used as a passageway. A call bell system has been installed throughout wards and rear centre, operated from switchboard in the main office. On grounds 6,000 trees were planted. During the past year four boilers have been reset, six hand stokers installed with draft gauges and CO-> recorders installed in boiler plant. Deolizer and fittings have also been installed and connected. Piping throughout the boiler plant and much of the basement has been recovered. Installation of return traps for steam to infirmary and garage where steam formerly went to waste. Installed reduction valves on main steam arteries, resulting in a saving of steam and water. Additional water supply to infirmary and industrial building from city main has been connected to increase pressure and install stand pipes for fire protection. In the laundry there has been added a tumbler dryer, metal dryer and long press. There has also been inaugurated an exchange system for ward bedding and linens. The laundry quota of employees has been reduced from 18 to 12 with increased production of work, and employees' laundry is done on a slip system that is equal to the service of a commercial plant. ACKNOWLEDGMENTS I wish to express my appreciation to the various organizations, societies and individuals who have been generous in their donations of gifts such as candy, fruit, reading matter, etc., and to all who participated in entertainments. These entertainments have been greatly enjoyed by the patients. To the Board of Trustees I wish to express my sincere thanks for their assistance, counsel and support. Respectfully submitted RANSOM A. GREENE, Superintendent.

TREASURER'S REPORT

To the Department of Mental Diseases I respectfully submit the following report of the finances of this institution for the fiscal year ending November 30, 1924. Cash Account

Income Receipts Board of inmates Private $23,762. 16 Reimbursements, insane 55,869. 12

$79,63 1 . 28 . . 2

14 P.D. 22. Sales Travel, Transportation and Office Expenses $63.01 Clothing and Materials 226.25 Medical and General Care 8.75 Farm Cows and calves $389. 35 Pigs and hogs 10. 00 Hides 90. 82 Sundries 10. 16 500.33 Repairs, Ordinary 474.29

Total sales 1,272.63 Miscellaneous

Refunds previous year . . . $137.07 Interest on bank balances 420.87 Rent 262.66 Sundries 228.76 1,049.36 Board of employees 665.00

Total income $82,618.27 Maintenance Balance from previous year, brought forward $4,507.93 Appropriation, current year $525,495.00 Appropriation, current year, additional $6,900.00 and $4,225. S2. 11,125.82 536,620. 82

Total $541,128.75 Expenses (as analyzed below) 526,493. 12

Balance reverting to Treasury of Commonwealth $14,635.63

A?ialysis of Expenses

Personal services . . . $235,686.55 Religious instruction 1,805.00 Travel, transportation and office expenses 5.515.74 Food 92,122.95 Clothing and materials 17,463.33 Furnishings and household supplies 30,511.99 Medical and general care 17,283.95 Heat, light and power 35,059. 15 Farm 26,704. 80 Garage, stable and grounds 3,102.86 Repairs, ordinary 12,611.86 Repairs and renewals 37,251.47 Tools and machinery 48,624.94

Total expenses for maintenance $526,493. 1

Special Appropriations

Balance December 1, 1923 . . . $140.37 Appropriations for current year 3,600.00

Total $3,740.37 Expended during the year (see statement below) $1,214.55 Reverting to Treasury of Commonwealth .77 1,215.32

Balance November 30, 1924, carried to next year $2,525.05

Object P.D. 22. 15 VALUATION Nov. 30, 1924 Real Estate Land (336 acres) $47,800. 00 Buildings 758,344. 19

SS06.144. 19 Personal Property Travel, Transportation and Office Expenses 3,277. 70 Food 17,282. 99 Clothing and Materials 21,055. 56 Furnishings and Household Supplies 90,197. 85 Medical and General Care 17,290. 40 Heat, Light and Power 16,677. 05 Farm 25,815.36 Garage, Stable and Grounds 6,103. 92 Repairs 1 2,894. 49

$210,595.32 - Summary Real Estate $808,144. 19 Personal Property 210,595. 32

$1,016,739.51 STATISTICAL TABLES As ADOPTED BY AMERICAN PSYCHIATRIC ASSOCIATION PRESCRIBED BY MASSACHUSETTS DEPARTMENT OF MENTAL DISEASES

Table 1 . — General Information

1 Date of opening as an institution for the insane, 1854. 2. Type of institution: State. 3.. Hospital plant Value of hospital property Real estate including buildings $608,144. 19 Personal property 210,595. 32

Total $1,016,739. 51 Total acreage of hospital property owned, 336 Total acreage under cultivation during previous year, 93 4. Officers and employees Actually in Service Vacancies at End at End of Year op Year M. F. T. M. F. T. Superintendents 1 - 1 - - Assistant physicians 9 1 10 - 1 1

Total physicians 10 1 11 11 Stewards 1 - 1 - - - Resident dentists 1 - 1 - - - Graduate nurses 3 12 15 - - Other nurses and attendants 58 58 116 9 16 25 Teachers of occupational therapy 3 3 6 - - - Social workers - 2 2 - - All other officers and employees 66 53 119 4 6 10

Total officers and employees 142 129 271 13 23 36 5. Census of patient population at end of year September 30, 1924 Absent prom Insti- Actually in tution but still Institution on Books M. F. T. M. F. T. White Insane 672 735 1,407 103 100 203 All other cases ------

Total 672 735 1,407 103 100 203 Colored Insane 19 9 28 3 2 5

Grand Total 691 744 1,435 106 102 208 M. F. T. 6. Patients employed in industrial classes or in general hospital work on date of report 548 601 1,149 7. Average daily number of all patients actually in institution during year 678.1153 722.0769 1,400.1922 9. Persons given advice or treatment in out patient clinics during year 74 78 15 2

Table 2. — Financial Statement

See treasurer's report for data requested under this table. 16 P.D. 22. P.D. 22. 17

Table 4. — Nativity of First Admissions and of Parents of First Admissions for the Year ending September 30, 1924

Parents of Parents of Patients Male Patients Female Patients

F.» M.2 Both M. ! Both

United States .... 167 105 Austria 1 5 "Canada 28 41 England 11 25

Finland 1 Germany 2 Greece 3 Hungary 4 Ireland 17 Italy 5 Norway 3 Poland 9 Portugal 27 Russia 3 Scotland 5 Sweden 1

Turkey in Asia . 2 Turkey in Europe 1 Wales 1 tWest Indies

Unascertained . . .

Total 158 293 158 316 135 135 270

Includes Newfoundland. fExcept Cuba and Porto Rico. 'Fathers. 2Mothers.

Table 5. — Citizenship of First Admissions for the Year ending September 30, 1924 18 P.D. 22.

Table 7. — Race of First Admissions classified with Reference to Principal Psychoses for the Year ending September 30, 192k

Race P.D. 22. 19

Table 7. Race of First Admissions classified with Reference to Principal Psychoses for the Year ending September 30, 1924— Continued

Race 20 P.D. 22.

Table 8. — Age of First Admissions classified with Reference to Principal Psychoses for the Year ending September SO, 1924

Psychoses P.D. 22. 21

Table 8. — Age of First Admissions classified with Reference to Principal Psychoses for the Year ending September 30, 19£4 — Concluded

Psychoses c

22 P.D. 22.

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l»Mm l« Iho I I

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-h ~* ' I t-- c*j i m cn

rtcq I n i n-n«« i i

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03 C3 en — c^'* oocooo'-iwaioiM'Hb.Tp

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io«co»o I Tt*i-H

-3 M»$:J1 'Pi c- r d||§.: o S ° SB mO !j| > St3 C-g ° Ola's *"> — 5s |5.S ,3 a; o.s ca. o - ; -Il^ 03 CD — " SMjoo o c.'S „ a'q'-""

ffl

Table 10. — Environment of First Admissions classified ivith Reference to Principal Psychoses for the Year ending September 30, 192k

Psychoses 24 P.D. 22.

Table 12. — Use of Alcohol by First Admissions classified with Reference to Prin- cipal Psychoses for the Year ending September 30, 1924-

Psychoses I

P.D. 22. 25

I I I I ^H I I I 1-H I <-1 I I I I I

-H I I I I I I I I I I I I I I I I I | I I I —

- - —I I

i i i i i i i a,

i i i i i i i i

"^5

I I I I I I I I I I I I I I I I I I

I O}

i-i -H I SO I I I I I I I I I

- ^ MM" I I I I f —' I ( i I t —• t I (

)^| |^HTJ*| | «f*CT"HlOW I CO"* I

i<0

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l*-HCOCNJl I I I (N^ I MUJCNO I CM I f-N I

- I ^t«Q0»OCq I ' -«CO | | CO CO *£> CD

"53

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^cêc^ôtôooJo^c4co^»o

26 P.D. 22.

Table 14. — Psychoses of Readmissions for the Year ending September SO, 1924

Psychoses

Traumatic psychoses : . . Senile psychoses Psychoses with cerebral arteriosclerosis

General paralysis : Psychoses with cerebral syphilis Psychoses with Huntington's chorea Psychoses with brain tumor Psychoses with other brain or nervous diseases Alcoholic psychoses Psychoses due to drugs and other exogenous toxins Psychoses with pellagra Psychoses with other somatic diseases Manic-depressive psychoses Involution melancholia Dementia praecox Paranoia and paranoid conditions Epileptic psychoses Psychoneuroses and neuroses Psychoses with psychopathic personality Psychoses with mental deficiency Undiagnosed psychoses Without psychosis

Total I 32 67

Table 15. — Discharges of Patients classified with Reference to Principal Psychoses and Condition on Discharge for the Year ending September SO, 1924 P.D. 22. 27

z 28 P.D. 22.

« tS I

2 a

o S

s a g o o 2 *= « B; jh

lO NH

"3 2 » °

"^ S'S. a gag a. 2*3 a a -o-o Sv^-a a asg-s HHOO

< I

30 P.D. 22.

i-i . I M»«rt I I I I ! —

I I I I I I 5f IMM I I I —> —i c OS

• I IOON — I I —r r I — I

*^ OQOC -H I I I -H I -h

I —• s I — O I

- <=

I I -H I | rHrH |

-Hi I ID IM I I I I

I I I I I I CO ^S

I I I I CO I —I I I I

I I I CO—i I I I I

i i i i i i i

| —I | I c t . I | — — — I I I I I I

—I —I I I I I

I I I —I I I

IC»IIIIIII1-h|

I I I I | | | | I — i I l l « CM l l 05

I I GO I I I I I I I I I I I I

g "sa

a. a 53s o a 3 &2 Sgo a 45,0 60 & 8 H -D 3-o -^ q j-? _ a a ~o ag-g-s £ g,

CJ C3 cffij 0*0 |,"5co o -g q o"o_oao c a a S y g acq >..'- .- £<££o££££3Q££§£Q*li£M5:&5S pq I < — M«'*«0«Ot>.M3!0-'N! ;KXO;C-:i P.D. 22. 31

Table 18. — Total Duration of Hospital Life of Patients dying in Hospital classified according to Principal Psychoses for the Year ending September 30, 192k

Psychoses 32 P.D. 22.

Table 18. — Total Duration of Hospital Life of Patients dying in Hospital classified according to Principal Psychoses for the Year ending September 30, 192k — Concluded

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