TH** •O0«-»iA Public Document No. 117 SECOND ANNUAL EEPOET Massachusetts Commission on Mental Diseases THE COMMONWEALTH OF MASSACHUSETTS Year ending November 30, 1917. BOSTON: WRIGHT & POTTER PRINTING CO., STATE PRINTERS, 32 DERNE street. 1918. Publication of this Document approved by the Supervisor of Administration. TABLE OF CONTENTS. * PAGE Members of the Commission and List of Officers, 5 Letter of Transmission to Governor and Council, 7 Duties of the Commission, ..... 9,10 Activities of the Commission, ..... 10-15 Review of the Year: — All Classes under Care, ..... 16,17 The Insane, ....... 17-23 The Feeble-minded, . 23,24 The Epileptic, ....... 24,25 Report of the Pathologist, ..... 25-54 Reports of Committees on Nursing Service, . 54-61 Out-patient Departments, ..... 61-71 Commitments for Observation and Temporary Care, 71-73 Stability of Service, ...... 74,75 Capacity for Patients, ..... 76-78 Institutions : — Public 79-127 Private, . 127-130 Unlicensed Homes, . 131 Family Care of the Insane, .... 131-134 The Commission: — Proceedings of, . 135 Plans and Specifications, ..... 135 Estimates of State Expenses for 1918: — The Commission, 135, 136 Maintenance Appropriations, 136-138 Special Appropriations, .... 139-142 Financial Statement of Commission, 143, 144 Support Department, ..... 145-148 Deportations, ....... 148, 149 Transfers, ....... 150 Financial Department, . 150 General Matters : — New Legislation, ...... 151-160 Nineteen-year Statement as to Special Appropriations, 160-162 Financial Statistics, ....... 163-201 General Statistics, ....... 203-265 Directors^ of Institutions, ...... 266-278 Index, ......... 279-286 Digitized by the Internet Archive in 2010 with funding from Boston Library Consortium IVIember Libraries http://www.archive.org/details/annualreportofma1917mass2 Members of the Massachusetts Commission on Mental Diseases. Nov. 30, 1917. GEORGE M. KLINE, M.D., Chairman, Beveely. JOHN B. TIVNAN, Salem. HENRY M. POLLOCK, M.D., Boston. CHAS. G. DEWEY, M.D., Boston. ELMER A. STEVENS, . somervtlle. OFFICERS. LOWELL F. T\'ENTWORTH, M.D., SAML^EL W. CRITTENDEN, M.D. Assisiant to Director. Assistant to Director. Nellie F. Ball, First Clerk. Claea L. Fitch, Stenographer. Eda W. Fitch, Clerk. M. LomsE Small, Clerk. Rebecca F. Waeshaw, Clerk. Elmeh E. Southaed, M.D., Pathologist. Mtetelle M. Caxavan, M.D., Assistant Pathologist. Haeet C. Solomox, M.D., Investigator of Brain Syphilis. Lillian D. Ridee, Stenographer. Ellen R. Scott, Technician. Waeren a. Mebeill, Financial Agent. Rebecca J. Geeene, Cashier. Alice M. Beown, Stenographer. Edith A. Stevens, Clerk. John I. Robinson, Clerk. Feancis B. Gaednee, Support Agent. Benjamin F. Waed, Visitor. AIaihde F. Feeetht, Stenographer. Paul A. Green, Visitor. ' ALa.bt L. Ballotj, Clerk. Feedeeick R. Houghton, Visitor. Feances C. O'Connoe, Clerk. Mabel G. Gbagg, Visitor. Department of Family Care. Transportation Agents. Feed A. Hewet. Claibe T. McInnebnet. Joseph P. Madden, Laboratory Assistant and Messenger, ®l)e ComtncniDealtl) of itta00act)xi5ett0. State House, Boston, July 25, 1918. To His Excellency the Governor and the Honorable Council. The undersigned, members of the Massachusetts Commission on Mental Diseases, respectfully submit the second annual re- port of the Commission for the year ending Nov, 30, 1917. The matters, however, relating to general statistics cover the year ending September 30. GEORGE M. KLINE. JOHN B. TIVNAN. HENRY M. POLLOCK. CHAS. G. DEWEY. ELMER A. STEVENS. Slje Ccmttionroealtl) of illa05acl)U0ett0. EEPOET OF THE MASSACHUSETTS COMMISSION ON MENTAL DISEASES. DUTIES OF THE COMMISSION. The_ Massachusetts Commission on Mental Diseases was established by chapter 285 of the General Acts of 1916, suc- ceeding the former State Board of Insanity, The Commission has general supervision of all public and private institutions for the insane, feeble-minded and epileptic persons, etc., and it has the right of investigation and recom- mendation as to any matter relating to the classes under care. Each State institution has, however, its Board of Trustees ap- pointed by the Governor and Council. The Commission inspects the institutions with reference to matters considered worthy of observation, and ascertains whether the laws relative to patients are properly observed. It has power to investigate the question of sanity and con- dition of any person restrained of his liberty by reason of alleged insanity, and discharge any such person, who, in its opinion, is not insane, or who can be cared for after such dis- charge without danger to others and with benefit to himself. It acts often as a board of appeal in adjusting difficulties. The powers of the Commission also control the interrelations of institutions and matters which are common to them all, such as transfers of patients, deportation of patients to other States and countries, claims to support as State charges in institu- tions, etc. Expenditure of money under special appropriations for new buildings, unusual repairs, etc., is under the control of the Com- 10 COMMISSION ON MENTAL DISEASES. [Jan. mission. It is required to prepare plans for buildings and to select land to be taken by the Commonwealth for the purpose of any new or extension of existing institutions. The Commis- sion also analyzes all requests for maintenance, appropriations, etc. The laws regarding the insane and other classes under care will be found in chapter 504 of the Acts of 1909, and amend- ments thereof. SPECIAL NEEDS OF THE INSTITUTIONS. The Commission believes that the special requests for appro- priations should be limited to the essential requirements, and that the building program should provide accommodations only for the expected increase in population and for the over- crowding. Inasmuch as it would be inadvisable to attempt any large building operations during the period of the war, there has been no further development at the Metropolitan Hospital site, it being thought best to provide additional accommodations at the Boston State Hospital in accordance with the plan of development of that institution. The need for accommoda- tions is greatest in the districts served by the Boston State Hospital and the Northampton State Hospital. With their increasing admission rate it has been necessary to make room by transferring numbers of patients to outlying institutions. The Commission believes it advisable to evolve a program to cover a period of at least ten years, caring for the needs of each hospital district, so that a definite policy can be presented to the Legislature each year for appropriations other than those necessary to care for the maintenance of institutions. Work on the proposed school for the feeble-minded at Bel- chertown has been delayed inasmuch as a water supply cannot be obtained on the site, as was assured when the property was purchased, and to secure a supply elsewhere requires further legislation. To care for the property temporarily, clear some of the land and put in crops, a colony of boys was transferred from the Wrentham State School to one of the farm buildings at Belchertown, being operated by and under the supervision 1918.] PUBLIC DOCUMENT — No. 117. 11 of the Wrentham State School. In the recommendations of the Commission a request is included to provide a water supply for the proposed school. THE STANDARD OF CARE in the State hospitals has been materially lowered by reason of the war, and great difficulty is being experienced in keeping a quota of officers and employees barely sufficient to administer our institutions with safety. Extra demands have been made on the members of the medical staffs whose training and ex- perience especially fit them for the examinations of drafted men and of the National Guard. For several years difficulty has been experienced in recruiting new employees. Much higher wages received in the community during the past year presented an even greater handicap to the institutions, and a revision of the wage schedule was impera- tive. It should be pointed out that the wage schedule of the nurse and attendant group has always been very low, the best proof being that these services no longer attract applicants. The result has been prejudicial to the best interests and welfare of the patients. Low wages attract only the restless and un- satisfactory; employees of a higher standard can easily find better-paid work. To obtain a class of employees who will con- tinue in the service, a living wage and proper housing condi- tions must be provided. While this might appear to require a material increase in the appropriation for personal service, it is believed that not so large a number of employees, if competent, would be required. The State would be the gainer, and the patients receive adequate and proper care. Under these conditions it would not be neces- sary to engage indifferent employees, unmindful of the best interests of the patients, and wasteful of institutional property. At the present time, owing to the inadequate working force, it is necessary for the institutions to send representatives con- tinuously to employment agencies. 12 COMMISSION ON MENTAL DISEASES. [Jan. STANDARDIZATION OF SALARIES. During the year the Commission has co-operated with a sub- committee of the Governor's Council, and the Supervisor of Administration, in the work of standardization of salaries of officers and employees at the State institutions, to the end that there will be uniformity in classification and titles, definitions of duties of positions, and schedules of wages. Many confer- ences of the director of the Commission and superintendents of State institutions were held with the Supervisor of Adminis- tration and his assistants. WAR WORK COMMITTEE. Because of the demand for physicians experienced in the care of nervous and mental diseases, brought about by reason of the war, arid the possibility of the State service being able to render assistance to the government, especially in matters of personnel, there was formed the Massachusetts Committee for War Work in Neurology and Psychiatry, with the following membership: Dr. George M. Kline, chairman; Dr. Walter E. Fernald; Dr. Elisha H. Cohoon; Dr. John A. Houston, treas- urer; Dr.