Public Document No. 21 SIXTIETH ANNUAL REPORT THE TRUSTEES NORTHAMPTON STATE HOSPITAL, Year ending November 30, 1915. BOSTON: WEIGHT & POTTER PRINTING CO., STATE PRINTERS, 32 DERNE STREET. 1916. Approved by The State Board of Publication. CONTENTS, PAGE List of Officers, 5 Report of Trustees, 7 Report of Superintendent, . 13 Report of Treasurer, . .34 Statistics, 41 . OFFICERS NORTHAMPTON STATE HOSPITAL. TRUSTEES CHARLES S. SHATTUCK, Hatfield. JOSEPH W. STEVENS, Secretary, Greenfield. EMILY N. NEWTON, Holtoke. CAROLINE A. YALE, Northampton. LUKE CORCORAN, M.D., Springfield. JOHN McQUAID, PlTTSFIELD. HENRY L. WILLIAMS, Chairman, Northampton. RESIDENT OFFICERS. JOHN A. HOUSTON, M.D., .... Superintendent. EDWARD C. GREENE, M.D., .... First Assistant Physician. ANGELA BOBER, M.D., ..... Senior Assistant Physician. ARTHUR N. BALL, M.D., .... Assistant Physician. BEATRICE A. REED, M.D., .... Junior Assistant Physician. HARRIET M. WHITNEY, M.D., . Physician to Out-patient Department. LEWIS F. BABBITT, Treasurer (office at the hospital) LEE N. SINCLAIR Engineer. CARL W. HAMMOND Farmer. SUSAN E. WARREN, ..... Matron. Stye tfflmmontDealtl) of JttaB.0acI)U0ette. TRUSTEES' REPORT. To His Excellency the Governor of the Commonwealth and the Honorable Council. The trustees of the Northampton State Hospital respect- fully submit herewith their report of the affairs of the hospital for the fiscal year ending Nov. 30, 1915. We refer to the reports of the superintendent and the treas- urer, which are transmitted as a part of our report, for a more detailed account of the management of the hospital, its finan- cial affairs, movement of population, results of treatment and varied activities of the institution. We have been handicapped the past year by reason of having been granted an inadequate appropriation for the maintenance of our patients. We were required to make estimates for the support of 900 patients, though we had reason to believe that we should probably have to care for a daily average number of at least 950. At the time of making our estimates there were 945 patients under our care, and within a few weeks we had more than 970 to support. Upon our representation of these facts we were allowed to estimate for the support of 920. We were furthermore required to base our estimates on too smaU a per capita cost; we had to use as a basis the appro- priation made in 1914 for the support of 900 patients, di- vided by 930, the average number actually supported. Finally, these obviously inadequate estimates were arbitrarily reduced by the legislative committee, in the hope that we could some- 8 NORTHAMPTON STATE HOSPITAL. [Dec. how get along with the appropriation that was granted. A considerably smaller maintenance appropriation, proportionate to the number of patients, was allowed to us than was allowed to any of the other institutions, even to those that care only for chronic insane. It is universally recognized that the acute and recoverable cases require more care, and at a greater ex- pense, than the chronic cases; it pays the Commonwealth to get its cases well as soon as possible. In granting our appro- priation it seems to have been ignored that our hospital cares for many private patients, varying from 120 to 150 in num- ber; the past year we received for their board $35,000. Their friends pay for more attention and for a greater variety in food. If, therefore, our expenditures in these directions should be greater than those of the institutions that care only for cases supported wholly at public expense, these factors should be taken into consideration in the examination of our estimates, and in comparing the cost at our hospital with the cost at these other institutions. Our estimates for food were cut to a point below our requirements, and as a result our inventory shows that we had food supplies, to the value of $2,000, less on hand at the end of the year than at the beginning. Our request for money with which to engage more nurses was refused. It is well recognized that success in treatment of mental cases depends, in a large measure, on the nursing service, and if we are embarrassed by inferior quality, or by lack in numbers, of our nursing force, our measure of success is correspondingly less than it should be. It is not economy to afford our hospitals too few caretakers for their inmates. The ratio of nurses to patients is smaller at our hospital than in any of the other State institutions, and our efforts to raise this ratio to proper requirements have hitherto been thwarted by inadequate appropriations. Our Board fully realizes the need of watchfulness and care in the expenditure of appropriations; by the exercise of strict economy we have lived within our income this year. This, however, was made possible only by the relief afforded by the transfer of 80 patients to other institutions by the State Board of Insanitv. 1915.] PUBLIC DOCUMENT — No. 21. 9 During the year the expenses under the heading "Miscel- laneous" have been much larger than the appropriation al- lowed for this purpose, principally because more patients have been maintained in family care than we were told to estimate for. The cost of their support appears under the above heading. In order to live within our income, therefore, we had to reduce the expenditures for other purposes; this could be done most easily for repairs for the time being, but every one of experi- ence knows that repairs must be made, and that if deferred they will eventually cost more than if attended to when need arises. The building operations that were mentioned in our report last year as being well under way have been completed, — the stable for farm horses, the pump house with fire pumps in- stalled, and the corridor and bay window in the department for women. All these will add to our efficiency and conven- ience. The corridors and bay window make the life of the patients much pleasanter, affording more sunshine and cheer to the wards which they adjoin, and opportunity for patients to get out of doors, even in inclement weather. With the growth of the institution has come a steady demand for more power and light. A new engine and electric generator is needed to supplement our present equipment, which con- sists of two units, — first, an engine of 155 horse power operat- ing an electric generator of 100-kilowatt capacity, caring for the heavy load of power and light during the day and early even- ing; and second, a small engine with generator of 373^-kilowatt capacity, which cares for the lights during the night. Our re- quirements for power and light have outgrown the capacity of the smaller unit during fourteen hours of each day in winter and eleven hours in summer. In case of injury or need of re- pairs to the larger unit we should be seriously handicapped. We ask, therefore, for a special appropriation with which to purchase and install a new engine and generator. We have obtained estimates of the cost of various engines and genera- tors, from which we find we shall need, for this purpose, an appropriation of $4,300. We renew our request of last year for an appropriation to 10 NORTHAMPTON STATE HOSPITAL. [Dec. build a house and tower for the care and protection of our fire hose and apparatus, as outlined in our annual report of 1914, to which we refer. Use of our hose at a fire in the winter of 1914 demonstrated that we had no suitable place for thawing, draining and drying the hose that is used in winter, whether at a fire or at the fire drills required by law. All of our appa- ratus, hose, ladders and trucks should be assembled and kept in an accessible central place. We have submitted plans and estimates of the cost of such a building to the State Board of Insanity. We recommend that an appropriation of $4,000 be granted for this purpose. The trustees have hoped for two years to be able to remodel and equip the rooms where the old laundry was located for dining rooms for our employees. These rooms adjoin the kitchen and are admirably adapted to the purpose. At present our employees are eating in four dining rooms, two divisions at each meal, and the rooms are overcrowded. Our nurses are eating at tables with patients, which is not desirable for either nurses or patients. The State Board of Insanity has approved of the plan, as did the legislative committee on its visit to the hospital last year. No special appropriation was asked for, as it was hoped we might do the work with our own force of employees from the maintenance allowance for repairs and improvements, but our total maintenance allowance was so much smaller than requested that we have been cramped all the year to live within the reduced appropriation. Inasmuch as the change suggested must be considered as additional equipment and not as a replacement we request a special appropriation for this purpose. We estimate that this will cost $2,300 by doing the work ourselves. We deem it wise to ask for a special appropriation for the installing of a vacuum system to insure a better circulation of steam through our heating apparatus and at a lower pressure than is required at present. This will result in more efficient heating of the radiators, with a lower consumption of coal, especially in spring and fall. A similar system is in operation in some of the other State institutions to their great advantage. It is proposed to purchase the material, and to install this 1915.] PUBLIC DOCUMENT — No.