Digitized by the Internet Archive in 2010 with funding from Boston Library Consortium Member Libraries http://www.archive.org/details/annualreportofdep1939mass Sty* GJommmtwsaltlt of M&8$nt\}mtttB REPORT OF THE DEPARTMENT OF MENTAL HEALTH NOVEMBER 30, 1939 Commissioner Clifton T. Perkins, M.D Melrose Assistant Commissioner Bardwell H. Flower, M.D Auburndale Table of Contents Duties and Proceedings of the Department Changes in Personnel Activities of the Department: 1. Mental Examination of Persons Coming Before the Courts 2. Examination of Juvenile Delinquents .... General Matters: 1. Changes in Private Institutions 2. Conferences . 3. Departmental Committees 4. Deportations . 5. Legislation for the Year Report of the Financial Division Report of the Pathologist Report of the Division of Mental Hygiene Report of the Division of Mental Deficiency Report of the Support Division Report of the Division of Statistical Research Report of the Division of Statistics : (a) Table of Contents (b) Departmental Statistics, Tables and Graphs (c) Statistical Review: Text, Tables and Graphs Mental Disorders Mental Deficiency . Epileptics, Non-Psychotic (d) Detailed Tables Mental Disorders Mental Deficiency . Directory of Department and Institutions Index PAGE 2 2 3 3 5 5 5 13 13 20 39 54 90 125 128 128 131 141 239 288 29S 426 457 467 <30V D6G COLL ®tje Cutmwmwtttltfj of M&BBixtk.\xBBtt& 100 Nashua Street Boston, Massachusetts To His Excellency the Governor and Honorable Council: The twentieth annual report of the Massachusetts Department of Mental Health for the year ending November 30, 1939 is respectfully submitted herewith. The matters relating to general statistics, however, cover the year ending September 30th. Clifton T. Perkins, M.D. Commissioner REPORT OF THE MASSACHUSETTS DEPARTMENT OF MENTAL HEALTH DUTIES OF THE DEPARTMENT The Department has general supervision of all public and private institutions for the mentally ill, mentally defective, epileptic and of persons in private hospitals addicted to the intemperate use of narcotics and stimulants. It has the right to make investigations and recommendations as to any matter relative to the classes under care, but the local administration of each State institution is under the control of its own Board of Trustees appointed by the Governor and Council. The direct powers of the Department concern the interrelations of institutions and matters which are common to them all, such as the distribution and transfer of patients between them, deportation of patients to other states and countries, and the determina- tion within statutory limits of the amount to be charged for the support of patients in institutions. The work of construction under special appropriations for new buildings and unusual repairs is under the control of the Department, and also expenditures of money for such purposes. The Department is required to prepare plans for buildings and also to select land to be taken by the Commonwealth for new or existing institutions. All requirements for maintenance appropriations are analyzed by the Department. The statutes relating to the Department of Mental Health are to be found in Chapters 19, 123 and 486 of the General Laws. CHANGES IN PERSONNEL On November 15, 1939, Charles W. Greenough was appointed Second Assistant Com- missioner, in accordance with the provisions of Chapter 511, of the Acts of 1939, and his appointment was approved by the Governor and Executive Council the same day. Mr. Greenough qualified under this appointment directly after approval. Mr. Greenough was born in Cambridge. He received his preliminary education in Noble and Greenough School; in 1919 he was graduated from Harvard University with the degree of A.B. (Honoris Causae); his academic work was interrupted for a period from 1917-1919 when he was a member of the Naval Aviation Service overseas on sub- marine patrol work. Following graduation from college, Mr. Greenough was engaged in the textile business at Lockwood Greene Co., in 1921 he joined the First of Boston Corporation; in recent years he has been connected with Lee Higginson Corporation up to his present appointment. Hans Molholm, M.D. On June 30, 1939, Dr. Hans Molholm, part-time psychiatrist in the Division of Mental Hygiene, resigned to accept the position as Assistant Physician at the Worcester State Hospital. Charles Brenner, M.D. On September 1, 1939, Charles Brenner was appointed as part-time psychiatrist in the Division of Mental Hygiene to replace Dr. Hans B. Molholm who resigned on July 1, 1939. Dr. Brenner received his preliminary education in the Boston schools and in 1931 was graduated from Harvard University with the degree of A.B. Cum Laude; in 1935 he was graduated from the Harvard Medical School with the degree of M.D. After his graduation he served as Medical House officer at the Peter Bent Brigham Hospital; from February to June of 1936 he was on the staff of the Boston State Hospital; from 1937 to 1938 was Assistant Physician at the Boston Psychopathic Hospital and from P.D. 117 3 September 1938, to the present time has been serving as Assistant Resident Neurologist at the Boston City Hospital. Julia A. Deming, M.D. On January 9, 1939, Julia A. Deming was appointed part-time psychiatrist in the Division of Mental Hygiene to replace Dr. Margaret D. Welch who resigned on January 7, 1939. Dr. Deming is a graduate of the Women's Medical College, Philadelphia. She began her psychiatric work with three months' interneship at the Westboro State Hospital; following this she was resident physician at the Boston Psychopathic Hospital for one year; was psychiatrist at the New England Home for Little Wanderers; was connected with a clinic in Vienna for several years and up to the present time has been doing part- time psychiatric work at the Coit House, Concord, New Hampshire. Robert P. Kemble, M.D. On May 3, 1939, Dr. Robert P. Kemble was appointed Director of Clinical Psychiatry to succeed Dr. Milton Kirkpatrick at the Worcester Child Guidance Clinic. Dr. Kemble was graduated from Princeton University with the degree of A.B.; from Susquehanna University with the degree of B.S. and from the Jefferson Medical College in 1933 with the degree of M.D. He served a rotating interneship in the Pennsylvania Hospital ; a residency in psychi- atry at the Pennsylvania Hospital for Mental and Nervous Diseases; a residency at the Institute of the Pennsylvania Hospital and a residency in psychiatry at the Payne Whitney Psychiatric Clinic, also a Fellowship at the Philadelphia Child Guidance Clinic. He is a Diplomate of the National Board of Medical Examiners. ACTIVITIES OF THE DEPARTMENT Mental Examination of Persons Coming Before the Courts During the year, 725 cases have been examined under the so-called "Briggs Law," Section 100 A, Chapter 123, of the General Laws. Forty-three cases were examined under the provisions of Section 99, Chapter 123, of the General Laws. Examination of Juvenile Delinquents The examination of juvenile delinquents under the provisions of Chapter 119, Section 58. A, General Laws, Tercentenary Edition, is a service rendered to juvenile sessions of courts as an aid to final decision regarding the disposition of each case. During the year ending September 30, 1939, examinations under the provisions of this statute were made by the following clinics : Boston Psychopathic Hospital 45 Boston State Hospital 160 Danvers State Hospital . 237 Foxborough State Hospital 19 Gardner State Hospital 29 Grafton State Hospital 22 Medfield State Hospital . . . 70 Monson State Hospital . . . 21 Northampton State Hospital 97 Taunton State Hospital 107 Westborough State Hospital . 7 Worcester State Hospital 56 Belchertown State School 32 Walter E. Fernald State School 87 Wrentham State School 23 Dr. Henry M. Baker 24 Judge Baker Guidance Center 105 Total Examinations . . 1,141 The total cases examined, 1,141, shows an increase of about 14% over the number reported as examined during the previous year. An accompanying chart gives the mental classification of these cases by total number and percentage. P.D. 117 CNCOCO 00 O 1 1 E-i f~ 2 o 00 •" CN 1 —1 CO ■o o « fe CD 1 1 0 ? ss QP s 1 COCN «5 IN 1 1 iO Eh* ! 1 iH osoco M rH ococo ^ ra * COOCD E-i 00 OS 00 ho:o (COO 10 — ICNCN 1 H £ co 2 E 1 CNCD oo oocob- s 2 fe rt(N co oo >o os CH w « ©CNIN .s ^ §s C-ICNCN ~£ in Q ss oo as t~iO H CQ00>O MUSO * CC CO* coco* j «! *COO (^ — it~© a « o fe IN* CO oo coo CO OS CO COIN CO *CD00 00 OS*— I fflOH * CN*CO £ CO CO*CO coco* OS— 1— 1 ,_, H cocot>. * rtiOf j i-T < CO coo (N co—i oo o pEJ H s niOH CO CO CO OS U3 HtfCC OS OD a. 00N 0 coco O .OS OS « —i *r* O oco O .coco OS OS «i ■N 03 *? *? •** o flee felOOO Eh it-u ■ovr1 o l I £-J rH ^H - ~ ~ v Gj Of PhPhPh P.D. 117 5 The majority of courts appear to have availed themselves of this service. In some instances, however, the usefulness of the examination has been largely negated by the fact that it was requested and carried out only after final disposition of the case had been made. It is interesting to note that 26 courts (more than 25%) referred no cases for such examination and that 18 additional courts requested the examination of only 3 or less cases during the year. GENERAL MATTERS Changes in Private Institutions On January 6, 1939, Dr. Donald Gregg of Channing Sanitarium died, and a new license was granted to Dr. Jackson M. Thomas. Dr. Hosea M. McAdoo resigned from the Ring Sanatorium and Hospital on February 1, 1939 and a new license was granted to Dr. Curtis T. Prout. On February 1, 1939, Dr. Frank E. Leslie was transferred to Wisconsin, a new license to conduct the Veterans' Administration Facility at Northampton was given to Dr. William M. Dobson. On July 5, 1939, a license was issued to George M. Schlomer, M.D. of Georgetown to conduct a Private Hospital known as the Baldpate, Inc. A license was issued on September 6, 1939 to Morris P. Pollock to conduct a private school for the Mentally Defectives in Brookline to be known as The Pollock School. Conferences Eight conferences of the Commissioner, Superintendents of the State Institutions under the Department and the Department officials, were held during the year. In addition to this the following Division Head Conferences were held: — Medical Division Heads ... 35 Business Division Heads . . 30 Departmental Committees Several Committees were formed during 1939 for the purpose of studying the details of various problems and making recommendations. These recommendations were to form the basis for the formation of definite Departmental policies. The following Committees were appointed by the Commissioner to serve throughout the year: Committee on Care of Institutional Patients, Committee on Construction, Committee on Family Care, Committee on Finance, Committee on Food, Committee on Forms and Statistics, Committee on Legislation and Regulations, Committee on Mental Hygiene, Committee on Nurses' Training Schools, Committee on Personnel and Labor Relations, Committee on Public Relations and Scientific Publications, and Com- mittee on Research. The Commissioner wishes to express his appreciation of the services of the members of the various Committees. Report of the Committee on Care of Institutional Patients Chairman — Dr. William A. Bryan Dr. Arthur N. Ball Dr. Morgan B. Hodskins Dr. Ransom A. Greene Dr. Earl K. Holt The Committee on the Care of Institutional Patients held sixteen meetings during the record year — twelve at Worcester and one each at the Statler Hotel, Boston ; the Norfolk State Prison; Concord Reformatory; and Sherborn Reformatory. In addition, committee members attended the combined meeting of all committees held with the Commissioner at the Westboro State Hospital June 19, 1939. At this last mentioned meeting a report containing sixty-five specific recommendations was submitted to the Commissioner. Among subjects considered were — standards and care of clothing, personal hygiene, beauty parlors, bathing facilities, outdoor activities, bed and mattress standardization, qualifications of personnel in relation to care of patients, visiting staff of specialists, boarding-out of patients, treatment units, optimum size of wards, diagnostic and ther- apeutic equipment requirements, pharmacies, dental departments, recreational direction and library facilities. In addition to the above, a special bed was designed by the Committee in collaboration with the Industrial Department of Norfolk State Prison which might be considered as a standard design; a chair designed by Dr. Greene of the Walter E. Fernald State School 6 P.D. 117 which can hold personal belongings in a special section, and an invalid chair developed at Worcester were tentatively approved by the Committee. Recommendations were made regarding problems of the aged, creation of an eligibility list for promotion of physicians, preparation and service of food, and the care of tubercu- lous and syphilitic patients. At the request of the Committee, Dr. Harry Solomon prepared a brochure on the Treatment of Syphilis in State Hospitals which was sent to all institutions with the approval of the Commissioner. Studies were made of the time factor involved in the proper toileting of patients in institutions represented on the Committee. Specific recommendations regarding the tuberculosis problem and need for a special survey were offered. Consideration was given to the utilization of various specialists. The Committee favored separate medical and surgical services in principle, but feel that personnel is inadequate in many institutions to properly operate separate services. Laboratory standards were considered in detail. Recommendations regarding restraint and seclusion were made. Respectfully submitted, Francis H. Sleeper, M.D. Secretary. Report of the Committee on Construction Chairman — Dr. Walter E. Lang Dr. Roderick B. Dexter Mr. Clarence D. Maynard Dr. Ransom A. Greene Dr. Harlan L. Paine The Committee on Construction met a number of times during the year and discussed several important topics, namely : Housing Survey and Low Cost Housing Projects. The work of Dr. Roderick B. Dexter, who conducted a housing survey while a member of the Department, was reviewed and certain changes in space allotment were suggested. The Committee felt that a re-survey of the housing facilities should be made in order to bring the material up to date, and certain standards, when adopted, should remain permanent unless definitely changed by the Department of Mental Health. The Committee felt that as a substitute for the more specialized building for acute reception of patients, or building for disturbed patients, considerable thought should be given to the low cost housing of quiet, continued treatment cases, thereby releasing space in the main group of buildings for specialized activities. The Committee thought that buildings which cost not more than $1,000 per bed might be considered for this group of patients. Respectfully submitted, William C. Gaebler, M.D. Secretary. Report of the Committee on Family Care Chairman — Dr. Charles E. Thompson Dr. Arthur N. Ball Dr. Walter E. Lang Dr. Clarence A. Bonner Dr. George E. McPherson Dr. William A. Bryan Dr. Harlan L. Paine Dr. Neil A. Dayton On November 12, 1939, the statute governing Family Care of patients, as amended by Section I of Chapter 500 of the Acts of 1939, became effective. The important change by the amendment was in the rate to be paid. This was raised from $4.50 to $6 maximum per week. In order to give study to the movement of Family Care, which had gained considerable impetus during the past few years, the Commissioner appointed a special committee of superintendents and members of the Department to consider the problem. The committee considered the subject exhaustively and went on record as favoring a Family Care Program in every institution as far as facilities permitted. The committee recommended that the selection of patients, the amount to be paid and the selection of the home be left to the superintendent or other authority. To assists however, in the administration of Family Care Placement, certain standard practice, were recommended: 1 . Mental patients placed in homes at the expense of the State or privately sup- ported were to be considered as in Family Care. P.D. 117 7 2. A suitable application on a prescribed form was to be made by the person seeking patient. 3. A detailed inspection and investigation of the home — in accordance with a suggested outline — was to be made. 4. Approval in writing of the home by the Superintendent before patient placement was to be necessary. In addition to the above, the committee suggested that patients be placed only in the building in which the family resided — each patient to have a separate bed. No patients were to be permitted to sleep or reside above the second floor of a dwelling. Patients in Family Care were to be eligible for Medical and Dental care and other services of the hospital, as if resident in the hospital. Patients were to be visited at intervals by hospital representatives. Respectfully submitted, William C. Gaebler, M.D., Secretai y Report of the Committee on Finance Chairman — Dr. Harlan L. Paine '■■■■ Dr. Ralph M. Chambers Dr. Harold F. Norton Dr. Morgan B. Hodskins Gen. William I. Rose The Committee on Finance gave considerable thought to the program for economy which was instituted by his excellency, Governor Saltonstall. The year was peculiar in that it was the first year of the Biennial Budget. Economy in hospital operation was stressed. The Committee discussed proposed legislation of an increase in rate to be paid for boarding-out patients. The Committee recommended that Old Age Assistance be made available to patients when ready to leave the hospital on visit status. The financial value of a central bakery was discussed. The Committee felt that con- siderable savings in the Food Budget by such centralization would ensue. Respectfully submitted, William C. Gaebler, M.D. Secretary Report of the Committee on Food Chairman — Dr. William A. Bryan Dr. Roy D. Halloran Gen. William I. Rose Mr. Albert Houde Dr. Charles E. Thompson Dr. George E. McPherson The Committee on Food gave considerable attention to the theoretical ration allow- ance and the methodology of computing the Food Budget. Budgeting of food on a per diem basis in comparison with a ration was considered. The Committee felt that much study was needed and suggested a study of the past two years' food consumption, together with the next two years ensuing, as a basis for comparison. Considerable thought was given to centralization and consolidation of various pro- cedures, such as: standardized recipes, establishment of a central bakery, etc. Training classes for chefs, cooks, butchers and other food workers were recommended as being of benefit to the service. The Committee felt that food inventories should be low and suggested that further study betnade along this line. Farm production was discussed and the Committee suggested that a careful study be made, particularly as to farm costs. Respectfully submitted, William C. Gaebler, M.D. Secretary Report of the Committee on Forms and Statistics Chairman — Dr. Roy D. Halloran Dr. Arthur N. Ball Dr. George E. McPherson Mr. Joseph P. Gentile Dr. Francis H. Sleeper The Report of the Committee on Forms and Statistics for the year ended November 30, 1939, is hereby respectfully submitted: 8 P.D. 117 The purpose of this Committee was to scrutinize the forms in use in the various insti- tutions, particularly the B forms and the Special mimeographed forms. A meeting was held on Monday, February 6, 1939 and the general policy of the Department was out- lined by the Commissioner. It was determined that the first step should be a complete review of all of the forms in use in all of the institutions. This proved to be a tremendous task, as many hundreds of forms, other than the Standard A forms, were being used by the various institutions. It was thought advisable to first collect all Special and B forms so that they would be available in the Department for scrutiny by the Committee. This was done, a total of 789 Special forms and 41 B forms being collected. Subsequently, it was deemed advis- able to subject all of these forms in use to scrutiny by the various Superintendents to see whether or not any particular Special or B form now in use might be adopted for all of the institutions and made a Standard A form. With this thought in mind, seventeen copies of every B and Special mimeographed form in use were collected from each insti- tution. The Superintendents were requested to attach an explanatory paragraph to each form so that the recipient might have no difficulty in determining the exact use of the form that was being made. Forms from some one hospital were sent out every two weeks, so that the Superin- tendents might review the forms and send in comments. Each form was given a number and was accompanied by a mimeographed description. When the replies were received by the Secretary, the forms approved of or desired by each Superintendent were entered in tables drawn up for the purpose. This process was quite time-consuming as the amount of detail work involved was very large. For instance, the total forms received from one institution in sets of 17 forms each, had to be numbered, the descriptive para- graphs had to be mimeographed, and one form from each set of 17 had to be sorted out for each institution. A total of 789 Special Forms and 41 B Forms were thus circulated throughout the institutions. The handling of 17 copies of each of these forms involved a total of 14,110 forms. A total of 322 letters have been written in reference to the work of the Committee. The Committee is now ready to study the forms individually, taking advantage of the suggestions and comments made by the sixteen Superintendents con- sulted. When all forms had been circularized, and comments received, the forms were gone over and sorted into the following groups : 1. Medical Forms 11. Industrial Department Forms 2. Administrative Forms 12. Industrial Therapy Forms 3. Steward Forms 13. Laundry Forms 4. Clothing Forms 14. Library Forms 5. Dental Forms 15. Occupational Therapy Forms 6. Diet Forms 16. Pharmacist Forms 7. Engineer Forms 17. Social Service Forms 8. Financial Forms 18. Traveling School Clinic Forms 9. Farm Forms 19. Miscellaneous Forms 10. Hydrotherapy Forms Tables were drawn up under each heading listing the forms at the left of the table and the names of all the institutions across the page. Institutions were checked if they approved or desired particular forms. After the tables had been drawn up, the forms were collected in loose leaf books in exactly the same order as listed in the tables and both tables and books are now ready for consideration by the Committee. Respectfully submitted, Neil A. Dayton, M.D., Secretary Report of the Committee on Legislation and Regulations Chairman — Dr. Charles E. Thompson Dr. Roderick B. Dexter Dr. Harlan L. Paine Dr. Earl K. Holt This Committee has been active throughout the year. Its first duties consisted pri- marily of close scrutiny and recommendations upon bills pending before the General Court. Attention was given to all bills which had direct or indirect bearing upon the functions of the Department as a whole. Thereafter, there was undertaken the task of revising and bringing up to date Department Regulations. This has proven to be a P.D. 117 9 difficult, prolonged project and work upon it still is being carried on. The new D.M.H. Regulation No. 7 regarding escaped patients which was promulgated November 13, 1939 was based chiefly upon the recommendations of this Committee. It has also re- viewed Chapter 123 making recommendations for any necessary corrections or proposed amendments to be submitted to the next General Court. Respectfully submitted, Bardwell H. Flower, M.D., Secretary Report of the Committee on Mental Hygiene Chairman — Dr. Clarence A. Bonner Dr. C. Stanley Raymond Dr. Douglas A. Thorn The Committee on Mental Hygiene takes great pleasure in submitting the first annual report of its activities for the year ending November 30, 1939. During the year, five meetings were held by the Committee for the purpose of dis- cussing mental hygiene in its various phases, and making certain definite recommenda- tions to the Commissioner. The first major accomplishment of this Committee was a survey of the various types of mental hygiene clinics operating under the Department of Mental Health. This survey, made by the Director of the Division of Mental Hygiene, included a study of the time and place of meeting of each clinic, the clinic personnel, and the case load, and, in some instances, the cost of operation. As a result of this survey, it was revealed that geographically the State as a whole was adequately supplied with clinics, although in some instances the service being rendered indicated opportunities for improvement. For example, in certain clinics, first thought was given to diagnostic rather than ther- apeutic service. The Child Guidance Clinics adequately provided service to the com- munities in the State. There was, however, only a limited number of clinics available for therapy with reference to incipient cases of mental illness. The Committee wishes to stress the point that some of the Child Guidance Clinics now operating under the Division of Mental Hygiene should be reallocated to the hospi- tals, under the jurisdiction of the Department, in the immediate vicinity of the clinics. This would then give the Division the opportunity to provide a demonstration clinic and a clinic for the training of personnel. Much thought was given by the Committee to the educational and publicity programs to be conducted by the Division of Mental Hygiene in cooperation with the Massa- chusetts Society for Mental Hygiene. Definite programs for the education of lay persons is the goal which is expected to be attained within the next year. On September 1, 1939, a much needed Directory of Clinics, listing all the clinical facilities under the supervision of the Department of Mental Health was published by the Division of Mental Hygiene. This Directory was published for the purpose of assist- ing physicians, schools and various agencies in the more effective utilization of our community clinics. Another activity of the Committee was the study by the Director of the Division of Mental Hygiene of the publicity and educational programs being sponsored by the Massachusetts Tuberculosis League and the Department of Public Health. During this study, much valuable information and literature was obtained, which will be used as a basis for the building of a library of propaganda of an educational nature. The Committee has given serious thought to the subject of mental hygiene, having in mind the improvement and expansion of the work in the mental hygiene field to be conducted by the Department. The Committee as a whole agreed that all Child Guid- ance Clinics should have as a minimum personnel a psychiatrist, psychologist and psychiatric social worker; that the age limit for referrals to the Child Guidance Clinics should be fourteen years, and that standard records should be kept in each case; that mental hygiene work might be divided under the headings of School Clinics, Child Guidance Clinics, Clinics for Adult Incipient Cases, and Clinics for Patients on Visit from the Hospitals; that educational information should be disseminated by lectures, radio talks, demonstration clinics, and through the Directory of Clinics; and, that more clinical facilities should be made available for adult incipient cases. Respectfully submitted, Edgar C. Yerbury, M.D., Secretary 10 P.D. 117 Report of the Committee on Nurses' Training Schools Chairman — Dr. Ralph M. Chambers Dr. Earl K. Holt Dr. Walter E. Lang The Committee on Nurses' Training submits the twenty-third annual report of the Nurses' Training Schools for the year ending November 30, 1939. A new Committee was appointed by the Commissioner on January 1, 1939 to serve for a period of one year. The Committee consisted of Doctor Ralph M. Chambers, Chairman; Doctor Earl K. Holt and Doctor Walter E. Lang, Members; and Doctor Edgar C. Yerbury, Secretary. During the year, five regular and special meetings were held by the Committee to act upon the many routine and special matters pertaining to the administration of the several schools of nursing under the jurisdiction of the Department of Mental Health. These matters worthy of mention include : 1. A study of all legislative matters relative to nursing. 2. An inspection and survey of all the regular and psychiatric training schools under the Department of Mental Health. 3. The adoption of new forms of certificates for: (a) Affiliate Nurses. (b) Postgraduate Nurses completing courses in psychiatric nursing. (c) Attendant Nurses. (d) Residents in Psychiatry. 4. The adoption of new forms of diplomas for: (a) Psychiatric Nurses. (b) Nurses completing the regular three-year course. 5. The adoption of forms for records of nurses as recommended by the National League of Nursing Education. 6. The adoption of a new style cap for both nurses and attendant nurses in our institutions. The following hospitals have continued to conduct the regular three-year course of instruction in the art of nursing during the year: Danvers State Hospital Taunton State Hospital Medfield State Hospital Westborough State Hospital The hospitals listed below have conducted the two-year course in psychiatric nursing : Foxborough State Hospital Grafton State Hospital Gardner State Hospital Northampton State Hospital Classes in psychiatric nursing procedures for affiliate nurses have been held in the following institutions: Boston Psychopathic Hospital Taunton State Hospital Danvers State Hospital Worcester State Hospital Nurses interested in furthering their education by postgraduate instruction in psychi- atric nursing have been trained at the Worcester State Hospital and the Taunton State Hospital. During the week of June 19-23, the regular nurses' examinations for all schools of nursing under the jurisdiction of the Department of Mental Health was given by the Committee. The results of these examinations are indicated in the following table: Training Schools Juniors Seniors Passed Failed Percent Passed Passed Failed Percent Passed 23 44 1 0 95.8 100 21 41 0 0 100 100 The results of training in both the regular and psychiatric nurses' training schools are very gratifying, as only one student enrolled in the regular school of nursing failed to meet the requirements of the examination. On November 30, 1939, the total enrollment of all nurses in both the regular accredited and psychiatric training schools is presented in the tables which follow : P.D. 117 11 Accredited Training Schools Prelim- inary Inter- mediate Senior Affiliate Post- graduate Boston Psychopathic Hospital Danvers State Hospital . . . . Medfield State Hospital Taunton State Hospital Westborough State Hospital .... Worcester State Hospital . . . 0 3 7 0 14 0 0 6 3 0 8 0 0 7 4 5 6 0 18 10 0 25 0 13 0 0 0 0 0 2 24 17 22 66 2 Psychiatric Training Schools Senior Foxborough State Hospital . Gardner State Hospital . Grafton State Hospital . Northampton State Hospital . Total The matter of affiliate training in psychiatric nursing for all schools approved by the Board of Registration of Nurses has been given much consideration during the year. Early in June a conference was held between the Secretary and Supervisor of the Board of Registration of Nurses and the Committee on Nurses' Training. At this conference, it was brought out that at the present time the facilities in our mental hospitals are far less than the demand for affiliate training. A study of the number of affiliate nurses now receiving psychiatric training in our mental hospitals in a year's time would indicate that nearly three hundred were given formal training for at least a three months' period. This training has been available even though the housing facilities have not been in- creased. The Committee desires to go on record as definitely favoring the training of affiliate nurses as a desirable procedure to be continued by the Department of Mental Health. The Committee wishes to express its sincere appreciation to the Commissioner for his helpful cooperation and assistance throughout the year. . Respectfully submitted, Edgar C. Yerbury, M.D., Secretary t Report of the Committee on Personnel and Labor Relations Chairman — Dr. Roderick B. Dexter Dr. Ralph M. Chambers Dr. Roy D. Halloran Dr. Ransom A. Greene Dr. Walter E. Lang During the early part of the year the Committee scrutinized bills pending before the General Court which had to do entirely with matters pertaining to personnel. It then gave consideration to many proposals from various sources including vacation allow- ances, central employment, residence of employees on hospital grounds, institution accommodations for employees, formation of grievance committees, intra-institutional employee promotional schemes, employee quotas and ratios, etc. Throughout the latter half of the year the Committee has given intensive attention to a program of standardized sick leave for the entire Department. Its recommendations in this regard have been phrased in the form of a Regulation and are complete, except for a few minor correlative and technical details. Respectfully submitted, Bardwell H. Flower, M.D., Secretary Report of the Committee on Public Relations and Scientific Publications Chairman — Dr. Arthur N. Ball Dr. Clarence A. Bonner Dr. William A. Bryan Dr. Harold F. Norton 12 P.D. 117 Six meetings of the Committee on Public Relations and Scientific Publications were held during the year — one at Boston State and five at Worcester, in addition to the Superintendents' Meeting at Grafton on June 12, 1939 when the Committee Report was presented for discussion. A careful survey of the various methods used by the schools and hospitals in the maintenance of cordial public relations was made by the Committee by means of a detailed questionnaire. After the questionnaire data were analyzed consideration was given in committee to such subjects as the issuance of basic data concerning schools and hospitals in brochure form to new employees; the organization of women's auxiliaries, the creation of formal institutional speakers' bureaus; the utilization of radio, moving pictures and lantern slides with automatic slide demonstrators. Special admission letters to patients explaining procedures to be followed in their care and privileges to be extended were discussed. Policies regarding relationships with medical societies, dental societies, service and women's clubs were considered. The entire matter of relationships with newspapers and magazines was considered in detail, with particular emphasis on type of publicity to be released. The advisability of special activities on National Hospital Day in the institutions, the question of annual expositions depicting basic information regarding mental health and illness received attention. The establish- ment of special lecture courses for various groups was advocated as well as educational symposia for staff members. Considerable discussion was held on the subject of a medium for publication of admin- istrative and psychiatric data from the different institutions. Recommendations on various aspects of the aforementioned topics were made by the Committee to the Com- missioner. Respectfully submitted, Francis H. Sleeper, M.D., Secretary Report op the Committee on Research Chairman — Dr. Abraham Myerson Dr. Neil A. Dayton Dr. Francis H. Sleeper Dr. Henry B. Elkind Dr. Harry C. Solomon Dr. Roy G. Hoskins Dr. Douglas A. Thorn We take great pleasure in submitting the annual report of the activities of the Research Advisory Committee for the year ending November 30, 1939. The Committee was appointed by the Commissioner on January 1, 1939 to serve for a period of one year. The Committee was appointed to give advice and recommend policies regarding research in our State institutions under the supervision of the Depart- ment of Mental Health. The object of the Committee was to build a living organization for research through those men who have a broader outlook in this field than men who have been actively tied up with the duties of research in our hospitals and schools. Dur- ing the year, seven regular and special meetings were held. The first State-wide research project instituted by the Committee was the Total Push or Total Activation Treatment Program for Chronic Schizophrenia. Any male patient between the ages of thirty-five and forty years who had been ten years in the hospital was considered for this study, provided he was in generally good physical con- dition but mentally showed evidence of deterioration so as to be unresponsive, hostile, asocial or untidy. This program was worked up carefully in protocol form, and standard procedures and forms were drawn up by the Committee to be used in working out this project so that the results which were reported could be favorably compared and tab- ulated. This procedure was begun in twelve of our institutions. Prior to the institution of this program, a meeting was held at the McLean Hospital on May 26, to which our Superintendents and physicians who would be delegated to assume responsibility for the work in their respective hospitals were invited. At this meeting, the work which had been carried on by the staff of the McLean Hospital was reviewed, and the results demonstrated to the group. Another special research project which the Committee favored and sponsored was the study of the problem of the aged. This problem has continued to increase as far as hospital admissions are concerned, and statistics indicate that this type of problem represents 22.2% of all the admissions in our State mental hospitals. In addition to the point of view of looking upon research for advancement and the ultimate cure of patients, P.D. 117 13 there is the economic point of view. This increase in admissions in the old age group represents increased costs to the State, a fact which was considered at the time this program was instituted. It was decided that this problem should be approached oh a State-wide basis, assigning various portions of the total problem to each interested hospital. During the year, many protocols have been presented to the Committee by members of the various hospital staffs for recommendations and approval before undertaking the work. In order to stimulate research throughout our mental institutions, plans have been considered for the organization of a research society, and these plans will be presented at a meeting to be called in December. All those who have indicated an interest in research, as well as those who have shown their ability to do research, will be invited to attend this meeting to consider the organization of a society which will have as its chief interest the promotion and stimulation of further research in Massachusetts. Respectfully submitted, Edgar C. Yerbury, M.D., Secretary Deportations One hundred sixty-one cases were considered for deportation during 1939, in compari- son to one hundred fifty cases in 1938. The Department deported seventy-one to other states and three to other countries and, in addition, the United States Department of Labor deported two to other countries; in all, seventy-six. Since October 1, 1898, 4,950 patients have been deported by this Department. Details of the disposition of cases under consideration for deportation are shown in Table 175. New Legislation — 1939 Chapter 54. — An Act Further Regulating the Temporary Absence on Leave of Certain Prisoners Committed to the Bridgewater State Hospital. Section one hundred and five of chapter one hundred and twenty-three of the General Laws, as amended by chapter one hundred and thirty of the acts of nineteen hundred and thirty-six, is hereby further amended by inserting after the word "director" in the seventy-first line the words : — and the commissioner, — so that the last paragraph will read as follows : — If a prisoner under complaint or indictment is committed in accordance with section one hundred, and such complaint or indictment is dismissed or nol prossed or if a pris- oner is committed in accordance with sections one hundred and three or one hundred and four, and his sentence has expired, the superintendent of the institution to which commitment was made or said medical director and the commissioner, in case of com- mitment to the Bridgewater state hsopital, as the case may be, may permit such prisoner temporarily to leave such institution in accordance with sections eighty-eight and ninety. The word "prisoner" as used in this section shall include all persons committed under section one hundred, whether or not in custody, when so committed; and in construing this section a maximum and minimum sentence shall be held to have expired at the end of the minimum term, and an indeterminate sentence, at the end of the maximum period fixed by law. (Approved March 11, 1939 ) Chapter 197. — An Act Prohibiting Employees and other persons connected with Hospitals from furnishing certain information about certain personal injury cases to Attorneys at Law or their Representatives, and making changes in the law relating to Runners, so called. Section 1. Chapter two hundred and twenty-one of the General Laws is hereby amended by striking out section forty-three, as appearing in the Tercentenary Edition, and inserting in place thereof the following: — Section 43. No attorney at law shall, through any runner, agent or person, hereinafter called a runner, who is employed by him solicit a person to employ him, nor shall any such runner solicit a person to employ such attorney, to present a claim for damages, or to prosecute an action for the enforce- ment thereof, and no attorney at law or runner shall directly or indirectly give or promise any person any money, fee, commission, profitable employment or other personal advan- tage in consideration of his employing such attorney on behalf of a person having a claim for damages, or of his soliciting or procuring the person who has such claim to employ such attorney to present such claim or to prosecute an action for the enforcement thereof. 14 P.D. 117 No attorney at law shall appear in any action or suit for the enforcement of a claim in connection with which he has violated this section. A district court, upon complaint alleging violation of any provision of this section by any runner who resides or has a place of business within its judicial district, may issue an order of notice to the person complained of to show cause why he should not be ordered to desist and refrain from violation of any such provision on penalty of contempt. Section 2. Said chapter two hundred and twenty-one is hereby further amended by inserting after section forty-four, as so appearing, the two following new sections : — Section 44-4- • No person in the employ of, or in any capacity attached to or connected with, any hospital, infirmary or other institution, public or private, which receives patients for medical or surgical treatment, shall communicate directly or indirectly, with any attorney at law, or any person representing such attorney, for the purpose of enabling such attorney, or any associate or employee of such attorney, to solicit employ- ment to present a claim for damages or prosecute an action for the enforcement thereof, on behalf of any patient in any such institution. A district court, upon complaint alleging violation of any provision of this section by any person employed by, or attached to, or connected with, any such hospital, infirmary or other institution situated within its judicial district, may issue an order of notice to the person complained of to show cause why he should not be ordered to desist and refrain from violation of any such provision on penalty of contempt. Section 44B. The superintendent or other person in immediate charge of each hospital, infirmary or institution referred to in section forty-four A shall cause to be posted and kept posted in a conspicuous place therein printed copies of said section. Printed copies of said section shall, on application therefor, be furnished to each such hospital, infirmary and institution by the department of public health at a price to be determined by the commission on administration and finance. Any such superintendent or other person who violates any provision of this section shall be punished by a fine of not more than five hundred dollars. (Approved May 12, 1989.) Chapter 272. — An Act Changing the Name of the State Infirmary to the Tewksbury State Hospital and Infirmary. Section 1. The name of the State Infirmary is hereby changed to the Tewksbury State Hospital and Infirmary. Section 2. When used in any statute, ordinance, by-law, rule or regulation, the phrase "State Infirmary," or any words connoting the same, shall mean the Tewksbury State Hospital and Infirmary, unless a contrary intent clearly appears. (Approved June 8, 1939.) Chapter 417. — An Act further extending the Provisions of certain Enabling Acts so that the Commonwealth may accept and use for Public Projects certain Federal Funds. Whereas, The deferred operation of this act would tend to defeat its purpose, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience. Section 1. Wherever in chapter three hundred and sixty-five of the acts of nineteen hundred and thirty-three, and acts in amendment thereof and in addition thereto, reference is made to the National Industrial Recovery Act or any title or part thereof, or to the Emergency Relief Appropriation Act of 1935, such reference shall be deemed and held to refer also to all acts and joint resolutions of Congress enacted during nineteen hundred and thirty-nine, nineteen hundred and forty and nineteen hundred and forty- one, authorizing grants or loans, or both, of federal funds for public projects. Section 2. Section two of said chapter three hundred and sixty-five, as most recently amended by section two of chapter three hundred and eighty of the acts of nineteen hundred and thirty-five, is hereby further amended by inserting after the word "grant" in the thirteenth line and the first time it appears in the forty-first line, in each instance, the words : — or loan, — so as to read as follows : — Section 2. The commonwealth may engage in any public works project included in any "comprehensive program of public works" prepared under section two hundred and two of Title II of the National Industrial Recovery Act and in any public project falling within one or more of the classes of pro- jects for which an appropriation of federal funds has been made available by section one of the joint resolution of Congress known as the Emergency Relief Appropriation Act of nineteen hundred and thirty-five, but only in case such project is approved, as herein- after provided, by the commission and by the governor and in case the proper federal P.D. 117 15 authorities have approved a grant or loan therefor of federal money; provided, that such approval by the commission or by the governor shall not be granted for any project which will cause the aggregate expenditure hereunder to be in excess of twenty-five million dollars; and provided, further, that out of such sum not more than ten million dollars shall be expended for the construction, reconstruction and resurfacing of roads and for projects similar to those enumerated in section two hundred and four of said Title II. All projects for the construction, reconstruction or resurfacing of roads and the construction of sewers shall be done by human labor, except in so far as machinery is, in the opinion of the state or federal officer or department having charge of the project, reasonably necessary, and the wages for such labor shall not be less than the prevailing rate of wages as established by the federal government. Nothing contained in this act shall be construed to prevent the commonwealth from engaging hereunder in any project for which funds have already been appropriated in whole or in part, if such project shall be approved as herein required. Such projects, so approved, shall be carried out in all respects subject to the provisions of said Title II and of said Emergency Relief Appro- priation Act and to such terms, conditions, rules and regulations, not inconsistent with the applicable federal laws and regulations, as the commission may establish, with the approval of the governor, to ensure the proper execution of such projects. The common- wealth may accept and use for carrying out any projects so approved any grant or loan, or any grant and loan, of federal funds under section two hundred and three of said Title II or under said Emergency Relief Appropriation Act and, for the purpose only of carry- ing out such projects except as provided in section two A, may from time to time borrow from the United States of America or other sources, or both, on the credit of the common- wealth such sums, not exceeding, in the aggregate, seventeen million dollars, exclusive of amounts borrowed for repurchase of obligations under said section two A, as may be required, and may issue bonds, notes or other forms of written acknowledgment of debt, referred to in this act as obligations. In anticipation of the sale of obligations issued under this section, the state treasurer may from time to time, with the approval of the governor, pay from the Highway Fund, without appropriation, any of the expenses of carrying out any projects authorized by this act; but all money so paid from said fund shall be repaid to such fund out of the proceeds of obligations issued and sold under this section or under said section two A. {Approved Augvst 3, 1939.) Chapter 1+25, General Laws Section 54. Any person in the service of the commonwealth, or of a county, city or town which, by vote of its county commissioners or city council or of its inhabitants at a town meeting, accepts this section, shall be entitled, during the time of his service in the organized militia, under sections eleven, seventeen, eighteen, nineteen, one hundred and five or one hundred and fifty-four, or during his annual tour of duty of not exceeding fifteen days as a member of the organized reserve of the army of the United States or of the United States naval reserve forces, to receive pay therefor, without loss of his ordinary remuneration as a.n employee or official of the commonwealth, or of such county, city or town, and shall also be entitled to the same leaves of absence or vacation with pay given to other like employees or officials. {Approved August 3, 1939.) Chapter 427. — An Act relative to competitive bidding on state contracts. Chapter twenty-nine of the General Laws is hereby amended by inserting after section eight, as appearing in the Tercentenary Edition, the following new section: — Section 8 A. No officer having charge of any office, department or undertaking which receives a periodic appropriation from the commonwealth shall award any contract for the con- struction, reconstruction, alteration, repair or development at public expense of any building, road, bridge or other physical property if the amount involved therein is one thousand dollars or over, unless a notice inviting proposals therefor shall have been posted, not less than one week prior to the time specified in such notice for the opening of said proposals, in a conspicuous place on or near the premises of such officer, and shall have remained so posted until the time so specified, and, if the amount involved therein is in excess of five thousand dollars, unless such a notice shall also have been published at least once not less than three weeks prior to the time so specified, and at such other times prior thereto, if any, as the commission on administration and finance shall direct, in such newspaper or newspapers as said commission, having regard to the locality of the work involved in such contract, shall prescribe; provided, that such newspaper 16 P.D. 117 publication may be omitted, in cases of special emergencies involving the health and safety of the people and their property, upon the written approval of said commission. Proposals for any contract subject to this section shall be in writing and shall be opened in public at a time and place specified in the posted or published notice, and after being so opened shall be open to public inspection. No contract or preliminary plans and specifications shall be split or divided for the purpose of evading the provisions of this section. The provisions of this section shall not apply to any transaction between the commonwealth and any of its political subdivisions. {Approved August 4, 1939.) Chapter 500. — An Act relative to the Care of the Mentally Diseased and the Work of the Department of Mental Health. Section 1. Section sixteen of chapter one hundred and twenty-three of the General Laws, as amended by section nine of chapter four hundred and eighty-six of the acts of nineteen hundred and thirty-eight, is hereby further amended by striking out, in the eighth and ninth lines, the words "four dollars and fifty cents" and inserting in place thereof the words : — six dollars, — and by adding at the end the following new sen- tence : — The department shall have the same authority in the case of patients directly committed to it, — so as to read as follows: — Section 16. The superintendent of each state hospital may place at board in a suitable family or in a place in this commonwealth or elsewhere any patient in such hospital who is in the charge of the department and is quiet and not dangerous nor committed as a dipsomaniac or inebriate, nor addicted to the intemperate use of narcotics or stimulants. The cost to the commonwealth of the board of such patients supported at the public expense shall not exceed six dollars a week for each patient. The department shall have the same authority in the case of patients directly committed to it. Section 2. Section forty-three of said chapter one hundred and twenty-three, as appearing in the Tercentenary Edition, is hereby repealed. Section 3. Nothing in this act shall be deemed to terminate the employment or the term of office of the superintendent and the assistant phj^sicians at the Westborough state hospital, or any of them, in office immediately prior to the taking effect of this act. Section 4. Section fifty-six of said chapter one hundred and twenty-three, as so appearing, is hereby repealed. Section 5. Said chapter one hundred and twenty-three is hereby further amended by striking out section seventy-seven, as amended by section five of chapter three hundred and fourteen of the acts of nineteen hundred and thirty-five, and inserting in place thereof the following: — Section 77. If a person is found by two physicians qualified as provided in section fifty-three to be in such mental condition that his commitment to an institution for the insane is necessary for his proper care or observation, he may be committed by any judge mentioned in section fifty, to a state hospital, to the McLean hospital, or, in case such person is eligible for admission, to an institution established and maintained by the United States government, the person having charge of which is licensed under section thirty-four A, for a period of forty days pending the determination of his insanity. Within thirty days after such commitment the superintendent of the institution to which the person has been committed shall discharge him if he is not insane, and shall notify the judge who committed him, or, if he is insane he shall report the patient's mental condition to the judge, with the recommendation that he shall be com- mitted as an insane person, or discharged to the care of his guardian, relatives or friends if he is harmless and can properly be cared for by them. Within the said forty days the committing judge may authorize a discharge as aforesaid, or he may commit the patient to any institution for the insane as an insane person if, in his opinion, such commitment is necessary. If, in the opinion of the judge, additional medical testimony as to the mental condition of the alleged insane person is desirable, he may appoint a physician to examine and report thereon. In case of the death, resignation or removal of the judge committing a person for observation, his successor in office, or, in case of the absence or disability of the judge committing a person as aforesaid, any judge or special justice of the same court, shall receive the notice or report provided for by this section and carry out any subsequent proceedings hereunder. Section 6. Section sixty-six of said chapter one hundred and twenty-three, as appear- ing in the Tercentenary Edition, is hereby amended by adding at the end the following new paragraph: — P.D. 117 17 If a feeble-minded person is committed to such a school, the department shall there- after have power, whenever advisable, to transfer him to the custody or supervision of the department; and thereafter the provisions of section sixty-six A, relative to removal, temporary release and discharge of feeble-minded persons, shall apply to such person. Section 7. Said chapter one hundred and twenty-three is hereby further amended by striking out section seventy-nine, as amended by section seven of said chapter three hundred and fourteen, and inserting in place thereof the following: — Section 79. The superintendent or manager of any institution for the insane may, when requested by a physician, member of the board of health, sheriff, deputy sheriff, member of the state police, selectman, police officer of a town, or by an agent of the institutions department of Boston, receive and care for in such institution as a patient, for a period not exceeding ten days, any person deemed by such superintendent or manager to be in need of immedi- ate care and treatment because of mental derangement other than drunkenness. Such request for admission of a patient shall be put in writing and be filed at the institution at the time of his reception, or within twenty-four hours thereafter, together with a statement in a form prescribed or approved by the department, giving such information as it deems appropriate. Any such patient deemed by the superintendent or manager not suitable for such care shall, upon the request of the superintendent or manager, be removed forthwith from the institution by the person requesting his reception, and, if he is not so removed, such person shall be liable to the commonwealth or to the person maintaining the private institution, as the case may be, for all reasonable expenses incurred under this section on account of the patient, which may be recovered in contract by the state treasurer or by such person, as the case may be. The superintendent or manager shall either cause every such patient to be examined by two physicians, quali- fied as provided in section fifty-three, and cause application to be made for his admission or commitment to such institution, or cause him to be removed therefrom before the expiration of said period of ten days, unless he signs a request to remain therein under section eighty-six. Reasonable expenses incurred for the examination of the patient and his transportation to the institution shall be allowed, certified and paid as provided by section seventy-four. Section 8. Section eighty of said chapter one hundred and twenty-three, as appearing in the Tercentenary Edition, is hereby amended by striking out, in the eighth line, the word "needing" and inserting in place thereof the following: — deemed by such super- intendent or manager to be in need of, — so as to read as follows : — Section 80. The superintendent or manager of any institution to which commitments may be made under section sixty-two may, when requested by a physician, by a member of the board of health or a police officer of a town, by an agent of the institutions department of Boston, by a member of the state police, or by the wife, husband, guardian or, in the case of an unmarried person having no guardian, by the next of kin, receive and care for in such institution, as a patient for a period not exceeding fifteen days, any person deemed by such superintendent or manager to be in need of immediate care and treat- ment because he has become so addicted to the intemperate use of narcotics or stimulants that he has lost the power of self-control. Such request for the admission of a patient shall be made in writing and filed at the institution at the time of his reception, or within twenty-four hours thereafter, together with a statement, in a form prescribed by the department having supervision of the institution, giving such information as it deems appropriate. The trustees, superintendent or manager of such institutions shall cause to be kept a record, in such form as the department having supervision of the institution requires of each case treated therein, which shall at all times be open to the inspection of such department and its agents. Such record shall not be a public record, nor shall the same be received as evidence in any legal proceeding. The superintendent or manager of such an institution shall not detain any person received as above for more than fifteen days, unless, before the expiration of that period, such person has been committed under section sixty-two, or has signed a request to remain at said institution under section eighty-six. Section 9. Section eighty-two of said chapter one hundred and twenty-three, as so appearing, is hereby amended by striking out, in the second line, the words "delirium tremens and", — so as to read as follows: — Section 82. No person suffering from in- sanity, mental derangement, deliriums, or mental confusion, except drunkenness, shall, except in case of emergency, be placed or detained in a lockup, police station, city prison, house of detention, jail or other penal institution or place for the detention of criminals. 18 P.D. 117 If, in case of emergency, any such person is so placed or detained, he shall forthwith be examined by a physician and shall be furnished suitable medical care and nursing and shall not be so detained for more than twelve hours. Any such person not so placed or detained who is arrested by or comes under the care or protection of the police, and any other such person who is in need of immediate care and treatment which cannot be provided without public expense, shall be cared for by the board of health of the town where such person may be. Such board of health shall cause such person to be examined by a physician as soon as possible, shall furnish him with suitable medical care and nursing, and shall cause him to be duly admitted or committed to an institution, unless prior to such admission or commitment he shall recover or be suitably provided for by his relatives or friends. Reasonable expenses for board, lodging, medical care, nursing, clothing and all other necessary expenses incurred by the board of health, under this section, shall be allowed, certified and paid in the same manner as provided by section seventy-four. Section 10. Said chapter one hundred and twenty-three is hereby further amended by striking out section eighty-six, as amended by section eight of said chapter three hundred and fourteen, and inserting in place thereof the following: — Section 86. The trustees, superintendent or manager of any institution to which an insane person, a dipsomaniac, an inebriate, or one addicted to the intemperate use of narcotics or stimu- lants, may be committed may receive and detain therein as a boarder and patient any person who is desirous of submitting himself to treatment, and who makes written application therefor and is mentally competent to make the application; and any such person who desires so to submit himself for treatment may make such written application. Except as otherwise hereinafter provided, no such person shall be detained more than three days after having given written notice of his intention or desire to leave the institu- tion; provided, that if his condition is deemed by the trustees, superintendent or manager to be such that further hospital care is necessary and that he is no longer mentally com- petent to be detained therein as a voluntary patient, or that he could not be discharged from such institution with safety to himself and to others, said superintendent or manager shall forthwith cause application to be made for his commitment to an institution for the insane, and, during the pendency of such application, may detain him under the written application hereinbefore referred to. Section 11. Section eighty-seven of said chapter one hundred and twenty-three, as so appearing, is hereby amended by striking out, in the eighth line, the words "three months" and inserting in place thereof the words : — ten days, — so as to read as follows : — Section 87. The trustees of the Monson state hospital may receive and detain therein as a patient any person who is certified to be subject to epilepsy by a physician qualified as provided in section fifty-three, and who desires to submit himself to treatment and makes written application therefor, and whose age and mental condition are such as to render him competent to make such application, or for whom application is made by a parent or guardian. No such patient shall be detained more than ten days after having given written notice of his intention or desire to leave the hospital. Upon the patient's reception at the hospital, the superintendent shall report the particulars of the case to the department, which may investigate the same. Section 12. Said chapter one hundred and twenty-three is hereby further amended by striking out section thirty-six, as so appearing, and inserting in place thereof the following: — Section 86. The superintendent or head physician of each institution shall cause all implements or devices of restraint to be kept under lock and key when not in actual use. Section 13. Section forty of said chapter one hundred and twenty-three, as so appear- ing, is hereby amended by adding at the end the following new sentence: — Locked doors on buildings housing patients in institutions under the jurisdiction of the depart- ment shall not be construed as constituting an obstruction of egress within the meaning of any section of chapter one hundred and forty-three, — so as to read as follows : — Section Ifi. Each institution shall be provided with proper means of escape from fire and suitable apparatus for the extinguishment of fire, and no building shall be erected or maintained at such institution without a written certificate of approval from the building inspector of the department of public safety for the district in which it is to be erected or maintained. Locked doors on buildings housing patients in institutions under the jurisdiction of the department shall not be construed as constituting an obstruction of egress within the meaning of any section of chapter one hundred and forty-three. {Approved August 12, 1939.) P.D. 117 19 Chapter 511. — An Act providing for a Second Assistant Commissioner in the Department of Mental Health. Section 1. Chapter nineteen of the General Laws is hereby amended by striking out section one, as amended by section two of chapter four hundred and eighty-six of the acts of nineteen hundred and thirty-eight, and inserting in place thereof the following: — Section 1. There shall be a department of mental health, in this chapter called the department, and a commissioner of mental health who shall have the exclusive super- vision and control of the department. All action of the department shall be taken by the commissioner or, under his direction, by such agents or subordinate officers as he may determine. There shall be in the department an assistant commissioner, qualified as hereinafter provided, who shall perform such duties as the commissioner may pre- scribe, and a second assistant commissioner qualified as hereinafter provided who shall, under the direction of the commissioner, have charge of the financial matters relating to the department and perform such other duties as the commissioner may prescribe. The commissioner and assistant commissioner shall be physicians who are diplomates in psychiatry of the American Board of Psychiatry and Neurology, Incorporated, and shall have had at least five years' experience on the resident administrative staff of a state or federal hospital for mental diseases or in any equivalent psychiatric organization, or at least four years' experience as aforesaid and at least one year's experience in the department controlling such hospital. The second assistant commissioner shall be a man of business experience qualified to undertake the management of the financial and business interests of the department. In the event of the disability or absence of the commissioner, or of a vacancy in his office by reason of death or otherwise, the assistant commissioner shall exercise the powers and perform the duties of the commissioner. In the event of the death, absence or disability of both the commissioner and the assistant commissioner, the governor, with the advice and consent of the council, may appoint an acting commissioner, who shall serve until the commissioner or the assistant commissioner is able to perform the duties of the office. Section 2. Said chapter nineteen is hereby further amended by striking out section two, as amended by section three of said chapter four hundred and eighty-six, and insert- ing in place thereof the following: — Section 2. Upon the expiration of the term of office of the commissioner, his successor shall be appointed for six years by the governor, with the advice and consent of the council; and the commissioner shall receive such salary, not exceeding ten thousand dollars, as the governor and council may determine. Upon the expiration of the term of office of an assistant commissioner, his successor shall be appointed for four years by the commissioner, with the approval of the governor and council ; and the assistant commissioner shall receive such salary, not exceeding seventy- five hundred dollars, as the governor and council may determine. Upon the expiration of the term of office of the second assistant commissioner, his successor shall be appointed for four years by the commissioner, with the approval of the governor and council; and the second assistant commissioner shall receive such salary, not exceeding five thousand dollars, as the governor and council may determine. The commissioner, assist- ant commissioner and second assistant commissioner shall be reimbursed for expenses necessarily incurred in the performance of their duties, and shall devote their entire time to the affairs of the department. Section 3. As soon as may be after the effective date of this act, a second assistant commissioner in the department of mental health, qualified as provided in section one, shall be appointed for four years by the commissioner of mental health, with the approval of the governor and council. Nothing in this act shall affect the commissioner of mental health or the assistant commissioner in said department, except as expressly provided therein. (Approved August 12, 1989.) Additional Legislation of General Interest in 1939 1. Chapter 238. — Abolishing the Commissioner ship and Associate Commissioner ship in the Division of Civil Service and placing said Division under the supervision and control of a Director and a Commission, and fw ther defining the powers and duties of said Division, its officers and employees. 2. Chapter 387. — An act making effective certain limitations on expenditures con- tained in the general appropriation act and providing further reductions in certain items thereof. 20 P.D. 117 3. Chapter 415. — An act further regulating the practice of medicine and dentistry within the Commonwealth by aliens. 4. Chapter 480. — An act requiring fair competition foi bidders on the construction, reconstruction, alteration, remodelling or repair of certain public works by the Common- wealth or any political subdivision thereof. 5. Chapter 502. — Making certain State fiscal requirements biennial instead of annual. 6. Chapter 508. — Making miscellaneous changes in the laws which have become neces- sary or advisable to provide for Biennial Sessions of the General Court. REPORT OF THE FINANCIAL DIVISION (Including Financial Statistics for the Year Ended November 30, 1939. Tables 1 to 11, inclusive, immediately follow this report.) To the Commissioner of Mental Health: The report of the activities for the Financial Division is submitted for the fiscal year ending November 30, 1939. This report has embodied in it the finances of the depart- ment, the institutions under its financial control, report of the Engineering, Farm and Food sub-divisions, information relating to the work of the division on appropriations for special purposes, supervision of major repairs, and various tables dealing with these activities. In Table 1 are brought together in consolidated form expenditures from appropriations controlled by the Department, having to do with the care of patients in hospitals for mental diseases (including epilepsy) and schools for mental defectives. The total expend- itures show an increase of $286,881.81. Of this amount $213,052.90 is under "Personal Services" and $293,250.02 under "New Construction". "Maintenance and Operation" shows a decrease of $219,421.11. The expenditures of the Department itself, given in Table 2, amount to $341,541.71, an increase over 1938 of $32,031.34. "Personal Services" shows a large increase because of the filling of a number of vacant positions. "Expenses" shows a slight increase. The amount spent under "Persons Boarded in Hospital Cottages" was increased $1,233.89 because of a change in rate from $8.50 to $10 in the middle of the year. Additional money was spent on research under "Investigation of Mental Diseases", and on "Board- ing Feeble-minded Persons". Table 3 shows the amount appropriated by the legislature for the fiscal year and the balance available from the previous year (which represents liabilities for indebtedness incurred prior to the close of the previous fiscal year). These two amounts represent the total appropriation available for the current year. Next is the gross expenses, then the receipts which are for sales only. Receipts for board of patients are shown in Table 8. They are not deducted to arrive at the net expenses and net weekly per capita cost. Next are shown the expenses arrived at by deducting sales from the gross expenses and then with the daily average number of patients, the weekly per capita cost is obtained. The weekly per capita cost average for the twelve mental hospitals is $8,084; that for schools for defectives is $7,101, with an average of $7,899 for the sixteen institutions whose appropriations are supervised by the Department. Comparing the previous fiscal year ending November 30, 1938, the average weekly per capita cost for the twelve mental hospitals was $8,231 or $.15 higher than 1939. For the schools for mental defectives for the fiscal year 1938 the average weekly per capita cost was $7,066 or $.03 lower than the average per capita cost for the fiscal year 1939. Taking the total of the sixteen institu- tions for 1938, the average weekly per capita cost was $8,011 as compared with the average per capita cost of 1939 of $7,899 or $.11 higher than the average of 1939. As the net weekly per capita cost for the Boston Psychopathic Hospital is exceptional compared with that for the other institutions, the average weekly per capita cost for the twelve mental hospitals, when recomputed without the Boston Psychopathic Hospital for 1939 is $7,905, and the average per capita cost for the fifteen institutions computed without the Boston Psychopathic Hospital is $7,753. Table 4 gives in detail the expenses and weekly per capita costs grouped according to the adopted standard of analysis of maintenance expenses of all classes of institutions in the Commonwealth. In comparison with the expenses of 1938, increases are shown under Personal Services, Food and Medical and General Care. Decreases were shown under all other classifications, particularly under Repairs Ordinary and Repairs and Renewals. P.D. 117 21 The average weekly per capita cost per patient for personnel for 1938 was $4,554 and for 1939, $4,632, an increase of $.078 from 1938. This detail will be noted in Table 5. The rotation of persons employed for the year shows a slight increase per person for the hospitals for 1939. (Table 6.) Appropriations for construction, permanent betterments, real estate and furnishings, unlike that for maintenance and operation, are made for two years, beginning with the passage of the act dealing with special appropriations by the legislature. Detail of all special appropriations is given in the report of the Engineering division and in Table 7 where are shown all of the appropriations of this nature active during the fiscal year. This table deals with indebtedness incurred and balances available rather than with the actual cash payments and cash balances, and more clearly represents the actual condi- tion of the appropriation as it shows the true balances available for additional expendi- tures. In its budget request for 1939 the Department asked for $6,878,743.20. The amount appropriated was $148,300. Receipts during the year from paying patients, collected under the direction of the Division of Legal Settlement and Support Claims, amounted to $831,091.54, an increase over the receipts of 1938 of $29,336.92. The per capita amount received in 1939, based on average daily patient population, was $30.04. The receipts from paying patients were 7.188% of the total cost of maintenance. (Table 8.) Section 27, chapter 123 of the General Laws reads as follows: "The Trustees of each state hospital shall be a corporation for the purpose of taking and holding by them and their successors, in trust for the Commonwealth, any grant or devise of land, and any gift or bequest of money or other personal property, made for the use of the state hospitals of which they are trustees, and for the purpose of preserving and investing the proceeds thereof in notes or bonds secured by good and sufficient mortgages or other securities, with all the powers necessary to carry said purposes into effect. They may expend any unrestricted gift or bequest, or part thereof, in the erection or alteration of buildings on land belonging to the state hospital, subject to the approval of the depart- ment, but all such buildings shall belong to the state hospital and be managed as a part thereof." Under this section hospitals have received gifts as shown in Table 9 which have been deposited as funds, the proceeds of which have been used for the benefit of the patients in accordance with the terms or restrictions placed thereon by the donor. This depart- ment encourages gifts made under this law and from them special benefits are derived by the patients in ways not always possible from the funds of the Commonwealth. The printing plant, conducted by the Department at the Gardner State Hospital, is carried on as occupational therapy for the benefit of patients, and at the same time meets the printing needs of the Department and its institutions. During the year approx- imately the following material was printed: 310,000 letterheads; 63,500 envelopes; 38,700 each Christmas folders and envelopes; 37,350 Christmas labels, 67,200 triplicate order blanks; 3,500,000 medical and other forms and cards of 240 varieties; 173,984 pay roll checks; 3,000 booklets; 1,200 bulletins and books, 10,450 annual reports for the depart- ment and its institutions, and 1,000 reprints. The reports of the Engineering, Farm and Food sub-divisions follow. Report of Supervising Hospital Construction Engineer — Walter E. Boyd There were few special appropriations for the year 1939 and none were of any size. Those that were available were for correcting defects in service. An appropriation for Steam lines at the Boston State Hospital provides for the instal- lation of a new large steam line from the Power Plant in the east group to a distribution center in the west group. This line will be adequate to serve the entire west group should the existing mains break down. It also will enable the return of all of the condensate from the west group instead of wasting a large percentage as is necessarily done now. Plans have been completed but as the work cannot be installed during the winter it will be started early in the spring. The installation should result in a material saving at the power plant. An extension of the replacement of open wiring was carried on at the Danvers State Hospital. Most of the work consisted of new wiring and fixtures at the Middleton Colony. Flood lights were installed around the colony buildings and the ground lighting improved. The stairway and night lights in both groups were placed on a time switch automatically turning them on and off as required. The project put the wiring at the Danvers State Hospital on an efficient and up-to-date basis. 22 P.D. 117 Sewer beds at the Hersey Farm of the Foxborough State Hospital were completed and placed in operation. At the Grafton State Hospital contracts were awarded and work started on the instal- lation of multiple retort stokers and coal handling apparatus. The work was started late in the fall and two stokers and the coal handling equipment were put into operation for the winter. The entire project will be completed early in 1940 and is expected to result in marked savings and more efficient operation. Plans were prepared for additional sewer beds at the Grafton State Hospital but unsuccessful negotiations for drainage rights delayed the project so that the actual work will not start until 1940. The dining room in Ward R Building at the Medfield State Hospital was renovated by the installation of tile floors and walls, repainting and the installation of modern sanitary serving-room equipment. A contract was awarded and work started on the replacement of open wiring at the Taunton State Hospital. This reduces one more fire hazard. The piggery was practically completed, so that this activity can be removed from the main hospital to the farm at Raynham Colony. Several sewer beds at the Westborough State Hospital were resurfaced by the addition of a layer of filter sand, improving the filtering and simplifying the maintenance of the beds. At the Monson State Hospital an additional steam line was installed in the steam tunnel from the power house to the head of the tunnel at the old power house. This is a smaller line for use in the summer and will result in steam economies and also permit repairs to the large line. The garage at this institution was completed by contract. The water supply at Templeton Colony of the Walter E. Fernald State School was continued with the awarding of further contracts, for the pumps, filter, standpipe and house connections. Because of delays due to large quantities of rock and shortage of ground water, causing changes in plans, the work was not finished in 1939 as anticipated. It will be completed in 1940, giving the Colony a central water supply and eliminating the present shallow wells. Studies were made of power plant operation, budget requests on special appropriations and heat and other plant operation were considered, and the usual inspections of insti- tutions were made. Report of the Senior Structural Engineer — Clarence D. Maynard The institution requests for funds under the Repairs and Renewals and Garage sections of the budget were investigated and conferences were held with the Budget Commissioner and important items included in the budget requests. Fire prevention and renewal of equipment programs were continued. Budget requests were made for the years 1939 and 1940. A new control table was installed, operating room equipment purchased and self- closing fire doors installed at the Boston Psychopathic Hospital. At the Boston State Hospital, bakery and kitchen equipment was installed, the steam turbines were repaired and overhauled, the program of floor covering continued, cafeteria equipment installed in West A building, and new porches erected at West B building. Extensive repairs to the exterior walls were necessary at the Middleton Colony of the Dan vers State Hospital; temperature controls and dial thermometers were installed on hot water lines; steel access panels to ventilating ducts were installed and remote control of fire pump installed. At the Foxborough State Hospital, the fire protection program was continued and stair grilles and window guards were installed. A new brooder house was built and the steam and hot water lines to cottages were completed. The program of replacing ice refrigeration with electric refrigeration was continued at the Gardner State Hospital. New ranges were installed, the water standpipe was painted, farm scales were purchased and new laundry equipment installed. At the Grafton State Hospital, a ceramic floor was laid in the Pines D dining-room. A new silo was constructed and a central brooder house built. A program of weather- stripping and caulking windows was inaugurated and a new smoke flue was erected at the boiler house. At the Medfield State Hospital an ice cream freezer and hardening cabinet was pur- chased, bakery equipment installed, and a new silo erected, and the program of weather- stripping continued. P.D. 117 23 A new silo was built at the Taunton State Hospital, equipment was purchased for the new piggery and metal shelving provided for the Infirmaries which were recently reno- vated. A new floor was laid in the chapel at the Worcester State Hospital and the water tower was painted and a protective wire fence erected around the tank. A new pasteurizer was purchased for the dairy. At the Monson State Hospital the walls and ceiling of the cow barn were renewed and the program of replacement of domestic hot water tanks continued. The main electric cable was laid underground at the north side of the boiler plant and the roofing replaced at Farm Groups No. 1 and 2. A new pasteurizer was installed in the dairy of the Belchertown State School and the hot water thermostatic mixing valves repaired. The number one stoker was remodelled and an asphalt tile floor installed in Infirmary Building K. The program of renewal of plumbing, wiring and roofing was continued at the Walter E. Fernald State School and dairy equipment installed. Boiler baffle walls in the boiler plant also were installed. At the Wrentham State School new tile floors were installed in dormitories E and F. A new silo was built and funds provided for the completion of the cow barn. New sewing room equipment was installed in "F" building. New window shades were installed in "O" building. Fire prevention inspections were made at the institutions and contract supervision was given to the following special appropriation projects: Reslating Roofs, Dan vers; Steam and Hot Water lines, Foxborough; Pines E Ward Building and Dining and Service Building including furnishings, Grafton State Hospital; Fire Protection, Westborough; Medical Equipment and Bake Ovens, Worcester State Hospital. A total of sixty-three visits was made to the institutions. Report of the Assistant Engineer — Joseph P. Gentile During 1939 the institutions of the Department were visited for the purpose of con- ducting the routine inspections on fire protection; for obtaining data necessary to prepare projects; and for maintaining supervision of projects during their progress. At the Boston State Hospital the Work of building hard-surfaced roads, concrete walks and curbing, installing sewers for surface drainage, grading and landscaping was con- tinued with W. P. A. labor. A new water main with hydrants was installed at the Belcher Group of the Gardner State Hospital. This water main will be used for fire fighting purposes exclusively. Work has been started on the installation of sprinklers in the cow and horse barns at the Belcher Group. Enclosed fireproof stairs were erected to replace open fire escapes on the Speare and Dewson Buildings of Warren Colony at the Westborough State Hospital. The reconstruction of Richmond Sanatorium at the Westborough State Hospital was completed. The X-Ray suite of the Worcester State Hospital was remodeled and new X-Ray Equipment installed. The Administration Building of the Worcester State Hospital was completely rewired including new lighting fixtures in the offices and the superintendent's suite. Work has been started on the installation of walk-in refrigerator boxes in the basement of the kitchen and dining building of the Monson State Hospital. Two additional exits were provided for each ward of the Clough and South Buildings at the Monson State Hospital by the erection of two enclosed fireproof stairs on each building. A study is being made of paints, being used at the institutions, to determine a standard of quality for the different paints. Report of Assistant Engineer — Francis D. Kirby During the year general alterations and installations, surveys and inspections of plumbing work were made by the department and maintenance personnel at the various institutions, including the drawing of plans and specifications by the department. At the Worcester State Hospital a general survey of the plumbing in the main execu- tive building was made, including the completion of plans and specifications for the work to be done. 24 P.D. 117 Plumbing work in the Employees' Building was done to the amount of funds allowed. A final survey was made of all plumbing work to be done at the Summer Street building. All work on the hydrotherapy suite in "O" Building was completed and a plumbing and heating survey was made of the hydrotherapy suite to be completed in "E" Building at the Foxborough State Hospital. At the Gardner State Hospital plans and specifications were drawn for additional plumbing facilities on the second and third floors of the Men's and Women's Infirmary Buildings. At the end of the year 75% of the work on the hydrotherapy suite at the Grafton State Hospital was completed. At the Medfield State Hospital a survey of plumbing for additional toilet facilities for use of employees on the second floor in G-2 and G-4 building was made. All plumbing alteration work started at this hospital was completed. A general survey was made for additional toilet facilities for plumbing in East and West Godding Buildings. All plumbing and ventilation work previously started in wards 1, 2, 3, 4, 5, 6, 7, 8, and 9 was completed at the Taunton State Hospital. At the Monson State Hospital a complete survey was made for the renovation of all plumbing in Farm Group Building No. 6, including the preparation of plans and specifi- cations. In general, check-ups were made of hot water temperature controls in the various hospitals and of cross connections in water supply lines. Inspections were made of plumbing work done by institution maintenance plumbers. All of the renovation projects included plumbing, heating, electric work, plastering, carpentry, tile and marble work, painting and general work necessary for the completion of each project. At present there are five uncompleted projects: Hydrotherapy suite, E Building, Foxborough State Hospital; Hydrotherapy suite, Elms A Building, Grafton State Hospi- tal; Completion of unfinished work, Employees' Building, Worcester State Hospital; Completion of unfinished work, Summer Street department, Worcester State Hospital; Completion of unfinished work in C and D Buildings, Boston State Hospital. Report of Senior Engineering Aid — Lloyd C. Latimer Following is the location and brief description of work performed during the year 1939. Boston State Hospital — Prepared plans, specifications and alternate design for two (2) reinforced concrete porch additions to Building H. Foxborough State Hospital — Completed field engineering and inspection work on new Sewage Disposal plant at Hersey Farm. Gardner State Hospital — Plans for third floor addition to toilet section of Men's Infirmary Building. Made fire inspection and recommendations for minimizing hazards. Medfield State Hospital — Plans for renovation of second floor toilets in Buildings G-2 and G-4. Prepared plans for cafeteria in basement of Building R. Northampton State Hospital — Made fire inspection and report. Taunton State Hospital — Completed field engineering work for construction of piggery at Raynham farm. Prepared plans for renovation of toilet sections in the East and West Godding buildings. Westborough State Hospital — Field engineering and inspection for resurfacing of sewer beds. Worcester State Hospital — Plans for toilet and bath renovations in Executive Build- ing were made. Monson State Hospital — Plans for renovation of plumbing in Farm Group No. 6 were made. Belchertown State School — Made fire inspection and report. General — Made estimates of material quantities and costs, annual check-up of institutional housing survey with many new hospital floor plans for same, computation of per capita tabulations, together with miscellaneous small plans, sketches and specifi- cations for various purposes. Report of the Farm Coordinator — Wallace F. Garrett Partial reclaiming of forests and hospital woodlands continued as speedily as finances, labor and equipment would permit, removing damage resulting from the hurricane of P.D. 117 25 1938. Two million feet of native lumber were sawed into boards and distributed to all units of the department. Reforesting of certain areas progressed in an attempt to pro- mote the native lumber requirements of the future. Vegetable production reached a maximum poundage despite the excessive drought existing during the summer season. Products conserved were in abundance thus reducing the purchased food requirement during the winter. Eggs produced at the various hospital poultry projects increased compared with previous year's statistics. Hybrid females were used in certain locations for the purpose of comparison and results were satisfactory. Dairy animals were again increased numerically in an endeavor to supply the fluid milk requirements of the department. The livestock remained in excellent physical condition throughout the period and excessive mortality was avoided. Monthly meetings of all head farmers were held and interesting speakers provided to discuss current problems. As a result of such discussions the efficiency of the group has been held at a high level, a distinct benefit to the Commonwealth. Experimental programs supervised by the Massachusetts Experimental Station con- tinued at several selected units. The results of such projects is published and held as a distinct benefit to the State's agricultural program. The Federal Government, Department of Agriculture, has instituted erosion control demonstration projects at several of the hospitals. It is anticipated such a program will improve control methods of soil and moisture. For farm detail note tables 10 and 11. Report of Food Coordinator — Albert E. Houde During 1939 measures were inaugurated to effect standards in food preparation. Included in these standards were the economic application of quickly frozen fresh eggs, milk solids, hydrogenated and emulsified shortenings, flavors, and pastry and bread flours. A standard formula for the making of bread was put into practice, this formula evolv- ing from economic advantages and the consideration of hospital needs. Practical demonstrations accompanied by moving picture explanations and dis- cussions were conducted at both Westborough and Northampton State Hospitals. As a movement toward the standardization of hospital food control — curtailment of waste and similar subsidization — the foundation for a Unit Cost Report was made. This report will provide the department and institutions with an intimate insight and control of all food units purchased and produced by the institutions. This report in its final developments will precipitate an eventual food ration as prac- ticed by the hospitals and become the accurate medium for all hospitals making their future food requests and subsequent allotments. Respectfully submitted, William I. Rose, Business Agent. 26 P.D..117 Financial Statistics for the Year Ended November 30, 1939 • Table 1. Total Expenditures of Department and Institutions New Con Maintenance struction. Personal and Permanent Department and Institutions Services Operation (Net) i Betterments, Real Estate and Furnishings Total Department of Mental Health . $258,933.36 $82,573.30 $341,506.66 Hospitals for Mental Diseases: Boston Psychopathic Hospital 179,507.35 66,339 . 23 - 245,846.58 Boston State Hospital ... 638,069.82 479,637.30 $38,863.14 1,156,570.26 Danvers State Hospital . 521,937.69 404,770.20 59,514.32 986,222.21 Foxborough State Hospital . 341,536.69 239,361.94 44,190.90 625,089.53 Gardner State Hospital . 332,652.78 266,331.65 74,351.81 673,336.24 Grafton State Hospital . 405,253.99 262,998.03 477,964.19 1,146,216.21 Medfield State Hospital 442,350.10 269,320.37 ' 81,109.93 792,780.40 Metropolitan State Hospital 413,501.93 333,386.76 878.29 747,766.98 Northampton State Hospital 438,844.19 320.141.34 16,102.78 775,088.31 Taunton State Hospital 417,537.21' 279,228.64 65,280.80 762,046.65 Westborough State Hospital 404,322.28 ,255,999.33 114,939.76 775,261.37 Worcester State Hospital 628,372.08 437,656.67 188,480.03 1,254,508.78 Monson State Hospital . 408/440.08 281,385.25 122,758.25 812,583.58 Total Hospitals $5,572,326.19 $3,896,556.71 $1,284,434.20 $10,753,317.10 Schools for Mental Defectives: Belchertown State School $298,489.91 $217,867.16 $42,616.02 $558,973.09 Walter E. Fernald State School . 431,913.46 313,633.18 115,492.59 861,039.23 Wrentham State School 378,604.32 284,970.23 34,428.30 698,002.85 Total Schools .... $1,109,007.69 $816,470.57 $192,536.91 $2,118,015.17 Grand Total . . . '. $6,940,267.24 $4,795,600.58 $1,476,971.11 $13,212,838.93 'Less Sales Table 2. Departmental Receipts and Expenditures Expenditures ' 1 LPPROPRTATTOI' s Expenditures , Appro- priation 1939 Brought Forward from 1938 Appropria-' tion Total Available Balance Commissioner's Salary Personal Services .... Expenses Transportation .... Persons Boarded, Hospital Cot- Investigation of Mental Diseases Boarding Feeble-Minded Patients $10,000.00 169,000.00 42,971.79 5,860.31 24,000.00 103,785.07 3,000.00 $ — 1,956.71 8,308.24 $10,000.00 169,000.00 44,928.50 5,860.31 24,000.00 112,093.31 3,000.00 $10,000.00 157,763.55 41,415.33 5,859.98 22,452.40 102,553.34 1,497.11 $1,236.45 3,513.17 .33 1,547.60 9,539.97 1,502.89 Total $358,617.17 $10,264.95 $368,882.12 $341,541.71 $27,340.41 Receipts Payable to State Treasurer: Licenses, Private Hospitals Board in Hospital Cottages Sales: Forms Other Receipts: Deposit on Plans College — Training Refunds a/c previous years Total $950.00 416.67 237.50 50.00 40.00 ,729.22 P.D. 117 27 o O S3 -O IS H O H o s e ES, 55. 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Analy sis of Pay Rolls — By Institution Average Weekly Pee Capita Cost Institutions Industrial Medical Ward Service and Edu- cational All Others Total Hospitals for Mental Diseases: Boston Psychopathic Hospital . $8,851 $10,784 $.550 $19,561 $39,748 Boston State Hospital .377 2.769 .156 1.993 5.296 Danvers State Hospital .304 2.243 .072 1.635 4.255 Foxborough State Hospital .357 2.153 .087 1.947 4.545 Gardner State Hospital .329 1.892 .130 1.803 4.155 Grafton State Hospital .369 2.207 .102 2.450 5.129 Medfield State Hospital .279 2.274 .106 1.913 4.572 Metropolitan State Hospital .264 2.268 .073 1.588 4.194 Northampton State Hospital .332 2.082 .063 1.581 4.060 Taunton State Hospital .377 2.288 .085 1.929 4.680 Westborough State Hospital .356 2.178 .064 2.204 4.803 Worcester State Hospital . .297 2.431 .085 1.942 4.757 Monson State Hospital (epileptic) .331 2.669 .085 1.983 5.069 Averages $.361 $2,337 $.094 $1,963 $4 . 757 Schools for Mental Defectives: Belchertown State School .... $.303 $1,889 $.311 $1,810 $4,314 Walter E. Fernald State School. .332 2.116 .342 1.515 4.307 Wrentham State School .... .298 1.875 .263 1.284 3.722 Averages $.312 $1,968 $.305 $1,504 $4,089 $. 352 $2,267 $.134 $1,877 $4,632 Table 6. Rotation in Service of Persons Employed in Institutions Persons Institution Industrial Medical Ward Service and Edu- cational All Others Total Hospitals for Mental Diseases: Boston Psychopathic Hospital . 1.333 1.410 1.50 1.379 1.386 Boston State Hospital 1.736 1.801 1.235 1.566 1.710 Danvers State Hospital 1.411 1.578 1.125 1.245 1.455 Foxborough State Hospital 1.363 1.291 1.166 1.307 1.298 Gardner State Hospital 1.00 1.372 1.00 1.189 1.278 Grafton State Hospital 1.238 1.424 .857 1.195 1.306 Medfield State Hospital 1.454 1.428 1.50 1.55 1.467 Metropolitan State Hospital 1.095 1.360 1.142 1.185 1.291 Northampton State Hospital 1.066 1.303 1.00 1.238 1.268 Taunton State Hospital 1.379 1.347 .875 1.237 1.303 Westborough State Hospital 1.50 1.603 1.166 1.245 1.443 Worcester State Hospital . 1.411 1.671 1.20 1.201 1.485 Monson State Hospital (epileptic) 1.222 1.313 1.00 1.134 1.243 1.347 1.490 1.088 1.289 1.405 Schools for Mental Defectives: Belchertown State School .... 1.142 1.331 1.256 1.161 1.259 Walter E. Fernald State School. 1.00 1.351 1.117 1.125 1.263 Wrentham State School .... .909 1.50 1.038 1.231 1.382 1.00 1.40 1.126 1.169 1.303 Total Average 1.209 1.474 1.105 1.273 1.388 NOTE — Baser! on actual number employed as compared with quota 32 P.D. 117 3 ocd as>ooo t^ NffiOO CO 00 ost>.cc CD-HO0 rH o NNN 0 0! o OlO cocon ■* OOO^iO TJH »0 (NflO r-H t^i-H CO N -f COCO 0 0X1 Tf ooo MOON o i^most^ OCN rt<^cN OC0CD ^ i d COi-ICO 0 =5 rt 89 oo ooo 30 CO o CO HO ClON OCOO". . 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Pub. No. 9, p. 88-90 of Am. Assoc. Adv. Science, 1939. Alexander, L. and Looney, J. M. — Histologic changes in senile dementia and related conditions studied by silver impregnation and microincineration. Arch. Neur. and Psychiat. 40: 1075, Dec. 1938. Alexander, L. and Myerson, A. — Cell minerals in amaurotic idiocy, tuberous sclero- sis and related conditions, studied by microincineration and spectroscopy. Examples of degenerative and neoplastic cell disease. Am. Jour. Psychiat. 96: 77-85 July 1939. Alexander, L., Myerson, A. and Pijoan, M. — Beri-beri and scurvy. An experi- mental study. Trans. Am. Neurol. Assoc, The William Byrd Press, Richmond, Va., 64: 135-139, 1938. Angyal, Andras — The structure of wholes. Phil, of Sci. 6: 25, Jan. 1939. Atwell, C. R. — Comparison of Vocabulary Scores on the Stanford-Binet and the Revised Stanford-Binet. Jour. Educ. Psychol., 30, 467-469, 1939. Barton, W. E. — Narcosis treatment in the psychoses. Bull. Mass. Dept. Ment. Health, Symposium on Therapy, p. 41, Sept. 1939. Benda, Clemens — Studies in Mongolism, I. Growth and Physical Development. Arch. Neur. and Psychiat., Jfl: pp. 83-97, January 1939. Benda, Clemens — Studies in Mongolism, II. The Thyroid Gland. Arch. Neur. and Psychiat., 41: pp. 245-259, February 1939. Benda, Clemens — Studies in Mongolism, III. The Pituitary Body. Arch. Neur. and Psychiat., 42: pp. 1-20, July 1939. Benda, Clemens — Further Clinical and Pathologic Studies in Mongolism (with demon- stration of lantern slides). Proceedings of the Am. Ass'n Mental Dene, 44-' 47-58, 1939. Bonner, C. A. and Taylor, L. E. — A study of Accidents in a Mental Hospital. Am. Jour. Psychiat., 96: No. 2, p. 283, September 1939. Bryan, W. A. — Prima Donnas on the payroll. National Safety News. 39: 50 and 80-81, June 1939. Bryan, W. A. — Cost in relation to standard of State Hospital care. Am. Ass'n Adv. Sci., Mental Health, No. 9: p. 174, 1939. Buermann, A. and Alexander, L. — The reaction of the cerebral vessels to intra- carotid injection of horse serum in sensitized and non-sensitized guinea pigs. Confinia Neurologica 2: 215-219, 1939. Campbell, C. M. — ■ Human Needs and Social Resources. Mental Health. Publication of the Am. Ass'n for the Adv. of Sci., No. 9: The Science Press, 1939. Campbell, CM. — The Criteria of Specialists in Psychiatry and of Facilities for Gradu- ate Work. Mental Health. Publication of the Am. Ass'n for the Adv. of Sci., No. 9. The Science Press, 1939. Campbell, C. M. — A Note on the Imagination and Its Exploitation; Psalmanazar and Helene Smith. Transactions of the Am. Neur. Ass'n., pp. 198-200, 1939. Cameron, D. E. and Jellinek, E. M. — Physiological studies in insulin treatment of acute schizophrenia. II. Pulse rate and blood pressure. Endocrinology 25: 100, July 1939. Can a van, Myrtelle M. — Lesions in Spinal Cord in Mental Disease and Defect recognized by Myelin Sheath Stain. Jour, of the Med. Ass'n of Georgia, XXVIII, No. 8, p. 324-331, August 1939. Canavan, Myrtelle M. — Obituary. George Burgess Magrath. Arch. Path. 27, p. 620-623, March 1939. Canavan, Myrtelle M. and Taft, A. E. — Waverley Researches in the Pathology of the Feeble-Minded. (Research Series, Cases XXXI-to XL). Chase, Louis S. — Effects of vitamin Bi in schizophrenia. Am. J. Psychiat., 95: 1035, March 1939. Cohen, B. and Myerson, A. — Benzedrine sulphate — an antidote for the untoward hypnotic and ataxic effects of phenobarbital in the treatment of epilepsy. Bull. Mass., Dept. of Mental Health, "Symposium on Therapy," p. 49-55, September 1939. Cohen, L. H. and Hoskins, R. G. — Neuro-endocrinology. Cyclopedia of Medicine, Vol. 5: Chapt. X, pp. 690-713, F. A. Davis and Co., 1939. P.D. 117 51 Cohen, L. H. — Psychiatric changes associated with induced hyper-thyroidism in schizophrenia. Psychosomatic Med. 1: 414, July 1939. Cohen, L. H. — The therapeutic significance of fear in the metrazol treatment of schizophrenia. Am. Jour. Psychiat. 95: 1349, May 1939. Cohen, L. H. — The pharmacologic antagonism of metrazol and sodium amytal as seen in human individuals (schizophrenic patients). Jour. Lab. and Clin. Med., 24: 681, April 1939. Cohen, L. H. — Factors involved in the stability of the therapeutic effect in the metrazol treatment of schizophrenia. (A report of 146 cases.) New England Jour. Med. 220: 780, May 11, 1939. Cohen, L. H. — The return of cognitive conscious functions after convulsions induced with metrazol. Arch. Neur. and Psychiat., J^l: 489, March 1939. Corwin, William and Thompson, J. W. — Experimental Anoxemia (Report of a Case). Arch. Neur. and Psychiat., 40: pp. 1233-1240, December 1938. Corwin, William and Thompson, J. W. — Treatment of the Total Organism in Schi- zophrenic Patients. Am. Jour. Psychiat. 95, No. 5, p. 1059, March 1939. Cottington, Frances and Gavigan, A. J. — Metrazol treatment of depressions. New England Jour. Med. 220: 990, June 15, 1939. Darrah, L. W. — The Difficulties of being "Normal." Jour, of Nerv. and Ment. Dis., 90: 730, 1939. Devereux, George — The social cultural implications of incest among the Mohave Indians. Psychoanalytic Quart. 8: 510, October 1939. Farrell, M. J. — Insulin Treatment and Psychotherapy in Chronic Dementia Praecox Patients. Bull. Mass., Dept. of Mental Health, Symposium on Therapy, p. 11-16, September 1939. Flower, B. H. and Cohen B. — The Attention Defect in Schizophrenia, its Grada- tions and Therapeutic Implications. Bull. Mass., Dept. of Mental Health, Symposium on Therapy, p. 63-67, September, 1939. Freeman, H. — Skin and body temperatures of schizophrenic and normal subjects under varying environmental conditions. Arch. Neur. and Psychiat. J+2: 724, Oct., 1939. Freeman, H. and Lengyel, B. A. — The effects of high humidity on skin temperature at cool and warm conditions. Jour. Nutrit. 17: 43, January 1939. Friedman, Emerick — The Convulsive Irritative Therapy: Report of over 3,000 cases. Jour. Am. Med. Ass'n. 112: 501, Feb. 1939. Gavigan, A. J. and Pettee, Evelyn H. — The care of the aged. Am. Jour. Nurs. 39: 150, January 1939. Hanfmann, Eugenia — A qualitative analysis of the Healy Pictorial Completion Test II. Am. Jour. Orthopsychiat. 9: 325, April 1939. Hanfmann, Eugenia — Thought disturbances in schizophrenia as revealed by per- formance in a picture completion test. Jour. Abnorm. and Soc. Psych. 34: 248, April 1939. Hoagland, Hudson; Rubin, M. A. and Cameron, D. Ewen — Brain wave frequencies and cellular matabolism. Effects of dinitrophenol. Jour. Neurophysiol. 2: 170, March 1939. Holt, W. L. and Schwab, R. S. — An easily made apparatus for use in "Closed System" pneumo-encephalography, with notes on technic for its use. Arch. Neur. and Psychiat. 41: 1021, May 1939. Hoskins, R. G. and Cohen, L. H. — Psychopathy, psychosis and internal secretions. Cyclopedia of Medicine. Vol. 5: Chapt. IX, pp. 646-690, F. A. Davis and Co. 1939. Hoskins, R. G., Levene, H. M. and Bevin, S. — The relationship of male sex hormone to the level of bodily vigor in senility. Endocrinology 25: 143, July 1939. Jellinek, E. M. — The function of biometric methodology in psychiatric research. Am. Ass'n Adv. Sci., Mental Health, No. 9: p. 48, 1939. Jellinek, E. M. — Physiological studies in insulin treatment of acute schizophrenia. I. Methods. Endocrinology 25: 96, July 1939. Jellinek, E. M. and Looney, J. M. — Statistics on some biochemical variables on healthy men in the age range of 20 to 45 years. Jour. Biol. Chem. 128: 621, May 1939. Jellinek, E. M. — Some principles of psychiatric classification. Psychiatry 2: 161, May 1939. 52 P.D. 117 Kent, Grace H. — The Use and Abuse of Mental Tests in Clinical Diagnoses. Psychol. Rec, 2, No. 17, December 1938. Kent, Grace H. — Self-Derived Norms for Institutions. Psychol. Rec. 3, No. 16, October 1939. Kopp, I. — Untreated Syphilis in Pregnancy, Juvenile Paresis — Case Report. Bull. Genito-Infect. Dis., November 1939. Kopp, I. — Technic, Physiology and Results in the Application of Therapeutic Hyper- pyrexia. Jour. Conn. Med. Soc, 8, 38, 1939. Kopp, I. — The Effect of Fever on Postural Changes in Blood Pressure and Pulse Rate. Am. Heart Jour. 18, 46, 1939. Kopp, I. and Solomon, H. C. — Reinfection (?) in Neurosyphilis. Am. Jour. Syph., Gonorr. and Ven. Dis., 23, 54, 1939. Kopp, I. and Solomon, H. C. — The Malarial Treatment of General Paresis: Relation of the Height, Duration and Frequency of Fever to the Clinical and Serologic Results. Am. Jour. Syph., Gonorr. and Ven. Dis., 23, 585, 1939. Kopp, I. and Solomon, H. C. — Interstitial Keratitis in Patients with Neurosyphilis of Congenital Origin; with a Discussion of Fever as a Precipitating Factor of Keratitis in the Paretic Variety. Am. Jour. Syph., Gonorr. and Ven. Disease, 23, 751, 1939. Loman, J., Lesses, M. F. and Myerson, A. — Human Autonomic Pharmacology. XV. The effect of a cetyl-beta-methylcholine chloride (mecholyl) by iontophoresis on arterial hypertension. Annals Inst. Med. 12: 1213-1222 (Feb.) 1939. Loman, J., Rinkel, M. and Myerson, A. — Comparative effects of amphetamine sulfate (benzedrine sulfate) paredrine and propadrine on the blood pressure. Am. Heart Jour. 18: 89-93, July, 1939. Longpre, Fernand — The Use of Sodium Amytal Combined with Psychotherapy in Non-Cooperative and Cataleptic Patients. Bull. Mass., Dept. of Mental Health — "Symposium on Therapy" pp. 5-8, Sept., 1939. Looney, J. M. — The determination of serum phosphatase and its clinical significance. New England Jour. Med., 220: 623, April 1939. Looney, J. M. — Changes in lactic acid, pH and gases produced in the blood of normal and schizophrenic subjects by exercise. Am. Jour. Med. Sci. 198: 57, July 1939. Looney, J. M. and Walsh, Anna I. — The determination of spinal fluid protein with the photoelectric colorimeter. Jour. Biol. Chem. 127: 117, January 1939. Looney, J. M., Jellinek, E. M. and Dyer, Cora J. — Physiological studies in insulin treatment of acute schizophrenia. V. The blood minerals. Endocrinology 25: 282, August 1939. Looney, J. M., Freeman, William and Small, Rose R. — Studies on the Phytotoxic Index. III. (An evaluation of the method with reference to depressed psychotic patients). Am. Jour. Med. Sci. 198: 528, October 1939. Looney, J. M. and Walsh, Anna I. — The determination of globulin and albumin in blood serum by the photoelectric colorimeter. Jour. Biol. Chem. 130: 635, October 1939. Maletz, Leo — The Place of the Mental Hygiene Clinic in the Community. Mental Hygiene, 23, No. 2, April 1939. Maletz, Leo — Pastoral Psychiatry — John Bonsell. Mental Hygiene, 23, No. 4, October 1939. Maletz, Leo — Experience with a Miniature Newspaper. Bull, of the Mass. Ass'n. Occupat. Therapy, 13, No. 3, May 1939. Michelson, Harry — The Use of Metrazol in the Treatment of Schizophrenia. Bull. Mass., Dept. of Mental Health — Symposium on Therapy, pp. 25-29, Sept, 1939. Myerson, A. — The relationship of hereditary factors to mental processes. Assoc. Res. in Nerv. and Ment. Dis. 19: 16-49, Sept. 1939. Myerson, A. — The relation of the autonomic nervous system to pharmacology. Jour. Conn. State Med. Society 3: 1921, January 1939. Myerson, A. — Theory and principles of the "total push" method in the treatment of chronic schizophrenia. Am. Jour. Psychiat. 95: 1197-1204, March 1939. Myerson, A. —Sources of mental disease: their amelioration and prevention. Sum- mary and critique. Am. Ass'n Adv. of Science, No. 9, pp. 120-136, 1939. Myerson, A. — The reciprocal pharmacologic effects of amphetamine (benzedrine) sulfate and the barbiturates. New England Jour. Med. 221: 561-563, Oct. 12, 1939. P.D. 117 53 Myerson, A. — Summary of the report of the American Neurological Association Committee for the Investigation of Sterilization. Am. Jour. Med. Jurisprud. 1: 253-257, December 1938. Myerson, A. and Neustadt, R. — Influence of ultraviolet irradiation upon excretion of hormones in the male. Endocrinology 25: 7-12, July 1939. Neustadt, R. — Photo-colorimetric method for the determination of androsterones in urine. Endocrinology 23: 711-717, December 1938. Osgood, R., and Robinson, L. J. — Brilliant Vital Red as an Anti-Convulsant in the Treatment of Epilepsy. Arch. Neurol, and Psychiat. 40: 1178-1204, Dec. 1938. Randall, Lowell O. — • The effects of insulin on serum lipids and choline esterase in schizophrenia. (Preliminary Report) Jour. Biol. Chem. 128: LXXXII, June 1939. Randall, L. O. and Cohen, L. H. — Serum lipids in schizophrenia. Psychiat. Quart. 13: 441, July 1939 Randall, L. O. and Jellinek, E. M. — Physiological studies in insulin treatment of acute schizophrenia. IV. The choline esterase activity of the blood serum. Endo- crinology 25: 278, Aug. 1939. Randall, L. O. and Jellinek, E. M. — Physiological studies in insulin treatment of acute schizophrenia. III. The serum lipids. Endocrinology 25: 105, July 1939. Raymond, C. Stanley — A State Program for the Supervision and Training of the Feebleminded. Am. Ass'n Adv. of Science, Dec. 30, 1938. Robinson, L. J. — Syncope, Convulsions and the Unconscious State. Relation to the Hyperactive Carotid Sinus Reflex. Arch. Neurol, and Psychiat. 41: 290-297, Feb. 1939. Robinson, L. J. — Venous Blood Pressure Measurements During Syncope Caused by a Hyperirritable Carotid Sinus Reflex. Am. Jour. Med. Sci. 197: 100-102, Jan. 1939. Robinson, L. J. — Radiologic Gastrointestinal Studies in Epilepsy. Am. Jour. Psychiat. 95: 1095-1102, March 1939. Robinson, L. J. — Induction of Seizures by Closing of the Eyes, or by Qcular Pressure in a Patient with Epilepsy. Jour. Nerv. and Ment. Dis. 90: 333-336, Sept. 1939. Roheim, Geza — Racial differences in the neurosis and psychosis. Psychiatry. 2: 375, Aug. 1939. Rosenzweig, Saul — The significance of frustration as a problem of research. Charac- ter and Personality 7: 120, Dec. 1938. Rosenzweig, Saul — General outline of frustration. Character and Personality 7: 151, Dec. 1938. Rubin, M. A. — Electroencephalographic localization of atrophy in the cerebral cortex of man. Proc. Soc. Exp. Biol, and Med. 40: 153, Feb. 1939. Rubin, M. A. — The electroencephalogram of schizophrenic patients during administra- tion of Vitamin Bi. Proc. Soc. Exp. Biol, and Med. 42: 440, Nov. 1939. Rubin, M. A. and Wall, Conrad — Brain potential changes in man induced by metra- zol. Jour. Neur. and Psychiat. 2: 107, Apr. 1939. Rubin, M. A. and Cohen, L. H. — A variability study of the normal and schizophrenic occipital alpha rhythm. II. The electroencephalogram and imagery-type. Jour. Ment. Sci. 85: 779, July 1939. Schube, P. G. and Cowell, J. G. — Art of Psychotic Persons — A Restraint-Activity Index and its Relation to Diagnosis. Arch. Neurol, and Psychiat. 41: 711-720, 1939. Schube, P. G. and Prescott, Blake — The Effect of Copper and Iron upon the Second- ary Anemia of Therapeutic Malaria in General Paresis. Jour. Lab. and Clin. Med. 24: No. 4. p. 346-352, 1939. Schube, P. G., Raskin, Naomi and Campbell, Eleanor — Cholesterolysis in the Blood Plasma of Individuals with Mental Disorders. Jour. Lab. and Clin. Med. 25: No. 2, p. 142-148, 1939. Schube, P. G., Myerson, A. and Lambert, R. — Human Autonomic Pharmacology. XVII. The effect of acetyl-beta-methylcholine chloride on the gall bladder. Am. Jour. Digest. Dis. 5: 687-690, Dec. 1938. Schube, P. G., Myerson, A. and Lambert, R. — The effect of benzedrine, benzedrine and atrophine, and atrophine on the gall bladder. Am. Jour. Med. Sci. 197: 57-61, Jan. 1939. Schwager, Ethel Jeane — The art of understanding. Pac. Coast Jour. Nurs. 35: 474, Aug. 1939. 54 P.D. 117 Semrad, E. V. (joint author) — Observations in The Use of Fluid and Lumbar Puncture in the Treatment of Delirium Tremens. Annals of Int. Med. 12: p. 2006, June 1939. Shakow, David — Function of the psychologist in the state hospital. Jour. Con. Psych. 8: 20, Jan. 1939. Shakow, David and Pazeian, Bessie — Adult norms for the K-S Clinical Formboards, Jour. App. Psych. 23: 495, Aug. 1939. Sullivan, Daniel J. and Flanagan, Norris B. — Practical Psychotherapy with Adolescents — A Brief Survey of the Field for the General Practitioner. New England Jour. Med. 221: 414-419. Wall, Conrad — Significance of behavior during hypoglycemia. Bull. Mass. Dept. of Mental Health, Symposium on Therapy, p. 21, Sept. 1939. Watson, James — Psychotherapy for the poor. A state-city cooperative enterprise in the field of mental hygiene. Ment. Hyg. 23: 558, Oct. 1939. Wegrocki, H. J. — A critique of cultural and statistical concepts of abnormality. Jour. Abnorm. and Soc. Psych. 34: 166, April 1939. Wells, F. L. — ■ The Plan of Search at Various Levels of Abstraction. The Jour. General Psychology, 21: 163-185, 1939. Yakovlev, Paul I. — Morphologic Abnormalities of the Brain in a case of abortive Tuberous Sclerosis. Arch, of Neurol, and Psychiat. Ifl: 119, Jan. 1939. Respectfully submitted, Myrtelle M. Canavan, M.D., Pathologist. REPORT OF THE DIVISION OF MENTAL HYGIENE To the Commissioner of Mental Health: I take much pleasure in submitting the seventeenth annual report of the Division of Mental Hygiene, covering the period from December 1, 1938 to November 30, 1939. In this report, various subjects are discussed in the following order: I. General Functions and Development of the Division of Mental Hygiene. II. The Child Guidance Clinics. (a) Procedure at the Clinics. (b) The clinics under the auspices of the Division — (1) Report of Social Service. (2) Report of Psychological Service. (c) The clinics under the direction of the Division — (1) Report of Springfield Child Guidance Clinic. (2) Report of Worcester Child Guidance Clinic. (d) The clinics under the auspices of the State Hospitals and supervised by the Division. III. The Educational Program. (1) Staff conferences. (2) Conferences with school personnel, social workers and other agencies. (3) Dissemination of mental hygiene information by lectures to the public. (4) Instruction of students in the Division — (a) Speech students. (b) Remedial tutors. (c) Occupational therapy students. (d) Social service students. (e) Medical students. IV. Research Activities. A. Divisional. B. Institutional. I. General Functions and Development of the Division of Mental Hygiene There has been little change in the functions of the Division during the past year, the work being carried on in the clinical, educational and research fields as in previous years. In 1922, the Division was organized for the purpose of carrying on a program dealing with all matters pertaining to the causes and prevention of delinquency, convulsive P.D. 117 55 disorders and mental illness. At the time of its organization, no trained personnel was available for the undertaking of this program and it was, therefore, necessary to train the personnel for its own needs, and later the Division trained personnel for other states where similar programs were being instituted. Procedures and standardized techniques were established only after careful study, analysis and practice. The initial work of the Division was directed in conducting Habit Clinics. In 1922, three such clinics were opened in East Boston, North End (Boston), and at the Roxbury Neighborhood House. The following year several additional clinics were established in Boston and nearby towns. Since that time, clinics have been established in communities where the need for such service seemed essential. Some of the original clinics have been absorbed as extramural hospital activities, while others were closed after functioning for several years. During the past year, twelve clinics have been operating under the auspices of the Division. Since the organization of the Division, it has been recognized that education in the mental hygiene field has been one of increasing interest and importance. For the past few years, much thought has been given to this matter as one of the outstanding phases of the Division's endeavors. Plans have included the expansion of this service, so as to reach a maximum number of persons. Growth of this phase of the work has been rapid and encouraging. Detailed information relative to the various educational activities will be found in a subsequent section of this report. Several advisory committees were established by the Commissioner at the beginning of the year, as part of the new organization program of the Department of Mental Health. It was through the efforts of the Committees on Research and Mental Hygiene that much ground work was laid for expanding the work of education and research in the Division. Concentrated effort was made to stimulate the various staff physicians in our mental institutions to give more thought and time to the vitally important subject of research. At the time of the organization of the Division, money was appropriated by the legis- lature for the purpose of investigating the causes of delinquency, dependency, epilepsy and mental illness. The original research program included a series of studies of con- vulsive disorders by the staff of the Division. Biochemical studies and researches in the field of neurosyphilis were started at the Boston State Hospital and the Boston Psychopathic Hospital respectively, under the able direction of two well-trained psychi- atrists. Previous to this time, the research activities had been confined to the Waverley Researches, which have been carried on since 1919. Interest increased in the field of preventive medicine, and other research centers were established. In 1930, an appropriation was made for the study of Dementia Praecox at the Worcester State Hospital, and, in 1937, additional money was appropriated to be used for research in epilepsy at the Monson State Hospital. All of these research centers have continued to devote much time and energy to the study of their specific problems. The survey of all institutions relative to extramural activities and the training of students, which was begun last year, was completed by the Director prior to June 1. The survey revealed that geographically the State as a whole has been adequately provided with clinics. The service rendered showed opportunity for improvement, certain clinics having given only diagnostic rather than therapeutic service. It was also revealed that there were only a limited number of clinics available for adults, who sought early treatment for mild mental disorders. One of the recommendations of the survey was the expansion of this type of clinic, with the thought in mind that if patients were given an opportunity to receive adequate treatment in the out-patient clinics, hospitali- zation in many cases might be unnecessary. The data obtained regarding extramural activities were compiled for publication in a booklet entitled "Directory of Clinics under the direction of the Division of Mental Hygiene." This publication has been sent to many of the social agencies, hospital super- intendents, physicians and superintendents of schools throughout the State. The information relative to student training will be assimilated by a special advisory committee which will be appointed by the Commissioner at a future date. The following changes in personnel occurred during the year : Dec. 5, 1938 — Miss Edith Mason transferred from the Danvers State Hospital to fill the vacancy in the social service staff as psychiatric social worker. 56 P.D. 117 Jan. 7, 1939. — Doctor Margaret D. Welch resigned her position as senior psychiatrist. Jan. 9, 1939. — Doctor Julia Deming was appointed to the position of senior psychia- trist. July 1, 1939. — Doctor Hans B. Molholm resigned to accept a position at the Wor- cester State Hospital. Sept. 1, 1939. — Doctor Charles Brenner was appointed as senior psychiatrist to fill the vacancy in the psychiatric staff. The appointment became permanent on November 20. Sept. 1, 1939. — Mrs. Ada Allport resigned her position as psychologist. Sept. 21, 1939. — Mrs. Edith Carlson was appointed to a full-time position as psy- chologist, her position formerly being on a part-time basis. Sept. 25, 1939. — Miss Sybil Stone was granted a leave of absence from her position as psychologist for a period of six months. This vacancy has been filled on a temporary basis. Nov. 20, 1939. — Doctor Ella P. Cahill's appointment as senior psychiatrist, full time, became permanent. II. The Child Guidance Clinics The aim of the Child Guidance Clinics is to prevent difficulties which arise from some of the simple traits of childhood. Early correction of the simple problems may mean the prevention of delinquency, dependency, and mental disorder in later life. The policy of the clinics has been to give intensive study and treatment to children presenting per- sonality, conduct and scholastic problems. Every case referred has been accepted for some type of service. On January 1, the age range for admission to the clinics was changed, so that children up through the age of fourteen years could be accepted for study and treatment. At this time, the name Habit Clinic was changed to Child Guid- ance Clinic. (a) The procedure at the Child Guidance Clinics is briefly described for the benefit of interested persons. The clinic offers assistance with the problems of child training and personal development to persons interested in the welfare of children. The first important procedure of the clinic begins with a careful physical examination, except where recent and adequate reports of examinations are available. Physical defects or disease must be carefully considered before proceeding with treatment of the child. In some cases, physical defects are found to be the primary causative factor in the par- ticular problem for which the case was referred to the clinic. The next step in the study is made by the psychiatric social worker, who seeks to gain insight into the child's background and environment in all of its phases; namely, home, school and play aspects. This information is obtained from the parents, physicians, teachers and other persons interested in the child. A complete report of the family situation, together with developmental, personal and scholastic histories of the child are included in the social service study. The psychologist then proceeds to study the child by evaluating his intellectual capacity, his achievement scholastically, and his special aptitudes and disabilities. In recommended cases, special educational tests are given for the purpose of helping to plan the child's educational program and school placement. Observation of the child's conduct and reactions during the psychological examination offers an excellent oppor- tunity for a better understanding of the child's personality. The final step in the procedure is made by the psychiatrist, who establishes a contact with the child and his parents. This study includes observations of the child's behavior and reactions, his personality and inner mental life, together with other factors having a bearing on the problem. After all the facts have been coordinated and summarized, the case is reviewed at a conference, where recommendations for treatment to be followed are outlined by the psychiatrist. An interview with the parents or other persons interested in the child is then held, and advice given as to the child's needs for healthy mental and physical development. In many clinics, special therapeutic services have been provided for speech and reading difficulties. These services have been rendered by senior and graduate students of Emerson College and Boston University, under the direction of well-trained supervisors. During the past two years, the services of student occupational therapists have been P.D. 117 57 available at the Brockton and Quincy Child Guidance Clinics. These specialized services have proved valuable in many cases in aiding children to overcome handicaps which interfere with satisfactory adjustment. (b) The Clinics maintained and sponsored by the Division have continued to function on a high level, serving the same communities as last year with one exception. The clinic at Reading was closed on September 1, in view of the small number of cases being referred for treatment. An additional weekly session of the Brockton Clinic was insti- tuted on October 23, in order to more adequately serve the needs of the City of Brockton and surrounding towns. It was through the efforts of the Superintendent of Schools of Brockton that subsidy was obtained to help maintain the additional clinic session. At the conclusion of the year, the Division was maintaining clinics in Boston at the Boston Dispensary, the New England Hospital for Women and Children, and the West End Health Unit, as well as at the Brockton School Department, the Lawrence General Hospital, the Lowell General Hospital, the North Reading Sanitorium, the Norwood Hospital and the Woodward Institute in Quincy. The Springfield Child Guidance Clinic and the Worcester Child Guidance Clinic have continued to operate as incorporated organizations, being subsidized by their respective Child Guidance Clinic Association. (1) Report op Social Service Social Service of the Division of Mental Hygiene has carried out during the year various types of social therapy in keeping with high therapeutic standards in the special- ized field of child guidance. Every case referred to the clinics has received some social service guidance. The staff has considered each case from many angles to determine whether or not a child would require or would be able to benefit from a full type of ser- vice, or whether less intensive treatment would meet his needs. The work has been divided into Full and Special Service, so as to better care for the large number of cases known to the clinics during the year. Full Service indicates that intensive treatment has been prescribed and the social worker has obtained a detailed history from the child's parents in the home, the teacher in the school, and other persons interested in the particular case. After the child has been examined at the clinic, it has been the responsibility of the social worker to assist in carrying out the therapeutic recommendations made by the psychiatrist. This might include carrying out certain treatment with the parents and the child in the home, as well as contacting physicians, clergymen, recreational directors and educators for the purpose of providing the child with the type of treatment or program to fit his individual needs. Cases have been classified as Special Service for various reasons and have required only partial histories in most instances. Special Service cases include — 1 . Children brought to the clinic for diagnosis and consultation only. 2. Children, who because of mental retardation or other factors, have been unable to benefit from clinic treatment. 3. Children referred to another agency qualified to meet their needs; such as, the Division of Mental Deficiency, a general or specialized hospital, a school, or a social organization. im 4. Children who can be treated at clinic without a social study; for example, infants for simple habit training, or children with certain types of speech defect. 5. Cases in which clinic contact has to be brief because of the distance from the home to the clinic, illness or because the family do not wish further service. 58 P.D. 117 4652 4517 3565 4185 3759 3492 3317 2857 2523 2412 2264 (671 1474 1570 1202 619 189 1923 1924 1925 1926 1927 1928 1929 1930 193) 1932 1933 1934 1935 1936 1937 1938 1939 Graph 1. - Number of Visits of Children to Child Guidance Clinics 1923 - 1939 Graph I indicates the total number of visits made by children to the Child Guidance Climes from the time of their organization in 1923 through the year 1939. A summary of the work accomplished in the various clinics, together with an analysis, is represented in the tables which follow : — Table No. 1. Child Guidance Clinics — Types of Service Rendered, December 1, 1938 — November 30, 1939 Total Full Service Special Service Cooper- Cooper- Unas- Clinic Case Load Total Clinic ative Total Clinic ative signed Boston Dispensary . 159 99 99 57 57 3 Brockton .... 135 83 83 - 52 52 - - Lawrence .... 89 60 60 - 29 27 2 - Lowell .... 77 35 34 1 42 40 2 - New England Hospital 129 94 92 2 31 26 5 4 North Reading . 27 4 4 - 23 6 17 - Norwood .... 108 82 82 - 26 26 — - Quincy .... 151 124 124 - 26 26 - 1 Reading .... 53 43 43 - 10 10 — — West End .... 149 120 118 2 29 24 5 - Total .... 1,077 744 739 5 325 294 31 8 Table No. 1 shows that of the total case load, 1077, 744 cases were given full service. Of this number, 5 were carried cooperatively; that is, another social agency took respon- sibility for the social treatment, and the clinic social worker gave consultative service and, in most instances, obtained the history. 31 of the 325 Special Service cases fall into this cooperative group. There were 8 cases in which decision had not yet been reached as to the type of service needed. These will be found in the last column as unassigned. P.D. 117 59 Table No. 2. Child Guidance Clinics — Proportion of Different Types of Service Rendered December 1, 1988 — November 30, 1939 Total Full Per Special Per Unassigned Per Load Service Cent Service Cent Cent Boston Dispensary 159 99 62% 57 36% 3 2% Brockton .... 135 83 61% 52 39% — — Lawrence .... 89 60 67% 29 33% - _ Lowell 77 35 45% 42 55% — - New England Hospital 129 94 73% 31 24% 4 3% North Reading 27 4 15% 23 85% - — Norwood .... 108 82 76% 26 24% — _ Quincy 151 124 82% 26 17% 1 1% Reading .... 53 43 81% 10 19% — — West End .... 149 120 80% 29 20% — ~ Total .... 1,077 744 69% 325 30% 8 1 Table No. 2 shows both by numbers and per cent the proportion of the different types of service rendered. 69% received Full Service, 30% Special Service, and 1% were unassigned. Table No. 3. Child Guidance Clinics — Cases Contacted During the Year, December 1, 1938 — November 30, 1939 >> a 03 C O a a O m a o a c a a "3 ■3*3 rS'2- to c '•B -a 0 o >> -3 T3 a m "s 0 53 is o 0 '3 V o Total Number of Cases Continued 309 707 25 26 45 11 36 12 32 48 21 53 Total Number of New Cases 123 108 37 64 85 13 62 97 31 87 Total Number of Old Cases Reopened from Previous Year .... 11 1 7 2 8 2 14 6 1 9 61 Total Number of Cases Served During 159 135 89 77 129 27 108 151 53 149 1,077 Total Number of Cases Closed During 110 63 51 55 85 25 68 101 53 103 714 Total Number of Cases Continued to 363 49 72 38 22 44 2 40 50 46 *Clinic closed 9-30-39. Table No. 3 indicates that of the 1,077 cases contacted during the year, 309 had been continued from the previous year, 707 were new cases, and 61 reopened from the previous year. Of the 1,077 cases, 714 were closed during the year, and 363 will be carried forward to next year. Table No. 4. Child Guidance Clinics — December 1, 1938 to November 30, 1939 Children New Cases Old Cases Visits to Clinic Case Attending Attending Attending Clinic by Clinic Load Clinic Clinic Clinic Children Sessions Boston Dispensary .... 159 147 123 24 438 91 135 133 108 25 835 51 89 84 37 47 488 45 77 76 64 12 272 45 New England Hospital . 129 116 85 31 362 48 North Reading .... 27 17 13 4 24 8 108 102 62 40 569 47 151 132 97 . 35 628 46 53 43 31 12 170 31 149 137 87 50 731 45 Total 1,077 987 707 280 4,517 457 *Closed 9/39. 60 P.D. 117 Table No. 4 shows that 1,077 cases were served, of these 987 attended clinic. The difference between these two numbers, 90, represents old cases which were continued by social service, but did not attend clinic during the year. 707 represents the total intake of new cases, as no new cases were accepted until they had attended clinic. In addition, there were 280 continued or reopened cases which attended clinic sessions. The 9S7 children who attended made 4,517 visits to clinic, or an average of 5 visits per child. This is not representative, however, as some children attended clinic only once, and others as high as 38 times. The number of clinic sessions held was 457. This is an increase over previous years, largely due to the fact that the Brockton Clinic increased its clinic sessions during the last two months of the year. No clinic sessions were held in Reading after July. The case load was carried over from the Reading Clinic to September in order to determine whether cases should be referred to other clinics. Table No. 5. Child Guidance Clinics — Monthly Statistics, December 1, 1938 to November SO, 1939 Total Number Total Total Number Total Number Total Total of Children Number of Old Cases of Visits Number Case Attending of New Attending to Clinic by of Clinic Load Clinic Cases Clinic Children Sessions December 381 235 67 168 372 45 January 424 236 72 164 420 45 February 416 244 61 183 360 37 March . 452 290 78 212 512 47 April 461 262 56 206 418 38 May 480 301 74 227 559 45 June . , 459 260 54 206 396 43 July 395 176 46 130 268 38 September 400 184 45 139 255 35 October 404 252 76 186 419 40 November '■ 431 281 78 203 538 44 Total 707 4,517 457 Table No. 5 shows the monthly statistics. To prevent duplication, the first, second and fourth columns are not totaled, as the same children often attend clinic over a period of months. It is indicated that the largest number of new cases and of visits to the clinics occurred in the Spring and the Fall. The highest number of new cases, 78, attended in both March and November, while the largest number of visits, 559, were made by children in May, the second highest, 538, occurring in November. The highest number of clinic sessions, 47, took place in March. Table No. 6. Child' Guidance Clinics Number and Percentage December — Sex of the Children Served by the Clinics, 1, 1938 — November 30, 1939 Clinic Male Female Total 88 71 159 95 40 135 66 23 89 47 30 77 70 59 129 13 14 27 78 30 108 98 53 151 33 20 53 104 45 149 692 385 1,077 64% 36% 100% Table No. 6 indicates that of the total number of children, 1,077, served during the year, 692 were boys and 385 were girls. The percentage is 64% male and 36% female. This proportion has been much the same from year to year. It is noteworthy, however, P.D. 117 61 that in the clinics where the majority of cases have been referred from general medical clinics, including the Boston Dispensary, New England Hospital and North Reading Sanatorium, there has been a more even distribution of boys and girls. In the clinics where the schools have been the chief source of referral; namely, Brockton, Lawrence, Lowell, Norwood, Quincy and Reading, the larger proportion served have been boys. No definite conclusion can be drawn from these figures, since the West End Clinic does not substantiate these facts. Table No. 7. Child Guidance Clinics — Preschool and School Children — December 1, 1938 to November 30, 1939 Clinic Preschool School Total 53 106 159 18 117 135 4 85 89 16 61 77 48 81 129 3 24 27 26 82 108 39 112 151 11 42 53 45 104 149 263 814 1,077 24% 76% 100% Table No. 7 shows that of the total, 1,077, 263 cases or 24% were of preschool age, and 814 cases or 76% were of school age. Table No. 8. Child Guidance Clinics — Sources of Neiv Cases — December 1, 1938 to November 30, 1939 Source of Referral Per Cent Schools .... Health Agencies . Friends and Relatives Physicians Family Agencies . Children's Agencies Clinic Staff . Community Education Nursery Schools . Settlements and Churches 36.63% 33.52% 16.13% 5.80% 2.83% 2.12% 1.42% 1.13% .28% .14% Total 100% Table No. 8 gives the sources from which new cases were referred during the year. The number of new cases totaled 707. The greatest number of cases 259 or 36.63% were referred by schools; the second highest number, 237 or 33.52% were referred by health agencies. Following these in order, the highest number of referrals came from friends and relatives, physicians, family agencies, children's agencies, clinic staff, community education, nursery schools, and settlement and churches. This proportion of referrals varies little from last year, excepting that the previous year health agencies stood highest in referrals and schools were second. This change is probably due to the fact that the Brockton Clinic had only functioned during the last two months of the previous year, and has functioned throughout the present year. It is located in the school department building, and the large majority of the cases were referred directly by the schools. 62 P.D. 117 Table No. 9. Child Guidance Clinics — Sources of New Cases — December 1, 1938 to November 80, 1939 >> G 03 CD Tr a a — 73 Source or Referral c a O co so o o C 01 % J2 o3 o o & o >> o a '3 ■3 03 s 13 o pq PQ J !< !< X O1 « H Health Agencies 33 2 - 5 19 2 b 4 - 17 88 75 4 2 6 30 11 1 4 4 13 149 Schools — 7 - 1 - — 4 1 1 - 14 3 74 23 22 (3 - 27 44 19 27 245 Friends and Relatives - 4 1 6 10 - 9 9 4 b 48 2 5 4 9 12 - 11 13 1 9 66 Physicians 1 - 1 - 1 - - V 1 1 12 3 2 5 8 1 - 1 7 - 2 29 Nursery Schools 2 Children's Agencies 1 - - - - - 1 1 3 8 - - 1 1 3 - 1 - - 1 7 Family Agencies 3 1 — 1 7 1 3 - 1 - - 2 3 - 3 13 Community Education - — - 2 - - - - - - 2 - 1 - 3 - - - 1 - 1 6 Clinic Staff 1 4 - 1 1 - - 1 - 2 10 Settlements and Churches - - - - - - - 1 - - 1 Totals 123 108 37 64 85 13 62 97 31 87 707 Table No. 9 gives in detail not only the source of referral of new cases in each clinic, but also the number of cases of preschool and school age. The highest number of pre- school children, 88, were referred by health agencies, 48 by friends and relatives, 14 by schools, 12 by physicians, 8 by children's agencies, 7 by family agencies, 2 by nursery schools and 2 by community education, making a total of 181. Of the 526 children of school age referred, the highest number, 245, were referred by schools, 149 by health agencies, 66 by friends and relatives, 29 by physicians, 13 by family agencies, 10 by clinic staff, 7 by children's agencies, 6 by community education, and 1 by settlements or churches. 26% of the new cases were of preschool age, and 75% were of school age. The preponderance of school over preschool age children is partly due to the fact that the largest single source of referral of cases was the schools. It is interesting to note that all agencies, except nursery schools, referred more children of school than preschool age. It is probable that families and other persons do not consider the problems of early childhood serious enough to refer to a clinic, or hope the child will outgrow his difficulties. Another potent factor is that until children enter school they are less likely to come to the attention of those outside the home who are familiar with clinical resources. P.D. 117 63 Table No. 10. Child Guidance Clinics — Number of Interviews December 1, 1938 to November 30, 1939 Clinic Boston Dispensary . Brockton . Lawrence . Lowell New England Hospital Total . Number of Interviews 1,564 2,166 1,161 946 1,165 Clinic North Reading Norwood Quincy Reading West End Number of Interviews 50 1,746 2,517 577 2,026 13,918 Table No. 10 shows the total number of interviews, 13,918, given by the various members of the clinic staff, including the psychiatrists, psychologists, social workers, speech and occupational therapists and remedial tutors. This figure represents inter- views with children, parents, teachers, representatives of social agencies, and other interested persons. The Quincy Clinic had the highest number of interviews, 2,517; the Brockton Clinic was second with 2,166 interviews, and the West End Clinic was third with 2,026 inter- views. These three clinics, in addition to having the services of psychiatrists, psycholo- gists and social workers as provided in all of our child guidance Clinics, have had other types of service to offer the child. The Brockton Clinic has had speech therapy, occupa- tional therapy and remedial tutoring. The Quincy Clinic has had speech and occupational therapy, and the West End Clinic has had speech therapy and remedial tutoring. The Norwood, New England Hospital and Lawrence Clinics have had speech therapy. The number of interviews at the Boston Dispensary Clinic was high, due in part to the many interviews between the members of the hospital and clinic staffs. Speech therapy was started at the Lowell Clinic in October. The North Reading Clinic has been conducted on a consultation basis. There were no sessions of the Reading Clinic after July. There has been only one change in the social service personnel during the past year. Miss Edith Mason, psychiatric social worker at the Danvers State Hospital, transferred to the Division on December 5, 1938 to fill the vacancy in our Social Service Department. The social work has been carried on with a staff of five clinic social workers and one research social worker. In October, there was a change in the distribution of the work among the social service personnel. It was arranged to have one social worker give all her time to the Brockton Clinic, in view of the additional weekly session of the clinic. It had been the custom up to this time to have each social worker responsible for the social case work, clinic management and community contacts in two clinic centers. There have been eleven weekly clinic sessions during the year at which the social worker has served as clinic manager, in addition to the North Reading Clinic session which has been held on a consultation basis, and when request has been received for this service. The social service staff has taken an active part in the educational program of the Division of Mental Hygiene. It has cooperated in giving talks to social agencies, women's and mothers' clubs, and other interested organizations. Practice training and guidance of students from the Boston University School of Religious and Social Work, and from the Simmons College School of Social Work have continued in the Social Service Department as part of the student training program of the Division. The greatest educational work of the social service staff is carried on during the natural performance of their various duties. Education is effected through contacts with clients, educators, representatives of social agencies, of churches and hospitals, as well as with physicians, nurses, and non-professional people. While it is with gratification that we look upon the work accomplished by Social Service during the past year, it is with the realization that it has only been possible through the cooperation and support of many interested persons, including members of the Department and the various personnel of the Division. 64 P.D. 117 (2) Report of Psychological Service A review of the program of the Psychological Department for the past year is herewith presented. The work of psychological service was carried out during the greater part of the year by a staff of five part-time psychologists. On September 1, Mrs. Ada L. Allport resigned her position of psychologist. Miss Sybil A. Stone was granted a leave of absence for a six months' period starting September 25, and her position has been filled on a temporary basis by a substitute psychologist. One of the psychologists, who had been employed on a part-time basis, was appointed to a full-time position. The psychological staff since September has consisted of four psychologists, one on a full-time basis, and three on a part-time basis. The organization of the psychological service on a part-time basis has had advantages. It has increased the number of workers available, so that it has been possible for clinics to be held simultaneously or in quick succession in widely separated communities, and it has enabled the psychologists to pursue other activities which would broaden their usefulness to the clinics. It was, however, deemed advisable to employ one psychologist on a full-time basis, in order to integrate the psychological service more efficiently with the rest of the clinic service, both from the administrative and the therapeutic point of view. The full-time psychologist has been in charge of the psychological equipment, has substituted in the clinics for an absent member of the psychological staff, and has been available for con- ferences with the psychiatrist and social workers. She has arranged psychological staff conferences, and has been responsible for the psychological statistics. The function of the psychological service in the clinics is to appraise the child's intel- lectual endowment, school achievement, and personality traits, and to discover his particular abilities and disabilities in order to enable him to utilize his capacities to optimal advantage in relation to his social, educational, and vocational needs. The actual carrying out of this program varies in the different clinics, due to variations in the types of problems presented. In some of the clinics, which are held in hospitals, the psychologist may be asked to interview a young patient on the ward, studying the child in relation to the total clinical and social picture as presented in the hospital records. In the clinics which have a preponderance of school problems, part of the psychological service may include the supervision of reading and speech therapy, consultation with the schools' educational adviser and with teachers, planning of the child's academic program, and participation in school conferences. The psychologists have participated in the educational program of the Division, interpreting their part of the service to students in training, to schools, and to other interested agencies. They have taken part in the weekly staff conferences and, at inter- vals throughout the year, have presented research and psychological material of general interest. During the fiscal year, 841 complete psychological examinations were made. This figure does not represent the actual amount of psychological service rendered, as it does not include the number of separate tests given, nor the number of interviews between the psychologist and parents, teachers, and staff members. The tests most frequently used in the clinics are : The Stanford 1916 Revision of the Binet-Simon Scale. It is employed for children of school age wherever it is applicable. The Gesell Developmental Schedules. These schedules are used in making the psycho- logical appraisal of infants. The Merrill-Palmer Scale. This is a useful scale in studying the capacity of preschool children. . One of these three examinations is given routinely to the children at clinic wherever it is expedient. In some cases, the routine examination suffices. Supplementary tests may be given when the results of the examination do not seem entirely representative, or where a more intensive study is desired. The following are the supplementary tests most frequently used : Language Tests: Otis Self-Administering Tests of Mental Ability; Pintner-Toops Revised Direction Test; Kent Emergency Test. Achievement Tests, Tests of General Information, and Diagnostic School Tests: Detroit Word Recognition Tests; Durrell-Sullivan Reading Capacity and Achievement Tests; P.D. 117 65 Gray's Oral Reading Test; Commonwealth of Massachusetts School Tests; Metropolitan Achievement Tests; Monroe's Reading Aptitude Tests; Judge Baker Foundation Scaled Information Test; Stanford Achievement Tests. Performance Tests: Healy Pictorial Completion I and II; Porteus Mazes; Mare and Foal Picture Form Board; Cube Imitation Test; Manikin, Kent-Kohs Color Cubes; Lincoln Hollow Square; Healy Construction Tests A and B; Woodworth- Wells Sub- stitution Test; Goodenough Drawing Test. The psychologists, during the year, averaged over two studies per clinic session. This pressure has made the maintaining of high standards of service increasingly difficult. It is felt that further psychological service is essential, not only for the most efficient functioning of the clinics, but also for the purpose of enabling the psychologists to con- duct research studies along psychological lines on the material presented in their clinical work. The opportunity for developing such research is especially inviting in the Brock- ton Clinic, where the School Department has offered its full cooperation. Among the aims of the psychology staff for the future is the development of research activities. The projects which the psychologists have carried on outside the Division have in- cluded research work, lecturing, teaching, preparing material for publication, and work in other child guidance clinics. The knowledge and experience gained in these various undertakings have been a real contribution to the high standards of psychological service maintained in the Division. (c) The Child Guidance Clinics under the direction of the Division The Springfield and Worcester Child Guidance Clinics are distinctive in themselves, as each operates on a full-time schedule and is subsidized by its respective community. Each clinic is incorporated and is in charge of a full-time director, who is responsible to both the Child Guidance Clinic Association and the Division for the efficient manage- ment of the clinic. The following reports indicate the accomplishments of the Springfield and Worcester Child Guidance Clinics during the past year: (1) Report of the Springfield Child Guidance Clinic The Springfield Child Guidance Clinic completed its first year in November, 1939, and reviewing its activities presents a gratifying and encouraging picture of accomplish- ment. While the case load has been high in proportion to the amount of staff, one appre- ciates that such a situation was inevitable in an area where they have been seeking a full-time clinic for several years, because of inadequate clinic resources. The cases had been accumulating over a long period and a sorting process and disposition of a portion of them was imperative. The inauguration of the clinic represented the fruition of sixteen years' effort on the part of the community to provide a full-time psychiatric service for children. The first stimulus toward the clinic occurred in 1922 when the Connecticut Valley Committee for Mental Hygiene (a branch of the Massachusetts Society) manifested a sincere interest in a psychiatric program and sponsored two lecture series in which prominent psychia- trists participated. This aroused much enthusiasm in several groups who proceeded to investigate the possibilities of securing some psychiatric clinical service from the State. Their request was granted, and a weekly clinical unit was sent out by the Massachusetts Division of Mental Hygiene in 1925. This plan operated for a year when the Division found it necessary to discontinue the service. The local sponsors — resolute in their desire for these specialized services and undaunted by the withdrawal of the Division's unit — ■ succeeded in making arrangements with Monson State Hospital for a medical psychiatric contribution and with Mt. Holyoke for the assistance of a psychologist. A psychiatric social worker was secured and underwritten by the Springfield Women's Club for a period of three years, while the Community Chest met incidental expenses and the Springfield Hospital provided quarters. This arrangement continued from 1926 to 1929 when the Community Chest and Springfield Hospital assumed the expense of the clinic with the exception of the medical service, which Monson State Hospital continued to contribute by sending in a psychiatrist for two half days a week. Both the clinic and the community concurred in the conviction that a part-time clime was inadequate to meet the demands and continued in their quest for a full service. The mental hygiene survey conducted by the Massachusetts Society for Mental Hygiene vividly portrayed 66 P.D. 117 the community's particular needs, and this gave added impetus to securing the full-time services needed. The combined efforts of the community, the Massachusetts Society for Mental Hygiene, and the State Department of Mental Health resulted in the opening of a full-time clinic at the Wesson Memorial Hospital in November, 1938. The clinic program has been of a far wider scope than might be indicated in a numerical picture, and can perhaps be more clearly comprehended from the fact that 102 different organizations have been contacted either through the medium of individual cases, lectures and conferences, together with the fact that the clinic has served not only the greater Springfield area, but also those part of Western Massachusetts not accessible to Worcester and Pittsfield clinical resources. The clinic has demonstrated the usefulness and value of a psychiatric service to children and parents, as well as the benefits of a cooperative service with other agencies — a service which these agencies are unable to provide and one which enhances their own effectiveness. Agencies recognizing the com- plexities of psychiatric situations and their inability to deal with them in the absence of specially trained staff, readily refer children in order that they may deliver a complete and well rounded-out treatment program to those whom they are serving. The tabula- tion of lectures and conferences represents the clinic's endeavor to have the mental hygiene point of view permeate the manifold activities in this area as much as possible. Obviously a small clinic such as ours has been able only to meet a small proportion of the demands put upon it by those desiring the service, and additional staff is impera- tive if we are to more efficiently and adequately serve this section of the State. A clinic which defines its duties as consisting, not only of a distinctive service in the study and treatment of psychiatric difficulties of children, but also that of a wider approach to the community as a whole is inevitably faced with the question as to which is the more effective and important task, and how best to divide its energies and resources. Having a limited staff has necessitated a painstaking evaluation and distribution of services, earnestly attempting to devote a proportionate amount to the study and treat- ment of the individual child, and at the same time avoid any omission in other directions of the program. This has not always been easy to accomplish because of the numerous demands for educational service, but the staff's willingness to give unsparingly of their time after hours has made it possible to effect a nice balance between the study and treatment aspects of the program and the educational activities. Research, while one appreciates its vital importance and value in a Child Guidance Clinic, could not be considered because of insufficient staff and the presence of the other phases of the program. Utilization of the play situation as a part of child guidance techniques has become valuable for both diagnostic and therapeutic purposes. It is considered as one of the more important mediums of expression by which a child reveals his experiences, conflicts and many times provides him with an excellent opportunity to work through his conflict. This is particularly true in the younger age group where the use of play has been more productive than direct procedure. The Springfield Women's Club, by financial contribution and the services of one of its committees, redecorated and furnished the children's play room. This project was supplemented by one of the older clinic patients who donated a large, fully equipped doll house. All of this has provided the clinic with the necessary equipment for this special- ized form of inquiry into the child's mental life. The psychological program, in addition to routine psychological appraisals (psycho- metric examinations), has consisted of considerable work with Rorshack and Thematic Apperception Techniques — the results of which have been most interesting and have served as valuable aids in the diagnostic and therapeutic procedures. There has been a particularly close working relationship between the schools and the clinic, furthered by the interest and active participation of the superintendent, assistant superintendent and other administrators in the various school departments. Throughout the year, conferences have been held with the school personnel to discuss either individual problems, general mental hygiene problems or clinic policies. One of the most convincing indicators of the schools' interest in the clinic and in psychiatric problems in general is seen in the number of referrals by the schools. The accompanying statistical picture shows that the problems referred to this clinic correlate closely with those seen in other child guidance clinics operating under the direction of the Division of Mental Hygiene, and likewise the philosophy of function P.D. 117 67 existing in these clinics one assumes to be fairly similar, with perhaps some minor differ- ences. Of real import in the philosophy of this clinic is the fact that it is concerned with problems whose origin is in the inner life of the child, rather than those which are the result of external factors and hence the responsibility of another agency. In the interest of economy, the staff have attempted to avoid accepting for treatment those cases where problems were explainable in terms of environmental situations susceptible to treatment by other agencies. Still another difference may be in our emphasis on a treatment service rather than on diagnostic — this is made more possible in a full-time permanent clinic than is sometimes practicable in a traveling clinic by reason of the time factor and con- sequent arrangement of appointments. The small number of defectives referred to the clinic certainly reflects understanding on the part of the community regarding clinical resources and also assures one of a minimum amount of duplication of effort in state clinics. It is clearly understood that Belchertown State School provides opportunities for cases in which there is a question of intellectual impairment. Inasmuch as we are attempting to do a distinctive „ob, it is of paramount importance that we not duplicate the service offered by another agency. During the year there have been some changes in the personnel which fortunately did not embarrass the service too seriously. Our first and temporary psychologist, Mrs. Mary Camp, resigned December 20, 1938, when it was possible to appoint one permanently from the Civil Service list. Doctor Elizabeth Hincks accepted the appointment on January 5, 1939, and remained until November 1, 1939, when she resigned to accept a position at the New England Home for Little Wanderers. The vacancy was filled by a temporary appointee, Miss Elizabeth Starkweather, pending the publication of the list of Civil Service permanent psy- chologists. Miss Marion Kennedy, speech pathologist resigned in September to enter private practice. Miss Eileen Fleming, a second year student from the Boston College School of Social Work, started her training in the clinic in September, 1939. Miss Florence Slutz from the American International College has been with the clinic on a volunteer part-time basis as record clerk and receptionist since September, 1939. Edward Soles, M.A., a teacher for many years with a keen interest in and under- standing of children's needs, organized a tutoring program in the clinic which has con- tinued with excellent results. By reason of his psychological background and his experi- ence in the reading field, he has played an important part in the treatment program of many children. Such a role has been unavoidable for him, inasmuch as most all of our reading problems have been accompanied by personality deviations of varying degrees — in these situations his personal relationship with the children has been of real value. Remedial work, particularly in reading has become an essential part of the clinic's pro- gram — chiefly because of the related emotional problems. Frequently reading dis- abilities are but symptoms of underlying emotional difficulties which make a purely pedagogical approach to the problem ineffectual and calls for the assistance of someone trained in dealing with emotional factors, a service which the schools are unequipped to give at the present time. The clinic has been most fortunate in having a Board of Directors whose interest and energy have been responsible for the success of the clinic. The Director, in behalf of the staff, wishes to express appreciation to the Department of Mental Health and the Board of Directors for their fine support and whole-hearted cooperation. The clinic also sin- cerely appreciates the generous consideration given by the Community Chest, Spring- field Council of Social Agencies, the Junior League and Springfield Women's Club. Teaching: Problems in Child Guidance (University Extension 15 lectures — 30 hours). Single Lectures Given by the Staff: Forest Park Junior High School. Springfield Council of Social Agencies. Children's Home. Junior League. Jewish Mother's Club. Probus Club. Council of Jewish Women. City Health Nurses. 68 P.D. 117 Day Nursery. Children's Aid Association — Board members and staff. League of Women's Voters. Federation of Women's Clubs. Hampden Parent-Teacher Association. Wesson Memorial Hospital Nurses. Wesson Memorial Graduate Association. Springfield Academy of Medicine. Northampton Mental Hygiene Association. Carew Street School Parent-Teacher Association. Red Cross. Girl Reserves. South Congregational Mothers' Club. Tatham Parent-Teacher Association. Elias Brookings Parent-Teacher Association. Table I. New Cases M. F. T. Preschool . 27 116 25 68 52 184 Total 143 93 236 Table II. Cases Active on December 1, 1939 M. F. T. School 8 27 5 21 13 48 Total 35 26 61 Table III. Full Service Cases . Special Service Cases Diagnostic Service Cases Type of Service Classification of New Cases 151 40 45 Total Table IV. Summary of Sources of Referral Health Agencies Social Agencies Interested Individuals Educational Agencies Police and Court Recreational Agencies 236 66 62 54 50 3 1 Total 236 Table V. Intervieics Interviews with Psychiatrist . Interviews with Pediatrician . Interviews with Psychologist Interviews with Social Worker History .... Treatment Agencies .... Total Number of Visits by Patients Number of Clinic Sessions 1,229 56 248 378 367 200 745 1,528 242 P.D. 117 69 Table VI. Personnel Report Regular Staff Full Time Part Time Psychiatrist 1 - Pediatrist - 1 Psychologist . - 1 Social Worker 1 - Clerical Worker 1 - Remedial Tutor - 1 Receptionist - 1 Staff in Training Social Worker - 1 (2) Report of the Worcester Child Guidance Clinic The Worcester Child Guidance Clinic has taken as a definition of its function, "The treatment of behavior problems in the emotional and social growth of children and adolescents." Developments of the past year have brought the clinic to a better realiz- ation of this function, and viewing these developments in retrospect affords evidence of this accomplishment. The year was opened under difficulties. Doctor Kirkpatrick had just resigned from the directorship and there was no psychiatrist attached to the staff until May, 1939, when Doctor Robert Kemble began as director. During this time, psychiatrists from the Worcester State Hospital gave their services to the clinic. In September, Doctor Phyllis E. Schaefer began her duties as assistant psychiatrist, and Miss Alice Fleming filled the position as psychometrist. Miss Ethel Burnell, one of our social workers, left at the end of June to become chief social worker of the Colorado Springs Child Guidance Clinic. The year was thus one of staff reorganization which had to be accomplished in the face of increased demands for clinic services. Fewer cases could be accepted for treatment, but the statistics show that cases were given more service. The total number of interviews per case was greater, and the empha- sis in these additional interviews was directed toward getting cases started on a treatment basis, as contrasted with the more diagnostic type of service. Cases have been ap- proached with the idea of helping them, rather than merely knowing or studying them, and the treatment process has been scrutinized with an eye to the dynamic factors influencing change and growth. Thus the movement or progress of a case has become the focus of attention. This has led an interest in the factors which bring a child to the clinic, and those which tend to continue bringing him there. These factors lie partly in the individual and his prob- lems, and partly in the clinic and the therapist, together they are important to the relationship through which treatment must operate. This relationship and its factors need not be vague or mysterious; they can be approached and investigated just as any other processes or happenings. It is obvious that for growth and change to be seen and helped, there must be continued interviews over a period of time. This will explain the aim of the clinic in approaching each case with the idea of its continuing, instead of merely studying and appraising it. In those cases that do continue, the clinic has been of greatest service. Therefore, the emphasis has been on getting them to continue rather than merely be studied and then left to their own devices. The difference this makes can best be seen in the form of the application interview. The application could be an elaborate and exhaustive collection of information about a case, with investigation of every factor that seems significant. On the other hand, it can be directed simply to the elements that decide whether the case will continue or not: does this mother want the help the clinic offers; can she be given an understanding of how treatment is carried ; or by regular appointments over a period of time, can she make the necessary arrangements? This is an important shift in emphasis, and in making it we have seen gratifying improvement in the continuity of treatment. This is but one example of how attention to the dynamics of treatment adds to the value of treatment and affords insight and perspective to the therapeutic process. Simi- larly, an awareness of the therapeutic situation and the relationship between patient and therapist is used to clarify and strengthen the relationships that the child must make in his everyday life. 70 P.D. 117 The clinic has fulfilled and extended its other responsibilities to the community. The number of talks to community groups was more than tripled in the past year. A pro- gram of service to the public schools of Webster has been continued, with constant examination into how that service can be made most effective. In the difficult problem of delinquency, new approaches are being tried. Here the probation officers of the Worcester courts have been most helpful with suggestions and cooperation. The uses of group therapy in the form of a play group are being studied from the material of the group completed in May, 1939. Another group is being formed to con- tinue investigating this form of treatment, which seems to have some interesting possi- bilities. Miss Burnell continued her program at the Girls' Club, placing her emphasis this year upon her work with the leaders, and discussion groups with the older girls in the club. She gave a series of lectures on the emotional development of the child, at the same time affording an opportunity for the discussion of problems of particular concern to the leaders. In the training of workers in this field, the clinic continues to afford a year's work to three student social workers, and a student psychologist. One psychiatrist is in training for the whole year, and in addition the resident psychiatrists of the Worcester State Hospital each receive three months of training at the clinic. The training program has been given more from and substance through the use of weekly seminars in each of the three phases of work : therapy, social work, and psychological testing. The critical evaluation of the clinic's work is being continued in the follow-up study, the goal being approximately three hundred follow-up visits on cases that were carried on a treatment basis. Though no predictions can be made concerning the form the statistics will take, the staff has already learned a great deal from the individual reports. This is an arduous and difficult task and it is expected to be completed during 1940. In all, the Worcester Child Guidance Clinic seems definitely accepted by the com- munity as a valuable resource. More cases come to us than we can handle at all times, and this is perhaps the best indication that our services are appreciated. The clinic is taking up its next responsibility, the critical evaluation and improvement of the quality of the services it gives. Annual Service Report — December 1, 1938 to November 30, 1939 I. Report of Case Load A. Carried Cases 1 . Cases carried over from last year 2. Intake a. New cases accepted . b. Old cases reopened (1) last closed before present year (2) last closed within present year 3. Total cases open at some time in this year 4. Cases taken from service . 5. Cases carried forward to next year . Closed Cases Followed Up (Not reopened) Applications Rejected Applications Withdrawn .... B. C. D. II. Type of Service Classification A. New Accepted Cases 6. Full service a. Clinic staff cases (9 reopened) b. Cooperative cases (7 reopened) c. Full service not a or b 7. Special and Diagnostic Service (advice) (9 reopened) 8. Total new cases accepted . Cases Taken From Service 9. Full service a. Clinic staff cases b. Cooperative cases 10. Special service (advice) Total 205 172 24 1 402 169 233 220 10 9 78 26 0 93 197 45 15 109 11. Total cases closed during this year 169 P.D. 117 71 III. Sources Referring New Accepted Cases Full Special Total 12. Agencies a. Social 19 14 . 33 b. Medical . 3 4 . 7 13. Schools a. Public 6 . 3 . 9 b. Other 0 . 7 . 7 14. Juvenile Court 7 . 49 56 15. Private physicians 3 . 2 5 16. Parents, relatives, self 65 14 . 79 17. Others (friends) . 1 0 . 1 18. Total new cases accepted . . . 104 . . 93 . . 197 IV. Summary of Work With or About Patients A. By Psychiatrists Total 1. Interviews with patients a. for examination 183 b. for treatment 591 2. Interviews about patients . . 33 3. Physical examinations by clinic staff members . . . . . 2 B. By Psychologists 1. Interviews with patients a. for examination 175 b. for re-examination . . . 17 c. for treatment 546 2. Interviews about patients . . 12 C. By Social Workers 1. Interviews in clinic 994 2. Interviews outside clinic . . . . . ... 300 3. Telephone calls 833 D. Referral Interviews 151 V. Service to Webster Schools A. 1. Cases carried over from last year ....... 31 2. New cases 9 3. Cases closed • 29 4. Number of cases receiving service 40 B. 1. Social workers' interviews with patients, parents, teachers and others 145 2. Psychiatrists' interviews with patients, parents, teachers and others . . . . . . . . . . . . . 33 3. Total number of interviews in Webster schools .... 178 VI. Number of Interviews Given by Staff Members 3,402 VII. Number of Educational Lectures given by Staff Members to Community Organizations ....... 75 VIII. Personnel Report (Average staff during year) A. Regular Staff Full Time 1. Psychiatrists 2 2. Psychologists . . . . •;'•'. 2 3. Social Workers 3 4. Clerical Workers . . .... . 2 B. Staff in Training 1. Social Workers . . . . . .3 2. Psychologist . 1 3. Psychiatrists ... '.",'. : . 5 different internes each for three month period. (d) The Child Guidance Clinics under the auspices of the State Hospitals of the Depart- ment of Mental Health were placed under the supervision of the Division on January 1. This new policy has brought about no change in the clinic administration, but the Divi- Part Time 1 (vol) 1 72 P.D. 117 sion has stimulated interest in maintaining the high level of therapeutic service which has long been in existence in Massachusetts. The clinics operated by the various insti- tutions have efficiently served the same communities as last year in Athol, Attleboro, Beverly, Boston (Psychopathic Hospital), Brockton, Fall River, Fitchburg, Gardner, Haverhill, Holyoke, Lawrence, Lynn, New Bedford, Newburyport, Northampton, Quincy, Salem, Waltham, and Warwick. A review of the work accomplished at these clinics would indicate that more thought is being given to therapeutic rather than diagnostic service. Table No. 1. Child Guidance Clinics — Under the Auspices of the State Hospitals December 1, 1939 to November 30, 1939 New Cases Visits Re -exami- NATIONS No. of Clinic Center Clinic Sessions M F T M F T M F T Athol 2 2 3 1 4 1 1 2 3 15 9 24 • 20 12 32 4 1 5 52 26 16 42 66 62 128 10 10 20 40 Boston Psychopathic Hospital 167 133 300 319 183 502 25 21 46 302 29 8 37 74 21 95 4 1 5 50 Fall River 19 20 39 24 30 54 4 3 7 52 65 44 109 76 48 124 11 4 15 64 28 8 36 38 8 46 10 — 10 38 46 22 68 307 186 493 25 11 36 34 47 25 72 461 222 683 1 — 1 49 9 7 16 34 16 50 7 3 10 17 42 25 67 181 90 271 34 3 37 41 16 10 26 24 20 44 5 5 10 52 14 6 20 45 25 70 10 5 15 19 31 23 54 71 59 130 - 1 1 40 34 23 57 62 35 97 2 2 4 39 45 25 70 510 214 724 4 2 6 36 14 7 21 77 36 113 14 7 21 36 8 4 12 8 4 12 - - - 3 Total 657 415 1,072 2,400 1,272 3,672 171 80 251 967 *Cases from Attleboro were seen at the Taunton State Hospital. III. The Educational Program (1) Staff conferences. The regular staff conferences have been held each week on Monday afternoons through- out the year. The purpose of these meetings has been for the formal presentation of challenging cases and other interesting subjects by the various staff members. This type of roundtable conference has proved very valuable, as it has afforded those present an opportunity of discussing, not only the case being considered, but also new phases of treatment which might be helpful in dealing with the many problems revealed in the total study. Several times during the year, guest speakers addressed the staff on various subjects related to the field of child guidance. (2) Conferences with personnel. Another type of conference, which has been a vital part of the educational program of the Division, has been held with school administrators, teachers, nurses and the personnel of referring agencies. At these conferences, problems of the individual child have been discussed with the thought in mind as to how each interested person could contribute to the solution of the problems. These conferences have taken place at weekly intervals in some communities, while in others they have been held at such times as the need seemed urgent. (3) The dissemination of mental hygiene information. The Division has co-operated with many clubs and organizations by providing speakers for their programs. The subjects of the talks have been confined to the functions of the Division, and the principles of mental hygiene which apply to mental and physical health. Much time has been devoted to this work by various staff members who have given unselfishly of their time outside of office hours. P.D. 117 73 Talks to Organizations Date 12/ 6/3S- 1/16/39- 1/17/39- 1/17/39- 1/24/39- 2/ 6/39- 2/ 7/39- 2/14/39- 2/17/39- 2/28/39- 2/28/39- 3/ 6/39- 3/ 8/39- 3/14/39- 3/14/39- 3/15/39- 3/20/39- 3/28/39- 4/ 2/39- 4/ 4/39- 4/20/39- 4/26/39- 5/ 2/39- 5/12/39- 5/12/39- 5/23/39- 6/14/39- 9/14/39- 10/ 9/39- 10/17/39- Speaker -Dr. Yerbury. -Miss Hillis. -Dr, Yerbury. -Miss Hoskins. -Dr. Yerbury. -Dr. Yerbury. -Dr. Yerbury. -Miss Hoskins. -Dr. Cahill -Dr. Yerbury. -Dr. Yerbury. -Dr. Yerbury. -Dr. Yerbury. -Dr. Yerbury. -Miss Hoskins. -Dr. Cahill. -Dr. Yerbury. -Dr. Cahill. -Dr. Yerbury. -Dr. Cahill. -Dr. Yerbury. -Dr. Yerbury. -Miss Hillis. -Dr. Yerbury. -Dr. Yerbury. -Dr. Yerbury. -Dr. Yerbury. -Dr. Yerbury. -Miss Hoskins. -Mrs. Newell. 10/24/39— Miss Hoskins. 10/27/39— Dr. Yerbury. 10/30/39— Dr. Cahill. 11/13/39— Mrs. Newell. 11/20/39— Miss Hoskins. Organization Gloucester Mother's Club. Wollaston Mother's Club. Dedham Nursing Assoc. East Boston Social Center. Women's Club of Lynn. Gloucester Y.M.C.A. New Bedford Professional and Business Women's Club. East Boston Social Center. Probationers of Norwood Prac- tical Nurses. Radio Station WCOP. Canton Mothers' Club. The Hadley School, Swampscott. Salem Mothers' Club. Radio Station WCOP. East Boston Social Center. Teachers of the Highland Street School, Reading. South Yarmouth Women's Club. Franklin School Parent-Teacher Assoc, Lexington. Young People's Forum, First Church, Everett. Parent-Teacher Assoc, Vose School, Milton. Mass. State Nurses' Assoc, Dis- trict No. 3. North Eastern District Mental Hygiene Advisory Committee. Social Agencies of Brockton. First Congregational Church, Winchester. Danvers State Hospital. South Eastern District Mental Hygiene Advisory Committee. Central District Mental Hygiene Advisory Committee. Nurses' Graduation Exercises, Danvers State Hospital. Unitarian Parish House, Jamaica Plain. Norwood Women's Community Committee. Mothers' Club, Church of the Holy Spirit, Mattapan. Bristol County Teachers' Assoc, Fall River. Mothers' Club, Canton. Universalist Women's Assoc, Quincy. Mothers' Club, Norfolk House, Roxbury. Subject The Understanding Heart. Mental Training ofthePreschool Child. Growing Usefulness of the Habit Clinic. Habit Training for Children — I. The Division of Mental Hygiene and the Use of the Habit Clinics. Mental Illness and Its Prevention. Mental Health and Its Relation to the Business Woman and Her Job. Habit Training for Children— II. Significance of Early Training and Im- portance of Prevention. The Habit Clinic and Its Relation to the Child. How the Habit Clinic Treats the Vari- ous Problems of Childhood. The Development of Character and Personality. Mental Health. Some of the Problems Dealt with at the Habit Clinic. Habit Training for Children — III. The Work of the Reading Habit Clinic. Growing Usefulness of the Habit Clinics. Significance and Importance of Early Habit Training. Development of Character and Per- sonality. Significance of Early Habit Training. -The Value of Affiliated Nursing. Mental Hygiene. Functions of the Brockton Habit Clinic. The Growing Usefulness of the Habit Clinic. Mental Hygiene. Mental Hygiene. Mental Hygiene. Progress in Nursing. The Importance of Mental Health in Childhood. Summary of the Work Accomplished by the Norwood Child Guidance Clinic since 1929. How to Develop the Best in our Children. Teacher-Child Relationships. Early Habit Training nificance. and Its Sig" Mental Hygiene Program of Quincy Child Guidance Clinic. Parent-Child Relationships. (4) Instruction of students in the Division. (a) At the time of the reopening of the clinics in September, a change was made in the policy of providing speech therapy in the clinics. Previously this had been conducted in some of the clinics by the regular staff therapist. Arrangements for affiliation with Emerson College were completed in September, so that regular service was made avail- able for all the clinics. Senior graduate students from this college were assigned for a definite period of training under direct supervision of the staff speech therapist. This 74 P.D. 117 service has proved to be mutually beneficial to both the clinics and the students, as many more children needing this service have been able to receive instruction, and the student teachers have been able to gain invaluable experience in their chosen profession. (b) Work in remedial reading in some of the clinics has been continued as in previous years. Graduate students from Boston University School of Education have been assigned as instructors under the supervision of Miss Helen Sullivan, a member of the Boston University Staff. These students have served for a period of nine months, during which they have been able to gain much experience. In view of the great demand for this type of service, and the few students available, student teachers were not available for all clinics. It is the hope of the Director that in the near future the services of a full-time remedial teacher will be added to the personnel of the Division. (c) Occupational therapy has proved very effective in our clinics as a standard pro- cedure. At the beginning of the year, two students from the Boston School of Occupa- tional Therapy were assigned to the Division for training at the Quincy and Brockton Clinics. These students remained until their summer vacation. At the reopening of the clinics in September, the service of only one student was available, due to the limited number of students in the senior class. The former policy, which permitted all children to attend the occupational therapy class, was changed so that only cases referred by the psychiatrist have been admitted. This arrangement has been much more desirable, as it has given the student occupational therapist more time in which to plan and carry out the therapeutic program with the individual child. The work of these students has been carefully followed up by a supervisor from the Boston School of Occupational Therapy. (d) The Simmons School of Social Work and the Boston University School of Religious and Social Work each continued to send two students to the Division until September, at which time the quota from each school was raised to three. This has afforded the students an excellent opportunity to get their practical training in the psychiatric field under the able guidance of the Chief Social Worker in the Division. Lectures, conferences and round table discussions, in addition to the field work, have oriented them in psychi- atric social service. (e) The Division has always cooperated in the educational program of medical students from Tufts College Medical School and, up until September, continued to instruct fourth-year students at the Boston Dispensary Child Guidance Clinic. It is with a feeling of regret that I report the school saw fit to withdraw this affiliation at the opening of the 1939-40 session, because of the small number present in the senior class. Psychi- atric education of the young physician has been rather inadequate in the past and, if physicians are to have a better understanding of the emotional and psychological needs of their patients, much more training and experience in the psychiatric field will be necessary. , The first step in the standardization of training given all students under the super- vision of the Division of Mental Hygiene was accomplished when the Director completed his survey of the training problems. This information will be available for use of the advisory committee on student activities which the Commissioner is planning to appoint. The question of setting up standard minimum curricula is an important one, as it will provide more agencies in our institutions qualified to teach. The training of personnel for Child Guidance Clinics is still a matter of concern to the Director. There is no training center at present for persons desiring to enter the child guidance field. I would recommend, as I did last year, that some definite plan for the establishment of a large training center should be carefully considered as a future program of the Division. This center should be affiliated with some medical unit, where adequate consulting services for children are available. By training psychiatrists, psychol- ogists, psychiatric social workers and other personnel doing special therapies, vacancies which arise in the child guidance field throughout the State could readily be filled by experienced persons. This would greatly enhance the service now being given in some of the clinics. IV. Research Activities A. Divisional The research activities within the Division have been conducted during the past year by the Consultant in Research, assisted by the research social worker. P.D. 117 75 I. The research project ''Environmental Factors and Their Relation to Social Adjust- ment was completed by Douglas A. Thorn, M.D., and Florence S. Johnson, M.S.S. It was published in Mental Hygiene, Vol. XXIII, No. 3, July, 1939, pp. 379-413. This project consisted of a study of a group of well-adjusted children. In the concluding remarks, it was stated that "certain observations have been made on a group of children who have succeeded in making the necessary adjustments to life. These adjustments have resulted in happiness and efficiency, which have benefited society as well as the individual." It was further brought out in the follow-up studies that "habits, personality traits, and attitudes have become so much a part of the individual's personality make-up that they are likely to persist as the individual advances in years." The children who made up this group were not simply adjusted to a particular life situation. In the process of growing up, in their training and experiences, they had acquired an adjustability which is essential in meeting the varied life situations with which mankind is confronted in his journey from the cradle to the grave. This adjustability seems to be the objectives which all philosophies and doctrines are seeking. As there is no one road leading to success, it seems obvious that the contribution that the child's environment makes during the early years is of paramount importance. In this particular study, the positive influence of a healthy environment was stressed. II. The Study of Adoptions, which was begun last year, was completed, and the results were published in the Journal of Pediatrics, Vol. XV, No. 2, August, 1939. In this study, it was concluded that "the problem at the moment is not one of getting the perfect child into the perfect home, but rather the broad, socialized problem of bringing together the largest number of acceptable children and the largest number of acceptable homes, with the object of increasing the sum total of the satisfactions to be derived by both adoptive parents and the child, and with the minimum amount of risk of creating in- compatible relationships." III. A Follow-Up Study of the Prepsychotic Child and the Pre-Delinquent Child, which was started last year, has been continued throughout this year. This study was prompted by a desire to learn the subsequent adjustment of children who had manifested delin- quent and pre-delinquent behavior rather early in life. It was felt desirable to determine some of the underlying factors contributing to delinquency and to the cessation of delin- quent behavior. The study is being made on a group of one hundred boys who had shown delinquent tendencies and who had previously been known to the child guidance clinics. Each case record has been analyzed and the facts tabulated. A follow-up visit has been made to the home of each boy, and all the agencies to which the case has been known have been contacted. The study has been made by dividing the cases into two groups; the first group dealing with personality adjustments of the boys, and the second with their adjustment as regards delinquent conduct. As the study has progressed, it has been found that there was a close correlation between the cooperation of the parents with the clinic and the subsequent adjustment of these cases. It has also been learned that a close relationship existed between poor environmental conditions and the con- tinuance of delinquent behavior. IV. A Study of Superior Children was started during the year. A group of one hundred children, known to the child guidance clinics ten years ago, having intelligence quotients at that time of 130 or higher, have been included in this project. The determination of their present intelligence ratings is being made by psychological retests. Follow-up visits are being made with the object of learning the present emotional stability of these children, the relation between superior children and environmental factors, and the intellectual equipment of the parents. This study has not progressed sufficiently to draw any conclusions. V. The study entitled "The Frequency of Convulsions in Children and the Effect of these Convulsions in Later Life" was completed by Doctor Arthur Berk. As yet the material has not been published and the conclusions are not available. It is expected that this paper will be published in one of the leading journals in the very near future. VI. The Study of the Relationship between Conduct Disorders and the Physical Condition of the Child was started during the year, but has been temporarily discontinued. B. Institutional Active research has been carried on in the several research centers, which are located in our mental institutions and supervised by the Director of the Division. The various 76 P.D. 117 projects conducted throughout the year have been under the immediate direction of psychiatrists, who have had long experience and interest in this type of work. I. The Psychiatric Institute, under the direction of Doctor Myrtelle M. Canavan, concluded a section of the work on the Waverley Researches during the Fall season. The results of this particular project were published in a concise and comprehensive report entitled "Waverley Researches in the Pathology of the Feeble-minded," Research Series, Cases XXXI-XL, by Myrtelle M. Canavan, M.D., and A. E. Taft, M.D. II. The work carried on at the Boston Psychopathic Hospital, under the direction of Doctor Harry C. Solomon, as in previous years has dealt with various studies of the problem of neurosyphilis and the newer therapeutic means of treatment. In his report, Doctor Solomon has enumerated the various projects which were completed during the year, and also those which have been started as follows : 1. The effect of autohemotherapy upon "fixed" positive blood Wassermann reactions in patients who have had syphilis of the central nervous system, but whose spinal fluids have become negative, was tested out in sixteen patients who were treated by twenty- five to fifty weekly intramuscular injections of their own blood in 25cc. quantity, and the serological responses tested for over a year. No significant benefit was evident. 2. A study of the malarial treatment of general paresis and relation of the height, duration, and frequency of fever, and the clinic and serologic results. A paper dealing with this subject has been published. 3. The effect of artificial fever on the sedimentation rate. It was found that mechani- cally-induced fever had no effect upon the sedimentation rate. 4. A study of anemia and the sedimentation rate in malaria. It was found that with an anemia resulting from malaria, there was a marked increase in the sedimentation rate. The sedimentation rate tends to parallel the red cell count. The greater the anemia, the more rapid the fall, but the sedimentation rate does not parallel the fibrinogen values nor does it follow the values of plasma protein, albumin, or globulin. 5. Comparison was made of the sedimentation rate during malaria with the same patient's blood when artificially diluted. The sedimentation rate obtained during the anemia due to malaria is more rapid than that obtained for similar red blood cell levels produced by dilution of the patient's blood with his own serum, indicating that the red cell count is not the sole factor in the sedimentation rate. 6. A study of the plasma proteins in malarial therapy. In four patients who were having malaria, a study was made of the quantity of total plasma, albumin, globulin, and fibrinogen. It was found that there was generally a slight fall in the total plasma protein, a fall in the albumin, and an increase, both relative and absolute, in the globulin fractions. In one patient receiving typhoid vaccine fever, there changes were not ob- served. 7. A survey was made of the untoward reactions due to tryparsamide as they occurred in the clinic from 1923-1939. It is interesting to note that there have been no case of fatal outcome from the use of the drug during this period, and in the last three years, there has been no evidence of visual damage. However, during the same period, there has been an increase in the number of "allgergic" reactions and jaundice. The following is a brief summary of the work under way, in addition to the foregoing: 1. The evaluation of the effect of the various components of vitamin B complex on the lightening pains in tabetic neurosyphilis. 2. A study of the effect of vitamin B, on optic atrophy. The drug is being given both intravenously and into the cisterna magnum, in conjuction with other types of treatment, to see if improvement in the usual therapeutic results might be obtained. 3. Study is being made of the effect of pressor chugs; such as, benzedrine sulphate and ephedrine upon cases of petit mal epilepsy. 4. Reduction of body temperature. We are at the present time dealing with the problem of reduction of temperature, and then a swing up above normal ; thus, affording a range in temperature of some twelve to fifteen degrees, which theoretically ought to be extremely effective in dealing with spirochetal infections, especially general paresis. P.D. 117 77 Publications 1. Reinfection (?) in Neurosyphilis. Am. Jour. Syphilis, Gonorrhea, & Venereal Diseases, Vol. 23, No. 1, 54-68, Jan., 1939. (Harry C. Solomon and Israel Kopp). 2. The Effect of Treatment on the Mental Level of Patients with General Paresis. Amer. Jour. Psychiat., Vol. 95, No. 5, Mar., 1939. (Samuel H. Epstein and Harry C. Solomon). 3. The Effect of Fever on Postural Changes in Blood Pressure and Pulse Rate. Amer. Heart Jour., Vol. 18, No. 1, 46-56, July, 1939. (Israel Kopp). 4. The Malarial Treatment of General Paresis : Relation of the Height, Duration, and Frequency of Fever to the Clinical and Serologic Results. Amer. Jour. Syphilis, Gonor- rhea, & Venereal Diseases, Vol. 23, No. 5, 585-597, Sept., 1939. (Harry C. Solomon and Israel Kopp). 5. Interstitial Keratitis in Patients with Neurosyphilis of Congenital Origin; With a Discussion of Fever as a Precipitating Factor of Keratitis in the Paretic Variety. Amer. Jour. Syphilis, Gonorrhea, & Venereal Diseases, Vol. 23, No. 6, 751-758, Nov., 1939. (Harry C. Solomon and Israel Kopp). III. The Research Division of the Boston State Hospital has continued its work during the year under the direction of Doctor Abraham Myerson. The fields of investigation have been arranged under eight headings and are described in the following report : I. Human autonomic pharmacology and allied subjects. The main efforts of the laboratory in this field have been directed to the study and development of new drugs. 1. An interesting new chemical, furfuryl trimethyl ammonium iodide, shows the following general characteristics. It acts on the eye as a parasympathetic drug and thus narrows the palpebral fissure, constricts the pupil, lowers the intra-ocular tension, and probably increases the power of accommodation. It has a marked effect upon sweating, and thus reduces the temperature of the body very effectively. It increases salivation, lacrimation and rhinorrhea. It has little effect on blood pressure, thus differing from the true parasympathetic drugs, such as mecholyl (acetyl-beta-methylcholine chloride). It has only a moderate effect upon heart muscle. It increases gastrointestinal peristalsis and genitourinary smooth muscle activity. It probably has a clinical field of usefulness inasmuch as it can be taken by mouth. We have not as yet entered into this phase of work. A paper on this drug, which will be the first publication to concern its human pharmacology, is already prepared for publication. 2. Extensive clinical work is now going on in regard to the relationship between benzedrine (amphetamine) sulfate and the barbiturates. Present clinical studies show that the two drugs act well in correcting the excess reactions to the other drug, and furthermore produce a total effect which is of value in the neuroses and in manic-depres- sive psychosis. 3. One of the important pharmaceutical houses is collaborating with the Director in an effort to develop new and better antiepileptic drugs, and also to develop the interesting mood effects of benzedrine (amphetamine) sulfate by linking up its molecule with that of other drugs having an effect on the mood. This work will probably be an important phase of the next year's activity. 4. Brain metabolism — (a) An important research, which has been conclusively and satisfactorily carried out has been on the question of the metabolism of sugar by the brain. This study involved the use of the jugular puncture method and is the first study of its kind. In its results, it completely contraverts certain assumptions that have been made. It shows conclusively that after insulin the brain loses the power to use sugar and oxygen for a much longer period of time than the muscles of the body do, thus contra- dicting the statement that following insulin the therapeutic results observed are due to the greater use of oxygen and sugar by the brain. As a matter of actual fact, the brain has a reduced power to use oxygen and sugar for a considerable period of time. This research bears quite heavily on certain phases of narcosis and stupor. This study was carried out by Doctor Julius Loman. (b) Certain experimental studies on metrazol were also carried out in this laboratory. It was shown that during and following the period of stupor the brain sugar was not diminished, thus distinguishing this type of reaction from that found in insulin shock. Certain other important metabolic results were observed which are incorporated in a paper soon to be published. 78 P.D. 117 II. Biochemistry of alcohol. Under the leadership of Doctor Max Rinkel a long series of experiments were carried out to study the quantitative relationship of alcohol in the brain, arterial and basilic bloods. These studies are still in progress. They give some measure of the activity of the brain under alcohol and will be published in extenso later on. III. Neuropathological studies. Studies in neuropathology have taken interesting and important directions during the past year. These have been largely carried out by Doctor Leo Alexander in association with the Director. 1. An investigation of cell minerals in various types of idiocy was carried out. This study disclosed facts of great theoretic interest and also of diagnostic importance. It showed that the ganglion cell disease of amaurotic family idiocy was characterized by demineralization of an extreme degree, whereas the cells in tuberous sclerosis showed marked hypermineralization of the cytoplasm. Consequently, amaurotic family idiocy, in respect to its ganglion cells, aligns itself with other degenerative conditions, and tuberous clerosis with diseases of a neoplastic nature. 2. Clinical and experimental investigations of brain damage due to alcoholism and vitamin deficiency constituted an important part of the laboratory work during the past year. The major result of these studies was the experimental reproduction of Wernicke's disease (hemorrhagic polio-encephalitis) in pigeons, thus lining up vitamin deficiency with the condition found in chronic alcoholism and the associated vitamin deficiencies in man. The vitamin deficiency or imbalance was a diet rich in vitamins A, C, D, and Bo, but lacking completely in vitamin Bj. 3. Many other studies were carried out in collaboration with other groups, but since they did not constitute a primary part of the activities of this laboratory, they are only mentioned here. Thus, studies of the vascular system, the role of the cerebral vessels in disseminated encephalomyelitis, certain of the results and pathogenesis of electrical injury to the brain, the experimental reproduction of brain tumors, a study of the histo- logic changes in senile dementia and related conditions were carried out by Doctor Alexander as part of his activities as a member of other organizations. 4. The laboratory has made an interesting connection with E. I. du Pont de Nemours and Company, Inc., who most cordially sent us samples of their newest dyes which, it is anticipated, will give us new methods of staining the nervous and other tissues of the body. IV. Vitamin deficiencies: their effects on the nervous system and the blood. A vitamin B2 deficiency state was produced in pigeons by putting them on a diet of polished rice, at the same time giving them injections of vitamin Bt. A characteristic deficiency state ensued, easily identified, and associated with a moderate to marked anemia and hyperplastic changes in the bone marrow. Therapies with riboflavin, nicotinic acid, and vitamin BB were without effect. There was a striking effect on both the clinical and hematological aspects of the deficiency by the administration of yeast, concentrated tablets, or dilute liver extract injections. Concentrated liver extract injections had a less marked effect than the dilute form. Suggestive results were obtained with Elvehjem's anti-chick dermatitis factor. These researches were carried out by Doctor William Dameshek and Doctor Paul G. Myerson. V. Sex hormone studies. One of the most interesting activities of the laboratory has been the study of the sex hormones in the urine of patients of diverse types and under experimental conditions. The results of these investigations, carried out under the leadership of Doctor Rudolf Neustadt, may be summaried as follows, although only a hint, rather than a complete account, can be given in an abstract of this kind. 1. It has been shown that ultraviolet irradiation of the body and especially of the genitalia immediately and markedly increases the output of sex hormones, male and female, in the urine. 2. Studies carried out on thyroid gland conditions show that both hyperthyroidism and hypothyroid conditions are very definitely associated with a deficient manufacture or secretion of sexual hormones. 3. We believe we are developing a system of identification of the sexual constitution of the individual by the study of the urinary hormones. This is by far the most important part of our work and suggests leads of enormous importance for future work. We believe at the present time that we can identify the true homosexual individual by the relative amounts of male and female hormones in his urine, and that we can also identify the P.D. 117 79 individual of deficient sexual drive by his hormonal content. We are receiving the col- laboration of the state hospitals of Massachusetts in doing this work and within a few months will have material for a conclusive publication. 4. Studies are being carried out in this laboratory in respect to the relationship of iodine, cholesterol and the sexual hormones in the urine. This work is in a- preliminary stage. VI. Heredity studies. — 1. At the McLean Hospital in Waverley, we have been carrying out a series of researches on the mental diseases of distinguished families. We have selected very important American families, some of whose members have been patients at the McLean Hospital, and we have attempted to build up a family tree which will indicate the amount of mental disease in these families. The point of the research is fundamentally this: The liabilities of mental disease have been sufficiently pointed out but only very sporadic attempts have been made to show that there may be some degree of asset value present. In other words, a certain amount of, or certain types of, mental disease may occur in gifted individuals in disproportionate amount. This has been pointed out in connection with manic-depressive psychoses by several workers. Our researches indicate the following : That if the present sterilization laws of Germany and of certain states of the United States, notably California had been carried out in the early part of the nineteenth century, the most distinguished philosopher and the most distinguished psychologist of America would not have been born. Moreover, very im- portant individuals who have played a great role in the development of New England had enough mental disease in their immediate ancestors and in their collaterals to brand them, under the laws of some states and countries, as inferior individuals who should have been sterilized. In other words, the question is raised, whether or not in bringing up the matter of sterilization and mental disease, the nature of the particular and individ- ual family group should not be taken into account, since mental disease, especially manic- depressive psychosis, may be episodic in the history of a life which, on the whole, is highly meritorious and socially valuable. 2. A research is also being carried out on a statistical basis to see whether or not the families of dementia praecox patients have a low marriage and birth rate. It has been shown quite conclusively that dementia praecox acts as a barrier to marriage. The question which we raise is whether or not the collaterals and siblings of such individuals also have a low marriage and birth rate, since it is from them that the constitutionally disabled stock comes. This work has been carried out under the auspices of the American Neurological Association by a grant from the Carnegie Corporation. Mrs. Rosalie Boyle has acted as field worker, Miss Mollie S. Levin as secretary, and Doctors Tillotson and Chittick have generously collaborated. VII. The "total push" method in the treatment of chronic schizophrenia. As Chair- man of the Committee on Research for the State Department of Mental Health, the Director has carried out in collaboration with various other hospitals of the State and especially the McLean Hospital, researches on the treatment of schizophrenia by the total push method. This was described in last year's report, and needs no amplification nor description here. It has been definitely shown that even the deteriorated and chronic schizophrenics may be greatly improved in conduct, working ability, and general social contact by the total push method, which perhaps had better be described as an "increased activation method", since the technique is not that of "push" necessarily, nor is it by any stretch of the imagination "total." The results at the McLean Hospital have been very satis- factory. Patients who have been out of activity and exceedingly difficult to manage for twenty years have improved greatly in conduct, work ability and social contact. Patients of lesser periods of disease have also done well, although no patient has been cured by the method. Utilization of the method at the McLean Hospital on acute cases has given very promising results, especially in the type of case which shows merely a passive retreat rather than a very active, hostile social attitude. At the State hospitals where there are lesser facilities, the results have been more difficult to obtain, yet in several institutions marked improvement in the condition of the patients has been noted. 80 p.D. 117 The projected program is to carry on this research for a year, during which time enough facts will have been gathered to lead to a further orientation of the problem and a more developed approach. VIII. Organization activities. 1. By virtue of the fact that the Director is chairman of the State Research Committee, a lineup with other hospitals has taken place in re- search activity. Thus, a very interesting research on the treatment of epilepsy has been carried out for three years at the Grafton State Hospital, the active worker in this insti- tution being Doctor Benjamin Cohen. Certain drugs have been selected for experi- mental use and we have shown the following: (a) Large doses of phenobarbital effectively reduce the incidence of major epileptic attacks. When toxic symptoms occur, they can be corrected by the judicious use of benzedrine (amphetamine) sulfate, (b) The com- bination of phenobarbital and dilantin greatly enhances the value of either drug in the treatment of severe epilepsy. The attacks have been reduced SO and more per cent, and in many instances the patients have been free of attacks indefinitely, (c) Mebaral is a very useful non-toxic drug in the treatment of major and minor epileptic attacks. So far as our researches go, it is equal to either dilantin or phenobarbital. 2. The Director is a member of the Research Council for the Study of Alcoholism for the American Association for the Advancement of Science, and as such is collaborat- ing on the study of alcoholism throughout the United States. 3. The Director has just been appointed consultant in research on drug addiction to the government hospital in Louisville, Kentucky. Achnowledgments are made to the Commonwealth of Massachusetts, the Rockefeller Foundation, the Child Neurology Research (Friedsam Foundation), the Charlton Fund (Tufts College Medical School), the Carnegie Corporation of New York, the Emergency Committee for the Displacement of Foreign Medical Scientists, the Works Progress Administration Project No. 18088, and to the following pharmaceutical houses: Smith, Kline and French Laboratories; Winthrop Chemical Company; Sharp and Dohme; Merck and Company, and Hoffmann-La Roche. Papers Published 1. Summary of the Report of the American Neurological Association Committee for the Investigation of Sterilization. Amer. Jour. Medical Jurisprudence 1: 253-257 (Dec.) 1938. (A. Myerson). 2. Beri-beri and Scurvy. An experimental study. Trans. Amer. Neurol. Assoc, The William Byrd Press, Richmond, Va., 64: 135-139, 1938. (L. Alexander, A. Myerson, M. Pijoan). 3. Photo-colorimetric method for the determination of androsterones in urine. Endo- crinology 23: 711-717 (Dec.) 1938. (R. Neustadt). 4. Human Autonomic Pharmacology. XVII. The effect of acetyl-beta-methylcholine chloride on the gallbladder. Amer. Jour. Digest, Dis. 5: 687-690 (Dec.) 1938. (P. G. Schube, A. Myerson, R. Lambert). 5. The Relation of the Autonomic Nervous System to Pharmacology. Jour. Conn. State Med. Soc. 3: 19-21 (Jan.) 1939. (A. Myerson). 6. The Effect of Benzedrine, Benzedrine and Atropine, and Atropine on the Gall Bladder. Amer. Jour. Med. Sci. 197: 57-61 (Jan.) 1939. (P. G. Schube, A. Myerson, R. Lambert). 7. Human Autonomic Pharmacology. XV. The Effect of Acetyl-beta-methylcholine Chloride (mecholyl) by Iontophoresis on Arterial Hypertension. Annals Int. Med. 12: 1213-1222 (Feb.) 1939. (J. Loman, M. F. Lesses, A. Myerson). 8. Comparative Effects of Amphetamine Sulfate (benzedrine sulfate), Paredrine and Propadrine on the Blood Pressure. Amer. Heart Jour. 18: 89-93 (July) 1939. (J. Loman, M. Rinkel, A. Myerson). 9. The Reciprocal Pharmacologic Effects of Amphetamine (benzedrine) Sulfate and the Barbiturates. New Eng. Jour. Med. 221: 561-563 (Oct. 12) 1939. (A. Myerson). 10. Benzedrine Sulphate — An Antidote for the Untoward Hypnotic and Ataxic Effects of Phenobarbital in the Treatment of Epilepsy. In "Symposium on Therapy"; Bull. Mass. Dept. of Mental Health, (Sept.) 1939. (B. Cohen, A. Myerson). 11. Theory and Principles of the "Total Push" Method in the Treatment of Chronic Schizophrenia. Amer. Jour. Psychiat. 95: 1197-1204 (March) 1939. (A. Myerson). 12. Influence of Ultraviolet Irradiation upon Excretion of Sex Hormones in the Male. Endocrinology 25: 7-12 (July) 1939. (A. Myerson, R. Neustadt). P.D. 117 81 13. The Reaction of the Cerebral Vessels to Intracarotid Injection of Horse Serum in Sensitized and Non-sensitized Guinea Pigs. Confinia Neurologica 2: 215-219, 1939. (A. Buermann, L. Alexander). 14. Cell Minerals in Amaurotic Idiocy, Tuberus Sclerosis and Related Conditions, Studied by Microincineration and Spectroscopy. Examples of degenerative and of neoplastic cell disease. Amer. Jour. Psychiat. 96: 77-85 (July) 1939. (L. Alexander, A. Myerson). 15. The Relationship of Hereditary Factors to Mental Processes. Research Pub. Assoc. Res. in Nerv. & Ment. Dis. 19: 16-49 (Sept.) 1939. (A. Myerson). 16. Sources of Mental Disease: Their Amelioration and Prevention. Summary and Critique. Pub. No. 9, 120-136 Amer. Assoc, for the Advance of Sci., 1939. (A. Myerson). 17. Alcoholism and Mental Disease. Pub. No. 9, 83-90, Amer. Assoc, for the Advance of Sci., 1939. (L. Alexander). Papers in Press 1. Topographic and Histologic Identity of the Experimental (avitaminotic) Wernicke Lesions with Those Occurring in Hemorrhagic Polioencephalitis in Chronic Alcoholism in Man. Amer. Jour. Pathol. (L. Alexander). 2. The Rationale of Amphetamine (Benzedrine) Sulfate Therapy. Amer. Jour. Med. Sci. (A. Myerson). 3. The Effect of Amphetamine Sulfate (benzedrine sulfate) and Paredrine Hydro- bromide upon Sodium Amytal Narcosis. New Eng. Jour. Med. (A. Myerson, J. Loman, M. Rinkel, M. F. Lesses). 4. The Synergism of Phenobarbital, Dilantin and Other Drugs in the Treatment of Institutional Epilepsy. Jour. Amer. Med. Assoc. (B. Cohen, N. Showstack, A. Myerson) 5. Changes in Oxygen, Carbon Dioxide and Sugar Content in the Arterial and Internal Jugular Blood during Metrazol Convulsions. Arch. Neurol. & Psychiat. (J. Loman, M. Rinkel, A. Myerson). 6. The Attitudes of Neurologists, Psychiatrists, and Psychologists towards Psycho- analysis. Amer. Jour. Psychiat. (A. Myerson). 7. Total Push Method. III. Schema for the Recording of Certain Important Atti- tudes in Chronic Schizophrenia. Amer. Jour. Psychiat. (A. Myerson). 8. The Social Psychology of Alcoholism. Diseases of the Nervous System. (A. Myer- son). 9. A Distinctive Vitamin B Deficiency State in Pigeons. Amer. Jour. Med. Sci. (W. Dameshek, P. G. Myerson). 10. Errors and Problems in Psychiatry. Mental Hygiene. (A. Myerson). Papers Read 1. A Group of Neurological Conditions of Interest to the General Practitioner: Elec- trical Injuries, Eastern Equine Encephalitis, Brain Diseases Due to Chronic Alcoholism. (Read by L. Alexander before the North Shore Medical Society, Dec. 8, 1938). 2. Human Autonomic Pharmacology. (Read by A. Myerson before the St. Lukes Guild at Boston State Hospital, Dec. 14, 1938). 3. The Total Push Method in the Treatment of Schizophrenia. (Read by A. Myerson before the Boston Society of Psychiatry and Neurology, Dec. 15, 1938). 4. Problems of Vitamin Deficiency and the Nervous System. (Read by A. Myerson before the Hartford City Medical Society, Dec. 19, 1938). 5. Electrical Injuries. (Read by L. Alexander before the Utilities Accident Prevention Committee of New England, Dec. 20, 1938). 6. Sources of Mental Disease: Their Amelioration and Prevention. (Read by A. Myerson before the American Association for the Advancement of Science, Richmond, Va., Dec. 28, 1938). 7. The Relationship of Heredity Factors to Mental Processes. (Read by A. Myerson before the Association for Research in Nervous and Mental Disease, New York City, Dec. 27, 1938). 8. The Neuropathology of Alcoholism. (Read by L. Alexander before the Boston Society of Psychiatry and Neurology, Jan. 19, 1939). 9. Brain Waves. (Read by J. Loman before the Phi Lambda Kappa Medical Fra- ternity, Jan. 20, 1939). 82 P.D. 117 10. Theory and Practice of the Total Push Method in the Treatment of Chronic Schizophrenia. (Read by A. Myerson and K. Tillotson before the Massachusetts Psychi- atric Society, Jan. 27, 1939). 11. Clinical Syndromes in Neurology. (Read by J. Loman before the Attleboro Medical Society, Feb. 3, 1939). 12. Physiotherapeutics and Motivation in the Treatment of Chronic Schizophrenia. (Read by A. Myerson before the New England Society of Physical Medicine, Mar. 15, 1939). 13. Human Autonomic Pharmacology. (Read by J. Loman before the Sir William Osier Honor Society of the Middlesex University School of Medicine, Apr. 26, 1939). 14. The Total Push Method of Treatment of Chronic Schizophrenia. (Read by A. Myerson and K. J. Tillotson before the American Psychiatric Association, Chicago, 111., May 12, 1939). 15. The Neuroses. (Read by A. Myerson before the Central Association of Public Health Nurses, Grafton State Hospital, May 26, 1939). . 16. The Total Push Method in the Treatment of Chronic Schizophrenia (with demon- stration). (Read by A. Myerson before staff members of the various state hospitals of Massachusetts at the McLean Hospital, May 26, 1939). 17. Cell Minerals in Amaurotic Idiocy, Tuberous Sclerosis and Related Conditions, Studied by Microincineration and Spectroscopy. (Read by L. Alexander and A. Myerson before the American Association on Mental Deficiency, Chicago, Illinois, May 3, 1939). 18. Exhibit: Mineral Studies of the Brain by Means of Microincineration and Spectro- scopy: Exhibit of Apparatus Used; Photomicrographs of Normal and Pathologic Brain Tissue; Reproduction of Spectroscopic Graphs. (By L. Alexander and A. Myerson at the American Medical Association, St. Louis, Missouri, May 15-19, 1939). 19. The Social Psychology of Alcoholism. (Read by A. Myerson before the American Psychopathological Association, Atlantic City, N. J., June 5, 1939). 20. The Synergism of Phenobarbital, Dilantin and Other Drugs in the Treatment of Institutional Epilepsy. (Read by B. Cohen, N. Showstack and A. Myerson before the American Psychopathological Association, Atlantic City, N. J., June 5, 1939). 21. Neuropathological Aspects of Alcoholism. (Read by L. Alexander before the American Psychopathological Association, Atlantic City, N. J., June 5, 1939). 22. Topographic and Histologic Identity of the Experimental (avitaminotic) Wernicke Lesions with Those Occurring in Hemorrhagic Polioencephalitis in Chronic Alcoholism in Man. (Read by L. Alexander before the American Association of Neuropathologists, Atlantic City, N. J., June 5, 1939). 23. Intracranial Dynamics. (Read by J. Loman before the American Psychopatho- logical Association, Atlantic City, N. J., June 5, 1939). 24. The Legal Side of Medicine, or The Doctor in Court. (Read by A. Myerson before the Boston City Hospital House Officers' Association, June 28, 1939). 25. Human Autonomic Pharmacology (with exhibit). (Read by A. Myerson before the Third International Neurological Congress, Copenhagen, Denmark, August 21-25, 1939). 26. Beri-beri and Wernicke's Hemorrhagic Polioencephalitis. An experimental study. (Read by L. Alexander before the Third International Neurological Congress, Copen- hagen, Denmark, August 25, 1939). 27. Heredity and Environment in Relationship to Intelligence, Personality and Mental Disease. (Read by A. Myerson before the Boston Dispensary Staff, October 20, 1939). 28. Clinical Review of the Disorders of Motion. (Read by A. Myerson before the Jewish Memorial Hospital, October 31, 1939). 29. The Theories and Facts of the Inheritance of Mental Disease, and the Value of Sterilization. (Read by A. Myerson before the New York Academy of Medicine, New York City, November 30, 1939). 30. Alcoholism and Mental Disease. (Read by L. Alexander before the American Association for the Advancement of Science, Richmond, Va., December 28, 1938). IV. The chief research projects carried on during the year at the Monson State Hospital by Doctor Leon J. Robinson and Doctor Rudolph Osgood, under the direction of Doctor Morgan R. Hodgskins, Superintendent, were directed along two distinct lines. 1. The comparative effects of phenobarbital and dilantin in the treatment of epilepsy. 2. Electroencephalographic studies of epileptic patients. P.D. 117 83 Preliminary reports of observations in the above projects have been made informally from time to time, but the work will be carried over to the next year before summaries of results are published. Several papers have been prepared and published during the year ending November 30, 1939. 1. Brilliant Vital Red as an Anti-Convulsant in the Treatment of Epilepsy. Arch. Neurol, and Psychiat. 40: 1178-1204, Dec, 1938. (R. Osgood, L. J. Robinson). 2. Venous Blood Pressure Measurements During Syncope Caused by a Hyperirritable Carotid Sinus Reflex. Amer. Jour. Med. Sci. 197: 100-102, Jan., 1939. (L. J. Robinson). 3. Syncope, Convulsions and the Unconscious State. Relation to the Hyperactive Carotid Sinus Reflex. Arch. Neurol, and Psychiat. 41: 290-297, Feb., 1939. (L. J. Robinson) . 4. Radiologic Gastrointestinal Studies in Epilepsy. Amer. Jour. Psychiat. 95: 1095- 1102, Mar., 1939. (L. J. Robinson). 5. Induction of Seizures by Closing of the Eyes, or by Ocular Pressure in a Patient with Epilepsy. Jour. Nerv. and Ment. Dis. 90: 333-336, Sept., 1939. (L. J. Robinson). V. Dementia Praecox (schizophrenia) has continued to be the chief matter of investi- gation of the Research Department of the Worcester State Hospital. A report of the activities of this Department is herewith submitted by Doctor Andras Angyal, Resident Director, for the year ending November 30, 1939. The Research Department has, as in previous years, been subsidized by the Division of Mental Hygiene of the Massachusetts Department of Mental Health, the Worcester State Hospital, the Memorial Foundation for Neuro-Endocrine Research, and the Rocke- feller Foundation. In addition, the Armour Company has contributed a special stipend to be used for study of the biochemistry of hormones. Doctor R. G. Hoskins has continued as Director of the Research Department. During the year, several changes in personnel have taken place. Mr. E. M. Jellinek, Chief Statistician, Doctor Louis H. Cohen, Senior Psychiatrist, and Doctor Bela Lengyel, Statistician, left the Worcester State Hospital to assume positions elsewhere. Doctor O. Kant, Senior Psychiatrist, Doctor N. Blackman, Assistant Physician, and Doctor Allan Mather, Endocrinologist, joined our staff. A considerable part of the activity of the Research Service during the last year was devoted to the study of the effects of sex hormones in schizophrenia. This work is being carried out under the direct supervision of Doctor R. G. Hoskins, and all departments are contributing their share to this study. The endocrine preparation on which most work has been done during this year is Testosterone Propionate. The schedule consists of three six-week periods, one before, one during, and one following medication. The program includes the study of the following biochemical and physiological items: sex hormone assays on 24-hour-amount urine samples; basal oxygen consumption rate; glucose tolerance, uric acid and adrenalin determination in the blood; blood lipids; hematocrit determination; blood morphology; basal blood pressure and pulse; and tests for autonomic reactivity with nicotine, adrenalin, and cyanide. Continued observations on the behavior and mental status of the patients are recorded by the psychiatrists, and also a standardized rating is filed weekly by the psychiatrists. The battery of psycho- logical tests used with the patients on the Testosterone Study includes the Army Alpha, Thematic Apperception, Attitude-Interest, Play Procedure, Drawing, Aspiration, Social Situation, and a special association test containing sex-loaded words. The effect of the latter is studied by means of the galvanic skin response, as well as the actual associations. In suitably cooperative patients, electroencephalograms are obtained by Doctor Rubin. The biochemical studies, which form the greater part of this program, are reported in connection with the work of the biochemical laboratory. Hormonal preparations other than Testosterone Propionate, the effects of which on schizophrenic patients are being studied, include various pituitary preparations, pregnant mare serum extract, and Stilboestrol. Another group study which has been carried out is that in connection with the insulin and metrazol treatments. The purpose of the study is to discover prognostic and differ- ential therapeutic indicators which would allow the prediction of the type of patient most likely to respond favorably to insulin or metrazol treatment respectively. A further aim of this study is to utilize the therapeutic responsiveness as one of the means of divid- ing the schizophrenic group into more meaningful sub-groups than the conventional 84 P.D. 117 sub-type classification. Each patient is subjected to two weeks' intensive study before and after medication. The clinical observations on the insulin cases are made by Doctor C. Wall, and on the metrazol cases by Doctor B. Simon. The program includes studies of the following biochemical and physiological variables: blood minerals and choline esterase, hematocrit and blood lipids, blood morphology, blood circulation time, daily basal pulse rate, and tests with intravenous adrenalin. The main items of the psycho- logical test battery in this study are the Stanford-Binet, K-R Association Test, Aspira- tion and Play Procedure. Another cooperative study under the direct supervision of Doctor Hoskins was under- taken in order to determine how far an ameliorative therapeutic program may be worked out for old schizophrenic patients. Twelve patients around sixty years of age are the subjects of this study. The schedule includes a metabolic check-up of two weeks' dura- tion, followed by a six-week period of treatment with such therapeutic agents as are indicated in the results of the tests. After the six-week medication period, another metabolic recheck is done, after which the therapeutic plans are reconsidered. It is planned that the duration of study in each case should be about a year, consisting of alternate six-week treatment and two-week test periods. Psychiatric observations and weekly behavior ratings are made by members of the psychiatric department. The psychological examinations consist mainly of tests on memory and deterioration. Besides the aforementioned collective studies, a number of individual investigations have also been carried out by the various members of the research staff. Doctor Andreas Angyal, in collaboration with Doctor Blackman, has studied the nystagmic response to rotatory and caloric stimulation of the vestibular organ in 58 schizophrenic and 20 normal persons. The variables studied were absolute number and average frequency of ny- stagmic beats (Number of nystagmic beats) (Total duration of reaction). In response to rotatory stimulation, they found a 21% reduction of the absolute, and a 26.2% reduction of the nystagmic frequency in the patients as compared with normal controls. In response to caloric stimulation, the schizophrenics showed a 38.8% reduction of nystagmic frequency, and a 48.3% reduction of absolute number of nystagmic beats. Besides the general reduction of vestibular reactivity, a small group with particularly low responsiveness has been detected. It is noteworthy that all the patients who have the clinical syndrome previously described by Doctor Angyal belong to this very low group. In previous years in a number of studies from our Research Service, a distinct reduction of responsiveness to various physiological stimuli has been observed. Doctor Angyal, in collaboration with Doctor Freeman and Doctor Hoskins, made a theoretical evaluation of this fact, connecting these physiological features with the clinical symptoms of with- drawal. Doctor Conrad Wall continued his follow-up studies on the adjustment of patients who recovered following insulin treatment and who were discharged from the hospital. Preliminary evaluation of the data gives promise that this work will be particularly informative as to the permanency of insulin recovery. Doctor Wall, in collaboration with Doctor Hoskins, studied the effects of Testosterone in a homosexual individual with acute psychotic episodes. The effects of the Testosterone were best revealed in the patient's phantasies which, concomitantly with the medication periods, turned in a more or less obviously heterosexual direction. Doctor Wall also studied the therapeutic effects of Diethylstilboestrol in 8 female patients suffering from involutional melancholia. In the majority of cases, a more or less marked improvement in mental and physical condition was noted, and the results seem encouraging for the continuance of this experi- ment. Doctor Otto Kant carried out an intensive catamnestic study on a large group of schizophrenic patients who have recovered and who have been living outside of the hospital for at least the last five years. Two hundred fifty such cases were contacted by letter, and Doctor Kant succeeded in examining personally about one hundred of these patients, in addition to collecting the information which could be obtained from the patients' relatives, friends, and from various social agencies. The material has not been finally evaluated as yet, but various significant conclusions can already be made. It appears that a schizophrenic heredity definitely decreases the chance for recovery, while P.D. 117 85 a manic-depressive heredity increases it. Extroverted prepsychotic personality and psychogenic precipitating factors are favorable for the prognosis. Simple, hebephrenic, and paranoid types of schizophrenia are associated with an extremely poor prognosis. Doctor Kant also completed a study on the problem of differential diagnosis in schizo- phrenia. The significance of the various schizophrenic symptoms is discussed in the light of Doctor Kant's theory of stratafication of personality structure. Doctor Nathan Blackman made an interesting experiment in group therapy with schizophrenic patients. As a result of this, a literary club has been organized by the patients themselves, partially through their own initiative and partially through Doctor Blackman's encouragement. The group edits a monthly publication, "The Current," of which to date four issues have appeared, and several hundred copies of each issue have been sold by the patients. This method of occupational therapy, which lays par- ticular emphasis on fostering the patients' initiative, is definitely useful in the process of socialization. Doctor Blackman is also studying the capillaries of the nail-bed in schizophrenic patients and normal controls. The morphology of the capillaries as well as the rate of flow of blood are being observed. The results are not conclusive as yet, but in some cases in the patients quite marked abnormalities have been observed. Doctor Harry Freeman has been studying the respiratory sensitivity to varying percentages of C02 (2% to 6%) to determine whether this function is altered in schizo- phrenia. Ten normal and ten schizophrenia subjects were tested. The factors investi- gated were respiratory rate, respiratory volume, heart rate, and skin temperature. Contrary to the findings of Golla, Doctor Freeman's data on preliminary analysis seem to indicate no difference between patients and normals. Doctor Freeman, in another study in collaboration with Doctor Neustatter, aimed to remove the metrazol-produced fear reactions by preliminary induction of anesthesia with cyclopropane and nitrous oxide. The anesthetic agent completely removed fear of the treatment in the 5 patients so treated and did not seem to affect adversely the convulsive threshold. Doctor Morton A. Rubin has been working on an encephalography method of detec- tion of cortical atrophy. The results obtained with this method are in fair agreement with the findings obtained by pneumoencephalography and thus this method, if per- fected, may prove to be of considerable practical value. Doctor Rubin, in collaboration with Doctor Freeman, studied the effects of intravenously administered sodium cyanide on the brain wave pattern in a case of catatonic stupor and in a patient with narcolepsy. In these cases, slow rhythms were found. This was attributed to depressed cortical activity presumably present in this type of patient. Consequently an attempt was made to produce such a cortical state experimentally. Anesthesia is shown to depress cortical function and to produce slow-wave activity. Cyclopropane was chosen for the anesthetic, since it has a rapid induction period and recovery from its effects is also rapid. Sodium cyanide was given to seven schizophrenic patients during light cyclopropane anesthesia, expecting to obtain the same regular, slow rhythms as in the stuporous catatonic and the narcoleptic under the influence of cyanide alone. In most experiments, the cyanide was without effect. In those cases, however, in which it was possible to evoke a cortical response to sodium cyanide during anesthesia there was, contrary to expectations, an increase in the number of fast waves. These findings would indicate that slow rhythms do not necessarily imply depressed cerebral activity, but that the slow rhythm is a product of various factors at present not understood. Working with the hypothesis that certain disturbances of affectivLty in schizophrenia might be related to dysfunction of the hypothalamus, Doctor Rubin, following the suggestion of Doctor Hoskins and in collaboration with Professor John Fulton of Yale, has undertaken a study of the effects of surgically produced lesions of the hypothalamus in monkeys. These animals with bilaterally placed lesions of the anterior hypothalamus exhibited marked behavioral changes. They became "shy" and much easier to handle after operation, and once caught they made no attempt to escape. In one of three monkeys a clearcut adiposito-genital syndrome developed. In another animal, marked atrophy of the ovaries and adrenals was found on autopsy. The third animal had lesions in the posterior Itypothalamus, and, in contrast with the other two monkeys, showed no atrophy of the gonads. Electroenphalographic tracings obtained- from these monkeys before and after operation are still in the process of analysis. 86 P.D. 117 On the basis of reports from the Armour Company of a hypothalamic extract which produced a state similar to catatonia in rats, at the suggestion of Doctor Hoskins, Doctor Rubin undertook to investigate the experimental potentialities of such an extract. So far, however, the tests have been confused by the action of the preservative that was used in the extract, hence no evaluation is possible. During the year, the biochemical laboratory, under the direction of Doctor Joseph M. Looney, has collaborated on the sex hormone study, the insulin-metrazol study, and in the study on old schizophrenic patients. Various chemical methods were tried for the estimation of estrogens but none of these were found to be sensitive enough to be used on the small amounts occurring in male urine. The method of chemical estimation has, therefore, been held in abeyance and the method of assay using spayed mice is being utilized. The use of the photoelectric colorimeter has been compared with the Oesting technique and this method has been adapted for use. For large concentrations, it is more accurate than the Oesting method but it will not serve for very small amounts. Doctor Looney has also modified slightly the Oesting procedure so that it gives some- what better results. Miss Howe has been determining the androgen output of schizophrenic patients and normal control subjects before and after giving Testosterone. The results so far indicate a marked difference between patients and controls, the former not increasing their androgen output after medication while the latter do. Doctor Mather has taken up the work of utilizing the photoelectric colorimeter for androgen assays, and also is continuing the study of better methods of extraction. This investigation promises to be a valuable contribution to the sex-hormone field and to offer a basis of more certain methods for separating the various hormones. He is also making estimations of the estrogen output in the two groups, using the spayed mouse as the test object. Doctor Randall has carried on a number of investigations of changes in body lipids under various experimental conditions. The results of these studies indicate that the lipid metabolism may be significantly related to the schizophrenic process. There is an increase in all lipid fractions except free cholesterol in patients when they are treated with insulin or metrazol. Further, these levels are maintained in the recovered patients, but not in the non-recovered group. In the Testosterone-treated patients, there is also an increase in the lipid fractions. Doctor Randall has also studied the changes in fat distribution on prolonged treatment with insulin, using rabbits for this experiment. A similar study of the organs of pituitary-treated and pregnant rabbits has been com- pleted in collaboration with Doctor Graubard of Clark University. Miss Small has carried on investigations on the effect of Testosterone on the organ weights of immature male and female rats. The uterine weight changes give a good means of assay. A comparison with Oesting color units was not successful. Apparently, the action of the color component is not the same as that of Testosterone. A further study is contemplated, therefore, of the effect of Androsterone rather than Testosterone. In connection with the general problem of vigor, she has also carried out an investigation of the effects of Stilboestrol on the activity of rats. A significant increase in activity was found during the period of injection. Doctor Looney has devised a new method for the determination of serum albumin and serum globulin which has greatly simplified the methods of analyses now used, increased their accuracy, and cut the time required for an analysis from four or five hours to about ten minutes. The method makes use of the photoelectric colorimeter to measure the turbidity produced when a protein precipitant is added to serum. A protective colloid is added which holds the precipitate in colloidal suspension and gives a stable opalescent solution well adapted to measurement by the photoelectric cell. The total protein is measured by precipitating all the proteins with sulfosalycylic acid and the globulin estimated separated by precipitation with one-half saturation with ammonium sulfate. Miss Walsh studied the comparative efficiency of the old and new methods for the determination of albumin and globulin. She has also made all analyses dealing with lactic acid, blood sugar, uric acid, and glucose tolerance tests in connection with the therapeutic studies. Miss Dyer has been carrying out the determination on blood gases, and the deter- minations of total nitrogen, creatine and cretinine on the patients on Testosterone medi- cation. She has also modified the method for the determination of magnesium so that it P.D. 117 87 can be carried out using the photoelectric colorimeter. Using this method, she is investi- gating the magnesium metabolism of normal and schizophrenic subjects. Mr. Romanoff has been carrying out estimations of choline esterase, which doubtfully suggest that Testosterone causes some increase in the choline-esterase content of the blood of patients under treatment but not in the normal subjects. He has also been studying the effect of Testosterone on the tissue respiration of rat organs. The Psychology Department, under the direction of Mr. David Shakow, has invested a considerable amount of work in the devising, standardizing, and validating of psycho- logical tests in an attempt to increase and improve our psychological tools for further studies in schizophrenia. Three studies in the use and validity of the Thematic Apper- ception Test with psychotic subjects were completed, two by Doctor Harrison and one by Mr. Rotter. Doctor Harrison investigated the general clinical usefulness and validity of the tests and reports the use of a semi-objective method of analysis which determined attitudes and conflicts, as well as prevailing characteristics with a fairly high degree of validity. The second and third studies — attempts at quantitative validations against case history material and by the method of "blind analysis" — corroborated the findings of the first study in a more quantitative way. Mr. Snyder reorganized the items in the imagery test previously used by Doctor Cohen, and examined 30 additional schizophrenics and 15 normals. The results of the previous study are not corroborated, and it is now felt that this device is not a valid diagnostic measure. It appears rather to measure the degree of confusion of the asso- ciative processes, and the patients' ability to concentrate. Doctor Rodnick is attempting to determine whether metrazol has a greater disrupting effect upon a more recently acquired habit system than on an incompatible older habit system. Qn the basis of 14 metrazol and 5 control subjects thus far obtained, the results indicate a greater effect of metrazol on the more recently acquired habit system. Doctor Rosenzweig, in collaboration with Doctor Hoskins, studied personality changes concomitant with sex hormone medication in a selected case of schizophrenia. He is also experimenting with a device (Photoscope) which exposes pictures of varying degrees of sexual content. An experimental program has been organized from which it is hoped to be able to evaluate this device for measuring changes in sexual interest and the effec- tiveness of sex hormone medication. Doctor Rodnick and Mr. Rotter have completed a preliminary study of 8 normal subjects on the reactions to an experimentally induced frustrating situation. The re- actions to the situation were studied by means of the responses to the Thematic Apper- ception Test after success and failure. The results thus far indicate an increase in aggres- sion after failure. It is now planned by Doctor Rodnick to continue the study with a group of schizophrenics. Mr. Shakow, in collaboration with various members of the Psychology Department, is working on a comprehensive program on deterioration which will consider, besides current material, the material collected over a period of ten years or so on the same patients. With respect to intellectual functioning, the various psychometric data and the various studies of the thinking process (Ach-Sacharov, Wegrocki Tests, etc.) are being used. With respect to emotional and motivational deterioration, the work on aspiration, frustration, and the various Lewin studies are being used. All the analyses for such studies as required statistical treatment have been carried out by the statistical office, which is at present under the direction of Mrs. Hazel Stone. The following articles were published during the year from the Research Service: 1. Histologic Changes in Senile Dementia and Related Conditions Studied by Silver Impregnation and Microincineration. Arch. Neurol. & Psychiat. Jfi: 1075, Dec, 1938. (L. Alexander and J. M. Looney). 2. The Significance of Frustration as a Problem of Research. Character & Personality 7: 120, Dec, 1938. (S. Rosenzweig). 3. General Outline of Frustration. Character & Personality 7: 151, Dec, 1938. (S. Rosenzweig) . 4. The Function of Biometric Methodology in Psychiatric Research. Amer. Assoc. Adv. Sci., Mental Health, 9: 48, 1939. (E. M. Jellinek). 5. The Structure of Wholes. Phil, of Sc 6: 25, Jan., 1939. (Andras Angyal). 6. The Effects of High Humidity on Skin Temperature at Cool and Warm Conditions. Jour. Nutrition 17: 43, Jan., 1939. (H. Freeman and B. A. Lengyel). 88 P.D. 117 7. Function of the Psychologist in the State Hospital. Jour. Con. Psychol. 8: 20, Jan., 1939. (D. Shakow). 8. Electroencephalographic Localization of Atrophy in the Cerebral Cortex of Man. Proc. Soc. Exper. Biol. & Med. 40: 153, Feb., 1939. (M. A. Rubin). 9. Brain Wave Frequencies and Cellular Metabolism. Effects of Dinitrophenol. Jour. Neurophysiol. 2: 170, Mar., 1939. (H. Hoagland, M. A. Rubin, D. E. Cameron). 10. The Return of Cognitive Conscious Functions after Convulsions Induced with Metrazol. Arch. Neurol. & Psychiat. 41: 4S9, Mar., 1939. (L. H. Cohen). 11. Effects of Vitamin Bi in Schizophrenia. Amer. Jour. Psychiat. 95: 1035, Mar., 1939. (L. S. Chase). 12. A Critique of Cultural and Statistical Concepts of Abnormality. Jour. Abnorm. & Social Psychol. 34: 166, Apr., 1939. (H. J. Wegrocki). 13. Thought Disturbances in Schizophrenia as Revealed by Performance in a Picture Completion Test. Jour. Abnorm. & Social Psychol. 34: 248, Apr., 1939. (E. Hanfmann). 14. The Pharmacologic Antagonism of Metrazol and Sodium Amytal as Seen in Human Individuals (Schizophrenic Patients). Jour. Lab. & Clin. Med. 24: 681, Apr., 1939. (L. H. Cohen). 15. Brain Potential Changes in Man Induced by Metrazol. Brit. Jour. Neurol. & Psychiat. 2: 107, Apr., 1939. (M. A. Rubin and C. Wall). 16. A Qualitative Analysis of the Healy Pictorial Completion Test II. Amer. Jour. Grthopsychiat. 9: 325, Apr., 1939. (E. Hanfmann). 17. Factors Involved in the Stability of the Therapeutic Effect in the Metrazol Treat- ment of Schizophrenia. (A report of 146 cases.) N. E. Jour. Med. 220: 780, May 11, 1939. (L. H. Cohen). 18. Some Principles of Psychiatric Classification. Psychiatry 2: 161, May, 1939. (E. M. Jellinek). 19. Statistics on Some Biochemical Variables on Healthy Men in the Age Range of 20 to 45 years. Jour. Biol. Chem. 128: 621, May, 1939. (E. M. Jellinek, J. M. Looney). 20. The Therapeutic Significance of Fear in the Metrazol Treatment of Schizophrenia. Amer. Jour. Psychiat. 95: 1349, May, 1939. (L. H. Cohen). 21. The Effects of Insulin on Serum Lipids and Choline Esterase in Schizophrenia. (Preliminary Report) Jour. Biol. Chem. 128: LXXXII, June, 1939. (L. O. Randall). 22. Serum Lipids in Schizophrenia. Psychiat. Quart. 13: 441, July, 1939. (L. O. Randall, Louis H. Cohen). 23. Changes in Lactic Acid, pH, and Gases Produced in the Blood of Normal and Schizophrenia Subjects by Exercise. Amer. Jour. Med. Sci. 198: 57, July, 1939. (J. M. Looney). 24. A Variability Study of the Normal and Schizophrenic Occipital Alpha Rhythm. II. The Electro-encephalogram and Imagery-type. Jour. Ment. Sci. 85: 779, July, 1939. (M. A. Rubin, L. H. Cohen). 25. Psychiatric Changes Associated with Induced Hyperthyroidism in Schizophrenia. Psychosomatic Medicine 1: 414, July, 1939. (L. H. Cohen). 26. Physiological Studies in Insulin Treatment of Acute Schizophrenia. I. Methods. Endocrinology 25: 96, July, 1939. (E. M. Jellinek). 27. Physiological Studies in Insulin Treatment of Acute Schizophrenia. II. Pulse Rate and Blood Pressure. Endocrinology 25: 100, July, 1939. (D. E. Cameron, E. M. Jellinek). 28. Physiological Studies in Insulin Treatment of Acute Schizophrenia. III. The Serum Lipids. Endocrinology 25: 105, July, 1939. (L. O. Randall, E. M. Jellinek). 29. Physiological Studies in Insulin Treatment of Acute Schizophrenia. IV. The Choline Esterase Activity of the Blood Serum. Endocrinology 25: 278, Aug., 1939. (L. O. Randall, E. M. Jellinek). 30. Physiological Studies in Insulin Treatment of Acute Schizophrenia. V. The Blood Minerals. Endocrinology 25: 282, Aug., 1939. (J. M. Looney, E. M. Jellinek, C. J. Dyer). 31. Significance of Behavior During Hypoglycemia. Mass. Dept. Mental Health, Symposium on Therapy, p. 21, Sept., 1939. (C. Wall). 32. Studies on the Phytotoxic Index. III. (An evaluation of the method with refer- ence to depressed psychotic patients.) Amer. Jour. Med. Sci. 198: 528, Oct., 1939. (J. M. Looney, W. Freeman, R. R. Small). P.D. 117 89 33. Skin and Body Temperatures of Schizophrenic and Normal Subjects Under Varying Environmental Conditions. Arch. Neurol. & Psychiat. J+2: 724, Oct., 1939. (H. Freeman). 34. The Determination of Globulin and Albumin in Blood Serum by the Photo- electric Colorimeter. Jour. Biol. Chem. 130: 635, Oct., 1939. (J. M. Looney, A. I. Walsh). 35. The Electroencephalogram of Schizophrenic Patients During Administration of Vitamin Bi. Proc. Soc. Exper. Biol. & Med. 42: 440, Nov., 1939. (M. A. Rubin). 36. Psychopathy, Psychosis and Internal Secretions. Cyclopedia of Med. 5: Chapt. IX, pp. 646-690, F. A. Davis & Co., 1939. (R. G. Hoskins, L. H. Cohen). 37. Neuro-endocrinology. Cyclopedia of Medicine 5: Chapt. X, pp. 690-713, F. A. Davis & Co., 1939. (L. H. Cohen, R. G. Hoskins). In summarizing the work of the Division of Mental Hygiene for the fiscal year ending November 30, 1939, it can be said that the Child Guidance Clinics have functioned on a high level, serving the various sections of the State more adequately than in previous years. A number of the clinics have adopted the policy of providing, not only diagnostic, but therapeutic service as well. There has been considerable expansion of the educational program in its various fields, including training of students, conferences with educators and social agencies, talks and lectures to groups and organizations, and dissemination of mental hygiene information to reach greater numbers of the general population. Much enthusiasm has been shown during the past year in research by the members of the Department of Mental Health and the personnel in our mental institutions, so that very definite programs of research are now being carried out in most of our institutions and in the Division. I desire to express my sincere appreciation to the Commissioner of the Department of Mental Health for his invaluable guidance and advice. Gratitude is extended to the Directors of the various Divisions, and the members of the Mental Hygiene and Research Committees for their cooperation and assistance. I wish to thank all those in the Division who have served so faithfully and have given such loyal support throughout the year. Respectfully submitted, Edgar C. Ybrbury, M.D., Director, Division of Mental Hygiene. 90 RD. 117 REPORT OF THE DIVISION OF MENTAL DEFICIENCY To the Commissioner of Mental Health: A report of the Division of Mental Deficiency for the year ended November 30, 1939, is respectfully submitted. The subjects listed below are discussed in this report : I. Traveling Psychiatric School Clinics for the Examination of Retarded Children in the Public Schools. (a) Historical Sketch of Organization, 1914-1939. (b) Primary Reasons for Cases Being Referred to School Clinics, 1939. (c) Age of School Clinic Cases Examined during the Year 1939. (d) Intellectual Status of First Examinations, 1939. (e) Intellectual Status of Re-Examinations, 1939. (f) Personnel of Clinics, 1939, by Institution. (g) Comparison between Intellectual Status of First Examinations and Re- Examinations, 1939. (h) Comparison between Intellectual Status of First Examinations and Re- Examinations, 1928-1939. (j) First Examinations, Re-Examinations and Subsequent Recommendations of Psychiatrists, School Clinic Examinations, 1939, by Place of Residence and Sex. (k) Total Examinations, 1926-1939 by Clinic. (1) Total Towns Examined, 1926-1939, by Clinic. II. Incidence of Retardation, 1939. III. Central Registry for Mental Defectives. (a) Type of Contact in Mental Defectives Reported to Central Registry, 1939. (b) Age, I. Q., and Sex of Mental Defectives Reported to Central Registry, 1939. (c) Percentage Distribution of Age Groups in Mental Defectives Reported to Central Registry, 1939. IV. Research in Mental Deficiency. V. Social Service Division. VI. Analysis of Waiting Lists of All State Schools, 1939. VII. Recommendations. Graph I. Number of Clinic Examinations, 1915-1939. Graph II. Residence of Applicants on Waiting Lists of State Schools, 1939 : Rates Per 100,000 Estimated Population of Same County. I. Traveling Psychiatric School Clinics (a) History During the year 1939, the Division continued its direction of the fifteen traveling psychiatric school clinics coming under this Department. These clinics have been in operation for twenty-five years, and have been state-wide in their function since 1921, or a period of eighteen years. The Massachusetts School Clinic System was devised and placed in operation by the late Dr. Walter E. Fernald, who sent out the first traveling clinic from the Waverley School on December 15, 1914. In 1917, the late Dr. George L. Wallace sent out the second traveling clinic from the Wrentham State School. As time went on, however, it soon became evident that these two clinics could not examine all the backward children in the public schools of the entire State, and the formation of additional units became imperative. Dr. Fernald placed the matter before the Commissioner of Mental Diseases, the late Dr. George M. Kline, and in 1921, as a result of their collaboration, traveling clinics were created to operate from each of the fourteen institutions under the Depart- ment of Mental Diseases. Thus, for the first time an adequate state-wide system for the examination of all retarded children was made possible. The fifteenth clinic was added in January, 1928. Dr. Kline saw that the withdrawal of a psychiatrist from the medical staff of the various hospitals was impracticable and, therefore, increased the quota of each institution by one physician and one psychologist to carry on this important work. Dr. Payson Smith, former Commissioner of Education, took an active part in framing the law relat- ing to retarded children, and in outlining and enforcing the school clinic regulations which have contributed so materially to the school clinic system. P.D. 117 91 The General Court of 1919 enacted a law to legalize the operation of the clinics in the public school system. This law was later amended by the Legislature in 1922, and again in 1931. It now reads as follows : Chapter 71, section 46, General Laws, as amended by chapter 231, statutes of 1922, and chapter 358, statutes of 1931: — "The School Committee of every town shall annually ascertain, under regulations prescribed by the Department of Education and the Department of Mental Diseases, the number of children three years or more retarded in mental development in attendance upon its public schools, or of school age and resident therein. At the beginning of each school year the committee of every town where there are ten or more such children shall establish special classes for their instruction according to their mental attainments, under regulations prescribed by the department. A child appearing to be mentally retarded in any less degree may, upon request of the superintendent of schools of the town where he attends school, be examined under such regulations as may be prescribed by the department of education and the department of mental diseases. No child under the control of the department of public welfare or of the child welfare division of the institutions department of the city of Boston who is three years or more retarded in mental development within the meaning of this section shall, after complaint made by the school committee to the department of public welfare or said division, be placed in a town which is not required to maintain a special class as provided for in this section. (Approved May 26, 1931)." It will be noted that radical changes in the school clinic law were effected during 1931. Heretofore, only those children three or more years retarded were eligible for examina- tion. The new law states specifically, "A child appearing to be mentally retarded in any less degree may, upon the request of the superintendent of schools of the town where he attends school, be examined under such regulations," etc. This permits the examination of two very important groups: (1) children retarded but one or two years in school work; and (2) children presenting various behavior problems which have been interfering with their school progress. This is one of the most constructive moves ever made in our particular field. It makes possible the early examination and placement of a child show- ing retardation before he has progressed to the point that he is included in the classifi- cation of "three years retarded." The Department of Education has outlined certain regulations dealing with exami- nations and special class provision. The first paragraph of these regulations applies in particular to the school clinics under the supervision of this Division. It reads as follows : 1. The school committee shall require the examination of all children of school age residing in the town who appear to be three or more years retarded in mental development. The examination shall be given by the State Department of Mental Diseases or an examiner approved by that Department. The growth in the number of examinations completed by the traveling clinics each year is outlined in Graph I. The striking increase in 1921 is due, of course, to the simul- taneous operation of fourteen clinics. For the year 1933, also, we note a substantial increase in the number of examinations due, of course, to the change in the law in 1931. At the end of 1939, a grand total of 122,098 examinations of retarded children have been conducted by the clinics during the twenty-five years of their operation. In connection with the school clinic work, the Director has held numerous conferences with officials of the Department of Education, with school superintendents, with clinic psychiatrists and clinic social workers, so that the service rendered by the clinic may best meet the varying needs of the school systems involved. There has been a steady increase of interest throughout the State in the work which is being done by our traveling clinics. School superintendents now welcome any assist- ance which the clinics can give, and have become enthusiastic supporters of this system of examining retarded children. They were not long in recognizing the fact that the service provided is detached from the local school organization and, as such, can provide an examination which is wholly impersonal. In the past, parents of retarded children have been sometimes critical of the decisions made by the local school superintendent in reference to the placement of retarded children in special classes. Now they are proving to be less critical as they recognize that the decisions are based on very complete medical and psychiatric examinations by a clinic which is not a part of the local school organization. 92 P.D. 117 8BS6 67ZZ I 43 43 ■ 4^ 3°7 253 2/0 247 263 I I9/5-/9/6 -19/7 /9/8/9I9-I920-/92H922/923- (924 /925/926-/927/928/92S-/930 /93/-/932-I933-/934-I93S-/936 /937- (938-/939 Graph I. — Number of School Clinic Examinations, 1915- 1939, by Years It is a standard practice for the psychiatrist of the traveling clinics to invite the parents of children examined to come to the schools and to confer with them following the exami- nations. Many parents cooperate in this matter, and have come to a better understand- ing of their children when behavior problems and other difficulties are interpreted to them by the psychiatrist. Superintendents of the various state hospitals and schools recognize the value of the traveling school clinic as an out-patient activity. The service which can be rendered to the community in the diagnosis and placement of backward children in the schools is of incalculable value. Several of the superintendents have been most cooperative in assuming extra territory in which to conduct examinations. (b) Primary Reasons for Cases Being Referred to School Clinics, 1939: All Institutions. Prior to 1931, the law regulating the activities of the traveling school clinics specified definitely that children must be three or more years retarded before they could be ex- amined. During 1931 a change in the law was effected which now makes it possible to . examine children who show any lesser degree of retardation. Insert Table In Table 1 we present the primary reasons for cases being referred to our school clinics during the year 1939. Of the 7,971 children examined during the year, 70% were referred because of retardation; 16% because of some school problem; 1.6% had personality difficulties; .9% were behavior problems; .5% were physical problems, and .2% were social problems. Roughly, 70% of cases were referred because of retardation, and 30% of cases because of other reasons. In the sexes we observe that the males show larger relative proportions in cases referred because of retardation, behavior and person ality problems. The females show larger proportions in school problems and physical problems. As is to be expected, retardation makes up a smaller proportion in first exam- inations, 64% as contrasted with 84% in the re-examinations. School problems make up 19% of first examinations and but 8% of re-examinations; behavior problems 1.1% of first examinations and .3% of re-examinations; personality difficulties 1.8% of first examinations and 1.2% of re-examinations; and social problems .2% of first examinations and .3% of re-examinations. The variety of problems now being presented to the clinic shows the rapidly changing trend in the demands made upon our traveling school clinic. Formerly it was expected that all of our children would be referred to the clinic because of retardation. In fact, that was the primary reason for the creation of the clinics. Now we see that other prob- lems are arising within the public schools and giving the educators serious concern. P.D. 117 93 d SS oomi-- CD | ■* t^coco & ooo O O OOO o a o cci'-i^ rt | rH •*.-( W S= 125 £5 cocoi-h i>-*CN coooo o OmcN CO W^< OOCOOa l-H -H .— 1 rH 6 SOtHO cat^co oooo COCOOa •^cooo co coo ■*cot^ t^ CD ■* oa co .i s ^ T-\ | O O 1 O O 1 o jjoil Tf 1 ■* rH | rH w l in p. ^ % -a &S T-HTfHlN COTjtCO CN^CN o3 — 100 Oat^cD £ lOi-HCO iOhn IS? COOCO COCOi-H cocai-n ol t~COCa t-OaOO •fcacD ^HCN—I -d.fi o o t^ OaCD CN CO 00 ^lOO cn woo t~-*oo Ph fc CO'*'-H Nmcq ss 03 i-llQ COOCa COOCO C3 t»O0Tt< WCOtJ< COtHO "S « CDmcD 00 00 00 t~CDt> o3 2 NCOO rHCDt^ oooat-~ cn woo CN OCN Tttino Ph ^ W^HCO •* WCa cacoco CN'-HCO .-H i-H corn w ooo OOO ooo 6£ ooo OOO ooo ooo OOO ooo o H CaCOCN OOaOa OStNrH HDOO COOCD I>Oat^ £ t>Oat~ CDCOCN cornea COH to rH CN lONN a 0> » 2-d SfePCl gtnPQ gfanPa d o d a _o 03 o 03 d 1 03 d 1 03 03 d a 03 W H3 H 03 M 0) O [^ Ph H Eq ts O _S O ju Sa sq Cq <«J a XI § ■ H &H j£ co coco OHC1MOOCOOHCoooooaoot>--*'-H oa o » d >h A! co^'mcot^oooaO'HcNcoTi.oocaO'-i>£; -p 0 H 94 P.D. 117 These, of course, are problems quite apart from retardation, although in some instances there is a combination of retardation and another type of problem. We see now that the clinics are offering a broader and more useful service to the public schools in that they are examining various school and behavior problems which are often the cause of such serious difficulties within the various school systems. (c) Age of School Clinic Cases Examined during the Year 1939, by Sex: Numbers and Percentages. In Table 2 we present the age distribution of all examinations made by the various school clinics during the year 1939. It will be noticed that the substantial numbers start at the chronological age of 5 years with 462 children examined, or 5.7 per cent of the total. Children 6 years of age made up 10.5%. Fewer children were examined in the ages of 7, 8 and 9 years. Children 10 years of age make up 10.6% of the total, and the following two years place even larger percentages, the highest percentage of 11.4 being observed in the 12 year group. There is a steady dropping off at that point in numbers, with children 16 years of age making up 1.6% of the total. In the sexes we note that the highest percentage for the males, that of 11.3%, occurs in both the ages 10 and 11 years. In the females the high figure of 14.3% is noted in girls aged 6 years. It is of interest that in the early examinations at the age of 5, 6 or 7 years the females show much higher percentages than the males. However, in practically all ages from 8 to 15 years the males show higher percentages than the females. Insert Table 2 (d) Intellectual Status of First Examinations, 1939 Table 3 records the intellectual status of first examinations, outlining the distribution of intelligence quotient groups. In interpreting this table it must be recalled that the decisions are not based upon the mental tests alone. The psychiatrist bases his decision on facts resulting from a very complete survey of the child's history and life. This gives a diagnosis which is the result of an accurate evaluating of the personality, the mental and physical characteristics, and the environmental factors. It gives a diagnosis based on the child's reaction to his educational and home environments rather than one based solely upon arbitrary mental tests. Insert Table 3 The first examinations present interesting sex differences. Of the total first examina- tions of boys, 16.9% were diagnosed as mentally defective (I. Q. 0-.69), while 18.3% of the girls fell in this grouping. However, it will be noted that in the dull group the males presented higher proportions than the females. Higher proportions of females are being diagnosed as mentally defective, borderline, normal, and superior. The average I. Q. for both sexes was .83. In .6% of first examinations the diagnosis was deferred. It has been a definite policy of all clinic psychiatrists to defer the diagnosis in doubtful cases. If the psychiatrist doubts the mental status of the child, he defers his diagnosis and requests that the child return for another examination on the next visit of the clinic. (e) Intellectual Status of Re-Examinations, 1939 Table 4 records the intellectual status of all re-examinations, divided into intelligence quotient groups. When the clinics return to the schools for their next visit, the super- intendents assemble the cases in which various factors suggest re-examination. Insert Table-4 While the material is not presented in this table, it is interesting to observe the dis- appearance of conduct disorders when children have been placed in a special class. Children having had a great deal of difficulty in the regular classes show a very favorable reaction when placed in classes suited to their respective mental ages. School superin- tendents have repeatedly told of complete changes in the behavior patterns of children following the placement of the child in a special class. Many of the conduct disorders of these children disappear when they are no longer subjected to the strains and stresses of regular class work in competition with children of higher intelligence. Noticeable sex differences are observed in Table 4. Of the total re-examinations of boys, 32.6% were diagnosed as mentally defective (I. Q. 0-.69), while 43.5% of the girls fell in this grouping. That is, relatively larger proportions of girls were diagnosed as feebleminded among the re-examinations than was noted in the first examinations. However, in the borderline, dull, average and superior groups the males present higher P.D. 117 95 NoooooioooeNieMcoN^wiooi oooooot~ooooast^r^oooot^oot~t>-t~ I I I 00 I I I CO-H I I I I 1 rHi-l | COrtCMCOCO I CM HINBJH HCJHH i-l CM UO OS iH ■* -* OS CO ■* as b- o> os os to to 1 t»'-icoM''*'ratoco'-icoo5toiNrH-* CM tH CO OS to ■* IN O 00 CO ^0000l>t^OiN(N00Ot0rt<-H0001 CO CM CO i-h IN CO CO CM rt 00 I-H -h i-H to C0'*-*'*iOT)-i O'*os>ooor-'*t^'*osoqo0i-n^-'*,ic IN -HIN Hi- iiNi-h ■* to i-i i-i to OOlO-HONiOODOlOOlOMNNOlO tD -* t~ i-H M< CM tO tO i-l CO t- r-i to to ^H -H00Csir^-it -< co m as cs tc co Ttno as m ^« cm I mm I t- oo to to t>. t>. oo to to r~ t-- t- to to f- h- -* Tf t» -* t~ >H ^H t- CO tO tO i-l O I t^oot^i^r^f-oot^t^t-t^t^t^wt^ Tf tOOSOt t^ootot>-t I co l H I I I I I CO I i-H I I I I !>COi-i|CqCt|^'-iC0C0(N'l I tO-*-*t-.tOtOtOCMmCM00C0 I t~ t~ CO —I IN CM i-l m IN -^ i-H OS tO CO I OlOOO-H I 1-ICO I iON*eOfflHO't|ClNSH P g*E- ■3§s|cis2«°oi -«>o^ 96 P.D. 117 proportions. These percentage distributions are reflected in the average intelligence quotient. The average I. Q. of boys re-examined was .75 while that of the girls was .71. (/) Personnel of Clinics, 1939, by Institutions Table 5 gives the names of the psychiatrists, psychologists and social workers who carried on the work of the various traveling school clinics during 1939. At this point the Director wishes to say a word of appreciation for the very fine work which has been done by the various traveling school clinics during the past year. The work of the clinic personnel has been so satisfactory that a complete change in attitude on the part of local school officials has been effected. In the early days of the traveling school clinic work, which began on a state-wide basis in 1921, some resistance was encountered on the part of school officials who were rather doubtful of the usefulness of the clinic work. In that particular period the various clinics encountered many difficulties in the field. Over the past years, however, there has been a quite universal change to a spirit of complete cooperation on the part of school superintendents, school boards and boards of selectmen. These individuals have come to the point of understanding completely the value to the school of the clinic work, and have repeatedly expressed their apprecia- tion of this service. Both the Department and the clinics are very appreciative of the various expressions of commendation which have been received. Insert Table-5 Table 5. — Personnel of Traveling School Clinics, by Institution, for Year Ended November 30, 1939 Psychologist or Institution Psychiatrist in Charge PSYCHOMETRIST Social Worker Belchertown Herbert L. Flynn, M.D. Catherine A. Burnham Dorothy I. Peeso Lulu H. Warner, M.D. Lois R. Macomber Boston Psychopathic Mary Palmer, M.D. Rosemary Mehan — Boston State Margaret R. Simpson, M.D. Ruth Lambert Rose A. Long Mary Foley Danvers Doris M. Sidwell, M.D. Elaine Kelleher Flora M. Remillard, M.D. Norma Monroe Josephine Tinsley — Barbara Foster Marjorie Burnham Foxborough Mary Hammond, M.D. Margaret R. Simpson, M.D. Lillian F. Shapiro — Gardner Janet S. Barnes, M.D. Beatrice N. Wolfson — Grafton Anna C. Wellington, M.D. Emaline L. Kelly Clara E. Barnes — Medfield . Grace T. Cragg, M.D. Esther Poutas Dorothy Parkhurst Edmund M. Pease, M.D. Esther Odell Monson Florence A. Beaulieu, M.D. Dorothy H. Roche Lula P. Hayes Ruth Holmes Northampton . Elizabeth Kundert, M.D. Mabel Martin Caroline Wright Taunton . Olga E. Steinecke, M.D. Bettina S. Everett Mary L. Lynch W. E. Fernald . Esther S. B. Woodward, M.D. Eleanor E. Hobbie — Westborough . Betsy Coffin, M.D. Adelaide Proctor Eda W. Anderson Faith Hawkins Annie Heal Worcester . Lonnie 0. Farrar, M.D. David Shakow Mr. Shakow's Staff Wrentham Charlotte A. Mitchell, M.D. Dorothy R. McLellan Clinic personnel really has a very serious responsibility in making a diagnosis of mental deficiency and in rendering advice which may have a profound effect upon the future life of the child. In all instances the clinic personnel has attempted to make clear to the school and to the family, wherever possible, the details of the situation and the best way in which their advice might be applied. Many difficult and trying situations have had to be met, and the way in which the clinics have handled the many problems has earned the commendation of all concerned. The clinics report annually to the Department the cost of operation during the year. These costs include salaries, maintenance, expenses in the field, traveling expenses, supplies, etc. The average cost of each examination for the year 1939 was found to be $5.83. The total cost for fifteen clinics in conducting 7,971 examinations was $46,530.06. (g) Comparison between Intellectual Status of School Clinic First Examinations and Re-Examinations, 1939 Table 6 shows the percentage comparisons between the I. Q. distributions of the first examinations and re-examinations. We note distinct differences. In the first examina- P.D. 117 97 tions 17.4% of the group were mentally defective, while in the re-examinations 35.5% fell in this classification. We also note that the re-examinations present smaller percent- ages in most of the higher mental classifications. The average intelligence quotient of first examinations was .83, and that for re-examinations was .74 for both sexes. Table 6. — Percentage Distribution of Intelligence Quotient Groupings of School Clinic First Examinations, 1939, by Sex First Examinations Total 0-.69 .70-. 79 .80-. 89 .90-1.09 1 . 10 plus Diagnosis Deterred Average Male . Female 100.0 100.0 16.9 18.3 26.8 27.6 27.9 20.9 23.7 25.7 3.8 6.6 .5 .6 .82 .83 Both Sexes . 100.0 17.4 27.1 25.4 24.4 4.8 .6 .83 Re-Examinations Male . Female 100.0 100.0 32.6 43.5 33.7 31.5 23.1 16.0 9.8 7.3 .4 .1 1.4 - .75 .71 Both Sexes . 100.0 35.5 33.1 21.2 9.1 .3 .4 .74 Within both groups we see a larger percentage of females in the mentally defective classification. Among the first examinations the percentages feebleminded are 16.9 for males and 18.3 for females; in the re-examinations much greater differences are observed with 32.6% for the males and 43.5% for the females. We expect the lower grade cases to return for re-examination, but here we note that the females return in decidedly larger proportions than the males. (h) Comparison between Intellectual Status of School Clinic First Examinations and Re-Examinations, 1928-1939 Table 7 presents the percentage distributions of intelligence groupings in first and re-examinations for the years 1928-1939, inclusive. We note that there appears to be an upward trend in the intelligence of cases coming up for first examinations from 1928 to 1939. The increase in average I. Q. to .79 for 1933 as compared with .74 for 1932 is to be expected inasmuch as problem children as well as retarded children were being referred for examination. The average I. Q. of these first examinations increased from ,69 in 1928 to .83 in 1939. We note also that the 43.8 per cent of mental defectives in 1928 decreased to 17.4% mentally defective in 1939. Even in the re-examinations the intelligence quotients have increased. In 1928 the average I. Q. of children re-examined was .66, and this increased to .74 in 1939. In 1928, 54.8% of children re-examined were mentally defective. In 1939 only 35.5% were mentally defective. These figures demonstrate the expansion of the service rendered by the traveling school clinic and point out that each year larger numbers of conduct and behavior problems are contributing to retardation than have been observed in previous years. (,/) First Examinations, Re-Examinations and Subsequent Recommendations of Psychiatrists, School Clinic Examinations, 1939, by Place of Residence and Sex. Table 8 reveals that a total of 7,971 examinations were conducted by all clinics during the year 1939. Of these, 5,702 or 71.5% were first examinations and 2,269 or 28.4% were re-examinations. The sex difference is noticeable in that 5,379 or 67.4% of all examinations were males and 2,592 or 32.5% were females. Of all examinations 1,813 or 22.7% were recommended for special classes: 22.9% of the males and 22.2% of the females. Three hundred sixty-six or 4.5% of the total were recommended for placement within a state school: 3.9% of the males and 5.8%) of the females. Those recommended for social supervision numbered 975 — 12.2% of the total, and 1,102 or 13.8% of cases were in need of coaching in special subjects. A total of 1,813 children were recommended for special class care in Massachusetts during a single school year. As the total in special classes in the towns having first examinations during 1939 is now 5,580, we can see the great need for additional special class provision. 98 P.D. 117 Table 7. — Intellectual Status of School Clinic First and Re-Examinations for the Years 1928-1939 First Examinations Total 0-.69 .70-. 79 .80-. 89 .90-1.09 1 . 10 plus Diagnosis Deferred Average 1928 Number . Per cent . 4,916 100.0 2,150 43.8 1,206 24.5 769 15.6 327 6.6 16 .3 448 9.1 .69 1929 Number . Per cent . 4,923 100.0 1,772 35.9 1,437 29.1 722 14.6 407 8.2 34 .6 551 11.1 .73 1930 Number . Per cent . 5,224 100.0 2,025 38.7 1,569 30.0 799 15.2 362 6.9 23 .4 446 8.5 .72 1931 Number . Per cent . 5,015 100.0 1,610 32.1 1,536 30.6 960 19.2 371 7.4 16 .3 522 10.4 .73 1932 Number . Per cent . 4,461 100.0 1,377 30.9 1,336 29.9 928 20.8 395 8.9 19 .4 406 9.1 .74 1933 Number . Per cent . 6,569 100.0 1,571 23.9 1,609 24.5 1,365 20.8 1,209 18.4 180 2.7 635 9.7 .79 1934 Number . Per cent . 6,445 100.0 1,459 22.6 1,563 24.2 1,303 20.2 1,177 18.3 153 2.4 790 12.3 .79 1935 Number . Per cent . 6,636 100.0 1,371 20.7 1,893 28.5 1,688 25.4 1,446 21.8 182 2.7 56 .9 .81 1936 Number . Per cent . 6,468 100.0 1,372 21.2 1,872 28.9 1,535 23.7 1,362 21.1 285 4.4 42 .7 .81 1937 Number . Per cent . 6,266 100.0 1,191 19.0 1,714 27.3 1,526 24.4 1,506 24.0 273 4.4 56 .9 .82 . 1938 Number . Per cent . 5,917 100.0 1,015 17.1 1,645 27.8 1,515 25.6 1,477 25.0 232 3.9 33 .6 .82 ' 1939 Number . Per cent . 5,702 100.0 993 17.4 1,548 27.1 1,454 25.4 1,395 24.4 277 4.8 35 .6 .83 Re-Examinations 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 Number Per cent Number Per cent Number Per cent Number Per cent Number Per cent Number Per cent Number Per cent Number Per cent Number Per cent Number Per cent Number Per cent Number Per cent 1,370 100.0 1,336 100.0 1,303 100.0 1,424 100.0 1,618 100.0 2,087 100.0 1,792 100.0 2,087 100.0 1,918 100.0 2,039 100.0 2,180 100.0 2,269 100.0 746 54.8 357 26.1 158 11.5 56 4.0 2 .1 51 3.8 624 46.7 367 27.4 179 13.3 70 5.2 8 .5 88 6.5 648 49.7 390 29.9 165 12.6 48 3.6 1 .07 51 3.9 664 46.7 430 30.2 208 14.6 38 2.7 1 .07 83 5.8 734 45.4 539 33.3 201 12.4 53 3.3 - 91 5.6 973 46.6 588 28.2 290 13.9 97 4.7 3 .1 136 6.5 725 40.4 539 30.1 234 13.1 83 4.6 3 .2 208 11.6 787 37.7 695 33.3 425 20.4 166 7.9 6 .3 8 .4 763 39.8 630 32.8 350 18.2 143 7.5 17 .9 15 .8 743 36.4 653 32.0 438 21.5 173 8.5 13 .6 19 1.0 832 38.2 755 34.6 419 19.2 153 7.0 8 .4 13 .6 807 35.5 753 33.1 482 21.2 208 9.1 8 .3 11 .4 Several interesting sex differences are demonstrated in Table 8. In the total children coming up for examination the boys outnumber the girls in a 2:1 ratio. In the first examinations the ratio is 1.8:1. 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CO CO IN CO O IN CM CO t- as O IN US O IN CM CO CO CO CO CO IN CO iO h I •H * |i i-HIN i-Hi-Hi-H I *4 | i-h I I tJI I ,-HtH CO I 00-HCOtH 1 OHHrtH | COCO I IN 1-4 U5 CO I i-H i-l CM iH | CO I I TJH cp>. CDCOiO I "50H I Ol I N I I Tf< COCNJNCOOCO CO00M< CO t> H i-H CO IN CO "* i-H l-H l-H mio I m I io I I INTJH ,-H tH ■-H I I IN l-H 00 i-H IN l-H I CO i-H I-H I i-H I IO I I I | H UJ | N 1 i-H | | S-P .fe PHCP ^&H^mHPO^^pRO^H2^?PSt-iS§fepqc-iPHm b- g tf.vii ••*!-•! *--B$ l&li 1^| Ja|!||^illl||flll||^Hl S3 -h H «> iTi0-d ■a»?k*s^nHli-°Hwo a J 5c«E«; > „Q > a >o3.1ij2^H c, to o !>, cSrtrtrfrtcjrtrtajojajiuiijiDajQjaia^i^ajiuaj-d-c!^.^ P.D. 117 113 MOOrt 1 on OS OJWrtO IN iH -H | COCOCO 1 o OS ©CNCO CO ■* cocor-cooo OS ooco-hcnco© to CO iHiH 1 1 1 oo I 1 CN CN 1 1 1 l> 1 ,_, a CO 00 CM 1 1 1 «5 1 . ,_, "5 rr t-»-H(N«0 1 1 00 l> oo . to OSTflCSi-l CO CO CO CNCN^t< IN CO o CO . • Pq . Gard Wren . Med. . W.E. . Bel. . 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M to— -h ."5 to Qpq 03 03 . o.d 5 d'a'Sr'J 3-rt -if 03 o ow fi o - a g k >i-§£|£|5das £t;.c 3 if* 2 a s> > cm S»K.3 — o ^ 1-H H On 114 P.D. 117 One hundred twenty-one towns maintaining 354 special classes accommodated 5,580 children in these classes, an average of 15 children per class. Comparing this total of 5,580 children in special classes with the total school population of 305,353, we note that 1.82% were in special classes during the year 1939. The 97 towns not maintaining special classes revealed a total grammar school population of 31,253 children. In these towns a total of 741 children were referred to the clinics as retarded, and there appear to be no special classes available for their instruction. A total of 5,702 children were referred to the clinics for the first time during 1939. In other words, 1.69% of the total school population were referred during a single school year. Dividing the 1.69% of the total school population referred in accordance with diagnosis, we note that .30% were diagnosed as mentally defective and 1.39% as not mentally defective. This demonstrates that the ratio of not mentally defective children to mentally defective children is 4:1. That is, the mentally defective child is not alone in having difficulties in the public school. Other children with varying degrees of intel- ligence between mental defect and normal have difficulties in meeting the requirements of the school curriculum. We may say in general that we are viewing the first steps of special class development. The schools listed as having special classes are simply pioneers in the establishment of a specialized service for children below average in intelligence or adjustment. The special classes of today are simply taking care of the outstanding cases of mental retardation. There is evidence piling up on all sides which would lead us to believe that the present special class organization is simply a nucleus about which an expansion program should be built. The findings of this report show that for every mental defective failing in school work we have, in addition, four children of higher mental grade who do not make a success of their school work. The population of our special classes is made up of cases of obvious mental deficiency. The question arises: Are we to leave the large number of high grade cases in the unhappy half-way position between the special class and the regular class without adequate or understanding provision for their training? We have found that it is quite difficult to have unusual children coached in special subjects in the regular public school classes. Lack of evenness in accomplishment in the various school subjects is quite commonly observed. Some of our public schools have made no provision for the outstanding cases of mental deficiency which obviously should be segregated for special training. Others have pro- vided these special classes, and have seen a remarkable reduction in the difficulties observed in the regular classes, and an acceleration of the progress of the regular classes. Some schools have gone further and have added sufficient classes to enable them to classify their retarded children by both chronologic age and mental age. This is a step in the right direction, but there is still a great unexplored field in the provision of special classes for the borderline cases. Large numbers occur in these groups, and yet no ade- quate provision for their care is being made at the present time. We observe that 1.69% of the total school population served by our clinics were referred because of retardation during 1939. This figure does not cover the total number of cases of retardation which have accumulated in the particular schools. These are first examinations of a single year only. Some of the children may be referred as retarded at the age of nine years or earlier and others may become retarded between the ages of nine and sixteen, the age of leaving school. Consequently, the total number of cases of retardation is subject to an accumulation over 9 years. We note that the percentage of .30% of the total school population diagnosed as mentally defective is small in pro- portion to other estimates of the incidence of mental defect. Again, we must recall that this, too, is a figure for a single year, and that the actual accumulated number of mental defectives within the school system is much higher. The previous paragraph outlines the fact that the proportions of children diagnosed as mentally defective and children diagnosed as retarded (not mentally defective) for any one year are quite small in relation to the total school population. Inasmuch as the clinics are finding practically the same proportion of children retarded each year, it is necessary to consider the accumulation of cases that is occurring year after year before arriving at a total figure. The determination of this total number of retarded or mentally defective who have accumulated in a school at any one time is rather difficult. There- fore, we determined to use a different approach, and compare the new cases of retardation or mental defect diagnosed during one year with the new cases entering school during the P.D. 117' 115 same year. We recorded the number of children actually within the first grade of the various schools, the new cases of retardation and mental defect diagnosed the same year, and calculated the percentage. The total figure for children entering the first grade is not typical of all grades, but is higher than the total entering other grades. Consequently, the resulting rates will be smaller but the error will be on the side of conservatism. It was found that there was a total of 38,183 children in the first grades of those schools in which first examinations of retarded children were held during the year 1939. We may say that this represents the approximate number of new students entering these schools during a single year. We have observed in previous tables that a total of 5,702 children were referred to all clinics because of retardation for the first time during the year 1939. Comparing this total of 5,702 with the 38,183 new students entering the schools, we find that new cases of retardation and mental defect discovered during 1939 are 14.9% of the number entering school during the same year. That is, when we com- pare the new cases of retardation discovered during a single year with the new children entering school for the same year, we find that one child in six is retarded in some degree. Dividing the mental defectives from those merely retarded, we note that the new cases diagnosed as mentally defective during a single year are 2.6% of the number of children entering school for the first time during a single year. The new cases diagnosed as retarded (not mentally defective) constitute 11.2% of the number of children entering school for the first time. All of this, of course, is for the year 1939. We feel that thes& percentages of 2.6 for mental defect and 11.2 for retardation give us a much better picture of the relative amounts of these conditions actually present in our school systems. There is nothing to be gained in discussing the differences in the number of retardates and mental defectives observed in the different towns. Some of the larger percentages are observed in towns which are having an examination for the first time. In these instances the children referred for first examination represent an accumulation of re- tarded children over a period of years. The smaller numbers are observed in towns which have been having these examinations every year. In other instances the small number of cases referred is a matter of selection on the part of the superintendent. In the long run we may say that the higher rates for retardation observed in particular schools indicate simply the active interest of various superintendents in the problem of retardation, and a comprehensive understanding of the necessity of special class care of backward children. They are referring all of the children who are becoming retarded in their particular school systems. The reasons for the smaller numbers presented by some of the towns are more or less subject to conjecture. We get some idea of the necessity for enlargement of our special class provision in the figures presented for this one year. We note that 121 towns have provided a total of 354 special classes caring for 5,580 children. Referring to Table 8, we note that a total of 1,813 children were recommended for special classes during 1939. That is, about one third of the school rooms now devoted to special classes will be needed to take care of the new cases recommended for special class care in 1939. We see the urgent need for increasing the number of special classes now available. III. Central Registry for Mental Defectives In 1919 the Legislature amended Chapter 123 of the General Laws establishing a registry for the feebleminded. This law was amended in 1936, and now reads as follows: Chapter one hundred and twenty-three of the general Laws is hereby amended by striking out section thirteen, as appearing in the Tercentenary Edition and inserting in place thereof the following: — Section 13. "The department shall establish and maintain a registry of mental defectives, and may report therefrom such statistical information as it deems proper; but the name of any person so registered shall not be made public except upon written request therefore, to public officials or other persons having authority over the person so registered, or to chari- table corporations incorporated in this commonwealth and subject to section twelve of chapter one hundred and eighty, and the records constituting the registry shall not be open to public inspection." (Approved May 22, 1936). Dr. Walter E. Fernald for many years had expressed great interest in the carrying out of such a registry, feeling that it would give invaluable information as to the com- munity problem of mental defect and would provide opportunity for the building up of a satisfactory plan for the care of such cases. 116 P.D. 117 In 1922 institutions under this Department started sending in cards to the Registry, reporting all mental defectives examined by their traveling school clinics. For many years the traveling school clinics constituted the sole source of information on mentally defective children. In 1929 and 1930 the present Director of the Division undertook the expansion of this work with the thought of bringing into use other sources contacting mental defectives in the community. Up to that point little attention had been given the mental defectives admitted to or cared for by mental hospitals. In addition, there had been no uniform reporting on admissions to our state schools for mental defectives. Arrangements were made to have all cases of this type reported by mental hospitals, state schools and several other clinics. Each year following, additions have been made to the number of sources reporting mental defectives to the Central Registry. At the present time we are receiving reports on mental defectives from (1) traveling school clinics; (2) admissions to state hospitals; (3) admissions to state schools; (4) cases placed on the waiting lists of state schools; (5) defective delinquents examined by hospital and Department psychiatrists; (6) out-patient examinations of state hospitals; (7) out- patient examinations of state schools; (8) mental hygiene clinics; (9) habit clinics; (10) child guidance clinics; (11) adjustment clinics; (12) defective delinquents admitted to Bridgewater; (13) mentally defective prisoners examined under the Briggs Law; (14) cases referred to the Division of Mental Deficiency; (15) cases examined by the Division of Mental Hygiene; (16) children examined by the psychological clinic of the Springfield schools; (17) cases referred to the Massachusetts Society for the Prevention of Cruelty to Children; and (18) the New England Home for Little Wanderers. (a) Type of Contact in Mental Defectives Reported to Central Registry, 1939. Table 12 reports the type of contact in cases reported to the Central Registry during 1939. Reports were made by thirteen state hospitals; three state schools; the Depart- ment for Defective Delinquents at Bridgewater; Department of Mental Health (Briggs Law examinations); Division of Mental Deficiency, D. M. H.; Division of Mental Hy- giene, D. M. H.; the Springfield public schools; the M. S. P. C. C; and the N. E. Home for Little Wanderers. The largest number of cases was reported by the Wrentham State School, 688. Fernald with 622 and Belchertown with 493 also reported large numbers. In the state hospitals Monson reported the largest number, 378; Dan vers was second with 301 ; and Taunton third with 297. The Springfield schools have been very coopera- tive and reported a total of 108 children examined in their psychological clinics during the year. Other clinics reporting were the M. S. P. C. C. with 22, and the N. E. Home for Little Wanderers with 4. Insert Table 12 Our reports came from clinics of many different types. The fifteen traveling school clinics operating in the public schools furnished the largest number of defectives with a total of 1,878. Admissions to state hospitals were second in order with 575 children reported. Admissions to state schools were third with 551 cases reported; waiting lists of state schools, fourth with 285; out-patient examinations of state schools were fifth in order with 248 cases; and Defective Delinquents with 237 were sixth. These cases are examined through the law requiring the examination of juvenile delinquents or through admission to the Department for Defective Delinquents at Bridgewater. (b) Age, I. Q., and Sex of Mental Defectives Reported to Central Registry, 1939 Table 13 outlines the age of cases reported to the Central Registry during 1939 by intelligence quotient and sex. Of the total of 4,144 cases, 2,439 or 58.8% were males and 1,705 or 41.1% were females. In the school clinic cases also we had greater amounts of retardation among the males. Here, however, we see that this same sex proportion persists only up to the age of 20 years. Over the age of 20 years the females are showing larger numbers of cases reported to the Central Registry. In discussing the intelligence of cases reported, we observe that there are comparatively few cases in the lower I. Q. groupings. Substantial numbers are not encountered until we reach the .40-49 and .50-59 groups. This, of course, is to be expected as the general population shows this same general distribution. We know that there are many more persons in the community with an intelligence quotient between .60 and .69 than there are with intelligence quotients between 0 and .09. Therefore, we may expect to draw more of these higher grade cases in those being reported to the Central Registry. 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OtOOscOtO"5COtOTf lO © o t-OOOOiOOO^iOrf^i c < ft CNiOcOi-l'H t~ © « rt 1-1 _ osootocoioooooosco OS o ©a 0 s COt~COlNtOI>COTf co •*OU5i-l T © o so H cm" Os OS^t"OCDi-iCO'*'Ot>. ■* o "§ H cotocNr~ioososos -f ih t~- to oo co i-i © S~ o ^ o © "e so V © R. to C£ 00 SO 00 e O ^ © co ©s c 1 C I. a 5 co 4 5 H «! ►h « >>>>>>, >>>>>> « | ■^OSTfOSOBOSOS.2 C3 o CO ft EH rH i-i CN CO r(i n, v 0«30U30000£ i-i i-i CN CO •* iC h-3 CO-hOO^CNOsiCOCO — 1CN -h-h i-H -HCOcNLOcOt^Mi'H^ HNHilH -H CNCO-*CNO0t~COCN 00 O O OS OS 00 lO "* CNI>iOCOCN'O'H00i-i O to Tf -* CM i-i OOOO00*OOh I-HCOSOSOSIOCNCN O 00 o co •* CO iH IfJ -i m CO cm m rH "* -i- CS I I .- cj 03 C3 03 O a "o >> >> T CS > ro ra w ^ i ' US « 0J >> L; sos os os^ d h CM CO Tti p,^ E-l PL, O«50i0000o5 — I i-i CM CO ■* Ui P 118 P.D. 117 In practically all I. Q. groups the excess of males noted in the totals is to be observed. The sex differences appear to be becoming more marked as we go higher in the intellectual scale. There are being relatively fewer high grade females reported to the Registry or, vice versa, there are relatively more males reported as we go higher in the intellectual scale. (c) Percentage Distribution of Age Groups in Mental Defectives Reported to Central Registry, 1939 Table 14 gives us a percentage distribution of the ages condensed from Table 13. Surprisingly large numbers of children are being reported at comparatively young ages. Thus in Table 14 we have 69 males and 70 females 4 years of age or less; 478 males and 286 females were between the ages of 5 and 9 years; 1,036 males and 589 females were between the ages of 10 and 14 years. From this point on we see a sharp dropping off in numbers. During the school period the intelligence of children is subjected to closer scrutiny and, therefore, we may expect larger numbers during the school ages. The cases examined under 4 years are reported, of course, by the various habit, child guidance and adjustment clinics dealing essentially with younger children. We note that the males predominate in cases reported in the groups 19 years or younger, 86% of the males and 76% of the females falling in these ages. Over 19, the females show larger percentages. In the group 20-29 years they present 10.9%, with 6.7% for the males; in the group 30-39 years 6.7%, and 3.1% for the males. It appears that the male mental defectives are reported to the Central Registry in the younger ages while the females show a tend- ency to a greater scatter throughout the age groups. There is a greater chance that male mental defectives will have their intellectual capacity interfere with their success in younger ages and thus bring them to the attention of various examining or reporting agencies. It is apparent that the female mental defectives tend to show greater success in the community and postpone the discovery of their defect until they are considerably older. Table 14. — Age of Cases Reported to Central Registry for Mental Defectives, 1939, by Sex: Numbers and Percentages Age Group Total No. % Male No. Female No. 0- 4 years 5- 9 years 10-14 years 15-19 vears 20-29 years 30-39 years 40-49 years 50 plus years Unknown . Total 139 764 1,625 876 351 193 94 95 7 3.3 18.4 39.2 21.1 8.4 4.6 2.2 2.2 .1 69 478 1,036 523 165 78 38 49 3 2.8 19.5 42.4 21.4 6.7 3.1 1.5 2.0 .1 70 286 589 353 186 115 56 46 4 4.1 16.7 34.5 20.7 10.9 6.7 3.2 2.6 .2 4,144 100.0 2,439 100.0 1,705 100.0 It is an interesting commentary on our present day civilization that a total of 4,144 cases of mental deficiency were reported to the Central Registry during a single year. This is at a rate of 93 per 100,000 of the general population. The admission rate to our state schools for mental defectives for the same year was 6 per 100,000, while the rate for cases in residence in state schools was 118. The numbers and proportions of cases being reported as mentally defective give us some idea of the possibilities for the future as far as mental deficiency is concerned. Quite obviously the State cannot assume the care of all these defective children, and yet there is a rather good chance that many of them will be failures unless given a helping hand during the school period and the years immediately following. We see here the need for a state-wide supervisory group interested in and understanding the many problems connected with mental deficiency and retarda- tion. The community adjustment of mental defectives is rarely accidental. It means intelligent direction and supervision at the hands of understanding persons. Otherwise, the economic load of caring for many thousands of failing mental defectives may become unbearable. P.D. 117 119 IV. Research in Mental Deficiency In October, 1926, the Division inaugurated a research project in mental deficiency based upon the school clinic examinations. In December, 1926, a research worker was obtained to carry on the project. The worker visited the various institutions and recorded the findings of the various school clinic examinations. A recording code was elaborated and a code sheet printed. In 1929, however, the Department replaced the code sheet with a printed statistical machine card which saved a great deal of time and effort in the recording of data. The analysis of this material was made possible through the utilization of the new statistical system established by the Department. The Division research cards are punched and sorted by the machines in the Statistical Division. A single research worker is available for this work. Inasmuch as the material available now involves over 46,000 cases, it is extremely difficult to publish the results of this work as rapidly as might be desired. In 1938 the code was revised. It was felt desirable that the clinical diagnoses on the school clinic code should agree with those on the state school statistical code, which was based on the Standard Classified Nomenclature of Disease. Height and weight standards were also altered. Consequently, in addition to coding current records, the worker has corrected 6,784 old cards to agree with these changes. As a total of over 122,098 examinations are now available, it is also highly desirable that the coding work be continued so that this rather remarkable sample might be sub- ject to a thoroughgoing analysis. One additional worker should be made available for this research project in order that it may be completed. At present the new examinations completed each year are more than one worker can possibly cover. Table 15. — Statistical Survey of Cases — Division of Mental Deficiency Social Service — Year Ending November 30, 1939 I Status — December 1, 1938: Committed cases 22 Voluntary cases 330 — 352 II Cases referred during the year: Referred by public agencies 57 Referred by private agencies 20 Referred by Dept. of Mental Health 8 Referred by individuals 8 Reopened from previous years 3 III Type of cases referred for social supervision : 1. Wage earning . 20 2. Special class 26 3. Home Training 22 4. Boarding out 6 History 3 Investigation 19 96 IV Nature of service rendered: Investigation of homes 52 Placement in homes 34 Removal from homes 24 Arrangement for dental and medical care 83 Arrangement for recreation . 117 School adjustments 38 Home adjustments and home training lessons 150 History 22 Investigations • 24 Incidental services 269 V Cases closed during the year: Cases referred to public agencies 23 Cases referred to private agencies 5 Cases unable to locate 19 Cases committed to institutions 12 Investigations for Department 11 Cases not supervisable 28 Cases satisfactorily adjusted 38 136 VI Status — November 30, 1939: Committed cases 21 Voluntary cases 291 312 Summary of visits — Three Workers 1,957 120 P.D. 117 V. Social Service Cases are referred to the Division of Mental Deficiency by child guidance clinics, traveling school clinics, public and private agencies, by the Department and by indi- viduals. Each case is studied carefully and a selected group becomes eligible for : I. Supervision under commitment. Cases are under legal status authorizing the Department to supervise in the community for an indefinite period. II. Voluntary supervision. Cases not requiring commitment but which need our services in adjusting to community living. III. Special cases include investigations for the Department; such as, histories for prison cases, cases referred from outside the state, etc. Records kept for both committed and voluntary cases include: (1) History, (2) Inves- tigation, (3) Social case work, (4) Social analysis. During the year 1939 the Division of Mental Deficiency had 488 cases under its super- vision (Table 15). Of these cases, 136 were closed as follows: 23 to public agencies; 5 to private agencies; 19 moved, address unknown; 12 committed to institutions; 11 inves- tigated for Department; 28 not supervisable or application withdrawn; 38 adjusted satisfactorily in community. These 38 patients have reached the point where they appeared capable of "carrying on", in most cases having been under the guidance of the Department for a number of j^ears. One girl was discharged as she had been super- vised for some time and proved capable, honest and reliable. It was felt she could be self-supporting and make good without further supervision. It is interesting to note that she still consults her social worker. New cases referred for social supervision during the year classify as follows: 20 wage earning; 26 special class; 22 home training; 6 boarding out; 3 history; 19 investigation. Under Service Rendered the following was accomplished: 52 homes were investigated; 34 cases were placed in homes; 24 cases were removed from homes; 83 cases received medical and dental care; 117 cases, recreation arranged for; 38 school adjustments; 150 home adjustments and home training lessons; 269 incidental services including shopping. The three visitors connected with the Division made 1,957 visits. Of these 716 were made to patients; 498 were made to relatives and interested friends; 348 were made to employers; 297 were made to agencies; 98 were made to clinics. The Home Training for the children of very low mental ages who are living in their own homes has been continued with very successful results. This work was described in detail in the 1938 Annual Report. Both private and public agencies are interested in this field and there are about forty children receiving the Home Training lessons at the present time. During the past year, the Division has been fortunate in finding a training home for girls who have left special class but are not yet ready to become wage earners. They average in age from sixteen to twenty and are trained in routine housework, cooking, and the care of children. The home is situated in a rural section of a progressive town where there are many church activities and a 4-H club. This affords a normal atmosphere with wholesome recreation for these girls. As time goes on more communities are aware of the need of planning for and working with these handicapped people in their midst. We have found that even the low grade child, under training adapted to his needs, may become at least a socially accepted member of his own household and a happier human being. May we not then look for- ward to doing greater things in bringing out inherent capacities and desirable traits in others who classify as mental defectives? An illustration of how much a community can do in a plan for a mentally deficient girl follows: 1. Social worker from Division interviewed special class teacher re a possible candidate for supervision by Department. Visitor gave teacher a typed program telling her in detail what our work is and what our objectives are. School agreed to keep girl until plan was made for her. 2. Special class teacher showed program to minister of church which girl attended. This aroused his interest and he asked to keep program. 3. Public agency helping family interviewed. It was felt by agency and social worker that girl should be removed from her home as a very undesirable older sister was returning to the home and mother was away during the day. Mother was not P.D. 117 121 willing to consider plan to remove girl from home at this time. The public agency was finally able to persuade the mother with the help of the minister. 4. Girl examined at a State school clinic. Taken to clinic by special class teacher. Girl found physically fit and community supervision recommended. 5. Public Welfare worker explained case fully to local judge. Girl committed to the Department of Mental Health. 6. Minister found a home where woman was willing to train the girl. In this instance the social worker interested a teacher in a program for mental defec- tives. The teacher interested the girl's pastor. The public agency cooperated by arrang- ing commitment to the Department of Mental Health. The judge in this case has shown keen interest. The State schools helped by arranging for the examination of the girl to determine her eligibility. A private agency was contacted in regard to placement of the girl and became interested, too, in the program. Besides the agencies involved, the local church people supplied uniforms for the girl, and lest she become homesick, the pastor telephoned or saw her during her first weeks away from her home. Even if this girl should not prove one of our "successes" she will have aroused a whole community to work together to give her the chance she needed to bring out her potentialities and help her to become a self-supporting member of her community. VI. Analysis of Waiting Lists of All State Schools, 1939 In 1929 the Division assumed a new duty of assembling statistical data in reference to the waiting lists comprising urgent applications to the three state schools for the mentally deficient. A brief code was outlined embracing descriptive data on these wait- ing list cases. The superintendents of the three schools reviewed their applicants, elim- inating all cases not considered as urgent. They then filled out a code sheet for each urgent case as of the date July 1, 1929, and forwarded these to the Division. The Sta- tistical Division then transcribed the information from the coded sheets to punch cards, and subjected the material to analysis. The waiting lists are kept up to date at all times. Each month the state schools forward to the Division their code sheets for all new cases placed on the waiting list during the month. They also send in lists of all cases withdrawn from these waiting lists for any reason whatsoever. This enables us to keep the lists balanced at the end of each calendar month. Punch cards are then made up for new cases and filed pending further analysis. The descriptive material presented is of incalculable value to the Department in deter- mining the type of expansion program to be adopted. A few facts resulting from the analysis are presented in the following summary: On November 30, 1939 there were 123 cases on the waiting list of the Belchertown State School, 1,491 cases on the waiting list of the Walter E. Fernald State School, and 1,253 cases on the waiting list of the Wrentham State School. The total number on the waiting lists for the three state schools was 2,867. Of these, 48.2% were males and 51.7% were females. Table 16. — Cases on the Waiting List of the Three State Schools on November 30, 1939, by County and City or Town of Residence County and City or Town of Residence Number County and City or Town of Residence Numb er County and City or Town of Residence Number Barnstable . 38 Pittsfield . 9 Raynham 1 Sheffield . 1 Rehoboth 3 Barnstable 7 Washington 1 Somerset . 2 Bourne 1 Williamstown . 3 Swansea . 2 Brewster . 1 Windsor . 1 Taunton . 23 Chatham 1 Westport 4 Dennis 6 Bristol . 238 Falmouth 10 Dukes . 2 Harwich . 1 Attleboro 12 Mashpee . . 2 Berkley 2 Edgartown 1 Orleans 3 Dartmouth 5 Gosnold . 1 Provincetown . 5 Dighton . 1 Yarmouth 1 Easton Pairhaven 6 7 Essex 284 Berkshire 23 Fall River 65 Amesbury 8 Freetown 1 Andover . 10 Adams . 2 Mansfield 13 Beverly . 9 Cheshire . 1 New Bedford 83 Boxford . 1 Great Barrington . 4 North Attleboro 6 Danvers . 9 North Adams . 1 Norton 2 Georgetown 1 122 P.D. 117 Table 16. — Cases on the Waiting List of the Three State Schools on November 30, 1989, by County and City or Town of Residence. — Concluded County and City or Town of Residence Number County and City or Town of Residence Number County and City or Town of Residence Number Gloucester Groveland Hamilton Haverhill Ipswich Lawrence Lynn Manchester Marblehead Merrimac Methuen Middleton Nahant Newburyport North Andover Peabody . Rockport Rowley Salem Salisbury Saugus Swampscott Franklin Bernardston Buckland Conway . Deerfield . Gill . Greenfield Hawley Montague Orange Shelbourne Shutesbury Wendell . Hampden Agawam . Chester . Chicopee . Hampden Holyoke . Ludlow Palmer Springfield Westfield West Springfield Hampshire Amherst . Belchertown Chesterfield Easthampton Granby Huntington Northampton Ware Middlesex Acton Arlington Ashby Ashland Ayer Bedford Belmont Billerica Boxborough Burlington 14 Cambridge 1 Carlisle 1 Chelmsford 29 Concord . 8 Dracut 46 Everett . 50 Framingham 2 Hudson 2 Lexington 2 Littleton 12 Lowell 1 Maiden 1 Marlborough . 18 Maynard 3 Medford . 14 Melrose . 2 Natick 1 Newton 28 North Reading 1 Pepperell 6 Reading . 4 Shirley . Somerville 20 Stoneham Tewksbury 1 Townsend 2 Wakefield 2 Waltham 1 Watertown 1 Wayland . 1 Westford . 1 Weston 4 Wilmington 2 Winchester T i 3 Woburn Nantucket 40 Nantucket 1 Norfolk 3 8 Avon 1 Bellingham 6 Braintree 1 Brookline 1 Canton 15 Cohasset . 3 Dedham . 1 Foxborough Franklin . 23 Holbrook Medfield . 3 Medway . 7 Millis 1 Milton 2 Needham 4 Norwood . 1 Quincy 3 Randolph 2 Sharon Stoughton >43 Walpole . Welles! ey 1 Westwood 14 1 1 2 2 Weymouth Plymouth Abington 11 Bridgewater 2 Brockton 2 Duxbury . 2 Hanover . 81 Hanson . 2 Hingham 4 Hull 2 Kingston .... 1 Lakeville .... 27 Marion . . . . 15 Middleborough 9 Norwell . 5 Plymouth 1 Rockland 51 Scituate .... 45 Wareham 11 West Bridgewater . 4 Whitman 41 15 Suffolk 11 37 Boston . . . . 1 Chelsea . . . . 2 Revere . 7 1 53 Winthrop Worcester 10 70 Athol . . . . 2 Auburn . . . . 13 Barre . . . . 23 Blackstone 21 Boylston . 1 Brookfield 1 Charlton . . . . 1 Clinton . . . . 6 Fitchburg 15 Gardner . . . . 16 Grafton . Harvard . . . . 1 Holden . . . . Hopedale 1 Lancaster Leicester . . . . 55 Leominster Milford . . . . 4 Millbury . . . . 2 Northbridge 9 North Brookfield . 12 Oxford . 5 Phillipston 1 Royalston 8 Shrewsbury 3 Southborough 6 Southbridge 1 Sterling . . . . 2 Sturbridge 3 Sutton . . . . 2 Templeton 8 Upton . . . . 7 Uxbridge .... 11 Warren . . . . 36 Webster . . . . 6 Westborough . 6 Westminster . 4 Winchendon . 5 5 1 Worcester Non-Residents 8 Unknown 01 9 Grand Total 14 27 3 3 Table 16 outlines the number of cases on the waiting lists of our three state schools in accordance with place of residence. Residents of Suffolk County show the largest number of cases on the waiting lists with a total of 791. Middlesex County is second with 643; Worcester third with 299; and Essex County fourth with 284. The smallest numbers on the waiting lists are presented by Nantucket with 1 case, Dukes with 2, and Berkshire and Hampshire with 23 cases each. P.D. 117 123 In reviewing the reasons for the urgency of admission, we note that retardation was the cause of application in 70% of both sexes together. Behavior was the primary reason in 5% for both sexes. Marked physical defect was the reason in 1.1% of cases, and .2% were social problems. With regard to the intelligence quotient of children on the waiting lists, we note that the males exceeded the females in the imbecile group (males 25.6%, females 24.3%), and the not mentally defective group (males 7.1%, females 6.0%). The females showed a higher percentage than the males in the moron group (females 31.2%, males 25.4%). In reference to the ages of applicants on the waiting lists, 80% of the males were under 15 years of age, while but 60% of the females fell in this group. In the age group 15-19 years 12% of the males and 19% of the females were reported. But 3% of males are placed on the waiting lists at ages of 20 years or over, as against 16% of the females. Twenty-one cases on the list were 40 years of age or over. These cases make up .4% of the males and .9% of the females. It is clear that many of the mentally defective boys get into difficulties under 15 years of age. The girls have more difficulties in the older ages. A study was also made of the source of application by county of residence, and com- pared with the estimated population of these counties in 1939 (Graph II). The highest rate of applications per 100,000 of the population was observed in Barnstable County with a rate of 94 applicants. Suffolk was second with 84; Middlesex third with 65; Bristol fourth with 64; and Plymouth and Worcester fifth with 59. Essex, Norfolk, Franklin, Dukes, Hampshire, Nantucket, Berkshire and Hampden presented the lowest rates with 55, 45, 38, 31, 30, 29, 18 and 12 persons on the application list per 100,000 of the population of each county, respectively. Graph II. — Residence of Applicants on Waiting Lists of State Schools, 1939: Rates per 100,000 Estimated Population of Same County The total of 2,867* on the waiting lists of the three schools indicates the urgent need for the enlargement of our present schools and the construction of an additional institution to care for these mentally deficient individuals. *This total is revised monthly with consideration of all withdrawals and new additions during the month. 124 P.D. 117 VII. Recommendations Every three months the Division prepares a detailed analysis of the waiting list of each state school and presents it to the superintendent of the institution for his informa- tion. Our analyses of the waiting lists for admission to the three state schools have demonstrated the need for increases in institutional provision for mental defectives. The total of 2,867 cases on the waiting lists indicates an urgent need for the enlargmeent of existing facilities and the construction of an additional state school to care for mentally defective individuals now in the community. The rate of increase in the number of new and unsuccessful applicants for admission each year is so high that the foregoing con- clusion is inescapable. In 1938 only 280 children could be admitted to our three state schools, and in 1939 only 308, whereas 453 were admitted in 1937. When new construc- tion does not keep up with the increasing demand, overcrowding results and the number of possible admissions decreases from year to year. The state school is the nucleus around which a satisfactory plan for the care of mental defectives must be built. There is a type of mental defective with certain physical or conduct difficulties that can be best cared for within a state school. Without adequate provision for this destructive institu- tional type of case, other efforts in the care of this group are severely handicapped. In the past the supposedly ideal treatment of the mental defective of high mental grade has been admission to a specialized school, a period of education and training, followed by placement at wages and supervision in the community. There is little doubt but that this schedule is necessary and advisable for certain types of cases. However, with changing economic and social conditions, increasing numbers of mental defectives have come to the attention of various social and state agencies. For several years the three state schools in Massachusetts have had a resident population of over 5,000 persons, and about 300 admissions each year. To the Central Registry for Mental Defectives over 4,000 cases of mental deficiency have been reported each year. Based on the 1939 figures, 7.4% or one in thirteen of the new cases being registered is gaining admission to a state school, leaving 93% still in the community. Within ten years our registry will have over 40,000 new cases recorded. About 3,000 of these will have gained admis- sion to a state school, leaving 37,000 remaining in the community. The need for com- munity supervision is obvious. The cost of state school care in Massachusetts, including capital charges and depre- ciation, is about $450 per year. Community supervision can be supplied by our Divisional workers at a cost of about $30 per year. If we look ahead to the 40,000 new cases that will be registered by 1949, we see that the cost of making institutional provision for this entire group* would be approximately $80,000,000. In addition, the cost of maintenance would be approximately $15,000,000 per annum. State-wide community care of this group would cost approximately $1,200,000 per year. Here we have the suggestion that community care is not going to be the advisable approach for the future but the abso- lutely necessary one. During the past year the three workers of the Division were asked to care for a total of 488 cases. As is well known, this is an impossible case load. This average case load of 162 cases per worker means that only a limited service can be ex- pected. It is requested that two additional social workers be made available to the Division of Mental Deficiency for the more efficient carrying out of the present work and the extension of our present activities. The special class movement has been of great help in the keeping of the younger retarded children in the community. Without this development in the field of education many additional thousands of children would have had to be admitted to one of our state schools. The special class cares for this retarded group until they are sixteen. When they leave school this supervision is relaxed and difficulties arise. At the age of 16 the mental defective is not ready to stand on his own feet alone and unassisted. Ad- ditional supervision for these children until they reach the age of 21 would be of tre- mendous benefit in tiding them over a very critical period, and would undoubtedly keep in the community many now being admitted to state schools between the ages of 16 and 21. In certain instances it may be feasible to continue special classes to older ages than 16 years. In other instances the school itself may be able to provide the necessary supervision for children leaving special classes. However, in the great bulk of cases available, service such as is supplied by the Division of Mental Deficiency should be made *This estimate is based upon a conservative construction cost per bed of $2,000. Recent costs in Massa- chusetts have run above S3, 000 per bed. P.D. 117 125 use of in this important supervision project. Community adjustment and self-support are accomplishments which are beyond many mental defectives unless a guiding hand is available. The means of providing this needed assistance should be effected at the earliest possible date. At the end of 1939 the Division was carrying a total of 312 persons on its books. Many of these would require admission to a state school if this supervision were not available. The keeping of these cases in the community has been responsible for a saving to the Commonwealth of many thousands of dollars reckoned in terms of state school care. At a time when expenses of state school provision are becoming almost prohibitive, the enlargement of the divisional activities along the line of community supervision seems a more sensible way of caring for the thousands of mental defectives coming to our attention. We should be working toward a state- wide plan for the community super- vision of mental defectives. A plan for the supervision of mental defectives in the younger years will mean a smaller number of these individuals becoming public charges later in life. Appreciation is herewith expressed to the Commissioner for his cooperation through- out the year. Respectfully submitted, Neil A. Dayton, M.D., Director REPORT OF THE SUPPORT DIVISION To the Commissioner of Mental Health: I herewith report the work of this Division for the year ending November 30, 1939, as follows: Visits to the Hospitals 179 Histories taken at Hospitals 4,964 Visits to relatives of patients and others for investigation: By outside visits 6,130 By office calls 814 By telephone 1,545 Total Investigations 8,489 Cases submitted for deportation to the U. S. Commissioner of Immi- gration Cases submitted for deportation by the Department Support Cases not including Ex-Service men of the World War Cases pending November 30, 1938 1,248 New Cases 3,502 Made Reimbursing . Accepted as State Charges Pending November 30, 1939 Reimbursing Cases Cases remaining in Hospitals November 30, 1938 New Cases Died Discharged or on visit Nov. 30, 1939 . Dropped — accepted as State Charges Transferred toother Institutions . Accepted by Veterans' Administration Remaining in Hospitals Nov. 30, 1939 . o 97 4,750 1,114 2,064 1,572 4,750 2,307 1,199 3,506 392 554 158 85 5 2,312 3,506 Cases of Ex-Service men of the World War considered by the U. S. Veterans' Ad- ministration for support between November 30, 1938 and November 30, 1939 Cases remaining in Hospitals Nov. 30, 1938 „ 8 New Cases 14 22 P.D. 117 0 9 1 12 22 462 12 450 462 146 28 174 17 157 126 Died Discharged or on visit Made Reimbursing Remaining in Hospitals Nov. 30, 1939 . . . ... Ex-service men actually in the Hospitals November 30, 1939 Cases chargeable to Veterans' Administration Cases not yet chargeable (rejected or pending) Attorney General Cases Cases pending in the office of the Attorney General, Nov. 30, 1938 Reported during the year Cases closed during the year Cases pending Nov. 30, 1939 174 Summary of Work of Investigators and Clerical Force There were 946 investigations made at Probate Courts. In addition to outside work, the staff of Investigators spent nearly 5,000 hours in the office preparing for such work and reporting the results of their investigations. Three thousand, three hundred and eight-four letters were written concerning the general work of the Division and 1,209 letters concerning ex-service men and Veterans Administration matters. 336 clinical abstracts and 579 stencils forms were transmitted to the Veterans Administration. Eight thousand, two hundred and twenty-eight documents relating to Probate matters were handled. 5,758 history slips were prepared for the use of the Investigators and, including transfer records, 6,770 histories were written. About 20,000 bills were sent out, not including bills sent to the Veterans Administra- tion. Bills amounting to $6,974.00 were rendered to the Veterans Administration during the year. Receipts for Support of Reimbursing Patients Hospital Psychopathic . Boston Danvers Foxborough Gardner Grafton Medfield . Metropolitan . Northampton . Taunton . Westborough . Worcester . Monson Belchertown Fernald Wrentham Infirmary . Bridge water Hospital Cottages Family Care Foxboro Labor Alms Houses Year ending: Year ending: Total since Nov. 30, 1938 Nov. 30, 1939 Jan. 1, 1904 $565.00 $445.80 $41,400.93 88,072.67 82,353.79 1,881,539.35 105,145.07 105,904.04 2,455,426.56 52,139.61 58,028.42 828,526.74 37,779.24 28,592.70 495,414.79 25,384.34 31,529.68 511,521.74 48,817.39 44,521.76 885,599.95 47,763 . 74 50,525.41 331,803.35 89,610.11 101,359.63 1,912,465.10 61,196.50 75,872.36 1,387,172.14 110,590.70 110,354.84 2,439,731.34 66,865.87 58,769.07 1,792,045.19 15,040.37 14,269.05 419,497.25 5,733.47 11,780.18 98,654.03 19,242.14 19,362.04 379,550.15 11,299.52 13,033.07 191,491.25 1,444.47 6,840.71 102,048.23 3,077.57 4,759.49 121,993.42 416.69 416.67 3,443.29 - — 17,344.87 — - 3,370.45 - - 923 . 66 $790,184.47 $818,718.71 $16,300,963.78 This report shows that the total collections on account of reimbursements for support of patients were $818,718.71. Of this amount $6,288 was received for the support of ex-service men of the World War, leaving a balance of $812,430.71 as the amount col- lected for the support of civilian cases. ' ( ] Total receipts for support indicate a per capita collection for the year of $28.07 as against $27.52 for year ending Nov. 30, 1938. P.D. 117 Yearly Totals from January 1, 1904 From January 1, 1904 to September 30, 1904 Year ending September 30, 1905 From October 1, 1905 to November 30, 1906 (14 months) . . . . Year ending November 30, 1907 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 Year ending November 30 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 (including soldiers $3,421.75) 1920 (including soldiers 99,008.25) 1921 (including soldiers 106,951.57) 1922 (including soldiers 127,106.00) 1923 (including soldiers 106,573.00) 1924 (including soldiers 302,434.00) 1925 (including soldiers 36,271 . 00) 1926 (including soldiers 67,369.00) 1927 (including soldiers 1928 (including soldiers 1929 (including soldiers 1930 (including soldiers 1931 (including soldiers 1932 (including soldiers 1933 (including soldiers 1934 (including soldiers 1935 (including soldiers 1936 (including soldiers 1937 (including soldiers 1938 (including soldiers 1939 (including soldiers 84,500.00) 87,599.00) 14,926.86) 18,104.00) 19,048.00) 849 . 00) 11,220.00) 6,698.00) 4,642.00) 7,634.00) 9,477.00) 7,823.00) 6,288.00) 127 $31,882.11 72,750,93 87,804.66 79,495.76 86,867.04 102,468.57 117,588.91 124,083.94 133,059.95 133,818.23 130,671.57 139,375.33 141,585.18 174,710.70 179,161.66 182,240.81 296,178.62 311,631.57 359,582.44 364,142.75 601,505.73 452,416.45 922,452 . 99 987,469 . 80 ,006,625.43 939,846.19 947,503.03 917,593.67 819,870.81 778,830.53 754,582.59 779,117.76 765,727.72 769,417.17 790,184.47 818,718.71 $16,300,963.78 Number and Board Rates of Reimbursing Patients for the Year Ending October 1, 1939 United States Average Weekly per Deportation Cases Soldier C ases Institutions Daily Average October Average Average Number Capita 1, 1939 Daily Weekly Daily Weekly Rate Average Number Per Capita Average Number Per Capita M. F. M. F. M. F. M. F. Psychopathic .21 .46 6.94 0 0 .14 35.00 _ _ _ Boston . 65.63 155.71 7.42 72 164 — — - .06 .92 14.00 Danvers 88.06 179.12 7.49 97 211 - - - .58 14.00 Foxborough . 54.63 83.42 7.55 55 114 - - - .13 14.00. Gardner 23.97 45.39 7.85 30 56 — — - — — _ Grafton 18.27 43.55 8.17 18 29 - — - .47 14.00 Medfield 34.46 68.25 8.06 35 70 .34 35.00 .17 14.00 Metropolitan 34.67 90.82 7.87 49 102 - - - .18 14.00 Northampton 76.88 161.11 7.47 75 177 _ _ . - 1.00 14.00 Taunton 58.73 108.40 7.56 54 126 .08 35.00 .36 14.00 Westborough 92.57 184.08 7.49 88 227 - - - .72 1.80 14.00 Worcester 60.99 87.17 7.85 72 107 — - - .20 .92 14.00 Monson Sane 1 . Insane/ 25.82 29.12 4.84 32 32 — — — — - — Belchertown 15.39 15.96 5.57 22 22 — — — — — - Fernald 33.93 27.61 6.12 54 36 — - — - — — Wrentham . 31.00 17.57 5.17 48 26 _ — - — — — Infirmary .47 7.31 6.16 0 9 - - - - — - Bridgewater 9.72 - 7.24 5 0 — — - 1.42 14.00 Hosp. Cottages . 2.43 1.00 2.47 4 1 - - — — - - Family Care - - - 0 2 - - - _ 727.83 1,306.06 7.39 810 1,511 .56 35.00 4.82 4.11 14.00 I am submitting on the same sheet, a statement showing receipts on account of support for each year from January 1, 1904, which shows the receipts by hospitals for each year and also for the year ending November 30, 1938, and the total receipts credited to each hospital since January 1, 1904. The total receipts on account of reimbursements since January 1, 1904 are $16,300,963.78. This Division has an active reimbursing list of approximately 2,312, the maximum rate in any case being $10 per week and the minimum rate being 50 cents per week. 128 P.D. 117 For the fiscal year ending November 30, 1939, this Division of the Department sub- mitted 102 cases to the Medical Division, for deportation to other states and countries. Respectfully submitted, Paul A. Green, Supervisor. Acknowledgment Grateful appreciation is herewith expressed to the Rockefeller Foundation for the appropriation received to be used in the work of completing and publishing some of the researches conducted under previous grants. The first volume of publication is expected in January, 1940. Under date of November 20, 1939 the Foundation was good enough to extend the present grant for one year or until December 31, 1940. We anticipate that additional material will be brought out within the coming year. Clifton T. Perkins, M.D., Commissioner. REPORT OF THE DIVISION OF STATISTICAL RESEARCH To the Commissioner of Mental Health: A report of the work of the Division of Statistical Research for the year ending Novem- ber 30, 1939 is respectfully submitted. During the past year the analysis and writing up of the Rockefeller Foundation Re- search material has been continued and the material for the first volume was completed and accepted by a publisher. It is anticipated that this book will come from the press early in 1940. The analysis and writing up is being continued, and it is hoped that a second volume will be completed in the coming year. The Director wishes to express his appreciation to the Commissioner and to the other members of the Research Committee for their cooperation and advice which has been most helpful at all times. Respectfully submitted, Neil A. Dayton, M.D., Director. REPORT OF THE DIVISION OF STATISTICS To the Commissioner of Mental Health: A report on the work of the Division of Statistics for the year ending November 30? 1939, is respectfully submitted. Summary of Contents, Division of Statistics I. Departmental Statistics, Tables A. to J. — Pages 131-138 II. Statistical Review: Subjects of Text Discussion. A. General Discussion of All Classes under Care in Mental Hospitals — Pages 141-147 B. Admissions to Mental Hospitals During 1939. — Pages 147-176 C. Discharges to the Community from Mental Hospitals During 1939. — Pages 176-198 D. Deaths in Mental Hospitals During 1939. — Pages 198-216 E. Resident Population and Patients Out of Mental Hospitals on September 30, 1939. — Pages 216-238 F. General Discussion of All Classes under Care in State Schools. — Pages 238-243 G. Admissions to State Schools During 1939. — Pages 244-251 H. Discharges to the Community from State Schools During 1939. — Pages 251-261 J. Deaths in State Schools During 1939. — Pages 261-270 K. Resident Population and Patients Out of State Schools on September 30, 1939. — Pages 270-287 L. General Discussion of Epileptics (Non-Psychotic) Under Care, 1939. — Page 288 M. Admission of Non-Psychotic Epileptic Patients, 1939. — Pages 288-289 N. Discharges to the Community of Epileptic Patients (Non-Psychotic), 1939. — Pages 289-290 O. Deaths of Epileptic Patients (Non-Psychotic), 1939. — Pages 291-292 P. Non-Psychotic Epileptics in Residence on September 30, 1939. — Page 292 III. Graphs Departmental Statistics — Graphs A. to C. Mental Disorders — Graphs 1 to 9, inclusive. Mental Deficiency — Graphs 10 to 16, inclusive. P.D. 117 129 IV. Detailed Tables. Mental Disorders — Pages 298-425 Mental Deficiency — Pages 426-456 Non-Psychotic Epileptics at Monson State Hospital — Pages 293-296 Since 1927, a completely centralized statistical system has been in operation in the thirteen State Hospitals and the three State Schools. A new system of recording data on all patients was put into effective operation, both at the individual institutions and at the central Department. By this means the amount of available data on our patient population, both insane and feebleminded, was tremendously increased. The system was installed also at the Bridgewater State Hospital, the Mental Wards at Tewksbury, the McLean Hospital, and U. S. Veterans' Hospitals Nos. 95 and 107, Northampton and Bedford, respectively. A total of twenty-one institutions come under the Depart- ment statistical system and this provides an invaluable Statewide sample of mental disease or defect for any one year. Approximately ninety-eight per cent of admis- sions for mental disease in the Commonwealth are reported by this means. Each institution sends to the Department a statistical card indicating the admission, discharge or death of each patient, and at the end of the year a set of twenty standard tables are made up and returned to the institution for publication in its annual report. All statistical work is removed from the institution and the machine equipment at the central office made use of to relieve institutions of these duties. The Division also pre- pares the annual report for each hospital and school which is required by the United States Bureau of the Census. Other analyses are made from time to time in connection with various research projects under way in certain hospitals and schools. During 1934, a new departure was made in presenting statistics on patients in our mental hospitals. In addition to presenting data in accordance with the new psychiatric classification of mental disorders, all admissions, discharges, deaths, resident population and patients out of institutions were divided into first and readmissions. This is a new approach which has been developed and used for the first time in Massa- chusetts. The 1934 Report was the first to add an analysis of patients out of institutions, on visit, etc., at the end of the year. In view of the fact that these patients comprise ten per cent of the total number of cases on the books of mental hospitals in this State, their inclusion in our annual statistics has been made a permanent procedure. From year to year certain general refinements and additions are made to the Annual Report. These are adopted in accordance with the numbers of requests for new and heretofore unpublished data, or to complete the presentation of certain items which had formerly been only partially covered. The year of 1937 marked a very significant change in the presentation of statistics by the Department. It has been deemed advisable to change completely the set-up used in the past in reference to the cases designated as first or readmissions. When Massa- chusetts adopted its statistical system in accordance with the advices of the National Committee for Mental Hygiene in the year 1917, first admissions under court commit- ment were to take precedence over all other forms of admissions. Consequently, pre- vious admissions under temporary care or observation commitment were discarded in deciding whether a case was a first or a readmission. At the time of the adoption of this criterion, it was felt that the court commitment cases were usually psychotic, while the other forms of admission embraced the non-psychotic group. Recently, an investigation under our Rockefeller Research project showed that definite changes have taken place over the years which render invalid these original assumptions*. Our research analyses have shown that substantial numbers of temporary care and observation care cases discharged at the end of the ten-day or thirty-five day period have been diagnosed as "with psychosis". Under the old statistical plan, these admissions were not counted. If these patients were admitted a year or two later on a court commitment, the previous temporary care admission would be discarded and the present admission considered as a first admission. Cases have been encountered with several previous admissions, all with psychosis, coming in under the various short forms of admission. Yet, when first ad- mitted on court commitment, they have been reported as a first admission. * The research material for the years 1917-1933 has been used to give us the data for trend studies, all presented on the new basis. The tables showing changes in the psychoses over the years 1917-1933 are also based upon the research analysts. Otherwise the present report would offer data which could not be compared with the earlier years. 130 P.D. 117 These facts have seemed to warrant a complete change in the classification of our first and readmissions. Experience has taught that a first or readmission should mean exactly what this classification suggests. A first admission should mean that the patient is entering a mental hospital for the first time. Clearly, the administrative detail of his entrance, such as form of admission, is a minor issue. In turn, a readmission should mean that the patient has had a previous admission to a mental hospital and is again being returned to a mental hospital. The old classification as to first and readmissions, originally adopted in accordance with the criteria of the National Committee for Mental Hygiene, no longer meets our changed requirements. It may be well to explain that the inclusion of all types of admission forms in our regular statistics will mean an increase in admission rates in comparison with the previous statistics based on court commitments only. However, the admission rates of the past, based on court admissions only, were understating the number of psychotic individuals admitted to our mental hospitals. It is obvious that this condition should be corrected at the earliest possible moment. While this change will increase our admission rates, at the same time it will also increase the discharge rates. The past emphasis on court cases tended to minimize the efficiency of our hospitals in that patients remaining for shorter periods, those admitted by temporary care, observation or voluntary admission, are excluded from the statistics on discharge. Many of these are definitely psychotic. This means that our discharge rates were based on the court cases, which have a longer hospital stay. Inclusion of the short residence psychoses will balance this situation and show the true situation in reference to both discharge rates and the length of hospital stay. For example, the court cases "with mental disorder" who were discharged during 1936 showed a hospital residence of 1.1 years (first admissions) and 1.8 years (read- missions). By including all types of admissions, the 1939 cases "with mental disorder'' who were discharged show an average hospital stay of .8 years (first admissions) and 1 .3 years (readmissions). This change enables us to present the true picture of the outcome of all admissions "with mental disorder" and of the general efficiency of our mental hospitals in Massachusetts. ; . Another change was initiated beginning with the 1937 report. For many years the statistics of the Monson State Hospital have been unsatisfactory owing to the obvious mixture of the patients at that institution. Monson has not only cared for epileptics with psychoses but also for other, and often younger patients who have epilepsy without the presence of a mental disorder. For some years, the section on convulsive disorders of the American Psychiatric Association has presented a separate clinical classification for epileptics without mental disorder. Other states have used this clinical classification in reporting their non-psychotic epileptics and it has been deemed advisable that Massa- chusetts should conform to this procedure so that comparable statistics may be available. As a consequence, in 1937 the statistics of the Monson State Hospital were divided into two sections. The first section is based on the psychiatric classification and presents data on the epileptic psychoses using the regular standard tables of the American Psychi- atric Association. The second section is based upon the clinical classification of con- vulsive disorders, non-psychotic. These tables are presented completely in the Annual Report of the Monson State Hospital, and certain of the tables on the non-psychotic epileptics are also presented in a new section on the Annual Report of the Department of Mental Health. With the exception of the above changes, the present report presents the same material as in preceding years. The main part of the report, devoted to mental diseases, offers separate sections on admissions, discharges, deaths, and resident population. The material of these sections, is, of course, divided into first and readmissions. The section on mental deficiency presents the same divisions. Owing to the extremely small numbers of readmissions, however, the discharges, deaths, and resident population are not divided into first and readmissions. The third section on non-psychotic epileptics completes the report which embraces a total of 278 tables. Respectfully submitted, Neil A. Dayton, M.D., Director P.D. 117 131 lOooiaioc.N^CJNNNio tfl ■*■* -h 0 T)< OMtC^OartTfO-OMH ■*' to m co otto ■* in CO ooooj.t~coTt 05 ■* t^^ C0_m_^_O tC_O_C0_t> 0_0_ °i in 10 r~ DO CO; m ■* of of H«rt -# CO (NHN i-T CO ofofi-f CO O" 0 CO «© m Tj< m m lOCOOOOOt^^HOt^Olt^iO m ■*-*i-i OS ■* a m bt C tOMCO'tOOOrtTfO'HOMrH CO com co 01 000 ■* CD OOOmiNONNrHnNlOINrH O a 92 OtDrfr-00MO!D-HH00OO 00 COOOI> O t^ z ;=" S C» ■* CN 00 00 Tf 00 -rr1 t~ in CD "3N CO C 1 _0J OOOOOOOOiOOI'O rt< hNO X Ol - 5 ■-< c"1 oioiooNooaoosomoo CO HOIO Ol 0 80 1 oicoooini>t"~oi.~HOiO"*oi OJ COOTfi t> 0 HO-fMOOOO-tOCCIM c; Ol -*r-i GO 00 S~ ■* i-i t^oq oi oi o< 01 in 01 -h 10 01.CC CO -1 CO to ■* -O 93 H 000500IOOOOOMHO 0 005 0 0 O OtOHO-'DOOONOa'.'JO) co 000 O Tf < 3 -y t.<< 05 O) O Ol CINHNOOtOi'HiawOflO CO IS HHOmOiaOMNOM 00 -*ooo O 00 O Oli-iOlt-HOOCO'-iCOOl-HCOiO to co CO-^O) CO of 0 in ;s T3 £ oooocooomccoincomo CO 000 0 o< &H" — on ototoiooocooi-^ooot^ «> i-h com CM 0 oi-*t^ocot^cQtooit^co-tf<-H CO CO-"" -# 05 CO CI3 O 0 NHinmoooooi-ncoooto 00 tc mo ■X w 01 m co 00 coco co to tc t- m to ■"l 00 com ■* CC3 «3 X of CO ^ ■JS -*mocotOT) oohc 00 0 5 H^H GO i-Ht^001C00100 01C01>0101CO 0 oit^o 0 -h O_00 MhhNhiOiOiOOOi-i 1> CO O Cxfr-T J> oc 03 u -*-» t- ■tionHOrtNOoociain^ 01 hooo 0 2 Ph © ^ NQOaOOONOONHfflOrt 10 oii>o X t^ oi_ ol_ •* co_ -* co oo_ CO t^- in ■* 10 00 C0O5 05 °i e 20^ of Of i-f i-H i-H rn" i-i" of i-T H of i-T 01 t-H r-t i-H m CM oiooocooimcoooo^ocooo oiooi^ g^ 5 M iHCONOlOrtCOMiOiOOOCCCB 05 -*o * ° a.S 0000000000000000000000 0000 H O "& s 93 5 e =Q 5 P < GG H m < 1? 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P.D. 117 133 r~oo'HOTtt.-<(M ■^-t~t-oor~t^t-.t^t^.oooo H OS O OS -H 00 COCOC5COOOt~'Ot~-*CM''#'HO Trosi--oot~ooi>t^t^t^oooooo CN-tfCNCOt~^,Tt>»-0 00'-'OCNt'~ COOSCDiOcOt^^t^cOOCOCOOO co os t- qo i- oo i> j> t^ oo oo oo oo OOOOOOOJMONtOtOffi'OOl aooocoi>cooot^cocot^t^t>t^ OSCN>-i^ CON-*' i-H—icOaO lOcoosososiOTtosi-HCOtococ^ OOONCiONlN CMiOCNOSCN CM H OS t~ OS CO 00 lO t*. CD r-- CO **- CD t^t~t~ 0>-H CD ooi>co o "a s C3 rf CO »0 » CO CO CO CO— tCDOOCN OS t- ■* CM t- iH CO TPt^COt^CO 00 CD CO 00 CD t- CD cOCOt-COcO oosoo 00 CD CD o e O^iiON^O CNiOOCNIM OS CO CM CO OS CO CM lOCO^-tf-* CD t~- b- O CD t- t- CDcOCOCOt- iO lO "O 00 O IO O 40»OcDiO»0 CDiO PU P-> o° ■_'^_ — of™ — m ^ ' w_.rtt.Kcug"35C.c30C«i£ 3 3 K "«; — „ 3 o_ o o-g S> o o •goo "g.oooo-g Q CDT3CC is i a lis "sls.2 a 'a |a£5 ...Swa .5 b t-J3 S3 GO <1 ■< 134 P.D. 117 Tj-iaaTjiTt-iPSO">OTtnt^t^-oocjc»co t- nwoo OHinooiNN oot^mooco •oiNinnt-iNo Hri-^iNoo CN <3> ■* OS ■* CO C0COO5lNTt< o "a >C PS IN Oi OS 00 00 USCOOCCNlN O CD PS t~ IN CO t>- HOiOOffi CN TtiOMNO t~ t~- ps *H CN IN INtJhO'-IO OWOMN OJ^OOPSCDPS OOiNOlt-nO ONOCOOtO >n ici M i-i cn cn »o co -+j ^"■§3j2 3^-2§2 Sm» * i-S 3 co M^^oa.-g aco 3 u£ "S 2.2, w — CO •8§3-S •S.COGO-g q a -a go ScoS| S flfcCO .2 oS a) P.D. 117 135 Table E. — Percentages of Total Net Expenditures by the State Expended for the Care of Mental Disease, Mental Defect and Epilepsy from 1913 to 1989 Total Expended for Fiscal Year Ended November 30 or Total Expended Care of Insane Each Year by the State Feebleminded and Epileptic* Percentage 1913 $24,543,221.70 $4,632,593.84 18.88 1919 . , . 53,769,626.25 6,864,669.63 12.77 1920 46,648,928.67 7,852,184.56 16.83 1921 41,669,278.65 8,252,082.46 19.80 1922 ... 44,114,727.08 8,217,175.36 18.63 1923 45,438,413.85 8,777,574.59 19.10 1924 47,286,108.80 8,577,393.51 18.14 1925 . 46,613,633.49 8,506,305.01 18.25 1926 .... 49,164,754.28 8,674,918.98 17.64 1927 51,537,132.98 9,537,342.42 18.51 1928 53,763,560.75 10,441,689.17 19.42 1929 .... 58,346,381 . 85 12,030,668.66 20.62 1930 64,150,582.95 12,728,067.23 19.84 1931 75,282,580.95 12,408,228.22 16.48 1932 77,971,941.54 11,495,403.21 14.74 1933 64,091,084.85 8,921,067.31 13.92 1934 71,570,396.94 10,684,191.91 14.93 1935 83,034,847.94 14,314,064.13 17.33 1936 93,384,601.54 14,398,158.44 15.42 1937 98,604,007.51 13,533,255.49 13.72 1938 113,124,705.28 13,452,784.09 11.89 1939 131,571,492.03 13,790,233.58 10.48 * Includes Department, Institutions, Mental Wards at Tewksbury, and State Farm (Bridgewater) . Note: — The absence of data for years 1914 to 1918 inclusive is due to the fact that figures are not avail- able. Previous to 1918 the report of the Auditor of the Commonwealth did not show a recapitulation giving the total State expenses inasmuch as many of the expenses of the State were paid out of funds. In 1924 a comparison of 1923 with 1913 was desired and an analysis of the Auditor's report of 1913 was made throwing all fund expenditures into the revenue expenditures of that year. This was a task of such mag- nitude that it has not been deemed advisable to continue covering the years 1914 to 1918 inclusive. Table F. — Number of Patients in State Institutions for the Insane, Feebleminded, and Epileptic, and Overcrowding, September 30, 1939 Institutions Capacity Patients in Institutions Overcrowding Number Percent- age State Hospitals Boston State Hospital Boston Psychopathic Hospital Danvers State Hospital . Foxborough State Hospital Gardner State Hospital . Grafton State Hospital . Medfield State Hospital Metropolitan State Hospital Northampton State Hospital Taunton State Hospital Westborough State Hospital Worcester State Hospital Total Monson State Hospital (epileptic) Total State Hospitals and Monson State Schools Belchertown State School Walter E. Fernald State School . Wrentham State School Total Aggregate All D. M. H. Institutions Bridgewater Tewksbury Grand Total All Institutions 1,977 109 1,853 1,269 1,161 1,258 1,549 1,598 1,729 1,437 1,298 2,300 17,538 1,165 18,703 1,102 1,540 1,361 4,003 22,706 908 603 24,217 2,322 75 2,385 1,393 1,403 1,481 1,867 1,913 2,016 1,740 1,609 2,419 20,623 1,543 22,166 1,306 1,944 1,988 5,238 27,404 881 450 28,735 345 -34 532 124 242 223 318 315 287 303 311 119 3,085 378 3,463 204 404 627 1,235 4,698 -27 -153 4,518 17.45 -31.19 28.71 9.77 20.84 17.72 20.52 19.71 16.59 21.08 23.95 5.17 17.59 32.44 18.51 18.51 26.23 46.06 30.85 20.69 -2.97 -25.37 18.65 Note: — Minus sign indicates number or percentage below capacity. 136 P.D. 117 Table G. — Number of Patients and Overcrowding in State Institutions for the Insane Feebleminded and Epileptic on September 30 for Five Year Periods, 1905-1980 and Yearly Periods 1930-1939 Inclusive Rated Capacity Actual Number of Patients in Institutions Overcrowding Institutions by Years Excess Number of Patients Percent- age 1905 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary State Schools 8,552 462 9,014 1,022 1,002 8,552 521 9,073 998 1,028 59 59 -24 26 12.77 .65 -2.34 2.59 Total 1910 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary .... State Schools ........ 11,038 9,627 853 10,480 1,335 1,690 11,099 10,364 770 11,134 1,428 1,567 61 737 -83 654 93 -123 .55 7.65 -9.73 6.24 6.96 -7.27 Total 1915 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary .... State Schools 13,505 11,489 968 12,457 1,491 2,488 14,129 12,240 1,015 13,255 1,531 2,309 624 751 47 798 40 -179 4.62 6.53 4.85 6.40 2.68 -7.19 Total . 1920 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary .... State Schools . 16,436 12,593 967 13,560 1,508 2,823 17,095 13,204 960 14,164 1,522 2,820 659 611 -7 604 14 -3 4.00 4.85 -.72 4.45 .92 -.10 Total . 1925 State Hospitals Monson Hospital — Epileptic . . State Hospitals and Monson Bridgewater and State Infirmary .... State Schools 17,891 13,343 967 14,310 1,581 3,498 18,506 15,156 1,182 16,338 1,652 3,593 615 1,813 215 2,028 71 95 3.43 13.58 22.23 14.17 4.49 2.71 Total 1930 State Hospitals Monson Hospital — Epileptic . . . . . State Hospitals and Monson . . . . . Bridgewater and State Infirmary .... State Schools 19,389 14,689 1,131 15,820 1,581 3,866 21,583 16,809 1,290 18,099 1,749 4,159 2,194 2,120 159 2,279 168 293 11.31 14.43 14.05 14.40 10.62 7.57 Total 1931 State Hospitals Monson Hospital — Epileptic . . . . . State Hospitals and Monson . . Bridgewater and State Infirmary . . . . State Schools . . . . . . 21,267 16,171 1,131 17,302 1,581 4,061 24,007 17,474 1,340 18,814 1,632 4,412 2,740 1,303 209 1,512 51 351 12.88 8.05 18.47 8.73 3.22 8.64 Total . . : . 1932 State Hospitals . . . ... . ... Monson Hospital — Epileptic . . . . . State Hospitals and Monson . . . . . Bridgewater and State Infirmary . . . . State Schools 22,944 16,372 1,171 17,543 1,511 4,297 24,858 17,859 1,396 19,255 1,601 4,566 1,914 1,487 225 1,712 90 269 8.34 9.08 19.21 9.75 5.95 6.26 Total 1933 Monson Hospital — Epileptic . . State Hospitals and Monson Bridgewater and State Infirmary .... State Schools ..... 23,351 16,612 1,059 17,671 1,511 3,893 25,422 18,263 1,412 19,675 1,543 4,771 2,071 1,651 353 2,004 32 878 8.86 9.93 33.33 11.34 2.11 22.55 Total . ... 23,075 25,989 2,914 12.62 P.D. 117 137 Table G. — Number of Patients and Overcrowding in State Institutions for the Insane, Feebleminded and Epileptic on September 30 for Five Year Periods, 1905-1930 and Yearly Periods 1930-1939 Inclusive — Concluded Institutions by Years Rated Capacity Actual Number of Patients in Institutions Overcrowding Excess Number of Patients Percent- age 1934 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary State Schools .... Total 1935 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary State Schools .... Total 1936 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary State Schools .... Total 1937 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary State Schools .... Total 1938 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary State Schools .... Total 1939 State Hospitals Monson Hospital — Epileptic State Hospitals and Monson Bridgewater and State Infirmary State Schools .... Total 16,612 1,059 17,671 1,511 3,893 23,075 16,848 1,147 17,995 1,511 3,999 23,505 16,848 1,147 17,995 1,511 3,999 23,505 17,487 1,164 18,651 1,511 4,001 24,163 17,574 1,177 18,751 1,511 4,003 24,265 17,538 1,165 18,703 1,511 4,003 24,217 18,638 1,453 20,091 1,488 4,933 26,512 19,111 1,476 20,587 1,446 5,009 27,042 19,673 1,514 21,187 1,389 5,133 27,709 20,023 1,521 21,544 1,371 5,244 28,159 20,506 1,550 22,056 1,364 5,225 28,645 20,623 1,543 22,166 1,331 5,238 28,735 2,026 394 2,420 -23 1,040 3,437 2,263 329 2,592 -65 1,010 3,537 2,825 367 3,192 -122 1,134 4,204 2,536 357 2,893 -140 1,243 3,996 2,932 373 3,305 -147 1,222 4,380 3,085 378 3,463 -180 1,235 4,518 12.19 37.20 13.69 -1.52 26.71 14.89 13.43 28.68 14.40 -4.30 25.25 15.04 16.76 31.99 17.73 -8.07 28.35 17.88 14.50 30.67 15.51 -9.26 31.06 16.53 16.68 31.69 17.62 -9.72 30.52 18.05 17.59 32.44 18.51 -11.91 30.85 18.65 Note: — Minus sign indicates number or percentage below capacity. 138 P.D. 117 Table H. — Paying Patients, Number and Percent in State Hospitals on September 30, 1904-1939* Number of Number of Percentage of Year Patients in Paying Resident Institutions Patients Patients 1904 10,100 1,189 11.7 1905 10,071 1,217 12.1 1906 . 10,237 1,299 12.7 1907 10,602 1,300 12.3 1908 11,460 1,390 12.1 1909 11,994 1,488 12.4 1910 12,562 1,462 11.6 1911 12,972 1,521 11.3 1912 13,481 1,585 11.8 1913 13,949 1,603 11.5 1914 14,202 1,503 10.6 1915 14,786 1,506 10.2 1916 15,054 1,535 10.2 1917 15,434 1,512 9.8 1918 15,476 1.595 10.3 1919 15,217 1,548 10.2 1920 15,678 1,526 9.7 1921 16,428 1,683 10.2 1922 16,810 1,604 9.4 1923 17,051 1,985 11.6 1924 17,515 1,916 10.9 1925 17,990 2,051 11.4 1926 18,149 2,194 12.1 1927 18,573 2,282 12.3 1928 18,997 2,336 12.2 1929 19,391 2,345 12.0 1930 19,848 2,361 11.0 1931 20,446 2,310 11.2 1932 20,856 2,219 10.6 1933 21,218 2,156 10.1 1934 21,579 2,066 9.5 1935 22,033 1,998 9.0 1936 22,576 2,053 9.1 1937 22,915 2,081 9.1 1938 23,420 2,125 9.1 1939 23,497 2,106 8 9 1 Includes Mental Wards, Tewksbury, and Bridgewater. Table J. — Paying Patients, Number and Percent in State Schools on September SO, 1904-1939 Number of Number of Percentage of Year Patients in Paying Resident Schools Patients Patients 1904 897 95 8.9 1905 1,073 96 8.9 1906 1,170 92 7.9 1907 1,278 89 7.0 1908 1,382 82 5.9 1909 1,493 75 5.7 1910 1,617 60 3.7 1911 1,692 67 3.9 1912 1,895 70 3.7 1913 1,972 70 3.5 1914 2,244 41 1.8 1915 2,359 39 1.7 1916 2,632 37 1.5 1917 2,723 23 0.9 1918 2,813 21 0.7 1919 2,789 29 1.0 1920 2,870 30 1.0 1921 2,991 37 1.2 1922 2,899 31 1.0 1923 3,239 43 1.4 1924 3,510 52 1.5 1925 3,643 78 2.1 1926 3,710 121 3.3 1927 3,837 166 4.3 1928 ... 3,912 174 4.4 1929 3,941 151 3.8 1930 4,159 186 4.4 1931 4,412 192 4.3 1932 4,566 186 4.0 1933 4,771 192 4.0 1934 4,993 197 3.9 1935 5,009 199 3.9 1936 5,133 195 3.8 1937 5,244 203 3.9 1938 5,225 206 3.9 1939 5,238 208 3.9 P.D. 117 139 "5.54 /S/7 /920 WMM. J930 1/93/ /932 W&3M /934 1935 /936 /937 /938 WB'^s^ Graph A. — Average Weekly Per Capita Costs for Maintenance, 1917 to 1939. *7.32 #7.// $6,4-7 1*5.76 *6.9B *7.59 s4 / / / / //TTTTvv' Graph B. — Per Cent of Cost of Maintenance for All Patients, Collected from Paying Patients, 1917 to 1939. 140 P.D. 117 JO .40 so .so */.oo Graph C. — Portion of Every State Dollar Expended on Mental Health, 1919 to 1939. P.D. 117 141 STATISTICAL REVIEW Mental Disorders Section A. General Discussions of All Glasses Within Mental Hospitals, 1939, and Previous Years Section A is devoted to a general discussion of all classes within mental hospitals and presents material in reference to the care of mental patients in Massachusetts for the years 1904-1939. Other items of general interest are outlined. All Classes Within Hospitals, 1939 Table 1 presents the number of patients in all classes within public and private institu- tions on September 30, 1939. Table 1. - - Patients of All Classes Within Institutions on September SO, 1989 Without Mental Disorder Total With Institutions All Mental Epileptic Forms Disorder and Epileptic Mentally Borderline Other Mentally Defective or Dull* Groups Defective Mental Hospitals Boston State 2,322 2,302 — _ 2 _ 18 Boston Psychopathic 75 63 - - 1 _ 11 Danvers .... 2,385 2,366 — — 3 _ 16 Foxborough 1,393 1,393 — _ _ _ Gardner 1,403 1,376 - - 22 _ 5 Grafton 1,481 1,477 _ _ 3 _ 1 Medfield 1,867 1,865 — _ 1 _ 1 Metropolitan 1,913 1,913 — — _ _ Northampton 2,016 2,002 - - 11 _ 3 Taunton 1,740 1,740 - _ - _ Westborough 1,609 1,597 - 2 1 _ 9 Worcester . 2,419 2,406 — _ 2 _ 11 Monscn (Epileptic) 1,543 532 - 1,004 3 - 4 Total .... 22,166 21,032 - 1,006 49 . 79 State Schools Belchertown 1,306 - 29 - 1,247 29 1 Walter E. Fernald . 1,944 - 49 - 1,860 33 2 Wrentham .... 1,988 - 146 - 1,796 46 Total .... 5,238 - 224 - 4,903 108 3 Other Public Institutions Tewksbury State Hospital and Infirmary 450 439 - _ 11 _ _ Bridgewater State Hospi- tal (Mental) . 881 854 - 1 18 _ 8 Bridgewater Defective De- linquents 612 — — — 612 — _ Infirmaries (County) 58 21 — 6 31 _ _ Hospital Cottages for Children 64 - - - 64 - - Total .... 2,065 1,314 - 7 736 - 8 Private and Governmental Institutions McLean Hospital 211 206 - 1 _ _ 4 Veterans' Adm. Facility, No. 95 . . 779 775 - _ 2 _ 2 Veterans' Adm. Facility, No. 107 . 1,161 1,158 - - _ - 3 Twenty other private in- stitutions 359 199 - 2 98 - 60 Total .... 2,510 2,338 - 3 100 - 69 Total — All Classes . 31,979 24,684 224 1,016 5,788 108 159 1 Patients not mentally defective. There were 31,979 patients in all classes under treatment within public and private institutions on September 30, 1939. This is a rate of 721 patients under treatment for each 100,000 in the general population*, or approximately one person in 138. Of this *Estimated population, 1939 — 4,431,946. 142 P.D. 117 total number 24,684 (77.1%) were diagnosed with mental disorder; 5,788 (18.0%) were mentally defective; 224 (.7%) were both epileptic and mentally defective; 159 (.4%) were classified as other groups; 108 (.3%) were borderline or dull; and 1,016 (3.1%) were epileptic. The total number under care in the twenty-two state and governmental institutions was 31,409 or 98.2%. In the twenty-one private institutions the number was 570 or 1.7%. During the year the number of patients within hospitals increased from a total of 31,248 on September 30, 1938 to a total of 31,979 on September 30, 1939, an increase of 731 patients or 2.3%. (a) The Mentally III The patients with mental disorder in public and private institutions on September 30, 1939 number 24,684. This is a rate of 556 per 100,000 of the population of the State, or one in every 179 of the population. Those with mental disorder in State institutions numbered 22,346, a rate of 504 per 100,000 or one in every 198 of the population. This is an increase over the previous year of 31 patients. Government hospitals cared for 1933 mental patients, a rate of 43 per 100,000 or one in every 2,325 of the population. Mental patients in private institutions numbered 405, as compared with 383 for the year 1938. This is a rate of 9 per 100,000 or one in every 11,111 of the population. (b) The Epileptic and Mentally Defective There were 224 patients who were both epileptic and mentally defective in public institutions at the end of the year, a rate of 5 per 100,000 of the population. (c) The Epileptic The epileptic population numbered 1,016, most of whom were cared for in public institutions. The rate is 22 per 100,000, or one in every 4,545 of the population. One thousand six, or 99%, were at the Monson State Hospital for Epileptics. (d) The Mentally Defective There were 98 mentally defective patients in private institutions and 5,690 in public and governmental institutions, a total of 5,788. This is a rate of 130 per 100,000 of the population of the State, or one in every 769. There was an increase over the previous year of 581 patients. The defective delinquents at Bridgewater were added to this table during the present year and this accounts for the large increase over the preceding year. (e) Borderline or Dull One hundred eight resident patients were classified as borderline or dull intelligence. The rate for this group is 2 per 100,000 of the general population. (/) Other Groups Without Mental Disorder Patients in public, governmental and private institutions classified under "other groups without mental disorder" numbered 159. Ninety-five were in public institutions, comprising 59% of the total. The rate for this class is 3 per 100,000 of the general popu- lation of the State. In the above group are included cases of alcoholism, drug addiction, psychopathic personality and others not included in sections (b), (c), (d) or (e) above. Patients Within Institutions and Annual Increase, 1904-1939 Table 2 presents the number of patients actually within public, private and govern- mental institutions on September 30 of each year from 1904 to 1939 inclusive and the annual increase for each year. In all hospitals, the number rose from 10,948 in 1904 to 31,309 in 1939, an increase of 185% or 5% per year. The average annual increase in number of patients within hospitals is 589 cases. The number of patients within State hospitals rose from 9,666 in 1904 to 23,497 in 1939, an increase of 143% or 4% per year. The average annual increase is 409 per year. The number of patients within State Schools rose from 847 in 1904 to 5,238 in 1939, an increase of 518% or 14% per year. The average annual increase was 123 patients per year. The average annual increase of patients within private institutions for the insane was 57. The mentally defective present an annual decrease of -.9. P.D. 117 143 <£ tCcNtCtomt~TfrN.cN I iO«NHNOSHOOiOiiHOM10^COlSn o> > I 1-1 t~-tf CO )NffilOOOiO^MU)!OlOiOHNO»NHH 3 TC COO I OJiOiO-^COCO 0 ~hC2 I 00 t~ ^P I CO— CO — — I — I — (M — CO ;j tOONNeffiC-H^l-JNNMOrtNMiOMNNLlO^MMWcCMCJiHt^artNM OmOifOHDiOOMSCOC- itO©CNtO>ntecor~"*,l>00CO0000Tt'(M;r-. — i ■* ^t< tJ< — M»i01»OW- ^_ m * oo cn ^ o_to i> cs as — ti< in t*. en oh_nnn — —"—"—"—"——"— — cN — ia^HHNHioMeHNNe«HMioMOM*ooWH moin — c^cNcoa;co-*o6to- to<^int~t^t~oo-*cooinot~o — inoscoto — oo i-i cm c-i co i-c to f^ t^ co o: cr. o — — ' —i o o C'l -m -m co -fi -!- uom w O t^ 00 00 00 O — IM CO CO cocococooococococococo-i7,'*'*^ti-*M,Tt>^tiTi-THT)"r~" oo" oo~oo"o"ai"o"o"— "— 'cncncnco'co" — — — — — — — — ,-.- — — — — — — HriH — rtrt — — — — (0OOO«00Mfflcq0)00i0«^inMH^i — coo^oo — incot~TfcNCM^cN^TH^^inot~c^c^TfOTji — t~odt-o- ooooair^intococo- cNooin^cooiOtOTtiOi-o^in — tooinoo — coitoo^t^.0000 00!DiniNNCOOOO(NOi';ffllNrfrtS-i'-HOOiOtO(NINNiO(00)raNNtOMiHffl '^03OON^,ttNi0r-iC]OO^OiH(>^Ni-i^itNC)r-0NS^NaiC0NC000i-'O omoococNastc- oocooocootocioo- ocnj cva^ o go ^cooototo- oo»o- ooco- co o" — — cn" co" co" ■*" m" m" to" to" r~" oo" oo" oo" oo" as o" o" c — < o i o- (Mco-^iotoi-^oocno — (Mco-^ontot^ooco OOOOOO — — — — — — —— — — C^CNCMNCNICNCnICNCNCNCOCOCOCOCOCOCOCOCOCO 144 P.D. 117 Table 3. — Patients on Visit and Escape from State Hospitals on September 30, 1928-1989: Numbers and Percentages Yfar Total Patients on Books1 Patients on Visit Patients on Escape Percentage on Visit Percentage on Escape 1928 1929 .... 1930 1931 . 1932 .... 1933 .... 1934 .... 1935 . 1936 .... 1937 .... 1938 1939 20,996 21,359 22,103 22,453 23,022 23,606 23,872 24,450 25,155 25,621 26,086 26,280 1,496 1.502 1,742 1,514 1,679 1,817 1,764 2,021 2,184 2,302 2,269 2,338 250 197 222 178 147 160 138 85 72 68 75 70 7.1 7 0 7.9 6.7 7.3 7.7 7.4 8.2 8.7 8.9 8.6 8.8 1.2 .9 1.0 .8 .6 .6 .6 .3 .3 .2 .2 .2 1 All classes on books of State Hospitals, Tewksbury and Bridgewater. Patients Out of Institutions at End of Year Table 3 records the number of patients out on visit and on escape at the end of each year, 1928-1939. The number of patients on visit increased from 1,496 in 1928 to 2,338 in 1939 and the percentages from 7.1 to 8.8. Clearly the hospitals are placing a larger percentage of their patients in the community as time goes on. The number of patients on escape decreased from 250 in 1928 to 70 in 1939 and the percentages from 1.2 to .2. Table 4 shows the number of visits taking place during the single year, 1939. We have recorded the total number of visits made by patients during the entire year, have compared this with the daily average population and calculated a visit rate for each hospital. Psychopathic shows the highest rate with 507 visits per 1,000 of the daily average population. Of the active admitting hospitals, Danvers shows the high rate of 366 and Northampton a rate of 329. Metropolitan leads the chronic transfer group with a rate of 120. Monson shows a rate of 441. The rate for the entire State Hospital group is 231. The females with a rate of 243 show a greater tendency to go out on visit than the males, 223. Table 4. — Number of Patients Placed on Visit during the Year 1939, by Institution and Sex: Rates per 1,000 Daily Average Population on Books Number of Patients Rates per 1,000 Daily Average Placed on Visit Daily Average Institutions Population on Books During Year Population M. F. T. M. F. T. M. F. T. Boston Psychopathic 76 54 130 33 33 66 434.2 611.1 507.6 Danvers 1,242 1,448 2,690 458 528 986 368.7 364.6 366.5 Northampton 1,095 1,292 2,387 301 485 786 274.8 375.3 329.2 Westborough 790 1,083 1,873 234 303 537 296.2 279.7 286.7 Boston State 1,154 1,463 2,617 348 360 708 301.5 246.0 270.5 Taunton .... 939 991 1,930 221 262 483 235.3 264.3 250.2 Foxborough 717 831 1,548 169 214 383 235.7 257.5 247.4 Worcester .... 1,428 1,511 2,939 333 371 704 233.1 245.5 239.5 Monson .... 769 859 1,628 376 342 718 488.9 398.1 441.0 Metropolitan 892 1,040 1,932 92 141 233 103.1 135.5 120.6 Medfield .... 798 1,137 1,935 72 115 187 90.2 101.1 96.6 Gardner .... 855 743 1,598 46 83 129 53.8 111.7 80.7 Grafton .... 770 785 1,555 18 40 58 23.3 50.9 37.2 Total .... 11,525 13,237 24,762 2,701 3.277 5,978 234.3 247.5 241.4 McLean .... 102 160 262 63 66 129 617.6 412.5 492.3 Vet. Adm. Fac. No. 107 . 1,216 - 1,216 361 — 361 296.8 - 296.8 Vet. Adm. Fac. No. 95 . 773 - 773 127 — 127 164.2 — 164.2 Tewksbury 75 383 458 1 7 8 13.3 18.2 17.4 Bridgewater 880 - 880 2 - 2 2.2 - 2.2 Total .... 3,046 543 3,589 554 73 627 181.8 134.4 174.7 Grand Total 14,571 13,780 28,351 3,255 3,350 6,605 223 3 243.1 231.5 P.D. 117 145 <5s I Kj "So £CQ is o B C5 Oh 03 s -w B =• O 0 Ssa to if -o C^ 5 fc, 1U ft, H Bq a < « CO H fa fa 137 144 281 95 131 226 8 1 9 11 - 11 4 20 24 7 8 15 12,493 13,658 26,151 10.9 10.5 10.7 7.6 9.5 8.6 PS ■< p < 1-5 fa 130 167 297 214 248 462 14 9 23 12 9 21 4 9 13 2 7 9 12,511 13,677 26,188 10.3 12.2 11.3 17.1 18.1 17.6 K H « H O H Q fa 366 449 815 183 248 431 14 5 19 13 6 19 4 13 17 2 19 21 12,537 13,672 26,209 29.1 32 8 31.0 14 5 18.1 16.4 « H n s a > o fa 285 368 653 210 220 430 11 6 17 14 3 17 6 11 17 2 7 9 12,493 13,708 26,201 22 . 8 26.8 24 . 9 16.8 16.0 16.4 K H M 0 H O o fa 228 234 462 146 175 321 24 3 27 25 5 30 4 20 24 3 11 14 12,477 13,682 26,159 18.2 17.1 17.6 11.7 12 7 12.2 < H 0 H fa i 2,704 3,284 5,988 1,919 2,343 4,262 271 66 337 244 59 303 97 228 325 55 166 221 150,115 164,011314,126 18.0 20.0 19.0 12.7 14.2 13.5 Placed on visit Returned from visit On escape Returned from escape Placed in family care Returned from family care On books at end of month Visit rate per 1,000 on books .... Return rate per 1 ,000 on books .... « a n S a H o. a CD H fa 241 288 529 179 210 389 35 7 42 32 7 39 6 11 17 2 15 17 12,588 13,692 26,280 19.1 21.0 20.1 14.2 15.3 14.8 Eh 0Q S> a < fa i CDCDCMCDiOHHCOlO*0 00 "O Tf CO CO CO CO ■ • Tt< CO N 00 CO cd"'-1 ~* CM cO0000cocDHHOst>.|> O 00 CM CM t> • CM hH CD 00 CO co"'"1'-' ooohhocsoi-^coco COCDCOCO — lO ■ ■ CMi-H lOOOCO cm"'~''h D fa 3!ClrtONOClCOO •H I> Tf CO ■* CM OS • ■ cc •* h co oo co'Mr-' CM COt^OOCO—lsOiHCOb- tHIO C0>-lt» ■ • COCM CDIO00 comcoHH--i-cH.-ioO'-i t^ — COCM ri CM • ■ CM CM iO-Ht» a >-3 fa t^t^O00O-H— < LOCO i-h O -h CO CO CO CM CD • • lOCO HON co"rt'-' CM noicoftcoctoi ^05 CM — CO • ■ CM —l CD_ OS CO co" "" H-t^COCOWt^OSf-H COCMCOCO OS ■ ■ cm -- t*_oo o CM*^''-' < fa r^t^r^'Ocor^cocDco 00 OS CM CM -* CM CM ■ • HH CM H0O i-H co"1-"-1 CM OOWh/SOIhOhiO 00b- CMCMCO • • Nh COHCj OS-fCOasb-CDCDOOS CSCMCMi-hi-h OS • • i-H — ■* IO OS CM_rH s < fa CMOOHHDWHH CM -* CM CM CO ~h 00 ■ - LOCO ooco CD^1^ CM os-h-cccocococmcmlo 0000 h ho ■ • CM H CD ri CO socNcemcorHoiN CO LO CM rt H 00 ■ ■ CM— "*00CN csf-1 rH a < H fa CO00H1CD00'OCDH-CO CM H CM -H CM i-H CO ■ ■ COCM i-H CM 00 co'^ CM CM OS >* CO 00 — (TfMN 00— H — b- . . — — i CDCO00 co"'-' *oiocooh«ioo) •* OS CM -h i-h CD ■ - i-H HH-HC~ CM_rH a-s CD - O O O r* O . .£>.>?e§o 1 §|s-sg§ ■■ss s^sSts .So ono^SOi c-d o,th c-a g « g § 3 1) 3 § 3J« 3 5 CU C3 CU ^ CU 33. S CD PL,rtOrtPHCiO>pH — — J3 03 -^ CD 146 P.D. 117 Table 5 presents the number of visits, escapes and cases placed in family care during each month of 1939 and also the cases returned each month. The visit rates show the tendency for the fewest patients to go out in the months of January and February, the rates being 11.3 and 10.7 respectively. The visit rates rise to higher levels in the warmer months of April, May, June, July, August and September. The highest visit rate for the year per 1,000 patients on the books is 31.0, in the holiday month of December. In general, the rates for cases returned from visit follow the trend observed in the visit rates themselves. The only month in which the return rate exceeds the visit rate is January. The total visit rate is higher than the return rate due to the fact that a certain proportion of cases sent on visit never return to the hospital but are discharged to the community. Table 6. — Family Care Under Institution Trustees During 1989 Other Cases Patients Re- Patients in Number \d- Number Re- leaving maining in Family Care mitted during turned to Insti- Familv Care Familv Care Hospitals September 30, Year tution during Status during September 30, and School 1938 Year Year 1939 M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Boston State . _ 2 2 2 9 Danvers . 8 8 13 36 49 1 5 6 3 12 15 9 27 36 Foxborough . — 5 5 - 8 8 7 7 - 3 3 - ' 3 3 Gardner 10 107 117 12 68 70 5 53 58 2 5 7 15 107 122 Grafton . 2 12 14 — 4 4 1 3 4 1 1 1 12 13 Medfield 8 8 - 2 2 1 1 - 2 2 - 7 7 Metropolitan 6 6 2 8 10 1 8 9 12 3 - 4 4 Northampton 7 16 23 5 7 3 2 5 3 3 6 3 16 19 Taunton 1 2 3 - - - 1 1 — — — 2 2 Westborough 11 16 27 o 6 8 1 3 4 - 2 2 12 17 29 Worcester 33 75 108 64 117 181 31 56 87 22 39 61 44 97 141 Belchertown . 4 16 20 15 33 48 1 12 13 1 1 18 36 54 Total 68 273 341 110 277 387 45 150 195 31 72 103 102 328 430 Table 7. — Patients in Family Care from Institutions and Under the Department of All State Hospitals September 30, 1904-1939 Family Care From Under the Year Grand Total Institutions Department M. F. T. M. F. T. M. F. T. 1904 ... . . 14 199 213 _ 14 199 213 1905 13 243 256 1 2 3 12 241 253 1906 13 282 295 10 10 13 272 285 1907 13 270 283 8 8 13 262 275 1908 12 238 250 1 5 6 1 1 233 244 1909 10 239 249 8 8 10 231 241 1910 16 269 285 2 8 10 14 261 275 1911 15 294 309 1 10 11 14 284 298 1912 15 327 342 2 24 26 13 303 316 1913 14 352 366 2 28 30 12 324 336 1914 21 320 341 9 30 39 12 290 302 1915 28 375 403 27 290 317 1 85 86 1916 35 363 398 35 299 334 64 64 1917 29 296 325 29 249 278 47 47 1918 23 263 286 23 219 242 44 44 1919 27 228 255 27 190 217 38 38 1920 15 201 216 15 167 182 34 34 1921 10 185 195 10 154 164 31 31 1922 12 187 199 12 158 170 29 29 1923 9 159 168 9 132 141 27 27 1924 4 152 156 4 132 136 20 20 1925 10 154 164 10 131 141 23 23 1926 8 149 157 8 127 135 22 22 1927 14 156 170 14 136 150 20 20 1928 28 128 156 28 109 137 19 19 1929 23 147 170 23 130 153 17 17 1930 23 146 169 23 132 155 14 14 1931 19 173 192 19 151 170 22 22 1932 24 184 208 24 171 195 13 13 1933 34 231 265 34 217 251 14 14 1934 35 242 277 35 242 277 _ _ _ 1935 38 273 311 38 273 311 _ _ _ 1936 48 275 323 48 275 323 _ _ _ 1937 63 273 336 63 273 336 - — - 1938 68 273 341 68 273 341 _ _ _ 1939 102 328 430 102 328 430 _ P.D. 117 14- Family Caee Under Institution Trustees and Under the Department Table 6 shows that the number of cases in family care on September 30, 1939 (430) increased by 89 from the figure for 193S (341). A total of 387 new cases were placed in family care during the year. Of these, 195 were returned to the institution during the year, while 103 cases were taken from family care through return to the community, death, or change of status to visit. At the end of the year Worcester, with 141 patients out, had the largest number in family care. Gardner was next with 122, Belchertown third with 54, and Danvers fourth with 36 patients out in family care. Table 7 shows the status of family care between 1904 and 1939. In the early years, family care cases were supervised almost entirely by the Department of Mental Diseases. Gradually this supervision has been taken over by the individual institutions. The Department ceased to supervise family care cases in 1934. At the end of 1939 a total of 430 cases were under family care supervision, 328 females and 102 males. The number of 430 under care during 1939 is at the rate of approximately 9 per 100,000 of the general population. Ex-Service Men in State Hospitals, 1928-1939 On September 30, 1928, there were 387 ex-service men on the books of State Hospitals, while on September 30, 1939 there were 474 (Table 8). The daily average number on the books during each statistical year increased from 409.18 in 1928 to 503.38 in 1939. The daily average number actually cared for during the twelve-year period increased from 393.97 to 444.88. Table 8. — Ex-Service Men in State Hospitals, 1928-1939: Daily Average Numbers^ Number on Books Daily Average Number Daily Average dumber Year Septembe -30 on Books during Year Actually in Hospital during Year M. F. T. M. F. T. M. F. T. 1928 . 387 387 408.18 1.00 409. 18 392.97 1.00 393.97 1929 . 414 7 421 409 . 07 7.35 416.42 350.46 6.36 356 . 82 1930 . 369 5 374 368.03 4.62 372.65 329.94 4.62 334 56 1931 . 360 8 368 371.24 7 15 378.39 339.55 7.15 346.70 1932 . 401 8 409 415.39 9.00 429 . 39 380.34 8.62 388.96 1933 . 383 8 391 417.22 8.00 425.22 374.86 8.00 382 . 86 1934 . 416 6 422 421.45 5.75 427 . 20 374.18 5.16 379.34 1935 . 475 6 481 464.41 5.70 470.11 401.47 4.26 405.73 1936 . 506 9 515 504 . 38 8.00 512.38 456.09 7.00 463 . 09 1937 . 528 8 536 587 . 96 9.23 597.19 515.14 5.39 520.53 1938 . 454 7 461 533 . 53 7.36 540.89 469 . 47 6.36 475 . 83 1939 . 466 8 474 497 . 07 6.31 503.38 438.57 6.31 444 . 88 1 Includes all State Hospitals, Bridgewater and Tewksbury. Section B. All Admissions to Mental Hospitals During 193-9 As mentioned in the report of the Division of Statistics, (Page 129) the year 1937 marked a change in the presentation of the Department statistics. Up to 1937 Depart- mental statistics were presented on the basis of cases admitted to hospitals under court commitment, the data on temporary care, observation and voluntary admissions being considered separately. As it was found that non-inclusion of these other types of admis- sions made our statistics less complete than might be desired, the method of analysis was changed. Beginning with 1937 we include in our statistics all types of admissions to mental hospitals, whatever the legal form admitting the patient. First and Readmissions, 1937-1939, by Form of Admission Table 9 presents the number of first admissions and readmissions to mental hospitals 1937-1939 by forms of admission. There were 6,833 admissions during 1937, 3,798 males and 3,035 females. In 1939 the number of admissions decreased to 6,799, 3,741 males and 3,058 females. There is a decrease from 5,006 total first admissions 1937, to 4,997, total first admissions in 1938 a further decrease to 4,869 in 1939. A decrease is also observed in the court commitments, 3,101 in 1937 to 3,038 in 1939. The observa- tion cases increased from 588 to 684. Only 992 cases were admitted under temporary care, as compared with 1,142 in 1937 and 155 on voluntary papers, as compared with 175. The number of readmissions rose from 1,827 in 1937 to 1,937 in 1938 but decreased to 1,930 in 1939. Increases are observed in all forms of commitment between the years 1937-1938 but some decreases are seen in 1939. The number of court cases rose from 148 P.D. 117 1,293 in 1937 to 1,326 in 1938 then dropped to 1,314 in 1939; temporary care, from 291 in 1937 to 325 in 1938 and dropped to 302 in 1939. Observations rose from 149 in 1937 to 191 in 1938 and continued to rise to 215 in 1939. A slight increase is observed in the voluntary from 94 in 1937 to 99 in 1939. Table 9. — First and Readmissions to State Hospitals, 1937-1939, by Form of Admission and Sex Sex Aggre- gate First Admiss ONS Readmissions Year Total Court Tempo- rary Care Obser- vation Volun- tary Total Court Tempo- rary Care Obser- vation Volun- tary 1937 T. M. F. 6,833 3,798 3,035 5,006 2,775 2,231 3,101 1,563 1,538 1,142 700 442 588 401 187 175 111 64 1,827 1,023 804 1,293 679 614 291 190 101 149 101 48 94 53 41 1938 T. M. F. 6,934 3,838 3,096 4,997 2,797 2,200 3,119 1,619 1,500 1,074 615 459 665 479 186 139 84 55 1,937 1,041 896 1,326 659 667 325 196 129 191 131 60 95 55 40 1939 T. M. F. 6,799 3,741 3,058 4,869 2,723 2,146 3,038 1,552 1,486 992 592 400 684 487 197 155 92 63 1,930 1,018 912 1,314 651 663 302 175 127 215 144 71 99 48 51 First Admissions and Readmissions, 1917-1939 Table 10 presents the numbers and rates for first admissions and readmissions to all Massachusetts mental hospitals over the years 1917-1939. The figures on this table are presented on the new basis as they have been taken from our Rockefeller Research Project. This analysis uses the same method of evaluation, including court commitment, observation, temporary care and voluntary admissions, beginning with the year 1917. It has been the aim of the Statistical Division to present a state-wide picture of mental disorders and we, therefore, include figures for the private institutions as well as the public mental hospitals. As economic and social changes may cause a shifting of patients from private to public institutions, we feel that a report embracing both groups is neces- sary to show us the true incidence of mental disease in our state population in so far as incidence can be checked by the numbers of patients coming into mental hospitals. The total column, showing the admission rates of first admissions to hospitals of all types, presents a rate of 105 in 1917 which drops to 92, the low of all years, in 1920. This, it will be recalled, is the first year of the Eighteenth Amendment. Gradual increases occur but the 1917 rate of 105 is not surpassed until 1931 when a rate of 106 is observed. The year 1936 presents the high rate of 119 and 1938 continues the 1937 rate of 114. The rate for 1939 dropped to 111. Over the 23-year period between 1917 and 1939 the first admission rates have increased from 105 to 111, or but 6 patients per 100,000. This is a 5.7% increase or about one quarter of 1% per year. The readmissions show a rate of 38 in 1917 and 39 in 1918. In general the rates remain flat until 1933. Beginning with 1934 increases are noted which rise to the high of 46.3 per 100,000 in the year 1939. Over the 22-year period the readmissions have shown an increase of but 8 patients per 100,000 of the population. This is an increase of 20.3% or .9% per year. These figures in the first and readmissions are for the state-wide sample, including all types of institutions admitting mental patients. In the State hospitals, we observe the first admission rate of 97 in 1917. The low of 84 occurs in 1920 and then there is a gradual return to a higher level. The rate of 100 in 1931 is the first to exceed the 1917 figure of 97. This continues to 1935 when a rise to 105 is seen. The high rate of 110 occurs in 1936 with a decrease to 104 in 1939. The readmissions to State hospitals show a rate of 34 in 1917, a slow drop to the low of 28 in 1925, 1926 and 1927. From 1934 on definite increases are observed. The first year to surpass 1917 is 1934, with a rate of 37. The high rate of 40 is observed in 1939. In summarizing this table, we can say that the State hospitals have shown a moderate increase in first admission rates of about 7% between 1917 and 1939. The readmissions operating on a lower level, have shown an increase of about 15%. When we come to the total of all hospitals, including the governmental and private institutions, we find the approximate increase for first admissions is 5% and for readmissions is 20%. P.D. 117 149 a, ©> CO S3.g II 18 § 5. si as > J 2 < WW si cffi O ps.-a S3- BBS ■A8 * S £ S c •-.5 ° 0CO'H(Ni)iTf00'*-H»O^,0-.tl0mOMN00(0O'fiO incD*OcOCOf^«'*fCO'^OcDt''.-'^^'-i^cNCN»OCOCOOCN C000i0©~H(NOTt.'*t^CNOOaiCDCDCOOOO.oow <%« .as o «'S « ^H C CTiOrttCO .Tt<'^<'*t»t»OOOOCJ© COCOCOCOCOCOINCOC^C^C^COCOCOCOCOCOCOCOCOCOCO^ CMt»l^OCNt»eC00O'OC!0OWCNU5r-lc<5t»'*e0e003C0 N'tlO^NiflCDOOr^OOOCOCOCOOOOOiOOCOCO^ QOlOQOOOOiQOOOfflQOOOOOOCOOOOHOOO COOOl^cCCOOO'-i'-it— f"*c<5i-'*iOt~CDt^T-lCNCCiei5COCD COCOCOCOCOCOCO"*COCOCOCOCOCOCOCOCO-*joo-*iQ!-KOt".coTt<05coiocDTii iotNTj(CM'Oco-*>-i'-icoomeOCOO'-i'-i-'SOcO00a>O-^CNC0'*'Oc0^00OlO^HlNc0-»"OC0t>-00i32 i-li-ir-i(NCNCN " * * o^ o 54 'a v, m ■r o.2 ° 2 S'oMf.2 Cj3 s a> g 0,5333 o o o o o 150 P.D. 117 First and Read-missions, 1939, by Hospital Table 11 presents the admission forms used in first admissions and readmissions in 1939, by hospital. Of the total first admissions, 56% were court commitments, 26% were admitted under temporary care, 13% under observation commitment and 3% on voluntary papers. In the readmissions, 60% were court admissions, 23% temporary care, 10% observation commitments and 4% voluntary. As might be expected, court commitment is being used more often in the case of readmissions. Table 11. — First and Readmissions to Mental Hospitals, 1939, by Form of Admission and by Hospital Aggre- Fir st Admissions Hospitals gate Total Court Temporary Observation Voluntary Care No. % No. % No. % No. % No. % B. Psychopathic 2,114 1,573 100.0 95 6.03 1,157 73.55 270 17.16 51 3.24 Boston State . 1,075 704 100.0 513 72.86 132 18.74 57 8.09 2 .28 Dan vers 890 633 100.0 451 71.24 89 14.06 90 14.21 3 .47 Foxborough . 323 229 100.0 181 79.03 12 5.24 34 14.84 9 .87 Northampton 582 438 100.0 373 85.15 23 5.25 38 8.67 4 .91 Taunton 574 436 100.0 332 76.14 39 8.94 58 13.30 7 1.60 Westborough . 521 330 100.0 284 86.06 1 .30 39 11.81 6 1.81 Worcester 821 552 100.0 423 76 . 63 13 2.35 109 19.74 7 1.26 136 95 100.0 67 70.52 14 14.73 12 12.63 2 2.10 Grafton 124 67 100.0 65 97.01 - - 2 2.98 - - Medfield 283 161 100.0 138 85.71 10 6.21 11 6.83 2 1.24 Metropolitan 129 - - — - - - - - - - Monson . 135 96 100.0 30 31 . 25 - _ 1 1.04 65 67.70 Tewksbury 1 1 100.0 1 100.00 - - - - - - Bridgewater . 90 45 100.0 28 62.22 — — 17 37.77 - — McLean 209 130 100.0 69 53.07 20 15.38 4 3.07 37 28.46 Vet. Adm. Fa- cility No. 107 129 55 100.0 48 87.27 - - - - 7 12.72 Vet. Adm. Fa- cility No. 95 190 67 100.0 51 76.11 2 2.98 2 2.98 12 17.91 Total1 8,326 5,612 100.0 3,149 56.11 1,512 26.94 744 13.25 207 3.68 Readmissioi Total Number Rate per 100,000 Public Private Yeah Public and estimated popula- Institution Institution Private tion of Number Number Institutions State 1928 419 9.70 238 181 1929 . 448 10.22 266 182 193Q . . 437 10.28 321 ,116 1931 . 466 10.96 367 < 99 1932 . 433 10.18 358 75 1933 . 432 9.88 324 108 1934 . 447 10.13 387 60 1935 . 454 10.43 398 56 1936 . 483 11.00 411 72 1937 . 451 10.27 381 70 1938 . 433 9.81 329 104 1939 . 428 9.65 318 no i All publ c an d pr vate inst tut ions for the insan i and epileptic. Legal Status of First Admissions during 1939, by Hospital Table 13 gives the various combinations of legal forms used in first admissions to mental hospitals during 1939. For example, a patient may enter under temporary care (ten day paper), be committed for observation (40 days) and at the end of that period be committed for an indefinite period. The court commitment, used alone, is the most common form, comprising 28% of first admissions. The temporary care admission is second with 19%. Next we have the combination of temporary care followed by court commitment, comprising 16%, and fourth the combination of observation commitment followed by court commitment in 12%. Considering the State hospitals only, regular court commitment was used to the great- est extent in the following institutions: Grafton — 86%, Medfield — 59%, and West- borough — 46%. In the temporary care form of admission, Boston Psychopathic Hospital shows the high figure of 63%. In order follow Boston State with 17% and Danvers and Gardner with 14% each. The combination of temporary care followed by court commitment comprises 32% of admissions at Danvers, 22% at Boston State and 19% at Taunton. The following table compares the percentage distributions of the combinations of admission forms in first admissions and readmissions during 1939. Court commitment and the voluntary forms are used more commonly in readmissions than in first admissions. Temporary care and observation forms are substantially reduced in readmissions. 152 P.D. 117 A. co © 5| 5 I fc-H <» - Oh CO ■Is ^ b -© ^1 ^ CO CN —■ | OO-HHiO 1 (N o go 65 00 W Tf ■* t- OS O o CO rH CN o ^ ° s Z< 6 Z 00C000 1 MOWOO 1 i-h 00 ^C)H ONi'OS CO 0 o«»n 1 | COMGS 1 00 o 65 OSOiO o ^h -+ ~h d H IO ^ T-H c Q a 6 Z BOO 1 I <-h|>(N-# 1 CO § fflrH rH CN CO ic i a i I l -*-*■* i I O z o H 65 oo o o to «! K d 00 | « | 1 HHIO | | t~ O lO CO hSMOOMNMM 1 O o a 65 IN tH CO i-h rH lO iO lO t-» -— < o Z CNrH -h IN o 0 M ■-H lO O CNrH -i IN Os COCNt- 1 1 OOsOOCO 1 00 o W x 5 £ CD lO rr CO t-- -f OS d CO <-" i-i "-■ o ° 2 W O d 13 "S>CNt- 1 INHHifl | O Os n 00-hCN TprHiJI CN z O . . . C fe'fi'-C CO o-o o r >00 St; 0 -0-0TJ.0 3 m BIOS ~ O ^ O cu as cu co aT-rj b '£ J. t. 1- fcc I- g S c3 •55 • S O fi S K O r; o oooo "'a J 2* S £ £ £ S"S «o o H O>n-'COOO> co tJD»t-CQO,0,p,t.i-,l-- -,rHflJ'Hr"Hdr^aj* 3 C nS. ScEE »J3-C O dJD O O 0J III oXi+'+J OHOchHEhchOOO 1 i-H I OOt-H^HCO lilt o £3>o 6? ■* d^ffo d "dec, as IN CO o BS . h »: o UZZ d | rH | IOi-Hi-ICO 1 1 1 1 ■* >< is CN hi 1 1 rf 1 | OCO 1 00 1 O "2 o'k. Z -f ^ c5? CO t~ (NO CO d ■^&h2 ^ CO^H o H - C 6 Z »-H I 1 iO I 1 OOCO 1 IN 1 OS CN >- O 1 1 1 1 1 1 1 1 1 1 o PJ p & d o a o o CQ M f-l 6 Z r-< | 1 ! 1 1 1 1 1 1 1 1 OIM 1 1 1 1 CN 1 1 o W W & d t^ in o o m 0 Eh -hi CO !N o 2 < « 2 03 e Q- 00 1 t^ 1 1 1 1 1 O 1 1 "5 Z rt -f CO CO CO t» CD l> 00 lO lO t- 1 o Z < a *3§ UJICINON W-HH o i-H CN -hi o J o 3 NOMNOrt t^CNCN^H 1 o !5 CN CNiH in CO IN 1 1 CO 1 1 O 1 1 1 1 o z 0 CO Z 155 (^ OS CO o CN CD o o § 6 OS 1 1 CO 1 | rH | | | | CN CO co K OsCOt^t^ 1 OstHi-iO 1 W o Eh 15? OCN lO COCOCOCD d CO CO i-H i-H CN o H o K o d Z i-HCOt^Th ICN-HI-HI-HI |CO CN £ NH00 COT* oscouoco 1 cNrHcocN l o o fH 0 65 CO t> TfiCNOst^ i-h d h)( CN o H 0 >> OS IS 0 ■ lO-Hic— i |hhi[^cno I m o m Z •O CN i-h COOS CO rt co z 65 COOs'OCNCNt^O'H^ilN'-i o o OsOOt^ iCOst-O iH o IN i-H CN o Eh z p OOOSCOi-Hi— 1 IO CO rH OS rH IO CO < CNC0C0 (N00CO00 co H I? -* h 3 o . . . o CO .... a .■§ . . . >,.2 os p fH c3 cu a Eh . . . . -f > o . . . a-s-e? CC ^ K 3 s 0^2 O > J < ■ ' >oo |-g ' o T3T3T3^ 3 a CS cbiq ;-'-£ o oooo soJ >io. >>>>>)>>oxi g 'S^ bo3 03 03 a- grO "3 l-ltfefl(-r*-tt-.l-,C3 ^O o o>-^-oooo> en •pftr.piftaaa^t' 3 c s^ EccS s-^^ o VrQ o a; 0 o) (UpQ-hh-i OHOHHE-tf-iOOO P.D. 117 153 Percentage Distribution in Legal Status of All Cases Admitted for the First Time and All Readmissions, 1939 All Cases All Admitted for Readmitted First Time Cases Court Commitment 28.2 30.1 Temporary Care 19.7 15.2 Observation 10.7 7.9 Voluntary 1.4 3.7 Temporary Care and Voluntary 1.2 1.0 Temporary Care and Observation .... 3.3 3.2 Temporary Care and Court 16.8 20.9 Temporary Care, Observation and Court ... 4.5 5.4 Observation and Court 12.7 10.1 Others and Court .1 1.3 Other Combinations 1.0 .6 Legal Status of Readmissions During 1939, by Hospital Table 14 shows the distribution of the combinations of legal forms in readmissions for 1939, by hospital. Court commitment was used most often at Grafton, Medfield and Westborough, comprising 70%, 70% and 45% of readmissions, respectively. Temporary care admissions followed by court commitment were found in 36% of the Northampton and Dan vers readmissions, 28% at Foxborough and Taunton and 25% at Worcester. Temporary care admissions were high at the Psychopathic Hospital with 69%, Boston State and Danvers being next in order with 14% and 16% respectively. It is interesting to note that of the 2,107 cases admitted to the Boston Psychopathic Hospital during 1939 over 90% were temporary care, observation or voluntary cases. Of the 2,107 admissions a total of 946 went directly to other institutions. The remaining 1,082 were returned to the community. The cases going to other institutions are not duplicated in our statistics, being counted but once. Diagnosis of Admissions, 1939, by Form of Admission Table 15 shows the psychoses admitted under the various legal forms. In the first admissions, 99% of court commitments were diagnosed as "with mental disorder" and only .6% "without mental disorder". The temporary care admissions comprised 69% "with mental disorder" and 30% "without mental disorder". In the observation com- mitments, 41% were "with mental disorder" and 58% "without mental disorder". The voluntary form was made up of 61% "with mental disorder" and 38% "without mental disorder". Obviously the temporary care, observation and voluntary forms are being used in admitting the borderline cases of mental disorder, many of whom are being diagnosed as "without mental disorder". In the readmissions, very similar percent- ages are observed for the various admission forms. In first admissions the psychoses with cerebral arteriosclerosis made up 26% of court commitments, dementia praecox 22% and senile psychoses 8%. The temporary care group shows without psychoses 25%, the alcoholic psychoses 17% and the psychoneu- roses 12%. In the observations, the leading groups are without psychoses 50%, the alcoholic psychoses and psychoneuroses with 9% each and primary behavior disorders 8%. In the voluntary admissions, without psychoses is high with 35%, followed by the psychoneuroses with 16% and the convulsive disorders with 12%. In the readmissions the leading psychoses among the court commitments are dementia praecox 31%, manic-depressive psychoses 22% and psychoses with cerebral arterio- sclerosis 8%. The temporary care cases show without psychoses high with 35%, the alcoholic psychoses second with 13% and the manic-depressive group third with 11%. Among the observation admissions, the without psychoses group with 59% is followed by 11% in the alcoholic psychoses. Among the voluntary admissions the without psy- choses group shows 31%, psychoneuroses, 23% and manic-depressive, 21%. The outstanding point in this table is the large number of cases who are admitted on short residence forms and classified as psychotic but who are returned to the community. In the first admissions, 686 temporary care cases "with mental disorder" were allowed to leave the hospital at the end of a ten-day period. In the observation group (40 days) 282 persons "with mental disorder" were allowed to leave. Among the readmissions 154 P.D. 117 OS « g? 00 CO CO -tf fH CO CN lO 05 ^* 1 o d H-f1,"J!M35)t>-' CO CO c d Tt< CO CO CN CO iO O C5 -h CN 1 00 fc ■«t in i-i CO 0 £S om« [ 1 00O500O 1 1 o ij OCNCN "3 t- d w E b- "-1 o a H O S3 CNCOCO 1 |HNrtO 1 1 t-~ 2 00 CM 3 z es m |h i i i r~ l oo l 1 o o o >-H CO •* d Eh t*- i-H »-i o to < K O d S3 OS ! 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IS v la St A o •b-S • SI. r cu o o c "3 o H -d a 03 6 £ ^^Q^?: ^ £^ - Q^ £SQ£ ^^t5t5£ 156 P.D. 117 190 temporary care cases and 83 observation cases also were returned to the community, although diagnosed as having a mental disorder. Number of Times Admitted, All Admissions, 1939 Table 16 presents the number of the present admission of patients coming into mental hospitals during 1939. Of the 6,799 admissions, 4,869 or 71% were admitted for the first time, 806 or 11% were having their second admission, 511 or 7% their third admis- sion, 274 or 4% their fourth admission and 131 or 1% their fifth admission. Forty patients, or .5% were having their tenth or higher admission. While nearly three- quarters of mental cases coming into mental hospitals are first admissions, the read- missions show many cases who have been in mental hospitals repeatedly. The 1,930 patients admitted two or more times represent at least 4,527 previous admissions. The average number of times admitted for all admissions 1939 is 1.67 times, 1.65 times for the males and 1.68 times for the females. Table 16. — Number of Times Admitted, All Admissions, 1939: Percentage Distribution Times Admitted Number Percentage Number M. F. T. M. F. T. 2,723 2,146 4,869 72.7 70.1 71.6 428 378 806 11.4 12.3 11.8 266 245 511 7.1 8.0 7.5 133 141 274 3.5 4.6 4.0 75 56 131 2.0 1.8 1.9 39 43 82 1.0 1.4 1.2 24 18 42 .6 .5 .6 11 10 21 .2 .3 .3 17 6 23 .4 .1 .3 Ten plus 25 15 40 .6 .4 .5 Total . 3,741 3,058 6,799 100.0 100.0 100.0 Average Number of Times Admitted 1.65 1.68 1.67 (See Table 203 for detail) Table 17. — Average Number of Times Admitted, All Admissions, 1939, by Diagnosis Diagnoses Number Average Number of Times Admitted Manic-depressive psychoses With psychopathic personality . With convulsive disorders (epilepsy) With mental deficiency Dementia praecox .... Without psychoses .... With other forms of syphilis With organic changes of nervous system Undiagnosed psychoses Alcoholic psychoses .... Psychoneuroses . . Paranoia and paranoid conditions Involutional psychoses . . With syphilitic meningoencephalitis Due to drugs, etc. .... Traumatic psychoses .... With other disturbances of circulation With other infectious diseases Due to other metabolic diseases, etc. With epidemic encephalitis With cerebral arteriosclerosis Senile psychoses Primary behavior disorders Due to new growth .... 656 90 156 206 1,219 958 27 122 93 575 384 136 248 225 46 22 38 21 101 11 1.036 293 123 13 2.77 2.53 2 12 L95 1.79 1.77 1.66 1.63 1.58 1.54 1.47 1.43 1.41 1.33 1.26 1.22 1.21 1.19 1 19 1.18 1.18 1.13 1.08 1.07 Total With Mental Disorder Total Without Mental Disorder Grand Total 5.718 1,081 6,799 1.66 1.69 1.67 (See Table 203 for detail) P.D. 117 157 Table 17 gives the average number of times admitted, by diagnosis. These are ar- ranged in order, showing the tendency for readmission in certain psychoses. The 6,799 admissions of 1939 have had a total of 11,354 admissions up to the present date. The highest averages for the number of times admitted are as follows: manic-depressive, 2.77; with psychopathic personality; 2.53; with convulsive disorders, 2.12; with mental deficiencjr, 1.95; dementia praecox, 1.79; and without psychoses, 1.77. The group show- ing the least tendency to readmission is due to new growth, with an average of 1 .07. The group "without mental disorder" comprises 15.8% of all admissions and shows an average of 1.69 admissions per patient. The borderline group evidently shows symptoms which cause return to hospital although no psychosis is present. Nativity and Parentage op Admissions, 1939 Table 18 outlines the nativity of first admissions and readmissions for 1939, presenting rates for the same nativity groups in the population 15 years of age and over (1930 Census). The foreign born show a first admission rate of 142 per 100,000 and the native born a rate of 165. When the native born are subdivided in accordance with parentage, the native born with both parents foreign born show an admission rate of 160 and the native born with one parent foreign born and the other parent native born, an admission rate of 166. Apparentl,v the higher rate for the native born is maintained by the high admission rates in the native born of foreign or mixed parentage. The native born with both parents native born show the low rate of 147 per 100,000. In the readmissions, the foreign born present an admission rate of 47 per 100,000 while the native born show a much higher rate of 70. When we subdivide this native born group in accordance with parentage, we find the native born of foreign parentage with an admission rate of 72, the native born of mixed parentage with an admission rate of 69 and the native born of native parentage with an admission rate of 64. In the readmissions as in the first admissions the foreign born show the lowest admission rate of all the nativity groups and all of the native born groups are decidedly higher. Table 18. — Nativity and Parentage of First and Readmissions, 1939: Rates per 100,000 of Same Nativity Groups 15 Years of Age and Over, 1930 Census Aggre- gate Foreign Born Native Born Nativity Pa RENTAGE Ol ? Native F OSK Admissions Foreign Mixed Native Unknown Nu m beet- First Admissions Readmissions 4,869 1,930 1,464 489 3,394 1,439 11 2 1,285 582 517 216 1,388 605 204 36 All Types Rates First Admissions Readmissions All Types 6.799 158.0 62.6 220.6 1,953 142.1 47.4 189.5 4.833 165.4 70.1 235.5 13 1.867 160.3 72.6 232.9 733 166.2 69.4 235.6 1.993 147.7 64.4 212.1 240 (See Tables 178 and 179 for detail) Admission Ages of Native and Foreign Born Admissions, 1939 Table 19 shows that the average age of the foreign born first admissions was 57 years while that of the native born was 42 years. This finding renders remarkable the low admission rate of the foreign born in Table 18. It is well known that the admission rates are higher in the older ages. Here we note the older foreign born admissions showing lower admission rates than the native born of younger average ages. When we subdivide the native born in accordance with parentage, the native born of foreign parentage present an average admission age of 40 years, the native born of mixed parentage present an average admission age of 39 years and the native born of native parentage, an average of 45 years. In the readmissions, the foreign born show an average admission age of 51 years while the native born present an average age of 39 years. Subdividing the native born, we have an average of 38 years for both the native born of foreign parentage and the native born of mixed parentage and 41 years for the native born of native parentage. 158 P.D. 117 s e 'I ~= « a u> d> ft* S - s C3 tr CI T- s MOliOCOlNO oo f-l hc> ooooh mo CN lO CO CO CO -* CO lO ■* m Z 0 ©COCN CDCNOOO t^ OQ fa" CN O 00 o-. CO 00 o CO s m -* co co h cn m -* a < H tf -*CO00COO5H o ^ OC0000OIS (M m co co co ■* co ■* in H CO 00 CO CO 05 _ H f~ cn o o m co i> t~ 55 io ■* -* co -* ■* m ■* O IS DQ a OOOOIOOINN CO fa oocoohcdcjj© oo < IO h -* -* -* ** t^ -f E-i to o oo oo o ■* t- m CN fa § CO IO •* CO CO •* ■* ■* -f CD ...>... 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CO TP IOTP "5 m bo CO CO CO CD bfl be 00C0_CO TfHOOO oo ■tf I-i" I--" -H-tf CO S "S 2 03, »o c 1 E-i cot^t~-cr oo is coo oo 1 1 ^h' t^rPt^t* CO CO CD OCOiCCM CM [3 Ph H^irtcC | 1 CD Cm Orf CD-I- CO US z 0 asmes i-i t^ 3 OCOCOtP 1 1 t^ a^toN CD ■* s 0 ■< COcMOt^OO 1 O til H cocooorous CO Ph oo r-- i-i 05 " i, cu t^CDCMOJiO 1 CM COCOrt lOCM £ Uh COCO" C30 3 Z CO CO OO'-O CO 1 ost^cOTfco oo § Thco O 0(^0)00 CM 05 F-i MOBO I -H W -h CO O OS -H^-,CMCO i-i US us CD COCOO"5 O TP C3 Ph fcn TtOcM CO E< 00_ Ct) t- i-i i oo e i-Hi-T Tp" £ X! co t^ co tc x co CO tP tP iO iO Tp tP s Ph t~00Tp 3 cm" £ coocnooico iooooon CO CM i HOM i-i t^. 1-il-l cm" C31OCOC0 CN t- H 6 248. 7 154. 6 367 . 7 979. 0 191. CM a) Ph iO-OiO 1 00 oo CO 0»tP-iO "3 oo 55 0 Ph HiHCCt-. -1 rt B CO 00CMC0CO CO o S 0 NsdcO 1 CO oo s OCD--ICO --I tP CO i-H US C0_ CM CM < J CM COUSi-ICOCO a> H co oo co us oo co O H t» co CO CM »-i t^ CNcn" CO t, CD oco us co i-i co 00 XI OOCOcDOt- us 8 Ph 0_CSU3 rt o 3 co" Z CM COOU3CNCO USUSt^.TP-1 TP 3 CO TP CO i-1 -i 1^._ t-* " co" z o H 0 z c o J ■e £ 5 < Td CU CD £ & o H § Single Marrie Widow Divorc Separa Unkno P.D. 117 163 Census). In first admissions the high admission rates are presented by Greece — 640 per 100,000, Portugal — 374, Austria — 283 and Italy — 216. The low admission rates are shown by England — 127, Germany — 128 and Sweden — 135. In the native born readmissions, the high rates are shown by Greece — 235, Portugal — 168 and Russia — 138. The low rates are shown by Austria — 47, Poland — 50 and Scotland — 54. Citizenship of Admissions, 1939 Table 25 presents the citizenship of first and readmissions to all mental hospitals during the year 1939. In both first admissions and readmissions, non-citizens who have taken out their first papers show the low admission rates, 54 and 9 per 100,000 of the corresponding population, respectively. Citizens by birth and naturalized citizens show rates of 108 and 1 14 in first admissions. The high admission rate of 127 per 100,000 is found in the alien group. The readmissions have their high rate, 48, in the alien group, also. As the United States Census data do not record citizenship by age, it is impossible to exclude those under 15 years in making up the above rates. Citizens by birth include thousands of individuals in the population who are under the age of 15 years while the aliens present only a few in these ages. Therefore, the rates, based on the present popu- lation figures, favor the citizens by birth decidedly. Comparisons should be confined, therefore, to the groups with similar age distributions, namely the naturalized foreign born and the alien foreign born. Apparently the naturalized foreign born are a better prospect in regard to mental disorder than the foreign born who do not become citizens . Graph 1. — Marital Condition of First Admissions and Readmissions, 1939: Rates per 100,000 of Same Marital Condition in Massachusetts Population, 1930 Census Marital Condition of Admissions, 1939: Rates per 100,000 of Corresponding Population Table 26 and Graph I present the numbers and admission rates per 100,000 of the population for the various marital groups entering mental hospitals. The total line shows the male first admissions with a rate of 181 per 100,000 and the females with a much lower rate of 132. In readmissions the males show a rate of 67 and the females a lower rate of 56. 164 P.D. 117 In first admissions the married show the low admission rate of 110 per 100,000 of the married population, the single a higher rate of 173 per 100,000, the widowed a much higher rate of 296 and the divorced the extremely high rate of 600. In the readmissions the married show the low rate of 43, the widowed the next lowest, 70, the single a rate of 75 and the divorced the extremely high rate of 378. Of all marital groups the low admission rates occur in the married. We now measure these rates in terms of their departures from the low rates of the married group. The rate of the single females is 38% higher than that of the married females, while the rate of the single males is 80% higher than that of the married males. The widowed females offer a rate 119% higher than that of the married females, while the widowed males are 205% higher than the married males. The rate of the divorced females is 400% higher than that of the married females and the rate of the divorced males is 717% higher than that of the married males. Single, widowed or divorced males show a greater chance of developing mental disorder than the females of these same groups. These differences suggest that marriage is more of a protective factor in the case of the males than in the case of the females. Marital Condition and Average Admission Age, 1939 Table 27 presents the average admission ages of first admissions and readmissions by marital condition. Female first admissions are about 2.1 years older than male first admissions (females — 48.3 years, males — 46.2 years). The widowed show the high admission age of 69 years, the married and divorced 49 years each, the separated average 47 years and the single 36 years. In the married, the divorced and the separated the females are admitted at younger average ages than the males. In readmissions the high admission age of 62 years occurs in the widowed ; the married average 46 years, the divorced 42 years, the separated 46 years and the single 34 years. While the differences between the sexes are small, practically the same relationships as in first admissions are seen. Female readmissions present the lower admission ages in the married, the widowed, the divorced and the separated. Table 27. — Admission Age of First and Readmissions, 1939, by Marital Condition: Averages Marital Condition First Admissions Readmissions M. F. T. M. F. T. Single Married Widowed Divorced Separated Unknown ........ 35.0 51.4 69.5 50.5 50.3 56.6 38.1 46.4 69.6 46.6 42.8 61.6 36.2 49.2 69.6 49.1 47.5 58.3 34.3 47.4 63 8 45.4 48.9 35.7 I 45.8 61.8 40.6 43.4 34.9 46.6 62.6 42.8 46.5 All Groups 46.2 48.3 47.1 42.0 43.7 42.8 (See Tables 195 and 196 for detail) The admission ages shown suggest that some of the variations in Table 26 may be due to age differences. While we can explain the high admission rate for the widowed on a basis of age, we cannot do so in the case of the divorced. The average admission age of 49 years for the divorced indicates that a large part of the admissions in this group come from the same ages as the married admissions (average 49 years) yet the rate for the divorced is over six times that of the married. Again, the single, drawing admissions from the younger ages (average 36 years) with low admission rates, show a total admission rate which is higher than that of the married. Economic Status of Admissions, 1939 In Table 28 first admissions record 21% as dependent in economic status, 70% as marginal and 4% as comfortable. The females show slightly higher percentages in the comfortable. In readmissions 17% were reported as dependent, 73% as marginal and 6% as comfortable. Apparently, the dependents are under-represented in the read- P.D. 117 165 Table 28. — Economic Status of First and Readmissions, 1989: Percentage Distribution First Admissions Readmissions Status Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. Dependent Marginal Comfortable Unknown 607 445 1,052 1,926 1,490 3,416 105 105 210 85 106 191 22.2 70.7 3.8 3.1 20.7 69.4 4.8 4.9 21.6 70.1 4.3 3.9 181 762 52 23 159 665 65 23 340 1,427 117 46 17.7 74.8 5.1 2.2 17.4 72.9 7.1 2.5 17.6 73.9 6.0 2.3 Total 2,723 2,146 4,869 100.0 100.0 100.0 1,018 912 1,930 100.0 100 0 100.0 (See Tables 199 and 200 for detail) Admissions from Rural and Urban Areas, 1939: Rates per 100,000 Population In Table 29 first admissions from the urban areas show an admission rate of 118 and those from the rural areas a much lower rate of 49. The rate for the cities is approximately two and one-half times that of the rural areas. In the readmissions the urban group shows an admission rate of 46 with 18 for the rural sections. Here also the urban rate is approximately two and one-half times that of the rural rate. City dwellers have a far greater chance of being admitted for mental disorders than those living in the villages or rural areas. Table 29. — Environment of First and Readmissions, 1989: Rates per 100,000 Population of Same Environment, 1980 Census Admissions Total Urban Rural Unknown First Admissions: 4,869 4,555 205 109 114.5 118.8 49.0 Readmissions : 1,930 1,796 76 58 45.4 46.8 18.1 All Admissions: 6,799 6,351 281 167 159.9 165.7 67.1 167 pop. o 3,499 2,500 tO.OOO 23,000 50,000 WO.OOO 250,000 9,999 24*999 49*999 99/999 249°999 MORE Graph 2. — Population of Place of Residence of First Admissions and Readmissions, 1939: Admission Rates per 100,000 of Same Population Group 1G6 P.D. 117 a? 'SI CO CD S as c _o 1 c3 cu CH CO 03 « S 3 OMMCCCOOrt 1 COOMCOOON co co co co ■* co t- CC WiH iH 00 00 CO 00 t^cDCOCMOOOOOm rH CM CM rH CO CD in o co 05 _o S'e -d < CO eS « CO a 3 lO CO lO CO iH T)H CD 1 CN CM CN CM O m t^ 00 0)00010 iOiniNO-Hr-00> OOf OE^hO cm m co >o ■* o co ih Tf1 as co 00 Population in Eanh Unit — 1930 Census 199,957 544,970 693,428 576,467 460,411 993,187 781,188 CO OS CN z o H < J u ft. o Ph 0- 2,499 2,500- 9,999 10,000- 24,999 25,000- 49,999 . 50,000- 99,999 100,000-249,999 250,000+ Unknown "os "o H CD CO CO 00 m CC CD o H CO iOCOOOCDi-1 in CN 6 O -»s> B i-i CN t- — i rH CO CM o CO u fa ■* -*cocm fii-i O *«o o z S i-H CO 00 -US CO t» OS o 0 co m ■* «o oo i-i d S in cn o CO a < a H OcOOJOHOlrH o a r- O ■* LO CN CO CO hQiOh o> 1-4" rH CO CO CO K CO X! g oo cn co m co o -h CN fa co -*ooos *h 3 -* z 0 «5itOOOt«N o "3 s § m sioi-mio o 53 lOCN o CO 05 0 -^ "S3 S H on H Tt< m os t~~ cm oo rf OS 53 t— CN CN CD co m 00 CO "5 ■rt ' ' ' ."£ o J- ° _5?T3!/J O o> g a eg E "3 O H StJ-U S^: co g -^ C3 c3 G bfiS ^ 3 e 1) o- o C StfpH'OffiOP I P.D. 117 167 Population of Place of Residence of Admissions, 1939 Table 30 and Graph 2 show the low admission rate (92.5 per 100,000) for first admis- sions in the small cities with population between 10,000 and 24,999. The admission rates for all population groups from the villages up to 250,000 population are fairly constant. The large cities (250,000+) show a rate which is 59% higher than that of any of the other groups. In the readmissions the low rate of 30 occurs in the towns, the 2,500-9,999 group. In readmissions, the large cities (250,000+), with a rate of 77, are 92% higher than any of the other population groups. In the readmissions the difference between the admission rates of the other population groups and the large cities is more pronounced than in first admissions. The large cities are over-represented in readmissions. Degree of Education of Admissions, 1939 Table 31 shows that 52% of first admissions during 1939 had a common school educa- tion and 23% a high school education. Five per cent report a college education and 5% were illiterate. The females present the higher percentages in the illiterate, "reads only" and high school groups, and the males are higher in the groups "reads and writes", common school and college. In the readmissions, common school is again high with 53%, high school second with 28% and the college group third with 6%. If the educational accomplishments of first admissions of previous years have remained constant, then the higher educational groups are the ones tending to readmission. Intemperate Use of Alcohol in Admissions, 1939 In Table 32, the total figures show that 26% of all first admissions and 28% of read- missions were recorded as intemperate in the use of alcohol. In first admissions the total for the group "with mental disorder" is 22% of intemperance and for the group "without mental disorder" 46%. This borderline group, with short episodes of mental disorders, shows nearly one half of admissions who are chronic alcoholics. In readmissions the patients actually psychotic show 22% of intemperance while those "without mental disorder" record 59% of intemperance. In this last group nearly 6 out of every ten patients are chronic drinkers. Marked sex differences are observed. In first admissions "with mental disorder" the males show 34% intemperate and the females but 7%. In those "without mental dis- order", however, the sex differences are much less, with 51% intemperate in the males and 32% in the females. Essentially the same relationships occur in readmissions. In male first admissions the high proportions of intemperance occur in the alcoholic psycho- ses — 100%, traumatic psychoses and without psychoses — 57% and due to drugs — 55%. In the females we see the highest proportion of intemperance again in the alcoholic psychoses — 100%; followed by without psychoses — 37%, with psychopathic personal- ity — 24% and with syphilitic meningo-encephalitis — 21%. In the male readmissions the alcoholic psychoses, traumatic psychoses and other disturbances of circulation show 100% of intemperance; undiagnosed and due to drugs, 80% and without psychoses, 70%. In the females the alcoholic psychoses and due to drugs show 100% of intemperance; without psychoses, 42% and psychopathic personal- ity, 27%. Intemperate alcoholic habits are present in a large per cent of mental disorders not diagnosed as the alcoholic psychoses. One in every four of first admissions and one in every three of readmissions were intemperate in the use of alcohol. The higher percent- ages in the readmissions, particularly in certain psychoses, indicate that the intemperate use of alcohol is a prominent factor in causing the readmission. Intemperate Use of Alcohol in First Admissions, 1917-1939 In Table 33 first admissions for the year 1917 show the high intemperance of 25.8%. This drops precipitately to the low of 14% in 1920, the first year of the Eighteenth Amendment. From that point onward there are slightly higher percentages, reaching 20.2% in 1932. First admissions offered 19% of intemperance in 1933 when the Prohi- bition Amendment was repealed. Since that time we have seen gradual increases with a new high for all years since 1917 of 26.5% in 1938. In 1939 the figure for chronic alcohol- ism is 26.0%. The numbers intemperate increased from 884 in 1933 to 1,325 in 1938, an increase of 49%. Total admissions increased 9% between the same years. The 168 P.D. 117 zS to t5 e co S 2" se O"0 HO Ot-~C0t--CD^H00CTi OO OS 00 TfMNHtDtOiOOiO O CO t-i © CM CO I> ^ I I OOOBOONO I I OiOMtOMNiOON I OOOi-iOt^Ob- OONfOOOOlOO OOOONOHCOt OtN I CO I IN I cocccNCNcoco^oot^ I I co co co i-i co co co n co mcocM COCDii0O0i—r^NN.iO iHHOOOOHt»OOiOON«l»WO«l»iON»c)N »NirtOOiOSOO0iN00O')iC)i*i0 00 00i*tOSiH i-l CNiOOiOiOCNCM i-HC^COi-HCNCOCNi-lCNiOi-'CNiOi-i T}ThGCCN-*-cK00©iOi-it-~t-~a>r~CDC0CN|CDCX)i* co ^h -h i-i — hcn^ "HinroooiHrtrt -h^-i ■* i-H CO h-H I I 00CO I CO I I 1-HCDCN I I OOWhNhhiocO CD i-H i-H i-H i-H tO hi-li-iT).O3'J'lOCD— iiC^HOO CN lOr-H OS HHrt HfllNNH i-H 00 i-Hi-H©00©CT>0>-*CNOCOt~OCNa>-rcNCOLOOCOO;i-HCD (NNinOOOOliOr^clcc-.NNOONCONMOlCOi.OOOO co -hcO'H iCi-HCocccOTf coirar~co»ocDcocN-Hr^-i<-HOO ^ i-H mcN'-HCOCN-t<0"3'1< "0C0i-iOiCi-it~(M02CD o 0.-2 _q S mo.M 5 ° 8.2 ™ S w £ +£ 2? 3 QJ 1 C O [ S3 CO 2*9 sS 5 £ ' 2 S3 o cs: >,h3 ft-^c=. c3 co tfiOCOOOCgo -3J2 °.^n ■h-^Ti co CO ** ■>, G"3 X c 5? o o CO 3 O C0.J3 -+J - ■£•£^3 p a, c 2 a"? >>^ BblJ Pi 03 35 «_, ft co feU o-2 ^ftgi)" 'cone .2 co a ©KO oi© 010 o6i-i 10 © t>C0 CO-H cij-g^g bu 3 S3 O ■3-J3 CD-* hCN CO o 13 .a S3 3T3 » 2 3 o2 j3r3 S3 © C3 0 w ° ££ H a 2 ft HH O co ft. p££ P.D. 117 169 males show vastly higher percentages of intemperance than females throughout the years. During the years preceding the Eighteenth Amendment the percentages of intemperance for the sexes were closer together than after the year 1920. It is to be noted that since 1933 intemperance in the females has been increasing more rapidly than in the males with the result that the relationship between males and females is approaching the same relationship as was observed in the year 1917. Evidently prohibi- tion was of the greatest assistance to the sex needing it the least, the female. Since the return of liquor in 1933, a greater increase of intemperance in females than in males is to be noted. Table 33. — First Admissions, 1917-1939, Classified as Intemperate in the Use of Alcohol: Percentage Distribution l First Number Percent of Year Admissions Intemperate First Admissions j M. F. T. M. F. T. M. F. T. 1917 .... 1,853 1,805 3,658 727 217 944 39.2 12.0 25.8 1918 . 1,860 1,727 3,587 589 144 733 31.6 8.3 20.4 1919 . 1,929 1,756 3,685 566 124 690 29.3 7.0 18.7 1920 . 1,708 1,571 3,279 392 69 461 22.9 4.3 14.0 1921 . 1,848 1,593 3,441 455 78 533 24.6 4.8 15.4 1922 . 2,049 1,764 3,813 555 100 655 27.0 5.6 17.1 1923 . 1,804 1,694 3,498 606 91 697 33.5 5.3 19.9 1924 . 1,959 1,677 3,636 683 95 778 34.8 5.6 21.3 1925 . 2,081 1,721 3,802 651 118 769 31.2 6.8 20.2 1926 . 1,941 1,714 3,655 608 154 762 31.3 8.9 20.8 1927 . 2,082 1,756 3,838 691 84 775 33.1 4.7 20.1 1928 . 2,212 1,820 4,032 681 118 799 30.7 6.4 19.8 1929 . 2,209 1,912 4,121 669 92 761 30.2 4.8 18.4 1930 . 2,295 1,978 4,273 674 111 785 29.3 5.6 18.3 1931 . 2,472 2,036 4,508 745 124 869 30.1 6.0 19.2 1932 . 2,510 1,988 4,498 786 126 912 31.3 6.3 20.2 1933 . 2,568 1,986 4,554 771 113 884 30.0 5.6 19.4 1934 . 2,590 1,975 4,565 833 148 981 32.1 7.4 21 4 1935 . 2,685 2,148 4,833 924 191 1,115 34.4 8.8 23.0 1936 . 2,847 2,203 5,050 1,028 217 1,245 36.1 9.8 24.6 1937 . 2,775 2,231 5,006 1,029 242 1,271 37.0 10.8 25.3 1938 . 2,797 2,200 4,997 1,080 245 1,325 38.6 11.1 26.5 1939 . 2,723 2,146 4,869 1,045 221 1,266 38.3 10.2 26.0 1 Includes all State Hospitals, Bridgewater, Tewksbury, and McLean, and No. 107 included in 1929 and thereafter. U. S. Vet. Adm. Facilities No. 95 Table 34A. — Number and Percentage with Senile Psychoses, First and Readmissions, 1917-1939 First Admissions Readmissions Year Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. 1917 . 104 154 258 5.6 8.5 7.0 13 16 29 1.9 2.5 2.2 1918 . 110 188 298 5.9 10.8 8.3 11 15 26 1.5 2.3 1.9 1919 . 105 186 291 5.4 10.5 7.8 4 14 18 .5 2.2 1.3 1920 . 116 194 310 6.7 12.3 9.4 8 17 25 1.1 2.7 1.9 1921 . 133 203 336 7.1 12.7 9.7 15 26 41 2.0 3.9 2.9 1922 . 133 178 311 6.4 10.0 8.1 6 15 21 .9 2.3 1.6 1923 . 78 172 250 4.3 10.1 7.1 13 20 33 2.0 3.5 2.7 1924 . 84 137 221 4.2 8.1 6.0 13 17 30 1.8 2.8 2.2 1925 . 97 190 287 4.6 11.0 7.5 7 15 22 1.0 2.5 1.7 1926 . 88 184 272 4.5 10.7 7.4 8 18 26 1.2 3.0 2.0 1927 . 86 184 270 4.1 10.4 7.0 4 18 22 . 5 2.9 1.7 1928 . 140 205 345 6.3 11.2 8.5 6 20 26 .7 2.8 1.7 1929 . 87 200 287 3.9 10.4 6.9 6 20 26 .7 3.1 1.8 1930 . 105 178 283 4.5 8.9 6.6 9 22 31 1.1 3.0 2.0 1931 . 89 186 275 3.6 9.1 6.1 8 19 27 .9 2.5 1.6 1932 . - • .-- 90 133 223 3.5 6.6 4.9 9 18 27 1.0 2.4 1.7 1933 . 92 166 258 3.5 8.3 5.6 5 15 20 .5 1.9 1.2 1934 . 93 157 250 3.5 7.9 5.4 18 11 29 1.8 1.3 1.6 1935 . 112 180 292 4.1 8.3 6.0 11 19 30 1.1 2.3 1.7 1936 . 95 151 246 3.3 6.8 4.8 6 11 17 .6 1.2 .9 1937 . 96 209 305 3.4 9.3 6.0 8 17 25 .7 2.1 1.3 1938 . 133 175 308 4.7 7.9 6.1 9 17 26 .8 1.8 1.3 1939 . 97 169 266 3.5 7.8 5.4 13 14 27 1.2 1.5 1.3 Total 2,363 4,079 6,442 4.5 9.3 6.7 210 394 604 1.1 2.4 1.7 170 P.D. 117 Incidence of Certain Diagnoses in First Admissions and Readmissions, 1917-1939 Tables 34A to 34J, inclusive, show the percentage of first admissions and readmissions in certain psychoses over the period 1917-1939, inclusive. Only those psychoses most important numerically are reported. Since 1937 the data of our Rockefeller Research Project have been used to give us these percentages based upon all first admissions and all readmissions, regardless of the legal form of admission. Before this, the percentages were calculated on court commitments only. Senile Psychoses Table 34A shows that 9.3% of female first admissions in the classification of senile psychoses is over twice that of the males (4.5%). The males show the high of 7.1% in 1921 and a gradual decrease to the low of 3.3% in 1936. The females show a decrease from the high of 12.7% in 1921 to the low of 6.6% in 1932. In the readmissions 1.1% of the males were classified as senile psychoses. The females more than double this with 2.4%. The males have shown lower percentages during the past ten years than during the first ten years of the period studied. The females show a high of 3.9% in 1921, and a decrease to a low of 1.2% in 1936. Psychoses with Cerebral Arteriosclerosis Table 34B demonstrates that 13.3% of male first admissions and 12.9% of female first admissions were classified as psychoses with cerebral arteriosclerosis. In this psy- chosis we see definite increases. The male figure rises from a low of 7.6% in 1917 to 17.4% in 1934; the female increases from a low of 5.9% in 1919 to a high of 21.0% in 1939. In the readmissions, also, the sexes are balanced; this psychosis constituting 3.9% of male and 4.0% of female admissions. The males show a low of 2% in 1921 with high percentages during the last ten years of the period. The females show an increase from a low of 1.4% in 1917 to a high of 7.3% in 1939. Table 34B. — Number and Percentage ivith Cerebral Arteriosclerosis, First and Readmissions, 1917-1989 First Admissions Readmi SSIONS Year Number Percent Number Percent M. F. T. M. F. T. M. F. T M. F. T. 1917 . 142 119 261 7.6 6.5 7.1 21 9 30 3.1 1.4 2.3 1918 . 165 120 285 8.8 6.9 7.9 17 11 28 2.3 1.7 2.0 1919 . 190 104 294 9.8 5.9 7.9 22 13 35 3.2 2.1 2.7 1920 . 169 123 292 9.8 7.8 8.9 17 18 35 2.5 2.9 2.7 1921 . 173 99 272 9.3 6.2 7.9 15 16 31 2.0 2.4 2.2 1922 . 193 158 351 9.4 8.9 9.2 15 10 25 2.3 1.5 1.9 1923 . 185 190 375 10.2 11.2 10.7 17 26 43 2.7 4.5 3.6 1924 . 204 202 406 10.4 12.0 11.1 22 23 45 3.1 3.8 3.4 1925 . 236 198 434 11.3 11.5 11.4 22 19 41 3.4 3.2 3.3 1926 . 239 201 440 12.3 11.7 12.0 16 27 43 2.4 4.5 3.4 1927 . 276 185 461 13.2 10.5 12.0 39 22 61 5.7 3.6 4.7 1928 . 280 186 466 12.6 10.2 11.5 26 18 44 3.3 2.5 2.9 1929 . 294 232 526 13.3 12.1 12.7 35 22 57 4.6 3.4 4.1 1930 . 318 258 576 13.8 13.0 13.4 23 16 39 2.9 2.2 2.5 1931 . 351 307 658 14.1 15.0 14.5 37 24 61 4.2 3.2 3.7 1932 . 378 288 666 15.0 14.4 14.8 42 42 84 5.0 5.7 5.3 1933 . 393 327 720 15.3 16.4 15.8 43 49 92 5.0 6.3 5.6 1934 . 453 347 800 17.4 17.5 17.5 47 40 87 4.8 5.0 4.9 1935 . 451 316 767 16.7 14.7 15.8 46 33 79 4.7 4.0 4.4 1936 . 473 399 872 16.6 18.1 17.2 52 46 98 5.5 5.1 5.3 1937 . 460 397 857 16.5 17.7 17.1 47 46 93 4.5 5.7 5.0 1938 . 420 393 813 15.0 17.8 16.2 54 53 107 5.1 5.9 5.5 1939 . 463 451 914 17.0 21.0 18.7 55 67 122 5.4 7.3 6.3 Total 6,906 5,600 12,506 13.3 12.9 13.1 730 650 1,380 3.9 4.0 4.0 Psychoses with Syphilitic Meningo-Encephalitis (General Paresis) Table 34C points out that 8.0% of male and 2.4% of female first admissions were classified as general paresis, the percentage for the males being over three times that for the females. The males show a decrease from a high of 10.9% in 1923 to a low of 4.9% in 1937. The females show a decrease from a high of 3.6% in 1921 to a low of 1.3% in 1937. P.D. 117 171 In the readmissions the males with general paresis, 4.9%, are nearly four times as numerous as the females, 1.3%. The male percentage decreased from the high of 14.14% in 1918 to the low of 2.2% in 1938. Females present, in general, lower percentages during the last ten years of the period than during the first ten years. Table 34C. — Number and Percentage with Syphilitic Meningoencephalitis, (General Paresis), First and Readmissions, 1917-1939 First Admissions Readmissions Yeah Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. 1917 . 193 52 245 10.4 2.8 6.6 70 8 78 10.3 1.2 5.9 1918 . 201 51 252 10.8 2.9 7.0 105 13 118 14.4 2.0 8.6 1919 . 184 45 229 9.5 2.5 6.2 57 12 69 8.3 1.9 5.3 1920 . 186 51 237 10.8 3.2 7.2 57 11 68 8.5 1.8 5.3 1921 . 177 58 235 9.5 3.6 6.8 47 13 60 6.5 1.9 4.3 1922 . 190 58 248 9.2 3.2 6.5 30 12 42 4.6 1.9 3.2 1923 . 198 48 246 10.9 2.8 7.0 41 6 47 6.6 1.0 3.9 1924 . 201 57 258 10.2 3.3 7.0 36 7 43 5.0 1.1 3.2 1925 . 215 36 251 10.3 2.0 6.6 27 9 36 4.1 1.5 2.9 1926 . 183 50 233 9.4 2.9 6.3 32 9 41 4.9 1.5 3.3 1927 . 176 34 210 8.4 1.9 5.4 21 6 27 3.0 .9 2.0 1928 . 181 50 231 8.1 2.7 5.7 28 6 34 3.5 .8 2.2 1929 . 186 37 223 8.4 1.9 5.4 34 4 38 4.5 .6 2.7 1930 . 208 49 257 9.0 2.4 6.0 42 7 49 5.2 .9 3.2 1931 . 166 38 204 6.7 1.8 4.5 31 11 42 3.5 1.4 2.6 1932 . 170 54 224 6.7 2.7 4.9 43 6 49 5.1 .8 3.1 1933 . 182 38 220 7.0 1.9 4.8 30 12 42 3.5 1.5 2.5 1934 . 174 51 225 6.7 2.5 4.9 26 18 44 2.6 2.2 2.4 1935 . 191 46 237 7.1 2.1 4.9 31 9 40 3.1 1.1 2.2 1936 . 151 57 208 5.3 2.5 4.1 26 13 39 2.7 1.4 2.1 1937 . 137 30 167 4.9 1.3 3 3 32 10 42 3.1 1.2 2.2 1938 . 149 39 188 5.3 1.7 3.7 23 7 30 2.2 • .7 1.5 1939 . 149 32 181 5.4 1.4 3.7 28 16 44 2.7 1.7 2.2 Total 4,148 1,061 5,209 8.0 2.4 5.4 897 225 1,122 4.9 1.3 3.2 Table 34D. Number and Percentage with Alcoholic Psychoses, First and Readmissions, 1917-1939 First Admissions Readmissions Year Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. 1917 . 346 89 435 18.6 4.9 11.8 113 22 135 16.7 3.4 10.3 1918 . 242 45 287 13.0 2.6 8.0 81 21 102 11.1 3.2 7.4 1919 . 233 54 287 12.0 3.0 7.7 66 20 86 9.7 3.2 6.6 1920 . 109 17 126 6.3 1.0 3.8 40 8 48 5.9 1.3 3.7 1921 . 149 27 176 8.0 1.6 5.1 67 17 84 9.2 2.5 6.1 1922 . 245 39 284 11.9 2.2 7.4 65 15 80 10.0 2.3 6.2 1923 . 279 39 318 15.4 2.3 9.0 78 11 89 12.5 1.9 7.4 1924 . 324 36 360 16.5 2.1 9.9 98 16 114 13.8 2.6 8.7 1925 . 272 35 307 13.0 2.0 8.0 69 8 77 10.7 1.3 6.2 1926 . 249 40 289 12.8 2.3 7.9 69 11 80 10.5 1.8 6.4 1927 . 309 32 341 14.8 1.8 8.8 84 12 96 12.3 1.9 7.4 1928 . 295 46 341 13.3 2.5 8.4 85 9 94 10.8 1.2 6.3 1929 . 320 39 359 14.4 2.0 8.7 93 13 106 12.3 2.0 7.6 1930 . 289 42 331 12.5 2.1 7.7 97 10 107 12.2 1.4 7.1 1931 . 339 41 380 13.7 2.0 8.4 92 10 102 10.5 1.3 6.3 1932 . 309 55 364 12.3 2.7 8.0 89 16 105 10.6 2.1 6.6 1933 . 292 40 332 11.3 2.0 7.2 91 12 103 10.6 1.5 6.3 1934 . 349 46 395 13.4 2.3 8.6 111 18 129 11.3 2.2 7.3 1935 . 362 66 428 13.4 3.0 8.8 151 21 172 15.4 2.6 9.6 1936 . 395 56 451 13.8 2.5 8.9 119 21 140 12.6 2.3 7.6 1937 . 387 67 454 13.9 3.0 9.0 138 17 155 13.4 2.1 8.4 1938 . 394 67 461 14.0 3.0 9.2 142 15 157 13.6 1.6 8.1 1939 . 351 68 419 12.8 3.1 8.6 136 20 156 13.3 2.1 8.0 Total 6,839 1,086 7,925 13.2 2.5 8.3 2,174 343 2,517 11.8 2.1 7.3 Alcoholic Psychoses Table 34D demonstrates that the males, with 13.2%, show a percentage five times as high as that of the females, 2.5%, for the alcoholic psychoses. The males show a 172 P.D. 117 high of 18.6% in 1917 and a drop to the low of 6.3% in 1920, the first year of the Eigh- teenth Amendment. Gradual rises follow. After the repeal of prohibition in 1933, we see a consistent increase from the 1933 figure of 11.3% to 14.0% in 1938. The females show a high of 4.9% in 1917 and a drop to the low of 1.0% in 1920. From the 1933 figure of 2.0% there is a rise to 3.1% in 1939. Among the readmissions the alcoholic psychoses comprise 2.1% of females and 11.8% of males. The males show the high of 16.7% in 1917, the low of 5.9% in 1920 and a rise from that point onward. Since 1933, with 10.6% of alcoholic psychoses there has been a rise to 13.3% in 1939. In the females, the last year of prohibition, 1933, shows 1.5% of alcoholic psychoses rising to 2.1% in 1939. Dementia Praecox Table 34E shows that 16.3% of male first admissions were diagnosed as dementia praecox over the period 1917-1939 and that the females were one-quarter higher with 20.3%. The males show the high of 23.7% in 1920 and a decrease to the low of 12.2% in 1936. The females show the high of 27.6% in 1919 and a decrease to 16.5% in 1936. Dementia praecox comprises much higher percentages of readmissions than first admissions. The males make up 25% and females 27% of all readmissions over the period 1917-1939. Comparison of these percentages with first admissions suggests a greater tendency to readmission in the males. The males show the high of 33.2% in 1920 and a decrease to 19.5% in 1934. The females show the high of 37.7% in 1917 and a decrease to the low of 21.9% in 1936. Table 34E. — Number and Percentage with Dementia Praecox, First and Readmissions, 1917-1 939 First Admissions Readmissions Year Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. 1917 . 391 431 822 21.1 23.8 22.4 173 238 411 25.6 37.7 31.5 1918 . 424 429 853 22.7 24.8 23.7 216 219 435 29.7 34.3 31.9 1919 . 447 485 932 23.1 27.6 25.2 214 205 419 31.5 33.4 32.4 1920 . 405 387 792 23.7 24.6 24.1 222 224 446 33.2 36.6 34.8 1921 . 433 437 870 23.4 27.4 25.2 225 216 441 31.1 32.9 32.0 1922 . 411 391 802 20.0 22.1 21.0 171 188 359 26.3 29.8 28.0 1923 . 306 372 678 16.9 21.9 19.3 173 158 331 27.8 27.9 27.8 1924 . 382 359 741 19.4 21.4 20.3 205 179 384 28.9 29.8 29.3 1925 . 362 358 720 17.3 20.8 18.9 194 166 360 30.1 28.4 29.3 1926 . 364 368 732 18.7 21.4 20.0 191 150 341 29.3 25.3 27.4 1927 . 377 391 768 18.1 22.2 20.0 172 194 366 25.2 32.0 28.4 1928 . 317 326 643 14.3 17.9 15.9 213 175 388 27.1 25.0 26.1 1929 . 325 372 697 14.7 19.4 16.9 205 161 366 27.1 25.5 26.4 1930 . 311 357 668 13.5 18.0 15.6 202 182 384 25.4 25.5 25.5 1931 . 322 368 690 13.0 18.0 15.3 196 190 386 22.4 25.8 24.0 1932 . 335 346 681 13.3 17.4 15.1 177 167 344 21.2 22.7 21.9 1933 . 341 390 731 13.2 19.6 16.0 175 209 384 20.5 27.2 23.7 1934 . 335 350 685 12.9 17.7 15.0 191 207 398 19.5 26.3 22.5 1935 . 364 410 774 13.5 19.0 16.0 208 203 411 21.3 25.2 23.0 1936 . 350 364 714 12.2 16.5 14.1 206 195 401 21.9 21.9 21.9 1937 . 365 389 754 13.1 17.4 15.0 263 201 464 25.7 25.0 25.3 1938 . 390 368 758 13.9 16.7 15.1 252 218 470 24.2 24.3 24.2 1939 . 406 367 773 14.9 17.1 15.8 232 214 446 22.7 23.4 23.1 Total 8,463 8,815 17,278 16.3 20.3 18.1 4,676 4,459 9,135 25.5 27.7 26.5 Over the past 23 years the percentages of this very serious mental disorder have been decreasing in both first admissions and readmissions. Particularly significant are the larger decreases in first admissions. Manic-Depressive Psychoses Male first admissions diagnosed as manic-depressive make up 6.9% of all first admis- sions (Table 34F). The females are higher with 12.1%. The male percentages, after rising from a low of 5.2% in 1918 to 9.3% in 1932, have dropped to 4.2% for 1939. In the females, the last ten years are showing higher percentages than the first ten years of the period studied, except for 1939 when the low of all years is observed, 8.2%. In common with dementia praecox, this diagnosis comprises much larger percentages of the readmissions than of the first admissions, 16.1% of male and 26.8% of female readmissions. As in first admissions, the percentage for the females is nearly twice P.D. 117 173 that for the males. The male readmissions also show a rise from a low of 12.4% in 1918 to a high of 21.1% in 1931 and a drop to 12.9% in 1939. The females rose from a low of 21.9% in 1920 to a high of 32.0% in 1937. Table 34F. — Number and Percentage with Manic-Depressive Psychoses, First and Readmissions, 1917-1939 First Admissions Readmissions Yeah Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. 1917 . 105 198 303 5.6 10 9 8.2 98 158 256 14.5 25.0 19.6 1918 . 97 194 291 5.2 11.2 8.1 90 147 237 12.4 23.0 17.3 1919 . 108 190 298 5.5 10.8 8.0 101 158 259 14.8 25.8 20.0 1920 . 121 164 285 7.0 10.4 8.6 98 134 232 14.6 21.9 18.1 1921 . 120 163 283 6.4 10.2 8.2 134 164 298 18.5 25.0 21.6 1922 . 113 188 301 5.5 10.6 7.8 94 153 247 14.4 24.3 19.3 1923 . 134 210 344 7.4 12.3 9.8 103 153 256 16.5 27.0 21.5 1924 . 146 222 368 7.4 13.2 10.1 106 142 248 14.9 23.7 18.9 1925 . 142 252 394 6.8 14.6 10.3 99 145 244 15.3 24.8 19.8 1926 . 153 233 386 7.8 13.5 10.5 115 172 287 17.6 29.1 23.1 1927 . 128 235 363 6.1 13.3 9.4 114 155 269 16.7 25.5 20.9 1928 . 174 266 440 7.8 14.6 10.9 130 203 333 16.5 29.0 22.4 1929 . 157 261 418 7.1 13.6 10.1 142 190 332 18.8 30.1 23.9 1930 . 209 263 472 9.1 13.2 11.0 134 215 349 16.8 30.1 23.1 1931 . 221 246 467 8.9 12.0 10.3 184 188 372 21.1 25.5 23.1 1932 . 234 271 505 9.3 13.6 11.2 159 197 356 19.0 26.8 22.7 1933 . 190 260 450 7.3 13.0 9.8 154 204 358 18.0 26.6 22.1 1934 . 167 204 371 6.4 10.3 8.1 151 204 355 15.4 25.9 20.1 1935 . 175 267 442 6.5 12.4 9.1 169 219 388 17.3 27.2 21.7 1936 . 232 262 494 8.1 11.8 9.7 145 266 411 15.4 29.9 22.4 1937 . 198 277 475 7.1 12.4 9.4 163 258 421 15.9 32.0 23.0 1938 . 136 268 404 4.8 12.1 8.0 138 260 398 13.2 29.0 20.5 1939 . 116 176 292 4.2 8.2 5.9 132 232 364 12.9 25.4 18.8 Total 3,576 5,270 8,846 6.9 12.1 9.2 2,953 4,317 7,270 16.1 26.8 21.1 Psychoses with Mental Deficiency Table 34G shows that 2.2% of male and 2.6% of female first admissions were placed in this diagnostic classification. In the males the high of 2.6% occurs in 1926, 1930 and 1938 and the low of 1.7% in 1937. The females are high, with 3.3%, in 1920 and 1931 and low, with 1.7%, in 1927. Table 34G. — Number and Percentage with Mental Deficiency, First and Readmissions, 1917-1939 First Admissions Readmissions Year Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. 1917 . 47 43 90 2.5 2.3 2.4 29 25 54 4.3 3.9 4.1 1918 . 34 37 71 1.8 2.1 1.9 28 24 52 3.8 3.7 3.8 1919 . 44 42 86 2.2 2.3 2.3 23 30 53 3.3 4.9 4.1 1920 . 44 52 96 2.5 3.3 2.9 33 20 53 4.9 3.2 4.1 1921 . 41 43 84 2.2 2.6 2.4 35 32 67 4.8 4.8 4.8 1922 . 52 53 105 2.5 3.0 2.7 27 36 63 4.1 5.7 4.9 1923 . : 39 33 72 2.1 1.9 2.0 25 19 44 4.0 3.3 3.7 1924 . 45 51 96 2.2 3.0 2.6 19 27 46 2.6 4.5 3.5 1925 . 53 52 105 2.5 3.0 2.7 31 28 59 4.8 4.7 4.8 1926 . 52 40 92 2.6 2.3 2.5 27 29 56 4.1 4.9 4.5 1927 . 43 31 74 2.0 1.7 1.9 40 29 69 5.8 4.7 5.3 1928 . 47 48 95 2.1 2.6 2.3 49 27 76 6.2 3.8 5.1 1929 . 41 59 100 1.8 3.0 2.4 34 31 65 4.5 4.9 4.6 1930 . 61 69 130 2.6 3.4 3.0 29 43 72 3.6 6.0 4.7 1931 . 59 68 127 2.3 3.3 2.8 30 48 78 3.4 6.5 4.8 1932 . 58 58 116 2.3 2.9 2.5 38 40 78 4.5 5.4 4.9 1933 . 52 54 106 2.0 2.7 2.3 41 33 74 4.8 4.3 4.5 1934 . 48 57 105 1.8 2.8 2.3 34 39 73 3.4 4.9 4.1 1935 . 49 49 98 1.8 2.2 2.0 35 38 73 3.5 4.7 4.0 1936 . 65 48 113 2.2 2.1 2.2 41 38 79 4.3 4.2 4.3 1937 . 49 54 103 1.7 2.4 2.0 28 30 58 2.7 3.7 3.1 1938 . 74 59 133 2.6 2.6 2.6 41 38 79 3.9 4.2 4.0 1939 . 77 56 133 2.8 2.6 2.7 41 32 73 4.0 3.5 3.7 Total 1,174 1,156 2,330 2.2 2.6 2.4 758 736 1,494 4.1 4.5 4.3 174 P.D. 117 This psychosis tends to readmission. We note the higher proportions of 4.1% in the males and 4.5% in the females. The distribution is evenly balanced in the males with the last ten years on a slightly lower level than the first ten years. In the females the level is higher in the last ten years of the period studied. Table 34H. — Number and Percentage with Psychoses Due to Drugs, First and Readmissions, 1917-1989 First Admissions Readmissions Year Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. 1917 . 4 6 10 .2 .3 .2 i 2 2 _ .1 1918 . 4 8 12 .2 .4 .3 3 2 0 .4 .3 .3 1919 . 5 2 7 .2 .1 .1 1 2 3 .1 .3 .2 1920 . 3 9 12 .1 .5 .3 1 3 4 .1 .4 .3 1921 . 7 4 11 .3 .2 . 3 3 6 9 .4 .9 .6 1922 . 11 12 23 .5 .6 .6 3 4 7 .4 .6 .5 1923 . 9 9 18 .4 .5 . 0 3 3 6 .4 .5 .5 1924 . 10 8 18 .5 .4 .4 4 — 4 . 5 - . 5 1925 . 8 4 12 .3 .2 .3 2 2 4 .3 .3 .3 1926 . 12 8 20 - .6 .4 . 5 2 4 6 .3 .6 .4 1927 . 11 6 17 .5 .3 .4 2 3 5 .2 .4 .3 1928 . 9 7 16 .4 .3 .3 4 2 6 .5 .2 .4 1929 . 14 10 24 .6 .5 . o 4 3 7 .5 .4 .5 1930 . 13 21 34 .5 1.0 .7 9 4 13 1.1 .5 .8 1931 . 23 28 51 .9 1.3 1.1 6 6 12 .6 .8 .7 1932 . 20 18 38 .7 .9 .8 7 6 13 .8 .8 .8 1933 . 17 13 30 .6 .6 .6 6 3 9 .7 .3 .5 1934 . 15 13 28 .5 .6 .6 8 o 13 .8 .6 .7 1935 . 13 15 28 .4 .6 . 0 4 4 8 .4 .4 .4 1936 . 12 11 23 .4 .4 .4 .5 3 8 .5 .3 .4 1937 . 18 14 32 .6 .6 .6 o 6 11 .4 .7 .6 1938 . 11 18 29 .3 .8 . o 6 6 12 .5 .6 .6 1939 . 20 19 39 .7 .8 .8 o 2 7 .4 .2 .3 Total 269 263 532 .5 .6 . 5 95 79 174 .5 .4 .5 Table 34J. Number and Percentage with Psychoneuroses, First and Readmissions, 1917-1939 First Admissions Readmissions Year Number Percent Number Percent M. F. T. M. F. T. M. F. T. M. F. T. 1917 . 23 46 69 1.2 2.5 1.8 8 9 17 1.1 1.4 1.3 1918 . 33 42 75 1.7 2.4 2.0 o 19 24 .6 2.9 1.7 1919 . 25 47 72 1.2 2.6 1.9 14 10 24 2.0 1.6 1.8 1920 . 28 24 52 1.6 1.5 1.5 2 18 20 .2 2.9 1.5 1921 . 34 37 71 1.8 2.3 2.0 14 16 30 1.9 2.4 2.1 1922 . 48 62 110 2.3 3.5 2.8 16 18 34 2.4 2.8 2.6 1923 . 34 51 85 1.8 3.0 2.4 9 14 23 1.4 2.4 1.9 1924 . 34 50 84 1.7 2.9 2.3 12 14 26 1.6 2.3 1.9 1925 . 51 28 79 2.4 1.6 2.0 9 7 16 1.3 1.1 1.3 1926 . 32 48 80 1.6 2.8 2.1 11 21 32 1.6 3.5 2.5 1927 . 31 48 79 1.4 2.7 2.0 11 18 29 1.6 2.9 2.2 1928 . 33 48 81 1.4 2.6 2.0 7 24 31 .8 3.4 2.0 1929 . 42 45 87 1.9 2.3 2.1 7 17 24 .9 2.6 1.7 1930 . 57 49 106 2.4 2.4 2.4 20 21 41 2.5 2.9 2.7 1931 . 56 64 120 2.2 3.1 2.6 25 21 46 2.8 2.8 2.8 1932 . 46 75 121 1.8 3.7 2.6 13 38 51 1.5 5.1 3.2 1933 . 72 81 153 2.8 4.0 3.3 37 33 70 4.3 4.3 4.3 1934 . 80 76 156 3.0 3.8 3.4 27 28 55 2.7 3.5 3.1 1935 . 87 113 200 3.2 5.2 4.1 21 33 54 2.1 4.0 3.0 1936 . 106 123 229 3.7 5.5 4.5 37 43 80 3.9 4.8 4.3 1937 . 131 135 266 4.7 6.0 5.3 50 36 86 4.8 4.4 4.7 1938 . 135 168 303 4.8 7.6 6.0 43 60 103 4.1 6.6 5.3 1939 . 137 157 294 5.0 7.3 6 0 40 50 90 3.9 5.4 4.6 Total 1,355 1,617 2,972 2.6 3.7 3.1 438 568 1,006 2.3 3.5 2 9 Psychoses Due to Drugs Table 34H shows that the sexes are fairly evenly balanced in first admissions. This psychosis presents .5% for male and .6% for female first admissions. In the males the low of .1% occurs in 1920 and the high of .9% in 1931. In the females the low of .1% P.D. 117 175 occurs in 1919 and the high of 1.3% in 1931. Both sexes are showing higher levels over the last ten years of the period. This psychosis comprises .5% of male and .4% of female readmissions. A tendency to higher levels during the past ten years is noted in both sexes. In 1939 there has been a decided decrease in female readmissions from .6% in 1938 to .2% in 1939. Psychoneuroses Table 34J shows that 2.6% of male and 3.7% of female first admissions were diagnosed as psychoneuroses. Definite increases have taken place over the years in this classifica- tion. In the males the low of 1.2% occurs in 1917 and 1919, increasing fourfold to the high of 5.0% in 1939. In the females there is a parallel increase, a rise from the low of 1.5% in 1920 to the high of 7.6% in 1938. This diagnosis made up 2.3% of male and 3.5% of female readmissions. The male percentages increase from the low of .2% in 1920 to the high of 4.8% in 1937. The female percentages rise from the low of 1.1% in 1925 to the high of 6.6% in 1938. In both first admissions and readmissions the psychoneuroses have increased more than 300% over the 23 year period. Economic Status of First and Readmissions, 1939, by Diagnosis Table 35 presents the percentage distribution of the psychoses in the groups dependent, marginal and comfortable for both first admissions and readmissions. In the first admis- sions nearly 40% of the entire dependent group are included in the old-age diagnoses, 31.8% in psychoses with cerebral arteriosclerosis and 8.5% in senile psychoses. Dementia praecox includes 13.0% of the dependent and without psychoses, 9.4%. Of the cases of marginal economic status, 17.2% are diagnosed dementia praecox, 15.3% without psychoses, 13.9% with cerebral arteriosclerosis and 9.6% alcoholic psychoses. In the comfortable group, 15.2% are diagnosed dementia praecox, 14.7% without psychoses and manic-depressive, and 13.3% with cerebral arteriosclerosis. Table 35. — Economic Status of First and Readmissions, 1939, by Diagnosis: Percentage Distribution Diagnoses F IEST AD1 •IISSIONS Readmi SSIONS De- Mar- Com- Un- De- Mar- Com- Un- pendent ginal fortable known pendent ginal fortable known With syphilitic meningoencephalitis 3.1 3.9 3.3 3.1 3.8 1.9 6.5 With other forms of syphilis .7 .3 - — .8 1 _ 2.1 With epidemic encephalitis . .1 .1 .4 .5 — .1 - — With other infectious diseases .3 .3 — .5 — .2 — _ Alcoholic psychoses 6.6 9.6 2.3 6.8 6.1 8.5 6.8 10.8 Due to drugs, etc .3 .9 .9 — — .4 — Traumatic psychoses .2 .4 - - - .1 .8 _ With cerebral arteriosclerosis 31.8 13.9 13.3 39.7 12.3 4.9 3.4 10.8 With other disturbances of circula- tion .5 .6 .4 1.0 — .3 .8 _ With convulsive disorders (epilepsy) 2.9 1.3 .4 .5 8.2 3.0 3.4 2.1 Senile psychoses .... 8.5 3.8 10.0 13.0 2.6 .9 1.7 4.3 Involutional psychoses . . . 1.8 4.3 5.2 4.1 .8 3.6 3.4 4.3 Due to other metabolic diseases, etc. 1.4 1.9 2.3 2.6 .8 .3 2.5 _ Due to new growth .09 .3 - — - .07 _ _ With organic changes of nervous system ...... 2.2 1.7 9 2.0 1.7 1.6 .8 4.3 Psychoneuroses .... 3.1 6.9 8.5 2.6 4.4 4.6 5.9 2.1 Manic-depressive psychoses 3.1 6.5 14.7 2.6 11.1 19.9 30.7 10.8 Dementia praecox .... 13.0 17.2 15.2 8.3 25.0 23.0 19.6 19.5 Paranoia and paranoid conditions 1.9 2.1 4.2 1.5 1.4 1.6 1.7 2.1 With psychopathic personality .6 .9 .4 - 1.4 3.0 .8 - With mental deficiency 5.9 1.9 1.4 1.0 7.6 3.1 — 4.3 Undiagnosed psychoses . .8 1.6 - 1.5 .2 1.6 - - Without psychoses .... 9.4 15.3 14.7 7.8 10.5 15.6 17.0 15.2 Primary behavior disorders . .4 3.2 .4 - .2 .4 - - Total With Mental Disorder 90.1 81.3 84.7 92.1 89.1 83.8 82.9 84.7 Total Without Mental Disorder 9.8 18.6 15 2 7.8 10.8 16.1 17.0 15.2 Grand Total 100.0 100.0 100.0 100.0 100 0 100.0 100.0 100.0 (See Tables 199 and 200 for detail) In the readmissions, dementia praecox dominates the dependent and marginal groups with 25.0% and 23.0% respectively. Manic-depressive shows 11.1% and 19.9% and without psychoses shows 10.5% and 15.6%. Cerebral arteriosclerosis is high only in the 176 P.D. 117 dependent group with 12.3%. Of the comfortable group, 30.7% are found in the manic- depressive psychoses, 19.6% in dementia praecox and 17.0% in without psychoses. Diagnosis of Readmissions Admitted by Transfer and Cases Admitted Directly from Psychopathic Table 36 shows the psychoses of cases transferred from one mental hospital to another and those discharged from the Boston Psychopathic Hospital and admitted the same day to another hospital. As these cases have remained in the resident population of some one of our hospitals and thus within the State statistical system, they are not included in the admission statistics. They do appear, of course, in the tables on resident population. Manic-depressive psychoses made up 10% of the transfers and 16% of these Psychopathic Hospital discharges. Alcoholic psychoses made up 5% of the transfers and 10% of the others. Twelve per cent of the Psychopathic cases were undiagnosed. De- mentia praecox, which made up 15% of first admissions and 23% of readmissions in 1939, constitutes 50% of transfers and 26% of cases leaving Psychopathic and going directly to another hospital. The tendency of this psychosis to chronicity, with a result- ant retention within hospitals, is obvious. Table 36. — Diagnosis of Cases Admitted by Transfer to Hospitals for Mental Disorders and Cases Admitted Directly to Other Institutions from Psychopathic, 1939: Percentage Distribution Transfers From Psychopathic to Other B OSPITALS1 Number Percent Number ] 5ercen1 M. F. T. M. F. T M. F. T. M. F. T. With syphilitic meningoen- cephalitis .... 8 4 12 3.6 2.7 3 2 26 7 33 5.0 1.7 3.5 With other forms of syphilis 4 - 4 1.8 - 1.0 2 1 3 .3 2 .3 With epidemic encephalitis - — — - - — 1 — 1 .1 _ .1 With other infectious diseases 1 — 1 4 - .2 - _ - _ _ _ Alcoholic psychoses 19 2 21 8^7 1.3 5.7 70 24 94 13.5 5.9 10.2 Due to drugs, etc. - - - - - - 1 8 9 .1 1.9 .9 Traumatic psychoses . — — - _ - - 2 _ 2 .3 _ .2 With cerebral arteriosclerosis 9 8 17 4.1 5.4 4.6 2 3 5 .3 .7 .5 With other disturbances of circulation 1 _ 1 .4 _ 2 _ 1 1 _ .2 .1 With convulsive disorders (epilepsy) 5 1 6 2.2 .6 1.6 21 11 32 4.0 2.7 3.4 Senile psychoses 1 1 2 .4 .6 .5 8 12 20 1.5 2.9 2.1 Involutional psychoses 3 11 14 1.3 7.4 3.8 7 17 24 1.3 4.2 2.6 Due to other metabolic dis- eases .... — 1 1 — .6 .2 3 5 8 . 5 1.2 .8 Due to new growth — - - - — - 1 - 1 .1 — .1 With organic changes of ner- vous system 5 3 8 2.2 2.0 2.1 14 8 22 2.7 1.9 2.3 Psychoneuroses 6 2 8 2.7 1.3 2.1 17 10 27 3.3 2.4 2.9 Manic-depressive psychoses 27 10 37 12.3 6.8 10.1 63 87 150 12.2 21.6 16.3 Dementia praecox 115 70 185 52.7 47.6 50.6 141 98 239 27.3 24.3 26.0 Paranoia and paranoid con- ditions .... 3 13 16 1.3 8.8 4.3 19 30 49 3.6 7.4 5.3 With psychopathic personal- ity 3 2 5 1.3 1.3 1.3 13 9 22 2.5 2.2 2.3 With mental deficiency 8 14 22 3.6 9.5 6.0 29 19 48 5.6 4.7 5.2 Undiagnosed psychoses — 3 3 - 2.0 .8 63 51 114 12.2 12.6 12.4 Without psychoses — 2 2 — 1.3 .5 10 — 10 1.9 - 1.0 Primary behavior disorders — - — - - — 2 1 3 .3 .2 .3 Total With Mental Dis- order 218 145 363 99.9 98. G 99.4 503 401 904 97.6 99.7 98.5 Total Without Mental Disorder . - 2 2 - 1.3 .5 12 1 13 2.3 .2 1.4 Grand Total 218 147 365 100.0 100.0 100.0 515 402 917 100.0 100.0 100.0 1 These cases are discharges from the Psychopathic and committed to other institutions the same day. Section G. First and Readmissions Discharged from Mental Hospitals During 1939 The following section presents data in reference to patients discharged from mental hospitals to the community during the year ended September 30, 1939. As in the case of admissions, we have discarded the old criterion of court admission and have based the outlined data on all patients leaving mental hospitals, including those admitted under court, temporary care, observation and voluntary status. The deaths are con- sidered separately in a later section. P.D. 117 17- Discharges to the Community, 1937-1939, by Form of Admission Table 37 shows that 3,175 first admissions and 1,464 readmissions, a total of 4,639 cases, were discharged to the community in 1939. In the first admissions, 1,802 males and 1,373 females, and in the readmissions 769 males and 695 females left hospitals to return to the community. Table 37. — First and Readmissions Discharged from All Hospitals for Mental Disorders, 1937-1939 by Form of Admission and Sex Year Sex Aggre- gate First Admissions Readmissions Total Court Tempo- rary Care Obser- vation Volun- tary Total Court Tempo- rary Care Obser- vation Volun- tary 1937 T. M. F. 4,329 2,516 1,813 3,053 1,809 1,244 1,339 711 628 1,052 642 410 507 359 148 155 97 58 1,276 707 569 764 375 389 278 183 95 154 104 50 80 45 35 1938 T. M. F. 4,610 2,638 1,972 3,123 1,822 1,301 1,405 732 673 1,008 572 436 595 441 154 115 77 38 1,487 816 671 905 450 455 303 183 120 183 124 59 96 59 37 1939 T. M. F. 4,639 2,571 2,068 3,175 1,802 1,373 1,483 713 770 923 548 375 629 456 173 140 85 55 1,464 769 695 879 420 459 296 172 124 203 134 69 86 43 43 In the first admissions, the number of court commitments increased from 1,405 in 1938 to 1,483 in 1939, of observation cases from 595 to 629. The number of admissions under temporary care papers and voluntary status decreased from 1,008 to 923 and from 115 to 140, respectively. Decreases are observed in the court, temporary care and volun- tary forms among the readmissions. Court cases drop from 905 to 879, temporary care from 303 to 296 and voluntary from 96 to 86. Observation forms increased from 183 to 203. Diagnosis in Discharges to the Community, 1939 Table 38 reports that 15.3% of the 3,175 first admissions returned to the community were diagnosed as dementia praecox. This is very interesting to compare with the 15.8% of the same diagnosis in first admissions entering mental hospitals during the year. The alcoholic psychoses made up 11.4% of discharges and only 8.6% of first admissions. Manic-depressive psychoses made up 9% of discharged first admissions and 5% of first admissions entering. The percentage of discharges diagnosed "without mental disorder" is high, 25.2%, as compared with 16.1% of admissions in this clinical grouping during the same year. In first admissions by court commitment discharged, dementia praecox comprises 26%, manic-depressive psychoses 15% and cerebral arteriosclerosis 12%. The group "without mental disorder" is small, 1.6%. In temporary care first admissions dis- charged, the total "without mental disorder" comprises 33%, the alcoholic psychoses 16% and psychoneuroses 13%. In the observation cases discharged, "without mental disorder" comprises 64%, the alcoholic psychoses 10% and psychoneuroses 9%. The voluntary cases discharged show "without mental disorder" 47%, psychoneuroses 17% and syphilitic meningo-encephalitis 7%. Temporary care, observation and voluntary forms of admission are high in cases diagnosed "without mental disorder". Where no complicated legal obstructions are placed in the way of patients coming into mental hospitals we see cases being admitted before the psychosis has developed fully. They respond to treatment and are discharged quickly. It is to be hoped, of course, that this early treatment will have an effect in checking any further development of the incipient mental disorder. We do know that a goodly proportion of these "with mental disorder" cases never return to mental hospitals. Among the 1,464 readmissions returned to the community, the manic-depressive psychoses comprise 24%, dementia praecox 20% and the alcoholic psychoses 8%. The total "without mental disorder" makes up 20% of the readmissions discharged. 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'*- c- 'a j3 .2 to £> n a to to a o ^ tm -n 0>tn " to hco ,Cco Sfco r-m tpto "^ O rr c to ° to l-s.Is. 9, 0,n:3°m%0a ic psychos admission missions sychopath admission missions iepressive admission missions ional psyc admission missions itic psychi admission missions rganic cha admission missions ;rebral art admission missions "•Ic cd'So c a'm c£'Sc ^•Sc-S-ScE-S I to. 9 o sal £-o-£ T3 oj c s|.a Undiagnosed First admis Readmissio Due to new g First admis her in admis missio her di admis missio other admis ° «1 gft« Q °'mX> ° tola ° m^ jc.c tujs.b ty _ .J3 a ~fetf.rfttf §ftP= 2«a«it3uiflct3«icaBfflci«itastj ^S.b tujc.t tu'C.c ^'n.^ ^ D.C i^jC.C c^^h.5 tu £ £ £ Q ^ ^ § £ h ^ ^ P.D. 117 is: OO O I (Mrt Hri —I "* 00 iOO Nco ooo oo -H— I r*rt IN NN CM"* || —IN | | iiO HN CDiO —I— I 0500 OO 'QIC 0«0 rtCM COIN -<— I "*CD OO I I -H00 I O 000 000 COIN O 00 lO 00—1 II CO IN I CM lO 00O OO: OO ON coco n 000 CNO O UJN O"* mo t)> o ■ JS a o u CO TJ M O Q in ■P o s "a 10 ' '-— g c B o CO o C I^'k fl CD' e.S O'S.'" ~ " 9 S'S"? 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S3 0>,fi.S5 4)^3.3 0J.C.S3 0) S.S3 4>-3.!3 'm C u n O ri S3 o 00 £3 m CD £3 m o."B-g„OT3-a ni * B >* S O <0 o3 o3 fl.H » .-SEhhh.S&mPh IS £ E3 O _« O ,„ HJT3-J HJT3-- £aESsS |S«'Br:*'8 fSrtfScH' J si -O co o3 gpHPn' o 184 P.D. 117 A review of first admissions shows the total "with mental disorder" with the high discharge rate of 272 cases per 1,000 or one out of every four under care in the age group 0-19 years. The rates drop with age, the 20-29 year age group presenting a rate of 247, 30-39 years a rate of 174, 40-49 years a rate of 129, 50-59 years-92, 60-69 years-75, and 70 years and over-61. The cases "without mental disorder" show high discharge rates throughout all age groups, the high of 928 occurring in the age group 20-29 years and the low of 720 occurring in the age group 60-69 years. In all psychoses the younger age groups are showing the higher discharge rates. In other words, the younger the patient, the greater chance he has of being returned to the community. Discussing the age differences in discharge rates of the various psychoses, we exclude under 20 years because of the small numbers involved. In the 20-29 year group, due to drugs and other disturbances of circulation show the high discharge rates of 1,000. The 30-39 year group shows due to new growth, due to drugs, psychoneuroses and undiag- nosed psychoses with the high discharge rates of 1,000, 722, 675 and 666, respectively. In the 40-49 year group, due to drugs, due to new growth, psychoneuroses and undiag- nosed psychoses show the high discharge rates of 684, 666, 606 and 533, respectively. In the 50-59 year age group, due to drugs, psychoneuroses and other disturbances of circulation show the high discharge rates of 571, 528 and 368, respectively. Due to drugs, other infectious diseases and psychoneuroses have the high discharge rates in the 60-69 year group of 555, 500 and 400, respectively. In the group 70 years and over, the high discharge rates are shown by psychoses due to drugs with 1,000 and psychoneu- roses with 300. Certain psychoses tend to have high discharge rates in all age groups. At the other extreme, we note that dementia praecox, psychoses with mental deficiency and psychoses with convulsive disorders tend to have the low discharge rates whatever the age group. Sex differences are relatively small compared with those of previous years. Going back only two years, when the new basis for outlining data was put into effect, we see the male discharge rate in the total first admissions "with mental disorder" for all ages combined is considerably higher than the female; 131 per 1,000 under care for the males to 107 for the females in 1937 and 131 to 114 in 1938. This year the male discharge rate is but 124 as compared with the female of 119. Again, in examining rates of the sexes by age groups a change is noticed. In 1937 five of the seven age groups show higher rates in the males and in 1938 six are higher in the males. However, in 1939 only four of the age groups have higher male rates than female, while in three the female rates are higher. The discharge rates for readmissions are not discussed owing to space limitations. However, Table 40 reveals that they show the same general characteristics as those for the first admissions. Economic Status of Discharges to the Community, 1939: Discharge Rates per 1,000 Under Care Table 41 shows the influence of economic status of patients upon the discharge rates during 1939. In first admissions the dependent show a discharge rate of 104 per 1,000 dependent patients under care. The marginal show a higher discharge rate of 171 and the com- fortable a rate of 159. The discharge rate of the marginal group is 64% higher than that of the dependent while the discharge rate of the comfortable is 52% higher. The dis- charge rates of the sexes stay close together in the dependent group where the male rate is .9% higher. In the marginal classification the discharge rate for males is 30% higher and in the comfortable group 22% higher. Apparently economic status has a greater tendency to raise the discharge rates in the case of men than women. In readmissions the dependent show a discharge rate of 95, the marginal a discharge rate of 113 and the comfortable 162. Here the rate for the marginal is 18% higher than that for the dependent, while the rate for the comfortable is 70% higher. Thus com- fortable economic status would appear to influence the discharge rate of readmissions to a greater extent than that of first admissions. Sex differences are less pronounced in readmissions than in first admissions, the male rate being 4% higher than the female rate in the dependent group, 13% higher in the marginal group and 8% higher in the comfortable group. P.D. 117 Table 41. 185 Economic Status of First and Read-missions Discharged, 1939, by Sex: Discharge Rates per 1,000 Under Care . Economic Status Dependent: Under Care . Discharges Rate per 1,000 Marginal: Under Care . Discharges Rate per 1,000 Comfortable : Under Care . Discharges Rate per 1,000 Unknown: Under Care Discharges Rate per 1,000 Total : Under Care . Discharges Rate per 1,000 Total 3,703 380 66.9 12,337 2,029 164.4 585 103 176.0 364 59 162.0 2,873 289 100.5 12,109 1,587 131.0 938 142 151.3 368 50 135.8 6,576 669 101.7 24,446 3,616 147.9 1,523 245 160.8 732 109 148.9 16,989 16,288 2,571 2,068 151.3 126.9 33,277 4,639 139.4 First Admissions M. 2,442 257 105.2 7,412 1,435 193.6 363 65 179.0 274 45 164.2 1,884 197 104.5 7,122 1,056 148.2 533 78 146.3 279 42 150.5 4,326 454 104.9 14,534 2,491 171.3 896 143 159.5 553 87 157.3 10,491 1,802 171.7 9,818 1,373 139.8 20,309 3,175 156.3 Readmissions M. T. 1,261 989 123 92 97.5 93.0 4,925 4,987 594 531 120.6 106.4 222 405 38 64 171.1 158.0 90 89 14 8 155.5 89.8 2,250 215 95.5 9,912 1,125 113.4 627 102 162.6 179 22 122.9 6,498 6,470 769 695 118.3 107.4 12,968 1,464 112.8 Marital Condition of Discharges to the Community, 1939: Discharge Rates per 1,000 Under Care Table 42 and Graph 3 outline the discharge rates for the various marital conditions in both first admissions and readmissions. In first admissions the high discharge rate of 245 per 1,000 under care occurs in the separated. Next in order are the married with a discharge rate of 198, the divorced 182, the widowed 133, and the single 128. The males in all marital groups show decidedly higher discharge rates than the females. The married and divorced females, particularly, are making a poorer showing in leaving hospital than the males of the same groups. In readmissions the high discharge rate of 213 occurs in the divorced. This is followed by a rate of 181 in the separated, 142 in the married, 106 in the widowed and 88 in the single. Table 42. — Marital Condition of First and Readmissions Discharged, 1939, by Sex: Discharge Rates per 1,000 Under Care Total First Admissions Readmissions Marital Condition M. F. T. M. F. T. M. F. T. Single: Under Care . 9,998 7,259 17,257 5,831 4,220 10.051 4,167 3,039 7,206 Discharges 1,167 760 1,927 808 483 1,291 359 277 636 Rate per 1,000 116.7 104.6 111.6 138.5 114.4 128.4 86.1 91.1 88.2 Married: Under Care . 5,050 6,124 11,174 3,277 3,645 6,922 1,773 2,479 4,252 Discharges 1,052 929 1,981 747 629 1,376 305 300 605 Rate per 1,000 208.3 151.6 177.2 227.9 172.5 198.7 172.0 121.0 142.2 Widowed: Under Care . 1,112 2,109 3,221 851 1,532 2,383 261 577 838 Discharges 164 243 407 131 187 318 33 56 89 Rate per 1,000 147.4 115.2 126.3 153.9 122.0 133 . 4 126.4 97.0 106.2 Divorced: Under Care . 476 454 930 293 238 531 183 216 399 Discharges 102 80 182 60 37 97 42 43 85 Rate per 1,000 214.2 176.2 195.6 204.7 155.4 182.6 229.5 199.0 213.0 Separated: Under Care . 309 326 635 200 171 371 109 155 264 Discharges 84 55 139 55 36 91 29 19 48 Rate per 1,000 271.8 168.7 218.8 275.0 210.5 245.2 266.0 122.5 181.8 Unknown: Under Care . 44 16 60 39 12 51 5 4 9 Discharges 2 1 3 1 1 2 1 - 1 Rate per 1,000 45.4 62.5 50.0 25.6 83.3 39.2 200.0 — 111. 1 Total: Under Care . 16,989 16,288 33,277 10,491 9,818 20,309 1,498 6,470 12,968 Discharges 2,571 2,068 4,639 1,802 1,373 3,175 769 695 1,464 Rate per 1,000 151.3 126.9 139.4 171.7 139.8 156.3 118.3 107.4 112.8 186 P.D. 117 First Admissions HUH Reodmissions 198 142 133 SINGLE MARRIED WIDOWED DIVORCED SEPARATED Graph 3. — Marital Condition of First and Read- missions Discharged, 1939: Discharge Rates per 1,000 Under Care Country of Birth of Discharges to the Community, 1939: Discharge Rates per 1,000 Under Care Table 43 presents the discharge rates per 1,000 under care by country of birth of patients. In first admissions discharged the United States shows the high rate of 176 and is followed by Scotland with 150, Italy with 140, Portugal with 131 and Canada with 128. The lowest discharge rates occur in Greece with 78, Sweden with 72 and Austria with 42. Table 43. — Country of Birth of First and Readmissions Discharged, 1989: Discharge Rates per 1,000 Under Care First Admissi ONS Readmissions Country of Birth Total Total Rate Country of Birth Total Total Rate Under Dis- per Under Dis- per Care charges 1,000 Care charges 1,000 United States 13,087 2,316 176.9 Scotland 79 10 126.5 Scotland 146 22 150.6 United States 8,965 1,114 124.2 Italv 748 105 140.3 Russia 480 58 120.8 Portugal 251 33 131.4 Portugal 95 10 105.2 Canada1 1,671 215 128.6 Canada1 772 80 103.6 Finland 133 16 120.3 Italv 434 40 92.1 Russia . 485 56 115.4 Germany 77 7 90.9 Ireland . 1 ,478 167 112.9 Austria . 67 6 89.5 England 427 48 112.4 England 217 17 78.3 Poland 590 57 96.6 Greece . 64 5 78.1 Germany 139 12 86.3 Finland 78 6 76.9 102 8 78.4 Poland 246 17 69.1 207 15 72.4 Ireland . 845 58 68.6 Austria . 142 6 42 2 Sweden 129 6 46.5 All Other Countries 703 99 145.8 All Other Countries 420 30 71.4 Total 20,309 3,175 156.3 Total 12,968 1,464 112.8 (See Table 225 for detail) 1 Includes Newfoundland. P.D. 117 187 In readmissions the high discharge rates are shown by Scotland with 126 per 1,000 under care, United States with 124, Russia 120, Portugal 105 and Canada 103. The low discharge rates occur in Poland with 69, Ireland 68 and Sweden 46. The number of discharges coming from any one country is rather small and for that reason no partic- ular significance can be attached to the findings for any one year. Discharges to the Community, 1939, by Number of This Admission: Discharge Rates per 1,000 Under Care Table 44 shows the discharge rates in accordance with the number of this admission. For example, during 1939 the State hospitals had 5,015 patients under care who were having their third admission to a mental hospital. Of this number 418 were discharged, giving a discharge rate of 83 per 1,000 under care for this third admission group. While the high discharge rate occurs in those having eleven admissions, 222, the numbers are very small. Cases having twelve or more admissions show the next highest rate of 209. Cases having their tenth admission show a rate of 208, ninth admission 178, eighth admission 176 and seventh admission 157. After seeing this regular decrease in both rates and number of admissions, it is interesting to note that the first and second admis- sions are next with the rate of 156. The lowest discharge rate, 83, is shown by patients having their third admission and the fourth admissions are close with the rate of 91. In the totals, the males show a higher discharge rate, 151, than the females, 126. This higher discharge rate for males persists throughout. Apparently patients having their third or fourth admission are those tending to remain longest in mental hospitals. Table 44. - Discharge Rates of First and Readmissions Under Care in Hospitals for Mental Disorders, 1939, by Number of This Admission and Sex Number op This Cases Under Care Di scharges Rate per 1,000 Admission M. F. T. M. F. T. M. F. T. First 10,491 9,818 20,309 1,802 1,373 3,175 171.7 139.8 156.3 Second 1,926 1.810 3,736 297 287 584 154.2 158.5 156.3 Third . 2,542 2,473 5,015 221 197 418 86.9 79 6 83.3 Fourth 1,060 1,159 2,219 108 94 202 101.8 81.1 91.0 Fifth . 471 499 970 53 52 105 112.5 104.2 108.2 Sixth . 209 238 447 30 22 52 143.5 92.4 116.3 Seventh 123 112 235 23 14 37 186.9 125.0 157.4 Eighth . 55 70 125 9 13 22 163.6 185.7 176.0 Ninth . 41 43 84 9 6 15 219.5 139.5 178.5 Tenth . 23 25 48 7 3 10 304.3 120.0 208.3 Eleventh 14 13 27 3 3 6 214.2 230.7 222.2 Twelfth or over 34 28 62 9 4 13 264.7 142.8 209.6 Total 16,989 16,288 33,277 2,571 2,068 4,639 151.3 126.9 139 4 Mental Condition op Discharges to the Community, 1939, by Diagnosis Table 45 presents the condition on discharge of cases returned to the community during 1939. Of all first admissions leaving hospital, 21.5% were recorded as without psychoses, 21.2% as recovered, 42.5% as improved and 14.6% as unimproved. Six out of every seven patients discharged either were without a mental disorder or had shown definite improvement. In the total "with mental disorder" 28.1% were discharged as recovered, 54.3% as improved and 17.4% as unimproved. In other words, 82.4% of these patients, once definitely psychotic, were returned to the community as either recovered or improved. High proportions of recovery are observed in psychoses with other infec- tious diseases, 66%; alcoholic psychoses, 64%; due to drugs, 56%; with mental deficiency, 45% and other metabolic diseases 42%. Leading the improved group are psychoses with syphilitic meningo-encephalitis, 79%; with other forms of syphilis, 75%; involu- tional psychoses, 68%; senile psychoses, 67% and epidemic encephalitis, 66%. Of the three psychoses most important numerically, dementia praecox shows 11% recovered, 65% improved and 23% unimproved; alcoholic psychoses show 64% recovered, 31% improved and 4% unimproved and manic-depressive show 31% recovered, 56% im- proved and 12% unimproved. It is encouraging that dementia praecox shows over seven out of every ten discharges of this diagnosis as either recovered or improved. In the readmissions we find 19% of total discharges without psychoses, 21 % recovered, 48% improved and 12% unimproved. The readmissions have fewer unimproved (12%) than the first admissions (14%). The readmissions are also making a better showing 188 P.D. 117 5 o *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 .1 i I I I i I i I I i i i I I I I I I I go i I I 50 I CO t- HCiQ i-i cOi-i lO tf2 CM eotoci'-'ONiON »o moot^ocNt^oo cm r-IIN COCNi- ri rHCOCNHCO 50 « I ho imjjb! 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C o h^J ■ c 'o a S m => C -a CO o -d.S oQ 53 _ s 5JJ 50 & o 'iS P.D.117 189 than first admissions in the group "with mental disorder" with 26% recovered, 58% improved and 14% unimproved. This last figure is lower than the 17% unimproved in psychotic first admissions. Individual psychoses will not be discussed owing to space limitations. Length of Hospital Stay of Discharges to the Community, 1939, by Condition on Discharge Table 46 presents the average length of hospital stay during the present admission of first admissions and readmissions returned to the community in 1939 by condition on discharge and diagnosis. In the total "with mental disorder" the 668 recovered remained-.98 years, the 1,289 improved-. 83 years, and the 415 unimproved-.45 years. Complete recovery from the psychosis required a longer period of hospital residence than the attainment of a condition permitting return to the community. In the re- covered, due to drugs and due to new growth, .08 years each, remained the shortest time in hospital. With epidemic encephalitis, 7.50 years; syphilitic meningo-encephalitis, 5.51 years; involutional psychoses, 3.17 years; and senile psychoses, 2.81 years remained the longest time in hospital. Psychoses due to new growth show the short hospital stay in the improved, .04 years. Psychoses with epidemic encephalitis, other disturbances of circulation, other metabolic diseases, due to new growth and undiagnosed psychoses all show the short hospital stay of .04 years in the unimproved. In comparison with the general average, dementia praecox shows a long hospital residence in the recovered and the unimproved. Table 46. — Average Length of Hospital Stay during This Admission of First and Read- missions Discharged during 1939, by Condition on Discharge and Diagnosis First Ai >MISSIONS Readmissions Diagnoses Re- Im Unim- Without Re- Im- Unim- Without covered proved proved Psychoses covered proved proved Psychoses With syphilitic meningo-en- cephalitis 5.51 .68 .23 — 4.50 1.89 .36 - With other forms of syphilis — .69 .20 - _ 3.41 — - With epidemic encephalitis . 7.50 .74 .04 - - - - - With other infectious diseases .19 1.98 — — — - — — Alcoholic psychoses .73 .81 1.17 - .92 .90 6.27 - Due to drugs, etc. . .08 .14 .37 - .20 .08 — - Traumatic psychoses .51 .86 .12 - .04 5.94 .29 - With cerebral arteriosclerosis 1 10 .62 .23 - .63 1.44 .67 — With other disturbances of cir- culation .... .20 . 53 04 - - .04 - - With convulsive disorders (epi- lepsy) .23 .58 .99 - 1. 11 .29 .42 - Senile psychoses 2.81 .96 .06 _ 1.50 1.64 .61 - Involutional psychoses . 3.17 1.37 .09 - 2.85 1.75 .43 - Due to other metabolic dis- eases, etc .17 55 .04 — .12 09 - - Due to new growth .08 .04 .04 - - - - - With organic changes of ner- vous system .37 .53 .29 - 3.89 1.14 .04 — Psychoneuroses .25 .20 .11 - .71 .63 .05 - Manic-depressive psychoses 1 . 35 .75 .40 - 1.42 .99 .87 - Dementia praecox . 1.80 .76 .87 - 1.57 1.60 2 . 35 - Paranoia and paranoid condi- tions ..... 1.20 1.21 .11 - 6.68 3.02 .78 - With psychopathic personality .66 1.38 .33 - 1.11 1.60 .15 - With mental deficiency . .87 2.61 .27 - 4.48 1.22 .70 - Undiagnosed psychoses . .12 .20 .04 - .04 .04 04 - Without psychoses . - - - 10 - - - .13 Primary behavior disorders . .08 05 .05 - .12 .04 .04 - Total With Mental Disorder .98 .83 .45 _ 1.41 1.37 1.14 _ Total Without Mental Dis- order1 .08 .05 05 .10 .12 .04 .04 13 Grand Total 97 79 41 10 1.40 1.37 1.11 .13 ' Includes without psychoses and primary behavior disorders. In the readmissions "with mental disorder" the recovered remained an average of 1.41 years in hospital before being returned to the community, the improved an average of 1.37 years and the unimproved an average of 1.14 years. Undiagnosed psychosis show a short hospital residence, whatever the condition on discharge. Also, traumatic 190 P.D. 117 q 2= B5INNWWOKO! I OH-H?lfM^OtDnn-';«3t^0003O-"MC0-*' lO -* C^ m > ft „Jj oj _q 3 CftoAOO .■oo« 5 « cj O M«-£ c-g a 2 o^ ^3 O C3 0) -*e fc-< ■£ -C tl'-S o o o +2 c; <^ S? ^ "£ o O o ^ ^ ^ o oQ 53 — c 03 0) ^ O P.D. 117 191 psychoses show a short residence in the recovered, with other disturbances of circulation in the improved and with organic changes of the nervous system and psychoneuroses in the unimproved. Dementia praecox shows a long hospital residence in all groups of the readmissions when compared with the general average. MENTAL REF/C/E/VCY MVOLVT/ONAL DEMENT/A PRAECOX SE/V/LE PSYC//OPATH/C PERSONAL/TV SYPff/L/T/C MEM/VGO- E/VCEPffALir/S PARAAfO/A MAA//C~ DEPRESS/VE ALCOffOL/C CEREBRAL ARTERIO- SCLEROSIS PSYC/fO- A/EUROSES TOTAL W/TH MENTAL D/SORDi 7QTAL MTffOVr I . 09 MENTAL DISORDOfg ./ TOTAL-ALL FORMSX 2.3 2.5 F/rsi Ae/m/ssfons fteadm/ss/Ofjs Graph 4. — Length of Time in Residence during This Admission of Certain Diagnoses, First Admissions and Readmissions Discharged during 1939: Averages in Years Length of Hospital Stay of Discharges to the Community, 1939, by Diagnosis Table 47 and Graph 4 present the average length of hospital residence during the present admission of cases returning to the community during 1939. First admissions "with mental disorder" show an average hospital residence of .80 years or over nine months. The average residence of the females, .96 years, is much longer than that of the males, .65 years. The long hospital residences are shown by psychoses with epidemic encephalitis, 1.75 years; with mental deficiency, 1.64 years; with involutional psychoses, 192 P.D. 117 1.52 years; senile, 1.15 years; and dementia praecox, 1.12 years. The psychoses with shorter hospital residences are those with due to drugs, .11 years; without psychoses, .10 years; undiagnosed, .07 years; and due to new growth, .05 years. In with epidemic encephalitis, with mental deficiency, senile psychoses, paranoia, with other infectious diseases, traumatic psychoses and with other forms of syphilis, we observe the males showing a greater length of hospital stay. The readmissions "with mental disorder" show an average hospital stay of 1.35 years or about a year and four months. The readmissions also show a longer hospital residence for the females, 1.47 years, than for the males, 1.22 years. The traumatic psychoses with 4.01 years, other forms of syphilis with 3.44 years, paranoia with 2.59 years and mental deficienc}- with 2.35 years present the longer hospital residences. Due to other metabolic diseases with an average stay of .10 years, and undiagnosed psychoses and other disturbances of circulation with .04 years, show the short average hospital resi- dences. Remarkable differences in length of hospital stay are noted. In first admissions, psychoses with epidemic encephalitis with a stay of 1.75 years, remain one year and eight months longer than the psychoses due to new growth with an average of .05 years. Among the readmissions, the traumatic psychoses with an average of 4.01 years remain in hospital almost four years longer than the undiagnosed psychoses and with other disturbances of circulation with an average stay of .04 years. Total Length of Hospital Stay during Previous Admissions and the Present Admission; Readmissions Discharged to the Community, 1939, by Diagnosis Table 48 shows the length of hospital stay during previous admissions as well as the present admission of all readmissions discharged to the community during 1939. The fourteen hundred sixty-four readmissions returned to the community during 1939 had been in hospital an average of 2.03 years during their lives, .93 years in hospital during previous admissions and 1.10 years during this admission. The average stay, 2.25 years, of the females is 22% longer than the 1 .83 years of the males. During previous admissions the females showed an average hospital stay which was 11% longer than that of the males. During the present admission the hospital stay of the females averaged 33% longer than that of the males. Table 48. — Average Length of Hospital Stay > during Previous Admissions and the Present Admission: Readmissions Discharged, 1939, by Diagnosis and Sex Diagnoses Readmissions Discharged — ■ ■lOSPIT ul Stat in Years This Admission Previous Admissions All Admissions M. F. T. M. F. T. M. F. T. With syphilitic meningo-encephalitis 1.61 1.78 1.66 .54 1.58 .88 2.15 3.36 2.54 With other forms of syphilis . 3.44 - 3.44 1.44 — 1.44 4.88 4.88 Alcoholic psychoses .... .94 1.33 1.00 .43 .41 .42 1.37 1 . 74 1 . 42 Due to drugs, etc. . *. .15 .12 .13 .16 .33 .24 .31 .45 .37 Traumatic psychoses . . 4.81 .04 4.01 .29 .08 .26 5.10 .12 4.27 With cerebral arteriosclerosis . .77 1.46 1.12 1.02 1.64 1.33 1.79 3.10 2.45 With other disturbances of circulation . — .04 .04 - .08 .08 - .12 .12 With convulsive disorders (epilepsy) .16 .97 .51 .48 .29 .40 .64 1.26 .91 Senile psychoses . . " . 1.85 1.02 1.37 1.22 .64 .87 3.07 1.66 2.24 Involutional psychoses .... 2.38 1.65 1.72 1.11 .47 .54 3.49 2.12 2.26 Due to other metabolic diseases, etc. .09 12 .10 1.30 .50 1.07 1.39 .62 1.17 With organic changes of nervous system 2 00 1.55 1.83 .81 .34 .62 2.81 1.89 2.45 Psychoneuroses ..... .82 .70 .76 .51 .29 .38 1.33 .99 1.14 Manic-depressive psychoses . 1.19 1.10 1.13 .82 1.16 1.04 2.01 2.26 2.17 Dementia praecox . . . . 1.53 1.97 1.73 1.25 1.21 1.23 2.78 3.18 2 96 Paranoia and paranoid conditions 1.80 3 05 2.59 1.40 1.36 1.37 3.20 4.41 3.96 With psychopathic personality .74 1.44 1.13 1.10 1.63 1.38 1.84 3.07 2.51 With mental deficiency .... .93 3.51 2.35 1.50 1.80 1.67 2.43 5.31 4.02 Undiagnosed psychoses .... .04 .04 .04 1.07 .15 .38 1.11' .19 .42 Without psychoses _ .13 .12 .13 .87 .58 .76 1.00 .70 .89 Primary behavior disorders .04 .06 .05 09 .03 .07 .13 .09 .12 Total With Mental Disorder 1.22 1.47 1.35 .89 1.06 .97 2.11 2 . 53 2 . 32 Total Without Mental Disorder .12 .12 .12 .86 .56 .75 .98 .68 .87 Grand Total .95 1.27 1.10 .88 .98 .93 1.83 2.25 2.03 1 Exclusive of time spent out on visit, etc. P.D. 117 193 Considering the total of all admissions, the long hospital residence is shown by the psychoses with other forms of syphilis with 4.88 years and traumatic psychoses with 4.27 years. In order follow mental deficiency, 4.02 years; paranoia, 3.96 years; dementia praecox, 2.96 years; and syphilitic meningo-encephalitis, 2.54 years. The short hospital residences during all admissions are observed in psychoses with other disturbances of circulation, .12 years; due to drugs, .37 years; undiagnosed psychoses, .42 years and convulsive disorders .91 years. It is observed that the psychoses in which definite organic changes have taken place are the ones tending to long hospital residence. Four of the six psychoses showing the longest hospital stay; namely, traumatic psychoses, mental deficiency, syphilitic meningo- encephalitis and other forms of syphilis fall in this group. Dementia praecox and paranoia are the only ones of the functional group appearing here. This table points out definitely that the length of hospital stay during previous admissions must be con- sidered if we are to obtain a satisfactory picture of the total time spent in mental hospitals by the various groups of the clinical classification. Here we note that of the total average time in mental hospitals, 2.03 years, .93 years or 45% occurred during previous admis- sions. Length of Hospital Stay during the Present Admission of Discharges to the Community, 1939, by Hospital Table 49 presents the average length of hospital stay of discharges during 1939, by hospital. The Psychopathic Hospital, with a preponderance of temporary care cases, shows the short hospital stay of .05 years or about 18 days. Of the active admitting hospitals with court commitments predominating, Foxborough shows the short hospital stay in first admissions of .47 years or five and one half months. Worcester is second with a stay of .63 years or over seven months. Taunton and Dan vers are tied for third place with a stay of .71 years or eight and one half months. Monson shows an average residence of 1.46 years. Among the transfer hospitals, Gardner shows the shortest average residence, .44 years or about five months. The numbers of first admissions coming to the transfer hospitals are, of course, small. Table 49. — Average Length of Hospital Stay during This Admission, First and Readmissions Discharged, 1939, by Hospital Hospitals Length of Residence in Yeabs Total First Admissions Read- missions Boston Psychopathic .... Worcester Taunton Danvers Foxborough Northampton Westborough Boston State Gardner Grafton Monson Medfield Metropolitan McLean . Bridgewater Veterans' Administration Facility No. 95 Veterans' Administration Facility No. 107 Tewksbury Total With Mental Disorder Total Without Mental Disorder . Grand Total .69 .73 .82 .88 .94 1.02 1.51 .81 1.04 1.22 1.30 2.72 .39 .61 .81 1.37 12.50 10 .77 .05 .63 .71 .71 .47 .90 .95 1.19 .44 .80 1.46 1.46 2.74 .33 .71 .31 .63 12.50 . 80 .09 .05 .90 .77 1.03 1.63 1.03 1.11 2.15 1.76 1.32 .59 1.00 2.71 .47 .41 1.23 1.65 1.35 .12 The readmissions at Psychopathic show the same short average stay of about 18 days. Among the active admitting hospitals, Taunton and Worcester again show short residence, .77 years and .90 years, respectively. Monson readmissions are in hospital for a much shorter period than first admissions, .59 years as compared with 1.46 years. Of the transfer hospitals, the shortest residence, 1.00 years, is at Medfield. 194 P.D. 117 Length of Hospital Stay op Discharges Returned to the Community, 1939, by Age at Admission Table 50 gives the average length of hospital stay in accordance with the age at admission. All admissions together remained a total of .77 years or about 9 months. First admissions remained .62 years and readmissions 1.10 years. The readmissions remained in residence nearly six months longer than first admissions. In first admissions the females remained .82 years, over 4 months longer than the males (.47 years). In readmissions the females remained an average of 1 .27 years, which is about four months longer than the average for the males, .95 years. In the age groups we observe that patients coming into mental hospitals in the younger and older years tend to have a short hospital stay, with the longer hospital residences occurring in the ages 40-69 years. The first admissions admitted under 20 years of age were discharged after a hospital stay of slightly less than six months. The long hospital residence of .99 years or about one year occurs in patients admitted between 50 and 59 years. Those coming in at older ages show gradual decreases in length of hospital residence. Table 50. — Average Length of Hospital Stay during This Admission, First and Readmissions Discharged, 1989, by Age at Admission and Sex A ge at Admission Total First Admissions Readmissions M. F. T. M. F. T. M. F. T. 0-19 Years 20-29 Years 30-39 Years 40-49 Years 50-59 Years 60-69 Years 70-79 Years 80-89 Years 90 Years and o ver .36 .71 .45 .56 .92 .77 .64 .28 .61 .77 .84 1.11 1.46 1.17 .56 .14 .12 .46 .74 .62 .80 1.17 .97 .60 .23 .12 .33 .60 .45 . 58 . 58 . 58 .30 .63 .43 .39 1 . 03 .67 .69 1 . 38 .99 .70 .87 .78 .49 .54 .52 .18 .14 .17 .12 .12 .45 .65 .53 1 . 06 1.13 1 . 09 .74 1.15 .94 .86 1 . 28 1 . 04 1 . 57 1 . 60 1 . 59 .94 1 . 72 1 . 35 1 . 28 .64 .99 1.10 - 1.10 Total .61 .97 .77 .47 .82 .62 .95 1 . 27 1.10 (See Tables 212 and 213 for detail) In general the readmissions, also, show short hospital residences in the younger and older ages. Patients readmitted under the age of 20 remained .53 years or about six months. Those readmitted between the ages of 50 and 59 years remained the longest period of 1.59 years or one and one-half years. In readmissions there is a greater tendency for long hospital residence to be associated with the ages from 40 to 49 years than in first admissions. Age of Discharges Returned to the Community, 1939, by Diagnosis Table 51 shows the average age at discharge in first admissions and readmissions by diagnosis. All first admissions "with mental disorder" were returned to the community at an average age of 44.0 years. In the total "without mental disorder" the average at discharge is lower, 35.6 years. This difference exists in the readmissions to a lesser degree. The average age at discharge of these cases "with mental disorder" is 43.2 years and of "without mental disorder", 39.0 years. Another similarity may be observed in the total average ages of the sexes. In both the first and readmissions, the females "with mental disorder" are one year older than the males; whereas, in the "without mental disorder" groups the females are two years younger than the males. In the first ad- missions the oldest average ages at discharge are found in the senile psychoses, 72 years ; cerebral arteriosclerosis, 69 years; involutional psychoses, 53 years and due to new growth and other disturbances of circulation, 51 years. The youngest discharge ages are found in dementia praecox, epilepsy, with mental deficiency and epidemic enceph- alitis, 32 years each. In the readmissions the oldest average discharge ages are found in senile psychoses, 68 years; cerebral arteriosclerosis, 66 years and other disturbances of circulation, 57 years. The youngest discharge ages are noted in convulsive disorders, 32 years; with psychopathic personality, 34 years and dementia praecox and mental deficiency, 36 years each. 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So T3.S oQ no K 03 0 55 0 < •■£,•. -"S-gg ... -g -s§-S.|. ■ S -| ■ -g-2 .g jj to o -g, i ^^.2 o o S^ -S .88 .|S§ . I ZVl .|".S| .-EJ&-S •c8j|§"S -"5 I^SLf |^| .§&S| • tot &£ 3 a e " o 6-e « _gti £ "rg >> ° oj §* ° O ^3 MStI C> CO 1^,+^ W( ,-GKcoO& 03 co"-* C3 •a S-s r°>»&3 o.^-?-= £ S 5?=^ S,3 ="3^ OJ S ' h ?^ 3 P.-3 „jCl.S5SX«"?ajio) ms.o c-c iXfl 2 a5 o mj3 « a;^ > °.S e.2 s-" O.0J^3 ^^.rH+J ^>.(S lH*jCTI^KS+JoC(r'>) "oaOOO.OOCBCOOOO ' 3fiB!ao«EC 03 ^3 +^ C -^j-i H +^ JCJ.r O C3 03 c3 ^■5 ° §-5 s^ 03 §5 3 oj^5 ^p^S-S^ sf -S-S B 53 C3 03 -gJ3 Hf II "a Is Eh -o c c3 o o Ei Eh o 196 P.D. 117 10 —< r- o -< N in tj< Hnscom i-h OMM'OOONO CD00O5COCO •-i NOoraf-oio >-i 05 O CO m 05 O CO ONCNO oo in oo oo oo o Tti co «5n«ok; CO U3 CM lO i-H IN ~h CO l^05Hf-HiO co M< ■* •* ** -* -# rt< cococococo CM co cs Tti as co oo >o cm •* cc oo r- (N >C -h 00 — i t- t- "O . CO CO r-c i-H CN »H —i t~ os co O0000 -hi CO CO CO OS IN Tf O COi-hiN-hicM lO 00 00 CO OS -hi CO -HI CO oot> r~ ira nf o o CO -0 CO OS iO i-hCM-hOOO OCOCMH+l 0-H05CM-H oo oo r- 05 cm -hi i-h i-h mHrtrtio ioi-hcocooo T)iio^HC005 CM 00 CO "0 CM -H< -HI -HI CO CM "C "HI -HI -HI CO 05 CO CO O "* CO -Hi CM t>.0-HCMiO io -Hirt^Ht^ot^t>- Hioajoo CO O CO ■* -Hi co i-h OS mNifNiO CO lO -HI Tt< -HI -HI Tfl CO Tt< -HI Tfl CO CM iO — i -hi CO IN -h O O CO IO -HI -HI -HI Tfl HH ^1 COOi^COCO 0-H050-H (N>O00i-nO lO-HCOHflOO -H "HICOCOOCO-HH^. OS CM h» O 'O -HI »0 00 CM f- -H 00 lO r^-COCM-HiCN i-h t^ CM lO CO lO CM i-h i-H NNrHOOO ■^ IO CO 00 Tf CM CM CO t- J3 . B . . ri CO CO r3 o o o BB ■OT) 3 tfi M °- l-J-d «^Q^;p:cH|iH O^SoS H>>§m P.D. 117 197 Age of Discharges to the Community, 1939, by Hospital Table 52 gives the average age at discharge of first admissions and readmissions leaving various hospitals. The Psychopathic Hospital, dealing almost exclusively with short term residents, shows a discharge age of 34.4 years, 35.1 years in the males and 33.1 years in the females. In the readmissions the same hospital shows an average of 36.1 years, 36.8 years in the males and 35.1 years in the females. In the active admitting hospitals, Boston State shows the high average discharge age of 53.3 years for first admissions. The low average discharge age of this group is shown by Foxborough with 39.0 years. In the readmissions, Boston State shows the high average discharge age of 46.0 years and Taunton the low average of 40.2 years. In the second group, the chronic transfer hospitals, the high discharge age of first admissions is shown by Gardner with 45.3 years and the low discharge age by Grafton with 38.4 years. In the readmissions of this group Metropolitan shows the high average of 45.8 years and Grafton the low average of 33.3 years. The Monson State Hospital, admitting epileptics only, cares for many children. This, of course, distributes the discharge ages in the younger groups. Length of Hospital Stay of Discharges Returned to the Community, 1939, by Nativity Table 53 shows the average length of residence during the present admission of first admissions and readmissions discharged during 1939, by nativity. The total native born first admissions show a hospital residence of .58 years (about seven months), while the foreign born remain in hospital .74 years (about nine months). In readmissions the native born show a hospital stay of 1 .04 years and the foreign born remain about three months longer, an average of one year and four months. In the foreign born first admis- sions the females show a hospital residence of almost 2 months longer than the males. In the native born the females show a hospital stay of five months longer than the males. In the foreign born readmissions the males show a hospital stay of two months longer than the females, but the native born males stay in hospitals almost five and one- half months longer than the females. Table 53. — Average Length of Residence During This Admission, First and Readmissions Discharged, 1939, by Nativity Groups and Sex Nativity Total First Admissions Readmissions M. F. T. M. F. T. M. F. T. Foreign Born Native Born: Foreign Parentage Mixed Parentage Native Parentage Unknown Parentage Nativity Unknown .88 .54 .58 .52 .52 .40 .05 .95 .98 1.10 .81 .98 .58 .52 .90 .73 .80 .64 .72 .47 .23 .66 .82 .74 .41 .82 .58 .46 .93 .66 .31 .81 .51 .41 .74 . 55 .37 .64 .49 .05 .77 .26 1.39 1.22 1.30 .83 1 . 28 1 . 04 .89 1.43 1.13 .98 .80 .89 .74 1 . 40 1 . 04 .51 .04 .38 .04 .04 Total .61 .97 .77 .47 .82 .62 .95 1.27 1.10 Studying the native born in accordance with parentage, we find the native born with parents foreign born show the long hospital stay of .66 years, the native born with both parents native born an average of .55 years, and the native born of mixed parentage the short hospital stay of .51 years. In the readmissions the native born of foreign parentage offer a long hospital stay of 1.13 years and the native born of native parentage show a hospital stay of 1.04 years. The native born of mixed parentage, with .89 years, are lowest. Times Out on Visit in Discharges to the Community, 1939, by Diagnosis Table 54 outlines the number of times patients left the hospital on visit previous to their discharge, by diagnosis. All patients discharged 1939, show an average of .84 times out of hospital before being permanently returned to the community. Some 57% were discharged directly from the hospital and 42% had one or more visits previous to dis- charge. The group "with mental disorder" shows an average of 1.08 visits. The group "without mental disorder" shows an average of .06 visits. The high average numbers 198 P.D. 117 of visits are shown by epidemic encephalitis, 1.83; other forms of syphilis, 1.77; dementia praecox, 1.63; and syphilitic meningo-en cephalitis, 1.60. The smallest average number of visits are shown by due to new growth, .16; without psychoses, .06 and undiagnosed psychoses, .05. Table 54. — Times Out on Visit during This Admission of Cases Discharged, 1989, by Diagnosis Total Num BEB OF Times on Visit Average Number of Times Diagnoses Cases No. of Visits None One Two Three Four- Six Seven- Nine Ten or More Out With epidemic encephalitis 6 11 2 1 1 1 1 1.83 With other forms of syphilis 9 16 4 3 1 - - - 1 1.77 Dementia praecox 784 1,279 192 322 143 46 50 14 17 1.63 With syphilitic meningo- encephalitis 103 165 28 46 12 5 6 4 2 1.60 With mental deficiency 93 140 35 28 12 10 4 2 2 1.50 Involutional psychoses 159 224 39 73 28 7 9 T 2 1.40 Manic-depressive psychoses 654 873 191 277 97 40 35 10 4 1.33 Senile psychoses 52 65 1.5 21 10 3 3 _ _ 1.25 Paranoia and paranoid con- ditions .... 99 123 44 31 13 2 5 2 2 1.24 With convulsive disorders (epilepsy) S3 102 40 19 13 4 5 _ 2 1.22 Traumatic psychoses . 21 24 5 12 3 - 1 - - 1.14 With organic changes of ner- vous system 53 58 27 16 5 2 1 1 1 1.09 With other disturbances of circulation 19 17 10 7 - 1 - 1 _ .89 With psychopathic person- ality S3 71 46 23 6 2 5 1 — .85 Due to other metabolic dis- eases, etc. 56 36 31 19 4 1 1 - - .64 With cerebral arteriosclerosis 307 188 172 110 17 2 3 2 1 .61 Alcoholic psychoses 486 269 339 98 26 6 12 T 4 .55 With other infectious diseases 12 6 6 6 — _ - - - .50 Psychoneuroses 356 164 265 65 10 6 7 2 1 .46 Due to drugs, etc. 44 11 35 7 2 - - - _ .25 Due to new growth 6 1 5 1 - - - - - .16 Undiagnosed psychoses 55 3 52 3 — — — - - .05 Without psychoses 972 65 941 19 5 1 5 - 1 .06 Primary behavior disorders 127 1 126 1 - - - - - .007 Total With Mental Dis- order .... 3,540 3,846 1,583 1,188 403 138 148 41 39 1.08 Total Without Mental Disorder 1,099 66 1,067 20 5 1 5 - 1 .06 Grand Total 4.639 3,912 2,650 1,208 408 139 153 41 40 .84 Percent 100.0 57.1 26.0 8.7 ... 3.2 .8 .8 Section D. Deaths in Mental Hospitals During the Year 1939 The following section presents data in reference to all cases dying in mental hospitals during the year 1939. As in the case of admissions and discharges, the deaths reported are no longer confined to court admissions. The data as outlined are based on all cases dying in mental hospitals and include those admitted under court, temporary care, observation and voluntary status. Deaths in Mental Hospitals, 1939, by Form of Admission Table 55 shows that 1,893 deaths occurred in 1939, 976 males and 917 females. This is an increase of 11% over the 1,704 deaths in 1938. Of the 1,488 first admissions dying, 1,348 were admitted by court commitment, 71 under temporary care, 52 under observa- tion and 17 on voluntary papers. Of the 405 readmissions, 386 were on court papers, 7 on temporary care, 4 on observation and 8 on voluntary. In first admissions there is an increase over 1938 in the court and temporary cases dying and a slight decrease in the observation and voluntary cases. The number of court readmissions dying decreased 14%. Diagnosis in Deaths, 1939, by Form op Admission Table 56 presents the legal form of admission of patients who died during 1939 by diagnosis. Three psychoses are important among the deaths in first admissions. Six hundred one deaths were diagnosed as psychoses with cerebral arteriosclerosis. They P.D. 117 199 make up 40% of the court commitments, 33% of the temporary care cases and 53% of observations. Senile psychoses, with 228 deaths, make up 16% of court commitments, 8% of temporary care admissions and 1% of the observation commitments. Dementia praecox, with 190 deaths, comprises 13% of court commitments, 1% of temporary care and 3% of observation cases. Table 55. — First and Readmissions Dying in Hospitals for Mental Disorders, 1937-1939 by Form of Admission and Sex Sex Aggre- First Admiss IONS Readmissions Year gate Tem- Tem- Total Court porary Obser- Volun- Total Court porary Obser- Volun- Care vation tary Care vation tary T. 1,974 1,580 1,432 71 64 13 394 377 10 4 3 1937 M. 1,023 831 735 52 34 10 192 183 5 2 2 F. 951 749 697 19 30 3 202 194 5 2 1 T. 1,704 1,232 1,085 60 69 18 472 452 7 7 6 1938 M. 873 646 553 46 34 13 227 212 6 5 4 F. 831 586 532 14 35 o 245 240 1 2 , 2 T 1,893 1,488 1.348 71 52 17 405 386 7 4 8 1939 M. 976 782 693 48 32 9 194 186 5 1 2 F. 917 706 655 23 20 8 211 200 2 3 6 Among the readmissions dementia praecox records 123 deaths, comprising 31% of court commitments. Cerebral arteriosclerosis is second with 76 deaths, 18% of court commitments, 42% of temporary care and 25% of observation. Manic-depressive is third with 57 deaths, making up 13% of court commitments, 28% of temporary care admissions and 50% of the observation cases dying during 1939. Diagnosis in Deaths, 1939: Death Rates per 1,000 Under Treatment In Table 57 we record the death rate per 1,000 under treatment of the various psy- choses by first admissions and readmissions. The total death rate for first admissions is 79. This rate is seven times the death rate of the general population for 1939, 11.3. In the subdivision "with mental disorder" the death rate is 83 and in the group "without mental disorder", 4. In the readmissions the total death rate is 34 per 1,000 under treatment, or over three times that of the general population. The subgroup "with mental disorder" shows a death rate of 35 and the group "without mental disorder" a rate of 8. In first admissions, psychoses due to new growth and other disturbances of circulation show death rates of 533, and 311 per 1,000 under treatment respectively. Cerebral arteriosclerosis is also high with a rate of 296. Senile psychoses and other metabolic diseases show high rates of 270 and 275 respectively. The low death rates are shown in epidemic encephalitis, 18, psychopathic personality, 13 and psychoneuroses, 4. Only in psychoneuroses and without psychoses, 5, are the death rates lower than in the general population, 11.3. In the readmissions the four high rates are shown by psychoses with other disturbances of circulation, 416; cerebral arteriosclerosis, 203; other infectious diseases, 200 and senile psychoses, 159. The low rates are shown by dementia praecox, 20; mental deficiency, 18; and psychopathic personality, 11. Diagnosis in Deaths 1939, by Age: Death Rates per 1,000 Under Treatment Table 58 presents the death rates for the various psychoses in both first and read- missions by age. The death rates for specific psychoses as outlined in Table 57 might well be influenced by a preponderance of young patients with low death rates or old patients with high death rates. Therefore, Table 58 offers the death rates by age, giving the cases under treatment in each age group and the number dying within the same group. In first admissions "with mental disorder" we notice the three age groups up to 39 years showing comparable death rates of 19, 16 and 22 per 1,000 under treatment. The 40-49 year age group increases to a death rate of 27, the 50-59 year group to 48, the 60-69 year group to 117, the 70-79 year group to 211 and the 80 years plus group to 381. 200 P.D. 117 6S i i i i i i i i i i i i i i i i i i i i i I I 00 I I I I I I I I I I 1 I I i i i i i i oo I I I l I I I rt>H | | | ■ | | | | (N I I I I I I o, 03 I I I I I I I I I JIM t~CN -*I>CNCN CO tooi'SON oo nocok!"* m ^ -*TO-H -HCN I CN -* f~ 00 00 m I N I MCOQNN I CN t- rHrH IOCNiH m fc5? -h t>-CN CN^f h- CN rf rf OS OrtiOO»Bi-iOSOI»M»OtlMNNON001'tl* OO"-1 t- O— iTOCNCMtJi CO tTCSCN CN H g £ "S c $ 5? bi O. £ U-Sjj S'J.S'S D-C3-S -3.2^3 *J i- >>_.«. s as o a 3 O -SJ3r3"o "" •S'S'o co g-g to ^^ OS eg co o C o a o XI co . 73 -r < h ^ r ..3 cd a a* i.s-s- g o ^£ca 3 S'55 | ^S-S M ° co S cS _, &_ coo ij^ 0"S' I'Sgp^ci-s! i; ri Qi qi d ^^C c »cia5 S S"" cSo ' coiiE •^ "j3.2 CD (3 _ . a-5 gg S £^-5: — bi 2-<= is Pi* P.D. 117 201 In seven of the eight age groups, the males show a higher death rate than the females. Only in the 0-19 year group are the females higher. Table 57. — First and Readmissions Dying, 1989, by Diagnosis, Death Rates per 1,000 Under Treatment Death Death Rate Rate First Admissions per Readmissions per 1,000 1,000 533. With other disturbances of circulation 416. With other disturbances of circulation . 311: With cerebral arteriosclerosis 203. With cerebral arteriosclerosis . 296. With other infectious diseases 200. Due to other metabolic diseases, etc. 275. Senile psychoses ..... 159. Senile psychoses . _ . 270. Due to other metabolic diseases, etc. . 142. With other infectious diseases 172. With syphilitic meningo-encephalitis . 79. With organic changes of nervous system 143. With other forms of syphilis 75. With other forms of syphilis . 132. With organic changes of nervous system 61. With syphilitic meningo-encephalitis 122. With convulsive disorders (epilepsy) . 53. Undiagnosed psychoses .... 64. Manic-depressive psychoses 38. Due to drugs, etc 62. Alcohohc psychoses .... 36. With convulsive disorders (epilepsy) 57. Involutional psychoses . 33. Alcoholic psychoses .... 55. Paranoia and paranoid conditions 32. Involutional psychoses . 46. With epidemic encephalitis . . ."'■ 24. Paranoia and paranoid conditions 42. 20. Manic-depressive psychoses 41. With mental deficiency .... 18. Traumatic psychoses .... 37. With psychopathic personality 11. Dementia praecox 25. Due to drugs, etc. . _ With mental deficiency .... 24. Traumatic psychoses .... _ With epidemic encephalitis . 18. Due to new growth .... _ With psychopathic personality 13. Psychoneuroses .... _ Psychoneuroses 4. Undiagnosed psychoses .... - Without psychoses 5. Without psychoses Total With Mental Disorder S. Total With Mental Disorder 83. 35. Total Without Mental Disorder . 4. Total Without Mental Disorder . Grand Total 8. Grand Total 79. 34. Death Rate, General Population of Massachusetts, 1939, 11.3 per thousand population. The readmissions show low death rates up to 60 years. The 60-69 year group presents a rate of 66, the 70-79 year group, 110 and the 80 years plus group, 212. It will be observed that these death rates are considerably lower than those of the first admissions. As in the first admissions, the readmissions show consistently higher death rates in the males. In only two age groups, 40-49 years and 50-59 years, do the death rates of the females exceed those of the males. We now consider the death rates in the various age groups of specific psychoses in first admissions. In the group 0-19 years, the high death rate, 1,000, is shown by other infectious diseases. In the 20-29 year group, the high death rates of 250, are shown by other infectious diseases and other forms of syphilis. In the 30-39 year group, other disturbances of circulation with 250 and other metabolic diseases with 142 present the high death rates. Cerebral arteriosclerosis, with a death rate of 214, and other metabolic diseases, with 166, are high in the group 40-49 years. In the 50-59 year group, psychoses due to new growth, 750, and other metabolic diseases, 348, are high. In the group 60-69 years, psychoses due to new growth with 666 and other disturbances of circulation with 384 are high. The 70-79 year group records the high death rates in due to new growth, 1,000, other metabolic diseases, 526, and other disturbances of circulation, 500. In the 80 years plus group, organic changes of the nervous system and other disturbances of circulation, with death rates of 1,000 each, are high. The psychoses involving the circulatory system are showing high death rates in most of the age groups. Economic Status of Deaths, 1939: Death Rates per 1,000 Under Treatment Table 59 tests the possible influence of economic status of mental patients upon their death rates in hospital, by first admissions and readmissions. In 1939, 4,023 first admis- sions under treatment were classified as dependent in economic status. Of these 455 died, giving a death rate of 113 per 1,000 under treatment. This was the high rate of the first admission group. The marginal show a lower rate of 66 and the comfortable, the upper economic group, present the low death rate of 65. In the dependent first admis- sions, the males show a death rate of 116, which is 7% higher than the rate of 108 for 202 P.D. 117 H ll mo -*io co I II II coco TOCN ©O II 00 1 CDOO — 1 — (N 00O HN to 00CO 00CO OCO >0 (NCD ■* T). TO OKI O COCN -c" CN CNiO CN H II O 1 II CN00 II II 00 — IN 1 t"0 CD 1 II — CO — I II iO t*(N 00th hh O0CD t~ TO-rM •* (N — Tf — IC K ■< a II II II ©TO II II US | 1 1 MO II II OCN II II fe OTO IN THO »OCN — TO --I CO O M S II TO 1 II -HO II II COCO. 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T > "5 c o 3 p. o •a i- o cu -a o 5 0) — o s a jCtj'8 c o'o a J'3fl«)'iiiS ■ — a> 3 — b-3--* ^- 3-r-*— 3-— 3 3'-* O 3" — O 3>*H e-S * r-g a s-j * g g^ a|,a a sp5 a s * a = "d j, -*>"0 e+^x; a+»"B S-^"0 m-^'C q,-^"0 o-^'O 3 '8-- * 3-3 c £•- »_s.t; ojja.S cu.3.3 » 0.3 B t» I-1 3 »- o o ffl.o o m °.2 o o3.2 o >) rj '3-3 £ '3 m 3 $ oj c $ +a 03 g . 03 g 3-PT3 M-^-d O to 03 c3 co cS -3.3 co a.h a .•Sfqtf.Sfetf ^ « 3 -W 73 G S.S o 3.5 o s3 "3 ° s'5 ■5-5 S:S-5 a S osgg cag 5fig O-S-3 +> 3 CO 3 a » S a -!3 3 cj O OH 205 P.D. 117 the females. In the marginal first admissions the death rates vary a little for the two sexes, 63 for males and 69 for females. In the comfortable group the male death rate of 100 is 138% higher than the female rate of 42. Dependent economic status is associated with the high death rate in mental disorders. Table 59. — Economic Status of First and Readmissions Who Died, 1989, by Sex: Death Rates per 1,000 Under Treatment Total First Admissions Readmissions M. F. T. M. F. T. M. F. T. Dependent: Under Treatment Deaths . Rate per 1,000 . 3,455 312 90.3 2,604 223 85.6 6,059 535 88.2 2,302 268 116.4 1,721 187 108.6 4,023 455 113.0 1,153 44 38.1 883 36 40.7 2,036 80 39.2 Marginal : Under Treatment Deaths . Rate per 1,000 11,422 571 49.9 10,906 602 55.1 22,328 1,173 52.5 6,846 434 63.3 6,415 447 69.6 13,261 881 66.4 4,576 137 29.9 4,491 155 34.5 9,067 292 32.2 Comfortable: Under Treatment . Deaths . Rate per 1,000 533 40 75.0 877 36 41.0 1,410 76 53.9 330 33 100.0 496 21 42.3 826 54 65.3 203 7 34.4 381 15 39.3 584 22 37.6 Unknown: Under Treatment Deaths . Rate per 1,000 339 53 156.3 323 56 173.3 662 109 164.6 254 47 185.0 253 51 201.5 507 98 193.2 85 6 70.5 70 5 71.4 155 11 70.9 Total: Under Treatment. Deaths . Rate per 1,000 15,749 976 61.9 14,710 917 62.3 30,459 1,893 62.1 9,732 782 80.3 8,885 706 79.4 18,617 1,488 79.9 6,017 194 32.2 5,825 211 36.2 11,842 405 34.2 Death Rate, General Population of Massachusetts, 1939, 11.3 per 1,000 population. In the readmissions the dependent group presents the high death rate of 39. The comfortable group is lower with a death rate of 37 and the marginal still lower with 32. In readmissions the females show higher death rates than the males in all of the economic status groups. Table 60. — Marital Condition of First and Readmissions Who Died, 1939, by Sex: Death Rates per 1,000 Under Treatment Marital Condition Total First Admissions Readmissions M. F. T. M. F. T. M. F. T. Single: Under Treatment Deaths . Rate per 1,000 9,328 330 35.3 6,623 265 40.0 15,951 595 37.3 5,450 236 43.3 3,854 196 50.8 9,304 432 46.4 3,878 94 24.2 2,769 69 24.9 6,647 163 24.5 Married: Under Treatment Deaths . Rate per 1,000 . 4,601 372 80.8 5,418 285 52.6 10,019 657 65.5 2,985 311 104.1 3,234 198 61.2 6,219 509 81.8 1,616 61 37.7 2,184 87 39.8 3,800 148 38.9 Widowed: Under Treatment Deaths . Rater per 1,000 . 1,051 220 209.3 1,943 330 169.8 2,994 550 183.7 806 191 236.9 1,412 290 205.3 2,218 481 216.8 245 29 118.3 531 40 75.3 776 69 88.9 Divorced: Under Treatment Deaths . Rate per 1,000 440 31 70.4 441 25 60.8 851 56 65.8 268 25 93.2 216 12 55.5 484 37 76.4 172 6 34.8 195 13 66.6 367 19 51.7 Separated: Under Treatment Deaths . Rate per 1,000 . 287 21 73.1 299 12 40.1 586 33 56.3 185 17 91.8 157 10 63.6 342 27 78.9 102 4 39.2 142 2 14.0 244 6 24.5 Unknown: Under Treatment Deaths . Rate per 1,000 . 42 2 47.6 16 58 2 34.4 38 2 52.6 12 50 2 40.0 4 4 8 Total: Under Treatment Deaths . Rate per 1,000 . 15,749 976 61.9 14,710 917 62.3 30,459 1,893 62.1 9,732 782 80.3 8,885 706 79.4 18,617 1,488 79.9 6,017 194 32.2 5,825 211 36.2 11,842 405 34.2 P.D. 117 207 Marital Condition of Deaths, 1939: Death Rates per 1,000 Under Treatment Table 60 outlines the death rates in the marital condition groups of first admissions and readmissions dying in mental hospitals during 1939. In first admissions the low death rate of 46 per 1,000 under treatment occurs in the single. Next in order are the divorced with a death rate of 76, the separated with 78, the married with 81 and the widowed with 216. While the single show younger age distributions and the widowed show older age distributions, the married, the divorced and the separated are on similar age levels and are comparable. In the single, the females show death rates higher than the males. In the married, the widowed, the divorced and the separated, the male death rates are decidedly higher than those of the females. The low death rate of the readmissions, 24, occurs in the single and separated groups. Then we have the married with a death rate of 38, the divorced, 51 and the widowed, 88. In the married and the divorced, the females show higher death rates than the males. In the widowed and the separated the males show much higher rates. The rate is the same for both sexes in the single group. Readmission death rates of the various marital groups show a smaller range than that of the first admissions. If marital condition influences death rates, the effect is more pronounced in first admissions than in read- missions. Country of Birth of Patients Dying, 1939: Rates per 1,000 Under Treatment Table 61 presents the death rates of first admissions and readmissions dying during 1939, by country of birth. One hundred thirty-one patients born in Germany were under treatment in mental hospitals during 1939. Of these 27 died, giving the high death rate of 206 per 1,000 under treatment. In order follow Sweden with a death rate of 140, Canada with 135, Scotland with 115 and Ireland and England with 114 each. The United States presents a death rate of 69. The low rates are shown by Russia, Poland and Austria with death rates of 63, 50 and 30 respectively. In readmissions the high death rate of 63 occurs in natives of Austria. England, Scotland and Canada, all with a rate of 54 are in second place and Ireland, with 52, is third. Greece, Russia and Poland show the low death rates of 16, 15 and 13 respectively. Table 61. — Deaths in First and Readmissions during 1939, by Country of Birth: Death Rates per 1,000 Under Treatment Country of Birth First Admissions Total Under Treatment Total Deaths Rate per 1,000 Readmissions Total Under Treatment Total Deaths Rate per 1,000 Germany Sweden Canada1 . Scotland . Ireland England . Portugal . Greece Finland . Italy United States . Russia Poland Austria All other countries Total 131 192 1,570 138 1,398 403 243 119 682 11,855 460 540 133 655 27 27 213 16 160 46 21 8 9 48 821 29 27 4 32 206.1 140.6 135.6 115.9 114.4 114.1 86.4 81.6 75.6 70.3 69.2 63.0 50.0 30.0 48.8 73 117 719 74 799 201 86 60 69 406 1,112 444 226 63 393 3 5 39 4 42 11 2 1 2 12 259 7 3 4 11 41.0 42.7 54.2 54.0 52.5 54.7 23.2 16.6 28.9 29.5 31.9 15.7 13.2 63.4 27.9 18,617 1,488 79.9 405 34.2 (See Table 225 for detail) 1 Includes Newfoundland. Number of This Admission in Deaths, 1939: Deaths Rates per 1,000 Under Treatment Table 62 presents the death rates of first admissions and readmissions dying during 1939, in accordance with the number of the present admission. Excluding all orders of admission showing less than 100 cases under treatment (those having eight or more admissions) we note that the high death rate of 79 occurs in first admissions. Those having six admissions follow with a death rate of 52 and second admissions with 46 are third. Then, in order, are seventh admissions, third admissions, fourth admissions and fifth admissions showing death rates of 33, 29, 28 and 19 respectively. 208 P.D. 117 Table 62. — Death Rates of First and Readmissions Under Treatment in Hospitals for Mental Disorders, 1939, by Number of This Admission and Sex Cases Under Number of Treatment Deaths Rate per ,000 This Admission M. F. T. M. F. T. M. F. , T. First .... 9,732 8,885 18,617 782 706 1,488 80.3 79.4 79.9 Second 1,759 1,606 3,365 85 73 158 48.3 45.4 46.9 Third 2,383 2,270 4,653 60 79 139 25.1 34.8 29.8 Fourth 992 1,049 2,041 26 33 59 26.2 31.4 28.9 Fifth 439 442 881 7 10 17 15.9 22.6 19.2 Sixth . 193 207 400 10 11 21 51.8 53.1 52.5 Seventh 106 101 207 4 3 7 37.7 29.7 33.8 Eighth 43 57 100 - - - - - - Ninth 38 40 78 - 2 2 — 50.0 50.0 Tenth 21 21 42 1 — 1 47.6 - 23.8 Eleventh 14 12 26 - — — - - — Twelfth or over 29 20 49 1 - 1 34.4 - 20.4 Total 15,749 14,710 30,459 976 917 1,893 61.9 62.3 62.1 Length of Hospital Stay during This Admission op Deaths, 1939: by Diagnosis Table 63 and Graph 5 show the length of hospital stay of first admissions and read- missions dying during 1939, by diagnosis. First admissions of the group "with mental disorder" remained 5.0 years previous to death; readmissions, 9.1 years during the present admission. In first admissions dementia praecox shows the long hospital stay of 17.5 years previous to death. Traumatic psychoses present a residence of 14.9 years; mental deficiency, 14.4 years; psychopathic personality, 13.7 years; convulsive dis- orders, 10.5 years and paranoia, 10.4 years. The shorter hospital residences previous to death are shown by due to new growth with .40 years; psychoneuroses, .29 years; other infectious diseases, .20 years and undiagnosed psychoses, .10 years. In four of the seven psychoses presenting long hospital residences before death, the females show a hospital stay which exceeds that of the males. Length of Hospital Stay during the Present Admission and Previous Admissions, Readmissions Dying during 1939, by Diagnosis Table 64 presents the length of time spent in hospital by readmitted patients who died during 1939. This is time in hospital during the present admission as compared with the time spent in hospital during all previous admissions. This is carried out for each psychosis. The data are important as they give the complete hospital history of these patients. The group "with mental disorder" spent an average of 9.1 years in hospital during the present admission previous to death. The same patients had been in hospital an average of 3.6 years before the present admission, giving them a total hospital residence during their lives of 12.7 years. If we consider this total of all admis- sions together, in the separate psychoses it will be observed that mental deficiency shows the longest period of time in hospital, 22.8 years. Other totals are 21.6 years for without psychoses, 20.8 years for dementia praecox, 18.8 years for alcoholic psychoses, 17.5 years for psychopathic personality and 12.3 years for both manic-depressive psychoses and convulsive disorders. The short total hospital residences during life are shown by the psychoses due to other metabolic diseases with .88 years, other disturbances of cir- culation, .75 years, and other infectious diseases, .12 years. The seven psychoses showing the long total hospital stay have a tendency towards shorter periods of residence in the previous admissions and a longer period in the last admission. Conversely, the psychoses showing the short total hospital stay tend to have a larger proportion of the total time in the previous admissions, while the present admission is relatively short. Length of Hospital Stay during this Admission of Deaths, 1939, by Hospital Table 65 shows the length of hospital stay of cases dying in various hospitals during 1939. The Psychopathic Hospital shows a short stay of .06 years in the first admissions and .08 years in the readmissions. Of the active admitting hospitals, Boston State presents the longest hospital stay for first admissions, 4.2 years. Worcester follows with 3.6 years, Taunton shows 3.4 years and Foxborough, Westborough and Danvers, 3.1 P.D. 117 209 COlOO'O'OCDNOOiON'O^W'H «3 HOOHffl NMOMNC0IN00 t- in tj< r>. -^ *o i^-iouoincn IN NOOONOOONOOtDOOOOO'Ji O -F ^O *0 CN CO i-i ^* ■— < aDiOiOTf005i-HNt-t^TfTtCOCOIN^ co ■* ta co 01 • NlCrtl000)O-INr^00»Ol0C0C0HH oooo —ICO o Tt<00 o « 5 c?fe^3 •^_sn Js ,3 3J3 p ft « o o. .. - . , o&taA „ 55 o CD >i Pi c3 o c ■a cd gft"oj2g>g £ s ? s a a ^+'-!:5?SftS«'ot, 43 ja ;„ o.-S s-a K Mi ccCBi!o'3g«'o^oJ1"5o CD Q d <-" ° .,5 .2 CO g 3^-g-g So^^ 2 :g 3 J3 -g r3 -g -d •a ^~ £ 5 cd s o o o o o ^ 41 © CD S5'3 3 3 3 g [j 'ca'ts 210 P.D. 117 years each. Monson shows a long average residence of 9.9 years. Among the transfer hospitals, the longest average residence, 14.9 years, is found at Medfield. OEME7VT/A PRAECOX ME/VTAL DEEIC/E/VCV PSYCHOPATHIC PEPSOA/Al/ry W7TH CQJVWLSWE 07SOPDEPS PA PA NO /A ALCO/fOL/C MA/V/C - depressive /a7volutiohal syphilitic MEM/A/GO - E/VCEPHALITIS SENILE CEREBRAL ARTERIO- SCLEROSIS OTHER META-\ <$ BOLIC DISEASES^ .5 TOTAL ALL FORMS izs 76.7 75.6 First Admissions P eadmissions 9.2 Graph 5. — Length of Time in Residence during This Admission of Certain Diagnoses, First Admissions and Readmissions Dying, 1939: Averages in Years In readmissions the long hospital residences previous to death are shown by Fox- borough and Northampton with averages of 9.4 years and 8.6 years respectively. The average residence at Monson, 10.3 years, is slightly longer than that for first admissions. The transfer hospitals show long average residences for Grafton, 18.5 years and for Medfield, 16.1 years. Length of Hospital Stay of Deaths, 1939, by Age at Admission Table 66 shows the length of time in hospital during the present admission of patients dying during 1939, by age at admission. In first admissions patients admitted between 20-29 years of age remained in hospital 17 years, 30-39 years are next with 16 years and P.D. 117 211 those admitted in the ages 40-49 remained 9 years. A certain proportion of patients admitted under the age of 40 remain a long time in hospital prior to death; yet we re- member that this same age span shows high discharge rates. The males show the longer hospital stay in patients admitted under the age of 30 years. In all other age groups, except 90 plus years, the females show the longer hospital residence previous to death. Table 64. — Average Length of Hospital Stay during the Present Admission and Previous Admissions, Readmissions Dying, 1939, by Diagnosis and Sex Diagnoses All Admissions This Admission Pbevious Admissions M. F. T. M. F. T. M. F. T. With mental deficiency 22.35 23.37 22.83 16.02 17.51 16.72 6.33 5.86 6.11 Without psychoses . 21.68 — 21.68 16.68 — 16.68 5.00 — 5.00 Dementia praecox 22.65 19.52 20.87 14.32 15.15 14.79 8.33 4.37 6.08 Alcoholic psychoses . 19.36 15.83 18.88 15.92 14.16 15.68 3.44 1.67 3.20 With psychopathic personality 17.50 17.50 17.50 17.50 12.50 15.00 - 5.00 2.50 Manic-depressive psychoses 14.07 10.79 12.34 11.07 5.87 8.33 3.00 4.92 4.01 With convulsive disorders (epilepsy) .... 7.10 15. 56 12.31 5.89 14.00 10.88 1.21 1.56 1.43 Involutional psychoses 7.50 9.79 9.50 3.50 7.60 7.09 4.00 2.19 2.41 Paranoia and paranoid condi- 6.83 8.92 8.30 2.50 7.21 5.80 4.33 1.71 2.50 With other forms of syphilis 11.00 1.50 7.83 8.00 .12 5.37 3.00 1.38 2.46 With epidemic encephalitis 7.50 - 7.50 7.50 - 7.50 - - - With organic changes of nervous system 5.06 8.24 6.88 5.06 5.63 5.39 - 2.61 1.49 With syphilitic meningo-enceph- 4.64 o. oo 4.99 3.26 5.47 4.10 1.38 .08 .89 Senile psychoses 4.69 3.49 3.82 3.58 2.73 2.96 1.11 .76 .86 With cerebral arteriosclerosis . 3.86 3.76 3.81 1.48 2.12 1.78 2.38 1.64 2.03 Due to other metabolic diseases, etc .20 1.05 .88 .20 .67 .58 - .38 .30 With other disturbances of cir- culation 1.50 .57 .75 .04 .48 .39 1.46 .09 .36 With other infectious diseases . .12 - .12 .12 - .12 - - — Total With Mental Disorder 13.37 12.25 12.78 9.17 9.19 9.18 4.20 3.06 3.60 Total Without Mental Dis- order 21.68 - 21.68 16.68 - 16.68 5.00 - 5.00 Grand Total 13.50 12.25 12.85 9.29 9.19 9.24 4.21 3.06 3.61 Table 65. — Length of Time in Residence During This Admission, First and Readmissions Dying 1939, by Hospital: Averages in Years Hospitals Length of Hospital Stay Total First Deaths Admissions Readmissions .06 .06 .08 4.95 4.29 8.05 4.78 3.15 9.44 4.28 3.11 8.24 4.10 3.45 7.49 4.09 3.66 6.07 3.90 3.10 7.37 3.62 2.93 8.60 Medfield 15.21 14.90 16.13 Grafton 12.69 8.23 18.51 10.07 9.94 10.30 7.66 6.63 10.33 3.87 3.11 4.20 23.80 24.47 19.50 20.65 20.96 20.00 8.95 8.36 11.00 Veterans' Adm. Facility No. 107 2.30 2.86 1.86 Veterans' Adm. Facility No. 95 1.42 .40 7.50 Total 5.94 5.04 9.24 In readmissions the long hospital residence previous to death, 16 years, is shown by patients admitted between the ages of 20 and 29 years. Admissions aged 30-39 years show an average stay of 15 years. Patients 0-19 years present a stay of 14 years. In the readmissions the ages under 40 years are important from the viewpoint of a possible 212 P.D. 117 long hospital stay previous to death. The females show the longer hospital stay in the age groups 20-29 years, 60-69 years, 70-79 years and 80-89 years. In all other age groups the males show the longer hospital residence. Table 66. — Length of Time in Residence During THIS Admission, First and Readmissions Dying, 1939, by Age at Admission and Sex: Averages in Years Age at Admission Total M. First Admissions M. F. Readmissions M. 0-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 vears 80-89 years 90 years and ov Total 11.55 17.10 14.90 10.54 6.17 3.07 1.22 .93 .49 5.43 17.06 17.59 11.19 8.89 17.09 16.20 10.87 6.72 10.22 18.42 14.21 9.15 4.63 2.76 1.22 .79 .49 5.43 15.84 19.71 10.78 6.01 3.18 1.83 1.00 .12 7.70 17.63 16.61 9.92 5.29 2.95 1.53 .90 .36 14.55 14.30 17.20 13.60 11.03 4.20 1.22 2.23 18.85 13.91 11.85 9.88 4.28 2.79 2.86 14.55 16.09 15.22 12.62 10.37 4.24 2.06 2.47 5.73 6.15 5.94 4.85 5.24 5.04 9.29 9.19 (See Tables 220 and 221 for detail) Age of Patients Dying, 1939, by Diagnosis The average age at death of first admissions "with mental disorder" was 67.4 years, 68.6 years for the females and 66.3 years for the males (Table 67). The high average ages at death in first admissions are shown by the senile psychoses with 78 years ; cerebral arteriosclerosis, 73 years; other disturbances of circulation, 66 years and paranoia, 65 years. The young average ages at death are observed in psychoses with other in- fectious diseases with 43 years, without psychoses, 38 years and epidemic encephalitis, 32 years. In readmissions the males average 62.5 years at death and the females 63.1 years. The high average ages at death are shown by the senile psychoses, 75 years; psychopathic personality, 72 years; cerebral arteriosclerosis, 70 years and paranoia and without psychoses, 67 years each. The younger ages at death occur in psychoses with other infectious diseases and epidemic encephalitis, 37 years each. Patients dying are drawn largely from the older age groups. The average age at death of 66.4 years is 24.4 years higher than the average age of 42.0 years for cases discharged to the community, 1939. Age of Patients Dying, 1939, by Hospital Table 68 presents the average age at death of first admissions and readmissions dying in various hospitals, 1939. Among first admissions to the active admitting hospitals, Westborough is high with the average age at death of 69.8 years. In order follow Wor- cester with 69.0 years, Foxborough with 68.5 years and Northampton with 68.3 years. Among the transfer hospitals, Medfield shows the high average age of 68.2 years. In the readmissions, Northampton with 68.5 years and Westborough with 67.0 years present the high average ages at death of the admitting hospital group. The average at Grafton, 67.5 years, is the highest of the transfer hospitals. Causes of Death of Patients Dying, 1939 Table 69 outlines the causes of death in patients dying, 1939, arranged in order of importance. Diseases of the myocardium are the chief cause of death, 18% of cases (population 11%). Other diseases of the heart with 11% (population 10%), broncho- pneumonia with 10% (population 3%), arteriosclerosis with 8% (population 1%), cerebral hemorrhage with 5% (population 8%) and tuberculosis of the respiratory system with 5% (population 2%) are next in order. An interesting finding is presented when we add together the percentages for cardio-vascular diseases (diseases of the myocardium, arteriosclerosis, cerebral hemorrhage, other diseases of the heart, chronic endocarditis and diseases of the coronary arteries and angina pectoris). These conditions account for 48.2% of the deaths in connection with mental disorders (population 44.9%). Disorders involving the lungs show a high incidence in mental disorders also. The total (bronchopneumonia, tuberculosis of the respiratory system and lobar pneumonia) is 18.8% (population 9.0%). Combining these two major groups under the headings "cardio-vascular disorders" and "respiratory disorders", we find that they account for 67.0% of deaths in mental diseases and only 53.9% of deaths in the general population. P.D. 117 213 as OiOOiO OOiO Ot^CN — CN OOihO OOO mo oo El Eh COCOiOCO CDCN OtOOOcO lOcD— HO io io io oo "o 00 CM ioOrt[, io — i — 'ooooosco i-^cocncn f~r^r-- CNt^ a < OWOlO TOO OOOCOrf OcNOO OOO oo f~ 0 S cdhioh COO iOOiOOCO O -■* io iO io iO iO lOlO IO to OS — I CN OS >OCN t- CN I-- CO O 10 * CD CN t^. t>- 1- CM t~ CM g t>-t~i>co COCO COiO-*iOt>. 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CD IO coio^ior^ iOCOtPOCO P ►J ■* t*» CD CO CO CO CO CO CO CO CO IO ^i CO CD IO CD IO CO •rH r.*^ cnoor-CM OOCOt^-CHCO OlOiCDCMt^ CO O Eh H CM TfOOCSNCJO oot^-iOTjico -HrHiO C-i 0 rH CM rH -H CM CM CO 00 d H rH* o PS PS _ rn CM CM CO r- iO CM Oicor-iO"-i COO 1 1 1 r^ o fa 00 O) ■* Oi CO -h t^ -t CO CM CM CM rH rHrH 01 d o p co OCMCMCOrHCMO OiCOOOiiO COOiCOCMt^ CO o g CO rH CD O Tf CM CO CO -# CO rHrH rHlO t- rH rHl-Hl-H rH 01 d o . *o "lO rH Ol m ►J £ 2 Eh _o s £ 00 O 03 Eh En w c o • -a -j -0 . -0 >> M -h 2 t; 2 n M& • •* a a a ■b<2< , 6 0 p o pq Westborc Worceste Foxborou Northam Danvers Taunton Boston S Medfield Grafton Gardner Metropol Monson McLean Tewksbu Veterans' Bridgewa Veterans' "o H P.D. 117 215 Nearly seven out of every ten deaths occurring in mental disorders involve the heart or lungs. Also notable is the low for cancer deaths in mental diseases, 5% (population 13%). Table 69. — Causes of Death of Patients Dying in Hospitals for Mental Disorders, 1939, Compared with Causes of Death in the General Population: Numbers and Percentages Causes of Death Mental Disorders Number M. F. Per Cent M. T. General Population Per Cent Diseases of the myocardium Other diseases of the heart Bronchopneumonia Arteriosclerosis Cerebral hemorrhage Tuberculosis of the respiratory system Cancer and other malignant tumors Nephritis General paralysis of the insane Diseases of the coronary arteries and angina pectoris Lobar pneumonia Other external causes -. Diabetes Syphilis (non-nervous forms) Chronic endocarditis (valvular disease) . Epilepsy Other diseases of the respiratory system . Hernia, intestinal obstruction . Suicides Other diseases of the nervous system Diarrhea and enteritis .... Ill-defined causes of death All other causes 183 92 95 100 51 60 42 43 61 45 18 17 11 15 9 14 5 7 7 7 3 91 176 122 104 54 53 42 57 39 16 21 39 32 15 8 13 6 4 1 96 359 214 199 154 104 102 99 82 77 66 57 49 26 23 22 20 13 12 11 9 4 4 187 4.6 1.8 1.7 .3 9.3 19.1 13.3 11.3 5.8 5.7 4.5 6.2 4.2 1.7 2.2 4.2 3.4 1.6 .8 1.4 .6 .8 .5 .4 .2 .4 .1 10.4 18.9 11.3 10.5 8.1 5.4 5.3 5.2 4.3 4.0 3.4 3.0 2.5 1.3 1.2 1.1 1.0 .6 .6 .5 .4 .2 .2 9.8 11.9 10.9 3.7 1.5 8.9 2.9 13.7 5.7 .2 8.6 2.4 5.5 2.9 .4 3.1 .1 .1 . 7 1.1 .2 .2 .06 14.1 Total 976 917 1,893 100.0 100.0 100.0 100.0 (See Table 224 for detail) Length of Hospital Stay of Patients Dying, 1939, by Number of Times Admitted Table 70 gives the length of time in residence previous to death during the present admission, and in addition, the total hospital stay during all previous admissions, by number of times the patient was admitted to mental hospitals. The total figure on average length of hospital stay of the last admission, during which the patient died, was 5.9 years. When we add to this figure the total time these patients had spent in hospital, during previous admissions, a hospital stay during life of 12.8 years is observed. Table 70. — Length of Time in Residence during This Admission and All Admissions, Cases Dying during 1939, by Number of Times Admitted: Averages in Years Average Length of Hospital Stay in Years Number of Times Admitted Number This Admission All Admissions M. F. T. M. F. T. M. F. T. One . 782 706 1,488 4.85 5.24 5.04 Two 85 73 158 6.75 6.39 6.59 8.07 6.89 7.53 Three 60 79 139 11.26 10.82 11.01 18.08 15.18 16.43 Four 26 33 59 13.37 11.57 12.37 18.51 16.63 17.46 Five 7 10 17 5.42 8.24 7.08 12.35 12.30 12.32 Six . 10 11 21 11.74 10.75 11.22 . 17.77 12.95 15.24 Seven 4 3 7 12.25 5 . 83 9 . 50 25.00 10.83 18.92 Eight - - - - - - - - - Nine - 2 2 — 9.14 9.14 17.50 17.50 Ten or more . 2 - 2 .04 .04 1.48 1.48 Total 976 917 1,893 5.73 6 . 15 5 . 94 13.50 12.25 12.85 (See Tables 222 and 223 for detail) Considering the present admission, during which the patient died, patients coming to mental hospitals but once show the short hospital stay of 5.0 years; admitted twice — 6.5 years. Patients having three and four admissions remained in hospital for their last admission much longer; namely, 11.0 years and 12.3 years. Small numbers in other 216 P.D. 117 groups produce expected variations. In general, however, the averages of length of stay before death are somewhat lower in patients having a large number of admissions. We now consider the total length of hospital residence during all admissions. The patients admitted twice show an average of 7.5 years. Patients admitted three times spent 16.4 years in hospital during all admissions. Patients admitted four times spent 17.4 years in hospital during all admissions. The patients admitted five times spent a total of 12.3 years. Average Length of Hospital Stay per Admission of Patients Dying, 1939, by Number of Times Admitted Table 71 studies the readmissions and presents the average length of hospital residence during all admissions in accordance with the number of times admitted. For example, patients coming to mental hospitals twice showed a total length of hospital stay of 7.5 years or an average of 3.7 years for each of the two admissions. Patients admitted three times spent 16.4 years in hospital or an average of 5.4 years for each of the three admis- sions. Patients admitted four, five and six times showed an average hospital residence per admission of 4.3 years, 2.4 years and 2.5 years respectively. Multiple admissions over six are omitted because of small numbers. There is a tendency for the average time in hospital per admission to decrease as the number of admissions increases. Table 71. — Length of Time in Residence during Each Admission, Readmissions Dying during 1939: Averages in Years Number of Times Admitted Average Length of Stay in Years During All Admissions Average Length of Stay in Years for Each Time Admitted 7.53 16.43 17.46 12.32 15.24 18.92 17.50 1.48 3.76 5.47 4.36 2.46 Six 2.54 2.70 1.94 .13 (See Table 223 for detail) Section E. Resident Population of Mental Hospitals on September 30, 1939 In the preceding sections we have discussed admissions, discharges to the community and deaths for 1939. We now discuss the whole number of patients under care and analyze specific factors in patients within mental hospitals and all patients temporarily out of mental hospitals, on September 30, 1939. On that date there were 25,910 patients within the thirteen State hospitals under the Department, the Bridgewater State Hospi- tal (Department of Correction), the Mental Wards at the Tewksbury State Hospital and Infirmary (Department of Public Welfare), the two Veterans' Administration Facilities, Nos. 95 and 107 (United States Government), and the twenty-one private hospitals. Of this number 13,491 were males and 12,419 females. In this analysis it should be recalled that the resident population is, in part, an accum- ulation of admissions of previous years who have not died or who have not been dis- charged. Of the patients coming into hospitals during any one year a certain number are discharged after a fairly short hospital residence, another group dies and still others remain within the institution for varying periods of time. Study of the resident popula- tion will provide valuable information as to the characteristics of this last group, which tends to chronicity and long residence within mental hospitals. Patients in Residence in Public and Private Mental Hospitals on September 30, 1904-1939 Table 72 presents the numbers of patients in the various types of mental hospitals on September 30 of each year from 1904 to 1939, inclusive. Rates per 100,000 of the population are presented for all hospitals together and for the State hospitals alone. P.D. 117 217 m Tf^NN-*"5a5i-iOKiom!DC)rt' lOL0!DC0C0HC0CD^C0Q0N00^©0>TPOiO0>HWOrtiO00QO^0rHOL0O01O»O ^HOCMC0C0"cMC0C0incOint~t^incOcOl-~Olininc0C0incDt^cOinininr^int-^t^incO00 §K OOTf|-~i-iOOt^~HCMOOCMCOt-~CO^''cH'-HTtiCOCJit^COCMCOt^CMCOCOini-~T i000^00C0CO00t»ini-iCMrHI--CMC0CMCMOC0OC0inO00-*,C0OCO00c00}O00a5l0i-n 0505020cNO)CMCMCMCOCMCOCMCMCMo ai io m Tt< »o ^ o ro I I I I I I I I I I I I I I I I I OlCDCBCNCOTOfflllMO^l.'Ji-HO C0CMCMC0OO)"*0000OCMt^t~00Tj Tf iOCOCO -rt* t}< rj* rj< NOraOOOOLOfiONNOO-JNO- 'OOOCO'-i C00000030-HCMCO-!?-?Tt CMCMCMeMCOCOCOCOCOCOCOCOCOCOCOCOCOCOCOCO COCMCSOSCOO^OOOO — i NOONMOOOihiNW COCOCOCOCO-^TtH'^^'ct* OOJOliOiON tTONOOOO inoaimcoooT-ticocMocooocoi 'mrtMi.'!OOOCO:COClTOi.OrHNN-*CDO 0005030>©0~H'H>-ICMCMCOCOCOCOCO-*-t-OOOOOa500'-l'-' t^- 00 - 00 © CM Tt< t". ©CM -* CO 00 ~t>rr~odoo"ododoo''oro"o~ o* o o"©©©'"^''-~ t-Ti-h oo^cotnoocot^ooin^cocooocj3CS)oi^coooocNTtit^-oico^cOTticN»t^cooint>- incooooooinTt '-' co ^ -cHt^cDCM-S-fiocNiraei'N-}'ioto-Hraooc :0^rfNcMHlNMn'C»iOCOCCCONNOOOiaiOOOC jTjH'^'r^-^TtHTtl'»tT^TtlTtl'^T^^Tt1-^'*Ttl'^'^inintni HOOO CM Ttf~ ■* COt^ CO CO CO 00 OS CM CO 00 OS "-1 i-l COCO'*'* CM COO — CM CO cocococM-*f~incooot^r^oot^oo-'*CMO)'-io COCMi-'i-HCOCOCOlOCOCOt'^Ca© — iCOt-JiON ■ 00 -h ©cm ■* cm 00 o -sr cm t- co o_^o •* o> -# © © © ©o"o"o"'Hcfc*mw^T*id in inininco"© ^^oooo~©©©©"^cm cm cm^coco T^Tt*in in rtlHHrtrHHrtrtrtiHTHrHrtHrtHrtrtrtrtHrtiH(NNNNNMCNCNNMNN ocoooscoin--ft^-t>i^cocM-rfOinooo5ooino^T-Ht>.05cM'cHoso:oMco05coci^a5a5coaSdiaicadiOOOO**'-4'-4'-*'-*c$c*c$ o©cot^©iot^iocMoo©io^tt»"t^^t^t^i>"oo"odododcscsorooo Tfinot^ooo30—icMco^t'incDt^ooo50^HcMcOTt 218 P.D. 117 Considering all hospitals together, 9,840 patients were in residence at the end of 1904. In 1914 this number had increased to 14,582; in 1924 to 18,288; in 1934 to 23,419 and in 1939 to 25,910. The year 1904 presents a residence rate of 324 persons in mental hospitals per 100,000 of the general population. In 1939 this rate had increased to 584. This is a rate increase of 80% or 2.2% per year. In the second section of this table the numbers and residence rates are restricted to patients within the 13 State hospitals under the Department of Mental Health. In 1904 the State hospitals had 8,445 patients in residence or 85% of all mental patients in the State. In 1939 the State hospitals cared for 22,166 patients, still 85%. The rates per 100,000 of the population rose from 278 in 1904, to 500 in 1939, an increase of 79% or 2.2% per year. Bridgewater and Tewksbury show an increase from 1,062 in 1904 to the high of 1,749 in 1930 and a decrease to 1,331 in 1939. The Governmental hospitals have shown a marked increase in numbers in residence, from 339 in 1924 to 1,940 in 1939. McLean shows a small increase, from 189 patients in 1904 to 211 in 1939. The other fourteen private hospitals show an increase from 144 in 1904 to 262 in 1939. In 1939 fifteen private institutions cared for but 1.8% of the total patients, two Government hospitals for 7.4%, the Hospital for the Criminal Insane and the Mental Wards at Tewksbury for 5.1%, and the State hospitals under the Department (13) for 85.5%. Sex differences are observed. In the totals for all hospitals the residence rates for males within hospitals are higher than females in 29 of the 36 years under consideration . The females show higher residence rates in but 7 years, 1904 and the years 1918-1923, inclusive. In the State hospitals alone the females show higher residence rates than the males in all but one of the 36 years (1912). The sex differences observed demonstrate clearly how incomplete are statistics based upon State hospital population alone and emphasize the necessity for consideration of all patients in all types of institutions. In State hospitals the residence rates for the males increased from 267 in 1904 to 487 in 1939. This is an increase of 82%. In the females the residence rates increased from 289 in 1904 to 511 in 1939. This is an increase of 76%,, In other words, in the State hospitals alone, the sexes have shown about the same degree of increase over the 36 year period. In making these same calculations in the total figures for all patients in all types of mental hospitals we get radically different results, owing chiefly to the establishment of the Government hospitals, which have absorbed males who ordinarily would have gone to State hospitals. Residence rates for males increased from 321 in 1904 to 630 in 1939, an increase of 96%. The female rates increased from 328 in 1904 to 542 in 1939, an increase of 65%. Mental disease is becoming increasingly serious for the males. The observed sex differences in all types of hospitals and in the State hospitals demonstrate very clearly that the significance of mental disease as a state-wide problem can be determined only by a thorough study of all cases of mental disease under care in hospitals, whatever the type. Diagnosis op Patients in Residence on September 30, 1939, by Form of Admission Table 73 and Graph 6 give the diagnosis of first admissions and readmissions in res- idence in all mental hospitals by form of admission.* On September 30, 1939 there were 13,954 first admissions in mental hospitals, 7,148 males and 6,806 females. Of this total 13,865 were diagnosed as "with mental disorder" and 89 as "without mental disorder". Dementia praecox makes up 48.0% of first admissions in residence. Then follow in order psychoses with cerebral arteriosclerosis, 8.3%; with mental deficiency, 7.8%; alcoholic psychoses, 6.1%; and manic-depressive psychoses, 5.6%. Dementia praecox comprises 15% of first admissions coming into mental hospitals in 1939, and 48% of the resident population. Resident court commitments (first admissions) show dementia praecox predominating with 49.1%. Psychoses with cerebral arteriosclerosis comprise 8.5% and mental defi- ciency 8.0%. In the resident temporary care first admissions the high groups are demen- tia praecox with 21.0%; without psychosis and paranoia with 15.7% each. The leading *The total number of patients discussed from this point on is 23,927 instead of the 25,910 noted in Table 72. This difference is accounted for by the following three points: (1) exclusion of the 262 patients in residence in the fourteen private hospitals, (2) exclusion of the 1,004 non-psychotic epileptics at the Mon- son State Hospital (see separate section Epilepsy, beginning with Table 156) and (3) exclusion of the 717 non-residents of Massachusetts at the two Veterans' hospitals. 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With cerebral arterioscleros With other disturbances of With convulsive disorders 1 Senile psychoses . Involutional psychoses Due to other metabolic dis< Due to new growth With organic changes of ner Psychoneuroses Manic-depressive psychosei Dementia praecox Paranoia and paranoid con With psychopathic persona With mental deficiency Undiagnosed psychoses Without psychoses Primary behavior disorders S3 rH IS IS 'ea'oj o o Eh Eh "3 o b^ a 08 o P.D. 117 221 diagnoses of the observation commitments are without psychosis with 42.3% and alco- holic psychoses with 19.2%. Among the resident voluntary first admissions psychoses with epilepsy comprise 86.8%. In addition to the first admissions there were 9,973 readmitted cases in the resident population on September 30, 1939, 5,054 males and 4,919 females. Of the grand total 9,909 were diagnosed as "with mental disorder" and 64 as "without mental disorder". Psychoses prominent numerically in the resident readmissions are dementia praecox, 56.1%; manic-depressive, 10.9%; mental deficiency, 8.5%; alcoholic psychoses, 4.6%. DEMENT/A PRAECOX CEREBRAL ARTERfOSCLEROSL m$8mmmmm& mwMMwm*mwmm ao.i BBB 8.3 9m2.s MENTAL DEFfCfE/VCY mtaazs mmmm s.s PERCENT OF ALCOffOUC MAAf/C- OEPRESSfVE HI 6./ E^ 4.6 wmmrnm TO. 9 RESIDEAW POPl/lATION, 7939 SEAffLE 1 .8 ' COA/VULSIVE D/SOROERS ■ 3.9 mm 4.2 SYPfffLfTfC AfEMNGO-Wl 3.7 F/VCFP/fALfTfS m 2.2 mvoLur/ojvAi m 3.r m 1.9 PARAA/O/A M3.0 m2.e H First Admissions PSYCffO/VEl/ROSES PSyC/fOPAT/f/C PERSONALITY 1 .8 EH Readmissions G .9 0 7.2 without psychoses 1.6 1.6 OTHER FORMS OF SYPHILIS 1.6 1.3 OTffER METABOLIC 1 .5 DISEASES \.2 EPIDEMIC FA/CEPHALITIS 1.4 Graph 6. — First Admissions and Readmissions in Residence on September 30, 1939, by Diagnoses: Percentage Distribution In the readmissions in the resident population, entering hospitals through court commitment, dementia praecox comprises 56.9%, manic-depressive 10.9% and mental deficiency 8.6%. In temporary care resident readmissions dementia praecox and without psychosis make up 25% each. The observation commitments in residence show 44.4% without psychoses and 22.2% alcoholic psychoses. Psychoses with convulsive disorders comprise 70.0% and psychoneuroses 10.0% in the resident voluntary readmissions. 222 P.D. 117 Economic Status of the Resident Population and Patients Out on September 30, 1939 Table 74 shows the economic status of patients of the resident population, by first admissions and readmissions. Of the 13,954 first admissions in residence, 22% are recorded as dependent in economic status, 70% as marginal and 4% as comfortable. In patients still on the books of the hospitals but in the community on visit, etc., we have a lower proportion of the dependent, 17%; a higher proportion of the marginal, 75%; and an equal proportion of the comfortable, 4%. Here we have the suggestion that a patient in a higher economic group has a greater chance of being placed on visit than one in a lower group. This means a greater chance of discharge as visits commonly precede discharge. Table 74. — Economic Status of the Resident Population and Patients Out on September 30, 1939, First and Readmissions, by Sex: Numbers and Percentages First Adm ISSIONS Readm ISSIONS Economic Status Number Per Cent Number Per Cent M. F. T. M. F. T. M. F. T. M. F. T. Resident Popu- lation: Dependent 1,777 1,337 3,114 24.8 19.6 22.3 986 755 1,741 19.5 15.3 17.4 Marginal 4,977 4,912 9,889 69.6 72.1 70.8 3,845 3,805 7,650 76.0 77.3 76.7 Comfortable . 232 397 629 3.2 5.8 4.5 158 302 460 3.1 6.1 4.6 Unknown 162 160 322 2.2 2.3 2.3 65 57 122 1.2 1.1 1.2 Total . 7,148 6,806 13,954 100.0 100.0 100.0 5,054 4,919 9,973 100.0 100.0 100.0 Patients Out: Dependent 140 163 303 18.4 17.4 17.9 108 106 214 22.4 16.4 19.0 Marginal 566 707 1,273 74.5 75.7 75.2 349 496 845 72.5 76.8 75.0 Comfortable . 33 37 70 4.3 3.9 4.1 19 24 43 3.9 3.7 3.8 Unknown1 20 26 46 2.6 2.7 2.7 5 19 24 1.0 2.9 2.1 Total 759 933 1,692 100.0 100.0 100.0 481 645 1,126 100.0 100.0 100.0 Of the 9,973 readmissions in residence, 17% are recorded as dependent, 76% as mar- ginal and 4% as comfortable. Readmitted patients out on visit show about the same distribution with 19% dependent, 75% marginal and 3% comfortable. As we trace economic status through admissions, discharges, deaths and the resident population, we find interesting material. First admissions entering mental hospitals during 1939 showed 21% as dependent (Table 28). First admissions discharged pre- sented 14% in the dependent group (Table 41). The deaths in first admissions listed 30% as dependent (Table 59). Now we observe the first admissions of the resident population are showing 22% as dependent and of the patients out on visit, 17% dependent (Table 74). Dependent economic status in first admissions is linked with a high death rate and a low discharge rate. Marital Condition of the Resident Population and Patients Out on September 30, 1939 Table 75 presents the marital condition of the resident population and of patients temporarily out on visit, etc., on September 30, 1939, by first admissions and read- missions. Of the 13,954 first admissions in residence 54% were single, 31% married, 10% widowed, 2% divorced and 1% separated. Among the patients temporarily out on visit (potential candidates for discharge) we see a lower proportion of the single, 44%, a higher proportion of the married, 41%, and similar proportions of the widowed, di- vorced and separated, 9%, 2% and 1%, respectively. Of the 9,973 readmissions in the resident population, 58% were single, 30% married, 6% widowed, 2% divorced and 1% separated. The patients temporarily out on visit show a lower per cent of the single, 49%, a higher per cent of the married, 40%, and a lower per cent of the widowed, 5%. Comparison of marital condition in the resident population with the marital condition of admissions, discharges and deaths for the year provides interesting data. The single comprise 39% of first admissions entering hospital in 1939 (Table 26), 40% of first admissions discharged (Table 42), 29% of first admissions dying (Table 60) and 54% of first admissions in the resident population (Table 75). The married make up 39% P.D. 117 223 of first admissions entering, 43% of first admissions discharged, 34% of first admissions dying and 31% of first admissions in the resident population. In first admissions the single are showing a remarkable tendency towards accumulation within mental hospitals. The married are higher in the discharges and deaths than the single and therefore have little opportunity to accumulate. The widowed, the divorced and the separated are not being retained. In the readmissions also pa.tients of single marital condition are having long hospital residences and are tending to comprise a large proportion of the resident population. Patients of the married, widowed, divorced and separated groups are evidently leaving hospitals more rapidly, either through discharge or death, and are showing no tendency towards retention. Table 75. — Marital Condition of the Resident Population and Patients Out on September 30, 1989, First and Readmissions, by Sex Resident Population Marital Condition First Admissions Readmissions M. F. T. % M. F. T. % Single Married .... Widowed .... Divorced .... Separated .... Unknown .... 4,406 1,927 484 183 113 35 3,175 2,407 935 167 111 11 7,581 4,334 1,419 350 224 46 54.3 31.0 10.1 2.5 1.6 .3 3,425 1,250 183 124 69 3 2,423 1,797 435 139 121 4 5,848 3,047 618 263 190 7 58.6 30.5 6.1 2.6 1.9 .07 Total .... 7,148 6,806 13,954 100.0 5,054 4,919 9,973 100.0 Patients Out on Visit, ETC. Marital Condition First Admissions Readmission 3 M. F. T. % M. F. T. % Sinsrle Married .... Widowed .... Divorced .... Separated .... Unknown .... 381 292 45 25 15 1 366 411 120 22 14 747 703 165 47 29 1 44.1 41.5 9.7 2.7 1.7 .05 289 157 16 11 7 1 270 559 295 452 46 62 21 32 13 20 1 49.6 40.1 5.5 2.8 1.7 .08 Total .... 759 933 1,692 100.0 481 645 1,126 100.0 Table 76. — Admission Ages of First and Readmissions in the Resident Population, September 30, 1939 Age at Admission Total First Admissions Readmissions M. F. T. M. F. T. M. F. T. Under 14 years . 68 81 149 58 60 118 10 21 31 15-19 years 447 363 8.10 297 254 551 150 109 259 20-29 vears 2,747 1,933 4,680 1.670 1,151 2,821 1,077 782 1,859 30-39 vears 3,288 2,870 6,158 1,747 1,602 3,349 1,541 1,268 2,809 40-49 years 2,577 2,819 5,398 1,387 1,511 2,898 1,190 1,308 2,498 50-59 years 1,696 1,997 3,693 976 1,080 2,056 720 917 1,637 60-69 years 896 1,029 1,925 608 629 1,237 288 400 688 70-79 years 398 494 892 330 400 730 68 94 162 80-89 years 80 130 210 70 112 182 10 18 28 90 years and over 5 9 14 5 7 12 - 2 Total . 12,202 11,725 23,927 7,148 6,806 13,954 5,054 4,919 9,973 Average admission age 40.7 43.3 42.0 41.3 43.8 42.5 39.8 42.7 41.2 (See Tables 231 and 232 for detail) Age at Admission of Patients in Residence on September 30, 1939 Table 76 presents the distribution of first admissions and readmissions in the resident population, by age at admission. First admissions now in the resident population pre- sented an average age, at admission, of 42.5 years, 41.3 years for the males and 43.8 years for the females. Resident patients aged 30-39 years at time of admission show 224 P.D. 117 the largest number of patients, 3,349. Those aged 40-49 years include 2,898 cases and the 20-29 year group 2,821. Thus, of these first admissions in residence, 9,068 or 64% were admitted between the ages of 20 and 49 years. The males show the larger numbers in all ages from 15 to 39 years. Under 14 years of age, and from 40 onward, the females show the larger numbers. Readmissions in the resident population show an average admission age of 41.2 years, 39.8 years for the males and 42.7 years for the females. The readmissions are younger than the first admissions, due to the fact that persons developing a mental disorder early in life are the ones tending to readmission. The readmissions in residence show the largest number (2,809) who were aged 30-39 years at the time of admission. A total of 2,498 were admitted in the ages 40-49 years and 1,859 in the ages 20-29 years. Here we have a total of 7,166 patients, or 71% of all readmissions, who were admitted between the ages of 20 and 49 years. The readmissions show the males with larger numbers in the age groups 15-39 years. Females are higher in all other age groups. Length of Hospital Stay of Patients in Residence on September 30, 1939, by Age at Admission Table 77 and Graph 7 give the average length of stay during the present admission of all first admissions and readmissions in the resident population in accordance with the age at admission. First admissions admitted between the ages 20-29 years have shown the longest period of hospital residence, 13.6 years. Patients admitted in the age group 30-39 years are next with an average stay of 12.9 years. Then we observe a gradual decrease of hospital residence as the older ages are approached. Table 77. — ■ Average Length of Hospital Stay during the Present Admission, First and Readmissions in Residence on September 30, 1939, by Age at Admission Age at Admission Average Length of Hospital Stay All Admissions First Admissions Read- Under 19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80-89 years 10.1 12.9 11.8 9.0 6.3 4.0 1.6 .6 10.5 13.6 12.9 9.6 6.2 3.9 1.4 .5 9.2 11.8 10.6 8.3 6.5 4.1 2.5 1.1 In readmissions also those admitted in the age group 20-29 years have shown the long hospital residence, 11.8 years. As in first admissions we see a gradually decreasing length of time in hospitals during the present admission as the older ages at admission are approached. In previous tables it has been noted that patients admitted in younger ages have shown high discharge rates and low death rates in comparison with the admis- sions in the older age groups. It is evident, too, that a certain proportion of the cases admitted in the younger ages tend toward chronicity and retention in hospitals. Over a long period of time these cases will accumulate to high levels in spite of high death and discharge rates. Diagnosis in Admissions, Discharges and Deaths, 1939, and the Resident Population and Patients Out on Visit on September 30, 1939 Table 78 is a combined table which gives a review of the mental disorders occurring in patients coming into mental hospitals, in those leaving mental hospitals by discharge or death, in the resident population, and in patients temporarily out of mental hospitals on visit, by first admissions and readmissions. Only the numerically important psychoses will be discussed. Psychoses with cerebral arteriosclerosis made up 18% of first admissions entering hospital, 8% of first admissions discharged, 40% of first admissions dying, and 8% of the first admissions in the resident population. This psychosis shows a low discharge rate, an extremely high death rate and no tendency towards retention within hospitals. Dementia praecox made up 15% of first admissions, 15% of first admission discharges, 12% of first admission deaths and 48% of first admissions in the resident population. This psychosis is low in both dis- P.D. 117 225 charges and deaths. Its outstanding point is the remarkable tendency to accumulation in the resident population. The without psychosis group made up 13% of admissions, 21% of discharges, .2% of deaths and .6% of the resident population. Obviously this group is leaving hospitals very rapidly. Manic-depressive psychoses made up 5% of admissions, 9% of discharges, 3% of deaths and 5% of the resident population. This psychosis is leaving hospitals rapidly, shows a low death rate and no tendency towards retention. 12.9 UNDER 20-29 30-39 40'49 50-59 60-69 70YRS. 20YRS. YRS. YRS. YRS. YRS. YRS. &OVER Age at Admission Graph 7. — Length of Time in Residence during This Admission of Cases in Residence in Hospitals for Mental Disorders on September 30, 1939, by Age at Admission: Averages in Years In readmissions dementia praecox makes up 23% of patients entering mental hospitals during the year, 20% of readmissions discharged, 30% of readmissions dying, and 56% of the readmissions in the resident population. This psychosis has a low discharge rate and a tendency toward retention within hospitals. The small number of discharges each year and the long hospital stay tend to have an accumulative effect as 56 % of the resident readmissions are classified as dementia praecox. Manic-depressive psychoses made up 18% of readmissions coming into hospitals, 24% of the readmissions discharged, 14% of the deaths and 10% of the resident population. This psychosis is high in discharges and low in retention. Admission Ages of Admissions, Discharges and Deaths, 1939, Compared with the Admission Ages of the Resident Population on September 30, 1939, by Diagnosis In Table 79 we compare the average age of first admissions and readmissions entering hospitals during 1939, with the average age at admission of patients discharged, of patients dying, of patients in the resident population and of patients on visit on Septem- ber 30, 1939 by diagnosis. This table will show how patients of certain admission ages tend to distribute themselves in the discharges, deaths and resident population. 226 P.D. 117 Si rt-i .SBg hiON TO i-H O 03 CM -fi CO i« CO ih io eq co co ■*iOON(N«3 ■* t~ 00 MNOrt r-J Tf CO CO 0 —I Neo^offlONioocqoooNOBaiffiHtoNiooeo O CD CM ^H 00 MOCOOHO'fMrtCS-HHUJonoOtOOOMlO'HtDO CO CD 00 C01 IN t^ OCO^'CH. II I -I • • ■ ■ •O u> 00 1-1 CO -^ >-l i-i 1-1 ^OIN t~OOC000CNCNC0CNTiOi-ii-iCOTti:c00>WH«3ON0NN00n co coi-ico i-HTtlOOCOi-HCMCOi-H-tfl t>CM t^icH-HCOCDOOCOt^COCOTt10000CN0000500^00l^T!1t^CO CO 00 00 HiOMH HfflioiON (Ni-HCOCN 00 tH coco cu CJ 0.2 CI OQi^3 rn -2™ a§ o 9 .-s cu Cu 0! O ,; o a- Sggo ,•-, d cu s-« a-2 &aEg a js-g s ^S.S'S cx^-a-d 2*0 ** h oOOOOOCO •d-d-g-d-g^ 3^ I'SlJS d ?2o _cd ej o d, a o -S d gjE; -a 0iuw>g|5tg&S.2 e u cp-s 0? a g-o cd P M) ri f£ CO COry^ ft , . O CCl fe S U a » 5 - ' % A 5 & C8 * 53 — d ds Sg <»5 ?'d 1 g^^^'S a P.D. 117 227 H P. Ph lOOO COM OOOrfOMOMiO lOiOOOOONNOOOMHOffl OfflH^ONOiOiO ^^Tfm^ujratoioiNNio-* Tt> -* co co ■* co co ■* co cot^ooosooiooOLO^HCocoio^eocooo^HcoiOcooot^ TfT»'O^<'*C0'*-^C0iOC0C0>OC0'H '-lO-*00-iCOC0t^iOM,lN-*-*i'*C0C0l0C0C0 OJCO NO ^00 53 ~i, ? © C ~ tl a-. CI Ob Q 05 Bh '*i r© C3! 3? &o a tiO s. Q iO CO fe tt> W a, O *4) "M !? tf C3 © "a s a-. O ps-i SB COlOiO>OCD CN kO i-H »o CO lO CM COOSOOO coco co 10 i-i coco co>o ooi-iioi-oiOi-i^H'^t^ooi^cocoooooo'-ococo'Ot^i^oo osc»t-c-ico»ooO'H"3>OrHOtoe iH Ci CO K0 O O ■* -^ •* co io co to m •* ■* ■* -^f co ■* co co rr co 'H t^.coo^Hcor-.ooojiMcocoiocoooot^'^'t^.t^.t^t^oioOTf cot^oo5C35iocoooO'H'H'-io]OOait~ooO"Ooscot^oq Tf*COCOCO-tt-iOTt"O'*COCOCO-*COCNCOCOcN Q.e O e .51 g t~co*o~*oocooooioair^~H©io^cooo^iooot-cococo oioo500 -*iO-*COTjOi-iCNO>00CM -3<'*coco'*TjiTft>mcot-tfnoiOTt,cococoTt>-« ft+^ bOoo o S * to © OOCO J o ^Jtn M „ to in c3_, O, ;>3&H^Q,C^cci 5 R n n. ca -S -« go O O d o o £3 += M _ _ d» grg-aS.S o o o o ^^^OH^^ a o a 6 m 3 t. 3-- S?03 § SEE 3? 8.2 &J3 > a> x a; § &.a M 3 - SO.. ||| sp S3 — 3 II it ^"ca •^ +^ o o 228 P.D. 117 In the first admissions, the group "with mental disorder" presents an average admis- sion age of 49.3 years. Patients who were discharged during that same year were 6.6 years younger at the time of admission, an average admission age of 42.7 years. As these admission ages remain remarkably constant over the years, we may say that the patients discharged during 1939 were selected from the younger ages of patients admitted during previous years. The average admission age of patients dying during the year was 13.2 years higher than that of the admissions, an average of 62.5 years. Clearly the patients who die are the patients of older ages in the admissions of previous years. First admis- sions in the resident population presented an average admission age of 42.6 years, 6.7 years younger than the admission age of the admissions, 49.3 years. Apparently the young admissions of previous years have gone to make up a certain portion of the resident population. The readmissions coming into mental hospitals during 1939 presented an average admission age of 43.5 years. The readmissions discharged presented an admission age of 41.3 years, 2.2 years younger. The deaths had an admission age 10.1 years higher than the admissions, 53.6 years. Readmissions in the resident population, with an admission age of 41.2 years, averaged 2.3 years younger at admission than readmissions entering during the year. Limitations of space present a separate discussion of the individual psychoses but the figures are available for study. In general, both first admissions and readmissions coming into hospitals each year are tending to divide themselves into three groups from the viewpoint of age: (1) younger admissions who will reappear in the discharges, (2) other young admissions who will remain and be found in the resident population and (3) a group decidedly older at admission who will reappear among the deaths. Thus, the young admissions contribute to both a favorable group discharged and an unfavorable group tending to remain within the resident population of mental hospitals. Present Age of Patients in Residence on September 30, 1939 Table 80 shows the -present age of first admissions and readmissions in the resident population on September 30, 1939. The resident first admissions show an average present age of 52.3 years, 51.0 years for the males and 53.5 years for the females. The largest number of patients, 3,237, falls in the group who are now 50-59 years of age. The group aged 40^9 years contains 2,880 patients and the 60-69 year group 2,593 patients. Thus, 62% of the first admissions in the resident population are between the ages of 40 and 70. Table 80. — Present Age of First and Readmissions in the Resident Population September 30, 1989 Present Age Total M. F. First Admissions M. Readmissions F. Under 14 years 15-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80-89 years 90 years and over Total . Average Present Age 24 122 987 2,052 2,968 2,845 2,011 974 206 13 26 117 735 1,583 2,550 2,776 2,299 1,296 310 33 50 239 1,722 3,635 5,518 5,621 4,310 2,270 516 46 22 88 603 1,117 1,493 1,706 1,250 701 156 12 17 78 455 860 1,387 1,531 1,343 889 227 19 39 166 1,058 1,977 2,880 3,237 2,593 1,590 383 31 2 34 384 935 1,475 1,139 761 273 50 1 9 39 280 723 1,163 1,245 956 407 83 14 11 73 664 1,658 2,638 2,384 1,717 680 133 15 12,202 11,725 50.1 52.8 23,927 51.4 7,148 6,806 13,954 51.0 53.5 52.3 5,054 4,919 9,973 48.7 51.8 50.2 (See Tables 233 and 234 for detail) The readmissions in residence show an average present age of 50.2 years, 48.7 years for the males and 51.8 years for the females. Patients aged 40-49 years at present com- prise the largest number, 2,638. The group aged 50-59 years records 2,384 patients and the group 60-69 years — 1,717. Readmissions in residence show 67% between the ages of 40 and 70, a slightly larger proportion than the first admissions (62%). P.D. 117 229 Present Age of Patients in Residence on September 30, 1939, by Diagnosis Table 81 gives the average present age of the different psychoses of first admissions and readmissions now in the resident population. All first admissions in residence show an average present age of 52.3 years, 52.3 years for those "with mental disorder" and 44.0 years for those "without mental disorder". The highest average present ages are shown by senile psychoses with 75.3 years, cerebral arteriosclerosis with 70.7 years, paranoia and involutional psychoses with 57.2 years each and alcoholic psychoses with 57.0 years. The young average ages are shown by convulsive disorders with an average of 45.1 years, psychopathic personality with 43.7 years, without psychosis with 44.5 years and epidemic encephalitis with 33.6 years. Table 81. — Average Present Age of Resident Population on September SO, 1939: First and Readmissions, by Diagnosis With syphilitic meningoencephalitis With other forms of syphilis With epidemic encephalitis With other infectious diseases . Alcoholic psychoses Due to drugs, etc Traumatic psychoses With cerebral arteriosclerosis With other disturbances of circulation . With convulsive disorders (epilepsy) Senile psychoses Involutional psychoses . . . . Due to other metabolic diseases, etc. Due to new growth With organic changes of nervous system Psychoneuroses ...... Manic-depressive psychoses Dementia praecox . Paranoia and paranoid conditions . With psychopathic personality With mental deficiency . . . . Undiagnosed psychoses . . . . Without psychoses Primary behavior disorders Total With Mental Disorder . Total Without Mental Disorder Grand Total . . . . First Admissions Number 528 94 46 12 862 6 62 1,164 24 545 574 438 74 1 180 117 787 6,700 432 103 1,097 19 85 13,865 89 13,954 Average Present Age 48.6 52.8 33.6 47.5 57.0 50.0 52.2 70.7 56.6 45.1 75.3 57.2 53.7 45.0 48.1 46.5 50.0 48.6 57.2 43.7 45.3 51.3 44.5 33.5 52.3 44.0 Readmissions Number 222 32 40 4 464 9 24 252 6 420 83 192 26 3 93 98 1,090 5,600 266 128 848 9 63 1 9,909 64 Average Present Age 48.5 50.9 38.1 35.5 57.1 58.3 47.5 69.1 65.0 44.6 75.5 58.9 50.3 48.3 42.2 47.4 53.3 48.9 58.0 42.5 43.9 53.8 44.6 25.0 50.2 44.3 (See Tables 227 and 229 for detail) The readmissions in residence show an average present age of 50.2 years, 50.2 years for cases "with mental disorder" and 44.3 years for cases "without mental disorder". In readmissions high average present ages are shown by senile psychoses with 75.5 years, cerebral arteriosclerosis with 69.1 years, other disturbances of circulation with 65.0 years and involutional psychoses with 58.9 years. The low average present ages are shown by psychopathic personality, 42.5 years; organic changes of the nervous system, 42.2; epidemic encephalitis, 38.1 years and other infectious diseases, 35.5 years. Present Age of the Resident Population and Patients Out on September 30, 1939, by Hospital Table 82 compares the average present age of patients in various mental hospitals on September 30, 1939, with the age at admission of these same patients. The same data are offered for patients temporarily out of hospital on visit, etc. The BostonPsycho- pathic Hospital, with a preponderance of temporary care cases, has the youngest resident population, averaging 36 years. Of the active admitting hospitals, the high averages in present age of first admissions in the resident population are shown by Taunton with 53.5 years, Boston State with 53.2 years and Northampton with 51.7 years. The young- est present age, 50.1 years, is shown by Foxborough. Of the transfer hospitals the high 230 P.D. 117 average is shown by Grafton, 55.7 years, and the low average by Metropolitan, 52.2 years. The Hospital for Epileptics at Monson presents an average present age of resident patients of 43.4 years. The admission ages of these same patients are also available by hospital. The hospitals which had a high average age of patients at time of admission are now tending to show high average ages in the resident population. Readmissions in the resident population show the high average present ages at North- ampton with 52.1 years, Westborough with 51.0 years and Worcester with 50.7 years Foxborough again shows the low average, 48.0 years, in the admitting group. Among the transfer hospitals, Grafton shows the high present age of 53.4 years and Metropolitan Hospital the low with 49.6 years. The Hospital for Epileptics shows an average of 44.1 3rears. The study of the average present ages of patients who have been placed out on visit shows that they have been drawn from the younger patients. The average present age of first admissions in the resident population was 52.3 years, while the average of first admissions out on visit, was 44.5 years. In the readmissions the present age of the resident population was 50.2 years while the present age of readmissions out on visit, was 43.4 years. Table 82. — Average Present Age and Admission Age of First and Readmissions in the Resident Population and Patients Out on September 30, 1939, by Hospital Resident P( JPTJLATION Patieni s Out First Admissions Readmissions First Admissions Readmissions Hospitals Age at Age at Age at Age at Present Admis- Present Admis- Present Admis- Present Admis- Age sion Age sion Age sion Age sion Boston Psychopathic 36.4 36.3 37.4 37.4 37.8 37.5 34.6 34.6 Taunton .... 53.5 45.4 49.5 41.6 43.0 40.7 39.8 35.3 Boston State 53.2 44.6 49.3 40.1 45.8 44.0 40.3 37.7 Northampton 51.7 43 8 52.1 43.6 43.1 40.7 45.0 43.3 Danvers .... 51.6 43.8 49.5 41.0 45.2 42.7 41.6 38.7 Worcester .... 51.6 42.4 50.7 41.2 45.4 42.1 44.5 41.7 Westborough 51.5 44.3 51.0 43.4 41.3 38.7 43.7 39.3 Foxborough 50.1 43.0 48.0 39.6' 42.0 39.9 39.4 36.9 Grafton .... 55.7 41.4 53.4 40.5 51.8 46.4 50.4 47.1 Medfield .... 54.6 41.7 52.1 40.8 44.5 43.5 40.0 36.5 Gardner .... 54.1 40.0 52.7 41.7 54.3 43.5 54.2 44.6 Metropolitan 52.2 47.5 49.6 43.8 49.7 45. 5 39.6 35.7 Monson .... 43.4 32.7 44.1 33.4 28.7 25.6 35.6 31.6 Tewksbury 58.4 37.0 59.3 39.0 - - - -' McLean .... 57.8 50.4 55.9 47.1 46.2 44.1 43.0 40.8 Bridgewater 51.2 34.5 48.0 38.2 - - 45.0 25.0 Vet. Adm. Fac. No. 107 . 47.7 42.2 46.6 39.9 51.6 51.6 47.4 42.2 Vet. Adm. Fac. No. 95 . 46.7 39.0 45.5 35.6 45.0 43.0 47.8 39.2 Total 52.3 42.5 50.2 41.2 44.5 41.5 43.4 39.9 (See Tables 231-238 for detail) Length op Hospital Stay op Patients in Residence on September 30, 1939, by Diagnosis Table 83 and Graph 8 present the average length of hospital stay of first admissions and readmissions who were in residence within hospitals at the end of the year, by diagnosis. The first admissions "with mental disorder" had remained in hospital a total of 10.27 years up to the end of 1939, 10.34 years for the males and 10.21 years for the females. In the resident first admissions, psychoses due to new growth had shown the longest hospital stay, 17.5 years. Following in order are dementia praecox with a hospital residence of 13.5 years; mental deficiency with 11.3 years; convulsive disorders, 11.2 years; alcoholic psychoses, 9.9 years and psychopathic personality, 8.1 years. The shorter periods of time within hospital are shown by senile psychoses, 3.7 years; psycho- neuroses, 3.3 years; with cerebral arteriosclerosis, 3.0 years; and undiagnosed psychoses, .2 years. P.D. 117 231 Table 83. — Average Length of Hospital Stay during the Present Admission,1 First and Readmissions in the Resident Population on September SO, 1939, by Diagnosis Total First Admissions Readmissions Diagnoses M. F. T. M. F. T. M. F. T. With syphilitic meningoenceph- alitis 5.40 6.23 5.59 5.15 6.72 5.50 6.01 5.10 5.80 With other forms of syphilis . 5.69 8.96 6.65 6.03 10.31 7.26 4.67 5.32 4.87 With epidemic encephalitis 7.82 7.79 7.81 7.93 8.24 8.07 7.73 7.00 7.51 With other infectious diseases . 11.35 4.81 6.85 14.00 4.92 7.94 .75 4.54 3.59 Alcoholic psychoses . 9.24 9.46 9.28 9.91 10.10 9.94 8.01 8.21 8.04 Due to drugs, etc. 8.22 15.00 10.03 3.96 13.75 7.22 10.66 16.52 11.90 Traumatic psychoses 6.50 6.29 6.46 6.21 5.41 6.02 7.10 12.87 7.58 With cerebral arteriosclerosis . 3.11 3.29 3.20 2.97 3.12 3.04 3.83 4.00 3.93 With other disturbances of cir- culation . . . 3.09 8.24 5.32 3.43 8.20 5.22 .56 8.31 5.72 With convulsive disorders (epi- lepsy) 9.36 12.44 10.84 9.80 12.65 11.29 8.90 12.11 10.24 Senile psychoses 3.69 4.00 3.89 3.60 3.82 3.74 4.22 5.39 4.93 Involutional psychoses 4.88 5.41 5.26 5.13 5.05 5.07 4.33 6.26 5.68 Due to other metabolic diseases, etc 5.97 6.46 6.26 4.93 6.20 5.62 11.03 7.00 8.09 Due to new growth . - 6.71 6.71 - 17.50 17.50 - 3.12 3.12 With organic changes of nervous system 4.63 4.39 4.54 4.39 3.55 4.07 5.10 6.06 5.45 Psychoneuroses . . . 3.22 3.74 3.52 2.90 3.60 3.34 3.52 3.95 3.74 Manic-depressive psychoses . 6.91 7.71 7.41 7.12 7.89 7.60 6.75 7.58 7.27 Dementia praecox 12.38 12.22 12.30 13.81 13.34 13.57 10.69 10.86 10.78 Paranoia and paranoid condi- tions 6.64 7.89 7.47 6.91 8.44 7.90 6.18 7.03 6.75 With psychopathic personality 6.87 7.59 7.20 7.53 8.80 8.16 6.39 6.49 6 43 With mental deficiency . 10.87 10.54 10.71 11.68 11.00 11.36 9.69 10.02 9.86 Undiagnosed psychoses . .39 .32 .33 .45 .20 .26 .12 .53 .48 Without psychoses: . 7.87 8.97 8.24 9.30 9.86 9.48 5.94 7.79 6.55 Alcoholism .... .17 .12 .16 .12 .12 .12 .25 .12 .22 Drug Addiction - .75 .75 - - - - .75 .75 Epidemic encephalitis . 12.50 - 12:50 - — — 12.50 _ 12.50 Psychopathic personality — pathological sexuality ■ .62 - .62 .79 — ' .79 .12 - .12 Psychopathic personality — - pathological emotionality .12 - .12 .12 — .12 — - _ Psychopathic personality — asocial or amoral trends . .35 .12 .32 .12 - .12 .46 .12 .40 Psychopathic personality — mixed types .12 7.50 2.58 .12 — .12 — 7.50 7.50 Epilepsy .... 7.00 2.62 4.81 1.50 - 1.50 12.50 2.62 5.91 Mental deficiency 13.16 13.20 13.17 15.15 13.42 14.54 9.70 12.76 10.68 Idiot 13.03 18.75 14.17 13.03 25.00 14.36 - 12.50 12.50 Imbecile .... 12.77 14.60 13.54 14.40 15.79 15.13 10.21 .37 8.98 Moron 13.46 10.76 12.61 16.94 5.42 13.91 9.40 14.57 11.30 Other non-psychotic diseases 5.09 6.18 5.63 4.27 5.52 4.95 5.77 6.97 6.31 No other condition .75 .34 .61 1.25 .41 .83 .45 .12 .39 Primary behavior disorders .96 .12 .80 .12 .12 .12 3.50 3.50 Total With Mental Disorder 9.88 9.93 9.90 10.34 10.21 10.27 9.23 9.54 9.38 Total Without Mental Dis- order 7.61 8.79 7.99 8.84 9.52 9.06 5.88 7.79 6.50 Grand Total . 9.86 9.92 9.89 10.32 10.20 10.27 9.20 9.53 9.36 (See Tables 239-241 for detail) 1 This table considers only the length of time spent in hospitals during the present admission. First admissions "without mental disorder" had remained an average of 9.0 years. Table 83 presents the length of stay of the subdivisions of the without psychosis group. The long residence observed appears to be due to cases of mental deficiency without psychosis. Nine cases of idiocy had remained an average of 14.3 years each, 23 cases of imbecility had remained 15.1 years each and 19 morons had remained 13.9 years each. A total of 51 of the 85 resident cases without psychosis placed in the mental deficiency classification. In readmissions the total "with mental disorder" had remained in residence 9.3 years, 9.2 years for the males and 9.5 years for the females. Psychoses due to drugs presented the long hospital stay of 11.9 years. Next in order are dementia praecox, 10.7 years; convulsive disorders, 10.2 years; psychoses with mental deficiency, 9.8 years and alcoholic psychoses and due to other metabolic diseases, 8.0 years each. The short hospital residences are shown by psychoneuroses, 3.7 years; other infectious diseases, 3.5 years; due to new growth, 3.1 years; and undiagnosed psychoses, .4 years. The "without mental disorder" group of the readmissions had remained an average of 6.5 years. Again, the mental deficiency subdivision in the group without psychosis 232 p.D. 117 shows the long average period in residence. One idiot remained 12.5 years, eight im- beciles 8.9 years each and nineteen morons 11.3 years each. Of the 63 readmissions in residence diagnosed without psychosis, 28 were in the mental deficiency classification. Due to A/etv Growth Dement/a Praecox Mental Deficiency Convulsive Disorders Alcoholic Psychopathic Personality Epidemic Encephalitis Paranoia Other fnfectious Diseases Manic -Depress/ye Other Forms of Syphilis Due to Drugs Traumatic Other AfetabolicDiseases Syphilitic Meningo-Encephalitis Other Disturbances of Circulation involutional Organic Changes of jVervous System Seniie Psychoneuroses Cerebraf Arteriosclerosis Aii Psychoses Graph 8. — Length of Time in Residence during This Admission of First Admissions and Readmissions in Residence in Hospitals for Mental Disorders on September 30, 1939, by Diagnoses: Averages in Years While the medical staff of the various institutions have been unwilling to diagnose these patients as psychotic, they have considered them unsuitable for return to the community. The patients of the lower mental grades, at the idiot or imbecile level, are quite obviously unable to care for themselves. These patients, together with the morons, present such symptoms as irritability, excitability, assaultiveness and episodic outbursts which render their return to the community highly inadvisable. Hospital administrators report that these cases, necessarily diagnosed as non-psychotic, constitute some of their most serious conduct problems and that continued institutional care is necessary. If we calculate the maintenance cost, capital investment, cost of a central department, depreciation, etc., we arrive at a total annual per capita cost of approximately $450. for State hospital care of mental patients. With an average hospital stay during the present admission of 9.89 years, the 23,927 patients in residence at present have cost the Com- monwealth at the end of 1939, over one hundred six millions of dollars ($106,487,113.) during the present admission. Length of Hospital Stay during Previous Admissions and the Present Admission, Readmissions in Residence on September 30, 1939 Table 84 records the total hospital stay during their lives of readmissions now in the resident population. This is obtained by adding the length of time in hospitals during P.D. 117 233 all previous admissions to the length of time in hospital during the present admission. A total of 9,973 readmissions had spent an average of 4.42 years in hospitals during previous admissions. During this present admission they have remained in hospitals an average of 9.36 years, which gives a total hospital stay, up to the end of 1939, of 13.78 years. Table 84. — Average Length of Hospital Stay during Previous Admissions and the Present Admission, Readmitted Cases in Residence September 30, 1939, by Diagnosis Time in Institution Time in Institution Time in Institution during Previous during Present during All Admissions Admission Admissions Diagnoses M. F. T. M. F. T. M. F. T. With syphilitic meningoenceph- alitis .... 2.19 2.84 2.34 6.01 5.10 5.80 8.20 7.94 8.14 With other forms of syphilis 1.97 3.53 2.46 4.67 5.32 4.87 6.64 8.85 7.33 With epidemic encephalitis 2.25 1.59 2.05 7.73 7.00 7.51 9.98 8.59 9.56 With other infectious diseases .75 .12 .28 .75 4.54 3.59 1.50 4.66 3.87 Alcoholic psychoses . 3.48 4.09 3.57 8.01 8.21 8.04 11.40 12.30 11.61 Due to drugs, etc. 4.17 4.12 4.16 10.66 16.52 11.90 14.83 20.64 16.06 Traumatic psychoses 1.38 3 93 1.59 7.10 12.87 7.58 8.48 16.80 9.17 With cerebral arteriosclerosis . 1.19 1.70 1.48 3.83 4.00 3.93 5.02 5.70 5.41 With other disturbances of cir- culation ..... 1.62 .53 .89 .56 8.31 5.72 2.18 8.84 6.61 With convulsive disorders (epi- lepsy) 3.02 2.56 2.83 8.90 12.11 10.24 11.92 14.67 13.07 Senile psychoses 1.87 2.58 2.30 4.22 5.39 4.93 6.09 7.97 7.23 Involutional psychoses 1.32 1.78 1.64 4.33 6.26 5.68 5.65 8.04 7.32 Due to other metabolic diseases, etc 2.37 2.59 2.53 11.03 7.00 8.09 13.40 9.59 10.62 Due to new growth . — 2.66 2.66 — 3.12 3.12 _ 5.78 5.78 With organic changes of nervous system 2.19 2.24 2.20 5.10 6.06 5.45 7.29 8.30 7.65 Psychoneuroses 1.13 .94 1.03 3.52 3.95 3.74 4.65 4.89 4.77 Manic depressive psychoses . 2.68 3.29 3.07 6.75 7.58 7.27 9.43 10.87 10.34 Dementia praecox 4.81 5.40 5.10 10.69 10.86 10.78 15.50 16.26 15.88 Paranoia and paranoid condi- tions 3.41 3.34 3.36 6.18 7.03 6.75 9.59 10.37 10.11 With psychopathic personality 2.41 2.81 2.59 6.39 6.49 6.43 8.80 9.30 9.02 With mental deficiency 6.72 7.09 6.91 9.69 10.02 9.86 16.41 17.11 16.77 Undiagnosed psychoses . .75 1.04 1.01 .12 .53 .48 .87 1.57 1.49 Without psychoses . 4.20 3.40 3.93 5.94 7.79 6.55 10.14 11.19 10.48 Primary behavior disorders 4.50 - 4.50 3.50 - 3.50 8.00 - 8.00 Total With Mental Disorder 4.20 4.66 4.43 9.23 9.54 9.38 13.43 14.20 13.81 Total Without Mental Dis- 4.21 3.40 3.94 5.88 7.79 6.50 10.09 11.19 10.48 Grand Total 4.20 4.65 4.42 9.20 9.53 9.36 13.40 14.18 13.74 (See Tables 241 and 242 for detail) The longest hospital residences during previous admissions are shown by the psychoses with mental deficiency, 6.9 years and dementia praecox, 5.1 years. The short hospital residences during previous admissions are shown by other disturbances of circulation, .89 years, and other infectious diseases, .28 years. As the length of time spent in residence during the present readmission has been demonstrated separately in Table 83 we pass on to the total time in hospital during both the previous admissions and the present admission. In this total time for all admissions the long hospital residences are observed in psychoses with mental deficiency, 16.7 years; due to drugs, 16.0 years, dementia praecox, 15.8 years; convulsive disorders, 13.0 years and alcoholic psychoses, 11.6 years. The short total hospital residences are observed in psychoneuroses, 4.7 years; other infectious diseases, 3.8 years; and undiagnosed psychoses, 1.4 years. Using the estimated cost of $450 per year, these 9,973 readmissions have cost the Commonwealth, an average of $1,989 each, during all previous admissions, or a total of $19,836,297. This sum indicates the cost previous to the present admission. Adding this earlier cost of $19,836,297 to the cost of the present admissions in residence of $106,487,113 (see preceding section), we have a grand total cost during all admissions for the resident population of $126,323,410. 23-1 P.D. 117 00 0 0 & £ «£ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 • • 1 1 1 1 1 00 o1 0 lO "3 0 0 0 z M 2 O 1= Z 1 1 1 1 1 1 1 1 1 1 1 1 1 ! 1 1 1 CNCN 1 1 1 1 1 ■* 1 T)< & ooeo i~- cot»i 0 co t- t>.©co 00 co coco 0 00 ■ ■ 1 1 ■ 1 • • 1 - 1 -II ■ t ■ ■ • 1 -1 -1 0*-< C0 i-H »C3 -»t ~H CN CN O — © 1-- 06^' 0 OS m >-! 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The native born are divided by parentage into three groups; foreign, mixed and native. When we compare the first admissions to our State schools with the population 24 years of age and under, we find that the native born show an admission rate of 16.1 per 100,000 while the foreign born show a lower rate of 4.7. Relatively the foreign born of these ages contribute one quarter as many mental defectives to our State schools as do the native born 24 years of age and under. When we divide the native born in accordance with the nativity of their parents, we find that the native born of native parentage show the high admission rate of 18.9. The native born of mixed parentage are second with a rate of 14.5, while the native born of foreign parentage show the low rate of 10.7. The foreign born and the native born with both parents foreign born are making a very good showing in incidence of admissions to State schools for mental defectives. Age op First Admissions to State Schools 1939, by Nativity Table 105 shows that the foreign born have a high average admission age, 17.5 years. The native born have an average admission age of 13.5 years. Among the native born the highest average admission age, 15.2 years, occurs in the native born of mixed parent- age, 11.5 years for the males and 20.1 years for the females. The lowest average admis- sion age, 12.0 years, occurs in the native born of native parentage, 11.4 years for the males and 12.6 years for the females. The native born of native parentage present, therefore, the low admission age as well as the high admission rate (Table 104). Table 105. — Average Age of First Admissions to State Schools, 1939, by Nativity, Parentage and Sex Nativity Groups Average Age M. F. T. 12.5 18.7 15.2 16.4 20.1 12.6 17.8 7.5 17.5 Native Born: Foreign Parentage (both parents foreign born) . Mixed Parentage (one parent native — one foreign) Native Parentage (both parents native born) Unknown Parentage Nativity Unknown 11.7 12.3 11.5 11.4 13.0 13.5 14.6 15.2 12.0 15.9 7.5 11 7 15.2 13.6 (See Table 247 for detail) Clinical Diagnosis and Average Intelligence Quotient of Admissions to State Schools, 1939 Table 106 outlines the average intelligence quotient of first admissions and read- missions for 1939 in the various clinical diagnosis groups. Due to the fact that "other forms" includes a number of small groups, it is omitted from discussion. Among the first admissions the highest average admission I. Q. of .54 occurs in the familial classifica- tion. The undifferentiated cases are second with an average admission I. Q. of .52. This group, of course, comprises individuals who lack the outstanding characteristics which would place them in one of the clinical groups. The low averages are observed in mongolism, .25 and with developmental cranial anomalies, .28. The male first admissions show an average admission I. Q. of .46, while that for the females is .48. The males present a higher average admission I. Q. in four of the ten diagnosis groups. Owing to the small numbers involved, the readmissions will not be discussed. Clinical Diagnosis and Average Age of Admissions to State Schools, 1939 Table 107 shows the average ages of first admissions and readmissions in the various clinical diagnosis groups. Owing to difficulties with small numbers, the groups having less than 10 first admissions will not be discussed. The highest average admission age, 14.9 years, occurs in the familial group. The undifferentiated are second with 14.4 years. Patients with congenital cerebral spastic infantile paralyses show the low average admis- sion age of 8.7 years. 250 P.D. 117 Table 106. — Clinical Diagnosis and Average Intelligence Quotient of First Admissions and Readmissions to State Schools, 19S9, by Sex First Admissions Readmissions Numbei Average I.Q. Number Average LQ. Clinical Diagnoses M. F. T. M. F. T. M. F. T. M. F. T. 12 9 21 .25 .26 .25 With developmental cranial anomalies 6 3 9 .30 .25 .28 "With other organic nervous disease . 3 2 5 .18 .50 .31 With congenital cerebral spastic in- fantile paralyses .... 4 6 10 .32 .36 .35 1 1 .25 - .25 Post-traumatic — natal - 5 5 - .37 .37 3 2 5 .45 .30 .39 - 1 1 - .55 .55 Post-traumatic — post-natal 2 I 3 .55 .15 .41 With endocrine disorders . 3 3 6 .48 .38 .43 - 1 1 - .25 .25 66 70 136 .52 .51 .52 4 3 7 .57 .68 .62 32 44 76 .49 .57 .54 2 1 3 .50 .55 .51 3 3 6 .58 .21 .40 - 1 1 - .55 .55 Total 134 148 282 .46 .48 .47 7 7 14 .50 .56 .53 (See Tables 254 and 255 for detail) Table 107. Clinical Diagnosis and Average Age at Admission of First Admissions and Readmissions to State Schools, 1939, by Sex First Ae missions Real missions Clinical Diagnoses Number Average Age Number Average Age M. F. T. M. F. T. M. F. T. M. F. T. With developmental cranial anomalies With congenital cerebral spastic in- fantile paralyses .... Post-traumatic — post-natal With endocrine disorders . With other organic nervous disease . Post-traumatic — natal 6 4 12 2 3 3 3 66 32 3 3 6 9 1 3 2 2 70 44 5 3 9 10 21 3 6 5 5 136 76 5 6 5.8 9.5 7.0 5.5 10.8 8.7 9.3 12.0 10.5 15.0 3.5 11.1 12.5 10.8 11.6 15.8 5.5 11.7 7.8 18.0 11.9 12.9 35.8 14.4 12.0 17.0 14.9 - 15.5 15.5 10.8 14.5 12.6 1 4 2 1 1 3 1 1 1 1 1 7 3 1 17.5 - 17.5 - 32.5 32.5 - 17.5 17.5 11.2 20.8 15.3 15.0 42.5 24.1 - 37.5 37.5 Total 134 148 282 11.7 15.2 13.6 7 7 14 13.2 27.5 20.3 (See Tables 252 and 253 for detail) Still confining ourselves to the groups containing 10 or more first admissions, we note that the average admission age is higher for the females in all groups. It is interesting that the hereditary group (familial), with its many social and economic handicaps, should succeed in keeping the children out of institutions until such a comparatively late age. Table 108. — Clinical Diagnosis of Admissions to Slate Schools, 1939, by School Walter E. Clinical Diagnoses T 3TAL Belch ERTOWN Fernald Wrh NTH AM No. % No. % No. % No. % 79 26.6 49 39.5 5 7.5 25 23.5 21 7.0 3 2.4 6 9.0 12 11.3 With developmental cranial anomalies . 9 3.0 1 .8 1 1.5 7 6.6 With congenital cerebral spastic infantile paralyses 11 3.7 — - 5 7.5 6 5.6 6 2.0 3 2.4 1 1.5 2 1.8 5 1.6 1 .8 2 3.0 2 1.8 Post-traumatic — post-natal .... 3 1.0 2 1.6 - - 1 .9 With endocrine disorders ..... 7 2.3 - - 3 4.5 4 3.7 With other organic nervous disease 0 1.6 1 .8 — — 4 3.7 Undifferentiated 143 48.3 62 50.0 40 60.6 41 38.6 7 2.3 2 1.6 3 4.5 2 1.8 Total 296 100.0 124 100.0 66 100.0 106 100.0 P.D. 117 251 Clinical Diagnosis op Admissions to State Schools, 1939, by School Table 108 presents the clinical diagnoses of admissions to State schools during 1939 by individual schools. Rather marked differences are observed. For example, Belcher- town places 50% in the undifferentiated group, while the Walter E. Fernald uses this diagnosis in 60% of admissions and Wrentham in 38% of admissions. Belchertown places 39% of admissions in the familial group, Walter E. Fernald 7%, and Wrentham 23%. That a selection of certain types for admission is possible is demonstrated by the figures on mongolism. Belchertown admitted 2% in this diagnosis, Walter E. Fernald 9% and Wrentham 11%. In admissions diagnosed with congenital cerebral paralyses, Belchertown admitted none, Walter E. Fernald 7% and Wrentham 5%. It should be remembered that admissions are selected from rather large waiting lists. The urgency for admission of the various types may vary also in accordance with the population of the areas served by the respective schools. Country op Origin of Native Born of Foreign or Mixed Parentage, First Admissions to State Schools, 1939: Rates per 100,000 Population Aged 0-24 Years of Same Country of Origin Table 109 gives the country of origin of the native born of foreign or mixed parentage for first admissions during 1939. As 92% of admissions are under 25 years of age, the population comparisons are restricted to these ages. Patients with Portugal as the country of origin show the high admission rate to State schools (53). Canada and Poland demonstrate rates of 13 and 12, respectively. The low admission rate of 5 is shown for Greece, Scotland and England. At the bottom of Table 109, we present the admission rate for the native born of native parentage, 21.6. This rate is higher than the rate of 12.1 for the native born of foreign or mixed parentage. Table 109. — Country of Origin of Native Born of Foreign or Mixed Parentage, First Admissions to State Schools, 1939: Rates per 100,000 Population Aged 0-2J/. Years of Same Country of Origin Population 0-24 First- Rates per Country or Origin Years, 1930 Admissions 100,000 Same Census 1939 Country of Origin 27,841 15 53.8 245,773 34 13.8 Poland 104,464 13 12.4 133,870 16 11.9 Italy 174,969 20 11.4 64,832 7 10.7 16,716 1 5.9 All other Countries 152,822 9 5.8 51,770 3 5.7 19,434 1 5.1 Unknown - 2 - 992,491 121 12.1 Rate for Native of Native Parentage (155 eases) ■ — 21.6. 1 Includes Newfoundland. Section H. All Discharges from State Schools for the Mentally Deficient, 1939 The section following discusses various factors in reference to discharges from State schools. Discharges to the Community from State Schools, 1917-1939 Table 110 presents the numbers and rates per 1,000 under care of discharges from the State schools over the period 1917-1939. With the exception of 1926, the males have shown a larger number of cases under care than the females from 1917 to 1929. From 1930 to 1939, however, the females have shown larger numbers under care. In discharges, the males have shown larger numbers leaving State schools than the females in every year of the 23-year period with the exception of 1926. The larger number of male discharges from 1930 onward in the face of a larger number of females under care is interesting. In the discharge rates, the year 1920 presents the high of 105. The total rate shows irregularity between 1917 and 1924. After that point a rough trend is dis- 252 P.D. 117 cernible. The years 1925-1927 show discharge rates between 60 and 69. During the next three years, 1928-1930, the rates drop to between 40 and 49. The years 1931-1934 show a further drop in rates to between 30 and 39. The years 1935, 1936, 1937 and 1938 have shown higher discharge rates with 51, 40, 43 and 43, respectively. The rate drops to 36 in 1939. In the sexes, the males have shown higher discharge rates in 22 of the 23 years included in this table, the only exception being the year 1926. Table 110. — Discharges from State Schools, 1917-1939, by Sex: Rates per Thousand Under Care Numb br Under Care Discharges Rates per 1,000 Under Years Care M. F. T. M. F. T. M. F. T. 1917 .... 1,808 1,430 3,238 172 80 252 95.1 55.9 77.8 1918 1,824 1,517 3,341 120 37 157 65.7 24.3 46.9 1919 1,925 1,576 3,501 78 52 130 40.5 32.9 37.1 1920 1,941 1,636 3,577 247 129 376 127.2 78.8 105.1 1921 1,863 1,714 3,577 103 56 159 55.2 32.6 44.4 1922 1,908 1,749 3,657 192 120 312 100.6 68.6 85.3 1923 2,086 1,893 3,979 120 40 160 57.5 21.1 40.2 1924 2,236 2,091 4,327 137 65 202 61.2 31.0 46.6 1925 2,254 2,207 4,461 185 102 287 82.0 46.2 64.3 1926 2,235 2,255 4,490 139 154 293 62.1 68.2 65.2 1927 2,270 2,244 4,514 196 99 295 86.3 44.1 65.3 1928 2,324 2,200 4,584 136 79 215 58.5 34.9 46.9 1929 2,322 2,287 4,609 110 76 186 47.3 33.2 40.3 1930 2,365 2,435 4,800 114 80 194 48.2 32.8 40.4 1931 2,441 2,577 5,018 97 69 166 39.7 26.7 33.0 1932 2,492 2,695 5,187 98 69 167 39.3 25.6 32.1 1933 2,628 2,807 5,435 89 79 168 33.8 28.1 30.9 1934 2,733 2,939 5,672 92 86 178 33.6 29.2 31.3 1935 2,805 2,999 5,804 174 126 300 62.0 42.0 51.6 1936 2,836 3,063 5,899 140 97 237 49.3 31.6 40.1 1937 2,950 3,134 6,084 135 131 266 45.7 41.7 43.7 1938 2,911 3,118 6,029 136 127 263 46.7 40.7 43.6 1939 2,878 3,121 5,999 111 106 217 38.5 33.9 36.1 Mental Status and Average Age of Discharges to the Community, 1939 Table 111 outlines the average age of discharges in the various mental status groups. The 217 patients returned to the community present an average discharge age of 23.6 years, 20.5 years for the males and 26.8 years for the females. The higher discharge age for the females is partially due to the fact that the females admitted are uniformly older than the males (see Table 100). In the idiot group, the 6 cases discharged left the institution at an average age of 20.0 years. The 58 cases in the imbecile group averaged 20.5 years. The 139 cases in the moron group averaged 24.7 years and the 14 cases in the group not mentally defective averaged 27.1 years of age at discharge. In the idiot group, the females were 1.7 years older than the males at the time of discharge and in the imbecile group 2.6 years older. In the moron group, the females were 8.1 years older and in the group not mentally defective 3.4 years younger. Table 111. — Mental Status and Average Age of Discharges from State Schools, 1939, by Sex: Numbers and Averages Mental St VTUS Number Average Age Discharge AT M. F. T. M. F. T. Idiot 3 34 72 2 3 24 67 12 6 58 139 14 19.1 19.4 20.8 30.0 20.8 22.0 28.9 26.6 20 20 24 27 0 5 7 Not Mentally I 1 Total 111 106 217 20.5 26.8 23 6 (See Table 256 for detail) Age of Discharges Returned to the Community, 1939, by School Table 112 presents the age distribution of patients discharged from State schools during 1939. Eighty-nine or 41% of the total discharges were under 20 years of age; 87 or 40% were between the ages of 20 and 29 years and 41 or 18% were 30 years of age P.D. 117 253 or over. It is apparent that the ages under 30 years are the most favorable for the dis- charge of patients from State schools. Table 112. — Age at Discharge of Patients Discharged from State Schools, 1939, by School and Sex Age at Discharge Total M. F. Belchertown M. Walter E. Fernald M. M. Under 5 years .5- 9 years 10-14 years 15-19 years 20-24 years 25- 29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years 55-59 years 60 years and over Total Average Age 46 30 12 3 2 1 2 9 17 22 23 13 7 4 1 1 23 15 12 9 4 4 111 106 217 20.5 26.8 23.6 20 38 49 27 70 25.0 26.1 25.7 18.5 25.0 20.8 20.7 28.7 83 24.6 In the sexes we note that the discharge age is younger for boys than for girls. The average age for all discharges was 23.6 years, 20.5 years for the males and 26.8 years for the females. Discharges from Belchertown showed the highest average age, 25.7 years, 25.0 years for the males and 26.1 years for the females. Wrentham was second with an average of 24.6 years, 20.7 years for the males and 28.7 years for the females. Fernald discharges were the youngest with an average age of 20.8 years, 18.5 years for the males and 25.0 years for the females. In every school the males discharged are younger than the females. Table 113. — Discharges from State Schools, 1989, by School: Numbers and Rates per 1,000 Cases Under Care 1 State Schools Number Under Care NuMBEP. OF Discharges Rate per 1,000 Under Care M. F. T. M. F. T. M. F. T. Belchertown Walter E. Fernald Wrentham .... 640 1,248 990 930 890 1,301 1,570 2 138 2,291 20 38 58 49 27 76 42 41 83 31. 40. 36. 39. 30. 35. 42. 31. 36. Total .... 2,878 3,121 5,999 111 106 217 38. 33. 36. 1 Includes discharges irrespective of l.Q. Cases under care are obtained by adding resident population and patients out on September 30, 1939, and all discharges and all deaths during the year 1939. Discharges to the Community, 1939, by School: Rates per 1,000 Cases under Care During 1939, 217 patients were discharged from the three State schools for the men- tally defective (Table 113). Of these, 111 or 51% were males and 106 or 49% were females. While the sexes balance in all schools combined, two of the individual schools show marked sex differences in discharges. Of the 58 patients discharged from Belcher- town, 34.4% were males and 65.5% females. Of the 76 discharged from Fernald State School, 64.4% were males and 35.5% were females. Of the 83 discharged from Wrentham 50.6% were males and 49.3% females. The rate of discharge per 1,000 cases under care for all schools is 36, 38 for the males and 33 for the females. Fernald presents a rate of 35; Belchertown and Wrentham 36 each. The discharge rate for females is higher than for males at Belchertown, lower at Fernald and Wrentham. Mental Status of Discharges to the Community, 1939, by Age: Rates per 1,000 under Care of Same Groups Table 1 14 presents the discharge rates per thousand under care by mental status and age at discharge. Higher discharge rates are observed in the mental status groups show- 254 P.D. 117 ing the higher intelligence. The idiot group shows a discharge rate of 7 per thousand idiots under care; the imbecile group a rate of 24; the moron group a rate of 53. The not mentally defective group is highest with a rate of 92. Higher discharge rates for the females occur in the idiot and not mentally defective classifications but the males are higher in the imbecile and moron groupings. In reference to age, the idiots show their high discharge rate of 17 in the 20-29 year age group. For imbeciles, the high rate of 41 occurs in the 0-9 year- age group. The morons present a high rate of 66 in the 20-29 year group and the not mentally defective a high rate of 250 in the 40-49 year age group. Table 114. — Discharges from State Schools, 1989, by Mental Status and Age at Discharge : Rates per 1,000 Cases Under Care of Same Mental Status and Age Mental Status Sex Age Distribution All Ages 0-9 Years 10-19 Years 20-29 Years 30-39 Years 40-49 Years 50-59 Years 60 Years and Over Idiot .... M. F. T. 6. 7. 7. 14. 7. 9. 3. 15. 19. 17. - : - : Imbecile M. F. T. 27. 20. 24. 51. 28. 41. 32. 28. 30. 45. 25. 35. 4. 17. 11. 7. 7. 7. _ - Moron M. F. T 63. 45. 53. - 72. 34. 58. 81. 57. 66. 31. 45. 41. 26. 50. 45. 45. 33. - Not Mentally Defective M. F. T. 30. 137. 92. _ 23. 120. 58. 178. 142. 100. 142. 250. 250. 250. _ ~ Total .... M. F. T. 38. 33. 36. 25. 11. 19. 46. 30. 40. 54. 46. 50. 12. 32. 24. 15. 32. 26. 14. 8. - (See Table 277 for detail) 54 0-9 W -19 20-29 30-39 40-49 50-59 YRS. YRS. YRS. YRS. YRS. YRS. Graph 12. — Age of Discharges from State Schools, Rates per 1,000 Under Care of Same Ages 1939: The discharge rates by age are outlined in Graph 12. Age appears to have a greater influence on the discharge of males than of females. The males show sharply increasing discharge rates from 25 in the 0-9 year group to 46 in the 10-19 year group and to 54 in the 20-29 year group. Then they drop to a low rate of 12 in the age group 30-39 P.D. 117 255 years and 15 in the age group 40-49 years. The discharge rates of the females vary from a low rate of 11 in the age group 0-9 years to the high of 46 in the 20-29 year group and back to a low rate of 14 in the 50-59 year group. Clinical Diagnosis of Discharges to the Community, 1939, by Age: Rates per 100,000 under Care of Same Groups Table 115 outlines the discharge rates per thousand cases under care by clinical group- ing and by age distribution. The high discharge rate for the clinical groups, 64, occurs in the group with other organic nervous diseases (2 cases). Post-traumatic, post-natal is second with 60 (2 cases) ; and post-infectional and undifferentiated third with 40 (1 1 and 100 cases, respectively). The low discharge rates occur in post-traumatic — natal, 8 (1 case) and with developmental cranial anomalies 12 (2 cases). The age rates across the bottom of the table show the high discharge rate of 50 in the age group 20-29 years. The 10-19 group is second with a rate of 40 per thousand under care. The 30-39 and 40-49 groups present discharge rates of 24 and 26, respectively. The familial group (62 cases) demonstrates the high discharge rate of 56 in the age group 20-29 years and the low rate of 10 in the age group 10-19 years. The undifferentiated group (100 cases) offers the high discharge rate of 55 in the 10-19 year age group and the low rate of 7 in the 0-9 year group. Table 115. — Discharges from State Schools, 1939, by Clinical Diagnosis and Age at Discharge: Rates per 1,000 Cases under Care l of Same Clinical Groupings and Age 0-9 10-19 20-29 30-39 40-49 50-59 60 Years Clinical Diagnoses Total Years Years Years Years Years Years and Over Familial .... 33. 15. 10. 56. 37. 34. 20. - Mongolism .... 21. 37. 20. 13. - - - - With developmental cranial anomalies 12. 23. 15. - — — — — With congenital cerebral spastic infantile paralyses 23. 35. 15. 16. 25. - - - Post-infectional . 40. 52. 63. 26. 20. — 90. — Post-traumatic — natal . 8. - 15. _ - - - - Post-traumatic — post-natal 60. - 83. 166. - - - - With epilepsy — idiopathic 20. - 32. 37. - — - - With endocrine disorders . 25. - 28. 52. - — - - With other organic nervous disease .... 64. — 100. — — 500. — — Undifferentiated 40. 7. 55. 54. 16. 30. - - Other forms 63. - 157. 62. 54. 17. - - Total .... 36. 19. 40. 50. 24. 26. 8. - 1 Cases under care include the resident population and cases out on September 30, 1939, plus discharge and deaths during the year 1939. It is interesting to compare the discharge rate of 36 cases per thousand under care in State schools for mental defectives (88% first admissions) with the discharge rate of 156 per thousand first admissions under care in mental hospitals. While the mental hospitals discharged one patient out of every 7 under care during 1939, the state schools discharged but one patient out of every 27 under care. Economic Status of Discharges to the Community, 1939, by Mental Status: Rates per 1,000 under Care of Same Groups Table 116 outlines the economic status of discharges in the various mental status groups, presenting also the rates per thousand under care of the same groups. There were no discharges in the comfortable group. The marginal group presents a discharge rate of 40, 45 in the males and 34 in the females. The group of dependent economic status shows a rate of 32, 28 in the males and 34 in the females. The imbeciles and morons show higher discharge rates in the marginal group. The idiot and not mentally defective groups show the high discharge rates in the dependent group. Length of School Stay of Discharges to the Community, 1928-1939, by Mental Status Table 117 outlines the length of time that discharges remained in residence in State schools for each year of the period 1928-1939, by mental status. The total column shows little variation in length of residence over the past twelve years. With the excep- 256 P.D. 117 EC ~ s e CO 3 « < « c S » O rO an tt, o> a • :<-i o OS OH 6 K < ~s '< 5; 6q a ► o H fa H Q t- ►j < h Z H Eh' OS OS- 00 o CO 00 CN 1 1 1 1 1 CO.-* IN lOi-HOS ft O00N — ti-os CO IN 1 1 1 1 1 1 t^CNt^ 00 — CO O S co — o O — CO co co CN 1 1 1 1 1 IOCN.O CO CO E-i lOCN- lO lO tJ< o IN 00 CO CO CO 1 1 CO ■tf 1 1 oo os co i-HCOlO COrt CN 55 O « o ft -* ooo (NCOCO 00 coco m CO 00 1 1 CN 1 1 HNUJ 00cOt»i ■* s- s ho« C0C1-T COCNiO ooiot^ CO oo I I IN 1 1 t^CNCO cot^co H O — — 00 CM COO ©-tf CO Os 1 1 ■* 1 1 TflOOTtH OsiOlN CO cf H ►3 G H ft C! t>CO CN — o — cn OS 1 1 CO iH 1 1 t^cqcq n s a o>oco 00 H CO — OS CO ©O OS CO 1 1 "1 1 1 >ocot^. CO oo o S ft NCIO OS CM OS — CO CO CI t» 1 1 1 1 1 cocot~ oo CO £ ■* — OS o — OCC CN CO CO 1 1 CM i-i 1 1 (NCOCO ■* H •#cOcN iCt^CO co ci coho ■#1-1 CO O 1 1 CO OS 1 1 ost^co OS.-ICO OS IN Ui 0 ft SDOSTf o^j„'"' oj (_ c3 a < a o 5 fa ioooooooooot~>o CM oooooooooo>ot^ Noootoooooonoo -f HHH rH i-H i— ( i— I i— t £§ fa s moooto I o l l l t~>o t^OOOCO O o i-i ■* K « - cl .2 .2 . . o3 +jj . . . .-t3 . . Q j •< 2"g "3-i S « C O g J _-S 03 O O I-. £ O S° 1 1 1 ^ St- • £ 03 03 O O ' g SO » ' S "S R-g EEeoojc 6 F-H ■33 0) o^ °3 o3 afi^3 fc-O .SO'OgChl.nuo*'" 03 0 ~ bo •T,"^"ff «(h H feSt£t£fafafai£i£i£h30 i CQ SQ c3^ •2 I ^> s CJ -^ >a i i co l l 1 1 1 i i i CO 1 1 ri •* CM CO §Q z OS 1 1 NHN CM 1 1 i i i OOrHt^ S CM CM CO «3 i-H OOcOiO COCM-h >H | 1 CO 1 1 00 00 CO H U5 t^ CO CO O CM rt r* CM 55 c « o coceoo C0-H— I •C 1 1 CM 1 1 cOt^«3 fe OS >o CO co ■c °i 3 05 -i H t~ •* CM CM H >3 CMcor~ O-tf iO t- 1 1 -1 | | ©t^CO 5 fe 05 co co H CO CO ra a co—icm' t~t~co co I I co I I —100 CO § CO «o co 1^ co t~ H OS-*© wcot- C0-H1C0 ■"• 1 1 ccj'oo H 05 CM COCHIN ■* 05 CM CM CM iO 00 H fflrtO t-iOCO t~rH00 1 1 1 ©t~o6 0 fe 05 rH CO rH —i m 00 rH s CM co CO COOS OOrH-* co com -H | | oot~«> 2 O CM r-lrHCO CM rH ■*i-HCO 1—1 co rH ■* (DTf (O ooocn i-H^ICO 00 1 1 CO 00 CO H 00 rH ID CO •O CM ©T« ©_ CM •o IN co" "i" ►3 O5O00 cooco fflrt^' CO 1 1 ■*-HN Hi &h" INH CM— I CO —1 CM CM fcH CM m 00 o H CM t^^T« U50H CM CO CO >a i i 05t~0 a •O COCM—i CO CO l^CMrH 00 t- CO " CM EC a CD s .© ■M o D a "S "S "3 EH OP V CD cd < 5 © 5 © g .© s © 3 o "3 °- "S <=>. C3 O « °. "3 o a Sent: r Tre hs . per 1 V rH .ble: Tn er 1 town: der Tre aths . te per 1 V rH s- - 0 "ea fe.j-j a ■f ferfl a s-a& o CT3 cS-S .§■§35 "T3 ca-S o a) cl aj os ,ie»e h a u ^ S C <» c8 ■3 a j» oj W gPQtf 3^0« ■£&£)« Q 3 O B H ^2 T1 a a U e Eh CO s e ^^ VJ a 2 O ri ■< S w OQ i-noCMin inccrHt^ COt-iOiO mcot^t^ JS cu ■3 a§ 2lSl 266 P.D. 117 the females. Belchertown is higher with an average of 24 years, 17 years for the males and 28 years for the females. Fernald shows the highest average age at death, 31 years, 26 years for the males and 40 years for the females. All the schools show the females with higher average ages at death than the males. Table 131. — Age at Death of Patients who Died in State Schools, 1939, by School and Sex Age at Death Total M. Belchebtown M. F. Walter E. Fernald M. F. Wrentham M. Under 5 years 5- 9 years 10-14 years 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years 55-59 years 60 years and over Total Average Age 27 21 48 18.1 30.8 23.7 17.5 28.2 24.6 8 5 13 26.2 40.5 31.7 14.0 27.5 18.7 Length of School Stay of Deaths in State Schools, 1939, by Mental Status Table 132 gives the length of school stay during this admission of cases dying in State schools during 1939 by mental status. The totals reveal that patients dying had re- mained within the institution an average of 10.9 years previous to death, 8.8 years for the males and 13.7 years for the females. The shortest average length of stay, 7.3 years, occurs in the idiot group. The imbecile group shows an average residence before death of 14.6 years and the moron group 15.6 years. In the idiot, imbecile and moron groups the length of residence for the females is longer than for the males. Table 132. — Length of School Residence during THIS Admission, Deaths in State Schools, 1939, by Mental Status and Sex Mental Status Number Average Net Residence IN Y EARS M. F. T. M. F. T Idiot 17 8 1 1 7 7 7 24 15 8 1 7.0 12.9 7.5 7.5 7.9 16.5 16.7 7 14 15 7 3 6 6 Not Mentallj r Defective 5 Total . 27 21 48 8.8 13.7 10 9 Table 133. — Length of School Residence during ALL Admissions, Deaths in State Schools, 1939, by Mental Status and Sex Mental Status Number Average Net Residence in Years M. F. T. M. F. T. Idiot 17 S 1 1 7 7 7 24 15 8 1 7.3 7.9 12.9 19.3 7.5 21.7 7.5 7.5 15.9 20.0 7.5 Total 27 21 48 9.0 16.3 12.2 (See Table 266 for detail) Table 133 gives the length of school residence during all admissions of patients dying in State Schools during 1939. Here we include all previous admissions. The 48 patients dying had remained in residence a total of 12.2 years during all admissions previous to death. The average for the males was 9.0 years and for the females 16.3 years. The P.D. 117 267 __ o o a 65 II III 'III o d I o c o o 9 Q«£ _c Z II 1 1 |H| | | ,H i co.2 oa 65 o II III 'III o — i ft c o d >, o o J3 d m c3 - ■~ 03 6 Z II 1 1 1 IH | | | - 65 o o j II 1 1 1 1 1 • 1 o d o3 o o ft > » 03 5 o d 03 6 Z II 1 1 1 1 Nl ■* e 65 ■* l-l 1-ll-KN o ^ T)< — 1 ^H ^H(N d 3 -* rt l-Hl-KN o M C o § o z f 1 |H | r-*-H 65 coo ■ S -d a +s 03 "' ' ° "3 m d . 03 ' 03 CO M K i_ a ■ -Q- -O <: 8 ^ m "^ Q C3 "*ft (D O o ■ -5 -fas ■ ■ ■ to D So'C0dC g1^ OJ'-fet-gMdS P-i S co s^ ^"ss 5 _,+s.«r>j co co co co o3 co ^13 a 2 — "R ■"•<--. "5 ■» ^55° ° ° o s fi O ^ ^O $ CO CO C0*5+s "h3 co d «-i cq J2 2 59 co d ►Sort 55S5d> H 155 CO coco o t^ 03 CO coco o co d CO CO CO o O.S Z 1 — 1 rtrt 1 1 1 1 co (N OCN (M O o i-o 65 ■ 1 1 ■ • • 1 1 d si in eq in o "3 -.3 3* d p CO CO 1 | iHCOCO 1 tH 1 - o '3 ffl 65 II 1 1 1 1 1 ° 1 o JM'o o d Ts t. 0 o3 o o J-1 O > CO ft t ^ m JS d-a o d 2 II 1 1 1 1 Ml - d £ 65 o o II ■ 1 1 • 1 1 1 o o o o ~ §T3 iO U3 o £-§g 1-1 g-3 d z II H | |H | | | o ^:Sa rt &3 d 2 i-" 1 1 1 1 co 1 1 I •* o 65 o '1 1 1 1 1 1 1 1 o -k cS'oS Jan o o d o PL, 3 c ' 03 d 2 H 1 1 1 1 1 1 1 1 ~ GO 13 . . d . 03 o • • CO d g 'S d O CO ■ ' O '03 13 ~~ d c3 • -H -3 CO CO .d a . .-*» .03 . O o • • £> • d 03 03 co bo « t-.- M • Q -° < CO P 1 o b ■ -.S -T3 _ • ■ ■ O Q 6 S S =0 03 C-Sto S co .2 S-KCB03 E? "S Q m E S3 03 & ^^ m * „S?.^|ocodQ ■| |2q §^ s£|-a 00 O §f2 b-3 > g'aS He £|||2ortS|3 tod^J3°OOOo3d 03 .2j-°°a>^1'cod+s '-t-s cod^-j^ — S22cod S 2 g^ S 2 g g m§ -2 g^ C3^.2^.2 go £ort QQQQO> O l-IM f> M M W g S 1 268 P.D. 117 morons show the longest school residence previous to death, 20.0 years, 7.5 years for the males and 21.7 years for the females. The idiots and not mentally defective show an average of 7.5 years. The imbeciles show a residence of 15.9 years, 12.9 years for the males and 19.3 years for the females. Cause of Death of Patients Dying in State Schools, 1939 by Clinical Diagnosis Table 134 presents the causes of death of patients dying in State schools during 1939 in accordance with the main groupings of the International List, by clinical diagnosis. The totals show that infectious diseases account for 27% of deaths, diseases of the respiratory system for 25%, and congenital malformations for 16%. Over 60% of deaths of mental defectives for 1939 fall in these three groups. We shall not discuss the clinical groups having less than five deaths. Cases of hered- itary mental defect (familial) and of mongolism show their highest percentage of deaths among infectious diseases. The undifferentiated show a high percentage of deaths in infectious diseases, diseases of the respiratory system and diseases of the circulatory system. Comparative statistics between the clinical groups are unreliable due to the small number of deaths for a single year. Table 135. — Percentage Distribution of Caitses of Death and Mental Status of Patients Who Died in State Schools during 1989 Compared with Causes of Death of General Population, 1989 Causes of Death Percentage Total Idiot Imbecile Moron Not Mentally Defective General Popu- lation Infectious and Parasitic Diseases: Influenza Dysentery Tuberculosis of the respiratory system Disseminated tuberculosis .... Syphilis Cancer and Other Tumors: Cancer and other malignant tumors Non-malignant tumors Rheumatic Diseases, Nutritional Diseases, Dis- eases of the Endocrine Glands and Other General Diseases: Other general diseases Diseases of the Nervous System and of the Organs of Special Sense: Meningitis Other diseases of the nervous system . Diseases of the Circulatory System: Endocarditis Myocarditis Other diseases of the heart .... Diseases of the Respiratory System: Bronchopneumonia (including capillary bronchitis) Lobar pneumonia Pleurisy Asthma Diseases of the Digestive System: Other diseases of the digestive system Congenital Malformations: Congenital malformation (still-birth not in- cluded) Violent and Accidental Deaths: Other accidents All Other Causes Total 2.0 2.0 18.7 2.0 2.0 2.0 2.0 2.0 4.1 10.4 2.0 2.0 16.6 4.1 2.0 2.0 2.0 16.6 2.0 100.0 4.1 8.3 4.1 4.1 4.1 20.8 8.3 4.1 25.0 40.0 6.6 6.6 6.6 20.0 6.6 13.3 12.5 12.5 37.5 12.5 12.5 100.0 100.0 100.0 100.0 .4 .02 2.9 .001 .4 13.7 .4 .007 3.3 11.9 10.9 3.7 2.4 .1 .1 .1 .3 47.6 (See Table 267 for detail) Cause of Death of Patients Dying in State Schools, 1939 by Mental Status Table 135 gives the percentage distribution of the causes of death in the various mental status groups for 1939. In the totals, the four prominent causes of death are tuberculosis of the respiratory system, 18.7%, bronchopneumonia and congenital mal- formations 16.6% each and endocarditis, 10.4%. Adding all causes we find that failure of the heart or respiratory system is linked with 57% of deaths in mental defectives. P.D. 117 269 In the idiot group congenital malformation is first, with 25.0%, and bronchopneumonia second, with 20.8%. In the imbecile group, tuberculosis of the respiratory system is first with 40.0%, bronchopneumonia second with 20.0%. In the moron group, endo- carditis was the chief cause of death with 37.5%. Tuberculosis and bronchopneumonia are prominent in every mental status group. Owing to the younger ages of the resident population of State schools and the older ages of the general population, exact comparisons of causes of death are impossible. However, we note certain diseases are very high in mental deficiency. The infectious diseases account for 26% of State school deaths and 3% of deaths in the population. Other significant differences are congenital malformations (State schools 16%, — popu- lation .7%) and bronchopneumonia (State schools 16%, — population 3%). Clinical Diagnosis of Deaths in State Schools, 1939, by Intelligence Quotient Table 136 outlines the average intelligence quotient of patients dying during 1939 divided into the various clinical groups. The average intelligence quotient of all patients dying was .27, .22 for males and .35 for females. The average intelligence quotient of discharges was .53 (Table 122). This shows that patients of higher intelligence are discharged while those of lower intelligence contribute materially to the deaths. Con- sidering only the groups with five or more cases, we note that the highest average I. Q. at death occurs in the familial group with .49. The undifferentiated show an average I. Q. of .20, the Mongols .18. It will be noted that the females present higher average I. Q.'s in nearly all of the clinical groups. Table 136. — Average Intelligence Quotient of Deaths in State Schools, 1939, by Clinical Diagnosis and Sex Clinical Diagnoses Number M. F. Average Intelligence Quotient M. With congenital cerebral spastic infantile paralyses Post-traumatic — natal .... With other organic nervous disease With epilepsy — idiopathic .... Mongolism . Undifferentiated With endocrine disorders .... Post-infectional With developmental cranial anomalies Familial ........ Other forms Total - .05 .05 05 - .05 — .15 .15 15 .20 .17 16 .25 .18 16 .31 .20 25 - .25 - .25 .25 31 .15 .27 42 .53 .49 - .41 .41 27 .35 .27 (See Table 265 for detail) Table 137. — Average Age of Deaths in State Schools, 1939, by Clinical Diagnosis and Sex Average Age at Death Clinical Diagnoses Number IN Years M. F. T. M. F. T. Post-traumatic — natal .... 1 1 3.5 3.5 With other organic nervous disease — 1 1 _ 7.5 7.5 2 - 2 12.5 - 12.5 Mongolism ....... 7 2 9 17.6 10.0 15.9 With developmental cranial anomalies 3 1 4 19.1 7.5 16.2 Post-infectional — 1 1 — 17.5 17.5 With epilepsy — idiopathic .... 2 2 4 15.0 27.5 21.2 8 3 11 23.8 30.8 25.7 Familial 4 7 11 15.0 42.5 32.5 With congenital cerebral spastic infantile paralyses - 1 1 - 37.5 37.5 Other forms - 3 3 - 37.8 37.8 Total 27 21 48 18.1 30.8 23.7 (See Table 264 for detail) 270 P.D. 117 Clinical Diagnosis of Deaths in State Schools, 1939, by Age Table 137 presents the average age of patients dying in State schools by clinical groupings. The average age at death was 23.7 years, 18.1 years for the males and 30.8 years for the females. The clinical groups showing the highest average ages at death are with congenital cerebral spastic infantile paralyses, 37.5 years; familial, 32.5 years; and undifferentiated, 25.7 years. At the other extreme we have the youngest ages at death in the groups post-traumatic — natal, 3.5 years; with other organic nervous disease, 7.5 years; and endocrine disorders, 12.5 years. Length of School Stay of Deaths in State Schools, 1939, by Clinical Diagnosis Table 138 gives the average length of school stay of the 1939 deaths, by clinical group- ings. Cases dying in State schools during 1939 had remained an average of 10.9 years previous to death, 8.8 years for the males and 13.7 years for the females. The longest time in residence occurs in the groups with congenital cerebral spastic infantile paralyses, 27.5 years (one case) and undifferentiated 14.1 years. The shorter average lengths of residence are seen in the groups with other organic nervous disease, 1.5 years, and post- traumatic — natal, 2.5 years (one case each). Table 138. — Average Length of Residence during THIS Admission of Patients Dying in State Schools, 1939, by Clinical Diagnosis and Sex Average Length OP Clinical Diagnoses Number Residence in Years M. F. T. M. F. T. Familial 4 7 11 7.2 13.9 11.5 Mongolism 7 2 9 8.9 4 0 7.8 With developmental cranial anomalies 3 1 4 3 2 1.5 2.7 With congenital cerebral spastic infantile paralyses - 1 1 _ 27.5 27.5 Post-infectional .... _ 1 1 _ 12.5 12.5 Post-traumatic — natal .... 1 _ 1 2.5 2.5 With epilepsy — idiopathic .... 2 2 4 7.5 20.0 13.7 With endocrine disorders .... 2 - 2 4.0 _ 4.0 With other organic nervous disease _ 1 1 1.5 1.5 Undifferentiated 8 3 11 13.8 15.0 14.1 Other forms - 3 3 .18.3 18.3 Total 27 21 48 8.8 13.7 10.9 Section K. Patients in Residence in State Schools for the Mentally Deficient on September 30, 1939 The following section is devoted to a discussion of various factors in the resident population and patients carried on the books of State schools on September 30, 1939. Patients Resident in Public and Private Schools, 1904-1939 Table 139 outlines the patients in residence in public and private schools for mental defectives on September 30 of each year from 1904 to 1939, inclusive. The rates per hundred thousand population are given on the totals for all schools and for the State schools. The numbers in all institutions for mental defectives increased from 927 in 1904 to 6,002 in 1939. The rate increased from 30 per hundred thousand of the popula- tion in 1904 to 135 in 1939. This is an increase in rates of 350%. The total rates for the males increased from 38 in 1904 to 146 in 1939, a rate increase of 284%. The females increased from a rate of 23 in 1904 to 125 in 1939, an increase of 443%. The residence rates for the males are higher than those for the females in all years of the period. How- ever, the greater increases in the females are bringing about a balance between the sexes. In 1904 the residence rate for the males was 65% higher than that for the females. In 1939 the residence rate was but 16% higher. In considering the figures for State schools only, we note that the numbers increased from 847 in 1904 to 5,238 in 1939. The resident rates have increased from 27 in 1904 to 118 in 1939. The males increased from a rate of 34 in 1904 to 118 in 1939, an increase of 247%. The females increased from 21 in 1904 to 117 in 1939, an increase of 457%. The males have shown higher residence rates in all years from 1904 to 1921, during the year 1924, from 1928 to 1930 and from 1937 to 1939. The sexes showed the same rates in the years 1922, 1923, 1926 and 1927. In 1925 and 1931 to 1936 the females have P.D. 117 271 E- < > P- J O O B cccOtOOOl>00t>00OC:0;0i0000000000t>X OOOOtONn>ntOtDOOONCOINO'00)(NMO^ClOOrHO<1000!^(DW(NOM0001N ►2 ° E-i 2 NiONNCO'ONOON^iOW^^iOiOO'tOacOWCOOOONONWlOiO'^'^Ol^ HiHHHHHH(i5MW0USO«!NMX)00Nt«NNM»«»M»00a0100l»00l0<0 C:OOai02(350'-'00-Oi«DI>COinOO'H"Ot^OiOOOM>OC35"-<'Hi'*>0 coeoco-*-*'*'i,iooioooNNNNNNN(JOfflaaooo«'H'H(NMNcoracon COt-0>NC<5"i60SOt»o6'Ot»OTtOii3 00Tfi!O00C<)iO00-H^«DTft^^HC^C^>-i^H'-H|>Ct^0i(MO(NTft>OrtO-*i^C0^t,«D W*^*'0'OlOOffl50t»t-OOOOOOOOWMt»05050500'-H'-l'-HCMCVIooooO'Hi-i(onHj^iioio>0"0"ONoiooiHiMnH/io< •-iNe>3'*'ncot-ooo50'-ie-* T-T « P= 00 O 'O CO o ^H IMt-H lO 00 00 r-H ■* -* CO oo H OSOCNOOCM CO t~00^HO0Tl» I OSlOi-H rtrt lOOlC-HHCM i-l CO-* Oi-H OOOSOCDCO^H ramort TtiCDCO-H -HHCO.-H -HCD ^H'-H'CHIM 1C OS 00 CM rH ,-1 CN t-H TjH CO ■* lO NOrH^mo 00-H/CDrHHinO OJ S _ 0.0*^ = S ^h Ci2 O 3 O P.D. 117 273 shown higher residence rates. Marked increases have been made in bed provision for females who are mentally defective. It is interesting to recall that the resident rates for mental hospitals rose from 278 in 1904 to 500 in 1939, an increase of 79%. Over the same period, the resident rates for State schools rose from 27 in 1904 to 118 in 1939, an increase of 337%. Residence rates for mental diseases, ten times as high as the residence rates for mental defectives in 1904, are only four times as high in 1939. Mental defect is gaining on mental diseases as a major public health problem. Mental Status of Patients Resident in State Schools, 1939, by School Table 140 presents the mental status of cases resident in the three State schools on September 30, 1939, giving the percentage distributions. Considering the totals, the idiot group makes up 15.2% of the resident population of all schools, 16.8% of the males and 13.7% of the females. The imbecile group constitutes 42.1% of the resident popu- lation, 44.4% of males and 40.0% of females. The morons comprise 40.4%, 36.5% of males and 44.1% of females. The borderline group makes up 1.6%; with .4% for the dull normals and .05% for the normals. The males exceed the females in the idiot, imbecile, dull normal and normal classifications. The females offer a higher percentage in the moron and borderline cases. Considering the schools separately, Wrentham has the largest percentage in the idiot group, 17.1%. Wrentham and Fernald each have 44.0% in the imbecile group. Belchertown has the largest proportion in the moron group, 46.4%. Length of School Stay of Patients in Residence, 1939, by Age at Admission Table 141 presents material on the age at admission and average length of school stay of all patients in residence in State schools on September 30, 1939. For all patients in residence, the average admission age was 13.7 years, 11.9 years for males and 15.3 years for females. The average length of time in residence for all patients within schools was 11.6 years, 11.7 years for males and 11.5 years for females. A total of 1,572 patients was admitted between the age of 5 and 9 years; 1,513 between the age of 10 and 14 years; and 996 between the age of 15 and 19 years. Sixty-five per cent of the resident population were admitted under the age of 15 years; 91 % under the age of 25 years and 97% under 35 years. In comparing the sexes we note that the males are higher in the admission age groups under 5 years, 5-9 years and 10-14 years, a total of 1,952 of the resident males being admitted during these ages as compared with 1,490 of the females. However, in the admission ages over 15 years we find the females predominating with 1,207 of the resident females admitted in these age groups as compared with 589 of the males. Males tend to be admitted under the age of 15 years (76%). Among the females only 55% fall in the same ages. In the females the distribution of admission ages show a more uniform spread throughout all ages. Table 141. — Average Length of School Residence during This Admission, Patients Resident in State Schools on September 30, 1989, by Age at Admission and Sex Age at Admission Number Average Length of Residence in Years M. F. T. M. F. T. 10-14 years 20-24 years 25-29 years 55-59 vears 60 years and over 198 159 357 957 615 1,572 797 716 1,513 371 625 996 108 269 377 49 138 187 22 89 111 22 46 68 7 22 29 5 9 14 2 7 9 2 2 4 1 1 8.8 8.0 8.4 11.2 11.1 HI 12.1 11.9 12.0 12.7 10.7 11.4 13.4 13.9 13.8 14 0 12.4 12.8 15.1 13.0 13.4 13.8 11.2 12.0 13.0 9.1 10.0 10.5 13.7 12.5 12.5 117 11.9 5.0 25.0 15.0 .1 - 1 Total Average Admission Age and Average Length of Residence ...... 2,541 2,697 5,238 11.9 15.3 13.7 11.7 11.5 11.6 274 P.D. 117 In the second section of this table we note that all patients in residence have remained there an average of 11.6 years. Those admitted under five years or over 60 years of age have shown a short school stay of 8.4 and .1 years, respectively. The length of stay increases gradually through the various age groups up to a school residence of 13.8 years in the age group 20-24 years. The 30-34 group also shows a long stay of 13.4 years. The males show a longer period of residence in State schools than females in ten of the thirteen age periods. The length of stay is remarkably constant whatever the age at admission. Length of School Stay of Patients in Residence, 1939, by Present Age Table 142 presents the present age and average length of school stay of patients in residence on September 30, 1939. The average present age of all resident cases was 24.9 years, 23.3 years for the males and 26.4 years for the females. The average length of residence is 11.6 years, 11.7 years for the males and 11.5 years for the females. In present age, the 15-19 year group leads with 1,030 cases. The 20-24 year group is second with 831 cases; the 10-14 year group third with 827 cases; and the 25-29 year age group fourth with 607 cases. It is interesting to note that we have a total of 256 cases, or 4% in residence who are over 50 years of age. Sixty-seven are over 60 years of age and 4 are over 70. Only 51 of the resident cases are under 5 years of age. A total of 62% of resident patients are between the ages of 10 and 30 years. From the age of 20 years onward, the females offer the larger numbers except in the age group 55-59 years. Up to 19 years and in the 55-59 year group, the males present the larger numbers. Table 142. — Average Length of School Residence during This Admission, Patients Resident in State Schools on September SO, 1939, by Present Age and Sex Present Age Number Average Length of Residence in Years M. F. T. M. F. T. 10-14 years 25-29 years 30-34 years 45-49 years . . ..... 65-69 years 30 21 51 186 147 333 495 332 827 571 459 1,030 357 474 831 268 339 607 210 279 489 142 219 361 95 179 274 78 101 179 44 76 120 36 33 69 19 23 42 10 11 21 4 4 1.3 1.3 1.3 2.7 3.1 2.9 4.9 4.9 4.9 6.6 5.5 6.1 11.1 8.4 9.5 14.8 12.6 13.6 18.6 15.6 16.9 21.6 17.9 19.4 24.8 18.8 20.9 28.4 23.3 26.9 30.3 25.2 27.1 32.8 29.6 31.3 34.6 29.3 31.7 32.5 31.7 32.1 36.6 36.6 Total Average Present Age and Average Length of Residence 2,541 2,697 5.238 23.3 26.4 24.9 11.7 11.5 11.6 Viewing the average length of time in residence in the second section of Table 142 we note a positive correlation between age and length of residence. Patients under 5 years of age at the present time have remained in schools an average of 1.3 years. Gradual increases occur until a school stay of over thirty-six years is seen in those who are 70 years of age. Significant sex differences occur. In eleven of the fifteen age groups the males have remained within school for longer periods than the females. If we calculate the maintenance costs, interest on capital investment, depreciation, etc., we come to an approximate figure of $450.00 per year for the State school care of each mental defective. The 5,238 cases in residence in our State schools, with an average stay of 11.6 years, have already cost the Commonwealth the sum of $27,342,360. Mental Status of Patients Resident in State Schools, 1929-1939 : Rates per 100,000 of Population Aged 0-44 Years Table 143 gives the mental status of cases in residence in State schools on September 30 of each year from 1929 to 1939. In comparison with the State population aged 0-44 years (1930 census), the rate for the resident population of State schools increased P.D. 117 275 from 126 per hundred thousand in 1929 to 168 in 1939, a rate increase of 33% in ten years, or 3.3% per year. Among the idiots, the rate of 23 in 1929 approximates the 25 of 1939. The imbecile group increases from a low of 46 in 1929 to a high of 70 in 1939. The morons show a less precipitate increase, from 52 in 1929 to 68 in 1939. The group not mentally defective shows uniformly low rates between 3 and 5 throughout the years studied. Over the period 1929 to 1939, both the imbeciles and morons show marked increases, while the idiot and not mentally defective groups show little change. The accumulation of these various mental status groups within institutions measures, to a certain degree, both the extent of community demand for provision and the possi- bility of return to the community of the different types of patients. The idiot group presents uniform residence rates throughout the ten year period. The imbecile and moron groups both show conspicuous increases, the trend being more marked in the imbeciles. The high death rate in the idiot group undoubtedly is a contributing factor in keeping the residence rates on an even level. The moron group is showing a low death rate, a high discharge rate and a moderate degree of accumulation. There is less opportun- ity of placing the imbeciles in the community as parolees and this group is showing a pronounced accumulation. Table 143. — Mental Status of Cases Resident in State Schools on September 30, 1929- 1939: Numbers and Rates per 100,000 Population of State 0-44 Years of Age, 1930 Census Not Total I DIO Imbecile Moron Mentally Years Defective No. Rate No. Rat e No. Rate No. Rat e No. Rate 1929 .... 3,941 126. 721 23 1,450 46. 1,622 52 148 4. 1930 . 4,159 133. 778 24 1,517 48. 1,737 55 127 4. 1931 . 4,412 141. 821 26 1,623 52. 1,816 58 152 4. 1932 . 4,566 146. 836 26 1,649 52. 1,920 61 161 5. L933 . 4,771 153. 908 29 1,723 55. 1,961 62 179 5. 1934 . 4,933 158. 699 22 1,978 63. 2,103 67 153 4. 1935 . 5,009 160. 726 23 2,052 65. 2,089 67 142 4. 1936 . 5,133 164. 729 23 2,137 68. 2,141 68 126 4. 1937 . 5,244 168. 771 24 2,216 71. 2,144 68 113 3. 1938 . 5,225 167. 771 21 2,221 71. '2,128 68 105 3. 1939 . 5,238 168. 798 25 2,208 70. 2,121 68 Ill 3. Nativity of Patients Resident in State Schools, 1939, by Admission Age The average admission age of the resident population was 13.7 years, 11.9 years for males and 15.3 years for females (Table 144). The native born of the resident population were admitted 6.4 years younger than the foreign born, 13.5 years for the native born and 19.9 years for the foreign born. The native born with both parents foreign born were admitted at an average age of 13.9 years, 12.5 years for males and 15.1 years for females. The native born with one parent foreign born and the other parent native born show an average admission age of 13.4 years, 11.6 years for males and 15.1 years for females. The native born of native parentage were admitted at an average of 13.0 years, 11.5 years for males and 14.5 years for females. It is seen that within the native born classification, the three parentage groups show admission ages within a year of each other. Admission Age, Present Age and Length of School Stay of Resident Population and Patients out on September 30, 1939 Table 145 gives us the average age at admission, the average present age and the average length of school stay of patients in residence and patients out on visit, etc. on September 30, 1939 for the three schools. The Fernald State School shows the highest average present age of resident patients, 27.4 years. Belchertown is second with an average of 24.6 years. Wrentham shows the youngest resident age, 22.6 years. All show older present ages in females than in males. Turning to the third section of this table, we note that the Fernald State School shows the longest average residence of 14.1 years, 22.4 years for the males and 13.9 years for the females. Wrentham is next in order with 10.3 years for the resident cases, 9.2 years for the males and 11.2 years for the females. Belchertown presents an average of 8.3 years, 8.7 years for the males and 8.0 years for the females. 278 P.D. 117 1 O m tH CM IN CM t-- 00 CO Tf 1 1 1 o Tf 1 ON1DHHH 1 1 1 1 1 1 CO T* ce t>- ^f t» >o co ih t>- CM CMCMrH oo co CO 11 - '5 s Eh' Eh' o ea'3 £S ^.Ph Ol CO lO CO 05 tJH •* t- •* CO 1 1 1 t~ 2 1 ThCM 1 HHH | | | | | | en cm O) O —i O CO CM ~h Tf Eh' -h-"-i 't IO P=l lO H «« £ t" cc Ph a! "g C a) & °5 i-HenCncOCOOOCO^HCM — ' 1 1 1 CO CO < 1 COIOCO 1 1 1 1 1 1 I | | ». »o i: COCOOrH CM H S r-* ~H ^ 3 A CM a s B oi H s» H a OiOMTfONOOWLTifiN 1 CO en 1 CO CO CO CO t^ CM i-h lO CM CM 1 1 t* en Oh c f~ -? 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J cs co cm Tti en rt< oo co co oo co cm i C ^ cm t^ en en Tfi cm ^ cm cm |h I I IO CM o < loooiotnsMH ec o Er l-H lO00t^T*CM i-H CM En O fa" -h CO CD CO CM -h cm" m CO CO Eh a & v e OOtD'iM't'OOOlOtrfNrH CS CO MOO ■*" CM^h CO 00 o iOMONOCCh 1 1 1 1 1 1 rHOOOCOi-H CM T" IO >3 S i-h cnt^co—i ■^1 ^ s S rt CM i-h CM 1 e o pq 1 O s i. « ^ cmco cot^t*. i-h co c»Tt< en -*f-i 00 t~ ocncMiooot^coi-HCococMCMi-H CO o iOt^rtCnf~CO-HCOCMr-H co K Eh Eh CM CD CO CO i-h HH CO of '"' Z V ~ H en io co io en oo en co cm en t-- cm I t^ CO cS t* m en co t^ -h cm en en co cm i-h I co io Q E< IO — i i-c CM CO CO 00 TC CN SO Z co ■ CO -H < 0 Eh" i-h co !•» CO CM i-i CO m Eh CM CM CM CD th ^> K CM a CO 0 t- o c8 - < COt~C~~HCCCncMCM^»OCMCMi-H eniccnt^o-^CMCM <* en Ph Jh CD Th CO CS i-H CD i-H CM ■>*< 1 1 rHrt rtOCOn^HHM oo >o CO -Hcnt^co—i lO o H^fCOrt O i-H 8 & of pq i<=i 7~ 1 H T 8 C3 O < a < Z fc o 0 00 DQ a Q < co QQ o u co co o < idSc]B3rt = 3SrtcI"i ~ r*ic3cdc3ccin3cddrirto3aSra ,,.coS:cococococococococo,„ CUQJCUtDCUCUCUCUCUCUO,,, 10 >>>>>>>,>,>>>>>>>>>>>>>£ o > 10 ^t-i^^^^^^^^^S o > c3o>TticnT)-cnTt. a 1 1 l l l l l 1 ll ,riooioo«ooiooooino t~> <-i h CM CM CO CO "CH Tt< lO lO CO •n "-H H CM CM CO CO t* ■* io "O >, 3 1 1 ►SiOOiOOiOOiOOiOOiOO I— 1 i-H i-h CM CM CO CO "* Tf< IO lO CD ' P.D. 117 277 The cases out of institutions represent those who are on visit, parole, or escape or in family care at the end of the year. The present age of these cases is 31.1 years, 27.7 years for the males and 33.3 years for the females. The males out of institutions are four years older and the females seven years older than those resident within institutions. The present ages of patients out in the community are 35.1 years for Belchertown, 31.5 years for Fernald and 27.0 years for Wrentham. These cases placed out of institutions have been under the care of the three schools for 12.7 years, 12.2 years for the males and 13.0 years for the females. They have been on the books 15.3 years for the Fernald State School, 13.0 j^ears for Wrentham and 11.0 years for Belchertown. Table 145. — Average Admission Age, Average Present Age and Average School Residence of Patients Resident in State Schools, and Out on Visit, etc., on September 30, 1939, by School and Sex Cases in Residence State Schools Average Age at Admission Average Present Age Average Length of School Stay M. F. T. M. F. T. M. F. T. Belchertown . Walter E. Fernald Wrentham 14.5 17.6 16.3 12.0 15.3 13.3 10.3 13.7 12.3 23.2 26.1 19.5 25.6 29.2 24.9 24.6 27.4 22.6 8.7 8.0 8.3 22.4 13.9 14.1 9.2 11.2 10.3 Total 11.9 15.3 13.7 23.3 26.4 24.9 11.4 11.1 11.2 Cases Out of Institution Belchertown . Walter E. Fernald Wrentham 20.9 13.7 12.4 25.6 24.1 18.7 16.2 15.1 14.0 32.3 36.5 26.6 36.4 24.9 28.5 35.1 31.5 27.0 11.4 12.9 12.5 10.9 17.7 13.4 11.0 15.3 13.0 Total 15.5 20.3 18.4 27.7 33.3 31.1 12.2 13.0 12.7 (See Tables 268 and 269 for detail) Clinical Diagnosis of Resident Population, 1939, by School Table 146 outlines the clinical classification of cases in residence at the three State schools on September 30, 1939. Taking the groups in numerical order, we find that the undifferentiated make up 46% of the resident population at Wrentham, 41% at Fernald and 30% at Belchertown. The familial group is high at Belchertown with 49%; inter- mediate at Wrentham with 30%; and low at Fernald with 15%. In the cases of mongol- ism we find the largest percentage resident at Wrentham, 6%, with 4% at Fernald and Belchertown. Post-infectional is high at Fernald, 6%, and low at Wrentham, 2%; Belchertown has 5%. Clinical Diagnosis in Admissions, Discharges, Deaths, 1939, and in the Resident Population and Patients out on September 30, 1939 Table 147 presents a comparison of the clinical diagnoses in admissions, discharges, deaths, resident population and patients out on visit, etc., for the year 1939. It gives us an excellent opportunity to compare the trends in the various clinical groupings for the five different classes of patients mentioned. By inspection, we may determine the tendency of certain clinical groups to predominate in admissions, discharges, deaths or in the resident population. We note that cases of mongolism made up 7% of admis- sions, 3% of discharges, 18% of deaths and but 5% of the resident population. These findings show at a glance that few mongolians are discharged, many of them die, and few accumulate in the resident population. A similar situation is seen in the groups with developmental cranial anomalies, with other organic nervous disease, with epilepsy — - idiopathic and with endocrine disorders. In each of these groups high percentages among the deaths are observed. Certain groups are high in discharges. The familial group made up 26% of admissions, and showed an even higher proportion, 28%, of discharges. This clinical group and the undifferentiated show this tendency to high proportions among the discharges. Certain of the clinical diagnoses show a tendency toward retention within State schools. 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"g 05 5 ©3 *> '£ 09 g I -I -e » 02 S co -S ° e ■&* s « I O-HOCOCN I CiOOClCDt^ -HCN -HTt*CO I comt~r~oo I t^ I co l I l mi'NNH i n t ro l l l - M MM E 2 a a c3 c3 cc3 co S a> m >t >i >> t4 a a a a o o o r]fiaau»H:ifrtE*>»*a^M ^ CO t— •— < d> (D OJ OJC^^CTS oj I i i ± ^^^^ i 7T ^ SH^ooHMcOTfioomo P.D. 117 291 Section O. Deaths of Non-Psychotic Epileptic Patients, 1939 During 1939 there was a total of 41 deaths among the non-psychotic epileptic patients, an increase of 57% from the 26 deaths during 1938. Duration of Hospital Life of Non-Psychotic Epileptic Patients Dying 1938 and 1939 Table 162 shows that the total duration of institutional life of patients dying during 1939 was 10.0 years. This was somewhat longer than the same average of 9.1 for the year 1938. In 1939 a total of 6 deaths, or 14% of the total, occurred under one year. In 1938, 19% of the total died after a hospital stay of under one year. In 1939, 8 patients, or 19% of the deaths and in 1938, 3 patients, or 11%, had spent 20 years or more of their lives within institutions. , Table 162. — Total Duration of Institutional Life during All Admissions of Epileptics (Non-Psychotic) Who Died in 1938 and 1939: Percentage Distribution Duration of Institutional Life Number Percent Number Percent Less than 1 month . 1- 3 months .... 4- 7 months .... 8-11 months .... 1 year 2 years 3 years 4 years 5- 9 years .... 10-14 years .... 15-19 years .... 20 years and over Total Average Length of Residence 2 4 4^8 4.8 2.4 7.3 7.3 4.8 4.8 19.5 7.3 14.6 19.5 3.8 7.6 3.8 3.8 7.6 7.6 3.8 23.0 11.5 15.3 11.5 100.0 10.04 26 9.17 100.0 (See Table 173 for detail) Causes of Death in Non-Psychotic Epileptic Patients Dying, 1938 and 1939 In Table 163 epilepsy is given as a cause of death in 36% of patients dying during 1939. Bronchopneumonia and other respiratory diseases are very high, being the cause in 26% of deaths. Tuberculosis of the respiratory system and accidental suffocation each account for 9% of the deaths. In the preceding year, 1938, epilepsy was responsible for 38% of deaths and bronchopneumonia and other respiratory diseases for 34%. Excluding epilepsy as a cause of death, diseases of the respiratory system of one type or another are prominent in the causes of death among the epileptics. Table 163. — Causes of Death of Epileptics {Non-Psychotic) Dying in 1938 and 1939 1939 1938 Causes of Death Number Percent Number Percent Tuberculosis of the respiratory system 4 9.7 1 3.8 15 36.5 10 38.5 — - 1 3.8 Bronchopneumonia and other respiratory diseases 11 26.8 9 34.6 1 2.4 1 3.8 Other diseases of the stomach .... - — 1 3.8 - - 1 3.8 - - 2 7.7 1 2.4 _ 1 2.4 _ _ 1 2.4 _ _ Diseases of the nasal fossae and annexae 1 2.4 _ _ 1 2.4 _ _ 1 2.4 _ _ Accidental mechanical suffocation 4 9.7 - - Total 41 100.0 26 100.0 (See Table 171 for detail) 292 P.D. 117 Section P. Non-Psychotic Epileptic Patients in Residence in the Monson State Hospital on September 30, 1939 On September 30, 1939, there were 701 first admissions classified as non-psychotic epileptics residents at the Monson State Hospital, 353 males and 348 females. Read- missions in residence totaled 303 patients, 142 males and 161 females. Length of Hospital Stay During the Present Admission of All Non-Psychotic Epileptic Patients in Residencc, September 30, 1939, by Diagnosis Table 164 shows that of the 701 first admissions in residence, 1 was diagnosed as toxaemic-exogenous, 167 were toxaemic-endogenous, 255 due to brain disease and 278 idiopathic. The males predominate in the symptomatic, while the females present a high number in the idiopathic group. In the readmissions in residence, 3 were diagnosed as toxaemic-exogenous, 84 as toxaemic-endogenous, and 64 as due to brain disease. One hundred fifty-two placed in the idiopathic group. The first admissions in residence had remained in hospital a total of 8.9 years at the end of 1939, an average of 8.1 years for the males and 9.8 years for the females. The toxaemic-endogenous group had remained the longest with an average of 10.8 years, and the group due to brain disease the shortest time with 5.9 years. Table 164. — Average Length of Hospital Residence during the Present Admission of All Epileptics (Non-Psychotic) , First and Readmissions in Residence on September 30, 1939, by Diagnosis and Sex First Admissions Epileptic Gpotjps Number Average Net Hospital Residence in Years M. F. T. M. F. T. Symptomatic Toxaemic: 1 84 139 129 83 116 149 1 167 255 278 7.5 10.8 5.2 9.4 10.7 6.7 11.8 7 5 Due to brain disease 10.8 5.9 10 7 Total .... 353 348 701 8.1 9.8 8 9 Readmissions Symptomatic Toxaemic: 3 42 35 62 42 29 90 3 84 64 152 6.8 13.9 9.9 12.1 12.6 7.2 12.6 6 8 13 3 8.7 12.4 142 161 303 12.0 11.6 11.8 The readmissions in residence had remained an average of 11.8 years, 12.0 years for the males and 11.6 years for the females. In readmissions, also, the toxaemic-endogenous group had remained longest, an average of 13.3 years. The toxaemic-exogenous had remained the shortest time, 6.8 years. P.D. 117 293 Table 165. — Movement of Population of Epileptics (Non-Psychotic), for the Year Ended September 30, 1939, by Sex Total Regular Court Commitment Obser- vation Voluntary M. F. T. M. F. T. M F. T. M. F. T. Patients on books of institution Sep- tember 30, 1938 .... Admissions during year: First admissions .... 528 32 7 533 31 9 1,061 63 16 181 10 5 203 10 4 384 20 9 1 - 1 347 21 2 330 21 5 677 42 7 Total admissions .... Transfers from other mental hos- 39 40 1 79 1 15 14 1 29 1 1 - 1 23 26 49 Total received during year . 39 41 80 15 15 30 1 - 1 23 26 49 Total on books during year 567 574 1,141 196 218 414 1 - 1 370 356 726 Discharged from books during year: As improved As unimproved As without psychosis 17 11 28 5 5 10 1 - 1 11 6 17 Total discharged to community Transferred to other mental hospitals Died during year .... 17 19 11 22 28 41 5 7 5 8 10 15 1 - 1 11 12 6 14 17 26 Total discharged, transferred and died during year 36 33 69 12 13 25 1 - 1 23 20 43 Patients remaining on books of hospi- tal at end of year: On visit or otherwise absent . 495 36 509 31 1,004 67 171 13 194 11 365 24 - - - 324 23 315 20 639 43 Total 531 540 1,071 184 205 389 - - - 347 335 682 Note: During the year one male was changed from the epileptic classification to the psychiatric classi- fication. Table 166. Age of First Admissions, of Epileptics (Non-Psychotic), 1939, by Diagnosis and Sex Age Groups M. F. T. Symptomatic Toxaemic Exogenous M. F. T. Endogenous M. F. T. Due to Brain Disease M. F. T. Idiopathic M. F. T. Under 5 years 5- 9 years 10-14 years 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years 55-59 years 60 years and over Total . - 2 1 1 1 2 - 8 7 15 5 3 8 3 3 6 2 13 20 14 34 294 P.D. 117 Table 167. — Degree of Education of First Admissions, of Epileptics (Non-Psychotic) 1939, by Sex Degree of Education Patients 16 Years and Under Degree of Education Patients 17 Years and Over M. F. T. M. F. T. Less than first grade First grade Second grade Third grade Fourth grade Fifth grade Sixth or higher 16 18 34 2 2 4 2 2 4-4 1 - 1 Illiterate Reads only Reads and writes Common School High School College Unknown . 1 2 3 8 7 15 Total . 23 22 45 Total . 9 9 18 Table 168. — Population of Place of Residence of First Admissions of Epileptics (Non- Psychotic), 1989, by Diagnosis and Sex Total Symptomatic Population Toxa EMIC Due to Brain Disease Idiopathic Exogenous Endogenous M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 1 - 1 7 5 12 5 7 12 7 6 13 3 2 5 5 8 13 4 3 7 1 - 1 2 2 4 2 3 5 2 2 4 12 3 - 2 2 1 - 1 2,500- 9,999 10,000- 24,999 25,000- 49,999 50,000- 99,999 100,000-249,999 500,000 plus 5 3 8 3 3 6 4 4 8 2-2 4 2 6 2 2 4 - 1 1 - 1 1 1 - 1 1 3 4 1 1 2 32 31 63 1 1 3 5 8 20 14 34 9 11 20 Table 169. — Economic Status of First Admissions of Epileptics (Non-Psychotic) , 1939, by Diagnosis and Sex Total Symptomatic Economic Status 1 OXAEMIC Due to Brain Disease Idiopathic Exogenous Endogenous M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 13 17 17 14 2 - 30 31 2 - 1 1 2 3 5 1 2 3 7 7 14 11 7 18 2-2 4 7 11 5 4 9 32 31 63 1 1 3 5 8 20 14 34 9 11 20 P.D. 117 295 o a Eh 55 > o E-< &h' a i-H | | |H|| 1 Mn H| | | | H | | || | lO H III 1 H | |- I | | H II 1 II ■ — I 1 1 II 1 H|| 1 CN ■-H H i-H CO W ■HHIOCM |(M 1 | In IOl B 1 O 1 h | | oj ] a | io t— H i-l i-H CN CO CO o CO cp cq H Eh g H P3 a +j 2 ^ co s'g E-i O O OS HHHHCNHlOO H | CN HH | CO OS HO (*. 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Patients on escape September 30, 1939 .... Daily average number of pa- tients on escape during year Patients boarded out September 30, 1939 .... Daily average number of pa- tients boarded out during year Ex-service men on books Sep- tember 30, 1939 . Ex-service men in residence Sep- tember 30, 1939 . Daily average number on books during year .... Daily average number actually in hospital during year Support of patient population (exclusiye of patients on es- cape and on visit) Supported by State Reimbursing Ex-service patients for whom pay is received from the Federal Government Non-insane patients actually in hospitals September 30, 1939 Mentally defective Epileptic .... • "o3 O Eh P.D. 117 303 H Ocom 1 n OTO CO 1 il n wco 00 CNiOCO 1 1 oo l b- •a i lOil b- COIN IO con r~ coo n CN ■■* lf5n CO 100 z o ID Z fe 0 ITJnn | b- *0 * 1 n n l l 1 TOCO OS nincN 1 1 t> 1 U5 CN 1 s CNIO t> 11 rH CN CO CO On CN oo 00 OS s lOUJf I * COTO OS I I l n i n CN t- OS no * 1 '1 n I CN co l N!D OS rHrl (N TO TO t^co IN t~ t> 00 E-i * osmoo CO TOO TO TOTO to Oil o i>r~ * 00nf- nooooot^ to m SIOhO- OS oo TO CO nioiO cocoes oo tv CNCN * -1 IN CO 00_ —i IN £ " " § *OSnTO t~ CNO t~ "OCN t> o* n CO-* O * osco OCOOOMC1 OS n OOOnco OS TOOO t~CN o n TOOO CNCOn O tv TO_ CN TO *00 CN -<" ** n E-i OitHN CN * t~ ii ICO * OS il O con t» OsncO nCNO 1 CO CN 1 OS*i1CN t> oo* TO COIN CO n n (NOS noon CO n iooq 00_ CNn if iOTO_ TO M CN 0 P 0 K O Ph OOMiOO CN CNt- OS UN TO TO-i * com 00 OOcN* TOU0O0 1 00 * 1 Om n oo cooo * CN OSN OlO tv O OSi-H © --I IN INTO CN 05 H rt" ** £ S MHtDrt O CNO CN 1 iH il coo CO COCO OS nosos O0N.O0 1 US 00 1 0002 H OS CN CO 00 CN— I CO CN n ncN IO CO to b- --I CNO Eri TOn —ICO 00 CNOS il OS-* TO O0TO n OCN OS 1 *CN no* | cN O oo O500 O 00 n COIN OS TO il * IO'* CI TO ^ •~< CN Z 0 z fe O00 1 CM o oo O ii* iO 00* CN "3n O 1 COTO OUH |aj n n - O— i 00 00 iO TO n CN om *iO o O p 00 n OS n , ¥ ■^ r? > °i ~ CO ^ E-i P-: OK ■H O > « 304 P.D. 117 N m O CO 1 COCO co co o " - CO HI CO CN l> 00 co N CO oo l> t> (N Eh" OtJhinOO to 'tfoO'-ieoo CO 1 CN 1 ■* | to oo o ■* I >oco CN O _' •O CN CN-h r~ CO ■* IO -rj< CO lO a> CO N os 2 0 H H rH rH 00 H 2 fa o OS & n co c-q CO OS HH IO co oo CO CO rt Eh t-J miCCD-* CO 00-* .-lOiO co i-i-* | | i >o OS CO OhlOiO rH CO oo CN — i CN ■* T}( rH -CH IO rH oo 2 CO CO co o CO o Eh ft 3 CN CN CN CN- CN < a fa iOHhcN 1 iH to i-l | t--rH "O 1 CO 1 1 1 CO rH Ol OOrH | H< CO »o CN n CO 00 OS OS os « CN CN CN 0_ CN o tH rH i-T -H Os g m | H^H/ t- CNCOrHCOnH CO iHrH | | | CN 00 OS CN 1 lOrH 00 rH U0 CO CO lO o_ >0 CN o_ co os o_ >> i o •A ■ 3 -co CO 1 . *» a . d to S • -d * -p .gco oj a£ •8 01 to -a a • y) ' CO • tO h DO CQ 03 rH J I'd • O "-P g g^-'ftOs ca ■£> O M CO o -=^.So^ O 3J? h 3 a o -a -a >■ a 2 2 § p. g.-i . £ -a 3 P CO ° £ 5? 2 S 1 § || || • o £ o o, g ^ .U -o 8-2*1 3 * 8 > o . 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I I I o (^ o ■^iOCNCNCN 1 1 1 1 CN ^h O Tt< Tt< CN i-f i-H t-I 1 1 1 CN Hf CO CO 2 « 1 ■< OH ^>H Eh' J§5 o oo co r~ i-h ■* co I I I N-l-H •O i-H CD Tt< rH CO CN 1 1 1 COrH ionoo: I hh i i i CO rH CM CO t^ IO CO 1 *s iO H Eh' Ph" O t^ t^ t^ CO T« ^H | rH | CN CN'H iH CN CN rH ^H CN rH | i-H | COrH rt 00 IQ IO CO CN CN 1 1 1 1 COiH 02 00 en CO PS < >H Eh' Eh LO !-- 00 T« .-H | | | | | >o t^-CH-H-HrH | | | | | CN 00CO-HCO 1 1 1 1 1 1 CN t^ co oo CO CO PS < >H CO Eh E=i t~ CO CO CO rH rH | | | | IO CN CO CM CN iH rH | | | | CO lOCOrHrH | | | | | | CN c CO CO « CN E-i Eh rfoooion I I I I i-h 00 rH CN--HCOCOCN 1 1 1 1 I -*> CNOOlOCNrH | | | | rH CO rf cn to PS H >< H Eh" HOOHHIM | | | | lOCN NOOOh 1 H | | | NHH | rHrH | | | | t^rH 1> oo CO cn en CO Number of Admission o E m a -4J o r\ G> ^ OJ O. _C3 03 ObHEHfiHEHaacBEilZl-H "3 o P.D. 117 377 to m on (2 ° Ch Eh' 1 1 1 1 1 1 «5 1 1 1 II O 1 i TO II H | | | ( | | CO I I I 1 I 1 I I 1 I II Ml i cm ii ii i i i i i i m 1 1 1 1 1 1 "5 1 1 1 II » 1 IH 11 1 — 1 | t I J t ■ — • With Convulsive Disorders (Epilepsy) E-i 3 I 1 I 1 I I m 1 ih i irt eq I — i l il il I I iiiit* 1 1 1 1 1 1 CM 1 i-H | | rH rH | || || || | | 1 1 1 1 CM 1 1 1 1 l-IHl | | 1 1 -1 1 H| || || | | 1 1 1 1 0 rH CM CM 00 "O CO CD CM Oi CO — CO — — Hrf -H -). CM CO — — "tf O CM CJJ CM O — U0 — iO 1 — CO "* | ] © CO — lO CM— CM— — — Il — CM — "* CM rH — | — CO — — — in a Q &. 0 00 H to P «! O Infectious and Parasitic Diseases: Typhoid and paratyphoid fever Scarlet fever Lethargic encephalitis (epidemic) . Tuberculosis of the meninges .... Tuberculosis of the respiratory system Tuberculosis of other organs .... Disseminated tuberculosis .... Syphilis (non-nervous forms) .... Purulent infection, septicaemia (non- Other infectious diseases Cancer and Other Tumors: Cancer and other malignant tumors Tumor (non-cancerous) Rheumatic Diseases, Nutritional Diseases, Diseases of the Endocrine Glands and Other General Diseases: Diabetes Diseases of the thyroid and parathyroid Other diseases ....... Diseases of the Blood and Blood-making Organs: Pernicious anemia Other diseases of the blood and blood-making organs Chronic Poisonings and Intoxications: Alcoholism (acute or chronic) Diseases of the Nervous System and Organs of Special Se?ise: Encephalitis (non-epidemic) .... Progressive locomotor ataxia (tabes dorsalis) Other diseases of the spinal cord . Cerebral hemorrhage 378 P.D. 117 to z; E H « =°£ Ph E-i *5 o< 1 1 1 i-i ' l-HtN"5 co — iOr-i 1 05 CM CM Willi 11-lCO HCOWr, 1 | | Ilili-H | — i t— i c«» U51O00 1 1 1 1 -t" With Convulsive Disorders (Epilepsy) H fr S 1 1 1 CD 1 | 1 HU) HN M 1 1 1 | | | Ifl | || HCN | rH | | | | | With Cerebral Arterio- sclerosis EH 8 5 13 1 - 1 2 3 5 90 70 160 17 6 23 53 68 121 50 23 73 3 3 1 2 3 1 2 3 0 to g is X E <;ph - 1 1 1 1 -i 1 5 3 1 4 8 1 9 12 1 13 1 1 1 1 With Syphilitic Meningo- enceph- alitis 54 15 69 1 1 1 1 2 Total Without Mental Disorder 2 1 1 1 1 1 1 1 1 1 1 ' SH 1 | | | | 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ri | | | 1 1 j E-i (B ~i B ° E-i 8N"*Offi HTtilNffi CO CO -tfi CO m — i CO — 1(- CM CN»C COt-HlO CO CM^- f-HCOCMCOCN rHCOCOCO <-l CM Tp *-* CO 1 »0 — ^H ■* CN OS CO "# -i< CO lO —1 CO ■-Ht^Cl (NlO CO—ilO CO CM — < —i CO CN CO CM .-H CO CO CO — I CN *T -f CO I W —"- 1 i-< t- CNCN >C 00 r-H CM ■* <~- IrHOiCO U3 IN O IN O « n CD tH 00 ilffiO H •< H Q & o 03 H CO P •<: O Cerebral embolism and thrombosis General paralysis of the insane Dementia praecox and other psychoses Other diseases of the nervous system . Diseases of the Circulatory System: Pericarditis Chronic endocarditis (valvular disease) Diseases of the myocardium .... Diseases of the coronary arteries and angina pectoris Other diseases of the heart Arteriosclerosis Gangrene Other diseases of the arteries .... Diseases of the veins Other diseases o Q 5 S to E "• o« >J CO P co o o E E £ ° Bi6 0Ph "SO 5 W E < K O 5 p. in QO|p i pq pH(C »JO O fc B > O t> K " ' £ ^ Ph "■S Pi b J" >>~ -° I l I I CO 1 INI 1 X - 1 1 1 1 1 1 1 1 — | | COCO— 1 1 - 1 — m CD CO OS t* | 1 1 1 ■O 1 1 CO- | >o 1 IN 1 1 l l 1 tN 1 <-■ 1 CQ 1 t» 1 1 "3 1 1 — l>-r<00CO 1 1 1 1 1 1 1 »M | | 1 1 1 1 l 1 1 1 IIIIHHI 1 1 1 1 1 — 1 1 1 1 1 1 1 1 — 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 — 1 1 1 1 1 •X! 1 1 1 1 1 «J 1 1 1 1 i l 1 i 1 1 1 lO 1 1 1 - 1 1 1 1 —COCO'* 1 1 1 1 CM 1 1 1 1 1 (M l< 1,11 1 l 1 IIMHIM 1 1 1 1 I to— 1 — 1 1 1 1 -# 1 1 1 1 1 co 1 1 1 1 1 l 1 IIII^MI - 1 1 1 1 OCNCOCO 1 1 1 1 CNrHtM 1 CO — t~lN ,_, | | — 1 1 1 1 1 — 00— 1 (NCN- — — iMIN -*© — — — — 1 CDMH | N | OJ * CO — 1 I . ss o o ."« K) i '.« S 6Q ' ' ' '.2 ."& s? . M o • [e •' o ' ' ' * o CD "3 -a bC . e . .a . •• • a a S3 • E ■ ■ • 3 • a t-< CD • ■ • a • .i§ ,2 2 ■ -re • & i «0 ' " f-t ' ' ' ' • * • • S3 'm stem on-p *H • e o O O •_o •. so SR § -a m • i? • • m • • -2 E • CD • ■ o ■ 2 >> c z "3 § .T3-S SI ."d'§ O o °s -C g g -^ a S o | a o3'5 * || 2 n „ a *•-: E.a = »*c l°^ O ^ -O 'St co C3 Tuberculosis of the respiratory s Tuberculosis of other organs . Disseminated tuberculosis Syphilis (non-nervous forms) . Purulent infection, septicaemia ( Other infectious diseases . Q J 3 Eh 3 -o 3 Cancer and other malignant tun Tumor (non-cancerous) . heumatic Diseases, Nutritional Di Other General Diseases: Acute rheumatic fever Diabetes Diseases of the thyroid and para Other diseases .... iseases of the Blood and Blood-ma, Hemorrhagic conditions . Alcoholism (acute or chronic) iseases of the Nervous System and Encephalitis (non-epidemic) . 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F. T. M. F. T. Barnstable 9 8 17 20 17 37 o - 5 6 3 9 - 1 1 1 1 2 2 2 4 5 4 9 2 2 4 7 5 12 1 - 1 2 _ 2 5 1 6 9 10 19 2 5 7 10 14 24 1 - 1 1 2 3 1 3 4 6 12 18 1 1 2 0 4 9 - _ _ 3 3 6 _ _ _ - 3 3 Wellfleet _ _ _ 3 4 7 1 1 2 - - Total 30 24 54 78 82 160 Berkshire 4 0 9 36 29 65 Alford - 1 1 - _ _ 1 1 2 2 1 3 1 _ 1 6 1 7 Clarksburg - - - 1 2 3 — 1 1 10 11 21 - - - 2 2 4 Florida — - - 1 1 2 Great Barrington 7 6 13 13 17 30 - - _ 2 1 3 1 1 2 3 2 5 Lee ' 3 1 4 13 8 21 - 1 1 11 12 23 Monterey 1 - 1 1 1 2 1 - 1 1 1 9 New Marlborough - 9 9 4 1 5 North Adams 14 - 14 74 53 127 Otis _ - _ 3 2 5 Pittsfield 32 20 52 140 98 238 - - - 1 1 2 - 2 2 3 3 6 1 _ 1 2 2 4 Sheffield - 1 1 5 3 8 6 1 7 5 6 11 Tyringham - - - 1 - 1 1 - 1 2 — 2 - — - 4 1 5 2 4 6 9 15 24 - - - 2 2 4 Total 75 54 129 357 276 633 Bristol - 2 2 8 7 15 21 10 31 79 66 145 - - - 1 - 1 2 1 3 14 17 31 2 1 3 8 7 15 3 1 4 8 12 20 10 5 15 22 29 51 Fall River 57 50 107 313 308 621 5 2 7 4 3 7 6 4 10 14 29 43 72 78 150 337 321 658 7 6 13 28 29 57 - 3 3 5 6 11 - 2 2 4 5 9 1 2 3 9 3 12 5 2 7 11 7 18 4 2 6 5 12 17 - 1 1 8 3 11 30 21 51 97 101 198 - 3 3 9 5 14 Total 225 196 421 984 970 1,954 P.D. 117 421 Table 245. — County and City or Town of Residence of Admissions and Cases in Residence in Hospitals for Mental Disorders on September SO, 1939, by Sex — Continued County and City or Town Admissions 1939 M. F. T. Resident Population Sept. 30, 1939 M. Dukes Chilmark Edgartown .... Gay Head .... Gosnold Oak Bluffs .... Tisbury Total .... Essex Amesbury .... Andover Beverly Boxford . . . Danvers Essex Georgetown .... Gloucester .... Groveland .... Hamilton Haverhill Ipswich Lawrence Lynn Lynnfield Manchester .... Marblehead .... Merrimac .... Methuen Middleton .... Nahant Newbury Newburyport .... North Andover Peabody Rockport Rowley Salem Salisbury Saugus Swampscott .... Topsfield Wenham West Newbury Total .... Franklin Ash field ..... Bernardston *. Buckland Charlemont .... Colrain Conway Deerfield Erving Gill Greenfield .... Hawley Heath Leverett Leydon Monroe . . . . . Montague .... Northfield .... Orange Rowe Shelbourne .... Sunderland .... Warwick Wendell Whately Total .... 7 13 22 11 4 21 2 1 30 2 40 106 4 4 21 1 3 1 1 15 1 2 23 7 38 81 2 10 3 14 2 3 5 2 7 6 1 20 368 292 11 17 43 1 14 5 1 36 3 3 53 9 78 187 2 18 5 21 2 1 4 17 11 23 9 1 55 2 13 14 1 26 22 49 4 26 6 8 69 5 5 158 10 279 329 6 1 18 7 33 1 2 1 65 12 71 9 4 144 4 30 14 3 1 3 19 30 61 3 21 3 18 46 2 4 125 21 243 284 2 6 19 4 38 3 4 8 37 16 46 16 2 116 2 29 24 1 2 1,425 1,257 1 9 2 3 2 15 1 1 49 1 1 3 3 1 26 7 18 2 3 1 4 1 1 5 1 24 2 1 22 7 14 2 8 2 1 1 35 45 52 110 7 47 9 26 115 7 9 283 31 522 613 8 7 37 11 71 4 6 9 102 28 117 25 6 260 6 59 38 4 3 5 2,682 4 3 20 1 2 73 3 2 3 4 1 48 14 32 4 16 3 1 3 5 29 22 160 422 P.D. 1 Table 245. — County and City or Town of Residence of Admissions and Cases in Residence in Hospitals for Mental Disorders on September SO, 1939, by Sex — Continued Admissions Resident Population 1939 Sept. 30. 19 County and City or Town M. F. T. M. F. T. Hampden Agawam 1 3 4 12 16 28 Blandford .... 1 1 2 Brimfield _ 1 1 1 2 1 6 5 11 16 24 40 128 109 237 East Longmeadow 1 5 6 11 Granville .... 1 _ 3 1 _ 4 5 9 36 30 66 193 184 377 Longmeadow . 1 3 7 10 4 7 11 18 16 34 Monson .... 9 13 22 Montgomery . _ _ _ 1 26 27 6 7 13 30 29 59 1 2 3 Southwick _ 2 2 8 8 16 Springfield .... 83 87 170 437 473 910 _. 3 3 Wales .... 2 2 _ Westfield .... 12 14 26 56 67 123 West Springfield .... 7 3 10 24 31 55 Wilbraham 1 1 6 8 14 Total 173 178 351 946 1,010 1,956 Hampshire Amherst 4 6 10 20 25 45 Belchertown 3 1 4 20 9 29 ' Chesterfield 1 1 2 3 3 Cummington . _ 2 5 7 ' Easthampton . 4 8 12 34 33 67 Goshen _ _ _ 1 1 Granby 1 _ 1 3 2 5 Hadley 1 _ 1 16 4 20 j Hatfield . _ 2 2 6 7 13 Huntington 1 _ 1 1 4 5 Middlefield _ 1 1 Northampton . 24 24 48 92 55 147 Pelham 2 2 1 1 2 Plainfield . _ _ 2 2 Quabbin Reservoir N \ 1 _ 1 4 2 6 Southampton . 1 1 2 4 4 8 South Hadley . 3 2 5 17 15 32 Ware 6 2 8 27 18 45 Westhampton . 1 - 1 Williamsburg . 2 _ 2 8 6 14 Worthington . - - - 1 - 1 Total . . ... . . . 54 47 101 263 191 454 Middlesex Acton 2 1 3 7 10 17 Arlington 34 21 55 73 87 160 Ashby 3 _ 3 2 3 5 Ashland . 2 _ 2 6 6 12 Ayer . 4 4 8 6 11 17 Bedford 2 1 3 3 6 9 Belmont . 20 20 40 39 62 101 Billerica . 5 6 11 12 12 24 Boxborough 1 — 1 Burlington _ _ _ 3 4 7 Cambridge 137 117 254 429 382 811 Carlisle 1 1 2 _ 2 Chelmsford 3 4 7 18 22 40 Concord . 8 5 13 16 13 29 Dracut 3 2 5 17 15 32 Dunstable 1 1 1 - 1 Everett 40 24 64 112 101 213 Framingham . 11 15 26 48 79 127 Groton 4 2 6 3 12 15 Holliston . 1 3 4 8 12 20 Hopkinton 1 1 2 6 9 15 Hudson 7 7 • 14 24 19 43 Lexington 4 4 8 22 13 35 Lincoln 1 1 2 4 2 6 Littleton . 1 1 2 6 5 11 Lowell 55 53 108 345 336 681 P.D. 117 423 Table 245. — County and City or Town of Residence of Admissions and Cases in Residence in Hospitals for Mental Disorders on September SO, 1939, by Sex — Continued County and City ok Town Admissions 1939 F. T. Resident Population Sept. 30, 1939 M. T. Maiden Marlborough .... Maynard Medford Melrose Natick Newton North Reading Pepperell Reading Sherborn Shirley . . . . i . Somerville Stoneham .... Stow Sudbury Tewksbury .... Townsend .... Tyngsborough Wakefield .... Waltham Watertown .... Wayland Westford Weston Wilmington .... Winchester .... Woburn Total .... Nantucket Nantucket .... Total .... Norfolk Avon Bellingham .... Braintree Brookline .... Canton Cohasset ..... Dedham ..... Dover Foxborough .... Franklin Holbrook Medfield . . . Medway Millis Milton Needham Norfolk Norwood Plainville .... Quincy Randolph . . . . Sharon Stoughton .... Walpole Wellesley Westwood .... Weymouth .... Wrentham .... Total .... 60 11 7 46 l(i 10 55 4 1 5 1 2 82 2 6 2 2 10 38 36 4 1 1 17 37 4 1 11 2 8 4 3 2 11 9 11 1 -10 11 7 38 23 11 48 1 3 1 3 60 4 3 2 1 2 11 26 22 2 2 5 3 3 10 37 4 2 49 5 7 4 4 1 10 4 100 22 14 84 39 21 103 4 2 8 2 5 142 13 3 4 7 4 2 21 64 58 6 3 6 3 144 50 25 114 39 23 120 6 6 20 246 16 4 4 32 5 3 30 117 71 4 4 2 11 161 50 22 124 52 38 151 4 8 16 4 4 259 20 2 3 20 5 2 29 144 59 11 8 5 12 5 27 74 8 3 19 2 13 10 5 2 2 11 21 4 11 2 105 13 1 10 11 7 3 26 9 8 33 88 22 4 35 1 23 24 9 4 10 4 29 26 34 3 129 21 5 27 21 18 4 55 12 4 39 115 20 9 38 1 10 23 8 7 12 3 32 29 5 26 3 166 18 6 20 17 18 5 54 21 305 100 47 238 91 61 271 10 14 36 4 10 505 36 6 7 52 10 5 59 261 130 15 12 7 23 6 18 4 3 10 21 8 53 25 35 33 88 784 629 1,413 2,376 2,494 4,870 6 2 8 14 10 24 13 12 72 203 42 13 73 2 33 47 17 11 22 7 61 55 5 60 6 295 39 11 47 38 36 9 109 33 224 180 404 654 717 1,371 424 P.D. 11; Table 245. — County and City or Town of Residence of Admissions and Cases in Residence in Hospitals for Mental Disorders on September 30, 1939, by Sex — ■ Continued Admissions Resident Population 1939 Sept. 30. 1939 County and City oh Town M. F. T. M. F. T. Plymouth Abington . 2 3 5 11 11 2° Bridgewater 8 13 47 22 69 Brockton . 70 47 117 251 177 428 Carver 1 1 7 2 9 Duxbury . 5 1 6 7 10 17 East Bridgewater . 6 3 9 13 13 26 Halifax 4 2 6 2 1 3 10 10 20 Hanson 6 _ 6 5 5 10 Hingham .... 6 2 8 15 10 25 Hull . 2 3 5 8 0 13 2 1 3 6 9 15 Lakeville . 1 1 2 2 4 Marion 1 1 2 3 10 Marshfield 2 3 5 5 1 6 Mattapoisett . 1 1 9 2 11 Middleborough 10 18 16 34 Norwell 2 2 4 4 5 9 Pembroke 1 1 8 6 14 Plymouth 8 18 26 43 40 S3 1 1 7 3 10 Rockland . 8 .5 13 21 25 46 Scituate 1 4 8 6 14 Wareham 6 5 11 15 9 24 West Bridgewater . 3 3 6 9 4 13 5 7 12 14 22 36 Total 153 121 274 550 424 974 Suffolk 1,024 903 1,927 3,018 3,229 6,247 61 30 91 145 106 251 Revere 33 30 63 76 80 156 Winthrop 23 14 37 33 44 77 Total 1,141 977 2,118 3,272 3,459 6,731 Worcester Ashburnham . 3 6 9 7 8 15 Athol .... 9 6 15 28 22 50 Auburn .... 7 1 8 8 10 18 Barre .... 1 4 7 12 Berlin .... 1 1 2 1 2 3 Blackstone 2 7 19 9 28 Bolton 2 2 5 3 8 Boylston .... 1 _ 1 2 2 4 Brookfield .... 1 _ 1 3 4 7 4 _ 4 8 5 13 7 9 16 27 36 63 2 3 6 1 7 4 5 7 10 17 East Brookfield 1 3 2 2 4 27 35 62 128 120 248 10 11 21 51 52 103 4 5 12 10 22 Hardwick 3 _ 3 9 9 18 1 _ 1 5 1 6 1 2 5 4 9 2 _ 2 4 3 7 3 4 3 3 6 9 2 4 6 9 15 4 5 5 9 14 9 14 23 59 44 103 Lunenberg .... 5 2 7 5 4 9 _ _ 2 2 Milford 14 4 18 51 34 85 Millbury .... 5 2 7 14 11 25 Millville 1 1 2 9 2 11 New Braintree .... 1 1 Northborough 2 _ 2 9 16 Northbridge 5 4 9 26 12 38 North Brookfield . 3 3 4 11 _ 4 1 5 Oxford 4 3 7 U 8 19 P.D. 117 425 Table 245. — County and City or Town of Residence of Admissions and Cases in Residence in Hospitals for Mental Disorders on September 80, 1939, by Sex — Concluded County and City or Town Admissions 1939 F. Resident Population Sept. 30, 1939 M. T. Paxton Petersham Phillipston Princeton Quabbin Reservoir * Royalston Rutland . Shrewsbury Southborough . Southbridge Spencer Sterling Sturbridge Sutton Templeton Upton Uxbridge . Warren Webster West borough . West Boylston West Brookfield Westminster Winchendon Worcester Total Non-Residents Unknown Total Grand Total . 4 1 10 4 1 2 1 2 3 2 7 1 1 1 1 1 2 2 4 2 4 13 6 45 15 2 4 6 19 2 19 11 33 25 2 2 4 1 11 6 33 14 3 5 3 19 S 10 8 26 10 2 1 5 2 3 2 2 6 6 5 24 12 78 29 5 9 9 38 10 29 19 .59 35 4 1 5 176 3 159 8 335 15 565 11 512 26 1,077 400 94 18 320 50 5 720 144 23 1,351 136 116 1,170 47 5 2,521 183 121 112 55 167 252 52 304 3,780 3,098 6,878 12,697 12,234 24,931 * The towns of Enfield, Greenwich and Prescott of Hampshire County and Dana of Worcester County have been taken over by the building of the Quabbin Reservoir (Chapter 240, 5, Acts of 1938). Note: — The number of admissions for 1939 is larger than the total First and Readmissions together because of the fact that the Non-Psychotic (Epileptic) First and Readmissions to the Monson State Hospital have been added to this table. The same applies to the Resident Population. 426 P.D. 117 CO 00 OJ CO tc moj i> 00~ OS i I 1 M _ »ft •OCDCDt ,_, h t~r- co 00 ■* tC Hi C OS lO OS — OJ 0>T OJ s < oOcoojt t~ CN-H co OJ 1 OJ l i 1 OJ 1> 000 OS CO o fc OJCO 00 OS) CO co OJ OJ lO c CC CO g B P5 * lOlO 1 Ol OS «n-i ■* CO.H r~ 1 1 1 __ OJ _- iOOOSrH rH s 00 CO CO CO OS a. 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I H5- — 3S lOtxM i-l — mtooO' TtH -f c -CT3 «U CO c 3 3 8 rt 2 S.S-S ^"oO-Js-S -- 9 £S| .3 . t- h b aj c oj i> J? -i-> 3 -OT3 ojO aj a g g y>H«-5 3 S C0« - co __ r-T3^S OJ oo co o c ^i >"o.2 3 ojH ^tfPuQQ HHQ Q -g — CM cot ujtos oo 452 P.D. 117 Table 278. — County and City or Town of Residence of Patients Admitted and Patients Resident in State Schools on September 30, 1939, by Sex Admissions Resident Population CODNTY AND ClTY OR TOWN M. F. T. M. F. T. Barnstable Barnstable _ _ _ 7 4 11 Bourne _ _ 3 1 4 Brewster . _ 1 1 1 1 Chatham . _ 2 2 Dennis _ 1 3 4 Eastham . _ 1 1 2 Falmouth _ 1 1 2 7 9 Harwich . _ 2 3 5 Orleans _ 1 1 Provincetown . 2 4 6 Sandwich . 6 g Wellfleet . 1 1 Yarmouth - - - 2 1 3 Total - 2 2 20 35 55 Berkshire Adams _ _ _ 8 7 15 Alford _ 1 1 2 2 Becket 1 1 2 Cheshire . ... 1 1 2 Dalton 1 _ 1 4 . 3 7 Egremont _ 1 1 Great Barrington 1 2 3 2 7 9 Hinsdale . 1 1 1 2 3 Lanesborough _ 2 2 Lee _ 1 1 4 8 12 Lenox 1 1 North Adams . 4 4 8 17 16 33 Otis . 1 1 Peru . 1 1 Pittsfield . 2 3 5 21 29 50 Richmond 1 1 Sheffield . 1 1 1 8 9 Stockbridge _ 1 1 1 2 3 Washington 1 1 West Stockbridge _ _ 1 1 Williamstown . - 1 1 - 3 3 Total 8 15 23 64 95 159 Bristol Acushnet _ 1 1 5 5 10 Attleboro . 1 1 14 6 20 Berkley _ 1 2 3 Dartmouth _ _ 1 1 Dighton . _ 1 1 3 2 5 Easton _ 5 3 8 Fairhaven _ 5 3 8 Fall River 2 7 9 60 68 128 Freetown _ _ 4 __ 4 Mansfield I 1 4 3 7 New Bedford . 3 2 5 49 72 121 North Attleborough 1 1 9 4 13 Norton _ 5 1 6 Raynham _ _ _ 1 3 4 Rehoboth _ _ 2 5 7 Seekonk . 1 1 2 Somerset . 1 1 Swansea . _ 1 1 Taunton . 3 2 5 19 19 38 Westport - - - - 3 3 Total 9 15 24 189 201 390 Dukes Chi] mark .... 1 _ 1 1 1 Gay Head 1 _ 1 _ Oak Bluffs _ 1 1 2 Tisbury ' - - - - 2 2 Total 2 - 2 2 3 5 P.D. 117 453 Table 278. — County and City or Town of Residence of Patients Admitted and Patients Resident in State Schools on September 30, 1939, by Sex — Continued Admissions Resident Population County and City or Town M. F. T. M. F. T. Essex Amesbury 1 1 2 10 6 16 Andover _ 5 6 11 Beverly _ _ _ 9 8 17 Boxford _ - _ _ 1 1 Dahvers . _ _ _ 5 7 12 Essex _ _ _ 1 1 2 Georgetown _ _ _ 1 1 Gloucester _ 1 1 15 15 30 Gfoveland _ 1 1 2 Hamilton . _ _ _ 1 1 Haverhill . - _ _ 29 36 65 Ipswich — _ _ 4 3 7 Lawrence . - 1 1 36 38 74 Lynn 3 1 4 38 45 83 Lynnfiekl . _ _ 3 1 4 Manchester _ _ _ 1 1 2 Marblehead _ _ _ 5 5 10 Merrimac _ _ 1 2 3 Methuen . _ 1 1 9 11 20 Middleton _ 2 2 Nahant _ _ _ 2 1 3 Newbury . _ _ _ 1 1 2 Newbury port 2 _ 2 12 8 20 North Andover _ _ 4 4 Peabody . 1 _ 1 17 7 24 Rockport . _ _ 5 1 6 Rowley _ _ _ 1 1 2 Salem . i 1 1 2 23 15 38 Salisbury - _ 1 1 2 Saugus 1 1 2 15 17 32 Swampscott — _ 3 2 5 Topsfield . _ _ _ 2 1 3 Wenham - - - 1 1 Total 9 7 16 257 248 505 Franklin Ashfield _ _ 2 2 Bernardston _ _ 2 4 6 Buckland . 1 1 2 4 1 5 Charlemont 1 1 1 2 3 Colrain _ 1 1 Conway _ _ _ 3 3 Deerfield . 1 _ 1 3 1 4 Erving _ _ _ _ 2 2 Gill . _ _ _ _ 3 3 Greenfield 2 2 4 17 11 28 Heath _ _ 1 1 Leverett . _ _ _ _ 2 2 Montague 1 2 3 8 12 20 New Salem _ _ 1 \ Northfield _ _ 6 1 7 Orange - 2 2 3 7 10 Rowe — 1 1 2 2 4 Shelbourne . _ 3 3 Shutesbury _ _ _ 1 1 Sunderland _ _ _ 1 2 3 Warwick . 1 _ 1 1 1 2 Wendell . _ 1 1 Whately . - - - 1 2 3 Total . . . . . \ 7 8 15 53 62 115 Hampden - 1 1 4 3 7 — _ 2 2 _ _ _ 4 4 1 3 4 22 21 43 East Longmeadow _ _ _ 2 2 _ _ _ 1 1 - _ _ 1 _ 1 3 6 9 44 44 88 - - 3 6 9 — _ _ 3 4 7 — _ _ 5 7 12 _ _ _ 4 5 9 _ _ _ 2 4 6 - _ _ 3 3 5 17 22 97 97 194 - 1 1 ' 2 3 5 454 P.D. 117 Table 278. — County and City or Town of Residence of Patients Admitted and Patients Resident in State Schools on September 30, 1939, by Sex — Continued A DMI88ION8 Resident Population County and City oh Town M. F. T. M. F. T. Westfield 1 4 5 21 19 40 - 1 1 10 7 17 - - - 2 2 4 10 33 43 230 224 454 Hampshire Amherst _ _ _ 5 5 10 Belchertown _ 3 3 2 20 22 Curnmington _ - - 2 2 1 _ 1 o 12 17 _ _ _ _ 2 2 _ _ - 1 1 2 - - - 2 1 3 Hatfield _ _ — 1 1 2 _ _ - 3 4 7 ■ Middlefield .... _ _ _ 1 _ 1 2 fi 14 12 26 Pelham .... _ _ _ 1 _ 1 Plainfield _ _ _ 2 1 3 Quabbin Reservoir * _ _ _ 1 3 4 . South Hadley .... _ - _ 6 6 12 _. _ _ 5 1 6 Westhampton _ _ _ 1 1 Williamsburg .... - - _ - 7 7 W orthington .... - - - - 2 2 Total 4 5 9 49 81 130 Middlesex Acton .... _ _ _ 2 1 3 _ _ _ 16 8 24 Ashby _ _ _ - 1 1 Ashland _ _ _ 4 _ 4 _ _ _ _ 1 1 _ _ _ 1 2 3 Belmont .... _ 1 1 9 11 20 _ 5 1 6 Boxborough _ _ _ 3 - 3 Cambridge .... 2 1 3 61 114 175 Carlisle _ _ — 2 _ 2 Chelmsford _ _ _ 5 4 9 _ _ _ 6 1 7 Dracut 1 _ 1 5 3 8 Everett 3 - 3 27 26 53 — 3 9 22 31 _ _ _ 1 2 3 Holliston _ _ _ 4 2 6 Hopkinton _ _ _ 1 3 4 _ _ _ 4 6 10 Lexington .... _ _ _ 1 4 5 _ _ _ 3 _ 3 2 _ ?, 64 55 119 1 4 26 27 53 Marlborough _ _ _ 13 5 18 _ _ _ 2 3 5 Medford 1 2 3 19 29 48 ; Melrose . . _ _ _ 5 7 12 Natick _ _ _ 6 3 9 2 _ ?, 33 24 57 North Reading 1 1 9 1 3 - _ _ 3 2 5 Reading _ _ _ 8 18 26 Shirley .... _ _ _ 6 2 8 Somerville 4 1 5 64 45 109 Stoneham _ _ 4 7 11 Sudbury .... _ _ - _ 2 2 Tewksbury .... - 2 2 27 33 60 Townsend .... _ _ _ 2 2 4 Wakefield 1 _ 1 11 4 15 1 _ 1 52 19 71 1 _ 1 7 12 19 - _ _ - 2 2 _ _ _ 3 3 6 ) Wilmington . . . ; . _ _ _ 2 2 4 Winchester .... _ 1 1 4 9 Woburn - 1 1 16 13 29 Total 24 11 35 549 536 1,085 P.D. 117 455 Table 278. — County and City or Town of Residence of Patients Admitted and Patients Resident in State Schools on September SO, 1989, by Sex — Continued Admissions Resident Population County and City or Town M. F. T. M. F. T. Nantucket - - 2 2 Total - - 2 2 Norfolk Avon — — — 1 1 Bellingham — — - 3 3 Braintree . 1 1 2 9 8 17 Brookline . 1 1 10 6 16 Canton - — - 7 4 11 Cohasset . - - - 3 2 5 Dedham . 1 1 2 12 9 21 Dover - — - 1 1 2 Foxborough 1 1 1 3 4 Franklin . 1 1 4 10 14 Holbrook . — — - 2 2 4 Medfield . - — - 3 3 Medwav . - - - 2 4 6 Millis - — - 1 1 Milton 1 1 8 6 14 Needham . - - - 4 2 6 Norfolk . — — - 1 1 Norwood - — — 8 7 15 Plainville . — — — 3 3 Quincy 3 2 5 32 30 62 Randclph — — — 2 13 Sharon 2 2 3 9 12 Stoughton 1 1 11 9 20 Walpole - — - 4 6 10 Wellesley . 1 1 2 6 25 31 Westwood — — - 1 5 6 Weymouth - - - 9 7 16 Wrentham - — — 2 2 4 Total 8 10 18 145 166 311 Plymouth Abington ..... 1 1 4 7 11 Bridgewater — — — 2 4 6 Brockton . 1 3 4 30 35 65 Carver 1 1 2 2 Duxbury 1 .1 2 1 3 East Bridgewater — — — 3 3 Halifax — — - 2 2 Hanover - — — 2 2 Hanson — — — 1 1 2 Hingham . — - — 2 3 5 Hull — — — 1 1 2 Kingston . 1 1 4 1 5 Marion — — — 2 2 Mattapoisett - - - 2 2 Middleborough 1 1 3 5 8 Norwell — — — 1 1 Pembroke 2 2 3 3 Plymouth - - - 7 9 16 Plympton — — — 112 Rockland . — — — 3 4 7 Scituate 1 1 4 2 6 Wareham . 1 1 2 6 8 West Bridgewater - - - 1 1 Whitman . _ ~~ ~ 4 4 8 Total 7 6 13 74 98 172 Suffolk Boston ...... 24 23 47 527 567 1,094 Chelsea 2 2 26 21 47 Revere ...... — - — 23 14 37 Winthrop 1 1 2 7 17 24 Total 27 24 51 583 619 1,202 4513 P.D. 117 Table 278. — County and City or Town of Residence of Patients Admitted and Patients Resident in State Schools on September SO, 1939, by Sex — Concluded Admissions Resident Population County and City or Town M. F. T. M. F. T. (V orcester Ashburnham _ _ _ 4 3 7 Athol _ _ _ 10 18 28 Auburn _ _ _ 2 2 Barre _ _ _ 1 1 Blackstone _ _ _ 2 2 Bolton _ _ _ 1 1 Boylston . _ _ 1 1 2 Brookfield _ _ _ 3 2 5 Charlton . 2 1 3 5 4 9 Clinton 1 2 3 Douglas _ _ _ 3 3 Dudley . _ _ _ 2 2 4 East Brookfield _ _ _ 1 1 Fitchburg 3 1 4 26 21 47 Gardner 1 2 3 10 13 23 Grafton 1 1 Hardwick _ _ _ 3 1 4 Harvard _ _ _ 1 1 2 Holden 1 1 2 6 3 9 Hopedale . _ _ _ 2 1 3 Hubbardston . _ _ _ 2 2 Lancaster _ _ _ 2 3 5 Leicester . _ _ _ 4 2 6 Leominster 2 2 13 11 24 Lunenberg _ _ _ 2 2 4 Mendon _ _ _ 1 1 Milford 1 2 3 15 12 27 Millbury . 1 1 3 4 7 Millville . _ _ - 3 1 4 Northborough . _ _ _ 2 6 8 Northbridge _ _ _ 5 4 9 North Brookfield Oxford - - 5 1 6 2 2 Petersham _ _ _ 2 2 Phillipston 1 1 2 2 4 Rutland _ _ _ 1 1 2 Shrewsbury - - - 2 2 Southborough . — — - 1 1 Southbridge 1 2 3 14 17 31 Spencer 2 2 2 5 7 Sterling _ _ — 2 1 3 Sturbridge 1 1 6 2 8 Sutton 1 1 2 3 5 Templeton 2 2 6 5 11 Upton - - — 3 5 8 Uxbridge . - _ — 3 1 4 Warren _ _ - 2 4 6 Webster . 1 1 8 13 21 Westborough . - - - 7 2 9 West Boylston — — - 2 1 3 West Brookfield — - — 1 2 3 Westminster _ - — 2 2 Winchendon 1 2 3 7 9 16 Worcester 7 2 9 109 116 225 Total 23 18 41 317 318 635 Non-Residents 3 1 4 9 9 18 Grand Total 141 155 296 2,541 2,697 5,238 * The towns of Enfield, Greenwich, Prescott and Dana have been taken over bv the building of the Quabbin Reservoir (Chapter 240, 5, Acts of 1938). P.D. 117 457 DIRECTORY OF INSTITUTIONS November 30, 1939 1. Public Institutions: (a) State Hospitals for Mental Disorders. (b) State Schools for Mental Defectives. 2. Private Institutions: (a) For Mental and Nervous Disorders. (b) For Persons Addicted to the Intemperate Use of Narcotics or Stimulants. (c) For Mental Defectives. (d) For Epileptics. PUBLIC INSTITUTIONS State Hospitals for Mental Disorders Boston Psychopathic Hospital (opened 1912 as a Department of the Boston State Hospital. Became a separate hospital December 1, 1920): — Trustees: William Healy, M.D., Boston, Chairman; Ohanning Frothingham, M.D., Boston; Carrie I. Felch, M.D., Boston; Mrs. Josephine L. Murray, Boston; Mr. Charles F. Rowley, Boston; Mr. Monroe Kaplan, Boston; Mr. Isaac Kaplan, West Newton. Trustees' meetings: Second Thursday of each month. Medical Director: C. Macfie Campbell, M.D. Chief Executive Officer: Salomon Gagnon, M.D. Chief Medical Officer: Gaylord P. Coon, M.D. Senior Physicians: John P. Powers, M.D.; Harry C. Solomon, M.D.; Oscar J. Raeder, M.D.; Frank C. d'Elseaux, M.D.; Whitman K. Coffin, M.D.; Howard E. Weatherly, M.D.; Jane F. O'Neil, M.D. Assistant Physicians: Mary Palmer, M.D.; Irma Bache, M.D.; H. Jackson DeShon, M.D.; Kathleen Kilgariff, M.D.; Joseph M. Lesko, M.D.; Lazarus Secunda, M.D. Internes : Stanley Peal, M.D.; Bruce R. Merrill, M.D. ; Arthur F. Valenstein, M.D.; Daniel W. Badal, M.D. Dentist: Peter J. Dalton, D.M.D. Head Social Worker: Esther C. Cook, B.A. Head Occupational Therapist: Alice E. Waite. Principal of School of Nursing: Mary E. Fitzgerald, R.N. Treasurer: Anna F. Caulfield. Staff Meetings: Every day, except Saturdays, Sundays and Holidays, 12 to 1 P.M. Visiting Days: Every day, 2 to 4 P.M. and 6 to 7 P.M. Location: 74 Fenwood Road, near corner of Brookline Avenue. Boston State Hospital (opened 1839) : — Trustees: Thomas D. Russo, Boston, Acting Chairman; Mrs. Gertrude A. Mac- donnell, Boston, Secretary; Josephine E. Thurlow, R.N., Winchester; Alexander M. Sullivan, Boston; Joseph J. Cardillo, Somerville; Harry B. Berman, Newton; Francis J. Callanan, M.D., Boston. Regular meetings: Third Wednesday of each month. Superintendent: Harold F. Norton, M.D. Assistant Superintendent: Purcell G. Schube, M.D. Director of Clinical Psychiatry: Ralph S. Banay, M.D. Senior Physicians: Norris B. Flanagan, M.D.; Peter P. Gudas, M.D.; N. Anthony Bicchieri, M.D.; Theodore F. Lindberg, M.D.; Daniel J. Sullivan, M.D.; Joseph P. Thornton, M.D.; Louis S. Chase, M.D. Assistant Physicians: William J. Clauser, M.D.; Michael A. Grassi, M.D. (Temp.); John M. Hill, M.D.; Ernst Schmidhofer, M.D.; John F. Sullivan, M.D.; Charles S. Mullin, Jr., M.D. (L. O. A.). Pathologist: Naomi Raskin, M.D. Dentist: Kaen Noonan, D.M.D. Steward: Charles A. Perry. Treasurer: Rose J. Siciliano. Visiting days: 2 to 4 P.M. daily. Staff meetings are held four times a week. 458 p.D. 117 Location: Administration Building, 591 Morton Street, corner Harvard Street, Dorchester; East Group, Harvard Street, Dorchester, near Blue Hill Avenue; West Group, Walk Hill Street, Mattapan; Post Office, Dorchester Center. Bridgewater State Hospital (opened 1886, 1895) :— Post Office, State Farm. Railroad Station, South Bridgewater (New York, New Haven and Hartford). Supervision of Department of Correction: Arthur T. Lyman, Commissioner. Medical Director: William T. Hanson, M.D. Superintendent: James E. Warren. First Assistant: George H. Maxfield, M.D. Assistant Physicians: Abraham L. Schwartz, M.D. ; Charles H. MacLaughlin, M.D. Steward: Thomas W. Hunter. Treasurer: Fred P. Turner. Dentist: John H. Hall, D.D.S. Visiting days: For relatives or friends of patients, every day; for general public, every day with the exception of Sundays and holidays. Staff meetings: Two or three times a week at 9:30 A.M. Location: One-quarter mile from railroad. Danvers State Hospital (opened 1878) : — Post Office, Hathorne; railroad station, Danvers (Boston & Maine). Trustees: S. Herbert Wilkins, Chairman, Salem; James F. Ingraham, Peabody; Arthur C. Nason, M.D., Newburyport; H. C. McStay, Swampscott; Francis T. Russell, Dorchester; Annie T. Flagg, Andover; Mary T. O'Sullivan, Lowell. Regular meetings: Third Thursday of each month. Superintendent: Clarence A. Bonner, M.D. Assistant Superintendent: Wm. Charles Inman, M.D. Clinical Director: Leo Maletz, M.D. Senior Physicians: Melvin Goodman, M.D.; Doris M. Sidewell, M.D.; Myer Asekoff, M.D. Assistant Physicians: Flora M. Remillard, M.D.; Mona C. Mehan, M.D.; Louise H. Jacob, M.D.; Peter B. Hagopian, M.D.; Samuel H. Marder, M.D.; Francis X. Sullivan, M.D.; Pasquale A. Buoniconto, M.D. Pathologist: Salvador Jacobs, M.D. Resident Dentist: George W. Wheeler, D.M.D. Treasurer: Miss Hulda Aronson. Steward: Adam D. Smith. Visiting days: Wednesdays, Saturdays, Sundays and Holidays, from 9:00 to 11:00 A.M. and 2:00 to 4:00 P.M. Staff meetings: Daily, except Sundays and holidays, at 8:00 A.M. Location: Maple and Newbury Streets, Danvers, two and one-half miles from railroad station. Foxborough State Hospital (opened 1893. Devoted exclusively to the care of the insane since June 1, 1914): — Trustees: E. H. Lewis Harnett, M.D., Dorchester, Chairman; Helen J. Fay, West- wood, Secretary; Bennet B. Bristol, Foxborough; William H. Bannon, Fox- borough; William J. Bulman, Brockton; Ethel W. Dodd, Wrentham; Noel C. King, Holbrook. Regular meetings: Second Wednesday of each month. Superintendent: Roderick B. Dexter, M.D. Assistant Superintendent: Grosvenor B. Pearson, M.D. Senior Physicians: David Rothschild, M.D.; Morris L. Sharp, M.D.; John T. Shea, M.D.; Margaret R. Simpson, M.D. Assistant Physicians: Israel Zeltzerman, M.D.; Carl V. Lendgren, M.D.; Zoe Ullian, M.D. Dentist: Edward E. Small, D.M.D. Treasurer: Harriett S. Bayley. Steward: Chester R. Harper. Visiting days: Every day from 9 to 11 A. M. and 2 to 4 P.M. P.D. 117 459 Staff meetings: Daily, except Sundays and holidays, at 8:30 A.M. Location: One mile north of Foxborough Center. Gardner State Hospital (opened 1902): — Post Office, East Gardner, Mass.; railroad station, East Gardner, Mass. Trustees: Owen A. Hoban, Gardner, Chairman: Mrs. Margaret X. O'Brien, Wor- cester, Secretary; John C. Hughes, D.M.D., Gardner; George A. Marshall, Fitchburg; Miss Margaret E. Hayden, Athol; Edward P. Gilgun, Woburn; Frank W. Lyman, Fitchburg. Regular meetings: First Friday occurring on or after the fourth day of each month. Superintendent: Charles E. Thompson, M.D. Assistant Superintendent: Frederick P. Moore, M.D. Senior Physicians: Harold K. Marshall, M.D.; William A. Hunter, M.D. Assistant Physicians: Paul H. Wilcox, M.D.; Janet S. Barnes, M.D.; Edwin J. Palmer, M.D.; Solomon M. Haimes, M.D. Dentist: Joseph N. Carriere, D.M.D. Treasurer: Gertrude W. Perry. Steward: Myron L. Marr. Visiting days: Every day at any hour, including Sundays and holidays. Staff meetings: Daily 8-9 A.M. Location: East Gardner, two minutes' walk from East Gardner Railroad Station. Off route 2 at Westminster and three miles from Gardner. Grafton State Hospital, formerly Worcester State Asylum (opened 1877) : — Trustees: Ernest L. Anderson, Worcester, Chairman; Martha Ducey, Shrewsbury, Secretary; Winslow P. Burhoe, Reading; Frank J. Ludy, North Grafton; Charles D. Bourcier, Grafton; Rose Herbert, Worcester; Leon Cangiano, Hingham. Superintendent: Harlan L. Paine, M.D. Assistant Superintendent: W. Everett Glass, M.D. Senior Physicians: H. Wilbur Smith, M.D.; James L. McAuslan, M.D.; Benjamin Cohen, M.D. Assistant Physicians: Mary Johnson, M.D.; Anna C. Wellington, M.D.; Richard W. Nelson, M.D.; Soli Morris, M.D. Treasurer: Susie G. Warren. Steward: Roy S. Shipman. Dentist: Edward I. Naiman, D.M.D. Visiting days: Every day. Visiting hours: 9:30 to 11:00 A.M.; 1:00 to 4:00 P.M. Location: The hospital is situated on the main line of the Boston and Albany Rail- road, between Worcester and Westborough, station, North Grafton. It is about 8 miles from Worcester, and can be reached by bus from there or from the West- borough or North Grafton Stations of the Boston and Albany Railroad. Correspondence relating to patients at the Grafton State Hospital should be addressed to the Superintendent, Grafton State Hospital, North Grafton, Mass. Medfield State Hospital (opened 1896) : — Post Office, Harding. Bus service from Park Square and Forest Hills to Medfield. Trustees: George O. Clark, M.D., Boston, Chairman; M. James Shaughnessy, M.D., Framingham, Secretary; Eugene M. Carman, Somerville; Mrs. Louise Williams, Taunton; John H. Craig, Natick; Mrs. Elizabeth B. Rugg, Kingston. Regular meetings: Second Friday of each month. Superintendent: Earl K. Holt, M.D. Assistant Superintendent: Arthur J. Gavigan, M.D. Senior Physicians: Vicente A. Navarro, M.D.; Grace T. Cragg, M.D.; Harry M. Gardiner, M.D. Assistant Physicians: Edmund M. Pease, M.D.; Nathan Baratt, M.D.; Henry Benjamin, M.D.; Martin A. Berezin, M.D. Dentist: Elton V. Faass, D.M.D. Treasurer: Miss Josephine M. Baker. Steward: Pascal A. Cantoreggi. 460 RD. 117 Visiting days: Every day. Staff meetings: Monday, Wednesday and Thursday, at 8:30 A.M. Location: Two miles north of Medfield Center on Route 27. Metropolitan State Hospital (opened October 29, 1930): — Post Office: Waltham, Massachusetts. Railroad Station: Waverley, Massachusetts. Trustees: Reverend John R. McCool, Peabody, Chairman; Miss Anna M. Manion, Waltham, Secretary; Erwin C. Miller, M.D., Worcester; Richard J. Dunn, Esq., Newton; Gilbert Horrax, M.D., Chestnut Hill; Miriam C. Regan, Esq., South Boston; Mrs. J. Haskell Casey, Belmont. Regular meetings: Third Thursday of each month. Superintendent: Roy D. Halloran, M.D. Assistant Superintendent: William Corwin, M.D. Senior Physicians: Elvin V. Semrad, M.D.; Richard C. Wadsworth, M.D. (Pathol- ogist). Assistant Physicians: Clementine McKeon, M.D.; Emerick Friedman, M.D.; Richard C. Cooke, M.D.; Paul H. Wilcox, M.D. Resident Dentist: John M. O'Connor, D.M.D. Treasurer: Cora E. Norris. Steward: Howard R. Carley. Visiting days: Every day. Staff meetings: Daily. Location: On Trapelo Road, Waltham, about two miles from Waverley Square (Fitchburg Division and South Division, Boston and Maine or Boston Elevated from Harvard Square). Bus service from Waverley Square to Hospital. Monson State Hospital (opened 1898) : — Post Office and railroad station, Palmer (Boston & Albany). Trustees: George A. Moore, M.D., Palmer, Chairman; Mrs. Gertrude E. Quinn, Springfield, Secretary; George D. Storrs, Ware; Joseph L. Simon, Beverly; Justus G. Hanson, M.D., Northampton; Stuart Winch, Turners Falls; Hannah Carolynn Simmons, M.D., Worcester. Regular meetings: First Thursday of each month. Superintendent: Morgan B. Hodskins, M-D. Assistant Superintendent: H. Sinclair Tait, M.D. Senior Physicians: Donald J. MacLean, M.D.; Leon J. Robinson, M.D.; Florence A. Beaulieu, M.D. Assistant Physicians: Lucie G. Forrer, M.D.; Benjamin Margulois, M.D. Dentist: Arthur R. Adam, D.D.S. Treasurer: Alice C. Haymann. Steward: William H. Daly. Visiting days: Every day. Staff meetings: Every day, except Sundays and holidays, at 8:30 A.M. Location: One mile from railroad station. Northampton State Hospital (opened 1858) : — Trustees: John C. O'Brien, M.D., Greenfield, Chairman; Mrs. Anne O'Keefe Heffernan, Northampton, Secretary; Samuel Michelman, Northampton; James H. Benson, Springfield; Albert M. Darling, Sunderland; Allen H. Bagg, Pitts- field; Mrs. Mary P. Bailey, Northampton. Regular meetings: Second Thursday of each month. Superintendent: Arthur N. Ball, M.D. Assistant Superintendent: Guy C. Randall, M.D. Senior Physicians: B. Edwin Zawacki, M.D.; Elizabeth Kundert, M.D.; Fernand Longpre, M.D.; Lee W. Darrah, M.D. Assistant Physicians: E. Phillip Freedman, M.D.; Helen M. Wiestling, M.D.; Harry Michelson, M.D.; Phillip Shapiro, M.D. Pathologist: Ruth Parker, M.D. Dentist: Lucien H. Harris, D.D.S. Treasurer: Eva L. Graves. P.D. 117 461 Steward: Frank W. Smith. Visiting days: Tuesdays, Fridays and Saturdays on which days members of the medical staff are in attendance to consult with visitors; but if impossible to come on those days, visitors may come on any day. Staff meetings: Every day except Saturdays, Sundays and holidays at 8:30 A.M. Location: Prince Street, Northampton, one and one-half miles from the railroad station. (Boston & Maine and New York, New Haven & Hartford railroads.) Taxi cab service from the station, bus service from Springfield and Holyoke. Taunton State Hospital (opened 1854) : — Trustees: Charles C. Cain, Jr., Attleboro, Chairman; Mrs. Elizabeth C. M. Gifford, Boston, Secretary; Mrs. Mary B. Besse, Wareham; Irving Linley, North Attle- boro; Gerald O'Sullivan, M.D., Fall River; Lawrence Quinn, M.D., New Bed- ford; Samuel C. Stone, Attleboro. Regular meetings: Second Thursday of each month. Superintendent: Ralph M. Chambers, M.D. Assistant Superintendent: Roger G. Osterheld, M.D. Director of Clinical Psychiatry: Abraham M. Stiffle, M.D. Senior Physicians: Henry L. Hartman, M.D.; Wilfrid Seguin, M.D.; Olga E. Steinecke, M.D.; Walter W. Jetter, M.D. (Pathology). Assistant Physicians: Ernest Z. Bower, M.D.; Charles E. Fiman, M.D.; Grace E. Gillis, M.D.; Eugene S. Gladsden, M.D.; Vincent C. Vielhaber, M.D. Dentist: Wilfred R. Wilson, D.M.D. Treasurer: Yvonne B. Patenaude. Steward: Frederick H. Bradford. Visiting days: Every day. Staff meetings: Daily, 8:15 A.M. and 1:00 P.M. Location: Hodges Avenue, one mile from railroad station (New York, New Haven & Hartford.) Mental Wards, Tewksbury State Hospital and Infirmary (opened 1866): — Post Office, Tewksbury; railroad station, Lowell. Trustees: Elliott C. Cutler, M.D., Boston, Chairman; William M. Collins, M.D., Lowell, Vice Chairman; Mrs. Mary E. Cogan, Stoneham, Secretary; Miss Ida M. Cannon, Cambridge; William F. Maguire, D.M.D., Randolph; Robert M. Beirne, Lawrence; James C. Coughlin, D.M.D., Lowell. Regular meetings: Usually first Friday of each month. Superintendent: Lawrence K. Kelley, LL.B., M.D. Assistant Superintendent: Patrick J. Meehan, M.D. Senior Physicians: Charles L. Trickey, M.D. (Director of Clinical Psychiatry); H. Spencer Glidden, M.D. (Pathologist); Edward J. O'Donoghue, M.D.; C. Winthrop Houghton, M.D.; James F. Lawlor, M.D.; Louis W. Stern, M.D. Assistant Physicians: Charles J. Carden, M.D.; George J. M. Grant, M.D.; Harry B. Plunket, M.D.; Philip F. Bond, M.D.; Edwin B. Thomas, M.D.; Manuel Kaufman, M.D. Dentist: Charles D. Broe, D.M.D. Steward: Thomas F. Flynn. Treasurer: Thomas F. McKay. Principal Clerk: Robert E. Gay. Visiting days: Every day. Staff meetings: Tuesday at 1:30 P.M. Location: About one-half mile from bus line, Lowell to Boston, via Tewksbury five miles from Lowell; twenty miles from Boston. Westborough State Hospital (opened 1886) : — Trustees: N. Emmons Paine, M.D., West Newton, Chairman; Kathrine L. Sullivan, Canton, Secretary; Sewall C. Brackett, Boston; Thomas F. Dolan, Newton; John A. Frye, Marlborough; Sadie E. Casey, Milford; Rufus M. Shaw, West- borough. Regular meetings: Second Thursday of each month. Superintendent: Walter E. Lang, M.D. 462 P.D. 117 Assistant Superintendent: Rollin V. Hadley, M.D. Senior Physicians: Betsy Coffin, M.D.; George E. Peatick, M.D. Assistant Physicians: Dora E. Brault, M.D.; Sidney Cohen, M.D.: Alexander J. Mozzer, M.D.; Marlin C. Moore, M.D. Pathologist: Lydia B. Pierce, M.D. Dentist: Paul L. Budge, D.D.S. Steward: P. I. Wiley. Treasurer: Carrie G. Poor. Visiting days: Every day. Staff meetings : Daily. Location: Two and one-quarter miles from Westborough Station (Boston & Albany); one mile from Talbot Station (New York, New Haven & Hartford). Worcester State Hospital (opened 1833) : — Trustees: William J. Delahanty, M.D., Worcester, Chairman; Mrs. Anna C. Tatman, Worcester, Secretary; Mrs. Frank Dresser, Worcester; John L. Bianchi, Worcester; Robert F. Portle, Worcester; Harry Kenney, Boston: Robert Burns, Auburn. Regular meetings: Second Tuesday of each month. Superintendent: William A. Bryan, M.D. Assistant Superintendent: Walter E. Barton, M.D. Clinical Director: William Malamud, M.D. Senior Physicians: Lonnie O. Farrar, M.D.; Embrie J. Borkovic, M.D.; Norman D. Render, M.D.; William L. Holt, Jr., M.D.; Benjamin Simon, M.D. Assistant Physicians: Erel L. Guidone, M.D.; S. Harvard Kaufman, M.D.; Hans B. Molholm, M.D.; Bertram T. Spira, M.D.; Ellsworth F. Waite, M.D. Pathologist: William Freeman, M.D. Dentist: Simon G. Harootian, D.D.S. Steward: Herbert W. Smith. Treasurer: Margaret T. Crimmins. Visiting days: Tuesdays, Saturdays, Sundays and holidays from 9 to 11 A.M. 1 :30 to 4:30 P.M. Staff meetings: Daily. Location: Belmont Street, Worcester, one and a half miles from Union Station (Boston & Albany; New York, New Haven & Hartford; and Boston & Maine). The Summer Street Department is located in the building formerly known as the Worcester State Asylum, on Summer Street, about five minutes' walk from the Union Station. Correspondence relating to patients should be addressed to the Superintendent, Worcester State Hospital, Worcester, Mass. Correspondence intended for Steward or Treasurer of the Hospital should be addressed to the Worcester State Hospital, Worcester, Mass. State Schools for Mental Defectives Belchertown State School (for the mentally deficient; opened 1922): — Post Office and railroad station, Belchertown, Mass. (Central Vermont Railroad from Palmer or Amherst; Boston & Maine for freight only. Busses from Spring- field, Holyoke, Amherst and Ware.) Trustees: James L. Harrop, Worcester, Chairman; Edwin C. Gilbert, M.D., Spring- field, Secretary; Mrs. Bessie F. Dewey, Northampton; Mrs. Henry F. Nash, Greenfield; James H. Dillon, Holyoke; Frederick P. Bulman, Athol; Eugene J. O'Neil, Chicopee Falls. Regular meetings: Second Thursday of each month. Superintendent: George E. McPherson, M.D. Assistant Superintendent: Raymond A. Kinmonth, M.D. Senior Physicians: Herbert L. Flynn, M.D.; Lois E. Taylor, M.D.;Lulu H. Warner, M.D. Assistant Physician: Henry W. Kraszewski, M.D. Dentist: Arthur E. Westwell, D.M.D. Steward: John J. Cronin. Treasurer: Dora B. Wesley. P.D. 117 463 Visiting days: Every day, except holidays, 9:30 to 11:30 A.M., 1:30 to 4:30 P.M., and at other times by special permission. Staff meetings: Daily at 9:00 A.M. Location: One-quarter mile from railroad station. On the state road to Holyoke and one-half mile from the center of the town. Walter E. Fernald State School at Waltham (opened 1848) : — Post Office and railroad station, Waverley (Boston & Maine). Trustees appointed by the Governor: Francis J. Barnes, M.D., President, Cam- bridge; Mrs. Julia T. Boyle, Secretary, Cambridge; Mrs. Margaret H. Fernald, Marlborough; Mr. Louis S. Haddad, Marlborough; Mrs. Ray B. Jacobs, Boston, and Norbert A. Wilhelm, M.D., Newton Centre. Trustees appointed by the Corporation: Stephen Bowen, Treasurer, Boston; Charles Francis Adams, Concord, Vice-President; Paul R. Withington, M.D., Milton; Roger S. Warner, Ipswich; John E. Rogerson, Milton; Warren R. Sisson, M.D., Brookline. Quarterly meetings : Second Thursday of October, January, April and July. Annual meetings: Second Thursday in December. Superintendent: Ransom A. Greene, M.D. Assistant Superintendent: Malcolm J. Farrell, M.D. Clinical Director: Paul I. Yakovlev, M.D. Senior Physicians: L. Maude Warren, M.D.; Esther S. B. Woodward, M.D.; Mary T. Muldoon, M.D.; Fred Vere Dowling, M.D. Assistant Physicians: John D. Maloney, M.D.; Lawrence P. Bowser, M.D.; Constance G. Hartwell, M.D. Dentist: Maurice W. Blumsack, D.M.D. Treasurer: Emily E. Guild. Steward: Henry R. Rose. Visiting days: For the parents or friends of the patients, Wednesday, Thursday, and Saturday afternoons, and the first Sunday of each month. Staff meetings: Daily at 9 A.M. Location: About one mile from Waverley station (Fitchburg Division and Southern Division, Boston & Maine), or Boston Elevated from Harvard Square. Wrentham State School (opened 1907) : — Post Office and railroad station, Wrentham. Trustees: Albert J. Sargent, Boxboro, Chairman; Mrs. William A. Murray, Milford, Secretary; Frank J. Nerney, Attleboro; Warren J. Swett, Canton; Judge James A. Mulhall, Quincy; Francis X. Powers, Worcester; Alice M. Patterson, M.D., Marblehead. Regular meetings : Second Tuesday of every month. Superintendent: C. Stanley Raymond, M.D. Assistant Superintendent: Henry A. Tadgell, M.D. Senior Physicians: Karl V. Quinn, M.D.; Bessie F. Brown, M.D.; Clemens E. Benda, M.D.; Charlotte A. Mitchell, M.D.; Alcinda de Aguiar, M.D. Assistant Physicians: John H. F. Connor, M.D.; Anne G. Levingston, M.D. Dentist: John A. Nash, D.M.D. Steward: Perry E. Curtis. Treasurer: Elizabeth Oldham. Visiting days: Every day 9 to 11 A.M., 1:15 to 4:30 P.M. Location: Emerald Street, Wrentham, one mile from railroad station, (New York, New Haven and Hartford railroad). One-half mile from Winter Street stop. Boston and Providence bus line. Telephone: Wrentham 24. 464 P.D. 117 PRIVATE INSTITUTIONS For the Care op Mental and Nervous Disorders Baldpate Inc., George M. Schlomer, M.D., Georgetown. Bosworth Hospital, George A. Gaunt, M.D., 166 Lancaster Terrace, Brookline. Bournewood Hospital, George H. Torney, M.D., 300 South Street, Brookline. Channing Sanitarium, Jackson M. Thomas, M.D., Wellesley Avenue, Wellesley. Glenside, Mabel D. Ordway, M.D., 6 Parley Vale, Jamaica Plain. McLean Hospital, For Nervous and Mental Patients (opened 1818): — Department of the Massachusetts General Hospital. Post Office and railroad station, Waverley (Boston and Maine R. R.). President: William Endicott, Boston. Vice-President: Sewall H. Fessenden, Boston. Treasurer: Henry R. Guild, Esq., Boston. Secretary: Reginal Gray, Esq., Boston. Trustees appointed by the Governor: Miss Betty Dumaine, Groton; Charles J. Dunn, Esq., Boston; Eben S. Draper, Boston; Michael A. Fredo, Esq., Boston. Trustees appointed by the corporation: Henry K. Sherrill, Boston, Chairman; Sewall H. Fessenden, Boston; Phillips Ketcham, Esq., Boston; Hans Zinsser, M.D., Boston; John R. Macomber, Boston; Francis C. Gray, Esq., Boston; Lincoln Davis, M.D., Boston; Henry R. Guild, Esq., Boston. Regular meetings: In the Trustees' Room at the Massachusetts General Hospital in Boston on Fridays at intervals of two weeks, beginning sixteen days after the first Wednesday in February. Superintendent Emeritus: Frederic H. Packard, M.D. Director: W. Franklin Wood, M.D. Psychiatrist-in-Chief : Kenneth J. Tillotson, M.D. Senior Physicians: Rupert A. Chittick, M.D.; David A. Young, M.D. Pathologist: vacancy. Director of Laboratories: Elmer H. Stotz, Ph.D. Resident Physicians: John B. Tompkins, M.D.; Daniel C. Dawes, M.D.; David Wies, M.D. ; Wolfgang Sulzbach, M.D.; Paul M. Howard, M.D.; Lucie J. Jessner, M.D.; John E. Harty, M.D.; Beatrice R. Kershaw, M.D. Roentgenologist: James R. Lingley, M.D. Dental Surgeon: George O. Bartlett, D.M.D. Visiting Internist: Wyman Richardson, M.D. Staff meetings: Wednesdays and Fridays at 11:30 A.M. The Reeves' Sanitarium, Clarence M. Kelley, M.D., 283 Vinton Street, Melrose Highlands. Ring Sanatorium and Hospital, Inc., Curtis T. Prout, M.D., Arlington Heights. Veterans' Administration Facility, No. 95, Northampton, Mass. (for beneficiaries of the Veterans' Administration, suffering from nervous or mental diseases; opened May 12, 1924) :— Under control of Veterans' Administration, Washington, D.C. Administrator of Veterans' Affairs: Gen. Frank T. Hines, Washington, D. C. Assistant Administrator: Colonel George E. Ijams, Washington, D. C. Medical Director: Charles M. Griffith, M.D., Washington, D. C. Manager: William M. Dobson, M.D. Clinical Director: Frederick R. Sims, M.D. Ward Surgeons: Fred E. Steele, Jr., M.D.; Ralph W. Brown, M.D.; Louis V. Manley, M.D.; William J. Johnson, M.D.; Darley G. Plumb, M.D. Pathologist & Chief of Clinical Laboratory: Louis V. Manley, M.D. Chief of Dental Service: Francis J. Rogers, D.M.D. Chief of Roentgenology Laboratory: Louis V. Manley, M.D. Consultant in Ear, Nose and Throat: Joseph D. Collins, M.D. Consultant in Ophthalmology: Frank E. Dow, M.D. P.D. 117 465 Consultant in Surgery: Thomas F. Corriden, M.D. Staff meetings: Mondays, Wednesdays, and Fridays. Time of meetings: 10:30 A.M. Location: Florence Street, Leeds, Massachusetts. One mile beyond the village of Florence on the Berkshire Trail. Bus connection from Northampton. Post Office: Northampton, Mass. Veterans' Administration Facility, No. 107, Bedford, Mass. (for beneficiaries of the Veterans' Administration, suffering from nervous or mental diseases, opened July 17, 1928) :— Under control of Veterans' Administration, Washington, D. C. Administrator of Veterans' Affairs: General Frank T. Hines, Washington, D. C. Medical Director: Charles M. Griffith, M.D. Manager: Winthrop Adams, M.D. Clinical Director: Walter P. Burrier, M.D. Acting Pathologist and Ward Surgeon: Antonino Triolo, M.D. Senior Physicians: John F. O'Brien, M.D.; Aaron H. Braverman, M.D.; Louis V. J. Lopez, M.D. Junior Physicians: William H. Vicary, M.D.; Waldemere G. Richter, M.D.; Irving I. Ludwig, M.D. Associate Physicians: Joseph Weber, M.D.; Louis A. Cibelli, M.D.; Raymond E. Feldman, M.D. Chief of Dental Service: William E. Sinton, D.M.D. Consultant in Eye, Ear, Nose and Throat: George A. Leahey, M.D. Consultant in Roentgenology: John H. Lambert, M.D. Consultant in Dermatology: C. Guy Lane, M.D. Consultant in Surgery: Henry C. Marble, M.D. Consultant in Genito-Urinary Surgery: Sylvester B. Kelley, M.D. Consultant in Internal Medicine: G. Philip Grabfield, M.D. Staff meetings: Tuesdays, Wednesdays and Fridays at 10:00 A.M. Location: Spring Road, Bedford, Mass. One mile in from State Highway. Bus connection from Arlington Heights, Mass. Westwood Lodge, William J. Hammond, M.D., Westwood. Wiswall Sanatorium, Edward H. Wiswall, M.D., 203 Grove Street, Wellesley. For the Care of Persons Addicted to the Intemperate Use of Narcotics or Stimulants Grove Hall Institute, George Colton Moore, M.D., 232 Townsend Street, Roxbury. Private Hospital, Frederick L. Taylor, M.D., 45 Center Street, Roxbury. Washingtonian Home, Hugh Barr Gray, M.D., 41 Waltham Street, Boston. For the Care of Mental Defectives Clarke School, Miss Edith G. Clarke, 16 Summit Street, Newton. Elm Hill Private School and Home for the Feeble-minded, George A. Brown, M.D., Barre. The Freer School, for girls only, Miss Cora E. Morse, 31 Park Circle, Arlington Heights. 4611 P.D. 117 The Hospital Cottages for Children, Baldwinsville. Town of Templeton (incorpor- ated and opened 1882) : — President: Edward F. Mann, Worcester. Treasurer: Parker Trowbridge, Worcester. Clerk: Reverend Baldwin W. Callahan, Gardner. Trustees appointed by the Governor: Jos. C. Tomasello, Boston; Mrs. Thomas H. Mahoney, Waban; Mrs. Abner S. McLaud, Greenfield; Fred C. Hailer, Roslindale; Eli M. Levatinsky, Dorchester. Trustees appointed by the Corporation: Edward F. Mann, Worcester; J. Sidney Stone, Boston; John G. Henry, M.D., Winchendon; Mrs. Thomas Allen, Jr.; Brookline; Donald W. Campbell, Worcester; F. Harold Danield, Worcester; Mrs. C. S. Dickinson, Baldwinsville; Mrs. Herbert C. Fisher, Worcester; Robert B. Greenwood, Winchendon; Mrs. Edward H. Hutchins, Boston; Mrs. Edward G. Iselin, Milton; William G. Lord, Athol; Frederick A. Turner, Boston; Mrs. John H. Waite, Baldwinsville; Mrs. George R. Wallace, Jr., Fitchburg; Edward G. Watkins, Gardner. Quarterly meetings: January, April, July, October. Superintendent: Alan W. Chadwick, B.S. Medical Director: E. St. John Ward, M.D., F.A.C.S., D.Sc. Assistant Physician: Shari Band Gaspar, M.D. Visiting days: Every day. Location: Bridge Street one mile from (Boston & Maine) railroad station and from center of town of Baldwinsville, at junction of routes 68, 32, 202. Perkins School, Franklin H. Perkins, M.D., Lancaster. The Pollock School, Morris P. Pollock, 28 Alton Place, Brookline. Stand ish Manor, Miss Alice M. Myers, Halifax. For the Care of Epileptics Woodlawn Sanitarium, Eudora Faxon, M.D., 500 Crafts Street, West Newton. For the Care of Feeble-minded and Epileptic The Lila Sanatorium, Richard C. Eley, M.D., 732 Main Street, Woburn. P.D. 117 467 INDEX A Accidents in State Hospitals — (see Casualties) Acreage — Building sites and grounds, and acres under cultivation, 131 Admissions — Mental Hospitals: 131, 147-176, 224, 236, 298-307, 310-348, 382, 413- 425 State Schools: 131, 239, 244-251, 275, 284, 426-432, 452 Epileptics, Non-Psychotic: 288, 292 Private Hospitals: 142, 309 Private Schooh: 309 Age at Admissions — Mental Hospitals Admissions: By country of origin of foreign born, 316; by country of origin of native born, 321; by hospital, 160, 327; by marital condition, 163, 340; by diagnosis, 159, 225, 323; by nativity and parentage, 157, 311 Discharges: By length of hospital stay, 193, 361; by diagnosis, 225, 353 Deaths: By length of hospital stay, 211, 373; by diagnosis, 212, 225, 369 Resident Population: By first and readmissions, 223; by hospital, 229, 397; by length of hospital stay, 224; by diagnosis, 225, 385, 391* Cases Out: By hospital, 229, 401 ; by diagnosis, 225, 388, 394 Age at admission — State Schooh Admissions: By clinical diagnosis, 249, 430; by first and readmissions and rates per hundred thousand population, 246; by mental status, 245, 429; by nativity and parentage, 249, 429 Discharges: By length of school residence, 258 Resident Population: By clinical diagnosis, 284; by intelligence quotient, 279; by length of school residence, 273: bv nativity and parentage, 275; by school, 277, 441 Cases Out: By school, 277, 442 Age at Admission — Epileptics, Non-Psychotic Admissions: By diagnosis, 293; rates per 100,000 population, 289 Age at Death — Mental Hospitals: By hospital, 214, 367; by diagnosis, 213, 363 State Schools: By clinical diagnosis, 264, 270, 438; by comparison with death rates in same ages in general population, 262; by mental status, 262, 264, 437, 450; by school, 264 Epileptics, Non-Psychotic: By diagnosis, 296 Age at Discharge — Mental Hospitals: By hospital, 196, 359; by diagnosis, 194, 349 State Schools: By clinical diagnosis, 255, 258, 433; by mental status, 253, 432, 450; rates per 1,000 cases under care, 253; by school, 253 Age of Central Registry cases — at examination, 94; by intelligence quotient, 116 Age, Present — Mental Hospitals Discharges: Rates per 1,000 under care by diagnosis, 179 Deaths: Rates per 1,000 under treatment by diagnosis, 202 Resident Population: By first and readmissions, 228; by hospital, 230, 399; by diagnosis, 229, 385, 391 Cases Out: By hospital, 229, 401 ; by diagnosis, 388, 394 Age, Present — State Schools Resident Population: By clinical diagnosis, 284, 447; by length of school residence, 274; by mental status, 450; percentage distribution, 281; by school, 277, 441 Cases Out: By mental status, 450; by school, 277, 442 Alcoholic Habits — Intemperance in Mental Hospital admissions, 1917-1939, 169; by diagnosis, 168, 335; by economic status, 159 Alcoholic Psychoses, 171 Aliens, 160, 308, 384 Appropriations — compared with expenditures, 26; for maintenance and operation, 27; special appropriations for construction, permanent betterments, real estate and furnishings, 32 Assistant Commissioner, D. M. H. — 1 Attorney General Cases, 126 Autopsies in State Institutions, 44-46 468 P.D. 117 B Baldpate, Inc. — Directory, 464; license issued to George M. Schlomer, M.D., 5 Belchertown State School — Directory, 462 Betterments — special appropriations, 32 Boston Dispensary Child Guidance Clinic, 56-63 Boston Psychopathic Hospital — Directory, 457 Boston State Hospital — Directory, 457 Bosworth Hospital — Directory, 464 Bournewood Hospital — Directory, 464 Brenner, Charles, M.D., Psychiatrist in Division of Mental Hygiene — appointment of, 2 Bridgewater State Hospital — Directory, 458 Brockton Child Guidance Clinic, 56-63 C Capability on Discharge — Patients leaving State Schools, 258, 426, 435 Capacity — And overcrowding in State Hospitals and Schools, 135; rated, 299-307 Cases Out — Mental Hospitals: 144, 222-230, 298-307, 382, 388, 394, 401, 413^19 State Schools: 275, 426, 442, 449 Epileptics, Non-Psychotic: 295 Casualties — State Hospitals, 46 Causes of Death — Mental Hospitals: By diagnosis, 377; number and percentage distri- bution, 215 State Schools: By clinical diagnosis, 268; by mental status, 268, 440 Epileptics, Non-Psychotic: By diagnosis, 296; by year, 1938 and 1939, 291 Central Registry for Mental Defectives — (see Mental Defectives) Cerebral Arteriosclerosis, 170 Changes in Personnel, 2-3 Channing Sanitarium — Directory, 464; new license granted to Dr. Jackson M. Thomas, 5 Citizenship — Mental Hospitals Admissions: Rates per 100,000 corresponding population, 162 Resident Population: By country of birth, 384 Cities and Towns — Traveling School Clinic examinations, 104-115 City or Town of Residence — (see County of Residence) Clarke School — Directory, 465 Clinical Diagnoses — State Schools Admissions: By age at admission, 249, 430; by intelligence quotient, 249, 432; percentage distribution, 277; by school, 251 Discharges: By age at discharge, 260, 433; rates per 1,000 cases under care, 255; by average age at discharge, 260; by capability on discharge, 258, 435; by intelligence quotient, 260, 434; by length of school residence, 260, 436; per- centage distribution, 277 Deaths: By age at death, 270, 438; rates per 1,000 cases under treatment, 261; by cause of death, 268; by intelligence quotient, 269, 439; by length of school residence, 270; percentage distribution, 277 Resident Population: By admission and present age, 284; by color, 448; by intelli- gence quotient, 284, 443 ; by length of school residence, 444 ; percentage distri- bution, 277; b3' present age, 447 Cases Out: By color, 449; percentage distribution, 277 Clinics Traveling School, 90-115 Child Guidance, Division of Mental Hygiene, 56-63 Color — Mental Hospitals Admissions: Number by first and readmissions, 413 Discharges: Number by first and readmissions, 413 Deaths: Number by first and readmissions, 413 Resident Population: Number by first and readmissions, 413; by diagnosis and percentage distribution, 235 Cases Out: Number bv first and readmissions, 413 P.D. 117 469 Color — State Schools Resident Population: By clinical diagnosis, 448 Case? Out: By clinical diagnosis, 449 Commissioner, D. M. H. — 1, 2. 128 Committee on Care of Institutional Patients — Report of, 5 Committee on Construction — Report of, 6 Committee on Family Care — Report of, 6 Committee on Finance — Report of, 7 Committee on Food — Report of, 7 Committee on Forms and Statistics — Report of, 7 Committee on Legislation and Regulations — Report of, 8 Committee on Mental Hygiene — Report of, 9 Committee on Nurses' Training Schools — ■ Report of, 10 Committee on Personnel and Labor Relations -^Report of, 11 Committee on Public Relations and Scientific Pmilications — • Report of, 11 Committee on Research — Report of, 12 Community Supervision of Mental Defectives — (see Mental Defectives) Condition on Discharge — Mental Hospitals, 298-307 Discharges: By diagnosis, 357; length of residence, 189; percentage distribution, 188 Epileptics, Non-Psychotic — Discharges: By diagnosis, 289; by legal status, 293 Conferences, 5 Construction at State Hospitals and Schools — Special appropriations, 32 Costs, Per Capita — (see Per Capita Costs) Costs, Total — (see Total Costs) Country of Birth — Mental Hospitals Admissio7is: Number by first and readmissions, 382; by parentage, 310 Discharges: Number by first and readmissions, 382; number and rates per 1,000 under care, 186 Deaths: Number by first and readmissions, 382; number and rates per 1,000 under treatment, 207 Resident Population: Number by first and readmissions, 382; number and rates per 100,000 same country of birth, 235: by citizenship, 384 Cases Out: Number by first and readmissions, 382 Country of Birth — State Schools Ad?nissions: By parentage, 429 Country of Origin — Foreign Born to Mental Hospitals Admissions: By age at admission, 316; by first and readmissions, rates per 100,000 population of same country of origin, 161; by diagnosis, 313 Country of Origin — Native Born to Mental Hospitals Admissions: By age at admission, 321; by diagnosis, 218; by first and readmissions, rates per 100,000 population of same country of origin, 161 — ■ Native Born to State Schools Admissions: Number and rates per 100,000 population, aged 0-24 years, same country of origin, 251 County of Residence — Mental Hospitals: Admissions and cases in residence, by city and town, 420; rates per 100,000 population, same county, 236 State Schools: Admissions and cases in residence, by city and town, 452; rates per 100,000 population same county, 285 Court Commitments — ■ (see Legal Status) D Daily Average Population in Residence — Ex-service men, 147; Mental Hospitals, 298-307; State Schools, 426 Daily Average Population on Books — Ex-service men, 147; Mental Hospitals, 144, 298-307; State Schools, 242, 426 Danvers State Hospital — Directory, 458 Deaths — Sudden deaths in State Institutions, 45 Deaths — Mental Hospitals: 198-216, 224, 298-306, 363-383, 413-419 State Schools: 261, 277, 426, 437, 450 Epileptics, Non-Psychotic: 291, 293, 295 470 P.D. 117 Delinquents — (see Juvenile Delinquents) Deming, Julia A., M.D., Psychiatrist in Division of Mental Hygiene — appointment of, 3 Dementia Praecox, 172 Dentists — Number resident in each institution, 132 Departmental Statistics, 131-140 Deportations, 13, 125, 308 Diagnoses — ■ Epileptics, Non-Psychotic Admissions: By age at admission, 293; compared with diagnoses of discharges, deaths, resident population and cases out, 295; by economic status, 294; by number and percent, 288; by population of place of residence, 294 Discharges: Compared with diagnoses of admissions, deaths, resident population and cases out, 295; by condition on discharge, 289 Deaths: By age at death, 296; by^cause of death, 296; compared with diagnoses of admissions, discharges, resident population and cases out, 295; by length of residence, 296 Resident Population: Compared with diagnoses of admissions, discharges, deaths and cases out, 295; by length of residence, 292 Cases Out: Compared with diagnoses of admissions, discharges, deaths and resident population, 295 Diagnoses — Mental Hospitals Admissions: By age at admission, 159, 323; by average age at admission compared with average age at admission of discharges, deaths, resident population and cases out, 225; by alcoholic habits, 335; compared with percentage distribution of diagnoses in discharges, deaths, resident population and cases out, 225; by country of origin of foreign born, 316; by country of origin of native born, 318; by degree of education, 341; by detailed classification, all first and read- missions, 414; by economic status, 343; by hospital, 329; by legal form of admission, 153; by marital condition, 338; by number of times admitted, 156, 347; by number and percent classified as intemperate in the use of alcohol, 168; by population of place of residence, 345; by transfers, 155; by transfers and cases discharged directly from Psychopathic to other institutions, 176 Discharges: By age at admission, 353; by average age at admission compared with average age at admission of admissions, deaths, resident population and cases out, 225; by age at discharge, 194, 349; compared with percentage distribution of diagnoses in admissions, deaths, resident population and cases out, 225; by detailed classification, all first and readmissions discharged, 414; by dis- charge rates per 1,000 cases under care, 179; by discharge rates per 1,000 cases under care and present age, 180; by legal form of admission, 177; by length of hospital stay, 191; by mental condition on discharge, 187, 357; by number of times out on visit, 197 Deaths: By age at admission, 369; by average age at admission, compared with average age at admission of admissions, discharges, resident population and cases out, 225; by age at death, 212, 363; by cause of death, 377; compared with percentage distribution of diagnoses in admissions, discharges, resident population and cases out, 225; by death rates per 1,000 under treatment, 199; by death rates per 1,000 under treatment and present age, 202; by detailed classification, all first and readmissions dying, 414; by legal form of admission, 198; by length of hospital stay, 210 Resident Population: By admission age and present age, 385, 391 ; by present age, 229; by average age at admission compared with average age at admission of admissions, discharges, deaths, and cases out, 225; by color, 235, 413; com- pared with percentage distribution of diagnoses in admissions, discharges, deaths and cases out, 224; by detailed classification, all first and readmissions in residence, 414; by legal form of admission, 218; by length of hospital stay, 231, 405-412; percentage distribution, 219 Cases Out: By admission age and present age, 388, 394; by average age at admission compared with average age at admission of admissions, discharges, deaths and resident population, 225 ; compared with percentage distribution of diagno- ses in admissions, discharges, deaths and resident population, 225 ; by detailed classification, all first and readmissions out, 414 P.D. 117 471 Directory of Institutions, 457 Discharged Directly to Other Institutions from Psychopathic — And transfers, by diagnosis, 176 Discharges — Mental Hospitals: 176-198, 224, 298-307, 349-362, 382, 413-419 State Schools: 251-261, 277, 426, 433-437, 450 Epileptics, Non-Psychotic: 289, 293 Division Reports — Financial, 20-38; Mental Deficiency, 90-125; Mental Hygiene, 54-89; Pathology, 39-54; Statistical Research, 128; Statistics, 128-140; Sup- port, 125-128 Drug Psychoses, 174 Duration of Hospital Residence — (see Length of Residence) Duties of the Department, 2 E Economic Status — Mental Hospitals Admissions: By diagnosis, 175, 430; by number and percent of first and readmissions, 165; by use of alcohol, 159 Discharges: By number and rates per 1,000 cases under care, 184 Deaths: By number and rates per 1,000 cases under treatment, 201 Resident Population: By number and percent, 222 Cases Out: By number and percent, 222 Economic Status — State Schools Admissions: By mental status, 430; percentage distribution, by mental status, 247 Discharges: By mental status and rates per 1,000 under care, 255 Deaths: By mental status and rates per 1,000 under treatment, 264 Economic Status — Epileptics, Non-Psychotic Admissions: By diagnosis, 294, 343 Education — Mental Hospitals Admissions: By diagnosis, 341; number and percentage distribution, by first and readmissions, 166 — Epileptics, Non-Psychotic Admissions: By age groups, 294 Educational Program — Division of Mental Hygiene, 72 Elm Hill Private School and Home for the Feebleminded — Directory, 465 Employees — Number in institutions, 132 Environment — Mental Hospital Admissions: Rates per 100,000 population of same environment, 165 Escapes — Mental Hospitals: General statistics, by hospital, 298-307; number and percent, 1928-1939, 144; number placed and returned by month, 145 State Schools: General statistics, by school, 426; number and percent, 1910-1939, 241; number and percent, by school, 242 Expenditures — And receipts of Department, 28, 140; of Department and Institutions, 26, 134 Expenses — For maintenance and operation, 27-30 Ex-service men — Number in Mental Hospitals, 298-307; 1928-1939, 147; support cases, 125 F Family Care Patients — General statistics, 298-307; number placed and returned, by month, 145; number under institution trustees, by hospital, 146; number under institutions and under Department, 1904-1939, 146 Farm and Garden Products — Value, 37-38 Financial Division — Report of, (William I. Rose, Business Agent), 20-38 Foreign Born — Mental Hospital Admissions: By age at admission, 316; by country of origin, rates per 100,000 population same country of origin, 160; by diagnosis, 313 Form of Admission — (see Legal Status) Foxborough State Hospital — Directory, 458 Freer School — Directory, 465 Furnishings — Special appropriations, 32 472 P.D. 117 G Gardner State Hospital — Directory, 459 General Statistics — Mental Hospitals, 298-307; State Schools, 426-428 Glenside — Directory, 464 Graduate Nurses — Number employed in institutions, 132 Grafton State Hospital — Directory, 459 Greenough, Charles W., Second Assistant Commissioner — appointment of, 2 Grove Hall Institute — Directory, 465 H Habit Clinics — (see Child Guidance Clinics) Hospital Cottages for Children — ■ Directory, 466 Hospital Life, Duration — (see Length of Residence) I Industrial and Educational Department, State Hospitals and Schools — Number employed, 132 Intelligence Quotient — Central Registry Cases: By age groups, 116 Intelligence Quotient — School Clinic Cases: By examining clinic, first examinations, 94; by examining clinic, re-examinations, 94; by number and percent of first and re-examinations, 1928-1939, 97; by percentage distribution of first and re-examinations, 96 Intelligence Quotient — State Schools Admissions: By clinical diagnosis, 249, 432 Discharges: By clinical diagnosis, 260, 435 Deaths: By clinical diagnosis, 269, 439 Resident Population: By age at admission, 279; by clinical diagnosis, 282, 443; by length of school residence, 281, 446 Intemperate Use of Alcohol — (see Alcoholic Habits) Investigations — Pathology Division, 47; Support Division, 126 J Juvenile Delinquents — Examination of, 3, 4 K Kemble, Robert P., M.D., Director of Clinical Psychiatry at the Worcester Child Guidance Clinic — appointment of, 3 L Lawrence Child Guidance Clinic, 56-63 Legal Status — ■ Mental Hospitals Admissions: 151-154, 298-307 Discharges: 177, 298-307 Deaths: 198, 298-307 Resident Population: 218 — State Schools Admissions: 244, 426 Discharges: 426 Deaths: 426 — Epileptics, Non-Psychotic Admissions: 293 Discharges: 293 Deaths: 293 Resident Population: 293 Cases Out: 293 Legislation — New, 13-19; of general interest in 1939, 19-20 Length of Residence — Mental Hospitals Discharges: By age at admission, 194, 361; by certain psychoses, 191; by hospital, 193; by diagnosis, 189; by nativity groups, 197 Deaths: By age at admission, 210, 373; by certain psychoses, 210; by hospital, 208; by number of times admitted, 215, 375; by diagnosis, 208 Resident Population: By age at admission, 224; by diagnosis, 230, 405-412 P.D. 117 473 Length of Residence — State Schools Discharges: By age at admission, 258; by clinical diagnosis, 260, 436; by mental status, 255, 436; by mental status and year, 1928-1939, 255 Deaths: By clinical diagnosis, 270; by mental status, 264, 439 Resident Population: By age at admission, 273; by clinical diagnosis, 284, 444; by intelligence quotient, 281, 446; by present age, 274; by school, 277 Cases Out: By school, 277 Length of Residence — Epileptics, Non-Psychotic Discharges: By number and percent, 289 Deaths: By diagnosis, 296; by year, 1938 and 1939, 291 Resident Population: By diagnosis, 292 Lila Sanatorium — Directory, 466 Lowell Child Guidance Clinic, 56-63 M Maintenance and Operation of State Institutions, 26-30, 133, 139 Manic-depressive Psychoses, 172 Marital Condition — Mental Hospitals Admissions: By age at admission, 164, 340; by diagnosis, 338; number and rates per 100,000 population same marital condition, 163 Discharges: Number and rates per 1,000 under care of same marital condition, 185 Deaths: Number and rates per 1,000 under treatment of same marital condition, 206 Resident Population: By number and percent, 222 Cases Out: By number and percent, 223 Massachusetts Traveling School Clinic System. 90-115 McLean Hospital — Directory, 464 Medfield State Hospital — Directory, 459 Mental and Physical Examination of Children — Juvenile Delinquents, 3, 4 Mental Condition of Discharges from Mental Hospitals — (see Condition on Discharge) Mental Defectives — Central Registry, 115-118; community supervision, 120 Mental Deficiency Division — Report of, (Neil A. Dayton, M.D., Director), 90-125 Mental Deficiency — Psychoses With, 173 Mental Examination of Persons Coming Before the Courts, 3 Mental Hygiene Clinics, 56-72 Mental Hygiene Division — Report of, (Edgar C. Yerbury, M.D., Director), 54-89 Mental Hygiene Research Activities, 74 Mental Status — ■ State Schools Admissions: By age at admission, 245, 429; by economic status, 247, 430; by number and percentage distribution, 245; by population of place of residence, 430; by year, 1928-1939, 244 Discharges: By age at discharge, 252, 432; by age at discharge and rates per 1,000 under care, 253; by present age and rates per 1,000 under care, 450; by economic status and rates per 1,000 under care, 255; by length of school stay, 257, 436; by length of school stay, 1928-1939, 255 Deaths: By age at death, 264, 437; by age at death and rates per 1,000 under treat- ment, 262; by present age and rates per 1,000 under treatment, 450; by cause of death, 268, 440; by economic status and rates per 1,000 under treatment, 264; by length of school stay, 266, 439 Resident Population: By population of place of residence, 282, 444; by present age, 450; by school, 273; by year, 1929-1939, 274 Cases Out: By present age, 450 Metropolitan State Hospital — Directory, 460 Molholm, Hans, M.D., Psychiatrist in Division of Mental Hygiene — resignation of, .2 Monson State Hospital — Directory, 460 N Native Born Admissions to Mental Hospitals — (see Country of Origin) Nativity and Parentage — ■ Mental Hospitals Admissions: By age at admission, 157, 311; rates per 100,000 population of same nativity groups aged 15 years and over, 1930 Census, 157 Discharges: By length of residence, 197 474 P.D. 117 Nativity and Parentage — State Schools Admissions: By age at admission, 249, 428; rates per 100,000 population of same nativity groups aged 0-24 years, 1930 Census, 249 Resident Popidation: By age at admission, 275 Nativity and Parentage — Epileptics, Non-Psychotic Admissions: Rates per 100,000 population of same nativity groups aged 0-24 years, 1930 Census, 288 New Construction, Permanent Betterments, Real Estate and Furnishings, 26, 32 New England Hospital Child Guidance Clinic, 56-63 Non-Insane Patients — 298-307 North Reading Child Guidance Clinic, 56-63 Northampton State Hospital — Directory, 460 Norwood Child Guidance Clinic, 56-63 Nurses — Number in each institution, 132; training schools, 10 0 Observation Cases — (see Legal Status) Officers and Employees in State Institutions, 132 Overcrowding in State Institutions, 136 P Parentage and Nativity — (see Nativity and Parentage) Paroles at State Schools — Number and percent, 1910-1939, 241 ; by school, 242, 426 Pathology Division — Report of, (Myrtelle M. Canavan, M.D., Pathologist), 39-54 Patients at Small Private Hospitals and Schools, 141, 216, 239, 309 Patients in Residence — Mental Hospitals: 132, 141, 216-238, 298-307, 382-425 State Schools: 132, 141, 239, 270-287, 426, 441-456 Epileptics, Non-Psychotic: 292, 295 Public and Private Hospitals, 1904-1939: 216 Public and Private Schools, 1904-1939: 270 Patients on Books — Mental Hospitals: 144, 298-307 State Schools: 239, 426 Epileptics, Non-Psychotic: 293 Patients on Visit and Escape — Mental Hospitals: 144, 222-227, 298-307, 401, 413-419 State Schools: 241, 426, 442 Epileptics, Non-Psychotic: 293 Patients under Care —Mental Hospitals: 141, 179-189 State Schools: 141, 251, 450 Epileptics, Non-Psychotic: 288 Patients under Treatment — Mental Hospitals: 199-208, 298-307 State Schools: 261, 450 Paying Patients, 36, 125, 134, 138 Payrolls — Analysis of, 31 Per Capita Costs — Stats Hospitals and Schools: According to Massachusetts Standard of Analysis, 28; by analysis of payrolls, by institution, 31; appropriations and expenses for maintenance and operations, 27-30; for maintenance and opera- tion, 1917-1939, 133, 139 Perkins School — Directory, 466 Personal Services, 26, 28 Personnel — State Institutions, 132; Traveling School Clinics, 96 Physicians — Number in each institution, 132 Pollock School — Directory, 466; license issued to Morris P. Pollock, 5 Population of Place of Residence — ■ Mental Hospitals Admissions: By diagnosis, 345; rates per 100,000 of same population units, 1930 Census, 166 Population of Place of Residence — State Schools Admissions: By mental status, 430; rates per 100,000 of same population units, 1930 Census, 246 Resident Popidation: By mental status, 282, 444 Population of Place of Residence — Epileptics, Non-Psychotic Admissions: By diagnosis, 294 P.D. 117 475 Present Age — (see Age) Private Hospital — Directory, 465 Private Hospitals — Number of patients, 141, 309; in residence, 1904-1939, 216; admis- sions, 1917-1939, 149 Private Institutions — Changes in, 5 Private Schools — Number of patients, 141, 239, 309 Psychiatrists — Traveling School Clinic, 96 Psychological Service — Division of Mental Hygiene, 64 Psychologists — Traveling School Clinic, 96 Psychoneuroses, 175 Psychoses — (see Diagnoses) Publications — Division of Mental Hygiene, 80, 87; Division of Pathology, 50 Quincy Child Guidance Clinic, 56-63 R Race — Mental Hospital admissions, 337 Rates per 100,000 State Population — Mental Hospitals Admissions: By country of birth of first and readmissions in resident population, 235 ; by county of residence of all admissions and resident population, 236 ; by citizenship, 162; by environment, 165; first and readmissions, 1917-1939, 149; foreign born, by country of origin, 161 ; by marital condition, 162; native born, by country of origin, 161 ; by nativity and parentage of first and readmissions, 480; by population of place of residence, 165; voluntary admissions to public and private institutions, 1928-1939, 151 Resident Population: By country of birth of first and readmissions in resident popu- lation, 235; by county of residence of all admissions and resident population, 236; by number and annual increase, 1904-1939, 142; number and rate of all public and private hospitals, 1904-1939, 217 Rates per 100,000 State Population — State Schools Admissions: By age at admission, 246; by country of origin of native born, 251; by county of residence of admissions and resident population, 285; by mental status, 1928-1939, 244; by nativity and parentage, 249; by number, 1904- 1939, 239; by population of place of residence, 246 Resident Population: By county of residence of admissions and resident population, 285; by mental status, 1929-1939, 274; by mental status and population of place of residence, 282; by number, 1904-1939, 241; by number and annual increase, 1904-1939, 142 Rates per 100,000 State Population — Epileptics, Non-Psychotic Admissions: By age at admission, 289; by nativity and parentage, 288 Rates per 100,000 State Population — Private Institutions: By first and readmissions, 1917-1939, 149; by number and annual increase of resident population, 1904- 1939, 142 Rates per 1,000 State Population — Mental Hospitals Discharges: By number of this admission, 187; by diagnosis, 179; by diagnosis and present age, 180 Deaths: By number of this admission, 207; by diagnosis, 199; by diagnosis and present age, 199 Reading Child Guidance Clinic, 56-63 Real Estate — Special appropriation, 32 Reasons for Referral, School Clinic Examinations, 92-94 Receipts — And expenditures of Department, 26-27; collected from paying patients, 36; Support Division, 126 Recommendations — Division of Mental Deficiency, 124; Traveling School Clinic cases, 97-105 Reeves' Sanitarium — Directory, 464 Reimbursing Cases — Board Rates, 36, 127; State Institutions, 126 Religious Instruction in State Institutions — Expenses, 28 Reports — (see Division Reports) 476 P.D. 117 Research Activities — Mental Deficiency, 119; Mental Hygiene (Dr. Thorn), 74; Monson (Dr. Hoskins), 82; Boston State (Dr. Myerson), 77; Boston Psychopathic (Dr. Solomon), 76; Worcester (Dr. Angyal), 83; Statistical, 128; Psychiatric Institute (Dr. Canavan), 76; McLean, 79; Grafton (Dr. Cohen), 80 Residence — (see Length of Residence) Residence — Of cases examined by Traveling School Clinics, 97-105 Resident Population — (see Patients in Residence) Retardation — Incidence in public school children of Massachusetts, 106-115 Ring Sanatorium and Hospital, Inc., — Directory, 446; new license granted to Dr. Curtis T. Prout, 5 Rockefeller Fund, Laura Spelman, 128 Rotation in Service — Persons employed in institutions, 31 S Schizophrenia — Publications, 87; research, 83 Senile Psychoses, 170 Service Rendered — Child Guidance Clinics, 58 Social Service — Division of Mental Deficiency, 120 Social Workers — Number in each institution, 132; Traveling School Clinic, 96 Sources of Contact — Central Registry cases, 116; Child Guidance Clinic cases, 117 Special Classes — Retarded children in public schools, 106-115 Springfield Child Guidance Clinic, 65-69 Standish Manor — Directory, 466 Statistical Division — Report of, (Neil A. Dayton, M.D., Director), 128-140 Statistical Research Division — Report of, (Neil A. Dayton, M.D., Director), 128 Statistical Review — Mental Disorders, 141-238; Mental Deficiency, 239-287; Epilepsy, Non-Psychotic, 288-296 Statistics — Departmental, 131-140; Epilepsy, Non-Psychotic, 288-296; Financial, 26-38; General, 298-307, 426; Mental Disorders, 141-238; Mental Deficiency, 239-287; Mental Hygiene Child Guidance Clinics, 60 Sudden Deaths in State Hospitals, 45 Suicides in State Hospitals, 46 Support of Patient Population — State Hospitals, 298-307 State Schools, 426 Support Division — ■ Report of, (Paul A. Green, Supsrvisor), 125-123 Syphilitic Meningo-encephaltis, 170 T Taunton State Hospital — Directory, 461 Temporary Care Cases — (see Legal Status) Tewksbury State Hospital and Infirmary, Mental Wards — Directory, 461 Times Admitted — Mental Hospitals Admissions: 156, 347 Discharges: 187 Deaths: 207, 215, 375 Times Out on Visit, etc., — Mental Hospitals, by diagnosis, 197 State Schools, 258, 435 Total Costs — Estimated for resident population: State Hospitals, 232; State Schools, 274 Transfers — Mental Hospitals Admissions: General statistics by institution, 298-307; by diagnosis, 135; cases discharged directly from Psychopathic to other institutions, by diagnosis, 176 Discharges: General statistics, by institution, 298-307; by diagnosis, 178 Transfers — State Schools Admissions: General statistics by school, 426; number and first and readmissions, 244 Discharges: General statistics by school, 426 Transfers — Epileptics, Non-Psychotic Admissions: 293 Discharges: 293 Traveling School Clinics, 90-115 Trust Funds, 36 P.D. 117 477 V Valuation — Land, building and betterments, personal property, farm and garden products, industrial, 131 Value — Farm and garden products, 37-38 Veterans — Number in mental hospitals, 147, 298-307 Veterans' Administration Facility No. 95 — Directory, 464; new license given to Dr. William M. Dobson, 5 Veterans' Administration Facility No. 107 — Directory, 465 Visits — Mental Hospitals: General statistics by hospital, 298-307; number and percent, 1928-1939, 144; number placed and returned by month, 145; rates per 1,000 daily average population, by institution, 144 Visits — State Schools: General statistics by school, 426; number and percent 1910-1939, 241; rates per 1,000 daily average population by school, 242; number and percent by school, 242; number of times by school, 435 Voluntary Care Cases — (see Legal Status) Voluntary Care Cases — Public and Private Institutions: 1928-1939, 151 W Waiting Lists of Patients to State Schools, 121-123 Walter E. Fernald State School — Directory, 463 Washingtonian Home — Directory, 465 West End Child Guidance Clinic, 56-63 Westborough State Hospital — Directory, 461 Westwood Lodge — Directory, 465 Wiswall Sanatorium — Directory, 465 Woodlawn Sanitarium — Directory, 466 Worcester Child Guidance Clinic — 69-70 Worcester State Hospital — Directory, 462 Wrentham State School — Directory, 463 5 I 1 9 ACME ^BINDING CO., INC. MAY 5 1991 \(\n ^ftMBR'.OGE STREET CHAKti3T0WN,MAS8

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African (black) 78 47 125 22 15 37 100 62 162 African (part black) 5 2 7 1 4 5 6 6 12 American Indian 1 — 1 — — — 1 — 1 Armenian . 10 11 21 2 1 3 12 12 24 Chinese 12 - 12 3 - 3 15 - 15 Dutch and Flemish 5 - 5 4 2 6 9 2 11 English 443 359 802 152 156 308 595 515 1,110 Finnish 30 11 41 10 14 24 40 25 65 French 185 144 329 50 49 99 235 193 428 German 45 39 84 16 12 28 61 51 112 Greek 23 12 35 5 9 14 28 21 49 Hebrew 68 88 156 68 79 147 136 167 303 Irish . 595 461 1,056 230 174 404 825 635 1,460 Italian ' 194 133 327 68 57 125 262 190 452 Lithuanian 41 20 61 10 9 19 51 29 SO Magyar 2 - 2 - - - 2 - 2 Mexican — 1 1 - — - - 1 1 Portuguese 56 37 93 20 18 38 76 55 131 Scandinavian 2 . 50 27 77 18 18 36 68 45 113 Scotch 33 36 69 12 10 22 45 46 91 Slavonic 3 . 96 90 186 25 31 56 121 121 242 Spanish 1 1 2 - 1 1 1 2 3 Syrian 4 7 11 2 5 7 6 12 18 Turkish 4 — 4 - - - 4 — 4 Welsh _ . 2 1 3 - - - 2 1 3 West Indian 4 . 3 1 4 — — - 3 1 4 Other specific races 5 4 9 5 1 6 10 5 15 Race Unknown. 60 63 123 13 7 20 73 70 143 Mixed 672 551 1,223 282 240 522 954 791 1,745 Total . 2,723 2,146 4,869 1,018 912 1,930 3,741 3,058 6,799 1 Includes "North" and "South". 2 Includes Norwegians, Danes and Swedes. 3 Includes Bohemians, Bosnians, Croatians, Dalmatians, Herzegovinians, Montenegrins, Moravians, Pohsh, Russians, Ruthenians, Servians, Slovaks, Slovenians. 4 Except Cuba. 338 P.D. 117 I - -^i cm I i-i i-i «o co I co-h I tp co mi ^ co oo co oo co th mi i-i mn r-i cm cq i-i cm CM I —i I COCM I 00 I I I CO I i-l I t>- CM OS CM CO CM •-< t~ i-l O I I i-i CO i-i I OH | Tfi I tJI | m-HDO>HHN I CO | 05 I CO I ocm I hom I -h o i-i cn m o cm oo -* io co o cm co co io i-i rH CO ©i-H CM CM H i-H H H i-H ijl Ml I-l Mi CM I leOii | lOlOHNiHOOHiifflONNNMOillH i—i CO OS CM i — 1 1 — I -—I CM to I i ihs-* i en: iN-tWHijuooiici: I i i-i i-i i HHiONNOOmONC-fOOOCCCOONOOifiOlOtOO i-i i-i HOIHHONHNN* COCOOOSiOi-h-hcOCOCM r4 h CO pH HrHi-l CM ococooocncocot^.t-.ooioooocoMicMoO'OooooooO'-i CM CO O COCCCO -H00O3CMCM-I CMO0-H -HOOCM-#COOOt>OOCO<3>i-OOOiOiO-HOt-CJMit>.t^cOa> OS lO OSi-iCOCOi-iCMCOCOCOCM O CMoocO'*t^ooasOi-iCMco-*Oi-it~.'-i'Mimcoooootoosco ■h! 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