HOUSE 
No. 2400 
C&e Commontoealtf) of fpassactmsettg 
REPORT 
OF THE 
SPECIAL COMMISSION ESTABLISHED TO STUDY THE 
WHOLE MATTER OF THE MENTALLY DISEASED 
IN THEIR RELATION TO THE COMMON- 
WEALTH, INCLUDING ALL PHASES 
OF WORK OF THE DEPART- 
MENT OF MENTAL 
DISEASES 
Under Chapter 1 of the Resolves op 1938 
March 1, 1939 
BOSTON 
WRIGHT & POTTER PRINTING CO.. LEGISLATIVE PRINTERS 
32 DERNE STREET 
1939 Cf)e Commontoealtft of Q^a00ac|ju0ett0 
State House, Boston, Mass., March 1, 1938. 
To the General Court of Massachusetts. 
The Special Commission, created originally under 
chapter 7, Resolves of 1937, and subsequently revived 
under chapter 1, Resolves of 1938, to investigate the 
whole matter of the mentally diseased in their relation 
to the Commonwealth, including all phases of the De- 
partment of Mental Diseases, respectfully submits the 
following report as the expression of the findings of the 
Commission. 
JOHN F. PERKINS, 
Chairman. 
ERLAND F. FISH, 
Vice-Chairman. 
JOSEPH W. MONAHAN. 
THOMAS P. DILLON. 
JOHN M. GRAY. 
W. A. BROWN. 
FRANCIS X. COYNE. CONTENTS. 
Section I. Organization of the Commission ..... 7 
Section II. Chronology of the Commission . . . . .10 
Section III. The Report ......... 14 
PAGE 
Appendices. 
1. Report of Special Commission, 1937 (House, No. 320) ... 31 
2. Problem of Construction ........ 66 
A. General Comments ....... 66 
B. Capacity of Institutions ...... 66 
C. Fire Protection ........ 69 
D. Construction for Hygienic Purposes . . . .71 
E. Farm Construction ....... 71 
F. Buildings Housing Employees ..... 72 
G. Miscellaneous ........ 72 
H. Institution for the Criminally Insane . . . .73 
I. Unit for Psychotic Children ...... 73 
J. School for the Mentally Deficient ..... 73 
K. Individual Recommendations, by Hospitals ... 73 
3. Ten-year Building Program ..... facing 90 
4. Problem of the Criminally Insane . . . . . .91 
An Act providing for the Establishment of the Norfolk State 
Hospital for the Care of the Criminal Insane . . 94 
Table relating to Bridgewater State Hospital for the Criminal 
Insane — Admissions during Years ending September 
30, 1923 to 1938 96 
5. Problem of the Mental Division at the Tewksbury State Infirmary 98 
Table relating to Mental Wards, Tewksbury State Infirmary — 
Admissions during Year, Rated Capacity, Patients 
within Hospital and Overcrowding on September 30 of 
Each Year, 1923 to 1938 99 
6. Problem of the Mentally Deficient ...... 101 
1. Institutional Provision for Mental Defectives in Massachu- 
setts (with tables and charts) . . . . .101 
2. Community Care of the Mentally Defective (with tables 
and charts) . . . . . . . .113 
7. Problem of Psychotic Children . . . . . . .125 
Table showing Total Cases, Aged 0 to 16 Years, on the Books 
of State Mental Hospitals, Psychotic Epileptics at 
Monson, and Psychotic Cases at the Three State Schools, 
on September 30, 1937 ...... 126 6 
CONTENTS. 
PAGE 
8. Problems of Education, Prevention and Research . . . .129 
A. Introduction . . . . . . . .129 
B. Division of Mental Hygiene Report for the Special Com- 
mission ........ 157 
List of Publications — Studies by the Division of 
Psychiatric Research, Boston State Hospital, 
1925-37, including Publications; and List of Pub- 
lications from The Department of Therapeutic 
Research, Boston Psychopathic Hospital . 162-179 
Memorandum regarding the Neuro-Endocrine Re- 
searches at the Worcester State Hospital . . 179 
C. Report of the Committee on Research Center and Methods 
to the Special Commission . . . . .196 
9. Problem of Maintenance ........ 204 
A. Income (with table) ....... 204 
B. Expenses (with tables) ....... 207 
10. Study of the Laws ......... 233 
11. A Survey of the Mental Institutions of Massachusetts . . . 246 
12. Problem of Personnel . . . . . . . .311 
13. Problem of the Epilepsies ........ 322 
14. Problem of Psychotic Adults ....... 326 
15. Problem of Narcotic Addicts ....... 341 
16. Problem of Alcoholic Addicts ....... 344 
17. Problem of the Boston Psychopathic Hospital .... 348 
18. Table showing Detail of Capacity and Population of Institutions 
on January 1, 1939 ....... 353 
19. List of Committees Assigned by the Commission .... 355 
20. Investigation of Sudden Deaths in the Hospitals .... 357 
Summary of Statement made by Dr. Clifton T. Perkins, then 
Acting Commissioner of Mental Diseases, in a Report to 
Governor Charles F. Hurley, released by the Governor’s 
Office on January 7, 1938 ...... 357 C&e Commontoealtli of qpaiwtac&uaettis 
REPORT OF THE SPECIAL COMMISSION ES- 
TABLISHED TO STUDY THE WHOLE 
MATTER OF THE MENTALLY DISEASED 
IN THEIR RELATION TO THE COMMON- 
WEALTH, INCLUDING ALL PHASES OF 
WORK OF THE DEPARTMENT OF MEN- 
TAL DISEASES. 
SECTION I. ORGANIZATION OF THE COMMISSION. 
When the Special Commission on Mental Diseases, 
created by chapter 7 of the Resolves of 1937, filed its 
report with the Legislature on December 17, 1937, it 
recommended that the Special Commission, or a similar 
group, be authorized to continue the investigation rec- 
ommended by the Governor in his inaugural message 
to the General Court on January 7, 1937. The Commis- 
sion desired to continue its study relative to the formu- 
lation of a ten-year building program for the Depart- 
ment of Mental Diseases, to review the organizational 
set-up of the Department and the hospitals under its 
supervision, and to inquire into certain policies of the 
Department and the hospitals. 
This recommendation was included by the Governor 
in his message to the Legislature on January 5, 1938, 
which follows: 
By virtue of the authority of this Legislature, I was empowered to 
appoint an unpaid Special Commission to investigate the problem of 
the mentally ill. The Commonwealth has been fortunate in obtaining 
for this service men of outstanding character and ability who have 8 
HOUSE —No. 2400. 
[Mar. 
labored tirelessly in most unusual harmony since assuming office in 
April, 1937. Last month the Commission submitted a very compre- 
hensive report which suggests a constructive plan for the reorganiza- 
tion of the Department of Mental Diseases. I recommend that appro- 
priate legislation be enacted to include the salient features of this 
report. I recommend further that you authorize me to reappoint the 
Commission for another year in order that it may complete the work 
which it has so creditably begun. 
The Commission was recreated and empowered to 
continue its study under chapter 1 of the Resolves of 
1938, which was signed by the Governor on January 31, 
1938. The resolve follows: 
Resolved, That the unpaid special commission, established by 
chapter seven of the resolves of nineteen hundred and thirty-seven, is 
hereby revived and continued for the purpose of continuing its inves- 
tigation and study of the whole matter of the mentally diseased in 
their relation to the commonwealth, including all phases of the work 
of the department of mental diseases. Said commission shall hold 
hearings, may require of the department of mental diseases and such 
other departments and such commissions or officers of the common- 
wealth as have or can obtain information in relation to the subject 
matter of this resolve such assistance as may be helpful in the course 
of its investigation and study, and may require by summons the at- 
tendance and testimony of witnesses and the production of such books 
and papers as relate to the matter under investigation. Said com- 
mission may travel within and outside the commonwealth, and it 
shall make a supplementary report to the general court of the results 
of its investigation and study hereunder and its recommendations, if 
any, together with drafts of legislation necessary to carry said recom- 
mendations into effect, by filing the same with the clerk of the house 
of representatives on or before the first Wednesday of December in 
the current year. For the purposes of this resolve, said commission 
may expend such sums as may hereafter be appropriated therefor, in 
addition to the unexpended balance of the amount appropriated by 
item thirty-six b of chapter four hundred and thirty-four of the acts 
of nineteen hundred and thirty-seven, and said balance is hereby 
made available for payment of expenses incurred by said commission. 
The first meeting of the Commission was held Febru- 
ary 4, 1938, at the State House. Those attending were 
Judge John F. Perkins of Milton, Chairman, Maj.-Gen. 
Erland F. Fish of Brookline, Vice-Chairman, Dr. L. 
Vernon Briggs of Boston, the Rev. Otis F. Kelly of 1939.] 
HOUSE —No. 2400. 
9 
Brighton, Judge Joseph W. Monahan of Belmont, Repre- 
sentative Thomas P. Dillon of Cambridge, and Mr. 
John M. Gray of Salem. William J. Griffin, Secretary, 
and Margaret R. Cotter, Stenographer, were reappointed. 
On October 5 Father Kelly resigned his position with 
the Commission, and on October 11 Dr. Briggs also 
resigned. To fill these vacancies the Governor, acting 
under authority of chapter 7, Resolves of 1937, ap- 
pointed Representative Francis X. Coyne of Boston and 
Representative William A. Brown of North Abington. 
The new members served with the Commission until 
it went out of existence. 10 
HOUSE — No. 2400. 
[Mar 
SECTION II. CHRONOLOGY OF THE COMMISSION. 
The Special Commission on Mental Diseases came into 
being in May, 1937, when the Department of Mental 
Diseases and certain hospitals were prominent in the 
public mind because of charges of neglect of patients, in- 
adequate and poorly prepared food, insufficient and badly 
furnished buildings, low morale among the Department 
and hospital personnel, and waste and extravagance in 
the expenditure of public moneys. 
Governor Charles F. Hurley, in his 1937 inaugural 
message, had noted that there had been requests by the 
Department of Mental Diseases, for itself and the state 
schools and hospitals, for a sum totalling $28,000,000, or 
$17,000,000 in excess of the largest budget the Depart- 
ment had ever been given. While sympathetic toward 
any program which would better the welfare of the pa- 
tients and the hospital personnel, nevertheless, he be- 
lieved that the program advanced by the Department 
should be closely scrutinized by a special commission. 
In addition, certain events at the Boston State Hos- 
pital had focussed public attention on that institution, 
with subsequent publicity which alarmed the public and 
convinced many that there was something radically 
wrong with the administration of the hospital. 
At the first meeting of the Commission, the chairman 
emphasized the necessity of obtaining first-hand informa- 
tion as to conditions in the hospitals so that, if the admin- 
istration of the hospitals had not fallen down, the public 
could be reassured on this point, or, if there was some- 
thing wrong, corrective measures could be applied. 
Members of the Commission visited the hospitals per- 
sonally and conferred with the staff and personnel, as well 
as patients. Thorough examination of the food, the ac- 
commodations and the treatment given the patients was 1939.] 
HOUSE —No. 2400. 
11 
made. Inspection of the buildings took considerable 
time. Individually, the superintendents were questioned 
about their specific problems. The Commission held 
many hearings attended by representatives of the De- 
partment of Mental Diseases and other state depart- 
ments, as well as representatives of the agencies which 
come in contact with the Department. As a result of 
this study we were convinced that a reorganization of 
the central department was needed, and recommended 
a reorganization bill which was amended and became law. 
Unfortunately it did not become operative until Octo- 
ber 5, 1938. 
The Commission came to the conclusion that a per- 
sonal inspection of the hospitals, as well as consultation 
with competent authorities, would satisfy the demand 
for first-hand information. At a meeting held at the 
State House in June, 1937, we asked the superintendents 
to give their views on various matters, and appointed- 
groups of them to committees to study various subjects 
and report their findings and recommendations. The 
Commission found these studies helpful, A list of the 
superintendents and the committees to which they were 
assigned will be found in Appendix 19. 
An important by-product of the meeting of the super- 
intendents and the Commission, and the inspection of 
the hospitals by the Commission, was the noticeable im- 
provement in the various hospitals. Apparently the in- 
terest shown by the Commission in their work, and the 
opportunity afforded them to assist the Commission with 
their technical knowledge, proved a stimulus which pro- 
duced beneficial results all around. This improvement, 
we are pleased to note, continued throughout the life of 
the Commission. 
Among the matters studied was that of the food bud- 
get, and the Commission became convinced that for the 
existing complicated system there should be substituted 
a more simple system based on the number of persons 
to be fed. This was done, and a survey shows that food 
costs, in money value, dropped in 1938. 12 
HOUSE —No. 2400. 
[Mar. 
When the Commission was recreated on February 1, 
1938, plans were laid for a thorough professional inspec- 
tion of the hospitals. We obtained the assistance of Dr. 
Samuel W. Hamilton, director of the Mental Hospital 
Survey Committee (a subsidiary of the National Com- 
mittee for Mental Hygiene of New York), a recognized 
expert in this specialty, and commissioned him to make 
a study of each of the hospitals and schools. With him 
were Dr. Morgan B. Hodskins, superintendent of the 
Monson State Hospital, the Rev. Otis F. Kelly and Dr. 
Grover A. Kempf, associate director of the Mental 
Hospital Survey Committee. The survey was completed 
late in January of this year. 
During the second year of its existence the Commission 
members continued to visit hospitals in this State, as 
well as outside. Because of the pressing need for a 
hospital for the criminal insane the Commission visited 
what is considered to be the finest institution of its kind 
in the country, the Menard Branch (Hospital for Crimi- 
nal Insane) of the Illinois State Penitentiary, located at 
Chester, 111., and obtained helpful information. We 
were able to do this through the courtesy of Mr. A. L. 
Bowen, director of the Department of Public Welfare, 
Springfield, 111., and Mr. Joseph E. Ragen, superintend- 
ent of prisons in Illinois. 
The Commission in its studies emphasized the medical 
aspect of the administration of the hospitals, because 
during the last year reports on the audits of certain 
hospitals were made by State Auditor Thomas H. Buck- 
ley, while Patrick J. Moynihan, chairman of the Commis- 
sion on Administration and Finance, also made a general 
survey into the business administration. 
At the suggestion of Governor Hurley, Chairman 
Moynihan and Eugene M. McSweeney, Commissioner of 
Public Safety, made an investigation relative to the 
matter of sudden deaths in the hospitals. A statement 
issued by the Governor’s office relative to this investiga- 
tion and comments of the then Acting Commissioner, 
Dr. Clifton T. Perkins, will be found in Appendix 20. 1939.] 
HOUSE — No. 2400. 
13 
Dr. David L. Williams was Commissioner of Mental 
Diseases when the Special Commission came into exist- 
ence in May, 1937. Governor Hurley initiated removal 
proceedings shortly thereafter, and the Commissioner 
became ill. He did not take an active part in the adminis- 
tration of the Department from that time on. He did, 
however, appoint his assistant, Dr. Clifton T. Perkins, 
as Acting Commissioner on May 6, 1937, a position he 
retained until he was appointed Commissioner of Mental 
Health on October 5, 1938. 14 
HOUSE— No. 2400. 
[Mar. 
SECTION III. THE REPORT. 
Throughout its existence in 1937, the Special Com- 
mission studying the whole matter of the mentally dis- 
eased in their relationship to the Commonwealth was 
handicapped because there was no active Commissioner 
of Mental Diseases with whom the Commission mem- 
bers could sit down in friendly fashion and discuss the 
affairs of this huge Department. 
After a painstaking study, which included many visits 
to the hospitals, the Department, and consultation with 
many interested persons, the Commission came to the 
conclusion that the foremost matters to be taken up 
were the reorganization of the central department, 
and a study of the individual hospitals with a view to 
determining whether public apprehension over the ad- 
ministration of the hospitals was justified, and, if so, 
what remedial steps should be taken. 
In addition, the Commission had other matters to 
study, including the ten-year building program, size of 
hospitals, disposition of the so-called criminally insane, 
mentally ill at Tewksbury, schools for the feeble-minded, 
problem of psychotic children, defective delinquents, 
housing of employees, food, education and research, and 
a study of the laws relating to the work of the Depart- 
ment. We have included as Appendix 1 the 1937 report 
submitted to the Legislature. It gives in detail the or- 
ganization of the Department in 1937 (Chart A) and 
the organization recommended by the Commission 
(Chart B), as well as recommendations for eliminating 
the administrative duties of the trustees and the quali- 
fications for the key executives in the Department and 
the hospitals. Chart C portrays the organization of the 
Department at the present time. 
In addition, the Commission advocated a transfer to 
the Department of certain duties of the boards of trus- 
tees, including that of appointing or removing super- 1939.] 
HOUSE — No. 2400. 
15 
intendents. The superintendent, in turn, would appoint, 
subject to the Department rules, subordinate personnel. 
We recommended that the trustees act chiefly as a link 
Chart A DEPARTMENT OF MENTAL DISEASES - 1937 
EXECUTIVE DEPARTMENT 
k Lieut 
OTERNOX 
klCt/ERAOR] 
COUNC! L\ 
DEPARTMENT OP MENTAL DISEASES 
ESCARPS OETRUSTEES I 
'6 INSTITUTIONS 
7 MEMBERS CAEN | 
COMM!33fONEZ 
associate I 
COMMISSIONER 3 
ASSISTANT 
\COMNJ IS SI ONE R 
j/ASSISTANT I 
\oMMiJsSIQnER ( 
between the hospital and the public, so as to relieve them 
of onerous administrative duties they could not ade- 
quately perform for various reasons; but we specifically 
reserved to them the authority to conduct investigations 
at any time. 
Chart B REORGANIZATION PROPOSED BY COMMISSION -1931' 
lLT.GOV.1 
IcTov 
[COUNCIL | 
DEPT.OF MENTAL HEALTH 
BOARD .f TRUSTEES 
(Limited Potters) 
i ASSOCIATE. 
I COMMISSIONERS 
I 
COMMISSIONER. 
FIRST AND SECOND 
ASSOCIATE COMMISSIONERS 
DIVISION OF 
HOSPITA L 
INSPECTIONS 
AND 
STANDARDS 
DIVISION OF 
MENTAL HYGIENE 
RESEARCH 
AND 
STATISTICS 
PIV1 SION OF 
CONSTRUCTION 
MAINTENANCE 
AND 
EQUIPMENT 
OTHER 
D IVI S I O N S 
Note Associate Co mtn ij j ionsr t Abolished 
Our bill was sent to the Legislature with an earnest 
request that it be adopted as speedily as possible, so that 
the Commission or a similar agency could continue to 
work with the co-operation of an active Commissioner 
and properly staffed Department. 16 
HOUSE —No. 2400. 
[Mar. 
The legislation was delayed as it moved through the 
legislative process. Public hearings were held before the 
committees on state administration and public welfare, 
sitting jointly, and the ways and means committee. 
Amendments, which changed the bill drastically in several 
respects, were offered in committee and in the two 
branches of the General Court. (See charts.) 
The Governor signed the bill on June 7, 1938. During 
the interim between the filing of the report and the sign- 
ing of the bill, the Commission’s appeal for speed was 
CUrt C DEPARTMENT AS ORGANIZED AT PRESENT 
ILT.GOV.I 
MK 
COUNCIL 
DEPT. OF MENTAL HEALTH 
6CARD of TRUSTEES 
(Limited Fou»cv*t) 
COMMISSIONER. 
ASST. COMMISSIONER 
D IV I S ION 
OF 
HOSPITAL 
IN SPECTION 
OTHER. 
DIVISION 
OTHER. 
0 I V I -5 1 O N 
OTHER, 
PIVI SION 
Kota- Division cf Hospital Inspections was created by tbe Cow missions r 
and was not created by law. ' 
lost. No emergency preamble was attached and there- 
fore the bill did not become law until October 5, 1938. 
Thus again the Commission was compelled to work with- 
out an active Commissioner during a major portion of 
the second year of its existence. At all times the Com- 
mission had the full co-operation of Dr. Clifton T. Perkins 
while he was Acting Commissioner, but, naturally, he 
was reluctant to initiate policies which might be disowned 
or changed radically by his successor. 
After his appointment and confirmation, Dr. Perkins, 
who consulted frequently with the Commission, inaugu- 
rated a program designed to increase the supervision of 
the Department over the hospitals, and at the same time 1939.] 
HOUSE — No. 2400. 
17 
not interfere, unduly, with the administration of the in- 
stitutions. He has continued the same divisions, but 
added an inspector of hospitals, whose duty it is to check 
the private and public mental hospitals; has provided the 
business agent with needed assistants; and has in mind 
other policies which will, we believe, in time greatly 
enhance the effectiveness and efficiency of the Department. 
The law reorganizing the Department, wdth but a single 
exception referred to later, has not been in effect a suffi- 
cient length of time to indicate where major changes are 
necessary. Whatever changes we have recommended 
in Appendix 10 are the recommendations of the com- 
mittee of superintendents, who examined the laws relat- 
ing to the Department at our request, and others which 
seemed desirable from the administrative viewpoint. The 
Legislature authorized the Senate Counsel, Mr. Fernald 
Hutchins, to study the laws relating to the Department, 
with a view to ironing out ambiguities and clarifying the 
law. This Commission has co-operated with Mr. Hutchins 
in its recommendations for clarifying the law. 
In our 1937 report we stated that as a result of our 
investigation we had come to the conclusion that the 
mentally ill in Massachusetts state hospitals were receiv- 
ing a type of care and treatment better than the average 
person in comfortable circumstances obtains when he 
becomes sick. The majority of the Commission were 
laymen, unfamiliar with the details of hospital adminis- 
tration and the care and treatment of the mentally ill, 
and were determined that a further check should be 
made by persons professionally qualified to do so. 
We arranged, therefore, for a thorough inspection of 
the various institutions by an expert trained in that 
specialty, Dr. Samuel W. Hamilton of New York, director 
of the Mental Hospital Survey Committee. In this work 
he was assisted by Dr. Morgan B. Hodskins, superin- 
tendent of the Monson State Hospital, the Rev. Otis F. 
Kelly of Brighton, and Dr. Grover A. Kempf, associate 
director of the Mental Hospital Survey Committee. 
We did not ask Dr. Hamilton specifically to inspect 
the business administrations of the hospitals, because the 18 
HOUSE— No. 2400. 
[Mar. 
State Auditor, Thomas H. Buckley, was then engaged 
in his annual audit of the hospitals, and Patrick J. Moyni- 
han, chairman of the State Commission on Administra- 
tion and Finance, at the instance of Governor Hurley, 
had made special studies. 
A reading of Dr. Hamilton’s report (Appendix 11) will 
convince any one that Massachusetts has held her posi- 
tion as a leader in the field of psychiatry. Although 
handicapped in many respects, the hospital superintend- 
ents have shown a commendable spirit in adhering to 
the high standards which have always been associated 
with Massachusetts mental hospitals. This thoroughly 
professional study amply justifies the confidence of the 
Commission in the hospitals, as stated in our 1937 report. 
Relatives and friends of patients in the state hospitals, 
as well as the general public, can be assured that the 
standards of care and treatment provided by the state 
hospitals for the patients in their charge rank with the 
best in the country. 
At our suggestion, Dr, Hamilton included in his report 
his conclusions and recommendations. These, of course, 
represent his personal opinions and are open to discus- 
sion and consideration, but we have appended them in 
the belief that the public should be as completely in- 
formed as possible regarding the state hospitals. It is 
the first time to our knowledge that a report of a com- 
plete and independent survey of the Department and 
all the Massachusetts mental hospitals has ever been 
made public. 
In our 1937 report we stated that lack of time pre- 
vented the Commission from completing its study of 
certain subjects which properly came within the scope 
of the resolve, particularly in formulating a building 
program for the next ten years. We noted these un- 
finished subjects as follows: 
Building Program 
One of the major duties confronting the Commission 
was a formulation of a ten-year building program. The 1939.] 
HOUSE — No. 2400. 
19 
Commission spent many months examining the build- 
ings at the various state hospitals and schools. We also 
studied the various types of hospital construction, not 
only in this State but in other States. 
In the hospital buildings, exclusive of feeble-minded 
schools and Bridgewater, the total capacity in accord- 
ance with the Department’s allotment of space is 18,716. 
A 300-bed building under construction at Grafton will 
bring the total to 19,016. The total number of patients 
resident in the hospitals as of January 1, 1939, was 
21,765. Deducting the working capacity figured by 
the Department from this would show a need for 3,049 
beds. Our study, however, convinced us that the work- 
ing capacity of the hospitals could be figured on a more 
liberal basis than it has been in the past, and it would be 
conservative to say that the total excess at the present 
time, after a re-allotment of space, would properly not 
exceed 2,700 beds. 
The average increase in the resident population in the 
hospitals is 400 a year, but this average, we have been 
informed, is gradually declining. A conservative esti- 
mate for additional beds to take care of this increase 
for the next five years is 1,885 beds, which, added to the 
2,700 beds necessary to eliminate overcrowding, makes 
a grand total of 4,585 beds. In our building program 
we have recommended a sufficient number of beds to 
eliminate the overcrowding and to take care of this esti- 
mated increase for the next five years. 
We have in mind that by that time the Department’s 
program of boarding out patients will have reached a 
peak, thus easing pressure for new beds; that means 
will be perfected to move out of the hospitals those 
custodial patients entitled to receive old age benefits 
now denied them because of their residence in institu- 
tions; and that the rapid advances being made in curing 
mentally ill patients will result in the discharge of a 
substantial number of patients. We have also recom- 
mended a sufficient number of beds to take care of the 
present overcrowding and the normal increase in the 
institutions for the feeble-minded. 20 
HOUSE —No. 2400. 
[Mar. 
The need for building construction is constantly 
changing as the needs of the hospitals and the policies 
of the Department vary from time to time. While we 
have set up our building program on a yearly basis, 
nevertheless, it is not a hard and fast model. Undoubt- 
edly, certain projects may be advanced several years 
ahead of the time indicated in the building program, 
while others may be postponed. 
We have tried to outline a well-rounded building 
program which, for a ten-year period, will provide ac- 
commodations for the present and future population of 
the hospitals. Each of the items has been thoroughly 
studied before it was placed in the program. In doing 
so we had to reject scores of projects submitted to us by 
the Department and the superintendents because, in 
our opinion, there was a more pressing need for the proj- 
ects named in the building program. 
In the last few years we have recommended the con- 
struction of buildings for the housing of superintendents, 
hospital officers and employees. Several of the super- 
intendents are compelled to live in hospital buildings at 
the present time. By the time accommodations have 
been erected for the employees, we believe that these 
other important, but not as pressing, needs can be satis- 
fied. 
The Department has recently launched an ambitious 
program to board out patients in carefully selected 
homes. If the Department’s goal of boarding out from 
450 to 500 patients is reached there will be a saving of 
between $1,500,000 and $2,000,000 in capital investment 
for new buildings, plus the cost of maintaining them. 
Size of Hospitals. 
A 2,000-bed hospital has been the traditional size for 
hospitals in this State, and our investigation discloses that 
mental hospitals range in size from 1,100-bed to 10,000- 
bed institutions. There are medical men who advocate 
the smaller size hospital because the treatment is more 
individual and concentrated, while others favor the larger 1939.] 
HOUSE —No. 2400. 
21 
size hospitals because of economy in administration and 
maintenance. In our building program we have recom- 
mended that those hospitals which have not been built 
up to the 2,000-bed limit be added to until that limit is 
reached, with the exception of Foxborough, which, tem- 
porarily at least, should be limited to 1,700 beds. 
We have not made a final recommendation on this im- 
portant policy of size because the future development of 
the hospitals will be decided by new and as yet undeter- 
mined standards. It is a subject, however, which could 
well be studied by a committee of superintendents re- 
ferred to elsewhere. This committee should be familiar 
with the changes of thought on this subject, so that the 
Department at all times will be thoroughly conversant 
with the latest opinion on this matter. 
Care of the So-Called Criminally Insane. 
The Commission was officially represented before the 
ways and means committee last year and a recommen- 
dation was made that a hospital for the criminally insane 
be constructed on state land at Norfolk at a cost of 
$1,700,000. Authority to construct this hospital was 
given by the Legislature (chapter 421, Acts of 1935), and 
only awaits an appropriation by the General Court to 
become a reality. We have been pleased to note that 
His Excellency, Governor Leverett Saltonstall, has in- 
cluded this recommendation in his 1939 budget message. 
In Appendix 4 we have given our reasons for the con- 
struction of the hospital and the transfer of the criminally 
insane patients to the Department of Mental Health. 
Mentally III at Tewksbury. 
The mentally ill population at Tewksbury State In- 
firmary is gradually declining, as is shown in Appendix 5. 
No new patients have been accepted since October 10, 
1931. With this policy in effect the population will fall 
as patients die, and the rate of decreases can be acceler- 
ated as desired by the transfer, when space is available, 22 
HOUSE —No. 2400. 
[Mar. 
of patients to institutions directly under the control of 
the Department of Mental Health. 
Schools for Feeble-Minded 
We wish to emphasize the importance of training the 
mentally deficient so that they can find their place in 
the community and become assets rather than liabilities. 
For a full discussion as to the whole problem of the men- 
tally deficient see Appendix 6. 
There are approximately 3,200 mentally deficient per- 
sons on the waiting list for entry into the feeble-minded 
schools. This list is kept up to date constantly by a 
monthly check. It has been estimated that there are 
approximately 90,000 feeble-minded persons throughout 
the State. A new school for the feeble-minded has been 
discussed for many years. We have recommended in our 
building program that no new school be built, but that 
the existing schools be brought up to the 2,000-bed limit, 
thus providing space for about 664 additional patients. 
For years the complaint has been made, and the 
graphs included in Appendix 6 bear out the contention, 
that the state schools have gradually filled up with cus- 
todial cases. Accommodations have necessarily been cur- 
tailed for the trainable high-grade moron for whom the 
schools were originally intended. A question arises as 
to whether custodial cases are to remain as such, or 
whether, by a broadening of the boarding-out program, 
they can be moved into the community, where, we be- 
lieve, they will be as happy as they now are in the 
schools. 
By building up the schools to the 2,000-bed limit, and 
moving custodial cases into the community when feasible, 
additional accommodations will be provided for high- 
grade morons. We wish to emphasize the importance of 
training this type of the mentally deficient. 
High-grade morons have been successfully trained in 
the schools to assume a very definite place in society and 
become, as a result of this training, an asset rather than 
a liability. The plight of the untrained high-grade 1939.] 
HOUSE —No. 2400. 
23 
moron is a tragic one — he considers himself misunder- 
stood because he, himself, cannot understand. The 
possibility of his becoming a defective delinquent in- 
creases with time. If, however, he can be admitted to 
a state school, trained in the aptitude for which he 
seems best developed, and then returned to the commu- 
nity, he soon finds his niche in society and lives a satis- 
factory existence. Thus, early training equips these 
young people to resist the pressure of modern existence 
under which, without that training, they are more likely 
to break down completely later in life. 
Community care of the mentally deficient means to 
keep them in the community. By doing so the State is 
saved the capital investment for buildings to house them, 
the maintenance of those buildings, and the salaries of 
additional personnel. In addition to the purely financial 
side of the matter it is a good thing for the mental de- 
fective and for the community that he remain out of 
the hospital as long as it is consistent with his welfare 
and the public at large. It is essential, therefore, that an 
extensive program of community care for the mentally 
deficient be carried on, and this matter is discussed in 
detail in Section 2 of Appendix 6. 
A committee of superintendents, recently created by 
the Department, will study this problem in the future. 
It has many angles which merit long and serious con- 
sideration, and all factors involved should be thoroughly 
studied to determine who should be accommodated in the 
proposed new facilities. 
Psychotic Children 
The problem of psychotic children has long interested 
those engaged in the study of psychiatry. Unfortunately 
there is no special institution for these children in Massa- 
chusetts. We have recommended the construction of 
a 100-bed building on the grounds of the Metropolitan 
State Hospital in Waltham. 
If such a building is constructed it will be possible to 
segregate children so that contact with adult psychotics 24 
HOUSE —No. 2400. 
[Mar. 
will be impossible; also it will make it possible to re- 
move psychotic children from the state schools where 
they now mingle with the mentally deficient children. 
Experience has shown that by segregating psychotic 
children the probability of curing them is greatly en- 
hanced. In addition, congregating the children will 
permit concentration on effort designed to cure them. 
(See Appendix 14.) 
Defective Delinquents. 
We believe the problem of the defective delinquent 
is primarily a correctional one, although complicated by 
a mental condition. In our opinion they can be better 
accommodated at Bridgewater State Farm, particu- 
larly when overcrowding is relieved by the release of 
quarters now assigned to the criminally insane. We 
recommend that the Department of Mental Health lay 
out a program of treatment to be applied by properly 
qualified personnel in the Department of Correction. 
Increased facilities in the defective delinquent section 
of Bridgewater will be of considerable assistance to the 
Massachusetts Training Schools in solving a vexing 
administrative problem. Occasionally there are sen- 
tenced to the schools boys and girls who, it is believed, 
should properly be at Bridgewater. 
We have recommended a law which will permit the 
trustees of the training schools to transfer an inmate to 
the defective delinquent section at Bridgewater for ex- 
amination. If found not to be a defective delinquent 
the inmate will be returned to the training school. If 
found to be a defective delinquent, however, he could 
be kept at Bridgewater away from harmful contact with 
the inmate population in the training school until — 
unless an earlier release seems warranted — he is twenty- 
one years old. At that time a re-examination shall be 
made, and if his condition warrants he shall be brought 
before a court for recommitment. (See Appendices 4, 
6 and 10.) 1939.] 
HOUSE —No. 2400. 
25 
Housing of Employees. 
We recommend that as many hospital employees be 
allowed to live off the institution grounds as may seem 
reasonable and proper to the superintendents, among 
whom there is a considerable difference of opinion on 
this policy. We have done so in the belief that as many 
employees as possible should enjoy a normal home life with 
all the advantages that go with living in a community 
rather than in a hospital. This might prove a desirable 
inducement to many who dislike living in an institution. 
At first glance this policy may appear to be a costly 
one because of the salary increases granted in lieu of 
maintenance, but it will pay dividends in the savings in 
capital investments for employee’s homes. In addition, 
various problems of supervision that go along with living 
in the hospital will disappear with advantage to all con- 
cerned. (See Section F, Appendix 2.) 
Food. 
This subject has been thoroughly studied for many 
years. A new system of estimating budgetary needs has 
been put into effect, and, by and large, has worked well 
and receives the co-operation of the superintendents. 
The Department is engaged in the study of purchasing, 
cooking and serving foods with a view to serving well- 
cooked food with the greatest efficiency. A committee 
of superintendents has been appointed to study the rami- 
fications of this important subject, and will recommend 
changes in policy to the Department periodically as the 
need is indicated. It does not seem advisable for the 
Commission to make a recommendation of policy on a 
subject which changes from time to time. (See Subsec- 
tion II, Section B, Appendix 9.) 
Clothing. — This is another important item of cost. 
We recommend that the Department of Correction, 
which provides the clothing for patients in the mental 
hospitals, confer with the Department of Mental Health 26 
HOUSE — No. 2400. 
[Mar. 
to perfect means of installing a system of annual produc- 
tion. The savings, we have been told, will be enormous. 
The Department of Mental Health has a certain mini- 
mum number of patients in its hospitals at all times, and 
it seems that the needs of these patients could be accu- 
rately gauged well in advance of actual needs. With 
the hospital clothing orders grouped together, the De- 
partment of Correction could buy materials in larger 
quantities at a lower cost. This would result in sub- 
stantial savings to the State and to the taxpayers. (See 
Subsection IX, Section B, Appendix 9.) 
Furniture. — What is true of the interdepartmental 
procedure in regard to the purchase of clothing also ap- 
plies to furniture. (See Subsection X, Section B, Appen- 
dix 9.) 
Education, Research and Prevention. 
We thoroughly believe that a policy of educating the 
public in matters relating to mental diseases will be most 
effective in removing the stigma unfortunately still fixed 
in the public mind in regard to a patient in a mental 
hospital. Furthermore, the medical profession as a body 
should receive the benefit of this educational process so 
that the knowledge of the advances in psychiatry will be 
available to its members. As a result, earlier diagnosis 
will be made in many cases, and this is likely to shorten 
the period of treatment and hasten the discharge of the 
patient. 
In co-ordinated research lies the hope for the preven- 
tion and cure of mental diseases. Over a period of years 
the Rockefeller Foundation and similar agencies, as well 
as private individuals, have encouraged research by con- 
tributing sums to those States and institutions which 
have shown they merit such consideration. This con- 
tribution to pure science is worthy of the highest praise. 
In this respect Massachusetts has been treated gen- 
erously by the Rockefeller Foundation, the Memorial 
Foundation for Neuro-Endocrine Research, the Armour 1939.] 
HOUSE— No. 2400. 
27 
Foundation, the Worcester and Springfield Community 
Chests, and other philanthropic organizations, as well as 
private individuals. In itself this is an indication that 
Massachusetts has not lagged behind in research, but 
that it is consistently forging ahead. We wish to thank 
these contributors for their assistance and co-operation 
in the past, and express the hope that in the future 
Massachusetts will warrant further generous considera- 
tion. (See Appendix 8.) 
In past years the Department issued a quarterly Bul- 
letin containing articles of value to those in the field of 
psychiatry. In the opinion of those who read it while 
it was being published regularly, the Bulletin had fallen 
low because the format and printing were poor. There 
is a small sum available for the printing of the Bulletin 
quarterly, but it would be exhausted in one issue. We 
have recommended legislation in Appendix 10 which 
would permit the Department to accept advertising for 
the Bulletin. 
This advertising revenue, in addition to money received 
from an expanded circulation, would permit the modern- 
izing of the format and a material improvement in the 
quality of the printing. If the money received through 
the Bulletin exceeds actual needs the excess money could 
be used to support a publication intended for the hos- 
pital personnel and the general public. This, we believe, 
would aid the Department in its program of educating 
the public as to its work. (See Section A, Appendix 8, 
and Appendix 11.) 
Laws. 
We have studied the laws relating to the Department 
and the hospitals and make our recommendations for 
changes in Appendix 10. Preceding each recommenda- 
tion for a change is a summary of the reasons for the 
recommendation. 
Thorough Investigation of Each Hospital. 
A complete investigation of the medical administration 
of the hospitals and schools under the Department has 28 
HOUSE —No. 2400. 
[Mar. 
been made by Dr. Hamilton, referred to above. His 
survey, hospital by hospital, is given in Appendix 11. 
A study of the “whole matter of the mentally dis- 
eased in their relation to the Commonwealth” takes in 
many phases of the work which require a large knowl- 
edge of the subject and intense study of its many phases. 
During its investigation the Commission studied many 
branches of this subject to which it could not, because 
its time was limited, make extensive surveys. We have 
included in our Appendices full discussions of these im- 
portant phases of psychiatry, but have not made specific 
recommendations. These Appendices are included be- 
cause of their informative value. 
In our opinion the Department of Mental Health 
should be a living organization constantly studying every 
possible means to reach higher standards. It should not 
be concerned primarily with the actual administration 
of the hospitals, but should exercise constant vigilance 
to insure that these standards are maintained. 
The problem is one of persistently endeavoring to 
improve standards which change from year to year as 
knowledge increases and new methods are devised. 
These changes come more quickly than the layman 
realizes, and the Commission felt it was inadvisable to 
enter into the purely administrative activities of the 
Department. But it did concentrate on policies intended 
to include the administration of the Department and 
hospitals, for we believe the solution lies in an alert 
organization which is continuously checking its methods 
and techniques. 
The Department has such an organization, but we 
believe this would be strengthened by an advisory body 
which we refer to later (Chart D). Standing commit- 
tees have been appointed to study subjects of vital con- 
cern to the hospitals, and others will be appointed as 
the need develops. These committees are composed of 
superintendents and representatives of the Department. 1939.] 
HOUSE —No. 2400. 
29 
By changing the personnel of these committees periodi- 
cally the superintendents and Department representa- 
tives will become familiar with the major problems 
confronting the Department. The knowledge thus 
gained should accrue to the benefit of the patient in 
better treatment, and to the taxpayer in checking the 
mounting cost of caring for the mentally ill. 
Chart D - DEPARTMENT AS PROPOSED BY COMMISSION- 
Ligov.i 
IGOVI 
COUNCIL 
DEPT.OF MENTAL HEALTH 
6OAR0.1 TRUSTEES 
(Limited Poweel) 
COMMISSIONER. 
■ AWlSORT COUNCIL .f 
O.pM MENTAL HEALTH 
A6ST. COMMISSIONER. 
SUPERINTENDS 
COMMITTEE 
DlV IS ION 
OF 
HOSPITAL 
INSPECTION 
OTHER. 
DlVI SION 
OTM E R. 
DIVISION 
OTHER. 
DIVISION 
Thus far committees have been named, as follows: 
Legislation and Regulations, Finance, Publicity and 
Scientific Publications, Food, Construction and Mainte- 
nance, Personnel and Labor Relations, Nursing, Mental 
Hygiene, Statistics and Forms and Care of Institution 
Patients. 
However, it is equally important, in the opinion of 
the Commission, that when these committees make 
recommendations to the Commissioner he have a group 
with whom he can consult before reaching a decision 
on major policies. One of the reasons for establishing 
the former unpaid associate commissioners was to give 
the Commissioner an opportunity to discuss his problems 
with men from outside the State service who could look 
at his problems from a different point of view. 30 
HOUSE —No. 2400. 
[Mar, 
We believe the principle should be retained, and have 
recommended the establishment of a Board to be known 
as the Advisory Council of the Department of Mental 
Health, to be composed of men of substance and standing 
in various lines of endeavor, who would give the Com- 
missioner the benefit of their experience to help him cope 
with the problems of the Department. 
By concentrating the power of appointing these men 
in the Commissioner, he is assured of a group which will 
work in sympathy with him. We have deliberately 
omitted any reference in our proposed legislation to the 
number of councillors, the term of office, or nature of 
their duties, so as not to handicap the Commissioner or 
the Council. Later, perhaps, the Council may be more 
formally organized, but we would rather wait until time 
has shown the need. 
The Commission wishes publicly to express its appre- 
ciation to — 
The superintendents of the hospitals, and especially 
Dr. Morgan B. Hodskins, superintendent of the Monson 
State Hospital, who assisted in the survey of the hos- 
pitals ; 
The officials of the Department, and particularly the 
Commissioner, Dr. Clifton T. Perkins; 
The Mental Hospital Survey Committee, and particu- 
larly Dr. Samuel W. Hamilton and Dr. Grover A. Kempf; 
The Rev. Otis F. Kelly, who assisted in the survey of 
the hospitals; 
Dr. L. Vernon Briggs, who assisted in formulating the 
building program; 
— for the splendid co-operation given the Commission 
in carrying out its duties. 
The body of the report represents the conclusions of 
the Commission, but we have not hesitated to include in 
the Appendices full discussions on various subjects pre- 
pared for our use by the superintendents and the De- 
partment officials, but these do not necessarily represent 
the formed opinion of the Commission on these subjects. 1939.] 
HOUSE — No. 2400. 
31 
Appendix 1. 
REPORT OF SPECIAL COMMISSION, 1937. 
A Special Commission was created for an investigation and 
study of the whole matter of the mentally diseased in their 
relation to the Commonwealth, including all phases of the 
work of the Department of Mental Diseases, under chapter 7 
of the Resolves of 1937, which follows: 
Resolved, That an unpaid special commission, consisting of seven 
persons to be appointed by the governor, is hereby established for 
the purpose of making an investigation and study of the whole mat- 
ter of the mentally diseased in their relation to the commonwealth, 
including all phases of the work of the department of mental diseases, 
particularly as set forth in so much of the address of His Excellency, 
the Governor, printed as current senate document number one as 
relates to mental diseases. Said commission shall hold hearings, 
may require of the department of mental diseases, and such other 
department, commission or officer of the commonwealth, as has or 
can obtain information in relation to the subject matter of this resolve 
such assistance as may be helpful in the course of its investigation and 
study, may require by summons the attendance and testimony of 
witnesses and the production of books and papers as relate to the 
matter under investigation. Said commission shall be provided with 
quarters in the state house or elsewhere and may expend after an 
appropriation has been made for legal, clerical, and other services 
and expenses, such sums, not exceeding, in the aggregate, seven thou- 
sand dollars, as may hereafter be appropriated. Said commission 
shall report to the general court, the results of its investigations and 
study and its recommendations, if any, together with drafts of legis- 
lation necessary to carry its recommendations into effect, by filing 
the same with the clerk of the house of representatives not later than 
the first Wednesday of December in the current year. 
To understand the work of the Commission it is necessary 
to realize that in the period preceding the inaugural message, 
and the recommendation of the Governor for the establish- 
ment of the Commission, certain occurrences in the Depart- 32 
HOUSE— No. 2400. 
[Mar. 
merit of Mental Diseases and the Boston State Hospital at- 
tracted a great deal of attention and were given considerable 
publicity in the newspapers. Subsequently, the Department 
submitted its annual budgetary request, asking for an appro- 
priation of approximately $12,000,000 for ordinary current 
expenses of the Department and the hospitals under its juris- 
diction, and the staggering sum of approximately $17,000,000 
more for new construction of buildings and radical alterations 
in existing buildings. 
These circumstances convinced the Governor that the matter 
was urgent, and led him to request the establishment of a 
Special Commission in his inaugural message. That portion of 
the Governor’s message follows: 
There is an important phase of administration which has seriously 
disturbed the Governors of Massachusetts for many years. I refer 
to the problem of the mentally diseased. I would, first of all, call to 
your attention that the care of those unfortunately thus afflicted has 
normally absorbed about one quarter of the active income of the state. 
I think it is only fair to say that none of my predecessors has ever 
begrudged the spending of this large proportion of our revenue. Cer- 
tainly, I am, and shall continue to be, in entire sympathy with every 
reasonable request for appropriations toward this eminently worthy 
cause. 
However, there has been, for some years, a definite sentiment in 
administrative circles that there should be instituted some form of 
legalized review and analysis of the affairs and of the plans of the 
Department of Mental Diseases. Let me say at once, for the benefit 
of those who may have relatives or friends in our state hospitals, that 
the sentiment has not been engendered by reports of any physical 
abuse of the inmates of these institutions. On the contrary, our tra- 
ditions in this regard are very high and very sound. 
Specifically, there is reason to believe that the proper care of the 
mentally sick, for which the Commonwealth holds itself duly respon- 
sible, is gradually being extended into fields where we cannot sensibly 
assume responsibility. There is in the public mind an ever-growing 
tendency, which has been deliberately fostered and directed, to throw 
upon the care of the Commonwealth many who should and could be 
cared for at home. The practical distinctions between the insane, 
the neurotic, the moronic, and the retarded are being obscured, to 
all intents and purposes, so as to favor the shifting of humane respon- 
sibility for the care and the upbringing of all these types from the 
home to state institutions. Theory and practice are being most plau- 
sibly confused in the elusive name of science. 
These constantly expanding operations of the Department of Mental 
Diseases are supported by what are practically the police powers of 1939.] 
HOUSE— No. 2400. 
33 
the State. As you can all see, we must be correspondingly on our 
guard against the possibility of officious error and injustice. Already 
this Department has tremendous authority over the lives of 25,000 
of our people. Without a scientifically limited and publicly approved 
program, it is quite possible that, at some future day, the Depart- 
ment may come under the control of a politically powerful group who 
may love theory because it is novel, and who may define efficiency 
in terms of number of inmates and of unlimited extension of building 
operations and of personnel. 
This brings me at once to the matter of finance. Our former Com- 
missioner of Mental Diseases, on November 30, 1936, filed a series 
of requisitions winch would have entailed the expenditure of $28,- 
000,000, — over two and one half times as much as was spent by the 
Department last year. On submitting the details of these requisi- 
tions to a group of men trained by education and experience in the 
practical and scientific aspects of the problem, I was informed that 
the program outlined was unsatisfactory in several important details, 
— details involving the expenditure of millions of dollars of state 
funds. 
In the light of these facts I suggest that the Legislature empower 
me to appoint a commission to consider the whole matter of the men- 
tally diseased in their relation to the Commonwealth. I would have 
the members of tlois commission submit a complete program which 
would envisage our needs for the next decade, at least. I would have 
them include in this program a correct outline of the obligations and 
of the rights of the Commonwealth in the light of modern, scientific 
knowledge and practice, and I would have them draw up a complete 
scheme of building operations sufficient to meet our requirements for 
years to come, eliminating all unbusinesslike or overlapping details 
caused by haphazard planning. Fragmentary handling of this prob- 
lem is no longer excusable. 
Therefore, I respectfully request from your honorable bodies the 
power to appoint a commission of five members, composed of a com- 
petent specialist in mental diseases, a tried and skilled hospital ad- 
ministrator, a builder or an architect who understands well the material 
aspects of hospital construction, an outstanding medical man in 
general practice, and a jurist thoroughly acquainted with the problems 
of juvenile delinquency. I ask that this commission be empowered 
to investigate all phases of the work of the Department of Mental 
Diseases, and that it be authorized and directed to engage in such 
study as will enable it to bring in for our consideration a complete, 
practical and scientific plan for the wise handling of this problem in a 
systematic and truly state-wide fashion during the next ten years. 
It is our hope that such a plan, wisely conceived and clearly de- 
veloped, will serve as a directive norm for those who may be respon- 
sible for the work of this important Department. It is my further 34 
HOUSE —No. 2400. 
[Mar. 
hope that this plan may be a model for all those, whether at home or 
abroad, who are sincerely interested in the public care of the mentally 
defective. 
Under authority of the resolve the Governor appointed the 
following persons to the Commission: 
Judge John F. Perkins, Milton. 
Maj.-Gen. Erland F. Fish, Brookline. 
The Rev. Otis F. Kelly, Brighton. 
Judge Joseph W. Monahan, Belmont. 
Dr. L. Vernon Briggs, Boston. 
Representative Thomas P. Dillon, Cambridge. 
Mr. John M. Gray, Salem. 
Members of the Commission were sworn into office by the 
Governor on April 26, 1937. At the first meeting of the Com- 
mission, held that day, Judge Perkins was elected chairman, 
Major-General Fish was chosen as vice-chairman, William J. 
Griffin was named secretary, and Margaret R. Cotter was 
appointed stenographer. 
The Governor spoke briefly to the Commission. He referred 
to his inaugural message and said he felt that there was a real 
need for a thorough and impartial investigation of the whole 
matter of the mentally afflicted, and their relationship to the 
State. He related that he is intensely interested in the welfare 
of the mentally ill, but is also cognizant of the fact that the 
Department of Mental Diseases now absorbs about one quarter 
of the active income of the State. He told the Commission 
that he hoped that upon the completion of their investigation 
the members would be able to present a report that would be 
helpful to those in charge of the Department, and also be of 
benefit to the taxpayers. 
Activities ob1 the Commission. 
The magnitude of the task confronting the Commission was 
full}'' realized from the start. In its endeavors to obtain in- 
formation that might be helpful in formulating a program — a 
program which would better the welfare of the 28,000 patients 
and the 7,000 employees of the Department, and still be of 
benefit to the taxpayers — the Commission has sought in- 
formation from every source available. It visited the Depart- 
ment of Mental Diseases and various hospitals under its 1939.] 
HOUSE —No. 2400. 
35 
jurisdiction; attended meetings of the Department and the 
superintendents of the state hospitals; staff meetings at various 
hospitals; trustees’ meetings at various hospitals; meetings of 
the Department and the trustees of all hospitals; and meetings 
of the Commissioner of Mental Diseases and the Associate 
Commissioners. 
In addition, it held hearings which were attended by the 
superintendents, individually and as a group; by the Commis- 
sioner of Mental Diseases and his chief executive aides; the 
Commissioner and the Associate Commissioners; representa- 
tives of the Auditor’s Department, the Department of Cor- 
rection, and the Commission on Administration and Finance. 
Assistance was also received from the Boston School Committee, 
the Rockefeller Foundation, the New York State Department 
of Mental Hygiene, and the National Committee for Mental 
Hygiene. 
Importance and Need of Investigation. 
The importance and need of the investigation of the care of 
the mentally ill in Massachusetts was amply indicated in the 
Governor’s message to the Legislature. 
Because of the peculiar treatment required — often pro- 
longed — the majority of the mentally ill must be cared for at 
public expense, — a duty which the State recognized and 
assumed many years ago. The financial burden to the State, 
therefore, for buildings, equipment, maintenance and salaries 
of officials and employees, constitutes one of the largest items 
in the annual budget. 
The constant increase in this tax burden has, as the Gover- 
nor pointed out in his message, “ seriously disturbed the Gov- 
ernors of Massachusetts for many years.” At no time since 
its creation has the Commission forgotten that, among other 
duties, it represented the inarticulate taxpayer who supplies 
the money to run this huge Department. 
For many years Massachusetts has had the reputation 
throughout the country of being a leader in the care of the 
mentally ill. The methods of providing for hospitals and ad- 
ministering hospitals in this State have been imitated by many 
of our sister States. Many States have found it wise to engage 
permanently the services of physicians who received their 
training in the Massachusetts state hospitals. Many States, 
too, have temporarily borrowed the services of superintendents 
of our state hospitals to organize their own departments for the 36 
HOUSE —No. 2400. 
[Mar. 
care of the mentally ill. Only recently the Governor of Ken- 
tucky requested Governor Hurley to permit a superintendent 
of a state hospital to go there to assist and direct them in the 
organization of a new and modern state hospital modeled on 
the Massachusetts system. 
The Commission has been strongly impressed by the very 
evident fact that in many and probably most instances the 
mentally ill in the state hospitals of Massachusetts are pro- 
vided with far better surroundings and better medical and 
surgical care than are available to the average citizen in com- 
fortable circumstances when he becomes sick. 
We have dwelt on the excellence of the care provided by the 
State for the mentally ill because recently, in newspapers, 
popular literature and even in medical psychiatric literature 
articles have been published which give the idea that the 
Massachusetts care of the mentally ill has broken down, and 
the whole Department of Mental Diseases has become honey- 
combed with politics. 
The citizens of this State may be reassured on this point. 
It is true that the Department organization at the State House 
broke down this year, and that for several years it has not given 
the hospitals the assistance and co-operation they have a right 
to expect; and in some cases laxity has crept into the hospitals. 
On the whole, however, the hospitals have maintained their 
standards, and the work of caring for the mentally ill, of en- 
couraging preventive measures in their communities, and of 
conducting research projects has been carried on with high 
fidelity to the best traditions. For this the superintendents 
deserve high praise. We wish also to express our thanks to the 
superintendents, and to the Acting Commissioner, Dr. Clifton 
T. Perkins, and his associates in the Department, for their 
help and admirable spirit of co-operation. 
The Department of Mental Diseases. 
History and Present Condition. 
The Commonwealth of Massachusetts began to care for the 
mentally ill as early as 1832, when a mental hospital was estab- 
lished in Worcester. Previously, insane persons were incarcer- 
ated in jails, hidden in almshouses and frequently brutally 
treated. 
In 1854 a Special Commission on Lunacy was appointed to 
ascertain the number and condition of the insane, and this 1939.] 
HOUSE —No. 2400. 
37 
commission made definite recommendations. Later, in 1863, 
a committee was appointed to make further investigations and 
this committee recommended that a permanent Commission 
on Lunacy be appointed. 
The State Board of Charity was established in 1863, and, 
for the first time, the insane of Massachusetts came under 
central supervision. This Board was later superseded by the 
State Board of Health, Lunacy and Charity. A State Board of 
Insanity was formed in 1898, was reorganized in 1912 and again 
in 1914. The Massachusetts Commission on Mental Diseases, 
now the Department of Mental Diseases, succeeded this Board 
in 1916. 
Wise legislation for the insane began in earnest in 1881. 
Voluntary admission, which was used in the early days, was 
re-established that year. Provisions were also made for emer- 
gency admission. With the inauguration of state care, a sepa- 
rate division was established by the Department in 1904 to 
study the question of support of patients. State care of the 
feeble-minded and epileptic became effective in 1908. When 
the Department was established as such in 1916, Dr. George 
M. Kline was chosen Commissioner, and remained Commis- 
sioner until his death in January, 1933. Dr. James V. May 
was Commissioner from January, 1933, to June, 1934, when 
he was succeeded by Dr. Winfred Overholser, who in turn was 
succeeded by Dr. David L. Williams, the present Commissioner. 
The Department of Mental Diseases, already well organized 
by the previous Boards of Insanity, was managed most effi- 
ciently during the long service of Dr. Kline, from 1916 to 1933. 
Dr. Kline devoted all of his time to the work of the Depart- 
ment, and exercised a degree of control not attained by any 
other Commissioner. He constantly visited the hospitals, kept 
himself familiar with the problems and needs of the hospitals, 
and took a deep personal interest in the officers of the hospitals, 
particularly the medical officers. He studied their abilities, to 
know better how to encourage them and to help them to culti- 
vate their talents. For that purpose he instituted the custom 
of bringing to the Department, as assistants to the Commis- 
sioner, physicians who had the grade of assistant superintend- 
ent of a hospital. His plan was to train these young men for 
superintendents when vacancies occurred. Working in the 
Department under Dr. Kline these men were expected to be- 
come familiar with administrative methods and to get the so- 
called “Department view-point.” By conducting hospital in- 38 
HOUSE —No. 2400. 
[Mar. 
spections, they were expected to become familiar with all the 
details of hospital administration. This system worked reason- 
ably well under Dr. Kline because of his personal talent and 
enthusiasm. But even under Dr. Kline the method was more 
effective for training prospective hospital superintendents than 
for promoting the welfare of the hospitals, because the inspec- 
tors were not the equals of the superintendents in training and 
experience, and their inspections were not so valuable or effec- 
tive as inspections should be. 
Under Dr. Kline the Department had become a one-man 
affair. Subsequent commissioners were not men of such out- 
standing executive ability as Dr. Kline, and the Department, 
under their regime, began to lose its vigor. 
The appointment of Dr. Williams, who was confirmed De- 
cember 9, 1936, was severely criticised as a purely political 
appointment, and it was alleged that he did not have the 
necessary qualifications to perform the duties of his office. He 
carried on as Commissioner until May 20, 1937, when he was 
taken sick, and has not reported for duty at the State House 
since that time. However, he still remains Commissioner. 
Shortly afterward, Dr. Joseph E. Barrett, the assistant com- 
missioner, who was Acting Commissioner in the absence of 
Dr. Williams, resigned under charges preferred by the State 
Auditor. 
This left the Department without an active legal head, and 
conditions in the Department soon became nothing less than 
chaotic. The Governor could not appoint a new Commissioner 
as the office was not vacant; and there was no assistant com- 
missioner. Under the law a new assistant commissioner must 
be appointed by the Commissioner, who could not be reached. 
This condition lasted until June 23, 1937, when Dr. Williams 
recovered sufficiently to appoint Dr. Clifton T. Perkins as 
assistant commissioner. In the meantime, a large volume of 
matters, which legally required the action of the Commis- 
sioner or Acting Commissioner, had accumulated, and the 
personnel of the Department was for a long time busily en- 
gaged in disposing of this accumulated business. 
In consequence of these conditions the work of the Depart- 
ment has become ineffective, both in its internal administra- 
tion and in its supervision of the various hospitals under its 
Reorganization of Department 1939.] 
HOUSE — No. 2400. 
39 
jurisdiction. We believe a complete reorganization of the De- 
partment is called for. The Commission therefore recom- 
mends — 
A. The abolition of the Department of Mental Diseases. 
B. The creation of a new department to he known as the 
Department of Mental Health. 
Care of the mentally ill is a medical problem, but recogni- 
tion of this has been extremely slow. However, the stigma 
and public disgrace formerly attached to the mentally ill and 
their families have gradually diminished, so that people have 
become more and more willing to admit the existence of mental 
disease and to seek medical care. The growing need for addi- 
tional hospitals is largely due to this changed attitude. 
In recent years the work of the Department of Mental Dis- 
eases and the hospitals under its control has expanded to 
include not only the care and treatment of those already 
mentally ill, but also measures for the prevention of mental dis- 
eases, for the education of the public, and for research to de- 
termine the causes of mental diseases. In addition, the Depart- 
ment has furnished assistance to the schools of cities and towns 
by examining retarded children and establishing special classes 
for the education of mentally deficient children for whom hos- 
pitalization is not necessary. 
The term “mental health” more nearly describes the present 
work of the Department. 
C. The executive control of the Department of Mental Health 
to be in the hands of one Commissioner, with two Associate Com- 
missioners to assist him. 
The Department is now composed of one full-time Com- 
missioner and four unpaid Associate Commissioners, whose 
work is largely advisory. When interviewed by the Commis- 
sion, the Associate Commissioners readily admitted that with 
the extensive outside activities which they all have, it is im- 
possible for them adequately to perform the duties the law 
requires; that for many years the Commissioner has domi- 
nated the Department; and that their work has been little 
more than a formality. They have been generous with their 
time and efforts, but their duties have become too burden- 
some to be handled effectively by them. 
The Commission considered three possible plans of depart- 
mental administrative control: 40 
HOUSE— No. 2400. 
[Mar. 
First. — A full-time Commissioner, who would be the ex- 
ecutive head of the Department, and a board of advisers, who 
would, on occasion, give him their views on the pressing prob- 
lems of the Department. 
Second. — A three-man Commission, each Commissioner 
having equal powers, who would divide the work of the De- 
partment. 
Third. — A Commissioner who would be the executive head 
of the Department, but who would have two well-qualified 
and able associates to whom he could turn over a great part of 
his work. 
After lengthy discussions the Commission came to the con- 
clusion that the third plan gave greater promise than the 
others. It combines the advantages of a single Commissioner, 
and the three-man Commission. The Department, according 
to the best estimates, will continue to expand; and to increase 
the load on a single Commissioner would be unwise. On the 
other hand, to divide the responsibility for administering the 
affairs of the Department would be equally inadvisable. 
To carry out this plan there should be a full-time Commis- 
sioner, whose duty it would be to see that the work of the 
Department is properly and efficiently carried on. 
There should also be a first Associate Commissioner, with 
professional qualifications equal to those of the Commissioner. 
As his chief duty he should maintain active and intelligent 
contact with the hospitals for the mentally ill. The first As- 
sociate Commissioner, therefore, should be in charge of the 
hospital inspection service, to which we refer later. It would 
be his duty to make certain that the hospitals receive the assist- 
ance and co-operation they have a right to expect from the 
Department, and have not received in the past few years; that 
the hospitals are maintained according to the best standards 
of medical practice; that public moneys expended in hospitals 
are expended for useful purposes, and not wasted on things 
that are more decorative than helpful to the patients. 
There should also be a second Associate Commissioner, who 
should be a physician, familiar with hospital administration 
for the care of people who suffer from diseases common to both 
sane and insane. He should be a man whose standing and 
authority would command the respect of hospital superintend- 
ents and officials, and it should be part of his duties to see that 
the standards of general medical care are maintained without 
extravagant expenditure of state money. 1939.] 
HOUSE —No. 2400. 
41 
To obtain continuity in the Department, it is recommended 
that the terms of the Commissioners be six years, and that their 
appointments be staggered at the start so that there will be an 
appointment every two years, thus leaving at all times two 
men thoroughly familiar with the policies and aims of the 
Department. 
To command the respect of the many highly trained men in 
the various hospitals, those in charge of the Department should 
be highly trained themselves, and by their achievements should 
have reached a position of eminence in their profession. To 
obtain such men, adequate salaries must be paid. It is there- 
fore recommended that the Commissioner be paid not less than 
the sum of $10,000 per year, and the Associate Commissioners 
not less than the sum of $9,500 per year. 
This plan leaves administrative authority in the hands of 
one man, but associates with him two other men who also have 
the title of Commissioner and who are qualified professionally. 
They will share the work and, although subordinate to him, 
will be qualified to perform his duties in the event of his sick- 
ness or absence. By this arrangement the Department at all 
times will be in charge of a competent head, familiar with its 
work and its problems, and able to command the respect of the 
hospital superintendents and other subordinates. 
D. The Commissioner and first Associate Commissioners to 
he diplomates of the American Board of Psychiatry and Neurol- 
ogy, and to have had at least seven years’ experience on the staff 
of a State or Federal hospital for mental diseases, or in any equiva- 
lent psychiatric organization. The second Associate Commissioner 
to be a physician with at least seven years’ experience on the staff 
of a general hospital. 
It is impossible to define by law all the qualifications that 
men should have to hold executive positions in the Department 
and in the hospitals. It is, however, of the highest importance 
that minimum qualifications be required so that the many 
thousand patients in the State’s care shall not suffer through 
the incompetence of executives, and the taxpayers shall be 
protected from expensive, inefficient and unwise administration. 
Proved ability and experience are the qualities desired, and 
although there can be no certainty in advance that a man will 
perform new duties effectively, the requirements we recommend 
go a long way toward assuring this result. 42 
HOUSE —No. 2400. 
[Mar. 
A diploma from the American Board of Psychiatry and Neu- 
rology is the recognized indication of competency in the practice 
of either psychiatry or neurology. Any physician is eligible for 
examination and certification by this Board if he meets the 
professional requirements demanded by it before the issuance 
of a diploma. 
For further details regarding the American Board of Psy 
chiatry and Neurology, see Appendix A. 
E. The work of the Department of Mental Health to he ad- 
ministered through various divisions. 
1. The Division of Hospital Standards and Inspection. — 
Under the present law (section 24, chapter 123, General Laws) 
one of the most important duties of the Department is the 
inspection of hospitals. To inspect a large hospital adequately 
the inspector should spend at least a week in the hospital. (For 
inspections made in recent years see Appendix B.) 
It will be seen from the list of inspections that since 1933 
only three hospitals have been inspected by the Department 
of Mental Diseases in the manner prescribed by law; namely, 
the Westborough State Hospital in 1934, the Boston State 
Hospital in 1935, and the Northampton State Hospital in 1936, 
with a supplementary report in 1937. In addition to this there 
was one inspection of the Hospital Cottages for Children in 
1936. 
Examination of inspections of private hospitals shows a 
comparable situation. The two Veterans Administration Hos- 
pitals for Mental Diseases in Northampton and Bedford have 
not been inspected by the Department since 1933. These 
records are taken from the Department of Mental Diseases. 
Not only did the Department fail in the number of inspec- 
tions which good administration and the law require, but also 
in their quality. Enough time was not given, and of the time 
given much was wasted in trivial and unimportant details. 
Until recently, whole days were spent in checking commitment 
papers which had been previously checked by hospital em- 
ployees; and the time remaining was devoted mainly to an 
examination of the physical properties. Little of medical value 
appears in the reports. They were filed under the name of the 
inspecting doctor, not under the name of the hospital, and 
very little, if anything, was done about them. 
The Commission wishes to emphasize, as forcibly as possible, 
its belief that the true function of inspections is something 1939.] 
HOUSE — No. 2400. 
43 
quite different from the trivial checking of details which has 
prevailed in the past. Their purpose should be to help, and 
to stimulate improvement, not merely to find fault. They 
should be used to keep all hospitals in a state of friendly rivalry 
for leadership in better methods and higher standards; and 
under skillful direction, they should become a most valuable 
and effective tool in producing good management. 
Owing to the importance of this division it is suggested that 
it be headed by the first Associate Commissioner. But the 
director of this division, whether first Associate Commissioner 
or not, should be thoroughly familiar with hospital practice. 
If not first Associate Commissioner, he should be a diplomate 
of the American Board of Psychiatry and Neurology, and should 
have had at least five years’ experience on the staff of a State 
or Federal hospital for mental diseases, or in any equivalent 
psychiatric organization. He should have a competent staff 
to make the investigations, including experts in the psychiatric 
and medical care of patients, food experts, and such other 
experts as he may need to perform properly the duties assigned 
to this division. 
2. The Division of Mental Hygiene, Statistics and Research. —■ 
The number of patients in the hospitals of the Department 
has been constantly increasing and promises to continue to 
do so. 
Obviously the way to attack the problem is to treat cases in 
their first stages, and also to encourage preventive measures 
and research. For that reason the Commission recommends a 
Division of Mental Hygiene, Statistics and Research, to co- 
ordinate research work and the preventive measures of the 
Department. 
The director of this division should have the same quali- 
fications as the director of the Division of Hospital Standards 
and Inspection. 
3. Division on Construction, Maintenance and Equipment. — 
The work of this division is non-medical, and should be headed 
by a professionally competent construction engineer or other 
person of similar capacity. Its duties are twofold: first, to 
see that adequate physical facilities are provided for the proper 
care of the mentally ill; and second, to see that in so doing 
no money is wasted. 
A building program should be worked out. All types of 
buildings should be standardized. All specifications and con- 
tracts should be studied and approved by the division. Under 44 
HOUSE —No. 2400. 
[Mar. 
present conditions, private architects and engineers who are 
employed to prepare plans and specifications vary widely in 
their ability to produce economical projects. Sometimes hos- 
pital authorities, in their endeavor to surpass other state in- 
stitutions, forget the importance of economy, and the present 
Department authorities, owing to their lack of technical 
knowledge, fail to detect and veto the unnecessary expense. 
The same thing is true in regard to the purchase of equip- 
ment. The process of standardization which the Commission 
on Administration and Finance has been working toward for 
years should be developed much more intensively. All requi- 
sitions should be studied, and only approved when they conform 
to the standards prescribed by the division. 
This whole question of construction, maintenance and equip- 
ment is more fully discussed in Appendix C. 
4. Other Divisions. — The Commission felt at one time that 
all the business activities of the Department should be handled 
by a Division on Finance, Settlement and Support. To do so 
might hamper the Commissioner in setting up his Department. 
So such a division is not recommended. But the Commissioner 
is empowered, as he is under the present laws, to establish such 
other divisions as he may from time to time determine, and 
assign to those divisions their functions. 
Relation between the Department and Hospitals. 
1. Superintendents. — Under the present law the power to 
appoint and remove superintendents is vested in the Boards 
of Trustees of the various hospitals. These Boards, composed 
as they are of high-minded citizens willing to give their services 
generously to the Commonwealth, are of the greatest value as 
a link between a hospital and the community which it serves, 
and are universally looked upon by the superintendents of the 
hospitals as their most valuable allies in maintaining intelligent 
and friendly relations with the people of the community. But 
that such Boards should be able to judge the qualifications and 
competency of physicians in medical matters is not to be 
expected, and, with few exceptions, they have appointed as 
superintendents men recommended to them by the Depart- 
ment of Mental Diseases. It seems obvious that as the super- 
intendents are the responsible heads of the medical and busi- 
ness administration of their hospitals, they should be directly 
accountable to the Department which is primarily responsible 
for the care of the mentally ill. 1939.1 
HOUSE —No. 2400. 
45 
The Commission therefore recommends that the power to 
appoint and remove superintendents be vested in the Com- 
missioner of Mental Health, with the approval of at least one 
Associate Commissioner. Machinery to safeguard the rights 
of a superintendent in case his removal is sought is provided 
for in the proposed law. 
2. Qualifications of Superintendents. — It is vitally necessary 
to have men of the highest caliber as superintendents of the 
various institutions for the mentally ill. To insure the ap- 
pointment of such men, and to prevent the appointment of 
unfit men through favoritism or politics, the Commission 
recommends that the qualifications of superintendents be the 
same as those for the directors of the Division of Hospital 
Standards and Inspection, and the Division of Mental Hygiene, 
Statistics and Research. 
It would be manifestly unfair to demand that the present 
hospital superintendents be suddenly ousted from their posi- 
tions because they are not diplomates of the American Board 
of Psychiatry and Neurology. In our proposed reorganization 
we have inserted a provision that such requirement shall apply 
only to superintendents hereafter appointed. 
3. Trustees. — Under the present law the Boards of Trustees 
are appointed by the Governor and Council. They are unpaid, 
and have many onerous duties in connection with the ad- 
ministration of their hospitals. It is obvious that no Board of 
unpaid citizens, for the most part not physicians, and not 
familiar with problems of medical administration, can properly 
and satisfactorily perform all the duties imposed upon them. 
Usually the Trustees consider themselves merely as approvers 
of the actions of the superintendent, except in cases of flagrant 
incompetency or misconduct, and act largely in an advisory 
capacity in business matters, leaving the details to the super- 
intendent and the Department of Mental Diseases. The De- 
partment has, in fact, performed most of the work assigned by 
law to the Trustees. 
The Commission therefore recommends that the Boards of 
Trustees be retained as at present constituted; that they act 
as Trustees for certain property, both real and personal, as at 
present provided by law; that they be required to maintain 
familiarity with their respective hospitals and hospital matters; 
that they make special investigations in their respective hos- 
pitals when such are needed; and that they be authorized to 
make recommendations to the Department when they find 46 
HOUSE— No. 2400. 
[Mar. 
conditions existing which they think should be remedied by the 
Department; but that full control of the hospitals be vested 
in the Department of Mental Health, and all powers and 
duties now in the Trustees, except as enumerated above, be 
transferred to the Department. 
Under this arrangement the Trustees would continue to 
exercise their most valuable function as a bond and as a means 
of communication between the hospital and the community it 
serves. They would serve as a check on both the hospital super- 
intendents and the Department as representatives of the 
citizens. 
Continuation of the Investigation. 
One of the principal purposes for which the Commission 
was appointed, as indicated in the Governor’s inaugural mes- 
sage, was to formulate a ten-year building program. Because 
of the conditions already described, it has been impossible to 
prepare such a program in the time available. The following 
factors will indicate, to some extent, the necessity for thorough 
consideration of this subject: 
A. Building Program. 
1. Size of Hospitals. — In this State the traditional maxi- 
mum size of a state hospital has been 2,000 beds. Experience 
has apparently demonstrated that when this limit is passed 
care for the patients with reasonable economy is not feasible. 
In certain other countries the maximum size of the institutions 
for the insane is placed at 1,100 beds. Nearly all of the state 
hospitals under the Department of Mental Diseases are at 
present overcrowded. Several of them have not yet been com- 
pleted to provide 2,000 beds. 
What constitutes the proper size for a state hospital raises 
many questions requiring further study. 
2. The Care of the So-called Criminal Insane. — The Legis- 
lature has already enacted enabling legislation for the transfer 
of the criminal insane at Bridgewater to the care of the Depart- 
ment of Mental Diseases, and the erection of a hospital for 
their care on land now owned by the Norfolk Prison Colony. 
Although this particular plan has been endorsed by those 
who have given consideration to the question, and although 
this Commission agrees that the present provisions for this class 
of patients are not proper, nevertheless we have not been able 
to study the question sufficiently to approve the location of a 
hospital of this nature adjacent to the Norfolk Prison Colony. 1939.] 
HOUSE —No. 2400. 
47 
This question deserves further study in conjunction with a 
properly functioning Department of Mental Health. 
3. The Care of Mentally III Patients at Tewksbury State In- 
firmary. — At present there are approximately 500 patients 
suffering from chronic mental diseases at the Tewksbury State 
Infirmary. Most of them will have to be taken care of for life 
in institutions. The Infirmary is no longer permitted to accept 
new patients from the community. The superintendent of the 
Tewksbury Infirmary, which is under the jurisdiction of the 
Department of Public Welfare, has suggested either that these 
patients be removed from the Infirmary, or that he be given 
authority to receive new patients from the community and 
conduct a psychiatric service for them in order to stimulate 
the practice of psychiatry at the institution. This subject, 
also, requires further study. 
4. Schools for Feeble-Minded. — The state schools for the 
feeble-minded are all over-crowded and have large waiting lists. 
In 1930 the Legislature authorized an appropriation for the 
purchase of land for a new school for the feeble-minded. A 
site was selected at Andover, but owing to the objections of the 
citizens of Andover, it was not approved by the Governor and 
Council. The whole problem of the training and education of 
feeble-minded persons, both in the institutions and in the com- 
munities of the State, deserves careful study. 
5. Psychotic Children. — There is no adequate provision in 
the state hospital system for the study and care of psychotic 
children. The few that are at present committed because of 
the immediate necessity of their receiving scientific care and 
treatment have to be hospitalized with adult insane because 
existing accommodations make segregation impossible. This 
interferes with the proper treatment of psychotic children and 
prevents the timely care which might save many of them from 
permanent insanity. The advisability of providing a hospital 
for such children has been recognized for years, and last year 
the Federal government allocated $198,350 for erection of such 
a hospital. However, it was impossible to secure bids to build 
the proposed hospital within the sum allocated. 
The Department of Mental Diseases recommends a hospital 
for psychotic children in this year’s budget. The Commission 
has been unable to make a proper study of this subject and 
therefore makes no recommendation. 
6. Defective Delinquents. — There are approximately 800 
adult defective delinquents cared for at the Bridgewater State 48 
HOUSE —No. 2400. 
[Mar, 
Farm. The proper care and training of these defective delin- 
quents raise a further problem. Here, again, it has not been 
possible for this Commission adequately to investigate the 
matter. 
7. Housing of Employees. — The state hospitals furnish liv- 
ing quarters for the great majority of their employees. The 
reason for this is clear where a hospital is located at a long 
distance from a residential district; but is not so obvious when 
the hospital is in or close to a city or a good-sized town. 
During the late depression it was relatively easy to get 
competent people for attendants and other hospital positions. 
With the better economic conditions of 1936 and 1937 the state 
hospitals found it more difficult to get competent help with 
the living conditions and salaries which the State provides. 
Without doubt many employees who now live in the hospitals 
could live more normal lives by having their homes in neigh- 
boring communities, without injury to their work, and prob- 
ably with benefit to it; and this might provide a desirable 
inducement to many who dislike living in an institution. 
Furthermore, to build accommodations for employees is ex- 
pensive. Recently in one hospital in a large city a very elabo- 
rate building was erected for employees at great expense. No 
adequate study was made to determine how many of these 
employees could have been housed outside. 
The whole question of living accommodations for employees 
of state hospitals should be carefully considered in connection 
with the proposed building program. 
B. Food. 
At the time when this investigation was inaugurated, the 
problem of providing proper and sufficient food for the in- 
mates of state hospitals was receiving considerable publicity. 
Our investigation has shown us that the patients of the state 
hospitals have been adequately fed. It revealed, however, 
that the methods of estimating and determining what appro- 
priations should be made for food are radically wrong. In 
several cases requests for food appropriations were at least 
double the amount which the superintendent considered ade- 
quate, and were cut in halves with no ill results to the insti- 
tution. In one instance, where a request for an appropriation 
was reduced by nearly $130,000, the superintendent stated 
that his patients were adequately fed; that if the added $130,- 
000 had been appropriated he would not have known what to 
do with it. 1939.] 
HOUSE —No. 2400. 
49 
We are informed that the Department has already changed 
its method of estimating the budgetary requirements for food, 
but there is no doubt that the whole food problem requires 
further investigation and experimentation in conjunction with 
a properly functioning Department of Mental Health. 
C. Other Conditions and Policies in the Care of the Mentally III. 
The Commonwealth furnishes care and medical treatment 
for all patients who come to its hospitals suffering from mental 
diseases at a maximum charge (except at the Psychopathic 
Hospital) of $10 per week. This is collected from an extremely 
small percentage of the families and friends of patients. The 
State is also furnishing facilities for the study and care of re- 
tarded children, and for the examination of problem children 
and others at the public expense. 
In no other specialty in medicine does the State furnish care 
for all who apply at a charge which practically prohibits pri- 
vate competition. Private practice in psychiatry is almost 
entirely restricted to the wealthy. As a result there is little 
incentive for the best medical students to enter private prac- 
tice in the care of the mentally ill, and the fact that institu- 
tional life is necessary for physicians entering the service of a 
state hospital acts as an additional deterrent. 
This is only a general statement, because in the state serv- 
ice there are many able physicians and psychiatrists with 
high ideals. Nevertheless, we are convinced that the tend- 
ency to place the care of the mentally ill entirely in the hands 
of the State, and the necessity of institutional life for phy- 
sicians, have retarded the development of psychiatry as a 
medical science. This whole question is one of great impor- 
tance to the taxpayers and to the medical profession, and 
deserves intensive study. 
Incidental to this is the matter of rates charged for patients 
by the State. It is believed that there are many families who, 
though unable to afford the expense of private institutions, 
could well pay more than the State charges. If some practical 
way of securing additional income from this source can be 
worked out it should be adopted. 
D. Education, Research and Prevention. 
The Commission has devoted much thought to the ques- 
tion of research in the Department of Mental Diseases and 50 
HOUSE —No. 2400. 
[Mar 
its associated hospitals. It is obvious that the care of the 
mentally ill will continue to be one of the largest burdens on 
the taxpayers of the Commonwealth unless more successful 
methods of prevention and cure are discovered. In research 
lies the only hope of dealing with the problem of mental dis- 
ease with reasonable success. Unless wisely carried on it is 
expensive and fruitless. Hitherto the research carried on has 
been too dependent on the enthusiasm of individuals. It has 
not had sufficient encouragement and guidance from the 
Department. 
Here, again, is a subject which deserves much careful inves- 
tigation. Not only should it be studied with a properly func- 
tioning Department of Mental Health, but information and 
advice should also be obtained from private institutions de- 
voted to research. 
E. Study of Laws in Relation to Mental Health, particularly 
regarding Commitments and Discharges. 
The laws regarding the different aspects of mental health 
and disease represent a gradual accumulation of legislation. 
This should be studied and made systematic and comprehensive, 
and as simple and clear as such a complex and many-sided 
problem permits. 
F. Thorough Investigation of Each Hospital. 
The Commission is convinced that a thorough inspection of 
each of the state hospitals should be made. Reports on the 
Boston State Hospital, Westborough State Hospital, Boston 
Psychopathic Hospital and the Department of Mental Diseases, 
made by State Auditor Thomas H. Buckley, and submitted to 
the Governor, have been referred to the Commission, and these 
reports should be considered when the investigations of va- 
rious hospitals are made. 
The Commission, since its creation in April, 1937, has learned 
much about the problem which mental disease brings to the 
Commonwealth, but it has not had time to conduct a com- 
plete investigation leading to comprehensive recommendations. 
With the knowledge already acquired, it should be able to 
carry on a systematic and thorough investigation if it is re- 
established by the Legislature, provided it has a properly 
functioning Department to work with. 1939.] 
HOUSE— No. 2400. 
51 
We therefore recommend that the investigation already 
begun be carried to its conclusion, and so that no further time 
will be lost, we recommend the early passage of the resolve 
accompanying this report. (For the Resolve see Appendix D.) 
For enabling legislation to carry out the recommendations 
of the Commission see Appendix E. 
Appendix A. 
THE AMERICAN BOARD OF PSYCHIATRY AND 
NEUROLOGY. 
The American Board of Psychiatry and Neurology, Incorporated, 
with executive offices at 1028 Connecticut Avenue, Northwest, Wash- 
ington, D. C., is composed of twelve members, four from the American 
Neurological Association, four from the American Psychiatric Asso- 
ciation, and two neurologists and two psychiatrists elected by the 
section on Nervous and Mental Diseases of the American Medical 
Association. 
The chief functions of this Board are 
(a) To determine the competence of specialists in psychiatry and 
neurology. 
(b) To arrange, control and conduct investigations and examinations 
to test the qualifications of voluntary candidates for certificates 
issued by the Board. 
(c) To grant and issue certificates or other recognition of special knowl- 
edge in the field of psychiatry and neurology to successful volun- 
tary applicants therefor. 
(d) To serve the public, physicians, hospitals and medical schools by 
preparing lists of practitioners who shall have been certified by 
the Board. 
(e) To consider and advise as to any course of study and technical 
training, and to diffuse any information calculated to promote 
and insure the fitness of persons desirous of qualifying for a cer- 
tificate of qualification to be issued thereby. 52 
HOUSE — No. 2400. 
[Mar 
Appendix B. 
Inspections made in Recent Yeabs. 
Name of Institution. 
Date. 
Time spent 
(Days). 
Boston Psychopathic Hospital 
1923 
3 
1924 
3 
1927 
2 
1933 
7 
Boston State Hospital 
1923 
16 
1924 
2 
1927 
8i 
1929 
4 
' 
1932 
7 
1933 
3 
1935 
5 
Danvers State Hospital 
1923 
5 
1924 
2 
1927 
61 
1932 
8 
1933 
4 
Foxborough State Hospital 
1922 
4 
1923 
4 
1925 
2 
1926 
3i 
1930 
4 
1932 
4 
1933 
4 
Gardner State Hospital 
1922 
3 
1923 
3 
1924 
3 
1926 
4 
1929 
4 
Grafton State Hospital 
1923 
3 
1925 
2 
1926 
3 
1927 
1 
1930 
2 
1931 
5 
Medfield State Hospital 
1923 
3 
1925 
2 
1927 
4 
1930 
5 
1932 
5 
1933 
5 
Metropolitan State Hospital (opened in 1930) . 
1932 
2 
1933 
o 
Northampton State Hospital 
1923 
5 
1924 
3 
1926 
4 
1929 
7 
1932 
1936 
5 
Taunton State Hospital .... 
1923 
1 
1924 
3 
1926 
4 
1933 
7 
State Hospitals. 1939. 
HOUSE —No. 2400. 
53 
Inspections made in Recent Years — Continued. 
State Hospitals — Concluded. 
Name of Institution. 
Date. 
Time spent 
(Days). 
Westborough State Hospital 
1923 
51 
1923 
62 
1924 
3 
1927 
4 
1930 
5 
1932 
5 
1933 
5 
1934 
2 
Worcester State Hospital 
1923 
4 
1924 
2 
1925 
2 
1926 
3i 
1930 
4 
1932 
7 
Monson State Hospital 
1923 
4 
1925 
6 
1926 
3 
1929 
4 
Belchertown State School 
1923 
3 
1925 
2 
1926 
2 
1930 
2 
1931 
5 
Walter E. Fernald School 
1923 
4 
1925 
4 
1927 
3* 
1929 
2 
1931 
6 
1933 
4 
Wrentham State School 
1923 
4 
1925 
3 
1927 
3 
1930 
5 
1931 
4 
1933 
4 
Mental Wards, State Infirmary at Tewksbury 
1922 
1 
1923 
2 
1925 
1 
1927 
1 
Bridgewater State Hospital 
1923 
1 
1924 
2 
1927 
2 
1930 
2 
Hospital Cottages for Children 
1923 
3 
1924 
1 
1927 
1 
1929 
1 
1936 
1 
1 Full days. 2 Part-time periods. 54 
HOUSE — No. 2400. 
[Mar, 
Inspections made in Recent Years — Continued. 
Private Institutions. 
Name of Institution. 
Date. 
Bournowood Hospital 
Oct. 26, 1922 
Mar. 9, 1925 
Apr. 4, 1927 
Oct. 16, 1929 
Sept. 20, 1932 
May 1, 1933 
Jan. 11, 1935 
Oct. 25, 1935 
Charming Sanitarium 
Feb. 16, 1925 
Apr. 7. 1927 
Sent. 28, 1928 
Aug. 22, 1929 
Sept. 22, 1932 
May 22, 1933 
Jan. 8, 1935 
Oct. 22. 1935 
Dr. Reeves’ Sanitarium 
Mar. 2, 11, 1925 
Mar. 2, 1927 
Feb. 17, 1928 
Oct. 25, 1929 
Sept. 19, 1932 
Apr. 26, 1933 
July 8, 1935 
Glenside 
Feb. 11, 1925 
Mar. 16, 1927 
Jan. 17, 1929 
Oct. 21. 22. 1929 
Nov. 16. 1932 
May 1, 1933 
Mar. 30, 1934 
June 20, 1935 
McLean Hospital ... 
Nov. 6, 1923 
Mar. 10, 11. 1925 
Mar. 17, 18, 1927 
Oct. 23. 24. 1929 
June 30, 1932 
July 1, 2, 1932 
Apr. 24, 25, 1933 
Jan. 18, 28, 29, 1938 
Ring Sanatorium and Hospital, Inc 
Oct. 23, 1922 
Mar. 11, 1925 
Feb. 19, 1925 
Jan. 4, 1927 
Oct. 1, 1928 
Oct. 25, 1929 
Oct. 27, 1932 
Apr. 25, 26, 1933 
Apr. 25, 1934 
Sept. 26, 1935 
Wiswall Sanatorium 
Feb. 16, 1925 
Apr. 7, 1927 
Oct. 16, 1929 
Sept. 22, 1932 
May 22, 1933 
Jan. 4, 1935 
Oct. 22, 1935 
Westwood Lodge 
Feb. 11, 1925 
Mar. 28, 1927 
Oct. 24. 1928 
Dec. 17, 1928 
Oct. 21, 1929 
May 26, 1933 
June 13, 1934 
June 20, 1935 1939. 
HOUSE — No. 2400. 
55 
Inspections made in Recent Years — Continued. 
Private Institutions — Continued. 
Name of Institution. 
Date. 
Bosworth Hospital (opened 1933) ....... 
Nov. 6. 1933 
Jan. 15, 1935 
Oct. 15, 1935 
Veterans Administration Facility, Northampton (opened 1921) 
Sept. 23, 1924 
Nov. 5, 1921 
Jan. 8, 1925 
Feb. 24, 1925 
Nov. 20, 21, 1929 
Nov. 2, 3, 1932 
May 25, 1933 
Veterans’ Administration Facility, Bedford (opened August, 1928) . 
Dec. 19, 1928 
Oct. 28, 1929 
Oct. 17, 18, 1932 
May 3, 4. 1933 
Woodlawn Sanitarium 
Mar. 30, 1927 
May 12, 1927 
July 26, 1929 
Sept. 20, 1932 
May 22, 1933 
June 20, 1934 
Oct. 10. 1935 
Lila Sanatorium (licensed Sept. 10, 1937) ..... 
July 31. 1937 
Dr. Frederick L. Taylor’s Private Hospital 
Oct. 23, 1922 
Mar. 5, 1925 
June 7, 1927 
June 21, 1929 
May 23, 1933 
Dec. 20, 1934 
July 9, 1935 
Grove Hall Institute 
Dec. 20, 1934 
July 9, 1935 
Washingtonian Home ......... 
Mar. 4, 1925 
June 22, 1927 
June 24, 1929 
May 2. 1933 
Nov. 13, 1934 
July 25, 1935 
Mar. 25, 1936 
Clarke School 
Oct. 15, 1929 
Sept, 20, 1932 
June 7, 1933 
June 20, 1934 
Oct. 10, 1935 
Elm Hill Private School and Home for the Feeble-minded . 
Feb. 28, 1925 
May 5, 1927 
June 25, 1929 
Sept. 23, 1932 
May 11, 1933 
Dec. 6, 1934 
Sept. 4, 1936 
Perkins School .......... 
Oct. 17, 1924 
Mar. 26, 1925 
Apr. 21, 1927 
Sept. 12, 1929 
Sept, 23, 1932 
May 11, 1933 56 
HOUSE— No. 2400. 
[Mar 
Inspections made in Recent Years — 
Concluded 
Name of Institution. 
Date. 
Standish Manor 
Nov. 3, 1922 
Mar. 25, 1925 
May 27, 1927 
Aug. 19, 1929 
Sept. 24, 1932 
May 6, 1933 
Dec. 27, 1934 
Oct. 15, 1935 
The Freer School 
Mar. 1, 1922 
June 28. 1927 
Oct. 10, 1929 
Oct. 27, 1932 
Apr. 26, 1933 
Apr. 30, 1934 
Oct. 9, 1935 
Private Institutions — Concluded 
Appendix C. 
CONSTRUCTION, MAINTENANCE AND EQUIPMENT. 
In many of the hospitals crowded conditions exist, particularly for 
the patients. To a great extent this might have been avoided with- 
out extra cost if better planning had been used. 
Design of Hospitals. 
Many of the older institutions consist of a central building with 
wings attached to it. In the opinion of many of the superintendents 
this provides the best arrangement. It is easier to administer because 
those in charge have immediate access to all parts of the hospital; 
and it has the advantage of not compelling patients and attendants 
to go outside in inclement weather. It is also more economical to 
maintain. Doubtless there are other arrangements which have ad- 
vantages of their own, and particular situations may require special 
treatment. But whatever the arrangement adopted, it should be 
clearly thought out, coherent and suited to its purpose. 
Unfortunately this has not been the practice in the development 
of our state hospitals. Individual buildings have been added with 
no true relation to the rest of the hospital. In one instance, where 
there was plenty of land next to the main group, property was bought 
across a main highway, and on this a new group of buildings was 
erected. The superintendent said he knew of no valid reason why 
this had been done. 1939.] 
HOUSE —No. 2400. 
57 
The manner in which accommodations for officers have been pro- 
vided is subject to the same criticism. In one hospital the officers’ 
quarters were placed in the administrative building, resulting in a 
large building of an expensive type of construction, instead of a small 
unit solely for administrative purposes and separate domestic quarters 
of a less expensive character. In other cases individual houses were 
built for officers, where duplex houses, such as are used in New York 
institutions, would have served the purpose equally well and have 
been less expensive to build and more economical to maintain. Un- 
necessarily expensive administrative buildings, service buildings and 
halls have also been built. 
With the exception of the Schools for Feeble-minded and the 
Monson State Hospital for Epileptics, each hospital consists of build- 
ings which serve similar purposes, and there is no reason why each 
should not have similar accommodations and equipment, and be con- 
structed of similar material. This, however, is not the case. For 
example, interior finish for buildings that have similar uses varies 
greatly, not only in different hospitals but also in the separate parts 
of the same hospital. In one instance expensive tile was used in base- 
ment corridors and kitchen, and a less expensive but equally service- 
able tile was used in the more frequented parts of the same building. 
Another example is the kitchen, bakery and canning equipment, 
which has been installed during the past few years with no effort at 
standardization. At one hospital elaborate canning machinery and 
expensive stainless steel sinks and tables had been installed, to be 
used, we were told, only five weeks a year. 
Standahdization of Hospitals. 
Regarding purchased material, such as tableware, the same situa- 
tion was found. In the cost of staff tableware prices ranged from forty- 
three cents to ninety-three cents per cup and saucer. A leading 
restaurant company in Boston uses a good type of china that costs 
eighteen cents per cup and saucer. 
Such items as those given are mere illustrations of the waste which 
results from the lack of proper standards. The extra expense does 
not add one iota to the comfort of the patients. With proper planning 
and standardization additional accommodations undoubtedly could 
have been provided without increasing the amount which the State 
has paid out. 
The hospital buildings, with few exceptions, are in very good 
condition. 
Condition of Buildings. 
The farm buildings at some institutions are in poor condition and 
should be rebuilt, some in different locations, and others altered and 
renewed to meet present standards. 58 
HOUSE —No. 2400. 
[Mar. 
The boiler plants at most institutions are in fairly good condition, 
although some need repairs; and in others new apparatus is required. 
Many of the hospitals are close to power lines of public utility com- 
panies, some are at a considerable distance from them. Study should be 
made to determine whether it is more economical to run a power 
plant at the institution or to buy power from a public utility company; 
and where the institution has its own plant it is important that the 
best type of apparatus and most economical fuel should be used. 
Where buildings have recently been constructed additional land- 
scaping is required; but with this exception the grounds at the various 
institutions are in good condition. 
Condition op Grounds. 
Time did not permit of anything but a superficial examination of 
the hospitals and grounds, but enough was disclosed to show that 
great savings can be made by proper planning and standardization 
of buildings, materials, equipment and supplies. 
Appendix D. 
Resolve to provide foe Continuance of the Investigation and 
Study of the Whole Subject of the Mentally Diseased in 
their Relation to the Commonwealth, and all Phases of 
the Work of the Department of Mental Diseases. 
Resolved, That an unpaid special commission, consisting of seven 
persons to be appointed by the governor, is hereby established for the 
purpose of making an investigation and study of the whole matter of 
the mentally diseased in their relation to the commonwealth, includ- 
ing all phases of the work of the department of mental diseases, par- 
ticularly as set forth in so much of the address of His Excellency, the 
Governor, printed as senate document number one in nineteen hun- 
dred and thirty-seven as relates to mental diseases. Said commission 
shall hold hearings, may require of the department of mental diseases 
and such 'other department, commission or officer of the common- 
wealth, as have or can obtain information in relation to the subject 
matter of this resolve such assistance as may be helpful in the course 
of its investigation and study, may require by summons the attendance 
and testimony of witnesses and the production of books and papers 
as relate to the matter under investigation, and may travel within 
and without the commonwealth. Said commission shall be provided 
with quarters in the state house or elsewhere and may expend after 
an appropriation has been made for legal, clerical, and other services 
and expenses, such sums, not exceeding, in the aggregate, 
dollars, as may hereafter be appropriated. Said commission shall 
report to the general court the results of its investigations and study 1939.] 
HOUSE —No. 2400. 
59 
and its recommendations, if any, together with drafts of legislation 
necessary to carry its recommendations into effect, by filing the same 
with the clerk of the house of representatives not later than the first 
Wednesday of December in the current year. 
Appendix E 
LEGISLATION PROPOSED IN 1938. 
An Act abolishing the Department of Mental Diseases and 
CREATING THE DEPARTMENT OF MENTAL HEALTH. 
Be it enacted by the Senate and House of Representatives in General 
Court assembled, and by the authority of the same, as follows: 
Section 1. The department of mental diseases is hereby abolished 
and the powers and duties of said department shall hereafter be exer- 
cised and performed by the department of mental health created by 
this act. 
Section 2. The General Laws are hereby amended by striking 
out chapter nineteen, as amended, and inserting in place thereof the 
following: — 
Chapter 19. 
Department of Mental Health. 
Section 1. There shall be a department of mental health, consisting 
of the commissioner of mental health and first and second associate 
commissioners. The commissioner and the first associate commis- 
sioner shall be physicians who are diplomates in psychiatry of the 
American Board of Psychiatry and Neurology, Incorporated, and shall 
have had at least seven years’ experience on the staff of a state or fed- 
eral hospital for mental diseases or in any equivalent psychiatric 
organization. The second associate commissioner, if not qualified as 
aforesaid, shall be a physician who has had at least seven years’ 
experience on the staff of a hospital for general medical and surgical 
cases. 
Section 2. Upon the expiration of the term of office of a commis- 
sioner or an associate commissioner, his successor shah be appointed 
for six years by the governor, with the advice and consent of the 
council. The commissioner shall receive such salary, not exceeding 
ten thousand dollars, and the associate commissioners such salaries, 
not exceeding ninety-five hundred dollars, as the governor and coun- 
cil may determine. The commissioner and associate commissioners 
shall be reimbursed for expenses necessarily incurred in the perform 
ance of their duties, and shall devote their entire time to the affairs 
of the department. 
Section 3. The commissioner shall be the executive and adminis- 
trative head of the department. In the event of the death, vacancy, 60 
HOUSE —No. 2400. 
[Mar. 
disability or absence of the commissioner, the associate commissioners 
in the order of seniority, shall perform the duties of the commissioner. 
The commissioner shall appoint and may remove such agents and 
subordinate officers as the department may deem necessary. Physi- 
cians, pathologists and psychiatrists shall be exempt from chapter 
thirty-one. 
Section J+. The commissioner shall organize the department in 
divisions, including a division of hospital standards and inspection; 
a division of mental hygiene, statistics and research; a division of 
construction, equipment and maintenance; and such other divisions 
as he may from time to time determine, and shall assign to said divi- 
sions their functions. 
Section 5. Except as otherwise provided in this chapter, directors 
of divisions of the department shall be appointed and may be removed 
by the commissioner, with the approval of at least one of the associate 
commissioners. The director of the division of hospital standards 
and inspection and the director of the division of mental hygiene, 
statistics and research shall each be a physician and a diplomate in 
psychiatry of the American Board of Psychiatry and Neurology, 
Incorporated. 
Section 6. The commissioner, with the approval of at least one of 
the associate commissioners, may designate an associate commis- 
sioner to be the director of the division of hospital standards and 
inspection or of the division of mental hygiene, statistics and research. 
Section 3. Section one of chapter one hundred and twenty-three 
of the General Laws, as appearing in the Tercentenary Edition, is 
hereby amended by striking out the third and fourth lines and in- 
serting in place thereof the following: — 
“Commissioner”, commissioner of mental health 
“Department”, department of mental health. 
Section 4. Section thirteen A of said chapter one hundred and 
twenty-three, as so appearing, is hereby amended by inserting after 
the word “hygiene” in the fifth line the words: —, statistics and 
research, — and by inserting after the word “duties” in the sixth 
line the words: —, and those assigned to it as provided by section 
four of chapter nineteen, — so as to read as follows: — Section ISA. 
Such of the powers and duties conferred or imposed upon the depart- 
ment, relating to the cause and prevention of mental disease, feeble- 
mindedness, epilepsy and other conditions of abnormal mentality, as 
the commissioner may determine may be exercised and performed by 
the division of mental hygiene, statistics and research. In addition 
to said powers and duties, and those assigned to it as provided by 
section four of chapter nineteen, said division shall institute inquiries 
and investigations for the purpose of ascertaining the causes of mental 
disease, including epilepsy and feeble-mindedness, with a view to uts 
prevention. It may also establish, foster and develop out-patient 
clinics. 1939.] 
HOUSE— No. 2400. 
61 
Section 5. Section sixteen of said chapter one hundred and 
twenty-three, as so appearing, is hereby amended by striking out, in 
the fifth, sixth and seventh lines, the words “Any such patient in a 
state hospital may so be placed at board by the trustees thereof, and 
such boarder shall be deemed to be an inmate of the state hospital,” 
— so as to read as follows: — Section 16. The department may place 
at board in a suitable family or in a place in this commonwealth or 
elsewhere any patient in an institution who is in the charge of the 
department and is quiet and not dangerous nor committed as a dipso- 
maniac 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 four dollars 
and fifty cents a week for each patient. 
Section 6. Section sixteen A of said chapter one hundred and 
twenty-three, as so appearing, is hereby amended by striking out, in 
the first and second lines, the words “, or the trustees of state hospi- 
tals with the approval of the department”, — and by striking out, in 
the fifth, sixth and seventh lines, the words “Any such patient in a 
state hospital so placed at board by the trustees thereof, shall be 
deemed to be an inmate of the state hospital”, — so as to read as 
follows: — Section 16A. The department may place at board, under 
direction, in approved private homes, with provisions for occupational 
therapy, such patients under supervision as they believe will be bene- 
fited from a period of training therein. The number of patients so 
placed shall be approved by the department. The cost to the com- 
monwealth of the board of such patients supported at the public 
expense shall not be limited by the amount specified in section sixteen. 
Section 7. Said chapter one hundred and twenty-three is hereby 
further amended by striking out section twenty-five, as most recently 
amended by section four of chapter four hundred and twenty-one of 
the acts of nineteen hundred and thirty-five, and inserting in place 
thereof the following: — 
Section 25. The state institutions under the control of the depart- 
ment shall be Worcester state hospital, Taunton state hospital, 
Northampton state hospital, Danvers state hospital, Grafton state 
hospital, Westborough state hospital, Foxborough state hospital, 
Medfield state hospital, Monson state hospital, Gardner state hospi- 
tal, Wrentham state school, Boston state hospital, Walter E. Fernald 
state school, Boston psychopathic hospital, Belchertown state school, 
Metropolitan state hospital, and such others as may hereafter be 
added by authority of law. 
Section 8. Section twenty-six of said chapter one hundred and 
twenty-three, as so appearing, is hereby repealed. 
Section 9. Said chapter one hundred and twenty-three is hereby 
further amended by striking out section twenty-seven, as so appear- 
ing, and inserting in place thereof the following: — 62 
HOUSE —No. 2400. 
[Mar. 
Section 27. The trustees of each state hospital shall be a corpo- 
ration for the purpose of taking and holding, by them and their suc- 
cessors, 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 hospital 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 hos- 
pital subject to the approval of the department, but all such build- 
ings shall belong to the state hospital and be managed as part thereof. 
Section 10. Said chapter one hundred and twenty-three is hereby 
further amended by striking out section twenty-eight, as so appear- 
ing, and inserting in place thereof the two following new sections: — 
Section 28. The department shall appoint for each state hospital 
a treasurer, who shall give bond for the faithful performance of his 
duties, and may remove him. 
Section 28A. The department shall appoint for each state hospital 
a superintendent, who shall be a physician who is a diplomate in 
psychiatry of the American Board of Psychiatry and Neurology, 
Incorporated, and shall have had at least five years administrative 
experience in a state or federal hospital for mental diseases or an 
equivalent psychiatric organization. The superintendent, subject to 
rules made by the department, shall appoint and may remove assist- 
ant physicians and necessary subordinate officers and other persons. 
A superintendent of a state hospital may be removed by the de- 
partment for inefficiency, failure to perform duties properly or other 
good cause. A superintendent sought to be so removed shall be noti- 
fied of the proposed action and shall be furnished with a copy of the 
reasons therefor and shall be given a hearing before the department, 
and be allowed to answer the charges preferred against him, either 
personally or by counsel. 
Section 11. Said chapter one hundred and twenty-three is hereby 
further amended by striking out section twenty-nine, as so appear- 
ing, and inserting in place thereof the following: — 
Section 29. (a) The trustees of each state hospital shall visit and 
familiarize themselves with their respective state hospitals, and may 
from time to time make suggestions to the department as to improve- 
ments therein, especially such as will make the administration thereof 
more effective, economical and humane. 
(6) All trustees shall have free access to all books, records, and 
accounts pertaining to their respective state hospitals, and shall be 
admitted at all times to the buildings and premises thereof. 
(c) They shall keep a record of their doings and shall record their 
visits to the state hospitals in a book kept there for that purpose. 1939.] 
HOUSE — No. 2400. 
63 
They shall transmit promptly to the department a copy of the pro- 
ceedings of each meeting. 
(d) They may personally hear and investigate the complaints and 
requests of any inmate, officer or employee of the state hospital. If 
they deem any such matter of sufficient importance, after determin- 
ing what, if anything, should be done relative thereto, they shall 
make written report of the determination to the department. 
(e) They may at any time cause the superintendent or any officer 
or employee of their respective state hospital to appear before them 
and answer any questions or produce any books or documents rela- 
tive to the state hospital. 
Section 12. Said chapter one hundred and twenty-three is hereby 
further amended by striking out section thirty, as so appearing, and 
inserting in place thereof the following; — 
Section SO. The superintendent of each state hospital subject to 
the rules and regulations of the department, shall cause to be given 
to the nurses, attendants and patients thereof instruction in such 
arts, crafts, manual training, kindergarten and other branches and 
lines of occupation as may be appropriate for the patients to under- 
take, especially such patients as are physically unfit to perform the 
usual work in or about the hospitals. 
Section 13. Said chapter one hundred and twenty-three is hereby 
further amended by striking out section thirty-one, as so appearing, 
and inserting in place thereof the following: — 
Section 31. The department shall cause all persons who are placed 
at board by it in families at public expense to be visited at least once 
in three months. 
Section 14. Said chapter one hundred and twenty-three is hereby 
further amended by striking out section thirty-two, as most recently 
amended by chapter one hundred and fifteen of the acts of nineteen 
hundred and thirty-three, and inserting in place thereof the fol- 
lowing: — 
Section 32. All accounts for the maintenance of each of the state 
hospitals shall be approved by the superintendent thereof and shall 
be filed with the comptroller and shall be paid by the commonwealth. 
Full copies of the payrolls and bills shall be kept at each hospital. 
Section 15. Section forty-five of said chapter one hundred and 
twenty-three, as so appearing, is hereby amended by striking out, in 
the fourth line, the word “trustees” and inserting in place thereof the 
word: — department, — so as to read as follows: — Section J+5. The 
Walter E. Fernald state school, the Belchertown state school and the 
Wrentham state school shall each maintain a school department for 
the instruction and education of feeble-minded persons who are within 
the school age or who in the judgment of the department thereof are 
capable of being benefited by school instruction, and a custodial de- 
partment for the care and custody of feeble-minded persons beyond 
the school age or not capable of being benefited by school instruction. 64 
HOUSE —No. 2400. 
[Mar. 
Section 16. Section forty-six of said chapter one hundred and 
twenty-three, as so appearing, is hereby amended by striking out, in 
the third line, the words “as the trustees shall see fit”, — and by 
striking out, in the fourth line, the word “trustees” and inserting in 
place thereof the word: — department, — so as to read as follows: — 
Section Ifi. Persons received by the Walter E. Fernald state school, 
by the Belchertown state school and by the Wrentham state school 
shall be classified in said departments, and the department may re- 
ceive and discharge pupils, and may at any time discharge any pupil 
or other inmate and cause him to be removed to his home. 
Section 17. The governor, with the advice and consent of the 
council, shall forthwith appoint a commissioner of mental health to 
serve until December thirty-first, nineteen hundred and forty-three, 
and a first associate commissioner to serve until December thirty- 
first, nineteen hundred and forty-one, and a second associate com- 
missioner to serve until December thirty-first, nineteen hundred and 
thirty-nine. Upon the expiration of their respective terms, their suc- 
cessors shall be appointed as provided in section two of this act. 
Section 18. All unexpended balances of moneys heretofore appro- 
priated for the department of mental diseases shall be immediately 
available for expenditure by the department of mental health created 
by this act. All furniture, equipment, papers and other property now 
in the possession of said department of mental diseases shall immedi- 
ately pass into the possession of said department of mental health. 
All petitions, hearings and other proceedings pending before said 
department of mental diseases or any officer thereof, and all prosecu- 
tions, legal or other proceedings and investigations begun by said 
department of mental diseases and not completed at the time of the 
taking effect of this act, shall continue unabated and remain in full 
force and effect, notwithstanding the passage of this act, and may be 
completed before, by and in the name of the department of mental 
health. All orders, rules and regulations made by said department of 
mental diseases or any officer thereof which are in effect immediately 
prior to the time this act takes effect shall remain in full force and 
effect until revoked or modified in accordance with law by said depart- 
ment of mental health. All contracts and obligations of said depart- 
ment of mental diseases, in force on said effective date, shall, notwith- 
standing the provisions of this act, remain in full force and effect and, 
after said effective date, be performed by said department of mental 
health. 
Section 19. The employees of said department of mental diseases 
who are subject to the civil service laws are hereby transferred, sub- 
ject to the approval of the commissioner, to serve under the said 
department of mental health without impairment of their civil service 
status, and such employees shall retain any step increases from the 
minimum pay of their grade earned during their service with the said 1939.] 
HOUSE — No. 2400. 
65 
department of mental diseases, and for retirement purposes their 
service with the commonwealth shall be deemed to be continuous as 
defined in section one of chapter thirty-two of the General Laws. 
Section 20. The employees of the institutions, the control of 
which is transferred by this act from the department of mental dis- 
eases to the department of mental health, who are subject to the civil 
service laws are hereby transferred, subject to the approval of the 
commissioner of mental health, to the said department of mental 
health without impairment of their civil service status, and such em- 
ployees shall retain any step increases from the minimum pay of their 
grade earned during their service with the said department of mental 
diseases, and for retirement purposes their service shall be deemed to 
be continuous as defined in section one of chapter thirty-two of the 
General Laws. Non-civil service employees of said institutions shall 
be transferred, subject to the approval of the commissioner of mental 
health, to the said department of mental health without any impair- 
ment of their status, and for retirement purposes their service with 
the commonwealth shall be deemed to be continuous as defined in 
said section one. 
Section 21. The trustees of institutions, the control of which is 
transferred by this act from the department of mental diseases to the 
department of mental health, shall continue to serve as such trustees 
until the expiration of their respective terms notwithstanding the 
passage of this act, and the powers and duties of said trustees shall be 
restricted to the powers and duties conferred and imposed upon them, 
by chapter one hundred and twenty-three of the General Laws as 
amended, notwithstanding the provisions of any general or special 
law to the contrary. 
Section 22. The eligibility requirements provided by this act for 
superintendents of institutions under the control of the department of 
mental health shall not apply to superintendents appointed under 
this act who were such superintendents immediately prior to the effec- 
tive date thereof, and for retirement purposes their service with the 
commonwealth shall be deemed to be continuous as defined in section 
one of chapter thirty-two of the General Laws. 
Section 23. When used in any statute, ordinance, by-law, rule or 
regulation the phrases “department of mental diseases” and “com- 
missioner of mental diseases”, or any words connoting the same, shall 
mean the department of mental health and the commissioner of 
mental health, respectively, unless a contrary intention clearly appears. 66 
HOUSE —No. 2400. 
[Mar. 
Appendix 2. 
PROBLEM OF CONSTRUCTION. 
A. General Comments. 
In studying the needs of the various institutions, each super- 
intendent was asked to send in what in his opinion was re- 
quired in his institution to increase the bed capacity for patients. 
In addition, there was a committee of two superintendents 
and an engineer of the Department, who worked out a program 
in accordance with requirements of the various institutions, 
which included not only suggestions for increasing housing 
facilities for patients, but also included recommendations for 
renovations, replacements, etc. 
Our Commission has visited the thirteen mental institutions 
and the three feeble-minded institutions, and we have studied 
the buildings from the standpoint of their present use, con- 
struction and feasibility as to additions and renovations. We 
have also studied the suggestions made by the superintendents, 
and the list given by the subcommittee, which comprised two 
superintendents and the engineer of the Department, and also 
suggestions as made by the Department heads. 
We have likewise visited many institutions in certain sister 
States, laying special emphasis on the construction problem. 
E. Capacity of Institutions. 
In all hospital buildings exclusive of feeble-minded schools 
and Bridgewater, the total capacity in accordance with the 
Department’s allotment of space is 18,716. (There is now 
under construction a building at Grafton which will add 
300 beds, making a total capacity of 19,016.) The total 
number in the hospitals, in accordance with reports made 
January 1, 1939, is 21,765 patients. Deducting the working 
capacity figured by the Department from this would show a 
need for 3,049 beds. 
In several of the institutions the working capacity could be 
figured more liberally than it has been in the past, and it would 1939.] 
HOUSE —No. 2400. 
67 
be conservative to say that the total excess at the present 
time, after a re-allotment, should be figured at not over 2,700. 
The table in Appendix 18, showing institution population 
figures of January 1, 1939, should be consulted. 
In the feeble-minded institutions, which includes the Belcher- 
town, Walter E. Fernald and Wrentham State Schools, the 
figured capacity is 4,003 beds. The number under care is 
5,279, indicating a shortage of 1,276 beds. 
The working capacities of these institutions are figured out 
on the same basis as the hospital buildings, and after a con- 
sultation with the various superintendents and the officials in 
the Department, it was agreed that the estimated shortage 
was excessive, and by refiguring on a more equitable basis this 
apparent shortage of beds could be reduced approximately 
20 per cent, which would be approximately 664 beds short. 
On figuring the capacities of the mental institutions and al- 
lowing for the re-allotment of space wherever possible, a con- 
servative estimate of the number of beds needed to take care 
of present crowding in the hospitals for mental patients is 
2,700, and the number of beds needed for feeble-minded 
schools is 664. Therefore it would be necessary to provide the 
above number of beds to take care of present patients. It is 
also necessary to figure on taking care of the normal increase 
of patients, which is approximately 400 per year. 
Our Commission is not recommending increasing the 
capacity of the following hospitals: Boston State, Danvers, 
Worcester. 
Any buildings recommended for the Boston State Hospital 
would be replacements of present wooden structures, and 
buildings recommended for Danvers would be to provide an 
admission building, which when built, and after a rearrange- 
ment is made of the working capacity, would provide adequate 
space for a number of patients. There is no excess of patients 
over the capacity at Worcester, and it will not be necessary 
to provide any additional space in this institution. 
The Commission recommends that wherever possible the 
capacities of the mental hospitals be figured at 2,000. This 
may vary slightly over or under this figure, but we are con- 
vinced, after consultation with heads of various institutions, 
not only in this State but in other States, that a working capac- 
ity of 2,000 allows for economy of operation and more indi- 
vidual care of patients. It has been our privilege to visit 
certain sister States and give special study to size, capacity and 68 
HOUSE —No. 2400. 
[Mar. 
general structure of various types of institutions. We have 
given special study to these institutions varying in size from 
1,200 beds to approximately 10,000 beds, and varying in 
structure from single-story buildings to nine or ten story 
buildings. 
There are many merits to the small institution of twelve 
to fifteen hundred beds, but we believe in general that a two 
thousand bed capacity is not excessive. We feel very favor- 
ably impressed with one hospital which we visited where the 
majority of the buildings were of the one-story type. We believe 
that for general and infirmary care this is very desirable. It 
simplifies administration, minimizes fire risk, is conducive to 
good ventilation, is easy of access for visitors, and permits 
ready exit for out-of-door activities of the patients, many of 
whom, because of physical infirmities, would ordinarily be 
closely confined in a taller building. 
In our recommendations for a building program we have 
figured on each institution, with the exception of Foxborough, 
being brought to the 2,000 capacity. The Foxborough Hos- 
pital, because of the situation and the small area owned by 
the institution, in our opinion, should be limited, at least 
temporarily, to a capacity of approximately 1,700. 
In accordance with the ten-year program submitted after 
a survey of the space now in use, all hospitals, with the ex- 
ception of the Foxborough Hospital, will have provisions for 
2,000 people. 
There is an average increase in the total population of the 
hospitals of approximately 400 per year. But this average, 
we have been informed, is gradually declining. 
We have estimated the present shortage of beds at 2,700. 
A conservative estimate of the increase of patients over a five- 
year period, keeping in mind this gradual drop in the number 
added to the resident institution population each year, is 
1,885. In our building program we have recommended the 
addition of beds in sufficient quantities to eliminate the present 
overcrowding, and to take care of a normal increase for the 
next five years, or a grand total of 4,585 beds. 
This, of course, contemplates that the Department’s program 
for boarding out of patients will in five years reach a high peak, 
thus easing the pressure for new beds; that means will be 
perfected to move out of the hospitals those custodial patients 
entitled to receive old age benefits now denied them because 1939.] 
HOUSE— No. 2400. 
69 
of their residence in institutions; and that the rapid advances 
being made in curing mentally ill patients will result in the dis- 
charge of a substantial number of patients. These are the 
chief reasons why we have concentrated construction of build- 
ings to house patients in the first five years of the ten-year 
building program. 
In studying conditions at the feeble-minded institutions we 
have estimated that there is a shortage of bed space of approxi- 
mately 664 in all institutions, and in accordance with our 
program we have planned to bring each of these institutions 
up to approximately 2,000 capacity by providing a total of 
1,138 beds during a five-year period. 
The question of a new feeble-minded institution in the 
eastern part of the State was considered, but it was decided 
that a more definite study should be made of this problem by 
the Department, as there are some of the present institutions 
which could be planned to provide for a type of patient which 
would not need more than custodial care. The Commission 
has consulted with the Department heads regarding this prob- 
lem which they are studying at the present time. 
The Commission has given special study to the question of 
psychotic children, and this is dealt with somewhat in more 
detail in a special section of this report. There are at the 
present time nearly fifty psychotic children under the age of 
sixteen in the various hospitals for adult psychotics, and there 
are more than an equal number in the various schools for the 
mental defectives. The Commission has felt that these chil- 
dren should be segregated from their present contacts and 
should be congregated in a unit devoted to their special care. 
We have spent some time in studying the care of psychotic 
children in some of our sister States. 
As a result of our study we feel that a unit of approximately 
100 beds should be established on the grounds of one of the 
present state hospitals, and we suggest that this be estab- 
lished on the grounds of the Metropolitan State Hospital. 
For a period of many years the Department has been fol- 
lowing a program of fire protection. From the standpoint of 
construction this program has been carried along the general 
principles of — 
C. Fire Protection. 70 
HOUSE —No. 2400 
[Mar 
1. Making all new building structures of first-class construc- 
tion, which means fireproof. 
2. Installing fire protection measures, such as sprinklers, 
in buildings housing patients, with particular emphasis on 
wards where infirm and physically ill patients are housed; 
fire-resistant material on the outside of these buildings, if 
they are wooden structures; and the modernizing of electric 
wiring. 
3. Gradual replacement of non-fireproof material by fire- 
proof material in the wards housing patients. 
4. By making fire departments more readily accessible to 
hospital service through installation of fire alarm systems. 
5. By repeating the same process in buildings housing em- 
ployees. 
6. By repeating the same process in structures housing 
animals. 
7. Finally, by repeating the same process in storage centers. 
Without any question, all future construction should be 
fireproof. 
A number of existing buildings at the institutions are of 
second-class construction. This type of construction consists 
of exterior brick walls, wood floors and wood partition work. 
In many of these buildings also there are wood stairways that 
are not fully protected with fireproof walls. A program of 
continuing to replace these wooden floors, placing fireproof 
stairwells at strategic points, and extending sprinkler systems 
should be continued. In many of the buildings the exterior 
walls are of brick and the corridors are of brick, lending them- 
selves readily to remodeling for fire protection. 
A central fire alarm system has been installed in some of 
the newer buildings and has been extended somewhat in some 
of the older institutions. This affords excellent protection, as 
it is so arranged that there is a central register in the main 
office where somebody is always on duty, and the alarm boxes 
are located throughout the various buildings at the institution. 
A signal from any one of these boxes notifies the central office 
at once as to the location of the fire, and in some instances it 
is directly connected with a community fire department. The 
installation of such fire alarm systems should be continued 
as far as practicable. 
The items appearing for fire protection in the recommended 
building program refer to following out the above policy in the 
order enumerated. 1939.] 
HOUSE — No. 2400. 
71 
D. Construction for Hygienic Purposes. 
In all new construction it is to be expected that water sup- 
ply, sewerage facilities and plumbing will be in accordance 
with the latest methods. The plumbing in the older buildings 
of a number of the institutions is in extremely poor condition. 
In recent years the Department has been carrying on a pro- 
gram of renewing and replacing antiquated plumbing. This 
policy should be continued. 
The question of laundry facilities is likewise intimately tied 
up with the personal and ward hygiene of the hospitals. Sev- 
eral of the institutions are now carrying on laundry work under 
conditions which materially handicap the internal administra- 
tion of those institutions. Many of the laundries are in need 
of much repair and are laid out in such a way that supervision 
of the individuals working in the laundry is not possible. Some 
laundries are in locations which require larger space and in- 
creased apparatus. 
Laundry work is utilized by most of the hospitals as an ex- 
cellent form of industrial therapy for many patients, and as 
each hospital has essentially the same problem in this regard 
it should be a comparatively simple job to plan a standard 
laundry and arrange for each institution to have the right 
type of equipment and space. We suggest from the stand- 
point of efficiency and proper supervision that where practicable 
such laundries be one-story buildings, where this is not prac- 
ticable, to make every effort to confine the laundry work to a 
single floor. In the construction of new laundries and in the 
remodeling of old laundries we believe that this thought should 
be borne in mind. 
E. Farm Construction. 
The farm groups at the various institutions are more or less 
similar, but the layout and arrangements of these groups vary 
considerably. There are a great many buildings in connection 
with the farm groups which are badly in need of repairs or 
replacement if farming is to be continued, and at several of 
the institutions the farm buildings are located very close to 
the main group of buildings housing patients or employees. 
In some cases they occupy space which should be more prop- 
erly adapted for extensions to the wards or the immediate 
service branches of the hospital. A definite program as to the 72 
HOUSE —No. 2400. 
[Mar. 
type of farm buildings and accommodations required, with a 
high degree of standardization of these buildings and accom- 
modations, should be carried out. 
In many institutions accommodations for employees are not 
adequate, in fact, in some places they live on the wards hous- 
ing the patients whom they care for all day. In the detail 
of our building program we have made suggestions for build- 
ings to house employees, basing these suggestions upon the 
customary program of the state institutions over the past ten 
years. The trends of the time indicate, however, that insti- 
tutional employees are gradually being released from the bond 
of living at the institution. This policy of liberalization is 
commented on elsewhere in this report. From a construction 
standpoint we have set up in the building program the various 
buildings which would be needed, together with the estimated 
capital outlay for such buildings, if employees are continued 
to be housed at the institution. We would recommend, how- 
ever, if employees are permitted to live in the community, 
that their present housing accommodations be reviewed rather 
carefully, with the thought in mind of turning these buildings 
into use for patients. 
F. Buildings Housing Employees 
In the building program also may be found certain items 
calling for houses for superintendents who now live in the ad- 
ministration buildings of four institutions. The superintend- 
ents at the Danvers and Worcester State Hospitals live in 
administration buildings, intimately connected with the wards. 
The superintendents at the Grafton and Gardner State Hos- 
pitals live in detached administration buildings. The reor- 
ganization bill for the Department, chapter 486, Acts of 1938, 
does not demand that superintendents live on the grounds of 
the institutions. It would appear in the past that superin- 
tendents’ houses have been built around a thought that super- 
intendents would entertain the trustees and perhaps do other 
official entertaining in their homes. The cost of similar houses, 
if constructed, would depend upon the continuance or not of 
the policy relating to the official entertaining. 
G. Miscellaneous. 
The Commission has given consideration to various remodel- 
ing projects, replacements and additions. Such projects require 
planning, more or less, as conditions arise, and vary from in- 1939.] 
HOUSE —No. 2400. 
73 
stitution to institution. These miscellaneous projects do not 
lend themselves to any general comment. 
We recommend a long-range building program (Appendix 3) 
bearing in mind the qualifying comments given above. 
We recommend the erection of an institution for the crimi- 
nally insane, as noted in the building program. A detail of 
this proposal is contained in Appendix 4, dealing with the 
problem of the criminally insane. 
H. Institution for the Criminally Insane. 
I. Unit for Psychotic Children. 
We recommend the erection of a special unit for psychotic 
children. A detail of this proposal is contained in Appendix 7, 
dealing with the problem of psychotic children. 
J. School for the Mentally Deficient. 
The Commission has carefully studied a former proposal 
for a new school for the mentally deficient. We believe that 
such a project might become a necessity in the years to come, 
but that it is postponable at the moment. The detail upon 
which this suggestion is based will be found in Appendix 6, 
dealing with the problem of the mentally deficient. 
K. Individual Recommendations, by Hospitals. 
Boston Psychopathic Hospital. 
No buildings recommended. 
We have been led to believe that the X-ray and operating 
room equipment is outdated and is totally inadequate for 
meeting the present needs of the hospital. The X-ray equip- 
ment is not insulated or shockproof, and provides a possible 
danger to those who are using it. 
A program was started in replacing the windows of the 
seclusion rooms by modern detention windows; it would seem 
advisable to continue this program to include similar detention 
windows on the acute receiving wards and convalescent 
wards. 
Boston State Hospital. 
No new buildings recommended. 
We suggest the replacement of West C and D and the A, 
E and F buildings. These are stucco buildings of third-class 
construction in which there are certain unsanitary features, 74 
HOUSE 
No. 2400. 
[Mar. 
and are obsolete. It is difficult to properly heat these build- 
ings in cold weather, and the cost of maintaining them seems 
excessive. In general, they have outlived their usefulness. 
The hospital is bisected by Morton Street which is an active 
thoroughfare carrying heavy traffic. We recommend that a 
tunnel be constructed under Morton Street for the ready and 
safe passage of patients from the West Group to the East 
Group, where the greater part of the administrative activities 
are conducted. 
At the present time the crossing of patients from one hos- 
pital group to the other affords not only a danger to the pa- 
tient, but frequently constitutes heavy traffic tie-ups for long 
periods of time. 
The industrial building recommended is to replace the 
present facilities which are in the basement of one of the medi- 
cal buildings. The facilities for good industrial work are lack- 
ing in the present set-up, and likewise the electric wiring has 
been condemned by the Department of Public Safety. Present 
facilities would require considerable alteration at an expense 
far in excess of $15,000 in order to make them accessible. 
Even then, conditions would be crowded and not too satisfac- 
tory, even though they were safe. 
Sooner or later there must be some enlargement of the 
dining-room service in the West Group which, at the present 
time, is conducted under crowded and rather inadequate 
conditions. 
The proposed project dealing with electric wiring is to place 
all electric wires under ground. This is in accordance with 
modern methods, and would eliminate the breakage of cur- 
rent which occasionally comes from broken wires during the 
heavy winter storms. Along with this project, and of special 
significance, is the replacement of steam lines which have 
been in existence for a period of some years, and which now 
cost considerable for yearly maintenance. We are told that 
corrosion causes many breaks in these lines each year, and 
we recommend this project purely on a basis of long-range 
economy. 
The three officers’ cottages suggested are designed to take 
care of married doctors. If the State is to continue a policy of 
providing maintenance for a resident staff we feel that it should 
provide adequate living accommodations whereby a certain 
amount of private life will be enjoyed. 1939. 
HOUSE —No. 2400 
75 
The paint shop proposed is designed to replace the present 
accommodations which are quite inadequate, and to provide 
better control of the materials available in the present paint 
shop. 
Danvers State Hospital. 
In accordance with the Department allotment, the present 
capacity of the Danvers State Hospital is 1,861 patients. On 
examination it appears that with a re-allotment of space the 
capacity of the present institution could be increased con- 
siderablv. 
A receiving building, which is quite necessary in this insti- 
tution, if built to accommodate 150 patients, would probably 
relieve most of the overcrowded conditions. This building 
could be built in such a manner that additions could be made 
at a later time, if the re-allotment of the space required a larger 
center. We recommend that this building be built soon. This 
hospital has the largest acute admission rate of any of the 
institutions under the Department, with the exception of the 
Boston Psychopathic Hospital. It serves the thickly settled 
and industrial district north of Boston, extending to the New 
Hampshire line. 
The present chapel has a seating capacity of 300, and there 
have been repeated requests for enlarging this chapel. It is a 
second-class building, and something should be done to elimi- 
nate the fire hazard, and a definite decision should be made 
as to the proper size of chapels for all institutions, and if a 
capacity of 300 is too small, and there are institutions which 
cannot accommodate more than this, they should be enlarged. 
It is estimated that to enlarge the chapel will cost $130,000. 
An allotment should be made for fireproofing the first floor 
of the main building. This project has been started in a por- 
tion of this building, and it is estimated that it will cost $150,000 
to complete this work, and would involve wards which now 
accommodate nearly 600 patients. This could be spread over 
a period of four years. 
Sprinklers have been installed in most of the main buildings 
and buildings which are of second-class construction. This 
program should be continued, and it is estimated that it would 
cost $43,000 to complete sprinklers for the entire hospital. 
This could be spread out over a period of two or three years. 
A completely new boiler plant has just been installed, but 
the old engines and generators are still in place. These are 76 
HOUSE —No. 2400. 
[Mar. 
very old and renewals must be made shortly. It has been 
estimated that to install complete new engines and generators 
would cost $130,000. This program also may be spread over 
two years. 
The present laundry is not large enough to do the work of 
the institution. The work room in the basement is poorly 
lighted and poorly ventilated, whereas the other activities are 
conducted on the floor above. Much of the equipment is ob- 
solete, and the elevator is an old hydraulic lift with poor safety 
devices. It should be modernized either by replacement or by 
remodeling. 
Additional hydrotherapeutic equipment for continued treat- 
ment seems necessary on both the men’s and women’s services. 
It is desired that such services be fully equipped with auto- 
matic control that would provide for more adequate treatment 
of the restless and agitated type of patient. 
If the State is to continue to house its employees, the Dan- 
vers State Hospital should have more accommodations within 
the next few years. To this end we have suggested a project 
calling for a building for married couples. 
Foxhorough State Hospital. 
This hospital has at the present time a population of only 
1,400 patients. It is located about twenty-six miles from the 
center of Boston and could well be built up to a larger capacity 
to good advantage. The original portion of the institution 
has been renovated from time to time but there are still many 
buildings which are in very poor condition. This applies 
particularly to C and O buildings, and to the cafeteria and 
assembly buildings. 
Both C and O buildings are old, of second-class construction 
with wooden floors, and plumbing is in very poor condition. 
With certain renovations, making these buildings fireproof 
and more sanitary, accommodations could be provided for 106 
additional patients at a relatively low capital outlay. 
There is need for a medical and surgical building, and the 
Commission recommends that a building to accommodate 325 
patients be built. 
The present kitchen and dining-room accommodations are 
quite inadequate and cannot accommodate even the present 
population. A complete remodeling, with increase in size of 
the present cafeteria, should be completed before long, and is 
certainly a prerequisite to any appreciable increase in patients. 1939.] 
HOUSE —No. 2400. 
77 
The fire protection program already inaugurated should be 
carried on as rapidly as possible. 
The various wards would, of course, be remodeled so as to 
be fireproof, but the extension of sprinklers in the wooden 
cottages occupied by employees, and in certain of the farm 
buildings, should be completed. A fire alarm system is most 
desirable. 
The garage and equipment recommended are designed to 
provide facilities for putting under cover a large amount of 
motor vehicle equipment and farm equipment which is now 
left out of doors in all kinds of weather. This building would 
also provide for a repair shop for motor vehicle equipment. 
It seems advisable to eventually consider the purchase of 
more land at the Foxborough State Hospital, particularly 
that section which runs along the southern boundary of the 
property of the hospital, and which would provide the hospital 
with an opportunity to request the closing of the public 
thoroughfare, — Chestnut Street. 
It is suggested that the old assembly hall, which has been 
abandoned so far as its original purposes are concerned, be 
remodeled and made into an adequate vegetable storage build- 
ing, with the possibility of adding facilities for canning. The 
present vegetable storage facilities are quite inadequate, and 
the remodeling of this old assembly building seems to be a 
feasible project. 
Gardner State Hospital. 
The central building at the Valley Farm Group at this hos- 
pital is of wooden construction and has been condemned for a 
period of years, and should be modernized, either by replace- 
ment or remodeling. 
Many of the Colony buildings at Gardner are old wooden 
structures. Some are close to one hundred years old. Several 
of them have been condemned. 
For many years this hospital was considered a transfer 
hospital. In recent years it has been utilized as a receiving 
hospital, and the general type of patient is changing from 
those who are well institutionalized to a more active group. 
In the future program of the hospital should be added an ad- 
mission building and hospital building for both men and 
women patients. 
Continuation of fire protection program in buildings housing 
patients should be made. 78 
HOUSE— No. 2400. 
[Mar 
The hospital at the present time is approximately 20 per 
cent overcrowded, and not only should this overcrowding not 
increase, but there should be some reduction in it. The build- 
ing of an additional colony group for one hundred patients is 
suggested, such construction to be of simple type and relatively 
low cost. 
The question of a superintendent’s house is dependent upon 
the general policy to be adopted relative to the responsibility 
of superintendents. In this instance the superintendent lives 
in the administration building, which is crowded with admin- 
istrative offices and employees’ quarters, but is not compli- 
cated by having wards for patients in the immediate proximity. 
The present living accommodations for the superintendent are 
not conducive to privacy nor to the freedom from interruption 
of the continual patient problems which are bound to come 
to the administrator who actually lives in a part of the hos- 
pital proper. 
A suggestion for additional cottages for physicians is 
prompted by the unsatisfactory living accommodations for 
married physicians at the Gardner State Hospital at the pres- 
ent time. As a general policy it seems proper that physicians 
and their families should be comfortably housed and somewhat 
removed from the daily contact with their work. Additional 
consideration must be given to the families of physicians if 
continued service of the latter is to be expected. 
If the State is to continue the policy of housing employees, 
this hospital, within the next few years, will require additional 
accommodations for employees. The recommended project 
for an employees’ building is designed to cover this need within 
the next few years. 
A new central building at the Wachusett Colony is designed 
to further relieve some of the crowding and to take care of some 
of the future anticipated patients. 
Grafton State Hospital. 
The present population at this hospital is approximately 
1,550, and a new building to house 300 additional patients will 
be opened during the calendar year of 1939. 
The present laundry facilities are barely adequate to take 
care of the present population, and a new laundry should be 
built to properly take care of the needs in the immediate years 
to come. 1939.] 
HOUSE — No. 2400. 
79 
By the end of the current year the women’s section (Pines) 
will be fairly complete. We recommend a similar ward and 
service addition for the men’s group (Elms). 
Additions to the storehouse and bakery equipment will be 
necessary to properly meet the needs of the hospital after the 
current year. 
Eventually sun porches should be added to both the men’s 
and women’s infirmary buildings. 
Eventually sun porches should be added to the women’s 
acute receiving buildings identified as Pines B and C, and to 
the men’s infirmary building, identified as Elms B and C. 
Within the next year the present Pines service building will 
be vacated, and this service taken over by the new building 
which is now under construction. For the relatively small 
sum of $25,000 the present Pines service building could be 
changed into a new women’s admission building, housing 50 
patients, and we recommend this procedure. 
The present tunnel between Pines E and the new service 
building under construction is small and narrow and carries 
steam lines. By the addition of a new tunnel it would be pos- 
sible to route patient traffic indoors so that it would be unneces- 
sary for patients to go out of doors in inclement weather in 
passing to the service building for meals. This project should 
be carried out. 
At the present time the patients in the Willows Group 
(female) have to cross a public highway for their meals, and we 
suggest a passageway from this group to the service building. 
As additions to the hospital are made it will be necessary to 
have additional heating facilities, and a new building is pro- 
vided in the building program for this purpose. 
Grafton is another hospital in which the superintendent re- 
sides in the administration building, which is crowded with 
various administrative offices and with other quarters for em- 
ployees. Provisions are made in the building program for con- 
struction of a superintendent’s house whereby the superin- 
tendent might be permitted to be relieved, in his home life, 
from the immediate contact and anxieties of his daily duties. 
This, we believe, is a suggestion which will lead to increased 
contentment and efficiency. The present superintendent’s 
quarters would be available for other urgent administrative 
purposes. 
Two officers’ cottages or possibly a duplex house for two 
physicians’ families, are recommended in order to make more 80 
HOUSE— No. 2400. 
[Mar 
suitable accommodations for married physicians, and in order 
to attract the type of physicians whom the State would like to 
have in continued service. 
If the State is to continue its program for maintaining em- 
ployees, the Grafton State Hospital should be provided with 
additional facilities for housing such employees, and we have 
proposed a building to accommodate married couples. 
Medfield State Hospital. 
For a period of many years this hospital was considered 
essentially a transfer hospital. In recent years it has assumed 
the function of an acute receiving hospital, serving as one of 
the outlets for the thickly settled metropolitan area. The con- 
struction of the hospital has not kept pace with the changing 
functions of the hospital. The majority of the buildings are 
two-story buildings and have had inadequate fire protection. A 
program of correcting this deficiency has been in progress dur- 
ing the past few years, and should be continued at as rapid a 
pace as possible. 
Most of the plumbing throughout the various ward buildings 
has been unsanitary and obsolete. Some progress has been 
made in recent years towards rectifying this condition, and the 
program of replacing the plumbing should continue without 
interruption. 
In view of the changing functions of the hospital, an acute 
receiving building and a building for disturbed men, as well as 
one for disturbed women, should be added in the not too distant 
future. 
It would appear that the present Infirmary was designed 
around the thought of giving care only to employees and to 
those patients who required major surgical operations. The 
rooms for such employees or patients, as the case may be, are 
on the second floor, with an operating room and other facilities 
on the first floor. There is no elevator service available. There 
should be a modernization of this Infirmary, with an addition 
whereby the greater portion of the physically ill patients might 
be congregated and medical service for them concentrated in 
this building. We feel that this change is urgent. 
The layout of the buildings at Medfield lend themselves very 
readily to being connected by corridors. At the present time 
they are completely separated and have to be administered as 
more or less individual units. Problems coincident to the 1939.] 
HOUSE —No. 2400. 
81 
administration of this hospital would be greatly diminished by 
the addition of connecting corridors. 
We are recommending the reconstruction of the present em- 
ployees’ dining room into an employees’ cafeteria, primarily on 
the behalf of increased service and increased efficiency, to- 
gether with the economy and diminution of table waste that 
are consistent with such service. This is designed to serve 350 
people per meal. 
A project is included to renovate the present pantries, of 
which building changes approximate one half of the proposed 
expenditure and new equipment the other half. The present 
location of the general dining rooms for approximately 1,000 
patients is such that separate scullery and dish-washing pan- 
tries are necessary for the men’s and women’s sections. The 
proposal is to renovate these sections, putting in waterproof 
floors and side walls, minimizing the vermin problem, and re- 
placing obsolete equipment with new. 
A new shop and industrial building is proposed to replace the 
present inadequate quarters which have repeatedly been con- 
demned by the Department of Public Safety. Equipment is 
now housed in the basements of certain ward buildings and 
constitutes a fire hazard. It is expected that all hospital in- 
dustries will be moved to the new building, and that the present 
site of these industries will be renovated and made safe for the 
centralization of the occupational therapy rooms. 
The Medfield State Hospital has been seriously handicapped 
in recent years in obtaining proper medical personnel through 
inadequate facilities for the housing of married doctors. Pro- 
posal is made for two officers’ cottages which should be com- 
pleted to meet this need within the next few years. 
During the next few years serious consideration should be 
given to the erection of a new administration building. The 
present administration building is inadequate, poorly arranged, 
is not fireproof, and the facilities for administrative purposes, 
storing of records, etc., are very poor. Just as soon as the 
immediate patient needs are taken care of this administration 
building should be provided. 
Metropolitan State Hospital. 
This is the newest hospital from the standpoint of construc- 
tion. It is not as yet completely built, and is not equipped to 
care for all types of patients. At the present time it is considered 82 
HOUSE —No. 2400. 
[Mar. 
a transfer hospital only. A receiving building should be added 
at an early date, so that this hospital can assume the functions 
of a receiving hospital and relieve the pressure for admissions 
in the metropolitan area. 
In the future development, provisions should be made for 
a building for disturbed men and one for disturbed women. 
It is on the grounds of the Metropolitan State Hospital that 
we recommend a building be placed for psychotic children, a 
detail of which is discussed elsewhere in this report. 
As the hospital grows there should be provided a shop build- 
ing for the usual hospital industries; also, after the addition 
of the new proposed buildings, there should be some definite 
effort put into completing the landscaping and regrading of the 
grounds around the building. There has already been some 
work done along this line which has added materially to the 
appearance of the grounds around the Metropolitan State 
Hospital. This should be carried on after the final placing of 
new buildings is made. 
Northampton State Hospital. 
A program for fireproofing the main group of buildings at 
this institution should be continued. 
The main farm group is now located close to the male wards 
and the new kitchen and cafeteria units. The buildings are 
of wood construction and form both a fire and health menace. 
A development is proposed for a new farm group, including a 
new farm dormitory for 100 patients, a barn group and dairy 
group, situated some distance from the main hospital group. 
This program should be started relatively soon. 
Northampton State Hospital serves a large western section 
of the State and is located 60 miles from the nearest public 
hospital for psychotic adults. This hospital, therefore, has to 
be rather complete in itself and cannot depend too much on 
service from other state hospitals. Adequate provisions should 
be made for the proper care of patients suffering from tuber- 
culosis. A new building for these patients is recommended. 
We suggest that this building be placed in the vicinity of the 
present farm group after the latter has been developed under 
the new proposal. 
In the building program we have provided for additional 
ward buildings. These are designed to take care of some of 
the present overcrowding which is 17 per cent, also to elimi- 1939.] 
HOUSE —No. 2400. 
83 
nate the necessity of transferring patients from Northampton 
to hospitals not remotely situated from their homes. We would 
again point out that the Northampton State Hospital serves a 
large section of the State, and the nearest other hospital for 
adult psychotic patients is 60 miles away. 
This hospital should be provided with an additional turbine 
and generator. Several times within recent years the hospital 
has been without electric current, due to flood conditions, and 
there should be available another emergency machine. 
A new bath house is suggested so that provisions may be 
made for central bathing of all patients who are able to be up 
and about. At the present time bathing facilities are quite 
inadequate, and are contained on the individual wards. It is 
our feeling that this does not represent optimum efficiency 
and is not particularly economical. 
The proposed addition to the women’s nurses’ home is made 
contingent upon the policy of the State relative to housing 
employees. 
Taunton State Hospital 
This hospital at the present time has a resident population 
of approximately 1,660 patients. It serves the large Cape 
area, extending as far as Provincetown. The hospital is not 
able to care for the demands for new admissions coming from 
its own district, and many of these patients have to be trans- 
ferred to other hospitals a long distance from the homes of 
friends and relatives. We believe that Taunton State Hospital 
should ultimately be developed so as to care for the greater 
part of these patients, and eliminate the long traveling distance 
for friends and relatives. Additional patient facilities recom- 
mended in the building program are designed with this thought 
in mind. Among these are the proposed male Infirmary and 
the psychiatric or admission building, which are designed to 
be added to the new group of buildings which were added dur- 
ing the past few years. The present facilities for the care of 
tuberculosis and many of the acute type of patients are not 
adequate. 
Much progress has been made in recent years in renovating 
the obsolete plumbing in the main group of buildings. This 
should be continued until all such plumbing is modernized. 
The present laundry at Taunton is a two-story structure 
and is inadequate for the present demands made upon it. It 
should be replaced. 84 
HOUSE —No. 2400. 
[Mar. 
It is proposed to add a new kitchen and dining room building 
for the new hospital group, such building to be of fireproof 
construction and to accommodate the service facilities for this 
new hospital group. At the present time the service facilities 
are in the main section of the hospital some distance away, 
and service forms a most difficult and not too satisfactory 
administrative problem. 
After an addition to the present fire-protection program, 
we are proposing extension of the present fire alarm system 
throughout the hospital. 
We are including a project calling for placing electric wires 
completely under ground, changing the wires in the hospital, 
which are now run in wooden moldings, and making certain 
necessary changes in the power plant, so that the hospital may 
generate all of its own electricity. It is not thought that such 
a procedure would require any additional personnel, and it 
seems to be an economical proposal. 
A greenhouse is proposed as a future development to replace 
the present greenhouse which is now becoming rather obsolete, 
and is located in the proposed way of future developments. The 
hospital is rather reluctant to even think of giving up its green- 
house activities, and the replacement of present facilities is 
desirable within the next few years. 
Two officers’ cottages are proposed which are designed to be 
of double cottage type, and by this means it is hoped to attract, 
accommodate and hold for continued service a high grade of 
medical personnel. 
During the recent development of the Taunton State Hos- 
pital the newer buildings have been laid out with a plan in 
mind to change the entrance to the institution from its present 
inconvenient site to the Bay Street end. Some progress has 
been made in this respect by making a dam in the river, with 
abutments for a bridge. The proposal offered in the building 
program is to purchase certain pieces of real estate and to con- 
tinue the roads and sidewalks for this entrance. Eventually a 
new administration building would be placed close to this 
entrance, which is much nearer to the main line of traffic and 
would eliminate the necessity of auto traffic approaching the 
wards for patients, except when such cars had immediate busi- 
ness at the wards. 
A new farm dormitory is proposed at one of the colonies in 
order to accommodate more patients who may be occupied in 
farm activities. 1939.] 
HOUSE —No. 2400. 
85 
We are also proposing a new root cellar as an eventual de- 
velopment for the more adequate storage of home-grown vege- 
tables. 
Westborough State Hospital. 
Under the auspices of the Federal grants this hospital has 
been provided with storage facilities, kitchen, dining room, 
laundry, and other service facilities, for a patient population 
of 2,000. It now has a resident population of approximately 
1,575 patients. It could be built up to a 2,000-bed hospital 
with less capital outlay than would be the case in other insti- 
tutions where the service facilities would have to be increased. 
The present power plant, however, is old and is showing 
considerable need of repair or replacement. It undoubtedly 
will have to be replaced within the next three or four years, 
irrespective of additional resident population. We believe that 
a detailed study of the efficiency of this plant would indicate 
the need of a new plant in the near future. The generating 
equipment is insufficient for the hospital requirements at the 
present time, and it is necessary to purchase a portion of the 
electricity used. 
The main administration building is an old structure which 
has outlived the usefulness of its original purpose. A certain 
section of it could be remodeled so as to accommodate 300 
additional patients, and we believe this is the economical thing 
to do. 
The dairy group is now located on various sections of the 
hospital grounds. Many of the buildings are old wooden struc- 
tures which are quite dilapidated and need to be replaced. In 
the replacing of this group we suggest that from the standpoint 
of efficiency the group be centralized near the farm activities. 
A new admission building is suggested because of the serv- 
ice facilities already available, and because of the fact that 
this hospital receives a large number of acute admissions not 
only from the immediate vicinity of Westborough, but also 
from the thickly settled metropolitan area just west of Boston 
proper. 
In the future development a building for disturbed women 
patients should be provided, complete with special dining 
facilities. 
In our building program we have recommended remodeling 
the old store building which was replaced when new storage 
facilities were made available two or three years ago. How- 
ever, in view of the fact that this building was severely dam- 86 
HOUSE —No. 2400. 
[Mar 
aged during the storm last fall, we feel it inadvisable to at- 
tempt to reconstruct it. 
Provisions are made in the building program for three 
officers’ cottages designed for married physicians. The need 
for such accommodations has been dwelt upon repeatedly. 
Worcester State Hospital. 
We do feel, however, that the fire protection program (re- 
placing wooden floors, completion of rewiring, installation of 
fire alarm system, extension of sprinklers, etc.) which has 
been started should continue to completion as rapidly as 
possible and without interruption. 
No additional bed space is recommended for this hospital. 
The present laundry is inadequate for the needs of the 
hospital and working conditions for both patients and em- 
ployees are far from ideal. From both the humanitarian and 
economical point of view this should be replaced at an early 
date. 
The male wards of the main building have been without 
proper porches for several years, and we feel that these addi- 
tions should be made in the not too distant future. 
The wards for acute medical and surgical cases have been 
functioning efficiently over a period of years. They are, how- 
ever, without an elevator, and the wards as a wFole should 
be modernized. We recommend the renovation of these 
wards. 
Cooking and feeding facilities in the Summer Street branch, 
housing over 500 patients, require complete renovation. A 
modern kitchen and cafeteria are recommended. 
Under the present plans it is proposed to remodel the present 
laundry into a storeroom, after a new laundry has been pro- 
vided. This is set up in the building program for considera- 
tion in the immediate years to come. 
Provision is also made for central bathing facilities and 
additional hydrotherapeutic facilities on the men’s wards, such 
equipment to more or less duplicate that which has been in 
existence on the women’s wards during the last few years. 
We suggest a project putting an additional wing onto the 
present cow barn in the main hospital group which would 
provide concentration of the milking herd in one place, saving 
the cost of transportation of milk, and providing better con- 
trol of the production and distribution of milk. 1939.] 
HOUSE— No. 2400. 
87 
In the next few years it would be most desirable to provide 
better accommodations for patients employed in industrial 
workshops in the hospital, and we would propose an industrial 
building. The present shops are inadequate, the working 
conditions poor, and they do not provide for adequate patient 
supervision. 
The superintendent at the Worcester State Hospital resides 
in an apartment in the administration building immediately 
adjacent to wards housing patients. We feel that this provides 
an extremely difficult mode of living for a superintendent, and 
we suggest the erection of a superintendent’s house on the 
grounds of the hospital, as a building project to be considered 
immediately after the patient needs have been completed. 
Monson State Hospital. 
This hospital is the only public hospital in the State devoted 
for the sole care of both psychotic and non-psychotic patients 
suffering from epilepsy. The pressure for admissions is heavy, 
and there is a relatively long waiting list. Ward additions and 
infirmaries should be made at a very early date. The present 
resident population at Monson is approximately 1,450, and in 
our building program we are recommending the addition of 
500-odd beds. 
The program of fire protection and fire prevention already 
inaugurated should continue. 
In some of the older buildings a great deal of the plumbing is 
obsolete and unsanitary. This should be replaced as rapidly 
as possible. 
We also recommend the addition of a new assembly build- 
ing. The present facilities for such purposes are located on the 
second floor of the old kitchen building. This does not provide 
sufficient space, and it likewise is undesirable to bring a large 
number of epileptic patients together on the second floor of a 
building with the type of egress that exists. 
Eventually it will be necessary to provide for new laundry 
facilities, especially as patient population increases; also, as 
the size of the hospital increases, it will be necessary to provide 
adequate facilities for industrial therapy among the patients, 
and this is suggested in the construction program. 
The question of adding officers’ cottages depends upon the 
state policy relative to housing such employees on the grounds. 
At the present time certain staff members reside in the adminis- 88 
HOUSE —No. 2400. 
[Mar. 
tration building. This is inconvenient for proper living quar- 
ters, and it also takes away valuable space which should be 
utilized for administrative purposes. 
If farming activities are to be continued it is suggested that 
serious consideration be given to the proposal for additional 
land purchase of four parcels which are either adjoining to or 
completely surrounded by the present state property at the 
Monson State Hospital. 
Belchertown State School. 
This institution has a resident population of approximately 
only 1,300 patients. Contingent upon any ward additions, 
there would have to be added another boiler and an extension 
to the boiler house. The waiting list for mental defectives at 
this school is so long and the pressure for their admission so 
great that we feel additional ward buildings to this institu- 
tion should be made in the near future. If the hospital is to 
be later developed into a 2,000-bed institution, additional 
steam, water and sewerage facilities will be required. All 
recommended additions have been made with a view to in- 
creasing this school to 2,000-bed capacity. 
Two officers’ cottages are recommended for the steward 
and a staff physician. The school officials feel very keenly 
about the question of continuing to have the families of hospital 
officers living in the hospital buildings. 
The question of additional buildings for employees would 
depend upon a general policy of housing employees on the 
institution grounds. 
Walter E. Fernald State School. 
The construction problem here resolves itself into facilities 
for the care of additional patients, due to the long waiting list 
and pressure for admissions. An additional building to the 
school was planned in 1938, but the plans were abandoned 
when funds did not become available. We have studied the 
question as to increasing the size of the lowest cost buildings 
at Templeton Colony, connected with this school, and have 
commented on that in the section dealing with the care of 
mental defectives. We have not included this in our building 
program because such a proposal would depend upon the future 
policy of the Department in regard to the transfer of adult 
patients away from the school. 1939.] 
HOUSE— No. 2400. 
89 
Eventually with the enlargement of the hospital some addi- 
tion will be necessary to extend the present power and heating 
facilities. 
It is proposed to revamp the present old recreation building 
and concentrate the laboratory services for research purposes 
in this unit. 
It is suggested that the old administration building be re- 
modeled and put into active use for living accommodations for 
employees. 
Two officers’ cottages are recommended for staff physicians 
with families. 
It is suggested that additional wings be added to the present 
industrial building so that all of the school industries may be 
concentrated, and also for the purpose of doing away with the 
present unsatisfactory industrial conditions which exist in 
some of the basement rooms. Recommendations to abandon 
some of these latter rooms have been made by the Department 
of Public Safety. 
The program for fire prevention should be continued. A 
great deal of additional work in this line is necessary, particu- 
larly at the Templeton Colony. 
Wrentham State School. 
The building program here is also recommended on the 
basis of the long waiting list and pressure for admissions. 
The present power plant is inadequate for the needs of the 
hospital at this time, and has been the subject of official com- 
ment over a period of years. A new power plant is most cer- 
tainly a prerequisite to any program calling for additional 
buildings. The newest boiler is over twenty years old, and the 
generating equipment is entirely outdated. 
Within the next few years the Wrentham State School 
should be provided with adequate gymnasium facilities. At 
the present time such facilities are cramped, small rooms in the 
school building are used, and floor space is not sufficient for 
any large gathering or to organize groups for special recrea- 
tional activities. Gymnasium and recreational activities form 
a distinct part in the program of therapy in a school for mental 
defectives. 
After a new gymnasium has been provided it would be pos- 
sible to remodel the present schoolhouse and have additional 
schoolrooms for extra class work. 90 
HOUSE— No. 2400. 
[Mar. 
There should be a second floor added to the storehouse. 
The school administration is handicapped by cramped accom- 
modations at the present time, and certainly will require an 
addition as the size of the school increases. 
Some attention should be given to renewing the surface on 
the present filter beds. We are informed that these are filtering 
improperly and that they should be resurfaced and the drain 
pipe replaced. This certainly is a necessary prerequisite before 
any appreciable increase in size can be made to the school. 
During the next few years there should be an addition to 
the present clinical building whereby patients requiring close 
observation and study would be readily accessible. 
Officers’ cottages are necessary to provide proper living ac- 
commodations for those key individuals in the institution who 
have families. A 10 
TEAK. 
B1 
JllDING PROG HAN 
FOIL DEPARTMENT OF 
SUBMITTED BY SPECIAL COMM 
MENTAL HEALTH COMMONWE 
IS5ION OM MENTAL DISEASES/ 
A17H of MASSACHUSETTS 
1939 
1940 
1941 
1942 
1943 
1944 
1945 
1946 
1947 
1948 
INSTITUTION 
PROJECT 
BE.DS 
AMOUNT 
PROJECT 
5ED5 
AMOUNT 
PROJECT 
6£D5 
AMOUNT 
PROJECT 
5£DS 
AMOUNT 
PR.OJECT 
>£05 
AMOUNT 
PROJECT 
&EDS 
AMOUNT 
PROJECT 
>£0S 
AMOUNT 
PROJECT 
>£D5 
\MOUNT 
PR.OJECT 
)£D5 
AMOUNT 
PROJECT 
m 
MOUNT 
BO-STOIn) 
PSYCHOPATHIC 
X-R.AY EQUIPMENT 
10,000 
DtTtNTlON WINDOWS 
23,000 
Boston 
STATE 
tunnel 
30,000 
Replace West 
C grD. 
450,000 
industrial bldg. 
40,ooo 
replace A-E-F 
4oo,ooo 
Print Shop 
14,000 
enlarge West, 
dining Room 
elec. Wires Under 
GROUND NEW ST. LIME) 
30000 
121,500 
3 off cottages 
45000 
Dan veils 
Admission blog 
ado. To Laundry 
BLOG £• EQUIP 
iso 
350, OOO 
95,000 
Fireproofing 
75,ooo 
New Engines &- 
QENfRMORS 
130,000 
FIREPRjOOFINQ 
75,ooo 
Cony. Baths 
Married Couples 
Home 
84 
73000 
15 0,000 
Comp. Sprinklers 
Renov. bear. 
Center & Chapel 
00 
I4o,ooo 
FO*BOR.OU<3H 
REMODEL C 0tDG 
7C, 
50,000 
M l d. 4 Surgical 
Bios. 
325 
750,000 
REMODEL "o'BLOG 
30 
115,000 
remodel cafeteria 
J 50,000 
Remodel Assemble 
Bldg. 
SPRINKLERS 
Fire Alarm Sys. 
10,000 
1 0,000 
2 0,0 00 
Garage Sequip. 
13,000 
Purchase Laho 
10,450 
Q AR.DNER- 
Central Blog. 
Valley 
loo 
8S,ooo 
AOMISilOU 0Lt><3 
Ntw Colony Group 
100 
loo 
250.000 
110.000 
hosf. bldg. Fem. 
Central Blog. 
Wachusett 
84 
loo 
175,000 
85,ooo 
Hosp. Bldg Male 
84 
175,000 
Sprinkers 
Z off Cottages 
52,500 
10,000 
Emp. Blog. 
100,000 
Sopt. House 
20,000 
Grafton 
CWWGtPuiC Service 
t« Admiss. Bu>a 
50 
25,000 
Ward Blog Zr 
5EFLVICt - ELMS 
3 00 
400,000 
bldg For Married 
Couples. 
84 
150,000 
Iaundry Bldg 
4 EQUIP 
100,000 
Tunnel Pines 'ET 
r, new serf. Bldg- 
A PD. BOILER 
A op- td store house 
EOUIP, 10VEH5 
9.000 
10,400 
So/oco 
15.000 
5on Porches 
pines B 5- C. 
20,000 
5up7- House 
Zoff cottages 
20,000 
20,000 
Aunporches 
Elms 6 & C. 
PASS. WILLOWS BLOC 
To Service Bldg 
29,ooo 
14,375 
M EDFIELD 
Dist. bids, Male 
&- female 
14o 
224,000 
acute Bldg 
140 
325,000 
renew toilets 
£• baths 
ADD.TO INFIRMARY 
1 40 
50.000 
275.000 
Conn. Corridors 
fir$ protection 
75.000 
70.000 
fire Protection 
70,000 
5hop Bids &- 
INDUSTRIAL Blog. 
141,000 
Administration 
BLDG. S- RENOV, 
EMP. CAFETERIA 
150,000 
1 1,000 
Renovate 
Pantries 
12,000 
ZOFF COTTAGEJ 
25,000 
METROPOLITAN- 
chno Psychiatric 
100 
300,000 
RECEPTION BlDO 
ISO 
400,000 
Dist. Bldg, Male 
200 
350,000 
dist. Blog Fem. 
Zoo 
380,000 
Shop Building 
34,000 
Landscaping &• 
Grading 
2Soo 
0 
NOR-T HAMPTON 
Farm Dormitory 
Add. To Infirmary 
IOO 
75 
195.000 
4o,ooo 
Ward Bldg. 
ISO 
230,000 
IB. Bldg. 
75 
175,000 
Ward Blog 
ISO 
230,000 
Fireproof 
MAIN GROUP 
4*0 OOO 
Fireproof Main 
Group 
dairy Group 
turbine 8- GEN. 
40.000 
80.000 
21.000 
Fire proof Maim 
group. 
Bath House 
ADD NURSES Home 
40,006 
27, 000 
8S,ooo 
Fireproof Main 
Group 
4D,ooo 
Dairy Barn 
15,000 
Taunton 
Laundry Bids 
EQUIP. 
110,000 
Farm Dormitory 
Raynham 
So 
I35,ooo 
Male Infirmary 
2oo 
425,000 
Psychiatric Blog. 
150 
RlT. Er DIN. RM\ 
Group / 
Bay STREET ENT. 
Fire Alarm Sys. 
QeN- 3- REWIRING 
80.000 
76.000 
l 5, 000 
33, 000 
Renovate Joiiets 
&■ Baths 
47,5oo 
Root cellar 
Green house 
2 off Cottages 
17,000 
10,000 
2(0,000 
WEST BOR.O0QH 
Power Plant 
ZSo.ooo 
Admission bldg. 
220 
500,000 
disturbed Bldg. 
Zoo 
350,000 
Bimodei adminis- 
tration bldg 
S- WARDS 
3oo 
400,000 
Dairy Group 
Remodel oldY 
Store BlDG / 
go, OOO 
3o,ooo 
3 OFF COTTAGES 
37,500 
W'OP.CESTER^ 
Launort Bids. 
&- EQUIP. 
150.000 
Fireproof 1st. Fi. 
Store House 
75.000 
75.000 
Fireproofing 
new Male Bath 
House 
75.000 
80.000 
RlNov. Kitchen 5- T 
din. Rm. Summer ST-J 
industrial bldg 
fireproofing 
Comp Rewiring 
125,000 
4.0,000 
-7 5,0 00 
50.0 00 
Porches - Quimbs 
t, SAU56UR-Y 
comp. Fire alar* 
CONC. FIRS - WASHBURN 
50.000 
10, 000 
31.000 
15I000 
15. OOO 
Renovate 
Thayer 6 Folsom 
3S,ooo 
30pt House 
20,000 
Mon son 
WARD 4 INFIRMARY 
Atwtw Plumbing 
&F1RE PROTECTION 
life 
175,000 
25, OOO 
WARD 5 INFIRMARY 
renew Plumbing 
Sfire Protection 
ISO 
200,000 
25,000 
womens Blog, 
120 
180,000 
Mens &loq. 
120 
180,ooo 
Ado, To Hospital 
3o 
40,000 
Assembly Bldg. 
150,000 
Laundry Bids, 
&- Equipment 
4-0,000 
industrial Blog 
Remodel old Kitche 
Purchase Laho. 
•^0,000 
34.000 
22.000 
2 off Cottages 
25 000 
Su b-Total 
732 
1,549,000 
950 
2,145,000 
760 
2,075,000 
1055 
2,278,ooo 
1090 
2,400,000 
500 
2,199,000 
- 
1,2 54,000 
- 
735,450 
386,000 
114,573- 
BELCHER-TOWN 
INFIRMARY 
power Plant 
23o 
250,000 
4o,ooo 
Boys Dormitory 
Contagious Hosf 
no 
3o 
125,000 
50,000 
Girls Dormitory 
no 
125,000 
Add. To Hospital 
4>o 
75,000 
Steam. Water 6- 
Sewer Faciuties 
37,000 
2 OFF COTTA66S 
2oooo 
4 EMP. COTTAGES 
120,000 
W. E. Fer.na.ld 
Girls infirmary 
IOO 
140,000 
Boys Dormitory 
no 
125,000 
REMODEL reception 
Blog.S' Hospital 
Girls Dormitory 
So 
no 
125.000 
125.000 
Ext Power. £- 
H eating 
40000 
Repaodel old 
6lo<3 
Re Model Rec. Bido, 
fire protection 
WlN<3S . IMO. &L0<3. 
20.000 
15, 000 
38.000 
70.000 
• 
2 OFF COTTAGES 
2 5,000 
WR.ENTH AM 
1 N FIRM ART 
Power Plant 
DC. 
175.000 
225.000 
Hospital Bldg. 
to© 
225,000 
School & Gymn. 
add to Hospital 
12 
/4c,ooo 
12,000 
Renew Sewer. 
BEDS 
39,000 
Ado. To Cunical Bio< 
PE model Adm Blog 
remodel School 
So. 000 
18, ot>o 
10,000 
Add.To Storehoui 
3 0,000 
3 OFF Cottages 
37,300 
Su8- Total 
446 
850.000 
250 
300,000 
240 
475,000 
no 
|25,ooo 
CoO 
75,000 
12 
2(2 ,000 
- 
219,000 
- 
78,ooc 
- 
50,000 
182,500 
Gpland. Total 
1178 
2,334,000 
1200 
2.445,0« 
1020 
2,550,000 
1145 
2,403,00c 
1150 
2.47 5,ooc 
512 
2,4lo,oo( 
- 
1,473,000 
- 
8l3,6oc 
- 
434,000 
~ 
357, 075 
institution Foil 
CRIMINAL INSANE 
500 
1(T5c\odc 
APPENDIX 3 
Note: The commission realizes that force of circumstances 
MAY CAUSE THE ADVANCEMENT OF CERTAIN PROJECTS. 
TO A YEAR OTHER THAN THAT INDICATED IN THE. 
BUILDING- PROGRAM, AND AT THE SAME TIME OtHER- 
PROJECTS MAY BE POSTPONED 039.1 
HOUSE — No. 2400. 
91 
Appendix 4. 
PROBLEM OF THE CRIMINALLY INSANE. 
In our 1937 report we stated that the Legislature had passed 
enabling legislation for the erection of a state hospital for the 
care of the criminally insane on land owned by the Norfolk 
Prison Colony, and that while we had given much considera- 
tion to the problem of the criminally insane, we did not have 
sufficient time, because of the pressure of other matters before 
us, to reach a decision as to whether we should approve such 
a location, even though the site is favored by many interested 
persons. 
A separate hospital for the criminally insane has long been 
sought. Dr. L. Vernon Briggs, at one time a member of this 
Commission, suggested such a hospital while he was a member 
of the State Board of Insanity in 1913. Francis B. Sayre, 
former State Commissioner of Correction, urged that the De- 
partment of Mental Diseases take over the care of the crimi- 
nally insane. His successor, Dr. A. Warren Stearns, formerly 
an associate commissioner of mental diseases, approved the 
idea. In recent times, Arthur T. Lyman, present Commis- 
sioner of Correction, and James A. Warren, superintendent of 
the Bridgewater State Farm, where the criminally insane are 
housed, have strongly urged that these unfortunates be trans- 
ferred to the Department of Mental Diseases. 
The term “criminally insane” is misused in regard to many 
of the patients in the state hospital department of the Bridge- 
water State Farm. Many are confined there who have never 
been convicted of any crime. Others never have been arrested, 
having been transferred from other hospitals where they were 
regularly committed for mental diseases. 
If homicide or other crime is attributable to the mental dis- 
ease of the patient, he is not a criminal. In fact, in certain 
offences, the law directs that a mental examination be made 
prior to trial, a nd, if the person be found mentally incompetent, 92 
HOUSE —No. 2400. 
[Mar. 
he is sent to Bridgewater without further delay and never comes 
to trial while in that condition. 
A person convicted of a crime while mentally normal, and 
who afterwards becomes insane while serving sentence, is a 
sick man as well as a criminal, and should be given hospital 
care and treatment for disease just as he would for any other 
ailment he contracted. 
We find at the state hospital department at Bridgewater 
State Farm that patients belonging to both these classes are 
branded as “criminally insane.” They are cared for entirely 
as prisoners; the problem is necessarily custodial and not medi- 
cal to the officials there. The medical care and treatment is 
limited to periodic, usually annual, physical and mental exam- 
inations, the results of which are recorded in the patient’s case 
record, and such emergency treatment for injuries and inter- 
current disease as may be necessary. 
We find that no attempt is made whatever to use recog- 
nized forms of treatment for mental disease as such. 
There are no hydrotherapy, no occupational therapy, no 
psychotherapy, and none of the other methods of counteract- 
ing or quieting the disturbance of disturbed patients. 
It is true that many of the patients are of the most serious 
tj'-pe as regards danger to the lives, health or property of others, 
but since they are patients through no fault of their own, and 
since the State has adopted the policy of assuming full respon- 
sibility for the care of the mentally ill, they should receive the 
medical care and treatment that is available to other patients 
suffering from similar diseases in other state hospitals. 
Our investigations have shown us that there are a number 
of patients in the hospitals under the Department of Mental 
Health who have similar tendencies to violence. They receive, 
however, more adequate medical psychiatric attention and 
treatment. Seldom do they attempt a violent act, and rarely 
do they succeed. We are convinced that these attempts to 
commit acts of violence are less frequent and less serious by 
far than they would be if the patients did not receive the psy- 
chiatric treatment now denied those at Bridgewater. 
There is a tendency on the part of the public to become 
fearful of patients who are harmless and who are granted a 
certain amount of liberty during the day, which they value 
highly. Such liberty is part of the psychiatric treatment. It 
encourages the patient to assume as much responsibility as 
possible, fosters self-respect and self-restraint, and brings him 1939.] 
HOUSE —No. 2400. 
93 
in pleasant association with persons in the neighborhood living 
normal family and community lives. 
The vast majority of people living in the neighborhood of 
state hospitals have no fear of these patients, but, on the con- 
trary, are inclined to welcome their presence at community 
recreations. They are willing in this respect to contribute 
their part to the restoration of the mental faculties of the 
patients. 
A small minority have always objected to this liberty and 
have demanded that it be restricted. They have referred to 
these patients as “homicidal maniacs,” who have permission to 
wander at will around the countryside. Their objections have 
made the patients restless and resentful, with detrimental 
results to their morale and their prospects for improvement 
and recovery. 
There are several advantages to be gained by the erection of 
a hospital for the criminally insane. 
It has become quite obvious that the problem of the crimi- 
nally insane is primarily a medical problem rather than a cor- 
rectional one, but likewise a medical problem in which a high 
degree of segregation, and security of segregation, must be 
maintained. 
With the removal of the criminally insane from Bridgewater 
to a new institution under the Department of Mental Health, 
the present Bridgewater facilities would become available, 
with some remodeling, for the care of a much larger number of 
defective delinquents from the schools for the mentally defi- 
cient, and would, in a measure, relieve the present long waiting 
list. Because of the lack of proper facilities in the Department 
of Correction, the schools have, by necessity, continued to 
care for many of this type. The defective delinquent problem 
is more clearly a correctional one, and the dangers coincidental 
to intermingling this class with the non-delinquent feeble- 
minded are obvious. 
It thus is apparent that the “bottle neck” which is hamper- 
ing progress in two large state departments is the present lack 
of proper care and segregation of the criminally insane. The 
Commission has given this problem considerable study and has 
put forth special effort to visit a sister State to study the most 
modern methods of care and construction of a hospital for the 
criminally insane. 
Last year a representative of the Commission appeared 
before the ways and means committee to advocate the erection 94 
HOUSE— No. 2400. 
[Mar. 
of a 500-bed hospital for the criminally insane at a cost not to 
exceed $1,700,000. Unfortunately nothing was done at that 
time. We wish to reiterate our recommendation for the early 
erection of such a hospital on state-owned land near the Nor- 
folk Prison Colony, and the transfer to the hospital of crimi- 
nally insane patients at the Bridgewater State Farm. The 
hospital would be under the supervision of the Department of 
Mental Health, which could then transfer from the present 
state hospitals to the proposed state hospital those patients 
who have tendencies to violence, etc. 
The Legislature recognized the merit of this proposal, and in 
1935 the following act (chapter 421, Acts of 1935) was passed 
authorizing the construction of a hospital to be known as the 
Norfolk State Hospital. It was clearly the intent of the Legis- 
lature that the institution be built within a comparatively brief 
time. The next and final step, that of appropriating the money, 
will make the hospital a reality. This step should be taken 
at once. 
Chapter 421, Acts of 1935 
An Act providing for the Establishment of the Norfolk State 
Hospital for the Care of the Criminal Insane. 
Be it enacted, etc., as follows: 
Section 1. As soon as funds become available for the construc- 
tion of a state hospital for the criminal insane, the commissioner of 
correction is hereby authorized, with the approval of the governor 
and council, to transfer to the department of mental diseases the 
control of so much of the land now occupied by the state prison colony 
at Norfolk, as, in the opinion of the commissioner of correction, the 
commissioner of mental diseases and the chairman of the commission 
on administration and finance, may be necessary for such a state 
hospital. 
Section 2. Upon the transfer to the department of mental dis- 
eases of the control of any land under section one there shall be con- 
structed thereon a state hospital for the criminal insane, to be known 
as the Norfolk state hospital, and any funds received from the fed- 
eral government may be used for such construction. Upon receipt 
of notification from said department that said state hospital is ready 
for the reception of patients, the governor shall issue his proclamation 
establishing said hospital and fixing a time for the opening thereof 
for use as a state hospital for the criminal insane. Thereupon said 
hospital shall be subject to all provisions of law applicable to state 
hospitals for the criminal insane, under the control of said depart- 
ment. As soon as may be after the time fixed by such proclamation, 1939.] 
HOUSE —No. 2400. 
95 
all insane criminals then confined at the Bridgewater state hospital 
shall be transferred to said Norfolk state hospital or to some other 
state hospital under the control of said department. 
Section 3. Section five of chapter nineteen of the General Laws, 
as amended by section two of chapter three hundred and fourteen of 
the acts of the current year, is hereby further amended by inserting 
after the word “ hospital ” the first time it occurs in the eighth line 
the words; — , Norfolk state hospital, — so as to read as follows; — 
Section 5. The boards of trustees of the following public institutions 
shall serve in the department, Belchertown state school, Boston 
psychopathic hospital, Boston state hospital, Danvers state hos- 
pital, Foxborough state hospital, Gardner state hospital, Grafton 
state hospital, Walter E. Fernald state school, Medfield state hos- 
pital, Metropolitan state hospital, Monson state hospital, Norfolk 
state hospital, Northampton state hospital, Taunton state hospital, 
Westborough state hospital, Worcester state hospital and Wrentham 
state school. 
Section 4. Section twenty-five of chapter one hundred and 
twenty-three of the General Laws, as amended by section three of 
said chapter three hundred and fourteen, is hereby further amended 
by inserting after the word “hospital” in the tenth line the words: 
— , Norfolk state hospital, — so as to read as follows: — Section 25. 
The state institutions under the control of the department shall be 
Worcester state hospital, Taunton state hospital, Northampton 
state hospital, Danvers state hospital, Grafton state hospital, West- 
borough state hospital, Foxborough state hospital, Medfield state 
hospital, Monson state hospital, Gardner state hospital, Wrentham 
state school, Boston state hospital, Walter E. Fernald state school, 
Boston psychopathic hospital, Belchertown state school, Metropoli- 
tan state hospital, Norfolk state hospital, and such others as may 
hereafter be added by authority of law. 
Section 5. Of the appointments of trustees of the Norfolk state 
hospital which shall be originally made by the governor, with the 
advice and consent of the council, under authority of this act, as 
soon as may be after the proclamation of the governor provided for 
in section two, one shall serve until the expiration of one year, one 
until the expiration of two years, one until the expiration of three 
years, one until the expiration of four years, one until the expiration 
of five years, one until the expiration of six years, and one until the 
expiration of seven years, from the first Wednesday in February 
following such proclamation, subject, however, to the provisions of 
section six of chapter nineteen of the General Laws. 
Section 6. Section three shall become effective upon the original 
appointment of the trustees of the Norfolk state hospital, and section 
four upon the proclamation provided for in section two. 
Approved July 15, 1935. 96 
HOUSE —No. 2400. 
[Mar. 
The following table outlines the factor of overcrowding at 
the Bridgewater State Hospital for the Criminal Insane for 
1923 to 1938, inclusive: 
Bridgewater State Hospital for the Criminal Insane — Admissions 
during Years ending September 30, 1923 to 1938. 
Rated 
Capacity. 
Patients in 
Institutions. 
Over- 
All Admissions. 1 
Years. 
crowding 
(Per Cent). 
First 
Admissions. 
Readmis- 
sions. 
1923 .... 
908 
876 
—3.522 
65 
14 
1924 .... 
908 
916 
.88 
68 
22 
1923 .... 
908 
915 
.77 
67 
14 
1926 .... 
908 
942 
3.74 
63 
27 
19273 .... 
908 
954 
5.06 
57 
5 
1928 .... 
908 
940 
3.52 
37 
23 
1929 .... 
908 
937 
3.19 
48 
19 
1930 .... 
908 
942 
3.74 
65 
23 
1931 .... 
908 
938 
3.30 
58 
19 
1932 .... 
908 
944 
3.96 
58 
16 
1933 .... 
908 
938 
3.30 
58 
17 
1934 .... 
908 
911 
.33 
59 
3 
1935 .... 
908 
903 
— .552 
51 
10 
1936 .... 
908 
877 
—3.412 
40 
6 
1937 .... 
908 
887 
— 2.312 
40 
28 
1938 .... 
908 
895 
— 1.432 
61 
43 
1 Transfers excluded. 
2 Indicates under capacity. 
3 Court admissions only for the years 1923 to 1927. 
The rated capacity of this institution has remained at 908 
beds during the entire period. Bridgewater was under capacity 
3.5 per cent in 1923. Beginning with 1924 onward we see 
the number of patients rising gradually above the rated ca- 
pacity. The greatest degree of overcrowding, 5.0 per cent, 
occurred in 1927, when 954 patients were cared for in a rated 
capacity of 908 beds. From 1928 to 1933 overcrowding at 
Bridgewater remained on an even level of 3.3 per cent; 1934 
saw a drop in overcrowding to .3 per cent; 1935, 1936, 1937 
and 1938 show a condition of under capacity. In 1938 there 
were 1.43 per cent fewer patients than beds in accordance with 
the rated capacity. 1939.] 
HOUSE — No. 2400. 
97 
The first and readmissions are outlined in the last two col- 
umns of the table. We note that the largest number of admis- 
sions occurred in the years 1924 to 1926, when 90 persons were 
committed to Bridgewater. Following 1926 the admissions 
were on a somewhat lower level for three years, returning to a 
total of 88 in 1930; 1931 to 1933 are slightly lower. From 1934 
on we see a decidedly lower level of admissions, there being a 
total of 62 persons coming to Bridgewater in 1934, 61 in 1935, 
46 in 1936, and 68 in 1937, but a rise to 104 in 1938. From these 
figures it is evident that the number of criminal insane com- 
mitted to the Bridgewater State Hospital has shown a tendency 
to decrease over the past fifteen years. The rise in 1938 evi- 
dently comprised a number of short residence cases, as the 
number of patients remaining in hospital at the end of the 
year does not show any substantial increase. HOUSE— No. 2400. 
[Mar. 
98 
Appendix 5. 
PROBLEM OF THE MENTAL DIVISION AT THE TEWKS- 
BURY STATE INFIRMARY. 
In the mental department of the Tewksbury State Infirmary, 
an institution in the State Department of Public Welfare, are 
nearly 500 patients suffering from chronic mental disease. Most 
of them will have to be taken care of for life, and the problem 
is mainly a custodial one. 
The superintendent, Dr. Laurence K. Kelley, has suggested 
either that these patients be removed from the Infirmary, or 
that he be given authority to receive new patients from the 
community and conduct a psychiatric service for them in order 
to stimulate the practice of psychiatry at the institution. 
On September 1, 1931, the Infirmary stopped accepting 
patients from state mental hospitals. As of September 5, that 
year, there were 784 patients in the mental department. The 
gradual reduction in the number of patients is shown in the 
table on page 99. 
The table reports the changes in overcrowding at the 
Tewksbury State Infirmary for the years 1923-38, inclusive. 
The overcrowding at Tewksbury reached its high point in 1930, 
when 807 patients were cared for in a rated capacity of 673 
beds. Following 1930, overcrowding dropped rapidly, becom- 
ing an under-capacity condition in 1934, when 577 patients 
were cared for by a rated bed capacity of 603. This year this 
institution was 4.3 per cent under capacity. In succeeding 
years the bed capacity remains the same, but the number of 
patients dropped to 543, 512, 484 in 1935, 1936 and 1937, re- 
spectively. The year 1937 shows the condition of under capac- 
ity to the extent of 19.7 per cent. 
The sudden reversal of overcrowding at Tewksbury is ex- 
plained by the decreasing number of admissions as observed in 
the last two columns of the table. While this institution had 
been admitting about 40 to 50 patients per year, in 1932 the 
admissions dropped to 3. From 1933 on there have been no 1939.] 
HOUSE — No. 2400. 
99 
admissions to this institution. Certain patients are discharged 
or die each year, and, with no admissions to replace them, we 
may expect the gradual disappearance of mental patients at 
the Tewksbury State Infirmary. 
Mental Wards, Tewksbury State Infirmary — Admissions during Year, 
Rated Capacity, Patients within Hospital and Overcrowding and 
Under Capacity on September 30 of Each Year, 1923 to 1938. 
Years. 
Rated 
Capacity. 
Patients in 
Institutions. 
Over- 
crowding 
(Per Cent). 
All Admissions. 1 
First 
Admissions. 
Readmis- 
sions. 
1923 .... 
673 
712 
5.79 
33 
4 
1924 .... 
673 
754 
12.03 
36 
3 
1925 .... 
673 
737 
9.50 
41 
4 
1926 .... 
673 
741 
10.10 
46 
1 
19272 .... 
673 
773 
14.85 
40 
3 
1928 .... 
673 
788 
17.08 
47 
4 
1929 .... 
673 
788 
17,08 
53 
2 
1930 .... 
673 
807 
19,91 
48 
2 
1931 .... 
673 
694 
3.12 
33 
9 
1932 .... 
603 
657 
8.95 
2 
1 
1933 .... 
603 
605 
.33 
- 
- 
1934 .... 
603 
677 
—4.31s 
- 
- 
1935 .... 
603 
543 
—9.953 
- 
- 
1936 .... 
603 
512 
-15.093 
- 
- 
1937 .... 
603 
484 
-19.733 
- 
- 
1938 .... 
603 
469 
-22.223 
- 
- 
1 Transfers excluded. 
2 Court admissions only for the years 1923 to 1927. 
3 Indicates under capacity. 
While the Commission strongly favors the stimulation of the 
practice of psychiatry, not only in state institutions but among 
the medical profession at large, to authorize the Infirmary to 
conduct a psychiatric service would be counter to one of the 
fundamental recommendations of the Commission. 
In our bill to reorganize the Department of Mental Diseases 
into the Department of Mental Health, we emphasized that 
the Commissioner should have full powers and responsibility 
to conduct the Department, and, through the superintendent, 
the hospitals. 100 
HOUSE — No. 2400. 
[Mar. 
To permit the Infirmary to maintain a psychiatric service 
would lessen, not strengthen, the control of the Commissioner, 
as the Infirmary is part of the State Department of Public 
Welfare, and its officers are responsible to officials in no way 
connected with the Department of Mental Health. 
We therefore recommend that no action be taken at this 
time in connection with the mental department at Tewksbury 
State Infirmary, but suggest that in the future the Depart- 
ment of Mental Health, if such a program is feasible, remove 
a certain number of patients from the Infirmary to its own 
hospitals, so that within a limited period the Infirmary will be 
solely concerned with welfare patients. 1939.] 
HOUSE —No. 2400. 
101 
Appendix 6. 
PROBLEM OF THE MENTALLY DEFICIENT. 
1. Institutional Provision for Mental Defectives in 
Massachusetts. 
(a) Introduction. 
Before reaching a decision as to the ideal institutional provi- 
sion for mental defectives in Massachusetts, let us view the 
subject from its broader aspects. It is known that mental 
deficiency is a widespread condition affecting all social and 
economic levels and involving from 2 to 3 per cent of the gen- 
eral population. Thus, there are between 85,000 and 128,000 
of such persons in our Commonwealth. Out of these large num- 
bers we have only about 5,200 in the state schools and another 
3,200 on the urgent waiting lists. Here we have a total of 
8,400 who have failed in the community. This is about 10 
per cent of the lowest estimate for this group in the population 
(85,000). Here is a point rarely discussed in connection with 
the problem of mental deficiency. We see the remarkable po- 
tentialities for good in this group, in that 90 per cent of these 
handicapped individuals have succeeded in adjusting themselves 
in the community. However, the main concern, for the present, 
is with this 10 per cent who are not making the grade. 
Mental defectives in the community are subjected to the same 
social and economic influences which affect all of us. In times 
of stress the individual who lacks the characteristics making 
for success feels the pinch first. Consequently, children and 
adults, able to stay in the community under favorable circum- 
stances, are no longer able to do so, and make application to a 
state school. This is a situation which has been prominent for 
the past fifteen or twenty years in this Commonwealth. Chang- 
ing social valuations in the post-war period, the stepping up of 
competition, and the continued urbanization of our popula- 
tion have made it increasingly difficult for the mental defective 
to adjust himself. The world familiar to him has been changing 102 
HOUSE— No. 2400. 
[Mar. 
so rapidly that he has been unable to meet the shifting require- 
ments for social and economic adjustment. 
Two pioneers in mental deficiency, Drs. Walter E. Fernald 
and George I. Wallace, insisted that the state schools should 
be maintained as training schools and not simply as custodial 
institutions. During their lives they tried hard to hold to these 
traditions. However, the demand for admission to the state 
schools increased to such an extent during the past fifteen 
years that their successors have been forced to recede from this 
original position. Circumstances made it impossible to con- 
tinue to select the same proportions of the higher grade cases 
— the morons — for training. The idiots, the low grade im- 
beciles, the mongols, the cretins, the hydrocephalics, the cases 
of spastic paralysis, and other pathological types, had to be 
given precedence in the matter of admission. It can be under- 
stood that there was very little space left for the higher grade 
cases, — those making up the trainable moron group. Now it 
happens that these lower grade cases often become permanent 
residents of the schools, remaining until their death. Conse- 
quently, the schools gradually have become loaded with 
chronic cases with little chance of discharge. The ideal, of 
course, is to return to the community each year a number of 
trained mental defectives which approximates the number of 
admissions. Thus the annual turnover will permit the admis- 
sion of new cases. 
If the most satisfactory results from the program for the 
care of mental defectives are to be obtained, the first thing is 
to return to the emphasis of the ideal of the training principle. 
Allowing the state schools to become mere custodial institu- 
tions for chronic cases is a serious error. By failing to meet, 
first, obligations to the higher grade mental defectives, we 
are not only doing them a great injustice, but by such a policy 
the State is simply postponing inevitable expenditure. The 
trained mental defectives are a good bet for community ad- 
justment. The idle and untrained mental defective drifts 
straight into trouble. 
Not all high grade mental defectives need the state school. 
However, certain ones emerge from the mass comparatively 
early, and show by their conduct that thorough institutional 
training will be necessary. When adequate training is not 
available they become serious problems. Massachusetts has 
always been noted for its educational opportunities. Yet the 
group needing education and training most, those carrying the 1939.] 
HOUSE —No. 2400. 
103 
highest potentialities for disaster, is being denied such train- 
ing. The humanitarian principle behind the thought is only- 
half of the matter. Such a program would be the best form 
of insurance for society against possible future difficulties with 
this particular group. 
Let us review the experience of the past thirty years in refer- 
ence to the institutional provision for the mentally defective in 
Massachusetts, and see if it offers any suggestions for changes 
in our present program. 
(6) The Increasing Waiting Lists, 1915-38. 
Massachusetts opened its first state school for mental de- 
fectives in South Boston in 1848. Over the succeeding years 
a slow but steady increase in the demand for institutional 
provision was made up to about 1900. From that date to 1915 
the demand increased slightly and was answered by the open- 
ing of a second state school in 1907 (Wrentham). Over the 
NUMBERS ON THE WAITING LISTS OF THREE STATE SCHOOLS, 
1915-1938; AVERAGE NUMBERS FOR PERIODS 
GRAPH i 
twenty-four year period, 1915-38, there has been an unprec- 
edented increase in the demand for admission to the state 
schools maintained by the Commonwealth. As the two schools 
could fulfill only part of the demands made upon them, it 
became necessary to establish a “waiting list” on which the 
names and histories of persons seeking admission were recorded. 
The numbers on these lists represent the excess remaining after 104 
HOUSE— No. 2400. 
[Mar. 
the schools have admitted all cases possible. Graph 1, on page 
103, pictures the tremendous increase in demand over the period 
mentioned. 
During the five-year period, 1915-19, there was an average 
of 624 cases on the waiting lists of the two state schools (Waver- 
ley and Wrentham). In 1922 a third school was opened, but in 
spite of this increased provision the period 1920-24 saw a 
yearly average waiting list of 1,100 persons. During 1925-29 
this number doubled, rising to 2,042. In 1930-34 it rose 
another thousand cases to an average of 3,271, and in 1935-38 
dropped to 3,155. This slight drop in the waiting lists was 
occasioned by the fact that state schools were able to eliminate 
certain old cases from their waiting lists. In the effort to keep 
the waiting lists within reasonable proportions, the schools 
were requested to go over their lists carefully and eliminate the 
names of all patients who could not be considered as active 
applicants. The reviewing of these cases resulted in the reduc- 
tions noted. From 624 to 3,271 there is a fivefold increase. 
Evidently something epochal had happened to the social fabric 
of Massachusetts in the post-war period which made it less 
possible for the mental defectives to adjust themselves in the 
community; that is, to the same degree that had been possible 
in the earlier years. A 50 per cent rise in waiting lists in 1930- 
34 over 1925-29 could be attributed to the well-known depres- 
sion, but the 100 per cent increase of 1925-29 over 1920-24 
occurred during the post-war boom period. While this particu- 
lar period may have been a good one economically, it is evident 
that it introduced factors, such as a stepping up of competition, 
which emphasized the intellectual and social shortcomings of 
the mentally deficient. 
(c) Decreasing Proportions of Waiting Lists Admitted, 1915-38. 
This trend affected the administration of state schools for 
the care of mentally defective children. The first effect was to 
make more difficult the selection of cases for admission. Graph 
2, following, shows how smaller and smaller proportions of the 
waiting lists could be admitted as time went on. 
In 1915-19 the schools could admit 68 out of every hundred 
on their waiting list. They could select a certain proportion 
of the low grade cases, the pathological types, the imbeciles 
and still have room for a certain number of the higher grade 
cases showing potentialities for training and possible parole. 1939.] 
HOUSE —No. 2400. 
105 
In 1920-24 they could admit but 39 out of every hundred cases 
on the waiting list. Here the choice was becoming more cir- 
cumscribed. In 1925-29 the percentage of the waiting list 
GRAPH 2 
PERCENTAGE OP TOTAL CASES ON THE WAITING LISTS WHICH 
WERE ADMITTED 1915-1938 
that could be admitted dropped to 16 per cent; in 1930-34, 
to 13 per cent; and in 1935-38, to 12 per cent. In these last 
two periods the schools could admit but 13 and 12 out of each 
100 awaiting admission to their institutions. 
(d) Decreasing Intelligence of Admissions, 1915-38. 
In this situation it is evident that the schools were being 
limited in their selection to the most urgent cases, — those of 
lower mental grade and the pathological types. This necessary 
selection of cases from the lower intellectual levels is shown by 
Graph 3, following, which gives the average intelligence quo- 
tients of admissions to the Wrentham State School over the 
period 1915-38. These data were available for Wrentham 
only, but show the trends quite unmistakably. 
With the small waiting list in 1915-19, which permitted 68 
per cent of cases on the waiting list to be admitted, we find an 
average admission intelligence quotient of .53. For this period 
all of the admissions averaged in the moron group. The re- 
markable possibilities of training and discharging individuals in 
this high grade group are evident. In the four following five- 106 
HOUSE— No. 2400. 
[Mar. 
year periods the average intelligence quotients of admissions 
dropped to .49, .45, .44 and .39. In these four periods the 
averages had dropped from the moron to the imbecile group. 
GRAPH 3 
AVERAGE INTELLIGENCE QUOTIENT OF PATIENTS ADMITTED 
TO WRENTHAM STATE SCHOOL, 1915-1938. 
It is noted that the limitations of selection have produced a 
marked lowering of the intellectual status of admissions coming 
to the state schools. 
(e) Decreasing Discharge Rates, 1915-38. 
The effect of this elimination from the admissions of the 
major portion of the higher grade cases, the morons, were as 
might be expected. The less promising cases being admitted 
tended to accumulate within institutions. With few of the 
higher grade cases available to preserve the annual turnover, it 
is found that the discharge rates were seriously interfered with. 
Graph 4, following, pictures the discharge rates for the five 
periods under discussion. 
For the first five-year period, 1915-19, the discharge rate 
was 64 per 1,000 under care. In 1920-24 it rose slightly to 71, 
dropped to 62 in 1925-29, decreased about 50 per cent to a 
rate of 36 in 1930-34, and rose in 1935-38 to 49. A certain 
part of the low discharge rate of 1930-34 is due to the depres- 
sion period. However, this is not responsible for all of this 
drop. Even during the depression we were still able to place 
trained mental defectives on parole, even though the wages 
were somewhat lower than those of previous periods. The fact 1939.] 
HOUSE — No. 2400. 
107 
that people could not pay the usual high salaries for domestic 
or farm help made them search for help that would accept a 
lower salary. . Our state school social service departments re- 
ported that they had little difficulty in placing boys and girls, 
even though they had to accept somewhat lower salaries. In 
connection with the foregoing it should be recalled that the 
average school stay of cases discharged is between five and six 
years. Consequently there is a decided lag in the effect pro- 
duced by the lower grade admissions. Admissions of 1915, 
GRAPH 4 
PATIENTS DISCHARGED FROM STATE SCHOOLS, 1915-1939: 
RATES PER 1,000 UNDER TREATMENT 
for example, were not discharged until about 1920 or 1921. 
The high discharge rates of 1925-29 were due, in part, to the 
comparatively high I. Q. of admissions of the period 1920-24. 
Here there is concrete evidence of what happens when the 
training school ideal is necessarily forgotten in the press of cir- 
cumstances and supplanted by the principle of custodial care. 
It may be observed that during the last two periods the dis- 
charge rates were lowered materially. With fewer individuals 
leaving the state schools one can see that the inevitable accu- 
mulation of more or less permanent residents is already an 
established fact. 
(/) Increasing Overcrowding, 1915-38. 
Now what happens when the pressure for admission con- 
tinues and the discharge rates fall to low levels? The state 108 
HOUSE —No. 2400. 
[Mar. 
schools are faced with waiting lists of thousands of urgent 
applicants, and, at the same time, a decreasing turnover of 
patients to provide vacant beds. It is quite understandable 
that they would make some effort to meet the many demands 
for admission. What happens under these circumstances? 
Graph 5, following, pictures the overcrowding in state schools 
for the years 1915-38. These figures are based on a compari- 
son between actual capacities and the number of patients 
within institutions for each period. 
GRAPH 5 
OVERCROWDING IN STATE SCHOOLS, 1915-1938: PERCENTAGES 
£Mlnus (-)means Munder capacity” 
During the two periods 1915-19 and 1920-24, which show 
little pressure of admissions and high discharge rates, the 
overcrowding remained at low levels. In the later years the 
numbers seeking admission increased enormously (as may be 
noted in Graph 1). In the face of this clamor the schools felt 
obliged to keep the number of admissions up to the numbers 
admitted during previous years, at least. Had it been possible 
to continue discharging the same numbers each year, a certain 
number of vacancies would have been available. However, 
when the lower grade admissions could not be discharged the 
overcrowding mounted accordingly. During the years 1915-25 1939.] 
HOUSE— No. 2400. 
109 
the state schools were actually under capacity. In 1925-29 
the overcrowding was 6 per cent, in 1930-34 it rose to 14 per 
cent, and in 1935-38 to the high of 28 per cent. 
(g) Decreasing Admission Rates, 1915-38. 
How has all of this affected the number of cases coming 
into the state schools? In the face of overcrowding it is obvious 
that the schools must curtail admissions, or, at least, not in- 
crease admissions. Yet they are between two fires. On the 
one hand they face a mounting overcrowding, and, on the other, 
NUMBER OF ADMISSIONS COMPARED WITH BED CAPACITY OF STATE SCHOOLS, 
1915-1938: ADMISSION RATES PER 1,000 BEDS OP CAPACITY 
GRAPH 6 
more insistent demands for admission from their increasing 
waiting fists. However, the physical impossibility of caring 
for larger numbers in the limited space available has finally 
won out, and we see the admission rates decreasing. The 
figures are available in Graph 6, above. 
Comparing the numbers of admissions with the available 
capacity one sees how the admission rates struck a high point 
in 1915-19. In that period 160 children were admitted per 
1,000 beds of capacity. This period showed a small waiting 
fist, the highest average I. Q., a high discharge rate, and no 
overcrowding within state schools. The periods 1925-29, 110 
HOUSE— No. 2400. 
[Mar. 
1930-34 and 1935-38 show lower admission rates, with reduc- 
tions to 106, 109 and 101 admissions per 1,000 beds of capacity. 
These periods showed tremendous waiting lists, with low 
average intelligence of admissions, low discharge rates and 
high percentages of overcrowding. 
We are back at the beginning of the vicious circle. Now the 
schools must begin all over again and be even more careful to 
select only the most urgent cases, — those of the pathological 
types and those of lower mental gradings. Again we are to 
go through the sequence of increasing waiting lists, admission 
of low grade cases, decreasing discharge rates and increasing 
overcrowding. Allowing circumstances to turn the State away 
from the ideal of a training program to the dubious goal of 
permanent custodial care has meant more serious difficulties. 
As a part of a long-range program of decreasing admission 
rates and minimizing future construction programs, the De- 
partment, in 1938, inaugurated the system of boarding in 
private homes certain carefully selected mentally defective 
patients. The number of cases tried to date is small, the trial 
period has been only five months, but the effects have been 
sufficiently encouraging to warrant extension of the program. 
A similar program is being tried in New York State, and has 
been used in the hospitals for the adult insane in this Com- 
monwealth for many years. 
([h) State School Provision in Other States, 1933. 
Lest it be thought that Massachusetts has been too back- 
ward in this matter of institutional provision for its mental 
defectives, a table is being presented which shows the efforts 
made by Massachusetts and other leading States in this direc- 
tion as of the year 1933. In 1929 Massachusetts was second 
in provision for mental defectives in the United States. In 
1933 she had dropped to fifth position (Department of Census 
figures for United States for 1933). Table 1 shows the neigh- 
boring State of New York with a slightly lower residence rate 
than Massachusetts. It should be explained, however, that 
New York has made remarkable strides since 1933 in the 
direction of adding to the bed capacity within state schools; 
for example, in 1935 New York had eleven new buildings under 
construction at Letchworth Village, and other new construc- 
tions in process at four other state schools. Over the same 
years Massachusetts had made little progress. 1939.] 
HOUSE —No. 2400. 
Table 1, — Patients within State Schools for Mental Defectives in the 
Ten Leading States, 1933. 
[Rates per 100,000 population, 1930 census.} 
State. 
Population, 
1930 Census. 
Mental 
Defectives 
within State 
Schools. 
Rate per 
100,000 
Population. 
Delaware ........ 
238,380 
317 
132.98 
Wyoming 
225,565 
285 
126.34 
Iowa ......... 
2,470,939 
2,899 
117.32 
New Hampshire 
465,293 
543 
116.70 
Massachusetts ....... 
4,249.614 
4,771 
112.26 
Idaho 
445,032 
493 
110.77 
North Dakota 
680,845 
730 
107.21 
Maine ........ 
797,423 
796 
99.82 
New York 
12,588,066 
12,359 
98.18 
District of Columbia 
486,869 
465 
95.50 
Note. — In 1929 a similar study showed New Hampshire in 
first position and Massachu- 
setts second. In five years Massachusetts has dropped from second to fifth position. 
(i) Summary. 
The Commonwealth had a consistent plan for the develop- 
ment of the institutional care of mental defectives from 1848. 
This program proved satisfactory until about 1920. The 
post-war period, for some unknown reason, was very rough 
on mental defectives in the community, with the result that 
thousands began to clamor for admission where hundreds had 
come before. The Commonwealth faced a new condition here, 
and one which demanded extraordinary provisions. A new 
school was opened in 1922, but this was not sufficient to cover 
the increasing needs. Dr. George M. Kline, then the Commis- 
sioner, believed that another school was necessary, and in 
1930 requested the sum of $50,000 for the purchase of land for 
a fourth state school. An additional $75,000 for plans, etc., 
was appropriated in 1931. However, the depression economy 
was with us at about that time, and it checked the develop- 
ment of this fourth school before it could get started. 
Now we find that the Commonwealth is definitely behind 
schedule in its institutional provision for the mentally de- 
fective. It is obvious that steps must be taken soon to remedy 
this situation. While attempts have been made to meet 112 
HOUSE —No. 2400. 
[Mar. 
the vastly increasing demands for institutional provision 
for the mentally defective, these efforts were far below the 
requirements of the period under discussion. 
At the present time there are about 5,200 persons within 
our three state schools. These schools are about 31 per cent 
overcrowded (1938), the actual capacity being about 4,000 
beds. This makes the State 1,200 beds short of fulfilling present 
needs, but by refiguring capacities adjusted for children, this 
might be cut down to 664 beds. In addition, there are over 
3.200 cases on the combined waiting lists of the three state 
schools. This fist is kept current, the books being balanced 
each month. New additions to the waiting list are added, and 
withdrawals are subtracted so that the Department has an 
up-to-date figure on its waiting lists for the first of each month. 
This work has been carried on by the Statistical Division for 
the past eight years. Six hundred and sixty-four beds are 
needed to relieve the present overcrowded condition, plus 
3.200 beds for those on the present waiting fists, or a total of 
3.864 new beds required. This means practically doubling 
the present capacity of 4,000 beds, raising it to a new total of 
7.864 beds. Bringing each of the present schools up to 2,000 
beds each would raise the total capacity from 4,000 to 6,000 
beds and take care of the existing overcrowding (600 beds) 
and remove 1,400 cases from the waiting fist. The question 
of providing a fourth state school for the 1,800 cases remain- 
ing on the waiting fist should receive more study. 
However, with a bed capacity of 7,864 beds the Common- 
wealth would be able to bring institutional care of the mental 
defectives to its previous high levels; to pursue a satisfactory 
training program; to return a certain proportion of the moron 
group to the community; and to actually save the State money 
through an active prevention of costly failures on the part of 
untrained mental defectives. The hope of psychiatry is in 
prevention. Giving mental defectives a means of meeting 
fife’s problems is prevention at a high level. 
(j) Recommendations. 
1. Increase the capacity of the present state schools to 
approximately 2,000 beds each. A new school has been given 
some study, but from the sole viewpoint of economy this is 
temporarily postponable. The first step should be to increase 
the capacity of the present schools as noted above. The next 1939.] 
HOUSE — No. 2400. 
113 
step would consist of increasing the size of Templeton Colony 
by adding low construction cost buildings for able-bodied 
patients chronologically beyond the school-training age. Such 
patients would be transferred from the high-cost schools to 
Templeton, permitting admission to the schools of the younger, 
trainable groups on the waiting lists. 
2. Each state school should have a sum added to its annual 
appropriation for the purpose of providing funds for the board- 
ing out, in the community, of selected cases now in residence 
within schools. This would enable certain mental defectives, 
past the training period, but not suitable for parole, to be 
placed in selected homes in the community, at an estimated 
cost of $4 or $5 per week. This cost is far less than the state 
school maintenance costs, which, in 1938, averaged $7.75 per 
week. 
3. It would be advantageous if statutory provision were 
made whereby transfers from the schools to the Department 
were made possible, and in Appendix 10 we have recommended 
legislation to authorize such transfers. 
2. Community Care of the Mentally Defective. 
(a) Introduction. 
In addition to those mental defectives needing institutional 
care there are numerous cases which can be cared for in the 
community if given proper supervision. The mental defec- 
tive presenting a behavior problem in addition to his mental 
deficiency needs the twenty-four hour supervision and training 
of the state school. However, other thousands of mental de- 
fectives do not show these deviations in behavior. They simply 
lack initiative and the judgment necessary to control them- 
selves and their affairs successfully. With a little assistance 
they get along remarkably well in the community. 
(h) Community Supervision as Carried on hy the Division of 
Mental Deficiency. 
When the Division of Mental Deficiency was created in 
1922, Dr. Walter E. Fernald advised the Commissioner, Dr. 
Kline, that, in addition to the maintenance of the central 
registry and supervision of school clinics, the Division should 
make plans for carrying out a program of community super- 
vision of mental defectives. Beginning with two social workers 114 
HOUSE —No. 2400. 
[Mar. 
the Division exercised supervision over cases referred or com- 
mitted to it, with the thought of keeping these mentally defec- 
tive persons in the community and rendering unnecessary 
their admission to one of our state schools. Various social 
agencies and other state agencies have referred cases to the 
Division for action. 
After acceptance, the social workers find positions for these 
persons, keeping in constant touch with employers and the 
homes involved. If one position or wage home proves unsatis- 
factory, another is provided. Advice is given to many parents 
of the younger children, and active supervision is exercised over 
those in the older ages or from sixteen years up. During the 
fifteen years the Division has been operating, several hundred 
mental defectives have been assisted to an adjustment in the 
community, and thus admission to a state school rendered 
unnecessary. 
Some of the research work in mental deficiency in reference 
to state school discharges has shown that the average case 
coming into a state school costs the Commonwealth between 
$2,000 and $2,600 before his discharge or death. If the Divi- 
sion has succeeded in keeping only 500 cases out of institutions, 
the Commonwealth has saved an expenditure of over a million 
dollars. The cost of the three social workers over this fifteen- 
year period has amounted to about $67,500 in salary. Basing 
the comparisons on this minimum number of 500 cases, we 
see that community supervision has amounted to only about 
6 per cent of the cost of state school care. 
Now one might ask, what are the needs for community super- 
vision throughout the State? To answer this it will be neces- 
sary to review present knowledge of the extent of mental 
deficiency throughout our population. When the Division of 
Mental Deficiency was started, in 1922, a part of the planned 
work was the maintenance of a central registry for mental 
defectives. Dr. Fernald expressed the opinion that the State 
must first learn of the extent of the problem of mental de- 
ficiency before it could intelligently plan a program. The 
first cases reported to the central registry came from the 
fifteen traveling school clinics. Over the later years, however, 
this has been organized a little more extensively, and now the 
Division receives monthly reports from all institutions, giving 
(c) Present Need for Community Supervision. 1939.] 
HOUSE — No. 2400. 
115 
names and descriptive data on new cases of mental deficiency 
contacted during the month. These sources are as follows: 
(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 ex- 
aminations 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) de- 
fective delinquents admitted to Bridgewater; (13) mentally 
defective prisoners examined under section 100A, chapter 123; 
(14) cases referred to the Division of Mental Deficiency; (15) 
cases examined by the Division of Mental Hygiene; and (16) 
children examined by the psychological clinic of the Spring- 
field schools. During last year, for example, there were 2,313 
new cases of mental deficiency reported through the school 
clinics and an additional 2,744 from other sources. Here is a 
total of 5,057 new cases of mental deficiency being reported to 
the Department each year. Out of these 5,057 only about 
400 are admitted to our state schools. It is apparent that 
there are about 4,600 mental defectives coming to the atten- 
tion of the Department each year, who are remaining in the 
community. It is estimated that there are now a total of over 
60,000 cases so registered. These figures give some idea of the 
extent of the problem in Massachusetts. 
Many of these children are being cared for by the educa- 
tional system through special classes, and other thousands are 
being cared for at home. Many will never need to come to a 
state school, and others will adjust in the community without 
supervision. However, in this number of over 5,000 coming 
to the attention of the Department each year there are many 
whose general behavior and conduct is such that they will 
require state school care later if not given a helping hand in 
the younger years. It has been the experience of the Depart- 
ment that mentally retarded children do very well as long as 
they are under the supervision of the special classes in the 
public schools. When these children leave the schools, how- 
ever, and there is no definite plan for keeping them busy, their 
troubles begin. Without training for any particular kind of 
work they drift into the easiest thing at hand. They are 
frequently made use of by persons not unwilling to take ad- 
vantage of their intellectual shortcomings. There is a distinct 
need for the supervision of all children leaving special classes. 116 
HOUSE —No. 2400. 
[Mar. 
For two or three years these children need a guiding hand to 
help them in securing work and to aid them in their general 
adjustment. 
It is not certain, as some extremists allege, that the mental 
defective is a “menace to civilization.” Basically the mental 
defective wants to do the right thing as much as any one else. 
However, he lacks the intelligence and judgment to know 
when questionable propositions are being put up to him. 
Consequently, he often gets involved in doubtful activities 
without knowing what it is all about. The mental defective 
wants to be like other people and to do his part. If he is given 
half a chance in this direction he will turn out to be a steady, 
reliable worker and a self-supporting citizen. Without this 
helping hand his potentialities for difficulties and possible 
failure are decidedly above the average. 
(d) Plan for Enlarging the Present Facilities for Community 
Supervision. 
Present needs require a comprehensive community super- 
vision plan to study every case reported to the central registry 
or on waiting lists to state schools. Experience with cases 
under supervision of the Department has shown that remark- 
able community adjustments are possible with cases that are 
marked for admission to a state school. 
The Commonwealth should consider it vitally important to 
guide these cases away from the paths that lead to maladjust- 
ment and eventually the state school. Concentrating upon 
state school provision alone has been tried, with the results 
as outlined in Graph 1. Now it becomes necessary to go back 
of this state school plan and reach these mental defectives 
before they develop the characteristics which place them on 
the waiting lists. 
In this community supervision the Division of Mental De- 
ficiency has been confined to an advisory capacity for children 
who are cared for at home by their parents or to the supervi- 
sion of older cases who are able to earn their own living. There 
have been many instances in which the Division has wished to 
place certain cases in boarding homes. 
There are many younger children or children with physical 
infirmities who are without parents or relatives and yet who 
need understanding home care. If the Division had funds 1939.] 
HOUSE— No. 2400. 
117 
available, it could arrange for temporary boarding homes at a 
rate of $4 or $5 per week, and thus keep these children in the 
community. 
Ordinarily, cases of this sort are placed on the waiting list 
and marked as urgent. In reality the financial difficulty is the 
only factor making the case urgent. Their conduct does not 
warrant institutional care. They could be cared for in the 
community if some means were available for paying for their 
maintenance. 
GRAPH 7 
RESIDENCE OF APPLICANTS ON WAITING LISTS OP STATE 
SCHOOLS, NOVEMBER, 1936: RATES PER 100,000 
ESTIMATED POPULATION OF SAME COUNTY 
WAITING LISTS 
Pat/£nts per _ 
/OO,OOO POPULAT/ON 
75* 
Bapnjtable 
surroLK 
M/ODLESEX 
50-74 
IVOPCEST£P . . _ _ . 
£*js£K MASSACHUSETTS 
bp/stol ,rMt ,utur, 
PL rMOUTH 
DUKE'S 
25-43 
(NOPEOLK 
PPANKL/N 
NANTUCKET 
ZO-24 
'HAMPDEN 
BEPKSH/PE 
HAMPSHIRE 
For the first time in the history of the Commonwealth, the 
proposal for boarding out of mental defectives in the Depart- 
ment was inaugurated in 1938, when the Legislature appropri- 
ated a sum for this purpose. However, the statutory right of 
the Department to continue this worthy program was over- 
looked in the reorganization bill (chapter 486 of the Acts of 
1938). The Commission recommends the re-establishment of 
this power to the Department, and appends suggested legisla- 
tion to that end (see Appendix 10). 118 
HOUSE —No. 2400. 
[Mar. 
It should be remembered, of course, that this boarding out 
plan will not eradicate the waiting lists nor necessarily obviate 
a certain amount of enlargement of the state schools. 
Mental defectives fall into many classes in reference to in- 
telligence, personality, conduct, physique, health, etc., much 
in the same manner as the general population. Mental defect- 
ives with certain combinations of characteristics need state 
school training, and cannot get along in the community satis- 
factorily without it. There are others, however, who can get 
along in the community if a good home and understanding 
care are provided. It is suggested that the State make an 
effort to take certain suitable children without financial re- 
sources out of the schools and put them in the community at 
a lower cost than that of institutional provision. 
As we view the larger problem of mental deficiency through- 
out the State, it is obvious that other sections as well as Boston 
need the service now being provided by the Division of Mental 
Deficiency. Graph 7, on page 117, shows the geographic distri- 
bution of cases on the waiting list. Middlesex, Suffolk and 
Barnstable are high in rates for cases on the waiting lists. The 
eastern half of the State would need, therefore, larger numbers 
of supervising social workers. 
It is suggested that, when possible, the work of the Division 
of Mental Deficiency be extended to include different sections 
of the State. Additional social workers could contact all wait- 
ing list cases, problem cases reported to the central registry, 
behavior problems in special classes, and all children leaving 
special classes. They could act chiefly in an advisory capacity 
to parents or relatives in reference to the home care and treat- 
ment of children being brought to our attention. Every 
effort would be made by these social workers to keep these 
children in the community rather than admitting them to a 
state school. If their characteristics permit it, positions 
would be obtained for them and boarding homes arranged. 
The following table gives the list of cities and towns in Massa- 
chusetts and the number of children on the waiting list of our 
three state schools coming from each of these localities. This 
geographic distribution of cases gives a suggestion of the num- 
ber of workers required for the supervision of this group. 1939. 
HOUSE — No. 2400. 
119 
Table 2. — Cases on the Waiting List of the Three State Schools on 
November 30, 1936, by County and City or Town of Residence. 
[Taken from Department’s 1937 Report.! 
County and 
City or Town 
Num- 
ber. 
County and 
City or Town 
Num- 
ber. 
County and 
City or Town 
Num- 
ber. 
of Residence. 
of Residence. 
of Residence. 
Barnstable . 
46 
Marblehead . 
4 
Concord 
4 
10 
Merrimac 
4 
Dracut . 
1 
Barnstable 
Methuen . 
17 
Everett . 
36 
Bourne . 
2 
Middleton 
1 
Framingham . 
19 
Brewster . 
2 
Nahant . 
2 
Holliston 
1 
Chatham 
1 
Newbury 
1 
Hopkinton 
2 
Dennis 
i 
10 
Newburyport 
24 
Hudson 
13 
Falmouth 
North Andover 
1 
Lexington 
6 
Mashpee . 
2 
Peabody^ 
15 
Lincoln . 
1 
Orleans . 
2 
5 
Littleton 
3 
Provincetown . 
8 
3 
Lowell 
61 
Yarmouth 
2 
Salem 
33 
Malden . 
44 
18 
Saugus . 
13 
Marlborough . 
10 
Berkshire 
Swampscott . 
3 
Maynard 
7 
Adams 
Cheshire . 
Great Barrington . 
4 
1 
1 
Topsfield 
Franklin 
1 
20 
Medford 
Melrose . 
Natick . 
48 
11 
12 
35 
Lenox 
1 
Buckland 
2 
North Reading 
1 
Otis .... 
1 
1 Charlemont . 
1 
Peppered 
3 
Pittsfield 
5 
1 
j Conway 
2 
Reading 
12 
Stockbridge 
! Deerfield 
1 
2 
Washington 
i 
i Gill 
1 
60 
Williamstown . . . 
2 
Greenfield 
2 
Stoneham 
7 
Windsor . 
1 
Heath 
2 
Tewksbury . 
84 
216 
Montague 
4 
Townsend 
5 
Bristol . 
| North field 
2 
Wakefield 
18 
Acushnet 
Attleboro 
Berkley . 
Dartmouth 
Dighton . 
Easton 
Fairhaven 
Fall River 
1 
16 
2 
4 
1 
4 
10 
57 
j Orange . 
j Wendell . 
Hampden 
Agawam 
Chester . 
Chicopee 
Granville 
2 
1 
50 
1 
2 
10 
1 
Waltham 
Watertown 
Way land 
W'estford 
Weston . 
Wilmington . 
Winchester 
Woburn . 
26 
23 
2 
4 
1 
6 
17 
21 
Freetown 
1 
Holyoke 
7 
Nantucket . 
1 
Mansfield 
12 
Ludlow . 
1 
New Bedford . 
75 
Monson . 
1 
Nantucket 
North Attleborough 
8 
Palmer . 
3 
Norton . 
Rehoboth 
1 
3 
Springfield 
Westfield 
T1 
5 
Norfolk 
153 
Seekonk . 
Somerset 
1 
2 
West Springfield . 
2 
Bellingham . 
2 
4 
Taunton . 
14 
Hampshire . 
9 
12 
Westport . 
4 
1 
Canton 
4 
Dukes 
3 
! Belchertown . 
1 
1 
Cohasset 
Dedham 
2 
6 
Gosnold . 
1 
j Easthampton 
1 
Foxborough . 
3 
Oak Bluffs 
2 
i Granby . 
3 
Franklin 
4 
Essex 
363 
; Northampton 
\ Ware 
1 
1 
Holbrook 
Medfield 
Medway 
1 
2 
2 
Amesbury 
15 
! Middlesex . 
782 
Millis 
2 
Andover . 
13 
Milton 
13 
Beverly , 
10 
i Acton 
4 
Needham 
6 
Danvers . 
10 
| Arlington 
16 
Norfolk . 
2 
Essex 
1 
Ashby . 
1 
Norwood 
9 
Georgetown 
1 
Ashland 
1 
Plainfield 
1 
Gloucester 
18 
Ayer 
2 
Quincy . 
35 
Groveland 
1 
Bedford . 
1 
Randolph 
5 
Hamilton 
1 
Belmont 
17 
Sharon . 
8 
Haverhill 
35 
, Billerica 
4 
Stoughton 
10 
Ipswich 
6 
Boxborough . 
2 
W'alpole . 
Wellesley 
5 
Lawrence 
55 
Burlington 
2 
3 
Lynn 
68 
i Cambridge 
no 
Westwood 
3 
Lynnfield 
1 
| Carlisle . 
4 
Weymouth 
8 
Manchester 
1 
1 Chelmsford . 
12 
Wrentham 
1 120 
HOUSE —No. 2400. 
[Mar. 
Table 2. — Cases on the Waiting List of the Three State Schools on 
November SO, 1936, by County and City or Town of Residence — Con. 
County and 
City or Town 
Num- 
ber. 
County and 
City or Town 
Num- 
ber. 
County and 
Num- 
of Residence. 
of Residence. 
of Residence. 
ber. 
Plymouth 
87 
Revere . 
33 
Northbridge . 
4 
2 
Winthrop 
17 
North Brookfield . 
1 
Bridgewater 
Brockton 
16 
28 
Worcester . 
325 
Oxford 
Phillipston 
1 
1 
1 
2 
Shrewsbury 
2 
Ashburnham . 
2 
Southborough 
2 
1 
5 
Athol 
5 
Spencer , 
1 
Hingham 
Hiill 
Auburn . 
3 
Sterling . 
3 
1 
2 
Blackstone 
1 
Sutton 
2 
Kingston 
Bolton 
1 
Templeton 
2 
Boylston 
5 
Upton 
3 
Middleborough 
5 
1 
Brookfield 
Clinton . 
1 
4 
Uxbridge 
Warren . 
1 
1 
Plymouth 
Fitchburg 
45 
Webster . 
7 
Gardner. 
2 
Westborough . 
10 
6 
Grafton . 
3 
West Boylston 
5 
Harvard. 
4 
Winchendon . 
3 
West Bridgewater 
Whitman 
1 
5 
Holden . 
Hopedale 
1 
2 
Worcester 
157 
Lancaster 
1 
Non-residents 
— 
Suffolk 
930 
Leicester 
Leominster 
2 
20 
Unknown 
288 
Boston 
834 
Milford 
12 
Chelsea . 
46 
Millbury 
5 
Grand total 
3,291 
The Division of Mental Deficiency is not supervising these 
cases on the waiting list. To do this six social workers would 
be needed in the Division, such workers to be located as fol- 
lows: one worker in Worcester to care for the 422 cases on the 
waiting list in Berkshire, Hampden, Hampshire, Franklin and 
Worcester counties; two workers to supervise the 1,145 cases 
on the waiting list of Middlesex and Essex counties, one worker 
to be located in Cambridge and the other in Lynn or Lawrence; 
two workers in Boston to supervise the 930 cases on the waiting 
list for Suffolk County; one worker in Taunton to supervise 
the 502 cases from Norfolk, Bristol, Plymouth and Barnstable 
counties. It is understood, of course, that these six workers 
can only lay the groundwork of this new activity. However, 
it is felt that, from the beginning, these six workers would pay 
their own salaries over many times in the prevention of admis- 
sions to our state schools. 
The work at first would be frankly advisory. The Division 
would feel its way cautiously until it could determine the lines 
along which the work should be developed. The big point of 
this program, of course, would be that of offering advice to 
families in reference to home training, etc. Adequate home 1939.] 
HOUSE — No. 2400. 
121 
training and supervision would do much to keep the mental 
defective in the community. The point would be to save the 
institutions for the most serious cases, or those in which no 
family, relative or financial aid is available. This is preventive 
work of a high order. Here we have the means of prevention 
of maladjustment in the individual, and, at the same time, the 
prevention of future expense to the State. 
The age of children coming into the state schools or appear- 
ing on the waiting lists points out the fact that constructive 
work with the mental defectives must be started at an early 
age; for example, the admission ages of cases coming to the 
three state schools during 1936 show that 9 per cent were under 
five years of age (Table 3): 
Table 3. — Ages of First Admissions to State Schools, 1936. 
(Rates per 100,000 of same ages in Massachusetts population, 1930 census.) 
Age Groups. 
First Admissions. 
Accumulative 
Percentages. 
Number. 
Percentages. 
Under 5 years 
39 
9.11 
9.11 
5-9 years 
122 
28,50 
37.61 
10-14 years 
138 
32.24 
69.85 
15-19 years 
92 
21.49 
91.34 
20-24 years 
23 
5.37 
96.71 
25-29 years 
7 
1.63 
98.34 
30 years plus 
7 
1.63 
99.97 
Total 
428 
99.97 
- 
Approximately 28 per cent were placed in the 5 to 9 year 
group, about 32 per cent in the ages 10 to 14 years, and more 
than 21 per cent in the ages 15 to 19 years. More than 37 per 
cent were 9 years or younger, and nearly 70 per cent, 14 years 
or younger. Here is seen the necessity of attacking the problem 
of mental deficiency in the younger and formative years. These 
children are coming into the state schools at such compara- 
tively early ages that constructive community work will have 
to be done much earlier than has been anticipated. The State 
should not wait until the ages of 15 to 20 years before doing 
anything for the mentally defective. Then it is too late. 122 
HOUSE— No. 2400. 
[Mar. 
The waiting lists show a somewhat similar situation (Table 4); 
Table 4. — Age at Time of Placement on Waiting List — Cases listed 
on November 30, 1936. 
Age Groups. 
Number. 
Percentage 
Distribution. 
Accumulative 
Percentages. 
0-4 years 
397 
12.66 
12.66 
5-9 years 
853 
27.20 
39.86 
10-14 years ’ . 
909 
28.99 
68.85 
15-19 years 
607 
19.36 
88.21 
20-24 years 
183 
5.83 
94.04 
25-29 years 
79 
2.51 
96.55 
30-34 years ...... 
52 
1.65 
98.20 
35-39 years 
22 
.70 
98.90 
40-44 years 
17 
.54 
99.44 
45-49 years 
7 
.22 
99.66 
50 years plus , 
9 
.28 
99.94 
Unknown 
156 
- 
- 
Total 
3,291 
100.0 
- 
Average age 
12.7 
- 
- 
Note. — Averages and percentages computed minus the "unknown.” 
More than 12 per cent were under 5 years of age when 
admission was first sought, nearly 40 per cent were 9 years or 
younger, and more than 68 per cent were 14 years or under. 
The waiting lists also are made up of a goodly proportion of 
cases in the younger ages. 
The point is clear. Work on mental defect in the com- 
munity must be done at a very early age if the State hopes to 
keep these cases out of the state schools. Conduct and behavior 
patterns are well set by the age of 12 or 15 years. The State 
should be on the scene before lack of parental understanding or 
home care, lack of occupation or training suited to his mental 
age, and, in some cases, actual mistreatment, have made the 
harmless mental defective into a defective delinquent. 
(e) Departmental Research in Mental Deficiency — Need of 
Increase in Personnel. 
The Division has had an active interest in research and has 
had one worker devoting full time to this activity. The records 1939.] 
HOUSE —No. 2400. 
123 
of the school clinic examinations of retarded children in the 
public schools provide the basic material for this project. 
Data are recorded on a specially coded card from the school 
clinic records in the various institutions. This worker spends 
part of her time within institutions coding this material directly 
on the card, and the remainder in the preparation of tables 
and material for publication. Over the past few years many 
articles have been published contributing to the general knowl- 
edge of the subject of mental deficiency. It has been suggested 
that two additional workers be added to this project. One 
worker working full time can code about 4,000 records per year. 
School clinics are reporting at the present time over 8,000 
cases each year. The addition of two wmrkers would enable 
the Department to keep this work caught up, and have one 
worker devote full time to preparation of tables, statistical 
analyses, bibliographies, etc. School clinic examinations now 
total over 114,000, and this material is of such unusual interest 
that Massachusetts should be publishing several articles each 
year based on this subject matter. 
(/) Research within State Schools. 
Each one of the state schools has a remarkable opportunity 
for study of mental defectives under its care. The Wrentham 
State School is the only school now equipped for research. 
They have a special research building with equipment and 
personnel. This has been opened but recently. A research 
building, equipment and personnel should be made available 
to both the W. E. Fernald and the Belchertown State Schools. 
Both of these schools should be given the opportunity of for- 
warding research work. In this connection a special point 
should be made of seeing that adequate personnel is added 
for research activities. The present medical staffs are loaded 
to capacity with the usual work and cannot be expected to 
turn out extra work. Investigations that tell us anything new 
about mental defectives are a step in the direction of preven- 
tion and possible eradication of this condition. Money spent 
in this direction will bear heavy dividends in later years. 
(g) Recommendations. 
1. Initiate a state-wide plan for the community supervision 
of mental defectives, increasing the present number of social 
workers in the Division of Mental Deficiency. This group 124 
HOUSE —No. 2400. 
[Mar. 
would lay the groundwork for study and supervision of chil- 
dren on the waiting lists of state schools, individual problem 
cases met with in special classes, children leaving special classes, 
and special problems referred to the central registry. 
2. The purpose would be to advise parents of younger 
mental defectives in reference to home care and training; to 
co-operate with city, town and school officials and social agencies 
in reference to placement and training of older defectives; and 
to secure jobs and supervise homes and recreation of the still 
older defectives. The whole plan would be built around the 
thought of (1) keeping the mental defective in the community, 
and (2) providing supervision, assistance and industrial guid- 
ance to prevent maladjustment and future difficulties on the 
part of this group. 
3. Add permissive legislation and funds to the Department 
for the purpose of boarding out certain mental defectives. 
This would permit boarding home care for certain younger or 
physically handicapped mental defectives who could be kept in 
the community, but who lack parents, relatives or financial 
support. Inaugurate boarding out care in connection with 
each of the schools. 
4. Increase the research workers in the Division of Mental 
Deficiency to assist in the analysis and publication of the vast 
amount of data available through the 114,000 completed school 
clinic examinations. This tremendous number of examinations 
of retarded school children offers information not available in 
any other place in the world. Massachusetts should take ad- 
vantage of this unparalleled opportunity to learn more about 
these mental defectives who are remaining in the community. 1939.] 
HOUSE— No. 2400. 
125 
Appendix 7. 
PROBLEM OF PSYCHOTIC CHILDREN. 
As in any other branch of modern medicine the problem of 
psychotic children should be studied, first, from the standpoint 
of diagnosis; second, from the standpoint of prevention; and 
third, from the standpoint of treatment. Thinking in terms of 
identification and treatment at the earliest possible moment, 
the great value of the habit clinics and the child guidance clinics 
can readily be seen. These clinics have already been tried in 
the community. Elsewhere in this report, namely, in the sec- 
tion dealing with mentally deficient individuals and that sec- 
tion dealing with mental hygiene, there will be found detailed 
comments regarding these two types of clinics. 
Generally speaking, the habit clinics care for children from 
two years of age until six years of age, and the child guidance 
clinics from six to fourteen years of age. Briefly, these clinics 
are composed of a psychiatrist, a psychologist to provide men- 
tal measurement, and a psychiatric social worker to provide the 
social histories and such environmental factors as have to do 
with the case at hand, and to assist in carrying on treatments. 
The aim of these clinics is to detect mental aberrations in 
children during their early stages. By correction of these 
difficulties it is hoped to ultimately decrease the admission of 
adult psychotics to the mental hospitals; also to eliminate as 
far as possible psychoses in children. 
Some of these children respond readily to treatment and do 
not require further care. This is prevention of the best sort. 
Still other children do require continued treatment. At the 
present time they have only the alternative of going to the 
usual large public adult mental hospital, or of staying at home 
under the care of a private physician, which many times is 
unsatisfactory and expensive, or finally of going to a private 
hospital, which, too frequently, is beyond the economic resources 
of the family. Some of these children find their psychosis 
complicated by mental deficiency, and these children ultimately 
are committed to the various schools for mental defectives. 126 
HOUSE —No. 2400. 
[Mar. 
The general and humanitarian problems arising out of the inter- 
mingling of psychotic children with psychotic adults are obvious. 
The psychotic children are the losers as a result of such intermin- 
gling. Likewise, the effect of intermingling psychotic children 
who are mentally deficient with similar children who are not 
psychotic is very disturbing to the school for the mentally 
deficient, and is not conducive to proper care for either group. 
Over a period of years there has been an average of approxi- 
mately fifty psychotic children under the age of sixteen who 
have been cared for in the state hospitals for adult psychotics. 
A breakdown of this figure is found in the following table, 
which was made up as of September 30, 1937. There has been 
Total Cases, aged 0 to 16 Years, on the Books of State Mental Hospitals, 
Psychotic Epileptics at Monson, and Psychotic Cases at the Three 
State Schools, on September 30, 1937. 
Age Groups. 
Grand 
Total. 
Total 
State 
Hospitals 
Only. 
Monson 
State 
Hospital 
(Psychotic 
Epileptics 
Only). 
The Three 
State 
Schools 
(Psychotic 
Cases 
Only). 
M. 
F. 
T. 
M. 
F. 
T. 
M. 
F. 
T. 
M. 
F. 
T. 
16 years 
26 
17 
43 
18 
13 
31 
7 
3 
10. 
1 
1 
2 
15 years ..... 
21 
14 
35 
12 
9 
21 
3 
2 
5 
6 
3 
9 
14 years 
4 
12 
16 
1 
4 
5 
1 
3 
4 
2 
5 
7 
13 years 
9 
12 
21 
2 
7 
9 
2 
3 
5 
5 
2 
7 
12 years 
4 
5 
9 
3 
3 
6 
1 
2 
3 
- 
- 
- 
11 years 
5 
5 
10 
1 
1 
2 
1 
2 
3 
3 
2 
5 
10 years 
3 
2 
5 
- 
2 
2 
2 
- 
2 
1 
- 
1 
9 years 
5 
1 
6 
1 
- 
1 
2 
- 
2 
2 
1 
3 
8 years 
1 
4 
5 
- 
- 
- 
- 
2 
2 
1 
2 
3 
7 years ..... 
2 
- 
2 
1 
- 
1 
- 
- 
- 
1 
- 
1 
6 years 
2 
1 
3 
- 
- 
- 
2 
1 
3 
- 
- 
- 
5 years ..... 
4 years 
3 years 
2 years 
1 year 
Under 1 year .... 
1 
- 
1 
- 
- 
- 
1 
- 
1 
- 
- 
- 
Total 
83 
73 
156 
39 
39 
78 
22 
18 
40 
22 
16 
38 1939.] 
HOUSE — No. 2400. 
127 
very little variation from year to year. There are approxi- 
mately seventy-five children with varying degrees of psychotic 
manifestations in the schools for the mentally deficient and 
in the epileptic hospital. 
The Commission has taken occasion to study the methods 
by which psychotic children are cared for in certain sister 
States, and has visited certain institutions in this regard. We 
are convinced it is most important to segregate such children 
from psychotic adults and from the non-psychotic mental 
deficients. Purely aside from the dangers and improprieties 
of intermingling, it is reasonable to expect that concentrated 
medical service on a group of these children in a given unit 
would be conducive to far better medical treatment and results. 
Such a program has already been inaugurated in New York 
and Pennsylvania. Also, aside from the immediate medical 
care which would result from concentration of these children 
in a given unit, is the long-range advantage which would be 
gained by studying these children in groups during their pro- 
longed hospital stay. This would open up a new branch of 
research to Massachusetts which undoubtedly would show 
good returns over a period of years. 
One must not forget that children continue to be children 
even when psychotic, and the normal age traits are present. 
They respond to training better than adults do because their 
children’s habits are not so well established. Training has a 
larger place in the care of psychotic children than in the care 
of psychotic adults. Reports from the States where such 
treatment is now being carried on indicate that the treat- 
ment of the psychotic child can be carried on quite successfully, 
not only in the matter of treatment concerned, but also in the 
continuation of education. Other States have found it advisable 
to have a hospital for psychotic children as a separate unit, 
distinctly separated from any section dealing with psychotic 
adults or with non-psychotic children. 
The Commission feels that the Commonwealth has made a 
good beginning for providing facilities for the identification of 
psychotic children in the community. These facilities should 
be augmented from time to time, as definite needs are demon- 
strated and finances will permit. 
We feel, however, that the frankly psychotic child has not 
been given the care and treatment it should receive. Cogni- 
zance has been taken of this fact by the Department and the 128 
HOUSE —No. 2400. 
[Mar. 
hospitals for several years, as well as by many social and civic 
organizations, including the Massachusetts Child Council, the 
Massachusetts Council for Social Agencies, and the Massachu- 
setts Society for Mental Hygiene. 
As a means of relieving the problems of psychotic children, 
we recommend the construction of a modem and complete 
new unit of approximately 100-bed capacity to be erected in 
conjunction with and on the grounds of one of the existing 
state hospitals. The Commission has thought of the grounds 
of the Metropolitan State Hospital as a logical site. We believe 
that this proposal is relatively urgent. 1939.] 
HOUSE —No. 2400. 
129 
Appendix 8. 
PROBLEMS OF EDUCATION, PREVENTION 
AND RESEARCH. 
A. INTRODUCTION. 
The question of just how prevalent mental disorder is in the 
State of Massachusetts is a very difficult question to answer, 
as there are available no reliable statistics concerning the non- 
hospitalized mentally ill. Reliable data, however, are available 
concerning the hospitalized patients in the State. The follow- 
ing table gives the census of patients in the various hospitals 
as of January 1, 1939: 
Patients. 
State hospitals (12) 20,314 
Hospital for epileptics 1,451 
Schools for feeble-minded (3) 5,279 
Mental wards, Tewksbury 464 
Bridgewater State Hospital 888 
Veterans’ facilities (2) 1,863 
Private hospitals and schools 623 
Total 30,882 
Recently a professor of medicine at Johns Hopkins stated 
that approximately a third of his patients who consulted him 
for what they supposed were physical diseases were in reality 
suffering from neuroses. This estimate, perhaps, may be 
applied in general to the relative incidence of neuroses in the 
practice of the average general practitioner. As has been em- 
phasized, however, no more than a guess can be offered as to 
the true incidence of the so-called neuroses. 
It should be noted that the hospitalization of mental patients 
has been increasing at a greater rate than can be accounted for 
by the increase in the general population. The average in- 
crease of state hospital patients for which the State has had to 
furnish additional accommodations from 1904 to 1937, inclu- 
sive, has been 416 patients per year. 130 
HOUSE —No. 2400 
[Mar 
Year. 
Total. 
State Hospitals. 2 
State Schools. 
Governmental and Private Institutions. 
MENTAL DISORDERS.3 
MENTALLY DEFECTIVE. 
Num- 
ber. 
Annual 
Increase. 
Rate per 
100,000. 
Num- 
ber. 
Annual 
Increase. 
Rate per 
100,000. 
Num- 
ber. 
Annual 
Increase. 
Rate per 
100,000. 
Num- 
ber. 
Annual 
Increase. 
Rate per 
100,000. 
Num- 
ber. 
Annual 
Increase. 
Rate per 
100,000. 
1904 
10,948 
858 
361.3 
9,666 
897 
319.0 
847 
47 
28.0 
256 
-70 
8.4 
179 
-16 
5.9 
1905 
11,536 
588 
373.9 
10,071 
405 
326,4 
1,028 
181 
33.3 
260 
4 
8.4 
177 
-2 
5.7 
1906 
11,805 
269 
375.7 
10,237 
166 
325.8 
1,120 
92 
35.6 
277 
17 
8.8 
171 
-6 
5.4 
1907 
12,302 
497 
384.7 
10,602 
365 
331.5 
1,228 
108 
38.4 
307 
30 
9.6 
165 
-6 
5.2 
1908 
13,277 
975 
408.0 
11,460 
858 
352,2 
1,332 
104 
40.9 
325 
18 
10.0 
160 
-5 
4.9 
1909 
13,943 
666 
421.2 
11,994 
534 
362.3 
1,443 
111 
43.6 
339 
14 
10.2 
167 
7 
5.0 
1910 
14,646 
703 
435.1 
12,562 
568 
373.2 
1,567 
124 
46.5 
336 
-3 
10.0 
181 
14 
5.4 
1911 
15,129 
483 
443.0 
12,972 
410 
379.9 
1,642 
75 
48.0 
341 
5 
10.0 
174 
-7 
5.1 
1912 
15,850 
721 
457.6 
13,481 
509 
389.2 
1,845 
203 
53.3 
362 
21 
10.5 
162 
-12 
4.7 
1913 
16,312 
462 
464.5 
13,862 
381 
394.7 
1,922 
77 
54.7 
366 
4 
10.4 
162 
- 
4.6 
1914 
16,820 
508 
472.4 
14,202 
340 
398.9 
2,194 
272 
61.6 
357 
-9 
10.0 
67 
-95 
1.9 
1915 
17,395 
575 
482.0 
14,657 
455 
406.1 
2,309 
115 
64.0 
367 
10 
10.2 
62 
-5 
1.7 
1916 
18,069 
674 
494.0 
15,054 
397 
411 5 
2,582 
273 
70.6 
373 
6 
10.2 
60 
-2 
1.6 
1917 
18,612 
543 
502.1 
15,434 
380 
416.4 
2,673 
91 
72.1 
446 
73 
12.0 
59 
-1 
1.6 
1918 
18,951 
339 
504.7 
15,476 
42 
412.1 
2,763 
90 
73.6 
491 
45 
13.1 
221 
162 
5.9 
Total Patients within All Public, Private and Governmental Institutions, September 30, 1904-37. 
[Rates per 100,000 estimated state population, and annual increase.'] 1939.] 
HOUSE —No. 2400. 
131 
1919 . 
18,811 
—1404 
494.5 
15,409 
-67 
405.1 
2,739 
-24 
72.0 
452 
-39 
11.9 
211 
-10 
5.5 
1920 . 
19,177 
366 
497.8 
15,686 
277 
407.2 
2,820 
81 
73.2 
453 
1 
11.8 
218 
7 
5.7 
1921 . 
20,041 
864 
514.9 
16,428 
742 
422 1 
2,941 
121 
75.6 
485 
32 
12.5 
187 
-31 
4.8 
1922 . 
20,271 
230 
515.6 
16,810 
382 
427.5 
2,849 
-92 
72.5 
443 
-42 
11.3 
169 
-18 
4.3 
1923 . 
20,916 
645 
526.6 
17,051 
241 
429,3 
3,239 
390 
81.6 
452 
9 
11.4 
174 
5 
4.4 
1924 . 
21,940 
1,024 
547.0 
17,515 
464 
436.6 
3,460 
221 
86.3 
787 
335 
19.6 
178 
4 
4.4 
1925 . 
22,645 
705 
559.0 
17,990 
475 
444.1 
3,593 
133 
88.7 
895 
108 
22.1 
167 
-11 
4.1 
1926 . 
22,876 
231 
559.2 
18,149 
159 
443.7 
3,660 
67 
89.4 
890 
-5 
21.8 
177 
10 
4.3 
1927 . 
23,492 
616 
568.8 
18,597 
448 
450.2 
3,787 
127 
91.7 
914 
24 
22.1 
194 
17 
4.7 
1928 . 
24,362 
870 
584.2 
18,997 
400 
455.6 
3,912 
125 
93.8 
1,267 
363 
30.4 
186 
-8 
4.5 
1929 . 
24,877 
515 
590.9 
19,391 
394 
460.6 
3,941 
29 
93.6 
1,322 
55 
31.4 
223 
37 
5.3 
1930 . 
25,675 
798 
604.2 
19,848 
457 
467.1 
4,159 
218 
97.8 
1,468 
146 
34,5 
200 
-23 
4.7 
1931 . 
26,646 
971 
621.2 
20,446 
598 
476.7 
4,412 
253 
102.8 
1,603 
135 
37.4 
185 
-15 
4.3 
1932 . 
27,179 
533 
627.8 
20,856 
410 
481.8 
4,566 
154 
105.4 
1,568 
-35 
36.2 
189 
4 
4.4 
1933 . 
27,893 
714 
638.5 
21,218 
362 
485.7 
4,771 
205 
109.2 
1,719 
151 
39.3 
185 
-4 
4.2 
1934 . 
28,532 
639 
647.2 
21,579 
361 
489.5 
4,933 
162 
111.9 
1,831 
112 
41.5 
189 
4 
4.3 
1935 . 
29,172 
640 
670.4 
22,033 
454 
506.3 
5,009 
76 
115.1 
1,927 
96 
44.2 
203 
14 
4.6 
1936 . 
29,836 
664 
682.5 
22,576 
543 
516.4 
5,133 
124 
117.4 
1,919 
-8 
43.9 
208 
5 
4.7 
1937 . 
30,383 
547 
691.8 
22,915 
339 
521.8 
5,244 
111 
119.4 
2,001 
82 
45.5 
223 
15 
5.0 
Average, 34 years 
(596) 
(416) 
(130) 
(49) 
(.8) 
1 Population estimated for each intercensal year. 2 Includes Bridgewater and Tewksbury. 
» Includes Veterans’ Administration Facility No. 95 from April 25, 1924, and Veterans’ Administration Facility No. 107 from August 11, 1928. 
1 Minus sign indicates decrease. 132 
HOUSE —No. 2400. 
[Mar. 
The average annual increase over the same period for pa- 
tients within the state schools has been 130 patients per year. 
For comparative purposes the rate per 100,000 of population, 
the population being estimated for intercensal years, is shown 
in table form for all hospitals, for state hospitals, and for state 
schools from 1904 to 1937 (page 130). 
It may be said that in September, 1937, approximately 1 
person out of each 145 residents of Massachusetts was a 
patient in a hospital or school under the supervision of the 
Department of Mental Health. 
We have no desire to make the situation more serious than 
it actually is, but we feel that the Legislature should have as 
complete a knowledge of this general problem as the wise 
expenditure of 13 to 20 cents of each tax dollar demands. Let 
us see how good a job Massachusetts has been doing for the 
mentally ill and feeble-minded as measured by the yardstick 
of expenditures of money. 
The latest comparative data available are from the publica- 
tion, “Patients in Hospitals for Mental Disease, 1936,” pub- 
lished by the United States Census Bureau in 1938. 
In 1936 Massachusetts had a patient per capita cost per 
year of $403.40, exceeded only by the District of Columbia at 
$655.60, and the State of Wisconsin at $432.50, per patient 
per year. 
In this year Massachusetts had 476.2 patients per 100,000 
of population as patients in state hospitals, the second highest 
rate in the country, being exceeded only by New York, with a 
rate of 480.3 per 100,000. Actually the rate for Massachu- 
setts, as reported in the annual report of the Commissioner 
of Mental Health in 1937, including the mental wards at 
Tewksbury and the patients at Bridgewater State Hospital, 
was 516.4 per 100,000. There can be no question, then, that 
in comparison with other States Massachusetts has carried a 
heavy load. 
In the census bureau statistics cognizance is taken of the 
percentage of overcrowding. These estimates of overcrowding 
are made by the individual States and represent the difference 
between rated bed capacity of the hospital and patients actu- 
ally in residence. According to the United States Census 
Report for 1936 there was an average excess of population over 
capacity in Massachusetts state hospitals of 2,672 patients, or 
an overcrowding of the state hospitals of 15.6 per cent. This 
percentage of overcrowding was exceeded by nineteen other 1939.] 
HOUSE— No. 2400. 
133 
States. In trying to evaluate this data it must also be consid- 
ered that the standards set for the amount of space allowed 
per patient vary between States, and these data cannot be 
accepted as wholly comparable. 
The number of deaths per 1,000 patients under treatment 
in state hospitals for the entire United States for 1936 was 
71.9, for Massachusetts, 68.1. In general, then, the death 
rate is better than the average for the country, but sixteen 
States have somewhat lower death rates. The relatively low 
death rate is surprisingly good when consideration is given to 
the age of our patients admitted for the first time to the state 
hospitals. The following table will serve to introduce a prob- 
lem which must be faced, namely, the great increase in the aged 
group who need hospital treatment: 
First Admission of Patients to State Hospitals of the New England and 
Middle Atlantic States. 
Male. 
Female. 
All 
Ages. 
Age 60 
or Over. 
Percent- 
age 60 
or Over. 
All 
Ages. 
Age 60 
or Over. 
Percent- 
age 60 
or Over. 
New England States. 
Maine . . . 
245 
79 
32.2 
203 
56 
27.5 
New Hampshire 
191 
5« 
30,4 
173 
53 
30.6 
Vermont .... 
154 
29 
18.8 
104 
32 
30.8 
Massachusetts . 
1,672 
585 
34.9 
1,621 
556 
34.3 
Rhode Island 
206 
50 
24.2 
162 
49 
30.2 
Connecticut 
719 
207 
28.8 
534 
137 
23.7 
Middle Atlantic States. 
New York .... 
6,374 
1,818 
28.5 
5,454 
1,613 
29.0 
New Jersey 
1,237 
283 
22.9 
1,060 
285 
26.9 
Pennsylvania 
2,054 
451 
21.9 
1,592 
347 
21.2 
It is to be noted that a significantly higher number of elderly 
patients are being admitted to Massachusetts state hospitals 
than in the other States in this geographical area. More 
people are living to old age at the present time than was true 
three decades ago. This has been brought about by a lowering 
of the death rate among children. Researches are urgently 
needed in order to combat the steady increase in admissions 
of elderly patients to mental hospitals. 134 
HOUSE —No. 2400. 
[Mar. 
Let us combine the statistics on first admissions for the 
psychoses with hardening of the arteries of the brain and those 
due primarily to the ravages of old age — technically speaking, 
the psychoses with cerebral arteriosclerosis and the senile 
psychoses — for the past twenty-one years. 
Number and Percentage of First Admissions suffering from Senile Psy- 
choses and Psychoses with Cerebral Arteriosclerosis. 
Year. 
Senile. 
Cerebral 
Arteriosclerosis. 
Both. 
Number. 
Per Cent. 
Number. 
Per Cent. 
Number. 
Per Cent. 
1917 . 
258 
7.0 
261 
7.1 
519 
14.1 
1918 . 
298 
8.3 
285 
7.9 
583 
16.2 
1919 . 
291 
7,8 
294 
7.9 
585 
15.7 
1920 . 
310 
9.4 
292 
8.9 
602 
18.3 
1921 . 
336 
9.7 
272 
7,9 
608 
17.6 
1922 , 
311 
8.1 
351 
9.2 
662 
17.3 
1923 . 
250 
7.1 
375 
10.7 
625 
17.8 
1924 . 
221 
6.0 
406 
11.1 
627 
17.1 
1925 . 
287 
7.5 
434 
11.4 
721 
18.9 
1926 . 
272 
7.4 
440 
12.0 
712 
19.4 
1927 . 
270 
7.0 
461 
12.0 
731 
19.0 
\ 
1928 . 
345 
8.5 
466 
11.5 
811 
20.0 
1929 . 
287 
6.9 
526 
12.7 
813 
19.6 
1930 . 
283 
6.6 
576 
13.4 
859 
20.0 
1931 . 
275 
6.1 
658 
14.5 
933 
20.6 
1932 . 
223 
4.9 
666 
14.8 
889 
19.7 
1933 . 
258 
5.6 
720 
15.8 
978 
21.4 
1934 . 
247 
5.4 
797 
17.5 
1,044 
22.9 
1935 . 
290 
6.0 
767 
15.9 
1,057 
21.9 
1936 . 
245 
4,8 
870 
17.2 
1,115 
22.0 
1937 . 
302 
6.0 
853 
17.1 
1,155 
23.1 
In other words, since 1917 there has been almost a 123 per 
cent increase in the actual number of patients admitted to 
our state hospitals suffering from senile psychoses and with cere- 
bral arteriosclerosis. 
In another part of this report comment is made on the 
incidence of intemperance in patients admitted to the hospi- 
tals, and also to the steady increase in patients admitted 
because of mental disorder caused by alcohol. 1939.] 
HOUSE— No. 2400. 
135 
On the other side of the ledger is the apparent decrease in 
mental disorder due to syphilis. With the nation-wide cam- 
paign so ably led by Dr. Parran of the United States Public 
Health Service, and with the continued advances in treatment 
and preventive measures, we can hope that a further reduction 
in mental disease due to this disease may be accomplished. 
With this introduction we can now discuss the education, 
prevention and research phases of the problem of mental ill- 
ness in Massachusetts. 
The subjects of education, research and prevention of mental 
disease may be considered together. It is rather well known 
that the care of the mentally ill is primarily a problem for the 
state government to handle. At the present time more than 
95 per cent of the hospitalization of the mentally ill in the 
United States is under governmental auspices. This being the 
case, the taxpayer who underwrites the cost of government is 
entitled to know how that portion of his tax dollar, allocated 
to the care of the mentally ill, is expended. 
Section 3A, chapter 123 of the General Laws, defines the 
duties of the Department relative to mental health, and 
authorizes the Department not only to carry on research and 
inaugurate and prosecute preventive measures, but also to dis- 
seminate such information relative to the mental health of the 
citizens of the Commonwealth as it considers proper for diffu- 
sion among the people. Not only is it appropriate that educa- 
tional efforts be made in regard to the general population, but 
efforts should also be made to educate the personnel within 
the institution and to disseminate information to the medical 
profession which may be of value in aiding the physicians to 
exercise preventive and curative functions in general. There 
are several very important reasons why information per- 
taining to mental disease should be disseminated among the 
people. Perhaps the most important, from the standpoint of 
preventive medicine, pertains to the so-called stigma attached 
to patients who have been so unfortunate as to have suffered 
from mental illness. 
To partly explain this question of stigmatization, we should 
like to quote from a recent address given by Dr. Alan Gregg, 
director for the Medical Sciences, the Rockefeller Foundation: 
Another obstacle for research in mental diseases deserves your atten- 
tion and your understanding. Most diseases begin or show their 
presence first by changes, like pain, weakness, fever — pitiful and 
noticeable, but not morally alarming or socially dangerous. 136 
HOUSE —No. 2400. 
[Mar. 
But suppose a disease begins, with a loss of good judgment or self- 
control as the very first sign. What a confusion for all concerned! 
The disapproval and resentment we visit upon foolishness or immorality 
is immediately attached to such a disease. We may as well admit that 
it takes great self-control for healthy persons to follow the rules of 
civilized behavior, to say nothing of the difficulties of fulfilling the 
demands of Christian ethics. 
If it happened that one of the first symptoms of a disease was not a 
chill or a headache, but a loss of self-control, how could we who are 
still struggling for self-mastery easily condone the sufferer’s lapse? 
We should think he wasn’t suffering — we should suspect he was 
enjoying it. Not until his misbehavior became unendurably flagrant 
would we concede that he was ill, and then, with almost uncontrollable 
aversion, we should put a taboo upon him and his disease. 
Again, disease would be tainted with a moral flavor as it was in 
ancient India, or as it is among primitive peoples today. And thus 
would we forgo the moral credit of associating with such a sick man, 
and so lose the opportunity to be familiar with his disease. Now that 
is what happens in many mental diseases. From such circumstances 
comes a moral aversion amounting to horror of diseases that actually 
do show themselves in ways that break down social relationships, 
offend our moral sensibilities, our fastidious tastes, and our emotional 
equanimity. And so there is an immense taboo on mental disease, — 
a taboo resembling the savage’s terror, and quite as inimical to observa- 
tion, reasoning and study. 
Happily and hopefully it is lifting, but let us understand that it 
exists and why it exists, for here especially we should recall the ancient 
“Ye shall know the truth and the truth shall make you free.” 1 
The “taboo” which Dr. Gregg emphasizes is generally 
spoken of as the “stigma” among patients and their relatives. 
It represents a throwback to medieval thinking. It is born of 
unreasoning fear, and it continues to live because of ignorance. 
People are ashamed to say that they have relatives who are 
mentally ill, or have been mentally ill, for fear that they, them- 
selves, will be regarded as coming from poor stock. Of perhaps 
greater importance, potential employers are dubious regarding 
the advisability of employing former mental patients. Educa- 
tion of the general population may also be of significant help 
in reducing the incidence of necessary hospitalization. Two of 
the major types of mental illness, namely, the alcoholic psy- 
choses and the psychoses with syphilitic meningoencephalitis 
— both are preventable. If there was no alcoholism and no 
syphilis there would be no mental illness due to these two 
1 Mental Hygiene, Vol. 23, January, 1939. 1939.] 
HOUSE —No. 2400. 
137 
conditions. On the other hand, the psychoses due to syphilis 
are gradually decreasing. The decrease in the incidence of 
mental disorder due to syphilis has been brought about partly 
through educational propaganda of the type inaugurated by 
Dr. Parran of the United States Public Health Service, and 
partly through the results of scientific research. 
It was not until 1911 that it was known for a certainty that 
the psychosis now known as syphilitic meningoencephalitis 
was actually due to the action on the brain of the germ causing 
syphilis. The discovery by Noguchi and Moore of the Trepo- 
nema pallidum in the brains of patients dying from general 
paresis, or, as it is now known, syphilitic meningoencephalitis, 
was the clinching evidence needed to make the causative factor 
of this condition a certainty. Research has been .the second 
great factor in the reduction of the syphilitic psychosis. The 
discovery of the Wassermann test, which will indicate the 
presence of syphilis by an examination of the blood, the devel- 
opment of compounds of arsenic that could be injected into 
the veins of a person, thus killing the germ of syphilis without 
injuring the person suffering from syphilis, represented another 
step in advance. Later, research developed even better meth- 
ods of treatment. 
The discovery by Wagner von Jauregg of the curative 
value of elevating the temperature of the patient suffering 
from neuro-syphilis by means of inoculation with malaria 
represented a still greater advance in treatment. At the be- 
ginning of this century the mortality rate of syphilitic meningo- 
encephalitis was tremendously high. Very few of the patients 
suffering from this condition lived more than six months after 
admission to our mental hospitals. Without treatment, this 
particular disease is a killing disease, and is steadily progressive 
in the great majority of cases. Still later came more refined 
methods of treatment. The ability to elevate the temperature 
of the body by electrical means also proved of value in the 
treatment of central nervous system syphilis. It may be 
pointed out that Wagner von Jauregg received the Nobel 
prize in medicine for his discovery that artificial inoculation 
with malaria had a curative effect in neuro-syphilis in a fairly 
high percentage of cases. 
We have touched lightly upon the research aspects of only 
one mental disorder merely to show the importance of research 
and what may be expected from the expenditure of money in 
this direction. To again quote Dr. Gregg; 138 
HOUSE —No. 2400. 
[Mar. 
The mere existence of research work in a mental hospital improves 
the care given all the patients. They are seen more often — some are 
watched far more attentively. It is like introducing accounting in a 
business house. Records are kept. Failures are recognized and re- 
ported. This you are accomplishing wherever your fire has lit the 
investigator’s lamp. You are giving encouragement to those medical 
scientists and physicians who have wanted to do research work. You 
have encouraged some younger men to prepare themselves for careers 
in psychiatric research. 
To further quote from Dr. Gregg, who is perhaps in the best 
position of any man in the United States to know the policies 
of great foundations in rendering grants in aid available for 
researches: 
I know of no foundation whose trustees would continue to vote 
funds if they thus eliminated the interest and collaboration of others. 
Indeed, most foundation grants are made on the condition that funds 
be obtained from other sources on a one-to-five or a fifty-fifty or an 
eighty-five-to-fifteen ratio. Many is the time I have seen a private 
donor unlock with a relatively small sum a large foundation grant 
which was conditional upon his measure of collaboration. 
Dr. Gregg goes on to say: 
If research in mental disease is to attract fine research minds, and 
if it is to be successful, time is needed, not merely increased funds. 
Fifty thousand dollars a year for ten years in superior hands is usually 
better than a million over a two-year period in the same hands. Te- 
nacity of purpose and seriousness of intent are worth more than princely 
but wavering generosity, because the test of time must be met by 
any theory of cause or method of cure. Brilliant ideas need stages of 
trial and development as well as mere initiation. You must be patient 
and long-suffering in this task; the sick you seek to aid have long been 
that. . . . And may I suggest that some of you have the courage to 
inquire in your own States what is the budget for study and continu- 
ing search beyond the causes of the mental disorders for which such 
huge sums are being spent? Or to visit the institutions and see what a 
sad state of human suffering your funds are spent to render needless? 
The State of Massachusetts has for many years been in the 
forefront in the matter of investigation of mental illness. For 
many years the Department has had a Division of Mental 
Hygiene whose primary duties are the responsibility for con- 
duct of preventive measures and research. In 1936 and 1937 
the National Committee for Mental Hygiene conducted a 
survey and tentative appraisal of research activities, facilities 1939.] 
HOUSE —No. 2400. 
139 
and possibilities in state hospitals and other tax-supported 
institutions for the mentally ill and defective in the United 
States. A quotation from the report of this committee and 
the significance of research in public institutions is germane. 
The appropriateness of looking to our publicly supported hospitals 
for investigatory work is evident when we take into account the vast 
patient populations now resident in these hospitals that offer unrivalled 
opportunities for observation and study. And in contributing to an 
enlargement of knowledge in the psychiatric field, staff members 
become imbued with a scientific spirit that is reflected in better clini- 
cal work. It is a matter of observation that without research, any 
clinical group of workers tends to drift into a scholastic attitude in 
which the opinions of former authorities are substituted for actual 
observation and frequent reorientation. On the other hand medical 
groups that have one or more members working on some research 
project are stimulated to a greater alertness and usefulness to their 
patients. It is also worthy of note that the task of recruiting promis- 
ing men for mental hospital posts is facilitated if there can be held out 
the inducements of clinical work that is not routinized and, in addition, 
opportunities for investigatory efforts. 
Excerpts from the summary of findings of this committee 
are given. 
Twenty of the 273 public institutions can be designated as research 
centers because of the character and quality of their investigatory 
work, the caliber of their personnel, and the resources at their disposal 
for scientific studies. 
In addition to these twenty centers there are thirty-two publicly 
supported hospitals that offer distinct possibilities for research work, 
judging by the advantages they enjoy in the way of basic facilities 
that lend themselves to investigate activities. 
It is noted that research interest is most marked in the 
Middle Atlantic, New England and North Central States. 
It is estimated that not more than two or three million dollars are 
expended annually for psychiatric research in the United States, and 
that of this amount more than one half is derived from foundations, 
individuals and private agencies. 
As a result of this survey superintendents stated that the chief 
deterrents to the prosecution of research in mental hospitals are . . . 
inadequate staffs, remuneration insufficient to attract the best men, 
difficulty in securing facilities, and lack of funds for investigatory pur- 
poses. All agree that research activities in hospitals tend to quicken 
the scientific interest of the staff, thereby improving the care and 
treatment of patients. 140 
HOUSE — No. 2400. 
[Mar. 
It is considered significant that in twenty-one hospitals the 
research facilities were being used by outside groups. The 
committee reported that “although there is a vast field for 
research in mental deficiency and convulsive disorders, there is 
a dearth of interest in investigative work in mental institu- 
tions devoting attention to these conditions/’ Those con- 
nected with the aforementioned study were convinced that 
“a signal contribution might be made in placing mental hy- 
giene and psychiatric research on a firmer and more productive 
basis in this country if a capable group of scientists having 
access to research funds could devote attention to strengthen- 
ing the twenty research centers to facilitate the training of 
research personnel for other hospitals; collaboration with the 
thirty-two potential centers to foster investigatory work; se- 
curing greater recognition for psychiatric research as a matter 
of public policy in the more progressive States; fostering 
closer affiliations between mental hospitals and medical schools; 
and recruiting promising young scientists in the field of psy- 
chiatry.” 
It must be a satisfaction to the citizens of Massachusetts to 
know that as a result of this impartial investigation on the 
part of the National Committee for Mental Hygiene it is 
found that four of the twenty leading research centers in 
mental disease in the United States are located in Massachu- 
setts. These institutions are the Boston Psychopathic Hospi- 
tal, Boston State Hospital, Worcester State Hospital and 
Wrentham State School. There are more leading research 
centers in Massachusetts than in any other State. This is 
indeed an enviable position, and every effort should be made 
to retain this lead. The summary of the report of the Com- 
mittee on Research Center and Methods submitted to the 
Special Commission is appended as Section C of this Appendix. 
In general, the Special Commission on Mental Diseases is 
in agreement with the fundamental policies outlined in this 
report. However, the mechanics of how the results desired by 
the Committee on Research are to be accomplished is a matter 
which should be left to the discretion of the Department of 
Mental Health. 
In the question of education, a general policy of education 
of the general population should be followed by the Depart- 
ment of Mental Health, with the basic object in mind of doing 
away in Massachusetts with the feeling of stigmatization on 
the part of patients in our mental hospitals and their relatives. 1939.] 
HOUSE —No. 2400. 
141 
Many people in our Commonwealth know that there is no 
sound reason for this feeling of stigmatization. It should be 
an objective of the Department to further dispel ignorance in 
this matter. This can be accomplished by a state-wide policy 
of educating the people by means of all sixteen institutions 
working on the matter under the direction of the Department 
of Mental Health, together with private individuals and organi- 
zations. 
The most vital problem in connection with the major prob- 
lem of mental health in our State is the question of personnel. 
Given the proper type of personnel, solutions of practically 
all of the problems under discussion will be forthcoming. It 
is essential and imperative that the staff members in the 
various state hospitals receive proper instruction. The rela- 
tionships of the doctor to patient and doctor to relative is 
particularly important in dealing with the problems of mental 
illness. There is a very large demand for properly trained 
professional personnel. This has always been a problem in 
mental hospitals. Superintendents of institutions point out 
that in the past, when times were good, economically speak- 
ing, it was very difficult to obtain personnel with high qualifi- 
cations. When times became bad the mental hospital staffs 
improved. Naturally, there were many exceptions to this 
rule. 
The importance of psychiatry has received appropriate 
attention in medical schools only in recent years. The impor- 
tance of this problem has been a matter of concern of the 
National Committee for Mental Hygiene for many years, and 
there is a division of psychiatric education which is responsible 
for the entire matter of education. Indeed, one of the general 
purposes of the National Committee for Mental Hygiene is 
developing trained personnel in the field of psychiatry and 
mental hygiene. Massachusetts in its state hospital system 
has trained a large number of physicians in psychiatry, who, 
after receiving their training, have either gone to private prac- 
tice or have entered the field of psychiatry in other States. 
It is perfectly true that mental illness, like other illness, has 
no geographical boundaries, and that any policy restricting 
the training of psychiatrists in the Massachusetts system, for 
service only in Massachusetts, would be shortsighted so far as 
the public health of the nation is concerned. Certain States 
do not have the educational facilities that exist in Massachu- 
setts, New York, Illinois, Pennsylvania and some of the other 142 
HOUSE — No. 2400. 
[Mar. 
larger States. It would seem, then, that our State has a cer- 
tain national, as well as state, responsibility. Doctors, after 
they have received their medical school training, are not 
qualified to practice psychiatry without further training. The 
best places in which this training can be obtained to permit 
qualification as psychiatric specialists are in state hospitals, 
psychopathic hospitals and the larger private mental hospitals. 
Well-founded opinion has been presented to the Special 
Commission that the system of training in vogue in the Massa- 
chusetts system at the present time could be changed to the 
advantage of the potential psychiatrist. At the present time 
the training of the majority of our state hospital physicians is 
obtained within the institution to which the potential psychia- 
trist is attached as a staff member. The actual details of how 
the training program for staff members is carried out is left to 
the Department of Mental Health and the institutions under 
its control. Strong recommendations have been made to the 
Commission that some such educational program as follows 
might be considered and possibly put into effect in the immedi- 
ate future: 
That minimum standards should be established; that all potential 
staff members should be graduates of acceptable medical schools; 
should have had general hospital interneships; and that a new grade 
for psychiatric trainees should be established at a slightly lower salary 
than that given the assistant physician at the present time. 
It would seem that such a reduction in salary is justified during a 
training period. During the training period the psychiatric interne 
should be under the administrative control of the Department of 
Mental Health, and should receive basic training in perhaps four acute 
receiving hospitals in which the staffs are well qualified to teach. 
The curriculum for the basic psychiatric instruction should include, 
in addition to clinical psychiatry, a certain amount of clinical neurol- 
ogy, psychology, psychometrics, bio-chemistry and general pathology 
of mental disease, psycho-biolog}' and psycho-pathology. All of the 
subjects that the American Board of Psychiatry and Neurology examines 
candidates in should he included in the curriculum. Additional subjects 
to be taught should be added in the discretion of the teaching faculties, 
with the approval of the Department. 
One institution would probably be unable to carry the teaching 
load necessary for replacements in the Massachusetts state system. 
With a well-qualified professional personnel one can constantly expect 
resignations from staff members, due to better opportunities, vacan- 
cies caused by promotions, and resignations due to various reasons. 
For this reason it is felt that several institutions should be approved 1939.] 
HOUSE —No. 2400. 
143 
for special training. In addition to the intramural psychiatry, special 
training in the treatment of the epilepsies should be given at Monson. 
Special training in the treatment of feeble-minded should be given in 
one of the schools for the feeble-minded. Special training in caring 
for the neuroses should be given in the adult out-patient departments 
of selected institutions. Special training should be given in the ex- 
amination of retarded children in the traveling school clinics. Ex- 
perience should be given in the examination of prisoners toward the 
latter part of the period of training. A period of not less than three 
months’ training should be given in child guidance clinics and habit 
clinics. 
It has been called to our attention that candidates for 
certificates from the American Board of Psychiatry and Neu- 
rology, who have been employed for long periods of time in 
the schools for the feeble-minded, are examined to a large 
extent in the psychoses only. It is the opinion of the Com- 
mission that both the schools and the hospitals might profit by an 
“exchange” system of staff members who have been in the service 
perhaps for some time. This would serve to give a given insti- 
tution the benefit of the viewpoint of the staff member working 
on an exchange basis from another type of institution. 
The Commission also approves of the idea of international 
exchange arrangements, tending, as it may, to render less pro- 
vincial the individual staff members as a result of their inter- 
national contacts. The viewpoints of the different staffs should 
be stimulating. 
It is fully understood by the Commission that training, 
extending possibly over a two-year period, will not produce a 
specialist in psychiatry. It is definitely felt, however, that 
such training would be markedly superior to that given in any 
institution in Massachusetts at the present time. It is further 
suggested that with a well-organized course which might well 
be given under the combined mgis of one of the medical schools 
and the Department of Mental Health, in collaboration with 
the institutions under its jurisdiction, an advanced degree 
might be granted which would be an additional inducement 
for men of outstanding ability to enter the psychiatric field. 
At this point we call attention to an interesting suggestion 
which has been made, namely, that every institution should 
have a clinical director. The clinical director should have, 
among his other duties, the major responsibility for the teach- 
ing of subordinate staff members within his institution. His 
qualifications should be so outstanding that there could be no [Mar. 
144 
HOUSE— No. 2400. 
question regarding his professional leadership within a given 
institution. The salary of the clinical director should be com- 
mensurate with his responsibilities. Such an arrangement 
might induce particularly able psychiatrists to remain in the 
clinical field rather than to shift their interests to the adminis- 
trative field. In other words, the clinical field would be made 
sufficiently attractive, financially, to warrant the psychiatrist 
staying in that field. Many of the staff members in the Massa- 
chusetts state hospital service have been in the service for 
many years. There is a tendency for some institutional staff 
members to get into a “rut” and remain content with treat- 
ment and diagnostic methods which are obsolete. It is the 
feeling of the Commission that measures should be taken to 
prevent such tendencies toward lack of progressiveness. It is 
suggested that every five years all staff members be encouraged 
to take a three months’ “refresher course.” 
In the interests of maintaining and increasing the standards 
of professional attainment, it is suggested that all staff mem- 
bers in the Massachusetts state system, who have attained the 
service time requirements of the American Board of Psychiatry 
and Neurology, be required to obtain a certificate from that 
Board within two years of attaining the time qualifications. 
In other words, all physicians who have been in the service for 
periods of over eight years shall be required to hold a certifi- 
cate as a specialist in psychiatry. The present courses which 
for the last several years have been given at the Metropolitan 
State Hospital, in preparation for examination for the Ameri- 
can Board of Psychiatry and Neurology, should be continued. 
A psychiatric symposium which was held during the past 
year in one of the hospitals seemed to prove very stimulating 
and satisfactory. Similarly arranged symposia should he given 
as frequently as material worth reporting accumulates. Along 
this line it is felt that the old association for assistant physicians 
should be revived. This would tend to break down the 
traditional isolation of the institutional psychiatrist, and 
would give him the opportunity of finding out how various 
problems are handled in the different institutions coming under 
the system. 
It is felt that such an arrangement would be stimulating to 
the various staff members, provided suitable demonstrations 
were arranged and opportunity was given for interchange of 
ideas among the various staff members. 1939.] 
HOUSE —No. 2400. 
145 
There is available in the state hospitals of the Common- 
wealth a large amount of clinical neurological material. It is 
felt that this material could he utilized to far greater advantage 
than perhaps has been the case in the past. Some change of per- 
sonnel in the state hospitals and schools is a healthy sign. One 
of the best outlets for men who are leaving the state service is 
the private practice of neurology and psychiatry. This being 
the case, facilities available for the clinical teaching of neurology 
should be utilized as much as possible. 
In addition to the educational suggestions made above, we 
should like to see the Department Bulletin revived so that the 
staff of one hospital will know in a general way what is hap- 
pening in the other hospitals. We understand that many of 
the physicians in the state service would not write articles for 
the Bulletin because they believed that the circulation of the 
Bulletin was small and that their productions would be “buried” 
in the publication. The format of the Bulletin was not too sat- 
isfactory. The print was very small and the “general set-up” 
was not good. We believe that the format of the Bulletin 
should also be changed for psychological reasons, and, in gen- 
eral, that it should be completely revivified. It is felt that 
with a Bulletin coming out quarterly a great deal of good would 
be accomplished, particularly if the editorial board was truly 
representative, not only of the Department, but also of the 
institutions coming under its jurisdiction. In order to accom- 
plish this aim, however, the expense of operating the Bulletin 
would have to be markedly increased. Few will read the 
Bulletin in its present format. We are of the very definite 
opinion that sufficient funds should be made available for the 
Department to publish a Bulletin in such form that it can be 
widely disseminated and read. It is the opinion of the Com- 
mission that legislation should be passed permitting adver- 
tising in this journal, and permitting a paid circulation. This 
procedure has already been followed in the State of New York 
and the journal has a great following. 
Any profits obtained from advertising in the Bulletin should 
be used to expand future issues of the publication, and if the 
advertising revenue warrants the issuance of a publication 
similar to the “house organs” used by commercial companies, 
for distribution to the Department and hospital personnel, the 
publication could also be available to the public, and in this 
way would be a decided help to the Department in its program 
to educate the public regarding its work. 146 
HOUSE —No. 2400. 
[Mar. 
It is believed that the circularization of medical reprints by 
the Division of Statistics should be continued. This method 
serves to call to the attention of the individual physician re- 
prints of great medical importance. 
Of the most vital importance in the question of education of 
staffs is the establishment in each hospital of a first-class medi- 
cal library. A good library, in all probability, can do more in 
the way of improving the caliber of medical treatment than 
any other single factor. Sufficient money should be made 
available to each of the institutions to permit adequate library 
facilities. The medical books are the tools of the doctor. 
The best way to keep abreast of the medical times is for the 
doctor to read his medical journals and to attend his medical 
meetings. We believe that all staff members should be en- 
couraged to acquire membership in their state and national, 
medical and psychiatric societies, and membership in these 
societies should be taken into consideration in the rating of 
individual staff members. It is further believed that the De- 
partment should inaugurate a policy of paying the expenses of 
all staff members presenting technical papers before national 
society meetings. Not only would such a policy stimulate 
staff members to produce original work, but, what is as impor- 
tant, it would give them an audience for constructive criticism. 
The payment of expenses should be limited to original con- 
tributions. For physicians who are interested in progressing 
along the administrative rather than the clinical route, steps 
should be taken for the inauguration of courses in adminis- 
trative procedures. All physicians with the grade of assistant 
superintendent, who aspire to the grade of superintendent, 
should have taken basic courses in business administration. 
These courses can be acquired through any of the larger uni- 
versities or the University Extension Courses. 
The relationships with the various medical schools should be 
strengthened by continued affiliations with the schools through 
teaching. Staff appointments in the medical schools should 
be encouraged, and time for the giving of lecture courses in 
medical schools should be granted without loss of pay. Such 
teaching affiliations should be encouraged. Generally speak- 
ing, the teaching institution is the best institution. Affiliations 
with leading general hospitals for the training of medical in- 
ternes should be encouraged. The entire question of psycho- 
somatic relationships is being considered more and more im- 
portant in recent years. The development of these extramural 1939.] 
HOUSE — No. 2400. 
147 
contacts on the part of state hospital physicians is of vital 
importance in the preventive field. Unless medical students 
and physicians in general practice receive proper instruction 
in psychosomatic medicine, little can be hoped for in the way 
of preventive psychiatry. 
It is perfectly true that the bulk of sick patients are seen 
first by their family doctor. It is unfortunately true that in- 
struction in psychiatry in most medical schools, even at the 
present time, is considered relatively meager. 
What has been said relative to instruction of intramural pro- 
fessional personnel is equally applicable to the ancillary services. 
Instruction for attendants and nurses, affiliated, under- 
graduate and graduate, should be greatly strengthened. It is 
the opinion of the Commission that the instruction of these 
groups would result in an improvement of the care given our 
mental patients. Special instruction should be given to occu- 
pational therapists, students in training for psychiatric social 
work, and other allied disciplines. 
In short, and to a very large extent, the future of preventive 
work in the field of psychiatry is to be hoped for through the 
medium of educational efforts directed toward (1) the general 
population, (2) the medical profession, including the staffs of 
mental hospitals, (3) the medical student, and (4) 
ancillary disciplines. 
The Division of Mental Hygiene was organized to fulfill the 
provisions of section 3A, chapter 123 of the General Laws. The 
Division of Mental Hygiene Report for the Commission (page 
157) relates briefly the developments of the Division since its 
organization. In this report attention is called to the fact 
that “the most important aspect of research of any type is 
personnel, and it soon became obvious that those best equipped 
by education, training and experience were already participat- 
ing in activities of various kinds which would not permit their 
being employed on a full-time basis by the State. The ques- 
tion of adequate compensation would have also prevented the 
plan.” The plan as developed has been demonstrated to be 
very productive, and we believe that the part-time employ- 
ment of research personnel is warranted. 
The relationship between the Department of Mental Health 
and the Massachusetts Society for Mental Hygiene continues 
cordial and co-operative. In addition to the educational efforts 
of the Division of Mental Hygiene, we are informed that the 
Superintendents’ Committee on Public Relations and Scientific 148 
HOUSE— No. 2400. 
[Mar. 
Publications is reviewing the entire matter of public education 
in the State with a view to making recommendations for any 
additional action needed in regard to educational efforts di- 
rected toward the general public. All legitimate educational 
and co-operative devices should be used by the Department in 
its educational program, constituting as it does part of the 
larger preventive program. These efforts should be addressed 
to private practitioners of medicine, to teachers and psycholo- 
gists. Emphasis should be placed on educational material of 
proven worth of a utilitarian nature. Efforts should be made 
as soon as possible to evaluate as well as possible the contribu- 
tion of the child guidance and habit clinics. Material of proven 
value should be disseminated among the medical profession 
and other agencies which can exercise preventive measures. 
Consideration should be given by the Department to the 
establishment of adult psychiatric clinics in cities of over 
100,000 population. Such clinics could be operated as a joint 
enterprise with local departments of public welfare. Such 
clinics are now in operation in the city of Worcester with appar- 
ent success. Care should be taken that only patients who are 
unable to pay for private psychiatric care be treated in such 
clinics. Private general hospitals should be encouraged in so 
far as is possible by the Department to operate psychiatric 
departments. The Massachusetts General Hospital has broken 
the ice in this State, and if other general hospitals should open 
such departments there would doubtless be a lessening of the 
attitude of stigmatization on the part of the uninformed pub- 
lic that now so unfortunately exists. A greater utilization of 
the voluntary form of commitment in Massachusetts is an- 
other matter which is deserving of serious consideration, par- 
ticularly on the part of the hospital superintendents. 
The following description of the activities of the habit clinics 
is taken from the Report of the Division of Mental Hygiene 
for 1937, written by Dr. Douglas A. Thom: 
The clinics maintained by the Division continue to stress the qual- 
ity of the work rather than quantity. The careful study of the prob- 
lem and treatment of the individual child has been the objective, and 
we have avoided any procedures that would tend to defeat this aim 
or lower the standard of the service rendered to the public. While 
not being disposed to limit our intake of cases, we have endeavored 
to keep the number accepted for intensive treatment consistent with 
highest therapeutic standards. Clinics maintaining such aims and 
standards cannot undertake to study intensively all of the cases 1939.] 
HOUSE — No. 2400. 
149 
referred — to do so would naturally reduce the number of cases that 
could be accepted for treatment as well as impede progress in those 
cases where service is most needed. Therefore it is necessary to 
select wisely those cases for prolonged study and treatment. This 
selection is not made on any arbitrary basis, or by avoiding the chal- 
lenge which the most difficult cases offer when it is deemed practi- 
cable to do so. Rather, the selection is made on the basis of whether 
a child will be benefited by the specialized type of service we have to 
offer, and whether therapeutic effort is likely to be a prudent expendi- 
ture of time and money. Every case referred is accepted for appraisal 
at least, if not for detailed study and treatment. In those cases where 
a complete clinic service would seem to be impractical (either from 
the patient’s standpoint or from that of the clinic), a consultation 
service is always rendered in which an appraisal of the case is given 
to the referring agency, with recommendations made as to the most 
practical disposition of the case. 
Because such frequent inquiries are made both by correspondence 
and by personal visits from interested persons regarding clinic service, 
a brief resume of the clinics’ mode of operation would seem appro- 
priate at this time. Children are referred to the clinics from various 
sources and for many reasons: behavior problems as related either 
in the home or outside; personality deviations so marked as to inter- 
fere with social and scholastic adjustment; various neurotic traits; 
educational disabilities in the form of inability to read; difficulty in 
concentration, and application interfering with school progress; and 
lastly, problems of delinquency. The variety of problems and situa- 
tions brought before the clinics necessitates a comprehensive method 
of study. This is outlined briefly in the following description of 
clinic routine: 
The clinic procedure is devised on the assumption that a child who 
presents difficulty in the home, school or other contacts, or manifests 
symptoms or signs of disturbance in the course of physical and mental 
development, requires a thorough study in order to determine the 
real sources of his difficulty. The full study of the child begins with 
a careful physical survey, except where recent and adequate reports 
of physical examinations are available. Physical defects or disease 
must be carefully evaluated in any psychiatric program which is to 
be outlined. In some cases where physical factors are found to be 
acute and predominantly the causative factor in the particular prob- 
lem for which the case was referred, the habit clinic may act in an 
advisory capacity to the pediatrician; in others, the psychiatric pro- 
gram may proceed simultaneously and co-operatively with the medi- 
cal program. 
The psychological study of the child is the next step. This in- 
cludes an evaluation of his intellectual capacity, his school achieve- 
ment, and his special abilities and disabilities. The psychologist’s 
contribution to our knowledge of the child’s intellectual development 150 
HOUSE —No. 2400. 
[Mar. 
is important, and offers a basis for planning his educational program 
and his school placement. In addition to this, the psychologist’s 
observations of the child during his period of study aids appreciably 
in obtaining a better understanding of the child’s personality. 
A detailed study of the child’s environment is made by a psychiat- 
ric social worker. This information is obtained from one or both 
parents, from the physician, and from teachers and others familiar 
with the child and his varied environments. It includes a complete 
picture of the family situation; a detailed developmental and medical 
history; a record of the child’s adaptation to the school, both as 
regards his scholastic achievement and his adjustment to the teacher 
and the pupils, as well as his behavior in the play group. The com- 
pleted study is a picture of environmental background and the child’s 
relationship to parents, teachers, siblings and others. 
The psychiatrist then acquaints himself with the child and the 
parents, as well as with the data already collected by the other staff 
members co-operating in the case. The psychiatrist’s study begins 
with an observation of the child’s behavior in the examining room, 
and goes on to a more intensive investigation of his emotional drives, 
interests, attitudes, personal relationships and his mental attitudes 
toward life in general, and specifically toward the problem for which 
he was referred. 
In dealing with children of pre-school age, psychiatric inquiry and 
therapy are directed frequently more to the parent and the environ- 
ment rather than to the child himself. We know that many of the 
difficulties of these younger children are but secondary to the problems 
of the parents. 
The next step in clinic routine is the summarizing and co-ordinating 
by the psychiatrist of all the information and impressions obtained 
by staff members preparatory to a staff discussion. Physicians, 
teachers, social workers and others interested are invited to discus- 
sions. The case is reviewed, the observations of the various staff 
members reported and discussed, a diagnostic summary made, and 
plans for treatment outlined. 
Treatment varies with the individual case, and it is impossible in 
a report of this nature to adequately discuss the question of treatment 
of the social, educational, psychological and psychiatric problems. 
However, one might roughty list treatment procedures as follows: 
1. Direct information and advice to parents and teachers. 
2. Direct application of remedial procedures appropriate to specific 
needs of the child. 
3. Direct psychotherapy with the child. 
4. Psychotherapy for the parent. 
5. Social treatment for the environment. 
Any one or several of the above approaches to the child’s problem 
may be undertaken by one or more members of the clinic staff, fre- 
quently in co-operation with the school, or social agency interested 1939.] 
HOUSE —No. 2400. 
151 
in the case. A portion of therapy consists of parental education and 
environmental reconstruction, excepting in those cases where we are 
faced with a situation in which the problem is a fundamental one, 
involving the whole organization of the personality and character of 
the child. The difficulties encountered in attempting to influence 
the fundamental personality organization of an individual are many 
and varied. However, with the knowledge available regarding the 
nature of the influences that determine personality and character, 
it is possible in certain cases to evaluate what is taking place in the 
mental life of these children. Not infrequently we see the gradual 
development of the potential neurotic, eccentric, delinquent and 
psychotic adult, and it is in these cases where we should eventually 
find possibilities for fruitful preventive work. Some of our most 
interesting, as well as our most challenging cases, fall within this 
group. 
For the more serious personality problems we have made a system- 
atic and concerted effort at treatment. Our objective has been to 
facilitate the child’s emotional, intellectual and social development 
in order that he may attain a more satisfactory adjustment to life. 
The following tables show the total case load for the various 
habit clinics and the sources of the new cases, and types of 
service rendered as well as more detailed information on special 
service: 
Total Case Load showing Number of New and Old Cases attending 
Clinic, Number of Visits made by Children to Clinic, and Number 
of Clinic Sessions, December 1, 1936, to November 30, 1937. 
Habit Clinics. 
Case 
Load. 
Number 
of 
Children 
attending 
Clinic. 
New 
Cases 
attending 
Clinic. 
Old 
Cases 
attending 
Clinic. 
Visits to 
Clinic by 
Children. 
Number 
of Clinic 
Sessions. 
Total .... 
1,1361 
1,024 
724 
300 
4,185 
424 
Boston Dispensary 
187 
164 
131 
33 
458 
94 
Lawrence 
153 
139 
90 
49 
719 
47 
Lowell .... 
80 
71 
49 
22 
262 
48 
New England Hospital 
154 
130 
96 
34 
385 
45 
North Reading . 
29 
23 
23 
- 
29 
9 
Norwood 
107 
103 
70 
33 
438 
46 
Quincy 
234 
212 
145 
67 
888 
44 
Reading 
50 
44 
34 
10 
191 
43 
West End 
142 
138 
86 
52 
815 
48 
1 The first column includes 112 old cases that were active with social service, 
return to clinic. 
jut did not HOUSE —No. 2400. 
[Mar. 
Habit Clinics — Continued. 
Sources of New Cases, December 1, 1936, to November 30, 1937. 
Total .... 
Boston Dispensary . 
Lawrence .... 
Lowell .... 
New England Hospital . 
North Reading 
Norwood .... 
Quincy .... 
Reading .... 
West End .... 
724 
131 
90 
49 
96 
23 
70 
145 
34 
86 
Total New Cases. 
tO tO GO Or 4*. Cn 
t— 4*- Cn I to CO 
Schools. 
>-* to 
to to to 4*- h- rf*. 
-vJtOOH^COtOrf^OOCOOS 
Health Agencies. 
I-* to »—* 1-- H- o 
—'J "T CO O i c33 03 03 03 
Friends and Rela- 
tives. 
4*- H-* 03 H-* | 03 Cn CO 1 03 
Physicians. 
to 
Oi H rfk | ICOtOO'itOOO 
Children’s Agencies. 
03 1 COCO | oo CO ‘ oo 
Family Agencies. 
20 
1 
14 
3 
2 
Community Educa- 
tion. 
to to CO | | | | | I 
Clinic Staff. 
»-* 1 I I | | | | I H* 
Settlements. 
Types of Service rendered, December 1, 1936, to November 30, 1937. 
Full Service. 
Special Service. 
Total 
Case 
Load. 
Total. 
RESPONSIBILITY. 
Total. 
RESPONSIBILITY. 
Clinic. 
Co-op- 
erative. 
Clinic. 
Co-op- 
erative. 
Boston Dispensary 
187 
133 
130 
3 
54 
48 
6 
Lawrence 
153 
105 
104 
1 
48 
43 
5 
Lowell .... 
80 
56 
55 
1 
24 
22 
2 
New England Hospital . 
154 
140 
140 
- 
14 
14 
- 
North Reading 
29 
9 
7 
2 
20 
- 
20 
Norwood 
107 
80 
80 
- 
27 
27 
- 
Quincy .... 
234 
158 
158 
- 
76 
75 
1 
Reading . . « . 
50 
40 
40 
- 
10 
10 
- 
West End 
142 
122 
122 
- 
20 
17 
3 
Total number of cases 
1,136 
843 
836 
7 
293 
256 
37 
Percentage of totals . 
100 
74 
73 
1 
26 
23 
3 1939.] 
HOUSE —No. 2400. 
153 
Habit Clinics—Concluded. 
Types and Number of Cases given Special Service, December 1, 1936, to 
November 30, 1937. 
Total number of cases receiving special service 293 
1. Diagnosis and consultation requested 79 
2. Complete investigation not necessary for treatment 23 
3. Complete investigation not practicable 25 
4. Family history already known to clinic 15 
5. Cases referred to another clinic or agency 15 
6. Patient’s problem ceased after one visit to clinic 9 
7. Family not interested in clinic treatment 50 
8. Social situation too poor for patient to profit from clinic treatment ... 8 
9. Patient too retarded to benefit by clinic treatment 69 
The following table presents the type of clinic in operation 
at the various institutions under the Department of Mental 
Diseases during the year 1937: HOUSE —No. 2400. 
[Mar. 
Type of Clinic. 
Institution. 
Child 
Guidance. 
Habit. 
Juvenile 
Court. 
General 
Out-Patient. 
Mental 
or Mental 
Hygiene. 
Traveling 
School Clinic. 
Total. 
Hospitals. 
Psychopathic 
- 
- 
- 
1 
1 
1 in 2 towns 
3 
Boston State 
- 
- 
1 
- 
- 
1 in 3 towns 
2 
Danvers 
6 
1 
1 
1 
1 
1 in 36 towns 
11 
Foxborough 
- 
- 
- 
1 
2 
1 in 23 towns 
4 
Gardner 
4 
- 
1 
2 
- 
1 in 29 towns 
8 
Grafton 
- 
- 
1‘ 
1 
- 
1 in 19 towns 
3 
Medfield 
1 
- 
2 
- 
- 
1 in 17 towns 
4 
Metropolitan 
1 
- 
- 
- 
- 
- 
1 
Monson 
1 
- 
1 
1 
- 
1 in 8 towns 
4 
Northampton 
2 
- 
I 
1 
8 
1 in 42 towns 
13 
Taunton 
- 
- 
- 
I 
3 
1 in 56 towns 
5 
Westborough 
I 
- 
1 
1 
4 
1 in 5 towns 
8 
Worcester 
1 
- 
- 
1 
1 
1 in 47 towns 
4 
Schools. 
Belchertown 
- 
_ 
1 
- 
1 in 37 towns 
3 
W. E. Fernald 
- 
- 
1 
1 
- 
1 in 13 towns 
3 
Wrentham 
- 
- 
1 
1 
- 
1 in 15 towns 
3 
Division of Mental Hygiene 
- 
9 
- 
- 
- 
- 
9 
Total ......... 
17 
10 
12 
14 
20 
15 
88 
1 By appointment in Hudson, Leominster, Milford, Natick, Whitinsville, Blackstone, Uxbridge. 
1 By appointment in Adams, Franklin, Greenfield, Holyoke, Ware, Williamstown. 
Number and Type of Clinics in Operation under the Department of Mental Health during the Year ending November SO, 1937. 1939.] 
HOUSE— No. 2400. 
155 
The following table outlines the number of examinations by 
the various clinics under the Department during the year 1937. 
We observe that a total of 16,324 persons were examined by 
the various clinics operating in 1937. It is interesting to note 
that the greater part of these examinations were of individuals 
under 16 years of age. Of the total, 12,289 were under 16 
years of age and 4,035 were 16 years of age or older. Of this 
grand total of 16,324, 11,341 were new cases or first examina- 
tions, and 4,983 were cases which had been seen previously 
and had returned to clinic for another examination. 
Of the total examined, 750 were examined by child guidance 
clinics; 1,057 by the habit clinics; 923 juveniles were exam- 
ined in connection with the Juvenile Court work; 2,739 were 
seen in the general out-patient clinics and 2,550 in the mental 
hygiene clinics. The largest number were examined by the 
fifteen traveling school clinics which operate throughout the 
public schools of the State. Here we have a total of 8,305 
children examined during the year. 
At the bottom of the table we note several percentages in 
connection with the patients under 16 years or over 16 years. 
Of persons being examined for the first time, 84 per cent were 
under 16 years and 15 per cent, 16 years or over. Here we 
have an example of the mental hygiene implications in these 
various clinic examinations. Roughly, five out of every six 
persons examined by a clinic under the Department of Mental 
Diseases are found to be under 16 years of age. In re-exami- 
nations we note, as might be expected, that the older indi- 
viduals are appearing more frequently for additional psychiat- 
ric advice. In the re-examinations but 54 per cent are under 
16 years, while 45 per cent are over 16 years. If we consider 
first and re-examinations together, we observe that 75 per cent 
of persons coming up for psychiatric advice are 16 years of age 
and younger, and 25 per cent are 16 years of age or older. 156 
HOUSE— No. 2400. 
[Mar 
Number of Examinations conducted by Clinics of Institutions under the Department of Mental Diseases during the Year ending 
November 30, 1937. 
[By type of clinic and age.] 
Type of Clinic. 
First Examinations. 
Re-Examinations. 
Grand Total. 
0-15 Years. 
16 Years 
or Over. 
Total. 
0-15 Years. 
16 Years 
or Over. 
Total. 
0-15 Years. 
16 Years 
or Over. 
Total. 
Child guidance 
600 
30 
630 
118 
2 
120 
718 
32 
750 
Habit clinics 
757 
- 
757 
300 
- 
300 
1,057 
- 
1,057 
Juvenile Court 
659 
253 
912 
8 
3 
11 
667 
256 
923 
General out-patient .... 
1,110 
652 
1,762 
109 
868 
977 
1,219 
1,520 
2,739 
Mental or mental hygiene . 
168 
846 
1,014 
155 
1,381 
1,536 
323 
2,227 
2,550 
Traveling school clinics 
6,266 
- 
6,266 
2,039 
- 
2,039 
8,305 
- 
8,305 
Total 
9,560 
1,781 
11,341 
2,729 
2,254 
4,983 
12,289 
4,035 
16,324 
Per cent 
84.2 
15.7 
100.0 
54.7 
45.2 
100.0 
75.2 
24.7 
100.0 1939.] 
HOUSE — No. 2400. 
157 
B. DIVISION OF MENTAL HYGIENE REPORT FOR THE 
SPECIAL COMMISSION. 
The act establishing the Division of Mental Hygiene, which 
was approved June 8, 1922, stated: 
The department shall take cognizance of all matters affecting the 
mental health of the citizens of the commonwealth, and shall make 
investigations and inquiries relative to all causes and conditions that 
tend to jeopardize said health, and the causes of mental disease, 
feeble-mindedness and epilepsy, and the effects of employments, con- 
ditions and circumstances on mental health, including the effect 
thereon of the use of drugs, liquors and stimulants. It shall collect 
and disseminate such information relating thereto as it considers 
proper for diffusion among the people, and shall define what physical 
ailments, habits and conditions surrounding employment are to be 
deemed dangerous to mental health. 
The act as originally written gave such scope to investiga- 
tions and researches that there has been no need for change 
during the past fifteen years, and much remains still to be 
accomplished in carrying out the provisions of the act. The 
basic and fundamental purpose which prompted the creation 
of the Division of Mental Hygiene was to permit and encourage 
research in the field of mental disease, and to provide adequate 
facilities for the diagnosis and treatment for the early and 
incipient cases of mental illness, with the ultimate objective of 
affecting in some measure, at least, the ever-increasing influx 
of mental patients to our state hospitals. With that funda- 
mental idea in mind, the work of the Division quite naturally 
divided itself into two major activities: (1) research work of 
the laboratory type in neuropathology, physiology and pharma- 
cology, supplemented by clinical investigations with patients 
already in state institutions, and (2) the organization and 
development of adequate clinical facilities throughout the State 
for the purpose of permitting those suffering from incipient 
mental disorders to have the same opportunity for consultation 
and treatment as those individuals suffering from physical dis- 
orders, and for the first time this clinical service was extended 
to include children with undesirable habits, personality dis- 
orders, and delinquent trends, all of which bear a close rela- 
tionship to the maladjustments of later life. 
It seemed wise at the time the Division of Mental Hygiene 
was created (as it still does to the Director) that the ultimate 158 
HOUSE —No. 2400. 
[Mar. 
responsibility of both the research of the laboratory type and 
the organization of the clinical facilities of the community be 
delegated to the twelve state hospitals and the three schools for 
the mental defectives situated throughout the State, and that 
the interests of both the clinical and the laboratory work would 
be best served by the Division of Mental Hygiene stimulating 
and co-ordinating the various activities throughout the State, 
giving particular attention to those centers where help was 
most needed. 
The most important aspect or research of any type is per- 
sonnel, and it soon became obvious that those best equipped 
by education, training and experience were already participat- 
ing in activities of various kinds which would not permit their 
being employed on a full-time basis by the State. The question 
of adequate compensation would have also prevented such a 
plan. The Director found no difficulty, however, in interesting 
a limited number of qualified physicians to engage in directing 
research activities and to get the co-operation of those already 
employed by the State. Drs. Harry C. Solomon, Abraham 
Myerson, Oscar J. Raeder, Myrtelle Canavan and Paul Yakov- 
lev are some of the outstanding physicians who have co-op- 
erated and contributed to the research work. 
In the organization and development of the clinical facilities, 
the staffs of the various state hospitals were found adequate 
to deal with the incipient mental illnesses of adult life. It was, 
however, necessary to start the training of an entirely new 
group of psychiatrists, social workers and psychologists in 
dealing with the problems of children. 
The clinics and staff conferences which have been held weekly 
for the past fifteen years have been used for the purpose of 
training students in social work, psychology and psychiatry. 
The Division of Mental Hygiene has co-operated with the 
Smith School for Psychiatric Social Work and with the School 
for Social Work at Simmons College, and anticipates working 
with the new School of Social Work connected with Boston 
College. Psychiatrists from time to time have also received 
short periods of training at the clinics. These men, to a very 
large extent, have been recruited from our own state hospitals. 
The clinics are always available for such training. We have no 
record of the actual number of men and women who have 
availed themselves of the opportunity of working at the clinics, 
but they have come from Monson, Danvers, Taunton, West- 
borough and Northampton. 1939.] 
HOUSE —No. 2400. 
159 
Although the clinics were organized and developed primarily 
as therapeutic centers, we have not lost sight of the value of 
the accumulation of clinical data for research purposes. There 
is appended a list of the papers which have been written and 
published by the Division of Mental Hygiene dealing with the 
various phases of child psychology, family relationships and 
mental hygiene. 
Keeping in mind the importance of educating the public, the 
Division of Mental Hygiene has had a very close working plan 
with the Massachusetts Society for Mental Hygiene. These 
two organizations have participated in no small amount of 
educational work during the past fifteen years, — education in 
the sense that throughout the State many parents, teachers, 
nurses, doctors and social agencies have been awakened to the 
need of recognizing early symptoms of maladjustment in chil- 
dren which lead to delinquency and mental instability in later 
life, and to seek assistance from the sources available through- 
out the State which are operated by both public and private 
organizations. In other words, the Massachusetts Society for 
Mental Hygiene with the Division has attempted to educate 
the public with reference to the needs for the type of clinic which 
the Division of Mental Hygiene, with the co-operation of the 
state hospitals, has been organizing. This educational work 
has been done very largely through lectures, radio and the 
printed word, stressing the importance of mental health as a 
factor in the individual’s happiness and efficiency, and attempt- 
ing to provide facilities for the protection of mental health com- 
parable to those the public enjoys for the protection of physical 
health. 
The pamphlets and monographs prepared by the Division 
of Mental Hygiene, including “Child Management” and 
“Guiding the Adolescent,” have had considerable educational 
value. “Child Management” was published by the Children’s 
Bureau in Washington, and over a million copies have been 
distributed. A series of pamphlets relating to personality 
deviations and undesirable habits in children was published 
by the National Committee for Mental Hygiene, and had an 
extremely wide distribution and are still being used in various 
clinics throughout the country. These particular pamphlets 
were reprinted in several different languages for the purpose 
of making them more valuable to the foreign elements coming 
to the clinics. One might add in passing that the clinics have 
received visitors from practically every part of the world. 160 
HOUSE — No. 2400. 
[Mar. 
This recognition is mentioned, as it perhaps bears some evi- 
dence of the value placed upon what the State of Massachusetts 
has done in the field of mental hygiene. 
A survey of the laboratory activities for the past fifteen years 
would be extremely difficult to present in any concise form, 
but a carefully prepared bibliography is appended of the re- 
searches, authors and place of publication of work that has 
been done by or in co-operation with the Division of Mental 
Hygiene since it was first organized. These researches have 
been directed to a very large extent by Dr. Abraham Myerson 
at the Boston State Hospital, Dr. Harry C. Solomon at the 
Boston Psychopathic Hospital, Dr. Roy Hoskins at the Worces- 
ter State Hospital, and the Director of the Division with, as 
will be noted, numerous collaborators. 
In an effort to create more interest in research problems 
throughout the state hospitals, and to aid and stimulate those 
who might have contributions to make in the field of research, 
Dr. Overholser, in May, 1935, appointed a Department Re- 
search Committee made up of Drs. Myerson, Thom, Hoskins, 
Dayton and Solomon. This committee was selected for the 
purpose of stimulating and co-ordinating research in the various 
institutions under the Department of Mental Diseases, feeling 
that a group of workers interested in various aspects of re- 
search would be in a position to contribute more generously 
to the needs of the individual hospitals and the schools which 
came under the supervision of the Department. To each 
member of the Research Committee was assigned a group of 
hospitals which he was to investigate as to the research work 
being pursued, the facilities for such work, and what members 
of the staff, if any, were prepared to assume research responsi- 
bilities. The committee has given the matter of research con- 
siderable attention, held several meetings, received protocols 
outlining certain types of research from various members of 
the hospital staffs, and has co-operated with these individual 
members in an attempt to promote research activities. 
One of the functions of the Research Committee was to guide 
and direct those members of the state hospital staffs who were 
interested in research and urge them to take up a specific 
problem, either clinical, statistical or from the laboratory, and 
to pursue it in such a careful, critical manner that our knowl- 
edge about mental illness would be enhanced because of these 
efforts. There are many young people on the hospital staffs 
who have a desire to do something more than the routine 1939.] 
HOUSE — No. 2400. 
161 
hospital duties, but who are unfamiliar with the techniques 
and disciplines of research, and who are not oriented as to 
what has been done in a particular field of research, or even 
how to obtain the information that is available with reference 
to the particular subject in which they are interested. The 
research activities of the entire state hospital services might 
well be given a great impetus in the right direction if this 
Research Committee were enlarged so as to include outstand- 
ing physicians, physiologists and chemists who are working in 
other fields of medicine. This topic is to be considered in 
more detail in the report of the subcommittee organized to 
make a study of the Department of Mental Diseases. 
The objectives for which the Division of Mental Hygiene 
has been working have been outlined in a very general way, 
and there is appended a record of the activities of the labora- 
tory researches and clinical activities under the organization. 
The report of the subcommittee already mentioned should 
cover in more detail how best a Division of Research can serve 
the needs of the State. Inasmuch as this report is to be in 
the hands of your committee in the near future, it is only 
mentioned in passing. 
Appended to this general statement is — 
1. A list of researches. 
2. A list of clinics conducted by the state hospitals and the 
Division of Mental Hygiene, with a separate list of those 
clinics which have been organized by the Division of Mental 
Hygiene and the supervision which they have at the present 
time. 
3. A list of appropriations and expenditures of the Division 
of Mental Hygiene since it was started in 1922. This table 
also indicates the amount of money which has been expended 
by the dementia praecox researches and the child guidance 
clinic at the Worcester State Hospital. HOUSE — No. 2400. 
[Mar. 
162 
List of Publications. 
Thom, Douglas A.: Alcohol as a Factor in the Production of Epilepsy 
and Allied Convulsive Disorders. Bulletin of the Massachusetts 
Department of Mental Diseases, Vol. II, No. 2, July, 1918. 
Thom, Douglas A., and Singer, H. Douglas; The Care of Neuro- 
Psychiatric Disabilities. Bulletin of the Massachusetts Depart- 
ment of Mental Diseases, Vol. V, No. 4, Oct., 1921. 
Thom, Douglas A.: Results and Future Opportunities in the Field of 
Clinics, Social Service and Parole. Mental Hygiene, Vol. VI, No. 
4, Oct., 1922. 
Taylor, Marianna: The Child in the Home. Mental Hygiene, 
Vol. VI, No. 4, Oct., 1922. 
Wirt, Margaret: The Laws of Massachusetts for the Care and 
Protection of Children. 1922. 
Thom, Douglas A.: Mental Problems of Childhood. Bulletin of 
the Massachusetts Department of Mental Diseases, January, 1923. 
Thom, Douglas A.: The Organization and Development of Mental 
Clinics for Community Care. Bulletin of the Massachusetts De- 
partment of Mental Diseases, Vol. VII, No. 4, Dec., 1923. 
Thom, Douglas A.; Colony of Gheel. Bulletin of the Massachu- 
setts Department of Mental Diseases, Vol. VII, No. 4, Dec., 1923. 
Thom, Douglas A.: The Relation between Infantile Convulsions 
and the Chronic Convulsive Disorders of Later Life. Archives of 
Neur. and Psych., 1924. 
Reynolds, Bertha: Interpretation of the Social Work, Division of 
Mental Hygiene. Bulletin of the Massachusetts Department of 
Mental Diseases, Vol. VIII, April, 1924. 
Graham, Virginia; The Intelligence of Italian and Jewish Children 
in the Habit Clinics of the Massachusetts Division of Mental Hy- 
giene. 1924. 
Thom, Douglas A.: Infantile Convulsions, their Frequency and 
Importance. 1925. 
Ruddiman, Helen: Environment as a Factor in Acute Personality 
Changes in Children. 1925. 
Toben, Louise: The Relationship between Enureses and Mastur- 
bation in Children, 1925. 
Foster, Sybil: A Study of the Personality Make-up and Social 
Setting of Fifty Jealous Children. Bulletin of the Massachusetts 
Department of Mental Diseases, Vol. IX, Dec., 1925. 
Hardwick, Rose S.: The Fellowship of Kindred Minds — Picture 
from the Office of our Psychologist. Little Wanderers’ Advocate, 
Nov., 1925. 
McCollister, Crystal L.: A Study of Habit Clinic Children hav- 
ing Convulsions. 1926. 
Peck, Eleanor : Habit Changes in the Pre-School Child as Demon- 
strated by the Play School. 1926. 1939.] 
HOUSE —No. 2400. 
163 
Thom, Douglas A.: The Importance of Early Years. Bulletin of 
the Massachusetts Department of Mental Diseases, Vol. X, Oct., 
1926. 
Reynolds, Bebtha C.: Environmental Handicaps of Four Hun- 
dred Habit Clinic Children. Bulletin of the Massachusetts De- 
partment of Mental Diseases, Vol. X, Oct., 1926. 
Thom, Douglas A.: General Problems of the United States Vet- 
erans’ Bureau. Bulletin of the Massachusetts Department of 
Mental Diseases, Vol. X, Nos. 3 and 4, Oct., 1926. 
Foster, Sybil: Personality Deviations and their Relation to the 
Home. Bulletin of the Massachusetts Department of Mental 
Diseases, Vol. X, Oct., 1926. 
Hardwick, Rose S.: Certain Aspects of the Psychology of the Pre- 
School Child. Massachusetts Department of Public Health, Vol. 
14, No. 1, March, 1927. 
Hardwick, Rose S.: The Use and Abuse of Psychological Exami- 
nations. Little Wanderers’ Advocate, March, 1927, 
Hardwick, Rose S.: Intelligence and Conduct. Chapter in “Every- 
day Problems of the Everyday Child.” Published by D. Appleton 
& Co., 1927. 
Weill, Blanche: Toys and Companions. Chapter in “Everyday 
Problems of the Everyday Child.” Published by D. Appleton & Co., 
1927. 
Thom, Douglas A.: Everyday Problems of the Everyday Child 
(book). Published by D. Appleton & Co., 1927. 
Hardwick, Rose S,: The Psychological Examination, What it is 
and is not. Child Welfare League of America Bulletin, Oct. 15, 
1927. 
Thom, Douglas A.: Infantile Convulsions, their Frequency and 
Importance. Bulletin of the Massachusetts Department of Mental 
Diseases, Vol. XI, No. 4, April, 1927. 
Cooper, Olive A.: Parental Attitudes and their Relation to Neu- 
rotic Traits. Bulletin of the Massachusetts Department of Mental 
Diseases, Vol. XI, Oct., 1927. 
Partch, Maurine: A Study of All Habit Clinic Children Examined 
During the Year 1927. 
Bellerose, Dorothea: A Study of the Behavior Problems of Only, 
Oldest, Middle and Youngest Children. 1927. 
Hardwick, Rose S.: The Left-handed Child. Journal of National 
Educational Association, Nov., 1928. 
Thom, Douglas A.: Book Review of “Shell Shock and its After- 
math,” by Norman Fenton. Mental Hygiene, Vol. XII, No. 2, 
April, 1928. 
Cooper, Olive A.; Habit Clinics and their Purpose. Massachusetts 
Department of Public Health, April, 1929. 
Foster, Sybil, and Stebbins, Dorothy: Problems Presented and 
Results of Treatment in One-Hundred-Fifty Cases Seen at the 164 
HOUSE —No. 2400. 
[Mar. 
Habit Clinic for Pre-School Children in Boston. Mental Hygiene, 
Vol. XIII, No. 3, July, 1929. 
Hall, Dorothy E.: Domestic Conflict and its Effect on the Chil- 
dren. Bulletin of the Massachusetts Department of Mental Dis- 
eases, Vol. XIII, April, 1929. 
Hardwick, Rose S.: Report of the Annual Meeting of the American 
Psychological Association. Bulletin of the Massachusetts De- 
partment of Mental Diseases, Vol. XIII, April, 1929. 
Robbins, Samuel D.: Speech Correction in the Habit Clinics. Bul- 
letin of the Massachusetts Department of Mental Diseases, Vol. 
XIII, Nos. 1 and 2, April, 1929. 
Division of Mental Hygiene, Massachusetts Society for Men- 
tal Hygiene. Community Health Association: Literature for 
Parents on Habit Training for Children. Bulletin of the Massa- 
chusetts Department of Mental Diseases, Vol. XIII, Nos. 1 and 2, 
April, 1929. 
Hardwick, Rose S.: Scores Versus Aptitudes. Little Wanderers’ 
Advocate, June, 1929. 
Thom, Douglas A.: The Importance of the Individual in the Treat- 
ment of Epilepsy. Bulletin of the Massachusetts Department of 
Mental Diseases, Vol. XIV, Oct., 1930. 
Thom, Douglas A.: Psychotherapy in Private Practice. Read be- 
fore the American Psychiatric Assoc., June, 1932. 
Cooper, Olive A.; The Place of Mental Hygiene in the Public School 
Plan. School Hygiene Hand Book of Department of Public Health, 
1930. 
Thom, Douglas A.: Child Training and Parental Education. Paper 
read at White House Conference, 1930. 
Thom, Douglas A.: Medical Attitude Toward the Sex Education 
of Childhood. Paper read at White House Conference, 1930. 
Cooper, Olive A.: Psychological Hazards of the Adolescent in In- 
dustry. 1930. 
Hardwick, Rose S.: Why I Believe in Nursery Schools. Nursery 
Training School News, Nov., 1930. 
Cooper, Olive A.: Neurotic Traits and their Relation to Later Diffi- 
culties. 1931. 
Saunders, Margaret: Short Auditory Span Disability. Childhood 
Education, Oct., 1931. 
Bogardus, Helen: Standardization of Ellis Memory Test for Chil- 
dren of Three to Seven Years Old. 1931. 
Sears, Florence: Some Possible Motives in Sexual Delinquency 
in Children of Normal Intelligence. Smith College Studies in Social 
Work, Sept., 1931. 
Hardwick, Rose S.: Difficulties of Speaking, Hearing and Seeing, 
Understanding the Child. April, 1932. 1939.] 
HOUSE— No. 2400. 
165 
Hardwick, Rose S.; The Psychologist in the Habit Clinics. Psy- 
chological Exchange, Oct., 1932. 
Thom, Douglas A.: Mental Hygiene and the Depression. Mental 
Hygiene, Yol. XVI, No. 4, Oct., 1932. 
Thom, Douglas A.: Habits: their Formation, their Value, their 
Danger. Mental Hygiene, Vol. XVI, No. 3, July, 1932. 
Thom, Douglas A.: Education and Crime. Harvard Teachers’ 
Record, April, 1932. 
Thom, Douglas A.: Mental Hygiene and the College Student. 1932. 
Thom, Douglas A.: Normal Youth and its Everyday Problems 
(book). D. Appleton & Co., New York, 1932. 
Cooper, Olive A.: The Place of Occupational Therapy in a Psycho- 
therapeutic Program. 1932. 
Robbins, Samuel D.: The Relation between the Short Auditory 
Memory Span, Disability and Disorders of Speech. Read at Ameri- 
can Society for the Study of Disorders of Speech, St. Louis, Nov., 
1932. 
Cooper, Olive A.: Habits as a Basis for Health. 1932. 
Hardwick, Rose S.: The Types of Reading Disability. Childhood 
Education, April, 1932. 
Thom, Douglas A., and Blake, Mabelle B.: The Significance of 
Mental Hygiene in College. June, 1932. 
Berk, Arthur; Lane, Leonore; and Tandy, Myrtle: Personality 
Study of One Hundred Parents. Bulletin of Massachusetts De- 
partment of Mental Diseases, Vol. XVII, Nos. 1 and 2, April, 1933. 
Berk, Arthur; Lane, Leonore; and Tandy, Myrtle: A Study of 
the Relationships between the Problems of Habit Clinic Patients 
and their Parents. Bulletin of the Massachusetts Department of 
Mental Diseases, Vol. XVII, Nos. 1 and 2, April, 1933. 
Berk, Arthur; Lane, Leonore; and Tandy, Myrtle: Follow-up 
Study of Thirty Habit Clinic Children who Manifested Delinquency 
Problems before the Age of Ten Years. Bulletin of the Massa- 
chusetts Department of Mental Diseases, Vol. XVII, Nos. 1 and 2, 
April, 1933. 
Cooper, Olive A.: Adolescence. 1933. 
Pigois, Paul: Leadership and Domination Among Children. The 
Sociologist, June, 1933. (Material on cases for the paper furnished 
by the Division of Mental Hygiene.) 
Hoskins, Ethel: Ten Years of Social Work in the Habit Clinics of 
the Division of Mental Hygiene, from 1923 to 1933. Bulletin of the 
Massachusetts Department of Mental Diseases, Vol. X'VIII, A os. 
3 and 4, Oct., 1934. 
Lane, Leonore: Study of Twenty-Five Habit Clinic Children whose 
Parents are Well-Adjusted Individuals. 1934 (not published). 
Spencer, Harvey: Adoption of Children. Bulletin of the Massa- 
chusetts Department of Mental Diseases, Vol. XIX, Nos. 1 and 2, 
April, 1935. 166 
HOUSE —No. 2400. 
[Mar. 
Thom, Douglas A.: Parent-Child Relationship. Bulletin of the 
Massachusetts Department of Mental Diseases, Vol. XIX, Nos. 
1 and 2, April, 1935. 
Thom, Douglas A., and Winslow, Dorothy C.: A Follow-up Study 
of Fifty Problem Children with Poor Prognoses and Fifty Problem 
Children with Good Prognoses. Bulletin of the Massachusetts De- 
partment of Mental Diseases, Vol. XIX, Nos. 1 and 2, April, 1935. 
Culbert, Eleanor: The Relationship between Emotional Disturb- 
ances and School Retardation. 1935 (not published). 
Thom, Douglas A.; Spencer, Harvey; Berk, Arthur; Stone, 
Sybil; Lane, Leonore; and Johnston, Florence: A Study of 
One Hundred and Twenty Well-Adjusted High School Students. 
Bulletin of the Massachusetts Department of Mental Diseases, Vol. 
XX, Oct., 1936. 
Thom, Douglas A.: Psychiatric Implications of Education — The 
Pre-School Period. American Journal of Psychiatry, Vol. 92, No. 4, 
Jan., 1936. 
Stone, Sybil: A Study of Psychological Re-Testing of the Habit 
Clinic Children to Determine whether Re-Tests are Sufficiently 
Helpful to the Children to Justify the Expenditure of Time and 
Money Involved. 1936 (not published). 
Johnston, Florence S.: A Follow-up Study of Sixty Habit Clinic 
Cases, Half of which Improved during Clinic Contact and Half of 
which did not Improve, with the Hope of Determining the value of 
Therapeutic Methods and the Permanency of Results. 1936 (not 
published). 
Stone, Sybil: Investigation of the Resources of Infant Testing. 1936 
(not published). 
Newell, Nancy: Educational Background of One Hundred Young 
Women Delinquents. Pi Lambda Theta, 1936. 
Robbins, Samuel D.: Relative Attention Paid to Vowels and Con- 
sonants by Stammerers and Normal Speakers. Proceedings of the 
American Speech Correction Association, Vol. VI, 1936. 
Thom, Douglas A., and Smith, Richard M.: Childhood, Vol. I, 
“Health: Physical, Mental and Emotional” (book). Houghton 
Mifflin Co., 1937. 
Robbins, Samuel D.: The Cause of Reading Disabilities and their 
Remedy. Journal of Speech Disorders, Vol. 2, No. 2, June, 1937. 
Robbins, Samuel D.: The Correction of Speech Defects of Early 
Childhood (a clinical manual). Expression Co., Boston, 1937. 
Robbins, Samuel D.: What Causes Stammering? Emerson Quar- 
terly, April, 1937. 
Robbins, Samuel D.: Address before the Senate Committee on Edu- 
cation, Washington, D. C., on the importance of passing Bill, S. 1634, 
to provide for the education of all types of physically handicapped 
children. Published in the Official Proceedings of the Hearing. 1939.] 
HOUSE —No. 2400. 
167 
Thom, Douglas A.: Psychotherapy in Private Practice. Read be- 
fore the American Psychiatric Assoc., June, 1932. 
Laxe, Leonore: A Statistical Study of Two Hundred Italian Habit 
Clinic Children. 1934 (not published). 
Laxe, Leoxore: Statistical Study of All Children Treated in the 
Habit Clinics between Dec., 1926, and Dec., 1931. 1934. 
In Process. 
Newell, Nancy: A Statistical Analysis of All the Habit Clinic Cases 
During the Ten-Year Period. 
Culbert, Eleanor: Comparison of Results from Goodenough Draw- 
ing and Manikin Tests. 
Berk, Arthur: The Management of Convulsive Disorders in an 
Out-Patient Department. 
Berk, Arthur; The Attitude of the Well-Adjusted Child toward his 
Parents, with Special Consideration of the Parent-Child Relation- 
ship. 
Robbins,,Samuel D.; Russel, G. Oscar; and Hawk, Sara Stinch- 
field: A Revised and Enlarged Dictionary of Terms Dealing with 
Disorders of Speech, and a Causal Classification of Disorders of 
Speech and Voice. 
Thom, Douglas A., and Johnston, Florence S.: Revision of a 
Study of One Hundred and Twenty Well-Adjusted High School 
Students (including a later follow-up study of the same cases). 
Thom, Douglas A., and Johnston, Florence S.: A Follow-up 
Study of Boys from Eight to Thirteen Years, inclusive, who at- 
tended the Habit Clinic during a Five-Year Period, and mani- 
fested Pre-Delinquent Behavior and Certain Adverse Personality 
Deviations. 
List of Publications from the Division of Psychiatric Research, 
1925-37, Boston State Hospital. 
Group 1. Chemistry of the Brain. 
A group of studies on the pressure and the chemistry of the brain 
was carried out for several years, the basis of the study being a jugular 
puncture, by which it became possible to study blood directly coming 
from the brain, in so far as its chemistry and pressure were concerned. 
This technique is now quite widely used as a means of studying brain 
activity, and has been utilized notably by the Boston City Hospital 
Research Division in studies on circulation of the brain and epilepsy. 
This series of publications directly demonstrated those factors 
which influence the pressure within the brain as well as showed that 
the brain is an active metabolic organ using up sugar and oxygen 
in very definite amounts, and indicated the conditions under which 168 
HOUSE— No. 2400. 
[Mar. 
this use of sugar was increased and decreased. To illustrate this 
point, the pressures within the head were found to be markedly 
changed by drugs and by posture. Further, the effect of insulin, 
a chemical substance largely used in treatment of various conditions, 
and lately introduced into the treatment of general paresis, has been 
shown to be associated with a marked change in the use of oxygen 
by the brain; that is to say, if a large dose of insulin is given, the brain 
uses much less oxygen than previously, and may be thrown into a 
serious condition, due to what amounts to asphyxiation. 
Myerson, A; Hirsch, H. L.; and Halloran, R. D.: Intra-Carotid 
Route in the Treatment of General Paresis. Boston M. and S. J, 
192, 712-716, 1925. 
Myerson, A.; Halloran, R. D.; and Hirsch, H. L.: Technic for 
Obtaining Blood from the Internal Jugular Vein and Internal 
Carotid Artery. Arch. Neurol, and Psychiat. 17: 807-808 (June), 
1927. 
Myerson, A., and Halloran, R. D.: Studies of the Biochemistry 
of the Brain Blood by the Internal Jugular Puncture. Am. J. 
Psychiat. 10, 3:389-406 (Nov.), 1930. 
Myerson, A., and Roman, J.: Internal Jugular Venous Pressure and 
its Relationship to Cerebrospinal Fluid Pressure. J. Nerv. and Ment. 
Dis. 74, 192-194 (Aug.), 1931. 
Myerson, A.; Roman, J.; Edwards, H. T.; and Dill, D. B.: The 
Composition of Blood in the Artery, in the Internal Jugular Vein 
and in the Femoral Vein during Oxygen Want. Am. J. Physiol. 
98, 3:373-377 (Oct.), 1931. 
Myerson, A., and Roman, J.: Internal Jugular Venous Pressure in 
Man. Its Relationship to Cerebrospinal Fluid and Carotid Ar- 
terial Pressures. Arch. Neurol, and Psychiat. 27, 836-846 (Apr.), 
1932. 
Roman, J., and Myerson, A.; The Action of Certain Drugs on the 
Cerebrospinal Fluid and on the Internal Jugular Venous and Sys- 
temic Arterial Pressures of Man. Arch. Neurol, and Psychiat. 
27, 1226-1244 (May), 1932. 
Dameshek, W., and Roman, J.: Direct Intra-Arterial Blood Pres- 
sure Readings in Man. Am. J. Physiol. 101, 1: 140-148 (June), 
1932. 
Dameshek, W.; Myerson, A.; and Roman, J. The Effects of So- 
dium Amytal on the Metabolism. Am. J. Psychiat. 91, 1:113-135 
(July), 1934. 
Dameshek, W., and Myerson, A.: Insulin Hypoglycemia. Arch. 
Neurol, and Psychiat. 33, 1-11 (June), 1935. 
Roman, J.; Myerson, A.; and Goldman, D.: Effects of Alterations 
in Posture on the Cerebrospinal Fluid Pressure. Arch. Neurol, 
and Psychiat. 33, 1279-1295 (June), 1935. 1939.] 
HOUSE —No. 2400. 
169 
Loman, J.; Dameshek, W.; Myerson, A.; and Goldman, D.: Effect 
of Alterations in Posture on the Intra-Arterial Blood Pressure in 
Man. I. Pressure in the Carotid, Brachial and Femoral Arteries 
in Normal Subjects. II. Pressure in the Carotid Artery in Arterio- 
sclerosis, during Syncope and after the Use of Vasodilator Drugs. 
Arch. Neurol, and Psychiat. 35, 6: 1216-1232 (June), 1936. 
Loman, J., and Myerson, A.: Visualization of the Cerebral Vessels 
by Direct Intracarotid Injection of Thorium Dioxide (Thorotrast). 
Am. J. Roent. and Radium Therapy 35, 2: 188-193 (Feb.), 1936. 
Loman, J., and Myerson, A.: Studies in the Dynamics of the Hu- 
man Craniovertebral Cavity. Am. J. Psychiat. 92, 4; 791-815 (Jan.), 
1936. 
Group II. Human Autonomic Pharmacology. 
In this series of studies the effects of chemical substances which 
operate very much as does one part of the nervous system, the auto- 
nomic nervous system, have been extensively studied on the various 
organs of the body. As an immediate practical result, it may be stated 
that the influence of benzedrine sulfate on the mood of man has been 
definitely established, and it has been found that in certain condi- 
tions a very beneficial effect is produced by this drug, whereas in other 
conditions no effect, or even harmful effects, may be had. Moreover, 
the X-ray study of the gastrointestinal tract has been definitely helped 
by use of this drug, in that it tends to relieve spasm of the intestine in 
a very marked measure. A great deal of light has been thrown on the 
physiology of the body as related to the activity of autonomic drugs 
by these publications, and it may be stated that the exhibit of the 
laboratory was one of the few to receive honorable mention at the 
last American Medical Association convention. 
Myerson, A., and Ritvo, Max: Benzedrine Sulfate and its Value 
in Spasm of the Gastrointestinal Tract. J. A. M. A. 107, 1: 24-26 
(July 4), 1935. 
Myerson, A.; Roman, J.; and Dameshek, W.; Physiologic Effects 
of Benzedrine and its Relationship to Other Drugs affecting the 
Autonomic Nervous System. Am. J. Med. Sci. 192, 4: 560-574 
(Oct.), 1936. 
Myerson, A.: Effect of Benzedrine Sulfate on Mood and Fatigue 
in Normal and in Neurotic Persons. Arch. Neurol, and Psychiat. 
36, 4:816-822 (Oct.), 1936. 
Myerson, A.; Rinkel, M.; and Dameshek, W.: The Autonomic 
Pharmacology of the Gastric Juices. New England J. Med. 215, 
22:1005-1013 (Nov. 26), 1936. 
Myerson, A.; Roman, J.; and Dameshek, W.: Physiologic Effects 
of Acetyl-Beta-Methylcholine (Mecholyl) and its Relationship to 
Other Drugs affecting the Autonomic Nervous System. Am. J. 
Med. Sci. 193, 2, 198 (Feb.), 1937. 170 
HOUSE —No. 2400. 
[Mar. 
Schube, P. G.; Ritvo, M.; Myerson, A.; and Lambert, R.: Human 
Autonomic Pharmacology. IV. The Effect of Benzedrine Sul- 
fate on the Gall-bladder. New England J. Med. 216, 16: 
(Apr. 22), 1937. 
Myerson, A.; Schube, P. G.; and Ritvo, M.: Human Autonomic 
Pharmacology. V. The Effect of Acetyl-Beta-Methylcholine 
(Mecholyl) on the Atonic Colon. Radiology, 28, 552 (May), 1937. 
Myerson, A.; Loman, J.; and Rinkel, M.: Human Autonomic 
Pharmacology. VI. General and Local Sweating, produced by 
Acetyl-Beta-Methylcholine Chloride (Mecholyl). Am, J. Med. 
Sci. 194, 1:75-79 (July), 1937. 
Dameshek, W.; Loman, J.; and Myerson, A.; Human Autonomic 
Pharmacology. VJL The Effect on the Normal Cardiovascular 
System of Acetyl-Beta-Methylcholine Chloride, Atropine, Prostig- 
min, Benzedrine, with Especial Reference to the Electrocardio- 
gram. Am. J. Med. Sci. To be published. 
Loman, J.; Rinkel, M.; and Myerson, A.: Human Autonomic 
Pharmacology. VIII. The Effect of Iontophoresis on the Gastric 
Juices with Especial Reference to Acetyl-Beta-Methylcholine 
Chloride (Mecholyl). Am. J. Digest, Dis. and Nutr. 4, 6: 385-390 
(Aug.), 1937. 
Myerson, A., and Thau, W.: Human Autonomic Pharmacology. 
IX. The Effect of Cholinergic and Adrenergic Drugs on the Eye. 
Arch. Ophth. 18, 78-90 (July), 1937. 
Myerson, A.; Rinkel, M.; Loman, J.; and Myerson, P.: Human 
Autonomic Pharmacology. X. The Synergism of Prostigmin and 
Mecholyl. J. Pharm. and Exper. Therap. 60, 3:296-311 (July), 
1937. 
Myerson, A., and Thau, W.: Human Autonomic Pharmacology. 
XI. The Effect of Benzedrine Sulphate on the Argyll Robertson 
Pupil. Arch. Neurol, and Psychiat. To be published. 
Myerson, A.: Human Autonomic Pharmacology. XII. Theories 
and Results of Autonomic Drug Administration. J. A. M. A. To 
be published. 
Greenberg, B.; Loman, J.; and Myerson, A.: Human Autonomic 
Pharmacology. XIII. The Effect of Mecholyl and Prostigmin on 
the Size and Tonus of the Urinary Bladder. To be published. 
Dameshek, W., and Feinsilver, 0.: Human Autonomic Pharma- 
cology. XIV. The Use of Acetyl-Beta-Methyl-Choline Chloride 
(Mecholyl) as a Diagnostic Test for Poisoning by the Atropine 
Series of Drugs. J. A. M. A. 109, 8: 561-564 (Aug. 21), 1937. 
Loman, J.; Lesses, M. F.; and Myerson, A.: Human Autonomic 
Pharmacology. XV. The Effect of Acetyl-Beta-Methyl-Choline 
Chloride (Mecholyl) by Iontophoresis on Arterial Hypertension. To 
be published. 
Lesses, M. F., and Myerson, A.: Human Autonomic Pharmacol- 
ogy. XVI. Benzedrine Sulphate as an Aid in the Treatment of 
Obesity. J. A. M. A. To be published. 1939.] 
HOUSE — No. 2400. 
171 
Rinkel, M.; Dameshek, W.; and Myerson, A.: Human Auto- 
nomic Pharmacology. XVII. A Comparative Study of the Action 
of Acetylcholine Chloride and Acetyl-Beta-Methylcholine Chloride. 
To be published. 
Schube, P. G.; Myerson, A.; Ritvo, M.; and Lambert, R.: Human 
Autonomic Pharmacology. XVIII. The Effect of Acetyl-Beta- 
Methylcholine Chloride on the Gall-bladder. To be published. 
Schube, P. G.; McManamy, M. C.; Trapp, C. E.; and Myerson, 
A.: The Effect of Benzedrine Sulfate on Certain Abnormal Mental 
States. Am. J. Psychiat. To be published. 
Group 111. Mineral Studies and Pathology. 
The role of the minerals in the functioning of the organism has 
become of increasing importance, just as the role of the vitamines 
has become highly significant. This laboratory utilized two new 
methods, — the microincineration method and the spectroscopic 
studies. These are highly technical procedures, involve a great deal 
of careful work, and certain fundamental papers on the subject have 
emanated from this laboratory. The first comprehensive study done 
on the minerals of the brain has come from this laboratory. It has 
been shown, for example, that young cells contain more minerals, and 
the older tissues of the body, including the brain, become deficient in 
minerals. In other words, one of the processes by which youth and 
old age are differentiated has come clearly to light. Furthermore, 
all actively growing tissues, such as tumors of various kinds, show an 
increased mineral activity. Perhaps more pertinently, as recently 
discovered by this laboratory, certain types of feeble-mindedness, 
hitherto of unknown physiology, are definitely associated in certain 
groups by differential mineral metabolism, and in other groups by an 
increased mineral activity. 
Alexander, L.; Myerson, A.; and Goldman, D.: The Mineral 
Content of Various Cerebral Lesions as Demonstrated by the Micro- 
incineration Method. Am. J. Path. 13, 3:405-439 (May), 1937. 
Alexander, L.: The Neurone as Studied by Microincineration. 
Anat. Rec. 67, 1937. 
Alexander, L., and Myerson, A.: Minerals in Normal and Patho- 
logic Brain Tissue, Studied by Microincineration and Spectros- 
copy. Arch. Neurol, and Psychiat. To be published. 
Alexander, L., and Campbell, A. C. P.: Local Anaphylactic Lesions 
of the Brain in Guinea Pigs. Am. J. Path. 13, 2: 229-248 (March), 
1937. 
Campbell, A. C. P.; Alexander, L.; and Putnam, T. J.: The 
Vascular Pattern in Various Lesions of the Human Central Ner- 
vous System. Studies with the Benzidine Stain. Arch. Neurol, 
and Psychiat. To be published. 172 
HOUSE — No. 2400. 
[Mar. 
Alexander, L.; Pijoan, M.; Schube, P. G.; and Moore, M.: Ascor- 
bic Acid Content of Blood Plasma in Alcoholic Psychoses. Arch. 
Neurol, and Psychiat. To be published. 
Myerson, A.; Leary, T.; and Hodgson, J. S.: Symposium — In- 
tracranial Pathology, Lesions, Diagnosis and Treatment. New 
England J. Med. 204, 984-992 (May 7), 1931. 
Group IV. Eugenics and Sterilization Studies. 
This group of studies was done by the Director and his associate, 
Dr. Leo Alexander, as the chairman and research associate, respec- 
tively, of a committee appointed by the American Neurological Asso- 
ciation. This work has thrown clear light on the limitations of any 
sterilization techniques in relationship to the present knowledge con- 
cerning mental disease and feeble-mindedness. This work definitely 
excludes epilepsy from the hereditary list of the diseases. Moreover, 
it demolishes many false assumptions made in the literature, and, on 
the whole, tends to establish in a clear and more precise manner the 
relationship of heredity to the mental diseases. This work has been 
officially endorsed by the American Neurological Association and by 
the American Eugenics Society. 
Myerson, A.: Researches in Feeble-mindedness with Special Rela- 
tionship to Inheritance. Bulletin of the Massachusetts Department 
of Mental Diseases, 14, 1 and 2: 108-229 (April), 1930. 
Myerson, A.: The Pathological and Biological Bases of Mental 
Deficiency. Reprinted from the Proc. of the 54th Annual Session 
of the American Association for the Study of the Feeble-minded, 
held at Washington, D. C., May 5-7, 1930. 
Myerson, A.: Nature of Feeble-mindedness. Am. J. Psychiat., Vol. 
12, No. 6: 1205-1226 (May), 1933. 
Myerson, A.: A Critique of Proposed “Ideal” Sterilization Legisla- 
tion. Arch. Neurol, and Psychiat. 33, 453-463 (March), 1935. 
Myerson, A. (Chairman): Report of the Committee for the Investi- 
gation of Sterilization. American Neurological Association, June 5, 
1935. 
Myerson, A.: Summary of the Report of the American Neurological 
Association Committee for the Investigation of Sterilization. Am. 
J. Psychiat. 92, 3:615-625 (Nov.), 1935. 
Myerson, A. (Chairman): Eugenical Sterilization — A Reorienta- 
tion of the Problem, by the Committee of the American Neurologi- 
cal Association for the Investigation of Sterilization. The Mac- 
Millan Co., New York, Oct., 1936, pp. 211. 
In this series of papers the Director has attempted to make clear 
the various developments of the symptom groups constituting the 
V. The Neuroses. 1939.] 
HOUSE —No. 2400. 
173 
neuroses, and to bring them into line with physiology as well as psy- 
chology. It cannot, of course, be stated that any direct practical 
results have followed, except so far as a clearer and more precise 
definition of a problem is the first essential to desired results. 
Myerson, A.: The Physiological Approach to the Psychoneurosis. 
Bulletin of the Massachusetts Department of Mental Diseases, 15, 
1 and 2 (April), 1931. 
Myerson, A.: Neuroses and Neuropsychoses. The Relationship of 
Symptom Groups. Am. J. Psychiat. 93, 2:263-301 (Sept.), 1936. 
Myerson, A.: Neuroses and Neuropsychoses. Illustrative Case His- 
tories. Am. J. Psychiat. To be published. 
These include by-products of the various activities of the labora- 
tory, have received attention in the literature, and are part of the 
general progress of medicine. 
Group VI. Other Studies. 
Roman, J.: Comparison of Treated and Untreated Cases of General 
Paresis. Bulletin of the Massachusetts Department of Mental Dis- 
eases, 15, 1 and 2 (April), 1931. 
Stephenson, C.: Sedimentation Rates in Various Psychoses. Bulle- 
tin of the Massachusetts Department of Mental Diseases, 15, 1 
and 2 (April), 1931. 
Dameshek, W.: The White Blood Cells in General Paresis. Bulletin 
of the Massachusetts Department of Mental Diseases, 15, 1 and 2 
(April), 1931. 
Myerson, A.: Inheritance and Environment in Relation to Per- 
sonality. Mental Health Bull. 111. Soc. for Ment. Hyg. 9, 5: 1-4 
(Feb.), 1931. 
Myerson, A.; Social Psychiatric Aspects of the Minor Delinquent. 
Am. J. Psychiat. 13, 3:501-517 (Nov.), 1933. 
Myerson, A., and Roman, J.: Progress in Neurology, 1932. New 
England J. Med. 210, 314-322 (Feb. 8), 1934. 
Dameshek, W.: Primary Hypochromic Anemia (Hypoferrism). 111. 
West Va. Medical J. 30, 5 (May), 1934. 
Myerson, A., and Berlin, D.; A Case of Post-Encephalitic Parkin- 
son’s Disease treated by Total Thyroidectomy. New England J. 
Med. 210, 23: 1205-1206 (June 7), 1934. 
Myerson, A.; The Social Conditioning of the Visceral Activities. 
New England J. Med. 211, 5: 189-192 (Aug.), 1934. 
Dameshek, W., and Castle, W. B.: Assay of Commercial Extracts 
of Liver for Parenteral Use in Pernicious Anemia. J. A. M. A. 103, 
802-806 (Sept. 15), 1934. 
Roman, J.: Progress in Neurology in 1933. New England J. Med. 212, 
1: 13-25 (Jan. 3), 1935. 174 
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[Mar. 
Myerson, A.: Hysterical Paralysis and its Treatment. J. A. M. A. 
105, 20:1565-1567 (Nov. 16), 1935. 
Myerson, A.: Relation of Trauma to Mental Diseases. Am. J. 
Psychiat. 92, 5:1031-1038 (March), 1935. 
Loman, J.: Progress in Neurology in 1935. New England J. Med. 
216, 2: 56-64 (Jan. 14), 1937. 
It must be stated in relationship to all research that what one 
laboratory does becomes the starting point for the activities of another 
laboratory. There is a collaboration in science which is of vital im- 
portance. The work of this laboratory, it can be stated without undue 
modesty, has become firmly incorporated into the working technique 
of medicine at the present time. Most of the problems of psychiatry 
are still unsolved. This laboratory’s work is in direct line to then- 
solution. That solution may not come for a generation or two, but 
this is a short time in science, and especially in those extraordinarily 
difficult problems which relate to the mind of man. 
List of Publications feom the Department of Therapeutic 
Research, Boston Psychopathic Hospital. 
Solomon, H. C.; A Review of Recent Literature on Neurosyphilis. 
Arch. Neurol, and Psychiat., Feb., 1922, Vol. VII, pp. 235-248. 
Solomon, H. C.; Thompson, L. J.; and Pfeiffer, H. M.; Circu- 
lation of Phenosulphonephthalein in the Cerebrospinal System. 
Jour. Amer. Med. Assoc., Vol. 79, p. 1014, Sept. 23, 1922. 
Solomon, H. C.: Serious Cases of Mental Diseases or So-Called In- 
sanity. Massachusetts Department of Public Health, Boston, 1922, 
IX, pp. 42-44. 
Solomon, H. C.: Is the Treatment of Patients with General Paral- 
ysis Worth While? Jour. Nerv. and Ment. Dis., Lancaster, Pa., 
1922. 
Solomon, H. C., and Taft, A. E.: Effects of Antisyphilitic Therapy 
as Indicated by the Histological Study of the Cerebral Cortex in 
Cases of General Paresis. Arch. Neurol, and Psychiat., Vol. 8, 
p. 341, Oct., 1922. 
Solomon, H. C.: Treatment of Neurosyphilis. Jour. Amer. Med. 
Assoc., 1923, LXXXI, pp. 1742-1748. 
Solomon, H. C.: Value of Treatment in General Paresis. Boston 
Med. and Surg. Jour., April 26, 1923, CLXXVIII, pp. 635-639. 
Solomon, H. C.; The Treatment of Neurosyphilis. Trans. N. H. 
Med. Soc., Concord, N. H., 1923, CXXXII, pp. 237-247. 
Solomon, H. C.: The Circulation of P. S. P. in the Cerebrospinal 
System. Jour. Nerv. and Ment. Dis., New York, 1922, LVI, p. 599. 
Solomon, H. C.; Thompson, L. J.; and Pfeiffer, H. M.: The 
Therapeutic Applications of the Effect of Hypertonic Solutions on 
the Cerebrospinal Fluid Pressure. A Critical Review. Jour. Nerv. 
and Ment. Dis., May, 1924, LIX, pp. 474, 488. 1939.] 
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175 
Solomon, H. C.: The Treatment of Neurosyphilis. Jour. Amer. 
Med. Assoc., Nov. 24, 1923, Vol. 81, p. 1742; also in Penn. Med. 
Jour., Vol. 25, pp. 256-245, Jan., 1922. 
Solomon, H. C.; Pfeiffer, H. M.; and Thompson, P. J.: Cerebro- 
spinal Fluid Pressures. Concerning the Initial Fall in Pressure 
Readings and a Method of Obtaining a Standard Reading. Amer. 
Jour. Med. Sci., Phila., 1923, CLXVI, p. 341. 
Solomon, H. C., and Klauder, J. V.: Juvenile Paresis. Amer. Jour. 
Med. Sci., Oct., 1923, No. 4, Vol. CLXVI, p. 545. 
Solomon, H. C.: General Paresis: What it is and its Therapeutic 
Possibilities. Am. Jour, of Psych., Vol. II, No. 4, April, 1923. 
Solomon, H. C.: Concerning the Swift-Ellis Method in the Treat- 
ment of Neuro-syphilis. Boston Med. and Surg. Jour., Vol. 191, 
No. 10, p. 464, Sept. 4, 1924. 
Solomon, H. C.: Tryparsamide. Boston Med. and Surg. Jour., 
Vol. 191, No. 23, p. 1093, Dec. 4, 1924. 
Solomon, H. C., and Viets, H. R.: A Comparison of Tryparsamide 
and Other Drugs in the Treatment of Neurosyphilis. Jour. Amer. 
Med. Assoc., Sept. 20, 1924, Vol. 83, p. 891. 
Solomon, H. C.; Raising Cerebrospinal Fluid Pressure, with Espe- 
cial Regard to the Effect on Lumbar Puncture Headache. Jour. 
Amer. Med. Assoc., May 10, 1924, Vol. 82, pp. 1512-1515. 
Solomon, H. C.: Some Dogmatic Statements Concerning Treatment 
of Neuro-syphilis. Boston Med. and Surg. Jour., Vol. 193, No. 9, 
p. 390, Aug. 27, 1925. 
Solomon, H. C., and Viets, H. R.: Tryparsamide Treatment of 
Neuro-syphilis. Second Report. Jour. Amer. Med. Assoc., Aug. 
1, 1925, Vol. 85, p. 329. 
Ayer, J. B., and Solomon, H. C.: Cerebrospinal Fluid from Differ- 
ent Loci. Arch, of Neurol, and Psychiat., 1925, XIV, pp. 303-314. 
Solomon, H. C.: To Banish Paresis from the Earth. Monthly Bull. 
Mass. Soc. for Mental Hygiene, Nov., 1925. 
Solomon, H. C.: Pregnancies as a Factor in the Prevention of Neuro- 
syphilis. Amer. Jour, of Syphilis, Vol. X, No. 1, Jan., 1926. 
Solomon, H. C.; Berk, A.; Theiler, M.; and Clay, C. L.: The 
Use of Sodaku in the Treatment of General Paralysis. Arch, of 
Int. Med., Sept., 1926, Vol. 38, p. 391. 
Solomon, H. C., and Berk, A.: Malaria in the Treatment of Gen- 
eral Paresis. Jour. Nerv. and Ment. Dis., 1926, LXIII, pp. 2o3—2o8. 
Solomon, H. C.: What Causes Mental Disease? Hygieia, July and 
Aug., 1928, Vol. 6, and Nos. 7-8. 
Solomon, H. C., and Berk, A.: Prolonged Treatment in Neuro- 
syphilis. Amer. Jour. Syphilis, Vol. 12, pp. 445, Oct., 1928. 
Berk A. and Tivnan, P. E.: Apparatus for Pneumorachiocentesis. 
Arch. Neurol, and Psychiat., Vol. 22, pp. 582-584, Sept., 1929. 
Hinton, W. A., and Berk, A.: A Glycerol Modification of the Kahn 
Test. ’ N. E. Jour, of Med., Oct. 3, 1929, Vol. 201, pp. 667-670. 176 
HOUSE —No. 2400. 
[Mar. 
Solomon, H. C.: Treatment of Neurosyphilis. Ann. Int. Med. 3, 
pp. 447-451, Nov., 1929. 
Hinton, W. A., and Berk, A.: The Hinton Glycerol Cholesterol 
Reaction for Syphilis. Second Modification. N. E. Jour, of Med., 
Yol. 202, pp. 1054-1059, May 29, 1930. 
Klauder, J. V., and Solomon, H. C.: Trauma and Dementia Para- 
lytica. Jour. Amer. Med. Assoc., Jan. 3, 1931, Vol. 96, pp. 1-7. 
Solomon, H. C.; Kaufman, M. R.; and D’Elseaux, F.: Some 
Effects of the Inhalation of Carbon Dioxide and Oxygen, and of 
Intravenous Sodium Amytal on Certain Neuropsychiatric Condi- 
tions. Am. J. of Psych., Vol. X, No. 5, March, 1931. 
Solomon, H. C., and Epstein, S. H.: Tryparsamide in the Treat- 
ment of Neuro-syphilis. New York State Jour, of Med., Aug. 15, 
1931. 
Solomon, H. C.: The Treatment of Neurosyphilis. Urologic and 
Cutaneous Rev., April, 1932, pp. 223-228. 
Solomon, H. C., and Epstein, S. H.: Encephalography Under Nar- 
cosis Produced by Non-Volatile Anesthetics. Jour. Amer. Med. 
Assoc., May 2, 1932, Vol. 98, pp. 1794-96. 
Solomon, H. C.: Treatment of Neurosyphilis. Bull. New York 
Acad, of Med. 8: 428-441, July, 1932. 
Westling, H. M., and Berk, A.: The Hinton Test in the Diagnosis 
and Treatment of Syphilis in a Penal Institution. N. E. Jour, of 
Med., Vol. 207, No. 16, pp. 690-693, Oct. 20, 1932. 
D’Elseaux, F., and Solomon, H. C.: The Use of Carbon Dioxide 
Mixtures in Stupors Occurring in Psychoses. Arch. Neurol, and 
Psychiat., Feb., 1933, Vol. 29, pp. 213-230. 
Solomon, H. C.; Epstein, S. H.; and Berk, A.: The Differential 
Effects of Arsphenamine and Tryparsamide. Amer. Jour, of Syphilis, 
XVII, 45, Jan., 1933. 
Solomon, H. C.: A Brief Description of Psjmhiatric Conditions in 
Massachusetts. Amer. Jour, of Psych., XII, 5 March, 1933. 
Merritt, H.; Moore, M.; and Solomon, H. C.: The Iron Reaction 
in Paretic Neurosyphilis. Amer. Jour, of Syphilis, Vol. 17, 3 July, 
1933. 
Moore, M., and Solomon, H. C.: Contributions of Haslem, Bayle, 
Esmarch, and Jassen to the History of Neurosyphilis. Arch. Neurol, 
and Psychiat., Oct., 1934. 
Moore, M., and Solomon, H. C.: Contributors to the History of 
Syphilis of the Nervous System. Arch. Derm, and Syphilis, May, 
1935, Vol. 31, pp. 692-700. 
Solomon, H. C., and Epstein, S. H.: Dementia Paralytica, Results 
of Treatment with Malaria in Association with Other Forms of 
Therapy. Arch. Neurol, and Psychiat., May, 1935, pp. 1088- 
1927, Vol. 33, No. 5. 
Solomon, H. C., and Epstein, S. H.: Dementia Paralytica: Results 
of Treatment with Tryparsamide. Arch. Neurol, and Psychiat., 
June, 1935, Vol. 33, No. 6, pp. 1216-1231. 1939.] 
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177 
Solomon, H. C., and Epstein, S. H.: General Paresis: Treatment 
with Tryparsamide, Induced Fever Sequence. Amer. Jour, of 
Syphilis, Gonorrhea and Yen. Dis., Vol. 20, No. 3, pp. 281-295, 
May, 1936. 
Epstein, S. H.; Solomon, H. C.; and Kopp, I.: Dementia Para- 
lytica: Results of Treatment with Diathermy Fever. Amer. Med. 
Assoc. Jour., May, 1936, pp. 1527-1535, Vol. 106, No. 18. 
Maletz, L., and Solomon, H. C.: Spinal Fluid Reaction in General 
Paresis as Modified by a Combination of Therapeutic Malaria and 
Tryparsamide. Amer. Jour, of Syphilis, Gonorrhea and Venereal 
Diseases, Vol. 21, No. 3, pp. 287, May, 1937. 
Moore, M., and Merritt, H.: Tumors of the Brain Associated with 
Marked Pleocytosis in the Cerebrospinal Fluid. Jour, of Neurol, 
and Psycho., Vol. XIII, No. 50, Oct., 1932. 
Moore, M.; Merritt, H.; and Solomon, H. C.: The Iron Re- 
action in Paretic Neurosyphilis. Amer. Jour, of Syphilis, Vol. 
XVII, No. 3, p. 387, July, 1933. 
Moore, M., and Merritt, H.: The Argyll Robertson Pupil: An 
Anatomic-Physiologic Explanation of the Phenomenon, with a 
Survey of its Occurrence in Neurosyphilis. Arch. Neurol, and 
Psychiat., Vol. 30, pp. 357-373, Aug., 1933. 
Moore, M.: Symposium on Neurosyphilis: Acute Syphilitic 
Meningitis. Jour, of Nerv. and Ment. Dis., Vol. 80, No. 3, Sept., 
1934. 
Moore, M., and Merritt, H.: Acute Syphilitic Meningitis. Medi- 
cine, Vol. 14, No. 1, Feb., 1935. 
Moore, M., and Solomon, H. C.: Josephe Grunpeck and His Neat 
Treatise on the French Evil. A Translation with a Biographical 
Note. British Jour, of Ven. Dis., Vol. XI, p. 1, 1935. 
Moore, M.; Allen, A.; and Daly, B. B.; Subdural Hemorrhage 
in Psychotic Patients. A Study of 245 Cases Found Among 3,100 
Consecutive Autopsies. Jour, of Nerv. and Ment. Dis., Vol. 82, 
No. 2, pp. 193-196, Aug., 1935. 
Moore, M., and Lennox, Wm.: A Comparison of the Weights of 
Brain, Liver, Heart, Spleen and Kidneys of Epileptic and Schizo- 
phrenic Patients. Amer. Jour, of Psych., Vol. 92, No. 6, pp. 1439- 
1450, May, 1936. 
Moore, M., and Merritt, H.: Dementia Paralytics at the Boston 
Pschopathic Hospital. A Survey of 2,274 Cases. N. E. Jour, of 
Med., Vol. 215, No. 3, pp. 108-110, July 16, 1936. 
Moore, M., and Merritt, H.: The Role of Syphilis of the Nervous 
System in the Production of Mental Disease. A Survey of the Va- 
rious Forms of Neurosyphilis Occurring at the Boston Psycho- 
pathic Hospital from 1921-34. Jour, of Amer. Med. Assoc., Vol. 
107, pp. 1292-1293, Oct. 17, 1936. 
Moore, M., and Brown, Douglas, V.: The Co.J of Institutional Care 
of Epileptics in Massachusetts. Amer. Jour, of Psychiat. (in press). HOUSE —No. 2400. 
[Mar. 
178 
Moore, M., and Manning, C.: Syphilis and Sassafras. Amer. Jour, 
of Syphilis, Gonorrhea and Venereal Diseases, ol. 20, No. 6, p. 646, 
Nov., 1936; also in N. E. Quarterly, Vol. IX, No. 3, 1936. 
Kaufman, M. R., and Kasanin, J.: A Study of the Functional 
Psychoses in Childhood. Amer. Jour, of Psych., Vol. II, No. 9, 
1929. 
Kaufman, M. R., and Spiegel, E.: Experimentelle Analyse der 
Beinflussung Katatoner Zustande durch Einatmen von Kohlensaure- 
Saurerstoff-mischungen. Ztschr. f. d. ges. Neur. u. Psych., Vol. 
127. 
Kaufman, M. R.: The Use of Carbon Dioxide Oxygen Mixtures in 
Certain Cases of Stupor. Amer. Jour, of Psych., May, 1931. 
Kaufman, M. R.: Psychosis in Paget’s Disease (Osteitis Deformans). 
Arch. Neurol, and Psychiat., April, 1929. 
Kopp, Israel: Metabolic Rates in Therapeutic Fever. Amer. Jour, 
of Med. Sci., Vol. 190, p. 491, Oct., 1935. 
Kopp, Israel: The Velocity of the Blood Flow in Therapeutic Hyper- 
pyrexia. Amer. Heart Jour., Vol. 11, p. 475, April, 1936. 
Kopp, Israel: The Arm-to-Carotid Circulation Time in Prolonged 
Therapeutic Fever. Amer. Heart Jour., Vol. 11, p. 667, June, 1936. 
Epstein, S. H., and Yakovlev, P. I.: Case of Decerebrate Rigidity 
with Autopsy. Jour, of Neurol, and Psycho., Vol. 10, pp. 295-303, 
April, 1930. 
Epstein, S. H., and Dameshek, W.: Involvement of the Central 
Nervous System in a Case of Glandular Fever. N. E. Jour. Med., 
Vol. 205, No. 26, pp. 1238-1241, Dec. 24, 1931. 
Epstein, S. H., and Marvin, F. W.: Observations of Pentobarbital- 
Sodium in Lumbar Punctures, Convulsive and Manic States. 
N. E. Jour Med., Vol. 207, No. 6, pp. 256-259, Aug. 11, 1932. 
Epstein, S. H.: Chemotherapy of Neurosyphilis. R. I. Jour, of 
Med., Vol. 15, pp. 175-177, Nov., 1932. 
Epstein, S. H., and Lott, G. M.: Lumbar Puncture in Psychotic 
Patients. Jour. Nerv. and Ment. Dis., Vol. 76, No. 6, pp. 593-595, 
Epstein, S. H., and Hanflig, S. S.: A New Apparatus for Encepha- 
lography. Amer. Jour, of Roentgenology and Radium Therapy, 
Vol. XXIX, No. 5, May, 1933. 
Epstein, S. H.: Fever Therapy in Neurosyphilis. Bull. Mass. Soc. 
for Social Hygiene, Oct., 1933. 
Epstein, S. H.: A Diagnosis and Treatment File for Neurosyphilis 
Clinics. Amer. Jour, of Syphilis and Neurology, No. 18, No. 4, 
p. 516, Oct., 1934. 
Epstein, S. H., and McHugh, T.: Therapeutic Hyperpyrexia In- 
duced by Diathermy and Electric Blanket. Arch, of Physical 
Therapy, X-ray, Radium, Vol. XVI, pp. 32-35, Jan., 1935. 
Epstein, S. H.: The Hinton Test in Neurosyphilis. N. E. Jour. 
Med., Vol. 212, No. 11, pp. 495-496, March 14, 1935. 1939.] 
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179 
Epstein, S. H.: Hyperpyrexia at the Boston Psychopathic Hospital. 
N- E- Jour- of Med-, Vol. 212, No. 14, pp. 611-613, April 4, 1935. 
Epstein, S. H., and \ on Stobch, T. J. C.: An Improved Apparatus 
for Encephalography Adaptable to Ventriculography. Amer. Jour, 
of Roentgenology, Oct., 1935, Vol. 34, pp. 451. 
Epstein, S. H.: Medical and Surgical Aspects of Charcot Joints. 
Am. Jour, of Syph., July, 1936, Vol. 20, pp. 386-393. 
Books. 
Solomon, H. C., and Solomon, M. H.; Syphilis of the Innocent. 
Washington, 1922. 
Ayeb, J. B., and Solomon, H. C.: Examination of Cerebrospinal 
Fluid from Different Loci. The Human Cerebrospinal Fluid, 
Hoeber, 1924, Vol. 4, p. 85. 
Solomon, H. C.: The Cerebrospinal Fluid in Syphilis of the Nervous 
System. The Human Cerebrospinal Fluid, Hoeber, 1924, Vol. 4, 
p. 395. 
Solomon, H. C.: Syphilis of the Central Nervous System. Text- 
book of Medicine, Cecil, 1927. 
Solomon, H. C.: Psychiatry. The Specialties in General Practice, 
edited by Palfrey. Saunder, 1927. 
Solomon, H. C.: General Paresis, pp. 591-616. Oxford System of 
Medicine, 1928, Vol. 6. 
Solomon, H. C.: Trauma and Neurosyphilis, pp. 273-288. Trauma 
and Disease, edited by Brahdy and Kahn. Lea & Febiger, Phila., 
1937. 
Chapters in Text-Books. 
Memorandum Regarding the Neuro-Endocrine Re- 
searches at the Worcester State Hospital. 
The first endeavors at Worcester centered around endocrine 
studies, involving the extensive use of various endocrine 
therapies. In 1931 we turned, in addition, to a study of the 
“natural history” of schizophrenia; that is, we began study- 
ing the variation of a large number of physiological and psy- 
chological functions in schizophrenic patients and in normal 
controls. These orientation studies lasted through 1934. 
An analysis of the accumulated data revealed certain facts 
which may be regarded as leads for researches on schizophrenia. 
The data point: (a) towards a depressed and otherwise anom- 
alous oxygen metabolism, (6) an impairment of the autonomic 
nervous system, and (c) towards difficulties of integration on 
the physiological as well as on the psychological level. 180 
HOUSE —No. 2400. 
[Mar. 
Since 1935 our activities have, in the main, assumed an “ex- 
perimental” character, largely determined by the above three 
leads. At present this experimental activity is being organized 
more systematically around central concepts and around the 
exploitation of the possibilities which insulin administration 
offers as a tool of exploration. 
In addition to funds from the Commonwealth, the research 
project at Worcester is at present in receipt of an annual 
subvention from the Rockefeller Foundation in the amount of 
$16,500, and from the Memorial Foundation for Neuro-Endo- 
crine Research of approximately $20,000. Substantial aid from 
various pharmaceutical firms in the form of valuable medica- 
ments is also received. 
The money from the Memorial Foundation for Neuro- 
Endocrine Research, the Rockefeller Foundation, and the 
Armour Fund is spent independent of the Department of 
Mental Diseases, but the Department is called upon to approve 
the maintenance of a certain number of research workers. As 
a matter of fact, this maintenance is a substantial contribution 
on the part of the State. 
In addition to the following publications we have several in 
press and in preparation: 
Hoskins, R. G.: Endocrine Factors in Dementia Prascox. New 
Eng. J. Med. 200:361, 1929. 
Hoskins, R. G., and Sleeper, F. H.: Basal Metabolism in Schizo- 
phrenia. Arch. Neurol, and Psychiat. 21: 887, 1929. 
Hoskins, R. G., and Sleeper, F. H.; Endocrine Studies in Dementia 
Prsecox. Endocrinology 13: 245, 1929. 
Hoskins, R. G., and Sleeper, F. H.: The Effects of Ingested Thy- 
roid Substance on the Blood Morphology of Man. Endokrinologie 
5:89, 1929. 
Hoskins, R. G., and Sleeper, F. H.: A Case of Hebephrenic De- 
mentia Prsecox with Marked Improvement under Thyroid Treat- 
ment. Endocrinology 13: 459, 1929. 
Hoskins, R. G., and Sleeper, F. H.: A Metabolic Study of Desic- 
cated Suprarenal Medication in Man. Endocrinology 14: 109, 1930. 
Sleeper, F. H., and Hoskins, R. G.: Galactose Tolerance in De- 
mentia Prsecox. Arch. Neurol, and Psychiat. 24: 550, 1930. 
Hoskins, R. G., and Sleeper, F. H.: The Thyroid Factor in De- 
mentia Prsecox. Am. J. of Psychiat. 10: 411, 1930. 
Hoskins, R. G.: Dementia Prsecox. A Simplified Formulation. 
J. A. M. A. 96: 1209, 1931. 
Erickson, M. H., and Hoskins, R. G.: Grading of Patients in Men- 
tal Hospitals as Therapeutic Measure. Am. J. of Psychiat. 11: 
103, 1931. 1939.] 
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181 
Hoskins, R. G.: An Analysis of the Schizophrenia Problem from the 
Standpoint of the Investigator. J. A. M. A. 97: 682, 1931. 
Freeman, H.; Hoskins, R. G.; and Sleeper, F. H.: The Blood 
Pressure in Schizophrenia. Arch, of Neurol, and Psychiat. 27: 
333, 1932. 
Hoskins, R. G., and Sleeper, F. H.: Endocrine Therapy in the 
Psychoses. Am. J. of the Med. Sci. 184: 158, 1932. 
Hoskins, R. G., and Jellinek, E. M.: Studies on Thyroid Medica- 
tion. I. Some Conditions determining the Hematopoietic Effects. 
Endocrinology 16: No. 5, 455-486, 1932. (With the technical 
assistance of Louis DeLaura.) 
Hoskins, R. G.: Oxygen Consumption (“Basal Metabolic Rate”) 
in Schizophrenia. II. Distributions in Two Hundred and Four- 
teen Cases. Arch, of Neurol, and Psychiat. 28: No. 6, 1346, 1932. 
(With the technical assistance of Anna Walsh.) 
Freeman, H: The Effect of “Habituation” on Blood Pressure in 
Schizophrenia. Arch. Neurol, and Psychiat. 29: No. 1, 139, 1933. 
Hoskins, R. G., and Freeman, H.: Some Effects of a Glycerin Ex- 
tract of Suprarenal Cortex Potent by Mouth. Endocrinology 17; 
No. 1, 29, 1933. 
Looney, J. M.: The Effect of the Ingestion of Tyrosine on the Blood 
Phenols and Blood Uric Acid as Determined by Methods of Folin 
and Benedict. J. Biol. Chem. 100: Ixiv, 1933. 
Hoskins, R. G., and Sleeper, F. H.: Organic Functions in Schizo- 
phrenia. Arch. Neurol, and Psychiat. 30: 123, 1933. Abstracted: 
J. Nerv. and Ment. Dis. 78; 187, 1933. 
Hoskins, R. G., and Sleeper, F. H.; Shakow, D.; Jellinek, 
E. M.; Looney, J. M.; and Erickson, M. H.: A Co-operative 
Research in Schizophrenia. Arch. Neurol, and Psychiat. 30:388, 
1933. 
Looney, J. M., and Childs, H. M.: The Blood Cholesterol in Schizo- 
phrenia. Arch. Neurol, and Psychiat. 30: 567, 1933. 
Hoskins, R. G.: Schizophrenia from the Physiological Point of 
View. Annals of Internal Medicine, 7; 445, 1933. 
Freeman, W.: The Fasting Blood Sugar in Schizophrenia. Am. 
J. Med. Sci. 186: 621, 1933. (With the technical assistance of 
Ella K. Ruggles, S.B.) 
Freeman, H.: The Sedimentation Rate of the Blood in Schizo- 
phrenia. Arch. Neurol, and Psychiat. 30; 1298, 1933. 
Freeman, H.; Linder, F. E.; and Hoskins, R. G.: Further Studies 
of a Glycerin Extract of Adrenal Cortex Potent by Mouth. Endo- 
crinology 17: No. 6, 677, 1933. 
Hoskins, R. G., and Jellinek, E. M.: The Schizophrenic Person- 
ality, with Special Regard to Psychologic and Organic Concomi- 
tants. Proceedings of the Assoc, for Research in Nerv. and Ment. 
Dis., Vol. XIV, pp. 211-233, 1933. 
Hoskins, R. G.: The Manganese Treatment of “Schizophrenic 
Disorders.” J. Nerv. and Ment. Dis. 79: 59, 1934. 182 
HOUSE — No. 2400. 
[Mar. 
Looney, J. M., and Childs, H.: A Comparison of the Methods for 
Collection of Blood to be Used in the Determination of Gases. 
J. Biol. Chem. 104; 53, 1934. 
Huston, P. E.: Sensory Threshold to Direct Current Stimulation in 
Schizophrenic and Normal Subjects. Arch. Neurol, and Psychiat. 
31:590, 1934. 
Freeman, H.: Arm-to-Carotid Circulation Time in Normal and 
Schizophrenic Individuals. Psychiatric Quarterly 8:290, 1934. 
Looney, J. M., and Hoskins, R. G.: The Effect of Dinitrophenol 
on the Metabolism as Seen in Schizophrenic Patients. N. E. J. 
Med. 210:1206, 1934. 
Erickson, M. H.: The Concomitance of Organic and Psychologic 
Changes during Marked Improvement in Schizophrenia. A Case 
Analysis. Am Jour. Psychiat. 13:1349, 1934. 
Carmichael, H. T., and Linder, F. E.: The Relation between Oral 
and Rectal Temperatures in Normal and Schizophrenic Subjects. 
Am. J. Med, Sci. 188: 69, 1934. 
Freeman, H.: The Effect of Dinitrophenol on Circulation Time. 
J. Pharm. and Exper. Ther. 51: 477, 1934. 
Freeman, W.; Looney, J. M.; and Small, R.: Phytotoxic Index. 
I. Results of Studies with 68 Male Schizophrenic Patients. Arch. 
Neurol, and Psychiat. 32: 554, 1934, 
Huston, P. E.; Shakow, D.; and Erickson, M. H.: A Study of 
Hypnotically Induced Complexes by Means of the Luria Technic. 
J. Gen. Psych. 11: 65, 1934. 
Freeman, H., and Hoskins, R. G.: Comparative Sensitiveness of 
Schizophrenic and Normal Subjects to Glycerin Extract of Adrenal 
Cortex. Endocrinology 18:576, 1934. 
Freeman, W., and Looney, J. M.: Studies on the Phytotoxic Index. 
II. Menstrual Toxin (“Menotoxin ”). J. Pharm. and Exper. Ther. 
52; 178, 1934. 
Linton, J. M.; Hamelink, M. H.; and Hoskins, R. G.; Cardio- 
vascular System in Schizophrenia Studied by the Schneider Method. 
Arch. Neurol, and Psychiat. 32: 712, 1934. 
Looney, J. M., and Childs, H. M.: The Lactic Acid and Glutathione 
Content of the Blood of Schizophrenic Patients. J. Clin. Inves. 
13:963, 1934. 
Freeman, H., and Linder, F. E.: Some Factors Determining the 
Variability of Skin Temperature. Arch. Int. Med. 54: 981, 1934. 
Huston, P. E., and Hayes, J. T.: Apparatus for the Study of Con- 
tinuous Reactions. J. Exper. Psychol. 17: 885, 1934, 
Freeman, H., and Carmichael, H. T.: A Pharmacodynamic In- 
vestigation of the Atonomic Nervous System in Schizophrenia. 
I. Effect of Intravenous Injections of Epinephrine on the Blood 
Pressure and Pulse Rate. Arch. Neurol, and Psychiat. 33:342, 
1935. 1939.] 
HOUSE — No. 2400. 
183 
Linder, F. E., and Carmichael, H. T.: A Biometric Study of the 
Relation Between Oral and Rectal Temperatures in Normal and 
Schizophrenic Subjects. Human Biology 7: 24, 1935. 
Sleeper, I. H.: An Investigation of Polyuria in Schizophrenia. Am. 
J. Psychiat. 91:1019, 1935. 
Looney, J. M., and Hoskins, R. G.: The Therapeutic Use of Dini- 
trophenol and 3.5 Dinitro-Ortho-Cresol in Schizophrenia. Am. J. 
Psychiat. 91: 1009, 1935. 
Gottlieb, J. S., and Linder, F. E.: The Effect of Changes in the 
Environmental Temperature on the Rectal and Oral Temperatures 
in Schizophrenic and Normal Subjects. Arch. Neurol, and Psychiat. 
33:764, 1935. 
Millard, M. S., and Shakow, D.: A Note on Color-Blindness in 
Some Psychotic Groups. Jour. Social Psychology 6: No. 2, 252, 
1935. 
Freeman, H.: The Effect of Certain Environmental Conditions on 
the Skin Temperature, Body Temperature, and Oxygen Consump- 
tion Rate of Normal Individuals. Journal of Refrigerating Engi- 
neering, 1935. 
Huston, P. E.: The Latent Time of the Patellar Tendon Reflex. 
Jour. Gen. Psychol. 13: 3, 1935. 
Angyal, A.: The Perceptual Basis of Somatic Delusions in a Case 
of Schizophrenia. Arch. Neurol, and Psychiat. 34; 270, 1935. 
Carmichael, H. T.; Rheingold, J.; and Linder, F. E.: The Bro- 
mide Permeability Test in Schizophrenia. Jour. Nerv. and Ment. 
Dis. 82: 125, 1935. 
Gottlieb, J. S.: The Effect of Changes in the Environmental Tem- 
perature on the Blood Pressure and Pulse Rate in Normal Men, 
Am. J. Physiol. 113:181, 1935. 
Looney, J. M., and Freeman, H.: Volume of Blood in Normal 
Subjects and in Patients with Schizophrenia. Arch. Neurol, and 
Psychiat. 34: 956, 1935. 
Shakow, D., and Millard, M. S.: A Psychometric Study of 150 
Adult Delinquents. Jour. Social Psychology 6: 437, 1935. 
Krinsky, C. M., and Gottlieb, J. S.: Peripheral Venous Blood 
Pressure in Schizophrenic and in Normal Subjects. Arch. Neurol, 
and Psychiat. 35: 304, 1936. 
Hoskins, R. G., and Gottlieb, J. S.: Is the Pressor Effect of Glycerin 
Extract of Adrenal Glands due to Epinephrine? Endocrinology 
20: 188, 1936. 
Sleeper, F. H., and Jellinek, E. M.: A Comparative Physiologic, 
Psychologic and Psychiatric Study of Polyuric and Non-Polyuric 
Schizophrenic Patients, Jour. Nerv. and Ment. Dis. 83: 557, 1936. 
Angyal, A.: The Experience of the Body-Self in Schizophrenia. Arch. 
Neurol, and Psychiat. 35:1029, 1936. 184 
HOUSE —No. 2400. 
[Mar. 
Looney, J. M., and Darnell, M. C.: The Blood Pressure-Raising 
Principle of Adrenal Cortex Extracts. Jour. Biol. Chem. 114, 
1936. (Proc. Am. Soc. Biol. Chem., pp. Ixii-lxiii, 1936.) 
Gottlieb, J. S.: Relationship of the Systolic to the Diastolic Blood 
Pressure in Schizophrenia. The Effect of Environmental Tempera- 
ture. Arch. Neurol, and Psychiat. 35: 1256, 1936. 
Jellinek, E. M.: Measurements of the Consistency of Fasting 
Oxygen Consumption Rates in Schizophrenic Patients and Normal 
Controls. Biometric Bulletin 1: 15, 1936. 
Fertig, J. W.; The Use of Interaction in the Removal of Correlated 
Variation. Biometric Bulletin 1: 1, 1936. 
Jellinek, E. M., and Fertig, J. W.; A Method for the Estimation 
of Average Heart Rates from Cardiochronographic Records. J. of 
Psychology 1: 193-199, 1936. 
Angyal, A.: Phenomena Resembling Lilliputian Hallucinations in 
Schizophrenia. Arch. Neurol, and Psychiat. 36: 34, 1936. 
Shakow, D., and Huston, P. E.: Studies of Motor Function in 
Schizophrenia. I. Speed of Tapping. Jour. Gen. Psych. 15; 
63, 1936. 
Miller, W. R.: Psychogenic Factors in the Polyuria of Schizophrenia. 
Jour. Nerv. and Ment. Dis. 84: 418, 1936. 
Freeman, H., and Carmichael, H. T.: A Pharmacodynamic Study 
of the Autonomic Nervous System in Normal Men. The Effects 
of Intravenous Injections of Epinephrine, Atropine, Ergotamine 
and Physostigmine upon the Blood Pressure and Pulse Rate. Jour. 
Pharm. and Exper. Ther. 58: 409, 1936. 
Fertig, J. W.; On a Method of Testing the Hypothesis that an Ob- 
served Sample of n Variables and of size N has been drawn from a 
Specified Population of the Same Number of Variables. Annals of 
Math. Statistics, Vol. VII, No. 3, 1936. (With the technical as- 
sistance of Margaret V. Leary.) 
Jellinek, E. M.: Estimates of Intra-Individual and Inter-Individual 
Variation of the Erythrocyte and Leukocyte Counts in Man. 
Pluman Biology 8: 581, 1936. 
Jellinek, E. M., and Looney, J. M.: Studies in Seasonal Variation 
of Physiological Functions. I. The Seasonal Variation of Blood 
Cholesterol. Biometric Bull. 1: 83, 1936. 
Fertig, J. W.: The Testing of Certain Hypothesis by Means of 
Lambda Criteria, with Particular Reference to Physiological Re- 
search. Part K. The drawing of one or more samples from com- 
pletely or partially specified populations. Biometric Bull. 1; 45, 
1936. 
Hoagland, H.; Rubin, M. A.; and Cameron, D. E.: Electrical 
Brain Waves in Schizophrenics during Insulin Treatments. J. of 
Psychology, 3: 513, 1937. 1939.] 
HOUSE— No. 2400. 
185 
Freeman, H.; Linder, F. E.; and Nickerson, R. F.: The Bilateral 
Symmetry of Skin Temperature. Jour, of Nutrition 13: 34, 1937. 
Looney, J. M., and Jellinek, E. M.: The Oxygen and Carbon Di- 
oxide Content of the Arterial and Venous Blood of Normal Sub- 
jects. Am. J. Physiol. 118: 225, 1937. 
Hoskins, R. G., and Fierman, J. H.: The Pressor Effects of Pro- 
longed Administration of Glycerin Extract of Adrenal Cortex. Endo- 
crinology 21:119, 1937. 
Rosenzweig, S., and Shakow, D.; Play Technique in Schizophrenia 
and Other Psychoses. I. Rationale. II. An Experimental Study 
of Schizophrenic Constructions with Play Materials. Am. J. 
Orthopsychiat. 7: 32, 1937. 
Huston, P. E.; Shakow, D.; and Riggs, L. A.: Studies of Motor 
Function Schizophrenia. II. Reaction Time. J. Gen. Psych. 
16:39, 1937. 
Rickers-Ovsiankina, M.: Studies in the Personality Structure of 
Schizophrenic Individuals. I. The Accessibility of Schizophrenics 
to Environmental Influences. J. Gen. Psych. 16:153, 1937. II. 
Reaction to Interrupted Tasks. Ibid., p. 179, 1937. 
Rubin, M. A.; Cohen, L. H.; and Hoagland, H.: The Effect of 
Artificially Raised Metabolic Rate on the Electro-Encephalogram 
of Schizophrenic Patients. Endocrinology 21: 536, 1937. 
Rosenzweig, S., and Shakow, D.; Mirror Behavior in Schizophrenic 
and Normal Individuals. J. Nerv. and Ment. Dis. 86: 166, 1937. 
Nickerson, R. F.: An Improved Technic for the Determination of 
Insensible Perspiration. J. Lab. and Clin. Med. 22:412, 1937. 
Rosenzweig, S.: Schools of Psychology: A Complementary Pattern. 
Phil, of Sci. 4:96, 1937. 
Harris, A. J., and Shakow, D.: The Clinical Significance of Numeri- 
cal Measures of Scatter on the Stanford-Binet. Psych. Bull. 34; 
134, 1937. 
Hanfmann, E., and Kasanin, J.: A Method for the Study of Con- 
cept Formation. J. Psych. 3: 521, 1937. 
Hoagland, H.; Cameron, D. E.; and Rubin, M. A.: The “Delta 
Index ” of the Electro-Encephalogram in Relation to Insulin Treat- 
ments of Schizophrenia. Psych. Record, Vol. I, No. 15, pp. 196- 
202, 1937. 
Yakovlev, Paul I.: Epilepsy and Parkinsonism. N. E. J. of Med., 
Vol. 198, No. 12, May 10, 1928, pp. 629-638. 
Hodskins, Morgan B., and Yakovlev, Paul I.: Anatomico-Clini- 
cal Observations on Myoclonus in Epileptics and on Related Symp- 
tom Complexes. Am. J. Psych., Vol. IX, No. 5, March, 1930. 
Researches of the Monson State Hospital. 186 
HOUSE —No. 2400. 
[Mar. 
Hodskins, Morgan B., and Yakovlev, Paul I.: Neurosomatic 
Deterioration in Epilepsy. Arch. Neurol, and Psych., May, 1930, 
Vol. 23, pp. 986-1031. 
Guthrie, R. H.: Influence of Intercurrent Febrile Disorders on 
Pre-existing Epilepsy. Arch. Neurol, and Psych. 27:753-758, 
October, 1930. 
Yakovlev, Paul I., and Guthrie, R. H.: Congenital ectodermoses 
(Neurocutaneous Syndromes) in Epileptic Patients. Arch. Neurol, 
and Psych. 27: 1145-1194, Dec., 1931. 
Hodskins, Morgan B., and Yakovlev, Paul I.: Clinico-Patho- 
logical Contribution to the Concept of Neurosomatic Deterioration 
in Epilepsy with Report of Two Cases. Bulletin of the Massachu- 
setts Department of Mental Diseases, Oct., 1930. 
Hodskins, Morgan B., and Yakovlev, Paul I.: Neurosomatic 
Deterioration in Epilepsy. Arch. Neurol, and Psych., Jan., 1932, 
Vol. 27, pp. 113-137. 
Hodskins, Morgan B.; Guthrie, R. H.; and Naurison, J. Z.: 
Studies in the Blood Volume of Epileptics. Am. J. Psychiat. 11: 
623-641, Jan., 1932. 
Yakovlev, Paul I.: Paradoxical Forms of the Tendon Reflexes 
and their Clinical and Physiological Significance. Bulletin of the 
Massachusetts Department of Mental Diseases, April, 1932. 
Guthrie, Riley H.: Some Recent Researches in Epilepsy at the 
Monson State Hospital. N. E. J. M. 208: 646-648, March, 1933. 
Stein, C.: Hereditary Factors in Epilepsy. Am. J. Psych. 12: 989- 
1031, March, 1933. 
Hodskins, M. B., and Guthrie, R. H.: Cancer Complicating and 
Modifying the Course of Epilepsy. Am. J. Psychiat., 1933. 
Karlsberg, I. J.: The Effect of Intercurrent Chronic Pulmonary 
Tuberculosis on the Convulsion Threshold in Epilepsy. Am. J. 
Psych., Vol. XIII, Jan., 1934. 
Stein, C.: Studies in Endocrine Therapy in Epilepsy (1st report). 
Am. J. Psych., Vol. XIII, No. 4, Jan., 1934. 
Guthrie, R. H., and Lebowitz, Wm. M.: Epilepsy in Identical 
Twins; A Presentation of Three Pairs of Twins. J. Nerv. and 
Ment. Dis. 81: 385-398, April, 1935. 
Stein, C.: The Role of Mental Hygiene in General Practice, N. E. 
J, of Med., Vol. 214, No. 14, pp. 665-671, April 2, 1936. 
Yakovlev, Paul I.: Neurologic Mechanism Concerned in Epileptic 
Seizures. Arch, of Neurol, and Psychiat., March, 1937, Vol. 37, 
pp. 523-554. 
Stein, C.: Studies in Endocrine Therapy in Epilepsy (2d report). 
Am. J. of Psych., Vol. 93, No. 5, March, 1937. 
Robinson, L. J.: Neurologic Complications Following the Adminis- 
tration of Serums and Vaccines. N. E. J. M. 216: 831-837, May 
13, 1937. 1939.] 
HOUSE — No. 2400. 
187 
The following are papers completed but not yet published: 
Robinson, L. J.: Benzedrine Sulfate in the Treatment of Syncope 
Due to a Hyperactive Carotid Sinus Reflex. N. E. J. M. To be 
published in 1937. 
Robinson, L. J.: Syncope, Convulsions and the Unconscious State: 
Their Relationship to the Hyperirritable Carotid Sinus Reflex 
Amongst 1,000 Patients in an Institution for Epilepsy. 
Robinson, L. J.: Notes on the Observed Effects of Prostigmin. 
Osgood, Rudolf, and Robinson, L. J.: Brilliant Vital Red as an 
Anticonvulsant in Epilepsy. 
Research in progress at the present time: 
Gastrointestinal Studies by X-ray Examination of Patients with 
Epilepsy. 
Blood Calcium and Phosphorus Studies in Patients with Epilepsy. 
Canavan, Myrtelle M., and Clark, Rosamond: The Mental 
Health of 463 Children from Dementia Prsecox Stock. Mental 
Hygiene, Yol. VII, No. 1, pp, 137-148, Jan., 1923. 
Canavan, Myrtelle M., and Clark, Rosamond: The Mental 
Health of 581 Offspring of Non-Psychotic Parents. Mental Hy- 
giene, Yol. VII, No. 4, pp. 770-778, Oct., 1923. 
Canavan, Myrtelle M., and Clark, Rosamond: Second Report 
on Mental Health of Children of Dementia Prsecox Stock. Mental 
Hygiene, Yol. XX, July, 1936, pp. 463-471. 
Raeder, O. J., and Canavan, Myrtelle M.: Remarks on the 
Pathology of the Feeble-Minded. Bulletin of the Massachusetts 
Department of Mental Diseases, XIV, Nos. 1-2, p. 234, April, 
1930. 
Raeder, O. J.: Interim Report on the Third Series of Ten Cases 
(Waverley Researches in the Pathology of Feeble-minded), pre- 
sented before the Boston Society of Psychiatry and Neurology on 
March 18, 1926. Report of these proceedings and discussions 
published in Arch, of Neurol, and Psychiat., Yol. 16, p. 505, 
1926. 
Clinics conducted by State Hospitals and Division of Mental 
Hygiene. 
Attleboro. — Taunton State Hospital, Mental and Mental Hygiene 
Clinic, Sturdy Memorial Hospital. Last Mon. 1.30-4 p.m. 
Belchertown. — Belchertown State School General Out-Patient Clinic 
at the institution. Wed. 9-11 a.m., 1-4 p.m. 188 
HOUSE —No. 2400. 
[Mar. 
Belmont. — Grafton State Hospital Adjustment Clinic, Junior High 
School Building. 1st and 3d Mon. 9.30 a.m.-3.30 p.m. 1 
Beverly. — Danvers State Hospital Habit Clinic, Health Center. 
Wed. 9-11 a.m. 1 
Boston. — Boston Psychopathic Hospital Out-Patient Department. 
Daily, 2-5 p.m. (for children), and 9-12 a.m. (for children and 
adults). 
Boston Dispensary Habit Clinic. Wed. and Thurs. 9.30 (Divi- 
sion of Mental Hygiene).1 
New England Hospital Habit Clinic. Thurs. 9.30 (Division of 
Mental Hygiene).1 
West End Habit Clinic, 25 Blossom Street. Wed. 2 p.m. (Division 
of Mental Hygiene).1 
Foxborough State Hospital Mental Hygiene Clinic, Boston Psycho- 
pathic Hospital. Last Mon. 7 p.m. 
Westborough State Hospital Clinics, Massachusetts Memorial Hos- 
pital. Tues. 10 a.m.-4 p.m. (General Out-Patient); Wed. 10 a.m- 
4 p.m. (Mental and Mental Hygiene). 
Brockton. — Foxborough State Hospital Mental and Mental Hygiene 
Clinic, Brockton Hospital. Wed. 2-4 p.m. 
Concord. — Grafton State Hospital Adjustment Clinic, High School. 
1st and 3d Wed. 9.30 a.m.-3.30 p.m. 1 
Fall River. — Taunton State Hospital Mental and Mental Hygiene 
Clinic, City Hall Annex. Wed. 9.30-12 a.m. 
Fitchburg. — Gardner State Hospital Child Guidance Clinic. Mon., 
Fri. 1.30-4 p.m. 1 
Gardner State Hospital General Out-Patient Clinic, City Hall. 
Wed. 3-5 p.m. 
Gardner. — Gardner State Hospital Child Guidance Clinic, Prospect 
Street School. Tues. 1.30-4 p.m.1 
Greenfield. — Northampton State Hospital Mental and Mental Hy- 
giene Clinic, Franklin County Hospital. 3d Tues. 1-3 p.m. 
Haverhill. — Danvers State Hospital Child Guidance Clinic, High 
School. Sat. 9-11 a.m.1 
Holyoke. — Northampton State Hospital Child Guidance Clinic, 
Skinner Clinic of Holyoke Hospital. Wed. 1-3.30 p.m. 1 
Lawrence. — Danvers State Hospital Mental and Mental Hygiene 
Clinic, International Institute. 1st and 3d Fri. 9-11 a.m. 
Lawrence Habit Clinic, General Hospital. Tues. 2 p.m. (Division 
of Mental Hygiene).1 
Leominster. — Grafton State Hospital Adjustment Clinic, Junior 
High School. Fri. 9.30 a.m.-3.30 p.m. 1 
Lexington. — Grafton State Hospital Adjustment Clinic, High School. 
Tues. 9.30 a.m.-3.30 p.m. 1 
1 For children only. 1939.] 
HOUSE — No. 2400. 
189 
Lowell. Lowell Habit Clinic, General Hospital. Wed. 2 p.m. (Di- 
vision of Mental Hygiene).1 
Westborough State Hospital General Out-Patient Clinic, St. John’s 
Hospital. 1st Tues. 7 p.m. 
Lynn. — Danvers State Hospital Child Guidance Clinic, Child Wel- 
fare House. Tues. 9-11 a.m. 1 
Danvers State Hospital Mental and Mental Hygiene Clinic, Lynn 
Hospital, Wed. 2-4 p.m. 
Melrose. — Danvers State Hospital Child Guidance Clinic. Thurs. 
9.30-11.30 a.m.1 
Natick. — Grafton State Hospital Adjustment Clinic, High School. 
1st and 3d Thurs. 9.30 a.m.-3.30 p.m. 1 
New Bedford. — Taunton State Hospital Mental and Mental Hygiene 
Clinic, Olympia Building. Wed. 1.30-4 p.m. 
N ewhuryport. — Danvers State Hospital Child Guidance Clinic, 
Health Center. 2d and 4th Fri. 2-4 p.m. 1 
North Adams. — Northampton State Hospital Mental and Mental 
. Hygiene Clinic, Board of Health Rooms. 2d Thurs. 1-3 p.m. 
Northampton. — Northampton State Hospital Child Guidance Clinic, 
People’s Institute. Wed. 4-6 p.m. 1 
Northampton State Hospital General Out-Patient Clinic at the 
institution. Daily 9.30-11 a.m., 1.30-4.30 p.m. 
North Grafton. — (1) Grafton State Hospital Adjustment Clinic. Sat. 
9-12 A.M. 1 
(2) Grafton State Hospital General Out-Patient Clinic at the in- 
stitution. Sat. 9-12 a.m.; other days, by appointment. 
North Reading. — North Reading Sanatorium Habit Clinic. 1st 
Tues. 10 a.m. (Division of Mental Hygiene).1 
Norwood. — (1) Habit Clinic, Norwood Hospital. Fri. 9.30 (Divi- 
sion of Mental Hygiene).1 
(2) Medfield State Hospital Child Guidance Clinic, Norwood Hos- 
pital. 3d Tues. 3-5 p.m. 1 
Orange. — Gardner State Hospital Child Guidance Clinic, Visiting 
Nurses’ Rooms. 1st Wed. 1.30-4 p.m.1 
Pittsfield. — Northampton State Hospital Mental and Mental Hy- 
giene Clinic, House of Mercy Hospital. 4th Thurs. 1-3 p.m. 
Quincy. — Habit Clinic, Woodward Institute. Thurs. 2.30 p.m. 
(Division of Mental Hygiene).1 
Medfield State Hospital Child Guidance Clinic, High School. 
Thurs. 2-4 p.m. 1 
Medfield State Hospital Juvenile Court Clinic, District Court. 
Tues., except the third, 2-4 p.m. 1 
Reading. — Habit Clinic, High School. Tues. 2 p.m. (Division of 
Mental Hygiene).1 
i For children only. 190 
HOUSE —No. 2400. 
[Mar. 
Salem. — Danvers State Hospital Child Guidance Clinic, Pinkham 
Memorial Hospital. Mon. 2-4 p.m, 1 
Springfield. — Northampton State Hospital Juvenile Court Clinic, 
District Court. Fri. 9 a.m. 1 
Northampton State Hospital Mental and Mental Hygiene Clinic, 
Board of Health Rooms. 1st Thurs. 2-4 p.m. 
Springfield Hospital Child Guidance Clinic (State auspices in part. 
Morgan B. Hodskins, M.D., loaned by Monson State Hospital). 
Mon., Wed. 2-5 p.m.; Fri. 2-4 p.m. 1 
Taunton. — Taunton State Hospital Mental and Mental Hygiene 
Clinic at the institution. Thurs. 10-12 a.m. 
Waltham. — Westborough State Hospital General Out-Patient Clinic, 
Department of Public Welfare, City Hall. 2d Tues. and 3d Wed. 
7 P.M. 
Waverley. — W. E. Fernald State School General Out-Patient Depart- 
ment at the institution. Wed. 9 a.m. 
Westborough. — Westborough State Hospital General Out-Patient 
Clinic at the institution. Daily, except Sat. and Sun., 2-5 p.m,; 
1st Sun. 3 p.m. 
Worcester. — Worcester Child Guidance Clinic — Daily, full time.1 
(Sponsored by the Child Guidance Association in Worcester and 
by the Worcester State Hospital; is under state auspices.) 
Wrentham. — Wrentham State School General Out-Patient Clinic 
at the institution. Wed. 8.30 a.m. 
•For children only. 1939.] 
HOUSE — No. 2400. 
191 
Habit Clinics. 
Clinic. 
Started. 
Discontinued. 
Remarks. 
East Boston 
June 6, 1923 
Oct. 2, 1924 
Turned over to Boston Psycho- 
pathic Hospital. 
North End . 
June 8, 1923 
July, 1928 
Because it was considered more 
economical to transfer the cases 
to the West End clinic. 
Roxbury Neighborhood 
House. 
West End . 
Oct. 25, 1923 
Jan. 12, 1924 
Sept. 18, 1924 
Because it was felt that the loca- 
tion of the clinic was not suffi- 
ciently accessible to serve the 
group for which it was intended, 
and the clinic was later moved to 
Boston Dispensary. 
Lynn .... 
Lawrence 
Boston Dispensary1 . 
Mar. 5, 1924 
Apr. 5, 1924 
Dec. 5, 1924 
Mar. 30, 1926 
Turned over to local auspices and 
later to Danvers State Hospital. 
Lowell . . 
Lowell (reopened) 
Reading 
Dec. 3, 1924 
Jan. 22, 1932 
Dec., 1924 
Nov. 30, 1927 
Beverly 
Mar. 12, 1925 
Apr. 13, 1932 
Turned over to Danvers State 
Hospital. 
Springfield . 
Quincy 
New England Hospital 
Oct., 1924 
Oct. 7, 1926 
Dec. 1,1927 
Oct. 31, 1925 
Turned over to Monson State Hos- 
pital. 
North End Consultant 
Clinic, North Bennet 
Street Play School. 
North Reading Sana- 
torium. 
Norwood 
Oct. 10, 1928 
July, 1928 
Oct. 11, 1929 
Oct., 1929 
Because it was felt advisable to 
have all cases attend the West 
End clinic for more detailed 
study and treatment. 
Northampton 
May 15, 1931 
Dec. 31, 1931 
Turned over to Northampton State 
Hospital. 
Holyoke 
June 12,1931 
Dec. 31, 1931 
Turned over to Northampton State 
Hospital. 
1 Two clinics each week beginning March, 1933. 
List of Habit Clinics — Division of Mental Hygiene. 192 
HOUSE —No. 2400. 
[Mar, 
Habit Clinics — Continued. 
Increase in Number Treated — Division of Mental Hyqiene. 
Date. 
Number of 
New Cases. 
Total Cases 
Carried. 
Visits of 
Children 
to Clinic. 
Dec. 1, 1925-Dec. 1, 1926 .... 
368 
- 
1,275 
Dec. 1, 1926-Dec. 1, 1927 .... 
355 
471 
1,474 
Dec. 1, 1927-Dec. 1, 1928 .... 
418 
481 
1,570 
Dec. 1, 1928-Dec. 1, 1929 .... 
509 
600 
2,264 
Dec. 1, 1929-Dec. 1, 1930 .... 
498 
628 
2,523 
Dec. 1, 1930-Dec. 1, 1931 .... 
603 
708 
2,411 
Dec. 1, 1931-Dec. 1, 1932 .... 
594 
800 
2,857 
Dec. 1, 1932-Dec. 1, 1933 .... 
795 
1,091 
3,565 
Dec. 1, 1933-Dec. 1, 1934 .... 
681 
1,053 
3,492 
Dec. 1, 1934-Dec. 1, 1935 .... 
643 
1,035 
3,317 
Dec. 1, 1935-Dec. 1, 1936 .... 
666 
1,042 
3,759 
Dec. 1, 1936-Dec. 1, 1937 .... 
724 
1,136 
4,185 
Dec. 1, 1937-Dec. 1, 1938 .... 
760 
1,150 
4,652 1939.] 
HOUSE — No. 2400. 
193 
Habit Clinics — Concluded. 
Appropriations and Expenditures — Division of Mental Hyqiene. 
Yeah. 
Appropriation. 
Expenditures. 
Worcester 
Child Guid- 
ance Clinic. 
Dementia 
Prsecox 
Research.1 
1922 
$3,000 00 
$3,000 002 
- 
- 
1923 
25,000 00 
6,896 92 
- 
- 
1924 
25,169 98 
18,598 53 
- 
- 
1925 
22,146 45 
21,743 59 
- 
- 
1926 
23,562 86 
18,541 20 
- 
- 
1927 
26,521 66 
28,827 21 
- 
- 
1928 
27,500 00 
26,203 41 
- 
- 
1929 
36,000 00 
30,864 67 
- 
- 
1930 
83,150 00 
66,660 17 
$9,153 97 
$16,088 99 
1931 
84,885 00 
97,830 35 3 
14,920 20 
26,137 09 
1932 
85,000 00 
93,574 974 
13,499 00 
24,657 77 
1933 
84,200 00 
84,784 89 s 
12,257 23 
22,020 40 
1934 
81,830 00 
82,893 653 
11,178 60 
22,460 63 
1935 
86,340 00 
87,445 437 
13,084 54 
25,105 27 
1936 
91,550 00 
89,840 893 
12,674 98 
24,376 73 
1937 
99,309 98 
93,984 60 
13,604 90 
26,714 67 
1938 
110,220 00 
97,386 89 
13,387 78 
27,982 07 
1 Included in column “Expenditures.” 
2 Established in 1922, and does not include balance brought forward from previous year. 
3 Balance brought forward from previous year, $25,525.16. 
4 Balance brought forward from previous year, $12,579.81. 
5 Balance brought forward from previous year, $4,004.84. 
3 Balance brought forward from previous year, $3,419.95. 
7 Balance brought forward from previous year, $2,356.30. 
3 Balance brought forward from previous year, $1,250.87. 194 
HOUSE — No. 2400. 
[Mar. 
Memorial Foundation for Neuro-Endocrine Research — 
Worcester Researches. 
Salaries .... 
Operating expenses . 
1933. 
. $19,021 08 
894 93 
Total .... 
. $19,916 01 
Salaries .... 
Operating expenses . 
1934. 
. $22,752 15 
1,652 20 
Total .... 
. $24,404 35 
Salaries .... 
Operating expenses . 
1935. 
. $20,068 16 
741 66 
Total .... 
. $20,809 82 
Salaries .... 
Operating expenses . 
1936. 
. $17,013 00 
948 98 
Total .... 
. $17,961 98 
Salaries .... 
Operating Expenses 
1937.1 
. $9,343 27 
805 80 
Total .... 
. $10,149 07 
January, 1933, to June SO, 1937. 
Salaries 
Operating expenses 
. $88,197 66 
5,043 57 
Total .... 
. $93,241 23 
1 To June 30. 1939.] 
HOUSE — No. 2400. 
195 
Rockefeller Foundation — Worcester Researches. 
Receipts 
Disbursements . 
July 1, 1934, to June 30, 1935. 
. $16,500 00 
. 16,360 60 
Balance 
$139 40 
Receipts 
Balance 
July 1, 1935, to June 30, 1936. 
. $16,360 60 
139 40 
Disbursements . 
$16,500 00 
. 16,291 62 
Balance 
$208 38 
Receipts 
Balance 
July 1, 1936, to June 30, 1937. 
. $16,291 62 
208 38 
Disbursements . 
$16,500 00 
. 15,403 29 
Balance 
. $1,096 71 
Total Actual Receipts, July 1, 1934, to June 30, 
1934- 
1935- 
1936- 
1937. 
. $16,500 00 
. 16,360 60 
. 16,291 62 
Total . 
. 
. $49,152 22 
Since July 1, 1934, a grant of $16,500 per year, assured up to June 
30, 1940. 
From January, 1936, a grant of $3,500 per year for 1936 and 1937, 
from Armour & Co. 
From July 1, 1937, to June 30, 1940, a grant of $49,500. 196 
HOUSE —No. 2400. 
[Mar. 
C. REPORT OF THE COMMITTEE ON RESEARCH CENTER 
AND METHODS TO THE SPECIAL COMMISSION. 
Your Committee on Research Center and Methods submits 
the following considerations on research under the Department 
of Mental Diseases. 
The State has a special responsibility with regard to mental 
disorders. It has more or less established a monopoly of the 
treatment of mental patients, and it is bound to accept all that 
is involved in the assumption of such responsibility. This 
responsibility is not met by the mere maintenance of a tra- 
ditional level of care and treatment, but demands at the same 
time an intelligent, consistent and continuous program of 
research into the causes of insanity, and into the possible im- 
provement of methods of study, treatment and care of mental 
patients. The steadily increasing demands made by mental 
disorders on the budget of the State makes research of the 
above nature obligatory and a matter of immediate concern. 
The necessity for research is obvious in view of the many 
unsolved problems in the field of mental disorders. To deal 
with these problems requires a serious effort, intelligently 
directed and continuously maintained. It is not only the 
psychiatrist who is aware of the necessity for research. The 
intelligent taxpayer is becoming somewhat impatient under the 
increasing load of the budget for mental disorders which is 
chiefly expended in the direction of treatment and care of those 
who have already broken down. He anticipates increasing 
burdens with the growth of population, and he would like to 
see systematic research and a purposeful attack on the causes 
of insanity with a view to prevention, and on the treatment of 
insanity with a view to cure or amelioration. 
The spirit of investigation and of inquiry should permeate 
every state hospital and be kept alive in every ward physician. 
The general clinical work in a hospital where no investigative 
work is being done is bound to fall to a level of dull mediocrity. 
Not only intellectual curiosity but the interests of the patients 
themselves make investigative work an essential aspect of the 
activity of a mental hospital. It is evident that every state 
hospital should have its own laboratory, not only as a center 
of investigation, but as a necessary condition of thorough study 
of the patients. The American Medical Association recognizes 
as accredited hospitals for the training of medical interns only 1939.] 
HOUSE— No. 2400. 
197 
those hospitals which have an effective laboratory. At present 
it refuses to recognize as accredited hospitals several Massa- 
chusetts state hospitals. 
It may be claimed that every ward physician in a mental 
hospital is responsible himself for maintaining an alert and 
active interest in investigation and for carrying on some in- 
dividual piece of work however modest. It must be strongly 
emphasized that under the present arrangements, where ward 
physicians very often have an almost intolerable load of routine 
duties, the flame of interest in research is bound to flicker and 
finally be extinguished. Investigative activity cannot be car- 
ried on by men whose case-load is far beyond the standards 
set by the American Psychiatric Association, and completely 
uses up all the time and energies of the individual. It is im- 
portant, in considering the development of investigative ac- 
tivity in the mental hospitals, to give due weight to the ex- 
cessive demands that are already made on the ward physicians 
of many of these hospitals. 
The investigative spirit in the individual ward physician is 
one of the most valuable assets of a mental hospital. It can 
be maintained only under favorable circumstances, with no 
chronic overburdening with daily routine, with adequate time 
for concentration on some personal topic of investigation, with 
a reasonable supply of medical journals and books available, 
and with opportunity for consultation and discussion with 
competent advisers. It is the responsibility of those in author- 
ity to establish and to maintain such favorable conditions. 
The importance of research may be illustrated by the situa- 
tion in industry. In many industrial organizations one finds 
large divisions fully manned and amply supplied with funds 
whose whole function it is to study certain fundamental proc- 
esses which have a bearing on that industry. Many of these 
researches do not have an immediate utilitarian goal. The 
directors of these industries realize that research into funda- 
mental processes, with fuller knowledge of the subtle under- 
lying forces, will in the long run give them greater control 
over nature and enable them to deal more efficiently with their 
specific technical problems. It is true that some of these re- 
searches will bear upon the direct solution of some problem 
which is of immediate importance; other researches have a 
much longer range. Figures can be obtained to show that a 
considerable percentage of the annual expenditure in some 
large industries is devoted to research activities. 198 
HOUSE —No. 2400. 
[Mar. 
In general medicine the importance of research is clearly- 
understood and generally accepted. In the field of the infec- 
tious and metabolic disorders noteworthy advances in public 
health have been made on the basis of the research activities 
of special workers. These results have been attained by the 
expenditure of large funds appropriated by Federal, state and 
municipal authorities, or made available by special foundations 
or by the endowments of medical schools and hospitals. For 
the study of a single disease like cancer large funds have been 
made available, and in many centers highly skilled workers are 
devoting all their energies to studying the basal factors under- 
lying this disease. 
In comparison with the funds available in industry and in 
the field of general medicine, the amount expended on research 
into mental disorders is negligible, although this is a field of 
health which has begun to arouse widespread interest and con- 
cern, and which has most important social implications. 
It is well to recognize explicitly that the physical and chemi- 
cal problems taken up for research in industry are of compara- 
tively simple nature; the solution of a problem can often be at 
once turned to practical account, and may often bring in large 
financial gains directly dependent upon the solution of the 
problem. In general medicine the problems are more compli- 
cated than those of industry. But there, too, the results in the 
improvement of public health and the economic gains to the 
community are often easily demonstrable; the results of inves- 
tigations in the field of infectious and metabolic disorders have 
often been capable of an immediate and practial application. 
It is well to realize that the field of mental disorders is some- 
what different. With their complicated physiological, personal 
and social determinants one must expect research to be a more 
protracted affair, and one must not expect too rapid and easily 
demonstrable returns. Even when important causal factors 
are demonstrated, there may be greater resistance to innova- 
tions in view of the subtle influence of traditions and beliefs. 
Responsibility for the prosecution of research into mental 
disorders devolves upon the State, which has taken under its 
care the great majority of mental patients. The effort put 
forth in research should be proportionate to the importance 
of the topic, and should not be looked upon merely as an inci- 
dental function or a side issue in the Department of Mental 
Diseases. 1939.] 
HOUSE— No. 2400. 
199 
There is a tendency to consider mental disorders or mental 
diseases as if the term disease represented the same concept as 
when used in internal medicine. It is well, therefore, to keep 
in mind the concrete fact which the State has to deal with, — 
namely, mental patients or people who have broken down in a 
great variety of ways in their adaptation to the tasks of life. 
In each case one has to face the concrete fact of the human indi- 
vidual in his social environment, and one cannot start with the 
assumption that the key to the disorder has to be found by the 
exclusive investigation of biochemical or physiological processes. 
In a large proportion of cases the understanding and the treat- 
ment of the case require a consideration of problems of human 
adaptation involving psychological and sociological factors. 
To make the situation with regard to research concrete, one 
may divide the general problems of research into those dealt 
with — 
At the impersonal level (biochemical, physiological, immunological, 
etc.). 
At the psychological level (analysis of the forces of the personality, 
— instincts, emotions, repressions, thwarting, privation, etc.). 
At the sociological level (analysis of environmental factors in family, 
school, occupation, social group). 
(а) At the impersonal level there are problems connected 
with — 
The results of head injury. 
The influence of poisons (alcohol, lead, etc.). 
Vitamin deficiency of various types. 
The composition of the blood and cerebrospinal fluid. 
Disorders of various systems (the neuro-endocrine system, 
etc.), physiological and neurological symptoms, their nature 
and localization. 
Puerperal disorders. 
The psychiatric concomitants of bodily disorders. 
The biochemical and physiological bases of the psychoses. 
The methods involved in these studies are the methods of 
the basal medical sciences, — biochemical, physiological, path- 
ological, immunological. They require special training, and, 
as a rule, special equipment and instruments of precision. 
(б) At the Psychological Level. — In addition to the methods 
and principles of the basal disciplines referred to, the psychia- 
trist, to do justice to other factors in human nature, should 200 
HOUSE —No. 2400. 
[Mar. 
study the instinctive and emotional mechanisms, and investi- 
gate with increasing precision the dynamic equilibrium of the 
human personality and the adaptation of the human individual 
to the complex demands of his environment. 
It is important to recognize that we still require detailed and 
systematic investigation into the natural history of mental 
disorders, their various types, their symptomatology, their 
evolution, their causes, their treatment. 
Investigation is also required into such problems as follow: 
The types of individual (constitutional traits) predisposed to 
special types of mental disorder. 
Hereditary influences in mental disorders (the study of 
family psychoses, of identical twins). 
The role of special traits in the evolution and in the equi- 
librium of the personality (sex constitution; power component; 
sensitiveness; phantasy; capacity for sublimation; social 
response; the result of conflicts, repressions, frustrations; the 
influence of special experiences; the development of compen- 
sations and special interests and codes). 
The analysis of special symptoms, e.g., bed-wetting, morbid 
fears, sexual anomalies, wayward behavior, hallucinations, de- 
lusions, and of special syndromes, e.g., the catatonic syndrome 
and its relation to similar syndromes in encephalitis and other 
conditions. 
The evaluation of psychoanalytic doctrines. 
The methods of testing for special abilities and disabilities, 
the methods of testing the equipment of the individual (“in- 
telligence,” vocational, personality tests). 
In this field of investigation the methods will not be merely 
those required for the investigation of the impersonal problems 
of the basic sciences, but will need to include the historical, 
the statistical, the psychoanalytic and other such methods. 
(c) At the Sociological Level. — The relationship between the 
individual and his cultural environment is one of continual 
interaction; the isolated individual is an abstraction, a useful 
figment. The mental disorder can in many instances only be 
studied and treated adequately when due attention is paid to 
the situation in which the patient has evolved and to which he 
has to react. 
Further research is required into — 
The dynamic relationship between the individual child and 
the family setting, especially the parents. 1939.] 
HOUSE —No. 2400. 
201 
The interaction between child and school setting (school- 
mates, teachers). 
The relation of the individual to fellow workers and to occu- 
pational status. 
The influence on the developing personality and on the adult 
of economic, racial, religious factors. 
The influence of social resources or privations (e.g., oppor- 
tunities for cultural development, aesthetic satisfactions, rec- 
reation, social fellowship and group activities). 
In such researches both the historical and the statistical 
method will be employed, with some use of the experimental 
method {e.g., study of the same child in different foster homes, 
in relation to different teachers; modification in the industrial 
environment, etc.). 
Research into the causes and 'prevention of insanity, as in- 
dicated by the above brief outline, may be especially focussed 
upon any one of the underlying topics: 
Exogenous factors. 
Genetic factors. 
Constitutional vulnerability and its types. 
Conditioning factors in the home, the school, the workshop, 
the neighborhood. 
The role of economic, social and cultural factors; acute 
stresses. 
Research into the treatment of mental disorders may be spe- 
cially focussed upon special problems within the following 
fields: 
Drugs, glandular products, physical procedures (hydro- 
therapy, fever therapy, etc.). 
Psychotherapy. 
Occupational therapy, social readaptation. 
The comparative results of various types of care (e.g., hos- 
pital, boarding-out, etc.). 
The above outline indicates the variety of topics within the 
extensive and complex field of mental disorders which require 
further and prolonged investigation. Many of these topics are 
already being investigated, often by men seriously overburdened 
by their routine duties and heavy case-load. 
Any comprehensive scheme for the investigation of all these 
topics would be Utopian. It is assumed by the committee that 
plans for the fostering of psychiatric research in Massachusetts 
will involve a certain continuity, and consist of development 
rather than any drastic rearrangement. 202 
HOUSE —No. 2400. 
[Mar. 
PI The committee calls attention to the fact that special in- 
vestigations are being carried on (a) at the Boston Psycho- 
pathic Hospital, which was established in 1912, with research 
into the causes and prevention of insanity as one of its special 
functions; (b) at the Boston State Hospital, where research is 
being carried on with the help of special funds from outside 
sources; (c) at the Worcester State Hospital, where there is a 
similar situation of external support for a special series of in- 
vestigations; (d) at the State Department of Mental Dis- 
eases, where very important statistical researches have been 
made possible by grants from outside sources. 
These grants from outside sources entitle one to hope that 
with honest support of research and solid guarantee of con- 
tinuity the State may find its own efforts generously re- 
enforced from other sources. 
The Committee does not believe that Massachusetts needs 
any new central research building, nor does it recommend that 
there should be any bureaucratic control of research which 
would in any way hamper the best utilization by the individual 
worker of his native endowment and interests. It believes, 
however, that there should be quite explicit development of 
the function of research throughout the whole state hospital 
system, and that for this purpose there should be a definite 
division in the Department of Mental Diseases which has a 
special responsibility for this functional development. The 
director of this division should have a dignified status and a 
salary commensurate with his responsibility. The relations 
between the director of research, the central authority and the 
local authorities in the hospital would depend upon the organi- 
zation of the Department and its personnel. The budget of the 
division should be reasonably proportionate to the scope of the 
work. The committee recommends that out of the total bud- 
get of the Department adequate funds should be allocated 
annually for the prosecution of the researches already on foot, 
and for those other important and promising researches which 
only await funds in order to be undertaken. The committee 
makes no recommendation of a specific annual figure in view of 
the various factors which are involved in the construction of the 
budget of the Department, and in view of the many and vary- 
ing factors involved in the special research activities. 
In this connection it seems relevant to call attention to the 
generous support which outside foundations have given to 
state departments, state hospitals and individual laboratories 1939.] 
HOUSE —No. 2400. 
203 
when the foundations were convinced that an earnest and 
consistent endeavor was being made in the direction of an at- 
tack upon fundamental problems in an important health field. 
Such foundations do not wish in any way to relieve States or 
municipalities of their proper responsibilities, and are disin- 
clined to be the sole support of investigations for which state 
and municipal authorities also have a certain responsibility. 
When they see, however, that a State is in earnest in doing 
its part in regard to such important health problems, they 
are often willing to give generous support over considerable 
periods of time. The committee wishes specially to emphasize 
this factor of the financial support of research which may be 
expected from various outside sources, such as the larger 
foundations when they are aware of the serious and continued 
interest of the State in psychiatric research. Individual workers 
are frequently in a position to bring the importance and the 
significance of special investigations to the attention of those 
who are able to give support to research. Funds from outside 
sources are particularly valuable, inasmuch as they give an 
elasticity to the organization of research activity which is 
not possible with the funds allocated by the state department. 
As continuity no doubt is desired, the role of the head of 
the division of research will be not the institution of any new 
center, but rather the encouragement of the functional ac- 
tivity of the already existing centers, and the encouragement 
of research within the individual hospitals. It will be part 
of his function to assist in the establishment of an adequate 
laboratory in every state hospital, in the provision of facili- 
ties for encouraging the spirit of research in each state hos- 
pital, and in aiding the younger physicians to get appropriate 
further training in centers specially adapted to their needs and 
interest. It is recommended that he should have at his dis- 
posal a carefully chosen advisory committee on research com- 
posed of members representing the numerous and diverse 
fields of scientific activity which are closely related to the 
field of psychiatric research. 
With regard to the individual hospitals, the committee 
recommends that steps be taken to establish a laboratory in 
each one of these hospitals, and that in his annual budget each 
superintendent should request a special appropriation for the 
specific investigation for which the members of his staff may 
require special funds and which they seem competent to carry 
on profitably. 204 
HOUSE —No. 2400. 
[Mar. 
Appendix 9. 
PROBLEM OF MAINTENANCE. 
A. INCOME. 
The greatest source of income to the Department is now 
derived from the charge made to the relatives of patients for 
the board of such patients in the various institutions. The 
authority for such procedure is found in section 96, chapter 
123 of the General Laws, which specifies that the Department 
may charge a sum not to exceed $10 per week for each person 
who may be a patient in any of the hospitals except the Boston 
Psychopathic Hospital, where a limit is not established, and 
except in the State Infirmary and Bridgewater State Hospital, 
where no charge can be made for patients who are under sen- 
tence. 
The appended table shows collections for the last ten-year 
period from the years 1929 to 1938, inclusive. It will be noted 
that in none of those years did the collections from this source 
go below three quarters of a million dollars. During the more 
progressive economic years the collections approximated 
$1,000,000 per year, reaching a low point in 1934 and showing 
a gradual rise up to and including 1938. These collections have 
been made through the Division of Settlement and Support 
in the central department, which Division has six field workers 
or investigators. 
The various investigators are notified by the hospitals as 
to newly admitted patients. They visit the hospitals, check 
the hospital records, talk with the patients, and then look into 
the various sources of income of the patients and legally 
responsible relatives. After this investigation an amount is 
established by the Department as to what is deemed an equi- 
table weekly amount for the support of the patient. 
The investigators are able to reach the hospitals at varying 
intervals of time; sometimes at two-week intervals, sometimes 
at monthly intervals. They thus contact patients and rela- 
tives many times after the situation which caused the patient’s 1939.] 
HOUSE —No. 2400. 
205 
admission to the hospital has become less acute, and thus the 
relatives in many instances resist a proposal for payment. 
Also, it should be noted that in view of the large number of 
patients who are admitted for short periods of time only (ten 
to thirty days) the investigators from the Department miss 
many opportunities for collection. Many patients are dis- 
charged before the investigators are able to get around to their 
regular visits. Likewise, in view of the high admission rate, 
together with the large backlog of the resident population in 
the hospitals, it is almost impossible for the investigators to 
keep up-to-date with any possible improved financial status 
of patients who have been cared for on a free or reduced cost 
basis. 
The Commission has entertained seriously the thought 
that a separate investigator detached to the individual hos- 
pitals would be able to contact relatives at the time of admis- 
sion of the patient, and would also be able to devote more 
time to rechecking the financial status of the resident popu- 
lation. We feel that the efforts of such investigators would 
probably return as income to the Commonwealth many times 
the cost of their services. It probably would not be feasible 
to carry out this suggestion in its broadest sense at the mo- 
ment, but it might be tried in one or two strategic hospitals 
with high admission rates for a two-year period, and we so 
recommend. 
The Commission has noted the large number of patients 
in our public hospitals who are citizens of this country but 
who do not have a settlement in the State. For many years the 
Department has followed the policy of removing these pa- 
tients to the State of their legal settlement, and we encourage 
the continuance of this policy, particularly as it affects pa- 
tients who are likely to require a long hospital residence. We 
have also had called to our attention certain patients whose 
income is such that they might well afford private hospital 
care. These patients should be encouraged to seek care in 
the properly licensed and less crowded mental hospitals. The 
Commission was surprised to learn that there were 4,538 aliens 
residing in the institutions on September 30, 1937, of whom 
798 were admitted during that year. This represents a sub- 
stantial percentage of the whole resident population of the 
hospitals. Based on the average cost of maintenance, Massa- 
chusetts’ taxpayers are called upon to provide $2,052,960 a 
year. The Department is cognizant of this group, and efforts 206 
HOUSE —No. 2400. 
[Mar. 
have been made in the past to deport these alien patients to 
their native countries, but the number has been relatively 
small. In view of the tremendous burden on Massachusetts’ 
taxpayers, we strongly recommend that the Department 
immediately adopt an aggressive policy to return as many of 
these aliens as is possible. We further recommend that, 
through the Governor, it should seek the co-operation of the 
Federal government and the governments in other countries 
to relieve our citizens of this tax burden. The importance of 
this problem can be seen if one considers that if the entire 
alien patient population were removed, overcrowding in the 
hospitals would disappear, and the normal increase would be 
provided for several years to come. 
The Commission has given special consideration to the 
suggestion that the statutory limit of $10 per week for the 
support of patients be elevated to a higher figure. We believe 
that this may be worthy of further consideration at a later 
date, but we feel that the above suggestions aimed towards 
increasing collections under the present statutory limit should 
be carried’out as a first step. 
The Commission has taken cognizance of other sources of 
income derived from licenses issued to private hospitals, special 
receipts from sales, etc. The total amount of this income is 
relatively small, and we have no further recommendations 
to make regarding it. 
Collections for,[Support of Patients, 1929-38, inclusive. 
Year ending Nov. 30, 1929 . 
$939,846 19 
Year ending Nov. 30, 1930 . 
947,503 03 
Year ending Nov. 30, 1931 . 
917,593 67 
Year ending Nov. 30, 1932 . 
819,870 81 
Year ending Nov. 30, 1933 . 
778,830 53 
Year ending Nov. 30, 1934 . 
754,582 59 
Year ending Nov. 30, 1935 . 
779,117 76 
Year ending Nov. 30, 1936 . 
765,727 72 
Year ending Nov. 30, 1937 . 
769,417 17 
Year ending Nov. 30, 1938 . 
790,184 47 
Total .... 
18,262,673 94 1939.] 
HOUSE— No. 2400. 
207 
B. EXPENSES. 
The problem of maintenance expenses resolves itself pri- 
marily into the question of expenses for the institutions coming 
under the jurisdiction of the Department of Mental Health, 
since these institutions account for over 99 per cent of the 
total expenditures. 
Table 1 shows the breakdown of these expenditures during 
the fiscal year ending November 30, 1938, and will give an 
idea as to the magnitude of the individual items entering into 
the expense problem: 
Table 1. — Total Expenditures, 1938, by Items. 
Personal services 
. $6,497,947 
59 
Food 
. 2,686,746 
30 
Medical and general care 
285,922 
18 
Religious instruction 
29,365 
27 
Farm 
68 
Heat and other plant operations 
. 1,050,692 
07 
Travel, transportation and office expense 
108,156 
33 
Garage and grounds 
. •. 88,592 
40 
Clothing and materials 
310,569 
33 
Furnishings and household supplies 
411,191 
12 
Repairs, ordinary 
208,565 
80 
Repairs and renewals 
295,583 
31 
Total 
. $12,320,549 
38 
Table 2 shows the breakdown of the per capita cost per 
week, based on patient population in each of the institutions. 
The Psychopathic Hospital is considered separately; the 
acute receiving hospitals (those who yearly admit 200 or more 
patients) are identified by (A) and are averaged as a group 
near the bottom of the table. The hospitals not receiving 
200 acute admissions per year are identified as (B) and are 
likewise averaged near the bottom of the table. The three 
schools are considered separately and averaged; and an aver- 
age is given for all institutions except the Boston Psychopathic 
Hospital. 
This table is self-explanatory except the last column, which 
gives a factor indicating the equivalent of 1 cent per patient 
per week. These figures are simply for the matter of conven- 
ience. They are not absolutely accurate, but they do approxi- 208 
HOUSE — No. 2400. 
[Mar. 
mate accuracy. By using these figures one can readily translate 
any item in the subdivisions of the table into total costs; for 
example, under the caption “Clothing and Materials” it is 
indicated that the Medfield State Hospital spent per patient 
per week, 21.3 cents. The 1 cent expenditure factor in the 
last column referring to Medfield is $947.42, Multiplying 
these two figures together gives a total of $20,180.04 expended 
for the entire year. The detailed reports show that the Med- 
field State Hospital actually spent $20,150.33. Again, the 
factors may be used properly in studying total costs, even 
though they only approximate accuracy. These same factors 
may be used in the other tables to follow in arriving at an 
estimate of total costs. 
Table 3 shows a similar breakdown, but involving the one 
item “Personal Services,” and it shows the various subdivi- 
sions into which each such institutional services are classified. 
Table 4 shows the same breakdown in relation to “Medical 
and General Care;” Table 5, in regard to “Clothing and 
Materials;” Table 6, in regard to “Furnishings and House- 
hold Supplies.” 
A study of these total cost figures is, of course, only a part 
of the entire picture which is built around the policy of provid- 
ing for the patients in the institutions adequate medical care, 
good food, reasonable clothing, personal services within reason- 
able limits; and, likewise, working, recreational and devotional 
accommodations within rational limits and with relative freedom 
from hazards. 1939.] 
HOUSE —No. 2400. 
Institution. 
Personal 
Service. 
Food. 
Medical 
and 
General 
Care. 
Re- 
ligious 
Instruc- 
tion. 
Farm. 
Heat, 
etc. 
Travel, 
etc. 
Garage 
and 
Grounds. 
Clothing 
and Ma- 
terials. 
Furnish- 
ings and 
House- 
hold 
Supplies. 
Repairs, 
Ordi- 
nary. 
Repairs 
and Re- 
newals. 
Total. 
Expendi- 
ture of 
1 Cent per 
Capita per 
Week, 
equiva- 
lent to — 
Hospitals. 
Psychopathic .... 
139.688 
$5,993 
$3,079 
$0,266 
- 
$2,813 
$1,102 
$0,150 
$0,170 
$0,833 
$0,631 
$1,077 
$55,807 
$45.09 
Boston State (A) . 
5.197 
2.022 
.197 
.016 
$0,009 
.834 
.082 
.070 
.287 
.322 
.252 
.244 
9.537 
1,231.13 
Danvers (A) .... 
4.131 
1.771 
.139 
.017 
.253 
.894 
.074 
.050 
.226 
.323 
.177 
.144 
8.204 
1,197.56 
Foxborough (A) 
4.506 
1.851 
.160 
.018 
.272 
.704 
.083 
.053 
.205 
.317 
.127 
.159 
8.461 
736.23 
Medfield (A) . 
4,535 
2.017' 
.155 
.022 
.272 
.584 
.064 
.046 
.213 
.284 
.117 
.147 
8.454 
947.42 
Northampton (A) . 
3.964 
1.837 
.200 
.013 
.197 
.699 
,050 
,044 
.157 
,283 
.132 
.157 
7.733 
1,057.41 
Taunton (A) .... 
4.515 
1.922 
.132 
.024 
.278 
.671 
.081 
,033 
.146 
.287 
.141 
.154 
8.385 
884.78 
Westborough (A) . 
4.726 
1.836 
.174 
.018 
.260 
.680 
.078 
.099 
.224 
.266 
.143 
.201 
8.706 
833.97 
Worcester (A) 
5.080 
2.039 
.350 
.023 
.196 
.709 
.097 
.053 
.188 
.304 
.131 
.258 
9.430 
1,221.40 
Gardner (B) .... 
4.338 
1.961 
.500 
.017 
.423 
.789 
.066 
j 097 
.230 
.244 
.178 
.377 
9.222 
743.54 
Grafton (B) .... 
5.030 
1.909 
.189 
.021 
.394 
.835 
.067 
.081 
.256 
.300 
.147 
.287 
9,517 
801.55 
Metropolitan (B) . 
3.979 
1.754 
.190 
.021 
.038 
.855 
.059 
,054 
.221 
.271 
.083 
.227 
7.752 
971.77 
Monson (B) . 
4.944 
1.868 
.127 
.019 
.227 
.891 
.078 
.065 
.203 
.299 
.145 
.170 
9.036 
808.61 
Table 2. — Total Expenses, 1988. 
[Per capita costs per week, based on patient population, expressed in dollars.] 210 
HOUSE —No. 2400. 
[Mar. 
Institution 
Personal 
Service. 
Food. 
Medical 
and 
General 
Care. 
Re- 
ligious 
Instruc- 
tion. 
Farm. 
Heat, 
etc. 
Travel, 
etc. 
Garage 
and 
Grounds. 
Clothing 
and Ma- 
terials. 
Furnish- 
ings and 
House- 
hold 
Supplies 
Repairs, 
Ordi- 
nary. 
Repairs 
and Re- 
newals. 
Total. 
Expendi- 
ture of 
1 Cent per 
Capita per 
Week, 
equiva- 
lent to — 
Sub-total averages: 
Psychopathic .... 
$39,688 
$5,993 
$3,079 
$0,266 
- 
$2,813 
$1.102 
$0,150 
$0,170 
$0,833 
$0,631 
$1,077 
$55,807 
$45.09 
Group (A) .... 
4,599 
1.918 
.194 
.019 
$0 208 
.732 
.077 
.056 
.208 
.300 
.157 
.187 
8.654 
8,109.93 
Group (B) .... 
4.546 
1.865 
.244 
.020 
.256 
.843 
.067 
.073 
.227 
.279 
.135 
.261 
8.817 
3,325.49 
Sub-total averages, Groups 
(A) and (B). 
4.584 
1.902 
.209 
.019 
.222 
.764 
.074 
.061 
.214 
.294 
.150 
.209 
8.702 
11,435.43 
Schools. 
Belchertown .... 
4.297 
1.970 
.158 
.023 
.401 
.580 
.083 
.088 
.246 
.279 
’ .144 
.192 
8.460 
678.13 
Fernald 
4.117 
1.670 
.116 
,027 
.304 
.729 
.068 
,066 
.246 
.269 
.111 
.229 
7.952 
1,020.24 
Wrentham .... 
3.537 
1.743 
.104 
.017 
.343 
.482 
.060 
.055 
.227 
.242 
.123 
.153 
7.088 
1,034.50 
Sub-total averages . 
3.942 
1.772 
.122 
.022 
.343 
.598 
.069 
.067 
.239 
.261 
.124 
.191 
7.750 
2,732.87 
Grand total averages 
4.572 
1.890 
.201 
.021 
.244 
.739 
.076 
.062 
.219 
.289 
.147 
.208 
8.669 
14,213 40 
" 
Method of Compulation. 
Northampton, religious instruction expenditure, 1.3 cents X $1,057.41 = $1,374.63 (actually spent, $1,400). 
Medfield, clothing expenditure, 21.3 cents X $947,42 = $20,180.04 (actually spent, $20,150.33). 
Westborough, total expenditure, 870.6 cents X $833.97 = $726,054.28 (actually spent, $726,094.94). 
Table 2. — Total Expenses, 1938 — Concluded. 
[Per capita costs per week, based on patient population, expressed in dollars.] 1939.] 
HOUSE —No. 2400. 
211 
Kitchen 
and 
Dining 
Room. 
Ward Service. 
Indus- 
try and 
Educa- 
tion. 
En- 
gineering 
Depart- 
ment. 
Stable, 
Garage 
and 
Grounds. 
Expendi- 
ture of 
Institution. 
Medi- 
cal. 
Admin- 
istra- 
tion. 
Domes- 
tic 
Service. 
Male. 
Female. 
Repairs. 
Farm. 
Total. 
1 Cent per 
Patient 
per Week, 
equiva- 
lent to — 
Hospitals. 
Psychopathic .... 
$8,805 
$10,776 
$2,290 
$2,598 
$5,389 
$5,332 
$0,569 
$2,990 
$0,935 
- 
- 
$39,683 
$45.09 
Boston State (A) 
.313 
.453 
.333 
.421 
1.240 
1.560 
.149 
.282 
.220 
$0,082 
$0,145 
5.198 
1,231 13 
Danvers (A) 
.316 
.311 
.267 
.239 
.998 
1.124 
.072 
.337 
.199 
.199 
.067 
4.131 
1,197.56 
Foxborough (A) 
.370 
.397 
.320 
.327 
.978 
1.125 
.086 
.360 
.186 
.225 
.130 
4.506 
736.23 
Medfield (A) .... 
.276 
.302 
.277 
.315 
.958 
1.290 
.101 
.392 
.244 
.268 
.111 
4.535 
947.42 
Northampton (A) . 
,323 
.281 
.261 
.266 
.892 
1.120 
.060 
.280 
.196 
.209 
.076 
3.963 
1,057.41 
Taunton (A) . 
.350 
.366 
.337 
.256 
1.110 
1.089 
.083 
.403 
.229 
.210 
.082 
4.515 
884.78 
Westborough (A) 
.365 
.383 
.407 
.373 
.979 
1.082 
.070 
.517 
.206 
.281 
.062 
4.726 
833.97 
Worcester (A) . 
.321 
.432 
.314 
.442 
1.221 
1.385 
.096 
,353 
.204 
.193 
.118 
5.080 
1,221.40 
Gardner (B) .... 
.346 
.385 
.461 
.199 
1,124 
.867 
.138 
.261 
.202 
.253 
.103 
4,338 
743.54 
Grafton (B) .... 
.378 
.336 
.428 
.411 
1.067 
1.083 
.101 
.444 
.281 
.353 
.149 
5.030 
801.55 
Metropolitan (B) 
.277 
.308 
.307 
.237 
1,057 
1.121 
.063 
.256 
.173 
.090 
.090 
3.979 
971.77 
Monson (B) 
.341 
.310 
.372 
.266 
1.270 
1,355 
.075 
.329 
.258 
.280 
.088 
4.944 
808.61 
Table 3. — Personal Services, 1938. 
[Weekly per capita costs, expressed in dollars.) HOUSE —No. 2400. 
[Mar. 
Kitchen 
and 
Dining 
Room. 
Ward Service. 
Indus- 
try and 
Educa- 
tion. 
En- 
gineering 
Depart- 
ment. 
Stable, 
Garage 
and 
Grounds. 
Expendi- 
Institution. 
Medi- 
cal. 
Admin- 
istra- 
tion. 
Domes- 
tic 
Service. 
Male. 
Female. 
Repairs. 
Farm. 
Total. 
1 Cent per 
Patient 
per Week, 
equiva- 
lent to — 
Sub-total averages: 
Psychopathic .... 
$8.805 
810.776 
*2.290 
*2.598 
*5.389 
*5.332 
*0.569 
*2.990 
*0.935 
_ 
_ 
*39,683 
*15.09 
Group (A) .... 
.326 
.367 
.312 
.333 
1.059 
1,240 
.092 
.358 
.210 
*0.202 
*0.100 
4.599 
8,109.93 
Group (B) .... 
.332 
.332 
.386 
.277 
1.126 
1.112 
,092 
.320 
.226 
.236 
.107 
4.546 
3,325.49 
Sub-total averages, Groups (A) 
.328 
.357 
.333 
.317 
1.078 
1.203 
.092 
.347 
.215 
.212 
.102 
4.584 
11,435.43 
and (B). 
Schools. 
Belchertown .... 
.326 
.408 
.240 
.142 
.761 
1.110 
.309 
.398 
.248 
.243 
.110 
4.297 
678.13 
Fernald 
.286 
.359 
.252 
.135 
1.195 
.847 
.328 
.275 
.169 
.204 
.067 
4.117 
1,020.24 
Wrentham .... 
.274 
.337 
.151 
.102 
.856 
.917 
.256 
.299 
.129 
.152 
.063 
3.537 
1,034.50 
Sub-total averages . 
.292 
.363 
.211 
,124 
.959 
.939 
.296 
.315 
.174 
.194 
.076 
3.942 
2,732.87 
Grand total averages 
.348 
.391 
.316 
.287 
1.069 
1.165 
.132 
.349 
.209 
.208 
.096 
4.572 
14,213.40 
Table 3. — Personal Services, 1938 — Concluded, 
[Weekly per capita costs, expressed in dollars.] 1939.] 
HOUSE— No. 2400. 
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2.67 
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Medical Atten- 
tion (Extra). 
4* 
03 
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5 
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I- 
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H* 
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to 
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05 
73 
OO 
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to 
to 
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1 
1 
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971.77 
eeios 
743 54 
1,221.40 
833.97 
884.78 
1,057.41 
947.42 
736.23 
1,197.56 
■ 1,231.13 
60 9f 
Expenditure of 1 
Cent per Patient 
per Week, equiv- 
alent to — 
Table 4. — Medical and General Care, 1938. 
(Weekly per capita costs, expressed in cents.] HOUSE —No. 2400. 
[Mar 
214 
✓ 
Institution. 
Books. 
Entertainment. 
Funeral. 
Gratuity. 
Labor. 
Manual Training 
Supplies. 
Medicines. 
Medical Atten- 
tion (Extra). 
Patients Boarded 
Out. 
Return of Run- 
aways. 
School Books. 
Sputum Cups. 
Tobacco Pipes. 
Toilet Articles. 
T. B. 
Total. 
Expenditure of 1 
Cent per Patient 
per Week, equiv- 
alent to — 
Sub-total averages: 
Psychopathic 
30.05 
.77 
- 
- 
21.03 
2.16 
80.36 
- 
- 
- 
- 
- 
.36 
4.07 
- 
307.83 
45.09 
Group (A) 
.88 
1.00 
.41 
.10 
1.14 
.01 
7.78 
1.88 
3.14 
.005 
.01 
.007 
1.75 
1,36 
.001 
19.44 
8,109 93 
Group (B) 
.89 
.92 
.65 
,002 
1.16 
.01 
6.55 
1.37 
9.50 
.004 
,02 
.01 
2.14 
1.01 
- 
24.29 
3,325.49 
Sub-total averages, Groups (A) and (B) . 
.88 
.98 
.48 
.07 
1.15 
.01 
7.42 
1.73 
4.99 
.005 
.01 
.009 
1.86 
1.25 
.0008 
20,85 
11,435.43 
Schools. 
Belchertown ....... 
2.26 
.94 
.14 
- 
.38 
.25 
5.55 
1.21 
2.50 
.03 
.80 
- 
.03 
1.59 
.03 
15.76 
678.13 
Fernald 
1.75 
.85 
.10 
- 
.81 
.68 
3.49 
2.02 
- 
.02 
.29 
- 
.05 
1.47 
- 
11.58 
1,020.24 
Wrentham 
1.56 
.56 
.09 
- 
1.28 
.09 
3.33 
1.08 
- 
.009 
.95 
- 
.15 
1.29 
- 
10.43 
1,034.50 
Sub-total averages 
1.81 
.76 
.11 
- 
.88 
.35 
3.94 
1.46 
.62 
.02 
.66 
- 
.09 
1.43 
.008 
12.18 
2,732.87 
Grand total averages . 
1.15 
.94 
.41 
.06 
1.16 
.08 
6.98 
1.67 
4.14 
.008 
.14 
.007 
1.52 
1.30 
.002 
20.09 
14,213.40 
Note. $290.80 subtracted from total of Metropolitan State Hospital (refund account of reimbursing patient); $7,626 31 included in total of “ Psychopathic” (laundry 
done outside) = 53 cents in grand total. 
Table 4. — Medical and General Care, 1938 — Concluded. 
[Weekly per capita costs, expressed in cents.] 1939 
HOUSE — No. 2400. 
215 
Institution. 
Boots, 
Shoos, etc. 
Outer 
Clothing. 
Under 
Clothing. 
Dry Goods 
for Clothing, 
Hats and 
Caps. 
Leather, 
etc. 
Machinery 
for Manu- 
facturing. 
Socks and 
Smallwares. 
Total. 
Hospitals. 
Psychopathic 
2.56 
4.56 
6.70 
2.04 
.08 
.01 
- 
1.11 
17 06 
Boston State (A) 
5.91 
9.43 
9.12 
1.63 
.53 
.14 
.09 
1.90 
28.75 
Danvers (A) 
.31 
6.48 
3.76 
7.00 
.26 
2.28 
.24 
2.34 
22.67 
Foxborough (A) 
2.65 
5.30 
4.91 
4.95 
.08 
.25 
.21 
2.20 
20.55 
Medfield (A) 
3.46 
3.08 
1.66 
9.77 
.48 
.27 
.25 
2.28 
21,26 
Northampton (A) 
3.20 
4.44 
3.29 
2.77 
,13 
.34 
.01 
1.47 
15.66 
Taunton (A) 
• .50 
.73 
1.22 
8.28 
.26 
1.92 
.16 
1.56 
14.64 
Westborough (A) 
2.92 
6.55 
4.84 
5.68 
.10 
.33 
.01 
1,96 
22,39 
Worcester (A) 
3.46 
4.58 
3.30 
5.04 
.18 
.52 
.14 
1.58 
18.81 
Gardner (B) 
1.39 
1.74 
.25 
12.99 
.17 
4.65 
.50 
1.29 
22.99 
Grafton (B) 
4.08 
10.17 
2.43 
5.68 
.40 
.55 
.44 
1.88 
25,63 
Metropolitan (B) 
3.53 
9.54 
3.12 
3,64 
.27 
.49 
.14 
1.38 
22.11 
Monson (B) . . . . 
2.44 
9.29 
2.60 
3.31 
.10 
1.00 
.28 
1.31 
20.34 
Table 5. — Clothing and Materials, 1938. 
(Weekly per capita costs, expressed in cents.] 216 
HOUSE —No. 2400. 
[Mar, 
Institution. 
Boots, 
Shoes, etc. 
Outer 
Clothing. 
Under 
Clothing. 
Dry Goods 
for Clothing. 
Hats and 
Caps. 
Leather, 
etc. 
Machinery 
for Manu- 
facturing. 
Socks and 
Smallwares. 
Total. 
Sub-total averages: 
Psychopathic 
2.56 
4.56 
6.70 
2.04 
.08 
.01 
- 
1.11 
17.06 
Group (A) 
2,88 
5.25 
4.14 
5.48 
.27 
.78 
.14 
1.90 
20.84 
Group (B) 
2.92 
7.89 
2.19 
6.14 
.24 
1.56 
.33 
1,46 
22.72 
Sub-total averages, Groups (A) and (B) 
2.89 
6.02 
3,57 
5.67 
.26 
1.01 
.19 
1.77 
21.39 
Schools. 
Belchertown ...... 
3.12 
4.05 
1.88 
11.39 
.20 
2.25 
.60 
1.09 
24.59 
Fernald 
8.68 
6.61 
1.44 
4.63 
.20 
1.27 
.40 
1.35 
24 59 
Wrentham 
5.65 
3.50 
2.23 
7.29 
.16 
1,52 
,01 
2.33 
22.70 
Sub-total averages .... 
6.15 
4.80 
1.85 
7.31 
.18 
1.61 
.30 
1.66 
23.87 
Grand total averages .... 
3,52 
5,78 
3.25 
5,98 
.24 
1.12 
.21 
1.75 
21.85 
Table 5. — Clothing and Materials, 1938 — Concluded. 
[Weekly per capita costs, expressed in cents.] 1939.] 
HOUSE — No. 2400. 
217 
o’ 
cd 
o 
p 
o 
p 
3 
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5= 
s 
H 
r 
2 
o 
B 
CD 
o 
0 
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8 
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v: 
0 
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Hospitals. 
Institution. 
o 
Cn 
o 
4^ 
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co 
co 
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o» 
O 
oo 
Beds, Bedding. 
4^. 
05 
OO 
OO 
to 
s 
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Or 
4- 
to 
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CO 
H- 
i- 
oo 
Carpets, Rugs. 
OO 
to 
o 
“ 
O 
9 
to 
o 
to 
oo 
to 
OO 
H- 
4“ 
to 
to 
oo 
oo 
CO 
Crockery, etc. 
to 
to 
->4 
CO 
to 
OO 
O 
o 
oo 
o 
s 
H- 
Dry Goods, etc. 
2 
o 
2 
to 
“ 
•4 
ai 
Cn 
2 
oo 
H- 
- 
►- 
Electric Lamps. 
CD 
4- 
oo 
s 
*! 
2 
oo 
2 
oo 
05 
H- 
Fire Hose. 
oo 
00 
OO 
OO 
CO 
5 
vj 
w 
2 
4*. 
w 
Furniture and Up- 
oo 
to 
holstery. 
oo 
Oi 
CO 
o 
O 
o 
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05 
oo 
oo 
05 
Oi 
oo 
05 
Or 
-*4 
•^1 
Kitchen. 
o 
oo 
o 
o 
o 
4* 
to 
2 
o 
05 
2 
•O 
& 
h- 
oo 
to 
to 
to 
to 
OO 
to 
OO 
OO 
to 
to 
- 
Laundry. 
2 
o 
s 
p 
CO 
05 
2 
s 
o 
to 
r 
- 
« 
r 
- 
to 
oo 
Lavatory. 
2 
CO 
o 
oo 
4* 
co 
O 
o* 
& 
s 
Machinery for 
oo 
*o 
O 
O 
1 
1 
Manufacturing. 
05 
to 
to 
- 
- 
to 
to 
to 
- 
- 
OO 
OO 
to 
Or 
Table Linens, etc. 
oo 
to 
s 
2 
Oi 
oo 
CO 
2 
p 
CO 
O 
Furnishing Super- 
I 
1 
1 
P' 
intendent’s 
c* 
K 
CO 
00 
o 
p 
o 
to 
o« 
o 
Oi 
oo 
Apartment. 
to 
to 
oo 
to 
OO 
to 
to 
to 
to 
oo 
CO 
05 
00 
OO 
oo 
*—1 
to 
oo 
Total. 
bo 
o 
4— 
4-> 
OO 
oo 
oo 
Crc 
co 
H- 
CO 
4^ 
4^ 
o 
Expenditure of 1 
00 
o 
oo 
CO 
•4 
oo 
o 
•^1 
w 
to 
oo 
Cc 
oo 
oc 
O 
Or 
-<I 
CO 
4* 
**4 
05 
CO 
*^4 
to 
oo 
4^ 
Or 
Cent per Patient 
per Week equiv- 
05 
-4 
c* 
o» 
Or 
4^ 
O 
CO 
oo 
4* 
4«- 
to 
CO 
C" 
05 
oo 
O 
CO 
alent to — 
Table 6. — Furniture and Household Supplies, 1938. 
[Weekly per capita costs, expressed in cents.] 218 
HOUSE —No. 2400. 
[Mar 
Sub-total averages: 
Psychopathic 
Group (A) 
Group (B) 
Sub-total averages, Groups (A) and (B) 
Schools. 
Belchcrtown 
Fernald 
Wrentham 
Sub-total averages 
Grand total averages .... 
Institution. 
18.00 
10.04 
7.68 
0.35 
3,88 
7.03 
7.92 
6.59 
8.85 
Beds, Bedding. 
3.70 
.57 
.51 
.55 
.82 
.66 
.39 
.60 
.57 
Carpets, Rugs. 
9.53 
2.71 
2.52 
2.66 
3.09 
1.61 
1.37 
1.89 
2.53 
Crockery, etc. 
.03 
.50 
.55 
.52 
.64 
.15 
.41 
.37 
.49 
Dry Goods, etc. 
05 M ' M O' -vj 05 OO >—* 
COW *vJWCOC5 
Electric Lamps. 
.84 
.19 
.43 
.26 
.35 
.33 
.12 
.25 
.26 
Fire Hose. 
13.12 
1.88 
2.24 
1.98 
3.06 
2.73 
2.08 
2.56 
2.13 
Furniture and Up- 
holstery. 
17.05 
6.71 
7.90 
7.06 
9.14 
8.28 
6.46 
7.80 
7 23 
Kitchen. 
1.37 
2.75 
2.43 
2.66 
3.80 
3.20 
2.75 
3.18 
2.75 
Laundry. 
8 03 
1.35 
1.09 
1.28 
1.10 
.58 
.81 
.80 
1.20 
Lavatory. 
.07 
.07 
.07 
.02 
.56 
.08 
.25 
.11 
Machinery " for 
Manufacturing.' 
5.99 
2.26 
1.72 
2.10 
1.47 
1.18 
1.67 
1.44 
1 99 
Table Linens, etc. 
5.53 
.12 
.12 
.12 
.28 
.18 
.17 
.14 
Furnishing Super- 
intendent’s 
Apartment. 
83.35 
30.00 
27.87 
29.38 
27.92 
26.90 
24.25 
26.14 
28.93 
Total 
45.09 
8,109.93 
3.325.49 
11,435.43 
678.13 
1,020.24 
1.034.50 
2,732.87 
14,213.40 
Expenditure of 1 
Cent per Patient 
per Week equiv- 
alent to — 
Table 6. — Furniture and Household Supplies, 1938 — Concluded. 
[Weekly per capita costa, expressed in cents.] 1939.] 
HOUSE — No. 2400. 
219 
I. Personal Services. 
I his problem constituted an expense item of approximately 
$6,500,000 in 1938. 
this item is of such magnitude that a special section has 
been devoted to discussing it, and it is referred to many times 
in discussions, both in the body of this report and the various 
appendices. In view of this it would be redundant to go into 
the detail of personal services at this point. We would again 
call attention, however, to the fact that the institutions are 
not pvermanned, and that in certain instances service could 
undoubtedly be improved by the addition of new or rearrange- 
ment of present personnel. The Department for several 
months has been engaged in a resurvey of the entire personnel 
problem. 
It was our feeling that this was purely an administrative 
matter and one which we as a Commission should leave to the 
Department for further consideration. However, in checking 
over budgetary items, including transfers between items in a 
five-year period, we learned that occasionally there have been 
transfers from the personal services item to other items. For 
example, money was transferred from the personal services 
item for the purpose of buying farm machinery. We do not, 
in view of the constant clamor for additional personnel, believe 
this is a good practice. When the Legislature appropriates 
money for personal services, such sums should be used only 
for that purpose. On the other hand, to prohibit such trans- 
fers by legislation would be harmful rather than helpful, as the 
personal services item is a flexible one and would be most 
quickly available if an emergency arose. We understand this 
departmental policy applies also to transfers from the food 
item. We are pleased, therefore, that the Department has 
adopted a policy of refusing to approve transfers from the per- 
sonal services item unless a grave emergency can be shown. 
The personnel item is an ever-increasing expense. This is 
due in some measure to the constant increase of patients in the 
institutions which, of course, requires additional personnel. 
It is likewise due to the annual step-rate increases which the 
state service offers to employees for faithful and long service. 
II. Food. 
This item constitutes the second largest one from the stand- 
point of maintenance costs. In 1938 it approximated a cost 
of $2,700,000. 220 
HOUSE— No. 2400. 
[Mar. 
Food is unquestionably one of the most vexing problems 
with which the institutions are faced. It is a problem which is 
of intense interest, not only to the patients and employees in 
the institutions, but also to those persons who have relatives 
or friends in the institutions and to the public at large. 
In our report last year we referred somewhat to this problem 
and commented that patients in the institutions were ade- 
quately fed. We did point out, however, that there was some- 
thing radically wrong with the methods of computing appro- 
priations for food, and it is this latter point that we will dwell 
upon here. 
For a period of many years the Department figured the food 
budgetary requests on a basis of a ration which undoubtedly 
was originally established on a firm foundation, but it had not 
undergone thorough study and revision for many years, and 
it was somewhat outdated. From our investigations, practi- 
cally all of the superintendents felt that there should be radical 
revision and a ration set-up as it applied to eggs, fruit, milk, 
butter and sugar. It likewise felt that the ration had not taken 
into consideration as much as it should of various groups of 
patients involved, such as youthful, invalid, overactive, hard- 
working and disturbed patients. There also were many com- 
plaints because the ration was set up on the basis of patients 
only and appropriations made on that basis. Food for the 
employees and officers of the institution had to be taken from 
this amount. This did not seem to be an equitable basis, 
either for figuring a balanced ration or for figuring appropria- 
tion needs. 
The above problems have been given considerable study, 
and the Department co-operating with the recommendations 
of the Commission has adopted a new method of figuring. 
Food for a given year is obtained from several sources. It is 
either (1) purchased within that year, (2) home produced 
within that year, (3) taken out of inventory of food left over 
from the previous year, or (4) given to the institution. The 
latter point is quite irregular and can be disposed of rapidly by 
stating that from time to time it has been possible to obtain 
small amounts of certain food items from the Surplus Com- 
modities Division of the Federal government under the re- 
strictions governing such commodities. These gifts are not 
reflected materially in total costs for food. 
Food is dispensed to patients and employees (the latter con- 
sist of regular employees, special employees and students) 1939.] 
HOUSE— No. 2400. 
221 
and also to certain officers of the institutions who are permitted 
a yearly dollar and cent allowance. 
By referring to Table 7, it will be easy to follow the use 
of these factors in computing 1938 budget requests for pur- 
chased food. 
Column 1. Merely enumerates the various institutions. 
Column 10. The revised ration was estimated to cost ap- 
proximately 24.3 cents per individual per day in those insti- 
tutions where food was procured for a large number of people 
(the Boston Psychopathic Hospital being the only exception). 
Column 9. Shows the same figure on a yearly basis. 
Column 8. Details the quota of patients and employees 
who actually eat in the hospital dining rooms and who repre- 
sent the total so-called “feeders” at the institution. 
Column 7. Is arrived at by multiplying the figures of Col- 
umns 8 and 9, and shows the total amount estimated necessary 
for food for those who eat in the institution dining rooms. 
Column 6. Indicates the allowance for the family main- 
tenance of certain institutional officers who are entitled to 
such allowance. This amount is obviously not available for 
the use of patients or the general run of employees who eat in 
the usual dining room. 
Column 5. Is arrived at by adding Columns 6 and 7 to- 
gether, which indicates the total food allowance for every one 
at the institution. 
Column 4. Indicates the food inventory available at the 
various institutions at the close of the fiscal year of 1937. 
Column 3. Indicates the estimated value of food that would 
be produced at the institution during 1938. 
Column 2. Indicates the final budget request for food, 
which funds had to be appropriated in 1938. It is arrived at 
by subtracting the figures in Columns 3 and 4 from the total 
food allowance necessary, which is found in Column 5. 
From this table it will be seen that all institutions, except 
the Boston Psychopathic Hospital, were put on essentially the 
same equitable basis, allowing the internal administration of 
each hospital to make ration allowance adjustments for the 
variations found necessary in the different groups of patients. 
It was not thought that this standardized ration and cost 
would necessarily be a panacea for all the food problems. It 
was started simply as a basis for equitable feeding and manage- 
ment control, with the idea of revision downward as further 
study would indicate might be proper. 222 
HOUSE —No. 2400. 
[Mar. 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
Institution. 
Budget 
Estimated 
Home 
Produce. 
Actual 
Store- 
house 
Total 
Food 
Allow- 
ance for 
Family 
Total 
Amount 
to Insti- 
tution 
“Feeders.” 
Estimated Number of 
“Feeders” —Employees 
Plus Patients. 
Allow- 
ance per 
Allow- 
ance per 
menda- 
tions. 
Inventory, 
Nov. 30. 
1937. 
Allow- 
ance. 
Mainte- 
nance for 
Officers. 
Em- 
ployees. 
Patients. 
Total. 
\ ear per 
Person. 
Day per 
Person. 
Hospitals. 
Psychopathic 
$28,000 
- 
$1,506 
$29,506 
$700 
$28,806 
117 
90 
207 
$139.10 
$0,381 
Boston State 
247,800 
- 
10,268 
261,068 
2,576 
261,492 
591 
2,330 
2,921 
89.50 
.245 
Danvers .... 
144,200 
$80,670 
13,018 
237,888 
4,170 
233,718 
369 
2,260 
2,629 
88.75 
.243 
Foxborough 
88,200 
44,300 
10,168 
142,668 
3,361 
139,307 
214 
1,340 
1,554 
89.50 
.245 
Gardner .... 
74,500 
67,560 
20,104 
162,164 
5,370 
156,794 
314 
1,450 
1,764 
88,75 
.243 
Grafton .... 
03,800 
62,420 
13,354 
169,574 
4,233 
165,341 
327 
1,535 
1,862 
88.75 
.243 
Medfield .... 
132,600 
59,516 
12,489 
204,605 
2,978 
201,627 
377 
1,890 
2,267 
88.75 
.243 
Metropolitan 
107,800 
8,000 
12,619 
187,419 
4,207 
184,212 
249 
1,810 
2,059 
89.50 
.245 
Northampton 
136,200 
02,364 
13,098 
211,662 
3,945 
207,717 
369 
1,970 
2,339 
88.75 
.243 
Taunton .... 
118,400 
53,630 
17,973 
190,003 
3,763 
186,240 
400 
1,686 
2,086 
89.00 
.244 
Westborough 
114,300 
55,929 
9,622 
179,851 
5,005 
174,846 
404 
1,560 
1,964 
89.00 
.244 
Worcester .... 
202,000 
55,700 
6,177 
263,877 
6,451 
257,426 
570 
2,330 
2,900 
88.75 
.213 
Monson .... 
117,000 
41,310 
9,966 
168,276 
3,976 
164,300 
321 
1,530 
1,851 
88.75 
.243 
Schools. 
Belchertown 
75,400 
55,996 
13,134 
144,530 
3,761 
140,769 
242 
1,320 
1,562 
90.00 
.2465 
W. E. Fernald 
120,900 
77,050 
12,982 
210,932 
3,489 
207,443 
433 
1,900 
2,333 
89.00 
.244 
Wrentham .... 
115,600 
67,000 
20,256 
202,856 
4,727 
198,129 
321 
1,910 
2,231 
88.80 
.2435 
Table 7. — Analysis, 1938 Food Budget Recommendations. 1939.] 
HOUSE— No. 2400. 
223 
Of particular concern in the figures brought to light last 
year was the general high value of food inventories. One of 
the goals in the food problem was aimed at diminishing the 
higher inventories. 
Table 8, detailing the 1939 food requests, shows some 
of the revisions obtained from a year of close study. It is 
demonstrated in certain minor variations and the allowance 
per person per day, and in the marked diminution of inventory. 
Our investigations show that the Department is continuing 
to study the whole problem of food from a point where it is 
received after having been raised or purchased by the insti- 
tution through its storage, preparation, service, consumption 
and waste. To that end, a commissary agent was added to 
the Department for the sole purpose of studying the entire 
food problem and carrying out such experimentations as would 
be necessary and reducing it to a simpler and more equitable 
form. 
The Commission believes that the Department and its co- 
operating institutions have done a very creditable piece of 
work during the past year in regard to this tremendous prob- 
lem, and believe that it will ultimately result in better service 
at proportionately lower cost. 
III. Medical and General Care. 
This item is represented by a total expenditure in 1938 of 
approximately $286,000. 
Table 4 details the breakdown of the individual hospital 
expenses in this item for 1938. It will be noted that there is 
a wide variation in costs in certain of these items, and it is 
hoped that this will be a subject for scrutiny by the Depart- 
ment. It is satisfying to note that in the budget for the bi- 
ennium 1939 to 1940 the Department has made some attempt 
to standardize costs for certain general types of care within 
reasonable limits. 
The cost of family care or boarding out of patients is ex- 
pressed in this particular division of expenditures. This 
particular subject has been a point of discussion in other 
sections of this report. It is hoped that this program will be 
continued and will become an integral part of the adminis- 
tration of each institution. 
Generally speaking, the hospitals are fairly well equipped 
for the carrying out of the usual medical and surgical pro- 224 
HOUSE — No. 2400 
[Mar, 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
Institution. 
Final 
Recom- 
Home 
Produce 
(Plus). 
Store- 
house 
Total 
Food 
Expended 
for 
Family 
Mainte- 
nance 
(1938). 
(Deduct.) 
Total 
Amount 
to Insti- 
tution 
“Feeders.” 
Estimated Number of 
“ Feeders ’ ’ — Employees 
plus Patients. 
Allow- 
ance per 
Allow- 
ance per 
menda- 
tions. 
Inventory 
(Plus). 
Allow- 
ance. 
Em- 
ployees. 
Patients. 
Total. 
Year per 
Person. 
Day per 
Person. 
Hospitals. 
Psychopathic 
$28,005 
- 
*1,402 
*29,407 
*702 
*28,705 
130 
90 
220 
*130.48 
*0.357 
Boston State 
256,020 
- 
7,116 
263,136 
2,724 
260,412 
662 
2,440 
3,102 
83.95 
.23 
Danvers 
174,319 
*66,065 
6,972 
247,356 
4,321 
243,035 
455 
2,340 
2,895 
83.95 
.23 
Foxborough 
99,974 
35,957 
7,339 
143,270 
3,242 
140,030 
268 
1,400 
1,668 
83.95 
.23 
Gardner 
79,113 
63,734 
9,906 
152,753 
5,253 
147,500 
297 
1,460 
1,757 
83.95 
.23 
Grafton 
92,037 
64,422 
8,253 
164,712 
4,116 
160,596 
343 
1,570 
1,913 
83.95 
.23 
Medfield 
123,247 
59,266 
11,119 
193,632 
3,905 
189,727 
395 
1,865 
2,260 
83.95 
.23 
Metropolitan 
182,654 
5,368 
7,326 
195,348 
3,691 
191,657 
333 
1,950 
2,283 
83.95 
.23 
Northampton 
141,423 
59,192 
11,456 
212,171 
4,379 
207,792 
444 
2,030 
2,474 
83.95 
.23 
Taunton 
113,073 
59,328 
9,195 
181,596 
3,371 
178,225 
408 
1,725 
2,123 
83.95 
.23 
Westborough 
114,709 
46,108 
8,008 
168,825 
4,703 
164,122 
380 
1,575 
1,955 
83.95 
.23 
Worcester 
206,930 
49,673 
4,760 
261,393 
6,102 
255,291 
591 
2,450 
3,041 
83.95 
.23 
Monson 
123,558 
33,000 
4,238 
160,796 
2,970 
157,826 
355 
1,535 
1,880 
83.95 
.23 
Schools. 
Belchertown 
78,065 
55,047 
6,868 
139,980 
4,233 
135,747 
267 
1,350 
1,617 
83.95 
.23 
W. E. Fernald 
127,268 
61,505 
9,576 
198,349 
4,005 
194,344 
405 
1,900 
2,315 
83.95 
.23 
Wrentham 
111,207 
71,940 
14,105 
197,252 
5,175 
192,077 
348 
1,940 
2,288 
83.95 
.23 
Table 8. — Estimated Analysis, 1939 Food Expenditures. 1939.] 
HOUSE — No. 2400. 
225 
cedures. A few hospitals have lagged behind and we suggest 
that they be encouraged to modernize their facilities in this 
regard. 
A large item of cost is that allocated to toilet and personal 
articles. Over a period of years the institutions have encouraged 
their patients to increase their self-respect through increased 
personal appearance and personal hygiene. This is an excellent 
policy, and it is reflected to a degree in this division of the 
appropriation. 
In like manner, entertainment and tobacco have contributed 
materially to the enjoyment and general good mental hygiene 
of the patients and are expressed in this item. 
We suggest that careful study be given to any program 
which would call for curtailment of the present standards of 
medical and general care. A new division of hospital inspection 
within the Department will undoubtedly be particularly con- 
cerned with this latter point. 
IV. Religious Instruction. 
This item amounted to an annual expenditure of approx- 
imately $30,000 in 1938. 
It provides for the spiritual welfare of the patients and 
embraces the Protestant, Catholic and Jewish faiths. All in- 
stitutions have access to ministration from recognized repre- 
sentatives of these three denominations. 
V. Farm. 
This item amounted to an expenditure of approximately 
$347,000 in 1938. 
Farms are run in connection with the institutions for the 
purposes of (1) producing home-grown food and (2) serving as 
an outlet, in the way of occupational therapy, for patients. 
The various farm activities seem to provide an excellent thera- 
peutic outlet for large numbers of patients in the schools for 
mental defectives. However, the superintendents are of varied 
opinions as to the therapeutic value of certain farming activities 
to adult psychotic patients. Certain superintendents feel that 
vegetable gardens which require varied activity and in which 
the season is relatively short are therapeutically worth while. 
They express the opinion, however, that when patients are 
assigned to the more permanent routine duties connected with 
the care of cattle and swine, they are liable to be overlooked at 
a time when they might leave the hospital. 226 
HOUSE —No. 2400. 
[Mar. 
Since the main value of the farm seems to be concerned 
with the value of food produced, it would seem worth while to 
continue the special study started by the Department last 
year in correlating the value of production with costs, and 
minimizing farm activities where they appear too costly. To 
this end it is worthy to note that the Department has recently 
abandoned the farm at the Boston State Hospital. At the 
close of the last fiscal year it eliminated the raising of swine at 
the Foxborough State Hospital, and has concentrated the 
collection of garbage from the Metropolitan Boston hospitals 
to be delivered to the Danvers State Hospital, where it is used 
for raising pork at a relatively cheap price. 
These appear to be commendable steps and show the result 
of co-ordinated effort between the Department and the in- 
stitutions. The Department maintains a farm co-ordinator, 
who is the immediate director of this activity. 
We suggest that this form of study be continued to other 
aspects of farm activity, bearing in mind that the expense of 
personal services at the farm is an integral part of farm costs. 
VI. Heat and Other Plant Operations. 
The items making up this division of expense have to do with 
the heating of the buildings, gas, electricity, water for the entire 
institution, refrigeration and sewage disposal. In 1938 these 
operations represented a total cost of approximately $1,000,000. 
Variations in cost are dependent largely upon condition in 
hospitals from year to year. The Department engineers in con- 
junction with those at the institutions, those in other state 
departments, and certain private engineering firms, over a 
period of years have made many studies relating to the prob- 
lems reflected in this item of cost. Studies have had to do with 
the relative merits of steam or water for heat; technical aspects 
of high cost boiler and generating units; relative merit of oil 
and coal for fuel; the merit of gas, coal or electricity for cooking 
purposes and the relative value of manufactured versus pur- 
chased electricity; and the merits of water, sewage and electric 
rates, etc. These represent technical problems of such financial 
magnitude that all possible advice should be sought with the 
single goal in mind of providing necessary care to the patients 
at the lowest possible cost. 
We commend the co-operation shown between the institu- 
tions and Department engineers and the inter-relationship of 1939.] 
HOUSE — No. 2400. 
227 
the engineers of the Departments of Mental Health, Public 
Safety, Public Health, Public Utilities, and the Commission on 
Administration and Finance. 
VII. Travel, Transportation and Office Expense. 
This portion of the cost of maintenance represented $108,000 
in 1938. 
The items making up this cost are individually small. They 
constitute postage, telephone, travel costs, etc., and the con- 
trol of them must, of necessity, be distributed in so many hands 
that it should require eternal vigilance on the part of both the 
Department and the hospitals to minimize these costs. 
There is a limit below which, if costs are cut, inefficiency in 
service is bound to result. During the past year the Depart- 
ment gave some study to telephone costs and installed a tele- 
type between the Department and two strategically placed 
hospitals, — Worcester State Hospital and Monson State Hos- 
pital. An analysis of these costs over previous telephone costs 
has not been completed. 
It is probable that as the program goes forward for addi- 
tional family care for patients, there may be an increase in 
travel expenses necessitated by increased demands for com- 
munity supervision of these patients. 
We recommend that further study be given to the cost of 
these various items which, of necessity, are so flexible. 
VIII, Garage and Grounds. 
The total cost of these items in 1938 approximated $89,000. 
The variations in cost from year to year are accounted for 
mainly by the turnover of passenger cars and trucks, with the 
occasional addition of one of these items as necessity demands. 
We feel that further study should be given to the question 
of repairs to motor vehicles, and also to the costs involved in 
the purchase of implements, tools and materials used for work 
on the roads and grounds. 
IX. Clothing and Material. 
The items making up this division approximated a cost of 
$311,000 in 1938. Clothing is obtained from several sources 
during a given year: (1) purchased; (2) manufactured at the 
institution* (3) supplied by relatives and friends of patients, 228 
HOUSE— No. 2400. 
[Mar. 
and (4) withdrawn from inventory which is accumulated from 
the previous year. 
A great deal of ready-made clothing which is purchased 
must by statute and regulation be purchased from the Depart- 
ment of Correction. This has been a subject of controversy 
over a long period of time, and one regarding which many of 
the superintendents have strong opinions. There is much to 
be said on both sides. The superintendents complain that the 
quality and workmanship of the clothing supplied to the in- 
stitutions by the Department of Correction is below standard 
of clothing which they could purchase outside. On the other 
hand, the Department of Correction argues that the superin- 
tendents put in orders and demand delivery within a ridicu- 
lously short time. 
Further, the correctional authorities state that there has 
been a marked increase in the workmanship of the clothing 
manufactured by their Department, with the installation of 
more modern machinery and equipment. In any event, hard 
feelings and bickering between two state departments do no 
good to any one. We believe that through the co-ordinative 
efforts between the two departments and the Commission on 
Administration and Finance, mutual satisfaction will be gained, 
to the ultimate benefit of the patients. 
We have been told that if a system of annual production is 
installed, savings to the taxpayers will be enormous. In the 
hospitals at all times there is a certain minimum number of 
patients. The needs of these patients, the Commission be- 
lieves, can be accurately gauged well in advance of actual 
needs. By installing a system of annual production, the De- 
partment of Correction could group orders for certain clothing 
and buy the materials in larger quantities at a lower cost. 
With the advent of biennial budgets, the installation of this 
annual production can be made much more easily. 
Clothing manufactured at the institutions is readily dis- 
cernible through a study of the costs enumerated in Table 5; 
for example, in those institutions where the per capita cost for 
boots and shoes is low, the cost of leather for manufacturing 
them within the institution is relatively high, such as is repre- 
sented in the case of Danvers and Taunton State Hospitals. 
It will be noted, also, that at Gardner and Monson State 
Hospitals there is a considerable manufacture of shoes, but 
the cost for purchased boots and shoes is also high, and this 
refers primarily to items which are used by patients out of 1939.] 
HOUSE — No. 2400. 
229 
doors in winter, which items are not manufactured. The same 
point applies to Taunton State Hospital in the cost for outer 
clothing which is low and the relatively high cost of dry goods 
for manufacturing clothing. It is also well shown in the Gard- 
ner State Hospital, with a low cost for purchased underclothing 
but a correspondingly high cost for dry goods for manufacturing 
clothing. The manufacture of clothing in the institutions 
gives an outlet for some industrial therapy to patients, but 
not all superintendents are united in their opinion as to the 
value of such therapeutic outlet. 
Prior to the onset of the general economic depression, large 
amounts of clothing were received from the friends and rela- 
tives of patients. This has decreased materially in recent 
years. One or two of the hospitals, however, through the per- 
sonal diligent efforts of the administration, have succeeded 
in maintaining a fairly good level of home-furnished clothing. 
In one hospital, approximately 50 per cent of the clothing 
needs of the women patients is furnished by family and friends. 
Particularly should such gifts be welcome during the various 
holiday seasons. We are led to believe that the therapeutic 
advantages are great to the patients who receive clothing from 
their own home or friends. This tends to minimize the stigma, 
if any, that may be attached to the wearing of state clothing. 
We urge the continued efforts of those hospitals which have 
shown good results in maintaining the level of home-furnished 
clothing, and the renewed strong efforts of those hospitals 
which have fallen behind in recent years. It seems to us that 
this is one place where therapeutic advantages to the patients 
can be rendered at lower cost to the Commonwealth, and we 
cannot stress too much the urgency of further efforts to procure 
clothing from home. 
The expenditures for clothing over the years have varied 
tremendously in the institutions. It is apparent to the Com- 
mission that no uniform amount per patient per year for 
clothing will ever completely answer the requirements in each 
and every institution. However, we do believe that as a 
basis from which to work, an attempt at some degree of stand- 
ardization should be tried. It would seem to us that a large 
proportion of the general clothing should be in use among the 
patients, and that there should be relatively little inventory 
except for seasonal clothing. A study of clothing inventory 
might be worth while. It is pleasing to note that in the final 
budgetary requests for the biennium 1939-40, the Department 230 
HOUSE —No. 2400. 
[Mar. 
has attempted to establish a standard minimum allowance for 
this trial period, taking into consideration the three sources 
from which clothing is obtained. As might be expected, a 
slightly higher standard was established for the schools than 
for the hospitals. This procedure is similar to that which 
was followed in the case of food. We understand that the 
Department is continuing further studies in regard to this 
problem, and that the studies should result in material savings 
in years to come. We approve of and encourage these studies. 
This division of expenses approximated $411,000 in 1938. 
The items making up this division are of such a nature that 
their only appreciable sources for a given year are through 
purchase or withdrawals from inventory, and they are so varied 
that administrative control is spread out into the hands of 
many individuals. A rapid survey of the items making up this 
division, found in Table 6, will greatly illustrate this point. 
Again, the majority of these items are of such a nature that 
they can well be standardized, and some effort at standardiza- 
tion of individual items has been made over a period of many 
years. Considerable study as to breakage of such items as 
crockery, and a study of loss of smallwares, such as electric 
light bulbs, crockery, silverware, table linen, etc., would indeed 
be worth while with a view to better management control. 
Many of the items making up this cost are of such a nature that, 
if storage facilities are available and control is proper, they 
might be purchased at a time and in sufficient quantities to take 
advantage of downward market fluctuations. These are all 
points for further detailed study, and we understand that the 
Department has already embarked upon such a program. 
X. Furnishings and Household Supplies. 
As in the case of clothing, the Commission is not convinced 
that standardization will solve all of the problems concerned in 
this division of expense, but we do believe that an attempt at 
some degree of standardization should be tried as a basis from 
which control and management could be increased to the ulti- 
mate benefit of the Commonwealth. It is to be expected that 
a lower standard basis might be established for the schools than 
would be the case in the hospitals. The Department in its 
requests for the biennium, 1939-40, has made a beginning in 
this regard, following the same general principles that were 
involved in the requests for food and clothing. Further steps 1939.] 
HOUSE — No. 2400. 
231 
would undoubtedly depend upon the results of this two-year 
trial period. 
\\ hat we have had to say regarding the installation of an 
annual production system in the case of clothing applies also 
to the manufacturing of furnishings and household supplies. 
XI. Repairs, Ordinary. 
Ihe items making up this division constituted an expense 
of approximately $209,000 in 1938. They constitute lumber, 
paint, brick, hardware, cement, electrical supplies, steam 
and plumbing supplies, tools, and the many other items which 
are so necessary in maintaining the physical upkeep of the 
institutions. It is obvious that the source of these items for 
any given year is mostly through purchase, but occasionally 
sizable inventories are accumulated. Because of the nature 
of these items, such an accumulation of surplus supplies is 
very easy to get out of administrative control. We discourage 
a tendency to such accumulations. We understand that the 
attention of the Department has been called to this, and it 
has taken steps to increase the control of these items and to 
redistribute to several institutions any large accumulation in 
a given institution. During the past year one hospital has 
made a decided attempt to place all of these items under strict 
control. We commend this action and look forward to a favor- 
able report at the end of the trial year, — a report of such a 
nature that a similar system might be instituted in other 
hospitals. 
Although we caution the overstocking of these supplies, we 
also point out the necessity of having adequate supplies on 
hand to maintain the buildings. The older buildings, engines, 
etc., need constant repair and upkeep in order to avoid pre- 
mature heavy replacement expenses. The newer buildings 
likewise require a certain amount of upkeep and renovation. 
It is also true that failure of attention to repairs as they are 
needed not infrequently leads to larger expenses in other 
maintenance items. A small faucet leak, for example, if per- 
mitted to continue will be reflected in increased water cost. 
Of special interest in the items making up this division of 
cost is that for paint. Repainting of wards and furniture is 
necessary periodically, and this forms an aesthetic appeal not 
only to the patients and employees in the institutions, but also 
to their visitors. It creates cheerfulness which is hard to 232 
HOUSE —No. 2400. 
[Mar. 
duplicate in any other way. The process of redecorating, 
particularly of articles of furniture, forms a good therapeutic 
outlet for large groups of patients in many institutions. 
The whole question of repairs should, and undoubtedly will, 
receive further study as to relative costs in comparison with 
the needs of each institution. We are not prepared to state 
just how far standardization might go without hampering 
efficiency. It does seem to us, however, that there should be 
some balance between material purchased and the personnel 
available to use this material so as to minimize surplus. This 
particular point was given recognition by the Department in 
its final appropriation request for the biennium of 1939 to 1940. 
XII. Repairs and Renewals. 
The total expenditure for this division approximated 
$296,000 in 1938. It is made up of expense items which do not 
recur annually and which consist primarily of replacements of 
structures or machines which have outlived their usefulness 
from an efficiency point of view. The nature of these items is 
such that they cannot lend themselves to any general comment. 
Each one has to be considered on its merits and in relation to 
the individual institutions as circumstances arise. Since a 
repair and renewal project is based on urgent need for efficiency 
and economy, we suggest that, as appropriations become avail- 
able for these projects, they be instituted with as little delay 
as possible. 1939.] 
HOUSE — No. 2400. 
233 
Appendix 10. 
STUDY OF THE LAWS. 
A committee of superintendents was appointed by the Com- 
mission to study the laws relating to the Department of 
Mental Health and the hospitals under its jurisdiction. We 
have studied with a great deal of care the recommendations of 
the committee and have endorsed many of the changes sug- 
gested by them to assist them in their administrative duties. 
In addition, we have consulted others as to the effect of these 
laws and have studied many changes recommended to us by 
interested persons. Our recommendations for changes follow. 
Through inadvertence the Department’s authority to place 
at board any patient in a hospital which is in the charge of the 
Department was eliminated in the re-organization bill, and 
the authority to place patients at board was vested in the 
superintendent. That authority should be revived. 
In addition, we believe that the amount which the Depart- 
ment or hospital may expend to place any such patient at 
board should be increased from $4.50 to $6. Our reason for 
so recommending is given in detail in section 14, on the prob- 
lem of the psychotic adult, and referred to in several other 
sections. The proposed change is recommended in section 1. 
Occasionally there are sentenced to the Massachusetts 
Training Schools boys and girls who, it is believed, should 
properly be at Bridgewater. Removal in a legal manner of 
these boys and girls to the department for defective delin- 
quents at Bridgewater would be of considerable assistance to 
the training schools in solving a vexing administrative prob- 
lem. We believe that in the best interests of the inmates in 
the training schools there should be some method whereby 
those who properly should be at Bridgewater can be trans- 
ferred, and have so recommended in section 2 of the proposed 
act. 
In our report we have given the reasons why we believe the 
Commissioner should have the advice and counsel of an Ad- 234 
HOUSE —No. 2400. 
[Mar. 
visory Council to the Department of Mental Health. We 
therefore recommend section 3. 
Under section 43 of the present law the superintendent and 
assistant physician at Westborough State Hospital shall be of 
the homeopathic school of medicine. This seems to be an 
unnecessary restriction in these times, and it is recommended 
that this restriction be eliminated. We recommend, therefore, 
repeal of Section 43 of the present law in section 4 of the pro- 
posed act. 
Section 5 protects the term of office of the superintendent 
and assistant physicians at the Westborough State Hospital. 
Section 56 of the present law provides that in making a 
commitment of an insane person, the judge shall inquire of the 
applicant for his commitment whether he desires the insane 
person to be treated according to homeopathic principles of 
medicine. This, again, seems to us to be an unreasonable and 
unnecessary restriction at the present time, and in section 6 
we have recommended its repeal. 
Section 77 of the present law provides for a commitment of 
thirty-five days for observation purposes, and outlines the pro- 
cedure to govern such a commitment. It further provides 
that a report shall be made to the judge within thirty days, 
and that the judge make final disposition within five days, or 
a total of thirty-five days from commitment to the time when 
a decision must be made. This five-day period allows very 
little opportunity for the judge to consider the case thoroughly 
and execute his final order, particularly in doubtful cases where 
additional information and medical evidence may be desired. 
We do not believe it would impose a hardship on any one 
to increase this period to a total of forty days, and have so 
recommended in section 7. 
The usefulness of section 66A of the present law, which au- 
thorizes commitment of feeble-minded persons to the Depart- 
ment with the approval of the Department, and establishes 
authority for the Department to transfer such patient to the 
school for the feeble-minded or cause his removal to the De- 
partment for Defective Delinquents at Bridgewater, would 
be greatly increased if provision were also included for the 
transfer of suitable patients to a school for the feeble-minded 
under the direct custody of the Department, We have pro- 
posed such a change in section 8. 
Section 79 of the present law provides for emergency hos- 
pital care and treatment for a period of ten days for any one 1939.] 
HOUSE — No. 2400. 
235 
needing immediate care and treatment because of mental 
derangement other than delirium tremens or drunkenness. 
Presumably, under ordinary circumstances a differentiation 
between drunkenness and mental disorder could be made. 
However, the differentiation of delirium tremens from delir- 
ium due to other causes would constitute a difficult diagnostic 
problem. In cases where there is an acute delirium there is 
obvious need for immediate care. Delirium from whatever 
cause may necessitate or justify immediate admission to a 
mental hospital, and any delay incidental to a differentiation 
of delirium tremens from other delirium might jeopardize life. 
To avoid possible hazard to life through delay incidental to 
differentiation, we recommend section 9. 
The same problem of differentiation applies to those addicted 
to drugs. Under section 80 of the present law such persons 
“needing immediate care and treatment” can be admitted 
for a period not exceeding fifteen days. We have suggested a 
change so that any one appearing to need hospitalization can 
be admitted under section 10. 
Section 82 of the present law prohibits detention in a jail, 
lock-up or place provided for the detention of criminals of any 
person suffering from “insanity, mental derangement, delir- 
ium or mental confusion except delirium tremens and drunk- 
enness.” A deletion of the restrictive implications of section 
79 regarding delirium tremens has been recommended for 
favorable consideration. It is likewise recommended that this 
restriction be eliminated from this section. This will be ac- 
complished by section 11 of the proposed act. 
Section 86 of the present law authorizes voluntary admis- 
sion of persons where such persons are competent to make 
an application. This authorization obviates necessity for 
delay and permits avoidance of embarrassment or resentment 
that might exist if court procedure were required. 
As the section now stands there is an implied promise that 
no voluntary patient will be detained more than three days 
beyond his formal request for discharge. A patient detained 
on a voluntary basis should not be under the false impression 
that if his condition at the time of his request for release is 
such that he should not be allowed to go, it may be necessary 
to secure regular commitment 5 also it is believed that when the 
patient is in such mental condition as to be incapable of ap- 
preciating his true situation he should not be continued on a 
voluntary status, and authority should be given to permit 236 
HOUSE — No. 2400. 
[Mar. 
application for commitment after he has become incompetent. 
To correct this we recommend section 12 of the proposed act. 
Section 87 of the present law authorizes voluntary admis- 
sion of persons suffering from epilepsy, and requires that such 
patient shall not be detained for more than three months 
beyond the written notice of his intention or desire to leave 
the hospital. A study showed that the extended period of 
three months beyond given written notice seems to be un- 
necessary and impracticable. We recommend a reduction of 
the period from three months to ten days in section 13 of the 
proposed act. 
Section 23 of the present law obligates the Department to 
apply for commitment to an institution in the case of insane, 
epileptic or feeble-minded persons who should be properly 
institutionalized but are resident in unlicensed places. The 
section, as at present worded, does not give the Department 
the authority to enter the place and examine the patient. In 
other words, the Department has no legal right, except by 
implication, to obtain the necessary information for any action 
under this section. It is therefore proposed that section 23 
be amended as recommended in section 14. 
Section 36 of the present law demands that the “superin- 
tendent or head physician of each institution, or in his absence 
one of the assistant physicians, shall 'personally keep under 
lock and key all implements or devices of restraint. . . .” The 
intent is apparently to afford a maximum safeguard against 
unwarranted use of restraint. It would seem, however, that 
sections 35, 37 and 38 of the present law afford ample protec- 
tion against any indiscriminate use of restraint. These sec- 
tions provide regulations for application of restraint, define 
restraint and specify the open records to be kept, and estab- 
lish penalties for non-observance of these statutes. The obli- 
gation that a superintendent have personal custody over 
restraint devices seems unnecessary, and the proposed change 
is recommended in section 15 of the proposed act. 
Section 40 of the present law requires that the buildings of 
each hospital shall have proper means of escape from fire, 
suitable apparatus for extinguishing fires, and that “no . . . 
building shall be erected or maintained . . . without a writ- 
ten certificate of approval from the building inspector of the 
department of public safety. ...” 
The care of mental patients requires that the majority of 
ward doors must be locked. The Department has often been 1939.] 
HOUSE — No. 2400. 
237 
unable to comply with section 40 because locked ward doors 
are generally interpreted by building inspectors as “ obstruc- 
tion of egress,” under the provisions of chapter 143. It seems 
unwise to suggest the repeal of section 40, inasmuch as ade- 
quate protection against fire and provisions for fire fighting must 
be maintained. We therefore recommend revision by means 
of section 16 of the proposed act. 
Proposed Legislation. 
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 nine- 
teen 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 after the word “patient” at the end 
the following sentence: — 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. Chapter one hundred and twenty of the General 
Laws is hereby amended by inserting after section seventeen, 
as appearing in the Tercentenary Edition, the following new 
section: — Section 17A. If any person committed or trans- 
ferred to the industrial school for boys, to the Lyman school 
for boys, or to the industrial school for girls appears to the 
trustees to be mentally defective, they may remove such per- 
son to a department for defective delinquents established under 
sections one hundred and seventeen to one hundred and twenty- 
four, inclusive, of chapter one hundred and twenty-three for 
not more than forty days, but in no event beyond the expiration 
of his sentence, pending the determination of his mental con- 
dition. Within thirty days after such removal the medical 238 
HOUSE —No. 2400. 
[Mar. 
director appointed under section forty-eight of chapter one 
hundred and twenty-five shall report said person’s mental 
condition to the said trustees. 
If, in the opinion of said director, such person is not men- 
tally defective, he shall so certify upon the order of removal, 
and notice, accompanied by a written statement regarding 
the mental condition of such person, shall be given to the 
said trustees, who shall thereupon cause such person to be 
reconveyed to the institution from which he was removed, 
there to remain pursuant to the original sentence. 
If the said medical director certifies that such person is 
mentally defective the trustees shall forthwith recommend to 
the department of correction that such person be transferred 
to a department for defective delinquents, and the commis- 
sioner of correction shall immediately transfer such person to 
such a department, there to be held on the mittimus until the 
term of sentence expires. 
Any person removed or transferred under this section shall 
be accompanied by all mittimuses and processes, a copy of 
the medical report, and a written statement covering the 
history and conduct of the person, and the circumstances of 
the person’s home, so far as they can be ascertained. 
At any time prior to the expiration of the term of sentence 
of such person, an officer of the department of correction, 
department of public welfare, or department of mental health 
may file in the court by which such person was committed an 
application for his commitment to a department of defective 
delinquents. 
If, on a hearing on such application, the court finds the de- 
fendant to be mentally defective, and, after examination into 
his record, character and personality, that he has shown him- 
self to be an habitual delinquent, or shows tendencies towards 
becoming such, and that such delinquency is or may become 
a menace to the public, and that he is not a proper subject for 
the schools for the feeble-minded or for commitment as an in- 
sane person, the court shall make and record a finding to the 
effect that the defendant is a defective delinquent, and may 
commit him to such a department for defective delinquents, 
according to his age and sex, as provided in section one hun- 
dred and seventeen of said chapter one hundred and twenty- 
three. 
Note. — If the above form is used, sections 115, 120 and 123 will 
have to be amended to conform. 1939.] 
HOUSE — No. 2400. 
239 
Section 3. Chapter nineteen of the General Laws is hereby 
amended by inserting after section four A, as amended, the 
following new section: — 
Section In order that the Commissioner may receive 
or obtain the advice and judgment of leading men in the com- 
munity m regard to the general policies and problems of the 
department, he is authorized, if he deems it necessary or ad- 
visable, to appoint a board which shall be known as the advi- 
sory council of the department of mental health. The council 
shall not exceed in number, and shall perform such 
duties as the commissioner shall from time to time assign to 
them. They shall receive no salary, but shall receive the 
necessary traveling and other expenses while in the perform- 
ance of their official duties. Said board shall meet whenever 
requested so to do by the commissioner. 
Section 4. Section forty-three of said chapter one hundred 
and twenty-three, as appearing in the Tercentenary Edition, 
is hereby repealed. 
Section 5. Nothing in this act shall be deemed to termi- 
nate the employment or the term of office of the superintendent 
and the assistant physicians at the Westborough State Hospi- 
tal, or any of them, in office immediately prior to the taking 
effect of this act. 
Section 6. Section fifty-six of said chapter one hundred 
and twenty-three, as so appearing, is hereby repealed. 
Section 7. Chapter one hundred and twenty-three of the 
General Laws is hereby 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 sec- 
tion : — 
Section 77. If a person is found by two physicians qualified 
as provided in section fifty-three to be in such mental condi- 
tion that his commitment to an institution for the insane is 
necessary for his proper care or observation, he may be com- 
mitted 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 main- 
tained 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 240 
HOUSE— No. 2400. 
[Mar. 
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 recom- 
mendation that he shall be committed 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 dis- 
charge 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 physi- 
cian 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 8. Section sixty-six of said chapter one hundred 
and twenty-three, as appearing in the Tercentenary Edition, 
is hereby amended by adding at the end the following new 
paragraph: — 
If a feeble-minded person is committed to such a school, 
the department shall thereafter have power, whenever advis- 
able, 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 9. 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 institu- 
tion for the insane may, when requested by a physician, mem- 
ber 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 ex- 
ceeding ten days, any person deemed by such superintendent 
or manager to be in need of immediate care and treatment 
because of mental derangement other than drunkenness. Such 
request for admission of a patient shall be put in writing and 1939.] 
HOUSE —No. 2400. 
241 
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 request- 
ing his reception, and, if he is not so removed, such person 
shall be liable to the commonwealth or to the person maintain- 
ing the private institution, as the case may be, for all reason- 
able 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 super- 
intendent or manager shall cause every such patient either to 
be examined by two physicians, qualified as provided in sec- 
tion fifty-three, and cause application to be made for his ad- 
mission or commitment to such institution, or 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 10. 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 superintendent 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 Bos- 
ton, 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 insti- 
tution, 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 treatment 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 242 
HOUSE —No. 2400. 
[Mar. 
within twenty-four hours thereafter, together with a state- 
ment, in a form prescribed by the department having super- 
vision 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 re- 
ceived as evidence in any legal proceeding. The superintend- 
ent 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 11. Section eighty-two of said chapter one hun- 
dred 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 insanity, mental derangement, deliriums, or 
mental confusions, except drunkenness, shall, except in case of 
emergency, be placed or detained in a lock-up, police station, 
city prison, house of detention, jail or other penal institution 
or place for the detention of criminals. If, in case of emer- 
gency, any such person is so placed or detained, he shall forth- 
with be examined by a physician and shall be furnished suit- 
able 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 protec- 
tion 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 neces- 
sary expenses incurred by the board of health, under this sec- 
tion, shall be allowed, certified and paid in the same manner 
as provided by section seventy-four. 1939.] 
HOUSE— No. 2400. 
243 
Section 12, 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 in- 
ebriate, or one addicted to the intemperate use of narcotics or 
stimulants, may be committed may receive and detain therein 
as a boarder and patient any person who is desirous of submit- 
ting 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 treat- 
ment may make such written application. Except as other- 
wise 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 institution; 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 competent 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 cause forthwith appli- 
cation 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 13. Section eighty-seven of said chapter one hun- 
dred 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 writ- 
ten notice of his intention or desire to leave the hospital. 
Upon the patient’s- reception at the hospital the superintend- 
ent shall report the particulars of the case to the department, 
which may investigate the same. 244 
HOUSE — No. 2400. 
[Mar. 
Section 14. Section twenty-three of said chapter one hun- 
dred and twenty-three, as so appearing, is hereby amended by 
striking out the entire section and substituting therefor the 
following: — 
Section 23. If the department has reason to believe that an 
insane, epileptic or feeble-minded person who is a proper 
subject for treatment or custody in an institution is confined 
at public charge or otherwise, in any place not licensed by the 
department, the department shall have authority to visit the 
place of detention and to examine the patient. If the result of 
such examination discloses that said patient is a proper sub- 
ject for treatment or custody in an institution, application 
shall be made to a judge for commitment of such person to 
an institution. 
Section 15. Chapter one hundred and twenty-three of the 
General Laws is amended by striking out section thirty-six, 
as so appearing, and inserting in place thereof the following 
section: — 
Section 36. 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 16. Chapter one hundred and twenty-three of the 
General Laws is further amended by adding to section forty, 
as so appearing, the following sentence: — Locked doors on 
buildings housing patients in institutions under the jurisdic- 
tion 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, — so as to read as fol- 
lows : — Section 40. 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. 
Section 17. Chapter one hundred and twenty-three of the 
General Laws is hereby amended by inserting after section 
twenty-four, as appearing in the Tercentenary Edition, the 
following new section: — 1939.] 
HOUSE — No. 2400. 
245 
Section 2J/.A. The department may solicit and accept ad- 
vertisements for insertion in the publication issued by it and 
known as the Bulletin of the Department of Mental Health. 
Section twenty-seven of chapter thirty shall apply to moneys 
received by the department for or on account of such advertise- 
ments; provided, that any net profits derived from such ad- 
vertisements may be used in improving said publication or 
expended in connection with the issuance by the department 
of a publication concerning the hospitals and institutions 
under its control or under its general supervision, or in both 
such manners. All action by the department under authority 
of this section shall be subject to the approval of the commis- 
sion on administration and finance. HOUSE— No. 2400. 
[Mar 
246 
Appendix 11. 
A SURVEY OF THE MENTAL INSTITUTIONS OF MASSA- 
CHUSETTS. 
Conducted by the Mental Hospital Survey Committee. 
Mental Hospital Survey Committee. 
Arthur P. Noyes, M.D., Aciing Chairman. 
S. Spafford Ackerly, M.D. 
Louis Casamajor, M.D. 
Ross McC. Chapman, M.D. 
Franklin G. Ebaugh, M.D. 
Clarence M. Hincks, M.D. 
J. Allen Jackson, M.D. 
Lawrence Kolb, M.D. 
Bernard T. McGhie, M.D. 
Winfred Overholser, M.D. 
Frederick W. Parsons, M.D. 
Arthur H. Ruggles, M.D. 
William L. Russell, M.D. 
H. Douglas Singer, M.D. 
The National Committee for Mental Hygiene 
American Psychiatric Association 
United States Public Health Service 
American Medical Association 
The American Board of Psychiatry and Neurology 
American Neurological Association 
The Canadian National Committee for Mental Hygiene 
The Canadian Medical Association 
Participating Agencies. 
Samuel W. Hamilton, M.D., Director. 
Grover A. Kempf, M.D., Associate Director. 
THE SURVEY. 
I. The Occasion 
Administrative changes in the state hospital system of 
Massachusetts late in 1936 led to setting up a Special Com- 
mission on Mental Diseases by the Legislature of 1937. In 
the second year of its existence this Commission organized a 
formal survey of the institutions for the mentally sick, defec- 
tive and epileptic. This task was entrusted to the Rev. Otis 
F. Kelly, a member of the Special Commission; Dr. Morgan 
B. Hodskins, one of the seniors among the state institution 
superintendents; and Dr. S. W. Hamilton, representing the 1939.] 
HOUSE —No. 2400 
247 
Mental Hospital Survey Committee, whose headquarters are 
in New York City. 
The study proceeded intermittently through several months. 
A change in the plan of work was rendered necessary by the 
resignation oi bather Kelly irom the Special Commission, and 
by the illness of Dr. Hodskins. Dr. Grover A. Kempf, asso- 
ciate director of the Mental Hospital Survey Committee, 
then completed the study. 
There is no lack of information on which to draw about the 
Massachusetts institutions. That Commonwealth has long 
been the one to set many of the standards in the field of mental 
hygiene, and its practices and its statistics are quoted in the 
professional and administrative literature of the whole coun- 
try. Its published reports have been drawn upon here, together 
with fresh data from the statistical division of the State Depart- 
ment of Mental Health; reports in the files of the National 
Committee for Mental Hygiene on a variety of topics have 
been consulted; persons well acquainted with Massachusetts 
have been interviewed and information taken from the United 
States Bureau of the Census. Most of all, the institutional 
activities have been studied on the ground. 
With much pleasure and sincere gratitude acknowledgment 
is made of the indebtedness of the surveyors to the member of 
the Special Commission and the representative of the institu- 
tion staffs in showing the way through the hospitals and open- 
ing up the various problems of the situation. At the same time 
it must be made clear that this is in no sense their report, but 
purely that of the Mental Hospital Survey Committee staff. 
Wherever we differ from local authorities in our interpretation 
of conditions or in our recommendations for action, we have 
tried to present our reasons. 
II. Central Organization 
The Commissioner of Mental Health, appointed for a term 
of six years, has very considerable powers of inspection and 
supervision. His is obviously a position demanding expert 
knowledge and broadsighted leadership. The law provides an 
assistant commissioner and a director of mental hygiene to serve 
under the Commissioner. The Department has created posi- 
tions, also, for an inspector, a director of statistics and research, 
and an assistant to the Commissioner. Several of these posi- 
tions were recently filled after a period during which the 
Department was seriously understaffed. Following custom in 248 
HOUSE— No. 2400. 
[Mar. 
this State, several appointments were made from among the 
assistant superintendents. 
There is also a business organization in the office of the 
Department. The number of functionaries in this field has 
recently been increased. It is expected that in this way the 
problems of finance, of building, and of operation will receive 
better and quicker attention; that activity will be expedited 
and due economy maintained. 
Certainly in the professional field this organization is far 
from top-heavy. It is a practice to call to the Department 
some of the ablest assistant superintendents in the service, and 
good results are accordingly obtained. One might hope that a 
modification of this policy will be established in one regard. 
The inspection service should be strengthened so that more 
attention will be paid to the individual patient during the 
inspector’s visit. There is not much experience in this coun- 
try on which to assert that this added function has a value 
commensurate with its cost. One other commonwealth has 
carried it on for about three decades, apparently with advan- 
tage. If Massachusetts should decide to do the same, it will 
probably seem desirable to have a more permanent official 
than has previously been designated to this position; thus far 
each inspector has been looking forward to settling down into 
a superintendency. 
The new Department has an unusual opportunity to serve 
the mentally sick and defective of Massachusetts. The pecul- 
iar circumstances under which it has come into office give to 
the Department an unusual incentive to freedom of action. 
Good precedents will, of course, be followed, but the situation 
encourages departures from custom much more than is usually 
the case. It is to be hoped that departures will be made. The 
history of the Massachusetts state service is indeed a distin- 
guished record of ability on the part of those who directed it. 
Each of the able men who guided the course of the Depart- 
ment under its various titles was an innovator, and innovation 
is an essential of progress. 
III. Plant. 
The Commonwealth has expended considerable sums under 
wise professional direction to meet the needs of the mentally 
sick. The first institution was opened in 1832, a handsome 
brick structure, and almost every type of architecture that 1939.] 
HOUSE — No. 2400. 
249 
has been popular in the century since then is represented some- 
where in the State. 
Older buildings are constructed of brick or stone with wooden 
beams. Fire walls sometimes extend from basement to ceiling; 
nevertheless, the fire risk in such structures has been consider- 
able. Of late many old stair wells have been torn out and 
replaced by non-burning elements. Sprinklers have been in- 
stalled in some dangerous places. This program of recon- 
struction must continue for some years. 
The height of buildings varies from the bungalow to four- 
story structures. Since the Department can obtain any archi- 
tectural advice that it wishes, and the Special commission for 
whom this report is drawn has an architect member, it would 
be superfluous to enter on an argument regarding the most 
economical number of stories to which to build. Something, 
however, should be said about the matter from the standpoint 
of the patient. 
For patients who are entirely bedridden any height of 
building is acceptable; there exist in another commonwealth 
some skyscrapers designed for such patients. It seems easy to 
forget that relatively few mental hospital patients are com- 
pletely bedridden. To be sure, the number of old people 
entering the hospitals is increasing, but many of these, either 
at the time of admission or after they have received good medi- 
cal and nursing attention for a few weeks, are quite able to get 
around. In practice, high buildings are never equipped with 
elevators on so liberal a scale that patients can be sent up and 
down at any given moment in considerable numbers. It should 
be remembered that public hospitals cannot, like commercial 
buildings, have a considerable organization of elevator oper- 
ators, hence slower machines are installed, to be self-operated, 
and therefore to empty a ward of 30 or 60 patients by elevator 
service takes a long time. Since this is the case, extra person- 
nel is necessary in order to get the patients out of doors, for 
only a few can go at a time, and they must be brought back 
the same way. This additional personnel may not be available 
at the moment when weather and the daily program unite to 
make the lawns inviting. In the better planned high buildings 
this difficulty is only partly solved by arranging considerable 
porch space on each story. 
Four-story buildings are uncommon in Massachusetts except 
as a fourth story has been equipped to house personnel, but 250 
HOUSE— No. 2400. 
[Mar. 
they exist. Three-story buildings are common. Efforts are 
made in most hospitals to classify the patients so that the 
feebler ones will be on the ground floor, but this plan seldom 
works entirely well. In order to have patients out of doors 
easily and often, one and two story buildings are most effective. 
It may be remarked that the newest hospital in California has 
a large number of one-story structures. Apparently the mild- 
ness of the climate is not the only reason for this arrangement, 
since it prevails also in the newest institution in Illinois. 
The so-called Kirkbride style consists of a central adminis- 
trative and residential block, with other blocks attached and 
projecting to the side or to the back. These wings are usually 
homologous. This style prevailed in the second half of the 
previous century. It was modified at times by separating these 
blocks somewhat and running corridors between them. 
A later development may be called the corridor type of in- 
stitution, two admirable examples of which are in Massachu- 
setts at Foxborough and Waltham. The corridors serve not 
only as passageways, but also as sitting rooms, for they are 
broad, well lighted and attractive. The principal section of 
the Metropolitan State Hospital at Waltham is built around a 
large enclosure available for sports, or preferably for scenic 
treatment. Around 1890 there came a movement for the 
development of institutions on the cottage plan. In time some 
of these “cottages” were built for 100 or 200 patients. Med- 
field is an interesting example of this type of institution, which, 
indeed, has many attractive and satisfactory features. 
With the increasing demands for space in the hospitals, 
original plans have been extended or modified. This procedure 
is usually designed to save spending money in a particular 
year, and often brings quite uneconomical results in later years 
by breaking down one service function after another — laun- 
dry, storeroom, power plant, sewage disposal, water supply — 
so that they have to be replaced. 
Most buildings in the Massachusetts institutions are in 
good style, with a reasonable degree of ornamentation and 
desirable proportions. Utilities did not always have adequate 
space in the older buildings, and plumbing at times was some- 
what skimped; but in most hospitals such faults have been 
corrected. Rooms for the nurses’ utilities, record rooms and 
linen closets are not always adequate. Sections constructed 
for the disturbed are apt to have narrow corridors, perhaps 1939.] 
HOUSE — No. 2400. 
251 
smaller rooms, and to be bare; but many disturbed groups 
have been shifted into newer structures. 
Institutions generally have good assembly halls. A develop- 
ment of later years has been the use of such halls as gymnasia, 
in which case proper space for the storage of chairs is important. 
In an earlier period these halls were placed in the administra- 
tion building on the second floor or even higher, but more 
modern ones are on the ground floor. An occupational build- 
ing is usually some discarded structure that has been remodeled. 
Those that have been planned for their own purpose may be 
very beautiful. 
Since this report is concerned with the care and treatment 
of the patients, but little has been or will be said about build- 
ings. In general, the trends in Massachusetts may be com- 
mended, but one might issue a word of warning against allo- 
cating any building to an institution in disregard of the opinion 
and experience of its superintendent, as has been done in at 
least one instance. It seems unfortunate also that a hospital 
built according to a carefully worked out plan should then have 
its functions dislocated by forcing into the plant additional 
elements perhaps quite incoherent to the previous structures. 
The money of the Commonwealth should be wisely and 
economically spent. This is sometimes the justification of 
authorities for adding a nondescript building to a plant, as, for 
instance, a building for prolonged cases instead of a more 
costly one for reception of new patients. In the long run this 
procedure is not economical. Every building should be care- 
fully planned for a particular group. 
IV. Medical Organization and Activitiei 
Each institution has a medical head, a medical staff of 
varied experience and acquirements, a business organization 
headed by a steward, and several department heads. 
Superintendents have for years been men of experience and 
excellent training in psychiatry before they ever reached this 
grade. For some years it was the practice to give a physician 
who was likely to attain a superintendency a term in the De- 
partment during which he made inspection of all the hospitals, 
and to acquaint him in other ways with the activities of the 
Department. Indeed, this plan has only once been departed 
from recently. The advantages to the patients over whose 
needs the superintendent is to preside need not be dilated on. 252 
HOUSE —No. 2400. 
[Mar. 
He has a considerable measure of authority, and until recently 
the administration of the Department did not hamper those 
with the most energy and initiative from developing their 
special interests in the treatment of the patients and the 
development of the hospitals. Of course, this means that a 
superintendent also has opportunity to make some mistakes 
and to offer no little resistance to a new scheme that does not 
appear to him to be desirable. On the whole, this arrange- 
ment is better than what prevails in some more centralized 
services where tenure is less secure. Occasional mistakes and 
occasional opposition are much more than compensated in the 
ability of all these officers to plan ahead over a period of years 
and carry out their plans as facilities and support become 
available. 
The next ranking officer is usually called the assistant super- 
intendent. A few such positions have been filled by the ap- 
pointment of able men from outside the State, and several 
instances could be mentioned in which this has been of very 
great benefit to the Massachusetts service. As a rule, the 
assistant superintendent has achieved his promotion in his 
own hospital; no examinations are given and promotion de- 
pends partly on chance, — the promotion or retirement of the 
man ahead, — and mostly on the judgment of the superin- 
tendent. A system of state-wide competition introduced into 
promotions to this grade would be to the advantage of the 
service. 
Another medical position of considerable importance but 
not existing in every hospital is that of clinical director. He 
should be free from harassing administrative duties and be 
able to give a great deal of attention to the needs of the indi- 
vidual patients, to the details of treatment, and to the training 
of the younger physicians. None of the hospitals is so small 
that it should not have such an officer. A man of great clinical 
ability should be appointed to this position, and the salary 
should be such that one who is not ambitious to pass on to 
the superintendency through a period of administrative activ- 
ity as first assistant should be content and comfortable on the 
salary available. 
Another special position that Massachusetts for many years 
has sought to keep filled in every hospital is that of patholo- 
gist. In rank and emoluments he does not equal the medical 
officers already mentioned. There is a soundness and depth 1939.] 
HOUSE — No. 2400. 
253 
about the medical service of an institution with a good patho- 
logical department that is hard to equal under other arrange- 
ments, and this is one of the reasons for the pre-eminence of 
Massachusetts institutions in the country. The supply of able 
pathologists is always small. Measures should be taken to 
hold them. 
Several hospitals follow the plan of having one large medi- 
cal office in which all the assistants except the assistant super- 
intendent have desks. The usual argument is that it is desir- 
able to have the physician near his records, and the records 
must be filed at the center. At a busy time of day one can see 
such a room with one physician attempting to use the dicta- 
phone, another dictating to a stenographer, two talking with 
visitors about their patients, and others trying to do their 
paper work. 
Since the physician should be near his patients, it is desir- 
able that offices and examining rooms be installed on each 
medical service. To some extent this has been done in certain 
hospitals, but others are slow in following suit. 
Salaries in Massachusetts are neither high nor low. They 
have always been respectable, but the Commonwealth has 
sometimes had to depend on the accessory advantages of pleas- 
ant environment and intellectual atmosphere to hold persons 
who had better offers elsewhere. The following table gives a 
few comparisons: 254 
HOUSE —No. 2400. 
[Mar. 
Salaries of Hospital Personnel, 1938. 
[With maintenance.] 
Massachusetts. 
New York. 
Pennsylvania. 
Medical. 
Superintendent 
84,000-85,700 
84,000-16,000 
$6,000-88,000 
Assistant superintendent 
3,300- 4,020 
3,200- 4,000 
3,732- 5,232 
Clinical director 
3,300- 4,020 
3,200- 4,000 
2,880- 5,232 
Pathologist 
2,520- 3,060 
3,200- 4,000 
2,592- 3,732 
Senior physician 
2,520- 3,060 
2,400- 3,200 
2,592- 3,732 
Junior physician 
1,800- 2,420 
1,800- 2,400 
1,500- 2,592 
Nursing. 
Superintendent of nurses 
82,040-82,400 
82,000 
81.632-82,232 
Head nurse 
1,080- 1,200 
1,152 
1,044- 1,304 
Charge attendant ..... 
840- 1,080 
8792- 8888 
900- 1,020 
Attendant 
540- 840 
648- 792 
660- 900 
Other. 
Occupational therapist (chief) 
$1,200-81,560 
81,500-81,800 
81,284-81,824 
Physical education instructor . 
780- 1,080 
81,200 
924- 1,284 
Psychologist 
1,320- 1,800 
- 
1,392- 2,064 
Social worker ...... 
1,800- 2,160 
81,500-81,800 
1,224- 2,232 
Steward 
2,280- 2,640 
3,000- 4,000 
3;000- 3,600 
Source. 
Massachusetts: Medical salaries: Data collected by the Mental Hospital Survey Committee, 
1937. Other salaries: Schedule of salaries received from the Department of Mental 
Diseases. 
New York: Handbook of the Department of Mental Hygiene, 1938. 
Pennsylvania: Classification of the positions in . . . Pennsylvania . . . state-owned insti- 
tutions, 1936. 
The following table gives the number of medical positions 
in each institution exclusive of the superintendent, the census 
at the end of 1938, and the ratio of assistant physicians to 
patients; 1939. 
HOUSE — No. 2400. 
255 
Census. 
Assistant 
Physicians. 
Ratio of 
Assistant 
Physicians 
to Patients. 
Boston State Hospital 
2,299 
16 
1 : 143,7 
Danvers State Hospital 
2,304 
13 
1 : 177.2 
Foxborough State Hospital .... 
1,426 
8 
1 : 178.3 
Gardner State Hospital . . . . 
1,424 
8 
1 : 178.0 
Grafton State Hospital 
1,535 
8 
1 : 191.9 
Medfield State Hospital 
1,813 
9 
1; 201.4 
Metropolitan State Hospital .... 
1,846 
8 
1: 230.8 
Northampton State Hospital .... 
2,021 
10 
1 : 202.1 
Taunton State Hospital 
1,659 
11 
1: 150.8 
Westborough State Hospital .... 
1,564 
10 
1 : 156.4 
Worcester State Hospital 
2,349 
13 
1 : 180.7 
Total 
20,240 
114 
1 : 177.5 
The American Psychiatric Association has recommended 
that a hospital that serves as a center for all mental hygiene 
activities in its district shall have a ratio of not less than 1 as- 
sistant physician to 150 patients. The Massachusetts institu- 
tions do carry this community function. It will be noted how 
closely they approach the desired standard. For comparison, 
a few institutions in other states are mentioned: 
Census. 
Assistant 
Physicians. 
Ratio of 
Assistant 
Physicians 
to Patients. 
New York state hospitals (exclusive of two psy- 
66,432 
391 
1: 169.9 
chopathic hospitals). 
Allentown, Pennsylvania, state hospital . 
1,607 
10 
Delaware state hospital 
1,127 
9 
1; 125.2 
St. Elizabeth’s Hospital, Washington, D. C. . 
5,836 
42 
1: 135.7 
Source. 
New York: Data received from the New York State Department of Mental Hygiene, as of 
June 30. 1938. 
Allentown and Delaware state hospitals: Data collected by the Mental Hospital Survey 
Committee, 1937 and 1938. 
St. Elizabeth’s Hospital: Census: Annual Report of the Secretary of the Interior, June 30, 
1938. 
Physicians: Data collected by the Mental Hospital Survey Committee, 1937 and 1938. 256 
HOUSE — No. 2400. 
[Mar. 
No standards have been set up as to the ratio of physicians 
to patients most desirable in institutions for mental defectives. 
In the country at large there is some little variation in the dis- 
tribution of responsibilities in such an institution. Compari- 
sons with other States have been here made: 
Census. 
Assistant 
Physicians. 
Ratio of 
Assistant 
Physicians 
to Patients. 
Institutions for Mental Defectives. 
Belchertown state school 
1,306 
5 
1: 261.2 
Walter E. Fernald state school .... 
1,972 
9 
1: 219.1 
Wrentham state school 
2,001 
7 
1: 285.9 
Total, Massachusetts 
5,279 
21 
1:251.4 
New York state schools for mental defectives . 
14,275 
51 
1 : 279.9 
Pennhurst (Pennsylvania) state school . 
1,792 
8 
1:224.0 
Institutions for Epileptics. 
Monson State Hospital 
1,461 
8 
1:182.6 
Craig Colony, New York ..... 
2,281 
12 
1: 190.1 
New Jersey State Village for Epileptics, Skill- 
man. 
1,446 
7 
1:206.6 
Source. 
Massachusetts; Data as of January 1, 1 939, received from the office of the Commissioner of 
Mental Health. 
New York: Data received from the New York State Department of Menta Hygiene, as of 
June 30, 1938. 
Pennhurst State School: Census: Eighth Biennial Report of the Department of Welfare, 
May 31, 1936. Assistant Physicians: Data received February 6, 1939. 
New Jersey State Village for Epileptics, Skillman: Annual Report, year ending June 30, 
1936. 
A study that goes beyond the usual standards for diagnosis 
and treatment and involves comparisons of groups of cases and 
the formulation of conclusions of wider scope than are re- 
quired for the individual patient may be called research. 
Probably every physician at some time should attempt special 
studies that might be included under such a title. Systematic 
research, however, generally requires the co-operation of rep- 
resentatives of various disciplines — not only physicians with 
varied backgrounds of training, but also technicians of per- 
haps several types. Research is always in progress in the 
State of Massachusetts. Private funds have been added to 
state moneys, especially at the Boston State Hospital, the 
Worcester State Hospital and the Wrentham State School — a 1939.] 
HOUSE— No. 2400. 
257 
very desirable combination of resources. The Boston Psycho- 
pathic Hospital has received grants from various sources at 
different times; very excellent studies have been put out from 
other institutions, also, and one would need to name almost 
every one of them to exhaust the list. 
Since the studious physician is likely to be the ablest phy- 
sician, it is greatly to the advantage of the Commonwealth 
that research shall be continued, stimulated and promoted. 
Its existence attracts keen minds among the younger physi- 
cians, and helps to retain those with more experience; it pro- 
duces a very healthy emulation among the different hospitals. 
Records are good in Massachusetts. As might be expected, 
there are variations. It must probably be agreed that the 
clearest, best arranged case records come from Boston insti- 
tutions. 
Histories of the patients prior to admission are most often 
taken by the social worker, and are generally good. If a 
physician takes such a record he is apt to make it short and 
rather skimpy of material on the personality. It is fortunate 
that social workers can procure such excellent documents, but 
certainly the physician should be able to do as much; he 
should review all information brought in by others and am- 
plify it. Admission notes are usually good. Physical exami- 
nations are adequate; some are much better arranged than 
others. A mental status taken at one sitting and soon after 
admission is found in the records of the Boston hospitals only. 
Progress notes are usually good, but in one hospital they were 
to be found very much neglected. Laboratory reports are well 
filed. Dental records may enter the clinical history file after 
the patient’s discharge; in some institutions, never. 
The medical staffs of these hospitals sit together from two 
to six times a week. The superintendent, the assistant super- 
intendent or the clinical director presides. The principal sub- 
ject discussed is the individual patient, his history, his con- 
dition, and the nature of his mental illness. For presentation 
of the history a typewritten abstract is prepared by the phy- 
sician who has been assigned to make special examination of 
the patient. The question of legal commitment is considered, 
and often takes up an undue part of the time of the staff to 
the suppression of the still more important questions of treat- 
ment. At other conferences pathological material is reported. 
At another type of meeting medical literature is reviewed, and 
special studies are presented by staff members. This confer- 258 
HOUSE —No. 2400. 
[Mar. 
ence system is, of course, most creditable, and in late years has 
been imitated by the staffs of general hospitals. In some in- 
stitutions it is capable of improvement; any hospital that does 
not review systematically the current psychiatric literature 
should give serious thought to that lack. This, like other 
medical procedures, should be restudied from time to time. 
Massachusetts has long recognized that the salary of the 
assistant physician is not adequate for the early acquirement 
of anywhere near all the books that are tools of his trade. 
good medical libraries have been gradually accu- 
mulated. There is variety in the expertness of those who have 
these libraries in charge. A graduate librarian is likely to be 
the most efficient in making the books useful. Usually the 
same person has charge, also, of the general library from which 
reading matter is supplied to the patients. 
Psychiatric service to several groups is offered in varying 
measure by these hospitals and schools: 
1. Since it is desirable that a large part of the patients who leave 
the hospital should have the benefit of further supervision and medi- 
cal advice for some time, physicians hold office hours in several places 
in the hospital district at stated times. Patients who are on visit 
may report their progress and receive counsel without undergoing 
the hardship of a trip back to the hospital, with perhaps loss of time 
from a needed job. This work should be carried on indefinitely. 
2. Under statutory arrangement dating from the year 1919 the 
state institutions carry some responsibility in the field of public edu- 
cation. They are expected to examine each year all school children 
in their districts who are three years or more retarded. Of course, 
many other children are referred for an opinion at the same time. 
This is a very important and helpful arrangement, and any criticism 
refers to detail rather than principle. If a physician recommends 
that the child be treated in a special class, this arrangement must be 
carried out or the school superintendent is in peril of prosecution. 
The procedure has now been in use so many years that a large experi- 
ence has accumulated, and it is probable that occasion should soon 
be found to review these clinical procedures and see what modifica- 
tion would make them even more useful than before. 
3. Much clinical service is given to juvenile courts. This, too, is a 
very valuable service and in few places outside of Massachusetts do 
state hospitals and schools make themselves so useful in this field. 
4. Child Guidance. — One hospital has developed a community 
clinic for children which has attained the best standards of the time, 
— standards formulated on the basis of experience in many parts of 
the country. At the moment this type of clinical study and advice is 1939.] 
HOUSE — No. 2400. 
259 
intermittent for lack of trained personnel. Most of the institutions 
give occasional advice in this field. 
5. Service to Adults. — Some of the hospitals arrange to have part 
of the time of their clinic physicians available for study and consul- 
tation on adult patients. Probably more of this service is given at 
the hospital, but it is often difficult to get the patient to lay aside his 
prejudices and seek treatment there. The Boston Psychopathic Hos- 
pital has the largest out-patient service. At the present time there 
is call for much more of this service. Fortunately, more physicians 
in private practice are devoting their attention to psychiatry, and it 
may be hoped that this need of the community is being met tempo- 
rarily rather than permanently by the assignment of additional staff 
physician hours to such work. 
6. Teaching. — A considerable number of the older staff members 
carry responsibility for the teaching of some group. Since the teach- 
ing function in any hospital organization tends to make its members 
more alert, observant and active, this feature of the Massachusetts 
state service is most gratifying. 
7. The relation to the institutions of the schools of medicine is a 
very important matter. If young physicians are to have that knowl- 
edge of mental illness and mental medicine that will enable them to 
meet the needs of the communities in which they settle, they must 
learn these things at the mental hospitals. The three important 
schools of medicine in Boston have well-organized arrangements. 
Harvard and Boston University students are taught at the Boston 
Psychopathic Hospital; the course has the commendation of medical 
educators and involves the personal contact of students and patients 
that is so important in all types of medical learning. Boston Univer- 
sity and Tufts do most of their teaching at the Boston State Hospital 
and the Metropolitan State Hospital. They also have a very happy 
arrangement by which a student spends from two weeks to three 
months in residence at one of several state hospitals. That students 
appreciate the value of such experience is, of course, to be expected. 
The practice has been very valuable also to the institutions, in that 
a considerable number of the present staff physicians were attracted 
to psychiatry through this experience during undergraduate years. 
Many staff physicians are responsible for the teaching of pupil nurses. 
Certain institutions also conduct classes for students of law, students 
of theology, students of psychology, students of social work, students 
of occupational therapy, students of laboratory technique, and some- 
times other groups. 
8. Psychology. — All the institutions employ a psychologist (usu- 
ally under the title “psychometrist”), whose primary duties are in 
the school clinics and court clinics. Occasional service is given to 
adult patients in the hospital. Where research is carried on, highly 
qualified psychologists are found on the staff, several of them widely 260 
HOUSE 
No. 2400. 
[Mar. 
respected for their contribution to our knowledge of the mental 
patient. 
9. Inter-Institutional Relations. — Distances between institutions are 
not great in this Commonwealth. What might require more organ- 
ization in some States is easy to bring about here. 
The Commissioner is accustomed to call fairly frequent meetings 
of the superintendents; usually a meal is taken by all together in 
some convenient place in Boston, and business is discussed during 
and after the repast. 
There are no similar stated sessions for the assistant physicians. 
Medical organizations to which most of the assistants belong furnish 
platforms from which to set forth special studies and discussions. 
These are the New England Society of Psychiatry, the Massachusetts 
Psychiatric Society, and the Boston Society of Psychiatry and Neu- 
rology. 
The offer of the American Board of Psychiatry and Neurol- 
ogy to examine and certify experienced and well-equipped 
men as specialists in these branches of medical practice was 
eagerly accepted in Massachusetts. Pursuant to a demand by 
many of the assistant physicians for instruction in some of 
the topics with which they were less familiar, a course was 
organized at the Metropolitan State Hospital. It has been 
given four times and has undergone no little expansion. It is 
possible for any assistant physician to drive to Waltham, 
spend the day, and go home at night, and this is being done 
by a considerable number. 
The hospitals that are most active and best known in the 
teaching of research often receive a fellow in psychiatry from 
the National Committee for Mental Hygiene or one of the 
foundations. In this way selected physicians from many parts 
of the country have benefited from and made their contribu- 
tions to the Massachusetts state service. 
Each superintendent has carefully studied his positions, 
and when opportunity offers to make a promotion he is guided 
by the usual criteria of length of service, diligence and adapta- 
tion to hospital needs. It is probable that still better results 
can be obtained by giving candidates for promotion a suitable 
examination. Basic requirements should be laid down by the 
Department, including length of service, interne experience, 
and scope of examination. Not all these examinations need 
be competitive if the State will arrange to give promotions in 
the lower grades to every one who will earn it. 
The exigencies of out-patient service have sometimes been 1939.] 
HOUSE — No. 2400. 
261 
met by placing physicians therein with only meager special 
training. Better provision should be made. This matter 
requires oversight by the Department, and assurance to every 
superintendent that on need he can get a man or woman who 
has had the requisite training for undertaking such work with 
the prospect of success. 
No system has been arrived at by which physicians will 
routinely get experience in different types of institutions. 
Sometimes this has been arranged on the initiative of the indi- 
vidual. Perhaps a physician has been more available to fill a 
post at another institution than was any one on the resident 
staff. There have been physicians at the schools and at the 
hospital for convulsive disorders who, after several years of 
service, have found it difficult to move to a hospital for the 
different and important experience available there without 
accepting a decrease in salary that might be embarrassing to 
a man with a family. For the strengthening of the service it 
would seem desirable to make such arrangements as would 
assure a physician who wishes it an occasional period of work 
in an institution of different type from the one that he elects 
for his principal service. 
V. Nursing. 
Nursing in the hospitals may be organized in one group, 
or in two. If the organization is unified, the superintendent 
of nurses is at the head and has both male and female assist- 
ants. In the two-headed organization there is a chief super- 
visor for the men’s service, and the superintendent of nurses 
serves the women; the two function independently and report 
direct to the administrative medical service. There is, of 
course, room for difference of opinion on the merits of these 
two organizations, and the personal qualifications of some 
incumbent of an important position must at times be the 
deciding factor in the scheme chosen. 
Graduate and registered nurses are sought for important 
positions in the nursing service, and a considerable number 
have been employed. This number fluctuates from time to 
time. 
Certain hospitals maintain a three-year course in nursing. 
The superintendent of nurses is at the head of the school and 
usually has quite adequate help from the medical staff in lec- 
turing. Reviews and instruction on the wards might in some 262 
HOUSE— No. 2400. 
[Mar. 
instances be strengthened. The student spends a year in 
some general hospital learning techniques in medicine and sur- 
gery that can better be taught there. Graduates of such a 
course take the usual licensing examination and become 
registered nurses. 
Several hospitals are giving a two-year course of nursing. 
The studies are usually pursued earnestly. Students are some- 
what older than the group that ordinarily enters the school of 
the general hospital in these days. They do a full day’s work, 
and pursue their study afterward. Their diplomas are of 
limited use to them outside the mental hospital; but such 
trainees are of very great value, and their services are widely 
desired in hospitals here and elsewhere. 
No suitable provision exists by which a man can get full 
training in nursing in these institutions. A few have been 
admitted to the two-year course and are, of course, very valu- 
able to the institutions after that period of study. Since there 
are so many nursing positions for men, not only in mental but 
also in other types of hospitals in this country (over 16,000), 
and since there are so few graduate male nurses (about 600), 
it is desirable that in every section of the country there shall 
be at least one good school for men. Certain difficulties are 
experienced in finding and holding the best type of young man 
for training as a nurse, but it can be done and is being done 
successfully. Certainly every mental hospital considers itself 
fortunate whenever a capable trained man is added to its organ- 
ization, and the Commonwealth ought to be training some. 
These are unskilled persons when employed (attendants) 
and are taught largely by the apprentice system after they enter 
the hospital service. A course of lectures and demonstrations 
for attendants is prescribed by the Department. Hospitals 
differ in the frequency with which this course is repeated. It 
appears to be well conceived. 
The following table covers the hospitals only, not the schools. 
It shows the nursing personnel, population at the end of 1938, 
and the ratio: 1939.] 
HOUSE — No. 2400. 
263 
Hospital. 
Census. 
Number of 
Nurses and 
Attendants. 
Ratio of 
Nurses and 
Attendants 
to Patients. 
Boston State Hospital .... 
2,299 
464 
1:5.0 
Danvers State Hospital 
2,304 
344 
1: 6.7 
Foxborough State Hospital .... 
1,426 
185 
1: 7.7 
Gardner State Hospital 
1,424 
185 
1 : 7.7 
Grafton State Hospital ..... 
1,535 
212 
1 : 7.2 
Medfield State Hospital 
1,813 
278 
1: 6.5 
Metropolitan State Hospital .... 
1,846 
258 
1 : 7.2 
Northampton State Hospital .... 
2,021 
290 
1: 7.0 
Taunton State Hospital 
1,659 
262 
1: 6.3 
Westborough State Hospital .... 
1,564 
227 
1: 6.9 
Worcester State Hospital 
2,349 
380 
1: 6.2 
Total 
20,240 
3,085 
1 : 6.6 
This is a creditable showing. The Boston State Hospital 
leads with 1 : 5, which is unusual except in institutions of 
rapid turnover like the Psychopathic Hospital. Perhaps some 
institutions have assigned too many attendants to other 
duties, and therefore give poorer service to their patients than 
the record shows. 
Nursing salaries are perhaps adequate for the present, when 
great numbers of people are out of work. This situation might 
be quickly changed. The point that should always be stressed 
in a consideration of certain salaries is that the head nurse or 
charge attendant carries a great responsibility. In the direction 
of a unit, commonly called a ward or a cottage, there may be 
one or several subordinates. This should be a position of honor 
and should carry a large enough salary so that changes will be 
infrequent. It is recommended that in any revision of the 
salary schedule the emoluments of this position shall be in- 
creased. 
Nursing personnel is generally provided with suitable rooms 
away from the wards. The large increases in personnel called 
for by the growing census and by the addition of a third nurs- 
ing shift have led to granting larger sums for commutation of 
quarters. Certainly married people should be encouraged to 
live outside, and some single folks. Experience shows that a 
considerable fraction of the unmarried employees work more 
steadily if quartered on the hospital premises. 264 
HOUSE— No. 2400. 
[Mar. 
As one goes about the institutions of Massachusetts, he 
develops a growing appreciation of the intelligence, alertness, 
attentiveness and general capacity of the nursing personnel of 
both sexes. No doubt the years of depression have brought 
into the service persons with a higher average of education than 
usual, but one who has seen the institutions over many years 
must testify that the type of administration, the security ex- 
perienced by those who are interested in their duties, and the 
general level of public service in this Commonwealth, all play a 
part in the excellent standards of the institutions. 
VI. Food: Source, Preparation, Service. 
Foodstuffs are raised in considerable quantity on the hospital 
and school farms. Expert advice is obtained from an agricul- 
tural college about most of the procedures, and farms appear 
to be well managed and fertile. Most purchases of food are 
made by a central department on requisition from the Depart- 
ment of Mental Health. 
The allowance for food purchase for the year ending Novem- 
ber 30, 1936, varied from 11| cents a day at Gardner State 
Hospital to cents at Metropolitan State Hospital, with an 
average of 15| cents a day at the state schools. In addition, 
large quantities of foodstuffs are raised at Gardner and other 
hospitals that have extensive farms. A standard ration set up 
by the Department assures an adequate and balanced diet. 
The Department should and doubtless has reviewed all infor- 
mation assembled by the Special Commission on Mental Dis- 
eases and decided whether more is needed. 
A dietitian is regularly in charge of food preparation. She 
usually reports to the steward on her activities. It is possible 
to get women of experience and ability for these positions. It 
is said that good cooks are available in adequate number and 
have been for several years. During prosperous times this 
situation changes for the worse. 
Every institution has good kitchens. In some instances 
further improvements are planned. Some of the newer build- 
ings, such as that at the Metropolitan State Hospital, are 
striking in the arrangement of facilities and the beauty of the 
apparatus. The bake shop is generally adjacent to the kitchen 
and the butcher shop at a convenient distance. Sometimes 
storage facilities are under the same roof with the kitchen, 
though under different administration. 1939.] 
HOUSE —No. 2400. 
265 
Food is generally well cooked and almost invariably arrives 
at the dining room hot and attractive. 
Every institution has both large dining rooms and small. 
Table service is usually from insulated carts. Well-equipped 
pantries for the small dining rooms are the rule. 
The dietitian is usually responsible for the serving of food 
in any congregate dining room, but the nursing organization 
designates those who determine whether a patient has eaten 
adequately and take appropriate action. The nursing organi- 
zation carries entire responsibility for smaller dining rooms 
which accommodate disturbed patients, and those in build- 
ings at a distance from the centers of hospital activity. 
The cafeteria has become popular in this State as elsewhere; 
indeed, two of the earliest mental hospital cafeterias were those 
at Westborough and Worcester, and the one giving the broadest 
choice of items in this country is at Taunton. Service in these 
cafeterias is usually well organized. Both patients and em- 
ployees who work there are uniformed attractively and trained 
to give prompt service, but not to hurry their patients. A weak 
spot at some of the hospitals is the excessive number of patients 
allowed to start for the dining room at one time, causing too 
long periods of standing before reaching the food counter. The 
layout of the hospital has something to do with this difficulty, 
which, however, has been overcome in several institutions. 
Patients are generally allowed to choose whatever table they 
will when they have received their food. Since dishes are 
heated before they are put in use, the patient’s meal is appe- 
tizing when he gets seated, except that carrying the liquids that 
he will drink results in slopping. Members of the nursing per- 
sonnel watch those who are inclined to eat too little and make 
sure (if necessary) that they have second helpings. 
Different arrangements prevail for assembling the dishes 
afterward, and there is considerable variation in the comfort 
with which the patients leave the place. 
As for the smaller dining rooms, variation in standards exists 
there. In some places food is likely to be cold before it is eaten. 
On the other hand, one finds dining rooms for quite disturbed 
patients in which excellent standards of conduct are observed, 
to the great benefit of all concerned. 
In order to fit the meals into the working hours of employees 
whose time is limited to eight hours, there are some institutions 
that serve supper inordinately early and make no provision for 
refreshment by a bedtime snack, neither foi the new patient 266 
HOUSE —No. 2400. 
[Mar. 
who has till recently been on an entirely different schedule, nor 
for the working patient who is doing heavy manual labor. This 
is one of the difficulties that trouble institution managements 
in days of transition. A good spacing of meals is an important 
health measure. 
On the whole, the Commonwealth may be proud of the han- 
dling of the food problem. In some places the functioning is 
better than at others. 
VII. Groups of Patients and Methods of Treatment. 
Some patients are brought to the hospital by relatives or 
friends. A large number are accompanied by peace officers. 
In the metropolitan area, from which there are many such 
patients to move from the Boston Psychopathic Hospital to 
other institutions, a considerable measure of skill has been 
developed by the transportation officers. To be sure, the sheriff 
or policeman will maintain a kindly attitude, but they are not 
nurses and their preparation for this type of work has not been 
systematic; their efficiency is not at all to be compared with 
that of hospital employees trained for the task. The old Com- 
monwealth of Virginia and the young State of Idaho both send 
hospital employees from the state hospital for the new patient, 
on notification of the issuance of a court order. Certainly the 
employment of the police for this function is far below the 
general nursing standards of Massachusetts. It is to be hoped 
that this unfortunate procedure will quickly be corrected. 
The reception accommodations vary considerably. In some 
institutions the patient comes into the main office and may feel 
that he is being stared at by clerks, by officials, by business 
persons who have come to see the steward, and by casual 
visitors. He is seen by a physician. If he has to come into the 
main medical office, there is no privacy for the interview. 
Fortunately, the more recent and better standard of a separate 
reception building at a little distance from the main group, 
with a comfortable and preferably attractive reception room 
where the physician makes his first acquaintance with the case, 
is gradually being extended to all institutions. 
Of the hospital personnel, the first to greet and look after the 
needs of the new patient is usually a supervisor or some other 
representative of the nursing personnel; but a social worker is 
occasionally designated for this function. In some institutions 
the reception wards are well arranged for the new patient by 
being small and having in them only patients with an appear- 1939.] 
HOUSE— No. 2400. 
267 
ance of freshness and an air of recovery. In others, the new- 
comer immediately sees other patients who have been long ill 
or who at the moment are desperately ill. This is hardly an 
encouraging companionship for one who comes in fearful and 
gloomy about his own future. 
It has already been remarked that the state hospitals and 
state schools of Massachusetts have competent staffs of at- 
tending specialists. In general, such branches of medical 
practice as surgery, gynecology, orthopedics, opthalmology and 
several more receive quite adequate attention; that is, the 
resident staff gives such examinations and treatment as are 
ordinarily adequate, and in cases that go beyond their experi- 
ence the attending staffs are called in to advise or operate. 
Perhaps there is room for improvement, and it may be that 
hospitals should resurvey their resident population with a view 
to determine whether there are hernias, hemorrhoids, varicose 
veins, or other disorders that could be helped by the surgeon; 
whether there are cases of diabetes or duodenal ulcer or chronic 
bronchitis or arthritis in which a consultant would recommend 
still more effective remedies than those that are now in use. 
One comes away from visits to these institutions with gratifi- 
cation at the active attention regularly accorded the patient, 
but it is not intended in this report to indicate that these or 
any other medical groups may ever rest on their laurels. One 
must always be searching for more and better methods of 
treatment. 
Many of the institutions are equipped with good surgical 
suites, and the attending surgeon performs any necessary oper- 
ation there. Hospitals that are not so well equipped have made 
arrangements with general hospitals in the neighborhood, so 
that a patient is taken to a very good place for the operation 
and perhaps brought back at once to the mental hospital. 
This is a fair arrangement when none better is available. It 
should be remembered, however, that sometimes patients with 
annoying types of conduct require surgical treatment, and such 
a patient may be so feeble or otherwise impaired after the 
operation that removal several miles to his own institution for 
post-operative care is not the best plan. 
In the case of the Fernald School, it is quite convenient to 
send surgical patients a short distance to the Metropolitan 
State Hospital, where they may stay as long as necessary. 
Dental work is generally well attended to. the number of 
resident dentists in the institutions is noted on a previous page. 268 
HOUSE —No. 2400. 
[Mar. 
It was once remarked that the branch of medical activity per- 
haps best provided for in American mental hospitals is den- 
tistry; certainly very creditable work is being done. There 
are places where a dental hygienist would add to the effective- 
ness of the program. 
In every hospital one finds variation of interest in the use 
of various kinds of apparatus for the treatment of the inci- 
dental ills — sometimes, indeed, severe — that can be reached 
in such ways. Stimulative hydrotherapy, heat applied in 
various ways (most conveniently, perhaps, by electric current, 
direct or induced), and other measures of like sort are found 
located usually near the wards where the largest number of 
physically ill are cared for. There is a field of great usefulness 
here, and often it is well for some physician to specialize in 
such matters, and be commissioned by the superintendent to 
organize them in a convenient place with a competent personnel 
in charge. Certainly a considerable number of patients are 
improved in mood as well as in body if given the personal 
attention employed in massage, in treatment by fight, in 
hydrotherapy and other such measures. 
Hydrotherapy requires a special ward, particularly in regard 
to the use of the prolonged bath for the quieting of excitement 
and the induction of sleep. Installations for this therapy are 
found in all the hospitals. There is considerable difference in 
the extent to which they are used, depending largely on the 
convictions of the superintendent and to some extent on the 
convenience of the facilities; for instance it was noted in one 
hospital that certain tubs close to wards for disturbed patients 
were much used; that other tubs placed in a basement were 
less used. It may not be feasible to withdraw one or more 
employees from a ward two or three floors away — or even one 
floor away — and send them to this special room. More often 
than not, the patient is confined to the tub by some sort of a 
canvas sheet over it. This is not the ideal arrangement, for 
the bath should be a place of freedom. To covers that merely 
protect the aesthetic sense of the onlooker, no objection can 
be raised. 
One hospital makes more use of this treatment apparently 
than any other. Special apparatus has been devised for the 
control of temperature in the tubs. This is also being installed 
in other places. It is very fine and may be recommended where 
funds are available. But let no one be misled into thinking that 1939.] 
HOUSE —No. 2400. 
269 
the apparatus is the essential thing. The prolonged bath can 
be given in any bathtub when one especially equipped is not 
available. 
For some years the Department has made available to the 
hospitals the special services of a physician who has given her 
attention to hydrotherapeutic procedure and some other items 
of physiotherapy till she is recognized throughout the country 
as a leading authority. This is a very fine arrangement, going 
beyond what any other similar state service has attempted. 
This physician not only discusses such matters with the resident- 
staff, but she also devotes considerable time to training special 
personnel in very careful and effective fashion. 
It is related that certain Arabian physicians in the Middle 
Ages organized occupations for the benefit of their mental 
patients. Recognition that work is good for the mentally sick 
as well as for the mentally sound is certainly ancient; never- 
theless, the way in which the crafts have been organized for 
the benefit of the patients during the current century is perhaps 
somewhat more systematic than was older practice. Various 
allocations of responsibilities in this field are found in different 
sections of the country. 
In Massachusetts the greater number of types of shop em- 
ployment are embraced in the department of occupational 
therapy, and those in charge of such departments are graduates 
of special schools which give, indeed, an admirable training. 
Certain other occupations are embraced in a department of 
industrial therapy, and it is usually not expected of the crafts- 
men who supervise the repair of shoes, the weaving of towelling, 
or the repair of kitchenware, that they exercise as much 
ingenuity in following the changes in the patients’ attention and 
interest as should be done by the occupational therapy aides. 
To put the matter in another way, those who are likely to work 
with a measure of steadiness are sent to the industrial shop, the 
laundry, the sewing room or the farm, whereas those whose 
response is less reliable are directed into occupational therapy. 
Some of these departments are particularly fine, and many of 
them must seem to be models to patients who may have come 
from some less enlightened section. 
Superintendents usually wish that they could increase their 
occupational therapy personnel, and in this they should be 
encouraged so far as it is economically possible. In the long 
run it is cheaper for the Commonwealth to persuade a patient 270 
HOUSE —No. 2400. 
[Mar. 
to be usefully active than to allow him to vegetate and perhaps 
develop an antagonistic attitude. Since one could hardly run 
controlled experiments in this field, what has just been stated 
so confidently is difficult to prove; but it is the common testi- 
mony of those with experience. 
The organizing of competitive sports for the benefit of the 
patients has not yet proceeded to the level of greatest useful- 
ness, though considerable progress has been made. Only within 
relatively few years has an adequate supply of teachers of 
physical education been available from schools of education and 
universities. Such teachers can now be obtained. After ap- 
pointment to the hospital they must pass a period of apprentice- 
ship in learning about the manifestations of mental illness and 
how to meet the special requirements in this field. Interest has 
been shown by certain educational institutions in having part 
of the training of their students done in mental hospitals. In 
this way the supply of competent personnel should become still 
more accessible. 
There is need in some of the hospitals of skilled directors 
supplemented by assigned attendants, so that patients may 
have the benefits not merely of recreation but also the more 
definite benefit of a sport program that is adjusted to their 
particular needs. Perhaps men are more quickly responsive 
to this than to almost any other approach, and it is hoped that 
the male patients may have quite competent treatment of this 
sort in every hospital shortly. The positions of director and 
assistant should be placed on every hospital pay roll. 
Music therapy is often considered a minor matter, though 
it is generally recognized that group singing brings great enjoy- 
ment and improvement of mood to both normal and abnormal 
people. In skilled hands the use of music and the dramatic 
arts is organized in a way that may be somewhat comparable 
with physical education and occupational therapy. This field 
should be cultivated, and what is done now in Massachusetts 
may well be expanded into the hospitals that are making less 
use of it. The music director should be scheduled in the pay 
roll. 
Recreation is considered of sufficient importance so that it is 
an item in the minimal standards set up by the American 
Psychiatric Association for mental hospitals. It may be said 
that each of the hospitals in this State has a good and varied 
program in this field. 1939.] 
HOUSE — No. 2400. 
271 
Each hospital has a library for the patients. There is varia- 
tion in the effectiveness with which they are administered. A 
librarian who will study the needs as well as the desires of the 
individual patients, particularly those who have recently left 
home, can be of great help in promoting an ameliorative pro- 
gram. Early demonstration of this was made at McLean 
Hospital. The word “ bibliotherapy ” is not fanciful, for courses 
of well-selected reading have helped many a patient. Very 
commendable work is done in several of the hospitals. There 
is still opportunity for the development of this matter. 
Religious services are scheduled in every institution, and 
those with varying religious inclinations receive attention from 
clergymen of appropriate faith. Probably somewhat too little 
pastoral service is expected; if organized, such service is helpful 
to many patients. Some institutions serve as fields for the 
training of ministerial students, and this arrangement might 
probably be extended. 
In one instance a state official offered the criticism that 
undertakers were not employed as required by law for the 
transportation of the deceased. He apparently overlooked the 
fact that the Legislature consistently appropriated too little 
money to carry out this requirement. The Legislature of 1938 
appointed a recess commission to study this situation. This 
survey ascertained that the general custom is to have burial 
services conducted not only decently but also in accordance 
with the sensibilities of friends and other citizens. 
Human beings quite generally object to limitation of their 
freedom of movement, and, so far as possible, this objection 
should be respected. The tendency therefore to use mechanical 
restraint except as a legitimate means of treatment should be 
deprecated — and combated. Reducing the amount of me- 
chanical restraint to the lowest desirable figure may be said to 
depend on three things; 
1. The conviction and energy of the physician. 
2. The ability of the nursing personnel. 
3. The adequacy of provision of measures of treatment, such as 
hydrotherapy, physical activity and interesting occupation. 
The record of Massachusetts is creditable in this regard. In 
the following list is noted the number of cases reported in re- 
straint during the month of October, 1938: 272 
HOUSE —No. 2400. 
[Mar. 
Institution. 
Average 
Daily 
Patient 
Population. 
Patients under 
Restraint. 1 
Number. 
Per Cent. 
Boston State Hospital 
2,384 
- 
- 
Danvers State Hospital ..... 
2,310 
26 
1.12 
Foxborough State Hospital .... 
1,406 
10 
.71 
Gardner State Hospital 
1,435 
1 
.07 
Grafton State Hospital 
1,523 
- 
- 
Medfield State Hospital 
1,820 
10 
.54 
Metropolitan State Hospital .... 
1,865 
2 
.10 
Northampton State Hospital .... 
2,033 
20 
.98 
Taunton State Hospital 
1,689 
20 
1,18 
Westborough State Hospital .... 
1,592 
11 
.69 
Worcester State Hospital ..... 
2,358 
48 
2.03 
1 These figures cover mechanical restraint only. 
Human beings at times wish to be by themselves and un- 
molested by any other person, but forced separation from one’s 
fellows often meets objection. It is sometimes necessary to 
protect other persons, and still more to protect the aggressive 
individual from suffering at the hands of others, presumably 
for his aggression. If the patient is in a room by himself and 
cannot get out because the door is locked or otherwise fastened, 
he may be considered to be in seclusion. Since seclusion is 
officially frowned upon, and therefore some stigma attaches to 
reports of patients so managed, the word is defined in various 
ways, either officially or otherwise. Officially in Massachusetts 
a patient is in seclusion only if fastened into a room between the 
hours of 7 a.m. and 6 p.m. Official statistics therefore make no 
record of the number of doors fastened at night. Unofficially 
there is a tendency to think, if the door is not locked but held 
closed by a piece of cloth or paper squeezed between the door 
and the jamb, that the case is hardly reportable. 
This is a practice that needs review. In many regards 
seclusion is much less objectionable than restraint, but it can 
be used too freely. The fault, however, may not lie at all with 
those who are looking after the patients, but with those who 
control the appropriations. It may be remarked that some 
difficulties have been created by going from the two-shift to 
the three-shift system of nursing in most of these institutions, 
and the wards where some restless patients are quartered may 1939.] 
HOUSE —No. 2400. 
273 
be rather thinly covered during one of the shifts. Again let 
tribute be paid to the good medical and nursing service of the 
institutions, but at the same time one may say that this is 
another of those measures that need frequent restudy. 
Mental hospitals are not expected to receive defective 
(feeble-minded) persons unless they have in addition a mental 
illness; circumstances would seldom arise in which a person 
with pure defect would be admitted. On the other hand, in 
the course of years a considerable number of defectives develop 
mental illnesses while at the state schools. They are then 
committed to the state hospital. The school proceeds to admit 
some one from its ponderous waiting list, and when the original 
patient has recovered from his mental disorder there is no 
place for him in the school. He had already shown his in- 
ability to get along in the community and may not have de- 
veloped any greater capacity. The mental hospital must, 
therefore, keep him. Fortunately, some of these patients are 
suitable for boarding out, and the hospitals to which they go 
will be able to place some of them in that way. Others, whose 
sex activity is undisciplined, will continue to occupy beds in 
the mental hospitals until the Commonwealth has further 
expanded its training school capacity. 
The aged and infirm have increased so greatly in number of 
late years that they have overrun their accommodations in 
many institutions and now occupy wards that are not especially 
suitable for them. Generally speaking, it has been attempted 
in the mental hospitals and in the schools to place infirm people 
on the ground floor as far as possible. An argument for one- 
story buildings for the care of this type of person is well 
grounded. The example of the State of Illinois might be 
adduced to indicate that such a program is possible even in a 
region where cold weather often prevails. Buildings at Monson 
and at the schools are in point. Structural requirements for 
economy of movement on the part of the nurses are well under- 
stood: wards near the ground level, ramps in suitable places, 
wheel-chair pavilions or porches, dormitories not too large but 
easy of supervision, single rooms for patients who disturb 
others or who may be near the end of life, well-equipped utility 
rooms, and the like. There is still much study to be made of 
the physiology and pathology of old age, and important facts 
may yet be collected in mental hospitals. 
Tuberculosis is found through all levels of society. It is 
likely to do most damage where it is unrecognized, where 274 
HOUSE —No. 2400. 
[Mar. 
human beings are crowded together, and where exercise and 
ventilation are neglected. Ordinarily a careful study of a 
mental hospital population in this section of the country will 
show that up to 5 per cent of the patients are infected. If 
treatment programs are good, many of this 5 per cent already 
have arrested lesions; that is, the disease has ceased to pro- 
gress and the patient can live under mild restrictions an active 
and normal life. Of course, the type of life that he actually 
lives depends more upon his mental illness than upon his 
pulmonary damage. 
The simplest arrangement for the care of these cases is to 
diagnose them by physical signs, — loss of weight, cough, 
pallor, fever or other obvious symptoms, — and then isolate 
them in whatever quarters may be available. Under this 
scheme they are already advanced cases when diagnosed, and 
the isolation is apt to be faulty, with peril both to other pa- 
tients and personnel. Better hospitals provide ample diag- 
nostic facilities and special buildings, or at least special wards, 
and every necessary attention to nursing, to diet, to graduated 
activity, to proper exposure to outdoor air and light, and to 
other established measures of treatment. 
Several Massachusetts institutions are now well equipped 
to give all these measures of treatment and also to provide 
surgical procedures that of late years have been found most 
useful. Some physician on the hospital staff carries these 
patients as well as others on his service, and usually has as- 
sistance from a consultant who is an expert in the treatment 
of tuberculosis. 
The opening of a new tuberculosis building at one hospital 
may be the occasion for the transfer of a few cases from other 
hospitals, especially if the provision in the older institution is 
not such that the most dangerous cases (that is, those most 
likely to spread the disease) can be properly isolated. There 
have not been in any one institution enough cases to warrant 
appointing to take charge of them a physician who is already 
expert in their treatment. 
Experience elsewhere indicates that perhaps the best way 
to manage this problem is to bring together from several insti- 
tutions those patients that have pulmonary tuberculosis and 
place them under treatment on a special service under the 
direction of some one who may, indeed, have had little psychi- 
atric experience, but who can direct all the best measures for 
the physical disorder. Consideration should be given to such 1939.] 
HOUSE —No. 2400 
275 
an arrangement for all the cases that are in the eastern end 
of Massachusetts. 
Some of the fundamentals of hygiene should be reviewed. 
Temperature is disregarded in some institutions, and wards 
are kept at an unconscionable heat. Frequently one finds no 
thermometer on a ward. Ventilation also is disregarded and 
sitting rooms and bedrooms become stuffy. 
In many hospitals there are patients who may never leave 
the building from October to May. Some of these are the most 
disturbed patients, but others could hardly be so described. 
The situation is relieved in some instances by going to and from 
a congregate dining room three times a day, and in others, by 
the availability of porches. Reasons offered for not taking 
patients out of doors are that they are too disturbed, that they 
prefer not to go, or that they have not sufficient heavy clothing. 
The care of the face is usually well looked after, barbers of 
reasonable skill being appointed to serve the men. Hospitals 
have also hairdressing parlors for women, and a large number 
receive those attentions that do much to rebuild the shaken 
self-esteem. 
Clothing generally is adequate, but there is too much varia- 
tion in the efforts that are made to keep the men presentable. 
More attention is paid to the fit of shoes than was once the 
practice, but further improvement could be made in some insti- 
tutions. 
Bathing apparently is given quite adequate attention. Most 
wards have some bathing facilities, and their frequent use in 
summer is much appreciated. Central bathing is employed 
occasionally, and it may be difficult for a patient to get an 
extra bath when he is hot and sticky. 
Several hospitals employ a podiatrist to come at stated inter- 
vals and relieve the foot ailments of the patient. This is a very 
merciful arrangement. 
Visiting has been encouraged in Massachusetts to such an 
extent that a physician expects to interrupt whatever he is 
doing in order to talk with relatives. The matter should be 
better organized. It is not good treatment for a patient to 
have an interview interrupted at perhaps a critical time, and 
the physician called away. I he matter can be adjusted if un- 
due pressures are removed. Certain days and hours should be 
set for discussions with the physicians. 
Contrasts in the number of patients that are allowed to go 
about the grounds without supervision may depend on several 276 
HOUSE — No. 2400. 
[Mar. 
elements. The location of the hospital, whether in city or 
country, makes considerable difference in this regard. The 
layout of the hospital may make a difference; a hospital in 
Michigan has an enclosed park of eleven acres, where a for- 
getful patient may go about quite happy who might wander 
away under other conditions. The frequency of admissions is 
of consequence; where admissions are fewer and the hospital 
population is more stable, a larger number of patients can be 
left to their own devices. The policy of the institution may be 
determined by the temperament of some officer who may be 
more or less cautious. 
The approximate number having ground privileges in sev- 
eral institutions on January 1, 1939, is set forth in the following 
table: 
Institution. 
Census. 
Ground Privileges. 
Patients. 
Per Cent. 
Boston State Hospital 
2,299 
133 
5.8 
Foxborough State Hospital .... 
1,426 
173 
12.1 
Medfield State Hospital 
1,813 
400 
22.1 
Metropolitan State Hospital .... 
1,846 
223 
12.1 
Northampton State Hospital .... 
2,021 
207 
10.2 
Taunton State Hospital 
1,659 
250 
15.1 
Westborough State Hospital .... 
1,564 
433 
27.7 
Worcester State Hospital 
2,349 
626 
26.6 
Many patients on leaving the hospital are carried on the 
books for a year. This arrangement enables the staff to give 
a measure of supervision and help through its social service, 
and is a valuable extension of treatment and a type of insur- 
ance against relapse by those who must go to an environment 
with which they are out of sympathy. 
If relatives insist on removing a patient against the advice 
of the hospital physicians, it is customary here to carry the 
patient as “on visit” in order that the formalities of readmis- 
sion may not be a cause of delay in returning, and that various 
superfluous reports may not become necessary. This policy 
is to be commended. Such relatives are commonly required 
to sign a statement saying that the removal is against advice. 
Perhaps such a statement is required even in some instances 1939.] 
HOUSE— No. 2400. 
277 
where the record indicates that the physicians are really in 
favor of the removal, as a precautionary measure against 
unwarranted criticism. 
The only large reservoir of mentally ill patients outside the 
state hospitals is the mental wards of the State Infirmary at 
Tewksbury. Their patients are all transfers from the other 
wards of the State Infirmary. The Department of Mental 
Health has some authority over these transfers and a general 
supervisory function. It has long been thought that the better 
standards of the state hospitals should be extended to these 
patients, numbering about 500, but no serious movement is 
under way at the present time to provide for them. This 
question should receive a definite decision. 
A vast amount has been done in the field of public education 
in the Commonwealth of Massachusetts. The Massachusetts 
Society for Mental Hygiene which engages in that work is 
one of the oldest of such bodies. It is well organized, has the 
support of many able and public-spirited men and women, 
and has had adequate funds for a considerable program. 
VIII. Activities Outside the Institution. 
Many hospital officers and department heads in the state 
service have contributed to this campaign. It is probable that 
the abbreviation of the recent political raid upon the institu- 
tions can be traced to the fact that the Department and its 
several institutions have taken the public into their confidence 
about their activities and their difficulties during previous 
years. 
Follow-up work, as it is sometimes called, has long been 
practiced in this State. The following table shows the number 
of social workers in each institution. They have various other 
duties than the supervision of the patient on visit, but in all 
instances some of them are engaged in hospital supervision. 278 
HOUSE —No. 2400. 
[Mar 
Institution. 
Quota of Social Workers. 
Boston State Hospital 
5 
Danvers State Hospital 
4 
Foxborough State Hospital ....... 
3 
Gardner State Hospital 
3 
Grafton State Hospital 
1 
Medfield State Hospital 
3 
Metropolitan State Hospital 
2 
Northampton State Hospital ....... 
3 
Taunton State Hospital ........ 
3 
Westborough State Hospital 
3 
Worcester State Hospital 
4 
Monson State Hospital 
2 
Belchertown State School 
3 
Walter E. Fernald State School 
3 
Wrentham State School 
2 
No modern hospital of any type can expect to get the best 
possible results except by a good follow-up system, and the 
mental hospitals of Massachusetts have done wisely in organ- 
izing this field. 
As indicated in the previous paragraph, a large part of the 
activity of the social workers is actually social service. In 
addition they take a very large number of histories of patients. 
As a rule, these histories are arranged excellently, stated 
clearly and seldom verbose. For the physician they illuminate 
the problems of the patients involved. 
In some hospitals the social worker has considerable respon- 
sibilities for the new patient, not only in getting acquainted, 
but also in explaining the situation which is not only novel to 
him but perhaps also terrifying. This is a valuable assignment 
if social workers are numerous enough so that they will not 
have to neglect the things that no one else can do while attend- 
ing to things that might be assigned to some one else. 
Social workers have many duties in connection with the 
out-patient clinics, the school clinics and the juvenile court 
clinics. As noted in the section on “Medical Activities,” 
these institutions carry considerable responsibility in those 
fields. 
The social worker prepares the way for the physician, ob- 
tains vital facts, and enables the local social organizations to 
understand and profit by the observations of the psychiatrist. 1939.] 
HOUSE — No. 2400. 
279 
In the aggregate a vast clinical service is performed for the 
citizens of Massachusetts who are not in the hospitals, par- 
ticularly for its children, by the staffs of these hospitals. A 
mere enumeration of the places where work is done is impres- 
sive. A study of the schedules is still more impressive. One 
can hardly overstress the value to the community of placing 
at its service the experience of the institution psychiatrists. 
We have not attempted to give an estimate of time spent on 
school or court service. Out-patient clinics are maintained 
in 50 cities and towns. 
Massachusetts was the first American Commonwealth to 
undertake systematically the boarding out of patients as a 
type of treatment. This has been European practice in one 
form or another for several centuries. In Massachusetts 
responsibility for the system was divided for some time be- 
tween the institution at Gardner and an assistant to the Com- 
missioner. More recently it has been taken up by other 
institutions. 
Conservatism is not only natural to those who have seen 
schemes come and go, but is also commendable within bounds. 
It might be expected that the experience of many other coun- 
tries, plus successful use of the system in this Commonwealth 
since 1885, would lead progressive administrators not only to 
place out a modest number of patients in families, but also to 
throw their influence in favor of such modifications of the sys- 
tem as would make it much more widely useful. It is gener- 
ally recognized by those who have any experience that $4.50 
per week is too low a board rate in the State of Massachusetts. 
A certain number of patients can be placed out at this rate, 
but not nearly all those for whom that management would be 
most helpful. 
Every institution should send suitable patients into family 
life. There is no one of these institutions that lacks some 
patient who cannot be cared for by relatives, but who could 
live with reasonable happiness and considerable comfort in 
the care of some family under supervision of the physicians 
and social workers of the institution. 
Most activities of the hospitals have been discussed func- 
tionally in a previous section. It is intended here to make 
simply a brief characterization of the various hospitals, with 
a comment on some special characteristics. 
IX. The Hospitals. 280 
HOUSE — No. 2400. 
[Mar. 
This institution stands near the Fenway, and overlooks it 
from many of the windows. The district, however, is resi- 
dential, and the surroundings are not comparable to those of 
the larger institutions in the country. The building is modern 
and without fire risk. 
Boston Psychopathic Hospital. 
The institution is one of the older reception hospitals for 
temporary observation and study, having been in use since 
1912. Usually this function is allotted to municipalities, but 
in this instance the Commonwealth recognized a community 
need that was not being met elsewhere, and provided boldly 
and broadly for it. This is a psychiatric teaching center for 
two medical schools, and gives courses in psychology and so- 
ciology to many neighboring schools and colleges. It conducts 
an active out-patient department and serves as a consulting 
center for courts and private physicians. Its excellent library 
is much used. Indeed, its facilities are now inadequate to its 
program, and everywhere except in the wards it seems crowded. 
There are not enough beds, not enough consulting rooms, 
not enough office space, and the laboratories are pitifully out 
of relation to the great amount of clinical work carried on here. 
Quarters for officers and employees are inadequate because of 
the changing and greatly increased demands since the institu- 
tion was opened in 1912. Two small and well-planned units 
for reception purposes were devoted to other purposes as far 
back as the war period, and are still needed for special treat- 
ments and studies. 
Much valuable research has been carried on here. Students 
of psychiatry from all sections of the country have sought 
staff appointments or fellowships in this hospital. A psycho- 
logical division does a certain amount of routine work, particu- 
larly with children, and also carries on special studies. 
Under present arrangements this institution does not train 
the younger staff members of the state hospital service in 
nearly the measure that was originally hoped. Only one hos- 
pital sends every new physician to Boston for a month. Means 
should be found to utilize the teaching possibilities of this 
hospital vastly more by the staff physicians of the other state 
institutions. Service to psychiatric interests throughout the 
nation should be continued, with greater emphasis on service 
to psychiatry in Massachusetts. 1939.] 
HOUSE —No. 2400. 
281 
Most patients do not remain here long, but small groups are 
retained for treatment and a very few for teaching purposes. 
The intimate relation with the Harvard Medical School and 
several general hospitals is capitalized to provide accommoda- 
tions elsewhere for neuropathological work and some of the more 
complicated laboratory procedures. 
Clinical standards are excellent and the records and reports 
made are admirable. Patients receive as considerable indi- 
vidual attention as is probably feasible in such a turnover. 
All nursing is organized under the principal of the school. 
Affiliates come from seven general hospitals. Attendants have 
a short course. 
The prolonged bath is widely used during the daytime. 
Occupational therapy has a special problem in stirring the 
interest of patients who stay but a few days. Physical educa- 
tion is not well organized. 
Studies on the treatment of syphilis of the central nervous 
system made here have been quoted throughout the country. 
Boston State Hospital. 
This is a clumsily distributed institution in the southwestern 
part of the city of Boston. It has functioned since 1839; the 
State took it over in 1908. Parts of the grounds are very 
attractive; others are still rough. Highways border the insti- 
tution on three sides and cut through it, and houses overlook 
most of its property. No effort has been made to obtain privacy 
through planting suitable hedgerows. 
The buildings are of various styles and types. The earliest 
ones are of frame and stucco, and rather easily damaged. 
Those of another period have been protected against fire by 
sprinklers, and more recent ones are of brick and concrete. 
The appearance of the buildings is generally attractive. The 
service units are good, though shops are not large enough. 
Farming has recently been discontinued and the barns con- 
signed to storage purposes. 
At the time of the survey, many changes had recently been 
made in the personnel. The assistant superintendent was 
acting as steward. The lack of experience among employees 
was in contrast to usual standards in Massachusetts. Medical 
students are not at present assigned to this hospital. 
The Institute is an elaborate building staffed by a very able 
group of persons engaged in research. It is also a teaching 282 
HOUSE —No. 2400. 
[Mar. 
point for the hospital staff, and conferences are held there 
weekly. Private funds largely finance it. 
The clinic building is used for reception purposes. It was 
not originally designed to care for disturbed patients. This 
is a very well-equipped building with hydrotherapeutic and 
physiotherapeutic apparatus and personnel. The medical 
library is located there, with 1,174 volumes. 
Cases requiring major surgery are sent to a general hospital 
near by. The tuberculosis building is well designed for its 
purpose. 
A night medical officer remains up till morning and goes 
through all wards. 
Nursing is organized in a unitary system. The ratio is 1 
nurse or attendant to each 5.4 patients. This is by all odds 
the best ratio in the State of Massachusetts, and reflects credit 
on a former superintendent who successfully insisted that the 
needs of his patients required this number of nurses and at- 
tendants. Graduate nurses usually remain in the hospital 
but a short time, it is stated, under present practices. A two- 
year course in nursing has been given. This will be discon- 
tinued and affiliate pupils received. 
Physical education is carried on actively. An art instructor 
works on a volunteer basis. The patients’ library contains 
800 volumes. 
One cafeteria is a makeshift and its service is not satisfactory. 
Another is well equipped, though poorly laid out. Service of 
the disturbed, either in their ward dining rooms or their rooms, 
is good. 
On the top of Hathorne hill in the town of Danvers stands 
this imposing castle of mercy. The approach is pleasant and 
not too steep. On all sides one can look across rolling country- 
side for miles. The Middleton Colony is on lower sloping 
land only a mile and a half away. The district contains a pop- 
ulation of 2,312,500. 
Danvers State Hospital. 
The main building, a sturdy structure of brick and beam, 
has been given modern fireproof stair wells in most sections 
so that the fire peril is much lessened. Some other buildings 
are of frame construction. 
Three colleges send students of sociology here for clinical 
teaching. 
The medical library contains 500 volumes in charge of an 
untrained but attentive person. 1939.] 
HOUSE— No. 2400. 
283 
The school of nursing teaches women only; it is a three- 
year course. Affiliate students come from four hospitals. 
Though men are not trained in this school, an affiliate man 
has been received. Students in the home school are given no 
experience on men’s wards. 
The reception service is badly placed and does not assure 
the new patient against observation of and by the older pa- 
tients. Isolation of tuberculosis cases is not complete, since 
the special pavilion is not equipped for the custody of disturbed 
patients. 
The physiotherapeutic apparatus is actively used. The oc- 
cupational therapy shop [is inadequate. Physical education 
has the attention of two employees. Singing is the only exten- 
sive use of musical therapy. The patients’ library contains 
2,000 books. 
A large and pleasant dining room for patients has been 
recently put into service. Cafeteria service is used. 
Foxborough State Hospital. 
This institution was developed during several years on a 
definite plan by one of the ablest builders among American 
hospital psychiatrists. It was planned with careful detail to 
accommodate 1,000 patients and the necessary staff. It is 
an admirable example of an institution of the block type with 
connecting corridors, these corridors being usually two stories 
and basement in height, and serving section by section as 
sitting rooms for the adjacent wards. A few old buildings 
were included in the L-shaped layout and wrere integrated with 
the new ones. 
Policies having changed, the institution has now been in- 
creased in size, and several functions have broken down and 
required replacement when facilities became overloaded. This 
is the usual history of American mental hospitals. 
A restricted site on rolling land in eastern Massachusetts 
shelters the hospital. Most of the buildings are on a level 
tract, but the new tuberculosis unit is at a distinctly higher 
level and connected with the rest of the group by a tunnel. 
The institution owns 385 acres. The farm, being distant about 
two miles from the main hospital, has a colony building for 
workers. Obviously, this institution should not be expanded. 
Consultants are called occasionally from Boston. The labo- 
ratory work of this hospital has equalled the best standards of 
the state service. 284 
HOUSE —No. 2400. 
[Mar. 
A two-year course in nursing is given, and both sexes are 
accepted as students. The instruction is given largely by the 
principal and assistant principal of the school of nursing, but 
their administrative authority reaches to only one of the 
male wards. 
The large dining room of the institution has service from 
insulated carts which bring the food to the tables from the 
near-by kitchen. These carts are falling into disrepair and the 
present system will be changed to cafeteria service. Fifty to 
sixty special diets daily are prepared in addition to what is 
prescribed for the patients in the tuberculosis pavilion. 
A large part of therapeutic occupation is carried out in the 
wards. The occupational therapist is also responsible for all 
recreation. Physical education has had but little attention. 
There is an orchestra of employees. 
Besides three social workers there are two students. After- 
care is said to be well done, and two workers are in the field all 
the while. Pre-parole investigations are made. 
Gardner State Hospital. 
This institution was established with a special purpose in 
view, — to take idle but able-bodied persons with chronic ill- 
ness from the various hospitals where they had been received 
and studied, and to give them simple dwellings in the country 
under the immediate care of mechanics and house mothers, 
but also under the expert supervision of the resident physicians. 
It was intended to scatter the patients about in “numerous 
small separate farmsteads and industrial groups, each complete 
in its home equipment and interest.” This plan was pursued 
until 1912, since when the tendency has been toward the 
construction of fireproof buildings of larger size than those in 
the original scheme. 
In 1915 this hospital was authorized to receive new patients, 
and in 1924 the building for the physically ill was developed 
and a reception service organized, since when the institution 
has done general district work. There still remain a consid- 
erable number of patients transferred from other institutions 
in accordance with the original plan. 
The time has now come when another trend observable in 
hospital population all over the land is interfering with the 
original purpose of this institution. Patients long in the hospi- 
tal are growing old, and a larger number of elderly people are 
included among the patients newly admitted. Hence ther 1939.] 
HOUSE — No. 2400. 
285 
number of able-bodied is relatively smaller, and there are more 
who must be managed as invalids rather than as employment 
problems. 
The hospital is situated in a pleasant hilly district, and its 
buildings extend more than a mile from end to end of the plot. 
There is considerable variation in the size of the housing units, 
and no small ones have been built for many years. Indeed, 
three have been condemned. The land is of the type usually 
found on abandoned farms. This terrain was deliberately 
chosen, and its choice seems well justified; for after many years 
of rehabilitation the fields have proved to be fertile. 
The superintendent and trustees have urged that more 
buildings of simple construction be added to the present lay- 
out. This has met official resistance, probably because of the 
difficulty in justifying such a policy in case a disastrous fire 
were to occur. Perhaps a compromise may be reached through 
the use of some type of construction similar to the prefabri- 
cated house. Means should be found to expand this institu- 
tion somewhat in accordance with the vision of those who 
brought about its founding. 
Whatever may be done about the original plan, there is need 
of some additional construction of a permanent type. A recep- 
tion building is needed, and either a new treatment building or 
additions to the one now existing. There is need, also, of con- 
struction for the housing of personnel and officers. 
This hospital has specialized, also, on the placing of patients 
in the community. For many years less interest in the board- 
ing-out system was felt in other units of the state service. 
The amount allowed for board is $4.50 and is inadequate. A 
larger allowance seems likely, to permit placing many more 
patients out. This hospital is rivaled by only one in having 
the largest number under boarding care. 
Grafton State Hospital. 
This institution occupies 1,100 acres eight miles from the 
city of Worcester. The terrain is hilly, well-wooded land 
only partly developed, and promising to furnish outdoor occu- 
pation in subduing nature for years to come. Two hundred 
and ninety acres already are cultivated, and other stretches 
of peat or fertile loam have been marked for improvement 
within the next several years. 
Until 1915 this was a colony of the Worcester institution 
and accepted only transfers, but for over twenty years it has 286 
HOUSE 
-No. 2400. 
[Mar, 
received new patients. The buildings for patients are scat- 
tered about the tract in four groups, three near enough to have 
a common heating plant. There is considerable liability to 
fire throughout the institution. Sprinkler systems have been 
installed at points of greatest danger, and other measures 
taken for protection against conflagration. Porches are in- 
frequent, and some of them have been glazed and closed in. 
The medical library has 500 volumes. 
Male students of nursing from one Boston institution come 
here for three months’ affiliation. There are no accommoda- 
tions for women affiliates. Medical college seniors and summer 
student internes get service here, and clinics are given to other 
students of nursing and certain theological students. 
A considerable number of tubs are available for the prolonged 
bath, and are used up to 10 o’clock at night. Physical edu- 
cation is little represented. 
All the cooks are women. There are five kitchens, sixteen 
dining rooms for patients, five for employees, and one for the 
staff. Many pantries are crudely equipped, and little atten- 
tion is paid to such niceties as warming plates. 
The tuberculosis service is disappointing, and the wards 
designated for these patients lack desirable equipment. The 
most active cases are not in the tuberculosis wards but in the 
infirmaries. 
There is one open building. Ground privileges are seldom 
given because two highways and a railroad intersect the tract. 
A large number of the patients in this institution were re- 
ceived by transfer and have no friends that can be found. 
Efforts to locate relatives or friends have been made over the 
radio as far west as Wisconsin. 
Medfield State Hospital. 
This is a country hospital standing on a hilltop well above 
the highway and at a distance from any village. The hospital 
owns 630 acres, rents 100 and cultivates 260. 
For eighteen years after its opening in 1896 patients were 
received here only by transfer. There are still in the hospital 
some 500 patients without known relatives. This situation 
decreases the number of visitors. 
The original buildings are cottages of the Queen Anne type, 
arranged in a large rectangle. The attractiveness of this ar- 
rangement was seriously damaged by placing other buildings 
inside the quadrangle. Later buildings are at a suitable dis- 1939.] 
HOUSE — No. 2400. 
287 
tance behind the original ones. Much reconstruction has been 
necessary to remove fire risks and otherwise bring the struc- 
tures up to present-day requirements. The more recent build- 
ings have more permanent elements. 
The autopsy rate here is about 50 per cent. The medical 
library is inferior, except for its pathological division. 
The school of nursing maintains a three-year course, for 
women only. 
The receiving buildings unfortunately accommodate also 
many ill and old people. Occupational therapy is available 
only on the women’s service, but the industrial department 
provides occupation for some of the men. Physical education 
is but little developed, being without leadership. The pa- 
tients’ library has over 1,000 books, all gifts. 
The service in the main dining room is satisfactory except 
that all dishes are cold. Insulated carts bring hot food to the 
point of service. As in many places, no water is served with 
the meal. Service to disturbed women is especially good. 
Three open buildings for each sex house over 400 patients, 
and 30 patients in other buildings have ground privileges. 
Metropolitan State Hospital. 
This is the newest institution in the State. It is located in 
the town of Waltham, the buildings standing mostly on rocky 
hillsides, and patches of cured peat land in the bottoms are 
saved for cultivation. Only 383 acres are owned. 
The metropolitan district includes three counties. This 
hospital has received patients from this district, but only 
through transfer from other institutions. The population is 
therefore almost entirely made up of patients with prolonged 
mental disorders, since recoverable cases among early admis- 
sions have already returned to their homes, and relatively 
few recoverable cases are admitted at present. 
A receiving building is to be added to the plant, and direct 
admissions will then be accepted. 
The patients’ buildings are in two groups. One is a series 
of three-story blocks connected by broad corridors that serve 
not only for passage but also as sitting-rooms. These corridors 
go around three sides of a quadrangle, and the dining room 
and some accompanying structures fill in the fourth side. 
The buildings are carefully designed in many regards, but it 
must be said that their appearance is not altogether cheerful. 
Certain supposed economies in construction have resulted 288 
HOUSE —No. 2400. 
[Mar. 
poorly, since storms drive through the brick. The buildings 
are entirely fire-resistant. Porches are a usual feature of the 
wards and are adequate in size. These blocks have but few 
single rooms. 
A large building consisting of center and several wings is 
called the medical building. This is constructed along different 
lines, with emphasis on facilities for the treatment of those 
with physical illnesses. In this building are eight dining rooms, 
whereas the continued treatment group sends all but one ward 
to the congregate cafeteria. 
The installations in this institution are generally excellent. 
The laboratory and morgue are in a separate building, where 
study and teaching can easily be carried on. Autopsies reach 
68 per cent of the deaths. The course given to assistant phy- 
sicians from all over the State during the last few years centers 
in this hospital. 
Five members of the medical staff have teaching appoint- 
ments in local medical schools. Research is under way. 
The attendants’ training course differs from many in that 
lectures and demonstrations run through the year. 
The hospital is well supplied with tubs arranged for the pro- 
longed bath, but with its present population these are seldom 
used. Physical education is carried on by one instructress. 
The patients’ library contains 5,000 books. 
Over 225 patients have ground privileges, and there are four 
open wards. 
Northampton State Hospital 
This institution stands at the top of a beautiful, gently 
sloping hill. The original building, in use since 1858, is a 
three-story and basement Kirkbride style of structure with a 
spacious entrance hall and impressive staircase. The farm 
buildings are at present too near the wards; but in architecture 
all these structures are attractive and were apparently made 
of the best materials of their day. Across a highway and near 
the edge of the hill is a group of recent structures consisting of 
four wings running back from a transverse front. These are 
good fire-resistant buildings, though not so pleasant as would 
be detached structures. 
The amusement hall is attractive but has been outgrown. 
Plumbing, even in reconstructed water sections, is not 
everywhere adequate. In one ward the ratio of toilet seats 
to patients is 1: 32. 1939.] 
HOUSE —No. 2400. 
289 
The medical library contains about 500 volumes. Though 
long the residence of Dr. Pliny Earle, this institution has no 
copies of the Journal of Psychiatry prior to three years ago; 
distressing destruction of the older magazines has occurred. 
A two-year school of nursing is maintained for students 
of both sexes. Training of attendants is not attempted. 
There is no separate reception service, and the new patient 
goes at once into an infirmary. Physiotherapy is not much 
developed. There is no gymnasium, but a recreational director 
is in charge of physical education on the lawn in suitable 
weather. The patients’ library contains 2,500 books. 
Certain exercise yards might be somewhat attractive, but 
too many patients are required to use them. The disturbed 
wards for women are very noisy because the ceilings have not 
been treated with sound-deadening material. Cases requiring 
major surgery are sent to a general hospital near by. 
There is a fine new kitchen building and four large new cafe- 
terias. 
Ground privileges are granted to 200 patients, and about 
120 have the privilege of going to town. 
Taunton State Hospital. 
This institution serves the southeastern section of the State, 
including Cape Cod. The land is slightly rolling, well wooded, 
and, when cultivated, is adequately fertile. Four hundred and 
sixty-seven acres are owned. There is an old plant, attractive 
in many ways but requiring reconstruction, and a quite new 
plant housing the physically sick and the new patients. There 
are also some service units rendered inadequate by increasing 
the size of the institution; for instance, the laundry and the 
dairy barn. 
The autopsy rate here is 41.6 per cent. The pathologist has 
charge of the medical library of 1,100 volumes, which includes 
the Army Library Index and the Index Medicus. 
Insulin therapy and prolonged narcosis are not under use. 
Metrazol therapy is carried actively. 
The school of nursing accepts girls only. It gives a three- 
year course, the second year being spent in a general hospital. 
Eighteen or twenty affiliate pupil nurses also are at all times 
under training here. 
The prolonged bath is used twenty-four hours a day for 
women and twenty hours for men. No seclusion is employed, 290 
HOUSE —No. 2400. 
[Mar. 
and the only type of restraint is an ordinary sheet with a 
clove hitch. The occupational therapy program includes 
classes in eight wards of each sex. Physical education is pro- 
vided for women only. The excellent patients’ library con- 
tains 7,000 volumes and has adequate annual replacements. 
The main dining room has cafeteria service. In this room 
every care is taken to see that patients have plenty of time to 
make their choice, and no less than three main dishes are 
offered. 
Two to three hundred patients have ground privileges. 
Westborough State Hospital. 
The original plant was built for a reform school and was 
converted to hospital use in 1884. It is pleasantly situated on 
sloping land near a lake. The old buildings are decidedly in- 
flammable. Later additions were of factory construction, and 
the colony houses are frame buildings, but the most recent 
structures are of steel and concrete. Various suitable measures 
have been taken for fire protection. 
Plumbing has been largely replaced; the poorest ratio of 
toilets to patients is 1:22. Electric refrigeration is used 
throughout the institution and storage of ice has been 
abandoned. 
Adequate examining rooms are available on the different 
services, but no physician has his office close to his patients. 
The medical library is not strong. 
The principal of the training school is officially responsible 
for all nursing, but gives by far the most of her time to the 
women’s service. The school of nursing maintains a three- 
year course. 
This hospital uses the prolonged bath by day and by night 
much more freely than do most institutions. There are four 
batteries of tubs, and a special point is made of assuring free- 
dom of movement in the bath. Physical education is undevel- 
oped. The patients’ library numbers 3,500 volumes. 
The patients’ cafeteria is a new structure. There are 15 
other dining rooms for patients in various parts of the grounds, 
and 5 for employees. Four hundred and thirty patients have 
ground privileges, and there are 7 open wards. 1939.] 
HOUSE — No. 2400. 
291 
Worcester State Hospital. 
' This institution has two divisions. The older is the smaller 
and is now called the Summer Street Branch. It is the original 
hospital of the State, opened in 1832. It now houses a few hun- 
dred patients of the continued treatment type. The main 
hospital is on the outskirts of the city; it is a building of modi- 
fied Kirkbride type with additions and extensions. There are 
several accessory buildings, detached from the main structure. 
The organization is very active. There are 16 medical con- 
sultants, a dentist, a physiologist and a physical educator. 
Besides the usual medical staff there is a research service whose 
director comes from Boston several times a week. Six other 
physicians and several other specialists make up the staff of 
the research service. There is a medical and surgical service 
whose residents are specially but not psychiatrically trained. 
The out-patient department carries an excellent child guidance 
clinic in the city. This hospital has for some time had both an 
assistant superintendent and a clinical director. It is a great 
training and teaching center. 
The ratio of physicians to patients, calculated exclusive 
of administrators and special research physicians, is 1: 181. 
Among all these physicians great variety of training is found, 
including much in neurology and some in psychoanalysis. 
The medical library contains some 2,700 books and 700 
bound volumes of periodicals. It is in charge of an erudite 
medical librarian. 
Training of undergraduate nurses is confined to affiliates 
from three schools, each of whom spends three months here. 
A postgraduate course also is given. The new attendant gets 
a course of 44 hours. The nursing service is united under the 
superintendent of nurses. 
A variety of treatments, chemical, hydriatic and psycho- 
logical, is always in progress. The therapies discussed else- 
where in this report are all actively employed except physical 
education, in which there is no instructor. Elaborate central 
bathing facilities have been developed, and most of the bathing 
in the separate wards has been abolished. The patients’ library 
is in charge of the medical librarian. It numbers over 2,400 
books and 50 current magazines. 
Not only are there four psychologists on the staff, but also 
two psychological internes and as many as four students. 292 
HOUSE —No. 2400. 
[Mar. 
Besides the general kitchen there are two diet kitchens. 
There is a large general dining room, attractive in style, and 
with an efficient cafeteria service. There is also a small cafe- 
teria for disturbed patients of each sex. 
Accommodations for tuberculosis cases are not entirely 
satisfactory. 
There are six open wards besides two colony buildings. 
X, Insane Criminals. 
The policy of the Commonwealth is to identify as soon as 
possible among its lawbreakers those whose mental state is 
disordered. The Briggs Law, so called, requires psychiatric 
examinations of prisoners who have committed graver offences, 
and of all prisoners whose records indicate an inclination to 
repeat their offences. Suitable arrangements have been made 
to bring these about. The state hospital staffs make many 
of the prescribed examinations. 
Offenders whose mental state is considered abnormal are 
not to be brought to trial till recovered. These and others 
who have been found while serving sentence to be mentally ill 
are placed under a special commitment as insane and turned 
over to the Department of Correction for treatment, in case 
the offender is of the male sex. Women of similar types are 
sent to one or another of the civil state hospitals. 
Permissive legislation has been passed to enable the De- 
partment of Mental Health to build for these patients and 
assume their care. 
Another special group are the feeble-minded offenders, or 
defective delinquents. They also are committed to the De- 
partment of Correction. At present their management is not 
an issue, since the Legislature is not proposing their transfer 
to the other department. 
Administratively this institution is a branch of the State 
Farm, where prisoners of ordinary intellectual standards and 
defective delinquents are under custody, as well as the men- 
tally ill. The institution dates from 1888. During the survey 
it housed 891 men; no women are treated here. 
Bridgewater State Hospital. 
A lay superintendent has charge of the whole group. The 
State Hospital itself has a medical superintendent and three 
assistants. These and similar details are presented in this 1939.] 
HOUSE —No. 2400. 
293 
section because this hospital is not in the Department of Men- 
tal Health, and therefore has not been discussed in previous 
chapters. The Department of Mental Health has only the 
responsibility of inspecting and making recommendations. 
This has been done, it is said, about once a year. 
On a slightly elevated plateau in eastern Massachusetts, 
five miles from the town of Bridgewater, this institution is 
located. The plant is on the whole unattractive. Some im- 
provement might be made by decoration in gayer colors, but 
the buildings for the most part have a somber appearance and 
the architects have apparently been more esthetically influenced 
by penitentiary standards than by hospital style. The build- 
ings are of two and three stories, with a large number of cells 
and considerable dormitory space. Sitting rooms, as a rule, 
are adequate, but where the more deteriorated patients exer- 
cise, still more space would be advantageous. 
Some of the buildings are now old. It is the practice to 
scrub all floors of the institution daily and to take other stren- 
uous measures to keep out vermin of every sort. Another 
reason for this vigorous treatment of floors is that little indoor 
work other than housekeeping is available for the patients. 
A 17-acre tract enclosed by a high wall is the truck garden 
for the institution. The farming is done by the mental patients. 
There are 123 attendants, making a ratio of attendants to 
patients of 1: 7.2. The institution employs no graduate nurse. 
Little restraint is used here, but seclusion is freely employed, 
especially at night. As usual in a population of this sort there 
are some desperate souls who might take advantage of any 
opportunity to injure a fellow patient or an employee. For 
the most part, the problems of care and treatment are not 
different from those found in the civil state hospital. There 
has long been criticism of the regime here. It does not appear 
to be unduly repressive, but the lack of planned activity for 
many of the patients is regrettable. 
A considerable number of admissions come from jails on a 
thirty-five day commitment for observation. This procedure 
works less well here than in the civil state hospitals. No his- 
tory may be available from the jail, and the mental capacity 
and responsibility of the patient may not be determinable 
within that time. 
The superintendent is strongly of the opinion that the 
Department of Mental Health should build for these patients. 
He is confident that the present practice of paying a larger 294 
HOUSE —No. 2400. 
[Mar. 
wage to ward employees here than in the civil institutions 
should be continued, and that it will not be difficult to make 
a case for it. 
Convulsive disorders, a large part of which are usually in- 
cluded under the term “epilepsy,” are prevalent in every 
community. No census of cases in this country has ever 
been taken. When war comes on and a draft is instituted, 
the number of citizens who report having such disorders is 
surprising to one who is unfamiliar with the subject. This 
indicates merely that in many cases the convulsions are few 
or occur at a time of day or night when they do not interfere 
with social and business activities. Hence, only a fraction of 
the known cases require hospital care. 
XI. Treatment of Convulsive Disorders. 
In 1898, after due preparation, Massachusetts opened a 
hospital for epileptics. Humanitarian and social principles 
determined the admission policy from the beginning. The 
first patients were transfers from the state hospitals. When 
patients were received direct from the community, preference 
was given to those who were the greatest burdens on their 
families or their municipalities. Accordingly, the patients 
received have very largely been the most thoroughly estab- 
lished cases. 
Under such circumstances special measures must be taken 
in order to get patients who have recently developed convul- 
sive disorders to come to the hospital for study. The well- 
to-do often send their members to private hospitals for this 
purpose. In Massachusetts the Monson State Hospital offers 
an arrangement by which the indigent epileptic may come into 
the hospital for two weeks to receive a careful examination and 
appropriate advice. This opportunity was taken advantage of 
in 78 cases during the last year, mostly from the western part 
of the State. Most early cases can be and are treated in an 
office or a clinic at home, but such a period of hospital study 
may be very important for them. 
The admission policy of the State is to accept for longer care 
those patients that present the greatest difficulties to their 
families and their neighborhoods. In general it may be said 
that there are three ways of entering the hospital: 
1. The patient may come of his own desire and enter as a voluntary 
admission. The unfortunate obiter dictum in a case of mental dis- 
order some years ago that has resulted in so much restriction of vol- 1939.] 
HOUSE — No. 2400. 
295 
untary admissions to the mental hospitals has not exercised the same 
devastating effect on admissions to the institution for epileptics. 
2. A patient may be received under a commitment for mental dis- 
ease. This makes simple the transfer of suitable patients from the 
other state hospitals. It also makes easy the admission of epileptics 
who in the course of their disorder have developed a definite mental 
illness in the community. 
3. There is a special law under which epileptics who should not be 
at large can be committed to the institution without any statement 
regarding their sanity. This wise provision takes care of those un- 
fortunates who are not reasonable enough to enter the hospital of 
their own volition. 
An institution for the care and treatment of epileptics has 
some points in common with the hospital for mental disorders. 
There must be provision at all times for a few patients who are 
so disturbed that they need special nursing and other special 
measures to prevent injury to themselves and others. There 
must also be a variety of occupations to prevent, as far as 
possible, the distressing deterioration of interest that char- 
acterizes so many of these cases. The institution also re- 
sembles the training school for defectives. Many epileptics 
are defective in intellect. Their schooling must be carried as 
far as possible, but they must be given, also, a special amount 
of training in types of work that are suited to their disorder 
and to their mental capacity, and that will assure them of 
hygienic life. These institutions accordingly have a school 
that carries patients through elementary work, and since some 
epileptics are as bright as children in the community, special 
provision is often made for this small group to carry them 
into the higher school grades. There is much vocational train- 
ing, especially outdoor employment. Some parts of the insti- 
tution will resemble an infirmary or a hospital for incurable 
diseases; for some epileptics are cripples and others deteriorate 
into a torpid state in which they must be cared for like young 
children. 
All this the Commonwealth has provided in the hospital at 
Monson. 
Monson State Hospital. 
Among some hills across a river from the town of Palmer 
is a tract of 661 acres supplemented by 15 acres that are rented. 
On slopes stand groups of buildings, conveniently separated 
by watercourses running down to the valley. One group of 
buildings is for children of both sexes; another, houses many 296 
HOUSE— No. 2400. 
[Mar. 
boys and men; the third, provides for all others. Near the 
center of the institution is the administration building and 
across the road is the reception building. The construction 
represents many periods. As might be expected, the oldest 
buildings are distinct fire risks, whereas the newest ones cause 
no concern on this score. A program fairly well agreed upon 
provides the necessary reconstruction to assure safety, the 
cost to be spread over several years. 
When visited in summer the institution had a census of 
1,506, but during the school year some 70 more patients come 
in for training. The school carries as many patients as pos- 
sible through the fifth grade. 
An active program of treatment and study has always been 
practiced here. Indeed, this hospital staff has supplied leader- 
ship in its field, and its published reports are accorded great 
respect. The neurological service, the pathological depart- 
ment and the school all receive due attention. Medical stu- 
dents come all the way from Boston for clinics. There are two 
internes on the staff continuously. Psychological service is 
supplied. The records contain much valuable material; as a 
rule, no summary is available for the reader, but the detailed 
findings can easily be located. Nursing personnel is approxi- 
mately 1 to each 6 patients. This reflects the very great 
needs of the helpless and crippled groups. There are positions 
for 27 graduate nurses. 
Problems of feeding have led to the recent building of a new 
kitchen with adjacent dining room. The service of food varies 
in accordance with the needs of the particular group of pa- 
tients, and those who can make use of it have quite as com- 
fortable a dining arrangement here as would be likely at home. 
Some buildings have poor dining rooms in basements. 
Discipline is in the hands of the physicians. Transfer, re- 
striction of privileges, and separation from other patients are 
the means ordinarily used. Restraint is used only in special 
conditions, such as manipulative vomiting, and not as a matter 
of discipline. It is also employed occasionally in epileptic 
furor. Seclusion is occasionally used. About 10 patients are 
locked in their rooms at night, apparently for good medical 
reasons. 
On a day when the population was 1,501, two thirds of the 
patients were idle, somewhat less than a third were inconti- 
nent, and one fifteenth were cared for in bed. This gives a 
hint of the problems of care for this type of patient. It also 1939.] 
HOUSE —No. 2400. 
297 
shows the need for constant study into every means available 
for stimulating the interest of the large deteriorated group. 
Occupational therapy here reaches, perhaps, 150 patients, or 
10 per cent. Hospital industries occupy 350. Sports receive 
some attention, but could be further developed. The patients’ 
library numbers 1,400 volumes and is well supported. 
The chief emphasis of the activities of the two social workers 
is on getting histories and assisting in an out-patient clinic. 
About 500 patients, or a third of the population, have ground 
privileges. There are usually 200 at home on visit. 
XII. The Training and Care of Mental Defectives. 
Massachusetts was the first State to undertake institutional 
management of the mental defective, and opened its school in 
1848. As time went on the demands of the community in- 
creased. The original school developed a colony at Templeton 
in the northern part of the State. Other schools were added 
at Wrentham and Belchertown. In structure and in organi- 
zation these show the continuity of planning and the inspira- 
tion of the great minds of Howe, Seguin, Fernald, Wallace 
and others. 
These schools were established primarily to serve as training 
and educational centers for younger defectives. It was hoped 
that children of pre-school age would go to the institution, be 
developed there, and return to society under supervision. At 
the same time the lower-grade children would receive special 
hospital care and habit-training where training was possible. 
The state policy with regard to mental defectives is challenged 
by the existence of a huge waiting list. Two thousand names 
are recorded at one school, 750 at another, 600 at the third. 
Selections are made from these lists whenever vacancies occur, 
but not by priority. The new admission must be chosen with 
a view to his fitting into the vacancy that has occurred. It is 
hard to see how public needs and demands can be satisfactorily 
met by this system; plainly, another institution will be 
required. 
Another development has interfered with the original plan. 
There is an increasing inclination in society to consider that 
wrongdoers should be treated more on the basis of their en- 
dowment than on the basis of their delinquency. More and 
more feeble-minded persons who have committed offences 
are sent to these schools for defectives. This forces the insti- 298 
HOUSE — No. 2400. 
[Mar. 
tution into a closer approximation to correctional institutions, 
where older incorrigibles are collected. Such a situation af- 
fects the amount of freedom that can be given to any of the 
patients; it affects the program, and it affects the atmosphere 
of the school. These difficulties have been, for the most part, 
satisfactorily met in the institutions. 
Sound construction has been the rule in these schools as in 
the mental hospitals. Efforts have been made to keep con- 
struction costs lower for able-bodied children than for the 
sick or crippled. This effort is commendable, but has some- 
times made elements easier to destroy and quicker to disinte- 
grate. 
Medical care in these institutions is excellent. The resident 
staff do most of what is necessary and consultants are on call. 
Each institution has a good hospital and some graduate nurses 
to look after the physically ill. The usual preventive inocu- 
lations are given. 
The incidence of tuberculosis appears to be low in these 
schools. 
Clinical records in these institutions are very illuminating 
in the types and quantity of material they carry. There is 
rarely on file a summary review of all the information obtained. 
Most of the housing in these schools is in cottages presided 
over by a matron. Sometimes a group of men are under the 
direction of a man. 
Food is simple, good and abundant. Good appetites are 
the rule, but cripples and children of low-grade intellect have 
to be fed; this work is done by employees and older patients. 
Every house has its dining room. 
Discipline is the responsibility of the ward physician. Dis- 
cipline involves (1) posting the name; (2) deprivation of 
privileges; (3) rest in bed; or (4) seclusion. 
The emphasis laid upon sense training for children of the 
lower class is very admirable. Many are able to go as far as 
fifth-grade work, and a few do even better in one or perhaps 
two subjects. Speech training is usually given as a concomitant 
of school work. Music is taught in several ways; considerable 
singing is done by groups and orchestras, and rhythmic bands 
are developed. 
Industrial training is given in such subjects as woodwork, 
weaving, bookbinding, domestic science and the like. A large 
number of boys and men are employed on the farms. 1939.] 
HOUSE — No. 2400. 
299 
Physical education is looked after satisfactorily. Perhaps 
in some of the schools it might be carried even further without 
profit. 
There is an excellent program of amusements. Religious 
services are held regularly. The libraries are appropriate. 
The Walter E. Fernald State School. 
In 1848 the first institution for mental defectives in this 
country was opened in South Boston. Later it was moved to 
Waverley; and it now bears the name of one of its great super- 
intendents. It is located in a pleasant, hilly district. Grading 
has been wisely done, so that the advantages of the hilltop 
are preserved for the most prominent buildings, and at the 
same time the beauty of the slopes and lowlands has not been 
destroyed. The institution comprises separate buildings of 
various styles designed to meet the needs of different groups. 
A relatively simple type of cottage is repeated several times to 
house the largest number; but those who are feeble and those 
who are very young have special accommodations. A good 
school building has been in use for some years, and there is 
a new assembly hall. 
At Templeton, about seventy miles from the parent school, 
there is a colony for 310 boys. The land is rough, and the 
patients live the life of the woodsman in simple buildings, 
considerably overcrowded, with plenty of work and an at- 
mosphere of accomplishment. It is stated that when one of 
these boys has occasion to return to the school because of 
misbehavior or illness, he is always very desirous of getting 
back to the colony. 
By arrangement with the Metropolitan State Hospital pa- 
tients in need of surgical treatment or of more than ordinary 
medical care are sent to that well-equipped hospital for the 
duration of their illness. Very few deaths occur at the school, 
only three in one year. More die at the Metropolitan State 
Hospital. This arrangement perhaps influences the organiza- 
tion of the school; there are but two graduate nurses here. 
The pathologist is clinical director. 
New patients are received in accordance with the type of 
vacancy existing in the school at the moment. There are 
some epileptics scattered through the institution, the institu- 
tion for epileptics not having adequate capacity to care for 
them. 300 
HOUSE — No. 2400. 
[Mar. 
Each cottage has its dining room. 
The cottages are mostly open, but when the children go out 
of doors they are supervised. Since a large number of girls 
have been sex delinquents in their communities, it is the policy 
of the school to give very close supervision to all their female 
patients. A few boys have ground privileges. 
Ever since its founding this school has been the fountain of 
advice to many Massachusetts families about the management 
of feeble-minded members in their homes. An afternoon is 
set aside every week for these consultations. All the medical 
staff participates at different times in this clinic, and psycholo- 
gists and social workers contribute their special knowledge. 
The Wrentham State School. 
This institution was planned on the basis of experience at 
Waverley, was erected according to plan, and, when expanded 
beyond the original plan, was not rendered inharmonious. 
The institution owns 625 acres of rolling land, mostly the 
sandy loam characteristic of eastern Massachusetts. The 
buildings are arranged about a large, level quadrangle. One 
notices no indication of confinement on the grounds, and the 
general impression is about the same as one would get in any 
children’s village that had been expanded to an unusual size. 
A standard type of cottage was worked out and repeated several 
times. On the first floor and in the basement are day rooms, 
and sleeping quarters are on the first and second floors. Some 
one-story buildings for children and cripples have been added. 
There are four farm cottages a half mile from the center. 
The medical staff includes an assistant superintendent, six 
assistants and a clinical director. One physician spends his 
time with the school clinic. 
The laboratory is engaged in research investigation. Fifty 
per cent of deaths come to autopsy. X-ray equipment is 
good. 
Belchertown State School 
This is the youngest of the three institutions for defectives, 
having begun operations in 1922. It receives patients who are 
two years old and over, from the western half of the State. 
During the survey it had a population of 1,311, including an 
overload of 5 per cent. It was originally planned to develop 
this school to a considerably larger size, and this scheme will 
probably be effected when the economic depression lifts. 1939.] 
HOUSE — No. 2400. 
301 
Construction is good. As an economy measure the roofs 
were laid on beams and are not fire-resistant. 
The provision made for these children may be described as 
adequate but economical. Beds in dormitories are rather 
close, and sitting rooms are a little too small, but a playroom 
in the basement of each cottage relieves the situation. Porches 
are small. 
Plumbing is thoroughly adequate, but two details of installa- 
tion are objectionable; shower heads have sometimes been 
placed over the middle of a toilet room, and there is no privacy 
in the toilets. 
The school has eleven teachers. The schoolrooms wrap 
around a well-appointed assembly hall. There is also a good 
industrial building with shops of different kinds. 
XIII. Discussion and Recommendations. 
Any criticism of a fine medical organization performing 
sympathetically and intelligently a vast service to its com- 
monwealth may seem superfluous. But this is not so. Massa- 
chusetts in most matters is not satisfied with the good, but 
only with the best. This has been the case with its organiza- 
tion for mental health activities, whose progress has been 
checked to a degree by the events of the last several years. 
It is believed that not only those whose daily work is with the 
mental patients, but also the body of intelligent public opinion, 
is in favor of every measure, great or small, that will put the 
Department in the forefront of such organizations anywhere 
in the world. 
Accordingly, the following remarks and recommendations 
are submitted to the Special Commission on Mental Diseases. 
Theirs is not the responsibility or power to have these measures 
made effective, but they can speak for the people of the State, 
and what they say will be sympathetically heard by the De- 
partment of Mental Health. 
If the State does not go forward it cannot maintain the 
standards already set up. The new Department can count on 
support if it goes ahead, but would fare ill if it should try to 
stand still. 
Organization of Department. 
Earnest discussion preceded the legislation of 1938 by which 
the present structure of the Department was set up. Perhaps 
no immediate change should be advocated, but a thorough 302 
HOUSE —No. 2400. 
[Mar. 
trial of this scheme should be had. The abolition of the asso- 
ciate commissionerships probably bore some relation to the 
fact that the old law placed on these men duties that they 
were not in a position to carry out, except in a routine and 
rather blind manner. There was, however, a virtue in the 
organization that should be imitated, but in better form and 
detail. 
1. Probably the most effective organization would be a council on 
mental health. The councillors should be persons expert in various 
fields related to the work of the Department. A sanitarian, an engi- 
neer, a social welfare worker, a business man of large interests, a 
psychiatrist outside of official circles, an internist could be of much 
service to the mentally ill of Massachusetts if they were called to- 
gether at stated intervals to discuss the problems of the institutions. 
Needless to say, they should not be burdened with any responsibility 
for signing pay rolls or contracts, or doing other routine matters 
about which they cannot possibly be informed. 
2. More vigorous inspection of institutions should be maintained 
by the Department. This will include interviews by the inspector 
with all new patients. It will also include a better inspection of plant 
than has sometimes been afforded. The unhappy conditions that 
have grown up through the years have in some plants been corrected. 
Inspection will supply reminders to those in control of finances about 
things that need to be changed. 
3. Official attention should be given to standards of treatment; 
for instance, in syphilis, tuberculosis and alcoholism there should be 
some unification of practice where the best methods are not now in 
use. 
4. Another division in the Commissioner’s office should correlate 
the institution clinics, the relations of the Department with the 
schools, and relations with adult education. The relation of the 
hospital clinics to elementary schools and high schools should be 
studied. Advising this division there should be a co-operative com- 
mittee of educators, personnel officers and welfare executives. With 
the continuous activity of this committee, the subjects just mentioned 
can be taken out of the realm of the spasmodic and into the realm 
of structure and principle. The committee would be interested in 
the relations of mental hygiene with industry also. 
5. In the organization of the Department there should be a divi- 
sion of research, co-ordinating the special studies made in all the 
institutions. This division should have an advisory body of men 
with interest in and knowledge of research, and to this body a report 
should be rendered every year on what is being studied and what 
has been learned. Research should be applied to all the activities of 
the hospitals. Not only should there be further study of physiological 
functions and chemical treatment, but a review of procedure, such 1939.] 
HOUSE — No. 2400. 
303 
as, for instance, to determine how much can be accomplished by the 
nurse, what the special therapist can do, how much attention from a 
physician is important in various groups of cases. 
6. The Department of Mental Health should be interested in the 
psychopathic departments of general hospitals, and should promote 
their establishment by local authorities in order that every resident 
of the State may have easy access to treatment for all stages and 
forms of mental illness. The influence of the Department, if exercised 
vigorously, could accomplish much in this direction. 
7. In spite of occasional advocacy of a sort of totalitarian arrange- 
ment by which local institutional boards would be abolished, this 
Commonwealth has kept them in existence, with somewhat decreased 
power, to be sure, but with very considerable influence. Their serv- 
ices to the community and through the community to the patients is 
very great. The Department should cultivate not only the good will 
of board members, but also their activity in behalf of the hospitals 
that they represent. 
8. It is believed that the fine traditions enjoyed by the Depart- 
ment for many years, in respect both to business and to professional 
activities, have suffered from the impact of political considerations. 
Speedy elimination of any selfish interests that remain will tend to 
restore public confidence in this important Department. 
Statutes Relating to Admission. 
The commitment law of Massachusetts is liberal, and, in 
the main useful, as it stands, but is susceptible to improve- 
ment so as to conform to the conditions and needs that are 
actually met in practice. 
9. The idea of “treatment'’ should replace that of “commitment,” 
which is an inheritance of the time when the insane were treated as 
disorderly characters and committed to jail. The term “insanity” 
should be replaced by “mental illness.” The wiser judgment and 
authority of medical officials should be relied upon as implicitly as 
those of judges. A large proportion of patients suffering from mental 
illness would accept hospital treatment without protest. “Commit- 
ment” is associated with and in some places is patterned after crimi- 
nal procedure. It is humiliating to patient and family, determines to 
a considerable extent the “stigma” attached to hospital treatment for 
mental illness, and is frequently resented more than hospital residence. 
The system occasions unnecessary expense, perpetuates an outworn 
and misleading conception of mental illness, and impedes the develop- 
ment of much-needed extension of facilities. In Massachusetts 
fears of “railroading” and malicious detention may be dismissed. 
Designing persons who wished to sequester any one improperly would 
never resort to one of the recognized mental hospitals, which are, as 304 
HOUSE— No. 2400. 
[Mar. 
a rule, freely accessible, and are inspected regularly by state medical 
officers.1 
Many years ago commitment was not required. In Maryland, 
Rhode Island and Delaware many patients are received in the mental 
hospital without recourse to the court. In New York certain types 
of cases may be admitted on the certificate of one physician. A court 
order is, indeed, necessary for the detention of some protesting pa- 
tients, and access to the courts by the patient or by some one in his 
behalf is a fundamental right that cannot be denied. No one is more 
concerned in obtaining the protection of court authority than those 
who find it necessary to bring an objecting and perhaps menacing 
patient under treatment, and the hospital physician whose profes- 
sional duty it is to protect the sick man and society and to furnish 
suitable treatment to an irrational person.1 
A chief justice of Massachusetts expounded this subject many 
years ago in the words: The right to restrain an insane person of 
his liberty is found in that great law of humanity which makes it 
necessary to confine those who, going at large, would be dangerous 
to themselves or others. . . . The question must, then, arise in each 
particular case . . . whether restraint is necessary for his restoration 
or will be conducive thereto. . . . The law relating to the mentally 
ill has been gradually amended in the direction of facilitating treat- 
ment. Its provisions, however, still contain too much that harks 
back to conceptions of “insanity,” “commitment,” “railroading,” and 
relies on legal formalities and technicalities too much to permit the 
freer development of the facilities and practices that will extend treat- 
ment and preventive measures to mental illness in all its stages and 
phases in the community, and that are required for a widespread 
mental hygiene program. 
10. The health officer should supplant the poor authorities as the 
one responsible for the mentally sick patient pending commitment. 
His request made on proper form should be sufficient basis for the 
reception of suitable cases and their detention in the hospital for 
twenty or thirty days. The question of suitability should be deter- 
mined by the superintendent. 
Specialization hy Hospitals. 
11. In a service so large as Massachusetts there is opportunity for 
specialization in various directions. It is, indeed, impossible for hos- 
pitals to expand exactly alike, since the interest and the spirit of two 
superintendents can seldom be identical. Specialization saves need 
of duplicating facilities for small groups needing the same treatment. 
12. In this connection it should be pointed out that the original 
character of the institution at Gardner should be preserved. Let it 
be agreed that it is better for patients and for their relatives that 
1 Dr. William L. Russell, Memorandum, 1938. 1939.] 
HOUSE —No. 2400. 
305 
each state hospital should be a receiving point. The district, how- 
ever, from which Gardner receives should be made small, and empha- 
sis should be laid, as in the early days of the institution, on the plac- 
ing of patients in small groups where they can be encouraged in useful 
activity. If necessary, transfers of the physically infirm should be 
made to other institutions in order that this one shall not have so 
large a number of them as to defeat its primary purpose. It should be 
provided with any necessary facilities for those who are disturbed; 
from the disturbed group will come a constant stream of patients into 
the cottages, there to be absorbed among the workers. 
13. There are many advantages in centralizing the treatment of 
tuberculosis. The unit at Foxborough might be expanded for this 
purpose, since the original plan of keeping the population of that 
institution at 1,000 has already been discarded. If some other 
point should be considered more desirable, the Foxborough pavilion 
should be converted to other uses. 
14. Some hospital might well specialize on the treatment of volun- 
tary patients. It would have a very happy effect on some groups in 
the community if it were known that even one hospital would welcome 
the applicant, provide suitable treatment without stigmatizing legal 
formalities, and thoroughly respect the patient’s judgment. Since 
no hospital is small enough for such procedure, every hospital should 
encourage admissions of voluntary patients, and have some section 
in which they can feel comfortable. 
15. Comment has been made on the difference in practice regard- 
ing nurse training. One hospital, for instance, has no accommoda- 
tions for women, but specializes on giving affiliate instruction to a group 
of male student nurses. Perhaps this is the institution in which there 
should be developed an excellent school for male nurses. The need 
of trained men has been presented in paragraph No, 5. 
16. Some institutions might well specialize in the care and treat- 
ment of elderly patients. To some extent this is done now at the State 
Infirmary, but without the same direction that would be given in an 
institution fully under the jurisdiction of the Department of Mental 
Health. 
17. Various types of special treatment could and should be de- 
veloped, and hospital administrators should be encouraged to develop 
and exploit any new and probably useful measures. This would in 
no way interfere with as high a standard of general care as is now 
maintained in any institution in the State. 
Treatment. 
18. The new patient should be received in a building so planned 
and furnished as to seem to him a homelike place. 
19. The program of treatment for disturbed patients should be 
reviewed and further steps taken to reduce the number of those who 
spend the night behind a locked door. [Mar. 
306 
HOUSE —No. 2400. 
20. Fundamental physiological activities should be insisted on. 
Patients should be gotten out of doors with much more regularity 
than now exists. Explanation of failure in this regard is sometimes 
based on alleged shortage of personnel; again, on conflict with the 
program of other activities; again, on lack of sufficient outer wraps or 
overshoes. Ventilation should have as much attention as proper 
bedding. The hair, the face and the feet should be given proper 
attention. 
21. A matter that requires review is the efficacy of plans for occu- 
pying patients with useful work. There seem to be differences in the 
results of the efforts put out. Occupational therapy and hospital 
industry — whatever division is made of these activities — should 
be penetrated by consistent and skillful effort to have every patient 
employed at something useful if it is at all possible to do so. Some 
attendants have a special power of leadership in this field. If, for 
financial or other reasons, such persons have not taken a course in 
occupational therapy, it should still be possible to detail them to this 
work. There should be constant study of the organization to see 
that, aside from the trained therapist, other persons are so assigned 
— nurses or attendants — whose native capacity can be developed 
within the hospital. Such detailing of nursing personnel should not 
be at the expense of the regular nursing activities. Administrative 
ingenuity can certainly master this detail. 
22. Physical education should be much expanded in the hospitals 
and perhaps to some extent in the schools. Its benefits to the physique 
and to the morale are about equal. Some institutions have asked 
for several years for the appointment of a director of physical edu- 
cation— without success. Such provision should promptly be made. 
23. The very fine work that has been done by a few hospitals in 
maintaining a system of family care in the face of inadequate ap- 
propriations should be taken up with more vigor by other institutions. 
24. The inebriate presents a social problem in every State in the 
country. Massachusetts in a previous period organized special 
measures for the alleviation of the situation created by the large 
number of persons in the community whose use of alcoholic beverages 
not only damages their own usefulness and acceptability but also 
creates perils for others. Perhaps the old measures would not meet 
the present situation and should not be revived. Certainly the best 
thought of the day should be applied to this matter, here as elsewhere. 
A start may be made by giving out-patient treatment to such persons 
in the clinics. 
Personnel. 
25. The training of personnel is fundamentally important. At 
several points in this report, mention has been made of the training 
of physicians and of nurses. Other groups of personnel also need 
training. There should be an annual review to see what has been 
accomplished in this field. 1939.] 
HOUSE — No. 2400. 
307 
26. Schools of nursing should be strengthened. Most of these 
hospitals should continue to give full training for registration, with 
the assistance of a general hospital affiliation. These hospitals also 
should provide affiliations for a large number of general hospital 
training schools. The ordinary nurse on registry refuses to take 
mental cases, and it is the responsibility of psychiatric organizations 
to fill this need in the community. Added to this is the well-known 
fact that it is always difficult and usually impossible to get enough 
graduates of general hospital schools to fill even the posts for physical 
nursing in the mental hospitals. A nurse supervisor on the staff of 
the central office of the Department might do much to establish a 
uniform, effective system of training in the different hospitals, and 
take a hand in shaping nursing legislation and governmental adminis- 
tration of nursing education and practice. 
27. Students of many disciplines should be encouraged to do part 
of their undergraduate work in the state hospitals. The experience 
of a few of these institutions shows that faculties welcome such an 
opportunity for field work. One may mention students of theology, 
students of medical technology, students of psychology, student li- 
brarians. Students of social work should do at least part of their 
field work in a mental hospital. The graduates of other schools of 
social service that do not follow this plan receive too little psychiatric 
teaching, and have been found unsympathetic to the needs of the 
state hospitals. A field thus far very little cultivated lies in the law 
schools. Those who are going to make the laws and perhaps ad- 
minister the law should learn during their student days more about 
the human being, so that laws may be reasonable. 
28. Commutation of subsistence and quarters should be provided 
liberally for married employees and employees of long service, rather 
than to require them to live in. 
29. It is not proposed that all salaries and wages be increased, but 
it is desirable that at an early time the wages of nurses and attend- 
ants shall be added to. Whatever increases the respect in which 
these positions are held reduces wasteful overturn of personnel and 
makes for better care of the patients. 
Community Activities. 
An ideal set for the institutions of Massachusetts some 
years ago was that each should be the center of all mental 
hygiene activities in its district. Much has been done to 
make this plan a reality. It should always be held in mind. 
30. The work of the clinics should be reviewed. Perhaps there 
has been somewhat less advance in their functioning than would be 
the case if they were not so much better than one finds in many other 
parts of the country. This is the penalty often paid by a progressive 
organization that institutes something new. The situation should 308 
HOUSE — No. 2400. 
[Mar. 
be reviewed with a view to determining whether clinic physicians are 
given the best type of training before undertaking their work; whether 
they are given the most helpful supervision during the period of their 
clinic service; whether they all are expected to operate in the same 
way in spite of the fact that rural and urban activities must actually 
be different. It seems very probable that a clinic will not do good 
work if a social worker is available only a half day a week. This and 
other matters require thought and study. Perhaps the decisions of 
school clinics are under the law too automatic, so that both parents 
and educators at times dislike to send their children to the clinic. 
On the other hand, there is a widespread demand from social agencies 
and individuals for broader service from clinics. It is probable that 
some clinics should carry education and research much farther than 
others. Training of clinic physicians at the Boston Psychopathic 
Hospital should be considered. 
31. Social service should be strengthened. Perhaps some of the 
more active hospitals should even reach the ratio obtained in a Michi- 
gan institution, wrhere there is a social worker to every 200 of the 
resident population. No excessive case load is an economy. 
Institutions. 
32. No further increases in size above about 1,500 beds should be 
made except in so far as some particular function requires a special 
structure. 
33. A review of the building program should be held, with a view 
to determining if more one-story structures cannot be erected with 
reasonable economy, especially to provide for the aged and feeble. 
34. A hospital of 1,500 beds, designed to give the most suitable care 
and treatment to the insane criminals now in Bridgewater, should be 
erected, and not in the neighborhood of a prison. Additional patients 
whose trend of activity entitles them to the same close oversight may 
be sent there from other hospitals. 
35. To the Boston Psychopathic Hospital a wing should be added 
with the following facilities: At least two units for adults containing 
15 to 20 beds, and at least one unit for children; pathological labora- 
tories of ample size; a record room; special interviewing and con- 
ference rooms; additional quarters for personnel; rooms for physicians. 
36. A bridge or tunnel is needed between the different groups of 
buildings at the Boston State Hospital that will relieve the present 
peril in crossing the highway. Such treatment of the grounds should 
be sought as will save the patients from the present unsatisfactory 
observation by neighbors on all sides. 
37. Several more hospitals should have a well-planned reception 
service. These should not be so large that they cannot be homelike. 
Danvers, Northampton and Worcester are cases in point. These 
institutions have a considerable admission rate and should be able to 
receive their new patients in a building separate from the rest of the 1939.] 
HOUSE — No. 2400. 
309 
hospital. Many patients should be kept under intensive treatment 
up to two or even three years. 
38. Mentally sick children appear now and then in homes and 
institutions for children and create much greater difficulties than their 
number would indicate. A unit for such children should be developed 
at one of the hospitals. 
39. The great waiting list of mental defectives should not be per- 
mitted to stand. The Commonwealth should either reject an appli- 
cant or make provision for him. Another institution should be planned. 
40. Arrangements should be made to relieve the state hospitals of 
defectives without psychosis. 
41. When a new institution for defectives is developed, it might do 
well to specialize on those patients whose inclination or training has 
been anti-social. Since such persons are found in all the training 
schools, there would certainly be some in the new one, and if a larger 
number of them were provided for it would enable the older institu- 
tions to transfer such cases and to resume the freer atmosphere that 
originally existed. Certainly some of the present structures in which 
such youth are housed are not convenient for their care, and cause 
an unnecessary measure of concern to those responsible for the pa- 
tients. 
42. The service of food should be reviewed. In cafeterias service 
should be revised if meals are not served hot, if water as well as other 
fluids is not easily available, if there is no choice of main dish, if fluids 
are slopped over the counter and the trays, if more than four min- 
utes are used to pass from the door of the dining room past the counters 
and to one’s seat. In other dining rooms the best standards should 
be sought. 
43. Antiquated equipment should be replaced. Any activity that 
is worth carrying on in a hospital is deserving of equipment and sup- 
plies that will make it function well. 
44. Fire hazards still exist. They should be surveyed and speedily 
eliminated. 
Medical Staffs. 
45. The opportunity of competition for promotion on the part of 
physicians in the same grade in all the institutions, rather than con- 
fining promotion in each hospital to its own staff, will combat the tend- 
ency of a large service to discourage some of the keener minds and 
lead them to seek opportunities outside the hospitals. Non-competi- 
tive examinations should be instituted for promotions from the lower 
to higher grades in the state service. Competitive examinations 
should be required of candidates for first assistant superintendent, 
clinical director and superintendent. 
46. Since many physicians take up hospital psychiatry as a career, 
the Department should make it possible for such men to have experi- 
ence on the staffs of three types of institutions: hospitals for mental 
disorders, hospitals for epileptics, and schools for mental defectives. 310 
HOUSE — No. 2400. 
[Mar. 
47. Every hospital organization should be a teaching body. New 
physicians come to the institution with little knowledge of psychiatry, 
and the privilege of training these physicians in their work and in 
assuring their knowledge of this branch of medicine should be a seri- 
ous concern of the older members of the staff. Similarly, the training 
of every employee of the institution to base all his activities on what 
will be in the long run most helpful to the patients is one of the most 
important responsibilities of the medical staff. 
48. Courses should be arranged by which physicians in the state 
service keep fresh the knowledge they already have, and learn the 
newer methods and practices. 
49. The practice of receiving affiliate internes from general hos- 
pitals should be much extended. The state service has a great deal 
to offer these young physicians if its facilities are properly organized 
for this purpose. The experience of two of the medical schools in 
Boston of sending their undergraduates to the hospitals has laid the 
groundwork for this greater service, which, indeed, will reach many 
young physicians from medical schools outside of Massachusetts 
who have had no opportunity to learn psychiatry at the bedside during 
their undergraduate course, but have come to Massachusetts for 
their interneships. 
50. Clinical records should be still further improved in clarity and 
conciseness. 
51. The system of frequent recommitment of the new patient 
creates an unprogressive atmosphere in the medical staff conference. 
Its time should be devoted to clinical issues, the nature of the mental 
disorder, and the treatment to be attempted. 
53. The offices of physicians should be near the patients. The 
present concentration of medical desks in several of the institutions 
should be broken up and more separate offices provided. 
52. The weaker medical libraries should be steadily enlarged. 
The surveyors tender their grateful appreciation to officers 
and employees in the Department and in the many institu- 
tions for their unfailing courtesy and patience in giving the 
information that was asked in connection with this study. 1939.] 
HOUSE — No. 2400. 
311 
Appendix 12. 
PROBLEM OF PERSONNEL. 
The thirteen hospitals and three schools within the Depart- 
ment of Mental Health had quota positions for employees as 
of December 1, 1938, totaling 6,9764 To this should be added 
207 non-quota workers, consisting chiefly of students attached 
for training purposes. 
Prior to the passage of the so-called Forty-eight Hour Law,2 
each institution had attempted to house its entire personnel 
with the exception of a relatively small maintenance group 
consisting of engineers, carpenters, painters, etc. (non-mainte- 
nance quota1)- This policy resulted in a considerable capital 
investment by the Commonwealth in buildings devoted solely 
or partly to employee quarters. 
At the present time employees are quartered in nurses homes 
providing large numbers of single or double rooms, in cottages, 
in remodeled buildings, in portions of buildings devoted to 
administration, in some instances in ward buildings and base- 
ment sections, etc. Furthermore, there has developed in the 
course of time some crowding of employees, due, at least in 
part, to the fact that additions of positions to pay rolls could 
not immediately be matched by the addition of a like number 
of adequate quarters, and in part to the addition of students 
from schools affiliated for teaching purposes. The exact pic- 
ture of such crowding and of rooms not entirely adequate or 
satisfactory cannot be expressed in figures available at present. 
It is recommended that the Department of Mental Health 
conduct a careful survey of the employee housing situation in 
each of the institutions under its jurisdiction, and, acting upon 
information so obtained, take steps to eliminate undesirable 
quarters (such as basement or ward rooms) and undue 
crowding. 
1 See Table 1, “Institution Personnel.” 
1 Acts of 1935, chapter 444, approved July 25, 1935 312 
HOUSE —No. 2400. 
[Mar. 
This thought naturally leads to a consideration of outside 
maintenance policies for employees. The 1935 act, previously 
referred to, brought into the service of the hospitals and schools 
within a few weeks’ time over 1,000 individuals. Local facilities 
being inadequate to house the greater number of them, a re- 
stricted number were allowed to reside off the grounds and 
receive money in lieu of maintenance at the institution. This 
number allowed to reside outside was conditioned, in each 
instance, by the institution’s ability to provide quarters. 
Table 1. — Institution Personneld 
Institution. 
Quota 
Positions. 
Non-Quota 
Employees 
Furnished 
Main- 
tenance. 
Quota 
Employees 
Furnished 
Main- 
tenance. 
Quota 
Employees 
Furnished 
no Main- 
tenance. 
Quota 
Employees, 
Money in 
Lieu of 
Part Main- 
tenance. 
Hospitals. 
Psychopathic . 
156 
24 
102 
16 
38 
Boston State . 
738 
19 
598 
35 
105 
Danvers . 
550 
20 
344 
35 
171 
Foxborough 
332 
3 
206 
22 
104 
Gardner . 
334 
- 
268 
19 
47 
Grafton . 
415 
• 2 
287 
35 
93 
Medfield . 
477 
- 
343 
42 
92 
Metropolitan . 
415 
6 
232 
26 
157 
Northampton . 
474 
- 
373 
32 
19 
Taunton . 
442 
51 
382 
31 
29 
Westborough . 
424 
- 
373 
32 
19 
Worcester 
632 
82 
445 
39 
148 
Monson . 
419 
- 
300 
33 
86 
Schools. 
Belchertown . 
298 
- 
220 
24 
54 
W. E. Fernald 
465 
- 
413 
27 
25 
Wrentham 
405 
- 
299 
22 
84 
Totals 
6,976 
207 
5,172 
468 
1,336 
1 Data derived from Department of Mental Health records. 
Compensation in lieu of maintenance was computed at the 
following yearly rates: in lieu of room, $120; in lieu of one 
meal, $80; in lieu of two meals, $160. 
The state hospital system has had experience with this out- 
side residence of a small proportion of employees for over 1939.] 
HOUSE — No. 2400. 
313 
three years. In the main, it has been satisfactory to all con- 
cerned. Certainly most of the fears at the outset have not 
been realized. 
The future of the outside maintenance policy would seem 
to be quite clearly indicated. It allows the individual a more 
normal mode of life, which is particularly important to those 
who are married and have families. It tends to assist in the 
abolition of the pre-existing isolation of the hospital from the 
community, and it can with careful expansion in the future 
decrease expenditure for construction. Likewise by this same 
method it seems likely that present unsuitable quarters and 
crowding may be eliminated. However, it must be clearly 
recognized that a certain per cent of employees should prob- 
ably reside on the institution grounds in order that sufficient 
personnel may be available for emergencies such as fire. Like- 
wise, the extension of an outside residence policy for employees 
will probably not be so applicable to hospitals in rural sections 
where commutation facilities are limited as it will be to hospi- 
tals adjacent to large centers of population. 
The Commission is of the opinion that a careful study of all 
phases of employee maintenance should be made by the De- 
partment of Mental Health in collaboration with the superin- 
tendents, giving full consideration to the conditions peculiar 
to each institution. Such a survey would seem properly to be 
the function of the present committee of superintendents on 
personnel and labor relations. Some standardization should 
probably be established regarding selected ranks and classes 
of employees whose residence on the grounds of the institutions 
seem desirable. Restrictions of this nature should be made 
along broad, general lines and should not be so rigidly drawn 
that further extension of outside maintenance policies could 
not be allowed where local conditions made this advisable. 
There appears common agreement to the thought that married 
employees in subordinate rank should be given preference for 
residence in the community. 
Study of the suggestions that some employees’ quarters may 
be converted to patients’ use should be a part of this survey. 
Considerable argument for and against this proposal has been 
heard, and it is referred to more fully elsewhere in this report. 
Since this matter is, for the present, purely in the nature of an 
experiment, it is recommended that the plan should first be 
tried in only one or two instances where conditions are satis- 
factory and the administrators of the institution are favorably 314 
HOUSE —No. 2400. 
[Mar. 
inclined to the proposal. Probably the only class of patients 
who could safely be accommodated in this manner would be 
so-called “parole patients,” those who have been granted privi- 
leges of the grounds and whose return to community life is 
anticipated. 
Some thought has been given the wage-scale of employees. 
The opinion has been expressed that certain subordinate posi- 
tions are underpaid. Superintendents state that it is their 
experience that in times of economic depression satisfactory 
personnel have readily been obtained, but during periods of 
general economic prosperity relatively large numbers of em- 
ployees have left the service and it has been extremely difficult 
to replace them with individuals of the proper type. However, 
since this problem is interdepartmental, definite specific recom- 
mendations cannot be made. A salary schedule for the insti- 
tutional service in the Department is presented for considera- 
tion: 
Salary Schedule — Institutional Service. 
Title. 
Salary Range 
per Annum. 
Assistant baker 
1720- $900 > 
Assistant cook ............ 
540- 7201 
Assistant dietitian ........... 
840- 1,080' 
Assistant herdsman 
720- 900 > 
Assistant meatcutter .......... 
540- 7201 
Assistant pharmacist .......... 
840- 1,140' 
Assistant physician 
1,800- 2,400 > 
Assistant principal of school of nursing 
1,440- 1,800 > 
Assistant psychiatric social worker 
1,020- 1,3201 
Assistant state hospital steward ........ 
1,440- 1,800' 
Assistant superintendent of State Hospital 
3,300- 4,020 * 
Attendant nurse 
540- 840 > 
Baker 
1,140- 1,320' 
Barber 
660- 900' 
Blacksmith 
1,440- 1,7402 
Carpenter 
1,440- 1,7402 
Carpenter foreman (working foreman) 
1,740- 2,0402 
Charge attendant nurse 
840- 1,080' 
Chauffeur . . . 
960- 1,200' 
Chef 
1,320- 1,560' 
Chief executive officer of Boston Psychopathic Hospital 
3,600- 4,320' 
1 With maintenance. 2 Without maintenance. 1939.] 
HOUSE —No. 2400. 
315 
Salary Schedule — Institutional Service — Continued. 
Title. 
Salary Range 
per Annum. 
Chief hospital supervisor, attendant 
$1,440- $1,800' 
Chief hospital supervisor, graduate nurse 
1,620- 1,9801 
Chief medical officer of Boston Psychopathic Hospital 
3,420- 4.1401 
Chief power plant engineer, Grade A . • 
2,280- 2,6401 
Chief power plant engineer. Grade B 
2,040- 2,4001 
Chief power plant engineer, Grade C 
2,040- 2,400 ' 
Chief power plant engineer, Grade D 
1,800- 2,160' 
Clinical assistant 
540- 600' 
Clothing caretaker 
780- 960‘ 
Construction handyman 
1,320- 1,5602 
Cook 
720- 9001 
Dairyman 
720- 9001 
Dental assistant 
780- 1,080‘ 
Dentist 
1,680- 2,160' 
Dietitian 
1,320- 1,560' 
Dining room attendant 
480- 660' 
Director of clinical psychiatry 
3,300- 4,020 > 
Dormitory matron for the feeble-minded ...... 
840- 1,080' 
Electrician 
1,440- 1,7402 
Electrician’s helper 
1,260- 1,5002 
Farmer 
1,020- 1,200' 
Farm Colony supervisor 
1,320- 1,560' 
Farmhand 
660- 840‘ 
First-class power plant engineer ........ 
2,040- 2,2802 
Florist 
900- 1,140' 
Garage foreman (working foreman) ....... 
1,380- 1,620‘ 
Groundskeeper 
900- 1,140‘ 
Head cook 
1,020- 1,200‘ 
Head dining room attendant 
720- 900' 
Head farmer 
1,440- 1,800 > 
Head housekeeper 
1,080- 1,320' 
Head industrial therapist 
1,200- 1,560' 
Head laundryman 
1,140- 1,320' 
Head nurse 
1,080- 1,200' 
Head occupational therapist 
1,200- 1,560' 
Head psychiatric nurse ...-••••• 
960- 1,140> 
Head psychologist 
2,280- 2,640' 
Head seamstress • 
720- 900' 
1 With maintenance. 2 Without maintenance. 316 
HOUSE —No. 2400. 
[Mar 
Salany Schedule — Institutional Service — Continued. 
Title. 
Salary Range 
per Annum. 
Head social worker . . . . . . . . . . 
$1,800- $2,160' 
Head teacher of institution school 
1,440- 1,800' 
Head waiter ............ 
720- 900' 
Herdsman ............. 
1,020- 1,200' 
Hospital recreation room caretaker ....... 
840- 1,080 ■ 
Hospital supervisor, attendant 
1,200- 1,380' 
Hospital supervisor, graduate nurse 
1,320- 1,560' 
Hospital usher ........... 
660- 900' 
Housekeeper ............ 
540- 7801 
Housemaid 
480- 660 ■ 
Hydrotherapist . 
1,080- 1,320' 
Industrial therapist .......... 
OO 
4^ 
O 
1 
4^ 
O 
Institution porter ........... 
540- 720' 
Institution school teacher 
900- 1,320' 
Institution stableman 
840- 1,020' 
Institution teamster .......... 
660- 900' 
Institution treasurer . . . . . . . . 
1,560- 1,920 *• 
Interne 
300' 
Interne, Boston Psychopathic Hospital 
900' 
Junior boys’ industrial instructor . . 
780- 1,080' 
Junior chemist ........... 
1,320- 1,800 " 
Junior clerk (includes junior clerk and typist) 
540- 900 * 
Junior clerk and stenographer ........ 
540- 900' 
Kitchen helper ......... 
480- 660 ■ 
Laboratory assistant 
780- 1,080 
Laboratory technician 
840- 1,140' 
Launderer ........ 
720- 900■ 
Laundry worker ........ 
480- 660' 
Library reference assistant 
1,560- 1,920 ‘ 
Machinist ...... 
Cn 
1 
O 
Maintenance foreman of State Hospital 
2,160- 2,5202 
Mason 
1,440- 1,7402 
Meat cutter ........ 
900- 1,140' 
Mechanical handyman ........ 
1,320- 1,5602 
Medical director, Boston Psychopathic Hospital (part time) 
3,0002 
Motor equipment repairman i 
1,020- 1,320" 
Motor truck driver ........ 
960- 1,200' 
Occupational therapist 
780- 1,080' 
1 With maintenance. 2 Without maintenance. 1939. 
HOUSE —No. 2400. 
317 
Salary Schedule — Institutional Service — Concluded. 
Title. 
Salary Range 
per Annum. 
Painter 
$1,320- $1,5602 
Painter foreman (working foreman) ....... 
4^ 
4- 
0 
1 
4*. 
O 
Pharmacist 
1,200- 1,440“ 
Physiotherapist ........... 
1,080- 1,320“ 
Plumber and steamfitter ...... 
1,440- 1,740 * 
Poultryman ............ 
CO 
Q 
O' 
1 
4- 
O 
Power plant helper ........... 
1,260- 1,440 * 
Principal clerk ........... 
1,440- 1,8001 
Principal of school of nursing ........ 
2,040- 2,400“ 
Psychiatric graduate nurse 
780- 900 “ 
Psychiatric social worker 
1,320- 1,8001 
Psychologist 
1,320- 1,800“ 
Psychometrist 
780- 1,080“ 
Seamstress 
540- 720> 
Second-class power plant engineer 
1,920- 2.1602 
Senior boys’ industrial instructor 
1,080- 1,440“ 
Senior clerk ............ 
960- 1,320 > 
Senior clerk and typist 
960- 1,320“ 
Senior clerk and stenographer ........ 
960- 1,320“ 
Senior library assistant .......... 
1,140- 1,500“ 
Senior physician 
2,520- 3,060“ 
Special attendant, State Hospital 
840- 1,0801 
State hospital steward .......... 
2,280- 2,640“ 
Steam fireman ........... 
1,440- 1,800^ 
Storekeeper 
1,080- 1,440“ 
Storeroom helper 
780- 1,080“ 
Student nurse ............ 
540- 780 “ 
Superintendent of State Hospital 
4,500- 5,700“ 
Supervising institution housekeeper 
840- 1,0201 
Swineherd 
900- 1,140“ 
Third-class power plant engineer 
1,680- 1,9202 
Tinsmith ............. 
1,380- 1,6802: 
Tractor driver ............ 
960- 1,200“ 
Vegetable gardener 
900- 1,140“ 
Waiter ............. 
480- 6601 
Watchman 
660- 1,020“ 
Working foreman ............ 
1,7402 
X-ray technician 
840- 1,140“ 
1 With maintenance. 2 Without maintenance. 318 
HOUSE —No. 2400. 
[Mar. 
One phase of this question of remuneration concerns money 
allowed in lieu of maintenance. Practically all subordinate 
positions are salaried with the understanding that the institu- 
tion shall provide maintenance. Maintenance for such posi- 
tions consists of one room, meals and laundry. The maximum 
extra compensation allowed for those who have been placed 
outside has been $280 per year ($120 in lieu of room; $160 in 
lieu of two meals). In other words, under such circumstances 
the employee is allowed $5.36 per week with which to provide 
lodging and two meals a day, the third meal being received at 
the Hospital. 
The relationship of physician and ward personnel quotas to 
patient population has been reviewed. The following table 
presents the actual quotas allotted each institution as of 
December 1, 1938: 
Institution. 
Medical.2 
Ward Service. 3 
Male. 
Female. 
Total. 
Hospitals. 
Psychopathic .... 
21 
28 
27 
55 
Boston State .... 
18 
204 
260 
464 
Danvers ..... 
15 
160 
184 
344 
Foxborough .... 
11 
85 
100 
185 
Gardner ..... 
10 
107 
78 
185 
Grafton 
10 
106 
106 
212 
Medfield 
11 
115 
163 
278 
Metropolitan .... 
10 
131 
127 
258 
Northampton .... 
12 
127 
163 
290 
Taunton 
13 
126 
136 
262 
Westborough .... 
12 
107 
120 
227 
Worcester 
17 
177 
203 
380 
Monson ..... 
9 
129 
126 
255 
Schools. 
Belchertown .... 
7 
71 
95 
166 
W. E. Fernald .... 
11 
170 
123 
293 
Wrentham 
11 
125 
135 
260 
1 Data obtained from Department of Mental Health records. 
2 Includes one dentist at each institution. 
Composed of those having direct supervision of patients: attendants, supervisors 
nurses of all grades, hydrotherapists, etc. 
Table 2.—Personnel Quotas.1 1939.] 
HOUSE — No. 2400. 
319 
The ratios of these quotas to the expected patient population 
in the institutions are shown in the following table: 
Table 3. — Ratios, Personnel per 100 Patients, 1939. 
Institution. 
Medical. 
Ward Service. 1 
Patient 
Quota 
X 100.2 
Male. 
Female. 
Total. 
Hospitals. 
Psychopathic 
23.3 
31.1 
30.0 
61.1 
.90 
Boston State 
.7 
8.3 
10.6 
19.0 
24.40 
Danvers .... 
.6 
6.8 
7.8 
14.7 
23.40 
Foxborough .... 
.7 
6.0 
7.1 
13.2 
14.00 
Gardner .... 
.6 
7.3 
5.3 
12.6 
14.60 
Grafton .... 
.6 
6.7 
6.7 
13.5 
15.70 
Medfield .... 
.5 
6.1 
8.7 
14.9 
18.65 
Metropolitan 
.5 
6.7 
6.5 
13.2 
19.50 
Northampton 
.5 
6.2 
8.0 
14,2 
20.30 
Taunton .... 
.7 
7.3 
7.8 
15.1 
17.25 
Westborough 
.7 
6.7 
7.6 
14.4 
15.75 
Worcester .... 
.6 
7.2 
8.2 
15.5 
24.50 
Average, 11 hospitals . 
.6 
6.8 
7,7 
14.6 
- 
Monson .... 
.5 
8.4 
8.2 
16.6 
15.35 
Schools. 
Belchertown 
.5 
5.2 
7.0 
12.2 
13.50 
W. E. Fernald . . . 
.5 
8 9 
6,4 
15.4 
19.00 
Wrentham .... 
.5 
6.4 
6.9 
13,4 
19.40 
Average, three schools 
.5 
6.8 
6.7 
13.7 
- 
1 Based on 1938’s quota positions. 
2 Based on 1939’s patient quotas, i.e., estimated patient population. 
In studying medical personnel ratios, one notes .6 per 100 
patients as an average for 11 state hospitals. Expressed in 
other terms, this represents approximately 1 medical officer per 
166 patients, a very favorable proportion. In evaluating these 
figures, however, it must be realized that not all of the medical 
officers of a given hospital spend the major part of their time 
dealing with patients in the practice of psychiatry. Included 
in each hospital’s medical quota is the dentist and the superin- 
tendent. In most instances it also includes a school clinic 320 
HOUSE — No. 2400. 
[Mar. 
physician, whose time on the wards is minimal. In some insti- 
tutions there is a pathologist who likewise is not available for 
regular ward duty. Each of these is contributing his part to 
the patients’ welfare by very necessary and worth-while duties, 
but no one of them is regularly available for the day by day 
practice of psychiatry with the individual patient. The inclu- 
sion of these positions in quotas from which ratios are derived 
is perhaps proper but should be understood. When adjust- 
ment is made for such positions, the ratios are more real and 
less favorable. In any determination of medical quota it must 
be remembered that the foundation of psychiatric success, as 
in any branch of medicine, is the careful clinical study of the 
individual patient by the physician. 
The ward personnel ratios in the main show fair standardiza- 
tion of employee allotments to the institutions. It is not ob- 
vious why one hospital should require 19.0 employees on ward 
service per 100 patients and another require only 12.6 em- 
ployees. The Department is understood to have prepared 
similar comparative tables for all classifications of its employees. 
Such tables will serve as basic guides in adjusting employee 
quotas in the interest of efficiency, economy and proper utili- 
zation of salary funds. It is expected that such basic data will 
be supplemented by detailed information made available by 
the newly created Division of State Hospital Inspection. 
The utilization of such a scheme of control demands not 
only a careful study of individual hospital conditions, but also 
requires rather strict adherence to classification and duty 
assignments of employees. The superintendent should review 
his institution’s pay roll to ascertain that each employee is 
actually performing duties within his classification. Where 
this is not the case, steps should be taken to reassign the posi- 
tion in proper classification. Only when classification is ad- 
hered to will ratios present a true picture for each hospital. 
In connection with this we wish to make reference to our 
belief (see page 204, Appendix 9, “Problem of Maintenance”) 
that transfers from the personal services item should be few 
and far between, and only when completely justified. It has 
come to our attention that there have been vacancies in vari- 
ous classifications for, in some cases, considerable periods of 
time. We believe that a superintendent or board of trustees 
should have a reasonable period in which to select staff and 
employee personnel, but we feel that this period should be 1939.] 
HOUSE —No. 2400. 
321 
limited to a month. Usually when a medical man is about to 
leave he gives the hospital authorities advance notice, and, with 
the additional 30 days, it seems to us that a properly qualified 
successor could be chosen. 
If the money alloted for personal services is used up by keep- 
ing of quotas filled, in conformity with the desire of the Legis- 
lature that patients in the mental institutions be given proper 
care, there will be no incentive for transferring to other less 
important items. 322 
HOUSE —No. 2400. 
[Mar. 
Appendix 13. 
PROBLEM OF THE EPILEPSIES. 
The care, treatment and study of epilepsy within the Massa- 
chusetts state hospital system is provided chiefly at the Mon- 
son State Hospital, whose patient population is restricted to 
those suffering from convulsive disorders. The following table 
indicates the distribution of epileptics in the state hospitals 
and schools. A study of this table shows that 75.3 per cent of 
epileptics in institutions whose figures were available are cared 
for at Monson State Hospital. It is also evident that the 
patient population of Monson consists roughly of one third 
psychotic (insane) patients and two thirds non-psychotic 
(sane) individuals. Elsewhere in the state hospitals there is 
no significant number of epileptics in any single institution, 
except at Grafton. The epileptic population there in residence 
has accumulated chiefly by transfer of psychotic patients from 
Monson to relieve crowding in the latter institution. 
The foregoing statements make it clear that the practice to 
date has been to allocate epileptics chiefly to one hospital, 
allowing a relatively small overflow to collect in a second insti- 
tution. While there may be some doubt regarding the neces- 
sity of segregation of insane adult epileptics from other types 
of insane patients, there is no question of the desirability of 
such practice for the sane and childhood groups. In the case 
of these adults, their handling within a large psychotic group 
presents a considerable administrative problem. The deterio- 
rated, physically incapacitated, demand a large amount of 
infirmary-type care. Epileptic children should be segregated 
because of the psychic trauma to the non-convulsive of similar 
age. Likewise, school and recreational facilities must be fur- 
nished, intermingling with adult patients discouraged, and 
appropriate housing must be provided with adequate nursing 
service for infants and the ill or incapacitated. 1939.] 
HOUSE — No. 2400. 
323 
The problem of epileptic segregation necessitates a scrutiny 
of the present housing situation. The average number under 
care at Monson during 1938 was 1,481 patients.1 On many 
occasions the population was of course in excess of this figure.2 
The rated capacity of the hospital was 1,177 patients;1 
1938’s average census was, therefore, 304 in excess of this 
figure, or 25.8 per cent. 
Admission and discharge rates show the expected slow ac- 
cumulation in resident population. 
Table 1. — Known Epileptics in Residence in Institutions, 
September 30, 1937.3 
Institution. 
With Psychosis, 
Without Psychosis. 
Hospitals. 
Psychopathic 
1 
- 
Boston State 
42 
- 
Danvers 
35 
- 
Foxborough 
22 
- 
Gardner 
5 
- 
Grafton 
144 
- 
Medfield 
33 
- 
Metropolitan ...... 
3 
- 
Monson 
558 
957 
Northampton . . . . 
18 
- 
Taunton 
25 
- 
West borough 
28 
- 
Worcester 
16 
- 
Schools. 
Belchertown 
- 
33 
W. E. Fernald 
- 
55 
Wrentham 
- 
35 
Other institutions ..... 
49 
3 
Totals 
979 
1,083 
1 For fiscal year ending November 30, 1938. From Department of Mental Health monthly 
census and capacity tables. 
2 For instance, as of November 1, 1938, there were 1,564 patients actually in residence. 
5 Data derived from the annual reports of the institutions and from the annual report of 
the Commissioner. 324 
HOUSE — No. 2400. 
[Mar. 
Table 2. — Admissions and Discharges, Monson State Hospital, 
1933-37, inclusive.1 
For the Year ending 
November 30 — 
Total 
Admissions. 
Discharges, 
Exclusive of 
Transfers. 
Resident 
Population, 
Increase. 
1933 
224 
191 
33 
1934 
202 
197 
5 
1935 
226 
179 
47 
1936 
190 
164 
26 
1937 
198 
161 
37 
Totals ...... 
1,040 
892 
148 
Even in spite of this admission rate, the hospital has a wait- 
ing list of 1792 desiring care and treatment. Furthermore, 
there is a relatively small but constant influx of epileptics into 
the unrestricted state hospitals each year. 
To meet this situation, the logical step appears to be addi- 
tional construction at the Monson State Hospital. There has 
been recommended to the Commission by the superintendent 
in a letter of February 25, 1938, the broad outline for the build- 
ing up of this hospital to approximately 2,000 patients. In 
essence this plan suggests; 
1. Buildings on male side of hospital: 
(o) A male infirmary for 160 patients. 
(b) A ward building to accommodate 160 patients. 
(c) A building for deteriorated boys requiring special care — 
100 patients. 
2. Buildings on female side of hospital: 
(a) Ward building for 160 patients. 
(b) A building for deteriorated girls requiring special care — 
100 patients. 
(c) A building to house 100 children under six years of age, 
divided equally between boys and girls. 
Such a program would, of course, necessitate some additions 
to the services of supply throughout the hospital and possibly 
additional quarters for personnel. 
Any proposal to continue the relative concentration of epi- 
leptics at Monson has a direct bearing upon research. The 
1 Data taken from The Annual Report of the Commissioner of Mental Diseases ’ ’ for the 
respective years. 
As of January 1, 1939. Personal communication from superintendent of Monson State 
Hospital. 1939.] 
HOUSE —No. 2400. 
325 
whole problem of the epilepsies is far from solution, despite 
discovery of new methods of study during recent years. Out- 
standing research contributions have been forthcoming from 
Monson over the past thirty years, and research remains a 
vital interest. The hospital has at present co-operative con- 
tacts with outstanding Boston neurologists for investigative 
programs. These and other contacts should be fostered and 
extended in such a center of epileptic population. 
Any attempt to study the whole problem of the epilepsies 
soon reveals that available data are incomplete. The figures 
grouped in Table 1 for “Other institutions” do not include 
many of the private institutions and schools. There are no 
accurate statistics available regarding non-institutionalized 
cases. Thought should be given to a central registry for epi- 
leptics such as exists for mental defectives at the present time. 326 
HOUSE —No. 2400. 
[Mar. 
Appendix 14. 
PROBLEM OF PSYCHOTIC ADULTS. 
Overcrowding. 
In the State of Massachusetts approximately 75 per cent of 
the insane are cared for in public hospitals. The statutes 
provide for the care and supervision of these people through 
the Department of Mental Health. There are thirteen insti- 
tutions solely for the care of this group in the State of Massa- 
chusetts. Many years ago, when the State took over this 
responsibility, institutions were built to adequately care for 
the insane as the laws prohibited their detention in jails and 
almshouses. In that period they were known as asylums and 
gave largely custodial care. 
Today, however, the function of these institutions is vastly 
different, and they are in fact modern hospitals for the mentally 
ill. This change has been brought about by the tremendous 
research of the last quarter century in the problem of in- 
sanity, stressing largely the nature and treatment of these 
conditions. Formerly there was a definite stigma attached 
on'being an inmate of an asylum, but, due to an enlightened 
public and a better understanding by the medical profession 
of mental illness, this has decreased to a great extent. 
Hospital care is now recognized as being absolutely essen- 
tial in the treatment of these conditions, and therefore the 
population of the hospital has had a steady increase for a num- 
ber of years. 
Additions to these institutions in the form of new buildings 
in some instances, and remodeling in others, have not pro- 
vided sufficient space to give adequate care to all desiring 
treatment. There exists, therefore, today an overcrowding in 
our institutions amounting to approximately 18 per cent. 
To give an example of the steady increase in the population 
of the state hospitals, reference is made to Table 1. which 
shows the increase in number from 1904 to 1937; also the 
annual increase for each year. It is to be noted that there is 
approximately an average increase of 416 patients yearly, 
which affords an index of the number of extra beds to be pro- 
vided for annually. 1939.] 
HOUSE — No. 2400. 
327 
Table 1. — Increase in Population in State Hospitals, 1904-37. 
Year. 
State Hospitai.s. 
Number. 
Annual 
Increase. 
Rate per 
100,000. 
1904 
9,666 
897 
319.0 
1905 
10,071 
405 
326.4 
1906 
10,237 
166 
325.8 
1907 
10,602 
365 
331.5 
1908 
11,460 
858 
352.2 
1909 
11,994 
534 
362.3 
1910 
12,562 
568 
373.2 
1911 
12,972 
410 
379.9 
1912 
13,481 
509 
389.2 
1913 
13,862 
381 
394.7 
1914 
14,202 
340 
398.9 
1915 
14,657 
455 
406.1 
1916 
15,054 
397 
411.5 
1917 
15,434 
380 
416.4 
1918 
15,476 
42 
412.1 
1919 
15,409 
-67 
405.1 
1920 
15,686 
277 
407.2 
1921 
16,428 
742 
422,1 
1922 
16,810 
382 
427.5 
1923 
17,051 
241 
429.3 
1924 
17,515 
464 
436.6 
1925 
17,990 
475 
444.1 
1926 
18,149 
159 
443.7 
1927 
18,597 
448 
450.2 
1928 
18,997 
400 
455.6 
1929 
19,391 
394 
460.6 
1930 
19,848 
457 
467.1 
1931 
20,446 
598 
476.7 
1932 
20,856 
410 
481.8 
1933 
21,218 
362 
485.7 
1934 
21,579 
361 
489.5 
1935 
22,033 
454 
506.3 
1936 
22,576 
543 
516.4 
1937 
22,915 
339 
521.8 
Average (34 years) 
- 
416 
- 328 
HOUSE —No. 2400. 
[Mar. 
It is needless to say that overcrowding tends to irritation, 
accidents and attempts at violence which can be prevented 
by sufficient space. 
To further show the tendency of overcrowding, Tables 2 
and 3 give a comparison of a ten-year interval of 1928 and 1938. 
Table 2. — Capacity and Overcrowding of Mental Hospitals, Decem- 
ber 1, 1938, 
Institution. 
Capacity. 
Patients in 
Institution. 
Overcrowding. 
Number. 
Per Cent. 
Psychopathic .... 
109 
71 
381 
34.861 
Boston State .... 
2,116 
2,360 
244 
11.53 
Danvers 
1,861 
2,325 
464 
24.93 
Foxborough .... 
1,134 
1,430 
296 
26.10 
Gardner 
1,186 
1,430 
244 
20.57 
Grafton ..... 
1,258 
1,543 
285 
22.66 
Medfield ..... 
1,553 
1,824 
271 
17.45 
Metropolitan .... 
1,589 
1,875 
286 
17.99 
Monson 
1,177 
1,545 
368 
31.27 
Northampton .... 
1,729 
2,037 
308 
17.81 
Taunton 
1,285 
1,699 
414 
32.22 
Westborough .... 
1,334 
1,611 
277 
20.76 
Worcester 
2,385 
2,346 
391 
1.641 
Total 
18,716 
22,096 
3,380 
18.06 
1 Number under working capacity, no overcrowding. 1939.] 
HOUSE — No. 2400. 
329 
Table 3. — Capacity and Overcrowding of Mental Hospitals, October 
1, 1928. 
Institution. 
Capacity. 
Patients in 
Institution. 
Overcrowding. 
Number. 
Per Cent. 
Psychopathic .... 
126 
86 
40 ‘ 
31.74* 
Boston State .... 
1,897 
2,266 
369 
19.45 
Danvers ..... 
1,684 
1,925 
241 
14 31 
Foxborough .... 
905 
957 
52 
5.74 
Gardner . 
. 
1,032 
1,097 
65 
6.29 
Grafton 
1,152 
1,555 
403 
34.98 
Medfield 
1,544 
1,790 
246 
15.92 
Monson ..... 
967 
1,214 
247 
25.54 
Northampton .... 
1,565 
1,304 
261* 
31.74 * 
Taunton . • . 
1,204 
1,463 
259 
21.51 
Westborough .... 
1,221 
1,390 
169 
13.84 
Worcester 
2,152 
2,222 
70 
2.91 
Total 
17,030 
18,997 
1,967 
11.55 
1 Number under working capacity, no overcrowding. 
These tables give the capacity, number of patients in the 
institution and per cent of overcrowding by hospitals. It is 
interesting to note that in 1928 overcrowding of 11.55 per 
cent existed in the twelve institutions. In spite of the addition 
of a new hospital (Metropolitan State Hospital, 1930) of 1,589 
beds, the overcrowding has increased to 18.06 per cent in 1938. 
It is evident, therefore, that the State must provide additional 
facilities for proper care. This should include both ward and 
service buildings. 
Types of Mental Illness. 
Of all the mental diseases, dementia prsecox heads the list 
in frequency in our state institutions. For many years every 
effort has been made to learn the nature and treatment of 
this condition but without much success. Only recently a treat- 
ment known as shock therapy by medicine (insulin or metra- 
zol) has given any encouragement in this respect. 
In Table 4 it is to be noted that of the 13,524 patients who 
were in residence for the first time, 48.5 per cent are suffering 330 
HOUSE 
No. 2400. 
[Mar. 
from dementia praecox; of the 9,512 who have had more than 
one admission to a hospital, 56.3 per cent were dementia 
praecox. From the above one can see that this disease con- 
stitutes more than 50 per cent of the resident population of the 
hospitals. 
Table 4, — Percentage of Mental Disorders in Residence, September 
30, 1937. 
First Admissions. 
Readmissions. 
Mental Disorders. 
M. 
F. 
T. 
Per 
Cent. 
M. 
F. 
T. 
Per 
Cent. 
With syphilitic meningo-en- 
402 
118 
520 
3.8 
155 
46 
201 
2.1 
cephalitis. 
With other forms of syphilis 
61 
25 
86 
.6 
23 
8 
31 
.3 
With epidemic encephalitis 
30 
20 
50 
4 
32 
13 
45 
.5 
With other infectious diseases . 
6 
7 
13 
.1 
- 
2 
2 
.02 
Alcoholic psychoses 
746 
122 
868 
6.4 
384 
76 
460 
4.8 
Due to drugs, etc. 
7 
6 
13 
.1 
5 
3 
8 
.1 
Traumatic psychoses 
38 
8 
46 
.3 
25 
2 
27 
.3 
With cerebral arteriosclerosis 
532 
524 
1,056 
7.7 
96 
114 
210 
2.2 
With other disturbances of cir- 
11 
13 
24 
.2 
4 
4 
8 
.1 
culation. 
With convulsive disorders (epi- 
264 
293 
557 
4.1 
230 
192 
422 
4.4 
lepsy). 
Senile psychoses 
182 
352 
534 
3.9 
30 
48 
78 
.8 
Involutional psychoses 
120 
270 
390 
2.9 
46 
119 
165 
1.7 
Due to other metabolic diseases, 
33 
46 
79 
6 
6 
16 
22 
.2 
etc. 
Due to new growth 
I 
1 
2 
.01 
2 
2 
4 
.04 
With organic changes of nervous 
91 
56 
147 
1.1 
44 
26 
70 
.7 
system. 
Psychoneuroses .... 
43 
59 
102 
.7 
39 
42 
81 
.8 
Manic-depressive psychoses 
315 
567 
882 
6.5 
417 
680 
1,097 
11.5 
Dementia pnecox 
3,231 
3,385 
6,616 
48.5 
2,684 
2,695 
5,379 
56.3 
Paranoia and paranoid condi- 
142 
281 
423 
3,1 
74 
161 
235 
2.5 
With psychopathic personality . 
51 
47 
98 
.7 
60 
57 
117 
1.2 
With mental deficiency 
535 
473 
1,008 
7.4 
405 
436 
841 
8.8 
Undiagnosed psychoses 
6 
4 
10 
.1 
7 
2 
9 
.1 
Without psychoses 
66 
29 
95 
.7 
29 
19 
48 
.5 
Primary behavior disorders 
4 
2 
6 
.04 
3 
- 
3 
.03 
Total with mental disorder . 
6,847 
6,677 
13,524 
99.3 
4,768 
4,744 
9,512 
99.5 
Total without mental dis- 
order. 
70 
31 
101 
.7 
32 
19 
51 
,5 
Grand total .... 
6,917 
6,708 
13,625 
100.0 
4,800 
4,763 
9,563 
100.0 1939.] 
HOUSE —No. 2400. 
331 
The manic-depressive psychosis is characterized by a high 
readmission rate. The more rapid relapses occur the longer 
the tendency is for the period of hospitalization to become. 
Other types of illnesses which show rather high incidence 
in the first and readmissions in the resident population are the 
psychoses with mental deficiency. 
Table 5. — First Admission by Mental Disorders during 1937, 
Mental Disorders. 
Number. 
Per Cent. 
With syphilitic meningoencephalitis .... 
167 
3.4 
With other forms of syphilis 
19 
.4 
With epidemic encephalitis 
7 
.1 
With other infectious diseases 
23 
.5 
Alcoholic psychoses 
453 
9.1 
Due to drugs, etc 
32 
.6 
Traumatic psychoses 
24 
.5 
With cerebral arteriosclerosis 
853 
17.1 
With other disturbances of circulation .... 
56 
1.1 
With convulsive disorders (epilepsy) 
96 
1.9 
Senile psychoses 
302 
6.1 
Involutional psychoses 
146 
2.9 
Due to other metabolic diseases, etc. .... 
72 
1.4 
Due to new growth ........ 
10 
.2 
With organic changes of nervous system .... 
85 
1.7 
Psychoneuroses ......... 
266 
5.3 
Manic-depressive psychoses ...... 
471 
9.4 
Dementia prtecox 
746 
15.0 
Paranoia and paranoid conditions 
107 
2.1 
With psychopathic personality 
58 
1.2 
With mental deficiency 
103 
2.1 
Undiagnosed psychoses 
94 
1.9 
Without psychoses , 
643 
12.9 
Primary behavior disorders ...... 
152 
3.0 
Total with mental disorder 
4,190 
84.1 
Total without mental disorder 
795 
15.9 
Grand total 
4,985 
100,0 332 
HOUSE —No. 2400. 
[Mar. 
Table 6. — First Admission by Mental Illness during 1928. 
Psychoses. 
Male. 
Female. 
Total, 
Per Cent. 
Traumatic 
13 
2 
15 
.4 
Senile 
126 
191 
317 
10.0 
Cerebral arteriosclerosis 
236 
160 
396 
12.7 
General paralysis . . 
168 
44 
202 
6.5 
Cerebral syphilis 
15 
7 
22 
.7 
Huntington’s chorea ...... 
1 
3 
4 
.1 
With brain tumor 
2 
2 
4 
.1 
With other brain or nervous diseases 
37 
26 
63 
2.0 
Alcoholic 
179 
32 
211 
6.7 
Due to drugs and other exogenous toxins 
6 
2 
8 
.2 
With pellagra 
- 
2 
2 
.6 
With other somatic diseases .... 
34 
67 
101 
3.2 
Manic-depressive ...... 
141 
246 
387 
12.4 
Involution melancholia ..... 
22 
61 
83 
2.6 
Dementia prsecox 
332 
295 
627 
20.1 
Paranoia or paranoid conditions 
38 
39 
77 
2.4 
Epileptic psychoses 
32 
26 
58 
2,8 
Psychoneuroses and neuroses .... 
15 
18 
33 
1.0 
With psychopathic personality .... 
12 
12 
24 
.7 
With mental deficiency 
44 
39 
83 
2.6 
Undiagnosed psychoses ..... 
161 
157 
318 
10.1 
Without psychoses 
39 
41 
80 
2.5 
Total ........ 
1,643 
1,472 
3,115 
100.0 
Table 5 shows the number and percentage of first admis- 
sions by illness during the year 1937 and has no relation to 
the resident population. 
The Commission wishes to call attention to one particular 
group of mental disorders that has increased materially during 
the last ten years. 
In comparing Tables 5 and 6 it will be noted that a group 
known as psychosis with cerebral arteriosclerosis has increased 
from 12.7 per cent in 1928 to 17.1 per cent in 1937. This rise 
no doubt should effect the nature of a building program to 
be instituted, as it is particularly significant that an increased 
number of persons of the old-age group are being admitted 
to our hospitals, and these cases require a different classifica- 
tion and should be confined in either an infirmary or hospital 1939.] 
HOUSE — No. 2400. 
333 
unit. The institutions at the present time do not have suffi- 
cient facilities for the proper care of this increasing group. 
What can be done to help relieve some of the overcrowding? 
Boarding-out Patients. 
By boarding out, or family care, is meant the placing of 
patients who no longer require full, daily hospital supervision 
in selected families in the community, in order that they may 
benefit by the environment of family life rather than remain 
in an institutional atmosphere. This plan has been in vogue 
in Belgium and Scotland for many years, where it is used 
extensively. Some 3,000 patients are in family care in Belgium. 
In 1885 the State Board of Charities established by legis- 
lation the boarding out of patients in private families. Until 
1915 they remained under the supervision of this Department, 
when the control was transferred to the individual state 
hospitals. 
The home in which the patient is placed becomes an in- 
tegral part of the hospital. The patients are visited by a 
physician and social workers at stated intervals to determine 
the effect of such care on the patient, and also to look into 
his physical and mental needs at the time. If the patient fails 
to adjust in his new environment he is returned to the hospital 
and his place is taken by another suitable patient. The homes 
are carefully selected and inspected to determine the fitness 
of the family to take boarding-out patients. There results 
thereby a very close co-operation between the home and the 
hospital. 
Certain questions may well be asked: Would the patients 
be exploited and overworked, would they receive proper food, 
and are they well cared for? 
These questions are perfectly natural. However, those 
who have had experience tell us that more often the reason 
given by the family for desiring boarding-out patients is the 
presence of unused rooms in the home. Careful selection of 
the home and family is of first importance, and the best results 
are obtained by careful and repeated supervision by the hos- 
pital after the patient is placed. 
Table 7 gives the number of patients placed in family care 
since 1904, and it is estimated that between 450 to 500 pa- 
tients will have been placed by 1940, HOUSE —No. 2400. 
[Mar. 
Table 7. — Patients in Family Care from Institutions and Under the 
Department of All State Hospitals, September 30,1904-38. 
Year. 
Family Care, 
Grand Total. 
From 
Institutions. 
Under the 
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 
11 
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 
64 
258 
322 
64 
258 
322 
- 
- 
- 1939.] 
HOUSE — No. 2400. 
335 
Family care affords an opportunity for the patient to do 
things that he likes, to enjoy the outdoors and the sharing of 
home life. It is natural to expect that the individual would 
be happier in home surroundings rather than confined with 
large numbers in a hospital. Furthermore, economically it 
represents a distinct saving to the Commonwealth. The aver- 
age cost per week for each patient in family care amounts to 
approximately $7. This includes board, $4.50, as stipulated 
by statute (section 16, chapter 123 of the General Laws), 
clothing, and medical supervision furnished in most cases 
by the hospital. In the hospital the same care would cost 
$8.25. Thus there is a saving of about $36,000 per year for 
every 100 patients boarded out. To this must be added the 
saving on the capital investment of $200,000 that would be 
necessary to provide accommodations for the same number 
if they were to remain in a hospital. If the boarding-out pro- 
gram of 450 to 500 patients by 1940 is realized as planned by 
the Department of Mental Health, a saving of 
$2,000,000 on capital investment will be made. 
The Commission therefore recommends that — 
1. The boarding-out program be increased as much as 
possible. 
2. In view of economic conditions the weekly rate paid for 
board be raised from S4.50, but shall not exceed S6 per week. 
Legislation to this end is contained in Appendix 10. 
Old-Age Assistance. 
Another method of reducing the cost and also the number of 
patients in the hospitals is through the use of the Old Age 
Assistance Act, for those who are eligible. 
The economic condition of the relatives of some of the 
patients is frequently such that they cannot take on the extra 
burden of supporting another individual without added finan- 
cial help, yet there are a number of patients who are well 
enough to be tried out on visit if they could avail themselves 
of this aid. At the present time a patient must be completely 
discharged before old-age assistance will be granted. If pro- 
vision were made whereby the patient on visit could receive 
aid, a greater number, no doubt, would leave the hospital at 
an earlier date. HOUSE — No. 2400. 
[Mar. 
336 
Centralization of Special Cases — Tubercular and 
Maternity. 
Tubercular Cases. 
It is well known that tuberculosis frequently is a complica- 
tion of dementia prsecox. This is largely due to the sedentary 
habits of these cases, their unwillingness to co-operate in 
their care, and refusal to indulge in proper voluntary exercise. 
In an apparently healthy person tuberculosis often develops 
insidiously. The annual physical examinations at the hospital 
frequently bring out symptoms of this disease, and further 
diagnostic tests are made to confirm the findings. New ad- 
missions who are tubercular also add to the list. 
The facilities for caring for tubercular cases in this State 
are inadequate. Only a few hospitals have separate buildings 
of fireproof construction for this group, the remainder having 
either frame-shell type of pavilion which is now outmoded, 
or separate wards of small capacity. These wards are not 
equipped to care for the disturbed tubercular patient who 
must remain on the regular disturbed ward in a room, thereby 
being a potential menace to the other patients in this ward. 
In October, 1937, there were 589 known tubercular cases in 
residence in the hospitals. 
Centralization of these cases in buildings or groups of build- 
ings of sufficient size and located at certain of the institutions 
so as to serve all parts of the State is recommended as a means 
of solving this problem. There should be at least four units, 
located in the western, central, northeastern and southeastern 
portions of the State. 
Maternity Cases. 
Although the incidence of mental illness developing in ma- 
ternity cases is not excessive, sufficient numbers are admitted 
yearly to give consideration to this problem. Aside from the 
Worcester State Hospital, where there is a small unit exclu- 
sive for maternity cases and a nursery, adequate facilities 
are not at hand for proper prenatal to after-delivery care in 
our hospitals. At least two such units should be maintained 
totally apart from the others, to which maternity cases may 
be admitted or transferred from other hospitals. These units 
should be located to serve the state hospital from a geographic 
point of view. 1939.] 
HOUSE —No. 2400. 
337 
The Commission recommends — 
1. For tubercular patients, that four units of sufficient size 
be established and so located in certain of the institutions as 
to serve all sections of the State. 
2. For maternity cases, that one additional maternity unit 
be established to afford proper maternity care for the eastern 
portion of the State. 
Building Program. 
General Consideration. 
Many of the hospitals of the State constructed years ago 
were of stone or brick exteriors and wood interiors. In some 
instances frame buildings were built in a cottage-type plan of 
hospital. This is particularly true of some of the buildings at 
the Grafton State Hospital. This type of construction is not 
fireproof and also is expensive to remodel and maintain. Fur- 
thermore, utilization of all the space is frequently impossible 
in order to properly classify patients to their best advantage. 
As before mentioned, there is an increase in the number of pa- 
tients of advanced years in residence, and with the present 
economic uncertainty this type of patient will probably con- 
tinue to show an increase. These cases require infirmary and 
frequently medical and surgical care. Adequate facilities for 
this type of treatment are not available in many of the hospi- 
tals, which leads to overcrowding of this group. 
In order that newly admitted patients entering the hospital 
for the first time receive every advantage, separate units or 
acute receiving buildings should be maintained. Frequently 
many of these cases recover in a few months and require no 
further hospitalization. It is not good treatment to have these 
cases mixed with those of the continued treatment type, where 
less active therapy is required. 
In accordance with modern medical trends our hospitals 
should afford every advantage to the physically ill patient. 
To do this, adequate hospital units should be maintained in 
order to give proper surgical and medical attention to these 
conditions. All of the hospitals have infirmary wards where 
this type of work is now being done, and frequently under 
much handicap. Few of the hospitals have proper isolation 
facilities for infectious cases, so that when they do occur, in 
order to prevent contagion, entire wards must be vacated. 338 
HOUSE —No. 2400. 
[Mar 
The ideal size of an institution that can be operated effi- 
ciently is thought to be 2,000 beds. Referring to Table 8, 
under date of December 1, 1938, excluding the Boston Psycho- 
pathic Hospital, which has but 109 beds, 12 hospitals give care 
to 22,025 patients (column 6). Yet only two of the hospitals 
have a working capacity of over 2,000 (column 3). The others 
range from 1,134 to 1,861. In the last column it is to be noted 
that four of the hospitals have to date an average number 
under care of over 2,000 patients, and the other eight hospitals 
vary from 1,376 to 1,861, respectively. 
Size of Hospital. 
Table 8. — Working Capacity and Patients Actually in Residence, 
December 1, 1938, 
Institutions. 
Working 
Capacity. 
In Institution 
Exclusive op 
Patients Boarded 
in Families. 
Average 
Number 
under 
Care to 
Date. 
M. 
F. 
T. 
M. 
F. 
T. 
1 
2 
3 
4 
5 
6 
7 
Psychopathic 
60 
49 
109 
38 
33 
71 
74 
Boston State 
1,004 
1,112 
2,116 
1,029 
1,331 
2,360 
2,411 
Danvers ... 
870 
991 
1,881 
1,082 
1,243 
2,325 
2,339 
Foxborough .... 
543 
591 
1,134 
663 
767 
1,430 
1,376 
Gardner .... 
712 
474 
1,186 
831 
599 
1,430 
1,531 
Grafton .... 
646 
612 
1,258 
777 
765 
1,543 
1,498 
Medfield .... 
638 
915 
1,553 
752 
1,072 
1,824 I 
1.861 
Metropolitan 
813 
776 
1,589 
859 
1,016 
1,875 
1.821 
Monson .... 
511 
666 
1,177 
729 
816 
1,545 
1.533 
Northampton 
730 
999 
1,729 
937 
1,100 
2,037 
2,013 
Taunton .... 
623 
662 
1,285 
843 
856 
1,699 
1,690 
Westborough 
548 
788 
1,334 
688 
923 
1,611 
1,571 
Worcester .... 
1,252 
1,133 
2,385 
1,149 
1,197 
2,346 
2,463 
Totals . . . 
8,948 
9,768 
18,716 
10,377 
11,719 
22,096 
1 
22,181 
Unless the saturation point has been reached, which is 
doubtful, the eight hospitals which are less than 2,000 capacity 
should be enlarged to this figure. This would give approxi- 
mately 24,000 beds at the end of a building program continued 
over a period of years. 1939.] 
HOUSE — No. 2400. 
339 
Types of Hospitals. 
In this country three types of hospitals have been built in 
the past, and each has been modified to meet the needs of a 
particular type of institution. 
The Kirkbride plan consists of a central administration 
building in which all administrative functions are carried out. 
From this building to either side are wings ending in cross 
sections, which give accommodations to lavatories, bath- 
rooms, etc. Continuing on from these cross sections, other 
wings were added and could be extended to very distant points. 
This frequently brought about a much spread-out institution. 
This allowed for the classification of the quieter group near the 
administration building, while the disturbed patients were in 
the more distant wings. 
One disadvantage was that with the further addition of wings 
the patients residing in the last wing were too distant to receive 
proper medical attention. In this State a number of hospitals 
were built on a modified Kirkbride plan, among these being 
the Danvers and Worcester State Hospitals. 
To meet the disadvantages of the Kirkbride plan a block 
system became in vogue in some hospitals. In this type a 
series of block buildings were constructed about a central ad- 
ministration building. This likewise has some disadvantages, 
mainly insufficient fresh air and sunlight. 
The ideal type is the cottage plan. Here separate buildings 
are constructed and equipped to give proper classification. 
These closely surround a central administration building, and 
in close proximity to this building are the acute receiving 
units and hospital buildings. At a distance are buildings for 
the more disturbed and continued treatment cases. 
In the course of the investigation the Commission visited 
all of the institutions as well as a number in the neighboring 
States. In one State buildings of nine or more stories were 
constructed with porches for outdoor activities. Yet sufficient 
land area was available. Many of the patients confined for 
long periods had no opportunity to set foot on land for years, 
and their only opportunity for fresh air and exercise was con- 
fined to the porch. In another State one-story buildings were 
constructed with ample recreation grounds surrounding the 
buildings, affording, in our opinion, the ideal plan. Recreation 
could be carried out both winter and summer, and we believe 
this to be an important part of therapy. 340 
HOUSE— No. 2400. 
[Mar. 
Since the establishment of the forty-eight-hour law, money 
in lieu of maintenance was given to employees for whom there 
were no quarters available. No dissatisfaction has occurred. 
On the contrary, many employees prefer to live with their 
families. Consideration might well be given to extend this 
plan to all employees except those who, it is felt, should remain 
at the institution for emergencies. This would make available 
in some institutions buildings that could be converted at a 
minimum expense into patients’ quarters. Furthermore, the 
capital investment on more employees’ buildings would also 
be saved. 
The Commission recommends — 
1. That a building program be promulgated to furnish suffi- 
cient bed space to care for the excess number in the hospitals 
and to further expansion. 
2. That units be established for the care of the tubercular, 
acute reception building, medical and surgical units with isola- 
tion departments. 
3. That the study to determine the type of hospital that 
would best suit the needs of the Commonwealth be continued 
by the Department. 1939.] 
HOUSE — No. 2400. 
341 
Appendix 15. 
PROBLEM OF NARCOTIC ADDICTS. 
Under section 62, chapter 123 of the General Laws, “Any 
of the judges named in section fifty, or a judge of the municipal 
court of the city of Boston, may commit to the state farm, or 
to any other institution under the department of correction 
that may be designated by the governor, to the McLean hos- 
pital, or to a private licensed institution, by an order of com- 
mitment, directed to the trustees, superintendent, or manager 
thereof, as the case may be, made in accordance with section 
fifty-one, and accompanied by a certificate, in accordance with 
section fifty-three, by two physicians qualified as therein pro- 
vided, any male or female person, who is subject to dipsomania 
or inebriety either in public or private, or who is so addicted 
to the intemperate use of narcotics or stimulants as to have 
lost the power of self-control.” 
In other words, although the problem of drug addiction is 
considered to be pre-eminently a medical problem, yet the 
State at the present time furnishes no facilities for treatment 
for drug addiction except in institutions under the jurisdiction 
of the Department of Correction. This Commission feels 
that emphasis should be placed on the medical nature of the 
problem; that psychological factors are of vital importance; 
and that the problem properly comes under the jurisdiction of 
the Department of Mental Health. 
This Commission wishes to call attention to the report of 
the special commission on drug addiction authorized by chap- 
ter 36 of the Resolves of 1930 and published in December, 1930. 
As a result of its investigation and researches the afore- 
mentioned Commission offered as its first recommendation 
“that fifty beds should be set aside in one of the hospitals of 
the Department of Mental Diseases or in a new ward added 
to one of these hospitals, for the treatment of and experimenta- 
tion with drug addiction, its causes, effect, nature and cure.” 342 
HOUSE— No. 2400. 
[Mar. 
While this Commission has not had the opportunity of 
thoroughly studying the problem of narcotic addiction in 
Massachusetts, it is convinced that a serious problem does 
exist. Accurate data on the incidence of narcotic addiction 
are extremely difficult to obtain. It was primarily for this 
reason that the commission on drug addiction recommended 
a small experimental unit of fifty beds “until more definite 
information as to its need and usefulness were established.” 
Since 1930 there has been reported, both in the lay and 
medical press, an increase in drug addiction through the use 
of a drug called “marihuana.” This weed is easily grown 
and obtained without too great difficulty. The problem of 
drug addiction is thus increased. 
This Commission likewise believes that there exists in many 
cases a fundamental psychological derangement as a basis for 
the development and continuation of the drug habit. 
Hospitalization should be for both males and females. 
Inasmuch as this Commission is in accord with certain sug- 
gestions of the commission on drug addiction, we wish to repeat 
those suggestions for purposes of emphasis: 
(a) Treatment and care should be free only if the patient is unable 
to pay. 
(b) The type of treatment should be left entirely to the discretion 
of the physician in charge, with the approval of the Department having 
jurisdiction over the hospital. 
(c) Voluntary patients should be required to submit to the rules of 
the institution, both as to duration of stay and as to required periodic 
reports for examination after discharge. 
(d) Voluntary patients who have violated the rules of the institu- 
tion as to duration of stay or after-care should be readmitted only on 
commitment as outlined in the next paragraph. 
(e) Involuntary patients should be committed in the manner pro- 
vided for the commitment of the insane, of dipsomaniacs, or of drug 
addicts in the manner prescribed by sections 51, 52, 53, 62, 63 and 
86 of chapter 123 of the General Laws of Massachusetts, as amended 
by chapter 535 of the Acts of 1922, sections 4, 5 and 6; and the Acts 
of 1922, chapter 535, section 4, must be amended to include the name 
of the institution for drug addicts and the name of the Department 
having jurisdiction over such institution. 
(/) Involuntary commitments should be limited to a period not 
exceeding two years, and enforced after-care should be limited to a 
period of three years after original commitment to the institution. 
{g) iNo patient, voluntary or committed, should be discharged 
within three months after the date of commitment. 1939.] 
HOUSE— No. 2400. 
343 
(h) A social service department should be established in connection 
with the institution, with an adequate number of workers to follow up 
all discharged cases. 
Further, the institution when constructed should have 
adequate general and psychological laboratory facilities, in- 
cluding personnel. 
As the Special Commission has been unable to give thorough 
study to this very difficult subject, no specific recommendation 
is made. HOUSE —No. 2400. 
[Mar. 
344 
Appendix 16. 
PROBLEM OF ALCOHOLIC ADDICTS. 
What has been said of drug addiction concerning facilities for 
treatment applies equally to alcoholism. The report of the 
special commission on the advisability of establishing public 
clinics, etc., for treatment of persons of confirmed habits of 
intoxication, December 4, 1935, points out that “the principal 
disadvantage of the present provision for the civil commitment 
of inebriates is that even though the commitment is civil it 
must be made to a penal institution, — namely, the State 
Farm in the case of men, and the Reformatory for Women in 
the case of women. An additional handicap exists in the fact 
that although a criminal commitment for drunkenness to the 
State Farm calls for a maximum of one year, a civil commit- 
ment to the same institution by reason of inebriety provides 
for a maximum of two years.” 
The same report commented that “it would be entirely 
logical for the General Court to authorize the care of the in- 
ebriates by the Department of Mental Diseases, as was the 
case prior to 1922.” 
The necessity for keeping such patients separate from the 
insane is obvious. It seems equally obvious that they should 
be kept separate from criminals. It has been pointed out that 
there has been some reluctance on the part of the courts to 
make use of the existing provisions of civil commitment. 
The potential importance of the problem of alcoholism may 
be emphasized by a comparison of the first admissions of 
patients suffering from alcoholic psychoses and the incidence 
of first admissions classified as intemperate in the use of al- 
cohol for the year 1920, the first year of the Eighteenth Amend- 
ment, and from 1933, the first year of repeal, to the present 
time. 1939.] 
HOUSE — No. 2400. 
345 
Year. 
Total 
First Ad- 
missions, 
AH 
Diagnoses. 
Alcoholic 
First Ad- 
missions, 
Alcoholic 
Psychoses. 
Psychoses, 
Per Cent 
First Ad- 
missions. 
Number In- 
temperate, 
All 
First Ad- 
missions. 
Per Cent 
First Ad- 
missions. 
1920 .... 
3,279 
126 
3.8 
461 
14.0 
1933 .... 
4,554 
332 
7.2 
884 
19.4 
1934 .... 
4,549 
395 
8.6 
981 
21.5 
1935 .... 
4,816 
428 
8.8 
1,113 
23.1 
1936 .... 
5,035 
451 
8.9 
1,242 
24.6 
1937 .... 
4,985 
453 
9.0 
1,269 
25.4 
1938 .... 
4,980 
461 
9.2 
1,325 
26.6 
There is a slow, steady increase in hospitalization, due to 
the alcoholic psychoses. Of perhaps greater importance is 
the high percentage of first admissions to the hospitals classi- 
fied as intemperate in the use of alcohol. Since 1933 there has 
also been a gradual increase in the number of patients recorded 
as intemperate. When alcohol is used to excess it exerts a 
poisonous effect on the brain cells. It is entirely possible that 
in many mentally ill patients over-indulgence in alcohol is the 
“straw that breaks the camel’s back” and actually precipi- 
tates latent psychoses. It is, of course, true that alcoholism 
itself may be only a symptom of mental disorder. 
The outcome of alcoholic psychoses is rather good for early 
cases; in other words, they are fairly amenable to treatment. 
The average length of time of residence in hospitals of first 
admissions discharged as recovered in 1937 was 0.68 year; as 
improved, 0.50 year; and as unimproved, 1.37 years. During 
the year 376 patients suffering from alcoholic psychoses were 
discharged: 174, or 46.2 per cent, as recovered; 192, or 51 
per cent, as improved; and 10, or 2.6 per cent, as unimproved; 
453 patients were admitted in 1937 with alcoholic psychoses. 
The death rate in this group is relatively low; 65 deaths oc- 
curred during the year in this grouping. 
Alcoholic psychoses can be prevented by abstinence from 
alcohol. The disease is preventable. Social factors play a 
significant role in the development of the alcoholic habit. 
Often it represents a withdrawal from reality, an escape from 
the hard facts of life. 
There are, roughly, ninety to a hundred thousand arrests 
each year for drunkenness in Massachusetts. Many of these HOUSE —No. 2400. 
[Mar. 
346 
arrests are made on chronic drinkers. Is it time to enact 
legislation that repeated arrests for drunkenness will result in 
mandatory admission to a hospital for inebriates for periods of 
not less than three months? This is about the shortest time 
required to do anything constructive from a medico-social 
point of view. The costs of repeated arrests and occasional 
incarceration in correctional institutions, and perhaps the 
incidence of hospitalization for frank alcoholic and even other 
psychoses in which alcoholism may be a precipitating factor, 
might be reduced by such measures. 
The important point from the taxpayers’ point of view is 
whether the incidence of admissions to hospitals can be reduced. 
From the medical viewpoint prevention of the alcoholic psy- 
choses is vitally important. The proverbial “ounce of preven- 
tion is worth a pound of cure” is particularly appropriate in 
this connection. 
Again, the State did take cognizance of alcoholism as a men- 
tal problem when the Foxborough State Hospital was opened 
in 1893 as a hospital for inebriates, who were required to be of 
good character and repute apart from habits of inebriety. It 
was known as the Massachusetts Hospital for Dipsomaniacs 
and Inebriates. The law provided that the persons committed 
thereto could be held for a period of two years, although the 
trustees were empowered to parole them at liberty during that 
time under such limitations as they deemed best. 
The hospital was not designed for strictly custodial cases, 
and the trustees made appeals for more careful discrimination 
in the selection of patients sent for treatment. 
In 1905 the name of this hospital was changed to the Fox- 
borough Hospital, and a ward was set apart for mental patients. 
The trustees reported in 1910 that the hospital at Foxborough 
was intended for young and hopeful cases, and that the hospi- 
tal was handicapped in that it was not equipped for the various 
types of inebriates committed thereto. They recommended 
sufficient land for agricultural development, a sufficient plant 
for industrial training and workshops, and also for segregation. 
Accordingly, land was purchased for a new hospital at Nor- 
folk and a colony established there. For a time this was oper- 
ated as a branch of the Foxborough Hospital, but eventually 
it was made a separate institution known as the Norfolk State 
Hospital in 1914. The hospital at Norfolk continued to operate 
until it was closed as a result of prohibition in 1919. 1939.] 
HOUSE —No. 2400. 
347 
In 1922 provision was made to care for male and female 
inebriates at the State Farm in Bridgewater under the Depart- 
ment of Correction, but all those who wished treatment in 
private hospitals continued to be received at the private hospi- 
tals licensed under this Department. The women inebriates 
since 1933 have been sent to the Reformatory for Women. 
At the present time facilities for such preventive measures 
are not available in the Massachusetts state hospitals, and 
until the General Court is ready to make such facilities avail- 
able no mandatory legislation making problems of inebriety a 
responsibility of the Department of Mental Health should be 
enacted. 348 
HOUSE — No. 2400. 
[Mar. 
Appendix 17. 
PROBLEM OF THE BOSTON PSYCHOPATHIC HOSPITAL. 
The Boston Psychopathic Hospital was created by an act 
of the Legislature in 1909. It was to be operated in conjunc- 
tion with the Boston State Hospital, as its psychopathic de- 
partment, although the building was located at 74 Fenwood 
Road. 
The Purpose of the Hospital. 
The purpose of the hospital was — 
1. To give care and examination, hospitalization and study 
of all classes of mental patients. 
2. To provide for short intensive treatment of the incipient, 
acute and curable mental diseases. 
3. To provide facilities for scientific investigation with a 
view to prevention and cure of mental disease. 
4. To give clinical instruction to medical students, the 
medical profession and particularly the family physician, in 
order that they would be better able to recognize mental 
disease in its early stages. 
5. To be an educational center for associated workers, — 
nurses, social workers and other specialized groups. 
6. To afford free consultation for the poor and to aid in the 
home care of mental patients. 
The term “psychopathic” has been used in connection with 
many other activities besides the true Psychopathic Hospital, 
such as psychopathic wards and units. 
The true Psychopathic Hospital is an institution for the 
reception of doubtful and difficult cases for study, in contrast 
to the state hospital which receives, largely, court committed 
cases for long and continued treatment. The Psychopathic 
Hospital is not to be thought of as a haven for the purely 
committed case. 
In the second annual report of the psychopathic depart- 
ment of the Boston State Hospital in 1913, statistics show that 
there were 1,391 non-court cases admitted during the year; 1939.] 
HOUSE — No. 2400. 
349 
and of these, 726, or more than 50 per cent, were eventually 
committed to other state hospitals as insane. It is further 
stated that the other 665 patients were spared the stigma of 
court commitment. The report further indicated that with the 
establishment of a Psychopathic Hospital in the community 
as a resort for the mentally-ill individual, there would occur 
an increase in the financial burden of the State. The mainte- 
nance cost of the Psychopathic Department is buried in the 
general maintenance figures of the Boston State Hospital, so 
that a comparative figure for the per capita cost for the years 
1912-20 is not available. 
In 1920 the Psychopathic Department withdrew from the 
Boston State Hospital and became a separate unit, having its 
own board of trustees and separate appropriations. 
In the first annual report of the newly organized Psycho- 
pathic Hospital in 1920, it is stated that the hospital has be- 
come a clearing house for the disposal of a large number of 
patients. It was the feeling at the time that the length of 
stay in the hospital was limited to only ten days. However, 
it was felt that if the hospital were to undertake the treatment 
of curable cases, as well as the study of the nature of the causes 
of insanity, the hospital should be prepared to care for pa- 
tients for longer periods; that is, weeks and months. 
The appropriation for that year was $204,442, and with a 
daily average population of 93 patients it represented a weekly 
per capita cost of $41.91. This high figure was due to the 
relatively small number of patients in residence. At that 
time there were 112 officers and employees, of which 15 were 
physicians. 
In 1930, after a ten-year interval, appropriations had in- 
creased to $248,856.79, or an increase of 21.6 per cent. There 
was, however, little change in the daily average population, 
which was 86.40 for the year. The per capita cost for this 
year amounted to $55.39, and shows an increase of $13.48. 
At the same time, the personnel had increased from 112 to 
141 in number. The increase in cost was largely attributed to 
the increased personnel, which at this time represented nearly 
two thirds of the total appropriation. 
In 1937, the last report available, the total appropriation 
had increased to $255,600 — again without showing any 
material increase in the number of patients cared for. The 
gross per capita weekly cost for this year was $63.88, and the 
personnel had again showed an increase to 157. 350 
HOUSE — No. 2400. 
[Mar 
General Comment. 
The Boston Psychopathic Hospital has essentially two di- 
rectors, a medical director and a chief executive officer, both 
charged with the responsibility of administering the affairs 
of the hospital. It is essentially a dual control, and must lead 
to difficulty. 
The medical director is a part-time physician, and cares 
largely for the general supervision of the patients; teaching; 
the out-patient and research departments. 
The chief executive officer cares for the routine business of 
the hospital, purchasing supplies, and generally looks after the 
welfare of the institution. Through his department, commit- 
ments of patients are made to other hospitals, as are hospital 
discharges. 
At the present time there are 18 physicians assigned to the 
staff. Of these, 11 care for patients in the house, 3 are occu- 
pied with the out-patient department, 2 are in X-ray and 
laboratory work, and 2 are in the executive department. 
With the large number of patients admitted yearly, it is 
evident that the work-up of the cases must be brief, and fre- 
quently it is necessary to form an opinion of the patient’s 
mental condition in six or seven days, in order to effect the 
patient’s commitment to another hospital before the expira- 
tion of his temporary care period. The end result, then, is 
the resemblance to a clearing house, as previously mentioned. 
Much of the work is duplicated if the patient is committed 
to one of the larger state hospitals, where a complete new' 
work-up of the case is again made without reference to any 
extent to the records of the Boston Psychopathic Hospital. 
It would seem, therefore, that these same cases could be ad- 
mitted directly to other hospitals and commitment recom- 
mended from there just as well as from the Boston Psycho- 
pathic Hospital. Furthermore, the per capita cost is decidedly 
less in a larger institution, averaging from $7 to $8 per week, 
in contrast to the present per capita cost of the Boston Psycho- 
pathic Hospital, which is $63.88. It is true that considerable 
benefit is given to various social agencies by the out-patient 
department of the hospital. During the year ending Septem- 
ber 30, 1937, 736 new patients were seen and advised in this 
department. There are three physicians and one social worker 
assigned to care ior this work; other personnel, such as psycholo- 
gists and stenographers, are drawn from the general hospital 
staff. 1939.] 
HOUSE — No. 2400. 
351 
What to do with the Boston Psychopathic Hospital. 
From the above figures it can be noted that the per capita 
cost has increased from $41.91 to $63.88, or $21.97 in 17 years. 
Yet there has been no gross change in either the bed capacity 
or the number of patients received yearly. It would, there- 
fore, appear advisable that a study be made to justify further 
need of this hospital. 
The Commission has several thoughts on the matter presented 
to it: 
1. Complete abolition of the Boston Psychopathic Hos- 
pital as such, with a transfer of the several associated depart- 
ments — as the out-patient department and clinic for venereal 
disease — to some other city hospital center. The mental 
patients to be admitted directly to the several state hospitals 
serving the eastern portion of the State; or, instead, the es- 
tablishment of a psychiatric service in the general hospitals 
serving the city of Boston. The Commonwealth could well 
afford to reimburse the various hospitals for the maintenance 
of such patients at a much lower figure than is now being 
spent for the same care at the Boston Psychopathic Hospital. 
It would still afford teaching material for the medical schools 
in Massachusetts. 
2. The present building might well serve as an office build- 
ing for several of the state departments. This could be ac- 
complished at a minimum of expense. One might think of the 
building as a center for the state medical activities, namely, 
for the Department of Mental Health, the Department of 
Public Health and state laboratories. 
The annual expense of maintaining the building would be 
relatively small, and it would likewise reduce the necessity of 
constructing further public buildings to house some of the 
departments which have outgrown their present quarters. 
3, As an alternative — the preservation of the past accom- 
plishments of the Boston Psychopathic Hospital and the reduc- 
tion of expenditures; a reorganization might well be considered. 
The bed capacity could be increased to perhaps 200. 
As many patients as possible could be kept for continued 
hospitalization; particularly, those recommended 35-day court 
observations. Regular commitments could be made to other 
hospitals, as has been done in the past. 
The medical personnel could be drawn from the general 
state hospital group for a period of study in psychiatry and 352 
HOUSE — No. 2400. 
[Mar. 
modern treatment of mental disease. This would afford a well- 
trained personnel for the outlying state hospital group. 
It is interesting to note in this respect that very few of the 
physicians trained at the Boston Psychopathic Hospital have 
remained in the state hospital system. 
With an increase in patients under care, and a reduction of 
cost of medical personnel, the annual appropriation could be 
materially reduced in comparison with the amount of work 
done. 
The following table gives a comparison of the total number 
of patients received, the daily average number in the hospital, 
by year, the ratio of patients to ward employees and to total 
employees, the weekly per capita cost, and the yearly appro- 
priations : 
Boston Psychopathic Hospital — General Medical Statistics. 
Year. 
Admis- 
sions. 
Average 
Number 
of 
Patients 
in Resi- 
dence. 
Ward 
Per- 
sonnel. 
Ratio of 
Patients 
to Ward 
Em- 
ployees. 
Total 
Number 
of Em- 
ployees. 
Ratio of 
Patients 
to Total 
Per- 
sonnel. 
Weekly 
per 
Capita 
Cost. 
General 
Appro- 
priation, 
Y early 
Total. 
1921 . 
1,964 
93.82 
45 
2.0 
112 
.839 
$39 90 
$198,885 
1922 . 
2,006 
91.80 
47 
2.0 
120 
.76 
39 03 
213,674 
1923 . 
1,862 
78.91 
48 
1.6 
135 
.58 
45 57 
211,158 
1924 . 
1,839 
85.92 
48 
1.9 
138 
.62 
43 89 
220,010 
1925 . 
1,716 
85.57 
48 
1.7 
140 
.61 
44 34 
221,550 
1926 . 
1,602 
84.31 
48 
1.7 
138 
.61 
49 64 
224,900 
1927 . 
1,747 
85.08 
53 
1.6 
143 
.6 
46 90 
232,350 
1928 . 
1,906 
87.93 
49 
1.7 
140 
.628 
48 52 
248,579 
1929 . 
1,870 
79.27 
50 
1.6 
146 
.54 
56 12 
254,700 
1930 . 
1,882 
86.40 
46 
1.9 
141 
.61 
51 91 
255,850 
1931 . 
1,914 
83.80 
48 
1.7 
121 
.5 
52 90 
253,100 
1932 . 
1,948 
79.81 
49 
1.6 
144 
.55 
53 33 
235,450 
1933 . 
2,019 
73,90 
48 
1.5 
143 
.51 
52 63 
209,287 
1934 . 
2,000 
73.20 
48 
1.5 
145 
.50 
52 96 
212,930 
1935 . 
1,935 
80.43 
55 
1.4 
153 
.52 
54 64 
234,897 
1936 . 
2,089 
81.34 
56 
1.4 
151 
.54 
57 24 
244,360 
1937 . 
2,121 
73.93 
56 
1.3 
151 
.49 
61 65 
255,600 1939.] 
HOUSE — No. 2400. 
In Institution 
Excess of 
Patients. 
Average 
Number 
Working Capacity, 
1938. 
Whole 
Num- 
EXCLUSIVE OF 
Patients Boarded 
IN INSTITUTION. 
Institutions. 
ber 
in 
FAMILIES. 
Under 
Under 
Care. 
NUMBER. 
PER CENT. 
Esti- 
To 
Date. 
Per 
Cent 
of Ex- 
cess. 
Care 
to 
M. 
F. 
T. 
M. 
F. 
T. 
M. 
F. 
T. 
M. 
F. 
T. 
mated, 
1939. 
Date. 
Hospitals. 
Psychopathic 
60 
49 
109 
74 
49 
25 
74 
ID 
24 * 
35 > 
18.331 
48.98‘ 
32. ID 
90 
64 
28.89- 
64 
Boston State 
1,004 
1,112 
2,116 
2,301 
997 
1,302 
2,299 
71 
190 
183 
0.70* 
17.09 
8.47 
2,440 
2,313 
5.20- 
2,315 
Danvers 
870 
991 
1,861 
2,312 
1,076 
1,228 
2,304 
206 
237 
443 
23.68 
23.92 
23.81 
2,340 
2,302 
1.62- 
2,310 
Foxborough 
543 
591 
1,134 
1,431 
661 
765 
1,426 
118 
174 
292 
21.73 
29.44 
25.75 
1,400 
1,423 
1.64 
1,430 
Gardner 
712 
474 
1,186 
1,539 
824 
600 
1,424 
112 
126 
238 
15.73 
26,58 
20.07 
1,460 
1,427 
2.26- 
1,543 
Grafton 
646 
612 
1,258 
1,548 
774 
761 
1,535 
128 
149 
277 
19.81 
24.35 
22.02 
1,570 
1,538 
2.04- 
1,552 
Medfield 
638 
915 
1,553 
1,819 
750 
1,063 
1,813 
112 
148 
260 
17.55 
16.17 
16.74 
1,865 
1,813 
2.79- 
1,819 
Metropolitan 
813, 
776 
1,589 
1,853 
845 
1,001 
1,846 
32 
225 
257 
3.94 
28.99 
16.17 
1,950 
1,854 
4.92- 
1,861 
Monson 
511 
666 
1,177 
1,451 
684 
767 
1,451 
173 
101 
274 
33.86 
15.17 
23.28 
1,535 
1,481 
3.51- 
1,481 
Northampton 
730 
999 
1,729 
2,045 
938 
1,083 
2,021 
208 
84 
292 
28.49 
8.41 
16.89 
2,030 
2,019 
.54- 
2,042 
Taunton 
623 
662 
1,285 
1,661 
826 
833 
1,659 
203 
171 
374 
32.58 
25.83 
29.11 
1,725 
1,669 
3.25- 
1,672 
Westborough 
546 
788 
1,334 
1,592 
663 
901 
1,564 
117 
113 
230 
21.43 
14.34 
17.24 
1,575 
1,583 
.51 
1,611 
Worcester 
1,252 
1,133 
2,385 
2,466 
1,153 
1,196 
2,349 
99 - 
63 
36* 
7.911 
5.56 
1.511 
2,450 
2,347 
4.20- 
2,463 
Total 
8,948 
9,768 
18,716 
22,092 
10,240 
11,525 
21,765 
1,292 
1,757 
3,049 
14.44 
17.99 
16.29 
22,430 
21,833 
2.66- 
22,163 
1 Decrease. 
Table showing Detail of Capacity and Population of Institutions, January 1, 1939. 
CAPACITY AND POPULATION OF INSTITUTIONS 
Ap'pendix 1S . HOUSE —No. 2400. 
[Mar. 
In Institution 
Excess of 
Patients. 
Average 
Number 
- 
Working Capacity, 
1938. 
Whole 
EXCLUSIVE OF 
Patients Boarded 
IN INSTITUTION. 
Institutions. 
ber 
in Families. 
Under 
Under 
Care. 
NUMBER. 
PER CENT. 
Esti- 
To 
Date. 
Per 
Cent 
of Ex- 
cess. 
Care 
to 
M. 
F. 
T. 
M. 
F. 
T. 
M. 
F. 
T. 
M. 
F. 
T. 
mated, 
1939. 
Date. 
Hospitals. 
Bridgewater 
908 
- 
908 
888 
888 
- 
888 
20 > 
- 
20' 
2.20' 
- 
2.20' 
910 
889 
2.31' 
889 
Mental wards, Tewks- 
bury. 
107 
496 
603 
464 
77 
387 
464 
30' 
109' 
139' 
28 04 ‘ 
21.98' 
23.05' 
490 
465 
5.10' 
465 
Total 
1,015 
496 
1,511 
1,352 
965 
387 
1,352 
50 > 
109' 
159' 
4.93' 
21.98' 
10.52' 
1,400 
1,354 
3.29' 
1,354 
Grand totals 
9,963 
10,264 
20,227 
23,444 
11,205 
11,912 
23,117 
1,242 
1,648 
2,890 
12.47 
16.06 
14.29 
23,830 
23,187 
2,70' 
23,517 
Schools. 
Belchertown 
440 
662 
1,102 
1,306 
558 
748 
1,306 
118 
86 
204 
26.82 
12.99 
18.51 
1,320 
1,301 
1.21 ■ 
1,326 
W. E. Fernald 
906 
634 
1,540 
1,972 
1,165 
807 
1,972 
259 
173 
432 
28.59 
27.29 
28.05 
1,900 
1,972 
3.79 
1,972 
Wrentham . 
637 
724 
1,361 
2,001 
864 
1,137 
2,001 
227 
413 
640 
35.64 
57.04 
47.02 
1,940 
1,998 
2.99 
1,998 
Total 
1,983 
2,020 
4,003 
5,279 
2,587 
2,692 
5,279 
604 
672 
1,276 
30.46 
33.27 
31.88 
5,160 
5,274 
2.21 
5,296 
Aggregates . 
11,946 
12,284 
24,230 
28,723 
13,792 
14,604 
28,396 
1,846 
2,320 
4,166 
15.45 
18.89 
17.19 
28,990 
28,461 
1.82' 
28,813 
1 Decrease. 
Table showing Detail of Capacity and Population of Institutions, January 1, 1939 — Concluded. 1939.] 
HOUSE —No. 2400. 
355 
Appendix 19. 
LIST OF COMMITTEES ASSIGNED BY THE COMMISSION. 
I. Relation between Department and Hospital: 
Dr. Morgan B. Hodskins, Monson State Hospital. 
Dr. C. Stanley Raymond, Wrentham State School. 
Dr. Ralph M. Chambers, Taunton State Hospital. 
II. Delinquent and Psychotic Children; 
Dr. Ransom A. Greene, Fernald State School. 
Dr. Clarence A. Bonner, Danvers State Hospital. 
Dr. Edwin S. Ward, Hospital Cottages for Children. 
III. Food, Clothing, Furniture, etc.: 
Dr. George E. McPherson, Belchertown State School. 
Dr. W. Franklin Wood, McLean Hospital. 
Dr. Harold F. Norton, Boston State Hospital. 
Mr. Herbert Smith, Steward at Worcester State Hospital. 
IV. Hospital Standards : 
Dr. Roy D. Halloran, Metropolitan State Hospital. 
Dr. William A. Bryan, Worcester State Hospital. 
Dr. Walter E. Lang, Westborough State Hospital. 
V. Construction : 
Dr. A. Warren Stearns, Associate Commissioner, De- 
partment of Mental Diseases. 
Dr. Arthur N. Ball, Northampton State Hospital. 
Walter E. Boyd, Supervising Hospital Construction En- 
gineer, Department of Mental Diseases. 
VI. Boston Psychopathic Hospital: 
Dr. A. Warren Stearns, Associate Commissioner. 
Dr. Henry M. Pollock, Associate Commissioner. 
Dr. Riley H. Guthrie, Psychopathic Hospital. 
Dr. Douglas A. Thom, Department of Mental Diseases 
(Director of Division of Mental Hygiene). 
VII. Methods of Admission and Discharge: 
Dr. George E. McPherson, Belchertown State School. 
Dr. Earl K. Holt, Medfield State Hospital. 
Dr. Roderick B. Dexter, Foxborough State Hospital. 356 
HOUSE— No. 2400. 
[Mar. 
VIII. Research Center and Methods: 
Dr. Douglas A. Thom, Department of Mental Diseases. 
Dr. Abraham Myerson. 
Dr. R. G. Hoskins, Director of Research at Worcester 
State Hospital. 
Dr. C. Macfie Campbell, Psychopathic Hospital. 
IX. Bridgewater and Tewksbury: 
Dr. Laurence K. Kelley, State Infirmary. 
Dr. A. Warren Stearns, Associate Commissioner. 
Dr. Harlan L. Paine, Grafton State Hospital. 
X. Private Care of Patients and Housing of Employees: 
Dr. Harlan L. Paine, Grafton State Hospital. 
Dr. Charles E. Thompson, Gardner State Hospital. 
Dr. Walter E. Lang, Westborough State Hospital. 1939.] 
HOUSE — No. 2400. 
357 
Appendix 20. 
INVESTIGATION OF SUDDEN DEATHS IN THE HOSPITALS. 
An investigation of sudden deaths in mental hospitals was 
made by Eugene M. McSweeney, Commissioner of Public 
Safety, and Patrick J. Moynihan, chairman of the Commission 
on Administration and Finance. The following statement was 
released by the Governor’s office on January 7, 1938: 
Dr. Clifton T. Perkins, Acting Commissioner of Mental 
Diseases, in a report to Governor Charles F. Hurley containing 
an analysis of 232 so-called “sudden deaths” which occurred 
in 16 state hospitals and schools for mental defectives, together 
with the mental wards at Bridgewater and Tewksbury, declared: 
It is true that the suicidal propensity among the mentally ill is far 
greater than among those of normal mentality, and the effect of sug- 
gestion through public comment has many times greatly indicated 
the urgency, from a medical point of view, in restraining publicity on 
this type of death. 
The pointing out of ways and means for suggestible minds to com- 
plete their vizualized self-sacrifice is far removed from the slightest 
trait of medical therapy. 
The report covers the fiscal year December 1, 1936, to No- 
vember 30, 1937, inclusive. 
Dr. Perkins declared that each suicide was — 
thoroughly investigated, and from time to time, at least during the 
past seven months, investigations have resulted in establishing definite 
policies relative to the administration of given hospitals. 
Since there has been some question raised in the public press rela- 
tive to drownings, I would point out that the only drowning was 
case No. 120, who was drowned in a body of water on the hospital 
grounds, and not in a tub within the hospital as had been implied. 
It likewise will be noted that of the seven suicides from poisoning, 
six of these took that poison and were in critical condition prior to 
admission to the hospital, and the seventh case took poison at home 
some months after leaving the hospital. 358 
HOUSE —No. 2400. 
[Mar. 
Of the three suicides as a result of burning, one committed the act 
at home prior to admission to the hospital; a second committed the 
act with matches produced by a relative for smoking purposes; and 
the third committed the act through matches probably obtained from 
somewhere on the ward on which the patient resided. 
In relation to so-called “sudden deaths,” Dr. Perkins 
reported: 
You will note that many of these deaths are accredited to fractures, 
and in this regard I would state that all patients who die within a year 
of a fracture, no matter how simple that fracture might be, are considered 
sudden deaths and are subject to the scrutiny of the medical examiner. 
In these cases the medical examiner generally accepts jurisdiction, occa- 
sionally he does not. 
In studying the detail of this special group it cannot be overlooked 
that to a certain degree the relation of accidents or assaults on pa- 
tients as noted above, are proportional to the numerical and intel- 
lectual amount of personnel available for supervision of patients, 
and likewise to the degree of overcrowding. It likewise cannot be 
overlooked that the physical make-up of patients is a large factor to 
be considered. Stout people in general do not break bones as readily 
as those of thin make-up. Elderly individuals might receive a rela- 
tively light blow which might result seriously. In our crowded state 
institutions, which among the hospitals (exclusive of the schools for 
the feeble-minded) run to as high as 31.5 per cent overcrowding, we 
cannot guarantee freedom from altercations. 
From an analysis of deaths from alcoholism, it will be noted that 
in all cases the acute alcoholism was acquired prior to hospital admis- 
sion, was the immediate cause for hospital admission, and in no case did 
the patient live long after commitment. In the larger cities in the Com- 
monwealth acute alcoholic cases are usually cared for in special wards 
in the larger general hospitals, but in the smaller towns and outlying 
districts the acute alcoholics in the frenzy of delirium tremens, requir- 
ing immediate and expert medical attention, have as an outlet only 
admission to a state mental hospital. 
I have commented somewhat on fractures above, but in studying the 
fractures further, as summarized, you will note that eighteen occurred 
outside of the hospital, and a breakdown of the analysis appears in the 
following summary. You will note particularly that there was one death 
from fracture which was of a homicidal nature and constituted the only 
so-called “homicide” within the hospitals during the year 1937. 
The large number of sudden deaths, totaling 95, in which none of 
the above classifications played any part are due to sudden, unex- 
pected developments during the natural course of disease process, but 
because of their suddenness were referred for special study to the 
Department, the State Pathologist, and, in most instances, the 
Medical Examiner. 1939.] 
HOUSE— No. 2400. 
359 
Summarized Analysis of Cases of Suicides and Other Violent or Sudden 
Deaths reported to the Department of Mental Diseases by State 
Institutions under its Jurisdiction for Fiscal Year 1937. 
Total cases reported 
232 
Suicides, including one questionable case which may 
have been accidental death and 
so recorded by 
medical examiner .... 
24 
Fatal act occurred prior to hospital admission 
. 8 
Fatal act occurred while on visit or escape 
. 4 
Fatal act occurred within hospital 
. 12 
Cases in which altercations between patients, impulsive 
actions of patients, or unprovoked assaults oc- 
curred in cases dying within one 
year 
(fractures 
sustained in eight of these cases) 
11 
Deaths from acute alcoholism or immediate 
effects of 
alcoholism 
10 
Time elapsing between hospital admission and death: 
Same day 
2 
One day 
• 
. 2 
Within one week .... 
. 4 
Within three weeks .... 
. 1 
Within five weeks .... 
. 1 
Fractures which occurred any time within twelve months 
prior to death .... 
79 
Fractures occurred in hospital . 
. 61 
Fractures occurred outside hospital . 
. 18 
From accidental falls 
. 57 
Altercation between patients . 
. 6 
Suicide 
1 
Impulsive act of patient . 
. 6 
Homicide 
. 1 
Cause not determined 
. 7 
Patients with injuries which played no 
significant role 
in cause of death (accidental) . 
22 
Sudden deaths in which alcoholism, fractures 
, suicides, 
homicides and injuries played no 
significant part 
95 
Total 
241 
Number counted twice .... 
9 
Suicide 
1 
Altercations and fractures . 
. 8 
Corrected total 
232