Dublin Core
Title
Fifth biennial report of the Board of Trustees of the State Psychopathic Hospital at the University of Michigan for the Biennial Period ending June 30, 1916
Subject
Psychiatric hospitals.
Description
Fifth biennial report of the Board of Trustees of the State Psychopathic Hospital at the University of Michigan for the Biennial Period ending June 30, 1916. Delivered to the State Legislature. Strong emphasis made by the Trustees in regards to the inadequate facilities provided for the work of the hospital, in both size and arrangement of buildings. Details on the newly developed out-patient services established at Ann Arbor and the hospital in Detroit are included in this report. Reports by the medical director and treasurer included.
Creator
Board of Trustees, State Psychopathic Hospital at the University of Michigan
Source
Original document held by Traverse Area District Library.
Publisher
Lansing: Wynkoop Hallenbeck Crawford Co., State Printers
Date
1917
Contributor
State of Michigan.
Rights
This document is in the public domain.
Relation
See other reports from the Board of Trustees at various institutions in the "Traverse City State Hospital" Digital Collection.
Format
PDF.
Language
English.
Type
Document.
Identifier
MSH0004
Coverage
Ann Arbor, Washtenaw County, Michigan
PDF Text
Text
FIFTH BIENNIAL REPORT
OF THE
BOARD OF TRUSTEES
OF THE
STATE-PSYCHOPATHIC HOSPITAL
AT THE
UNIVERSITY OF MICHIGAN
FOR THE
BIENNIAL PERIOD ENDING J U N E 30 1916.
BY AUTHORITY
LANSING, MICHIGAN
WYNKOOP HALLENBECK CRAWFORD CO., STATE PRINTERS
1917
REPORT OF TRUSTEES.
To the Legislature of the State of Michigan:
The Board of Trustees of the State Psychopathic Hospital at the
University of Michigan has the honor of submitting the following report:
The membership of the Board remains the same as during the previous
period excepting that Harry C. Davis, member from the Board of Trustees of the Traverse City State Hospital, has been succeeded by M. F.
Quaintance from the Same Board.
Meetings of the Board have been held at the Hospital and the Trustees have maintained an active interest in the work of the institution.
The various detailed statements of the medical work and business
administration are given in the accompanying reports of the Medical
Director, the Business Officer and the Treasurer. The Board wishes to
express its appreciation of the faithful service of the former Business
Officer of the hospital, Mr. J. B. Draper, who lost his life by accident
in November, 1915. His work in organizing the business affairs of the
institution during its formative years was unusually valuable.
The number of patients treated during the period was 510 as against
465 in the previous period. There continues as in former years a greater
demand for the admission of patients than the limited capacity of the
hospital can satisfy. There have been no notable changes of the buildings or grounds of the hospital during the period.
The Board must again emphasize the very inadequate facilities which
are provided for the work of the hospital. Both in size and arrangements the building is quite unsuited for the successful conduct of the
work of an organization of its type. These difficulties can only be
remedied by the erection of a new building planned with an appreciation
of the work it is to do. It is hoped that the public will become more
familiar with the great service the institution is doing and that adequate provision will be made for its needs at an early date.
The average rate for the maintenance of public patients was fl.257
per diem. The increase of this rate over that of previous years is largely due to the increased cost of food stuffs.
The most notable feature of the work of the period has been the development of the out-patient service at Ann Arbor and the establishment
of a similar psychopathic clinic directed by the hospital in Detroit.
The Board of Trustees acting in harmony with the research purposes
of the Psychopathic Hospital have appreciated that insanity is not
a disease to be studied only in its manifestations in the individual himself or in the morbid structure of the brain. It has its causes in ab-
6
STATE OP MICHIGAN.
normalities present in the family from which he is derived and in forces
active in the environment in which he has lived; such factors are not
open to study within the walls of the hospital. To understand these
it is essential that the interests and activities of the hospital reach out
into the homes and among the families and into the public life of our
communities. To make it possible to carry on investigations along
these lines the Board of Trustees have approved of the organization of
out-patient services or psychopathic clinics under the direct control of
the medical officers of the Psychopathic Hospital.
A beginning of this phase of the hospital's activities has been made
in the establishment of an out-patient service in Detroit in connection
with the Wayne County Probate Court.
It is planned to establish similar organizations in other centers of
larger population whenever local co-operation can be secured.
The Board of Trustees feel that institutions of the type of the State
Psychopathic Hospital must assume the position of leaders in the work
of public service in matters pertaining to mental disorders. Such activities will extend its functions far beyond the traditional lines limiting institutions caring for the insane. It is largely by efforts for public
education and through extra-mural activities that we may expect to
achieve success in attacking the sources for the production of insanity
and mental disorders.
Signed,
CHAUNCEY F. COOK,
WALTEE H. SAWYER,
FRED S. CASE,
WM. L. CLEMENTS,
STUART GALBRAITH,
BENJ. S. HANCHETT,
FRANK B. LELAND,
M. F. QUAINTANCE,
PSYCHOPATHIC HOSPITAL.
REPORT OF THE MEDICAL DIRECTOR.
In accordance with the statutes of this State, I have the honor of submitting my report as Medical Director of the State Psychopathic Hospital for the period covering July 1st, 1914, to June 30, 1916.
The close of the period marks the end of the first decade of the Hospitals' existence. Such a length of time should be sufficient for the institution to have established its field of work among the other organizations of the State caring for mental disorders. It should also have
determined the lines of activity which would be most promising for
its future development.
While the statutes establishing the hospital specified certain lines of
activity as its work, its functions as concerned the class of patients it
was to treat have been largely determined by its later experiences. Its
designation as a psychopathic hospital implied that it was to maintain
certain distinctive differences from the other hospitals maintained by
the State for the care of the insane.
In the development of its laboratory and research activities, there
was little difficulty in maintaining this distinction. Its relationship
to the class of mental disorders it was to treat has been less easy to
establish. As the hospital was a State institution, it was necessary to
receive patients from any part of the State. By reason of its snial]
capacity, namely, sixty-two beds, it was obvious that some restrictions
to admission would be desirable.
The term, psychopathic, as used in its official designation, suggested
that its work should be confined to those mental abnormalities not
usually classed as states of insanity. Experience early showed that
this would not be possible. The information usually available from prehospital examinations was rarely adequate to determine any distinctions between these two classes. This likewise prevented any distinctions between curable and non-curable disorders.
As the hospital was provided with unusual facilities for treatment,
in any case where treatment would be of any use,, it became essential
to select from those admitted to the hospital all who might be expected
to react favorably to what the hospital might do. In the case of the
others, what was needed was competent observation and advice as to
the best method for their future care. To accomplish this it was necessary to develop to the utmost the diagnostic side of the hospital's activities.
The institution has thus assumed to a considerable degree the functions of a clearing house for mental disorders and has equipped its
laboratories and developed its medical routine to best serve this purpose.
The results of its treatment are indicated in the fact that less than
one-fourth of those discharged go from the hospital to one of the other
State institutions.
8
STATE OF MICHIGAN.
CLINICAL AND LABORATORY WORK.
As in previous years, the hospital has followed the plan of routine
intensive study of the clinical symptomatology of its patients with a
systematic consideration of the results of this in each individual admitted. The discussion of these studies at frequent conferences of the
medical officers serves to keep up an orderly routine and increase the
thoroughness of the medical work.
The activities of the laboratory have chiefly concerned the study of
the material received from the State Hospitals, by the modern methods
of neuro-pathology. On account of the considerable amount of material
received it has been found necessary to limit the work to that which has
come from cases well observed during their hospital life or to that
material which presented interesting pathological problems. The results of many of these studies have been communicated to the hospital
interested in the case. Some of these have been published in the medical literature of the period.
The serological work of the laboratory has greatly increased in
amount. At the present time, the laboratory of this hospital makes
Wassermann tests for all of the Michigan institutions caring for mental
disorders.
PUBLISHED CONTRIBUTIONS.
There have been reported on various occasions and published in the
medical literature of the years 1914-1916 the following contributions by
members of the hospital staff.
Barrett, Albert M.—Clinical and anatomical study of a case of Dementia praecox with acute death. Journal Michigan State Medical
Association, January, 1915, page 61.
Barrett, Albert M.—Extra mural responsibilities of State Hospitals
for the Insane. Proceedings Joint Board of Trustees of State Hospitals of Michigan, July, 1915.
Barrett, Albert M.—Multiple carcinoma involving the brain. Transactions Hospital Clinical Society, University of Michigan, January,
1916. Vol. 7.
Barrett, Albert M.—Syphilitic Psychoses associated with Manic Depressive symptoms and course. Journal American Medical Association. December 2, .1916. Page 1,639.
Jacoby, Arnold L.—Constitutional Syphilis associated with an hallucinatory mental disorder. Transactions Hospital Clinical Society, University of Michigan. April, 1916.
Haskell, Eobert H.—Acute Alcoholic Hallucinosis in General Paralysis, with Herpes Zoster following intraspinous treatment. Transactions
Hospital Clinical Society, University of- Michigan. February, 1915.
Vol. 6.
Hulbert, Harold S.—Technical improvement in Lange's colloidal gold
test. Transactions Hospital Clinical Society, University of Michigan.
October, 1915.
PSYCHOPATHIC HOSPITAL.
9
OUT-PATIENT WORK.
In the development of the medical activities of the hospital, it has become increasingly apparent that many of the problems relating to the
mental disorders of patients have ramifications far beyond the confines
of the hospital. The most striking of these relate to the influence of
environment and habits of the patient. The interest in this aspect of
mental disorders became awakened in the studies of familial syphilis
which the hospital has been carrying on during recent years.
These interests have lead to the organization of out-patient services
under the direct supervision of the Psychopathic Hospital. The first of
these was developed in connection with the out-patient services of the
General hospital of the University.
Somewhat later, a service was organized in Detroit in relation with
the Wayne County Juvenile Court. This service known as the Detroit
Psychopathic Clinic, has the assistance of a trained psychologist and
a social service worker. This assistance has been made possible by the
Associated Charities of Detroit and the Wayne County Probate Court.
On one day each week a physician from the Psychopathic Hospital
is in attendance at the Clinic. The Clinic examines all cases of mental
abnormalities referred to it from any of the Charitable organizations of
Wayne county. The brief time that this organization has existed has
shown its value not alone in giving helpful advice to those mentally
ill, but in bringing the medical and research interests of the Psychopathic Hospital in contact with mental diseases at their earliest phases
and the sources responsible for the production of a large variety of
problems directly the concern of an institution such as this. It is planned to organize similar services in other cities of the State whenever
local conditions will insure their successful maintenance.
GELATIONS WITH THE STATE HOSPITALS.
There has continued through the period the same helpful co-operation
between the State institutions caring for those mentally disordered and
the Psychopathic Hospital.
The medical director in his capacity of pathologist to the State Hospitals for the Insane has made visits, as time permitted, to the several
hospitals. At these occasions there have been conferences with the
medical officers, and demonstrations of material sent from the hospital
to the laboratory of the Psychopathic Hospital.
There have been held at the Psychopathic Hospital several meetings
of the Superintendents of the Michigan State Hospitals. At these there
was presented a clinical program by the staff of this hospital, and there
were discussions of problems of mutual interest to those engaged in
the care of those mentally diseased. As a result of these, psychiatric
work in Michigan has been advanced in a number of specific directions.
The plan has been inaugurated during the period of having a medical
assistant from one of the State Hospitals detailed to the Psychopathic
Hospital for the period of a month. During this time he receives special
instruction in clinical problems and methods.
10
STATE OF MICHIGAN.
FUTURE DEVELOPMENTS.
Extensive developments of the work of the hospital are impossible until the institution is provided with a building adequate to its needs. Anyone who is familiar with the construction and arrangements of the present building must realize how poorly it is adapted to the cure of patients
with mental disorders, and how unsuited it is to carry on its purpose of
investigation and teaching. Those interested in the administration of
the hospital feel that this situation should be appreciated by the people
of the State and that within the next few years the legislature should
make provision for a new building adequate to its needs.
The interest which has been taken in the organization of out-patient
services has shown that along this direction of activity it will find a field
of great usefulness.
The awakening of the people of Michigan to the menace of mental abnormalities, in particular the feeblemindedness, makes it opportune for
the Psychopathic Hospital to interest itself in efforts for public education as to the causes and prevention of mental disorders. Plans for undertaking this are now being formulated.
OFFICIAL CHANGES.
The following changes among the officials of the Hospital have occurred during the period.
Dr. Eobert H. Haskell resigned his position as First Assistant Physician on April 1, 1915 to become Superintendent of the Ionia State Hospital. Dr. Arnold L. Jacoby has been appointed to this position.
In July, 1915—Dr. Harold S. Hulbert was appointed Second Assistant Physician.
In Octobei', 1915, Dr. W. I. Lillie was appointed Eesident Physician.
Dr. Adeline E. Gurd was appointed Pathologist in the hospital in November, 1915.
Following the death of Mr. J. B. Draper, in November, 1915, Mr.
Robert G. Greve was appointed Business Officer of the hospital.
Respectfully submitted,
ALBERT M. BARRETT,
Medical Director.
PSYCHOPATHIC HOSPITAL.
11
CLINICAL EEPORT.
As iii former reports, the information regarding the clinical work of
the hospital is considered in two divisions. The first of these includes a
tabulation of the general statistics relating to the clinical disorders
which have been treated during the period; the second is a detailed analysis of the various clinical groups.
GENERAL STATISTICAL
TABLES.
Information given in the general tables may be compared with that
given in similar tabulations by other State institutions for the insane,
but in doing so the peculiar relations under which the State Psychopathic Hospital operates must be borne in mind.
This hospital receives patients from the entire State rather than from
any one district. Admissions, so far as possible, are restricted to mental
disorders in their earlier stages of to those functional mental abnormalities which are not regarded as cominitable to the larger State Hospitals.
The small capacity compared with the other institutions caring for
the insane, and an active demand for admission to a hospital of its
special character, results in a far shorter period of treatment for any individual case than is afforded by the larger institutions.
TABLE No. I.—Showing the number of patients admitted and discharged and remaining
June 30, 1916.
Year ending
June 30, 1915.
M.
Admitted on original commitments .
Public
Year ending
June 30, 1916.
T.
F.
M.
F.
Total
since beginning.
T.
M.
F.
T.
66
1
27
76
5
33
142
6
60
81
10
35
87
8
30
168
18
65
575
94
236
590
88
215
1,165
181
451
By transfer from State institutions .
Public . . .
Private
State. . .
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
0
0
8
7
21
6
2
15
14
»
36
Total number admitted . . . .
94
114
208
126
126
252
941
916
1,857
16
36
39
1
1
12
55
35
1
7
28
91
74
2
8
10
56
51
2
6
11
60
58
1
3
21
116
109
3
9
129
299
417
30
40
138
292
410
16
32
267
591
827
46
72
93
110
203
125
133
258
915
888
1,803
26
28
54
Voluntary
Discharged:
As recovered
As improved . .
...
As not insane
Died
Total number discharged . . .
Remaining June 30 1916
"
"
STATE OF MICHIGAN.
12
In this table are given the number and character of the admissions
and discharges of the period and from the beginning of the work of the
hospital.
The total number of admissions is about 10% greater than for the previous period.
Only one patient was received by transfer from one of the other State
Hospitals.
One hundred and twenty-five patients voluntarily sought treatment
without court commitment. This forms about 27% of all admissions.
The comparative increase each year since the opening of the hospital
is as follows:
1906. 1907. 1908.
Male
Female
1909.
1910.
1911.
1912.
1913.
1914.
1915.
1916.
27
28
39
40
48
59
78
70
89
92
96
96
118
101
109
88
117
104
94
114
126
126
53
79
107
148
181
192
219
197
221
208
252
6.
Total.
The admission for the period by months has been:
July 1, 1914, to June 30, 1915.
7.
8.
10.
11.
12.
1.
2.
3.
4
K
-
Male
Female .
11
6
5
8
12
13
8
9
6
6
4
4
9
9
9
16
8
10
7
10
13
11
94
114
17
13
25
17
12
11
13
16
25
18
17
24
208
PSYCHOPATHIC HOSPITAL.
13
July 1, J.915, to June 30, 1916.
8
9
10
11
12.
1
2
3.
4
9
12
12
10
7
10
14
11
9
9
12
10
6
12
12
13
8
7
12
16
16
9
9
126
126
16
24
17
24
20
21
16
24
21
19
32
18
252
7
Male
it*.
The average monthly admission for the period was 19.
number admitted during any one month was 32.
6
Total.
The largest
TABLE No. II.—Showing the forms of insanity in -patients admitted and discharged from the beginning until June 30, 1916.
Year ending June 30, 1915.
Admitted.
Discharged.
Paraphrenia systematica . . . .
Melancholia, involutional . .
Neuraesthenia . . . .
Anxiety neuroses
Constitutional criminalities .
Psychopathic personalities, adult
Psychopathic personalities, juvenile.
Alcoholic mental disorders . .
..
.
...
General paralysis
.
...
Cerebral arteriosclerosis . .
Cerebral tumor . . .
Huntingdon's chorea . . .
.
...
....
Discharged.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
21
15
1
0
0
28
25
1
49
40
2
7
0
21
20
1
0
0
30
25
1
5
0
51
45
2
5
0
28
15
0
3
0
41
23
5
0
0
69
38
5
3
0
29
15
0
2
0
40
28
4
2
0
69
43
4
4
0
203
165
!1
252
171
27
455
336
38
10
11
198
160
11
2
3
240
166
26
7
8
438
326
37
9
11
0
2
0
1
0
0
12
0
0
0
0
14
0
0
13
0
0
0
0
16
0
0
7
0
0
0
0
20
0
0
0
0
27
0
0
0
0
5
0
0
0
0
19
0
0
0
0
24
0
0
0
11
21 (a) 125
27
17
1
3
2
0
14
146
44
3
19
27
0
0
3
0
1
0
11
120
17
1
0
14
'139
44
4
2
2
0
0
6
3
0
0
0
2
0
2
0
0
8
3
2
0
0
5
3
1
1
0
1
1
14
4
2
31
14
0
2
0
6
4
0
1
12
6
0
0
1
5
0
26
22
5
5
1
4
12
1
3
0
1
3
0
2
0
0
3
0
ll
I
Presenile mental disorders . . .
Admitted.
T.
8
..
Discharged.
Admitted.
F.
?
Imbecility
Total since beginning.
M.
Insane conditions:
Dementia praecox
Year ending June 30, 1916
I
0
n
0
I
•s
I
I
0
0
0
0
0
0
4°
5
I
i
0
0
0
0
0
:
8
'•
T.
0
0
20
0
0
0
0
7
0
0
0
0
11
0
0
0
0
18
0
10
3
2
13
9
5
1
0
22
5
()
0
0
7
0
0
0
0
13
0
15
0
6
3
35
14
12
9
5
1
0
19
5
f
0
1
9
12
3
0
0
3
0
3
0
0
4
12
6
0
0
12
5
0
0
6
0
4
0
0
3
12
9
0
0
9
80
11
1
2
30
3
12
0
0
16
83
23
1
2
46
80
11
1
2
30
3
12
0
0
15
83
23
1
2
45
20
1
4
1
4
16
3
3
1
0
2
1
2
1
1
18
4
17
1
3
1
0
4
3
3
1
0
21
7
6
2
0
136
17
26
15
4
27
11
17
11
14
163
28
43
26
18
132
17
25
15
4
27
10
17
11
13
159
27
42
26
17
4
0
1
0
0
9
1
0
0
0
1
2
0
0
0
10
3
0
0
0
1
2
1
0
0
I
41
19
1
0
0
0
13
60
6
3
4
38
4
2
0
3
19
2
1
1
4
3
6
0
i
7
57
6
3
1
7
Traumatic insanity
Psychoses associated with pernicious anemia
Psychoses associated with articular rheumatism . . .
Psychoses associated with nephritis
Psychoses associated with paralysis agitans
Delirium, toxic. .
....
...
Non-insane conditions—adult :
Sydenham's chorea . .
.
Miscellaneous . .
..
..
Non-insane conditions—juvenile :
Juvenile criminals . . , .
Total . .
...
....
0
0
0
0
1
0
1
0
0
2
3
4
0
2
3
5
3
3
0
4
1
4
3
2
7
6
7
0 I
2
2
4
3
3
0
4
1
4
3
2
6
5
7
0
0
0
0
0
0
0
0
0
4
0
0
0
0
4
0
1
1 (a) 1
0
1
5
4
9
1
2
1
6
13
1
0
0
1
4
0
2
1
5
9
u'Vl
0
0
0
4
0
0
0
3
0
0
0
1
0
0
0
4
0
5
0
36
1
12
4
66
1
17
4
102
0
5
0
36
1
12
4
66
102
0
0
0
0
0
0
0
2
0
0
0
2
0
0
0
0
0
0
0
2
1
2
2
20
0
2
0
12
1
4
2
32
1
2
2
20
0
2
0
12
1
4
2
32
0
0
0
0
0
5
2
7
5
2
252 125 133 258
941
916 1,857
915
888
0
3
0
0
2
3
3
0
0
1
0
1
0
0
3
3
4
0
0
0
3
i
0
0
0
0
1
0
2
0
0
2
0
2
0
0
3
0
1
0
0
0
0
0
0
0
4
0
1
0
0
4
0
0
0
5
0
0
0
2
0
1
0
3
0
1
0
5
0
0
0
3
0
0
0
1
1
0
1
1
0
0
0
0
0
1
0
0
0
1
0
1
0
0
0
1
1
0
0
0
0
2
0
1
1
0
1
1
0
1
0
0
0
0
0
0
0
0
0
0
3
0
0
1
1
3
0
0
0
0
1
0
1
0
0
2
0
1
0
0
3
0
0
0
2
0
0
0
3
0
0
0
1
0
0
0
94 114 208
1
93 110 203 126
3
3
(a) Female: in former period diagnosed hysteria, rediagnosed and discharged as psychosis associated with pellagra.
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Total heredity
1
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.
Insanity
Apoplexy and paralysis
Psychopathic conditions
Alcoholism
17
PSYCHOPATHIC HOSPITAL.
The variety of clinical forms given in this table is about as in former
years. The chief clinical groups occur in about the same relative numbers.
The relative frequency of conditions which could not be classified is
1.9%, a number relatively much smaller than in previous years.
It was possible to obtain some information as to the occurrence of
factors important from the aspect of heredity in 81.9% of all the insane
admitted. In all cases of insanity in which information was obtained,
hereditary influences were present among the ancestors in 67.4%' of instances. These were among the parents in 59.4% of instances; among
the grandparents in 10.8% ; among collateral lines in 14.8% ; and among
the brothers and sisters in 14.8%.
In many families there were several instances of mental abnormalities. In the families of 277 insane individuals there were 825 individuals who showed mental abnormalities.
TABLE No. IV.—Shelving the age of patients admitted.
Year ending
June 30, 1916.
Year ending
June 30, 1915.
M.
From 0 to 4 years
0
2
4
From 15 to 19 years.
From 20 to 24 years .
]2
From 25 to 29 years
From 30 to 34 years .
From 35 to 39 years
18
9
12
6
From 45 to 49 years .
From 50 to 54 years .
From 60 to 64 years .
From 80 to 84 years .
Total .
. . .
7
6
11
0
0
0
0
0
0
94
F.
T.
M.
0
2
4
22
22
0
1
2
5
10
6
3
0
1
0
0
0
34
28
24
20
18
12
18
3
0
1
0
0
0
20
12
20
17
7
7
10
7
4
3
0
0
1
114
208
0
0
0
15
.10
16
19
12
14
11
126
F.
0
0
3
6
16
21
17
14
16
11
9
9
3
0
0
1
0
0
126
Total
since beginning.
T.
0
1
5
11
26
41
29
34
33
18
16
19
10
4
M.
F.
1
7
23
66
104
0
2
6
76
95
3
1
0
1
121
104
114
88
97
68
71
30
15
9
5
1
17
104
120
122
122
91
67
49
25
4
6
2
1
24
252
941
916
T.
1
9
29
142
199
225
224
236
210
188
135
120
55
19
15
7
2
41
1,857
The largest number of admissions occurred between the ages of 20 and
28. The greater number of admissions occurred at earlier ages than in
previous periods.
STATE OF MICHIGAN.
18
TABLE No. V.—Showing civil condition of patients admitted.
Year ending
June 30, 1915.
M.
Single
Married . .
Divorced .
...
Total
F.
Total
since beginning.
Year ending
June 30, 1916.
T.
46
44
2
1
•1
40
62
10
2
0
86
106
12
3
1
94
114
208
M.
49
68
4
4
1
126
T.-
M.
F.
44
70
8
4
0
93
138
12
8
1
408
465
33
32
3
310
508
67
29
2
718
973
100
61
5
126
252
941
916
1,857
F.
T.
TABLE No. VI.—Showing degree of education of patients admitted.
Year ending
June 30, 1915.
M.
6
Academic. . . .
Common school
Read only .
Total
F.
Year ending
June 30, 1916.
T.
M.
F.
Total
since beginning.
T.
M.
F.
T.
1851
13
2
2
2
5
23
74
7
0
0
5
11
41
125
20
2
2
7
13
20
60
18
1
7
7
2
36
69
16
0
1
2
15
56
129
34
1
8
9
67
162
583
64
3
14
41
39
188
606
47
0
1
42
106
350
1,189
111
3
15
83
94
114
208
126
126
252
934
923
1,857
TABLE No. VII.—Showing the occupation of those admitted during the current period
and from beginning.
Year ending
June 30, 1915.
M.
Professional
Personal service, police and military . . .
Manufacturing and mechanical inAgriculture, transportation
Total
and
F.
Year ending
June 30, 1916.
T.
M.
Total
since beginning.
T.
F.
M.
F.
T.
3
10
7
0
4
8
1
1
7
18
8
1
12
10
15
2
11
11
0
0
23
21
15
2
76
71
109
36
56
48
8
4
132
119
117
40
2
13
17
0
3
2
16
4
15
0
8
4
23
17
146
0
85
17
231
2
19
25
4
29
112
12
124
26
0
9
6
1
0
82
6
c
2
26
82
15
11
3
37
0
3
3
0
0
85
3
4
0
37
85
6
7
0
285
0
38
39
12
0
609
25
61
8
285
609
63
100
20
94
114
208
126
126
252
941
916
1,857
PSYCHOPATHIC HOSPITAL.
19
TABLE No. VIII.—-Showing the nativity of patients admitted.
Year ending
June 30, 1915.
Holland .
Ireland
Italy . -. .
Poland . .
...
Total
since beginning.
F.
T.
M.
F.
T.
M.
F.
T.
94
63
81
11
2
114
75
99
13
208
138
180
24
4
126
64
92
24
10
126
78
101
21
4
252
142
193
45
14
941
556
762
135
44
916
577
743
144
29
1,857
1,133
1,505
279
73
0
0
0
1
0
0
0
0
0
1
1
0
0
0
1
0
0
0
1
1
0
0
0
1
2
0
0
1
0
2
0
1
3
0
0
1
1
5
2
1
12
0
2
3
0
7
0
5
4
0
10
0
1
4
1
17
0
6
8
1
45
2
19
27
7
54
0
12
38
99
2
31
65
14
0
1
0
0
0
0
0
0
0
0
1
0
1
2
1
2
0
2
5
0
0
1
0
0
0
0
1
5
7
1
2
1
7
1
0
0
3
1
2
1
1
8
5
4
1
0
7
4
6
0
1
15
9
10
1
0
1
0
14
1
1
1
12
0
0
0
6
1
1
1
18.
M.
Total born in United States . . . . . .
Year ending
June 30, 1916.
0
0
4
0
?
I
0
I
?
0
0
0
I
I
i
i
0
1
1
Sweden . . .
Syria
0
0
0
0
0
0
0
2
1
0
2
0
0
0
Wales . .
0
0
0
2
0
0
0
2
0
0
0
4
0
1
0
10
0
0
0
4
0
1
1
1
1
1
O
1
TABLE No. IX.—Showing the nativity of parents.
Year ending
June 30, 1915.
M.
Both native born
One foreign born, ons native born . .
One foreign born, one unknown . . .
One native born, one unknown . . . .
Unascertained
Total
F.
34
36
10
1
2
11
36
44
17
3
4
10
•04
114
Year ending
June 30, 1916.
T.
70
80
27
M.
F.
Total
since beginning.
T.
M.
F.
606
819
231
9
12
180
1 , 857
41
52
21
2
5
o
84
105
29
5
6
23
293
432
110
6
21
43
53
8
3
1
18
3
99
313
387
121
o
9
81
208
126
126
252
941
916
4
4
T.
In tables VIII and IX it is shown that 15.7% of those admitted were
foreign born and 52.4% had one or both of their parents foreign born.
63.3% of those admitted were born in Michigan.
20
STATE OF MICHIGAN.
TABLE No. X.—Showing counties from which patients have been received.
Year ending
June 30, 1915.
M.
Allegan
Antrim
Bay
Benzie .
Calhoun
Chippewa
Clare
Clinton
F.
Year ending
June 30, 1916.
M.
T.
0
0
2
0
0
0
0
1
0
1
0
0
3
0
1
0
0
0
3
0
0
0
0
6
0
0
0
0
9
0
0
2
1
0
0
1
0
3
0
0
1
2
4
0
0
0
0
0
0
0
2
0
0
0
0
2
0
0
0
0
F.
2
1
1
3
0
1
0
0
4
0
0
3
0
1
0
1
0
0
1
0
0
0
1
0
2
0
1
0
2
2
0
1
3
4
0
0
2
4
1
0
8
0
1
3
0
3
2
0
0
0
1
i
2
0
4
0
2
0
5
1
1
4
0
9
0
0
0
0
2
1
0
0
3
2
1
0
0
3
4
1
1
7
1
0
0
0
7
4
2
1
1
14
5
2
Iron
Isabella
Jackson
Kalamazoo
0
0
3
0
0
0
0
5
2
0
Kent . •.
8
0
0
0
0
6
0
0
4
0
14
0
0
4
0
1
3
0
0
1
1
1
1
0
3
2
4
1
0
4
0
0
0
3
0
0
0
0
0
0
0
0
0
,3
0
2
0
0
0
1
0
0
0
0
3
0
0
0
0
4
0
0
0
2
2
0
Delta
Dickinson
Emmet
Gogebic
Grand Traverse
Gratiot
Hillsdale
Lapeer
Leelanau
Lenawee
Luce
Manistee
Marquette
Mason
Menominee
Midland
Missaukee
0
0 '
0
8
2
0
1
1
1
0
Total
since beginning.
T.
M.
0
0
0
3
0
0
0
1
4
2
1
1
6
0
1
0
1
8
0
0
o
0
0
1
0
1
1
0
0
0
5
1
9
0
0
0
2
1
3
0
1
0
1
4
0
7
1
12
9
0
3
0
10
3
4
4
0
3
26
1
1
0
5
21
0
5
19
15
2
5
5
7
20
3
1
0
1
2
0
10
1
0
8
3
8
0
3
6
2
0
0
6
1
11
0
1
12
2
32
1
0
18
7
43
0
0
4
3
1
1
1
18
29
2
0
1
3
1
7
5
1
4
3
22
17
5
0
3
8
o
1
1
0
1
o
o
0
4
26
8
0
7
0
0
15
0
1
4
0
65
0
2
8
0
7
4
0
0
2
20
15
0
1
8
2
0
1
1
2
4
3
12
4
2
0
0
2
2
0
2
0
21
16
0
i
0
4
2
0
0
2
1
0
0
0
0
0
0
0
0
0
T.
F.
17
25
6
3
36
13
4
0
7
37
3
0
57
1
0
14
1
16
15
2
0
12
2
2
9
0
1
0
1
11
15
0
10
1
22
12
4
5
0
8
47
1
10
26
35
5
6
18
1
3
14
5
1
1
30
9
75
3
1
2
35
54
10
6
58
30
9
0
11
63
11
0
122
1
2
22
1
36
30
2
1
20
6
5
21
4
3
2
1
32
31
0
21
PSYCHOPATHIC HOSPITAL.
TABLE No. X.—Concluded.
Year ending
June 30, 1916.
Year ending
June 30, 1915.
M.
Otsego .
St Clair .
St Joseph .
Tuscola
Van Buren . . .
Washtenaw
Wexford
Total .
...
P.
T.
1
0
0
0
0
0
0
0
0
3
0
0
1
2
0
0
3
2
0
0
9
24
1
1
2
0
0
0
1
0
0
0
0
2
0
0
6
1
0
2
1
0
0
0
12
20
0
0
3
0
0
0
1
0
0
0
0
5
0
0
7
3
0
2
4
2
0
0
21
44
1
1
94
114
208
M.
F.
Total
since beginning.
T.
16
23
0
1
1
0
2
1
0
0
0
0
0
7
0
0
1
3
0
1
0
1
0
0
17
27
1
0
5
0
3
1
0
0
0
0
0
13
0
0
2
5
0
1
4
1
0
1
33
50
1
1
126
126
252
4
0
1
0
0
0
0
0
0
6
0
0
1
2
0
0
4
0
0
1
M.
F.
T.
4
2
14
2
2
0
9
0
1
42
0
2
54
8
1
12
3
27
3
2
0
13
0
2
79
3
4
101
17
1
4
4
18
17
5
2
4
109
135
1
0
33
33
11
4
16
234
266
5
4
941
916
8
1
13
1
0
0
4
0
1
37
3
2
47
9
0
15
16
6
2
12
125
131
1,857
Tlie State Psychopathic Hospital is an institution to which any county
of the State may send patients. Since the opening of the Hospital, patients have been received from 78 of the 83 counties of the State. During this period, patients were admitted from 59 different counties. The
largest numbers came from Wayne, Washtenaw and Kent.
TABLE No. XI.—Showing the form of insanity of patients discharged and the results of treatment.
Total since beginning.
Period ending June 30, 1916.
Recovered.
Improved.
Unimproved.
Recovered.
Not
insane.
Died.
Improved.
Unimproved.
Not
insane.
Died.
M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T.
Insane conditions:
Manic depressive insanity
Dementia praecox
Paraphrenia systematica
Psychopathic conditions
Constitutional criminalities
Psychopathic personalities, adult . . .
Psychopathic personalities, juvenile.
Alcoholic mental disorders
Cocaine intoxication.
Imbecility
General paralysis
Cerebral syphilis . . .
Amyotrophic lateral sclerosis
16 12 28 20 29 49 13 28 41
0 1 1 14 26 40 21 26 47
0 0 0 0 3 3 1 2 3
0 0 0 1 4 5 1 3 4
0 0 0 0 0 0 0 0 0
1
0
0
0
0
0
0 63 64 127 70 72 142 59 101 160
0 1 3 4 47 47 94 111 116 227
0 3 1 4 5 10 15 3 14 17
0 0 0 0 1 4 5 1 3 4
0 0 0 0 1 0 1 2 8 10
8
0
1
0
0
0
0
6
0
0
0
0
7
0
0
0
0 0 0
5 22 27
0 0 0
1 0 1
0 0 0
0
2
0
0
0
0
4
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 1 1
5 40 45 10 57 67
6 3 9 14 9 23
0 0 0 3 1 4
2 0 2 0 0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
2
0
0
0
C
2
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
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0
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0
0
0
7
1
0
1
0
0
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0
0
0
0 1C
7
3 1 3
0 0 0 0
1 0 0 0
0 2 0 4
1
0
0
0
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0
0
c 0
7 16
80
0
0
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0
0
0
0
0
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0
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0 31
0 ' 5
0 0
0 2
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1 32 33
7 12 6
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0
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2 35 13 0 13
4 10 0 1 1 I
0 1 0 0 0 0
0 0g 0 0 0 0
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26 24 40 0
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0
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0
0
0
5
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0
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23 12 35
0 ( 0
6 A 8
1 j: 3
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1
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0
0
0
0
0
0 17
1 11
0 11
0 2
] 0
1 18 107 25 132
7 18 4 3 7
3 U 14 14 28
0 2 11 10 21
6 6 2 7 c
8
1
0
2
0
0
0
0
1
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
1
0
1
0
0
5
0
1
0
0
0
2
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 16
0 0
( 0
0 0
0 0
7 23 17 10 27
0 0
0
1 1
0
1 ]
0 0 (
1 1
3 6
5
1
0
0
0
2
2
0
0
0
C
0
0
iS2
1 01
0
11
0
2£
'±
£
1
0
0
0
£
3
t
1
1
0
0
1
0
0
0
0
6
1
1
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
80
0
0
1
(
0
3
0
0
0
0
3 9 12
4 21 25
10
5
0 g 0
0 0 0
5 1 6 2
^C 3 1 4 0
0 1 0 1 1
0 12 17 29 0
0 6 3 9 3
0
0
0
3
2
2
0
1
3
5
6
2
0
0
0
3
0
1
0
0
9 0
2 0
1 0
0 0
0 0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
1
2
0
0
0
1
2
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
d
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
7
TABLE No. XL—Concluded.
Period ending June 30, 1916.
Improved.
Recovered.
Unimproved.
Total since beginning.
Not
insane.
Died.
Recovered.
Improved.
Unimproved.
Not
insane.
Died.
M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T.
Basedow's disease
Psychoses associated with pernicious
Psychoses associated with articular
Psychoses associated with nephritis .
Psychoses associated with myxoePsychoses associated with pellagra . .
Psychoses associated with paralysis
agitans . . . . . .
Delirium, toxic. .
Delirium, collapse. .
Post infectious psychoses
Unclassified conditions
Non-insane conditions — adult :
Sydenham's chorea . .
Tabes dorsalis
Miscellaneous
Non-insane conditions —juvenile:
Total .
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
1
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
fl
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
2
0
0
0
1 0
2 0
2
0
0
0
1
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
3
0
1 1
0
1 a
0
0
0
0
3
0
0
0
1
0
0
0
4
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0'
0
0
o
0
0
0
0
0
0
0
0
0
0
0
1
1
0
4
2
5
0
1
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
1 1
26 23 49 92 115 207 90 93 183
0
0
0
0
1
0
0
0
0
0
0
0
0
2
1
0
0
0
0
0
0
0
0
0
0
0
4
0
2
3
0
2
7
0
0
0
0
0
0
0
0
0
3
0
0
1
4
2
4
1 0 0 0 0 0 0
7 0 4 4 0 0 0
2 0 1 1 0 1 1
4 15 19 34 18 36 54
0
1
0
3
0
0
1
2
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 1 0
0
0
0
0
0
0
0
0
7 10 17
3
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
1 1
1
1
0
0
3
3
1
4
3
5
1
0
0
1
0
0
1
0
2
0
1
0
1
2
0
0
1
0
1
0
0
0
0
0
0
2
2
4
0
0
0
1
0
0
0
1
0
1
2
0
0
1
2
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
2
1
0
0
0
1 1 1 0
0 0 0 2
1 1 1 3
1
2
4
0
0
0
0
0
0
0
0
0
0
4
0
6
0
5
0
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 1 0 1
0 2 2 4
0 2 0 2
0 20 12 32
0
0
0
2
5
0
0
2
0
0
7
5 129 138 267 299 292 591 417 410 827 40 32 72 30 16 46
TABLE No. XII.—Showing the duration of residence in months of all cases discharged.
Recovered.
M.
F.
Improved.
T.
M.
F.
Unimproved.
M.
T.
F.
Died.
M.
T.
F.
Not insane.
M. .
T.
F.
Total.
T.
M.
F.
T.
2
0
0
4
12
0
0
0
3
5
2
0
0
7
17
2
0
4
13
26
0
0
3
8
34
2
0
7
21
60
9
6
5
9
20
6
3
8
6
21
15
9
13
15
41
0
1
1
1
1
0
3
1
3
1
0
4
2
4
2
0
0
0
1
1
0
0
0
1
1
0
0
0
2
2
13
7
10
28
60
6
6
12
21
62
19
13
22
49
122
4
0
0
1
2
7
2
0
2
2
11
2
0
3
4
19
5
9
5
2
18
9
11
11
6
37
14
20
16
8
11
11
5
29
19
13
9
3
2
0
0
1
0
1
0
0
5
18
8
8
4
3
3
0
0
2
0
1
0
0
0
0
0
0
0
0
0
1
0
0
0
0
37
16
14
12
4
44
19
19
18
11
81
35
33
30
15
8 months. . .
9 months
10 months . . .
1
0
0
0
2
0
0
0
3
0
0
0
2
2
0
1
3
5
0
4
5
7
0
5
3
2
2
0
0
2
1
1
4
3
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
4
2
1
5
7
1
5
11
11
3
6
14 months . .
18 months
25 months . .
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
1
1
1
0
3
1
1
0
1
1
0
0
2
0
1
1
3
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
1
0
0
3
1
2
1
6
2
2
1
26
23
49
92
115
207
90
93
183
7
10
17
3
2
5
218
243
461
1 week or less
2 weeks . . . .
3 weeks . .
4 weeks . . . .
2 months . .
3 months.
4 months. . . .
5 months. . .
7 months . .
Total
...
1
0
1-3
H
O
W
PSYCHOPATHIC HOSPITAL.
25
In table XI are given the results of treatment according to clinical
type. Patients are classified as recovered when they are in their normal
mental condition at the time they are discharged; as improved when
their mental condition is improved over that at the time of their admission; as unimproved when their mental condition has not changed for
the better at the time of their discharge.
According to the above standards, 13.5% of those discharged were recovered, 31.7% improved, and 50.5% unimproved. The deaths numbered
2.8% of those discharged.
Table XII gives the length of residence of the patients discharged.
Of those discharged 22.4% remained in the hospital one month or less;
66.4% remained three months or less, and 12.3% remained longer than
t> months.
More than three-fourths of the recoveries occurred with a period of
treatment that did not exceed three months.
TABLE No. XIII.—Shoieing the age of patients discharged recovered.
Period ending
June 30, 1916.
M.
From 10 to 14 years. .
From 15 to 19 years . . . .
From 20 to 24 years . . .
From 25 to 29 years
From 30 to 34 years . . .
From 35 to 39 years ...
From 40 to 44 years
From 45 to 49 years . . .
From 50 to 54 years
From 55 to 59 years
From 60 to 64 years
From 65 to 70 years . . .
Unascertained
Total . . .
..
,
...
.
0
3
3
1
1
4
5
2
3
3
1
0
0
26
F.
Total
since beginning.
M.
T.
0
3
3
4
2
1
0
6
6
5
3
5
2
4
2
1
1
0
0
23
F.
T.
7
6
5
4
2
0
0
0
13
9
14
13
21
18
14
12
8
4
1
2
2
15
18
24
15
17
15
14
10
5
2
1
0
2
28
27
38
28
38
33
28
22
13
6
2
2
49
129
138
267
STATE OF MICHIGAN.
26
TABLE No. XIV.—Showing the causes of death.
Period ending
June 30, 1916.
M.
Abscess, cerebral
Broncho-pneumonia
...
Broncho-pneumonia, general paralysis
....
Cystitis . . .
...
..
....
Exhaustion in delirium
Exhaustion, general paralysis
Gangrene, senile
Gastric ulcer, haemorrhage
Suicide, by cutting throat with pin
Total
T.
0
1
0
0
0
I
0
0
1
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
Nephritis, acute parenchymatous
F.
Total
since beginning.
M.
0
3
0
0
0
0
0
1
0
0
0
0
0
o1
1
1
1
1
1
0
0
0
0
0
0
1
0
1
1
2
0
Q
0
1
T.
0
4
0
1
4
1
1
0
0
0
0
2
1
6
0
1
0
1
1
0
2
0
1
0
3
2
4
1
2
0
1
1
0
0
2
1
0
0
40
32
0
1
0
2
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
7
10
17
1
1
1
2
1
0
3
3
0
2
1
1
1
1
F.
0
3
1
2
1
6
1
1
7
4
1
2
1
1
1
1
3
3
6
2
1
1
2
3
4
2
3
2
5
1
1
2
1
3
72
TABLE No. XV—Showing age of patients who died.
Year ending
June 30, 1915.
M.
From
From
From
From
From
From
From
10 to 14 years
20 to 24 years
25 to 29 years .
30 to 34 years .
35 to 39 years
40 to 44 years . . .
50 to 54 years
From 60 to 64 years
Total
..
F.
Year ending
June 30, 1916.
M.
T.
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
2
0
1
0
0
0
0
0
0
0
0
0
0
0
0
5
2
0
0
0
0
0
0
1
0
0
0
0
0
0
3
0
0
0
0
2
6
8
5
1
0
0
0
1
F.
Total
since beginning.
T.
0
0
0
0
0
1
0
0
0
0
0
2
1
0
0
0
4
M.
0
0
0
0
0
2
0
0
0
1
0
5
1
0
0
0
9
F.
T.
1
0
1
0
0
3
3
4
4
6
3
7
4
0
1
2
0
0
1
3
2
1
0
7
7
3
4
3
1
1
0
0
39
33
1
2
3
2
4
3
11
11
9
7
10
5
1
o.
2
72
27
PSYCHOPATHIC HOSPITAL.
TABLE No. XVI.—Showing the number of transfers between the Psychopathic Hospital and
the State Insane Hospitals.
K. S. H.
P. S. H.
M.
Received by transfer from
Transferred to
F.
'.in' 'si'
F.
T.
M.
52
13 ' i t '
1
T. C. S. H.
T.
M.
F.
T.
M.
F.
1
30
8
13
21
1
1
Epileptic
Farm
Colony.
W. C. H.
M. I F.
M.
F.
N. S. H.
M.
2
Total
since
beginning.
Lapeer.
T.
T.
F.
T.
M.
F.
T.
' '6'
' i
37
45
25
63
61
108
1
Received by transfer from
Transferred to
0
i
i
. .„
6
i ' 'i'
Of all patients discharged, 23.4%' were transferred directly to one of
the State Hospitals for the Insane.
OUT-PATIENT
SERVICES.
During the present period the State Psychopathic Hospital has undertaken a new line of activity, by the establishment of out-patient services.
For several years the Hospital has been interested in what might be
designated as extra-mural problems of mental disorders. This interest,
and an appreciation that it was possible to make the hospital more
widely useful to the State, has lead to the organization of out-patient
services.
At the present time, two of these have been established, one at Anu
Arbor, and one in Detroit.
PSYCHIATRIC OUT-PATIENT SERVICE, UNIVERSITY HOSPITAL.
In May, 1915, the Psychopathic Hospital organized a local out-patient
service in psychiatry in connection with the General Hospital of the
University of Michigan.
The patients are referred directly to the service by the admitting physician of the General Hospital or from one of its clinical services.
The following table gives statistical information regarding this work:
STATE OP MICHIGAN.
28
TABLE I.—Showing the number and source of out-patients.
Admitting physician—general hospital.
Clinic of neurology
Clinic of dermatology
Clinic of internal medicine
Clinic of otology
Clinic of gynecology
Clinic of surgery
Clinic of obstetrics
Clinic of genito-urinary surgery.
Clinic of ophthalmology
University health service
Total.
Male.
Female.
Total.
19
32
14
12
10
22
5
14
0
11
3
3
0
0
0
29
54
19
26
91
68
159
TABLE II.-—Showing diagnosis made in out-patients examined.
Male.
Manic depressive insanity.
Dementia praecox
Anxiety neurosis
Hysteria
Presenile mental disorder. .
Epilepsy
Imbecility
Cerebral arteriosclerosis. . .
Senile insanity
General paresis
Cerebral syphilis
Symptomatic mental state.
Alcoholic mental disorder..
Unclassified mental state. .
Pituitary disease
Hereditary syphilis
Tabes dorsalis
Infantile hemiplegia
Juvenile delinquency
Miscellaneous
Total. . .
Female.
Total.
11
5
5
12
7
4
16
4
23
12
5
7
4
0
21
5
1
2
0
5
1
1
3
5
12
5
1
24
1
4
0
25
5
2
12
1
2
2
1
2
5
92
160
PSYCHOPATHIC
HOSPITAL.
29
DETKOIT PSYCHOPATHIC CLINIC.
RESIDENT OFFICEES.
Nellie B. Perkins, Ph. D., Psychologist.
Ethel Plumb, Social Service Assistant.
In February, 1916, an out-patient service was established in Detroit.
This service was organized in connection with the Wayne County Juvenile Court and the Associated Charities of Detroit. The clinic is located
in the Wayne County Detention Home.
Through the financial aid of the Associated Charities of Detroit, it
has been possible to provide resident assistants, who are in local charge
of the work of the clinic, and to conduct the work with systematic
thoroughness.
The Psychopathic Clinic will examine any individual with mental disorder referred to it from any of the organized charities of Wayne County,
and give advice as to treatment. Patients entering the clinic are first referred to the social service assistant,who prepares a personal history of the
patient. The information embodied in this is obtained from investigations
into the family and social life of the patient, and the relations which may
have occurred with various charitable or correctionary organizations.
With this record, the patient comes to the psychologist of the clinic,
who makes a mental examination of the patient. After these preliminary examinations have been made the patient is presented at a clinical
conference held each week by a physician from the staff of the State
Psychopathic Hospital. Further examinations may then be made and
advice given as to the patients future care and treatment.
The following tables give statistical information concerning the work
of the clinic.
STATE OF MICHIGAN.
30
TABLE I.—Showing the number of patients examined and the sources from ivhich they were
referred to the clinic.
Probate Court, Juvenile Division
Probate Court, Insane Division
Probate Court, Mothers' Pension Division
Associated Charities, Main Office
Associated Charities, Children's Aid Society
Associated Charities, Woman's Hospital
Associated Charities, Salvation Army
Associated Charities, Y. W. C. A
Poor Commission
Board ol Health
Board of Education
Jewish Charities
Catholic Charities
Federated Clinics
Family or private physicians
Visiting Nurse, Dodge Bros
Circuit or Police Court
Florence Crittenden Home
Ford Motor Co., Social Service
Edison Electric Co
Girls' Protective League
House of the Good Shepherd...
Total
35
6
10
8
19
5
1
1
3
11
2
3
125
TABLE II.—Showing diagnosis made in patients examined.
Feeblemindedness
Subnormality
Psychopathic personality. . ..
Manic depressive insanity. . .
Dementia praecox
Cerebral syphilis
Symptomatic mental disorders.
Alcoholic insanity
Paranoid condition
Hysteria
Unclassified conditions. .
Total.
30
11
2
1
7
2
2
10
40
125
PSYCHOPATHIC HOSPITAL.
31
REPORT OF THE CLINICAL GROUPS.
MA,NIC DEPRESSIVE INSANITY.
During this biennial period there were admitted 118 cases of manic
depressive insanity of which number 49 were males and 69 females. The
following table shows the frequency of this form of disorder among the
admissions to this hospital.
Female.
Male.
Per cent.
No.
Manic depressive insanity
220
49
22.3
No.
Total.
Per cent.
240
C9 "28^7'
Per cent.
No.
460
118
25.4
There are considered among those under treatment during this period
G males and 13 females who were admitted during the previous period
but were discharged in this. In all, 137 cases of manic depressive insanity were under treatment.
There was a relative increase of 2.7% in the number of admissions with
this disorder over that of the previous period. This increase was about
equal for the two sexes.
The following table shows the relative frequency of the several forms of
this disorder. The diagnosis was determined from the phase of the
disorder present at the time of admission.
Male.
No.
Manic
Depressive. . .
Mixed
19
29
1
Female.
Per cent.
38.8
59.1
2.0
No.
23
44
2
Per cent.
33.3
63.7
2.9
Total.
No.
42
73
3
Per cent.
35.6
61.8
2.5
It will be seen from this table that the depressive phase was the most
frequent type. It appears to be the more frequent in the female sex,
while the manic phase was more frequent in the male sex. The admissions in the mixed phase showed a decrease of 9% from those of the previous period, only 2.5% of the manic depressive cases showing this phase.
The three following tables show the number of patients who have had
at least one attack other than the one at present; the form of the first
attack in those having more than one attack, and the form of the first
attack in all cases admitted.
32
STATE OP MICHIGAN.
Male.
More than one attack
First attack.
Female.
21
28
Total.
51
67
30
39
The form of the first attack in those patients having more than one
attack is shown in the following table.
Male.
Manic
Female.
8
38
2
3
5
24
0
1
3
14
2
2
Mixed
Total.
The form of the first attack in all cases of manic depressive insanity
admitted was as follows :
Male.
Female.
16
29
2
2
18
49
1
1
Manic
Mixed
Total.
34
78
3
3
These tables show that a previous attack had occurred in 42.8% of all
male and 43.4% of all female cases of this disorder. In the group as
a whole, previous attacks had occurred in 43.2% of all cases admitted.
In seven, or 5.9% of the cases, the first attack presented a phase different from the one at this admission.
The form of the first attack in all cases admitted was manic in 28.8%;
depressive in 66.1%; mixed in 2.5% and unknown in 2.5%.
The following table shows the age of patients at the time of the first
attack and the age of the patients at the time of their admission.
Admission.
First attack.
Depressive.
Manic.
Manic.
Mixed.
Mixed.
Depressive.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
10-14.
15-19.
20-24.
25-29.
30-34.
1
4
1
5
2
2
9
5
3
10
0
3
4
2
4
0
1
7
8
5
0
4
11
10
9
0
0
0
1
1
0
0
1
5
2
8
6
4
9
0
0
2
0
2
0
0
3
3
4
0
0
5
3
6
0
0
2
1
4
4
2
4
0
0
1
4
2
0
0
0
0
0
0
0
0
0
0
0
35-39.
40-44.
45-49.
50-54.
55-59.
0
1
0
0
1
1
1
2
1
0
1
2
1
3
3
7
9
8
4
5
1
11
9
7
8
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
2
2
1
3
1
0
2
1
3
3
2
6
2
3
3
9
7
9
4
6
8
13
11
7
9
17
1
0
0
0
0
0
0
0
0
0
0
0
0
0
60-64.
65-69.
70-74.
75-79.
Unk..
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
1
0
0
2
0
0
0'
0
1
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
1
6
2
4
2
2
1
1
0
0
0
0
0
1
1
1
1
1
0
0
1
1
T.
1
1
1
PSYCHOPATHIC HOSPITAL.
33
It may be observed from this table that where the first attack was
manic in phase that 38.1% were under the age of 25. Where the first
attack was one of depression, 20.5% were tinder the age of 25. In all
cases admitted, the first attack occurred before the 25th year in 27.2%
and before the 50th year in 83.8% of instances.
HEREDITY.
Information concerning the occurrence of nervous and mental disorders in the families of the patients with this disorder was obtained in
105 of the 108 cases admitted.
The nature and distribution of these are shown in the following table.
In 82% of the families where information was available, there were
instances of mental abnormalities other than those of the patient.
In the families of the 87 cases showing abnormalities of the family and
antecedents there were 35 in which there was one other instance of abnormality. There were 23 families with 2, 18 with 3, 6 with 4, 3 with 5,
1 with 6, and 1 with 8 instances of abnormalities. In the 87 families,
there were 270 abnormal individuals.
Atavistic.
Direct.
Apoplexy or paralysis . .
Psychopathic . . . .
M
F
T
13
15
6
28
4
5
5
8
30
50
?
Total heredity . . . . 20
Q
M.
4
1
p
Collateral.
T
M.
F
Brothers
and
sisters.
Total.
T.
M.
F.
T.
M
F
5
T
3
2
0
0
7
3
1
1
8
0
1
0
7
1
0
1
15
1
1
1
1
0
0
0
4
1
0
I
0
26
4
3
4
29
10
5
6
55
14
8
10
5
12
9
9
18
1
6
7
37
50
87
6
6
12
7
18
13
49
69
118
Total
ETIOLOGY.
Of the 118 patients admitted, 18 were regarded by their friends as
showing peculiarities of personality preceding the acute outbreak.
In 77 cases there were experiences closely associated with the onset of
the disorder, which were regarded by their friends as of causative; importance.
In 11 cases the onset was associated with puerperal experiences. In
one instance short manic episodes of a week to ten days duration occurred at the menstrual period. In 11 instances, financial difficulties were
assigned as the cause. Physical illness or surgical treatment was noted
in 8 instances. Overwork or illness in the family were regarded as
causes in 26 instances.
Wassermann examinations of the blood serum were made in 117 of the
34
STATE OF MICHIGAN.
118 admissions. It was found strongly positive in three cases. The first
of these was a woman of 24 admitted in a frank manic excitement. The
history showed a previous depressed phase. The neurological examination and the examination of the cerebrospinal fluid was negative. Her
mental condition returned to normal after four months.
The second case was a woman 32 years old who showed in her previous life many episodes of abnormal irritability and finally was admitted
to the hospital, showing the characteristic symptoms of the manic phase.
There were no evidences of involvement of the central nervous system by
syphilis shown in the neurological or spinal fluid examinations.
The third case was a male 32 years of age at the time of his admission.
The history showed many manic episodes for the seven years prior to his
admission. In the hospital he showed a mild euphoria with a slight
paranoid trend and a pressure of thought and motor activity. No pathology was revealed by the neurological examination but the Wassermann
examination of the cerebrospinal fluid was slightly positive. There was
no increase in the albumen or globulin content nor in the cellular elements.
One patient, a male 39 years of age, in his second attack of depression
showed a doubtful Wassermann on the blood serum without other evidence of luetic involvement, but the history revealed the fact that his
wife died of general paresis a few months prior to his last attack.
RESULTS OF TREATMENT.
The following table shows the condition of the cases of manic depressive insanity at the time of discharge from the hospital. There are considered here the cases admitted during this period and 19 cases of this
disorder remaining over from the previous period.
The average duration of treatment was 117.9 days. All the patients
were discharged to their homes, except 35 who were transferred to the
various State Hospitals.
Manic.
Unimproved . .
Died
Depressive.
Mixed.
M.
F.
T.
M.
F.
T.
M.
F.
6
9
5
0
3
7
8
0
2
9
16
13
0
10
10
8
1
4
8
21
19
1
10
18
31
27
2
14
0
1
0
0
0
1
1
1
0
1
3
0
Total.
T.
1
2
1
0
0
M.
F.
16 12
20 29
13 28
1
1
5 12
T.
28
49
41
2
17
It may be seen from this table that of the 120 patients discharged
23.3% were discharged recovered; 40.8% improved; 34.1% unimproved;
and 1.7% died.
Of the 38 cases of the manic phase 23.7% were discharged recovered
and 42.1% improved. Of the 78 depressive cases 23.5% were discharged
recovered and 39.7% improved.
Grouping the recoveries and improvements together we find from this
table that 65.8% of the manic cases and 62.8%' of the depressive cases
PSYCHOPATHIC HOSPITAL.
35
were benefltted by their hospital treatment. Two patients died from intercurreut disorders. It was possible to make a laboratory study of the
central nervous system in one of these.
Case 1727. Agitated depression:—A male in whose family were two
other instances of mental abnormalities. Throughout his life he had
been regarded as one who was extremely irritable. At the age of 50 he
was definitely depressed following some neighborhood trouble, but was
not in a hospital. At 58 his wife left him and instituted divorce proceedings because of his extreme irritability. He again became depressed and
continued so for two months. After this, his wife returned to him. Two
months before his admission, at the age of 60, she again left him and be
became depressed and attempted suicide. The examinations showed him
moderately emaciated with evidences of arteriosclerosis. His blood pressure was 150. He was extremely weak and his mood Was that of deep
depression. He talked but little and what he said coincided well with
his mood. He expressed self pity, talked of being poisoned, and made
feeble attempts at suicide. He became more deeply depressed and gradually failed in strength, in spite of supportive and stimulating measures. After five weeks he developed a severe diarrhoea and passed into
a deep stupor, in which he died on the third day.
The autopsy showed an early carcinomatous change of the pylorus.
The gross examination of the brain showed slight arteriosclerosis of the
basal trunks and a moderate degree of leptomeningitis.
Histological examination of the cortex showed a moderate fatty degeneration of the nerve cells. The vessel lymph spaces held large accumulations of fatty pigments. The process as a whole appeared to be one
of recent origin. Aside from this, the cortex showed little that was pathological.
DEMENTIA PREACOX.
There were admitted 78 patients whose mental disorder was diagnosed
dementia praecox. This number formed 16.9% of all patients admitted.
Male.
No.
Hospital admissions
220
30
Per cent.
' 'ii'.e'
Female.
No.
240
48
Per cent.
'ao.'o'
Total.
No.
460
78
Per cent.
16.9
The 30 male cases formed 13.6% of all men admitted and the 48 female
cases 20.0% of all women admitted.
The 78 cases occurred in the following types.
STATE OF MICHIGAN.
36
Male.
No.
Dementia simplex
Female.
Per cent.
Catatonia
5
19
4
2
Total
30
No.
16.6
63.3
13.3
6.6
Total.
Per cent.
4
g
6
8.3
56.2
22.9
12.3
No.
Per cent.
9
46
15
8
48
11.5
59.0
19.2
10.2
78
AGE.
The onset occurred before the 25th year in 36.6% of the male cases
and 50% of the females, or 44.7% of all cases of dementia praceox which
were admitted.
The youngest age of onset was 10 years and the oldest 41.
Admission.
Onset.
M.
T.
F.
M.
F.
T.
10-14..
15-19
20-24 .
25-29 . . . .
30-34 .
1
3
7
14
2
2
7
14
9
7
3
10
21
23
9
0
3
6
16
2
1
8
9
16
6
1
11
15
32
8
35-39 . . .
40-44
45-49
3
0
0
0
5
2
0
2
8
2
0
2
3
0
0
0
4
3
1
0
7
3
1
0
The relative frequency of occurrence before the 25th year of the various clinical forms was:
Per
cent.
Dementia simplex
Hebephrenic
Catatonic
Paranoid
88.8
39.1
53.3
0.0
Information concerning hereditary influences was obtained in 71 instances. Of these, there were 41 or 57.7%, in which there was insanity
or some other predisposing factor present among the ancestors or
families.
PSYCHOPATHIC HOSPITAL.
Direct.
M
4
2
2°
Total heredity. . . .
8
T
M
F
j
T
M.
F
I
Brothers
and
sisters.
Collateral.
M.
T
F
Total,
T
3
3
4
3
5
4
5
2
1
0
0
4
0
0
3
5
5
0
0
1
0
1
0
5
0
0
0
6
0
1
0
1
0
0
0
2
0
0
0
COOOO
Insanity
Apoplexy or paralysis . .
F
Atavistic,
37
13
21
3
7
10
2
5
7
1
2
3
Total
M.
F
T.
8
3
1
2
13
7
4
3
21
10
5
5
14
27
41
12
4
18
3
30
30
48
78
In 39 families there was more than one occurrence of disease, and in
families of the 78 cases of dementia praecox there were 153 known instances of mental and nervous abnormalities.
ETIOLOGY.
In 21 instances the onset of the disease was associated directly with
some unusual experience in the life of the individual. In five instances,
the first symptoms followed a physical injury. In 5 there were unusual
sexual complications at the onset. Four cases developed following childbirth.
RESULTS OF TREATMENT.
The results of treatment are shown in the following table. In addition
to those admitted during the period, there are included 10 males and 10
females who were admitted previous to the present period.
M.
F.
0
Unimproved . . .
Died
14
...
21
0
5
Per cent.
T.
1
26
26
0
5
1
40
47
0
10
51 3
62.5
12.8
Of those discharged, 56 returned to their families and 31 were transferred to one of the State Hospitals for the insane.
DEMENTIA SIMPLEX.
There were admitted 9 cases of dementia praecox, 5 male and 4 female,
in which the course was that of a simple deterioration, without delusions or hallucinations.
STATE OF MICHIGAN.
38
This number formed 11.5% of all cases of dementia praecox admitted.
The ages at onset and at admission are shown in the following table:
Onset.
M.
10-14..
15-19
20-24. .
25-29
.
F.
1
2
. .
Vdmission
T.
1
]
1
1
2
0
F.
M.
2
3
3
1
T.
1
1
1
1
0
3
1
1
1
4
9
2
In 88.8 per cent of the cases the disease developed before the age of 25.
The results of treatment of the patients of this group are shown in the
following table. This includes 1 male admitted in the previous period.
M.
F.
0
2
3
1
T.
0
3
1
0
0
4
1
All of those discharged were returned to their homes.
HEBBPHBENIC FORM.
There were admitted 46 cases of this form of dementia praecox. Of
there, 19 were males and 27 were females. This number constituted 59%
of all cases of dementia praecox admitted.
The ages at onset and at admission were:
Onset.
M.
10-14. .
15-19
20-24 .
25-29
30-34
35-39. .
40-44
Unknown
Admission
T.
F.
M.
1
5
7
6
1
6
11
18
1
1
t
0
0
0
2
3
5
0
2
0
1
4
12
4
F.
T.
0
0
4
13
0
6
4
11
0
6
8
24
1
1
2
3
4
1
0
0
0
3
1
0
In 39.1% of these cases, the onset occurred before the age of 25.
The following table gives the results of treatment. In this are included 5 males and 6 females admitted in the former period.
PSYCHOPATHIC HOSPITAL.
39
M.
F.
0
T.
0
14
16
3
15
2
0
21
31
Of the 32 patients who were discharged, 12 males and 12 females were
transferred to one of the other State Hospitals. The remainder were returned to their homes.
CATATONIC FORM.
There were admitted 15 cases which showed the clinical course of the
catatonic form of dementia praecox. Four of these were males and 11
females. This group constituted 19.2% of all cases of dementia praecox
admitted.
The ages at onset and admission were:
1Admission
Onset.
M.
F.
0
1
15-19
20-24
25-29 .
30-34
35-39 . .
2
0
1
T.
1
0
I
2
1
F.
M.
1
0
1
3
2
0
1
9
2
T.
1
1
5
5
4
3
2
1
2
2
The onset in 53.3% of the cases was before the age of 25.
The results of treatment are shown in the following table, included
in this is one case admitted during the previous period.
M.
F.
0
3
1
1
T.
1
4
5
1
1
7
6
2
PARANOID FORM.
There were 8 cases of the paranoid form of dementia praecox. Two
of these were males and 6 were females.
7
40
STATE OF MICHIGAN.
The ages at onset and admission were:
Onset.
F.
M.
25-29
30-34 . .
35-39
40-44
45-49
l Admission
T.
1
3
0
0
1
1
0
1
o
0
T.
1
0
1
1
0
4
1
2
2
o
F.
M.
1
. 3
2
1
2
1
0
2
1
o
The disease developed in all instances after the age of 25. The earliest
age of onset was 28 and the latest 41.
The results of treatment are shown in the following table. Included
in this are 3 males and 3 females admitted in the previous period.
M.
Recovered .
Improved
.
.
F.
0
2
2
1
T.
0
4
4
1
0
6
6
2
Five of those discharged were transferred to another State Hospital.
PARANOID MENTAL DISORDERS.
Under this heading are placed a number of cases in which the mental
symptoms were of a paranoid type, but in which the clinical course was
different from that of the paranoid form of dementia praecox and
it did not seem possible to find a relationship with any specific cause.
Some of these cases in their clinical course correspond to the group
which Kraeplin has arranged as paraphrenia systematica. Others having certain features in common but less clear in their clinical position
are placed in a general group of paranoid conditions.
PARAPHRENIA SYSTEMATIC^.
The mental disorders of ten individuals admitted during the period
are grouped under this heading. Three of these were males and 7 females. This number formed 2.2% of all admissions.
Female.
Male.
No.
Paraphrenia svstematica,
220
3
Per cent.
1 .4
No.
240
7
Total.
Per cent.
2.V
No.
460
10
Per cent.
2^2
41
PSYCHOPATHIC HOSPITAL.
Of those discharged, 5 were transferred to one of the other State Hospitals for the Insane.
The ages at onset and admission were:
1Admission
Onset.
M.
F.
1
20-24 . .
25-29 . . . .
30-34 . .
35-39
40-44 .
45-49 . . .
50-54 .
55-59
. .
F.
M.
T,
0
0
0
1
0
5
1
3
0
5
0
1
1
1
0
0
1
4
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
1
0
0
1
2
...
T.
0
1
2
5
1
0
0
1
Hereditary factors were present among the ancestry in three instances.
RESULTS OF TREATMENT.
The results of treatment were:
Recovered
.
Unimproved . . . .
.
.
.
T.
F.
M.
0
0
4
3
0
0
1
1
1
. .
5
4
1
Of those discharged, 7 were returned to their families and 2 were transferred to one of the State Hospitals.
PARANOID DISORDERS (UNDIFFERENTIATED) .
There were admitted during the period a number of individuals whose
mental disorder was characterized by more or less elaborated delusions,
and which showed symptoms and course different from the paranoid
conditions grouped elsewhere.
There were 7 of these cases, 1 male and 6 females; in all, forming 1.5%
of the admissions.
Male.
No.
Hospital admissions
Paranoid disorders (undifferentiatedl
220
1
Per cent.
" ' 0 '. 5 '
Total.
Female.
No.
240
6
Per cent.
2^5
No.
460
7
Per cent.
1.5
42
STATE OP MICHIGAN.
The ages at onset and at admission were:
Admission
Onset.
F.
M.
30-34
35-39
40-44
45-49
50-54
55-59
T.
0
0
0
0
0
2
0
1
1
2
o
0
1
1
M.
2
0
1
0
1
1
3
F.
0
0
0
0
1
0
0
T.
0
2
1
1
1
1
0
0
0
2
1
1
2
I
Hereditary factors were present among the antecedents in 3 instances:
The results of treatment are given in the following table:
F.
M.
0
0
1
0
T.
0
3
2
1
0
3
3
1
Five of these returned to their families and one was transferred to a
State Hospital.
SYPHILITIC MENTAL DISORDERS.
There were admitted during the period 50 cases in which the mental
disease was due to syphilis of the central nervous system. Clinically
these were represented as follows:
M.
General paralysis
Cerebrospinal syphilis .
Tabes
.
28
5
1
F.
T.
12
4
0
40
q
1
SYPHILIS IN RELATION TO ADMISSIONS.
Routine examinations by the Wassermann test of the patients admitted
during the period showed that among 449 individuals tested, there were
74 in whom the Wassermann reaction was positive. This indicates that
about 16.5% of all admissions to .this hospital had syphilis. If there is
deducted from these the 50 cases of definitely syphilitic types of nervous
disorders, there remain 24 cases, or 5.3%, who had syphilis but whose
mental disturbance was of a non-syphilitic type.
PSYCHOPATHIC HOSPITAL.
43
EFFECTS OF SYPHILIS IN THE FAMILIES OF PATIENTS HAVING SYPHILIS OF
THE CENTRAL NERVOUS SYSTEM.
For several years it has been the practice in this hospital, whenever
possible, to examine for the presence of syphilis, members of the families
of patients who have syphilitic forms of mental disease.
During the present period, Wassermann tests were made upon the
blood of some member of the family of 26 patients. Of 22 mates of
patients, 5, or 22.7%, gave a positive Wassermann reaction on the blood.
One parent gave a positive Wassermann reaction on the blood.
In 3 other families there was a definite history of syphilis of the nervous system of the mate of the patient.
In 26 families, syphilis was present in 9 members apart from the
patient, or in 34.6%.
Among the mates of 20 general paralytics, syphilis was present in 5,
or 25%.
There were examined 15 children from the families of 11 cases of general paralysis. Seven of these showed stigmata of hereditary syphilis
and the blood of 4 gave a positive Wassermann reaction.
GENERAL PARALYSIS.
During the present biennial period there were admitted 40 cases of
general paralysis. Twenty-eight were males and 12 were females. This
number constituted 8.7% of all cases admitted. Of all male patients
admitted 12.7% belonged to this group, and 5% of all females. The relative frequency of the disease as it concerned the sexes was as 2.?> to 1.
Female.
Male.
No.
General paralysis . . . .
220
28
Per cent.
12.7
No.
240
12
Total.
Per cent.
5
No.
460
40
Per cent.
's'.7
CLINICAL FORMS.
The majority of the cases coursed as the demented type. Cases of the
agitated and expansive types were relatively more frequent than in the
previous period.
One case was of more than usual interest in that it occurred at the late
age of 71.
There was admitted one case of juvenile paresis, the child of a tabetic
mother.
44
STATE OF MICHIGAN.
Demented
Agitated
Delirious . . .
J uveuile
19 '
5 i
2
1 ;
''
T.
F.
M.
1 ;
8
1
•
0
27
6
5
1
1
o
AGE.
Excluding two cases associated with extreme variation from the usual
age, viz 7 and 64, the average age of onset of the disease of the males was
:>4.3 years, and 36 years of the females.
Onset.
M.
5-9
10-14. .
15-19 .
20-24. .
25-29
F.
1
0
1
2
30-34 . .
35-39
40-44 . . .
45-49
50-54
4
g
55-59
60-64..
65-69
70-74 . .
0
4
2
0
1
0
0
j Vdmission
T.
M.
F.
T.
1
0
1
2
6
0
1
0
0
4
0
o
0
o
o
6
1
2
1
0
10
9
6
3
0
4
10
4
4
0
4
1
2
2
1
g
11
6
6
1
1
1
1
0
0
0
0
0
1
1
0
0
1
0
0
1
0
0
0
0
1
0
0
0
1
o
0
1
0
5
HEREDITY.
Hereditary factors were found among the ancestors or families of
62.5% of the cases in which information was available. Among the
families of these 40 cases of general paralysis, there were G4 instances
of mental abnormalities.
PSYCHOPATHIC HOSPITAL.
Direct.
F.
Brothers
and
sisters.
Collateral.
Atavistic.
M
45
M.
2
0
0
0
4
0
0
0
5
1
1
3
2
1
0
2
7
2
1
5
2
4
10
5
15
Negative . . . .
Unknown
6
12
3
4
9
16
Total . .
28
12
40
3
M
1
0
0
0
0
0
0
0
1
0
0
0
0
2
2
2
1
5
oooo
Total heredity . . . .
I
T
oooo
Insanity
Apoplexy or paralysis . .
Alcoholism
M
F
T.
T.
T.
F
F.
M.
F
Total.
2
0
0
0
3
10
1
0
1
0
0
0
2
T.
DATE OF SYPHILITIC INFECTION.
In 20 cases the date of infection was approximately determined. The
average interval between infection and onset of the symptoms of general
paralysis was 14.3 years.
0.
11.
14.
15.
18.
20.
23.
25.
1
1
3
2
2
1
1
31.
•
1
1
ALCOHOLIC INFLUENCES.
A history of more than moderate alcoholism was obtained in only 6
instances. There was one case presenting a complication of alcoholic
hallucinosis with general paralysis.
NEUROLOGICAL DISTURBANCES.
The most constant neurological abnormalities were in the pupils and
tendon reflexes. In 50% of the cases the pupils were irregular; in 35%
the pupils were unequal; in 40% the reaction was sluggish and in 25%
the light reactions were absent. In 22.5% the knee jerks were absent.
In 10% they were unequal and in 17.5% they were increased. Babinski's reflex was present in 5% of the cases. Tremors were present in
55%' of instances. In 10% of the cases there was a history of either
apoplectiform or epileptiform attacks.
SEROLOGICAL.
In all cases examined the serological findings were characteristic of
this disease. The blood in 38 cases gave a strongly positive Wassermann reaction and in 2 cases the reaction was weakly positive. The
cerebrospinal fluid was examined in 37 cases and in all instances gave
46
STATE OF MICHIGAN.
a strongly positive Wasserinanii reaction. The cells varied between a
minimum of 5 and a maximum of 320.
During the latter part of the period, interest has been shown in the
application of Lange's colloidal gold test. Of 21 cases tested, 19 gave a
curve characteristic of general paralysis and 2 gave a type of curve of
cerebrospinal syphilis. That these latter cases were cases of general
paralysis was proven by other diagnostic points.
KESTJLTS OF TREATMENT.
During the period an active interest has been shown in the medicinal
treatment of cases of general paralysis. Some cases have been treated
by intraspinal injections of salvarsan, after the method of Swift and
Ellis; others have been given salvarsan intravenously, and others went
through an energetic treatment with mercury. While in some cases it
was possible to influence for good the serological findings, in no case
did the spinal fluid become normal. In some cases the progress of the
clinical symptoms seemed to be benefltted but this was only temporary.
On the whole, it has seemed as if no certain benefits had been obtained
from treatment.
The following table shows the condition of patients discharged. Included in this are 5 males who were admitted in the previous period.
F.
M.
Recovered
Improved .
Unimproved . .
Died.
.
0
5
23
1
. .
4
T.
0
0
12
0
0
0
5
35
1
4
Of the 40 patients discharged, 22 were transferred to one of the State
Hospitals and 18 returned to their families.
CEREBRO-SPINAL SYPHILIS.
There were admitted during the period 9 cases of syphilis of the
central nervous system, with mental disorders.
The relation of these to admissions was:
Male.
No.
Hospital admission
Cerebrospinal syphilis. . .
220
5
Female.
Per cent.
2.2
No.
240
4
Total.
Per cent.
i.6
No.
460
9
Per cent.
1.9
PSYCHOPATHIC HOSPITAL.
47
AGE.
The ages at admission ranged between 22 and 59. The interval between infection and the outbreak of mental symptoms varied from 5
months to 27 years.
HEREDITY.
Hereditary factors were present in 3, or 37.5%, of 8 cases in which
information was obtained.
CLINICAL.
In 3 cases the symptoms were referable largely to vascular involvement. In 4 the process was meningeal. In 8 cases there were noted
prolonged disturbances of the consciousness. Some of these were in
association with apoplectiform attacks. Wassermann reaction was positive on the blood of all cases, and on the cerebrospinal fluid of 6 cases.
In 3 cases the fluid was negative in dilutions up to 0.8 cc.
RESULTS OF TREATMENT.
M.
Recovered
Died
F,
0
4
.
...
0
1
0
T.
0
3
0
0
1
0
7
0
1
1
Energetic treatment with salvarsan was carried out in 8 cases. This
was given either intravenously or intraspinally after the method of
Swift and Ellis. Improvements were marked under both methods.
Neither method semed to produce results superior to the other. One
patient, whose disease was complicated with severe general arteriosclerosis and nephritis, died.
Case No. 1587. Syphilitic endarteritis: Male, aged 54 years at admission. His mother died of apoplexy at 68. He himself was a moderate user of alcohol. No information as to occurrence of syphilitic infection. Since the age of 34 he believed that he had kidney and heart
trouble. At 51 he complained of severe pains in the left arm and leg,
with much impairment of ability to use the left arm. Ten months before
his admission he had an apopletic attack followed by prolonged unconsciousness. There was no motor paralysis following this attack.
After four days he showed no change in his conduct and took up his
business affairs. Following this attack, the pain which had previously
given him much concern did not return. A month later a second stroke
occurred. During and following this attack there was paralysis of the
left side and difficulty in speaking. The effects of this never passed
away and after that he was unclear in his comprehension most of the
time. Two months later a third attack occurred, followed by a condition of stupor lasting two weeks. The mental confusion grew worse
and at no time was he lucid. In the succeeding months he had several attacks of cardiac and respiratory disturbance.
48
STATE OF MICHIGAN.
His examination at admission showed chronic interstitial nephritis;
hypertension; hypertrophy of left ventricle, and marked mycardial
changes. The urea content of the blood was at the high normal limit.
Blood pressure was 180. The pupils were irregular. Their direct light
reaction was slowed. There was a well marked Rhomberg's symptom.
The knee jerks were greatly increased. At times Babinski's reflex was
obtained. There was tremor of the fingers but not of the tongue or lips.
The left hand grasp was much weaker than the right. The fundus examination showed advanced arteriosclerotic changes, edema of the
retina, and retinal hemorrhages. Wassermann reaction was positive
on blood and spinal fluid. There were 6 cells per cu. mm.; Nonne-Apelt
test gave slight reaction in Phase I; Lange's test gave a slight change
in the luetic zone.
Mentally he continued unclear and usually showed a mild delirious
restlessness. There was a profound memory defect with slight romancing at times. Towards the last, there were paraphasic disturbances. The
heart symptoms increased and death occurred 10 weeks after his admission.
The pathological diagnosis was—Acute purulent broncho-pneumonia;
syphilitic changes in aorta and kidneys; syphilitic orchitis; general
arteriosclerosis; organized thrombus of pancreatic artery. The gross examination of the brain showed widespread syphilitic endarteritis of the
vessels at the base and in the pia, recent hemorrhage into the pia-arachnoid, and an area of focal softening in the right lenticular nucleus.
The microscopic study of the brain showed thickening of the pia with
infiltration of lymphocytes and rarely a plasma cell. The endothelium
of the vessels of the pia was enormously proliferated, in some vessels almost closing the lumen. The elastic coat was split and broken in places.
Around the vessels were large numbers of lymphocytes and occasionally
a mast cell. The marginal glia, especially the fibrous part, was excessively thickened. In the medullary substance of the convolutions, there
was marked hypertrophy of the glia cells.
The nerve cells showed varying degrees of changes. Many were practically normal and others, especially some of the small pyramidal cells,
were sclerosed. Some cells showed characteristic axonal reaction type
of change. In a number of places there were focal devastations and miliary softenings.
Summary: The changes, both gross and microscopic, were typical of
syphilitic endarteritis and secondary reactions in the nervous parenchyma, and a slight syphilitic meningitis. There was also changes of a
type met with in toxic conditions such as uraemia or alcohol.
TABES.
One case of tabes was under treatment. The mental symptoms were
chiefly of a neuraesthenic type. There was little improvement under
active treatment by intra-spinal injections of salvarsan in small doses.
PSYCHOPATHIC HOSPITAL.
49
ALCOHOLIC MENTAL DISORDERS.
During this period there were treated 18 cases, all males, of mental
disorders caused by alcohol. This number represents 8.18% of the male
admissions for the period and 3.9%' of the total admissions of both sexes.
This is a decrease of 2% in the admission rate of this class of disorder
over the former period.
The classification into clinical groups was made as follows:
M.
Delirium tremens. .
..
1
6
1
...
1
6
1
2
8
0
0
0
0
0
2
Chronic alcoholism . . .
T.
F.
8
There was a decrease in numbers compared with previous years of
cases of delirium tremens and chronic alcoholism. One case of delirium
tremens was of unusual interest in that the patient was said to have had
delirious episodes, similar to the one at the time of admission, about
once each year for 18 years.
HEREDITY.
Positive heredity was noted in nine cases. In the remaining nine cases,
the family history was given as entirely negative or no information regarding this was obtained. The following table shows the distribution
of the hereditary influences:
Apoplexy or paralysis . .
Total heredity . . . .
Unknown
Total .
Atavistic.
Brothers
and
sisters.
Collateral.
M.
F.
T.
M.
F.
T.
M.
1
0
0
4
0
0
0
0
1
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
5
0
5
0
0
0
2
F.
Total.
T.
M.
F.
T.
M.
F.
0000
Direct.
T.
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
3
0
0
6
0
0
0
0
3
0
0
6
0
2
2
0
2
9
0
9
3
6
0
0
3
6
18
0
18
Three of the cases of delirium tremens had had previous attacks and
four of the cases of chronic alcoholism had previously been in institutions for treatment for some form of alcoholic mental disorder.
50
STATE OF MICHIGAN.
A study of the Wassermann reactions of this series revealed two positive cases and sixteen negative. One of these was a bartender, admitted
in an attack of delirium tremens. The examination of his cerebrospinal
fluid was negative except for a slight increase in the globulin. He presented no neurological abnormalities of cerebrospinal syphilis. The other
case of positive Wassermann reaction was a man 33 years old with gummatous necrosis of the bones of the face, which had existed for about six
years and was still active. The examination of his cerebrospinal fluid
was entirely negative as was also a Wassermann examination of the
blood of his wife. The examination of the cerebrospinal fluid of the two
cases of Korsakow's psychosis revealed a very high albumen content.
Neurological examinations revealed abnormalities in all the cases, the
most constant disturbance noted being tremors and irregularities in the
outline of the pupils. Irregular pupils were noted in every case and
tremors in 13 cases. Inequality in the size of the pupils was present in
6 cases and diminished reaction to direct light in a like number. The
Achilles reflex was absent in two and unequal in one case. Unequal knee
jerks were noted in two cases.
The average duration of treatment for this group of cases was 57 days.
The following table shows the condition at the time of discharge:
Hecovered.
Acute alcoholism
Delirium tremens
Alcoholic paranoia
Chronic alcoholism
Korsakow's psychosis
1
4
0
2
0
Improved.
0
2
0
6
2
Unimproved .
Died.
0
0
1
0
0
.
0
0.
0
0
0
Total.
1
6
1
8
2
DRUG INTOXICATION.
In this group are included 11 patients,6 males and 5 females, constituting 2.19% of the total admissions for the period. This number is an increase of five cases over the previous period, or an increase of .79%. This
increase is no doubt due to the enactment of the Harrison Act.
In one of these cases the family history reveals the fact that the
mother, grandmother and father were all drug users. This was a boy of
16 years who had been using both morphine and heroin, given him first
by his grandmother, since he was nine years old. He was infantile in
physical development and subnormal mentally. He presented evidences
of disorder of function of the glands of internal secretion.
In another case the father and paternal grandfather were morphine
users, and the father had suicided. This patient was a woman 30 years
of age, who had used morphine, whiskey and paregoric for nine years,
following a surgical operation. The Wassermann reaction was positive
on both the blood serum and the spinal fluid. Albumen and globulin
were also increased.
PSYCHOPATHIC HOSPITAL.
51
Another case, a man 57 years old, who had used drugs and whiskey
for 11 years, presented a positive Wassermann reaction on his blood
serum. The Wassermann reactions of the other 9 cases were negative.
One of these had a scar of an old gummatous necrosis.
The previous history of each of the 11 cases showed the patients to be
of neurotic makeup, and in two of the cases there were numerous hysterical episodes throughout the previous life. The reason given by the patient, or his family, for the use of the drug, was in 9 instances some form
of physical illness. The amount of drug used daily based on the statement of the patient varied from "seven cents worth of gum opium" in one
case to 20 grains of morphine and 30 grains of cocaine in another. The
method of treatment used was the immediate withdrawal of the drug. In.
one case there was a delirium with auditory hallucinations of a day's
duration, followed by diarrhoea and motor restlessness for a few days.
In another case there was an hysterical dream state of a few hours duration following the withdrawal, in which the patient acted out the part of
receiving an injection from his father. The average length of residence
of these cases was 39 days. All of the cases were discharged to their
homes, except one case which was transferred to a State Hospital.
The following table shows the division of these cases according to the
drug used, together with the condition at the time of discharge:
Recovered.
M.
Morphine . . .
Morphine and alcohol
Heroin . . . .
0
1
0
0
1
F.
Improved.
M.
T.
1
0
0
1
1
0
1
2
0
2
0
0
1
1
0
F.
Unimproved.
2
0
1
0
0
'•
M.
T.
4
0
3
0
0
0
0
0
0
0
T.
0
0
0
0
0
0
0
0
0
0
EPILEPSY.
There were admitted during the period 10 cases of epilepsy. This number constituted 2.1% of all patients admitted.
Male.
No.
Hospital admissions
Epilepsy .
. .
220
6
Per cent.
• -j-y-
Female.
No.
240
4
Per cent.
' 'i'.e'
Total.
No.
460
10
Per cent.
2.1
The ages at admission varied widely. The youngest patient was aged
7 and the oldest 49. Hereditary factors were present in 7 of 8 cases, or
87.5%, in which information was obtained.
STATE OF MICHIGAN.
52
The Wassermann reaction was positive in the blood in one case but
the cerebrospinal fluid was not pathological. Under active anti-syphilitic
treatment, these attacks occurred less frequently.
The result of treatment of all cases discharged was:
M.
Recovered .
.
F.
0
0
6
1
T.
0
0
2
2
8
1
9
0
Of those discharged, 4 were transferred to other State Hospitals and
the remainder returned to the custody of their families.
IMBECILITY.
This group includes all cases of feeblemindedness admitted during the
period, excepting those in which there was in addition to the mental defectiveness a well differentiated psychosis. There were 19 cases which belong here; 11 were males and 8 were females.
Male.
No.
220
11
Female.
Per cent.
5.0
No.
240
8
Total.
Per cent.
3.3
No.
460
19
Per cent .
4.1
AGE.
Eleven of these were adults and 8 were juveniles. The youngest age
was 13 and the oldest 43. The mental age in no case execeeded that of
11 years. The lowest mental age was 7.
PSYCHOPATHIC
HOSPITAL.
53
HEREDITY.
Hereditary factors were present among 15 or 93.7%, of 16 cases in
which information was available.
Direct.
Atavistic.
f
0
0
.1
1
4
2
2
oooo
2
9
0
Insanity, .
Apoplexy or paralysis . .
Psychopathic
i
7
M.
F.
Total.
F.
T.
M.
F.
T.
M.
F.
1
0
1
0
oooo
T.
Brothers
and
sisters.
oooo
F.
Collateral.
1
0
1
0
1
0
1
0
1
0
1
0
0
0
6
1
3
1
1
0
2
1
7
1
5
2
0
2
0
2
2
2
4
11
4
15
1
3
1
3
8
19
T.
M.
oooo
M.
:
0
'
Total . . .
11
T.
There were 21 children born to the 4 patients who were married. In 4
cases there were found stigmata of hereditary syphilis, but only one case
gave a positive Wassermann reaction on the blood. In 9 cases there were
neurological abnormalities.
FORENSIC RELATIONS.
Fifteen of these 19 cases had come into conflict with the courts over
various legal offenses. All three of the juvenile females were sex
offenders.
RESULTS OF TREATMENT.
Recovered . .
"Unimproved
. .
.
.
T.
F.
M.
0
2
9
0
0
0
7
1
0
2
16
1
Of those discharged, 11 returned to their families, 3 were transferred
to another institution, and 4 were returned to the custody of the probate
court.
STATE OF MICHIGAN.
HYSTERIA.
There were admitted 41 cases of hysteria. Of these, 9 were males and
32 were females. This number formed 4.1% of the males admitted,
13.3% of the females, and 8.9% of all patients who were admitted during the period.
Male.
Per cent.
No.
Hysteria .
. .
Female.
220
9
4.1
Total.
Per cent.
No.
240
32
13.3
Per cent.
No.
460
41
8^9
In 14 of these, conversion symptoms dominated in the clinical manifestations. There were 27 cases in which the symptoms centered chiefly
around attacks of anxiety.
The ages of onset and admission are shown in the following table:
jAdmission
Onset.
F.
St.
10-14..
15-19...
20-24 .
25-29
0
1
2
0
5
11
4
3
30-34 ...
35-39 . . .
40-44
45-49
0
50-54
55-59
60-64
0
0
0
1
1
0
0
M.
T.
F.
T.
0
1
7
0
1
7
0
6
13
0
0
0
6
11
3
3
2
4
3
2
1
4
2
1
1
0
1
3
1
0
1
4
0
0
0
0
2
0
1
0
2
0
1
2
2
1
7
3
2
1
1
0
0
17
6
e
PSYCHOPATHIC HOSPITAL.
55
HEREDITY.
Information regarding the hereditary factors was obtained in 33 cases.
Direct.
Apoplexy or paralysis . .
Brothers
and
sisters.
Collateral.
M.
F.
T.
M.
F.
T.
M.
F.
0
1
1
3
1
1
1
4
2
2
0
0
0
0
1
0
0
0
1
0
0
0
1
0
0
0
0
1
0
3
6
9
0
1
1
1
2
Alcoholism
Total heredity . . . .
Atavistic.
Total.
T.
M.
F.
T.
M.
F.
2
0
0
0
0
4
0
1
0
4
0
1
0
1
1
1
1
7
3
3
1
8
4
4
2
0
5
5 | 4
14
18
2
3
13
5
15
8
9
32
41
?
0
T.
3
Total
The foregoing table shows that hereditary factors were present in
54.5% of the cases belonging in this group. Among the families of 41
individuals, there were 68 instances of mental or nervous abnormalities.
ETIOLOGICAL FACTORS.
In 11 instances the onset of the disease was intimately related to an
inability to adequately adjust themselves to situations occurring in their
married life. In 7 other instances there were unusual emotional situations intimately related to the outbreak of the symptoms.
RESULTS OF TREATMENT.
The results of treatment are shown in the following table:
F.
M.
1
5
2
2
T.
6
22
4
4
7
27
6
6
Of those discharged, 39 returned to their homes, and 2 were transferred to one of the State Hospitals. The average length of time under
treatment was 3.07 months.
STATE OF MICHIGAN.
56
PSYCHONEUROSES (Excluding Hysteria).
There were admitted 4 patients who are included in this group. According to their clinical symptomatology, they were represented as follows:
F.
M.
3
1
T.
0
0
3
1
The age of admission of these cases was:
F.
M.
1
1
2
15-19 . . .
20-24
25-29
T.
0
0
0
1
1
2
Hereditary factors were present in 2 of the 4 cases.
ANXIETY NEUROSIS.
This group includes 3 males. Two were discharged from treatment as
improved and 1 remains into the next period. All returned to their
homes. In addition, one woman admitted in a former period was transferred to a State Hospital in an unimproved condition.
COMPULSION NEUROSIS.
A man who suffered from compulsive thoughts and impulses was under treatment for 5 weeks, and was discharged in an improved condition.
57
PSYCHOPATHIC HOSPITAL.
PSYCHOPATHIC PERSONALITIES.
There were admitted a considerable number of individuals who had
definite mental abnormalities but could not be adequately placed among
other groups in this analysis. These abnormalities consisted of constitutional defects of character and peculiar habits rather than any definite
psychosis.
There were in this group 31 individuals, 16 males and 15 females.
Male.
Per cent.
No.
220
16
Psychopathic personalities . . .
Female.
No.
240
15
• '^2'
Total.
Per cent.
6.2
Per cent.
No.
460
31
6.7
While having in common abnormalities of personality, the ways in
which these were manifested varied too widely to permit of more than
a loose arrangement according to clinical type.
M.
13
3
Psychopathic personalities, juvenile
T.
F.
15
0
28
3
AGE.
The- ages at admission were:
F.
M.
5- 9
10-14
15 19.
20-24
25-29 . . . .
30-34 .
35-39
40-44.
45-49 . . .
50-54 . . . .
5 5 59 .
60-64 . .
.
..
.
.
.
.
.
T.
1
1
1
2
0
0
2
2
1
1
3
4
4
0
1
1
1
3
3
1
3
4
2
2
1
2
2
0
0
1
4
1
2
1
0
STATE OF MICHIGAN.
58
HEREDITY.
Hereditary abnormalities were present in 22 or
& of 25 cases in
which information was available.
In 20 families there were 79 abnormal individuals.
Direct.
Atavistic.
Brothers
and
sisters.
Collateral.
Total.
M.
F.
T.
M
F.
T.
M
Insanity
Apoplexy or paralysis . .
Psychopathic . . . .
3
0
1
2
2
0
1
4
5
0
2
6
2
0
8
0
0
0
0
2
0
0
0
2
0
0
0
1
0
0
0
3
0
0
0
0
0
0
0
2
0
1
1
2
0
1
1
Total heredity . . . .
6
7
13
2
0
2
2
1
3
0
4
4
F
T
M
F
T
M
5
0
2
5
12
0
3
7
10
12
22
2
3
1
3
3
6
15
!
T
0
1
2
Negative . .
Unknown
Total. . .
F
26
31
RESULTS OF TREATMENT.
M.
14
1
1
T.
•F.
11 i
2 i
3 !
j
25
3
4
Only one of those discharged was transferred to another institution,
the remaining going to their families, or on their own responsibility.
SENILE DEMENTIA.
There were admitted one man .ancL'two women whose mental disorder
was due to senile atrophy of the brain. This number formed 0.6% of
all patients admitted.
The ages at admission were 72, 75 and 72 respectively.
All were discharged in an unimproved condition. Of these, 2 were returned to their homes and 1 was transferred to the Kalamazoo State
Hospital.
PSYCHOPATHIC HOSPITAL.
59
PRESENILE MENTAL DISORDERS.
Under this heading are considered 5 patients whose mental disorder
was a severe depression with marked anxiety coming on in the late
adult years. The clinical position of this group is uncertain but all of
these cases showed much similarity in their symptomatology and age of
occurrence.
Male.
Per cent.
No.
Hospital admissions
Female.
220
1
.45
Total.
Per cent.
No.
240
4
1.6
Per cent.
No.
460
1.1
Hereditary factors were present in but one case.
The aee at onset and admission was:
Admission
Onset.
50-54. . . .
55-59
60-64 . .
T.
F.
M.
0
1
0
2
2
0
M.
2
3
0
F.
T.
0
1
2
0
1
2
2
1
1
Hereditary factors were present in but one instance.
The results of treatment were:
M.
Recovered
Improved
Unimproved
Remaining
F.
0
0
1
0
T.
0
1
2
1
0
1
3
1
Three of these patients were transferred to one of the State Hospitals.
STATE OF MICHIGAN.
60
CEREBRAL ARTERIOSCLEROSIS.
During the biennial period there were admitted 13 individuals whose
mental disorder resulted from arteriosclerotic changes in the brain.
Eleven of these were males and 2 were females.
This group represented 2.8% of all admissions.
Female.
Male.
Per cent.
No.
220
11
Cerebral arteriosclerosis
Total.
Per cent.
No.
240
2
5.0
Per cent.
No.
460
13
.8
2.8
Age at onset and admission:
Admission
Onset.
40-44 .
45-49 . .
50-54
55-59 . .
60-64
65-69 . .
"Unknown .
T.
F.
M.
...
T.
F.
M.
2
0
0
4
0
0
0
1
2
0
0
2
0
1
4
0
0
0
2
0
2
2
1
0
3
2
2
2
0
3
2
1
1
0
0
1
1
1
5
0
0
HEREDITY.
Hereditary factors were present in 6 of the 10 cases in which information was available.
Atavistic.
Direct.
Total heredity . . . .
4
Negative .
Total
M.
F.
T.
2
0
11
0
0
0
0
0
0
0
0
6
0
0
8
2
M.
F.
M.
F.
T.
0
0
0
0
oooo
1
2
T.
0
0
0
0
0
0
0
0
0 j
0
0
0
0
0
0
0
0
0
0
0
0
0
i1
. . . .1
!
T.
M.
F.
0
1
1
2
2
0
0
0
2
1
1
2
c
Insanity. .
Apoplexy or paralysis . .
Psychopathic
Alcoholism
F.
Total.
ooco
M.
Brothers
and
sisters.
Collateral.
4
'
6
4
3
4
3
2
|
1
11
T.
13
PSYCHOPATHIC HOSPITAL.
61
As somatic abnormalities associated with the cerebral arteriosclerosis,
lesions of the heart were found in 58% of instances. In 43% there were
evidence of nephritis. In one-half of the cases there were sclerotic
changes in the superficial arteries of the arm. The blood pressure was
above 175 in 83% of instances. Among neurological disturbances, a
history of apoplectiform attacks was obtained in one third of the cases.
In 83%' there were vascular changes in the fundus of the eye.
In no instance was there a positive Wassermann reaction obtained
either on the blood serum or on the cerebrospinal fluid.
The average period of residence of those discharged was 7 weeks. Of
those who were discharged, 8 returned to their homes and 3 were transferred to one of the State Hospitals.
RESULTS OF TREATMENT.
M.
Recovered .
Unimproved . .
Died
Remaining
....
F.
0
4
5
0
1
1
0
0
3
SYMPTOMATIC
T.
0
6
0
3
0
MENTAL DISORDERS.
In this general class are grouped 24 cases, 11 males and 13 females. In
each of these cases the mental disorder was considered as symptomatic
of an existing physical disease. The following table shows the relative
frequency of these disorders among the admissions to this hospital.
Female.
Male.
No.
Hospital admissions
Symptomatic mental disorders
Per cent.
220
11
5
No.
240
13
Total.
Per cent.
5 .4
Per cent.
No.
460
24
5.2
In 17 of the cases the etiological factor was a definitely recognized
physical disease and in 7 cases the causative factor was not clearly demonstrated. The following table shows the etiological relations:
M.
Mental
Mental
Mental
Mental
disorders associated with nephritis
disorders associated with pellagra .
disorders associated with acute articular rheumatism
disorders associated with pernicious anemia
F.
T.
3
1
4
1
1
6
4
2
0
2
2
4
4
7
62
STATE OF MICHIGAN.
MENTAL DISORDERS ASSOCIATED WITH NEPHRITIS.
Five of the cases classified as disorders associated with nephritis
showed a paranoid trend with irritability and episodes of delirium or
stupor. Both acute and chronic forms of nephritis were present.
One case, a woman of 48, in addition to nephritis, had a colon infection of one kidney with extreme emaciation. Mentally there were short
periods of unclearness and extreme fatigability. As her kidney condition improved, there was corresponding mental improvement. One of
the cases was in an individual who had been an excessive user of alcohol.
There were two deaths among the cases of this group. In one it was
possible to make a laboratory study of the central nervous system.
Case A. B. No. 1270. Psychosis associated with nephritis:—Male, aged
67 at admission. One brother had died of heart failure and the daughter
of the patient suffered from multiple sclerosis. Our patient had two
severe injuries in his early life, about which we were able to learn little
except that one of them confined him to a hospital for three months.
At 66 he began to be troubled with dyspnoea and other symtoms of
cardiac failure. Five weeks before admission he was delirious for a few
hours and from then on became very irritable, although usually clear in
his grasp. He was committed to the hospital because of an aggressive
attack upon his wife.
Upon admission he was unclear and stuporous. There was much air
hunger and his respiration soon became Cheyne-Stokes in character. The
physical examination showed a markedly enlarged heart to the left and
an atypical aortic pulse. There was marked edema of the ankles and
general anasarca. Wassermann on the blood was doubtful. The physical
diagnosis was made of chronic uremia, double aortic lesion, chronic interstitial nephritis. His condition became progressively worse and he
died after nine days in the hospital.
The autopsy showed an enormous heart with hypertrophy and dilatation of the left side. The whole arterial system showed marked sclerosis. The arch of the aorta was much dilated and showed areas of calcification. All the heart valves, especially the aortic, were thickened and
incompetent. All organs showed chronic passive congestion and the kidneys showed the changes of old interstitial nephritis. The brain weighed
1225 grams. The dura was diffusely adherent. The diploe of the calvarium was greatly congested. Histological examination of the brain showed
the pia to be moderately thickened. There were scattered fibroblasts
and epitheloid cells. In some vessels there were short chains of streptococci. The finer vessels of the cortex were not pathologically altered.
The cortex showed normal topographical arrangements. The nerve cells
were not notably changed. There was no pathology of the glia. None
of the changes could be regarded as of diagnostic importance.
MENTAL DISORDERS ASSOCIATED WITH PELLAGEA.
The disorder of one male and one female was associated with, well defined pellagra, (^astro-intestinal disturbances and the skin manifestations were quite characteristic. The mental picture in each case was
that of a mild stupor with delirious episodes. The female patient showed
PSYCHOPATHIC HOSPITAL.
63
a delusional trend of a paranoid type. One patient died and a study of
the central nervous system showed interesting pathological changes.
Case S. M. No. 1417. Psychosis associated with pellagra:—A female
4-2 years of age upon admission. One sister of the patient died of some
unknown spinal trouble at the age of 15. Her early life was uneventful but her married life was unhappy on account of alcoholic and shiftless habits of her husband.
A year before admission her health began to fail and she became unstable emotionally. She expressed mild delusions of persecution. Five
weeks before admission she developed a peculiar skin condition of her
face and arms. The delusions became more and more prominent. Upon
admission it was noted that she was restless, unclear, and rambling in
her talk. There was a definite weakness of the right arm but an accurate
neurological examination was impossible on account of her mental condition. The skin condition of the arms was considered pellagra on account of the symmetrical pigmentation and sharp limitation of the erythema with its predilection for the extensor surfaces. Her confusion
continued and on the tenth day she died.
In the cortex there was an absence of coarse focal changes. In all sections the nerve cells showed severe changes. These consisted of dissolution of the chromophilic substance of the cell body and in the larger
pyramids of a displacement of the nucleus towards the cell wall. The
glia was much increased in the molecular and to a lesser degree in the
deeper layers. The form of- the cell was that characteristic for regressive
changes. An occasional rod cell was noted. The spinal cord showed no
pathological changes. The changes as a whole were of the type met with
in chronic intoxications. They have often been observed in chronic alcoholism and pellagra.
MENTAL DISORDERS ASSOCIATED WITH ACUTE ARTICULAR RHEUMATISM.
There were four cases belonging in this group. These were all males,
aged respectively 32, 40, 41 and 44 at the time of admission. They correspond to that group of cases discussed in a paper appearing from this
hospital and published in the American Journal of Insanity, 1914.
One of these patients died and the nervous system was studied in the
laboratory.
Case No. 1817. Psychosis associated with rheumatism and endocarditis:
•—Male, aged 32 at admission. His father was an alcoholic. He was 32
when admitted. At about the age of 22 he had a severe attack of rheumatism and at 30 a second attack. At that time, red blotches appeared
on the arms and body. These areas swelled rapidly and soon disappeared.
Sometimes they reached the size of a half walnut. He had worked as a
bartender and had been a steady drinker but never drunk. Two or three
months before admission he had a third attack of rheumatism with the
same skin lesions as in the former attack.
When admitted to the hospital his comprehension was unclear. He
did not know where he was and he talked of his food being poisoned and
of other patients being syphilitics. He was very active and the associations shown in his talk were loosely formed. Later he said he was John
the Baptist and that he heard his mother calling to him.
64
STATE OF MICHIGAN.
The examinations showed his heart to be enlarged and atypical murmurs. His blood pressure was 150, the Wassermann on his blood was
negative, and the spinal fluid examination was negative except for an increase of albumen. While in the hospital, there appeared on his body,
in various places, irregular painful red swellings, which disappeared in
a few hours. He failed rapidly in spite of all supportive measures until
he died 20 days after admission.
An autopsy was made. The pathological diagnosis of the internal organs was malignant endocarditis of the mitral valve; eroupous pneumonia; grey hepatization; empyema. The brain weight was 1294 grams.
There was thrombosis of several venous branches near the longiturinal
sinus. The pia was transparent and its veins moderately congested. The
brain itself showed no gross changes. Histological studies of the brain
showed a recent thrombosis of the longitudinal sinus and some of its confluent veins. The pia was greatly thickened by a recent increase of connective tissue. In some places there was an enormous proliferation of
flbroblasts. There was no appreciable loss of nerve cells. In all regions
there were a few nerve cells, in which there was a mild disintegration of
the tigroid of the cell. Many of the arteries, both of the pia and the cortex, showed recent proliferative changes in the intima. There were no
marked changes in the cortex topography. Many nerve cells in all layers
showed slight breaking up of the tigroid and a tendency of the ground
substance to stain. In several regions of the cortex, the glia of the first
layer was enormously increased in thickness and there was active proliferation among the glia cells. Throughout the cortex and medulla, many
glia cells were in stages of active progression. The changes in the brain
were apparently recent in their origin and were apparently directly related to the toxic process associated with the bacterial endocarditis.
MENTAL DISORDERS ASSOCIATED WITH PERNICIOUS ANEMIA.
This group was represented by two females, aged 39 and 42 years, and
two males, aged 46 and 60 years. The mental symptoms were those of
an asthenia with episodes of unclearness and delusions of a paranoid
trend.
Two patients died. The clinical course and pathological findings are
given in the following abstracts:
Case W. C. A. No. 1812. Psychosis associated with pernicious anemia:
—Male, aged 60 at admission. Until a year previously he had been a
successful physician. At that time he complained of feeling tired, appeared listless, and sometimes was observed talking to himself. These
symptoms followed an injury to the back and wrist upon entering a moving street car. Six months later there appeared paraesthesiae of the
hands and feet, and he staggered in walking. He became irritable and
unstable, and extremely excitable. Upon admission he showed a clear
comprehension, a marked retentive memory defect, and circumstantiality: The examination of the blood showed 2,710,000 reds and 70%
haemoglobin. The smear showed anisocytosis and poikilocytosis. The
neurological examination then showed a marked ataxia of the lower extremities, with sensory changes of hands and feet. Stereognosis was lost
in the left hand. There was a loss of vibration sensibility in the bones
of the extremities. The knee jerks and Achilles jerks were lost. There
PSYCHOPATHIC
HOSPITAL.
65
was a Babinski reflex on the right side. He failed rapidly and gradually
passed into deep stupor, which continued until his death 27 days after
admission.
The autopsy showed that aside from a general anaemia, there was little pathological found in the examination of the internal organs. Thd
brain after hardening showed no gross focal changes. Histological studies of the nervous system showed the pia to be slightly thickened, the increase being largely cellular, with many phagocytes and a small number
of plasma cells. The margin of the cortex was thickly studded with
corpora amylacea. There was much increase in the cellular glia of the
marginal layer. Changes in the nerve cells were slight and scattered.
A few cells of the deeper layers showed absence of tigroid and a displacement of the nucleus. In the cortex of the frontal region were scattered
placques of the type first noted in this laboratory as occurring in the
brain in pernicious anaemia. In one lamella of the cerebellum was a
small focal softening. The cord at all levels showed areas of degeneration of the type so frequently met with in this disease. In distribution,
they occurred in all of the columns of the cord.
Case M. T. No. 1556. Psychosis associated with Pernicious anemia:—•
Female aged 42. Aside from the death of a sister from anemia at the
age of 40, her family history was not important. At the age of 34 she
complained of stomach trouble, and about the same time there was an
acute change in her mental condition. She had several attacks of acute
fear which she explained afterward by saying that she thought she had
given birth to a child. She then became sad and expressed ideas of un\vorthiness, and occasionally she talked of suicide. In this condition,
she was admitted to the hospital. Her blood count then showed 4,027,400
reds and 80% to 90% haemoglobin. The differential count showed nothing abnormal. She had excellent insight into her condition and after f>7
days was discharged recovered. Her blood condition was then considered suggestive of pernicious anemia, so she continued treatment for this
at irregular intervals at home. Eight years later she had an attack of
mumps and from then on complained much of nervousness and weakness. She had fainting attacks and gastro-intestinal upsets. For these
things she was admitted to the Medical Clinic of the University Hospital
where her blood count showed 1,150,000 reds and 27% haemoglobin.
The blood smears were typically those of pernicious anemia. She rapidly
passed into a deep coma and was transferred to this hospital after six
days. Here her stupor was of varying depths, but she never was entirely
clear. The only idea expressed by her were sad, of having "to die and
burn forever and forever." Her temperature ranged from 100 to 102 by
axilla and there were periods of mild delirium. On account of the deep
stupor a satisfactory neurological examination was not possible. The
knee jerks were present and slightly increased. Death occm-red 13 days
following her admission.
The pathological diagnosis of the body was: acute purulent appendicitis, general septicaemia, subserous haemorrhages, dilatation of the
heart, severe anaemia, hyperplasia of lymphoid marrow and of haemolymph nodes, fibrosis of spleen, multiple telangiectasis of skin, diffuse
hemorrhage into pericrania! tissues.
The brain weighed 1230 grams. There were numerous small haemorrhages on the inner surface of the dura and in the pia. The cerebrospinal
STATE OF MICHIGAN.
fluid was increased and the brain was edematous. The cortex showed interesting pathology. The pia mater showed a slight increase of cells
among the fibres. There was no coarse disturbance of the nerve cell arrangement. There were many cells, chiefly of the larger size, which
showed mild degrees of eccentric dissolution of the tigroid and displacement of the nucleus. A few cells showed severe disintegrative changes
with glia cells clustered about the fragments of the cell body. There were
many unusual forms of cells scattered through the nerve cell layers. Some
of these were large rod cells. Others were glia cells in various stages of
progressive and regressive changes. In the medullary part of the convolutions there Avere in sections from several regions, focal accumulations
of glia and epitheloid cells, arranged concentrically about an area free
of cells. Their characteristics were quite like the placques which have
been noted in the nervous system of pernicious anemia. There was a
slight degree of endarteritis among the capillaries of the cortex, but no
arteriosclerotic changes among the larger vessels. Serial sections of the
spinal cord showed an entire absence of the changes commonly found in
this disease.
MENTAL DISORDERS OF A TOXIC TYPE BUT UNKNOWN ETIOLOGY.
Among the cases included here were 1 male and 6 females whose mental picture was that of more or less unclearness of consciousness associated with hallucinations and delusions more or less bizarre. In one
case there was a history of long continued use of alcohol. One case Avas
that of a delirium with a valvular heart lesion and attacks of angina. In
two cases there were severe gastro-intestinal symptoms such as severe
vomiting and diarrhoea. In none of these cases which came to autopsy
were there any changes in the central nervous system of diagnostic importance.
HBEEDITY.
The occurrence of hereditary factors among the patients included in
this group of symptomatic disorders is given in the following table:
Apoplexy and paralysis.
Alcoholic
Total heredity . . . .
Total.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
1
1
2
1
1
0
2
0
2
1
4
1
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
2
0
0
0
3
1
0
0
2
2
2
1
4
0
2
0
6
2
4
1
5
3
8
0
1
1
0
0
0
2
2
4
7
6
13
o
2
5
2
7
4
11
13
24
Negative
—
Total. . .
Brothers
and
sisters.
Collateral.
Atavistic.
Direct.
T.
—
PSYCHOPATHIC HOSPITAL.
BRAIN
67
TUMOR.
Three cases of brain tumor were under treatment during this period.
Case No. 1825, a male, 43 years old, was admitted with the following
symptoms: headaches, projectile vomiting, general epileptiform seizures,
nystagmus, choked disc, left sided Babinski, and progressive mental deterioration and dullness. It was thought that there was a tumor rather
deep in the right frontal lobe. He was discharged unimproved.
Case No. 1709, was a female, 33 years of age, who died after 25 days
in the hospital. The autopsy showed multiple carcinomata throughout
the brain, with a large cystic broken down carcinoma in the left temporal region. The primary tumor was probably in the head of the pancreas with metastases in the heart, liver, peritoneum, mesentery, all the
glands of the thorax and abdomen, and in the left tube and ovary. A
detailed report of this case may be found in the Proceedings of the Clinical Society of the University of Michigan, June, 1916.
Case No. 1715 was a female, 61 years of age, who at the age of 20 had
been in a sanitarium for nervous or mental trouble, from which she completely recovered. At fifty, she underwent a decided change. She became irritable and moody and from then on was not considered normal.
Six months before admission a facial paralysis on the left side and a
memory defect were noted by the family. It was thought that she had a
stroke of paralysis. Her conduct became more difficult to control and
the memory defect became more pronounced. She frequently had trouble in walking. She complained of headaches and vomited frequently.
Upon admission the examinations revealed a general arteriosclerosis and
a blood pressure of 200. There was a Babinski reflex on the right side
and she fell to the left when in the Ehomberg position. There was no
choked disc and the Wassermann on the blood serum and cerebrospiual
fluid was negative. The latter showed an increase in the albumen content. She was confused and wandered about, frequently losing herself
on the ward. The retentive memory defect was most pronounced. After
a month there appeared weakness and spasticity of the whole left side,
which disappeared after a few days. She gradually became weaker and
soon there appeared a double choked disc, 4 diopters 011 the right and 3
on the left. An X-ray examination failed to show positive findings.
Mentally, the deterioration advanced until she passed into a stupor of
varying depths. Forced movements of the left arm and hand of a Jacksoniau type were observed on numerous occasions. There was weakness of the extrinsic muscles of the left eye. A brain puncture was made
in the right frontal region but the bit of brain removed showed no evidence of tumor. She became more stuporous and the forced movements
of the left arm became more frequent. After 162 days in the hospital,
she died. The autopsy showed a very large alveolar sarcoma in the right
occipito-temporal region extending to the surface. A smaller one was in
the right lenticular region. The cerebral vessels showed a moderate degree of arteriosclerosis.
68
STATE OF MICHIGAN.
MULTIPLE SCLEROSIS.
Two cases of this disease were admitted during this period. One of
these, Case No. 1597, was a girl of 19, whose mother was hysterical. The
meutal examination was entirely negative but the neurological examination showed nystagmus, intention tremors, ataxia, and reflex disturbances of this disease. The Wassermann on her blood was negative. The
cerebrospinal fluid showed 8 cells, slight increase in globulin and albumen and with the Lange colloidal gold it gave an atypical meningitic
curve. After 35 days she was discharged as not insane and immediately
admitted to the University Hospital Neural Clinic.
The other case, No. 1554, was a boy of 12 with the characteristic neurological findings. He showed advanced mental deterioration and after
24 days he was discharged unimproved.
SYDENHAM'S CHOREA.
There was admitted a girl, aged 15, on account of chorea and recent
acts of sexual delinquency. Observation demonstrated valvular disease
of the heart and mild choreiform movements of the head, trunk and
extremities. There was no definite mental disorder and she was discharged to her family after a few weeks treatment, the chorea being
greatly improved.
NON-INSANE
CONDITIONS.
ADULTS.
There were admitted a few individuals whose conduct had been such
as to raise the question of a mental disturbance, but whose hospital observation showed nothing to warrant their being adjudged insane or
that their actions had been the result of any serious mental abnormalities.
Two of these were male adults. One of these had been arrested on suspicion of participating in a munition conspiracy. The other was a man
who by reason of domestic incompatibilities had acted in an unusual
manner. Both were discharged at the end of the observation period.
JUVENILE DELINQUENTS.
There were admitted during the period a number of youthful individuals because of various acts of delinquency. The greater number of
these were found to be feebleminded and have been classed in the group
of imbecility. One girl, aged 19, remains over, in whom no mental disorder can be found. Her conduct was that of one of depraved character
and unrestrained impulses.
PSYCHOPATHIC HOSPITAL.
69
UNCLASSIFIED CONDITIONS.
There were admitted 9 individuals whose mental disorder could not
be placed among any of the preceding groups. Five of these were males
and 4 were females. In some instances, the individual was under observation for too brief a period. In others, there were difficulties of interpretation, which made it unwise to give to the disorder a definite diagnosis.
In all, this group formed 1.9% of those admitted during the period.
Male.
Female.
Per cent.
No.
220
Per cent.
No.
2.1 |
5
Total.
240
4
1.7
Per cent.
No.
460
9
1.9
HEREDITY.
Hereditary factors were present among the ancestors in 4 instances in
which information was obtained.
RESULTS OF TREATMENT.
M.
Recovered
Unimproved . .
Died
Remaining . .
....
....
...
F.
0
2
3
0
0
t.
0
1
1
2
0
0
3
4
2
0
Of 7 individuals who were discharged 5 returned to their families and
2 were transferred to a State Hospital.
STATE OF MICHIGAN.
70
EEPOET OP THE PATHOLOGICAL LABOEATOEY.
The laboratory of the State Psychopathic Hospital is a central laboratory to which the State Hospitals may send material for study.
The following tables rive statistical information relating to the work
done:
TABLE No. 1.—Number of cases mewed between July 1, 1915, and June 30, 1916, with
Kalamazoo State Hospital
Pontiac State Hospital .
Newberry State Hospital .
Traverse City State Hospital
State Psychopathic Hospital
Outside sources. . . .
...
.
Year
ending
June 30,
1915.
Year
ending
June 30,
1916.
62
65
32
6
8
127
65
17
8
13
112
3
118
5
230
8
115
123
238
33
11
0
6
Total
for
period.
PSYCHOPATHIC HOSPITAL.
71
TABLE No. 2.—Clinical diagnosis oj cases studied in tne laboratory.
Year
ending
June 30,
1015.
Alcoholic insanity, chronic
Alcoholic insanity, delirium tremens
Alcoholic insanity, Korsakow's psychosis
Alzheimer's disease
Cerebral arteriosclerosis
Cerebral haemorrhage, traumatic
Cerebral haemorrhage, fat emboli
Chorea, Huntington's
Dementia praecox
Encephalitis
Epilepsy
Imbecility
Manic depressive insanity
Myelitis, compression
Pellagra
Pernicious anemia
Presenile depression
Senile dementia
Syphilis, central nervous system, general paralysis. .
Syphilis, central nervous system, gumma
Syphilis, central nervous system, meningo-vaseular.
Toxic psychoses, rheumatism
Toxic psychoses, nephritis
Toxic psychoses, undifferentiated
Tumor, central nervous system
Material unstudied or undiagnosed
Miscellaneous neuro-pathological material
Total. .
Year
Tn*.,i
ending ! J ° tdl
June 30, I period.
1016.
2
0
0
0
2
1
1
2
4
1
1
26
13
0
0
0
39
1
1
1
4
1
7
1
5
1
3
1
1
6
1
11
1
1
1
1
21
2
4
0
0
32
115
2
1
4
3
1
13
6
2
2
1
1
1
3
57
- 2
1
1
3
4
89
4
123
238
TABLE No. 3. —Number of cases reported to the State Hospitals during the period.
indudes 188 cases received during previous periods but reported in this.
4
6
This
Kalamazoo State Hospital. . .
Pontiac State Hospital
Traverse City State Hospital.
Newberry State Hospital....
56
104
35
Total number reported.
228
33
72
STATE OF MICHIGAN.
TABLE No. 4.—Number of Wassermann tests made between July 1, 1914, and June 30,
1916, and their sources.
Year ending
June 30, 1915.
Year ending
June 30, 1916.
CSF. Blood . Total. CSF.
Kalamazoo State Hospital
Traverse City State Hospital
Newberry State Hospital.
State Psychopathic Hospital
Ionia State Hospital
Michigan Home & Training School .
Total .
173
142
20
49
99
802
416
315
270
270
975
558
335
319
369
0
0
0
0
8
69
0
0
8
69
0
0
483 2,150 2,633
Blood . Total. CSF. Blood . Total.
296 1,019 1,315
121
423
544
9
431
440
234
42
276
113
368
481
3
0
0
0
Total
for period.
427
230
189
243
430
230
189
243
469 1,821
263
839
29
91
212
746
504
638
2,290
1,102
775
595
850
3
0
0
0
435
299
189
243
438
299
189
243
584 3,564 4,148 1,067 5,714
6,781
REPORT OF THE SECRETARY AND BUSINESS OFFICER.
Ann Arbor, Mich., June 30, 1916.
To the Board of Trustees:
Gentlemen—I have the honor to present the report of the business
transactions of the hospital for the biennial period ending June 30, 191.6.
The whole number of patient days was 42,122; the average daily cost
per patient per day was fl.257; the highest rate for any one month was
|1.29; the lowest $1.25 per patient per day.
In comparing these rates with those of the two years just proceeding
it will be noticed that they have increased considerably. This is due almost entirely to the increased cost of food stuffs.
PSYCHOPATHIC HOSPITAL.
DISBURSEMENTS.
ON ACCOUNT OF CURRENT EXPENSES.
July 1, 1914 to June 30, 1916.
Pood
Clothing
Laundry Expenses
Heating and Light
Floral, Greenhouse and Grounds
Medical Department
Office, Stationery, Etc
Amusement and Instruction
Furniture and Household Supplies
Improvements and Repairs
Miscellaneous Expenses
Farm, Garden and Stock
Refunds
Total for Biennial Period
123,745 19
122 03
2,564 73
3,578 95
307 96
11,977 25
1,835 60
336 75
5,818 93
4,809 81
2,848 61
3 25
158 28
158,107 34
DISBURSEMENTS.
4
;,
ON ACCOUNT OF CLINICAL LABORATORY.
July 1, 1914 to June 30, 1916.
Officers' Salaries
Animal Food
Heating and Light
Floral, Greenhouse and Grounds
Medical Department
Amusement and Instruction
Office, Stationery, Etc
Furniture and Housekeeping Supplies
Improvements and Repairs
Farm, Garden and Stock
Miscellaneous Expenses
Total for Biennial Period
f 14,001 68
27 33
48 19
8 85
6,417 93
20
1,107 94
1 70
49 59
49 61
475 65
$22,188 67
74
STATE OP MICHIGAN.
RECEIPTS.
ON ACCOUNT OF CURRENT EXPENSES.
July 1, 1914 to June 30, 1916.
From
From
From
From
From
From
State for County Patients
.........................
State for State Patients
...........................
Private Patients
.................................
Interest Accounts
...............................
Refund on Pay Roll
..............................
Miscellaneous Sales
..............................
Total for Biennial Period
$45,016 44
994 58
18,176 42
815 95
3 87
73 82
$65,081 08
RECEIPTS.
ON ACCOUNT OF CLINICAL LABORATORY.
July 1, 1914 to June 30, 1916.
Special Appropriation
Wassermann Tests
Refund on Pay Roll
From Miscellaneous Sales
Total for Biennial Period
$27,000 00
427 50
30 00
100 80
$27,5P« 30
PSYCHOPATHIC
HOSPITAL.
75
Table showing the number of hospital days and the daily per capita
costs by months from July 1, 1914 to June 30, 1916.
Patient
hospital
days.
From July 1, 1914, to June 30, 1916:
July, 1914
August, 1914
September, 1914
October, 1914
November, 1914
December, 1914
January, 1915
February, 1915
March, 1915
April, 1915
May, 1915
June, 1915
July, 1915
August, 1915
September, 1915
October, 1915
November, 1915
December, 1915
January, 1916
February, 1916
March, 1916
April, 1916
May, 1910
June, 1916
1,775
1,818
1,731
1,787
1,688
1,698
1,800
1,593
1,808
1,765
1,704
1,717
1,846
1,793
1,700
1,692
1,757
1,803
1,852
1,743
1,822
1,677
1,862
1,691
Daily
per capita
cost.
-
$1 27
1 291 26
1 27
1 25
126
1 2»
1-26
1 27~
1 26
126
1 25
1 25
1 25
1 25
1 2'6
1 .26;
1 25
1 25
1 25
125
1 25
1 25
1 25-
SUMMARY OF INVENTORY, JUNE 30, 1916.
Hospital buildings
Furniture
Fixtures
Apparatus
Books
Supplies
Total...
S3,109
707
5,550
1,140
3,983
43
33
43
36
07
$78,269 23
14,490 62
$92,759 85
Respectfully submitted,
ROBERT G. GREVE,,
Secretary.
76
STATE OP MICHIGAN.
REPORT OF TREASURER.
I
• •
;
'
July 1, 1916.
To -the Board of Trustees of the State Psychopathic Hospital:
Gentlemen—Herewith I hand you report of the State Psychopathic
Hospital for the biennial period ending June 30, 1916:
RECEIPTS.
Balance in Treasury July 1, 1914
By cash from State Treasurer, annual appropriation, laboratory (Sec. 28, Act 278, Public Acts 1907)
By cash from State Treasurer (Support of State Patients).
By cash from State Treasurer (Support of County Patients)
By cash from Private Patients
By cash from Earnings Institution (Interest, etc.)
f 9,359 07
27,000 00
994 58
44,649 02
18,543 84
1,453 94
$102,000 45
DISBURSEMENTS.
Clinical Laboratory Accounts
Current Expenses (Running Account)
Balance June 30, 1916
f22,188 67
58,107 34
21,704 44
$102,000 45
Very respectfully submitted,
R. A. CAMPBELL,
Treasurer.
OF THE
BOARD OF TRUSTEES
OF THE
STATE-PSYCHOPATHIC HOSPITAL
AT THE
UNIVERSITY OF MICHIGAN
FOR THE
BIENNIAL PERIOD ENDING J U N E 30 1916.
BY AUTHORITY
LANSING, MICHIGAN
WYNKOOP HALLENBECK CRAWFORD CO., STATE PRINTERS
1917
REPORT OF TRUSTEES.
To the Legislature of the State of Michigan:
The Board of Trustees of the State Psychopathic Hospital at the
University of Michigan has the honor of submitting the following report:
The membership of the Board remains the same as during the previous
period excepting that Harry C. Davis, member from the Board of Trustees of the Traverse City State Hospital, has been succeeded by M. F.
Quaintance from the Same Board.
Meetings of the Board have been held at the Hospital and the Trustees have maintained an active interest in the work of the institution.
The various detailed statements of the medical work and business
administration are given in the accompanying reports of the Medical
Director, the Business Officer and the Treasurer. The Board wishes to
express its appreciation of the faithful service of the former Business
Officer of the hospital, Mr. J. B. Draper, who lost his life by accident
in November, 1915. His work in organizing the business affairs of the
institution during its formative years was unusually valuable.
The number of patients treated during the period was 510 as against
465 in the previous period. There continues as in former years a greater
demand for the admission of patients than the limited capacity of the
hospital can satisfy. There have been no notable changes of the buildings or grounds of the hospital during the period.
The Board must again emphasize the very inadequate facilities which
are provided for the work of the hospital. Both in size and arrangements the building is quite unsuited for the successful conduct of the
work of an organization of its type. These difficulties can only be
remedied by the erection of a new building planned with an appreciation
of the work it is to do. It is hoped that the public will become more
familiar with the great service the institution is doing and that adequate provision will be made for its needs at an early date.
The average rate for the maintenance of public patients was fl.257
per diem. The increase of this rate over that of previous years is largely due to the increased cost of food stuffs.
The most notable feature of the work of the period has been the development of the out-patient service at Ann Arbor and the establishment
of a similar psychopathic clinic directed by the hospital in Detroit.
The Board of Trustees acting in harmony with the research purposes
of the Psychopathic Hospital have appreciated that insanity is not
a disease to be studied only in its manifestations in the individual himself or in the morbid structure of the brain. It has its causes in ab-
6
STATE OP MICHIGAN.
normalities present in the family from which he is derived and in forces
active in the environment in which he has lived; such factors are not
open to study within the walls of the hospital. To understand these
it is essential that the interests and activities of the hospital reach out
into the homes and among the families and into the public life of our
communities. To make it possible to carry on investigations along
these lines the Board of Trustees have approved of the organization of
out-patient services or psychopathic clinics under the direct control of
the medical officers of the Psychopathic Hospital.
A beginning of this phase of the hospital's activities has been made
in the establishment of an out-patient service in Detroit in connection
with the Wayne County Probate Court.
It is planned to establish similar organizations in other centers of
larger population whenever local co-operation can be secured.
The Board of Trustees feel that institutions of the type of the State
Psychopathic Hospital must assume the position of leaders in the work
of public service in matters pertaining to mental disorders. Such activities will extend its functions far beyond the traditional lines limiting institutions caring for the insane. It is largely by efforts for public
education and through extra-mural activities that we may expect to
achieve success in attacking the sources for the production of insanity
and mental disorders.
Signed,
CHAUNCEY F. COOK,
WALTEE H. SAWYER,
FRED S. CASE,
WM. L. CLEMENTS,
STUART GALBRAITH,
BENJ. S. HANCHETT,
FRANK B. LELAND,
M. F. QUAINTANCE,
PSYCHOPATHIC HOSPITAL.
REPORT OF THE MEDICAL DIRECTOR.
In accordance with the statutes of this State, I have the honor of submitting my report as Medical Director of the State Psychopathic Hospital for the period covering July 1st, 1914, to June 30, 1916.
The close of the period marks the end of the first decade of the Hospitals' existence. Such a length of time should be sufficient for the institution to have established its field of work among the other organizations of the State caring for mental disorders. It should also have
determined the lines of activity which would be most promising for
its future development.
While the statutes establishing the hospital specified certain lines of
activity as its work, its functions as concerned the class of patients it
was to treat have been largely determined by its later experiences. Its
designation as a psychopathic hospital implied that it was to maintain
certain distinctive differences from the other hospitals maintained by
the State for the care of the insane.
In the development of its laboratory and research activities, there
was little difficulty in maintaining this distinction. Its relationship
to the class of mental disorders it was to treat has been less easy to
establish. As the hospital was a State institution, it was necessary to
receive patients from any part of the State. By reason of its snial]
capacity, namely, sixty-two beds, it was obvious that some restrictions
to admission would be desirable.
The term, psychopathic, as used in its official designation, suggested
that its work should be confined to those mental abnormalities not
usually classed as states of insanity. Experience early showed that
this would not be possible. The information usually available from prehospital examinations was rarely adequate to determine any distinctions between these two classes. This likewise prevented any distinctions between curable and non-curable disorders.
As the hospital was provided with unusual facilities for treatment,
in any case where treatment would be of any use,, it became essential
to select from those admitted to the hospital all who might be expected
to react favorably to what the hospital might do. In the case of the
others, what was needed was competent observation and advice as to
the best method for their future care. To accomplish this it was necessary to develop to the utmost the diagnostic side of the hospital's activities.
The institution has thus assumed to a considerable degree the functions of a clearing house for mental disorders and has equipped its
laboratories and developed its medical routine to best serve this purpose.
The results of its treatment are indicated in the fact that less than
one-fourth of those discharged go from the hospital to one of the other
State institutions.
8
STATE OF MICHIGAN.
CLINICAL AND LABORATORY WORK.
As in previous years, the hospital has followed the plan of routine
intensive study of the clinical symptomatology of its patients with a
systematic consideration of the results of this in each individual admitted. The discussion of these studies at frequent conferences of the
medical officers serves to keep up an orderly routine and increase the
thoroughness of the medical work.
The activities of the laboratory have chiefly concerned the study of
the material received from the State Hospitals, by the modern methods
of neuro-pathology. On account of the considerable amount of material
received it has been found necessary to limit the work to that which has
come from cases well observed during their hospital life or to that
material which presented interesting pathological problems. The results of many of these studies have been communicated to the hospital
interested in the case. Some of these have been published in the medical literature of the period.
The serological work of the laboratory has greatly increased in
amount. At the present time, the laboratory of this hospital makes
Wassermann tests for all of the Michigan institutions caring for mental
disorders.
PUBLISHED CONTRIBUTIONS.
There have been reported on various occasions and published in the
medical literature of the years 1914-1916 the following contributions by
members of the hospital staff.
Barrett, Albert M.—Clinical and anatomical study of a case of Dementia praecox with acute death. Journal Michigan State Medical
Association, January, 1915, page 61.
Barrett, Albert M.—Extra mural responsibilities of State Hospitals
for the Insane. Proceedings Joint Board of Trustees of State Hospitals of Michigan, July, 1915.
Barrett, Albert M.—Multiple carcinoma involving the brain. Transactions Hospital Clinical Society, University of Michigan, January,
1916. Vol. 7.
Barrett, Albert M.—Syphilitic Psychoses associated with Manic Depressive symptoms and course. Journal American Medical Association. December 2, .1916. Page 1,639.
Jacoby, Arnold L.—Constitutional Syphilis associated with an hallucinatory mental disorder. Transactions Hospital Clinical Society, University of Michigan. April, 1916.
Haskell, Eobert H.—Acute Alcoholic Hallucinosis in General Paralysis, with Herpes Zoster following intraspinous treatment. Transactions
Hospital Clinical Society, University of- Michigan. February, 1915.
Vol. 6.
Hulbert, Harold S.—Technical improvement in Lange's colloidal gold
test. Transactions Hospital Clinical Society, University of Michigan.
October, 1915.
PSYCHOPATHIC HOSPITAL.
9
OUT-PATIENT WORK.
In the development of the medical activities of the hospital, it has become increasingly apparent that many of the problems relating to the
mental disorders of patients have ramifications far beyond the confines
of the hospital. The most striking of these relate to the influence of
environment and habits of the patient. The interest in this aspect of
mental disorders became awakened in the studies of familial syphilis
which the hospital has been carrying on during recent years.
These interests have lead to the organization of out-patient services
under the direct supervision of the Psychopathic Hospital. The first of
these was developed in connection with the out-patient services of the
General hospital of the University.
Somewhat later, a service was organized in Detroit in relation with
the Wayne County Juvenile Court. This service known as the Detroit
Psychopathic Clinic, has the assistance of a trained psychologist and
a social service worker. This assistance has been made possible by the
Associated Charities of Detroit and the Wayne County Probate Court.
On one day each week a physician from the Psychopathic Hospital
is in attendance at the Clinic. The Clinic examines all cases of mental
abnormalities referred to it from any of the Charitable organizations of
Wayne county. The brief time that this organization has existed has
shown its value not alone in giving helpful advice to those mentally
ill, but in bringing the medical and research interests of the Psychopathic Hospital in contact with mental diseases at their earliest phases
and the sources responsible for the production of a large variety of
problems directly the concern of an institution such as this. It is planned to organize similar services in other cities of the State whenever
local conditions will insure their successful maintenance.
GELATIONS WITH THE STATE HOSPITALS.
There has continued through the period the same helpful co-operation
between the State institutions caring for those mentally disordered and
the Psychopathic Hospital.
The medical director in his capacity of pathologist to the State Hospitals for the Insane has made visits, as time permitted, to the several
hospitals. At these occasions there have been conferences with the
medical officers, and demonstrations of material sent from the hospital
to the laboratory of the Psychopathic Hospital.
There have been held at the Psychopathic Hospital several meetings
of the Superintendents of the Michigan State Hospitals. At these there
was presented a clinical program by the staff of this hospital, and there
were discussions of problems of mutual interest to those engaged in
the care of those mentally diseased. As a result of these, psychiatric
work in Michigan has been advanced in a number of specific directions.
The plan has been inaugurated during the period of having a medical
assistant from one of the State Hospitals detailed to the Psychopathic
Hospital for the period of a month. During this time he receives special
instruction in clinical problems and methods.
10
STATE OF MICHIGAN.
FUTURE DEVELOPMENTS.
Extensive developments of the work of the hospital are impossible until the institution is provided with a building adequate to its needs. Anyone who is familiar with the construction and arrangements of the present building must realize how poorly it is adapted to the cure of patients
with mental disorders, and how unsuited it is to carry on its purpose of
investigation and teaching. Those interested in the administration of
the hospital feel that this situation should be appreciated by the people
of the State and that within the next few years the legislature should
make provision for a new building adequate to its needs.
The interest which has been taken in the organization of out-patient
services has shown that along this direction of activity it will find a field
of great usefulness.
The awakening of the people of Michigan to the menace of mental abnormalities, in particular the feeblemindedness, makes it opportune for
the Psychopathic Hospital to interest itself in efforts for public education as to the causes and prevention of mental disorders. Plans for undertaking this are now being formulated.
OFFICIAL CHANGES.
The following changes among the officials of the Hospital have occurred during the period.
Dr. Eobert H. Haskell resigned his position as First Assistant Physician on April 1, 1915 to become Superintendent of the Ionia State Hospital. Dr. Arnold L. Jacoby has been appointed to this position.
In July, 1915—Dr. Harold S. Hulbert was appointed Second Assistant Physician.
In Octobei', 1915, Dr. W. I. Lillie was appointed Eesident Physician.
Dr. Adeline E. Gurd was appointed Pathologist in the hospital in November, 1915.
Following the death of Mr. J. B. Draper, in November, 1915, Mr.
Robert G. Greve was appointed Business Officer of the hospital.
Respectfully submitted,
ALBERT M. BARRETT,
Medical Director.
PSYCHOPATHIC HOSPITAL.
11
CLINICAL EEPORT.
As iii former reports, the information regarding the clinical work of
the hospital is considered in two divisions. The first of these includes a
tabulation of the general statistics relating to the clinical disorders
which have been treated during the period; the second is a detailed analysis of the various clinical groups.
GENERAL STATISTICAL
TABLES.
Information given in the general tables may be compared with that
given in similar tabulations by other State institutions for the insane,
but in doing so the peculiar relations under which the State Psychopathic Hospital operates must be borne in mind.
This hospital receives patients from the entire State rather than from
any one district. Admissions, so far as possible, are restricted to mental
disorders in their earlier stages of to those functional mental abnormalities which are not regarded as cominitable to the larger State Hospitals.
The small capacity compared with the other institutions caring for
the insane, and an active demand for admission to a hospital of its
special character, results in a far shorter period of treatment for any individual case than is afforded by the larger institutions.
TABLE No. I.—Showing the number of patients admitted and discharged and remaining
June 30, 1916.
Year ending
June 30, 1915.
M.
Admitted on original commitments .
Public
Year ending
June 30, 1916.
T.
F.
M.
F.
Total
since beginning.
T.
M.
F.
T.
66
1
27
76
5
33
142
6
60
81
10
35
87
8
30
168
18
65
575
94
236
590
88
215
1,165
181
451
By transfer from State institutions .
Public . . .
Private
State. . .
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
0
0
8
7
21
6
2
15
14
»
36
Total number admitted . . . .
94
114
208
126
126
252
941
916
1,857
16
36
39
1
1
12
55
35
1
7
28
91
74
2
8
10
56
51
2
6
11
60
58
1
3
21
116
109
3
9
129
299
417
30
40
138
292
410
16
32
267
591
827
46
72
93
110
203
125
133
258
915
888
1,803
26
28
54
Voluntary
Discharged:
As recovered
As improved . .
...
As not insane
Died
Total number discharged . . .
Remaining June 30 1916
"
"
STATE OF MICHIGAN.
12
In this table are given the number and character of the admissions
and discharges of the period and from the beginning of the work of the
hospital.
The total number of admissions is about 10% greater than for the previous period.
Only one patient was received by transfer from one of the other State
Hospitals.
One hundred and twenty-five patients voluntarily sought treatment
without court commitment. This forms about 27% of all admissions.
The comparative increase each year since the opening of the hospital
is as follows:
1906. 1907. 1908.
Male
Female
1909.
1910.
1911.
1912.
1913.
1914.
1915.
1916.
27
28
39
40
48
59
78
70
89
92
96
96
118
101
109
88
117
104
94
114
126
126
53
79
107
148
181
192
219
197
221
208
252
6.
Total.
The admission for the period by months has been:
July 1, 1914, to June 30, 1915.
7.
8.
10.
11.
12.
1.
2.
3.
4
K
-
Male
Female .
11
6
5
8
12
13
8
9
6
6
4
4
9
9
9
16
8
10
7
10
13
11
94
114
17
13
25
17
12
11
13
16
25
18
17
24
208
PSYCHOPATHIC HOSPITAL.
13
July 1, J.915, to June 30, 1916.
8
9
10
11
12.
1
2
3.
4
9
12
12
10
7
10
14
11
9
9
12
10
6
12
12
13
8
7
12
16
16
9
9
126
126
16
24
17
24
20
21
16
24
21
19
32
18
252
7
Male
it*.
The average monthly admission for the period was 19.
number admitted during any one month was 32.
6
Total.
The largest
TABLE No. II.—Showing the forms of insanity in -patients admitted and discharged from the beginning until June 30, 1916.
Year ending June 30, 1915.
Admitted.
Discharged.
Paraphrenia systematica . . . .
Melancholia, involutional . .
Neuraesthenia . . . .
Anxiety neuroses
Constitutional criminalities .
Psychopathic personalities, adult
Psychopathic personalities, juvenile.
Alcoholic mental disorders . .
..
.
...
General paralysis
.
...
Cerebral arteriosclerosis . .
Cerebral tumor . . .
Huntingdon's chorea . . .
.
...
....
Discharged.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
21
15
1
0
0
28
25
1
49
40
2
7
0
21
20
1
0
0
30
25
1
5
0
51
45
2
5
0
28
15
0
3
0
41
23
5
0
0
69
38
5
3
0
29
15
0
2
0
40
28
4
2
0
69
43
4
4
0
203
165
!1
252
171
27
455
336
38
10
11
198
160
11
2
3
240
166
26
7
8
438
326
37
9
11
0
2
0
1
0
0
12
0
0
0
0
14
0
0
13
0
0
0
0
16
0
0
7
0
0
0
0
20
0
0
0
0
27
0
0
0
0
5
0
0
0
0
19
0
0
0
0
24
0
0
0
11
21 (a) 125
27
17
1
3
2
0
14
146
44
3
19
27
0
0
3
0
1
0
11
120
17
1
0
14
'139
44
4
2
2
0
0
6
3
0
0
0
2
0
2
0
0
8
3
2
0
0
5
3
1
1
0
1
1
14
4
2
31
14
0
2
0
6
4
0
1
12
6
0
0
1
5
0
26
22
5
5
1
4
12
1
3
0
1
3
0
2
0
0
3
0
ll
I
Presenile mental disorders . . .
Admitted.
T.
8
..
Discharged.
Admitted.
F.
?
Imbecility
Total since beginning.
M.
Insane conditions:
Dementia praecox
Year ending June 30, 1916
I
0
n
0
I
•s
I
I
0
0
0
0
0
0
4°
5
I
i
0
0
0
0
0
:
8
'•
T.
0
0
20
0
0
0
0
7
0
0
0
0
11
0
0
0
0
18
0
10
3
2
13
9
5
1
0
22
5
()
0
0
7
0
0
0
0
13
0
15
0
6
3
35
14
12
9
5
1
0
19
5
f
0
1
9
12
3
0
0
3
0
3
0
0
4
12
6
0
0
12
5
0
0
6
0
4
0
0
3
12
9
0
0
9
80
11
1
2
30
3
12
0
0
16
83
23
1
2
46
80
11
1
2
30
3
12
0
0
15
83
23
1
2
45
20
1
4
1
4
16
3
3
1
0
2
1
2
1
1
18
4
17
1
3
1
0
4
3
3
1
0
21
7
6
2
0
136
17
26
15
4
27
11
17
11
14
163
28
43
26
18
132
17
25
15
4
27
10
17
11
13
159
27
42
26
17
4
0
1
0
0
9
1
0
0
0
1
2
0
0
0
10
3
0
0
0
1
2
1
0
0
I
41
19
1
0
0
0
13
60
6
3
4
38
4
2
0
3
19
2
1
1
4
3
6
0
i
7
57
6
3
1
7
Traumatic insanity
Psychoses associated with pernicious anemia
Psychoses associated with articular rheumatism . . .
Psychoses associated with nephritis
Psychoses associated with paralysis agitans
Delirium, toxic. .
....
...
Non-insane conditions—adult :
Sydenham's chorea . .
.
Miscellaneous . .
..
..
Non-insane conditions—juvenile :
Juvenile criminals . . , .
Total . .
...
....
0
0
0
0
1
0
1
0
0
2
3
4
0
2
3
5
3
3
0
4
1
4
3
2
7
6
7
0 I
2
2
4
3
3
0
4
1
4
3
2
6
5
7
0
0
0
0
0
0
0
0
0
4
0
0
0
0
4
0
1
1 (a) 1
0
1
5
4
9
1
2
1
6
13
1
0
0
1
4
0
2
1
5
9
u'Vl
0
0
0
4
0
0
0
3
0
0
0
1
0
0
0
4
0
5
0
36
1
12
4
66
1
17
4
102
0
5
0
36
1
12
4
66
102
0
0
0
0
0
0
0
2
0
0
0
2
0
0
0
0
0
0
0
2
1
2
2
20
0
2
0
12
1
4
2
32
1
2
2
20
0
2
0
12
1
4
2
32
0
0
0
0
0
5
2
7
5
2
252 125 133 258
941
916 1,857
915
888
0
3
0
0
2
3
3
0
0
1
0
1
0
0
3
3
4
0
0
0
3
i
0
0
0
0
1
0
2
0
0
2
0
2
0
0
3
0
1
0
0
0
0
0
0
0
4
0
1
0
0
4
0
0
0
5
0
0
0
2
0
1
0
3
0
1
0
5
0
0
0
3
0
0
0
1
1
0
1
1
0
0
0
0
0
1
0
0
0
1
0
1
0
0
0
1
1
0
0
0
0
2
0
1
1
0
1
1
0
1
0
0
0
0
0
0
0
0
0
0
3
0
0
1
1
3
0
0
0
0
1
0
1
0
0
2
0
1
0
0
3
0
0
0
2
0
0
0
3
0
0
0
1
0
0
0
94 114 208
1
93 110 203 126
3
3
(a) Female: in former period diagnosed hysteria, rediagnosed and discharged as psychosis associated with pellagra.
1
6
31
1
17
02
^
0
K
O
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1,803
Q
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W
16
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STATE OF MICHIGAN.
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Total heredity
1
S
.
Insanity
Apoplexy and paralysis
Psychopathic conditions
Alcoholism
17
PSYCHOPATHIC HOSPITAL.
The variety of clinical forms given in this table is about as in former
years. The chief clinical groups occur in about the same relative numbers.
The relative frequency of conditions which could not be classified is
1.9%, a number relatively much smaller than in previous years.
It was possible to obtain some information as to the occurrence of
factors important from the aspect of heredity in 81.9% of all the insane
admitted. In all cases of insanity in which information was obtained,
hereditary influences were present among the ancestors in 67.4%' of instances. These were among the parents in 59.4% of instances; among
the grandparents in 10.8% ; among collateral lines in 14.8% ; and among
the brothers and sisters in 14.8%.
In many families there were several instances of mental abnormalities. In the families of 277 insane individuals there were 825 individuals who showed mental abnormalities.
TABLE No. IV.—Shelving the age of patients admitted.
Year ending
June 30, 1916.
Year ending
June 30, 1915.
M.
From 0 to 4 years
0
2
4
From 15 to 19 years.
From 20 to 24 years .
]2
From 25 to 29 years
From 30 to 34 years .
From 35 to 39 years
18
9
12
6
From 45 to 49 years .
From 50 to 54 years .
From 60 to 64 years .
From 80 to 84 years .
Total .
. . .
7
6
11
0
0
0
0
0
0
94
F.
T.
M.
0
2
4
22
22
0
1
2
5
10
6
3
0
1
0
0
0
34
28
24
20
18
12
18
3
0
1
0
0
0
20
12
20
17
7
7
10
7
4
3
0
0
1
114
208
0
0
0
15
.10
16
19
12
14
11
126
F.
0
0
3
6
16
21
17
14
16
11
9
9
3
0
0
1
0
0
126
Total
since beginning.
T.
0
1
5
11
26
41
29
34
33
18
16
19
10
4
M.
F.
1
7
23
66
104
0
2
6
76
95
3
1
0
1
121
104
114
88
97
68
71
30
15
9
5
1
17
104
120
122
122
91
67
49
25
4
6
2
1
24
252
941
916
T.
1
9
29
142
199
225
224
236
210
188
135
120
55
19
15
7
2
41
1,857
The largest number of admissions occurred between the ages of 20 and
28. The greater number of admissions occurred at earlier ages than in
previous periods.
STATE OF MICHIGAN.
18
TABLE No. V.—Showing civil condition of patients admitted.
Year ending
June 30, 1915.
M.
Single
Married . .
Divorced .
...
Total
F.
Total
since beginning.
Year ending
June 30, 1916.
T.
46
44
2
1
•1
40
62
10
2
0
86
106
12
3
1
94
114
208
M.
49
68
4
4
1
126
T.-
M.
F.
44
70
8
4
0
93
138
12
8
1
408
465
33
32
3
310
508
67
29
2
718
973
100
61
5
126
252
941
916
1,857
F.
T.
TABLE No. VI.—Showing degree of education of patients admitted.
Year ending
June 30, 1915.
M.
6
Academic. . . .
Common school
Read only .
Total
F.
Year ending
June 30, 1916.
T.
M.
F.
Total
since beginning.
T.
M.
F.
T.
1851
13
2
2
2
5
23
74
7
0
0
5
11
41
125
20
2
2
7
13
20
60
18
1
7
7
2
36
69
16
0
1
2
15
56
129
34
1
8
9
67
162
583
64
3
14
41
39
188
606
47
0
1
42
106
350
1,189
111
3
15
83
94
114
208
126
126
252
934
923
1,857
TABLE No. VII.—Showing the occupation of those admitted during the current period
and from beginning.
Year ending
June 30, 1915.
M.
Professional
Personal service, police and military . . .
Manufacturing and mechanical inAgriculture, transportation
Total
and
F.
Year ending
June 30, 1916.
T.
M.
Total
since beginning.
T.
F.
M.
F.
T.
3
10
7
0
4
8
1
1
7
18
8
1
12
10
15
2
11
11
0
0
23
21
15
2
76
71
109
36
56
48
8
4
132
119
117
40
2
13
17
0
3
2
16
4
15
0
8
4
23
17
146
0
85
17
231
2
19
25
4
29
112
12
124
26
0
9
6
1
0
82
6
c
2
26
82
15
11
3
37
0
3
3
0
0
85
3
4
0
37
85
6
7
0
285
0
38
39
12
0
609
25
61
8
285
609
63
100
20
94
114
208
126
126
252
941
916
1,857
PSYCHOPATHIC HOSPITAL.
19
TABLE No. VIII.—-Showing the nativity of patients admitted.
Year ending
June 30, 1915.
Holland .
Ireland
Italy . -. .
Poland . .
...
Total
since beginning.
F.
T.
M.
F.
T.
M.
F.
T.
94
63
81
11
2
114
75
99
13
208
138
180
24
4
126
64
92
24
10
126
78
101
21
4
252
142
193
45
14
941
556
762
135
44
916
577
743
144
29
1,857
1,133
1,505
279
73
0
0
0
1
0
0
0
0
0
1
1
0
0
0
1
0
0
0
1
1
0
0
0
1
2
0
0
1
0
2
0
1
3
0
0
1
1
5
2
1
12
0
2
3
0
7
0
5
4
0
10
0
1
4
1
17
0
6
8
1
45
2
19
27
7
54
0
12
38
99
2
31
65
14
0
1
0
0
0
0
0
0
0
0
1
0
1
2
1
2
0
2
5
0
0
1
0
0
0
0
1
5
7
1
2
1
7
1
0
0
3
1
2
1
1
8
5
4
1
0
7
4
6
0
1
15
9
10
1
0
1
0
14
1
1
1
12
0
0
0
6
1
1
1
18.
M.
Total born in United States . . . . . .
Year ending
June 30, 1916.
0
0
4
0
?
I
0
I
?
0
0
0
I
I
i
i
0
1
1
Sweden . . .
Syria
0
0
0
0
0
0
0
2
1
0
2
0
0
0
Wales . .
0
0
0
2
0
0
0
2
0
0
0
4
0
1
0
10
0
0
0
4
0
1
1
1
1
1
O
1
TABLE No. IX.—Showing the nativity of parents.
Year ending
June 30, 1915.
M.
Both native born
One foreign born, ons native born . .
One foreign born, one unknown . . .
One native born, one unknown . . . .
Unascertained
Total
F.
34
36
10
1
2
11
36
44
17
3
4
10
•04
114
Year ending
June 30, 1916.
T.
70
80
27
M.
F.
Total
since beginning.
T.
M.
F.
606
819
231
9
12
180
1 , 857
41
52
21
2
5
o
84
105
29
5
6
23
293
432
110
6
21
43
53
8
3
1
18
3
99
313
387
121
o
9
81
208
126
126
252
941
916
4
4
T.
In tables VIII and IX it is shown that 15.7% of those admitted were
foreign born and 52.4% had one or both of their parents foreign born.
63.3% of those admitted were born in Michigan.
20
STATE OF MICHIGAN.
TABLE No. X.—Showing counties from which patients have been received.
Year ending
June 30, 1915.
M.
Allegan
Antrim
Bay
Benzie .
Calhoun
Chippewa
Clare
Clinton
F.
Year ending
June 30, 1916.
M.
T.
0
0
2
0
0
0
0
1
0
1
0
0
3
0
1
0
0
0
3
0
0
0
0
6
0
0
0
0
9
0
0
2
1
0
0
1
0
3
0
0
1
2
4
0
0
0
0
0
0
0
2
0
0
0
0
2
0
0
0
0
F.
2
1
1
3
0
1
0
0
4
0
0
3
0
1
0
1
0
0
1
0
0
0
1
0
2
0
1
0
2
2
0
1
3
4
0
0
2
4
1
0
8
0
1
3
0
3
2
0
0
0
1
i
2
0
4
0
2
0
5
1
1
4
0
9
0
0
0
0
2
1
0
0
3
2
1
0
0
3
4
1
1
7
1
0
0
0
7
4
2
1
1
14
5
2
Iron
Isabella
Jackson
Kalamazoo
0
0
3
0
0
0
0
5
2
0
Kent . •.
8
0
0
0
0
6
0
0
4
0
14
0
0
4
0
1
3
0
0
1
1
1
1
0
3
2
4
1
0
4
0
0
0
3
0
0
0
0
0
0
0
0
0
,3
0
2
0
0
0
1
0
0
0
0
3
0
0
0
0
4
0
0
0
2
2
0
Delta
Dickinson
Emmet
Gogebic
Grand Traverse
Gratiot
Hillsdale
Lapeer
Leelanau
Lenawee
Luce
Manistee
Marquette
Mason
Menominee
Midland
Missaukee
0
0 '
0
8
2
0
1
1
1
0
Total
since beginning.
T.
M.
0
0
0
3
0
0
0
1
4
2
1
1
6
0
1
0
1
8
0
0
o
0
0
1
0
1
1
0
0
0
5
1
9
0
0
0
2
1
3
0
1
0
1
4
0
7
1
12
9
0
3
0
10
3
4
4
0
3
26
1
1
0
5
21
0
5
19
15
2
5
5
7
20
3
1
0
1
2
0
10
1
0
8
3
8
0
3
6
2
0
0
6
1
11
0
1
12
2
32
1
0
18
7
43
0
0
4
3
1
1
1
18
29
2
0
1
3
1
7
5
1
4
3
22
17
5
0
3
8
o
1
1
0
1
o
o
0
4
26
8
0
7
0
0
15
0
1
4
0
65
0
2
8
0
7
4
0
0
2
20
15
0
1
8
2
0
1
1
2
4
3
12
4
2
0
0
2
2
0
2
0
21
16
0
i
0
4
2
0
0
2
1
0
0
0
0
0
0
0
0
0
T.
F.
17
25
6
3
36
13
4
0
7
37
3
0
57
1
0
14
1
16
15
2
0
12
2
2
9
0
1
0
1
11
15
0
10
1
22
12
4
5
0
8
47
1
10
26
35
5
6
18
1
3
14
5
1
1
30
9
75
3
1
2
35
54
10
6
58
30
9
0
11
63
11
0
122
1
2
22
1
36
30
2
1
20
6
5
21
4
3
2
1
32
31
0
21
PSYCHOPATHIC HOSPITAL.
TABLE No. X.—Concluded.
Year ending
June 30, 1916.
Year ending
June 30, 1915.
M.
Otsego .
St Clair .
St Joseph .
Tuscola
Van Buren . . .
Washtenaw
Wexford
Total .
...
P.
T.
1
0
0
0
0
0
0
0
0
3
0
0
1
2
0
0
3
2
0
0
9
24
1
1
2
0
0
0
1
0
0
0
0
2
0
0
6
1
0
2
1
0
0
0
12
20
0
0
3
0
0
0
1
0
0
0
0
5
0
0
7
3
0
2
4
2
0
0
21
44
1
1
94
114
208
M.
F.
Total
since beginning.
T.
16
23
0
1
1
0
2
1
0
0
0
0
0
7
0
0
1
3
0
1
0
1
0
0
17
27
1
0
5
0
3
1
0
0
0
0
0
13
0
0
2
5
0
1
4
1
0
1
33
50
1
1
126
126
252
4
0
1
0
0
0
0
0
0
6
0
0
1
2
0
0
4
0
0
1
M.
F.
T.
4
2
14
2
2
0
9
0
1
42
0
2
54
8
1
12
3
27
3
2
0
13
0
2
79
3
4
101
17
1
4
4
18
17
5
2
4
109
135
1
0
33
33
11
4
16
234
266
5
4
941
916
8
1
13
1
0
0
4
0
1
37
3
2
47
9
0
15
16
6
2
12
125
131
1,857
Tlie State Psychopathic Hospital is an institution to which any county
of the State may send patients. Since the opening of the Hospital, patients have been received from 78 of the 83 counties of the State. During this period, patients were admitted from 59 different counties. The
largest numbers came from Wayne, Washtenaw and Kent.
TABLE No. XI.—Showing the form of insanity of patients discharged and the results of treatment.
Total since beginning.
Period ending June 30, 1916.
Recovered.
Improved.
Unimproved.
Recovered.
Not
insane.
Died.
Improved.
Unimproved.
Not
insane.
Died.
M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T.
Insane conditions:
Manic depressive insanity
Dementia praecox
Paraphrenia systematica
Psychopathic conditions
Constitutional criminalities
Psychopathic personalities, adult . . .
Psychopathic personalities, juvenile.
Alcoholic mental disorders
Cocaine intoxication.
Imbecility
General paralysis
Cerebral syphilis . . .
Amyotrophic lateral sclerosis
16 12 28 20 29 49 13 28 41
0 1 1 14 26 40 21 26 47
0 0 0 0 3 3 1 2 3
0 0 0 1 4 5 1 3 4
0 0 0 0 0 0 0 0 0
1
0
0
0
0
0
0 63 64 127 70 72 142 59 101 160
0 1 3 4 47 47 94 111 116 227
0 3 1 4 5 10 15 3 14 17
0 0 0 0 1 4 5 1 3 4
0 0 0 0 1 0 1 2 8 10
8
0
1
0
0
0
0
6
0
0
0
0
7
0
0
0
0 0 0
5 22 27
0 0 0
1 0 1
0 0 0
0
2
0
0
0
0
4
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 1 1
5 40 45 10 57 67
6 3 9 14 9 23
0 0 0 3 1 4
2 0 2 0 0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
2
0
0
0
C
2
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
7
1
0
1
0
0
2
0
0
0
0 1C
7
3 1 3
0 0 0 0
1 0 0 0
0 2 0 4
1
0
0
0
1
0
0
c 0
7 16
80
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 31
0 ' 5
0 0
0 2
0 0
1 32 33
7 12 6
1
0 C
0
0
0 ( 4
2 35 13 0 13
4 10 0 1 1 I
0 1 0 0 0 0
0 0g 0 0 0 0
1
26 24 40 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
4
0
0
0
0
3
2
0
1
7
2
0
1
23 12 35
0 ( 0
6 A 8
1 j: 3
1 £
1
1
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0 17
1 11
0 11
0 2
] 0
1 18 107 25 132
7 18 4 3 7
3 U 14 14 28
0 2 11 10 21
6 6 2 7 c
8
1
0
2
0
0
0
0
1
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
1
0
1
0
0
5
0
1
0
0
0
2
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 16
0 0
( 0
0 0
0 0
7 23 17 10 27
0 0
0
1 1
0
1 ]
0 0 (
1 1
3 6
5
1
0
0
0
2
2
0
0
0
C
0
0
iS2
1 01
0
11
0
2£
'±
£
1
0
0
0
£
3
t
1
1
0
0
1
0
0
0
0
6
1
1
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
80
0
0
1
(
0
3
0
0
0
0
3 9 12
4 21 25
10
5
0 g 0
0 0 0
5 1 6 2
^C 3 1 4 0
0 1 0 1 1
0 12 17 29 0
0 6 3 9 3
0
0
0
3
2
2
0
1
3
5
6
2
0
0
0
3
0
1
0
0
9 0
2 0
1 0
0 0
0 0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
1
2
0
0
0
1
2
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
d
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
7
TABLE No. XL—Concluded.
Period ending June 30, 1916.
Improved.
Recovered.
Unimproved.
Total since beginning.
Not
insane.
Died.
Recovered.
Improved.
Unimproved.
Not
insane.
Died.
M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T.
Basedow's disease
Psychoses associated with pernicious
Psychoses associated with articular
Psychoses associated with nephritis .
Psychoses associated with myxoePsychoses associated with pellagra . .
Psychoses associated with paralysis
agitans . . . . . .
Delirium, toxic. .
Delirium, collapse. .
Post infectious psychoses
Unclassified conditions
Non-insane conditions — adult :
Sydenham's chorea . .
Tabes dorsalis
Miscellaneous
Non-insane conditions —juvenile:
Total .
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
1
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
fl
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
2
0
0
0
1 0
2 0
2
0
0
0
1
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
3
0
1 1
0
1 a
0
0
0
0
3
0
0
0
1
0
0
0
4
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0'
0
0
o
0
0
0
0
0
0
0
0
0
0
0
1
1
0
4
2
5
0
1
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
1 1
26 23 49 92 115 207 90 93 183
0
0
0
0
1
0
0
0
0
0
0
0
0
2
1
0
0
0
0
0
0
0
0
0
0
0
4
0
2
3
0
2
7
0
0
0
0
0
0
0
0
0
3
0
0
1
4
2
4
1 0 0 0 0 0 0
7 0 4 4 0 0 0
2 0 1 1 0 1 1
4 15 19 34 18 36 54
0
1
0
3
0
0
1
2
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 1 0
0
0
0
0
0
0
0
0
7 10 17
3
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
1 1
1
1
0
0
3
3
1
4
3
5
1
0
0
1
0
0
1
0
2
0
1
0
1
2
0
0
1
0
1
0
0
0
0
0
0
2
2
4
0
0
0
1
0
0
0
1
0
1
2
0
0
1
2
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
2
1
0
0
0
1 1 1 0
0 0 0 2
1 1 1 3
1
2
4
0
0
0
0
0
0
0
0
0
0
4
0
6
0
5
0
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 1 0 1
0 2 2 4
0 2 0 2
0 20 12 32
0
0
0
2
5
0
0
2
0
0
7
5 129 138 267 299 292 591 417 410 827 40 32 72 30 16 46
TABLE No. XII.—Showing the duration of residence in months of all cases discharged.
Recovered.
M.
F.
Improved.
T.
M.
F.
Unimproved.
M.
T.
F.
Died.
M.
T.
F.
Not insane.
M. .
T.
F.
Total.
T.
M.
F.
T.
2
0
0
4
12
0
0
0
3
5
2
0
0
7
17
2
0
4
13
26
0
0
3
8
34
2
0
7
21
60
9
6
5
9
20
6
3
8
6
21
15
9
13
15
41
0
1
1
1
1
0
3
1
3
1
0
4
2
4
2
0
0
0
1
1
0
0
0
1
1
0
0
0
2
2
13
7
10
28
60
6
6
12
21
62
19
13
22
49
122
4
0
0
1
2
7
2
0
2
2
11
2
0
3
4
19
5
9
5
2
18
9
11
11
6
37
14
20
16
8
11
11
5
29
19
13
9
3
2
0
0
1
0
1
0
0
5
18
8
8
4
3
3
0
0
2
0
1
0
0
0
0
0
0
0
0
0
1
0
0
0
0
37
16
14
12
4
44
19
19
18
11
81
35
33
30
15
8 months. . .
9 months
10 months . . .
1
0
0
0
2
0
0
0
3
0
0
0
2
2
0
1
3
5
0
4
5
7
0
5
3
2
2
0
0
2
1
1
4
3
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
4
2
1
5
7
1
5
11
11
3
6
14 months . .
18 months
25 months . .
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
1
1
1
0
3
1
1
0
1
1
0
0
2
0
1
1
3
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
1
0
0
3
1
2
1
6
2
2
1
26
23
49
92
115
207
90
93
183
7
10
17
3
2
5
218
243
461
1 week or less
2 weeks . . . .
3 weeks . .
4 weeks . . . .
2 months . .
3 months.
4 months. . . .
5 months. . .
7 months . .
Total
...
1
0
1-3
H
O
W
PSYCHOPATHIC HOSPITAL.
25
In table XI are given the results of treatment according to clinical
type. Patients are classified as recovered when they are in their normal
mental condition at the time they are discharged; as improved when
their mental condition is improved over that at the time of their admission; as unimproved when their mental condition has not changed for
the better at the time of their discharge.
According to the above standards, 13.5% of those discharged were recovered, 31.7% improved, and 50.5% unimproved. The deaths numbered
2.8% of those discharged.
Table XII gives the length of residence of the patients discharged.
Of those discharged 22.4% remained in the hospital one month or less;
66.4% remained three months or less, and 12.3% remained longer than
t> months.
More than three-fourths of the recoveries occurred with a period of
treatment that did not exceed three months.
TABLE No. XIII.—Shoieing the age of patients discharged recovered.
Period ending
June 30, 1916.
M.
From 10 to 14 years. .
From 15 to 19 years . . . .
From 20 to 24 years . . .
From 25 to 29 years
From 30 to 34 years . . .
From 35 to 39 years ...
From 40 to 44 years
From 45 to 49 years . . .
From 50 to 54 years
From 55 to 59 years
From 60 to 64 years
From 65 to 70 years . . .
Unascertained
Total . . .
..
,
...
.
0
3
3
1
1
4
5
2
3
3
1
0
0
26
F.
Total
since beginning.
M.
T.
0
3
3
4
2
1
0
6
6
5
3
5
2
4
2
1
1
0
0
23
F.
T.
7
6
5
4
2
0
0
0
13
9
14
13
21
18
14
12
8
4
1
2
2
15
18
24
15
17
15
14
10
5
2
1
0
2
28
27
38
28
38
33
28
22
13
6
2
2
49
129
138
267
STATE OF MICHIGAN.
26
TABLE No. XIV.—Showing the causes of death.
Period ending
June 30, 1916.
M.
Abscess, cerebral
Broncho-pneumonia
...
Broncho-pneumonia, general paralysis
....
Cystitis . . .
...
..
....
Exhaustion in delirium
Exhaustion, general paralysis
Gangrene, senile
Gastric ulcer, haemorrhage
Suicide, by cutting throat with pin
Total
T.
0
1
0
0
0
I
0
0
1
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
Nephritis, acute parenchymatous
F.
Total
since beginning.
M.
0
3
0
0
0
0
0
1
0
0
0
0
0
o1
1
1
1
1
1
0
0
0
0
0
0
1
0
1
1
2
0
Q
0
1
T.
0
4
0
1
4
1
1
0
0
0
0
2
1
6
0
1
0
1
1
0
2
0
1
0
3
2
4
1
2
0
1
1
0
0
2
1
0
0
40
32
0
1
0
2
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
7
10
17
1
1
1
2
1
0
3
3
0
2
1
1
1
1
F.
0
3
1
2
1
6
1
1
7
4
1
2
1
1
1
1
3
3
6
2
1
1
2
3
4
2
3
2
5
1
1
2
1
3
72
TABLE No. XV—Showing age of patients who died.
Year ending
June 30, 1915.
M.
From
From
From
From
From
From
From
10 to 14 years
20 to 24 years
25 to 29 years .
30 to 34 years .
35 to 39 years
40 to 44 years . . .
50 to 54 years
From 60 to 64 years
Total
..
F.
Year ending
June 30, 1916.
M.
T.
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
2
0
1
0
0
0
0
0
0
0
0
0
0
0
0
5
2
0
0
0
0
0
0
1
0
0
0
0
0
0
3
0
0
0
0
2
6
8
5
1
0
0
0
1
F.
Total
since beginning.
T.
0
0
0
0
0
1
0
0
0
0
0
2
1
0
0
0
4
M.
0
0
0
0
0
2
0
0
0
1
0
5
1
0
0
0
9
F.
T.
1
0
1
0
0
3
3
4
4
6
3
7
4
0
1
2
0
0
1
3
2
1
0
7
7
3
4
3
1
1
0
0
39
33
1
2
3
2
4
3
11
11
9
7
10
5
1
o.
2
72
27
PSYCHOPATHIC HOSPITAL.
TABLE No. XVI.—Showing the number of transfers between the Psychopathic Hospital and
the State Insane Hospitals.
K. S. H.
P. S. H.
M.
Received by transfer from
Transferred to
F.
'.in' 'si'
F.
T.
M.
52
13 ' i t '
1
T. C. S. H.
T.
M.
F.
T.
M.
F.
1
30
8
13
21
1
1
Epileptic
Farm
Colony.
W. C. H.
M. I F.
M.
F.
N. S. H.
M.
2
Total
since
beginning.
Lapeer.
T.
T.
F.
T.
M.
F.
T.
' '6'
' i
37
45
25
63
61
108
1
Received by transfer from
Transferred to
0
i
i
. .„
6
i ' 'i'
Of all patients discharged, 23.4%' were transferred directly to one of
the State Hospitals for the Insane.
OUT-PATIENT
SERVICES.
During the present period the State Psychopathic Hospital has undertaken a new line of activity, by the establishment of out-patient services.
For several years the Hospital has been interested in what might be
designated as extra-mural problems of mental disorders. This interest,
and an appreciation that it was possible to make the hospital more
widely useful to the State, has lead to the organization of out-patient
services.
At the present time, two of these have been established, one at Anu
Arbor, and one in Detroit.
PSYCHIATRIC OUT-PATIENT SERVICE, UNIVERSITY HOSPITAL.
In May, 1915, the Psychopathic Hospital organized a local out-patient
service in psychiatry in connection with the General Hospital of the
University of Michigan.
The patients are referred directly to the service by the admitting physician of the General Hospital or from one of its clinical services.
The following table gives statistical information regarding this work:
STATE OP MICHIGAN.
28
TABLE I.—Showing the number and source of out-patients.
Admitting physician—general hospital.
Clinic of neurology
Clinic of dermatology
Clinic of internal medicine
Clinic of otology
Clinic of gynecology
Clinic of surgery
Clinic of obstetrics
Clinic of genito-urinary surgery.
Clinic of ophthalmology
University health service
Total.
Male.
Female.
Total.
19
32
14
12
10
22
5
14
0
11
3
3
0
0
0
29
54
19
26
91
68
159
TABLE II.-—Showing diagnosis made in out-patients examined.
Male.
Manic depressive insanity.
Dementia praecox
Anxiety neurosis
Hysteria
Presenile mental disorder. .
Epilepsy
Imbecility
Cerebral arteriosclerosis. . .
Senile insanity
General paresis
Cerebral syphilis
Symptomatic mental state.
Alcoholic mental disorder..
Unclassified mental state. .
Pituitary disease
Hereditary syphilis
Tabes dorsalis
Infantile hemiplegia
Juvenile delinquency
Miscellaneous
Total. . .
Female.
Total.
11
5
5
12
7
4
16
4
23
12
5
7
4
0
21
5
1
2
0
5
1
1
3
5
12
5
1
24
1
4
0
25
5
2
12
1
2
2
1
2
5
92
160
PSYCHOPATHIC
HOSPITAL.
29
DETKOIT PSYCHOPATHIC CLINIC.
RESIDENT OFFICEES.
Nellie B. Perkins, Ph. D., Psychologist.
Ethel Plumb, Social Service Assistant.
In February, 1916, an out-patient service was established in Detroit.
This service was organized in connection with the Wayne County Juvenile Court and the Associated Charities of Detroit. The clinic is located
in the Wayne County Detention Home.
Through the financial aid of the Associated Charities of Detroit, it
has been possible to provide resident assistants, who are in local charge
of the work of the clinic, and to conduct the work with systematic
thoroughness.
The Psychopathic Clinic will examine any individual with mental disorder referred to it from any of the organized charities of Wayne County,
and give advice as to treatment. Patients entering the clinic are first referred to the social service assistant,who prepares a personal history of the
patient. The information embodied in this is obtained from investigations
into the family and social life of the patient, and the relations which may
have occurred with various charitable or correctionary organizations.
With this record, the patient comes to the psychologist of the clinic,
who makes a mental examination of the patient. After these preliminary examinations have been made the patient is presented at a clinical
conference held each week by a physician from the staff of the State
Psychopathic Hospital. Further examinations may then be made and
advice given as to the patients future care and treatment.
The following tables give statistical information concerning the work
of the clinic.
STATE OF MICHIGAN.
30
TABLE I.—Showing the number of patients examined and the sources from ivhich they were
referred to the clinic.
Probate Court, Juvenile Division
Probate Court, Insane Division
Probate Court, Mothers' Pension Division
Associated Charities, Main Office
Associated Charities, Children's Aid Society
Associated Charities, Woman's Hospital
Associated Charities, Salvation Army
Associated Charities, Y. W. C. A
Poor Commission
Board ol Health
Board of Education
Jewish Charities
Catholic Charities
Federated Clinics
Family or private physicians
Visiting Nurse, Dodge Bros
Circuit or Police Court
Florence Crittenden Home
Ford Motor Co., Social Service
Edison Electric Co
Girls' Protective League
House of the Good Shepherd...
Total
35
6
10
8
19
5
1
1
3
11
2
3
125
TABLE II.—Showing diagnosis made in patients examined.
Feeblemindedness
Subnormality
Psychopathic personality. . ..
Manic depressive insanity. . .
Dementia praecox
Cerebral syphilis
Symptomatic mental disorders.
Alcoholic insanity
Paranoid condition
Hysteria
Unclassified conditions. .
Total.
30
11
2
1
7
2
2
10
40
125
PSYCHOPATHIC HOSPITAL.
31
REPORT OF THE CLINICAL GROUPS.
MA,NIC DEPRESSIVE INSANITY.
During this biennial period there were admitted 118 cases of manic
depressive insanity of which number 49 were males and 69 females. The
following table shows the frequency of this form of disorder among the
admissions to this hospital.
Female.
Male.
Per cent.
No.
Manic depressive insanity
220
49
22.3
No.
Total.
Per cent.
240
C9 "28^7'
Per cent.
No.
460
118
25.4
There are considered among those under treatment during this period
G males and 13 females who were admitted during the previous period
but were discharged in this. In all, 137 cases of manic depressive insanity were under treatment.
There was a relative increase of 2.7% in the number of admissions with
this disorder over that of the previous period. This increase was about
equal for the two sexes.
The following table shows the relative frequency of the several forms of
this disorder. The diagnosis was determined from the phase of the
disorder present at the time of admission.
Male.
No.
Manic
Depressive. . .
Mixed
19
29
1
Female.
Per cent.
38.8
59.1
2.0
No.
23
44
2
Per cent.
33.3
63.7
2.9
Total.
No.
42
73
3
Per cent.
35.6
61.8
2.5
It will be seen from this table that the depressive phase was the most
frequent type. It appears to be the more frequent in the female sex,
while the manic phase was more frequent in the male sex. The admissions in the mixed phase showed a decrease of 9% from those of the previous period, only 2.5% of the manic depressive cases showing this phase.
The three following tables show the number of patients who have had
at least one attack other than the one at present; the form of the first
attack in those having more than one attack, and the form of the first
attack in all cases admitted.
32
STATE OP MICHIGAN.
Male.
More than one attack
First attack.
Female.
21
28
Total.
51
67
30
39
The form of the first attack in those patients having more than one
attack is shown in the following table.
Male.
Manic
Female.
8
38
2
3
5
24
0
1
3
14
2
2
Mixed
Total.
The form of the first attack in all cases of manic depressive insanity
admitted was as follows :
Male.
Female.
16
29
2
2
18
49
1
1
Manic
Mixed
Total.
34
78
3
3
These tables show that a previous attack had occurred in 42.8% of all
male and 43.4% of all female cases of this disorder. In the group as
a whole, previous attacks had occurred in 43.2% of all cases admitted.
In seven, or 5.9% of the cases, the first attack presented a phase different from the one at this admission.
The form of the first attack in all cases admitted was manic in 28.8%;
depressive in 66.1%; mixed in 2.5% and unknown in 2.5%.
The following table shows the age of patients at the time of the first
attack and the age of the patients at the time of their admission.
Admission.
First attack.
Depressive.
Manic.
Manic.
Mixed.
Mixed.
Depressive.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
10-14.
15-19.
20-24.
25-29.
30-34.
1
4
1
5
2
2
9
5
3
10
0
3
4
2
4
0
1
7
8
5
0
4
11
10
9
0
0
0
1
1
0
0
1
5
2
8
6
4
9
0
0
2
0
2
0
0
3
3
4
0
0
5
3
6
0
0
2
1
4
4
2
4
0
0
1
4
2
0
0
0
0
0
0
0
0
0
0
0
35-39.
40-44.
45-49.
50-54.
55-59.
0
1
0
0
1
1
1
2
1
0
1
2
1
3
3
7
9
8
4
5
1
11
9
7
8
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
2
2
1
3
1
0
2
1
3
3
2
6
2
3
3
9
7
9
4
6
8
13
11
7
9
17
1
0
0
0
0
0
0
0
0
0
0
0
0
0
60-64.
65-69.
70-74.
75-79.
Unk..
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
1
0
0
2
0
0
0'
0
1
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
1
6
2
4
2
2
1
1
0
0
0
0
0
1
1
1
1
1
0
0
1
1
T.
1
1
1
PSYCHOPATHIC HOSPITAL.
33
It may be observed from this table that where the first attack was
manic in phase that 38.1% were under the age of 25. Where the first
attack was one of depression, 20.5% were tinder the age of 25. In all
cases admitted, the first attack occurred before the 25th year in 27.2%
and before the 50th year in 83.8% of instances.
HEREDITY.
Information concerning the occurrence of nervous and mental disorders in the families of the patients with this disorder was obtained in
105 of the 108 cases admitted.
The nature and distribution of these are shown in the following table.
In 82% of the families where information was available, there were
instances of mental abnormalities other than those of the patient.
In the families of the 87 cases showing abnormalities of the family and
antecedents there were 35 in which there was one other instance of abnormality. There were 23 families with 2, 18 with 3, 6 with 4, 3 with 5,
1 with 6, and 1 with 8 instances of abnormalities. In the 87 families,
there were 270 abnormal individuals.
Atavistic.
Direct.
Apoplexy or paralysis . .
Psychopathic . . . .
M
F
T
13
15
6
28
4
5
5
8
30
50
?
Total heredity . . . . 20
Q
M.
4
1
p
Collateral.
T
M.
F
Brothers
and
sisters.
Total.
T.
M.
F.
T.
M
F
5
T
3
2
0
0
7
3
1
1
8
0
1
0
7
1
0
1
15
1
1
1
1
0
0
0
4
1
0
I
0
26
4
3
4
29
10
5
6
55
14
8
10
5
12
9
9
18
1
6
7
37
50
87
6
6
12
7
18
13
49
69
118
Total
ETIOLOGY.
Of the 118 patients admitted, 18 were regarded by their friends as
showing peculiarities of personality preceding the acute outbreak.
In 77 cases there were experiences closely associated with the onset of
the disorder, which were regarded by their friends as of causative; importance.
In 11 cases the onset was associated with puerperal experiences. In
one instance short manic episodes of a week to ten days duration occurred at the menstrual period. In 11 instances, financial difficulties were
assigned as the cause. Physical illness or surgical treatment was noted
in 8 instances. Overwork or illness in the family were regarded as
causes in 26 instances.
Wassermann examinations of the blood serum were made in 117 of the
34
STATE OF MICHIGAN.
118 admissions. It was found strongly positive in three cases. The first
of these was a woman of 24 admitted in a frank manic excitement. The
history showed a previous depressed phase. The neurological examination and the examination of the cerebrospinal fluid was negative. Her
mental condition returned to normal after four months.
The second case was a woman 32 years old who showed in her previous life many episodes of abnormal irritability and finally was admitted
to the hospital, showing the characteristic symptoms of the manic phase.
There were no evidences of involvement of the central nervous system by
syphilis shown in the neurological or spinal fluid examinations.
The third case was a male 32 years of age at the time of his admission.
The history showed many manic episodes for the seven years prior to his
admission. In the hospital he showed a mild euphoria with a slight
paranoid trend and a pressure of thought and motor activity. No pathology was revealed by the neurological examination but the Wassermann
examination of the cerebrospinal fluid was slightly positive. There was
no increase in the albumen or globulin content nor in the cellular elements.
One patient, a male 39 years of age, in his second attack of depression
showed a doubtful Wassermann on the blood serum without other evidence of luetic involvement, but the history revealed the fact that his
wife died of general paresis a few months prior to his last attack.
RESULTS OF TREATMENT.
The following table shows the condition of the cases of manic depressive insanity at the time of discharge from the hospital. There are considered here the cases admitted during this period and 19 cases of this
disorder remaining over from the previous period.
The average duration of treatment was 117.9 days. All the patients
were discharged to their homes, except 35 who were transferred to the
various State Hospitals.
Manic.
Unimproved . .
Died
Depressive.
Mixed.
M.
F.
T.
M.
F.
T.
M.
F.
6
9
5
0
3
7
8
0
2
9
16
13
0
10
10
8
1
4
8
21
19
1
10
18
31
27
2
14
0
1
0
0
0
1
1
1
0
1
3
0
Total.
T.
1
2
1
0
0
M.
F.
16 12
20 29
13 28
1
1
5 12
T.
28
49
41
2
17
It may be seen from this table that of the 120 patients discharged
23.3% were discharged recovered; 40.8% improved; 34.1% unimproved;
and 1.7% died.
Of the 38 cases of the manic phase 23.7% were discharged recovered
and 42.1% improved. Of the 78 depressive cases 23.5% were discharged
recovered and 39.7% improved.
Grouping the recoveries and improvements together we find from this
table that 65.8% of the manic cases and 62.8%' of the depressive cases
PSYCHOPATHIC HOSPITAL.
35
were benefltted by their hospital treatment. Two patients died from intercurreut disorders. It was possible to make a laboratory study of the
central nervous system in one of these.
Case 1727. Agitated depression:—A male in whose family were two
other instances of mental abnormalities. Throughout his life he had
been regarded as one who was extremely irritable. At the age of 50 he
was definitely depressed following some neighborhood trouble, but was
not in a hospital. At 58 his wife left him and instituted divorce proceedings because of his extreme irritability. He again became depressed and
continued so for two months. After this, his wife returned to him. Two
months before his admission, at the age of 60, she again left him and be
became depressed and attempted suicide. The examinations showed him
moderately emaciated with evidences of arteriosclerosis. His blood pressure was 150. He was extremely weak and his mood Was that of deep
depression. He talked but little and what he said coincided well with
his mood. He expressed self pity, talked of being poisoned, and made
feeble attempts at suicide. He became more deeply depressed and gradually failed in strength, in spite of supportive and stimulating measures. After five weeks he developed a severe diarrhoea and passed into
a deep stupor, in which he died on the third day.
The autopsy showed an early carcinomatous change of the pylorus.
The gross examination of the brain showed slight arteriosclerosis of the
basal trunks and a moderate degree of leptomeningitis.
Histological examination of the cortex showed a moderate fatty degeneration of the nerve cells. The vessel lymph spaces held large accumulations of fatty pigments. The process as a whole appeared to be one
of recent origin. Aside from this, the cortex showed little that was pathological.
DEMENTIA PREACOX.
There were admitted 78 patients whose mental disorder was diagnosed
dementia praecox. This number formed 16.9% of all patients admitted.
Male.
No.
Hospital admissions
220
30
Per cent.
' 'ii'.e'
Female.
No.
240
48
Per cent.
'ao.'o'
Total.
No.
460
78
Per cent.
16.9
The 30 male cases formed 13.6% of all men admitted and the 48 female
cases 20.0% of all women admitted.
The 78 cases occurred in the following types.
STATE OF MICHIGAN.
36
Male.
No.
Dementia simplex
Female.
Per cent.
Catatonia
5
19
4
2
Total
30
No.
16.6
63.3
13.3
6.6
Total.
Per cent.
4
g
6
8.3
56.2
22.9
12.3
No.
Per cent.
9
46
15
8
48
11.5
59.0
19.2
10.2
78
AGE.
The onset occurred before the 25th year in 36.6% of the male cases
and 50% of the females, or 44.7% of all cases of dementia praceox which
were admitted.
The youngest age of onset was 10 years and the oldest 41.
Admission.
Onset.
M.
T.
F.
M.
F.
T.
10-14..
15-19
20-24 .
25-29 . . . .
30-34 .
1
3
7
14
2
2
7
14
9
7
3
10
21
23
9
0
3
6
16
2
1
8
9
16
6
1
11
15
32
8
35-39 . . .
40-44
45-49
3
0
0
0
5
2
0
2
8
2
0
2
3
0
0
0
4
3
1
0
7
3
1
0
The relative frequency of occurrence before the 25th year of the various clinical forms was:
Per
cent.
Dementia simplex
Hebephrenic
Catatonic
Paranoid
88.8
39.1
53.3
0.0
Information concerning hereditary influences was obtained in 71 instances. Of these, there were 41 or 57.7%, in which there was insanity
or some other predisposing factor present among the ancestors or
families.
PSYCHOPATHIC HOSPITAL.
Direct.
M
4
2
2°
Total heredity. . . .
8
T
M
F
j
T
M.
F
I
Brothers
and
sisters.
Collateral.
M.
T
F
Total,
T
3
3
4
3
5
4
5
2
1
0
0
4
0
0
3
5
5
0
0
1
0
1
0
5
0
0
0
6
0
1
0
1
0
0
0
2
0
0
0
COOOO
Insanity
Apoplexy or paralysis . .
F
Atavistic,
37
13
21
3
7
10
2
5
7
1
2
3
Total
M.
F
T.
8
3
1
2
13
7
4
3
21
10
5
5
14
27
41
12
4
18
3
30
30
48
78
In 39 families there was more than one occurrence of disease, and in
families of the 78 cases of dementia praecox there were 153 known instances of mental and nervous abnormalities.
ETIOLOGY.
In 21 instances the onset of the disease was associated directly with
some unusual experience in the life of the individual. In five instances,
the first symptoms followed a physical injury. In 5 there were unusual
sexual complications at the onset. Four cases developed following childbirth.
RESULTS OF TREATMENT.
The results of treatment are shown in the following table. In addition
to those admitted during the period, there are included 10 males and 10
females who were admitted previous to the present period.
M.
F.
0
Unimproved . . .
Died
14
...
21
0
5
Per cent.
T.
1
26
26
0
5
1
40
47
0
10
51 3
62.5
12.8
Of those discharged, 56 returned to their families and 31 were transferred to one of the State Hospitals for the insane.
DEMENTIA SIMPLEX.
There were admitted 9 cases of dementia praecox, 5 male and 4 female,
in which the course was that of a simple deterioration, without delusions or hallucinations.
STATE OF MICHIGAN.
38
This number formed 11.5% of all cases of dementia praecox admitted.
The ages at onset and at admission are shown in the following table:
Onset.
M.
10-14..
15-19
20-24. .
25-29
.
F.
1
2
. .
Vdmission
T.
1
]
1
1
2
0
F.
M.
2
3
3
1
T.
1
1
1
1
0
3
1
1
1
4
9
2
In 88.8 per cent of the cases the disease developed before the age of 25.
The results of treatment of the patients of this group are shown in the
following table. This includes 1 male admitted in the previous period.
M.
F.
0
2
3
1
T.
0
3
1
0
0
4
1
All of those discharged were returned to their homes.
HEBBPHBENIC FORM.
There were admitted 46 cases of this form of dementia praecox. Of
there, 19 were males and 27 were females. This number constituted 59%
of all cases of dementia praecox admitted.
The ages at onset and at admission were:
Onset.
M.
10-14. .
15-19
20-24 .
25-29
30-34
35-39. .
40-44
Unknown
Admission
T.
F.
M.
1
5
7
6
1
6
11
18
1
1
t
0
0
0
2
3
5
0
2
0
1
4
12
4
F.
T.
0
0
4
13
0
6
4
11
0
6
8
24
1
1
2
3
4
1
0
0
0
3
1
0
In 39.1% of these cases, the onset occurred before the age of 25.
The following table gives the results of treatment. In this are included 5 males and 6 females admitted in the former period.
PSYCHOPATHIC HOSPITAL.
39
M.
F.
0
T.
0
14
16
3
15
2
0
21
31
Of the 32 patients who were discharged, 12 males and 12 females were
transferred to one of the other State Hospitals. The remainder were returned to their homes.
CATATONIC FORM.
There were admitted 15 cases which showed the clinical course of the
catatonic form of dementia praecox. Four of these were males and 11
females. This group constituted 19.2% of all cases of dementia praecox
admitted.
The ages at onset and admission were:
1Admission
Onset.
M.
F.
0
1
15-19
20-24
25-29 .
30-34
35-39 . .
2
0
1
T.
1
0
I
2
1
F.
M.
1
0
1
3
2
0
1
9
2
T.
1
1
5
5
4
3
2
1
2
2
The onset in 53.3% of the cases was before the age of 25.
The results of treatment are shown in the following table, included
in this is one case admitted during the previous period.
M.
F.
0
3
1
1
T.
1
4
5
1
1
7
6
2
PARANOID FORM.
There were 8 cases of the paranoid form of dementia praecox. Two
of these were males and 6 were females.
7
40
STATE OF MICHIGAN.
The ages at onset and admission were:
Onset.
F.
M.
25-29
30-34 . .
35-39
40-44
45-49
l Admission
T.
1
3
0
0
1
1
0
1
o
0
T.
1
0
1
1
0
4
1
2
2
o
F.
M.
1
. 3
2
1
2
1
0
2
1
o
The disease developed in all instances after the age of 25. The earliest
age of onset was 28 and the latest 41.
The results of treatment are shown in the following table. Included
in this are 3 males and 3 females admitted in the previous period.
M.
Recovered .
Improved
.
.
F.
0
2
2
1
T.
0
4
4
1
0
6
6
2
Five of those discharged were transferred to another State Hospital.
PARANOID MENTAL DISORDERS.
Under this heading are placed a number of cases in which the mental
symptoms were of a paranoid type, but in which the clinical course was
different from that of the paranoid form of dementia praecox and
it did not seem possible to find a relationship with any specific cause.
Some of these cases in their clinical course correspond to the group
which Kraeplin has arranged as paraphrenia systematica. Others having certain features in common but less clear in their clinical position
are placed in a general group of paranoid conditions.
PARAPHRENIA SYSTEMATIC^.
The mental disorders of ten individuals admitted during the period
are grouped under this heading. Three of these were males and 7 females. This number formed 2.2% of all admissions.
Female.
Male.
No.
Paraphrenia svstematica,
220
3
Per cent.
1 .4
No.
240
7
Total.
Per cent.
2.V
No.
460
10
Per cent.
2^2
41
PSYCHOPATHIC HOSPITAL.
Of those discharged, 5 were transferred to one of the other State Hospitals for the Insane.
The ages at onset and admission were:
1Admission
Onset.
M.
F.
1
20-24 . .
25-29 . . . .
30-34 . .
35-39
40-44 .
45-49 . . .
50-54 .
55-59
. .
F.
M.
T,
0
0
0
1
0
5
1
3
0
5
0
1
1
1
0
0
1
4
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
1
0
0
1
2
...
T.
0
1
2
5
1
0
0
1
Hereditary factors were present among the ancestry in three instances.
RESULTS OF TREATMENT.
The results of treatment were:
Recovered
.
Unimproved . . . .
.
.
.
T.
F.
M.
0
0
4
3
0
0
1
1
1
. .
5
4
1
Of those discharged, 7 were returned to their families and 2 were transferred to one of the State Hospitals.
PARANOID DISORDERS (UNDIFFERENTIATED) .
There were admitted during the period a number of individuals whose
mental disorder was characterized by more or less elaborated delusions,
and which showed symptoms and course different from the paranoid
conditions grouped elsewhere.
There were 7 of these cases, 1 male and 6 females; in all, forming 1.5%
of the admissions.
Male.
No.
Hospital admissions
Paranoid disorders (undifferentiatedl
220
1
Per cent.
" ' 0 '. 5 '
Total.
Female.
No.
240
6
Per cent.
2^5
No.
460
7
Per cent.
1.5
42
STATE OP MICHIGAN.
The ages at onset and at admission were:
Admission
Onset.
F.
M.
30-34
35-39
40-44
45-49
50-54
55-59
T.
0
0
0
0
0
2
0
1
1
2
o
0
1
1
M.
2
0
1
0
1
1
3
F.
0
0
0
0
1
0
0
T.
0
2
1
1
1
1
0
0
0
2
1
1
2
I
Hereditary factors were present among the antecedents in 3 instances:
The results of treatment are given in the following table:
F.
M.
0
0
1
0
T.
0
3
2
1
0
3
3
1
Five of these returned to their families and one was transferred to a
State Hospital.
SYPHILITIC MENTAL DISORDERS.
There were admitted during the period 50 cases in which the mental
disease was due to syphilis of the central nervous system. Clinically
these were represented as follows:
M.
General paralysis
Cerebrospinal syphilis .
Tabes
.
28
5
1
F.
T.
12
4
0
40
q
1
SYPHILIS IN RELATION TO ADMISSIONS.
Routine examinations by the Wassermann test of the patients admitted
during the period showed that among 449 individuals tested, there were
74 in whom the Wassermann reaction was positive. This indicates that
about 16.5% of all admissions to .this hospital had syphilis. If there is
deducted from these the 50 cases of definitely syphilitic types of nervous
disorders, there remain 24 cases, or 5.3%, who had syphilis but whose
mental disturbance was of a non-syphilitic type.
PSYCHOPATHIC HOSPITAL.
43
EFFECTS OF SYPHILIS IN THE FAMILIES OF PATIENTS HAVING SYPHILIS OF
THE CENTRAL NERVOUS SYSTEM.
For several years it has been the practice in this hospital, whenever
possible, to examine for the presence of syphilis, members of the families
of patients who have syphilitic forms of mental disease.
During the present period, Wassermann tests were made upon the
blood of some member of the family of 26 patients. Of 22 mates of
patients, 5, or 22.7%, gave a positive Wassermann reaction on the blood.
One parent gave a positive Wassermann reaction on the blood.
In 3 other families there was a definite history of syphilis of the nervous system of the mate of the patient.
In 26 families, syphilis was present in 9 members apart from the
patient, or in 34.6%.
Among the mates of 20 general paralytics, syphilis was present in 5,
or 25%.
There were examined 15 children from the families of 11 cases of general paralysis. Seven of these showed stigmata of hereditary syphilis
and the blood of 4 gave a positive Wassermann reaction.
GENERAL PARALYSIS.
During the present biennial period there were admitted 40 cases of
general paralysis. Twenty-eight were males and 12 were females. This
number constituted 8.7% of all cases admitted. Of all male patients
admitted 12.7% belonged to this group, and 5% of all females. The relative frequency of the disease as it concerned the sexes was as 2.?> to 1.
Female.
Male.
No.
General paralysis . . . .
220
28
Per cent.
12.7
No.
240
12
Total.
Per cent.
5
No.
460
40
Per cent.
's'.7
CLINICAL FORMS.
The majority of the cases coursed as the demented type. Cases of the
agitated and expansive types were relatively more frequent than in the
previous period.
One case was of more than usual interest in that it occurred at the late
age of 71.
There was admitted one case of juvenile paresis, the child of a tabetic
mother.
44
STATE OF MICHIGAN.
Demented
Agitated
Delirious . . .
J uveuile
19 '
5 i
2
1 ;
''
T.
F.
M.
1 ;
8
1
•
0
27
6
5
1
1
o
AGE.
Excluding two cases associated with extreme variation from the usual
age, viz 7 and 64, the average age of onset of the disease of the males was
:>4.3 years, and 36 years of the females.
Onset.
M.
5-9
10-14. .
15-19 .
20-24. .
25-29
F.
1
0
1
2
30-34 . .
35-39
40-44 . . .
45-49
50-54
4
g
55-59
60-64..
65-69
70-74 . .
0
4
2
0
1
0
0
j Vdmission
T.
M.
F.
T.
1
0
1
2
6
0
1
0
0
4
0
o
0
o
o
6
1
2
1
0
10
9
6
3
0
4
10
4
4
0
4
1
2
2
1
g
11
6
6
1
1
1
1
0
0
0
0
0
1
1
0
0
1
0
0
1
0
0
0
0
1
0
0
0
1
o
0
1
0
5
HEREDITY.
Hereditary factors were found among the ancestors or families of
62.5% of the cases in which information was available. Among the
families of these 40 cases of general paralysis, there were G4 instances
of mental abnormalities.
PSYCHOPATHIC HOSPITAL.
Direct.
F.
Brothers
and
sisters.
Collateral.
Atavistic.
M
45
M.
2
0
0
0
4
0
0
0
5
1
1
3
2
1
0
2
7
2
1
5
2
4
10
5
15
Negative . . . .
Unknown
6
12
3
4
9
16
Total . .
28
12
40
3
M
1
0
0
0
0
0
0
0
1
0
0
0
0
2
2
2
1
5
oooo
Total heredity . . . .
I
T
oooo
Insanity
Apoplexy or paralysis . .
Alcoholism
M
F
T.
T.
T.
F
F.
M.
F
Total.
2
0
0
0
3
10
1
0
1
0
0
0
2
T.
DATE OF SYPHILITIC INFECTION.
In 20 cases the date of infection was approximately determined. The
average interval between infection and onset of the symptoms of general
paralysis was 14.3 years.
0.
11.
14.
15.
18.
20.
23.
25.
1
1
3
2
2
1
1
31.
•
1
1
ALCOHOLIC INFLUENCES.
A history of more than moderate alcoholism was obtained in only 6
instances. There was one case presenting a complication of alcoholic
hallucinosis with general paralysis.
NEUROLOGICAL DISTURBANCES.
The most constant neurological abnormalities were in the pupils and
tendon reflexes. In 50% of the cases the pupils were irregular; in 35%
the pupils were unequal; in 40% the reaction was sluggish and in 25%
the light reactions were absent. In 22.5% the knee jerks were absent.
In 10% they were unequal and in 17.5% they were increased. Babinski's reflex was present in 5% of the cases. Tremors were present in
55%' of instances. In 10% of the cases there was a history of either
apoplectiform or epileptiform attacks.
SEROLOGICAL.
In all cases examined the serological findings were characteristic of
this disease. The blood in 38 cases gave a strongly positive Wassermann reaction and in 2 cases the reaction was weakly positive. The
cerebrospinal fluid was examined in 37 cases and in all instances gave
46
STATE OF MICHIGAN.
a strongly positive Wasserinanii reaction. The cells varied between a
minimum of 5 and a maximum of 320.
During the latter part of the period, interest has been shown in the
application of Lange's colloidal gold test. Of 21 cases tested, 19 gave a
curve characteristic of general paralysis and 2 gave a type of curve of
cerebrospinal syphilis. That these latter cases were cases of general
paralysis was proven by other diagnostic points.
KESTJLTS OF TREATMENT.
During the period an active interest has been shown in the medicinal
treatment of cases of general paralysis. Some cases have been treated
by intraspinal injections of salvarsan, after the method of Swift and
Ellis; others have been given salvarsan intravenously, and others went
through an energetic treatment with mercury. While in some cases it
was possible to influence for good the serological findings, in no case
did the spinal fluid become normal. In some cases the progress of the
clinical symptoms seemed to be benefltted but this was only temporary.
On the whole, it has seemed as if no certain benefits had been obtained
from treatment.
The following table shows the condition of patients discharged. Included in this are 5 males who were admitted in the previous period.
F.
M.
Recovered
Improved .
Unimproved . .
Died.
.
0
5
23
1
. .
4
T.
0
0
12
0
0
0
5
35
1
4
Of the 40 patients discharged, 22 were transferred to one of the State
Hospitals and 18 returned to their families.
CEREBRO-SPINAL SYPHILIS.
There were admitted during the period 9 cases of syphilis of the
central nervous system, with mental disorders.
The relation of these to admissions was:
Male.
No.
Hospital admission
Cerebrospinal syphilis. . .
220
5
Female.
Per cent.
2.2
No.
240
4
Total.
Per cent.
i.6
No.
460
9
Per cent.
1.9
PSYCHOPATHIC HOSPITAL.
47
AGE.
The ages at admission ranged between 22 and 59. The interval between infection and the outbreak of mental symptoms varied from 5
months to 27 years.
HEREDITY.
Hereditary factors were present in 3, or 37.5%, of 8 cases in which
information was obtained.
CLINICAL.
In 3 cases the symptoms were referable largely to vascular involvement. In 4 the process was meningeal. In 8 cases there were noted
prolonged disturbances of the consciousness. Some of these were in
association with apoplectiform attacks. Wassermann reaction was positive on the blood of all cases, and on the cerebrospinal fluid of 6 cases.
In 3 cases the fluid was negative in dilutions up to 0.8 cc.
RESULTS OF TREATMENT.
M.
Recovered
Died
F,
0
4
.
...
0
1
0
T.
0
3
0
0
1
0
7
0
1
1
Energetic treatment with salvarsan was carried out in 8 cases. This
was given either intravenously or intraspinally after the method of
Swift and Ellis. Improvements were marked under both methods.
Neither method semed to produce results superior to the other. One
patient, whose disease was complicated with severe general arteriosclerosis and nephritis, died.
Case No. 1587. Syphilitic endarteritis: Male, aged 54 years at admission. His mother died of apoplexy at 68. He himself was a moderate user of alcohol. No information as to occurrence of syphilitic infection. Since the age of 34 he believed that he had kidney and heart
trouble. At 51 he complained of severe pains in the left arm and leg,
with much impairment of ability to use the left arm. Ten months before
his admission he had an apopletic attack followed by prolonged unconsciousness. There was no motor paralysis following this attack.
After four days he showed no change in his conduct and took up his
business affairs. Following this attack, the pain which had previously
given him much concern did not return. A month later a second stroke
occurred. During and following this attack there was paralysis of the
left side and difficulty in speaking. The effects of this never passed
away and after that he was unclear in his comprehension most of the
time. Two months later a third attack occurred, followed by a condition of stupor lasting two weeks. The mental confusion grew worse
and at no time was he lucid. In the succeeding months he had several attacks of cardiac and respiratory disturbance.
48
STATE OF MICHIGAN.
His examination at admission showed chronic interstitial nephritis;
hypertension; hypertrophy of left ventricle, and marked mycardial
changes. The urea content of the blood was at the high normal limit.
Blood pressure was 180. The pupils were irregular. Their direct light
reaction was slowed. There was a well marked Rhomberg's symptom.
The knee jerks were greatly increased. At times Babinski's reflex was
obtained. There was tremor of the fingers but not of the tongue or lips.
The left hand grasp was much weaker than the right. The fundus examination showed advanced arteriosclerotic changes, edema of the
retina, and retinal hemorrhages. Wassermann reaction was positive
on blood and spinal fluid. There were 6 cells per cu. mm.; Nonne-Apelt
test gave slight reaction in Phase I; Lange's test gave a slight change
in the luetic zone.
Mentally he continued unclear and usually showed a mild delirious
restlessness. There was a profound memory defect with slight romancing at times. Towards the last, there were paraphasic disturbances. The
heart symptoms increased and death occurred 10 weeks after his admission.
The pathological diagnosis was—Acute purulent broncho-pneumonia;
syphilitic changes in aorta and kidneys; syphilitic orchitis; general
arteriosclerosis; organized thrombus of pancreatic artery. The gross examination of the brain showed widespread syphilitic endarteritis of the
vessels at the base and in the pia, recent hemorrhage into the pia-arachnoid, and an area of focal softening in the right lenticular nucleus.
The microscopic study of the brain showed thickening of the pia with
infiltration of lymphocytes and rarely a plasma cell. The endothelium
of the vessels of the pia was enormously proliferated, in some vessels almost closing the lumen. The elastic coat was split and broken in places.
Around the vessels were large numbers of lymphocytes and occasionally
a mast cell. The marginal glia, especially the fibrous part, was excessively thickened. In the medullary substance of the convolutions, there
was marked hypertrophy of the glia cells.
The nerve cells showed varying degrees of changes. Many were practically normal and others, especially some of the small pyramidal cells,
were sclerosed. Some cells showed characteristic axonal reaction type
of change. In a number of places there were focal devastations and miliary softenings.
Summary: The changes, both gross and microscopic, were typical of
syphilitic endarteritis and secondary reactions in the nervous parenchyma, and a slight syphilitic meningitis. There was also changes of a
type met with in toxic conditions such as uraemia or alcohol.
TABES.
One case of tabes was under treatment. The mental symptoms were
chiefly of a neuraesthenic type. There was little improvement under
active treatment by intra-spinal injections of salvarsan in small doses.
PSYCHOPATHIC HOSPITAL.
49
ALCOHOLIC MENTAL DISORDERS.
During this period there were treated 18 cases, all males, of mental
disorders caused by alcohol. This number represents 8.18% of the male
admissions for the period and 3.9%' of the total admissions of both sexes.
This is a decrease of 2% in the admission rate of this class of disorder
over the former period.
The classification into clinical groups was made as follows:
M.
Delirium tremens. .
..
1
6
1
...
1
6
1
2
8
0
0
0
0
0
2
Chronic alcoholism . . .
T.
F.
8
There was a decrease in numbers compared with previous years of
cases of delirium tremens and chronic alcoholism. One case of delirium
tremens was of unusual interest in that the patient was said to have had
delirious episodes, similar to the one at the time of admission, about
once each year for 18 years.
HEREDITY.
Positive heredity was noted in nine cases. In the remaining nine cases,
the family history was given as entirely negative or no information regarding this was obtained. The following table shows the distribution
of the hereditary influences:
Apoplexy or paralysis . .
Total heredity . . . .
Unknown
Total .
Atavistic.
Brothers
and
sisters.
Collateral.
M.
F.
T.
M.
F.
T.
M.
1
0
0
4
0
0
0
0
1
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
5
0
5
0
0
0
2
F.
Total.
T.
M.
F.
T.
M.
F.
0000
Direct.
T.
1
0
0
1
1
0
0
1
0
0
0
0
1
0
0
1
3
0
0
6
0
0
0
0
3
0
0
6
0
2
2
0
2
9
0
9
3
6
0
0
3
6
18
0
18
Three of the cases of delirium tremens had had previous attacks and
four of the cases of chronic alcoholism had previously been in institutions for treatment for some form of alcoholic mental disorder.
50
STATE OF MICHIGAN.
A study of the Wassermann reactions of this series revealed two positive cases and sixteen negative. One of these was a bartender, admitted
in an attack of delirium tremens. The examination of his cerebrospinal
fluid was negative except for a slight increase in the globulin. He presented no neurological abnormalities of cerebrospinal syphilis. The other
case of positive Wassermann reaction was a man 33 years old with gummatous necrosis of the bones of the face, which had existed for about six
years and was still active. The examination of his cerebrospinal fluid
was entirely negative as was also a Wassermann examination of the
blood of his wife. The examination of the cerebrospinal fluid of the two
cases of Korsakow's psychosis revealed a very high albumen content.
Neurological examinations revealed abnormalities in all the cases, the
most constant disturbance noted being tremors and irregularities in the
outline of the pupils. Irregular pupils were noted in every case and
tremors in 13 cases. Inequality in the size of the pupils was present in
6 cases and diminished reaction to direct light in a like number. The
Achilles reflex was absent in two and unequal in one case. Unequal knee
jerks were noted in two cases.
The average duration of treatment for this group of cases was 57 days.
The following table shows the condition at the time of discharge:
Hecovered.
Acute alcoholism
Delirium tremens
Alcoholic paranoia
Chronic alcoholism
Korsakow's psychosis
1
4
0
2
0
Improved.
0
2
0
6
2
Unimproved .
Died.
0
0
1
0
0
.
0
0.
0
0
0
Total.
1
6
1
8
2
DRUG INTOXICATION.
In this group are included 11 patients,6 males and 5 females, constituting 2.19% of the total admissions for the period. This number is an increase of five cases over the previous period, or an increase of .79%. This
increase is no doubt due to the enactment of the Harrison Act.
In one of these cases the family history reveals the fact that the
mother, grandmother and father were all drug users. This was a boy of
16 years who had been using both morphine and heroin, given him first
by his grandmother, since he was nine years old. He was infantile in
physical development and subnormal mentally. He presented evidences
of disorder of function of the glands of internal secretion.
In another case the father and paternal grandfather were morphine
users, and the father had suicided. This patient was a woman 30 years
of age, who had used morphine, whiskey and paregoric for nine years,
following a surgical operation. The Wassermann reaction was positive
on both the blood serum and the spinal fluid. Albumen and globulin
were also increased.
PSYCHOPATHIC HOSPITAL.
51
Another case, a man 57 years old, who had used drugs and whiskey
for 11 years, presented a positive Wassermann reaction on his blood
serum. The Wassermann reactions of the other 9 cases were negative.
One of these had a scar of an old gummatous necrosis.
The previous history of each of the 11 cases showed the patients to be
of neurotic makeup, and in two of the cases there were numerous hysterical episodes throughout the previous life. The reason given by the patient, or his family, for the use of the drug, was in 9 instances some form
of physical illness. The amount of drug used daily based on the statement of the patient varied from "seven cents worth of gum opium" in one
case to 20 grains of morphine and 30 grains of cocaine in another. The
method of treatment used was the immediate withdrawal of the drug. In.
one case there was a delirium with auditory hallucinations of a day's
duration, followed by diarrhoea and motor restlessness for a few days.
In another case there was an hysterical dream state of a few hours duration following the withdrawal, in which the patient acted out the part of
receiving an injection from his father. The average length of residence
of these cases was 39 days. All of the cases were discharged to their
homes, except one case which was transferred to a State Hospital.
The following table shows the division of these cases according to the
drug used, together with the condition at the time of discharge:
Recovered.
M.
Morphine . . .
Morphine and alcohol
Heroin . . . .
0
1
0
0
1
F.
Improved.
M.
T.
1
0
0
1
1
0
1
2
0
2
0
0
1
1
0
F.
Unimproved.
2
0
1
0
0
'•
M.
T.
4
0
3
0
0
0
0
0
0
0
T.
0
0
0
0
0
0
0
0
0
0
EPILEPSY.
There were admitted during the period 10 cases of epilepsy. This number constituted 2.1% of all patients admitted.
Male.
No.
Hospital admissions
Epilepsy .
. .
220
6
Per cent.
• -j-y-
Female.
No.
240
4
Per cent.
' 'i'.e'
Total.
No.
460
10
Per cent.
2.1
The ages at admission varied widely. The youngest patient was aged
7 and the oldest 49. Hereditary factors were present in 7 of 8 cases, or
87.5%, in which information was obtained.
STATE OF MICHIGAN.
52
The Wassermann reaction was positive in the blood in one case but
the cerebrospinal fluid was not pathological. Under active anti-syphilitic
treatment, these attacks occurred less frequently.
The result of treatment of all cases discharged was:
M.
Recovered .
.
F.
0
0
6
1
T.
0
0
2
2
8
1
9
0
Of those discharged, 4 were transferred to other State Hospitals and
the remainder returned to the custody of their families.
IMBECILITY.
This group includes all cases of feeblemindedness admitted during the
period, excepting those in which there was in addition to the mental defectiveness a well differentiated psychosis. There were 19 cases which belong here; 11 were males and 8 were females.
Male.
No.
220
11
Female.
Per cent.
5.0
No.
240
8
Total.
Per cent.
3.3
No.
460
19
Per cent .
4.1
AGE.
Eleven of these were adults and 8 were juveniles. The youngest age
was 13 and the oldest 43. The mental age in no case execeeded that of
11 years. The lowest mental age was 7.
PSYCHOPATHIC
HOSPITAL.
53
HEREDITY.
Hereditary factors were present among 15 or 93.7%, of 16 cases in
which information was available.
Direct.
Atavistic.
f
0
0
.1
1
4
2
2
oooo
2
9
0
Insanity, .
Apoplexy or paralysis . .
Psychopathic
i
7
M.
F.
Total.
F.
T.
M.
F.
T.
M.
F.
1
0
1
0
oooo
T.
Brothers
and
sisters.
oooo
F.
Collateral.
1
0
1
0
1
0
1
0
1
0
1
0
0
0
6
1
3
1
1
0
2
1
7
1
5
2
0
2
0
2
2
2
4
11
4
15
1
3
1
3
8
19
T.
M.
oooo
M.
:
0
'
Total . . .
11
T.
There were 21 children born to the 4 patients who were married. In 4
cases there were found stigmata of hereditary syphilis, but only one case
gave a positive Wassermann reaction on the blood. In 9 cases there were
neurological abnormalities.
FORENSIC RELATIONS.
Fifteen of these 19 cases had come into conflict with the courts over
various legal offenses. All three of the juvenile females were sex
offenders.
RESULTS OF TREATMENT.
Recovered . .
"Unimproved
. .
.
.
T.
F.
M.
0
2
9
0
0
0
7
1
0
2
16
1
Of those discharged, 11 returned to their families, 3 were transferred
to another institution, and 4 were returned to the custody of the probate
court.
STATE OF MICHIGAN.
HYSTERIA.
There were admitted 41 cases of hysteria. Of these, 9 were males and
32 were females. This number formed 4.1% of the males admitted,
13.3% of the females, and 8.9% of all patients who were admitted during the period.
Male.
Per cent.
No.
Hysteria .
. .
Female.
220
9
4.1
Total.
Per cent.
No.
240
32
13.3
Per cent.
No.
460
41
8^9
In 14 of these, conversion symptoms dominated in the clinical manifestations. There were 27 cases in which the symptoms centered chiefly
around attacks of anxiety.
The ages of onset and admission are shown in the following table:
jAdmission
Onset.
F.
St.
10-14..
15-19...
20-24 .
25-29
0
1
2
0
5
11
4
3
30-34 ...
35-39 . . .
40-44
45-49
0
50-54
55-59
60-64
0
0
0
1
1
0
0
M.
T.
F.
T.
0
1
7
0
1
7
0
6
13
0
0
0
6
11
3
3
2
4
3
2
1
4
2
1
1
0
1
3
1
0
1
4
0
0
0
0
2
0
1
0
2
0
1
2
2
1
7
3
2
1
1
0
0
17
6
e
PSYCHOPATHIC HOSPITAL.
55
HEREDITY.
Information regarding the hereditary factors was obtained in 33 cases.
Direct.
Apoplexy or paralysis . .
Brothers
and
sisters.
Collateral.
M.
F.
T.
M.
F.
T.
M.
F.
0
1
1
3
1
1
1
4
2
2
0
0
0
0
1
0
0
0
1
0
0
0
1
0
0
0
0
1
0
3
6
9
0
1
1
1
2
Alcoholism
Total heredity . . . .
Atavistic.
Total.
T.
M.
F.
T.
M.
F.
2
0
0
0
0
4
0
1
0
4
0
1
0
1
1
1
1
7
3
3
1
8
4
4
2
0
5
5 | 4
14
18
2
3
13
5
15
8
9
32
41
?
0
T.
3
Total
The foregoing table shows that hereditary factors were present in
54.5% of the cases belonging in this group. Among the families of 41
individuals, there were 68 instances of mental or nervous abnormalities.
ETIOLOGICAL FACTORS.
In 11 instances the onset of the disease was intimately related to an
inability to adequately adjust themselves to situations occurring in their
married life. In 7 other instances there were unusual emotional situations intimately related to the outbreak of the symptoms.
RESULTS OF TREATMENT.
The results of treatment are shown in the following table:
F.
M.
1
5
2
2
T.
6
22
4
4
7
27
6
6
Of those discharged, 39 returned to their homes, and 2 were transferred to one of the State Hospitals. The average length of time under
treatment was 3.07 months.
STATE OF MICHIGAN.
56
PSYCHONEUROSES (Excluding Hysteria).
There were admitted 4 patients who are included in this group. According to their clinical symptomatology, they were represented as follows:
F.
M.
3
1
T.
0
0
3
1
The age of admission of these cases was:
F.
M.
1
1
2
15-19 . . .
20-24
25-29
T.
0
0
0
1
1
2
Hereditary factors were present in 2 of the 4 cases.
ANXIETY NEUROSIS.
This group includes 3 males. Two were discharged from treatment as
improved and 1 remains into the next period. All returned to their
homes. In addition, one woman admitted in a former period was transferred to a State Hospital in an unimproved condition.
COMPULSION NEUROSIS.
A man who suffered from compulsive thoughts and impulses was under treatment for 5 weeks, and was discharged in an improved condition.
57
PSYCHOPATHIC HOSPITAL.
PSYCHOPATHIC PERSONALITIES.
There were admitted a considerable number of individuals who had
definite mental abnormalities but could not be adequately placed among
other groups in this analysis. These abnormalities consisted of constitutional defects of character and peculiar habits rather than any definite
psychosis.
There were in this group 31 individuals, 16 males and 15 females.
Male.
Per cent.
No.
220
16
Psychopathic personalities . . .
Female.
No.
240
15
• '^2'
Total.
Per cent.
6.2
Per cent.
No.
460
31
6.7
While having in common abnormalities of personality, the ways in
which these were manifested varied too widely to permit of more than
a loose arrangement according to clinical type.
M.
13
3
Psychopathic personalities, juvenile
T.
F.
15
0
28
3
AGE.
The- ages at admission were:
F.
M.
5- 9
10-14
15 19.
20-24
25-29 . . . .
30-34 .
35-39
40-44.
45-49 . . .
50-54 . . . .
5 5 59 .
60-64 . .
.
..
.
.
.
.
.
T.
1
1
1
2
0
0
2
2
1
1
3
4
4
0
1
1
1
3
3
1
3
4
2
2
1
2
2
0
0
1
4
1
2
1
0
STATE OF MICHIGAN.
58
HEREDITY.
Hereditary abnormalities were present in 22 or
& of 25 cases in
which information was available.
In 20 families there were 79 abnormal individuals.
Direct.
Atavistic.
Brothers
and
sisters.
Collateral.
Total.
M.
F.
T.
M
F.
T.
M
Insanity
Apoplexy or paralysis . .
Psychopathic . . . .
3
0
1
2
2
0
1
4
5
0
2
6
2
0
8
0
0
0
0
2
0
0
0
2
0
0
0
1
0
0
0
3
0
0
0
0
0
0
0
2
0
1
1
2
0
1
1
Total heredity . . . .
6
7
13
2
0
2
2
1
3
0
4
4
F
T
M
F
T
M
5
0
2
5
12
0
3
7
10
12
22
2
3
1
3
3
6
15
!
T
0
1
2
Negative . .
Unknown
Total. . .
F
26
31
RESULTS OF TREATMENT.
M.
14
1
1
T.
•F.
11 i
2 i
3 !
j
25
3
4
Only one of those discharged was transferred to another institution,
the remaining going to their families, or on their own responsibility.
SENILE DEMENTIA.
There were admitted one man .ancL'two women whose mental disorder
was due to senile atrophy of the brain. This number formed 0.6% of
all patients admitted.
The ages at admission were 72, 75 and 72 respectively.
All were discharged in an unimproved condition. Of these, 2 were returned to their homes and 1 was transferred to the Kalamazoo State
Hospital.
PSYCHOPATHIC HOSPITAL.
59
PRESENILE MENTAL DISORDERS.
Under this heading are considered 5 patients whose mental disorder
was a severe depression with marked anxiety coming on in the late
adult years. The clinical position of this group is uncertain but all of
these cases showed much similarity in their symptomatology and age of
occurrence.
Male.
Per cent.
No.
Hospital admissions
Female.
220
1
.45
Total.
Per cent.
No.
240
4
1.6
Per cent.
No.
460
1.1
Hereditary factors were present in but one case.
The aee at onset and admission was:
Admission
Onset.
50-54. . . .
55-59
60-64 . .
T.
F.
M.
0
1
0
2
2
0
M.
2
3
0
F.
T.
0
1
2
0
1
2
2
1
1
Hereditary factors were present in but one instance.
The results of treatment were:
M.
Recovered
Improved
Unimproved
Remaining
F.
0
0
1
0
T.
0
1
2
1
0
1
3
1
Three of these patients were transferred to one of the State Hospitals.
STATE OF MICHIGAN.
60
CEREBRAL ARTERIOSCLEROSIS.
During the biennial period there were admitted 13 individuals whose
mental disorder resulted from arteriosclerotic changes in the brain.
Eleven of these were males and 2 were females.
This group represented 2.8% of all admissions.
Female.
Male.
Per cent.
No.
220
11
Cerebral arteriosclerosis
Total.
Per cent.
No.
240
2
5.0
Per cent.
No.
460
13
.8
2.8
Age at onset and admission:
Admission
Onset.
40-44 .
45-49 . .
50-54
55-59 . .
60-64
65-69 . .
"Unknown .
T.
F.
M.
...
T.
F.
M.
2
0
0
4
0
0
0
1
2
0
0
2
0
1
4
0
0
0
2
0
2
2
1
0
3
2
2
2
0
3
2
1
1
0
0
1
1
1
5
0
0
HEREDITY.
Hereditary factors were present in 6 of the 10 cases in which information was available.
Atavistic.
Direct.
Total heredity . . . .
4
Negative .
Total
M.
F.
T.
2
0
11
0
0
0
0
0
0
0
0
6
0
0
8
2
M.
F.
M.
F.
T.
0
0
0
0
oooo
1
2
T.
0
0
0
0
0
0
0
0
0 j
0
0
0
0
0
0
0
0
0
0
0
0
0
i1
. . . .1
!
T.
M.
F.
0
1
1
2
2
0
0
0
2
1
1
2
c
Insanity. .
Apoplexy or paralysis . .
Psychopathic
Alcoholism
F.
Total.
ooco
M.
Brothers
and
sisters.
Collateral.
4
'
6
4
3
4
3
2
|
1
11
T.
13
PSYCHOPATHIC HOSPITAL.
61
As somatic abnormalities associated with the cerebral arteriosclerosis,
lesions of the heart were found in 58% of instances. In 43% there were
evidence of nephritis. In one-half of the cases there were sclerotic
changes in the superficial arteries of the arm. The blood pressure was
above 175 in 83% of instances. Among neurological disturbances, a
history of apoplectiform attacks was obtained in one third of the cases.
In 83%' there were vascular changes in the fundus of the eye.
In no instance was there a positive Wassermann reaction obtained
either on the blood serum or on the cerebrospinal fluid.
The average period of residence of those discharged was 7 weeks. Of
those who were discharged, 8 returned to their homes and 3 were transferred to one of the State Hospitals.
RESULTS OF TREATMENT.
M.
Recovered .
Unimproved . .
Died
Remaining
....
F.
0
4
5
0
1
1
0
0
3
SYMPTOMATIC
T.
0
6
0
3
0
MENTAL DISORDERS.
In this general class are grouped 24 cases, 11 males and 13 females. In
each of these cases the mental disorder was considered as symptomatic
of an existing physical disease. The following table shows the relative
frequency of these disorders among the admissions to this hospital.
Female.
Male.
No.
Hospital admissions
Symptomatic mental disorders
Per cent.
220
11
5
No.
240
13
Total.
Per cent.
5 .4
Per cent.
No.
460
24
5.2
In 17 of the cases the etiological factor was a definitely recognized
physical disease and in 7 cases the causative factor was not clearly demonstrated. The following table shows the etiological relations:
M.
Mental
Mental
Mental
Mental
disorders associated with nephritis
disorders associated with pellagra .
disorders associated with acute articular rheumatism
disorders associated with pernicious anemia
F.
T.
3
1
4
1
1
6
4
2
0
2
2
4
4
7
62
STATE OF MICHIGAN.
MENTAL DISORDERS ASSOCIATED WITH NEPHRITIS.
Five of the cases classified as disorders associated with nephritis
showed a paranoid trend with irritability and episodes of delirium or
stupor. Both acute and chronic forms of nephritis were present.
One case, a woman of 48, in addition to nephritis, had a colon infection of one kidney with extreme emaciation. Mentally there were short
periods of unclearness and extreme fatigability. As her kidney condition improved, there was corresponding mental improvement. One of
the cases was in an individual who had been an excessive user of alcohol.
There were two deaths among the cases of this group. In one it was
possible to make a laboratory study of the central nervous system.
Case A. B. No. 1270. Psychosis associated with nephritis:—Male, aged
67 at admission. One brother had died of heart failure and the daughter
of the patient suffered from multiple sclerosis. Our patient had two
severe injuries in his early life, about which we were able to learn little
except that one of them confined him to a hospital for three months.
At 66 he began to be troubled with dyspnoea and other symtoms of
cardiac failure. Five weeks before admission he was delirious for a few
hours and from then on became very irritable, although usually clear in
his grasp. He was committed to the hospital because of an aggressive
attack upon his wife.
Upon admission he was unclear and stuporous. There was much air
hunger and his respiration soon became Cheyne-Stokes in character. The
physical examination showed a markedly enlarged heart to the left and
an atypical aortic pulse. There was marked edema of the ankles and
general anasarca. Wassermann on the blood was doubtful. The physical
diagnosis was made of chronic uremia, double aortic lesion, chronic interstitial nephritis. His condition became progressively worse and he
died after nine days in the hospital.
The autopsy showed an enormous heart with hypertrophy and dilatation of the left side. The whole arterial system showed marked sclerosis. The arch of the aorta was much dilated and showed areas of calcification. All the heart valves, especially the aortic, were thickened and
incompetent. All organs showed chronic passive congestion and the kidneys showed the changes of old interstitial nephritis. The brain weighed
1225 grams. The dura was diffusely adherent. The diploe of the calvarium was greatly congested. Histological examination of the brain showed
the pia to be moderately thickened. There were scattered fibroblasts
and epitheloid cells. In some vessels there were short chains of streptococci. The finer vessels of the cortex were not pathologically altered.
The cortex showed normal topographical arrangements. The nerve cells
were not notably changed. There was no pathology of the glia. None
of the changes could be regarded as of diagnostic importance.
MENTAL DISORDERS ASSOCIATED WITH PELLAGEA.
The disorder of one male and one female was associated with, well defined pellagra, (^astro-intestinal disturbances and the skin manifestations were quite characteristic. The mental picture in each case was
that of a mild stupor with delirious episodes. The female patient showed
PSYCHOPATHIC HOSPITAL.
63
a delusional trend of a paranoid type. One patient died and a study of
the central nervous system showed interesting pathological changes.
Case S. M. No. 1417. Psychosis associated with pellagra:—A female
4-2 years of age upon admission. One sister of the patient died of some
unknown spinal trouble at the age of 15. Her early life was uneventful but her married life was unhappy on account of alcoholic and shiftless habits of her husband.
A year before admission her health began to fail and she became unstable emotionally. She expressed mild delusions of persecution. Five
weeks before admission she developed a peculiar skin condition of her
face and arms. The delusions became more and more prominent. Upon
admission it was noted that she was restless, unclear, and rambling in
her talk. There was a definite weakness of the right arm but an accurate
neurological examination was impossible on account of her mental condition. The skin condition of the arms was considered pellagra on account of the symmetrical pigmentation and sharp limitation of the erythema with its predilection for the extensor surfaces. Her confusion
continued and on the tenth day she died.
In the cortex there was an absence of coarse focal changes. In all sections the nerve cells showed severe changes. These consisted of dissolution of the chromophilic substance of the cell body and in the larger
pyramids of a displacement of the nucleus towards the cell wall. The
glia was much increased in the molecular and to a lesser degree in the
deeper layers. The form of- the cell was that characteristic for regressive
changes. An occasional rod cell was noted. The spinal cord showed no
pathological changes. The changes as a whole were of the type met with
in chronic intoxications. They have often been observed in chronic alcoholism and pellagra.
MENTAL DISORDERS ASSOCIATED WITH ACUTE ARTICULAR RHEUMATISM.
There were four cases belonging in this group. These were all males,
aged respectively 32, 40, 41 and 44 at the time of admission. They correspond to that group of cases discussed in a paper appearing from this
hospital and published in the American Journal of Insanity, 1914.
One of these patients died and the nervous system was studied in the
laboratory.
Case No. 1817. Psychosis associated with rheumatism and endocarditis:
•—Male, aged 32 at admission. His father was an alcoholic. He was 32
when admitted. At about the age of 22 he had a severe attack of rheumatism and at 30 a second attack. At that time, red blotches appeared
on the arms and body. These areas swelled rapidly and soon disappeared.
Sometimes they reached the size of a half walnut. He had worked as a
bartender and had been a steady drinker but never drunk. Two or three
months before admission he had a third attack of rheumatism with the
same skin lesions as in the former attack.
When admitted to the hospital his comprehension was unclear. He
did not know where he was and he talked of his food being poisoned and
of other patients being syphilitics. He was very active and the associations shown in his talk were loosely formed. Later he said he was John
the Baptist and that he heard his mother calling to him.
64
STATE OF MICHIGAN.
The examinations showed his heart to be enlarged and atypical murmurs. His blood pressure was 150, the Wassermann on his blood was
negative, and the spinal fluid examination was negative except for an increase of albumen. While in the hospital, there appeared on his body,
in various places, irregular painful red swellings, which disappeared in
a few hours. He failed rapidly in spite of all supportive measures until
he died 20 days after admission.
An autopsy was made. The pathological diagnosis of the internal organs was malignant endocarditis of the mitral valve; eroupous pneumonia; grey hepatization; empyema. The brain weight was 1294 grams.
There was thrombosis of several venous branches near the longiturinal
sinus. The pia was transparent and its veins moderately congested. The
brain itself showed no gross changes. Histological studies of the brain
showed a recent thrombosis of the longitudinal sinus and some of its confluent veins. The pia was greatly thickened by a recent increase of connective tissue. In some places there was an enormous proliferation of
flbroblasts. There was no appreciable loss of nerve cells. In all regions
there were a few nerve cells, in which there was a mild disintegration of
the tigroid of the cell. Many of the arteries, both of the pia and the cortex, showed recent proliferative changes in the intima. There were no
marked changes in the cortex topography. Many nerve cells in all layers
showed slight breaking up of the tigroid and a tendency of the ground
substance to stain. In several regions of the cortex, the glia of the first
layer was enormously increased in thickness and there was active proliferation among the glia cells. Throughout the cortex and medulla, many
glia cells were in stages of active progression. The changes in the brain
were apparently recent in their origin and were apparently directly related to the toxic process associated with the bacterial endocarditis.
MENTAL DISORDERS ASSOCIATED WITH PERNICIOUS ANEMIA.
This group was represented by two females, aged 39 and 42 years, and
two males, aged 46 and 60 years. The mental symptoms were those of
an asthenia with episodes of unclearness and delusions of a paranoid
trend.
Two patients died. The clinical course and pathological findings are
given in the following abstracts:
Case W. C. A. No. 1812. Psychosis associated with pernicious anemia:
—Male, aged 60 at admission. Until a year previously he had been a
successful physician. At that time he complained of feeling tired, appeared listless, and sometimes was observed talking to himself. These
symptoms followed an injury to the back and wrist upon entering a moving street car. Six months later there appeared paraesthesiae of the
hands and feet, and he staggered in walking. He became irritable and
unstable, and extremely excitable. Upon admission he showed a clear
comprehension, a marked retentive memory defect, and circumstantiality: The examination of the blood showed 2,710,000 reds and 70%
haemoglobin. The smear showed anisocytosis and poikilocytosis. The
neurological examination then showed a marked ataxia of the lower extremities, with sensory changes of hands and feet. Stereognosis was lost
in the left hand. There was a loss of vibration sensibility in the bones
of the extremities. The knee jerks and Achilles jerks were lost. There
PSYCHOPATHIC
HOSPITAL.
65
was a Babinski reflex on the right side. He failed rapidly and gradually
passed into deep stupor, which continued until his death 27 days after
admission.
The autopsy showed that aside from a general anaemia, there was little pathological found in the examination of the internal organs. Thd
brain after hardening showed no gross focal changes. Histological studies of the nervous system showed the pia to be slightly thickened, the increase being largely cellular, with many phagocytes and a small number
of plasma cells. The margin of the cortex was thickly studded with
corpora amylacea. There was much increase in the cellular glia of the
marginal layer. Changes in the nerve cells were slight and scattered.
A few cells of the deeper layers showed absence of tigroid and a displacement of the nucleus. In the cortex of the frontal region were scattered
placques of the type first noted in this laboratory as occurring in the
brain in pernicious anaemia. In one lamella of the cerebellum was a
small focal softening. The cord at all levels showed areas of degeneration of the type so frequently met with in this disease. In distribution,
they occurred in all of the columns of the cord.
Case M. T. No. 1556. Psychosis associated with Pernicious anemia:—•
Female aged 42. Aside from the death of a sister from anemia at the
age of 40, her family history was not important. At the age of 34 she
complained of stomach trouble, and about the same time there was an
acute change in her mental condition. She had several attacks of acute
fear which she explained afterward by saying that she thought she had
given birth to a child. She then became sad and expressed ideas of un\vorthiness, and occasionally she talked of suicide. In this condition,
she was admitted to the hospital. Her blood count then showed 4,027,400
reds and 80% to 90% haemoglobin. The differential count showed nothing abnormal. She had excellent insight into her condition and after f>7
days was discharged recovered. Her blood condition was then considered suggestive of pernicious anemia, so she continued treatment for this
at irregular intervals at home. Eight years later she had an attack of
mumps and from then on complained much of nervousness and weakness. She had fainting attacks and gastro-intestinal upsets. For these
things she was admitted to the Medical Clinic of the University Hospital
where her blood count showed 1,150,000 reds and 27% haemoglobin.
The blood smears were typically those of pernicious anemia. She rapidly
passed into a deep coma and was transferred to this hospital after six
days. Here her stupor was of varying depths, but she never was entirely
clear. The only idea expressed by her were sad, of having "to die and
burn forever and forever." Her temperature ranged from 100 to 102 by
axilla and there were periods of mild delirium. On account of the deep
stupor a satisfactory neurological examination was not possible. The
knee jerks were present and slightly increased. Death occm-red 13 days
following her admission.
The pathological diagnosis of the body was: acute purulent appendicitis, general septicaemia, subserous haemorrhages, dilatation of the
heart, severe anaemia, hyperplasia of lymphoid marrow and of haemolymph nodes, fibrosis of spleen, multiple telangiectasis of skin, diffuse
hemorrhage into pericrania! tissues.
The brain weighed 1230 grams. There were numerous small haemorrhages on the inner surface of the dura and in the pia. The cerebrospinal
STATE OF MICHIGAN.
fluid was increased and the brain was edematous. The cortex showed interesting pathology. The pia mater showed a slight increase of cells
among the fibres. There was no coarse disturbance of the nerve cell arrangement. There were many cells, chiefly of the larger size, which
showed mild degrees of eccentric dissolution of the tigroid and displacement of the nucleus. A few cells showed severe disintegrative changes
with glia cells clustered about the fragments of the cell body. There were
many unusual forms of cells scattered through the nerve cell layers. Some
of these were large rod cells. Others were glia cells in various stages of
progressive and regressive changes. In the medullary part of the convolutions there Avere in sections from several regions, focal accumulations
of glia and epitheloid cells, arranged concentrically about an area free
of cells. Their characteristics were quite like the placques which have
been noted in the nervous system of pernicious anemia. There was a
slight degree of endarteritis among the capillaries of the cortex, but no
arteriosclerotic changes among the larger vessels. Serial sections of the
spinal cord showed an entire absence of the changes commonly found in
this disease.
MENTAL DISORDERS OF A TOXIC TYPE BUT UNKNOWN ETIOLOGY.
Among the cases included here were 1 male and 6 females whose mental picture was that of more or less unclearness of consciousness associated with hallucinations and delusions more or less bizarre. In one
case there was a history of long continued use of alcohol. One case Avas
that of a delirium with a valvular heart lesion and attacks of angina. In
two cases there were severe gastro-intestinal symptoms such as severe
vomiting and diarrhoea. In none of these cases which came to autopsy
were there any changes in the central nervous system of diagnostic importance.
HBEEDITY.
The occurrence of hereditary factors among the patients included in
this group of symptomatic disorders is given in the following table:
Apoplexy and paralysis.
Alcoholic
Total heredity . . . .
Total.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
1
1
2
1
1
0
2
0
2
1
4
1
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
2
0
0
0
3
1
0
0
2
2
2
1
4
0
2
0
6
2
4
1
5
3
8
0
1
1
0
0
0
2
2
4
7
6
13
o
2
5
2
7
4
11
13
24
Negative
—
Total. . .
Brothers
and
sisters.
Collateral.
Atavistic.
Direct.
T.
—
PSYCHOPATHIC HOSPITAL.
BRAIN
67
TUMOR.
Three cases of brain tumor were under treatment during this period.
Case No. 1825, a male, 43 years old, was admitted with the following
symptoms: headaches, projectile vomiting, general epileptiform seizures,
nystagmus, choked disc, left sided Babinski, and progressive mental deterioration and dullness. It was thought that there was a tumor rather
deep in the right frontal lobe. He was discharged unimproved.
Case No. 1709, was a female, 33 years of age, who died after 25 days
in the hospital. The autopsy showed multiple carcinomata throughout
the brain, with a large cystic broken down carcinoma in the left temporal region. The primary tumor was probably in the head of the pancreas with metastases in the heart, liver, peritoneum, mesentery, all the
glands of the thorax and abdomen, and in the left tube and ovary. A
detailed report of this case may be found in the Proceedings of the Clinical Society of the University of Michigan, June, 1916.
Case No. 1715 was a female, 61 years of age, who at the age of 20 had
been in a sanitarium for nervous or mental trouble, from which she completely recovered. At fifty, she underwent a decided change. She became irritable and moody and from then on was not considered normal.
Six months before admission a facial paralysis on the left side and a
memory defect were noted by the family. It was thought that she had a
stroke of paralysis. Her conduct became more difficult to control and
the memory defect became more pronounced. She frequently had trouble in walking. She complained of headaches and vomited frequently.
Upon admission the examinations revealed a general arteriosclerosis and
a blood pressure of 200. There was a Babinski reflex on the right side
and she fell to the left when in the Ehomberg position. There was no
choked disc and the Wassermann on the blood serum and cerebrospiual
fluid was negative. The latter showed an increase in the albumen content. She was confused and wandered about, frequently losing herself
on the ward. The retentive memory defect was most pronounced. After
a month there appeared weakness and spasticity of the whole left side,
which disappeared after a few days. She gradually became weaker and
soon there appeared a double choked disc, 4 diopters 011 the right and 3
on the left. An X-ray examination failed to show positive findings.
Mentally, the deterioration advanced until she passed into a stupor of
varying depths. Forced movements of the left arm and hand of a Jacksoniau type were observed on numerous occasions. There was weakness of the extrinsic muscles of the left eye. A brain puncture was made
in the right frontal region but the bit of brain removed showed no evidence of tumor. She became more stuporous and the forced movements
of the left arm became more frequent. After 162 days in the hospital,
she died. The autopsy showed a very large alveolar sarcoma in the right
occipito-temporal region extending to the surface. A smaller one was in
the right lenticular region. The cerebral vessels showed a moderate degree of arteriosclerosis.
68
STATE OF MICHIGAN.
MULTIPLE SCLEROSIS.
Two cases of this disease were admitted during this period. One of
these, Case No. 1597, was a girl of 19, whose mother was hysterical. The
meutal examination was entirely negative but the neurological examination showed nystagmus, intention tremors, ataxia, and reflex disturbances of this disease. The Wassermann on her blood was negative. The
cerebrospinal fluid showed 8 cells, slight increase in globulin and albumen and with the Lange colloidal gold it gave an atypical meningitic
curve. After 35 days she was discharged as not insane and immediately
admitted to the University Hospital Neural Clinic.
The other case, No. 1554, was a boy of 12 with the characteristic neurological findings. He showed advanced mental deterioration and after
24 days he was discharged unimproved.
SYDENHAM'S CHOREA.
There was admitted a girl, aged 15, on account of chorea and recent
acts of sexual delinquency. Observation demonstrated valvular disease
of the heart and mild choreiform movements of the head, trunk and
extremities. There was no definite mental disorder and she was discharged to her family after a few weeks treatment, the chorea being
greatly improved.
NON-INSANE
CONDITIONS.
ADULTS.
There were admitted a few individuals whose conduct had been such
as to raise the question of a mental disturbance, but whose hospital observation showed nothing to warrant their being adjudged insane or
that their actions had been the result of any serious mental abnormalities.
Two of these were male adults. One of these had been arrested on suspicion of participating in a munition conspiracy. The other was a man
who by reason of domestic incompatibilities had acted in an unusual
manner. Both were discharged at the end of the observation period.
JUVENILE DELINQUENTS.
There were admitted during the period a number of youthful individuals because of various acts of delinquency. The greater number of
these were found to be feebleminded and have been classed in the group
of imbecility. One girl, aged 19, remains over, in whom no mental disorder can be found. Her conduct was that of one of depraved character
and unrestrained impulses.
PSYCHOPATHIC HOSPITAL.
69
UNCLASSIFIED CONDITIONS.
There were admitted 9 individuals whose mental disorder could not
be placed among any of the preceding groups. Five of these were males
and 4 were females. In some instances, the individual was under observation for too brief a period. In others, there were difficulties of interpretation, which made it unwise to give to the disorder a definite diagnosis.
In all, this group formed 1.9% of those admitted during the period.
Male.
Female.
Per cent.
No.
220
Per cent.
No.
2.1 |
5
Total.
240
4
1.7
Per cent.
No.
460
9
1.9
HEREDITY.
Hereditary factors were present among the ancestors in 4 instances in
which information was obtained.
RESULTS OF TREATMENT.
M.
Recovered
Unimproved . .
Died
Remaining . .
....
....
...
F.
0
2
3
0
0
t.
0
1
1
2
0
0
3
4
2
0
Of 7 individuals who were discharged 5 returned to their families and
2 were transferred to a State Hospital.
STATE OF MICHIGAN.
70
EEPOET OP THE PATHOLOGICAL LABOEATOEY.
The laboratory of the State Psychopathic Hospital is a central laboratory to which the State Hospitals may send material for study.
The following tables rive statistical information relating to the work
done:
TABLE No. 1.—Number of cases mewed between July 1, 1915, and June 30, 1916, with
Kalamazoo State Hospital
Pontiac State Hospital .
Newberry State Hospital .
Traverse City State Hospital
State Psychopathic Hospital
Outside sources. . . .
...
.
Year
ending
June 30,
1915.
Year
ending
June 30,
1916.
62
65
32
6
8
127
65
17
8
13
112
3
118
5
230
8
115
123
238
33
11
0
6
Total
for
period.
PSYCHOPATHIC HOSPITAL.
71
TABLE No. 2.—Clinical diagnosis oj cases studied in tne laboratory.
Year
ending
June 30,
1015.
Alcoholic insanity, chronic
Alcoholic insanity, delirium tremens
Alcoholic insanity, Korsakow's psychosis
Alzheimer's disease
Cerebral arteriosclerosis
Cerebral haemorrhage, traumatic
Cerebral haemorrhage, fat emboli
Chorea, Huntington's
Dementia praecox
Encephalitis
Epilepsy
Imbecility
Manic depressive insanity
Myelitis, compression
Pellagra
Pernicious anemia
Presenile depression
Senile dementia
Syphilis, central nervous system, general paralysis. .
Syphilis, central nervous system, gumma
Syphilis, central nervous system, meningo-vaseular.
Toxic psychoses, rheumatism
Toxic psychoses, nephritis
Toxic psychoses, undifferentiated
Tumor, central nervous system
Material unstudied or undiagnosed
Miscellaneous neuro-pathological material
Total. .
Year
Tn*.,i
ending ! J ° tdl
June 30, I period.
1016.
2
0
0
0
2
1
1
2
4
1
1
26
13
0
0
0
39
1
1
1
4
1
7
1
5
1
3
1
1
6
1
11
1
1
1
1
21
2
4
0
0
32
115
2
1
4
3
1
13
6
2
2
1
1
1
3
57
- 2
1
1
3
4
89
4
123
238
TABLE No. 3. —Number of cases reported to the State Hospitals during the period.
indudes 188 cases received during previous periods but reported in this.
4
6
This
Kalamazoo State Hospital. . .
Pontiac State Hospital
Traverse City State Hospital.
Newberry State Hospital....
56
104
35
Total number reported.
228
33
72
STATE OF MICHIGAN.
TABLE No. 4.—Number of Wassermann tests made between July 1, 1914, and June 30,
1916, and their sources.
Year ending
June 30, 1915.
Year ending
June 30, 1916.
CSF. Blood . Total. CSF.
Kalamazoo State Hospital
Traverse City State Hospital
Newberry State Hospital.
State Psychopathic Hospital
Ionia State Hospital
Michigan Home & Training School .
Total .
173
142
20
49
99
802
416
315
270
270
975
558
335
319
369
0
0
0
0
8
69
0
0
8
69
0
0
483 2,150 2,633
Blood . Total. CSF. Blood . Total.
296 1,019 1,315
121
423
544
9
431
440
234
42
276
113
368
481
3
0
0
0
Total
for period.
427
230
189
243
430
230
189
243
469 1,821
263
839
29
91
212
746
504
638
2,290
1,102
775
595
850
3
0
0
0
435
299
189
243
438
299
189
243
584 3,564 4,148 1,067 5,714
6,781
REPORT OF THE SECRETARY AND BUSINESS OFFICER.
Ann Arbor, Mich., June 30, 1916.
To the Board of Trustees:
Gentlemen—I have the honor to present the report of the business
transactions of the hospital for the biennial period ending June 30, 191.6.
The whole number of patient days was 42,122; the average daily cost
per patient per day was fl.257; the highest rate for any one month was
|1.29; the lowest $1.25 per patient per day.
In comparing these rates with those of the two years just proceeding
it will be noticed that they have increased considerably. This is due almost entirely to the increased cost of food stuffs.
PSYCHOPATHIC HOSPITAL.
DISBURSEMENTS.
ON ACCOUNT OF CURRENT EXPENSES.
July 1, 1914 to June 30, 1916.
Pood
Clothing
Laundry Expenses
Heating and Light
Floral, Greenhouse and Grounds
Medical Department
Office, Stationery, Etc
Amusement and Instruction
Furniture and Household Supplies
Improvements and Repairs
Miscellaneous Expenses
Farm, Garden and Stock
Refunds
Total for Biennial Period
123,745 19
122 03
2,564 73
3,578 95
307 96
11,977 25
1,835 60
336 75
5,818 93
4,809 81
2,848 61
3 25
158 28
158,107 34
DISBURSEMENTS.
4
;,
ON ACCOUNT OF CLINICAL LABORATORY.
July 1, 1914 to June 30, 1916.
Officers' Salaries
Animal Food
Heating and Light
Floral, Greenhouse and Grounds
Medical Department
Amusement and Instruction
Office, Stationery, Etc
Furniture and Housekeeping Supplies
Improvements and Repairs
Farm, Garden and Stock
Miscellaneous Expenses
Total for Biennial Period
f 14,001 68
27 33
48 19
8 85
6,417 93
20
1,107 94
1 70
49 59
49 61
475 65
$22,188 67
74
STATE OP MICHIGAN.
RECEIPTS.
ON ACCOUNT OF CURRENT EXPENSES.
July 1, 1914 to June 30, 1916.
From
From
From
From
From
From
State for County Patients
.........................
State for State Patients
...........................
Private Patients
.................................
Interest Accounts
...............................
Refund on Pay Roll
..............................
Miscellaneous Sales
..............................
Total for Biennial Period
$45,016 44
994 58
18,176 42
815 95
3 87
73 82
$65,081 08
RECEIPTS.
ON ACCOUNT OF CLINICAL LABORATORY.
July 1, 1914 to June 30, 1916.
Special Appropriation
Wassermann Tests
Refund on Pay Roll
From Miscellaneous Sales
Total for Biennial Period
$27,000 00
427 50
30 00
100 80
$27,5P« 30
PSYCHOPATHIC
HOSPITAL.
75
Table showing the number of hospital days and the daily per capita
costs by months from July 1, 1914 to June 30, 1916.
Patient
hospital
days.
From July 1, 1914, to June 30, 1916:
July, 1914
August, 1914
September, 1914
October, 1914
November, 1914
December, 1914
January, 1915
February, 1915
March, 1915
April, 1915
May, 1915
June, 1915
July, 1915
August, 1915
September, 1915
October, 1915
November, 1915
December, 1915
January, 1916
February, 1916
March, 1916
April, 1916
May, 1910
June, 1916
1,775
1,818
1,731
1,787
1,688
1,698
1,800
1,593
1,808
1,765
1,704
1,717
1,846
1,793
1,700
1,692
1,757
1,803
1,852
1,743
1,822
1,677
1,862
1,691
Daily
per capita
cost.
-
$1 27
1 291 26
1 27
1 25
126
1 2»
1-26
1 27~
1 26
126
1 25
1 25
1 25
1 25
1 2'6
1 .26;
1 25
1 25
1 25
125
1 25
1 25
1 25-
SUMMARY OF INVENTORY, JUNE 30, 1916.
Hospital buildings
Furniture
Fixtures
Apparatus
Books
Supplies
Total...
S3,109
707
5,550
1,140
3,983
43
33
43
36
07
$78,269 23
14,490 62
$92,759 85
Respectfully submitted,
ROBERT G. GREVE,,
Secretary.
76
STATE OP MICHIGAN.
REPORT OF TREASURER.
I
• •
;
'
July 1, 1916.
To -the Board of Trustees of the State Psychopathic Hospital:
Gentlemen—Herewith I hand you report of the State Psychopathic
Hospital for the biennial period ending June 30, 1916:
RECEIPTS.
Balance in Treasury July 1, 1914
By cash from State Treasurer, annual appropriation, laboratory (Sec. 28, Act 278, Public Acts 1907)
By cash from State Treasurer (Support of State Patients).
By cash from State Treasurer (Support of County Patients)
By cash from Private Patients
By cash from Earnings Institution (Interest, etc.)
f 9,359 07
27,000 00
994 58
44,649 02
18,543 84
1,453 94
$102,000 45
DISBURSEMENTS.
Clinical Laboratory Accounts
Current Expenses (Running Account)
Balance June 30, 1916
f22,188 67
58,107 34
21,704 44
$102,000 45
Very respectfully submitted,
R. A. CAMPBELL,
Treasurer.
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