Sixth biennial report of the Board of Trustees of the State Psychopathic Hospital at the University of Michigan for the Biennial Period ending June 30, 1918

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Title

Sixth biennial report of the Board of Trustees of the State Psychopathic Hospital at the University of Michigan for the Biennial Period ending June 30, 1918

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. Trustees again brought to the attention of the Legislature the inadequate facilities provided for the work of the hospital, in both size and arrangement of buildings. Due to the First World War, a cooperative agreement with the Surgeon General of the Army led to the instruction of officers of the Medical Corps of the Army beginning in June 1917. An additional cooperative agreement with the State Board of Health led to the extension of the out-patient ward, to examine women for mental disorders who might come under the care of the State Board for the spread of venereal diseases. 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

Fort Wayne, IN: Fort Wayne Printing Company, Contractors for Michigan State Printing and Binding.

Date

1919

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

MSH0005

Coverage

Ann Arbor, Washtenaw County, Michigan

PDF Text

Text

SIXTH BIENNIAL REPORT
OF THE

BOARD OF TRUSTEES
OF THE

State Psychopathic Hospital
AT THE

UNIVERSITY OF MICHIGAN
FOR THE

BIENNIAL PERIOD ENDING JUNE 30, 1918.

BY AUTHORITY

FORT

WAYNE PRINTING COMPANY

CONTRACTORS FOR MICHIGAN STATE PRINTING AND BINDING
FORT WAYNE, INDIANA

1919

OFFICERS OF THE STATE PSYCHOPATHIC HOSPITAL.

TRUSTEES.

Chauncey F. Cook
Fred S. Case
Dr. Walter H. Sawyer
Wm. L. Clements
Benjamin S. Hanchett
Frank B. Leland
Albert C. Stevenson
William Lloyd

Hillsdale
-. . . Sault Ste. Marie
Hillsdale
Bay City
Grand Rapids
Detroit
Port Huron
Manistee
OFFICERS.

Albert M. Barrett, A. B., M. D
Arnold L. Jacoby (absent on leave)
Bertrand L. Jones, A. M., M. D
Raymond F. .Wafer, M. D
James M. Stanton, M. D
Robert G. Greve
Adeline E. Gurd, M. D
Sobei Ide, M. D
Agnes Tennant, R. N

Medical Director
First Assistant Physician
Acting First Assistant Physician
Second Assistant Physician
Resident Physician
Business Officer
Pathologist
Serologist
Head Nurse

REPORT OF TRUSTEES.

To ilie 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 continues the same excepting that
M. F. Quaintance, member from the Board of Trustees of the Traverse
City State Hospital, has been succeeded by William Lloyd, from the
same Board, and Albert E. Stevenson has succeeded Dr. Stewart Galbraith
from the Board of Trustees of the Pontiac State Hospital.
Meetings of the Board of Trustees have been held at intervals at the
Hospital and the Trustees have maintained an active interest in the
work of the institution. Detailed statements of the medical work of
the hospital and its business administration are given in accompanying
reports of the Medical Director, the Business Officer and the Treasurer
of the Hospital.
The number of patients treated during the period was 538 as against
510 of the previous period. There continues, as in other years, a greater
demand for the admission of patients than the capacity of the hospital
can accommodate.
The Board of Trustees must again bring to the attention of the Legislature the inadequate facilities, both in size and arrangements that have
been provided for the hospital. Many patients for whom the Hospital
might do much by treatment must be refused admission. The progressive development of the medical, research, and teaching work of the
hospital has reached a point where no further extensions are possible,
until more space is provided.
The pressing needs of the Hospital can only be met by the erection of
a new building. It is hoped that the public may become more familiar
with the important service the Hospital is giving to the State and that
adequate provision for the work will be made at an early date.
The average per capita cost for the maintenance of patients during
the period was $1.34 per diem.
The per diem cost for the entire hospital administration, including
salaries, current expenses of the laboratory and repairs and improvements was $2.16. The increase of the per diem costs over that of previous years is accounted for by the increased cost of supplies and extensions
of the medical work of the hospital.
The out-patient services of the hospital located in Detroit and Ann
Arbor have become most important features of the work of the hospital.
During the past period they have treated a far larger number of patients
than in previous years, and through these agencies the influence of the
hospital throughout the State has been greatly extended.

6

STATE OF MICHIGAN.

In cooperation with the State Board of Health, the trustees have
approved an extension of the out-patient ward of the hospital to aid
in the examinations for mental disorders of women who might come
under their care in connection with the efforts of the Board of Health
against the spread of venereal diseases.
The War has presented to the Psychopathic Hospital opportunities
for helpful service to the Government. At the request of the Surgeon
General of the Army the trustees have gladly offered the facilities of the
hospital for instruction of officers of the Medical Corps of the Army who
were to be assigned to the care of mental and nervous disorders in the
Army. Courses of instruction began in June 1917 and have continued
through the period.
Signed:
CHAUNCEY F. COOK,
WALTER H. SAWYER,
FRED S. CASE,
WM. L. CLEMENTS,
BENJ. S. HANCHETT,
FRANK B. LELAND,
ALBERT C. STEVENSON,
WILLIAM LLOYD.

PSYCHOPATHIC HOSPITAL.

ORGANIZATION.

The State Psychopathic Hospital of the University of Michigan was
established in 1901. Its purposes are defined by legislative statutes of
1907, as follows:
Act 278, Public Acts 1907, Sec. 15—Patients admitted to the Psychopathic Hospital are divided into two classes:
First: Public patients are such as are kept and maintained by the
State.
Second: Private patients are such as are kept and maintained without
expense to the State.
Sec. 17.—Patients may be admitted to the Psychopathic Hospital
at the University of Michigan in accordance with the following provisions :
First: Persons adjudged insane according to the provisions of act two
hundred seventeen, sections fifteen and sixteen, public acts of nineteen
hundred three, may be committed to the Psychopathic Hospital at the
University of Michigan, whenever, in the opinion of the judge of probate,
it may be deemed advisable: Provided, That before such patient be sent
to said hospital, he shall obtain the approval of the director of the Psychopathic Hospital for such action. But, if an insane patient committed
to the Psychopathic Hospital cannot be received because of lack of room,
he shall be committed to the proper asylum in the district in which he
resides and receive treatment until there is room for him at the Psychopathic Hospital, and if it appears in the course of his treatment in such
asylum that he would not probably be benefited by treatment at the
Psychopathic Hospital, he shall remain at said asylum. In all orders
made by the judge of probate for the admission of an insane person to
the Psychopathic Hospital at the University of Michigan, it shall be
specified that in case such patient shall not recover after a satisfactory
period of observation and treatment, or whenever, in the opinion of the
director of the Psychopathic Hospital at the University of Michigan,
further residence in said hospital is inadvisable, such patient shall be
transferred to the asylum in the district of which said patient was a
legal resident or to such other asylum as the judge of probate may designate in such order of committal: Provided, That whenever an insane
person is to be so transferred, due notice of such transfer shall be given
to the judge of probate and the person making application for such
admission and to the superintendent of the asylum to which such patient
is to be transferred.
Second: When, in accordance with section sixteen, act two hundred
seventeen, public acts of nineteen hundred three, in the hearing as to
the insanity of a person, it may seem advisable to the court, that on
account of doubt as to the sanity or insanity of a person, or if in the
opinion of the court, a permanent order of insanity is inadvisable, or if
in the opinion of the court and examining physicians, the case presents
complicating diseases which may be treated by the clinical physicians

8

STATE'OP MICHIGAN.

in the general hospital of the University, and by such treatment their
mental or nervous disability be cured or benefited, the court may continue said hearing in said court not to exceed thirty-five days, and direct
that such person shall be sent to the Psychopathic Hospital at the University of Michigan, as a public or private patient, as a person afflicted
with some nervous or mental disease and that said person be there confined, observed and treated for a period not longer than thirty-five days.
Before the expiration of this period the director of the Psychopathic
Hospital shall return to the judge of probate the results of his observation
and treatment of said patient, and an opinion stating whether said patient,
is insane or sane. If observation has shown that the patient is insane, then
the court shall notify said patient, the relatives and the person making
the application for said admission to the asylum, and may pass judgment
of insanity and order that said person to be confined as an insane patient
in the Psychopathic Hospital at the University of Michigan, or in the
State asylum for the insane in the district of which said patient is a legal
resident, or in such other asylum for the insane in the State of Michigan
as may seem advisable; and it sha'l thereupon be further ordered that said
patient be transferred to the State asylum for the insane of the district
of which said patient was a legal resident, or to such asylum as said
judge of probate may designate, when in the opinion of the director of
the Psychopathic Hospital further residence in said hospital would not
result in recovery or would be inadvisable: Provided, That whenever
an insane patient is to be transferred to an asylum in accordance with such
provision, due notice of the intention of such transfer shall be given to
the judge of probate, the person making application for the admission
of said patient into an asylum, and the superintendent of the State asylum
for the insane, to which said patient is to be transferred. If the results
of the observation of said person show that, in the opinion of the director
of the Psychopathic Hospital, said person is not insane, then the order
for confinement, observation and treatment shall be vacated and the
patient discharged from the Psychopathic Hospital.
Third: Persons who are residents of the State of Michigan, who are
afflicted mentally, or with serious nervous disorder, but who are not
insane, nor been legally adjudged insane, may be admitted to the Psychopathic Hospital at the University of Michigan as voluntary patients,
either at the discretion of the director of said hospital, or in accordance
with the statutes providing for the admission of voluntary patients to
the Michigan State Asylums for the insane. Such voluntary patients,
when so received, shall be subject to the general rules and regulations
of the Psychopathic Hospital. All voluntary patients shall be supported
without expense to the State, and the amount agreed upon for the maintenance of such voluntary patients in the Psychopathic Hospital shall
be secured by a properly executed bond to be approved by the medical
director, and there shall be made such advance payments as may be
required by the action of the board of trustees of the Psychopathic
Hospital at the University of Michigan, and bills for their maintenance
shall be collected monthly. Voluntary patients so received may be
discharged at any time by the medical director, and in case any voluntary
patient in the Psychopathic Hospital at the University of Michigan
is believed to be insane, the proceedings shall be carried out as provided
for such contingency by act two hundred seventeen, section twentynine, public acts of nineteen hundred three;

PSYCHOPATHIC HOSPITAL.

9

Fourth: In case the superintendent of any one of the asylums for the
insane in the State of Michigan shall be of the opinion that the condition
of mind of any person who is confined in such asylum may be benefited
by residence and treatment at the Psychopathic Hospital at the University
of Michigan, he may cause said patient to be conveyed to said hospital,
and, in case said patient, while there confined, shall be restored to sanity,
such patient shall be discharged; but, in case such patient shall be found
incurable, such patient may be returned to the asylum from which said
patient was received, or may be discharged or paroled from the Psychopathic Hospital by its director, with the consent of the superintendent
of the asylum from which such patient was received. Whenever, in
accordance with the above provisions, a patient shall be transferred
from any asylum to the Psychopathic Hospital, the superintendent of
such asylum shall notify the guardian, if any, of such patient and the
judge of probate of the county of which such patient was a resident, and
when said patient is discharged, paroled or returned to the asylum from
which said patient was received, the director of the Psychopathic Hospital
shall inform said guardian, if any, and the judge of probate, before taking
such action.
Voluntary patients may be admitted at public expense in accordance
with Public Acts 1915, Act 27. The hospital may admit
any
resident of this State who is desirous of submitting himself to treatment
as a patient, and who makes written application therefor, and whose
mental condition is such as to render him competent to make such application: Provided, The approval of the judge of probate of the country in
which such person resides shall be obtained in writing and such person
shall not be detained for more than three days after having given notice
in writing of his intention or desire to leave such institution. The rate
of charge for insane patients, and the rules for admission of insane patients
so far as not inconsistent, shall apply to such voluntary patients.
Section 21. Par 2, Any insane patient of the Psychopathic Hospital
may be transferred to the State Asylum for the Insane in the district
of which said patient was a legal resident, or to such asylum as the judge
of probate may' designate in his order of admission, whenever, after a
satisfactory period of observation and treatment, it is found that said
patient is incurable, or that further confinement in the Psychopathic
Hospital at the University of Michigan is inadvisable: Provided, That
whenever an insane person is to be transferred, due notice of such transfer
shall be given to the judge of probate, and to the person making the
application for the admission of said patient to an asylum, and to the
superintendent of the asylum to which patient is to be transferred.

10

STATE OF MICHIGAN.

REPORT OF THE MEDICAL DIRECTOR.

In accordance with the statutes of this State, I have the honor of submitting to the legislature of the State of Michigan my report as Medical
Director of the State Psychopathic Hospital covering its sixth Biennial
Period.
During this period the general policy of the operation of the hospital
has continued along much the same lines as previously. In common
with all institutions the hospital has felt the influence of the situation
brought about by the war. The problem of maintaining former standards
has been difficult. In addition to this the hospital was called upon to do
special work in connection with the instruction of medical officers of the
army.
The hospital has treated a somewhat larger number of patients than
in any previous period. It is not to be expected that any marked increase
in the number treated can occur until the capacity of the hospital is
increased. Under present conditions there is always a waiting list of
patients desiring admission as soon as vacancies occur. It would be
possible to increase the admissions if it were possible to make transfers
of patients, whose problems are custodial, more rapidly to the State
Hospitals. The greater number of admissions are from the eastern part
of the State and the present crowded condition of the Pontiac State
Hospital offers far fewer opportunities for transfer than could be utilized.
In spite of the clear definition in the statutes of the State, as to the
field of work of this hospital, it is found difficult to adhere to these owing
to the great pressure that is continually present for the admission of
patients. Friends of patients and committing authorities are not able
or willing to recognize the unsuitability of many patients for admission
to this hospital. The desire to keep the hospital filled to its capacity
and to be of as much service to the State as possible results in the admission
of many patients quite unsuited to the purposes and facilities of the
hospital.
CLINICAL AND LABORATORY WORK.

A detailed account of the clinical work is given in another section.
The foundation of the clinical work is the routine intensive study of
each patient's personal history and the clinical manifestations of his
disorder. The results of these are presented at frequent conferences of
the medical staff.
The activities of the laboratory have chiefly been centered in the
intensive study of the nervous system of patients, whose clinical course
has been well studied. A tabulation of this work is given in another
section.

PSYCHOPATHIC HOSPITAL.

11

SOCIAL SERVICE.

During the period the hospital added to its staff a worker trained in
the social aspects of mental disorders. It thus became possible to undertake a more thorough study of the social relations of patients in their
pre-institutional life, and to keep in touch with their progress after
discharge.
A systematic study was made of the after life of a large number of
patients who had been discharged from the hospital in the earlier, years
of its existence. The results of this will be published during the coming
year.
MEDICAL INSTKUCTION.

In this work the hospital has one of its most interesting and usefu
activities. The instruction of former years has already shown results
among medical practitioners, especially those who have gone out from
the Medical School of the University within recent years. There is
a more widespread interest in psychiatry and the standards of medical
examinations for hospital commitment have improved.
At the present time students of the fourth year medical class receive
45 hours of clinical lectures on psychiatric medicine and 16 hours of
practical work at the bedside.
MILITARY MEDICAL WORK.

Soon after the beginning of the war the Surgeon General of the Army
requested that certain hospitals devoted to mental and nervous disorders
should arrange courses of instruction in neuro-psychiatry. To these
would be assigned- for intensive training medical officers, who would
later on be given charge of the care and treatment of mental and nervous
disorders in the medical organization of the army. The hospitals so
selected to do this were: The Henry Phipps Psychiatric Clinic at Baltimore, The Government Hospital for the Insane at Washington, The New
York Neurological Institute, The Philadelphia General Hospital, and the
Psychopathic Hospital at Ann Arbor.
The Medical Director of this hospital was appointed Military Director
of the hospital and in cooperation with Professor Camp of the Department of Nervous Diseases of-the University, Professor Slocum of the
Department of Ophthalmology, and Dr. Furstenberg of the Department
of Otology, a course of instruction was conducted.
This work has continued through the last year of the period. In all
79 officers have been in attendance remaining for instruction from 4
to 6 weeks.
OUT-PATIENT SERVICES.

This work which had its beginning during the preceding period has
been greatly extended during this. The hospital now conducts two
services for out-patients. One, locally in connection with the medical
work of the General Hospital of the University, examined during the
period 407 patients; and one in Detroit examined and gave advice to 978

12

STATE OF MICHIGAN.

patients during the period. This latter service known as the Wayne
County Psychopathic Clinic, Wayne County Out-Patient Service of the
State Psychopathic Hospital, was organized in 1916. This service is
located in rooms in the Wayne County Juvenile Court Building in Detroit.
Its work is conducted by a trained psychologist and a social service
worker. It is supervised by the State Psychopathic Hospital. At intervals
a physician of this hospital attends the clinic and gives advice to such
cases as have been referred from the regular routine work of the clinic.
The financial support of the clinic is provided in part by Wayne County
public funds and in part by ph lanthropic individuals of Detroit.
Since the beginning of the war the Michigan State Board of Health
has been active in systematic efforts to prevent the spread of venereal
diseases among the soldiers in mobilization camps. In carrying this out,
women who were found to be infected were interned in hospitals for
treatment. As it has long been appreciated that women of this class
were frequently mentally deficient or disordered, it was felt that the
present occasion offered an unusual opportunity for studying this problem.
It was also believed that the results of such studies would be a great aid
in determining the after-care of those who were treated.
The Psychopathic Hospital was requested to supervise an organization
that would make systematic mental examinations of these individuals.
A group of trained workers were provided by the Board of Health and
the Work placed under the direct supervision of the Detroit Out-Patient
Service of this hospital. Detailed reports of the work of the various
out-patient services is given in another section.
RELATIONS WITH THE STATE HOSPITALS.

There continues the same cooperation of the State Hospitals treating
mental disorders and the Psychopathic Hospital in the investigation
of problems common to their work. This cooperation has resulted in
decided advances in medical standards in the State Hospitals and the
maintenance of a live interest in clinical problems of mental disorders.
Extensions of the work of former years has not been advisable owing to
the depleted personnel of the medical staff of the hospitals and the difficulties of administration incident to war conditions.
FUTURE DEVELOPMENTS.

The Psychopathic Hospital is in urgent need of a new building for
its work that will be adequate in size and arrangements. Anyone who
is familiar with the construction and arrangements of the present building
must realize how poorly it is adapted to the treatment of patients with mental
disorders and how unsuited it is to carry on its purposes of investigation
and teaching. Those who are interested in the administration of the
hospital urgently request that at some early date the legislature make
provision for a building better adapted in size and plans for its needs.
It is planned to further extend the out-patient services to other cities
convenient to access to Ann Arbor as soon as arrangements can be made.

PSYCHOPATHIC HOSPITAL.

13

OFFICIAL CHANGES.

The following changes in the Medical Staff have occured during the
period.
Dr. Arnold L. Jacoby, first assistant physician, was granted leave of
absence in April 1917 in order to enter the medical service of the navy.
Dr. Earl Palmer was appointed acting first assistant physician in May
1917.
Dr. Harold S. Hulburt resigned as second assistant physician in January
1917. He was succeeded by Dr. Raymond F. Wafer, appointed in July
1917.
Dr. W. I. Lillie resigned as resident physician in July 1916 and was
succeeded by Dr. Robert Hale, who served until July 1917, leaving to
enter military service.
Dr. Bertrand L. Jones was appointed resident physician in July 1917,
serving in this capacity until May 191-8 when he succeeded to the position
of acting first assistant physician.
Respectfully submitted,
ALBERT M. BARRETT,
Medical Director.

14

STATE OF MICHIGAN.

CLINICAL REPORT.
Information regarding the medical work of the hospital is considered
in two sections. The first of these consists of a tabulation of the admission
and discharges considered from various aspects of social, causative and
treatment relations. The second is a detailed analysis of the more
important clinical groups.
GENERAL STATISTICAL TABLES,

Information given in these tables may be compared with similar tabulations made by other State Hospitals for the Insane, but in doing so
the peculiar relations under which the State Psychopathic Hospital
operates should be given consideration. This hospital receives patients
from the entire State of Michigan, rather than from any one section of
the State. The small capacity of the hospital and its special field of
work require that admission should as far. as possible be restricted to
mental disorders in their earlier stages and to functional nervous abnormalities which are not regarded as commitable to the larger State Hospitals.
A constantly pressing demand for the admission of patients necessitates
a somewhat rapid change of patients and this results in a far shorter
period of treatment for most individuals than in the larger State Hospitals
for the Insane.
TABLE No. 1.—Showing the number of patients admitted and discharged and remaining
June SO, 1918.
Year ending
June 30, 1917.

Year ending
June 30, 1918.

Total
since beginning.

M.

M.

M.


Admission by court commitment.
Public maintenance
Admission voluntary
Transferred from State
Hospitals
State maintenance
Total number admitted
Patients in hospital at beginning
of year
Discharged
With psychosis
Died .
- Without psychosis
Died

F.

F.

T.

F.

T.

71
6

89

160
10

55

76
10

131
13

3
30

42

6
72

0
33

4
46

1
0
1

1
0
0

2
0
1

2
1
0

]
0

112

139

251

94

139

233 1,147 1,194 2,341

26
138

28
167

54
305

26
120

28
167

54
287

16
38
44
7

7
61
54
5

23
99
98
12

9
34
37
5

14
44
58
7

23
78
95
12

154
371
498
52

1
4
2
0

0
4
7
1

1
8
9
1

1
3
7
0

1
0
6
0

2
3
13
0

2
7
39
0

139

251

96

130

24

37

112
Patients in hospital at close of period . .

T.

4
79

701
103
3
299

303

10
602

3
3
0

11
8
22

8
4
15

19
12
37

755 1 , 456
102 205

159 313
397 768
522 1,020
44
96
1
4
29
1

3
11
68
1

226 1,123 1,157 2,280
61

PSYCHOPATHIC HOSPITAL.

15

The above table shows the number and legal relations of those admitted
during the biennial period, and from the beginning of the work in this
hospital. It also shows the results of treatment of those who were
discharged. The total number of admissions is about six percent larger
than in the previous period.
The number of those entering the hospital as voluntary patients was
considerably larger than in any previous period. Since 1915 it has been
possible for patients to be admitted as voluntary public charges. This
provision is not yet as widely known throughout the State as is desirable.
In the present period 10 patients of this class were admitted. Voluntary
admissions form 33 percent of all admissions to the hospital.
One-third of all admissions are maintained privately. The comparative
increase of admissions each year since the opening of the hospital is as
follows:
1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914. 1915. 1916. 1917. 1918.

27
Female

39
40

48
59

78

26

70

89
92

96
96

118
101

109
88

117
104

94
114

126
126

112
139

94
139

53

79

107

148

181

192

219

197

221

208

252

251

233

The admission for the period by months has been:
July 1, 1916 to June 30, 1917.

Male
Female

7.

8.

9.

7
14

10
13

11
13

21

23

24

11.

12.

1.

2.

3.

4.

5.

6

Total

10
8

13
15

13
10

7
9

7
7

10
17

7
11

6
11

11
11

112
139

18

28

23

16

14

27

18

17

22

251

10.

July 1, 1917 to June 30, 1918.

Female

7.

8.

9.

10.

11.

7
11

7
10

6
13

6
12

9
9

18

17

19

18

18

1.

2.

3.

4.

5.

0.

Total

7
9

7
15

10
12

9
10

11
10

8
17

7
11

94
139

16

22

22

19

21

25

18 233

12.

The average monthly admissions was 20. The largest number admitted
in any one month was 28.
The variety of clinical forms given in the following table is about as
in former years. By far the most frequent form of psychoses are those
belonging in the manic depressive group.
The relative frequency of disorders that remained undiagnosed was
2.5 per cent of admissions.

16

STATE OF MICHIGAN.

TABLE No. II.—Showing the forms of insanity in patients admitted and discharged during
the biennial period.
Year ending
June 30, 1917.
Admitted.
M.

Traumatic Psychoses:
1
Traumatic delirium .
Senile Psychoses:
1
Presbyophrenic type
Psychoses with cerebral arterio5
sclerosis
General Paralysis:
Demented type
14
1
Expansive type
Agitated type
1
1
Juvenile type
Psychoses with Cerebral Syphilis. .
Vascular type
0
Meningitic type
0
Psychoses with Brain Tumor
3
Psychoses with other Brain or
Nervous diseases:
Multiple sclerosis
0
Multiple neuritis
0
1
Meningeal hemorrhage
Tabes
0
Alcoholic Psychoses :
Pathological intoxication
0
1
Korsakow's psychosis
Chronic paranoid type
4
Psychoses due to drugs and other
exogenous toxins:
Opium intoxication
3
Chloral intoxication
0
Veronal intoxication
0
Psychoses with pellagra
0
Psychoses with other somatic diseases :
Delirium with septicaemia
0
Delirium typhoid fever
0
Exhaustion delirium
0
1
Delirium with uraemia
Delirium of unknown origin. . . . 2
Psychoses with Basedow's
disease
0
Psychoses with rheumatism. . . . 1
Psychoses with pernicious
0
anaemia
0
Psychoses with tetany
0
Psychoses with Glaucoma
Manic Depressive Psychoses:
8
Manic type
17
0
Mixed type
1
Dementia Praecox
0
3
12
Hebephrenic type
4

Year ending
June 30, 1918.

Discharged.

Admitted.

Discharged.

M.

F.

T.

M.

F.

T.

1
1
13

1
1
0

0
0
0

1
1
0

1
1
0

0
0
1

1
1
1

5
0
0
0

18
2
0
0

4
1
1
0

1
2
0
0

5
3
1
0

6
2
2
1

1
2
0
0

7.
4
2
1

1
1

1
1

0

1

1

1
3
2

0
0

4

1
2
1

2

1
1
1

1
1
3

0
0
0
1

0
O

1
1

0
0
0
0

1
1
0
0

1
1
0
0

0
0
0
0

1
2
0
0

1
2
0
0

0
1
4

0
0
0

0
1
4

0
4

1

0
0
0

1
0
4

0
2

1

0
0
0

0
2

4
0
1
0

2
0
0
1

0
1
0

1

3
0
1
1

0
0
0

0
1
0
0

0
1
0
1

1
0
0
1

0
0
0
0

1
0
0
1

1
1
0

0
0
0
0

1
1
0
0

1

1
0

0
0

1

1
0
1
1

1

0
0
0

2
0
4
0
0
0

10
28
1
0
4
7
14
1

F.

T

M.

F.

0
0
6

1
1
11

1
1
8

0
0
5

5
0
0
0

19
1
1
1

13
2
0
0

2
1
2

2
1
5

0
0
2

2

0
1
0

1

0
1
1
1

0
0
1
0

0
0
0

0
1
4

0
1
0

1

1
1
0
0
0
0
3

1

T

1

0
2

0
3

0
0

0
0
0

1
0
0

0
0
1
0
0
0
0
0
1
0

18
45
1
1

8
18
0
1

32
1
0

11

19
50
1
1

6
14
1
0

15
28
1
9

21
42
2
9

4
10
26
5

1
2
12
4

5
7
12
2

6
9
24
6

4
5
8
4

7
8
6
2

11
13
14
6

1

0

1
1

1

0
0
0

1

0
0
0

1

0

1
1
1

0
0
0
2

1

2

2

1

1
2

0

1

0
1
1

0
1
0

2
0
0

1

2
0
0
1

6 12
10 26
1 0
0
5
3
6
6
4

5
8
8
0

1

3
1
3
0
1
1
18
36
1
5
8
14
14
4

PSYCHOPATHIC HOSPITAL.

17

TABLE No. II—Continued.
Year ending
June 30, 1917.
Discharged.

Admitted.
M.

Paranoia and Paranoiac Conditions :
Paranoia
Paraplirenia systematica
Presenile paranoiac condition. . .
Paranoiac condition with impaired hearing '
Undiflerentiated paranoiac conditions
Epileptic Psychoses
Neuroses and Psychoneuroses :
Hysterical type
Psychasthenic type
Neurasthenic type
Anxiety neurosis
Compulsion neurosis
Psychoses with Constitutional
Psychopathic Inferiority . . . .
Psychoses with Mental Deficiency
Undiagnosed Psychoses
Not Insane:
Epilepsy without psychosis . . . .
Drug addiction without psychosis
Constitutional psychopathic
inferiority without psychosis
Mental deficiencywithout
psychosis
Subnormal
Feebleminded
Idiot
Constitutional syphilis without
psychosis
Total

P.

Year ending
June 30, 1918.

T.

1
1
0
0
0
7

1
3
1

2
4
1

0

0

M.

2

2

0

7

4
1
1
0
0

5
9
0
0
1

9
10
1
0
1

0
2
0
0
0
6
6
2
1
0
0

F.

T.

Admitted.

Discharged.

M.

F.

T.

M.

1
2
0
0
3
4
2
1
0

0
3
1

1
5
1

1
2
2

1
4
2

0
3
0

0
4
1

0
7
1

0

0

0

1

1

1

1

4

1

5

0

6

3

2

5

5
7
0
0
1

11
9
1
0
1

2
1
0
2
0

7
6
0
0
0

9
7
0
2
0

F.

T.

1

1

2

5

2

6

2
0

7
7
0
0
0

9
8
0
2
0

5

8

13

3

11

14

6

8

14

8

9

17

0
1

2
6

2
7

0
1

1
4

1
5

1
0

2
5

3
5

1
0

3
7

4
7

0

0

0

0

0

0

2

0

2

2

0

2

1

0

1

1

0

1

1

1

2

1

1

2

5

6

11

6

6

12

5

5

10

5

4

9

0
0
0

5
0

0
0
0

6
0
5

6
0
5

4
1

4

5
0
4

2

3
0
3

7
1
5

2
1
0

3
0
3

5
1
3

0

0

0

0

0

0

0

0

0

0

1

1

0

1

1

1

0

0
1

0

0

1

0

1

112 139 251 113 138 251

94 139 233

95 131 226

Some information regarding the family constitution was obtained in
89 percent of all admissions. In all cases in which information was
available influences regarded as of significance in their relation to insanity
among descendants were present among 68.2 per cent. These occurred
among the parents in 57.8 per cent of instances; among the grandparents
in 9.2; among collateral lines in 17.7 per cent and among the brothers and
sisters in 15.3 per cent. The following table shows the hereditary factors
in patients admitted:

TABLE No. III.—Showing the occurrence of hereditary factors in patients admitted.
Period ending June 30, 1918.

-

Direct.

M. F.

Insanity
Apoplexy and paralysis .
Psychopathic conditions
Alcoholism

23
10
14
19

45
11
30
18

Atavistic. Collateral.

Brothers
and
Sisters.

Total since beginning.

Total.

Direct.

Atavistic. Collateral.

Brothers
and
Sisters.

Total.

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.

68
21
44
37

334

7
4
1
2

6 13 12 30 42 12 14 26 54
3 7 1 4 5 1 1 2 16
0 1 3 1 4 7 6 13 25
4 6 0 1 1 1 3 4 22

95 149
19 35
37 62
48 66

126 164 290 45 39 84 101 126 227 62 76 138
78 61 139 30 37 67 7 10 17 10 8 18
46 78 124 8 3 11 16 11 27 17 29 46
66 53 119 8 8 16 5 4 9 9 6 15

125
87
88

F.

405
116
121
71

T.

739
241
208
159

50
H
[>
1-3
H
<-,

Total heredity

66 104 170 14 13 27 16 36 52 21 24 45 117 177 294 316 356 672 91 87 178 129 151 280 98 119 217

634

713 1,347

g

h-1

0

Negative
Unknown

66 71 137
23 30 53

318
. .195

Total

89 101 190

1.147 1,194 2,341

330
151

648
346

3
3

PSYCHOPATHIC HOSPITAL.

19

TABLE No. IV.—Showing the age of patients admitted.
Year ending
June 30, 1917.
M.

From 0 to 4 years
From
From
From
From
From
From
From
From

10 to
15 to
20 to
25 to
30 to
35 to
40 to
45 to

14 years
19 years
24 years
29 years
34 years
39 years
44 years
49 years

From 55 to 59 years
From 60 to 64 years
From 65 to 69 years
From 70 to 74 years
From 75 to 79 years
From 80 to 84 years
Age unknown

...

..
..

Total

F.

Year ending
June 30, 1918.

T.

0
1
0
0

0
0
5
14
15
12
22
23
17
13
8
6
0
2
1
1
0
0

0
0
7
23
29
25
35
44
30
19
14
12
6
4
1
2
0
0

112

139

251

0
0
2
9
14
13
13
21
13
6
6
6
6
2

M.

F.

M.

F.

1
8
' 27
84
131

0
2
13
99
131
131
165
170
153
121
83
57
27
7
7
3
1
24

1
10
40
183
262
279
295
318
263
233
161
136
66
25
17
9
2
41

233 1,147 1,194

2,341

T.

0
0
1
0
2
2
9
9
13
21
14
15
13
23
13 ' 25
14
9
17
9
4
8
2
2
2
3
1
1
1
0
0
0

0
0
0
0

89

139

Total
since beginning

0
1
4
18
34
29
36
38
23
26
12
4
5
2
1
0
0
0

148
130
148
110
112
78
79
39
18
10
6
17

T.

From this table we see that the largest number of admissions occurred
between the ages of 30 and 40.
TABLE No. V.—Showing civil condition of patients admitted.
Year ending
June 30, 1917.
M.

Single
Widowed . .

Total

. ..

F.

T.

Year ending
June 30, 1918.
M.

F.

44
68
0
0
0

49
79
7
1
3

93
147
7
1
3

49
41
2
1
1

54
76
5
2
2

112

139

251

94

139

Total
since beginning

T.

M.

F.

103
117
7
3
3

501
574
35
33
4

413
663
79
32
7

914
1,237
114
65
11

233 1,147 1,194

2,341

T.

STATE OF MICHIGAN.

20

TABLE No. VI.—Showing degree of education of patients admitted.
Year ending
June 30, 1917.
M.

Illiterate
Common school
College
Unascertained
Total

F.

Year ending
June 30, 1918.

T.

M.

F.

1
8
65
19
9
10

1
5
87
32
7
7

2
13
152
51
16
17

' 2
4
46
20
14
8

1
1
81
43
5
8

112

139

251

94

139

Total
since beginning

T.

M.

F.

T.

3
5
127
63
19
16

17
82
688
201
100
59

3
54
766
263
51
57

20
136
1,454
464
151
116

233 1,147 1,194

2,341

TABLE No. VII.—Showing the occupation of those admitted during the current period
and from beginning.
Year ending
June 30, 1917.
M.

Professional
Mercantile and trading
Personal service, police and
military
Laboring and servants
Manufacturing and mechanical industry
Agriculture, transportation
and other outdoor
Student
No occupation

Total

15
18
2
1

F.

T.

26
31
2
1

0
, 29
15
24
0
3
1
4

11
13
0
0
0
12
0
0
85
8
5
5

15
24

112

139

Year ending
June 30, 1918.
M.

85
11
6
9

13
16
0
5
1
2

14
3
1
0
0
10
0
0
88
7
9
7

251

94

139

0
41

21
10
1
3
1
21

F.

T.

35
13
2
3
1
31
13
16
88
12
10
9

Total
since beginning
M.

F.

112
99
112
40

81
64
9
4

18
196
140
325

0
107
12

0
46
41
18

233 1,147

T.

0
782
40
75
20

193
163
121
44
18
303
152
325
782
86
116
38

1,194

2,341

21

PSYCHOPATHIC HOSPITAL.
TABLE No. VIII.—Showing the nativity of patients admitted.
Year ending
June 30, 1917.

Total admissions
Total born in Michigan
Total born in United States.
Unascertained
Armenia
Austria . . . ,
Bohemia
Canada . . .
England
..
...
Germany
Holland
Hungary
Italy
Poland

M.

F.

T.

112
70

139
78
104
27
8
0
0
1
0
0
15
1
0
2
2
1
0
1
0
1
0
1
0

1
1

251
148
188
48
15
0
0
3
0
0
22
1
3
4
3
1
0
1
0
2
0
3
2
1
1

0
0
0
8

0
1
0
15

84
21
7
0
0
2
0
0
7
0
3
2
1
0
0
0
0
1

..

0
2
2
0
0
0
1
0

Scotland
Sweden
Syria.
Wales
West Indies .

Year ending
June 30, 1918.

7

M.

94
59
74
14
6
2
0
0
0
0
3
0
2
3
0
0
0
0
0
0
0
1
1
0
0
0
0
0

fi

Total
since beginning
M.

F.

F.

T.

139
86
109
16
14
0
0
0
0
0
7
0
3
0
1

233 1,147 1,194
685
741
145
183
920
956
187
30
170
20
57
51
2
3
0
1
0
0
4
4
0
0
2
0
1
0
0
10
55
76
1
0
2
24
5
15
3
32
40
1
10
8
2
0
6
1
0
0
2
2
1
1
0
0
3
6
0
1
0
0
11
9
2
2
8
5
0
4
7
1
1
2
1
0
0
2
0
0
1
0
0
25
28
20

0
0
1
0
0
0

1
1
1

0
0
0
0
14

T.

2,341
1,426
1,876
357
108
3
1
8
2

1

131
3
39
72
18
8
1
4
1
9
1
20
13
11
3
1
2
1
53

The above table shows that the number of foreign-born patients was
much larger than in any previous period. Foreign born formed 21 per
cent of admissions.
TABLE No. IX.—Showing the natimtlj of parents.
Year ending
June 30, 1917.

Year ending
June 30, 1918.

Total
since beginning

•'
M.

One foreign born, one
One foreign born, one
One native born, one
Unascertained
Total

F.

T.

44
38
10
3
2
15

51
50
21
4
6
7

95
88
31
7

112

139

M.

F.

8
22

28
38
7
2
5
14

40
57
21
2
3
16

251

94

139

T.

68
95
28
4
8
30

M.

F.

365
508
127
9

404
769
494 1,002
163
290
11
20
18
28
104
232

10
128

T.

233 1,147 1,194 2,341

From the above table it is seen that patients whose parents were foreign born almost equal those of native-born parents among the admissions,

22

STATE OF MICHIGAN.
TABLE No. X.—Showing counties from which patients have been received.
Year ending
June 30, 1918.

Year ending
June 30, 1917.
M.

0
0
1
0
0
0
0
0
2
0

Alpena

Bay

Benzie

0
2
2
0
0

Cass
Cheboygan
Clare
Clinton
Delta
Eaton
Emmet
Gladwin
Gogebic
Gratiot
Hillsdale

0
0
0
0
0

....
....

.

losco
Iron

.

....

1

0
2
0
3
1
0
0
0
2
1
0
7
1
0
0
1

e
i
Kent
Lake
Lena wee
Luce .

Menominee. . . .
Monroe

0
3
0
0
4
0
2
0
0
0
0
1
0
0
1
0
0
1
0
2
0

F.

0
0
0
0
0
1
1
0
0
0
0
2
1
0

1
1

0
0

1
1
1

0
5
1
5
0
0
0
3
1
1
0
3
2
0
0
1
11
1
0
10
0
1
3
0
1
2
0
0
0
0
0
0
0
0
0
0
1
2
1

F.

M.

T.

0
0
1
0
0
1
1
0
2
0
0
4
3
0
1
1
0
0

1
1

2
0
7
1
8
1
0
0
3
3
2
0
10
3
0
0
2
13
2
0
13
0
1
7
0
3
2
0
0
0
1
0
0
1
0
0

1
1

4
1

0
1
4
0
0
0
0
0
3
1
0
0
1
0
0
0

1

0
2
0
0
0
3
1
3
0
0

1
1
1
1

3
4
0
0
0
0
2
0
0
5
0
2
1
0
1
1
0
0
2
0
0
0
0
0
0
0

1

0
0

Total
since beginning.
M.

T.

1
0
0
0

1
1

0

1
1
1

1

0
4
1
0
0
0
0
0
0

1

0
3
0
9
0
0
1
2
2
1
2
5
0
0
0
0
9
2
0
2
0
1
1
1
1
2
0
0
3
1
0
0
0
0
0
0
2
3
1

1
1
4
0
1
1
0
1
4
' 2
1
0
5
1
0

7
2
17
9
0
4
0
3
31
2
5
21
18
2
5

0
1
0
2
0
1
0
6
1
12

10
2
0
10
3
1
1
17
3
38
2
1
2
19
32
6
6
33
18
5
0
5
30
9
0
73
0
4
13
0
23
16
0
1
10
5
3
12
5
2
2
1
22
18
0

0
0
2
3
3
2
5
9
0
0
0
0
11
2
0
7
0
3
2
1
2
3
0
0
5
1
0
0
0
0
0
0
3
3
1

F.

4
0
10
3
5
3
1
6
22
1
6
9
25
4
2
9
0
3
7
3
3
0
26
8
57
2
0
2
22
28
8
5
44
15
4
0
8
57
6
0
69
1
2
18
2
18
19
2
0
15
3
2
9
0
1
0
1
14
20
2

T.

11
2
27
12
5
7
1
9
53
3
11
30
43
6
7
19
2
3
17
6
4
1
43
11
95
4
1
4
41
60
14
11
77
33
9
0
13
87
15
0
142
1
6
31
2
41
35
2
1
25
8
5
21
5
3
2
2
36
38
2

PSYCHOPATHIC HOSPITAL.

23

TABLE No. X.—Concluded.
Year ending
June 30, 1917.
M.

Muskegon
Oakland

F.

Year ending
June 30, 1918.
M.

T.

T.

4
0
1
1
0

13
1
14
1
0

10
2
17
3
2

23
3
31
4
2

2
0
0
2

0
0
0
0
5

0
2
0
0
7

1
6
0
1
40

0
9
0
1
50

1
15
0
2
90

11

2
0

0
0
1
1
0

1
0
2
0
0

1
0
3
1
0

3
2
53
11
0

1
2
62
9
1

4
4
115
20
1,

2
2
1
1
0

6
4
3
1
1

2
1
1
0
1

5
2
1
0
1

7
3
2
0
2

21
19
9
2
14

25
21
7
3
5

46
40
16
5
19

13
35
0
0

11
39
0
2

24
74
0
2

9
24
1
1

8
41
2
0

17
65
3
1

147
190
5
5

128
215
3
2

275
405
8
7

112

139

251

94

139

7
0
3
0
0

0
0
0
0
3

1
0
0
0
4

Presque Isle. ...
Saginaw
Schoolcraft ....

0
0
5
1
0

0
0
6
1
0

St Glair
Tuscola

4
2
2
0
1

Total

F.

3
0
0
1
0

3
0
3
0
0

Washtenaw . . . .

M.

T.

1
0
1
0
0
0

4
0
0
0
0
1
0
0
0
1

Ontonagon
Oscoda

F.

Total
since beginning.

0
0

233 1,147 1,194 2,341

This hospital is open to patients from any county of Michigan. Patients
not resident in Michigan are not received. During this period 71 of the
83 counties of the State sent patients for treatment.

STATE OF MICHIGAN.
TABLE No. XI.—Showing the form of insanity of patients discharged and the results of
treatment.
Period ending June 30, 1918.


Recovered.

Traumatic psychoses:
Traumatic delirium
Senile psychoses :
Presbyophrenic type
Psychoses with cerebral arterioGeneral paralysis:

Psychoses with cerebral syphilis:
Psychoses with brain 'tumor
Psychoses with other brain or
nervous diseases:
Multiple neuritis
Tabes
Alcoholic psychoses:
Psychoses due to drugs and other
exogenous toxins:
Chloral intoxication
Veronal intoxication
Psychoses with pellagra
Psychoses with other somatic
diseases:
Delirium with septicaemia
Delirium with typhoid fever . . .
Delirium of unknown origin. . . .
Psychoses with Basedow's
Psychoses with rheumatism . . . .
Psychoses with pernicious
Psychoses with glaucoma
Manic-depressive psychoses :
Manic type
Mixed type
Dementia praecox:
Simple type
Paranoia and paranoiac conditions
Presenile paranoiac conditions.
Paranoiac conditions with impaired hearing
Undifferentiated paranoiac con
Epileptic psychoses
Neuroses and psychoneuroses :

Improved.

Unimproved.

Died.

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

F.

T.

2
0
0
0
0
0
0
0
0
0

0

2

0

0

0

0

0

0

6

0

0

0
0
0
0

0
0
0
0

5
1
0
0

2
0
0
0

7
1
0
0

14
2

18
4
2
1

0
0
0
0

0

2
1

4
2
0
0

0
0
0

0
0
0

0
0
0

1
2
0

1
2
0

0
0
2

0
2

1

1
0
4

0
0
0
0
1
0
0
0
0
2

0

5

0
2
7

0

0

0
0
1

0
0

0
0
3

0
0
1
0
1
0
1

0
0
0
0

0
0

1

0
1
0
0

0

0

0
0
0
0

0
0

0
0
0
0

0
1
0
1

0
1
0

0
0
0

1
0
1

0
0
3

0
0
0

0
0
3

0
0
2

0
0
0

0
0
2

1

2
0
0
0

1
0
0
0

0
0
1

1
0
1
0

0
0
0
1

0
0
0
0

0
0
0
1

1
1

0
0
0

0

1
1

0
0
0

0
1
0
1
1

0
0
0
0
0

0
0
0
0
0

0
0
0
0
0

0

1
1

1
2

0
0

0
2

0
2

1
0
0
0

0
0

0
0
0

1

0

0

0

0

1

0
1

2
8

1

0
0
0
0
0
1
0

1

0
0

1

0

1

2
0

0

0

1

0
2

0
0
0

0
0

0
0

1

0
0

0
0
0

1
0
0

0
0
0

0
0
0

0
0
0

0
0
0
0
0
0
0
0
1
0

5
8
0
0

4
3
0
2

9
11
0
2

5
13
0
1

6
29
1
0

11
42
1
1

4
3
1
0

12
22
0
3

16
25
1
3

0
4
0
0

0
0
0
0

0
0

1
1

1
1
0
0

1
5
8
2

4
3
9
0

5
8
17
2

3
3
10
6

5
10
11
2

8
13
21
8

0
0
0
0

0
0
0

0
0
0

0
0
0

0
1
0

0
0
2

0
1
2

1
3
0

1
5
1

2
8
1

0

0

0

0

1

1

0

0

0

1

0
0

1

0

0
3

1
1

1
4

2
0

2
1

1

3
2
0
0
0

4
2
0
0
0

7
3
1
2
0

7
0
0
0
1

14
9
1
2
1

0
0
0
0
0

2
6
0
0
0

0
0

1
1
0

1

0

0
0
0
0

0
0

1

0

1
1

1

1
1

1

0
0

1

0
0
0

0
0
0

0
0
0

0

0
0
0
0

1

1

0

1

0
0

1

0
0

1
0
0

0

0

0
0

0
0

0
0
0

0
1
0

1

1

1

1

4
0
0
0

8
0
0

0
0

0
0

0
0
0

0
0
0

0
0
0

0
0
1

0

0

4
7

0
0

0

2
6
0
0
0

0
0
0
0
0

0
0
0
0
0

0
0
0
0
0

1

0

1

1

PETCHOPATHIC HOSPITAL.

25

TABLE No. XI—Concluded.
Period ending June 30, 1918.
Recovered.

Psychoses with constitutional
Psychoses with mental deficiency
Undiagnosed psychoses
Not insane:
Epilepsy without psychosis . . . .
Drug addiction without psychosis
Constitutional psychopathic
inferiority without psychosis .
Mental deficiency without psyIdiot *
Constitutional syphilis without
psychosis
Total

Improved.

Unimproved.

Died.

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

1
0
0
0

0
0
0

5
0
0

13
2
3

18
2
3

5
1
1

6
2
7

11
3
8

0
0

0
0

0
0

2
0

0
0

2
0

0

0

0
0
0
0
0
0

1
0
0
0
3
0
0
0
0
0
0

27

22

49

2

0
0
0
0

0

1

F.

T.

7

5

12

4

5

9

0
0
0
0
0
0

0
0
0
0

0
0
0
0

2
1
0
0

8
0
7
0

10
1
7
0

0
0
0
0

1
0
1

0

1
0
1
0

0

0

0
0
0
0
0

1

1

2

0

0

0

90 125 215

12

13

25

79 109 188

1
0
1

1
0
1

0
0

0
0

0

0

In Table XI are given results of treatment in all patients discharged
according to their various clinical disorders. Patients are regarded as
recovered when they are in their normal mental condition at discharge;
as improved when their mental condition at discharge is more or less
improved over that at admission; as unimproved when their mental
condition has not changed for the better.
According to these standards 10.3 per cent were discharged as recovered;
39.4 per cent as improved; 45.0 per cent as unimproved, and 5.2 per cent
died.

26

STATE OP MICHIGAN.

TABLE No. XII.—Showing duration of residence in months of all cases discharged.
Recovered.

M. F.

Improved.

Unimproved.

Died.

Total.

T.

M. F.

T.

M. F.

T.

M.

F.

T.

M.

F.

0
0
1
2
6

1
0
3
7
14

1
2
3
15
26

0
1
7
7
31

1
3
10
22
57

5
5
7
8
20

11
4
9
15
32

16
9
16
23
52

3
1
2
1
2

1
2
3
3
1

4
3
5
4
3

10
8
14
29
56

12 22
7 15
20 34
27 56
70 126

0
1
1
0
0
0
0

10
2
0
1
0
0
0
0
0

16
5
0
2
1
0
0
0
0

5
7
8
2
3
3
1
1
0

20
16
7
7
3
0
2
2
2

25
23
15
9
6
3
3
3
2

14
7
12
3
1
0
2
0
0

17
13
8
7
3
1
2
1
1

31
20
20
10
4
1
4
1
1

1
1
1
0
0
0
0
0
0

2
0
0
0
0
0
0

3
1
1
0
0
0
1
0
0

26
18
21
6
5
3
3
1
0

49
31
15
15
6
1
5
3
3

0
0
0
0

0
0
0
0

0
0
0
0

1
1
0
0

2
2
0
0

3
3
0
0

2
2
1
1

0
1
0
0

2
3
1
1

0
0
0
0

0
0
0
0

0
0
0
0

3
.3
1
1

2
3
0
0

Total. . . 27

22

49

90 125 215

12

1 week or less . . . 1
2 weeks
0
2
5
8

2 months

6

4 months
5 months

. . .3

7 months
9 months
10 months
11 months

....

12 months
14 months
18 months
24 months

79 109 188

1
0

13

T.

75
49 •
36
21
11
4
8
4
3
5
6
1
1

25 208 269 477

TABLE No. XIII.—Showing age of patients discharged recovered.
Period ending
June 30, 1918.
-

/

From 20 to 24 years
From 35 to 39 years .

Total

..

Total
from beginning

....

...

M.

F.

T.

M.

F.

T.

0
0

1
1
4
3
1
5

1
1
8
4
4
9

0
13
13
15
16
25

3
16
22
27
16
22

3
29
35
42
32
47

3

2
4
2
0
0

4
0
1
0
0
0

7
2
5
2
0
0

21
14
12
6
1
2

19
10
6
2
1
0

40
24
18
8
2
2

27

23

50

156

161

317

4
1
3
4

PSYCHOPATHIC HOSPITAL.

27

TABLE No. XIV.—Showing the causes of death.
Biennial
period.
M.

F.

Total since
beginning.

T.

M.

2
1
1
0

1

0
4
1
0
1

1
6
2
1
1

5
3
3
0
2

1
4
1
1
0

6
4
1
2

1
0
1
1
1

0
1
0
0
2

1
1
1
1
3

1
2
0
1
2

1
2
1
0
0

2
4
1
1
2

2
1
2
0

0

1

1
1
1

3

2
2
3
1
4

3
0
0
0
4

1
2
1
1
0

4
2
1
1
4

1
1
1
0

A

m'n '

'r'miQ ' ' ' '

Ttrnnrhn TiTipiirnnnia

^ptlpral Tiaralvsis

Cystitis

. .

0
1

0

1
1

1

0

1

0
1

0

1

1
1

0

1

1

1

0

1
1

0
p

.'

lv •

r»nn

i

ilofmiV ' ' '

0

1

0
0

Tetany

1
4
1
1
1

. 1

0

1

1
1
0

0

1

1

0

1

2
2
1
1
1

1
1
1

0
0
0

1

1
1

1
1
1
1
3

0
0
0
7
3

1
3
1
7
6

13

25

52

45

0
2

....

i

3

T.

1
1
0

I

Total

1

F.

12

1

3
1
0
3

97

28

STATE OF MICHIGAN.
TABLE No. XV.—Showing the age of patients who
Year ending
June 30, 1917.
M.

From 10 to 14 years

F.

Year ending
June 30, 1918.

T.

M.

F.

Total
since beginning.

T.

M.

F.

T.

1
0
1
0
0

0
0
2
5
2

1
0
3
5
2

0
0

1
1

1
1

0

1

1

34 years
39 years
44 years
49 years
54 years

1
0
0
2

0
1
2
0

1
1
2
2

1
2
1
1
0

1
1
1
2
0

2
3
2
3
0

4
6
5
5
8

2
1
9
11
3

6
7
14
16
11

From 55 to 59 years
From 60 to 64 years
From 65 to 69 years

1
1
2

1
0
0

2
1

2

0
0
0

0
1
0

0
1
0

4
8
6
0
1
2

5
4
1
1
0
0

9
12
7
1
1
2

7

6

13

5

7

12

51

46

From 20 to 24 years
From 25 to 29 years
From
From
From
From
From

30 to
35 to
40 to
45 to
50 to

From 75 to 79 years
Unascertained

Total

97

TABLE No. XVI.—Showing the number of patients transferred between the State Psychopathic Hospital and other State Institutions.
Transferred to.

Received from.

Biennial
Period.

M.

F.

Pontiac State Hospital
Kalamazoo State Hospital

1
1

0
0

Michigan Farm Colony for
Epileptics . . .
Michigan Home and Training

1

0

Total

3

0

Biennial
Period.

From
Beginning.

From
beginning .

M.

F.

T.

M.

F.

T.

1
1

18
18
2
0

11
8
0
1

29
26
2
1

20
10
5
0
0

25
7
5
1
0

45 140 148 288
17 101 87 188
10 49 41 90
1
5
5 10
0
G
7 13

1

1

0

1

1

0

T.

3

39

20

59

36

38

1

M.

F.

T.

2

0

2

0

1

1

74 303 289 592

Thus it is seen that of all patients discharged, 15.5 per cent were
transferred directly to one of the other State Hospitals.
OUT-PATIENT SERVICE.

The Psychopathic Hospital operates two services for patients who do
not enter the hospital for treatment. One of these is a local service in
connection with the admission service of the General Hospital of the
University of Michigan. The other is located in Detroit and operates
as a mental clinic in connection with the Wayne County Juvenile Court
and the Associated Charities of Detroit.

29

PSYCHOPATHIC HOSPITAL.

TABLE No. I.—Showing Diagnoses made in Psychiatric Out-Patient Service of the
General Hospital.

Traumatic delirium
Pre-senile depression

.

Migraine . . .

...

.

Alcoholic hallucinosis . .
Drug addiction, morphine
Pernicious anemia .
. .
Deliria of unknown origin

.

No diagnosis made
Total

...

...

...

Paranoiac conditions
Epilepsy .
.
Neurosis and psychoneurosis :
Neurasthenic type

....

...

.
.

.

.

Year ending
June 30, 1918.

M.

T.

M.

P.

T.

0
1
2
2
2

0
1
3
12
12

0
2
0
0
1

1
5
0
3
10

2
0
0
1
0

6
0
0
1
1

2
0
0
0
0

3
1
1
0
0

2
1
1
0

3
1
1
1

1
3
0
3
9
1
1
1
0
0
0
0
0

1

0
0
0
0

0
0
0

1
5
0
0

0
1
1
0

1
6
1
0

0
2
0
0

0
0
0
1

3
16
11
0
7

1
10
3
2
3

4
26
14
2
10

9
3
1
2

1

2
11
8
0
3

0
2
0
1
3
20
11
1
5

8
8
3
3

24
11
0
3

32
19
3
6

13
5
11
8

13
10
1
4

2
10
1
4
13

7
3
1
4
5

9
13
2
8
18

3
10
0
11
15

1
5
0
2
11

26
15
12
12
4
15
0
13
26

123

93

216

114

77

191

0
0
1
10
10
4
0
0
0
1
1
0
0
1

.,

Cerebro-spinal syphilis .
Tabes
Multiple sclerosis. . .
...

Year ending
June 30, 1917.
F.

1

30

STATE OF MICHIGAN.
TABLE No. II.—Showing the number and source of out-patients.
July, 1, 1916
to
June 30, 1917.

General hospital clinic of neurology
General hospital clinic of surgery

General hospital clinic of gynecology
General hospital clinic of genito-urinary surgery . . .
General hospital clinic of orthopedic surgery
General hospital clinic of contagious diseases
University students' health service
Miscellaneous sources

Total

July 1, 1917
to
June 30, 1918.

M.

F.

T.

M.

F.

T.

10
28
16
6
7

2
21
17
5
5

12
49
33
11
12

26
20
28
2
4

12
18
11
3
3

38
38
39
5
7

6
3
0
1
4

3
1
6
5
2

9
4
6
6
6

5
5
0
2
3

4
3
11
1
1

9
8
11
3
4

0
0
0
12
21
9

2
1
1
0
13
9

2
1
1
12
34
18

2
0
0
10
1
.6

0
3
0
0
2
5

2
3
0
-10
3
11

123

93

216

114

77

191

PSYCHOPATHIC HOSPITAL.

31

WAYNE COUNTY OUT-PATIENT SERVICE
OF THE
STATE PSYCHOPATHIC HOSPITAL.
RESIDENT OFFICERS.

Nellie L. Perkins, Ph. D., Psychologist.
Margaret Wylie, A. B., Assistant Psychologist.
Ethel Plumb, A. B., Registrar and Chief of Social Service.
Sarah Dunlap, A. B., Field Worker.
This Branch of the Out-Patient Service has now been open nearly
three years. From the first, the work has been of the most practical
nature, namely, an attempt to solve the problems of maladjustment
arising in the community served by the clinic. This was necessarily
the case as the funds for maintaining the resident staff were subscribed
by individuals, and the real worth of a work of this kind had to be demonstrated before provisions for a permanent organization would be made.
The results have been gratifying, and already the value of the work done
has been recognized and appreciated to the extent that the County is
willing to contribute toward the support and holds out the hope that
eventually it will take over the entire organization, making it part of
the Court system.
A review of the types of cases handled and organizations served shows
a steady growth of the work with an ever-increasing active part in the
social service carried on in Wayne County. The function of the clinic
seemed to have been definitely indicated after a short period of practice.
From the beginning, it has been used as a center for advice in the handling
of problems in social adjustment. Whenever an organization found a
case that did not improve under the usual methods of relief, especially
if there were several organizations working with the family group, it was
referred to the clinic for study and advice, the purpose being to determine
whether mental defect or abnormality were responsible for the existing
conditions. It is of interest to note that about 80% of the problem cases
which have been troublesome for years were found to be distinctly in
need of study in a clinic of this kind. Among the cases referred, there was
a large group of feebleminded, a surprising number of definite psychoses
and the ever present borderline cases made up of psychopaths that are
not so easily classified as either of the other groups, but frequently more
difficult relative to diagnosis, prognosis and care. Where the examination did not show the presence of a psychiatric condition, very often the
study led to the discovery of peculiar temperaments or unusual attitudes
which, when understood, made social service possible where it had not
been before. Considerable assistance of this kind has been given with
fairly satisfactory results in many cases.
The main interest
however, has been placed in detecting abnormal mental conditions
with a view to ridding the community of this group in order that
the reconstruction attempted by social agencies would not be
lost. The examinations have led to many commitments to
institutions, and have already relieved conditions somewhat. Advice

32

STATE OF MICHIGAN.

given in cases where custodial or hospital care was not necessary, but
where much depended upon a better understanding of the individual
temperament, has in many instances materially changed the methods
of handling certain groups with the result that some of the problem cases
are no longer giving trouble. As the workers become acquainted with
our methods and learn how to handle cases under direct:ons, the clinic
can serve a larger group and the work of the social agencies will also be
more effective. Not only have the efforts led to educating the community
to a more intelligent understanding of a social behavior, but it has also
meant closer cooperation between social agencies, and less duplication
of work, all of which makes necessary more careful planning of case work.
Perhaps the change in the point of view, due to the recognition of the
fact that there is a certain group of individuals that cannot be helped
and must be regarded as social waste, has been as valuable as some of the
more positive results, in that it has re-directed efforts which were practically lost. This has been one of the most difficult tasks, due to the old
sentimental approach and lack of scientific backing for case work.

PSYCHOPATHIC HOSPITAL.

33

NUMBER OF PATIENTS EXAMINED, AGENCIES REFERRING
THEM AND REASONS FOR REQUESTING
A PSYCHIATRIC EXAMINATION.

COURTS.
JUVENILE COURT:
Feebleminded
Subnormal
Retarded
Feebleminded and epileptic
Epileptic
Psychopathic personality
Neurasthenia
Hysteria
Anxiety neurosis
Symptomatic mental state
Pathological irritability. . :
Unclassified insane
Manic depressive
Dementia praecox
Supernormal
No psychiatric condition
No diagnosis made
Deferred

157
80
5
2
4
17
2
17
1
1
1
4
3
1
1
76
5
22

399

JUVENILE DIVISION OF POLICE:

Feebleminded
Subnormal
Psychopathic personality
No psychiatric condition

5
3
1
2

MOTHEE'S PENSION AND NEGLECT:
Feebleminded
Subnormal
Epileptic
Psychopathic personality
Hysteria
Anxiety neurosis
Unclassified insane
General paralysis
No psychiatric conditionDeferred
No diagnoses made

31
12
1
2
2
1
3
1
8
5
1

11

67

POLICE, CIRCUIT AND RECOKDEB'S COUKTS:

No diagnosis made

2

COUNTY AGENT:
Psychopathic personality
No diagnosis made

1
1

o

o

PROBATE COURT, INSANE DIVISION:

Feebleminded
Subnormal
Feebleminded and epileptic
Psychopathic personality
Unclassified insane
Dementia praecox
No psychiatric condition
Deferred
No diagnosis made

'
:

11
1
1
2
3
3
5
1
2

29

510

34

STATE OF MICHIGAN.

While all the cases referred have in some way shown atypical behavior,
those sent by the courts, with the exception of the Mother's Pension
and Neglect groups, have been the more serious offenders, and their
conduct has been sufficiently anti-social to have brought them into conflict
with the law. In many of these individuals the defect is quite apparent
and they are referred for examination without Court hearing. Upon
receipt of a positive diagnosis, the charges are withdrawn, it being the
opinion of the Court that it is useless to prefer charges against a feebleminded or insane individual, and the case is often referred to the Insane
Division of the Probate Court for hearing for commitment to the proper
institution.
A second large group referred by the Juvenile Court is composed of those
cases whose offense is serious enough to warrant commitment to the
Industrial Schools. To be effective, these Institutions must work with
reformable types, those capable of receiving training. The Court therefore
does not wish to flood them with the mentally abnormal or definitely
defective, so that all questionable cases are examined before commitment
and the disposition depends upon the diagnosis.
The group sent by the Mother's Pension Department is particularly
interesting, not so much because of their troubling others, as themselves.
These cases are generally reported because they are unsuccessful, even
with the financial aid and supervision of the Court, and do not use to
advantage what is given them. They fall into two groups; those who
spend funds unwisely, and those whose conduct is questionable, the
result of poor judgment and general lack of ability to live up to certain
standards insisted upon by the Court. This type of relief provides not
only financial aid, but attempts supervision in the more difficult cases.
The visiting housekeepers are called in to supervise the family budget
and give concrete lessons in management; the pension officers advise
and look after the conduct of the various members of the family. In
case of failure to meet the requirements, the pension may be revoked.
Before the establishment of the clinic, the giving of a pension was a
matter of experiment, and in many cases proved expensive and unreliable.
Now whenever it is felt that the applicant is mentally incompetent, the
case is referred for examination, and whether a pension is granted depends
upon the findings and recommendation. There will always be some
borderline cases where experiment is the only possible fair test, but after
an examination the court worker has the benefit of the study, and can
handle the case more intelligently because of suggestions which are
possible only after an investigation of this type. The results seem to
indicate that many of these families have succeeded with a pension
because of the special provisions made to meet their requirements, whereas
they might have failed if left to themselves as formerly. The per cent of
feeblemindedness and insanity runs very high in this group. This is also
true of those referred by the Neglect Division of the Juvenile Court,
as is shown by the table. Work with these groups is the most difficult
and often the least successful because ths problem is always complicated
by so many social conditions, over which we have little control, but we
hope to change some of this when we have passed over the experimental
stage and are better acquainted with the possibilities at our disposal.
The records show a marked increase in the number of cases referred
by the Insane Division of the Probate Court. This is due to the fact

PSYCHOPATHIC HOSPITAL.

35

that the Judges are using the clinic more frequently in those cases o
conflicting or indefinite diagnosis where it is a question of commitment
to the State Hospitals. Cases are referred whenever there is any disagreement on the part of the certifying physicians, especially if it is a
question of commitment to the State Psychopathic Hospital. There is a
hesitancy on the part of the general practitioner to recommend the State
Hospitals especially if he is not certain of the diagnosis or if the family
objects. An observation order for the Psychopathic Hospital is frequently
used as a simple way out of the difficulty because it not only relieves him
of the responsibility of a correct diagnosis, but also shifts the family's
disfavor. This is not always a wise disposition of the case as many of
them have old psychoses and are distinctly custodial types. They could
be committed directly to Pontiac and save the unnecessary expense and
extra time by going directly to the State Hospital, thus leaving the
Psychopathic Hospital for those cases with borderline conditions or
psychoses of more recent onset. The clinic, situated as it is and because
of its relation to the Court, has the opportunity to select cases and tries to
direct types to Ann Arbor which will be of some value in demonstration
teaching, and while it is not always possible to do this because of the
existing conditions, among them public opinion and certain legal and
medical obstacles, there have been occasions when we could serve in this
capacity. In time we hope to develop this side of the work.
DEPARTMENT OF EDUCATION.
BOABD OF EDUCATION, CHILD STUDY DEPARTMENT:

Feebleminded
Subnormal
Supernormal
Feebleminded and epileptic
Psychopathic personality
Hysteria
Dementia praecox
No psychiatric condition
Deferred
TRUANCY DEPARTMENT:
Feebleminded
Subnormal
No psychiatric condition

1
4
3
1
3
2
1
4
4

23

2
1
1

RECREATION COMMISSION:

Feebleminded..

1

1
28

The Detroit schools have an exceptionally good Child Study Department but so far most of the emphasis has been put on the feebleminded
and subnormal child, with no provision for those who are not feebleminded
but a-typical, due to emotional and volitional peculiarities. Neither
has anything been done with the High School groups. These two classes
are now being referred to this clinic as the Board of Education appreciates
that work with types of this kind is essential, but as yet they are not
equipped to handle it. We have found a surprising number of psychopathic children, several of whom made interesting studies.
: The Board of Education has offered this clinic the use of their Special
rooms for borderline mental defectiveness, speech classes, fresh air rooms
for tubercular children, and classes for crippled children, making it

36

STATE OF MICHIGAN.

possible for us to care for many of the children in their homes where
social nursing, rather than Institutional care would be more effective
provided that they could receive the advantages of special educational
methods so essential in their training.
CHARITABLE

ORGANIZATIONS.

CHILD CAKING AGENCIES.
CHILDREN'S AID SOCIETY:
Feebleminded
.......................................................
Subnormal
..........................................................
Retarded
..................
.
......................................
Epileptic . . . :
.......................................................
Psychopathic personality
.............................................
Hysteria
...........................................................
Unclassified insane
.....................................
..
.............
Manic-depressive
....................................................
Deferred
...........................................................
No psychiatric condition
...............................
..............
No diagnosis made
..................................................
ST. VINCENT DE PAUL SOCIETY:

Feebleminded
.......................................................
Subnormal
.....................................................
Retarded
...........................................................
Feebleminded and epileptic
...........................................
Pathological irritability
..............................................
Unclassified insane
...................................................
Dementia praecox
..............................................
Deferred
...........................................................
No psychiatric condition
.............................................

PROTESTANT ORPHAN ASYLUM:

Subnormal

NEIGHBORHOOD HOUSE:

No psychiatric condition

.........................................................
.............................................

26
28
3
1
2
I
3
1
10
35
1
-

Ill

22
.... 12
2
1
1
2
..... 1
1
6

- 48

1
1

1
161

These agencies place children in boarding homes or for adoption and
in either case a mental examination is quite essential, especially if there
is any question of abnormality or defect because such a child is not
suitable for adoption, and as the State provides Institutional care for
them at a much lower cost than is possible in an ordinary boarding home,
the agencies encourage commitment of Institutional types. It not only
costs more to care for these children, but it is the exceptional woman
who can manage them with no more than the ordinary equipment found
in an average home. The schools frequently expel them and they are
sent home for indefinite periods which necessitates providing daily occupation and amusements. They get into mischief and often become neighborhood nuisances. This leads to changing them from boarding home to
boarding home, which neither solves the difficulty nor is fair to the
patient. It has been found that the wiser plan was to have an examination
made, and then provide special boarding homes for the a-typical children.
Temporary provisions have now been made. The children are kept in
little colonies until there are vacancies for them in the State Institution.
The length of stay varies somewhat,' and may be^as long as eighteen
months or two years, depending upon the waiting list, but these provisions
have proved much more satisfactory than the old system of random
placing which amounted to long drawn out and ill-controlled experiments
which seldom succeeded.

PSYCHOPATHIC HOSPITAL.

37

AGENCIES PROVIDING MATERIAL RELIEF.
ASSOCIATED CHARITIES:

Feebleminded
Subnormal
Compulsion neurosis
Deferred
No psychiatric condition

.

4
2
1
2
1

VISITING HOUSEKEEPER'S ASSOCIATION:
Feebleminded

1

POOH COMMISSION:
Feebleminded
Subnormal
Psychopathic personality
Unclassified insane
Alcoholic dementia
General paralysis
No psychiatric condition

1
2
1
1
1
1
1

10

j

8

UNITED JEWISH CHARITIES:

Feebleminded
Subnormal
Psychopathic personality
Hysteria
Unclassified insane
General paralysis
Manic-depressive
No psychiatric condition

6
2
1
3
2
1
1
1

———~

17

AMERICAN RED CROSS CIVILIAN RELIEF:

Feebleminded

1

1
37

These organizations supplement the work done by the Mother's Pension
and Neglect divisions of the Juvenile Court, and provide for those cases
which do not come under any of the headings of the Mother's Pension
law and therefore cannot receive aid from the Court. As would be
expected, they closely resemble in type the cases discussed under the
Pension group. They too have failed to make the required social adjustment and many of them are incapable of competing with others. Examination shows many of them to be low grade feebleminded, and for the most
part, distinctly Institutional types. Some are recommended for commitment to the State School, but more often not because of the difficulty
of having them committed when it means provision for a large family
of children. We have instances where the mother and several of all
of the children were found to be feebleminded, and the entire family
is now at Lapeer, but the solution is seldom so simple.

38

STATE OP MICHIGAN.

AGENCIES CARING FOR GIRLS AND YOUNG WOMEN.
GIRL'S PROTECTIVE LEAGUE:
Feebleminded
Subnormal
Feebleminded and epileptic
Epileptic
Psychopathic personality
Hysteria
Anxiety neurosis
Psychaesthenia
Insane
Deferred

..'

6
1
1
1
3
6
I
1
1
1

22

B U R E A U OF CATHOLIC CHARITIES:

Feebleminded
Subnormal
No psychiatric condition
Deferred

2
1
2
1

FLORENCE CRITTENDEN HOME:

Feebleminded
Subnormal
Psychopathic personality
Manic-depressive
No psychiatric condition
Deferred
ST. AGNES HOME:
Feebleminded
Subnormal
Retarded
Dementia praecox

3
1
1
1
1
1
2
3
1
1
43

By far the most interesting group of cases are those referred by this
group. These organizations provide for girls 17 years of age or older,
or that group just beyond the jurisdiction of the Juvenile Court, and while
the main purpose is not the solution of problems of delinquency but is
rather protective, there are a large number of young women who have
offended against the law and these are referred by the Police Courts to
these agencies, so that the delinquent also is prominent in this group.
The reasons for referring some of them to the clinic are much the same as
in other cases, namely, the ordinary way of providing for them is not
successful, or they persist in their anti-social reactions apparently in
spite of themselves and the efforts of the Protective League. For the
most part, these have proved to be psychoneurotic individuals, with a
few definite psychoses.
The Florence Crittenden and Salvation Army Homes have arrived at
a practical, even if not always accurate criterion to warrant requesting
a psychiatric examination, namely, two or more illegitimate pregnancies.
It is of interest to note that in practically every case referred for this
reason, the patient was found to be either feebleminded or insane.

PSYCHOPATHIC HOSPITAL.

39

MEDICAL GROUP.
HARPER HOSPITAL:
Feebleminded
Subnormal
Retarded
Hysteria
Insane
No psychiatric condition

'.

4
7
1
1
1
5

"WOMAN'S HOSPITAL:
Feebleminded
Subnormal
Psychopathic personality
Insane
No psychiatric condition

6
2
1
1
1-

GRACE HOSPITAL:
Hysteria

1

1g

11

CHILDREN S FKEE HOSPITAL:

Subnormal
Epileptic
Deferred

:

1
1
1

FORD HOSPITAL:
Hysteria

1

CITY BOARD OF HEALTH:

Feebleminded
Subnormal
Feebleminded and epileptic
Psychopathic personality
Deferred

7
1
1
1
1

11

VISITING NURSES ASSOCIATION:

Feebleminded
Subnormal
Epileptic
.'
Psychopathic personality
Hysteria
Unclassified insane
Dementia praecox
No psychiatric condition
BABIES MILK F U N D :

Feebleminded

4
1
2
1
1
4
1
1
,

1

PRIVATE PHYSICIAN AND F A M I L Y :

Feebleminded
Subnormal
Psychopathic personality
Hysteria
Unclassified insane
Dementia praecox
Manic-depressive
No psychiatric condition
Deferred

7
2
1
3
3
1
3
3
1

24
86

40

STATE OF MICHIGAN.

STATE BOARD OF HEALTH.
Feebleminded
Subnormal
Retarded
Feebleminded and epileptic
Epileptic
Psychopathic personality
Dementia praecox
Manic-depressive
No psychiatric condition

35
27
5
1
1
7
1
1
12

90
176

As there are no clinics in any of the hospitals for the diagnosis or treatment of mental cases, most of these are referred to this clinic. Work
with the medical group has been particularly satisfactory, and has led
to many interesting consultations in case work. The physicians make
physical examinations, X-Rays, etc., and the hospitals have opened
their clinics and given hospital care to bed patients referred from this
clinic. The Visiting Nurses have done unusually good social nursing
on cases returned to their homes where special care was needed.
Private physicians frequently refer cases, sometimes with the request
that we diagnose and report back to them, but more often release the
cases to us, largely because with the numerous demands made upon
them they have little time to devote to the endless petty details of having
a patient committed to a State Institution, and they know that the
clinic is equipped to handle this part of the work. Some time ago we
found that we obtained better results with little effort to ourselves, and
much less inconvenience to the patient's family, if we took charge of the
preliminary work in connection with commitments.
In March, 1918, the clinic was asked by the State Board of Health
to make mental examinations of all cases interned for venereal disease
in Detroit hospitals. This request came at the suggestion of the Social
Workers who were handling the follow-up work in an attempt to rehabilitate the patients when released, as it was apparent that constructive
work was out of the question with many of them as they were definitely
defective and incapable of self-support under ordinary conditions of
employment. While mental defects and abnormalities were not altogether responsible for the failures in adjustment, they occurred in sufficient
numbers to make practical a systematic examination of all patients
with a view to segregating the a-typical as a group which could then
be dealt with accordingly and not allowed to hamper the work and confuse
results. We expected to find mental disabilities among this group, but
the number found far exceeds any of our early estimates. Feeblemindedness is the most frequent condition.

PSYCHOPATHIC HOSPITAL.

41

INDUSTRIAL GROUP.
FORD MOTOR COMPANY:

Feebleminded
Neurasthenia
Unclassified insane
Dementia praecox
Manic-depressive
No psychiatric condition
Deferred
No diagnosis made
DODGE BROTHERS:
Compulsion neurosis
Dementia praecpx
General paralysis

1
1
5
2
1
2
1
2

15

2
1
1

SOLVAY PROCESS COMPANY:

Epileptic
j. L. HUDSON COMPANY:
Anxiety neurosis

2
1

2
1

UNION TRUST COMPANY:

Psychopathic personality

1

1
23

Among the more recent developments is the use of the clinic made by
the Welfare Departments of the industries. The types referred vary in
age and condition because the Welfare Departments look after the entire
family, as well as the employees, probably the father or older brother.
This leads to the discovery of many feebleminded and epileptic children
who are being cared for at home to the neglect of the others. Insane
and feebleminded wives are also frequently the cause of inability to meet
the requirements' laid down by the factory for employees. Of all cases
referred these have the promptest and most thorough after-care. All
recommendations are acted upon without question. Whether it is
because the industries want immediate relief from the disturbing factors
for economic reasons, or it is simply another instance of their prompt and
efficient methods which is part of their routine, the fact remains
that their social supervisors carry out all directions immediately upon
recommendation, and the case is not closed unt 1 advice is carried out or
the employee in whose interest the case was taken up leaves the factory.

42

STATE OF MICHIGAN.

SUMMARY.
DIAGNOSIS:
Feebleminded
Subnormal
Retarded
Feebleminded and epileptic
Epileptic
Psychopathic personality
Hysteria
Psychoneuroses other than hysteria
Unclassified insane
Dementia praecox
Manic-depressive
Paranoia
General paralysis
Alcoholic dementia
Symptomatic mental state
Deferred
No psychiatric condition
No diagnoses made

347
198
20
8
13
49
36
12
33
13
11
1
4
1
1
50
167
14
978

RECOMMENDATIONS.
INSTITUTIONS HOSPITALS:

Lapeer
Wahjamega
Pontiac
Eloise
State Psychopathic Hospital
St. Joseph's Retreat

258
6
39
10
52
1

366

INSTITUTIONS, CORRECTIONAL:

House of Good Shepherd
Adrian
Lansing
Ford Republic
House of correction

9
7
15
19
3
CO

EDUCATION:
Special room
Public schools
School for crippled children
Fresh air school
Private schools

16
2
1
1
3

COURT CARE:
Mother's pension
Remove from home
Remove the children
Release to parents
Release from House Good Shepherd
Release from Ford Republic
Probation
Parole

6
16
3
1
6
1
121
2

SOCIAL CARE:
Supervision and social nursing
Deport
Bay Court
Florence Crittenden Home

220
17
1
1

MEDICAL CARE:
Harper Hospital
University of Michigan Hospital
Receiving hospital
RETURN TO PSYCHOPATHIC CLINIC:
NO ADVICE GIVEN:

1
5
1
83
51
978

23

156

239

PSYCHOPATHIC HOSPITAL.

43

This table gives an idea of the type of after-care recommended. The
proportion of Institutional cases is high, as would be expected, but the
more interesting fact brought out is, that while many of them do
not require custodial care,, very few can manage for themselves unless
conditions can be specialized for them, and some sort of social service
is necessary if they are to succeed. The table would indicate that very
little medical work was done, but this is the fault of the method of compiling the statistics. The medical care recorded in the table refers only
to those cases where the problem was purely medical and not psychiatric.
All other cases are lost because the clinical picture is dominated by the
mental condition, rather than the physical, as is shown by the recommendations.
WAYNE COUNTY PSYCHOPATHIC CLINIC
BY NELLIE L. PERKINS.
Psychologist.
December 1, 1918.

44

STATE OF MICHIGAN.

REPORT OF THE CLINICAL GROUPS.
MANIC-DEPRESSIVE INSANITY.

During this biennial period there were admitted 139 cases of manicdepressive insanity of which number 47 were males and 92 females.
The following table shows the frequency of this form of disorder among
the admissions to this hospital.
Male.

Female

Total

No.

Per cent.

No.

Per cent.

No.

Per cent.

206
47

22's

278
92

'33'i' '

484
139

' '28'7' '

There are considered among those under treatment during this period
five males and fourteen females who were admitted during the previous
period but were discharged in this. In all 158 cases of manic depressive
insanity were under treatment.
There was a relative increase of 3.3% in the number of admissions
with this disorder over that of the previous period. This increase was
almost wholly distributed among the female cases.
The following table shows the relative frequency of the several forms
of this disease. The diagnosis was determined from the course of the
disease of each case during the residence of the patient in the hospital.
Female.

Male.

Mixed

Total.

No.

Per cent.

No.

Per cent.

No.

14
31
1
1

29.1
66.0
2.5
2.5

25
56
2
9

27.6
60.8
2. 1
9.5

39
87
3
10

Per cent.
28.8
62.5
2.
6.7

Except in the so-called "circular group," it was the phase of the disorder
present at the time of admission which determined the diagnosis.
It will be seen from the above table that the depressive phase was the
most frequent. Both the manic and the depressive phase are more
frequent in the male sex; while the circular is more frequent in the female.
In the previous period the depressive phase was more frequent among
females.

PSYCHOPATHIC HOSPITAL.

45

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.
Male.

Female.

20
27

40
52

Total.
60
79

The form of the first attack in those patients having more than one
attack is shown in the following table.
Male.
4

Mixed . . . .

13
1
1
1

Female.
12
22

0
0

6

Total.
16
35
1
1
7

The form of the first attack in all cases of manic-depressive insanity
admitted was as follows:

Manic
Mixed. . . .

Male.

Female.

11

25
53
2
6

32

2
1

1

47

Q

92

Total.
36
85

4

7
7

139

These tables show that a previous attack had occurred in 42.5% of
all male and 43.4% of all female cases of this disorder. These percentages
are almost identical with those of the previous period. In the group as a
whole, previous attacks had occurred in 43.1% of all cases admitted.
In eleven, or approximately 8% of the cases, the first attack presented
a phase different from the one of this admission.
The form of the first attack in all cases admitted was manic in 25.9%;
depressive in 56.1%; mixed in 2.8%; circular in 5%, and unknown in 5%.
The following table shows the age of patients at the time of the first
attack and the age of patients at the time of their admission.

Admission.

First attack.

Depressive.

Manic.
M.

10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79

.

.

Total

....

F.

Mixed.

T.

M.

F.

T.

M.

F.

T.

0

0
1
1
0
0

F.

T.

M.

F.

T.

M.

Mixed.

T.

M.

F.

T.

M.

1
0
2
5
14
13
15
15
8

0
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
0
0

0
0
0
0
0

0
0
0
0
0

2

3

1

9

0
1
3
3
1
3
0
2
0

0
3
7
1
4
2
2
2
2

0
4
10
4
5
5
2
4
2

0
0
1

0
0
0

0
1
4
1
1
1
0
0
1

2
3
4
8
4
2

1
0
1
3
11
9
7
11
6

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

1
0
0
0
0
0

0
0
2
0
0
0

1
0
2
0
0
0

2
4
1
0
0
0

5
1
1
0
0
0

7
5
2
0
0
0

0
0
0
0
0
1
0
0
0
0
0
0
0
0
0

2

3

1

9

10

14

25

39

31

56

87

1

1
6
6
4
6
2
2
0
1

1
7
10
8
6
5
2
1
1

0
0
2
5
7
4
4
5
0

1
2
3
5
14
6
5
5
5

1
2
5
10
21
10
9
10
5

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
2

3
1
1
0
0
0

2
1
0
0
0
2

5
2
1
0
0
2

0
0
0
0
0
0

13

30

43

32

51

83

1

1
1

1

Oil culai

F.

0
0
1
0
4
0
1
0
0
1
1
0
0
0
0 • 0
1
0

0
1
4
4
0
3
0
1
0

1

M.

Depressive.

Manic.

Circular.

1

1

0

1

1

1

F.

0
1
3
1
1
2
0
0
0

1

T.

PSYCHOPATHIC HOSPITAL.

47

From the above table it is evident that, where the first attack was
manic in character, 41.8% occurred under the twenty-fifth year. Where
the first attack was depressive in character, only 9.6% occurred under
the twenty-fifth year. This is less than half the number in the previous
period. In all cases admitted, the first attack occurred before the twentyfifth year in 23.8% and before the fiftieth year in 85.6%.
There is one group of the depressive cases which calls for separate
consideration, those in which there seems to be some connection with
the involution period. There were five cases admitted in the period, or
3.6% of all cases admitted. Four of the five cases were females, and
their ages were respectively 46, 48, 49 and 54. The one male was 55.
Four of the five had had no definite previous attack. All were apprehensive, and agitated. Three of the five died apparently from exhaustion
and starvation. Mechanical feeding was necessary in four of these cases.
There is also a group of six cases, or 4.3% in which there was a strong
paranoid tendency; of these, five were females, and all occurred between
the 34th and 53rd year.
One other group of manic-depressive cases should be noted at this
point; namely, those with unmistakable evidences of mental deficiency.
Two such cases were admitted during the period. Both were mild manic
cases, the so-called "hypomanic" phase, and are not inciuded in the
table on page 74, under the group headed "Psychosis with Mental
Deficiency". The reason for not including these two cases under this
last named group is that both came into the hospital primarily because
of manic excitement and manic tendencies. One was a male age 48; he
had shown a change of character and temperament for a year precedingadmission, and was regarded as improved when discharged. The other
was a female age 23, and had had a sub-acute course dating back for a
period of nearly three years. The male showed, by psychometric test,
a mental age of 9 years, and the female a mental age of 9.16 years.
Both individuals judged by economic and social, as well as educational
criteria, had a history that confirmed the results of psychometry.
HEREDITY.

Information concerning the occurrence of nervous and mental disorders
in the families of the patient with this disorder was obtained in 129 of the
139 cases admitted.
The nature of the distribution of these are shown in the following table.
In 72% of the families where information was available, there were
instances of mental abnormalities other than those of the patient.
In the families of the 93 cases showing abnormalities of the family
and antecedents, there were 34 in which there was one other instance
of abnormality. There were 31 families with two, fifteen with three,
six with four, six with five, two with six, two with seven, and two with
eleven instances of abnormalities. In the 93 families, there were 318
abnormal individuals.

STATE OF MICHIGAN.

48

Direct.

Atavistic. Collateral.

Brothers
and
Sisters.

Total.

M. F. T. M. F. T. M. F. T. M. F. T. M. F. T.

Psychopathic Inferiority

Total heredity .

8 20 28
3 7 10
1 10 11
3 2 5

2
1
1
1

2
0
0
0

4 5 15 20 5
1 1 1 2 0
1 0 0 0 0
1 0 1 1 0

5 10 20 42 62
0 0 5 8 13
0 0 2 10 12
0 0 4 3 7

15 39 54

5

2

7

5 10 31 63 94

6 17 23

5

14 22 36

Unknown

2

Total . . . .

...

7

9

47 92 139

ETIOLOGY.

Of the 139 patients admitted, eighteen were reported by the informants
as having peculiarities of personality preceding the acute outbreak.
In 107 cases there were experiences closely associated with the onset
of the disorder, which were regarded by their friends as of causative
importance. Many of these experiences may be better regarded as
precipitating factors than as true etiological factors. They seem to
appear at a time when the individual is under stress which, either because
of his make-up or because of his physical condition, he is not able to
meet.
In ten cases the onset was associated with the puerperium. In three
instances the attack appeared to be influenced by the appearance of the
menses or associated with menstrual disorders. In 18 instances financial
or occupational difficulties seemed to precipitate the attack. Physical
illness or surgical treatment was given in 17 instances.
Illness or death in the family occurred in sixteen cases. Conjugal
troubles including quarrels, desertion, divorce, etc. were assigned as
causes in eight instances. Insanity in the family was thought to precipitate in three instances; enlistment of a son or husband in five instances;
religion was held as responsible in three cases; disappointment in love
in five, and the menopause in one.
Wassermann examinations of the blood serum were made in 135 of the
139 cases admitted. It was found strongly positive in one case only.
Three cases gave a doubtful reaction on the first examination, but all
of these were returned as negative on subsequent examination. One
male shows a cell count of six cells in the spinal fluid. In none of these
doubtful cases was there a history or clinical evidence of a luetic infection.
The one case in which the blood Wassermann was strongly positive,
was a wonian, twenty years of age. Her family history was bad, her
mother being a neurotic; her father suicidal, one sister mentally deficient,
one brother insane and two paternal uncles alcoholic. She was of limited
education. She was of an excitable temperament, em . tionally unstable,

PSYCHOPATHIC HOSPITAL.

49

and even before her attack always seemed to do things as if under high
tension. She married at seventeen. She had no previous attacks.
The present trouble dated one month previous to admission. She
suddenly became elated following child birth. Physical and neurological examinations negative. Blood Wassermann + + + +. 6 cells.
Nonne-Apelt, phase one, two dilutions doubtful. Gold sol, almost a
flat curve, 00011000000. She entertained delusions of reference. The
predominating mental symptoms were those of a manic excitement: she
was resistive, irritable, exhibited a pressure of speech, was profane,
destructive, and had to be tube fed. She also had auditory and visual
hallucinations.
EESULTS OF TREATMENTS.

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 for males was 77 days, for females,
103 days; for both sexes, 94.3 days. All the patients were discharged
to their homes, except nine who died, and sixteen who were transferred
to the various State Hospitals.
Manic.

Depressive.

Mixed.

Circular.

Total.

M. F. T. M. F. T. M. F. T. M. F. T. M. F. T.

Unimproved
Died
Remaining

-

5 4 9 8 3 11
5 6 11 13 29 42
4 12 16 2 23 25
0 1 1 4 4 8
1 4 5 7 10 17

0 0 0 0
0 1 1 1
1 0 1 0
0 0 0 0
0 1 1 0

2
0
3
0
4

2 13 9 22
1 19 36 55
3 7 38 45
0 4 5 9
4 8 19 27

It may be seen from this table that of the 130 patients discharged,
16.9% were discharged recovered; 42.3% improved; 34.6% unimproved;
and 6.9% died.
Of the 37 cases of the manic phase, 24.3% were discharged recovered,
and 30% improved. Of the 86 depressive cases, 12.7% were discharged
recovered, and 48.8% improved.
Grouping the recoveries and improvements together we find from this
table that 65.7% of the manic cases and 56.9% of the depressive cases
were benefited by their hospital treatment. Nine patients died from
inter current disorders.
It was possible to make a laboratory study of the central nervous
system in one of these.
Case 1945—Manic-depressive, depressed phase. Male, age 55. Stationary Engineer, One sister insane. Always a hard and conscientious
worker, particular about details, and of good habits. No previous
attacks. Present trouble sub-acute, and of about' one year's duration
previous to admission. Financial losses due to playing margins in the
stock market seem*i'o have been the precipitating situation. Physical

STATE OF MICHIGAN.

50

examination showed little except a general adenopathy, a scaphoid
abdomen, and blood pressure, systolic, 150. Neurological examination
also showed little except a slight oedema of the nerve head and the retina
with slight arteriosclerotic changes. Serological examinations negative
except for a count of six cells in the C. S. F.
His sleep was extremely disturbed. He lost 18 pounds in weight
during his residence here of 18 days. He expressed delusions of selfaccusation, and was deeply depressed, and agitated. Mechanical feeding
became necessary.
Autopsy was performed 1J^ hours after death. In the gross, the brain
appeared normal, but small. It weighed 1190 grams. No pathology
in the chest organs. Stomach greatly contracted, and its mucosa much
congested. Capsules of both kidneys adherent. Adrenals hypertrophied and very firm. All the muscular tissues deeply colored, probably
the result of starvation. No gross cause of death was found.
Histological examination of the cortex showed nothing distinctly
pathological except an excess of fatty pigments in the pia and in the
endothelia of all blood vessels, even to the finest capillaries, and in the
glia cells.
The left adrenal showed irregular light-colored patches in which the
cell nuclei were much reduced in number and the cell bodies large and
pale. Many small hemorrhages and a general venous congestion were
also seen.
DEMENTIA PRAECOX.

There were admitted 89 patients whose mental disorder was diagnosed
as Dementia Praecox. This number formed 18.4% of all patients admitted.

Per cent.

No.

Dementia praecox

206
40

Total.

Female.

Male.



19.4

No.

Per cent.

No.

Per cent.

17.6

484
89

18.4

' 278
49

The 40 male cases formed 19.4% of all males admitted and the 49 female
cases 17.6% of all females admitted.
The 89 cases occurred in the following clinical forms:
Female.

Male.

Paranoid type
Hebephrenic type
Simple type
Total

No.

Per cent.

4
8
20
8

10
20
50
20

40

No.

Per cent.

No.

Per cent.

20.4
32.6
40.8
6.1

15
23
40
11

16.8
25.8
44.9
12.4

11
15
20
3
49

Total.

f

89

51

PSYCHOPATHIC HOSPITAL.
AGE.

The following table shows that the onset of the mental disorder
occurred before the 25th year in 48.6% of the male cases and 34.8%
of the females or 40.8% of all cases of Dementia Praecox admitted.
The youngest age of onset was 12 and the oldest 43.
Admission

Onset.
F.

M.

10-14
15-19
20-24
25-29. . .
30-34
35-39. .
40-44. .
45-49
50-54 .
55-59 . . . .

9
11
6
1

2
3
11
8
10
10

4
10
20
19
16
11

6
11
8
8

1

2

3

2

. . .

....

3

3

F.

M.

T.

T.

2

2
10

10
11
13
2

16
21
19
21
6

1

1

2

1
1

0
0

1
1

4

6

The relative frequency of occurrence before the 25th year of the various
clinical types was:
Per cent.
Paranoid type
Catatonic t y p e . . . .
Hebephrenic type.
Simple type

20.0
43.4
37.5
63.6

Information regarding hereditary influences was obtained in 80 cases.
Among these there were 54 or 67.5% in the families of which there was
a history of insanity or some other predisposing factor.
In these 54 families there were 163 individuals who were mentally
or nervously disordered. The following table gives the details:
Direct.
M.

Apoplexy or
Psychopathic. . . .

7

2
3
2
Total heredity . . . 14
Unknown

Total .

Atavistic.
T.

M.

F.

7 14
1
7 10
4
6
19 33

2
1
0
3

3
6

3
9

F.

Brothers
and sisters.

Collateral.

Total.

T.

M.

F.

T.

M.

F.

T.

M.

F.

1

3

2

4

6

2

1

3

2

3

1

2

3

13
3

2

4

6

3

3

6

4
2
22
15
3

13
3
9
7
32
11
6

26
6
13
9
54
26
9

40

49

89

T.

52

STATE OF MICHIGAN.
ETIOLOGY.

Information regarding the personal constitution of the patient was
obtained in 61 cases.
In 35 instances there were abnormalities of personality that had attracted the attention of others. The most frequently observed peculiarities were unusual reticence or seclusiveness, various oddities of character,
and indefinite nervous manifestations.
In 29 instances there were quite definite precipitating causes. These
were reactions to experiences of strong emotional quality or in relation
with some physical disorder or accident. In 4 instances the acute attack
occurred after confinement.
RESULTS OF TREATMENT.

The results of treatment are given in the following table. Among these
are included 10 cases remaining over from the previous period.
M.
0
16
22
0
7

Died

F.
2
1G
28
1
7

T.
2
32
50
1
14

Per cent.

23
37.6
58 8
1.1

Of those discharged 53 returned to their families and 31 were transferred
to one of the larger State Hospitals for the Insane.
PARANOID TYPES.

There were admitted 15 patients that belonged to this group,
of these were males and 11 were females.
The ages at onset and at admission were:—
\dmission

Onset.
M.

20-24
25-29
30-34
35-39

2
1

0
1

F.

T.
1
3
5
2

Four

3
4
5
3

M.

F.

1
0

T.
1
3
7
4

0
3
5
3

2
1

Hereditary predisposition was present in 10 of 13 cases regarding
whom information was available.
The results of treatment were:—
M.

Unimproved.

0
1
3
1

F.

T.
1
4
5
2

1
5
8
3

PSYCHOPATHIC HOSPITAL.

53

CATATONIC TYPE.

There were admitted 23 cases belonging in this group. Eight of these
were males and 15 were females, as may be seen in the following table:
Admission

Onset.
M.
0
1

10 14

15-19
20-24
25-29
30-34
35-39
40-44

2

4

0

o
1
o

P.

T.

M.

1

1

2
4
2
2

3

I

1
2

6
6
2
I

2

F.

T.

1

2

6
2
2

8
5
3
3
2

1

o

3
1
0
1

3
1

2

Hereditary factors were present in the families of 68.4% of cases.
The results of treatment are given in the following table: This includes
two patients remaining over from the previous period.
M.
Recovered
Died

.

0
5
3
0
1

F.
1
3
10
1
1

T.
1
8
13
1
2

One patient with acute catatonic stupor died. This was F. D. 2185,
a young woman aged 21 at her admission to the hospital. Her father
for several years showed marked psychopathic traits, became addicted
to the use of chloroform and died from heart disorder. She was born
at a difficult instrumental labor. In childhood she was delicate, suffered
much from gastro-intestinal disorder, and required for a long time a
carefully regulated diet. Temperamentally she was rather serious and
was always regarded as being a nervous child. She did well in school
and had completed two years in college when she developed mental
peculiarities. On account of straightened family circumstances she was
obliged to work while attending college. She at times showed unhappiness over her situation, and complained of being tired and unable to
do her work as well as formerly. Her mood became continuously mildly
depressed. She withdrew from companionship of others and about
a week before her admission suddenly broke into tears. When given a
hypodermic she became greatly agitated, asserting that it would cause
her to fall asleep and she would not awake. For a few days she became
more normal in her behavior, then she began to make a peculiar humming
noise with her mouth and smack her lips. This persisted for some days.
She no longer showed her usual interest in things around her. This
attitude lead to her admission here.
The physical examination showed the following: Good development
and nutrition, muscles in general are moderately spastic. The heart
rapid and at times arrhythmic. Respirations increased in frequency

54

STATE OF MICHIGAN.

and shallow. Her behavior was unusual, she held herself in a rather
stiff attitude, her pupils were widely dilated and she usually would keep
her gaze away from the one talking with her. Her motor reactions soon
took on a stereotyped character. She stood in strange attitudes. She
kept up a peculiar rhythmic noise and for a long time continuously
smacked her lips. Finally she resisted whatever was done for her and
refused to talk or eat. The first few days she would at times give attention
to questions, but usually she was quite out of touch with things around her.
When she would attend her comprehension was clear. Her stream of
thought was hesitating and interrupted by frequent blocking. Her
productions of thought were few, they largely concerned her family
and were at times expression of fear of harm coming to herself or mother.
There were frequent instances of ambivalent thought. Three days
after her admission her attitude was extremely negativistic. She refused
to talk or do anything for herself. Her facial expression was one of
troubled perplexity. Her physical failure was rapid. In spite of artificial feeding and saline infusions her nutrition failed. Her hands and
feet became cyanotic, the surface of her body was cool and moist. Her
heart was rapid and shallow. There was no rise in temperature. Death
occurred 11 days after admission. The autopsy showed no gross pathological changes in the body organs. There was no gross change in the
thyroid or thymus glands.
The brain appeared under tension and somewhat more voluminous
than usual. It weighed 1350 grams. The membrane was clear. The
veins of the pia mater were slightly filled. The brain substance was
excessively moist, but not softened.
The histological studies of the brain showed very marked pathological
conditions among nerve cells and glia, and blood vessels. The nerve
cells especially in the second and third layers of the cortex were excessively
filled with fat, and many showed granular degeneration. The nucleus
was frequently folded and of irregular outline. The glia in the molecular
layer was increased. Many abnormal glia cells were present in all layers.
There were many of the ameboid type. Endothelium of the blood vessels
was frequently observed in a state of proliferation, many of the nuclei
showed mitoses.
The changes present in this case agree with those that have previously
been observed in rare instances of sudden death in dementia praecox,
and show definitely that at least in some cases of this disease there is
associated a definite structural disorder of the brain.

PSYCHOPATHIC HOSPITAL.

55

HEBEPHBBNIC TYPE.

There were admitted 40 cases whose mental disorder was of this type.
The cases were equally divided between the two sexes.
The ages at onset and admission were:
Admission

Onset.
F.

M.

15-19
20-24
25-29
30-34
35-39
40-44
45-49

T.

I

F.

M.

T.

4
6
5
4

4

3
3

5
10
8
7

3
7
5
3

0
3
5
4

3
10
10
7

0
0

7
1

7
1

2

1

1

6
1
1

8
1
1

2

0
0

Hereditary factors were present in 63 per cent of the cases, regarding
which information was available.
The results of treatment are shown in the following table; this includes
four patients admitted in the previous period.
M.
Recovered

F.

8
10
4

Died

T.

9
11

17
21

2

6

SIMPLE TYPE.

Eleven of the cases admitted belonged in this group. Eight of these
were males and three were females.
The ages at onset of the disorder and at admission were:
\dmission

Onset.
M.

10-14
15-19
20-24
25-29
30-34
35-39
50-54 . .
55-59

F.

M.

T.

F.

T.

2
1
1

1
0
2

3
1
3

2

I

1
1

3
2

2

0

2

2

0

2

1
1
1

1
0
0

2
1
1

2

0

2

56

STATE OF MICHIGAN.

Hereditary factors were present in 63% of the cases.
The results of treatment are shown in the following table:
This includes two patients remaining from the previous period.
M.

Recovered
Unimproved
Died
Remaining



...

T.

F.

2
6

0
2

2
8

1

2

3

PARANOIA AND PARANOIAC CONDITIONS.

Under this heading are placed a number of cases in which the mental
symptoms were of a paranoiac 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 Kraepelin has described and defined as paraphrenia systematica;
some show distinct presenile features; some are associated with impaired
hearing; and some are less clear in their clinical position and as a consequence are grouped together as a general group of undifferentiated
paranoid conditions.
The following shows the total number of such conditions admitted
during the period. Nine are males, and fourteen are females, or 4.7%
of all admissions.
Female.

Male.

1
4
0
0
4

Paranoiac conditions with impaired
Undifferentiated paranoiac conditions
Total

Paranoiac conditions including

Total.

1
7
2

2
11
2
1
7

1
3

9

23

14

No.

Per cent.

No.

206
9

4.3

278
14

Per cent.

5

No.

Per cent.

484
23

4.7

It is interesting to note that but two cases of true paranoia were admitted during the period, or .4 of one per cent. Of paranoid cases associated
with impaired hearing there was but one, or .2 of one per cent. Presenile
paranoiac conditions number the same as those of paranoia.

PSYCHOPATHIC HOSPITAL.

57

PAEAPHRENIA SYSTEMATICA.

Eleven cases admitted during the period were grouped under this
heading, four of them males, and seven females; in all they make 2.2%
of the total admissions.
Male.
No.

Total.

Female.

Per cent.

206
4

2

No.

Per cent.

No.

Per cent.

278
7

2.5

484
11

2.2

The following table is interesting in that it shows the onset in 63.7%
of the eleven cases of paraphrenia sytesmatica occurred before the
thirtieth year, and 100% before the 45th year.
Onset.
M.

15 to
20 to
25 to
30 to
35 to
40 to
45 to
50 to
55 to

19
24
29
34
39
44
49
54
59

F.

M.

T.
1
0

0
2
2

Total

\dmission .

1

F.

T.

0
2
1
0
0

0
1
0
1
3

0
3
1
1
3

2
0

0

0
0

1
0
0
0

1
1
0
0

2
1
0
0

7

11

4

7

11

2

0
0

2
2
0

4

0
0
0
0

2
0
0

4

2

0

Hereditary factors were present among the ancestry in five instances,
or 46.5% of the cases.
RESULTS OF TREATMENT (PARAPHRENIA SYSTEMATICA).

The following table shows the results of treatment in the cases of
paraphrenia systematica discharged during the period. One case
improved. This stands in contrast to eight discharged as unimproved.
It is needless to say that the prognosis in this condition is bad.
M.

Improved
Unimproved
Died
Total

.

...

. . .

. .

. .

F.

T

0
1
3
0

0
0
5
0

0
1
8
0

4

5

9

58

STATE OF MICHIGAN.

Of those discharged seven were returned to their families and two were
transferred to some one of the State Hospitals.
PARANOIAC CONDITIONS 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 seven of these cases, four males, and three females, in all
forming 1.4% of all admissions.
PARANOID DISORDERS

UNDIFFERENTIATED.

Male.
No.

Hospital admissions
Paranoid disorders, (undifferentiated

206
4

Female.

Per cent.

2

No.

278
3

Total.

Per cent.

1

No.

Per cent.

484
7

1.4

The ages at onset and admission are shown in the following table:
\dmission

Onset.
M.

25
30
35
40
45

to
to
to
to
to

29
34
39
44
49

50 to 54
55 to 59
60 to 64
Unknown
Total

F.

M.

T.

F.

T.

1
1
0
0
1

1
1
0
1
0

2
2
0
1
1

1
1
0
0
1

0
1
1
1
0

2
1
1
1

0

o

0
I
0
0

0
0

0

0
0
0
0

0

0
0
0
0

0
0
1
0

4

3

4

3

7

1

1

1

Hereditary factors were present among the antecedents in five instances,
three of these being in the direct line.
The results of treatment are given in the following table:
M.

Unimproved

1
0
2
1

F.

T.
0
2
2
0

1
2
4
1

All of the above cases were returned to their families, some against
advice, and one, by escape.

PSYCHOPATHIC HOSPITAL.

59

The following tables show at a glance the heredity in all of the twenty three cases of the entire group of paranoia and paranoiac conditions.
The first table shows the number of separate instances in each of the
different sub-groups. Forty-seven per cent of the cases show that
hereditary factors were denied or unknown. The positive instances
are almost equally distributed between paraphrenia systematica and the
undifferentiated cases.
The second table shows the different forms of hereditary taint in the
twenty-three cases. Apoplexy and paralysis lead with 33|%; and
insanity and alcohol each with 25% of the total instances with positive
heredity.



M.

Paranoia
Paraphrenia
Systematica. . . .
Presenile condition
Deaf. .
Unclassified

0
1
0
0

Total heredity

2

Denied

M.

F.

T.

M.

F.

T.

M.

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

2

0
2
1.
1
3

1

0
0

0
1

0
1
0
0
1

5

7

0

0

0

1

1

2

2

F.

0
1
1
1

1

.

.

Total .

....

T.

..

.

Direct.

Total

T.

M.

F.

0
1
0
0
0

0
2
0
0
1

0
2
0
0
3

0
3
1
1
2

0
5
1
1
5

1

3

5

7

12

4
0

5
2

9
2

9

14

23

F.

. .

..

Atavistic.

Brothers
and
sisters.

Collateral.

T.

Total.

T.

T.

M.

F.

T.

M.

P.

T.

M.

F.

T.

M.

F.

0

1

0
0
0
0

0
0
0
0

0
0
0
0

0
0
1
0

1
0
0
0

1
0
1
0

1
0
1
0

0
0
0
0

1
0
1
0

2

3

3
0

1
4
0
3

1

1
0
1

1
2
1

3
0
2

4
2
3

5

7

12

4
0

5
2

9
2

9

14

23

Total heredity
Denied
Unknown

Total.

F.

M.

Insanity
Apoplexy or paralysis
Psychopathic. . . .
Alcoholism

Brothers
and
sisters.

Collateral.

Atavistic.

Direct.

....

2

60

STATE OF MICHIGAN.
RESULTS OF TREATMENT.

Results of treatment in the cases of paraphrenia and the undifferentiated cases have already been noted. The following table shows the
results for the entire group of paranoia and the paranoiac conditions.
Of the 21 cases discharged, 15 were regarded as unimproved, or 71.4%.
Only 1 case recovered, and that was an undifferentiated case, a male of
60, who had delusions of marital infidelity. He entered the hospital
physically under-nourished: As he gained in weight and as his sleep
became more regular, his mental condition improved and at the end of a
month's treatment he was discharged as recovered.
M.
Recovered
Improved
Unimproved

F.

T.

1
1
6

0

2

2

1
5
15
4

4

Q

Of the 21 cases discharged, 17 were returned to their respective families,
and 4 were transferred to the State Hospital.

MENTAL DISORDERS DUE TO SYPHILIS.
During the biennial period, 39* cases were admitted in which the
mental disease was due to syphilitic involvement of the central nervous
system. Clinically these cases were classified as follows:
F.

M.

8

23
1
0

Tabes

FREQUENCY

OF SYPHILIS AMONG CASES

T.
31
7
1

6
1

ADMITTED.

Of the 484 patients admitted during the period, 433 had the Wassermann
test made on their blood, and of these 93 had the Wassermann test made
on their cerebrospinal fluid. The results of these tests were as follows:
Blood.

Positive

Cerebrospinal fluid.

M.

F.

T.

27
168

21
217

48
385

M.
24
25

F.

16
28

T.
40
53

*Two cases, 1 male and 1 female, with constitutional syphilis but not insane were admitted
for examination.

PSYCHOPATHIC HOSPITAL.

61

Of the total admissions, 48 or about 9.92% had syphilis. Deducting
39 cases whose mental disease was directly due to syphilis and 2 cases
of constitution syphilis not insane, leaves 7 cases, or 1.45%, who had
syphilis but whose mental disturbance was of a non-syphilitic type.
Distinguishing between the sexes, 27 cases, or 13.05 % of males admitted
and 21 cases or 7.55% of females admitted gave positive Wassermann
test. It is interesting to note that of the 7 cases classified as cerebrospinal
syphilis, 6 were females while only 8 of the 31 cases of general paralysis
were women.
FAMILIAL SYPHILIS.

For several years it has been the practice of this hospital, whenever
possible, to examine for the presence of syphilis, members of the family
of patients who have had syphilitic forms of mental disease. Difierent
members of the family are examined neurologically and a Wassermann is
made on their blood. When this is found strongly positive, they are
usually advised to enter the hospital for a lumbar puncture and for further treatment.
During the present period Wassermann tests were made upon the blood
of the wives in seventeen cases of male general paralytics. The result of
this showed that eight wives exhibited the presence of syphilis, or a percentage of forty-seven.
Tests made upon the blood of the husbands of six women, who had
general paralysis, showed that five of these had syphilis, a percentage of
83.3.
There were six cases of wives who had cerebro-spinal syphilis; the husbands of five of these showed the presence of syphilis, a percentage of
83.3.
In twenty-nine cases of mental disorder due to syphilis in which members of the family were examined, the mate showed the evidence of
syphilis in eighteen instances, or a peicentage of 62.
Examination of the blood of sixteen children distributed through these
cases gave only one positive Wassermann reaction. In one case of juvenile paresis, the blood of the parents was positive.
GENERAL PARALYSIS.

During the biennial period, 23 male and 8 female, or a total of 31 cases
of general paralysis were admitted. The ratios and percentages as related
to total admissions were as follows:
Male.

General paralysis

Female.

Total.

No.

Per cent.

No.

Per cent.

No.

Per cent.

206
23

'ii'ie' '

278
8

' '2\87' '

484
31

6.40

62

STATE OF MICHIGAN.
CLINICAL FOKMS.

The majority of the cases were of the demented type. In one case of
juvenile paralysis, both parents were luetic. Two cases of the demented
and 1 of the expansive types also had the Lissauer syndrome. The
cases were classified as follows:
M.

Demented
Agitated
Delirious

F.

16
4
2
0
1

T.

6
2
0
0
0

22
6
2
0
1

AGE.

Leaving out 1 case of juvenile paralysis aged 13 years, the average
age at time of admission for males was 36.1 and for females 36.5.
The following table shows the age at the time of onset of the disease
and age at time of admission of patients to the hospital:
Admission.

Onset.
Age.
M.

F.

1
0

10-14 .
20-24
25-29
30-34
35-39. .
40-44
45-49

4
11
5
0

M.

1
1
3
4
14
7
1

0
1
1
0
3
2
1

2

,

T.

F.

1
0
2
4
11
5
0

T.

1
1
3
4
14
7
1

0
1
1
0
3
2
1

HEREDITY.

Hereditary factors were found in 19 of the 31 cases admitted, or 61.22%
of cases in which information was obtained. 10 cases gave negative
histories for instances of hereditary factors.
Among the antecedent and collateral relatives of the 31 cases of general
naralysis, there were 61 instances of mental abnormalities.
Direct.

Insanity
Apoplexy or paralysis
Psychopathic. . . .
Alcholic
Total heredity . . .

Total

Brothers
and
sisters.

Collateral

Atavistic

Total

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

F.

2
1
2
2

1
0
0
0

3
1
2
2

2
0
0
0

1
0
0
0

3
0
0
0

0
0
0
0

2
2
0
0

2
2
0
0

1
0
0

1
0
0
1

2
0
1
1

5
2

5
2
0
1

10
3
3
3

11
10
2

8
0
0

19
1O
2

23

8

31

1
3

T.

PSYCHOPATHIC HOSPITAL.

63

PRODROMAL PERIOD.

The approximate date of syphilitic imection was obtained in 21 of the
31 cases. The average interval between the date of infection and onset
of mental symptoms was 11.95 years.
Time in years

5

7

8

9

10

11

12

13

14

15

16

24

1

1

1

1

5

2

1

3

2

1

2

1

NEUROLOGICAL DISTURBANCES.

No.
of cases. Per cent.

Pupil

23
20
17

70.97
70.97
41.93
51.61
25.81
22 58
58 06
83 87
6 45
74 19
64.52
54 84

10

32.26

22

Unequal
.
Reaction sluggish

22
13
16
8
7
18
26
2

Both
Apoplectiform or epileptiform

In 6 cases the pupillary reflex to light was absent on 1 side only, but
in each of these cases the light reflex was sluggish on the opposite side.
Tabetic symptoms were present in 10 cases, all of which showed disturbance in locomotion.
SEROLOGICAL CONDITIONS.

Wassermann test on the blood of the 31 cases showed a strong positive
reaction in 27 cases, + in 1 case, and + + in three cases. The Wassermann test on the cerebro-spinal fluid showed a strongly positive reaction
in 30 cases. In one case, the fluid was not examined.
The number of cells per cu. mm. in the cerebrospinal fluid in 29 cases
examined was as follows:
No. of cells per cu. mm

No of cases

5
to

11
to

16
to

21
to

31
to

41
to
60

100

61
to

Over

1

5

7

3

4

6

2

1

10

15

20

30

40

100

64

STATE OF MICHIGAN.

In all except 3 cases, the albumen content of the cerebrospinal fluid
was greatly increased. In 5 cases, the Nonne-Apelt (Phase I) test was
positive in 5 dilutions of the fluid; in 19 cases, the fluid showed positive
test in 10 dilutions; and in 3 cases was positive in 15 dilutions.
Quantitative test by the Nissl-Esbach method gave the following
results in 29 cases examined:
Per cent, albumen
No of cases .

03 +

04 +

05 +

06 +

1

0

0

6

07 + .08 + .09 + .10 +
2

10

5

5

The Colloidal gold test was made on 28 cases with the characteristic
curve of general paralysis in 26 cases and with the curve of cerebrospinal
syphilis in 2 cases, 1 of which later gave the typical curve of general
paralysis.
RESULTS OF TREATMENT.

Energetic anti-syphilitic treatment of general paralysis, by known
methods, appears to be of benefit only to cases in which the disease
has made slight progress. In favorable cases, the progress of the disease
appears to be arrested and notable improvement has been observed.
Our methods of treatment have been varied from time to time with hope
of finding some manner of treatment which would give more encouraging
results than methods used up to the present have given.
Salvarsan or closely related substitutes have been given intravenously
in all cases treated. In addition mercurial inunctions and periodical
withdrawal of varying amounts of cerebrospinal fluid and the introduction of from 0.3 mg. to 1.2 mg. of Salvarsan into the spinal canal have
been resorted to.
In only 1 instance of a series of about 9 cases which received energetic
treatment were the results satisfactory.
This case (No. 2009) was admitted to the hospital, February 2, 1917.
Primary infection occurred 5 years prior to onset of mental symptoms. At
the time of admission to the hospital, the abnormal mental condition was
indicated by the patient's euphoric mood, mildly grandiose ideas, overactivity, unreliability, irritability, defective memory, and disturbance of
attention. Neurological examination showed deafness in left ear, sluggish
and irregular pupils, exaggerated knee and tendo-achilles reflexes, tremors
of the tongue and fingers.
Laboratory examination of the blood and cerebrospinal fluid showed:
Blood-Wassermann + + + +, Cerebrospinalfluid-Wassermann+ + + +,
cells in csf. 157 per cu.mm., pressure greatly increased (Nonne-Apelt
test 10 dil. + ), (Nissl-Esbach Method 0.09%.)' Collodial-gold curve
55555542000.
This patient received 17 intravenous and 24 intraspinal injections
of Salvarsan at intervals of 1 week each. He remained in the hospital
40 days after first admission and then returned every week for treatment.
The amount of cerebrospinal fluid withdrawn each week varied from 15
c.c. to 70 c.c. and at no time was there serious reaction following the
withdrawal of the fluid. The fluid was withdrawn as soon as possible
following the intravenous injection of Salvarsan. The dosage of Sal-

PSYCHOPATHIC HOSPITAL.

65

varsan was usually 0.6 gm. The dosage of Salvarsan injected intradurally immediately following withdrawal of the fluid was 0.3 mg. increased
gradually to 1.2 mg.
Examination after treatments were discontinued, showed neurological
conditions unchanged. Wassermann test on the blood was ±. Wassermann test on the cerebrospinal fluid showed 0.10 c.c. = + + + +.
0.08 c.c. = _ + +, 0.05 c.c. = ±. Other fluid findings were: Color =
clear, pressure increased, cells = 8 per cu. mm., Nonne-Apelt = 2 dil.
+ , 5 dil. ±, Nissl-Esbach .026 per cent albumen.
The patient has continued at work but has shown minor irregularities
of conduct which are gradually interfering with his domestic and business
relations.
Of 14 cases of general paralysis receiving various degrees of treatment,
6 showed improvement and 5 of these returned to their homes. Only 1
untreated case showed improvement. 1 treated case with extensive
focal lesion and Lissauer's syndrome died.
The following table shows the condition of patients discharged. Four
male patients admitted in the previous biennial period are included.
Re covered.

Improved.

Unimproved.

Died.

General paralysis.
M.

Demented
Expansive

....

P.

T.

M.

P.

5
1

2
0

T

7
1

M.

14

P

T

2
2

4
2
0

18
4
2

1

0

1

M

1

P

0

T

1

Of 34 patients discharged, 19 were transferred to one of the State
Hospitals and 14 returned to their homes.
The average period of residence of patients of this group was 104.2 days.
Case H. M. 2144. A male aged 36 at admission. Temperamentally
he was neurotic, emotional and unstable. At 24 probably luetic infection. No serious after -effects were noted. Nine months before admission there developed an unusual irritability, and unreasonableness.
There was a tendency to sleep during the day. These symptoms gradually
increased. Six months after the first symptoms there occurred a convulsion followed by unconsciousness. From this there was seemingly
good recovery. Two weeks later another attack of unconsciousness
lasting a number of hours. During the next week there were a number of
similar attacks. After this period he showed marked mental change.
He had a profound memory disturbance for retention and recall of names.
There was a marked paraphasia with inability to name many objects or
call them by their proper name. His mood was expansive, and he expressed numerous grandiose ideas.
On admission to this hospital he
showed no serious condition of the body organs, but there were numerous
and severe neurological disturbances. The pupils were dilated, irregular in outline, and reacted sluggishly to light. All tendon reflexes
were much increased.
There was a severe dysarthria and paraphasia with amnesia for names. Mentally he was euphoric and

66

STATE OF MICHIGAN.

showed a rather characteristic mental state of paresis. Focal disturbances were always prominent. At one time there was a transitory
paralysis of the tongue, and the aphasic condition did not improve.
About 5 weeks after admission the knee jerks disappeared and he developed
a marked ataxia in gait and arm movements. From this time on there
was retention of urine. The neurological findings were as follows. The
blood always gave a strongly positive Wassermann reaction. Six examinations of the spinal fluid all showed increase of cells, varying between 14
and 41. The albumen was usually increased about twice over normal.
The colloidal gold reaction was always that of a typical paretic process.
The Wassermann reaction was always strongly positive. Death occurred
from cystitis and infection from a deep decubitus about 4 months after
admission. The study of the nervous system gave the following results.
The brain at autopsy weighed 1310 grams. Characteristic histological
changes of general paralysis were present throughout the cortex, but
varied greatly in intensity in different regions. The pia was slightly
thickened and in only isolated places were plasma cells present. There
was a moderate purulent meningitis present in all regions. In the left
frontal and left temporal regions the changes were of extreme severity.
Here there was marked distortion of the normal architecture and vessel
infiltrations were intense. Nerve cell degenerations were severe and rod
cells numerous. In other regions the changes were extremely slight.
The spinal cord showed a characteristic tabetic type of dorsal column
degeneration. The distribution of the changes in the brain is of much
interest in view of the clinical symptoms.
CEEBBROSPINAL SYPHILIS.

Seven cases, admitted during this biennial period, were classified as
syphilis of the central nervous system of the non-parenchymatous form.
It is interesting to note that, of these 7 cases, six were females and 1 case
remaining from the proceeding period was a female.
The relation of these to total admissions was:
Male.

Female.

Total.

No.

Per cent.

No.

Per cent.

No.

Per cent.

206
1

' '6'4s' '

278
6

' ' z.ih' '

484
7

' ' i '. 45

67

PSYCHOPATHIC HOSPITAL.
AGE.

The average age at time of onset of the disease for the females was
39.7 years.
Age.

Admission.

Onset.
M.

30-34 . .
40-44

F.

1

M.

T.

2
4

1

3
4

T.

F.

3

2
4

4

PRODRO-MAL PERIOD.

In 2 of the 7 cases admitted the date of primary infection was not
known. Of the other 5 cases the interval between date of infection and
onset of symptoms was given as 3, 5, 10, 8 and 9 years.
HEREDITY.

Of the 7 cases admitted, 4 gave negative histories of hereditary factors
among antecedents or collaterals; two gave instances of insanity of direct
antecedents and 1 gave a history of apoplexy in a female collateral relative.
CLINICAL.
In 3 cases of this group, the symptoms were mostly due to vascular
involvement and in 4 cases the symptoms were of the meningeal type.
NEUROLOGICAL CONDITIONS.

Pupil.

[Irregular
Unequal
Reaction sluggish
[Reaction absent

Knee reflex

5
4
5
»

2

(Absent.. .
•! Unequal. .
I Increased.

Speech defect

6

Babinski on both sides.

1

Tremor..

Hands
Tongue
Both..

Apoplectiform or epileptiform attacks

6
5
. 5
2

One case had the knee reflex absent on one side and increased on the
opposite side. The same case had absent pupillary reflex on the right
side and sluggish on the left.

68

STATE OP MICHIGAN.
SEROLOGICAL TESTS.

Colloidal gold curve.

Wassermann
Cells
Number

C.S.P.

2014. .
2027
2036 . . .
2294

2320
2324
2330

....

++

1

|j

""

Esbach
Before treatin't After treatment.

+
+
++ I 1 1 1
1
1 _|_ _|_
_|
[_
+
1

Apelt

O.S.F.

Blood.

1

_j

|

I

+ ++ +

.06
10
.09
04

11122100000
45553321000
11232220000
01223210000

11122210000
22343300000
00133321000
00122100000

5+

08

5+

.06
.08

11223332000
12234321000
00000000000

11233100000
11233210000
00122100000

2
25
18
2

2+
10 +
2+
2+

94
31
21

2+

Case 2330 gave a negative Wassermann test after a course of treatment.
RESULTS OF TREATMENT.

Of 4 cases discharged, including 1 case remaining from the preceding
biennial period, all showed great improvement except 1, and all were
returned to their homes. The treatment of cases of cerebrospinal syphilis
was essentially the same as for general paralysis. Experience has shown
that energetic treatment of cerebrospinal syphilis gives much better
results than treatment of general paralysis from which fact the conclusion
has been derived that the tissues affected in the non-parenchymatous
type of syphilis are much more accessible to medication than in the
parenchymatous type.
The average period of residence of patients of this group was 152 days.
TABES WITH PSYCHOSIS.

One case of Tabes with mental symptoms was admitted. The mental
symptoms were those of hysteria with anxiety attacks. This patient
would not remain for a sufficient period of treatment and was discharged
against advice as unimproved. This was the patient's second admission
because of hysterical symptoms.

ALCOHOLIC MENTAL DISORDERS.
Ten patients, all males, whose mental disorders were attributed to the
excessive use of alcohol, were admitted during this period. This is only
55.5% of the number of cases, classified in the same group, admitted in
the preceding period and was only 4.85% of the total male admissions
and 2% of total admission of both sexes. This is a decrease of 1.9% in
the admission rate of this class of mental disorder as compared to the
preceding period and practically the same decrease as shown in the
preceding period.

PSYCHOPATHIC HOSPITAL.

69

CLINICAL GROUPING.

F.

M.
Acute alcoholism
Delirium tremens
Korsakow's psychosis .
Chronic alcoholism

.

1
0
1
8

.

Two cases had had previous attacks and 2 cases had had previous
institutional treatment for alcoholic mental disorders. Wassermann
tests on the blood of all cases were negative.
HEREDITY.

Atavistic.

Direct.
M.

P.

T.

Insanity
Apoplexy

1

0

1

Psychopathic . . .
Alcoholic

3

0

3

M.

F.

Brothers
and
sisters.

Collateral.

T

M.

F

T

-

Total heredity

Negative . .
Unknown

Total . . .

M.

F

T

Total.

T

0

1

3

0

' '3

4

0

4

3
3

0
0

3
3

10

0

10

No.
of cases.
6

Unequal

0
5
2
0

Pupils:
Unequal

2
0
2

0
Achilles-tendon reflex :

T

1

N E U R O L O G I C A L CONDITIONS.

Conditions.

F

1
1
0

STATE OF MICHIGAN.

70

RESULTS.

Recovered.

Acute alcholism

1

Chronic alcoholism . . .

2

Improved.

3

Unimproved.

3

Died.

1

Total.
1
1
8

The average period of residence for cases of this group was 48.6 days.
Six of these patients returned home and 2 were transferred to one of the
State Hospitals.
The clinical and laboratory report o'n the case that died is as follows:
Case W. S., 1887, male aged 59 at admission to this hospital. His
father had been insane and a sister was mentally and physically defective.
In early life was an excessive user of alcohol. He married and had six
normal children. At the age of 49 he showed evidences of cardiac disease.
These were not very troublesome until the age of 57 when he had periods
of dyspnoea and cyanosis. Under rest his condition improved. Three
months before admission the cardiac symptoms were severe. At all times
he showed a slight degree of memory impairment and there were episodic
occurrences of confusion. These led to his admission to this hospital.
The examinations then showed marked cardiac hypertrophy with dilatation, aortic regurgitation, and arrhythmia. Mentally he had a clear
comprehension but there was an extreme retentive memory disorder.
He was unable to learn the names of his physicians or nurses. He had a
tendency towards spontaneous confabulations and made up fanciful
accounts of recent experiences. While usually good humored, he became
irritable when opposed. There were from time to time acute attacks of
heart failure in one of which he died 4 months after admission.
The autopsy showed the following:—Cardiac hypertrophy. Weight
880 grams, ascites, mitral insufficiency, aortic stenosis, passive congestion
of the lungs, liver and kidneys.
The brain weighed 1465 grams. Its consistency was much softened
from a general oedema. The large arterial trunks were severely sclerotic.
Histological studies of the cortex showed: hyperplasia of the connective tissue of the pia mater, with moderate infiltration of phagocytic
cells. The medium sized and smaller vessels showed sclerotic changes.
The nerve cells in general showed but slight changes, but there were
isolated cells showing very severe alterations. These were sclerosed and
showed the axonal type of toxic reaction. The glia, both fibrous and
cellular, was increased and always of a regressive type. There were
rather numerous ameboid glia cells lying throughout the nerve cell layers.
The changes in the nervous system were indicative of a chronic toxic
process. They agree with changes not uncommonly met with in chronic
alcoholism.

PSYCHOPATHIC HOSPITAL.

DRUG INTOXICATIONS.
There were admitted 9 patients who were addicted to the use of narcotic
drugs. Six of these presented mental symptoms of a fairly definite
psychosis. Three patients showed little beyond the weakness of will
and character deterioration, commonly present in chronic users of drugs.
Seven cases were due to the chronic use of morphine; 1 to the use of
veronal, and 1 of chloral.
Cases of drug addiction formed 1.8% of all admissions:
Males.

Drug intoxications

Females.

No.

Per cent.

No.

206
5

2.4

278
4

Total.

Per cent.

1.4

No.

Per cent.

484
9

1.8

Seven patients used opium in some form. Five used morphine hypodermatically. The maximum quantity taken by any of these patients was
16 grams daily. One patient had for some time been taking 8 to 10
ounces of paregoric daily, and another 3 drams of the tincture of opium
each day.
The beginning of the habit with 4 patients was for relief from discomforts incidental to some physical or nervous disorder.
Results of treatment:
M.

Recovered
Improved
Unimproved .
Died
Remaining

T.

P.

3
1

2
1

1
0

0
1

5
2
1
1

The average duration of treament in the cases discharged as recovered
was 7 weeks The abstract and anatomical findings in the case that died
are here given:
Case A. D., 1954, a man aged 35, whose sister had epilepsy, was admitted
to the hospital by reason of addiction to morphine. At the age of 18
he contracted gonorrhoea. Treatment over a period of 7 years did not
bring a cure. Cystitis developed and an operation at the age of 25
brought little improvement. At this time he began the use of morphine
for relief of pain. At the end of a few months he was taking 4 grains
daily. This was gradually increased and for a long period he took 25
grains each day. For several years he had been a heavy drinker.
At his admission he was stuporous, and seemingly under the influence
of alcohol. He was restless and uneasy, movements were accompanied
by marked tremor and there was general muscular weakness. His

72

STATE OF MICHIGAN.

attention was distractible.. His comprehension was for the most part
clear, but on fatigue he soon became confused. He was unable to sleep.
The second morning he showed extreme apprehension. He was afraid
of the nurses or physicians. At times he was unclear and hallucinated.
He saw bats and flying creatures around him. There was extreme
physical prostration. Then he developed vomiting and a severe diarrhoea.
There rapidly developed a cardiac weakness, and death occurred on the
third day after admission.
The autopsy showed myocarditis, cardiac dilation, fatty degeneration
of the liver, passive congestion of the kidneys, acute dilation of the stomach.
The brain showed oedema of the membranes. The brain substance was
soft and wet, but otherwise showed no gross pathology Histological
studies of the brain showed hyperplasia of the connective tissue of the
pia-arachnoid without infiltration. The nerve cells were not definitely
altered from normal and the neuroglia was not pathological. The
pituitary body showed several relatively large cysts with colloid contents
lying between the nervous and glandular portions.
EPILEPSY.
Fourteen cases of epilepsy were admitted during the period. Twelve
of these were males and 2 were females. The entire number formed 2.8%
of all admissions.
In their clinical form 10 showed typical epileptic convulsions with
mental deterioration. Two of these were in etiological relation to head
injuries, both showing convulsions of a Jacksonian type. Two cases
were admitted in a state of mental unclearness. Both had at times
typical epileptic convulsions. Two cases had characteristic convulsions
without the existence of any definite psychic disturbance in the intervals
between attacks.
Hereditary factors were present in two-thirds of the cases.
The ages of onset and admission were as follows:
Onset.
M.
0- 4
5-9

10-14
15-19. .
20 24
25-29
30-34
35-39 . . . . . . . .
40-44
45-49 . . .
50-54. .
54-59
60-64. .
65-69

Admissions.
T.

P.

M.

F.

T.

1

0

1

2
3

0
0

2
3

1
2

0
0

1
2

3
1
0

0

3
2
1
2

2
2
0
1
1
1
1

0
0
2
0
0
0
0

2
2

1

0

1

2

1
1

0

2
1
1
1
1

PSYCHOPATHIC HOSPITAL.

73

Included among results of treatment is 1 case admitted in a previous
period:
M.

Unimproved
Died

3
8
1
I

F.

1
1
0
0

T.

4
9
I
1

An abstract of the case that died is here given:
Case R. H., 2238, Family History: Desertion by father during infancy.
Mother was nervous in disposition. As a child he was backward in
learning to walk. At the age of two he fell about 6 feet and was supposed
to have injured his spine. He stuttered for many years. In school
from the age of 6 to 12. He was extremely backward and at leaving
had only reached the third grade. At the age of 12 a trephine was made
in the right parietal bone for the purpose of relieving a supposed pressure.
Following this he appeared brighter and his speech defect was less marked.
From 15 to 27 he was profitably employed as an industrial laborer. He
then developed attacks of unconsciousness and periods of confusion in
which he would wander off. In January 1916 another trephine operation
was made, removing a button of bone from the left parietal bone. Three
days later there developed a paralysis of the right hand and face with
motor aphasia. After a week the aphasia and paralysis disappeared,
but from then on he was subject to attacks of Jacksonian epilepsy involving the right arm and face and sometimes the right leg. Then he developed
mental deterioration with depression and irritability. This lead to his
admission to this hospital. The chief points of interest concerned the
neurological feature of the case. There was present a tactile agnosia
of the right hand without motor paralysis. While there was considerable
loss of the appreciation of light touch in this hand, there was a total inability to name any object placed in the hand. When the same object
was placed in the left hand it was at once correctly named. At times he
complained of paraesthesia of the right hand. There were subjective
feelings of numbness and cold localized in a narrow band extending vertically through the right face over the vertex and down the right half of the
back. Both knee jerks were increased and there was a Babinski reflex in
the right foot. The Wassermann reaction on the spinal fluid and blood
was negative. Attacks of a Jacksonian type were frequent. At times
there were periods of confusion, and when at his best there was a characteristic epileptic type of mental deterioration.
Death occurred about three weeks after admission during a series of
convulsions.
The examination of the brain showed a defect caused by the second
trephine operation involving the middle portion of the left post central
convolution, and leaving the anterior central convolution intact. The
brain tissue in this place was broken down and adherent to the overlying dura.
Histological examination of this region showed the reactions characteristic
of softening with hyperplastic changes in the pia-arachnoid and dura.
Nerve cells had largely disappeared and the glia showed marked proliferative changes.

STATE OF MICHIGAN.

74

Several regions of the cortex away from the focal injury were studied.
In none of these were there normal relations. Nerve cells generally
showed changes of a toxic type. These varied from cells with slight
granular degeneration to others showing severe disintegration. Many
cells presented the changes characteristic of fibre injury. The protoplasmatic glia was present in excess and in all sections there were many
amoeboid forms of glia.

PSYCHOSES WITH MENTAL DEFICIENCY.
This series of cases, five in number, are grouped separately, because the
psychotic features are not so pronounced as the features of mental deficiency. Otherwise they could have been included under the various
psychoses without mental deficiency. In other words the psychotic
picture in each case is that of a brief or an episodic attack, and while
this attack may have been the factor that induced the relatives to bring
the patient to the hospital, yet during the patient's residence here, the
most pronounced feature was that of subnormal intellectuality or "hypophrenia."
The following table shows the form, and frequency relative to the
total hospital admissions for the period. The percentage of all cases is
approximately 1%.
Male.
,

With hypomanic features
With epileptiform features
With hysterical features

No.
0
1
0

206

Total.

Female.

Per cent.
0

4
0

No.
2
0
2
278

Per cent.
7
0
7

No.

2
1
2

Per cent.
4
2
4

484

Hereditary factors were reported in 4 of the 5 individuals, 3 in the
direct line; 1 showing insanity in the ancestry, and 2 showing hysteria.
Results of treatment, of course, have reference to the psychotic symptoms, and not to the mental deficiency. Two were discharged as
improved, and 2 as unimproved. One remained; none were removed to
State Hospitals.

PSYCHOPATHIC HOSPITAL.

75

MENTAL DEFICIENCY WITHOUT PSYCHOSES.
This group of cases, 10 in all being admitted during the period, includes
1 subnormal individual, and 9 definitely feebleminded. No idiots were
admitted. As mental deficiency is so manifestly in each case a restive
matter, and a matter of degree, no attempt is made to classify them as
"imbeciles," morons, "high,"-and "low-grade" "feebleminded," etc.,
etc. Social, economic, pedagogic, and physical factors all play so large
a part and in such complicated relationships, that the simplest grouping
possible seems to be the most helpful. The mental ages varied from
8.5 to 13.5. For statistical purposes they are grouped together in the
following table.
MENTAL DEFICIENCY
Male.
Per cent.

No.

Mental deficiency , .

.

206
3

...

Total.

Female.

1.4

No.

Per cent.

No.

Per cent.

278
7

2.8

484
10

2

In all they make up 2% of all admissions. Four are adults, and 6
are juveniles. The youngest age was 15, and the. oldest 41. Of the
juveniles, all except 2 were guilty of some delinquency; 3 females were
sexually del nquent.
Hereditary factors were present among 7 (63.6%) of all cases, and in
90% of all cases in which information was available.
The following tables show how the heredity is distributed:
Direct.

Atavistic.

Brothers
and
sisters.

Collateral.

Total.

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

F.

Subnormal
Feebleminded. . . .
Idiot
. .

0
1
0

0
4
0

0
5
0

0
0
0

0
0
0

0
0
0

0
0
0

0
1
0

0
1
0

0
1
0

0
0
0

0
1
0

0
2
0

0
5
0

0
7
0

Total heredity

1

4

5

0

0

0

0

1

1

1

0

1

2

5

7

1
0

1
1

2
1

3

7

10

Denied

Total

T.

STATE OF MICHIGAN.

76

Direct.

Atavistic.

Brothers
and
sisters.

Collateral.

Total.

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

F.

0
0
0

2
0
2
0

2
0
2
1

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

1
0
0
0

1
0
0
0

0
0

0
0
0
0

0
0
1
0

0
0
1
1

3
0
2
0

3
0
3
1

2

5

7

Unknown

1
0

1
1

2
1

Total

3

7

10

Insanity
Apoplexy or paralysis
Psychopathic. . . .
Alcoholism

1

1

0



Total heredity

T.

RESULTS OF TREATMENT.

The following table shows the results of treatment; as would be
expected none improved or recovered. What benefit might come from
M.
0
0
1

Died

0
2

F.

T.
0
0
7
1
0

0
0
8
1
2

hospital residence must necessarily be in regulated habits, and consequent physical improvement.
Of those discharged, 5 returned to their families, 1 was transferred to a
State Hospital, 2 to the custody of the court, and 1 died.
The case which died showed the following clinical history and pathology.
Case 1900. Female, age 15. Father and paternal grandfather both
insane. Mother feebleminded. Seven siblings of the patient all subnormal. The patient was slow in development during childhood, and
did not talk until 4 years old. In spite of this she was the main support
of the family at time of admission. Physical stigmata: absent nipples.
Developed Pott's disease during residence in hospital. Blood Wassermann negative.
Wassermann on fluid negative. Gold sol. curve,
11110000000.
Mental examination negative except for definite evidence of mental
deficiency. Mental age 8 years + . Died three weeks after admission
of an intercurrent tubercular meningitis.
Autopsy showed, in gross findings, the following: Apex of left lung
firmly adherent. Abdominal organs negative except spleen which was
large and adherent to stomach and mesentery, at lower pole and around
the hilus. Brain removed—. Calvarium rather thin, otherwise negative.

PSYCHOPATHIC HOSPITAL.

77

Histological examination of brain and cord showed: Process in the cord
is characteristic of a severe tubercular compression myelitis, with the
associated tubercular pachymengitis. The pia-arachnoid over the
cortex shows the beginning of meningitis, undoubtedly of tubercular
origin. Nothing of importance relative to the mental subnormality was
observed unless it was the difference in the thickness of the two hemispheres, the left measuring 11 c.m., the right 10 c.m.
PSYCHONEUROSES.
There were admitted 39 patients whose mental disorder belonged
in the group of neuroses and psychoneuroses. Of these eleven were males
and 28 females. This number formed:
Female.

Male.

'

Per cent.

No.

206
11

5.3

Total.

No.

Per cent.

No.

Per cent.

278
28

' 'io'i' '

484
39

8.0

These cases were distributed among the various clinical types of these
disorders as follows:
*

M.

F.

1
2
6
2
0

T.
1

0
0
12
15
1

2

18
17
1

Information concerning hereditary influences was obtained in 71
instances. In 23 families of this group there were 40 individuals who had
shown mental or nervous abnormalities. The following table gives details.
Direct.

Apoplexy and
Psychopathic. . . .

Total heredity

Total

Atavistic.

M.

F.

T.

M.

F.

T.

0

3

3

0
1

2
1

2
2

1

1

4

5

3
1

4
1

7
2

4

8

12

4

8

12

1

1

4

Brothers
and
sisters.

Collateral.

5

M.

1

1

I

F.

1

1

1

T.

2

2

2

Total.

M.

F.

T.

0

2

2

' '6'
0

M.

F.

T.

7

7

1
6
3

2
10

1
1

i
i

1
4
1

4

4

6

17

23

3
2

9
2

12
4

11

28

39

4

4

4

78

STATE OF MICHIGAN.

The ages at the onset of the nervous symptoms and at admission of
the cases of this group as a whole were:
Admission.

Onset.
M.

F.

1
0
5
1
0
2
0
2
0

10-14
15-19
20-24
25-29
30-34
35-39. .
40-44
45-49
Unknown

T.

6
3
3
4
4
2
2
1
3

M.

7
3
8
5
4
4
2
3
3

HYSTERIA.

F.

0
0
4
3
0
1
0
3

T.

3
3
5
3
3
7
3
1

3
3
9
6
3
8
3
4

_

The clinical course of 18 cases was that of various hysterical manifestations largely of a conversion character.
Four of these cases had convulsions at some time during thair course.
Seven showed episodes of unclearness. Two of these had fugues lasting
from a few hours to several weeks. Two cases were of a traumatic type,
the symptoms developing immediately following an accident.
PSYCHASTHENIC TYPE (Anxiety Hysteria).
Seventeen cases belonged in this group. In all there were noted either
frank attacks of anxiety, or various mental or nervous manifestations
that at some time or other had relations to anxiety episodes.
HESULTS OF TREATMENT.
Recovered.
M.

Total

F

Improved.

Unimproved.

Remaining.

T.

M.

F.

T.

M.

F.

T.

M.

F.

7
3
0
2
1

7
6
1
0
0

14
9
1
2
1

0
0

2
6

2
6

0
0

1
2

1
2

27

0

8

8

0

3

3

1
0

3
2

4
2

1

5

G

13

14

T.

PSYCHOPATHIC HOSPITAL.

79

PSYCHOPATHIC INFERIORITY.
In 48 patients there was present a constitutional state of mental instability that had resulted in failures to meet successfully common experiences in life or to adapt themselves to social regulations. These failures
were not'due to intellectual deficiency nor to the presence of one of the
principal psychoses. They resulted rather from an inherent weakness of
character, to lack of emotional control or to more or less well defined
paranoid traits.
Male.
No.

Psychopathic inferiority

206
21

Female.

Total.

Per cent.

No.

Per cent.

No.

Per cent.

10.2

278
27

9.7

484
48

''gig

In 27 of these, 11 males and 16 females, the mental reactions of the
individual at the time of his admission were of such a character as to
indicate the existence of a more or less well-defined psychotic disorder.
In most instances these were transitory in their occurrence, and manifested
themselves as outbursts of emotional excitement with disorderly behavior,
or unusual behavior with paranoid traits. These cases were in the general
statistical tables of this report, considered as belonging among the group of
psychoses.
Among those showing psychopathic inferiority there were 21 patients
in whom the mental abnormalities, manifested previous to admission and
while under treatment, were more those of their inherent consitutional
peculiarities rather than an acute psychotic episode. The larger number
of these were under 25 years of age. In most instances these had come
into conflict with home discipli ne or had been involved in various criminal
delinquencies. A considerable number of this type had entered the hospital
from its out-patient services.
AGE AT ADMISSION.
With psychoses
M.

10-14. .
15-19
20-24
25-29
30-34
35-39
40-44. .
45-49
50-54
55-59
60-64 . .

1
1
1
0
0
2
3
0
0
2
1

F.

1
1
3
2
2
1
1
4
1
0
0

Without psychoses
T.

2
2
4
2
2
3
4
4
1
2
1

M.

F.

T.

1
1
7

0
1
6

1
2
13

1
0
0

0
1
3

1
1
3

80

STATE OF MICHIGAN.

Hereditary nervous or mental factors were present in 73.3% of these
cases regarding which information was known.
Direct.

Atavistic.

Brothers
and
sisters.

Collateral.

Total.

M.

F.

T.

M.

F.

T.

M.

F.

T.

M.

F.

T.

Insanity
Apoplexy and
paralysis . .
Psychopathic. . . .
Alcoholism .

2
1
2
3

3
0
2
6

5
1
4
9

1
1

0
0

1
1

4

5

9

0

1

1

1

0

1

Total heredity

8

11

19

3

0

3

M.

F.

T.

7

9

2
2

4

0
2
7

16
2
4
11

15

18

33

Unknown

6
0

6
3

12
3

Total

21

27

48

4

5

9

1

0

1

The results of treatment in the two groups of patients were:
Psychoses with Psychopathic Inferiority:
M.

Recovered
Unimproved . .
Died
Remaining .

1

.

5
5
0

F.

T.
1
18

0
13
6
1

n

1

Psychopathic Inferiority without Psychoses:
M.

Recovered
Unimproved
Died

7
4

F.

T.

5
5

12
9

1

1

Of those discharged, 11 were returned to their homes and 10 passed into
efficient custody.

PSYCHOPATHIC HOSPITAL.

81

PSYCHOSES WITH SOMATIC DISEASES.
In this group are placed 19 cases in which the mental disorder was in
close etiological relation with some somatic disease. In the larger number
of instances this disorder was of an infectious or exhaustion type.
In 18 cases the etiological factors were fairly definite. In 4 cases the
symptoms and course were those of a toxic disorder but the nature of
the process could not be determined.
This group formed 3.9% of all patients admitted.
Male.
No.

Hospital admissions
Psychoses with somatic diseases

206

7

Female.

Total.

Per cent.

No.

Per cent.

No.

Per cent.

' s'i'

278
12

4.3

484
19

3.9

M.

F.

The etiological relationships were as follows:

Psychosis with pellagra . . . .

1
1
0

0

1

0
0

1

0
2

T.

0

1

5
2
1
0
1
0
0
1

6
2
1
1
1
1
1
1

4

2

AGE OF ADMISSION:
M.

20-24
25-29
30 34
35-39
40-44
45-49
50 54

.

.

..
. .
. ...
.

.

.

.

T.

1
0
1
0

2
1
3
3

3
1
4
3

0

3
0
0

3
1
4

1

.

F.

4

STATE OF MICHIGAN.

82

Hereditary factors were present in 52% of cases in this group. In
10 families there were 27 individuals who had shown some nervous or
mental abnormality.
1

Atavistic.

Direct.

M.

Apoplexy and
Psychopathic. . . .

1 1 Total heredity

Total

F.

T.

1

1

2

1
1
1

0
3
0

1
4
1

4

4

8

3

6

9

6

10

13

M.

F.

Brothers
and
sisters.

Collateral.

T.

M.

F.

T.

0

2

2

0

0

2

2

M.

F.

Total.

T.

M.

F.

1
1
1
1

3
0
3
0

4
1

4

6

10

3

6

9

7

12

19

2

2

T.

4
1

RESULTS OF TREATMENT.

M.

3
4
1
2
0

Died

F.

T.

4
3
2
2
1

7
7
3
4
1

In this group there was a relatively larger number that died than in
any other group.
PSYCHOSIS WITH PELLAGRA.

Case S. G., 1835, Male aged 68. Unknown family history, foundry
worker by occupation. At the age of 66 he had several operations for
hemorrhoids and following these a gradual physical decline. It was
observed that he looked yellow and waxen and that the skin of his hands
was dry. Several months after his admission to this hospital in May 1916
there were symptoms of mental disorder. His thought at times was incoherent. His memory was severly impaired and finally he became unable
to properly care for himself. He entered the Dermatological Clinic of
the University. At that time he showed a dermatitis of both hands, diarrhoea and advanced mental deterioration. A diagnosis was made of pellagra
with mental disorder. He was transferred to the Psychiatric Clinic. The

PSYCHOPATHIC HOSPITAL.

83

skin on the hands, feet and face was deeply fissured and pigmented, and
the skin over his body was of an appearance resembling ichthyosis.
Bowel movements were frequent and often bloody. The Wassermann
reaction on the blood was negative. The cerebrospinal fluid showed no
increase of cells or albumen. The Wassermann reaction on the spinal
fluid was negative. The blood and urine were not pathological.
Mentally he was unclear in comprehension, at times much disturbed
by visual hallucinations, marked disorientation. Generally he was dull
and mildly stuporous. At times he was for brief periods somewhat more
alert and would respond to questions, his replies showing an unclear
comprehension and disorientation. His physical failure was progressive.
The skin condition became somewhat improved, but his general strength
was weakened. About 3 weeks after his admission he developed coarse
tremors, especially marked on fatigue. Often there were choreiform
movements of the arms and hands. Failure was continuous and death
occurred five months after his admission.
The nervous system presented the following changes: The brain
showed no gross abnormalities. In microscopical studies the pia was
slightly thickened and showed many small endothelial thickenings on its
free surface. The lymph spaces of the pia-arachnoid contained many
small lymphocytes and similar cells were rather numerous in the adventitial spaces of the small cortical vessels, especially in the medullary
portion of the convolution. Isolated plasma cells were present in the
pia-arachnoid and there were large numbers of medium sized phagocytic
cells and a few megaloblasts. The nerve cells of the cortex were generally
more pale and more homogenous in structure than under usual conditions.
An occasional cell showed a characteristic axonal type of reaction. The
glia in the molecular layer of the cortex, both fibrous and cellular, was
considerably increased and showed regressive changes. The protoplasmatic glia was much increased in the medullar part of the convolutions
especially in the cerebellum and around the blood vessels.
The spinal cord showed large numbers of corpora amylacea, chiefly
in the dorsal columns. In these regions there was an increase in the
fibre-bearing glia cells. .
The histological changes in the central nervous system were those
of a parenchymatous degeneration of a toxic type, and infiltration and
hyperplastic changes of a subacute inflammatory reaction in the interstitial tissues.
PSYCHOSIS WITH TETANY.

Case G. C., 2274, a man.aged 46 at his admission to this hospital.
In disposition he was good-natured, abstinent from alcohol and was
never regarded as nervous or mentally ill until recently. At the ages
of 31 and 34 he had a Neisser infection and a luetic infection at the age of
42. At the age of 42 he had a sharp pain below the right knee cap.
Soon afterwards as he walked his right foot dragged and the muscles
of the leg "knotted up." The muscles of the right leg gradually became
stiff, and later the leg became similarly affected. This condition grew
progressively worse until about two years before admission, when his
eyesight began to fail. At times he would have attacks of sudden contractions in the leg muscles that caused him to fall to the ground. In
some of these the entire body was involved; his legs and arms would be

84

STATE OF MICHIGAN.

flexed on his trunk and his back bent forward. In the following months
he progressively lost more control of his muscles. Tetanoid attacks were
frequent. About six months before admission he had a sudden attack
of confusion in which he was extremely unclear and unable to help himself.
At times he was agitated and expressed an apprehensive content of thought.
This condition continued for several weeks, when there were at intervals
periods of clearness and later he was continuously clear, but there persisted an impaired memory The tetanoid contractures gradually became
more general and severe. He became quite helpless and was brought to
the General Hospital of the University. Soon after his admission there he
became unclear and finally he passed into a stupor in which condition he
entered this hospital.
The physical examinations showed him to be moderately well nourished
with a general hypertonicity of the muscles of the body. The skin over
the back and hands was atrophic with beginning trophic erosions over the
shoulders and back. The gums of the lower jaw were ulcerated, moderate
inguinal and cervical adenitis. Heart and lungs were not abnormal.
Blood pressure was 130 systolic and 90 diastolic. Moderate leucocytosis.
The blood gave a negative Wassermann reaction. The cerebrospinal
fluid showed no pathological changes. The urine contained many
hyaline casts, but no albumen.
The neurological abnormalities were: irregular pupils, arteriosclerotic
changes of the fundus of the eyes, sluggish pupillary reactions, tremors
of the lids, tongue, lips and extremities, marked dysarthria, extreme
hypertonicity of all muscles, increased tendon reflexes, Babinski's sign
in the right foot. Three days later all tendon reflexes were greatly
decreased. There was almost constant twitching of the muscles of the
hands, arms and face. At brief irregular intervals there were tonic
contractions of the muscles of the body and extremities. These could
sometimes be elicited by tapping the muscles. There was no control
of the sphincters.
Mentally he was always unclear and usually deeply stuporous. At
times he was extremely apprehensive. The stupor deepened and death
occurred 1 week after admission.

DELIRIUM OF UNKNOWN ORIGIN.

Case F. K., 2310, a woman aged 31 at her admission. So far as known
her family and early personal history showed nothing notable. She was
married at 18 and owing to the conduct of her husband was soon divorced.
Two months after this she remarried and.by this marriage had one miscarriage, and had one living normal child. Temperamentally she was
always impulsive, easily angered and difficult to get along with. Aside
from occasional episodes of temper and irritability there were no pronounced mental difficulties until about a month before her admission.
She then became over-active and talkative. She at times complained of
headache and sometimes appeared confused and unclear as to her surroundings. Showed an extreme jealousy of her husband and developed
a paranoid content of thought. These centered about her husband,
with ideas of poisoning and hypnotism. She refused food. She could
not sleep and was given rather frequent and heavy doses of chlorotone.
At her admission she .was deeply stuporous and quite helpless. The
physical examination showed that she was well nourished. The pulse

PSYCHOPATHIC HOSPITAL.

85

was always rapid and weak, varying between 120 and 160. The blood
count showed 12,695 leucocytes with 74% polynuclears. The urea
content was a little increased, 0.58. The Wassermann reaction was
negative. The urine showed an excessive amount of indican and acetone.
Blood cultures were negative. The cerebrospinal fluid was not pathological. The fundus examination showed neuro-retinitis of both eyes
and a slight swelling of the left nerve head. The knee jerks were about
normal until a few hours before death when they could not be obtained.
There was double ankle clonus. The pupils varied in width at first
were almost pinhead in size, and later they dilated widely and remained so
with only slight reaction to light. The last few days of her illness showed
a slight internal strabismus.
On a few occasions there were slight haemorrhages from the bowels.
A week after her admission there was a sudden rise of temperature to
103.4 and a fall to normal the next day, and never again rising. A few
weeks later she developed an acute otitis media. This seemed to be
entirely localized in the ear and yielded well to treatment. Mentally
she continued in deep stupor. Only on a few occasions when irritated
did she show any spontaneous talk or interest and then only for a brief
period. She was during her entire residence fed mechanically. There
was a progressive physical failure and death occurred 25 days after her
admission.
The autopsy showed the following: A few scattered small pus cavities
in the right lung. The heart was not pathological. The liver showed
many small pin-head sized whitish areas scattered through its substances.
Otherwise the body organs showed no gross pathology. The brain
weighed 1190 grams. In appearance and topographical relations it
showed no gross abnormalities. Histological studies showed extreme
changes in nerve cells of all regions. These were swollen and their
granular contents were pale and atrophic. The glia cells were increased
in number around the smaller blood vessels and many had undergone
retrograde changes. The changes as a whole were such as are occasionally
met with in toxic disorders affecting the nervous system. The liver
showed a most extreme degree of fatty degeneration. This affected the
parenchymal cells in all parts of the lobules. To a lesser degree the
kidney parenchymal cells showed the same changes.
While the etiological agent in this case was unknown, the changes within
the nervous system and body organs were definitely toxic in character.
Case M.M., 1991, age 22 at admission. She was backward in childhood development, not talking till the age of four. In school she showed
mental retardation and at the age of 17 she had only advanced to the
fifth grade. After school life she remained at home; there was regarded
as "odd, a poor eater, and unusually dependent on others."
Three weeks before admission she became irritable and over-active.
She talked much, spoke of hearing voices. This condition brought about
her admission to the hospital.
The examinations showed her to be poorly developed physically and
showing a number of stigmata of deviation. The teeth were badly
decayed and the lips and tongue covered with sores. The skin over the
body showed an erythematous blush. ' The thyroid was much enlarged.
There was a loud systolic heart murmur. The urine showed a trace of
albumen and many hyaline and a few granular casts. The blood at the

86

STATE OF MICHIGAN.

early examinations showed a slight leucocytosis. Later on this was more
pronounced. The Wassermann reaction was negative. The spinal
fluid showed four cells and a slightly increased albumen content. The
tendon reflexes were greatly increased. There was double ankle clonus
and a frequent fibrillary contraction of the muscles of the trunk and
extremities.
During the first few days she was clear in comprehension and her
distractibility and over-activity suggested a manic excitement. Later
she progressively became more unclear and her condition was that of a
delirium. With this unclearness there occurred a slight rise in temperature, leucocytosis and albuminuria. At no time during the course
did the temperature exceed 99.4 degrees. At times there were evidences
of cortical irritation such as muscular twitchings and choreiform movements, and a general increase in muscular tonus. There was progressive
physical failure and death occurred three weeks after admission.
The autopsy showed: chronic vegetative endocarditis of the mitral
valve, cystic degeneration of the thyroid gland. The brain weighed
1180 grams. The pia-arachnoid showed a number of haemorrhagic
effusions. The longitudinal sinus of the dura showed a large thrombus
in its posterior portion with extensions into the confluent veins and into
the right lateral sinus and right internal jugular.
Histological studies of the internal organs showed a chronic fibrous
thickening of the edge of the mitral valve, multiple small haemorrhages
in the liver, and an occluding septic thrombus of the longitudinal sinus
of the dura.
The nerve cells of the cortex as a whole were fairly normal. Some cells
showed acute swelling and a few showed severe disintegrative changes
of the cell granules. The chief interest lay in the condition t>f the blood
vessels. The larger veins of the pia were completely closed by thrombi,
some advanced in process of organization. There was in many vessels
of the pia a marked proliferation of the fibroblasts in their walls. The
connective tissue of the pia showed very marked proliferative changes.
The reactions in the brain were probably all secondary to the vascular
disturbance.
PSYCHOSES WITH BRAIN TUMOR.

There were admitted 7 cases of brain tumor with mental disorder
during this period. Four of these were males and 3 were females. This
number included 1.4% of all cases admitted.
Four cases were discharged unimproved and 3 died. Brief abstracts
of the clinical course and pathological findings are here given:
Glioma of left posterior frontal region:
Case M. B., a woman aged 60 at her admission. Six weeks previous
to this she had a sudden attack of confusion with almost total motor
aphasia. She could only repeat "yes" or "no." Her confusion soon
passed away but the aphasia persisted.
At her admission there were few notable abnormalities of the body
organs. The heart was a little enlarged to the left. The blood pressure
was 140 systolic and 80 diastolic. The blood on two occasions showed
a moderate leucocytosis. Wassermann's reaction on the blood was
negative. The neurological disturbances were: residuals. of a slight
right hemiplegia, weakness in muscular power of right hand and leg,

PSYCHOPATHIC HOSPITAL.

87

increased right knee jerks, Babinski's reflex was present in the left foot
but not the right. There was almost a total motor aphasia. She could
repeat a few monosyllables and familiar words. Usually she would
repeat part of the question, but beyond this there was little spontaneous
speech. She understood many simple questions, recognized familiar
objects, but could not name them. She could not read nor write. Most
of the time she was dull and stuporous. The right hand became completely helpless. She gradually became comatose and died three weeks
after admission.
The autopsy showed a gliomatous tumor of large size involving the
foot of the left third frontal convolution, the operculum and the region
up to the left lenticular nucleus.
Histological studies showed the tumor to be composed of closely
packed glia cells with larger numbers of intermixed glia fibres. In
places the cells had broken through the margins of the cortex and extended
out into the arachnoid lymph spaces. In many places the tumor had
undergone regressive changes with formation of small cystic cavities with
colloid contents. The nerve cells of the cortex away from the region of
the tumor were oedematous and showed considerable fatty degeneration.
Glioma of frontal lobes:
Case A. 0., 2309., a male aged 44 at his admission. Six months earlier
he developed severe headaches which became so severe as to force him
to give up his work. He showed at about the same time a definite mental
change. He became more dull and often fell asleep in his chair. He
expressed delusions of suspicion and feared that he was being harmed and
pursued. At times he would show brief episodes of confusion and unclear
comprehension.
At his admission the chief physical disorders were residuals of an old
fracture of the left leg and a mitral insufficiency.
The neurological abnormalities were: headaches, choked discs with
haemorrhages of the retina in both eyes, evenly contracted visual fields,
tremors of the hands, hypotonus of muscles of arms and legs, normal
tendon reflexes, at times loss of bladder and bowel control. No disordered
sensibility. His attitude and behavior was of one physically weak.
His comprehension varied. During the first few weeks it was generally
clear but at intervals there were brief episodes of inability to understand
questions on his situation. Towards the last he gradually became more
dull and stuporous, finally becoming comatose. The stream of thought
was slow and at times somewhat rambling. Memory was inaccurate
for both recent and remote experiences. The content of thought was
generally fairly normal in its relation to his situation, and at other times
showed a marked paranoid trend with fairly well elaborated delusions
of suspicion. This mood was usually good humored, often jocose. At
other times he was dull and apathetic. As there was definite evidence
of intracranial pressure, two decompression operations were done.. These
were followed by a slight improvement in the fundus changes, but mentally
he became more dull and finally deeply stuporous. Towards the last
.he developed a severe and continuous hiccoughing. Death occurred
following several days of coma.
The autopsy showed a large gliomatous tumor involving the septum
and anterior region of the fornix and extending out into the central
substance of the right and left frontal regions and into the lateral ventri-

88

STATE OF MICHIGAN.

cal cavities. The tumor in places showed many small cavities filled
with a colloid like substance and a few with recent haemorrhages. The
cavity of the acqueduct was entirely occluded by proliferation of the
neuroglia.
Histological studies of the tumor showed it to be a glioma with two
quite different methods of growth, one very slow in its development in
which enormous masses of fibres are present. These in places had
undergone degeneration, with haemorrhages and softening, which has
lead to the production of large amounts of connective tissue. The other
type of growth is a very rapid proliferation of neuroglia cells with practically no glia fibres or connective tissue formation.
The cortex in the regions of decompression showed severe changes.
The pia was packed with infiltrating cells, mostly small lymphocytes.
All the vessels adjacent to the area of injury showed proliferative changes
of their endothelial cells. The nerve cells were seriously altered from
normal. Many have degenerated and disappeared. The neuroglia
cells were increased in size and numbers. Large numbers of rod cells
were scattered through the cortex.
The cortex aside from the areas affected by the decompression operation
showed a pia mater comparatively normal in thickness, but with spots
where the endothelium was in early stages of proliferation. The nerve
cells were all pale and oedematous.
Glioma of the right occipital lobe:
Case A. H., 1917, a man aged 54 at his admission to this hospital.
Nervous or mental abnormalities do not appear to have been present
until the age of 53, when, following what was called an attack of influenza
he developed herpes zoster. The pain from this was intense and he
lost much in weight. He was admitted to the University Hospital where
a diagnosis of multiple neuritis was made. The skin condition seems to
have improved but there developed severe headaches and a failing of
vision. There gradually progressed a motor weakness and loss of sensation in the left arm. Later this involved the left leg and foot. Three
weeks before his admission to this hospital he became greatly depressed
and threatened suicide. His memory became poor and his comprehension slowed and at times unclear.
The physical examination at his admission showed him to be much
under-nourished. There was a leucoderma involving the skin over the
greater part of the body. The skin over the backs of the hands was
atrophic. The scars from the previous herpetic eruption extended around
the right side between the 9th to 12th ribs. Heart and lungs were
normal. Blood pressure was 135 systolic and 90 diastolic. Urine, and
blood Wassermann were negative.
Neurological abnormalities were striking. There were Romberg's
symptoms. The gait was ataxic. Both legs were somewhat spastic
and the left leg was weak in its motor force. At rest the right leg was kept
flexed on the body. The arm and knee jerks were increased and somewhat
more on the right than the left side. The left Achilles jerk was absent.
There was no definite Babinski's sign. On the left side of the body from
the neck to the anterior part of the sole of the foot there was complete
loss of touch sensibility. Pain appreciation was absent over the anterior
and outer surfaces of the left upper arms. Astereognosia of the left hand.
No sense of position of upper or lower extremities. Both fundi showed
swelling of the dies and there was left homonomous hemianopsia.

PSYCHOPATHIC HOSPITAL.

89

Mental symptoms consisted chiefly of a mild depression and a tendency
towards stupor. He gradually became more dull and died after several
days in coma.
The autopsy showed a large brain weighing 1560 grams. There was
a larger area of tumor substance filling in the central part of the right
occipital lobe. While the posterior limb of the capsule seemed uninvaded
by the tumor its position was so close to the position of the sensory
radiations that they might well have been injured by the growth. Posteriorly and externally the tumor extended into the surface of the cortex.
In consistency the tumor was firm. In many places it showed small
cysts of degenerations and scattered haemorrhages.
Histological studies showed the tumor to be a rapidly growing glioma.
It was composed of thickly packed glia cells of every size and shape.
Mitoses were numerous.
PSYCHOSES WITH CEREBRAL ARTERIOSCLEROSIS.

In 11 patients admitted tthis mental disorder was due to structural
changes in the brain associated with arteriosclerosis of its blood vessels.
Five of these were males and 6 were females.
These cases formed 2.3% of all admissions.
Male.

Female.

Total.

No.

Per cent.

No.

Per cent.

No.

Per cent.

206
5

• '2' 4' '

278
6

2.2

484
11

2.3

Hereditary factors were present in 7 of 8 cases in which information
was obtained. These all occurred in the parents or brothers and sisters
of the patient. In these seven families there were 23 abnormal individuals.
The earliest age of onset was between the years 30 and 34. Two-thirds
of the cases developed between the 45th and 60th year.
In 7 cases the patients had at one time or another attacks of an apoplectiform or epileptiform type. Heart murmurs were present in 6 cases.
Increased systolic blood pressure was present in 9 cases. In 3 cases the
pressure ranged between 110 and 150. In 5 between 160 and 200, and in
3 between 210 and 240. In 8 cases arteriosclerotic changes were present in
the vessels of the fundus of the eye.
In 8 cases the cerebrospinal fluid was examined. The cells in these
ranged in numbers between 2 and 8. All had negative Wassermarm
reactions.
RESULTS OF TREATMENT.

Recovered . . . .
Died

M.

F.

1

5
1

T.

6
8

90

STATE OF MICHIGAN.

Included among these are 3 cases admitted in the previous period.
Five of these cases were transferred to one of the other State Hospitals.
SENILE DEMENTIA.

There were admitted two men whose mental disorder was due to senile
brain atrophy. The ages of onset were 64 and 73, respectively. Both
were discharged in an unimproved condition.
TRAUMATIC PSYCHOSES

There were admitted 2 men in delirium that had its development following injury to the head. At their admission they were unclear, hallucinated, and confused in their thinking. Both cases made a complete
recovery, 1 after 2 weeks treatment and 1 after 4 weeks.
MULTIPLE NEURITIS.

Two women were under treatment with a mental disorder showing
unclearness, marked disturbance of retentive memory, and the neurological disorder of multiple neuritis. In neither case was the etiology
clear. Neither had used alcohol nor had they been exposed to any
toxic agent commonly producing multiple neuritis. One woman was
somewhat improved at her discharge, the other was unchanged.
UNDIAGNOSED PSYCHOSES.

There were under treatment 12 cases of mental disorder that could
not be definitely diagnosed. The reasons for this were largely too short
a period of observation, or lack of information regarding the early development of the disorder.
The number of this group admitted during the period formed 2.5%
of all admissions.
Male.

-

Total.

Female.

No.

Per cent.

No.

Per cent.

No.

Per cent.

206
1

' 'b'.b' '

278
11

' '4^9'

484
12

2.5

All of these cases were discharged in the period, three as improved,
8 as unimproved, and 1 died.

REPORT OF THE PATHOLOGICAL LABORATORY.
The laboratory of the State Psychopathic Hospital operates as a
central laboratory for all Michigan Hospitals for the Insane.
Its problems have been largely centered in the study of the nervous
system of such cases of mental disorder, as have been adequately studied
during life,

PSYCHOPATHIC HOSPITAL.

91

These studies have in many instances made it possible to have a clearer
understanding of the pathology associated with mental disorders, and
in their cumulative results will contribute much to the field of psychiatry.
The results of material sent from the State Hospitals are communicated
to the institutions interested and by this their medical standards are
improved.
The hospital makes Wassermann Examinations for all of the State
Hospitals and for the General Hospital of the University.
The number examined for the various State Hospitals is given in accompanying tables. •*

TABLE No. I.—Number of cases received between July 1, 1916 and June 30, 1918
and sources.
Year ending
Year ending
June 30, 1917. June 30, 1918.

Pontiac State Hospital
Traverse City State Hospital
Michigan Home and Training School Lapeer
University of Michigan Hospital

56
21

16
7
1
8

Total
for period

49
28
1

105
49
16
8

11
2

7

11
3
15

Total from Michigan State Hospitals . .
Outside sources

109
1

98
1

207
2

Total number received

110

99

209

STATE OF MICHIGAN.
TABLE No. II.—Clinical Diagnosis of cases studied in Laboratory.
Year
Year
Total
ending ending
June
30,
for
June 30,
1918.
Period.
1917.
Alcoholic mental disorder, chronic
Alcoholic mental disorder, Korsakow's psychosis
Alzheimer's disease
Amaurotic idiocy
Cerebral arteriosclerosis
Dementia praecox
Drug addiction
Epilepsy
Involution melancholia
Imbecility
Manic-depressive insanity
Myelitis, tubercular
Meningitis, purulent
Meningitis, tubercular
Non-psychotic, traumatic
Not insane
Paralysis agitans
Pernicious anemia
Pellagra
Senile dementia
.'
Syphilis, central nervous system, general paralysis
Syphilis, central nervous system, meningo-vascular
Syphilis, central nervous system, vascular
Syphilis, tabo-paresis
Traumatic psychosis
Toxic psychosis, undiflerentiated
.-.
Toxic psychosis, endocarditis
Tumor, central nervous system
Tetany
Material unstudied or undiagnosed
Cases diagnosed under two or more heads:
Arteriosclerosis and senile dementia
Arteriosclerosis and multiple softenings
Arteriosclerosis and brain tumor
Arteriosclerosis and syphilis
Alcoholic insanity and acute meningitis
Alcoholic insanity, chronic, and senile dementia
Alcoholic insanity, chronic and cerebral syphilis
Dementia, organic and trumatic epilepsy
Dementia praecox and multiple melanotic sarcomata
Huntington's chorea and tabes dorsalis
Senile dementia and epilepsy
Syphilis, general paralysis and acute meningitis
Syphilis, central nervous system, meningo-vascular, gummatous
Syphillis, central nervous system, vascular and general paralysis
Syphilis and tuberculosis
Total

2
0
2
•0
11
5
1
6
1
0
3
1
2
1
1
1
0
2
1
3
9
5
0
0
1
o
1
3
0
39

1
0
1
9
6
0
0
0
0

2
1
0
2
4
4
0
1
3
0
1
0
5
1
30

1
1
1
0
1
1
1
o
0
1
1
1
o
0
0
110

99

TABLE No. III.—Number of cases reported to the State Hospitals during the period.
This includes 54 cases received during previous periods but reported in this.
Kalamazoo State Hospital
Pontiac State Hospital
Traverse City State Hospital
Newberry State Hospital
Michigan Home and Training School, Lapeer.
Total number reported.

Number of Wassermann Tests made between July 1, 1916 to June 30, 1918.
Year ending
June 30, 1918.

Year ending
June 30, 1917.
C. S. P. Blood.

Kalamazoo State Hospital . .
.
Traverse City State Hospital
Newberry State Hospital
State Psychopathic Hospital
Ionia State Hospital
Wayne County Hospital
Michigan Home and Training School. . .

..
'

Blood.

1,840
452
389
346
367
17
305
94
233
228

915
190
30
78
175
35
0
8
2
0

3,617
755
590
555
694
135
529
289
1,408
433

4,532
945
620
633
869
170
529
297
1,410
433

IK
Kl
O

3,512

4,271

1,433

9,005

10,438

Q

1,485

13,942

15,427

2,918

22 , 947

25,865

O. S. F.

Blood.
1,327
355
362
299
304
13
305
86
233
228

2,290
400
228
256
390

2692
493
231
287
502

31
0
0
2
0

122
224
203
1,175
205

153
224
203
1,177
205

513
97
27
47
63
4
0
8
0
0

674

5,493

6,167

759

Total.

C. S. F.

Total.

402
93
3
31
112

Total for
period.

Total.

679

6,901

7,580

706

7,041

7,747

1,353

12,394

13 , 747

1,465

10,553

12,018

td
o
hj

w

O
02

94

STATE OF MICHIGAN.

REPORT OF THE SECRETARY AND BUSINESS OFFICER.

Ann Arbor, Mich., June 30, 1918.
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, 1918.
During this period the expenses of running the Hospital have been
considerably higher than they were for the two years just preceding.
By referring to the following tables it can easily be seen that this was due
almost entirely to the increased cost of food supplies and of hospital help
covered by the classification of the Medical Department. Both of these
increases were due to the conditions brought upon us by the war.
A small building was built for the housing of animals for the laboratory
at a cost of $773.90 but aside from that only the necessary repairs on the
building were made.
Our total number of patient days for the two years amounted to 41,634.
The average daily cost to the State per patient per day was $1.341, the
highest rate for any one month being $1.45 and the lowest rate $1.25.
DISBURSEMENTS.
ON ACCOUNT OF CURRENT EXPENSES.

July 1, 1916 to June 30,. 1918.
Food
Clothing
Laundry Expenses
Heating and Light
Medical Department
Office, Stationery, Etc
"
Amusement and Instruction
Furniture and Household Supplies
Improvements and Repairs
Miscellaneous Expenses
Refunds
'.
Total for Biennial Period.

$27,701
193
2,635
3,670
15,550
2,369
319
6,442
3,385
839
1,339

24
81
08
14
61
33
05
90
20
29
48

$64,446 13

PSYCHOPATHIC HOSPITAL.

95

DISBURSEMENTS.
ON ACCOUNT OP CLINICAL LABORATORY.

July 1, 1916 to June 30, 1918.
Officers' Salaries
Animal Food
Heating and Light
Medical Department
Amusement and Instruction
Office, Stationery, Etc
Improvements and Repairs

$17,680 02
328 19
71 76
6,700 16
11 17
1,732 38
801 32

Forward

$27,325 00

Brought Forward
Clothing
Farm, Garden and Stock
Miscellaneous Expenses

$27,325 00
8 82
34 00
486 07

Total for Biennial Period

$27,853 89

RECEIPTS.
ON ACCOUNT OF CURRENT EXPENSES.

July 1, 1916 to June 30, 1918.
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

$44,630 48
961 03
22,006 39
1,478 41
40 78
112 47
$69,229 56

96

STATE OF MICHIGAN.

RECEIPTS.
ON ACCOUNT OF CLINICAL LABORATORY.

July 1, 1917 to June 30, 1918.
Special Appropriation
Wassermann Tests
From Miscellaneous Sales..

$27,000 00
1,261 00
391 89

Total for Biennial Period

$28,652 89

Table showing the number of hospital days and the daily per capita
costs by months from July, 1916 to June 30, 1918.
Patient
hospital
days.

From July 1, 1916 to June 30, 1918:
July, 1916
August, 1916
September, 1916
October
November, 1916
December, 1916. .
January, 1917
February, 1917
March, 1917
April, 1917
May
June, 1917
July, 1917
August, 1917
September, 1917
October, 1917
November, 1917
December, 1917
January, 1918
February, 1918
March, 1918
April, 1918
May, 1918
June, 1918

1,712
1,846
1,800
1,800
1,651
1,667
1,701
1,595
1,729
1,806
1,701
1,539
1,727
1,768
1,718
1,814
1,752
1,724
1,764
1,614
1,877
1,737
1,781
1,813

.

.

Daily
per capita
cost
to state.

$1 26
1 25
1 25
125
1 25
126
1 28
1 3O
1 30
1 30
130
134
1 36
1 36
1 41
141
136
1 43
1 40
1 45
142
1 43
1 38
1 43

SUMMARY OF INVENTORY, JUNE 30, 1918.
Hospital buildings
Furniture
Fixtures
Apparatus
Books
Supplies
Total

$2 ,990
676
5,837
1,202
6,608

99
00
11
58
19

$79,043 13

17,314 87
$96,35800

Respectfully submitted,
ROBERT G. GREVE,
Secretary.

PSYCHOPATHIC HOSPITAL.

97

REPORT OF TREASURER.
July 1, 1918.
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, 1918.
RECEIPTS.
Balance in the Treasury July 1, 1916
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.)

$21,704 44
27,000
961
44,510
22,137
3,274

00
03
05
02
35

$119,586 89
DISBURSEMENTS.
Clinical Laboratory Accounts
Current Expenses (Running Account)
Balance June 30, 1918

$27,853 89
64,446 13
27,286 87
'$119,586 89

Very respectfully submitted,
R. A. CAMPBELL,
Treasurer.

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