Manteno State Hospital - Annual Report Manteno News 1953-1954 Contributed by Joseph Mehr, Ph.D Author of "An Illustrated History of Illinois Public Mental Health Services, 1847 - 2000" Partially authored by Elias S. Cohen, JD, MPA September 11, 1953 FIRST ANNUAL REPORT OF MANTENO STATE HOSPITAL The Manteno State Hospital Annual Report begins with this installment on the Hospital Edition of the Manteno News. It will appear serially each week until it is completed. This year, the report has departed from its usual format and style and has been cast in what is hoped a more popular and readable style. The big blue bus, looking something like a motorized freight car, rumbles down Route 54 carrying a cargo of people sick in the mind and body to the largest hospital for the mentally ill in the state of Illinois., From behind, the motorist on his way to Kankakee, Rantoul or Champaign, sees only "Hospital Car" and as he speeds past he reads "Illinois Department of Public Welfare" written on the side of the bus. The bus begins its journey at the three-story red brick building at Polk and Wood, located in Chicago's West Side Medical Center district. From the outside, the Cook County Psychopathic Hospital is not impressive. The old building, darkened by years of Chicago's smog and soot stands between Cook County General Hospital and the Illinois Neuropsychiatric Institute. Security screens on the windows yield some clue to the nature of the receiving hospital for the mentally ill of Cook county. Inside there is the hustle and bustle that inevitably accompanies the problems of the receiving unit: the business of getting case histories from families, holding court hearings, commitment proceedings, and the setting up of records for the hospital of commitment. Patients come into and leave "Psycho" quickly. Some stay one week, some two-but the law requires them to be taken to the state hospital within 24 hours of the order of commitment. Some patients arrive with their relatives, coming in a bit nervous, perhaps distracted, maybe even resistive. Others are brought by ambulance, emaciated to the point of disability or like ancient machines which can barely run anymore. Still another group comes in the patrol car of the "paddy wagon"- a small number come to the attention of the police because they may prove dangerous to themselves or their neighbors, and still others are picked up as alcoholics and sent to "Psycho" rather than Bridewell or Cook County Jail. The patient's sojourn here is short, and soon they are moved in groups to the big blue bus which carries them to one of the four state hospitals in the Chicago area. The bus, equipped with stretcher hangers for those patients who cannot sit up, pulls up at the ramp behind "Psycho" where the twenty patients committed to Manteno State Hospital are waiting. While the driver checks their personal property envelopes, their commitment papers, the social histories and everything else that must go along, the attendants and nurses load the bus. The driver steps into the little cage that surrounds the driver's seat, starts his motor and eases out of the alley behind the hospital. Down Ogden Avenue, and through Chicago, the blue bus rolls; through the slums toward the suburbs, and soon all signs of the city disappear as the Illinois prairie comes into view. Route 54, the four lane highway, runs along the Illinois Central railroad tracks with one mile of corn field looking just about like every other. The bus crosses Route 30, the Lincoln highway, and rolls southward through Monee and Peotone. About 55 miles south of Chicago it turns at a road which marks the northern end of Manteno. The sign at the corner reads "State Hospital", with an arrow pointing toward what looks like more corn fields. As the driver swings the hospital car onto the neat, well-kept grounds the patients first see the shady picnic grove, the swings and teeter boards, and then the low-lying ward buildings with long porches framed in what looks like an interminable series of arches. In about a minute, the bus is at the Administration building, employees generally refer to it as "Center" - a three-story red brick building unmarred by city grime, looking like a vague replica of Independence Hall in Philadelphia. The driver stops, gathers up his papers, the personal property envelopes, the commitment orders and makes his way to the record office on the second floor. He leaves the histories, and picks up a clerk to help him check in patients at the receiving ward. This is human cargo that is here to be repaired - care begins at this point for the patient on the bus - he is at Manteno State Hospital where all the knowledge about this particular illness will be brought to bear, within the limitations imposed by the shortages of manpower, materials and money, to effect his cure and his ultimate return to his home, his family and his community. September 25, 1953 HOSPITAL, BUILT TO HOUSE 5,500 NOW HAS 7,921 PATIENTS The twenty patients who got off the bus were integrated into the big hospital program. They became members of the mammoth hospital community which boarded an average daily population during the past fiscal year of 7,921. They became twenty of the more than 10,000 people who had received hospital care during the 12 month period ending June 30, 1953. These twenty moved towards all over the hospital grounds, but wherever they went they were always aware that there really was not enough room for them. The wards they went to always seemed crowded-and they were right. The hospital has been overcrowded since 1940 when the original capacity of 5,500 patients was reached and passed. Some patients moved to the treatment wards, some to the chronic wards, some to infirmaries and some to the acute hospital. A number of them moved to several wards in rapid succession and were discharged during the year. They were part of the 2480 who returned to their communities. A few who came to the hospital in already weakened condition died along with those patients who were long-term residents and who filled out their days here. They were numbered among the 656 patients who expired while in our care. The twenty who came in on the bus were roughly one percent of all admissions during the year. Of the 2925 who were admitted, some 1747 were committed and came in on the bus, through "Psycho", and to Manteno on a court order. Most of the rest came to the hospital on a voluntary basis - signing themselves in, free to leave on submission of a 15-day notice. The group that came in on the bus were a mixture and representation of the hospital population. They formed a microcosm of the melting pot of mental illness called Manteno. Perhaps not precisely representative, but approximately so. On any given day, Manteno State Hospital's patient population may be said to contain a population distributed by disease as follows: Syphilis of the central nervous system, pareses, other diseases attributable to syphilitic infection, 6%; alcoholism (with Psychosis), 3%; Psychosis with cerebral arteriosclerosis, 7%; Senile Psychosis, 4%; Parkinson's', Huntington's and Pick's diseases, 5%; Manic Depressive Psychoses, 3%; Schizophrenia, 48%; Psychosis with mental deficiency, 5%; Involuntary psychoses, 3%; without psychosis, 5%; and all other classifications, 11%. In terms of age levels, the distribution is heavily weighted with the aged, a group which is probably in greater need of nursing home care than psychiatric. The majority of patients at Manteno are over 50 years of age. In contrast, slightly more than 5% are under 30. One patient in six is over 70, and slightly over 4% are octogenarians or older. October 9, 1953 PATIENTS ENTER M.S.H. THROUGH DOOR OF DIAGNOSTIC BUILDING The big blue bus unloads behind the Diagnostic building. Those who are able to walk go down the half-flight of stairs led by the supervising nurse or attendant. The records office clerk checks the patients off her list as they come off the bus and then leaves to return to her papers. The patients shuffle down the hall - the terrazzo floor, the tile walls, the whole appearance of the building is one of immaculate cleanliness. The faint odor of iodoform that always seems to be associated with hospitals drifts down the hall from the pharmacy squeezed in its all-too-small space under the stairs. The patient enters the "dressing room" where he passes quickly before the supervising nurse who checks off his name on the list she holds before her. A male psychiatric aide waves him onto a scale and calls out the weight while another attendant takes a bright light and a reflector and runs it over the patient's body, looking for scars, bruises and cuts. The patients are moved into the shower room - their clothes and personal effects have been taken away for the time being until they can be washed, inventoried and either returned, or if contraband, stored. Those too feeble for showers are given tub baths - before the receiving room is left, the patients are examined, and if necessary, treated for vermin. Soon the patient finds himself, clad in pajamas and bathrobe, on the receiving ward - he doesn't know who is the doctor, who is the attendant; he's not quite sure what is expected of him here. There's a ping pong table in the day room where he will spend most of his time, a radio, magazines, checkers, and books - but most of the patients just sit if left to themselves. They are sick. On the female receiving ward another white uniform comes into the day room - the only difference between it and all the others the patients see is the small patch on the left shoulder - "ORT". It does not mean too much until the Occupational and Recreational therapy worker brings out a few games, or some cloth to be made into toys. Maybe the worker begins to sing and some of the women on the ward join in. The patient is a little less restless, fears are put aside momentarily, and she begins to feel a sense of friendship and a sense of care. Tomorrow the worker comes again, and once a week an evening social group, including both men and women on the receiving wards is held. A little punch, dancing, games, bingo and so on bring diversion to the first strange days at Manteno. Unfortunately the men do not have the daily visits from the therapy aides - the ORT staff has never had sufficient staff to set up a continuing program on the receiving service. After the patients leave the receiving ward, they may have special classes for ORT on the wards they reside, or they may not. Special classes are held for Hydrotherapy wards, male and female adjustment wards, intensive treatment wards, acutely disturbed women wards, and regressed wards. Because of the lack of help during the past winter the ORT program was discontinued on two of the five female regressed wards and cut down to half time on the remaining three. With the addition of summer help, however, the program is operated at full steam. Activities, planned each day, are presented to the patient on his or her own level of understanding, with emphasis on trying to lengthen their individual spans of attention. One of the major achievements has been the combining of the male and female classes in folk dancing, art and rhythm band. For the first time in several years, the ORT service was able to reach out to elderly male patients. Long years of inactivity, or minimal recreation, of sitting and rocking had thrown up a protective wall of resentment around these patients. With only two days a week on the ward, however, a semi-active program elicited response. The addition of summer help again enabled the program to expand to a daily basis on two wards, and three-day basis on one other. A similar program was started with the elderly female patients on two wards. When the summer students leave, however, a long and cheerless winter sets in on these and other wards. Occupational and Recreational therapy activities must be curtailed, and the sitting and rocking routine begins once more. Among the many groups of patients who receive some attention from the ORT service is a group of 50-75 men and women patients who, in addition to their mental illness, are in a state of rested Tuberculosis. They meet daily, and after 10 or 15 minutes of light calisthenics they engage in group games, and group projects such as window and wall decorations. Some have planted small gardens, while others make decorations for seasonal parties. Here, after a long period of enforced rest demanded by the course of Tuberculosis, these people are earnestly going about the business of leaning again to live, to work and to play together. In addition to the activities which are planned and held for special groups of patients, there are some ORT programs which are available to almost all patients. Movies are shown both on the wards and in the large meeting hall, social dances are held Friday evenings, and folk dancing is held once a week. Fix-it clubs, book clubs, social hours and a square dance club provide a variety of activities designed to fit the needs of a variety of individual interests. One special "club" which has filled a definite void, is the Foreign Language club. For two years now, a group of foreign born patients have met weekly to talk with others who share their language. Many patients came to Manteno, frightened, withdrawn, and seclusive after lonely years in a foreign country. Although the penetration of his reserve has been a slow process, there has been progress. The group now numbers about 20 to 30 people, who gather to chat, to sing, and perhaps to dance. The big event of the year at the hospital was the Fourth of July when 4,400 patients gathered in the park to view a parade replete with clowns, floats, a color guard, and the Manteno high school band. Iced soda was handed out to all the patients in prodigious quantities, and candy and prizes went to those who participated in games and contests. Other high spots during the year included trips by patients to the Chicago ball games and to the Kankakee County fair, and the three-day tour of duty the Clyde Brothers Circus put in on the Manteno State Hospital grounds. In general, the major accomplishments of the ORT service during the past year have been what might be termed administrative. Occupational and Recreational Therapy units have been pulled closer together. OT and RT aides are working together with classes. Expanded in-service training now gives all OT workers simple recreation techniques and all RT workers are able to give them a more varied program and are able to change activities when interest lags. Another accomplishment which has hospital-wide ramifications involves the inclusion of Occupational and Recreational Therapy progress notes in the patients' case records. Information about patients in ORT activities is an important part of the whole body of facts which must be marshaled in mapping a treatment program for patients. These notes, which now become a part of the record, will help to build up the clinical picture that the treating physician will have. Finally, the conclusion of the first year's operation of an Amusement Fund budget has indicated that planned spending results in better programming. In addition to its immediate effects on the Amusement Fund itself, it has developed a certain sense of long-range planning and what might be termed "needs-thinking." October 16, 1953 SOCIAL SERVICE HAS BIG ROLE IN PATIENT CARE PROGRAM After the court hearing at Cook County Psychopathic hospital, the relatives are alone. They are perhaps relieved, and perhaps afraid. They have consigned someone they have lived with and cared for to the mental hospital. They are not sure what this means, and immediately the full force and recognition of the mental illness does not hit them. The doubts and fears come into play with the first contact from the hospital - the first of a series of letters about the patient's history, about her clothing, about her trust fund, about an injury, an illness, about specific treatment, about a dozen other things. The first letter, like those that follow, is a request: "In order that your wife may receive maximum benefit from hospitalization it is necessary that our medical staff have rather detailed information concerning her behavior prior to and during her present illness. We therefore ask that you come to our Social Service Department at your earliest convenience to give this information..." Social Service joins the team at the very beginning of the patient care program. During the past year the Social Service Section has continued to work in three major areas; that dealing with the patients in the hospital, the operation of the LaSalle, Joliet and Chicago Heights Clinics, and the supervision of the Family Care Program. Despite the fact that staff has increased, the Social Service Section has decreased its caseload, electing to limit its work and devote increased attention to individual patients and to work more carefully and effectively with relatives of all patients referred to Social Service. In addition to the regular caseload, two other projects have been undertaken which have strengthened and enriched the Social Service staff. There has been one staff worker assigned to work on the intensive treatment team. This has brought about a cooperation among the disciplines which enables the best plan to be evolved for the patient receiving intensive treatment. In addition to the value to the patients involved, the collaboration of the team has been a stimulation learning process. The leaning process goes on not only for the staff, but for the patients, too. The details of commitment and discharge, civil rights and clinical contract are not easily understood, and yet these things are of vital importance to the patient who is leaving the hospital. Because the Social Service staff felt that many patients left the hospital with very little understanding of the meaning of Conditional Discharge, an "orientation class" on Conditional Discharges was set up in the spring of 1953. After a decision is made regarding a patient's release on "CD", a group of between four and six patients is gathered and informal meetings are held with them. The intricacies of commitment and discharge are explained, and strong emphasis is placed upon the meaning of the Conditional Discharge. The function of our clinics has also been discussed in terms of the supervision and help they might expect from them. From the questions which the patients have brought up, it is our impression that these sessions are very important. The meetings provide another opportunity for the patient to discuss individual problems which may be bothering him concerning his release. One patient stated the old-age problem of release succinctly when he said, "You get us well here at Manteno and then we go back to the place where we became ill." The outpatient clinics in LaSalle, Joliet, and Chicago Heights have operated as in the past. There was some greater stability and continuity in the operation of the clinics because the same physician has been available for them throughout the year. Although there was an early problem in staffing the clinic with a trained worker, that has been overcome and it is hoped that clinic attendance will increase. An innovation has been introduced in the Family Care program with the bringing of an occupational therapist to patients located in Family Care homes. Patients in four homes in Manteno, Pontiac, Chebanse and Clifton now receive materials and instruction from the therapist. The joy they receive from this activity is almost unbelievable - they are people who have led active lives and who now need this guidance for their leisure time. November 13, 1953 SERVICES RENDERED BY HOSPITAL STAFF RECEIVE RECOGNITION The Doctor leaves his office in the morning - he checks his mailbox to find out if there has been any special occurrence in the night just passed. Down the stairs, out the Administration building and over to the wards assigned to his service. If he serves the chronic wards, the wards of patients who have failed to respond to treatment, or who are susceptible to the therapies we know, his care may be spread over 900 or 1000 mentally ill. If he serves the infirm, the chair and bed-ridden patients who in all likelihood will end their days in the bed they now lie, his load may be reduced - he may serve but 600 acutely mentally and physically ill people. The full-time medical staff of Manteno State Hospital numbers 21. During the past year our physicians decreased from 26 to 21. These are the physicians who must care for 8000 patients, who must be on call, who must protect the environment against the public health hazards, who must oversee the tremendous program of TB prevention, and contagious disease control, and who must direct the medical program of Manteno State Hospital. The medical staff, however is aided by a group of part-time consultants in surgery, urology, roentgenology, orthopedics, ophthalmology, and so on. Among 8000 patients pathology of every description is seen and treated. The community of the sick demands the medical knowledge and ingenuity of the medical man at his best. The special techniques of diagnosis and treatment are called upon daily. Thousands of test tubes were filled, examined, and emptied by the white-coated technicians in the Clinical and Bacteriological Laboratories during the past year. Surrounded by the welter of test-tubes, retorts, petri dishes, reagent jars and distillation apparatus, clinical lab technicians on the second floor of the Diagnostic Building, prepared some 38,500 procedures during the last fiscal year. Urinalysis, hematology, serology and miscellaneous analysis passed beneath the inquiring eyes of laboratory men and women. The increase in the patient population, the increase in the research program, the increase in the employee examination programs have all added to the burden of a laboratory designed to do about half the work of the present set-up. On the other hand, the Bacteriological Laboratory worked through some 30,000 procedures including cultural examinations for enteric pathological bacteria. Examinations for acid fast bacilli, and bacteriological examination of dairy products, without feeling that the unit was being overtaxed. The laboratories are the watchdogs - the changing colors in the test-tubes, the growth of molds in the culture dishes, the parasite viewed through the microscope all raised the flags that bring the full force of every unit of the hospital to bear upon potential epidemic danger. Down the tiled hall about 50 feet from the clinical and bacteriological laboratories, and just adjacent to the Psychology Section lies the X-ray lab. The technician pins her radiation dosage badge to her uniform and prepares to take the picture. She measures the patients chest, sets the dial, asks, "Take a deep breath, please", pushes the button, murmurs "Thank you, that's all", removes the number plate, and begins again. More than 23,000 times the ritual takes place on chest examinations alone, and 3000 still more to photograph every bone and organ susceptible to x-ray examination. How many patients and employees were protected is difficult to say - Tuberculosis was detected in 84 newly admitted patients, and 17 cases were detected among the resident population. Of the 17, almost all of them (15) were detected in the minimal stage, and 2 were moderately advanced cases. Not a single far advance case was found in the hospital. Among employees but 3 cases were discovered, and steps were taken to provide leaves of absence and treatment for them. The TB program at Manteno State Hospital is a well developed one. During the past year it has been able to increase its scope. East TB ward now has a registered nurse on duty during the day-time, and it can be said that it is the first time in history of the TB unit that the nursing care available to patients can be called satisfactory. Treatment has been expanded - more collapse therapy and more chemotherapy was instituted than in previous years. The development of a chest surgery unit at Kankakee has made surgical procedures available to us. The most outstanding change in the area of chest disease detection has been the establishment of an observation unit for non-tuberculosis chest conditions. More than 60 patients went through a clinical work-up on that unit. Ten were found to have a malignancy of the lung, while more were diagnosed as having "suspected tumors". November 29, 1953 DIAGNOSIS, RESEARCH, TREATMENT CULMINATE HOSPITAL ACTIVITIES One of the first steps in the development of a treatment program for the new patient at Manteno is the determination of diagnosis. The diagnosis is the culmination of mental examinations, physical examinations, laboratory testing, review of patient's past history and his behavior. All of the knowledge which these examinations reveal serve a useful purpose in determining the illness and the consequent attack upon the disease. The psychologist plays a major part in the diagnostic work-up of the patient. His mental examination may or may not include psychological tests, and varies considerably in its comprehensiveness, the thoroughness of the examination being for the most part a compromise between the needs of the patient and time the psychologist is able to spend. During the past year the diagnostic program has undergone intensive re-evaluation with several steps for increased efficiency taken or planned. A new outline for psychological examination is planned and experimental use is underway. Procedures have been refined to provide earlier information for the Clinical Director and plans are complete for the appointment of staff psychologist as "Diagnosis Supervisor" to improve coordination of the diagnostic program and increase inservice training in this area. In addition to the diagnostic function the psychologist has entered into a very limited treatment program of psychotherapy. For lack of time, the psychotherapy program remains quite limited and it is not yet possible to accept all cases referred. However, during the past year it was possible through the establishment of group therapy and through increased individual therapy to enlarge the number of patients involved some 400 percent. The most significant advance in the program has been the appointment of therapy coordinator with subsequent progress in clarification of policy coordination with the Clinical Director, supervision of cases in progress and psychotherapy seminars for psychology interns. The most substantial change in the psychology program in terms of increased time came in the research programs of the unit. Collaborative projects with other disciplines have taken a substantial amount of departmental time, with almost the full time of two psychologists being devoted to work on evaluation of new drugs and on a special project in the diagnoses of schizophrenic patients under a project by *Dr. Gabriel Langfeldt, head of the Department of Psychiatry at the University of Oslo, Norway. Several other individual projects have been undertaken (one a Ph.D. Thesis) and others are planned for the coming year. In addition to the above mentioned programs the psychologists have made a substantial contribution to the training programs of the hospital by taking over heavy teaching schedules for psychiatric aides, attendants, recreation therapy aides, volunteer workers, theology students, summer students and the Occupational and Recreational Therapy School. It has not yet been possible to meet the requests for a weekly class for occupational therapy aides or to supply more time for attendants. Tentative plans demand coming from physicians, social workers, nurses, and psychiatric technicians. Unfortunately, mental illness is not like pneumonia. There are no wonder drugs at our command - no penicillin to return the schizophrenic to the world of reality, no streptomycin to free the paranoid from his persecutors, no aureomycin to relieve the anxieties of the psychoneurotic. Mental illness is the infant child of medicine. For this reason, Manteno State Hospital has increased its efforts in the area of research. Unless new techniques are discovered, and unless more is learned about the mechanisms involved in mental illness, the disease of the mind will be long term affairs and Manteno State Hospital will continue to house thousands of patients for whom there is no room. The great bulk of responsibility for the 24 hour care which the 8000 patients at Manteno State Hospital receive falls upon the nearly 650 employees who comprise the nursing service. Because our medical knowledge and our medical staff is limited, and because we are so dreadfully overcrowded and because we deal with such a large number of patients, both in terms of the total numbers involved, and in terms of the size of our wards and patients groups, an inordinate responsibility has been thrust upon the attendant personnel. The therapeutic approach then becomes one of the major tools available to us in our treatment program. For that reason, Manteno State Hospital places considerable emphasis upon the staff development of what is considered the backbone of the treatment program: the nursing services personnel. A total of 373 attendants and psychiatric aides completed inservice training during the past year. Of this number, 45 were attendants who took special training to qualify them for the position of psychiatric aide. In addition to this basic training, plans have been laid for periodic lectures and demonstrations to further equip the psychiatric aide for his duties in caring for the mentally ill. It is planned to hold two-hour classes every other week during what is generally considered the school year. Classes will be conducted on the employee's own time, although compensatory time-off will be attitude therapy, psychiatric nursing, ward management and psychodynamics. Another development which the psychiatric aides themselves have brought about is the organization of the psychiatric aides staff educational program. Each month, employees in the P.A. classification meet to hear guest speakers in the field of mental health or is allied fields. On some occasions, films are shown, and members of the hospital staff frequently provide the lecture staff, discussing the research projects and other developments going on at Manteno and elsewhere. The registered nurses have also set up an educational program and have had probate judges and others speak on juvenile institution and mental hospital commitments, the special problems of alcoholism, and the care and management of delinquent boys, as well as staff member lectures on T.B. surgery and special research under way in the area of pharmacology. Some of the films the nurses have seen included visual aid in general nursing procedures, physiology and psychiatry. During the past year a registered nurse workshop was conducted at the hospital, dealing with the personnel problems in the entire area of psychiatric nursing. The R.N.s were assisted in the meeting by the assistant to the nursing consultant in the general office of the department and by the personnel counselor at the hospital. Special efforts were made during the year to broaden the perspective and increase the capacity of the attendants and psychiatric aides during the year. In order that the people providing the hour to hour care of patients be equipped with some rudimentary understanding and tools in occupational and recreational therapy, a week-long course in ORT techniques was set up in the state ORT school located at Manteno State Hospital. About 30 employees attended the course over a period of three weeks. The arts, crafts and recreational activities taught during the course were specially geared to use on the wards. The program was set up in conjunction with the hospital ORT service, which now furnishes supplies and equipment needed by the ward personnel. Although employees on the 7-3 shift have little time for these activities with their patients, the aides who work from 3 to 11 have achieved some success in introducing games, puzzles, sewing and other activities on wards where the patients otherwise spent their time sitting and rocking. Another program which we hope will have ramifications reaching far beyond the confines of the hospital and out into the community, is the initiation of a liaison program with Recovery, Incorporated, an organization established under the leadership of **Dr. Abraham Low, and dedicated to a discipline of self help designed to prevent the return of ex-patients to the hospital. The program is organized around trained discussion leaders, schooled in the program and techniques of Recovery, Incorporated. At the end of the fiscal year, Manteno State Hospital sent two psychiatric aides to Chicago for a week-long training program in these techniques. It is planned that these aides will meet with patients ready for discharge to indoctrinate them in the techniques of Recovery, Inc., so that they will either join or form Recovery groups on the outside. Another innovation which it is felt recognizes the responsibility the psychiatric aides hold is the writing of psychiatric aide behavior notes for inclusion in the medical case records. Because the aides are the only employees who have the opportunity to observe patients in their day to day behavior, it was felt that their observations could contribute materially to the clinical picture of the patient which the case record presents. Aides are instructed in objective reporting and their notes cover eating and sleeping habits, care about clothing, leisure time activities, socialization habits, conversational habits, and so on. Literally hundreds of notes have gone into the record already, and the contribution is considered worth the added effort put into the job by the aides. One physical change which has improved the operation of the nursing service has been the moving of the office of the chief nurse to a new location which places all of the nursing service administrative offices in close juxtaposition. November 27, 1953 VALUE OF NURSING SERVICE TRAINING PROGRAM OUTLINED The jail, the almshouse, the "lunatic asylum", the hospital: This is the modern history of care for the mentally ill. At each stage of development the nature of the caretaker has similarly changed - turnkey, custodian, keeper, and attendant. But the patient is always the same. Perhaps confused, irritated, voluble, seclusive, anxious, hyperactive, deluded, but essentially in need of the same things in every age: Good nursing care meted out with understanding, with love, and with kindness - the therapeutic approach which postulates that every relationship that the psychiatric patient has with another person can either help him or hurt him, but it cannot leave him unaffected. This approach, must pervade the entire hospital staff to be truly effective. It is not sufficient merely to limit this to personnel involved in the provision of medical and adjunctive therapies. The approach must of necessity exist with all personnel. This is especially true at Manteno State Hospital, where a large proportion of the patient population is not confined to the ward or to a proscribed area or activity. More than 2500 patients at the hospital have grounds privileges, the right to come and go from the ward at will, and the right to go anywhere on the grounds of the hospital. These patients come into contact with employees in every corner of the hospital, and although the patients are able to function sufficiently well to have grounds privileges, employee attitude is of prime importance, Early in the fiscal year, an entire ward was given over to research activities in a joint venture among the staff of Manteno State Hospital, ***Dr. Carl C. Pfeiffer of the University of Illinois College of Medicine, and Dr. Nathaniel Apter, head of the Division of Psychiatry of the University of Chicago Clinics. Research has been concentrated on the schizophrenic reaction. The experiments, which have centered on the use of convulsant and anti-convulsant drugs, have brought about a fruitful collaboration of pharmacologist and psychiatrist. In addition to the studies regarding the aforementioned drugs, research is also beginning on study effects of induced acidosis, and a study of sneeze thresholds in schizophrenics. In addition to the contributions to the body of knowledge which the research projects can make there are other benefits which the field of psychiatry in general and the hospital in particular receive. Each of the physicians from the universities participating in the projects has brought medical students to work on the research ward at Manteno, providing them with laboratory in mental illness that is ordinarily denied them. It is hoped that this will contribute something to developing an interest among young physicians to enter the field of clinical psychiatry with emphasis on the psychoses. The contact of hospital staff with the outside research teams has also served as a stimulus to greater interests, and the enlargement of staff understanding in both the psychiatric and pharmacological considerations involved in mental illness. The diseases of the mind are dramatic. The mental machinery is complicated. The forces involved are chemical, electrical, psychic and physical. The approach to mental health may be through all or any of these forces, through chemical changes to the body or the brain, through electrical stimulation, through analytical probing, or through physical attack on an offending organ or the brain itself. Each of these is, in a sense, a radical procedure. In an effort to better select and observe patients deemed susceptible to electric and insulation shock therapy, one female ward was designed as a pre- and post-shock treatment to become available to a larger number of patients. Following pre-shock diagnosis and observation the patients are transferred to the Treatment Ward where treatments are administered and team of ward physicians, psychologists, social worker, and nurse attack the many-sided problems of each patient's illness. Patients who respond favorably to treatment are transferred back to the observation ward where an attempt at industrial placement may be made. Depending upon the success of the patient's rehabilitation, release from the institution or transfer to an industrial cottage may be considered. Those showing a tendency to relapse after cessation of intensive treatment are transferred to another ward for repeated courses of electric shock or maintenance shock therapy. Treatment patients continue to receive shock therapy even though they may be transferred to hydrotherapy or acute hospital wards so that the course of treatment is not interrupted. At the present time shock treatments can be administered to 60 or 70 patients in about 90 or 100 minutes on an ordinary residence ward without the use of restraints except for wristlets and ankle restrains in the post-shock period. The total number of female patients receiving treatment under this program is slightly less than 250 each month. It is hoped that the increased opportunities for trained observation before, during and following shock treatment will contribute somewhat to the knowledge available in the shock therapies. January 22, 1954 KITCHEN DINING ROOM MORE CONVENIENT FOR PATIENTS, EMPLOYEES The long line of patients moves past the serving line quickly. Four working patients dish out the noonday meal of Beef-Vegetable Stew, seasoned green beans, bread and butter, coconut pudding and coffee in tin plates on aluminum trays. The patients move quietly to the tables which seat 6 or 8 people, and quickly eat their meal. One is struck by the lack of conversation at the meal table. On many wards, the silence is broken only by the clatter of silverware against the trays and dishes, and in those dining rooms where noise may come from those who are disturbed, the lack of conversation is equally noticeable. For many patients, mealtime is the only experience which breaks into the dull routine of life on the ward. For others it is a respite from the work or play activity they may indulge in. But for few it is a therapeutic experience. This is denied them along with other phases of what might be called "good program" by virtue of the heavy tax placed upon the kitchen facilities built for 500 and more than half again that number. This is denied them because we must depend upon patient help for serving personnel. This is denied them because ovens are not available for roasting meats, and refrigeration space is something less than adequate. Because so many of the problems involved in the Dietary Program of the hospital depend upon the physical limitations of the kitchen, substantial effort was spent during the past year effecting changes in the main kitchen building. The officers dining room and servery was turned over to patients to be used as a patients' dining room. The old patients' dining room which was severely overcrowded was converted into a new dishwashing room equipped with a new Colt-Autosan dishwasher, a Cunningham glass washer and stainless steel work tables. Unfortunately, the initial planning of this facility by the Associate Architect left something to be desired and it has since become necessary to install a separate pre-rinse sink, and plans are underway for the construction of ventilating hoods to prevent deterioration of the interior of the room. Inasmuch as the canning program at the hospital was not substantial it was decided to eliminate the cannery and convert the space so vacated into another dining area. This unit was equipped with a cafeteria counter, water cooler, ice cream box, and two coffee urns in addition to the stainless steel back bar. Because this servery and the serving counter for the main dining room are back to back, it becomes possible to share refrigeration space as well as reduce the cross traffic in the kitchen itself. In the larger cafeteria, the serving counter was moved back seven feet to make room for additional table space' griddles were installed and provisions were made for the more efficient storage of chinaware. In the food preparation area, the employee's kitchen was moved to a position adjacent to the two employees' dining rooms and additional equipment in the form of a deep fat fryer, a small oven, and new steam kettles were installed. Counters, cabinets and sinks line the walls of the employees' kitchen area, and the new location reduces the traffic problem in the food preparation area. Among other new pieces of equipment which have been installed in the kitchen are a new pot and pan sink which our own maintenance force subsequently equipped with a soak tank and sterilizing tank, and a new ice cream machine with a capacity of manufacturing 50 gallons an hour. During the year some changes were made in an effort to improve the food service on the ward dining rooms. Several wards have been equipped with brightly colored plastic dishes, and two of the female wards have been supplied with colored uniforms for the patient help to wear at the counter. Some male wards have been supplied with white overalls for the men who serve food. Classes have been held at intervals throughout the year both to train new employees and further develop those who have been in employment at the hospital. Teaching techniques which have been used involve lectures, demonstrations and movies in the areas of food service, food preparation, sanitation and other matters connected with the dietary program. January 29, 1954 HOSPITAL RELIGIOUS PROGRAM REACHES ALL FAITHS A patient sits alone in the midst of strangers just as sick as he. His surroundings are unfamiliar, his life has become routinized in a way he has not known before and above all the uncertainty of what will be in this strange place makes peace of mind difficult. Yet in all his loneliness, and in the face of what seems like a thousand impersonal relationships, there is for him an island of the past in his church; a personal friend on whom he can lean if he wishes and to whom he can speak just as he spoke to his minister at home. The priest, the minister and the rabbi offer the hospital patient counsel, religious services, the rites of his religion and the opportunity to gather with others of his faith to pray together, sing together and socialize. Manteno State Hospital has for its religious program a staff of a Protestant Minister, a Catholic Priest and a Rabbi who serves the hospital on a part-time basis. In addition to the regular chaplaincy staff, ministers of various faiths visit the hospital for church services and for counseling individual patients. The Protestant Ministry is under the director of the Protestant Chaplain who has sought to make the overall Protestant religious program non-sectarian and non-denominational. The overall work of the chaplain falls into four major groupings. His work with groups includes Sunday services at Hinton Hall for those patients, worship services for patients on wards where they cannot leave, such as the Tuberculosis wards, infirmaries and so on, and group discussions for those who enjoy talking out some of their problems in a group. For those patients who are in midst of a struggle to recognize their spiritual and psychological lives, this group discussion work has been most welcome. It provides the opportunity for patients to share in a small group, feeling about self and the hospital which too often has been held within. The Protestant Chaplain's work with individuals includes visits with a large percentage of the 1000 newly admitted Protestant patients. In this work he has been assisted by theological students who come to the hospital for clinical training. They also aid in follow-up visits on the ward and in the chaplain's office. The Presbyterian minister from Manteno aids the hospital chaplain with visits on the ward and in the chaplain's office. The Presbyterian minister from Manteno aids the hospital chaplain with visits to infirmaries. During the past year the Protestant Chaplain conducted 75 funerals for patients who were buried at the hospital cemetery. Another activity which has brought considerable pleasure to patients is the work of the choir. The group is well trained and is able to obtain considerable benefit from the experience of group singing. New robes were purchased during the year and have provided still further esteem for members of the group. One of the most important functions of the Chaplain's work is the program he heads up in Clinical Pastoral training. With the students who completed their training during the summer of 1953, the number of students so trained by the Chaplain numbered 50. During this fiscal year 19 students came to the hospital. The training which they received n the hospital is designed to give the student minister greater insight into the nature of mental health and mental illness. This type of training is increasingly becoming part of the total plan of theological training, and while few if any of these students may actually enter the services of the chaplain, and at the same time helps to educate and enlighten future community leaders in the problem and relief of mental illness. The work of the Protestant Chaplain's office has undergone some change in emphasis during the past year. More attention has been directed toward the chronic patient than had been in the past. Whereas there was the tendency to be concerned primarily with those patients who were in the state of attempting to reorganize life patterns, the chaplain has now sought to broaden his efforts to include those older patients who seem to make some kind of positive adjustment in the hospital but who will in all probability remain in the hospital. A complete program, however, will not be possible until additional staff is available. At Manteno, approximately 3500 patients demand upon the single full time chaplain for their spiritual needs. Research, scheduled ward visits, and enlarged group work are all important and intriguing projects, but cannot be begun until some additional staff is available to the Protestant Chaplain. The same degree of overburdening occurs in the Catholic Chaplaincy program. The Catholic Chaplain who is on call twenty-four hours a day ministers to the almost 4000 patients who form his flock. In addition to the counsel he bears patients and relatives, the obligations of ritual worship and prayer are indeed vast. Through out the year, daily Mass was said for a total of 4400 patients while Holy Mass on Sundays and on the Holy Days of Obligation was said for a total of 27,000 patients. Confession was heard almost 45,000 times at Hinton Hall, and the Chaplain was able to visit the wards to hear confession from patients who could not go out 235 times. Holy Communion was held almost 7000 times on the wards at Hinton Hall, while Extreme Unction and Last Blessings were administered about 1100 times. The Jewish religious program at Manteno State Hospital took considerable strides during the year. Principal among its achievements were the acquisition of a Torah, the holy scroll containing the five books of Moses, and the construction of a Holy Ark, the consecrated cabinet which holds the Torah Scroll. The provision of an Ark and Torah gives Manteno State Hospital all the requirements for a synagogue. It enables the congregation participation in a service revolving around the Torah, which is thematic to Jewish ritual. The Ark was designed and constructed at the hospital. Manteno State Hospital became the first state hospital in Illinois to acquire a Torah and an Ark. Regular weekly services were held throughout the year for Jewish patients and at the holiday seasons special festivities were arranged for through the courtesy of the Sisterhoods of several Chicago and Kankakee congregations. The entire religious program at Manteno has two major needs: additional trained staff of chaplains who could give full service to those patients who feel the need for spiritual guidance, counseling and participation; and a chapel, a physical facility well suited to the prayer needs of all faiths and groups.   NOTES: *Gabriel Langfeldt, M.D. (Norway) - 1968 Stanley R. Dean Award for Research in Schizophrenia - This award is given in recognition of basic research accomplishments in the Behavioral Sciences contributing to our understanding of schizophrenia.  It is presented by the American College of Psychiatrists and The Fund for the Behavioral Sciences. From: http://www.miami.edu/mh-library/library_dean.html As a result of follow-up studies published in 1937 and 1939, Langfeldt divided schizophrenia into two groups; 'typical schizophrenia' which had a poor outcome, and the 'schizophreniform psychoses' which had a less typical clinical picture of schizophrenia and a good outcome. From: http://bjp.rcpsych.org/cgi/content/abstract/157/3/351 **Abraham A. Low, M.D Recovery, Inc. was founded in the 1930s by Dr. Abraham Low in Chicago. Abraham A. Low, M.D., a pioneering Chicago physician, was a truly interdisciplinary figure, with academic interests and scholarly contributions in such diverse areas as clinical neurology and psychiatry, neuropathology, electroconvulsive therapy, and group therapy. His writings in connection with Recovery Inc. also reflect a linguistic and philosophical sophistication that equipped him to address difficult issues requiring analysis from multiple perspectives. His work deserves reexamination because of its potential contribution to the reformation of biopsychosocial issues central to many areas of medicine, including psychiatry. From: http://www.recovery-inc.com/resources/low.html ***Carl Curt Pfeiffer, M.D., PhD., Rev. (1908-1988) The pioneer of biochemical therapy, Dr. Carl C. Pfeiffer was a research consultant at Manteno State Hospital in the 1950s. Dr. Pfeiffer wrote many books and papers about nutrition and its relation with mental health.  His most notable book, "Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry", written in 1987 is still very popular today.In 1973, he opened the Brain Bio Center in Princeton, New Jersey where during his research he found that many psychological problems could be traced to biochemical imbalances in the body. The Center developed series of tests to determine the various biochemical imbalances, which could then be treated with orthomolecular therapy.