Complete Annual Report of the Illinois Department of Public Welfare Manteno State Hospital BY RALPH HINTON, M.D., Managing Officer Population-Patients Present at close of year June 30.. . . . .3,189 in 1937 and 4,668 in 1938 Members of the medical staff as of June 30, 1938, included: Dr. Ralph T. Hinton, Managing Officer Dr. Bernard Skorodin, Senior Physician Dr. A. H. Gollmar, Junior Physician Dr. K. H. Tutunjian, Junior Physician Dr. D. K. Hur, Junior Physician Dr. J. B. Mossman, Junior Physician Dr. W. Weisdorf, Junior Physician Dr. N. B. Dobin, Junior Physician Dr. L. Schlan, Junior Physician Dr. B. Spira, Junior Physician Dr. P. Feldman, Junior Physician Dr. M. L. Stern, Junior Physician Dr. M. S. Croft, Junior Physician Dr. J. J. Sievers, Junior Physician Dr. H. S. Fein, Junior Physician Dr. A. Nehf, Junior Physician Dr. V. Watia, Resident Dr. F. L. Darnell, Resident Dr. E. J. Gagnon, Junior Dentist During the year, there has been a tremendous increase in the resident-patient population. At the time of the submission of the report one year ago, it totaled 3,189; at this writing, it is 4,668. A consideration of the movement of population discloses the fact that while many patients were received on transfer from other hospitals, there has been, nevertheless, a large increase of direct commitments. The number of first admissions, 1,513 committed and 179 voluntary, is, however, not a true picture of the situation. It has only been since the first of the year that the County Court of Cook County has committed any appreciable number of patients. Following the general letter of the Director of the Department of Public Welfare on January 5, 1938 addressed to county judges, the admission rate has been extremely large. If the present rate of increase continues, the institution may well expect to have all of its buildings fully occupied by April 1, 1939. Medical Department The work of the medical department has materially increased during the year. In this hospital’s last report, reference was made to the fact that a portion of the hospital building was being used as a receiving ward and that, in addition, many tubercular patients were being cared for in the same building. These conditions have been changed during the year. All new patients are now received at the Diagnostic Building, all active tubercular patients are now being cared for at the sanitarium erected for this group of patients, with the result that the hospital building is now used exclusively for medical and surgical cases. A major event during the year was the opening of the Diagnostic Building on October 15, 1937. This is a two-story building accommodating 364 patients. The front wing on the first floor, both on the male and female side, accommodates most of the incoming non-irritable patients. The rear wing on the first floor, contains the hydrotherapy department and most of the incoming acutely disturbed patients. After patients go through a sufficient period of observation, and are presented to the medical staff and definitely classified, they are transferred to the second floor, if there are indications for the newer therapeutic methods. Here again, the wing arrangement proves to be very useful. In the front wing, the actual treatments take place. In the rear wing, the patients are kept under close observation immediately before the course of treatment is begun and also after the completion of the course. During the year, 309 metrazol, 27 insulin, and 135 malarial cases have been treated. This hospital’s experiences with shock therapy are in agreement with those of other hospitals; namely, the best results are obtained in psychoses with a duration of six months or less. Especially good results in cases of involutional melancholia have been secured. A number of spectacular recoveries have been witnessed; of especial interest is the case of a woman, fifty-one years of age, who was committed to this institution with a history of inability to walk for thirteen years and a previous hospitalization in another hospital in 1933. She apparently was a psychoneurotic. After eleven injections of metrazol, she began walking and now is doing well. Since the facilities of the new laboratory in the Diagnostic Building offer greater opportunities, many research problems have been undertaken Dr. Siegfried Maurer, of the Otto Sprague Memorial Institute of Chicago, has been coming to the laboratory twice a week and, aided by his collaborators, especially Dr. H. 0. Wiles, has made a great deal of the research possible. Intensive studies on blood chemical changes during metrazol therapy have been made. The results of these studies were published in the American Journal of Psychiatry (Volume 94, No. 6, May, 1938) under the title “Blood Chemical Changes Occurring in the Treatment of Psychogenic Mental Disorders by Metrazol Convulsions” by S. Maurer, M.D., M. 0. Wiles, P.L.D., C. M. Marberg, P.L.D., and B. Skorodin, M.D., and M. L. Fisher, M.D. The conclusion of these studies is that during and immediately after the convulsion, there occurs a marked acidosis, the blood acidity being as high as is compatible with life. The next important research item was the study of the effect of metrazol therapy on meningeal permeability. The results indicate a marked increase in the latter, especially after the first convulsion. This work is now being prepared for publication by Drs. B. Skorodin, M. L. Fisher, S. Maurer and H. 0. Wiles. Dr. Maurer has also made intensive studies of the vitamins, especially Vitamin C. An article on this subject appeared in theIllinois Medical Journal, Vol. 74, No. 1, July, 1938: “The Effect of L. Cevitamic Acid on Insomnia” by S. Maurer, H. 0. Wiles, E. W. Schoeffel and M. L. Fisher. In order to stimulate the interest of the members of the medical staff in keeping abreast of current developments and literature, the “Monday Evening Club” has recently been organized. The club meets every other Monday at 7 P. M. By rotation, a staff member reads a paper and this -is followed by a general discussion. The papers may be either presentations of original studies or compilatory in nature. Several interesting papers have been presented. Dr. Feldman’s paper on “Histamine-A Suggested Form of Therapy in Psychoses” is of striking interest; it is quite original and merits further study. Shortly prior to the appearance of Dr. W. Marshall’s article in Clinical Medicine and Surgery of February, 1938 on “Histamine Phosphate in Manic Depressive Psychosis,” Dr. Feldman independently developed the thought that histamine might prove to be valuable in the treatment of the psychogenic psychoses. histamine. He suggested the ambulatory and the shock treatment by He studied a series of cases under the ambulatory treatment, but the results were negative. Histamine in shock doses is! of course, very dangerous and its administration must of necessity be standardized before it can be used in a State hospital. Dr. Spira read a comprehensive paper on general paresis and its treatment. Of interest, in his statement that some authorities claim that malarial therapy is a good prophylactic against general paresis and should be employed in all persons showing a positive spinal fluid with or without neurological symptoms. Dr. Weisdorf presented a paper on the cold presser test in psychoses. The need of studying the psychotics with this test both before and after shock therapy in order to gauge the changes in the physiology of the vasomotor mechanism, was aptly pointed out by the speaker. Dr. Schlan summarized the literature on narcosis therapy in psychiatry. Dr. Fisher read a paper on insulin therapy of psychogenic psychoses and on disturbances of ideation in Dementia Praecox. Dr. Dobin gave a comprehensive discussion on “Ophthalmology in Psychiatry” with especial reference to the effect of tryparsamide on vision. Dr. Skorodin presented two papers; one on “Respiration in Mental Disease” and another on “Meningeal Permeability and Metrazol Therapy.” These activities in the hospital department reflected the general increase in all institution activities. One hundred and one major surgical procedures were performed during the year as compared with sixty-five last year (57 per cent increase). This work has been stimulated by the addition of two residents to the staff, one in surgery and one in gynecology. All newly admitted patients pass through these departments for routine examination. If surgical conditions are present, the relatives of the patients are contacted and if permission is received, operative procedures are instituted. Dr. John R. Grant, of Freeport, Illinois, operates one day each month. Drs. Puestow and Lifvendahl of the University of Illinois, make visits when a sufficient number of cases have been prepared. In addition, some of the emergency cases have been operated by members of the staff. Twenty-three autopsies were performed by members of the staff during the year. Plans are now being developed for increased activity in this department during the coming year. One of the members of the staff has had considerable experience in pathology and will be in charge of this department. During the year, the hospital has been fortunate in not having to cope with any serious epidemic of infectious diseases. There have been some cases of influenza, pneumonia, staphylococcic sore throat and the like, but fortunately they did not get out of control. There are two types of patients committed to this hospital’s care in large numbers and who in turn become institution problems. These are the alcoholics and the cases of simple senile deterioration. Chronic alcoholism with deterioration, as is often the diagnosis when committed, is a problem becoming more serious each day. It is needless to say that successful treatment and rehabilitation is difficult, but that it is the writer’s opinion that this type of patient should not be taken care of among the insane population. Many come to the hospital voluntarily, and usually remain but a week or two. The relatives of others, even though committed in the usual way, will often insist on their parole or discharge after two or three weeks. Little or no good is thereby accomplished. Again, this type of patient not infrequently is able to obtain alcoholic beverages and the resulting effects need not be described. It is not the writer’s province to recommend what should be done with this type of individual, as it is appreciated that the courts have their problems and perhaps have no other alternative but to commit; nevertheless, it is believed that a hospital for the insane is not a proper solution for the majority of these patients. Another group, coming to this hospital in large numbers, is the senile dement. These, for the most part, are harmless, inoffensive nursing problems. Probably the great factor leading to the commitment of this type of patient is the increasing and growing disposition, on the part of the younger generation, to evade the responsibility and trouble entailed in caring for their worn out and broken down elderly relatives, and the growing attitude and feeling that this responsibility should be taken over by the State. Again the writer has no solution to offer, but it would be a fine thing, if, in some way, there could be an awakening of interest and sympathetic understanding of this type of patient, which in turn would result in their being properly cared for at home or in some environment with adequate nursing care. Again the X-ray laboratory has been active during the year. As stated one year ago, conferences are held once a week at which time X-ray films, cardiograms and B.M.R. reports are presented for interpretation and study. During the year, 1,140 X-ray films were taken in the laboratory. These included X-rays of chest and heart, gall bladder, and bone conditions. Fifty-five basal metabolic rates and forty-eight electrocardiograms have been taken and studied. Reference has already been made to the investigative work being done by Dr. Siegfried Maurer, of the Sprague Institute. During the year, he has been able to spend two days a week at the hospital. He has organized the laboratory and, on his recommendation, much new equipment and apparatus has been purchased. The Manteno State Hospital greatly appreciates the fine work Dr. Maurer is doing. He has presented many helpful suggestions and rendered valuable assistance in the treatment of the hospital’s patients. With the occupancy of the Diagnostic Building, it has been possible to carry out many of the ideas and suggestions referred to in previous reports. Various departments have been organized and patients now pass through them for routine examination. Several of the members of the staff, though in charge of the more chronic services, are in a position to spend a portion of their time in some special department. Adequate facilities are available in the way of examination rooms and equipment. In order that all members may have equal opportunity, these services are changed from time to time. Last year, the report of this hospital referred to the fact that it was planned to establish a psychiatric board, to make diagnoses, consider paroles, recommend treatment and the like. This plan has not been carried out as originally contemplated. However, the staff has been divided into two groups and, in turn, they consider the questions mentioned above. During the year, many new cottages have been opened. This has enabled the institution to classify the patients but not entirely to the degree desired. This problem is being given careful consideration. Most of the difficulty is due to the rapid influx of patients and this, in turn, disarranges previously planned schedules. During recent years, the hospital has made a practice of entertaining the Kankakee County Medical Society. This was again done in May of this year. At this meeting the wives of the members accompanied them and were entertained by wives of staff members during the business and scientific meeting. At this meeting, Dr. Puestow gave a very interesting discussion of the effect of certain drugs during post-operative states and Dr. Richter, of Evanston, discussed some of the more common cardiac conditions. Dental Department Dr. E. J. Gagnon continues to be in charge of the dental department. During the year 4,655 examinations were given, 1,926 of which were new cases, and 2,729 old cases. Other treatments included 3,707 gingivitis, 1,936 pyorrhea, and 472 general treatments. In addition, 4,457 scalings and prophylaxis treatments were given, and 2,834 extractions were made. Dentures and bridge and crown repair work as well as other treatments were given in this department. Nursing Service The personnel of the nursing department has shown a large increase in numbers during the year. This, of necessity, has been the result of opening many of the new cottages. The number of registered nurses has been augmented, hydrotherapists employed and additional supervising attendants appointed. A recent survey discloses the fact that among the personnel of this department there are sixteen who have had some nurse’s training, one hundred and ninety-eight have a high school education and one hundred and six have had some previous hospital experience. During the year, two hundred and three new attendants were employed. While two new dormitories for employes were opened during the year, the rapid increase in personnel has made it impossible for all to be housed and, as a consequence, one hundred and thirty-four members of this department are now living off the hospital grounds. The course of instruction for attendants, as outlined in the last report, has been continued throughout the year. On June 25th of last year, one hundred and sixty-nine attendants had completed this course of instruction. This course, as previously outlined, consists of a series of talks by the Managing Officer and members of the medical staff. The booklet of instructions, as prepared by the hospital, is reviewed by the Chief Nurse. In addition, the general care and treatment of patients is emphasized and practical demonstrations are given. In January of this year, a class of ninety-one attendants finished their training course and in June, another class of sixty completed the course. During the year, two of the registered nurses were sent to the Psychiatric Division of the Research and Educational Hospital for special instruction in metrazol and insulin therapy. In June of this year, the Dietary Department assumed charge of all employes working in the various dining rooms and who were heretofore considered as members of the nursing service. It is believed that this change will be to the advantage of all concerned. Until just recently, the employes working in the barber shop were charged to the nursing department, and they now are considered a department unto themselves. During the year, the hospital service has been very active; 1,485 patients having been treated. One hundred and sixty-nine operations, major and minor, have been performed. Dietary Department The fiscal year ending June 30, 1938, found a greater and more varied type of work accomplished by the Dietary Department. All the dining rooms in the institution were placed under the supervision of the dietary department. Male and female supervisors have been appointed to make daily rounds on the food supply, cleanliness of dining rooms, and the amount of garbage disposal. Helpful suggestions and a feeling of unity has resulted in greater personal interest in the work, more efficient service and a noticeable elimination of waste. The weight of patients has been carefully checked each month and a concentrated effort made to stop the loss on each ward where patients were found to be losing weight. Mimeographed menus are sent to each ward a week in advance in order that the attendants may know what foods to expect and how to serve them. All bread is sliced and wrapped before being sent to the wards. An attendant and a detail of patients wrap the bread at night in the bakery. Fresh bread is sent daily for each meal. Bread not used is returned to the kitchen and utilized in various recipes calling for dry bread and bread crumbs. In this way, no bread is wasted. A staff dining room has been opened at the west end of the general kitchen. The room has north, south and west exposures, has hospital-made drapes and table linen. It is quiet and offers an appreciated degree of privacy to members of the staff. The officers’ dining room has been enlarged, for the personnel has been considerably increased during the past year. Additional tables and chairs were placed in the employes’ dining room to take care of the increase in personnel; all are served without confusion or waiting. Hours of serving have been lengthened so that the employes may be more comfortable and served without delay. This change, though seemingly slight in itself, has been a great convenience to employes. Ice cream is served twice each week to all patients and employes. The unit cost of each serving is about nine-tenths of a cent per capita. The canning season in 1937 began the latter part of August and ended October 1st. During that time, 20,000 gallons of tomatoes, 15,000 gallons of sauerkraut and 3,000 gallons of grape juice were canned. In January, the dietary department opened a W. P. A. Project to assist in special diet work. The first step toward our goal was the preparation of special food for the T. B. wards. This was followed by special menus and food for the insulin and metrazol patients in the diagnostic building. Results have proven very gratifying. A training school for dietitians, who are to work in State institutions, has been inaugurated by Mrs. Christine R. Pensinger, State Food and Textile Adviser. The training, which is under the super vision of the chief dietitian, includes a working knowledge of State equipment, quantity cooking, and institutional ethics. A flour room has been added to the bakery and new proofing rooms installed. Additional bread pans have been purchased. A larger loaf is being made; hence, a saving in bread. An attendant and detail have been assigned to the general kitchen to clean up during and after the day’s work. This has made working conditions safer, pleasanter and much more efficient. Occupational and Recreational Department There is nothing particularly new or original in the work done in the way of occupations and recreation during the year. The goal of this department is to restore the patient to that state of health or well-being that will enable him to become economically useful. To be economically useful means, in its simplest terms, to be able to work. Occupational therapy gives the patient a useful occupation upon which his attention may be centered, thus diverting his attention from his own problems. A patient, whose hands are kept busy, will usually have his mind occupied. To have pride in the work he creates and a feeling of satisfaction in his own usefulness is of therapeutic value. Therefore, the occupation is adapted to the capacity of the individual patient and the experience of creating something with his own hands gives him a new valuation of his own worth and helps him regain confidence in himself. The story of Mrs. X can be duplicated a hundred times, with many variations, in an occupational therapy department. She is a woman, fifty-four years old, a high school graduate and before her marriage, worked for ten years as a milliner and was very successful. Before the onset of her psychosis eight years ago, she was a good cook and housekeeper and liked to sew. She went regularly to church. She enjoyed driving her automobile, attending the movies, theatre and ball games. Then she developed many paranoid delusions. She became irritable, rather resistive, negativistic, and at times combative. For about five years she was cared for at home. Her condition became progressively worse and when she could no longer be controlled at home, she was committed to an institution. Upon admission, she was described as seclusive and haughty, refusing to do even the simplest work. She was transferred to the Manteno State Hospital October 15, 1935, but it was not until about the first of this year that she was persuaded to attend an occupational class. She became interested in making balls of carpet strings which were woven into rugs on the looms, and also in fixing material for figure-eight rugs. She took an unusual amount of interest in combining colors. “Yes,” she told her husband upon his last visit, “I am tacking carpet strings, but you ought to see the pretty colors, and the pretty rugs they make with them.” Although she does not dance, she now attends the dances. She attends religious services and joins in the singing of hymns. On June 1, 1938, the doctor’s report shows that she is quiet and cooperative and does not show any gross behavior disorders. Stress is laid on the completion of a well made, useful project. This is a part of the treatment itself, arousing interest and giving a pleasant, stimulating reaction from bright and lively colors. Although the occupation class is still housed in the basement, it is hoped that a suitable building can soon be arranged for this work. Recreations and amusements, along with music, are important branches of this department. Patient dances are held three times a week, on Mondays from 2 :00 to 3:30 P. M. and on Thursdays from 2 :00 to 3:30 P. M. These dances are attended by shut-in and unoccupied patients, parolees and employes not on duty. The average attendance is about three hundred. On Fridays from 7:00 to 9:30 P. M., dances are attended by the industrial group of patients and employes not on duty. The average attendance is 650 and has been as high as 900. A g-piece patient orchestra (which is constantly growing and developing), is furnishing the music. On Friday evenings, this same orchestra is augmented to eighteen or twenty by the addition of some outsiders and employes. Usually there is a floor show, offered at each inter mission, consisting of patient or outside talent, to furnish amusement to those who cannot dance. The use of a public address system and colored lights gives to these dances a professional appearance which is appreciated. An occasional “stunt dance” lends variety and interest as well. Dancing is, without question, the hospital’s one amusement. Band concerts are given every two weeks. The band is called the “Manteno Community Band” because of the fact that it is made up of the patients, employes and some of the local citizenry. There has not been time to build a satisfactory band unit entirely out of patient material, so in order to have good band music, the services of the Manteno organization have been enlisted. The result is a fine all year-round hospital band. The concerts are formally presented from the stage of the auditorium. The program is of one hour and thirty minutes duration with special feature numbers. The personnel, at present, consists of twenty-seven members and is growing by one or two new members each week. This band acts as an ‘incentive for patients and also attracts the attention of the better class of available outside musicians. Concerts will be presented at least every other week the year round. Since January 15th, there have been two days out of each week devoted to athletic activities of some nature. Some of the methods have been as follows: Standard setting up exercises for men and women; basketball; indoor baseball; volleyball; marching to music, and the like. Until June 1st, these indoor sports proved interesting and helpful; however, since that date, outdoor games such as soft ball, horseshoe and croquet, have taken their places. Closed cottages, or shut-ins, have been taken out to the athletic grounds two days each week for scheduled games. Almost all evenings are devoted to scheduled games among the industrial patients, both men and women. Regular cottage competition is encouraged. Baseball, among the employes, is a popular game and a good team which plays against outside teams has been organized. This furnishes amusement for the patients who are brought out to witness these games. The hospital has been fortunate in securing the services of outside entertainers who have liberally given their talents to the patients, without remuneration. Each week, there has been some concert or entertainment lasting for an hour or two, mostly in the evenings, for the industrial patients. The average attendance has been about four hundred patients, with a few employes and visitors. Most all of these entertainments are of a musical nature. A Hammond organ furnishes the background for the majority of these events. During the winter and spring months, employes have enjoyed the facilities of the recreational center in the same sports as are furnished the patients. Last winter, a basketball team which was organized among employes, won the majority of its games. One night out of each week was devoted to a recreation night during which time the employes played basketball, volleyball, and played indoor baseball for three hours. One night was devoted to roller skating, also one morning, the skates being furnished by the employes themselves. An occasional employes’ dance has been given by the athletic department. Since January 1st, 132 church services have been held here by various religious sects. These services are conducted by outside theologians and are held in the recreational hall on Sundays; others intermittently during the week, with some of them given in the cottages, especially where the patients are infirm. Social Service Department Prior to September, 1937, the State of Illinois was divided into eight zones to care for patients on parole in the homes of relatives from State hospitals. The patients were under supervision of a State hospital social service department, which in turn, was under direct control of the Department of Public Welfare. The Manteno State Hospital, since its inception, has had a social service department which handled special cases referred to it by the medical staff. As the population grew, there followed a corresponding increase in the out-patient department which clearly indicated the need for further and more specialized service. Accordingly, in September, 1937, the Department of Public Welfare, in recognition of the above need, expanded and reorganized social service zoning in the State by adding a new zone called “Manteno. This new zone is comprised of seven counties; namely, Bureau, Putnam, LaSalle, Livingston, Grundy, Kendall and a part of Kankakee. As in other branches of this particular division of the Department of Public Welfare, the zone supervisor is a psychiatric social worker. The work of the department falls into four classifications: admissions, paroles, supervision and friendly service. 1. Because of the hospital’s rapid growth, which calls for careful centralization of functions, and as it is felt the Social Service Department should be a tool of the medical staff, new patients are admitted to the hospital through this department. As the patient’s relatives are interviewed immediately, which makes history available to the medical staff, the patients can be observed intelligently in terms of past behavior and there is little delay in instituting treatment for the patient. It is also found that giving the relatives an opportunity to discuss the patient and the patient’s illness gives them a sense of security and helps them overcome some of their bewilderment which, of course, is inevitable but which seems exaggerated after being confronted by the large institution. A total of 412 psychiatric social histories were received through this department. 2. When patients are to be paroled from the hospital, the total situation is referred to the social service department, where the psychiatric, medical and social implications of the individual cases are studied and the findings subsequently referred to the zone which will assume responsibility for supervision. Though this plan of helping the patient and his relatives during the usual ninety-day parole period has been in operation only since January, 1938, a total of 340 patients have been paroled into other zones. The supervising zone sends us regular reports of the patient’s adjustment, based upon home visits by the social worker and reports from the clinic which all paroled patients attend at least once a month. Thus the hospital has a total picture of the patient in relation to his illness and its treatment; so, at the expiration of parole, the hospital is in a position to advise for further care for the patient. In sixty-four cases, the medical staff felt that special investigations were needed before it could decide that the patients should be paroled. These pre-parole investigations were referred to outside zones, and on the basis of the investigations, the medical staff decided whether the patients could adjust on the outside. In cases where social adjustments were needed before it was felt parole should be granted, cooperative planning was carried on between the social service department of the hospital and the department of the other zone. In some cases, as a result of the pre-parole investigation, the social service department was able to alter an original plan for a patient awaiting parole, by working with interested individuals. 3. As other zones supervise this hospital’s paroled patients who dwell within their boundaries during the parole period, so the Manteno zone supervises patients within its boundaries paroled from either this hospital or other State hospitals. Though this hospital did not begin to parole patients into other zones until January, 1938, other hospitals almost immediately began to use the services of the new zone for supervision purposes. From October, 1937 through June, 1938, the Manteno zone supervised a total of 151 patients. This supervision was done wholly through home visits as the Manteno zone has not yet organized out-patient clinics. 4. Because of the relative newness of the department, the usual friendly services with patients in the hospital have been neglected. It is, therefore, difficult to evaluate this service. However, an attempt has been made to correlate visits with patients on the cottages in accordance with the suggestions given by the doctors in daily contact with the patients. *Federal Art Project The series of mural paintings placed in the lobby of the Administration Building, was completed in June with the installation of the remaining large mural and the four small mural panels. This mural project dates back to 1935 at which time Mrs. Increase Robinson, Assistant to the National Director of the Federal Art Project of the Illinois Works Progress Administration, visited the institution and approved the project. Artist Gustaf Dahlstrom was assigned to the work. However, a short time later, Mr. Dahlstrom was promoted to Supervisor of mural projects under Mr. George G. Shorp, State Director of the Federal Art Project, and as a result, the completion of the project was considerably delayed. The final installation of the mural panels was completed June 14th under the personal supervision of Mr. Dahlstrom. Those installed previously were rehung and retouched and the project is now complete. The subjects of the mural panels were inspired by the poem “Man-Te-Nau,” written by Oliver W. Barnard and published in his book “Poems of Hope,” containing 359 pages of poetry and blank verse. Poet Barnard’s homestead is the present site of the residence of the managing officer. Many comments of praise have been made on the beautiful appearance of the mural panels and the institution is very fortunate, indeed, to have been favored with a project of this kind. Mr. Dahlstrom, while at the institution, presented preliminary sketches for the mural panels for the lobby of the Diagnostic Building which will be incorporated in another project similar to the one just completed in the Administration Building. Clinical Record Office A total of 6,230 patients had been enrolled on the institution’s records by July 1, 1937. The system of rapid reference files installed in this office when the institution was opened in December, 1930 had become inadequate in size and use. A number of changes in the method of recording the pertinent statistical data for rapid reference was needed. Equipment was purchased, including eight binders with a visible capacity of 1,418 records to each binder. The new system has been found to have many advantages over the former system of rapid reference files. In addition to the full name of the patient, certain pertinent information is visible without the separation of the records. On the reversal of the records there is visible a listing of the 24 psychoses groupings, which have been arranged to conform with the new classification of mental diseases as adopted by the American Psychiatric Association on December 27, 1932, and put into effect by the Department on July 1, 1934. The remainder of the space on the printed forms provides for the entry of all statistical data maintained for rapid reference on all patients and in addition provides for a complete listing of correspondents, hospital residence, record of death, parole or discharge, and special information. The rapid growth of the institution, during the past year, has correspondingly increased the volume of work in the clinical record office and it has been necessary to add to the personnel of this office. There are now employed in this office, four full-time and one part-time employes. Each employe has been assigned certain definite duties. WPA Food Project A WPA food project was established here on July 6, 1937, under the direction of Miss Marian A. Wait, District Supervisor, Women’s and Professional Division of the Works Progress Administration. The project was opened with a personnel of eleven women who had been certified as the wage earners of their respective families. Some were assigned to power sewing and darning machines in the sewing and mending rooms; others assisted in the laundry and in the wards. On January 5, 1938, the course and purpose of the project was changed to the dietetic field. Mrs. Lillian Williams, dietitian, was assigned to the project. Each worker was given a complete physical examination, including Wassermann tests, (test for syphilis). The first classes were held in the kitchen of the tuberculosis ward. Meals and nourishments were prepared on the basis of one hundred, to teach the women institutional cookery. Using and increasing the recipes tested, the workers were assigned gradually to the general kitchen, and in the vegetable preparation room. They were given instruction in serving at the steam-table in the employes’ cafeteria. Special diets in the diagnostic male and female wards are now being prepared and served by the WPA women. Lesson plans covered the preparation of food for the well and the sick; they stressed the responsibility of accurately preparing food for the ill as per orders of attending physicians; varying menus that repeatedly require the same basic ingredients, in order to make the meals inviting to the patients; they stressed punctuality in serving nourishments at stated intervals, for the welfare of the sick; the arrangement of attractive trays and serving bed patients. Special diets in the hospital, to be prepared and served by WPA women, is under consideration at present. Owing to the limited time allowed WPA employes, each worker is on duty each month for twenty days of 6% hours each. The project time schedule has been set up in shifts; the sponsor is being served by WPA labor every day of the week, excepting Sunday. A daily record is kept of the project activities. There are twenty-eight employes in this project. The work has been planned in such a manner that each employe is given an opportunity to serve in all above mentioned departments. Such varied experience is educational, stimulates interest, and enables supervisors to transfer a worker from one department to another, when an emergency arises, with no loss of efficiency and little or no confusion. Farm and Garden Valuation of farm and garden products for the fiscal year just closing, is as follows: Farm Products . . . . . . . . . . . . . . . . . . . . . $ 6223.00 Garden Products . . . . . . . . . . . . . . . . . . .12,790.44 Fruits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .473.10 Meats (produced farm). . . . . . . . . . . . . ..12,115.27 Last year, reference was made to the fact that owing to sufficient rainfall, the prospect for bumper crops was good. Crops were better than the year before. Garden activities, as previously mentioned, were for the most part concentrated on Farm No. 3. All farm colonies are now fully occupied by patients. The transfer of patients from other institutions, as well as the reception of new patients, has enabled the institution to augment details working in this department. Within the near future, plans should be made for the raising of more hogs to supply the rapidly growing patient population. It will be necessary to construct an additional farrowing house and feeding sheds for the fattening of hogs. Attention should also be directed to the fact that facilities for slaughtering of hogs are inadequate. From its present small herd of twenty-five heifers which were received during the year the institution hopes to develop a dairy herd. It will perhaps be a physical impossibility to develop a herd of sufficient size to produce all milk used by the hospital, but it is believed a herd of 150 cows would be to the hospital’s advantage. Facilities at present are inadequate to care for but a relatively small herd, but it is hoped that the improvement program of the coming biennium will include a large and modern dairy barn. Permanent Improvements The building program, mentioned in the last report, was completed last fall. As already indicated, it included: Twelve ward buildings, a diagnostic building, two dormitories for employes, a building for tubercular patients, a mechanical stores building, two smaller ward buildings, seven physicians’ cottages, a cottage for the master mechanic, and a recreational center. These improvements and equipment represented an outlay of approximately $4,000,000. As already indicated, many of these buildings are now occupied and if the present rate of increase continues, all will be occupied by April 1, 1939. In previous reports, a brief description of the buildings in question was given and will not be repeated at this time. It will, perhaps, not be out of order to say that many compliments have been received concerning the Diagnostic Building. Many favorable comments relative to facilities and convenience have been made. Representatives from other states have visited this institution during the year. Most of them were favorably impressed with the type of construction, especially with the attempts which have been made to hold upkeep to a minimum. Reference has been made to the fact that owing to an increase in patient population, many new buildings have been opened during the year. These buildings, for the most part, have been named after men who have been prominent in the medical and psychiatric world. In order to make the dates of opening a matter of record, the following tabulation is given: Adler I. . . . . . . . . . . . . . . . . . . . . . . . . .August 1, 1937 Diagnostic Building . . . . . . . . . . . . . . . October 22, 1937 Sanitarium . . . . . . . . . . . . . . . . . . . November 16, 1937 Diagnostic Building (second floor). . . . . January 21, 1938 Rush I . . . . . . . . . . . . . . . . . . . . . . . . .January 4, 1938 Rush II . . . . . . . . . . . . . . . . . . . . . . . . . March 1, 1938 James II . . . . . . . . . . . . . . . . .. . . . . . . .March 2, 1938 James I. . . . . . . . . . . . . . . . . . . . . . . . . .April 28, 1938 Cullen II . . . . . . . . . . . . . . . . . . . . . . . . . .May 1, 1938 Cullen I . . . . . . . . . . . . . . . . . . . . . . . . . .May 18, 1938 Willis I . . . . . . . . . . . . . . . . . . . . . . . . . . . May 1, 1938 Willis II.. . . . . . . . . . . . . . . . . . . . . . . . . .May 18, 1938 Hunter II . . . . . . . . . . . . . . . . . . . . . . . . . June 8, 1938 Hunter I . . . . . . . . . . . . . . . . . . . . . . . . .June 22, 1938 Commissary On January 25th, the institution commissary was moved from the basement of Pinel Cottage to much larger quarters in the basement of the Amusement Hall. That the commissary is a convenience and enjoyed by the patient population, is evidenced by the volume of business done. Sale in June, 1938, amounted to $4,250. Whenever possible, the patients call personally at the commissary to make their purchases. Ward employes purchase for those unable to purchase for themselves. Profits are used for patients’ entertainment only. Annual Inventory The annual inventory of institution assets, outside the General Store, is one of the large individual tasks each year. Taking this inventory during a period of only a few days in the last week of June requires the help of a good many employes, many of whom may not have had experience to enable them to be accurate. There is the last day’s rush and possibility of carelessness. This year, Manteno State Hospital has developed a perpetual inventory for the assets of the institution outside the general star which is quite similar to the inventory in effect in the general store of all institutions. That system has worked out so well that equally great benefits are expected when applied to all other institution assets. The inventory of June 30th, this year, will be set up on perpetual inventory cards. The possibility of a more accurate inventory is seer as well as over the old method of taking the annual inventory. Major Improvements It is not possible to refer here to all of the major improvements made by the institution’s own force during the year, but a few items are given as follows: 56,000 square feet of sidewalk have been laid; 1,400 lineal feet of gutter has been installed: 10,400 lineal feet of roads have been excavated and the same filled with crushed rock; approximately 50,000 yards of dirt have been moved and used for filling and grading purposes; 800 elm and 1,250 walnut trees were planted last fall; approximately 8 acres of lawn have been seeded; approximately 4,350 yards of dirt were excavated and removed from beneath the kitchen; a new flour room was built in the basement beneath the bakery; approximately 2,150 yards of dirt were removed from beneath the laundry. This gives better ventilation and enables mechanics the better to work on pipe lines, sewers, etc.; the installation of new laundry machinery necessitated the building of large concrete foundations. At the same time, the air compressor was moved to the power house and an air line run from there back to the laundry; 2 hot water circulating pumps were installed in the power house, 2 small steam pumps were removed; 2,016 pieces of furniture including rockers, chairs and benches were repaired; an enclosed entrance to the sewing room at the T. B. Building has been erected. This was constructed of brick and has a slate roof; the front porch on Farm No. 3 has been enclosed with double, heavy, adjustable sash and combination storm and screen doors; a four-stall garage for trucks was erected. This building is 26 feet wide and 42 feet in length; nearly all screens and windows on the various cottages have been painted. The above items, and indefinite list could be presented, does not include items of general maintenance, such as repairs of locks, screens, windows, faucets, steam traps, window shades and the like. To keep up all the necessary repairs and to prevent needless deterioration of buildings and equipment, keeps the mechanical department very busy. Recommendations It is pleasing to note that an appropriation for permanent improvements, available this fall, has been made. While this program will include an extension and enlargement of the building for tubercular patients, enlargement of the kitchen, additional ward buildings, a staff house, a dormitory for employes, an additional boiler and generator, it is still believed that certain improvements are necessary in order to round out the institution Some previous recommendations made are repeated here: 2 hydro wards for chronic disturbed patients; an additional pavilion for tubercular patients; additional dormitories for employes ; the sinking of additional wells: the erection of service buildings for the garden, including a propagating house; the building of a dairy barn; the erection of a building to be used for the canning of vegetables; the erection of a building for the housing of fire fighting equipment; resurfacing of roads. To refer to some of these items more in detail, it will be necessary to partially repeat some of the things included in previous reports. There are a large number of patients, especially on the women’s side, who are chronically disturbed. Many of them need hydrotherapy a good portion of the time. It is difficult to care for them in any other way. It is for this reason, that a hydro building for each sex, should be constructed. The program now underway contemplates the addition of two additional wings to the building now being used for tubercular patients. While this will help and take care of the situation for a short time, it is recommended that, within the near future, an additional pavilion for female patients be erected and the one now being used for both sexes be used for male patients exclusively. Many employes are now living off the hospital grounds. Some have found it to be a difficult matter to find suitable quarters in the community. With the growth of the hospital, it will, of necessity, entail the expenditure of a large amount of money to provide housing facilities for all. An additional well, twelve inches in diameter and 225 feet in depth, has just been completed, but as yet is not in service. While this well will augment the supply of water, it must be borne in mind that at present this hospital is using approximately one million gallons per day and that, as the hospital grows, an additional supply of water will be needed. At present, the wells in use are taxed almost to capacity. Garden activities have been and will be increased. The propagation of a large number of plants, in early spring, is a difficult matter during inclement spring weather. For this reason, the erection of a glass propagating house to be used exclusively for growing of plants is recommended. Canning of surplus vegetables is an important industry. What has been done heretofore has been done under difficult conditions. At present, it is done in the basement of the kitchen, in an area inadequate in size and with insufficient equipment. To conduct this industry properly adequate quarters and equipment should be provided. At one end of the building a kraut house, with sanitary vats should be erected. The fire equipment, consisting essentially of a truck and pumper, is now housed in the garage at the rear of the power house. This apparatus should be more centrally located. It is recommended that a two-story building be erected. On the second floor should be housed those employes who would answer emergency calls. In addition, a tower of sufficient height to drain and dry the fire hose should be built. The resurfacing of the roads about the institution grounds should receive serious consideration. It is a difficult job, under present conditions, to keep them serviceable. The wear and tear to which they are subjected, especially following heavy rains, results in their becoming at times almost impassable. Again, during warm weather, high winds carry a great amount of debris about the grounds and into the buildings. It is true that several miles of macadamized roads will have to be built, but such construction will not only add to the attractiveness of the grounds, but eliminate, to a great degree, the dust problem. *Federal Art Project - Please contact me if you happen to know where these panels are or anything about them. Neither the HomeStar Bank or the Kankakee Historical Society know where they are. It would be a real travesty if they were destroyed and lost forever.