Complete Annual Report of the Illinois Department of Public Welfare Manteno State Hospital - July 1, 1938 - June 30, 1939 BY RALPH T. HINTON, M.D., Managing Officer Population-Patients Present at the close of the year, June 30...4,668 in 1938 and 5,385 in 1939 The members of the medical staff, as of June 30, 1939, included the following : Dr. Ralph T. Hinton, Managing Officer Dr. Louis Cohen, Clinical Director Dr. Bernard Skorodin, Senior Physician Dr. K. H. Tutunjian, Senior Physician Dr. M. S. Croft, Junior Physician Dr. M. Goldberg, Junior Physician Dr. G. L. Perkins, Junior Physician Dr. R. Rosenberg, Junior Physician Dr. W. Rosenberg, Junior Physician Dr. M. L. Stern, Junior Physician Dr. A. H. Gollmar, Junior Physician Dr. L. Schlan, Junior Physician Dr. B. Rosen, Junior Physician Dr. I. H. Spector, Junior Physician Dr. P. E. Feldman, Junior Physician Dr. I. Spinka, Junior Physician Dr. M. L. Frank, Junior Physician Dr. H. S. Fein, Junior Physician Dr. J. Hoff, Junior Physician Dr. M. Urist, Junior Physician Dr. W. Kirschbaum, Resident Dr. F. L. Darnell, Resident Dr. E. Paschkes, Interne Dr. E. J. Gagnon, Senior Dentist Dr. William J. Cunningham, Junior Dentist Last year the fact was mentioned that there had been a tremendous increase in the resident population of the Hospital. This year there is also an increase but not to the same extent. One year ago the population was 4,668, and at this writing it is 5,385, a net gain of 716. A perusal of the table showing movement of population discloses the fact that the county judges have complied with the suggestions contained in the general letter sent out by the Director, State Department of Public Welfare on January 5, 1938 and have committed 2,109 first admissions during the year. Medical Department Since the primary policy of the hospital is intensive treatment of the patients, it is gratifying to report that the application of newly developed therapies has been very extensive. Metrazol treatment in schizophrenia and manic-depressive psychosis was carried out during this last year for 228 women and 211 men, a total of 439 patients.Similarly, insulin treatments were carried out for 36 women and 40 men, a total of 76 patients. With the exception of three prolonged comas, one of which terminated fatally, none of these treatments was carried out with any mishap. Investigation of this fatality by the Legislative Committee indicated that this unfortunate complication was unavoidable. Malaria treatmentin the case of patients with syphilitic meningo-encephalitis was administered to 115 men and 76 women, a total of 191 patients. Syphilitic chemotherapy was carried out to the extent of 444 bismuth and 1,011 salvarsan treatments for the men patients. The luetic treatment service is so large that it commands the exclusive attention of one staff physician. The treatment of general paresis by cerebral impaludation has been introduced. It is of interest also to record the wide service which the hospital offers the patients and employes of the institution. The data gives some indication of how vital the general medical and surgical needs of the resident population are. As a sample of the service which the surgical department offers, a summary of major operations performed during the past year is indicated here: Thyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . 6 Tonsillectomy . . . . . . . . . . . . . . . . . . . . . . . 148 Repair of Cystocele . . . . . . . . . . . . . . . . . . . 27 Cholecystectomy . . . . . . . . . . . . . . . . . . . . . 3 Cholecystgastrostomy . . . . . . . . . . . . . . . . . . 1 Salpingo-oopherectomy . . . . . . . . . . . . . . . . 31 Repair of Rectocele. . . . . . . . . . . . . . . . . . . . 44 Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . 75 Herniotomy . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Appendectomy . . . . . . . . . . . . . . . . . . . . . . . 28 Hemorrhoidectomy . . . . . . . . . . . . . . . . . . . 11 Cystotomy . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Dilatation and Currettage. . . . . . . . . . . . . . . . 7 Peripheral nerve injuries . . . . . . . . . . . . . . . . . 4 Exploratory laparatomy . . . . . . . . . . . . . . . . . 6 Cerebral impaludation . . . . . . . . . . . . . . . . . . 1 Mastectomy . . . . . . . . . . . . . . . . . . . . . . . . 1 Rectopexy . . . . . . . . . . . . . . . . . . . . . . . . . 2 Amputation (foot) . . . . . . . . . . . . . . . . . . . . . 1 Uterine Suspension . . . . . . . . . . . . . . . . . . . . 4 Cervical amputation . . . . . . . . . . . . . . . . . . . . 6 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . 31 Growth of the clinical laboratory has proceeded very rapidly because of the necessity felt for an adequately equipped department as an adjunct for hospital work of a high caliber. The total number of patients received for X-ray during the past year was 1,033, it is reported by the X-ray department. Electrocardiographs were obtained in 85 patients and basal metabolic determinations in 60 patients. The total number of X-rays for specifically diagnosed conditions included those for skull, chest, spine, gastro-intestinal, gall bladder and other bone and internal conditions. It is reported by the pathological department, that the total number of autopsies performed since January 1, 1939 was 50. A microprojector has been purchased as has other essential laboratory equipment for pathological investigations. In the biochemical laboratory a total of 2,772 blood samples were obtained for the Kahn tests and 543 spinal fluids were examined for Kahn tests, protein, and gold curve. Other specific biochemical in vestigations carried out included blood counts, urinalysis, sulfanilamide index, spinal sugar and others. Dr. Louis H. Cohen has been appointed clinical director, a new post at this institution. This appointment is in line with the ambition of the institution to be granted recognition as a teaching hospital in psychiatry. Emphasis is now being laid therefore on the teaching and research program of the hospital. Dr. Cohen is a graduate of the Yale University School of Medicine, 1931, and has studied in various clinics in America and abroad. He has come from the Worcester State Hospital where he was senior research psychiatrist and later, acting clinical director. He is a Diplomate in Psychiatry and Neurology of the American Board of Psychiatry and Neurology. Dr. Walter R. Kirschbaum was appointed resident (pathologist). He has studied in various clinics in Germany and has been most interested in pathology, particularly neuropathology. He was a member of the faculty of the University of Hamburg. An accomplished pathologist, he represents an outstanding addition to the teaching staff of the hospital. Dr. Bernard Skorodin, senior physician, became a Diplomate in Psychiatry of the American Board of Psychiatry, and Neurology. Additions to the medical library have been made during this past year. The total number of new volumes purchased was 118, and the total number of new journals ordered was 19. Since the library represents an integral part of the teaching and'research program of the hospital it is felt that such an excellent start augurs well for the future, and it is hoped that the medical library will be even better equipped, particularly with periodical literature, within the very near future. The Journal Club has continued to have weekly meetings during which important articles in the recent literature are reviewed and discussed by the staff. The Monday Evening Club has continued its activities and introduced the innovation of inviting outside speakers to address its meetings. During the past year the following guestsaddressed the staff: Dr. Chester Darrow, Institute for Juvenile Research, on "The Autonomogram." Dr. Marvin Sukov, State Criminologist's Office, on "Survey of Criminology." Dr. Baker, University of Minnesota, on "Brain Changes in Hypoglycemia." Dr. A. A. Low, Illinois Psychiatric Institute, on "Group Psychotherapy." Dr. Low came on two occasions and gave clinical demonstrations with his talks. The club was also addressed by the managing officer on "Experiences in State Hospital Management," and by Dr. Siegfried Maurer, who gave a series of lectures on "Vitamins." The Hospital was the host for the April meeting of the Illinois Psychiatric Association on April 8, 1939. After an inspection tour and dinner, a scientific program was offered and the following papers were read: "Meningeal Permeability and Metrazol Therapy," by Dr. Bernard Skorodin, Manteno State Hospital. "The Mineral Content of the Brain after Insulin and Metrazol Experiments in Animals," by Dr. Erich Liebert and Dr. Gert Heilbrunn, Elgin State Hospital. " Mental Disease in Urban Areas," by Dr. H. Warren Dunham. As already stated, an immediate goal in the program of the clinical department is to raise and maintain the quality of psychiatric work so that this hospital will be recognized for psychiatric teaching by the American Medical Association. The appointment of a clinical director and a pathologist represents one step in this direction, increase in the size of the medical library represents another. It is hoped that with the teaching activities which go on in the formal teaching conference, the diagnostic and parole conferences, and the post-mortem examination room, the teaching functions of this hospital will be best exploited. Inevitably, specific problems of psychiatric interest arise and, with the growth of such an interest, research programs can be formulated and carried out. Progress in this direction is necessarily slow since the time and energy required for research of a high caliber presupposes a staff sufficiently large to provide for the routine needs of the hospital to which research interests cannot be sacrificed. Furthermore, researchers must be trained a long and arduous process. At the present time, despite the handicaps of msticient personnel, several research projects are under way. Research is the only hope whereby the enormous cost of custodial care may one day be diminished. Dental Department Dr. E. J. Gagnon continues to be in charge of the dental department. He is being assisted by Dr. William J. Cunningham who was transferred from the Jacksonville State Hospital on August 20, 1938. Nursing Department The nursing department began the year with an attendant personnel of 224 females and 207 males. Included in this group are six male and six female supervising attendants, and one male and one female hydrotherapist. Three new wards were opened in June 1938, patients having been transferred from Chicago State Hospital. These were for the most part destructive, untidy and combative. The employe staff increased in number to 450 by August 1, 1938. On July 1, 1938, the ward dining rooms were placed under the supervision of the dietary department. In October, 1938, McDowell Cottage was opened with 112 patients. The reception of patients from the psychopathic hospital was very heavy during the summer and fall months and necessitated the opening of this cottage. In December, 1938, and January, 1939, ten registered nurses were added to the staff. Two were transferred from the East Moline State Hospital, the others came from the general hospital field. This brought the Manteno State Hospital's number up to twenty. Four of these were placed in charge of metrazol and insulin wards. Two nurses were sent to the Research & Educational Hospitals for six weeks' special training. The infirm wards for male and female bedridden patients were placed under the charge of registered nurses at this time. On February 15, 1939, the school for attendants opened with an enrollment of 112. Classes were conducted by the staff physicians and registered nurses. One hundred five finished this three-months' course, and passed their examination in May, 1939. The hospital and operating rooms have been very active. The average for the year has been nine operations weekly, the greater number being major operations. The intensive treatment wards have had an average of 45 metrazol, 35 malarial and twelve insulin patients at a time. The series of treatments range from 18 to 25 each. The hydrotherapy department operated the first half of the year, with one male and one female therapist on eight-hour service only. In December, 1938, a second female therapist was added and sixteenhour service for women was placed in effect. The demand for sixteen-hour service for male patients has been just recently felt and there are two male therapists and sixteen-hour service in this department. There has been an average of twenty patients daily in each division. The year is closing with a personnel of 518 employes in the nursing department. Recreational Department Music in the Manteno State Hospital forms a fundamental background for nearly all forms and types of entertainment, within itself a definite form of therapy. The music department develops and creates initiative by personal and group instruction. Patients found to have some talent for or knowledge of music are approached through their ward physician and asked to become members of one of the following units: 1. The concert band. This unit comprises a membership not only of patients, but of local citizens and employes as well. Present membership, 26. Average attendance, 20. This unit plays regular concerts each week and all holiday festivals. Average musical ability that of third grade standards. Lately outfitted with washable uniforms. 2. The concert and dance orchestra. Membership of this unit is also comprised of patients, local musicians and employes, who donate their services in return for the instruction and entertainment they receive. This unit furnishes music for two patients' dances weekly and other special occasions. Patient personnel, which averages 16, changes often, due to the fact that when a patient improves creditably he is discharged. Instrumentation is as follows: lst, 2d, 3d saxophones; lst, 2d, 3d trumpet: 1st 2d trombone; piano, drums, guitar, bass, lst, 2d, 3d violin; 2 vocalists and the director. The equipment of the music department as of June 30, 1939, is as follows: Alto saxophone, 1; violins, 2 ; trap drums, 1 set; tenor saxophone, 1; cornet, 1. Entertainment Sources of entertainment for patients are many and varied. Perhaps the No. 1 source is talkies, produced from a twin projector installation, complete with perforated screen and sound. It is operated by a union operator. Shows, given twice each Tuesday, afternoon and evening, have an average attendance at both performances of 1,550 men and women, as well as 350 employes. Pictures are selected on a basis of suitability for mental hospital cases. Ballroom dancing is extremely popular among the patients, both male and female, and is presented twice weekly at the recreation hall. One dance is given each Wednesday from 1:30 to 3:00 P. M. for unemployed patients and again each Friday evening from 7 :30 to 9:30 for industrial patients, with, an average weekly attendance of over 1,100 at both dances. Informal dancing in cottage dayrooms is frequent. A small orchestra moves from cottage to cottage, covering one half-day at each period. Dances in the recreational hall are varied in character, and are presented as interestingly as possible, taking such forms as "Ladies' Choice," "Robber Dance," "Broom Dance," and "Prize Dance." More than 25 floor shows performed by patient or local dancing school talent or other sources have been presented in the last year during the twenty minute intermissions. Although the men and women are seated on opposite sides of the room, they dance together. Each evening dances begin with a Grand March with as many as 250 to 300 couples participating, and all patients are encouraged to dance. Roller-skating is a major form of recreation. Male and female patients skate together under supervision twice daily two days each week. Races and fancy skating are encouraged. Numerous concerts have been presented by local and outside talent, including the Federal Project Band of Joliet. During June and July, 1939, organ concerts were given each Tuesday evening. July 4th was celebrated with unusual enthusiasm on the athletic grounds. Two ball games, one by patients and one by employes, patients' croquet and horseshoe tournaments and tennis formed the major events, with 15 athletic events. A band concert from 1:00 to 4:00 P. M. lent a flavor of the July 4th spirit to the day. The band consisted of 22 members. Nearly 4,000 patients were present on the athletic field, with no escapes. An excellent show was presented that evening with a record attendance of over 2,000 patients and employes. Card parties are a weekly feature in the amusement hall for two hours each Monday afternoon. Candy treats are passed to each of the 24 tables where male and female patients mingle for various games, four to each table. The department has completely furnished two employe ball teams, one hard and one soft (or kitten) ball, with uniforms and equipment. They play at least two games each week against outside teams, and all cottages are encouraged to take their patients out for these games. Entertainment, as furnished, is a form of rest to the tired industrial patient. It is the aim of the department to supply proper forms of recreational therapy to the industrial patient of this institution. To this end he is given entertainment that will encourage relaxation of mind and body. At the same time it strives to stimulate action in the unoccupied patients through definite forms of real activity. Gymnastics, games, walks, etc., are used to help accomplish this end. Religious Services Protestant services are conducted, at present, twice a weekSunday, 2 :00 P. M. and Thursday, 9:15 A. M., the latter Lutheran. Catholic services are conducted weekly at 9:30 A. M. Sunday (not including special masses). Jewish services are held each Friday, 2 :00 P. M. Episcopal services are conducted the fourth Wednesday in each month. In each case, services are conducted by ministers of that particular faith. A conservative estimate would place the total number receiving religious education per week at 1,000 patients, plus employes. Services are accompanied by organ music supplied on the institution's instrument by a patient organist trained by the department, and conform as nearly as possible to the standards of each particular faith. Mid-week services are brought to the infirm patients in the cottages every Wednesday. A patient choir averaging 25 to 40 mixed voices is available for all services. This choir is directed by a member of the staff and is frequently enlarged for special occasions, using secular music as means of entertaining other patients. This is referred to as the "everybody sing program." Soloists are given every opportunity to display their talents. Dietary Department The fiscal year ended June 30, 1939 has brought many changes to the dietary department. It is in the midst of a building program. The physical layout of the kitchen is being entirely changed. Twentyfive feet are being added to each side of the main kitchen. The toilets for the patients are being removed from the main floor to the basement. Two new store rooms will be added. The partitions in the present store rooms are to be torn away and a new line-up of aluminum kettles of 150 gallons each are to be placed in this space. A driveway leading to a loading platform is being constructed. It will have a two-truck capacity and the trucks can be stored in the driveway over night. It is the ultimate goal of the dietary department to differentiate in the dietary needs of the various types of patients, with the completion of the remodeled kitchen, and the purchase of the necessary equipment. During the past year this department has encountered and triumphed over a number of difficulties, one of which was a snow storm so severe that the roads leading to the institution were blocked for several days. For two of these days there were only 4 persons on duty in the main kitchen, and yet the department was able to feed adequately 6,000 people. The Manteno State Hospital was proud to be the host of the Illinois Dietetic Association in February of this year. Some of the State guests at this meeting were Mr. A. L. Bowen, Mr. James P. Cox, and Mrs. Christine B. Pensinger of the State Department of Public Welfare. Miss Anna M. Tracy, president of the American Dietetic Association and numerous other dignitaries of both national and local organizations were present. Two large electric, stationary fans were placed in the main kitchen at the beginning of the summer and have helped in the ventilation of the kitchen. This spring cornmeal made from the corn, and cracked wheat from wheat grown -on the institution farm have been an integral part of the hospital's menus. Two new electric ice boxes have been installed in Prince and Williams cottages; ice box chests have been placed in Wines, Dewey, Dix, White, Hannah, and Barton cottages. A new root cellar has been completed north of the store room. In this the institution expects to store vegetables such as carrots, beets, parsnips, turnips, and potatoes for the winter. Special dietary work inaugurated by the Works Projects Administration, under the supervision of several dietitians, has done very good work. This additional help has made it possible to serve special diets to the pre-operative and post-operative patients in the hospital units, as well as take care of nourishments and feeding problems in Todd cottage, the four diagnostic wards and the tubercular sanitarium. Social Service Department The social service department comprises one social worker and one stenographer, the latter having been added to the department in June, 1938. The work of the department is two-fold in character: that done at the hospital and that done in the Manteno zone, comprised of the following counties: Kendall, Grundy, Livingston, LaSalle, Putnam, Bureau and half of Kankakee. The work done at the hospital consists of: Obtaining psychiatric social histories of all new patients with the exception of those coming from Psychopathic Hospital whose histories have been previously obtained. Writing letters to hospitals where patients have been previously hospitalized, letters to former attending physicians, letters regarding discharge or parole of patients, and letters regarding individual patients. Attending staff meetings. Giving information to relatives and others. Summarizing cases which are referred to the other State hospitals for supervision during the parole period. Paroling and discharging patients from the hospital. The work done in the Manteno zone consists of: Obtaining histories of patients in other hospitals, when such information is requested. Preparole investigations when requested by this hospital or other hospitals in own zone. Supervision of paroled patients in this zone, which includes visiting the homes and making reports regarding the patient's condition. Work done during the year: Number of new cases.. . . .. . . . . . . . . . . . . . . . . .2,623 Number of renewed cases. . . . . . . . . . . . . . . . . . .1,485 Histories obtained for own zone. . . . . . . . . . . . . . . 291 Histories for outside zones.. . . . . . . . . . . . . . . . . . . 17 Preparole investigations for outside zones. . . . . . . . . 21 Supervision of patients on parole (94 from outzone). . .907 Visits to patients on parole.. . . . . . . . . . . . . . . . . . . .29 To relatives and others. . . . . . . . . . . . . . . . . . . . . . 84 Summaries of histories for outside zones. . . . . . . . . .962 Relatives interviewed at hospital. . . . . . . . . . . . . . . .764 Permanent Improvements During the year contracts have been let for many new additions and improvements. The total expenditure will approximate $1,125,000. Included in the program are: 1. An addition to the building for tubercular patients. This includes two additional wings, similar in size and arrangement to those now in use. Important changes have been made in that supporting pillars have been omitted, acoustic ceiling and terrazzo floors installed. This addition will house 100 patients. 2. Three new ward buildings are being erected. These are of the same type as those now in use. Two will be used for female patients and one for male. These new buildings will provide 672 beds. 3. A much needed staff house will be completed this fall. This is being erected just to the south of the group of cottages originally erected for the use of staff members. The build ing will contain 24 two and three room apartments. In the basement will be a dining room, laundry and recreation room. 4. A new building, similar in type to those now in use is being erected just to the south of the administration building. This building will house 102 employes. 5. A new boiler is being installed at the power-house and will be ready for service this fall. While of different make it is of the same type as those recently installed. This addition will materially increase the horse power capacity of the boiler plant. 6. A new smoke stack has been in use the past few months. It is of the same type and construction as the one erected when the power plant was built. 7. A contract for a new generator of 1,250 K. W. capacity has been let but as yet it is not installed. It should be operating by fall. It will be driven by a turbine instead of a reciprocating engine. This installation will provide a little more than double the former capacity. 8. Reference has already been made to the fact that the kitchen is being enlarged. This consists of removing the north and south walls and extending the same approximately 25 feet. The toilets, now on the first floor, are being removed to the basement. The storerooms are being changed, and as a result of all changes, increased space will be provided. The fact that all food for patients and employes is being prepared in one kitchen makes the changes outlined a necessity. Additional equipment will be necessary but as yet a contract has not been let. 9. A root cellar, located to the north of the general store building, has just been completed. Such a cellar has been needed for a long time. This cellar will provide storage for vegetables and in its location will give the storekeeper opportunity to supervise the distribution of the same. Major Improvements 1. Rebuilt barn at South Farm, to increase capacity from 25 cows to 50 cows and 50. calves. Installed inside water system, wired for electricity, and connected drains to sewer. 2. Built bull pen, size 12 x 16 feet with concrete foundation and floors, wood sides, and galvanized iron roof. 3. Built a new milk house 14 x 20 feet with cement cooling vat. Wired for electricity, and connected drains to sewer. 4. Built four-stall truck garage, size 26 x 48 feet with sheet metal sides and roof, insulated walls and ceiling, cement floors, and wired for electricity, and piped for steam heat. 5. Constructed two compartment salt tank, capacity 90 tons, for water softener. 6. Built No. 4 well house, with tunnel leading to it from power house, installed with electricity and piped for steam heat. Building size 24 x 30 feet, material glazed tile walls and galvanized iron roof. 7. Constructed 420 rods of line fencing using concrete posts and woven wire at bottom and two barbed wires at the top. 8. Moved approximately 8,960 yards of dirt for grading about new buildings. 9. Excavated under laundry, doorways and partitions. 10. Painted screens and outside windows and frames and trim of all buildings. 11. Built 6,000 feet of side walks and 2,800 feet of curbing. 12. Cindered various roadways. Recommendations Many recommendations suggested in previous reports have been completed but it is still felt, that, to round out the institution, certain additions are necessary. It is noted that during the coming biennium appropriations have been made for the following: Dairy barn; hard surfacing of roads and sidewalks; slaughterhouse and additional hog house; laundry machinery; and furniture and fixtures. It is recommended that the following buildings be added: 1. Two hydro wards for chronic disturbed patients. 2. Service buildings for the garden, including a propagating house. 3. An occupational therapy building. 4. An addition to the hospital, providing facilities for the care of infirm, bedridden patients. 5. Dining room for industrial patients. 6. Kraut house. 7. Chapel for religious services. With the growth of the hospital and the increase in the number of chronic, disturbed patients, the necessity of hydrotherapeutic facilities for this type of patient becomes more apparent. It is recommended that a building for each sex, of approximately 100 beds each, be erected. To carry out garden operations properly a propagating house for the growing of plants to be transplanted is essential. Until the present time hot beds have been used. These are not entirely adequate, and again, during the spring months, weather conditions often prevent satisfactory results. Since the inception of the hospital the work of the occupational therapy department has been done in the basement of one of the cottages. The space is so limited and not only has the work been hampered but extension has been curtailed. Serious consideration should be given to the erection of a building, of ample capacity for both sexes. This therapeutic measure should be extended, but this is impossible under present conditions. Just to the north of the present hospital building is a plot of ground whereon should be erected a building for the housing of bed ridden, infirm patients. It is recommended that the present hospital be enlarged to conform, in outline, to the diagnostic building. The present hospital should be maintained for patients with physical disorders, the extension for the aged infirm, bedridden patients. Additional quarters for sick employes should be provided, as well as a kitchen for the entire unit. At the same time the operating room facilities should be enlarged. Such a unit would provide a medical center for all physically ill patients. The original two-story buildings are now occupied by male and female industrial patients. These patients have had their meals served to them in basement dining rooms. This condition should be remedied by the erection of a dining room, with a capacity of at least 500 in the court between the buildings in question. Sooner or later, with the continued growth of the hospital, it will be necessary to construct a chapel for religious services. At the present time these services are conducted in the recreational center. The open space, to the west of the diagnostic building, would be an ideal space for such a building.