Medical Services
The medical services have been supervised from an administrative
standpoint by Dr. D. Louis Steinburg, Assistant Managing
Officer, who reported for duty July 1, 1939, and from
the standpoint of clinical activities by Dr. Louis H.
Cohen, sho has been Clinical Director of this institution
since May 15, 1939. The appointment of Dr. Walter Kirschbaum,
as Pathologist, and Dr. Marta Palmer as Roentgenologist,
mark a real advancement in the medical program.
The clinical laboratory inder the supervision of Dr.
Kirschbaum is excellently equipped and well staffed
to perform all routine and many special procedures needed
to carry on scientific medical work.
The X-ray department is handicapped in that it has
only a thirteen milliampere unit. The purchase of a
modern five hundred milliampere unit is recommended.
A full program of scientific work is carried on by
the medical staff. A diagnostic staff meeting is held
three times a week, and staff meetings to consider paroles
are held twice a week. An active program of shock therapy
is in progress. Both insulin and metrazol are used.
This treatment is used chiefly in the treatment of schizophrenia
and the manic-depressive psychoses. General pareses
continues to be treated with fever therapy and chemotherapy.
Both malaria and inductothermy are used for the production
of fever.
The excellently appointed and equipped diagnostic unit
is proving its worth as a center for both diagnosis
and treatment.
The hospital for physical diseases with a capacity
of 200 beds is used for both patients and employees.
During the past year, there were 2262 patients and employees.
One hundred and twenty-seven major and 45 minor surgical
procedures were performed during the year. The following
incomplete list indicates the variety of surgical work
that has been performed: hysterectomy, salpingectomy,
uterine suspension, oophorectomy, repair of abdominal
and inguinal hernia, hemorrhoidectomy, tonsillectomy,
curettage, amputation, fracture including open reduction,
appendectomy, blood transfusion, prostatectomy, cholecystectomy,
and removal of cataracts. Examples of medical problems
arising are as follows: pernicious emia, peptic ulcer,
rhinitis, dermititis, angina pectoris, decompentated
heart, cystitis, nephritis, coronary occlusion, ingrown
toenails, cerebral hemmorrhage, conjunctivitis, mumps,
influenza, scarlet fever, hoid fever, erysipelas, pneumonia,
tuberculosis, gonorrhea, lyphangitis, diabetes, and
diabetic gangrene, arteriosclerosis, arteriosclerotic
gangrene, scabies, ringworm, pinworm, streptococcus
infection, tonsillitis, cellulitis, hypertension and
phlebitis. (Some words cut off the paper or spelled
differently than spelled at present day.)
For the care of chronic physically ill patients, two
ward units of 224 beds each have been set up as infirmaries.
These two units are too far removed from the acute physical
hospital, with central supply and special facilities,
to insure efficient operation. It is recommended that
the hospital be sufficiently enlarged to care for the
chronic physically ill patients.
The tuberculosis sanitarium has been enlarged from
100 beds to 200 beds. A new fluoroscopic unit has been
installed in the sanitarium. A program is now under
consideration to begin a survey of ill patients and
employees to determine the extent of tuberculosis in
this hospital. That this illness is frequently unrecognized
has been shown conclusively by surveys made in comparable
mental institutions. In the first 100 post-mortems performed
here by Dr. Kirschbaum, 24 per cent showed active tuberculous
lesions. A program of modern therapy including collapse
therapy has been instituted.
In addition to carrying out of an active medical program,
the staff has participated in an intensive teaching
program under the direction of Dr. Louis H. Cohen. In
addition to the regular diagnostic and parole staff
conferences, regular classes have been held for the
teaching of neuroanatomy, neurophysiology, neuropathology,
neuroroentgenology, psychiatry, and neurology.
Also the staff has shown a marked increase of interest
in medical and psychiatric matters as evidenced by the
increase of attendance by staff members at meetings
of scientific and professional organizations such as
the Illinois Psychiatric Association, The American Psychiatric
Association, The American Medical Association, etc.
A medical library has been opened in the diagnostic
unit. Only the beginning of a library exists, however,
as at the present time is consists of 157 volumes and
a subscription list of 22 periodicals.
A well-equipped pharmacy has been provided in the diagnostic
building and is staffed by two registered pharmacists.
The social service department consists of one chief
psychiatric social worker and one secretary. The appointment
of at least tow additional social service workers is
urgent.
Supervised occupational therapy is practically non-existent
in this hospital. The need for space and personnel to
carry out a minimal program is urgent.
The recreation department continues to carry on a comprehensive
and varied program. This program includes weekly movies,
dances, skating, athletic events, etc. Catholic Protestant
and Jewish services are held regularly each week.
A brief history of the typhoid epidemic, which occurred
here in 1939, may be summarized as follows:
On July 10, 1939, a patient was admitted to the hospital
for "acute physical ailments." This case was definitely
diagnosed as typhoid fever on July 14th. The patient
expired on July 15th. No other cased occurred until
in August, when several cases were admitted to the acute
hospital on August 14th. On the following few days,
patients were admitted to the hospital from all sections
of the institution, ushering in a catastrophic epidemic.
Four hundred and fifteen patients and 54 employees had
typhoid fever within the institution. Fifty-one deaths
occurred, including 3 employees.
The officials of this hospital in cooperation with
the officials of the Department of Public Welfare and
the Department of Public Health immediately mobilized
all of the necessary facilities to combat the epidemic.
The institution was quarantined, and strict isolation
instituted. Chlorination of the water system was begun,
and all excreta from the isolated cottages was disposed
of by incineration. Personnel and equipment were obtained.
All routine work of the hospital was interrupted. The
entire population of the institution was vaccinated
and a comprehensive program of stool examinations was
undertaken. The routine examination of stools continues.
To date, 19,522 stool examinations have been made. One
hundred and nine patient carriers are now isolated in
one cottage. There are 8 employee carriers, who are
permitted to work under the "Typhoid Carrier Agreement"
program in accordance with the Department of Public
Health rulings.
The epidemic subsided, and the institution was declared
free of typhoid fever on December 24, 1939. In March,
1940, three new cases of typhoid occurred resulting
in three deaths. At this writing there are two active
cases of typhoid fever in the hospital. One is a patient
who had typhoid fever in the epidemic last fall, and
one is a new case. The search for carriers continues
so that they may be isolated. The isolation of carriers
presents a difficult problem. All excreta must be collected
and incinerated; special precautions as to food handling,
laundry, etc., must be followed. The diversity of patient
carriers housed in one ward, as to age, duration of
psychoses, type of psychoses, and thevaried treatments
indicated makes the problem a difficult one.
Nursing Services
The nursing services were complicated during the past
year with the major nursing problem, the 1939 typhoid
fever epidemic.
At the beginning of the year, there were twenty registered
nurses. At the conclusion of this year there are forty-six
registered nurses, a majority of whom entered the service
during the epidemic. The increase of registered nurse
personnel has permitted a major change in supervision
of the nursing services to be made in February, 1940.
Prior ro that time, all supervisors were supervising
attendants. All have been replaces with registered nurses.
The extension of shock therapy in the treatment of
psychoses had the increased need of nursing care in
the acute hospital, infirmaries, and tuberculosis wards,
require a still further augmented trained nursing staff.
Inasmuch as the preponderance of all nursing work is
still done by untrained attendants, the need for a well-organized
program of education is clearly seen. While there has
been some previous instruction of attendants, the assignment
of a full-time instructor and introduction of a standardized
teaching program should have a marked effect in the
betterment of care given patients. At this writing the
printing of an attendants' manual is in progress.
During the past year, the patients living in the three
farm houses in the institution farms were evacuated.
The small number of patients in these cottages made
it difficult to give economical supervision of the proper
type. The second floor of the general store, formerly
housing patients, has likewise been evacuated, and is
now used for the increased supply of incoming materials.
During the past year the chief nurse's office, supervising
nurses' office, and classroom moved from their previous
scattered quarters and have been set up in the first
floor of the Administration Building. Part of the program
to concentrate the chief administrative officers in
the Administration Building.
Farms and Gardens
The significant changes in the department include the
discontinuance of the dairy project. This was done because
of inadequate facilities to maintain a herd of sufficient
size to permit economical operation. All of the cattle
were transferred to other institutions until such time
as adequate dairy barn facilities can be provided.
Due to the lack of sanitary facilities for the proper
housing and slaughtering of hogs, a gradual reduction
in the number of hogs by time is in progress, and it
is planned to discontinue raising hogs entirely unless
facilities can be provided.
Gardening, both as the means of producing vegetables
for the institution and as a healthful occupation for
patients will be continued and extended.
Dietary Services
During the past year, the main kitchen was enlarged,
and contracts have been let for the installation of
additional equipment to feed the institution's present
population.
During the past year, in addition to an assistant dietitian,
there was employees a chief cook, who acts as kitchen
manager, supervises cooking of all foods, and is responsible
for the sanitation of the department. All patient dining
rooms are staffed with personnel from the dietary department,
under the supervision of four dining room supervisors.
Ward rounds are made at each meal, and a detailed report
is given each day describing the service of the food,
condition of the food, condition of the dining rooms,
etc.
During the past year, a program was instituted requiring
all ward employees to go to the main cafeteria for their
meals. Prior to this time, food for employees on ward
duty was sent to the various wards.
Business Services
The business services of the hospital include all accounting
and clerical activities, general store, sewing and mending
room, laundry, and the commissary. The business practices
of this hospital, as well as of the other State institutions
in Illinois, have been standardized and remain under
the supervision of the Fiscal Supervisor of the Department
of Public Welfare.
No significant changes have taken place in this department
during the past year.
New Buildings and Improvements
During the past year the following new buildings, additions,
improvements and equipment were added:
An addition to the tuberculosis sanitarium, which was
completed August 18, 1939. This improvement consists
of two additional wings built symmetrically with the
two original wings. This new addition provides for the
care of 50 male and 50 female tuberculosis patients.
Nightingale Hall - a building to house employees, completed
August 18, 1939. This building conforms in in architectural
detail to the employees' halls of earlier construction.
Thoroughly equipped with the most modern conveniences,
it affords splendid living accommodations for women
occupants.
A medical staff building, which was completed March
7, 1940. This improvement provides well-furnished quarters
for medical staff officers and their families. There
are twenty five apartments of two and three room suites,
and a recreational assembly room, kitchen and dining
room. This unit supplements the twelve four and five
room cottages already in use by members of the medical
staff.
Additions and alterations to the main kitchen, completed
January 26, 1940. The contract for equipment had been
awarded, the installation of which is to be made in
the near future.
Ward buildings, including one male ward duplex unit,
two female ward duplex units, three connecting dining
room buildings, completed March 15, 1940. These buildings
correspond in architectural design and detail with same
style buildings heretofore constructed. There are two
individual wards to each duplex unit, where 112 patients
will be given housing and care. Connection corridors
from each ward lead to a central dining room, spacious
in size, to seat comfortably 224 patients. Medical rooms
in each ward are amply equipped for medical administration
and treatment.
Alterations and additions to the sewage disposal plant,
completed January 3, 1940. Contract No. 1 included the
construction of the following: Primary tank with a capacity
three times greater than that of the old existing tank,
mechanical bar screen, lift station having a maximum
capacity of 1,000,000 gallons of sewage, sufficient
in size for a population of 10,000 allowing 100 gallons
per capita. Contract No. 2 included the construction
of a digester, eight aerators, secondary settling tank,
three sludge beds, laboratory for continual control
of sewage treatment process. Additional laboratory equipment
for the sewage treatment plant was installed June 15,
1940.
A root cellar, completed August 8, 1939, is of concrete
construction throughout. This cellar, which was built
for vegetable storage, is of semi-subterranean type.
A well, 225 feet deep, was drilled during the past
year, to provide additional water supply. On June 30,
1940, this well was capped awaiting the pipe line and
pumping equipment, contract for which has been awarded
though the work has not been started.
A chimney, 180 feet high, of radial brick construction
was completed September 19, 1939. This chimney, which
serves the power plant, is 10 feet wide at the top.
The commercial boiler horse power it will serve is approximately
3,500. The installation of a new 500 H.P. boiler and
a stoker, with combustion control equipment, was completed
March 11, 1940.
Alterations and additions to the power-house, which
were completed April 9, 1940, included a boiler feed
pump, a deconcentrator, n removal equipment, combustion
control, boiler breeching, ladders, platforms and railings
around new boilers, and other necessary equipment.
The installation of a new 1,000 K.W. turbine generator
was completed April 24, 1940. This unit brings the electricity-producing
capacity of the plant to a point that should be ample
for a hospital of ten thousand beds.
The installation of a new filter plant equipment made
during the year, in conjunction with chlorinators, should
insure continued safety of the institution's water supply.
The filter equipment consists of two batteries of four
shells each. Dimensions 9 feet by 54 inch shell weight
allowing 26 inches free board above filter sand. Capacity
of 1,017.92 GPM. Duplicate chlorinating machines, each
having a maximum capacity to feed 300 lbs. of chlorine
in 24 hours, were installed. One apparatus has manual
control vacuum solution feed, the second apparatus operating
automatically.
Twenty-eight tubes in each of the three ammonia condensers
were replaced in the refrigerating plant in January,
1940.
Five multimeter boiler blow downs for the power plant
boilers were installed by institution mechanics, the
work being completed June 15, 1940.
During the year of 1939, 24,520.14 tons of coal were
consumed, a daily average of approximately 94.83 tons.
During the months from January through May 1940, the
coal consumption was 20, 364.4 tons, averaging daily
133.53 tons, reflection an increase of 13.5 per cent
over the corresponding months of 1939.
While weather conditions might in some way alter these
figures, the fact is that the increased demand of power
is reflected in every item of power service, which can
be attributed solely to the growth of this institution.
There was generated in electrical energy during the
year of 1939, 11,264.8 K.W. hours daily. During the
months of January through May 1940, the amount of electrical
energy generated averaged 14,844.5 K.W. hours daily,
an increase of approximately 34 per cent over the corresponding
months of the previous year.
Water pumped in gallons showed a daily average of 1,013,629
gallons. During the months of January through May 1940,
the daily average was 1,213,097 gallons, reflecting
an increase of 30 per cent over the corresponding months
of the previous year.
Water softened by chemical process used as domestic
hot water averaged 191,766.5 gallons per day during
the year of 1939. The period from January through May
1940 averaged in softened water for domestic use 182,
370 gallons per day, a decrease of 4 per cent over corresponding
months of 1939.
The condition of the power plant is most satisfactory;
other than the usual renewals or replacements due to
ordinary wear, the equipment may be said to be in excellent
state and operating with satisfaction.
The institution's street lighting system is not in
service and has not been operating for several years.
This is due to the type and manner of the original installation
of lighting cable which was made some 10 years ago.
The cable used at that time was of low voltage type,
600 volts. An inferior installation of cable was made,
having been laid but a few inches below the surface
and strung to the contour of the ground, instead of
18 inches below an established grade. When the final
grading of the ground around the buildings was done,
the cable was ripped and broken. This cable has been
repaired so many times that it is no longer useable.
It is estimated that 10,000 feet of parkway armor and
jute covered cable of 2,500 volt lead will be required
to restore to service the street lighting system.
Buildings and Grounds Services
The activities of these services include:
Fire DepartmentIt is the duty of this department to
have in serviceable condition all fire fighting apparatus
and equipment, and remove all fire hazards.
At frequent intervals a thorough inspection is made
of the fire truck and its equipment so that it may be
in complete readiness for service. Fire extinguishers
are checked and recharges made when found to be necessary.
Fire hose and fire hydrants are tested. Buildings and
premises are carefully watched for fire hazards which,
if found are removed without delay.
A recent ten-day survey of the fire fighting equipment
was made by representatives of the State Fire Marshal
with gratifying results.
Preparation and Furnishing New Buildings for Occupancy
New buildings are first thoroughly cleaned after which
complete furnishings are placed and arranged in the
proper place, even to the minutest detail.
Time required to prepare a new building for occupancy
is estimated at from three to four weeks, depending
largely upon the condition and size of the building.
During the time within the scope of this report the
following buildings were prepared for occupants:
Goodner I and II, and Clouston I and II. These are
male duplex ward buildings with connecting dining rooms,
each unit of which has a housing capacity for 224 patients.
Clouston I served throughout the past epidemic as an
isolated infirmary.
Nightingale Hall which now provides living quarters
for female employees, has 52 single unit apartments
with a recreational assembly room corresponding in size.
The medical staff house provides 25 apartments of 2
and 3 room suites with recreational assembly room, kitchen
and dining room.
Sanitation
Until March 1, 1940, the complete charge of sanitation
was assigned to the is department. At the time mentioned
a severance in many of the duties was made when the
new Department of Sanitation was created with the appointment
of Mr. Raymond Leland as Engineer.
During the period of the epidemic, this department
delivered all supplies to isolated wards, and brought
all soiled linens to the laundry. The disposing of waste
matter, feces, discarded food, dishwater and water used
for sponging and bathing the patients was done by boiling
in large cast iron kettles over constantly burning coal
fires at a site located on hospital property about 1.5
miles distant from the hospital buildings. This work,
though considerably reduced in volume, continues due
to the one isolated cottage for typhoid carriers.
The disposal of all institutional rubbish and garbage
is an important item of this department.
Extermination of roaches and insects has proceeded
to the point of their almost complete eradication. Frequent
applications must be made in order to continue the achieved
success.
Grounds
This department lately acquired the supervision of grounds.
Landscaping which heretofore was somewhat neglected
is being conducted on a wide and extensive scale. Some
of this work now within the course of completion, shows
results, The landscaping program includes the beautifying
of the grounds surrounding the six physicians' cottages,
and landscaping the main entrance, where trees and shrubs
were planted in a variety of spruce, cedar and juniper.
The roadway fronting on the east entrance of the Administration
Building was widened. The reshaping and trimming of
hedges, grading and seeding of lawns at the various
newly built ward buildings. Nightingale Hall and the
medical staff house were included in this program.
Streets and Sidewalks
Street maintenance is a constant problem. Cleaning of
gutters and inlets to insure drainage, scarifying and
reshaping of streets are some of the details encountered.
The building of new sidewalks, some of which are in
the course of construction, approximate 25,000 sq. ft.
for the year of 1940.
Trucks
To this department is assigned the detail of trucks.
Supplies from the general store are delivered daily
to the various departments. One truck and detail is
engaged exclusively for the hauling of waste matter
from the isolated ward to the cauldrons.
Two dump trucks are used for the hauling of dirt for
grading and landscaping, disposing of cinders, trucking
of coal and building material and various odd jobs when
the demand necessitates.
A delivery to the furniture shop of broken articles
and a return of repaired pieces is made each day.
The mechanical supervision of this department included
all other trucks not detailed directly to this department,
such as two large food trucks, two laundry trucks, one
1.5 ton service truck operated by the mechanical department.
Added to this department is the new garbage truck with
a specially designed body adaptable for this purpose.
This truck will take the place of two teams formerly
used for the removal of rubbish and garbage.
With the ever-increasing demand for dump trucks, due
more particularly to the landscaping, there is a decided
need for two additional dump trucks of the same type
and style as those now in use.
Sanitation Services
This is a new service instituted early n the spring
of 1940. It is under the direction of Mr. Raymond Leland,
Assistant Sanitary Engineer. The safety of the water
supply of this institution is the most important task
of this department.
In addition to the supervision over water filtration
and chlorination, the operation of the sewage disposal
system is a major function. In general, the engineer
makes routine sanitary inspections throughout the institution,
and initiates proper steps to correct defects and deficiencies
that may be found.
The water supply for the Manteno State Hospital is
derived from four wells located on the hospital grounds.
There are three shallow wells and one deep well. Well
No. 1 is 1,760 feet deep, Well No. 2 is 155 feet deep,
and Wells No2 and 4 are 226 feet deep. The new well
was completed February 6, 1940 at a cost of $2,050.00.
Negotiations are now in effect to install a pump and
pipeline.
The water coming from the wells empties into a 300,00
gallon ground storage reservoir. At this point the water
is chlorinated by two chlorinators located on the first
floor of the power-house. One chlorinator injects into
the discharge lone of Wells No. 1,3 and 4, while the
other chlorinator discharges into the suction line of
the booster pumps. This set-up allows the longest possible
contact period, and also permits the water entering
the reservoir from Well No. 2 to be chlorinated. Well
No. 2 empties directly into the reservoir without passing
through the pipe vault. The water is take from the reservoir
by booster pumps located in the basement of the power-house.
There are four booster pumps, two of these are electric
centrifugal pumps and the other two are displacement-type
cam pumps. The electrical pumps have a rated capacity
of 500 G.P.M. each, the small steam pumps have a capacity
of 350 G.P.M. and the converted fire pump has a capacity
of 1000 G.P.M.
The coagulating chemicals are added to the water just
ahead of the booster pumps. The chemicals used are aluminum
sulphate and d-treated sodium silicate. These are prepared
in tanks located in the power-house basement. The prepared
solutions are fed into the pipeline under pressure by
means of a small diaphragm, positive placement and chemical
feed pumps. The swirling action of the booster pumps
is utilized in mixing the chemical with the water.
The water flows from the booster pumps to the filters.
There are two rows of four-pressure units. These are
nine feet in diameter and fifty-four inches in height.
Each filter has one foot of graded gravel, two feet
of sand having an effective sized of .38 mm, and 26
inches of freeboard above the sand. The filters are
washed every 18 to 24 hours by reversing the flow of
water. The nominal filtration rate is 2 GPM. per square
foot of area. This gives a total capacity of 1,467,000
gallons per day for the eight units at the nominal rate.
The water leaving the filters is discharged into the
distribution system or into the 500,000 gallon elevated
storage tank, depending on the demand. The elevated
tower is 137 feet high to the over-flow.
A water testing laboratory was installed in the No.
4 well house. Complete chemical and bacteriological
control tests are tun in the laboratory. 24 hour supervision
of the water filtration plant was started March 10,
1940.
Sewage Disposal
The original sewage disposal plant constructed in 1930
consisted of one preliminary settling tank, 6 aeration
tanks, 1 final settling tank, 1 sludge digestion tank,
2 sludge drying beds and a pump house. Early in 1939
a program to enlarge the sewage disposal plant was begun.
The enlarged plant is now in operation. 24 hour supervision
is exercised over this plant. A laboratory is being
set up which will enable this department to control
carefully all treatment processes.
Recommendations
From the standpoint of physical structures, one of the
chief needs of this institution is a 500 bed addition
to the hospital for acute physical ailments to provide
space for the care of the chronic physically ill patients
now housed in ward units, The present hospital is so
located that ample ground space for the addition is
available. Buildings for occupational therapy, chapel,
patients' library and hydrotherapy facilities are also
needed.
From the standpoint of personnel, it is recommended
that in order to meet at least the minimum standards
suggested by the American Psychiatric Association, additional
physicians, graduate nurses and certain grades of technical
help including social service workers be added to the
staff. A revision of personnel salary schedules to provide
more equitable distribution would be a real aid in building
up "morale".
