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Text
January 15, 1956
Perceptual Changes Induced
M
Prorress Report
Maximilian Fink,
Director of Research
M. D.
927
By Drugs and
Electroshock
(c)
September 1, 1954—January 1, 1956
'
Hillside Hospital
Glen Oaks,
New
York
aHEMRY:
Beginning with a study of perceptual changes induced by electroshock, emphasis has shifted to a study of the mechanism of electroshock
therapy. A marked relationship was demonstrated between clinical improve-
ment and certain indices of altered cerebral function. Early, persistent
and severe changes in amytal tests and the electroencephalograms were ob-
served; but no correlation was demonstrated for memory
double simultaneous stimulation.
tests or tests of
clinical
improvement did not alvays persist, further studies
to elucidate the relationship of premorbid personality to both short and
long term improvement were devised. Preliminary data demonstrate a relationship between persistent improvement and a specific character pattern.
Since
suprathreshold simultaneous tactile stimulation techniques failed
to discriminate in terms of clinical response, threshold studies utilizing
square—wave electrical stimuli were undertaken. This technique elicits patterns of altered function not clinically apiarent, and the relation of these
patterns to clinical improvement is under study.
As
�PROGREeS REPORT
The
inception of
M~927
in September
1954 permitted an expansion
of studies previously undertaken as a Fellow of the National Fbundation
for Infantile Paralysis. Three studies were in progress: (a) evaluation
of the amytal test(l) in psychiatric subjects; (b) relation between al~
tered cerebral function and tests of simultaneous tactile stimulation;
(c) effect of lysergic acid diethylamide, pervitin, and amytal on visual perception.
and
In the amytal
test, the patient is
asked
questions concerning
his illness, orientation, and recall before and immediately after the intravenous administration of amytal to the point of nystagmus and slurred
speech. In the original studies at the Nount Sinai Hospital, the development of disorientation and explicit denial of illness was
clearly associated with diffuse cerebral dysfunction(1).
As a
admissions to Hillside Hospital were tested.
patients
control study, consecutive
Of 68
interviews essayed a-
not had recent electroshock therapy, 56 were adequately completed. Of these, 51 were "negative" for brain dysfunction;
and of the five " positive" results, hree showed other
evidence of brain
mong
damage.
who
had
In addition to further defining the scope of
this test as
an
in-
dex of
cerebral dysfunction, the study demonstrated other differences from
a group of patients with physical disabilities but without brain
disease.
There was more
transient disorientation
and
denial,
more withdrawal and
ludic behavior and more changes in the syntactical aspects of language in
the psychiatric population.‘
._____.________________________..____.______________________________________
*Kahn, R.L., Fink, M., & Heinstein, E.A.: The "Amytal Test"
in
Patients
with mental Illness, J. Hillside Hospital flzfi-lj, January 1955.
�2.
When
such
tests
were applied
in patients
who
had
recently under-
gone electroshock
therapy, "positive" amytal reSponses were elicited.
This aberration had previously been reported by Weinstein, Linn, and
Kahn(2), and formed the basis for
their explanation of the
mode
of action
of electroshock therapy.
In a second study,
patients undergoing electroshock therapy
tested by simultaneous tactile stimulation methods(5).
With
were
increasing
amounts of electroshock therapy,
patients demonstrated consistent alterations in the perception of the two stimuli. Failure to report one stimulus and mislocalization of one or both stimuli in predictable patterns
were demonstrated.
These
patterns
were
transient, however. Electroence-
phalographic records were also obtained in these subjects at weekly
vals.
progressive appearance of delta activity,
The
first
inter-
as random, low
voltage activity, and later as symmetric, high voltage bursts, previously
described by numerous authors(4) was confirmed. Attempts at this time to
correlate changes in the electroencephalogram
tests
and the simultaneous
tactile
unsuccessful.
were
third
group of
studies, of the effects of d~lysergic acid die—
thylamide and pervitin on visual perception were inconclusive. A variety
of ill~defined subjective perceptual alterations which failed of objec—
tive verification were observed and the study was discontinued.
A
The
experiences with amytal tests and simultaneous
tactile tests
formed the background for the studies undertaken since September 1954 un-
der
H—927.
To
determine the relationship between various indices of a1-
tered brain function (the amytal test, the electroencephalogram, and
�5.
tactile tests)
simultaneous
a correlated study was undertaken.
Conse—
cutive patients referred for electroshock therapy were studied. Treatment was administered three times a week. Electroencephalograms
were done
weekly on a day following a treatment.
tests
Simultaneous
tactile stimulation
tests were done once a week immediately preceding a treatment and 48 hours after a previous treatment. In addition,
special tests
of memory and recall utilizing the technique of retroactive inhibition
were carried out at weekly intervals.
and amytal
In addition to
intercorrelations between these indices, we were
anxious to determine the relation between such changes and clinical alteration in behavior. For this purpose a clinical evaluation of improvement
at weekly intervals during treatment
was made
ing therapy.
and the
These
patients
and unimproved.
showed
by
the
ratings
were
The
symptoms
their therapists;
and up to one month follow~
were made independently
classified as markedly
of the other indices,
improved, moderately improved,
markedly improved patients were those
that brought
and the
who no
longer
to the hospital; were rated improved
them
nurses' notes confirmed such aspects as being
able to sleep without medication, better appetite and improved capacity to
participate in hospital activities.
showed no change
The unimproved
or only transient changes.
were those who had some imtrovement
in
The
patients
were those who
moderately improved patients
symptoms, but
in
whom
severe dis-
turbances as obsessional thinking, paranoid ideas or somatic preoccupation
persisted.
A
marked
correlation
was found between
clinical
improvement and
early, persistent and severe changes in both the amytal tests and the
�4.
electroencephalogramx
to occur.
No
If
such changes did not appear, improvement
failed
such correlations were manifest between improvement and the
tests of recall function or
changes in simultaneous
tactile tests.
Thirty patients were essayed in this study, but 24 were success-
fully concluded.
At one month
post-treatment, eleven were classified by
the supervising psychiatrist as markedly improved; six as moderately improved; and seven as unimproved.
the markedly improved patients, every
one had at least one positive amytal test during treatment. Of the 50
tests given to this group, 58 (76%) were positive. In contrast, of the
unimproved
of the 45
Of
patients, five of the seven never showed a positive result, and
tests administered to this group, only 6 (15%) were positive.
The
moderately improved group showed more positive responses than the unimproved patients, but fell far short of the much improved
group.
In addition, there were consistent'changes in language and
non-
verbal aspects of behavior indicating alterations in adaptive mechanisms
in the much improved group, even in interviews not employing amytal.
These
alterations
were
either minimally or only transiently manifest in
the unimproved group and then only under the influence of sodium amytal.*
Concomitant studies of the electroencephalograms taken on a day
preceding the amytal
cords were
first
test indicate
M
a similar
relationship.
measured for per-cent time slow wave
The 160
re-
(delta) activity,
frequency of the
the duration of burst activity and the amplitude and
slowest waves present. The records were then placed in a rank serial
order.
Presented at the annual meeting of the American Psychiatric Association,
May 10, 1955; and submitted to the Archives of
Neurology & Psychiatry for
*
publication.
�5.
falling in the upoer third were labelled "high abnormality" and
those in the lower third as " low abnormality". Of the much improved
Those
patients,
25% showed a
ment; 80%
after
two weeks and 90%
patients, iowever,
first
after three
weeks.
The
treat-
In the unimproved
none had a high degree abnormality record during the
three weeks and only one had such a record by the fourth
treatment.
these
high degree abnormality after one week of
records of the moderately improved patients
week
fell
of
between
two groupsc*
Changes
in
memory and
learning were tested in these subjects by
using the principle of retroactive inhibition.
recall of three-letter originally learned
By
the serial testing of
words following the
interpola-
ted learning of nonsense syllables, patterns of decrement in learning and
recall
ment up
elicited. As a group, the patients showed increasing impairto the third week of treatment, and a rapid inorovement after the
were
cessation of treatment.
No
relationship, however, could
be
established
between impairment and resnonse to treatment.**
The
responses of these subjects to simultaneous
touch stimuli were also assessed.
ability to identify
and
While an
localize the
two
tactile tests using
increasing impairment in the
stimuli could be demonstrated
with increasing treatment, no relation to improvement was noted.
By
tent
the spring of 1955,
and severe changes
tal tests
it
was
our conclusion that early,
persis-
in both the electroencephalogram and in the
amy-
are a necessary, though not sufficient, pre~requisite for
..___....-—_.
m---_—.
»
Presented at the joint meeting of the Eastern and Southern E1ectroence~
phalographic Societies, Bethesda, September 50, 1955.
*
Presented before the Electroshock Research Association, May 8, 1955, and
awarded their Annual Prize Award and cited for excellence in research design.
**
�6.
improvement following electroshock therapy.
initial part of the
This obserVation confirmed the
hypothesis of weinstein, Linn and Kahn(2) ascribing the
therapeutic results of electroshock to the facilitation of patterns of denial by altered brain function. But was it true that the patient's improvement
resulted
from denial of
illness or denial of
other a-
More
symptoms?
daptive mechanisms manifest? Also, within a few months a number of the markedly improved patients had relapsed.
At
this time,
a second
Why?
electroshock population
was
studied.
First,
to confirm our previous observations on the relation between improvement
and changes
in the amytal tests and the electroencephalogram.
if exnlicit
denial is a mechanism in improvement,
it
post—treatment and directly related to improvement.
advanced
that those patients
who showed
cit verbal denial" personality
Secondly,
should be manifest
The
hypothesis
the characteristics of the
would be those more
was
“eXpli—
likely to maintain
im—
provement.
Between April and August,
were
studied. Satisfactory data
electroencephalograms and amytal
and again d
ring the second and
thirty consecutive electroshock patients
was
obtained in twenty-five subjects.
The
tests were carried out before treatment,
third week of treatment. The patients were
again independently rated for improvement by a supervising psychiatrist du-
ring treatment, and one month following treatment. These patients are also
now being seen in six month follow-up visits to assess the " long-term"
changes.
In addition to these
of subjects
was
tests, the
premorbid personality of
this
group
assessed by an interview with family members, psychologic
�7.
tests
and a
tachistoscopic study.
in independent interviews.
to
A
At
least
two
close relatives were seen
standardized questionnaire has been devised
den
verbal
"explicit
the
of
indicative
factors
characterological
elicit
this study fifteen characteristics defined as typiSuch
in
selected.
were
of
absent
in
this
personality
tyne
or
cally present
tons include prestige consciousness, sensitivity to criticism, imagination,
temper and attitudes to sex and illness. Each patient is rated on a scale
nial" personality.
of
0
to
denial
2
For
for each item - the higher score signifying a greater tendency to
o
l
Each
patient vas also tested
by a standard psychologic evaluation
These
Thematic
and
Tests.
Rorschach
the
Apperception
including
battery
tests were assessed for character structure and the usual tynes of defense
or adaptation.
tional
A
tachistoscopic study
was
devised, in which pairs of emo-
and non-emotional words were flashed on a screen
at
10, 20, 50, 100
patient's ability to identify the words,
the reaction time, and the distortions were ascertained. This pre-treat~
nent data is now being studied as to its ability to clarify the patient's
and 250 millisecond
periods.
The
usual defense patterns.
Only the short term
group nine
uatients
were
results of this study are available.
Of
this
rated as showing marked improvement; twelve as
mo-
derate inprovement; and four as unimproved.
Of
the physiological indices assessed in these patients, a signi-
ficant difference
was
again noted in the anytal tests and the electroence—
phalograms between the markedly improved and unimproved groups.
no
There was
difference between the markedly and moderately improved groups.
�8.
relation of personality ratings and improvement, an
indefinite correlation was manifest in this small group. Lcores expressive
of tendency to "oxalicit verbal denial" ranged from O to 25 in a scale of O
Asgarding the
to 50.
The
following table describes the natterns of each grouw
when "high"
and "low" scores are compared.
(10 and Below)
Low
fiarked Improvement (9)
Hoderate
"
"
Uninproved
High (Above 10)
2
7
(12)
7
5
(4)
e
0
Because the scores were unusually low
in this group, a sample of
consecutive private electroshock estients were studied.
lity ratings
and
clinical evaluations
were made.
To
Similar persona-
date, ten patients have
this study is continuing.
This study is still in progress. The six month follouaup is now
being undertaken and further correlations will be done. Kcanwhile, certain
conclusions can be entertained. The relationship between alteration in the
been studied and
physiological tests and improvement
It became apvarent that
the patients manifesting clinical exolicit denial of illness post-electro—
was
confirmed.
shock did not have the best long—term response.
Lesser degrees of adaptive
better prognostic value. This observation led to an analysis of the only verbatim recorded data for this series - the language changes
changes may have
in the amytal interviews.
The
data is
now
being analyzed for a variety of
adaptive language changes and correlations with clinical assessment are to
be made.
�9.
Chile these studies of the ohenbmena underlying improvement in
electroshock therapy have been under investigation, the
tual studies
have run concurrently.
group studied, the lack of
In the
first
(1954) electroshock
correlation between simultaneous tactile sti-
mulation tests and improvement
was
nuzsling.
The
tactile tests
tremely gross, hovever, and this might be a factor.
a more meaningful
was
developed.
anticipation that
be obtained from
Previous exteriences with von Frey hairs for
such threshold stimulation had convinced
mulus
In
were ex-
this index if threshused, equisnent for threshold electrical
correlation could
old stimulation techniques were
stimulation
tactile percen-
me
that the variation in the sti-
often exceeded the fluctuations in hreshold, and the studies were
inconclusive.
Reports by Segal(5) on the perception of square-wave elec-
trical stinuli
led to our development of similar equipment.
84~B
stimulators and isolation units monitored by a
deliver independent stimuli.
A
Dnnont
Two
Grass
oscillograph
switch box and l centimeter steel disc e-
Difficulties in isolating the stimuli
precluded this testing being carried out satisfactorily until septenber.
A continuation of the second electroshock group has been in prolectrodes corolete the assembly.
gress since September.
The same
nhysiological tests and personality assess~
patient's responses to simultaneous
hreshold electrical stimuli is tested before treatrent and at weekly intervals. To date, 18 patients have been studied. The same phenomena of exments are undertaken.
In addition, the
tinction, displacenent, nerseveration, and confabulrtion described in patients with organic mental syndrome with suprathreshold stimuli by Fink,
4.
�10.
Green, and Bender(6) are apparent
technique
elicits these patterns
in these natients during treatment. This
clinically manifest.
while extinction is also manifest in yrs-treatment testing, displacement
and perseveration are related to the extent of treatment. This study is
now
though they are not
in progress.
Concomitant with these studies, preliminary observations of a
milar nature have been
made
in patients undergoing insulin
coma
si—
therapy.
Recent reports of the value of prolonged come as the basis for improvement by Revitch, Kwalvasse? and Caplan, Sharass and Rowsell, and Yeager
gt
al<7> have been confirmed
in our patients. In
reported a direct relationship between altered brain function, altered patand
imnrovement.*
and
behavior
terns of adantation in lan mace
clinical
t:
.
'
-
one unusual case we
r
R.L., Graubert, D.H. and Fink, N.: Delusional Reduplication of Parts
of the Body After Insulin Coma Therapy, J. Hillside Hbsnital fl;154v147, 1955.
*
Kahn,
�11‘
Summary
of
Our
Work
to Date and Plans for the Future:
studies of perceptual changes induced by electroshock are pro-
is in elucidating the
factors underlying improvement following electroshock therapy: changes in
shysiologiccl indices; adaptive changes in language and behavior in resnonse
ceeding in two concurrent and related courses.
One
to altered brain function; and the factor of personality.
study of the watterns of threshold
tactile perception
The second
is
a
under conditions of
altered cerebral function; their relation to "inprovenent" following
elec—
troshock; and the relation to other indices of altered cerebral function.
The problems
before this study are conylex.
The
rating of "improve-
is primitive and further vork alcnf this line is mandat ry. The delineution of the explicit verbal denial character is a gross anprOfination
of this problem. FUrther study of the role of personality and a descrip-
went"
tion of defensive operations other than denial which may
significance is in progress. To clarify in our data the
have therapeutic
203
beneficial
be
which
ascribed to "general interest",
electroshock
can
of
therany
result
"spontaneous cure" or "placebo" effect, a control study is being instituted
on February 1.
Titb the concurrence of the Sedical Board of Hillside Yos-
be
will
electroshock
referred
for
therauy
treated, by ranpital, pitients
dom selection, by either pentotbal-convulsive electroshock or jentothal—
subconvulsive stimulation.
The
cerebral chmnjcs induced by pentothal-
subcenvulsive stimulation are miniwal and result in a minimal inprovenent
rate(8)
o
�M
References
l. einstein,
E.A., Lahn, R.L., Sugarman, L.A., & Linn, L.: Diagnostic Use
of Amobarbital sodium in Organic Brain Disease, Am. J. Tsychiat. 112:
889—894, 1955.
2. Heinstein, E.A., Linn, L. & Kahn, R.L.: Psychosis During Electroshock
Therapy: Its Relation to a Theory of Shock Therapy, Am. J. Psychiat.
102:22-26, 1952.
5. Bender, H.B., Fink, H., & Green, N.: Patterns in Perception of Simultaneous Tests of Face and Hand, Arch. Neurol. & Psychiat. §§3555-362,
1951-
,
~
4. Pacella, B.L., Barrera, o.”., a Kalinowsky, L.: Variations in the Electroencephalogram Associated with Electric Shock Therapy of Patients with
Mental Disorders, Arch. Neurol. & Psychiat., fll:567~58#, 1942.
f‘!
5. Segal, Harry: Prick Threshold stimulation with Square ‘ave Current: A
New Heasure of Skin Sensibility, Yale Jour. Biol. & Med., g§:145-154 1955.
A
6. Fink, 3., Green, D. & Bender, U.B.: Face-Hand Test as a Diagnostic Sign
of Organic Mental Syndrome, Eeurology.g:46-58, 1952.
,
7. (a) Revitch, E.: Observations on Organic Brain Damage and Clinical Improvement Folloring rotracted Insulin Coma, Psychiat. auart. gé:
72, 1954.
(b) Kualwasser, S. and Caplan, M.: A Case_of Prolonged Insulin
Treatment, J. Hillside Hospital 35145, 1952.
Coma:
(c) Shagass, C. and Rowsell, P.W.: Serial Electroencephalographic and
Clinical Studies in a Case of Prolonged Insulin Coma, .M.A. Arch.
Neurol. & Psychiat. 13:7059 1954.
(d) Yeager, C.L. 33 El:
glycemic Coma,
8. Ulett,
Electroencephalogranhic studies in PosthypoJ. Harv. & Ment. Dis. 118:455, 1955.
of Matched Grougs in the Evaluation of
Convulsive and Subconvulsive Photoshock, Bull, Kenn. Olin. l§:158,
G. A.
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April 2, 1956
Corrected Copy
RESEARCH ACTIVITIES
ANNUAL REPORT
SAME AS ORIGINAL
-
1955
�IDENTICAI. UP TO END OF PARAGRAPH
1.
Research Programs were actively carried out by the Research Service,
resident and attending psychiatrists, and by departments at the hospital.
(a) Research Service:
With the two additions to the
expand
staff,
Dr. Fink was able to continue and
his studies of the changes in behavior'widch fallowed electroshock therapy.
These studies were directed
to understanding the effects of the treatment
on
the
brain, as well as trying to understand the changes in the patients behavior, language,and memory which might result from such changes in brain function. There
were
three different tests that were used.
The changes
that
occured in the brain
patterns (electroencephalogram) were studied and it was shown that it was
necessary to have some changes in the brain wave patterns before patients be-
wave
came
better
from electroshock.
Secondly, by giving the patients injections of
who
have
that
patients
it
changes in brain function show certain specific changes in language after the
drug. Thirdly, by special tests of the ability of the patients to perceive two
touches simultaneously applied to different body parts, it is possible to get
a seditive drug (sodium amytal)
is possible to
show
another index of brain function. These three indices, together, form the best
way
available today to demonstrate changes in brain function.
One way
of showing changes in a patient
is to study his language.
We
have
continued our studies of language following the administration of sodium amytal.
In addition, Dr. Jaffe has begun a study of the changes in language which follow
changes
in the doctors attitude to the patient. For this purpose
interviews between himself and the patient during which he changes
is recording
his own attitude
he
to the patient and then measures and examines the type of responses the patient
has to this change.
�-3-
interest has
Much
been aroused in the newer drugs in psychiatry.
A
pre-
vious study at Iflllside Hospital had shown that small doses of reserpine had very
little effect
on our
controlled study
and the
patients.
When
purified reserpine
was undertaken by one of
internist, Dr.
was made
available, a
the resident physicians, Dr. Wachspress
Blumberg, to determine whether high doses of reserpine
eleviate anxiety in our patients. It was the impression of the observers
that the reserpine failed to relieve anxiety symptoms regardless of dosage and,
would
that it increased the depressive symptoms. These observations will
reported in a forthcoming issue of the Journal of the Hillside Heepital.
moreover,
be
In the biochemical program, under the direction of Dr. Harry Goldenberg,
three projects were undertaken. In one study of the effects of chlorpromazine,
Dr. Goldenberé
carried out fundamental studies
azine to under-Stand where and
how
this
on
drug might
the metabolism of chlorprcm-
act. In this study
he was
us-
ing special techniques that he had developed.
In a study of the effect of
some new drugs
in inducing disturbed behavior
like schizophrenia, Dr. Goldenberg had studied a variety of alkaloids
for their ability to affect a special enzyme system (serum cholinesterase) he
reported that the most powerful of the new compounds (hallucinogens) known as
which looks
to be a very potent enzyme inhibitor as well.
the development of a very refined technique so that he can
lysergic acid diethylamide
Most remarkable was
measure very minute
was
quantities of drugs in the body. Thirdly,
fundamental studies on the function of the
liver in the
he made some
metabolism of hormones.
(b) Psychiatric Staff :
(1) Ambivalence Study: This study was continued by Dr. 3. Tarachow,
H. Karin and
5. Freidman. In this study, an effort is
patients develop the kind of neurosis that they do.
psychologic
measured.
tests as well as
made
to understnad
Emphasis
is
made by
why some
special
clinical interview, the degree of ambivalence is
This study attempts to prove a hypothesis that there is a relation bea
�tween the
loss of a parent early in life and the type or neurosis that developes
in adulthood.
(2) Subculture 5tugy: Under the directian of Dr. R. Navarre, supervising
Graubert
D.
Dr.
of
(resident therapist),
psychiatrist, an interdisciplinary staff
Dr. H. Korin (psychology), Mr; A. Lurie (social service) and.Miss Z. Putter (group
activities)
have
studied the hospital environment as a therapeutic agent.
They
are emphasizing the fact that just coming to a hospital has therapeutic value.
Also, that there are
many
agencies at the hospital which affect a patients change,
besides the specific psychiatric treatment that they are receiving from the phy-
sicians. In a pilot study, they demonstrated the value of a diary of patients
activities in clarifying the communications between patient and therapist, and
also to explain unusual changes in patients behavior. The staff has devoted a
good part of its time to understanding some of the aspects in thenhospital which
motivate changes in the patient.
In September, following our preliminary exper-
(3) Chlogprcmazine Study:
iences with chlorpromazine, one of the newer psychiatric drugs, two of the res-
ident psychiatrists Drs.
a
potential substitute for insulin
coma
coma
undertook a study of
are divided into two groups in a randem fashion
insulin
It is
this drug as
therapy. Patients referred for insulin
R. Shaw and G. Gross,
coma
hoped
-
one receiving
routine
therapy; and the other receiving chlorpromazine for three months.
that this study will
make a
little bit
clearer the usefulness of this
new drug.
(h) Prognostic creteria in Electroshock Therapy:
PARAGRAPH REMAINS UNCHANGED
�-5(0)
Departmental Research Programs: In addition to the cooperation between
various hospital services, the following projects were in progress or jndere
taken during 1955.
(1) Medical Demrtment: In addition to the medical and physiologic
observations of the patients undergoing treatment with the newer drugs, reserb
pine and chlorpromazine, Dr. A. Blumberg has investigated a new test-the
test has
Funkenstein Test. This
been described as being able to
a patient will improve following electroshock or insulin
coma
tell
whether
treatment. There-
fore, to find out whether this is true at Hillside Hospital, Dr. Blumberg has
been seeing all the patients prior to physical treatments. The test is harms
less and so far, the results are not available. Dr. Blumberg also studied the
possibility that insulin
a number of hours.
He
dosage could be made smaller
showed, both by
clinical
if it were
and laboratory
divided over
studies, that
divided doses were not as good as single large dosages of insulin.
(2) Social Service: Student affiliates in Social Service have been
studying the inter-relations of various factors in patient care. For the most
part these studies relate the length of hospital stay, discharge evaluation,
fee paying, and.a follow-up of patients who were unsuitable for Hillside HOSpital. These studies show great promise because they help us understand the
social factors in mental illness.
�Department of Biochemistry
..............................
April 30, 1956
Progress Report, MarchpApril 1256
A.
Active Projects
1. Steroid Sulfate Conjugates
It
that high speed liver supernates catalyze sulfate
conjugation with the following sterols: deso corticosterone, androsterone,
and cholesterol, as well as dehydroisoandrosterone, estrone, and testosterone.
The underlined sterols conjugate most readily. Considering the various positions in which the hydroxyl functions are located in these molecules, it may be
concluded that the conjugase(s) is nonspecific and can act at C 17, 21, 3a, 38,
has been established
and on phenolic compounds.
least four steroid sulfates have been separated from urine using paper
chromatography. The major conjugate has been identified as dehydroisoandroster—
one sulfate. The other conjugates are under investigation.
At
2. Chlogpromazine Study
of a hitherto unidentified metabolite of chlorpromazine have been
isolated from 9 liters of a pooled urine collected on the wards. The compound
crystallizes in beautiful colorless needles, m.p. 190°C. It has been sent out
for an element analysis. We suspect it is chlorpromazine mercapturic acid; the
analysis will reveal whether our hunch is correct. Another metabolite has been
separated electrophoretically and is believed to be an hydroxy derivative.
270 mg.
B.
Projects Planned
to study the metabolism of mescaline this Summer, provided funds
are forthcoming from the Dazian Foundation (see below). The investigation
would throw light on the mode of detoxication of hallucinogens in the body and
facilitate follow~up work dealing with trace endogenous alkaloid excretion in
mental disease.
We
C
hope
. Funds
grant application was submitted to the Dazian Foundation fer personnel
support and for the purchase of a spectrofluorometer. We were infonned that
funds are not available for instrumentation, but that personnel coverage may
be forthcoming. Further information is not available at this time.
A
—
cc. to: Dr.
Fink
Dr. Jos. S.A. Miller
Max
H.
Goldenberg, Ph.D.
�HILLSIDE HOSPITAL
GLEN OAKS,
N.Y.
geptember h, 1956.
Mr. George W. Galinger
170 East 79 Street
New York, New York
Dear fir. Galinger:
is
Facilities".
a copy of the "Recommendations for Expansion of Research Space
and
This data has been compiled by Dr. Max Fink, who prepared an
original outline on the basis of the needs of the Department of Neurophysiology
and Neuropsychiatry, and on the basis also of a discussion with myself and with
the heads of the Departments of medicine and Biochemistry. The present draft also
was discussed in some detail at a special meeting of the Research Committee held
on Tuesday, August 28th.
Enclosed
I understand that
will refer these outlines, which include the main
functional uses to which thisnnew building will be put, to the architect. The
current plans are based on three floors of space (a basement and two floors)
with an approximate area of hO' x 100‘ for each floar. The data includes the
expected expansion during the next few years of the current projects of the
Department of Neurophysiology, the set-up and inclusion of a clinical laboratory,
projected space for dynamic and psychological research. The building plan should
include the possibility of establishing 12-20 interviewing or psychotherapy rooms
which would be housed on the first floor, either at the beginning of construction
or sometime later. Such space would be valuable in offering a replacement for the
present psychotherapy rooms used for in-patient psychotherapy and housed currently
on
you
the second floor of the Elizabeth Sloman Lowenstein Clinic Building.
where
Our
it
present plans are to leave the research and biochemistry department
presently is located, but to move the clinical laboratory into the new
research facilities.
If there is
any other data or clarification that you would 11g; from.n§;
the Research Committee or Dr. Fink, please feel free to communicate With me.~
Yours
JSAl-‘I:1b
encl.
sincerely,
Joseph S.A.Miller, M.D.
Medical Director
�TO:
DR.
1v .. 8-31-56
J.S.A.Miller
gear-1: Max
Fink,
q§UBJECT:
RECOMMENDfiTIONS F R EXPANSIOT OF RESEARCB;§?ACE.
M.D.
“u.-
following recommendations for the development of facilities for research
summarize the consensus of meetings held by me with my staff; Dr. Miller, Dr.
ReCohen
and
the
to
Blumberg;
Dr.
Mr.
as
presented
Dr.
Bachrach,
Goldenberg,
search Committee of the Medical Board, at its meeting August 28, 1956, and apBoard
of Directors.
the
committees
of
the
them
to
for
appropriate
referral
by
proved
The
I,
INTRODUCTION:
A.) Eggatiggi - The major share of the work in the recommended facilities
who
and
are in the acute
be
with
patients
the
chiefly
population,
will
in-patient
services. For this reason, the research building should be in close proximity,
recommended
Lowenstein
for consideraBuilding.
Sites
Morris
the
to
attached
or
a3
LowenThe
Morris
between
the
include
order
area
the
in
ofusefulness,
tion,
stein Building and 76th Avenue;.b) The smaller area lying between the Morris
Loqenstein and Elizabeth Sloman Lowenstein Buildings, the connecting tunnel and
76th Avenue; and c) The field east of the Morris Lowenstein Building, and north
of the Israel Strauss Pavilion.
W
3.) Facilities: 1.) In the development of the Research Service, during the past
two
Anamet
have
been
various
by
measures.
temporary
the
space.requirements
years,
needs
the
for
reasonable
well
work
expansion
as
the
as
of
present
program,
lysis
next five years, has resulted in the following recommendations. The character of
the research program, at present, is along the lines of experimental psychiatry
and neurophysiology. Such a program requires neurophysiology laboratory space,
sound recording rooms, and special laboratory equipment as the first objective.
logical expansion of the research program.as
outlined by the Research Committee, by the development of a section in Clinical
Psychodynamic Psychiatry, the next need is for facilities for interviewing
patients and relatives; offices for staff members; and space for the observation
of the psychoflierapeutic interview. The latter should be capable both for the
observation of single patients and, also, groups.
3.) For the cooperation of staff members, conference rooms are needed.
These should be so placed and equipped that much of the interaction between staff
members will occur in that area.
b.) Another need lies in facilities for the 2h-hour physiologic observation of patients. A four-bed unit, next to the thSiOlogy laboratories,
will serve both as a recovery room for physiologic studies, as well as an observation unit for physiologic and biochemical studies.
2.) Keeping in
mind the
5.) Another recommendation is with regard to the potential growth
and utilization of the medical library. During the past few months, in which
we have had a librarian on a full-time basis, space in the library has beCome
�-2 '9
overtaxed. A major portion of the librarian's time is devoted to work in
conjunction with the Research Service. It would be advisable that pro—
vision be made in the same area of research expansion for the medical
library. Facilities for an adequate reprint file, and facilities for
microfilm reading are recommended.
6.) For
time, the present separation of the Medical Clinic
(in.Morris Lowenstein Building), the X—ray laboratories (in the Littauer
Building), and the @linical Chemistry Laboratories (in the Sloman Lowenstein
Building), has made adequate service cumbersome. It is recommended that the
Clinical Chemistry Laboratory be relocated in the Research Building, in
close proximity to the physiologic observation ward.
some
With the moving of the present neurophysiology offices from their
present position, on the first floor of the Morris Lowenstein Building to
the Research Building, three rooms adjacent to the present Medical Clinic
will be vacated. It is recommended that these rooms be converted to the
x-ray, fluoroscopy and radio~isotope laboratories of the Department of
Medicine. With the Research Building attached or in proximity to the
Morris Lonenstein Building, the present separated facilities will be
in close proximity.
Relocation of the Clinical Chemistry Laboratory, from the Sloman Lowenstein to the Research Building, will free an additional 300 ft. of laboratory
space for the expansion of the Research Biochemistry Laboratories.
7.) In the history of the growth of this hospital, it is ap—
parent that the growth rapidly outstrips the projected allowances. In the
development of this building, it is recommended that provisions for expansion be provided in the initial designs, by ind.uding a foundation strong
enough for the addition of 100% of the Space; space for elevators; and
utility resources adequate for this type of expansion. Also storage space
rapidly outstrips the needs of the laboratories. For this reason, a recommendation is made that a basement storage, equal to 15% of the initial floor
area, be provided.
0.)
Name:
is inadvisable
'It"Laboratories"
to apply to this building or wing the
name
or "Experimental". To follow the traditions
"Research",
of the hospital, the name of a benefactor may he applied, or other non-
specific designation.
D.)
Research Beds:
item of research need is not recommended. That item is a
To
ward.
research
provide facilities for the continual observaspecial
tion of a large number of patients, separated, even in name only, from the
rest of the hospital group, would dilute to potentialities for the utilization of all other patients, as well as provide a psychologic barrier to
the experimental program. For the present, it is inadvisable to admit
One
patients for "research.".
�.3.
II.
.
GENERAL OUTIINE
0F SPACE RELOCATIQE:
Taking into account the available fUnds and the potentiality of additional Public Health Service support, a three-story building, approximately of
the size 100 ft. x no ft. is projected.
A.)
Basement: To include space for the following:
1.;
2.
3.)
h.)
Library stacks.
Storage Space.
Clinical Chemistry laboratory and offices.
Space for expansion of Chemistry Research laboratories.
include utilities,
enlarged to 5,000 sq. ft.).
(To
it
may
be advisable
to have the basement area
B.) Egret Floor:
l.)
waiting room - receptionist.
2. Medical library.
3. Large conference room.
Small
conference
room.
h.)
5. Offices and interviewing rooms - 12.
6.) Secretaryfs office and filing room.
C.) Second Floor:
1.)
2.)
3.)
h.)
5.)
6.)
III.
Neurophysiology laboratories - 2 - and central recording room.
Physiology observation ward.
Psychophysical laboratory.
Psychotherapy experimental laboratories - 2 - and central
sound recording room.
Four offices.
Small conference room.
SPECIFICATIOIB:
A.)‘.Taboratories:
l.)
Physiologic and Neurophysiologic Laboratory: Two rooms for
the simultaneous observation of two subjects should be placed about a central
third room, which will contain the physiologic recording equipment. In such a
system, single pieces of recording equipment can serve dual functions. Such rooms
should have independent facilities for temperature and humidity control. Initially,
the central equipment room will contain a single EEG unit; but space for a second
unit and a frequency analyzer should be allowed. The equipment room should contain
recording equipment capable of continuous, simultaneous observation of a number of
physiologic variables, such as blood pressure, pulse rate, respiratory rate, and
galvanic skin reflex. The position of these three rooms should be in close proximity to the physiologic observation ward.
a.) Location - Second floor.
b.) Approximate size: each experimental
sq. ft.,
the equipment room of 180 sq. ft., with an adjoining
smaller repair laboratory of 120 sq. ft.
room of 150
�.h.
c.) Relationship
access to
and access: Each experimental room to have
the phySiology ward; and to the equipment room.
Equipment room to have large glass port into experimental
room. Port to slide into wall to allow direct communication between equipment and experimental rooms.
d.) Special construction:
(1) Individual temperature and humidity control for
experimental rooms.
(2) Sliding port.
(3) Double walls and ceiling for sound-proofing.
(h) water piping and sink in each experimental room.
2.) - Physiological Observation War ‘ Attached to the physiological laboratory, there should be a four-bed observation unit. Such a unit should
be equipped for the 2b hour study of patients for biochemical and hormonal studies.
A nursing unit should be provided, as well as storage
space for the medical equipment needed to protect patients who are under investigation.
a.) Location: second floor.
800 sq. ft.
Size:
b.)
c. Relationship and access: access from the main hall and
offices; as well as the two physiology laboratories.
d.) Special construction:
(1) Two two-bed units.
(2) Two lavatcries and one shower.
(3) opace for storage of clothes of patients; and nursing
equipment.
(h) Nurses station of desk, storage space, reirigerator
and 3 1m 0
(5) Doors wide enough
for stretchers or bed.
3.) - Esychophysical Laboratory: This laboratory should be equipped
for visual and tactile studies. he room should have windows with built-in light-
proof shutters, and the doors should be such that complete darkness can be achieved.
For a visual laboratory, the length should be at least 2h to 26 feet. This room
should have individual temperature and humidity control.
a.) Location: second floor.
250
Size:
Length
sq.
ft.
b.)
and
c. Relationship
should be 2h
access: access to the
logy equipment room and an office.
d.) Special construction:
El) Light-proof shutters
ft.
hall, the
and doors.
2) Individual temperature and humidity
control.
physio—
�-5h.
Psychotherapy Experimental Laboratory:
Sound Recording Unit.
For the proper observation of patient and therapist, two experimental
rooms about a central observation equipment room, should be provided. These rooms
should be sound-proof and isolated, preferably at the end of a hall, away from traffic . Lighting should be provided in experimental rooms so that filming of the
procedure can be done without additional lights. The central equipment room should
contain sound recording equipment which can be controlled either remotely from inside
the observation room or from the equipment room itself. A port should be provided
from the equipment room into each of the experimental rooms for filming. It would be
advisable that at least one of the two experimental rooms be of sufficient size to
permit a group of six or eight patients to be under continuous observation. Observation will go on from the central equipment room through one-way vision.windows.
should be possible to accommodate a large
By adjustable, one-nay vision mirrors,
group of observers in the large experimental room, to study the procedures in the
smaller experimental room, while recording is accomplished for the separate recording
it
room.
a.) Location‘ second floor (this facility may be placed
the first floor in exchange for officeS.)
b.) Size: three rooms:
(1) Experimental room, large - ZhO sq. ft.
on
(é) Experimental room, small - 100 sq. ft.
(3) Recording-observation room 150 sq. ft.
0.) Relationship and Access:
(1) Both experimental rooms are to have one-way ports from
the recording room.
(2) The large experimental room should have a one-way port
into the small experimental room.
(3) Access to hall from each experimental room and recording
'
room.
(h) Access from recording room
into large experimental room.
d.) Special Construction:
(1) Double walls, ceiling for soundproofing.
(2) One-way mirrors as in (c)
each
into
filming
Special
room.
experimental
port
(3;
(A Cable connections from each experimental room to
recording room.
(5) Loudspeaker connections from small experimental room
to large.
(6) Microphone location and outlets placed in original wall
brackets and fixtures.
5, Clinical Laboratory:
Relocation of the Laboratories for Clinical Chemistry in close proximity to
the physiology ward is advisable. The Clinical Laboratories should heprovided with
adequate benches for routine and special test procedures. In View of the space
recommendation for Research Biochemical Laboratories, it is advisable to locate the
Chemical Laboratories in the basement, with access bv open stairway to the first
floor reception room.
a.) Location:
basement near
stairwell.
b.) Size: 750 sq. ft.
c.) Access: from hallway in basement; to first floor reception
room and second floor laboratories through stairwell and
elevator.
�u6u
d.) Special construction:
(1) High ceiling to allow for hanging pipes and "false"
ceiling.
(2)'work benches, sinks, electrical, compressed air, hot
and cold water, gas outlets according to detailed specifications of biochemist.
6. Allowance for Expansion of Research Biochemistry:
1500-2000
recommended
that
is
allowances
of
the
this
In
building, it
expansion.
biochemistry
future
be
for
basement
incomplete,
of
left
area
sq. ft.
Such area should have higher than average ceiling to allow for the installation
of necessary piping.
B.
foice
Space:
Individual work space for each of the members of the research service
inpsychiatry
in
experimental
The
requirement
staff
be
present
should
provided.
and
two
provision
psychologists,
clfiles two psychiatrists, a neurophysiologist,
and
additional
psychologist.
an
of
a
physiologist
addition
the
by
for expansion
into
would
requirements
I
space
picture
Clinical
Psychiatry,
In the section for
(anthropologist
scientist
social
two
a
psychologists,
clude three psychiatrists,
of
staff
makes
This
professional
a
total
worker.
and
a social
or sociologist),
One
three
persons.
1h. In addition, the secretarial services will require
in
she
act
also
receptionist
as
a
can
such
that
be
in
a position
secretary should
secretarial
Additional
of
offices.
section
the
of
entrance
the
a waiting room at
adv
In
be
where
records
will
kept.
section
and
filing
help should be in an office
pre-docresearch
fellows,
for
be
aside
set
two
additional
officesashould
dition,
research
the
with
who
become
associated
medical
students
may
toral psychologists or
nrqgram.
be
the
on
to
first floor,
largely
is
office
Location:
space
a.)
with some on the second.
b.) Size:
1.) Offices of
2.)
3.)
c.)
Access
1.)
2.)
3.)
ft.
are recommended.
Sixteen are required for the fourteen provisional
personnel and two additions.
A waiting roomplSO sq. ft.
A large secretarial office for two secretaries and
filing space - 150 sq. ft.
and Relationship:
Twelve offices on the first floor, each with access to.
two
of
sets
leave
advisable
be
to
may
a hallway. It
offices with an inter-connecting door for the administration heads of the two psychiatric sections.
The reception room should be at the entrance to the
and
staircommand
the
hallway
through
and
access
unit
case with the basement, second floor and all offices.
The
10x12 or 120 sq.
secretarial office should
be located close to the
reception room.
d.) §pggial construction:
Double walls and ceiling to establish privacy for the
patients under observation.
�C.) - Conference
Room:
important element in any research unit is a place where various
A
conference room so
and
discuss
activities.
their
workers can get together
This
would
be
workers
most
the
of
be
would
for
ideal.
central
placed that it
would prevent the use of one office, the lihary or a laboratory for group disand
slides
films; blackThere
be
for
should
projecting
provisions
cussions.
boards for discussions; and space for exhibits of projects under study.
An
A
second small conference room should be provided for similar purpose on
the second floor.
a.) Location: first floor for large
small.
room; second
floor for
180 sq. ft. and 120 sq. ft.
Access and Relationship}
(1) The large room should have access from the
b.)Size:
c.)
library.
(2) The small room needs access only from the
hall
and
hall.
centrally located on floor.
d.) Special construction: facilities for slide-projection,
blackboards, and exhibition space allocated on two walls
Both should be
of the room.
D.)
- Medical Library!
present Medical Library contains one thousand volumes. In
Committee
has been aware that the library
the
the
Library
assessing
collection,
be
obtained
during
volumes
thousand
will
that
one
approximately
by
deficient
is
the next two years. In addition, considering the number of journals now in subadded
and
texts
are
that
number
neurologic
of
and
the
psychiatric
scription,
hundred
hundred
four
to
of
three
the
rate
at
of
a
the
expansion
library
annually,
volumes per year is anticipated. In addition, the Library Committee anticipates
For
and
these
micro-cards.
micro-film
both
the
use
recommending that
library
removed
of
the
is
location
library
the
the
that
present
well
fact
as
reasons, as
from the main activities of both the resident and research staffs, it is recommended that space for the library be provided; the Space to be divided into a
main reading room; small librarian’s work room; and library stacks.
The
a.) Location:
1.) The main reading
room
to be
on the
first floor, The
preferably near the entrance to the building.
librarian's work room to be off the main reading room.
2.) Library stacks to be in the basement, preferably
under the main library.
b.) Size:
c.)
Main reading room
Librarian work room
Basement stacks:
900 sq.
100 sq.
750 sq.
ft.
ft.
ft.
Access and Relationship: The main reading room to have
access from the hall and from the large conference room.
The work room is to come off the main.reading room. The
stacks to have access from the basement hallway.
�.8d.) Special construction: In the main reading room, bookcases for current books, journal racks for current
journals; special equipment for microfilm reading.
Also a mechanical dumb-waiter to connect library and
the stacks.
E.) -;§nimal Laboratories:
Present studies on steroid metabolism, the role of cholinesterase and
acetylcholine, and the need for some experimental work on the threshholds of convulsions,hsve made me feel that facilities for animal studies diould be provided.
The space presently allocated in the Sloman Lowenstein Building is satisfactory;
and part of the funds allocated for this expansion should be utilized to equip
that space.
F.)
~
Storage Space:
Storage space for patient records, laboratory data and equipment,
should be provided. Such space should be considered in the basement. Minimal
allocation of 500 sq. ft. for the laboratories is suggested.
G.) - Egpansion:
._
Allowance should be made in the planning of this building, for the
addition of a third and fourth floors. For this reason, an elevator well should be
included in the original designs, as well as boiler and other facilities with expansion possibilities to accommodate doubling the original floor space.
an
Furthermore, to accommodate laboratories on the basement floor,
extra-high ceiling is recommended.
Also, construction of the foundation and supporting structures
should be such as to accommodate the increase in floor space.
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�October 3, 1956
I‘m‘iORflrflJm‘E
22; medical Affairs Committee
ESE:
Dr. Joseph S. A. Miller
Subject:
Report of Research Service, Second Year
-
To
September 1, 1956
At the request of the Medical Affairs Committee Chairman, I am sub.
mitting this report of the Research Service, describing its activity during its
second year. During this year, the staff has increased; we renewed our grants
with the U.5.J.H.S. and through the efforts of members of the Board of Directors,
received grants from the Kaufmann and Dazian Fbundations; and we were encouraged
by the results in our electroshock evaluation, reserpine and chlorpromazineinsulin, and anbivalence studies.
distressing feature of the year was the denigratration of the Research Service to separate services without a Director. As of September 1, 1956,
the Research Service is divided into a Section of Experimental Peychiatry (under
my direction); a Section of Clinical (Psychodynamic) Psychiatry, to be created;
a section of Biochemistry headed by Dr. H. Geldenberg; and a section of Internal
Medicine unfer Dr. Cohen's direction. 'Uhile there is some theoretical justification for such a development in a large institution, the development here has
led to a diapersicn of activities and a lack of adequate supervision of ongoing
One
activities.
high note at the end of this year has been the recommendation by
the Board of Directors that the Ford Foundation funds be allocated to relieving
the space problems of the Research tervice. Following this recommendation, and
after discussion with interested members of the hospital staff, I drew up a
basic program for the Research Building. This program was approved by the Research Committee of the Medical Board at its meeting on August 28, 1956, and is
now in the hands of the hospital architect.
A
A.
PROGREjs l§*9HGOING PROJECTS
l.
Electroshock.Evaluation.Proaec
: We
have completed
Electroshock Project # 3 which demonstrated the dependence of the rating of improvement following electroshock on the patient‘s personality; as well as elicited definite
measures of language changes which were correlated with improvement.
result of these studies, we instituted a "control" study, designed to validate our hypotheses. we are new in the midst of this study, which
will continue until spring, 1957.
As a
believe that we now understand the neurophysiologic, personality
and psychologic factors in electroshock therapy. Our data has both prognostic
and theoretical significance; and I plan to present a definitive report before
the American Psychiatric Association in may,.1957.
We
presented the language changes in electroshock to the American Psychopathological Association; the EEG changes to the Eastern LEG Society;
and will present a report entitled "Relation of Tests of Altered Brain Function
we have
�92-
to Behavioral Change lolloning Electroshock" to the Divisional A.P.A. meeting
in November, 1956. Reports of the memory changes, amobarbital test and EEG
changes in electroshock have already appeared in press.
T?
Meanwhile, as part of the resident training program, we have encouraged
a senior resident, Dr. Harold Esecover, to undertake a study of the type of psychotherapy which is best suited to different types of electroshock patients.
Furthermore, as a consequence of data presented at the American ELG
Society in June, I have devoted considerable time to an elucidation of the biochemical changes underlying electroshock. Such reading has led me to elaborate
a theory of the relationship of acetylcholine and cholinesterase in blood and
spinal fluid to electroshock results. nith the cooperation of Dr. Goldenberg,
this study will be added to the ongoing control electroshock study.
(a) Thorazine - Insulin:
The control study instituted
a year ago has continued with dramatic results. To date hS patients have been
studied, 22 on Thorazine and 23 on insulin. All were insulin coma condidates.
The thorazine group has demonstrated a higher improvement rate, and a lower
refusal and complication rate than the insulin patients. we are impressed by
this data and plan to complete the study by the end of the year, for presentation to the staff.
2. Drug Evaluation fifudies:
(b) Reserpine: See "com.
pleted projects."
(c) Anectine- Electroshock:
Continuing our studies of paralytic agents in electroshock, we utilized a technic for administration of anectine devised by ur. William Karliner of the Attend.
ing staff. ’Ue found it most useful and safe and the results prompted us to
recommend the adoption of this technic for our unit.‘
This study, undertaken by Dr.
Tarachow, has been successful in
defining enmivalence in operational terms, i.e., by the tests used to measure
A summary of the two
years work is being presented to the staff on Octit.
ober 7th.
3. émhiyalence Study:
In addition to Dr. Tarachow, Dr. H. Korin has beenzactive in this
project; and recently, under the resident training program, a senior resident,
Dr. Stanley Friedman, has been assigned to the project.
h. Commlication Studies: Aided by the grant from the
Foundation, Dr. J. Jaffe
has devoted this year to developing ways of measuring the verbal interaction between doctor and patient. To do this, he records his interviews with patient
before and after periods in which he modifies his attitude to the patient. At
one time he says little, later he may re-enforce the patient's positive (or
negative) comments. By noting changes in language, rate of speech and in mood,
Dr. Jaffe has developed an index of communication change.
Kaufmann
�-3...
present, he is testing the validity of his scoring methods, and
plans to apply them to doctor-patient interviews in the near future.
At
In addition, with Dr. Kahn, 3r; Jaffe has explored the possibility of
other technics, as sentence completion tests and the reading of'a standard parab
graph under conditions of immediate feed-back as measures of changes in commun-
ication patterns.
5. Autonomic Reactivity: In his
initial studies,
Dr. Blum»
berg demonstrated that the class;
ification of patients according to their blood pressure response to mecholyl was
meaningful for our population. He then applied the test to the patients on the
reserpine study, and noted a consistent and persistent lowering of blood pressure
11th an a-..
increase in the mecholyl response Iuring the period of reserpine action.
w“.
Host significant, however, has been his studies of the electroshock
He
has studied 100 patients, and established celrelations of their mechgroup.
olyl reactivity with age, diagnosis, and therapeutic result. He concluded that
the mecholyl responsivity is directly related to age - and that this is the determining factor, more than the primary illness. He is describing his observations in the forthcoming Israel Strauss Volume of the Journals
a consequence of these studies, he has recommended, and the Research Committee has approved, a study of better ways of measuring blood pressure;
and a collaborative biochemical venture (with
Goldenberg) inDC the chanes
As
.
r.
in adrenalinenoradrenalin in the blood.
6. Biochemistgy: (a) Steroid Sulfate Coniugates: As indicated earlier, the steroid studies were
undertaken because these hormones are known to be implicated both in the physiological response to stress as well as in the sexual processes. Three impartand observations have been made in the Hillside Hospital Laboratory. First,
has been noted that the steroids, which are manufactured by the adrenal and
it
sex glands, are converted in the liver to water-soluble steroid sulfate conjugu
ates. Since this is one of the major forms whereby the sex hormones are elim»
inated from the body (via urine), the liver evidently plays an important role
in maintaining hormonal balance. A second discovery in this area was made by
comparin“ male and female rat liver activity. Female rat liver was found to be
remarkably active in conjugating the steroids, particularly the male hormnnes.
This means that the female animal possess- a regulatory device whereby she
maintains her ielaleness by preierentic.lly excreting the male hormone which,
incidentally, are present in both senes.
s
Finally, in the first group of 18 normal human
observed that urinary steroid sulfate output is
a) so::-linked, being tnice as high in males as
b) appears to be low in value for calm people,
whoare innately tense, excitable, prone to
controls
it has
been
in females, and
but rises in subjects
anxiety.
(b) Psvchotomimetic and szchotherapeutic
Dru;s“
: Thesecond preject in the laboratory involves a study of the possible role of hallucinogens in the development
of mental disease. It has been hypothesized that indole-like compounds, comparable to LSD, acrenochrome, or a.crenolutine may be formed in vivo as a result
of faulty metabolism and give rise to the $3.rmptoms commonly.associated with the
psychoses. Initial studies in Our laboratory have failed to detect these alkalw
,
�.u.
oidal products in patient's urine. Ebssibly this is due to a poor choice of
patients, since none were actively hallucinating.
it
of
the
the
most
proportion
that
greater
likely
appears
suSpected alkaloids would be excreted in changed form, and very likely via the
feces. r‘his is suggested by metabolic studies which we have carried out to
is administered in known quantity.
determine shat happens to mescaline when
unaccounted
The
5%
the
rest
is
urine.
in
unchanged
comes
about
through
Only
carbon
diobe
A
as
of
expired
course
carbon
residues
might
of
the
portion
for.
LSD
the
isotope
the
drug.
in
would
account
not
nitrogen
for
xide, but this
hence
excretion
the
of
in
drug
accumulation
gut,
this
indicate
studios in Jurope
studies
For
subsequent
these
reasons
our
here.
seems
also
feces
the
likely
in
However,
it
will involve isotopically—labelled hallucinogens to determine their ultimate
decould
more
then
we
intelligently
these
at
our
facts
disposal,
Having
fate.
termine the excretion of related compounds by psychotics.
(c) 92lorpromazine project; Studies on
the metabolism of chlorpromazine by
psychotics were reported earlier, at which time chlorpromazine, chlorpromazine
were
derivative
alkaloidal
and
unidentified
an
chromogen,
the
purple
sulf Xide,
demonstrated in urine. A sufficient quantity of the last compound could not be
and
the project
conventional
methods,
by
identification
from
for
urine
isolated
was held up in April pending receipt of a continuous flow electrophoresis unit.
This item has been on order for h months but has not yet come in.
7. Tactile Perception: Following the technics devised by
Dr, Bender, Dr. Green and myself,
we have, with U.S.P.H.S. support, set up studies of tactile perception using
simultaneous threshold electrical stimuli. Patients have been studied before
and during electroshock. To date, the data amply demonstrates that the phenom!
ena of extinction, displacement and confabulation, noted clinically in childin
all
elicited
readily
are
cerebral
with
dysfunction,
and
organic
ren
patients
induced
the
organ—
with
electroshock,
Furthermore,
threshold
levels.
at
subjects
ic cerebral changes exaggerate the perceptual errors in identifiable patterns.
This study is continuing and it is planned to present the data before the appropriate neurologic societies.
'
8. Prognostic EngiCatorg g: glectrgshgggg This study,
designed by Dr.
Karliner to elucidate the relation between presenting symptoms and the results
of electroshock therapy, is continuing. Forty-five patients have been studied,
and it is anticipated that the results will be determined in the coming weeks.
�.5.
B.
COMPLETED PROJECTS:
collaborative study of
the urinary steroid pattern
changes with electroshock has been discontinued. The initial findings demonstrated a significant alteration in the steroid patterns after electroshock in
improved patients. After studying these results, Dr. Hellman of the SKI and
I prepared a protocol of experimental drug administration designed to clarify
these findings.
1. Sloan Ketterinr Study:
The
presentation of this protocol to the Research Committee, it was
their recommendation that, despite the merits of the research design, it not be
approved for this hospital. The chief criticism was one of the risk to the pat.
Upon
ient of the procedure.
these studies could not be meaningfully carried out at the hospital, the program.has been transferred to Creedmcor State Hospital, where the
cooperation of the Medical Director and the Commissioner of Mental Hygiene of
New York has been assured.
As
2. subculture:
project has been discontinued following the initial reports of the study group.
hour observation of a patient, islaeing prepared
The
primary study, that of a 2h
for the Research Committee by Dr. R. Navarre.
The
3. Reserpine Egalyation:
The high-dose reserpine evaluation study was completed in
harsh. The results demonstrated a limited usefulness of this drug in our population. Hhile it occasionally controlled overactivity, it did not reduce the
symptom of anxiety; and did increase existing feelings and states of depression.
The results were reported in the April issue of the Journal and summarized for
the administrator and staff in memoranda and meetings in April. As a result,
reserpine was made part of the hospital formulary, with specific recommendations
for its limited use.
C
.
PROJECTS Fulfil-ED:
0*.“
1. Cerebral Reactivity: In the course of our studies cf
electroshock, we have been imp
pressed by the differences in brain responsivity to electroshock. Some patients
show a quick and intense change in behavior and on our tests; while others require more frequent treatments, higher voltages, etc. to induce any change.
u
developed a series of hypotheses which ascribe the differences
in reactivity to (a) biochemical differences in acetylcholine-cholinesterase
metabolism; (b) personality differences; and (c) generalized hypo-responsivity
to all stresses. For this purpose, we are now elaborating protocols to test
these hypotheses. As developed, they will be submitted to appropriate granting agencies for support.
we have
2. Autonomic Reactivity: See "Ongoing ProjectS."
�3. Digghemistrv: Following the present studies it is
planned to continue the studies of bio-
chemical changes in mental
steroifs sulfate excretion
illness along the following lines.
end
a) Comprehensive survey of urinary
its relation to anxiety.
b) Circulating steroid sulfate
levels in blood and spinal fluid.
c) Enzymic and fluorometric evaluation of alkaloids excreted in feces, with particular reference to patients
who are hallucinating.
Cholinesterase and acetylcholine
levels in spinal fluid of patients undergoing electroshock therapy (as part of
the electroshock evaluation study).
d)
D.
STAFF CHANGES
essential change during this period has been the reorganization
of the hospital‘s research activities. As of SepteMber, 1956, the Section of
Experimental Psychiatry, which is one of the surviving sections of the Research
Service, consists of the following:
The
Dr. N. Fink
D?,
-
J, Jaffe
Dr. R. Kahn
Dr. H. Karin
Dr. H. Green
Research Associate
Research Assistant~Psychiatry
Sr. Research Assistant-Psychology
Research Assistantufsychology
Research Assistant-Neurophysiology
and a full
(Mrs. H. Hosquera).
time secretary (Miss Gayle Iankel) and 2/5
-
time
EEG
technician
chief addition has been the addition of the EEG technician and
the part time appointment of Dr. M. Green. For the present, and until December
1957
As
of
January
somatic
the
1,
Green
filerapies.
Dr.
1956,
supervising
is
31,
he will devote all his time at Hillside to experimental work.
The
E.
FUNDS:
for 1956-57 have been received from the U.S.P.H.S. From the
National Institute of Mental Health, support for Dre. Kahn and Karin, in the
electroshock evaluation study, and for biochemical studies in the relation of
alkaloids to mental disease. Also, from the National Institute of Arthritis,
funds for the study of steroid sulphates, now used to support one research
Grants
chemist (Hrs. Ruth Foley).
Also, a small grant from the Dazian Foundation supported the summer
employment of a chemist; while the Kaufmann Foundation has been supporting the
studies of Dr. J. Jaffe.
�I are planning to submit an application
for support of the studies in cerebral reactivity; while Hrs. Blumberg and
Miller are submitting one for their studies in autonomic reactivity. Both reAt present, Dr. H. Green and
quests are to
go
to the U.S.P.H.S. before
F.
OTHER
November
1, 1956.
ACTIVITIES
l.
hedical Library: In mic-1955, the hospital obtaineo
the services of a part-time 1110(l0a1
librarian. By the year's end, it was apparent that the acecuate utilization
of our library required a full time librarian, anc as of March 1956, miss Rosalind Lazarus was apppointed. I was appointed chairman of the Library Committee,
and through our joint efiorts, the medical library was activated. A definitive
budget was prepareC and approved; rules for library use established; and more
recently, a 2000 volume addition to the library was recommended to bring this
library up to the standard as the most complete psychiatric library in the North
Shore area.
of the Journal of the Hillsidee“
2. Israel gtreufig_folune
S
ervice
Research*
m<.1d3ers
o;t
of
the
the
By
active
aith Dr.
cooperation
HosEital:
S. Tarachov 3 the volume was orranized and editec. It is new in the hence of
the printer and fill appear in November, 1956.
3
3.
Isreal Strauss hemorial Lecture:
The appointment
of
the second lecturer,
Dr. Hilliam Halamud, an” the detailed arrangements for the lecture were made
by the Committee headed by Dr. Bender, with the active cooperation of members
of the Research Service.
Research Builcing: Following the recommendation of
the Board of Directors, the members
of the Research Service were most active in planninf the new structure; describA.
The
and
the
for
architect.
relationships
descriptive
ing its uses;
establishing
first blueprints were submitted and after considerable discussion, were returned
with corrections. Continued liason with the architect is planned.
5. Resident Training: During the past year, members of
the Research Service gave bimonthly
seminars on recent advances in psychiatric research. Two special lectures were
arranged; and the local Research Conference of the Nassau Heuropsychiatric Society'nas held at Hillside Hospital.
Respectfully submitted,
Mffigw
Fink, M.D.
Research Associate
(bxperimental Psychiatry)
Max
�fi—
-
Methods
New
Reports
.For Evaluating Electroshock
Hosfipifali
W
.
.
thropies, is engaged in a number of investigations into the
basic causes and treatment of
mental ailments.
Dr. Maximilian Fink, research associate at Hillside,
said that electroshock actual1y Fan change the way the
braln functions, and that
these Changes can be observed
and measured by electroencePhalography.
The change' in the brain also,
shows itself in the response to
dru es, M
s cholo gical testin e
and the weakening of unpleasant memories.
The Hillside researchers report new and definite methods
for measuring the extent of
these changes. In the successfully treated electroshock patient, these brain changes
enable the person to maintain
better control over his emotions and behave more like a
normal person.
An' important clue to how'to identify patients less likely
electric shock therapy affects to benefit from electroshock
the human brain has been un- so that they can be treated
covered by researchers at Hill- earlier by other methods.
side Hospital, Glen Oaks, it The electrOShock developwas announced today.
ment was described in the Hillisannual
report
side
Hospital
is
It expected that this discovery will increase the ability sued todayvto select patients most likely Hillside, a non-profit mental
to benefit from electroshock. hospital affiliated with the
This development also will help Federation of Jewish Philan‘
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patient to benefit more readily
from psychotherapy administered during and after the
.
tcourse of electroshock.
.tElectroshock therapy will
continue to be used in the
treatment of depressions occurring in patients in the 30
-to 60-year age groups, and
also in younger schezophrenics
showing mainly excitement
or stupor as symptoms.
In issuing the report, Dr.
Joseph s. A. Miller, medical
director, also presented the
following data about the
year’s activities at the hospital.
Among 575 patients treated
during the year, the average
length of hospitalization was
176 days. Of_ these, 32 patients were admittfld t0 the
Israel Strauss Adolescent Pavilion, a facility for adolescent
girls; which was founded in
October, 1954. The out-patient
service treated 224 patients.
‘
——~—
�.
following day-
BERNETHY—Elnia 1... on October 30,
1956. wife of the late Richard 3.. beloved mother at Gertrude Tobias and
1Estelie Abcrnethy.
ervices Thursday, November lst. 8:30 P.
M. at the Clarence F. Simonson Funeral
gall-[EL 1119-04 Hillside avenue. Richmond
ntermeni‘ Friday. 1]. A. M. Maple Grove
Cemetery.lALICCHlO—Raifaele, on October 30. 1956.
of 101-28 99 stret, Ozone Park, beloved
husband of Marianna, dear father of
.Vincent and Florence. dear brother of
Carmine. also survived by eight grand—
l
children.
Leposmg at the Cassese .Funeral‘ Home,
Inc.. 101-07 101 avenue, Ozone Park.
Funeral Saturday, 9:15 A. M. Solemn
requiem high mass St. Mary Gate of
Heaven
aterment St. John’s Cemetery.
IHRISTENSEN—Chauncy J., on October 30,
1956, after a long illness, belov‘ed husband of Amelia.‘ devoted father of the
late Dorothea C. Herold. loving grandfather of Barbara and Richard Herold.
‘uneral from the Walter B. Cooke Funeral
Home. 158-14‘ Northern boulevard. Flushing L. 1. Friday, 3 P. M.
nterment Cedar Grove Cemetery.
URClo—Lena. on October 28. 1956, of
73-11 Metropolitan avenue. Middle Village. devoted wile of Carl. loving mother
oi Salvatore and Joseph.
Leposing at the Phillips Funeral Home.
79-02 Metropolitan avenue. Middle Village. Funeral Friday at 10 A. M. Solemu mass of requiem at st. Margaret's
R. C. Church at 10:30 A. M.
nterment st. John's Cemetery.
“NAN—Elizabeth. on October 29. 1956. beloved wife of William. mother oi Lulu
Harrington and Mary Mattoe; also survived by two great-grandchildren.
teposing at the Walsh Funerar Home.
94-08 118th street. Richmond Hill. Services Friday. 1 P. M.
nterment Mount Olivet Cemetery.
HEDGE—Catherine V.. of 585 Seneca avenue. Ridgewood. on October 30. 1956.-age
66 years, beloved mother of Walter.
Joseph, Madeline, Frances Connell, Mary
Jo. (Dolly) Connell. devoted sister of
Ellen O'Loughlin, also survived by four
grandchildren.
’uneral Saturday. 9 A. M. from Charles
Morton Funeral Home. 578 Onderdonk
avenue, Ridgewood. Solemn requiem mass
St. Brigid’s R. C. Church. 9:30 A. M. e
nterment St. John’s Cemetery.
lAY—Laurance X, Staff Sgt. U.S.A.F..
suddenly at Carlisle. Mass. on Saturday.
October 27, 1956. beloved husband of
Patricia A. (nee Joerger). devoted father
of Donna Patricia. Laurance and Kevin
Gay, dear son of Lorraine and Margaret
,Gay. loving brother of James. Jere.
Patricia Papscun.
Marguerite
Clay.
Jeanne-Marie Dalessandro. and the late
Lorraine Edwina Gay.
uneral from the Gleason Funeral Home.
10-25 150th street. Whitestone. N. Y.
on Friday. November 2nd. at 10:30 A. M.
Solemn requiem mass st. Luke’s R. C.
Church at 11 A. M.
utennent United States National Cemetery,
Pinelawn. L. I.
lATCH—Helen Frances. on October 29.
1956. beloved wife of the late Lewis.
devoted mother of Ruth E.
ervices at Walter B. Cooke Mineral Home.
goaOSrgdena avenue. Brooklyn, Wednesday,
'
,
.
'
,
:iterment Walkill Valley Cemetery. Walden.
New York.
lAVERLY—Joseph. of 60-27 78 avenue.
Ridgewood. on October 28. 1956. age 76
years. beloved father of Joseph. Jr..
Henry and Robert Haverly. Catherine
Anastasia. Lucy Corrado. Lillian Caverler. Marie Roethel: also survived by 28
grandchildren and nine great-grandchildren.
uneral Friday. 9:30 A. M. from Charles
Morton Funeral Home. 578 Onderddnk
avenue. Ridgewood. Solemn requiem mass.
10 A. M at st. Matthias R. C: Church.
nterment St. Charles Cemetery. Pinelawn.
Long Island.
sum":
non
Until 5:39
in «m... or
I. IL Satori-y
llliib‘S—Mai‘ie (nee Gademann). on Octoher 30, 1956. beloved wife of Edward
Heiss. devoted mother of Carol Elizabeth.
Nancy Edwina and Bruce Edward G.
Heiss..deai sister of Frances. of Regen—
burg, Germany, loving daughter of Reinhold and Francisca Koob of Munich.
Reposing at the Leo F. Kearns Funeral
Home. 61-40 Woodhaven boulevard at
Dry Harbor road, Rego Park. Funeral
Friday, 9:30 A. M. Solemn requiem mass
at our Lady of Perpetual Help R. C.
Church. Richmond Hill, 10 A. M.
Interment St. Charles Cemetery.
Please omit flowers.
.,
..
,
HOFFMAN—Augusta E., on October 29,
1956. beloved mother of Fhillip Pflug,
dear grandmother of William Pflug,
sister of Anna Uphoff and William
Warnke.
Services. at the Stutzmann Funeral'Home,
224-39 Jamaica avenue. Queens Village,
L. I., on Thursday. 8 P. M. Funeral
Friday, 1:30 P. M.
Interment Lutheran Cemetery.
Jun—Wilhelmina M.. on October 30. 1956.
Beloved wife of Ernest. dear mother of
Jr.. and grandmother of Leona
Ergest
u .
SerVices at the Stutzmann Funeral Home.
224-39 Jamaica avenue. Queens Village.
L.‘ 1.. on Thursday. 8:30 PM. Funeral
a,_
~
Friday. 10
AM.
BAECH’I‘OLD—Emil Albert.‘on October 30.
1956. beloved husband of Anna '1‘. (nee
Pfei er). dear father of Mrs. Ruth H.
Will and Elmer A. Baechtold. brother
01 Christian A. and Walter 0. Baechotld.
also survived by two grandchildren.
Reposing ,at the Floral Park Chapel of
Thomas F. Dalton. 29 Atlantic avenue.
Religious serVices Thursday. 8 P. M.
followed by Masonic services, Eureka
Lodge No. 243, F. a. A. M.. Machinists
Lodge, F. 8: A. M'.,
Interment Friday, 2 P. M._ Lutheran
Cemetery.
.
BURNS—Samuel J., of 84 New York avenue.
Baldwin. formerly of Brooklyn, on October
29, 1956, son of the late George J: Alice
O’Keefe Burns; dear brother
of. Belle
Burns.
Reposing at the Fullerton Funeral Home,
131
Merrick road. Baldwm. Solemn
R. C.
Eeguiegl Firiiiaiss €5.00C1Arilatopher'l
urc
r ay :
.
.
2312
Third Street.
KOLLlNS—John S., of
East Meadow, L. I.. suddenly, on Monday, October 29 1956 in his 45th Year.
beloved husband of Angela. devoted
ratherr of Adrienne. dear brother of Mrs.
Bertha Bowers, Stanley and Tony
Kollins.
R'posing at‘ the Catholic Chapel. 2100 3e11more avenue, Bellmore. L. I.
Notice of funeral later.
Under direction of John J. Mlchalek.
'
Interment Maple Grove Memorial Park.
KENNEDY—Thomas F.. 116-30 221 street,
FUNERAL HOME.
BELMORE
Cambria Heights, L. .I. Beloved husband
of Ethel (nee Huxley), father of Eileen CAROW—Edward, of Malverne. suddenly
Devlin. Kathleen Wilson.» Ethel Albert.
October 30. 1956. beloved
brother of Loretta McGivney. Adeline on Tuesday.
of Rayhusband of Jennie. dear father
Doyle.. Ethel Casey. Seven grandchildren.
'
of Dorothy Koenig and
Reposing at the Funeral Home of Lawrence mond. brother survived
by four grand"
Eldred. also
D. Rouse Inc. 191.02 Linden boulevard,
children,
St. Albans. L. I. Solemn requiem mass. Reposing
at the Flinch a. Bruns Funeral
.Friday. 10 A.M.. Sacred Heart R.C. Home. 34
Hempstead avenue. Lynbrook.
Church. Cambria Heights. L. I.
Interment st. John's Cemetery. Middle The family will receive friends between
the hours of 3 to 5 P. M. 8: 7:30 to
Village. L. I.
10 P. ,M. Masonic services on Thursday.
[ALLY—Philip E., on October 27. 156. 8:30 P. M. Religious services on Friday.
dea; uncle of William F. Lawkins.
10 A. M.
Funeral from the Queens Village Chapel Interment
Knolls Memorial Park.
Nassau
at Thomas M. Quinn a Sons, 214-65 Port Washington.
Jamaica. avenue. Queens Village. L. I..‘
on Friday, 9:30 A. M. Solemn requiem FLORENCE—John W.. on October 30. 1956.
fies: Olfi Lady of Lourdes R. C. Church, of 315 Locust avenue. Unlondale. Beloved
husband of Frances. and loving father
Interment St. John’s Cemetery.
of John W. Jr.. Jeanne and Diane. SurLOMBARDO—Teresa
vived by one brother and two sisters.
(Rommanelli) ,
on
October 29, 1956, beloved wife of Angelo Reposing at the Martin Funeral Home. 412
Willis avenue. ,Williston Park. Solemn
Lombardo, devoted mother of Mary
requiem mass at St. Martha R.C. Church
Strollo, Anne Carro, Sue Cremona, John
Frank and Edmund Lombardo, dear sis- on Friday. 10 A.M.
ter of Rafiaela Genovese and Carmela Interment Holy.,Rood Cemetery.
Impci'ato, also survived by seven grand~
children.
KOLLINS—John S.. of 2312 {rm (1 street.
Reposing at the Leo F. Kearns Funeral
East Meadow, L.I.. suddenly n MonHome, 103-33 Lefierts boulevard near
day, October 29, 1956. in his 45th year.
Liberty avenue. Richmond Hil Funeral Beloved husband of Angela. devoted
Thursday. 10 A. M. Seryice at the father of Mrs. Sophie Kincinski AdriChristian Pentacostal Church 'of God, enne, dear brother of Mrs. Bertha Bowers.
Mrs. Ann Mankowskl. Stanley and Tony
10:30 A. M.
Also surviving are two
Interment “The Evergreensz”
Kalirdohlisllgi
en.
ran c
._
Regiaosing
1956.
29
BellOctober
2100
BeMAYER—Bertha. on
Catholic Chapel.
the
at
loved wrfe of Otto Mayer, active member
Bellmore. L. 1. Salem
avenue.
more
‘
of Ridgewood Heights Maenner Cbor.
high requiem mass on Friday Noyember
Memorial services at Buss-Avenius Funeral
2 at 11:15 A.M. at St. Rap leis R.C.
Home. 63-32 Forest avenue.
gewood.
Newbrldge road. East Meadow.
Church.
L. 1.. Wednesday. 8:30 P.
Funeral L. I.
Thursday, 11 AM.
Mt. Calvary Cemetery, Linden.
Inger-merit
Cremation Fresh Pond.
ew ersey.
Under direction of John J. Michalek
MEYER—George F., on Tuesday. October l
BELLMORE FUNERAL HOME
30. 1956. of 111~21 198 street. st. Albana.
L. I. Beloved husband of Florence Meyer.
149 w. Stanton
of
E.
and devoted father of Mrs. Florence McCRAI
Victoria
Combes. grandfather of Dorothy Combes. ,avenueltulaaldwin, on Monday. October 29.
SerVices at the Fairchild Chapel, 220-05
1956. beloved wife of Morton C. McHillside avenue. Queens Village on FriGraime; devoted mother of Douglaomnd
Kenneth: dear daughter of Eugenie and
_day at 8 PM.
Victor Fernandez.
NIGRl—Lucia. beloved mother of Edmund Reposlng
Funeral
Brother:
Weigand
at
oi”
the
ngl‘l
Nigrl Furniture House.
Home. 24 South Grand avenue, Baldwin.
Orstehnydia Mancino: in Italy. Gaetano. Services Wednesday. 8:30 P.M.
Elena. Dorotea, Teresna and Nicoletta. Interment Thursday. Milford Cemetery.
Reposmg at Robert Giordano Funeral Milford Connecticut.
Home. 2346 Pacific street. Brooklyn un-.
til Friday, 9:30 A. M. solemn requiem QUAGLIATo—Anita
Hill). on October
(nee
Our
of
Lady
Loretta
Church.
29. 1956. of 678 Franklin avenue. Massaf0“: alt/I
pequa. L. I. beloved wife of Ferdinando:
Interment St. John's Cemetery.
devoted mother of Mrs. Lucille Rubusto.
oasrfitLE—Aiwma. on-October 28, 1956. Mrs. Blanche Burns, Richard, Joseph.
Services Wednesday. October Slst. at and Ferdinand Quagliato; dear sister of
8 P. M. at the Clarence F. Simonson
Mrs. Rose Brandt. Mrs. Isabelle Snediker
Funeral Iflome, 119-04 Hillside
and William Hill; also: survived h- “-1-“
‘
___.__,_______———.
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DCK
TERA?!
or
one
administered
third
in
electroshock
therapy
we
in previous years
the adult patients. For the meet pert, it was prescribed for peuente in the
As
forties
and
fifties
who
electroshock was used
manifested depressive symptoms.
(21:
To
a lesser extent,
patients) in schisophrenic patients to modify
ms-
active, essenltin er delusional behavior.
the
studies
the
of
earlier
results
of
that
was
in this group pstients
It
Psychietry were applied and extended. Patients
of the Departmnt or
W
received
series
a
the
electroshock
psychiatrist
by
supervising
for
mmmded
encberbital
test
These
included
electroencepmlogren,
of neurophysiologic tests.
for organic brain disease,
and pemeptusl
tests,
tactile. During
per week, the tests were
both visual and
the course of treatmentfihieh ms adminstered three times
periodically repeated.
with clinical
Based upon changes
"alustiens
in these mumplwsiologic tests ceabined
psMiatx-ist, the extent
«amines; In these instances in which the neuro-
by the resident and supervising
of electroshock tmmpy was
treatment
bed
been
not
behavior
obtrdned,
in
alteration
for
basis
physiologie
intensively.
week
and
acre
occasionally
times
modified
five
to
per
regimes were
Ch
this basis, the usual com-es of
tmmnt m
the patients meshing between 6 me lo
batsmen 11 and 19 with
m
percent of the patients received more than 20
of
mtients rescind less
an incomplete series. Twenty-five
treehnen’os .. The number of tmtnnnts
tmtmsnts.
than 5 treatments, which in each instmee
10%
Four
and
to
reference
with
diswosie
therapy
results
at
in chart
is
condition at time at discharge is seen in chart #9.
The original studies relating the alteration in brain function indueed by
electroshock to the short term clinical results, were confirmed in this series
amounts-sud
of
and
his
Fink
staff
Dr.
where
study.
of patients in a predictive
shown
#10 and the
I
that only these patients in
when
alteration in the electroencephalogram and
�#2
mbarbikl taste
had bean
to warrant the rating of
a umber
031‘
reports have
mud,
had
mm
D.
clung. in behavior sufficient
uprated or momma. A: a Insult. of these studies,
been presented before nation]. psychiatric societies.
much
�#3
During 1953 there had been considerable experience
at the hospital
with
of the newer chemotherapeutic agents, chlorprousine and reserpine. It
decided to evaluate ohlorpronasim as a potential substitute for insulin
tVo
was
em
therapy.
The
use of chlorpronnzine we suggested by the many reports
thst
mlcrpronasinc had been successful in schisophrenio psychoses. Also, the specie;
report of the Medical Board noting the course of patients disohnrged
roam
dmonstnted that the poorest long tom results were found in the
insulin cone population. For this reason, a control study was instituted.
Beginning Septenber, 1955, and continuing until Deomber 31, 1956, :11 patients
in
1950 had
referred for insulin
coma
therapy by the supervising psychintriste were divided
into tee groups: one group received insulin coma therapy in the established
doses
received
in
and
second
therapy
the
urge
chlorprmsine
group
newer;
over a four month period.
Insulin
coma
therapy was given for a course of 50 comes
in most instances.
treatedlcsees.
The results
Chart #llxoflects the number of cones in insulin
of insulin some therapy is noted in Chart #12 and it is seen that of the 15
much
of
inproved or recovered.
were
a
four
rating
given
patients ,.
In the patients who were given chlorpronesine, dosage ranged betueen
daily with a
800
600
of
milligrams.
to
mge
Treatment was oontimed for a period or shut four months. In this group
200
and 3600 tailligrsms
of patients,
who were
median
unselected except for having been candidates for insulin
of
the
insulin
to
that
were
of
improvement
equivalent
the
ratings
moment,
cone population. 01' 21: patients discharged during 1956, one was discharged as
riftem
miinprored.
and
much
as
improved,
as
em
recovered, three as
inpmd,
some
Guptring the complication rates of both treatments, it was noted that prolonged
of
nine
tones
and
in
were
insulin
resis
cmplications
reactions
ledondary
ems,
the insulin some patients. Wtansion airfioient to cause fainting and severe
demtitis
were complications
in five of the chlorpronasine group. Agitation
�#h
and penis, seizures and
numbers
It
refusal of further therapy were seen in muivalent
of patients in both groups.
was the opinion of the numbers of the Deparhuent of
peydtiatry
ami
Manual
the resident physicians, Doétora Robert Shaw, George Gross
Mean
for this study, that in
to insulin coma therapy, chlorpromasine was safer, easier to ldminater, more
controllable in its effects, and had fewer aid: effects. It was their
recommendation that chlorpmmine therapy would be warranted as the initial
and Fred Coleman, who had hem responsible
treatment for patients in the younger age group
who were
suffering with
schizophrenic disorders. In such cmditions, they anticipated that chlorpromuino
would be most
behavior.
effective in modifying overactive, as saultive and delusional
�#5
cogg sagx rmmr
01'
the fifteen patients treated by insulin com therapy, the modification
of behavior was inadequate in five, loading to a
be combined with insulin come.
nemudntion
that. electroshock
of these, four patients were suffering
fm a
schizophrenic disorder and one from a manic-depressive
not one of the patients were mach improved
illness. In each instance,
or recovered after combined mutant.
Similarly, there were four patients or the insulin com group who had had metroshock therapy either prior to the insulin com or subsequent to the insulin con
moment.
Here
too, the mtinga or immemnt were in the lower
4
two
categories.
�
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Title
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Research Files and Unpublished Works
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Progress and annual reports; research activities (folder title).
Type
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Text
Identifier
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mfp-03-01-001-0-004
Date
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1956
Creator
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<a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a>
Subject
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<a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1954-1965
Relation
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The Max Fink Collection
Description
An account of the resource
Perceptual Changes Induced by Drugs and Electroshock - Progress Report; Research Activities - Annual report; Letters; Annual Reports - Department of Experimental Psychiatry; Newspaper clipping, Hospital reports new methods for evaluating electroshock, Long Island Daily Press, 1956-11-31;
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<a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a>
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Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York).
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en-US
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application/pdf
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Research