The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 1, page 1

Appendix 1. Photographs of the buildings and grounds of the former Still-Hildreth Sanatorium in Macon, Missouri. (Photos by Leslie M. Ching, DO, September 2013.)

Photograph 1. The main building (left) of the former Still-Hildreth Sanatorium is currently used for reduced-price housing for the elderly, and the annex (right) houses the Macon County Historical Society.

Photograph 2. The central staircase in the main building retains its luxurious touches.

The Still-Hildreth Sanatorium: A History and Chart Review—Appendices 1-6Leslie M. Ching, DO

The author has provided the following appendices to supplement her article in the Winter 2014 issue of The AAO Journal. She hopes researchers will find the following information useful.

Continued on page 2 of appendix 1

The AAO Journal • Vol. 24, No. 4 • Winter 2014Appendix 1, page 2

Photograph 5. The Still-Hildreth Sanatorium’s dairy barn is currently privately owned.

Photograph 6. The roof of the main building and the chimney of the furnace are seen from across the remaining lake.

Photograph 3. The interior of the main building remains well maintained as housing for the elderly.

Photograph 4. Patient rooms in the annex were used for those who were considered dangerous or violent by staff physicians.

The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 2, page 1

Appendix 2. Diagnosis Categories From Extant Patient Records, 1914-1930.This appendix is derived from a spreadsheet compiled by the Museum of Osteopathic Medicine on the diagnoses recorded on 1891 patient charts from the Still-Hildreth Sanatorium between 1914 and 1930. The majority of the patients at the Still-Hildreth Sanatorium had diagnoses related to mental health. However, the sanatorium also treated patients with a wide range of other diagnoses. The “not otherwise specified” (NOS) diagnoses did not fall into any of the subcategories. The subcategories are indicated with bullet points. Only the primary intake diagnoses were counted by the Museum of Osteopathic Medicine. There was no information about the discharge diagnoses in the museum’s spreadsheet.

Diagnosis N (1891)

Nonmedical diagnoses

Illegible 28

Examination 13

Transient 28

Rest and relaxation 1

Medical diagnoses

Acute alcoholism 1

Acute amentia 1

Acute confusional NOS 2

• puerperal 2

• melancholia 1

• insanity 1

Acute mania NOS 4

• febrile 2

Adiposa dolorosa 1

Alcoholism NOS 5

• psychosis 1

• epilepsy 2

• infection 1

Anemia 3

• pernicious 1

Apoplectic dementia 1

Apoplectic stroke 1

Apoplectic confusional psychosis 1

Apoplexy and hemiplegia 1

Arrested development 3

Arteriosclerosis NOS 7

• nephritis 6

Arthritis NOS 3

• gonorrhea 1

Ataxia NOS

Diagnosis N (1891)

• Friedreich 1

Bell mania gravis 1

Blindness 1

Bronchitis 1

Bulbar palsy 1

Cancer NOS 2

• brain 1

• breast 1

Cardiac NOS 2

• hypertrophy 2

• cardiovascular and renal 18

• congestive heart failure 1

Cardiovascular senile degeneration 1

Cerebral maldevelopment 2

Cerebral arteriosclerosis 2

Cerebral embolism 2

Cerebral hemorrhage 1

Cerebral sclerosis 1

Chorea, generalized 1

Climacteric depression 8

Climacteric melancholia 2

Degeneracy NOS

• congenital 1

• maldevelopment 1

• spinal cord 1

Dementia praecox NOS 533

• acute confusional 2

• advanced 6

• catatonic 6

• chronic 1

Continued on page 2 of appendix 2

NOS=not otherwise specified

The AAO Journal • Vol. 24, No. 4 • Winter 2014Appendix 2, page 2

Diagnosis N (1891)

• circular 1

• climacteric 1

• hebephrenic 13

• hypochondria 1

• idiotic degenerate 1

• incipient 70

• manic 1

• paranoiac 25

• simplex 1

• transient 2

• traumatic 1

Dementia NOS 26

• arteriosclerosis 23

• mania 1

• paranoia 3

• presenile 29

• senile 42

• traumatic 2

Depression NOS 7

• agitans 1

• arteriosclerosis 1

• involutional 29

• presenile 43

• psychosis 1

• puerperal 3

• recurrent 10

• religious 1

• senile 2

Diabetes 1

• with autointoxication 1

Diarrhea, chronic 1

Dipsomania 1

Drug habit 7

Encephalitis 1

• postinfectious 1

Encephalomalacia 6

Epilepsy NOS 17

• chronic 1

Diagnosis N (1891)

• dementia 5

• petit mal 1

• psychic 1

• traumatic 1

Fallen arches 1

Headache NOS 1

Huntington chorea 1

Hypochondria 32

Hypomania 2

Hypomelancholia 1

Hysteria NOS 32

Idiocy 1

Indigestion 1

Infection 1

Influenza 1

Involutional confusion 1

Mania NOS 3

• febrile 2

• recurrent 3

Manic-depressive NOS 46

• circular 3

• climacteric 15

• depressed 73

• manic 30

• psychosis 159

• puerperal 4

• recurrent 31

Meningitis 1

Migraine 2

Multiple sclerosis 2

Mumps 1

Muscular atrophy 1

Nephritis NOS 6

• interstitial 4

Nervous exhaustion 3

Neurasthenia 100

• postinfectious 1

Continued on page 3 of appendix 2

The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 2, page 3

Diagnosis N (1891)

Neuritis 1

Neurosis 1

• traumatic 1

Nonmental 5

Pancreatitis 1

Paralysis NOS 3

• agitans 8

Paranoia 22

Paresis 56

• incipient 1

Pellagra 1

Peptic ulcer 1

Pneumonia 1

Prolapsus 1

Psychasthenia 4

Psychoneurosis 7

Psychopathic constitution 1

Psychosis NOS

• climacteric 3

• climacteric confusional 1

• confusional 1

• exhaustion 7

• infection 21

• involutional 8

Diagnosis N (1891)

• postinfectious 9

• postoperative 1

• presenile 3

• puerperal 2

• toxic NOS 6

• toxic—alcoholism 3

• toxic—drug-related 7

• traumatic 3

Puerperal confusion 1

Renal colic 1

Retarded development 1

Rheumatoid arthritis 1

Sciatica rheumatism 1

Spasmodic torticollis 1

Syphilis-related

• cirrhosis 1

• taboparesis 6

Stroke/hemiplegia 6

Tic doloureux 1

Tuberculosis-related 1

• meningitis 2

• toxic psychosis 1

Volvulus 1

The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 3, page 1

Appendix 3. Revised Diagnostic Categories and Subcategories for Patient Charts From the Still-Hildreth Sanatorium.Patient diagnoses in Appendix 2 were reorganized by diagnostic categories and subcategories to make the data analysis more logical. The chart on the right assigns color codes to subcategories. Appendix 4 applies those color codes to the information from Appendix 2.

Category N (1891)

Psychiatric or neuropsychiatric 1668

Medical 84

Neurological 37

Nonmedical 75

Substance-related 27

Subcategory N (1891)

Psyc

hiat

ric o

r neu

rops

ychi

atric

Confusion 5

Psychosis or schizophrenia 687

Dementia 131

Anxiety disorders 222

Depression 107

Personality disorders 1

Bipolar disorder 357

Mental disorder due to medical condition or pregnancy

158

Neu

ro-

logi

cal General neurologic disorder 26

Developmental disorder 11

General medical disorder 84

Nonmedical 75

Substance-related 27

The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 4, page 1

Appendix 4. Revised Diagnoses Color-Coded by Subcategories for Patient Charts From the Still-Hildreth Sanatorium.Patient diagnoses in Appendix 2 were reorganized by diagnostic categories and subcategories to make the data analysis more logical. This chart shows each diagnosis and how it was categorized, using the color code in Appendix 3.

Psychiatric and neuropsychiatric diagnoses N

Acute confusional NOS 3

• puerperal 2

• melancholia 1

• insanity 1

Cardiovascular senile degeneration 1

Dementia praecox NOS 533

• acute confusional 2

• advanced 6

• catatonic 6

• chronic 1

• circular 1

• climacteric 1

• hebephrenic 13

• hypochondria 1

• idiotic degenerate 1

• incipient 70

• manic 1

• paranoic 25

• simplex 1

• transient 2

• traumatic 1

Dementia NOS 26

• apoplectic 1

• arteriosclerosis 23

• mania 1

• paranoia 3

• presenile 29

• senile 42

• traumatic 2

Depression NOS 7

• agitans 1

• arteriosclerosis 1

• climacteric 10

• involutional 29

• presenile 43

• psychosis 1

• puerperal 3

• recurrent 10

• religious 1

• senile 2

Dipsomania 1

Encephalomalacia 6

Hypochondria 32

Hypomania 2

Hypomelancholia 1

Hysteria NOS 32

Involutional confusion 1

Mania NOS 3

• acute 4

• febrile 4

• recurrent 3

Manic-depressive NOS 46

• circular 3

• climacteric 15

• depressed 73

• manic 30

• psychosis 159

• puerperal 4

• recurrent 31

Nervous exhaustion 3

Neurasthenia 100

• postinfectious 1

Neurosis 1

• traumatic 1

Paralysis agitans 8

Paranoia 22

Psychasthenia 4

Psychoneurosis 7

Psychopathic constitution 1

Psychosis NOS

• apoplectic confusional 1

• climacteric 3

• climacteric confusional 1

• confusional 1

Continued on page 2 of appendix 4

The AAO Journal • Vol. 24, No. 4 • Winter 2014Appendix 4, page 2

• exhaustion 7

• infection 21

• involutional 8

• postinfectious 9

• postoperative 1

• presenile 3

• puerperal 2

• toxic NOS 6

• toxic—alcoholism 3

• toxic—drug-related 7

• traumatic 3

Medical diagnoses

Adiposa dolorosa (Dercum disease) 1

Anemia 3

• pernicious 1

Arteriosclerosis NOS 7

• cerebral 3

• with nephritis 6

Arthritis NOS 3

• gonorrhea 1

• rheumatoid 1

Blindness 1

Bronchitis 1

Cancer NOS 2

• brain 1

• breast 1

Cardiac NOS 2

• hypertrophy 2

• cardiovascular and renal 18

• congestive heart failure 1

Diabetes 1

• with autointoxication 1

Diarrhea, chronic 1

Fallen arches 1

Indigestion 1

Infection 1

Influenza 1

Mumps 1

Muscular atrophy 1

Nephritis NOS 6

• interstitial 4

Pancreatitis 1

Pellagra 1

Peptic ulcer 1

Pneumonia 1

Prolapsus 1

Renal colic 1

Sciatica rheumatism 1

Spasmodic torticollis 1

Syphilis-related NOS

• cirrhosis 1

• taboparesis 6

• paresis 56

• paresis—incipient 1

Tuberculosis-related NOS 1

• meningitis 2

• toxic psychosis 1

Volvulus 1

Neurological diagnoses

Acute amentia (mental retardation) 1

Arrested development 4

Bell mania (excited delirium) 1

Bulbar palsy 1

Cerebral maldevelopment 2

Chorea, generalized 1

Degeneracy NOS

• congenital 1

• maldevelopment 1

• spinal cord 1

Encephalitis 1

• postinfectious 1

Epilepsy NOS 17

• chronic 1

• dementia 5

• petit mal 1

• psychic 1

• traumatic 1

Friedreich ataxia 1

Headache NOS 1

Huntington's chorea 1

Idiocy 1

Meningitis 1

Migraine 2

Multiple sclerosis 2

Neuritis 1

Paralysis NOS 3

Stroke/hemiplegia 6

Continued on page 3 of appendix 4

The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 4, page 3

• apoplectic stroke 2

• cerebral embolism 2

• cerebral hemorrhage 1

Tic doloureux 1

Addiction-related diagnoses

Alcoholism NOS 5

• acute 1

• psychosis 1

• epilepsy 2

• infection 1

Drug habit 7

Nonmedical diagnoses

Examination 13

Illegible 28

Nonmental 5

Rest and relaxation 1

Transient 28

The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 5, page 1

1. Still-Hildreth Osteopathic Sanatorium [pamphlet]. Still-Hildreth Collection 10. Museum of Osteopathic Medicine, Kirksville, MO; [ST-H-1]• Report of first year’s work

o Total number of patients received—138o Total number of transients—24o Basis of statistics (number of patients

received minus number of transients)—114

Appendix 5. Compilation of Known Published Patient Statistics (by Approximate Date).This is a compilation of published patient statistics organized by the approximate date of included patients. This list includes all of the statistics that this author was able to find.

DischargedUnder

observation Total

Cured 29 9 38

Benefited 29 29 58

Not improved 13 5 18

2. From the Macon sanatorium. The Journal of Osteopathy. April 1917;24(4):220-221.• SHS Bulletin No 10, dated March 1917• Complete Report of Patients Discharged March

1914-March 1917o Total number entered—521o Total number leaving institution—422o Transient and nonmental—167o Statistical purposes (excluding transient and

nonmental)—244

Total Recovered Improved

Dementia praecox 72 16

Paresis 12 1

Dementia (presenile, senile)

12

Traumatic psychosis 4 4

Toxic psychosis 10 9

Paranoia 3 0

Manic-pepressive

Melancholia type 57 35

Mania type 22 15

Infection psychoses type

10 8

Psychoneuroses

Psychasthenia type 2 1

Neurasthenia type 18 12

Hysteria type 6 6

Hypochondria type 3 3

Psychopathic constitution

8 2

Epilepsy 4

Neuritis 1

Shaded areas indicate data unavailable.

Continued on page 1 of appendix 5

The AAO Journal • Vol. 24, No. 4 • Winter 2014Appendix 5, page 2

3. Osteopathic sanatorium report. The Journal of Osteopathy. October 1917; 24(10):624-626.• SHS Bulletin No 12, dated September 1, 1917—extract from 3 months previous

o Total number leaving—61o Improved but taken away for various reasons before recovery was complete—11o Those not showing marked change, mostly long-standing cases—8o Nonmentals—11o Transients—12o Statistical purposes (excluding transients and nonmentals)—38o Discharged as cured —19 (50%)

Total Recovered Improved No Change Death

Dementia praecox 14 6 4 4

Paresis 1 1

Dementia (presenile, senile) 2 1 1

Manic-depressive

Depressive type 5 2 3

Manic type 3 1 1 1

Recurrent type 3 2 1

Infection psychoses type 3 3

Psychoneuroses

Neurasthenia type 3 2 1

Hysteria type 2 2

Drug Habit 1 1

Pellagra 1 1

Shaded areas indicate data unavailable.

4. This chart summarizes statistics from a 5-year period. Webster GV. Osteopathic statistics. In: Webster GV, ed. Concerning Osteopathy. Rev ed. Norwood, MA: Plimpton Press; 1921:167-172.

N

Total entering 1008

Total leaving 877

Nonmental (examination, opinion, advice) 344

Discharged as cured 254

Discharged as cured but relapsed 36

Discharged as improved 43

Continued on page 2 of appendix 5

The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 5, page 3

5. Hildreth AG. Fifteen years at Still-Hildreth. The Journal of Osteopathy. 1929;(36):518-21. http://www.mcmillinmedia.com/eamt/files/articles/arthild1.htm. Accessed January 9, 2014.

Total number of patients entering institution 3517

Total number of patients leaving institution 3380

Statistical purposes (excluding patients with some organic diseases, cases other than nervous or mental, and those coming for examination, opinion and advice)

1737

Cases other than nervous or mental 100

Examination, opinion, and advice 1148

Cases other than nervous or mental (sic) 100

Examination, opinion, and advice (sic) 1072

NRecovered(number)

Recovered(percent)

Dementia praecox 800 284 35.50%

Manic-depressive psychosis

615 407 66%

Infection and exhaustion psychoses

56 53 94%

Toxic psychosis 35 33 94%

Psychoneuroses 212 165 77%

Presenile delusional psychosis

6 3 50%

Traumatic psychosis 4 4 100%

Apoplectic confusional psychosis

2 2 100%

Incipient arteriosclerotic dementia

5 5 100%

Incipient presenile dementia

2 2 100%

Organic diseases 395

Shaded areas indicate data unavailable.

6. Still-Hildreth Osteopathic Sanatorium (SHOS) Collection. Museum of Osteopathic MedicineSM, Kirksville, MO; [1994.99.80]—SHOS, dementia praecox• From 1000 cases, rate of recovery was 33%.• “In early cases, patients that were ill six months, or

less, the recovery rate was 68%, those who had been ill one year, or less, the recovery rate was 60%. In chronic cases those that were ill over two years, the recovery rate was 20%....A poor heritage does not make the prognosis less favorable.”

• Report of patients discharged (March 1914-March 1931)

N

Total entering 4007

Total leaving 3877

Psychiatric cases* 1989

Examination, opinion, and advice 1313

Organic diseases 457

Nonpsychiatric cases 118

*excluding organic diseases, other than nervous or mental, and those coming for examination, opinion and advice

NRecovered(number)

Recovered(percent)

Psychiatric cases 1989 1101 55%

Dementia praecox 908 325 33%

Manic-depressive psychosis

713 473 66%

Infection and exhaustion psychoses

64 61 95%

Toxic psychosis 43 41 95%

Psychoneuroses 232 179 77%

Presenile psychoses 16 9 55%

Traumatic psychosis 4 4 100%

Incipient arteriosclerotic dementia

9 9 100%

Continued on page 3 of appendix 5

The AAO Journal • Vol. 24, No. 4 • Winter 2014Appendix 5, page 4

7. Still-Hildreth Osteopathic Sanatorium. Results in 840 cases of dementia praecox. Still-Hildreth Collection 12. Museum of Osteopathic MedicineSM, Kirksville, MO; [ST-H-11]. Same information reprinted in: Hildreth AG. The Lengthening Shadow of AT Still. 2nd ed. Macon, MO, and Paw Paw, MI: Mrs. A.G. Hildreth and Mrs. A.E. Van Vleck; 1942:275.

NRecovered(number)

Recovered(percent)

Admitted within the first 6 months of illness

263 179 68%

Admitted between 6-12 months of illness

163 78 48%

Admitted between 1-2 years of illness

129 37 29%

Admitted after 2 years of illness

285 57 20%

8. Fred M. Still, DO, compared the results of treatment of patients with schizophrenia at the Still-Hildreth Sanatorium and the Colorado Psychopathic Hospital.15

Still-Hildreth Sanatorium

Colorado Psychopathic

Hospital

Total number 1002 242

Total recovery 35% 3%

Hebephrenic recovery 36% 8%

Catatonic recovery 44% 18%

Paranoid recovery 26% 0%

9. Combined results from the Still-Hildreth Sanatorium and the Merrill Osteopathic Sanitarium. Merrill ES. Osteopathic and “old school” results in mental diseases. J Am Osteopath Assoc. April 1934; 33(8):327-328. Reprinted in J Am Osteopath Assoc. 2000;100(8):503-504. http://www.jaoa.org/content/100/8/503.full.pdf. Accessed January 9, 2014.

Diagnosis NRecovered(number)

Recovered(percent)

Dementia praecox 1024 375 36%

Manic-depressive 948 643 67%

Infection—exhaustion psychoses

96 90 93%

Toxic psychoses 110 94 85%

Psychoneuroses

• Neurasthenia 12 6 50%

• Hysteria 23 12 52%

• Psychasthenia 13 4 30.7%

Psychopathic 23 1 4%

Presenile psychoses 21 12 57%

Traumatic psychoses 5 4 80%

Incipient arteriosclerotic psychoses

14 11 80%

The AAO Journal • Vol. 24, No. 4 • Winter 2014 Appendix 6, page 1

1. General news: Still-Hildreth Sanatorium. The Journal of Osteopathy. July 1917;24(7):430-1.

2. Washburn Bay DE. Mental deficiency in children. Read at the annual session of the Osteopathic Cranial Association, July 18, 1948. In: Journal of the Osteopathic Cranial Association, 1948-1958. Rosen ME, ed. The Osteopathic Cranial Association; 2011:85-93.

3. Brigham FM. Recognition of the psycho-emotional patient. Academy of Applied Osteopathy Year Book: 1968. Fort Worth, TX: Academy of Applied Osteopathy:45-49.

4. Cranial Academy. Chapter 4: Cranial treatment and the psychiatrist. In: The Expanding Osteopathic Concept [pamphlet]. Cranial Academy; 1968.

5. Hildreth AG. The scope of osteopathy. Academy of Applied Osteopathy Year Book: 1943-44. Ann Arbor, MI: Academy of Applied Osteopathy:36-42.

6. Hoover HV. Place for psychosomatics in osteopathy. Academy of Applied Osteopathy Year Book: 1950. Kansas City, MO: Academy of Applied Osteopathy:85-86.

Appendix 6. Additional References.Although not cited in this article, the following references may be useful for those studying this subject further.

7. Jemmette BL. Some of the causes of insanity, with case reports, showing the results of treatment. J Am Osteopath Assoc. 1923;22(9):519-520 .

8. Magoun HI. Find it. Fix it. But don’t leave it alone. Academy of Applied Osteopathy Year Book: 1968. Fort Worth, TX: Academy of Applied Osteopathy:71-77.

9. Magoun HI. The Macon project. OCA Newsletter. 1958;11(3):1.10. Snyder C. Some catatonic dementia praecox symptoms and

case records. J Am Osteopath Assoc. 1924;24(4):264-265 .11. Millard FP. Insanity (illustrated). The Journal of Osteopathy.

1918;25(4):206-208.12. Weaver C. Functional nervous disorders. J Am Osteopath Assoc.

1922;21(9):561-563, 573-576.13. Woods JM, Woods RH. Outline of cranial study project.

In: Journal of the Osteopathic Cranial Association, 1948-1958. Rosen ME, ed. The Osteopathic Cranial Association 2011:365-366.

14. Woods RH. Psychological disturbances due to prenatal and natal injuries. Academy of Applied Osteopathy Year Book: 1960. Carmel, CA: Academy of Applied Osteopathy:59-62.