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REPORT

RELATING TO

LUNATIC HOSPITAL.

A

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SIXTH

ANNUAL REPORT OF THE TRUSTEES

STATE LUNATIC HOSPITAL

A T WORC ESTER

DECEMBER, 1838.

]$oston:

DUTTON AND WENTWORTH, STATE PRINTERS.

1839.

SIXTH ANNUAL REPORT

TRUSTEES OF THE STATE LUNATIC HOSPITAL,

DECEMBER, 1838.

To His Excellency Edward Everett, Governor, and the Honorable Council :

The Trustees of the State Lunatic Hospital, at Worcester, in compli- ance with the provisions of law, hereby submit their Sixth Annual

REPORT:

On no former occasion, have circumstances so auspicious, attended the performance of this duty. One fact of a most gratifying character exists now for the first time. This institution is substantially com- plete in all its parts. The bounty of the Legislature, from time to time most liberally bestowed, has enabled the Trustees to supply all those accommodations and appendages which, by promoting the cura- tive processes of such an establishment, are essential constituents of a perfect whole.

During the first two years of the existence of this institution, its utility was proved to the satisfaction of the people of the Common- wealth. In that brief period of time, almost three hundred insane per- sons, comprising a class of cases more hopeless and deplorable than were ever before collected together, were received at the Hospital. Of this number, about one hundred were restored to reason, and the con- dition of the remainder greatly ameliorated. It was also ascertained during the same time, that a far greater number were" still enduring

4 STATE LUNATIC HOSPITAL

the various miseries of insanity, in garrets, cellars, cages, dens, and other places of solitude and privation. Applications made at the Hos- pital in behalf of these sufferers were necessarily rejected for want of room. Under these circumstances, the Trustees made an appeal to the Legislature to enlarge the institution. The appeal was successful. Two wings, capable of accommodating a hundred additional patients, were added, — one in each of the two succeeding years. Almost im- mediately after these wings were opened for the reception of patients, they were filled. During the two years following the application last mentioned, the Trustees again felt constrained to ask pecuniary aid for the purchase of land to supply the wants of the institution, and to fur- nish the means of healthful agricultural employment for the patients, as one of the best restoratives. They also requested funds for the erection of a chapel, where the religious feelings of the inmates might find some solace for their sufferings, a stimulus for their efforts at self- command, and those higher consolations of a spiritual nature which are underivable from any but a religious source. And, as might have been expected beforehand, religious motives have been found to give more energy to the thoughts and affections, than any others could have im- parted. At the last session of the Legislature a further grant was made for the erection of an Infirmary, where the sick could have the comforts and alleviations appropriate to sickness, in apartments by themselves without disturbing others, and undisturbed by them. In no one instance, has any of these requests been refused or even delayed. They have been answered with a promptitude and in a spirit, which re- flects the highest honor upon the Legislature, and exhibits their conduct as an example, worthy to be imitated by other States and times.

The Hospital is now possessed of a farm and garden containing about sixty acres of fertile and highly cultivated land, whose produce, during the last season, has exceeded the sum of eighteen hundred dol- lars in value. It has spacious and commodious rooms, where skill and kindness will, as far as possible, assuage the pains of disease and death. And that nothing may be wanting which can subserve the physical or spiritual welfare of this afflicted portion of our fellow-beings, it has a chapel in which a very large majority of all the inmates do not forsake the assembling of themselves together for public and social worship, ev- ery Sabbath day. In submitting this report, therefore, the Trustees have no further occasion to solicit the aid of the Legislature for build- ings, appurtenances, or lands.

During the six years of the existence of this Hospital, eight hundred

STATE LUNATIC HOSPITAL. 5

and fifty-five insane persons have partaken of its remedial treatment. Of this number, three hundred and forty-four have recovered their lost reason. The residue, with few exceptions, have been reclaimed from a state of nakedness and filth; from ferocity, which assaulted relatives and friends with deadly intent ; from melancholy, which poured itself out in continual tears, to a quiet, an orderly, and, to a great extent, a cheerful community, observant of the decorous usages of civilized life. And, in the opinion of the Trustees, the blessing of this success, great, manifold, precious, as it is, is hardly superior in value to a less obvious, though not a less useful and real result. At the time of the establish- ment of this institution, the common ideas, prevalent among the great mass of the sane community, were almost as unsound upon the subject of insanity, as the ideas of the insane themselves were upon other sub- jects. The general opinion entertained at that time was, that insanity is an affection of the mind, and not a disease of the body, and that it is produced by a direct visitation of Heaven, instead of being the con- sequence of some departure from the organic laws to which our nature is subject, which laws men can discover and obey. It was further the common belief, that the victims of this visitation of Heaven must con- tinue to suffer its unknown and inexhaustible agonies, until rescued from them by another direct interposition of omnipotent power ; instead of supposing it to be a malady, curable by such restorative influences, as have been graciously placed within our own control, and even sus- ceptible of being prevented beforehand. So long as its causes were unknown, they could not be intelligently avoided ; so long as it was supposed that the Giver of reason had withdrawn the bestowment, those appointed means would, of course, be neglected, upon the use oi which the same Giver had made its restoration dependant. And in the mean time, while the friends of the maniac were idly awaiting divine interference, they would seek to secure themselves from his fury by such afPiictive discipline and violence of restraint, as would only aggra- vate, the disorder and eventually preclude all chances of recovery. Hundreds and hundreds of times has it happened, that if one, who un- derstood the real causes and the appropriate treatment of insanity, had witnessed the contests which have been carried on for years, between the passions of a demoniac and the activity of friends striving, by im- prisonment, stripes, drowning, to quell his rage, he would have been unable to determine which party was the most insane.

But the pre-eminent skill and success of the superintendent of this institution^ manifested for the benefit of so many of our fellow-beings,

6 STATE LUNATIC HOSPITAL.

aad in the midst of us all, have effected a deep change in public opinion. ■^^They have demonstrated that insanity is a physical disease; that it has its origin in certain natural causes, being induced by a violation of some of the organic laws upon which mental functions depend ; that these causes are not mysterious and inscrutable in any peculiar sense; that they are capable of being recognized and understood, like the causes which bring on consumption or the gout ; that insanity is a cur- able disease ; that it is a disease far less dangerous to life than fevers usually are ; that the means of effecting its cure have been graciously put into our hands ; and finally, that not only the means of cure, but the ways of prevention, in ordinary cases, have been entrusted to us, accompanied by the responsibility of rightly using them. Insanity, therefore, is no longer to be looked upon as some vast, unknown, and awful minister of evil or judgment to mankind ; as dreadful for its mysteriousness as for its actual terrors. It is not an evil to which one person is as much exposed as another ; or to whose assaults any one is equally exposed at all times, and under varying circumstances. It is a calculable agency. We see why it befalls and how it may be averted. We see, that should we all obey certain laws, which are annexed to our being, and are the conditions of enjoying mental soundness, we should be exempt from its power ; but we also see, that if we will transgress rules, to whose violation the dreadful consequences of insanity have been attached, it is as certain to befall us, as fire is to burn. The ex- cellence of these discoveries is, that they convert a disease, once most formidable and appalling from its uncertainty, into a measurable and calculable agency, — an agency whose action can be put aside, in most cases, by adopting certain precautions ; or can even be repelled, when expending its force upon us, by the application of certain known rem- edies. They make known, also, that there are certain indulgences, whose continuance is an infallible mode of bringing the full severity of its woe upon the transgressor.

The Trustees submit these remarks, not in the spirit of theorizing or speculation ; but for obvious and practical purposes, as they will pro- ceed to show.

As has been before stated, the causes of insanity have been dis- covered and classified. We propose to look at these causes from two different' points of view.

First. In regard to their efficiency in prostrating the minds of men ; that is, the relative proportions, in which these causes are found to contribute to this form of human suffering; and,

STATE LUNATIC HOSPITAL. 7

Secondly, The different degrees in which these causes are under im- mediate control ; that is, assuming them to be, to a very great extent, under human control, how soon can human intelligence, and human power diminish the number of the insane.

First. In regard to efficiency, the ascertained causes of insanity in the eight hundred and fifty-five cases at this Hospital, rank thus: 1, Intemperance ; 2, 111 health of all kinds ; 3, Masturbation ; 4, Do- mestic afflictions ; 5, Religious excitements ; 6, Loss of property and fear of poverty ; 7, Disappointed ambition ; 8, Injuries of the head ; 9, Use of snuff and tobacco. In a few cases, the cause of the insan- ity is unknown. Foreigners and citizens of other States found insane in this, have occasionally been committed, whose histories could not be ascertained. Probably we should approximate the truth very closely in distributing the unknown causes, under the above heads, according to their relative proportions.

Secondly. But if we look at the causes of insanity, not in the order of their efficiency, but in that of their subjection to human control, their position will be materially changed. The great object at the Hospital is the cure of insanity or the mitigation of its sufferings. The great object of the State and of individuals should be its prevention. The Hospital is succeeding pre-eminently well in accomplishing the former ; what can be done by the State and by individuals to effect the latter purpose 1

Nearly one third part of the cases, which have been in the Hospital from the beginning, are cases either proximately or remotely, of hered- itary insanity ; — that is, cases, when some near ancestor of the insane subject was insane, and has transmitted the disease to descendants, or rather, has communicated to the system of the descendants, a pre-disposi- tion to contract that disease. This presents a large class of cases, to a great extent, beyond present control. One of the highest of human responsibilities was violated by the ancestors, in forming an alliance, when they bore a hereditary taint of insanity in the system, and the consequence of that violation is, that the descendants now exist with an organization pre-adapted to incur the disease. They are incapable of resisting such exposures to it, as to others, would be perfectly harm- less. This class of cases now exists, probably to as great an extent as ever heretofore ; and year after year, victim after victim must come to fill the wards of the Hospital, and slowly to expiate an ancestor's transgression. We cannot now foretell, which of the descendants, in such cases, it will be, as we cannot foretell who will be injured, when

8 STATE LUNATIC HOSPITAL.

a gun is fired into a crowd of people. But the result is none the less certain, because we cannot now designate the sufferers, in whose per- sons an immutable law of the Creator is to be verified. While ances- tors continue to violate this law, some portion of their innocent de- scendants must bear the consequences. The transmitted tendency, however, does not in all cases, and by virtue of its own inherent en- ergy, produce the result. Some proximate cause is generally requisite ; some application by one's self of a torch to the train, laid by another. No means, therefore, either of prevention or of avoidance should be neglected. Still, however, this cause of insanity, so far as the present generation is concerned, is mainly beyond human control ; and should those to whom the dreadful heritage has descended imitate the conduct of their ancestors, the disease may be perpetuated in the lineage for generations to come.

After hereditary insanity, whose cause antedates even the existence of its victim, there are several other classes of cases, where the seeds of the disease are sown in childhood and youth to be developed in maturer years. Looking to proximate effects, in our efforts to mitigate this species of human woe, these causes, too, seem nearly beyond pre- sent prevention ; and hence to a great extent they may be set down as remediless. We refer to " ill health," " domestic afflictions," and "re- ligious excitements."

Chronic ill health, extreme feebleness of constitution, or a debility in the vital powers, existing from childhood to middle life, can rarely be replaced by soundness of constitution and a healthful and vigorous performance of all the physical fun.ctions. In these cases, the conditions on which the Creator has made human health dependant have not been known, or have not been observed ; and the consequence is the existence of a class of persons, who in addition to all the other evils of ill health, are more or less liable to the loss of reason. The field of labor here is with the young. It is in the power of parents so to rear and educate their children as greatly to diminish the chances of thsir ever becoming inmates of a Hospital for the Insane. Motives arising from this source address themselves especially to all who have the superintendence of the physical or intellectual education of the rising generation.

In point of subjection either to individual influence or to the collective power of the community, the next cause is equally beyond immediate control. All are liable to " domestic afflictions," and those whom we admire for the disinterestedness and fervor of their attachments ; — -

STATE LUNATIC HOSPITAL. 9

those, whose natures are so formed, that the existence of a friend is a boon more precious than their own life, — are most liable to be over- whelmed in the day of bereavement. The only way to obviate this cause of insanity is to cultivate throughout the community such just views of the government and attributes of God, as will tend to recon- cile its members to the wise ordinations of Providence.

Nor does the third cause, above mentioned, — that of " religious ex- citements," appear to be more within the remedial control of society. How wide from the appropriate office of religion it is to cause insan- ity,— to carry human beings backwards, as it were, from the knowl- edge and the contemplation of their Creator, instead of aiding their approaches towards Him ! Why then, should it produce this effect ! Why, in less than six years, should it have sent seventy persons to this Hospital for the Insane ! It can only be because its motives and its sanctions have not been rightly addressed to individuals ; or be- cause those individuals have widely misapprehended the true nature, office, and power of religion. There seems, then, little reason to an- ticipate, that either of these three causes of insanity will be materially diminished, until juster notions of our human condition, duty, desti- nation, shall pervade those portions of society, where error is now pre- paring its victims to become insane.

There are one or two other standing causes of insanity, which fall nearly into the same class as the preceding, but as the effects are not numerous, we shall pass them by.

But the cause of insanity, which ranks as the third in point of power to deprive its victims of reason, is perfectly within human control and that immediately. This form of insanity is suffered by the young. It differs from other forms, in two material respects. Before it is incurred, the way of prevention is perfectly certain ; afterwards, its cure is almost impossible. No one need ever suffer it, unless he so wills ; but when once infatuation has brought it on, it is too fatal to admit a second of- fence. It is not only most certain in its activity, but above all other kinds of insanity, it stamps its victims with every abhorrent and loath- some stigma of degradation. Such is the nature of this dreadful form of insanity, and the singleness and certainty of the cause from which it proceeds, that we feel perfectly authorized to say, if medical men, pa- rents and teachers of youth, would do their duty on this one subject to the rising generation, this frightful and prolific cause, which stands the third upon the list in point of destructive efficiency, would substantially cease, in a single year. It is the vice of ignorance, not of depravity. The sufferers are, personally, less offenders than victims; but the wel- 2

10 STATE LUNATIC HOSPITAL.

fare of the Hospital and the interests of humanity imperatively demand, that something should be done to rescue the most moral, conscientious, and sometimes the most promising youth of the State, from the mind- wasting ravages of an indulgence, of whose terrible consequences they have never been forewarned.

So, too, intemperance is another cause of insanity susceptible of im- mediate and final suppression. This stands at the opposite end of the scale, compared with hereditary insanity. One descends, the other is self-inflicted. In all the ascertained and proximate causes of insanity at this Hospital, intemperance stands out prominently and alone, as the most successful agent in the overthrow of human reason. One other cause, that of " ill health of all kinds," exhibits a small fraction more than two thirds as many victims as intemperance. The next most pro- lific cause is the one last above spoken of, and which is susceptible of be- ing prevented at once. After these two, there is no other which sends half so many inmates to the Hospital as intemperance. Here, there- fore, we meet with a calamity, self-produced by the sufferer. He is not brought into the world, exposed, though innocent, to the sorest of hu- man misfortunes, compelled to bear infirmities not his own, and to ex- piate offences, committed by his ancestors. But he is the voluntary procuring cause of his own fate ; and the punishment he suffers looked him in the face, during the transgressions which incurred it. But though this fact ought to supply adequate motives to all for resisting this form of temptation ; yet it is not so much on account of the suf- ferers themselves, as on account of others, that the Trustees here refer to it. They will now proceed to show how these two last classes of cases, which might be immediately prevented, bear upon the other classes, which are not the subjects of immediate prevention.

The number of the insane differs greatly in different countries. The disease is confined almost wholly to civilized nations. Among the sav- ages of North America and of Africa it is rarely known. It is uncom- mon among the half-civilized nations of Asia. But it prevails to a great extent in England, France, Germany, Norway, Holland and the United States. According to the latest compiled tables, the United States rank as the fourth, among civilized nations, in the proportion which the insane bear to the whole population ; their proportion being exceeded in Norway, Scotland and England only. The proportion in this country is set down at one in eight hundred. This proportion would give nearly nine hundred insane persons to Massachusetts. Owing to the cures, however, which have been effected at Charlestown and at this place, the last mentioned number must be considerably too large. Yet a great

STATE LUNATIC HOSPITAL. 11

number of applications for admission at this institution has been rejected every year, since its opening. And, although there are now (Dec. 31, 1838,) in the Hospital forty-three more inmates than there were a year ago, yet, during this year, we have been obliged to shut our doors upon not less than ninety of our afflicted fellow- beings, in whose behalf application has been here made for admis- sion. Supposing, however, that the whole number of insane persons in Massachusetts is only about six hundred, the existing accommoda- tions for their suitable treatment are wholly inadequate to the wants of the State. There should not be at this institution more than two hun- dred and twenty patients. The institution at Charlestown will not or- dinarily have more than a hundred and twenty more. A new Hospital at South Boston, erected by the city, and now almost completed, is de- signed for but about seventy more. When that institution is occupied, there will still be a deficiency in accommodations for about two hun- dred of this unfortunate class of our fellow-beings.

This leads us to speak of another fact, most important in this con- nexion. Insanity, though generally speaking one of the most curable of diseases, if seasonably attended to, becomes, when inveterate, one of the most intractable and hopeless. The twelfth Table of the Superin- tendent shows that upon the proper and usual basis of computation, the proportion of cures at this Hospital, in recent cases, — that is, in cases of less than one year's duration at the time when received, — is ninety- four per cent. ; while the proportion of cures in cases of more than five years' duration, has been only twelve and a half per cent., and in cases of more than ten years' duration, only three and a_;^half per cent. Or, to present the same fact in another striking point of view, the proportion of the old cases, remaining at the end of this year, is about eighty-seven and a half per cent. ; while the proportion of recent cases remaining at the same time, is only twelve and a half per cent.

In order to present this subject, strictly, as a pecuniary or economi- cal matter, the Trustees requested the Superintendent to prepare a sep- arate table, (see Table IS,) showing the actual expense of twenty of the earliest cases received at the Hospital, which, owing to the dura- tion of the disease, when admitted, were incurable, and therefore still remain ; and doubtless will continue a charge upon the State as long as life lasts. These cases are not selected, but are taken in their or- der. They are the first twenty cases of admission, which now remain. Their expense, before admission, is computed at only one dollar and fijty cents a week. These cases have already cost the Commonwealth

12 STATE LUNATIC HOSPITAL.

fifteen hundred and fifty 25-100 dollars each. On the other hand, and as a contrast to the above, the table shows the actual expense of the last twenty cases, which have been discharged from the Hospital, cured. It amounts only to forty-seven 50-100 dollars each. Hence it appears, that the expense already incurred for taking care of twenty cases, which, from neglect, had been suffered to run on until they became incurable, has been more than thirty-two times greater than the expense of the same number of cases, for which early and proper provision was made. The recent ca- ses are now well ; the old ones will doubtless continue a charge through life. However extraordinary it may appear, it is still true, that taking an average chance for cures, it would have been a pecuniary saving to the State to have taken seasonable care of these old cases, though at an ex- pense of eighty dollars a week, rather than, by neglect, to have in- curred the necessity of supporting them, even up to the present time. Another aggravation of intemperance, considered as a cause of in- sanity will appear from the following fact. Almost all cases of insan- ity, originating in this cause, are ferocious and dangerous, and hence its subjects are arrested and committed at once, in order to save the lives and property of the community from the peril of their being at large. Insanity arising from other causes is usually less violent and frantic, and the subjects of it are therefore postponed to make room for the intemperate; that is, under our system, the claims of him who has made himself a voluntary demoniac are preferred to the claims of those who came innocently by a pre-disposition to the disease. The criminal exclude the innocent; and guilt is made a passport to privileges denied to misfortune.

Again, it will be seen on inspection of Table 14, that the intemper- ate insane furnish a less proportion of cures, than any other class ex- cept one. Thus they occupy the rooms of the Hospital earliest ; they retain them longest ; they virtually close the doors of the Hospital against other cases of a recent date, and by thus postponing the admis- sion of such cases, to a later period, deprive them of the chance they otherwise would have enjoyed of a restoration to reason, to society, to their families.

Now, were it not for the two classes last above mentioned, in which the insanity is caused by the misconduct or guilt of the sufferers them- selves ; the liberal means provided in the State would, in a short time, it is believed, prove sufficient for the relief of its insane citizens.

STATE LUNATIC HOSPITAL. 13

In administering the affairs of the institution, a painful necessity has from time to time been imposed upon the Trustees, of remanding to the jails and houses of correction of the respective counties whence they came, a large number of the inmates, in order to make room for the more ferocious, committed by the courts. In all, seventy-three per- sons have been discharged from the Hospital, solely for want of room. This number is greater than that originally received from the jails, houses of correction and poor houses, when the Hospital was first opened. It will be seen, therefore, that the class of persons for whose relief it was primarily erected, and who otherwise might have participated in its privileges, have been excluded from time to time to make room for two classes of persons who have brought their insanity upon themselves by their own misconduct or crimes. In removing a part of the inmates to give accommodations to the two last named classes, the Trustees have made no discrimination between those whose insanity was occasioned without any fault or offence of their own, and those upon whom the disease was self-inflicted. This being a test not prescribed by the Leg- islature, they have not felt themselves authorized to apply it.

The Trustees have pointed out the above distinctions between the different causes of insanity for another reason of great practical im- portance. Not only is insanity regarded by the community at large as one of the greatest afflictions to which our nature is liable, but it is looked upon by some as a malady which brings disgrace as well as suf- fering. Instances have come to the knowledge of the Trustees, where a family has resorted to various devices, for a length of time, to conceal the insanity of one of its members ; supposing that if the fact were known, it would affix a reproachful stigma upon the character of the unfortunate sufferer. In this way, the best season for recovery has been lost. But as soon as it is generally known, that the causes of in- sanity are various; that some of them are voluntary, others involun- tary ; that some of them are as free from the slightest suspicion of wrong or dishonor as any epidemic can be, while other cases are wholly referrible to the previous fault or crime of the sufferers them- selves, the whole subject of insanity will be presented in a moral as- pect, entirely new. Those upon whom the disease has been entailed by their ancestors, or who suffer under it from causes beyond their own control, will be regarded with deep and genuine pity ; while such as are the direct authors of their own melancholy fate will be regard- ed— with pity it is true, but not unmingled — with condemnation.

The Trustees hope it will not be without practical results, to state

14 STATE LUNATIC HOSPITAL.

that great embarrassment, and sometimes serious evils, have ensued from the importunate demands of the friends of the insane, or of the towns which support their insane poor at the Hospital, to have a dis- charge granted, before a recovery is fully confirmed. It often happens that a patient, under the influence of the unsurpassed medical and moral treatment of the Superintendent, is shortly relieved from the external and obvious symptoms of insanity, while his recovery is yet imperfect, and if carried back to the scene of the exciting causes, a relapse would be almost inevitable. In this unconfirmed state, such patients are vis- ited by their friends, or by some agent of the town where they belong, who, on perceiving their apparent exemption from the former indica- tions of disease, insist upon an instantaneous discharge ; and some- times communicating their own views to the patient, they excite in him so strong a desire to be returned to his home and friends, as to make an enforced stay almost as dangerous as a premature removal. Under such circumstances, it is in vain to reason and to remonstrate. When the desire of being discharged is excited, the mischief is done. Six cases of this kind have occurred within the last year. A relapse has ensued, and after a few weeks, the patients have been returned in a worse condition than at first. Considering the painful necessity the Superintendent and the Trustees are under, of refusing so many earnest solicitations for admission to the Hospital, the public ought to be satisfied, that in every case, they will volunteer the discharge of a patient at the earliest hour, when, in the exercise of their best judgment, they believe it can be done with safety.

The Trustees would also, with a loud and earnest voice, call the attention of the public to the utility, to the humanity, to the necessity, •of attending to the earliest indications of insanity, in whatever form they may appear. We trust that what we have said in relation to the causes of insanity will not be without avail, in diminishing both their number and their efficiency. The remarkable difference, now estab- lished by the experiments of six years, between the curability of old and of recent cases, admonishes the community never to suffer the fa- vorable season for recovery to pass by unimproved. If the broad ave- nues through which this formidable enemy makes its attacks, are still left open; if it is permitted to make unresisted incursions into the domains of the soul ; then, when the citadel of reason is first seen to totter un- der its assaults, and the pillars of judgment are shaken and torn from their places, and the passions are set on fire to consume all the treas- ures of joy and of hope, which have been garnered up for years ; — then.

STATE LUNATIC HOSPITAL. 15

let all of human energy and alertness be instantaneously put forth to rescue the scene from total and remediless desolation.

The Trustees herewith submit the annual report of the Treasurer of the Hospital, from which it will be seen that its pecuniary concerns are in as favorable a condition as ever before. Since the enlargement of the institution, the duties of this officer have greatly increased. They have always been performed with the most exact and conscien- tious fidelity.

The report of the Superintendent, also, accompanies this. It is a document of extraordinary interest and value. While the Trustees would make honorable mention of all persons filling subordinate sta- tions at the institution ; they would ascribe its unexampled prosperity, to the assiduity and the skill, the talent and the benevolence of its pre- siding officer.

To supply the vacancy, which annually occurs, in consequence of the law that forbids an immediate reappointment of the senior mem- ber of the Board, the Hon. Edward D. Bangs, was commissioned as one of its members, at the commencement of the current year. That gentleman had attended a meeting for the organization of the Board and had made one or two of the monthly visitations of the Hospital, when, in March last, he was suddenly removed by death. It would be in vain for the Trustees, by any passing encomium of theirs, in this place, to attempt to add any thing to the reputation of a man, so uni- versally known, as was Mr Bangs, and so highly respected by all who knew him. But without recurring to the excellence of his character in private life, or to those offices of dignity and of trust, which he so long, so ably and so acceptably filled ; the Trustees cannot refrain from recording, in this place, the expression of their deep regret, that this institution should have lost a friend, who was so eminently quali- fied, by his knowledge of affairs and by his lively sympathy for the unfortunate, to advance its prosperity, and to obtain in its behalf the favorable regards of the public.

HORACE MANN, STEPHEN SALISBURY, ABRAHAM R. THOMPSON, MYRON LAWRENCE, WILLIAM LINCOLN.

Worcester, Dec. 31 si, 1888.

16

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STATE LUNATIC HOSPITAL. 26

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26

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STATE LUNATIC HOSPITAL.

%*i

TABLE L

Showing the state of the Hospital from December \st, 1837, to No' vember SOth, 183S.

Patients admitted,		177	Of the cases now in
Males,	96		the Hospital of less
Females, .	81-	—177 !	duration than 1 year.	28
Cases of less duration			Of longer duration
than 1 year, .	82		than 1 year, .	190—	—218
Males, 45			Patients in the Hospi-
Females, 37-	-82		tal in the course of
Cases of longer dui'a-			the year, .		3654
tion than 1 year,	95		In the Hospital at the
Males, . 51			commencement of
Females, 44-	-95-	—177	the yeai*, .	185
Admitted by the Com-ts,	123		Admitted during the
Private,	54-	—177	year.	177—	—362
Remain at the end of		1
the year, .		218
Males,	115
Females, .	103-	— 218

TABLE 2.

Discharges and Deaths.

	No. of each sex.	Recov'd.	ImproVd. iin^roV'd.	Harm- less.	Died.	Total.
Patients discharged, 144 Males, Females,	84 60	45 31	11 13	8 6	10 4	10 6
Of duration less than 1 year, 74 Males, Females,	144 47 27	76 38 26	24 2 4	14 0 0	14 0 0	16 3 1	144
Of duration more than 1 year, 70 Males, Females,	74 42 28	64 7 5	6 10 8	0 8 6	0 10 4	4 7 5	74
	70	12	18	14	14	12	70
Remains, Nov. .30, 218 Males, 115 Females, 103—218	Natii Fore Nati	t^es of t igners, res of 0	he Stat ther St	e, ates, .	*	188 20 10-	—218

Foreigners in the Hospital in the course of the year, Natives of other States, ...,,.

30

15 45

28

STATE LUNATIC HOSPITAL.

TABLE 3.

Duration of Insanity witli tliose remaining in the	Ages of	Patients in tlie Hospital, December ist/
Hospital, December 1st, 183	i. \		1838.
Less than 1 year,	28	Under 20, .... 4
From 1 to 5 yeais,	65	From 20 to 25, .			25
5 to 10,	44		25 to 30,			21
10 to 15, .		27		30 to 35,			34
15 to 20, .		14		35 to 40,			35
20 to 25, -		15		40 to 45,			30
25 to 30, .		3		45 to 50,			23
Over 30,		3		50 to 55,			le
Unknown, .		19		55 to 60,			8
			60 to 65,			6
	218	Unkr	65 to 70, 70 to 75, 75 to 80, own, .			8 3 1 4
			1				218

TABLE 4,

Number admitted and discharged each month.	Average of Patients in the Hospital each month.
	Admitted.	Discharged.
December,	13	8	December, . . . 190
January,	17	7	January, .		196
February,	16	6	February,		208
March,	9	7	March,		212
April,	15	14	April,		2]5i
May,	22	21	May, . .		212^
June,	21	17	J une.		217
July,	16	14	July,		220i
August,	10	18	August, .		217
September,	7	9	September,		210i
October,	16	11	October, .		213i
November,	15	12	November,		218i
	177	144	Average for 1838, about 211

STATE LUNATIC HOSPITAL,

29

TABLE 5.

Statistics of the State Lunatic Hospital, from Jan. 1833 to Dec. 1, 1838.

	1833.	1834.	1835.	1836.	1837.	183S.	Total.
Admissions, ....	153	119	113	125	168	177	855
Discharged, including Deaths and Elope- ments, ....	39	115	112	106	121	144	637
Discharged, recovered,	25	64	52	57	69	76	343
Discharged, improved.	7	22	23	17	23	24	116
Died, Eloped, ....	4 1	8	8 1	8 1	9 0	16 0	53 4
Patients in the Hospital in the course of each year, ....	153	233	24]	245	306	362	855
Patients remaining at the end of each year,	114	118	119	138	185	218
Males admitted, Females admitted,	96 57	79 39	51 62	66 59	94 75	96 81	482 373
Males discharged. Females discharged, .	20 15	59 49	57 46	56 41	65 47	74 54	331 252
Males died, .... Females died, ....	3 1	5 3	4 4	6 2	6 3	10 6	34 19
Patients sent by Courts, Private, ....	109 44	55 64	89 21	117 8	129 39	123 54
Recoveries : Males, .... Females, ....	25 13 12	64 33 31	52 27 25	58 32 26	69 37 32	76 45 31	344
Average in the Hospital each year,	107	117	120	127	163	211

m

STATE LUNATIC HOSPITAL.

TABLE 6.

Statistics of the different Seasons.

	1S33.	1834.	* 1835.	1836.	1837.	183S.	Total.
Admissions in Winter,	27	26	24	23	26	46	172
Admissions in Spring,	71	35	31	36	49	46	268
Admissions in Summer,	21	30	30	42	40	47	210
Admissions in Autumn,	21	28	28	24	53	38	202
Discharges in Winter,	0	22	21	20	15	18	86
Discharges in Spring,	7	33	30	33	38	37	178
Discharges in Summer,	10	28	31	24	30	43	166
Dischai-ges in Autumn,	24	24	22	21	38	32	161
Recoveries in Winter,	0	12	14	11	10	15	62
Recoveries in Spring,	0	20	13	14	17	23	87
Recoveries in Summer,	9	16	1	12	15	18	86
Recoveries in Autumn,	16	15	12	20	27	20	110
Deaths in Winter,	0	3	1	0	1	3	8
Deaths in Spring,	2	2	2	1	2	5	14
Deaths in Summer,	2	3	2	4	1	5	17
Deaths ia Autumn,	0	0	3	3	5	3	14

TABLE 7. Classification of Insanity.

	Whole No.	Each Sex.	Curable or Cured.	Total of Cura- ble or Cured.
Mania, Males, . Females,	444	236 208	137 131	268
Melancholia, Males, . Females,	235	129 106	75 65	140
Dementia, Males, . Females,	128	77 51	2 3	5
Idiots, Males, .	8	8	A few cases	notclas'fied

STATE LUNATIC HOSPITAL

31

TABLE a

Of Occupation.

Farmers,	« 102	Stonecutters, ... 2
Laborers,	89	Comb-makers,			2
Shoemakers,	39	Alusicians,			2
Seamen,	32	Turners,			2
Merchants, .	28	Harness-makers, .			2
Carpenters, .	23	Pedlers,			2
Manufacturers,	22	Physicians,			2
Teachers,	20	Broom-makers,			2
Blacksmiths,	12	Coppersmiths,			2
Printers,	11	Coachmen,			2
Tailors,	8	Butchers,			2
Students,	8	Currier,
Machinists, .	7	Bricklayer,
Clothiers,	6	Lawyer,
Millers,	4	Jeweller,
Coopers,	4	Watchman, ,
Painters,	4	Drover,
Paper-makers,	3	News Collector,
Calico Printers,	3	Rope-maker,
Cabinet-makers,	3	Engineer,
Clergymen,	3	Hatter,
Sail-makers,	3	Gardener,
Tanners,	3	Idiots,			'. 8
Bakers,	2	Vagrants,			. 24
Stevedores, .	2	Few Females only	are c	.lassi	Red.

TABLE 9.

Diseases which have proved Fatal,

Marasmus, .	13	Disease of the brain,	2
Epilepsy,		10	Brain fever from intemperance,
Consumption,		7	Disease of the heart.
Apoplexy,		4	Disease of the bladder,
Mortification of limbs.		3	Lung fever,
Suicide,		3	Dropsy,
Cholera Morbus, .		2
Hemorrhage,		2 '	Total, .	53
Inflammation of the bo^	ivels,	2

32

STATE LUNATIC HOSPITAL.

TABLE 10.

Duration of Insanity before admitted to the Hospital.

	1833.	1834.	1835.	1836.	1837.	1833.	Total.
Less than ] year,	48	56	49	54	73	82	*362
From 1 to 5 yeai-s,	20	29	37	37	58	50	231
5 to 10, .	27	14	17	13	15	16	102
10 to 20, ....	31	8	6	11	15	8	79
20 to 30, .	12	4	1	2	4	7	30
30 to 40, ....	3	1	1	2	1	1	9
Unknown, ....	12	6	7	6	5	13	49
Duration of Insanity with those remain-
ing at the end of each year :
Less than 1 year,	29	22	21	11	29	28	140
From 1 to 5 years, . .	20	25	22	39	51	65	222
5 to 10, .	20	24	34	35	38	44	195
10 to 20, ....	30	24	29	35	41	41	200
20 to 30, ....	9	5	3	7	11	18	51
Over 30, ....	3	2	4	2	2	3	16
Unknown, ....	8	16	6	9	13	19	71
Ages of Patients when admitted :
Under 20, ....	2	6	3	11	13	17	52
Between 20 and 30, .	34	23	22	29	58	47	213
30 and 40, .	48	44	42	30	34	51	249
40 and 50, .	34	28	30	25	31	32	180
50 and 60, .	14	9	11	16	13	20	83
60 and 70, .	17	6	6	10	12	8	59
70 and 80, .	5	2	5	0	7	2	21
Civil state of Patients admitted :
Single, ....	92	71	52	68	94	101	478
Married, ....	38	40	46	49	61	65	295
Widows, ....	12	4	8	6	11	5	46
Widowers,	11	4	7	2	o	6	32

See E.iplanation of 12th Table.

STATE LUNATIC HOSPITAL.

33

TABLE IL

Causes of Insanity, S^c.

138 20-

Intemperance,

Males, . Females,

111 Health, .

Epilepsy, .

Puei'peral, .

Religious, .

Masturbation,

Domestic Afflictions,

Loss of property and fear of poverty, .

Disappointed affection.

Disappointed ambition.

Injuries of the head,

Abuse of snuff and tobacco,

158 -158

110 32 22 70 81 75

58 38 23 10 5

Hereditary, or having in- sane ancestors or near kindred, •

Periodical, .

Homicidal, .

Actual homicides, .

Suicidal, or having a strong propensity to self-de struction.

Actual suicides.

267

152

16

12

96

Of 429 cases that have been

examined have dark

hair, eyes and com])lex-

ions, . . . 220

Light hair, eyes and com- plexions, . . 209

Of 1 52 periodical cases, 94

are caused by Intemperance, . . 94

Many unknown.

34

STATE LUNATIC HOSPITAL.

TABLE 12.

Shewing the comparative Curability of Insanity treated at different periods of disease.

			Total of Cases.	Of each Sex.	Cured or Curable.	Incurable. -
Less than 1 year's duration Males, . Females,			334	183 151	160 134	23 17
From 1 to 2 years, . Males, . Females,			118	61 57	37 42	24 15
From 2 to 5 years. . Males, . . Females,			141	80 61	23 22	57 39
From 5 to 10 yeai-s. Males, . Females,			96	50 46	7 5	43 41
From 10 to 15 years, Males, . Females,			64	40 24	2 1	38 23
From 15 to 20 years. Males, . Females,			26	18 8	1 0	17 8
From 20 to 25 years. Males, . Females,			18	10 8	0 0	10 8
From 25 to 30 yeai-s. Males, . Females,			6	5 I	0 0	5 1
Over 30 years. Males, . Females,			2	1 1	I	1 1

STATE LUNATIC HOSPITAL

35

TABLE 13.

Shevfing the per cent, of Cases from the most prominent Causes of In- sanity admitted each year.

	1833.	1834.	1S35.	1836.	1837.	183S.
Intemperance,	241	24	22^	Ui	lOi	161
111 Health,	8a	17|	211	22h	21i	28
The AflFections,	131	m	m	16	16	141
Concerning Propeity,	6i	101-	81	5h	6h	101
Religious of all kinds,	8^	6i	6i	7i	6i	9
Masturbation,	5	5|	71	16^	2U	5h

From Intemperance, the average for the first 3 years was 24 per cent. For the last 3 years, nearly 14 per cent. For the six years, about 19 per cent

36

STATE LUNATIC HOSPITAL,

TABLE 14.

Comparative Curability of cases of Insanity attaching at different

Ages.

				Total of Ca- ses.	Total of each Sex.	Cured or Cu- rable.	Incurable.
Under 20 years,	109
Males, .		,			61	19	42
Females,					48	30	18
From 20 to 25,				121
Males, .					70	33	37
Females,					51	29	22
From '25 to 30,				119
Males, .					65	33	32
Females,					54	29	25
From 30 to 35,				118
Males, .					76	34	42
Females,					42	26	16
From 35 to 40,				102
Males, .					46	24	22
Females,					56	28	28
From 40 to 45,				64
Males, .					3)	22	14
Fe males.					23	2[	7
From 45 to 50,				55
Males, .					29	22	7
Females,					26	23	3
Fi-om 50 to 55,				50
Males, .					24	14	10
Females,					26	16	10
From 55 to 60,				27
Males, .					13	10	3
Females,					14	8	6
From 60 to 65,				16
Males, .					9	9	0
Females,					7	6	1
From 65 to 70,				15
Males, .					11	7	4
Females,					4	3	1
From 70 to 75,				4
Males, .					3	2	1
Females,					1	1	0
Over 75,				3
Males, .					1	1	0
Females,					2	0	2

STATE LUNATIC HOSPITAL.

37

TABLE 15.

Shewing the relation of the paroxysms of excitement in from 50 to 60 cases of periodical Insanity, amounting to 425 distinctly marked, to the stale of the moon on the day of their occurrence. Also to the 53 deaths that have occurred in the Hospitcd.

Number of Paroxy	sms each day.		Number of Deaths	on each day.
Day of the Moon.	Tota'.	Male.	Fe- male.	First Quarter.	Day of the Moon.	Total.	Male.	Fe- male.	First Quarter.
1	9	4	5	1	1	1	1	0	1
2	27	15	12	2	2	5	3	2	2
3	16	11	5	3	3	4	1	3	3
4	18	9	9	4	4	3	2	1	4
5	12	7	5	5	5	2	1	1	5
6	17	9	8	6	6	1	J.	0	6
7	20	8	12	7	7 End of First Quar- ter.	2	0	2	7
End of First Quar- ter.	Second Quarter.	Second Quarter.
8	24	12	12	1	8	1	1	0	1
9	18	10	8	2	9	2	1	1	2
10	9	3	6	3	10	1	1	0	3
11	14	8	6	4	11	0	0	0	4
12	18	9	9	5	12	1	1	0	5
13	14	9	5	6	13	5	3	2	6
14	15	8	7	7	14 End of Second Quar- ter.	1	1	0	7
End of Second Quar- ter.	Third Quarter.	Third Quarter.
15	16	8	8	1	15	1	1	0	1
16	12	7	5	2	16	3	3	0	2
17	20	11	9	3	17	1	0	1	3
18	12	6	6	4	18	0	0	0	4
19	10	6	4	5	19	1	0	1	5
20	15	11	4	6	20	4	3	1	6
21	16	9	7	7	21 End of Third Quar- ter.	5	4	1	7
End of Third Quar- ter.	Fourth Quarter.	Fourth Quarter.
22	16	10	6	1	22	1	1	0	1
23	18	6	12	2	23	0	0	0	2
24	21	13	8	3	24	2	1	1	3
25	15	6	9	4	i 25	4	2	2	4
26	17	8	9	5	26	1	1	0	5
27	5	1	4	6	27	0	0	0	6
28	8	5	3	7	28 End of Fourth Quar- ter.	1	1	0	7
End of Fourth Quar- ter.	53	34	19

38

STATE LUNATIC HOSPITAL.

TABLE 16.

Shelving the relation between Cause and Recover^/.

	Whole Number.	No. of each Sex.	Cured or Curable.	Incurable.
Intemperance, Males, .... Females,	158	138 20	72 9	66 11
Domestic Afflictions of various kinds. Domestic Broils. Hl-requited Love. Anxiety about Property, &c. Males, .... Females,	193	82 111	49 63	33 48
111 Health, including Puerperal cases. Wounds, Amenorrhoea, &c. Males, .... Females,	155	38 117	19 78	19 39
Religious of all kinds. Males, .... Females,	70	38 32	22 17	16 15
Masturbation, Males, .... Females,	81	69 12	14 1	55 11
Epileptics, .... Males, .... Females,	30	27 3	4 0	23 3
Palsy, .... Males, .... Females,	15	13 2	2 0	11 2

STATE LUNATIC HOSPITAL.

39

TABLE 17.

Of Per Cent. — Recoveries.

	1834.	1835.	1836.	1837.	1838.
85 53 19	82 531 20a	S2h 151	84i 531 181	89^ 57 25i	86^ 52^ 15^

Per cent, of cases discharged recovered of

duration less than one year, Per cent, of recoveries of all discharged, . Per cent, of recoveries of old cases disch'd,

There have been admitted, since the Hospital was opened, 334 cases, of duration less than one year. There have been discharged, recovered, of recent cases, in the same time, 276, which is 82| per cent.

Deduct from 334, 28 recent cases, mostly convalescing, now in the Hos- pital, and there remains 306, of which 276 is 90| per cent.

Deduct from 306, the number above specified, 12, which is the number of deaths of recent cases, and there remains 294, which is 93^ per cent.

There have been 855 cases in the Hospital, and 344 recovei'ies, which is 40^ per cent.

Deaths.

Per cent, of deaths of all the patients in the Hos- pital each year, .....

Per cent, of the whole number in the Hospital, (53 of 855) 6 1-6 per cent.

1834.	1835.	1836. 1837.	1838.
3^	3^	3i 3	u

Cases old and recent, (190 of 218.)

There are, at present, in the Hospital, cases of more than one year's dura- tion 190, which is 87^ per cent.

Of less duration than one year 28 cases, which is 12| per cent.

There have been Foreigners in the Hospital, since its commencement, 123, (of 855) which is 14^ per cent.

Recovery of Insanity from certain causes : From Intemperance, Domestic Afflictions, 111 Health, . Religious causes, Masturbation,

51^ per cent. 58 per cent. 62i per cent. 55^ per cent. 18i per cent.

Hereditary, (267 of 855) . . 31^ per cent.

Periodical, (152 of 855) . . 18 percent.

Of the Periodical cases, 96 were from Intemperance, (96 of 152) 63 pr. cent. Of 840 patients whose civil state was known, there were

Single 555, which is . . QQ per cent.

Married 295, which is . . 34 per cent.

40

STATE LUNATIC HOSPITAL.

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STATE LUNATIC HOSPITAL. 41

Presenting our Sixth Annual Report, at the close of another year, we feel that we have great cause of gratitude to the Author of all good, that we have been so greatly blessed with health and security, and that its former prosperity has still attended this institution.

During the residence of nearly six years, we have been exempt from severe sickness, and no epidemic has ever visited the Hospital. In this period, we have had under our care dgTit hundred and fifty-jive. patients, exhibiting insanity in all its forms, from the high excitement which induces its victim to discard and destroy his raiment and ex- pose himself to injuries in a manner wholly reckless of consequences, to that state of imbecility and torpor, which unfits him from attending to what is absolutely necessary to his existence, much more to his security and comfort; yet we have never, in a single instance, had a patient either burned, scalded, or frozen.

This exemption from physical suffering, to which the insane, when at large or in confinement with their friends, are particularly liable, arises, to a great extent, from the excellent arrangements for warmth and ventilation which have been adopted, and to which we may fur- ther allude in the progress of the report.

Table L By a reference to the table it will be perceived that, in the course of the last year, we have admitted one hundred and seventy- seven patients, a greater number than has heretofore been admitted in any single year. Of these, ninety-six were males and eighty-one were females ; eighty-tioo were of less duration than one year, forty-five males and thirty-seven females, and ninety-five of longer duration than one yediX, fifty-one males ^.nd. forty-four females.

There have been sent to the Hospital by the different Courts, one hundred and twenty-three patients deemed furiously mad and danger- ous to go at large, and fifty-four have been admitted as private board- ers. Many rooms, daring the early part of the year, not being occu- pied by those sent by the courts, this unusually large number of private boarders were, in the course of the year, accommodated. At the present time we are hardly able to admit any of the latter class.

At the close of the year there were in the Hospital, two hundred and eighteen patients of whom one hundred and fifteen were males and one hundred and three were females. Of this number of cases twenty- eight are of duration less than one year, and one hundred and ninety of duration longer than one year.

During the year there have been in the Hospital, three hundred and sixty-two patients, one hundred and seventy-seven of whom were ad- 6

42 STATE LUNATIC HOSPITAL.

mitted in the course of the year, and one hundred and eighty-Jive were in the Hospital at the commencement of the year.

Table 2. There have been discharged during the year, including deaths, one hundred and forty-four patients, of whom eighty-four were males and sixty were females. Seventy-six of these recovered, forty- five males and thirty-one females; twenty-four were improved, eleven males and thirteen females; fourteen were not improved, eight males and six females; fourteen were discharged harmless and incurable, for want of room, ten males and four females ; and sixteen have died, ten males and six females.

Of this number of cases discharged, seventy-four were of less dura- tion than one year, forty-seven males and twenty-seven females. Of these sixty-four recovered, thirty-eight males and twenty-six females ; six were discharged improved, tivo males and four females; four have died, three males and one female.

Of the number of cases discharged, seventy were of duration longer than one year. Of these forty-tivo were males and twenty-eight were females; twelve recovered, seven males andj?we females; eighteen were discharged improved, ten males and eight females; and twelve died, seven males and five females.

Of the patients remaining at the end of the year, one hundred and eighty-eight are natives of this State, icn are natives of other States, and twenty are foreigners.

In the course of the year there have been in the Hospital, three hun- dred and seventeen persons belonging to the State, and forty-five na- tives of other states or foreigners.

These two tables furnish the principal statistics for the year.

The number of deaths the past year has been larger than in any former year, and yet we have never had a more healthy season. The first death that occurred was from mortified feet, the effect of frost. This man was at the point of death when he arrived at the Hospital, and survived but a ^qw hours. Five others were affected with fatal disease when they entered the Hospital, and survived but a few weeks ; one died in eight days,

Four epileptics, not included in the above list, have died suddenly without apparent previous indisposition except what had existed for a long time, showing no disposition to a fatal tendency till the fatal symptoms occurred.

In this institution, having no power to exclude patients sent by the courts, we shall always be liable to receive unfavorable cases, and, of course, to have a large list of deaths. Thus far, however, we must be

STATE LUNATIC HOSPITAL 43

considered fortunate, having had but fifty-three deaths of eight hun- dred and fifty five cases, which is about six and onefourth per cent, quite below the common average in hospitals of this character.

Table 3. From this table we learn the number of old cases re- maining under our care compared with those of recent origin. Twen- ty-eight only are of less duration than one year, v\^hile sixty-five have been of from one to five years' duration; forty-four from five to ten years, and nearly three times the number over ten years. The propor- tion, as before stated, is as twenty-eight to one hundred and ninety.

Respecting the ages of patients now in the Hospital, it will be seen, that, of any ten years, the greatest number of patients are between thirty and forty years of age, few are under tiventy, and more are be- tween the ages oi forty and fifty than between tivtnty and thirty. This, it is believed, is different from the fact with most hospitals for the insane, and may be accounted for, in part, from the accumulation of old cases in this Hospital, which was originally designed principally for incurables, many of whom will continue within its wards while life remains.

The institution commenced this year with one hundred and eighty- five patients, and closed with two hundred and eighteen ; showing an increase of thirty-three patients in the course of the year, although one hundred and forty-four have been discharged.

The average number for the year 1837 was one hundred and sixty- three ; the average number for the year 1838 is tivo hundred and eleven, a difference oi fifty -five in the average of the tivo years.

At this time the Hospital is as full of patients as it is desirable that it should ever be, and without the lodges, which should never be esti- mated as a part of the accommodations of the establishment, is already more than full.

Table 4. It will be seen by this table that three hundred and ttoen- ty-one patients were received and discharged in the course of the year, showing a change of more than an average of one patient daily for the weekdays of the year. In the last two months of spring and the first two months of summer, there were received and discharged one hun- dred and forty patients in one hundred and twenty-two days, sabbaths included.

The average for the month of July was greater than that for any other month, being two hundred and twenty and one-fourth, and that of November the next greatest, being two hundred and eighteen and one- half.

Such an exchange of patients as this table exhibits, tends greatly to

44 STATE LUNATIC HOSPITAL.

keep the house disturbed. Those who leave are quiet, either recov- ered, greatly improved or harmless, while those who are admitted are violent and noisy ; notwithstanding this, however, the Hospital is pro- verbially a quiet and peaceful residence to a large proportion of its inmates.

Table 5. From this table almost every statistical fact connected with our history as an institution, can be obtained. The whole number of admissions, and the number each year, the total number of discharges and the number discharged each year, the number that have remained at the end of each year, the number of deaths and elopements, the number that have been in the institution in the course of each year, the number of recoveries and of those that have been discharged improved. This table shows the manner in which the Hos- pital has been filled up and the regular increase of the average num- ber of every succeeding year, also the proportion of the sexes in the cases admitted, discharged, recovered and dead.

Table 6. From this table we learn the number of patients admit- ted, discharged, recovered and died at the different seasons of the year.

There have been admitted in the winter months, one hundred and seventy-two patients, which is a trifle more than twentT/ per cent, of the whole.

In the spring months there have been admitted tico hundred and sixtif-d^ht patients, which is more than thirty per cent, of the whole.

There have been admitted in the summer months, tivo hundred and ten, which is more than twenty-four and a half per cent, of the whole.

In the autumnal months there have been admitted two hundred and two, which is less than twentij-four per cent.

The discharges in winter have been eighty-six, which is less than fifteen per cent. The discharges in spring have been one hundred, and seventy -eight, which is more than thirty per cent. The discharges in summer have been one hundred and sixty-six, which is more than twenty-eight and a half per cent. The discharges in autumn have been one hundred and sixty-one, which is more than tiventy-seven per cent.

In winter the recoveries have been sixty-tioo, which is more than eighteen per cent, of the whole number of recoveries. The recoveries in spring have been eighty-seven, which is about twenty-five and a half per cent. The recoveries in summer have been eighty-six, which is about twenty-five and one-fourth per cent. The recoveries in autumn have been one hundred and ten, which is very nearly thirty-two per cent.

STATE LUNATIC HOSPITAL. 45

The deaths in winter have been eight, which is a trifle more than fifteen per cent, of the whole number of deaths. The deaths in spring have heenfowteen, which is about twenty-six and one-fourth per cent. The deaths in summer have been seventeen, which is about thirty-two per cent. The deaths in autumn have heen fourteen, which is twenty- six and one-fourth per cent.

It appears from this table that the admissions, discharges, recoveries and deaths have been least in the winter months. The number of ad- missions and discharges have been greatest in spring, while au- tumn affords the greatest number of recoveries, and summer the great- est number of deaths.

These facts may be too few to afford any criterion for correct con- clusions, but are preserved as valuable for future use.

Table 7. From this table may be learned the number of cases of different kinds of insanity that have been in the Hospital. The symp- toms of mania and melancholy as exhibited in strongly marked cases of either form of disease are very distinct and easily recognised, but as they are less prominent they become less obvious till it is difficult, indeed quite impossible to classify them distinctly. In forming this table I have endeavored to observe the usual rule of distinction. Such classification is of little or no practical utility, and is only useful as showino- the prevalence of high excitement or depression on the mind and feelings in the cases. The same is true of the cases of melan- cholia and mania on the one hand, and dementia on the other ; many patients belonging to the first two classes seem at first, or in the pro- gress of the disease, to be considerably demented, but if these symp- toms are soon removed, they will be found arranged in the other classes as not strictly belonging to the class dementia. We classify as idiots, those only who are so from birth, of course the number is quite small. A few are not classified.

The recoveries of mania are about sixty per cent., and the recov- eries of melancholia <i\)ow\. fifty-nine per cent., while recoveries of de- mentia, as we use the term, are from tico to three per cent. only.

This table also shows the influence which the large number of cases of dementia has upon the per cent, of recoveries in the Hospital. Without it the average would be about sixty per cent, of the discharg- ed, and probably nec^rly fifty per cent, of the whole that have been ad- mitted.

Table 8. From this table we learn that the farmers are still the most

46 STATE LUNATIC HOSPITAL.

numerous among the male inmates of the Hospital, and that' laborers are the next most numerous class. Great as is this list of farmers, it probably falls short of the proportion which this employment holds to the many trades enumerated in this table. There is unquestionably, in the community, more than thi-ee farmers to one shoemaker, and more than four to one merchant, or jive to one carpenter ; it cannot therefore be inferred that the employment of cultivating the land tends to produce insanity ; probably no business which is pursued by our citizens, has less tendency to it, and no set of men in their legitimate employment can be more exempt from the causes of disease, mental or physical. Hereditary predisposition and the influence of causes which disturb the nervous system independent of employment, such as intem- perance, speculation and domestic affliction, probably bring a large proportion of this respectable class of men into institutions for the in- sane.

The great list of employments in the table show conclusively that all mankind, of whatever pursuits, are liable to the evil, and that little can be said of the occupation as a cause of the insanity in any case.

Table 9 has reference to the number and causes of the deaths that have occurred in the Hospital. We have, as remarked at the commencement of this report, been unusually exempt from acute dis- eases and entirely so from epidemic febrile disease. Marasmus still stands at the head of the list of deaths as to numbers; a large propor- tion of the subjects of it come under our care with the disease upon them, or with symptoms which run directly into it, and prove fatal in a short time. Two individuals were brought into the Hospital this season, who were able to leave the bed for a short time only, both of whom went steadily down to death with a rapidity not a little accelera- ted by the influence of insanity.

Next to Marasmus, on our list, stands Epilepsy ; a disease to which the insane are particularly inclined. Four deaths from this disease have taken place during the last year. All but one sudden and unex- pected at the time ; in two of the subjects the symptoms of insanity were subsiding in the most favorable manner.

Consumption is generally the most fatal disease in hospitals for the insane, and in our records stands high among the causes of death. A considerable proportion of those who have died of consumption have come into the institution with symptoms of disease upon them. The little regard which the insane have to prudence and care respect- ing health, and the frequency of their exposures and privations ren-

STATE LUNATIC HOSPITAL. 47

deis them particularly liable to a class of diseases in no way connected with insanity.

In the course of this year, two patients have died of mortification of the limbs, one arising from frost, who survived his admission but two days. The other from land scurvy, who lingered two or three weeks before he expired ; another case of frost-bitten limbs survived, after great suffering and the loss of many of his toes ; and we have recently admitted a patient whose feet are frozen in a most shocking manner, and who, if he survives the severe wounds that now threaten his life, will, in future, be a cripple.

These cases are mentioned to show, that, as regards fatality, an in- stitution of the character of this Hospital will always be liable to re- ceive such cases of insanity complicated with other diseases as will swell its catalogue of deaths, and increase its per cent, of fatality above that of hospitals which have power to reject unfavorable cases.

Table 10. The number of cases admitted into the Hospital of less duration than one year has been, as appears by the table, three hundred and sixty-two, which is about two-fifths of all that have been in the in- stitution. With the exception of one year, the number of this recent class of cases remaining at the end of the year has varied from tioenty- one to twt7ity-nine ; most of these, in each year, had been recently ad- mitted and were generally more or less improved. Ai the close of the present year, there were ttocnty-eight cases of duration less than one year ; sixty-eight from one to Jz?;e years ; foriy-five from five to ten years ; forty-one from ten to twenty years ; eighteen from twenty to thirty years ; three over thirty years, and nineteen of which the dura- tion was unknown, — showing a great accumulation of very old cases. There are probably more cases over ttoenty years' duration than of less than one year.

This table shows that the number of single persons continues to be much larger than the married, as has always been the case in the Hos- pital. During the last year, we have received one hundred and one pa- tients that have never been married, sixty-five married, and eleven in a state of widowhood.

Table 11. The records of this table, — the causes, hereditary taint, periodicity, homicidal, and suicidal propensities, — are subjects of great interest, and are sufficient of themselves to fill the report.

Intemperance continues to be a prominent cause, but we are happy to think it is less frequent than formerly. It will elsewhere be re- corded that this cause, during the first three years of the Hospital, gave origin to tioenty-five per cent, of the cases of insanity admitted, while it

48 STATE LUNATIC HOSPITAL

it is supposed to be the cause in hut fourteen per cent, of the cases ad- mitted the last three years. If this is any indication of the proportion- ate diminution of its influence in other respects, unfavorable to public health and public morals, the prospect is most cheering. We have had no case of delirium tremens for the last year, and very few since the in- stitution was opened.

Of the one hundred and Jifty-Uvo cases of periodical insanity that have been in the Hospital, ninety-four have arisen from intemperance, nearly ttoo-tJnrds of the whole. This has reference not only to those cases in which a renewal of the cause produces a return of the disease, but to that state of periodicity which occurs at short intervals, and at regular periods, the subjects of which, remaining in confinement, have no access to these means of excitement during the intervals of the par- oxysms.

It has occurred to me, that the brain and its appendages, its nerves and blood-vessels, under the influence of the high stimulation of alco- hol, and the corresponding torpor when that influence is not felt and its effect has subsided, may have a tendency, after a long time, to induce a habit of disease which does not yield with the removal of the cause. This may be true of other causes of this form of insanity as well as intemperance. It is peculiarly liable to take place in females at the period of the menses, and continue independent of this cause as well as the other.

In all cases of periodical insanity in which the paroxysms occur at short intervals of one or a few months, what is called the lucid inter- val is a period of more or less gloom and depression : in proportion to the degree of severity which either of these opposite conditions present is the corresponding one of excitement and collapse.

If intemperance, besides producing ordinary insanity and delirium tremens, does in fact induce such a state of the brain as to establish pe- riodical insanity, the very worst form of all diseases affecting the mind, the whole catalogue of disastrous effects from it have not yet been known, and it may have in this way produced suffering as intense as any other calamity which has arisen from its noxious influence.

During the last year, a case of most appalling homicidal insanity, produced by intemperance, has been added to our large list of cases of this unfortunate class, swelling it now to twelve actual homicides, and sixteen who have made assaults with intent to kill, four of which have fortunately proved unsuccessful.

A large proportion of the cases of homicidal insanity have been pro- duced by intemperance ; and other individuals not strictly intemperate

STATE LUNATIC HOSPITAL. 49

seem to have been thrown by alcoholic drink into a state of temporary excitement, or such utter confusion of mind, as to make them quite unconscious of the influences which prompted to the fatal deed, or it has excited in their minds false and delusive impressions of duty which, thouo-h temporary, existed long enough to deprive a fellow-being of life, his family of a guide and protector, and the community of a valu- able citizen.

The number of admissions from religious causes has been about the same as usual the past year. A subject so deeply interesting to the human mind as its eternal well being, must ever have an agency in the production of insanity ; these cases come in bold relief before us, and we deprecate the influence which has produced them. All the most valuable institutions of society, however, are liable to the same objec- tion,— marriage, education and civilization, as well as Christianity, are the causes of insanity in many cases, though it is not the legitimate tendency of any of them to produce this effect.

There is no good without some corresponding evil, and the best in- stitutions of society can be perverted so as, in individual cases, to pro- duce mischievous effects.

Under the influence of many causes of disease affecting the mind, consolations of religion afford the best security and are the most effec- tual preventive. In a thousand cases religion interposes its soothing influences and confident hopes to secure the mind from distraction amid the evils of life, and thus doubtless prevents, more frequeally than it causes, insanity. Without it, Vv'here would the agitated mind seek rest, or the perturbed feelings find repose?

The number of admissions from masturbation, the last year, have been less, and the cases of a more favorable character. Six cases only are known to have arisen from this cause; but probably three or four others may have done so. F'aur or five of these cases have recovered, and have been discharged with such feelings of the nature and tenden- cy of the practice, as it may confidently be hoped, will ensure them from future indulgence and its consequences.

If, from this reduced number of cases from this debasing cause, we could indulge hope that the evil had diminished with the young, and that, as light is diffused upon the subject, the habit had become less common, it should encourage to perseverance in all the means which prudence and delicacy will admit, to exterminate a cause of insanity most fruitful in the destruction of every quality of mind and feeling which distinguishes man from animals of inferior creation.

7

50 STATE LUNATIC HOSPITAL.

The number of cases denominated hereditary, is very large on onr table ; for facts on this subject we rely wholly on information derived from friends. If near collateral relatives are or have been insane, we call the case hereditary, wishing to be understood that the family have a propensity to the disease.

The influence of hereditary pre-disposition is rarely, perhaps never, sufficient to produce insanity without the intervention of other causes ; but, with such causes, we believe that insanity is much more certainly induced in individuals having this pre-disposition. If the exciting causes of disease are avoided, the strongest pre-disposition need not re- sult in insanity.

We record sixteen cases of homicidal insanity, and twelve actual homicides. We denominate no cases homicidal in which there has not been an actual attack made with previous determination to kill, or a certain rush with a dangerous weapon in such a way as to endanger the life of the individual assailed. A great many patients in the mo- ments of passion and excitement threaten to kill and even prepare or secrete a weapon for the purpose. We have not called such cases hom- icidal,— if we did, our number would be four times greater than the records of the table.

One man discharged two pistols at his neighbor and friend, neither of which took effect, although they penetrated his clothes ; he then fired a ball into his own head, intending to destroy two lives at once. Three others made a desperate attack upon persons against whom their prejudices were excited with a dangerous weapon in hand, and inflicted severe wounds which fortunately did not prove fatal. These cases are recorded homicidal, and no others, except those whose well-aimed ef- forts destroyed the victims of their rage.

As to suicidal insanity, we have been less limited in our record ; we denominate as suicidal not only those who actually attempt self-destruc- tion, but also those who feel a strong desire to do it, or express great apprehensions that they shall be placed in a situation in which they cannot refrain from it, although they have the greatest horror of the deed, and alarming fears lest they should commit it.

The number of suicides has been small, — amounting to only three of nearly nine hundred insane, and of one hundred who were strongly predisposed to it.

Table 12. From this table, we learn some interesting facts on the subject of the comparative curability of insanity treated at early or late period of disease. There have been admitted into the hospital three

STATE LUNATIC HOSPITAL. 51

hundred and thirty-four cases of less duration than one year, of which there are recovered or supposed curable two hundred and ninety-four , which is eighty-eight per cent.

There will be found some variation in the number stated in this ta- bJe and table I5th. This table is most accurate as it has been cor- rected from time to time as information has been received of the dura- tion of the cases.

There have been admitted one hundred and eighteen cases of from one to tivo years' duration, of which seventy-nine have recovered or are supposed curable, which is a fraction more than sixty-six per cent.

There have been admitted one hundred and forty-one cases of from two to five years' duration, of which forty-five are recovered or sup- posed curable, which is a little less than thirty-six per cent.

There have been admitted nintty-six cases from^i!e to ten years' du- ration, of which ttvelve have recovered or are supposed curable, which is twelve and a half per cent.

There have been one hundred and eighteen cases over ten years' du- ration, of which ybwr have recovered, which is less than three and a half per cent.

These facts show most clearly the importance of placing patients under suitable care in early periods of disease, when the prospect of recovery is so favorable as is represented by the table.

Table 13. At the commencement of the institution, in 1833, a large proportion of the cases came from the public receptacles where they had been accumulating for years. There were many vagrants, the cause of whose insanity was intemperance, so as to make about one-fourth of the whole, to wit, tiventy-four and three-fourths per cent, of the admissions from that cause. Since that time the proportion has been regularly diminishing till the present year. In 1837 the propor- tion was only ten and one-eighth per cent,, the last year it again in- creased to sixteen and three-fourths per cent., a proportion considera- bly greater than the tico preceding years.

The regular increase of admissions from ill health probably arises Irom the fact that the Hospital has gained some reputation as a cura- tive institution, and the friends of patients have felt increased solici- tude to obtain the advantage of medical treatment here afforded. A large proportion of the private boarders are of this class of patients. During the past year this class has been unusually numerous, and the per oent. from the various causes of ill health is twenty-eight.

52 STATE LUNATIC HOSPITAL.

The cases from the various affections concerning property, and from religious causes have not varied much from year to year.

Table 14. From this table we learn the comparative curability of cases attacking at different ages.

The result of these observations differ very little from the last year. There have been admitted one kundi^ed and nine cases in which insan- ity commenced under twenty years of age, of these forty-nine recov- ered or are curable, which is nearly forty-six per cent. ; last year the recoveries of this class were dhoni forty -nine per cent.

There have been admitted one hundred and tioenty-one patients in whom insanity commenced between the ages o{ tvKnty and ticenty-fve, of whom sixty-tiDo recovered, which is fifty-one and one-third per cent.

There have been admitted one hundred and nineteen patients in whom insanity commenced between the ages of twenty five and thirty, of whom sixty-two recovered, which is about fifty-two per cent. Last year the average on these two classes was about forty-eight per cent.

There have been admitted one hundred and eighteen patients in whom insanity commenced between the ages of thirty and thirty-five of whom sixty recovered which is about^^if?/-onc per cent.

There have been admitted one hundred and tioo patients in whom insanity commenced between the ages of thirty-five and forty, of of whom fifty-two recovered, which is about fifty-one per cent.

There have been admitted sixty-four patients in whom insanity com- menced between the ages o^ forty and forty-five, of whom forty-three recovered, which is about sixty-seven per cent.

There have been admitted fifty-five patients in whom insanity com- menced between the ages of fifty and fifty-five, of whom thirty recov- ered, which is sixty per cent.

There have been admitted twenty-seven patients in whom insanity commenced between the ages oi fifty -five and sixty, of whom eighteen recovered, which is sixty-six per cent.

There have been admitted sixteen patients in whom insanity com- menced between the ages of sixty and sixty-five, of whom fifteen re- covered, which is nearly ninety per cent.

There have been admitted fifteen patients in whom insanity com- menced between the ages of sixty five and seventy, of whom ^ew recov- ered, which is about sixty-seven per cent.

There have been admitted seven patients whose insanity commenced

STATE LUNATIC HOSPITAL 53

after the age of seventy, of whom/owr recovered, which is ffty-stvcn per cent.

Table 15. Having last year made a table in which was noted the day of the moon on which three hundred and ffty paroxysms of excitement commenced, I now add the experience of the last year in an additional number of seventy-jive paroxysms, making in the whole four hundred and twenty-five paroxysms. The greatest number of par- oxysms, as will be seen in the table, occurred on the second day of the first quarter, which was Iwmty-sevtn ; this was also the case the year before, the number then being twenty-two.

This year the next greatest number will be found on the first day of the second quarter, which was ttoenty-foiir. Before the addition of those of the last year the day previous had the second number.

On the third day of the fourth quarter there occurred twenty-one paroxysms which is the third number.

On the last day of the first quarter and the third day of the third quarter an equal number occurred which is twentij.

The results of the present year have varied the results of former years but little, o^ four days that had the highest number this year, three had the highest last ; these four days have an aggregate of nine- ty-two paroxysms, while the four days on which the least number of paroxysms occurred have an aggregate of thirty-unc paroxysms only. Three of the four days having the least number are the same as in the table last year, one is different.

The days of the moon on which occurred the least number of par- oxysms, will be seen to be the^r.s^ day of the first quarter, the third day of the second quarter, and the last tico days of the fourth quarter. The extremes are tiventy-scven and five.

With respect to the fifty-three deaths which have occurred in the Hospital, an equal number occurred on the second day of the J??-5^ quar- ter, on the sixth day of the second quarter, and on the last day of the third quarter, which was^re.

On the third day of the j^rs^ quarter, on the sixth day of the third quarter, and on the fowth day o( the fourth quarter, an equal number of deaths occurred, which WRsfour.

On the fou7-th day of the second quarter, on the fourth day of the third quarter, and on the second and sixth days of the fourth quarter, no deaths occurred.

We have collected these facts with as much care as the nature of the subject will admit, time only can render them useful or

54 STATE LUNATIC HOSPITAL.

interesting as sustaining or overthrowing the popular opinion which, for centuries, has been prevalent with respect to the influence of the moon on the excitement of the insane. We have no theory to estab- lish and, of course, can wait the results of long experience and careful observation without a desire to make any deductions from them at this time.

In about thirty cases of periodical insanity that have been in the Hospital, the periods have been regular every four, six, eight or twelve weeks. A majority occur at monthly periods, that is, a lucid interval one month, and an excitement the next, making about six paroxysms in a year; others have four, and others have two paroxysms annually. In some cases the paroxysm occurs once a year regularly, but if the period is longer than this, it is usually more irregular.

In o?ie case belonging to the Hospital, regular paroxysms with regu- lar lucid intervals have occurred, each about six in a year, for at least /j/jc/ue successive years. Other cases have long been with us in which the paroxysms occur at nearly as regular periods.

One female is now in the Hospital who is greatly excited about iivo- ihirds of the time, and is quiet and rational the remainder. These ex- citements occur at nearly regular periods.

There have been two cases in which every other day was a day of excitement and the alternate day quiet.

During the very warm weather of the last summer we had unusual excitements in the Hospital, and we have always found the winter more quiet than the summer months.

Table 16. Shows the proportionate recovery of cases of insanity produced by different causes.

The number of cases caused by intemperance has been one hundred and fifty-eight, oi which eighty-one have recovered, or are curable, which is ahoni fifoy-one per cent.

The number of cases admitted, the cause of which are the various domestic afflictions, has been one hundred and ninety-three, of which one hundred and tivelve have recovered, which is a little less than sixty per cent.

The number admitted arising from ill health, has been one hundred and fifty-five, of these ninety-seven recovered, which is more than 5zx^?/- tiDo per cent.

The number of cases admitted arising from religious causes, has been seventy, of which thirty-nine recovered, which is more than fifty-five per cent.

STATE LUNATIC HOSPITAL. 55

The number of cases from masturbation has been eighty-one, of Vfhich ffteen have recovered, which is about eighteen and a half per cent.

On the subject of this last cause it is proper to remark that it is im- possible to decide what cases arise from it, and in what cases it is the effect of disease ; this, however, is certain, that it renders all incurable that do not abandon it.

Table 17. In this table I have brought together various interest- ing facts, and presented the per cent, of recoveries, deaths, &c.

We learn from it that, in cases of less duration than one year, insan- ity is a very curable disease, the recoveries of all that have been dis- charged being eightij-five per cent., varying from year to year, for the six years, from eighty-tioo per cent., annually, to eighty-nine and a half per cent.

The recoveries of all the cases discharged has been fifty-three per cent, on an average, varying from forty-six and a half to fifty-seven per cent.

The recoveries of cases of longer duration than one year has averaged nineteen, varying ^loxa. fifteen and a half io twenty-five and a half per cent.

These calculations have been made on the discharged. The follow- ing are made on the admitted.

There have been admitted since the Hospital was opened, three hun- dred and thirty-four cases of less duration than one year, of which two hundred and seventy-six have recovered, which is about eighty-tioo and ttco-thirds per cent.

In most institutions, it is customary to deduct cases that have not had sufficient time ; this may be said of the twenty-eight recent cases left in the Hospital at the end of the year ; these deducted, the per cent, of recoveries will be ninety and one half

If we make a further deduction of the deaths of the cases from this class, which is also the rule in many institutions, we should increase the per cent, to about ninety-four.

There have been in the institution eight hundred and fifty-five pa- tients of all forms of insanity ; of these, there have been discharged re- covered three hundred and forty-four, which is forty and one-fourth per cent.

The various modes of reporting adopted by different institutions make it extremely difficult to ascertain with accuracy the comparative suc- cess of each. Some institutions make a recent case one of three

56 STATE LUNATIC HOSPITAL.

months' duration ; others make it six months, which I believe is the general rule adopted in this country. We have called a case recent, that is of less duration than one year

There is great propriety in deducting cases of insufficient trial, as the disposition of friends to remove patients when recovering is quite too common and very disadvantageous to the institution.

In the course of the last year, six private patients who had been in- sane less than a year, and who were in a state of most favorable im- provenient, were removed from the Hospital by their friends. Five of these afterwards returned by order of the courts ; one has been dis- charged recovered, and the others are now convalescing. Thus six individuals have been recorded as eleven cases on our records, making six cases improved when discharged and not cured, which materially diminishes the i)er cent, of cures, both on the discharged and the ad- mitted. If these cases had not been discharged till recovered, we should have had^yc less admissions of recent cases the past year, to wit : seventji-sevcn, instead of eighty-two.

In this institution, we have some advantages over others; we can retain patients committed by the courts when improving, till they are recovered, which private institutions cannot do. They can, however, reject them if presented for admission a second time, which we cannot do if sent to us by the authority of the courts, so that our advantage is in this way counterbalanced, and we have a great disadvantage as a curative institution in the number and condition of old demented cases that cannot be discharged.

Of the deaths that have occurred in the Hospital, tioelve have been of recent cases, and forty-one of old cases. No one has died of fever, andyb//?- only of inflammatory disease.

The proportion of deaths must be considered small for the number of the imbecile, feeble and diseased that have annually been brought to our care, being only fifty-three of eight hundred and fifty-ficr, a little more than six per cent. ; the average on the number in the Hospital each year, is about three and a halfiper cent.

The proportion of old cases at the end of this year has been about the common average; it is eighty-seven and a haff per cent., and the recent cases of less duration than one year, twilvc and a half per cent. The number remaining this year is twenty-tight. The average number of recent cases at the end of the year for six years, is twenty-three and one-third.

STATE LUNATIC HOSPITAL. 57

Table 18. Shows the comparative expense of supporting a recent case of insanity till recovered, and an old case which is hopeless and incurable. The price of support before admitted to the Hospital is, in both cases, fixed at a low rate, probably lower than the actual expense, but since admitted into the Hospital, it is fixed at the actual rate of charge paid for support.

The twenty old cases in the table are the first twenty cases admitted into the Hospital which still remain, and which are known to have been in confinement nearly the whole time.

The twenty recent cases recovered, are taken from the last records of recovery ; the cases known to have existed not over three months, all of which have remained free from disease and able to labor, so far as is known, since their discharge.

These twenty old cases have cost their friends or the public, in the aggregate, thirty-one thousand and Jif teen dollars, — an average oi fif- teen hundred and fifty dollars and a fraction, each. The subjects of them are still in confinement at the same rate of expense without a hope that it will be materially lessened. The number of this class of patients now under our care, is not less than one hundred and ninety- five who will always be a burthen upon their friends or the public. The annual expense of supporting these 07ie hundred an'^^ ninety-five ^a- tients at tico dollars and fifty cents per week, is twenty-four thousand three hundred and fifty dollars.

If we suppose that these patients on the average should continue to live /€W, years each, the expense offuture support will be ^?oo hundred and forty- three thousand five hundred dollars, a sum sufiicient to erect a hospital in every New England State sufficiently large for the accommodation of all cases of insanity of less duration than one year, which will be likely to occur for half a century. Allowing this estimate to be true, the sum which will be expended in the support of twenty old cases of insanity, will be sixty-seven thousand and fifteen dollars, or three thousand three hundred and ffity dollars for each individual.

If these twenty cases had been subjected to proper medical treatment in a Hospital, when recent, we may suppose, that at least seventeen of them would have recovered at an expense not exceeding the average cost of support of the twenty recent cases in the table, to wit : forty- seven dollars and fifty cents. There would then have been a saving of actual expense to the friends or the public of more than fifty -seven thousand dollars, a sum sufficient to erect and endow an institution for the support of twenty recent insane persons perpetually. 8

58 STATE LUNATIC HOSPITAL.

This is not all, the seventeen persons who should recover under proper treatment, would no longer be a burthen upon their friends and useless in society, but would contribute their share to public and pri- vate wealth, domestic comfort, and the pleasures of rational life.

The twenty recent cases of insanity in the table had been affected,, on an average, six and a half weeks before admission to the Hospital^ and continued in the Hospital tioelve and a half weeks. Most of these cases, however, were convalescing at least half this time, and were quite rational and free from disease from two io four weeks before they left. This does not affect the jjrice of support, but will diminish the period of insanity on an average from nineteen weeks to nearly sixteen weeks.

The comfort and happiness of at least ten individuals is more or less disturbed by every insane person that is abroad in the community. Of the twenty old cases in the table, six are homicidal, having inflicted wounds of which ybii?- were immediately fatal. Thus, to the common disturbance and anxiety of friends occasioned by the insane, is added the deep and irreparable loss of valuable members of families, sacrificed to their rage and delusions, all of which might have been prevented by the timely application of the appropriate means of recovery !

I have now gone through the explanation of the tables, in a manner to render them intelligible to oil who may wish to examine them for information. Much has been suid m them of the per cent, of recovery and improvement, and the number and condition of the patients ad- mitted ; but there is one benefit derived from the Hospital which can- not be estimated in figures or presented in tables of per cent., which is equal to any other that can be contemplated or named. I refer to the improvement in the condition and comfort of the great number of hope- less and incurable insane that have come into its wards, for the amelio- ration of whose state, and the preservation of the community from dan- ger, the institution was principally designed.

In the abstract of our records at the commencement of this report the term " not improved," is often used. This relates to insanity alone, for in every other respect the condition of a large proportion of the in- mates of the Hospital is greatly improved. The furious and violent have become quiet and docile ; the filthy and degraded have become cleanly and respectful ; and the circumstances in which they are now situated, contrasted with the condition of suffering and wretchedness in which they formerly were, will be found to exhibit great improve- ment and decided benefit.

STATE LUNATIC HOSPITAL 59

While this paragraph is being written, with every room in this large establishment occupied, amounting in numbers to more than two hundred and thirtij patients, but unc individual, either man or woman, in our wards has upon his or her person any restraint whatever ; five only are in strong rooms in consequence of violence ; the remainder of the strong rooms are occupied by imbeciles and idiots, because we have no other place for them to occupy.

Of this number of insane persons, a very great proportion of whom were sent into the Hospital " furiously mad and dangerous to go at large," hoo hundred and twenty at least sit at the table at their meals, use knives, forks and crockery like other boarders, and generally con- duct themselves with decorum and propriety. At night, each has his bed, consisting of a good hair mattress, a straw bed, pillow of hair or feathers, and covering of blankets, comforters and quilts, a bedstead, &c., as comfortable in all respects as lodgers in a private family gen- erally are. It is rare that these privileges are abused; no injury has ever been done with knives and forks, comparatively little crockery has been broken, and the beds have been preserved neat and comfortable, with very few exceptions.

Many of these individuals engage in labor and unite in amusements, thus occupying their time profitably and pleasantly, so that few mani- fest any particular solicitude to leave or make any effort to escape.

During the past year we have relaxed the rigor of confinement, and, in a great number of cases, suffered our patients to go into the garden or workshops to labor, or into the fields and village for exercise and recreation, indulging them in long walks, on a pledge of punctual re- turn, without any attendance or supervision ; and we have seen the most decided benefit from these indulgences. At least, eighty patients have thus gone unrestrained during the past season, spe-iding day after day, and week after week, in this independent manneJ", and no one has escaped, or apparently wished to leave the Hospit-ii till regularly and honorably discharged. Not less than an equai number have la- bored more or less, or taken long walks and rides so slightly attended as, in innumerable instances, to admit of easy escape, with equal safety and advantage : the attendants, in such cases, being considered by them as guides and directors, ratJier than as task-masters and watch- men. Another class of patients, whose violence or discontent pre- cluded these indulgences, have labored almost daily under the eye of a skilful and vigilant attendant, and have been made more healthy and happier by the exercise thus afforded them. Besides these indulgenceg

60 STATE LUNATIC HOSPITAL.

without the walls of the Hospital, the verandahs afford delightful op- portunities of exercise and airing, amusements and labor, particularly to the females which contributed greatly to their comfort and happi- ness. These indulgences are extended alike to all who are capable of appreciating them. The benefit that has resulted from these and other modes of management in daily operation cannot be better illus- trated than by the brief rehearsal of a few interesting cases, most of them from the list of incurables.

No. I. Within a month after the opening of the institution, there was placed under our care a man who had committed homicide. On his trial for that offence, he had been proved insane, and, for want of a more suitable place, was confined in the common jail of the county in which the offence was committed. Here he had been imprisoned seventeen years, sometimes being permitted to have the company of the worst prisoners with whom he often quarrelled, and by whom he was often sadly beaten and abused ; sometimes he was a long time in soli- tude and occasionally loaded with heavy irons, at all times he was in close confinement and considered a dangerous man even when under the severest restraints.

When he first came into the Hospital he was violent, noisy, and of- ten furious ; he was permitted to enjoy the privilege of walking in the hall unrestrained on condition that he would not injure his associates, he soon became more calm and pleasant, and was occasionally taken out to labor ; he conducted well, and was soon indulged with greater liberties ; — the bible was given him, and he was fond of reading it ; he ^(?orked much abroad and with great pleasure, assisted the women in the kitchen to scrub the floors and in their other labors. He has been thus iiidulged more than five years, he has injured no one abroad, and has been lespectful and civil. He now takes his meals at table quietly and orderly, attends chapel much of the time, and, although a very in- sane man, and &t times violent in his language, is contented, peaceable and happy, and w^en calm has no desire to leave the Hospital, but considers it his residence for life.

No. 2. In the spring after the opening of the institution, a female was admitted who had been insane seven years. She was so extremely violent for some time before she was brought to the Hospital, that her friends had chained her closely to the floor, and she had remained in this position so long that she had entirely lost the use of her limbs. When she came under our care she was considered incurably insane ^nd lame for life. At first she was quite helpless as to getting about.

STATE LUNATIC HOSPITAL. 61

but so furious at times as to tear her clothes and do violence to all within her reach. By persevering efforts her limbs were after a while restored, and her health and mind improved.

She went home to her friends and remained a year, but finding that, though greatly benefited, she was not entirely cured, her friends, with her consent, it is believed, again brought her to the Hospital. Dur- ing her second residence with us she did better than before, but still exhibited a capriciousness of temper and estrangement of feeling that showed remains of disease. She was again put upon the use of rem- edies which she continued six months, when she seemed to be entirely restored. She now returned to her friends, and has since been well both in body and mind, and is now a pleasant, industrious and healthy young woman.

No. 3, is a case of homicidal insanity, the subject of v/hich has been in confinement tliirty-four years. Before he came to the Hos- pital, he had for more than a quarter of a century been confined in a filthy dungeon without the comforts of life, with neither bed nor cov- ering to keep him warm, and infested with vermin to such a degree that he could hardly sleep if the means of comfortable repose had been afforded him. He declares that for seven winters he did not feel the influence of fire, and that on one occasion a stout and healthy cock lio-hted upon a tree by the window of his cell and frozeto death ; this was the " cold Friday and Saturday" which, in the recollection of all who felt its influence, was proverbially the coldest season of the cold. During these three days he declares he did not lie down or sleep, but kept con- tinually walking to keep himself from freezing. He remained in this solitary and filthy cell, the object of the sport and abuse of every idle and mischievous person who took delight in the rage and violence which he could excite, till removed to the Hospital.

When he entered this institution he was furnished with a neat and cleanly room, a comfortable bed, and every thing necessary for his happiness. He had not been shaved for many years, he had not eaten at a table or in company, neither had he used a knife and fork during the whole period of this protracted confinement ; he soon, however, relearned their use, and became, to a considerable extent, a civil, quiet man.

Although the delusions of insanity remain the same, he is now com- fortable and happy, he walks abroad at this time unrestrained, takes o-reat care of the poultry, walks about the town and village in company with others, keeps his room in perfect order, makes his bed in the

62 STATE LUNATIC HOSPITAL.

neatest manner, attends chapel every Sabbath, and enjoys life as well as the nature of his delusion will permit.

No. 4. In the summer of 1834, there came into the Hospital a for- eioTier whose great violence had rendered him the terror of all who came in his way ; his beard was long and dirty, his countenance ex- ceedingly insane, and the rapidity and vigor of his muscular move- ments were such as to excite alarm in all who witnessed his gestures or listened to his vehement and excited language.

The first business was to shave him. Accompanied by the steward I visited his room to persuade him to submit to the operation without restraint. I proposed to him to be shaved, he replied, " not till you put me in irons," and appeared greatly enraged. He was soon quiet, and I said to him in a decided tone, " you must be shaved ; take your seat on the bench, and let the man shave you peaceably, for it must be done." He seated himself quietly, and was shaved without trouble. After the operation was over he asked me to give him a paper to show that the shaving was not voluntary but by compulsion, as his country- men would not receive him and treat him with respect if he had lost his beard which his religion obliged him to hold sacred. I promised him the certificate and he was satisfied, but was afterwards unwilling to be shaved although he never again resisted. He left the Hospital after some months' residence, in consequence of its crowded state, but returned two years afterwards the same savage, terrific man as before. He Avas violent for a time, but became more subdued, and after a while quite harmless and clever, except, occasionally a few days of excite- ment. During the summer and autumn he has walked the grounds and enclosures of the Hospital unrestrained, on giving his pledge that he would not extend his walks beyond the limits prescribed to him. He has been faithful to his engagements, and, although no less insane than ever, and having a full conviction that he ought to be immediate- ly liberated, and that we have no right to detain him ; yet he scrupu- lously regards his pledge, and will not violate it upon any consideration. He flies his kite, unites in sports with the neighboring boys who are fond of visiting him, is generally respectful, and attends public worship on the Sabbath much of the time.

Case 5. In the spring of 1835, a man was brought into the Hos- pital who had been insane sixteen years. He had been confined for a long time in a cage, and having become more quiet than usual, he was unchained and enlarged, he seized the first weapon that came in his way, assailed his brother, who was also insane, and slew him on the

STATE LUNATIC HOSPITAL. 63

spot ; one or more other members of the family were fortunate enough to escape his violence, and as soon as practicable he was secured and chained in the safest way possible, and so closely that he was unable to walk or rise. In this situation he was brought to the Hospital. When he first came under our care, he was unable to stand or walk, but could hop about a little. In this manner he moved for many months. His habits were as filthy as possible ; so much so that he was confined for a time in a solitary room ; he had nearly forgotten the use of knife and fork, and took his food in the most savage and oflTensive manner. It was a long time before these habits could be changed. After a time, however, he became more decent in his habits, and more cleanly in his person. His limbs, by the greatest attention, improved, and in a year he was able to walk, though in a very indifferent manner. As his habits became more cleanly, he was brought into the halls and associated with the other patients. In the course of another year, he was able to walk well, his habits became cleanly, and he could do some labor ; at present he is altogether cleanly, walks well, takes his food at table with others, using knife, fork, and crockery, walks abroad, works some, has at- tended chapel on the Sabbath, and is a very decent man in all respects so far as cleanliness is concerned. His mind is much demented, and will never recover.

Case 6. The following account of a man, who, for most of the time for more than twenty years, had been confined in a cell of a work- house, was transmitted to us about the time that the subject of it was admitted to the Hospital. He is a man o{ sixty-eight years of age, and has been insane nearly thirty years.

J*** M***, the person about whom you request information, was born in this town ; he is a shoemaker by trade ; his natural temper is irascible and, before his confinement, he drank spirituous liquors freely and ha- bitually, but not to the extent which, in popular language, gives the name of drunkard. He married early, and has a wife and children in

the State of , His insanity first discovered itself in the violence

of his language, the abuse of his family and others. He was prosecuted at this time for beating a colored woman, merely for the reason thatshe was a negro. After this, he was confined in the county jail ; this was during the summer of 1813. After his release from prison, he re- mained at large, although frequently insane, till 1816, when he was confined to the house of correction, by two justices of the peace, as a lunatic person so furiously mad as to render it dangerous to the peace and safety of the people for him to go at large. After remaining in

64 - STATE LUNATIC HOSPITAL.

the house a few months he was discharged, and for a time attended to his affairs with occasional aberrations of mind. His conduct becoming outrageous he was committed to the work-house, and has remained there until this time, a period of more than twenty years, and most of the time has, of necessity, been confined in a cell ; sometimes he has been so calm, and rational as to be permitted to associate with other inmates of the work-house; but as the recurrence of the more violent symptoms of insanity could not be foreseen, he has frequently been kept in close confinement during the intervals between his paroxysms, when, under other circumstances, he might have been at lai'ge. He has never showed any disposition to put an end to his own life, but has frequently destroyed his bedding and every thing within his reach. For years he has had antipathies against particular persons, so that, when in his fits of violent derangement, he would uniformily utter the most abusive language to them. His language is frequently profane, obscene and noisy, sometimes continuing his hallooing through several nights in succession.

I have rather given the sense than quoted the language of the writer, in his interesting account of this case. His father was insane many years ; and his sisters more or less so. In February last, this man came into the Hospital ; for several years before his removal he had not been shaved. On the journey, which was on a cold day, he took some cold and appeared considerably sick ; he was at this time uneasy and impatient ; but w^e kept him in the hall with sixteen others, and he in- jured no one. He was at first unwilling to undress at night and take his food at table. After a while, however, he consented to do both, and for a long time has given us no trouble of this kind. In less than a month he attended religious worship on the Sabbath, and continued to do so for many weeks in succession. Sometime in the month of June he became excited ; for a few days he talked much and loud ; he was soon calm, and has continued so ; he is now pleasant and quiet, walks about occasionally without attendants, goes to chapel on the Sabbath, dresses neatly, is very cleanly in his person, is civil and re- spectful to all in authority, and harmless and docile with all other pa- tients with whom he associates ; he keeps his bed, room, and garments clean, takes his food at table with knife and fork with propriety, and is in all respects a decent man. His mind is as insane as ever ; he has great possessions in his native town and in Boston, and offers large sums if he can go on to his farm and be suffered to manage his own business unmolested.

STATE LUNATIC HOSPITAL. 65

Case 7. Among the first patients committed to the Hospital, was a Vagrant, who, having wandered from his native State in the far West, was taken up and confined in one of the Houses of Correction in this Commonwealth. It was not known how long he had been insane, or what had caused his malady. The place of his confinement was not the best, and when he came into the institution his appearance was most forbidding. He was a mere skeleton in flesh ; his countenance was haggard in the extreme ; and he looked as if he was fast declining under fatal disease ; his mind was as dull and imbecile as his body was emaciated ; he had a voracious appetite, and complained of having been starved ; he was entirely negligent of his personal appearance, and his habits were all vitiated and depraved. He was allowed as much whole- some food as it was proper for him to have; but it was a long time before he became satisfied with his supply. His room was neat, and his bed comfortable, and it was enjoined upon him to keep them so. After a while, his appearance improved ; he gained flesh and strength, in the course of three or four months his liealth became good ; and he has since become corpulent and enjoys excellent health. His mind and feelings, however, did not improve so favorably, he was morose, ill- natured and obstinate. He made a desperate attack upon the Steward, who was endeavoring to persuade him to labor, and was determined that he would not work at any rate. After a while he could be persuaded to do some work, and in the course of the year became reconciled to labor ; he now assists much in the domestic work of the establishment, and often goes into the garden and field, and labors faithfully. The vigor of his mind has hardly kept pace with the increase of his physical strength, but has brightened up greatly, and he has become a very pleasant man. The greatest change has been made in his habits; it was nearly two years before he desired to change his habiliments, and assume the character of a gentleman ; he then wanted better clothes ; they were furnished him, and he was very much gratified; he kept them well, and they made him respect himself He now works every day, goes about the premises wherever he pleases, attends chapel every Sabbath attired in his " Sunday suit," with his " fingered gloves" and his " nine dollar hat," and enjoys himself well. He is still very insane, owns many houses and farms, great stocks of cattle, and vast possessions in this town and elsewhere, which he sometime intends to visit and enjoy.

Case 8. In the Spring of 1836, there was brought into the institu- tion, a female, who had been long in confinement, and who was reduced 9

m STATE LUNATIC HOSPITAL.

to degradation the most extreme and miserable that it is possible to con- ceive ; so bad were her habits that she was kept in a solitary room where she was regardless of ail decency ; she had not, for a long time, associated with any human being, and was considered hopeless and incurable. She was dressed in a decent suit when brought to the Hospital, and when introduced into her neat and pleasant apartment, she seemed pleased. The next day she worked a little and showed that she had not forgotten how to labor, and she was encouraged to perse- vere. Her personal habits, however, continued bad for a long time ; as she was brought to mingle more with decent society and saw what were the practices of others, her self-respect increased, and her habits improved. She is now neat and cleanly in her person, engages in daily labor in the work-room, attends the matron's parties weekly, and dresses genteelly ; she attends chapel every Sabbath, and much of the time has united in our choir of music, and thus from the most degraded and filthy being, she is transformed into a decent and useful woman. Yet there is no change in the state of her mind ; she is as insane as ever, and has the same delusions which have characterized her case from the commencement.

Case 9. The subject of the following case of Homicidal Insanity came into the Hospital in the Spring of 1834. He was a young man of twenty-three years of age when he committed the deed. He was known previously to be somewhat insane, but was supposed to be harmless, and entirely safe to be at large. On the morning of the homicide, he was left in the room with a child, some accounts have said, asleep in a cradle, but he says in a bed, while the mother of it went to milking. While she was gone, an irresistible impulse seized him to kill the child; he took a razor and cut its throat so effectually that it appeared not to have moved ; and when the distressed mother returned to witness the horrid spectacle, it was dead. He then seized an axe and followed an aged gentleman to destroy him also ; but he was rescued in time to save his life, and the maniac was arrested and confined. It has been said that he acted at the time from the supposed direction of Almighty power which he dared not resist ; he denies this at present, and says he can give no reason why he killed the child, but he could not help it and is entirely innocent. For a long time after he came into the Hospital, he had turns of great anxiety and distress ; at such times he would re- peatedly and loudly proclaim his innocence.

From the time of the homicide till he came into the Hospital he was in confinement in the jail of his native county, except for a season when

STATE LUNATIC HOSPITAL. 67

he was in an institution for the insane, from which he returned to the jail without particular benefit. For a long time after he came under our care he was a most unhappy man, talked loudly, vehemently and fre- quently about the child, and always has appeared particularly afraid of death. He has, for the last year or two, been generally quiet, works well, appears neat and cleanly in his person, keeps his room in good order, takes his food in the most quiet and orderly manner, attends chapel, and conducts himself well every Sabbath, and always wears a pleasant countenance, on which, nevertheless, anxiety is often seen to dwell ; and he most earnestly wishes that, if he dies, he may be re- moved to his native town and be buried with his fathers.

He is not very communicative on the subject of the homicide, it is possible he may not recollect all the circumstances of that dreadful day which has, for years, filled his mind with so great apprehension and alarm.

Case 10. The subject of this case came into the Hospital in the autumn of 1837 ; he had been insane about eighteen months ; his age was sixty-seven. The information given respecting him was this. The winter of 1836 was one of great severity in the region of his residence.

The supply of fodder for the cattle was deficient, and among others, our patient suffered greatly in his feelings to see his stock suf- fering with hunger, and, being unable to procure the means for their subsistence, was obliged to see some die of starvation, others he killed to save them from the same dreadful end. In addition to this, his wife sickened and was languishing with a rapid consumption. He was sus- tained in all these trials by the consolations and promises of Christianity ; he was an exemplary professor of religion, and his piety was ardent and sincere. In March 1836, a pig belonging to him was attacked with hydrophobia and was running at large among his and his neighbors' flocks ; he with others had great difficulty in securing the dangerous animal, and it cost them a labor of many hours to accomplish it , he be- came greatly fatigued and felt unpleasant sensations in his head, and on the following nights was sleepless and restless. His head feeling so bad, he was advised to be bled. This was done freely ; but he gained no relief, and almost immediately became worse. For the first time he now neglected to read his Bible, and omitted his morning and evening devotions. His sleeplessness and restlessness disturbed his sick wife, and he took separate lodgings. He now felt strangely indeed, and began to look upon himself as the vilest of men ; the Bible, which had

68 STATE LUNATIC HOSPITAL.

been his delight, became a thorn to him, and for months after he came to the Hospital the sight of it, mentioning it, or hearing it read, would throw him into the greatest possible excitement, and he would scream violently. While in this condition he had a great propensity to suicide, and, on one occasion he ran, with all speed, to a neighboring river, intending to drown himself; some of his friends seeing him and sus- necting his object, pursued and overtook him, thus preventing the dreadful purpose of his mind.

When he arose from his bed on the morning of the 19th of March, as he related the story, having passed a sleepless and wretched night, he felt as if he could tear in pieces every thing before him ; a sudden impulse seized him that he must kill his wife ; he rushed into her room, seized her as she lay sleeping, exceedingly feeble and emaciated, threw her upon the floor with great violence and stamped upon her. She awoke in great fright, screamed " murder," and exclaimed, " Mr.

, you have killed me." The family were aroused by her cries,

and soon came to her rescue. He was secured and confined ; his wife failed rapidly after this, and soon died. From this time he became im- pressed with the idea that he had murdered his wife ; her image was constantly before him as she lay upon the floor, her countenance wild and terrific, and the exclamation, " you have killed me," constantly sounded in his ears. Before and after he came to the Hospital he would exclaim at the top of his voice, " I killed my poor wife," and become so agitated that his whole system would tremble with agony and alarm. At the time of his wife's death he became frantic from the conviction,, that he had committed murder and killed the wife of his youth whom he tenderly loved ; he said he was "given over to the devil," was " unfit to live," and " a fit associate for the meanest imp of the infernal regions." He contemplated suicide and sought opportunities to effect his object, but was constantly watched by his family, or confined so as to prevent it. At times he would be so calm as to labor moderately ; but he informed me that, so great was his propensity to kill his asso- ciates and the children that were about him, he dared not trust him- self with the implements of labor in his hand, and that on more than one occasion he dropped them and ran away. He felt an irresistible propensity to kill, yet shuddered at the thought of doing a deed so hor- rible : he knew it was wrong, but yet in a moment it would return again so forcibly, that he could not restrain himself When most calm, he suffered m.ost from the apprehension that he should do some terrible

STATE LUNATIC HOSPITAL. 69

deed ; when this impulse to destroy was greatest, and a mighty strug- gle was going on in his mind, whether he should instantly destroy his family or not, they were often quite unconcerned, pursuing their em- ployments, not suspecting his designs.

On one occasion he felt that he must burn his barn ; he instantly seized a fire-brand and ran towards it with the fullest intention of ac- complishing his object ; he was fortunately prevented by the interference of his friends. Much of the time his thoughts were occupied by the contemplation of suicide, and the impression that he must commit homicide.

For a long time after he came to the Hospital he was the most wretched man conceivable. At the sight of the Bible he would scream many minutes so loud as to disturb the whole establishment ; by a visit from myself he would be thrown into the greatest agitation, and declared that he wanted to kill me and would kill me, making use of language violent and profane. At times he was composed and rational, would converse calmly, tell a story collectedly, and perhaps while seated by him, one of these impulses would seize him, he would be instantly in a rage and scream with frightful violence.

It was many months before he improved essentially ; his physical health was bad ; he had frequent, slight attacks of erysipelas in the face, and other sudden attacks of ill health. After a long time he be- came more composed and cheerful ; his diseased impressions wore away ; he was able to read the Bible with comfort and satisfaction ; attended religious worship in the chapel ; lost his gloom and despondency, and became a pleasant, social and rational man. He left us and returned to his home with the best feelings towards the institution and all his for- mer affection and attachment to his family. Most of the facts above detailed respecting the patient before he came to the Hospital were de- rived from him after his mind became composed and rational.

The history of similar cases might be written to fill a volume ; but enough has been presented to show tbat the institution, besides restor- ing many to health and soundness of mind, is ameliorating the conditi on and increasing the happiness of a large class of the most unfortunate of human sufferers whose history is never given to the public ; and these cases are, from time to time, presented to show the benefits which re- sult from watchful care and mild management in cases hopeless and incurable.

The results of labor have never been more satisfactory than the past

70

STATE LUNATIC HOSPITAL.

year. It is the first season that we have improved the land procured for us by the munificence of the government ; much of the farm pur- chased for us was in a low state, and will require enriching and culti- vation to make it as productive as it ought to be ; it has, however, already been very much improved. There is a manifest difference in the feelings of the cultivator when the land is his own or that of another ; this feeling pervades our family as well as others. The inmates who labor have taken an interest in all improvements, and have lent a cheer- ful hand in effecting them.

The garden, which has been cultivated for some years, has become quite productive, and is an interesting field of labor to a very large num- ber of the inmates. Ninety per cent, of the labor of a garden containing four acres, cultivated principally to roots and minor vegetables, has been performed by patients, many of whom have derived great pleasure and advantage from the exercise.

The following statement, furnished by the Steward, shows the amount of produce raised, the profit of our agricultural and horticultural ope- rations, and the labor on improvements of various kinds.

In the garden were raised

500 bushels of Carrots at	40 cents a bushel,	$200 00
200 " Beets	40 ''■		80 00
80 " Onions "	90 "		72 00
75 " Turnips "	40 "		30 00
90 " Ruta Baga "	2 shillings		30 00
100 " English Turnips "	25 cents		25 00
1000 Cabbages	5 "		50 00
1 1-2 loads of Winter Squashes,			30 00
5 " Pumpkins at $1 50 per load.		7 50
4 barrels of Pickles,			16 00
Green Vegetables in abundance, as	Beans, Peas,	green
Corn, Squashes, Lettuce, Cucumbers, &c., estimated at	75 00

Produce of the Garden,

1615 50

Besides this amount a large quantity of excellent fodder was fur- nished from the tops of the Ruta Baga, Beets, &c., which almost wholly fed a pair of oxen and seven cows for some weeks during the season of drought.

STATE LUNATIC HOSPITAL. tl

On the farm were raised 300 bushels of Potatoes at 37 1-2 cents per bushel, 40 " Corn at $1 17

16 tons of Hay at $15 per ton, 10 loads of Pumpkins at $1 50 per load, Corn Fodder, estimated at Pasturing seven cows 22 weeks, at 50 cents,

bushel.	$112 50
((	46 17
	240 00
	15 00
	10 00
cents,	77 00
Farm,	$500 00
Garden,	615 50

1116 17

We have raised, fattened and killed

12 hogs, weighing 4800 lbs.

6 pigs, « 1720 "

6520 lbs. at 11 cts., 717 20 Pigs sold, 126 00 ; killed 2, |5 00; Poultry, 128 lbs. at

16 cents, 51 48

1844 85

In addition to this, much labor was employed in various improve* ments on the garden and grounds. At least one hundred rods of wall have been built, the stone dug and drawn, ditches have been made, land cleared of bushes and stones, &c.

The sixteen tons of hay were mowed and made entirely by the pa- tients; the carting alone being done by the farmer. Vrom four io Jive hundred cords of wood have been sawed and piled ; tioo cellars for the infirmaries were dug, fifty-one feet by twenty-two , a very large propor- tion of which labor was performed by the inmates of the Hospital.

The females have not been less industrious than the males, but have been constantly employed in the various departments of domestic labor, making clothes and bedding, knitting socks and stockings, binding shoes, &c.

In the shops, more or less labor is constantly done. In the carpen- ter's shop, the labor has been principally confined to repairing furniture and utensils, and making such articles as are needed in the establishment.

In the shoe shop, the following statement will show the extent of our operations.

72 STATE LUNATIC HOSPITAL

The amount of work done, according to the statement of

the Overseer, with value of tools and stock on hand^ $1264 66

Expenses have been for stock, f 650 27

tools, 59 98

fuel, 10 00

Board and wages of Overseer, 301 82

1022 07

Making a profit of $242 59

The shop has been in operation ten months.

There have been from Uvo io four inmates in this shop constantly ^ during the season ; they have been required to do but little labor, no more than has been advantageous to them. In a number of cases, this labor has proved decidedly beneficial to convalescent patients, and has done good to all. There may be some discount on the value of manu- factured articles on hand ; but there can be no doubt that the business has afforded a profit ; and its convenience in repairing and furnishing shoes for our family, must be obvious to all.

At the commencement of the report I remarked that we had enjoyed uncommon health in the institution, and that much benefit in this par- ticular, may be attributed to the excellent arrangements, in the Hospital buildings, for warmth and ventilation ; both these objects are effected by hot air furnaces in the basement. From much experience and no little reflection I am fully satisfied that every other mode of warming, is objectionable ; and no other assists in ventilation, an object hardly secondary to warmth, as a means of promoting health in this and simi- lar establishments. - Stoves, steam and boiling water may be used to afford a proper degree of temperature, but can never be as safe and effectual as the furnaces which are here used. From the former, the warmth will not be well diffused, and the temperature will not be equal in different parts of the apartments ; some parts will be too warm, and others too cool, and the air will rush in at every crevice to supply com- bustion and the waste which the outlets will occasion.

Furnaces to warm such establishments should be placed in the basement of the building so that the heat can ascend directly to the apartments above ; the air chambers should be capacious, and the pas- sages large so that the current can be free, and a large volume of air be forced into the apartments heated not many degrees above the tem- perature at which they should be kept, so that the whole air may be

STATE LUNATIC HOSPITAL, 73

frequently changed, and the foul air be forced out at the ventilating passages.

In all cases external air should be used. If the cellar be sufficiently large to aiford a supply, the air is always contaminated with vegetable odors, or other offensive effluvia, which is a sufficient objection to its use; besides this, the air of a cellar, when in any way removed, must always be supplied from without. Many attempts to warm buildings in this way, have failed for want of attention to this important circum- stance. It requires a great quantity of air to warm so extensive an establishment as a Hospital, or so large a room as a church; if the cellar be as large as the building itself, the air cannot be removed from it to any great extent, unless the means of supplying the deficiency are amply provided ; for one given quantity of air cannot be removed with- out another be at hand to supply its place. If, therefore, a cellar is to be relied upon to supply air for a furnace, it is obvious that it must be many times as large as all the apartments to be heated.

In the construction of such furnaces, the principal design should be to keep up a constant and regular influx of warm, pure air, in such abundance, as to change the whole atmosphere of the apartments, fre- quently. In this way the currents are made to be outward, not only through the ventilating passages, or flues, but also through every cre- vice which admits air into the room.

The currents from the crevices being small, are met at their threshold by an ample supply of warm air, which, if it does not force it back, will warm it, and thus render it inoffensive. In rooms heated in this man- ner, the temperature will be equable and well diffused, so that at the windows and by the walls, it will be comfortable even in cold weather ; this will not be true of any other mode of warming.

For the purpose of ventilation, the flues for the escape of the contami- nated air must be in due proportion to the apertures admitting fresh air from without ; if too small, the escape of foul air will be retarded; if too large, the temperature of the rooms will be too much reduced, or the consumption of fuel be greater than is necessary. As on one hand we cannot derive air from a source which does not contain an abundant supply, so on the other, we cannot force any considerable current of air into a room already full of air that has no outlet ; as well may we attempt to force water into a vessel that is already full.

The furnaces we use and most approve in this Hospital, are con- structed by an ingenious mechanic in this village, one of which is 10

74 STATE LUNATIC HOSPITAL.

sufficient to warm fifty apartments in three stories, and the long halls connected with them ; the quantity of fuel which these consume in a day is one quarter of a cord of good wood during the cold season. In the Hospital, we prefer wood to coal for many reasons, particularly as it is here much cheaper. The preparation of wood for the fire, sawing, cutting, splitting, piling and carrying to the various departments, makes a great deal of valuable labor for our people, of which they are fond, and which they volunteer to perform. All the labor upon coal is disa- greeable and forbidding. There are other reasons not less important for preferring wood to coal. If it be found that the temperature of the rooms is too low, a small quantity of dry wood will make afire that will raise it immediately without making it too great in the end ; whereas, if coal be added to the fire under such circumstances, the temperature will continue to diminish for some time ; and, when the whole be- comes ignited, the fire will be too great, and the apartments become too warm.

I have made these remarks on the subject because I believe that some misapprehension exists as to the utility of furnaces in warming large establishments, and because I have the fullest conviction, arising from much experience and observation, that no other mode of warming or ventilating Hospital buildings should be adopted in any case, or that they can be equally conducive to the health and comfort of the inmates.

The Infirmaries, erected by order of the Government, have been com- pleted in a very satisfactory manner. They are durable structures of two stories, e<ic\\ fifty-one feet in length and eighteen feet in width, oc- cupying the entire space between the lateral wings and the lodges on one side, and the wash-room on the other.

The buildings are of brick and the roof of slate, which makes them nearly fire-proof; the apartments are spacious, well warmed and ven- tilated, and so secure as to render them as safe from escape as any part of the Hospital. They have been fitted up in a neat and comfortable manner, and are now ready for the sick.

It is a source of great satisfaction that we now have departments out of the halls, for the sick, where they can be quiet and undisturbed, and receive all the aid that any private boarding-house can afford. In case of an epidemic or infectious disease, the inmates of the wings may be preserved free from danger by the timely removal of all the infected. The basement rooms are useful for the storage of wood or vegetables, and contain the furnaces used for warming the apartments above.

STATE LUNATIC HOSPITAL. 75

Ever since the opening of the Hospital we have been impressed with the utility of reading for the better classes of our patients. The Bible and New Testament have been given to them freely and unreservedly ; newspapers and periodicals are greatly sought after, and extensively circulated throughout the establishment. From the Worcester County Bible Society, we have received two very liberal donations of Bibles and Testaments which lay us under the deepest obligations to that ex- cellent Association. From Alfred D. Foster, Esq., Bezaleel Taft, Esq., John Tappan, Esq., Samuel Jennison, Esq., and Miss Emilj Gardner, we have received valuable contributions of books which have furnished much useful and interesting reading for our people. In the month of July, a Miss Harland, of Philadelphia, visited the Hospital, and attended the religious worship of our Chapel on the Sabbath ; she expressed herself greatly pleased, and on leaving, placed ten dollars in my hand, with which she requested me to purchase a judicious list of books, designated by herself. Soon after this, our esteemed friend and fellow-laborer, Wm. M. Awl, M. D., Superintendent of the Ohio Lu- natic Asylum, while on a visit to the Hospital, also contributed ten dollars for the same benevolent design. For two successive years, the Trustees appropriated twenty-Jive dollars to purchase suitable books. By these means we have been able to furnish much valuable reading for our family, which has relieved many tedious hours of seclusion and confinement.

It is now more than a year since we commenced having religious worship in our chapel. During that time, with very few exceptions, we have had two regular meetings on each Sabbath ; more than one hundred sermons have been preached to our congregation by about thirty clergymen of different denominations. At the present time we have a regular chaplain. We have a choir of singers, who perform very acceptabljr every Sabbath ; in the course of the season, from thirty io forty patients have belonged to this choir, on some occasions the music has been led by a patient ; we have never less than two, and generally three ox four musical instruments in our choir.

It was our design at the commencement of religious worship for the insane, to give our chapel all the solemnity of a church dedicated to Almighty God, and to our religious exercises, all the dignity and char- acter of other religious assemblies ; for this purpose we employed a regular preacher, assembled a choir of singers, and adopted the same hours of meeting, that are customary in the New England churches.

We soon found, that to carry out our plans to perfection in this im-

76 STATE LUNATIC HOSPITAL.

portant part of moral management, we must have the aid and assis- tance of every person employed in the Hospital. If individuals , chose to attend church elsevi^here, it was proof to the minds of our patients that other places were preferred, and of course supposed better. This^ to many, seemed at first too arbitrary. Almost every person employed at the Hospital had attended some one of the churches in the village^ paid his taxes and owned or rented a seat for which he had paid or was obligated to pay. After much deliberation it was resolved to take a decided stand and make a regulation, that every officer of the insti- tution must attend worship in the chapel, on the Sabbath, and nowhere else. The example was set by my own family, my Assistant, the Stew- ard and Matron. With an unanimity and disinterested zeal worthy of all commendation, did our whole family come into the measure, and have persevered, without a desire of change to this time ; to this most benevolent and necessary action of our whole body of attendants and assistants, we are greatly indebted for the perfection and beauty with which this part of our plan of management has been accomplished.

The number of patients that have been in the Hospital, since the chapel was dedicated, is three hundred and seventy-six, of which num- ber, three hundred and fourteen have attended religious worship. Of the one hundred and seventy -seven that have been admitted during the last year, one hundred and forty-four have been in the chapel more or less.

The number that assemble on each Sabbath varies from one hundred and twenty to one hundred and forty, makmg, with our family, a con- gregation of from one hundred and seventy-five to two hundred.

The order and decorum of these meetings has been to all who have witnessed them no less gratifying than surprising ; the patients have, almost without exception, felt the importance of quiet and order.

The power of self-control, which many excited patients have exer- cised in the chapel, during the hour of worship, a control which no motive could induce them to exercise elsewhere, is itself a most forci- ble argument in favor of religious worship for the insane.

Many interesting examples might be given of the restraint which these occasions have imposed, which exhibit, in a strong light, the influence which our institutions of religion have upon the character of our citizens even when insane.

On the evening previous to the dedication of the chapel, a patient was brought to the Hospital, who had been quite furious and excited for a considerable time ; he was so much fatigued by his journey, that

STATE LUNATIC HOSPITAL. 77

he went immediately to bed, and we hoped would be quiet and rest well through the night ; after midnight he arose in great alarm, rushed to his window and broke the glass as rapidly as possible. The distur- bance which he made, aroused me and others, and we were immedi- ately in his room ; he was exceedingly agitated and declared that ene- mies were breaking into his room and he was fighting them off. He was placed in a strong room and suffered to remain till morning. When I visited him in the morning, he was composed and peaceable ; having learned that we were to have a public meeting in the chapel, he proposed to attend. I expressed some fears that he would not be able to control himself; but upon receiving his pledge, consented that he might attend. During the service he was perfectly quiet and con- ducted with the utmost propriety ; the next day he again broke his window on the same pretence. He continued considerably excited for some time after, but attended chapel every Sabbath and conducted with the utmost propriety. He recovered favorably and was discharged in less than three months.

Sometime in the Spring, a female patient came into the Hospital in the highest state of excitement ; she disturbed the whole establishment for three ox four days and nights previous to the Sabbath. On Sab- bath morning she appeared more composed, but far from being quiet ; when I visited the hall in which she was confined, she approached me very respectfully and asked if she could attend meeting. I told her our rules were very rigid and I was afraid she could not observe them strictly ; she inquired what they were, and was told that she must sit still, be quiet and attend strictly to the preacher; she promised to do all and was permitted to attend. She was still till the choir began to sing, when she struck up loudly, but not discordantly with the choir ; she was gently checked by the attendant who sat beside her and re- quested not to sing ; she replied in a whisper, " That was not in the pledge to the Doctor." She however, concluded to desist.

After the service was over, she complained bitterly that she was not permitted to sing unmolested, and declared that if she went in the after- noon she would sing at any rate. I was informed of her determina- tion and sent word to her, that as she was not accustomed to sing with our choir she must defer it till she had some opportunity to practise with them, when we should be very glad of her assistance. She hesi- tated a minute, and then said, " give me a cracker, with the aid of that I think I can stop my mouth and keep still." The cracker was given her ; during the singing she used her cracker, and went through the

7^8 STATE LUNATIC HOSPITAL.

service perfectly well, and, although often much excited, she has always conducted with propriety in the chapel.

Within a few days a man came into the Hospital in the state af most furious mania. He arrived in the evening, passed a disturbed night and was greatly excited the following day. The next night he was more calm, and was removed to a more comfortable apartment than he had previously occupied. This was on Friday morning. When I entered the hall in which was his apartment, to make my morning visit, I found him in great excitement, having just broken every thing within his reach, and exhibiting the greatest violence. When the attendant went to his room he made a desperate attack upon him, tried to strike,^ kick and bite all who assisted in holding and securing him with proper confinement. He soon became more calm, and the remainder of the day and the next he was composed and quiet, and promised that he would scrupulously observe every direction that I should give him.

The next day, being the Sabbath, I found him in bed, calm and quiet • he expressed a desire to attend religious worship in the chapel, on receiving his pledge he was permitted to attend. He conducted with the utmost propriety, and although yet quite insane has attended regularly each chapel exercise since, and has appeared as well as it is possible for any man whatever to appear.

On the same day that the last named patient came into the Hospital, another man equally violent and insane was also admitted. He was not as manageable at first as the patient last mentioned, but tore his clothes and refused in any way to be covered. During the whole of the Sabbath he was naked in his cell, and wholly destitute of self-com- mand and self-respect.

In the course of the next week he became more composed, consented to wear his clothes, and was removed to a more comfortable apartment. He was pleasant, but quite insane and considerably boisterous. On the Sabbath, which was the last, he proposed to attend chapel ; on his conforming to the rule, consent was given that he might attend. He went during the day, was greatly delighted with the meeting, and has since changed in the most favorable manner ; he appears at this time to be rapidly recovering.

Sometime in the winter, a young woman was brought to the Hos- pital, whose mind appeared perfectly demented ; she talked incessantly in the day time and most of the night, and there appeared to be no amendment in the case for a long time. One Sabbath morning while

STATE LUNATIC HOSPITAL. 79

talking in her indistinct and rapid manner as usual, I proposed to her to attend chapel more to see what influence the proposition would have upon her mind than from any expectation that she would consent to go or would command herself if she went. She expressed a desire to attend, and was permitted ; she was perfectly silent and quiet for the hour, made not the least disturbance and returned regularly to her room ; no sooner had she done so than she commenced talking again and continued it till the hour of service in the afternoon. She again attended in the same orderly manner and continued to do so for weeks although the same disposition to talk remained. She ultimately recov- ered, and the first motive which was effectual to excite self-control, was the desire and determination not to disturb the religious exercises of the Sabbath. The benefit of one hour of self-control in such a case, from such a cause is incalculable. It is needless to add cases. If a stranger was to visit our congregation in the chapel, he would at first discover little worthy of observation ; he would find from one hundred and fifty to two hundred people assembled together, quietly seated, neatly dressed, resembling in all respects an ordinary congregation.

If, however, he was told that here from eight to ten homicides were mingled with the others, and four times as many other individuals who, in their moments of excitement, had violated the public peace or trampled on private rights when wholly irresponsible ; that on his right hand sat the " owner" of all things whose self-complacency will not be likely to be disturbed by any animadversions which may be made upon the character of the " true God ;" that by him sits the poet and commentator who swallows every word that is uttered from the desk, and returns to write commentaries on the text which shall, at some future day, fill his purse with riches and the world with "celestial light ;" that here may be found " the King of England, the King of Heaven, the heir apparent to the throne of Prussia," and the " Prophet over Albany, who speaks from Jehovah," and who daily expects the " Patroon" to send him a coach with black horses, to carry him to his friends ; that here is also the military chieftain, the man of wealth, " the rich poor man and poor rich man," the mother of Christ and innumerable other characters not less consequential ; that here may also be found the laughing idiot, the perpetual jabberer, the gay, the passionate, the depressed, a hundred individuals with the delusions, impulses and propensities of insanity so active as to be constantly obvi- ous in their conduct and conversation elsewhere, now listening with deep solemnity to the exhibitions of divine truth, uniting with apparent

So STATE LUNATIC HOSPITAL.

devotion in the fervent prayer, and joining vj^ith pleasure in the song of praise, — I say, could all this fail to astonish him ? Can an hour, twice on each Sabbath, spent in this way fail to make the most favorable impression on the insane mind ?

What may not be expected from one hour of self-control, brought into requisition twice on each Sabbath, independent of the instructions and admonitions from the desk ?

The more I contemplate this subject, and the more I witness this influence, the greater is my estimate of good from our chapel exercises.

There is no community that observes the Sabbath more strictly than that of the Hospital ; no labor is done but what is work of neces- sity or mercy. Amusements are all laid aside, and the Bible, religious publications, sermons and other appropriate books are very generally read on the Sabbath, before and after worship, by the quiet and sober part of our family.

It has ever been our plan to bring the insane mind under the influ- ence of rational motives as far as possible. We discourage as far as practicable every departure from the customs and habits of rational society ; we acquiesce in the general desire to keep the Sabbath as holy time, and discountenance both labor and amusement as incom- patible with the solemn contemplations and religious duties of the day.

That the influence of regular religious worship should be well un- derstood and duly appreciated, individuals of all classes of the insane have been permitted to attend our religious exercises, who would give a pledge to observe suitable quiet and order in the place, and it has been truly interesting and curious to see how faithfully the pledge has been observed.

The religious melancholic has in no case been deprived of the priv- ilege of attending worship when desired, and we have learned a fact no less interesting than important, that the same judicious discourse and religious exercise will calm the excited, awaken serious contem- plation in the giddy and unreflecting mind, and at the same time in- spire confidence and awaken hope in the depressed and melancholy. Very few, if any, have been unfavorably affected by the exposition of religious truth in the judicious but forcible manner in which it has usually been given in our chapel. All our former views on this sub- ject have been more than realized by this year's experience of religious worship. The principles of Christianity are eminently calculated to excite rational contemplation, calm the perturbed feelings, and encour- age the faithless and desponding in the way of duty.

STATE LUNATIC HOSPITAL. 81

In the condition of composure, a motive of self-control can gener- ally be found to influence the insane ; he can be thrown upon his re- sponsibility and be made to feel that he is accountable for his conduct as well as others ; and, even when he is excited and agitated by the illusions and impulses of his disease, who can say, that the fervent de- votion of his soul poured out in prayer to his Heavenly Father, may not be heard with complacency, and accepted with approbation at the Throne of Grace ?

It will be seen, by our augmented numbers, as well as by the extent of our operations in the various departments of industry, that the duties and labors of the Hospital have increased every year since its establish- ment. No small item of responsibility and care has been added by the introduction of religious worship on the Sabbath.

While this report is being written we have more patients in the in- stitution than there are rooms for their accommodation. In the course of the last year a number of patients have been discharged for want of room and more than ninety applications have been rejected from the same cause. Such a crowded state of the Hospital is attended with much embarrassment when the press of patients from the courts is as great as it has recently been.

In the supervision of the establishment, I have derived every aid from my associates which it has been in their power to render ; and I take great pleasure in bearing testimony to the fidelity of all who have had a duty to perform in any department.

The success which has hitherto attended our efforts in the manage- ment of the institution, prompts us to continue our exertions to sustain its reputation and render it still worthy of the patronage of the gov- ernment and the confidence of the public.

SAMUEL B. WOODWARD.

State Lunatic Hospital, December, 1838.

n

STATE LUNATIC HOSPITAL.

TREASURER'S REPORT.

To His Excellency Edward Everett, Governor, and to the Honorabk Executive Council of the Commonwealth of Massachusetts :

The Treasurer of the State Lunatic Hospital respectfully presents his Sixth Annual Report.

The Treasurer charges himself with Receipts from December 1, 1837, to November 30, 1838, inclusive, as follows:

Prom the State Treasury, - - - $8,000 00

Prom cities, towns and individuals, including credits on sundry bills for flour barrels, grease, ashes, old iron, &c. ' - ^ - 21,550 74

Balance to next account, . - - 530 01

He credits himself	as follows :
For balance of last account.	1341 35
" payments foi	■ improvements and repairs.	1108 98
(( C(	salaries, wages and labor,	6513 29
(( tc	furniture and bedding.	1712 28
It l(	clothes, linen, &c.	2006 29
(( (<	fuel and lights, -	2692 41
<( ((	provisions and groceries,	12,760 57
(( «	medical supplies.	718 00
(( ((	hay and straw,	340 59
le (I	miscellaneous.	886 99
Deducting the balance of last account, the cost
of supporting the institution is -	$28,739 40

The item of clothing, linen, &c. includes the cost of most of the stock for the shoe shop, which has been put in operation since the last report.

STATE LUNATIC HOSPITAL.

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Provisions and Groceries include

Apples, pears, berries, oranges, lemons, raisins.

apple-sauce, &c.	-	-	$425 81 1-2
Spices, salt,	, and small	groceries.	-	191 64
Soap,	-	-	-	279 78
Honey,	-	13 lbs.	-	11 68
Vinegar,	-	7 barrels 36 gallons,	34 92
Milk,	-	4031 quarts, -	-	204 29
Butter,	-	8538 lbs.	-	1828 57
Cheese,	-	7973 lbs. 15 oz.	-	799 13
Beans,	-	33 bushels,	-	55 30
Eggs,	-	264 6-12 dozen.	-	53 22
Peas,	-	12 1-4 bushels.	-	23 44
Cabbages,	-	44	-	2 50
Turnips,	-	54 bushels.	-	19 95
Potatoes,	-	1073 bushels.	-	411 06
Corn,	-	952 bushels,	-	1041 38
Rye,	-	164 1-2 bushels.	-	115 88
Oats,	-	275 bushels.	-	144 58
Biscuit,	-	-	-	151 56
Rice,	-	1933 1-2 lbs.	-	99 17
Flour,	-	231 1-2 barrels.	-	2065 34
Tea,	-	680 lbs.	-	207 26
Coffee,	-	1437 lbs.	-	154 03
Brown sugar.	9349 3-4 lbs. -	-	832 97
Loaf sugar,	-	567 12-16 lbs.	-	86 93
Molasses,	-	607 gallons.	-	257 28
Poultry,	-	415 1-2 lbs. -	-	58 31
Fresh fish,	-	2878 1-2 lbs. (20 shad, 3 lobsteri	3,) 104 24
Salt fish.	-	4804 lbs.	-	180 66
Mackerel,	-	4 3-4 bbls. 102 lbs		61 24 1-2
Salmon,	-	1 bbl. 93 3-4 lbs.		28 61
Ham,	-	238 lbs.	-	33 61
Sausages,	.	184 1-2 lbs. -	-	26 90
Mutton and Lamb, -	1944 1-2 lbs. -	-	189 38
Pork,	-	2252 lbs.	-	253 19
Beef,	-	22,091 lbs.	-	1658 69

STATE LUNATIC HOSPITAL. 87

Salt beef, Salt Pork, Veal, Liver,

5 bbls. 544 1-2 lbs	75 76
8 bbls.	- 214 13
3531 lbs.	- 277 12
-	1 05
	$12,760 57

Fuel and Lights include

Wood,	496 cords, 10 inches.	2268 66
Charcoal,	1214 2-3 bushels.	130 26
Anthracite, -	4 tons 2 qrs. 22 lbs.	53 63
Oil,	263 1-2 gallons,	224 23
Wicking, and 82 lbs.	of candles.	15 63

$2692 41

Miscellaneous includes

Money paid to patients when discharged, or advanced to

them and charged in their accounts. Expenses of pursuing elopers, - - . -

Expenses of Trustees' visits, . -

Funeral expenses, -.-,..

Postage, _...._

Sleigh, $40 50— three cows, $140,

Books, periodicals, stationary, printing regulations, &c. - Sundries, .„.---

* Including ^50 for an escape of a preceding year.

183 47
64 57*
96 86
115 00
45 24
180 50
109 35
92 00

$886 99

The accounts, of more than one year's standing, on the first of Jan- uary in each year, are, by direction of the Trustees, placed in the hands of the Attorney for the Middle District for examination, and, if practicable, for collection. Very few, however, which are collectable, require his care. Several remain in his hands, and more will be placed there in the ensuing month.

88 STATE LUNATIC HOSPITAL.

The receipts from towns and individuals, during the past year, have been larger, and the expenditures less, than the estimates of the last report.

Of the appropriation made by the Legislature at its last session, $4000 remained in the treasury of the Commonwealth on the first inst. The Treasurer has since received it, and holds the unexpended bal- ance in his hands. The receipts will probably equal those of the past, in the year ensuing ; but, with the amount on hand, will not be sufii- cient for the expenditures. The Treasurer would propose that an appropriation of $9Q00 should be naade this year as in the two last years.

A. D. FOSTER,

TVecaurer of the State iMnatic Hospital,

Worcester, Dec. 1838.

= 5

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E V E W T H

ANNUAL REPORT OF THE TRUSTEES

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STATE LUNATIC HOSPITAL

AT WORCESTER

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DUTTON AND VVENTWORTH, STATE PRINTERS.

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