\\f~92r

1354 -&6 7

102 LUNATIC HOSPITAL AT WORCESTER. [Jan.»58.

SATURDAY.

Breakfast — Coffee, bread, butter, hash of meat and potatoes. Binner — Water, fish, salt or fresh, vegetables, boiled rice, bread and butter.

Supper — Tea or cocoa, bread and butter, apple sauce or honey.

\

The condiments provided, are salt, pepper, mustard and vinegar, for such as desire them.

Toast, griddle-cakes, fried pudding or cakes, to be used once or twice a week, as each kitchen can supply all its boarders equally. Milk is used freely. Apples, in the season of them, are served every day at dinner ; other fruits occasionally. The sick have a prescribed diet.

Bread and butter, or gingerbread, may be had for luncheon.

PUBLIC DOCUMENT No. 27.

TWENTY-SIXTH ANNUAL REPORT

THE TRUSTEES

STATE LUNATIC HOSPITAL

AT WORCESTER.

OCTOBER, 1858

BOSTON:

WILLIAM WHITE, PRINTER TO THE STATE.

1858.

Digitized by the Internet Archive

in 2010 with funding from

University of Massachusetts Amherst

http://www.archive.org/details/annualreportoftr24stat

OFFICERS OF THE HOSPITAL,

TRUSTEES.

THOMAS COLT, Esq., Chairman, Pittsfield.

CHARLES H. STEDMAN, M. D., ..... Boston.

JOSEPH N. BATES, M. D., . . . . . . . Worcester.

WILLIAM T. MERRIFIELD, Esq., . . . . . Worcester.

ROBERT W. HOOPER, M. D., . . . . . . Boston.

TREASURE R .

HENRY WOODWARD, Esq., ...... Worcester.

Office — Mechanics' Bank, Main Street, Worcester.

resident officers. MERRICK BEMIS, M. D., . . . . . . Superintendent.

FRANK H. RICE, M. D., ..... Assistant-Physician.

CAROLINE A. BEMIS, Matron.

HENRY C. PRENTISS, M. D., . . . . Clerk and Apothecary. GEORGE E. BLAKE, . . . Supervisor of Male Department. JULIA A. BUXTON, . . . Supervisor of Female Department. Rev. ISAAC HORSFORD, . Chaplain.

TWENTY-SIXTH ANNUAL REPORT

OF THE

TRUSTEES OF THE STATE LUNATIC HOSPITAL,

AT WORCESTER.

185 8.

To His Excellency the Governor, and the Honorable Council.

The Trustees of the State Lunatic Hospital at Worcester, in accordance with the requirements of the law, have the honor to submit this, their Twenty-Sixth Annual Report.

The discrepancy noticed in the last Annual Report of the Trustees, between the Act of the legislature of 1857, requiring that the Annual Reports of the various state institutions should be made up to the thirtieth of September in each year, and the provisions of the Revised Statutes that the annual meeting of the Trustees of the Worcester Hospital should be held in the month of December in each year, has been reconciled by the passage of an Act of the legislature of 1858 repealing sec- tion 5, chapter 48, of the Revised Statutes, and requiring the Trustees of the hospital to hold their annual meetings in October. The reports of the different officers of the hospital are accordingly made up to September 30th, 1858, and embrace a period of only ten months since their last Annual Report. The Trustees having altered their contracts with the patients for the payment of board, there will hereafter be no difficulty in submitting full reports for the year, from the different offi- cers of the hospital at the time prescribed by the Act of 1857.

6 LUNATIC HOSPITAL AT WORCESTER. [Oct.

In commencing our Report, we desire to express our acknowl- edgments and thanks to Divine Providence for the continued goodness and care which during the last year has kept the hospital from the ravages of unusual disease, has protected it from any great calamity, and by the prosperity vouchsafed to it seems to have marked its approval of the efforts that have been made to alleviate the sufferings of the greatest of human mis- fortunes.

There has not been a great amount of sickness among the inmates of the hospital, and the deaths have been almost wholly confined to worn-out and demented cases of long stand- ing. No epidemic disease has prevailed, and the general health of the hospital has been unusually good.

The report of the Superintendent, which is herewith trans- mitted, exhibits in full the general condition of the hospital and the results of its operations during the last ten months. "We have great pleasure in saying that the confidence we had in Dr. Bemis, and the high expectations we had of his abilities at the time he was appointed to the responsible position of Super- intendent of this old and large hospital have in no particular been disappointed, and we congratulate ourselves and the State that the institution possesses a man so well adapted to the position he occupies. The affairs of the hospital have been managed with prudence and economy, and yet with liberality towards its inmates in the matters of food, clothing and exer- cise. An increasing disposition to orderly and quiet behavior and cheerfulness of intercourse which has been manifest during the whole year, proves to the Trustees that the true remedial measures in the treatment of the insane, are those of gentle kindness, and only by these can be secured the cooperating efforts of the patient himself, which are so necessary to effect a permanent cure.

With great gratification we repeat, what was said in our last Report, that Dr. Bemis has not in a single instance made use of the so called strong-rooms for the confinement of patients ; and we are satisfied from past experience, that their use is by no means necessary in the treatment of even the very worst cases of insanity. Most of these rooms have been removed during the last year and their places occupied by rooms for the exercise and labor of the patients. A few of the rooms have

1858.] PUBLIC DOCUMENT— No. 27. 7

been dismantled and left for the present as a curious relic of the mistakes and misunderstandings of the past.

The restraint placed upon the patients has been slight, being simply a confinement to their own bed-room when too noisy and turbulent, and in a very few (only four) instances of suicidal mania, the camisole has been used. In most instances an appeal to the self-respect and sense of propriety of the patient has been sufficient to insure their good behavior and to prove that even the most insane do not entirely lose their power of self-control.

The Superintendent has made efforts during the year to give employment to the patients, and though he has succeeded in some measure, we regret it cannot be done to a greater extent. We deem a light and cheerful occupation of the bodily faculties an important curative element in the treatment of mental dis- ease, and this is the most important reason for introducing manual labor into an insane asylum. As a secondary object, it might be made a source of revenue to the institution. Most of the patients are willing and desirous to work. Their labor should certainly never be compulsory. But we see no reason why an insane asylum may not be a large industrial establish- ment, where the cheerfulness and gratification of voluntary and successful labor shall drive out the despondency of long days of weary listlessness, and by diverting the mind from the contem- plation of its own disease help to restore it to its natural health.

During the year, Dr. Frank H. Rice has continued, as Assistant-Physician, to render valuable aid to the Superintend- ent, and by his skill as well as interest in all the affairs of the institution, has earned the approbation of the Trustees and of Dr. Bemis. His fidelity to his duties make him a valuable officer of the hospital.

The Trustees have appointed only one Assistant-Physician, Dr. Bemis having preferred to manage the hospital without further medical assistance. This arrangement has imposed greater labor upon himself and Dr. Rice. As long as they find themselves equal to the task, the Trustees deem it for the best interests of the hospital that there should be but one Assistant- Physician.

The duties of Steward have been performed by Mrs. Bemis in a manner creditable to the hospital and highly acceptable to the Trustees.

8

LUNATIC HOSPITAL AT WORCESTER.

[Oct.

The Rev. Isaac Horsford has officiated as chaplain during the year in a manner entirely satisfactory to the Trustees and Superintendent.

By reference to the report of the Superintendent it will be seen that, at the close of the last year the number of patients

372

307

in the hospital was ....	.
Males,	. 177
Females,	. 195
Admitted during the last ten months,	.
Males, .' .	. 142
Females,	. 165
Discharged during the same period,	.
Males,	. 180
Females, .......	. 196

376

Whole number of patients who have received the care of the hospital during the last ten months, 679.

There are in the hospital at the close of this year 301 patients.

Males, Females,

141

160

127 patients have been discharged from the hospital as recovered, and many more of those discharged have been very much improved ; so much improved as to return to their accus- tomed employments. Of the 376 patients discharged, 149 were discharged to enter the new lunatic hospital which the State has erected at Northampton, and the Taunton Hospital. In pre- vious years, when this lunatic hospital was the only one founded by the State, there has been crowded into its walls 570 patients — a number which at once destroyed in a great measure the objects of the institution and rendered it a place to be carefully avoided by those who sought the means of curing' an insane relative or friend. So great an evil as this crowded condition of the hospital, demanded an immediate remedy which the State has provided by the erection of two new lunatic hospitals, one at Taunton and another at Northampton, thus excelling as she does in all her charities, in the provision she has made for the most unfortunate of all human beings.

1858.] PUBLIC DOCUMENT— No. 27. 9

In the Worcester Hospital there are private sleeping rooms for 276 patients. By placing several beds in the same room, the hospital can accommodate 306 patients, without being obliged, as was the case previous to the opening of the North- ampton Hospital, to place any patients at night in beds laid upon the floor. But the rooms in which the associated beds can be, and are placed, were designed for other uses, such as the exercise and recreation of the patients and for work rooms when the patients have employment. To use them for dormi- tories is a perversion of them from what we deem a very impor- tant purpose. The hospital is full with 276 patients, but can accommodate 306 by crowding the beds ; and a larger number cannot be accommodated without injury to the favorable con- dition of the patients.

When the hospital is in a crowded condition there is a ten- dency to discharge patients sooner than it is proper, in order to give more room to new applicants. A patient who relapses on account of premature discharge is almost always sure to be returned to the hospital in a condition greatly worse than at first, if not entirely incurable. In this way the evil of an over-crowded state of the hospital, reacts upon itself.

The Trustees have made such alterations in the wards of the hospital as will increase the entrance of light and air into every part of the different wards, and give to the patients opportu- nities of enjoying the beautiful prospect which the elevated position of the hospital buildings commands. Recesses have been formed in most of the wards, and furnished in such man- ner as to give them the appearance of a social sitting-room, instead of the comfortless look of a hospital hall. Pictures, and books, and plants, have been placed in the several wards, and the use and care bestowed upon them by the patients shows how acceptable they have been.

The Superintendent has given much attention to the classifi- cation of patients, classifying and separating them according to their previous social position in life. The Trustees desire to express their approval of such a classification, and their belief in its importance in the ultimate cure of the patients. The finer sensibilities of the insane are by no means lost in their affliction, and it would be no wonder if the insanity of a highly educated, intelligent and refined person should be increased rather than

2

10 LUNATIC HOSPITAL AT WORCESTER. [Oct.

cured, if the person is brought into close contact with those who were always coarse in their habits and tastes, rough in disposition, and filthy in their dress. We have no doubt that persons in the better walks of life have often been deprived of the benefits of a hospital from the dread of the associations they would be obliged to make within its walls. A classification into different wards can be made without depriving any class of patients of its rights and privileges, and we hope such a classi- fication may be completely carried out. Private lunatic hos- pitals, as demonstrated in the experience of other countries, more than our own, are liable to become great evils, and it is only by affording in public institutions the best medical aid and the most comfortable accommodations, that irresponsible and unwatched private hospitals can be rendered harmless.

The Trustees have been highly gratified with the perfect operation of the heating and ventilating apparatus which has recently been placed in the hospital. It has answered our expec- tations in every particular. The accompanying report of the Superintendent will show how economically it is worked, and how perfectly it answers its purpose.

During the year many improvements have been made on the farm. Stone wall has been built, under-drains have been made, ditches have been dug, water pipes repaired and relaid, buildings kept in order, and the land and out-buildings of the hospital carried on to a greater state of improvement. The hospital now possesses a choice lot of pure blooded animals, obtained, by careful breeding, at comparatively small cost to the hospital. Necessary furniture has been purchased for the hospital, so that the expenses for general improvements and repairs during the last ten months has been large. These expenses are always necessary to make and keep the Worcester hospital what it may, and should be, and what it has heretofore been, — a model insti- tution, creditable to the State and worthy of the public favor with which it has always been regarded.

During the last year the Trustees have added to the farm of the hospital two small pieces of land, one by exchange of a small piece previously owned by the hospital, and the other by payment of $1,275. One of these pieces was purchased to prevent the necessity of opening a street through some portion of the hospital grounds, and the other piece was deemed a

1858.] PUBLIC DOCUMENT— No. 27. 11

desirable purchase to preserve the proper and convenient shape of the farm.

The Treasurer's report transmitted herewith, shows a favor- able pecuniary condition of the hospital.

The Treasurer of the hospital finds some difficulty in the adjustment of his accounts with the State as settled by the State auditor. The account of the hospital against the State, for the support of State paupers for one of the quarters of last year, was returned to the Treasurer of the hospital with several deductions made from the balance due the hospital. One deduction was to the amount of 1622.24, being the amount already paid to the hospital, by the State, during the last six years for the support of a patient who, the agent of the Board of Alien Commissioners now decides, possessed, at the time of his commitment to the hospital, a legal residence in one of the towns of this Commonwealth, and consequently that the said town is liable for his support. In another instance the auditor has deducted $200 for the amount paid four years ago for the support of a patient who has not been in the hospital since that time. No objections were made to these charges, by the State authorities at the time they were paid, and now so long a time has elapsed that it is utterly impossible for the officers of the hospital to procure any legal proof that shall compel the towns to refund the amount taken by the State from the balance due the hospital. In some instances, in which the proofs of residence were deemed by the State auditor sufficient to warrant the deduction from our account, these proofs have been submitted to the legal adviser of the hospital, and he has declined to commence a suit against the towns designated because he did not consider such proofs strong enough to justify the risk of the action. It seems proper to the Trustees that if such deductions are to be made from the hospital accounts, there should be some limit to the time during which they shall be liable to such deduction, so that the hospital can find a remedy against the parties who may be legally liable. But it is the opinion of the Trustees that in the matter of the support of State paupers the hospital acts simply as the agent of the State, and any claims against any town for the support of an insane pauper, should be prosecuted by the State and in its name, and that the hospital should be relieved from the burden of prose-

12 LUNATIC HOSPITAL AT WORCESTER. [Oct.

cuting for the board of a patient, whose support in any case, costs the institution more than it ever receives.

Of all the public charities -which are justly the pride and boast of this Christian Commonwealth, there are none which more warmly commend themselves to the sympathies and watchful care of every citizen than the institutions which she has erected for the care and cure of the insane. For there is no inhabitant of the whole State of any age or sex, no person, however high his social position, however strong his physical health, or however great and just his pride of intellect that can feel always sure that he will never call for the experience or care that can only be obtained from these institutions. While he feels gratitude that accident or disease has not made him one of their inmates, he should be eager to alleviate in every possible way the condition of those upon whom so great a calamity has fallen.

THOMAS COLT. C. H. STEDMAN. J. N. BATES. WM. T. MERRIPIELD. R. W. HOOPER.

1858.]

PUBLIC DOCUMENT— No. 27.

13

TREASURER'S REPORT

The Treasurer respectfully submits the following report.

Cash on hand, December 1, 1857,

Received for interest on bonds,

From the Commonwealth for support of patients,

From towns and individuals, for support of patients,

From Mechanics' Bank,

The disbursements have been as follows : — Steward's orders, ..... Worcester Bank, .....

Mechanics' Bank,

Bills payable. Treasurer's note due Jan. 11 Interest to Worcester and Mechanics' Banks, Real Estate, ......

Recording Deeds, .....

Printing for Treasurer,

J. M. Barker, examining Treasurer's accounts Town of Waltham. Expenses of suit,' . Treasurer's salary, ....

Cash on hand, .....

$132 91

15 00

25,760 31

33,600 23

793 97

	$60,302 42
. $38,267 26
	8,955 46
	8,273	25
1858	, 2,000	00
	351	64
	1,275	00
	1	00
	16	25
;s,	5	00
	72	79
	480	93
	603	84
	$60,302	42

H. WOODWARD, Treasurer.

Worcester, October 13, 1858.

14 LUNATIC HOSPITAL AT WOKCESTER. [Oct.

SUPERINTENDENT'S REPORT.

Twenty-Sixth Annual Report of the Superintendent to the Trustees of the State Lunatic Hospital, at Worcester.

Gentlemen, — In obedience to the By-Laws of the State Lunatic Hospital, the Superintendent presents to its Board of Trustees the Twenty-Sixth Annual Report.

It is needless to remark that the year has been one of peculiar trial and severe labor.

In reviewing its history we hope it may be found that our efforts have been crowned with some degree of success.

Our aim has been to sustain the high character of the hospital, increase its usefulness, and to extend its curative facilities.

Whatever of good has been accomplished, must be attributed to your constant oversight, ready assistance, and wise direction in all the affairs of the institution.

During the entire year the general health of the patients has been good, with complete exemption from all epidemic diseases. For this blessing, we must all feel abundant cause for renewed thankfulness to God, as well as for the discipline, good order, and harmony which have always marked our household.

The hospital has accommodations for three hundred patients. Our tables will show that during almost the entire ten months, the period which this report covers, — we have been greatly crowded.

By order of his Excellency, Governor Banks, there were transferred to the hospital for insane at Northampton,

August 16, 1858—

Males, ...... 35

Females, . . . . . 16

— 51

1858.] PUBLIC DOCUMENT— No. 27. 15

September 20, 1858—

Males, . ..... 32

Females, ..... 31

— 63

September 30, 1858—

Males, .00

Females, 28

— 28

Total to Northampton, . . . 142

And to the State Lunatic Hospital at Taunton,

September 2, 1858—

Males, 3

Females, ...... 4

— 7

Whole number transferred, . . . 149

By the same authority we have received from the State Lunatic Hospital at Taunton, August 30, 1858—

Males, 17

Females, ...... 26

— 43

September 17, 1858 —

Males, ...... 4

Females, 11

— 15

Total from Taunton, . 58

From the Boston Lunatic Hospital,

September 20, 1858.

Males, > . 12

Females, ...... 19

— 31

Whole number received by transfer, . 89

Thus diminishing the number of patients in this hospital by the several tranfers —

Males, ...... 37

Females, 23

— 60

16 LUNATIC HOSPITAL AT WORCESTER. [Oct.

On the opening of the " hospital for insane," at North- ampton, the friends of all patients committed to this hospital on private bonds from the four western counties of the State, were at once notified by the undersigned of the occupancy of the hospital at Northampton, and of their right and privilege to remove their insane wards from this to that institution.

In preparing the annual reports of hospitals for the insane, great similarity in general character must occur, and consid- erable repetition in the details. Each report, however, adds something to the mass of facts, and the value of these depends upon their number and the faithfulness and accuracy of those who observe them.

Reports of hospitals for the insane have undoubtedly done much in diffusing a knowledge of the condition of the insane, the character of the disease, the proper method of treatment and the claims of hospitals upon the community

The whole number of patients in the hospital, December 1st, 1857, was —

Males, . 177

Females, 195

Total, 372

The whole number admitted from December 1, 1857, to Sep- tember 30, 1858, inclusive, was —

Males, 142

Females, 165

Total, 307

The whole number under treatment, from December 1,1857, to September 30, 1858, inclusive, was —

Males, . 319

Females, . . . . . .360

Total, . . - . . . .679

1858.]

PUBLIC DOCUMENT— No. 27.

17

The whole number discharged from December 1, 1857, to September 30, 1858, inclusive, was —

Males, .180

Females,

Total, As follows : —

196

376

	Males.	Females.	Total.
Recovered, ....	55	72	127
Improved,	97	77	174
Not improved, .	10	31	41
Died,	18	16	34
Total,	180	196	376

The whole number remaining in the hospital September 30,

1858, was —

Males, Females,

Total,

141 160

301

One hundred and twenty-seven patients have been discharged and have returned to their families and friends in the enjoy- ment of a degree of mental health and strength equal to that possessed by them previous to the attack of disease which placed them under our care.

One hundred and seventy-four have been discharged improved ; and although not recovered, many of them were sufficiently well to return to their accustomed occupation, and assist in the support of themselves and their families. Some of this class are periodically insane, having intervals of apparent health, of longer or shorter duration, during which they transact all the ordinary business of life, and are esteemed valuable members of society.

It is extremely difficult, in many cases, to decide whether or not, the patients have recovered. A large class of persons who

3

18 LUNATIC HOSPITAL AT WORCESTER. [Oct.

are brought within the care of hospitals for the insane never possessed strong and active minds, — could never manage well for themselves, or control at all the affairs of others. While under the care and guardianship of friends, they meet well enough the common events of life. But when oppressed by care and anxiety, — when afflicted with disease, or when bereaved by the loss of those upon whom they have leaned for support they become the ready victims to insanity. After a time they improve ; but old and familiar faces do not again shine upon the invalid with their accustomed cheerfulness. Arms once their willing support are not now outstretched. The charity of the almshouse is all that is offered them. Under a different state of things many of this class might be said to have recovered.

There has been during the year the usual amount of sick- ness ; confined mostly to the habitually feeble, demented, and long insane patients. During the winter several of the aged patients suffered from influenza. In the spring there were several cases of fever. During the summer and autumn there has been some diarrhoea and dysentery, generally of a mild character and yielding readily to proper remedies.

The mortality of the patients has been confined almost entirely to cases of marasmus, consumption, epilepsy and palsy.

It is not to be supposed however, that the inmates of hospi- tals for the insane are in the possession and enjoyment of robust health. With few exceptions they are all feeble. The excite- ment of distempered imaginations may keep up for a time a state of feverish activity, but it soon subsides and shows too plainly how sure and fatal have been the approaches of disease.

Table 1,

Showing the Admissions and state of the Hospital, from November 30, 1857, to September 30, 1858, inclusive.

Patients in the Hospital December 1, 1857, 372

Males, 177

Females, 195

Patients admitted in the course of the year, 307

Males, . 142

Females, 165

Whole number in the Hospital in the course of the year, . . 679

Males, 319

Females, 360

1858.] PUBLIC DOCUMENT— No. 27.

Table No. 1 — Continued.

19

Patients remaining in the Hospital September 30, 1858,

Males, 141

Females, 160

301

Of the admissions, there were cases of less duration than one year, 120

Males, 59

Females, 61

Of the admissions, there were cases of one year or more, . . 144

Males, 63

Females, » . 81

Of the admissions, there were cases, the duration of whose insanity

could not be ascertained, 43

Males, . . . 18

Females, 25

Patients committed by Courts, 151

Males, . 79

Females, 72

Patients committed by Overseers of the Poor, .... 22

Males, 10

Females, 12

Patients committed by order of the Governor, .... 88

Males, 32

Females, ' . . . .56

Patients on bonds, 44

Males, . . . • 21

Females, 23

Foreigners, and those who have no settlement in this State,

admitted in the course of the year, 136

Males, 53

Females, 83

Foreigners, and those who have no settlement in this State, dis- charged in the course of the year, 185

Males, 75

Females, 110

Patients discharged by order of the Governor, .... 149

Males, 70

Females, 79

Foreigners, and those who have no settlement in this State, remain- ing in the Hospital September 30th, 1858, .... 86

Males, 33

Females, 53

Foreigners and those who had no settlement in this State, remaining at the close of each year, as nearly as can be ascertained : —

1842,	34	1851,	. 208
1843,	38	1852,	. 241
1844,	38	1853,	. 216
1845,	57	1854,	. 151
1846,	52	1855,	. 115
1847,	121	1856,	. 155
1848,	150	1857,	. 119
1849,	167	1858,	. 86
1850,	181

20 LUNATIC HOSPITAL AT WORCESTER. [Oct.

By the foregoing table it is shown that you have discharged from this hospital, in the course of ten months, one hundred and eighty-five patients who had no settlement in this Common- wealth.

Many of them had recovered and are now supporting them- selves and families by their own labor. A large proportion of those not recovered, were able to labor, and at the time of dis- charge might, with little assistance and direction, procure their own livelihood.

Nearly all of those having no settlement in this Common- wealth were foreigners, a large majority of whom were Irish.

This large class of people stand in false relations to nearly every thing about them. They are strangers in a strange land. Surrounded by circumstances novel to them, met by customs to which they cannot adapt themselves, influenced by motives often extravagant and wild, they must necessarily become involved in harrassing doubt and perplexity.

They receive in prosperous times high wages, and are able at the cheapest rates to gratify vicious indulgences. They seek for labor in the most menial capacity, huddle together in the most objectionable places, neglect all the rules of health, and prefer the excitement or solace of rum or tobacco to the quiet, intelligent influences of well-ordered homes. Under this state of things it is natural to suppose that a large percentage of insanity would be found. The table also shows that only eighty- six patients remain in the hospital who are supposed to have no settlement in this Commonwealth. A smaller number than has been in the hospital at any time during the last twelve years.

The number of State paupers has diminished by thirty-three in the course of ten months.

The number discharged exceeds the number admitted by forty-nine.

In preparing the preceding table it is shown most conclusively that those who had no settlement in this Commonwealth have received the first and best privileges of this hospital.

1858.]

PUBLIC DOCUMENT— No. 27.

21

Table No. 2.

Supposed Causes of Insanity of Patients admitted to the Hospital from

January 18, 1833, to September 30, 1858, inclusive.

					1858.	Previously.
SUPPOSED CAUSES.
	Males.	Females.	Males.	Females.
Apoplexy, Asthma, .				-	-	2 o	-
Bowels, Disease of, .				-	-	1	-
Brain, Inflammation of,				-	-	1	5
Bronchitis,				-	-	2	13
Chorea, .					-	-	-	2
Congenital,					-	-	4	-
Constipation, Convulsions,					—	-	8	1 6
Dysentery, Dyspepsia, Epilepsy, Eruptive Disea	ses, .				8	4	1 2 73 2	2 30 1
Eyes, Disease of, loss of, . Fever,				-	-	1 1 25	32
Scarlet,				-	-	1	3
Ill-health,				19	35	135	467
Influenza,				-	-	1	5
Insolation,				-	-	12	-
Laryngitis, Measles, .				-	-	3	1 4
Nervous Irritation, .				_	-	-	4
Nymphomania, Old Age,				1	1	7	1 3
Otitis,					_	_	3	-
Palsy, _ . Periodical,					4	2	34 48	21 56
Pneumonia,					_	-	_	1
Rheumatism,					-	-	3	1
Satyriasis, Scrofula, .					-	-	1	2
Sea-sickness,					_	_	_	1
Somnambulism,				_	_	_	1
Sore Finger, .				_	-	_	1
Spinal Disease, Suppressed Eruption, Ulcer, .				-	-	5 1	1 4 3
Tic Doloureux,				_	_	_	1
Tumor, .				-	-	-	1

22 LUNATIC HOSPITAL AT WORCESTER. [Oct.

Table No. 2 — Continued.

			1858.	Previously.
SUPPOSED CAUSES.
	Males.	Females.	Males.	Females.
Whooping Cough, ....	_	_	_	1
Amenorrhea, .			-	-	-	14
Lactation,			-	-	-	5
Menorrhagia, .			-	-	-	2
Menorrhagia, suppressed,			-	-	-	1
Miscarriage,			-	-	-	1
Pregnancy,			-	-	-	3
Puerperal,			-	5	-	136
Turn of Life, .			-	5	-	21
Amputation of Leg,			-	-	1	-
Bathing in cold water,			-	-	2	-
Cut Foot,			-	-	1	1
Dog Bite,			-	-	1	-
Drinking cold water,			-	-	1	-
Dye-house, fumes of,			-	-	1	-
Exposure to cold, .			-	-	6	-
Fall,			-	-	-	4
Fracture of Arm, .			-	-	-	1
Injury, .			-	-	4	3
Injury of Head,			1	1	43	7
Kick of Horse,			-	-	1	-
Lead, poison of,			-	-	2	-
Lightning,			-	-	1	1
Loss of Blood,			-	-	1	-
Malformation of Head,			-	-	1	-
Poison, .			-	-	1	-
Spinal Injury, .			-	-	1	1
Excess of Labor,			-	-	28	51
Loss of Sleep, .			-	-	-	3
Fatigue and Exposure,			2	1	1	2
Study, excessive,			-	-	25	6
Inventions,			-	-	1	—
Excitement, .			-	-	2	4
Excitement of Politics,			-	-	1	2
Anticipation of Marriage,			-	-	-	1
Fortune being told, .			-	-	-	1
Enthusiasm,			-	-	-	1
Mesmerism,			-	-	-	1
Spiritualism, .			1	1	10	13
Light reading, Novels, &c	■)		-	-	-	1
Anxiety, .			-	-	2	11
Criminal Trial,			-	-	2	-
False Accusation, .			-	-	-	1
Imprisonment,			.-	-	1	-
Death of Brother, .			-	-	1	3
Children, .			-	-	3	19
Father,			-	-	2	1
Friends, .			_	_	2	3
Husband, .			—	—	-	19

1858.] PUBLIC DOCUMENT— No. 27.

Table No. 2 — Continued.

23

			1858.	Previously.
SUPPOSED CAUSES.
	Males.	Females.	Males.	Females.
Death of Mother, .			1	6
Niece,		-	-	-	1
Sister,			-	-	-	3
Wife,			-	-	10	-
Husband, departure of,			-	-	-	1
sickness of,			-	-	-	3
intemperance c	>,		-	-	-	2
desertion of,			-	-	-	2
abuse of, .			-	-	-	7
Abuse of master,			-	-	1	-
parent,			-	-	1	2
Domestic trouble,			2	9	57	127
grief,			-	-	56	137
cares,			—	—	-	1
Marriage, unfit,			-	-	4	2
Disappointment,			-	-	4	7
in Love,			-	-	47	51
Disappointed ambition,			1	1	5	5
Homesickness,			-	-	1	5
Lost in woods,			-	-	-	1
Shipwreck,			-	-	1	-
Fright, .			-	2	10	15
Fear,			_	-	2	_
of Death,			-	1	1	-
of Insanity,			-	-	1	-
Being witness in Court,			-	-	-	1
Seduction,			-	-	-	1
Millerism,			-	-	5	5
Religious,			-	-	89	142
Religious anxiety, .			-	-	1	4
excitement,			-	—	13	8
fanaticism,			-	-	13	7
perplexity,			-	-	9	3
Pathetism,			—	-	—	1
Infidelity,			-	-	1	-
Mormonism,			-	-	1	-
Pecuniary anxiety, .			-	-	18	5
difficulty,			-	-	55	8
loss,			—	-	43	10
Strike for Wages, .			-	-	1	_
California Excitement,			-	-	2	_
Poverty, .			-	-	-	1
Fear of Poverty,			3	-	25	11
Giving up Business,			-	-	1	-
Change of Business,			_	-	1	_
Indulgence of Parents,			-	-	3	1
Jealousy,			1	3	16	20
Passion uncontrolled,			-	-	-	1
Violent Temper,			—	—	1	14

24 LUNATIC HOSPITAL AT WORCESTER. [Oct.

Table No. 2 — Continued.

1858.

Previously.

SUPPOSED CAUSES.

Males.

Eemales.

Males.

Females.

Anger, .

Great Indignation, .

Intemperance,

Opium, use of,

Tobacco, use of,

Masturbation, .

Venery, excess of, .

11

3

2 1

1

413

1

232

1

46 3 3

24

Little is known respecting the causes of insanity. They may be remote and only slightly predisposing to the influence of the disease, or they may be immediate and exciting to a greater or less degree.

Among the remote causes are constitutional predisposition, hereditary or otherwise. The influence of education, moral and physical, the peculiarities of organization, and previous attacks of disease seriously disturbing the action of the brain.

Some of the immediate and exciting causes are domestic affliction, reverses of fortune, disappointments, jealousy, and unrestrained anger. The exciting causes may also be physical, as irregular menstruation, consequence of parturition, apo- plexy, blows on the head and abuse of strong drink.

It has been supposed that some peculiarity, mental or physical, is necessary to the development of insanity ; without the existence of which, causes capable of producing the disease will not affect the individual, or they will put in motion some other train of morbid phenomena.

Habitual intoxication does not always produce insanity. Some are afflicted with paralysis, some with apoplexy, others with disease of the liver or lungs.

Again, it is supposed that there is something in the state or condition of society which promotes a peculiar susceptibility to mental diseases. It is well known that a false system of edu- cation increases the susceptibility to mental disease.

By lack of moral discipline and by capricious indulgence, the passions acquire a controlling power, and thus form a char- acter subject to violent emotions. An overstrained and prema-

1858.] PUBLIC DOCUMENT— No. 27. 25

ture exercise of the intellectual powers is equally destructive to mental health. During the early years of existence the brain is inadequate to perform the task of reflection to any great extent, or to accomplish any purely intellectual labor.

The artificial forcing of young minds is utterly destructive to sound health of body or mind. Parents and teachers ambitious for the intellectual prowess of their children and pupils destroy their own hopes and lay the foundation for early bodily disease and mental decay.

Notwithstanding the extensive religious awakening and excite- ment during the early part of the year the insanity of few if any of the patients admitted during the ten months had any connection with the doubts, fears, and anxieties respecting a future state of existence.

We believe that the number of persons made insane by the influence of religious hopes and fears has been greatly over- stated. The insane mind is frequently occupied by delusions of a religious nature when it is well known that the cause of its derangement has no connection with feelings or impressions relating to a future state of existence. No richer or wider field than the invisible world, can be offered to the gloomy mis- anthrope whose mind is already diseased, none his imagina- tion will be more apt to choose to wander in and dwell on, when the whole origin of his derangement may have been nothing more than the influence of dyspepsia or some trivial reverse of fortune.

Ill health in its various forms, as usual, stands at the head of our table, sending us twice the number of females that it does of males.

Intemperance sends us thirteen, and domestic affliction fre- quently caused by intemperance, eleven.

26

LUNATIC HOSPITAL AT WORCESTER.

[Oct.

Table No. 3.

Diseases which have proved Fatal, from January 18, 1833, to September

30, 1858.

				1858.	Previously.
	Males.	Females.	Males.	Females.
Apoplexy,	_	_	14	9
Asthma, .				1	—	2	1
Anasmia, .				-	-	1	1
Asphyxia,				-	-	1	-
Bronchitis,				-	-	2	-
Brain Fever, .				-	-	1	-
Consumption, .				2	4	29	47
Convulsions, .				-	-	3	1
Cholera Morbus,				-	-	2	3
•Cholera, .				-	-	5	—
Cancer, .				-	-	1	1
Congestion of Lungs,			-	-	-	1
Brain,			-	-	1	1
Chronic Dysentery,			-	-	2	-
Meningitis,			2	-	1	-
Dysentery,			-	-	10	6
Dropsy, .			-	-	5	7
Delirium Tremens, .			-	-	3	-
Disease of Heart, .			-	-	9	11
of Bladder,			-	-	1	_
of Brain, .			-	-	6	14
Diarrhoea,			-	-	13	8
Enteritis,			-	_	3	6
Epilepsy,			4	2	41	15
Exhaustion,			-	-	27	43
Erysipelas,			-	-	9	10
Gangrene of Lungs,			-	-	1	1
Hydro-thorax,			-	-	1	1
Hemorrhage, .			-	-	4	4
Hemoptysis,			-	-	1	-
Inflammation of Bowels,			-	-	3	3
Jaundice,			_	-	-	2
Marasmus,			1	4	44	43
Mortification, .			_	_	_	1
Maniacal Exhaustion,			_	-	4	2
Malignant Fever, .			_	-	1	-
Old Age,			2	1	11	9
Palsy,			4	2	11	12
Pneumonia,			-	1	9	14
Pleurisy,			-	-	-	1
Kupture,			-	-	1	-
Syncope,			-	-	1	-
Suicide, .			_	_	13	8
Suppurative Phlebitis,			-	-	1	-
Typhoid Eever,			-	1	8	5
Typho Mania, ....	2	1	5	3
Total,				18	16	311	294

1858.]

PUBLIC DOCUMENT— No. 27.

27

TABLE 4.--S/ig

■ the Post Mortem Appearances of all Cases examined from November 30, 1857, to September 30, 1858.

Mental Disease.

Date of Post Mortem Exatui nation.

One year,

Four mouth;),

ExhallStiOD,

Fourteen hours,

Chronic and Paroxys-

Melancholia,

Melancholia ami Palsy,

Thirty-two hours,

Paralysie Generale,

Paroxysmal Mania and

Paralysie Generale,

Acute Mania.

Paroxysmal Mania,

Twelve months,

Twenty-four hrs.

General Appearance of Body.

Well formed, not much wasted, but rather thin ; enmplcMoii light, but slightly Sallow,

Great emaciation ; lividity of de- pending portions; rigor mortis strongly marked; complexion

'ull ; well formed when admitted : complexion sallow; much ema- ciated; sedemn of tinkles,

; rigor mortis

Somewhat emaciated: ci.i j.K-\i< -u

Strong, and well formed ; com- plexion light ; abundance of cutaneous fat: rigor mortis strongly marked,

larked ; ,-li^ht lividity of de-

pending portions,

marked . depending portion livid . feet ami ;i nk !. - swollen,

Strong, and well formed; much Very thin ; Strongly adherent

emaciated at tin I ' <!•■ ith : com- to Cranium, an "

plexion dusky and sallow, but little blood

Thin, a

Uttle blood,'

Thick, and much congested,

Thin and bloodless ; strongly adherent to Cranium,

Thin, ami adherent

ruled from I'niiiiuiii,

Scalp thick, and congested with venous blood, easily separated ; ecchymozedfrom

heating bis head against the

and contained

Head quite thin and large, am well formed,

Normal,

Head large ; Cranium

Head small and narrow, par- ticularly in front; Cranium thin J osseous, tissue dense; Diplce almost absent.

Of moderate thk

Cerebri! Substance.

of the membranes,

■ -mail whitish opaque bodice

imbedded in the substance of the Pia Mater,

t the top and side of brain,

Nothing unusual in appearance nf membrane,'

it. There was a moderate effusion in the cavity of the Arach- noid, and considerable vascular congestion. The membranes were perfectly healthy,

din.'il Si nil v tie.ir the I leeijiit..-!':iHetal -iltnrei, w.i- mi ., I he-i, ,i ,

of this membrane to the Arachnoid, and a bony deposit contain- ing spirilla1 of hone three-fourths of an inch in length. The

sides of the Brain, containing 1 in each Ride of the Brain, li : were small deposits of false : ditiou, containing small bony deposits. Tin- '

No adhesion of Dura Mater to Cranium o serum elTused in the Arachnoid cavit and opacity of that membrane,

Dan Mater Df usual thickness, and not adherent to Cranium or

Ar.iel 1 I Lin -li.-ht eltu-iou ,.,f -iTuiii in An-linoid I'avity ;

Pia Mater very v.tscular; Cliiudula? Pacchioni small,

r three pia. e-. and containing bony Cerebrum of

ttealthy to appearance.

E 0 change io substance or vessels of Brain.

the ventricles

> Pleura on both -ide-, and also to Mediastinum. J Air-cells and small bronchial tubes were much dilated, and I plugs of viscid mucous completely filled them. The capillary - emptied and nearly obliterated by <

ray matter natural in appearance and color: general con sis t- enee firm ; no congestion of vessels of Brain. The Vertebral and Basilar arteries were much thickened, and contained por-

tions i,| bum ami ealear is matter; portions of the Internal

Carotid and Cerebral arteries were completely ossified. The Choroid Plexus congested, and occupied with cysts, but a

small quantity of si

in the Cerebral subs

Iubstance of Brain apparently healthy; the ventricles were distended with serum, the Lateral containing one ounce each. The Basilar and Vertebral arteries were thickened and spotted 1 with an atheromatous deposit of a calcareous nature.

Nothing unusual in the appej

e substance or vessels

. and to appearance

Cerebellum softened, the arteries much thickened, ami *

. and apparently healthy,

1 in:; 1 lb and

t the si/i* of n large pea. imbedded mi the substance

Apparently healthy,

morbidly adherent to Cranium;

No change in substance of Brain

1858.] PUBLIC DOCUMENT— No. 27. 29

Three persons died, within the ten months which this report embraces, who were more than eighty years of age.

Four were between the ages of seventy and eighty years, and six were between the ages of sixty-five and seventy years. Making thirteen of those the cause of whose death is stated in the table of mortality upwards of sixty-five years of age each.

Of the patients who died, seven were admitted since Decem- ber 1, 1857. Two had been inmates of the hospital more than fifteen years, and two more than ten years each.

Two patients died within thirty-six hours after admission ; three within one week after admission, and two within two weeks after admission.

Table No. 5,

Showing the Ages of Patients admitted from November 30, 1857, to September 30, 1858.

Less than 15 years of age, - . 3

Between 15 and 20, 18

20 and 30, 63

30 and 40, 93

40 and 50, 78

50 and 60, 35

60 and 70, 12

70 and 80, 3

More than 80 years of age, 2

Total, 307

Table No. 6, Showing the Ages of Patients remaining in the Hospital, September 30,

1858.

Less than 15 years of age, 1

Between 15 and 20, 9

20 and 30, 52

30 and 40, 128

40 and 50, 84

50 and 60, 40

60 and 70, 15

70 and 80, 8

More than 80 years of age, 4

Total, 301

30

LUNATIC HOSPITAL AT WORCESTER.

[Oct.

Table No. 7,

Showing the Duration of Insanity before admission, of those admitted from November 30, 1857, to September 30, 1858.

Insane less than 1 year, 135
more than 1 and less than 2 years,				52
2 and less than 5 years,				40
5 and less than 10 years,				23
10 and less than 15 years,				19
15 and less than 20 years,				12
20 and less than 25 years,				8
25 and less than 30 years,				1
30 years,				2
Unascertained,				15
Total, 307

Table No. 8,

Slowing the Duration of Insanity of those remaining, September 30,

1858.

Insane less than 1 year, .
more than 1 and less than 2 years,				33
2 and less than 5 years,				52
5 and less than 10 years,				95
10 and less than 15 years,				30
15 and less than 20 years,				15
20 and less than 25 years,				9
25 and less than 30 years,				11
30 years,				3
Unascertained,				12
Total, 301

Table No. 9,

Slioioing the Civil Condition of Patients admitted from November 30, 1857, to September 30, 1858.

Unmarried, 158

Married, 122

Widows, 14

Widowers, ...... r ... 6

Unascertained, 7

Total, 307

1858.]

PUBLIC DOCUMENT— No. 27.

31

Table No. 10, Showing the Civil Condition of Patients remaining September 80, 1858.

Unmarried, . 165

Married, 84

Widows, 23

Widowers, .......... 8

Unascertained, . .21

Total, 301

Table No. 11,

Shovjing the Occupation of Patients admitted into the Hospital from January 18, 1833, to September 30, 1858, inclusive.

OCCUPATION OF PATIENTS.	1858.	Previously.
MALES.
Auctioneers, .......	-	3
Armorers,			-	3
Author,			1	-
Blacksmiths,			2	32
Bakers,			-	6
Butchers, .			-	5
Bookkeepers, . Book-binders, .			1	5 6
Boot-makers,			-	15
Brokers, .			-	2
Britannia-workers,			-	o
Brickmakers, .			-	5
Bellows-makers,			-	2
Brewers, .			-	2
Basket-makers,			-	-
Bricklayers, Butlers,			-	3 2
Barbers, .			-	3
Clergymen, Carpenters, Coppersmiths, .			2 8	16 107 6
Coopers, . Cabinet-makers,			1	15 9
Calico-printers,			-	3
Clothiers,			-	17
Comb-makers, .			-	4
Coach-makers, .			-	7
Card-makers, .			1	1
Chair-makers, .			—	3

32 LUNATIC HOSPITAL AT WORCESTER. [Oct.

Table No. 11 — Continued.

OCCUPATION OF PATIENTS.	1858.	Previously.
Cigar makers,		3
Coachmen,			-	16
Clerks,			2	24
Carpet weaver,			-	1
Curriers, .			-	7
Cashiers of Banks, .			-	4
Cordwainers, .			-	4
Collectors,			-	2
Caulkers,			-	4
Chandlers,			-	5
Camphene distiller, . Conductor on railroad,			1	1 1
Dyers, Druggists,			_	4 3
Draymen, Drover, .			—	3 1
Dancing master,			-	1
Daguerreotypist, Engravers,			1	1 2
Editors, .			-	4
Express-men, . Farmers, .			30	3 420
Fishermen,			1	12
Fruiterers,			-	4
Gunsmiths,			-	3
Gardeners,			-	9
Grocers, .			-	3
Glass-blowers, .			-	3
Gilders, .			-	2
Hotel-keepers, . Hatters, .			—	15 3
Hostlers, .			-	9
Housewrights, .			-	7
Harness-makers,			-	7
Ironmongers, .			-	3
Jewellers,			-	11
Lawyers, . * . Laborers,			32	12 290
Last-maker,			-	1
Manufacturers,			-	31
Millers, .			-	6
Merchants,			4	107
Masons, .			-	17
Miners,			-	5
Mat-makers,			-	3
Miniature painter, . Musicians,			—	1 7
Machinists,			1	29
Messengers, . .			-	2
Moulders,			-	6
Millwright,			-	1
Millers," •			1	3

1858.] PUBLIC DOCUMENT— No. 27.

Table No. 11 — Continued.

33

OCCUPATION OF PATIENTS.	1858.	Previously.
Nail r,		1
New men,				-	3
Optiscian,				-	1
Operatives in mill, .				2	47
Oystermen,				-	4
Painters, .				1	27
Printers, .				-	29
P hysicians,				-	11
Paper-makers,				-	4
Peddlers, .				-	17
Plot,				-	1
Potters,				-	3
Porters, .				-	9
Pump and Block-makers,				-	3
Pattern-makers,				1	4
Police officers, .				1	3
Rope-makers, .				-	9
Riggers, .				-	3
Restaurators, .				-	7
Shoemakers,				12	183
Sail-makers,				-	9
Soap-makers, .				-	4
Sash and Blind makers,				-	2
Stage drivers, .				-	4
Sea Captains, .				1	14
Sailors,				3	94
Saddlers, .				-	9
Silversmiths,				-	19
Students, .				-	49
Stock-maker, .				-	1
Silk-weavers, .				-	2
Ship Carpenters,				-	17
Ship Brokers, .				-	2
Shop keepers, .				-	3
Stone cutters, .				2	12
Soldiers, .				-	5
Spinners, .				-	13
Sheriffs, .				-	3
Shoe dealers, .				-	3
Stable keepers,				-	2
Shoe binders, .				-	7
Tailors, .				1	13
Teachers,				1	49
Tobacconists, .				_	3
Teamsters,				1	11
Tinmen, .				_	2
Umbrella-makers,				-	4
Victuallers,				_	3
Wheelwrights, .				-	13
Watch makers,				-	4
Wood-turners, .				_	3
Watchman,				_	1
Whip-maker, .				_	1
Weavers,			•	-	17

34 LUNATIC HOSPITAL AT WORCESTER. [Oct.

Table 11 — Continued.

OCCUPATION OF PATIENTS.	185S.	Previously.
FEMALES.
Carpet weavers,	-	2
Cooks,			-	55
Chamber maids,			-	33
Dress makers, .			4	47
Engraver, . •			-	1
Housekeepers, .			67	927
House maids			23	112
Laundresses,			8	44
Milliners, .			4	22
Mantua-makers,			-	6
Midwife,			1	-
Nurses,			1	12
Nursery-maids,			-	18
Operatives in mill, Seamstresses, .			8 7	116 305
Straw-sewers,				3	7
Shoe-binders,				-	16
Students, .				-	4
School girls,				5	36
Teachers,				2	56
Tailoresses,				3	33
Type-setter, Wool stapler, Weavers, .				-	1 1 17

Table No. 12,

Showing the Duration of Insanity before admission, of Patients admitted from January 18, 1833, to September 30, 1858.

Males.
Insane less than 1 year, 1,606
more than 1 year and less than 2 years,			326
2 years and less than 5 "			427
5 years and less than 10 "			233
10 years and less than 15 "			115
15 years and less than 20 "			35
20 vears and less than 25 "			37
25 years and less than 30 "			16
30 years, ....			24
Unascertained,			225
Total, 3,044

1858.] PUBLIC DOCUMENT— No. 27.

Table No. 12 — Continued.

35

Females.

more than 1 year and less than 2 years,			287
2 years and less than 5 "			373
5 years and less than 10 "			202
10 years and less than 15 "			127
15 yeai's and less than 20 "			36
20 years and less than 25 "			39
25 years and less than 30 "			9
30 years, .			24
			237
Total, 2,975

Table No. 13,

Showing the Ages of Patients admitted to the Hospital from January 18, 1833, to September 30, 1858.

	Males.	Females.
Less than 15 years of age,	19	24
Between 15 and 20 years of age,			199	183
20 and 30 "			799	773
30 and 40 "			689	762
40 and 50 "			583	606
50 and 60 "			310	359
60 and 70 "			180	143
70 and 80 "			50	51
More than 80 years of age,			7	14
Unascertained, . . . .			8	17
Totals, ....			2,844	2,932

Table No. 14,

Showing the Civil Condition of Patients admitted to the Hospital from January 18, 1833, to September 30, 1858.

Civil condition.

Males.

Females.

Unmarried,

Married,

Widowers, . . . . .

Widows,

Unascertained,

1,520

1,170

135

38

2,863

1,262 1,250

343 35

2,890

LUNATIC HOSPITAL AT WORCESTER. [Oct.

Table No. 15,

Showing the Number of Admissions and Discharges, and the Whole Number under Treatment for each of ten months.

		Admitted.	Discharged.
	Whole Number.

		Males.	Females.	Males.	Females.
December, 1857,	395	12	11	11	9
January, 1858,			393	9	7	5	15
February, "			393	10	8	8	7
March, "			397	11	8	9	10
April, "			401	11	12	13	12
May,			404	16	12	14	16
June, "			397	11	12	8	10
July, "			402	12	11	15	8
August, "			443	24	40	46	28
September, "			434	26	43	51	81
Totals, .				142	165	180	196

Table No. 16,

Showing the Admissions from each County during the last and previous

years.

				1858.	Total.	Previous^'.
			Whole No.
	Males.	Females.
Barnstable,				126	126
Berkshire,				5	2	7	177	184
Bristol,				21	37	58	281	239
Dukes,				_	-	-	19	19
Essex,				22	18	40	392	432
Franklin,				1	1	2	121	123
Hampden,				10	7	17	334	351
Hampshire,				2	4	6	214	220
Middlesex,				20	30	50	718	768
Nantucket,				-	-	-	31	31
Norfolk, .				3	2	5	565	570
Plymouth,				-	2	2	229	231
Suffolk, .				17	29	46	568	614
Worcester,				38	31	69	1,383	1,452
Other States,				3	2	5	12	17
Totals,				142	165	307	5,468	5,775

1858.]

PUBLIC DOCUMENT— No. 27.

37

Table No. 17,

Showing the whole number of Patients during the ten months, the average number, the number at the end of each year, the expense of each year, and the annual expense for each patient for each of the twenty-six years the Hospital has been in operation.

Year.	Whole No.	Average No.	No. at end of each year.	Current expenses of each year.	Annual expense for each patient.
1833, .	153	107	114	$12,272 91	$114 67
1834, .	233	117	118	15,840 97	135 38
1835, .	241	120	119	16,576 44	137 30
1836, .	245	127	138	21,395 28	168 44
1837, .	306	163	185	26,027 07	159 64
1838, .	362	211	218	28,739 40	136 20
1839, .	397	223	229	29,474 41	132 16
1840, .	391	229	236	27,844 98	121 59
1841, .	399	233	232	28,847 62	123 81
1842, .	430	238	238	29,546 87	111 12
1843, .	458	244	255	27,914 12	114 40
1844, .	491	261	263	29,278 75	112 17
1845, .	656	316	360	43,888 65	138 88
1846, .	637	359	367	39,870 37	111 06
1847, .	607	377	394	39,444 47	104 62
1848, .	655	404	409	42,860 05	106 09
1849, .	682	420	429	40,870 86	97 31
1850, .	670	440	441	46,776 13	106 40
1851, .	704	462	466	52,485 33	112 61
1852, .	775	515	532	43,878 35	85 20
1853, .	820	537	520	53,636 66	103 14
1854, .	819	430	381	53,221 52	123 77
1855, .	580	349	336	54,895 88	157 29
1856, .	577	357	376	45,631 37	128 64
1857, .	647	387	372	49,004 75	124 04
1858, .	679	372	301	38,267 26	102 86

38

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8 months

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18 months 2 years

10 years

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44

LUNATIC HOSPITAL AT WORCESTER. [Oct.

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46

LUNATIC HOSPITAL AT WORCESTER. [Oct.

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1858.] PUBLIC DOCUMENT— No. 27. 53

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54

LUNATIC HOSPITAL AT WORCESTER.

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1858.] PUBLIC DOCUMENT— No. 27. 55

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56

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PUBLIC DOCUMENT— No. 27.

59

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60 LUNATIC HOSPITAL AT WORCESTER. [Oct.

It will be seen that nearly all the foregoing tables date from the opening of the hospital. They thus embrace a period of twenty-six years, and cover nearly six thousand cases, contain- ing all that has been known and recorded concerning the patients.

The tables are as nearly correct as can be made from the records of the hospital, and may be relied upon as affording statistics relative to the peculiar features and conditions of insanity as observed in this hospital.

While it is a popular belief, that insanity is a disease of growing frequency in this community, it seems to be proper to afford all the information possible as to the mode and success of its treatment, the character and condition of the hospital, and its fitness for the care and recovery of those who may be placed within its wards.

No hospital for the insane within our acquaintance, possesses such complete accommodations for the classification of the several grades of patients and the various phases and con- ditions of disease. There are comfortable, cheerful, home-like wards for twelve classes of each sex, each ward having by itself all its appointments and arrangements complete, as to dining rooms, water closets, bath rooms and lavatories, ward robes, attendants' rooms and suicidal rooms. There are con- venient sick rooms, patients' visiting rooms and recreation rooms, in close proximity to each ward.

During the last year a complete separation has been main- tained between the foreign and native patients, much to their mutual satisfaction and benefit. The foreign patients have the same comforts and accommodations, the same grade of attendants, and receive the same care and attention that native patients do. But looking at the welfare of the patients, there seemed to be good and sufficient reasons for a separation. When in health they separate themselves. They do not occupy the same house or live in the same neighborhood, except in widely different capacities. They have but few feelings in common with each other. Opposite in religion and all the notions of social life, it would not be well to class the two races in the same wards, where each must bear from the other what was considered troublesome and offensive while in health.

1858.] PUBLIC DOCUMENT— No. 27. 61

But while an effort has constantly been made to keep up a style of life in the hospital which should not so widely differ from that to which our patients have been accustomed in their homes as to disturb their natural feelings or offend their tastes, the result has been greatly to elevate the condition of the foreign patients while in the hospital. So that the separation has not been brought about by any considerations of economy, such as plainer and cheaper accommodations, or a smaller allowance for the daily sustenance and care of the poor insane immigrant.

The subject of labor becomes of more importance each year. Its pecuniary value cannot be estimated. But aside from its cheering and healthy influences it procures for the patients many small comforts which could hardly be afforded otherwise.

We must again add our testimony to the value of agricultural and horticultural employment in the cure and recovery of the insane. It has of late been well established that a farm and gardens are very important parts in a system of the treatment of the insane, and we hope their utility may never be ques- tioned. They are valuable by affording employment, and thus contributing to the comfort, happiness and recovery of a large class of patients, as well as for the pleasure and luxury resulting from an abundant supply of fruits and vegetables obtained from them.

In making up the table of the products of the farm and gardens, we regard a few bushels of roots or a few barrels of fruit, more or less, as of little value in themselves. But in another view of the case, these little matters are of great importance. The pleasure of watching their growth and assist- ing in their cultivation has helped restore the insane to health. It has banished harrassing doubts and perplexities, dissipated distressing delusions, brought quiet and repose to excited mind, and sleep to wakeful eyes.

The farm and gardens belonging to the hospital were never more productive, and their results in all respects never more satisfactory than at present. The garden devoted to the raising of kitchen vegetables, has been, as usual, almost entirely managed by patients. We hope, in addition to this, to have a green-house for the cultivation of grapes.

62

LUNATIC HOSPITAL AT WORCESTER. [Oct.

In making up the table the present year before the harvest, will materially lessen the amount of the products of the farm, leaving, as it does, some of the crops on the ground.

Apples, .	50 bushels.	at $0 50-	- $25 00
Cherries, .	10	it	at	2	00	20 00
Plums,	1	a	at	2	00	2 00
Grapes, .	5	u	at	2	00	10 00
Corn, sweet,	150	a	at		50	75 00
Beans,	30	a	at	2	00	60 00
Peas,	60	a	at	1	00	60 00
Beets,	75	a	at		50	37 50
Cucumbers,	. 125	a	at		50	62 50
Tomatoes,	. 150	a	at		75	112 50
Squashes,	3,000	pounds,	at		01	30 00
Cabbages,	1,000 heads,	at		05	50 00
Milk, .	25,000	quarts,	at		05	1,250 00
Hay, .	75 tons,	at 12	00	800 00
Rowen, .	15 tons,	at 10	00	150 00
Corn Fodder, .	25	tons,	at	2	00	50 00
Potatoes,	100 bushels.	at		50	50 00
	12,844 50

The carrots, beets, and potatoes for winter use are not included. Beef and pork fattened on the place during the year is not yet slaughtered.

There are kept on the farm for the use of the hospital three horses, four oxen, one bull, and sixteen cows. There are growing up six yearling heifers, three yearling bulls, and four calves, and fifty swine.

In the. course of the year there have been built about two hundred and fifty rods of heavy stone wall, and about the same number of rods of large, capacious stone under-drains have been laid. Rocks have been blasted and removed from the fields, water pipes have been repaired, land reclaimed, and ditches made. A portion of all this labor has been performed by patients.

The labor of the female patients is no less important. They assist in the kitchen and wash room, and perform nearly all the ironing for the whole establishment. They work in the

1858.]

PUBLIC DOCUMENT— No. 27.

63

sewing room, and do much of the mending for the inmates. They make all the bedding, towels, napkins, table spreads, and window curtains. They also make the chemises, dresses, shirts, and some of the trousers and vests worn by the patients.

Some of them assist the attendants in the care of the dining rooms, and many of them prefer to take care of their own rooms and furniture.

The following table will show the number of articles made by the female patients, from November 30, 1857, to September 30, 1858.

Bed Ticks, .	26	Sheets,	383
Chemises, .	300	Shirts,	278
Coats, .	8	Skirts,	60
Dresses,	175	Skirts, embroidered,	18
Frocks,	19	Suspenders, pairs of,	160
Hose, pairs of,	32	Spreads,	45
Mattress Ticks, .	117	Table Covers,	20
Napkins,	75	Towels,	235
Pillows,	105	Trowsers, pairs of,	84
Pillow Cases,	400	Window Curtains,	. 150
Overalls, pairs of, .	14	Vests, .	. 23

Our mattresses have all been made over, and some fifty new ones manufactured by male patients.

Nothing contributes more to the happiness of the household than the round of amusement afforded them. Biding, walk- ing, reading, games of all kinds, cultivation of flowers, care of pets, birds, &c, the Matron's parties, dancing, singing, magic lantern scenes, maps and pictures, break up the monotony which must otherwise be dull and irksome.

The carriage is mostly devoted to females and feeble old men.

The males who do not labor much on the farm take frequent and long walks with an attendant. They also engage in games of base ball, cricket and quoits, and spend much of the time in the open air.

In addition to riding, the females walk in pleasant weather about the grounds in parties, or sit with their needle work or books in the grove within the inclosure and amuse themselves by watching the business of the street. In the house they play

64 LUNATIC HOSPITAL AT WORCESTER. [Oct.

all the various games of cards, draughts, dominoes, graces, battledoor, &c.

The males also, while in the house, engage in all the games that ingenuity can devise to occupy time.

It is to be hoped and expected that we may hereafter be able to have for the benefit of the patients, a reading-room and museum for each sex.

It is designed to fit up an apartment in a cheerful and attract- manner, in which the convalescent and the cultivated patients, who desire some place of resort, may quietly read and study, or amuse themselves with such objects of interest as we may be able to collect. If we are successful in making the arrange- ment, a want will be supplied which has long been felt by patients of refined feelings and cultivated minds ; especially while convalescing, and still so feeble as to be constantly annoyed by the many unpleasant associations of a hospital ward. We hope it will be in our power to place in these rooms, beside books, papers and periodicals, specimens of natural history, birds, minerals, shells, &c, pictures, charts, maps, globes, portraits, busts, &c. A multiplication of such objects cannot fail to render a residence in the hospital less irksome than it would otherwise be.

Although there must be restraint and privation connected with a residence in a hospital for the insane, we desire to sur- round the patients with so much that is cheerful and attractive, and such a variety of the means of occupation and amuse- ment, as to dispel many unpleasant associations and hasten a restoration to health and usefulness.

In view of these things, we have also in contemplation the furnishing of a billiard room for males, and a sort of calisthe- neum for females.

The process of warming and ventilating the hospital is quite perfect, and has been found to be satisfactory, by all who have examined it. Every apartment in the house is not only warmed, but thoroughly ventilated. The temperature is equal ; the warmth well diffused, and the air so constantly renewed by the operation of the fan, as to be always fresh and pure in every part of the house. The fan is in constant operation during summer and winter, affording the patients as much comfort in

1858.]

PUBLIC DOCUMENT— No. 27.

65

the warm weather by its supply of cool, fresh air, as in the winter by its constant breeze of warm air.

The following table will show the exact amount of coal con- sumed from November 30, 1857, to September 30, 1858.

Amount for

each Month.

lbs.

Daily Average, lbs.

December, 1857, January, 1858, February, " March, "

April, "

May, "

June, "

July,

August, "

September, "

Total, .

152,000

144,000

167,000

126,000

71,700

47,400

38,100

32,400

35,500

38,100

4,903 4,645 5,964 4,064 2,585 1,529 1,270 1,045 1,146 1,270

852,200 or, 426^ tons.

Little can be said in an annual report of a hospital for the insane respecting the treatment of insanity. But it may be necessary in passing to remark that all our patients are under treatment.

None are left without some effort being made to restore to them that degree of mental health which will enable them to return to their families and assume their ordinary business.

All occupation suited to their physical condition, all amuse- ment congenial to their tastes, all seclusion and restraint neces- sary for the safety of the patient, belong to the domains of medicine and might very properly be classed under the heads, hygienic and moral. Nothing can be of greater importance to the insane than a system of judicious moral treatment.

In fact the whole discipline of an asylum may be termed its system of moral treatment, inasmuch as its tendency is to

66 LUNATIC HOSPITAL AT WORCESTER. [Oct.

bring about a new class of mental impressions and direct the operations of the mind into healthy channels. The means in use in hospitals for the insane often seem to be slight and feeble, and to the inexperienced utterly inadequate to meet and overcome the passion, violence, and fury which has so often been observed in attacks of insanity.

But it must be borne in mind that the patients are under constant care and surveillance, and that wide departure from good order and correct discipline cannot be unobserved.

Kind, firm, persevering watchfulness takes the place of seclu- sion and mechanical restraint, and vastly diminishes the neces- sity of severe and repressive measures.

Thus it happens that patients who, while with their friends, surrounded with all the comforts of home, were furious, abu- sive, and uncontrollable, become harmless and obedient when they find themselves belonging to a community controlled and directed in all its movements, watched and restrained in all its manifestations of violence, and cheered and sustained by kind- ness and sympathy amid all its gloom and melancholy.

But every physician will understand how utterly useless is purely moral treatment in the case of those whose insanity depends upon a change in the pathological condition of the brain or any other organ. Here recourse must be had to medicines. And in order to fulfil the indications of treatment and meet the symptoms of disease as observed here, cathartics, emetics, and emetico-cathartics, warm baths, and warm baths with the application of cold to the head, are employed to a con- siderable extent. In many cases however stimulants and tonics are freely administered and are generally admissible in the later stages of mania when the system is much enfeebled by the process of disease and other sources of exhaustion to which neglected cases are sometimes exposed.

Still we must often be content with removing all causes of excitement and enforcing only hygienic rules. The dismissal of intimate friends, the removal of familiar objects of occupa- tion and amusement, the absence of noise and confusion, the suppression as far as possible of mental activity, the establish- ment of regular habits as to sleep, diet, and exercise, are all that can or need be done for the restoration of the patient to sound mental health. These are the influences which attend

1858.] PUBLIC DOCUMENT— No. 27. 67

a residence in a hospital for the insane, and which often restore health to the patient without the administration of medicine.

Looking over the events of the year now closed, we cannot too strongly express our gratitude to our Heavenly Father that we are able to record so much success and prosperity.

The number of patients who have been restored to usefulness and happiness has been large. There has not been an unusual amount of sickness and mortality. The condition of those who remain under our care is comfortable, and a large majority of them are contented and happy.

We desire in behalf of the patients to express our gratitude to Hon. George B. Upton, for a donation of fifty dollars for the purchase of engravings for one of the male wards ; to Samuel Jennison, Esq., for the purchase of statuary for one of the female wards ; to Messrs. Earle and Drew, publishers of the Massachusetts Spy ; to William R. Hooper, Esq., publisher of the Worcester Transcript ; Hon. J. S. C. Knowlton, publisher of the Worcester Palladium; and T. W. Caldwell, Esq., pub- lisher of the Bay State, for large and weekly packages of their best exchanges, as well as for their weekly and daily issues. Also to S. Thomson, Esq., for liberal supplies of illustrated papers ; to Nathan Hale, Esq., for the Boston Daily Advertiser since the opening of the hospital in 1833 ; to the publishers of the Salem Register, the Salem Gazette, the Andover Adver- tiser, the Bunker Hill Aurora, the Cambridge Chronicle, the New England Farmer, the Statesman, the Youth's Companion, Zion's Herald, Gospel Messenger, and to unknown friends for other weekly papers received by mail.

We are aso indebted to Hon. Charles Sumner for Public Documents, to Hon. Charles Mason for Patent Office Reports, and to Professor Henry for publications from the Smithsonian Institute, to Mr. Chamberlain of Boston for an interesting microscopical exhibition, and to Edwin Bynner, Esq., for a valuable watch dog.

I must express my sense of obligation to the other resident officers of the hospital for the persevering manner in which they have performed all their duties, and their untiring devotion to the interests of the institution.

To my assistant, Dr. F. H. Rice, I am under special obliga- tions for the fidelity and efficiency with which he carries out

9

68 LUNATIC HOSPITAL AT WORCESTER. [Oct.

all my plans and labors to promote the welfare of all the inmates of the hospital.

While we acknowledge with devout gratitude the many bles- sings vouchsafed to this institution during its whole history, let us hope that the same Good Providence will still watch over and protect it, and assist all who may be connected with it to elevate its character and increase its usefulness.

MERRICK BEMIS.

State Lunatic Hospital, Worcester, \ October 1, 1588. j

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