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Full text of "Annual report of the trustees of the State Lunatic Hospital at Worcester"

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TWELFTH 



ANNUAL REPORT OF THE TRUSTEES 



STATE LUNATIC HOSPITAL 



AT WORC ESTER. 



DE CEMBER, 1844. 



Boston: 

BUTTON AND WENTWORTH, STATE PRINTERS. 
1844. 



Digitized by the Internet Archive 

in 2010 with funding from 

University of Massachusetts Amherst 



http://www.archive.org/details/annualreportoftr10stat 



TWELFTH ANNUAL REPORT 



TRUSTEES OF THE STATE LUNATIC HOSPITAL. 



DECEMBER, 1844. 



To His Excellency George N. Briggs, Governor of the Commonwealth 
of Massachusetts, and to the Honorable Council : 

The State Lunatic Hospital having nearly completed the twelfth year 
of its successful operation, the Trustees respectfully present this, their 
Twelfth Annual 

REPORT: 

The Hospital, during the past year, has been more crowded with 
patients, and its operations generally have been more successful and 
beneficial, than in any former year. The smallest number of patients 
at any time during the year has been two hundred and fifty-three. The 
largest number two hundred and seventy-three. The average number 
has been two hundred and sixty-one. The number of attendants, in- 
cluding the Superintendent and his family, the Chaplain, Steward, &c, 
is about fifty-five, making upwards of three hundred persons as the 
average number under the same roof. 

By resolves of March 24th, 1843, the Trustees, Superintendent and 
Treasurer " were authorized so to enlarge the Hospital as to accommo- 
date one hundred and fifty more patients, together with all the neces- 
sary furniture and other accommodations for the same. Under these 
resolves the Trustees, as stated in our last report, together with the 
other gentlemen, erected, just at the close of the last year, the Johonnot 
Hall, consisting chiefly of two large rooms, and extending from the 
rear of the centre building to the chapel. These large rooms were 
much needed, as all our other rooms are small. Experience, since 



4 STATE LUNATIC HOSPITAL. 

our last report, has fully proved their usefulness. They also, at the 
same time, commenced upon the foundation of two extensive wings, 
one for males, the other for females, sufficiently large to contain the 
required number of patients ; but fearing that possibly the funds appro- 
priated might be insufficient, they contracted at first for finishing only, 
and furnishing the two upper stories. All the rooms in the two upper 
stories of the new wings are now nearly finished and partly furnished. 
The condition of our institution will more particularly appear by the 
Report of the Superintendent, which is herewith submitted. Under the 
smiles of Providence this Hospital has increased in size, usefulness and 
reputation, beyond the anticipations of its most sanguine friends. For 
its success we are largely indebted to the energy, ability and untiring 
exertions of Doct. Samuel B. Woodward, who has been the Superin- 
tendent from its beginning, and who has himself built it up and made 
it what it now is. He has already spent a large portion of his useful 
life in the care of this and other public institutions ; and we regret that 
we have to state that during the last spring and summer the Trustees 
thought his health so precarious, and so much impaired by confinement 
and close application to duties beyond what he had strength to perform, 
that they enjoined it upon him to break off at once from his duties here, 
and take a journey to the south for the benefit of his own health. He 
was absent two months, returned somewhat improved, and as we trust 
derived some information that may prove beneficial to all. 

During the sickness and absence of Doct. Woodward, Doct. John R. 
Lee, the Assistant Physician, had the whole medical care of the pa- 
tients, and shew that by his skill and experience he was entitled to the 
confidence of all. We feel grateful that the life, health and usefulness 
of our Superintendent has been so long continued to us ; but the time 
must come when age or infirmity will require a release from some por- 
tions of his present arduous duties. 

We think it necessary, even in the present condition of the Hospital, 
that there should be some additional officers. We are liable, as we 
have experienced the past autumn, to fevers and other sickness and 
disability among our attendants. If we have more officers we must 
have more accommodations for them. Nearly one half of the centre 
building is now taken up for dining rooms for the patients, being six of 
the largest rooms. The rest of this part of the Hospital is filled by the 
Superintendent and his family, the Steward and Matron, and other prin- 
cipal officers of the Institution, and is already more crowded than any 
other part of the building. This too is the only comfortable and con- 



STATE LUNATIC HOSPITAL. 5 

venient part of the Hospital for the superior officers. The Trustees 
have found it necessary, even for the present number of officers, to 
make them some further accommodations. 

In the infancy of our institution we had no chapel, and of course no 
chaplain, and no room in the building was reserved for Lis exclusive 
use. Ever since the erection of the chapel we have had a regular 
attendance upon public worship on the Sabbath ; and ever since the 
completion of the Johonnot Hall there has been a regular attendance 
of such as were sufficiently convalescent and quiet, upon daily prayers 
in that building. Upon these occasions the Rev. George Allen, the 
Chaplain, officiates with much credit to himself, and we trust affording 
much comfort and consolation to the afflicted, and much instruction and 
benefit to all his hearers. 

For the details of our financial operations the year past, we refer to 
the Report of the Treasurer. If there has been economy in the use 
or expenditure of the funds appropriated for the support, enlargement 
or improvement of our institution, we are much indebted to the prompt 
collections, punctual payments, and safe investment made by the Treas- 
urer. 

Of the Steward and Matron we can speak in terms of the highest 
commendation, for their careful and economical use of the public prop- 
erty, and kind treatment of the patients. The attendants and assist- 
ants all deserve praise. If there be a point of view in which this in- 
stitution shows itself to the most advantage, it is in the discipline and 
subordination of all the officers and persons employed therein, — each 
one knowing his place, and each one doing his appropriate duty. 

By a resolve of March 13th, 1844, two thousand dollars were appro- 
priated for the erection of a Laundry. The Trustees have selected a 
spot a little without the yard, and at some little distance from the other 
buildings, for a Laundry, where all the clothes may be washed, dried, 
ironed, mangled and aired. This building is now nearly finished. It 
is of brick, two stories high, fifty feet long and thirty-eight feet wide. 
It has been the study of the Trustees so to locate all the buildings, es- 
pecially the workshops where fire is used, as not to expose unnecessa- 
rily the principal buildings to the ravages of fire. The place in the 
main building heretofore used for ironing clothes was contracted, incon- 
venient and unsafe for that purpose ; it will not afford comfortable ac- 
commodations as a lodging-room even for any of the attendants ; but 
the building lately used as a wash-room, and which the Trustees had 
intended for a bakery, they found upon examination unfit for that pur- 



6 STATE LUNATIC HOSPITAL. 

pose ; it was of wood, and somewhat decayed. They had it removed 
without the yard, where it may be used as a store-room. They have 
also found it necessary and expedient to erect upon the same ground a 
substantial brick building for a bake-house, — the chambers over which 
will afford comfortable rooms for some of the attendants, thereby va- 
cating some of the chambers in the centre building, so as to give better 
accommodations for the Chaplain and others. This situation for a 
bakery is convenient, the necessity great, and the cost we trust not 
very considerable. 

During the year the meetings of the Trustees have been regularly 
attended, and the monthly visits to the Hospital regularly made. The 
by-laws have been revised, and made to conform to the present condi- 
tion of the Hospital. The Aqueduct, with iron pipes, as authorized by 
a resolve of March 13th, 1844, has been laid down : but as the dama- 
ges to be agreed upon or assessed for land occupied thereby, have not 
yet been settled, the whole cost cannot be here stated. 

The resources for the payment of ordinary expenses are the board 
of patients, the produce of the farm, and the proceeds of our mechan- 
ical operations. The current expenses for ordinary purposes, the past 
year, and the receipts for the payment thereof, can be better under- 
stood in the Treasurer's Report. 

Much good might result if the Trustees had authority to appropriate, 
from their funds for current expenses, when they may find it expedient, 
a sum not exceeding one thousand dollars in any one year, for the pur- 
chase of land, or for the erection, enlargement or permanent improve- 
ment of their fences and buildings. 

There is now a piece of productive land, about five acres, situated 
between the farm of the Hospital and the public highway, that has been 
recently sold for about five hundred dollars, and was purchased and is 
now held by a friend, and offered to our institution at the cost. We 
think it worth much more to the Hospital than to any other concern. 
Every year, as the number of our patients increases, we increase the 
productiveness of our land, the number of cattle upon our farm, and 
consume a greater amount of produce in our numerous family. 

Most of the funds derived from the estates of the late George S. 
Johonnot, and of Martha Johonnot, his widow, have been converted 
into cash ; particularly those bridge shares and bank shares that were 
of doubtful value. The times have been favorable for these opei'ations, 
and the loss on this part of their estates less than was feared. These 
funds were appropriated, by resolves of 1843, for the enlargement of 



STATE LUNATIC HOSPITAL. 7 

the Hospital, — for which purpose about twenty-eight thousand dollars 
have been already paid, and about fifteen thousand eight hundred dol- 
lars, in cash and in good funds, remain to pay for what has been done 
and for what is to be done to finish the wings agreeably to said resolves, 
and for furnishing the same. These new wings, one for males and the 
other for females, are each of them in the form of an L, and extend 
nearly on a line with the former front of the Hospital, and in the same 
direction each way one hundred feet, making the building in front two 
hundred feet longer than before. The centre building is seventy-six 
feet long. The two old front wings are each one hundred and twenty- 
four feet long. The new wings extend their front each way one hun- 
dred feet, making the whole front five hundred and twenty-four feet. 
The lateral wings extend backward ; the old lateral wings each from 
front to rear one hundred and thirty-six feet. The new lateral wings 
extend from the extreme front backward ; the new wing for males, 
from front to rear, one hundred feet. The new lateral wing for females 
only seventy-five feet, being as long as the Trustees calculated the 
funds appropriated would complete and furnish. The centre building 
is four stories high, and the wings are three stories, exclusive of the 
basement, which contains the kitchens, rooms for attendants, &c, and 
of the attic. The Johonnot Hall is seventy-six feet long, and the chap- 
el, which is a continuation of the same line of building, is forty feet, — 
both extending from the rear of the centre building one hundred and 
sixteen feet. On each side of the chapel are infirmaries and other 
rooms extending each way to the male and female central wings, and 
forming a hollow square or yard on each side of the Johonnot Hall. 
The whole, when completed, will afford good accommodations for four 
hundred patients and their attendants. 

The whole number of patients that have been admitted into the Hos- 
pital from the beginning is 2013. The whole number that have been 
discharged, including those that have died, is 1750. There remain 
now, at the end of the year, 263 patients. The number admitted the 
past year has been 236. The number discharged 228, of whom 124 
have recovered and 15 have died. Leaving at the Hospital 8 more pa- 
tients at the close of the year than at its commencement. 

The produce of the farm has been large, and chiefly consumed upon 
the premises. Much of the work in the shoe-shop is for the use of the 
patients. The cabinet furniture, the matresses, and the linen for the 
new wings, have been prepared by those of the household. 

R. Newton, Esq. has been employed by the Trustees as council, and 



8 STATE LUNATIC HOSPITAL. 

is now engaged in settling the land damage of the aqueduct. The 
amount paid for the aqueduct is $2,210 72. The pipe is of iron ; it 
has a bore of two inches diameter, and is one mile long. Its weight is 
about one hundred and forty pounds to the rod. Its strength has been 
tested by a powerful hydraulic press. 

Much yet remains to be done to carry out the designs of the benevo- 
lent founders of this institution. There is much room for the charita- 
bly disposed and affluent to do good. Many improvements remain yet 
to be made, and many distressed subjects to be relieved. 

The State Lunatic Hospital has uniformly received the patronage 
and encouragement of the wise and good. We feel it to be our duty, 
in behalf of the afflicted inmates and their friends, to acknowledge the 
bounty and kindness of our civil rulers, in erecting and supporting so 
useful an establishment. We would gratefully remember also individ- 
ual benefactors, among the foremost of whom are the late George S. 
Johonnot, Esq., and the late Martha Johonnot, his widow, who have 
bequeathed so large a portion of their estates in aid of the benevolent 
cause in which we are engaged. 

HENRY GARDNER, 
STEPHEN SALISBURY, 
JOSEPH SARGENT, 
S. C. PHILLIPS. 

Worcester, Dec. 1st, 1844. 



STATE LUNATIC HOSPITAL. 



TREASURER'S REPORT. 



To His Excellency George N. Rriggs, Governor, and to the Honor' 
able Executive Council of the Commonwealth of Massachusetts : 

The Treasurer of the State Lunatic Hospital respectfully presents 
his Twelfth Annual Report : 

The Treasurer charges himself from December 1, 1843 to Novem- 
ber 30, 1844, inclusive, as follows : 

For cash on hand Dec. 1, 1843, balance of 

account, ..... $ 3108 68 

For receipts from cities, towns and indi- 
viduals, ..... 28,878 37 
For credits on bills for sundry articles sold, 284 53 



He credits himself as follows : 
For payments for improvements and repairs, 
" " " salaries, wages and labor, 

" " " furniture and bedding, 

" " " clothing, linen, &c. 

" " " fuel and lights, . 

" " " provisions and groceries, 10,675 89 

" " " medical supplies, . 526 38 

" " hay $40, straw $120 20, 

" " " miscellaneous, 



,271 58 



736 47 
7871 41 
1656 33 
2447 66 
3984 19 



160 20 
1220 22 



Expenses for the year, 

Cash on hand balance to new account, 



29,278 75 
2,992 58 



Wood, . 

Charcoal, 

Anthracite, 

Oil, 

Candles, 

Wick, . 



The item Fuel and Lights includes 

572 cords 7 feet 5 inches, 
. 2164 bushels, . 

105 tons 340 lbs, 
. 487£ gallons, . 
6 lbs., 



$32,271 


58 


. 2554 32 


. 195 


56 


. 796 


13 


. 434 89 


2 


16 


1 


13 



$3984 19 



10 



STATE LUNATIC HOSPITAL. 



Provisions and Groceries include 



Fruits, &c, 


■ . . . 






8625 25 


Salt, spices and smal 


groceries, 






184 24 


Soap, 


. 






452 95 


Butter, 


12,453 lbs. . 






1746 04 


Cheese, . 


11,584| lbs. , 






703 96 


Eggs, . 


673 dozen, 






95 86 


Beans, 


31 bushels, 






45 08 


Peas, 


15/g bushels, 






18 59 


Milk, 


12 quarts, 






48 


Tea, 


873£ lbs. 






258 42 


Coffee, . 


1387 lbs. 






102 91 


Shells, . 


60 lbs. 






6 59 


Biscuit, . 


. 






87 66 


Brown Sugar, . 


11,911 lbs. 






791 36 


White Sugar, . 


802 lbs. 






95 70 


Molasses, 


935J gallons, H 






191 86 


Honey. . 


663J lbs. 5 gallons, 




56 97 


Vinegar and Cider, 


17 barrels 26 gallons, 




50 02 


Rice, 


1621 lbs. 




55 20 


Corn, 


752 bushels, 






524 80 


Oats, 


159J bushels, 






51 71 


Barley, . 


49 bushels, 






30 15 


Rye, 


334 bushels, 






. 257 37 


Flour, 


273£ barrels, 






. 1373 87 


Turnips, . 


1 1^ bushels, 






2 80 


Potatoes, . 


1842 bushels, 






545 32 


Poultry, . 


885i 9 6 lbs. 2 dozen pigeons, 


83 51 


Fresh Fish, 


626 lbs. 129 shad, 90 mackerel, 


57 85 


Salt Fish, 


6706 lbs. 


. 170 00 


Mackerel , 


3 barrels, 


31 75 


Salmon, 4 bbls. 75 lb 


3. smoked, 50 lbs. smoked Halibut, 


58 45 


Oysters, Clams, Lol 


)sters, ..... 


34 34 


Tongues and Sounds 


, . 2 barrels, 


10 50 


Herrings, 


2 boxes, . 


1 66 


Ham, 


560J lbs. and smoking others 


, 45 40 


Mutton and Lamb, 


. 1912J lbs. . 


. 137 95 


Beef, 


24,142£ lbs. . 


. 1236 98 


Pork, 


. 1937 lbs. . 


. 


. 


. 125 53 



STATE LUNATIC HOSPITAL. 



11 



Veal, 
Sausages, 
Tripe, 
Tongue, . 



. 4397 lbs. . 

. 507£ lbs. . 

. 199 lbs. . 
2£ lbs. 

Miscellaneous includes 



. 260 98 


49 


55 


15 


94 


00 


25 


$10,675 


89 



Cash advanced to patients and charged in their accounts, or 

paid to them when leaving the Hospital, 
Expenses after elopers or for their return, 
Expenses of sending home patients discharged, 

Funeral expenses, ...... 

Postage, ........ 

Books, stationery and printing, .... 

Three cows and two calves, two pairs oxen, one bull, and 
one horse, ....... 

Expenses of Trustees' visits, .... 

Analysis of water, ...... 

Filling ice cellar, ...... 

Pasturing, $30 08, rent of land, $32 87, . 

Repayment of money overpaid for patients, either by being 
paid in advance or through mistake of the Treasurer, in 
the time of their being in the Hospital, .... 

Sundries, . 

$1220 22 

No appropriation will be necessary for the current expenses of the 

ensuing year. 

ALFRED DWIGHT FOSTER, 

Treasurer of the Slate Lunatic Hospital. 
Worcester, December 10, 1844. 



$182 


17 


39 


85 


22 


37 


101 


50 


113 


64 


107 


53 


363 


00 


48 


Gl 


45 


00 


23 


00 


62 


95 


36 


74 


73 


86 



THE TWELFTH REPORT 

OF THE 

SUPERINTENDENT TO THE TRUSTEES 

OF THE 

STATE LUNATIC HOSPITAL, 

WORCESTER, MASS., 

From Dec. 1st, 1843, to Nov. '30th, 1844, inclusive. 



It is now twelve 3 ears since the Hospital was opened for the recep- 
tion of the insane. During this time there have been admitted into its 
wards 2013 patients. There have been discharged 1750, of which 
number 916 have recovered, 151 have died, and 683 have been dis- 
charged in various conditions, some greatly improved, some with im- 
proved health and habits, others as harmless and incurable, for want of 
room, and a few have been sent back to the jails and houses of correc- 
tion for the same reason. 

We have had from the commencement a succession of prosperous 
seasons, an unusual exemption from mortality, and such success in the 
recovery of insanity, as calls loudly for gratitude to the Giver of all 
good for his protection, guidance and blessing. 

The Hospital has been for a long term, in such a crowded state as to 
render additional accommodations necessary ; the pressing demands 
for admission being far beyond the means of relief. 

In 1843, the Legislature decided to add to the Hospital one hundred 
and fifty apartments, and to expend for this purpose a fund given to 
this institution by George and Martha Johonnot, who, in their last will, 
made it the residuary legatee of their estate. From this source the 
Hospital came in possession of a legacy of about $43,000, which has 
been expended according to the original design of its benevolent donors, 
that of adding to the accommodations for the insane in this Common- 
wealth. 

The additional wings, part of which are now nearly ready for occu- 



STATE LUNATIC HOSPITAL. 13 

pancy, extend in front, from the present verandahs, 66 feet, with a 
return wing from the southern extremity of 100 feet, and from the 
north of 75 feet. These buildings contain 160 apartments for patients, 
and such attendants and assistants as may be necessary to take charge 
of them. 

The walls throughout the building are hollow, to increase their 
dryness and to admit the plastering to be made on the brick surface, a 
consideration of some importance in a hospital for the insane. 

The rooms are 8 feet by 10, each has a window secured by a cast 
iron grating corresponding with the sash, so as to remove all offensive 
appearance. There are also ventilating openings over the doors, and 
two orifices in the inner wall of each room which terminate in the attic 
story, from whence the foul air escapes through the sky lights and 
windows. The halls are 12 feet wide, those of the front wings cros- 
sing those of the lateral wings at right angles. There are dining rooms 
in each story, to which the food is transferred from the kitchen by 
dumb waiters. There are also, sink rooms, water closets, &c, con- 
nected with each gallery. 

The kitchens, containing the most approved apparatus for cooking, 
conveying water, &c, are in the basement story. Here are also placed 
the furnaces for warming and ventilating the whole building. 

The verandahs have been enlarged ten feet in width, and through 
them we have easy access from the new wings to the centre building. 

The whole building presents a front of five hundred and twenty-five 
feet, this with the four lateral wings, Johonnot Hall, the chapel, infir- 
maries, bakery and solitary, which are all connected, make a range of 
thirteen hundred feet, besides out buildings, shops, laundry, &c. 

The new laundry is a commodious building, about 100 feet south 
east of the eastern extremity of the south wing. It is 50 feet long by 
30 feet wide, consisting of basement, centre, and attic stories, appro- 
priated to washing, drying and ironing the clothes. The wash room is 
fifty feet by twenty. In this room is a steam boiler, which heats all 
the water for washing, steams the clothes, and warms this large room 
and the ironing room directly over it. Warm and cold water are con- 
ducted to each tub by pipes and are again let off, after being used, by 
valves at the bottom of the tubs, a press is used as a substitute for 
wringing, dumb waiters carry the clothes to the attic, which is heated 
for the purpose of drying in winter and bad weather, and every ar- 
rangement is made for facilitating the labor in this department. 

Over the wash room is a room of the same size for ironing, and 



14 STATE LUNATIC HOSPITAL. 

airing the clothes. One end of this room is partitioned off as an airing 
room for the clothes after ironing, the furnace for heating the irons is 
placed in this partition, — the pipe of which passes around the room and 
affords sufficient heat for drying. Through the centre of this room 
runs the steam pipe for warming which is connected with the steam 
boiler below, over this is the ironing table where the laundress and her 
assistants, with a suitable selection of patients ply the irons. At the 
end of the room is the mangle by which much of the heavy work of 
this department is accomplished. 

Besides these rooms, this building has a convenient cellar, in which 
is the tank for water with suitable pipes and cocks for the regulation 
of the water for the whole establishment ; a kitchen and rooms for the 
accommodation of a family and the persons employed. 

A bakery and rooms for the seamstresses are now being erected on 
the site of the former wash house, which has been recently removed 
to another location. This building, sixty feet long and twenty wide, 
occupies the space between the chapel and the infirmary. It is to be 
two stories high and to contain eight rooms, suitable for the labor, board 
and lodging of all the persons employed in these two departments. 

These buildings, with the Johonnot Hall, erected last year from the 
funds left by the benevolent woman whose name it bears, compose the 
projected improvements which will add greatly to the comfort of the 
establishment. 

When these accommodations are completed, the Hospital will afford 
room for 400 patients, and apartments for nearly 100 other persons, 
most of whom are in some way employed about the establishment. 

The operations of the Hospital have been upon a more extended 
scale than any former year. The number of admissions and discharges 
has been greater, the number of residents more numerous, and more 
patients have recovered. The number of patients at the close of the 
year, (263,) exceeds the number of rooms by more than thirty. This 
number has been suffered to accumulate, with much present incon- 
venience, from an unwillingness to send patients away, when additional 
rooms will so soon be in readiness to accommodate all, we trust, who 
may desire a residence within the wards of the hospital. 

The interest in such institutions, has evidently greatly increased 
within a few years. The number of recent cases admitted is greater 
than at any former period, and in most of them the friends of the in- 
sane, desire to avail themselves early of the benefits of the Hospital. 
In the course of the last year quite a number of individuals have been 



STATE LUNATIC HOSPITAL. 15 

brought to the institution the first week of their illness, and many more 
within two, three, or four weeks. These are favorable indications, and 
induce a hope that insanity will be diminished, that fewer cases will be 
suffered to assume a chronic form, and the sufferings attendant upon 
this great calamity be essentially lessened. 

Following this brief description of the new buildings, I present the 
usual tables deduced from the records of the Hospital. On examining 
the tables heretofore presented in reports, with reference to the value 
of their statistics, I cannot persuade myself to omit any. I am aware 
they are of unequal value, but I trust none are wholly useless or unin- 
teresting. All the tables given are designed to present fads only. If 
the numbers cannot all be vouched for as mathematically correct, they 
approximate so closely to facts as to be safe for ordinary estimates. 

If we present reports, of what shall they consist? Not, surely, of 
essays on insanity, theories and views irrespective of the statistics 
which we gather in the institutions. These would of course do little to 
impress the public mind of the value of our observations. If our views 
and theories are founded on facts, and are supposed to derive weight 
from our experience and observation, why not present these facts as 
succinctly as possible, in tabular or other forms ? They are unsafe for 
us if they are unsafe for others. 

Fully believing that the statistics of insanity, are as valuable as any 
other vital statistics, I shall not discard them, but hope to see them ex- 
tended and perfected till they be found wholly correct and entirely 
reliable. 



16 



STATE LUNATIC HOSPITAL. 



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4 



26 



STATE LUNATIC HOSPITAL. 



8 

Ins 



< 





Hereditary. Periodical. 
Suicidal. Homicidal, &c. 


Hereditary. 
Idiotic. 
Hereditary. 
do 

Periodical. 
Hereditary. 

do 

do 
do 

Periodical. 




cb 

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si 
£ s 

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The Court 

do 

do 

do 
The Friends 

do 

do 
The Court 

do 

do 

do 
The Overseers 

do 
The Court 

do 

do 
The Overseers 
The Friends 
The Court 

do 
The Friends 
The Court 

do 

do 

do 

do 
The Friends 

do 
The Court 

do 
The Friends 




s § 

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Intense study, 

Followed fever, - 

Fear of poverty, 

Religious, - 

111 health, - 

Puerperal, - 

111 health, - - r 

Trouble, 

Hard study, - 

Unknown, - - 

do 
Hard labor, - 
Unknown, ... 
Domestic trouble, - 
Trouble, 
Religious, - 
Fright, - 
111 health, - 
Intemperance, 
Unknown, ... 
Intemperance, 
Religious, ■> 

do 

do 
Loss of property, - 
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Unknown, - ... 
Measles, - 
Masturbation, 

do 




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S "3d o i: ~o "So b *5b-o "5ofc:'bJDt;-o E o o o oliKooico "Sicro fc "5o £ 'ho 
s CO ,ar a * or a is b ur; s'C'D'C c ca'COr^ cj- cs b i« s 

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02 


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g fag fa gfcgfe § fa Sfa S 




CBS'S 


oi^'<fi~e»NNOOboowO'*^ | coocDcocononowi'30noio 
ionrtTf^NNiNn(Nnco*^n.'*.nnG i 5«nco(on>r5cD"cB<onNn 




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cococococDcor*i > 't*h't , "t*l s *t*i>r , 'Cocococococococococoo^aicT)c7iQ 
0O03(»c»raracocoracxic»cxic»cocococooDcwcX)Cococx>coc»cocxioDc» 



STATE LUNATIC HOSPITAL. 27 



'b|-ab-a b "2 T3 "S b"§ ^ -o^ b "3 ■o'Stj b -o 

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SQtfjStj Q^ Q2 pj S tf »2 P j M tf hSlM tf 02 Pj £ Pj £ 3Q £ 

bJOw bpw bD oiboho tnbo en bjo « W> 2 ^ 2 



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2goooooooooooo:^aooo<uooaoooooa)aooo<uaoooo© 
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? S T32 £ £ sc ? S 



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3 1> 3 (3 <Dg a>3<U3<Ua}3<U3 S> 3 O 3 

J= J5J3 J3J3 J3J3 -G J3 J3 J3 -C J3 -C J3 * J3 J3 JB -fi 

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B % >%£ :*,£ £ £ >»£ S -a S >> ?.* >>S 

— S$ GO i-h h- 1 i-l rt 1Q 



P jT 2 --"2 s\g S -- art- a H 2 "3 a 13 g _- « _~'3 s\j> £ s~ £ jf ja" 2 "» » £ 

^ 13 *0 "O T3 ■OT3 i. >. T) ;» "5 

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-c "So £ "3d t; "So S "5b o fc_o"5bb:'5oSoo-a Td-o t o o -o hjo o o o o £; o "5b o o fc "hb fc tj o "5b 

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28 



STATE LUNATIC HOSPITAL. 





1 sJ 

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g 73.07373 g O g 0-73-0 to g g-OT3 73 ©73 g 73 73 g .g g 73 73 73 .g 




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£ 


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Stat 

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g PBPC PC £ G 




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£0-3 £-3 a 073 £7= £ 073 £7= £-5 £-= £73 £ 073 

0373JS73 03™ 0373JS DJS73737373 0373JS 0)J2 03.273 OjJS 03 i™ 037373a 

fa s feSfe Sfag fa SfaSfaS faSfagfa g 








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STATE LUNATIC HOSPITAL. 29 



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<0 CO o cfl 



o-d 



§-§ |-§ § 1 §■§.§ 1 1 §.§ I 2£SJ£%S t-%-%-%-%-%-%-%-% f^^S-8^ 2.2 2.2^ 1 



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.2 g -a -a -o " g-o-D « | -§ -o -o •§ -a -a « |^-aT3-a-o-o-o-3'C--aT3-o'0-T:-o-oi3-a-o-a 
Qtf gp$ Qf_; Q_! 



^cooowSooooooooooooooooooooooooooooooooo 
■a S ? S £ 



3 003 o 3 0) _ o 3 03 .<u 

r R O O O O O £ rj- /? O C rj? O r"? O O O O O O O O O /^ O r^ O O f£j r*? OOOO^ r 9 O O O £ 

O a> Qj a> 03 O 0) <D O 4> V O 4> 

-S _C-a_5 _J J3 -S -C -C-H -3J3 J3 

Eh hhh H H H H HE- HH H 

g i» w J_ j3!OJ3«^B^ 01 "S iyi as W w W 



_JE-<Dgpj_! cu a h cj ^ a ;_■ g ;_> _;H^ gj D a, si ;=; :_ S cd E- fa £> 

TS T3-0 13 T3 T3 •> T3 "O "O T3 

.2 4> _ a> 2 « .2k .2 * .2 §J2 -2J2---2 .2.2.2 J£ 

b oTdo o o o'_"3d'„ o o"Sx)0 o't"5oo o'E hjo_o o o o _-a bj_ „ bet: fcuo_o fc bjo_ © o bjo 

gj ie gqjig ic g£i gia g^i» gaigai gigg m 

•S o o o o ol o o-Sl o o --Sl-Sl-Sl o o-i §■§ I o-l ©1 o o o o o-Sl © © © 

oo«ON-'ra>aii3iohcoTfonacoffit-iootoonii3o>i)i~soooK)rt_<o2«r!H 



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0)T3l3 -, OT3"Ci' , aT3'T3 _ O"OT3"O'T3 oxiT3T313T3T3"O r C r O r OT3*!3 ri OT3'U'T3T3'aT3T30T3'T3T3 r O 
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30 



STATE LUNATIC HOSPITAL. 





o 






=3 






•at 






E .2 






.2 S 






cm S 






ci 






.•3 ^3 


& 1 




■a "a 


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months 

years 
week 
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tX <M »< <*< 9J CM »t 91 



STATE LUNATIC HOSPITAL. 



31 



TABLE 1. 



Showing the Committals from each County in the State, the present and 
previous years. 









1844. 


Previously. 


Total. 


Barnstable, 


Males, 


3 








Females, . 




2 


36 


41 


Berkshire, 


Males, 




5 








Females, . 




3 


54 


62 


Bristol, . 


Males, 




10 








Females, . 




11 


103 


124 


Dukes, . 


Males, 













Females, . 







6 


6 


Essex, 


Males, 




14 








Females, . 




15 


240 


269 


Franklin, 


Males, 




1 








Females, . 







68 


69 


Hampden, s . 


Males, 
Females, . 




4 

4 


78 


86 


Hampshire, 


Males, 
Females, . 




4 

7 


102 


113 


Middlesex, 


Males, 




19 








Females, . 




16 


189 


224 


Nantucket, 


Males, 




1 








Females, . 




1 


12 


14 


Norfolk, 


Males, 




15 








Females, . 




16 


173 


204 


Plymouth, 


Males, 
Females, . 




2 
8 


75 


85 


Suffolk, . 


Males, 




16 








Females, . 




8 


186 


210 


Worcester, 


Males, 




16 








Females, . 




35 


449 


500 


Private boarders, 








6 


6 








236 


1777 


2013 



32 STATE LUNATIC HOSPITAL. 

The government of the State in its beneficence has established this 
Hospital, and assumed the payment of the salaries of its officers, and 
tenders its use, and their services for the relief of the insane. It is a 
noble monument of its public spirit, and regard to the wants of suffer- 
ing humanity. 

The charge for support at the Hospital embraces only the cost of 
board and the supervision of attendants and other assistants, who are 
all, in one way or another, devoted to the interests of the patients. 

It would appear, from the table, that this benefit was unequally dis- 
tributed ; some counties having many, others comparatively few inmates 
in its wards. But the counties receiving most benefit bear the greater 
proportion of expense, and those most exempt from the malady which 
renders its establishment desirable, have most cause for thankfulness. 
It is a blessing when necessary, but the greater blessing not to need, or 
be obliged to use it. 

It is the high honor of this ancient Commonwealth to be the first and 
foremost in providing for its insane. Its accommodations are more 
ample and probably not inferior to those of any other community in 
the world. It is to be hoped that they will be found sufficient for all 
its demands, and that a long time may elapse before they are fully 
occupied. 



STATE LUNATIC HOSPITAL. 



33 



TABLE 2. 

Showing the number of Admissions, and the state of the Hospital, from 
Dec. 1st, 1843, to Nov. 30th, 1844. 



Patients in the Hospital in the course of the 

Males, 

Females, ..... 


year, 


244 

247- 


491 


At the commencement of the year, 

Males, 

Females, . . 

Admitted in the course of the year, ' . 
Males, , 
Females, ..... 




135 

120 


°55 




109 
127- 


— 236 


Remain at the end of the year, 

Males, 

Females, ..... 




128 
135- 


— 263 



491 



255 



236 



263 



Patients admitted, . . 236 

Males, . . 109 

Females, . 127—236 

Cases of duration less 

than one year, . . .131 

Males, . . 49 

Females, . 82—131 

Cases of longer duration 

than one year, . . . 105 

Males, . . 60 

Females, . 45—105 

Cases committed by the 

Courts, . . .158 

By the Overseers, . 22 

Private boarders, . . 56 — 236 



Foreigners now in the 
Hospital, .... 
Males, . . 18 
Females, . 20 38 



38 



Patients now in the Hospital, 
Males, . . 128 
Females, . 135—263 

Cases of duration less 
than one year, . , 
Males, . . 19 

Females, . 32 51 

Cases of longer duration 
than one year, . 
Males, . . 109 
Females, . 103—212 



Foreigners discharged 
the last year, 

Males, . .11 
Females, . 1- 



-12 



Applications not received 
at the time, 

Not received at all, most- 
ly for want of room, . 



263 



51 



212 



12 



107 



77 



In the course of the last year seven cases of insanity, found by the 

Commissioners of Lunacy in the Massachusetts Prison, came into the 

Hospital. Three of these men were sent to the Hospital in the month 

of April. One had been in confinement nearly seven years, almost 

5 



34 STATE LUNATIC HOSPITAL. 

constantly in a solitary room of the prison, without labor, and al- 
most without exercise. He had delusions, supposed himself rich, and 
gave away, as he declared, large sums of money. He stated to the 
commissioners that he had $150,000 a day for services, was worth 
$360,000,000, and received " great legacies to pay for highway rob- 
beries." He will not labor as he has plenty of servants to do his 
work. 

This man is now in improved health, civil and respectful. He at- 
tends religious services every Sabbath, and family prayers frequently 
in the evening. He is evidently insane, but during the eight months 
that he has been in the Hospital has had no outbreak of violence, nor 
any marked periodicity or lucid interval. He appears better, is social 
in his feelings, unites in games with his associates, and enjoys himself 
well in his new situation. It can hardly be expected that he will re- 
cover. 

Another of these unfortunate men was in the Hospital apartment of 
the prison, recovering from illness, when visited by the Commissioners. 
He was a colored man, born a slave, and was supposed to have escaped 
from his master in Baltimore. He had been in solitary confinement 
four months previous to this illness. His delusion was respecting a 
" perpetual motion " which he had discovered, and which the world 
were using to move steam-boats, rail-cars, and all kinds of carriages. 
He too was rich, and thought himself a prophet. This man was not 
well when he came to the Hospital, was troubled with asthmatic breath- 
ing and some cough. Insanity was clearly marked in this case. 
He talked much of his perpetual motion. He was fond of playing 
the violin, in which amusement he was indulged, though he had no 
knowledge of music ; he attended church on the Sabbath when able, 
and though quite insane, and occasionally considerably excited, was 
never troublesome. He was attacked with lung fever in July, and died 
in a few days. 

The third person sent to the Hospital at this time, was a foreigner, 
by trade a glass blower, and by far the most violent and dangerous of 
the three. He had false hearing, and had attempted to kill one or more 
of those persons whom he supposed were talking to him or about him. 
From this false hearing came his delusions. Since he has been under 
our care, he has had turns of violence and great trouble from this 
source. When excited, he is disposed to be quarrelsome and suspicious 
of his attendants. At these times he fills his ears with bread, wax, or 



STATE LUNATIC HOSPITAL. 35 

wool, to remove the disagreeable noises which annoy him excessively. 
He is not always equally excited, but is never a safe man to be at 
large. His health is bad, owing to internal hemorrhage, which has oc- 
curred occasionally for some years, and which tends to increase his 
irritability and excitement. 

On the 9th of September, the other four insane prisoners were 
brought to the Hospital. 

The first on the list attempted homicide. He was not supposed in- 
sane when he committed the act. After a time he began to complain 
of his ears, said there were " worms in them." He gradually went 
into a dull, stupid state, and became speechless. For some time pre- 
vious to the meeting of the Commissioners, he assumed nearly the same 
posture on the floor every day, took his food irregularly, and was never 
found asleep. Since he came to the Hospital, his appearance has been 
similar ; he sits all day, unless compelled to move, in one position, his 
countenance is downcast, he is silent, never having uttered a word to 
any one, he neither turns his head to the right nor left, or moves his 
lips when spoken to, or urged to speak. At first he took little food, re- 
cently he has eaten better and gained some flesh. He has attended 
meeting a few times, on the Sabbath, and appears precisely as he does 
in the ward. His health is improving, and there is some ground to 
hope that he may yet be better, and perhaps ultimately recover. No 
one who examines the case can doubt of his insanity. 

Another of the prisoners is a young man, about twenty years of age. 
He did not appear insane when committed to the prison in Oct., 1843, 
but became so soon afterwards. He was incoherent, talkative and 
noisy for some weeks in succession, and then became dull and silent 
for a season — was inclined to keep his bed, and, when urged to talk, 
appeared no more rational than when excited. Sometime before the 
meeting of the Commission in Sept., he again became excited and con- 
tinued so till the time of the meeting. When first seen by the Commis- 
sioners he talked incessantly, was very profane, and laughed much and 
loudly. His eyes were red, his pulse frequent, and every thing about 
him indicated insanity. He was also a victim of self-pollution, proba- 
bly the cause of his disease. 

There was no change in him, after he came to the Hospital, till he 
took large doses of medicine, since which time he has gradually im- 
proved in his appearance and conduct. He is now quiet at night, talks 
less, is more easily controlled, labors some, has attended meeting on 



36 STATE LUNATIC HOSPITAL. 

the Sabbath, and has some indications of improvement which may, 
perhaps, result in complete recovery. 

The next of the four on our list is a colored man, who was commit- 
ted to prison in June last. He was quite violent at first, but afterwards 
became more quiet, and told his story of what had occurred to him 
since his pardon from the prison in 1839. He called himself God, 
President, King, &c, talked loudly, tore his clothes and bedding, and 
rubbed his straw to powder. Since he came to the Hospital he has 
been less violent, he still says he is God, but if any one else wishes to 
be God, he will give up his claim, there was no God at the prison, so 
he would be one. His eyes are blood-shot, and his countenance va- 
cant. He now says but little, works some, attends chapel on the Sab- 
bath, and is harmless and inoffensive. When in prison, his first out- 
break was in the chapel, during religious service. 

The fourth and last of the seven prisoners sent to the Hospital, was 
convicted of highway robbery. He had been in prison before, and left 
at the expiration of his sentence. After his re-committal, more than a 
year before he came to the Hospital, he was well enough to do some 
labor, but appeared eccentric and strange. He had a sudden outbreak 
in the shop where he was at work, after which he did no labor. Pie 
claimed to be the Savior, said that he had spiritual intercourse with in- 
dividuals abroad, and could accomplish many things at remote distances. 
He reads the Bible, talks much about it, and quotes it for all purposes. 
Pie has a Sabbath of his own, which is on Tuesday. When at the 
prison he knit from the yarn of cast off stockings, a whole suit for him- 
self, which he put on before the Commissioners. He has not changed 
in his character or conduct since he came to the Hospital. He has had 
one outbreak, and then undertook to defend himself from imaginary 
insults. He claimed the right to defend himself if he was misused, 
but finally consented to report his grievances and be non-resistant. He 
talks rapidly and with great freedom of language, but has recently ap- 
peared quite inoffensive ; he attends church, and works some, he mani- 
fests no disposition to change his residence. 

It is to be hoped that much good may result from the benevolent ac- 
tion of the government in this matter of insane prisoners, independent 
of the relief afforded to these individuals who have been, for a consid- 
erable time, secluded in places quite unsuitable for them. The prison 
itself is no place for the insane in any circumstances. They must be 
confined in close rooms, for their presence, with other prisoners in the 



STATE LUNATIC HOSPITAL. 37 

Hospital, or in the shops, would be subversive of all order and disci- 
pline. Whenever confined, they should be the subjects of frequent 
inspection by the medical officer, and every comfort should be afforded 
them which the nature of the case demands. If the insanity is real, 
who can so well direct the proper course of treatment as the physician ? 
If feigned, who can so well detect the counterfeit, and expose the im- 
position ? 

If it were made the duty of the physician of the prison to examine 
all such cases from day to day, or even one day in a week, to discover 
what physical derangement there is in the system, what manifestations 
of insanity or its counterfeit, the difficulties now embarrassing the Com- 
missioners would be greatly diminished. 

It cannot, generally, be a difficult matter for a medical man to dis- 
tinguish real insanity, if he devotes himself to the case and investigates 
the condition of the individual. It is a mistaken notion, quite prevalent 
in the community, that insanity can be easily simulated. This is far 
from being true. Few individuals, even the most intelligent in society, 
know sufficiently what are the distinctive marks of any one form of in- 
sanity, to counterfeit its symptoms, even if they are the most common 
that are exhibited in a Hospital. Can ignorant men, destitute of all 
knowledge of the subject, counterfeit the most difficult and unfrequent 
forms of disease ? It is the ignorant only who can believe such an ab- 
surdity. 

If the physician of the prison, after examining such cases, and duly 
considering them, should report his opinion to the officers as a guide to 
them in their course of discipline, it would relieve those who do not 
claim a knowledge of insanity from much embarrassment as to their duty. 
The neglect of this salutary provision tends directly to induce prisoners 
who are lazy, and choose not to work, to simulate insanity to avoid 
labor. 

Insane prisoners can be induced to labor in the shops or on the 
grounds of a Hospital where no tasks are imposed, no exactions requir- 
ed, and where silence is not necessary and cannot be compelled. But 
very different, indeed, is the condition of a laborer in the shops of a 
prison. There order must be preserved, silence imposed, and every 
movement must be in accordance with the system adopted. One noisy, 
irregular person would destroy all the discipline of such an establish- 
ment. The management of the insane at labor is entirely different, 
from that of the convict, and they cannot assimilate. It is to be hoped 



38 STATE LUNATIC HOSPITAL. 

that the salutary regulations adopted by the government will be contin- 
ued in force, and be followed by new ones connected with the inspec- 
tion of such individuals as are feigning insanity, or are really insane. 

There are those who seem to doubt whether a guilty, or a wicked 
man can be insane. Who is there among mankind that comes more 
directly under the influence of causes prolific in the production of insan- 
ity than the prisoner who has been detected in his crimes, whose schemes 
of wealth or aggrandizement are frustrated, and who is suffering igno- 
minious punishment as the result of his vicious career ? 

The Warden of the prison entertained no such views, and his con- 
duct towards these unfortunate men was most unexceptionable. He 
visited all the cases frequently, examined them with vigilance and care, 
and formed his opinions from his own observation. In this he evinced 
great benevolence as well as firmness and sound judgment. 

To many it seems strange that there should be so many criminal lun- 
atics in this country, and strong suspicions are entertained that the 
courts are too lenient in thus extending clemency to those who have 
committed offences. Sir James Graham recently stated in the British 
Parliament, in a debate on the report of the English Commissioners of 
Lunacy, that there were in confinement, in the Kingdom of Great 
Britain, 240 criminal lunatics, 85 of whom were in the Bethlehem 
Hospital, 33 in jails, and the remainder in the various asylums in the 
Kingdom. 

The English Metropolitan Commissioners recommend separate estab- 
lishments for criminal lunatics, to be made stronger and of more ready 
inspection, where separate confinement may diminish the danger which 
arises from the ordinary intercourse of our asylums. 

My experience would not confirm these views, as the criminal insane 
are often the most harmless and docile in the Hospital. They require 
care and watchfulness, to be sure, but they can usually be managed with 
as much safety as any other class of patients who are equally insane. 

There have been, in the Hospital, sixteen persons who have commit- 
ted homicide, and many more who have made assaults with intent to 
kill. Among this number are many in whom we place confidence, al- 
lowing them to be about the premises without particular suspicion. 

There may always be some cases of this character, in large public 
institutions, which cannot be too closely guarded, and for these there 
should be a few strong apartments, that the public may feel secure, and 
that such dangerous persons may not regain their liberty. Such was 



STATE LUNATIC HOSPITAL. 39 

the notorious Trask, who escaped from our strong apartments, which, 
on the first inspection, he declared to be like cobwebs, compared 
with those he left in Boston. Rogers, too, in his periods of excitement, 
required a room where he could be safe himself, and out of danger of 
injuring others. 

A few such apartments are quite as much needed for another class 
who should be made subjects of strict inquiry, and frequent observation 
by those who are fully acquainted with insanity. I allude to those who 
are arraigned for crime, who are suspected to be insane, and for whom 
the plea of insanity is to be made. At present, in cases of this descrip- 
tion, courts and juries, no less than medical witnesses, are wholly de- 
pendent upon the vague testimony of persons of inexperience, often of 
loose observation, and not unfrequently so connected with the individual 
on trial as to make their testimony not wholly safe and reliable. The 
physicians of jails rarely see such cases, and often feel incompetent to 
decide where there is any considerable difficulty. 

If in connection with our large institutions some such strong rooms 
could be provided, and the medical officers of the institution be instruc- 
ted to examine them frequently, and carefully, under all circumstances, 
and for a considerable period, the results might be more satisfactory and 
more safely relied upon, than they can be under the present system. 

At some time, not far distant, I hope, a suit of rooms for the violent 
insane of both sexes may be erected, at a suitable distance from our 
Hospital building, in which a few such apartments may be provided, 
with others to take the place of our present solitary rooms, which are 
so near as to annoy the better class of patients, and so constructed as 
to be neither pleasant, comfortable, or healthful. 

The subject of the jurisprudence of insanity is deeply interesting, 
and is claiming increased attention from year to year from the lawyer, 
the judge, and the medical man. The practice of our courts, and those 
of English judicature, is quite in advance of the principles laid down 
in their books. But the latter will make steady progress till more just 
views prevail, and criminal law be modified by the enlightened expe- 
rience of modern science and observation. 



40 



STATE LUNATIC HOSPITAL. 



TABLE 3. 

Showing the number of Discharges and Deaths, and the condition of 
those who have left the Hospital, from Dec. 1st, 1843, to Nov. 30th, 
1844. 





*s 






=3 


=y ^ 




-i- *- 






(D 


13 


£ 88 


a 3 








<u 


03 


>. 


3 u 


|| 








t— ■ 
o X 


> 

o 


O 




% bn 


• 


"3 




dec 




a 

g 


2 * 


Ǥ 


O) 


o 




£ 


PS 




Sk 


,5 a 


S 


H 


Patients discharged, . 228 
















Males, . 


117 


56 


19 


29 


4 


9 


117 


Females, 


111 


68 


21 


16 





6 


111 




228 


124 


40 


45 


4 


15 


228 


Patients discharged whose 
















insanity was of less du- 
















ration than one year, 100 
















Males, . 


41 


37 


3 








1 


41 


Females, 


59 


56 


1 








2 


59 




100 


93 


4 








3 


100 


Patients discharged whose 
















insanity was of longer 
















duration than one year, 128 
















Males, . 


76 


19 


16 


29 


4 


8 


76 


Females, 


52 


12 


20 


16 





4 


52 




128 


31 


36 


45 


4 


12 


128 



Facts relating to discharges. 

Discharged as harmless and incurable, mostly for want of room, in 

twelve years, - - - - - - -216 

Sent to the jails as incurable and dangerous, - - - - 40 

Discharged by the Probate Court, ----- 35 

" " " higher Courts, 9 

Sent to South Boston, - - - - - - -17 



It will be seen by the table that, in the course of the past year, forty 
patients were removed from the Hospital improved, but not recovered, 
forty-five as incurable and harmless, and four as incurable and danger- 
ous. That in the course of the last year, eighty-nine left the Hospital, 
most of whom ought to have been retained, and almost as many were 
denied admission for want of room. Nothing can show more clearly 



STATE LUNATIC HOSPITAL. 



41 



that the additional accommodations, now in progress, are necessary to 
supply the wants of the community. 

There are already enough patients in the Hospital, waiting for these 
accommodations to be in readiness, and more than can now be well pro- 
vided for, to fill one quarter of the additional apartments. 

In twelve years nearly three hundred patients have been sent away 
from the Hospital, who ought to have been retained. A large propor- 
tion of these individuals are now living, some in jails, some in cages 
and dungeons, and many in poorhouses, in a miserable condition, not 
so much from a disposition to neglect them as from the difficulty of tak- 
ing care of them in places so illy provided with suitable means. 



TABLE 4. 

Showing the number of Admissions and Discharges, and the average 
number of Patients each month in the year. 



Monthly Average. 


Admissions. 


Discharges. 


December, 






262 




20 


10 


January, 


_ 


. 


261 


1-2 


19 


24 


February, 


- 


. 


258 


2-3 


12 


14 


March, 


- 


_ 


255 


1-2 


15 


17 


April, 


- 


_ 


260 


1-2 


27 


19 


May, 


- 


_ - 


263 




18 


25 


June, 


- 


. 


258 


1-2 


20 


21 


July, 


- 


. 


259 


1-6 


19 


17 


August, 


- 


_ 


265 




32 


26 


September, 


- 


. 


265 


1-2 


20 


24 


October, 


- 


_ 


262 




21 


15 


November 


•ly 


Average, 


261 
261 


2-3 


13 


16 


Yeai 


236 


228 



42 



STATE LUNATIC HOSPITAL. 



TABLE 5. 

Showing the number of Residents, the average number of Patients, the 
number at the end of each year, and the Expense of each year, for the 
twelve years that the Hospital has been in operation. 



The Year. 


No. of Residents. 


Average No. 


No. at the end of the year. 


Annual Expense. 


1833 


153 


107 


114 


$12,272 91 


1834 


233 


117 


118 


15,840 27 


1835 


241 


120 


119 


16,576 44 


1836 


245 


127 


138 


21,395 28 


1837 


306 


163 


185 


26,027 07 


1838 


362 


211 


218 


28,739 40 


1839 


397 


223 


229 


29,474 41 


1840 


391 


229 


236 


27,844 98 


1841 


399 


233 


232 


28,847 62 


1842 


430 


238 


238 


27,546 87 


1843 


458 


244 


255 


27,914 12 


1844 


491 


261 


263 


29,278 75 



The accommodations of the Hospital will be for about 400 patients, 
and it has been erected at an expense of about $150,000, which is not 
far from $375 for each patient. I have estimated that the new wings 
would be erected for about $300 to an individual, perhaps something 
less. 

The cost of some of the English institutions is given in the report of 
the Metropolitan Commissioners, recently published by order of the 
government. The Wakefield Asylum cost £111 for each person ; the 
Gloucester £357. Most of the English institutions cost about £200 
for each individual. The Bedford Asylum cost £20,000, and will ac- 
commodate 200 patients, which is about $500 for each individual. The 
Asylum at Kent cost =£04,000, will accommodate 300 patients, which is 
more than $1000 each. The Hanwell Asylum, for 1000 patients, cost 
.£196,000, which is nearly $1000 for each patient. 

The English Commissioners, very justly in my opinion, discounte- 
nance low prices. They sanction no houses where the charge is less 
than 8 shillings a week, or about $2 00 of our currency, and they are 
better pleased with those which charge 9 or 10 shillings a week, which 
is from $2 25 to $2 50, about the customary charge of the New Eng- 
land public Hospitals. 

There is doubtless some danger of getting prices too low, though the 



STATE LUNATIC HOSPITAL. 43 

motive with those who strive to reduce them is unquestionably good. 
If the cost of living should increase, it would be difficult to raise the 
price, and there is danger, in such circumstances, of cheapening the 
living to poor-house fare, lest the cost of support should exceed the in- 
come. I think it much better to keep up the price to the average 
charge at the American Hospitals, and increase the comforts and bene- 
fits that a liberal price will allow, rather than reduce it to the minimum 
rate and endanger neglect and too cheap a diet. 



44 



STATE LUNATIC HOSPITAL. 



TABLE 6. 
Statistics of the Hospital, from Jan. 1883, to Nov. 30th, 1844. 





1833. 


1834. 


1835. 


1836. 


1837. 1838. 


1839. 


1840. 


1841 


1842. 


1843 

270 


1844. 


Whole No. of Pa- 
tients admitted, - 


153 


119 


113 


125 


168 177 


179 


162 


163 


198 


236 


Discharged, includ- 
ing deaths and 
elopements, 


39 


115 


112 


106 


121 


144 


168 


155 


167 


191 


203 


228 


Discharged recov'd, 


25 


64 


52 


58 


69 


76 


80 


82 


82 


88 


116 


124 


Discharged impro'd, 


7 


22 


23 


17 


23 


24 


29 


29 


36 


25 


32 


40 


Discharged not im- 
proved, - 


2 


20 


28 


22 


20 


28 


37 


29 


37 


66 


33 


49 


Died, 


4 


8 


8 


8 


9 


16 


22 


15 


12 


12 


22 


15 


Eloped, 


1 


1 


1 


1 


























Patients in the Hos- 
pital in the course 
of the year, 


153 


233 


241 


245 


306 


362 


397 


391 


399 


430 


458 


491 


Patients remaining 
at the end of the 
year, 


114 


118 


119 


138 


185 


218 


229 


236 


232 


238 


255 


263 


Males admitted, 


96 


68 


51 


66 


94 


96 


80 


75 


73 


107 


111 


109 


Females admitted, - 


57 


51 


62 


59 


74 


81 


99 


87 


90 


91 


109 


127 


Males discharged, - 


19 


58 


57 


56 


65 


74 


66 


59 


71 


96 


92108 


Females discharged, 


15 


48 


46 


41 


47 


54 


30 


81 


84 


83 


89105 


Males died, 


3 


5 


4 


6 


6 


10 


14 


9 


7 


3 


8 


9 


Females died, 


1 


3 


4 


2 


3 


6 


8 


6 


5 


9 


14 


6 


Patients sent by 

Courts, - 
Private, 


109 

44 


55 
64 


90 
23 


117 

8 


129 
39 


123 
54 


123 
56 


106 
56 


110 
53 


157 
41 


152 
68 


158 

78 


Recoveries : 

Males, 
Females, 


13 

12 


33 
31 


27 
25 


32 
26 


37 
32 


45 
31 


32 

48 


28 
54 


37 
45 


44 
44 


53 
63 


56 
68 


Average, - 


107 


117 


120 


127 


163 


211 


223 


229 


233 


238 


244, 


261 



STATE LUNATIC HOSPITAL. 



45 



TABLE 7. 
Statistics of the different Seasons. 





1833 


1834 


1835 1836 


1837 


1838 


1839 


1840 


1841 1842 1843 


1844 


Admissions — 
In Winter, 


























27 


26 


24 


23 


26 


46 


39 


32 


31 


50 


51 


51 


In Spring, 


72 


35 


31 


36 


49 


46 


38 


42 


37 


48 


58 


60 


In Summer, 


23 


30 


30 


42 


40 


47 


59 


44 


51 


40 


56 


71 


In Autumn, 


31 


28 


28 


24 


53 


38 


43 


44 


44 


60 


55 


54 


Discharges — 


























In Winter, 





22 


21 


20 


14 


18 


31 


29 


35 


37 


44 


48 


In Spring, 


1 


33 


30 


33 


36 


37 


38 


38 


33 


46 


49 


60 


In Summer, 


11 


28 


31 


24 


29 


44 


48 


41 


37 


46 


46 


65 


In Autumn, 


23 


24 


22 


21 


33 


29 


29 


32 


50 


50 


42 


55 


Recoveries — 


























In Winter, 





13 


13 


12 


10 


15 


13 


18 


20 


24 


24 


31 


In Spring, 





20 


11 


15 


17 


23 


24 


22 


10 


22 


34 


33 


In Summer, 


9 


16 


16 


12 


15 


18 


23 


20 


22 


25 


' 29 


23 


In Autumn, 


16 


15 


12 


19 


27 


20 


20 


22 


30 


19 


29 


37 


Deaths — 


























In Winter, 





3 


1 





1 


3 


5 


6 


1 


4 


5 


2 


In Spring, 


1 


2 


2 


1 


2 


5 


5 


6 


2 


1 


3 


3 


In Summer, 


3 


3 


2 


4 


1 


5 


7 


1 


5 


3 


6 


6 


In Autumn, 








3 


3 


5 


3 


5 


2 


4 


4 


8 


4 



TABLE 8. 



Ages of Patients 


in the Hospital, December 


Duration of Insanity with those remaining, 




1st, 1844. 






December 1st, 1844. 






Under 20, - 


_ 


_ 


9 


Less than 1 year, - 


_ 


51 


From 20 to 25, 


- 


- 


23 


From 1 to 2 years, 


- 


14 


" 25 to 30, 


- 


- 


28 


" 2 to 5 " - 


- 


70 


" 30 to 35, 


- 


- 


37 


" 5 to 10 " - 


- 


45 


" 35 to 40, 


- 


- 


39 


" 10 to 15 " - 


- 


28 


" 40 to 45, 


- 


- 


24 


" 15 to 20 " - 


- 


2.1 


" 45 to 50, 


- 


. 


34 


" 20 to 25 " - 


- 


7 


" 50 to 55, 


- 


. 


26 


" 25 to 30 '• - 


- 


7 


" 55 to 60, 


- 


- 


10 


Over 30 years, 


- 


7 


" 60 to 65, 


- 


- 


16 


Unknown, - 


- 


13 


" 65 to 70, 


- 


- 


8 








" 70 to 75, 


. 


- 


6 








" 75 to 80, 


. 


- 


1 








Over 80, - 






2 
263 


W = 




263 



46 



STATE LUNATIC HOSPITAL. 



TABLE 9. 

Classification of Insanity. 





Whole No. 


No. of each Sex. 


Curable. 


Total of Curable. 


Mania, ... 
Males, - 
Females, - 


999 


540 

459 


350 
323 


673 


Melancholia, - 
Males, - 
Females, - 


702 


310 

392 


168 
250 


418 


Dementia, -■--.- 
Males, - 
Females, - 


225 


139 

86 


4 
4 


8 


Idiots, - 
Males, - 
Females, 


12 


10 
2 







The various forms of insanity continue to appear in about the usual 
proportions. Violent insanity, assuming the form of mania, is the 
most common of any in this institution, designed principally for those 
" furiously mad and dangerous to be at large." The homicidal and 
the suicidal, often of the melancholy class, are of course the most dan- 
gerous of all. Our class of demented patients has been numerous ; 
they are generally imbecile, though sometimes impulsive and danger- 
ous. Idiots can hardly ever be violent, and are, of course, rarely com- 
mitted to this institution. These two classes of unfortunate beings are 
exciting unusual interest among the philanthropists of modern times. 

In 1828, a school for the instruction of idiotic male patients was es- 
tablished in Paris in connection with the Bicetre, and the plan has been 
extended by M. Leuret and Voisir. A similar school was established 
at the Salpetriere for females, in 1831, by M. Falret. At the Lan- 
caster Lunatic Asylum, and at the Hanwell Asylum in England, ef- 
forts are now making, on the same benevolent plan, to resuscitate minds 
impaired by disease, and to develop the mental powers of the congeni- 
tal idiot to a considerable degree of usefulness. A similar effort has 
been made in a few of the institutions in this country, in all, it is said, 



STATE LUNATIC HOSPITAL. 47 

with unexpected success. I have no doubt that such cases have too 
often been despaired of when patient continuance in effort might have 
been followed by favorable results. Such cases are not necessarily- 
hopeless. The brain, after severe disease, may be left in an inactive 
state when no organic lesion has taken place to fatally impair its 
functions. 

Many cases of palsy are followed by the loss of memory of names 
of persons, things, and even language, which, though in old age, have 
been learned anew more or less perfectly, so at last, as to be quite use- 
ful again. Some individuals of this description have a sort of double 
consciousness, the condition of knowledge, alternating after successive 
attacks of disease. May there not be even greater probability of re- 
storing an intellect prostrated by insanity in early life, where none of 
the faculties are wholly lost, though all are weakened and debilitated ? 

I am not informed what process of education has been adopted with 
these unfortunate persons. The first object undoubtedly is to fix the 
attention and excite interest. If the same means should be adopted 
which the patient mother uses to develop the mental powers of her in- 
fant, with the same sweetness of temper, patient trial and persevering 
effort, I have no doubt much might be accomplished. If attention can 
be excited, I have but little doubt that the object can be effected. It 
may require tenfold more perseverance and patience than it does to ed- 
ucate an active child, but what is this to the blank, the utter darkness in 
which the intellect and moral sensibilities of the idiot are enveloped, if 
by these means it can be removed. Could a mother be persuaded that 
her idiot child could be taught to know and understand, even if imper- 
fectly, its powers, capacity and destiny, if she could, by a life of ef- 
fort, teach it to read and understand the great moral truths without 
which its mind must be a blank, how willingly would she devote herself, 
day and night, watchfully and prayerfully, to give it such instruction as 
would increase its usefulness and add to its enjoyment. 

INFANTILE INSANITY. 

There is another class of unfortunate individuals, far more numerous 
than I had formerly supposed, and much more interesting than idiots, — 
I refer to Insane Children. 

Since I have been connected with this Hospital, I have been consult- 
ed in a number of cases of this description. These little patients have 
intelligent faces, well formed bodies, good developments of the head' 



48 STATE LUNATIC HOSPITAL 

and active minds. Their movements are free, easy and graceful, many 
of them are sprightly, even handsome ; they are generally restless, irri- 
table and extremely mischievous, and are rarely able to speak. In 
some cases, as soon as there is any mental development, the peculiar 
characteristics begin to appear, without any known cause. In other 
cases, epileptic fits have preceded these peculiarities. In one case the 
use of instruments in labor was supposed to be the cause ; epileptic 
convulsions probably sometimes arise from difficult parturition. 

No person familiar with these cases would be likely to mistake them 
for idiots ; they look differently, walk differently, and have different 
developments of body and mind. 

Some of these children have been benefitted by medical treatment. 
One, at the present time under my care for epilepsy, seems to be im- 
proving favorably. My attention has recently been particularly direct- 
ed to this subject as I have been, within a few days, consulted in three 
different cases, of which the epileptic child, above named, was one. I 
have strong hope that some of them may be cured, and then instructed. 
Like other insane persons, there is difficulty in fixing the attention, 
they move with great rapidity from one thing to another, and are impa- 
tient of i-estraint. 

In some such persons particular faculties seem much more active than 
others. One lad, in whose case I was consulted, was not able to artic- 
ulate, and of course had never learned to read, but was observing of many 
things, particularly of mechanical operations, drawing, &c. He has 
left many traces of his skill on the buildings and fences of his former 
residence, which are yet to be seen. He has now arrived at manhood, 
but I have no knowledge of his present condition or of his progress 
in improvement for the last few years. When a lad, he was extremely 
mischievous, but sprightly and interesting. 

Within a few days I have seen a very interesting case of this descrip- 
tion, a girl twelve years old, who has a well formed head, an intelligent 
and handsome face, a bright black eye, and easy and graceful manners. 
She is respectful and obedient in her conduct, gentle and affectionate in 
her temper and disposition, and usually quiet and unobtrusive, but is 
easily excited, impatient when urged to do any thing disagreeable to 
her, and if opposed utters a scream, but cannot articulate. She con- 
stantly hurries from one thing to another, and, like the insane, wants a 
safety valve to let off her excitement. She is excessively fond of 
music, would listen with apparent delight to the tones of a piano, seem- 



STATE LUNATIC HOSPITAL. 49 

ed to have an irresistible desire to perform herself, and would strike the 
keys with eagerness and great satisfaction. In her visit to me she 
would seize the bellows which hung in the room, and blow them with 
great effort and apparent delight. She is perpetually active, but is far 
less mischievous than formerly. She has very little power of atten- 
tion, and has, as yet, never been taught. I have referred the case to 
my friend, Dr. Howe, whose great success in a case apparently far 
more forbidding, is universally known, and I am happy to say he is in- 
terested in it, and I have no doubt will find his active benevolence ex- 
cited when he shall see her. 

A child two years old was lately brought to me at the request of the 
family physician, who had consulted me respecting it. It is unable to 
sit, to use its limbs, or talk, its face is intelligent, by no means idiotic. It 
has powers of mimicry unequalled by any child of its age I have ever 
met with. Having understood that it would imitate its father in what- 
ever motions he made, I tried some experiments with it, and was aston- 
ished and amused to find it copy my movements so exactly, and that 
too, with the most roguish expression conceivable, apparently much de- 
lighted. 

I have now the case formerly alluded to under my care for epilepsy, 
which, for some months, has been severe and of frequent recurrence. 
This child has an intelligent face, and a good developement of the 
head, except that it is small. Its form is graceful, and its movements 
easy and natural. Since it commenced the use of remedies, it has been 
more quiet and tranquil, less mischievous, sleeps better, has fewer fits, 
and they are less severe. If the epilepsy can be cured in this case, and 
I think it may be, I shall have great confidence that, under the care of 
its excellent mother, it may be taught to articulate, and finally be edu- 
cated. Indeed since I have seen this interesting child some effort has 
been made to teach it to talk, and with some little success. 

What has struck me as particularly worthy of remark in all these 
cases is that while some of the faculties of the mind are active and 
many of them capable of improvement, others are torpid or perver- 
ted, bearing, in this particular, much resemblance to certain cases of 
insanity. 

I have been consulted quite recently in a case of insanity which 
commenced in infancy, and has continued in some degree to this time, 
now twenty years. 

When an infant, this young man had epileptic fits, these did not con- 
7 



50 STATE LUNATIC HOSPITAL. 

tinue long, and the child was apparently healthy, sprightly, and intelli- 
gent, till eight years of age or upward, and learnt as well as other 
children. He then became affected with false vision, saio spiders, 
and other vermin, crawling over him and all about him, and particularly 
in his food, so that it was with difficulty that he could be prevailed on to 
eat. This delusion continued for some time. At that time, now ten or 
twelve years, I was consulted in the case, and prescribed some reme- 
dies. The delusion left him after a while, and he has since been in 
most respects better, is able to work, but not to learn much, although 
his mind seems not to be particularly inactive. He is talkative and in- 
quisitive in an unusual degree, asks childish questions, but is inattentive 
to the answers, and not profited by the information which he obtains. 
He is able to read and write some, but has not been able to acquire 
much knowledge. The present winter, he has attempted to acquire 
some additional learning ; commenced going to school and gave his at- 
tention to arithmetic, he made but little progress, and soon began to 
complain of his head, and confusion of thought, finally ceased to speak, 
because he says he could not speak right. For five or six weeks he 
has been almost constantly mute, speaking only occasionally. Since 
that time he has twice run away from his home, and wandered he 
knew not where, was lost and confused in his mind. 

When he returned home the first time, he was greatly rejoiced to 
see his friends, and to get back again. When found the second time, 
he was brought to me, to be placed under my care, his vision is not now 
disturbed, he does not talk because he is not satisfied with what he says, 
and he is tired of life. A few days since he purchased a pistol to take 
his own life, but it was taken from him before he made any attempts. 
He is a stout, hale, full grown young man, his head is of good size and 
well formed, his motions easy and graceful, his speech natural. He 
eats rather sparingly, is anxious to get well, and willing to adopt any 
means recommended for his cure. 

The subject of educating demented persons is new, it is at present 
exciting much attention, and the results are looked for with deep inter- 
est. The brain, in such cases may not be affected with organic changes, 
but only be in an extremely torpid or inactive state. Some such cases, 
after a long torpor in which all hope of recovery has been lost, have 
spontaneously come out of apparently the most forlorn condition, and 
been restored to health and mental soundness. So the idiot and congenital 
insane may have a brain capable of greater or less improvement, if 
persevering efforts are made to excite it to activity. 



STATE LUNATIC HOSPITAL. 



51 



If one old case of insanity in ten can be restored to soundness of 
mind by the appliances of insane hospitals, should not all of this class 
have the benefits of such a trial ? In a large proportion of these cases 
the physical health can be improved, perverted habits can be changed, 
and the mind be made to enjoy, in some degree, what it has been de- 
prived of under the influence of long continued and neglected disease. 
So if one idiotic or demented person can have his powers of mindren- 
dered active by effort, and some degree of knowledge imparted to him 
by which his enjoyment and usefulness can be increased, even if ten 
fail of improvement, it will be worth the effort in all. But the case is 
more favorable than this supposition allows. I have no doubt that near- 
ly all can be improved physically and mentally, and that the experiment 
will be productive of much good. It is certainly worthy of the consid- 
eration of the Christian and the philanthropist. 



TABLE 10. 

Showing the Causes of Insanity and circumstances connected with 
causes and predisposition to Insanity. 



Intemperance, 


260 


Jealousy, - 


6 


111 health, - 


318 


Fright, 


13 


Masturbation, 


139 


Palsy, - 


16 


Domestic Afflictions, 


203 


Hereditary, or having insane 




Religious, - 


173 


ancestors or kindred, 


525 


Property, - 


107 


Periodical, - 


381 


Disappointed Affection, 


63 


Homicidal, - 


22 


Disappointed Ambition, 


33 


Have committed Homicide, 


16 


Epilepsy, - 


49 


Suicidal, - 


213 


Puerperal, --.-.- 


56 


Have committed Suicide, - 


10 


Wounds of the Head, 


23 


Arising from physical causes, 


807 


Abuse of Snuff and Tobacco, 


9 


Arising from moral causes, 


604 




Many no 


t classed. 





The number of cases of insanity from intemperance is less than for- 
merly, and has sensibly diminished for three or four years. There 
have been two cases of delirium tremens in the Hospital the last year, 
both of which recovered favorably : this is probably more than the 
average for the last five years. It is reasonable to hope that the many 
influences now in successful progress, to remove this great scourge from 
our land, are already felt in the diminution of insanity from this cause. 

The secret vice, a cause nearly allied to intemperance, has also 



52 STATE LUNATIC HOSPITAL. 

fewer victims than formerly, which we may hope is caused by the infor- 
mation that has been diffused on the subject, and the warnings that have 
reached the young through the various channels of intelligence that 
have been opened on this hitherto obscene subject. 

The number of cases from religious causes, continues to be large. 
The last year has been as prolific of excitement on the subject as any 
of the past years. Millerism has had as many victims as in any former 
year, and though its prophets have so frequently proved false, the 
delusion continues to agitate the community to a most remarkable ex- 
tent. The repeated failure of the calculations on which this final con- 
summation is made to depend, would be sufficient, it would seem, to 
satisfy the honest, but misguided votary of the ignorance of his false 
guides of the true basis of their estimate, even if he still retains confi- 
dence in their integrity and good intentions. The delusion is one 
greatly calculated to disturb the excitable, and it is not surprising that 
many have become insane under its influence. 

By the table it will appear that a large number of the insane have 
insane kindred nearly allied to them. My opinion, often expressed in 
former reports, respecting this predisposition to insanity, remains un- 
changed. It should never be recorded as a cause, but only as one of 
the influences connected with the condition of the individual, which 
increases his liability to an attack of insanity. It always requires 
another, and often more than one cause, to induce insanity even where 
this predisposition exists ever so strongly. This constitutional tendency 
may be increased, and perhaps be developed by causes to which the 
system is subjected. Ancestors of a highly nervous temperament may 
have descendants that are insane, and the insane may have offspring of 
highly nervous temperaments who are never insane. These changes 
are constantly taking place in families, the results of intermarriage of 
individuals of different temperaments, as well as from a multitude of 
other causes. A predisposition of this character frequently ceases to 
operate on one or two generations and then subsequently appears, often 
excited by influences not understood, but which might be discovered by 
diligent inquiry. This is a subject of vast interest to society, and may 
at some future time be so carefully studied, and so well understood, as 
to make a marked difference in the predisposition of families to dan- 
gerous and fatal disease. 

From careful study of the laws of life, we may derive much benefit 
in the early training of individuals who, at its very outset, exhibit ten- 



STATE LUNATIC HOSPITAL. 53 

dencies to the development of predisposition to disease which, when 
once established, it may be difficult to influence. Here should be 
founded the very basis of education, that from well formed bodies, and 
brains well developed, intellectual and moral powers may emanate such 
as will prove a safeguard from disease, and particularly from insanity. 

The table shows a large number of periodical cases. This is an in- 
teresting form of insanity, and should be carefully studied by the jurist 
no less than the physician, for in connection with it comes the import- 
ant inquiry, what is a lucid interval, and how far are the rights to be 
restored to an individual who has been insane, and how far responsibil- 
ity rests upon such a person when his excitement has left him. In such 
cases there is generally a period of gloom and depression of spirits 
following high excitement, during which every thing appears as sombre 
and uninteresting as it does beautiful and cheering in the period of ex- 
citement. In both these conditions there is a false estimate of things 
by which the mind is swayed and the feelings estranged. Though the 
conversation may not exhibit marked inconsistency or delusion during 
the season of depression, yet the influence of unnatural feelings is 
manifested in all the conduct, in the transactions of business, and in 
social intercourse. If a person has an annual period of excitement, 
even if it be of short duration, followed by marked depression, of 
longer or shorter continuance, the integrity of his mind should be sus- 
pected at all times, especially if he deviates in his conduct from the 
common exhibition of character, either in his mental or moral relations. 
Such a man should be estimated by comparing him now with his best 
condition of mind when not suspected of insanity, or any deviation 
from a sound and healthy state. If the lucid interval be of short dura- 
tion, and the paroxysms of insanity near two, three, or four times a 
year, followed by longer or shorter periods of depression, it will never 
be safe to consider such an individual of sound mind. In all transac- 
tions of business, it should, in such cases, devolve on the opposite con- 
tracting party to show, in case of any subsequent dispute, that the man 
possessed a rational mind, uninfluenced by any traces of former 
disease. 

If the lucid interval be of longer duration so that the paroxyms of 
insanity recur once in two or more years, and the healthy and rational 
appearance and conduct of the man be fully restored, he should, un- 
hesitatingly, be considered of sound mind, and his civil rights and legal 
responsibilities should be restored to him. 



54 STATE LUNATIC HOSPITAL. 

Short intervals of apparent reason, with an insane man, should al- 
ways be distrusted, as they can never be relied upon, though at the 
time there may be evidence of a clear and collected state of mind. I 
have known many instances of this kind in insanity and the delirium 
of fever, where the friends, and even medical gentlemen of high stand- 
ing, supposed that the individual was conscious of what he was doing, 
and capable of transacting important business, when, after recovery, 
not a trace of recollection remained of any thing that occurred during 
this period. 

When a man has for years been subject to periods of insanity, the 
brain being, for a longer or shorter time under the influence of disease, 
either of excitement or collapse, it can hardly be supposed that the 
mind will continue to return to an entirely healthy condition, even if it 
be able to solve common problems, it may be perplexed by those more 
difficult. Such a man may be able to perform common labor and 
transact common business, while in things of greater magnitude he 
would show indecision quite unnatural to him, and a want of that fore- 
cast and sound judgment that had formerly characterized his mind. 



STATE LUNATIC HOSPITAL. 



55 



TABLE 11. 

Occupation. 



Farmers, - 






238 


Stevedores, 






2 


Laborers, - 


- 


- 


157 


Broom-makers, 


- 


- 


2 


Merchants, - 


- 


- 


78 


Copper-smiths, 


- 


- 


2 


Shoemakers, 


- 


. 


77 


Watchmen, 


- 


- 


2 


Seamen, 


- 


- 


66 


Drovers, 


. 


- 


2 


Carpenters, 


- 


- 


53 


Curriers, 


- 


- 


2 


Manufacturers, 


- 


- 


35 


Card-makers, 


- 


. 


2 


Teachers, - 


- 


- 


28 


Glass-blowers, 


- 


- 


2 


Students, - 


- 


- 


27 


Engineers, - 


- 


< 


2 


Blacksmiths, 


- 


- 


20 


Tobacconists, 


- 


- 


2 


Printers, 


- 


- 


20 


Weavers, - 


- 


. 


2 


Tailors, 


- 


- 


13 


Soldiers, 


. 


. 


2 


Machinists, 


- 


- 


11 


Umbrella-maker, 


. 


. 




Coopers, 


- 


- 


11 


Snath-maker, 


- 


- 




Bricklayers, 


- 


- 


10 


Gilder, 


- 


- 




Cabinet-makers, 


- 


- 


10 


Soap-maker, 


- 


- 




Clothiers, - 


- 


- 


8 


Sheriff, 


- 


- 




Clergymen, 


- 


- 


8 


Constable, - 


- 


- 




Painters, 


- 


- 


7 


Turner, 


- 


- 




Lawyers, - 


- 


- 


6 


News-collector, 


- 


. 




Physicians, 


- 


- 


6 


Broker, 


- 


- 




Sail-makers, 


- 


- 


6 


Hatter, 


- 


- 




Millers, 


- 


- 


5 


Gardener, - 


- 


. 




Bakers, 


- 


- 


5 


Mat-maker, 


- 


_ 




Rope-makers, 


- 


- 


5 


Stocking-weaver, 


- 


_ 




Jewellers, - 


- 


- 


5 


Bellows-maker, 


- 


. 




Musicians, - 


- 


- 


4 


Pump-maker, 


- 


_ 




Pedlers, 


- 


- 


4 


Chair-maker, 


- 


. 




Paper-makers, 


- 


- 


4 


Auctioneer, 


- 


- 




Harness-makers , 


- 


- 


4 


Miniature-painter, 


- 


. 




Coachmen, - 


- 


- 


4 


Wheelwright, 


- 


- 




Innkeepers, 


- 


- 


4 


Book-binder, 


- 


- 




Barbers, 


- 


- 


4 


Carriage-maker, 


- 


. 




Turners, 


- 


- 


3 


Females not accustomed 


to 




Calico-printers, 


- 


- 


3 


labor, 


- 


- 


170 


Tanners, 




- 


3 


Females accustomed to 


se- 




Comb-makers, 




- 


3 


dentary employments,. 


- 


212 


Butchers, - 


- 


- 


3 


Females accustomed to 


ac- 




Stone-cutters, 


- 




3 


tive employments, 


- 


355 


Book-keepers, 


- 


- 


3 


Many not classed. 









56 



STATE LUNATIC HOSPITAL. 



TABLE 12. 

Diseases which have proved fatal. 



Marasmus, 34 
Epilepsy, 15 
Apoplexy and Palsy, - 15 
Consumption, - - 14 
Suicide, 10 
Disease of the Heart, - 10 
Inflammation of the Brain, - 6 
Haemorrhage, - - 5 
Cholera Morbus, 4 
Inflammation of the Bowels, 4 
Lung Fever, 4 
Mortification of the Limbs, 3 
Dropsy, 3 
Diarrhoea, 3 
Disease of Brain from Intem- 
perance, - - - 2 



Dysenteric Fever, - 
Bronchitis, - 
Typhus Fever, 
Chronic Dysentery, 
Erysipelas, - 
Old Age, - 
Gastric Fever, 
Land Scurvy, 
Congestive Fever, - 
Concussion of the Brain, 
Disease of the Bladder, 



Total, 



151 



The number of deaths in the Hospital the past season, has not been 
great, and the patients have been unusually healthy. In the course of 
the autumn, typhus fever prevailed extensively in the vicinity, and three 
attendants and a number of patients were attacked with it. Some of 
the cases were mild, others severe, three were fatal. 

The first death from this cause was a man aged 44, who had been 
demented for years, and insane since 1820. We discovered little 
change in him, except that he was thirsty, his tongue was furred, and 
his eye more heavy than usual. His illness continued but a few days 
and he died rather suddenly. 

The second fatal case was an extremely slender woman, aged 42, 
who had been insane 23 years. Her attack was sudden and severe, 
the stomach was much disturbed, and the bowels affected with diarrhoea. 
She soon had apthae and red tongue, her strength was much prostrated, 
and she appeared extremely sick, but had no symptoms that threatened 
immediate death. One morning she got up, as usual, and while sitting 
in her chair, appeared faint, and was placed upon the bed, she became 
purple all over, the heart struggled violently, and she died almost im- 
mediately. 

The third fatal case was a man aged 76, who had been insane 36 



STATE LUNATIC HOSPITAL. 57 

years, nearly half his life ; many years of which he had spent in soli- 
tude, in a dark and damp cage under ground. He had been in the 
Hospital nearly eight years, and was generally healthy. When excited 
he was extremely violent, when in his lucid interval, he was calm and 
civil, quite harmless and pleasant. His attack was sudden and severe, 
marked particularly by severe billious symptoms, excessive vomiting, 
great thirst, dry and red tongue, and extreme exhaustion. 

In all these cases insanity had been of long duration, and they were 
hopeless of cure. In them all, particularly the first two, we saw re- 
peated, what we have often witnessed, the sudden failure of the powers 
in an insane patient under severe acute disease. 

On the evening of the 19th of May, Abner Rogers, Jr., whose as- 
sault and assassination of the lamented warden of the Massachusetts 
prison, and whose trial and escape from punishment, on the ground of 
insanity, made him extensively known in this vicinity, threw himself 
from the window of the great hall, while attending prayers, which pro- 
duced such a severe concussion as to result in his death in thirty-six 
hours. 

The case of Rogers, as a case of insanity, was very interesting. He 
had been a bad man, spent his life in courses of crime, and for many 
years was an inmate of a prison. At his trial it appeared that he had 
had strange turns, recurring at periods more or less regular, for some 
years before the. homicide. In childhood he had epileptic fits, which 
showed the tendency to disease of the brain and nervous system. It 
was also proved that at sundry boarding places he had had turns of ex- 
citement, of appearing strange, and of forgetfulness, which usually 
passed off in a few days and left him in his usual state of health. His 
temperament was truly nervous, and his imprudence and irregularities 
had increased the predisposition to excitement and impulse, to which 
he was constitutionally prone. 

Some days before the homicide, he had one of these excitements, 
was extremely irritable, apprehensive and suspicious ; his nights were 
sleepless, disturbed by threats from imaginary voices which produced a 
suspicion that the Warden was intending to inflict some severe punish- 
ment upon him. In the day time, while in the shop, he was extremely 
uneasy, passing repeatedly from his seat to the desk of the Overseer, 
and importuning him in the most imploring manner, to intercede with 
the Warden and prevent the punishment. Yet no punishment awaited 
him, he imagined all that so distressed and perplexed him. It can hardly 



58 STATE LUNATIC HOSPITAL. 

be doubted that false hearing was at the bottom of all the difficulty in 
the case. 

It was in this condition of mind, harrassed and perplexed by voices 
threatening with punishment the most cruel and unjust, that the impulse 
was excited to assault the Warden and give him the fatal thrust. For 
some days this state of mind continued, but soon yielded as on former 
and subsequent occasions, to calmness and self-control. 

When Rogers came to the Hospital, about the first of February, he 
had a slight paroxysm of this excitement, in which his pulse was fre- 
quent, his tongue furred, his eyes red and excited, his appetite bad, and 
he was restless and sleepless. After a few days he was better, but on 
the 30th of March had a return of similar symptoms, with head-ache 
and vertigo. This also passed by in a few days, and he continued his 
work regularly till the 14th or 15th of May following, when these 
symptoms recurred in an aggravated form. He was greatly excited in 
manner, had head ache, vertigo, furred tongue, loss of sleep, loss of 
appetite, and bad taste in the mouth, which he attributed to bad food. 
He told an associate at this time that the food which was offered him 
was a corpse, he knew by the smell. He was irritable, suspicious, and 
afraid to take his food, apprehending that it was the intention of those 
around to poison him. He could not sleep, and dared not, if he could, 
lest the opportunity should be improved to take his life. During this 
time his countenance was haggard and anxious, and his eye, under 
such circumstances, was the most piercing and the most insane, ex- 
pressing the strongest jealousy working within. I have, for years, 
been in the habit of contemplating the countenances of insane men and 
watching the indications of the insane eye, but I have never, in all my 
experience, seen an eye so indicative of. the workings of the mind as 
was that of this man. 

On the evening of the fatal leap, he requested to attend prayers with 
his associates, and as he had been more calm that day, it was thought 
safe for him to attend. He had before uniformly conducted with the 
utmost propriety on such occasions, and was gratified for the privilege 
of attending; so he now seemed. Towards the close of the service 
he became greatly excited, appeared agitated and alarmed, and request- 
ed to leave the room. He was watched with the greatest anxiety, by 
the officers present, who discovered his perturbation, and this probably 
increased his appi'ehensions of danger. He declared to one near him 
that the room was full of dead bodies. As quick as thought he stepped 
upon the seat and made the fatal plunge, — it seemed like magic to those 



STATE LUNATIC HOSPITAL. 59 

who were around him — his attendant sprung to seize him, but could not 
reach him, — not a dozen persons knew what had happened — most of 
the audience supposed that a gun was fired into the room, — the excite- 
ment was tremendous, but soon subsided and all was quiet. The de- 
luded man was found in a state of insensibility from which he did not 
recover ; he died in thirty-six hours. 

The last tragic scene of this man's life tended greatly to settle the 
public mind respecting his insanity. Before this there had been such a 
mixture of strange and rational conduct, so much self-possession in the 
lucid interval, and so much of the appearance of passion, jealousy and 
malevolence in his excitement, that many individuals could not see why 
he was not wholly a bad man, not insane, but responsible as other men 
for his conduct. This last scene cannot be explained on any rational 
view of the case, he acted from impulse only, regardless of conse- 
quences. 



60 



STATE LUNATIC HOSPITAL. 



TABLE 13. 

Showing the comparative Expense of supporting old and recent Cases 
of Insanity, from which we learn the economy of placing patients in 
Institutions in the early periods of Disease. 



No. of 
the Old 
Cases. 


Present 

Age. 


Time Insane. 


Estimate ex- 
pense at $100 a 
year before en- 
tering the Hos- 
jital, and vary- 
ing from $120 to 
$132 since. 


No. of the 
recent cases 
discharged. 


Present 
Age. 


Time Insane. 


Cost of 

support at 

$2 25 per 

week. 


2 


70 


29 years. 


$3332 00 


1649 


22 


14 weeks. 


$31 50 


7 


49 


18 


t ( 


2124 00 


1694 


60 


7 " 


15 75 


8 


61 


22 


it 


2624 00 


1695 


38 


13 " 


29 25 


12 


48 


26 


a 


3018 00 


1696 


36 


18 " 


40 50 


18 


72 


34 


a 


3918 00 


1700 


40 


6 " 


13 50 


19 


60 


19 


a 


2324 00 


1702 


30 


12 " 


27 00 


21 


40 


17 


a 


2113 00 


1706 


33 


18 " 


40 50 


44 


57 


26 


a 


3002 00 


1708 


22 


11 " 


24 75 


45 


61 


26 


a 


2955 00 


1709 


31 


9 " 


20 25 


102 


54 


26 


a 


2955 00 


1716 


26 


16 " 


36 00 


133 


45 


14 


n 


1551 00 


1718 


34 


26 " 


58 50 


209 


40 


17 


ti 


2084 00 


1719 


38 


19 " 


42 75 


223 


51 


21 


it 


2484 00 


1723 


64 


31 " 


69 75 


260 


48 


17 


tt 


2232 00 


1724 


42 


6 " 


13 50 


278 


50 


11 


it 


1544 00 


1728 


23 


16 " 


36 00 


319 


54 


10 


a 


1367 00 


1735 


28 


17 " 


38 25 


347 


59 


15 


a 


1764 00 


1737 


24 


20 " 


45 00 


367 


41 


13 


a 


1564 00 


1739 


40 


16 " 


36 00 


400 


44 


15 


a 


1764 00 


1740 


18 


16 " 


36 00 


425 


49 


14 


a 


2232 00 


1743 


36 


30 " 


67 50 


431 


37 


14 


a 


1532 00 


1747 


25 


23 " 


51 75 


435 


56 


16 


a 


1832 00 


1748 


32 


30 " 


67 50 


488 


37 


18 


it 


2032 00 


1749 


35 


21 " 


47 25 


532 


70 


14 


a 


1632 00 


1750 


21 


15 " 


33 75 




452 


years. 


; $53 ,979 00 


410 weeks. 


#922 50 



Whole expense of 24 old cases, - 
Average expense of old cases, 
Whole expense of 24 recent cases, 
Average expense of recent cases, - 



$53,979 00 

2,244 95 

922 50 

38 44 



STATE LUNATIC HOSPITAL. 



61 



TABLE 14. 

Sliowing the duration of Insanity, the ages and civil slate of Patients 
in the Hospital, admitted last year and previous years. 





1833 


1634 


1835 


1836 


1837 


1838 


1839 


1 40 


1841 


1842 


1843 


1844 


Duration before ad- 
























mission : 


























Less than 1 year, 


41 


56 


48 


54 


72 


82 


84 


75 


81 


106 


129 


127 


From 1 to 5 years, 


27 


29 


37 


37 


58 


50 


63 


56 


52 


58 


62 


68 


" 5 to 10 " 


27 


14 


15 


13 


14 


16 


18 


15 


12 


13 


15 


12 


" 10 to 20 " 


31 


6 


5 


11 


14 


8 


10 


10 


10 


5 


7 


10 


" 20 to 30 " 


12 


4 





2 


4 


7 


1 


3 


4 


5 


1 


5 


" 30 to 40 " 


3 


2 


1 


2 


1 


1 


1 


2 





4 


1 


3 


Unknown, 


12 


8 


7 


6 


5 


13 


2 


1 


4 


7 


5 


11 




153 


119 


113 


125 


168 


177 


179 


162 


163 


198 


220 


236 


Duration with those 


























remaining- at the 


























end of each year : 


























Less than 1 year, 


26 


22 


21 


11 


29 


28 


34 


28 


32 


40 


45 


51 


From 1 to 5 years, 


23 


25 


22 


39 


51 


65 


69 


75 


74 


89 


74 


84 


" 5 to 10 " 


20 


24 


34 


35 


38 


44 


44 


52 


53 


38 


55 


45 


" 10 to 20 " 


28 


24 


29 


35 


41 


41 


52 


52 


45 


37 


52 


49 


" 20 to 30 " 


7 


5 


3 


7 


11 


18 


14 


13 


15 


18 


19 


14 


" 30 to 40 " 


2 


2 


4 


2 


2 


3 


4 


5 


4 


6 


4 


7 


Unknown, 


8 


16 


6 


9 


13 


19 


12 


11 


9 


10 


6 


13 




114 


118 


119 


138 


185 


218 


229 236 


232 


238 


255 


263 


Ages of patients 


























when admitted : 


























Under 20 years, 


2 


12 


4 


11 


13 


17 


10 


10 


7 


14 


15 


16 


From 20 to 30 years, 


34 


31 


23 


29 


58 


47 


47 


46 


50 


55 


48 


64 


" 30 to 40 " 


46 


31 


36 


32 


34 


51 


49 


40 


45 


44 


62 


65 


" 40 to 50 " 


35 


31 


28 


26 


31 


32 


30 


34 


31 


46 


39 


43 


" 50 to 60 " 


14 


8 


13 


14 


13 


20 


21 


21 


19 


24 


38 


26 


" 60 to 70 " 


17 


5 


6 


13 


12 


8 


14 


6 


9 


12 


11 


17 


" 70 to 80 " 


3 





3 





7 


2 


8 


5 


1 


2 


5 


3 


Over 80 years, 


2 


1 




















1 


1 


2 


2 




153 


119 


113 


125 


168 


177 


179 


162 


163 


198 220 


236 


Civil state of patients 


























when admitted : 


























Single, 


92 


71 


52 


68 


94 


101 


80 


75 


82 


108 


92 


114 


Married, 


38 


40 


46 


49 


61 


65 


75 


71 


63 


76 


103 


102 


Widows, 


12 


4 


8 


6 


11 


5 


17 


12 


13 


12 


17 


17 


Widowers, 


11 


4 


7 


2 


2 


6 


7 


4 


5 


2 


8 


3 




153 


119 


113 


125 


168 


177 


179 


162 


163198 


220 


236 



62 



STATE LUNATIC HOSPITAL. 



TABLE 15. 

Showing the comparative Curability of Insanity treated at different 
periods of Disease. 





Total of Cases. 


Total of each Sex. 


Cured or Curable. 


Incurable. 


Of less duration than 1 year, 

Males, - 
Females, 


962 


448 
514 


397 
466 


51 

48 


From 1 to 2 years, - 
Males, - 
Females, 


332 


164 
168 


90 
103 


74 
65 


From 2 to 5 years, - 

Males, --- 
Females, 


323 


188 
135 


60 
51 


128 

84 


From 5 to 10 years, 
Males, - 
Females, 


186 


102 
84 


13 
12 


89 
72 


From 10 to 15 years, 
Males, - 
Females, 


105 


55 

50 


4 
3 


51 

47 


From 15 to 20 years, 
Males, - 
Females, 


39 


26 
13 


1 




25 
13 


From 20 to 25 years, 
Males, - 
Females, 


28 


15 
13 






15 
13 


From 25 to 30 years, 
Males, - 
Females, 


10 


8 
2 






8 
2 


Over 30 years, 
Males, - 
Females, 


13 


5 

8 






5 

8 



Some unknown. 



STATE LUNATIC HOSPITAL. 



63 



TABLE 16. 

Showing the comparative Curability of Insanity attacking at different 

Ages. 





I 
Total of Cases. 


Total of each Sex. 


Curable. 


Incurable. 


Under 20, 


332 








Males, ... 


- 


119 


50 


69 


Females, - 


- 


114 


74 


40 


From 20 to 25, 


291 








Males, ... 


_ 


160 


84 


76 


Females, - 


- 


131 


89 


42 


From 25 to 30, 


273 








Males, 


- 


143 


72 


71 


Females, - 


- 


130 


85 


45 


From 30 to 35, 


279 








Males, 


- 


150 


82 


68 


Females, - - - 


- 


129 


85 


44 


From 35 to 40, 


228 








Males, - 


- 


98 


53 


45 


Females, - 


- 


130 


85 


45 


From 40 to 45, 


187 








Males, - 


- 


98 


64 


34 


Females, - 


_ 


89 


56 


33 


From 45 to 50, 


145 








Males, 


- 


68 


47 


21 


Females, - 


- 


77 


61 


16 


From 50 to 55, 


127 








Males, 


- 


56 


37 


19 


Females, - 


_ 


71 


52 


19 


From 55 to 60, 


66 








Males, - 


- 


31 


20 


11 


Females, - 


_ 


35 


23 


12 


From 60 to 65, 


57 








Males, - 


- 


25 


19 


6 


Females, - 


_ 


32 


23 


9 


From 65 to 70, 


30 








Males, - 


- 


21 


14 


7 


Females, - 


_ 


9 


7 


2 


From 70 to 75, 


19 








Males, 


_ 


12 


5 


7 


Females, - 


_ 


7 


7 





Over 75, - 


14 








Males, - - - 


_ 


6 


3 


3 


Females, - 


- 


8 


2 


6 



64 



STATE LUNATIC HOSPITAL. 



TABLE 17. 

Showing the relation of Cause to Recovery. 



PHYSICAL CAUSES. 

Ill health, puerperal, followed 
fever, measles, wounds of 
the head, &c. - 

Males, 

Females, - 

Intemperance, - 
Males, - 
Females, - 

Masturbation and its results, 
debility, weakness, &c. - 
Males, 
Females, - - - 

Epilepsy, - 

Males, - 
Females, - 



Palsy, 



Males, 
Females, - 



MORAL CAUSES. 

Religious, including Mor- 
mon ism, Millerism, Fanat- 
icism, &c. - 
Males, - 
Females, - 

Afflictions, trouble, love, 
fright, fear of death, fu- 
ture punishment, poverty, 
&c. - 

Males, 

Females, - - - 



Whole Number. 



No. of each Sex. 



405 



258 



142 



49 



33 



177 



458 



82 
323 



231 

27 



128 
14 



43 
6 



24 

9 



90 

87 



185 
273 



Curable. 



Incurable. 



46 
235 



125 
14 



35 
1 



63 
61 



109 
166 



36 



106 
13 



93 
13 



38 
6 



20 



27 
26 



76 

107 



Cause unknown in many cases. 



STATE LUNATIC HOSPITAL. 



65 



TABLE 18. 

Shoioing the causes of Insanity as affecting persons pursuing different 

Occupations. 



OCCUPATIONS. 


CD 

CD 

2 

53 
a, 

E 

CD 

s 


73 


c 
a 

- CCi 


.2 

< 

s 

o 
B 


3 

.2 
Pi 


>. 

CD 

3, 
o 


B 

_o 
o 
In 
< 

■a 

CD 
'8 

a 
p. 

3 


a 
.2 
3 
S 
■< 

a 
"8 

1 

3 


a 

CD 

'3. 

- 


T3 
OS 

K 

CD 

3 

g 
8 


3 

o 
"3 

CD 





o 


Farmers, . 






54 


10 


23 


19 


22 


20 


3 





7 


1 


2 


161 


Shoemakers, 






8 


5 


22 


4 


8 


4 


2 





1 


1 





1 


56 


Laborers, 






55 


3 


13 


4 


6 


5 








2 





1 


2 


91 


Seamen, . 






25 


1 


5 


2 


5 


6 














2 





46 


Merchants, 






11 


2 


27 


2 


4 


13 








1 








1 


61 


Carpenters, 






15 


5 


C 


1 


5 


5 


2 





2 








1 


42 


Blacksmiths, 






4 


1 


1 





1 


2 


2 

















11 


Students, 









2 


17 


2 


2 











1 











24 


Clergymen, 












4 





1 


1 


1 

















7 


Lawyers, 






2 





2 


1 





1 




















6 


Physicians, 






2 














1 


1 

















4 


Printers, . 












11 


1 








1 





1 











14 


Manufacturers, 






9 





3 





4 


3 


1 


1 





1 








22 


Barbers, 









1 








1 























2 



This table continues to confirm the views expressed in former reports, 
that intemperance is the cause of insanity with those who pursue, ac- 
tive, rather than sedentary employments, and that those who pursue 
light and sedentary employments are more frequently the victims of the 
secret vice. 

9 



66 STATE LUNATIC HOSPITAL. 

Of the 160 farmers, 32£ per cent, became insane by intemperance, 
14J per cent, by the secret vice, 13§ per cent, by religious influences, 
and 12J per cent, by trouble respecting property. 

Of 91 laborers, 60 per cent, are from intemperance, 14 per cent, 
from the secret vice, 6£ per cent, from religious influences, and 5£ per 
cent, from anxiety about property. 

Of 46 seamen, 54 percent, of the cases are from intemperance, 11 
per cent, from the secret vice, 11 per cent, from religious influences, 
and 13 per cent, from trouble about property. 

Of the 53 who pursue active mechanical trades, carpenters, black- 
smiths, &c, 35 percent, arise from intemperance, 13 from the secret 
vice, 11 from religious influences, and 13 from anxiety about property. 

Of the 155 who pursue light and sedentary employments, including 
merchants, printers, students, and shoemakers, 12 per cent, arise from 
intemperance, 50 per cent, from the secret vice, 9 from religious influ- 
ences, and 11 from anxiety about property. 

Of 17 professional men who have been in the Hospital, 4 became in- 
sane by intemperance, 6 by the secret vice, 1 from religious influences, 
and 3 from anxiety about property. 



STATE LUNATIC HOSPITAL. 



67 



TABLE 19. 

Showing the state of the Moon at the commencement of a paroxysm of 
excitement in 106 cases of Periodical Insanity, amounting in all to 
789 paroxysms. Also the relation of the Moon to the 151 Deaths 
that have occurred in the Hospital. 



Number of 


Paroxysms each Day. 


Number of Death 


S EAC* 


[ Day. 




Day of the Moon. 


Whole 
No. 


Male. 


"3 
1 


%3 


Day of the Moon. 


Whole 
No. 


Male. 


a5 

S 


go 


1 


20 


12 


8 


1 


1 


1 


1 





1 


2 


46 


24 


22 


2 


2 


9 


6 


3 


2 


3 


28 


14 


14 


3 


3 


11 


5 


6 


3 


4 


31 


14 


17 


4 


4 


5 


3 


2 


4 


5 


26 


12 


14 


5 


5 


9 


4 


5 


5 


6 


31 


14 


17 


6 


6 


7 


5 


2 


6 


7 


42 


21 


21 


7 


7 


8 


1 


7 


7 


End of 1st qr. 










End of 1st qr. 










8 


38 


20 


18 


1 


8 


6 


3 


3 


1 


9 


27 


16 


11 


2 


9 


8 


2 


6 


2 


10 


18 


7 


11 


3 


10 


3 


3 





3 


11 


27 


11 


16 


4 


11 


3 


1 


2 


4 


12 


27 


16 


11 


5 


12 


4 


2 


2 


5 


13 


26 


14 


12 


6 


13 


8 


6 


2 


6 


14 


36 


15 


21 


7 


14 


5 


3 


2 


7 


End of 2d qr. 










End of 2d qr. 










15 


36 


20 


16 


1 


15 


4 


3 


1 


1 


16 


22 


11 


11 


2 


16 


10 


6 


4 


2 


17 


32 


18 


14 


3 


17 


6 


3 


3 


3 


18 


16 


9 


7 


4 


18 











4 


19 


23 


15 


8 


5 


19 


2 


1 


1 


5 


20 


33 


17 


16 


6 


20 


8 


5 


3 


6 


21 


30 


16 


14 


7 


21 


7 


4 


3 


7 


End of 3d qr. 










End of 3d qr. 










22 


28 


13 


15 


1 


22 


2 


1 


1 


1 


23 


33 


12 


21 


2 


23 


2 


1 


1 


2 


24 


34 


16 


18 


3 


24 


6 


2 


4 


3 


25 


25 


9 


16 


4 


25 


7 


4 


3 


4 


26 


24 


12 


12 


5 


26 


4 


2 


2 


5 


27 


13 


4 


9 


6 


27 











6 


28 


17 


9 


8 


7 


28 
Deaths, 


6 


4 


2 


7 


Paroxysms, 


789 


151 





68 STATE LUNATIC HOSPITAL. 

We have added to the records of the last year, on the subject of the 
moon, nine cases of periodical insanity and 61 paroxyms, in all 106 
cases and 789 paroxysms. The facts accumulated on this subject have 
become so numerous that I am unwilling to discontinue the record, 
though nothing occurs to sustain the theories that have, for so long a 
time, been prevalent upon the subject. 

The 15 deaths that have occurred in the Hospital the last year, ar- 
ranged according to the theory of Dr. Allen, the champion of lunar 
influence in modern times, will show at the new and full moon 8 deaths, 
and at the quadratures 7 deaths, which is a trifle in favor of this theory. 

There have now been 151 deaths in the Hospital ; 74 of them have 
been at the time of the new and full moon, and 77 at the quadratures. 

The whole number of paroxysms of excitement recorded in the 
table is 789 ; of these, 372 occurred at the new and full moon, which, 
according to Dr, Allen's views, is the period of increased excitement, 
and 417 at the quadratures, the period of diminished excitement. Thus 
we see that our observations do not confirm the plausible theory so 
fully sustained by Dr. Allen's tables. 

It is useless to go over the subject more fully. My observations have 
no reference to any theory, as I have never adopted one. The first 
period of diurnal excitement, from 4 o'clock in the morning till 9, may 
have some countenance from facts, as I think at day light, and as light 
advances in the morning, the violently insane are liable to be excited. 
The same is true of bright moon-light nights, which I have always 
attributed to light only, and not to the period of the day, or the lunar 
period. 

Some patients have morning and some evening excitements. I have 
no data to decide which are most numerous or most aggravated. It is 
quite as frequently the case that the violent insane are more excited 
after sleep, as that they are more quiet. 



STATE LUNATIC HOSPITAL. 



69 



TABLE 20. 
Of Per Cent. 





1834 


1835 


1836 


1831 


1838 


1839 


1840 


1841 


1842 


1843 


1844 


Recovery of cases of 
























less than 1 year, - 


82 


82 


84 


89 


86 


90 


91 


91 


91 


88 


93 


Recoveries of all dis- 
























charged, 


54 


46 


53 


57 


52 


47 


53 


49 


46 


59 


54 


Recoveries of all 
























cases, - . - 


20 


16 


19 


25 


15 


1? 


22 


21 


16 


29 


24 



Per Cent, of cases from the most prominent Causes each year. 





1833 


1834 


1835 


1836 


1837 


1838 


1839 


1840 


1841 


1842 


1843 


1844 


Ill health, 


8 


18 


21 


22 


21 


28 


27 


25 


21 


18 


16 


15 


Religious, 


9 


6 


7 


7 


6 


9 


5 


4 


4 


9 


13 


9 


The Affections, 


14 


12 


17 


16 


16 


15 


25 


17 


13 


15 


9 


10 


Property, 


7 


11 


.9 


6 


6 


10 


6 


5 


4 


5 


7 


3 


Intemperance, 


25 


24 


23 


15 


10 


16 


8 


12 


12 


8 


6 


8 


Mastuibation, - 


5 


6 


7 


16 


21 


6 


8 


7 


6 


4 


3 


2 



Per Cent of deaths of all in the Hospital each year. 



1833 


1834 


1835 


1836 
34 


1837 


1838 


1839 


1840 


1841 


1842 


1843 


1844 


2k 


3£ 


3£ 


3£ 


U 


5k 


3| 1 3 


21 


41 


3 



Per cent of deaths of the whole number, 151 of 2013, - - - -7k 
Per cent, of deaths of the average number the last year, 15 of 261, - - 5f 



Per Cent, of Recoveries compared with the admitted. 

There have been in the Hospital 2013 patients, of whom 916 have recovered, 
which is 45^ per cent. 

There have been admitted to the Hospital the last year 236 patients, and there 
have recovered 124, which is 52 per cent. 

There have been admitted 127 cases of duration less than one vear, of these 
93 have recovered, which is ------ 73 per cent. 



70 STATE LUNATIC HOSPITAL. 

The per cent, of recoveries of recent cases is very large in the 
American Institutions, which speaks well for the correctness of the 
moral and medical management. The treatment of the insane in all 
the American Hospitals is on the same principles and the appliances 
very nearly alike in each, Some depend upon medicine more than 
others, but when it is prescribed, it is nearly the same in all. 

Bleeding. All agree that depletion, by which I would be under- 
stood general bleeding and active cathartics, is not favorable in insanity, 
as it rarely affords more than temporary relief, and frequently produces 
marked injurious effects. When blood-letting has been employed free- 
ly and frequently in active mania, the only form of insanity in which it 
is commonly used to excess, if the excitement, for a short period, an 
hour or two, and sometimes a day or two, abates, it is generally renewed 
with increased violence, and under circumstances far less favorable for 
the benefit of other remedies. The indications for active depletion are 
usually the effect and not the cause of excitement, they grow out of the 
perpetual activity of the physical and mental powers, and are not the 
cause of it. By this course of remedies the strength and energy of 
the system is reduced, the nervous system is rendered more susceptible, 
and the actual violence of the symptoms is increased. The effect of 
great loss of blood is often to produce pain in the head, a sense of 
stricture, as if a fillet were tied around it tightly, ringing in the ears, 
and noises in the head which lead to false perceptions of sound, and 
illusions liable to result in permanent insanity. It is said that animals 
which are bled to death have congestion of blood in the vessels of the 
head ; the last rush of blood seems to be to this citadel of life. It is a 
fact also that I have noticed for many years, that affections of the heart 
are produced by excessive loss of blood in any way. An eminent prac- 
titioner of medicine once informed me, that when he had bled cases of 
severe and painful neuralgia, he had repeatedly found palsy of the side 
affected with the disease on his next visit. 

Free general bleeding is only useful in cases of entonic inflammation, 
such as pneumonia and phrenitis, with symptoms very unlike those at- 
tendant on insanity in any form. 

Cupping and Leeching. The effect of local bleeding is more fa- 
vorable, and may sometimes procure relief from distressing symptoms 
and afford an abatement of excitement that may give other remedies a 



STATE LUNATIC HOSPITAL. 71 

better opportunity to produce good effects. But even local bleeding 
can rarely be relied upon to cure insanity. It is usually prescribed to 
procure present relief rather than with the expectation of permanent 
benefit. Where there is a redness of the eyes, great head-ache, and 
much heat and throbbing of the carotid and temporal arteries, it may 
not be amiss to use local depletion, while at the same time every effort 
should be made to promote the circulation of blood in the extremities, 
and the quantity of blood abstracted at one time should not be very 
great. 

In some cases I have seen great excitement followed by a state of 
apparent dementia, almost immediately on free blood letting. Some 
time ago, a female, aged about 50, came under my care in the most 
violent mania. The remedies prescribed for her had but little effect, 
and it was resolved to bleed her freely. Sixteen or eighteen ounces of 
blood were taken from her arm, she became dull almost immediately, 
and remained so for a long time before she gained activity of mind, 
after which her excitement became as bad as ever and other remedies 
finally relieved her. 

A vigorous, athletic man, aged 55, was subject to the most violent 
paroxysms of periodical insanity. He had been under my care repeat- 
edly, and remedies had little effect in diminishing his excitement or 
abridging the length of his paroxysms. One day in the extreme of 
one of his excitements, he urged me to bleed him, and presented his 
arm for the purpose, held by the other hand so as to swell the veins to 
an inordinate size. I had him bled freely, principally to see what 
would be the effect of copious depletion in such a state of excitement. 
Within a few hours he seemed like an idiot, but the excitement was 
not essentially diminished. His mind was entirely chaotic for a num- 
ber of days, the paroxysm was prolonged to an unusual extent, and its 
violence, on the whole, was not lessened. 

. Some years ago, a ship-master came under my care, who had been 
bled about sixteen ounces, from twenty to thirty times in the course of 
five or six weeks. He looked pale and bloodless, was tremulous ,and 
weak, but his excitement was not essentially abated. He afterwards 
recovered under different treatment, and has had no return of disease. 

A patient is now under my care who was bled in the outset of dis- 
ease, four or five pounds, at as many different times. His body ap- 
peared bloodless, and his mind chaotic in the extreme ; he has become 
more quiet, but all our efforts have failed in removing his insanity. 



72 STATE LUNATIC HOSPITAL. 

Cathartics. Drastic purging is often even worse than bleeding. 
The effect of this remedy as a depletion, is probably less disastrous 
than blood-letting, but it produces other effects often very injurious. 
The digestive organs of the insane are peculiarly liable to disturbances. 
Dyspepsia, vomiting and costiveness or diarrhoea, are often trouble- 
some symptoms with them. Drastic cathartics generally aggravate 
these symptoms when they exist, and sometimes produce tiiern when 
they do not. Costiveness is generally easily obviated by mild cathar- 
tics, it is far less troublesome than diarrhoea, which is often obstinate, 
and too frequently a dangerous symptom when attendant on insanity. 
If the secretions of the liver are unhealthy or deficient, or if other 
conditions of the digestive organs require a change, the blue pill or 
small doses of calomel may be indicated. These remedies often pro- 
duce very favorable impressions and prepare the system for others 
which may be needed to remove the symptoms of insanity itself. 

In short, cathartics, as such, rarely do good in cases of insanity, but 
alterative remedies and laxatives are often necessary, and in many cases 
cannot be dispensed with. Tincture of Rhubarb and Senna with aro- 
matics, Aloetics, Colocynth and Guaiacum are valuable remedies of 
this class. 

I often combine compound extract of Colocynth with Ens veneris 
or Martial flowers, in torpid states of the intestinal canal with consti- 
pation. My favorite remedy in such cases, is the tincture or powder 
of Guaiacum. No remedy in my hands has a more favorable effect in 
those cases of melancholy attended by dyspepsia, costiveness, and gas- 
tric distress after taking food, than the aromatic tincture of Guaiacum 
prescribed so as to insure a laxative effect. It invigorates the stomach, 
acts favorably upon the bowels, proves diaphoretic, and, when neces- 
sary, emenagogue. It may be prescribed in doses of from one drachm 
three or four times a day, to half an ounce. Milk and sugar are alto- 
gether the best medicine in which it can be taken. The powder of 
Guaiacum is the better form of this remedy, if needed as a simple 
laxative, it rarely nauseates, and is useful in flatulency, giving tone to 
the whole alimentary canal, and effectively obviating constipation. 

Oil of Croton in combination, given in minute doses, often proves fa- 
vorable to remove costiveness. It is almost the only active purgative 
which can be prescribed favorably in small quantities. In combination 
with tonics, alteratives and narcotics, it can be used without swelling the 
bulk of the medicine, often in very small doses counteracting the con- 
stipating effects of other remedies. 



STATE LUNATIC HOSPITAL. 73 

Emetics. Emetics have never been extensively used in my prac- 
tice with the insane. Many practitioners think well of their effects, 
and I have occasionally prescribed them to obviate particular symptoms , 
but have not seen much good from them to relieve the symptoms of in- 
sanity. In certain conditions of the stomach, they are indicated in this, 
as well as other diseases. Ipecacuanha and sulphate of zinc and cop- 
per are generally preferable to antimony. Antimony in small doses, 
combined with narcotics to determine to the surface and obviate their 
constipating effects, may be prescribed for a short time in the com- 
mencement of the disease, but is not useful when it has progressed for 
some time, especially when tonics and generous diet become necessary. 
Antimony in small doses often destroys appetite and relaxes the tone of 
the stomach and bowels, so as to retard the progress of recovery. The 
patient requiring more tonics to restore strength to the system generally, 
and to the digestive organs particularly, than if it had not been used. 
It is not always a safe medicine, and generally does less good than it has 
credit for, yet I doubt not there are cases in which it may be useful. 

Narcotics. By far the most useful remedies in active mania, after 
the system is prepared for their use, are narcotics. 

It is generally conceded at the piesent day, that the condition of the 
brain in mania, is not inflammation, but rather a high state of irritation, 
increasing its activity and that of the nervous system generally. The 
symptoms are sometimes equivocal, and are calculated to mislead, but 
close observation and the effect of remedies conspire to show that the 
brain is not in a state of inflammation. For this state of the brain nar- 
cotics would seem to be the most natural remedies, and experience 
shows that such is the fact. In many cases, this state of excitement 
will, after a time, give place to more healthy and natural actions, and 
the disease will be cured without the use of remedies; but in a major- 
ity of cases the symptoms yield more readily and favorably where nar- 
cotics are prescribed. 

Morphine. The remedies of this class most extensively useful are 
the Sulphate of Morphine and other similar preparations. The exact 
time, circumstances, and cases when these remedies can be applied 
with the greatest benefit, must depend upon the judgment and expe- 
rience of the medical adviser. On this, doubtless, depends their great- 
er utility in the hands of some men than of others, though many more 
cases, suitable for their use, may have fallen under the care of one 
10 



74 STATE LUNATIC HOSPITAL. 

man than, of others who have management of institutions. Other 
practitioners have generally but a limited experience with them, as 
insanity, at the present day, is but little treated by medicine except in 
the institutions especially devoted to this class of patients. 

The Morphine should usually be administered in solution, beginning 
with greater or less doses, according to the nature of the case, and the 
urgency of the symptoms. Moderate doses should generally be first 
tried, and they may be cautiously enlarged till the system is under their 
influence, and the excitement is controlled. The effects should be 
carefully watched, and if any unpleasant or unfavorable symptoms 
occur, the remedy must be changed, modified or combined, so that 
these effects may be obviated. In a large majority of the cases no 
such effects will occur. When its effect is favorable, it exercises a 
controlling influence over the symptoms, and the patient becomes more 
quiet, rational and natural in every respect. These effects, once gain- 
ed, can in most cases be maintained till the recovery is complete. 
Sometimes symptoms occur which require that the remedy be increased, 
but more generally it can be cautiously diminished, and after a time 
be withdrawn, and the system suffer no inconvenience, and the insanity 
proved to be cured. The time that this remedy should be used varies, 
in different cases, from a few weeks to many months. 

In the few cases in which it is necessary to administer narcotics, in 
large doses to produce the most decided impressions, the tincture of 
opium is better than the salts, but generally the salts are more safe and 
agreeable in their effects. 

In some cases, the Dover's powder is the best form in which this 
remedy can be administered, especially in the early periods of disease, 
when the skin is inclined to increased temperature and unnatural dry- 
ness. 

For twelve years this remedy has been extensively used in this insti- 
tution, with the most marked success. 

The manner in which the Morphine has been used in this and other 
Hospitals in this country, continuing it till the symptoms have subsided, 
then omitting and seeing them return, then again and again removed 
by the renewal of the medicine, affords unequivocal evidence of its 
power to subdue maniacal excitements, relieve the delusions of the 
insane, and restore the brain and nervous system to a sound and healthy 
state. 

Most English writers speak of the extraordinary effects of this rem- 
edy in isolated cases, but caution against its general use. But the 



STATE LUNATIC HOSPITAL. 75 

practitioners in the English institutions have learned, by experience, to 
rely upon it with as much confidence as those in this country have for 
a long time done. 

I quote the following from the Report of the British Metropolitan 
Commissioners. 

"Preparations of opium and other sedatives, given in repeated and 
sufficient doses, are thought by the best practitioners, who conduct the 
medical treatment in the large asylums, to be of great efficacy, in 
subduing excitement and agitation, and, conjoined with the use of 
baths, cold applications to the head, and the use of antispasmodics and 
aperients are said to promote the cure of mania in the early and acute 
stages. 

It is rare that any benefit arises from single doses of opiates at night 
to produce sleep, unless the system is kept under the influence of 
them the whole time. In the most violent forms of disease, the doses 
should be repeated once in four or six hours. The medicine failed to 
gain any permanent credit while it was only prescribed at night, in large 
doses, for the purpose of procuring sleep. 

It is important to know, in this connection, the symptoms which con- 
tra indicate the use of this class of remedies. When the skin is hot 
and dry, the tongue covered with a white fur, or dry, smooth and red, 
the bowels obstinately constipated, the pupil of the eye greatly con- 
tracted, and the vessels of the conjunctiva injected with blood, the 
symptoms must be changed before the Morphine can be used with 
safety or advantage. With the dry, red, smooth tongue, which attends 
comparatively few cases, the use of opiates is generally unfavorable, 
but the other symptoms, above enumerated, can commonly be removed, 
or so far obviated, in a few days, as to make them unexceptionable. 

I have spoken thus far only of the use of the Morphine in maniacal 
excitement. In some forms of melancholy, especially where there is 
great mental anguish, and strong suicidal propensity, its operation is 
equally beneficial, often procuring relief in a short time, and carrying 
the patient along most favorably to health. In this form of disease, it 
is rarely necessary to use the remedy in large doses, but whatever is 
prescribed should be at regular intervals, from three to six times in the 
twenty-four hours. 

Datura Stramonium. Some practitioners place great reliance on 
the use of Stramonium in Mania. In some cases its effects are very 
favorable, in others it not only disappoints our hopes, but sometimes 



76 STATE LUNATIC HOSPITAL. 

actually coincides with diseased impressions, and aggravates the symp- 
toms. The late Dr. Todd used it successfully, and his testimony is 
a host in favor of any medicine. In my hands, in ordinary cases, it 
has not proved very successful. 

In cases of insanity connected with epilepsy, and especially in epi- 
lepsy disconnected with insanity, I have seen most excellent effects 
from this remedy. It is rare that a case of insanity complicated with 
epilepsy, entirely recovers, but under the use of stramonium the symp- 
toms of both are often greatly diminished in force and frequency. Tn 
many cases in which the paroxysms of epilepsy have recurred fre- 
quently, they have, for months, been wholly suspended by the use of 
the tincture of stramonium. 

I have now in my care a young woman who had for some years been 
subject to epileptic paroxysms, three or four times a week for the last 
two years, she has had turns of violent mania, with the most deter- 
mined purpose to commit suicide. At each recurrence, she would 
beat her head against the wall of her room, if otherwise restrained, so 
forcibly as to inflict severe wounds. She was put upon the use of 
Stramonium soon after she came to the Hospital ; after a considerable 
time the severity of the paroxysms abated, and the insanity was less 
violent. It is now more than ten months since she has had an epilep- 
tic fit or a severe paroxysm of insanity. Her health has improved in 
every respect ; she is more or less insane at all times, but is not violent. 
Instead of being one of the most troublesome patients in the house, 
she is quiet, harmless, and even useful, as she is industrious, and capa- 
ble of doing much profitable labor. The Stramonium is still used in 
such doses as slightly to impair the vision. 

This remedy rarely makes any favorable impression on epilepsy un- 
less it be used in sufficient doses to dilate the pupils of the eye slight- 
ly, and produce some difficulty of vision more or less of the time. 

In cases of insanity in which the condition of the brain is similar to 
that which exists in epilepsy, the Stramonium would doubtless do good, 
but to be able to distinguish these cases, requires discrimination and 
experience which few men possess. 

The best form of administering the Stramonium is in tincture of the 
seeds, or tincture of the extract. 

Conium Maculatum. The extract of Conium, either alone or in 
combination with mineral tonics, is a valuable remedy, and has proved 
useful in some forms of insanity. As a means of removing maniacal 



STATE LUNATIC HOSPITAL. 77 

excitement it is worthy of little confidence. But for some forms of 
melancholy, and especially chronic disease of the digestive organs, with 
melancholy or neuralgia, it often proves very useful. It is a deobstru- 
ent narcotic of no inconsiderable power. In cases of melancholy com- 
plicated with disease of the stomach and torpor of the liver, attended 
by uneasiness, restlessness, watchfulness, and nervous pains, it often 
affords great relief, and is auxiliary in accomplishing a cure. In pure 
neuralgia, Conium combined with Iron, Quinine, Nitrate of Silver, or 
the Arsenical solution of Fowler, often proves a very efficient remedy. 
It may be advantageously used for a long time, in large doses, without 
danger. It is only in large doses that it is useful in any case, and 
particularly as a deobstruent. The minimum dose is ten grains three 
times a day, the maximum dose, two, three, or four drachms, as fre- 
quently repeated. I have rarely found any advantage from doses less 
than fifteen or twenty grains, repeated three or four times a day, but 
commonly give from thirty to forty grains as frequently repeated. 

With the Carbonate, or Red Oxyd of Iron, it is more frequently pre- 
scribed, than in any other way. These two medicines, when combin- 
ed, qualify each other, and the combination seems to increase the effi- 
cacy of both. There is considerable difficulty in procuring a good 
quality of this extract, it should be made of the expressed juice of the 
plant, evaporated in a sand bath. 

When used in large doses, the extract of Conium produces tempo- 
rary vertigo, and a heavy, dull pain over the eyes, and across the fore- 
head. If this effect is never produced by the medicine, the dose is 
either too small or the medicine of a bad quality. 

Glandular tumors sometimes disappear quite suddenly under the use 
of this remedy. A lady came under my care with the deepest melan- 
choly, under the false impression that she had a hole in her stomach, 
and that all the food she took was impacted in the abdominal cavity. 
She had had for two years or more cessation of the menses, and an 
uterine tumor as large as a quart bowl. This tumor gave her little 
trouble and occasioned no anxiety, the other sufferings and alarm oc- 
cupied all her thoughts, and made her most unhappy. She took the 
extract of Conium in combination with the Red Oxyd of Iron, in doses 
of from thirty to forty grains, three times a day, with Sulphate of Mor- 
phine, particularly at night. After some months, the patient got better, 
the delusion vanished, the health was completely restored, and what 
was quite surprising to all who had any knowledge of the case, the tu- 
mor gradually diminished and finally entirely disappeared, and the 



78 STATE LUNATIC HOSPITAL. 

healthy functions of the uterus were restored. There has been no re- 
turn of either disease since, a period of five or six years. The lady 
noiv enjoys uninterrupted health. 

Camphor. This medicine has alternately been in favor with, and 
lost the confidence of, the medical practitioner, for centuries past, and 
its merits are now very unequally estimated by men of experience in 
the treatment of insanity. In the large doses in which it has some- 
times been used, it has doubtless produced very considerable effect in 
allaying irritation and procuring sleep. But it is not frequently used 
in this way, and when it is, its effects are not as certain or as safe as 
other medicines now more extensively relied upon. The use of Cam- 
phor is now principally confined to a combination with other moderate 
narcotics, to remove slight irritation of the nervous system, and pro- 
mote sleep. I have used it in various forms, and in large and small 
doses, without any favorable results. In dismenorrhcea connected 
with insanity, or without it, it is often a useful remedy, in doses of from 
five to ten grains, and frequently relieves from extreme suffering. The 
tincture is used externally to the head with temporary relief, and is 
perhaps more useful than diluted alcohol alone, though generally less 
efficacious than cold water. 

Camphor will probably never again receive the encomiums which it 
has occasionally had in times past, as a remedy for insanity, but it has 
a limited usefulness in some cases, and will not be likely to be wholly 
discarded. 

Hyoscyamtjs. The extract of Hyoscyamus has been extensively 
used as a remedy in maniacal excitements. It is probably at this day 
more extensively used, in this country, and in Europe, than any other 
of the narcotics, and until the preparations of Morphine were exten- 
sively introduced, it stood at the head of the list of narcotics, in this 
and similar diseases. 

It is a useful medicine in some cases of moderate excitement, in 
disturbances of the nervous system, and sleeplessness. In combina- 
tion with tonics, alteratives and other narcotics, it is useful to allay 
irritation and produce a quiet and equable state of the system in many 
forms of mental disease. 

In high maniacal excitement, and the extreme suffering of some 
cases of melancholy, it is only an auxiliary to the more powerful and 
efficacious remedies that we have before considered. Its virtues have 



STATE LUNATIC HOSPITAL. 79 

probably been overrated, but it is worth a trial in many forms of disease 
that do not require potent remedies. I hardly know of a remedy more 
likely to induce sleep in simple watchfulness, than a combination of 
Hyoscyamus, Camphor, and Lupuline, in equal proportions, from two 
to five grains each for a dose, repeated if necessary. In combination 
with Nux Vomica and Nitrate of Silver it often proves a valuable 
remedy. 

Nux Vomica, Belladonna, Veratrine. These remedies are useful 
in some conditions of the nervous system, but, so far as I have known, 
have not been extensively employed in insanity. 

Nux Vomica is useful in palsy, relaxation of the muscular tissues of 
the stomach, bowels, and bladder,- as well as in external muscular weak- 
ness. I have used it in cases of melancholy with flatulency and gen- 
eral relaxation of the muscular tone. In my practice it often enters 
into combination with Nitrate of Silver, in affections of the heart, in 
epilepsy, neuralgia, and chorea. It is a powerful remedial agent, and 
may be used in larger doses than is usually prescribed. The first un- 
pleasant symptom arising from its use, is a sense of constriction of the 
stomach, which is specific, and shows that the medicine is producing 
some effect. 

My own experience of Belladonna is quite limited. It is very apt 
to affect the vision considerably before it affects the nervous system 
generally, and this symptom sometimes coincides with the illusions of 
disease, or creates visual illusions which are likely to disturb the in- 
sane. This disagreeable effect is so often produced by it as to operate 
unfavorably to its extensive use. 

Veratrine is probably not strictly a narcotic, but is a remedy which 
affects the nervous system in a surprising manner. It will often pro- 
duce nausea and vomiting before it exhibits any very marked effect as 
a general remedy. When applied externally in the form of ointment 
or strong tincture, it relieves neuralgic pains in a surprising manner, 
usually producing a prickling sensation of the part to which it is ap- 
plied. When used internally, it has in some cases, produced strangury. 

Ammonia, Ether, Lytta, Aromatics, &c. In some low cases of 
melancholy, and, indeed, in some cases of high excitement, there is 
coldness of the surface and extremities, a moist skin, paleness or livid- 



80 STATE LUNATIC HOSPITAL. 

ity of the skin, particularly of the hands and feet, a weak pulse, and 
other indications of a languid circulation ; in such cases, diffusible stim- 
ulants are often indicated. In some cases of recent dementia, in which 
the patient will stand like a statue, with the face fixed to the floor, mov- 
ing neither hands, feet or head, nor taking food, nor attending to the 
calls of nature, without being moved by another ; strong stimulants, 
aromatics, wine and other cordials are indicated, and often produce 
decidedly good effects. The warm bath, frictions, mustard foot bath, 
&/C, are good auxiliaries in such cases. 

The Lytta is also useful for the removal of some local symptoms 
often connected with insanity. In many cases of unequal circulation 
of the blood, where the vessels of the brain are too excitable, and those 
of the extremities too torpid, Lytta, in connection with the use of 
stimulant baths and the diffusible stimulants, becomes a valuable rem- 
edy. Sometimes, even in old cases, it improves the health and gives 
energy to the mind. In such cases, the brain itself needs stimulation, 
being torpid and sluggish in its action, all the powers languish for want 
of vital energy. 

Counter Irritation. Blisters, setons and issues, were formerly 
in great use in insanity. In some cases they doubtless do well, es- 
pecially in chronic cases, arising from repelled eruptions, and the 
drying of old ulcers. In recent cases they often produce too much 
irritation, which, coinciding with disease, often increases excitement. 
There is often much difficulty in the management of them in severe cases. 
For the last number of years I have not often prescribed them. One 
case has been in the Hospital in which the cause is obviously the dry- 
ing up of ulcers on the legs. The application of stimulant dressings 
in a few days renewed the discharge, and the insanity disappeared at 
once. For some years, strict attention has been paid to these ulcers, 
keeping them always discharging, and the insanity has not recurred. 

Tonics. There are many cases of insanity benefitted by the use of 
Tonics. In acute mania, after the first excitement is over, tonics are 
often indicated, and not unfrequently may be used with propriety very 
early in the disease. In many such cases, the great excitement ex- 
hausts the vital principle rapidly, and the patient is found enfeebled 
while considerable excitement exists. In such cases, Quinine, Bark, 
Aromatics, and often wine, and other stimulants, are beneficial, used 
at the same time with narcotics. 



STATE LUNATIC HOSPITAL. 81 

In cases of melancholy, the use of tonics, in some form, is more 
frequently indicated than in mania. In melancholy the powers of life 
often flag, the digestive organs suffer from debility, and tonics ate the 
principal reliance for a cure. Iron, Bark, Nitrate of Silver, Sulphate 
of Zinc, with vegetable bitters and aromatics, are found useful reme- 
dies in this form of insanity. The combination of tonics and nar- 
cotics is often successful in melancholy. The extract of Conium. with 
the red oxyd of Iron and some aromatics, is a useful medicine, as is also 
the Nitrate of Silver with Nux Vomica, and extract of Ilyoscyamus, 
Capsicum, &c. Quinine, Bark, &c, are more generally indicated in 
the more acute forms of disease, while Iron, Silver, Zinc and the veg- 
etable bitters do better in the chronic forms. 

In many cases of insanity connected with chronic disease, the main 
object is to restore the health, as soon as this is re-established the mind 
improves, and not unfrequently this improvement is in strict accordance 
with improved health. In all cases of insanity the health should be 
made as perfect as possible, but in chronic cases the principal reliance 
for recovery of the mental malady is on the restoration of good health. 
There are many cases of chronic insanity benefitted by narcotics, and 
some are cured which have long been considered hopeless. 

I have often seen chronic insanity, which for a long time had been a 
source of wretchedness, and which had annoyed all who had come 
within the circle of its acquaintance, relieved by the use of Morphine, 
and the person afflicted, made pleasant, healthful, useful and agreeable, — 
changing the whole character while the medicine was in use, and some- 
times affecting a cure. But in many cases the symptoms return, to a 
greater or less extent, when the remedy is withdrawn. Permanent 
benefit is often gained in such cases by the combined influence of nar- 
cotics and tonics. Narcotics relieve the irritation of the system, and 
tonics restore the strength. In this form of disease, medical men often 
fail, for want of perseverance with remedies, which, if continued for a 
long time, frequently affect cures, when for a few months only, they 
make very little impression. 

Baths. The warm and cold baths are remedies of more general 
application than perhaps any others in institutions for the insane. The 
warm bath is often useful in acute mania, when the patient is continued 
in it for some time, and when it is renewed frequently on the occur- 
rence of excitement. It is also beneficial to cases of melancholy and 
11 



82 STATE LUNATIC HOSPITAL. 

chronic insanity, in which the functions of the skin are performed in 
an unhealthy manner, or when the surface is cold and dry. 

In warm climates baths of various descriptions are probably more 
beneficial than they are in cold ones. The skin is there more fre- 
quently subject to disease and its functions are more likely to be dis- 
turbed. 

The warm bath should be generally used in all institutions, with all, 
or nearly all patients, to promote cleanliness and keep up a healthy 
condition of the surface. The office of the skin is not so well under- 
stood, by the public generally, as it should be. Diseases often arise 
from neglect of baths, and in few diseases are the functions of this 
important organ more likely to be disturbed than in the various forms 
of insanity. The perspiration, in some cases, emits an odor quite pe- 
culiar and very offensive, which renders cleanliness and ventilation im- 
portant auxiliaries in their treatment. 

Local bathing, as the application of cold water to the head, and 
warm water or stimulant baths to the feet, is an important adjuvant in 
the treatment of insanity. Cold applied to the head and warmth to 
the feet frequently gives relief where the blood inclines to circulate 
unequally, so that the head is hot and painful, and the feet and other 
extremities cold. The Nitro-muriatic bath, the mustard bath and salt 
water bath are all useful local baths. Frequent ablution with warm 
water, or a solution of Saleratus and water, is often useful where baths 
are in any way objectionable. Friction with a brush or coarse towel, 
wet or dry, has very nearly the same effect, but in a more limited de- 
gree. 

It may be surprising to some that in such a full view of remedies 
applicable to the treatment of insanity, a list of medicines very fre- 
quently prescribed should be entirely overlooked. Of this list are 
Castor, Valerian, assafoetida, and some other mere nervines, which 
from time immemorial have had a conspicuous place in the treatment 
of nervous diseases, of which insanity is one. I have seen very little 
benefit from their use. They are disagreeable, often offensive to the 
stomach, and if they have any effect, the same good can be produced 
by articles less disgusting and of more certain and permanent effect. 

Insanity complicated with Diseases which tend to impede 

recovery. 

Palsy. The most insidious form of disease which is found to ac. 
company insanity is a partial palsy, which is often so trifling as wholly 



STATE LUNATIC HOSPITAL. 83 

to escape the observation of friends, and yet they discover that some- 
thing has changed the appearance of the individual affected with it- 
He is often irritable, forgetful and undecided ; has many schemes quite 
new and usually visionary; his gait is slightly changed, one limb fal- 
ters a little at first, and more in the progress of disease, till his walk 
becomes unsteady as if he were slightly intoxicated; his feelings are 
easily excited ; he weeps and scolds alternately, but is most of the time 
calm, often pleasant and agreeable ; little things disturb his equanimi- 
ty ; slight provocations excite his passions. His mind becomes weak- 
ened by degrees, and is childish and trifling. Sometimes he appears 
better, and the hopes of his friends are renewed ; they know not what 
is the matter, but they see a change in his whole character. If he has 
been provident and saving, he frequently becomes wasteful and extrav- 
agant ; he is restless, discontented, and desirous of change ; delusions 
and moral perversions follow. He is sent to a hospital for the insane, 
with the impression that his disease is trifling and will soon be removed. 
Fatal mistake, — irremediable mischief is begun in the brain, and the 
case is hopeless before the friends have apprehended danger. It may 
be protracted and exhibit some symptoms of amendment, but they are 
all delusive. Epilepsy, apoplexy, or fatal atrophy, will finally relieve 
the miserable sufferer by a sudden or lingering death. In such cases 
the friends are apt to be dissatisfied with the hasty and unfavorable 
opinion of the experienced medical adviser, and the patient is changed 
from place to place to obtain a more favorable prognosis, and with a 
hope that somewhere a cure may be found. I have lost and gained 
such patients in this way, but never give any encouragement ; they 
will never recover. 

Insanity sometimes follows a regular attack of palsy, which has the 
character of Hemiplegia. Though this form of mental disease affords 
little hope, it is not so certainly fatal as the one just described. The 
mind is rarely restored to its former vigor and activity after a paralytic 
attack, but there is more hope that the patient will regain a comforta- 
ble state, and that life will be prolonged. Loss of memory, an excita- 
ble state of feeling, and particularly a propensity to weep from slight 
causes, are almost universally characteristic of the mind after an attack 
of palsy. 

Asthma. A large number of cases of insanity, complicated with 
asthma, have come under my care. Asthmatics are more frequently 
insane than their proportion in society would admit, if their disease had 



84 STATE LUNATIC HOSPITAL. 

no agency, as a cause, in producing insanity. This complication does 
not necessarily interfere to prevent the recovery of patients affected 
with this disease ; yet I apprehend it is an impediment in the way of a 
cure. There is often a marked coincidence between the paroxysms of 
asthma and the periods of excitement in periodical insanity. It is an 
interesting subject of enquiry, whether the circulation of black blood 
to the brain, in asthma, predisposes to the excitement of mental dis- 
ease. Facts connected with it would be exceedingly interesting and 
instructive. 

Epilepsy. Epilepsy has generally been considered an incurable 
disease, and has been too often abandoned without an effort for its 
cure. But epilepsy, when not complicated with palsy, insanity, or in- 
curable injuries of the head, is not always hopeless. There are reme- 
dies which make a strong impression upon the disease, and are fre- 
quently successful in removing it, when used with efficiency and pur- 
sued perseveringly. My experience in this formidable malady has been 
considerable, and I speak with confidence of the effect of these reme- 
dies. Nitrate of Silver, and some of the active preparations of Datura 
Stramonium, are my principal reliance. I have gone into some detail 
of their effects in another place. My confidence in the efficacy of 
these remedies is unabated as my experience is enlarged. 

Some circumstances connected with this disease increase its danger 
and interfere with its cure. When complicated with established habits 
of intemperance it will rarely be cured, and the effect of that perni- 
cious habit on the brain is such that an abandonment of it will not al- 
ways leave the patient in circumstances to be benefitted by remedies. 
The practice of self pollution often induces epilepsy, and, while it is 
continued, renders the case hopeless. An abandonment of the habit 
will often place the patient in a favorable situation for recovery. These 
two evils connected with insanity render the case entirely hopeless. 

Epilepsy complicated with insanity, arising from whatever cause, is a 
most formidable and dreadful disease. The character of the excite- 
ment, in such cases, is the most dangerous and unmanageable, and 
often so completely impulsive that there is no safety in admitting the 
unhappy victim of disease into any association with other patients. 
Even when the mind is nearly demented, and the energies of the phy- 
sical powers are broken down, they suddenly rally to the most desper- 
ate effort, and mischief is done when all the powers seemed to be pros- 
trated. 



STATE LUNATIC HOSPITAL. 85 

Epileptics, like the hereditary and homicidal insane, have a peculiar 
constitutional irritability, easily excited, and difficult, to be wholly 
overcome. Errors in diet, irregularities of every kind, exposures and 
excesses, have all a great tendency to produce a return of disease when 
it has been essentially relieved by great attention to regimen and the 
use of appropriate remedies. With all these complications a majority 
of the cases of epilepsy can be essentially benefitted by regimen and 
medicine. In old and incurable cases of epilepsy combined with in- 
sanity, remedies have not only lessened the number of the paroxysms, 
but improved the health and diminished the insanity. A number of 
cases are now under my care which verify the statement ; and so many 
have for years received improvement, that I feel confident that no future 
adverse experience can invalidate its truth. I cannot say that I expect 
this class of patients will be frequently cured, but I have hope that a 
considerable proportion of them will remain permanently improved 
after a full trial of remedies, and that individuals who are thus affected 
may be restored to health and soundness of mind. 

One good result, of no inconsiderable magnitude, has arisen from 
the repeated experiments with remedial agents in these complicated 
cases of insanity with epilepsy, which is, that by them have been dis- 
covered the anti-epileptic powers of certain remedies and systems of 
regimen, thus greatly prolonging the intervals between the fits, and 
rendering the paroxysms less severe. If this discovery does not cure 
these complicated cases, it shows that great hopes may be derived from 
them in cases arising from certain irritations of the system, and per- 
haps continued, very considerably, by habit. 

Some years ago a most unfortunate man, about forty years of age, 
was brought to this Hospital. He had had epilepsy very badly for many 
years, had palsy of one arm, had lost one eye, and was, in his parox- 
ysms of insanity, one of the most desperate and dangerous men that I 
have ever met with. No hope whatever was entertained of any im- 
provement in the case. In the hope of giving some relief to such a 
forlorn case of suffering and disease, and making him more comforta- 
ble to his associates and those who had the care of him, I prescribed 
for him the Nitrate of Silver and extract of Stramonium. He pursued 
these remedies six months, and during that time never had a paroxysm 
of epilepsy. He became docile and pleasant, pursued light labor, and 
was trustworthy and harmless. The remedies were withdrawn, and 
the paroxysms of epilepsy recurred, but with less violence and fre- 
quency than before. He left our care some years ago. I have no 
knowledge of his present situation. 



86 STATE LUNATIC HOSPITAL. 

There is now in the Hospital a young woman, aged 27, who has 
been subject to epilepsy for five years, particularly at the menstrual 
period, during which she usually had from two to six or eight parox- 
ysms. Soon after she came under my care she had a recurrence of 
the menses, epilepsy and violent insanity. The paroxysms were at 
least two a day for three or four days. She has taken the Nitrate of 
Silver and Stramonium liberally since. At the next menstrual period 
she was quite insane for a number of days, but had no epilepsy. Since 
that time she has passed another menstrual period without a recurrence 
of epilepsy or insanity, which has not happened before for a long pe- 
riod. The trial of remedies has not yet been sufficient to insure a 
recovery, and I have many fears that the case will prove incurable: 
but the effect of the medicine to suspend the paroxysms of this com- 
plicated case of disease is remarkable and encouraging. 

There is a form of epilepsy occurring with those who have had par- 
tial palsy, and sometimes with those who have had occasional parox- 
ysms of epilepsy, which is terrific in its aspect and generally fatal in 
its event, and that very suddenly, which is worthy of consideration. 
The patient has an epileptic fit, which, in fifteen or twenty minutes, is 
succeeded by another, and these paroxysms occur at nearly the same 
regular intervals till death succeeds, in from 20 to 36 hours. The pa- 
tient rarely, if ever, wakes to consciousness, but in the intervals ap- 
pears perfectly apoplectic — the vessels of the face are tinged with 
blood, the countenance livid, and the power of swallowing and muscu- 
lar motion nearly or quite lost. 

I have seen a number of such cases die, and for some years after I 
became familiar with them I considered them hopeless. They fre- 
quently occur in institutions for the insane. I have recently adopted 
a course of treatment which has been successful in many cases. In- 
stead of blisters, sinapisms and other irritants, I place upon the han- 
dle of a spoon a scruple or half a drachm of calomel, and prying open 
the mouth introduce it as far as practicable, then snapping the other 
end of the spoon throw it as far as possible down the throat. If in 
four or six hours no effect is produced by it, I repeat half the quantity, 
and so proceed till free catharsis follows. In a very large proportion 
of the cases the paroxysms have subsided upon the operation of the 
medicine, and the patient has returned to his accustomed state of 
health in a few days. I do not remember to have lost but one case of 
this description for some years past, and have seen a number recover 
which, under any other prescription that I have seen used, would have 
certainly proved fatal. 



STATE LUNATIC HOSPITAL. 87 

Since I commenced writing this sheet a case of this description has 
been brought to my care. The epileptic paroxysms were not severe 
at first, and were not recognised as such by the attending physician. 
This patient was bled, in the onset of his disease, sixty ounces without 
relief, but he became pale and bloodless, the pulse, when reaction took 
place, having the rapidity and irritation that is found to follow exces- 
sive haemorrhage, the epileptic paroxysms became more distinct and 
genuine, and occurred once in 15 or 20 minutes. There is a slight 
degree of consciousness awakened in the interval of his paroxysms, 
but the patient does not speak, and will probably sink under his dis- 
ease and the injurious depletion prescribed for him. He is very in- 
sane, and it has been difficult to manage or control him. He is now 
dull, and makes no attempt to move. 

Some time since a lady came under my care with puerperal epilepsy. 
She had had fits once in 15 or 20 minutes for 20 hours, laid apo- 
plectic in the intervals of the paroxysms, and was abandoned by her 
medical adviser as in a hopeless state. After having over 40 convul- 
sions of this description, I prescribed the calomel as before named, 
and gave an enema of oil of turpentine and laudanum. The fits left 
her immediately on the operation of the medicine, but she was wholly 
blind for a week and quite insane. She gradually recovered and was 
quite well afterwards. 

Very good effects come from this practice in some cases of apoplexy 
and palsy, where the bowels are constipated and the power of deglu- 
tition lost. 

I apprehend that in most institutions, and particularly in private 
practice, there is great want of perseverance in cases of epilepsy. 
They are considered in the outset as incurable, and remedies which 
are not followed by immediate improvement of the symptoms are aban- 
doned, and the case is given up as hopeless. 

_ Diseases of the Digestive Organs. Dyspepsia and disease of 
the liver are often connected with insanity, as a cause or concomitant ; 
in either case it is not a favorable circumstance, and is a frequent im- 
pediment to recovery. Hypochondriacal melancholy is the most com- 
mon form of insanity connected with dyspepsia. If the case is not a 
bad one, restoration of health often removes the insanity. If the dis- 
ease of the digestive organs is severe, it frequently terminates in fatal 
marasmus. 

There is a condition of the stomach and bowels connected with 



88 STATE LUNATIC HOSPITAL. 

insanity that indicates serious disease, and often proves fatal. The 
tongue is red and dry, vomiting and diarrhoea are easily excited, the 
whole intestinal canal partakes of the disease, and a chronic diarrhoea 
often proves fatal. Such cases do not bear opiates well, and all reme- 
dies are often unavailing to promote a cure. 

A large proportion of the cases reported as arising from ill health 
have more or less connection with derangements of the digestive func- 
tions. Sometimes the liver is affected with torpor, and sometimes is 
active in producing a morbid secretion, which, by the ancients, was 
supposed to be a frequent cause of melancholy. For this they pre- 
scribed hellebore with great reputed success. Cases of melancholy re- 
lieved by this, or kindred remedies, do not seem to be common in 
modern times. 

Circumstances favoring the recovery from Insanity. 

Early Admission. It is conceded by all who have anything to do 
with the insane, that an early application of remedies and regimen 
proper in their treatment is favorable to the recovery of the recent in- 
sane. For this purpose, after it is settled that the disease is formed 
and established, they should immediately be sent to a hospital designed 
for their treatment, that they may not only have the proper remedies 
administered in season, but that improper appliances, from which many 
patients suffer while with their friends, may be avoided. In many cases 
of insanity means, both medical and moral, are adopted which are cal- 
culated to prolong and aggravate the symptoms before the patient is 
sent to a hospital. There is much choice in the institution itself, not 
only in its architectural arrangements, but in its location as to dryness 
or dampness, as to exposure, prospect, and outward accommodations. 

Classification. Nothing can be more important in such an insti- 
tution than suitable classification. It is but recently that due attention 
has been paid to this important consideration. Formerly a large pro- 
portion of the inmates of hospitals for the insane were confined in sol- 
itary rooms, chained, or in strait waiscoats, — the quiet and the violent 
crowded indiscriminately together. In Europe, if any separation was 
made, it had no reference to the character of the case, but to the rank 
of the individual to society, and this rule is not wholly abandoned at 
the present time. In some of the institutions, both in this country 
and abroad, the basis of classification was the amount paid for board 
and attendance. This objectionable rule has but recently been aban- 



STATE LUNATIC HOSPITAL. 89 

doned in some of the most prominent institutions in this country. 
While in existence it brought together, the violent maniac, the drivelling 
idiot, and the tranquil monomaniac, the outrageous, profane, and noisy, 
the convalescent, the timid, and the sensitive. Nothing could be worse 
than such an association for the curable and those recovering. A bet- 
ter system of classification generally prevails in all the institutions at 
the present day. 

Some writers recommend a strict adherence to the rule of bringing 
together cases of the same class only. The violent with the violent, 
the melancholies by themselves. This is a better system than had for- 
merly prevailed, but a more rational and common sense rule is to bring 
together not only those who will not injure each other, but to classify 
so that mutual good may be imparted, and so that no one shall associ- 
ate with those particularly obnoxious to him. 

In many of the smaller institutions the limited number of apartments 
renders perfect classification difficult, while in some of the great ones 
the apartments are too large and too few. It is desirable to have the 
wards of such a hospital of moderate size, and to have a considerable 
number of them. 

Diet. The diet of the insane should be simple and substantial. In 
a few cases it may be necessary to prescribe a light diet for a season, 
but even this is not common. The insane require a considerable quan- 
tity of food, and are usually fond of eating. In high maniacal excite- 
ment the energies of the system require frequent replenishment in con- 
sequence of the exhaustion produced by perpetual activity. They are 
rarely injured by food, and very frequently are made more quiet and 
tranquil by a full meal, a proof, if any be needed, that in mania there is 
no inflammation of the brain or its membranes. Low diet produces 
irritation and dissatisfaction, which coincides with the symptoms of 
disease and increases its intensity. It is generally safe to supply the 
demands of the patient for food. Many convalescents eat very lib- 
erally and gain flesh rapidly. It is always a favorable circumstance to 
find a recent case, that has been much excited, gaining flesh ; we pre- 
dict from this circumstance alone a favorable termination, even if in 
other respects there is no particular amendment. 

Perhaps there has been no greater improvement in the treatment of 
the insane than in the matter of diet, the old notions of starvation be- 
ing everywhere discarded, and a good diet substituted. 
12 



90 STATE LUNATIC HOSPITAL. 

Warmth and Ventilation are of the first importance in an institu- 
tion for the insane. The apartments should be of equable temperature 
at all times, free from too great dryness or dampness of the atmosphere 
and every nauseous effluvia. The residents in the wards should be 
placed in such a temperature that they neither think of being cold nor 
disagreeably warm. 

There should be a free circulation of pure air through all the wards 
of the Hospital, that all disagreeable effluvia be immediately removed 
from the apartments, and the air for respiration be as free from con- 
tamination as the external air. These important objects are most fa- 
vorably gained by the free admission of air from without, warmed in 
furnaces so as to admit of a large volume, heated to a moderate tem- 
perature. As a means of restoration to the insane these are more im- 
portant than is generally conceived. 

Occupation. There is now no difference of opinion among those 
who manage the insane relative to the value of employment. The in- 
sane should never be idle. By employment the maniac expends his 
excitement in a reasonable and proper way, which he would otherwise 
exhaust in noise, violence, and mischief. The depressed and melan- 
cholic will, by employment, be withdrawn from the theme of his gloomy 
musings to the consideration of other subjects calculated to disengage 
his mind from the influence of his delusions, and the wretchedness of 
his condition. While actively engaged, the monomaniac forgets his 
vagaries, brings into action powers which have been cast in the shade 
by intense contemplation of isolated subjects, till the mind, by habits 
long cherished, is absorbed in hallucinations of its own creation. The 
convalescent, by occupation, strengthens his physical powers, and brings 
the mind into regular channels of action, till sound and rational views 
take the place of the ideal creations of a distempered fancy. 

All are better for employment : with it the mind is kept active and 
vigorous ; without it, it is constantly becoming more limited in its sphere, 
till it famishes for want of aliment to sustain it, and it sinks into con- 
firmed and hopeless fatuity. Nothing is so bad for the sane or the in- 
sane as inactivity and idleness. 

Amusements. Recreation and amusements are important in the 
management of the insane. Acting upon the principle that diversion 
and change has a tendency to remove from the mind false impressions 
and abstraction, whatever is innocent in the way of relaxation may do 
good. 



STATE LUNATIC HOSPITAL. 91 

Riding, walking, dancing, music, and various active and sedentary 
games, are all useful to occupy the time and divert the mind. Active 
games promote health by the exercise which they give and the pleasure 
they afford. There can be no difference of opinion as to the utility of 
riding, walking, and other active exercises, for most of the inmates of 
hospitals for the insane. They are universally adopted in such estab- 
lishments, and such abundant testimony in their favor must establish 
the fact of their usefulness. 

Dancing may be objected to by some on account of its supposed 
immoral tendency, by others as being too exciting for many of the in- 
sane, and also as bringing together the sexes, which, in some institu- 
tions, they studiously endeavor to avoid. Dancing is an exercise of the 
right kind, and very harmless in a hospital where every movement is in 
the hands of the officers, where there is no exposure to vicissitudes of 
heat and cold, and where it is limited to seasonable hours. There may 
be some institutions, in the vicinity of large cities, where this amuse- 
ment might be objectionable, most of the inmates being from a small 
circle in extent ; the intimacies and associations formed at dancing par- 
ties might not be desirable abroad. In my own experience I have not 
met with any difficulty of this kind, and the amusement has been more 
gratifying to a large class of patients, and more beneficial in its results, 
than any other mere amusement. Besides those who engage in the 
exercise, a larger number assemble to enjoy the music, and witness the 
performance with apparently equal delight. 

Music is also one of the great sources of gratification in hospitals 
for the insane. Like dancing, it is beneficial to those who practice it, 
and to those who listen to it. It often does good by awakening old 
associations and long accustomed habits of pleasure, as well as by 
present gratification, most delightful and tranquilizing to the minds and 
feelings of the melancholy and desponding. Many highly excited ma- 
niacal patients listen attentively to plaintive music, and for the time 
are made calm and quiet by its influence. It is one of the appliances 
that rarely injures any one, and often does good to many, even of dif- 
ferent and nearly opposite character. 

Parties. Social intercourse is extremely useful to the intelligent 
and convalescent insane. Whatever brings them withing the sphere 
of customary influences, and makes a residence in a hospital appear 



92 STATE LUNATIC HOSPITAL. 

J ike a family or social circle, is calculated to promote their recovery. 
In this Hospital the Matron's parties, held twice a month, where the 
patients in considerable numbers meet to spend the afternoon socially 
and profitably, have been both useful and agreeable. At these parties 
much clothing and bedding for the patients is made, also articles for 
sale, by which the library is replenished and made valuable. 

There is also much visiting from one gallery to another, and to the 
apartments of the Matron and family, where an agreeable hour is often 
spent in cheering and comforting the unhappy, and in increasing the 
quiet and self-control of the more excited, thus leaving a favorable 
impression calculated to produce contentment and promote recovery. 
The more nearly the condition of the insane can approximate to that 
of the world abroad the better. The hospitals for their care and re- 
covery should be as much like private apartments as possible, when 
not incompatible with security and protection from external influences. 
A large number of patients, who spend the day in active and useful 
employments abroad, spend the evening in the social circle, singing, 
reading, and playing games in the different apartments of the institu- 
tion, where they act freely in whatever they do conformable to the 
lenient government every where adopted. 

Reading. A library of well selected books is essential to a hospi- 
tal for the insane. Reading is pursued as an amusement by some, and 
as a source of instruction and moral and religious improvement by 
others. Religious reading is enjoyed by many. All have free access 
to the Bible, and few, if any, are injured by it. It is a source of great 
comfort and consolation to many, to be able to resort to this founda- 
tion of religious hope in the hour of trial and despondency. A bless- 
ing so common is not anywhere fully appreciated, but when the twi- 
light of reason begins to dawn upon the mind that has been enveloped 
in darkness, and overwhelmed with religious gloom and anxious fore- 
bodings, then the promises there contained lighten the pathway, excite 
confidence, and buoy up the soul till consolation and safety is again 
felt in the hopes of the Gospel, and in that faith that " works by love 
and purifies the heart." 

Many prefer light reading, tales, periodical publications, newspapers, 
&/C A great number of these are sent to us by our friends, and many 
are regularly taken. 

The amount received by the sale of articles made by our family, has 
been nearly one hundred and fifty dollars the past year, all of which is 



STATE LUNATIC HOSPITAL. 93 

expended to replenish and sustain the library. We acknowledge with 
gratitude the receipt of valuable donations from the following sources : 
From the Rev. J. W. Hawkins, 100 temperance tracts; from Rev. T. 
F. Norris, a large number of books, papers and periodicals, of much 
value and interest, together with the Olive Branch ; from J. S. C. 
Knowlton, Esq. and J. W. Goodrich, Esq., editors in this town, a lib- 
eral supply of papers and periodicals. James M. Barnard, Esq., of 
Boston, has sent to us rare books and reports from foreign institutions, 
of uncommon interest and value. He has laid us under great obliga- 
tions for his continued interest in our welfare. From Judge Thomas, 
of this town, we received a liberal donation of books, which have 
afforded much valuable reading ; and from E. S. Thomas, Esq. a copy 
of his " Reminiscences." From the Hon. Edward Everett, we have 
received the Report of the Metropolitan Commissioners to the British 
Parliament, a rare and valuable gift. The Hon. Bezaleel Taft remem- 
bers us annually, by a donation to our library, and many other kind- 
nesses which we delight to remember. We also aknowledge the re- 
ceipt of books and papers from Thomas M. Pratt, Esq. of Northamp- 
ton ; papers and other valuable reading from Mr. Thompson, periodi- 
cal agent, Worcester, and from our valued friend Dr. Batchelder, of 
Utica. 

From the Hon. C. Hudson, D. P. King, J. R. Reading, Mr. Par- 
menter, Mr. Steward, and Dr. Simons, members of Congress, wc have 
received public documents and valuable papers. From Josepii Ad- 
shead, Esq., Manchester, England, we have received interesting foreign 
papers. 

We acknowledge the receipt of the following newspapers from their 
editors and publishers, to whom, with our thanks, we will make the 
slight return of a copy of our Annual Report : — The Greenfield Mer- 
cury, Boston Recorder, Hampshire Gazette, Olive Branch, Springfield 
Republican, Springfield Gazette, Old Colony Memorial, Congrega- 
tional Visitor, Mother's Magazine, Worcester Cataract, Christian 
Watchman, Social Monitor, Gospel Messenger, Youth's Companion, 
Christian Witness, Perfectionist, Advocate of Peace, New Bedford 
Mercury, Fall River Monitor, New York Observer, New Hampshire 
Patriot, Keene Sentinel. 

It would be gratifying to these editors to see with how much avidity 
the patients from different sections of the State seek for the intelligence 
from their own neighborhood ; how eagerly they glance over the news- 
paper they have been accustomed to read at home ; and what pleasant 



94 STATE LUNATIC HOSPITAL. 

associations these weekly messengers awaken of home, friends, and 
by-gone scenes. 

Many patients read newspapers when they would read little or noth- 
ing else ; and as the assistant physician enters the ward with the daily 
supply of papers, many a hopeless patient comes eagerly forward to 
receive them ; and they pass from patient to patient till they are com- 
pletely worn out, one reading the stories, another the politics, a third 
the ship news, and others the poetry, agricultural intelligence, etc. 
each as his taste may dh.tale. 

Reading produces much occupation, diverts the mind for the time 
by affording subjects for contemplation, and thus tends directly to pro- 
mote recovery and prevent fatuity when delusions remain. 

Writing is frequently as useful as reading. We are in the habit of 
indulging those who desire to write letters and other compositions for 
amusement, as a means of expending excitement. By the composi- 
tions of the insane we can often judge more accurately of the state of 
the mind than by conversation. Many patients write well before they 
are recovered, and thus deceive their friends, leading tfiem to suppose 
that they are better than they find them by observation ; and some who 
appear comfortably cannot write at all ; others commence a letter well 
and end it with a scribble. When the mind is not confused by writ- 
ing, it is often a salutary discipline, and helps to promote recovery. 

Labor is by common consent estimated above all other occupations 
for the insane by the managers of hospitals. All patients who will 
participate in it are benefitted by it, whether it be the excited, the de- 
pressed, the monomaniac, or the demented. By labor, health is im- 
proved, excitement is expended, the mind diverted from the delusions 
of disease, kept bright, and prevented from decay. No individual 
loses his mind while he is regularly employed, and very few become 
excited in consequence of occupation. 

In cases of mania, with persons accustomed to labor, after the first 
excitement of disease has subsided, there is a desire for employment, 
usually in the customary channels. If the man is a farmer he desires 
to labor on the land ; if a mechanic he prefers the workshop. Many 
females like active employments, others prefer the more sedentary; but 
nearly all wish to do something, and scarcely any improve if unem- 
ployed. Some extremely torpid, not to say demented patients wake 
up most favorably by the influence of labor, and improve considerably, 
if they do not recover. 



STATE LUNATIC HOSPITAL. 95 

There are many individuals in this Hospital who, previous to enter- 
ing it, had been in close confinement for years. Many of them com- 
menced labor under the most vigilant supervision, but by degrees gain- 
ed our confidence, and for the last few years have been permitted to 
go alone to their employments, where they perform much useful labor. 
Many of these individuals seem to have no more idea of leaving the 
establishment than children would the family domicil. 

Patient trial, persuasion, and uniform kind management, has brought 
many insane persons to be useful in the various departments of busi- 
ness. No such person becomes demented, or habitually indulges bit- 
ter feelings. All feel an interest in improvements and production, and 
become identified in interest and feeling with the institution. 

Convalescents labor for a season, and then frequently withdraw from 
it, preferring excursions about the town, and various amusements, to 
hard work. There are many exceptions to this rule with the working 
classes. They often prefer regular employment till they are sufficient- 
ly recovered to return home and pursue their own business. 

In connection with every public hospital for the insane, ample pro- 
vision should be made for agricultural and horticultural employments, 
and the more common mechanical trades. 

Farm. The farm connected with this Hospital is less than it should 
be, as more land could be advantageously cultivated. 

The quantity of the Products of the Farm and Garden is given in the 
folloioing statement, with the value as estimated by the Steward. 

Hay, 40 tons, at $13 00 per ton, - $520 00 

?, 65 00 

15 00 
40 00 
21 45 
98 00 
5 25 
149 85 
52 00 
40 70 
346 25 
40 00 
29 83 
Broom corn seed, 30 bushels, at 30 " - . 9 00 



Onions, 


130 bushels, 


at 


50 i 


Tomatoes, 


30 


(C 


at 


50 


Green peas, 


40 


« 


at 


100 


Potatoes, 


65 


(« 


at 


33 


Corn, 


140 


(( 


at 


70 


Soft corn, 


15 


(( 


at 


35 


Beets, 


405 


IC 


at 


37 


Ruta Baga, 


260 


<< 


at 


20 


Parsnips, 


110 


It 


at 


37 


Carrots, 


1385 


(( 


at 


25 


Cabbages, 


800 




at 


5 


Broom corn, 


, 459 1 


lbs. 


at 


H 



96 STATE LUNATIC HOSPITAL. 

Oats and straw, ----.- $20 00 

Winter squashes, 8,000 lbs., - - - 60 00 

Pumpkins, 16 loads, - - - - 16 00 

Corn fodder, - - . . . - 15 00 

Garden vegetables, ..... 100 00 

Poultry, 460 lbs., at 10 cents, - - - 46 00 

Pasturing 12 cows, ..... 150 00 

Milk, supposed about 36,000 quarts, at 4 cents, - - 1440 00 

Pork, 6445 lbs., at 3 J cents, - - - 354 47 

Beef, 6167 lbs., at 4£ " - - - - 277 51 

Pigs sold, - - - - - - ' 81 44 



$3992 75 

The stock has been fed from the farm and garden. The stock on 
hand is 4 horses, 5 oxen, 13 cows, and 40 swine. 

The farm consists of about 60 acres of land, a large proportion of 
which is pasturage. There are from 10 to 20 acres of cultivated land, 
on which this quantity of produce is raised. From our garden we 
have this year obtained more than 2500 bushels of roots, besides gar- 
den vegetables in great profusion, for use through the summer and 
autumn. These roots are fed to the stock. 

In addition to the labor on the farm and in the garden, the laborers 
have accomplished much in improvements, sawing and piling wood, 
taking care of stock, and attending to the order and neatness of the 
grounds and walks. 

One patient last winter sawed and split from 75 to 80 cords of wood, 
at a stipulated price, which was paid him by the Steward. 

Cabinet Shop. In the cabinet shop the bedsteads, tables and sinks 
have been made for the new wings, and a great amount of other labor 
has been done by patients, under the care of a vigilant and faithful 
overseer. 

Mattress Shop. In this shop, also, a great amount of labor has 
been done. Nearly all our mattresses are made over annually, and 
many new ones are also made. At present they are making the mat- 
tresses for the new wings, which we hope to be able to accomplish by 
the time they are ready for occupancy. 



STATE LUNATIC HOSPITAL. 97 

In the seamstresses' room nearly 82,000 worth of clothing and bed- 
ding have been made up for the establishment. One female has, in 
the course of the last year, bound 790 pairs of shoes, made 40 pairs 
of pantaloons and 32 vests, besides mending and much other work. 
Other individuals have done nearly or quite as much labor, and one 
hundred or more are daily employed in some useful manner. From 
six to ten females have been daily employed in the laundry. 

Shoe Shop. The following statement of the labor and expenses of 
the shoe shop is given by the overseer. 

Amount of work done for officers, assistants, and customers, -$537,62 
For patients, ...... 540,38 

Stock and shoes on hand, .... 175,00 



§1,253,00 



Expended in stock and tools, . . $657,00 
Stock and shoes on hand at the commencement 

of the year, .... 155,00 

Wages of overseer, . . . 227,00 

Board of overseer, . . . 100,00 

Binding, fuel, and light, . . . 60,00 



-$1,199,00 



$53,40 

No mechanical business is pursued at the Hospital which does not 
pay for itself, and furnish a moderate balance in favor of the State. 
This is intended to be small, as the whole establishment is benefitted 
by low prices of the articles sold rather than by profits cleared. 

Religious Exercises. The religious services of the chapel have 
been conducted, the past year, by our Chaplain, the Rev. George 
Allen, with his usual fidelity and ability. He has not only officia- 
ted twice on each Sabbath, but has attended devotional services each 
evening in the Johonnot Hall, at which a large proportion of our 
whole family have usually been present. Reading a portion of Scrip- 
ture, singing and prayer constitute this exercise. 

We feel that the experiment of religious services and instruction at 
this Hospital has been wholly favorable, and far more extensively useful 
than was at first anticipated. A larger class have been able to attend 
13 



98 STATE LUNATIC HOSPITAL. 

than was then expected, and the individuals whom we at first supposed 
might be excited and injured by these services, have been found to at- 
tend with entire tranquillity and composure. 

The influence of religious instruction at daily prayers, and weekly 
in the Chapel, has given our patients favorable impressions of the char- 
acter and designs of the Hospital, and has increased their confidence in 
the good intentions of the officers. 
/ In many instances, religious instruction has left influences far above 
its moral effects on the management of the insane. It has made per- 
manently good impressions upon the character of individuals, amending 
the heart, improving the life, awakening a sense of religious obligation, 
and transforming the habits from levity to sobriety, from dissoluteness 
to the proprieties of rational life. 

Religious instruction is here, as elsewhere, designed to strengthen 
and encourage us in the way of virtue, to regulate and guide the way- 
ward, to awaken the hopes, and afford comfort to the anxious and des- 
ponding, to calm and tranquiiize the agitated, to do us all present good 
and prepare us for an heavenly inheritance. 

A large portion of the insane are fully capable of appreciating these 
influences in all things but such as relate to their particular delusions. 
They know right from wrong, good from evil, and when hurried by pas- 
sion or impulse into improprieties or mischief, as fully repent and re- 
gret the consequences of their errors as other individuals. If this be 
true, then surely they should come under all the influences that tend to 
disengage them from error, and guide them in the way of duty. With 
a motive strongly presented to them, they can control their feelings and 
govern their conduct. What can more effectually reach the main spring 
of action in their minds than religious truth, presented in the right 
^manner and with the right spirit 1 

Conclusion. The past year has been one of unusual labor, anxiety 
and care. In addition to the management of 260 patients, on an aver- 
age, buildings have been erected affording more accommodations for 
the insane than the original Hospital, and though these have been' su- 
perintended, while being erected, by an able and competent architect, 
they have increased the labors and responsibility of the officers. The 
presence of so many individuals at labor in the immediate vicinity of 
the insane, increases the excitement and diminishes the discipline which 
it is desirable to maintain in such an institution. With all these em- 
barrassments, now nearly brought to a close, we have had a prosperous 



STATE LUNATIC HOSPITAL. 99 

season, and have great reason for gratitude to the Giver of all good that 
the year has closed so auspiciously. 

I would express my thanks to the Board of Trustees for many indul- 
gencies, during the past year, extended to myself personally, in a sea- 
son of ill health, and for their kindness to my family, no less than for 
the care and scrutiny with which they have managed the affairs of the 
Hospital. 

To my assistant, Dr. John R. Lee, and to the Steward and Matron, 
Mr. and Mrs. Hitchcock, I am indebted for every aid which I could 
have asked at their hands in the management of the Hospital, both 
while with them and while abroad in pursuit of health. Nothing was 
left undone which it was in their power to perforin. 

From the excellent supervisor, Mrs. Sarah Hayward, and all the 
overseers and officers of the Hospital, in their various departments, I 
have received every aid which it has been in their power to contribute, 
and acknowledge with grateful feelings, their deep sympathy in the 
hour of sickness, no less than their constant willingness to lessen the 
burden of my duty, and perform their own with cheerfulness and 
alacrity. 

Commending the Hospital and its great interests to the care of the 
government, and the protection of Heaven, I respectfully submit this 
Report. 

SAMUEL B. WOODWARD. 

State Lunatic Hospital, ) 
Worcester, Mass. Nov. 30, 1844. J 



100 



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STATE LUNATIC HOSPITAL. 



103 



REMARKS. 


Barometer 30.24 at 9£, A. M. 
Aurora borealis. 

Lightning in the evening. 

Thermometer 84° at U P. M. 86° at 2A. 
P.M. 


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i-tG^GO^iotot-eOCTiOi-iG^co-^iotoir-cocnOi-iG^corfiintot-cocno 



104 



STATE LUNATIC HOSPITAL. 





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Thunder storm. 

Rain commenced at 6£ P. M. 

High wind. 

Rain commenced at 8 A. M. 
Thunder storm in the night. 

White frost. 

Thunder storm in the afternoon. 
Rain in the night. 

Rain in the night. 


Inches 

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STATE LUNATIC HOSPITAL. 



105 







P3 


Rain commenced at 8^ P. M. 
Dense fog. 

Rain in the forenoon. 

Rain in the night. 

Rain commenced at 10£ P. M. 

Frost. 

Showers in the morning. 

Thunder storm in the afternoon. 




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