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SENATE No. 1.
TWENTY-SECOND
ANNUAL REPORT
THE TRUSTEES
STATE LUNATIC HOSPITAL,
AT WDKCESTER.
DECEMBER, 1854.
BOSTON:
WILLIAM WHITE, PRINTER TO THE STATE.
1855.
I
A
OFFICERS OF THE HOSPITAL.
*
TRUSTEES.
S. G. HOWE, Chairman, Boston.
HENRY MORRIS, Secretary, Springfield.
REJOICE NEWTON, Worcester.
JAMES B. CONGDON, New Bedford.
LINUS CHILD, Lowell.
TREASURER.
SAMUEL JENNISON, Worcester.
OFFICE : SAVING'S BANK FOSTER STREET, WORCESTER.
RESIDENT OFFICERS.
GEORGE CHANDLER, M. D.,
Superintendent.
GEORGE ALLEN,
Chaplain.
MERRICK BEMIS, M. D.,
Assistant Physician
EDWARD A. SMITH. M. D.,
u a
THOMAS HILL,
Steward.
ELIZABETH A. REID,
Matron.
JOHN T. MIRICK,
Supervisor.
PHEBE S. MIRICK,
u
TWENTY-SECOND ANNUAL REPORT
OF THE
TRUSTEES OF THE STATE LUNATIC HOSPITAL,
AT WORCESTER,
1854.
To His Excellency the Governor and the Honorable Council : —
In compliance with law and custom, the undersigned, Trus-
tees of the Massachusetts State Lunatic Hospital at Worcester,
present their Annual Report of " the condition of the hospital
and its concerns."
Under ordinary circumstances, this Report might well be
very concise, and confined to a summary of the principal
events of the year. But in the actual state of the case; in
the present condition of the question concerning the provisions
to be made for the insane of the Commonwealth ; and in
the prospect of legislative action upon the whole subject,
greater diffuseness may be allowed.
In setting forth the condition of the Hospital, and the
remedies for its defects, it will be necessary to examine cer-
tain principles and modes of treatment, which, though familiar
to professional, are not so to unprofessional readers. Argu-
ments that would be held superfluous ; considerations that
would be deemed perfectly trite by a body of physicians, may
be appropriately addressed to those whose studies and occupa-
tions have not familiarized them with the subject of insanity,
6 STATE LUNATIC HOSPITAL. [Jan.
but who may be called upon to take measures for the cure and
care of the insane of the State.
The year has been one of general health and prosperity.
No epidemic has occasioned unusual mortality in the Hospi-
tal ; no fatal accident has broken the usual quiet of the house-
hold ; no manifest abuse of trust has lowered the high character
of the body of officers and attendants.
However far short the Institution may have fallen of doing
the greatest possible good with its means, it certainly has con-
tinued to carry on, with marked success, the work of Christian
charity allotted to it by the State ; and another year of good
deeds may be added to its history of beneficence. That his-
tory has been glorious in the best sense ; and Massachusetts
may reflect upon it with as much satisfaction as upon any
part of her annals. Had she erected at Worcester a Military
Academy and an Arsenal, from which to draw men and weap-
ons to conquer in a hundred fields, she could not have won
such precious laurels as she has earned within these walls.
Since the opening of this Hospital, four thousand seven
hundred and fifty-seven insane persons have been received
within its friendly gates. Of these, two thousand one hundred
and seventy-two have gone forth again clad in their right
minds, or have partially recovered. Others, secluded from
the world, (which to them was one of excitement and suffer-
ing, while to it they were a terror and a burden,) here pass
their days peacefully, and receive that respectful attention
due to every being in human shape, however ruined and de-
graded he may be ; and those to whom the end comes, have
their eyes gently closed in death by friendly hands. Nor have
these only been benefited ; for thousands upon thousands of
relatives and friends have been relieved from dreadful anxiety,
by the State thus taking charge of those beloved ones for whom
they could do nothing.
Nor yet have benefits and blessings been conferred upon
these the receivers only, but the giver too has been doubly
blessed; and Massachusetts has been made richer in the heart's
treasures for every year in which, from its high pulpit at
Worcester, the Hospital has preached to all the people its
daily sermon of Christian love and charity.
The Trustees have great pleasure in such retrospect ; and
1855.] SENATE— No. 1. 7
they heartily ascribe the praise for that portion of the good
work which has been accomplished during the past year, to
the Superintendent, his assistants, and the faithful men and
women in attendance, by whose immediate agency it has been
effected.
It is easy and pleasant to render merited praise. It is agree-
able to indulge in complacent retrospect of past efforts and
acknowledged excellence. But it is a duty to be mindful of
faults and shortcomings. It must not be admitted that any
thing which has been done in the past, or any success which
has been obtained, can warrant a moment's pause in that long
career of improvement which is clearly open before this Hos-
pital. That career, indeed, must be pursued with unwonted zeal
and energy, if the character which its friends once claimed for
it, of being a model institution, can be regained and deserved.
This Hospital was once indeed a model one, in form and
in administration ; and Commissioners came up hither from
other States to study it, and went home to copy it. Our State
felt a reasonable pride in the Institution, and in that remarka-
ble and eminent man who so long ministered it; and she in-
dulged in not a little self-gratulation from year to year. It
seemed to be thought that, as we had begun with the coun-
try's highest achievement, we had also arrived at the ulti-
matum of the world's possible progress. But while indulging
in these pleasant remembrances of the past, and resting on our
laurels, great improvements were made elsewhere; other hospi-
tals were built on better models; other and better principles of
administration were adopted, until now we find ourselves be-
hind the rest of the world in respect to the facilities and the
means which we give to those who have the care of our insane.
It is well known that during the last quarter of a century,
and especially during the last ten years, close observation and
study of the phenomena of insanity, in Europe and in this
country, have thrown fresh light upon its pathology, and caused
this light to be so widely diffused that changes and im-
provements, amounting to revolutions, in the mode of treat-
ing the insane, have been demanded and obtained. These
changes and improvements have been, as it were, of a moral
nature ; merely causing the substitution of moral for mate-
rial agencies, in the administration of hospitals ; yet they
8 STATE LUNATIC HOSPITAL. [Jan.
required improved buildings, grounds, and material appliances
of various kinds.
The improvements in the art of manufacturing cotton cloth
have been so great within a quarter of a century, that a factory
which possessed only the machinery provided for it twenty-five
years ago, could not be run successfully in competition with new
ones. No ability or resource of its directors, no skill or zeal
of its agent, no fidelity or industry of its workmen, could ena-
ble it to do as much or as good work as its more modern com-
petitors. Now, a hospital for the insane is an establish-
ment for repairing health of body, and, through this, health
of mind. It is a place for repairing disordered men. It should
possess the best machinery, and the best of officers to work it.
The principal part of the machinery is the building, and its
importance is immense. It should not merely serve to house the
patients and protect them from the weather ; but it should afford
the greatest possible facility for applying the best mode of
treatment, by its situation, its construction, its conveniences, its
furniture, and its various means of occupation and amusement
within ; and by its gardens, its grounds, and its contrivances
and allurements to exercise and labor without. Lacking these
advantages, no ability or resources'of its trustees ; no skill or
zeal of its superintendent; no fidelity or industry of its attend-
ants, can ever enable it do so much or so perfect works of cure
as other institutions that possess them.
But when, besides the lack of these advantages, a hospital
is overcrowded with patients; when it is obliged to huddle
together over five hundred and fifty persons in apartments
constructed for only three hundred and twenty-seven, and con-
structed, too, when less space was thought to be requisite than
is now found to be essential ; when, moreover, the patients,
instead of being partly drawn according to the original purpose
from an intelligent and educated yeomanry, are drawn mainly
from a class which has no refinement, no culture, and not
much civilization even — that hospital must certainly degenerate.
Its degeneracy will be the more certain and the more striking if
a short-sighted economy tempts its managers to adopt the
readiest, instead of the wisest, methods of treatment, and to
choose the cheapest, instead of the best system of adminis-
tration.
1855.] SENATE— No. 1. 9
The patients, crowded close together, excite and exasperate
each other, and confusion becomes worse confounded. The
crowd must be brought to some kind of order ; and the temp-
tation is very strong to resort to the old and easy way of doing
it, — to wit, by main force, — by physical restraint and seclusion.
Hence, while in some other hospitals the managers are taking
down gratings, removing iron doors, breaking restraint chains,
tearing up strait-waistcoats, disusing camisoles and straps,
in a word, diminishing to nearly nothing the use of physical
restraint and of seclusion, and substituting therefor increased
supervision, and a variety of moral means, in that one they are
building up new cells, and relying upon mechanical contri-
vances for restraining the patients. Now, however high among
kindred institutions that hospital may have ranked, however
excellent it may have been considered at home, it must be
ranked low by competent and impartial judges.
Such, in the opinion of the undersigned, by the effect of
simple causes, and without manifest fault on the part of any
one, is the case with the Hospital at Worcester; and, such
being their opinion, they cannot honestly make a report touch-
ing the condition of the institution and its concerns without
making it known.
The Trustees may as well remark here, that, holding these
opinions, they should probably have exercised the power in-
trusted to them, and made important changes, both in the
structural arrangement of the premises, and in the mode of
administration, had it not been for several considerations, some
of which it may not be inappropriate to mention here.
One consideration is, the conservative character wisely given
by the State to the Board of Trustees, in the manner of its ap-
pointment. This necessarily makes it slow and cautious about
adopting any changes of policy. Now, the policy of delegation
of power to other hands, and of non-interference with the
immediate management of the Hospital, had been the settled
policy of this Board long before any of the undersigned be-
came members of it.
Another consideration is, the hope entertained by all the
present members of the Board that the Legislature would take
early measures for selling the lands belonging to the Hospital,
and erecting new and suitable buildings upon a site more ap-
2
10 STATE LUNATIC HOSPITAL. [Jan,
propriate and advantageous for the establishment, though of
far less marketable value. This hope was the result of a belief
that such a measure was called for by the best interests of the
State.
With these remarks, the Trustees proceed to consider, first,
the
NUMBER AND CLASSIFICATION OF PATIENTS.
The number of patients in the Hospital at the beginning of
the year was five hundred and twenty.
The number admitted during the year was two hundred and
ninety-nine. The whole number discharged was four hundred
and twenty-one, of whom two hundred and ten were trans-
ferred to the new Hospital at Taunton.
The average number of patients during the year, and during
many years, has been enormous. It far exceeds that for
which the Hospital has accommodations. It constitutes a
crowd. It embarrasses the administration. It lowers the
standard of health. It diminishes the comfort and increases
the excitement of patients, and the perplexities of attend-
ants. It makes the whole household uneasy. It leads to,
and perhaps justifies, the resort to objectionable methods of
government, and to restraints which are injurious. It is a
prolific source of other evils too numerous to mention. It
ought to be diminished, and kept down.
Of the two hundred and ninety-nine patients admitted
during the year, one hundred and sixteen were foreigners, of
whom ninety-four were Irish, and all paupers.
The Trustees would not mention this fact, in the present
state of the times, or they would mention it only to commend
the laudable readiness of Massachusetts to care for the
strangers within her gates, were "it not an important one in
view of the classification of patients, which they think it'
essential for every hospital to have the means of making, but
which ours has not. It has been stated to the Legislature be-
fore, and it should be repeated, that the Hospital at Worcester
is fast becoming a Hospital for foreigners, and that its doors
are becoming practically closed against that class of. persons
who for many years enjoyed its advantages ; to wit, the mid-
dling class of native population, — the intelligent yeomanry of
1855.] SENATE— No. 1. 11
Massachusetts, who can afford to pay the cost of their board,
and will not ask for charity. The proportion of Irish patients
to the whole number was ten per cent, in 1844; but over
thirty-one per cent, in 1854.
The State should adopt as her children all who congre-
gate upon her shores. She should make abundant provi-
sion for all, of whatever nation, kindred, tongue, or color,
who, having found a home within her borders, do there become
insane ; but that provision, while as favorable as possible
to their cure, should be suitable to their condition, their
wants, and their capacity for enjoyment. It should be made,
too, in such manner as not to cut oft' any class of her own
children, who become insane, from sharing her maternal care
and bounty.
It is important and pertinent to the present subject, to bear
in mind, that insanity does not change the nature of men and
women ; that it does not always blunt their sensibilities, or
lessen their prejudices, but that, on the contrary, it often inten-
sifies them. Among the insane of this State are wives and
daughters, widows and orphans, of farmers, mechanics, minis-
ters, schoolmasters, and the like. These women were taught
in our public schools, trained up in our proverbially neat and
orderly households, and accustomed to cultivated society ; and,
however ready and willing they might have been, when sane,
to help the poor, and elevate the humble, of whatever race or
color, they would have shrunk most sensitively from living
next door even to a wretched hovel, and from intimate associa-
tion with those who are accustomed to, and satisfied with
filthy habitations and filthier habits. Now, they do not lose
their sensibilities by becoming insane, and they ought not to
have them wounded by being herded together in the same
apartment with persons whose language, whose habits, and
whose manners, offend and shock them. Besides, such asso-
ciations do not promote the good of any patient, but may
retard, and perhaps prevent, the cure of some.
There is yet another class, who have, hitherto, been mingled
indiscriminately with the inmates of our hospitals, but for some
at least of whom, the undersigned think that express and sep-
arate provision should be made, either within or without the
common edifice ; to wit, criminal lunatics — those who have
12 STATE LUNATIC HOSPITAL. [Jan.
committed grave offences, but have been exempted from pun-
ishment by the courts on the ground of supposed insanity ;
and those who, becoming insane while undergoing sentence,
are transferred from the prisons to the hospitals.
The presence of any of this class is an evil; and if the num-
ber should be much increased, it would be a very grave one.
The hospital is a place of refuge for the unfortunate. To make
it a place of imprisonment for criminals, is to throw painful
associations about it. Nor is the objection merely a moral
one. The presence of criminals, who are often desperate men,
creates the necessity for greater means of restraint and security
than would be required with ordinary patients, and it converts
some part at least of the hospital into a prison. The
criminal should be treated with care and kindness, but not at
the expense of the well being, or the feelings of the innocent
insane, or their families.
Now, the presence of these two classes, in such large and
increasing numbers, lowers the State hospitals in public
estimation ; and the consequence is already, that they are less
used by those who, though they cannot well afford to pay a
high price, will seek the best accommodations for their insane
friends. Hence it is, that there begins to be a call for private
hospitals and asylums.
The multiplication of these private establishments would be
a great evil. It is one that may be prevented by making pub-
lic hospitals unobjectionable residences for patients of any class;
but it will be difficult of cure, if once it obtains footing.
If private hospitals should be multiplied in this State, they
will be established with a view of gain. They may become
valuable property. It may be impossible to suppress them by
legal means, and it will be very difficult to bring them under
such legal supervision as will prevent abuses.
The history of civilized nations shows that the multiplica-
tion of private hospitals and asylums for the insane will cer-
tainly ensue unless public hospitals are of the best kind, and
present opportunities for what the people deem proper classifi-
cation of patients ; and it shows, too, that such establishments
almost necessarily become serious evils. In Great Britain, so
many of them had become places of abomination, that the
government had to grapple with the evil, and has lessened and
1855.] SENATE— No. I. 13
limited it only by clothing the Lord Chancellor and the Com-
missioners in Lunacy with inquisitorial and executive powers,
which, however necessary for the protection of the lunatic,
would hardly be tolerated in this country.
It behooves the legislature to attend to this matter in sea-
son, as well to give to the public Hospitals more means of
proper classification of patients, as to prevent trouble in
future.
HEALTH MORTALITY CURES.
The number of deaths, and the number discharged as cured
or otherwise, and similar returns, for the past as well as for
previous years, will be found stated in the Report of the Su-
perintendent. Such facts are of value in a statistical point
of view, when drawn from a long period of time, and from a
large number of patients, and with a full understanding of all
the circumstances which may have an influence upon them.
But as these circumstances can scarcely be alike in different
hospitals, comparisons between them must be made with
great caution, else they lead to error. As a picture of the
Hospital edifice is more or less pleasing according as it is
taken from one or another point of view, so an account of its
sanatory condition will be more or less favorable according as
it may be taken from one or another statistical view. It is
natural, in both cases, to choose the most favorable stand point*
The number of deaths during the last year was thirty-four.
This, compared with the average number of patients during
the year, gives a mortality which, compared with that of the
whole population of Massachusetts, is very great, for that is
only 1.89 hundreths per cent. Compared with the average
mortality in the State Prison, it is prodigious, for that is only
three-fourths of one per cent.
It by no means follows from this, however, that the diet and
mode of life in the Hospital are less salubrious than in the
prison. The prisoners are mostly men of vigorous organiza-
tion, and at a period of life during which mortality is least
In most of our patients, the original stock of vitality was prob-
ably small ; in almost all it was sadly impaired before their
admission. Many brought here a poor nickering flame of life,
which would have soon been extinguished in the gusty world
14 STATE LUNATIC HOSPITAL. [Jan.
without, but which is now carefully tended, and will lick
up the last drop of the oil of life ere it dies in the socket.
It is morally certain, however, that the vital energy of the
patients must have been lessened, and the mortality among
them increased, by living so much of the time, and in so great
numbers, in the badly ventilated and poorly lighted wards and
chambers of this Hospital. The state of the air has been a
subject of complaint for years. The impression made upon
visitors during an hour's visit has been disagreeable and hurt-
ful ; what it must have been upon the patients is manifest in
their appearance.
The Trustees are happy to be able to state that the arrange-
ments just finished in some of the wards, under the direction of
Mr. Jonathan Preston, have proved of great benefit. They
remedy the evils so long complained of as much as the struc-
ture of the building admits.
There have been no deaths by accident, and but one by sui-
cide, during the year. Considering the number of patients and
the fewness of attendants, this speaks well for the watchful-
ness of the latter.
GENERAL CONDITION AND TREATMENT OF PATIENTS.
In the numerous visits which the Trustees have made, either
as a Board, or individually, — visits often made without previous
notice, and sometimes by night, they have found evidence
enough to satisfy them that the Hospital has been kept ha-
bitually as clean and tidy as circumstances would admit ; and
that the inmates were well fed, comfortably lodged, and kindly
treated. They have listened to complaints of patients, but
found they were all of such stuff as dreams are made of. In
no instance have friends of patients expressed to the Trustees
any dissatisfaction.
Now, when it is considered how completely dependent are
the patients upon those who have them in charge for comfort,
for health, and even for life itself; — how liable they are to
injury by one another, by fire, by accidents of various kinds;
when it is considered that the attendants may neglect and
even maltreat them with possible impunity, and moreover how
liable is the possession of great power to great abuses, there
certainly is reason for congratulation that in our Hospital, over-
1855.] SENATE— No. 1. 15
crowded with patients as it has been, no untoward event has
disturbed the peaceful current of the year. This is, in a great
degree, attributable to the influence of the Superintendent, who,
eminently conscientious, vigilant, and industrious himself, has
drawn about him a company of assistants who emulate his
virtues.
The Trustees think, however, that in several important mat-
ters of arrangement and of administration the Hospital needs,
and may have, great improvement. One of these is in respect
to the
RECREATION AND AMUSEMENTS OF THE PATIENTS.
Among the means of treating the insane, those which help
to divert their thoughts from their unnatural channels, and to
promote cheerfulness of heart, are very important. Fore-
most among these are, of course, the associates and attendants
of the patients, who should be of pleasant temper and cheer-
ful deportment. But these living agents can be aided greatly
by mechanical arrangements of apartments and grounds, by
facilities for games and amusements, and the like. In this
respect our Hospital is sadly deficient. Most of the wards are
ill lighted, and the sunbeams never enliven them. The apart-
ments are of tiresome rectangularity. There are no sunny
parlors, no cosy nooks, no cheerful bow windows opening on
green lawns ; no adornment of the halls, no variety of pleasant
sights for the eye, no variety of pleasant sounds for the ear ;
but, on the contrary, there is a dull monotony in the structure
of the rooms, unbroken by diversity of furniture, and an end-
less extent — square miles, indeed, of walls and ceilings — white-
washed, whitewashed every where, till the eye, wearied with
everlasting white, longs even for a stained spot to rest upon.
All this, of course, helps to give a character to the establish-
ment, and repels attendants of cheerful tempers, who love to
live in sunny spots, and amid pleasant scenes, or it dispirits
them after they come. At any rate, the visitor who compares
this Hospital with some others, is struck by the grave deport-
ment, the serious countenances, the almost melancholy aspect
of attendants and patients. He misses the glad countenance
which the merry heart maketh. There is a leaden gravity
which seems to defy relaxation ; and a gloomy air about
16 STATE LUNATIC HOSPITAL. [Jan.
the establishment, which must be unfavorable to the cure of
insane patients.
This will probably be amended, at least as far as structural
arrangements go, by letting in more sunlight, breaking up the
monotony of the wards, providing new parlors, and more fa-
cilities for amusement and occupations, by other alterations
which the Board have directed to be made.
EMPLOYMENT OF THE PATIENTS.
Another very important instrumentality in the treatment of
the insane, whether as regards the cure of their malady or
the melioration of their condition, is the means of controlling
and directing their minds, through the employment of their
hands, and the general occupation of their time. These means
should be varied, in view of the organization, the previous call-
ing, and the present condition of the patient. The employ-
ment should be of such nature, and such degree of urgency,
as will agreeably occupy, without severely taxing, the disor-
dered faculties. In view of the plurality of the mental
faculties, the occupation should be varied and adapted as
much as possible to the disordered faculty, or rather disordered
combinations of them, which, however, are almost endless.
A little reflection will show that idleness, so pregnant of
evil to the sane, may be equally dangerous to the insane;
and that the best remedy for a disordered current of thoughts
and feelings is their diversion into other channels by attractive
occupation.
In great trouble and in mental anguish, men seek for occu-
pation of body and of mind, lest they should go mad.; and,
when they have gone mad, they need it in order to get sane
again. Even in those cases where excessive occupation,
where anxiety, or where over-mental action has caused insanity,
it is not total inaction, but change of action, that is required.
Indeed, the mind will not rest in recent insanity. It is only
when serious changes in the brain lead to fatuity, that it be-
comes quite quiet ; and this condition we wish to prevent, or
at least postpone, as much as possible. Hence the necessity of
ample provision in every hospital, of varied material and
mechanical appliances and contrivances, to aid in the moral
treatment of the insane. This matter does not seem to have had
1855.] SENATE— No. 1. 17
sufficient attention in the organization, or in the administration
of this establishment. There is lack of variety and abundance
of means of recreation, and also of industrial occupations.
The fact that hundreds of tolerably strong and healthy men
and women are most comfortably fed and lodged in one house,
at public charge, and yet permitted to pass months and years
in idleness and sloth, would shock this active and industrious
community, were it not that custom has made it familiar, and
seems to warrant it.
It is true that many patients do recover reason under this
"let-alone" treatment; but so do men sick with the same
malady recover health though treated by doctors of different
schools, and swallowing drugs of opposite character. The
reputation of doctor and of drug may come from the fact that
they so often fail to defeat, and do only retard, the natural pro-
cesses which bring the majority of diseases to a safe issue. In
order to learn which system is best, we must compare one
with another working under circumstances as nearly alike as
possible.
It is easy to compare our Hospital with others in regard to
the variety of occupation provided for the patients, the atten-
tion paid to occupying them with industrial pursuits, and the
amount of labor they perform. In all these matters many other
hospitals take precedence of it. In the British hospitals espe-
cially, great attention is given to the occupation of the patients ;
and some of them almost deserve the name of industrial estab-
lishments. Some asylums in Scotland, and some district
asylums in Ireland, are particularly distinguished in this respect.
It is true that the circumstances are not the same in the
two countries. There is greater development of individuality
here ; more of self-guidance, and more of voluntary labor. There
is less disposition to submit to the direction of others ; and, as
people do not lose their ordinary characteristics in their insane
state, it may be more difficult to keep lunatics busily employed
in this country than it is in Great Britain. But one-third of
our patients are Irish ; the most of whom, if at home, and in
some of the district asylums, would surely be kept at work.
With regard to the Americans, they are quite as active and
industrious as any people ; only they are more fond of con-
sidering their labor to be voluntary and self-directed ; and it
3
18 STATE LUNATIC HOSPITAL. [Jan,
would seem that advantage might be taken of their general
peculiarities, so that they would be induced to join in some
industrial occupation.
Many, if not most, of our patients are regaled daily at table
with what would have been rare, and perhaps unknown luxu-
ries in their former homes. These cannot be needful for their
cure ; and the enjoyment of them might perhaps be made con-
ditional upon their doing a certain amount of work. Few
lose the sensitiveness of the " pocket nerve ;" and this, if not
already morbidly active, might be quickened by prospect of
immediate gain. It certainly would be better for the Hospital
and for the State, to have all the inmates who are in ordinary
bodily health busily engaged in light work, even by paying for
every hour's time, than to have hundreds lounging idly about
the wards, gradually losing the tone and vigor of their bodies?
and indifferent to every thing except the quantity and quality
of the next meal.
Of course the disinclination to steady occupation is seldom
to be regarded as laziness, or as in any way culpable, but
rather as one of the results of insanity, which deranges the
distribution of the nervous energy, and sometimes lessens the
amount of it. But though punishment, even by deprivation
of comfort, may not be just, yet inducements to regular
employment, in shape of wages or of little luxuries, may be
both just and proper, by encouraging regular exercise of body
and voluntary direction of the mental faculties, which become
habitual, and therefore pleasant and salutary.
It cannot be too often repeated that Nature, pitched out
even by so rude a fork as insanity, constantly tends to return -
and her plain indications may be often relied upon by the
uninitiated, though they contravene doctrines announced as axi-
omatic by the " professors." All agree that it is not right to
thwart directly the inclinations of the insane, or to' force
them to action when disposed to inaction; but still the prin-
ciple holds, that efforts at self-control are exercises which tend
to strengthen the enfeebled mind, and that patients should be
encouraged to make them.
It is true that, generally, we have rather to deal with deranged
than with diminished mental energy, in cases of recent insanity.
There is undue, involuntary, perhaps violent action of cer-
1855.] SENATE— No. 1. 19
tain faculties which disturbs the mental balance, and oversets
reason. There is danger that, by mere force of habit, this
undue action may become permanent, while by the same
cause the inaction of other faculties may be confirmed ; and
this is to be counteracted, while yet manageable, by strength-
ening the weakened faculties, and reestablishing the balance.
Constant and urgent inducement to action may therefore
be usefully presented to the mental faculties and disposi-
tions which are in abeyance, and new channels opened for
the thoughts and affections. In a word, deranged habits of
mind should not be left to grow worse by neglect; the
patient should not be abandoned to blind chance, but roused to
effort, and encouraged to sane mental exercise by succession of
pleasant objects, and by agreeable pursuits, which occupy the
mind without taxing or worrying it.
For this purpose, places of recreation, games, workshops,
gardens and the like, are to be provided in abundance and in
variety. But especially should there be opportunity and induce-
ments to engage in those tranquil and salubrious pursuits
which a large and well-managed farm presents in greater
variety and abundance than can be found elsewhere.
There are facts in abundance to show that these things are
most desirable and most useful in the cure and care of the
insane.
The value of the work done by the patients in the Worcester
Hospital in 1853, when there was over 500 of them, was only
$2,000, as estimated by the Superintendent. Only about one
in five there does a moderate day's work. In summer time
about one-quarter of the patients are said to do a moderate
day's work ; in winter only about one-fifth. The Superintend-
ent estimates that only $300 a year is saved to the Hospital
by the aid which the men render, and only $700 by that of
the women.
The Reports of some of the British Hospitals furnish a
striking contrast to this. In them, three-quarters of the patients
are industriously and usefully occupied. Some of the details
of their industrial pursuits show a striking contrast with ours,
and are, moreover, interesting in a moral point of view.
The Report of the Wilts County Asylum for 1852 says : —
" The employment of the patients is an object of primary
20 STATE LUNATIC HOSPITAL. [Jan.
consideration. A large proportion of the men are engaged in
agricultural pursuits."
" Under the active and judicious superintendence of the
matron, an increasing- majority of the female patients are occu-
pied in the domestic labors of the kitchen, laundry and wards,
and in needlework. The greater part of the bed and house
linen has been, and is in process of being, made by the assist-
ance of a single seamstress."
The Report for 1852 says : " The original outfit of clothing
was supplied by the Asylum for the North and East Ridings
of Yorkshire, an institution in which the industrial system has
been developed to the fullest extent, and where it was made
entirely by the patients. This is probably the first instance of
an asylum entering into a contract of such a kind. Great
interest was excited among the patients, who were made aware
that they were preparing clothing for another asylum ; and quite
a sensation was manifested when two carts, laden with heavy
bales of woollen clothes and shoes, shirts, and dresses for the
women, left the rooms of North and East Ridings Asylum."
Again: "during the year, all the clothing required for the in-
creasing number of inmates has been made by the patients.
In the tailors' and shoemakers' shops much work has been
done, the amount of which will be seen in the tables appended
to this Report. The female patients continue to be extensively
engaged, under the direction of the matron, in the various
services of the kitchen, the laundry, and the wards, and a large
stock of clothing and bed linen has been made by them,
assisted only by their ordinary attendants ; it not having been
thought necessary to fill the place of the seamstress, who left
her situation at midsummer. A further reduction in the staff
of servants of the establishment has been effected by the dis-
continuance of a second laundry-maid ; and, after some months'
trial, the success of this plan may be considered as proved."
Now, the Wilts County Asylum is not particularly distin-
guished for industrial activity among English Hospitals. If
the contract were made with some others, the inactivity which
characterizes ours would be more striking. There employment
is the rule, idleness the exception ; here it is the contrary.
There activity well directed, begets salutary industry; here
idleness undisturbed, becomes enervating sloth. It does not
1855.] SENATE— No. 1. 21
appear that the occupation of the patient retards cure ; but, on
the contrary, the evidence of its good effects, in a salutary and
curative point of view, is most abundant and convincing.
The Trustees think that the Worcester Hospital may be
greatly improved by more ample provision of means of indus-
trial occupation in workshops and upon the farm, and that the
present relief from the crowd (whose pressure has acted so un-
favorably to all improvement) furnishes a good opportunity for
introducing a better system of internal administration with this
view. The Trustees would not have the Hospital converted
into a workhouse. They would not enforce labor, or require it
with any view to immediate pecuniary gain ; but they believe
that the majority of the patients may be induced to do a con-
siderable amount of useful work, and, at the same time, pro-
mote their own health and happiness.
HABITS OF THE PATIENTS.
Following after this evil of inactivity, and probably aggra-
vated by it, is the great prevalence of morbid appetites and
filthy habits among the patients. This, too, is a matter re-
specting which it is difficult to make comparisons with other
hospitals ; but from all that can be learned by the Trustees, the
proportion of what may be called morbidly filthy cases is
uncommonly great in the Hospital at Worcester. Before the
exodus to Taunton, nearly half the whole number were of
this description, and the proportion is fearfully great even now.
This is a delicate matter to touch upon in a public report ;
nevertheless, it is an important one. It regards the comfort
and well being of the patients ; it is an indication of the hy-
gienic condition of the household, and of the degree of medical
care bestowed upon it ; and to avoid mention of it on proper
occasion would be squeamishness.
By filthy patients is meant those who, if not watched and
prevented, will besmear their persons with, and even swallow,
substances the most disgusting to the natural taste.
Now, all morbid appetites and unnatural habits are conse-
quent upon, or certainly connected with, some derangement of
the bodily functions ; and though the derangement may be of
special or minute parts of the nervous system, or even of
22 STATE LUNATIC HOSPITAL. [Jan.
intangible, and as yet obscure magnetic agencies, si ill, beyond
a peradventure, it must be increased or diminished by the
varying conditions of the great organs whose functions seem
to be more under our cognizance and control. A lunatic may
tell a hawk from a handsaw after supping on dry toast, but be
perplexed by their resemblance after minced pie. A suicidal
patient may be content to live through the night if he has
eaten the one, but be looking after razors and ropes if he has
swallowed the other. In the same manner, the distortion of
tastes, which makes things seem comely and desirable that
are usually offensive and repulsive ; the inversion of natural
tendencies which makes filth pleasanter than cleanliness ; and
the perversion of appetite that renders substances palatable
which are usually disgusting — these must be more or less
salient, according to the condition of the bodily health of the
sufferer. In all these matters there is great room for improve-
ment ; and the relief given by the reduction of the number of
patients, by improved ventilation, and by the greater amount
of medical and moral care which can be given by the Super-
intendent to each case, will probably bring it about. This
naturally leads to notice of the
DUTIES AND CARES OF THE SUPERINTENDENT.
It seems to the Trustees that too much labor and responsi-
bility, aside from his medical duties, have devolved upon the
Superintendent of this Hospital. Eight hours a day of such
close study as a careful physician ought to bestow upon the
malady of his patients, is surely as much as a man of ordinary
powers can bear, and wear well. But eight hours divided among
the patients of this Hospital, when it is crowded, would give
but about three-quarters of a minute to each, supposing not a
second to be lost in passing from one to the other ; and it would
give only about a minute and a quarter to the present number.
But, in reality, with all possible diligence, not one minute
could be given to each case.
It is commonly thought, that since most of the patients in a
public hospital are chronically insane, and since their condition
does not vary from day to day, all that the physician has to do
is, to assure himself of their presence and safety by a glance at
1955.] SENATE— No. 1. 23
them as he walks through the wards. But every day effects
changes, more or less considerable, rin every organized body
and there are exceptional cases in which, by some extraordi-
nary revolution in the system, reason is restored in the most
unexpected manner. These changes may come at any time ;
and they should be watched for, in order that the curative
tendency may be favored. It should be assumed that they
may happen to each and every patient, however old and
desperate his malady. As the anxious parent clings to hope
so long as there is a spark of life in a child's body, so the
physician of a hospital for the insane should hold that there
is a hope, because a possibility, of each patient's restoration
to reason. He should bear in mind that each one is some-
body's beloved child, or parent, or relation ; or, if not, then
that he is doubly unfortunate, and should, therefore, be doubly
interesting to him.
Besides, there are many patients who will not speak of any
pain or suffering which they may be undergoing ; and some
who cunningly conceal it. Certainly, therefore, the physician
should make frequent personal observation of each, and es-
pecially of those cases where the patients are too much
demented to seek relief of their own accord, even when suffer-
ing ever so much. But if we allow that five minutes should
be given to each case, the physician would have to labor ten
hours daily in order to attend to each patient three times a
week. It is true, he has his assistants ; but his ablest and
most trusty assistants are his own senses, and upon them he
must mainly rely.
Such calculations of the division of time cannot, indeed,
be very accurate or valuable; for some physicians have a natu-
ral quickness of perception, so sharpened through practice, that
a patient's condition is seen at a glance, as by a flash of rev-
elation. They have the intuition of genius. But surely, after
making every allowance, it must be admitted that the proper
medical care of the individual patients, — the regulation of their
diet and regimen, — the contrivance of their amusements and
occupations, and the general oversight of the moral condition
of the great household — these things are enough to occupy
fully and worthily the time and the energies of one man.
But, besides these duties, many others are imposed upon the
24 STATE LUNATIC HOSPITAL. [Jan.
Superintendent by the statutes, or have devolved upon him by
the common law of custom. He has to carry on the extensive
correspondence of the Hospital ; and much of this he cannot
do by deputy. He", virtually appoints, and is responsible for,
the Assistant Physicians, Steward and Matron. He directly
appoints, and is responsible for, the Clerk, Apothecary, Super-
visors of Departments, Overseers of the Wings, Overseers of the
Laundry, Bakery and Workhouse, Watchman, Farmer, and all
necessary Attendants in the galleries, laundry, bakery, kitchen,
workshops, and on the farm. He must " see, constantly, that
all persons thus appointed by him, and also all subordinate
officers appointed by the Board, perform, faithfully, the duties
required of them ; and from time to time he shall give them
such instructions as he may deem necessary to secure the
exact and thorough performance of their respective duties."
But, besides all this, the physician is, virtually, head of the
Steward's Department, and does a great deal of duty in other
departments which require much thought, and of course, divert
much of his power from his more legitimate field of action.
Now, much of this labor and responsibility ought to be, and
may be, spared to the Superintendent, and still a great deal
will remain. The " one-man power " must be maintained in
such an establishment. The Superintendent must be the real
head of the household, and have patriarchal power ; hence the
obvious necessity of so restricting the number of patients that
he can have daily and intimate knowledge of their individual
condition, and time and strength left to make all the necessary
provisions for their safety, comfort and cure. To gather into
this Hospital, therefore, more than twice as many patients as
can be thus carefully, properly and faithfully treated, is justifi-
able on no ground but that of stern necessity, which the State
cannot plead. To gather into it any more is unwise. It is
not even justifiable on the ground of economy ; for in this mat-
ter of care and cure of the insane, as in other matters, the best
way is the cheapest. It is the way that the men of Massa-
chusetts manage their individual business. In their banks,
manufactories, and workshops, they do not burden their cash-
iers, agents and overseers, with such a load of business that
some part of it must be slighted, some neglected, and all of it
done hurriedly ; and they should not so burden the Superin-
1855.] SENATE— No. 1. 25
tendents of their Hospitals. To attend to two hundred patients
faithfully and efficiently is good work for a good man ; to
attend to two hundred and fifty will tax the energies of the
best one to the uttermost. More than this one man cannot do,
and do well ; and let not Massachusetts require him to make
the vain attempt.
MECHANICAL RESTRAINT AND SECLUSION OF PATIENTS.
The sight of scores of men and women confined in cells,
dignified by the name of strong rooms, or restrained in the use
of their limbs by mechanical contrivances, has long constituted
the most melancholy feature of this Hospital. In the mind of
the visitor who doubted the necessity of this rude method of
treatment, and who suspected that its adoption was the result
of a parsimonious selection of the cheapest rather than the
best method, the melancholy was not unmingled with sterner
feeling.
There is about the insane a helpless dependence that is
more touching even than that of woman ; so that the unneces-
sary abridgment of their personal freedom, or the needless
diminution of their remaining means of enjoyment, is a wrong
which, if done with intent, or through unworthy motives
should meet with indignant reprobation. It has been done in
this Hospital partly through a supposed necessity, and partly
in consequence of the crowd of patients forced into it. It is
still done in other public institutions where the insane are con-
fined, and the matter therefore, should, in every possible way,
be brought before the public ; and appeals should be made to
the intellect and the conscience of the people, until the wrong
ceases.
The assertion, that public opinion in New England is less
enlightened than that of Old England with regard to the
treatment of the insane, may seem strange, but nevertheless it
is true. It is true, moreover, that here, in Massachusetts, prac-
tices are tolerated in some institutions* where the insane are
kept, which would there be indictable at common law, as will
be shown presently.
There are in the Worcester Hospital forty-eight " strong
* There are 23 insane persons confined in prisons in Massachusetts, and 152 under
charge of jailers.
4
26 STATE LUNATIC HOSPITAL. [Jan.
rooms," or rather cells. They are built of stone or brick, pre-
cisely like prison cells, with grated doors and windows, aper-
tures for putting in food, taking out vessels, &c. They are
so contrived that they can be easily warmed and cleansed
from filth that offends the eye, but in all other respects they
are unfit abodes for human beings. The older ones are per-
fectly detestable. Opened to the more enlightened moral sense
of this day, they seem like the relics of a comparatively barba-
rous age. Well might the Trustees, in the Report of last year,
ask, " How is it possible that the furious, the violent, the inde-
cent should ever be restored while occupying apartments unfit
for the abodes of dumb beasts ? " They might have added,
that any sane man, unless an eminent non-resistant, would
become " furious and violent " by being placed therein.
Even those cells constructed at so great cost within a few
years, are not fit habitations for the worst maniac, because
they needlessly aggravate his malady and his misery. They,
too, are stone cells, with iron doors and grated windows.
These cells have been almost continually in use since they
were built ; and when the Hospital was as crowded, as it some-
times has been, their use has doubtless seemed absolutely
necessary.
So many unfortunate men and women have been shut up
in them year after year, and so many others have been restrained
by mechanical contrivances, that such imprisonment and re-
straint have come to be considered as matters of course in
the treatment of the insane by official and unofficial visitors,
by legislative committees, and, to a certain extent, by the pub-
lic at large.
Now, it can be shown that neither "seclusion" nor "re-
straint " of insane persons is necessary, saving in rare and
exceptional cases, and then only for short periods of time
and in ordinary rooms ; first, by general reasoning ; second,
by experience in other places ; third, by experience here at
home within the last year.
First, as to the general reasoning. " Seclusion " of an insane
person is a dainty word for expressing his imprisonment in a
cell. Restraint is a dainty substitute for fettering his hands
or feet, or both, the fetters being of leather instead of iron.
Insanity, as was remarked before, deranges, but does not
1855.] SENATE— No. 1. 27
alter, the nature of men. It often merely intensifies certain
modes of mental action. It is especially apt to intensify the
lower and peculiarly selfish propensities. In dealing with
insane emotions and passions, we have often to deal with sane
ones merely raised to a higher power.
Human nature continues to pervade the motives, though the
actions be ever so extravagant ; as gravity pervades particles of
matter that may be forced upwards or sideways by disturbing
forces. We are to consider that opposition provokes to attger,
and that the soft answer turns away the wrath of insane as
well as of sane men. We are to consider the principle, that
whatever directly represses the individuality ; whatever restrains
the personal liberty; especially whatever restrains the freedom
of motion and locomotion, instantly excite opposition, temper
and rebellion. This is a sort of oppression of individual right
and freedom, which the most dull or deranged intellect can
feel, and which every one instinctively resists.
It is amazing how contentedly and unconsciously men bear
oppression, if their arms, legs and tongues are free. A man
who was sitting contentedly in a room immediately desires to
go out if any one locks the door. A man who never cared to
leave his quarter of the town, if put under arrest, at once wants
to break the jail limits, though they are as extensive as the
whole county. If the Legislature should enact that no inhab-
itant of Massachusetts should leave the State under heavy
penalties, there would be a rush of men, women and children
towards the borders.
The more directly restraint affects the person, the more
feeling and opposition it excites. A man who would only be
indignant if confined in a room, is furious if his hands are tied,
A woman who would only scold and fret at the imprisonment,
would scratch and bite at the bonds. An angry man whose
doubled fist would be dashed into any face that wore a look of
defiance, is soon calmed by a placid smile.
Now, the natural supposition is that people are not utterly
changed in these respects by insanity. So long as the senses,
are unimpaired, and the perceptive faculties, or any of them,
are active ; so long as any reason remains, (and its light is sel-.
dom entirely quenched,) so long must men be more or less
subject to the ordinary laws of humanity.
28 STATE LUNATIC HOSPITAL. [Jan.
Secondly. Abundant recent experience confirms the infer-
ence that would be drawn from a priori reasoning, and proves
that forcible restraint of insane persons usually does more harm
than good, and is very seldom necessary. Indeed, the great
modern reformation in the treatment of the insane is founded
upon this idea. The heroic Pinel confided in it. Having with
difficulty got permission from the timid authorities, who proph-
esied all sorts of evil, he first made what was deemed the peril-
ous experiment. He went to the cells of the great Parisian
madhouse, where furious men were struggling with their
chains, striking at whoever approached the gratings, spitting
at them, and yelling themselves hoarse with curses and impre-
cations. He boldly entered, and having charmed and calmed
the maniacs by his gentle but firm bearing, he struck off
their fetters. The prisoners were amazed at the sudden recov-
ery of freedom, and at the unexpected fact that no one would
fight or oppose them, and they soon became appeased and
quiet. They did not abuse, nor even care to exercise their
freedom, but soon yielded to that common instinct of human-
ity which is seldom lost, even through insanity, — the instinct
which leads us in childhood, in sickness, in prostration, when-
ever, in short, we are conscious of inability to guide ourselves,
then to seek the guidance of others, and, if the guidance can-
not be found in men, to seek it of God.
A reform was commenced at once ; and though it has been
obstructed, and occasionally retarded, as all reforms are sure to
be by timid conservatism, it has been carried on with the most
blessed results. In all civilized countries the reformation was
hailed with pleasure, and in all its principles were admitted to
a certain extent ; though practiced upon far more heartily and
fully in some than in others.
In some British hospitals the reform became a complete
revolution, and all forcible mechanical restraint of patients
and all seclusion were completely discarded. Their example
has been virtually followed by some hospitals in this country.
In others the principle of the reform was not admitted with
full faith, and there the old usages were clung to, or given up
grudgingly and by halves. The old cages were improved a
little, and called " strong rooms ;" and the iron chains were re-
placed by leathern straps.
1855.] SENATE— No. 1. 29
There was a conflict of opinion and of words. The force
of reasoning and the weight of evidence soon seemed in
favor of an almost complete reliance upon moral means,
and an almost complete abandonment of forcible restraint
and seclusion, in the treatment of the insane. Still, how-
ever, this " almost " left a wide margin for variety of prac-
tice in different hospitals, and for honest differences of opinion
as to the degree in which the principle of non-restraint, as it
was called, could be safely acted upon. In this, as in all
similar matters, men's judgments were unconsciously affected
by their character. Bold and hopeful reformers went forward ;
cautious and doubting conservatives held back.
The British Commissioners in Lunacy, conscious of the
vital importance of this matter, issued circulars to the Super-
intendents of public and private hospitals in the kingdom,
asking for the result of their experience in regard to it. The
answers are from one hundred and eighty-one institutions, and
embody a vast amount of interesting and important informa-
tion. In June, 1854, the Commissioners made their Report,
which concludes thus : —
" As the general result which may be fairly deduced from a careful examination
and review of the whole body of information thus collected, we feel ourselves fully
warranted in stating, that the disuse of instrumental restraint, as unnecessary and
injurious to the patients, is practically the rule in nearly all the public institutions
in the kingdom, and generally also in the best conducted private asylums, /even
those where the ' non-restraint system,' as an abstract principle, admitting of no
deviation or exception, has not, in terms, been adopted.
" For ourselves we have long been convinced, and have steadily acted on the
conviction, that the possibility of dispensing with mechanical coersion, in the man-
agement of the insane, is, in a vast majority of cases, a mere question of qxpense,
and that its continued or systematic use, in the asylums and licensed houses where
it still prevails, must, in a great measure, be ascribed to their want of suitable space
and accommodations, their defective structural arrangements, or their not possessing
an adequate staff of properly qualified attendants, and frequently to all these causes
combined. j
" As respects the question of seclusion, it will be seen, upon a pertisal of the
statements in Appendix (G,) that its occasional use for short periods, chfcfly during
paroxysms of epilepsy or violent mania, is generally considered beneficed.
"At the same time, we would observe, that the facilities which seclusion holds
out to harsh or indolent attendants, for getting rid of and neglecting 'xoublesome
patients under violent attacks of mania, instead of taking pains to soothe their
irritated feelings, and work off their excitement by exercise and chmge of scene,
render it liable to considerable abuse ; and that, as a practice, it is oppn, though in
a minor degree, to nearly the same objections which apply to the ijtore stringent
30 STATE LUNATIC HOSPITAL. [Jan.
forms of mechanical restraint. We are, therefore, strongly of opinion, that, when-
ever seclusion is resorted to as a means of tranquillizing the patient, it should only
be employed with the knowledge and direct sanction of the medical officers, and
even then be of very limited duration.
" Further experience, we think, has shown that, except for the reception of epi-
leptic patients during the continuance of their paroxyms, and, in a few cases, where
there is a determined propensity to suicide, the utility of padded rooms is not so
great as was at one time supposed, and that, for cases of ordinary maniacal excite-
ment, seclusion in a common day- room or sleeping-room of moderate size, from
which all articles that might furnish instruments of violence or destruction have
been removed, and v/hich is capable of being readily darkened, when required, by
a locked shutter, will, in general, be found to answer every useful piirpose."
In many American hospitals the principle of " non-restraint "
has been acted upon wisely, though without that attachment
to a theory which leads some to forbid a resort to any mechan-
ical restraint or forcible seclusion, even in those rare but not
unknown cases which are manifestly benefited by their prudent
use.
The Trustees have long regretted that circumstances did
not permit the adoption of this reform as fully at Worcester as
in other 'American hospitals.
A Corhmittee of the Board last year visited nine hospitals
or : of Nkw England, and there found that, taking the whole
number f patients, only one in three hundred was confined in
a sfccong room, while at Worcester more than ten times that
pre portion of patients were so confined. There were less than
six : undre.'l patients ; and yet the forty-eight strong rooms were
■ almost continually used for the forcible seclusion of men and
womm, many of whom were raving, and whose wretchedness
was toubtJess increased by their imprisonment and restraint.
Thi records of the Trustees will show how often and how
strong y they have denounced these rooms as unfit places of
habitation. But there was always a crowd of patients within
the Ho jpitai , and more pressing for admission. Those in charge
deemed it n. ;ssary to use these rooms. Still, therefore, men
and w >rien were thrust into them, and made more furious by
the cos nement; and still many others were restrained by
straps a vl various mechanical contrivances, who might have
had'- fret "!m: < motion, and the use of their limbs, if sufficient
space a, ' suiij lent means of medical and moral treatment
had been -,\t command, and if there had been fuller faith in
1855.] SENATE— No. 1. 31
the efficacy of milder measures. The principal evil, and that
which seemed to justify the use of so much seclusion and re-
straint, was the crowd of patients. Of this evil, the Trustees
and the Superintendent have complained, as often and as
loudly as seemed becoming and proper to do.
In 1853, the crowd was so great, and the danger of an epi-
demic so imminent, that a vigorous effort was made by the
Trustees to lessen the number, by summarily discharging one
hundred patients, and throwing them back upon the town
authorities. This, however, caused so much opposition, so
much complaint, and so much real distress, that it was not
persevered in long.
Thirdly. An opportunity has been furnished during-^he last*
year of showing here at home, by actual experiment, and
beyond all possibility of doubt or cavil, that the imprisonment
and restraint of insane persons, as practised at Worcester for
so many years, was not necessary for their proper care and. safe-_
keeping. During the months of January, February and March,
there had been sixty-six patients confined in the " strongrooms,"
twenty-one of them during the whole time, thirty-three nearly
half the time, the others during various periods from a day to
a month.
In April, two hundred and ten patients were removed to the
new hospital at Taunton. The patients selected were those
whose homes were in the neighborhood of Taunton, and not
those who were most troublesome. By reason of qne of those
curious circumstances which, if unnoticed, defeat statistical
calculations, it so happened that only a few of them were
of that violent class whom it had been deemed necessary
to confine at Worcester. Still, however, the change in their
condition, and consequently in their conduct, after arriving at
Taunton, and enjoying the superior advantages of the new
hospital, was most striking and most gratifying. Two hun-
dred and two out of the two hundred and ten patients enjoyed
the full liberty of the hospital, and the free use of their limb"
from the moment of their arrival. Not a single one was
fined in a " strong room." Nine were occasionally restrain
by being shut up in their ordinary chambers, 6r wore the
isole, or leathern straps, a few days at a time. One unfortu-^J
woman only had to have her hands confined most of the til
32 STATE LUNATIC HOSPITAL. [Jan.
though even she is now free. Among the patients transferred
were three who had been confined in strong rooms during the
whole of the three last months passed in Worcester, and six
who had been confined a third of the time. Now, every one
of these men were left perfectly free, and have remained so,
and have done no harm to themselves or others.
These facts, added to that of the confinement in prisons of
so many lunatics innocent of crime, prove the truth of what
was said above, that Massachusetts has been and is treating
lunatics in a manner that would be indictable at common law
in England.
In 1853, a man named William Robert was tried at the
Carnarvonshire Summer Assizes for having kept his brother,
a lunatic, needlessly confined with a chain in a room about
the dimensions of our strong rooms at Worcester. There was
no cruel intent proved or even alleged ; there was no stint of
food ; the man was in good health, and fat ; he was kept as
well, perhaps, as his relatives knew how to keep him ; and yet
Robert was found guilty of " unlawfully confining and
imprisoning his brother in an improper, excessive and cruel
manner," and he was himself condemned to one month's
imprisonment.
Lord Chief Justice Campbell, in his charge to the jury, dis-
tinctly stated the principle, that the use of restraint greater in
degree, more severe in character, or longer in duration, than is
necessary for the security and care of a lunatic, is an offence
at common law, and indictable as such.
Massachusetts is a sovereign State, and will not answer
the summons of any earthly court. She cannot be mulcted in
damages ; and there is no prison large or strong enough to hold
her. But there is a higher court before which she is arraigned
continually ; whose sentence she cannot escape ; but which she
must execute upon herself. The plea, that she had no cruel
intent, will avail but little, and that of ignorance can no longer
be made. If, in her hospitals, jails, houses of correction, and
almshouses, the helpless insane continue to be subjected to
greater privation of freedom and to greater suffering, than are
absolutely necessary for their care and safekeeping, she will
be continuing in wrong doing, and must suffer the heavy pen-
1855.] SENATE— No. 1. 33
alty of a condemning conscience, or the heavier penalty of
lack of conscience to condemn.
The Trustees, anxious to prevent any relapse into the old
system, under any pressure of a crowd, or under any supposed
necessity, and aware, moreover, of the temptation which the
existence of " strong rooms " offers to attendants to get rid of
the trouble of watching patients, by confining them under bar
and bolt, have directed the demolition of most of these offen-
sive cells, and the construction of comfortable sitting rooms in
their place. They trust that their successors will persevere in
the work, and that, in future, no seclusion and no mechanical
restraint will be used here, for the treatment of the insane,
except in those rare cases where solitude is required, or where
the patient must be restrained, either by men's hands or by
instruments, and in which the latter is the least objectionable.
REMEDY FOR DEFECTS. IMPROVEMENTS, ETC.
The Trustees having thus commented upon several imper-
fections of the Hospital, without, however, exhausting the
subject, may, of course, be expected to propose some effectual
remedy therefor. This they did in a memorial to the legisla-
ture at its last session. To this memorial they now refer, with
the remark, that additional experience, observation and reflec-
tion, have confirmed them in the opinions there set forth;
They showed that there are many important defects in the
establishment, which are radical and irremediable, and which
must embarrass those who administer its affairs, and prevent
them from doing so much for the cure and care of the insane
as they might otherwise do.
First. That the site of the building has become a very un-
favorable one, owing mainly to the rapid growth of the neigh-
borhood. The once quiet village of "Worcester has become a
busy manufacturing city, and is rapidly encompassing the
Hospital. Roads, streets, and rail-tracks run in front and rear,
and across the premises, so that the patients cannot go to walk,
or ramble in the fields and woods,without crossing some of them.
They cannot even stroll quietly in their own grounds and gar-
dens with any privacy and quiet. They are subject to the
observation of the curious, and the rudeness of the indiscreet
Now, the noise and din, the hurry and bustle, of an enter-
5
34 STATE LUNATIC HOSPITAL. [Jaii.
prising manufacturing town, the busy streets, the swift succes-
sion of passers by, the rush of cars, and the shriek of steam
whistles, may be pleasant and useful to certain patients ; they
may furnish a desirable excitement ; but the Hospital should be
so placed that such patients can have access to them, without
being so placed that none can escape from them.
Second. The memorial showed that the sewerage is very
imperfect, and that, owing to the situation of the land, no fea-
sible method had been found for carrying off the waste water
from the building. This is received into the gardens ; and
there some of it is absorbed, and some is evaporated, while
some remains stagnant at certain seasons, so that the air must
be more or less vitiated.
Third. That the structure of the main building is, for this
age, very bad. It has five kitchens, instead of one central one.
It is inconvenient in many respects. It lacks the many con-
veniences and appliances which experience has shown to be
important in the administration of such establishments, and
conducive to the comfort and well being of the patients.
Owing to the want of height between the floors, and to other
radical defects, it cannot be so modified as to meet the ad-
vanced requirements of the times.
Fourth. That the arrangements for ventilation were never
sufficient, and that, owing to structural defects in the building,
they can never be made so. There is not sufficient volume
of air in the wards ; and it cannot be kept pure without
changing it so rapidly as to create almost a gale of wind.
The evil has been much lessened by arrangements adopted
this season, but it cannot be completely abated.
Fifth. That the arrangements for warming the building are
imperfect and insecure. The building has already been on
fire several times ! TJie risk of fire is still greater than pru-
dent persons ought, unnecessarily, to run. It is greater than
careful men of business would run in a manufactory filled
with valuable merchandise.
These reasons were deemed sufficient to warrant a recom*
mendation to the legislature that the grounds and buildings
should be sold, and a new building erected upon a suitable site
in the immediate neighborhood. This recommendation the
Trustees distinctly made, and they endeavored to enforce it by
other considerations, such as that— "v
1855.] SENATE— No. 1. 35
First. If the old building is to be continued in use, the State
is bound, by considerations of safety of the patients, to intro-
duce a secure and efficient apparatus for warming. The best
one yet tried, and which would be applicable to the building,
is a steam apparatus, and this would cost from sixty to seventy-
five thousand dollars.
Second. The real estate of the present Hospital would sell
for at least one hundred thousand dollars more than the cost
of a suitable site for a building and a good farm in the neigh-
borhood. There would be a saving of one hundred and sev-
enty-five thousand dollars, so that there could be no weighty
objection on the lower considerations of economy, to what
is called for by higher considerations of humanity ; to wit, the
erection of a new hospital in all respects Avorthy of the State.
The Trustees might further enforce this recommendation by
many considerations, the result of the last year's experience
and observation, but they will close by quoting, from a high
authority, a passage very much to the point.
The Commissioners in Lunacy, in their last Report to the
British Parliament, July, 1854, after speaking of their endeav-
ors to improve the condition of hospitals, conclude thus : —
" We regret to say that our endeavors in this respect are, in several of these in-
stitutions, opposed by great difficulties, some arising from defects in the original
construction of the buildings, and others from an adherence to certain errors in
management and treatment, which, in the best conducted establishments for the
insane, are condemned, and have now become obsolete.
" Indeed, so formidable are the difficulties in the way of advancement, in old
and badly situated hospitals, that, in those instances where improvements have been
attempted, large sums of money have sometimes been spent without adequate results.
In such cases, th& only effectual mode of overcoming all obstacles to improvement
appears to be, to abandon the old buildings, and erect new 'buildings on eligible
sites ; a course which has already been taken at Manchester and Stafford, and about
to be adopted at Nottingham." :jfl
In consequence of the memorial' of the Trustees, the legisla-
ture, at its last session, arj^ointed a. Commission to consider the
matter, and also to ascertain the number, condition and
wants of the insane in the Commonwealth, and to report upon
the subject generally.
This Commission has performed its arduous task with re-
markable skiU and success. There has, probably, never been
collected, in any large community, such a mass of minute,
36 STATE LUNATIC HOSPITAL, [Jan,
thorough, and reliable information, concerning the number and
condition of the insane, as has been gathered by this Commis-
sion, excepting, perhaps, that gathered by the eminent Q,uete»
let in Belgium.
They have ascertained the names, age, sex and condition of
over twenty-four hundred insane persons, and of more than
one thousand idiotic persons.
This information will soon be spread before the legislature?
and will show the pressing necessity of further and immediate
provision for the insane of the Commonwealth.
The Trustees have had several interviews with the Commis*
sioners, and, after earnest consideration of the subject, have
coincided with them in the following conclusions :-—
That there is urgent need of more accommodations for the
insane, and that, therefore, a new Hospital should be erected
immediately in the western part of the State.
That the new Hospital should be constructed for no more
than two hundred and fifty patients.
That final action upon the question of the disposition to be
made of the property at Worcester, and the erection of a
new building in that neighborhood, (though the questions de-
serve serious attention,) should be deferred until after the
Western Hospital is completed.
That further alterations and improvements shall be made in
the old building, by means of funds now in the hands of the
Trustees, and the inconveniences and evils be borne as they
best can be, in view of their effectual remedy within a few
years.
It is partly in consequence of having come to these conclu-
sions that the Trustees have directed several alterations and
improvements in the old building and grounds.
Respectfully submitted by
S. G. nOWB,
REJOICE NEWTON,
JAMES B. CONGDON,
LINUS CHILD,
HENRY MORRIS,
I Trustees.
Worcester, December, 1854,
1855.1
SENATE— No. 1.
37
TREASURER'S REPORT.
To the Trustees of the State Lunatic Hospital : — -
The Treasurer respectfully reports : —
That the balance of cash in his hands on the
30th November, 1853, was
Since which time to the 30th of November,
1854, he has received
From the Commonwealth, for the support of
Lunatic Paupers, the sum of
From cities, towns, and individuals,
From the Steward of the Hospital, for articles
sold,
For interest on Worcester and Nashua Railroad
Bond, a legacy of Ziba Storrs, ♦
$23,131 85
19,108 84
32,736 52
344 27
30 00
$75,351 48
The Expenditures of the year have been as
For Wages and Labor, .
Improvements and Repairs,
Furniture,
Clothing,
Flour, 457 barrels,
Rye and Corn Meal,
Biscuit,
Coffee, 3,691 pounds,
Tea, 1,158
Sugar, 25,549 »
Rice, 2,701
Molasses, 1,149 gallons,
J3eef and Pork, 62,414 pounds,
follows : —
$11,543
98
3,645 44
1,333 82
1,626
90
4,820 12
1,586 78
236
99
494
09
387
28
1,760
10
139
73
351
81
4,845 98
38
STATE LUNATIC HOSPITAL.
[Jan.
For Fish, salt, 11,000 pounds,
" fresh, 3,865 "
Poultry, 670 pounds,
Bacon, 5,470 "
Potatoes, 1,885 bushels,
Beans and Peas,
Butter, 26,138 pounds,
Cheese, 1,631 "
Apples, 1,670 bushels,
Dried Apples,
Fresh Fruits,
Small Groceries, Spices, &c,
Vinegar and Cider,
Lard, 1,329 pounds,
Salt, $49.22 ; Saleratus, $37.21
Wood, 278 cords, .
Charcoal, 2,692 bushels, .
Hard Coal, 1,577,420 pounds,
Straw, ....
Whale Oil,
Lime and Cement, $73.57 ; Potash, $118.70,
Starch, $29.20 ; Hops, $39.10 ; Soap, $42.63,
Gas Light and Kepairs, ....
Medical supplies,
Postage, $40.26; Freight, $78.25, .
Books, Stationery and Blank Books,
Trustees' expenses, . . .
Expenses charged to Patients,
Expenses on account of Elopers,
Sexton's bills, ......
Expense of removals to Taunton Hospital,
2 Cows, $75 ; 3 pair Oxen, $430 ; pasturing, $25, 530 00
Land purchased of Samuel Putnam, . 175 00
Miscellaneous items, .... 125 61
$402 49
204 81
73 70
531 04
1,273 99
41 13
4,958 58
175 76
836 13
73 51
211 36
•108 54
68 82
155 89
86 43
1,982 50
335 59
5,544 65
254 30
151 91
192 27
110 93
667 90
193 46
118 51
181 46
299 00
72 47
76 89
170 15
63 71
Balance of Funds,
Consisting of a note of the Mas-
sachusetts Cotton Mills, dated
July 11, 1854, , , , $15,000 00
$53,221 51
22,129 97
1855.] SENATE— No. 1. 33
Cash deposited in Worcester B'nk, $4,879 03
Cash deposited in Central Bank, 2,002 02
Cash in the Treasurer's hands, . 248 92
$22,129 97
In addition to which the Treasurer holds a bond
of the Worcester and Nashua Railroad Co., . 500 00
$22,629 97
SAMUEL JENNISON, Treasurer.
Worcester, December 20, 1854.
Examined and found correct.
JAMES B. CONGDON, Auditing- Committee.
January 15, 1855.
1855.] SENATE— No. 1. 41
SUPERINTENDENT'S REPORT.
Twenty-second Annual Report of the Superintendent to the
Trustees of the State Lunatic Hospital.
Gentlemen: — The interesting facts and e*vents that have
occurred in this institution the past year are herewith presented.
The health of the inmates generally has, perhaps, never been
better. There has been but very little acute disease, and noth-
ing like an epidemic, among our household. By the timely
transfer, to the kindred institution in this State, of two hun-
dred and ten patients, the remainder were saved from the
contaminating influence of an excessively crowded house
during the warm weather. By order of the governor, we con-
veyed to the Second Hospital for the Insane in Taunton, on
Friday, the 7th of April, and on each of the five succeeding
Fridays, a car load of patients. By an arrangement of the
railroads, an extra engine took a car filled with some thirty-five
patients, and from two to five attendants, and ran to meet the
connecting train. There was no accident, and, indeed, no dif-
ficulty, in the transfer. The patients were mostly of a very
orderly class, and they were gratified with the ride. The pa-
tients selected by the Governor were those from that section
of the State, and from the counties of Norfolk, Suffolk, and
Middlesex — being one hundred and five of each sex. During
this time, our number of patients was reduced from five hun-
dred and fifty-nine to three hundred and forty-three. This
reduction took off no more than the overplus, and left this
Hospital quite full, but not crowded. The relief thus afforded
us was seized upon to paint and fit up several of our wards.
But more desirable to us than for any thing else, it gave us a
possible chance to abandon nine strong rooms that had been
daily used, ever since the institution was opened, for the vio-
lent and filthy males, and also to disuse, forever I trust for that
purpose, eight rooms in the basement of the north old wing,
6
42 STATE LUNATIC HOSPITAL. [Jan.
for the same class of females. These seventeen rooms have
not been occupied at all, for seven months past, by patients,
but they have been converted to other uses. They were never
proper for the purposes they were designed and put to ; and,
of late years, they were used only from what we thought abso-
lute necessity.
Abandoning these ill-contrived rooms, and reducing the
number of our patients to about the capacity of the institu-
tion, has lessened our cares and responsibilities, while we have
been enabled thereby to improve very materially the general
appearance of the institution and condition of its inmates.
The improvement in the ventilation, which, under the direc-
tion of the Hon. Jonathan Preston, has, in part, been effected,
and which will soon be finished, will render our wards still
more healthful and pleasant. We know that one fruitful
source of the just odium this Hospital has received the last
year or two arose, in a great degree, from its crowded wards,
another from its defective ventilation. The atmosphere of
apartments occupied by the healthy, we all know, becomes
vitiated soon, unless frequently changed. The air of the wards
of hospitals becomes vitiated, not only by respiration, but by
diseased secretions of the sick. At this Hospital, the same
room that is used as the sitting-room by day is made the dor-
mitory at night. The means of ventilating the sleeping apart-
ments in this Hospital are undoubtedly much more ample
than they are in the greater part of the private dwellings in
this State. But still, for a hospital, the means here are de-
ficient. Besides the window in each room, these means of
ventilation consist of an opening over the door, about eight
inches by thirty, into the gallery, into which the warm air of
the furnaces is diffused. Leading from each room, ventiducts,
opening in the attics, are constructed in the partition walls.
These ducts are about four inches square. In most of the
rooms there are two of these ducts — one from near the bottom,
and one from near the top. In those rooms that have but one
duct, that one is about four inches and a half square. This
improvement consists in continuing these ventiducts as they
come up to the attic, each story by itself, in wooden boxes,
into a main shaft near the chimney, into an enlargement of
which, recently altered for that purpose, this main shaft enters,
1855.] SENATE— No. 1. 43
and there the foul air from the rooms below comes in contact
with the nine-inch cast-iron smoke-pipe of the furnace in the
basement. Where it was not convenient to collect these ducts
into a brick chimney, Collins's Ventilators, thirty inches in
diameter, have been placed on the roof for that purpose. Here-
tofore, the foul air that came up through these ducts into the
attic diffused itself through the whole attic, seeking an open
window to escape, or to find another duct in which the current
was reversed by some means. It has been not at all uncom-
mon to find the current up in one duct, and down another, in
the same wing of the Hospital at the same time. When the
wind is strong against one side of the Hospital, and windows
open on the opposite side, it is not unfrequent that the air
rushed up the windward ducts, and down the leeward ones.
In ducts in the outer walls of brick buildings, the current of
air in winter is often down, and in summer up ; because, in
winter, the walls and ducts are colder than the air inside, and
in the summer the duct is often warmed by the direct rays of
the sun on the outside, and the air in the duct is rarefied and
raised. The internal partitions, when of brick, become colder
in summer than the surrounding atmosphere, and condense
it, and the current in flues in them is often down. The
smell of soot, from chimneys unused in summer, is from the
same cause. It is supposed that this change in the mode of
ventilation will increase the quantity of foul air that will pass
off, by increasing the currents, and render less liable the foul
air to return to the wards again after it has been carried to the
attics, by conveying it more directly to the Collins's Ventilators
or to the tops of the chimneys. The foul air, after it gets into
the chimneys, comes in immediate contact with the cast-iron
smoke-pipe, which, by its heat of the furnace for six months or
more in the year, will keep up a constant current upwards in
the ducts below. The external winds, the harder they strike
upon the Collins's Ventilators, will so much the more increase
the currents in those ducts that are collected in them. The
fixtures described above refer to the ducts that start from the
bottom of each room. The flues that start from the top of
the rooms open into the attic yet, and in extreme cold weather
will be closed, to enable us to warm the wards sufficiently.
All the water closets recently renewed are ventilated down-
44 STATE LUNATIC HOSPITAL. [Jan.
wards, which is also a decided improvement upon the old
movable pan. One new sewer has been laid down, and an-
other has been covered over a hundred feet farther from the
building. Other of the drains need covering, which can be
done early in the ensuing spring ; when, also, the piggery should
be removed, from the place it has occupied for twenty -two
years, to one more remote from the buildings. When the wind
is easterly, these pens have been offensive from their proximity.
TABULAR VIEW
46
STATE LUNATIC HOSPITAL.
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70
STATE LUNATIC HOSPITAL.
[Jan.
TABLE 1,
Showing the Admissions from each County the last and previous
i years.
1834.
Previously.
Total.
Barnstable,.
. Males,
. Females,
. 3
. 2—
5
115
120
Berkshire, .
it
. Males,
. Females,
. 7
. 2—
9
144
153
Bristol,
. Males,
. Females,
. 2
. 3—
5
275
280
Dukes,
. Males,
. Females,
. 1
. 1—
. 2
17
19
Essex,
. Males,
. Females,
. 12
. 22—
34
535
569
Franklin, .
-. Males,
. Females,
. 1
. 5—
6
102
108
Hampden, .
u
. Males,
. Females,
. 7
. 9—
16
236
252
Hampshire,
u
. Males,
. Females,
. 4
. 3—
7
181
188
Middlesex, .
u
. Males,
. Females,
. 24
. 14—
38
524
562
Nantucket, .
. Males,
. Females,
. 1
. 0—
1
30
31
Norfolk, > .
\ «
. Males,
. Females,
. 7
. 9—
16
541
557
Plymouth, .
. Males,
. Females,
. 2
. 3—
5
217
222
Suffolk, .
u
. Males,
. Females,
. 18
. 45—
63
464
527
Worcester,
u
. Males,
. Females,
. 35
. 57—
92
1,067
1,159
Other States,
. Males,
. Females,
. 0
0-
-
10
10
299
i
4,458
4,757
1855.] SENATE— No. 1. 71
More than one-third of this year had passed before any of
the commitments were diverted from this hospital to the new-
hospital in Taunton ; hence our books show some admis-
sions from the counties in that section of the Commonwealth.
It is probable that hereafter there will be but few, if any, sent
here from that part of the State, although there is nothing in
the laws, I believe, by which judges are required to commit
.the insane to that hospital rather than this. That point was
undoubtedly left unsettled purposely, that the friends of the
patient might make their election between the two institutions.
The laws give the governor authority, from time to time, to
equalize, if need be, the relative numbers in the two hospitals,
by transferring such patients from one to the other as he shall
see fit.
72
STATE LUNATIC HOSPITAL.
[Jan.
TABLE 2,
Showing the Admissions and State of the Hospital from Dec.
1, 1853, to Nov. 30, lj354.
Patients in the Hospital December
1, 1853, . . .520
Males, . . 266
Females, . . 254
Patients admitted in the course of
the year, . . . 299
Males, . .125
Females, . . 174
Whole number in the Hospital in
the course of the year, . 819
Males, . . 391
Females, . . 428
Patients remaining in the Hospi-
tal November 30, 1854, . 381
Males, . . 193
Females, . . 188
Of the admissions, there were
cases of less duration than one
year, . . . 140
Males, . . 55
Females, . . 85
Of the admissions, there were
cases of one year or more, . 114
Males, . . 50
Females, . . 64
Cases the duration of whose in-
sanity before admission not as-
certained, . . .45
Males, . . 17
Females, . ., ' 28
Patients committed by the Courts,'230
Males, . . 87
Females, . . 143
Committed by the
the Poor,
Males, »
Females, .
Overseers of
34
23
57
Committed on the warrant of the
Governor,
Males, . . 4
Females, . . 8
12
Foreigners, and those who have
no legal settlement in this
State, admitted during
year,
Males,
Females, .
the
41
84
Foreigners and those having no
legal settlement in the State
discharged during the year,
Males, . . 67
Females, . . 113
Those having no legal settlement
in this State, remaining in the
Hospital November 30, 1854,
Males, . . 67
Females, . . 84
125
180
151
State Paupers remaining in the Hos-
pital at the end 1 of each year, as
near as they can be ascertained : —
1842,
34
1843,
38
1844,
38
1845,
57
1846,
52
1847,
121
1848,
150
1849,
, 167
1850,
181
1851,
208
1852,
241
1853,
216
1854,
151
1855.1
SENATE— No. 1.
73
Continuation of TABLE 2.
Irish.
1846.
1847.
1848.
1849.
1850.
1851.
1852.
1853.
1854.
K
0)
to
OJ
&
M
M
M
Total.
1
o
Eh
03
O
a
o
H
A
o
a
o
03
03
o
A
o
03
03
O
H
03
o
Eh
a
o
H
Si
o
Eh
Admissions : —
Recent cases,
-
13
-
8
-
16
-
24
-
18
16
_
30
_
34
_
46 215
Males, .
6
-
2
-
7
-
12
-
7
-
5
6
_
8
_
10
I
Females,
7
-
6
-»
9
-
12
-
11
-
11
-
24
-
26
-
36
Chronic cases,
_
1
_
15
_
5
_
12
_
11
_
14
_
17
_
17
_
26
118
Males, .
1
-
6
-
3
-
4
-
2
-
6
-
8
_
3
_
7
Females,
-
-
9
-
2
_
8
_
9
-
8
_
9
_
14
_
19
Duration of Insan-
ity Unknown,
-
11
-
15
-
11
_
10
-
19
-
19
_
22
_
20
_
24
151
Males, .
7
-
9
-
6
_
5
-
14
-
9
_
10
_
6 -
6
Females,
4
-
6
-
5
-
5
-
5
-
10
-
12
-
14
-
18
Totals, .
25
38
32
46
48
49
69
71
96
484
Discharged: —
1
1
Recovered,
-
6
-
13
-
13
-
16
-
21
-
17
-
19
_
32
_
33
170
Males, .
3
■-
9
-
9
-
10
-
9
-
3
-
6
_
10
_
10
Females,
3
-
4
-
4
-
6
-
12
-
14
-
13
-
22
-
23
Died,
_
4
_
2
_
5
_
4
_
11
_
4
_
12
_
12
_
9
63
Males, .
2
-
-
-
1
-
1
-
5
_
2
—
5
_
3
_
4
Females,
2
-
2
-
4
-
3
-
6
-
2
-
7
-
9
-
5
Otherwise,
_
2
_
2
3
_
9
_
3
_
6
_
25
_
22
_
83
155
Males, .
1
■-
-
-
1
-
4
-
-
-
5
_
9
_
2
32
Females,
1
-
2
-
3
-
5
-
3
-
1
-
16
-
20
51
Totals, .
12
17
21
29
35
27
56
66
25
388
Increa
se
in i
iin
e y
ear
s,
•
•
•
96
10
74
STATE LUNATIC HOSPITAL.
[Jan.
TABLE 3,
Showing the number of Discharges and Deaths, and the con-
dition of those who left the Hospital, from December 1, 1853,
to November 30, 1854.
Incurable
Incurable
Improved
and
and dan-
Deaths.
o
d
o
"A
harmless.
gerous.
M
s-i
M
o
13
fl
■3
,C
■3
A
A
£.
«"
£
a
a
o
o
H
W
H
W
H
W
H
w
H
W
H
H
Patients discharged,
438
122
53
90
139
34
Males,
198
-
45
_
21
_
48
-
69
-
15
_
198
Females, .
240
1
77
-
32
-
42
-
70
-
19
-
240
Recent cases — less than
one yr. — discharged,
-
128
_
85
_
18
_
5
_
12
_
8
Males,
56
-
36
_
6
_
2
_
9
_
3
_
56
Females, .
72
J
49
-
12
-
3
-
3
-
5
-
72
Chronic cases — one yr.
or more — discharged.
-
220
_
30
-
26
-
58
-
83
-
23
Males,
105
_
8
_
8
_
32
-
45
_
12
_
105
Females, .
115
-
22
-
18
-
26
-
38
-
11
-
115
Patients discharged, the
duration of whose in-
sanity not ascertained,
-
90
-
7
_
9
-
27
-
44
-
3
Males,
37
J
1
_
7
_
14
_
15
_
_
_
37
Females, . v .
53
-
6
-
2
-
13
-
29
-
3
-
53
Totals, .
438
122
53
90
139
34
The results of the year have been favorable in a curative
point of view. One hundred and twenty-two have recovered
so as to return to their families and business. Others have
left us improved or otherwise, who, had they remained longer,
would have increased the number of cures. Some of those
transferred by the Governor had been with us only a few days.
Among the " harmless and incurable " are included a few
State paupers that the Overseers of the Poor took directly to
the State Almshouses, from one of which we have received
others in return. Those we received from the State Alms-
1855.1
SENATE— No. 1.
75
house have appeared about as harmless as any patients we
have. This has deterred me from advising and recommending
others to you to be sent back to the towns as fit subjects for
those institutions.
TABLE 4,
Showing' the number of Admissions and Discharges and the
average number in the Hospital each month in the year.
Monthly Av-
erage.
Admission.
Discharges.
December, 1853,
529
23
10
January, 1854,
541
25
13
February, "
548
18
16
March, "
548
30
19
April, "
496
34
163
May, "
365
22
103
June, "
350
39
31
July,
357
18
17
August, "
354
17
21
September, "
368
30
13
October, "
374
22
15
November,
377
21
17
Average number for the year,
430
76
STATE LUNATIC HOSPITAL.
[Jan.
TABLE 5,
Showing- the whole number of Residents during the year, the
average number each year, the number at the end of each year,
and the Expense of each of the twenty-two years the Hospital
has been in operation.
Whole No. of
Average No.
No. at the
Current Expenses
Annual Expense
The year.
residents dur-
each ;year.
end of each
each year.
per patient.
ing the year.
year.
1833
153
107
114
$12,272 91
$114 67
1834
233
117
118
15,840 27
135 38
1835
241
120
119
16,576 44
137 30
1836
245
127
138
21,395 28
168 44
1837
306
163
185
26,027 07
159 64
1838
362
211
218
28,739 40
136 20
1839
397
223
229
29,474 41
132 16
1840
391
229
236
27,844 98
121 59
1841
399
233
232
28,847 62
123 81
1842
430
238
238
27,546 87
111 12
1843
458
244
255
27,914 12
114 40
1844
491
261
263
29,278 75
112 17
1845
556
316
360
43,888 65
138 88
1846
637
359
367
39,870 37
111 06
1847
607
377
394
39,444 47
104 62
1848
655
404
409
42,860 05
106 09
1849
682
420
429
40,870 86
97 31
1850
670
440
441
46,776 13
106 40
1851
704
462
466
52,485 33
112 61
1852
775
515
532
43,878 35
85 20
1853
820
537
520
53,636 66
103 14
1854
819
430
381
53,221 51
123 77
1855.1
senate—No. i.
77
TABLE 6,
Shoiving- the causes of Insanity, and the circumstances connected
with the causes and predisposition to Insanity the last and pre-
vious years, as reported to us by their friends.
1854.
Previously
Ill health, .......
26
579
Intemperance,
12
376
Domestic affliction, .
19
353
Religion,
8
277
Masturbation,
11
208
Property,
6
192
Disappointed affection,
7
109
Disappointed ambition,
-
39
Epilepsy,
8
119
Puerperal, .
10
137
Wounds on the head,
1
51
Hard labor, .
3
60
Jealousy, . . •
1
18
Fright,
2
30
Palsy, _
1
36
Periodical cases,
26
886
Homicidal cases,
29
183
Have committed homicide,
2
25
Hereditary cases,
29
1,002
Suicidal cases,
25
436
Have committed suicide,
1
19
Cases arising from physical causes,
86
1,575
Cases arising from moral causes,
51
1,072
Probably in no part of the world are the causes of insanity
more numerous and more active than among the population
of Massachusetts. Here the mind, and body too, are often
worked to the extreme point of endurance. Here wealth and
station are the results of well-directed efforts ; and the general
diffusion of intelligence among the whole people stimulates a
vast many of them to compete successfully for these prizes.
But in the contest, where so many strive, not a few break down.
The results on their minds may not, perhaps, be any less dis-
astrous, whether wealth and station are obtained or not. The
true balance of the mind is disturbed by prosperity as well as
78
STATE LUNATIC HOSPITAL.
[Jan.
adversity. It is only in a sound body that the manifestations
of the mind are sane and entirely healthy. As a people^we
cannot boast of the highest standard of physical health, al-
though we may of general intelligence, enterprise and hard
work.
TABLE 7.
Duration of insanity before admission: —
Less than one year insane,
More than 1 and less than 2 years insane,
" " 2 '
i it
5
a
It
» " 5 '
< a
10
a
U
u a 10 t
I u
15
M
u
u u 15 t
i a
20
U
a
" " 20 '
i a
25
li
u
" " 25 '
I a
30
«
a
Over 30 years,
.
.
.
Unknown,
133
27
33
14
7
2
1
1
4
77
299
Duration of insanity with those remaining in the Hospital at the end of the year:
36
39
66
52
44
24
12
9
9
90
381
Less than one year,
1 year and less than 2,
2 years
5 "
<C (t
u u
5,
10,
10 "
a a
15,
15 "
u a
20,
20 "
it ((
25,
25 "
« if
30,
30 years and upwards,
Unknown,
Ages of Patients when admitted: —
Under 15 years,
15 years and less tl
20
30
40
50
60
70
80 years and more,
an 20, .
30, .
40, .
50, .
60, .
70, .
80, .
1
20
94
67
72
27
13
4
1
299
1855.] SENATE— No. 1.
79
TABLE 7— Continued.
Ages of Patients in the Hospital December 1, 1854: —
Less than 15 years, .....
-
15 years and less than 20, ....
12
20 » " " 30, .
78
30 " " " 40, .
106
40 " " " 50, .
101
50 " " " 60, .
42
60 " " " 70, .
25
70 " " " 80, .
15
80 years and more, .....
2
381
Civil state of Patients when admitted: —
Single, ......
153
Married, ......
112
Widows, ......
16
Widowers, ......
4
Unknown, ......
14
299
80
STATE LUNATIC HOSPITAL.
[Jan.
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Whole No. admitted, .
Whole No. discharged, .
Discharged recovered, .
Discharged improved, .
Discharged not improved,
Died, .
Eloped, .
Whole No. in Hospital
in course of the year, .
No. remaining at the end
of each year, .
Males admitted, .
Females admitted,
Males discharged,
Females discharged,
Males died,
Females died, .
Sent in by courts,
Sent in by friends and
overseers,
Sent in on warrant of Gov'r,
Males recovered,
Females recovered,
Average No. in Hospital,
1855.1
SENATE— No. 1.
81
TABLE 9.
Diseases that have proved fatal.
1854.
Previously.
Marasmus, .
5
78
Apoplexy and Palsy,
3
53
Consumption,
4
58
Epilepsy,
2
45
Disease of the Heart,
-
20
Suicide,
1
19
Disease of the Brain,
« .
-
20
Typhus Fever, .
-
11
Lung Fever,
4
18
Hemorrhage,
-
6
Dysenteric Fever,
-
9
Cholera Morbus,
-
4
Inflammation of the Bowels,
-
8
Mortification of the Limbs,
-
3
Dropsy, .....
1
8
Chronic Dysentery,
1
4
Erysipelas,
2
15
Diarrhoea, ....
1
18
Disease of the Brain from Intemperance
-
3
Bronchitis,
-
3
Old Age,
-
13
Gastric Fever, .
-
5
Land Scurvy,
-
1
Congestive Fever,
1
2
Concussion of the Brain,
-
1
Disease of the Bladder,
-
1
Fright, ....
-
1
Rupture,
-
1
Maniacal Exhaustion,
7
49
Convulsions,
-
2
Cholera, .
-
4
Asthma, .
1
1
Hydrothorax,
-
3
Cancer, .
-
1
Pleurisy,
1
Jaundice,
1
1
Chorea, .
-
1
34
491
11
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1855.] SENATE— No. 1. 83
In this table, the two hundred and ten that werejransf erred
were not taken into the count, Had they been reckoned, the
per cent, would have been different. For recent cases recov-
ered, it would have been 66; for all discharged, 28; and for
old cases, 12. The per cent, of deaths of all in the Hospital
would have been 4.15 ; and of the average number, 7.9.
By the persevering efforts of the Assistant Physicians, Drs.
Bemis and Smith, the patients have this year enjoyed, in walks,
in amusements and freedom on their parole of honor out of
doors, greater indulgence than ever before. They have been
enabled to do so, in part, because the grounds this year about
the building have been protected by fences for the first time.
Intruders have been kept off, and our quiet people could sit
and stroll about this hill pleasant days unmolested. Far less
mechanical restraint has been used than was formerly deemed
absolutely necessary. Amusements of various kinds, as
walking, riding, working, reading, writing, music and games,
have been put in requisition to arouse the listless minds of
the inactive, and to bring into a healthy channel the wander-
ing thoughts of the deluded.
We are under great obligation to the proprietors for the
following periodicals, for which we can make them in return
only this acknowledgment, and express the gratitude of our
patients who are made happy in their perusal : The Daily
Advertiser, Evening Gazette, Olive Branch, Puritan Recorder,
Christian Witness, Church Advocate, Youth's Companion,
Monthly Religious Magazine, Zion's Herald, New England
Farmer, Prisoner's Friend, from Boston ; Register, Essex
County Gazette and Advertiser, from Salem ; Old Colony
Memorial, Plymouth ; Lynn News, Lynn ; Assistant of the
Ministry at Large, Roxbury ; Gospel Messenger, Utica, N. Y. ;
Democrat, Taunton ; iEgis, Spy, Palladium and Journal, Wor-
cester ; Courant, Clinton ; and some papers and books from
several friends of the Hospital.
The stated daily and weekly religious services here have
been continued by the able Chaplain who has so long been
with us. These services, besides promoting something of re-
ligious growth in the hearts of all, are among the moral means
by which the insane as well as the sane become habituated to
84
STATE LUNATIC HOSPITAL.
[Jan.
the rules of order and decorum. Former associations are
awakened in their minds, which 'allay the restless feelings of
the insane, and help them to keep in subjection their wandering
thoughts. They are the occasion of some happiness and
activity on the Sabbath, and they mark the hour of repose at
night.
The patients assist in the various departments of the Hos-
pital, and their services are valuable for what they perform,
and still more valuable in its effects upon their own health.
Some thirty have regular daily duties assigned them out of
the wards; and, when there is any extra job on hand, as many
more are often taken out into the fields and shops by the sev-
eral assistants. The attendants are assisted in the wards, in
the care of them, in sewing and knitting, by a hundred or
more of the patients. But still there is a great want here of
some kind of mechanical labor, at which considerable numbers
could be engaged without danger to themselves, that would be
both healthful and pleasant in its performance.
The farm and garden have yielded full returns for the labor
bestowed, as the following estimate of the crops by the Stew-
ard will show : —
Apples, 95 bushels at 40c,
Cherries, 20 bushels at $2.00,
Com, sweet, in ears, 80 bushels at 50c.
Beans, 7 bushels at $2.00, .
Beets, 162 bushels,
Cabbage heads, 1,800 at 5 cents each,
Cucumbers, 85 bushels at 50c,
Turnips, 105 bushels at 25c,
Tomatoes, 50 bushels at 40c,
Onions, 145 bushels at 50c, .
Squashes, 3,583 lbs. at 2c, .
Peas, 30 bushels at $1.00,
Milk, 41,050 quarts at 3lc, .
Beef, 8,434 lbs. at 7c, .
Pork, 14,578 lbs. at 8c, .
Poultry, 150 lbs. at 10c,
$38 00
40 00
)
40 00
14 00
40 50
90 00
42 50
26 25
20 00
72 50
71 66
30 00
. 1,436 75
590 38
. 1,166 24
15 00
5,733 78
1855.] SENATE— No. 1. 85
And for wintering or fattening the stock on hand, of 4 horses,
2 oxen, 24 cows and 122 swine : —
Hay, 44 tons at $20.00, $880 00
Rowen, 4 tons at $15.00, 60 00
Corn fodder, 15 00
Carrots, 1,600 bushels at 25c, .... 400 00
$1,355 00
I cheerfully acknowledge the ready cooperation of the sev-
eral persons employed in this institution in carrying forward
the great purpose of this charity. The duties of those in the
immediate attendance on the insane are perplexing, and often
arduous, and, when faithfully discharged, can be fully remu-
nerated only by an approving conscience. We have been for-
tunate in acquiring and sustaining a high tone of moral and
intellectual excellence in the attendants and assistants.
Persons devoted exclusively to the care and attendance
on the insane are : —
Males, 13
Females, . . 18 — 31
Persons employed in the various departments to work
with and give exercise to the insane are :—
Males, 17
Females, . . . . . . . . * 18—35
66
The term of their services varies from several causes. About
one-third leave yearly. Some, from the length of time and
their devotion to it, become identified with its reputation.
Those best adapted to their stations generally remain longest.
To each of the members of your Board, who have been ever
ready to advise and assist me, and who have been active and
zealous in promoting the best interests of the insane, I am
glad of this opportunity to express my obligations and my
gratitude. The services of your Board have been rendered
86 STATE LUNATIC HOSPITAL. [Jan.
without pecuniary compensation, and visits of business to, and
inspection of, the Hospital, by some or all of its members,
have been frequent. The book of Monthly Visits shows that
no month since the institution was opened has passed without
a record of such a visit having been made. Thirty-seven times
have you been at this Hospital the past year, besides your
meetings of business elsewhere.
Most respectfully,
Your obedient servant,
GEORGE CHANDLER.
State Lunatic Hospital, Worcester,
Mass., December 1, 1854.
1855.]
SENATE— No. 1.
87
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89
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95
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96
STATE LUNATIC HOSPITAL.
[Jan.
03
5
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97
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99
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January 29, . . . . — 6 .
July 4, .... 93°.5.
Total Days, .... 225
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14
OFFICERS
OP THE
STATE LUNATIC HOSPITAL
AT WORCESTER,
1.855.
TRUSTEES
REJOICE NEWTON, President,
WILLIAM T. MERRIFIELD,
LINUS CHILD, .
HENRY MORRIS, Secretary,
CHARLES II . STEDMAN,
Worcester.
Worcester.
Lowell.
Springfield.
Boston.
TREASURER
-SAMUEL JENNISON, . ... . Worcester.
Office— Savings Bank, Foster Street.
RESIDENT OFFICERS
GEORGE CHANDLER, M. D.
GEORGE ALLEN, .
MERRICK BEMIS, M. D„
EDWARD A. SMITH, M. D.,
ELIZABETH A. REID, .
JOHN T. MIRICK, .
PHEBE S. MIRICK, .
Superintendent.
Chaplain.
Assistant Physician.
Assistant. Physician
and Steward.
Matron.
Supervisor .
$>8 25^W.PX
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