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

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54-^6 



PUBLIC DOCUMENT No. 9. 



TWENTY-FIFTH 



ANNUAL REPORT 



THE TRUSTEES 



STATE LUNATIC HOSPITAL 



AT WORCESTER. 



DECEMBER, 1857 



BOSTON: 

WILLIAM WHITE, PRINTER TO THE STATE. 

1857. 



OFFICERS OF THE HOSPITAL. 



TRUSTEES. 



LINUS CHILD, Chairman, 
CHARLES H. STEDMAN, 
THOMAS COLT, 
JOSEPH N. BATES, 
WILLIAM T. MERRIFIELD. 



Lowell. 
Boston. 

Pittsfield. 

Worcester. 
Worcester. 



TREASURER. 



HENRY WOODWARD, 



Worcester. 



Office — Mechanics' Bank, Main Street, Worcester. 



RESIDENT OFFICERS.' 1 

Superintendent. 
Assistant-Physician. 
. Matron. 
Steward. 
Re7. ISAAC HORSFORD, . . . Chaplain. 



MERRICK BEMIS, M. D., . 
FRANK H. RICE, M. D., . 
CAROLINE A. BEMIS, 



TWENTY-FIFTH ANNUAL REPORT 

OF THE 

TRUSTEES OF THE STATE LUNATIC HOSPITAL, 

AT WORCESTER, 
185 7. 



To His Excellency, the Governor, and the Honorable Council. 

The Trustees of the State Lunatic Hospital at Worcester, as 
required by law, hereby submit their Twenty-fifth Annual Report. 

By the 40th chapter of the Acts of the legislature of 1857, it 
is required that the annual reports of the various state insti- 
tutions shall be made up to September 80th in each year, and 
be transmitted to the governor and council before the 15th 
of October following. 

This statute does not repeal existing provisions of law in 
regard to the time of making and transmitting the Annual 
Reports of the State Lunatic Hospitals, nor other important 
provisions pertaining to these reports. 

By the provisions of the Revised Statutes, chap. 48, sect. 5, 
the annual meeting of the Trustees of the Worcester Hospital is 
required to be held in the month of December in each year. 

By the statute of May 20th, 1842, the Treasurer of the 
Hospital is required to make his annual report to the Trustees 
at their annual meeting in the month of December in each 
year, which is to embrace the receipts and expenditures for the 
year ending the 30th day of November, and the Trustees are 
required, at their annual meeting, to audit and examine said 
account and transmit the same with their Annual Report, to the 
governor and council. 



6 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

The Act of 1857 contains no provision for changing the time 
of holding the annual meeting of the Trustees, nor does it 
change the time at which the Treasurer is to make his annual 
report to the Trustees. Under the provisions of the Revised 
Statutes, chap. 48, sect. 5, the Trustees are required to make 
their report containing a particular statement of the condition 
of the hospital and all its concerns, to the 30th day of Novem- 
ber, inclusive, in each year. 

To accommodate the payment of bills due the hospital, as 
well as to facilitate the duties of the Treasurer, the rule has 
always existed at the Worcester Hospital, that the contracts 
with the patients for their board and expenses shall be payable 
on the first days of June and December in each year. 

The Trustees were unwilling to transmit their report to the 
governor and council unaccompanied with the annual report of 
the Treasurer of the hospital. 

That report could not be made at an earlier date, for the 
Revised Statutes, chap. 48, sect. 5, and the statute of 1842, 
now in force, requires the annual report of the Treasurer to be 
made to the Trustees at their annual meeting in December, to 
be by them audited and examined at said meeting. 

We have therefore taken the responsibility of delaying our 
Annual Report until we could receive and audit the report of the 
Treasurer. 

If the legislature should change the provisions of existing 
laws, so as to alter the time of holding the annual meeting of 
the Trustees from December to October, and require the report 
of the Treasurer to be made to the annual meeting of the Trus- 
tees in October, the Trustees would then change their con- 
tracts with the patients for board, so as to make them payable 
on the first days of April and October, and then there would be 
no difficulty in carrying out the provisions of the law of 1857. 

Upon recurring to the condition of the hospital for the past 
year, the Trustees find renewed occasion to acknowledge the 
gbodness of a kind Providence in permitting the institution to 
pursue its course as heretofore in dispensing blessings and com- 
parative comfort to those unfortunate individuals intrusted to 
its care. The report of the Superintendent, which is herewith 
submitted, presents in detail the results and condition of the 
hospital for the past year, which, in the judgment of the Trus- 



1858.] PUBLIC DOCUMENT— No. 9. 7 

tees, shows that the management of the institution by Doctor 
Bemis has been highly satisfactory. They deem it their duty 
to say that at no period since their connection with the institu- 
tion has it been better or more successfully conducted, than 
during the year which has just closed. 

As a whole, the patients have been more quiet and orderly 
than during any other like period which has fallen under their 
observation. 

Since Doctor Bemis entered upon his duties as Superintendent 
he has not, in a single instance, resorted to the use of the 
strong rooms for the confinement of patients ; and as a conse- 
quence, we are constrained to believe that the patients have 
been more quiet, and their paroxysms of excitement less fre- 
quent, and of a shorter duration. 

So well are we satisfied with the experience of the last fifteen 
months in this respect, that we are now prepared, when an 
opportunity shall offer, to remove the twelve remaining strong- 
rooms, and convert the space occupied by them into apartments 
in which the patients may be employed in various kinds of 
labor. 

The Trustees most heartily commend the plans of Doctor 
Bemis for giving employment to the patients, and which when 
successfully adopted, will, in their opinion, not only be found 
to be a source of some revenue to the hospital, but also a most 
important curative instrumentality. 

In his laborious and difficult duties, Doctor Bemis has been 
ably assisted by Doctor Frank H. Rice, as Assistant-Physician, 
whose fidelity and skill in the duties of his situation has strongly 
commended him to the most favorable regard of the Trustees, 
and to him it is due also to say that Doctor Bemis has derived 
great assistance from his able and valuable services. 

In the early part of the past year, Doctor Thomas H. Gage, 
who had satisfactorily discharged the duties of Assistant-Physi- 
cian, resigned his situation. 

The Trustees have not filled the place of Doctor Gage, as 
Doctor Bemis proposed that he and Doctor Rice should manage 
the affairs of the institution without further medical assistance. 

The duties of Chaplain have been performed the last year by 
Rev. Isaac Horsford in a manner entirely satisfactory to the 
Superintendent, and to the approbation of the Trustees. 



8 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

At the commencement of the last six months, Samuel Jennison, 
Esq., who for several years has discharged the duties of Treas- 
urer of the hospital with great fidelity, and to the entire appro- 
bation of the Trustees, resigned his situation. 

"We have appointed Henry Woodward, Esq., in his place, who 
has entered upon the discharge of the duties of his office. 

The Treasurer's report, which is herewith submitted, shows 
the financial condition of the hospital. 

From this, and from the books of the Treasurer, it will appear 
that on the first day of December, the amount of debts due 
from the hospital of every description, was about $19,000. On 
the same date, there was due to the hospital, most of which had 
become due on that day for board of patients, the sum of about 
144,000. This sum includes the amount due from the State 
for the support of State patients for the year ending December 
1st, and the amount due from other patients for the six months 
ending on the same date. These bills are now being collected, 
so that in a short time the whole debt due from the hospital 
will be paid, and a balance will remain in the treasury, of about 
$25,000 with which to meet the expenses of the next six 
months. 

At the close of the last year the situation of Steward became 
vacant, and since that time, the duties of that office have been 
performed by Doctor Bemis. 

At the close of the first nine months of the past year, the 
Matron of the hospital resigned her connection with the insti- 
tution, since which time the duties of Matron have been 
performed by Mrs. Bemis. 

The Trustees have voted to allow Doctor and Mrs. Bemis the 
salaries of Steward and Matron for the time which they have 
respectively performed those duties. 

By reference to the report of the Superintendent, it will be 
seen that the number of patients at the hospital for the last 
year has been greater than at any time since the number was 
reduced by the opening of the Taunton Hospital. 

At the close of the year 1856 the number in 

the hospital, was . . . . . 372 

Admitted during the year now closed, . . 271 

Discharged during the same period, . . 275 



1858.] PUBLIC DOCUMENT— No. 9. 9 

Whole number of different patients in the 

hospital during the year, .... 643 

Greatest number of patients at any one time, 404 

Average number for the whole year, . . 387 

By this statement it will be seen that the number of patients 
admitted during the year was at the rate of 22^ 8 ¥ per month. 

This fact shows not only the necessity, but the immense 
importance of institutions for the care and treatment of the 
insane. They also show the constant, and as it would seem, 
increasing liability of our people to be afflicted with this dread- 
ful malady. It should not be inferred that the whole number 
admitted in any one year are new cases. Many are cases of 
long standing, some are cases which have been discharged from 
the hospital in a condition deemed harmless, but who, on 
leaving the hospital and coming under other and different 
influences, frequently become dangerous and violent, thus ren- 
dering their return a matter of absolute necessity. 

There is perhaps no subject connected with the treatment of 
the insane, in which there is a greater liability to an unwise 
course of action, than in the premature removal of patients 
from the hospital. 

This course is unwise and unkind both to the patients and to 
the immediate managers of the institution. 

It not unfrequently happens that patients enter the hospital 
in a violent and excited state, but who soon become compara- 
tively mild, and in regard to whose recovery strong hopes are 
entertained. The great change in their condition so far encour- 
ages their friends, as to render it extremely difficult for the 
Superintendent and Trustees to resist their importunities to 
have them removed to their homes. When such patients are 
thus prematurely discharged, the t folly of such a course is 
speedily demonstrated by a relapse of the patients into a more 
hopeless state of insanity, rendering their return to the hospital 
a necessity, with a great probability that their stay may be 
prolonged almost indefinitely. 

It has ever been the policy of the Superintendent and Trustees 
of the Worcester Hospital to discountenance the premature 
discharge of patients. As by far the greater number of our 
patients are committed by order of the courts, thus placing the 

2 



10 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

question of their discharge at the disposal of the Trustees, we 
have generally denied the application of friends for their dis- 
charge, when in the judgment of the Superintendent, they 
would be benefited by a longer residence. 

It however frequently happens, that in consequence of the 
crowded state of our wards, and the necessity to make room 
for patients sent us by the order of the courts, patients are some- 
times discharged when a longer residence might have been 
beneficial to them. 

Applications are frequently made to the Trustees for the dis- 
charge of patients whose expenses are borne by the Common- 
wealth, under the idea that they can be sufficiently cared for 
at the State almshouses, and at a less expense than at a 
lunatic hospital. 

The Trustees have always deemed it proper to discharge such 
patients when, in the judgment of the Superintendent it was 
deemed safe so to do. 

But our experience has shown that the practice of discharg- 
ing this class of patients cannot be safely extended beyond 
what has been the ordinary practice of the Trustees. 

It has not unfrequently happened that patients of this class 
deemed incurable but harmless, have been discharged, and 
taken to the State almshouses. After a short residence there 
they are discharged, and on being at large they again become 
violent and dangerous, and are again committed to the hospital 
by order of the courts in a condition to make them the most 
troublesome and expensive patients in the institution. It may 
therefore well be doubted whether in the matter of economy 
alone it is wise to discharge patients from the hospital who 
cannot take care of themselves, with a view of supporting them 
at the State almshouses. 

In their last Annual Report the Trustees submitted a detailed 
statement of the improvements which had been made in the 
mode of warming and ventilating the hospital. 

This change has now been tested by the experience of the 
last year, and we feel entirely justified in saying that it has 
more than realized our expectations. The hospital is much better 
warmed, than was possible under the old system. The venti- 
lation which before was very imperfect and defective, is now 
completely successful. In determining to make the change, the 



1858.] PUBLIC DOCUMENT— No. 9. 11 

Trustees were of opinion that so great was the necessity for a 
more safe and complete mode of warming and ventilating the 
hospital, that they would be justified in making the change, 
though it should require a material increase in the annual 
expenditure for fuel. But they are happy to find, that during 
the past year they have been able to warm the buildings more 
perfectly, and to secure a more uniform temperature, with a 
ventilation as nearly perfect as can well be expected, with a less 
expenditure for fuel than was required under the old system. 

On the whole we are prepared to express our conviction that 
public buildings cannot be so safely and economically warmed 
and a perfect ventilation secured, as by constantly forcing into 
them fresh air by a mechanical force, and which in its passage 
to the various apartments, shall be heated to the requisite tem- 
perature by passing over pipes heated by steam. 

We are also enabled to report that all the expenses incurred 
in making these changes, together with sundry improvements in 
the various wards and apartments of the hospital, have been 
paid for without asking any appropriation from the State, and 
leaving the present available means of the hospital with 
which to meet in part the current expenses of the next six 
months at about the sum of -$25,000, and that after the payment 
of every debt now due from the hospital. 

As the hospital pays cash for all its supplies, and as nothing 
will become due from the patients for their board until June 
next, this surplus will all be expended before that time. 

The Trustees are of opinion that the price of board can be 
reduced at the end of the year 1858. The income from patients 
for the past year has been greater than for two or three years 
preceding. This has been owing to the greater number of 
patients. But it is understood that the Northampton Hospital 
will be opened for the reception of patients during the next 
spring. When that takes place, the number of patients at the 
Worcester Hospital will be somewhat reduced, with a conse- 
quent addition to cost per patient of maintaining the Worcester 
Hospital. 

We have therefore fixed the price of board per week at the 
same sum for the next year which was paid the past year, with 
a confident belief that thereafter it may be reduced. 



12 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

In concluding this Report, the Trustees ask particular atten- 
tion to the report of the Superintendent, and to the many 
interesting details and valuable suggestions that it contains, 
which will show that the institution is in a highly flourishing 
and satisfactory condition, under the able superintendence of 
Doctor Bemis, and to whom it is no more than justice for us to 
say that he has discharged his numerous and arduous duties 
with a fidelity, energy and ability which are worthy of all 
commendation. 

LINUS CHILD, 

THOMAS COLT, 

J. N. BATES, 

WILLIAM T. MERRIFIELD, 

Trustees. 



1858.] 



PUBLIC DOCUMENT— No. 9. 



13 



TREASURER'S REPORT 



To the Trustees of the State Lunatic Hospital : — 
The Treasurer submits his Annual Report. 

The receipts for the year have been as follows : — 
Cash in hands of Steward, ..... 
Received from the Commonwealth, and from towns 

and individuals for support of patients 
John Wright, 
P. Emory Aldrich, 
Interest on Bonds, 
Note due January 11, 1857, 
Due Worcester Bank, . 
Due Mechanics' Bank, 

The disbursements are as follows 



^140 61 



49,119 


11 


500 


00 


250 


00 


30 


00 


2,000 


00 


8,955 


46 


8,273 


25 



,268 43 



Steward's orders for Books, Print 
For Salaries and wages, 

Improvements and repairs, 

Furniture, 

Clothing, 

Flour, . 

Meal, . 

Provender, 

Biscuit and Rice, 

Coffee, 

Tea, . 

Sugar, 

Molasses, 



ng, &c, 



$322 65 

11,304 17 

4,417 04 

1,684 61 

2,351 13 

4,892 21 

166 89 

1,345 38 

295 61 

535 52 

521 70 

1,905 37 

403 79 



14 



LUNATIC HOSPITAL AT WORCESTER. [Jan. 



For small Groceries, 160786 

Butter, 
Cheese, 
Potatoes, 

Vegetables, . 

Fresh Fruit, 

Vinegar, 

Fresh Meat, 

Salt Meat, . 

Fish, . 

Fuel. . 

Light, . 

Medical supplies, 

Freight, 

Trustees' expenses, 

Sexton's charges, 

Live stock, . 

Heating and ventilating, 

Miscellaneous expenses, 

Worcester Bank, 

Cash refunded to towns, 

P. Emory Aldrich, (services,) 

Sundry accounts, 

Expense of suit against West Springfield, 

Samuel Jennison, for year 1856, 

Samuel Jennison for year 1857, 

Articles furnished by Steward, 

H. Woodward, salary and expenses, 

Cash on hand, .... 

$69,268 43 
Respectfully, 

II. WOODWARD, Treasurer. 
Worcester, December 21, 1857. 



1,658 


87 


74 


19 


1,209 


89 


133 


12 


1,068 15 


42 


06 


1,446 


96 


1,218 


59 


222 


50 


7,628 


24 


777 


38 


771 


98 


2 


78 


118 


00 


397 


05 


501 


97 


7,952 


75 


772 


99 


9,882 


86 


41 


25 


600 


00 


504 


07 


66 


00 


304 


21 


475 42 


385 


77 


157 


84 


132 


91 



Examined and approved by the Auditing Committee. 



J. N. BATES, 

WM. T. MERRIFIELD. 



December 30, 1857. 



1858.] 



PUBLIC DOCUMENT— No. 9. 



15 



SUPERINTENDENT'S REPORT. 



Twenty-fifth Annual Pteport of the Superintendent to the Trus- 
tees of the State Lunatic Hospital at Worcester. 

Gentlemen : — In conducting the affairs of the hospital dur- 
ing the past year, it has been our constant endeavor to maintain 
its reputation, and to add, if possible, to its usefulness. 

"We have made every effort to retain its highly curative 
character, and have spared no pains to make it comfortable, 
cheerful and homelike to those who have been committed to 
its care. 

From your frequent visits and thorough examinations into 
all departments of the institution, you have been able and ready 
at all times to give counsel and direction upon which the suc- 
cess of the year has mainly depended. 

At the commencement of the year, the whole number of 
patients in the hospital was — 



Males, . 


184 


Females, 


192 


Total, . 


376 


Admitted during the 


year — 


Males, . 


126 


Females, 


..... 145 


Total, . 


271 


Whole number under treatment during the year — 


Males, . 


310 


Females, 


337 


Total, . 


647 



16 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

Of this number there has been discharged : — 



Recovered, 
Improved, 
Not improved, 
Died, 




150 

75 

6 

44 



There were remaining in the hospital, at the close of the 
year, November 30, 1857 — 

Males, 177 

Females, 195 



Total, 



372 



It will be seen that one hundred and fifty patients have been 
discharged as recovered in the course of the year. " The cause 
of their commitment ceased to exist," and they returned to 
their homes restored to mental and physical health. 

Seventy-four have been discharged improved. Although 
many of this number were quite well when they left the hos- 
pital, they cannot be said to have recovered. 

Some of them are periodically insane, having long intervals 
of apparent health, during which they remain with their 
friends. 

Others possess a low grade of intellect, and were never able 
to take care of themselves, consequently cannot be consid- 
ered well. 

There has been during the year an unusual amount of sick- 
ness. In the summer and autumn there were several cases of 
fever and dysentery. There were also a few cases of pneumo- 
nia, and several cases of consumption. But a large proportion 
of the disease has been of an ill-defined character, afflicting 
those who have long been feeble and insane. 

The standard of health in a hospital for the insane is always 
low. We look in vain for the signs of vigorous health which 
might be supposed to exist in a community of such activity. 

The constant restlessness and lack of attention to the rules 



1858.] PUBLIC DOCUMENT— No. 9. 17 

of health, together with the loss of sleep, will of themselves 
undermine the best physical health, and reduce a large pro- 
portion of the patients in every hospital for the insane to the 
condition of hopeless invalids. 

TABLE 1, 

Showing the Admissions and state of the Hospital, from 
December 1, 1856, to November 30, 1857. 



Patients in the Hospital December 1, 1856, ... . . . 376 

Males, 184 

Females, 192 

Patients admitted in the course of the year , . . . . . 271 

Males, 126 

Females, 145 

Whole number in the Hospital in the course of the year, . . 647 

Males, 310 

Females, .......... 337 

Patients remaining in the Hospital November 30, 1857, . . 372 

Males, 177 

Females, . . . . . ... . . 195 

Of the admissions, there were cases of less duration than one year, 161 

Males, 79 

Females, 82 

Of the admissions, there were cases of one year or more, . 110 

Males, 52 

Females, ........... 58 

Cases, the duration of whose insanity before admission not ascer- 
tained, ........... 

Males, 

Females, ■. . . 

Patients committed by Courts, 182 

Males, 90 

Females, 92 

Patients committed by Overseers of the Poor, .... 46 

Males, . . 19 

Females, . . 27 

Patients on bonds, 43 

Males, • 19 

Females, 24 

Foreigners, and those who have no settlement in this State, ad- 
mitted in the course of the year, 76 

Males, 34 

Females, 42 

Foreigners, and those who have no settlement in this State, dis- 
charged in the course of the year, 118 

Males, 61 

Females, 57 



18 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

TABLE 1 — Continued. 



Foreigners, and those who have no settlement in this State, remain- 
ing in the Hospital November 30, 1857, 

Males, 

Females, 



119 
50 
69 



State paupers remaining in the Hospital at the close of each year, as nearly 
as can be ascertained 



1842, . 


34 


1850, . 


. 181 


1S43, . 


38 


1851, . 


. 208 


1844, . 


38 


1852, . 


. 241 


1845, . 


57 


1853, . 


. 216 


1846, . 


52 


1854, . 


. 151 


1847, . 


121 


1855, . 


. 115 


184S, . 


150 


1856, . . ' 


. 155 


1849, . 


167 


1857, . 


. 119 



The preceding table will show that you have discharged from 
this hospital, in the course of the year, one hundred and eighteen 
patients who have no settlement in this Commonwealth. 

Very few, if any, of these have been supported otherwise 
than by the charity of the State. They are generally friendless 
and destitute when they become insane, and if they recover, or 
so far improve as to come under your consideration for dis- 
charge, they have no homes to receive them, and no friends 
willing to assist them. 

Under these circumstances, the Alien Passenger Commis- 
sioners have received and placed in the State almshouses a 
considerable number. 

We have procured places for some who are now at service, 
and receiving wages. Others have been assisted by the Alien 
Passenger Commissioners with means to return to their friends 
in other States. 

You will remember that none of these patients have been 
recommended to you for discharge, whose mental and physical 
health did not make such a step advisable. 

Those taken to the almshouses have been visited and care- 
fully observed by the Commissioners themselves previous to 
their removal from the hospital. So that while the Alien 
Passenger Commissioners and the Board of Trustees have been 
equally anxious to relieve the Commonwealth of any unneces- 
sary expenditure, the interests of the patient have always been 
humanely regarded. 



1858.] 



PUBLIC DOCUMENT— No. 9. 



19 



The preceding table will also show that one hundred and 
nineteen patients remain in the hospital who are supposed to 
have no settlement in the Commonwealth. 

A further reference to the table will show the number of 
State paupers to have diminished thirty-six in the course of 
the year. 

The number of State paupers discharged exceeded the num- 
ber admitted by forty-two. 

TABLE 2, 

Showing- the supposed Causes of Insanity of Patients admitted 
in the course of the year. 



CAUSES. 


Males. 


Females. 


Total. 


Ill health, 


17 


41 


58 


Intemperance, 












22 


3 


25 


Domestic affliction, 












3 


10 


13 


Religious excitement, 












o 


2 


4 


Masturbation, 












3 


- 


3 


Disappointed affection, 















4 


6 


Disappointed ambition, 












2 


- 


2 


Epilepsy, 












7 


3 


10 


Puerperal, 












- 


5 


5 


Wound on the head, 












3 


1 


4 


Hard labor, . 












3 


2 


5 


Jealous)', 












4 


2 


6 


Fright, . 












1 


2 


3 


Palsy, . 












4 


3 


7 


Fear of poverty, . 












2 


1 


3 


Fear of death, 












1 


- 


1 


Fatigue and exposure, 












1 


2 


3 


Unascertained, 












49 


64 


113 


Hereditary cases, . 












11 


18 


29 


Periodical cases, . 












9 


17 


26 


Homicidal cases, . 












7 


2 


9 


Suicidal cases, 












6 


7 


13 



The causes of insanity are frequently obscure, — or rather 
there exists in a great proportion of cases a group of circum- 
stances all of which, taken together, are sufficient to produce 
an unsound state of mind, while none, not even the most prom- 
inent one of the combination, could of itself be considered an 
adequate cause. 



20 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

They are also remote, existing not only in former genera- 
tions, but in periods of life distant from the development of the 
disease. Thus the parent, while neglecting the moral and 
physical training of his child, may be laying the foundation 
of a train of infirmities, both in body and mind, that in the 
strength and passion of manhood, shall break out in uncontrol- 
lable insanity. 

Nothing is more difficult, than to give the precise causes of 
insanity ; therefore we are generally content to give in our table 
those which the friends of the patients suppose to be the true 
ones. 

Fifty-eight patients have been admitted in the course of the 
year, who had been for a considerable period of time previous 
to admission afflicted with ill health, and in the absence of other 
known causes this number is set down against " ill health " 
in the table. 

Ill health, in many of its forms, strongly predisposes to melan- 
choly and monomania. It is likewise generally accompanied 
by loss of sleep, which is one of the most prominent symptoms 
of acute mania. 

Intemperance has sent to us twenty-five of its victims, and it 
is shown in another table, that four hundred and thirty-four 
patients have been in previous years committed to this hospital 
from this cause, a fact strongly suggestive of the importance of 
providing in one of the hospitals already in existence more 
appropriate accommodations for their comfort and recovery. 

Seven patients have been admitted, whose insanity was prob- 
ably caused by development of tubercles in the brain. After 
the acute stage of mental disease had subsided, they sunk 
rapidly and died of consumption. 

Domestic affliction, sundering of family ties by death, loss of 
friends, prolonged absence of friends, breaking up of families 
by loss of property, and other causes disturbing the happiness 
of the home circle have given us thirteen of the patients under 
our care during the year; 

We have received several patients whose insanity seemed to 
be caused by disease of the membranes of the brain, commenc- 
ing and going on without attracting particular attention until 
the patient violates the public peace, and is brought to us by 
order of the court of probate. In the beginning the symptoms 



1858.] PUBLIC DOCUMENT— No. 9. 21 

are so slight as to escape the notice of the family in which the 
patient lives, and it is only by reflection and comparison that 
the friends can fix upon any time as the commencement of 
insanity. 

Digestion is impaired, the bowels are irregular in their 
action, and there is loss of sleep. The patient is restless, irri- 
table and morose. He cannot attend to his duties, but his 
mind frequently wanders in vague and extravagant schemes. 
He cannot stay at home, but goes from place to place, some- 
times talking strangely of his extensive business and large 
possessions. He neglects to take food, loses or gives away his 
clothing, meets and falls in readily with strange and unnatural 
associates, and thus goes on from bad to worse, until at length 
there is a complete breaking up of the mental faculties and the 
patient sinks to hopeless idiocy. 

Five of. those admitted during the year were more than eighty 
years of age, and four were between the ages of seventy and 
eighty years. In some of these the light of reason is almost 
entirely obliterated ; and it requires more than ordinary care 
to make them comfortable and decent. 

TABLE 3. 
Diseases ivhich have proved fatal during the year. 



Apoplexy, . . . . . . . . . .1 

Cancer, . . . . . . . . . . . .1 

Chronic Myringitis, ......... 2 

Consumption, .......... 7 

Chronic Dysentery, ......... 1 

Diarrhoea, .......... 1 

Delirium Tremens, 1 

Epilepsy, ........... 6 

Erysipelas, 2 

Gangrene of Lungs, ......... 2 

Maniacal Exhaustion, ........ 5 

Marasmus, .......... 4 

Pneumonia, .......... 1 

Palsy, 4 

Old Age, 3 

Influenza, .......... 2 

Suppurative Phlebitis, 1 

Total, 44 



22 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

Three patients died during the year who were more than 
eighty years of age. Nine of those who died were between the 
ages of seventy and eighty years and three were sixty-nine 
years of age. 

One patient died within six hours after his admission. One 
in three days after admission. One in eleven days after admis- 
sion. One in thirteen days after admission, and one in seven- 
teen days after admission. 

Nineteen of the deaths mentioned in the table occurred to 
patients admitted during the year. 

TABLE 4, 
Showing the Ages of Patients admitted during the year. 



Less than 15 years of age, 2 

Between 15 and 20, 16 

20 and 30, .77 

30 and 40, 78 

40 and 50, 61 

50 and 60, 22 

60 and 70, 7 

70 and 80, 4 

More than 80 years of age, 5 

Total, 271 



TABLE 5, 

Showing the Ages of Patients remaining in the Hospital 
November 30, 1857. 



9 



Less than 15 years of age, 

Between 15 and 20, 5 

20 and-30, 71 

30 and 40, 119 

40 and 50, 97 

50 and 60, . , 48 

60 and 70, 17 

70 and 80, 6 

More than 80 years of age, 7 

Total, 372 



1858.] 



PUBLIC DOCUMENT— No. 9. 



23 



TABLE 6, 

SJiowi?ig- the Duration of Insanity before admission, of those 
admitted during the year. 



Insane less than 1 year, 161 


more than 1 and less than 2 years, 








29 


2 and less than 5 years, 








27 


5 and less than 10 years, 








16 


10 and less than 15 years, 








11 


15 and less than 20 years, 








14 


20 and less than 25 years, 








3 


25 and less than 30 years, 








1 


30 years, 








2 


Unascertained, ..... 








7 


Total, 271 



TABLE 7, 

Showing' the Duration of Insanity of those remaining No- 
vember 30, 1857. 



Insane less than 1 year, .46 


more than 1 and less than 2 years, 






. 32 


2 and less than 5 years, 






. 63 


5 and less than 10 years, 






. 112 


10 and less than 15 years, 






. 51 


15 and less than 20 years, 






. 29 


20 and less than 25 years, 






. 10 


25 and less than 30 years, 






3 


30 years, 






7 


Unascertained, 






. 19 


Total, 372 



24 



LUNATIC HOSPITAL AT WORCESTER. [Jan. 



TABLE 8, 

Shoiving the Civil Condition of Patients admitted during- the 
year, and of those remaining at the end of the year. 



Unmarried, 124 

Married, 119 

Widows, 16 

Widowers, • ■ • .10 

Unascertained, . 2 

Total, 271 

Civil condition of those remaining, November 30, 1857 : — 

Unmarried, 204 

Married, 129 

Widows, 18 

Widowers, 19 

Unascertained, 2 

Total, 372 



TABLE 9, 

Showing the Occupation of Patients remaining, November 30, 

1857. 



Farmers, 30 


Sail-makers, .... 2 


Laborers, . 






38 


Rigger, 








1 


Shoemakers, 






22 


Peddlers, . 








2 


Manufacturers, . 






3 


Cooper, 








1 


Tailors, 






4 


Tinker, 








1 


Clerks, 






9 


Painter, 








1 


Operatives in Mill, 






6 


Hatter, 








1 


Sea Captains, 






1 


Paper-maker, 








1 


Sailors, 






5 


Bookkeepers, 








2 


Machinists, 






2 


Bookbinder, 








1 


Stone-masons, . 






3 


Editor, 








1 


Brick-masons, . 






2 


Lawyer, 








1 


Blacksmiths, 






5 


Clergyman, 








1 


Harness-maker, . 






1 


Teachers, . 








2 


Merchants, 






5 


Quack Doctor, 








1 


Stage Drivers, . 






3 


No employment, 






14 


Carpenters, 






3 





Overseers in Mill, 




2 


Total, 177 



1858.] PUBLIC DOCUMENT— No. 9. 

TABLE 9— Continued. 



25 



Women. 




Straw-sewer, 


. 1 


Housekeepers, . 


. 62 


Midwife, . 


. 1 


Seamstresses, 


. 28 


Laundresses, 


. 7 


Housemaids, 


. 23 


School Girls, 


. 3 


Operatives in Mill, . 


. 15 


No employment, 


. 46 


Milliners, .... 


. 4 







Teachers, .... 


. 5 


Total, . " . 


. 195 



TABLE 10, 

Showing the Occupation of Patients admitted in the course of 

the year. 



Farmers, 24 


Peddler, .... 


. 1 


Laborers, . 






28 


Waiter in Hotel, 


. 1 


Shoemakers, 






15 


Teacher, .... 


. 1 


Manufacturers, . 






4 


Editor, .... 


. 1 


Tailors, 






3 


Unascertained, . 


. 14 


Clerks, 






5 




— 


Operatives in Mill, 






5 


Total, 


. 126 


Sea Captains, 






2 






Sailors, 






2 


Women. 




Machinists, 






2 


Housekeepers, . 


. 51 


Stone-masons, . 






2 


Seamstresses, 


. 13 


Brick-masons, . 






2 


Housemaids, 


. 19 


Blacksmiths, 






2 


Operatives in Mill, . 


. 13 


Harness-makers, 






2 


Milliners, .... 


. 3 


Merchants, 






2 


Teachers, .... 


2 


Stage Drivers, . 






2 


Straw-sewer, 


. 1 


Carpenter, . 






1 


Midwife, .... 


. 1 


Overseer in Mill, 






1 


School Girls, 


. 5 


Sail-maker, 






1 


Laundresses, 


. 3 


Rigger, 






1 


No employment, 


. 34 


Plasterer, . 






1 







Fisherman, 






1 


Total,. 


. 145 



26 



LUNATIC HOSPITAL AT WORCESTER. [Jan. 



TABLE 11. 

Showing the number of Admissions and Discharges, and the 
Whole Number under Treatment for each month in the 
year. 







Admissions. 


Discharges. 




Whole 
S umber. 




















Males. 


Females. 


Males. 


Females. 


December, 1856, .... 


400 


12 


11 


18 


6 


January, 1857, 










399 


9 


14 


4 


6 


February, " 










410 


11 


10 


6 


12 


March, " 










416 


13 


11 


5 


10 


April, " 










423 


8 


14 


18 


18 


May, " 










410 


13 


10 


14 


12 


June, " 










413 


9 


20 


6 


18 


July, 










409 


11 


9 


11 


8 


August, " 










415 


10 


15 


14 


10 


September, " 










405 


6 


8 


11 


14 


October, " 










410 


14 


16 


8 


14 


November, " 










405 


10 


7 


18 15 


Total, . 












126 


145 


133 143 



The following table was prepared from the previous Reports 
of this hospital, by that eminent statistician, Doctor Edward 
Jarvis, of Dorchester, and is published by his request. 

It embraces all the causes of insanity given by the friends of 
patients, or discovered by other means, since the opening of 
the hospital. 

It does not, however, include the whole number of admissions, 
because in all cases where the cause has not been discovered, 
it has been registered in the table as " unknown." 

The following table does not include this large class of cases. 

The table is valuable as embracing a period of twenty-five 
years, and covering about five thousand and five hundred cases. 

The value of other tables would be equally increased by 
extending them through the whole number of years the hos- 
pital has been in existence, which they may hereafter be made 
to do. 



1858.] 



PUBLIC DOCUMENT— No. 9. 



27 



TABLE 12. 

Supposed Causes of Insanity of Patients admitted into the Hos- 
pital from January, 1838, to November 30, 1857. 



CAUSES. 



Apoplexy, . . . 
Asthma, .... 
Bowels, disease of, 
Brain, inflammat'n of, 
Bronchitis, . . 
Chorea, . . . 
Congenital, 
Constipation, . 
Convulsions, . 
Dysentery, 
Dyspepsia, . . 
Epilepsy, . . 
Eruptions, . . 
Eyes, disease of, 
Eyes, loss of, . 
Fever, . . . 
Fever, scarlet, 
111 health, . . 
Influenza, . 
Insolation, . . 
Laryngitis, . . 
Measles, . . . 
Nervous irritation 
Nymphomania, 
Old age, 
Olitis, . . 
Palsy, . . 
Periodical, . 
Pneumonia, 
Rheumatism, 
Satyriosis, . 
Scrofula, 
Sea-sickness, 
Somnambulism, 
Sore finger, 
Spinal disease, 
Suppressed eruption 
Suppressed ulcer, 
Tic douloureux, . 
Tumor, .... 
Whooping-cough, 
Amenorrhea, . . 
Lactation, . . . 
Menorrhagia, . . 
Menorrhagia suppres'd 



Males. 


Females. 


2 




o 


- 


1 


- 


1 


5 


2 


13 


- 


2 


4 


- 


- 


1 


8 


6 


1 


2 


2 


_ 


73 


30 


2 


1 


1 


- 


1 


- 


25 


32 


1 


3 


135 


467 


1 


5 


12 


- 


- 


1 


3 


4 


_ 


4 


- 


1 


7 


3 


3 


- 


34 


21 


48 


56 


- 


1 


3 


1 


1 


- 


- 


2 


_ 


1 


— 


1 


• 


1 

1 


5 


4 


1 


3 


_ 


1 


- 


1 


- 


1 


- 


14 


- 


5 


- 


2 


- 


1 



Miscarriage, . . 

Pregnancy, . . 

Puerperal, . . 

Turn of life, . . 

Amputation of leg, 

Bathing in cold water 

Cut foot, . . . 

Dog bite, . . . 

Drinking cold water 

Dye-house fumes, 

Exposure to cold, 

Fall, .... 

Fracture of arm, 

Injury,. . . . 

Injury of head, . 

Kick of horse, . 

Lead, poison of, . 

Lightning, . . 

Loss of blood, 

Malformat'n of head 

Poison, . . . 

Spinal injury, . 

Excess of labor, . 

Loss of sleep, 

Fatigue & exposure 

Study, excessive, 

Inventions, . . 

Excitement, . . 

Excitem't of politics 

Anticipation of mar- 
riage, . . . 

Fortune being told, 

Enthusiasm, . . 

Mesmerism, . . 

Spiritualism, . . 

Light reading, nov 
els, &c, . . . 

Anxiety, . . . 

Criminal trial, . 

False accusation, 

Imprisonment, . 

Death of brother, 

Death of children, 

Death of father, . 

Death of friends, 



4 

43 

1 

2 

1 
1 
1 
1 
1 
28 

1 

25 

1 

2 

i 



10 



28 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

TABLE 12— Continued. 



Death of husband, 
Death of mother, 
Death of niece, 
Death of sister, 
Death of wife, . 
Husband departur 
Husband sickness, 
Husband intemperate, 
Husband desertion, 
Husband abuse, . 
Abuse of master, . 
Abuse of parent, . 
Domestic trouble, 
Domestic grief, . 
Domestic cares, . 
Marriage, unfit, . 
Disappointment, . 
Disappointm't in love, 
Disappointment in 
ambition, . . . 
Home-sickness, . . 
Lost in woods, . . 
Shipwreck, .... 

Fright, 

Fear, 

Fear of death, . . . 
Fear of insanity, . . 
Being witness in Court, 
Seduction, .... 
Millerism, .... 
Religious, .... 
Religious anxiety, . 



Males. 


Females. 




19 


1 


6 


_ 


1 


- 


3 


10 


- 


- 


1 


- 


3 


— 


2 


- 


2 


- 


7 


1 


- 


1 


2 


57 


127 


56 


137 


- 


1 


4 


2 


4 


7 


47 


51 


5 


5 


1 


5 


- 


1 


1 


- 


10 


15 


2 


_ 


i 


_ 


i 


- 


- 


1 


- 


1 


5 


5 


89 


142 


1 


4 



Religious excite- 
ment, .... 
Religious fanaticism, 
Religious perplexity, 
Pathetism, . . . 
Infidelity, .... 
Mormonism, . . . 
Pecuniary anxiety, 
Pecuniary difficulty, 
Pecuniary loss, . 
Strike for wages, 
California fever, 
Poverty, . . . 
Fear of poverty, 
Giving up business, 
Change of business, 
Indulgence of pa- 
rents, .... 
Bad education, . . 
Violent temper, and 
passion, .... 
Jealousy, .... 
Passion uncontrolled, 

Anger, 

Great indignation, . 
Vicious habits, . . 
Irregularities, . . 
Intemperance, . . 
Opium, .... 
Tobacco, .... 
Masturbation, . . 
Venery, excess of, . 



13 

13 

9 

1 
1 

18 

55 

43 

1 

2 

25 
1 
1 

1 
2 

1 
16 



413 

1 

230 
1 



o 

8 
10 



1 
11 



13 

20 

1 

1 

1 
1 

46 
3 
3 

22 



1858.] 



PUBLIC DOCUMENT— No. 9. 



29 



TABLE 13, 

Showing the Admissions from each County during the last and 
previous years. 













1857. 


Total. 


Previously. 










Whole No. 




Males. 


Females. 








Barnstable, .... 


1 




1 


123 


126 


Berkshire, 










6 


4 


10 


167 


177 


Bristol, 










- 


- 


- 


281 


281 


Dukes, 










- 


- 


_ 


19 


19 


Essex, 










28 


33 


61 


331 


392 


Franklin, 










2 


3 


5 


116 


121 


Hampden, 




1 






14 


20 


34 


300 


334 


Hampshire, 










6 


o 


11 


203 


214 


Middlesex, 










31 


33 


64 


654 


718 


Nantucket, 










_ 


- 


- 


3L 


31 


Norfolk, 










1 





3 


562 


565 


Plymouth, 










1 


1 


o 


227 


229 


Suffolk, 










3 


10 


13 


555 


568 


Worcester, 










32 


33 


65 


1,318 


1,383 


Other States, 








1 


1 


2 


10 


12 


Totals, 










126 


145 


271 


5,197 


5,468 



30 



LUNATIC HOSPITAL AT WORCESTER. [Jan. 



TABLE 14, 

Shoiving the whole number of Patients during the year, the 
number at the end of each year, and the expenses of each of 
the twenty-five years the Hospital has been in operation. 





Whole Ko. of 
Patients dur- 
ing the year. 


Average No. 


Ko. at the end 


Current expenses 


Annual expense 


Year. 


each year. 


of each year. 


each year. 


for each patient. 


1833, . 


153 


107 


114 


$12,272 91 


'$114 67 


1834, . 


233 


117 


118 


15,840 97 


135 38 


1835, . 


241 


120 


119 


16,576 44 


137 30 


1836, . 


245 


127 


138 


21,395 28 


168 44 


1837, . 


306 


163 


185 


26,027 07 


159 64 


1838, . 


362 


211 


218 


28,739 40 


136 20 


1839, . 


397 


223 


229 


29,474 41 


132 16 


1840, . 


391 


229 


236 


27,844 98 


121 59 


1841, . 


399 


233 


232 


28,847 62 


123 81 


1842, . 


430 


238 


238 


29,546 87 


111 12 


1843, . 


458 


244 


255 


27,914 12 


114 40 


1844, . 


491 


261 


263 


29,278 75 


112 17 


1845, . 


656 


318 


360 


43,888 65 


138 88 


1846, . 


637 


359 


367 


39,870 37 


111 06 


1847, . 


607 


377 


394 


39,444 47 


104 62 


1848, . 


655 


404 


409 


42,860 05 


106 09 


1849, . 


682 


420 


429 


40,870 86 


97 31 


1850, . 


670 


440 


441 


46,776 13 


106 40 


1851, . 


704 


462 


466 


52,485 33 


112 61 


1852, . 


775 


515 


532 


43,878 35 


85 20 


1853, . 


820 


537 


520 


53,636 66 


103 14 


1854, . 


819 


430 


381 


53,221 52 


123 77 


1855, . 


580 


349 


336 


54,895 88 


157 29 


1856, . 


577 


357 


376 


45,631 37 


128 64 


1857, . 


647 


387 


372 


49,004 75 


124 04 



1858.] 



PUBLIC DOCUMENT— No. 9. 



31 



By referring to the Treasurer's Report, it will be seen that 
the disbursements for all purposes in the course of the year, 



were ...... 

Deduct from this amount on account 

of heating and ventilation, 
Due Worcester Bank, 
Cash refunded to towns, 
P. Emory Aldrich", (services,) 
Sundry accounts, 
Expense of suit, . 

Treasurer's expenses for year 1856, 

1857, 
Cash on the hand, 



,268 43 



Cost of su 
857, . 



upporting patients during the year 



17,952 75 








9,882 


86 








41 


25 








600 


00 








504 


07 








66 


00 








304 


21 








779 


63 








132 


91 












$20 


263 


68 







$49,004 75 



32 



LUNATIC HOSPITAL AT WORCESTER. [Jan. 




1858.] 



PUBLIC DOCUMENT— No. 9. 



33 






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1858.] PUBLIC DOCUMENT— No. 9. 53 

Manual labor is perhaps one of our most reliable curative 
resources. 

Every year's experience gives us additional proof of the 
value of well directed labor in the care and cure of the insane. 

The ordinary work of the farm and gardens is best, and 
in the warm season these supply a large number of patients 
with sufficient employment. But the amount of work per- 
formed by the patients on the farm and in the gardens, cannot 
be estimated by the crops grown upon the land, as probably 
much more labor has been expended in improvements on 
the farm and grounds of the hospital by laying down drains, 
filling up old foundations, removing and building walls, grading, 
reclaiming land, &c. In the winter it is much more difficult to 
provide suitable and sufficient employment for all who would 
be benefited thereby. 

Some are busied in and about the barn and stables. A few 
work in the cellars, removing rubbish, &c. Others assist in the 
carpenter's shop, repairing broken furniture for the house 
or tools for the farm. We always make and repair our own 
mattresses. We have on several occasions done some work for 
upholsterers in the city, and in the early part of the year made 
some clothing for manufacturers. Still for a great number we 
have not sufficient employment, and this difficulty is probably 
not confined to this hospital. We have carefully examined 
this subject, and thought much of the propriety of establishing 
for ourselves some kind of business in which many of the 
patients can engage. During the past year, it has been difficult 
to procure work from abroad, and of late, owing to the depressed 
state of business, utterly impossible. 

The establishment of any business of our own seems of 
less consequence since the removal of so many of the State 
paupers. Ability to labor being one of the chief reasons 
of their removal. Still it should be remembered that in every 
hospital for the insane there is a considerable number of 
patients who must remain for a long time. Some of them 
while under the control of an institution are not much 
deranged, but when at large, exhibit propensities dangerous to 
the community, and therefore require the care and discipline of 
an asylum. 

In every hospital for the insane this class must increase. 



54 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

Consequently it is the part of a wise and humane economy 
to provide for them some regular and available employment. 
Systematic labor is essential to their quiet and comfort, and 
often to their restoration to mental health. 

Nothing so soon interests the visitor at an English asylum as 
the amount of useful labor performed by the inmates. We 
have seen the result of a thorough system of employment 
in an English asylum for the insane, which might shame 
almost any industrial institution in our country. 

We would not impose upon the poor insane the burden 
of servants, or permit them under any circumstances to per- 
form menial service as such, but by pleasant daily tasks of 
labor, judiciously chosen and directed, assisted and animated 
by proper helps, lead them back to correct habits of life, 
and restore them to the enjoyment of rational beings. 

In the application of labor as a remedial measure, we engage 
the healthy powers of the mind and thereby bring quiet and 
rest to those that are diseased. If a patient laboring under 
any particular delusion or diseased impression be persuaded to 
perform any task, he must give his undivided attention to it if 
he does it well. While his mind is thus occupied it is neces- 
sarily diverted from his disease ; and in proportion as cheerful 
labor is continued will be the freedom from delusion and 
restoration to health. It will restore regularity to the opera- 
tions of the mind. It will give health and strength to the 
body and bring about a new and healthy class of impressions. 

Next in importance to manual labor is mental occupation. 

You will observe as you visit this or any similar institution 
a few, comparatively, at work; some engaged in playing 
games, others reading a newspaper, or perhaps a book. Two 
or three perhaps studying a picture or map; while a large 
number will be found sitting about, dull, idle, silent, manifest- 
ing no interest in any thing around them, leaning for support on 
the corners and projections of the apartment, gazing into va- 
cancy — with a listless stare, and if disturbed by another patient, 
muttering in broken and incoherent phrases, desiring nothing 
but the hour of surfeit at the table, or that of a more profound 
forgetfulness in sleep. 

When the weather is propitious, they walk or ride, but this 
soon becomes mechanical and affords no real enjoyment ; they 



1858.] PUBLIC DOCUMENT— No. 9. 55 

notice but little and converse less during the walk or ride, and 
are not much refreshed and exhilarated when they return. 

This class of patients make but little trouble in an asylum, 
and are too frequently overlooked and neglected, and if not 
already fatuous soon become so. 

They have apparently good physical health, are quiet in their 
habits, and unable to command attention by loss of power, or 
enlist sympathy by absence of visible sufferings, consequently 
they are forgotten in the pleasanter task of attending to the 
less needy but more susceptible patients of the ward. We be- 
lieve this class require much of our attention ; they need to be 
aroused into mental activity. Their minds should be awakened 
by some daily exercise, opening to them new and varied scenes. 
Thus assisted in labor and amusement, their minds will regain 
some strength ; their memories improve ; their habits become 
better ; and by perseverance many will be rendered capable of 
a much higher scale of enjoyment, and saved from a state 
of hopeless fatuity. Controlled by such considerations we 
take advantage of every method for exercising and improving 
the minds of our patients. And we have the satisfaction 
of witnessing in many cases, not only recovery from insanity 
but the acquisition of an improved state of mind, apparent 
to the friends, and appreciated by the patients themselves. 

There are two classes of patients brought to the hospital 
worthy of notice, as being apparently improper subjects for our 
care. 

We have received during the year several aged people, 
suffering simply from mental decay, and whose friends are 
ready to admit that the patients are brought here to die. All 
treatment in such cases must be quite unavailing. Proper 
attention to hygienic rules is all that can be suggested. 

The organs of the senses in aged people have suffered such 
physical changes that impressions are conveyed to the brain in 
a dim and indistinct manner. So that while the old man 
judges correctly on the events of his early life, his opinion of 
the things going on about him must be taken with much 
allowance. As disease progresses, sensations produced by 
objects around him are so slight and the ideas connected with 
them so confused that the individual loses all power of con- 
centration. 



56 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

So that while the occurrences of to-day are not regarded, the 
memory of childhood is strong and clear. " The years have 
now come in which he has no pleasure." " The grasshopper 
shall be a burden and desire shall fail." 

He now contends for the attentions bestowed upon children, 
and at the same time, feebly endeavors to maintain patriarchal 
authority. Placed by disease and decay in false relations 
to their family and friends they become the objects of incessant 
care and anxiety. There is an obvious impropriety in commit- 
ting this class to our care. They cannot recover, and but 
seldom improve. Their waning existence should be made 
cheerful and attractive, by all the delicate attentions of home. 
Although, from inability to associate the ideas connected with 
things going on around them, they may not suffer keenly the 
loss of home with its accustomed pleasures. Still, a hospital in 
its best estate is but a poor exchange for the kind offices of love 
and affection. 

The' other class are cases of recent disease, assuming very 
nearly the form of maniacal excitement, occasionally ushered in 
by slight depression, but more generally quite suddenly without 
any of the usual premonitory symptoms. 

Not unfrequently is there a manifestation of great fear or 
violence which passes rapidly into delirium, and the patient 
is brought to us in a peculiarly drooping and sinking condition. 
The tongue is loaded, the pulse small and frequent, the features 
contracted and expressive of great anxiety. The mind of the 
patient seems disturbed by vague and fearful apprehensions 
which are expressed by low and indistinct muttering. 

These cases generally prove fatal in a few days. Death 
resulting from exhaustion of the vital powers consequent upon 
prolonged excitement, fasting and absence of sleep. 

This disease seems to be aggravated by the agitation of 
travelling and change of location. 

Cathartics have entered somewhat largely into the medical 
treatment of our patients during the year. Perhaps we do not 
clearly understand the close relation existing between the brain 
and the condition of the alimentary canal. Much of the 
uneasiness and morbid sensibility from which so many of our 
patients suffer — that condition of mind which cannot be cheered 
by hope or diverted by pleasure, is frequently nothing more 



1858.] PUBLIC DOCUMENT— No. 9. 57 

than the natural result of the sympathy existing between the 
morbid conditions of the alimentary canal and the brain. 

We do not like to admit the frailty of man to such a degree 
that a slightly overtasked stomach or a constipated condition of 
the bowels will cloud all his worldly prospects, render him 
dissatisfied with life and all its blessings, make him suspicious 
of friends and jealous of his own household ; but it cannot 
be denied ; and the cure of that disordered state of the imagi- 
nation, so often observed in this class of patients, and their 
restoration to the best estate of manhood, may generally be 
brought about by the means directed to relieve the diseased 
state of the stomach and bowels. 

The process may be slow ; but if perseveringly followed and 
assisted by pure air, active exercise and cheerful companionship, 
will be crowned with success. 

No class of patients suffer more than those whose insanity is 
caused by disease of the digestive organs. The lassitude, the 
sense of oppression, the partial loss of memory, the inability 
to fix the attention renders them victims to every circumstance, 
and thus keeps up a mental irritability sufficient to interfere 
with the healthy action of all the intellectual faculties. 

We have received during the year a better class of patients 
than ever before. If we would have this desirable state of 
things continue, the wards must be embellished with greater 
liberality, and many of the apartments must be refurnished 
with more taste and elegance. 

The reason why those able to pay generously do not place 
their insane relatives here is simply because they find no 
suitable accommodations for them. It certainly is unwise to 
pamper the appetite of the insane by highly seasoned and 
luxurious food ; but there can be no reason why they should 
not be surrounded by books, music, pictures and elegant 
furniture. To deprive a man at once of all the refinements 
and luxuries of good society and reduce him to the cheerless 
simplicity of a pauper institution for the insane, would be 
any thing but curative in its results. Hence the necessity of 
greater exertion and more liberal expenditures in this depart- 
ment of the hospital. 

A reference to our tables will show that a very small 
proportion of cases are brought to us in the early stages of 
8 



58 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

disease. From mistaken views in regard to insanity, and false 
impressions in relation to the humanity of hospital treatment, 
months are allowed to pass with the patient at home. No effort 
is made by the friends to restore his gradually sinking powers, 
until he wanders away from his family and is exposed to cold 
and hunger, or perhaps commits some flagrant act and becomes 
dangerous to the peace and safety of the community. 

Thus, the chances of recovery are very much diminished, 
unjust conclusions are arrived at in regard to the curability of 
the disease, and all the benefits of judicious medical and moral 
treatment are lost. 

During the year there has been great freedom from mechani- 
cal restraint. 

We have not however succeeded so well with females as with 
males. In the early part of the year it was thought necessary, 
from motives of decency, to apply the camisole to two or three 
women for a short time while suffering from acute mania. In 
the spring one or two suicidal females wore the camisole 
frequently during a part of the day for several weeks. While 
two old patients, both of whom refused to wear clothing, often 
wore the camisole several days in succession for a period of six 
months, having it always removed at night. 

Since the first of July, however, there has been no application 
of mechanical restraint of any kind to any female patient under 
our care. Nor has any one since that time been secluded 
in her own or any other room during a whole day. 

No male patient has been secluded in his own or any other 
room a whole day during the year. There have been two 
applications of mechanical restraint to male patients in the 
course of the year. In one case the restraint was immediately 
removed. In the other the patient was suffering from a surgi- 
cal operation, and wristbands, which he wore for several days 
in succession, were placed upon him for the purpose of securing 
dressings. 

It is reasonable to suppose that brief periods of seclusion 
may be necessary in the care and treatment of the insane. It 
is possible likewise that mechanical restraint may be in rare 
cases beneficially applied. 

But no mistake can be more serious in its effects upon 



1858.] PUBLIC DOCUMENT— No. 9. 59 

the patients of a hospital for the insane, than the too frequent 
resort to the use of restraining apparatus. 

The amusements and pastimes of former years have been 
kept up, and every method has been adopted to relieve the 
patients of that dull and tedious monotony so often experienced 
by those who are so unfortunate as to be committed to the 
care of a hospital for the insane. 

As much of every day as can be set apart for that purpose is 
spent by the patients in the open air, riding, walking, or at 
work. 

The evenings are generally devoted to needle-work, reading, 
and games among the females, and reading and games among 
the males. 

Magic lantern exhibitions, parties and concerts, occasionally 
take place and afford great pleasure. 

Books and an abundance of newspapers are at all times 
accessible, which are highly valued. 

Maps and pictures are also instrumental in giving relief, 
while the little decorations of the wards and rooms made 
and put up by patients beguile them of many weary hours. 
In fulfilment of your wishes there has been placed in the 
Trustees' room a portrait of George Chandler, M. D., who was 
so long at the head of this hospital, and from whose perse- 
vering labor so much of its prosperity has resulted. The por- 
trait is by Wight, in the best style of art, and is said to be a 
correct likeness. 

We have made such additions as we could to the patients' 
libraries, and have also added a little to the embellishment 
of the wards. 

About one hundred volumes of medical books and publica- 
tions have been collected as the beginning of an office library. 

A medical library is a want of the institution, which should 
be supplied. Small additions, judiciously selected and safely 
kept, would soon give us a respectable collection of books at a 
moderate expense. 

We can now speak definitely of our method for warming and 
ventilating the hospital. The plan has been in operation 
one year and has accomplished its work in the most thorough 
and successful manner at a reasonable expense. 



60 



LUNATIC HOSPITAL AT WORCESTER. [Jan. 



The following table will show the exact amount of coal 
consumed in eight consecutive months : — 



April, 




. 


49,650 pounds 


May, . 




. 


48,000 


June, 




. 


42,000 


July, . 




. 


40,980 


August, 




. 


37,250 


September, 




. 


36,000 


October, 




. 


86,800 


November, 




• 


. 111,200 


dly average consumption was : — 


April, 1,655 pounds 


May, 1,548 


June, 1,400 


July, 1,321 


August, 1,201 


September, 1,200 


October, . . . 2,800 


November, . 






3,706 



It is impossible to give the precise amount consumed in the 
four months preceding the first of April. The air chamber 
under the wings for the transmission of air to the wards 
was for several weeks in an unfinished condition, allowing 
much of the heated air to escape without performing its office. 
This state of things made it necessary to consume a large 
amount of coal for about two months. 

As nearly as can be estimated, we consumed three tons daily 
during the months of December and January. And two tons 
daily during the months of February and March. 

This seems a small quantity of fuel when we consider 
the extremely cold and windy weather of the winter, and 
the unfinished condition of the air chamber. 

Our accounts show a much greater quantity of coal than the 
above statement will warrant. But you will remember that 
we had a small quantity only on hand, and made our first 
purchase of coal in January. Judging as well as we can from 



1858.J PUBLIC DOCUMENT— No. 9. 61 

the experience of the last year, we have now a supply sufficient 
to last a full year from the present time. 

In June we purchased seven hundred and fifty tons of coal, 
taking the bills of lading at $7.38 per ton. The coal was 
delivered in good order and is of first rate quality. 

In making this purchase it was supposed that the largest 
quantity it might be necessary to consume, under any circum- 
stances, would be three tons daily from the 1st of November to 
the 1st of April, and one ton daily from the 1st of April 
to the 1st of November. Making a daily average of two 
tons a day for the year. 

The table will show that the result for eight months is 
considerably within the estimate ; and that the whole quantity 
consumed in a year is not far from five hundred and fifty tons. 
While the hospital has been comfortably warmed in cold 
weather, it has been made cool in hot weather, and ventilated 
at all times. 

There is now in all parts of the house a constantly breathable 
condition of the atmosphere. In the wards assigned to violent 
and filthy patients the change is quite surprising. Formerly, 
when no filth offended the eye the air was always loaded 
with noxious odors. The patients were noisy, filthy and dis- 
gusting. Now they are quiet, comfortable and decent. 

In a hygienic point of view, the fan is the most important 
part of our apparatus, and its benefits can hardly be over- 
stated. 

As a mechanical contrivance it has no superior, and in 
its operation it will be found to compare favorably with any 
thing of its kind. Simple in its construction, effectual in its 
working, it can readily be adapted to any condition of the 
weather and requires but little power in its motion. 

Some attention has been given to the subject of improve- 
ments and repairs. One ward has been almost entirely refitted 
and refurnished. Some of the others have been painted. The 
patients' dining-rooms, situated in the centre building, have been 
given up, and pleasant dining-rooms made in the wards. 

In place of the old dining-rooms in the centre building 
we now have for each side of the hospital — male and female — 
a room furnished where a patient can be taken care of while 
sick, by his or her friends, without coming in contact with other 



62 



LUNATIC HOSPITAL AT WORCESTER. [Jan. 



patients. In another story, and contiguous to the wards, we 
have for each sex a furnished room where patients can receive 
their friends without being disturbed by other visitors. In the 
lower story near the entrance and opening into the wards 
are two sitting-rooms, one on each side of the house, for such 
patients as may not be strictly confined to the wards. There 
have also been put into the centre building two bathing-rooms 
with water closets. These changes have long been desired. 

In grading some portion of the grounds more than six 
thousand ox-cart loads of earth have been removed, besides 
removing and replacing the soil with a scraper. 

About two hundred rods of old wall have been removed and 
between fifty and sixty rods of heavy faced wall have been 
built. 

All the drains and cess pools of the establishment have been 
connected with the force pump, and the iron main pipe through 
which the sewerage is forced has been lengthened five hundred 
feet. 

These are some of the more important items of improvement 
and repairs which have been accomplished during the year. 

Articles made by the female patients in the months of Sep- 
tember, October and November, 1857 : — 



Bed Ticks, . 


. 50 


Pillow Cases, 


282 


Chemises, 


. 165 


Sheets, . 


224 


Dresses, 


. 57 


Spreads, 


27 


Frocks, . 


. 2 


Shirts, . 


. 67 


Hose, pairs of, 


. 32 


Table Covers, 


. 5 


Napkins, 


.30 


Towels, 


. 109 


Pants, pairs of, 


. 2 


Window Curtains, . 


. 50 


Pillows, 


. 85 


Yests, . 


. 2 



The following table will show some of the results of labor 
performed on the farm and in the gardens : — 

Apples, 

Cherries, 

Plums, 

Grapes, 

Corn, sweet, 

Beans, 



100 bushels 


at $0 50— 


$50 00 


10 " 


at 2 00 


20 00 


1 " 


at 2 00 


2 00 


5 " 


at 2 00 


10 00 


120 " 


at 50 


60 00 


25 " 


at 2 00 


50 00 



1858.] 



PUBLIC DOCUMENT— No. 9. 



63 



Pease, 


50 bushels, 


at$l 00- 


- $50 00 


Beets, . 


50 


at 





50 


25 00 


Onions, . 


150 " 


at 


1 


00 


150 00 


Cucumbers, 


100 " 


at 





50 


50 00 


Tomatoes, 


100 " 


at 





75 


75 00 


Parsnips, . 


30 " 


at 





50 


15 00 


Squashes, 


2,000 pounds, 


at 





01 


20 00 


Cabbages, 


2,500 heads, 


at 





03 


75 00 


Milk, . 


35,000 quarts, 


at 





05 


1,750 00 


Butter, 


2,000 pounds, 


at 





25 


500 00 


Beef, . 


5,000 " 


at 





09 


450 00 


Pork, 


8,550 « 


at 





10 


855 00 


Hay, 


75 tons, 


at 12 


00 


800 00 


Rowen, 


6 " 


at 10 


00 


60 00 


Corn fodder, 


. . . . 




. 




100 00 


Chinese Sugar Cane, 


• • . . 




. 




15 00 


Carrots, . 


800 bushels 


at 





25 


200 00 


Beets, 


800 " 


at 





20 


160 00 


Turnips, . 


500 " 


at 





15 


75 00 



Total, 



1,617 00 



To the other resident officers of the hospital I am under 
great obligation for their untiring devotion to the interests 
of the institution, and the cheerful spirit in which they have 
performed all their duties. 

Miss Elizabeth A. Eeid, who was for many years the kind 
and faithful Matron of the hospital, resigned her office on 
the 1st of October. 

Thomas H. Gage, M. D., who was assistant physician about 
one year, and who proved himself to be a valuable officer, left 
in July for private practice in this city. 

Thanks are due to Miss Dix for many kind attentions in 
behalf of the patients. 

Editors and publishers in various parts of the State send 
us their papers free of charge, for which we are truly grateful. 

From the Palladium office in this city we receive weekly 
large bundles of exchange papers, and from the Transcript 
office in this city, we receive the same daily, affording us 
a liberal supply of newspapers from all parts of the country. 



64 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

The Commissioner of Patents and other gentlemen con- 
nected with public offices, frequently send us valuable public 
documents. 

In reviewing the events of the year we feel that we have 
been signally blessed in all our efforts, and with emotions 
of gratitude to Him who has sustained us in the labors of the 
past we commence the duties of another year, hoping and 
trusting that by His direction we may be enabled to discharge 
them faithfully and well. 



MERRICK BEMIS. 



State Lunatic Hospital, "Worcester, 
December 1, 1857. 



METEOROLOGICAL OBSERVATIONS 

MADE AT THB 

STATE LUNATIC HOSPITAL, WORCESTER, MASS., 

By J. SMITH SARGENT, Clerk. 

Lat. 42° 16' 17", Long. 17° 48' 13".— Elevation, 5ZdfeeL 

1856-7. 



66 



LUNATIC HOSPITAL AT WOECESTER. [Jan. 




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PUBLIC DOCUMENT— No. 9. 



69 





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PUBLIC DOCUMENT— No. 9. 



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1858.] PUBLIC DOCUMENT— No. 9. 



BY-LAWS 

ESTABLISHED BY THE TRUSTEES OF THE STATE 
LUNATIC HOSPITAL IN WORCESTER. 



CHAPTER. I. 



Organization and Meetings of the Board of Trustees. 

Sect. 1. The Board of Trustees shall be organized as soon as 
may be, after the annual appointment of the members, at a meeting to 
be called by the Trustee who is first named in the commission of the 
Governor, at which meeting one of the Trustees shall be appointed 
Chairman, and another, Secretary of the Board. In case of the death, 
sickness, or absence of the Chairman, such other Trustee as may be 
first named in the commission of the Governor, shall perform the 
duties of Chairman until the Board, at its next following meeting, 
shall make an appointment. 

Sect. 2. The Chairman shall call meetings of the Board as often 
as he may deem the same expedient, or whenever he shall be requested 
to do so by any two Trustees. He shall preside at all meetings, shall 
prepare the Annual Report required to be laid before the Governor 
and Council, and shall be the organ of the Board in receiving and 
preparing all official communcations in relation to its concerns. 

Sect. 3. The Secretary shall keep a record of the proceedings of 
the Board, and shall prepare, or cause to be prepared, all documents, 
statements, and notices, which may be directed by the Board or by 
the Chairman. Whenever directed by the Board or Chairman, he 
shall give notice, in writing, to each Trustee, of the time and place 
appointed for a proposed meeting of the Board. He shall promptly 
communicate to the Treasurer all the proceedings of the Board in rela- 
tion to the settlement of accounts with patients, and the financial 
concerns of the institution. To assist him in the performance of his 
duties, he shall be authorized to employ the Clerk residing at the 
Hospital. 



84 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

Sect. 4. The monthly, semi-annual, and annual visitations of the 
Hospital shall be made, so far as may be, in connection with the meet- 
ings of the Board ; and, otherwise, in conformity to such arrange- 
ment as the Board may, from time to time, adopt. 

Sect. 5. The annual meeting of the Board shall always be held in 
the month of September, for the purpose of receiving the Annual Report 
of the Superintendent, and also of receiving and auditing the Annual 
Report of the Treasurer, and of considering and adopting the Annual 
Report of the Board, as prepared by the chairman, in order that the 
same may be seasonably forwarded to the office of the Secretary of 
the Commonwealth. 

Sect. 6. The Treasurer's Report shall contain a statement of all 
receipts and expenditures for the year ending the last day of August 
in each year ; and all bills for board and expenses of patients shall 
be payable to the Treasurer on the first days of December, March, 
June and September, in each year. 



CHAPTER II. 

Officers of tJie Hospital, Tenure of Office, and Salaries. 

Sect. 1. For conducting efficiently and economically the business 
of the institution, the following officers shall be appointed by the 
Trustees, viz. : a Superintendent, a Treasurer, one Assistant-Physi- 
cian, a Steward, a Matron, and a Chaplain. 

Sect. 2. The several officers appointed by the Board shall hold 
their offices during the pleasure of the Board, and shall not resign 
their offices without giving to the Board at least six months' notice of 
their intention so to do. 

Sect. 3. The salaries of the officers shall be established as fol- 
lows, viz. : — 

The Superintendent shall receive the sum of eighteen hundred dol- 
lars per annum, and shall be provided with furnished apartments, and 
also board and fuel for himself and family, together with the services 
of one female domestic, and horse-keeping for one horse. 

The Treasurer shall receive the sum of six hundred dollars per 
annum. 

The Assistant-Physician shall receive the sum of five hundred dol- 
lars for the first year, six hundred dollars for the second year, seven 
hundred dollars for the third year, and nine hundred dollars for the 
fourth and each succeeding year, together with board and fuel, and 
the use of a furnished apartment. The Steward and Matron shall 



1858.] PUBLIC DOCUMENT— No. 9. 85 

receive jointly the sum of seven hundred dollars per annum, together 
with board and fuel, and the use of furnished apartments. 

The Chaplain shall receive the sum of six hundred dollars per 
annum, together with board and fuel, and the use of a furnished apart- 
ment. 



CHAPTER III. 

Duty of Superintendent.. 

Sect. 1. The Superintendent shall be a physician, and shall con- 
stantly reside at the Hospital. 

Sect. 2. He shall have the superintendence of the Hospital, and 
of all the buildings and grounds connected therewith, the oversight 
and charge of the patients, and the general direction of all the con- 
cerns of the institution, subject to such regulations as may be, from 
time to time, established by the Trustees. 

Sect. 3. He shall visit all the patients personally, or learn their 
condition daily, and as much oftener as may be necessary, and shall 
direct such medical, moral, and physical treatment as may be best 
adapted to their relief, giving the fairest trial to kind and moral 
management. 

Sect. 4. He shall cause to be kept, a record showing the name, 
age, and residence of each patient, the time when received and 
removed, whether cured or relieved, whether eloped or dead, and if 
dead, from what cause. 

Sect. 5. He shall receive and answer all communications relating 
to the concerns of the institution, and shall cause a record of his 
correspondence to be regularly kept. 

Sect. 6. Under the general direction of the Trustees, he shall, 
from time to time, appoint such persons as he may deem qualified to 
perform the duties of Clerk and Apothecary, Supervisors of Depart- 
ments, Overseers of the Laundry, Bakery, and Workshops, Watch- 
men, Farmer, and also all necessary attendants, in the galleries, 
laundry, bakery, kitchen, workshops, and on the farm, and shall con- 
tract with them to perform the services required of them by the by- 
laws, on such conditions and at such rate of weekly or monthly 
wages as he shall deem expedient. 

He shall 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. 



86 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

He shall be authorized to discharge from service any of the persons 
thus appointed by him, upon their request, or whenever he shall cease 
to be satisfied in respect to the performance of their duties. 

Sect. 7. At each monthly visit of the Trustees, he shall exhibit 
all the records, and in a verbal or written report shall make known 
the state of the institution, specifying the cases of patients received 
or removed during the month, and accompanying the same with such 
suggestions and remarks as he may deem useful. 

Sect. 8. At the annual meeting of the Trustees, he shall submit 
a report in writing, upon such topics as may have been suggested by 
the progress of the institution and the experience of the year, including 
therein a tabular statement comprising all important particulars from 
the records. 



CHAPTER IV. 

Duty of Treasurer. 

Sect. 1 . The Treasurer shall give bonds for the faithful perform- 
ance of his duties, in the sum of fifteen thousand dollars, with such 
sureties as shall be approved by the Trustees. 

Sect. 2. He shall receive, hold, and disburse all the moneys 
which may be granted by the legislature or obtained from other 
sources for the use of the Hospital ; and once in each year, and 
oftener if required by the Trustees, he shall exhibit an account of his 
receipts and expenditures, with all the vouchers therefor, for the 
examination of the Board. 



CHAPTER V. 

Duty of the Assistant- Physician. 

Sect. 1. The Assistant-Physician shall always be a physician, 
and shall constantly reside at the Hospital. He shall exercise a gen- 
eral supervision of all the patients, under the direction of the Super- 
intendent. 

Sect. 2. The Assistant-Physician shall visit all the patients in 
his department daily, and oftener if necessary ; carefully observe their 
condition, Avants and treatment, and see that they have food, medicine, 
exercise, amusements, clothing and bedding, suitable for them ; exert 
what moral influence he can with them, and endeavor in every way to 
promote their comfort and recovery. 

Sect. 3. He shall see that the subordinate officers and attendants 



1858.] PUBLIC DOCUMENT— No. 9. 87 

are faithful and kind, attentive to the wants of the patients, and 
vigilant in the discharge of all their duties ; and he shall enter in a 
hook kept for the purpose, all instances of neglect of duty observed 
by him, or of which he may receive information, which shall be imme- 
diately reported to the Superintendent. 

Sect. 4. For the due performance of the duties enjoined in the 
foregoing sections, he shall spend much time in his department, shall 
be in constant communication with the Supervisors, Overseers, and 
Attendants, and shall carry out the plans and instructions of the 
Superintendent in the best manner he is able. 

Sect. 5. He shall report to the Superintendent daily, the general 
condition of his department, and the particular state of such patients 
as may be sick or greatly excited, requiring restraint or seclusion. 

Sect. 6. He shall attend to the warmth, cleanliness, ventilation, 
and good order of his department, and superintend the use of the 
bath. 

Sect. 7. He shall keep records of the cases of all the patients, 
describing the symptoms, the changes that may occur, from time to 
time, the mode of treatment, and all the peculiar circumstances con- 
nected therewith. 

Sect. 8. He shall attend to visitors when necessary, and shall 
always be ready to perform whatever services may be required of him 
by the Superintendent. 



CHAPTER VI. 

Duty of Steward. 

Sect. 1. The Steward, under the direction of the Superintendent, 
shall purchase furniture, fuel, stores, stock for the workshops, imple- 
ments and cattle for the farm, and all other necessary articles, and 
shall be responsible for the economical use of the same. 

Sect. 2. He shall keep clear and methodical, and exact accounts 
of all receipts and expenditures, and of charges against patients, and 
shall submit the same, together with proper vouchers therefor, to the 
Treasurer, at least once in three months, and as much oftener as the 
Treasurer shall require. 

Sect. 3. Under the direction of the Superintendent, he shall 
attend to engaging and discharging the subordinate officers and 
attendants, and to the settlement of their wages, for which latter 
purpose he shall keep regular accounts with them. 

Sect. 4. He shall constantly observe the conduct of the subordi- 
nate officers and attendants, and see that in all respects they do their 



88 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

duty, and forthwith report to the Superintendent any instance of mis- 
conduct or negligence on their part, which he may observe, or of 
which he may be informed. 

Sect. 5. He shall attend particularly to the business of the 
laundry, bakery, workshops, and farm ; shall see to the cleansing of 
the sewers as often as may be necessary, and that the grounds, yards 
and roads, the aqueduct, laundry, bakery, workshops, barns, and 
other out-buildings, and also the chapel and hall, are always kept in 
good order, in conformity to such directions as he may receive from 
the Superintendent. 

Sect. 6. He shall perform all services that may be required of 
him in maintaining the police of the establishment ; shall see to the 
opening and closing of the house, and that the attendants rise and 
commence business immediately after the ringing of the bell, and that 
they retire in proper season at night ; that the bell is rung at proper 
times, and that the fires are regularly kindled and extinguished. He 
shall go in search of elopers ; shall observe the conduct of inmates 
at the religious and other meetings ; and when in the wings, shall 
exert all the good influences he can to promote the comfort and 
recovery of the patients. 

Sect. 7. He shall receive visitors, give them all suitable informa- 
tion, and accompany them personally to such parts of the buildings 
and grounds as, by the permission of the Superintendent, are open 
for examination. 

Sect. 8. He shall be at all times ready to perform whatever 
extraordinary services shall be required of him by the Superintendent. 



CHAPTER VII. 

Duty of Matron. 

Sect. 1. The Matron shall have the general direction of the 
domestic concerns of the Hospital. 

Skct. 2. She shall attend to the cleanliness and good order of the 
apartments, have care of the cooking, sewing, clothing, and bedding, 
and, in connection with the Steward, shall take the general direction 
of the washing, ironing, and baking. 

Sect. 3. She shall see that all the female attendants are faithful 
and diligent in the discharge of their duties, kind and pleasant to 
patients wherever they meet them, discreet and regular in their deport- 
ment, and that they observe all the regulations of the Hospital. 

Sect. 4. She shall be in the way of seeing the patients frequently, 



1858.] PUBLIC DOCUMENT— No. 9. 89 

and shall be careful always to exert a good moral influence on them 
and the attendants, and shall spare no effort to promote the comfort 
and good order of the household. 

Sect. 5. She shall be at all times ready to perform whatever 
extraordinary services shall be required of her by the Superintendent. 



CHAPTER VIII. 

Duty of Chaplain. 

Sect. 1. The Chaplain shall conduct religious worship in the 
chapel on the Sabbath, as well as on such other days as may be set 
apart for religious observance by the authorities of the Common- 
wealth. 

Sect. 2. He shall also attend daily devotional exercises in the 
chapel, and, whenever he may be requested, shall officiate at funerals. 

Sect. 3. He shall perform all such other services relating to moral 
and religious instruction, as may be authorized and requested by the 
Superintendent. 



CHAPTER IX. 

Duty of Clerk and Apothecary. 

Sect. 1. The Clerk and Apothecary shall keep the records of the 
Hospital under the direction of the Superintendent; he shall copy, 
seal and direct letters, make copies of all documents, and other papers, 
post the books of the Steward, keep the weather table, and perform 
all other clerical services which may be required by the Superintend- 
ent or by the Secretary of the Board of Trustees. 

Sect. 2. He shall also prepare and put up the medicines pre- 
scribed by the Superintendent and Assistant-Physician. 

Sect. 3. He shall keep the office in order, wait upon visitors, and 
perform whatever other services shall be required of him by the 
Superintendent. 



CHAPTER X. 

Duties of the Supervisors. 

Sect. 1. The Supervisors of the respective departments are respon- 
sible in a great measure for the order and discipline of the institution. 
12 



90 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

It is their duty to see that the rules of the Hospital are carried out in 
every particular, and that every patient is treated with uniform kind- 
ness and attention. 

Sect. 2. They will administer all medicines prescribed by the 
Superintendent or Assistant- Physician, and see that their orders are 
most strictly observed. 

Skct. 3. They will pass all their time in the wards of their respec- 
tive departments and assist the attendants in their efforts to amuse, 
interest and employ the patients under their care. 

Sect. 4. They must prevent in every possible way, any disturb- 
ance, noise or confusion among the patients. 

Sect. 5. They must report at once all irregularities in the con- 
duct of the attendants, or neglect in the performance of duties, that 
may come under their notice. 

Sect. 6. They will act as mediums or messengers between the 
attendants and the office, receiving and transmitting all messages 
and requests between ihe same. 

Sect. 7. They should report to the Superintendent, each day 
before the regular visit of the Superintendent and Assist an t-Physi- 
cian, the general condition of the patients. 

Sect. 8. They must have the general charge and supervision of 
the clothing of patients, and of the beds and furniture in the wards. 

Sect. 9. They shall have the general charge and direction of the 
sick, and must know that orders of the Superintendent and Assistant- 
Physician are faithfully executed. 

Sect. 10. They shall in every possible way promote the general 
interests of the Hospital and be at all times in readiness to perform 
any service required by the Superintendent. 



CHAPTER XL 

Duty of Attendants. 

Sect. 1. Treatment of Patients. — In all their intercourse with 
the patients, the Attendants shall treat them with maiked respect and 
civility. They shall be kind and gentle in their manner, and avoid 
violence of every kind. They must answer, as well as they can, 
every civil question, and attend at once to every reasonable request. 
They must be quiet and calm under every provocation, and never 
scold, threaten, or recriminate ; and whenever they desire any thing 
done by a patient, they must request it in a respectful and becoming 
manner. 



1858.] TUBLIC DOCUMENT— No. 9. 91 

Sect. 2. In the care of the insane, sympathy, tact and kindness, 
should always take the place of force and authority. But if unfor- 
tunately force must at any time be resorted to, the manner of its 
employment should take away its offensiveness. 

Sect. 3. A cheerful lcok, a kind manner, a respectful demeanor, 
and sympathizing language, will do much towards quieting the most 
excited patient. 

Sect. 4. The opposition patients make, often arises from delu- 
sions that lead them to believe they are to be injured in person, 
property, or character, so that every attempt to control them, to 
administer food, medicine, or baths, or to do any thing for them, 
should be done in the most quiet and kind manner. 

Sect. 5. Angry looks, cross words, violent actions, will destroy 
the patient's confidence, and if submitted to such treatment in the 
commencement of his disease, will destroy all hope of recovery and 
cause years of sufFeiing to the patient, and anxiety to the friends. 

Sect. 6. Morning Duties. — The Attendants shall rise in the 
morning at the ringing of the bell, and at once commence the labors 
of the day. On opening the doors of the patients' sleeping rooms, 
they shall greet the patients with expressions of kindness, see that 
they arise from bed, are neatly dressed, properly washed, and have 
their hair and clothes well brushed in time for breakfast at the pre- 
scribed hour. 

Sect. 7. Immediately after the patients have arisen from bed, the 
Attendants shall remove the chamber vessels, spread open the beds 
for airing, see that the soiled beds and bedding are removed, and put 
the rooms in good order. 

Sect. 8. The Attendants shall keep the patients' rooms, and every 
part of the wards, perfectly neat and clean at all times. " Nothing 
is clean enough if it can be made cleaner." This rule must be most 
scrupulously observed. 

Sect. 9. Whenever any unpleasant odor is discovered, the cause 
is to be ascertained and removed at all times, day or night. 

Sect. 10. Whenever any room, or any part of the ward, or any 
furniture is soiled, it must be cleaned immediately. 

Sect. 11. Whenever any bed, or furniture has been disarranged, 
it must be put in order promptly and cheerfully. 

Sect. 12. The halls, sleeping rooms, parlors, staircases and 
closets must be swept and brushed as many times each day as may be 
necessary to keep them perfectly clean. 

Sect. 13. The windows, doors and standing work of the halls 
must be scrubbed as often as may be required. 



92 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

Sect. 14. The urinals and water closets must be thoroughly 
watched and frequently rinsed with hot water. 

Sect. 15. Bedding if wet only, must be cleansed by pouring hot 
water through the soiled part, and carefully dried before using. 

Sect. 16. Clean linen must be put on each bed once in every 
week, and oftener if necessary. Spreads are to be sent to the 
laundry when soiled. 

Sect. 17. If old or feeble patients wish to lie down during the 
day, they will go to their own room for that purpose ; and the 
Attendant must assist them if necessary. When they leave their 
beds the Attendants will see that they are put in order, and if soiled, 
that they are cleansed and dried. 

Sect. 18. Meals. — The Attendants shall cause the tables to be 
properly laid. They shall see that the furniture of the tables is 
always neat and clean. And so far as they can, shall make the 
tables appear cheerful and inviting. The Attendants must always be 
present at the tables, to prepare and distribute food to such patients 
as are not able to do it for themselves, and shall see that each one is 
well served. They shall be careful that no knife, fork or other article 
is taken from the tables and carried from the dining-rooms by any 
patient. 

Sect. 19. Patients who take their meals in their own rooms, or 
at a table in the ward, must be carefully served, and the Attendants 
must see that their food is brought to them warm and in good order. 
If necessary, one Attendant must remain by them while they are 
eating. 

Sect. 20. Patients are never to be forced to take food, but by the 
express order, and in the presence of, the Superintendent or Assistant- 
Physician. 

Sect. 21. The conduct of the table shall always be decorous. 
And for any deviation from the rules of propriety, the Attendant in 
charge must be held mainly responsible. 

Sect. 22. Baths. — Every patient must take a warm bath once in 
a week, unless otherwise directed by the Superintendent or Assist- 
ant-Physician. 

Sect. 23. The temperature of the bath may be such as is most 
agreeable to the patient. 

Sect. 24. Those who desire to bathe daily must be gratified 
in this respect, and assisted by the Attendants. 

Sect. 25. All hot baths, foot baths, sponge baths and shower 
baths, directed by the Superintendent or Assistant-Physician, must 
be scrupulously administered by the Attendant in charge. 



1858.] PUBLIC DOCUMENT— No. 9. 93 

Sect. 26. In bathing of patients, the rules of delicacy must be 
most strictly observed in all cases. 

Sect. 27. Shaving. — The shaving of patients must be done by 
the Attendant in each ward at regular intervals, and patients who 
desire to shave more frequently must be gratified. 

Sect. 28. Great care must be taken that no injury is done 
at the time of shaving. No patient must be allowed to use a razor 
unless permission has been given by the Superintendent. 

Sect. 29. When such permission has been granted, an Attendant 
must always be present. 

Sect. 30. When an Attendant is engaged in shaving a patient, 
no other patient should be near. 

Sect. 31. The shaving must always be neatly and quickly per- 
formed. The patient must not be sent from the chair until his face 
is smooth, clean and dry, and his hair and whiskers properly 
trimmed and brushed. 

Sect. 32. Patients at work on the Farm. — Whenever it is thought 
advisable for patients to work on the farm or in the gardens, some 
general order to that effect will be given to the Farmer or some other 
responsible person, and no patient is ever to be taken from the wards 
and put to labor unless some such order respecting the patient has 
been given. 

Sect. 33. The Farmer or Attendant at work with such patients 
will be held strictly responsible for their safe keeping until they are 
returned to the proper ward. 

Sect. 34. All farmers, mechanics and attendants are expected 
to work with the patients, and when thus employed will avoid every 
appearance of driving or superintending instead of working with and 
assisting them. 

Sect. 35. Retiring at Night. — Patients must not retire for the 
night before 8 o'clock P. M., without permission from the Assistant- 
Physician, except in cases of sickness and fatigue. 

Sect. 36. All those who do not attend chapel service at 8£ 
o'clock must retire at that time, unless special permission has been 
given to the contrary. 

Sect. 37. After returning from the chapel patients may retire in 
every part of the house. 

Sect. 38. At 9^- o'clock all patients, attendants, and other 
persons employed must be in their rooms, and no light is to be kept 
burning unless in case of sickness, always excepting the one light in 
each ward to be in readiness in case of accident. 

Sect. 39. Before closing the door for the night the Attendant 



94 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

should cheerfully bid the patient a " good night " and be sure that 
the patient is comfortably in bed. The door is then to be carefully 
locked. 

Sect. 40. No patient's door is ever to be left unlocked without 
permission from the Superintendent or Assistant- Physician. 

Sect. 41. Discipline. — No patient is ever to be placed in his 
room in the daytime, until he is actually unsafe and after all other 
means of control have failed. If placed in his room his case is to be 
reported at once. Under no circumstances whatever must it be done 
rashly or inconsiderately. When secluded in their own rooms they 
must be frequently observed, and reported if occupied in defacing the 
walls, injuring furniture, destroying clothing, or any unseemly act. 

Sect. 42. No means of restraint is ever to be placed on a 
patient except by the express order of the Superintendent, and in 
his presence. 

Sect. 43. Escapes. — Whenever a patient is missing he is to 
be reported at once, and all proper means taken to recover him 
under the direction of the Superintendent or Assistant- Physician. 

Sect. 44. Prohihited Articles. — Patients are not to have pos- 
session of any knife, razor or any other dangerous weapon, and 
whenever any one is suspected of having any thing of the kind 
a careful search is to be made for it until it is discovered. 

Sect. 45. Patients are not to be supplied with tobacco, cigars, 
or any stimulating beverage. 

Sect. 46. All letters, packages, &c, must pass through the 
office, and be inspected by the Superintendent or Assistant- Phy- 



CHAPTER XII. 

Duties of House Clerk. 

Sect. 1. It shall be the duty of the House Clerk to receive and 
mark neatly and legibly, all clothing brought with patients when they 
enter the hospital. She shall enter in a book kept for the purpose, 
the name and number of every article, and also take charge of any 
jewelry, knives, scissors, razors, &c, and all money and papers, and 
be responsible for their safe keeping until permission is given by the 
Superintendent for their delivery to the patient. 

Sect 2. She shall also mark and register all clothing provided for 
patients during their stay in the hospital. 

Sect. 3. She shall at all times be ready to assist the female 
patients in altering and repairing any article of clothing, and in every 
way make herself generally useful. 



1858.] PUBLIC DOCUMENT— No. 9. 95 

Sect. 4. She shall observe all the regulations of the hospital, 
and be ready at all times to perform any service required by the 
Superintendent. 



CHAPTER XIII. 

Duty of the Baker. 

Sect. 1. The Baker, under the direction of the Steward and 
Matron, shall prepare bread, pastry, and other articles pertaining to 
his department of cooking, and shall supply the kitchen with such 
quantity as may be required. 

Sect. 2. He shall take care of all supplies furnished him for use, 
and shall be held responsible for the judicious and economical use 
of them. 

Sect. 3. He shall take charge of the house and furniture, and 
always see personally to the fires and lights, and to the opening and 
shutting of the house. 

Sect. 4. He shall observe all the regulations of the Hospital, and 
see that they are observed by all persons employed in the bakery, 
and shall immediately report every instance of remissness or neglect 
of duty, to the Steward. 

Sect. 5. He shall be ready at all times to perform any service 
which may be required of him by the Superintendent. 



CHAPTER XIV. 

Duty of Farmer. 

Sect. 1. The Farmer, under the direction of the Steward, shall 
take care of the stock, barn, stables, and piggeries, shall see to the 
careful use and safe keeping of all implements of labor, and to the 
feeding and proper treatrqent of all the animals ; and he shall have 
charge of the teams and of all the work done upon the farm. 

Sect. 2. He shall be ready at all times to perform any service 
which may be required of him by the Superintendent. 



CHAPTER XV. 

Duty of the Engineer and Fireman. 
Sect. 1. It shall be the duty of the Engineer and Fireman to 
attend to, and take care of the steam apparatus for warming and 



96 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

ventilating the hospital. He will also supply steam for cooking, 
bathing and laundry purposes, and also for the stables whenever 
needed. 

Sect. 2. He must attend the force pumps, and see that they 
are kept in working order, and shall keep them in action so much of 
the time as may be necessary. 

Sect. 3. He must attend to the generation of steam so carefully 
as to be able to adapt it to all the variations of the temperature. 

Sect. 4. He must keep his department in a perfectly neat and 
orderly manner. 

Sect. 5. He will not permit any company or visitor in his depart- 
ment without permission from the Superintendent. 



CHAPTER XVI. 

Duty of the Overseer of the Kitchen. 

Sect. 1. The Overseer of the Kitchen shall have the general 
charge of all the cooking, under the direction of the Steward and 
Matron. He shall take care of supplies for the kitchen, and prepare 
food for the household as may be directed. 

Sect. 2. He shall see to the proper distribution and delivery of 
food to the various wards, and shall be responsible for the cooking of 
the same. 

Sect. 3. He shall personally take care of the fires and lights and 
see that his department is properly closed for the night. 

Sect. 4. He shall be mainly responsible for the conduct of such 
help as he may require in the performance of his duties. 

Sect. 5. He shall at all times be ready to perform any service 
required of him by the Superintendent. 



CHAPTER XVII. 

Duty of the Laundress. 

Sect. 1. The Laundress, under the direction of the Steward and 
Matron, shall have the general charge of the laundry. She shall on 
specified days collect the clothes and soiled linen from the place of 
their deposit and cause them to be properly washed and ironed and 
returned to the wards to which they belong. 

Sect. 2. The soiled clothes and bed linen belonging in the centre 
building, shall on specified days, be taken from the rooms to which 



1858.] PUBLIC DOCUMENT— No. 9. 97 

they belong, and after washing and ironing in a neat manner shall 
be returned to the rooms from which they were taken. 

Sect. 3. She shall take care of the laundry and its fixtures, keep 
them in good order, attend personally to the fires and lights, and 
secure the apartments at night. 

Sect. 4. She shall observe all the regulations of the hospital and 
see that they are observed by those employed in the laundry. 

Sect. 5. She will not permit any visitor or any company in the 
laundry, without permission from the Superintendent, Steward, or 
Matron. 



CHAPTER XVIII. 

Duties of the Watch. 

Sect. 1. The Watchman will visit the office at half past nine 
o'clock in the evening to receive his instructions for the night, and 
immediately commence his duties. 

Sect. 2. He shall be constantly awake, faithful, and vigilant. 
He shall visit each ward in the male department at least every hour 
during the night. He must avoid any noise, never converse in a loud 
tone with any one, and open and shut all doors as quietly as possible. 

Sect. 3. In treatment of patients he must observe the same rules 
as the attendants. 

Sect. 4. He must always attend to any want expressed by a 
patient. 

Sect. 5. He must notice any unusual noise in a patient's room 
and ascertain the cause, and if necessary, give notice to the attendant. 

Sect. 6. He must give especial attention to the sick, and faith- 
fully execute every order respecting them. 

Sect. 7. He must be scrupulously watchful in regard to fire, and 
if one occurs, must at once give notice to the Superintendent, but in 
no case make an alarm. 

Sect. 8. He must be on service twelve hours of each day. 

Sect. 9. He will at all times be in readiness to perform any ser- 
vice required by the Superintendent. 



CHAPTER XIX. 

Duties of the Watchwoman. 
Sect. 1. The Watchwoman will have charge of the female wards 
during the night, and be governed by the rules laid down for the 
watchman. 

13 



98 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

CHAPTER XX. 

Duty of Overseers of Workshops. 

Sect. 1. The Overseers of Workshops, under the direction of 
the Steward, shall take care of all stock supplied to them, and see 
that it is economically used and properly manufactured by the 
patients under their charge; and they shall keep regular accounts of 
all stock received and all articles manufactured, sold, or otherwise 
disposed of. 

Sect. 2. They shall exercise a judicious and prudent oversight of 
all patients under their charge, and shall see them returned to the 
wards, or placed in the care of their respective attendants, when their 
labor is done. 

Sect. 3. They shall take care of the apartments, and of all stock, 
tools, and fire therein ; shall see to the fires and lights, and that they 
are properly closed at night. 

Sect. 4. They shall be ready at all times to perform any service 
which may be required of them by the Superintendent. 



CHAPTER XXL 

Attendance upon Religious Service. 

Sect. 1. All persons employed in the Hospital, who are well and 
can be spared from their duties in the house or in the wards, shall 
attend evening prayers, and the religious services on the Sabbath, 
both morning and evening, unless leave of absence be specially 
granted. 

Sect. 2. Officers and attendants shall take especial care that their 
demeanor during the services shall be strictly becoming and worthy 
of imitation ; and it shall be considered a noticeable breach of duty, 
for any one to sleep habitually while present in the chapel. 

Sect. 3. The attendance of patients in the chapel shall be under 
the direction of the Superintendent ; and all the arrangements which 
he may direct concerning them, shall be faithfully carried into effect 
by the other officers and the attendants. 



CHAPTER XXII. 

Duty of the Yard Attendant. 
Sect. 1. Under the direction of the Steward, he shall take care of 
the yards and cellars. He shall keep all the walks, avenues, and 



1858.] PUBLIC DOCUMENT— No. 9. 99 

courts perfectly clean and neat- He shall remove all rubbish and 
filth, collect and take off whatever may be thrown from the windows 
of the wards. 

Sect. 2. He shall keep the cellars and attics well swept and 
whitewashed, and shall remove the dust from the dust holes as often 
as may be necessary. 

Sect. 3. He shall remove all the soiled straw beds, and at the 
request of the Supervisors shall return fresh and clean ones. 

Sect. 4. He shall see that the doors and gates of his department 
are secured for the night, and shall be ready at all times to perform 
any service required by the Superintendent. 



CHAPTER XXIII. 

Duties of Coachman. 

Sect. 1. He shall take care of all carriages, horses, harnesses, 
&c, and see that they are at all times in good order and ready for use. 

Sect. 2. He shall drive out with the patients at such times as 
may be directed by the Superintendent, and shall be careful that no 
accident occurs, and shall also see that the patients conduct them- 
selves in a becoming manner. 

Sect. 3. He shall never stop at any house, shop or store, or do 
any errands, or carry any messages or packages, without express 
direction from the Superintendent. 

Sect. 4. He will at once report any impropriety that occurs 
during the ride. 

Sect. 5. He will hold himself in readiness to perform any service 
required by the Superintendent. 



CHAPTER XXIV. 

Miscellaneous Regulations. 

Sect. 1. No officer or attendant, while connected with the Hospi- 
tal, shall at any time make use of distilled spirits or intoxicating 
liquor of any kind, at home or abroad ; nor shall any one of them 
make use of tobacco, or smoke a cigar or pipe about the premises. 

Sect. 2. No company shall be admitted into the wards occupied 
by the patients, except by express permission of the Superintendent. 
All other parts of the Hospital may be exhibited by the Assistant- 
Physician and the Steward or Matron, at such times and under such 
restrictions as the Superintendent shall direct. 



100 LUNATIC HOSPITAL AT WORCESTER. [Jan. 

Sect. 3. The Attendants shall always keep themselves well 
dressed, in neat and clean apparel. 

Sect. 4. All persons employed at the Hospital, shall avoid the 
use of profane, obscene, or vulgar language, treat each other with 
uniform civility, never indulge in loud talking or laughing, nor play 
at any game together, without the permission of the Superintendent. 
In all respects they shall exhibit a good example to the patients, and 
shall be held strictly responsible for the bad influence of their conduct. 

Sect. 5. All persons employed at the Hospital shall accustom 
themselves to speak respectfully of the officers and the institution, 
and shall inculcate these sentiments in their intercourse with the 
patients ; and they shall sustain and carry into operation all directions 
and prescriptions for the patients in the most ready and faithful 
manner. 

Sect. 6. All persons who have duty to perform in the Hospital, 
shall rise in the morning at the ringing of the bell. 

Sect. 7. Leave of absence will be granted to all persons employed 
in the various wards, by the Superintendent, and in his absence by 
the Assistant-Physician. 

Sect. 8. Leave of absence will be granted to all persons employed 
in the kitchen, laundry, bakery and serving rooms, by the Superin- 
tendent, and in his absence, by the Matron. 

Sect. 9. Leave of absence will be granted to all persons 
employed on the farm and in the various workshops, by the Superin- 
tendent, and in his absence by the Steward. 

Sect. 10. All persons who shall agree to perform service at the 
Hospital shall be considered as engaged for one year, unless a special 
contract shall be made for a longer or shorter term ; and no person 
employed at the Hospital shall discontinue service at or after the 
expiration of the year or term agreed for, without giving to the Stew- 
ard at least thirty days' notice of an intention so to do. 

Sect. 11. It is expected that the attendants will devote their 
whole time to the interests of the Hospital. 

Sect. 12. They will never leave their duties without permission, 
and whenever leave of absence is given, they will always leave their 
keys at the office until they return. 

Sect. 13. When they go out, they will never carry bundles, let- 
ters, or any thing for patients, or do any errand for them without 
permission from the Superintendent. 

Sect. 14. The Attendants must on no account, take any friend or 
visitor into any of the wards, without permission from the Superin- 
tendent. 



1858.] PUBLIC DOCUMENT— No. 9. 101 



DIET TABLE 

FOR THE STATE LUNATIC HOSPITAL 



SUNDAY. 



Breakfast — Coffee, bread, butter, hasb or fisb, and potatoes. 

Dinner — Water, bread, butter, cheese, crackers, and pie. 

Supper — Tea or cocoa, bread, butter, cold meat, and warm potatoes. 



Breakfast — Coffee, bread, butter, cold meat, warm potatoes. 
Dinner — Water, boiled dish, vegetables, pudding. 
Supper — Tea or cocoa, warm biscuit, butter, cheese. 

TUESDAY. 

Breakfast — Coffee, bread, butter, hash of meat and potatoes. 
Dinner — Water, roast meat, vegetables, bread and butter. 
Supper — Tea or cocoa, bread, butter, cheese, and plain cake. 

WEDNESDAY. 

Breakfast — Coffee, bread, butter, warm or cold roast meat, warm 
potatoes. 

Dinner — Water, stewed orbiked beans, or stewed peas, vegetables, 
or fish and vegetables, pudding, bread and butter. 

Supper — Tea or cocoa, bread, butter, cheese, gingerbread. 

THURSDAY. 

Breakfast — Coffee, bread and butter, steak, fish, or warm beans or 
peas stewed. 

Dinner — Water, soup with meat and vegetables. 

Supper — Tea or cocoa, bread, butter, pie and cheese, and buns or 
sugar gingerbread. 

FRIDAY. 

Breakfast — Coffee, bread, butter, fresh meat, cold or warm potatoes. 
Dinner — Water, bread, butter, boiled dish, vegetables and pudding. 
Supper — Tea or cocoa, warm biscuit, butter and cheese. 



102 LUNATIC HOSPITAL AT WORCESTER. [Jan/58. 



SATURDAY. 



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

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



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

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

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



APR 25S9W.PJI