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PUBLIC DOCUMENT No. 28.
THIRTIETH ANNUAL EEPOET
THE TRUSTEES
STATE LUNATIC HOSPITAL
^T W^OROESTEH.
OCTOBER, 1862
BOSTON:
WRIGHT & POTTER, STATE PRINTERS,
No. 4 Spring Lane.
18 6 3.
OFFICERS OF THE HOSPITAL.
TRUSTEE
WILLIAM T. MERRIFIELD, Esq.,
ROBERT W. HOOPER, M. D., .
Hon. EDWIN F. JENKS, .
EDWARD JARVIS, M. D., .
WILLIAM WORKMAN, M. D., .
Worcester.
Boston.
Adams.
Dorchester.
Worcester.
TREASURER.
HENRY WOODWARD, Esq., .
Office, Mechanics' Bank, Main Street.
Worcester.
RESIDENT OFFICERS.
MERRICK BEMIS, M. D., Superintendent.
FRANK H. RICE, M. D., Assistant-Physician.
HENRY C. PRENTISS, M. D., . . . . Clerk and Apothecary.
CAROLINE A. BEMIS, Matron.
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http://www.archive.org/details/annualreportoftr28stat
(Jlommonruealtl) of JMassarljusietts,
THIRTIETH ANNUAL REPORT
OF THE
TRUSTEES OF THE STATE LUNATIC HOSPITAL,
AT ^V^OROESTER.
To His Excellency the Governor, and the Honorable Council
of the Commonwealth of Massachusetts.
The Trustees of the Worcester Lunatic Hospital beg leave
to make the following Report of the state of the institution
under their charge, for the year ending September 30, 1862.
During the year that has now closed, the hospital has
enjoyed its usual prosperity, and accomplished a work similar
to that of previous years.
Six hundred patients — two hundred and ninety-two males,
three hundred and eight females — have enjoyed the privileges,
and been under the care of the institution within the year.
Of these
379
patients-
-184 males,
195 females-
—were here October 1, 1861 ;
221
u
108
((
113
ii
were admitted;
124
ii
58
u
66
a
were discharged recovered ;
39
ii
18
ii
21
ii
were discharged improved ;
7
((
5
ii
2
a
were discharged not improved ;
34
a
11
a
23
a
died in course of the year, and
396
ii
200
u
196
a
now remain.
6 LUNATIC HOSPITAL AT WORCESTER. [Oct.
Some improvements have been made. Another range of
the stone cells has been removed. They were not merely use-
less, but offensive and injurious, in reminding the patients of
the harsher treatment of the insane in olden time. But their
places are now taken by comfortable rooms that are acceptable
to the inmates, and important aids in the management and
treatment of the household.
Another, and last, range of these cells still remains ; but they
are never used for the purpose for which they were designed.
They are kept as curiosities, to show what ideas of insanity
and its liabilities have prevailed, and what means were sup-
posed to be necessary for its removal. These cells are now
sometimes used as places of storage, which, however, could
better be done elsewhere ; and they will soon give way to
rooms, which will add to the comfort of the patients, and be
useful in the administration of the house.
All the improvements, that have been made within the last
seven years, are advantageous to the hospital and the patients,
and increase the facility and success of management. The
system of warming by steam and of ventilating by the fan was
admirable in its conception, and is exceedingly comfortable to
the inmates of the house, as well as economical to the institu-
tion. This is honorable to the Trustees who, seven years ago,
conceived the plan, and to those who put it in execution. This
and other improvements have raised this hospital from its low
rank in 1855, to a high position among institutions for the
insane.
FORMER IDEAS OF INSANITY.
In the management of insanity there is continual progress.
The time was, within the memory of some now living, when
lunatics were considered as doomed to life-long disorder ; at
the best, they were considered as burdens upon public treas-
uries or their own estates for their care and support. Some of
the harmless insane were abroad strolling about the country,
objects sometimes of pity, often of derision, and occasionally
of fear. A considerable portion of these patients were dan-
gerous, or supposed to be so, and society felt it necessary for
its own security to protect itself from them. They were con-
fined in prisons, and in strong rooms or cages of poor-houses
and private dwellings.
1862.] PUBLIC DOCUMENT— No. 28. 7
When inquiry was made, in 1829, by order of the legislature
into the number and condition of the insane in this State,
many were found who had been thus imprisoned for periods,
varying from a few weeks to forty-five years.
The revelation of this state of things, so offensive to hu-
manity, produced a strong impression on the government and
the people, and a conviction that something should be done for
these wretched and neglected sufferers. But it was not pro-
posed to let them go free, for the safety of the community
seemed to require that they should be kept from the possibility
of doing harm. Yet the increasing intelligence and humanity
of the age demanded that, at least, they should be allowed to
have a better place of confinement, and it was primarily and
mainly for this purpose that the hospital was proposed. More
than one-half of those, who were admitted during the first
year, came from jails and almshouses, and one-third of the
whole had been imprisoned from ten to thirty-two years. The
idea of restoring the insane to health was then recognized, and
had its weight among the reasons for creating the hospital, but
it was not the primary and leading one ; and if this motive
had stood alone, probably the insane would have been obliged
to wait some years longer for this means and these opportuni-
ties of restoration.
In the purposes and the plan of the hospital the legislature
had principally in view a custodial establishment for the safety
and convenience of the sane community, and to relieve the
prisons and the poor-houses of their most undesirable and
troublesome inmates. The law offered it first to those who
" were so furiously mad as to be manifestly dangerous for the
peace and safety of the community to be at large ;" second, to
the town paupers ; and third, to " any poor persons suffering
under recent insanity." The last class includes a very small
proportion of the insane in the general community, but the law
authorized the Trustees to admit them " for a less sum " than
the actual cost of support.
For the first class, the furiously mad and the dangerous, the
law interposed the courts, sheriffs, and constables, to compel
them to enter the hospital. The order of commitment was
mandatory, and could not be resisted by the patient nor diso-
beyed by the hospital, which was obliged to receive all that were
8 LUNATIC HOSPITAL AT WORCESTER. [Oct.
sent in this manner. The reception of the other classes was
optional ; for the Trustees were permitted, not required, to
receive them.
Fortunately for the insane, the courts, by a very liberal
interpretation of the law, early began to include all the insane
in the first class ; and still more fortunately for all classes of
lunatics, the sagacious superintendent and managers of the
hospital soon saw that its widest and best sphere of usefulness
was in the cure of the curable cases, and the amelioration of
those that could not be restored. And thus, while they ful-
filled the first intention of the law — while they quieted the
public fear of harm from dangerous and troublesome lunatics,
and soothed the public conscience, by giving them a better place
of confinement and softening the hardness of their condition,
they applied their energies and their skill to the removal of the
disease from the curable cases, and the improvement of those
whose maladies had become fixed. The hospital early became
a curative as well as a custodial institution. From the begin-
ning, it has been a most valuable and effective agent of
humanity, and an essential element of the prosperity of the
Commonwealth. In the relief of suffering, in the restoration
of useful lives, in adding to the productive power of the people,
and in diminishing the costs of life-support of the insane, the
hospital has done a far higher, larger and more profitable work
than its projectors and fathers dared to hope.
WHAT THE HOSPITAL HAS DONE.
During the nearly thirty years of its operation, the hospital
has received into its wards, and taken the care of, six thousand
six hundred and sixty-three insane persons. Of these, it has
given three thousand one hundred and thirty-one back to their
homes and the world, to usefulness and the common enjoyments
of their families and society, and to the usual responsibilities'
of citizenship.
Of the thirty-five hundred and thirty-two who were not re-
stored to health, twelve hundred have been improved, their
violence has been subdued, their excitability calmed, their
pains assuaged, and their delusions controlled, in such a
measure, that they could live at their homes, be comfortable in
their families and neighborhoods, and partake of some, or even
many, of the blessings of society.
1862.] PUBLIC DOCUMENT— No. 28. 9
There remained and still remains another class who have
never recovered sufficient mental health, or power of self-con-
trol to go abroad and mingle with the world. These passed or
are passing the remainder of their days without mitigation of
their disease. A large proportion of this unimproved class
have died in the hospital after residing there through periods
varying from a few hours to almost thirty years. The second
patient that entered the house, January 22, 1833, died on the
25th day of July last. Most of these passed calmer and far
more comfortable lives under the soothing and restraining influ-
ence of the institution, than they had before they came, or
probably would if they had remained at their homes or their
former places of confinement. And few are they who have
come under tlie care of the hospital, that have been without
some benefit in various degrees, from the calming of the spirit
to the complete restoration of health.
The worth to the State of these blessings of improved and
established health, in so many of her weakened and disordered
children, is beyond all calculation. But the financial value of
the labors and results of the hospital, is a matter of great
importance to the Commonwealth. It has restored to life,
health and usefulness, three thousand one hundred and thirty-
one men and women, who were not only deprived of power to
sustain themselves and their families, and contribute to the
support of town and State, and add to the strength of the body
politic, but were a burden on their own estates or the public
treasuries, for their sustenance and for the extraordinary care
which their excited, wayward or depressed condition required.
Although the hospital has accomplished so much, it will not
be claimed that none of this restored life and power would have
been gained without its intervention. Some of these patients
probably would have recovered by other means, even if the
hospital had not existed ; yet these would have been few, as,
according to all observation, most of the insane who are not
removed from home, or submitted to the appropriate means of
restoration, remain in their disorder for life ; it is fair to
presume that most of these would have been insane for life, if
they had not had some such means and opportunities as they
have here enjoyed.
2
10
LUNATIC HOSPITAL AT WORCESTER. [Oct.
According to the life-tables, these three thousand one
hundred and thirty-one men and women lived or will live an
aggregate of 84,886 years after they regained their health, and
82,090 of these were working and self sustaining years, before
they arrived at the period of dependence in old age. Making,
however, some deduction for those that would have recovered
by other means if the hospital had not existed, and also for the
periodical cases whose years of health were cut off by every
succeeding attack, yet both of these deductions will not very
materially diminish the total sum of 84,886 years of usefulness
and enjoyment and the 82,090 years of labor and self-suste-
nance, that have been given back to these patients, and through
them to society and to the Commonwealth, by the labors and
influence of the hospital.
It must be farther considered, that insanity, if not removed,
is a life-enduring disease, and although, with its causes and
conditions, it shortens human life, it does not destroy men at
once. Mr. Le Cappelain, of London, calculated the value of
life to the permanently insane at the several ages. Taking his
tables and the common tables of the expectation of life of the
sane, it is easy to see the comparative chances of living in
mental health and mental disorder.
Expectation or probable duration of Life.
Sane.
Insane.
AGE.
Males.
Females.
Average
both Sexes.
20,
30,
40,
50,
60,
36.32
34.54
30.48
24.89
18.77
21.31
20.64
17.65
13.53
11.91
28.66
26.33
21.53
17.67
12.51
24.99
23.46
19.59
15.60
12.21
At these rates, the three thousand one hundred and thirty-one
who were restored, would have lived 54,911 years, if their
malady had not been removed, through all of which the State,
towns and people must have cared for and supported them.
1862.] PUBLIC DOCUMENT— No. 28. 11
The hospital then has done this double work. It has taken
away a burden and given back a support. It has cut off these
54,911 years of insanity, which were or would have been a
heavy tax upon the sympathies and a draft upon the resources
of the community, and given back, in their stead, as many and
fifty per cent, more years of aid and labor to the body politic,
and the cost of this great boon to the Commonwealth has been
merely the expense of supporting and caring for these three
thousand one hundred and thirty-one, through an average of
somewhat less than six months for each one.
Massachusetts may then take a reasonable satisfaction in this
great and profitable charity, first established here, and now
expanded into three institutions for the relief of the children
of her blood and the children of her adoption. All the money
the State has expended in the cost and support of these, has
been judiciously invested. It has brought back a large return
in the prevention of a great bill of expense for the support of
life-long lunacy, and it has given to the community a very large
amount of productive labor, to sustain the families and to aid
in its due proportion, the public treasury.
HOSPITALS USED BY FOREIGNERS MORE THAN NATIVES.
Yet although so much has been done, both in this and in the
other public hospitals, they have not been enabled to do all that
was and is desirable for our own people. By a singular, and
probably undesigned, yet inevitable effect of the course of legis-
lation in this Commonwealth, the privileges and advantages of
these public institutions have been diverted, in great measure,
from the channels in which they should naturally flow, to others
which should not receive them until the first are filled. These
hospital privileges and benefits have been and are lavished, and
even forced upon the State paupers who are strangers, without
stint and without cost, while they have been sold to our own
people at a price beyond the cost, and upon the most careful
exaction of security, and thus the State makes a profit out of the
sufferings of its own children, and that in their weakest and
most agonizing hour.
When the last inquiry was made, in 1854, 93 per cent, or
nearly all of the foreign lunatics were unable to sustain them-
selves, nor could their relatives or friends, upon whom they
12 LUNATIC HOSPITAL AT WORCESTER. [Oct.
might have a legal claim, support them. Having no estate nor
resources to fall back upon in their sickness, they were depend-
ent upon the public treasury for sustenance, and, as very few-
had paid sufficient tax to gain a legal settlement in any city or
town, they became the wards of the Commonwealth and were
State paupers. Their families live in narrow dwellings, with no
space beyond the necessities or endurance of healthy life, no
room for the accommodation of an insane member. They have
neither the courage, nor the patience, nor the power to watch
over and take care of one who is deranged ; consequently almost
as soon as one of them becomes insane, the physician is called,
complaint is made to the court and permission asked for his
committal to the hospital. The order is issued, and the officer
directed to take him to the place of healing. Thus nearly all
the foreign lunatics are sent, and a very large proportion of
them in the early and curable stage of their disease, to the
public appropriate institution. In 1854, there were in Massa-
chusetts only sixteen, or 2^- per cent, of the six hundred and
twenty-five foreign lunatics, who were not then or had not been
in some hospital especially provided for the treatment of such
cases as theirs.
At the present time there are, in the hospital —
Independent or pay patients, . , 92, or 23 per cent, of alL
Town paupers, .... 123, " 31 "
State paupers, .... 181, " 46 " "
396
These proportions vary very widely from the proportions of
these classes of the insane in the State. At the last enumera-
tion they were —
Independent, . . . 1,110, or 42.17 per cent, of all.
Town paupers, . . . 829, " 31.49
State paupers, . . . 693, " 26.33 " "
2,632
The watchfulness of the alien commissioners, and their energy
in removing from the State such foreign lunatics as have claims
1862.] PUBLIC DOCUMENT— No. 28. 13
for support elsewhere, render it extremely probable that the
proportion of State paupers among the insane in Massachusetts,
is less than it was seven years ago. Certainly there is no reason
to suppose that they are in larger, or that the independent class
are in smaller proportion now than they were in 1854. Admit-
ting, however, that these proportions are the same now as they
were at that time, then, if the State hospitals were equally
accessible and available to, and used with the same freedom by,
all classes of patients, each class would constitute the same
proportion of their inmates as it does of the whole insane
population of the Commonwealth.
It is remarkable that the proportions of the town paupers in
the hospital and in the whole community are almost identical —
31.06 and 31.49 per cent. But the proportions of the indepen-
dent and of the State pauper insane, in and out of the hospital,
are reversed. In this institution there is a very large excess of
the dependent aliens and a large deficiency of independent
natives. If these classes of the insane were represented in the
hospital according to their numbers in the whole State, there
would be one hundred and sixty-seven instead of ninety-two
of the native or pay-patients, and one hundred and four instead
of one hundred and eighty-one foreigners in the institution.
If the independent class of the insane were represented here
in as large a proportion as that which is supported by the Com-
monwealth, they would have two hundred and ninety-one
instead of ninety-two in the hospital; or, if, on tlie contrary,
the aliens were represented in as small a proportion as the self-
sustaining Americans are, there would be only fifty-seven
instead of one hundred and eighty-one lunatics of foreign birth
in this establishment.
The law requires the hospitals to receive, support and treat
these alien paupers, but limits the payment from the State
treasury to two dollars and sixty-two cents a week, which is
less than the actual cost. The hospitals have no property of
their own, no income, nor resource, except the payments made
for the board and care of patients. They have no other alter-
native but to charge upon the other patients the deficiency in
the payments for the State paupers, or the excess of the cost of
supporting and treating these over the allowance made by the
law.
14 LUNATIC HOSPITAL AT WORCESTER. [Oct.
During the four years and ten months ending with Septem-
ber, 1861, the whole cost of supporting the hospital was
$238,140.88. The average number of patients was 351.7, who
were supported in the institution in this period, an aggregate of
88,628 weeks, at an expense of two dollars sixty-eight cents
and seven mills per week for each. The State paupers consti-
tuted, in these years, nearly two-fifths, 39.2 per cent, of the
whole. Previous to May 23, 1857, the Commonwealth paid for
its wards in the hospital, for those in the institution not over
thirteen weeks, $2.50, for over thirteen and not exceeding
twenty-six weeks, $2.25, for over twenty-six and not exceeding
fifty-two weeks, $2 a week, and for over one year, $100 a year.
From May 23, 1857, to September 30, 1859, the State paid the
same as was charged for the board and care of other patients,
and from September 30, 1859, to May 30, 1862, the State
paid $2.50 per week for all, and since the latter date $2.62 per
week for all.* In the first period, the payments by the State
fell far short of the cost of supporting its wards. In the second
period there was no loss to the hospital on this account. In
the third period there was a deficiency of eighteen cents six
mills per week on each State pauper, and as these averaged
one hundred and thirty-seven during this time, the loss was
$25.58 a week, or $1,325 a year. The law of April, 1862,
increases the price of board and care of the State paupers to
$2.62 per week, but the great advance in the price of all the
means of living, especially of dry goods and groceries, increases
the expense of supporting these patients, so that the deficiency,
even at $2.62 per week, is now larger than it was before. But
whatever this deficiency may be, it must be included in the
expense of supporting the institution, and assessed upon those
whom the law requires to pay the full costs.
Thus the great body of the people of Massachusetts, the self-
sustaining farmers, mechanics, merchants, professional men,
when they send any of their deranged friends, and the towns?
*The law of 1837 ordered that "the salaries of the superintendent, assistant
physician, steward and matron, be paid quarterly out of the treasury of the
Commonwealth." This law was repealed in 1 859, by an Act which also limited
the payments of the State for its paupers. These salaries were then charged
to the towns and families that sent their patients to the hospital, and add
three thousand and two hundred dollars a year to the cost of their support in
the institution.
1862.] PUBLIC DOCUMENT— No. 28. 15
when they commit their insane paupers to the hospitals, are
virtually compelled to pay not only the actual cost of their
support, but also a bonus to the State equal to the deficiency
in its payment, for the privilege of entering the institution, and
for this, bond and security are required, so that, by no possi-
bility, the State shall suffer the loss of any part of the cost or
profits on the healing of its own children's mental maladies.
Tliere is a large class, in this as in every industrial commu-
nity, whose daily exertions with their small estates, or whose
hands and skill alone furnish income sufficient to support
themselves and their families, both in health and in ordinary
sickness, but not sufficient to pay the price of board of any
member in the hospital through three, twelve, or more months
requisite for his healing or custody. Accustomed to living
within their own means, to paying for all that they consume or
use, yet having little or no surplus, they look upon the promise
and the bond to pay three dollars a week in addition to their
ordinary and necessary expenses, as a matter extremely hard
for some and impossible for others.
In view of the difficulties now presented, the immediate
necessity of obtaining the requisite bonds, by persons unused to
asking such aid from others, and of discharging the obligations
to pay thirty-nine dollars quarterly, through months and per-
haps years of uncertainty, and especially if the patient be the
head of the family, and the principal source of income be cut
off in his sickness, it is natural and inevitable that the friends
should doubt and hesitate to assume these new burdens so
apparently and even manifestly beyond their power to bear.
With income sufficient, but only sufficient, to meet the expenses
of ordinary life, many of these families postpone,' as long as
possible, the dreaded day of increasing the drafts upon it; yet
being accustomed to self-dependence for the supply of all their
wants, they are unwilling to ask the aid of charity, and their
natural and habitual self-respect, and perhaps their pride, forbid
their applying to the town for assistance, and thus make their
first confession of pauperism. They thus retain their deranged
relative at home, from week to week, from month to month,
and some from year to year.
But at length, after a wearisome period of trial and disap-
pointment on the part of the family, the patient becomes more
16 LUNATIC HOSPITAL AT WORCESTER. [Oct.
violent and difficult to be managed, and the burden of his care
more oppressive and distressing, or the relatives become
exhausted with the ceaseless watching and painful anxiety ;
then for their own relief, rather than with any increased hope
of restoration, or any new confidence in the hospital, they send
their friend to it, but not until the chance of recovery is
lessened, often very materially diminished, and in too many
cases entirely lost.
Insanity is one of the most curable of serious diseases, if
properly treated in its early stages. But it tends to fix itself
upon the brain, and its chances of cure decrease rapidly with
delay, and after a variable period in different cases, the malady
is established for life, and all hope of restoration is gone. The
records of hospitals show, that about seventy to ninety per cent,
are restored, if taken within a year after the attack. A second
year added to the continuance of the disease increases its
incurableness, and a third and a fourth increase the difficulty
very greatly, until the fifth- and after, when if any one is
restored, it is considered rather a happy and unaccountable
accident, than the result of skill or science that would justify
the expectation that such may happen again.
In the twenty-nine and three-quarters years' experience of
the Worcester hospital, 72.68 per cent, of the recent cases,
or those of not over a year's standing, and only 25.17 per cent.
, of those of longer duration were restored. If the comparison
could be made between those which were sent to the hospital
within three months of their attack and those which came in
their second and third and later years, the advantage of early
treatment would be much more manifest.
The first effect of delay in sending insane patients to the
hospital being the diminished proportion of the recoveries, and
of course the increased proportion of the permanently insane,
the second effect, the increase of the lunatic population in the
community necessarily follows. The thirty-four hundred and
twenty-three who were sent to the Worcester hospital within
their first year, gave back twenty-four hundred and eighty-eight
to health and usefulness, and left nine hundred and thirty-five
in confirmed lunacy. But the twenty-six hundred and forty-
nine who came, after they had been deranged a year and more,
returned to health and usefulness only six hundred and sixty-
1863.] PUBLIC DOCUMENT— No. 28. 17
seven, and left nineteen hundred and eighty-two to swell the
ranks of the constant insane population of the State.*
There is in every country a constant insane population, con-
sisting in part of those whose disease is recent and curable, but,
in much greater part, of the old and incurable cases. The
proportion which these bear to the whole community varies
widely in different States and Nations, and depends partly on
the abundance and intensity of the causes that produce mental
disorder, but much more on the ratio of those patients who are
not submitted to, nor allowed to have the benefit of, the proper
remedial measures, in the early stages of their malady, which
in them is consequently extended from the few months needed
for the cure to a duration that only ends with life.
In a perfect state of things, where the best appliances, which
the science and skill of the age have provided for healing, are
offered to the lunatics in as early a stage of their malady as
they are to those who are attacked with fever or dysentery,
probably eighty and possibly ninety per cent, would be restored,
and only twenty or perhaps ten per cent, would be left among
the constant insane population. If this system of prompt and
proper attention had been pursued in any community, for an
entire generation, the number of lunatics in that community
would be represented by eighty or ninety per cent, of the
numbers annually attacked with mental disease, multiplied by
one-half, (as it requires about six months on an average to
effect a cure of the disease,) and ten or twenty per cent, of the
same number multiplied by the number of years they may be
expected to live.
During the seven years, from 1855 to 1861, inclusive, five
thousand one hundred and seventeen patients, or an annual
average of seven hundred and thirty-one, were admitted to all
the lunatic hospitals in Massachusetts. It may be safely
assumed that as many, and perhaps more, were attacked with
insanity ; for, although, among these, were many cases which
had begun in previous years, yet among those attacked in each
of these years were probably as many who were retained at
their homes to be sent to the hospitals at a later period, when
their disorder shall be of one, two, or more years' standing.
* These numbers do not include those whose previous history was not known.
3
18 LUNATIC HOSPITAL AT WORCESTER. [Oct.
It may, then, be admitted that in each year, from 1855 to 1861,
at least seven hundred and thirty-one of the people of this State,
or one in sixteen hundred and sixteen of the total average
population, became insane.
The causes of insanity are manifold. They are partly
organic and inherent, partly connected with personal habits,
some are due to social customs, and others are accidental.
Individually they vary from year to year, yet their sum total,
their aggregate force remains about the same, and they produce
about the same annual effect, and make about the same number
of lunatics, in proportion to the population, through successive
years. As, then, one in sixteen hundred and sixteen of the
people of Massachusetts has been received into the hospitals,
and probably as many made insane, in each of the last seven
years, there is every reason to suppose that as large a propor-
tion of her population will become insane in the next and each
of the succeeding years, unless the conditions and habits of the
people shall be changed and the causes of mental disturbance
be diminished.
If from the beginning, our public hospitals had, by favoring
legislation, been made as accessible and available, and offered
on as easy terms, to the American as to the Irish insane, and if
the popular sentiment and general custom had induced the
native families to send their lunatics to these institutions, in as
large proportion as the foreign families send theirs, then these
seven hundred and thirty-one, or that proportion of the people
annually attacked, would have left but a small number to be
permanently deranged, and Massachusetts would not have the
great insane population which, in 1854, was twenty-six hundred
and thirty-six, and probably is not less now.
POLICY OP OTHER STATES IN THE MANAGEMENT OF THEIR HOSPITALS.
Some other States, wisely deeming it to be their highest
interest and duty to keep their people in the best health and
efficiency ; to rescue as many as possible from mental destruc-
tion, and convert them from burdens upon, into supporters of,
the Commonwealth, have adopted and pursued a policy different
from that of Massachusetts, in the administration of their
lunatic hospitals, by opening the doors of these establishments
1862.] PUBLIC DOCUMENT— No. 28. 19
more widely for all their citizens, and making the way into
them more smooth and easy.
Twenty-four of the States have provided public hospitals for
the insane, and offer them, on various terms, to their people.
Ohio, Indiana, Illinois, "Wisconsin, and California assume and
pay, out of the public treasury, the whole expense of support-
ing these institutions, and invite all their people of every class —
the rich and the poor — to send their lunatics, to have board and
treatment, and be healed, without money and without price.
The law of Indiana says : " Insane persons residing in this
State, and having a legal settlement therein, shall be supported
in the hospital and receive medical treatment at the expense of
the State." The law of Wisconsin says : " Insane persons
residing in this State, and domiciled in any county therein,
shall be supported and receive medical treatment in the hospital
at the expense of the State."
New York, New Jersey, Pennsylvania, Michigan, and Georgia
pay the salaries of the officers out of their public treasuries,
and no part of this expense is charged upon the estates or friends
of the independent patients, nor upon the towns and counties
that send their paupers or pay the cost of patients of narrow
means.
Kentucky, Missouri, Louisiana, Tennessee, Mississippi and
Georgia pay for the support of all their pauper lunatics in their
hospitals, except that Missouri charges the cost of the clothing
to the counties.
In various other ways several States lighten the burden of the
support of patients in the hospitals, and remove or lessen the
objections on account of expense that vi^ould prevent the people
from sending their friends, or counties and towns from sending
their dependents to these institutions.
The law of Maine, passed in 1852, says : " Whenever any
person, unable to pay his or her board and expenses, shall be
committed to the Maine Insane Hospital, * * * the treasurer
of the hospital may charge to the State, and the State shall pay
one dollar per week of said patient's board, and deduct that
sum weekly from the charge to the patient, city, town, or
plantation liable for his or her support."
New Hampshire appropriates three thousand dollars a year
to pay the whole or a part of the bills of the indigent, and those
20 LUNATIC HOSPITAL AT WORCESTER. [Oct.
of limited means who are not paupers, nor ordinarily depend-
ent, but to whom the cost of supporting a patient in the
hospital would be inconvenient.
Pennsylvania " places the rate of board so much below the
cost, as to prevent any reasonable objection being made by those
in humble circumstances, who could pay for their friends, or by
counties and townships which are responsible for their poor,
to sending them to the institution." The report says this " has
unquestionably enabled many families in moderate circum-
stances to partake of the benefits of the hospital who could not
otherwise have done so." The same report adds : " The
promptness and liberality with which these appropriations to
meet the deficiency have been made by successive legislatures
is the most conclusive proof of their regarding the system as
subserving the best interests of the whole community without
being oppressive to any one."
The law of New York ordains, that " whenever a person in
indigent circumstances, not a pauper, shall become insane,"
" and his estate is insufficient to support him, and his family, or
himself if he has no family," then " the first judge of the
county shall investigate the case," " and he [the patient] shall
be supported in the hospital, at the expense of the county, until
he shall be restored to soundness of mind if effected within two
years, in order," says this humane law, " that he may be
restored to his family and his estate unimpaired."
The law of New Jersey orders, " that when a person in
indigent circumstances, not a pauper, becomes insane and his
estate is insufficient to support liimself and family, (or if he
has no family, himself,) under the visitation of insanity," " he
shall be admitted into the asylum and supported there at the
expense of the county, until he shall be restored to soundness
of mind, if effected within three years."
North Carolina pays the whole bills for the poor in the State
hospital, and charges eighty per cent, of this cost to the counties,
and assumes all the responsibility of collecting it.
Michigan requires that all insane persons, who " have insuffi-
cient estate to support themselves and their families, under the
visitation of insanity," shall be admitted to the State hospital
free of cost as to themselves, but their board is charged to the
counties. The trustees, in their last report, propose " the
1862.]
PUBLIC DOCUMENT— No.
21
assumption, on the part of the State, of a portion of the
expenses of the support of the pauper and indigent insane, to
the amount perhaps of one or one and a quarter dollars a week,"
in order to lighten the burden on the counties and families of
limited means, and induce them to send all their patients to the
hospital.
In several States, a large proportion of the expense of
supporting the hospitals is received directly from the public
treasury, and a small proportion from private or pay patients or
other sources. From the late annual reports, the facts of the
following table are derived, showing the amounts and propor-
tions of income received by the State hospitals from the State
treasuries and from other sources :
HOSPITAL.
Years.
Amount of
Monet Eeceived.
Pkoportion
PAID BY
State.
others.
State.
others.
East Virginia,
1850-57,
$245,963
$30,258
.89
.10
West Virginia,
1857-59,
135,000
49,129
.73
.26
North Carolina,
1858, '59,
55,955
17,867
.75
.24
Georgia, ....
1857, '58,
24,412
7,472
.76
.23
Louisiana, ....
1859, '60,
38,750
10,409
.78
.21
Mississippi, ....
1858,
34,000
4,380
.88
.11
Tennessee, ....
1855-59,
167,000
59,853
.73
.26
West Kentucky, .
1858 '59,
52,500
7,416
.96
.03
Iowa,
1861,
16,551
1,409
.94
.05
South Carolina requires its hospital to receive the pauper
patients from the several districts, but requires them to pay
only a part of the cost ; the rest is charged upon the private
patients, who pay not only for themselves but an excess to aid
the State or the districts, in the support of their wards. The
asylum report for 1858 said : " We have now one hundred and
seven paupers at a cost to the asylum of one hundred and
sixty-five dollars each, or seventeen thousand six hundred and
22 LUNATIC HOSPITAL AT WORCESTER. [Oct.
sixty-five dollars, for which we receive but ten thousand and
seven hundred dollars. The deficiency amounts to six thousand
nine hundred and fifty-five dollars, and is made up from the
profit derived from the paying patients." The grant by the
legislature was then one hundred dollars a year for each
pauper. It was then increased to one hundred and thirty-five
dollars, which is still short of the payment of the cost of the
advantages which the State receives. The report for 1859
says : " The average cost of supporting an insane person exceeds
one hundred and sixty-five dollars per annum." The legisla-
ture grants one hundred and thirty-five dollars for each of
the paupers, which still falls thirty dollars short of the amount
expended by the institution in their behalf.
The reports do not say whether those States which are quoted
in the preceding table as paying so large a part of the expense
of their public hospitals, get any return or profit from the
board and care of paying patients or other sources, nor whether
the charge upon the private patients exceeds the actual cost.
The charge to these varies with the accommodations required
and attentions given, but there is no evidence that any State,
except South Carolina and Massachusetts, assesses any part of
the cost of supporting the paupers upon the others who or
whose friends pay their bills.
COMPARATIVE COST OF SANE AND INSANE PAUPERS.
The cost of the support and care of the insane is every-
where greater than that of the sane of similar classes. The
town paupers of Massachusetts in the four years, 1857, 1858,
1859 and 1861, cost on an average one dollar and fifty cents
a week. The State paupers in the State almshouses cost one
dollar and nine cents a week through the four years, 1858 to
1861. The average cost of supporting and taking care of the
patients in this hospital was two dollars and seventy-five cents
a week for the same period.
There is a still wider difference in the expense of supporting
the sane and insane paupers in England and Ireland.
According to the ninth, tenth, eleventh, and twelfth annual
Reports of the Poor Law Board, and the eleventh, twelfth,
thirteenth and fourteenth reports of the Commissioners in
Lunacy, the cost of supporting an annual average of 122,892
1862.] PUBLIC DOCUMENT— No. 28. 23
paupers in all the workhouses of England and Wales, was
sixty-nine cents a week for each, through the four years, 1855
to 1859 inclusive, while the average cost of supporting the pau-
per lunatics, in the thirty-eight County and Borough Asylums,
was two dollars and thirteen cents a week for each, through
the same period.
The reports of the Inspectors of Lunatic Asylums and of
the Commissioners of the Poor in Ireland make similar state-
ments of the cost of supporting the sane and insane paupers.
Through the four years 1856 to 1859, the average cost of all
the indoor paupers in the workhouses, for provisions and
clothing, was 2s. 2^d., or fifty-three cents a week for each,
the average expense of supporting the patients in the sixteen
District Lunatic Asylums was <£20. 5s. lOd., or ninety-seven
dollars and forty-cents a year, and one dollar and eighty-four
cents a week for each, through the same period.
Some allowance must be made in regard to these statements
of the cost of supporting paupers in the almshouses of the
State and towns, and in the workhouses of England and Ireland,
in comparison with the cost of the inmates of hospitals. The
former include all of every age, nursing infants who cost
nothing and children who cost very little, as well as adults,
whereas none but adults are in the institutions for the insane.
EFFECT OP THE TWO POLICIES ON THE USE OP HOSPITALS AND
CURE OP PATIENTS.
The natural effect of the liberal and the economical policies
of offering the hospitals to the use of the people, is manifest in
the different ratios of the patients sent, in the early and in the
later stages of their malady, to the hospitals in Massachusetts,
Ohio, and Indiana.
In Ohio 73.7 per cent., in Indiana 70 per cent., in Illinois
70.5 per cent., and in Massachusetts 64.8 per cent, of the patients
in their State hospitals were sent in the first year after they
were attacked.
As a necessary consequence, those States which sent the
largest proportion in the early and curable stage, received back
the largest proportion in health and power of usefulness, and
had the smallest proportion left in confirmed immovable lunacy
to be supported for life by their estates or the public treasuries.
24 LUNATIC HOSPITAL AT WORCESTER. [Oct.
In the three public hospitals of Ohio, 64.59 per cent, of all
that were sent to them were restored, and 43.40 per cent,
remained insane for life. In Massachusetts, 44.05 per cent,
were restored, and 55.95 per cent, remained a life-burden on
the people.
It must be remembered, in this connection, that the reports
of admission into the hospitals of Massachusetts include both
the foreign or State paupers, who are admitted free, and the
American paying patients who are charged more than the cost
for their support. If distinction were made in the reports, and
it were shown how many of each of these two classes were sent
in the several stages of their disorder, it would, without doubt,
be found that a much larger proportion than 35.2 per cent, of
the native patients were kept out of the hospital until their
disease become more difficult and even impossible to be
removed.
It is not necessary to go abroad to find the connection between
the terms of admission and support, and the readiness with
which people avail themselves of hospital privileges for the cure
or custody of their insane friends. We have proof of this in
our own daily experience. Our Irish patients go free and
stay without cost, and they are sent early and have the best
opportunities of restoration. The Americans go at their own
cost, and pay all and more than all of the expense of their
support, and consequently a large proportion are kept away,
some for months and years, as long as their friends can endure
or take care of them, and many for life, because their friends
lack courage or money to take due advantage of the means of
restoration so largely provided in the State. In 1859, 97.5 per
cent, of all the foreign and only 58 per cent, of the native
lunatics then living in the State had been sent to some hospital.
The proportion of patients restored,|out of all admitted to
the hospitals, is twenty-three per cent, greater in Ohio than in
Massachusetts. Now no one will suppose that the hospitals of
Ohio are managed with more skill than those of this State.
But this difference in the results of their labors is due to the
difference in the proportion of patients sent in the curable
stage of their disorder.
Looking upon this matter merely as a question of political
economy, in its bearing upon the remote as well as present
1862.] PUBLIC DOCUMENT— No. 28. 25
means and prosperity of the State, it is plain that there are
important advantages on the side of the free and open system
of managing these public charitable institutions. They send
back to society a larger proportion of workers, producers, self-
supporters and contributors to the public treasury, and leave
a smaller proportion of the useless and burdensome class.
Inasmuch as they have a better or more available material to
work upon, they produce a more successful result, and convert
a larger proportion of costly men and women into profitable
members of the body politic. The Worcester and Taunton
hospitals have received 8,490 and restored 3,740 to health.
If these could have been sent at as early a stage of their disease
and as large a proportion restored as in Ohio, then twenty-
three per cent, or 860 would have been added to the useful and
self-sustaining citizens sent back to the world, and as many
taken from the class that has been or must be supported and
cared for, through life.
It must be farther considered that it costs no more to admin-
ister these institutions on the free principles of Ohio than on
the economical principles of Massachusetts. Both there and
here, provisions, groceries, clothing, labor, salaries, would be
the same under either system. The only difference is in the
way in which the cost is assessed upon the people. Here it is
imposed upon those who receive the immediate personal advan-
tage, many of whom are the least able to bear it, and always
at a period when they are the weakest and any burden is
distressing. In the other case, this cost of rescuirig the people
from permanent insanity, like the cost of schools, roads,
government, justice and police, is assessed upon the whole com-
munity, in the proportion that each one is able ]to pay. And in
both cases, it comes out of the aggregate property and income
of the Commonwealth.
The Trustees do not now propose that Massachusetts should
adopt the plan of Ohio, Indiana, and the other States that sup-
port their hospitals entirely out of the public treasury, and
assume the whole burden of these public institutions, but they
have thought it proper to present to the government and the
people the various methods adopted by other States for the
support of their lunatic establishments, and they commend
these to the careful consideration of the legislature, to see
4
26 LUNATIC HOSPITAL AT WOECESTER. [Oct.
whether, by any different plan, our hospitals may be made
more available and useful to our own people, and power and
opportunity given them to diminish this standing army of near
three thousand lunatics, which has, thus far, been kept full
and perhaps increased by annual recruits of the neglected and
uncured patients.
WORKING CAPITAL.
The hospital labors under embarrassment from the want of a
working capital, which would enable it to buy the materials
needed for use and consumption with cash, and at best advan-
tage. This necessarily grows out of the credit system, which
the law and custom have established for its management. The
law requires the towns and individuals to pay quarterly, and
now offers the same terms in behalf of the Commonwealth.
The hospital is therefore obliged to advance the entire cost of
supporting the institution for three months, before it receives
any return from any source. It must provide and serve out
groceries, provisions, and clothing ; it must employ officers,
attendants, and servants, and for these it must pay in money,
or obtain credit to the amount of one-quarter of the annual cost
of supporting the establishment, for the use of its inmates
and for the benefit of the State, towns and families, that send
patients to its care, and are responsible for the payment of
their bills. Now the hospital has no money nor capital applica-
ble to this purpose. All the property it possesses is invested
in lands, buildings, furniture, and stock, all of which are
necessary, in their present form and position for the operations
of the institution, and cannot be converted into available funds.
Nor is the hospital in the possession of any legitimate means
of earning or otherwise creating a working capital. Its only
sources of income are the receipts for the board and care of
three classes of patients, on conditions prescribed by the law.
By the terms of the law, the hospital must board, clothe and
take the care of the State paupers for two dollars and sixty-
two cents a week, which is less than the cost, and therefore at
a loss, and would run the hospital in debt to the extent of the
deficiency. It must take town paupers " for a sum not exceed-
ing the cost of their support." It may charge the independent
patients such a price as the trustees may think proper. The
1862.] PUBLIC DOCUMENT— No. 28. 27
first class is taken at a loss ; the second without profit ; and
the third is left by the law without limit of charge, except that
they are virtually required to pay not only for themselves as a
body, but for the deficiency of the State's payment for its
paupers. Considering that this class of paying patients is a
small one, not more than 23 per cent, of the whole, and that
they are already charged for more than they receive, it would
be invidious and inexpedient to increase their payments for the
purpose of gaining a surplus.
As then the hospital has no working capital, nor any means
of creating it, and yet such is necessary for the operations of
the establishment ; the only alternative is to use the capital of
others, either by borrowing money and paying cash for all that
is bought, or to buy on credit, by inducing the farmers, grocers
and other dealers, whose provisions and goods are needed for
consumption, and the persons employed, to allow the institution
to use their property and services during each quarter in
advance of payment.
Following the universally recognized wisdom and economy
of buying with cash, the hospital has generally borrowed from
the banks sums of money to enable it to pay in part, at least,
for the goods, wares, and provisions as they were bought, and
the services of the attendants, mechanics, and others as they
were rendered. In either case, whether the hospital buy on
credit or borrow money and buy with cash, in as far as it gives
credit it must obtain credit, and be in debt to the extent of the
cost of whatever material or service is furnished to the patients,
in the intervals of the quarterly or other payments.
At the end of the last quarter, September 30, 1862, the
hospital owed,
For money borrowed, $4,000 00
To grocers, traders, farmers, and others for supplies, 8,500 00
To officers, attendants, and laborers, . . . 2,800 00
$15,300 00
There was due to the hospital for board of patients.
From the State, $13,000 00
From towns, 5,360 00
From individuals, 4,232 00
,592 00
28 LUNATIC HOSPITAL AT WORCESTER. [Oct.
The amount of debts due from the hospital is, in fact, the
working capital, which should be owned by the institution, but
is really owned by the people who supply the materials or the
labor for its operations.
In this respect, the hospital is less favorably situated than
similar institutions in some other States. The laws of New
York and of New Jersey expressly order, that their lunatic
hospitals shall buy with cash and not on credit. And New York
grants money to the Utica hospital to enable it to do so. The
laws of some of the States and the regulations of some hospitals
require, that all payments for the board and care of patients
shall be made, some quarterly and some half-yearly, in the
advance.
The financial relations of the hospital to the Commonwealth
differ very materially from those of other public charitable insti-
tutions, which receive support from the public treasury. The
State makes its payments to the Institution for the Blind, the
Eye and Ear Infirmary, and the School for Idiots, quarterly in
the advance, for the support of beneficiaries in those establish-
ments through the next following term. These grants are of
specified sums, and, excepting that to the Idiot School, they are
given only on the general condition, that they shall be applied
to, and expended for, the benefit of those institutions. The Idiot
School is required to take a certain number of children recom-
mended by the governor, in consideration of the money received
from the State. No bond is exacted from either of these institu-
tions that the money shall be, nor any account required to show
that the money has been, expended as directed. But the money
is paid regularly on the quarter days, in the generous confidence
that it will be used in accordance with the designs of the
legislature.
The State pays the bills of the State almshouses for the sup-
port of its sane and insane paupers in those establishments
monthly and promptly, and moreover the law authorizes the
treasurer to pay to the superintendents five hundred dollars in
the advance to enable them to make their monthly purchases.
Thus the State supplies all these institutions with a working
capital, and they are not obliged to ask credit of banks, mer-
chants or farmers, who supply their wants.
1862.] PUBLIC DOCUMENT— No. 28. 29
Like the State almshouses, the hospitals are not separate
individualities. They have no independent existence. They are
simply parts of the Commonwealth. They are owned by the
State, and the trustees are merely its agents, acting in its name
and for its advantage ; and, it should be, solely on its responsi-
bility. For this purpose they hold and use the Commonwealth's
property which they can neither alienate nor pledge.
Liasmuch then as no institution can be carried on without a
working capital which must be either owned or hired, and inas-
much as capital never works gratuitously for those who do not
own it, but always exacts payment either in interest on money
loaned or in the increased charge for goods sold on credit over
those sold for cash, the more liberal policy practiced by the
State, in the support of its wards in the institutions for the Blind
and Idiots, and in the maintenance of its sane and insane paupers
at the State almshouses, is a wiser and more economical one
than that which it has adopted for the support of its insane
paupers in the lunatic hospitals.
However proper or expedient it may be for the State to allow,
or, by any legislation, to make it necessary for, its agents to
borrow money or obtain credit, in order to effect the purposes
entrusted to them by the law, still considering that the cost or
rent of the working capital thus obtained, which is six percent,
if in loans from banks, and as much and probably more if in
purchases on credit, — must be included in the needful expendi-
tures for the support of the hospital, and be charged with other
costs to, and be paid by, the towns and people of the Common-
wealth, it becomes a questionable economy for the State to
obtain it at these rates through its agents, the trustees, when it
can always obtain from the banks, through its own treasurer,
all that it wants for all its purposes, at five per cent.
CRIMINAL INSANE.
The experience of nearly thirty years' operation of this
hospital, and the careful observation of the successive boards
of trustees, of the superintendents, and others engaged in the
management of this institution, all go to establish and to
strengthen their conviction, that it is impolitic and wrong to
place insane criminals in the same rooms, wards, or even
30 LUNATIC HOSPITAL AT WORCESTER. [Oct.
establishments, with the honest and untainted patients, and
require them to live together.
No one will assert that the prison is a proper place for a
lunatic. And it is equally clear that the hospital created for,
and occupied by, patients from general society, is not a proper
place for a criminal. Admitting that the insane convict should
be removed from the one, it by no means follows that he
should be carried to the other. Whether viewed in the light
of humanity, or of economy, it is better that he be detained in
his prison than be admitted into the hospital; for, at the worst,
if he be not removed, he may remain insane for life for want
of the means of healing, while, if he be placed in a ward filled
with other and respectable patients, he may be an obstacle to
their restoration, and prevent some, perhaps many, from ever
regaining their health. The question is not simply whether
the insane convict shall or shall not have an opportunity of
being healed, but whether an attempt shall be made to save a
criminal and a worthless citizen, by the peril, and perhaps the
sacrifice of the restoration of some, possibly many, honest and
valuable men who must live and associate with him in the
hospital.
Lisanity disturbs the mental health of its victims in various
ways. Among the most common of these morbid conditions is
the exaltation of sensibility, which makes the patients timid,
anxious, suspicious, irritable, and even sometimes quarrelsome.
Some are depressed in spirit, and almost crushed with a sense
of imaginary sinfulness, or an intense consciousness of unworthi-
ness. To meet these morbid conditions of the patient, the
hospital managers endeavor to bring the most favorable influ-
ences to act upon him ; they surround him with every thing
soothing, gentle, and acceptable. They provide every thing to
cheer, encourage, and elevate him, and inspire him with confi-
dence that his new position in the hospital is all for his good.
They arrange all the circumstances, select the associates, and
control the conversation ; they determine the scenes that may
be visited, and the ideas that may be presented, according to
their influence on the over-sensitive and disordered mind.
It is among the best established principles of the treatment
of insanity, that a patient should be opposed or interfered with
as little as possible, consistently with his good ; that his notions
1862.] PUBLIC DOCUMENT— No. 28. 31
and arguments should not be disputed, his wishes and incli-
nations indulged, so far as they can be, safely, his opinions
and tastes treated with respect, when they are proper, but
always with tenderness, and that every thing should be done to
encourage his self-respect.
Among the patients in the hospital are always the members
of our own families, our parents, our brothers and sisters, our
sons and daughters. Prom their childhood they have been
taught to love virtue and abhor vice, to avoid even the appear-
ance of wickedness, to associate with good, and shun evil com-
pany. They have been accustomed to run from the base, the
degraded and the corrupt. Their sensibilities, their tastes, and
their consciences, have been cultivated and shaped in accord-
ance with their education and their habits. They lose none
of these in their disease. Insanity tends to exalt and intensify
them. They become morbidly sensitive, and even irritable in
respect to them.
To put a convict among such patients as these, to compel
them to associate with him in the same halls, to eat at the
same table, to hear his coarse and offensive conversation, his
vulgar slang, his profanity, his sneers at religion and honesty,
and religious and honest men, his contemptuous jeers at what
they have been taught to regard with reverence, his tales of
cunning and crime, of successful and unsuccessful villany ; all
this is in contravention of the best principles of managing
mental disorders, and diminishes, if it does not counteract, the
influence of the curative measures that may be used.
It is at least a singular view of governmental responsibility,
that, looking for the highest good of the community, and the
moral and spiritual welfare of all its members, educates children
and youth to walk in the ways of holiness, and encourages all
of every age to associate only with the pure and the upright,
when they are well and able to choose for themselves, but gives
them felons for familiar companions, when they are broken
down with mental disease, and too weak to choose their company.
The hospital is provided for all the families of the Common-
wealth. In the chances of life any one of us may be exposed
to the accidents or influences that cause insanity, as well as to
those that cause fever. Any of our children may be afflicted
with disease of the brain, as well as with disease of the lungs.
32 LUNATIC HOSPITAL AT WOKCBSTER. [Oct.
A daughter, the idol of her parents, becomes insane. Her
anxious and almost agonized friends take her to the hospital,
and leave her there, in confidence that her intensely sharpened
sensibilities will be soothed by the gentlest associates, the
tenderest language, and most refined manners of those that
surround her ; but she is shocked to find in the same hall with
her, perhaps sitting next to her at table, a convict from the
house of correction, a woman that had previously been a keeper
of a brothel, and still retains her vulgar obscenity, and her
lascivious ways. Or a son, trained in the same way, may
become deranged on the subject of religion. Self-chastening
and downcast, he enters the ward, and finds among the inmates
a burglar from the State prison, who has been educated and
practiced in all manner of wickedness, and takes a pleasure in the
display of his own corruption, and in offending the sensibilities
of such as he considers to be over-nice and fastidious.
Among the insane, there are always some whose recovery is
doubtful, whose chances of mental life or death hang like a
balance, so evenly adjusted, that the slightest weight will
turn the scale, the least disturbing cause will decide the issue
against them. These are watched by the officers and attendants
in the hospitals, with the tenderest solicitude, and guarded with
anxious vigilance to protect them from every unfavorable influ-
ence. To such as these, standing on the verge of mental death,
the presence and companionship of a felon from the prison may
be sufficient to overthrow them, and determine the fatal course
of their disease.
These are parts of the real and unavoidable life of our public
hospitals, and of all in every country that admit the two classes
of honest and criminal patients. These descriptions and com-
plaints are found scattered through the successive reports of
such hospitals in America and Great Britain, and the reports
of the commissioners in lunacy of England, and inspectors of
hospitals in Ireland.
In an economical view, the admission of convicts into the
hospitals is equally objectionable. These men have been and
are to be prisoners. When they shall be restored to health
they are not to return to the free world and their homes, but
to the prison whence they came. They have, therefore, every
motive to attempt to escape while they are in a weaker place of
1862.] PUBLIC DOCUMENT— No. 28. 33
detention. They must then be securely confined, and guarded,
and watched with extraordinary vigilance, during their whole
residence in the institution ; for the hospital is made respon-
sible for them. Their previous life and training, their character
and habits, render this responsibility exceedingly difficult to be
borne. They have been used to dissimulation, the practice of
deceit, and assumption of false appearances in the presence of
policemen and watchmen. They have studied the ways of
overcoming obstacles, of picking locks, undoing fastenings, and
moving bolts ; and with their experience in finding their way
into forbidden places, they are constantly seeking to find their
way out through the doors, windows, or walls, that are only
sufficient to hold the honest and appropriate inmates of the
house.
No confidence can be placed in their co-operation with the
government of the hospital ; no reliance on their apparent con-
tentment, or professed desire to remain and enjoy the benefits
of the institution. Wherever they may be, whether in the
house or abroad, in ward, dining-room, bathing-room, shop, or
field, no relaxation of the rigid watchfulness can be allowed.
The greater security of locks and bars and the severer disci-
pline, which their presence makes necessary in any ward,
applies to all the inmates, and lessens their freedom and
increases their discomfort and discontent. The addition of
a patient of this class increases the cost of managemen,t
probably two or three times his due proportion. The two
dollars and sixty-two cents which the State pays for his board
does not cover half, hardly a third, of the addition which his
presence makes to the expense of supporting the institution.
There are now in the hospital ten insane criniinals. Martin
Bumpus, George Freeman, Edgar Snow, John Connor, John
Donnegan and Matthew Watson, froni the State prison, and
Patrick Mulligan, Frank Norton, John Smith and Henry Wil-
liams, from the houses of correction. In addition to these male
convicts, several females have been sent from the prisons to the
hospital. One was from the jail in Worcester, to which she had
been committed for theft and various misdemeanors. Another
was from Cambridge jail, to which she was committed for
5
34 LUNATIC HOSPITAL AT WORCESTER. [Oct.
drunkenness. Two others have been, at times within the year,
confined in the lock-up for street walking.*
Nearly or quite all of these men have, at some time, escaped
from the hospital, and have been pursued and retaken. When-
ever any one of this class of patients escapes from the rooms
within, or from the attendants abroad, at once the legitimate
and appointed administration and work of the hospital are
interrupted, and all are devoted to the one absorbing purpose
of recovering the fugitive. All the available force of the insti-
tution, that can be spared, is withdrawn from their appropriate
work ; the officers forsake all other claims upon their attention,
the number of attendants is reduced to the lowest limit in the
wards, and as many as possible sent in pursuit of the prisoner.
If these means are not sufficient to retake him, then assistance
is obtained from abroad. Sheriffs are employed, policemen and
constables are called into requisition, neighbors are asked to
aid, and advertisements are sent to the papers.
Beside the loss of the services of the officers, attendants and
servants of the hospital, who are thus taken from their appointed
work, and whose salaries and wages must go on while they are
hunting escaped convicts, as well as when they are taking the
care of patients, the sheriffs, policemen and runners must be
paid for the time they give and the service they render for this
purpose. For this aid from abroad to pursue and retake elopers,
Donnegan has cost the hospital twenty-five dollars, and Freeman
about the same. Mulligan has cost about twenty dollars, and
Norton a smaller sum. Some have been retaken by the efforts
of the hospital officers, attendants and servants alone, and their
recovery cost only the time and wages of those engaged and
sent in pursuit, and no money was specifically paid for this pur-
pose. All of these expenses of pursuing and retaking escaped
convicts, have been paid by the hospital, and, of course, charged
to the other patients, as a part of the cost of supporting the
establishment.
Snow has not escaped, nor has he made any serious attempt
to do so ; but, on other accounts, he is worse than either of the
* Since this report was written, and before it was printed, two other women
have been received from the prisons, to which they had been committed for
street walking. One was from the house of correction at South Boston, and
the other from the jail in Cambridge.
1862.] PUBLIC DOCUMENT— No. 28. 36
others, by his persistent attempts to corrupt and disturb the
other patients in his ward, and diffuse among them a knowledge
of the ways of crime, by relating tales of his own and others'
lives of lawlessness and wickedness, and boasting of his daring
adventures, his cunning tricks, shifts and evasions in the pur-
suit of his vocation, and escaping from detection.
Whenever a convict patient has once succeeded in getting
away from the house or the attendants, altliough retaken and
brought back, yet he is all the more induced to try liis fortune
again in the same way. He has tried the house and found its
weakness and its insufficiency for the confinement of such cun-
ning and desperate men as himself, and he feels confident that,
as the house is not, and cannot be made any stronger, he can
do the same again, and trusts that he shall be more lucky in
eluding pursuit when he shall be once more abroad.
Tlie hospital government, conscious of having failed once,
and fearful of a second failure, find it necessary to increase
their vigilance and watch with more intensity ; and tlie care
and attention of the attendants, which are needed and are other-
wise given to soothe the distresses, calm the excitements,
restrain the waywardness, and enliven the torpid powers of
their patients, are necessarily withdrawn, in great measure,
from these appropriate objects, ami given to the unceasing
supervision of the convict, and guarding against his second
escape, which is then and there the most threatening danger.
Consequently the care of such a patient, which is, at first, much
more troublesome and expensive than that of the honest inmates,
becomes still more costly, and his presence is a still greater
burden on the operations of the institution after he has once
run away and been brought back.*
The admission of convicts to the common lunatic hospitals
is then, in every way, bad.
* On the evening of the 24th of October, while the attendants of the ward
were occupied in their usual duties connected with the patients, Bumpus, one
of the convict patients, went into the bathing-room, to which all the inmates
have unrestricted access, forced out the grating of the window, jumped to' the
ground and ran away. Although his escape was soon discovered and the alarm
given, yet as it was dark, the direction and course of his flight could not be
traced. The usual means were then taken, the household officers and many of
the attendants were called from their ordinary work, and gave themselves to
the business of pursuing the eloper. Sheriffs, policemen, and others were
employed, and sent on the same errand, and, after a diligent search, in various
36 LUNATIC HOSPITAL AT WORCESTER. [Oct.
It is false to humanity to compel the children of virtue to
live in the same halls with the children of wickedness. It is
unphilosophical to allow such offensive and disturbing influ-
ences to reach and act upon the delicate sensibilities and irri-
table temperaments of the insane. It is bad political economy
to put to hazard the chance of restoring honest patients and
increase their danger of permanent insanity.
After years of complaint from the managers of the Irish
hospitals, the government was persuaded to build a hospital
exclusively for the criminal lunatics at Dundrum, near Dublin.
This has been in successful operation twelve years.
New York built a similar establishment at Auburn, and
opened it in 1859. This has been satisfactory. It has done
much good to its inmates, and given great relief to the State
hospital at Utica. England has just now built a large asylum
for her criminal insane. Connecticut prepared a building for
the same class of patients, at Weathersfield, in connection with
the State prison, but for some reason not here known it has
never been used for this purpose.
Pennsylvania is now taking steps to provide such an estab-
lishment for her criminal lunatics; and Rhode Island authorizes
the governor to provide for the proper treatment of such
patients wherever he may think proper.
directions, for four days, he was discovered in Wareham, in this State, and
brought back to the hospital on the evening of the 28th.
Beside tlie cost of wages and the loss of time, thought and anxiety, of the
officers and men of the house, the direct cash expense of recovering Bumpus
was seventy-six dollars and seventy-five cents.
Paid to one sheriff, for time, travelling expenses and assistance
employed by him,
to another officer, for time and travelling expenses, .
to two other men, for time and travelling expenses, .
to carpenter, for repairing breach in wall and window,
to Worcester Spy, for advertising, ....
to Worcester Transcript, for advertising, .
|50 00
10 00
10 00
3 00
1 25
2 50
$76 75
To this should be added the cost of materials, iron grating, lumber, &c., used
in repair, and also the cost of postage and telegraphing in aid of the search.
By the law of 1862, the State pays this bill.
It is plain that it is very expensive to the Commonwealth or its people, to
thus keep its convicts in a place so unfitting as the lunatic hospitals, for their
detention.
•
1862.] PUBLIC DOCUMENT— No. 28. 37
The Trustees would now earnestly commend this matter to
the careful consideration of tlie legislature, and urge them, if
possible, to relieve the hospitals of this great and costly burden.
They propose, that the governor and council be authorized to
make provision for the custody and treatment of the insane
convicts of Massachusetts, in any suitable place in or out of
the State ; provided they think it for the interest of the Com-
monwealth to do so.
The New York Criminal Lunatic Asylum is sufficiently large
to accommodate twice as many patients as the State furnishes
of this class, and many more than the State probably will fur-
nish for years to come. A larger number would allow a better
classification, and could be more easily and advantageously
managed. It has been intimated to this Board, by some person
having official connection with that asylum, that the managers
would be glad to negotiate with the authorities of this or any
other State, to receive and treat patients of this class, on about
the same terms as are paid for the patients of New York.
It costs loss to manage this class in an asylum fitted for
them, like that at Auburn, than it does for the same persons in
an ordinary hospital, where the deficiency of strength of
the house must be compensated by the increase of custodians
and attendants. The last report of the Auburn asylum says,
that " the average cost of each patient for the year past, in-
cluding officers' salaries and the patients' clothing, has been
about $3.45 a week," which is considerably less than the cost
of supporting the patients at Utica. Add to this some reason-
able charge on account of the rent, interest on investments, not
charged to the account of the New York patients. Add, also,
the cost of transportation, from Massachusetts, and even the
expense of an occasional visit of the governor, or members of
the council, or committee of the legislature, still the expense
of maintaining our criminal lunatics in the asylum at Utica
would be much less than it really costs the people of this State
to keep them in the Northampton, Taunton, and Worcester
hospitals. It would then be an economical as well as a humane
measure to provide for the care of these patients in the New
York Criminal Lunatic Asylum, or in any other way different
from that now adopted in this State.
38 LUNATIC HOSPITAL AT WORCESTER. [Oct.
LABOR.
As in former years, the patients have been employed in as
many ways and as much of the time, during the last year, as
the means and opportunities of the hospital allowed. A few
were employed in all the working days of the year, as other
men and women are abroad. But most of them worked less
regularly, through various portions of the hours of the day,
and various proportions of the days of the week. A record is
daily made of the number of patients that have worked, and of
the ways in which they were occupied. Counting all that were
employed in part or the whole of the time, the number of men
varied from twenty-five in March, to thirty-seven in February,
and there was an average of slightly less than thirty (29|) at
work in some part of each month of the year. This is 14.6 per
cent, of the average number of males in the house. The number
of women varied from seventy-one in September, to ninety-four
in Marcli, and the average for the year was eighty-two and a
half; which is 41.6 per cent, of the average number of females
in the house.
In course of the year, seven thousand five hundred and
twenty-two and a half days' work were done by the men, and
thirteen thousand six hundred thirty-nine and three-quarters
by the women, making twenty-one thousand one hundred and
sixty-two and a quarter days' labor performed by the patients of
both sexes in the hospital. Through the three hundred and
twelve working days of the year, there was a number equal to
a constant average of three men employed in the kitchen, where
they did nine hundred and sixty-five and a half days' work ; an
average of three and two-thirds did eleven hundred and forty-
two and a half days' work in the bakery ; an average of four
and a half did fourteen hundred and three and a half days'
work in the laundry ; an average of nine and a half (9.58) did
twenty-nine hundred and ninety-one days' work on the farm, in
the garden, yards, stables, &c. The carpenters worked four
hundred and eleven days ; the painters two hundred and
seventeen days ; mattress-makers three hundred days ; and
men waited on masons twelve days. An average of a little
more than two female patients did seven hundred and forty-
eight and a half days' work in the kitchen ; an average of
slightly more than eleven did three thousand four hundred and
fifty-nine and three-quarters days' work in the laundry ; a con-
1862.] PUBLIC DOCUMENT— No. 28. 39
stant average of fifteen performed four thousand six hundred
and eighty-four days' work in the sewing rooms, and a some-
what larger average (15.34) did four thousand seven hundred
and forty-seven days' work in the halls and in their own rooms,
sewing, knitting, embroidering, and in manifold other ways
such as females happily know how to occupy themselves in.
Comparing these numbers with the average monthly number of
patients in the hospital, 401, the records of labor show that
11.8 per cent, of all the week days of the males and 22 per
cent, of all the week days of the females were occupied in the
various employments which were provided for them in, or
connected with, the institution. The proportion of females
employed was almost twice as great as that of the males. This
is due, in some measure, to the more ready willingness and
facility of the women to occupy their hands, but mainly to the
more abundant means and opportunities of occupation which
has been offered to them suited to their tastes and habits, and
accessible and available, at all seasons and in all kinds of
weather.
The experience of the labor of the past year was similar to
that of previous years, and was satisfactory : so many men and
women were employed comfortably, and generally contentedly,
and no accident happened, no harm, nor injury given to person
or property, from the instruments placed in the hands of these
lunatics. It was not to be expected that these people, of iinbal-
anced minds and sometimes of confused brains, would never
make a mistake in the application of their forces, and labor
always as steadily, skilfully, and successfully, and with as little
injury to the material on which, or the instruments with which
they worked, as sane men and women do. But whatever short-
comings there might have been in the amount and perfection of
their work, as compared with that done by other laborers else-
where, it has not been sufficient to throw a doubt on the pro-
priety and expediency of continuing, and, as far as possible,
increasing this system of occupying and treating patients.
Man's faculties and powers of body and mind were given him
for use. Action for a part of the time is his natural state, and
unbroken inactivity is his unnatural state. The health of man's
whole system, and the development and maintenance of all his
forces in their best condition, require that all his organs should
40 LUNATIC HOSPITAL AT WORCESTER. [Oct.
be exercised. This was ordained in the beginning, and has
been shown to be the inseparable law of our being ever since,
and those who sustain their health obey it, and generally by
their own volition. But when men become insane, their
powers of self-propulsion and of self-direction are impaired in
various degrees, and in some entirely lost. Some are torpid
and lead hardly more than a vegetable life, and only want to
be left alone. From these, upward, through various degrees of
quiescence and activity, to high excitability, there are all grades
of patients. They need some encouragement, persuasion,
urgency, and even authority, certainly some opportunity, to
induce them to use their powers and to labor, and some
sympathy and guidance to enable them to apply their powers
to definite purposes.
The first idea of a hospital was that of a place of confinement,
where the lunatics could be safely kept from the chance of
being injured and the opportunity of doing injury. It held and
fulfilled simply a negative responsibility, the prevention of
evil. Under judicious treatment, excitements were generally
repressed, and the wards were tolerably and sometimes com-
pletely quiet. This repression extended beyond the morbid
excitability, and reached even the healthy powers that ought to
have been in action. There was nothing for the hands to do,
and little for the brain to act upon. Hence listlessness and
torpor reigned, and nothing was offered to prevent, but much
to accelerate, the downward progress of those who were tending
to dementia. Many of the patients were inclined to sit or lie
in the halls and on their beds, if permitted ; they loved to
crouch in dark corners, where no noise would reach, and the
light would not disturb them. Others walked the halls, some
amused themselves with scratching the walls, whirling the
tongs, or in other trivial occupations within their reach. Occa-
sionally there would be a i-eaction of the morbidly repressed
nature, and an outbreak of excitement would happen, and
disturbance produced by one or more of the inmates.
Here then was and is wanted something to impart life and
action to these sleeping powers, something to occupy them in
such sane ways as the patients will consent to be occupied in.
Amusements, games, bowling alleys, billiard tables, gammon,
checkers, cards, and other means of light and pleasant occupa-
1862.] PUBLIC DOCUMENT— No. 28. 41
tiun have been provided, and used with success so far as they
go. The patients spend many hours at these games and play
them properly, and while doing so they keep their faculties in
sane action.
But all the amusements that can be brought into the hospital
fall short of the wants of occupation. They are insufficient to
occupy all of the patients, or even any of them, through as
many hours of the day and as many days of the year as they
are willing to, and can, be employed with advantage to them-
selves.
The American and Irish people, especially those classes from
which our public hospitals receive their patients, are utilitarians.
They work much and play little. According to their training
and habits, they busy themselves on farms, in shops, factories,
and elsewhere, working upon things that require definite and
successive processes, and have a valuable end and useful pur-
pose. In these ways, they get their greatest sum of enjoyment.
Work is their permanent occupation, and amusement is their
occasional relaxation. They love to spend their few hours a
month, some more and many less, in bowling and dancing, in
playing cards, chess, gammon, or in some other amusement,
and want no more. But they spend their eight, ten, or twelve
hours a day, from Monday to Saturday, from January to Decem-
ber, from the beginning to the end of their vigorous lives, in
cultivating the earth, making shoes, building and repairing
houses, attending machinery, &c., and ask for no change.
Amusements serve but to give a cheerful tone to the graver
business of life, as condiments give a pleasant relish to sub-
stantial food, but both would be wearisome and offensive if
used alone.
Although insanity perverts the mental actions, and often the
tastes and moral sentiments, yet it does not extinguish them.
Although it suspends, in various degrees, some of the intellec-
tual and physical faculties, it seldom suspends all, and rarely
destroys them. The lunatic retains, partially or entirely, his
capacity for labor, both with his muscles and with his brain.
It is the great business of the hospital and the managers of
the insane, first, to give healthy employment and exercise to all
the powers and faculties that are not lost, and thus keep them
alive and give them strength ; second, to give direction to the
6
42 LUNATIC HOSPITAL AT WORCESTER. [Oct.
powers and inclinations that are perverted ; and thirdly, to
raise into action and give life to those that are dormant or dead.
On this principle the English, Scotch, and Irish managers of
the insane have endeavored to occupy their patients in such
employments as they had been accustomed to, when in health,
or in such as are found, on trial, to be agreeable to them and
to which they are willing to give their hands and attention.
In this the Hospital Superintendents of Great Britain and
Ireland have been singularly successful. Beside the work on
the land, which seems to be everywhere adopted, they have
introduced into their public asylums, a great variety of mechan-
ical trades, with shops, tools, and machinery, for the use of
their patients. The plan of every new public asylum includes
a series of shops with their appropriate accompaniments as
certainly as it includes lodging and dining rooms.
The annual British and Irish reports state the number of
men and women employed and the days' work done in each
trade, or field of occupation. In the various asylums there
are male patients daily working as —
Bakers, Masons,
Blacksmiths, Mat-makers,
Bookbinders, Mop-makers,
Brickmakers, Oakum-pickers,
Cabinet-makers, Painters,
Carpenters, Plumbers,
Coir-pickers, Printers,
Engineers, Shoemakers,
Farmers, Tailors,
Flock-pickers, Tinmen,
Gardeners, Turners,
Glaziers, Upholsterers,
Macliinists, Weavers.
These are not all in any one, but they are all in the several
estabhshments of the three kingdoms, and for all of them
provision is made of rooms, and the usual means and facilities
of operation, in, or in connection with, the various asylums.
Beside household work, sewing, knitting, &c., which the
women do in our hospitals, they are also occupied in bonnet-
making, hat-making, plating straw, and picking flock. Some
1862.] PUBLIC DOCUMENT— No. 28. 43
are sometimes employed abroad, hay-making and in other work
which females in Europe occasionally perform.
In these ways, a large part of the patients of both sexes in
the lunatic asylums of Britain and Ireland are constantly
occupied, like persons of ordinary and healthy life, through
eight or ten and some through twelve hours a day. Tiiey go
to their several places of labor and work steadily through the
hours appointed for them.
In the asylums that report these operations minutely, the
constant average proportion of the male patients at work
varied, from 37 per cent, in Stafford, and 50 per cent, at
Colony Hatch, London, to 75 per cent, in Lancaster, and 95 per
cent, in Edinburgh, and the average of the whole seventeen
asylums was 67.2 per cent.
The average proportion of the females employed varied from
42 per cent, in Essex, and 49 per cent, in Stafford, to 79 per
cent, in Lancaster and Norfolk, and 80 per cent, in Edinburgh,
and the average in all these asylums was 69,2 per cent.
The others remained in their rooms or in the wards, for
apparently good reasons, which are stated, with the number
that were kept from labor by each.
MALES.
Excited with restraint, Quiet,
Excited without restraint, Aged and Infirm,
Excited in seclusion. Too Low-Spirited,
Excited without seclusion, Too Little Mind,
Sick, Able but Unwilling.
Sick in bed,
The conditions of the unemployed females were —
Excited, Aged and Infirm,
Excited in seclusion, Too Low-Spirited,
Sick, Too Little Mind,
Sick in bed, Able but Unwilling.
Quiet,
All the rest not thus situated went to their several spheres of
labor, in shop, garden, field, yard or elsewhere.
U LUNATIC HOSPITAL AT WORCESTER. [Oct.
In the sixteen public asylums of Ireland the men were
mostly engaged in cultivating the earth ; but others were
employed as
Basket-Makers, Shoemakers,
Blacksmiths, Tailors,
Carpenters, Weavers,
Knitters,
and in some other occupations not stated.
During the year 1858, there was a constant average of two
thousand and seven males and one thousand nine hundred and
fourteen females in these establishments. Of these one thou-
sand and seventy-five males, or 53.5 per cent, of all, and one
thousand and seventy-five females, or 56.1 per cent, of all, were
constantly employed.
During the year 1859, there was a constant average of two
thousand and seventy-nine males and one thousand nine hun-
dred and eighty females. Of these one thousand and sixty-five
males, or 51.2 per cent, of all, and one thousand two hundred
and forty-two females, or 62.7 per cent., were employed.
The proportion engaged in mechanical labor is less in Ireland
than in England, probably because a similar disproportion
exists among the sane population in the two kingdoms.
There is a smaller proportion of the Irish than of the English
patients occupied, in any kind of labor, but no reason is given
in the reports, which would explain the difference.
In all this employment of insane persons in such a variety of
ways, only a single accident, involving danger, is known to
have happened, and that was without bad result.
All those who have watched, directed or immediately super-
intended this system of labor in lunatic hospitals — the Com-
missioners in Lunacy for England, and the Inspectors of
Asylums for Ireland, and the Superintendents of Asylums, all
speak with satisfaction of its working and its results, and of its
effect on the management of the institutions and on the patients.
The Irish Inspectors, in their seventh report, say : " The system
of providing, for the inmates of the District Asylums, occupa-
tion suitable to their condition is carried out on an extensive
scale, with the best results." Dr. Cleaton, Superintendent of
1862.] PUBLIC DOCUMENT— No. 28. 45
the Rainhill, England, Asylum, says : " I am fully persuaded
that, next to the disuse of mechanical restraint, the most
important of recent improvements in the treatment of the
insane, is the extent to which occupation is adopted as an
auxiliary to the pharmaceutical remedies,"
The advantage is two-fold. First, in the small profit derived
from the labor of the patients, and second, and of far greater
value, the increased facility of managing the household, and
thirdly, and of more importance than all, is its power as a
remedial measure.
In several of the English asylums the insane mechanics keep
the buildings and furniture and agricultural tools in repair,
and even make new furniture and tools when needed ; they
make shoes, clothing, &c., and also some articles for sale.
Two-thirds of the furniture of the Prestwich Asylum was made
by the patients. Other reports speak of ploughs, wheelbarrows,
harrows, tables, chairs, bedsteads, &c., being made by their
men. In the School for Idiots at Redhill all the furniture was
made for a new hospital in the neighborhood. The pupils of
the Massachusetts School for Idiots make shoes, mats and
brooms, which are sold in the market at remunerating prices.
In view of all these facts, seeing that the experience here on
a small scale, and in Great Britain and Ireland on a large scale,
of employing patients in mechanical trades and thus giving
them more general and constant occupation at all seasons, has
been satisfactory and encouraging to farther extension of the
same, the Trustees after mature and careful consideration, and
full consultation with the Superintendent, have determined at
once to introduce the same system into the Worcester hospital.
They will begin moderately and proceed cautiously with such
means as are now in their hands.
The old building in the rear of the male wings of the hospital
which has been used for a wash house and laundry is about to
be vacated, by the removal of those operations to the new and
better house prepared for them. This old building is of brick,
two stories high, and has a large attic. It is fifty feet long and
forty feet wide. Here will be room which will accommodate
many shoemakers, tailors and other mechanics, and will meet
all the present wants and be sufficient for the trial of the
experiment.
46 LUNATIC HOSPITAL AT WORCESTER. [Oct.
The Trustees are aware that this will impose a new care and
responsibility on the Superintendent, and other officers, on the
attendants and all connected with the movements of the hospi-
tal, at least, until the new system gets into full operation. It
will require the most untiring supervision, and the most careful
thought to discriminate among the patients who shall be
employed, and how much and in what way. The daily and
hourly effect of labor on each one's condition must be watched,
so that none should suffer evil rather than gain good, and the
whole must be arranged, shaped, and daily directed for the
advantage of the patients.
But the Trustees are confident, that what has been done here
with a few may be done also with many ; that what is done in
England with so much ease and success, and what is accom-
plished in Ireland with patients of the same race as constitute
a large part of the household at Worcester, may also be done
in this institution. Our people, both native and foreign, are
as much accustomed to labor and as little used to idleness in
their days of health, as the people of England and Ireland.
Our officers are men of as much wisdom and tact, as much
energy and industry, they are as much devoted to their work
and wield as much influence over the wills and the movements
of the patients under their care as those of European hospitals.
There is no advantage or facility or means for this purpose, on
the other side of the ocean, that we have not, except the simple
fact, that their system is established and in successful, undis-
turbed operation, and all new comers to the asylums fall into it
as a matter of course, and work with the others, while ours is
yet to be begun, and our patients to be put on a new course,
with no multitude of workers already in shop and field inviting
the new patients to follow or accompany them. But the English
began this system within a very few years. Their asylums
began not all at once, but one after another, and their annual
reports, which told of their beginnings and progress, made no
especial complaint of difficulties in getting the new system into
operation and effecting so great a change in the habits of their
patients.
And now the Trustees think, the time has come for this
hospital to follow the examples so largely and so long set before
them. They think they would do wrong to the patients and to
the Commonwealth to postpone it ; and having a Superintendent
1862.] PUBLIC DOCUMENT— No. 28. 47
of great sagacity and energy, of great business talent as well
as scientific skill, assisted by a competent corps of officers and
attendants, and all, from the head to the servant, devoted
exclusively to the work of the hospital, with no interest, no
business, nor responsibility beyond the institution, all ready to
give their whole thoughts and all their anxieties to the great
work they have undertaken of managing these four hundred
lunatics, and of curing as many as possible and ameliorating all
the others — with such aids as these, the Trustees commence
this new purpose with confidence that the hospital will prosper
with this, as it has in every new advancement, and accomplish
more effectually the object of its creation.
The report of the Superintendent which accompanies this,
contains a full account of the condition and operations of the
hospital during the past year, and a general history of its
progress from its beginning in 1833. This will show how
large a work has been done, and how important the institutions
for the insane are to the happiness of the people and the
prosperity of the Commonwealth.
Looking into the future with the light of the past, considering
that what has been will be again, that there will be as many made
insane and as many patients sent to the hospitals in the coming
as in the last year, the Trustees of this institution look for as
great a responsibility to be thrown upon its managers and as
large a work to be required of them in 1863 as in 1862, and
these they are prepared to fulfil and perform.
In view of the intimate connection of the hospital with the
State, its towns, and families, and of its importance as an agent
of humanity and of public economy, it is again commended to
the generous confidence of the people and the just support of
the legislature.
Yery respectfully submitted, by the Trustees.
WILLIAM T. MERRIFIELD.
ROBERT W. HOOPER.
EDWIN F. JENKS.
EDWARD JARVIS.
WILLIAM WORKMAN.
Worcester, October 1, 1862.
48
LUNATIC HOSPITAL AT WORCESTER. [Oct.
TEEASURER'S REPORT.
To the Trustees
The Treasurer submits the following report.
Cash on hand September 30, 1861,
Received from the Commonwealth,
" " towns and individuals,
" " all other sources, .
Due Mechanics' Bank,
DISBURSEMENTS.
Steward's order.
Salaries, .....
Mechanics' Bank, (interest,)
Cost in suit, Treas. vs. Springfield,
Collection, stationery, &c., .
Cash, .....
1220 73
19,343 34
30,426 36
899 69
2,153 76
I.
. $48,482 49
3,464
51
684
50
171
11
87
97
153
30
,043 88
153,043 88
H. WOODWARD, Treasurer.
Worcester, October 1, 1862.
1862.]
PUBLIC DOCUMENT— No. 28.
49
SUPEEINTENDENT'S REPORT.
To the Trustees of the State Lunatic Hospital, at Worcester :
Gentlemen, — I am again called upon in obedience to the
laws of the Commonwealth, to report to you the operations and
results of the year ending September 30, 1862.
I trust that the retrospect about to be made will show that
the year past has been one of progress and some degree of
success.
It has been a year of general health and prosperity. No
serious calamity has befallen the institution or its inmates.
Nothing occurred to mar the general good order and comfort of
the house until late in the year, when a large number of our
male attendants enlisted in the service of their country, making
it necessary to employ an equally large number of men, and
strange hands in their places. This has been the cause of con-
siderable uneasiness and excitement in the male wards, and it
will probably require several months of hard labor to bring
back the usual comfortable state of things.
Table No. 1,
Showing the general results of the Year.
Males.
Females.
Total.
Patients in the Hospital October 1, 1861,
184
195
379
" admitted during the year, .
108
113
221
Whole number under treatment.
292
308
600
Discharged recovered,
58
66
124
" improved,
18
21
39
" not improved, ....
. ^
2
r
Died,
11
23
34
Whole number discharged during the year,
92
112
204
" " remaining September 30, 1862,
200
196
396-
50 LUNATIC HOSPITAL AT WOECESTER. [Oct.
The foregoing table shows that one hundred and twenty-four
patients have been discharged from the hospital as recovered.
In all these cases the cause of commitment had ceased to exist,
and they were, by your order, discharged from the care and
custody of the hospital, and returned to their homes and friends,
restored to a good degree of mental and physical health.
Thirty-nine have been discharged from tlie hospital improved.
Several of these were so much improved that it was difficult to
decide to which class they should be assigned, and they are now
regarded by their friends as having recovered their full measure
of mental health.
A few only of those discharged during the year are periodi-
cally insane, and have long intervals of apparent health, during
which they perform all the ordinary duties of life. These are
reported as improved.
The number of deaths among the females has been large, and
will be spoken of under its proper head.
The whole number admitted during the year was two hundred
and twenty-one, of whom one hundred and eight were males,
and one hundred and thirteen were females. A number some-
what less than the number of admissions of last year.
The diminution in the number of admissions was confined
mostly to the months of August and September.
The whole number under treatment was six hundred, of
whom two hundred and ninety-two were males, and three
hundred and eight were females.
The whole number discharged during the year was two hun-
dred and four, of whom ninety-two were males, and one hundred
and twelve were females.
The whole number remaining in the hospital at the close of
the year, was three hundred and ninety-six, of whom two hun-
dred were males, and one hundred and ninety-six were females.
It will be seen at a glance, that the recoveries were in the
ratio of fifty-six and one-tenth per cent, to the whole number
admitted, or twenty and two-thirds per cent, to the whole
number under treatment.
• Of those who were admitted during the year, eighty-seven
have been discharged recovered — forty-nine males, and thirty -
.eight females.
1862.] PUBLIC DOCUMENT— No. 28. 51
There has been, during the year, the usual amount of sick-
ness, confined almost entirely to the habitually feeble, the
demented, the epileptic, and the palsied patients.
Table No. 2,
Showing the Admissions and state of the Hospital, from October 1, 1861
to September 30, 1862.
Patients in the hospital October 1, 1861, 379
Males, . . 184
Females, . . . . . 195
Patients admitted in the course of the year, 221
Males, 108
Females, 113
Patients remaining in the hospital September 30, 1862, . . 396
Males, . 200
Females, 196
Of the admissions there were cases of less duration than one year, 117
Males, 57
Females, 60
Of the admissions there were cases of one year or more, . . 83
Males, 41
Females, 42
Of the admissions there were cases the duration of whose insanity
could not be ascertained, 21
Males, 10
Females, 11
Patients committed by Courts, 148
Males, 71
Females, 77
Patients committed by Overseers of Poor, . ... . . 21
Males, 9
Females, 12
Patients on bonds, 52
Males, 28
Females, 24
Foreigners and those having no settlement in the State, admitted
in course of the year, ........ 81
Males, 40
Females, 41
Foreigners and those having no settlement in the State, discharged
in course of year, ......... 76
Males, 37
Females, 39
52
LUNATIC HOSPITAL AT WORCESTER. [Oct.
Foreigners and those having no settlement in this State, remaining
in the hospital September 30, 1862, 157
Males, . . . .83
Females, 77
State Paupers remaining in the Hospital at the close of euch Year, as
nearly as can he ascertained.
1842, 34
1853, 216
1843,
38
1854,
. 151
1844,
38'
1855,
. 115
1845,
57
1856,
. 155
1846,
52
1857,
.119
1847,
121
1858,
. 121
1848,
150
1859,
. 124
1849, .
167
1860,
. 130
1850,
181
1861,
. 156
1851,
201
1862,
. 157
1852,
241
The foregoing table shows that you have discharged from the
hospital in the course of the year seventy-six patients who were
supposed to have no settlement in this Commonwealth, and of
the three hundred and ninety-six patients remaining in the
hospital at the close of the year one hundred and fifty-seven
are supposed to have no settlement in this Commonwealth,
nearly all of whom are of foreign birth.
A smaller number of patients than usual have been removed
to almshouses during the year, and but very few have been
discharged except to the care of friends and relatives.
Situations have been procured for a few where they could
labor and receive wages, and a few others have been enabled
to reach their friends in other parts of the country.
In all cases where patients dependent upon the charity of the
Commonwealth have been removed from the hospital previous
to recovery, they have been carefully observed by the alien
commissioners or their agent before any steps have been taken
to procure their discharge, and when the existence of relatives
or friends has been known, their pleasure has always been
consulted in the disposition of the patient.
1862.]
PUBLIC DOCUMENT— No. 28.
53
Table No. 3,
Showing the number Admitted, Restored, Improved, Died, ^c, in each
Month during the Year.
Admitted.
Removed.
Kemaining.
MONTHS.
a
o
•3
1
>
e
■d
S,
s
o
!2i
•d
o
«
s
S
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
"3
o
October, . .
12
16
28
4
7
2
-
-
-
1
2
7
9
189
202
391
November, .
14
8
22
-
6
2
1
-
2
1
3
9
200
201
401
December, .
8
8
16
3
4
1
1
-
1
1
4
5
10
203
199
402
January,
9
7
16
3
5
2
1
-
-
3
5
9
207
197
404
February,
9
7
16
2
4
1
2
-
1
-
4
6
212
198
410
March, . .
14
8
22
6
6
1
-
-
-
1
1
8
7
218
199
417
April, . . .
6
13
19
13
9
1
3
-
-
2
4
16
16
208
196
404
May, . . .
9
6
15
7
10
3
3
3
-
-
3
13
16
204
186
390
June, . . .
4
18
22
6
1
2
1
-
1
-
3
8
6
200
198
398
July, . . .
7
14
21
4
5
2
4
-
-
1
-
7
9
200
203
403
August, . .
6
5
11
8
4
1
2
1
-
-
1
10
7
196
201
397
September, .
10
3
13
2
5
2
2
-
-
2, 1
6
8
200
196
396
Totals, . .
108
113
221
58
66
18
21
5
?
1123
92
112
Til- ._ X? .
T
•1
1
;
j^i -
1
' L ^
1
Few patients are ordinarily admitted to the hospital during
the winter months.
On the approach of winter, however, when it becomes appar-*
ent that the suiFerers cannot be cared for during the cold and
stormy season in their own homes, the friends provide for their
safety and comfort in a hospital.
On the opening of spring the causes of mental derangement
increase and multiply as the season advances, causing a large
number of admissions during the warmer season of the year.
64
LUNATIC HOSPITAL AT WORCESTER. [Oct.
As has been elsewhere mentioned, this table indicates a con-
siderable diminution in the number of admissions during the
months of August and September.
This must be owing partly to the depressed condition of the
times, and the uncertain state of all industrial pursuits, reducing
in a great degree the ability of families and the willingness of
towns to place their insane under the care and treatment of
a hospital.
Something must also be due to the fact of the absence of so
large a proportion of the male population in the service of their
country.
Table No. 4,
Showing the Form of Disease in those Admitted and Discharged during
the Year.
Admitted.
Discharged.
FORM OF DISEASE.
■3
3
a
o
1
t
0
Mania,
" Chronic,
" with Epilepsy,
" with general Paralysis, .
Melancholia, . . . .
Dementia, ....
" Senile,
" with Epilepsy, .
" with genaral Paralysis,
Monomania of Fear,
" Pride,
" Suspicion,
41
15
5
2
17
14
4
3
5
2
39
13
4
24
19
3
3
2
4
2
80
28
9
2
41
33
7
6
7
6
2
46
7
3
14
13
6
2
2
53
7
2
24
17
3
1
4
1
99
14
5
38
30
8
3
6
1
Totals, ....
108
113
221
92
112
204
Eighty persons, forty-one males and thirty-nine females, when
admitted, were suffering from recently developed mania in its
'ordinary form.
Twenty-eight, fifteen males and thirteen females, had for a
considerably long period of time suffered all the symptoms of
mania and are classed in the above table as cases of chronic
mania.
Fifteen of those admitted during the year were epileptic, and
nine were afflicted with general paralysis.
1862.]
PUBLIC DOCUMENT— No. 28.
65
No attempt is made in tlie foregoing table to give a classifica-
tion of the various phases of insanity ; but to present in a
convenient manner the prominent manifestations as observed
in this hospital.
Table No. 5.
Supposed causes of Insanity of Patients admitted into the Hospital from
January 1833, to September 30, 1862.
1863.
Previously.
CAUSES.
Hales.
Females.
Males.
Females.
Apoplexy,
Asthma, .
-
-
2
2
1
Bronchitis,
-
-
2
13
Chorea, . . .
-
-
-
2
Constipation, .
Convulsions, .
-
-
2
8
1
6
Dysentery, . . .
■■
-
-
1
2
Dyspepsia,
Epilepsy,
Eruptive Diseases, .
9
5
7 '
108
5
6
33
5
Eyes, Disease of,
~
-
1
-
" Loss of, . . _ .
1
-
1
-
Fever, ....
2
3
34
39
Ill Health,
22
34
219
602
Influenza,
-
-
1
5
Insolution,
-
-
14
-
Laryngitis,
Nervous Irritation, .
—
—
~
1
6
Nymphomania,
Old Age,
0
1
15
1
8
Otitis^
Palsy, .
Pneumonia,
7
2
3
42
2.5
1
Rheumatism, .
-
-
3
1
Scrofula, .
-
-
3
4
Sea-sickness, .
-
-
-
1
Somnambulism,
-
-
-
1
Suppressed Eruption,
Suppressed Ulcer, .
Tic Douloureux,
-
-
6
2
4
3
1
Tumor, .
-
-
-
1
Whooping Cough, .
Amenorrhcea, .
-
-
:
1
20
Lactation, Excessive,
-
-
-
5
Menorrhagia, . . .
-
1
-
7
Menorrhagia, Suppressed
Miscarriage,
-
4
2
—
11
4
Pregnancy,
Puerperal,
Turn of Life, .
-
2
10
3
-
5
148
44
56 LUNATIC HOSPITAL AT WORCESTER. [Oct.
Table No. 5 — Concluded.
1863.
Previously.
CAUSES.
Males.
Females.
Males.
Females.
Amputation of Leg,
_
_
1
_
Bathing in Cold Water,
1
—
2
2
Drinking CoM Water,
-
-
1
-
Exposure to Cold, .
-
-
6
-
Injuries by Falling, &c.,
-
-
9
3
Injury of Head,
1
-
47
8
Injury of Spine,
2
-
4
2
Lead, Poison of.
—
—
2
-
Lightning, Stroke of,
-
-
1
1
Labor, Excessive, .
3
1
30
54
Loss of Sleep, .
-
-
2
5
Study, Excessive, .
-
-
25
6
Spiritualism. .
-
-
13
14
Criminal Trial,
-
-
-
1
False Accusation, .
-
-
-
1
Imprisonment, .
1
-
17
2
Death of R<-latives, .
2
2
20
61
Domestic Trouble, .
1
1
128
319
Marriage, Unhappy,
-
-
4
2
Disappointment in Love,
-
2
55
63
Dissappointed Ambition,
-
2
6
6
Home Sickness, . .
-
-
7
10
Fright, .
-
-
16
19
Seduction,
-
0
-
2
Political Excitement,
1
-
16
-
Religious Excitement,
-
5
136
172
Pecuniary Trouble, .
4
-
123
23
Poverty, .
-
-
-
1
" Fear of, .
2
-
33
12
Giving up Business,
—
-
3
—
Change of Business,
-
-
7
-'
Violent Temper,
-
1
3
18
Jealousy, .
-
1
19
27
Intemperance, .
19
2
186
68
Opium, Use of,
1
2
2
5
Tobacco, Use of.
-
-
1
3
Masturbation, .
15
12
256
37
Venery, Excess of, .
~
1
"
Of the above there were during the year-
Hereditary Cases,
Periodical "
Homicidal "
Suicidal "
17
26
11
17
9
3
13
15
1862.]
PUBLIC DOCUMENT— No. 28.
57
111 health is as usual the most prominent cause of insanity,
as classed in the foregoing table, which is made up from the
representations and descriptions of those who bring the patients
to the hospital.
Ill health arising from its many sources, is undoubtedly the
most fruitful cause of insanity.
But there are generally if not always several circumstances,
all of which unite to bring on that state of brain and nervous
system which results in mental derangement. The one that
seems most prominent to those best acquainted with the case is
the one recorded here.
It is difficult and often impossible to ascertain the true and
relative bearings of the various circumstances around us, upon
our own minds ; and how much more difficult is it to ascertain
the precise cause that suggests to the insane mind each suc-
cessive link in the chain of its delusion.
Fully believing however, that the statistics of insanity are of
as much worth as any vital statistics the table is presented with
the hope that it may be extended and perfected till it shall be
found entirely correct and thoroughly reliable.
Table No. 6.
Diseases loMch have proved Fatal from Jan. 1833, to Sept. 30, 1862.
186S.
Pkeviouslt.
DISEASES.
Males. Females.
Males.
Females.
Apoplexy,
Asthma, .
-
-
15
4
9
1
Anaemia, .
_
_
1
1
Asphyxia,
Bronchitis,
-
-
1
2
-
Brain Fever, .
_
-
1
-
Consumption, .
Convulsions,
2
8
37
3
60
1
Cholera Morbus,
_
-
2
3
Cholera, .
-
-
5
-
Cancer, .
_
-
1
1
Congestion of Lungs,
-
-
-
1
" " Brain,
1
-
1
1
Chronic Dysentery, .
" Meningitis, .
-
-
2
3
-r
Dysentery,
Dropsy, .
-
-
10
5
6
7
58 LUNATIC HOSPITAL AT WORCESTER. [Oct.
Table No. 6 — Concluded.
186S.
PREVIOnSLT.
DISEASES.
Males.
Females.
Males.
Females.
Delirium Tremens, ....
3
Disease of Heart,
-
-
9
11
" " Bladder, .
-
-
1
-
" " Brain, .
-
-
6
14
Diarrhoea,
-
-
13
8
Enteritis, .
-
-
3
6
Epilepsy, .
Exhaustion,
—
2
2
. 57
32
23
47
Erysipelas,
Gangrene of Lungs,
Hydrothorax, .
Hemorrhage, .
-
-
9
1
1
4
10
2
1
4
Hemoptysis,
-
-
1
-
Inflammation of Bowels,
-
-
3
3
Jaundice,
-
-
2
Marasmus,
1
2
49
53
Mortification, .
-
-
-
1
Maniacal Exhaustion,
-
-
5
6
Malignant Fever, .
-
-
1
-
Old Age,
5
-
19
13
Palsy,
Pneumonia,
2
3
22
15
16
9
Pleurisy, .
Rupture, .
Syncope, ...
Suicide, .
-
1
1
1
15
1
8
Smallpox,
Suppurative Phlebitis,
Typhoid Fever,
Typho Mania, .
-
5
1
8
7
1
6
5
Of the eleven males who died during the year, five died of
old age without any apparent disease. They were all more
than seventy years of age and three of them were each more
than eighty years of age. Two^ died of long continued palsy;
and two of phthisis ; and one of marasmus. One of those who
died of old age had been an inmate of the institution nearly
thirty years, his name being the second one on the records of
the hospital.
A larger than usual number of females have died during the
year. A reference to the table will sufficiently explain the
causes.
Eight died of phthisis a,nd five of typhomania. These last
died immediately after being brought to the institution. Three
1862.]
PUBLIC DOCUMENT— No. 28.
59
died of paralysis, two of marasmus, two of epilepsy, and two of
exhaustion.
Two of those who died of paralysis were each more thau
seventy years of age.
Table No. 7,
Showing the Ages of Patients Admitted, Discharged Recovered, not Re-
covered, and Died during the Year.
Admitted.
Discharged Ke-
Discharged not
Died.
COVERED.
Kecoveked.
AGES.
Males.
Females.
Males.
Females.
Males.
Females.
Males.
Females.
Less than 15,
3
1
Froml5 to20.
2
1
-
1
1
1
-
2
20 to 30,
27
24
13
18
3
5
-
6
30 to 40,
34
23
24
19
7
4
3
4
40 to 50,
26
41
15
17
6
8
-
4
50 to 60,
6
12
4
6
2
3
1
3
60 to 70,
7
8
1
4
2
1
-
2
70 to 80,
3
4
1
1
1
1
3
1
80 to 90,
-
-
-
-
-
-
4
1
Totals, . .
108
113
58
66
23
23
11
23
Table No. 8,
Showing the Duration of Insanity before Admission of Patients admitted
from January 1833, to September 30, 1862.
186S.
Pkeviodslt.
DURATION OF INSANITY.
Males.
Females.
Males.
Females.
Insane less than 1 year,
Insane more than 1 y'r and less than 2 yr's,
2 yr's and less than 5 yr's,
5 yr's and less than 10 yr's,
10 yr's and less than 15 yr's,
15 yr's and less than 20 yr's,
20 yr's and less than 25 yr's,
25 yr's and less than 30 yr's,
30 yr's, . . . .
Unascertained,
57 ■
25
14
8
2
1
1
60
23
17
9
2
1
1
1,587
382
475
239
124
42
38
17
24
237
1,797
367
412
193
139
. 40
43
9
24
253
Totals,
108
113
3,165
3,277
60
LUNATIC HOSPITAL AT WORCESTER. [Oct.
Table No. 9,
Showing the Ages of Patients admitted into the Hospital from January
1833 to September 30, 1862.
1863.
Pebviouslt.
AGES.
Males.
Females.
Males.
Females.
Less than 15 years, .
.
3
-
26
28
4
Between 15 and 20 years of
age, .
2
1
226
210
20 and 30 "
((
27
24
932
903
30 and 40 "
«
•34
23
817
897
40 and 50 "
((
26
41
524
585
50 and 60 «
((
6
12
349
396
60 and 70 "
u
7
8
209
164
70 and 80 "
(1
3
4
61
59
More than 80 years of age,
•
-
-
11
18
Unascertained,
•
-
-
8
17
Totals, .
108
113
3,165
3,277
Table No. 10,
Showing the Civil Condition of Patients admitted into the Hospital from
January 1833 to September 30, 1862.
1S6».
Pkbviodslt.
CIVIL CONDITION.
Males.
Females.
Males.
Females.
Unmarried,
Jklarried,
"Widowers, . . . , .
Widows,
Unascertained, . . .
49
53
5
1 '
53
45
15
1,591
1,376
153
45
1,473
1,365
397
42
Totals,
108
113
3,165
3,277
1862.]
PUBLIC DOCUMENT— No. 28.
61
Table No. 11,
Showing the Admissions from each County from Jan. 1833 to Sept. 30,
1862.
1S63.
Previously.
COUNTIES.
Whole No.
Males.
Females.
Total.
Barnstable, ....
126
126
Berkshire,
-
-
_
187
187
Bristol, .
-
_
_
290
290
Dukes, .
.:.
_
—
19
19
Essex, .
24
20
44
893
937
Franklin,
_
—
_
126
126
Hampden,
-
-
-
352
352
Hampshire,
-
1
1 •
221
222
Middlesex,
31
30
61
952
1,013
Nantucket,
_
_
—
31
31
Norfolk, .
4
-
4
593
•597
Plymouth,
-
-
-
233
233
Suffolk, .
6
6
12
676
688
Worcester,
43
56
99
1,726
1,825
Other States,
-
-
-
17
17
Totals, . . . .
108
113
221
6,442
6,663
Table No. 12,
Showing the Occupation of Patients admitted to the Hospital from
January 1833 to September 30, 1862.
O C CXJP ATION.
Previously.
. MALES.
Auctioneers,
Armorers,
Authors, ....
Blacksmiths,
Bakers, ....
Butchers, ....
Bookbinders,
Boot-makers,
Brokers, .
Book-keepers, .
Britannia-workers, .
Brickmakers,
Bellows-makers, .
Brewers, ....
3
3
2
37
6
7
7
19
3
8
2
5
2
2
62 LUNATIC HOSPITAL AT WORCESTER. [Oct.
Table No. 12 — Continued.
OCCUPATION.
186S.
Previously.
Basket-makers,
_
5
Bricklayers,
• •
-
2
Butlers, ....
-
7
Barbers, ....
-
19
Clergymen,
-
125
Carpenters,
3
6
Coppersmiths, .
1
16
Coopers, ....
-
12
Cabinet-makers,
1
3
Calico-printers, .
-
17
Clothiers, ....
-
4
Comb-makers, .
-
8
Coach-makers, . . ^
-
2
Card-makers, .
-
4
Chair-makers, .
-
4
Cigar-makers, .
1
3
Coachmen,
-
16
Clerks,
3
38
Carpet-weaver, .
-
1
Carriers, .
—
8
Cashiers of Banks, .
-
4
Cordwainers,
-
6
Collectors,
-
2
Caulkers, .
-
4
Chandlers,
-
5
Camphene-distiller, .
-
1
Conductors on Railroads,
-
3
Dyers,
-
4
Druggists, . . .
—
3
Draymen, .
-
3
Drover,
—
1
Dancing master.
-
1
Engineers,
—
3
Editors, .
-
4
Express-men, .
Farmers, .
24
4
505
Fishermen,
3
20
Fruiterers,
-
4
Gunsmiths,
-
3
Gardeners,
-
10
Grocers, .
-
3
Glass-blowers, .
-
3
Gilders,
-
2
Hotel-keepers, .
-
16
Hatters,
-
3
Hostlers, .
2
11
House-wrights, .
-
17
Harness-makers,
1
7
Ironmongers, .
-
3
Jewellers, .
-
12
Lawyers, .
"
13
1862.]
PUBLIC DOCUMENT— No. 28.
Table No. 12 — Continued,
63
OCCUPATION.
Previously.
Laborers, .
Last-maker,
Manufacturers, .
Millers,
Merchants,
Masons,
Miners,
Mat-makers,
Miniature-painter,
Musicians,
Machinists,
Messengers,
Moulders, .
Mill-wright,
Nailer, ...
Newsmen,
Optician, .
Operatives in Mills, .
Oyster-men,
Painters, .
Printers, .
Physicians,
Paper-makers, .
Peddlers, .
Pilot,
Potters,
Porters,
Pump and Block-makers,
Pattern-makers,
Plumbers, .
Police officers, .
Rope-makers, .
Riggers,
Restaurators,
Shoemakers,
Sail-makers,
Soap-makers,
Sash and blind-makers.
Stage drivers, .
Sea captains, .
Sailors,
Saddlers, .
Silversmiths,
Students, .
Stock-maker,
Silk-weavers,
Ship carpenters.
Ship brokers, .
Shop-keepers, .
Stone-cutters, .
Soldiers, .
21
1
3
408
1
35
16
117
17
5
3
1
7
39
2
8
1
1
3
1
66
4
34
29
12
4
19
1
3
9
3
5
8
4
9
3
7
229
9
4
2
5
16
104
9
19
53
1
2
18
2
10
14
9
64 LUNATIC HOSPITAL AT WORCESTER. [Oct.
Table No. 12 — Concluded.
OCCUPATION,
XS&2.
Previously.
Spinners,
_
13
Sheriffs, ....
-
3
Shoe dealers, .
-
5
Stable-keepers, .
-
2
Shoe-binders, .
—
7
Tailors,
1
17
Teachers, . . . . •
-
52
Tobacconists, .
-
o
O
Teamsters,
2
U
Tinners, . . f
—
2
Umbrella-makers,
-
4
Victuallers,
-
3
Wheelwrights, . - .
~
1
14
Watchmakers, .
-
5
Wood-turners, .
1
3
Watchman,
-
1
Whip-maker, .
-
1
Weavers, .
-
20
No occupation, .
.
3
—
. Females.
Carpet weavers,
-
2
Cooks, . .
-
63
Chambermaids, .
-
42
Dress-makers, .
2
61
Engraver,
—
1
House-keepers, .
House maids, .
65
27
1,119
170
Laundresses,
2
56
Milliners, .
-
31
Mantua-makers,
-
6
Midwife, .
-
1
Nurses,
-
15
Nursery maids, .
-
21
Operatives in mills, .
7
148
Seamstresses, .
4
332
Straw-sewers, .
-
10
Shoe-binders, .
-
19
Students, .
-
4
School girls,
3
51
Teachers, .
2
64
Tailoresses, . . .
,
-
39
Type-settgrs,
-
2
Wool stapler, .
-
1
Weavers, .
-
20
No occupation, . •
1
1862.]
PUBLIC DOCUMENT— No. 28.
65
Table No. 13,
Showing the Whole Number of Patients during the last year, the Average
Number, the number at the end of each year, the Expense of each year, the
Annual Expense for each Patient, and the expense of each patient per
week for each of the Thirty Years the Hospital has been in operation.
TEAK.
Wliole
Average
No. at end
of eacli
Current expenses
Annual expense
Expense per
week for
Number.
Number.
year.
of eacli year.
for eacli patient.
each patient.
1833, .
153
107
114
$12,272 91
$114 67
$2 25
1834, .
233
117
118
15,840 97
135 38
2 60
1835, .
241
120
119
16,576 44
137 30
2 64
1836, .
245
127
138
21,395 28
168 44
3 12
1887, .
306
163
185
26,027 07
159 64
3 07
1838, .
362
211
218
28,739 40
136 20
2 62
1839, .
397
223
229
29,474 41
132 16
2 58
1840, .
391
229
236
27,844 98
121 59
2 88
1841, .
399
233
232
28,847 62
123 81
2 38
1842, .
430
238
238
29,546 87
111 12
2 18
1843, .
458
244
255
27,914 12
114 40
2 20
1844, .
491
261
263
29,278 75
112 17
2 15
1845, .
656
316
360
43,888 65
138 88
2 66
1846, .
637
359
367
39,870 37
111 06
2 13
1817, .
607
377
394
39,444 47
104 62
2 01
1848, .
655
404
409
42,860 05
106 09
2 04
1849* .
682
420
429
40,870 86
97 31
1 87
1850, .
670
440
441
46,776 13
106 40
2 04
1851, .
704
462
466
52,485 33
112 61
2 16
1852, .
775
515
532
43,878 35
85 20
1 64
1853, .
820
537
520
53,606 66
103 14
1 98
1854, .
819
430
381
53,221 52
123 77
2 38
1855, .
580
349
336
54,895 88
157 29
3 02
1856, .
577
357
376
45,631 37
128 64
_ 2 47
1857, .
647
387
372
49,004 75
124 04
2 38
1858, .
679
372
301
38,267 26
102 86
2 39
1859, .
501
309
317
48,363 33
156 51
3 01
1860, .
532
324
331
47,757 01
147 39
2 88
1861, .
583
369
379
54,748 53
148 37
2 84
1862, .
600
401
396
53,043 88
132 18
2 50
66
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PUBLIC DOCUMENT— No. 28.
67
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Hereditary.
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do
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do
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Remains
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Discharged
Died
Remains
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do
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do . . .
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do . . .
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do . . .
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do . . .
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84
LUNATIC HOSPITAL AT WORCESTER. [Oct.
■« "3
S .2
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a -2
O 0)
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b
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•a ■a
■^ 1
02 W
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do
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do
do
do
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do
do
do
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.a
Improved
Old age
Recovered
Improved
Recovered
do
do
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Recovered
do
do
do
Not improved
Recovered
do
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Improved
do
Recovered
do
do
Improved
do
Not improved
Improved
JNot improved
Improved
Paralysis
Recovered
do
Improved
Recovered
Improved
Remains
Died
Discharged
Remains
Discharged
do
do
Remains
Discharged
do
do
do
Remains
Discharged
do
Died
Remains
, do
Discharged
do
do
Remains
Discharged
Remains
do
Discharged
Remains
Died
Discharged
do
Remains
Discharged
Remains
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Just. p. and Q,
Sup. Court
Police Court
Probate Court
do
do
do
do
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Probate Court
do
Private Bond
do
Probate Court
Private Bond
Probate Court
Just. P. and Q.
Police Court
Probate Court
do
Private Bond
do
Probate Court
Private Bond
do
Probate Court
do
Private Bond
Probate Court
do
Police Court
do
Probate Court
a a
.2 ".2
Unknown
6 weeks
2 years
6 months
2 days
years
Unknown
6 months
years
3 years
10 days
years
6 months
2 months
10 days
1 month
Unknown
7 years
3 weeks
7 days
years
8 do
2 do
5 do
5 do
9 do
2 months
Unknown
2\ years
1 month
2 years
3 weeks
Unknown
s
o
a.
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Old age,
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Intemperance,
^
...... .-§2 ...... ..r 2^:
do
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111 health,
Unknown,
do
Puerperal,
Unknown,
do
do
Over work,
111 health.
Unknown,
do
Financial tro
Suppressed n
Unknown,
Narcotics,
Unknown,
Masturbatior
Epilepsy,
Unknown,
Intemperanc
Paralysis,
Puerperal,
Unknown,
Love affair,
Domestic affl
Injury to hea
d
■r3.2
p
Married
do
do
Single
Married
0 0 0 ,S 0
r^ -O rO fclC'd
c
Married
Single
do
do
do
do
Unknown
Single
Married
Single
Married
Widower
Married
Single
do
do
do
Married
do
Single
do
do
Unknown
02
Female
Male
Female
do
Male
do
do
Female
Male
do
Female
Male
do
do
do
Female
do
do
Male
Female
Male
do
Female
Male
do
do
do
do
Female
do
do
Male
do
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1862.]
PUBLIC DOCUMENT— No. 28.
85
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86
LUNATIC HOSPITAL AT WORCESTER. [Oct.
■3 -i
S 1
o o
&
03 S
*
Periodical.
Hereditary.
do
do
do
do
c3
03
,£3
a
M
Not improved
do
Recovered
Not improved
Improved
Recovered
Improved
do
Not improved
Improved
Recovered
Not improved
Recovered
Improved
Not improved
Improved
do
Not improved
do
do
Improved
do
Not improved
Recovered
Not improved
do
Recovered
Improved
Not improved
Improved
do
do
Not improved
Si .S
« O C3
s s
'Ti Ti Ti n^ "^ "^
ootiOratiDwtiDKiJDm 60mt>D«
■So=«-So<3o-9o3o-Sc3-Sooooooooots-5o!S--oooo_o
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COCOC^COCOC<3(MCOCO(MC<ICO(MOOCOCOroOOCOC<I<M<M<N<N<N(M IM(M(MMlMlM
il
Is
P5§
Probate Court
Private Bond
Probate Court
do
do
Private Bond
do
Probate Court
Alien Comm.
Private Bond
Overseers
Private Bond
do
do
Probate Court
do
do
do
Private Bond
do
Probate Court
Private Bond
Overseers
Probate Court
Private Bond
Probate Court
do
do
do
do
do
do
do
s c
.2 ®.2
3 weeks
10 days
6 months
1 year
3 months
1 month
4 do
3 do
7 years
3 do
3 weeks
6 months
1 month
1 year
1 do
2 do
2 weeks
2 months
10 years
2 do
2 weeks
4 months
6 months
2 months
years
Unknown
3 months
3 years
years
6 months
1 year
2 months
5 weeks
1
o
o
o.
a,
m
Unknown, .
do , . .
Typhoid fever,
Epilepsy,
Menstrual trouble,
111 health, .
Masturbation,
Rel gious.
Unknown, .
Masturbation,
111 health, .
Bilious fever,
Domestic affliction,
111 health, .
Epilepsy,
Unknown, .
Religious,
Masturbation,
Old age,
Paralysis,
Unknown,
Old age.
Domestic affliction.
Puerperal, .
Ill health, .
Unknown, .
Ill health, .
do . . .
Epilepsy,
Puerperal, .
Ill health, .
do
Masturbation,
_ s
o
rdnj 'Ti ^ Ti -a '^ 'S'S
■% 'fcC'S 'B 'baZ 'bi'S % ^ 'S M-g "bCrS 'S-d'fcbSTs'bifcl'a'a'^'bcg'M^^'^ns M
02
ajoj (u to <u <o a> ^ ^ '^
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Age
admit-
ted.
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d
'A
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CDO'X>cocO':oyD<;DO^QO;ocooocci(:ocooco«o^coos0^cocococo^^<o
1862.]
PUBLIC DOCUMENT— No. 28.
8T
Hereditary.
Hereditary and Period,
do •
.3 ^ g ^ U > >
g'gS'^Tie 'S'S 2 -g 2 'g 2-^2 -c
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m
sissa Issass
CN<MrJ,-H,-l i-l I-H r-l i-H i-l .^
Probate Court
Private Bond
Probate Court
do
Private Bond
Probate Court
do
do
do
do
do
do
do
do
do
do
do
Overseers
Probate Court
Private Bond
Probate Court
do
do
do
do
do
4 weeks
3 months
3 years
Unknown
9 years
2 months
2 do
Few days
do
Unknown
10 months
2 months
9 weeks
1 do
4 years
4 weeks
4 days
1 week
2 years
11 do
6 weeks
1 year
3 months
6 years
3 do
2 weeks
Unknown, .
Gestation,
111 health, .
Unknown,
111 health, .
Unknown, .
do
Intemperance,
Misfortune, .
Intemperance,
Unknown,
Seduction, .
Turn of life, .
Intemperance,
Study, .
Improper bathing
Political,
Unknown,
Kleptomania,
Epilepsy,
Spinal injury,
Unknown, .
Ill health, .
Paralysis,
do
Intemperance,
'C t3 rd nd tS 'd
kS .S'^.S'* CrtC oSC=s C
Female
do
Male
do
Female
do
do
Male
do
do
do
Female
do
Male
do
do
do
do .
Famale
Male
do
do
Female
Male
Female
Male
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88 LUNATIC HOSPITAL AT WORCESTER. [Oct.
During the year past much attention has been paid to the
subject of labor. Strict and methodical accounts have been
kept of the number of patients employed, and the time of
service. More than twenty-one thousand days' work has been
performed, a great variety and amount of labor having been
accomplished. Strictly as our account has been kept, however,
we shall be misled if we rely too much upon it. We must
remember that for every four or five patients engaged in ordi-
nary labor, a competent person must be paid whose time is
necessarily spent in directing and assisting the insane at their
work, and who often accomplishes with his four or five patients
less labor, and of an inferior quality, than he would have
performed alone. Then there is the loss of time and expe^ise
attending the more frequent elopements. Then, too, there is
the great liability to accident from the use of tools among the
insane, and the increased danger from fire, when so large a
number of patients are permitted the privileges necessary to
induce them to labor.
Besides these considerations, the introduction of labor as a
system requires other outlays. As the system progresses, shops
must be erected, tools and machinery must be purchased, and a
large force of assistants must be employed.
We should anticipate, also, the annoying question of compen-
sation for labor actually performed, for it will be difficult to
make the patient believe the work he has done was of primary
importance to him in the progress of his recovery, and of little
or no value to the institution.
We are thoroughly satisfied, however, that occupation of
some kind has a curative influence of the highest importance,
and in order to realize the full benefit of it we have taken
unwearied pains in this direction.
. The following tables will show some of the results of labor
during the year.
At all times the character of the labor has been regulated
with due regard to the patient's feelings, and so far as possible,
in accordance with his previous occupation, and as great a
variety of labor has been provided as our limited means would
justify.
1862.]
PUBLIC DOCUMENT— No. 28.
89
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90
LUNATIC HOSPITAL AT WORCESTER. [Oct.
Articles Made in the Sewing-Rooms,
Aprons, . . . .21
Mats, 13
Blankets, .
7
Mattress Ticks,
73
Bed Spreads,
24
Mittens, pairs of,
89
Bed Ticks, .
109
Napkins, .
82
Bureau Spreads,
12
Neck Ties, .
79
Chemises, .
142
Night Dresses,
9
Coats,
2
Night Caps,
10
Collars,
7
Overalls, pairs of,
30
Comforters,
37
Pants, pairs of.
90
Curtains, .
19
Pillows,
30
Drawers, pairs of.
42
Pillow Cases,
426
Dresses,
154
Pillow Ticks,
37
Edging, yards of.
41
Sheets,
488
Embroidery, yards of.
7
Shirts, . ^
277
Frocks,
18
Skirts,
51
Hankerchiefs,
25
Suspenders, pairs
of,
163
Hose and Socks, pairs of,
166
Towels,
268
Jackets, . * .
13
Vests,
. 42
Articles Repaired in the Sewing-Rooms.
Aprons, . . . .17
Overalls, pairs of, . . 381
Bags, Meal and Clothes,
97
Pants,
. 1,325
Blankets, .
29
Pillows,
6
Bed Spreads,
. 89
Pillow Cases,
77
Bed Ticks, .
. 373
Sheets,
. 105
Caps, .
7
Shirts,
. 4,615
Chemises, .
7
Shirt Bosoms,
. 39
Coats,
. 776
Skirts,
. 42
Collars,
. 115
Socks, pairs of,
. 17
Curtains, .
18
Table Cloths,
. 23
Drawers, pairs of,
. 308
Towels,
. 10
Dresses,
68
Tunics,
4
Frocks,
. 219
Undershirts,
. 294
Jackets,
. 84
Vests,
. 414
Mattress Ticks, .
. 83
In the following table may be found some of the results of
the labor performed upon the farm; and besides this some
crops have been cultivated and gathered from land not belonging
to the institution, and of which no mention has been made, the
object simply being to procure more labor for the inmates than
1862.]
PUBLIC DOCUMENT— No. 28.
91
could otherwise be had. In the table the quantities are
nearly all true weights and measures, and the prices generally
those of the market. In addition to this, as usual there has
been an amount of other labor, such as underdraining, fencing,
improving the grounds and reclaiming land, much of which
has been performed by inmates of the hospital under proper
direction and assistance.
The patients labor only about six or eight hours each day as
a general rule. Some few, however, labor through the entire
day. In procuring this amount of labor our aim is only the
comfort and restoration of the patient. No question of
economy or profit is permitted to interfere with this object.
Apples, .
Pears, .
Grapes, .
Tomatoes,
Sweet Corn,
Beans, .
Parsnips,
Turnips,
Potatoes,
Beets, .
Carrots, .
Squashes,
Peppers,
Cucumbers,
Rhubarb,
Hay, .
Rowen, .
Corn Fodder,
Milk, .
Beef, .
Pork, .
Products of the Farm.
25 barrels,
at $2 25
$56 25
25 bushels
,at 2 00
50 00
2
at 2 00
4 00
150 «
at 50
75 00
50
at 1 00
50 00
75 "
at 2 00
150 00
. 300
at 50
150 00
400 «
at 20
80 00
1,200
at 50
600 00
600 «
at 20
120 00
800
at 20
160 00
7 tons
at 25 00
175 00
20 bushels,
at 20
4 00
75 "
at 50
37 50
. 2,500 pounds.
at 02
50 00
80 tons,
at 15 00
1,200 00
7 "
at 15 00
105 00
10 "
at 4 00
40 00
50,000 quarts,
at 04
2,000 00
81,050 pounds
at 08
648 40
95,036 «
at 06
580 21
5,325 36
I am unable to give my usual table for the daily and monthly
consumption of coal, but have no doubt that it has been some-
what greater during the year past, than for several years pre-
ceding. This is owing partly perhaps to the kind and quality
92 LUNATIC HOSPITAL AT WOBpCESTER. [Oct.
of coal used, partly to the condition of the apparatus and
partly to change of firemen, one having died and another having
enlisted in the army.
The apparatus for warming and ventilating, however, con-
tinues to give as good results as ever, and has not yet required
any extensive repairs.
It gives us pleasure to be able to report a good degree of
success in our efforts to amuse, instruct and gratify in our
patients a wholesome love of variety, and to introduce to them
many new subjects of thought, by lectures, readings, social
entertainments of various kinds, by books, pictures and maps,
and by every means which our limited income would allow.
Our lecture season continued with some interruptions through
the entire year. Concerts of sacred music have also frequently
been given by friends from the city. Sociables are often held
during the long winter evenings, at which both sexes join in
all the games common on such occasions. In all our labors
every effort has been made to keep alive the mental faculties of
the patients by introducing to them such subjects of thought
as require only simple and easy mental action, hoping thereby,
if possible, to assist in arresting the progress of disease and to
prevent the remaining faculties from being involved in that
general ruin which is sure to overtake the minds of those who
cannot be interested in any thing beyond the sphere of their
own personality.
The Sunday services in the chapel are still performed in a
most satisfactory manner by Rev. Samuel Souther, and there is
great reason to believe that the patients receive a large share
of comfort from his ministrations.
Drs. Rice and Prentiss continue to perform the duties of
Assistant-Physicians in the most acceptable manner to the
patients, and with a zeal for the welfare of the institution
worthy of all praise.
My assistants are almost without exception thoroughly
devoted to the best interests of those consigned to our care.
We are under obligations to many friends for books, pictures,
newspapers, and assistance in our social entertainments, which
have contributed largely to the comfort and happiness of the
inmates.
1862.] PUBLIC DOCUMENT— No. 28. 93
As we now close the labors of the past and commence the
duties of another year, we may well invoke the blessing of
Him without whose aid all our labors are vain.
By His blessing the closing year has been one of success.
May we hope that the same degree of prosperity will crown the
labors of the one now opening.
MER^CK BEMIS.
State Lunatic Hospital, Worcester,
October 1, 1862.
94
LUNATIC HOSPITAL AT WORCESTER. [Oct.
AN INVENTOEY
Of amounts in value of the Stock and Supplies on hand.
Live stock on the farm, ....
Produce of the farm on hand,
Carriages and agricultural implements.
Machinery and mechanical fixtures, .
Beds and bedding in the inmates' department.
Other furniture in inmates' department,
Superintendent's department.
Housekeeping department.
Ready-made clothing.
Dry goods.
Provisions and groceries,
Drugs and medicines.
Fuel,
Library, .
$3,250 00
2,500 00
^ 750 00
5,500 00
. 4,000 00
3,500 00
. 350 00
1,200 00
100 00
. 250 00
1,500 00
100 00
. 1,500 00
300 00
1862.] PUBLIC DOCUMENT— No. 28. 95
LAWS EELATING TO TERMS AND FORMS OF ADMIS-
SION.
[Chapter 223 Acts of 1862.]
An Act concerning state lunatic hospitals and insane and
idiotic persons.
Be it enacted, §"0., as follows :
Section 1. The titles of the state lunatic hospitals shall be severally,
The Worcester Lunatic Hospital, The Taunton Lunatic Hospital, and
The Northampton Lunatic Hospital.
Section 2. The lands now holden and which may hereafter be
holden, by the trustees of any state lunatic hospital, in trust for the Com-
monwealth, for the use of the institution of which they are trustees, shall
not be taken for any street, highway or railroad, without leave of the
legislature specially obtained.
Section 3. Any of the judges of the supreme judicial, superior, and
probate courts, and, in the city of Boston, of the police court, may commit
to either of the state lunatic hospitals, any insane person who, in their
opinion, is a proper subject for its treatment or custody. But in all
cases, the evidence and certificate of at least two respectable physicians,
shall be required to establish the fact of insanity. In all cases the judge
shall certify in what place the lunatic resided at the time of his commit-
ment ; or if ordered to be confined by any court, the judge shall certify
in what place the lunatic resided, at the time of the arrest in pursuance
of which he was held to answer before such court ; and such certificate
shall, for the purposes of this act, be conclusive evidence of his residence.
Section 4. Any person applying for the commitment or for the
admission of a lunatic to a state lunatic hospital, under the provisions of
this act, shall first give notice in writing to the mayor, or one or more of
the selectmen, of the place where the lunatic resides, of his intention to
make such application ; and satisfactory evidence that such notice has
been given shall be produced to the judge in cases of commitment, and to
the trustees upon applications for admission.
Section 5. Upon every application for the commitment or admis-
sion of an insane person to any hospital or asylum for the insane, there
shall be filed with the application or within ten days after the commit-
ment or admission, a statement in respect to such person, showing as
nearly as can be ascertained his age, birthplace, civil condition, and
96 LUNATIC HOSPITAL AT WORCESTER. [Oct.
occupation ; the supposed cause and the duration and character of his
disease, whether mild, violent, dangerous, homicidal, suicidal, paralytic or
epileptic ; the previous or present existence of insanity in the person or his
family ; his habits in regard to temperance ; whether he has been in any
lunatic hospital, and if so what one, when, and how long ; and, if the
patient is a woman, whether she has borne children, and, if so, what time
has elapsed since the birth of the youngest t the name and address of
some one or more of his nearest relations or friends, together with any
facts showing whether he has or has not a settlement, and if he has a settle-
ment, in what place ; and if the applicant is unable to state any of the
above particulars, he shall state his inability to do so. The statement or
a copy thereof shall be transmitted to the superintendent of the hospital
or asylum, to be filed with the order of commitment, or the application
for admission.
Section 6. The judge may hear and determine such applications, in
respect to persons alleged to be insane, at such times and places as he
may appoint ; and the presence of the alleged lunatic at the hearing may
be required or dispensed with, in the discretion of the judge ; and the
court may in its discretion, issue a warrant to the sheriflp, or his deputy,
directing him to summon a jury of six lawful men, to hear and determine
whether the alleged lunatic is insane. Whenever a jury is summoned,
pursuant to the provisions of this section, the same proceedings shall be
had and the same fees and expenses paid as are provided by the General
Statutes, chapter seventy-three, sections twelve, thirteen, fourteen, fifteen
and sixteen.
Section 7. Whenever application shall be made to any judge of
probate for the commitment of an insane person under the provisions of
this act, he may allow to the sherifi", deputy-sherifi" or constable, or other
person to whom a precept is directed by name, who may serve the same,
the same fees as are allowed to officers upon the commitment of persons to
prison, and such further sum for expenses incurred in said commitments,
or in bringing such lunatic before the judge, as to him may seem reason-
able ; and the sums so allowed shall be certified and paid, as provided in
the General Statutes, cha,pter seventy-three, section sixteen.
Section 8. Upon every application for the admission of an insane
person to the several State lunatic hospitals, or to any asylum or private
house for the reception of the insane, the applicant shall file with his appli-
cation a certificate, signed by two respectable physicians, one of whom,
when practicable, shall be the family physician of the patient, certifying
after due inquiry, and personal examination of the patient by them, within
one week prior to the date of the certificate, to the insanity of the person in
whose behalf admission is sought, and that such person is a fit subject for
remedial treatment at such hospital, asylum, or private house.
1862.] PUBLIC DOCUMENT— No. 28. 97
Section 9. Any insane person who is supported by any place as a
pauper, may be committed by the overseers of the poor thereof, to either
of the state lunatic hospitals, with the consent of the trustees, and shall
be kept for a sum not exceeding the actual expense of his support. And
the trustees shall receive into the hospital, any other insane person having
a settlement or residence in this Commonwealth, for such compensation
as they may determine.
Section 10. The expenses of the state lunatic hospitals for the
support of lunatics having known settlements in this state, shall be paid
quarterly, either by the persons obligated to pay, or by the place in which
such lunatics had thieir residence, at the time of their commitment, unless
other sufficient security is taken to the satisfaction of the trustees, for
such support. If any place or person refuses to pay whatever sum may
be charged and due according to the by-laws of the hospital, on account
of the support of such patient therein, or for the removal of any patient
whom the trustees are authorized by law to remove, for thirty days after
the same has been demanded by the treasurer, in writing, of the mayor
and aldermen of the city, or of the selectmen of the town, or of the person
liable therefor, the same, with interest from the time of such demand,
may be recovered for the use of the hospital in an action to be instituted
by the district-attorneys, or other prosecuting officers, in the name of the
treasurer, against such delinquent city, town or person.
Section 11. The expenses of the hospitals for the support of lunatics
not having known settlements in this state, committed thereto, shall be
paid quarterly by the Commonwealth at the same rates charged for city
and town pauper lunatics therein, but not to exceed the sum of two
dollars and sixty-two cents per week ; and the same may afterwards be
recovered, by the treasurer of the Commonwealth, of the lunatics them-
selves, if of sufficient ability to pay the same, or of any person or kindred
obligated by law to maintain them, or of the place of their settlement if
any such is ascertained ; and the district-attorneys, or other prosecuting
officers, shall institute suits therefor when requested.
Section 12. It shall be the official duty of the attorney-genei*al and
district-attorneys to advise and consult with the trustees and treasurers of
the several state lunatic hospitals, when requested by them, on all ques-
tions of law relating to their official business.
Section 13. If at any time, all the state lunatic hospitals shall be so
full that the inmates cannot all be suitably accommodated therein, and in
the opinion of the trustees of either hospital it is proper that some should
be removed, the trustees may remove to their respective homes, or to the
places of their legal settlement, or of their residence, so many as may be
necessary to affi)rd suitable accommodation for the remainder ; but only
such patients shall be selected for removal as, in the opinion of the
13
98 LUNATIC HOSPITAL AT WORCESTER. [Oct.
trustees and superintendent, are not susceptible of improvement and can
be suitably managed at their homes or in the places to which they may
be sent.
Section 14. Any judge of the supreme judicial or superior court, at
any term held within and for the county in which either hospital is
located, or the judge of the probate court of such county, or the trustees
of such hospital may, on application in writing for the discharge from
such hospital of any insane person who has remained there a sufficient
time to make it appear that he is incurable and not dangerous to the
peace arid safety of the community, cause him to be delivered to the
agents of any place in which he has a legal settlement or on which he
has a legal claim for support, or to his friends, when it appears that it
would not be to his injury, and that he would be comfortably and safely
provided for by any parent, kindred, friend, master or guardian, place or
institution. When application has been made to any judge for the dis-
charge of any insane person, any person interested in said discharge may
request a trial upon said application by a jury, and the judge before
whom the trial is to be held shall issue a warrant to the sheriff of the
county, or his deputy, directing him to summon a jury of six lawful men,
to hear and determine whether such insane person is incurable, and may
be comfortably and safely provided for according to the terms of this
section. The proceedings shall be the same in selecting jurors, conduct-
ing the trial and allowing the costs, as are provided in sections twelve,
thirteen, fourteen, fifteen and sixteen of chapter seventy-three of the
General Statutes.
Section 15. The several judges of probate in the counties where
the state lunatic hospitals are located, shall have the same authority at
any time to discharge from confinement lunatics committed to the hospi-
tals, as is conferred upon the trustees and the justices of the supreme
judicial and superior courts by the twenty-ninth section of chapter
seventy-three of the General Statutes.
Section 16. The money and cost of clothing which the trustees of
any state lunatic hospital may by law furnish to discharged pauper
lunatics, the expense of pursuing such as elope therefrom, and of burial
of pauper lunatics dying in the hospitals, shall be reimbursed to the
trustees by the places of legal settlement of city and town paupers, and
by the Commonwealth in the case of state paupers.
Section 17. When a person held in prison on a charge of having
committed an indictable offence is not indicted by the grand jury, or, on
trial is acquitted by the jury by reason of insanity, the jury in either case
shall certify that fact to the court, and thereupon if the court is satisfied
that he is insane, they may order him to be committed to one of the state
lunatic hospitals, under such limitations as they may direct.
1862.] PUBLIC DOCUMENT— No. 28. 99
Section 18. The eighth, ninth, tenth, eleventh, nineteenth, twen-
tieth, twenty-tirst, twenty-second, twenty-third,'^ twenty-fourth, twenty-
seventh, twenty-eighth and thirtieth sections of the seventy-third, and
the fifteenth section of the one hundred and seventy-first, and the
seventeenth section of the one hundred and seventy-second chapters of
the General Statutes, are hereby I'epealed.
PETITION
[The applicant must answer in writing the printed interrogations accompanying
this blank.]
To the HonoraUe the Judge of the Probate Court, in and for the County
of
of
on oath complains that
of , in said county of , is an insane
person, and a proper subject for the treatment and custody of the
"Worcester Lunatic Hospital.
Wherefore h prays that said
may be committed to the said Worcester Lunatic Hospital, according to
law
, ss. A. D. 186
Then the above named
made oath that the above complaint, by subscribed, is true.
Before me.
Justice of the Peace.
I, the subscriber, one of the selectmen of
where said
resides, hereby acknowledge that notice in writing has been given to me
of the intention to present the foregoing complaint and application.
A. D. 186
100 LUNATIC HOSPITAL AT WORCESTEE. [Oct.
To the Honorable the Judge of the Prolate Court, in and for the County
of
The subscriber, having made application to your Honor for the
commitment of
to the Worcester^ Lunatic Hospital, as a lunatic, now presents the
following statement, in answer to interrogatories : —
What is the age of the lunatic ? Ans.
Birthplace ? Ans.
Civil condition of lunatic ? Ans.
Occupation ? Ans.
Supposed cause of disease ? Ans.
Duration ? Ans.
Character — whether mild, violent, or dangerous ? Ans.
Homicidal or suicidal ? Ans.
Paralytic, or epileptic ? Ans.
Previous existence of insanity in the lunatic ? Ans.
Previous or present insanity in any of the family ? Ans.
Habits in regard to temperance ? Ans.
Whether he has been in any lunatic hospital ; if so, what one, when,
and how long. Ans.
(If a woman.) Has she ever borne any children? Ans.
(If a woman.) How long since the birth of her last child ? Ans.
Name and post-office address of some one of the nearest relatives or
friends ? Ans.
What facts show whether h has or has not a settlement, and
where, if anywhere, in this State. Ans.
[For the law relating to settlement, see Gen. Stat. chap. 69.]
Applicant.
physicians' certificate.
The subscribers, respectable physicians of
in the county of , having made due inquiry and
personal examination of • named
in the foregoing application, within one week prior to the date hereof,
certify that the said is insane,
and a proper subject for the treatment and custody of the Worcester
Lunatic Hospital.
A. D. 186
, ss. A. D. 186
Then the above named ^nd
made oath that the above certificate is true.
Justice of the Peace.
1862.] PUBLIC DOCUMENT— No. 28. 101
Gommonioealth of Massachusetts.
, ss.
At , in said county, on the
day of A. D. 186 .
On the application of
for the commitment of
of in said county, to the Worcester
Lunatic Hospital, ; notice
in writing having been given by said applicant to one of the selectmen
of where said
resides, of h intention to make said application, and said
having been duly notified of the time and place appointed
for hearing, it appears upon a full hearing that said
is an insane person, and a proper subject for the treatment and custody
of the Worcester Lunatic Hospital.
Therefore it is ordered that said
be committed to the said Worcester Lunatic Hospital.
Judge of Probate Court.
FOKM OF OVERSEERS BOND.
State Lunatic Hospital at Worcester.
Whereas, of , in the county
of , has been admitted a boarder in the State Lunatic
Hospital at Worcester, we
, a majority of the Overseers of the Poor of the
town of , in the county of , in behalf
of the inhabitants of said town, do hereby promise
Treasurer of said hospital, to pay him or his
successor in said office, the sum of dollar and
cents per week for the board of said
so long as he shall continue a boarder in said
hospital, with such extra charges as may be occasioned by
requiring more than ordinary care and attention, to provide for
suitable clothing, and to pay for all such necessary articles
of clothing as shall be procured for by the Steward of the
hospital, and to remove from said hospital whenever the room
occupied by shall be required for a class of patients having
preference by law, or in the opinion of the Superintendent, to be received
102 LUNATIC HOSPITAL AT WORCESTER. [Oct.
into said hospital ; and if he should be removed at the request of
before the expiration of six calendar months after
reception, to pay board for twenty-six weeks, unless he should be
sooner cured. Also to pay, not exceeding fifty dollars, for all damages
he may do to the furniture, and other property of said hospital, and
for reasonable charges in case of elopement, and funeral charges in case
of death. Payment to be made quarterly and at the time of removal,
with interest on each bill from and after the time it becomes due.
Witness our hands this day of
A. D. 18 .
Attest. (Signed,)
"^ Overseers of the Poor
> of the
) Town of
FORM OF PRIVATE BOND.
State Lunatic Hospital at Worcester.
Whereas , of , in the county
of , as Principal and ,
of , in the county of , as Surety,
do hereby jointly and severally promise
Treasurer of said hospital, to pay him or his successor in said office, the
sum of dollars and cents per week for the
board of said , so long as he shall continue a
boarder in said hospital, with such extra charges as may be occas-ioned
by requiring more than ordinary care and attention ; to provide
for suitable clothing, and to pay for all such necessary articles
of clothing as shall be procured for by the Steward of the
hospital, and to remove from said hospital whenever the room
occupied by shall be required for a class of patients having
preference by law, or in the opinion of the Superintendent, to be received
into said hospital. Also to pay, not exceeding fifty dollars, for all
damages he may do the furniture and other property of said hospital,
and for reasonable charges in case of elopement, and funeral charges in
case of death. Payment to be made quarterly and at the time of
removal, with interest on each bill from and after the time it becomes
due.
Witness our hands this day of , A. D. 18
Attest. (Signed,)
, Principal.
, Surety.
1862.] PUBLIC DOCUMENT— No. 28. 103
In conformity to the laws of the Commonwealth, the Trustees are
required at their annual meeting to establish the price of board. The
expense for the ensuing year will be at the rate of three dollars per
week for the first six months after the commitment of a patient, and two
dollars and seventy-five cents per week after the expiration of six
months. All necessary clothing must be supplied by the friends of the
patients.
Clothing will be supplied at the hospital if desirable and charged in
the bills at cost.
Damages done to the furniture and other property to the amount of
fifty dollars may also be charged.
Reasonable charges will be made in case of elopement, and funeral
charges in case of death.
All bills are collected by the Treasurer quarterly, or interest charged
on the same after becoming due.
Bills become due on the first of January, April, July, and October,
and when the patient leaves the hospital.
METEOROLOGICAL OBSERVATIONS
MADE AT
THE STATE LUNATIC HOSPITAL, WORCESTER, MASS.,
1861-2.
Latitude, 42» 16' 17" N. ; Longitude, 71° 48' 13" W.
Elevation, 536 feet.
Explanation. — The force of the wind is estimated upon a scale of 10 and indicated by figures
affixed to the letters denoting the direction. When no number is affixed, 1 is meant.
14
106
LUNATIC HOSPITAL AT WORCESTER.
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INDEX.
Page.
Accounts, 27
Admissions, 1861-2, 5, 49, 50, 51
from various causes, 55
in thirty years, 8, 55, 60
monthly, 53
of foreigners, 51
on bonds, 51
yearly, 66
Ages, 59, 60
Almshouses, State, money advanced to by State, 28
State, paid monthly by State, 28
Amusements, 40
insufficient for occupation, 41
Average number in Hospital, 65, 66
Blind Institution, money paid to in advance, 28
California Asylum, free, 19
Causes of insanity, 17, 18, 55
permanent, . . . . ' 18
Cells removed, 6
Classes to whom hospital was offered, 7
Constant insane population in State, .16
may be diminished, 18
Convict, insane, 29, 33
Counties from which patients are sent, 61
Courts, patients committed by, 51, 66
Credit, Hospital buys on and gives, 26
New Jersey and New York Asylums not allowed to buy on, . . . 28
Criminal insane, 29
cost of, 37
escapes of, 32
injurious to other patients, 31
increase cost of hospital, 34
provision for in Pennsylvania and Rhode Island, 36
require greater watchfulness, 33
should not be in hospital, 30
Criminal Lunatic Asylums in New York, England and Ireland, .... 36
I
Deaths, 49,66
causes of, 57
ratio of, 68
124 INDEX.
Page.
Debts due to and from hospital, .... 27
Discharges, 1861-2, 49
foreigners, 51
monthly, 53
yearly, 66
Early notions of insanity, 6, 7, 40
Economical and liberal policies, effect of, . 23
English Asylums, cost of paupers in, . ' . . 22
criminals in, . 36
mechanical trades in, 42
Escapes of criminal patients, . 32
cost of, . . . . . . ' . . 34
effect of on hospital, ; . 34
Expense of hospital, each patient in, 14, 65
in several States, 21
same under different policies, 25
sane and insane paupers, . 22
Eye and Ear Infirmary, paid by State, in advance, 28
Farm, products of, 91
Financial value of hospital labors, 8
Flowering season for twenty-four years, 21
Foreigners admitted, 51
at end of year, . 52
deficiency of paj'ment for paid by natives, 14
and natives, ratio of in hospital, .12
use hospital in undue proportion, 11,24
Forms of admission, • . 99
of disease of mind, 54
Health, years of, enjoyed by recovered patients, 10
Hospital, borrows money and buys on credit, . 26
credit given by, on all bills, 27
curative, 8
custodial originally, 7
enjoyed by foreigners more than natives, . . . . . . . 11
financial worth of its labors, 9
free in California, Illinois, Indiana, Ohio, Wisconsin, 19
improvements in, 6
income, sources of, . . • . . . 26
labors, results of, 8
loses by State paupers, 14
number and proportion of patients restored in, 8, 10
object of to employ powers sanely, 41
original object of, 7, 40
Idiot School, paid by State, in advance, 28
Illinois Hospital, free, 19
Improvements, 6
Indiana Hospital, free, !19
Insanefconstant number of in Massachusetts, 16
maj' be diminished, 18
how treated by managers of hospitals, £0
mental and moral condition of, ... 30
INDEX. 125
Page.
Insane, number made yearlj', 17
old and recent cases received and cured, 16
state of, thirty years ago, 7
Insanity, curable in early stages, 16
duration of, in curable, 17
duration of, in incurable, 10
years of, removed by hospital, . . . ' 11
Kentucky pays for paupers, . ; 19
Labor and amusements, comparative desirableness of, 41
needed by all, 39, 40
performed last year, 38, 89
Laws concerning insanity in Massachusetts, 95
Life tables, of sane and insane, 10
Maine pays part of cost of patients not rich, . 19
Married and single, 60
Mechanical trades, effect of, 44
in British asylums, 42
in Irish asylums, 44
safety of, in hospitals, 44
to be introduced at Worcester, 45
Meteorology, 105
summary of, 119
Michigan, counties pay for patients not rich, 20
Native patients, kept out of hospital by expense, ....... 15
pay for deficiency of foreigners, 14
New Hampshire pays part of cost of patients not rich, . . . . . . 19
New York, Criminal Lunatic Asylum, 36
hospital not allowed to buy on credit, 28
pays salaries, . 19
provides for support of patients not rich, 20
New Jersej', hospital not allowed to buy on credit, 28
pays salaries, 19
provides for support of patients not rich, 20
North Carolina pays part of paupers' support, 20
Officers, 3
Occupations of patients, 61
Ohio Hospitals, free, 28
Overseers of poor, patients committed by, 51
Patients, descriptive list of, 70
Paupers, sane and insane, comparative cost of, 22
Payment by State, in advance, to Blind Institution, &c., 28
monthly, to State Almshouses, 28
to hospitals, deficiency of paid by independent patients, . . . . 21
history of, 14
less than cost in Massachusetts, 13
less than cost in South Carolina, 21
Pennsylvania pays part of cost of patients not rich, 20
Policies of different States in support of hospitals, . 18
effect of on recovery of patients, 25
126 INDEX.
Page.
Rain and snow, twenty-one years, 120
Recoveries, 1861-2, 49
in each year, 66
in thirty years, 8
per cent., 68
ratio of, in Massachusetts and Ohio, 24
Salaries, how paid, 14
paid by State, in Georgia, Michigan, New Jersey, New York, and Pennsyl-
vania, 19
Snow and rain, 120
South Carolina makes independent patients help support poor, .... 21
State paupers at end of each year, 52
Treasurer's Report, 48
Trustees, . ' ■ • 3
Weather and wind, 118
Wisconsin Hospital, free, 19
Working capital, 26
borrowed, 29
at cost of independent patients, • . . . . 29
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