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

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PUBLIC DOCUMENT I^o. 23. 



THIRTY-SIXTH ANNUAL REPORT 



THE TRUSTEES 






STATE LUNATIC HOSPITAL 



W^OHCESTEK. 



October, 1868. 



BOSTON: 

WRIGHT & POTTER, STATE PRINTERS, 
79 Milk Street (corner of Federal). 
1869. 



Digitized by the Internet Archive 

in 2010 with funding from 

University of IVIassachusetts Amherst 



http://www.archive.org/details/annualreportoftr34stat 



TRUSTEES' REPORT, 



To His Excellency the Governor and the Honorable Council of 
the Commonwealth of Massachusetts. 

The Trustees of the Worcester Lunatic Hospital respectfully 
submit their Tliirty-Sixth Annual Report. 

This hospital was established nearly forty years ago in the 
suburbs of the quiet town of Worcester. It is now in the 
middle of a thriving and prosperous city. Its essential features 
remain the same as when it was built, with only the addition of 
such improvements as its construction permitted. It is yet far 
from being such a building as the wants of this community 
require. At no distant day it may be thought advisable to 
relinquish the valuable tract of land in which it stands, in ex- 
change for a more quiet and less expensive location at a little 
distance ; and, by such exchange, the Trustees believe that a 
jiew hospital, suited to the times and to the character of the 
Commonwealth, might be built without cost to the State. As 
it is, tlie Trustees have confidence that the condition of its 
inmates, during the past year, has been as satisfactory as at 
any previous time. 

By the Treasurer's report, the finances, which had been some- 
what embarrassed by the high cost of supplies, are now in a 
good condition ; and when all dues are received, and all debts 
paid, a balance will remain in favor of the hospital. 

The average cost per week of each patient, in 1867, was 
§1.60, and for the present year |3.80. The latter sum now 



4 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

nearly approaches the amount paid by the State and towns 
for their patients. The deficiency is made up by the payment 
of private patients, some of whom, at a sacrifice to their sense 
of pride and independence, prefer not to be a public burden. 

In the treatment of those under our care, we can hardly ven- 
ture to say that any very decided improvement has been made 
over former years, as our facilities have not increased with the 
progress of experience. "We have far from reached perfection 
in the treatment of the insane. There are more truths yet to 
be revealed to us, and we trust that nothing that thought or 
expenditure can give will be neglected to make this hospital 
what it should be. 

Freedom from personal restraint, instituted by the humane 
and courageous Pinel, marked an epoch in the annals of insan- 
ity. Another great step in advance will be to give useful and 
cheerful occupation to the insane, to relieve the tedious monot- 
ony of a hospital life, — to make a cheerful and happy home for 
such as are visited with this malady, from which no gift of mind 
or person can exempt us. Judge, counsellor, legislator and 
private citizen are all alike subject to it. It is the duty of 
every member of the community to use his power and influence 
to lessen the sufferings of those afflicted with insanity. 

The restraints formerly used here, partly from ignorance, but 
more from motives of economy, — the cell, the camisole, chains 
and other instruments of days gone by, — have been exchanged 
for the gentle but firm presence of faithful and conscientious 
attendants, at all hours, to protect the patient from injury to 
himself or to others. If such attendance could be had in pri- 
vate families, and the love and affection of friends not exhausted, 
there are many patients in our hospitals who might remain at 
home. Yet the surroundings of a hospital, which seem so 
painful to visitors, are a source of benefit to some patients, from 
the sympathy and interest they excite. 

It must not be supposed that the hardness of each individual 
case is in proportion to the complaints made by patients of the 
injustice of confining them to a hospital. This man who repre- 
sents his case to the visitor most eloquently as being separated 
from his family, for whose support he is able to work, in another 
hour is dangerous to approach. This one who claims the need 



1868.] PUBLIC DOCUMENT— No. 23. 5 

of her children for her fostering care, if placed at large would 
put a firebrand to her dwelling. 

Every attention possible is given to the complaints by patients 
of ill usage from their friends or attendants, and experimental 
visits to their homes, when the friends desire, are allowed, if 
safe and proper. Some are permitted to work at their trades 
in the city, while under the supervision of the hospital, and all 
are allowed the largest amount of liberty consistent with safety. 

The health of our Superintendent, after a life of twenty years 
of labor in the hospital, having failed, he was induced to take a 
vacation in the summer, which he passed in visiting the hospi- 
tals of other lands. He has returned, apparently restored to 
health, and filled with experience which he will detail to you in 
the report that accompanies this. 

In his absence, the duties of his office were most faithfully 
performed by Dr. Draper, to whom we feel gratefully indebted. 

Yery respectfully submitted by the Trustees. 

R. W. HOOPER. 
CHAS. MATTOON. 
HENRY CHAPIN. 
WM. WORKMAN. 
S. E. SEW ALL. 



LUNATIC HOSPITAL AT WOECESTER. [Oct. 



TREASUEEE'S EEPOET 



To the Trustees of the Worcester Lunatic Hospital. 

Gentlemen: — I herewith submit mj annual report of the 
financial condition of the Worcester Lunatic Hospital. 



Receipts. 

Cash on liancl September 30, 1867, 

received of the Commonwealth for support of patients, 
received of cities and towns for support of patients, . 
received of individuals for support of patients, . 
received from sale of farm products, 



The expenditures of the ; 


year have 


been 


as follows : — 


Provisions, — 


Flour, 524 bbls., $6,908 65 


Fresh meats. 












3,705 02 


Salt meats, . 












4,297 67 


Butter, 












4,871 76 


Sugar, 












2,032 36 


Eggs and groceries. 












1,424 65 


Tea, . 












698 30 


Coffee and chocolate, 












624 53 


Eice and crackers, 












373 82 


Meal, . 












130 50 


Fresh fruits. 












526 48 


Potatoes, . 












1,617 52 


Beans, 












578 70 


Fish, . 












594 61 


Molasses and sirup, 












749 22 


Ice, 












412 62 


Vinegar and pickles. 












236 75 


Cheese, 












145 23 


Furniture, bedding, table ware, &c.. 






2,477 93 


Medical supplies, 






1,135 23 


Books, papers, stationt 


iry, p 


rintir 


g, &<: 


•1 




792 79 



^1,779 04 
19,417 59 
27,203 83 
35,765 47 
3,087 83 

887,254 36 



1868.] 



PUBLIC DOCUMENT— No. 23. 



Fuel, .... 

Light, 

Soap, .... 

Improvements and repairs, 

Freight and express, . 

Live stock, . 

Salaries and wages, 

Miscellaneous, 

Provender, . 



Total amount of current expenses, 

Clothing, ..... 

Undertakers' bills, 

Paid on loan, . 

Cash on hand, September 30, 1868, 



^5,737 84 

1,175 73 

473 89 

4,164 34 

164 72 

705 00 

20,567 71 

2,829 74 

1,901 78 



§72,054 59 
2,395 72 
1,142 90 
7,500 00 
4,161 15 



Kesources. 



Cash, 

Due from the Commonwealth, 
Same, (Appendix bills,) 
Due from cities and towns, . 
Due from individuals. 



^4,975 76 
. 578 91 



57,254 36 

§4,161 15 
I 5,554 67 

7,707 26 
8,893 92 

§26,317 00 



Liabilities. 
Worcester County Institution for Savings, . 
Due for bills of supplies and expenses, 
Due for salaries and wages, 

Balance, 

Invested funds, (market value,) 
Dividends from the same on hand. 

Surplus, ...... 



Worcester Luxatic Hospital, } 
Worcester, Oct. 1, 18G8. | 



§4,500 00 
7,910 91 
4,983 90 
17,394 87 

. §8,922 13 

2,050 00 

72 00 

. §11,044 13 
D. W. BEMIS, Treasurer. 



We have examined the above account, with tLc vouchers, and find it correct. 

WILLIAM WOKKMAN, 
HENRY GIIAriN, 

Audit in fj Commilicc. 
WORCESTEK, Oct. 17, 18G3. 



8 LUNATIC HOSPITAL AT WORCESTER. [Oct. 



OFFICERS OF THE HOSPITAL. 



TKUSTEES 

EGBERT W. HOOPER, M. D., 
HON. CHARLES MATTOON, . 
HON. HENRY CHAPIN, . 
WILLIAM WORKMAN, M. D., 
HON. SAMUEL E. SEWALL, . 



. Boston. 

. Greenfield. 

. Worcester. 

. Worcester. 

. Boston. 



RESIDENT OFFICERS. 

MERRICK BEMIS, M. D., .... Superintendent. 

JOSEPH DRAPER, M. D., . . . . Assistant-Physician. 

CAROLINE A. BEMIS, Matron. 

DANIEL W. BEMIS, . ... . . . Steward. 

TREASURER. 

DANIEL W. BEMIS, Worcester. 

Office at the Hospital. 



SALARIED OFFICERS OF THE HOSPITAL. 

Superintendent, ^1,800 00 

Assistant-Physician, 900 00 

Matron, 200 00 

Steward and Treasurer, 1,000 00 



1868.] 



PUBLIC DOCUMENT— No. 23. 



SUPEEINTENDENT'S REPOET. 



To the Trustees of the Worcester Lunatic Hospital. 

Gentlemen: — In obedience to the laws of the Common- 
wealth, I have the honor to submit to you the Thirty-Sixth 
Annual Report of the Worcester Lunatic Hospital. 

For the general results of the year, and the condition of the 
patients in detail, you are respectfully referred to the following 
tabular statements, and such brief explanatory remarks as may 
accompany them : — 



Table No. 1, 

Sliowing ilte general results during the year. 





Males. 


Females. 


Totals. 


Patients in the Hospital, October 1, 1867, 


177 


178 


355 


Admitted during the year, .... 


158 


138 


296 


Whole number under treatment, 






335 


316 


651 


Discharged recovered, 






62 


48 


110 


improved. 






44 


48 


92 


not improved, 






20 


14 


34 


Died, 






21 


12 


33 


Whole number discharged, 






147 


122 


269 


Eemaining, September 30, 1868, 






188 


194 


382 



From this table, it appears that two hundred and ninety-six 
patients were admitted during the last year, of whom one 
hundred and fifty-eight were males, and one hundred and 
thirty-eight were females. 

At the close of the previous year, there were three hundred 
and fifty-five patients inmates of the hospital, of whom one 
2 



10 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

hundred and seventy-seven were males, and one hundred and 
seventy-eight were females, so that there were six hundred and 
fifty-one persons under treatment in the course of the year, of 
whom three hundred and thirty-five were males, and three 
hundred and sixteen were females ; the daily average was three 
hundred and seventy. No disturbing causes have operated to 
influence in any very great degree the usual results of the 
year. 

The number of patients discharged was two hundred and 
thirty-six, of whom one hundred and ten were recovered, 
ninety-two improved, and thirty-four not improved. Thirty- 
three were removed by death, of whom twenty-one were males, 
and twelve were females. 

The recoveries were thus in the ratio of a fraction more than 
thirty-nine per cent, to the number of admissions,— a gratify- 
ing result if compared with the percentage of recoveries in 
other old and long established hospitals. 

At the close of the year there were eight patients in the 
hospital who had recovered their usual degree of mental health, 
and were awaiting the convenience of their friends for their 
removal. If this number be added to the number of those 
discharged and tabulated, the ratio of recoveries to the num- 
ber discharged will be increased from forty-seven to fifty per 
cent. And if eight cases of recurrent mania and ten cases of 
unknown duration be included in the tabular statement, the 
ten per cent, of recovery of recent cases will be increased from 
fifty-four to sixty per cent. 

Again, if fifty-six patients who were transferred directly to 
other institutions be deducted from the whole number dis- 
charged, the ratio of recoveries to the number discharged will 
be sixty-one per cent., or sixty-five per cent, if the eight who 
had recovered and were remaining be added to the number 
of those discharged. 

The rate of mortality is somewhat less than during the 
previous year, and may be considered as quite moderate, if we 
regard the condition of many of the patients when admitted. 
The percentage of deaths of the average number of resi- 
dents was nine, and only five per cent., if calculated on the 
whole number under treatment. 



1868.] 



PUBLIC DOCUMENT— No. 23. 



11 



Table No. 2, 

Slioiving the Admissions and state of the Ilosjnial fro7n October 1, .1867, to 
Septemler 30, 1868. 



Males. 


Females. 


177 


178 


158 


138 


188 


194 


103 


82 


49 


48 


6 


8 


109 


88 


12 


10 


37 


36 


1 


3 


58 


60 


61 


63 


47 


48 


45 


45 


8 


8 


1 


6 



Patients in the Hospital, October 1, 1867, . 
admitted in the course of the year, 
remaining in the Hospital, Sept. 30, 1868, 
Of the admissions there were cases of one year or less 
duration, ...... 

Of the admissions there were cases of more than one 
year's duration, ..... 

Of the admissions there were cases the duration of 

whose insanity could not be ascertained, 
Patients committed by Courts, .... 

committed by Overseers of the Poor, 
on bonds, ...... 

committed by Governor's warrant, 
committed by the Board of State Charities, 
committed by Commissionei'S of Lunacy, 
Foreigners and those having no settlement in 

State, committed in course of the year, 
Foreigners and those having no settlement in 

State, discharged in course of the year. 
Foreigners and those having no settlement in 

State, remaining in the Hospital, Sept. 30, 1868, 
Patients in Hospital previously, .... 

in other Hospitals in this State previously, 
in Ilosjiltals of other States previously. 



the 
the 
the 



355 
296 
382 

185 

97 

14 

197 
22 
73 



118 

124 

95 
90 
16 

7. 



State Paupers remaining in the Hospital at the close of each year as nearly as 
can be ascertained. 



1842, 


34 


1851, . 


201 


1860, . 


130 


1843, 


88 


1852, 


241 


1801, . 


156 


1844, 


38 


1853, 


216 


1862, 


189 


1845, 


. . 57 


1854, 


151 


1863, . 


175 


1846, 


52 


1855, 


115 


1864, 


116 


1847, 


121 


1856, 


155 


1865, 


91 


1848, 


150 


18.57, 


119 


1866, 


129 


1849, 


167 


1858, 


121 


1867, . 


101 


1850, 


181 


1859, . 


124 


1868, 


95 



The preceding table shows that one hundred and eighty-five 
patients were admitted to the hospital in the course of tlie year 
whose insanity had existed one year or less previous to the 
date of their admission. Other tables in tliis connection show 
that about seventy-five per cent, of all patients admitted to the 
hospital who had been insane not more than one year previous 



12 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

to admission have recovered their mental health and useful- 
ness and have been restored to society. 

It may also readily be shown that a large proportion of those 
who are placed under treatment on the first appearance of dis- 
ease recover their customary health within a period of six 
months. 

The table also shows that one hundred and ninety-seven 
patients were committed by order of the probate courts of the 
several counties, thus making the commitment of patients an 
open, fair, legal proceeding. In all cases where the patient 
has been admitted by the officers of the hospital the admission 
has been given on the authority of a certificate of insanity from 
two physicians. And in those cases where the patient has vol- 
untarily sought the benefits of the institution an examination 
has at once been made and certificates procured from physi- 
cians not connected with the hospital. 

Of the one hundred and ninety-seven committed by the 
courts in the course of the year, one hundred and eighteen 
were supported by tlie charity of the Commonwealth. Of this 
class one hundred and twenty-four were discharged, leaving 
ninety-five in the hospital at the close of the year. 

The number of patients admitted into the hospital since it 
was opened amounts to eight thousand one hundred and ninety- 
eight, of whom four thousand and ninety-five have been males 
and four thousand one hundred and three females. 

Of this number, three thousand eight hundred and twenty- 
five have been discharged recovered, and one thousand four 
hundred and forty-six have been discharged improved ; the 
recoveries being in ih ratio of forty-eight and nine-tenths per 
cent, to the whole number, after deducting the number of those 
who remain under treatment. And the ratio of those dis- 
charged improved, to the whole number, is a fraction less than 
twenty per cent., after deducting those who remain in the 
hospital. 

Fifty-seven patients have been removed to otlier institutions 
in the course of the year by order of the Board of State Chari- 
ties, and five have been removed to their homes out of the 
Commonwealth. A large majority of these patients were sup- 
posed to be incurable, and had been residents in the hospital 
varying periods of time from a few weeks to several years. 



1868.] PUBLIC DOCUMENT— No. 23. 13 

I have done all in my power to carry out the plan of board- 
ing a few quiet chronic patients in private houses, whose con- 
dition seemed to warrant it, both in deference to the opinions 
encouraged by your board, and under the convictions on this 
subject which I urged in my reports of 1856 and 1857 ; but I 
must confess that I find very great difficulty in getting proper 
persons to interest themselves sufficiently in the subject to 
assist me in my efforts, and have thus far been able to procure 
suitable homes for a few cases only of those whose service 
would be of real value. 

In reference to those cases for whom asylums are sought out 
of the Commonwealth and similar cases so disposed of in former 
years, I beg leave to make a single remark. 

It is much to be regretted that there cannot be a fair under- 
standing and an equitable arrangement between the authorities 
of different countries and also between the authorities of differ- 
ent sections of our own country, for the purpose of facilitating 
and rendering such transfers humane and desirable, not only 
between this country and England, Scotland, Ireland and Ger- 
many, but between different States of our own country. 

Under the existing state of things lunatics who may be wisely 
and properly transferred to tlieir homes in a foreign country, 
are generally landed at Liverpool, where it not unfrequeritly 
happens that all trace of them is lost. Sometimes, however, 
they are picked up as wanderers in the streets, and are sent to 
English asylums or poor-houses. 

And in the case of those who are sent into other States, where 
they are supposed to have settlements, the result frequently is, 
that on arriving in the place of their settlement, either their 
identity or their insanity is repudiated by the authorities, and 
the unfortunate lunatic, unable to provide for himself, is let 
loose on the public streets, to take his chance of what Prov- 
idence may do for him. They sometimes succeed in begging 
their way back to the hospital. When they have done so they 
have been received by order of the Board of State Charities, 
and taken care of until they could again be transferred. 

Of the unrecovered patients discharged, many were removed 
by the Board of State Charities, and proper provision was made 
for them in other institutions ; some, however, were removed 
for whom no special provision was made for their care ; and 
some, as frequently happens, were very injudiciously removed, 



14 



LUNATIC HOSPITAL AT TVORCESTER. [Oct. 



and have consequently been readmitted in a much more hope- 
less condition than when they were taken away. 

Table No. 3, 

Showing the Number Admitted, Restored, Improved, Died, Sj-c, in each Month 

in the Year. 



* 


Admitted. 


Eemoved. I 


Kemaining. 


MONTHS. 








"d 


> 


-d 

li 


d 


Totab 












to 


1 


K 


K 


g 


s 


S 






r/J 


i 




























1— « 




"3 


fa 


o 


M. 


F. 


M. 


F. 


M. 


F. 


M. 


F. 


M. 


F. 


T. 


s 


&H 


o 


October, 


7 


11 


18 


9 


8 


5 


2 


1 


2 


3 


1 


11 


13 


24 


173 


176 


349 


November, . 


9 


11 


20 


1 


4 


3 


2 


1 


1 


1 


2 


6 


9 


15 


176 


178 


354 


December, . 


15 


9 


24 


3 


3 


4 


4 


2 


1 


- 


_ 


9 


8 


17 


182 


179 


361 


January, 


19 


5 


23 


■7 


5 


- 


2 


_ 


- 


_ 


- 


7 


7 


14 


193 


177 


370 


February, . 


8 


10 


18 


4 


2 


- 


1 


- 


- 


- 




4 


4 


8 


197 


183 


380 


March, 


11 


9 


20 


8 


4 


3 


5 


9 


3 


2 




22 


13 


35 


186 


179 


365 


April, . 


19 


17 


36 


9 


5 


3 


6 


1 


- 


6 




19 


12 


31 


186 


184 


370 


May, . 


9 


15 


24 


6 


2 


4 


9 


- 


2 


1 




11 


14 


25 


184 


185 


369 


June, . 


15 


16 


31 


7 


3 


8 


12 


2 


3 


1 




18 


19 


37 


181 


182 


363 


July, . 


21 


15 


36 


3 


5 


3 


3 


1 


1 


2 


- 


9 


9 


18 


193 


188 


381 


August, 


9 


8 


17 


8 


3 


6 


1 


1 


1 


2 


3 


17 


8 


25 


185 


188 


373 


September, . 


17 


12 


29 


4 


4 


5 


1 


2 


- 


3 


1 


14 


6 


20 


188 


194 


382 


Totals, 


158 


138 


296 


62 


48 


44 


48 


20 


14 


21 


12 


147 


122 


269 


- 


- 


- 



Table No. 4, 

Shoiving the form of Disease in those Admitted and Discharged during the year. 





Admitted. 


DlSCHAKGED. 


FORM OF DISEASE. 


% 


C3 


H 


3 


s 


o 

H 


Mania, 

" Chronic, 
" with Epilepsy, 
" Tvith general Paralysis, . 
Melancholia, 
Dementia, .... 
" Senile, 

" with Epilepsy, . 
" with general Paralysis, 
Monomania of Fear, 

of Suspicion, . 


61 

24 
9 
5 
6 

28 
5 

10 
8 
1 
1 


56 
20 

14 
33 
6 
4 
2 
2 
1 


117 
44 

9 1 

5 
20 
61 
11 
14 
10 

3 

2 


48 
26 
4 
3 
7 
30 
1 
4 
2 

1 


45 
21 

10 
29 
2 
1 
1 
1 


93 

47 
4 
o 

17 
59 
3 
5 
3 
1 
1 


Totals, .... 


158 


138 


298 


126 

1 


110 


236 



1868.] 



PUBLIC DOCUMENT— No. 23. 



15 



Table No. 5. 

Supjwsed Causes of Insanity of Patients admitted into the Hospital from 
January 18, 1833, to Septemler 30, 1868. 



CAUSES. 



Apoplexy, 

Asthma, . 

Bronchitis, 

Bowels, Disease of, 

Cancer, • 

Chorea, . 

Constipation, 

Convulsions, 

Dysentery, 

Dyspepsia, 

Epilepsy, . 

Eruptive Diseases, 

Eyes, Disease of, 

Eyes, Loss of, . 

Erysipelas, 

Fevers, . 

Hysteria, . 

Hemorrhoides, 

111 Health, 

Influenza, 

Insolation, 

Idiocy, 

Laryngitis, 

Measles, . 

Nervous Irritation, 

Nymphomania, 

Old Age,. 

Otitis, 

Paralysis, 

Pneumonia, 

Itheuniatism, . 

Scrofula, . 

Sea-sickness, . 

Somnambulism, 

Suppressed Eruption 

Suppressed Ulcer, 

Satyriasis, 

Tic Douloureux, 

Tumor, . 

Whooping Cough, 

Amenorrhcea, . 

Ivactation, Excesslv 

Menorrhagia, . 

Menorrhagia, Suppressed 

Miscarriage, 



1S68. 



Males. Females. 



li 



1 

12 



Previously. 



Males. Females. 



10 
2 

3 

188 
3 
2 

1 
52 

1 

257 

1 

19 

18 



30 

91 

5 
4 
1 

4 
1 
1 



1 
3 

12 
2 
2 

69 
3 



1 
72 
1 
1 
944 
3 

10 



4 
34 

30 

1 
4 
1 
2 

3 
3 



23 

4 

10 

27 

5 



16 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

Table No. 5. — Concluded. 









1SG8. 


Pkeviouslt. 


CAUSES. 












Males. 


Females. 


Males. 


Females. 


Pregnancy, 


_ 


_ 


_ 


12 


Puerperal, 






_ 


12 


— 


228 


Turn of Life, . 






- 


9 


- 


90 


Amputation of Leg, 






- 


- 


1 


- 


Bathing in Cold Water, 






_ 


- 


3 


- 


Drinking Cold Water, 






_ 


- 


1 


_ 


Exposure to Cold, . 






- 


- 


11 


13 


Injuries by Falling, &c., 






- 


_ 


21 


7 


Injury of Head, 






3 


2 


61 


14 


Injury of Spine, 






- 


- 


5 


8 


Lead, Poison of. 






5 • 


- 


5 


- 


Lightning, Stroke of. 






- 


_ 


- 


1 


Labor, Excessive, . 






- 


- 


44 


60 


Loss of Sleep, . 






- 


- 


1 


3 


Study, Excessive, . 






- 


- 


29 


12 


Spiritualism, . 






- 


- 


22 


24 


Criminal Trial, 






_ 


- 


- 


1 


False Accusation, . 






- 


_ 


- 


1 


Imprisonment, . 






- 


- 


4 


1 


Death of Relatives, . 






— 


— 


31 


90 


Domestic Trouble, , 






- 


- 


115 


346 


Marriage, Unhappy, 






2 


6 


2 


5 


Disappointment in Love, 






- 


6 


67 


102 


Disappointed Ambition, 






1 


- 


9 


9 


Home Sickness, 






— 


_ 


6 


18 


Fright,_ . 






- 


- 


21 


24 


Seduction, 






- 


- 


- 


3 


Millerism, 






- 


- 


9 


6 


Political Excitement, 






- 


- 


10 


1 


Religious Excitement, 






5 


2 


158 


177 


Pecuniary Trouble, 






- 


- 


145 


38 


Poverty, . 






- 


- 


1 


1 


Poverty, Fear of. 






- 


- 


32 


8 


Prosecution, . 






- 


- 


1 


- 


Giving up Business, . 






- 


- 


2 


- 


Change of Business, 






1 


- 


9 


- 


Violent Temper, 






- 


- 


2 


15 


Jealousy, 






- 


- 


18 


28 


Intemperance, 






30 


4 


630 


87 


Opium, Use of, 






- 


- 


3 


9 


Tobacco, Use of. 






- 


- 


2 


7 


Masturbation, . 






21 


6 


409 


69 


Venery, Excess of, . 






- 


- 


1 


- 


Unknown, 






12 


18 


1,143 


1,164 


Hereditary or Periodical, 




45 


55 


- 


- 


Totals, . 




• 


158 


138 


3,937 


3,965 



The foregoing table shows the assigned causes of insanity of 
the patients admitted during the year, and also of all the pa- 



1868.] 



PUBLIC DOCUMENT— No. 23. 



17 



tients admitted iu previous years since the hospital was opened. 
The classification is given as indicating very clearly the relation 
of cause and effect in the progress of mental disease. It does 
illustrate to some extent the predisposing influences as to 
whether they are moral or physical in their nature. In this 
respect the table is valuable, having been carefully kept nearly 
thirty-six years, and embracing more than eight thousand cases. 

1 have endeavored to re-arrange and classify anew the whole 
number of cases, and show in a more acceptable manner the 
conditions and circumstances influencing the health of the 
patients previous to invasion of mental disease. 

Having personally known a majority of all the patients ad- 
mitted to the hospital, and having carefully studied the histo- 
ries of all others, I may be able to present a new classification 
in my next annual report. 



Table No. 6, 

Showing the Ages of Patients Admitted, Discharged Recovered, not Recovered, 
and Died during the Year. 



AGES. 


Admitted. 


DiSCnAEGED EE- 
COVEKED. 


BiSCHAKGED NOT 

Eecoveked. 


Died. 




Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Less than 15, . 




1 




2 




1 






From 15 to 20, 


8 


5 


1 


2 


2 


6 


_ 


_ 


20 to 30, 


37 


2G 


21 


11 


17 


10 


2' 


1 


30 to 40, 


40 


30 


16 


9 


17 


12 


1 


o 


40 to 50, 


30 


40 


8 


11 


14 


18 


6 


o 


■ 50 to 60, 


22 


11 


12 


6 


9 


8 


6 


3 


60 to 70, 


6 


15 


2 


6 


3 


5 


1 


1 


70 to 80, 


12 


7 


2 


1 


1 


2 


5 


1 


80 to 90, 


- 


1 


- 


- 


- 


- 


- 


o 


Unknown,. . 


3 


2 


- 


- 


1 


- 


- 


- 


Totals, . . 


158 


138 


62 


48 


64. 


62 


21 


12 



18 



LUNATIC HOSPITAL AT WORCESTER. [Oct. 



Table No. 7, 

Showing tlie Ages of Patients Admitted, Discharged Recovered, not Recovered, 
and Died, from January 18, 1833, to September 30, 1867. 





Admitted. 


Discharged Ee- 

COVEEED. 


Discharged not 
Kecovered. 


Died. 


AGES. 




















Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Less than 15, . 


33 


27 


7 


11 


21 


12 


2 


2 


From 15 to 20, 


338 


243 


]30 


148 


71 


68 


15 


16 


20 to 30, 


1,042 


990 


519 


505 


376 


385 


69 


75 


30 to 40, 


966 


1,046 


467 


503 


410 


383 


106 


100 


40 to 50, 


832 


857 


352 


395 


299 


291 


112 


100 


50 to 60, 


440 


482 


193 


226 


166 


158 


79 


87 


60 to 70, 


266 


229 


93 


108 


103 


71 


58 


58 


70 to 80, 


104 


75 


24 


26 


27 


21 


44 


25 


80 to 90, 


1 


15 


6 


o 


5 


4 


6 


7 


Unknown, . . 


1 


1 


- 


- 


- 


- 


- 


- 


Totals, . . 


3,937 


3,965 


1,791 


1,924 


1,418 


1,393 


491 


470 



Table No. 8, 

Showing the Duration of Insanity before Admission of Patients Admitted, Dis- 
charged Recovered, not Recovered, and Died during the Year. 





Admitted. 


Discharged 
Kecovered. 


Discli'd not 
Kecovered. 


Died. 


DURATION OF ISSAKITY. 




















1 


1 
fa 




"3 

§ 
fa 




i 

fa 




1 

fa 


Insane 1 year or less, 


86 


74 


44 


38 


11 


16' 


5 


6 


More than 1 year, and less than 


















2 vears, 


15 


14 


9 


7 


14 


13 


2 


2 


More than 2 years, and less than 


















5 years, 


16 


19 


3 


3 


13 


16 


9 


2 


More than 5 years and less than 


















10 years, .... 
More than 10 years and less than 


11 


9 


- 


— 


16 


10 


2 


— 


15 years, .... 
More than 15 years and less than 


13 


5 


6 


- 


3 


4 


3 


— 


20 years, .... 


5 


3 


- 


- 


1 


1 


- 


- 


More than 20 years and less than 


















25 years, .... 
More than 25 years and less than 


4 


5 


— 


— 


1 


1 


— 


2 


30 years, .... 


2 


3 


- 


- 


1 


1 


- 


- 


Thirty years or more. 
Unknown, 


1 
5 

158 


1 
5 

138 


62 


48 


4 


- 


21 


- 


Totals, ..... 


64 


62 


12 



1868.] 



PUBLIC DOCUMENT— No. 23. 



19 



Table No. 9, 

Showing the Duration of Insanity lefore Admission of Patients Admitted, Dis- 
charged Recovered, not Recovered, and Died, from January 18, 1833, to Sep- 
tember 30, 1867. 





Admitted. 


Discharged Ee- 
covered. 


Discharged not 
Recovered. 


Died.' 


DDBATIOX OF IXSAXITY. 




m 




oi 




m 




. 




"a 
3 


s 

o 




a 
S 


"3 


■3 

a 


"3 


1 


Insane one year cr less, . 


2,486 


2,679 


1,378 


1,505 


672 


640 


244 


288 


More than one year, and 


















less than 2 years, . 


164 


130 


176 


161 


122 


94 


35 


17 


More than 2 years, and 


















less than 5 years, . 


549 


521 


118 


136 


210 


191 


93 


67 


More than 5 years, and 


















less than 10 years. 


303 


280 


48 

1 


57 


214 


208 


38 


31 


More than 10 A'ears, and 


















less then 15 years, 


158 


170 


14 


23 


112 


104 


32 


27 


More than 15 years, and 








1 










less than 20 years. 


73 


47 


9 


9 


46 


66 


20 


11 


More than 20 years, and 


















less than 25 years. 


50 


44 


7 


- 


33 


36 


5 


8 


More than 25 years, and 
less than 30 years, 


21 


16 


5 


1 


11 


10 


7 


6 


Thirty years or more. 


33 


29 


2 


5 


13 


13 


9 


7 


Unknown, 


100 


49 


24 


21 


45 


31 


8 8 


Totals, . 


3,937 3,965 


2,791 


1,924 


1,478 


1,393 


491 


470 



20 



LUNATIC HOSPITAL AT WORCESTER. [Oct. 



Table No. 10, 

Showing iJie Civil Condition of Patients Admitted, Discliarged Recovered, not 
Recovered, and Died during the year. 



CIVIL 


Admitted. 


DiSCHAEGED EE- 
COVEKED. 


Discharged not 
Eecovered. 


Died. 


CONDITION. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Unmarried, . 

Married, 

Widowers, 

Widows, 

Unknown, 


75 
67 

16 


50 
59 

29 


30 

26 

5 

1 


13 
21 

14 

48 


40 

18 

4 

2 


25 
25 

12 


5 

14 

2 


2 

7 

3 


Totals, 


158 


138 


62 

1 


64 


62 


21 


12 



Table No. 11, 

Showing the Civil Condition of Patients Admiiied, Discharged Recovered, not 
Recovered, and Died, from January 18, 1833, to September 30, 1'867. 



CIVIL 


Admitted. 


Discharged Ee- 
covered. 


Discharged NOT 
Eecoveked. 


Died. 


CONDITION. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Unmarried, . 

Married, 

Widowers, 

Widows, 

Unknown, 


2,072 

1,661 
179 

25 


1,686 

1,778 

480 
21 


890 

828 

70 

3 


769 

917 

235 
3 


893 

517 
56 

12 


732 
507 

140 
14 


187 
241 

57 

6 


198 
182 

88 
2 


Totals, 


3,937 


3,965 


1,791 


1,924 


1,478 


1,393 


491 


470 



18G8.] 



PUBLIC DOCUMENT— No. 23. 



2L 



Table No. 12, 

Showing the Occupation of Patients admi'ted to the Hospital from January 18, 
1833, to September 30, 1868. 



OCCUPATION OF JIALES. 


1868. 


Previously. 


Auctioneers, 




2 


Armorers, 








_ 


3 


Authors, .... 








_ 


3 


Blacksmiths and Iron-workers, 








2 


70 


Bakers, .... 








- 


12 


Butchers, .... 








_ 


5 


Book-a.2;ents, 








- 


2 


Book-binders, . 








1 


3 


Broom-makers, ... 








- 


2 


Book-keepers, . 








- 


10 


Brittania-workers, 








_ 


2 


Brick-makers, . . . 








_ 


6 


Bellows-makers, 








_ 


2 


Barbers, .... 








3 


16 


Clergymen, 








- 


25 


Carvers, .... 








- 


3 


Carpenters, 








6 


127 


Coppersmiths, . 








- 


9 


Coopers, .... 








- 


22 


Cabinet-makers, 








_ 


17 


Clothiers, . 








_ 


18 


Comb-makers, . 








_ 


4 


Confectioners, . 








_ 


3 


Card-makers, . 








_ 


1 


Chair-makers, . 








- 


3 


Cisar-makers, . 








_ 


6 


Clerks, .... 








9 


111 


Carpet-weaver?, 








- 


3 


Caulkers, .... 








_ 


3 


Camphene-distillers, . 








- 


3 


Dyers, .... 








- 


3 


Druggists, .... 








_ 


3 


Drovers, .... 








_ 


2 


Daguerreotypeists, . 








- 


4 


Engineers, 








2 


2 


Engravers, 








_ 


4 


Editors, .... 








_ 


4 


Expressmen, .... 








- 


14 


Farmers, .... 








26. 


763 


Fishermen, .... 








_ 


35 


Gardeners, .... 








_ 


10 


Glass-blowers, .... 








_ 


4 


Hotel-keepers, .... 








_ 


14 


Hatters, 








1 


8 


Harness-makers, 








1 


14 


Hacknien and Teamsters, 








_ 


37 


Jewellers, .... 








3 


21 



22 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

Table No. 12— Continued. 



OCCUPATION OF MALES. 



1S68. 



Lawyers, 

Laborers, ........ 39 

Manufacturers, 1 

Millers, 

Merchants, 2 

Masons, 4 

Miners, •••.... 
Miniature-painter, ..... 

Mat-makers, 

Musicians, ....... 2 

Machinists, 5 

Moulders, 

Operatives in Mills, 

Palm leaf splitter, 

Painters, 4 

Printers, 1 

Physicians, ....... 2 

Paper-makers, 

Peddlers, 

Potter, 

Pump and Block makers, . 
Pattern-makers, ..... 
Plumbers, ...... 

Police Officers, 

Rope-makers, ...... 

Restaurators, . . - . . . . . ■ 1 

Shoemakers and Boot-makers, .... 11 

Sail-makers, ...... 

Soap-makers, 

Sash and Blind makers, .... 

Sea-captains, 2 

Sailors, ........ 2 

Students, 1 

Ship-carpenters, ..... 

Shop-keepers, 3 

Stone-cutters, 

Soldiers, 2 

Sexton, . . . . 

Stevedore, 

Surveyors, ...... 

School-boys, 2 

Tailors, 1 

Teachers, 

Tobacconists, 

Tinners, ....... 

Tanners, ........ 4 

Umbrella-makers, 

Wheelwrights, ...... 

No occupation, ...... 7 

Totals, 158 



1868.] PUBLIC DOCUMENT— No. 23. 

Table No. 12 — Concluded. 



23 



OCCUPATION OF FEMALES. 


1S68. 


Previously. 


Actresses, . 




2 


Cooks, 














1 


64 


Engraver, 














— 


1 


Housekeepers, . 














77 


2,128 


Housemaids, 














23 


408 


Laundresses, 














- 


4 


Music teachers, 














- 


3 


Midwives, 














- 


2 


Nurses, 














1 


14 


Operatives in Mills, 














10 


227 


Seamstresses, . 














23 


746 


School-girls, 














1 


45 


Teachers, 














2 


82 


Type-setters, . 














- 


3 


TSo occupation, 














- 


286 


Totals, 














138 


3,965 



Table No. 13. 

Diseases icliich have proved fatal, from January 18, 1833, to September 30, 1868. 











1868. 


Previously. 


DISEASES. 












Males. 


Females. 


Males. 


Females. 


Apoplexia, 
Asphyxia, 
Asthma, . 








1 


1 


16 
2 

4 


11 
1 


Ascites, . 








_ 


_ 


5 


7 


Antochiria, 








1 


- 


16 


11 


Bronchitis, 








- 


- 


2 


- 


Carcinoma, 








- 


— 


2 


2 


Cardionosus, . 








_ 


_ 


13 


14 


Cholera, . 








_ 


_ 


5 


_ 


Cholera Morbus, 








_ 


- 


2 


3 


Cystitis, . 








- 


- 


1 


1 


Dysentcria, 








- 


- 


12 


6 


Delirium Tremens, 








_ 


- 


4 


_ 


Enteritis, 








_ 


— 


6 


9 


Epilepsia, 

Erysipelas, 

Hepatitis, 








4 
1 


1 


74 
9 


37 

10 

2 


Hydrothorax, . 








- 


- 


1 


1 


Hernia, . 








— 


- 


1 


— 


Inanilia, . 








- 


1 


38 


58 



21 LUNATIC HOSPITAL AT WORCESTER. 

Table No. 13 — Concluded. 



[Oct. 





1868. 


Previously. 


DISEASES. 












Males. 


Females. 


Males. 


Females. 


Mania, Exhaustive, .... 


2 


O 


15 


15 


Marasmus, 






1 


1 


72 


70 


Meningitis, 






_ 


_ 


11 


15 • 


Mortiticatio, 






_ 


_ 


_ 


1 


Necropneumonia, 






_ 


- 


1 


2 


Paralysis, 






9 


1 


55 


20 


Plitliisis Pulmonalis, 






1 


2 


65 


124 


Pleuritis, . 






— 


_ 


_ 


2 


Pneumonia, 






1 


_ 


15 


•9 


Senectns, 








3 


29 


21 


Typlio-Mania, . 






_ 


_ 


8 


11 


Typhoid Fever, 






_ 


_ 


8 


6 


Variola, . 






21 


12 


1 


- 


Totals, . 




• 


491 


470 



Table No. 14, 

Shoxo'mg the Admissions from each County, from January 18, 1833, to Septevi- 

ler 30, 1868. 









. 


1868. 




Previousl3'. 












AVhole Ko. 




Males. 


Females. 


Totals. 






Barnstable, 








128 


128 


Berkshire, 






- 


_ 


_ 


190 


190 


Bristol, 






1 


1 


2 


294 


296 


Dukes,.. 






1 


- 


1 


19- 


20 


Essex, 






29 


29 


58 


1,159 


1,217 


Franklin, 






X 


_ 


1 


126 


127 


Hampden, 






1 


4 


5 


372 


377 


Hampshire, 






1 


2 


3 


325 


228 


Middlesex, 






52 


40 


92 


1,386 ' 


1,379 


Nantucket, 






- 


- 


— 


32 


32 


Norfolk, . 






5 


7 


12 


637 


649 


Plymouth, 






- 


- 


_ 


238 


238 


Suffolk, . 






7 


9 


16 


742 


758 


Worcester, 






59 


45 


104 


2,312 


2,303 


Other States, 






• 1 


1 


2 


42 


44 


Totals, 






158 


138 


296 


7,902 


8,198 



1868.] 



PUBLIC DOCUMENT— No. 23. 



25 



Table No. 15, * 

Showing the Whole Nuniber of Patients during the last year, the Average Num- 
ber, 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-six years the Hospital has been in operation. 









K"o. at 


Current 


Annual 


Expense per 


YEAES. 


Whole 
Number. 


Average 
dumber. 


end of each 
Year. 


Expenses of eacb 
Year. 


Expense for each 
Patient. 


Week for 
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 


1837, . 


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 53 


18i0, . 


391 


229 


236 


27,844 98 


121 59 


2 33 


1841, . 


399 


233 


232 


28,847 62 


123 81 


2 38 


1842, . 


430 


238 


238 


29,546 87 


111 12 


2 13 


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 


1847, . 


607 


377 


394 


• -39,444 47 


104 62 


2 01 


1848, . 


655 


404 


409 


42,860 05 


106 09 


2 05 


1849, . 


682 


420 


429 


40,870 86 


97 31 


1 87 


1850, . 


1 670 


4-40 


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 


38,207 26 


102 86 


2 39 


1859, . 


i 501 


309 


317 


48,363 33 


150 51 


3 01 


1860, . 


! 532 


324 


331 


47,757 01 


147 39 


2 83 


1861, . 


583 


369 


379 


54,7,48 53 


148 37 


2 84 


1862, . 


600 


401 


396 


53,043 88 


132 18 


2 50 


1863, . 


611 


398 


399 


66,082 36 


166 03 


3 19 


1864, . 


625 


366 


344 


66,612 00 


182 00 


3 50 


1865, . 


565 


350 


343 


73,772 41 


211 37 


4 06 


1866, . 


! 630 


368 


381 


88,398 73 


239 28 


4 60 


1867, . 


i 669 


389 


355 


86,930 88 


223 47 


4 30 


1868, . 


651 


370 


382 


72,054 59 


197 60 


3 80 



No epidemic prevailed to any extent during tlie year, and 
the health of the patients ^yas, in general, good. 

The eold, wet spring, the very severe weather of summer, 
and the sudden changes of the temperature during almost the 
entire year, exerted an unfavorable influence on the sanitary 



26 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

condition of such patients as were enfeebled by age and 
exhausting bodily and mental disorders. The deaths of thirty- 
three patients, — twenty-one men and twelve women, — have 
been somewhat less than during the preceding year ; both 
absolutely, and when calculated in reference to the average 
population. By referring to the proper table it will be seen 
that the mortality for the year reached nine per cent, of the 
average number of residents, and five per cent, of the whole 
number of residents during the year ; while the average mor- 
tality, since the opening of the institution, has been a fraction 
more than eight per cent, on the average number of patients, 
and a fraction less than five per cent, on the whole number of 
residents. 

On comparing the mortality for the sexes separately, it will 
be found, as has been before noticed, that any seeming increase 
in the death-rate is nearly confined to male patients. When 
the rate of mortality in the hospital is considered, it must not 
be forgotten how large a proportion of the more feeble inmates 
are advanced in life, — more than one-third of those who died 
having passed their sixtieth year, — nor should it be forgotten 
that nearly all are broken in health of body and mind long 
before their admission to the hospital. 

As to the causes of death, there must be noticed the large 
proportion from paralysis, epilepsy, apoplexy and other cerebral 
disorders, of which, altogether, there were fifteen cases ; and 
also the proportion of thoracic diseases, of which there were as 
many as six cases : making, altogether, twenty-one deaths out 
of the thirty-three tabulated. The remaining twelve embrace 
a variety of cases, the character of which is shown in the table 
No. 13. 

Several cases were brought to the hospital in nearly a dying 
condition, and ought not to have been sent to a hospital at all. 
Their transit here most likely hastened their death, and entailed 
upon the institution an unnecessary expense in nursing and 
attendance, besides adding to our bills of mortality. They 
seem to have been committed simply because they were not 
cleanly in their habits, and required nursing and attendance. 
These patients should be taken care of elsewhere, for the few 
days or weeks they may live, and not be sent to an institution 
which should be kept as far as possible for curative purposes. 



1868.] PUBLIC DOCUMENT— No. 23. 27 

It will be seen by reference to table No. 15, that while the 
average number of patients was less than during the preceding 
year, the average weekly expense was reduced from four dollars 
and thirty cents to three dollars and eighty cents, — a fact which 
seems to promise for the future something of our old-time 
financial prosperity. The weekly expense steadily advanced 
during the war until it reached the sum of four dollars and 
sixty cents in 1866. While the cost of support has been mate- 
rially lessened, the property of the Commonwealth has not been 
suffered to deteriorate, nor has there been any reduction in the 
quality or quantity of the supplies. 

In fact, the whole treatment of the patients, in a medical, 
moral and hygienic point of view, has received a full share of 
attention, so that the institution might be, as it has been, as far 
as possible, curative, and afford relief in those cases where 
recovery seemed impossible. 

Insanity is so essentially a disease of debility, that, as a 
necessary starting point to its successful treatment, a good and 
generous dietary is indispensable. No less desirable are faith- 
ful and skilful nurses and attendants. In addition to this, 
large outlays must be made, annually, to provide other com- 
forts, without which little can be accomplished. 

Add to all this the expense necessary for the annual repairs 
of an establishment subject to the hard usage of a hospital for 
the insane, and it will not be expected that the weekly expense 
per patient can be reduced very much lower. 

All the usual sources of intellectual occupation are kept up, 
as formerly, — the library, periodicals, and daily and weekly 
papers. Tiie lectures, concerts, social re-unions have been the 
means of giving much comfort and relief to our patients who 
would otherwise have suffered from the dull monotony of a 
hospital routine. The usual recreations of games, rides, walks, 
and everything that can be made available for the healthy and 
innocent occupation of mind, have been freely encouraged and 
employed. I ought not to omit the daily religious services in 
the chapel, and the frequent, well-timed visits of the Chaplain, 
Rev. George Allen, as among the best and highest prized privi- 
leges of the patients. 

The usual tables showing the extent to which the patients 
have been industriously occupied by the amount of work oxe- 



28 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

cuted in the house, in the shops and in the gardens and on the 
farm are necessarily omitted. But when I remind you that 
last year nearly thirty thousand days' work were accomplished, 
and nearly the same amount in each of several previous years, 
you will be ready to believe that a respectable degree of indus- 
try has marked the year just closed. 

The great disproportion between the employed and the aggre- 
gate number of patients is always noticed and often commented 
upon. Those persons who regard this disproportion unfavorably 
are apt to overlook the greatly impaired physical condition of a 
large majority of insane persons. Regarding as I do occupation 
as one of the most important curative agents in the treatment 
of insanity, and urging its adoption upon all, both in and out 
of my own hospital, it ought of course to be my desire to bring 
this curative agent into full force. 

When we look for a moment at the population of the house, 
it is evident that we cannot draw to a much greater extent 
upon the fluctuating portion of it for carrying on the process of 
either trade or farm labor. This class of our patients, to us, 
improve, or recover and go away. During a large part of the 
time they are with us, they not only are unfit for labor, but re- 
quire extraordinary care and attention to preserve their health 
and lives. Then, the smaller class who sicken and die are not 
to be regarded in reference to any plan of occupation. If we 
turn our attention to the more, fixed population, we shall find 
indolence is one of the most marked characteristics of dementia, 
and that incapacity for useful employment is quite frequently 
the measure of imbecility. 

The general paralytics and epileptics, who comprise classes of 
large and increasing numbers, are, aside from all considerations 
of their physical condition, too uncertain and too dangerous for 
any sort of occupation. It is worthy of remark, that though 
the employments of the male patients are distributed among a 
great number of trades, we can claim at any one period but 
very few competent workmen, in any one of them most useful 
to the institution. Few indeed are there able to perform daily 
labor. 

For example, we have had committed to our care during the 
past year four masons, one of whom was discharged at the end 
of one week, one is upwards of seventy years of age, one is 



1868.] PUBLIC DOCUMENT— No. 23. 29 

demented, and constantly excited, and the fourth is demented, 
but works daily. Of painters there were three admissions, one 
of whom is a young man, paralytic, one is seventy-four years of 
age and helpless, and the third was discharged within two 
months of the time of his admission. Of tailors there was but 
one admission, a paralytic. Of blacksmiths there were two ad- 
missions, one of whom was a man seventy-three years of age, 
and one young man who was discharged at the end of sis weeks. 
Of shoemakers there were eight admissions, four of whom were 
discharged within about three months of the time of their ad- 
mission, one is homicidal and dangerous, two are paralytic, and 
one is epileptic. Of machinists there were five admissions, two 
of whom were discharged within two months of the time of 
their admission, one is homicidal, one paralytic, and one epilep- 
tic. Of carpenters there were five admissions, one of whom 
works daily, two are thoroughly demented, and two are each 
seventy-nine years of age, and work a little every day. 

Very nearly the same conditions will be found to exist, if we 
follow through the occupations of all those committed to the 
hospital in the course of any one year. 

Notwithstandhig all these discouragements, I am more than 
ever convinced of the value of systematic occupation as a pow- 
erful curative agent in the treatment of the insane — not man- 
ual labor merely, but occupation, manual and mental, which 
shall employ to the fullest extent consistent with improving 
health, every mind and every body under the care and control 
of the institution. 



30 



LUNATIC HOSPITAL AT WORCESTER. [Oct. 



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PUBLIC DOCUMENT— No. 23. 



31 



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36 



LUNATIC HOSPITAL AT WORCESTER. [Oct. 











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1868.] PUBLIC DOCUMENT— No. 23. 39 



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when 
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Ot~*lOC300CDtCCDOOOt^t>"CO<3^0COC^CDt^C^CDOlOCOO^l-^l^QOlOiOCZ3COiO 
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Time 
Admis 


rS ^ "^ '^ '^ '^ 5''^ rsi3ra'T3n3i3i3n3l3gl3l3i3'dl3l3l3i3'xJ-aT3i3i3i3'T3 


Of-noocot^co-^cDOi— KMooO"— KMco'Ot^O"— iiTO'^'C'CDOi-ieo-^iocoooas 


1 6 


coo5eo-*^-*>o'C>r3cocococo«>-ir^t-j^i^t^ooooQoooaoco050i(330505g5atg5 


II 1 


ti^i^^^lS^.t-^^^~l:^l^t^^^^^-^~^~t~t^^^t~t-^~l:^t~c^^^-^:-t~t^£-t--l>-^- 


t>.t»t~t~-t^t-l>>t»t~-l>-t--t~-t~r^t^t-'t--t-l:^t^l>'l:^t^t^t— t^tX^t^l^t^-c^r^ 



1868.] 



PUBLIC DOCUMENT— No. 23. 



43 



^ ^ 


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<s OJ 


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'O O O rj3 


t3 '3 




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Pe 

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0) o 

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reditary, 

do 
do 

do 
do 

cidal. 

Horn 
reditary. 


"3 


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V •go 

W 02 W 


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T3 T3 


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O CD CO CD to to l^ b- t-^ r^ 
CO OO QO 00 00 CO 00 CO OO 00 





44 LUNATIC HOSPITAL AT WORCESTER. [Oct. 





it 

B 1 

2 TS 
2 2 
=s ,2 


Periodical, 
do 

do 

Suicidal. 

Hereditary and do 
Suicidal. 

Hereditary. 

Homicidal. 

do 

do 

do 
Periodical. 




1 
1 


Improved 

do 
Not improved 

do 
Improved 

do 
Not improved 

do 
Improved 
Recovered 
Improved 

do 

do 
Recovered 
Improved 
Recovered 

do 
Exhaustion 
Not improved 

do 
Recovered 
Not improved 
Improved 
Not improved 
Improved 

do 
Not improved 
Improved 

do 

do 
Recovered 
Improved 
Recovered 




? 1 

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n P^ PP^ Q P^ O QPa^QP^Qp^Q Pi Q 




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(MTj<rt«C<5rtt-l^e>3lOF-J^OOt^Oi-H.-lr1CO'^t~>-l^-'-1 lO -1 ^ ^ >-l "S t^ OO >0 






Probate Court 

do 
Board of S. C. 
Probate Court 
Private Bond 

do 
Probate Court 

do 
The Overseers 
Private Bond 
Probate Court 

do 

do 

do 

do 

do 

do 

do 
Private Bond 
The Overseers 
Board of S. C. 
Probate Court 
Private Bond 
Probate Court 
Private Bond 
Probate Court 

do 

do 

do 

do 

do 
The Overseers 
Probate Court 




.2 ".2 

03 


m OD » CO ta 

o S o o'o o o !3 S'^'S o g'« !3 o'o ooSSSoSiacSoooajtto 
.^ S ^ t^B ^ ^ a^^ ^ p^s ;^ c p^ a p (... 

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Disappointmentinlove, 
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do 
111 health, . 
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Unknown, . 
Ill health, . . . 
Sun stroke, . _ . 
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do . . . 
Ill health, . 
Spiritualism, 
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III health, . 
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Old age. 
Unknown, . 
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111 health, . , . 
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Intemperance, 
Unknown, . 
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_ o 

11 

o 


Single 

do 
Married 
Single 
Married 
Widow 
Married 
Single 
Married 

do 

do 
Single 

do 
Widow 
Married 

do 
Single 
Widow 
Married 
Single 

Married 
Single 

do 
Widower 
Married 

do 

do 
Single 
Married 

do 

do 




>< 


ijl^liilo^ol^ioooo o^slo^o o|^oo|oJ2ogo 
§fe§Pi§6i g PuSfe §Pl g feS fiH S (ic 




Age 
when 
admit- 
ted. 


OCfl-'^ih^TtiSOCO-'^OiOUSOOOOMOOiaC^IOOODCOitO'-i'gOJ-^OSC^NOCOO 

^(MS5^ccw;rococ^coeo<M-HTt<-*io-*'Oso^(Mt-coc^cou5r-HC>5(NioiMe»» 






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5'T3T3'«'a'0'd'tfT3T3'0'T3'T3'B®'3T3'd'«'r!'«T3'«t3'«'«^T3'C'T3'T3'a't3 




1 


£co Sec OO ro OO 00 <» 00 OO 00 CO «: a; OT CO CO CO CO OO CO » 05 o Oi 05 05 Oi 05 05 OT 



1868.] 



PUBLIC DOCUMENT— No. 23< 45 



is CO "g 



•era 









.- ^ -3.1; 



0_'0_ O _ O _ "d _ O'O _ TS O .^ T3 T3 O 'O 

*»p,oei, ■« o, .2+jei.o p. ^t)::5p-o -mp. o&.o+;o 

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60 ai6Ca5t!D«6C aobC bC6D cn6BtDbo«W) 

2 S.2 S 2 S 2 2 §.2 4>.2 S.2 S .2 £.2 S.2 

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DO (ficQ «J caw oo OTcow tnmaa? co co oohtco ootn czi co 

s ssas sea s asaaaass aaasaaaa aass a 

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^ ■-! iHrH F-c iH i- l 

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s a a ^ ^& a & >,& ^ a ^^ ^ -Saa^^aa^^a ^^^ &si.a&sa ^ 

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rt2'o'do0^g'og,'5o~.2SS'rt2-^2 a« S-p,© o oH^ 0-5 ^ £, = '5 >.MO 

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rH o o'C'-H o o o c'S'-H'SrS o ©-r:^--^ O'C o o o o o o'C o OrS o o-CrS'C o'C'-S 
tcd -p £ tm-p -a T! T3 C t>c C M-a ts t bc C tea CtS'P'CO'P'P CtS'O tfTS -o C fcc C •p C to 

R^rtp cspcup jjpoJprt j-d B rfprt^t«B 

to gSia Sci^Sco ^cJiStg ^ pg cQ g^S^^ig 

BOOOOOiJoP.SodO^OOOHO^OOP^OPOOOOO©^OOP^OO 

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46 



LUNATIC HOSPITAL AT WORCESTER. 



[Oct. 



s r 



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48 



LUNATIC HOSPITAL AT WORCESTER. 



[Oct. 



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P5 



Suicidal. Homicidal. 
Hereditary. Periodical. 


Suicidal and Homicidal. 
Hereditary. 

do 

do do 

Periodical, 
do 

do 
do 

do 

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Homicidal. 
Hereditary and Suicidal, 
do 

do 
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do 

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3 

as 

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do 
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Improved 

do 

do 
Not improved 

do 
Improved 
Not improved 
Epilepsy 
Improved 

do 

do 
Exhaustion 
Recovered 
Improved 
Recovered 
Not improved 


Discharged 

or 
Kemaining. 


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Probate Court 

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Probate Court 

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Probate Court 
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Probate Court 


JJuration 
Supposed Cause. before 

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111 health, . 

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do . . . 
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do . . . 
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Paralysis, 


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50 



LUNATIC HOSPITAL AT WORCESTER. 



[Oct. 






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1868.] 



PUBLIC DOCUMENT— No. 23. 



58 



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54 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

In former reports, I have faintly sketched what seemed to 
me desirable in order to fulfil the important indication in the 
arrangements for the care and control of persons afflicted with 
mental disease. 

The attention which you have given to the matter has led 
me to investigate and study the subject faithfully, and to 
inquire what modifications and improvements, if any, can be 
made in our present system. 

The minds of medical men in all countries are now directed 
to the same subject, and are contemplating similar measures to 
tliose so feebly set forth in the annual reports of your hospital. 

In England, asylums which were regarded twelve years ago 
as models, are now being enlarged and improved by wide de- 
partures from the original plans. New asylums are being 
built upon improved plans. And while this change is going on 
in existing hospitals, new plans are submitted and approved, 
embodying entirely new principles of arrangement. On the 
Continent, the same questions occupy the minds of thinking 
men. 

If we consider that human nature is the same everywhere ; 
that man is, all the world over, subject to the same impulses, and 
governed by the same motives ; and that when insane, insanity 
assumes the same forms, and is successfully treated on the 
same general principles in all countries, we certainly ought to 
take as great an interest in the consideration of this subject as 
is taken by the humane of other countries. 

Our system finds its weakness mainly in the meagre, advan- 
tage we have at our command to classify, employ and occupy 
the minds and the bodies of our patients. It overlooks, to a 
great extent, the important fact that inactivity is incompatible 
with bodily vigor, and that exercise of all the faculties, bodily 
and mental, is the best method of preserving health, as well as 
of regaining it when lost. This law is laid deep in our organ- 
ization, and cannot be violated with impunity. Any system of 
treatment not based upon it, or in any way ignoring it, must of 
necessity prove worse than useless. 

If we look carefully at our own management, we shall find 
that our patients are and must be left too much to their own 
choice, whether to work or to be idle. No encouragement is 
held out, no inducement is offered to persuade them to labor. 



1868.] PUBLIC DOCUMENT— No. 23. 56 

They know almost at once that occupation is not the rule of 
the institution, and they act precisely as sane men and women 
would do under similar circumstances. Men are not apt to 
labor without some adequate motive. The insane will not 
labor for the benefit of their health, because they do not believe 
themselves diseased. 

What we need most of all is a systematic arrangement and 
control which puts every one to some occupation. It is not to 
be expected that the work of any large proportion of the insane 
will be remunerative. The object will be gained when the 
faculties, mental and physical, are employed. This woman 
whose vagaries have controlled all her actions for many years, 
may not be persuaded to engage in the useful labors of her 
early life. She will, however, carefully undertake any useless 
fancy work, and thus employed, be relieved from the thraldom 
of delusion. This man who refuses to assist the mechanic in 
any light labor, will enslave himself for years in the pursuit of 
perpetual motion. This young clerk who cannot confine him- 
self to the duty of an accurate copyist, is employed many 
weary hours in the equally laborious task of balancing imagi- 
nary accounts. To turn this waste of labor into healthy and 
useful channels, is a work next in importance to that of arous- 
ing the dormant energies of the demented and fatuous. How 
can we accomplish these desirable purposes ? We may lay the 
subject before the whole corps of assistants. If, happily, they 
are persuaded, and are willing to devote themselves to the 
duty, where are the means by which they can accomplish the 
results ? We may argue the advantages of occupation with 
the patients, but can we make it clear to such minds that labor 
is essential to recovery, and as such is a sufficient inducement 
to command their attention ? 

If a strong, active, convalescent mechanic is induced to labor, 
can we regularly pay him for his work ? If we remunerate 
one, can we all ? If a delicate lady is directed to occupy her- 
self in music and drawing, in addition to the ordinary occupa- 
tion of needle-work, can we assure her of a speedy return to 
society and friends ? If we advise a gentleman to keep up his 
habits of reading, writing and conversation, can we afford 
accommodation for his library ? Can any number of such 
visit the public library ? When all these obstacles are over- 



56 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

come, we shall find that we have no convenient rooms, no suffi- 
cient accommodations by which any number of our patients 
can gratify their own healthy tastes and feelings. 

With the common laboring men and women, the difficulties 
are more readily met and overcome, though no hospital or 
asylum in this country has yet provided the means necessary 
for this class. 

It is to be supposed that if all laborers were promised fair 
wages for their work, and regularly paid, a much larger pro- 
portion would be induced to engage in profitable employment. 
When the plan had proved successful, the wages of the patients 
might be kept, by the treasurer of the institution, on deposit 
for their benefit and use. 

In Great Britain, an extra allowance of some luxury, such 
as beer or tobacco, has a powerful effect, not only in producing 
quiet and good conduct, but in promoting habits of industry; 
and under the influence of such motives, many who would 
otherwise be idle and listless, perhaps noisy and destructive, 
engage regularly in useful labor. 

In regard to females, sewing and knitting, embroidery and 
fancy work furnish a ready resource. So also do the various 
departments of domestic labor. But they should have also 
the stimulant of remuneration. Labor, at present, is almost 
entirely compulsory, inasmuch as it is not, and cannot be, to 
any great extent, remunerative to the laborer. If we pay for 
it, there is the nice question of how much. Many of the 
insane, all of the demented, must be re-taught to labor, and at 
considerable expense ; and it must not be excessive, but grad- 
uated according to the strength and condition of every patient. 

It requires a large judgment and a nice discrimination to 
provide occupation for that growing class of active, intelligent 
minds which, for various reasons, find an asylum in our hospi- 
tals for the insane. How can we, for such patients, fill up all 
the hours of the day with recreation, amusement and exercise ? 
How can we gratify their intelligent wants ? How can we 
answer their just demands ? 

The establishment of hospitals for the insane was at the first 
an effort of philanthropy to redeem from jails and poor-houses, 
from cages and out-houses, the forlorn, the friendless and hope- 
less ; and now, having fulfilled their first mission so well, we 



1868.] PUBLIC DOCUMENT— No. 23. 57 

seem to have forgotten that there is yet the higher office to 
prevent and turn aside this great current of human suffering 
from another and more hopeful class. 

I know of no way by which this can be accomplished but by 
the adoption and execution of some such plan as we have con- 
sidered on other occasions. What has been attempted else- 
where can be accomplished here. We need a different class of 
houses, and more land. We need arrangements which will 
dispense, for the most part, with the necessity of locks, bolts 
and bars ; with camisoles and belts ; and, if possible, with 
drugs, medicines and sleeping draughts. We need all the 
arrangements for the highest comfort, the most perfect cleanli- 
ness, ventilation and warmth. We need everything calculated 
to promote the best hygienic condition of the insane. And 
above all, we need such arrangements and such means as will 
serve to give occupation to every mind and every body placed 
under the care of the asylum. 

During the last summer it was my good fortune to visit many 
institutions for the insane in foreign countries. Among other 
places visited was the town of Gheel, in Belgium, where the 
cottage system, so called, has perhaps reached its highest 
state of developement. 

The early history of this community, so far as it relates to 
the insane, is very obscure, and much of it is lost in tradition. 
It is supposed to be quite certain, liowever, that a church was 
built and dedicated to St. Martin as early as the seventh 
century where the town of Gheel now stands. To the little 
colony of Christians gathered about the church so recently 
built, the Irish princess Dymphna, accompanied by a priest 
named Gerbernus, fled from the rage of a cruel and wicked 
father. By their acts of charity and Christian benevolence, as 
well as by their quiet and pious conduct, they seemed to have 
gained the love and esteem of the few inhabitants of Gheel. 
But being pursued in their flight by the unnatural father, and 
discovered in their retreat, Dymphna was slain by her incestu- 
ous parent, while the good priest who had protected her, fell at 
the hands of his followers. It is related that some insane per- 
sons who witnessed this unnatural deed were so shocked by its 
horror as to recover at once their lost senses. Dymphna and 



58 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

Gerbernus were buried side by side, and soon a little chapel 
rose near their graves. 

In the meantime Dymphna was canonized, and hither to the 
chapel of St. Dymphna came the insane from all the country 
round about to bow at her shrine, and pray for the intercession 
of the blessed Saint that they might be healed of their infirmi- 
ties. As the fame and influence of the Saint increased, a new 
and massive church was erected at great expense of toil and 
money. So great was the faith in the miraculous power of the 
Saint, that quarrels took place between rival towns for the pos- 
session of her bones, and the Gheelans, almost by divine assist- 
ance, were enabled to retain and remove them to the prepared 
shrine in their new church. 

It is quite easy to understand how a thousand years ago the 
rude inhabitants of the little hamlet of Gheel were wrought 
upon by a belief in this supernatural agency. We, ourselves, 
in the days of spiritual manifestations and clairvoyant insight 
know how readily any absurd doctrine may obtain credence for 
peculiar medical efficacy. As a matter of fact in our every 
day experience we also know how frequently a removal from 
home and a change of scene is followed by an improvement in 
the condition of the insane mind. 

The practice of bringing the insane to the shrine of the 
Saint increased as the knowledge of her miraculous power 
became more widely known ; so that early in the history of 
Gheel the inhabitants became accustomed to the presence of 
lunatics among them, and also the care of providing" for their 
welfare. Living in the midst of a most barren and desolate 
tract of country, the Gheelans were of necessity industrious, 
and as we have already seen, they were filled with religious 
fervor. These two important traits rendered them peculiarly 
well fitted for the duty of providing for and taking care of the 
insane ; the duty being enforced by all the dictates of worldly 
interest as well as Christian charity. The insane were regarded 
with feelings of religious awe, and it was deemed the highest 
Christian duty to make every effort and suffer every sacrifice 
for their care. These feelings were handed down from genera- 
tion to generation, and enjoined by father upon son, till at last, 
instead of a hamlet with a rude chapel and a few demented 
wanderers, Gheel comes to be an important community, accept- 



1868.] PUBLIC DOCUMENT— No. 23, 59 

ing a labor and devoting itself religiously to a duty which has 
no parallel in history ; choosing cheerfully and hopefully a state 
of things which no other community could be persuaded to 
tolerate for a day. It is this religious feeling in regard to the 
lunatics, which has been and still is, more than anything else, 
their safety in the colony, and makes Gheel better adapted than 
any other place for this peculiar plan of treatment called the 
cottage plan. The religious fervor in behalf of the insane 
seemed to be the distinguishing trait of the Gheelan mind and 
habit. Insanity was supposed to be due to supernatural causes. 
The doctrines of the Church were such as to encourage this 
idea, consequently spiritual aid was regarded as the most effi- 
cient means of relief. Who then so likely to intercede for 
divine favor as the blessed Saint Dymphna ? 

The patient for whom the direct intercession of the Saint 
was desired, was placed in appropriate apartments adjoining 
the church under the care of persons retained for this purpose. 
These apartments consisted of two large and two smaller rooms 
or cells furnished with heavy oaken benches and iron rings to 
which furious patients might be fastened while awaiting their 
turn. Hither a priest would come daily to say mass and read 
prayers. If the patient was sufficiently tranquil an offering 
was performed daily for nine days in succession. The patient, 
preceded by priests and surrounded by assistants, chanting the 
praise of Saint Dymphna, marched in procession three times 
round the church. Each time as the procession passed through 
the chancel a halt was made at the tomb of the Saint, which is 
placed upon columns about four feet high, forming a sort of 
portico of gothic architecture. The procession kneeled and the 
lunatic dragged himself, or was dragged under this portico con- 
taining the remains of the Saint. They then exorcised him 
and conducted him back to the adjoining apartments. If the 
patient was too furious to be easily managed, a person from the 
country has been known to perform his part. While making 
the three circuits the friends and relatives remained in the 
interior of the church praying to the Saint for help. When 
nine days of such labor had passed the patient was generally 
freed from his restraint and restored to his family. 

It is certain, says the very able and accomplished superinten- 
dent, M. Bulkens, in one of his reports to the Belgian Liinacy 



60 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

Commissioners, that cures were effected in this way. For- 
tunately, however, for the insane, a belief in the miraculous 
power and direct intervention of the Saint has nearly passed 
away, and few, if any are now found willing to put their insane 
relatives through this ordeal. 

Such in brief is the story generally told and believed in 
regard to the origin and growth of Gheel. It begins in fable 
and ends with the condition and prospects of the colony at the 
present day. Commencing with some accidental circumstance 
happening to a few religious fanatics eleven centuries ago, it 
reaches forward to an important community of eleven thousand 
people, among whom are living in comparative comfort and 
freedom, and in the enjoyment of unusual social privileges, 
about eleven hundred lunatics. No doubt there have been 
great cruelties practised at Gheel, and probably bad results 
were produced by so strange a mixture of medicine and relig- 
ious fanaticism. But this was in no way peculiar to the habits 
or customs of Gheel. 

It can be shown that severer customs prevailed in other parts 
of Europe, and that the system pursued at Gheel tended in a 
great degree to remove the restraint and ameliorate the condi- 
tion of the insane. For as early as 1676 a municipal order was 
promulgated forbidding the keepers of lunatics to allow them 
to go abroad unrestrained, making the keepers responsible for 
damages done by lunatics, and imposing a fine for violation of 
the order ; thus showing that the keepers were, in their 
humane tendencies, in advance of the public opinion of their 
day. Still, so much freedom continued to be enjoyed by the 
patients, that in 1747 another municipal interference was con- 
sidered necessary to check the growing evil of permitting the 
insane the enjoyment of free air and exercise. But it is 
remarkable in this case that public opinion had taken a wide 
step in advance, and the magistrates in their municipal order 
enforced by fine, recognized the superiority of a careful per- 
sonal supervision to the promiscuous employment of chains and 
fetters. Again, so soon as 1754 another enactment was passed, 
in which the magistrates complain that the lunatics are so free 
that one can no longer distinguish between the patients and 
citizens, and when the keeper is admonished, he always replies, 
" My insane boarder is not dangerous. He does no harm to any 



1868.] PUBLIC DOCUMENT— No. 23. 61 

one. He is quiet and well-behaved." All the facts go to show 
that the management and treatment of the insane was at that 
time in Gheel far in advance of the spirit of the age, while 
doubtless they suffered much, which, to us to-day, would seem 
but little short of downright cruelty. 

In 1821, Esquirol visited this colony, and wrote nearly as 
follows : " The greater part of these unfortunates are fed like 
the peasantry of the country. In the town the dietary is bet- 
ter, and generally it is the same as that of the persons with 
whom they live. The lunatics, male and female, wander freely 
in the streets or in the country, without any one appearing to 
be watching them, even when they have trammels on their feet. 
If they try to escape, straps are used. If they are furious, they 
are chained by the hands and feet when they do not go out of 
doors, at least when they are lodged on a sequestered farm. In 
spite of these means of restraint, it happens often that they 
wander or escape, but the police of the surrounding districts 
stop them at eight or nine miles distance, and bring them 
back." 

Following Esquirol, Guislain and Moreau addressed them- 
selves to the French, Parigot and Bulkens to the Belgians, and 
Rollin and Droste to the Germans, giving to continental inquirers 
all the facts concerning Gheel and its system. In 1828, Sir 
Andrew Haliday, in his general view of lunatic asylums, gives 
his opinion of the system in the following remarks : " If the 
governors of St. Luke's were to form such an establishment 
upon some of the heaths or commons that are at no great dis- 
tance from the metropolis, they would more effectually, I 
imagine, fulfil the intentions of the supporters and contributors 
to this institution, than by transferring their supposed incura- 
bles, after a twelvemonth's trial, to the white and red houses at 
Bethnal Green, as very uniformly has hitherto been their prac- 
tice for a number of years, and that such an establishment 
might be formed at a very small expense must be apparent to 
all who will give themselves the trouble to think on the subject. 

" The renting of a considerable portion of any such heath or 
common would not be any great charge to the funds of the 
establishment, nor could the building of the cottages cost much, 
and such an arrangement might be made the means of keeping 
many poor but well-ordered families from the work-house, and 



62 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

of rendering them useful and industrious members of society. 
The average expense at St. Luke's was, some years ago, forty- 
six pounds eighteen shillings and threepence. He might be 
maintained at one-third of the expense at an establishment 
similar to that at Gheel, and have almost a certain prospect of 
being cured while the disease is yet curable." 

Since that day. Doctors Gumming, Webster, Browne and 
Coxe have all published favorable notices of the cottage 
system. More recently. Doctors Stevens and Sibbald have 
recorded their observations respecting the working of the 
system. 

According to all the published accounts of Gheel, and par- 
ticularly that of Dr. Sibbald, it seems that up to about this 
period of time no efl&cient system of general superintendence 
had been established, without which it would be strange if 
gross abuses and crimes injurious to the patients were not fre- 
quently practised. And without doubt, during the long ages 
the colony had existed, scenes of great cruelty had been suf- 
fered. Slight responsibility attached to the keepers, except so 
far as the dictates of their religion, and motives of worldly 
interest guided and directed them in the care of the insane. 
These could hardly have been sufficient to repress abuse or 
encourage kindness, much less to reclaim, organize and bring 
under general superintendence this strange moral waste. 

Guislain made Gheel the subject of a most searching exami- 
nation, and in consequence of the numerous abuses found to 
exist, condemed the whole system. Another inquiry followed, 
which also resulted in exposure and condemnation of flagrant 
abuses, but at the same time in recommendation of the system, 
and suggested an organized medical superintendence, under 
the control of the state. Consequently, in 1850 or 1851, 
M. Parigot was appointed resident medical superintendent, and 
from that time, a most remarkable change took place in the con- 
dition of the insane. The law which inaugurated this state of 
things creates a superintending body called the general com. 
mission, consisting of the governor of the province for its pres- 
ident, the provincial attorney, the commissary, the burgomas- 
ter, the dean, the medical inspector, and four members taken 
from the citizens of Gheel. These hold office for two years, 
and go out by rotation. This commission appoints annually a 



1868.] PUBLIC DOCUMENT— No. 23. 63 

committee of five inhabitants, whose office it is to control the 
general administration and finances. The medical administra- 
tion is lodged with the resident medical superintendent, who is 
appointed by the minister of justice. He writes the reports, 
grants certificates of cure, and superintends all the affairs of 
the colony, residing at the infirmary or asylum proper. Under 
him are four medical assistants, each residing in and visiting 
all the patients of his own district at least once in a week, and 
oftener when necessary, or when requested. They report 
quarterly to the resident medical superintendent, which, accom- 
panied by his comments thereupon, are sent to the superior 
commissioner. Patients may also be placed under the care of 
private practitioners, who agree to submit to the same regula- 
tions as are laid down for the assistant-physicians. Then 
comes a corps of civilian inspectors, one for each district, who 
go from house to house, noting the condition, wants and pros- 
pects of every patient, and making regular reports to the 
superintendent. 

A list is kept of those whose characters and dwellings are 
considered by the authorities as sufiicient to qualify them as 
nurses, and includes the names of those at present under their 
care. 

The insane of different sexes are not allowed to board with 
the same nurse, unless with the special sanction of the superior 
commission. Each lunatic is placed specially under the charge 
of the cottager with whom he boards, who is responsible for 
any injury done by the patient, and, except in case of emer- 
gency or extreme violence, he must not use any measure of 
restraint, such as the employment of straps, the belt, or the 
camisole, nor must he place the patient in seclusion without 
first having received authority for so doing from the assistant 
physician of the district in which he is located, and the physi- 
cian must report directly to the superintendent. 

Every nurse who violates these rules, who abuses a patient, 
or who neglects to obey the orders of the superior commission, 
or the committee, or the physicians, shall be deprived of his 
license to receive and take care of lunatics. I was informed 
that several householders had been so deprived of their licenses 
on account of their violation of regulations, or for neglect or 
abuse of patients. On the other hand, prizes and rewards are 



64 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

awarded to such nurses as distinguish themselves by their 
humanity and devotion to the welfare of their patients. A 
chaplain is connected with the establishment, for the comfort 
and benefit of the lunatics. 

Quiet patients also attend the public services in the various 
churches of the commune, unattended by their nurses. Those 
known to be excitable are accompanied by attendants. The 
local committee is authorized to fix the dietary, and also the 
hours of meals. The committee also appoint, when necessary, 
head attendants, to assist the assistant-physicians o Quiet and 
orderly patients are permitted to visit, unattended, public 
houses, places of amusement and refreshment, but the sale of 
drugs and spirituous liquors to all lunatics, is strictly forbidden. 
All the details as to clothing, bedding, furniture, &c., are 
under the direction of the local committee, with the concur- 
rence of the superintendent. Unsuitable patients ai^e excluded 
by law, and all classes of insane persons may be placed in the 
commune, except those who require continual restraint or 
coercion, those who are suicidal, homicidal or incendiaries, 
and those whose escapes shall have been frequent, or whose 
malady is of such a character as to offend the public peace or 
decency. 

We are now at Gheel. We know its geography, we have 
heard its traditions, we have glanced at its history. Let us 
look at it as it is, and consider briefly its working. The gen- 
eral appearance of the town is quite as good, perhaps better, 
than other towns of equal size in its neighborhood, and pro- 
duces, on the whole, a favorable impression on the mind of the 
visitor. The streets are quiet, but cheerful ; the houses tolera- 
bly comfortable, though rude in finish, and very plainly fur- 
nished ; the gardens are neat and well cultivated ; the people 
are well clothed, and they seemed to be well fed. They are 
industrious, and occupied chiefly in cultivating the soil; the 
manufactures being confined entirely to the needs of the dis- 
trict, except perhaps small quantities of lace, in the making of 
which a few women are employed. Some agricultural and 
dairy products are supplied to the Antwerp market. 

On the whole, the remembrance of the town is more pleasing 
than that of many Irish towns of the same size, and the general 
feeling in regard to its comforts is much the same as that in 



1868.] PUBLIC DOCUMENT— No. 23. 65 

regard to aii English or Scotch village, consisting chiefly of 
peasantry. The hamlets and houses outside the town had the 
same general character with those in the town, except that they 
were of ruder construction, less commodious and less tidy. 
There are in the community about eleven hundred lunatics ; a 
casual observer, a stranger, would pass a day in the village 
without detecting any marked signs of mental disease in the 
persons wandering about the streets. There is certainly less 
peculiar conduct which might be attributed to mental aberra- 
tion than is witnessed in any second-rate Italian town. 

In passing about the town, both alone and with Dr. Bulkens, 
I visited any and every house I desired, and I ought to state 
here my belief in the entire honesty and sincerity of the 
enlightened superintendent. Dr. Bulkens. 

Judging from what I saw, the insane in the commune of 
Gheel are kindly and well cared for. That abuses do exist the 
Doctor frankly admits. The abuses, if any, are not the result 
of the system pursued so much as the want of a sufficient 
number of intelligent medical assistants to carry out the plan 
adopted. 

The patients were in the enjoyment of a good degree of bodily 
health, were plainly but decently clad, and I believe they were 
provided with a sufficient quantity of wholesome, nutritious 
food. I was informed that the laws regulating the manage- 
ment of the insane, allow seventeen ounces of bread and five 
ounces of meat to each man, and fourteen ounces of bread 
and four ounces of meat to each woman per day ; vegetables 
■were being freely used also. They w^ere generally cleanly in 
their persons, though not particularly neat or tidy in their 
habits. The free air and the unrestrained exercise of tlie pow- 
ers of locomotion of so large a number of the insane add 
greatly to the health, quiet and general comfort of the whole. 
The sleeping accommodations of many of the patients were 
such as would not be satisfactory in a well-ordered lunatic 
asylum ; the rooms being small, often smaller than our single 
rooms, never so well lighted, sometimes in lofts or attics, and 
occasionally, for patients of filthy habits or those who are 
noisy, in out-ho.uses, as is sometimes practised at almshouses 
in towns of our own country. The beds of cleanly patients 
were neat and of the same quality as those of the family. 



Q6 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

There is generally no accommodation for bathiug, and little 
for general toilet purposes. 

At some of the houses where are placed patients belonging 
to wealthy families, the apartments were cheerful, agreeable 
and commodious, and were furnished with some degree of taste 
and elegance ; some of them contained pianos and other musi- 
cal instruments, and many of them books and pictures. 

Patients from the families of the laboring classes were in 
considerable numbers engaged at some useful labor ; but those 
from families of the wealthy were not employed, except as 
influenced by their pleasure or the character of their delusions. 

More than one-half, perhaps five-eighths, of the whole num- 
ber of patients follow some occupation, though with but little 
attempt at any regularity or organization. 

Some of both sexes were assisting the families with which 
they boarded in the various household duties, as cooks, nurses 
and companions for children. Some were laboring as shoe- 
makers, tailors, blacksmiths and wheelwrights. Many of both 
sexes were employed in the fields, at the usual farm labors. 
They all or nearly all enjoy the fruits of their own labor. Those 
who are able to make any contract to perform a piece of work, 
or to hire themselves out for a day or week, receive their wages 
and make such use of them as they please. 

One man was shown me who had purchased four cows from 
his earnings, and rented them to the villagers. Others were 
pointed out who owned goats or donkeys. One whom I saw 
had taken a contract to paint or color a house, and was about 
commencing his work. 

I was informed that many who were able to work performed 
labor only at irregular intervals, working a few days and earn- 
ing a little money, and then idling about until they had ex- 
pended their earnings. 

A large majority of the patients are paupers, but the amount 
of their earnings is never withheld and credited to the depart- 
ment from which they come, or to iheir families in payment 
for their support. Government wisely regulates this, the object 
being to induce habits of labor, thereby hoping to promote 
recovery. 

There is exercised by the patients great apparent freedom of 
action and choice of pleasure. They seem to move when and 



1868.] PUBLIC DOCUMENT— No. 23. 67 

where they please, with no one to watch their steps, They 
may work or play, but if they work they receive direct gain in 
shape of wages for their labor. They may go in and out as 
any other members of the family do. They may be and are to 
a certain extent interested in all the details of social life. 
Though not in their own homes they have a home, live in a 
family and are members of society, useless it may be, but still 
they are identified as a part of the community. 

There seems to be a general feeling of contentment among 
the insane which is not found in any asylum. In very few 
cases indeed did there seem to be any disposition to escape. 

But little actual restraint is suffered by the patients ; more 
perhaps, however, than in the best regulated asylums in Eng- 
land or America. But at Gheel restraint is only an interfer- 
ence with certain dangerous muscular efforts. If a patient 
strikes he wears a leather belt to which his arms are loosely 
strapped. If he tears his clothes or undresses himself he wears 
the camisole. If he attempts frequently to escape he wears 
anklets fastened together by a chain. Sometimes both anklets 
and wristlets are worn ; generally, however, the patient still 
enjoys free air, and moves about as well as he can where 
he likes. 

Tiie most unpleasant forms of restraint which I saw were 
those cases of excited epileptics, who, during excitement, wore 
the camisole, and were also fastened to the bed, and must, from 
the nature of the case, be left alone a large part of the time. 
The condition of such, as soon as reported, is improved by 
admission to the asylum proper. 

I am not able to state accurately the amount of restraint, 
but believe it to be a much larger percentage and of severer 
character than has been suffered in your own hospital at any 
time during the last twelve years. I believe also that restraint 
is going out of use at Gheel, and that if Dr. Bulkcns were well 
supported by able medical assistants, mechanical restraint would 
soon lose itself in ordinary seclusion in comfortable rooms and 
private gardens. That you may not consider me a careless or 
superficial observer, I will briefliy show how other alienists have 
seen the Commune of Gheel. In 1851 Dr. Earle writes : " The 
accommodations are of various grades ; at some houses which I 
visited the apartments were very agreeable and commodious, 



68 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

but ill none were they furnished in a style nearly so elegant as 
that of many of the private institutions for tlie insane in 
Belgium, France, England and America. But at Gheel much 
the greater proportion of the patients are supported at the 
expense of the public, and about fifty cents a week is paid for 
the board and care of each of these. No very great extent of 
luxury, either in furniture or food, can be supplied at the rate 
of seven cejits a day. Consequently many of tliese are placed 
in garrets, lofts, outhouses and other out of the way nooks and 
corners, where their accommodations can hardly be accurately 
described by that expressive word, comfortable. They appear 
however, to be decently clothed and sufficiently well-fed, arid of 
all that I saw in the numerous houses which I visited in Gheel 
and the surrounding country, I have no recollection of hearing 
a word of complaint in these respects. On the contrary, one 
woman at a large farm-house a mile or two out of town, was 
sorely troubled because there was too much food, too much 
clothing, in short too much of everything in the world." Again 
he says, " Within the town I saw but one patient in the streets 
upon whom there was any restraining apparatus. His waist 
was encircled with an iron belt to which his hands were secured 
by wristlets. In the suburbs and around the farm-houses how- 
ever there were several who were fettered with iron, the chain 
between the ancles being about eight inches in length. In 
some cases the rings around the ancles had abraded the skin 
and occasioned bad ulcers." 

In 1860 Dr. Sibbald writes : " One of the agreeable features 
of the place is the general contentment manifested by the 
insane. In very few cases, indeed, did they complain of the 
injustice of their detention, though questioned on the subject. 
The comparative liberty of free air was evidently valued by 
them as a great privilege, more especially among those who had 
been previously residents in asylums. In one case, that of a 
young man who had been confined in Guislain's Asylum at 
Ghent, I was particularly struck with this. He was one of 
those subjected to mechanical restraint. He had a leather belt 
around his waist to which his arms were loosely strapped to 
prevent him from tearing his clothes. I asked him whether he did 
not find this restraint very irksome, to which he replied in the 
affirmative. I then asked him why he was thus strapped and 



1868.] PUBLIC DOCUMENT— No. 23. 69 

received a very simple, straightforward answer, giving the true 
reason. In my next inquir^v I asked whether he had worn 
those things at Ghent? and he answered no. Then said I, 
would you not rather live there ? they were kind to you were 
they not ? Yes, replied he, but I prefer to walk about as I like." 
Again he says, " The greater number were restrained by anklets 
fastened together by a chain, which as well as the anklets is 
bound iu leather to prevent the unpleasant appearance and 
jingling of the chain, and to avoid the anklets hurting the 
wearer, others wore a belt to which their arms were strapped, 
as in the case of the young man whom I have described above, 
some wore both belt and anklets." 

Again he says, " As far as I could judge from the histories of 
the cases which I saw, I formed the opinion that two classes of 
cases, more than any other, derive benefit from this system. 
One class comprises the milder forms of acute mania, many of 
which may be successfully treated, though, at first sight, it 
might appear that their excitement would require that they 
should be more closely confined as a protection to themselves 
and others. The other class consists of partially demented 
eases who have, either through old age or from other causes, 
fallen into a second childhood. When such a patient is of the 
male sex he receives much more suitable care and attention 
from a kindly cottar's wife than is possible even from a con- 
scientious and experienced male attendant ; and when there are 
children in the family, the evident happiness which results 
from their playful intimacy with their broken-minded friend, 
either male or female, lights up as nothing else can do, the 
clouded remnant of their mental life." And again he says, 
" From what I saw I have every reason to believe in the thoroughly 
trustworthy nature of the reports of Dr. Bulkens. The 
patients appeared generally to be in good health, and as far as 
short residence can determine, they are well cared for. One 
thing which in such a place must speak strongly as to the char- 
acter of the administration, is the fact that tlie worthy medical 
inspector appears to be a favorite with his patients," 

In 1867 Dr. Howe writes : " Tliis establishment flourishes 
mainly, I think, in virtue of three great advantages for the 
treatment of insane persons, which were not and are not found 
in an equal degree at any public hospital in the world. 



70 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

"First, employment at domestic and agricultural work in com- 
pany with sane persons, and mostly in the open air. This pro- 
motes bodily and mental health, or at least retards the progress 
of disease. 

" Second, social and family relationship with sane persons. 
This keeps alive and active the unperverted sentiments and 
affections, and helps to restore the mental and moral balance. 

" Third, the greatest possible amount of personal freedom. 
This not only promotes bodily health, but, by preserving self- 
respect, promotes mental health." He says " the history of 
Gheel, from the twelfth to the nineteenth century, may be 
regarded as a severe test of human virtue and goodness. Tens of 
thousand^ of helpless lunatics were thrown upon the hands of sim- 
ple peasantry, whose control over them was only partially iViodified 
by priests and magistrates. Whoever studies carefully the 
condition of lunatics during these centuries, will conclude that, 
upon the whole, these unfortunates had more of human enjoy- 
ment, and less of suffering, than in other countries where peo- 
ple not only thought, with John, that they were possessed of 
devils, but with Jeremiah, that they should be put in prison 
and in the stocks. Upon the whole, human virtue stood the. test 
bravely at Gheel." Again he writes, " Here at Gheel one can- 
not but rejoice at seeing how large a proportion of the lunatics 
have entire freedom, and indulge the hope that, by some happy 
reform, thousands who are now needlessly imprisoned in otlier 
lunatic asylums, may have theirs also, and that to the sad loss 
of reason may not needlessly be added the loss of liberty also." 

I visited also the French colony, Fitz James, about fifty miles 
north of Paris, in the department of Oise. The little town of 
Clermont is situated in the midst of a fertile and beautiful 
agricultural region, and, from the eminence on the slope of 
which it stands, commands an extensive prospect. The original 
asylum, established by the father of the present managers, 
which has grown from a very small beginning in a private 
house to a large and prosperous institution, is situated on the 
border of this village. In 1849 the original proprietor died, 
when his sons, the present proprietors, assumed the manage 
ment, and reorganized the institution. The degree of pros- 
perity was such that, as early as 1856, it was thought advisable 
to procure more land than was at that time occupied, and try 



1868.] PUBLIC DOCUMENT— No. 23. 71 

the effect of a greater amount of out-of-door labor for those 
whose habits and proclivities would allow of their being em- 
ployed. Accordingly, an estate of about five hundred acres of 
land was purchased in the immediate neighborhood in order to 
carry out the plan. Upon the estate was a mansion-house and 
such other buildings as would constitute a gentleman's country 
residence. Other i)lain buildings of rather rude construction 
were erected, and soon forty able-bodied, quiet male patients, 
supported at the expense of the departments, were transferred 
from the original asylum proper to the colony, and put to work. 
These were all chronic cases, and had, for various periods of 
time, performed the out-of-door labor on the ninety acres of land 
cultivated in connection witli the asylum proper at Clermont. 

The results were so satisfactory, that Dr. Labitte soon erected 
other and more extensive buildings for the accommodation of a 
larger and increasing number of patients of both sexes. 

Alterations and additions continued to be demanded until 
the institution may now be considered quite complete of 
its kind. It has four distinct departments, with convenient 
out-buildings, stables, and such other fixtures as a large and 
well cultivated farm requires. During the seven or eight years 
since which this system has been inaugurated, the profits of the 
institution have been so large that the improvements necessary 
have been made and paid for from the annual income. This 
colony is simply an appendage to the asylum at Clermont, from 
which patients may be transferred, when thought desirable by 
the proprietor, and sent back to the asylum again if necessary. 

Tlie four sections to which I referred are : first, one devoted 
to male patients, who pay liberally for their support, and whose 
friends prefer placing them here rather than at Clermont. The 
accommodations are such as may be found in an old country 
house. Twenty-three male patients, with their attendants, have 
rooms in this old mansion house, in which are also apartments 
for the medical officers and their servants. Second, a corres- 
ponding establishment at a little distance for female pay pa- 
tients. These two sections are comfortable, though not 
furnished with any degree of taste or elegance. That of the 
males in the mansion-house could hardly be said to have been 
neat or tidy. Third, one for female paupers, situated at a little 
distance from the female pay patients, and at a greater distance 
and in the rear of the section for male pay patients. This sec- 



72 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

tioii is devoted cbiefly to laundry operations, and the washing 
for both asylums is performed here. Fourth, one for the labor- 
ers on the farm, where they live in small, rude dwellings, called 
cottages. These cottages are not models for comfort or conve- 
nience, nor are they patterns of good taste and cleanliness. 
There are other buildings occupied by patients, but of the same 
general character as those of the third and fourth sections. 

The mansion-bouse is of two stories, and so divided as to 
accommodate twenty-three patients and the medical officer and 
manager, with his family and the necessary servants and at- 
tendants. It has also, beside parlors and sitting-room, a biUiard 
room. It is quite pleasantly situated in a wide lawn, is sur- 
rounded by trees, and has a creek flowing in front. 

The section allotted to the female pay patients is also an old 
country house, of two stories, divided in the usual manner, and 
has the usual conveniences of a country hovise. It is well sit- 
uated in a fine lawn, and gives one, on the whole, a pleasing 
remembrance. Of the comforts and conveniences of the depart- 
ments for pauper patients, little can be said. They are desti- 
tute of all proper means of lighting, warming and ventilation. 
They have no conveniences for bathing, and but little attempt 
is made to preserve habits of common decency. The laundry 
is quite spacious, well arranged and convenient, and a large 
amount of useful labor is here performed. 

The farm buildings are convenient, and arranged with care 
and skill, and speak of the thrift and enterprise of the place much 
more plainly than do the buildings for other purposes. The 
stables were well filled with a fine stock of oxen and horses, 
and a large herd of cows were feeding on the lawn. An exten- 
sive piggery was filled with choice breeds, and more than one 
thousand rabbits were kept in boxes, where they were bred for 
the table and market. There were also butchers' stalls, sheds 
for carriages and farming implements, and a mill, with steam 
power ; and also, on the creek, in front of the male department, 
a small, showy building, which contains hydraulic apparatus for 
lifting water to such parts of the establishment as it may be 
desired. Besides these, there were store-houses and cellars and 
cider and wine vaults. 

The hospital, or asylum proper, of which I have spoken, is 
known as the Clermont Asylum, and the colony of Fitz James 



1868.] PUBLIC DOCUMENT— No. 23. 78 

is only an appendage to this, in which are lodged in detached 
buildings, not cottages or houses, the quiet and industrious pa- 
tients. Nor are these accommodations based upon the model 
of any family arrangements. They more nearly correspond 
to military barracks in second-rate villages. 

Dr. Gustave Labitte is the medical director and superin- 
tendent of the affairs of both establishments, and a brother, 
Alexander Labitte, has charge of the general administration 
and direct oversight at the colony where he resides. A med- 
ical assistant is employed at each institution. At the asylum 
proper each division or class has its appropriate airing court, 
beyond which the patients seldom go. Here, as at the colony, 
the accommodations for the pay patients are fair, while that of 
the paupers are bare, uncomfortable and coarse in the extreme. 
Eooms used as day-rooms contained no furniture but the 
plainest of wooden benches and heavy tables, not clean, on 
which tlieir meals were served. Their food was plain, but 
appeared to be sufficient in quantity and fair in quality. No 
great order or regularity was observed in dispensing the food, 
and on the whole the meal was unsatisfactory. Refractory 
patients could not be well supplied. Feeble patients were not 
properly attended, and deluded ones were suffered to absent 
tliemselves without an effort on the part of tlie attendants to 
satisfy their wants. 

In this asylum, consisting mainly of three separate ranges 
of buildings, each with its appropriate grounds and enclosures, 
there appeared to be an unusual amount of severe restraint of 
various kinds, which, added to the number of those who were 
suffering from bruises of varying degrees of severity, leaves on 
the mind of the visitor painful recollections. 

There seemed to be everywhere an utter want of authority, 
and almost complete absence of any executive power in tlie 
internal management of the establishment. 

At the colony, which is used as a sort of penal establishment 
for the strong and healthy and docile who quietly submit to 
the direction of taskmasters, the condition is better only as 
the patients are of a class who can labor witli profit and con- 
sequently enjoy freedom from restraint and the cheerful and 
healthy influences of out-of-door labor. 

Tlie medical end which should be kept in view seems to have 

10 



74 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

been lost sight of. The patients are not surrounded with any 
of the customs or habits of social life. I observed no marked 
attempt to introduce among them reciprocal relations, or to 
inspii-e them with sentiments of personal consideration. And 
I looked in vain for those conditions of social and domestic 
life of which the family is and must remain the model. 

That the patients perform a large amount of useful labor no 
one can for a moment doubt. The general thrift and pecu- 
niary prosperity of the place sufficiently prove this. Since its 
establishment, about six hundred acres of land, in a depart- 
ment where land is expensive, have been purchased out of the 
net proceeds of the establishment, besides the cost of the build- 
ings, fixtures, stock, farming implements and improvements. 
Here may be seen the best mowing and reaping machines ; the 
most approved ploughs, harrows, drills, cultivators ; the most 
successful methods of raising and fattening improved breeds of 
cattle, sheep and swine. Here, too, are the finest horses, the 
best cows, and sleekest oxen to bo found in the country, with 
prize sheep and swine. The buildings, courts, stables and out- 
houses, all prove how profitable to the proprietors has been the 
experiment. 

Tlie departments which send their poor insane to this colony, 
are not essentially different in their habits of feeling in regard 
to the insane from other localities, and consequently appreciate 
the pecuniary advantages of such a system. Although patients 
may not recover, the cost of maintenance may be lessened, and 
habits of obedience acquired may continue when returned to 
the local authorities. Such, in brief, are my impressions of 
Clermont. I know they differ widely from those of some other 
observers who have the same general hopes in regard to the 
insane, and the same or similar opinions in relation to their 
management with myself. 

Of the French asylums for the insane, you will permit me to 
make a passing remark of one or two. In Paris, the asylum 
of St. Anne is perhaps the best It has, architecturally, every 
advantage over others. Here are found all the accommoda- 
tions for classification, all the arrangements for care and 
custody, and all the fixtures for treatment which skill and 
ingenuity can devise and money procure. 

The buildings are neat, plain and substantial, and consist 
mainly of a separate block for reception and observation of 



1868.] PUBLIC DOCUMENT— No. 23. 75 

patients on admission, with rooms for medical offices and for a 
few convalescents. Opposite to this is a square with a block 
or pavilion occupying each corner and the middle of each side, 
with domestic offices and rooms for assistants in a centre block. 

These blocks are all connected by a covered walk, which 
divides the blocks and their appropriate courts from each 
other. The ranges of apartments on the right of the entrance 
are occupied by males, and those on the left by females. 
Day-rooms, dining-rooms, bath-rooms, and rooms for refractory 
patients are on the first floor, and the sleeping accommodations 
in associated dormitories are on the second floor. The domes- 
tic arrangements, kitchens and laundry are perfect, contain- 
ing the most expensive machinery of the latest pattern and 
improvement. There are large cellars, store-rooms and wine- 
vaults, filled with everything the market could supply. The 
sewing-rooms, linen and clothing stores are large, abundantly 
supplied, and were models of neatness and good order. The 
dietary was good, and seemed to be abundant. The medical 
stores appeared to be on a scale of the most lavish expendi- 
ture ; supplies of all kinds were plentifnl almost to waste- 
fulness. 

The apartments of tlie patients were very plainly but cleanly 
furnished. The bedding was good, and the sleeping-rooms 
light and airy. The rooms for excited patients open into 
separate airing courts. These rooms are of solid masonry, 
quite dark, often damp, and must at times be cold. Some of 
tliem, however, are very expensively padded, and did not 
appear to have ever been used. Many of the unpadded rooms 
were occupied, and in every case, I believe, the patient was 
also in the camisole. Here may be seen the most elaborate 
arrangements for the application of water as a remedial agent, 
and for the general purposes of bathing. In a large room 
devoted entirely to this use are contrivances quite extraor- 
dinary — ^jets of water of all sizes, from the finest stream to 
the most powerful douche, heavy enough to fell a strong man ; 
baths of every conceivable form — plunge baths, sitting baths, 
foot baths, head baths and shower baths ; baths in every 
direction — perpendicular, horizontal and upright. Tlien there 
was a sort of platform from which an attendant could control 
not only all other fixtures in the room, but also a powerful 
douche from flexible hose. Besides these, there was a coil of 



76 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

iron pipe enclosing a space four feet in diameter and more than 
six feet liigh, so arranged that a man could step inside. The 
pipe was punctured with small holes on the inside, so that 
when a patient was placed upright in the centre and the stop 
was turned the water came rushing with great power from a 
thousand jets and struck upon every inch of his body in con- 
tinued streams with immense force. In an adjoining room 
there was apparatus for vapor baths, and in another a score of 
ordinary bathing tubs with covers so fixed as to enclose the 
patient's body in the tub, leaving his head above the lid or 
cover. 

The patients were employed in the laundry, kitchens and 
sewing-rooms, and in and about the airing courts much as at 
other hospitals for the insane the world over. There seemed 
to be no general system of occupation, and no provision for any 
considerable amount of recreation or amusement, and little or 
no room for outside exercises. 

The hospital at Charenton, a short distance from Paris, is 
now being completed according to the original plan, only one- 
half of which has ever been constructed. The building is 
situated on the brow of a hill and overlooks a beautiful country. 
It is neat, plain, but rather showy in its exterior, consisting of 
a centre building and chapel at a little distance in the rear. 
From these two buildings proceed parallel wings or ranges of 
apartments. The centre and chapel are united by a range of 
apartments from front to rear, so that the centre group of apart- 
ments enclose four sides of a square ; in the centre of this 
is a statue of Esquirol. Each of the two parallel wings has 
four sm.all projecting wings, so as to form three sides of four 
courts in front of each parallel wing, the fourth side being 
enclosed by a simple erection or covered walk. The four 
divisions, consisting of the front wing and two of those' in the 
rear wing, are assigned to men. And the two remaining 
divisions to the women. 

In the male division there seemed to be an unusual amount 
of excitement and in a portion of it considerable violence, and 
many patients were in camisoles, muffs and wristbands with 
belts. Quite a large number were also in seclusion. No more 
than one division of the males were quiet, and in any degree as 
comfortable as in ordinary American asylums. The female 
patients appeared to be much more calm, and in every way 



1868.] PUBLIC DOCUMENT— No. 23. 77 

better managed. They were more tidily dressed, their apart- 
ments were more cleanly and better furnished, and many of 
them were employed in sewing, knitting and other light work. 
They also assisted to a small extent in the domestic offices. 
There seemed to be little or no occupation for the men, and but 
little recreation for either sex. 

The dining and sleeping accommodations are much like those 
of St. Anne, comfortable but no more. The food was good and 
sufficient, and a liberal allowance of light wine is given to the 
patients. Here too, much reliance is placed upon baths ; they 
are used in all their forms, simple and medicated. Cold water is 
employed in the neuroses, as headache, sleeplessness, hypochon- 
dria, hysteria and general atony. Long continued tepid baths 
are employed as a remedy for the excitement of acute mania, 
and one may see scores of patients locked into bathing tubs 
two, four, six, and even eight hours at a time. 

In the French asylums there is much to leave on the mind 
unpleasant impressions, and one's recollection is often painful. 
The manner and bearing of both physician and nurses seem 
not to be sincere and honest. There is a want of confidence 
and a restless suspicion on the part of both which must lead to 
great discomfort and frequent excitement. In the management 
of the insane, there did not seem to be a sufficient attempt to 
awaken their sense of honor and confidence in their own 
strength to recover their habits of self-control. ' There was 
entire absence of any teaching by example the value of moral 
power and religious confidence. There was no endeavor to 
excite motives of hope or fear. No influence tending to fix 
their attention on any particular subjects, or to lead them to 
engage in any variety of occupation, amusement or intercourse. 
The same general remarks may be applied to the asylums in 
Switzerland and Germany if we except the asylum near Neu- 
chatel, in Switzerland, which though small, is quite perfect in 
all its appointments. It is beautifully situated in a liighly cul- 
tivated region on the shores of the lake, commanding views of 
the distaint mountains, &c. The buildings enclose a square, 
are two stories high, and contain on the lower floor dining- 
rooms, sitting-rooms and libraries, and also a range of unoccu- 
pied rooms for excited patients. On the second floor are the 
dormitories and single bed-rooms. Here the conduct of the 
physician and nurses was different. I found Dr. Borell and 



78 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

liis family enjoying coffee, newspapers, books and music, with 
quite a group of his patients about him, all familiar, cheerful 
and happy. There was no appearance of suspicion ; no fear or 
dread of returning to the wards and apartments devoted to 
patients. The whole household seemed to be one family, moved 
by the same impulse, having the same motives, enjoying the 
same pleasures and entertaining the same hopes. There was 
here no seclusion and no restraint. The Doctor was just com- 
pleting a house for a few patients who could enjoy still larger 
liberties. This hospital was built and endowed for the poor of 
the district who pay only a nominal price. It may also receive 
the wealthy at higher rates, but must always accommodate the 
poor of its own neighborhood. 

The asylums at Geneva and Berne are both well situated, 
pleasantly arranged, and the patients seemed to enjoy a fair 
degree of comfort. There appeared to be no striking evidence 
of tact or skill in the management of either. There was a lack 
of tidiness and order, and want of discipline and control in the 
care of the patients, and in the administration of the general 
affairs of the asylums. 

The asylum at Frankfort, which is located near the city in 
the midst of a beautiful and growing suburb, is a pleasant 
building of modern plan and construction. The main wings 
are built on three sides of a square, and the patients' rooms are 
generally arranged on the back side of the wing and the cor- 
rider is open to the front. The day accommodations are 
mostly on the lower floor, and the sleeping-rooms are- above. 
The patients are kindly but carelessly provided for. They are 
untidy and unclean, and the house in all its parts is slovenly 
and dirty. 

In striking contrast with this is the asylum at Heppenheira, 
recently constructed upon an improved plan, and as yet occu- 
pied only in part. The building, consisting of centre, lateral 
and projecting wings, is plain, substantial and showy. Situated 
in the midst of a beautiful and healthy agricultural region, 
everything is charmingly neat and scrupulously clean. The 
patients are tidy, cheerful and social. There was perfect disci- 
pline in the control of the house, and great order observed in 
all the arrangements and details of management. There was 
more than usual attention given to the subjects of recreation, 
amusement and labor. The patients were well and cleanly 



1868.] PUBLIC DOCUMENT— No. 23. 79 

clad, the tables were bountifully spread. The beds were clean 
and comfortable, the house was roomy, airy and light. The 
furniture of the establishment was mostly made by the patients, 
who perform a large amount of useful labor. 

In the continental asylums the apartments assigned to 
patients have not that finished aspect of comfort which is 
found almost universally in American institutions. Yet com- 
pared with the prevailing customs and habits of the people 
they are probably as comfortably furnished as our own, and 
answer the wants of the people of those countries as well as 
our own hospitals answer the wants of our own people. In the 
more recent ones, the domestic offices, laundry, kitchen and 
store-rooms are well appointed and quite perfect. Their facili- 
ties for distributing supplies are however inferior. In the 
treatment of patients, mechanical appliances for the purpose of 
bodily restraint are more extensively used than in any asylums 
known to me on this side of the Atlantic. And I dare not 
write how extensively I have seen such means of restraint in 
actual use. I have doubtless seen much that was not usual 
and customary. But sometimes it was difficult to see all I 
desired, and frequently some departments were very reluctantly 
shown. This is especially true of Parisian asylums. 

In England the public institutions for the insane are of two 
kinds — hospitals for the middling and upper classes, and county 
asylums for the paupers. In some of tliese, patients from 
well-to-do families may be found who refund to the parish from 
which they come the expense of support. In Scotland, gen- 
erally, and in a few only of English asylums, both classes are 
admitted into the same institution, but commonly separate 
buildings are provided for the two classes. There are also 
hospitals founded like Bethlehem and St. Luke's, where curable 
cases are admitted of persons in good social position, who have 
become reduced ; and tliere are likewise many private asylums 
accommodating from three or four to seventy-five or one hun- 
dred patients. Tiiese may be and formerly were extensively 
owned and managed by non-professional persons who employed 
a physician to visit them. Some of them are now managed 
by the first alienists in the country, and a remarkably 
good feeling and understanding exists generally between them 
and the public hospitals and asylums. All these institutions, 
whether public or private, are under the inspection and control 



80 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

of the commissioners of lunacy. The private establishments 
differ but little from private houses ; none of them having been 
constructed for the purpose. They nearly all have fine sur- 
roundings, large and beautiful grounds laid out in vs^alks, 
lav/ns, croquet and bowling plats, tennis courts, and facilities 
for every amusement and recreation. In the house there are 
libraries, billiard and smoking rooms and reading rooms on the 
lower floor, and sleeping and dining rooms above. In these 
houses many of tlie rich keep their own servants, horses and 
carriages. 

There is, I believe, in no case any provision for manual labor, 
except in such private asylums as are occupied by ladies, wliere 
the light occupations sought by ladies in their homes are read- 
ily available. 

In the public asylums of England, what is termed the iion- 
restraint system prevails, and is, I believe, generally honestly 
and faithfully carried out. 

Cases of fury and violence, though by no means so common 
as with us, nevertheless do occur, and are often controlled by 
the administration of drugs, such as opium, nitrate of potash, 
digitalis and antimony. Seclusion in padded rooms is much 
resorted to, and in some asylums packing in wet sheets is sup- 
posed to exert a powerful controlling influence. Shower-baths 
are often ordered, both for their remedial effect and as a correc- 
tion for misconduct. 

Some alienists admitted frankly that the non-restraint system 
might be carried too far, and that in some cases it seemed to bo 
for the best interests of the patient that some restraint be ap- 
plied, but, on the whole, it was thought best to risk the little 
suffering that might result for want of restraint, rather than that 
multitudes should be unnecessarily deprived of their liberty. 

As it is in America, so it is in England. The very poor have 
better opportunities for curative treatment than the middling, 
well-to-do class ; for, when attacked, they are taken to the asy- 
lum, and are placed under such restrictions as will at least 
detain them during the acute and curable stage of disease. 
The wealthy can remain at home, can travel with servants, or 
can seek admission in a private asylum, where weeks must 
elapse before a vacant room can be obtained. 

Ten years ago the county asylum of England was on the corri- 
dor plan, with single rooms upon one side of the corridor only, 



1868.] PUBLIC DOCUMENT— No. 23. 81 

and large associated dormitories for about two-thirds of tlie pa- 
tients, and day-rooms for self-seclusion of a few upon each floor 
of the establishment ; the dining rooms being generally in 
some projecting portion of each corridor ; bath rooms, water 
closets, padded rooms, clothes rooms, and all other appoint- 
ments on each ward, with airing courts, and outside entrances 
corresponding to each ward. Then the chapel, recreation 
room, kitchens, laundry and general stores, in connection with 
the centre building, where the medical officers had their apart- 
ments. Then there were farm buildings and the bailiff's cottage 
at some distance. Of this plan the Derby and Essex County 
asylums were ten years ago the best examples. They have 
retained all they then had, and have both been enlarged and 
improved by slight departures from the original plans. 

But hospital architecture has made large strides in England, 
so that if we were to-day to make comparisons, where all are so 
good, our preferences would be strongly in favor of the asylums 
in Sussex, at Haywards Heath and at Worcester. These two 
seem to be in advance of all other county asylums which I saw, 
and it would be difficult to say which is best or which is best 
managed. They each consist of twelve wards, and accommo- 
date seven hundred patients. The construction is similar to 
other asylums in many respects, but the appointments are more 
complete. Corridors, with single rooms for a small portion of 
the patients, opening on one side, with large day-rooms in each 
story, and corresponding airing courts, and, as is usual in all 
the recently built institutions, a corridor of communication 
passing along the whole length of the wings, by which any 
ward may be entered without passing through any other ward. 
On the front of the first lateral wings are large showy one-story 
projections for dining-rooms, which communicate with all the 
wards by means of the corridor of communication. These 
rooms will each seat about three hundred and fifty persons, so 
that all able-bodied patients of the same sex sit at the same 
table. The laundry wing leads directly from the female side 
of the house, and the approaches of the stables and gardens-are 
from the male side. The recreation rooms are near the centre, 
and the chapel is outside. 

The hospital at Northampton and the asylum at Glasgow can 
be compared with our own institutions, inasmuch as they each 
11 



82 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

have both paupers and pay patients under the same roof, and 
in many respects are much hke American asylums. In these 
the apartments for paupers are not as well furnished and as 
well kept, the patients are not as well fed and cared for as in 
your own asylum, while the apartments for the pay patients are 
better supplied, their surroundings are more tasty and com- 
fortable, and, on the whole, they are better cared for than the 
corresponding class can be in your own hospital. The average 
price of board for paupers in English asylums is not materially 
less than is paid here, and the usual price for patients belonging 
to a class of well-to-do tradesmen, is from thirty to fifty pounds 
sterling. 

In asylums in England and Scotland of a still more recent 
date, the day-rooms and all accommodations are on the first 
jQoor, and all the sleeping accommodations in large dormitories, 
with a few single rooms, are on the second floor, except the 
infirmary wards, which are usually, though not always, on the 
first floor. 

Alterations now going on in some of the older asylums will 
convert them into blocks or pavilions, connected with each other 
by covered walks, each block or pavilion having day accommo- 
dations on the first floor, and sleeping rooms above assigned to 
particular classes of patients, and these classes generally taking 
their meals in one large dining hall. 

Many asylums of all classes have detached buildings or cot- 
tages, for the accommodation of a few patients who cannot well 
be classed in the asylum proper, and great advantage is found 
to result from this plan. 

In Ireland, the asylums were found to be quite as good as in 
England or Scotland, though of poorer construction, and labor- 
ing under other great disadvantages. The institutions were 
generally on the corridor plan, with rooms on one side only, 
and central dining-rooms. The kitchens, laundry and store- 
houses were all well constructed, and the patients seemed to be 
kindly and well cared for. 

In most of the particulars of moral treatment, the Englisli 
asylums are fully equal to those of the United States. In the 
most important of all, if reference be had to curative treat- 
ment, or the quietude, order and hygienic condition of the 
patients, — that of occupation for the inmates, — they are supe- 



1868.] PUBLIC DOCUMENT—Xo. 23. 83 

rior. Their superiority lies not in the more ardent wish or tlie 
greater efforts for the welfare of their patients, for in these 
respects none excel American superintendents,. but in the edu- 
cation of the people, and the nature of their political govern- 
ments, and also the social restraints under which they live. 
Obedience to authority becomes by education a habit and prin- 
ciple of life. The English peasant and mechanic have an 
ingrained belief that they are not only born to labor, but to 
obey authority, and they readily and without question do, as 
they are bid. Very different are they, and all the continental 
peasantry, from the American, who looks upon labor as some- 
what menial, or, at any rate, regards it as his capital, upon 
which he has a right to fix his price. 

As to correctional means, in the strict sense of the term, 
there are none in any good institution, and if strong measures 
are necessary, they must over bear at the same time more or 
less of a medical or therapeutical character, and correspond 
precisely to the mental peculiarity of the patient, whereby 
their particular healing aim is not lost. Therefore alienists 
direct the most reasonable mode, not excepting the most extended 
douche, the deprivation of nourishment, and the like, seeking 
out for each individual case the most suitable measure, which 
often requires the deepest meditation. 

Their argument is that the insane are diseased, and that their 
malady is not only curable, but, like all other maladies, curable 
in proportion to the promptness with which the treatment fol- 
lows the attack, and that there should be no obstacle in the way 
of receiving treatment. That some restraint is considered 
necessary by them for the violent and demonstrative, is man- 
ifested by their tenacity for the shower bath, the packing sheet, 
and nauseating doses of antimony. That a large amount 
of personal freedom is best for the many, is shown in their so 
pertinaciously following the system inaugurated by Dr. Con- 
nolly at a time when one could hardly think of institutions for 
the insane without chains, scourges and bands of iron. But, 
thanks to the humane spirit of the age, which has at last forced 
its way like a loving genius into the cells of human beings who 
had sunk to a condition lower than the brutes, and removed 
from most of them those unhappy conditions which a harder 
and colder age had made a necessity. 



84 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

For any success which has attended the labors in this hos- 
pital during the year past, great credit is due to Joseph Draper, 
M. D., Assistant-Physician, and D. W. Bemis, Esq., Steward and 
Treasurer, who have performed all their duties, and executed 
all plans faithfully and scrupulously. 

Alfred E. Walker, M. D., who acted as Assistant-Physician 
during a part of the year, leaves to engage in other duties, with 
the kind wishes of all who came in contact with him. 

fhe Supervisors, Marshall S, Greene, Miss Evans, and Miss 
P»utte , have done much to promote the welfare of the 

patients by the kindness and faithfulness in which they per- 
formed all their duties. The attendants generally are to be 
commended for their thorough devotion to the best interests of 
those committed to their care. 

Our thanks are due to Miss Dix for the kind interest she has 
manifested in the welfare of the institution. 

I desire to express my sense of obligation to the many friends 
who have contributed to the welfare of our patients by their 
frequent concerts in sacred music. 

We are also under obligations to many friends for especial 
favors, among whom may be mentioned Dr. R. W. Hooper, 
William Knowlton, Esq., Professor Bushee, Professor Harring- 
ton, Mr. Brainard, and others. 

To the publishers and proprietors of newspapers and period- 
icals in the city and throughout the Commonwealtb, who have 
sent to us their daily, weekly aud monthly issues, we are 
greatly indebted. 

To you, gentlemen, for the personal kindness, the cordial 
support, and the sympathy enjoyed at all times from each indi- 
vidual member of your board, permit me to renew the expres- 
sion of my grateful sense of obligation. 

With renewed vigor wo commence the labors of the new 
year, trusting that we may be able to devote ourselves wholly 
and entirely to the development of the highest and best possi- 
bilities of our calling. 



MERRICK BEMIS. 



Worcester Lunatic Hospital, | 
Worcester, Mass., Oct. 1, 1868. ^ 



METEOROLOGICAL OBSERVATIONS 



THE STATE LUNATIC HOSPITAL, WORCESTER, MASS., 

186r-8. 

Latitude, 42° 16' 17" iV". ; Longitude 71" 48' 13" W. 
Elevation, 528 feet. 



"Explanation. — The force of the -wind is estimated upon a scale of 10 and indicated by figure 
afiSxed to the letters denoting the direction. When no number is afBxed, 1 is meant. 



86 



LUNATIC HOSPITAL AT WORCESTER. 



[Oct. 











Ice formed ^ of an inch. 
Aurora Borealis. 

Hain. 

Cloudless frost. 
Frost. 

Rain. 

Frost. 
Slight rain. 

Hazy-fine weather. 

Thunder-shower in eve.- 

Aurora Borealis in even. 
Heavy frost, smoky. 

" smoky. 
Rainy. 






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PUBLIC DOCUMENT— No. 23. 



87 





a: 




Cloudy. 

Hazy A.M.; fair P.M. 

Cloudy and rainy.- 

Cloudy. 

Fair weather. 

Fair weather. 

Cloudy ; s'wflakes, A.M. 

Cloudy. 

Cloudy and rainy. 

Cloudy and rainy. 

Cloudy. 

Cloudy; snowfl'kes.P.M, 

Cloudy and blustering. 

Cloudy. 

Cl'dy with snow squalls. 

Cl'dy with snow. 

Fair A.M.; snow sq.P.M, 

Fair weather. 

Coldest dayof the season. 

Cloudy and squally. . 

Wild geese migrate. 

Cloudy and rainy. 

Cloudy and rainy. 

Cloudy and rainy. 

Cloudy slight aurora. 

Rain A.M. ; fair P.M. 

Fair weather. 

Cloudy and rainy. 

Drizzly. 

Fair weather. 




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10 a. m 

1 a. m. 

3 a. m. 

11 a. m. 
9 p. m. 

7 p.m. 
10 p. m. 

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88 



LUNATIC HOSPITAL AT WORCESTER. [Oct. 



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PUBLIC DOCUMENT— No. 23. 



89 








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90 



LUNATIC HOSPITAL AT WORCESTER. [Oct. 







< 




Fair weather. 

Hazy P. M. ; lunar halo 

Cloudless. [9 P.M. 

Cloudy A.M.; fair P. M. 

Fair A.M. ; cloudy P.M. 

Stormy and cloudy. 

Fair weather. 

Fair weather. 

riainy. 

Fair weather. 

Cloudy. 

Cloudless. 

Fair weather. 

Fair weather. 

Fair weather. 

Fair weather. 

C'dy A.M.; stormy P.M. 

Fair weather. 

Fair weather; snowsq's. 

Fair .weather. 

Fair weather. 

Fair weather. 

Fair weather, cold't day. 

Cloudy. 

Hazy all day. 

Cloudy all day. 

C'dy A.M.; stormy P.M. 

Stormy and cloudy. 

Fair weather. 






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Driving N.ls. snow st'm. 

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Aurora Borcalis, 9 P.M. 
Hazy, P. M. 
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PUBLIC DOCUMENT— No. 23. 



97 





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1868.] 



PUBLIC DOCUMENT— No. 23. 



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102 LUNATIC HOSPITAL AT WORCESTER. [Oct. 



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1868.] PUBLIC DOCUMENT— No. 23. 103 



APPENDIX. 



FORMS CONCERNING ADDinSSION TO THE HOSPITAL. 

PETITION. 

[The applicant must answer in -writing the printed interrogations accompanying this 

blank.] 

To the Honorable the Judge of the Prolate 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 AVorc ester Lunatic Hospital according to law. 

, ss. A. D. 18G . 

Then the above named made oath that 

the above complaint, by h subscribed, is true. 

Before me, , Justice of the Peace. 

I, the subscriber, one of the selectmen of 

where said . resides, hereby acknowledge 

that notice has been given^to me of the intention to present the foregoing 

complaint and application. 

A. D. 18G . 



To the Honorable ike Judge of the Probate 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 ans\7er 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. 



104 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

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-ofEce address of some 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. 



PHYSICIAI^S' 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 made 

oath that the above certificate is true. 

, Justice of the Peace. 



Commomveallh of Massachusetts. 
1 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. 

AVherefore it is ordered that said be committed 

to the said Worcester Lunatic Hospital. 

, Judge of Prolate Court. 



1868.] PUBLIC DOCUMENT— No. 23. 105 

FOEM OF OVEESEERS' BOND. 

Worcester Lunatic Hospital. 

Whereas, of , in the county of 

, has been admitted a boarder in the Worcester Lunatic 
Hospital, , 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 rate of board which may, from time to 
time, be determined by the Trustees of said hospital, for said patient, so long 
as h shall continue a boarder in said hospital, with such extra charges as 
may be occasioned by h requiring more than ordinary care and attention, 
to provide for h suitable clothing, and to pay for all such necessary articles 
of clothing as shall be procured for h by the Steward of the hospital, and to 
remove h from said hospital whenever the room occupied by h shall be re- 
quired 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 h 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 

Attest. (Signed,) 

' Overseers of the Poor 
of the 
Toion of 



FOEM OF PE IV ATE BOND. 

Worcester Lunatic Hospital. 

Whereas, of , in the county of 

, a? 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 rate of board which 
may, from time to time, be determined by the Trustees of said hospital, for 
said patient, so long as h shall continue a boarder in said hospital, with 
such extra charges as may be occasioned by h requiring more than ordinary 
care and attention ; to provide for h suitable clothing, and to pay for all 
such necessary articles of clothing as shall be procured for h by the 
Steward of the hospital, and to remove h from said hospital whenever 
the room occupied by h 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 

h may do the furniture and other property of said hosjiital, and for reason- 



106 LUNATIC HOSPITAL AT WORCESTER. [Oct. '68. 

able 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. 186 . 

, Principal. 

5 Surety. 



Patients will be received into the hospital at any time, if the following con- 
ditions are complied with : 

If the patient is in indigent circumstances, and has no settlement in any 
town in the Commonwealth, the Probate Court, or if in the city of Boston, 
the Superior Court, will issue a warrant for the commitment of the patient to 
the hospital. The State will then pay the cost of support, and the county 
from which the patient is sent will pay the expenses of the commitment. 

If the patient is in indigent circumstances, and has a settlement in any 
town in the Commonwealth, the Overseers of the Poor of that town may give 
a bond for the support of the patient. Or, when this is inconvenient, an 
application may be made to the Probate Court of the county where the 
patient resides, and a warrant will be issued for the commitment of the patient 
to the hospital, and the town will be held responsible for the support of the 
patient. 

In all other cases a bond from responsible persons, as principal and surety 
will be required for the expenses of the patient Avhile in the hospital. 

In all cases, before admission to the hospital, two physicians, one of whom 
shall be the family physician, must certify that the patient is insane. 

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. 

Damao-es 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 charge 
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. 



A^R2 5'^a^*^'^