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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 No. 23. 



POETY-rOUETH ANNUAL EEPOET 



THE TRUSTEES 



7/^/y- 



STATE LUNATIC HOSPITAL 



^V\^OIlCESTER. 



October, 1876 



BOSTON: 

ALBERT J. WEIGHT, STATE PRINTER, 
79 Milk Street (corner of Federal). 

1877. 



OFFICERS OF THE HOSPITAL. 



TKUSTBES. 

Col. JOHjST D. WASHBURN, . . . , . . . Worcester. 

Prof. JAJVIES B. THAYER, Cambridge. 

ROBERT W. HOOPER, M. D., Boston. 

Gen. WILLLiM S. LINCOLN, Worcester. 

THOMAS H. GAGE, M. D., Worceste)\ 



KESIDENT OFPICEKS 
BARNARD D. EASTMAN, M. D., . 

JOHN G. PARK, M. D., 

HOSEA M. QUINBY, M. D., .... 
EDWARD LAWRENCE, 



Superintendent, 
Assistant Superintenden t. 
Assistant Physician. 
Acting Steward. 



TREASUKER. 



ALBERT WOOD, 



Worcester. 



OlommDntccaltf) of illa00aj:l)U0dt0- 



TRUSTEES' REPORT. 



To His Excellency the Governor a?id the Honorable Council. 

The reports of the Superintendent and Treasurer, herewith 
submitted, set forth with clearness and precision tlie opera- 
tions of the Hospital during the past year, and its present 
condition. Generally speaking, it may be said that those 
operations have been conducted with fidelity and economy. 
The official staff of the institution have, and, it is believed, 
deserve, the confidence of this Board. 

The finances have been managed with exactness, and upon 
a system which experience has demonstrated to be sound. 
No bill exceeding in amount the sum of twenty dollars can be 
paid by the Treasurer without the previous approval of one of 
the members of this Board, acting as auditor; aud every bill 
of however small amount must be audited before being 
allowed to the Treasurer in his account. The reserved or 
surplus fund in the hands of this officer has increased some- 
what during the past "year ; the prospect of removal to the 
New Hospital within a year rendering it, in the judgment of 
the Trustees, advisable to limit somewhat the amount ex- 
pended in repairs on the old. 

The whole number of patients treated in the Hospital during the 
past year has been ........ 829 

The number in the Hospital at the present time is . . 487 
of private patients, ...... 132 

of state patients, ...... 35 

of town patients, ...... 320 



6 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

The Hospital is and has been, as it must be till the com- 
pletion and occupancy of the new building, crowded in every 
part. The best results of treatment cannot be attained under 
these circumstances, but it is believed that all has been accom- 
plished which could reasonably have been expected in the 
way of cure, improvement, or alleviation of suffering. 

New Hospital. 

The buildings of the New Hospital are approaching com- 
pletion, and will, it is hoped, be ready for occupancy in the 
summer of 1877. The work has been carried on with vigor 
during the past season, and, it is believed, has been faithfully 
performed. No effort on the part of the Trustees has been 
spared that all contracts should be honestly fuliilled. To this 
end there has hardly been a day during the season of building 
in which some one of their number has not been present. The 
amount of labor thus entailed upon the Board was not antici- 
pated when the duty of constructing a new hospital was 
imposed upon them by the Legislature. It is hoped the result 
will show that this duty has been fully discharged, and that, 
at the same time, the care and supervision of the Old Hospi- 
tal have not been neglected. 

The amount appropriated by the Legislature for the comple- 
tion of the Hospital will, it is believed, be sufficient, and it 
is not the intention of the Trustees to recommend any further 
appropriation for that purpose. The amount required for 
furnishing will depend, in a great degree, on the disposition 
the State shall make of the present hospital buildings. If 
they shall be devoted to any public charitable use, it will prob- 
ably be considered the wisest economy to retain in its present 
location the furniture now in use there. Otherwise, a con- 
siderable portion of it may be made available at the New 
Hospital. 

The following statement is submitted, which sets forth the 
amounts of money expended in the purchase and preparation 
of site and erection of buildings, up to the present time. 
Vouchers in detail for the whole of this expenditure are on 
file in the office of the Auditor of the Commonwealth. 



1876.] 



PUBLIC DOCUMENT— No. 23. 



New Hospital Account. 

The whole amount expended on the New Hospital 
buildings and grounds, at the close of the fiscal year 
ending September 30, 1875, was .... 

The expenditure during the fiscal j- ear ending Septem- 
ber 30, 1876, was ....... 

Total, 



,117 52 
289,182 22 
$879,299 74 



This total expenditure is classified as follows :- 



Land, ...... $112,247 71 

Barns and cottages, .... 18,873 74 

Grading, excavation, etc., . . . 69,497 85 

Foundations, 34,926 34 

Superstructure, masomy, . . . 333,992 79 

Carpentr3^ 135,971 73 

Painting, windows, guards, etc., . 18,636 54 

Water, gas, drainage, . . . 31,146 69 

Heating and ventilating, . . . 44,021 54 

Plastering, 27,321 97 

Architects, engineers, overseers, etc., 24,047 38 

Roads and grading pertaining thereto, 7,906 12 

Machinery, 6,485 87 

Miscellaneous, 10,985 18 

Expenses laying out old land and con- 
structing streets, .... 3,238 29 



,299 74 



The amount charged to " laying out old land " is not prop- 
erly a part of the cost of the new buildings, but it appears in 
the account for the following reason : — 

In accordance with an Act of the Legislature, the governor 
and council ordered $25,000 to be credited to the fund for 
constructing the new buildings, as compensation for the site 
occupied by the normal school, which amount was to include 
the construction of " suitable streets to and around said land." 
The $25,000 having all been carried to this fund, the expense 
of laying out and constructing the streets must obviously be 
charged to the same fund. 



8 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

A note for $2,500, given by the Trustees to Sarah Phillips, 
for land purchased of John Bartlett, is still unpaid, owing to 
a temporary legal disability on the part of the holder to 
receive the payment. 

JOHN D. WASHBURN. 
JAMES B. THAYER. 
R. W. HOOPER. 
WM. S. LINCOLN. 
THOMAS H. GAGE. 



1876.] 



PUBLIC DOCUMENT— No. 23. 



OFFICEES AKD THEIR SALARIES. 



B. D. Eastman, M. D. (Superintendent), . 
J. G. Park, M. D. (Assistant Superintendent), 
H. M. Quinby, M. D. (Assistant Phj'sician), 
Edward Lawrence (Acting Steward), 
Albert Wood (Treasurer) , . . . 



$2,500 00 

1,500 00 

1,000 00 

600 00 

500 00 



YALUE OF STOCK AWD SUPPLIES. 

Septembek 30, 1876. 



Live-stock, $6,075 00 

Produce of farm on hand, 5,121 82 

Carriages and agricultural implements, . . . 4,960 00 

Machinery and mechanical fixtures, .... 500 00 

Beds and bedding in inmates' department, . . . 11,902 00 

Other furniture in inmates' department, . . . 10,303 45 
Personal property of the State in Superintendent's 

department, . . - 12,011 63 

Dry goods, 2,333 15 

Provisions and groceries, ...... 3,501 04 

Drugs and medicines, 425 00 

Fuel, 2,289 45 

Library, 575 00 

Total, $59,997 54 

2 



10 LUNATIC HOSPITAL AT WORCESTER. [Oct. 



TREASURER'S REPORT. 



To the Trustees of the Worcester Lunatic Hospital. 

Gentlemen : — I herewith submit my Annual Report on 
the finances of the Worcester Lunatic Hospital for the year 
ending September 30, 1876. 



Receipts. 
Cash on hand September 30, 1875, .... 

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 for interest and sale of produce, etc.. 



^21,857 17 

10,762 65 

59,463 06 

, 39,712 55 

2,853 96 

$134,649 39 



The expenditures for the year have been as follows :- 



Provisions : 
Flour, 759 barrels. 
Meat of all kinds, 
Meal for cooliing, 
Beans, potatoes and other vegetables, 
Fish, .... 
Sugar, 

Molasses and syrup, . 
Tea, .... 
Coffee and chocolate, . 
Rice and crackers, 
Butter, 
Vinegar and pickles, . 

Amount carried forward, 



$5,736 


48 


11,632 


88 


508 


64 


820 


06 


1,239 


09 


2,807 


17 


588 


02 


825 


47 


965 


53 


616 


54 


5,479 


18 


34 


81 


$31,248 87 



1876.] 



PUBLIC DOCUMENT— No. 23. 



11 



Amount brought fortvaoxl, 
Cheese, .... 
Fresh fruits. 
Eggs, salt, and other groceries, 

Total for provisions, . 



$31,248 


87 


250 


77 


299 


39 


2.078 


59 



$33,877 62 



Salaries and wages. 

Provender and bedding for stock, 

Furniture, crockery, bedding, etc., 

Light, 

Soap, .... 

Medical supplies, 

Live-stock, . 

Carriages, harnesses, blacksmithing, etc.. 

Improvements and repairs, . 

Books, stationery and printing, 

Travelling and transportation, 

Fuel, .... 

Freight and express, . 

Ice, .... 

Trustees' expenses. 

Miscellaneous, 



Clothing and materials, 
Undertaker's charges, . 
Furnished to patients on account, 
Interest, . . . . . 



Cash on hand, September 30, 1876, 



Resources. 
Cash on hand, ..... 
Due from the Commonwealth, 

from cities and towns, . 

from individuals, .... 

Amount carried forward, 



34,810 62 

1,970 22 

3,679 55 

2,592 75 

1,165 79 

848 62 

155 00 

1,052 92 

3,428 78 

1,139 69 

24 75 

7,187 59 

119 60 

384 83 

168 74 

1,839 52 



$94,446 


59 


5,595 


29 


934 


05 


331 


97 


175 


00 


$101,482 90 


33,166 


49 


$134,649 39 


$33,166 49 


2,489 


60 


15,361 


21 


9,758 


71 



),776 01 



12 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

Amount brought forward, ..... $60,776 01 
Liabilities. 
Due for supplies, ..... $5,348 30 

for salaries and wages, . . . 2,987 27 

8,371 57 



$52,404 44 
Invested funds, market value, 5,391 05 



Total surplus, . . . . . . . $57,795 49 

ALBERT WOOD, Treasurer. 

Worcester Lunatic Hospital, October 1, 1876. 



1876.] 



PUBLIC DOCUMENT— No. 23. 



13 



SUPERTOTEISTDENT'S REPORT. 



To the Board of Trustees of the Worcester Ltmatic Hospital. 

Gentlemen : — Another year of our hospital work having 
come to a close, I lay before you the Forty-Fourth Annual 
Report. 

A summary of the movement of population is given in 
the following; table : — 



Table No. 1. 

Showing the General Results during the year. 





Males. 


Females. 


Total. 


Patients in the hospital, October 1, 1875, 


225' 


253 


478 


Admitted during the year, 


194 


157 


351 


Whole number under treatment, 






419 


410 


829 


Discharged recovered, . 






41 


31 


72 


impi'oved, . 






37 


60 


97 


not improved, 






47 


49 


96 


died, . . " . 






45 


32 


77 


Whole number discharged, . 






170 


172 


342 


Remaining September 30, 1876, 






249 


238 


487 


Largest number on any day, Feb. 28, 1876, , 


249 


278 


527 


Smallest number on any day, Oct. 5 and 6, 75, 


223 


251 


474 


Daily average during the year, 


241.45 


258.75 


500.20 


of state patients. 


27.23 


26.15 


53.38 


of town patients, 


155.76 


154.30 


310.06 


of private patients, . 


58.46 


78.30 


136.76 



14 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

The number of patients at the lieginning of the year, four 
hundred and seventy-eight (478), exceeded the number at 
the beginning of any previous year, except the one next pre- 
ceding and the two (1853 and 1854) just before the opening 
of the Taunton Lunatic Hospital. 

The number of admissions, three hundred and fifty-one 
(351), were less than for each of the six previous years, 
while, on account of fewer discharges, the number remaining 
at the end of the year, four hundred and eighty-seven (487), 
was larger than at any time since the opening of the Hospital, 
with the exception of the years already mentioned. 

Two patients were discharged from the rolls of the Hospital 
to be commuted by probate court, that the cost of their main- 
tenance could be collected from the towns in which they had 
settlements. The number of patients received was, there- 
fore, three hundred and forty-nine (349). Five persons 
were each received twice, the number oi persons admitted 
being three hundred and forty-four (344). Of these, about 
two-thirds, two hundred and forty-seven (247), had never 
before, so far as we could ascertain, been under hospital 
treatment, but many of them were chronic cases of long 
standing, entirely hopeless as to recovery, and with but little 
prospect of even improvement. About one-third were either 
cases of brain disease, essentially incurable, or those in which 
treatment had so long been delayed that the disorder had 
become ineradicably fixed. 

Of those discharged, seventy-two (72) are classed as re- 
covered. It is extremely difiicult, impossible indeed, in some 
cases, to decide whether a person should, upon discharge, be 
considered recovered or not. Some who seem to be entirely 
restored, and are sent out with the confident expectation that 
they will do well, disappoint us, and a large number whose 
cases can conscientiously only be entered as improved, com- 
plete their recovery afterwards. Inasmuch, also, as there is 
no fixed standard by which the mental condition of a dis- 
charged patient can be accurately gauged, the decision of the 
question must be somewhat afiected by (to borrow an astro- 
nomical term) ^''personal equation" and the record of the 
results of treatment will be more or less " the reflex of a 
mental temperament which may be unduly swayed either by 



1876.] PUBLIC DOCUMENT— No. 23. 15 

a natural hopefulness or an equally natural cautiousness of 
character." Indeed, it would seem from a comparison of the 
statistics of different hospitals, that the earlier superintendents 
must have classed as recovered, patients who would now be 
considered only improved. 

The distinguished superintendent of the Bloomingdale 
Asylum, New York City, in his last report, remarks upon 
this point as follows : — 

" There can be little doubt, at this time, that the innate traits of 
mind and heart which made the earlier race of hospital superin- 
tendents such zealous and successful workers in a new region of 
beneficence, led them also to form and express more encouraging 
opinions as to the curabilitj' of insanity than are justified b}' later 
experience on a broader scale. 

" Fortunatel}^, after making considerable allowance for enthusi- 
asm, and possibly, also, for a sagacious shrewdness which perceived 
the necessity for stirring public interest in a cause likely to languish 
unless ' hope told a flattering tale,' there is such positive and obvious 
good effected by hospitals for the insane as to call for their increase 
in number, or the enlargement of those which must receiA^e the indi- 
gent insane of every State or large city." 

The largest number in the house on any day, five hundred 
and twenty-seven (527), was one hundred and sixty-two 
(162), and the average number, five hundred (500), was one 
hundred and thirty-five (135), in excess of our accommo- 
dations. An examination of our dormitories and corridors, 
after the patients have retired, would lead any one to wonder 
how we had passed the year without serious accident, unless 
there be a special providence that watches over crowded 
lunatic hospitals. Not only are we numerically crowded, but 
we are oppressed by the perturbed condition of our popula- 
tion. The large number of cases admitted compels us to seek 
the discharge of those who can be cared for elsewhere. This 
takes away many of the quiet and orderly, who might safely 
occupy dormitories and corridors, while the disproportionate 
accumulation of the unavoidable residuum, noisy, turbulent, 
and disturbing, operates unfavorably against the comfort and 
success of the Hospital. 



16 LUNATIC HOSPITAL AT WORCESTER. [Oct. 



Table No. 2. 

Showing the Complications in the Cases admitted during the Year, 





Males. 


Females. 


Total. 


Epileptic, 


6 


5 


11 


Epileptic and homicidal, 






1 


- 


1 


Paralytic, .... 






14 


4 


18 


Paralytic and homicidal, . 






3 


1 


4 


Suicidal, 






14 


21 


35 


Homicidal, .... 






37 


12 


49 


Suicidal and paralytic, . 






2 


1 


3 


Suicidal and homicidal, . 






11 


1 


12 


Total number of cases epileptic. 






7 


5 


12 


Total number of cases paralytic, 






19 


5 


24 


Total number of cases suicidal, 






27 


23 


50 


Total number of cases homicidal, 






52 


14 


66 



Table No. 3. 

Showing the Relations of the Patients admitted to Institutions of this 

Mnd. 



Never before in any hospital. 
Former inmates of this hospital. 



of other hospitals in this 
State, 

of hospitals in other States 

of this hospital and of other 
hospitals in this State, 

of other hospitals in this 
State and hospitals in other 
States, 

of this hospital, of other hos- 
pitals in this State and of 
hospitals in other States, 

of this hospital and of hos 
pitals in other countries. 



Totals, 



144 
35 

5 

2 



194 



103 
37 

7 
2 



1 

157 



247 

72 

12 
4 

11 



2 
351 



1876.] 



PUBLIC DOCUMENT— No. 23. 



17 



Table No. 4. 

Showing the Sources from lohich the Patients admitted were directly 

drawn. 





Males. 


Females. 


Total. 


From the general population, 

McLean Asylum for the Insane, . 

Tewksbury Almshouse, 

Ipswich Receptacle, .... 

Houses of Correction, .... 

State Prison, ...... 

Northampton Hospital for Insane, 
Readmitted without discharge from hospital, 


175 

1 

2 
12 
2 
1 
1 


147 

1 
3 

5 
1 


322 
1 

4 
2 
17 
2 
1 
2 


Total, 


194 


157 


351 



Table No. 5. 

Showing hy whom the Patients^ remaining at the end of the Year^ 

are Supported. 



By the State (state patients), . 

Town (town patients). 

Friends (private patients), 

Total, .... 



20 


15 


171 


149 


58 


74 


249 


238 



35 
320 
132 

487 



18 LUNATIC HOSPITAL AT WORCESTER. [Oct. 



Table No. 6. 

Showing the alleged Causes of Insanity in the Number of Cases 
admitted during the year. 









Number 


3F Cases. 


NUIIBEK PkEDISPOSED. 


CAUSES. 


Males. 


Females. 


Males. 


Females. 


Business anxiety, .... 


10 


- 


5 


- 


Confinement in prison, 






1 


- 


- 


- 


Congenital, 






1 


- 


1 


- 


Disappointed affection. 






1 


2 


1 


- 


Domestic trouble, . 






- 


4 


- 


1 


Epilepsy, . 






8 


3 


3 


1 


Fright, . 






1 


- 


- 


- 


Grief, 






4 


4 


2 


- 


General paralysis, . 






7 


- 


1 


- 


Hard study, 






3 


- 


1 


- 


Hereditary, 






23 


15 


23 


15 


Ill-health, 






3 


11 


2 


8 


Injury to head, 






2 


3 


- 


- 


Intemperance, . 






32 


6 


12 


4 


Masturbation, . 






8 




3 


1 


Nervous debility, . 






- 




- 


- 


Old age, . 






- 




- 


- 


Overwork, 






6 




1 


- 


Paralysis, 






1 




- 


- 


Pecuniary trouble, . 






1 




- 


- 


Puerperal, 






- 


14 


- 


9 


Religious excitement, 






5 


10 


1 


6 


Sunstroke, 






4 


- 


3 


- 


Syphilomania, . 






1 


- 


1 


- 


Turn of life, . 




- 


3 


- 


1 


Uterine disease, 




- 


4 


- 


- 


Unascertained, 




72 


73 


- 


- 




194 


157 


60 


46 



1876.] PUBLIC DOCUMENT— No. 23. 19 

Although tables of the causes of insanity, as given in hos- 
pital reports, are not entirely trustworthy, they challenge 
close investigation, and they warrant us in saying that a very 
large proportion of insanity arises from transgression of 
known natural laws. For instance, intemperance stands, 
every year, one of the most prominent causes, and we know 
its direct influence upon the offending individual is not over- 
rated. We know, too, that it is a large factor in domestic 
trouble, general paralysis (itself the disease rather than 
cause), ill-health, business anxiety, etc. Hereditary predis- 
position is not only competent to develop insanity without an 
appreciable exciting agency, but it is the first element of 
weakness in a large proportion of the remaining cases. A 
prime factor in those cases attributed to ill-health, the puer- 
peral state, religious excitement, etc., is a lack of due 
strength and proper balance of the mental and nervous 
organization, dependent upon faulty education, insufficient 
self-control, irregular life, bad dietetic habits, etc. 

Closely allied to this subject, — the causation of insanity, — 
is that of its prevention. The study of the former is of prac- 
tical value, mainly, as it aids in accomplishing the latter. 
But the words of warning and instruction which have been 
given on this topic, line upon line and precept upon precept, 
seem, in a very surprising degree, to have been overlooked 
and unheeded. 

About two years ago, by authority of an Act of the Legis- 
lature, two gentlemen, distinguished alike for their enthusiastic 
philanthropy and active beneficence, were appointed to inves- 
tigate certain aspects of the subject of insanity. The report 
submitted b}' one of the gentlemen contains the following 
paragraph, which is quoted approvingly from " one who has 
had great experience in such matters " : — 

" Hospitals do not prevent insanity, because they do not, by the 
intercourse of their officers with society at large, by their published 
reports, and by their general relations to the public, seek to enlighten 
the people on the subject of insanity, — its predisposing causes, its 
hereditary tendencies, its relations to intemperance, ignorance, pov- 
erty, and crime, — and therefore they do not improve the community 
except in removing from its care some of its greatest burdens. An 
examination of hospital reports will show that they are chiefly filled 



20 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

with plans, suggestions, and arguments for the continuance of the 
system already established, and that they rarelj^ propose a wider 
field of usefulness or a more humane management of their inmates." 

In the twelfth annual report of the Board of State Charities, 
under the topic, "The Prevention of Insanity," it is stated : — 

" In the multitude of reports of hospitals and asylums, published 
from year to year, this question of prevention seems in a great 
measure to have been overlooked. From a cursory examination of 
more than fifty reports of our own three state hospitals, it would 
seem that the onl}^ distinct notice of possible prevention is in the 
Tenth Report of the Taunton Hospital." 

The primary object for the establishment of a lunatic hos- 
pital is, "the most humane and enlightened curative treatment 
of the insane," and a secondary one (which is on some accounts 
no less important than the first) is the care and custody of 
the incurable insane who need protection on their own 
account, or whose seclusion is necessary for the safety of 
society. With these responsibilities accomplished, a lunatic 
hospital has done all its direct duty. But every one is bound 
to do what he can, in his own proper sphere, for the general 
improvement of mankind, and officers of lunatic hospitals are 
not, and do not wish to be, any exception to this principle. 
Every superintendent of such an institution will, inevitably, 
in this age, be a practical philanthropist. Not only will he 
feel a deep interest in the welfare of his patients, but gather- 
ing, from his intimate relations to them and to their friends, 
a personal knowledge and keen appreciation of the extent 
of the wretchedness and woe caused by insanity, he cannot 
fail to labor for its prevention. 

The charge against the officers of lunatic hospitals, of not 
seeking to enlighten the people on the subject of insanity, is 
not well founded, and our own three state hospitals are 
especially free from any ground of complaint on this score. 
To substantiate this statement, to vindicate the hospitals of 
our own State, and, with the hope that a partial recapitulation 
of what has been written on this subject may be productive 
of good, some quotations from the published reports of these 
institutions are embodied in this Report. 



1876.] PUBLIC DOCUMENT— No. 23. 21 

The exact bearings of this whole subject were well enun- 
ciated in a few brief but pregnant sentences in the Report of 
the Trustees of the State Lunatic Hospital at Worcester for 
1838, which was written by that distinguished philanthropist, 
the late Horace Mann : — 

" The great object at the Hospital is the cure of insanity or the 
mitigations of its sufferings. The great object of the State and 
of individuals should be its prevention." 

And in a later report, the superintendent says : — 

" In a document like this, it is only proper to offer Jiints, not to 
discuss principles." 

The truths contained in these quotations underlie the whole 
scheme of hospital work and the broader field of the duty 
society and the State owe themselves in this matter. The 
hospital, as far as possible, is to cure its patients or mitigate 
their condition, and the results of hospital observations are 
briefly to be given to the public. To the State, to indi- 
viduals, to the devotees of social science, is intrusted the 
amplification and application of these truths to the prevention 
of insanity. For nearly half a century the hospital has been 
faithfully fulfilling its duty. Has the State, have individuals, 
has society done theirs as well? The hospitals have no 
antagonism to any well-digested scheme of what has been 
happily called " State Medicine," as applied to the prevention 
of insanity ; but it should not be forgotten that the subject 
has repeatedly received their attention. 

Almost every report which has emanated from the Worces- 
ter Lunatic Hospital since its opening, in 1833, is replete 
with enlightenment "on the subject of insanity," and "its 
predisposing causes, its hereditarj- tendencies, its relations to 
intemperance, ignorance, poverty, and crime," are succinctly 
but earnestly set before the community. Every table of the 
causes of insanity is an argument in favor of physical, men- 
tal, and moral hygiene, an essay on the prevention of insan- 
ity, and the context drives home the startling tabulated facts. 

In the report for 1838, to which reference has already been 
made, both the trustees and the superintendent discuss, in a 



22 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

very thorough and comprehensive manner, the causes of 
insanity and the means by which it can be prevented. 

The bearing of hereditary predisposition is discussed ; the 
marriage of those affected with, or strongly predisposed to, 
insanity, is held to be a violation of "one of the highest of 
human responsibilities"; the warning is given, that while 
ancestors continue to violate this law, "some portion of their 
innocent descendants must bear the consequences," and 
" should those to whom the dreadful heritage has descended 
imitate the conduct of their ancestors, the disease may be 
perpetuated in the lineage for generations to come " ! 

Alas ! this effort to enlighten the people on the hereditary 
tendencies of insanity has proved unsuccessful. The de- 
scendants of those who ought to have heeded this advice, but 
did not, can now be counted by hundreds among the insane 
of this Commonwealth. 

Strong appeals are made in other pages of this Report for 
the prevention of insanity, by avoiding those pernicious 
practices and habits which so frequently sap the nervous 
energy and produce permanent mental derangement, and by 
maintaining that mental and moral equanimity so conducive 
to the preservation of our highest powers. 

The distinction between those causes of insanity which are 
under the immediate control of the individual, and those 
which are not, is sharply drawn, and the avoidance of volun- 
tary insanity is urged upon all as a duty demanded both by 
the welfare of the individual and the prosperity of the State. 

In the following year, the causes and prevention of insanity 
are discussed at length by the superintendent, in part as 
follows : — 

" I would by no means overlook predisposition in examining the 
causes of insanity, but believe that temperament, misdirected edu- 
cation, active passions, and propensities not subject to the control 
of the mind, the neglect of intellectual culture, and more especially 
the neglect of establishing the control of the high moral sentiments, 
results in insanity far more frequently than a hereditary taint ; these 
may also increase predisposition which before had little tendency 
to become active. 

" A defective and faulty education, through the period of infancy 
and childhood, may, perhaps, be found to be the most prolific cause 



1876.] PUBLIC DOCUMENT— No. 23. 23 

of insanity ; by this, in many, a predisposition is pi'oduced, in 
others it is excited, and renders uncontrollable the animal propen- 
sities of our nature. Appetites indulged and perverted, passion 
unrestrained, and propensities rendered vigorous by indulgence, 
and subjected to no salutory restraint, bring us into a condition in 
which both physical and moral causes easily operate to produce 
insanity, if they do not produce it themselves. 

" Of the existing causes of insanity, intemperance still stands at 
the head of our list . . . it is not only the cause of disease, but it 
is emphatically the cause of causes. It is quite impossible to 
enumerate the amount of influence which it has in producing ill- 
health, domestic affliction, loss of property, and a large number of 
other causes, which stand so prominent in the table." 

Again, iu 1840 : — 

" Those first principles of physical education which teach us how 
to avoid disease, are all-important to all liable to insanity from 
hereditary predisposition. The physical health must be attended 
to, and the training of the faculties of the mind be such as to 
counteract the active propensities of our nature, correct the dis- 
position of the mind to wrong currents and too great activity, by 
bringing into action the antagonizing powers, and thus giving a 
sound bod}' and a well-balanced mind. Neglect of this early train- 
ing entails evils upon the young which are felt in all after-life. 

" The most frequent causes of predisposition to insanity are un- 
restrained indulgence of temper, unbridled appetites and desires, 
pernicious mechanical restraints upon the free movement of organs 
essential to life, improprieties of dress, excessive effeminacy or 
ill-directed education, by which the individual is not prepared to 
meet the vicissitudes and trials which must be encountered in the 
trials of life, and particularly from that intensity of the mind and 
feelings, .which is too often encouraged, but which over-taxes the 
young brain and excites it to morbid irritation or actual disease." 

In the ninth annual report (1841), the superintendent, in 
a few bold strokes, vividly depicts the hopeless character of 
insanity accompanied with paralysis and exaltation, and 
points out the connection of such cases with intemperance. 
Although he does not give this form of disease the name by 
which we now know it, the picture is unmistakable ; he is 
describing general paralysis, and he truly says "they will 
inevitably cZi'e." 



24 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

The subject is again taken up in the tenth report (1842), 
as follows : — 

"Those who have hereditary predisposition to insanity, and 
especially those who have periodical attacks in one or more recur- 
rences of disease, should carefully avoid all the voluntary causes of 
insanity, — such as intemperance, the secret vice, all excitements of 
a political or religious character, speculations, inventions, and every 
other unnatural excitement of the mind and feelings which may 
incur the tendency to disease. 

" A great proportion of our trials and sufferings are the result of 
our violations of the natural laws of life which are established for 
our guidance and to promote the happiness of our being. Here 
lie the causes of moral and physical evil, of disease, crime, and 
suffering. Here may also be found the causes of insanity. 

" We live in an age of excitement ; we love freedom of thought 
and inquiry, and, regardless of settled principles, wander into the 
false fields of speculation in search of something more to gratify, or 
something pleasant to enjoy. 

" Excitement is the aliment of our people ; it prompts them to 
new enterprise in business, to seek for new theories in politics, and 
novel schemes of religious faith, which at this time seem to be dis- 
turbing the quiet repose long felt in creeds which our fathers pro- 
fessed, and which have caused the stability of other times. 

"Political strife, religious vagaries, over-trading, debt, bank- 
ruptc}', sudden reverses, disappointed hopes, and the fearful looking 
for of judgments which are to dissolve the natural elements of time, 
all seem to have clustered together in these times, and are generally 
influential in producing insanity. The hospitals are filling up most 
fearfully with the victims of these evils, and the predisposed and 
periodical are, in great numbers, plunged by them into the vortex 
of disease. 

" There is undoubtedly an intimate connection between education 
and insanity^ especiallj^ between early training and that condition 
of the brain which is manifested in precocious mental development. 

" One of the great defects, both of nursery and school education, 
is the neglect of proper training of the bodily powers during child- 
hood and youth. 

" Next to neglect of the proper training of the locomotive system 
in producing physical imbecility and disease, is a pernicious system 
of dietetics, pampering the appetite with improper food, condiments 
and confectionery, inducing dyspepsia, the more inveterate because 
produced before the natural tone and vigor had been given to the 



1876.] PUBLIC DOCUMENT— No. 23. 25 

stomach when its susceptibility is greatest and its powers of en- 
durance least. 

" The evil," (ignorance or neglect of natural laws) " well under- 
stood, leads to the remedies which education must appl}' to counteract 
it. Firm and healthy bodies, brains, lungs, stomachs, and moving 
powers, must be first secured. Care must be taken that none of 
them be over-taxed. The precocious and feeble must be taken 
from their books and put to active exercises ; the robust and vigor- 
ous must be taken from cruel exercise and sports, and put to study 
and more placid enjoyments, lest with vigor they become unfeeling 
and pugnacious. 

" Some of the mental faculties may need restraint, and others 
encouragement ; active passions and propensities must be repressed, 
and all be kept under the guidance of the intellectual and moral 
powers. Firmness and cheerfulness under trial and suffering should 
be duly cultivated, that the evils which cross our paths may be 
borne where they cannot be avoided. In this way the ills of life 
may be endured without repining, the source of many diseases 
dried up at the fountain, and the causes of insanity be diminished 
both in number and severity." 

In the thirteenth annual report (1845), the Trustees make 
use of the followino; lano;uao:e : — 

" In the report of the Superintendent, much valuable information 
is communicated in relation to the causes and treatment of insanit}'. 

" The Trustees regard the diffusion of such information as an 
important collateral advantage of the Hospital. 

" A knowledge in the community of certain causes that induce 
insanit}', will tend to their removal." 

The report to which. these remarks apply is the last written 
by that disthiguished alienist, Dr. Samuel B. Woodward. 
In it he points out the fact that insanity frequently arises from 
intemperance and other excesses ; that transgression of natural 
laws will be followed by due penalty ; that the grovelling sen- 
sualist ruins his body, and mind, and soul ; that constitutional 
tendencies to insanity must be Avarded off by due observation 
of the laws of health ; that danger lies in unrestrained passion, 
ungoverned appetite, and unlimited indulgence ; that suitable 
training develops strength of character with which to meet 
the ills and calamities of life ; that the foundation of a useful 

4 



26 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

career must be laid by correct discipline in youth ; that in the 
neglect of these and other principles of physical, mental, and 
moral hygiene, lie the foundation of disease, and especially of 
insanity ! 

The preceding extracts comprise but a part of what is to 
be found in the first thirteen reports of the Worcester Lunatic 
Hospital. 

It Avill be observed that the first quotations are from the 
sixth annual report, a careful reading of which will show that 
the officers of the hospital had well improved their opportuni- 
ties for observation, and had, even then, grasped the whole 
subject of prevention of insanity ; and that they did, in fact, 
give the public such enlightenment on " the subject of insan- 
ity, predisposing causes, its hereditary tendencies, its rela- 
tions to intemperance, ignorance, poverty, and crime," that, 
had this advice been heeded, Massachusetts would not at this 
moment be engaged in the cure of so many insane. 

For the next nine years, the Hospital was under the charge 
of Dr. George Chandler. Several of his reports contain able 
discussions of the cause and prevention of insanity, from only 
one of which, the nineteenth (1849), shall I quote : — 

" The prevention of insanity should be the aim of an enlightened 
community, as well as its cure. This could be most effectually 
done by each individual obeying the laws of health, which include 
those that regulate the passions and emotions of the mind, as well 
as those that govern the ph^^sical system. For the full and healthy 
development of the offspring, the parents must be health}^ and 
active in body and mind. The children of the unhealthy and indo- 
lent are less numerous and less hardy than the children of those in 
more humble and more laborious stations in society. Hereditar}' 
predisposition to disease, which is either inherited from ancestors or 
acquired by the parents themselves by abuse of their own physical 
S3'stems, is transmitted to the lineal descendants, whose systems are 
thereby rendered more susceptible. In such persons, a smaller ex- 
citing cause would bring on similar diseased action than would be 
necessary in one having no hereditary susceptibilit}', whether the 
malady be of the brain or of any other organ. . 

" The phj'sical education of the young is of primary importance. 

"Many mechanical employments are prejudicial to health, and the 
younger the operative, the more susceptible his sj'stem is to any 
malign influence that may be brought to bear upon him. All em- 



1876.] PUBLIC DOCUMENT— No. 23. 27 

ployments that require undue physical exertion, all where an impure 
atmosphere is inhaled, and all where one position is for a long time 
maintained, are unfavorable to free development of the body, induce 
various diseases, and shorten life. 

" The proper education of the moral and intellectual faculties, is 
of immense importance to the individual's own happiness and to his 
usefulness to society. The character and conduct of those around 
him is the book from which he gets his first lessons in morals and 
self-government. As his faculty of imitation is very active, and by 
which he acquires much of his early knowledge, the moral obliquity 
of his nurse is as readily copied as her wisest example. The desire 
to gratify the appetite and to indulge the passions too often become 
governing principles with the young, and, unless this desire is 
restrained with a steady hand on the part of the parent or guardian, 
it becomes ungovernable and makes the individual unhappy in after- 
life, and an undesirable member of society. Libert}^ is the right of 
all ; but, to enjoy this blessing, it is necessary that each member of 
the community should refrain from trespassing on the rights of 
others. Children should be taught, and early led to practise, this 
precept. Every one who should have, and who should observe a 
just application of liberty and of what was due from himself to 
others, would become a law unto himself, and not be incommoded by 
anj' wholesome law of the community ; but he who has been taught 
to disregard the rights of others, can hardly fail to receive the con- 
demnation of his fellow-men. 

" The inducements of wealth and of places of honor, in this 
country-, are equally presented to all competitors who may enter the 
lists, and success usually crowns the well-directed efforts of all in 
every branch of- trade, and in all arts and professions. The ardent 
and ambitious are by these considerations stimulated to overtask 
their physical and mental powers. The allurements of science 
stimulate its votaries to long-continued trains of thought upon one 
subject, until the instrument of thought becomes fatigued and is 
liable to respond in an unhealthy tone, until strange fancies and 
delusions, upon that subject, arise in the mind. These delusions 
become permanent and real unless the attention is diverted to other 
subjects, and the brain gets relief from its incipient disease ; but 
with the great mass of the communitj', the all-absorbing desire of 
wealth and the advantages it brings to its possessor, are the princi- 
pal motives to action. The merchant expands his business be3'0nd 
his personal supervision, and he trusts his property with his neigh- 
bors, with a hope of compound interest in return. He watches 
anxiously the rise and fall of the market. He is elated with pros- 
perity, but the unseen reverses which come in the commercial world, 



28 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

as well as in all others, bring ruin to his hopes and not unfrequentl}^ 
crush his reason. The speculator ventures deeper and deeper, while 
successful, but at last he is wrecked in his calculations, and his mind 
sinks in the storm, unless it is buoyed up by a well-educated self- 
control. 

" Many persons in humble circumstances work hard and make 
great exertions to keep up respectable appearances, and to obtain 
those articles of luxury which the wealth of their neighbors enable 
them to make common use of. This overdoing to keep up appear- 
ances tends to break down some and bring on insanity." 

From 1856 to 1872 the Hospital vras under the superin- 
tendency of Dr. Merrick Bemis, who pointed out that many, 
very many, cases of insanity are caused by "irregular habits 
of life," by "faulty education," by "the popular excitements 
of the day," etc. 

He directs attention to the fact that " the parent, while neg- 
lecting the moral and physical training of his child, may be 
laying the foundation of a train of infirmities, both in body 
and mind, that in the strength and passion of manhood shall 
break out in uncontrollable insanity." 

In the report for 1860, several pages are devoted to the 
discussion of the causes of insanity, through the studying of 
which we may hope to " be able to exercise some control over 
the conditions which produce so great an evil," Particular 
attention is called to the observation, that perverted action of 
the "mind results from defect in its material instrument, that 
whatever disturbs the general health, whatever weakens the 
bodily powers, disturbs and deranges the healthy operations 
of the mind. The mind is depressed, irritable and morose, 
or calm, clear and cheerful, according as the body is well fed, 
properly clothed and thoroughly exercised." He touches 
upon the necessity of keeping the digestive apparatus in good 
order, of the importance of a judicious system of physical 
education, and upon similar topics, and expressly states that 
"every condition and circumstance in life which has a tend- 
ency to diminish vital force . . . promotes the develop- 
ment of insanity." 

The foregoing quotations comprise but a small part of what 
has been given to the world by the Worcester Hospital, in the 
forty-two years of its existence, on the causes and j)revention 



1876.] PUBLIC DOCUMENT— No. 23. 29 

of insanity. The whole subject is well epitomized in three 
lines from the report for 1875 : — 

" An ounce of prevention is worth a pound of cure. It is to the 
careful observance of the laws of physical, mental, and moral 
hygiene we must look for a diminution of insanity." 

About twenty-one years after the first patient was received 
at Worcester, the second State Lunatic Hospital was opened 
at Taunton, the first report being published in 1854. Almost 
every report from this institution has given the people en- 
lightenment on the subject of insanity, ably discussed its 
causes, and pointed out the methods by which it can be pre- 
vented. 

In the fourth annual report (1857), intemperance, as a 
prolific cause of insanity, is referred to as follows : — 

" The number of cases arising from intemperance has greatly 
increased during the past year. Among the men, they have con- 
stituted thirty per cent, of the whole number of admissions. There 
are also many other cases, doubtless, in which a long course of 
moderate stimulation has predisposed the system to take on this, 
as we know it does to take on various other diseases. 

" The brain cannot be kept for 3'ears in a constant, though it ma}^ 
be slight, abnormal condition, without altering its organic character 
and rendering it liable to at least functional disturbance, which 
constitutes insanity. Many of the cases of softening of the brain 
and of epilepsy result directly fi*om the use of intoxicating drinks. 
In still another way, also, intemperance should be regarded as a 
cause of this disease ; namel}^ by its effects upon the offspring of 
those addicted to it. The habitual use of alcohol is felt through 
more than one generatien ; and though the father ma}- not become 
insane, his children will have an additional tendency to insanity, 
especially if they pursue the same course, as they are likely to, for 
the appetite itself is also transmissible. A large part of the idiots 
and imbecile children are born of intemperate parents." 

The untoward influences of living beyond one's means, of 
a vicious system of education, and of solitary vice, are set 
forth in the fifth and sixth reports, as follows : — 

" There is one cause wliich undoubtedly acts extensively and 
peculiarly in this country, in inducing a condition of mind and body 



30 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

favorable to the successful attack of mental disease. The strife 
which is going on constantly, particularly in the less fortunate 
ranks of life, to better their condition and raise their social position, 
and the great effort which is continually being made, among a large 
class, to keep up appearances under straitened circumstances, giving 
rise to a permanentl}^ anxious state of mind and to long-continued 
over-tasking of the bodily powers, operates powerfully in our 
country in producing a state of mind to be easily disturbed by what 
would otherwise be slight and inefficient as a cause of disease. 
Another cause which undoubtedly acts strongly in this community, 
is the unwise system of educating the young. For the healthy 
adult, fully developed, and used to the kind of labor, six hours daily 
of concentrated mental labor is enough to try his strength and in 
man}' cases ultimately to impair his nervous system. Yet our 
3'oung children, with faculties just beginning to develop, with 
bodies needing almost constant exercise out of doors, and in the 
highest degree susceptible to all influences, whether good or bad, 
are confined for that full period in the regular hours of school, for 
which they are often compelled to spend several more in prepa- 
ration, 

" Next to intemperance and phj^sical derangement, with the 
latter of which causes it undoubtedly has much to do, ranks the 
indulgence in solitary sexual excess. The baneful effects of this 
habit in both sexes have been often dwelt upon, and I believe have 
not been over-rated. As a cause, I fear it is a growing one, increasing 
with increasing luxury, and with the diffusion of precocious knowl- 
edge which marks the present day. Its influence is far greater 
than the preceding table would indicate. That it is the cause of 
many of those functional irregularities which are supposed by 
friends to be the original cause, cannot, I think, be doubted. To 
this cause, to her more delicate sensibility and keener feelings, to 
the restraints imposed by society and custom upon her desires and 
emotions, to the afflictions and disappointments to which she is 
subject, and to the nature of her reading, which is addressed to the 
imagination and the heart, and not to the reason, must be ascribed 
the fact, that woman, free from many of the excesses of man, free 
from many of his labors and trials, still equals him in the number 
of her insane." 

Again, from the seventh report; — 

" In reviewing the table of causes, one cannot help being struck 
with the large proportion of cases which are self-induced. And the 
consideration of this class will be especially useful, if it should lead 



1876.] PUBLIC DOCUMENT— No. 23. 31 

any to the avoidance of practices and habits which are pregnant with 
danger. 

" Too free indulgence of the appetite, whether natural or artificial, 
an abandonment of restraint over the gratification of the senses, 
underlies a very large part of all these cases." 

In his eighth, ninth and tenth reports, Dr. Choate agam 
enforces the necessity of prevention, as follows : — 

" Not less important as a preventive against disease is the 
knowledge of what are its usual and most frequent causes. I have 
spoken so fully in former reports of the particular effects of habits 
which are under the control of each individual, that I will barely 
call attention at the present time to a few of the most prominent 
and potent causes on the list. Intemperance, as usual, stands at 
the head, and has been the acknowledged cause in more than one- 
fifth of all the cases admitted into the institution since its opening, 
where the cause was known. Ill-health, which in a large majority 
of cases covers up some radical defect in the habits of life, and is 
merely a penalty exacted for some offence against nature's laws, is 
chargeable with another fifth. Indulgence in the lower appetites 
and passions, too deep absorption in some of the fashionable excite- 
ments of society, and a want of care for the preservation of the 
health, particularly in females at seasons when their systems are 
peculiarly susceptible to the access of disease, have been assigned 
as the exciting causes in more than another fifth. These combined 
causes, which are with few exceptions self-induced, constitute the 
sources of disease in nearly eighty per cent, of all the cases. 

" Little can be added to what has been said in foriuer years 
respecting the causes of insanity, and the ability to ward off dis- 
ease by correct habits of life, which, with a few exceptions, is placed 
in the hands of all. The present record, no less than those of the 
past, shows an exceedingly large proportion of cases self-induced 
by habits within the control of the individual. In this, as in most 
other diseases, it is not some single act of imprudence, or exposure, 
or excess, which is the cause. It is some long-continued habit 
which slowl}' undermines the physical system, saps the vital ener- 
gies, and gradually induces a depraved and abnormal condition of 
both the mind and body. It is against forming those habits, then, 
that we are to contend, whether the}' consist in excessive labor, in 
exclusive attention to one pursuit, in too complete absorption in 
one train of thought, or in individual gratifications of the senses. 

" There can be no question that those who disregard the moral 
law, and the laws of nature, are not only more liable themselves to 



32 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

insanit}^, but also transmit this liability to their descendants. The 
parent who indulges in excessive use of poisonous substances, or 
who gives way to enervating or debilitating indulgences, even if not 
made insane himself, is exceedingly liable to pay the penalty of his 
transgression in witnessing the horrible epileptic convulsions, or the 
pitiable imbecility, or the more awful maniacal paroxysm, of his 
child. And if the child follows the evil course of the parent, which 
is too apt to be the case, an hereditary family tendency is formed, 
which develops into disease, upon what, under other circumstances, 
would be very far from being a sufficient exciting cause. The more 
we see of mental disease in its various forms, the more we must be 
convinced that the study of its prevention is infinitely more impor- 
tant than even the study of its cure, and that the dissemination of 
more correct views of the true way of life, and a more rigid observ- 
ance of the known laws of health and nature, would greatly dimin- 
ish its frequency." 

The predisposing causes of insanity, its hereditary tend- 
encies, its relations to intemperance, etc., are topics upon 
which the following extracts are found in the eleventh, twelfth, 
thirteenth and fourteenth reports : — 

" Excessive labor, excessive study, excessive indulgences, exces- 
sive zeal for either temporal or religious matters, if they become 
fixed habits of life, are likely to produce mental disease. Both the 
mental and the physical systems are so constituted, that they easily 
and quickl}' rally from the disturbing influence of a single violation of 
nature's law, but a continued habit of excess, in any direction, will, 
in the end, destroy the elasticity of one or both, and disease must 
be the result. 

" In the large majorities of cases, the system is previously pre- 
pared to yield to the exciting influence whenever it may be presented. 
And first among the preparing influences undoubtedly stands heredi- 
tary predisposition. The question, whether any near relatives have 
been insane, is comparatively seldom answered in the negative. 
The inquiry as to how hereditary tendency is formed, is the most 
important one in connection with the whole subject of insanity. 
That hereditary predisposition, like the large portion of the exciting 
causes, is originally within the control of the individual, and is pro- 
duced by some violation of the laws of nature, seems in the highest 
degree probable. Indeed, it is by no means unlikely that the same 
causes ; the same violations of nature ; the same wrong way of life, 
not carried far enough in the first generation to excite disease, may 



1876.] PUBLIC DOCUMENT— No. 23. 33 

in the second or third or farther on, the same tastes and habits 
being transmitted, be finally sufficient by accumulation to produce 
it, or to produce in a whole family a condition of the constitution 
which will make them an easy prey to slight exciting causes of dis- 
ease. And in this manner a man's sins and errors may most 
emphatically be said to be visited upon his children's children. 
Parents may unquestionably do much by a carefully considered plan 
of education and by guarding their children closely from their own 
errors, towards warding off family diseases, and even towards 
breaking up hereditary tendencies. It is a most instructive fact, 
that, in whatever direction we pursue our investigations into the 
causes of this direful disease, we must inevitably be brought to this 
same conclusion : the necessity of pursuing more closely the laws of 
nature ; of obeying more strictly the dictates of a pure and enlight- 
ened morality. 

" A higher civilization and greater cultivation of the intellectual 
powers, bring to the human mind new and deeper hopes and fears, 
the new restraints imposed by society and legislation, new distrac- 
tions by ambition, humiliation, and prosperous or adverse specula- 
tion, more frequent and intense mental efforts, too frequently a 
premature exercise of the intellectual faculties, and too many new 
modes of dissipation and unnatural excitement. The artificial life 
of modern society, while it brings new and more refined enjoyments, 
and develops more fully all the finer and nobler emotions and senti- 
ments, and educates to a higher point the reflective faculties of the 
mind, also brings new dangers in the excitements lurking in all its 
wa3'S, and threatening mental tranquillity and health. 

" The history of cases which is learned in a lunatic hospital, how- 
ever, shows that this cause (hereditary transmission) bears so large 
a part in the production of disease that too much can hardly be said 
in warning against the union of families in both of which it is 
known to exist, and which together will renew and increase the 
virulence of the poison -to such an extent that it can hardly be 
resisted. 

" Enough is known to prove the truth of the scriptural warning 
that the sins of the parents will be visited upon the children, and to 
offer another, and, it would seem, one of the most powerful induce- 
ments to morality, temperance, and a careful observance in all 
respects of the laws of nature and of health. 

" Early excessive indulgence and gratification of all the wishes 
and propensities, an education too luxurious and tender, too severe 
early mental exercise, and too great mental and phj^sical excite- 
ments, rolalively to the original nervous power and energy, are lia- 
ble, either by imi)airing the vital forces or by unduly increasing the 
5 



34 LUNATIC HOSPITAL AT WORCESTEE. [Oct. 

susceptibility of the brain and nervous s^^stem, to generate this 
acquired predisposition to insanit3\ An education of the mental to 
the neglect of the physical powers, or an undue cultivation of the 
sensibilities and imaginative faculties, alike, may produce a condi- 
tion favorable to the operation of any exciting cause." 

The present superintendent admonishes the public, in the 
twentieth annual report (1873), as follovs^s : — 

" We are straining to compass in our narrow span of life the 
work that would once have been deemed ample for a hundred years. 
With all this increased mental activity, we have made no correspond- 
ing gain in physical vigor, — rather the reverse. What wonder, then, 
that the mind, over-burdened, staggers beneath the ever-increasing 
load, and at last breaks down, and we write ' brain disease ' when 
we should have said ' lived too fast.' " 

In 1874 (twenty-first report), he writes of hereditary taint 
and its prevention in language alruost exactly equivalent to 
that quoted from the Worcester report for 1838. 

" Could we trace it closely enough, I think we should find this 
hereditary taint in the blood far more potent in the production of 
insanity than all the array of alleged causes which make so much 
show in tables. It is a leprosj^, poisoning life at the very fountain, 
which, concealed in one generation, breaks out in the next. I have 
known families where to escape from insanity was the exception, 
and 3"et the insane continued to intermarry ! Plainly the world 
has need for another Lj'curgus." 

The Northampton Lunatic Hospital was opened four years 
after iHat at Taunton. The reports of this hospital are among 
the most valuable and instructive that have ever been pub- 
lished, and although the special topics of the causes and pre- 
vention of insanity are not discussed at so great length as in 
those of the other state institutions, they have not been 
entirely overlooked. In the earlier reports, it is stated that 
cases of insanity are to a great extent due to long-continued 
violations of the common laws of health. The evils Avhich 
result to females, particularly from the sedentary employ- 
ments to Avhich they arc driven by circumstances or gravitate 
by indolence, and the neglect of suitable physical culture 



1876.' 



PUBLIC DOCUMENT— No. 23. 



35 



consequent thereon, are shown to lay the foundation of those 
disordered states of the system which in many cases eventually 
result in a morbid condition of the mind. 

It is unnecessary to refer at length to remarks in these 
reports upon that vicious system of education which stimu- 
lates the brain beyond its healthy action, neglect of invigo- 
rating sports and healthful exercises, bad hygienic surround- 
ings, which disastrously affect the children and youth, nor to 
overwrought cares and excitements of business, commercial 
speculations, exacting struggles for professional or political 
distinctions and vicious indulgences which overthrow adults, 
and for which the sufferer pays the penalty of an unsound 
mind in an unsound body. These are but repetitious of 
principles which have been reiterated so many times that to 
write upon them again seems to point to a paucity of topics. 

In looking over the reports of our state hospitals, from 
which these extracts have been taken, it was a surprise to 
find that so much had been written upon the prevention of 
insanity. While it is not possible to measure just what effect 
these writings may have had, it is apprehended this seed has 
not fallen into good ground, at least the fruits thereof are not 
apparent. The conclusion is Avell-nigh established, that it is 
useless to write what no one of those who really need it most 
will ever read, and what will not be heeded by those who 
do read it and who need it least. 



Table No. 7. 

Showing the ages of Patients Admitted, Discharged Recovered, not 
Recovered, and Died during the year. 



AGES. 


Admitted. 


DlSCHAROUD RE- 
COVEBKD. 


DiSCHAKGED KOT 

Recoveked. 


Died. 




Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


From 15 to 20, 


9 


6 


1 


2 


1 


2 


2 


1 


20 to 30, 


49 


33 


10 


7 


33 


33 


4 


1 


30 to 40, 


61 


48 


10 


9 


26 


29 


11 


1 


40 to 50, 


37 


35 


12 


7 


13 


22 


9 


6 


60 to 60, 


25 


18 


6 


4 


7 


13 


6 


8 


60 to 70, 


7 


13 


2 


2 


3 


7 


7 


13 


70 to 80, 


6 


4 


_ 


_ 


1 


3 


5 


1 


80 to 90, 


- 


- 


- 


31 


- 


- 


1 


1 


Total, . 


194 


157 


41 


84 


109 


45 


32 



36 



LUNATIC HOSPITAL AT WORCESTER. [Oct. 



Table No. 8. 
Showing the duration of Insanity before Admission of Patients 
Admitted, Discharged Recovered, not Recovered, and Died during 
the year. 





Admitted. 


Discharged Ee- 

COVEKED. 


Discharged not 
Kecovered. 


Died. 


DURATION OF INSANITY, 




















s 

s 


1 


■3 


"3 

i 




■3 
I 


■3 


a 


Insane one year or less, 


116 


91 


34 


23 


31 


37 


19 


11 


More than 1 year and 
less than 2 years, 


18 


18 


1 


4 


12 


12 


9 


6 


More than 2 years and 
. less than 5 years, 


23 


15 


4 


2 


15 


24 


10 


5 


More than 5 years and 
less than 10 years, . 


9 


12 


2 


_ 


11 


18 


3 


4 


More than 10 years and 
less than 15 years, . 


4 


4 


_ 


^ 


3 


6 


3 


2 


More than 15 years and 
less than 20 years, . 


6 


4 


_ 


1 


4 


7 


_ 


1 


More than 20 years and 
less than 25 years, . 


_ 


1 


_ 


_ 


2 


1 


_ 


_ 


More than 25 years and 
less than 30 years, . 


_ 


1 


_ 


_ 


_ 


_ 


_ 


_ 


Thirty years or more, . 


3 


3 


- 


1 


2 


1 


- 


2 


Unknown, 


15 
194 


8 
157 


- 


- 


4 


3 


1 

45 


1 


Total, . 


41 


31 


84 


109 


32 



The cases reported as recovered after more than fifteen and 
thirty years respectively, were in persons who had suffered 
several attacks of insanity from which they had so far re- 
covered as to resume their places in the family and in society. 
When another paroxysm occurred, and they were again 
brought to the hospital, the duration of insanity, as given, 
was reckoned from the beginnino- of the first attack. These 
persons having recovered their usual mental strength, and 
being able to resume their social responsibilities, are classed 
as recovered. It would more clearly give the whole truth to 
say, recovered from this paroxysm of recurrent insanity. 



1876.] 



PUBLIC DOCUMENT— No. 23. 



37 



Table No. 9. 

Sliowing the Civil Condition of Patients Admitted, Discharged Re- 
covered, not Recovered, and Died during the Year. 



cmL 


ADMITTED. 


DiSCHAKGED KE- 
COVEKED. 


DiSCHAKGED NOT 

Eecoveked. 


Died. 


CONDITION. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Unmarried, . 

Married, 

Widowers, 

Widows, 

Divorced, 

Unknown, 


91 

85 
14 

2 
•2 


59 
70 

25 
3 


14 

25 

2 


13 
12 

6 


52 

30 

2 


36 
56 

16 

1 


14 

25 

6 


6 
13 
13 


Total, 


194 


157 


41 


31 


84 


109 


45 


32 



Table No. 10. 
Shoioing the Occupation of Patients Admitted during the Year. 

Males. 



Artist, 1 


Operatives in mills, ... 10 


Book-keepers, . 






2 


Painters, . 






6 


Bookbinder, . 






1 


Peddlers, . 






2 


Brakeman, 






1 


Photographer, . 






1 


Carpenters, 






12 


Policeman, 






1 


Clergj'man, 






1 


Printers, . 






3 


Clerks, . 






5 


Reporter, . 






1 


Coal dealer. 






1 


Real estate agent. 






1 


Farmers, . 




- 


28 


Salesman, 






1 


Fishermen, 






3 


Seaman, . 






1 


Gardeners, 






2 


Shoemakers, . 






30 


Harness-makers, 






2 


Stone-cutter, , 






1 


Laborers, 






30 


Students, . 






2 


Lawyer, . 






1 


Teamsters, 






2 


Machinists, 






7 


Watchman, 






1 


Musician, 






1 


Wood-carver, . 






1 


Masons, . 






3 


No occupation. 






10 


Mechanics, 






6 


Unknown, 






4 


Merchants, 






7 




Moulders, 






2 


Total, 






194 



38 LUNATIC HOSPITAL AT WORCESTER. [Oct. 



Table No. 10. — Concluded. 
Females. 



Book-keeper, . 

Domestics, 
Housekeepers, . 
Milliners, 


1 

. 32 

. 66 

2 


Student, . 

Teachers, 

No occupation. 

Unknown, 


1 

2 

. 34 

1 


Operatives in rnills. 
Seamstress, 


. 17 
1 


Total, 


. 157 



Table No. 11. 

Showing the Diseases ivhich have proved Fatal during the year. 





Males. 


Females. 


Total. 


Acute mania, 


4 


3 


7 


Acute melancholia. 






1 


3 


4 


Apoplexy, .... 






3 


- 


S 


Brighfs disease, 






1 


- 


1 


Cholera morbus, . . . 






1 


- 


1 


Congestion of lungs. 






1 


1 


2 


Dysentery, .... 






1 


3 


4 


Exhaustion of chronic insanity, 






3 


2 


6 


Erysipelas, .... 






1 


1 


2 


General paralysis, . 






8 


1 


9 


Heart disease, 






- 


1 


1 


Hemorrhage of bowels, . 






- 


1 


1 


Inanition, .... 






- 


4 


4 


Obscure disease of brain. 






3 


- 


3 


Paralysis, .... 






4 


4 


8 


Pneumonia, .... 






2 


4 


6 


Phthisis, 






8 


2 


10 


Syphilis, 






1 


- 


1 


Sequelge of apoplexy, . 






1 


- 


1 


Suicide, 






- 


2 


2 


Senility, 






2 


- 


2 


Total, .... 


45 


32 


77 



1876.] PUBLIC DOCUMENT— No. 23. 39 

The number of deaths, although somewhat larger than 
usual, is not excessive when the condition of the patients 
received and the causes of death are considered. An unusual 
number died of pneumonia, in several cases only remotely 
connected with their insanity. In two, the disease originated 
before admission, and in one the patient was favorably pro- 
gressing towards recovery from his mental disorder when 
attacked with the disease of the luns^s. Several of the fatal 
cases of phthisis were far advanced when admitted. A large 
part of those who died from paralysis, apoplexy, brain dis- 
ease, syphilis, Bright's disease, etc., had but a short time to 
live when received. General paralysis outnumbers among 
men all other diseases, except phthisis, and from the number 
affected with that disorder who have recently been admitted, 
the deaths from it will not be lessened next year. One man 
who had been affected with paralysis, probably the result of 
cerebral hemorrhage, for twelve years, had been cared for at 
home until, as his disease approached its natural termination, 
he became maniacal, noisy, and troublesome, and his wife, 
who had supported the family by taking boarders, was com- 
pelled to send him to the hospital, where he survived seven 
days. Several others, equally certain to die when admitted, 
survived but little longer. The shortest time of residence of 
any one who died, was four days. This was a case of very 
violent recurrent mania, the man having had several attacks 
when it was thought he would not survive the exhaustion fol- 
lowing his excessive excitement. Upon admission, his case 
did not seem unusually serious, but the storm was just ready 
to burst into terrific violence, prostrating the vital energies 
beyond recovery in a very brief time. 

Nothing can be more faulty than to graduate the standard 
of hospital success by the number or ratio of deaths. There 
are so many contingencies and unexpressed conditions, that a 
merely numerical method will fail to give correct conclusions. 
While the number and character of the cases admitted con- 
tinue like those of the last few years, we must expect and 
cannot avoid a large number of deaths. 



40 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

Table No. 12. 

Showing the Admissions from each County during the year. 



COUNTIES. 


Males. 


Females. 


Total. 


Berkshire, . 

Essex, 

Middlesex, 

Norfolk, . 

Suffolk, 

Worcester, 


1 

49 
60 
2 
15 
67 


38 
54 
10 
10 
45 


1 

87 

114 

12 

25 

112 


Total, 


194 


157 


361 



As indicating the need of a hospital in the north-eastern 
portion of the State, it may be remarked that for six years 
Middlesex County has sent us more patients yearly than have 
been received from Worcester County. 



Table No. 13. 

Showing the Whole Number of Patients during each year, the Aver- 
age Number, the Number at the end of each year, the Expenses of 
each year, the Annucd Expense for each Patient, and the Expense 
of each Patient per week for each of the Forty four Years the 
Hospitcd has been in operation. 



YEARS. 


u 

a 

3 

a 
— 


a 

3 

> 

< 


Number at end 
of each year. 


Current expenses 
of each year. 


i .1 

"3 cj 

3 "> 


II 

rt 

p. a 


1833, . . .153 


107 


114 


$12,272 91 


$114 67 


$2 25 


1834, 








233 


117 


118 


15,840 97 


136 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 


1840, 








391 


229 


236 


27,844 98 


121 59 


2 32 


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 



1876.] 



PUBLIC DOCUMENT— No. 23. 



41 



Table No. 13 — Concluded. 



TEAK S. 


a 


1 
a 

§) 

> 


-a 

<" 03 
0) 

■s ^ 

a =« 

3 O 


1 ^ 

3 ° 

o 


1 1 
1 « 

3 dJ 


S| 


1847, 


607 


377 


394 


$39,440 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, 






670 


440 


441 


46,776 13 


106 40 


2 04 


1851, 






704 


462 


466 


52,485 33 


112 61 


2 16 


1852, 






775 


515 


532 


48,878 35 


85 20 


1 62 


1853, 






820 


537 


520 


53,606 66 


103 14 


1 98 


1854, 






819 


430 


381 


53,221 52 


123 77 


2 38 


1855, 






580 


349 


336 


54,895 88 


157 29 


3 02 


1856, 






577 


357 


376 


45,631 37 


128 64 


2 47 


1857, 






647 


387 


372 


49,004 75 


124 04 


2 38 


1858, 






679 


372 


301 


38,267 26 


102 86 


2 39 


1859, 






501 


309 


317 


48,363 33 


156 51 


3 01 


1860, 






532 


324 


331 


47,757 01 


147 39 


2 83 


1861, 






583 


369 


379 


54,748 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, 






669 


389 


355 


86,930 88 


223 47 


4 30 


1868, 






651 


370 


382 


72,054 59 


197 60 


3 80 


1869, 






719 


387 


376 


81,440 58 


209 04 


4 02 


1870, 






760 


396 


408 


75,715 51 


191 20 


3 68 


1871, 






879 


439 


421 


96,455 69 


219 27 


4 22 


1872, 






864 


450 


439 


92,533 93 


205 63 


3 95 


1873, 






846 


453 


469 


95,196 83 


210 14 


4 04 


1874, 






869 


476 


485 


101,463 68 


213 16 


4 10 


1875, 






847 


487 


478 


100,680 39 


206 74 


3 98 


1876, 






829 


500 


487 


94,446 69 


188 89 


3 64 



The current expenses show a considerable reduction from 
last year. A large part of this decrease was really made the 
preceding year, but was not apparent at that time because 
salaries and wages for fourteen months were included in that 
year's payments. 

That the average number of inmates was larger by twenty- 
seven (27) than for the previous year, while the additional 
expenditure which they entailed was scarcely perceptible, 
accounts for about one-half of the reduction of cost per capita, 
and low prices, and a judicious economy, which has not been 
allowed to lower the standard of hospital service, is to be 
credited with a part at least, of the remainder. 

6 



42 LUNATIC HOSPITAL AT WORCESTER. [Oct.'76. 

It should not be forgottea that, did we expect to remain in 
the old hospital, the necessit_y for keeping up to a higher 
standard the general condition of the buildings, and the de- 
mand for such improvements as Avould enable us to keep pace 
with the times, would yearly call for a large increase in the 
expenditure for repairs and improvements, and our surplus 
would not gain as rapidly as it has for three or four years 
past. 

The general routine of hospital life has not been particularly 
noteworthy during the past year. Both the medical and the 
moral treatment have been what experience has shown to be 
appropriate. Both are equally important in the successful 
treatment of insanity. While the skilful use of remedial 
agents sometimes averts threatened dissolution, and often aids 
in the restoration of enfeebled health, the control of the ex- 
cited, the encouragement of the desponding, and the soothing 
of the irritable, are no less necessary for the restoration of 
mental equilibrium. Cheering amusement, invigorating exer- 
cise and healthful labor aid in both departments, and occupy 
a prominent place in the resources at our command. 

To the faithful and zealous manner in which the assistant 
officers and the employes have discharged their duties is due 
much of the success which has attended the administration of 
the affairs of the hospital. 

With renewed acknowledgment of your co-operation and 
counsel, this Report is respectfully submitted. 

B, D. EASTMAN, 

jSuperintendent. 

WoKCESTER, October 12, 1876. 



APPENDIX. 



Suggestions to Feiends oe Patients, 



FORMS OF ADMISSIOIS^. 



SUGGESTIONS TO THE EEIENDS OF PATIENTS. 



Persons should never be brought to the hospital except in strict 
compliance with the requirements of the law. Blank forms of ad- 
mission, and all necessary information, will be furnished upon appli- 
cation to the Superintendent. 

No deception should ever be used in conveying a patient to the 
hospital. Let all arrangements be properl}^ made, and with suffi- 
cient assistance to control excitement, should any arise, let the 
person be plainly, but kindly told they are to go to the hospital. 
No continued resistance will ordinarily be made ; but, if it become 
necessary, better use /o?-ce than fraud. Do not call upon an officer 
for assistance, if it can be avoided ; the hospital is not a penal 
institution. 

If possible, some person should come with the patient who can 
give a correct history of the case. Effort should be made to incul- 
cate the idea that the officers and emploj^es of the hospital will be 
kind and friendly, and endeavor to promote the best interests of 
those under their charge. 

An abundance of underclothing should be brought with every 
patient, especially if they are at all disposed to derange their dress, 
together with suitable outen-garments for ordinary wear and for 
attending lectures and religious services, if their condition will 
admit. Jewelry, superfluous articles of dress, knives, etc., should 
not be brought, as they are liable to be lost, and the hospital will 
not be responsible for them. All practicable care will be taken to 
avoid loss or destruction of clothing, etc. ; but it cannot be entirely 
avoided. 

All packages sent by express to patients should be paid through, 
and plainly directed to the person for whom they are intended, care 
of Worcester Lunatic Hospital, Worcester, Mass. 

All letters for patients should be placed in an unsealed envelope, 
directed to the patient, and the whole placed in another envelope 
addressed to the Superintendent. Neither money nor postal- 
stamps should be sent directly to patients, but may be sent to the 
Superintendent, for their benefit. 



46 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

In all cases which have been at the hospital but a short time, or 
are subject to periodical attacks of excitement, friends should ascer- 
tain their condition, and the propriety of visiting them, before 
coming to see them. No objection will be made to a reasonable 
amount of visiting to such patients as will not be injuriously affected 
thereby. 

No letters written about persons while at the hospital should be 
shown them after their discharge. 

B. D. EASTMAN, M. D., 

Superintendent. 

WoECESTEK Lunatic Hospital, I 
WoRCESTEB,, Mass. 5 



1876.] PUBLIC DOCUMENT— No. 23. 47 



CONCERNING ADMISSION TO THE HOSPITAL. 



The laws of the Commonwealth prescribe three methods by which 
a person may be placed in the hospital, — 

First, By Order of Court. 

Second. Br Friends. 

Third. By Overseers of the Poor. 

First. By Order of Court. 

Any of the judges of the supreme judicial, superior and probate 
courts, and any trial justice of juvenile offenders of Suffolk County, 
may commit a person to the hospital. 

Commitments are usually made by the judges of probate court, 
the form of application, with the necessary accompanying certifi- 
cates, being as follows : — 

[The applicant must answer in writing the printed interrogatories accompanying this blank.] 

To the Monorcible Judge of the Proiate Court in and for the County of 

of on oath, complains that of 

in said county of , is an insane person, and a proper subject for 

the treatment and custody of the Worcester Lunatic Hospital. 

Wherefore h prays that said may be committed to the said 

Worcester Lunatic Hospital, 4iccording to law. 

88. A. D. 187 , 

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 mayor of the city of 

, where said resides, hereby acknowledge that notice 

in writing has been given to mo of the intention to present tbe foregoing 
complaint and application. 

A. v>. 187 . 



48 LUNATIC HOSPITAL AT WORCESTER. [Oct. 

To the Honorable Judge of the Prolate Court in and for the County of 

The subscriber, having made application to your honor for the commit- 
ment of to the. Worcester Lunatic Hospital as a lunatic, now 
presents the following statement, in answer to interrogatories :— 

What is the age of the lunatic ? Ans. 

Birthplace ? Ans. , 

Married or single ? Ans. 

Occupation ? Ans. 

Supposed cause of disease ? Ans. 

Duration? Ans. 

Character, — whether mild, violent, or dangerous ? Ans. 

Homicidal, or suicidal ? Ans. 

Paralytic, or epileptic ? Ans. 

Previous existence of insanity in the lunatic ? Ans. 

Previous or present insanity in any of the family ? Ans. 

Habits in regard to temperance ? Ans. 

Whether he has been in any lunatic hospital ; if so, what one, when, and 
how long ? Ans. 

(If a woman.) 
Has she ever borne any children ? Ans. 
How long since the birth of her last child ? Ans. 

Name and post-oflice address of some one of the nearest relatives or 
friends ? Ans. 

What facts show whether h has or has not a settlement, and where, if 
anywhere, in this State ? Ans. 

[For the law relating to settlements, see Gen. Stat., chap. 69. 
Supplement to Gen. Stat., 1868, chap. 328. 

'< " 1870, " 392. 

" " 1871, " 379. 

'« " 1874, " 274.] 

Applicant. 
Physicians' Cektificate. 
The subscribers, 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 
the said is insane, and a proper subject for the treatment and 

custody of the Worcester Lunatic Hospital. 



ss. A. D. 187 . 

Then the above-named and made oath that the 

above certificate is true. 

Justice of the Peace. 

Commonwealth of Massachusetts. 
ss. 
At in said county, on the day of a. d. 187 . 

On the application of for the commitment of of 

in said county, to the Worcester Lunatic Hospital, ; 



1876.] PUBLIC DOCUMENT— No. 23. 49 

notice in writing having been given by said aiiplicant to one of the selectmen 
of where said resides, of h intention 

to make said api)lication, and said having received all necessary 

notice of the time and place appointed for hearing, it appears uijou a full 
hearing that said is an insane person, and a proper subject for the 

treatment and custody of the Worcester Lunatic Hospital. 

Therefore it is ordered that said be committed to the said 

Worcester Lunatic Hosj)ital. 

Judge of the Probate Court. 



Second. By Friends — Private Patients. 

For the admission of private patients, application must be made 
by relative, guardian or friend, and certificate of insanity, acknowl- 
edgment of notice to selectmen or mayor, and satisfactory bond for 
support must be given according to the following form : — 

Commonwealth of Massachusetts, 
[state seal.] 

The Worcester Lunatic Hospital. 

In consideration of the admission of of in the county 

of as a patient at the Worcester Lunatic Hospital, at Worcester, 

Ave, the undersigned, promise to pay to the treasurer of said hospital the rate 
of board which may from time to time be determined by the trustees of said 
hospital, for said patient, so long as he shall continue a boarder in said 
hospital, with such extra charges as may be occasioned by the necessity of 
giving h more than ordinary care or attention ; to provide to pay for all 
clothing or other things necessary or proper for h health and comfort ; to 
pay for all damages which he may do to furniture or other property of 
said hospital ; to pay for reasonable charges in case of elopement, and funeral 
expenses in case of death; and to remove h from the hospital whenever 
the room occupied by h shall be required for a class of patients having 
preference by law, or who, in the opinion of the superintendent, should be 
received. We also promise that if, against the advice of the superintendent, 
he l)e removed, either by us or by any of h friends, before the expiration 
of three calendar months, we will pay board for thirteen weeks. 

Payments to be made quarterly, and at the time of removal, with interest 
on each bill from and after the time at which it becomes due. 

Witness our hands, thi.s day of a. d. 187 . 

Attest : Principal. 

[Post-offiof acUlrcss.] 

Surety. 

[Post-offlce luldrefs'.] 

If it becomes necessary to conimuniciitc with iuiy friend of the patient, 
addnes, — 

7 



50 LUNATIC HOSPITAL AT WOECESTER. [Oct. 

Statement of an applicant for the admission of , an 

Insane person, to the Worcester Lunatic Hospital : — 

Age of the insane person, Occupation, 

Birthplace, Eesidence, 

Civil condition (single, married, widowed or divorced), 

Is this the first attack of insanity ? Other attacks, and when, 

Supposed cause of insanity, 

Duration of this attack, 

Character of insanity,— whether mild, violent, or dangerous. 
Homicidal, or suicidal. 
Paralytic, or epileptic. 
Having delusions or hallucinations. 

Habits in regard to ardent spirits, oj)ium and tobacco, 

Natural eccentricities of temper, thought, or action. 

Any serious disease or bodily injury heretofore, 

Previous or present insanity in relatives. 

If ever in any institution for insane, when, where, and how long, 

If a woman, she has borne children ; the last years ago. 

Facts showing whether he has or has not a settlement, and, if any, 
where. 

Name and post-office address of some nearest relative or friends over eigh- 
teen years of age, 
Father, Mother, 

Children, Brothers, 

Sisters, Husband, 

Wife, 

If the applicant is unable to state any of the foregoing particulars, he shall 
state his inability to do so. 

Application. 

I request that the above-named may be admitted as a patient 

at the Worcester Lunatic Hospital. 

Applicant. 
A. D. 187 . 

[Post-office address.] 

Physicians' Certificate. 

We, the subscribers, respectable physicians in in the county of 

, having made due inquiry and personal examination of , 

named in the foregoing a]3plication, tvithin one week prior to the date hereof, 
certify that he is insane, and a proper subject for custody and remedial 
treatment in the Worcester Lunatic Hospital. And I, , farther 

certify that I am the family physician of the said 

M. D. 

M. D. 

A. D. 187 . 



1876.] PUBLIC DOCUMENT— No. 23. 51 

Acknowledgment of Notice. 

I, the subscriber, one of the selectmen, or mayor, of , where said 

resides, hereby acknowledge that notice in writing has been 
given to me of the intention to present the foregoing application. 
A. D. 18 . 

[See Acts of 1862, chap. 223, sects. 4, 5, S, 13. Acts of 1865, chap. 268.] 



Third. Bt Overseers of the Poor. 

Any insane person supported as a pauper by any city or town, 
may be placed by the overseers of the poor thereof in the hospital, 
with the consent of the trustees, upon compliance with the following 
form : — 

Commonwealth of Massachusetts, 
[state seal.] 

The Worcester Lunatic Hospital. 

In consideration of the admission of of in the county 

of as a patient at the Worcester Lunatic Hospital, at Worcester, 

we, the undersigned, being a majority of the overseers of the poor of the 
town of in the county of for and in behalf of the 

inhabitants of said town, promise to pay to the treasurer of said hospital the 
rate of board which may from time to time be determined by the trustees of 
said hospital, for said patient, so long as he shall continue a boarder in 
said hospital, Avith such extra charges as may be occasioned by the necessity 
of giving h more than ordinary care or attention ; to provide or pay for 
all clothing- or other things necessary or proper for h health and comfort ; 
to pay for all damages which he may do to furniture or other property of 
said hospital ; to pay for reasonable charges in case of elopement, and funeral 
expenses in case of death ; and to remove h from the hospital whenever 
the room occupied by h shall be required for a class of patients having 
preference by law, or who, in the opinion of the superintendent, should be 
received. We also promise that if, against the advice of the superintendent, 
he be removed, either by us or any of h friends, before the expiration 
of three calendar months, we will pay board for thirteen weeks. 

Payments to be made quarterly, and at the time of removal, with interest 
on each bill from and after the time at which it becomes due. 

Witness our hands, this day of A. D. 187 . 

Attest : 



Ovei'seers of the Poor of the Town of 

If it becomes necessary to communicate with any friend of the patient, 
address, — 



52 LUNATIC HOSPITAL AT WOItCESTER. [Oct. 

Statement of ati applicant for the admission of , an 

insane pei'son, to the Worcester Lunatic Hospital: — 

Age of the insane person, Occupation, 

Birtliplace, Residence, 

Civil condition (single, married, widowed or divorced). 

Is this the first attack of insanity ? Other attacks, and when, 

Supposed cause of insanity. 

Duration of this attack, 

Character of insanity, — whether mild, violent, or dangerous, 
Homicidal, or suicidal, 
Paralytic, or epileptic, 
Having delusions or hallucinations, 

Habits in regard to ardent spirits, opium and tobacco, 

Natural eccentricities of temper, thought, or action. 

Any serious disease or bodily injury heretofore, 

Previous or present insanity in relatives, 

If ever in any institution for insane, when, where, and how long, 

If a woman, she has borne children ; the last years ago. 

Facts showing whether he has or has not a settlement, and if any, 
where. 

Name and post-office address of some of nearest relatives or friends over 
eighteen years of age, 
Father, Mother, 

Children, Brothers, 

Sisters, Husband, 

Wife, 

If the applicant is unable to state any of the foregoing particulars, he shall 
state his inability to do so. 

Application. 
I request that the above-named may be admitted as a patient 

at the Worcester Lunatic Hospital. 



Applicant. 



A. D. 187 . 

[Post-office address.] 



Physicians' Certificate. 
We, the subscribers, respectable physicians in in the county of 

, having made due inquiry and personal examination of , 

named in the foregoing application, tvithin one week prior to the date hei'eof, 
certify that he is insane, and a proper subject for custody and remedial 
treatment in the Worcester Lunatic Hospital. And I, , further 

certify that I am the family physician of the said 

M. D. 
M. D. 

A. D. 187 . 



1876.] PUBLIC DOCUMENT— No. 23. 53 

ACKNOWLEDGaiENT OF NOTICE. 

I, the subscriber, one of the selectmen, or the mayor, of , where 

•said resides, hereby acknowledge that notice in writing has been 

given to me of the intention to present the foregoing application. 

A. D. 187 . 

[See Acts of 1862, chap. 223, sects. 4, 5, 8, 1.3. Acts of 1865, chap. 268.] 



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