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Full text of "Report of Commissioners Appointed under a resolve of the Legislature of Massachusetts, to Superintend the Erection of a Lunatic Hospital at Worcester, and to report a system of discipline and government for the same"

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REPORT 



RELATING TO 



LUNATIC HOSPITAL 



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^ REPORT 

OF • j A -) 

COMMISSIONERS 



APPOINTED UNDER 



A RESOLVE 



ILtg^iulutXivt of ^(iUf$ati)%inttt^ 



TO SUPERINT^KJ) THE ERECTION 

;; STAT^ A' ;) 
LUNATIC HOSPITAL AT WORCESTER, 



REPORT A SYSTEM OF DISCIPLINE AND GOVERNMENT 
FOR THE SAME. 



MADS JAUSUARTr 4th, 1832. 



DUTTON AND VVENTWORTH, PRINTERS TO THE STATE, 

No. 4, Exchange Street. 

1832. 



SENATE No. 2. 



To His Excellencij LEVI LINCOLN, Gover- 
nor of the Commonwealth of Massachusetts, 

The Commissioners appointed in pursuance of a Re- 
solve of the Legislature of March 10, A. D. 1830, "to 
superintend the erection of a Hospital, of sufficient di- 
mensions to accommodate a Superintendent and one 
hundred and twenty insane or mad persons," 



That the entire foundation, the external and partition 
walls, the roof, and the windows of such a Hospital are 
now completed. Having so for performed the duties 
assigned them under their commission, they now deem 
it incumbent upon them to give a detailed account of 
the manner in which those duties have been discharged. 

The slightest reflection will render it obvious, that 
an edifice designed for the residence of the insane 
must be materially different, both in form and in interior 
1 



arrangement, from ordinary habitations. The insane 
require equable warmth, but they cannot be intrusted 
with fire. They require hght and pure air, but the 
doors and windows which give light and ventilation to 
common dwellings, would furnish them with facihties 
for escape, and with opportunities for inflicting person- 
al injury, or even self-destruction. The insane often 
possess more than the ordinary strength of men, but 
they are far less capable than children of rendering it 
subservient to their own welfare, and no human agency 
can always be present with them to direct or control it. 
When great numbers of this unfortunate class of people 
are collected together, not only considerations of con- 
venience in superintending them, but the probabilities 
of their restoration and their security from mutual in- 
juries, require a classification founded upon scientific 
principles, according to the various degrees of intensi- 
ty, or forms of violence, which their maladies may as- 
sume. Regarded as individuals, suffering under some 
bodily or organic disease, (as is ordinarily the case,) it 
is apparent, that any habitation designed for their resi- 
dence, must partake, in a great degree, of the charac- 
ter of an Infirmary. No vigilance of care, or expense 
of labor, can successfully accomplish all these objects, 
if unaided by the skilful adaptation of the form and in- 
terior arrangement of the edifice in which they are 
placed. Architectural fitness, then, becomes indispen- 
sable to their welfare ; it promotes humane and com- 
passionate treatment, gives additional efficacy to medi- 
cal skill, and often disarms the rage of a spirit, intent 
upon the destruction of the body in which it dwells. 

The Resolve above referred to, gave the Commis- 
sioners no discretion as to the extent of the accommo- 



dations to be prepared ; but the choice of the materials, 
the form of the structure, with all the appendages, were 
submitted entirely to their views of propriety and fitness. 
Taking into consideration the public character of the 
edifice, and the object for which it was designed, 
the Commissioners beheve that no one could approve 
the use of a material less durable than brick or granite. 
The latter would have been preferred on some accounts, 
but as the difference in the expense would have been 
about thirty per cent., considerations of economy seemed 
imperative, and it was decided to construct it of brick. 
The bricks used in the vv^ork are judged, by competent 
men, to be of such a quality as to remove all grounds 
of apprehension on account of the durability of the 
fabric. 

To devise a plan for the construction of the Hospital, 
and for the commodious disposition of all its requisite 
appendages, occasioned the Commissioners much soli- 
citude. Of the variety of establishments for similar pur- 
poses, existing in Europe and in this country, not any 
two are constructed alike. Each, it is presumed, has 
been the result of an attempt to improve upon all v/hich 
preceded it ; but so various, and, in some degree so 
conflicting are the objects sought to be accomplish- 
ed, that the very means adopted for the furtherance of 
one, has, either directly or incidentally, been prejudicial 
to some other. It is not, therefore, without diflidence, 
that the Commissioners submit a particular description 
of the plan which, after much inquiry and deliberation, 
they have adopted. 

The Hospital consists of a Centre Building and two 
wings. The Centre Building is 76 feet in length, 40 feet 
in width, and four stories in height. The wioga are 



each 90 feet long in tront, and 100 in the rear, 36 feet 
wide, and three stories high. They are in the same 
line, extending to the right and left from the opposite 
ends of the Centre Building. The front of the Centre 
Building projects 22 feet forward of the front of the 
wings. The wings, being 36 feet wide, half their width, 
or 18 feet, joins upon the Centre Building; the other 
half falls in its rear. This arrangement connects the 
Centre with the wings, so far as to allow a free commu- 
nication between them by means of stair-ways and tho- 
rough-fares, and, at the same time, so far disconnects 
them, that the inside ends of the long halls in the wings, 
(hereafter mentioned) falling in the rear of the Centre, 
open into the external air, and thus, as it regards ven- 
tilation, the advantages of separate buildings are secur- 
ed to the wings. 

The cellar extends under the whole edifice. An ex- 
cavation to the depth of three or four feet v/as neces- 
sary in order to lay the foundation ; and, by excavating 
a little deeper than was indispensable for that purpose, 
a great amount of room is obtained, and many obvious 
advantages are secured. 

The basement story of the Centre Building is design- 
ed for store-rooms, a kitchen, laundry, &c. The front 
part of the second story, contains four rooms of conve- 
nient size, which, with the chambers immediately over 
them and the small sleeping apartments into which the 
fourth story is divided, are intended for a Superintend- 
ent and his family, a steward, and the domestics and 
laborers necessarily employed in and about so extensive 
an establishment. As this portion of the Hospital is to 
be used in the same way as any ordinary dwelling house, 
it is, according to the plan, to be finished in a similar 



manner. The rear of the 1st, 2d, and 3d stories of the 
Centre Building is designed for the dining and day-rooms 
of the insane. 

The wings are, in each story, divided in the centre by 
a long hall or aisle, 12 feet in width, and extending from 
end to end. In consequence of the wings' falling half 
their width, as before mentioned, in the rear of the 
Centre Building, these halls communicate, at both ends, 
with the external air and thus the means of a most tho- 
rough ventilation are secured. Whoever has visited 
any public establishment, where the entire end of a wing 
is met and closed in by the side of the main building, 
cannot fail to have perceived the noisomeness of the 
atmosphere at that place, compared with it at the outer 
end, where free admission has been given to the pure 
air. On each side of these halls are situated the apart- 
ments designed for the insane. They are 8 feet by 10, 
and all are provided with a permanent seat secured in the 
wall. Each apartment has a largo window v/ith an up- 
per sash of cast iron, and a lower sash of wood, both of 
which are glazed. Immediately without the wooden 
sash is a false sash of cast iron, corresponding with the 
wooden one in appearance and dimensions. This is set 
firmly into the sides of the window-frame, a narrow 
space being left at the bottom for water to pass off and 
save the frame from decay. When the wooden sash is 
raised, the false iron one presents a barrier against es- 
cape or injury from leaping out through the window. 
It is said, that a man, however furiously mad, or impa- 
tient of confinement he may be, will rarely attempt to 
break through a window until he has first tried unsuc- 
cessfully to raise it. If it be so, this simple contrivance 
will afford effectual security both to property and per- 



6 

son, without inflicting upon the patient any injurious re- 
straint. Each of these apartments is provided with two 
air flues, one for heated, the other for cold, air. It is 
intended to warm the wings by furnaces placed in the 
cellar. The hot air is to be conducted frona the furna- 
ces through flues in the hafl walls, and to be discharged 
through apertures into the halls. By these means, the air 
in the halls may be raised throughout to any desirable 
temperature. Over the door of each apartment, there 
is a small aperture, through which the heated air in the 
halls will pass into the rooms and thence will be carri- 
ed off" into the attic by means of the hot air flue of the 
room. The aperture of this flue is at the bottom of the 
room, and is to be kept open only in winter. The aper- 
ture of the other flue is at the top of the room and 
is to be kept open in the summer, so that, as the 
air is made light by heat, it wiH rise and pass off" 
through this channel, and the cool air from without will 
rush in to supply its place. All these flues open into 
the attic, which is ventilated by sky-lights in the roof, 
and large fan-windows at the ends. At the end of the 
wings, where they join on and are connected with the 
rear part of the Centre Building, the halls open into the 
dining and day rooms, before mentioned, in the Centre 
Building. These rooms are fitted up with the same 
means of strength and security as are provided for the 
apartments in the wings and, being directly connected 
with the halls, are to be warmed from them. The din- 
ing rooms, occupying the rear of the 1st, 2d, and 3d sto- 
ries of the Centre Building, are of course situated imme- 
diately over a portion of the kitchen. Adjoining these 
rooms a perpendicular space is left open from the kitch- 
en to the third story, through which, by means of an 
apparatus similar to a windlass, and called a dumb wait- 



er, the food can be raised from the kitchen and distri- 
buted to one hundred and twenty persons in six diffe- 
rent divisions without inconvenience. 

Each story in the wings is provided with a bathing 
room, washing room, &c. The large windows at each 
end of the hall, are protected by an open frame -work 
of iron. Each hall has a separate stair-way, leading 
into an outer yard, so that each story in each wing is as 
entirely disconnected from all the others, as if it were a 
separate building. This allows that separation and 
classification of the patients, on which all treatises upon 
the means of restoring the insane, so strenuously insist. 

The roof of the Hospital is covered with slate. Be- 
sides the security, which this material furnishes against 
fire, any other covering, it was believed, would seem in- 
congruous v/ith the public character of the building, its 
solidity, and expected durability. 

To prevent unhealthful moisture from being deposit- 
ed upon the inside walls of the edifice, an interstice or 
open space is left between the external and internal 
courses of bricks — the courses being strongly fastened 
together by tiles — so that a free circulation of air through 
all the exterior walls, from the underpinning to the attic, 
will effectually obviate that almost universal inconven- 
ience of brick habitations. — Carpenters are now enga- 
ged in completing the wood-work. 

Tt is obvious, that in an estabhshment like the 
one under consideration, an abundant supply of water, 
easily obtained, is more indispensable than in one ap- 
propriated to any other purpose.. To carry a sufficien- 
cy of water by hand, or even to propel it by pumps, 
over so extensive a building would have demanded so 
much labor, that its faithful performance could seldom 
be secured. At the distance of about 150 rods to the 



8 

north east of the Hospital-site is an elevation of land 
rising many feet higher than the top of the Hospital it- 
self, which promised to contain living springs of water. 
The Commissioners were of opinion, that, if water could 
be conveyed from this hill to a reservoir in the top of 
the Hospital, its abundance and the ease with which it 
could always be obtained would promote cleanliness 
more effectually than could be done by any vigilance or 
discipline on the part of the Superintendent. They 
therefore made an arrangement with William Eaton 
Esq., the proprietor of the land above mentioned, by 
which they were permitted to open wells and lay an 
aqueduct, and by which the Commonwealth may exer- 
cise the same privilege for the same purpose, at any fu- 
ture time, by paying to him or his assigns, as damages^ 
whatever sum of money the selectmen of the town of 
Worcester for the time being may award. The pipes 
have been laid and have afforded a supply of water for 
the use of the masons in the prosecution of their work. 
Whether a sufficiency of water for the purposes before 
mentioned can be obtained from this source is a ques- 
tion to be tested by experiment in a drier season, though 
very little apprehension is felt, that the experiment will 
not be satisfactory. 

It will be seen, by reference to the Report of the 
Committee which accompanied the Resolve for the 
erection of the Hospital, that the original appropriation 
of thirty thousand dollars was expected to defray the 
cost of the edifice, including all the masons and carpen- 
ters' work and materials, but exclusive of the expense 
of furnishing the rooms, and of all incidental charges. 
Such progress has now been made in the work, that the 
Commissioners are able to state, that the preparation of 



9 

the grounds ; the excavation and stoning of the cellar ; 
the construction of a road, by which an easy access is 
gained to the elevated site of the Hospital, requiring the 
removal of about nine thousand cubic yards of gravel ; 
raising the exterior walls of the edifice, which is 256 
feet in length, with partition walls of brick carried up 
from the foundation and dividing it into more than one hun- 
dred and thirty apartments ; the roof of slate ; the very 
expensive windows, with all the carpenters' labor and 
materials, so far as the same have been necessary in the 
progress of the work, have been accomplished at an ex- 
pense something less than tiventy four thousand dol- 
lars. 

As there is now reason to believe that the first appro- 
priation will accomplish all that was expected from it, 
it remains only to furnish the Hospital in a suitable man- 
ner, to erect the necessary out-buildings, to enclose the 
grounds, to fence out the separate yards, corresponding 
with the classification of the inmates, and to build a 
few solitary cells of great strength, deemed necessary 
in the opinion of the Commissioners for the confine- 
ment of those who are both dangerous and incurable, 
and whom bolts and bars alone can restrain. For these 
objects, the Legislature will make such further appro- 
priation as they may deem expedient. 

The Commissioners would deem themselves guilty of 
injustice towards their own feelings, as well as towards 
the deserts of others, did they dismiss this part of the 
subject without adverting to the very satisfactory man- 
ner in which the work, with some slight exceptions, has 
thus far been executed by the individuals with whom 
they have contracted. The whole labor on the Hospi- 
tal has been performed under the immediate care and 

2 



10 

superintendence of Mr Elias Carter of Worcester, who, 
before his engagement, was very highly recommended 
as a suitable person for that agency, and, since his en- 
gagement, has been recommended not less highly by the 
manner in which he has fulfilled it. The wood-work 
was not let out on contract, lest some hazard should be 
incurred in having that important portion of the labor 
unskilfully or negligently performed. The masonry has 
been executed, and it is believed very faithfully execut- 
ed, by Messrs. Goodman and Gorham of Springfield. 
Between the first day of May and the first day of No- 
vember, they laid into the work more than eleven hun- 
dred thousands of bricks. And the Commissioners have 
great pleasure in stating the kindred facts, that, during 
the whole season, not an accident has happened on the 
work, not an hour's time has been lost by any of the 
workmen on account of indisposition, and not a drop of 
ardent spirits has been consumed in its prosecution. 

Another and most important duty, with which the com- 
missioners were charged, remains to be performed. By 
the Resolve under which they were appointed, they were 
directed to report a system of regulations for the disci- 
pline and government of the Institution, at or before the 
time, when it should be ready to go into operation. 
That time, it is expected, will arrive in the course of 
the ensuing season ; and, as the Legislature alone have 
the power to give the force of law to any system of re- 
gulations which may be devised for its government, and 
in the ordinary course of events, will not reassemble 
until a period subsequent to that, at which it is expected 
the Hospital will be prepared for the reception of the 
insane, it was deemed advisable to make this part of 



u 

the Report in season to be acted upon at the ensuing 
session. 

The government and discipline of the Institution are 
supposed to involve the consideration of two questions. 

The Jirst relates to the classes of Lunatics to be com- 
mitted to its charge ; the authority by vt^hich they shall 
be committed, and by which they may be discharged, 
when the cause of their detention has ceased to exist, 
and also the mode in which the expenses of the Insti- 
tution shall be defrayed. 

The second respects the regulations, by which the in- 
sane shall be governed, whilst at the Hospital, including 
of course the visitatorial power, under which all regula- 
tions of this kind must be administered. 

Regarded as citizens of this Commonwealth, or as re- 
sidents therein, there are three classes of lunatics. 

The Jirst class comprehends ail those, whom the justi- 
ces of the Supreme Judicial Court or Justices of the 
Peace have, by virtue of the statutes of 1797, chap. 62, 
and 1816, chap. 28, committed to Jails and Houses of 
Correction, because their being suftered to go at large 
was deemed incompatible with the security of the citi- 
zens generally. 

The second class consists of town pauper lunatics. 
These are mostly confined in poor houses by order of 
the municipal authorities, though it has been the prac- 
tice of some towns to make private contracts with the 
keepers of Jaols and Houses of Correction to take their 
insane poor at a low price and imprison them in some 
of their unoccupied cells, where no person has been 
held responsible for their treatment, nor has the law 
delegated authority to any one to examine into their 
condition. Other towns have annually offered the keep- 



12 

ing of their insane poor at auction, and struck them off 
to the lowest bidder, by whom they have been taken 
and treated with various degrees of attention or of cru- 
elty, according to the character of the individual, who, 
in this competition for the profits of keeping them, 
would be likely to prevail. 

The third class consists of all the remainder of insane 
persons within the Commonwealth, and of course com- 
prehends those individuals, who are not so " furiously 
mad," in the language of the statutes, as to have been 
imprisoned with the first class ; and also those, who, 
having sufficient property of their own to support them- 
selves, or being supported by the generosity of their 
friends, do not receive that assistance from towns which 
would have included them in the second class. Of 
these the laws take no special cognizance. 

With regard to the first class of lunatics, who are 
now by law confined in Jails and Houses of Correction, 
it is believed that nothing but a plain recital of facts, 
can be necessary to enlist in their behalf, the liveli- 
est sympathies of the community. It is now more than 
thirty years since the laws of this Commonwealth have 
authorized their commitment to prison, whenever their 
being at large, should, in the opinion of two magis- 
trates, be judged " dangerous to the peace or safety of 
the good people." It is a well authenticated fact, that 
those, upon whom the first attack of insanity is most 
violent, and who are therefore more liable, from the ve- 
hemence of its assaults, to commit outrages upon the 
persons or property of others, are also most easily cured. 
Our laws, therefore, by authorizing their confinement, 
whenever, in the throes and paroxysms of their malady, 
they may have threatened aggression or excited alarm, 



13 

have at once removed the most hopeful cases beyond 
the reach of recovery. It may be emphatically repeat- 
ed, heijond the reach of recovery, for, from all the inqui- 
ries made by the Commissioners upon this subject, they 
have never heard of more than three or four instances 
of restoration, among all those who have been subject- 
ed to the rigors of a confinement, in Jails and Houses 
of Correction ; while well regulated Institutions for the 
reception and appropriate treatment of the insane, 
have returned fifty, sixty and in some instances ninety per 
cent, of recoveries. To him, whose mind is alienated, 
a prison is a tomb, and within its walls he must suflfer 
as one who awakes to life in the solitude of the grave. 
Existence and the capacity of pain are alone left him. 
From every former source of pleasure or contentment, 
he is violently sequestered. Every former habit is ab- 
ruptly broken off. No medical skill seconds the eflforts 
of nature for his recovery, or breaks the strength of 
pain, when it seizes him with convulsing grasp. No 
friends relieve each other in solacing the weariness of 
protracted disease. No assiduous affection guards the 
avenues of approaching disquietude. He is alike re- 
moved from all the occupations of health, and from all 
the attentions, every where, but within his homeless 
abode, bestowed upon sickness. The solitary cell, the 
noisome atmosphere, the unmitigated cold and the un- 
tempered heat, are of themselves sufficient soon to de- 
range every vital function of the body, and this only 
aggravates the derangement of his mind. On every 
side is raised up an insurmountable barrier against his 
recovery. Cut off from all the charities of life, endued 
with quickened sensibilities to pain, and perpetiwally 
stung by annoyances, which, though individually small, 



14 

rise by constant accii!nu!ation to agonies almost boyond 
the povver of mortal sufierance ; if his exiled mind in 
its devious wanderings ever approach the light by which 
it was once cheered and directed, it sees every thing 
unwelcoming, every thing repulsive and hostile, and is 
driven away into returnless banishment. 

From the absence of suitable Institutions amongst 
us, the insane have been visited with a heavier doom 
than that inflicted upon the voluntary contemners of the 
law. They have been condemned as no criminal ever 
was condemned, and have suffered as no criminal ever 
has suffered. The code by which they have been 
judged, denounces against them the penalties due only 
to crime, while it is unmitigated by any of those mer- 
ciful provisions which in our penal code, attemper jus- 
tice with humanity. Even when a criminal stands con- 
victed of perpetrating the most atrocious crime, the 
benignity of the law accompanies him to the solitude 
where he is to expiate his offence. He is comfortably 
clad and warmed and fed at the expense of the State, 
which inflicts his punishment. He is supplied with the 
means of moitd renovation, and when those proofs of 
penitence and reformation are given, which it is in his 
own power to furnish, the laws relent and authorize the 
remission of his sentence. But though the insane have 
been made fellow- prisoners with the criminal, they 
have suflered the absolute privation of every comfort 
for the body and every solace for the mind. Yet why 
should a man be treated even as a criminal, who by 
universal consent, is incapable of crime ? We under- 
stand what is signified by retributions for guilt, but to 
speak of retributions for insanity, does violence to every 
feeling of humanity and dictate of conscience. Yet 



15 

this wretched class of our fellow beings, whose only of- 
fence is what others justly regard as among the 
direst of calamities — as incapable of moral guilt, as 
unhappily they are of moral consolation — have been re- 
garded by our laws, as though they were rather the ob- 
jects of vengeance than of commiseration. And were 
a system now to be devised, whose express object if, 
should be to drive every victim of insanity beyond the 
limits of hope, it would scarcely be within the power of 
a perverse ingenuity to suggest one more infalhble than 
that, which for so many years has been in practical op- 
eration amongst us. That system could advance one 
paramount claim to preference. Its experiments have 
been numerous, and have scarcely ever failed in render- 
ing the most favorable cases of insanity utterly incura- 
ble. This practice reacts upon the community by 
which it is sanctioned. To say nothing of the amount 
of human suffering it has caused, it cannot be doubted 
that with appropriate treatment, one half at least, of 
all the lunatics, whose support must now continue to be 
a burden upon the State while they live, m.ight have 
been restored, and this half might have added as much 
to the resources of the State, as the other would have 
subtracted from them. 

For several years past all the channels of public in- 
formation and the resorts for public discussion have 
been rife with appeals to the community in behalf of 
prisoners confined for debt. From a comparison made 
by the Commissioners, they cannot entertain a doubt, 
that the aggregate of the term.s of confinement under 
the poor debtor laws has been much less than that of 
the imprisonment of the insane. According to returns 
made, in 1829, to the Office of the Secretary of the 



16 

Commonwealth, from Towns comprising less than half 
the population of the State, it was ascertained that one 
hundred and sixty one lunatics were in actual confine- 
ment, and of this number the duration of the confine- 
ment of one hundred and fifty, exceeded in the aggregate 
a thousand years. From the subjoined statements, de- 
rived from authentic documents, respecting the condi- 
tion of imprisoned lunatics, an estimate may be formed 
of the comparative rigors of the restraint, inflicted upon 
these two classes of our fellow citizens. 

" In Massachusetts, by an examination made with 
care, about thirty lunatics have been found in prison. 
In one prison were found three ; in another five ; in 
another six, and in another ten. It is a source of great 
complaint with the sheriffs and jailors, that they must 
receive such persons, because they have no suitable 
accommodations for them. Of those, last mentioned, 
one was found in an apartment in which he has been 
nine years. He had a wreath of rags round his body, 
and another round his neck. This was all his clothing. 
He had no bed, chair or bench. Two or three rough 
plank were strewed around the room ; a heap of filthy 
straw, like the nest of swine, was in the corner. He had 
built a bird's nest of mud in the iron grate of his den. 
Connected with his wretched apartment was a dark dun- 
geon, having no orifice for the admission of light, heat, 
or air, except the iron door, about 2 1-2 feet square, 
opening into it from the prison." 

" The other lunatics in the same prison were scatter- 
ed about in different apartments with thieves and mur- 
derers, and persons under arrest, but not yet convicted 
of guilt." 



17 

" In the prison of five lunatics, they were confined in 
separate cells, which were almost dark dungeons. It 
was difficult, after the door was open to see them dis- 
tinctly. The ventilation was so incomplete that more 
than one person on entering them has found the air so 
fetid as to produce nauseousness and almost vomiting. 
The old straw on which they were laid, and their filthy 
garments were such as to make their insanity more 
hopeless, and at one time it was not considered within 
the province of the physician's department to examine 
particularly the condition of the lunatics. In these cir- 
cumstances any improvement of their minds could hard- 
ly be expected. Instead of having three out of four re- 
stored to reason, as is the fact in some of the favored 
Lunatic Asylums, it is to be feared that, in these cir- 
cumstances, some, who might otherwise be restored, 
would become incurable, and that others might lose 
their lives, to say nothing of present suflfering." 

" In the prison in which were six lunatics, their con- 
dition was less wretched. But they were sometimes an 
annoyance, and sometimes a sport to the convicts ; and 
even the apartment, in which the females were confin- 
ed, opened into the yard of the men ; and there was an 
injurious interchange of obscenity and profaneness be- 
tween them, which was not restrained by the presence 
of the keeper." 

" In the prison, or House of Correction, so called, in 
which were ten lunatics, two were found about seventy 
years of age, a male and female, in the same apartment 
of an upper story. The female was lying on a heap 
of straw under a broken window. The snow in a se- 
vere storm, was beating through the v^/indow, and lay 
upon the straw around her withered body, which was 

3 



18 

partially covered with a few filthy and tattered gar- 
ments. The man was lying in the corner of the room 
in a similar situation, except that he was less exposed 
to the storm. The former had been in this apartment 
six, and the latter twenty one years." 

" Another lunatic, in the same prison was found in a 
plank apartment of the first story, where he had been 
eight years. During this time he had never left the 
room but twice. The door of this apartment had not 
been opened in eighteen months. The food was fur- 
nished through a small orifice in the door. The room 
was warmed by no fire ; and still the woman of the 
house said " /le had never froze.'''' As he was seen 
through the orifice in the door, the first question was, 
" is that a human being ?" The hair was gone from one 
side of his head, and his eyes were like balls of fire." 

" In the cellar of the same prison were five lunatics. 
The windows of this cellar were no defence against the 
storm, and, as might be supposed, the woman of the 
house said, "we have a sight to do to keep them from 
freezing.'''^ There was no fire in this cellar which could 
be felt by four of the lunatics. One of the five had a 
little fire of turf in an apartment of the cellar by him- 
self. She was, however, infuriate, if any one came near 
her. This woman was committed to this cellar seven- 
teen years ago. The apartments are about 6 feet by 
8. They are made of coarse plank and have an orifice 
in the door for the admission of light and air, about 6 
inches by 4. The darkness was such in two of these 
apartments, that nothing could be seen by looking 
through the orifice in the door. At the same time there 
was a poor lunatic in each. A man who has grown 



old was committed to one of them in 1810, and had 
Uved in it seventeen years." 

"An emaciated female was found in a similar apart- 
ment, in the dark, without fire, almost without cover- 
ing, where she had been nearly two years." 

" A colored woman in another, in which she had been 
six years ; and a miserable man in another in which he 
had been four years." [Second Report of Prison Dis- 
cipline Society.^'' 

Two facts may be urged in extenuation of a prac- 
tice so apparetly irreconcilable with the benevolent 
spirit of the age in which it originated. The proper 
mode of treating insanity was almost universally un- 
known at the time of its adoption ; and the jails and 
Houses of Correction were the only places where the 
strictness of confmement then deemed indispensable, 
could be enforced. 

Until a period comparatively recent, insanity has 
been deemed an incurable disease. The universal opin- 
ion had been that it was an awful visitation from Heav- 
en, and that no human agency could reverse the judge- 
ment by which it was inflicted. During the preva- 
lence of this inauspicious belief, as all efforts to restore 
the insane would be deemed unavailing, they of course 
w^ould be unattempted. And even at the present day 
and in communities otherwise highly enlightened, there 
is reason to fear that a lamentable degree of ignorance 
prevails upon this subject ; an ignorance, which, could it 
be once dispelled, some of the most painful records in 
the history of human suffering might be closed, immedi- 
ately and forever. It is now most abundantly demon- 
strated, that with appropriate medical and moral treat- 
ment, insanity yields with more readiness than ordinary 



20 

diseases. This cheering fact is established by a series of 
experiments, instituted from hoher motives and crowned 
with happier results, than any ever recorded in the bril- 
liant annals of science. A few individuals, justly enti- 
tled to a conspicuous station among the benefactors of 
their race, have exploded the barbarous doctrine that 
cruelty is the proper antidote to madness, and have dis- 
covered that skill, mildness and self-devotion to the 
welfare of the insane are the only efficacious means for 
their restoration. Their labors have been hallowed by 
the spirit of humanity that inspired them; reviving rea- 
son, and returning virtue and happiness have been their 
reward. 

These facts are deeply interesting, and, from 
among many similar statements, the following are se- 
lected to remove all doubts concerning their credibility. 

The seventh Report of the London Prison Discipline 
Society, published in 1827, shews, that, in the Retreat 
at York, out of forty patients admitted within three 
months after the first attack, forty were restored to their 
friends, recovered. Of those admitted after three, and 
within twelve months after the commencement of the 
malady, the proportion of cures was as twenty-five to 
forty five ; but of those whose disease was of more than 
two years standing, the proportion of cures was only as 
fourteen to seventy nine. The experiments of Doctor 
Burrows, at his private Asylum in England, exhibit simi- 
lar results. The last Report of the Visitors of the Con- 
necticut Retreat for the insane shows a ratio of recov- 
eries in the old cases, equivalent to 26 per cent, and 
out of twenty-four recent cases, twenty-two were recov- 
ered, being in the ratio of more than nifiety one percent. 
The Commissioners are informed, that, at the " Retreat" 
last mentioned, when the circumstances of the patient 



21 

are supposed to require it, a separate attendant is as- 
signed him, whose duty it is to remain constantly at his 
side, to occupy his attention with pleasing themes, to 
humor his caprices, and by skilfully adapting his own 
conduct to the fitful moods of madness, to soothe and 
pacify that portion of the mind which had been excited 
to frenzy, and so to allow those faculties whose action 
remains undisturbed, to gain the ascendancy. The pa- 
tient is conducted into the open air, the fields and the 
woods, that the restorative influences of nature may 
strike some chord in the heart, as yet unbroken in the 
fatal struggle with worldly disappointments. It is said, 
that, when the case is recent, attentions of this kind 
continued for eight or ten days, have scarcely ever failed 
to subdue the most terrific and fiend-like ferocity. From 
this systematic practice, it is believed, arises, in a great 
degree, the unparalleled success of that Institution. 

This novel mode of treating insanity has but lately 
superseded a system in which fetters, whips, confine- 
ment, starvation and suflfocation in water almost to 
drowning, were the standard remedies, by which minds, 
whose disease was an irregularity of action accelerated 
to delirium, were to be soothed and pacified and restor- 
ed to harmonious movement. Under that system, thou- 
sands of intellects have been precipitated from a con- 
dition of temporary danger to one of irretrievable ruin. 
But when the fierceness of the malady has been assuag- 
ed by the union of medical science with all the name- 
less attentions which benevolence alone can practise or 
conceive, the recuperative energies of the mind have 
soon prevailed, and an immortal nature has been restor- 
ed to the capacity of virtue and the enjoyment of hap- 
piness. 



?2 

To this unfortunate class of beings, humanity is in 
long arrears. One of the strongest, if not one of the first 
principles of social obligation arises from necessity of 
relief and ability to relieve. And when does a man so 
urgently require the light of others to direct his steps 
as when he wanders in darkness ? When does he stand 
in such extremity of need of the knowledge and guid- 
ance of his fellow-men as when his own mind is a wild 
chaos, agitated by passions which he cannot quell, and 
haunted by forms of terror, which the living energy of 
his nature is perpetually calling into being but cannot 
-disperse ? When does he so strenuously demand their 
succor, as when his own soul is like a living wound and 
lie has lost all power of distinguishing between the 
sources of healing and of torture ? If the insane have 
done nothing to- forfeit the claim which men who suffer 
have, by the law of nature, upon men who are able to 
prevent that suffering ; they should be treated, not with a 
sole regard to the security of others, but with special 
reference also to their own inisfortunes, and in a man- 
ner adapted to shorten their duration, or where that is 
impossible, at least to mitigate their severity. How- 
ever imperiously the public good may demand the co- 
.ercion of the insane, it can never be just to cast them 
into a hopeless dungeon, thereby making the cause of 
their confinement remediless, and then the confinement 
itself terminable only by the death of the sufferer. In 
its practical operation, such a system is a direct con- 
signment of human beings to the long-protracted and 
mysterious horrors of madness. 

In view of these facts and considerations, the Com- 
missioners cannot hesitate to recommend, that as soon 
as the Hospital at Worcester shall be prepared for the 



23 

reception of the insane, and that fact shall be made 
public by proclamation from the Governor of the Com- 
monwealth, all orders, decrees and sentences for the 
confinement of any lunatic, made by any Court or any 
judicial officers of this ('ommonwealth, by virtue of the 
statutes of 1797, chap. 62, and 1816, chap. 28, shall be 
so far modified, that said lunatics shall be committed to 
the custody of the Superintendent of the Hospital at 
Worcester, instead of being committed to any Jail or 
House of Correction, as heretofore required ; and, fur- 
ther, that all lunatics, who, at the time when such proc- 
lamation is made, shall be confined in any Jail or House 
of Correction, under any order, sentence or decree of 
any Court, or any judicial officers, by virtue of the stat- 
utes above mentioned, shall, as soon as convenient and 
practicable, be removed to said Hospital, under the di- 
rection of the Mayor and Aldermen of the City of Bos- 
ton, or of the County Commissioners of the several 
Counties in this Commonwealth, and at the expense of 
the Counties respectively. And as all information re- 
specting the disease of any lunatic to be removed to the 
Hospital as above suggested, the cause of such disease,. 
the period of its duration, the character, whether of fe- 
rocity, of melancholy or of any other type, which it may 
have assumed, will be not only necessary as a guide 
in the classification and treatment of each lunatic, but 
may also be a valuable item in forming statistical tables 
of insanity, such inforujation ought, as far as practica- 
ble, to be communicated by the County authorities res- 
pectively, at the time when the lunatics are removed 
from their several places of confinement. And, as the 
prolonged confinement of any lunatic committed to the 
Hospital by judicial authority, alter the cause of such 



24 

commitment shall have ceased to exist, will be a hard- 
ship upon the individual and occasion useless expense, 
it is recommended to confer the power of enlargement 
in all such cases upon the Board of Visitors, at any 
meeting when a majority of said board shall be present ; 
and also upon either of the Justices of the Supreme Ju- 
dicial Court, and of the Court of Common Pleas, to be 
exercised by said Justices upon the written application 
of any person, at any term of either of said Courts 
when holden within and for the County of Worcester. 

These provisions would embrace all those lunatics, 
whom the Commonwealth, by virtue of its sovereignty 
and for the security of its citizens, sentences to impri- 
sonment. 

It is believed that no further exposition can be neces- 
sary to demonstrate the entire unfitness of our jails and 
Houses of Correction as receptacles for the insane. 
When the Hospital at Worcester shall be completed, 
all pretence for the necessity and with it all excuse for 
the practice of confining town-pauper lunatics with 
condenmed criminals, will be removed. Such confine- 
ment has, in many instances, been effected by private 
contract between the towns and the keepers, when, for 
the purpose of saving a few shillings in the support of 
a lunatic, he has been subjected to the most aggravated 
sufferings. It is but a short time since, in a neighbor- 
ing county, a lunatic placed in a House of Correction by 
the Overseers of the Poor of the town to which he be- 
longed, was so frozen that he died. To prevent renew- 
ed instances of this cruel economy, it is suggested, that 
keepers of Jails and Houses of Correction should be 
prohibited under a penalty from making private con- 
tracts for the custody and support of lunatics within the 



25 

County Buildings, without the consent and approbation 
of the Mayor and Aldermen of the City of Boston, or of 
the County Commissioners of the respective counties. 

As to the other two classes of lunatics, namely, 
town-paupers, and those individuals, of whose existence 
and condition the laws take no special cognizance, the 
Cbmmissioners take the liberty to suggest, that the 
Commonwealth ought not, at least for the present, to 
do any thing more than to proffer them, as far as pos- 
sible, the benefits of the Institution. Over neither of 
these classes can the State assume an immediate and 
mandatory control, without a direct, and in some in- 
stances a harsh interference with the privileges and 
supposed rights of Corporations or individuals. As to 
town-pauper lunatics, it is true, that their condition, as 
they are now frequently treated, is one of severe priva- 
tion and wretchedness ; and much it is foreseen may be 
urged in favor of compulsory provisions, having for 
their object the more humane treatment of this unfor- 
tunate portion of our fellow-beings. But on the other 
hand, it should not be forgotten, that hitherto, the Insti- 
tution at Charlestown has been the only one of a pub- 
lic character in the State, where the insane have been 
received and treated according to the principles of 
mental and medical science ; that that Institution, al- 
though it has been recently enlarged, is still insufficient 
to accommodate one fourth part of the lunatics in the 
State, and that the habits of towns were fixed long 
prior to its existence. Hence, it may be confidently 
expected, that the course pursued by towns under past 
circumstances, will prove no indication of their future 
practice. 

But even upon the inadmissible supposition,^ that the 
4 



26 

inhabitante of our towns could be inaccessible to mo- 
tives of humanity ; still, motives of economy must be 
decisive in persuading them to {ilace their insane poor 
within the action of causes, so frequently efficacious in 
restoring an alienated mind. It seems now to be be- 
lieved that, if the organ of the brain be not injured, 
the mind, in every case of alienation, is reclaimable, if 
suitable means are resorted to on the first access of the 
disease. But if recovery is expected, assistance must be 
promptly afforded, for the chances of restoration rapidly 
diminish with the continuance of neglect. An incon- 
siderable sum promptly and judiciously expended, will 
achieve what no amount of labor or cost will be likely 
to accomplish after a delay of three or four years. 
Pecuniary interest, then, becomes the auxiliary of duty ; 
and economy and humanity, for these purposes, are 
convertible terms. 

For many years past, the actual expense of support- 
ing the insane population of the State cannot have 
been less, on an average, than forty thousand dollars 
annually. This subject, therefore, assumes an impor- 
tance as a matter of finance, if not as one of justice, 
of charity, and of duty. 

Some mode, of course, is to be provided by which the 
expense of supporting the inmates of the Institution is 
to be defrayed. In respect to the expenses incurred by 
those committed to the Hospital by virtue of the sta~ 
tutes of 1797, chap. 62, and 1816, chap. 28, as modi- 
fied by provisions herein previously recommended, no 
sufficient reason is discovered for any innovation upon 
former practice. The Board of Visitors ought, there- 
fore, to be invested with the same powers, which the 
Keepers of Houses of Correction now by law possess 



27 

against delinquent towns or individuals. As to town- 
pauper lunatics, and those persons, who, by the volun- 
tary agency of their friends, may enjoy the benefits of 
the Institution; it is recommended, that they should be 
kept for a sum, in no case exceeding the actual ex- 
pense incurred in their support, without reference to 
the original outlay of capital. And, j)erhaps the Visit- 
ors should be authorized in their discretion, to receive, 
for a sum something less than the actual cost, patients 
who have been recently attacked, as a bounty upon 
humane eflforts (or their prompt relief. This is a 
charitable Institution, and was especially designed for 
the necessities of the poorer classes of people. Hith- 
erto no place has existed within the State, where per- 
sons possessing something less than an average of pro- 
perty, could, according to commonly received notions 
of ability to bear expense, afTord to send the members 
of their families, or their friends, when attacked by this 
malady. The main object of the Legislature in estab- 
lishing this Institution, it is believed, was to supply that 
deficiency. It was a necessary part of the great circle 
of duties to be fulfilled by a government, constituted 
for the benefit of the people. Gratuitous education, 
universally diflfused ; laws repressing licentiousness, and 
encouraging industry by securing to every man his 
honest gains, may be primary duties in the order of 
performance. But, though secondary in time, it is a 
duty no less sacred in obligation, to furnish all needful 
succor to those, whose position has been so assigned 
them in the great machine of the Universe, that they 
suflfer without fault or oflfence of their own. 

The second consideration, connected with the disci- 
pline of the Institution, respects the regulations, by 



which the insane shall be governed whilst at the Hos- 
pital, and the visitatorial power, under which all such 
regulations shall be administered. 

The Officers of the Institution should be so arrang- 
ed and of such a number, as to insure the greatest effi- 
ciency and economy in the management of its concerns, 
and a proper responsibility to the public, who are its 
patrons. A great proportion of the economical regula- 
tions of the Hospital must necessarily be of such a na- 
ture as cannot properly be reached by enactments of the 
Legislature, not falling within the usual range of legis- 
lation. The same remark may be made of the appoint- 
ment of nearly all the subordinate officers, and the se- 
lection of the domestics of the establishment. The 
power to frame by-laws, and to appoint the officers re- 
ferred to, must therefore be placed in the hands of a 
Board of Visitors, whose duty it shall be to take charge 
of the general interests of the Institution, and to see 
that its affiiirs are conducted according to the require- 
ments of the Legislature — the regulations of its inter- 
nal police- — and the true intent and object of the Insti- 
tution itself. 

The appointment of such a Board should obviously 
proceed from the Government. The duties of the Vis- 
itors cannot be burdensome, after all the necessary reg- 
ulations of the Institution shall have been made, and 
the subordinate officers shall have been appointed. To 
mature and establish such regulations, and to make the 
necessary appointments, will require much time, care- 
ful inquiry, and judicious selection. 

The Board of Visitors should be so constituted, as to 
secure a wholesome responsibility to the public, and at 
tlie same time admit of a suitable division of the labor 



29 

of visitation. To secure these objects, the Commis- 
sioners recommend, that provision be made for the ap- 
pointment, by the Governor and Council, of five Visit- 
ors — a portion of the Board to be appointed annually, 
if the Legislature shall deem it expedient — that the 
Visitors thus appointed shall be required to establish, as 
soon as practicable, all the necessary by-laws and reg- 
ulations for the government of the Institution in all its 
departments, and to appoint or provide for the ap- 
pointment of all necessary subordinate officers. 

The most important appointment to be made by the 
Visitors will be that of the Principal or Superintendent. 
After much consideration, the Commissioners recom- 
mend, that the Superintendent be a Physician, resident 
at the Hospital, devoting to its interests all his skill and 
energies. There is abundant reason to believe, that 
the apartments of the Hospital will at all times be fully 
occupied by the insane. The care of one hundred and 
twenty such persons will, therefore, reasonably demand 
his constant attention and advice. Essential injury might 
accrue from an occasional absence of the Physician ; 
such injury certainly would accrue, if the inmates should 
be dependent upon one, whose private practice should 
call him abroad for any considerable portion of his 
time. The requirement of residence at the Hospital 
would not, however, preclude the Superintendent from 
consultations, which might be solicited by his profes- 
sional brethren. 

Periodical and thorough visitations of the Hospital 
will evidently be indispensable to its success, and to its 
good name in the community. They should be made 
as often as once in six weeks by one or more of the 
visitors ; semi-annually by a majority of them, and an- 



30 

nually by the whole Board. At each visitation a writ- 
ten account should be drawn up of the state of the In- 
stitution ; and at the annual visitation, which should be 
a short time before the sitting of the Legislature, a 
detailed Report should be made, to be laid before the 
Governor and Council, for the use of the Government, 
setting forth very particularly a view of its situation 
and of all its concerns. 

The duty of visitation, as already intimated, will not 
probably be at all burdensome, after the Institution 
shall have gone into operation. The Visitors will 
undoubtedly feel themselves amply compensated for 
their services in the opportunity afforded them to aid 
the cause of humanity, by a manifestation of the no- 
blest sympathies of the heart. No provision, therefore, 
need be made for defraying any but the actual expenses 
of the visitation. 

Previously, however, to the complete organization of 
the Establishment, so much of the time of the Board will 
necessarily be occupied, and very laboriously too, that 
justice would require, that provision be made for com- 
pensating them suitably for their services up to that 
period. 

The charge of the Treasury of the Institution will be 
an important matter ; and the power of appointing the 
Treasurer may, in the opinion of the Commissioners, 
safely be lodged in the hands of the Board of Visitors, 
leaving it optional with them to select one of their 
own number, or some other suitable person, who shall 
give bonds in such sum as the Board shall deem pro- 
per. The duties of this office will necessarily demand 
of the incumbent the devotion of much time and atten- 
tion ; he should, therefore, receive an adequate com- 



31 

pensation for his services, to be determined by the Leg- 
islature. 

The Treasurer should be required to present annu- 
ally to the Governor and Council, at the time when the 
Board of Visitors make their Report, a detailed and 
complete view of the financial concerns of the Institu- 
tion ; and the Governor should be authorized to draw 
his warrant upon the Treasury for such sums as may be 
necessary for the support of the same. 

The Commissioners conclude with the expression of 
their confident belief, that this Institution, under skilful 
management, will subserve the objects of a just econo- 
my ; and while it cannot fail to afford recovery or relief 
to a large class of unfortunate sufferers, may, at the 
same time, by the exhibition of an example worthy the 
imitation of other communities, aid, still more exten- 
sively, the general cause of philanthropy. 
Respectfully submitted, 

HORACE MANN. 
BEZALEEL TAFT, Jr. 
W. B. CALHOUN. 

Boston, January 4, 1832. 



32 



An Extract from the Codicil to the last Will and Testa- 
ment of Nathaniel Maccarty late of Worcester- in the 
County of Worcester, Esq., deceased, duly proved and 
approved, viz: 

2d " I revoke the Legacy of Five hundred dollars to 
the Mc Lean Hospital for the Insane at Charlestown. 
And I hereby give and bequeath the said sum of Five 
hundred dollars to the Commonwealth of Massachusetts 
if the Government thereof will accept the same in trust, 
that the same shall be faithfully appropriated and ex- 
pended under the direction of the Governor for the time 
being, in ornamenting, by the construction of walks, and 
in planting, with trees and shrubbery the public grounds 
in Worcester purchased and appropriated for the use 
and accommodation of a Lunatic Hospital, to the end 
that the said grounds may be made not only an object of 
tasteful regard to the citizen of the town, and to visitors, 
but of refreshment, and gratifying interest to the conva- 
lescent Patients and Inmates of the Establishment." 
THEOPHILUS WHEELER, 
Register of Probate for the County of Worcester. 



iD - 



EV