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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COMMISSIONERS

APPOINTED UNDER

A RESOLVE

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TO SUPERINT^KJ) THE ERECTION

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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