fen-dip Con S' Boston JL UN AT IC H OSFI TAjL WORCASTER, MASS . REPORT OF COMMISSIONERS APPOINTED UNDER A RESOLVE OF THE ILeatglatuve of jWaosac^uoetto, TO SUPERINTEND THE ERECTION OF A LUNATIC HOSPITAL AT WORCESTER, AND TO REPORT A SYSTEM OF DISCIPLINE AND GOVERNMENT FOR THE SAME. MADE JANUARY 4th, 1838 Boston: DUTTON AND WENTWORTH, PRINTERS TO THE STATE, No. 4, Exchange Street. 1832." Commonwealth of Mafsachusetts. Worcester, Mass., SENATE No. 2. To His Excellency 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," REPORT, That the entire foundation, the external and partition walls, the roof, and the windows of such a Hospital are now completed. Having so far 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 2 arrangement, from ordinary habitations. The insane require equable warmth, but they cannot be intrusted with fire. They require light and pure air, but the doors and windows which give light and ventilation to common dwellings, would furnish them with facilities 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- 3 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 believe 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 work 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 which 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 diffidence, 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 foot in width, and four stories in height. The wings are 4 each 90 feet long in front, 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 was 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 5 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 noisomcness 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 large window with 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 window7 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 from the furna- ces through flues in the hall 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 bo kept open in the summer, so that, as the air is made light by heat, it will 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- 7 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 with 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. It is obvious, that in an establishment 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 cast 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 twenty 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 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 11 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 first relates to the classes of Lunatics to be com- mitted to its charge ; the authority by which 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^rs^ class comprehends all 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 suffered 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, beyond 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 suffer 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 efforts 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 perpetually stung by annoyances, which, though individually small, 14 rise by constant accumulation to agonies almost boyond the power of mortal sufferance ; 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 moral 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 suffered 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 everv 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 it 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 infallible 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, might 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 terms 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 suffering." " 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 window, and lay upon the straw around her withered body, which was 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 "he 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 19 old was committed to one of them in 1810, and had lived 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 confinement 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 would 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 holier 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- larresults. 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 ninety 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 suffocation 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. 22 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 he 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 misfortunes, 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 Commonwealth, 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 Aidermen 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 information 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, after 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 condemned 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 Aidermen 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 Commissioners 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 principle? 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 26 inhabitants of our towns could be inaccessible to mo- tives of humanity; still, motives of economy must be decisive in persuading them to place 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, perhaps 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 efforts for 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, afford 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 diffused ; 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 suffer without fault or offence of their own. The second consideration, connected with the disci- pline of the Institution, respects the regulations, by 28 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 affairs 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 the 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 Me Lean Hospital for the Insane at Charlestown. And 1 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.