reprinted from 
(Parities 
v Review 
FOR OCTOBER,IB9B 
The New Hassachusetts 
Board of Insanity 
WALTER CHANNINQ, M.D. 
NEWYORK 
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cerning men and women who can not get through life alone, whether 
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drafts, or money orders, payable to The Charities Review. THE NEW MASSACHUSETTS BOARD 
WALTER CHANNING, M.D. 
[Reprinted from The CHARITIES Review for October, 1898.] 
The law creating this Board marks 
a step forward in the care of the 
insane, and is an indication of the 
progress being made in many parts 
of the world in the proper treatment 
of the indigent and defective classes. 
Little by little the needs of these 
classes have become more clearly 
recognized, owing to the investiga- 
tions of competent observers, and 
the natural result has been to sub- 
divide them into groups suggested 
by experience, so that they might 
be the more directly and specially 
dealt with. 
The advantages of this direct rela- 
tion are quite what they would be 
in a well conducted private business, 
where the effort is made to find out 
what a special class of patrons wants, 
and to see that it is provided. Many 
persons seem to believe that public 
and private business are entirely un- 
like, and that any one is competent 
enough to carry on the former, 
whereas a man must have skilled 
knowledge to make a success of the 
latter. Nothing could be further 
from the truth. The business of the 
State is like that of the individual— 
a wise adapting of means to ends, 
and not a process of unthinking 
almsgiving. 
It may be said of the insane as a 
class that they have not received 
as specialized supervision in many 
states as their needs and number 
have entitled them to. The idea is 
still somewhat prevalent that they 
are wilful and perverse, or wholly 
undeserving, and the public is satis- 
fied to provide for them as paupers. 
A somewhat melancholy illustration 
of the truth of this assertion is fur- 
nished by the hundreds of insane 
persons still wretchedly housed and 
cared for as paupers in the alms- 
houses of Massachusetts. 
Coming now more directly to the 
subject of this paper, we find that 
the new Board of Insanity in Massa- 
chusetts has not sprung into exist- 
ence as the result of sudden agita- 
tion, but has been slowly evolved in 
the natural order of things, though 
a fortunate concatenation of events 
may have hastened the final result. 
The insane first came under some 
formal supervision, as a small class 
among many others, when the Board 
of State Charities was organized in 
1863. The duties of this Board, 
which has since undergone two 
changes of name, were heterogeneous 
and numerous at the beginning, and 
have continued to be so to the pres- 
ent time, though some have been 
lopped off and others restricted. It 
must be admitted that a large and 
intelligent board might be able to 
supervise public institutions of vari- 
ous kinds in a very satisfactory man- 
ner, provided the number of inmates 
was so small that there would be 
1 2 
MASSACHUSETTS BOARD OF INSANITY. 
time enough to do the work thor- 
oughly. If, however, administrative 
functions were added to the super- 
visory ones, and the number in the 
institutions immensely increased, the 
question would be largely one of 
time. Manifestly, no board could 
give as much attention to a thousand 
persons in a given time as to one 
hundred. Just this difficulty has 
arisen with our State Board. The 
numbers under its supervision 
have rapidly augmented, and, even 
with improved facilities and self- 
sacrificing efforts to meet the in- 
creased demands, the time has been 
insufficient to meet them. 
While I believe the interests of no 
class of the State’s indigent have 
been neglected, it is true, neverthe- 
less, that the Board has not had suf- 
ficient opportunity to work out and 
solve some of the problems which 
have arisen and now press both for 
consideration and putting to the 
test. This is especially true of the 
insane, of whom there were in 1863, 
in the State hospitals, 1,164, against 
6,426 in 1897. This rapid increase 
alone makes the question of what 
shall be done with our insane a most 
perplexing one. Why has the ques- 
tion not been solved? Not because 
it is not possible of solution, not 
because the Board has not realized 
its importance, but partly, at least, 
because it has had to scatter its 
force in so many directions that it 
has not had momentum enough left 
over to accomplish this purpose. 
In any discussion of the care of 
the insane, it must be remembered 
that they are mentally weak and 
often in impaired bodily condition, 
and hence the medical side of the 
case can not be omitted. This fact 
introduces new and added difficul- 
ties which can be successfully dealt 
with only by persons possessing 
skilled and scientific knowledge of 
insanity. A very good illustration 
of this statement is furnished by the 
report of the Board of Lunacy and 
Charity for 1894, in which the short- 
comings of hospital superintendents 
are referred to anent an address by 
Dr. Weir Mitchell at the Fiftieth 
AnnualMeetingof the American Med- 
ical Psychological Association. The 
report first quoted from its report of 
the previous year, in which the state- 
ment was made that “ the care of 
the insane in the State hospitals was 
not altogether satisfactory, especially 
if regarded from a medical and scien- 
tific point of view,” and then goes 
on to consider the hospital situation, 
and what is desirable to raise the 
standard of the medical service. 
Though the report did not in the 
writer’s opinion do full justice to 
the excellent work already accom- 
plished in some of the hospitals, 
it was very suggestive and timely. 
Two facts were distinctly brought 
out. First, that such improved 
methods of medical work as were 
enumerated had been inaugurated 
by the hospital authorities them- 
selves of their own volition, inde- 
pendently of the Board, and, second, 
that the most of the suggested 
changes and improvements could 
only be successfully carried out 
under the supervision of men of 
the highest skill and scientific train- MASSACHUSETTS BOARD OF INSANITY. 
3 
ing, and it is no disparagement to 
the Board to say that it did not 
number among its members men of 
the required kind. 
These facts and various incidental 
occurrences served to arouse the 
interest of the medical profession, 
both in the hospitals and out of 
them, in the matter of more expert 
and extended supervision of the 
institutions for the insane. This it 
was felt could only be brought about 
by a separate Board of Lunacy which 
should devote the whole of the time 
at its disposal to the care of the 
insane alone. While this was not a 
new idea to many hospital men, the 
time had never before seemed favor- 
able to attempt to realize it. Now, 
however, the prospect was more 
hopeful, and an effort was made to 
see what could be done. 
It so happened that the years 
1895-6 were auspicious ones in which 
to inaugurate the movement. The 
separate care of the insane of the 
city of Boston was being urged 
by the Boston Medico-Psychological 
Society, as well as by various public- 
spirited citizens, and incidentally 
the evils of having criminals, paupers, 
and insane persons under the juris- 
diction of one person or board were 
strikingly brought out. A strenuous 
effort was being made by a number 
of interested persons, later organ- 
ized into a “ Citizens’ Committee,” to 
place the juvenile wards of the State, 
then under the jurisdiction of the 
Board of Lunacy and Charity, in the 
hands of a special Board of Trustees. 
Various physicians, interested in the 
care of the insane, organized a com- 
mittee to work for their interests, 
and the Relief Officers’ Association, 
composed of overseers of the poor 
throughout the State, petitioned the 
Legislature for the appointment of a 
Commission to investigate the chari- 
table institutions of the State, espe- 
cially having in view the adjustment 
of pauper settlements and State care 
of the insane. Petitions were also 
presented by medical men for a 
separate Board of Lunacy. 
The result of this and other agita- 
tion was the passage early in 1896 
of the following vote by the Legis- 
lature : “ Resolved, That the Gov- 
ernor by and with the advice of the 
Council be and he is hereby author- 
ized to appoint a Commission con- 
sisting of three persons to investi- 
gate the public charitable and 
reformatory interests and institu- 
tions of the Commonwealth; to 
inquire into the expediency of 
revising the system of administer- 
ing the same and of revising all 
existing laws in regard to pauperism 
and insanity, including all laws 
relating to pauper settlements ; and 
furthermore, to inquire into the 
relation of pauperism and insanity 
to crime, with a view to securing 
economy and efficiency in the care 
of the poor and the insane in this 
Commonwealth.” The Commission 
was asked to present its report by 
February 1, 1897. 
The Summer of 1896 was passed 
by this Commission, which was 
promptly appointed, in carefully 
investigating the subjects speci- 
fied. In its report it recommended 
the creation of a State Board of 4 
MASSACHUSETTS BOARD OF INSAN ITY. 
Insanity, to consist of five persons, 
two of whom should be expert in 
insanity, give their whole time to 
their duties, and receive an annual 
salary of $5,000 each. It also 
recommended that all the powers of 
the present Board of Lunacy and 
Charity be transferred to the new 
Board, and added various new duties 
in accord with the progress made in 
the care of the insane. It also 
recommended that all insane persons 
supported at public expense be 
placed under the care, custody, and 
control of the State and the expense 
borne by it. 
The report of the Commission was 
presented too late in the Spring of 
1897 to receive consideration by the 
Legislature, though hearings were 
held in reference to it before one of 
the Legislative Committees, and its 
recommendations were made public. 
During the Summer of 1897 the 
Board of Lunacy and Charity was 
kept constantly before the public 
by virtue of a deadly conflict which 
was waged between it and some of 
the advocates of the “ Children’s 
Bureau,” and this rather served to 
keep alive the interest in the report 
of the Commission. This was further 
stimulated by the successful working 
of the new law separating Boston’s 
insane from other dependent classes. 
Medical opinion had also unani- 
mously expressed its approval of 
a new Lunacy Board through the 
largest medical societies in the State, 
and committees had been appointed 
to take such action as might be 
necessary to bring this change about. 
By the time the Legislature met at 
the beginning of the present year, it 
was found that the consensus of pub- 
lic opinion was strong for a sepa- 
ration of the lunacy duties of the 
Board of Lunacy and Charity from its 
other duties. If there was any 
opposition it did not make itself 
openly felt. Even the Board it- 
self in a formal manner in the 
pages of its report was willing to 
say: “If the new Board were to 
have more complete control, and so 
were enabled to bring about without 
unnecessary delay a better classi- 
fication of the inmates of the several 
institutions for the insane, and a 
much needed reduction in the ex- 
pense to the State of caring for the 
pauper insane, the Board would be 
disposed to advocate its establish- 
ment.” 1 
Various hearings were held during 
the Winter by the Joint Committee on 
Public Charitable Institutions of the 
Legislature to consider the “ Report 
of the Commission to Investigate the 
Public Charitable and Reformatory 
Interests and Institutions of the 
Commonwealth” already referred to. 
Those on the Care of the Insane 
were well attended, largely by phy- 
sicians, though the public also ex- 
pressed its approval of a new Board 
through well known citizens. Some 
of the members of the Board of 
Lunacy and Charity were present and 
offered no opposition, and the Com- 
mittee itself appeared to be in favor. 
The hearings covered the State 
Care of the Insane as well as the de- 
sirability of a new Insanity Board. 
1 Nineteenth Annual Report, Board of Lunacy and Charity, 1897. MASSACHUSETTS BOARD OF INSANITY. 
5 
All of the medical profession, nearly 
all laymen, the “ Citizens’ Com- 
mittee,” and the Board of Lunacy 
and Charity were in favor of the 
former measure, and even the com- 
mittee was able to recognize the in- 
humanity of keeping over nine hun- 
dred insane persons in almshouses, 
in many of which they were neg- 
lected or wretchedly provided for. 
It was strenuously urged by members 
of the medical profession and others 
that it was a disgrace that such treat- 
ment should be continued, and the 
only remedy was to have the State 
care for them. While many members 
of the Legislative Committee agreed 
that this was all true, it was afraid, 
from motives of expediency, to put 
State Care into the bill, covering the 
interests of the insane, that it was to 
introduce into the Legislature. 
After much hard work by the 
Committee and others interested, 
and several conferences between 
them, a bill was drawn under the 
general direction of the Chairman of 
the Investigation Commission and 
was favorably acted upon by the 
Legislature in the Spring of 1898. 
October 1 of the present year was 
set as the time when the law would 
go into effect. 
While this bill does not include 
all of the recommendations of the 
Commission, it does include a large 
number of them, and paves the way 
for undertaking reforms later, that 
have now been passed over. The 
bill provides for the creation of a 
Board of Insanity to be composed of 
five persons, two at least of whom 
shall be experts in insanity. The 
Board is to appoint an executive 
officer who shall be a physician and 
expert in insanity and who may be 
a member of the Board, and his 
salary is to be fixed by the Governor 
and Council. It is to present 
annually a full report of the 
institutions under its supervision; 
and to include in its report “infor- 
mation embodying the experience of 
this country and other countries 
regarding the best and most success- 
ful methods of caring for such per- 
sons as come under its supervision; 
and it shall also encourage scientific 
investigation by the medical staffs 
of the various institutions under its 
supervision; and shall publish from 
time to time bulletins and reports 
of the scientific and clinical work 
done therein.” 
It is impossible in the limits of 
this brief paper to state many of 
the provisions of the bill. Only a 
few of them which indicate the 
thoroughness with which it has 
been drawn can be referred to. 
Among these are the following: 
The authority to exercise the pow- 
ers of boards of trustees in manag- 
ing institutions when directed by 
the Governor to do so; the inspect 
ing and approving of all plans for 
new buildings (no expenditure of 
more than $2,000 can be made for 
alterations or extensions of buildings 
without the approval of the Board); 
the authority to act as Commission- 
ers of Insanity under certain condi- 
tions either in the case of persons 
inside or outside of institutions; the 
very careful directions in regard to 
visitations of institutions and the 6 
MASSACHUSETTS BOARD OF INSANITY. 
records of such visits in a book kept 
for the purpose; the prescribing of 
a uniform system of bookkeeping 
for the different institutions; the 
prescribing of the form of certifi- 
cate to be used in commitments; 
the arrangement for semi-annual 
conferences between the Board and 
the trustees of the State institutions 
or their representatives. All the 
powers of the old Board are to be 
assumed by the new one, except 
those in reference to the settle- 
ments of the State poor. 
One of the most important pro- 
visions of the bill is, in part, the fol- 
lowing; “The State Board of Insanity 
shall report to the Legislature on or 
before the first Wednesday in Janu- 
ary, in the year 1900, such method 
or methods as in its opinion will 
most effectually provide for the care 
and support of the insane poor 
who, under existing laws, are cared 
for by or supported at the expense 
of the cities and towns of the Com- 
monwealth.” While there can be 
little doubt that, as the result of 
such a report, the necessary steps 
will be taken to ultimately remove 
all the insane poor from our alms- 
houses, it will remain a lasting dis- 
credit to the State that she was so 
dumb to the voice of humanity as 
to be influenced by a slight whimper 
of disapproval, and delay the right- 
ing of a glaring injustice. Had she 
fearlessly done her duty, even at 
the sacrifice of a little money, the 
great majority of the public would 
have applauded her. The Dorothea 
Dixes are still needed as much as 
ever to sting the slumbering legisla- 
tive conscience, and waken it from 
its self-indulgent sleep. 
The new State Board of Insanity 
has a great opportunity before it. 
“Forward” is now the watchword 
in philanthropic work, and public 
opinion will generously recognize 
any good work done. The whole 
medical profession is committed in 
favor of it. Scientific clinical and 
laboratory work has rapidly im- 
proved in some of the hospitals in 
recent years, and is capable of great 
development in all. The state 
institutions are almost without 
exception under the management 
of excellent boards of trustees. 
The total number of the insane 
in the State is not too large to 
be carefully supervised and to have 
records made of its movements. 
Such are some of the favoring con- 
ditions of the situation. 
The new Board is intended to be 
a supervisory and not an administra- 
tive one, which will vastly simplify 
its duties. While the law under 
which it is to act is specific in many 
directions, it appears to be broad 
enough in its scope to allow great 
freedom of action, so that it need 
not feel trammeled by the limita- 
tions of what the law allows. 
The end, no doubt, which the new 
Board will endeavor to achieve will 
be the inauguration of a broad and 
comprehensive State policy, in which 
the care of every dependent insane 
person in the State will be ade- 
quately provided for. Such a policy 
must be humane, scientific, and eco- 
nomical. If it is all three it will be 
wise, and if it is wise it will succeed.