In the Board of Aldermen, Dec'r 18, 1843. Laid upon the table and ordered to be printed. Attest, S. F. McCleary, City Clerk. In Common Council, October 26, 1843. Ordered, That the Board of Visitors of the Bos- ton Lunatic Hospital be directed to consider and re- port, whether some arrangements may not be made, whereby further employment may be afforded for V 2 LUNATIC? HOSPITAL. [Dec. the patients in said Institution, by the erection of suitable workshops or otherwise. Sent up for concurrence. EDWARD BLAKE, President. In the Board of Aldermen, October 30, 1843. Read and concurred. M. BRIMMER, Mayor. In City Council, December 18, 1843. The Board of Visitors of the Boston Lunatic Hos- pital, to whom was referred the Order of Octo- ber 26th, 1843, in relation to the employment of the inmates, ask leave to REPORT: That they have given the subject careful atten- tion, and appointed a Sub-Committee of the Board, consisting of Alderman Parker and Messrs. Harris and Ayer of the Common Council, to visit the State Hospital at Worcester and the McLean Asylum at Somerville, to examine these Institutions with refer- ence to the employment and amusement afforded the inmates. This Committee have submitted their Report, which is appended and made part of this Report. All which is respectfully submitted. For the Committee, M. BRIMMER, Chairman. MAY 4 1962 1843] CITY DOCUMENT—No. 32. 3 Board of Visitors of the Boston Lunatic Hospital* The undersigned a Sub-Committee of the Board of Visitors of the Boston Lunatic Hospital, to whom the subject of the " employment of the patients of said Institution, by the erection of suitable work- shops or otherwise" was committed, pursuant to an Order of the City Council, passed October 30th last, respectfully REPORT: That they have devoted much time and reflection to the subject committed to them. Aware of the importance of devising some means by which the irksomeness of confinement and restraint, under which the unhappy inmates are placed, could be re- lieved ; they have made all the inquiries they deem- ed necessary for an adequate knowledge in the exe- cution of the duties, which by the order of the City Council devolved upon them. With this view they visited the Institutions at Worcester and at Somer- ville, and from a conference with the respective Su- perintendents of those Hospitals, and by inspecting the mode adopted therein, they have been enabled to obtain such facts as will be detailed in the present report. Your Committee are fully satisfied, that if any employment can be devised, by which the mind as well as the body can be exercised, it would tend under proper modifications in many cases, to the ul- timate cure of the patient; and in all, it would so ameliorate their condition as to render the measure quite an object of consideration. In many cases 4 LUNATIC HOSPITAL. [Dec. past experience has demonstrated that the cause of the malady has been more of a physical, than moral nature—and the great number of cures Avhich have ' been effected by slight medical treatment, followed by a due regulation of diet and regimen, admonish those to whom the patients are committed, to make an effort to extend the restorative process now adopted; and to carry out with still greater success, so philanthropic an end, by means which have been placed within our reach. In this view, your Com- mittee feel warranted in the belief, that the instances are rare in the Boston Lunatic Hospital, where the patient lias not, in some degree, been made more comfortable, and reconciled to the treatment adopted in his case, while under the maintenance of this great public charity. It will not be denied that the Institution will labor under disadvantage in a com- parison with the discipline and accommodations of other similar Institutions, which are sustained by lib- eral endowments, and extensive bequests. But when it is considered that its support is tendered to the poor and the friendless; the amount of usefulness in the aggregate, is a fair offset to the enlarged ar- rangements of other more favored Infirmaries. As a pauper establishment, the Boston Lunatic Hospital has no option in the reception of the inmates of its family. Excluding only the ferocious maniac, it takes from the abodes of squalid poverty, the abject and the forlorn—the idiotic and demented child, the lunatic heir of crime and disgrace, and the vic- tim of vicious appetite and dishonor—including the besotted mendicant, and the self-debased libertine. To so many untoward causes may the moral and physical condition of most of the inmates be attrib- 1843.] CITY DOCUMENT.—No. 32. 5 uted, that the skill of the Superintendent is often baffled in tracing to its source the origin of their malady—and indeed in such a community, he may be deemed singularly fortunate if at all, his investi- gations should in any slight degree be attended with success. Taken, as in most cases they have been, from the lurking places of vice and misfortune, the Superintendent has been misled in discovering the true cause. He is often left to infer the proper mode of treatment from apparent symptoms only, for the patient is seldom able to describe his own feelings. Not infrequentlv has a latent injury of some years standing, been the origin of the imbecil- ity, which he exhibits; sometimes it may be imputed to organic disease ; and too often has it been found the result of protracted self-debasement, which evinces itself by the miserable and helpless condition into which the patient has been plunged. A further cause may be detected in native malformation and paralysis of some vital organ. This class of cases is ranked as incurable, and however hopeless they ap- pear, they have their vicissitudes—-and exhibit differ- ent phases as circumstances, beyond the reach of medical aid indicate. It is believed in all these cases, regular employment of what is left of mind and body, have been resorted to with advantage, when graduated to the strength of either in the pa- tient. Where active exercise in the open air has been practised, it has with but few exceptions, been attended with most salutary effects. If it has not produced a cure, it has served to soften the temper- ament of the individual, and has had the tendency to render more easy the task of self-government. In this respect if it has been productive of no other 6 LUNATIC HOSPITAL. [Dec. benefit, it has rendered the patient less obnoxious to the discipline, necessary to be sustained in all Insti- tutions of this description. It then becomes a subject of inquiry in what man- ner the system of employment contemplated in the Order of the City Council, can be introduced. Your Committee are of opinion, that pecuniary considerations should have no influence in reference to this measure. The importance of such an "im- provement to the patients, seems to forbid any nar- row calculations in this matter; and it would be a mistaken economy to compute the extent to which such an expenditure should be carried—and in the onset your Committee would premise, that they do not believe it could be made profitable in any other manner, than as an auxiliary in the treatment of the patients. The aim of the Institution is to restore the unfortunate inmate to his reason, and to return him to his family and friends. It is one of the evils of all Institutions of this character, that the patient is left to his own feelings among strangers, upon his admission, and the most unfavorable impressions are made upon him as to his confinement. He is apt to view his condition as that of a convict in a peniten- tiary, and until this delusion is dissipated, he is re- served, and remains jealous of every one around him—frequently abstaining from every privilege which may minister to his comfort, until he is con- vinced of his error, and becomes acquainted with his keeper. Your Committee have learned that in the State Lunatic Hospital at Worcester, the employ- ment adopted is the following, viz: The ordinary agricultural labor necessary to the good manage- ment of a farm—which usually employs six months 1843.] CITY DOCUMENT—No. 32. 7 of the year—making shoes—carpentering—and the manufacture of hair mattresses. In the first, it has been found that most of the inmates can be employ- ed and enter upon their work with alacrity, and that much service may be obtained from them. From the making of shoes, the whole establishment is sup- plied with shoes for daily use, and it has been found practicable to supply customers in the town, at such a price as will pay expenses of stock and labor. In the carpenters' shop, such light articles as chairs, tables, stools, &c. can be made; and the work has a very favorable influence on those who have been en- gaged in it; and your Committee were informed that no evil has resulted to the patients or others by per- mitting them the use of such tools, as are required by that branch of mechanics. In reference to the latter employment, the making of mattresses—the Committee learned, that although it did not require so much active exercise of the body as the others, yet it was attended with very beneficial effects; and not only defrayed expenses of stock and materials, but in some small degree compensated the labor. There was another resource for the educated pa- tients which the philanthropic Superintendent at Worcester had provided, viz. the gradual accumula- tion of a library; the cost of which had been defrayed by the sale to visitors of articles in needlework, of fancy and utility, made by the females—the fabric of which not only gave them employment, but op- erated as a stimulant to exertion. In the female department this measure might be introduced with ease in our own Hospital and without expense. For their cordial reception and for much valua- ble information, the Committee acknowledge their 8 LUNATIC HOSPITAL. [Dec. indebtedness to Dr. Woodward, the able Superin- tendent of the Worcester Hospital. In examining the departments of the McLean Asylum at Somerville, every facility of observation and inspection was afforded by Dr. Bell which could have been required—and from his suggestions the Committee have received hints which will be profit- able to consider. Their courteous reception by him and his readiness to impart such information as was desired, gave them a favorable opportunity to view the most recent improvements in the domestic ar- rangements of that Institution. Very little was per- ceptible in reference to the particular subject of in- quiry, viz: the employment of the inmates. This Institution is supported by the endowment from the liberal munificence of the individual, whose name it bears, and by such other bequests as from time to time have been made. With ample means and under the superintendence of a Board of Visitors, the inmates have been taken from all ranks; as well the wealthy as the middle classes—and in almost all instances the expenses of their maintenance are dis- bursed by themselves or their friends. Their accom- modations in furniture, apartments and privileges, are of a higher order than can be expected in a Public Institution like ours. Their employment, like that at Worcester, during the Summer months, was principally agriculture, and both here and at Worcester riding carriages for the females and the debilitated males, are provided for daily use. The carpenters' shop was a resource for such as had a taste or inclination for mechanical employment, but could not be made to reimburse expenses upon an extended scale. In each of the halls of the male 1843.] CITY DOCUMENT.—No. 32. 9 and female departments, were private parlors and sitting rooms, and the furniture and other arrange- ments correspond to that style of living. The soli- tary rooms are better arranged than at any Institu- tion within the knowledge of the Committee. These attracted their notice on account of their complete neatness, and exemption from unpleasant effluvia. The frequent occasions which occur for the use of apartments of this description render them necessary to every well regulated Lunatic Asylum. At Wor- cester and Somerville the Committee perceived their utility, and they Avere then occupied. It will be conceded, that in every Lunatic Hall, particularly where indiscriminate admission is necessary, such as our own, a class of patients are admitted who having been unaccustomed to restraint, become noisy and turbulent during the paroxysms of their malady—and often disturb an entire wing of the building by their raving and outcries—and this too as well at night, as in the day time, when surround- ed by their fellow sufferers. To those of strong nerves the phrensy of the insane is at all times ap- palling. But what influence can be more pernicious to the hypochondriac or the lunatic, than to be awakened from sleep by the frantic howl of the maniac in the dead silence of night? There are also instances in females, when these paroxysms though temporary are periodical, and who in a day or two become placid and calm. For these emer- gencies we have no accommodation or substitute; and the time seems to have arrived, when the dic- tates of humanity suggest their provision. Should it be necessary to urge this subject, another reason ex- ists why they are indispensable, In every Hospital it 2 10 LUNATIC HOSPITAL [Dec. is necessary to exact from the patients the most im- plicit observance of neatness and cleanliness, in their persons and apparel. When patients are under the influence of phrensy, they frequently manifest per- fect indifference to decency and self respect in their bodily functions, and general deportment, and some- times are prone to filthy practises and become offen- sive to observation. In such cases the solitary room with its proper furniture is the only means of keep- ing the patient from annoying others, and from com- municating his noxious habits to those who happily are exempt from the severity of his malady. The absence of these rooms in the Boston Institution, seems to have been an oversight in the construction of the building, and it is confidently anticipated that provision will be made forthwith, to remedy the de- fect. Connecting these suggestions with that of the em- ployment of the inmates, the Committee recom- mend that an additional building be erected of one story in height, with sufficient provision for four sol- itary rooms for each sex, with a carpenter's shop and such other rooms, for mechanical employment as from time to time may be deemed advisable ; to the end that the inmates may be employed in such a manner as will afford exercise of body and mind. The Committee believe that the improvement sug- gested may be made at an expense comparatively small, and by no means disproportionate to the ne- cessity and well being of the patients. They are of opinion that the expenditure will be more than re- imbursed in the speedy recovery of the patients, by affording them constant employment out of the Halls, where they are immured during the Winter 1843.] CITY DOCUMENT.—No. 32. 11 months; and by removing from their observation and knowledge malign influences, which being blended with all the patients, retard their recovery. This measure it is believed will be sanctioned by every philanthropic mind, who cannot but rejoice at the amount of human suffering which this great public charity has relieved, and is still relieving;— and it will tend to the extension of its usefulness by administering to the great necessity of those unfor- tunate individuals, who are committed to its care and protection. Your Committee therefore report the following Order, and recommend its adoption. All which is respectfully submitted. By order of the Committee, WILLIAM PARKER, Chairman. Boston, December 14, 1343. In Board of Visitors of the Boston Lunatic Hospital, December, 1843. Resolved, That it is expedient that provision be made by this Board, for the active employment of those of the inmates who may be of sufficient ca- pacity and ability to be employed in mechanical work, during the Winter months ;—in such a man- ner as may hereafter be determined, and that Soli- tary Rooms should be provided for the proper treat- ment of such of the psitients, who may be deemed to require such apartments. It is therefore 12 LUNATIC HOSPITAL. [Dec. Ordered, That the Chairman of this Board be re- quested to procure plans and estimates for the erec- tion of a building of one story in height, of sufficient size for solitary rooms, and for workshops, for me- chanical employment of the inmates—and that the same be reported to this Board.