J 7 j ANNUAL REPORT TO THE Y*' BOARD OF TRUSTEES ' OF THE |/ MASSACHUSETTS GENERAL HOSPITAL. The Committee of the Trustees of the Massachusetts General Hospital, who were appointed for that purpose, respectfully submit the annexed Reports, shewing the condition of the General Hos- pital in McLean Street, Boston, for the year 1835, and that of the McLean Asylum for the Insane, in Charlestown, since May last, when the present Superintendent of that Institution entered on the duties of his Office. By order of the Committee, F. C. GRAY, Chairman. January 27, 183G. REPORT OF THE SUPERINTENDENT OF THE GENERAL HOSPITAL IN McLEAN STREET, BOSTON, FOR THE YEAR 1835. Admitted at the Massachusetts General Hospital, from January 1, 1835 to January 1, 1836. Patients paying board Males. 160 Females. 34 Total. 194 Do. do. do. part of the time 20 10 30 Do. entirely free .... 144 137 281 Whole number .... 324 181 505 Well .... Wales. 132 Females. 61 Total. 193 Much relieved * ♦ 48 48 96 Relieved .... 46 33 79 Not relieved 41 26 07 Died .... 34 10 44 Removed as unfit 2 3 5 Do. for improper conduct 3 3 Eloped .... 5 5 Whole number 311 181 492 Discharged during the same period. Proportion of Deaths to whole number of results this year,—1 to Hi, nearly. Do. from commencement of operations in 1821 to the commence- ment of this year—1 to 14, nearly. Private. Ward paving. Free. In the whole house. Greatest number of patients at any visit 4 27 46 64 Least do. do. do. 1 7 21 35 Average weekly population 2.5 14.6 33.2 50.3 4 The number of beds being 67, the last table shews that the house has been sometimes nearly full, in both departments, at the same time, and on the average has been three quarters filled. The average population has been about 10 per cent, greater than during the six or seven former years. But the number received being not much over what has been usual, the difference in this particular would seem to arise from the patients remaining longer — which the tables shew must be principally the case with the free patients ; since the proportion of admissions of free to paying patients is, in round numbers, nearly as 3 to 2, while the share of the former in the average population, is to the latter nearly as 2 to 1. The annual expenses for 1835 were, For Stores ....... $5195 10 “ Wages . . . . . . . 3153 64 “ Fuel 1560 11 “ Furniture ....... 952 99 u Stationary ...... 78 89 “ Grounds ....... 105 11 “ Medicine ....... 928 53 “ Repairs and improvements . . . 2750 43 14,724 80 Less credit to contingent account ... 4 67 $14,720 13 If from the amount of annual expense . . 14,720 13 be deducted the charges of repairs and grounds, as not necessarily current . . . . 2855 54 and the balance ..... 11,864 59 be divided by 52, equal to . . . . 228 19 and this again by average population, 50.3, there remains for weekly expense of each patient . $4 53 GAMALIEL BRADFORD, Superintendent, REPORT Of the Superintendent of the McLean Asylum for the Insane, from May 1st to December 31 st, 1835, inclusive. No. Time of Admission. Sex. Married or Single. Age. 1835. Supposed Cause. Duration of the Disease, May, 1835. Residence in the Asylum. Discharged or Remains. State. Remarks. 110 1821 April 14 1824 June 12 M. Married 53 Intemperance 16 years 189 months Remains Improved 287 M. Single 50 Intemperance [perance 20 years 144 months Remains Not improved Imbecile. 301 April 25 1825 Feb. 6 M. Single 45 Disappointed Affection and Intern- 17 years 141 months Remains Not improved Periodical. 348 M. Single 43 Masturbation 14 years 131 months Remains Not improved Imbecile. 375 Sept. 17 F. Married 73 Repelled Eruption 14 years 124 months Remains Not improved 415 1826 May 5 F. Single 41 Unknown 17 years 116 months Remains Not improved Imbecile. 554 1828 Aug. 29 F. Married 35 Parturition 10 years 89 months Remains Not improved Imbecile. 577 Nov. 23 M. Single 40 Unknown 10 years 86 months Remains Not improved Fatuitous. 600 1829 April 18 M. Married 54 Unknown 16 years 81 months Remains Not improved 602 April 28 M. Married 52 Unknown 15 years 81 months Remains Not improved 635 Sept. 9 M. Married 73 Unknown 20 years 76 months Remains Not improved Perodical and Imbecile. 650 Dec. 7 F. Single 40 Unknown 8 years 73 months Remains Not improved Imbecile. 666 1830 March 17 M. Married 38 Intemperance 6 years 70 months Remains Not improved Imbecile. 683 May 2 F. Single 39 Death of Friends 6 years 68 months Remains Not improved Imbecile. 706 Aug. 9 M. Single 47 Intemperance 6 years 65 months Remains Not improved 735 Dec. 20 F. Widow 50 Unknown 6J years 61 months Remains Improved 739 1831 Jan. 12 M. Single 25 Masturbation 4J years 60 months Remains Not improved Imbecile. 760 April 25 M. Single 48 Unknown 24 years 57 months Remains Not improved Fatuitous. 767 May 27 F. Married 37 Disappointment 4 years 56 months Discharged Not improved 790 Aug. 10 F. Married 34 Following Parturition 5£ years 53 months Remains Much improved 792 Aug. 15 M. Single 31 Intemperance 4 years 36 months Discharged Recovered 886 1832 Aug. 15 F. Married 50 Unknown 6 years 41 months Remains Not improved Imbecile. 887 Aug. 17 F. Single 20 Unknown 4 years 41 months Remains Improved Imbecile. 930 1833 March 9 M. Married 40 Unknown 5 years 34 months Removed Not improved 940 April 20 M. Single 37 Unknown 6 years 33 months Remains Not improved 960 June 4 M. Married 36 Intemperance 5 years 31 months Remains Improved SUPERINTENDENT’S REPORT. No. Time of Admission. Sex. Married or Single. Age. 1835. Supposed Cause. Duration of the Disease, May, 1835. Residence in the Asylum. Discharged or Remains. State. Remarks. 965 June 21 M. Single 50 Intemperance 9 years 31 months Remains Not improved Imbecile. 966 June 25 F. Married 49 Unknown 6 years 31 months Removed Improved 972 July 5 M. Married 37 Inflammation of the Brain 3£ years 30 months Remains Improved Imbecile 976 July 19 M. Single 34 Intemperance 6| years 30 months Remains Not improved 996 Sept. 28 F. Married 33 111 Health 2 years 28 months Discharged Recovered 1005 Nov. 21 M. Single 37 Repelled Eruption 10 years 25 months Remains Much improved 1010 Dec. 9 M. Married 45 Unknown 65 years 18 months Removed Improved 1011 Dec. 10 M. Single 23 Chagrin 20 months 25 months Remains Improved Imbecile. 1013 Dec. 20 ISfU M. Married 54 Intemperance years 18 months Removed Much improved 1019 Jan. 8 M. Single 25 Unknown 2 years 24 months Remains Improved Imbecile. 1046 April 18 M. Widower 75 Age 2 years 21 months Remains Not improved Imbecile. 1048 April 23 M. Single 60 Unknown 5J years 20 months Remains Improved 1051 May 15 M. Single 36 Sedentary habits, inducing ill health 3 years 15£ months Removed Improved [years. 1054 May 19 M. Single 22 Epilepsy 15 months 19£ months Remains Not improved Periodical. Epileptic 10 1062 June 12 F. Married 32 Following Parturition 6£ years 18i months Remains Improved Imbecile. 1068 June 24 F. Single 51 Matrimonial Perplexity 11£ months 18 months Remains Recovered Suicidal. 1070 June 26 M. Single 37 Intemperance [ed with Palsy 11 months 17£ months Remains Not improved Periodical. 1081 July 20 M. Single 38 Organic disease of the Brain, attend- 35 months 15 months Died Epilepsy Periodical. 1084 Aug. 1 F. Married 53 Unknown months 124 months Removed Improved 1101 Oct. 16 F. Married 51 Religious Excitement 11 months 8 months Discharged Convalescent Discharged as well, but 1102 Oct. 17 F. Single 20 Unknown 6 years 7 months Removed Much improved relapsed after return- 1104 Oct. 22 F. Single 57 Great Mental and Bodily Exertion 8 months 14 months Remains Much improved ing to her friends. 1105 Oct. 25 F. Married 38 Loss of a Parent 2£ years 14 months Remains Not improved 1106 Nov. 5 M. Single 31 Masturbation [Business 7 months months Remains Much improved 1109 Nov. 7 M. Single 28 111 Health, and Perplexity about 2 years 7 months Removed Recovered Suicidal. 1114 Nov. 28 F. Married 57 111 Health 14 months 9 months Died Water in chest Suicidal. Asthmatic disease of loner 1115 Dec. 4 M. Single 45 Intemperance 8 months 6 months Removed Convalescent standing: was suspended by the attack ot insanity. 1117 Dec. 11 M. Married 58 Unknown 8 months 5 months Discharged Recovered 1118 Dec. 16 M. Single 25 I nflammation of the Brain 13 months 8 months Removed Not improved Fatuitous. 1121 Dec. 22 183/; M. Single 27 Masturbation 17 months 12 months Removed Not improved F atuitous. 1125 Jan. 17 F. Single 23 111 Health 10 months 11 months Remains Recovered 1126 Jan. 17 F. Married 32 Domestic Trouble 5 months 11 months Remains Much improved 1127 Jan. 20 M. Single 33 Masturbation 6 months 11 months Remains Not improved 1128 Feb. 2 M. Single 21 Hepatic Derangement 13 months 5 months Removed Convalescent Relapsed, after return- 1129 Feb. 7 M. Single 22 Excessive mental & bodily Exertion 3 months 6 months Discharged Recovered ing to his friends. 1130 Feb. 9 F. Single 22 III Health 10 months 11 months Remains Recovered 1132 Feb. 21 F. Married 53 Unknown [Exercise 3J years 11 months Remains Not improved l loo Feb. 24 M. Single 18 Sedentary Labour, and Want of 6 months 4 months Discharged Recovered 1134 March 2 M. Single 40 Unknown 15 months 5 months Removed Improved SUPERINTENDENT’S REPORT. No. Time of Admission. Sex. Married or Single. Age. 1835. Supposed Cause. Duration of the Disease, May, 1835. Residence in the Asylum. Discharged or Remains. State. Remarks. 1135 March 2 F. Married 22 Nursing and Confinement 7 months 3£ months Died Suicide 1136 March 13 M. Married 60 Intemperance 6 months 5£ months Discharged Recovered 1132 March 18 M. Single 28 Intemperance 9 months 5 months Removed Recovered 1138 March 20 M. Married 85 Loss of Property 12 years 9 months Remains Not improved 1140 April 1 F. Single 40 III Health 7 months 5£ months Removed Recovered 1141 April 7 M. Married 48 Fall upon the Head 9 months 9 months Remains Not improved Fatuitous. 1142 April 10 M. Single 30 Intemperance 13 months 9 months Remains Much improved 1143 April 11 F. Single 18 Fright 3 months 9 months Removed Recovered Paroxysmal. 1144 April 12 F. Single 34 111 Health 2 months 2£ months Discharged Recovered 1145 April 13 F. Married 26 111 Health, and Religious Anxiety 15 months months Died Consumption Suicidal. Paroxysms al- 1146 April 13 M. Single 22 111 Health 3 months 2£ months Discharged Recovered ternating with disease 1147 April 17 M. Single 21 Dyspepsia 1 month 4| months Discharged Recovered of the lungs. 1148 April 21 F. Widow 46 Hard Labour and Care 7 months 8 months Remains Much improved 1149 April 26 M. Married 40 III Health 2 months 7£ months Discharged Recovered 1150 April 27 F. Married 27 Typhus Fever 3 weeks 5£ months Discharged Recovered 1157 April 28 M. Married 35 Close Application to School teaching 2 months Duration before Admission. 7 j months Discharged Recovered 1152 May 8 M. Widower 67 Intemperance 4 months 5 months Discharged Recovered 1153 May 9 F. Widow 28 Following Parturition 21 months 8 months Remains Convalescent 1154 May 9 F. Single 32 III Health, ahd Religious Anxiety 2 months 8 months Remains Improved 1155 May 12 M. Single 28 Unknown 1 month 6 months Discharged Recovered 1156 May 13 M. Single 18 III Health [sick Husband 9 months 5 months Removed Recovered 1157 May 13 F. Widow 29 Anxiety and long watching over a 6 weeks 3 months Removed Improved 1158 June 4 M. Single 35 Want of Occupation 6 weeks 3J months Discharged Recovered 1159 June 4 M. Married 35 Religious Excitement 2 months 4£ months Removed Recovered 1160 June 5 M. Single 52 Anxiety about Property l month 3 months Discharged Recovered Suicidal. 1161 June 8 M. Single 22 Unknown 17 months 7 months Remains Improved 1162 June 10 M. Single 28 Religious Skepticism 7 years 5 months Removed Improved 1163 June 12 M. Widower 30 Loss of Wife 5 months 2 months Discharged Recovered 1164 June 13 F. Married 52 Hard Labour and Perplexity 1 week 2£ months Removed Recovered 1165 June 18 M. Married 35 Over Exertion and Anxiety 6 months 3 months Discharged Recovered 1166 July 15 M. Single 25 Epilepsy 2 days 20 days Discharged Recovered Epileptic for many yrs. 1167 July 15 F. Married 29 111 Health and over Exertion 3 months 2£ months Removed Recovered 1168 July 22 F. Widow 58 Hereditary Tendency, excited by ill 4 months 5| months Remains Convalescent 1169 July 23 F. Single 55 Unknown [Health 3 years 5J months Remains Improved 1170 July 23 M. Single 52 Unknown 6 years months Remains Improved 1171 July 27 M. Single 27 Disappointed Affection 2 years 5 months Remains Improved 1172 July 28 F. Single 52 111 Health [15 years duration 3 weeks 4 months Discharged Recovered 1173 Aug. 1 M. Married 35 III Health and Hypochondriasis of 1 month 5 months Remains Convalescent 1174 Aug. 7 M. Married 54 Intemperance 10 months 2 months Discharged Recovered SUPERINTENDENT’S REPORT No. Time of Admission. Sex. Married or Single. Age. 1835. Supposed Cause. Duration of the Disease. Residence in the Asylum. Discharged or Remains. State. Remarks. 1175 Aug. 19 F. Married 38 Ill Health 2£ months 4J months Remains Convalescent 1176 Aug. 19 F. Single 16 Unknown 2 years 3 months Removed Improved Periodical. 1177 Aug. 20 F. Married 33 111 Health 1 month 3 months Remains Convalescent 1178 Sept. 10 F. Single 27 Repelled Eruption 5 years months Died Erysipelas 1179 Sept. 16 F. Married 32 Anxiety for her Children 3 months 3 months Discharged Recovered 1180 Sept. 23 M. Married 33 Unknown 2 years 3 months Remains Much improved Periodical. 1181 Sept. 26 M. Married 46 Disappointed Expectations 1 month 3 months Removed Recovered 1182 Oct. 2 F. Single 23 111 Health 2 months 3 months Remains Much improved 1183 Oct. 2 M. Single 25 Intemperance 2 days 1 month Discharged Recovered 1184 Oct. 3 M. Single 21 Chagrin and Disappointment 18 months 3 months Remains Not improved 1185 Oct. 9 M. Single 29 Masturbation 5 years months Remains Improved Imbecile. 1186 Oct. 10 F. Married 35 Hard Labour 3 months 2£ months Remains Convalescent 1187 Oct. 12 F. Married 29 Following Parturition 3 years 2J months Remains Much improved 1188 Oct. 13 M. Married 47 Intemperance 4 months 2| months Remains Recovered 1189 Oct. 17 M. Single 26 Injury of the Head 5 months 2| months Remains Recovered 1190 Oct. 31 M. Single 17 Typhus Fever 2 weeks months Discharged Recovered 1191 Nov. 3 F. Single 42 Trouble with Domestics [Labour 11 months months Discharged Recovered 1192 Nov. 5 M. Married 54 Change from active to sedentary 3 months 2 months Remains Convalescent 1193 Nov. 5 F. Single 34 111 Health 8 months 24 days Died Erysipelas Suicidal. 1194 Nov. 5 M. Widower 58 Intemperance 2 months 2 months Remains Recovered 1195 Nov. 7 M. Single 19 Masturbation [and vegetable diet 5 years 2 months Remains Not improved 1196 Nov. 10 M. Married 35 Change from ordinary to abstemious 1 year 5 weeks Discharged Recovered 1197 Nov. 16 M. Married 44 Ecclesiastical Troubles 6 months 6 weeks Remains Convalescent Suicidal. 1198 Nov. 19 M. Single 35 Constitutional Tendency, excited by Death of Brother 1 month 5 weeks Remains Much improved 1199 Nov. 19 M. Single 27 111 Health, caused by a Fall 5 months 5 weeks Removed Improved 1200 Nov. 27 M. Married 32 Religious Anxiety 6 weeks 4 weeks Remains Convalescent 1201 Nov. 29 F. Single 20 Typhus Fever 2 weeks 4 weeks Remains Recovered 1202 Dec. 12 M. Married 34 Abstemious and vegetable diet 5 months 3 weeks Remains Not improved 1203 Dec. 15 M. Single 34 Disappointment in Business 6 years 2 weeks Remains Not improved Imbecile. 1204 Dec. 18 F. Single 25 Matrimonial Perplexity 3 weeks 13 days Remains 1205 Dec. 29 F. Single 21 111 Health 1 year 2 days Remains 1206 Dec. 31 M Married 46 Anxiety about Business 10 months I day Remains 9 SUMMARY. Patients remaining in the Asylum, May 1st, 1835. Males 50. Females 31. Total 81. Of these there had been insane more than 20 years . 3 “ 10 years . 11 “ 5 years . 16 “ 2 years . 15 “ 1 year . 9 Not more than 1 year . 27 Old cases 54, Recent 27.—Total 81 There havre been received Dec. 31st, Males 34, Females 21—55 Of these there had been insane more than 1 year . 15 Less than 1 year . 40—55 There have been in the Institution,—Old cases . . 69 Recent “ . . 67—136 Upwards of 70 years of age .... 4 Between 60 and 70 “ .... 3 “ 50 and 60 “ .... 24 “ 40 and 50 “ .... 21 u 30 and 40 “ .... 40 “ 20 and 30 “ .... 38 Under 20 “ 6—136 Married Females 24 Unmarried “ 23 Widows 5—52 Married Males 29 Unmarried “ 51 Widowers 4—84—136 10 Supposed Remote or Exciting Causes. Ill Health of various kinds 26 Intemperance . . . . * . . . .16 Masturbation 7 Disappointment and Mortification .... 6 Religious Excitement and Anxiety .... 5 Following Parturition 5 Excessive bodily or mental Labour .... 8 Repelled Eruptions 3 Inflammation of the Brain 2 Falls, and other Injuries 3 Death of Friends 3 Matrimonial Perplexities 2 Change from ordinary to vegetable and abstemious diet 2 Other Causes 48—136 May Admissions. 6 Eemovals. 4 Average No. of Patients, m June 8 8 86* July 7 5 ' 84£ Aug. 5 10 83 Sept. 4 7 m Oct. 9 8 81£ Nov. 11 6 82£ Dec. 5 11 m Annual 55 59 m Removed—Unfit, Male. 0 Female. 0 Total. 0 Eloped, 0 0 0 Died, 1 5 6 Not improved, 2 1 3 Improved, 6 4 10 Much improved, 1 1 2 Convalescent, 2 1 3* Recovered, 25 10 35 37 22 59 Of these 39 were recent, and 20 old cases. 11 Of the recent cases, there were—Recovered, 32 Convalescent, 2* Improved, 3 Died, 2—39 Of the old cases, there were—Recovered, 3 Convalescent, 1 Much improved, 2 Improved, 6 Not improved, 4 Died, 4—20—59 Of those remaining, there are—Recovered, 7 Convalescent, 9 Much improved 10 Improved, 15 Not improved, 36—77 Since the first of May (now eight months) there have been in the Institution one hundred and thirty-six patients,—there have been fifty-five admissions, and fifty-nine removals. Of the latter, six were by death, three not improved, three convalescent, and thirty-five recovered. Of the deceased, one Hydrothorax, one Phtisis Pulmonalis, one epilepsy, one suicide, and two erysipelas. Of those who were not recovered, eight were considered incurable, and ten had insufficient trial.f There are now remaining, seventy-seven patients, thirty-six of whom are considered incurable. There are in the left wing sixty-one rooms appropriated to patients; in this number are included four lodge rooms, and the four rooms under the dome. There are (January 5th) fifty male patients; should the number of admissions exceed the discharges, we shall soon be in want of room. The propriety of anticipating such an occurrence by the removal of some of the hopeless cases, is suggested as worthy of consideration. * One recovered, the others relapsed. f Appendix A. 12 The system of moral management which we have adopted, is still successfully pursued. In addition to the means of diversion and occupation formerly named, the better class of patients are now invited once a week to a dancing party in the oval room, the evening is spent in dancing, marching, and cheerful conversation. The presence of all the officers, and as many of the nurses and attendants as can be spared from the wings, who engage with them in the amusements of the occasion, is security against any improper conduct or occurrence. We have also introduced religious service on the Sabbath, and have made arrangements by which we hope to continue it every other Sabbath during the present year. For eight months, from thirty to forty have daily attended on our family worship ; and in no instance has there been any disturbance, nor have we known of any injurious effect; on the contrary, the influence has been highly salutary, and many who have recovered have spoken of these exercises, as having contributed to their restoration.* The following is a brief statement of our present system of occupation, diversion, and moral management. The patients rise and dress about half an hour before breakfast, which is at sunrise in the winter, and six o’clock in the summer. After breakfast they are taken out to walk, or to ride, or are engaged as far as possible in useful labour, as farming, sawing, splitting and piling wood, or assisting their attendants ; and a few are engaged in mechanical employments. A large number are occupied more or less in the amusements of bowling, quoits, throwing the ring, and in chequers, chess, back-gammon and other games,f and in the interval of these amusements, reading books from the library, newspapers and writing serve to fill up the time.J After tea they are assembled in the oval room, for family worship, which consists in reading a chapter from the Bible, singing two hymns, and a prayer. These are the occupations of the day. During the past summer, the bowling alley building was fitted up for a shop by the patients, and we have yet to find some simple * Appendix B. f Appendix C. t Appendix D. 13 mechanical labour in which most can be engaged. This is highly desirable, and we do not despair of ultimate success.* Once a week all the female patients who are well enough, assemble in the house, and spend an afternoon in sewing ; while thus employed, some interesting book is read, or they are engaged in conversation, and are indulged in occasional relaxation and amusement; these stay to tea with the family, and to attend the “ Belknap J sewing society,” is a privilege, which nearly all are anxious to enjoy ; the work for which they received pay the last quarter, amounted to sixteen dollars and thirty-nine cents, this and their future earnings they propose to appropriate for their own benefit, and that of those who may hereafter be members of this Institution. The female members of our family have interested themselves to provide occupation and amusement for the female patients, they have visited the wing for this purpose, and to read to them interesting books, they have also to some extent engaged them in domestic labour. I have already stated the weekly dancing parties and the reli- gious service on the Sabbath ; these stated observances are of incalculable benefit to our patients, the mind is thus provided with something to fix upon, and to anticipate, and the labour of prepa- ration is seen, and heard for days in advance; the females in pre- paring their dresses, and both males and females in practising the figures of the dance. Many interesting and highly gratifying anec- dotes might be mentioned in connection with these remarks, re- specting our religious and social meetings, but it is unnecessary ; the propriety and advantage of these things will appear at once to all. Our quiet and convalescent patients, are also taken with us to church ; to visit places of interest and amusement, are taken into our family, dine at our table,f and sit in our parlours ; they are made to feel as far as possible, that in coming here, they have only found a new home, new friends, new brothers and sisters ; and that we are interested to promote their comfort, welfare, and * Appendix E. t Appendix F. t So named, in honor of Miss Mary Belknap, a munificent donor to this Institution. 14 happiness. In the location of patients, this object is constantly kept in view, and they are brought forward as fast as possible, and are deprived of privileges and returned to the lower stories, only when they have proved by their conduct that they cannot exer- cise proper self control.* No punishment is in any case permit- ted, and the only measures which can be regarded as corrective, are, the deprivation of some accustomed privilege ; change in location, and the occasional use of the shower bath with the noisy and filthy. Personal restraint is in no case made use of, except with those disposed to destroy clothing or other property ; and with the furious to prevent injury to themselves or others ;—the number is always small who require any personal restraint. To carry on this system of moral management, it has been necessary to increase the number of attendants and nurses.f We trust that this increase of the current expenses of the Institution, will not be regarded otherwise than with satisfaction. We have not asked with how small a number can we get along ? but, how many can be advantageously employed ? We have spared no pains to secure those of intelligence and character. Many of them have formerly been engaged as teachers of schools. We will not continue any male or female attendant, whom we cannot invite into our family, seat at our table, and with whom we could not confidently place our own wives, sisters, and brothers. We do not consider their service as servile, they are the companions of the unfortunate ; engaged in the same employments with our- selves, they shall command our friendship and respect. 1 have on a former occasion expressed my entire confidence in the individuals associated with me in the management of the In- stitution. 1 ask not for the Institution or myself more devoted fellow labourers. I have been thus particular in detailing to you our system of management, that you might know the reasons for, and the results of, any changes from the system pursued by my highly respected predecessor. No change has been made, until after the most careful consideration I was convinced of its utility. * Appendix H. t Appendix G. 15 We have now commenced another year, and whether the re- sult will be prosperous or adverse, is known only to that Almighty Being, to whom we constantly commit our Institution and our- selves. But whatever may be the result, it shall leave me with the consciousness that I have endeavoured to discharge my duty. THOMAS G. LEE, Physician and Superintendent. McLean Asylum, Jan. 5, 1836. APPENDIX. ( A. ) One of the greatest trials the Physician of an Insane Asylum has to endure, is the premature removal of patients, and inter- ference in other respects, in the means of cure. A patient is placed under his care, suffering with the severest calamity to which man is liable:—he enters upon a course of treatment, the disease yields to remedies, and he becomes confident of success. At this stage, the friends call and learn his state, see him walking, riding out, and apparently “ clothed in his right mind,” insist upon visiting him, or conclude that “ he is so quiet and comfortable, they can get along very well with him at home.” Facts and arguments avail nothing against this reasoning, and he is com- pelled to see his patient cruelly sacrificed to, — and the reputation of the institution for success, and his own for skill, endangered by, —these blind but well meant measures of the friends of the pa- tients. I cannot forbear to state a few cases from our last year’s experience. Case 1068, was brought here anxious, despairing and suicidal, she could obtain no rest day nor night; she walked 16 to and fro, wrung her hands, tore her hair, screamed, &c. &c. She was put under a course of treatment, she improved, and in the course of a few months was apparently recovering ; her friends now concluded to take her home on a visit; they were advised of the almost certain consequences of such a step : the experiment was tried, and in five days the patient was returned to us worse than ever. The labor of months was lost; our house was sub- jected to a renewal of her disturbance, and she to another four months of suicidal horror. She again began to improve, became quiet, engaged in work, and was quite comfortable : and again it was concluded to make another experiment. I could not forbear telling them, that they were sacrificing their sister ; they yielded to my advice and allowed her to remain. She has since recover- ed, has been discharged (Feb. 3,1S36,) and remains well. I have no doubt the same result might have been obtained ten months earlier, if the friends had listened to the advice of those, who ought to have known best, what was for the good of the patient. Case 1115, was brought here in a state of chaotic madness, regardless of personal cleanliness, noisy and excited. He im- proved, became neat, quiet, engaged in labour and amusements, and was getting well; in this state he was removed.* Case 1125, was apparently idiotic, paid no regard to personal cleanliness, tore her clothes and bedding, was noisy, &tc. At the end of six months she was so far improved as to ride out with our best class of patients, and was doing well. In this state she was re- moved on a visit; at the end of a fortnight she was returned much worse than ever, more filthy and troublesome, tore and ate her clothes, blankets, and indeed, would swallow every thing she could get into her mouth. After being subjected to the trouble of at- tending ber another six months, we have the satisfaction to believe she is again recovering, and if not removed, will soon be well. Case 1128, was sullen, obstinate, irascible and dangerous. He had been deranged thirteen months ; and was getting worse. He remained with us five months, had become pleasant, cheerful, and * Note.—I have just learned by letter, that the convalescence in this case continued, and resulted in perfect recovery six weeks after his removal. 17 engaged in amusements and labour; on only one point did he manifest any insanity, and of this he seldom or never spoke, un- less he was addressed upon it. In this state he was removed. In a few weeks his disease returned, he wandered about the country for several months, and was finally committed to the State Hospi- tal by the Court, as dangerous to be at large. 1129, was a case of chaotic madness, noisy, filthy, &tc. After he began to get better, his friends twice came to remove him, but he became so much excited, that they were prevented from ac- complishing this purpose. Three months afterwards, six months from his admission, he was discharged recovered. Case 1173, was brought here bound hand and foot, noisy, pro- fane, and highly excited. In a few weeks he became quiet and apparently rational, attended family worship, and took his meals with the family. He was now visited by his brother, who talked with him for half an hour about his affairs at home, and three hours after he was a raving maniac; it was some weeks before he recov- ered from that half hour’s visit; he has since been doing well. I do not mention these cases because I suppose we are more troubled than other institutions, which are dependant upon the confidence of the public for patronage ; on the contrary, I suppose we are less so; we are situated in an intelligent community, where the advantages of judicious management are probably bet- ter understood than in any other; but friends will be solicitous, and some will be influenced by their feelings, or by reports of the success of a “ patent doctor,” or some “ patent medicine,” and will be anxious to try if they cannot hasten recovery. Very often these experiments are made, and some months after we have a patient returned to us, a confirmed and incurable maniac. Now with these facts before me, I wish to say to those who are about to place friends under our care ; first, try all the experiments you intend to do ; then satisfy yourselves that you can confide in our skill, discretion, and kindness ; and when your friend is placed here, leave him with confidence to our direction, until we discharge him well. If you cannot do this, do not bring him here. We wish to receive only such as we can have an opportunity to restore. 18 ( B. ) The experiment of allowing the patients to attend the worship of the family, has far exceeded our expectations, and has been attended with the best results. Ninety-five, out of the hundred and thirty-six, have attended upon these exercises, and a large part of them with great regu- larity. It has been with a few exceptions entirely voluntary. It is regarded as a privilege and as such is eagerly sought. The slightest irregularity of conduct has been followed by the omission of the individual from the list for a few evenings, and this depriva- tion has secured order and propriety. Patients, who could not otherwise be kept decently clothed, have exerted their powers of self control to be allow-ed to attend. One female, who was habitually noisy, obscene, and profane, after having repeatedly solicited this privilege, was told one morn- ing that she should attend that evening, if she kept quiet during the day. She provided herself with a stocking which she rolled into a ball, carried in her hand, and pressed into her mouth when- ever she felt her propensity active ; and thus guarded, she attend- ed prayers and conducted with becoming propriety ; she is now a regular attendant upon these and other exercises of the family ; is quiet, industrious and rational. When from any cause the ser- vice is omitted, there is a very general expression of disappoint- ment. The supervisor of the male wing, has often stated the case of a patient in a state of imbecility, who, when the exercise has been omitted, has opposed going to bed, taking him by the hand, and dragging him to the door, has repeated, “ let us go to prayers, let us go to prayers.” It is now about two months since we commenced service on the sabbath. The clergymen in this vicinity upon whom we have call- ed, have very cheerfully consented to officiate ; their remarks to us have corresponded with those of other strangers who have been 19 present at these exercises—“ how perfectly quiet.” Several have observed that it was the most interesting audience they had ever addressed. Fifty of the patients have been permitted to attend church on the sabbath, in company with the officers and attendants ; the effect of these exercises, is, not only to break in upon the mo- notony of their lives, and to induce habits of order and regularity, but, to soothe the feelings, awaken the affections, and carry the mind back to the memory of other and better days ; and also to cause them to recollect the infinite goodness and all-wise Provi- dence of God. If all are not edified, most are interested, and all are attentive and respectful. ( €. ) Idleness is the greatest evil we have to fear, it opens the way to every other, and no one can know, who has not had experi- ence, how very difficult it is to provide constant occupation for the patients in an Insane Asylum. Useful labor is always the best employment; but they can be thus engaged only a small part of the time, and besides, there are those who will not be thus occu- pied, and we are obliged to seek other employments. The vari- ous amusements named are among our resources, and they serve to beguile many an hour which would otherwise be spent in idle- ness, or the indulgence of diseased feeling. From the records kept by the Supervisors, I find that some of the patients in visit- ing objects of interest in the vicinity, &lc. have walked more than one hundred miles a month. From ten to sixteen have weekly attended the meetings of the “ Belknap Sewing Society,” since its organization, and from sixteen to twenty-six the family parties, and most engage either in the dancing or marching. Suitable refreshments are provided for these occasions, and a stranger while looking upon the happy faces about the room, would hardly suspect it was a party of insane patients. 20 ( D. ) In June last, two hundred dollars were appropriated for pur- chasing a library for the patients, a part only has as yet been expended. The library now numbers one hundred and sixty volumes. We take two daily papers, and once a week receive from an Editor’s table, from twelve to sixteen weekly papers and maga- zines, for the use of the patients. ( E. ) We have seen the very best results from labour. Patients, who without it were noisy and troublesome, have become quiet with it; one patient who was brought to the Institution in irons, and who until employed, was constantly raving and excited, when furnish- ed with occupation, became quiet; he braids and sews four or five cane hats a week besides spending his evenings at games, and except when interrupted by the entrance of strangers, is peaceable and quiet. Most of our farming, the sawing and splitting of nearly all our wood, has been done for the last eight months by patients, and our only difficulty has been, that we could not find enough for them to do. The influence of labour has been most salutary upon all en- gaged, no instance of a contrary tendency and no accident has occurred to my knowledge. Eighty-three have been more or less engaged in useful labour. No patient has been permitted to labour more than six hours a day, and most, a much shorter time. No record of the labour of the females was kept until quite lately. During one month they made twenty-five shirts, two dresses, two night-gowns, four pairs of 21 drawers, one apron, two caps, pieced and quilted four bed quilts, knit five pairs of hose, mended sixty-five garments, marked twenty- one articles, and folded and ironed clothes sixty-four hours, besides assisting the attendants in sweeping, making beds, &c. We shall always be pleased, if the friends of patients will furnish the means for occupying them, an important object will thus be accomplished, and in some cases they may assist towards their own support. ( F. ) Forty patients during their convalescence regularly dined, and some others occasionally took their meals with the family. ( G. ) On the first of May, our number of attendants was 11. We have since averaged Supposing our number of patients to have averaged eighty-two, which is not far from the fact, then there has been an attendant for every six patients. We have not found this number too large. No patient with active suicidal pro- pensity, is now permitted to be without a separate attendant. A most laudable ambition has existed among them, especially among the female nurses. There has been a rivalry to see who could keep things in the best order, and who could succeed best in the management of the patients. This has been the cause of many interesting occurrences, alike honorable to them, and gratify- ing to myself. As an illustration I will state one case. No. 1182, was brought here in a cataleptic state. She ap- peared idiotic, was inattentive to cleanliness, and indeed in every respect was as helpless as an infant. She was put under a course of treatment and began to improve, but was still filthy in her habits, and of course made a great deal of very unpleasant labor. A nurse 22 on one of the other stories, who had charge of the worst class of patients, and who had been quite successful in correcting their bad habits, expressed to different members of the family, the wish that I would let her have this patient in her story. Anxious to culti- vate this spirit among them of selecting out the worst cases, and making them the object of their special efforts, I directed the change in location to be made. The most unremitting attentions were given by the nurse. The patient was taken at regular and short intervals to the water closet, and solicited to perform there the offices of nature. Her habits were soon corrected, and from being a very troublesome, she became a very comfortable patient. She was also engaged in sewing and knitting, and though she has only been three months in the Institution, she is now so far im- proved as to be able to attend the family worship and parties, and engage in various kinds of light labour. Such attentions, will seldom fail to correct the most filthy habits, while neglect, solitary confinement, and the want of occupation, will often cause them. The success of any institution will de- pend very much upon the class of individuals engaged as attend- ants. “ There ought to be a sufficient number by whom the patient’s confidence or good opinion is to be cultivated, and in whom mildness and command of temper are indispensable.” Dr. Cox well observes, “ the idea which has too much prevailed, that it is necessary to commence an acquaintance with lunatics by an exhibition of strength, or an appearance of austerity, has been found to be extremely erroneous, and to be a part of that cruel system, dictated perhaps by timidity, which has too long pre- vailed, and unhappily still prevails in many of the receptacles for the insane. Let it be remembered, that in most instances of mental depression, the behaviour though it ought to be firm, can- not be too kind, conciliating and tender.” It is only by employing attendants of intelligence and elevated moral feelings, that such conduct can be secured : and while there are in our country more than one million, who profess the religion of Jesus, it must never be said, that a sufficient number of this class cannot be found who are willing to devote themselves to this work of love and mercy. 23 ( H. ) MORAL TREATMENT. The advantages of cultivating the affections, consulting the taste and feelings, and even indulging to a certain extent the freaks and fancies of the insane, will be best illustrated by cases. Case 110, has been insane seventeen years, and for sixteeen years a resident of this institution. He was the most habitually excitable,and irascible patient I ever knew; it was seldom he would speak pleasantly ; he walked to and fro with great impetuosity, threatened, stamped and beat violently with his fists. Even when alone, he would work himself into a state of furious excitement. He believed himself to be God, and any compulsion, roused his indignation and wrath ; he was indulged in his fancies, allowed to wear whiskers, long hair, &tc. and treated with uniform and studied respect. He soon became mild. For many years he had not been without the enclosure of the courts. He was now taken to ride, and invited into the family ; he occasionally attends family worship, and has in one instance attended the weekly parties, and on all these occasions has conducted with propriety. He is still “ a god,” no longer a god of vengeance, but one of kindness and mercy. He calls the physician and others “ my lord,” and offers to escort them on a journey with a million of troops : — it has now been several months since 1 have seen him angry or excited. He is comfortable himself, and no longer an annoyance to those about him. No. 1013, was also located with the worst class of patients, he had been insane three and an half years, and in the Institution sixteen months, and like the former case was highly irritable and irascible, and much of the time in a state of vindictive excitement. His self-respect was cultivated; he was invited to family prayers, to take his meals with the family, and removed to the upper story. He became pleasant and cheerful, and for several weeks had manifested no insanity, when he was removed to his friends. His diseased feelings have since returned, and he is still insane. No. 1148, is ordinarily cheerful and happy, her mind is weak, but slowly recovering its vigor. In two instances, the unintentional neglect of the physician to pay her his accustomed civilities, has thrown her into a state of anxiety and depression. In both cases, she was for several days disconsolate, neglected her employments and wept much. Assiduous attentions soon soothed her feelings, and restored her to her usual state. Facts contained in this appendix, and many others of the same character, remind us of the necessity of constantly treating the insane with the utmost delicacy, attention and respect. Visitors should always be introduced, and should receive them as they would their friends; their peculiarities should not be noticed, and they should be engaged in the ordinary topics of conver- sation. They shew the necessity of employing attendants and nurses of cultivated minds and feelings, who will engage in their labours with much of that spirit of patience and self-denial, which should characterize the missionaries of the cross. And they teach us the necessity of pursuing a consistent course of treatment, of cheering the desponding, soothing the irritated, and allaying every rising storm — and the importance, also, of securing their confi- dence, respect and affection. They should teach the friends to exercise patience and pru- dence, to avoid improper interference, and having committed their friend to his charge, they should throw the responsibility of every measure upon the Superintendent, by following his advice. And when he fails to satisfy the just expectations of the public, he will leave this for some other field of labour. CONCLUSION. I need not apologize for this detail of facts. Happily, there prevails in our country at this time a spirit of inquiry respecting the treatment of the insane. This State has set an honourable example in the establishment of its Hospital for the pauper luna- tics, the results of which are cheering to every benevolent and philanthropic heart. Other States are waking up to the import- ance of this subject, and the time is not far distant, when every district of our country will have its insane asylum. The present, then, is a critical period. The site, the plan of building, the arrangements and the system of treatment which will be adopted by new institutions, will depend very much upon the facts pre- sented to the public by those now in existence. Very little has as yet been done in this country in the way of giving useful employment to the patients of our insane hospitals ; and so far as I know, no institution has been established, where any considerable provision has been made for this purpose. Those to be hereafter erected, should be well provided with these facili- ties for the recovery of patients ; pasturage, meadow and tillage land, should be had in abundance. The farm should be well stocked, cattle, sheep and swine raised for the use of the inmates, should be fed from the produce of the farm. Corn, potatoes, grain, flax, all kinds of garden sauce, &ic. &tc. should be cultivated by the patients. There should be a dairy room, workshops, and store houses, all arranged for the particular object of employ- ing them. They should be engaged (in the times and seasons for the several labours) in cutting, making and loading hay, plant- ing, sowing and getting in garden and field crops, collecting and storing away fruit, sawing, splitting and piling wood, husking and shelling corn, dressing flax, tending stock, milking cows, making but- ter and cheese, washing, ironing, kitchen labor, spinning, weaving, knitting, sewing, &tc. &c. in fine, all the labour of a large farming establishment, besides various kinds of mechanical labour. With us this experiment has not been fully tried, but our limited expe- rience justifies us in using the strongest language in its favor. In Europe the experiment has been tried, and the results are con- clusive. I cannot do better service to the public, than by publishing the following statements from the reports of some of the European Institutions. Mr. Pinel says, “ That at the principal hospitals in Spain those of the insane capable of working, are distributed every morning into separate parties, an overlooker is deputed to each class, who apportions to them individually their respective employments, directs their exertions, and watches over their conduct. The whole day is thus occupied in salutary and refreshing exercises, which are in- terrupted only by short intervals of rest and relaxation. The fatigues of the day prepare the labourers for sleep and repose during the night. Hence it happens, that those whose condition does not place them above the necessity of submission to toil and labor, are almost always cured ; whilst the grandee, who would think himself degraded by exercise of this description, is generally incurable.” The following facts are from Mr. Halliday’s valuable work on the insane hospitals in Great Britain. “ It is not by seclusion and mystery, that they can be properly watched over, or by confinement in the wards or cells of an hospital that they are to be cured.—Experience has shown that a regulated intercourse with the world, and constant employment of the mind and body, are the best aids to medical treatment, and in the construction of every Asylum, these ought to be kept constantly in view. The great objection to the generality of the public Asy- lums in England, is their want of space for different work shops, and of a sufficient quantity of ground on which the patients can be employed in agricul- tural labour. “At Wakefield, the patients have uniformly been kept employed at their various trades, and in agricultural labor, and the best results have followed this judicious system. Dr. Ellis in a report remarks, that no accident has ever occurred from allowing the insane the use of instruments necessary for their trades or occupation, and that while labour has tended greatly to lessen the expense of the establishment, it has also aided in hastening their cure. “ At the Lancaster Asylum, all who are in a fit situation are employed in such occupations as are adapted to their abilities and previous habits : some in husbandry and gardening, getting stones and making roads upon the tvaste grounds adjoining the house, under the direction of attendants, and the women are employed in sewing, washing, and all household work. “ At the Stafford Lunatic Asylum,with one hundred and twenty patients, they cultivate thirty acres of pasturage, pleasure and garden grounds. The labour is performed entirely by the patients, assisted by two attendants, and all the making of linen and mending of clothes is done by the females — and the number of cures bears ample testimony to the judicious arrangement and proper treatment established in the Asylum. “ At the Gloucester Asylum, many of the men are regularly employed in cul- tivating the ground, and, notwithstanding they are entrusted with spades and other garden tools, no accident has occurred, not even among those who as car- penters are allowed the free use of edge tools. The females assist in all the household duties, and in needle work which, as the report states, is found not only useful to themselves, but also, most beneficial to the establishment. 27 “At the Richmond Lunatic Asylum, Ireland, the average number for 1827, was about two hundred and sixty; seventy-three were discharged recovered, thirteen relieved, and twenty-seven died. At the close of the year, twenty-five were convalescent, one hundred and thirty-two curable, and one hundred and twenty incurable. Eighteen patients were employed in garden labour, sixteen in spinning, twelve in knitting, and eighteen at needle work ; twenty-six were employed in keeping the house clean, twelve in washing, and sixteen in other employments, such as carrying coals, white washing the wards, weaving, tailor- ing, &c., and twelve were learning to read, so that of two hundred and seventy- seven, not less than one hundred and thirty were actively and usefully em- ployed. During the year not less than 3188 skeins of yarn were spun, 406 pairs of men’s, and 349 pairs of women’s stockings were knit, and of linen woven in the establishment, there were made by the female patients for the use of the inmates, 140 shirts, 180 chemises, 115 pillow cases, 56 pairs of sheets, 53 rollers, 83 bodices, 80 night-caps, besides the whole clothing of the male and female attendants. “ The Armugh District Asylum, Ireland, had been in operation about two years. Average number of patients about 76. Had received in that period 140 patients, of whom 41 had been discharged cured, 9 relieved, 6 not relieved, 8 died, and 76 remained in the Institution at the close of the second year. There are thirteen acres of land attached to the Institution, which is cultivated by the patients, and furnishes potatoes and vegetables for the consumption of the whole establishment. All the linen for the house consumption is woven by the patients in the Asylum, and all their clothing is made by themselves. The average number of patients employed during the second year, is thus stated by the Superintendent, Mr. Jackson. Of the males in garden labour 12; weaving 3; tailoring 3; mat making 2 ; household work 6 ; white washing 1; and of the females in spinning flax 6 ; making female clothing 8 ; washing 3 ; and in household duties 4. Total 48. Taking 76 the number at the close of the second year as the average number, though it was not probably so large, nearly two thirds were employed. ‘ As employment,’ adds this intelligent Superintendent, ‘is now generally allowed to be one of the best restoratives, every means has been used to promote it. Such as are at all capable among the females, are constantly occupied at plain work, spinning, &c. and the division in which these are most regularly carried on, is remarkable for its regularity and cheerfulness. The patients, with few exceptions, seem happy and grateful. Avoiding all compulsion, I mostly find a small premium has the desired effect.’—Holliday. “ Among the lower classes of the people, it will generally be found that useful occupation in the pursuits to which they have been most accustomed, is their best amusement, and such employment, the most salutary mode of recreation that can be resorted to. One of the principal objects kept in view in the direction of this (the Wakefield) Asylum, has been to obtain for the patients constant and regular employment; and for that purpose, not only farming and gardening, but all trades, have been forced into the service —we have spin- ners, weavers, tailors, shoemakers, brewers, bakers, blacksmiths, joiners, paint- ers, brick layers and stone masons, all employed. All the clothing is manu- factured and made by themselves; we bake our own bread, brew our own beer, and nearly one half of both male and female patients are constantly en- gaged in some kind of labour. The moment there is convalescence, the patient is enticed to occupy himself with his usual healthy pursuits, and indeed many never begin to amend until we have induced them to engage in such employments. I am thankful to say, that all this has been done, hitherto, without an injury of any consequence from one patient’s striking another when they are employed; and besides the great and evident benefit which such a system has had in the recovery of the patients themselves, it is a source of great saving to the institution ; for notwithstanding that we have for many years received only seven shillings a week for a pauper, a fund has accumu- lated, which by the end of the year will exceed three thousand pounds.” Director Doctor Ellis, to Doct. Halliday. OFFICERS OF THE INSTITUTION. 1836. Ebenezer Francis, President. Samuel Appleton, Vice-President. Henry Andrews, Treasurer. Nathaniel I. Bowditch, Secretary. TRUSTEES Charles Amory, George Bond, Thomas B. Curtis, Henry Edwards, Samuel A. Eliot, Francis C. Gray, Samuel Lawrence, Charles G. Loring, Josiah Quincy, Jr., Robert G. Shaw, John P. Thorndike, Edward Tuckerman. Gamaliel Bradford, M. D. Superintendent of the Hospital. Thomas G. Lee, M. D. Physician Superintendent of the Asylum, Columbus Tyler, Steward “ Mrs. Tyler, Matron “ Edward Rowland, Assistant &/■ Apothecary “ Homer Goodhue, Male Supervisor “ Mrs. Lewis, Female “ “