[WITH THE COMPLIMENTS OF THE WRITER.] 
THE EARLY HISTORY 
OF THE 
McLEAN ASYLUM FOR THE INSANE. 
A CRITICISM OF THE REPORT OF THE MASSACHUSETTS STATE 
BOARD OF HEALTH FOR 1877. 
BY 
MORRILL WYMAN, M. D. 
[Reprinted from The Boston Medical and 13, 1877.] 
CAMBRIDGE : 
$rinteti at tfje ftitergitie 
1877. First Physician and Superintendent of the 
McLean Asylum for the Insane. 
B. at Woburn, Mass., 1778; D. at Roxbury, Mass., 1842. THE EARLY HISTORY 
OF THE 
MCLEAN ASYLUM FOR THE IHSAHE. 
A CRITICISM OF THE REPORT OF THE STATE BOARD OF HEALTH FOR 
1877. 
BY MORRILL WYMAN, M. D. 
The Report of the State Board of Health of Massachusetts for the 
present year contains an article, by Hr. Charles F. Folsom, secretary 
of the board, entitled Disease of the Mind. Its principal object, in the 
words of the general report of the board, is to show, “ by citing well- 
known historical facts, that during the past century very great strides 
have been made in the treatment of mental disease.” 
After quoting from the reports of Dr. Bell and of Dr. Earle, made 
in 1847 and 1848, with regard to the very few instances of personal re- 
straint of the insane under their care, Dr. Folsom makes the following 
statement. The paragraph is quoted entire. 
“ With all this, the excited insane were found by a committee of our 
legislature in 1848 to be at the Worcester Asylum even in small rooms, 
‘ having the least advantages for light, none for ventilation, unfavorably 
located, dark, dreary, damp, and uncomfortable to that extent as to 
aggravate rather than to assist the cure of the unfortunate beings 
placed there; ’ the male violent insane at the McLean Asylum, then 
considered one of the best, were kept in stone cells in the cellar ; and 
this simply indicates the general knowledge of the time. The position 
and condition of the more quiet of the insane in asylums were very much 
better of course; but it was reserved for further study and experience 
to show that the most violent may be treated to a certain extent in a 
similar way.” 1 
Many persons, medical men and others, have received from this state- 
ment very erroneous impressions as to the apartments and treatment of 
the violent male insane at the McLean Asylum. If these impressions 
were well founded it would be a stain upon the reputation of those who 
instituted and continued such measures, and upon the board of trustees, 
for whose fidelity and judicious care of the asylum from its foundation 
it would be hard to find a parallel. 
1 Board of Health Report for 1877, page 353. 2 
The Early History of the McLean Asylum. 
I have therefore thought it best to correct the errors of statement in 
the above extract by a carefully prepared description, with drawings, of 
the building occupied by the violent male insane, and also to show what 
was the state of knowledge with regard to insanity and its treatment 
generally at the McLean previous to the period referred to. 
I am impelled to do this not only because the statement is a part of 
the report of the State Board of Health, and has been distributed as 
such, but also because it has been distributed in a separate pamphlet, 
with an authority which would not have attached to an individual writer. 
It may be here remarked that I have more than a general inter- 
est in correcting these errors. My father, Dr. Rufus Wyman, was 
appointed in 1818 the first physician and superintendent of the asylum ; 
in 1835, after seventeen years of service, his health failing under the 
care and anxiety inseparable from such an institution, he resigned. My 
early life and a part of my medical pupilage were spent there. I may 
therefore be presumed to know something of its history. 
When my father entered upon his duties he found buildings already 
erected. They consisted of a large and elegant house, the mansion of 
a gentleman of wealth, to which the trustees of the hospital had added 
two wings, each seventy-six feet in length by forty in breadth. The em- 
inence upon which these buildings stand is remarkable for its beauty, 
and although, in the words of the trustees, “ the situation selected ap- 
pears to unite every practical advantage,” it is much too small to admit 
of the proper arrangement of the buildings on the same level. The 
wings, as originally built, not differing materially in plan from hotels, 
are on a level several feet lower than the mansion. The buildings since 
added are necessarily on a still lower level. This abrupt slope, although 
it has some advantage and gives excellent opportunity for drainage, 
has compelled a crowding together of the different structures not desir- 
able, and no little skill and ingenuity have been required to obviate to 
the present extent this objection. 
“ The male violent insane were kept in stone cells in the cellar.” 
How far this statement correctly represents the facts it is now proposed 
to examine. 
The apartments occupied by the violent male insane in 1848, the 
rooms to which the report refers, are known at the asylum as the 
“ strong rooms,” and are four in number. They are in a brick build- 
ing, fifty-four feet by twenty-three feet, called the “ lodge ” or “ re- 
treat; ” it stands at the east of the mansion and quite detached from it. 
It was planned by my father and built under his direction in 1826. I 
have his original memoranda and manuscript plans, with a report to the 
trustees in March, 1825, on additions to be made to the asylum, of 
which this building was one. 
When the “ lodge ” was built, the McLean Asylum, which was the The Early History of the McLean Asylum. 
3 
first in New England, had been open eight years; during this period it 
had received a larger proportion than ever since of patients from jails 
and almshouses, where they had no proper care. Some, neglected by 
those who had charge of them, were filthy and noisy ; treated for years 
like lower animals, they came to resemble them in many of their habits ; 
they had no proper rooms, and suffering from cold in winter were often 
confined in cellars; their keepers, glad to be rid of them, sent them to 
the newly opened asylum. Subsequently, the earlier removal of the 
insane to asylums probably much diminished the number who fell into 
this dreadful condition. 
The “ lodge ” was originally of two stories, the upper intended for 
idiots and epileptics, those who were objectionable in their habits or 
subject to sudden outbreaks of frenzy. In this story the rooms were 
arranged as to warming, ventilation, and lighting as in the story below; 
the floor was to be warmed by steam or hot air circulating in channels 
beneath it. These apartments, however, were never finished, the num- 
ber of patients requiring them having lessened. They were afterwards 
remodeled and fitted for a different class of persons. The rest of the 
“ lodge ” is in the main as originally built, with the exception of an 
upper story added by Dr. Bell in 1850. 
The lower story contains the “ strong rooms.” These are now as 
when first built, except the front walls, which were removed last year 
when the building was transferred to the steward’s department. The 
class of boarders formerly occupying them is now in the “ Bowditch 
ward ” for excited cases. 
It should be distinctly understood that these rooms were exclusively 
for those unfortunate persons, some of whom are to be found in most large 
asylums, who at times are violent and noisy, who destroy their clothing, 
their bedding, even to the very mattresses on which they sleep, who 
defile their rooms in every possible way, — the most violent male insane. 
No others were ever placed in these rooms. Their number is small; 
these four rooms were more than sufficient for one hundred and fifty male 
boarders at the McLean. Mr. Tyler, for more than thirty years con- 
nected with the asylum as attendant, supervisor, and steward, a highly 
valued officer, assures me that more than two rooms were never known 
to have been occupied at the same time. But small as the number is,' 
even if it be but a single individual, he should be provided for in the 
manner best suited to his individual case. How this is to be done has 
been a difficult problem, and it is likely always will be. Reasoning and 
persuasion can avail nothing. They may be drugged with narcotics, 
but experience has decided against this plan for any length of time. 
Some would have them kept in apartments similar to those of the more 
quiet, and in their vicinity, holding and restraining them by sufficient 
manual force; others think they should be secured and prevented from The Early History of the McLean Asylum. 
doing mischief to themselves or others by means of manacles, strait- 
waistcoats, camisoles, muffs or mittens, as producing less desire for re- 
sistance than when opposed by manual strength. But neither of these 
plans prevents noise and filth, which render them utterly unfit compan- 
ions for the more quiet. Others, again, prefer to abolish all restraint upon 
the limbs, and while the paroxysm lasts leave these most unfortunate 
sufferers in proper apartments, where they can be made safe, and as far as 
possible comfortable, allowed the full exercise of their limbs, and where 
neither their noise nor their habits will disturb any one. This last 
is the method adopted by my father at the McLean. It was to carry 
out this method that he urged upon the trustees in 1825 the immediate 
erection of the “ lodge.” Its use was continued during the adminis- 
tration of Dr. Bell, who succeeded him at the asylum in 1836. 
In consequence of the formation of the ground, as above described, one 
side and one end of the lower story of the “ lodge,” for about one half 
its height, stands against a retaining wall. The other side (the front) 
and the other end opened upon an airing court fifty-seven by fifty; the 
floor of the “ lodge ” generally is two feet above the surface of the ground, 
the western end somewhat less, the ground falling off from the building 
in both these directions. On this floor, at this height above the surface 
of the ground, and in the front of the building, are the “ strong rooms.” 
Below the floors of these rooms is the cellar, about seven feet deep, ex- 
tending under the whole building. This cellar is well lighted with 
windows on the front and end, paved with bricks, well ventilated, and 
every part clean and whitened. Here is the furnace for heating the air 
for warming and ventilating the “ strong rooms ” above, and also the 
especial arrangement for warming their floors. These “ strong rooms ” 
nowhere come in contact with the external walls ; they are completely 
surrounded by corridors about five feet wide, properly ventilated and 
warmed, summer and winter. They are lighted by windows in the front 
wall, and also by smaller windows on the opposite side. The “ strong 
rooms ” are eleven feet by seven and a half on the floor, ten feet in 
height, the ceiling an elliptic arch, with a ventilating flue in the centre. 
They are entered by doors from the corridors, and lighted through un- 
glazed windows about two feet square, never closed in any way. Directly 
opposite these windows are the large windows, about three by five feet, 
in the front of the building, opening upon the airing court. In the cor- 
ridor are doors by which each room is completely separated from the 
others, and sound cut off as much as possible. Each room can be 
reached without passing any other. The walls, like those of other rooms 
in the asylum, are of brick plastered with Portland cement, made as 
smooth as possible ; the corners are rounded for cleanliness, as has re- 
cently been done for the new wards of the Massachusetts General Hos- 
pital. In one corner is a close-stool communicating with the corridor The Early History of the McLean Asylum. 
through the side of the room ; in two of the corners, are seats properly- 
fastened to the wall. The floor is of granite slabs, eight or ten inches 
thick, smoothly hammered, and laid in cement. This floor is inclined 
towards one corner of the room, that next the corridor, where there is 
a proper outlet and waste-pipe. This secures the immediate draining 
away of water during the washing of the floor, of necessity frequently 
repeated with this class of patients. 
Notwithstanding the ample preparations for ventilation and warming 
the air of the rooms and corridors, it was deemed essential that the floor 
also should be well warmed. To do this effectually and equably is a 
matter of no little difficulty. To he comfortable to those without cloth- 
ing it should have a temperature of about 100° ; this degree of warmth 
cannot be obtained from air fitted for respiration. In these “ strong 
rooms” the difficulty is met by warming the stone floor by a fire be- 
neath. It had already been successfully tried in a room in the asylum 
(it was not of stone nor in a cellar) fitted up for patients of this class. 
The fuel was burned in a proper fire-place, and the heated gases, after 
circulating through the whole space beneath the floor of the rooms, es- 
caped by a chimney. The floors were thus warmed night and day, 
summer and winter, the thick slabs of granite keeping up an equable 
temperature hardly to be obtained in any other way. This method of 
warming is by no means new; it is essentially that of the ancient hyp- 
ocaust, used two thousand years ago at Pompeii, as is fully shown by 
the excavations and also by the drawings upon the walls of the baths 
in this favorite watering-place of the Romans. In Pompeii the walls 
and ceilings also were hollow and warmed by the same fire. 
Adjoining the main corridor is the bath-room, and near that the room 
for clothing. 
The interior of the rooms is as plain as possible, but in other parts 
there is as much of architectural ornamentation as the use of the build- 
ing will allow. 
The room for the attendants is at the head of the stairs directly over 
the “ strong rooms,” where they can be within hearing of their charge 
and reach them at once either night or day. 
The drawings give in plan and section the details of the “ lodge.” 
It appears from this description, which I have endeavored to make 
accurate, that the “ lodge ” had an airing court fifty-seven by fifty for 
the use of the patients. That the strong rooms are quite open and above 
ground on two sides; on the other sides they are partially belcw the 
surface ; on all sides they are surrounded by corridors well lighted, well 
warmed, and ventilated. They are themselves fully lighted and warmed 
by two methods, each independent of the other; they are nowhere 
within five feet of the external wall, and have below them a cellar 
seven feet deep, also well warmed, lighted, and ventilated. A room 6 
The Early History of the McLean Asylum. 
so situated, having but one of its six sides of stone, can hardly be de- 
scribed with scientific exactness as a “ stone cell in a cellar.” Few 
persons would suspect from the report of the board the true position 
and construction of these rooms, the amount of skill, thought, and ex- 
perience which have been bestowed upon them, nor the degree of safe 
custody and comfort, without restraint upon the limbs, that they have 
brought to those who occupied them. I am quite sure that on no other 
part of the asylum did the physician exercise more fully his great talent 
for contriving and executing accommodations for the insane than here. 
This his numerous plans, sketches, and memoranda clearly show. I 
am equally sure that no patients received more care, or were more con- 
stantly in his thoughts, than the unfortunate persons for whom it was 
designed. It cannot be said of these rooms, as is said in the report 
of 1848 of those in the Worcester Asylum, that they are “ rooms having 
the least advantages of light, none for ventilation, unfavorably located, 
dark, dreary, damp, and uncomfortable.” 
It may be interesting to know that when the report of the commit- 
tee of our legislature in 1848, just referred to, was made, new strong 
rooms for females were being erected at Worcester from money appro- 
priated by the State, and in 1850, these having been found good and 
well suited to their purpose, similar rooms were built for males ; they 
were substantially imitations of the strong rooms of the McLean. 
The idea that these rooms are in the cellar may have arisen from 
the fact that they may be reached in two ways : either by entering the 
left wing at the second story from the level of the ground of the centre 
house or mansion, and descending by the stairs to the level of the cellar 
of the wing ; or they may be entered directly from the airing courts, 
above which they are raised by the usual underpinning of two feet, as 
is clearly shown by the elevation and section. The lower story of the 
new Bowditch ward, for excited patients, may be reached by an under- 
ground passage descending from the floor of the “ lodge ” by seventeen 
steps, but it is also entered directly from its airing court, the floor of 
the two buildings being about equally raised above their respective 
courts. The new Worcester Asylum, now nearly finished, owing to a 
similar formation of the ground, has a retaining wall of about half the 
height of that at the McLean, against which the rooms for the excited 
patients are placed. By no proper use of language can either be said 
to be in a cellar. 
The size of the “ strong rooms ” as compared with rooms for excited 
patients in some other asylums deserves notice. At the Danvers State 
Asylum, now just finished, the rooms for excited patients, according to 
the official report, are seventy-two in number, each twelve feet long, 
eight feet wide, and eleven and one half feet high ; at the McLean 
they are eleven feet long, seven and one half feet wide, and ten feet The Early History of the McLean Asylum. 
high ; at the new Worcester State Asylum, nearly finished, they are ten 
feet long, eight and one half feet wide, and eight feet and eight inches 
high ; the cubic space for each patient at the Danvers is the greatest, 
the McLean next, arid the Worcester least. 
The materials of which the walls of the several rooms in these three 
asylums are constructed are substantially the same : in all they are of 
brick ; at Danvers and the McLean, plastered with Portland cement in 
the neatest and smoothest manner; at Worcester, of bricks painted, 
without plaster. The McLean is the only one with rounded corners. 
The floors at Danvers and Worcester are of wood, not warmed; those 
at the McLean are of stone, warmed. 
The McLean “ strong room ” was provided with a comfortable mat- 
tress, or, if this were destroyed, with the best materials as a substitute 
that could be found. It had seats and a close-stool. By a strict rule 
of the asylum these rooms were the first visited in the morning. Every 
morning before breakfast the patient was bathed and placed in a similar 
adjoining room. Everything which had become soiled was removed, 
the room well washed, and the walls and floor carefully cleaned with 
transparent lime-water, which left the walls free from odor and visible 
lime deposit. The warm stone floor, besides the comfort it gives, must, 
in a sanitary point of view, be considered the best. It does not absorb 
offensive matter of any kind,—a very important fact if fiscal matter 
is the source of so much “ germ disease,” as sanitarians now assert; 
it is quickly dried, and again fit for use. If really better than wood 
it should not be rejected because of its apparent harshness, and it 
would not be if we consider for a moment the condition of the pa- 
tients. They have been accommodated elsewhere as long as possible. 
They are violent and raving in their excitement or delirium, pay little 
attention to their surroundings, and are so wanting in regard to the 
common decencies of life that, for the quiet and comfort of others as 
well as of themselves, their temporary seclusion has become a neces- 
sity. As to the floor itself, it is practically no harder than a hard pine 
floor ; neither yields to the pressure of the body. 
Dr. Bell, in his report for 1839, after more than ten years’ experience, 
says of these patients: “ There are, it is true, certain cases where the 
mind is so frenzied and chaotic that the individual is reckless and uncon- 
scious of what he does; here the provision of a suitable lodge room with 
stone floor, warmed by steam or hot air below, without glass or mov- 
able furniture, is the best and kindest appliance which can be adopted 
for a few days until medical and soothing treatment can place the suf- 
ferer in a condition to be operated upon by moral means. We never 
have had occasion, since the institution has been under my care, to use 
strong rooms as places of permanent detention, a few weeks being the 
extent of time which they have ever been occupied by a single person.” 8 
The Early History of the McLean Asylum. 
The following letter from the eminent alienist, Dr. Isaac Ray, gives 
his opinion of the “ strong rooms,” and their fitness for those who occu- 
pied them : — 
My dear Sir, — I recollect perfectly the rooms of the violent and 
excited patients at the McLean Asylum, to which you refer. They 
were in the basement story, and constructed very much like other 
patients’ rooms. They opened upon a common corridor, some four or 
five feet wide, which was lighted by ordinary windows in the wall. 
This light passed into the rooms through an unglazed window by the 
side of the door. The floors were made of stone slabs, which were 
heated by a fire beneath, and thus the air was warmed by heat radiated 
from the floors. I always thought them very well fitted for their allotted 
purpose, that of keeping violent, raving patients, and I never saw them 
occupied by any others. They were justly regarded, I think, consid- 
erably in advance of any other existing means for keeping that descrip- 
tion of patients. Of course improvements have followed the increase 
of means. The rooms now used for that purpose look out by a glazed 
window into a yard, the walls are smoothly plastered, the use of steam 
has led to a better method of warming, and the doors open upon a 
long, broad hall, tastefully wainscoted and painted. All these were 
very desirable, as anything is which gives a more cheerful aspect to the 
patient’s surroundings. But they add little or nothing to the essential 
requisites of a strong-room, — freedom of movement, perfect cleanliness, 
good warmth, and ventilation, — and in these particulars the old lodge 
rooms have never been surpassed, to my knowledge. 
Dr. Folsom speaks of the strong rooms at Worcester and at the 
McLean in the same breath, and in such a manner that an incautious 
reader might suppose there was little to choose between them. It 
would not be worth while now to describe the former. It is enough 
to say that they were destitute of the prime requisites just mentioned, 
while their surroundings were of the most repulsive character. 
You are at liberty to make any use of this letter which will serve 
your purpose. Yours truly, I. Ray. 
Dr. Wyman. 
3509 Baring Street, Philadelphia, September, 1877. 
Having corrected the errors of statement as to the rooms for the vio- 
lent insane, I will now consider the state of knowledge with regard to 
insanity generally and its treatment at the McLean. 
The report of the board assures us that the state of things which it 
assumes to have existed at the McLean in 1848 “ simply indicated the 
general knowledge of the time,” — a somewhat sweeping conclusion 
and not very precise in its meaning. It is reasonable to conclude, how- 
ever, that whatever else was intended by the expression it means that 
the state of knowledge at that time was at a low ebb. It is possible, The Early History of the McLean Asylum. 
9 
too, that the generalization was first made in the interest of progress, 
and in seeking for facts in support of this statement the selection of the 
McLean is not quite happy. However this may be, as the McLean 
has been selected it is now proposed to show from memoranda and the 
report of its physician in 1825 the knowledge with regard to the treat- 
ment of the insane then existing. There is no reason to believe that 
this knowledge was less in 1848. 
The report to the trustees from which the following extracts are made 
is dated March, 1825: — 
“ In constructing buildings for lunatics, their comfort, happiness, and 
cure should be regarded as the ultimate and all-important objects. 
Other objects contributing to the accomplishment of these great ends 
are of almost equal importance. Among these are provisions for the 
attendants conveniently to manage the patients and to execute the 
orders and directions of those to whom is confided the general superin- 
tendence of the institution. Upon the care, fidelity, and experience of 
the attendants, the quiet conduct and the eventual recovery of the 
boarders greatly depend. Suitable attendants cannot be procured un- 
less their convenience in the discharge of their duties be duly regarded, 
or if procured must be often changed, and consequently they will never 
acquire the requisite experience.” 
“ Few persons who are qualified to have the oversight and to be the 
companions of the boarders will be willing to perform the menial services. 
Indeed, these services degrade the attendant in the opinion of those 
under his care, and render them less submissive and respectful in their 
deportment. He should therefore have an assistant. The attendant 
would be likely to remain in the asylum a long time, and the often 
changing of the assistant, if necessary, would be attended with little in- 
convenience.” 
At this time the attendants, many of whom had been school-teachers, 
were selected with great care, usually on the recommendation of their 
clergymen. The principal attendants were required to keep journals 
recording the condition of those under their care and other matters per- 
taining to the administration of their office. This was done not only 
for the inspection of the physicians, but also to secure vigilance and close 
observation on the part of the attendants. 
“ The feelings and opinions of relatives and friends of lunatics must 
be consulted, for they are to select the residence of those under their 
care.” 
“ The public also must be consulted, for the institution, in a great de- 
gree, depends upon the charities of the public for its support, especially 
for the funds to defray the expenses of erecting its buildings. These 
contributions are to be expended with the greatest caution. Every 
measure and every plan should be well digested before any attempt to 
execute it.” 10 
The Early History of the McLean Asylum. 
“ The first great object presented is a proper classification of the 
subjects of a lunatic asylum. The evils to be avoided by an entire sep- 
aration of males from females are so apparent that no arguments are 
needed to show its propriety. A further division of lunatics of either 
sex into distinct classes or families is not to be disputed. But the dif- 
ficulties attending a suitable division are very great. These difficulties 
are various according to the form of government, the laws and customs 
of the country, and habits of the lunatics. In all cases the quiet are to 
be separated from the noisy and violent, the clean from the dirty, the 
clothed from the naked, and the latter from each other, that one patient 
should in the least possible degree disturb or offend another. Each 
division should form a little family, producing the greatest degree of 
comfort and happiness of which its members are susceptible. Some 
individuals who are much disturbed by noise require the most perfect 
seclusion and solitude ; for these two rooms are so constructed and so 
situated that they may be suitably accommodated. They will also an- 
swer for ordinary sleeping rooms.” 
“ There are lunatic males who are generally tranquil, harmless, sus- 
ceptible of much enjoyment, capable of walking abroad without an at- 
tendant, and in fact requiring little or no restraint. Their friends find 
it necessary to send such persons from home. They desire for them 
large, handsome, and convenient apartments, and sometimes accommo- 
dations for a servant. They are willing to pay in proportion to the 
accommodations required. Such boarders may constitute a single family, 
called house boarders, and have apartments in the connecting wings and 
front part of the centre house.” 
One or more boarders were always at the physician’s table, had rooms 
in the mansion house, and mingled with his family, went to Boston and 
elsewhere, and always without an attendant. The more quiet also 
passed their evenings in the physician’s family, and always appeared 
and were treated like other gentlemen. Some occupied themselves for 
months together as teachers of the physician’s children, with advantage 
to both. 
“ Class I. Other lunatics, whose friends may wish for them hand- 
some rooms and galleries, and have the means of paying the necessary 
expenses, still require to be restrained, and their rooms and airing 
courts must be so constructed that they cannot easily escape. These 
may constitute the first class, occupy one wing, and be divided into 
three families, each living in a single story. The convalescents and 
most tranquil may take the upper story, the most noisy and turbulent 
may take the basement story, and the remainder may take the middle 
story.” 
“ Class II. A second class, requiring to be restrained, may occupy the 
other wing. Neither their habits of life nor their pecuniary means will The Early History of the McLean Asylum. 
11 
require or permit the rooms of this class to be finished or furnished in 
a style so expensive as those of the first class. They may, however, 
be provided with every comfort and convenience to be found in the 
apartments of the other class, and have everything adapted to their 
habits and feelings. This class will also be divided into three families, 
to be distributed in the several stories as is contemplated for the first 
class. Provision is made for a further and temporary division of apart- 
ments whenever any particular boarders are found to have aversions to 
each other.” 
“ The wings thus improved would contain accommodations for the 
quiet, the sick, and those who are not excessively noisy.” 
“ Class III. The very noisy, dirty, and violent patients will form a 
third class. They may possibly be kept in the wing for the second 
class. But it is believed a distinct building is to be preferred. Apart- 
ments may be provided in the same building for idiots and epileptics. 
The principal objection to this separation is that the worst patients 
being far removed would be likely to be neglected. But the comfort 
and tranquillity of the other patients require the removal, and the neg- 
lect must be prevented by increased vigilance.” 
We here see some of the reasons for the selection of the site for the 
“ lodge ” for this class. It is as closely connected with the wing as 
possible, and yet detached ; the four rooms, which were more than suffi- 
cient for their accommodation, were upon that side farthest removed 
from the other buildings, so that noise and shoutings could not be heard 
in them ; this allowed the free opening of the windows of the lodge at 
all times. 
“ The proper situation of the day rooms (or parlors) is a subject on 
which competent judges entertain different opinions. In several well- 
approved institutions all the day rooms are on the first or first and sec- 
ond stories. Under this arrangement those who occupy the upper story 
are during the day removed far from their sleeping rooms. It is true 
they have a more easy access to their airing courts, and the attendants 
who keep in the day rooms can more readily afford assistance to each 
other as it may be needed. But when the sleeping rooms join the gal- 
leries and are immediately connected with the day rooms, the members 
of the family occupying the same are under less restraint and have a 
greater variety of accommodations. If sitting in the day room become 
unpleasant, the gallery is at hand for walking, and the airing court is 
sufficiently easy of access. If a patient be feeble or wearied, and desir- 
ous of passing an hour upon his bed, or if he prefer to write or read 
without the presence of others, his room is near and within the hear- 
ing and call of his attendant. These reasons seem to be conclusive for 
placing the sleeping rooms, day rooms, and galleries contiguous to each 
other and in the same story.” 12 
The Early History of the McLean Asylum 
“ The principal objections likely to be urged against this plan are 
that the classes will be too numerous for quiet or safety, and will re- 
quire the day rooms (parlors) to be too large. These objections do not 
appear to me to be valid or in any way proportional to the advantages 
gained.” 
Great differences of opinion have existed among those in charge of 
the insane as to the extent to which classification should be carried. 
The plan here given and adopted approached individualization. Dr. 
Bell thought it was carried too far. Of late the opinion has been gain- 
ing ground, especially in Europe, that a “ strictly individual treatment ” 
is needed. This cannot be approached without a classification at least 
as detailed as that adopted here more than half a century ago. 
“ The centre of each wing may be carried up so as to form large 
halls for the exercise of the boarders in the winter and in stormy 
weather. Work rooms may be here constructed in which the exercise 
of some mechanic arts will not disturb the patients in the lower sto- 
ries.” 
“ I he committees and the board of trustees may hold their meetings 
in the mansion house, some part of which may be used for the chapel.” 
The physician was descended of a Puritan stock ; he believed in the 
stated religious observance of the Sabbath; he had written in its defense, 
and believed what he wrote. The patients who were able attended divine 
service in the neighboring churches. Religious services were also held 
in the wings Sunday evenings; during which the physician read a ser- 
mon to those who were well enough and desired to attend. 
“ Each family is also provided with dining and work rooms, a separate 
airing court, and has access to it by separate stairs, that the members 
of different families may not mix together. The courts are so arranged 
that patients in an improved state of mind will not see those who are 
in a worse condition.” 
“Two rooms are provided for those who need inspection during the 
night.” 
“ The present garden for the exercise of the male boarders would be 
contiguous to their airing courts, but the boarders of one sex could not 
see those of the other during their exercise or amusements. The hill 
to be formed in glacis for walks, ornamented with trees and shrubbery.” 
“ In front of each connecting wing is a small court and a low building 
which is designed for house boarders who may be sick and cannot be re- 
moved to either wing or retained in the centre house. Small buildings 
of one story may be erected in the rear and front yards, as shown in 
the plans. Their height will not obstruct the view from other houses. 
This is a want which ought not to be overlooked.” 
We have here a plan of small, detached, one-story hospital buildings, 
much after that now so strongly advocated, and within a few years The Early History of the McLean Asylum. 
adopted by the other branch of the Massachusetts General Hospital in 
Boston. 
“ Near the broad steps of the stairs are holes through which the gal- 
leries and day rooms may be inspected ; similar holes are in the walls 
of the dining-rooms for viewing the tables, etc.; as a like provision 
is made in each story, the whole wing may be inspected without the 
knowledge of the boarders or attendants. Through these apertures 
the friends of a patient may see him without exposing him to the dan- 
gers of a visit.” 
Unceasing vigilance is the safety of the insane. These conveniences 
for the unexpected inspection of the boarders by their friends are a 
part of a plan. When the boarders were in the airing courts they were 
seen by their friends from the mansion house through a fine telescope 
mounted for the purpose. Few better arrangements could be devised 
for giving friends confidence in the treatment pursued. There may be 
objection to patients seeing their friends, but none to the friends seeing 
the patients. The influence of such a system upon all connected with 
the institution is obvious. 
The report is accompanied by detailed plans, in accordance with 
which the buildings were soon after erected. 
As has already been stated, some of the boarders were quite at liberty 
to come and go as they pleased. These found their own occupation 
and amusement; one was a frequent visitor at the reading-room of the 
Boston Athenaeum, and might have been seen daily among the literary 
gentlemen who associated there. A constant effort was made to in- 
crease the means of occupation and amusement for all. Walking in 
the airing courts or in the country with attendants, going to church on 
Sunday, visiting places of interest on other days, were the most com- 
mon, or riding in open wagons in pleasant weather. Soon afterwards 
the physician was “ authorized to procure a carriage and pair of horses 
to be used at the McLean Asylum for the insane, for the purpose of 
giving; air and exercise to the boarders.”1 These rides were then, as 
now, taken in the neighboring country. They were of necessity con- 
fined to those who were comparatively quiet and well behaved. But 
there were others who needed air and exercise even more than these ; 
for such a carriage-way of nearly half a mile in circuit was made round 
the garden, where they could ride and where neither their noise nor 
their appearance would disturb any. A row-boat upon Charles River, 
then attractive and unpolluted, was in frequent use, affording an amuse- 
ment particularly relished by those who had been sailors, of whom the 
asylum usually contained several. 
In summer, excursions in the harbor in large boats gave a pleasant 
sail, a run upon the islands, a chowder on board, and all the enjoyment 
1 Bowditch’s History of the Massachusetts General Hospital, page 84. 14 
The Early History of the McLean Asylum. 
of a day from home. There was bowling, gardening, the exercise of the 
mechanic arts, books, papers, and various games. Chess was a favorite 
with some ; the physician was an excellent player, and not unfrequently 
met with a worthy antagonist among his boarders. 
Such was the state of knowledge and such the condition of the several 
classes of boarders at the McLean fifty years ago, widely different from 
what is intended to be conveyed by the report of the Board of Health. 
“ The position and condition of the more quiet of the insane were 
much better of course,” says the report of the board, “ but it was re- 
served for further study and experience to show that the most violent 
may be treated to a certain extent in a similar way.” In expressing 
this opinion it is to be regretted that we have no account of this improved 
treatment. Indeed, very little is said, either directly or by the corre- 
spondents with regard to the “ most violent.” We read much — and very 
pleasant reading it is — of those in England and Scotland whose occupa- 
tions and treatment seem to be much like that just described as existing 
here, but I fail to find a satisfactory description of the other class, of 
their treatment and apartments, either here or abroad. The study and 
experience of a Scotch physician as late as 1875 1 have convinced him 
that seclusion is the best for “ those who use coarseness of language ” 
and for the “ destructive ; ” of these last two or three cases have occurred 
in his asylum in a year. To what extent seclusion is carried we have 
no means of knowing, nor have we any means of knowing if any destroy 
their clothing and bedding. There are probably such cases in Europe; 
we certainly have them in Massachusetts. The report gives us no in- 
timation of the proportion of such cases nor of their treatment, either 
here or abroad ; instead of “ well-known historic facts ” from which to 
judge of the progress in treating the “ most violent ” like the more quiet, 
we have an opinion. But in estimating the value of this opinion we 
must remember that the point of comparison, the “ stone cells in the cel- 
lar,” is proved not to exist; indeed the whole spirit of the sentence, so 
far as the McLean Asylum is concerned, fails to show a just apprecia- 
tion of the knowledge and practice of the two physicians who had charge 
of it through the first half of its existence. 
A more ornamental architecture may have been devised, and, it may 
be, some minor advantageous changes in details, in the hope of “ hiding 
by their comfortable and cheerful arrangements the necessities of re- 
straint,” but other than these, from my own observation, I do not believe 
that in either of the two asylums now being built at the expense of the 
State the arrangements for lighting, warming, and ventilating the apart- 
ments for the treatment and safe custody of the “ most violent ” insane 
are material improvements over those in use at the McLean fifty years 
age. The Bowditch excited ward is for another class of patients, as 
page 367. The Early History of the McLean Asylum. 
its name indicates ; it has no room peculiarly fitted for the comfort of 
the most violent. 
It must not be supposed that I deny a steady amelioration in the 
treatment of the insane generally during the past fifty years; that would 
be unjust to the talented and devoted laborers in this field. 
Of the experiments which have been tried here with a reasonable 
hope of success, some have led to important changes in treatment; some 
have been repeated abroad, and after a short trial accounts of them reach 
us as novelties. Dr. Bell in his final report, after twenty years’ service, 
has some instructive remarks on this subject. 
It is now demonstrated : 
(1.) That the report has not fairly represented the apartments of 
the violent male insane at the McLean, nor their treatment during the 
first thirty years of its existence. 
(2.) That the report has not fairly represented the state of knowl- 
edge at the McLean with regard to insanity, nor the treatment there of 
the insane generally during the same period. 
The report has been written, printed, and distributed at the expense 
of the State ; it bears the seal of the Commonwealth ; it goes forth to the 
people for whom it is written as a historical state document, and takes 
its place in public libraries bearing an authority which belongs to no 
individual ; its statements, therefore, should be cautiously made and care- 
fully verified. It is to be hoped, inasmuch as the board has elsewhere 
been pleased to make favorable mention of my father’s services, that 
the facts here presented under a sense of filial duty will also induce it 
to correct any errors prejudicial to his merits into which it may have 
fallen. As the first physician of the McLean he laid well and deep 
the foundation of a class of public charities before unknown in New 
England; he devoted himself to the one great object of his life with an 
untiring energy and fidelity scarcely to be equaled ; the evidence of the 
operations of his mind are still obvious in the mechanical and architect- 
ural arrangements and in the moral regime and internal system of most 
of the institutions for the insane in the land. Such services I would 
not have forgotten or undervalued in a history of insanity by an official 
board of his native State. 
Cambridge, December, 1877. Note to Page 13. 
The following extracts indicate the principles of treatment adopted at the 
McLean by its first physician. 
“A knowledge of the mental functions in health can be derived only from the 
history of mental operations. This history of facts, with the laws and princi- 
ples deduced therefrom by the aid of a sound logic, is called the philosophy of 
mind. Mental philosophy, then, is an indispensable study of an accomplished 
physician.” 
“ The treatment of insanity Chiefly depends upon the connexion between the 
mind and body. If there be inflammation of the brain, or its membranes, it is 
to be treated as inflammation of those parts. If there be other organic disease, 
whether of structure or of function, in any part of the body, medical treatment 
will be required. But in mental disorders, without symptoms of organic disease, 
a judicious moral management is more successful. It should afford agreeable 
occupation. It should engage the mind, and exercise the body; as swinging, 
riding, walking, sewing, embroidery, bowling, gardening, mechanic arts; to 
which may be added reading, writing, conversation, Ac., the whole to be per- 
formed with order and regularity. Even the taking of food, retiring to bed, 
rising in the morning, &c., at stated times, and conforming to stated rules in 
almost everything, is a most salutary discipline. It requires, however, constant 
attention and vigilance, with the greatest kindness in the attendants upon a 
lunatic. Moral treatment is indispensable, even in cases arising from organic 
disease. 
In regard to medical treatment, I believe, that purging, bleeding, low diet, &c., 
have been adopted with little discrimination. They are to be resorted to only 
when there is organic disease, which requires the ‘ reducing plan.’ But these 
remedies, especially in debilitated subjects, are seldom useful in relieving 
mental disease. They are usually injurious, and frequently fatal. It is 
undoubtedly true, that impressions upon the alimentary canal by purging or 
vomiting, and upon the skin of the extremities by blistering, are useful in 
chronic cases of mental disorders. But these remedies must be suited to the 
strength and general health of the patient.” 
A discourse on Mental Philosophy, as connected with Mental Disease, 
delivered before the Massachusetts Medical Society, June 2, 1830, by Eufus 
Wyman, M. D. Plate I. A plan of the mansion built in 1792 by Joseph Barrell, Esq., a Boston mer- 
chant, and of the two wings added by the trustees before the appointment of a physician. 
The outline sketch, Figure 2, shows the position and dimensions of a new building planned 
by Dr. Wyman in March, 1825, about six years after the opening of the asylum. Its site is 
about two hundred and forty-five feet from the mansion, on the high ground north of it, 
now occupied by the Appleton wards. 
Plate II. Principal story of the proposed building, consisting of a centre house and two 
wings. The centre house to contain apartments for the medical officers, for the visiting 
committee, and other visitors; and a parlor, a dining-room, and a sitting-room for the ac- 
commodation of twelve house boarders, as described at page 10. The kitchen and laundry 
are on the story below. The details of one wing are given. Each has a central gallery; 
on the outer side are the day and sleeping rooms, on the inner side the various offices, the 
rooms for the attendants, etc. By this arrangement the boarders have light and airy rooms 
and better views ; they do not overlook the courts in the front of the house, nor can they 
communicate with the other wing. When the gallery is divided as indicated by the broken 
line in Plate III., each gallery has its own day and dining room. 
Plate III. Another sketch showing a somewhat different arrangement of the details 
especially as to the gallery and dining-rooms. On the broad stairs are the openings for in- 
specting the galleries and dining-rooms. See page 13. Rooms for the accommodation of 
the most violent insane are at the end of the wing, as in the asylums recently built by the 
State. Provision was made for one hundred boarders. Plates II. and III. were photo- 
graphed from the original sketches. 
This plan was not adopted, probably on account of the expense, which must have appeared 
great, especially so soon after the erection of buildings then supposed ample. Subsequent 
experience has shown that these plans are singularly well adapted to the wants of the insti- 
tution since it has been relieved of a class of patients now cared for at the state asylums. 
Dr. Wyman soon after made a second report, with plans for additions to the two wings 
already built. It was proposed to light the staircase and interior passages by a large lan- 
tern at the intersection of the two roofs, that of the wing and its addition ; for architectural 
reasons this was objected to, and in place of the lantern a dome was substituted, and con- 
structed as it now appears, — an unfortunate arrangement as regards lighting, for which 
the physician is not answerable. 
Had either of the other two plans been adopted, the building would not have undergone 
alterations, made at great expense, for light and to improve intricate passages. 
Plate IV. Ground plan of the strong-rooms in the “ lodge,” showing the isolation of the 
rooms from the external walls and from each other; the corridors and the mode of lighting. 
Plate V. Section of the “ lodge,” showing the rooms, the ventilators, and hot-air flues, 
the floor, and in the cellar the hypocaust for warming it. The relations of the rooms to 
the surrounding courts, and the elevation above the surface, are also shown. See page 4. 
EXPLANATION OF THE PLATES. Hat el. 
I 
S lllllll P TO po 3 2 ct 
Ma rich /8 2 S' 
i 
The HSuoTYFEPRimiHoCo. 0 Devonshire St. Bostoh. Plate II. 
The HeliotyeePriktinoCo. 220 Dbyonshibe St. Bostok. Plate II I. 
The I&uotyiePrihtihoCo. 220 Dexqhshihe Sr. Boston PLAN OP THE LODGE. SECTION OF THE LODGE.