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Report Of Commissioners Appointed To Superintend Erection Of A Lunatic Hospital At Worcester

From: Reports And Other Documents Relating To The State Lunatic Hospital At Worcester, Mass.
Creator:  Horace Mann, Bezaleel Taft, Jr., and W.B. Calhoun (authors)
Date: January 4, 1832
Publisher: Dutton and Wentworth, Boston
Source: Available at selected libraries

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To His Excellency LEVI LINCOLN, Governor of the Commonwealth of Massachusetts.


The Commissioners appointed in pursuance of a Resolve of the Legislature, of March 10, A. D. 1830, "to superintend the erection of a Hospital, of sufficient dimensions to accommodate a superintendent and one hundred and twenty insane or mad persons,"




That the entire foundation, the external and partition walls, the roof and the windows of such a hospital, are now completed. Having so far performed the duties assigned them under their commission, they now deem it incumbent upon them to give a detailed account of the manner in which those duties have been discharged.


The slightest reflection will render it obvious, that an edifice designed for the residence of the insane, must be materially different, both in form and in interior arrangement, from ordinary habitations. The insane require equable warmth, but they cannot be entrusted with fire. They require light and pure air, but the doors and windows which give light and ventilation to common dwellings, would furnish them with facilities for escape, and with opportunities for inflicting personal injury, or even self-destruction. The insane often possess more than the ordinary strength of men, but they are far less capable than children of rendering it subservient to their own welfare, and no human agency can always be present with them to direct or control it. When great numbers of this unfortunate class of people are collected together, not only considerations of convenience in superintending them, but the probabilities of their restoration and their security from mutual injuries, require a classification founded upon scientific principles, according to the various degrees of intensity, or forms of violence, which their maladies may assume. Regarded as individuals, suffering under some bodily or organic disease, (as is ordinarily the case,) it is apparent, that any habitation designed for their residence must partake, in a great degree, of the character of an infirmary. No vigilance of care, or expense of labor, can successfully accomplish all these objects, if unaided by the skilful adaptation of the form and interior arrangement of the edifice in which they are placed. Architectural fitness, then, becomes indispensable to their welfare; it promotes humane and compassionate treatment, gives additional efficacy to medical skill, and often disarms the rage of a spirit, intent upon the destruction of the body in which it dwells.


The resolve above referred to, gave the Commissioners no discretion as to the extent of the accommodations to be prepared; but the choice of the materials, the form of the structure, with all the appendages, were submitted entirely to their views of propriety and fitness. Taking into consideration the public character of the edifice, and the object for which it was designed, the Commissioners believe that no one could approve the use of a material less durable than brick or granite. The latter would have been preferred on some accounts, but as the difference in the expense would have been about thirty per cent., considerations of economy seemed imperative, and it was decided to construct it of brick. The bricks used in the work are judged, by competent men, to be of such a quality as to remove all grounds of apprehension on account of the durability of the fabric.


To devise a plan for the construction of the Hospital, and for the commodious disposition of all its requisite appendages, occasioned the Commissioners much solicitude. Of the variety of establishments for similar purposes, existing in Europe and in this country, not any two are constructed alike. Each, it is presumed, has been the result of an attempt to improve upon all which preceded it; but so various, and, in some degree, so conflicting are the objects sought to be accomplished, that the very means adopted for the furtherance of one, has, either directly or incidentally, been prejudicial to some other. It is not, therefore, without diffidence, that the Commissioners submit a particular description of the plan which, after much inquiry and deliberation, they have adopted.


The Hospital consists of a centre building and two wings. The centre building is 76 feet in length, 40 feet in width, and four stories in height. The wings are each 90 feet long in front, and 100 in the rear, 36 feet wide, and three stories high. They are in the same line, extending to the right and left from the opposite ends of the centre building. The front of the centre building projects 22 feet forward of the front of the wings. The wings, being 36 feet wide, half their width, or 18 feet, joins upon the centre building; the other half falls in its rear. This arrangement connects the centre with the wings, so far as to allow a free communication between them by means of stairways and thorough-fares, and, at the same time, so far disconnects them, that the inside ends of the long halls in the wings, (hereafter mentioned,) falling in the rear of the centre, open into the external air, and thus, as it regards ventilation, the advantages of separate buildings are secured to the wings.

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The cellar extends under the whole edifice. An excavation to the depth of three or four feet was necessary in order to lay the foundation; and, by excavating a little deeper than was indispensable for that purpose, a great amount of room is obtained, and many obvious advantages are secured.


The basement story of the centre building is designed for storerooms, a kitchen, laundry, &c. The front part of the second story contains four rooms of convenient size, which, with the chambers immediately over them, and the small sleeping apartments into which the fourth story is divided, are intended for a superintendent and his family, a steward, and the domestics and laborers necessarily employed in and about so extensive an establishment. As this portion of the Hospital is to be used in the same way as any ordinary dwelling-house, it is, according to the plan, to be finished in a similar manner. The rear of the 1st, 2d and 3d stories of the centre building is designed for the dining and day-rooms of the insane.


The wings are, in each story, divided in the centre by a long hall or aisle, 12 feet in width, and extending from end to end. In consequence of the wings' falling half their width, as before mentioned, in the rear of the centre building, these halls communicate, at both ends, with the external air, and thus the means of a most thorough ventilation are secured. Whoever has visited any public establishment, where the entire end of a wing is met and closed in by the side of the main building, cannot have failed to perceive the noisomeness of the atmosphere at that place, compared with it at the outer end, where free admission has been given to the pure air. On each side of these halls are situated the apartments designed for the insane. They are 8 feet by 10, and all are provided with a permanent seat secured in the wall. Each apartment has a large window with an upper sash of cast iron, and a lower sash of wood, both of which are glazed. Immediately without the wooden sash is a false sash of cast iron, corresponding with the wooden one in appearance and dimensions. This is set firmly into the sides of the window-frame, a narrow space being left at the bottom for water to pass off, and save the frame from decay. When the wooden sash is raised, the false iron one presents a barrier against escape or injury from leaping out through the window. It is said, that a man, however furiously mad, or impatient of confinement he may be, will rarely attempt to break through a window, until he has first tried unsuccessfully to raise it. If it be so, this simple contrivance will afford effectual security both to property and person, without inflicting upon the patient any injurious restraint. Each of these apartments is provided with two air flues, one for heated, the other for cold, air. It is intended to warm the wings by furnaces placed in the cellar. The hot air is to be conducted from the furnaces through flues in the hall walls, and to be discharged through apertures into the halls. By these means, the air in the halls may be raised throughout to any desirable temperature. Over the door of each apartment there is a small aperture, through which the heated air in the halls will pass into the rooms, and thence will be carried off into the attic by means of the hot air flue of the room. The aperture of this flue is at the bottom of the room, and is to be kept open only in winter. The aperture of the other flue is at the top of the room, and is to be kept open in the summer, so that, as the air is made light by heat, it will rise and pass off through this channel, and the cool air from without will rush in to supply its place. All these flues open into the attic, which is ventilated by skylights in the roof, and large fan-windows at the ends. At the end of the wings, where they join on and are connected with the rear part of the centre building, the halls open into the dining and day-rooms, before mentioned, in the centre building. These rooms are fitted up with the same means of strength and security as are provided for the apartments in the wings, and, being directly connected with the halls, are to be warmed from them. The dining-rooms, occupying the rear of the first, second and third stories of the centre building, are of course situated immediately over a portion of the kitchen. Adjoining these rooms, a perpendicular space is left open from the kitchen to the third story, through which, by means of an apparatus similar to a windlass, and called a dumb waiter, the food can be raised from the kitchen and distributed to one hundred and twenty persons in six different divisions, without inconvenience.


Each story in the wings is provided with a bathing-room, washing-room, &c. The large windows at each end of the hall, are protected by an open frame-work of iron. Each hall has a separate stairway, leading into an outer yard, so that each story in each wing is as entirely disconnected from all the others, as if it were a separate building. This allows that separation and classification of the patients, on which all treatises upon the means of restoring the insane, so strenuously insist.

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The roof of the Hospital is covered with slate. Besides the security which this material furnishes against fire, any other covering, it was believed, would seem incongruous with the public character of the building, its solidity, and expected durability.


To prevent unhealthful moisture from being deposited upon the inside walls of the edifice, an interstice or open space is left between the external and internal courses of bricks -- the courses being strongly fastened together by tiles -- so that a free circulation of air through all the exterior walls, from the underpinning to the attic, will effectually obviate that almost universal inconvenience of brick habitations. -- Carpenters are now engaged in completing the wood-work.


It is obvious, that in an establishment like the one under consideration, an abundant supply of water, easily obtained, is more indispensable than in one appropriated to any other purpose. To carry a sufficiency of water by hand, or even to propel it by pumps, over so extensive a building, would have demanded so much labor, that its faithful performance could seldom be secured. At the distance of about 150 rods to the north east of the Hospital-site, is an elevation of land rising many feet higher than the top of the Hospital itself, which promised to contain living springs of water. The Commissioners were of opinion, that, if water could be conveyed from this hill to a reservoir in the top of the Hospital, its abundance and the ease with which it could always be obtained, would promote cleanliness more effectually than could be done by any vigilance or discipline on the part of the Superintendent. They therefore made an arrangement with William Eaton, Esq., the proprietor of the land above mentioned, by which they were permitted to open wells and lay an aqueduct, and by which the Commonwealth may exercise the same privilege for the same purpose, at any future time, by paying to him, or his assigns, as damages, whatever sum of money the selectmen of the town of Worcester for the time being may award. The pipes have been laid, and have afforded a supply of water for the use of the masons in the prosecution of their work. Whether a sufficiency of water for the purposes before mentioned can be obtained from this source, is a question to be tested by experiment in a drier season, though very little apprehension is felt that the experiment will not be satisfactory.


It will be seen, by reference to the report of the Committee which accompanied the resolve for the erection of the Hospital, that the original appropriation of thirty thousand dollars was expected to defray the cost of the edifice, including all the masons and carpenters' work and materials, but exclusive of the expense of furnishing the rooms, and of all incidental charges. Such progress has now been made in the work, that the Commissioners are able to state, that the preparation of the grounds; the excavation and stoning of the cellar; the construction of a road, by which an easy access is gained to the elevated site of the Hospital, requiring the removal of about nine thousand cubic yards of gravel; raising the exterior walls of the edifice, which is 256 feet in length, with partition walls of brick carried up from the foundation, and dividing it into more than one hundred and thirty apartments; the roof of slate; the very expensive windows, with all the carpenters' labor and materials, so far as the same have been necessary in the progress of the work, have been accomplished at an expense something less than twenty-four thousand dollars.


As there is now reason to believe that the first appropriation will accomplish all that was expected from it, it remains only to furnish the Hospital in a suitable manner, to erect the necessary out-buildings, to enclose the grounds, to fence out the separate yards, (1) corresponding with the classification of the inmates, and to build a few solitary cells of great strength, deemed necessary in the opinion of the Commissioners for the confinement of those who are both dangerous and incurable, and whom bolts and bars alone can restrain. For these objects, the Legislature will make such further appropriation as they may deem expedient.

(1) Note by the Superintendent. -- When the Hospital was erected, it was considered indispensable that yards, with high fences, should be provided for the exercise and airing of the patients. All institutions in the country have had them, and, so far as it is known, they are found connected with similar institutions in Europe. In warm climates they must be beneficial, as patients can spend a large proportion of their time in the open air. In this climate it is not so -- we have but few days in the year when patients can be safely suffered to lie upon the ground, a habit to which they are greatly prone, when in yards, unless strictly watched. Experience has satisfied me that yards are useless; especially so to this institution, since spacious and beautiful verandahs have been added to our wings. These are available at all seasons, and in all kinds of weather, are always neat and clean, and far less forbidding than yards. Airing and exercising grounds should not be enclosed in a manner that constantly presents the idea of confinement and bondage. Whenever patients are abroad, a sufficient number of attendants should accompany them, to afford security without restraint. Attendants, uniting with them in games, or accompanying them in their walks, seem to them companions and guides, rather than keepers; of course no unpleasant impression is excited if the conduct of the patients is regular and orderly; they go and come like persons at large and free -- their self-respect is awakened, which prevents acts of violence and indecency. Quite different are the feelings of patients when shut up in yards -- conscious of imprisonment and consequent degradation, they roll in the dirt, indulge in profane and obscene language, make unceasing efforts to escape, and are in a state of continual irritation and excitement. Escapes from yards have been numerous in this establishment, far more than from all other situations put together. From my experience I am ready to say, that as much care is necessary to prevent mischief and injury to health, and escapes, in yards, as in open fields, if attendants do their duty in both. Idiotic and torpid patients, to be sure, can be kept in these enclosures, but they are sure, if not constantly watched, to get upon the ground, take off their clothes, and especially uncover their heads, and expose them to the direct rays of the sun. These considerations induced the Board of Trustees to abandon the yards, especially as we have porticos or verandahs as a substitute, which afford every advantage of yards for the class of patients that cannot be permitted to go at large in the open field, and to many others. -- May, 1837.

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The Commissioners would deem themselves guilty of injustice towards their own feelings, as well as towards the deserts of others, did they dismiss this part of the subject without adverting to the very satisfactory manner in which the work, with some slight exceptions, has thus far been executed by the individuals with whom they have contracted. The whole labor on the Hospital has been performed under the immediate care and superintendence of Mr. Elias Carter of Worcester, who, before his engagement, was very highly recommended as a suitable person for that agency, and, since his engagement, has been recommended no less highly by the manner in which he has fulfilled it. The wood-work was not let out on contract, lest some hazard should be incurred in having that important portion of the labor unskillfully or negligently performed. The masonry has been executed, and it is believed very faithfully executed, by Messrs. Goodman and Gorham of Springfield. Between the first day of May and the first day of November, they laid into the work more than eleven hundred thousands of bricks. And the Commissioners have great pleasure in stating the kindred facts, that, during the whole season, not an accident has happened on the work, not an hour's time has been lost by any of the workmen on account of indisposition, and not a drop of ardent spirits has been consumed in its prosecution.


Another, and most important duty, with which the Commissioners were charged, remains to be performed. By the resolve under which they were appointed, they were directed in report a system of regulations for the discipline and government of the institution, at or before the time when it should be ready to go into operation. That time, it is expected, will arrive in the course of the ensuing season; and, as the Legislature alone have the power to give the force of law to any system of regulations which may be devised for its government, and in the ordinary course of events, will not reassemble until a period subsequent to that, at which it is expected the Hospital will be prepared for the reception of the insane, it was deemed advisable to make this part of the report in season to be acted upon at the ensuing session.


The government and discipline of the institution are supposed to involve the consideration of two questions.


The first relates to the classes of lunatics to be committed to its charge; the authority by which they shall be committed, and by which they may be discharged, when the cause of their detention has ceased to exist, and also the mode in which the expenses of the institution shall be defrayed.


The second respects the regulations, by which the insane shall be governed, whilst at the Hospital, including of course the visitatorial power, under which all regulations of this kind must be administered.


Regarded as citizens of this Commonwealth, or as residents therein, there are three classes of lunatics.


The first class comprehends all those whom the justices of the supreme judicial court, or justices of the peace, have, by virtue of the statutes of 1797, chap. 62, and 1816, chap. 28, committed to jails and houses of correction, because their being suffered to go at large was deemed incompatible with the security of the citizens generally.


The second class consists of town pauper lunatics. These are mostly confined in poor-houses, by order of the municipal authorities, though it has been the practice of some towns to make private contracts with the keepers of jails and houses of correction, to take their insane poor at a low price, and imprison them in some of their unoccupied cells, where no person has been held responsible for their treatment, nor has the law delegated authority to any one to examine into their condition. Other towns have annually offered the keeping of their insane poor at auction, and struck them off to the lowest bidder, by whom they have been taken and treated with various degrees of attention or of cruelty, according to the character of the individual, who, in this competition for the profits of keeping them, would be likely to prevail.


The third class consists of all the remainder of insane persons within the Commonwealth, and of course comprehends those individuals who are not so "furiously mad," in the language of the statutes, as to have been imprisoned with the first class; and also those who, having sufficient property of their own to support themselves, or being supported by the generosity of their friends, do not receive that assistance from towns which would have included them in the second class. Of these, the laws take no special cognizance.


With regard to the first class of lunatics, who are now by law confined in jails and houses of correction, it is believed that nothing but a plain recital of facts, can be necessary to enlist in their behalf the liveliest sympathies of the community. It is now more than thirty years since the laws of this Commonwealth have authorized their commitment to prison, whenever their being at large, should, in the opinion of two magistrates, be judged "dangerous to the peace or safety of the good people." It is a well authenticated fact, that those, upon whom the first attack of insanity is most violent, and who are therefore more liable, from the vehemence of its assaults, to commit outrages upon the persons or property of others, are also most easily cured. Our laws, therefore, by authorizing their confinement, whenever, in the throes and paroxysms of their malady, they may have threatened aggression or excited alarm, have at once removed the most hopeful cases beyond the reach of recovery. It may be emphatically repeated, beyond the reach of recovery, for, from all the inquiries made by the Commissioners upon this subject, they have never heard of more than three or four instances of restoration, among all those who have been subjected to the rigors of a confinement, in jails and houses of correction; while well regulated institutions for the reception and appropriate treatment of the insane, have returned fifty, sixty, and, in some instances, ninety per cent. of recoveries. To him, whose mind is alienated, a prison is a tomb, and within its walls he must suffer as one who awakes to life in the solitude of the grave. Existence and the capacity of pain are alone left him. From every former source of pleasure or contentment, he is violently sequestered. Every former habit is abruptly broken off. No medical skill seconds the efforts of nature for his recovery, or breaks the strength of pain, when it seizes him with convulsing grasp. No friends relieve each other in solacing the weariness of protracted disease. No assiduous affection guards the avenues of approaching disquietude. He is alike removed from all the occupations of health, and from all the attentions, everywhere, but within his homeless abode, bestowed upon sickness. The solitary cell, the noisome atmosphere, the unmitigated cold and the untempered heat, are of themselves sufficient soon to derange every vital function of the body, and this only aggravates the derangement of his mind. On every side is raised up an insurmountable barrier against his recovery. Cut off from all the charities of life, endued with quickened sensibilities to pain, and perpetually stung by annoyances, which, though individually small, rise by constant accumulation to agonies almost beyond the power of mortal sufferance; if his exiled mind in its devious wanderings ever approach the light by which it was once cheered and directed, it sees every thing unwelcoming, every thing repulsive and hostile, and is driven away into returnless banishment.

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From the absence of suitable institutions amongst us, the insane have been visited with a heavier doom than that inflicted upon the voluntary contemners of the law. They have been condemned as no criminal ever was condemned, and have suffered as no criminal ever has suffered. The code by which they have been judged, denounces against them the penalties due only to crime, while it is unmitigated by any of those merciful provisions which, in our penal code, attemper justice with humanity. Even when a criminal stands convicted of perpetrating the most atrocious crime, the benignity of the law accompanies him to the solitude where he is to expiate his offence. He is comfortably clad and warmed and fed at the expense of the State, which inflicts his punishment. He is supplied with the means of moral renovation, and when those proofs of penitence and reformation are given, which it is in his own power to furnish, the laws relent and authorize the remission of his sentence. But though the insane have been made fellow-prisoners with the criminal, they have suffered the absolute privation of every comfort for the body and every solace for the mind. Yet why should a man be treated even as a criminal, who, by universal consent, is incapable of crime? We understand what is signified by retributions for guilt, but to speak of retributions for insanity, does violence to every feeling of humanity and dictate of conscience. Yet this wretched class of our fellow beings, whose only offence is what others justly regard as among the direst of calamities, -- as incapable of moral guilt as unhappily they are of moral consolation, -- have been regarded by our laws as though they were rather the objects of vengeance than of commiseration. And were a system now to be devised, whose express object it should be to drive every victim of insanity beyond the limits of hope, it would scarcely be within the power of a perverse ingenuity to suggest one more infallible than that, which, for so many years, has been in practical operation amongst us. That system could advance one paramount claim to preference. Its experiments have been numerous, and have scarcely ever failed in rendering the most favorable cases of insanity utterly incurable. This practice re-acts upon the community by which it is sanctioned. To say nothing of the amount of human suffering it has caused, it cannot be doubted that, with appropriate treatment, one half at least of all the lunatics, whose support must now continue to be a burden upon the State while they live, might have been restored, and this half might have added as much to the resources of the State, as the other would have subtracted from them.


For several years past all the channels of public information and the resorts for public discussion have been rife with appeals to the community in behalf of prisoners confined for debt. From a comparison made by the commissioners, they cannot entertain a doubt, that the aggregate of the terms of confinement under the poor debtor laws has been much less than that of the imprisonment of the insane. According to returns made in 1829, to the office of the Secretary of the Commonwealth, from towns comprising less than half the population of the State, it was ascertained that one hundred and sixty-one lunatics were in actual confinement, and of this number the duration of the confinement of one hundred and fifty, exceeded in the aggregate a thousand years. From the subjoined statements, derived from authentic documents, respecting the condition of imprisoned lunatics, an estimate may be formed of the comparative rigors of the restraint inflicted upon these two classes of our fellow-citizens.


"In Massachusetts, by an examination made with care, about thirty lunatics have been found in prison. In one prison were found three; in another five; in another six, and in another ten. It is a source of great complaint with the sheriffs and jailors, that they must receive such persons, because they have no suitable accommodations for them. Of those last mentioned, one was found in an apartment in which he has been nine years. He had a wreath of rags round his body, and another round his neck. This was all his clothing. He had no bed, chair or bench. Two or three rough plank were strewed around the room; a heap of filthy straw, like the nest of swine, was in the corner. He had built a bird's nest of mud in the iron grate of his den. Connected with his wretched apartment was a dark dungeon, having no orifice for the admission of light, heat or air, except the iron door, about two and a half feet square, opening into it from the prison."


"The other lunatics in the same prison were scattered about in different apartments, with thieves and murderers, and persons under arrest, but not yet convicted of guilt."


"In the prison of five lunatics, they were confined in separate cells, which were almost dark dungeons. It was difficult, after the door was open, to see them distinctly. The ventilation was so incomplete that more than one person on entering them has found the air so fetid as to produce nauseousness, and almost vomiting. The old straw on which they were laid, and their filthy garments, were such as to make their insanity more hopeless, and at one time it was not considered within the province of the physician's department to examine particularly the condition of the lunatics. In these circumstances any improvement of their minds could hardly be expected. Instead of having three out of four restored to reason, as is the fact in some of the favored Lunatic Asylums, it is to be feared that, in these circumstances, some, who might otherwise be restored, would become incurable, and that others might lose their lives, to say nothing of present suffering."

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"In the prison in which were six lunatics, their condition was less wretched. But they were sometimes an annoyance, and sometimes a sport to the convicts; and even the apartment in which the females were confined, opened into the yard of the men; and there was an injurious interchange of obscenity and profaneness between them, which was not restrained by the presence of the keeper."


"In the prison, or house of correction, so called, in which were ten lunatics, two were found about seventy years of age, a male and female, in the same apartment of an upper story. The female was lying on a heap of straw under a broken window. The snow in a severe storm was beating through the window, and lay upon the straw around her withered body, which was partially covered with a few filthy and tattered garments. The man was lying in the corner of the room in a similar situation, except that he was less exposed to the storm. The former had been in this apartment six, and the latter twenty-one years."


"Another lunatic in the same prison was found in a plank apartment of the first story, where he had been eight years. During this time he had never left the room but twice. The door of this apartment had not been opened in eighteen months. The food was furnished through a small orifice in the door. The room was warmed by no fire; and still the woman of the house said, "he had never froze." As he was seen through the orifice in the door, the first question was, "is that a human being?" The hair was gone from one side of his head, and his eyes were like bails of fire."


"In the cellar of the same prison were five lunatics. The windows of this cellar were no defence against the storm, and, as might be supposed, the woman of the house said, "we have a sight to do to keep them from freezing." There was no fire in this cellar which could be felt by four of the lunatics. One of the five had a little fire of turf in an apartment of the cellar by herself. She was, however, infuriate, if any one came near her. This woman was committed to this cellar seventeen years ago. The apartments are about 6 feet by 8. They are made of coarse plank, and have an orifice in the door for the admission of light and air, about 6 inches by 4. The darkness was such in two of these apartments that nothing could be seen by looking through the orifice in the door. At the same time there was a poor lunatic in each. A man who has grown old was committed to one of them in 1810, and had lived in it seventeen years."


"An emaciated female was found in a similar apartment, in the dark, without fire, almost without covering, where she had been nearly two years."


"A colored woman in another, in which she had been six years; and a miserable man in another in which he had been four years." -- -Second Report of Prison Discipline Society.-


Two facts may be urged in extenuation of a practice so apparently irreconcilable with the benevolent spirit of the age in which it originated. The proper mode of treating insanity was almost universally unknown at the time of its adoption; and the jails and houses of correction were the only places where the strictness of confinement then deemed indispensable, could be enforced.


Until a period comparatively recent, insanity has been deemed an incurable disease. The universal opinion had been that it was an awful visitation from Heaven, and that no human agency could reverse the judgment by which it was inflicted. During the prevalence of this inauspicious belief, as all efforts to restore the insane would be deemed unavailing, they of course would be unattempted. And even at the present day and in communities otherwise highly enlightened, there is reason to fear that a lamentable degree of ignorance prevails upon this subject; an ignorance, which, could it be once dispelled, some of the most painful records in the history of human suffering might be closed, immediately and forever. It is now most abundantly demonstrated, that with appropriate medical and moral treatment, insanity yields with more readiness than ordinary diseases. This cheering fact is established by a series of experiments, instituted from holier motives and crowned with happier results, than any ever recorded in the brilliant annals of science. A few individuals, justly entitled to a conspicuous station among the benefactors of their race, have exploded the barbarous doctrine that cruelty is the proper antidote to madness, and have discovered that skill, mildness and self-devotion to the welfare of the insane, are the only efficacious means for their restoration. Their labors have been hallowed by the spirit of humanity that inspired them; reviving reason, and returning virtue and happiness have been their reward.


These facts are deeply interesting, and, from among many similar statements, the following are selected to remove all doubts concerning their credibility.


The seventh report of the London Prison Discipline Society, published in 1827, shows, that, in the Retreat at York, out of forty patients admitted within three months after the first attack, forty were restored to their friends, recovered. Of those admitted after three, and within twelve months after the commencement of the malady, the proportion of cures was as twenty-five to forty-five; but of those whose disease was of more than two years standing, the proportion of cures was only as fourteen to seventy-nine. The experiments of Doctor Burrows, at his private Asylum in England, exhibit similar results. The last report of the Visitors of the Connecticut Retreat for the insane, shows a ratio of recoveries in the old cases, equivalent to 26 per cent., and out of twenty-four recent cases, twenty-two were recovered, being in the ratio of more than ninety-one per cent. The Commissioners are informed, that, at the "Retreat" last mentioned, when the circumstances of the patient are supposed to require it, a separate attendant is assigned him, whose duty it is to remain constantly at his side, to occupy his attention with pleasing themes, to humor his caprices, and by skillfully adapting his own conduct to the fitful moods of madness, to soothe and pacify that portion of the mind which had been excited to frenzy, and so to allow those faculties whose action remains undisturbed, to gain the ascendancy. The patient is conducted into the open air, the fields and the woods, that the restorative influences of nature may strike some chord in the heart, as yet unbroken in the fatal struggle with worldly disappointments. It is said, that, when the case is recent, attentions of this kind continued for eight or ten days, have scarcely ever failed to subdue the most terrific and fiend-like ferocity. From this systematic practice, it is believed, arises, in a great degree, the unparalleled success of that institution.

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This novel mode of treating insanity has but lately superseded a system in which fetters, whips, confinement, starvation and suffocation in water almost to drowning, were the standard remedies, by which minds, whose disease was an irregularity of action accelerated to delirium, were to be soothed and pacified and restored to harmonious movement. Under that system, thousands of intellects have been precipitated from a condition of temporary danger to one of irretrievable ruin. But when the fierceness of the malady has been assuaged by the union of medical science with all the nameless attentions which benevolence alone can practise or conceive, the recuperative energies of the mind have soon prevailed, and an immortal nature has been restored to the capacity of virtue and the enjoyment of happiness.


To this unfortunate class of beings, humanity is in long arrears. One of the strongest, if not one of the first principles of social obligation arises from necessity of relief and ability to relieve. And when does a man so urgently require the light of others to direct his steps as when he wanders in darkness? When does he stand in such extremity of need of the knowledge and guidance of his fellow-men as when his own mind is a wild chaos, agitated by passions which he cannot quell, and haunted by forms of terror, which the living energy of his nature is perpetually calling into being but cannot disperse? When does he so strenuously demand their succor, as when his own soul is like a living wound, and he has lost all power of distinguishing between the sources of healing and of torture? If the insane have done nothing to forfeit the claim which men who suffer have, by the law of nature, upon men who are able to prevent that suffering; they should be treated, not with a sole regard to the security of others, but with special reference also to their own misfortunes, and in a manner adapted to shorten their duration, or where that is impossible, at least to mitigate their severity. However imperiously the public good may demand the coercion of the insane, it can never be just to cast them into a hopeless dungeon, thereby making the cause of their confinement remediless, and then the confinement itself terminable only by the death of the sufferer. In its practical operation, such a system is a direct consignment of human beings to the long-protracted and mysterious horrors of madness.


In view of these facts and considerations the Committee cannot hesitate to recommend, that, as soon as the Hospital at Worcester shall be prepared for the reception of the insane, and that fact shall be made public by proclamation from the Governor of the Commonwealth, all orders, decrees and sentences for the confinement of any lunatic, made by any court or any judicial officers of this Commonwealth, by virtue of the statutes of 1797, chap. 62, and 1816, chap. 28, shall be so far modified, that said lunatics shall be committed to the custody of the Superintendent of the Hospital at Worcester, instead of being committed to any jail or house of correction, as heretofore required; and, further, that all lunatics, who, at the time when such proclamation is made, shall be confined in any jail or house of correction, under any Order, sentence or decree of any court, or any judicial officers, by virtue of the statutes above mentioned, shall, as soon as convenient and practicable, be removed to said Hospital, under the direction of the mayor and aldermen of the city of Boston, or of the county commissioners of the several counties in this Commonwealth, and at the expense of the counties respectively. And as all information respecting the disease of any lunatic to be removed to the Hospital as above suggested, the cause of such disease, the period of its duration, the character, whether of ferocity, of melancholy, or of any other type, which it may have assumed, will be not only necessary as a guide in the classification and treatment of each lunatic, but may also be a valuable item in forming statistical tables of insanity, such information ought, as far as practicable, to be communicated by the county authorities respectively, at the time when the lunatics are removed from their several places of confinement. And, as the prolonged confinement of any lunatic committed to the Hospital by judicial authority, after the cause of such commitment shall have ceased to exist, will be a hardship upon the individual, and occasion useless expense, it is recommended to confer the power of enlargement in all such cases upon the Board of Visitors, at any meeting when a majority of said board shall be present; and also upon either of the Justices of the Supreme Judicial Court, and of the Court of Common Pleas, to be exercised by said Justices upon the written application of any person, at any term of either of said Courts, when holden within and for the county of Worcester.


These provisions would embrace all those lunatics whom the Commonwealth, by virtue of its sovereignty, and for the security of its citizens, sentences to imprisonment.

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It is believed that no further exposition can be necessary to demonstrate the entire unfitness of our jails and houses of correction, as receptacles for the insane. When the Hospital at Worcester shall be completed, all pretence for the necessity, and with it all excuse for the practice, of confining town-pauper lunatics with condemned criminals, will be removed. Such confinement has, in many instances, been effected by private contract between the towns and the keepers, when, for the purpose of saving a few shillings in the support of a lunatic, he has been subjected to the most aggravated sufferings. It is but a short time since, in a neighboring county, a lunatic placed in a house of correction by the overseers of the poor of the town to which he belonged, was so frozen that he died. To prevent renewed instances of this cruel economy, it is suggested, that keepers of jails and houses of correction should be prohibited, under a penalty, from making private contracts for the custody and support of lunatics within the county buildings, without the consent and approbation of the mayor and aldermen of the city of Boston, or of the county commissioners of the respective counties.


As to the other two classes of lunatics, namely, town paupers, and those individuals of whose existence and condition the laws take no special cognizance, the Commissioners take the liberty to suggest, that the Commonwealth ought not, at least for the present, to do any thing more than to proffer them, as far as possible, the benefits of the institution. Over neither of these classes can the State assume an immediate and mandatory control, without a direct, and in some instances a harsh interference with the privileges and supposed rights of corporations or individuals. As to town-pauper lunatics, it is true that their condition, as they are now frequently treated, is one of severe privation and wretchedness; and much, it is foreseen, may be urged in favor of compulsory provisions, having for their object the more humane treatment of this unfortunate portion of our fellow beings. But on the other hand, it should not be forgotten, that hitherto the institution at Charlestown has been the only one of a public character in the State, where the insane have been received and treated according to the principles of mental and medical science; that that institution, although it has been recently enlarged, is still insufficient to accommodate one fourth part of the lunatics in the State, and that the habits of towns were fixed long prior to its existence. Hence, it may be confidently expected, that the course pursued by towns under past circumstances, will prove no indication of their future practice.


But even upon the inadmissible supposition that the inhabitants of our towns could be inaccessible to motives of humanity, still, motives of economy must be decisive in persuading them to place their insane poor within the action of causes, so frequently efficacious in restoring an alienated mind. It seems now to be believed that, if the organ of the brain be not injured, the mind, in every case of alienation, is reclaimable, if suitable means are resorted to on the first access of the disease. But if recovery is expected, assistance must be promptly afforded, for the chances of restoration rapidly diminish with the continuance of neglect. An inconsiderable sum promptly and judiciously expended, will achieve what no amount of labor or cost will be likely to accomplish, after a delay of three or four years. Pecuniary interest, then, becomes the auxiliary of duty; and economy and humanity, for these purposes, are convertible terms.


For many years past, the actual expense of supporting the insane population of the State cannot have been less, on an average, than forty thousand dollars annually. This subject, therefore, assumes an importance as a matter of finance, if not as one of justice, of charity, and of duty.


Some mode, of course, is to be provided by which the expense of supporting the inmates of the institution is to be defrayed. In respect to the expenses incurred by those committed to the Hospital, by virtue of the statutes of 1797, chap. 62, and 1816, chap. 28, as modified by provisions herein previously recommended, no sufficient reason is discovered for any innovation upon former practice. The Board of Visitors ought, therefore, to be invested with the same powers, which the keepers of houses of correction now by law possess against delinquent towns or individuals. As to town-pauper lunatics, and those persons who, by the voluntary agency of their friends, may enjoy the benefits of the institution, it is recommended, that they should be kept for a sum, in no case exceeding the actual expense incurred in their support, without reference to the original outlay of capital. And, perhaps the Visitors should be authorized in their discretion to receive, for a sum something less than the actual cost, patients who have been recently attacked, as a bounty upon humane efforts for their prompt relief. This is a charitable institution, and was especially designed for the necessities of the poorer classes of people. Hitherto no place has existed within the State, where persons possessing something less than an average of property, could, according to commonly received notions of ability to bear expense, afford to send the members of their families, or their friends, when attacked by this malady. The main object of the Legislature in establishing this institution, it is believed, was to supply that deficiency. It was a necessary part of the great circle of duties to be fulfilled by a government constituted for the benefit of the people. Gratuitous education, universally diffused; laws repressing licentiousness, and encouraging industry by securing to every man his honest gains, may be primary duties in the order of performance. But, though secondary in time, it is a duty no less sacred in obligation, to furnish all needful succor to those, whose position has been so assigned them in the great machine of the universe, that they suffer without fault or offence of their own.

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The second consideration, connected with the discipline of the institution, respects the regulations by which the insane shall be governed whilst at the Hospital, and the visitatorial power, under which all such regulations shall be administered.


The officers of the institution should be so arranged and of such a number, as to insure the greatest efficacy and economy in the management of its concerns, and a proper responsibility to the public, who are its patrons. A great proportion of the economical regulations of the Hospital must necessarily be of such a nature as cannot properly be reached by enactments of the Legislature, not falling within the usual range of legislation. The same remark may be made of the appointment of nearly all the subordinate officers, and the selection of the domestics of the establishment. The power to frame by-laws, and to appoint the officers referred to, must therefore be placed in the hands of a Board of Visitors, whose duty it shall be to take charge of the general interests of the institution, and to see that its affairs are conducted according to the requirements of the Legislature -- the regulations of its internal police -- and the true intent and object of the institution itself.


The appointment of such a board should obviously proceed from the government. The duties of the Visitors cannot be burdensome, after all the necessary regulations of the institution shall have been made, and the subordinate officers shall have been appointed. To mature and establish such regulations, and to make the necessary appointments, will require much time, careful inquiry, and judicious selection.


The Board of Visitors should be so constituted, as to secure a wholesome responsibility to the public, and at the same time admit of a suitable division of the labor of visitation. To secure these objects, the Commissioners recommend, that provision be made for the appointment, by the Governor and Council, of five Visitors -- a portion of the board to be appointed annually, if the Legislature shall deem it expedient -- that the Visitors thus appointed shall be required to establish, as soon as practicable, all the necessary by-laws and regulations for the government of the institution in all its departments, and to appoint or provide for the appointment of all necessary subordinate officers.


The most important appointment to be made by the Visitors will be that of the Principal or Superintendent. After much consideration, the Commissioners recommend, that the Superintendent be a physician, resident at the Hospital, devoting to its interests all his skill and energies. There is abundant reason to believe, that the apartments of the Hospital will, at all times, be fully occupied by the insane. The care of one hundred and twenty such persons will, therefore, reasonably demand his constant attention and advice. Essential injury might accrue from an occasional absence of the physician; such injury certainly would accrue, if the inmates should be dependent upon one, whose private practice should call him abroad for any considerable portion of his time. The requirement of residence at the Hospital would not, however, preclude the Superintendent from consultations, which might be solicited by his professional brethren.


Periodical and thorough visitations of the Hospital will evidently be indispensable to its success, and to its good name in the community. They should be made as often as once in six weeks by one or more of the Visitors; semi-annually by a majority of them, and annually by the whole board. At each visitation a written account should be drawn up of the state of the institution; and at the annual visitation, which should be a short time before the sitting of the Legislature, a detailed report should be made, to be laid before the Governor and Council, for the use of the government, setting forth very particularly a view of its situation and of all its concerns.


The duty of visitation, as already intimated, will not probably be at all burdensome, after the institution shall have gone into operation. The Visitors will undoubtedly feel themselves amply compensated for their services in the opportunity afforded them to aid the cause of humanity, by a manifestation of the noblest sympathies of the heart. No provision, therefore, need be made for defraying any but the actual expenses of the visitation.


Previously, however, to the complete organization of the establishment, so much of the time of the board will necessarily be occupied, and very laboriously too, that justice would require, that provision be made for compensating them suitably for their services up to that period.


The charge of the treasury of the institution will be an important matter; and the power of appointing the treasurer may, in the opinion of the Commissioners, safely be lodged in the hands of the Board of Visitors, leaving it optional with them to select one of their own number, or some other suitable person, who shall give bonds in such sum as the board shall deem proper. The duties of this office will necessarily demand of the incumbent the devotion of much time and attention; he should, therefore, receive an adequate compensation for his services, to be determined by the Legislature.

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The treasurer should be required to present annually to the Governor and Council, at the time when the Board of Visitors make their report, a detailed and complete view of the financial concerns of the institution; and the Governor should be authorized to draw his warrant upon the treasury for such sums as may be necessary for the support of the same.


The Commissioners conclude with the expression of their confident belief, that this institution, under skilful management, will subserve the objects of a just economy; and while it cannot fail to afford recovery or relief to a large class of unfortunate sufferers, may, at the same time, by the exhibition of an example worthy the imitation of other communities, aid, still more extensively, the general cause of philanthropy.


Respectfully submitted,
HORACE MANN, BEZALEEL TAFT, Jr., W. B.CALHOUN. Boston, January 4, 1832.

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