First Annual Report Of The Trustees Of State Lunatic Hospital

From Reports And Other Documents Relating To The State Lunatic Hospital At Worcester, Mass.

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

THE subscribers, Trustees of the State Lunatic Hospital at Worcester, in compliance with the statute under which they were appointed, and by which it is made their duty, in the month of December, annually, to prepare “a full and detailed report, exhibiting a particular statement of the condition of the Hospital and of all its concerns,” respectfully submit the following as their first annual

REPORT:

The aspects in which, as the Trustees believe, the “condition” of the Hospital will always be most anxiously regarded by the benevolent Community which founded it, are,

First — the amount or proportion of cases in which it has restored its insane inmates to the full possession of their reason; and

Second — the degree of relief and amendment it has afforded, in cases where an entire restoration to reason has not been accomplished.

A few preliminary considerations seem to be essential, in order justly to appreciate the prosperity of the institution, during the brief period since it was opened.

In the first place, the time has been far too short to allow the various curative means practised at the institution, to produce their full and natural effects in difficult or chronic cases of insanity. No art can suddenly restore to healthful and vigorous action even the functions of the animal system, after they have been impaired and deranged by wasting diseases or privations. But the mind is far more delicate in its organization than the body, and its sphere of possible aberration is infinitely more wide. Hence, not only is it far more susceptible of deranged and eccentric movements, but the distance to which it may be driven from its true orbit, is also infinitely greater. When fatal diseases attack the body, the principle of vitality struggles for a season, and then our physical nature ceases to suffer by ceasing to exist. But the mind finds no refuge in extinction. Its maladies arrive at no limit growing out of their own severity. As by the law of its nature its existence is perpetual, there is a natural possibility of its indefinite progression in wandering and in suffering. The crisis which in bodily diseases becomes fatal, only adds vehemence to those of the mind. While high degrees of actual violence will crush and overwhelm the body at once, suspending all its functions forever, the mind will survive even a dissevered consciousness, and, as it still lives on, will bring into alternate action its various capacities of pain. Hence it must be apparent, that, during the few months since the institution was organized, scarcely sufficient time has yet elapsed, especially in cases of long continuance and of an aggravated character, to begin the great work of reducing to order a chaotic intellect. A miracle alone would have sufficed to substitute new classes of ideas and sentiments, and to superinduce, among them, new habits of association, instead of those which, from long duration and intense activity, had become almost like organic laws of thought and feeling.

The first patient was received into the Hospital on the nineteenth day of January last. Since that time one hundred and sixty-four have been admitted. The average time of their residence here has been about six months. The common mode of estimating cares, is by an annual per centage. In the report of the Superintendent, the per centage is shown, not for a period of twelve but of six months only.

Another obstacle to success has existed in the peculiar character and condition of the patients sent to the Hospital. Other institutions, both in Europe and America, which have exhibited the most remarkable proportion of cures, have discriminated in their admissions, receiving the more hopeful cases only. The inmates at Worcester have been a more select class than were ever before assembled together; but unfortunately for success in regard to cures, it has been a selection of the most deplorable cases in the whole community. Of the one hundred and sixty-four individuals received, considerably more than one half came from jails, almshouses and houses of correction, and about one third of the whole number had suffered confinement for periods varying from ten to thirty-two years. Many of these forsaken beings, during the dreadful period of their dungeon-life, had been systematically subjected to almost every form of privation and suffering. By this treatment every regular process of thought had been broken up , confusion had extended itself into every department of the intellect ; all ideas were deformed and had lost their true position and relation to each other, while the vital energies of mind sent abroad tumults of passions, that raged without object and without end. No where in this chaos did the serenity of truth or the confidence of reason prevail. The history of insanity does not furnish a single precedent which can cheer benevolence with the promise of many cures among this most deplorable class of sufferers.

There is another cause which has now ceased to operate, and which fortunately can never again recur, that has been highly adverse to the success of the institution during the current year. The Trustees allude to the reception of one hundred and sixty-four insane persons into this establishment during a period of little more than eleven months. In most cases it was impossible to obtain any accurate information of the specific kind of insanity which characterized the condition of each individual. A just classification, therefore, could not be made, until the Superintendent had been aided by an exact observation of each case ; and the inevitable mistake of sometimes placing individuals improperly together, would be first manifested by the injurious influences exerted by them all upon each other. The nurses and attendants, who at first were not only without experience, but destitute of any just conception of their peculiar duties, were to be morally trained and instructed themselves. It must be obvious too, that numberless unforeseen accidents and occurrences of an adverse nature must be inevitably attendant upon the first operations of so large and complicated an establishment.

Yet notwithstanding these untoward circumstances, counteracting with great force all healthful and mind-restoring influences, thirty-two insane persons have, in this short period of time, been fully recovered.

But, however deeply all our better feelings may be moved by the reflection, that thirty-two of our fellow beings, under the auspicious influences of this institution, have already been restored to reason, and returned to bless the families and friends, who, under the former coercive system of treatment, would have mourned their loss “without hope;” yet the ameliorated condition of such as have not been recovered, the Trustees regard as a subject for equal congratulation among men and gratitude to heaven. No one, who has not actually seen, from time to time, the inmates of the Hospital, can comprehend the extent of the change which has taken place in every external indication that marks the physical and moral condition of a human being. Many who, in their paroxysms, used formerly to wound and lacerate their own persons to a degree that threatened life itself, now habitually exercise an ordinary degree of prudence in avoiding the common causes of annoyance and accident. Not less than one hundred of those brought to the Hospital seemed to regard human beings as their enemies, and their first impulse was to assail them with open or disguised force. Now there are not more than twelve who offer violence. Of forty persons, who formerly divested themselves of clothing, even in the most inclement seasons of the year, only eight do it now. Through all the galleries, there is far less susceptibility to excitement, more quietude, more civility and kindness exercised towards each other. The wailings of the desponding and the ravings of the frantic are dispelled. The internal change is legible upon the countenance. With the insane it is emphatically true, that the dark shadows of the mind are visibly projected upon the face. Hence, from the alteration which has in many instances occurred in the outward aspect, amounting almost to a change in identity, there may be inferred a corresponding alteration of the condition within. The deep lines of anguish have been obliterated or softened, whose sharp engravings were begun, many years ago, in despair. The wide circle and heart-sickening variety of horrors, exhibited by the inmates, when first brought together, as though every region of the “dark immense” of insanity had sent a representative of its terrors, have been greatly reduced in extent, and mitigated in quality. If the erroneous action of the mind has not yet been rectified, the dreadful emotions that once accompanied and aggravated its movements have been dispelled, and they are now succeeded by milder and more peaceful sentiments. Happily, the feelings and emotions may be divested of their pain and terror, even after the intellect has forever lost all power of distinguishing the true from the false in its ideas and perceptions.

The system of treatment from which the foregoing results have been realized, has been a continued endeavor to preserve or re-establish the bodily health of the patients by careful attention to cleanliness, exercise, air, and a suitable diet. It has been the law of all those engaged in administering the daily affairs of the institution, to exclude, as far as in any manner possible, all causes of mental disquietude, by substituting persuasion for force, by practising forbearance, mildness, and all the nameless offices of humanity, and by imbuing in every practicable way, the minds of the patients with a new set of pleasing, cheerful, grateful and benevolent emotions. In fine, the whole scheme of moral treatment is embraced in a single idea — humanity — the law of love — that sympathy which appropriates another’s consciousness of pain, and makes it a personal relief from suffering, whenever another’s sufferings are relieved.

The financial condition of the institution will particularly appear from the Treasurer’s report. The general statements it contains are as follows:

The whole amount of the expenditures, up to November 30th, inclusive, is (This sum includes the cost of a large quantity of fuel, bread stuffs, vegetables, &c. for the present season.)    $12,196.25
The amount actually received for board of patients, &c. up to the same time, $2202.76. Amount of outstanding charges upon the Treasurer’s books,  $7451.28. For a total of $9,654.04

The Trustees deem it their duty fully to communicate certain other facts, intimately connected with the welfare of the institution, and with the benefits which our own citizens have a right to expect from its establishment. The whole number of patients admitted to the Hospital, as before stated, is one hundred and sixty-four. Of this number, according to the best information the Trustees have been able to obtain, thirty-three were foreigners, that is, persons having no legal settlement in this Commonwealth. There is every reason to believe, that this very large proportion of foreigners is owing to a belief prevalent in some parts of the State, that, if a foreigner or State pauper were sent to the Hospital by order of court, the town or city before chargeable with his maintenance, would be no longer liable, but that the expense of supporting all such persons would become a charge upon the funds of the institution, to be ultimately defrayed from the treasury of the Commonwealth. In four instances, certainly, where the former keeper of the insane foreigners or State paupers had been deputed to remove them to the Hospital, he has been asked whether those were the worst cases under his care, and has answered unhesitatingly, (perhaps unreflectingly,) that they were not. Thus our own citizens, whose insanity is more aggravated, and who consequently suffer more, are postponed to foreigners who suffer less, because the authorities of some of our municipal corporations believe that by removing the foreign pauper to the Hospital, they shall be exonerated from the burden of his support. In one instance, by virtue of the law authorizing the commitment of those insane persons “whose going at large would be manifestly dangerous to the good people of the Commonwealth, because they are so furiously mad,” an idiot has been committed, (of course upon the oaths of one or more persons, as to the facts of “furious madness” and “danger,”) who could neither stand nor walk, who was unable to extend the lower limbs from the closest possible contraction towards the body, and who had but little muscular strength even in the arms. It is manifest that the Legislature, in conferring the power of commitment to insure the safety of our citizens, never contemplated its exercise in a case of this kind. Neither the most upright intentions nor the greatest care, on the part of the courts invested with the power of commitment, can furnish an adequate security against these abuses. They must decide according to the evidence adduced. If the municipal authorities choose, for any reason, to remove State paupers or idiots to the Hospital, and can prove the allegations of “furious madness” and “danger,” the courts must decide accordingly. There are at the Hospital at this time twelve idiots, or persons bordering upon idiocy. The great misfortune of this is, that these idiots or imbeciles, of whose recovery there can never be the least gleam of hope, occupy places at the institution which would otherwise be filled by the curably insane. It is most respectfully suggested whether legislative provision should not be made, continuing, under all circumstances, the liability of the town or city to support any pauper after his removal to the Hospital, in the same manner as before; and also authorizing the Trustees to remove to the town or city whence they came, at the expense of said town or city respectively, all idiots or persons whom they may adjudge not dangerous to be at large, and not susceptible of mental improvement by the remedial treatment of the institution, provided such town or city, on being duly notified, shall not take upon themselves the removal of such idiot, or such person adjudged not to be dangerous and not susceptible of mental improvement as aforesaid. Should such provision be made, it would become necessary for the courts, in every case of commitment, to certify the town or city whence the person committed came, that the Trustees might know to whom application should be made for his return, in case the contingency above mentioned should happen. Such enactment would probably remedy the evil of sending foreign paupers and idiots to the Hospital, to the exclusion of our own citizens, and of those who are susceptible of cure. If some provision having this object in view be not adopted, it is obvious that the Hospital will soon become the mere receptacle of foreign paupers, idiots, imbeciles and incurables.

The Hospital is now in a very crowded condition. Originally designed to accommodate one hundred and twenty persons only, its inmates at one time, during the present month, actually exceeded that number ; and more than thirty strenuous applications for admission have been necessarily rejected. The Trustees fully concur in the suggestions made by the Superintendent, that additional accommodations are required partly for the very worst and partly for the best class of patients. Such incurables, as to a certain extent the Hospital must always be burdened with, might receive comfortable attendance and care in apartments entirely separated from the principal building, where their presence sometimes casts a cloud over those who are gradually emerging into the light of reason. A separate edifice for convalescents seems also to be imperiously demanded, where those whose minds are so fully restored as to render further companionship with the insane injurious, but whose recovery is not so fully established as to exclude the hazards of a relapse, might for a few weeks occupy a position upon the confines of society, mid-way, as it were, between the necessary restraints and discipline of a Hospital, and the manifest danger of mingling again suddenly in the sharp encounters of life. Such an addition to the present institution would render a transition from the partial restraints of its confinement to the freedom of the world, gradual, easy and safe; and would afford the mind time and opportunity to fortify and strengthen itself against the recurrence of those cruel mischances to which, even in its day of strength, it had fallen a victim.

As the law now stands, the moment an individual is discharged from the Hospital as cured, the special, parental care of the government over him immediately ceases. He is returned to the world, in which his past misfortune operates rather as repulsion than attraction. This institution was especially designed for the unfortunate poor, and most of those who will enjoy its benefits will be of that description. When a poor man is discharged as cured, he has of course nothing upon which he can subsist for a single day. He may not have either family or friends of ability to relieve him, or if he have, he may be destitute of any means to reach them. Dependent upon his own labor, he may find no employment. Subjected to disappointment and all the harshest ills of poverty, the chances of a relapse are indefinitely increased. But the condition of females is far more deplorable than that of men. How shall a female, who has no family, friends or acquaintance, except in the remotest counties in the State, travel back to the only persons who feel any special interest in her welfare! It is therefore respectfully suggested, whether the Trustees should not be authorized to bestow some small sums of money, in addition to necessary clothing, upon all such as leave the Hospital without any means at their command. Such gifts should be limited, in amount. Below the maximum they may vary according to the exigency of each particular case. And could the friends of the afflicted in different parts of the Commonwealth be persuaded to interest themselves in behalf of those who have been discharged from the Hospital, by procuring for them eligible employments, or favorable situations with benevolent people, where they might enjoy the cheap but invaluable blessing of kind treatment, they would render a most acceptable service in the cause of humanity.

Appended to this report, is one made by Dr. Woodward, the Superintendent of the Hospital. It contains much minute information of a statistical character, relative to the inmates of the establishment. The suggestions of the Superintendent derive great weight from his extensive knowledge and accurate judgment upon the subject of insanity; and the Trustees entertain a firm belief, that the prosperity of the institution, since it was opened, (unanticipated to such an extent even by its most sanguine friends,) is mainly attributable to the skillfulness and wisdom of the treatment, medical and moral, bestowed upon the patients by that able officer.

HORACE MANN,
BEZALEEL TAFT, JR.,
W. B. CALHOUN,
ALFRED DWIGHT FOSTER,
F. C. GRAY,
Trustees.
Worcester, December 3lst, 1833.

Source: Reports And Other Documents Relating To The State Lunatic Hospital At Worcester, Mass. Presented to the Governor by Horace Mann, Bezaleel Taft, Jr., W.B. Calhoun, Alfred Dwight Foster, and F.C. Gray, December 31st, 1833. Disability History Museum, http://www.disabilitymuseum.org/dhm/lib/detail.html?id=1981&page=all

 

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