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          REPORT OF  A COMMITTEE
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IN RELATION TO THE CONDITION
LUNATIC  HOSPITAL,
MADE MAY 23, 1862.
            BOSTON:

J. E. FARWELL & COMPANY, PRINTERS TO THE CITY,

          NO. 32 COKGRESS STREET.

             1 8.6 2 .
t 
MAY 4  My 
REPORT ON  LUNATIC  HOSPITAL.
              Board of Directors for Public Institutions, )
                              Boston, May 23, 1862.  >

  The Committee  appointed to consider the subject
of dining and reception rooms, and further bathing ac-
commodations at the Lunatic Hospital, submit the fol-
lowing

                   REPORT.

  They have thoroughly considered the matters refer-
red to them, and find that the necessary conveniences
cannot be arranged for want of room.  The result of
their  examination  of the premises has satisfied them
that another and more important  subject demands at-
tention.  They find that the  capacity of the Hospital
and grounds is totally inadequate for the present num-
ber of inmates.   The building is improperly crowded,
and so badly constructed and ventilated  that its ben-
eficial purposes  are in a great measure  defeated for
want  of conveniences such as insane patients require.
Additional room  is imperatively necessary for at  least
fifty inmates.  Common humanity  demands it.   With
accommodations  intended for only one hundred, there
are now nearly double that number.  The city charges
alone  are upwards  of one hundred  and twenty, or two 
4
 thirds  of the  whole, and are constantly increasing in
 numbers.  If  we provide only for this  class,  the ne-
 cessity for more  room  will still  exist.
   The  people  of  Boston have just reason  to be
 proud  of the public and private  charities  of the  city.
 Blest as  a wealthy, thriving,  and prosperous commu-
 nity, their liberality in  good works knows  no bounds.
 Whenever suffering humanity appeals for  aid  it finds
 ready  and generous sympathy.   The Massachusetts
 Hospital  and  the McLean Asylum, both  richly  en-
 dowed, and constantly  receiving  assistance from  the
 wealthy,  contribute  largely to relieve those able to
 avail themselves  of the advantages they  offer.   As
 far as  possible they also aid  to  alleviate the distress
 of those  unable to pay for treatment.  Extended as
 their conveniences  are, however, they are not equal
 to the  increasing demands  of a fast-growing commu-
 nity.
   With all  her  existing charities,  the  City is  con-
 stantly providing others.  The authorities have  taken
 the initiative  for  the establishment  of  a  Free City
 Hospital.   It is intended for the indigent, and also, at
 moderate  charge,  for persons  of  limited means, to a
 whom the expense  of  medical or surgical treatment
 at home is more  than they can bear.  The premises
 will  consist of costly structures, which are to be fur-
 nished with all  the  modern appliances that  skill and
 experience  can suggest.  A  square of some  seven
acres  of valuable  city land  has been dedicated  to  the
purpose ;  the foundations for the buildings laid, and
the walls  in rapid  course  of erection.  By another 
0
year the  whole will be  completed  and the  institu-
tion a  permanence.
  Important as medical  hospitals are, they dwindle
into insignificance when  compared with  the necessi-
ties  for hospitals for mental  disease.  Insanity is no
respector  of persons.  The rich  are  no more exempt
from its attacks than the  poor.   The histories of  asy-
lums record the wreck of many a brilliant intellect.
Few persons, not connected  with an  institution for
the insane,  have any idea  of the extent of this sub-
tle and fearful malady.  All know something  of phys-
ical  suffering, for that can  be  treated at home, while
mental ills  can be cared for only at an  asylum. How
important, then, that all in our power should  be done
for those thus afflicted.  The sufferer  may be the wife,
the child, the parent, or the brother or sister of either
of us.   With a suitable hospital  and  proper treatment
much  of misery may be  alleviated and many a mind,
and  even life, saved, that would  otherwise  be lost.
  Lunatic asylums are not prisons, nor their inmates
convicts or  criminals.  They are places of refuge for
the afflicted where they can receive the care and treat-
ment necessary for  their  relief.   Many places make
liberal  provision for such, but Boston is  remiss  and
backward.  The Boston  Hospital is  not sufficient for
its purpose, nor equal  to  the  demands  upon it.  It is
a city  institution,  and should  be one  in which  the
citizens might feel commendable  pride.  The tax pay-
ers have a right to  demand that it should be fully up
to the  times in  all proper  conveniences.   They con-
tribute  to its support, and it should be an  institution
of such capacity  as  to afford them  the  opportunity, 
                                                 \

when unfortunately necessary, to  avail themselves of
its advantages  at  a  moderate  charge.   They  should
not be compelled  to carry their friends to private es-
tablishments, less accessible, and at a much larger  cost
for board.  As  the Hospital now is they cannot be so
accommodated.   Almost  daily applications for  admis-
sion are refused for want of room  and proper conven-
iences.
  The original buildings  were erected twenty-three
years  ago, for a county receptacle.  At that  time  the
mode  of treatment of the insane   was very different
from  that of the present day.  In but few  hospitals
were any scientific efforts made for radical cure.  The
patients were generally  supposed   to be  beyond  the
chance of improvement.  If an insane person was sent
to one of them, it was with a view that he might be
restrained from injuring himself or others.  The cus-
tody,  rather than the cure, was the main object.
  In but few instances were the conveniences of home
ever  thought advisable in  a  hospital.   Strong  rooms
were  deemed a necessity,  and many  an  unfortunate
passed years  of his life in cells with iron grated doors
and windows.  This course of treatment had  a ten-
dency to  increase rather than  diminish the excitement
of the patient,  and consequently instead of his condi-
tion improving he grew  hopelessly worse.   Many of
our citizens  remember  the  " Cottage," with its block
of cells and its score of violent, naked, and  filthy in-
mates, for whom  it  was thought  no more could be
done.   Such  cells  and such patients were not uncom-
mon.   Every  hospital had them.   Fortunately  this
state  of things has  now passed  away.  It is  a  fact 
7
 worthy of mention that the abrogation  of " cells " in
 Massachusetts  institutions foist began  at  the  Boston
 Hospital, and it  is due  to Dr. Walker to say that he
 inaugurated the reform.   For a long time many super-
 intendents supposed  that  " strong rooms " could not
 be dispensed with, and  as late as the  erection of the
 Taunton Hospital a block of  them was built as a sup-
 posed necessity.  Through the exertions of one of the
 Trustees, who was  formerly a Director of the  Boston
 Hospital, and had witnessed the success of Dr. Walk-
 er's experiment,  their use was abandoned, and  subse-
 quently they were torn down.
   Dr. Walker's theory proved right, but it took time
 to demonstrate it.  Kindness,  confidence, and patience
 effected wonders.  One  after  another  the  " Cottage "
 patients were  transferred to the halls and  to compan-
 ionship with the other inmates.   Its good effect was
 soon visible.   Desperation and despondency gave way
 to self-respect  and hope, and  even the  " mad  man "
 was at times ashamed to render himself ridiculous in
 the eyes  of his fellows.  A desire to appear less crazy
 than their associates began to  possess them.  Return-
 ing reason began to  develop  in  many, and, aided by
 the skill  of the attentive Superintendent, sound minds
 were  restored  to some, who,  when confined  in the
 " cells," were said to  be incurable.  Now such things
 as  " cells " and  " strong  rooms "  are not  known in
 any hospital  of character or importance.
   Humanity, in this branch of medical  skill, may be
 said to be now in the  ascendent.   Men of  science are
making insanity a study.  The people  have begun to
learn that the mind once thrown from  its balance can 
  be restored.   To accomplish this the sufferer must be
  removed from  the  exciting causes of his injury.  He
  must have quiet and regularity in his habits.  He must
  be clear from the chance of unnatural stimulants, both
  physical and  mental.   He must have  unceasing care
  and attention.  This he  cannot secure at home, but
  only in an asylum.  There he  must receive kindness,
  and as far as  possible  every comfort, for  experience
'  has clearly demonstrated  that the nearer the hospital
  assimilates to  the  conveniences of home,  so, just in
  proportion, is the chance of  cure rendered more pos-
  sible.
    The city institution  does  not meet these  require-
 ments.  Its present capacity is not capable of furnish-
 ing the proper accommodations.  It was up to the times
 when built, but is behind the  necessities of the present
 day.  Amongst other matters requisite to make a per-
 fect hospital,  according to recommendations adopted at
 a Convention of Superintendents of American Lunatic
 Asylums, and approved by all  who have given attention
 to  the subject, it is stated that, —
   " Every  hospital having provision for two hundred
 or  more patients, should have in it at least eight dis-
 tinct wards for each sex, making sixteen classes in the
 entire establishment."   Our hospital has but six wards
 in all, being three for each sex, and perfect classifica-
 tion is not  possible.
    ' Each ward should  have in it a parlor, a dining-
 room,  a dumb-waiter, a bath-room, &c."  Ours  have
 neither.  What were  originally intended for parlors
 are  necessarily used for congregate  sleeping-rooms.
Separate ward  dining-rooms we  have none, but as far 
9
as the capacity of the general dining-rooms will admit,
the patients are compelled to take their meals together,
be they the convalescents, the demented, or the violent.
There  is but one bath-tub to each wing, and the want
of room prevents the introduction of more.  To these
the inmates of the three wards must resort for their
baths.   As  many of them need  bathing every day,
and as statute law requires that all must  have  a bath
once  a week, the  inconvenience is  manifest without
further comment.
  " No ceiling of any story occupied by patients should
be less than twelve feet in height."  Instead of meeting
this requirement we have no room where  the height is
greater than nine feet and ten inches, and some are as
low as nine  feet.   Proper ventilation in them  is not
possible.
  " The main building should  contain receiving-rooms
for company."  Ours has no reception-rooms whatever.
The  only apartments available for  visitors to the pa-
tients are the dining-rooms, and these can only be used
the short time between the preparation for meals.  As
their capacity is very limited, visitors  are  compelled to
be in such proximity to each other that  conversation
with their friends  upon family or private matters  is
next  to  impossible.   Convalescents and incurables,
whether boarders or city charges, are all assembled to-
gether, for there is no opportunity to classify or accom-
modate them otherwise.  The chapel also is inconven-
ient  and insufficient.  With a chaplain regularly en-
gaged  to perform services  on each Sabbath, the room
in which they are holden is not large enough to accom-
modate all who wish to attend.
                2 
10
   Thus much of the wants of the Hospital in its bear-
 ing upon humane  considerations.  We  come  now to
 consider them in  a financial view.  In  doing so we
 start upon a basis of facts  established by the experi-
 ence of last year.
   The entire expenses of  the Hospital for  1861  for
 178  inmates  were  $ 23,830.24, being  $ 133.871- per
 year, or $ 2.57J per week for each patient.
   The average cost of the material of meals was 66t2<j
 cents per week, or  $ 34.42 per year, and of medicines
 $3,161 per year, making a total annual cost of $37.58!
 per annum for each inmate.
   Of the whole number of inmates 58 were boarders.
 If we deduct $2,179.93, which was the cost of their sup-
 port, from the total expenses, it will leave $21,650.31,
 as the cost of the City charges, being $180.42 per year,
 or $ 3.47 per week  for each.
   If now we  deduct from the whole expenses the sum
 received for  boarders, which was  $8,578.00, it will
 show the net expenses  of the institution for  the year
 to have  been $ 15,252.24, being $ 85.69 per year, or
 $ 1.64T8(7 per week for each patient.
   The cost for one hundred additional boarders would
 be only, —

 Materials for meals and medicines, at $ 37.58J .    .   ' $ 3,758  50
 Three male attendants, at $ 18 per month  .    .    .     648  00
 Three female attendants, at $ 14 per month   .   .   .    504  00
 Cost of board for six attendants, at $ 2 per week  .    .      624  00
Interest on improvement, say ....          3 qqq aq
Extra fuel, lights, &c, say.....      5qq Aq
Making $ 90.34 per annum, or $ 1.73| per week, for each. 
11
  Adding the cost  for the 100 additional to the  ex-
penses of last year, which were $23,830.24, and  the
support of 278  inmates  is shown to be $32,864.74,
being $118.42 per year, or $2.27 per week for each.
  If now we deduct from the whole expenses the sum
of $ 24,178.00 which would be received from boarders,
estimating upon the increased  accommodations being
occupied by them, and  at  only $3.00 per  week, it
will leave the total net  cost  of the  institution for the
year at $8,686.74.   Dividing  this  sum by  120,  the
number of  " City charges,"  and it gives  $ 72.59  per
year, or $ 1.39 per week as the net cost of support of
insane city paupers.
  With  improved  accommodations, it is believed, a
higher paying  class of  patients would be received in
sufficient numbers  to render the  institution  self-sup-
porting.
  In view of the foregoing facts and suggestions, the
Committee  submit  that judicious  economy,  throwing
aside  all  considerations of  humanity,  demands  that
additional accommodations  for at  least  one hundred
patients  should  be provided.   To meet this  exigency
it was  thought that improvements  might  be made in
the old buildings, and new wings erected that would
furnish the  necessary conveniences,  and  also render
the Hospital  comparable in a measure with similar
institutions  elsewhere.   To that end  the  Committee
directed  the preparation  of  plans for two wings, to
run northerly from the present wings.   When  these
were  completed it was found that a greater  space of
land would  be  required to carry out the contemplated
improvement. 
12
  Can the necessary quantity be obtained  upon the
present location X  On the easterly side, the grounds  of
the House of Correction are within twenty feet of the
Hospital.   There is not room for a wing there with-
out the annexation  of a strip  of  land from the former
establishment.  On the westerly side it is still worse.  M
street as  laid out, but not  opened, runs within about
twelve feet of the end  of the  building.  To place  a
wing there would encroach upon  it.   There seems to
be no valid reason why it may not be discontinued, and
the Board of Aldermen  have  been petitioned  to that
effect.  Even with  that  accomplished,  there will yet
be a lack  of extent  of premises.  The whole quantity
of our grounds is a little over four acres.  An  institu-
tion to accommodate three hundred patients  should
not have  less than twenty acres.  More would  be bet-
ter, for there cannot be too much.
  The inmates  of a lunatic asylum require out-of-door
exercise.  They should be in the open air as much as
possible.    The  limits afforded them  should be ren-
dered inviting  by abundance of pleasant walks, orna-
mented with attractive  shrubbery and  flowers.  The
beauties  of nature  go further toward calling back
reason to the  beclouded  mind  than   any  other  ap-
pliance.
  The adjoining estate westerly is that formerly occu-
pied for the Alms House department, and was  sold in
1857 to Harrison Loring, Esq.  It is greatly to be re-
gretted that the city authorities, instead of disposing
of it, did not connect it with  the Hospital  premises.
Had they realized  the  importance  and  necessity  of
extensive grounds  for  such an  institution, they  un- 
13
doubtedly would have done so.   The idea of the Hos-
pital being hemmed in so closely, and particularly with
business pursuits,  evidently occurred to them when
they negotiated the sale.  One of the conditions of the
bond for a deed, and which is to go  into every  convey-
ance, provides  that, " In case it shall appear to the
satisfaction of the Board of Directors, or  a majority of
the same, that the patients in the Lunatic Hospital shall
be  injuriously affected  by  the noise, or from other
causes  growing out of the business operations on the
said lands, then the said sale shall  be  void;  and the
city shall take  possession of the  same, giving the par-
ties interested six months notice of such intention."
   It is  the duty of the Board to study the interests of
the institution, and the welfare of the inmates.  While
the city should protect itself in all its rights in the
premises, care should be taken  not to injure those of
others.
   A portion of the premises might perhaps be  secured
without recourse to the bond ; but the question  natu-
rally arises whether it would be more than a tempo-
rary relief, and whether it would  be advisable, with
only such advantages,  to  incur the expense of any
extended improvements.  To make the best use of the
present lands, and such additions as  might be acquired,
and the  improvement of the old buildings  with  new
extensions, would  not upon the whole render the in-
stitution what  it should be.  The old building cannot
be suitably modernized, and any attempt to  make  the
new part conform to it, would render the latter much
less suitable  than it  should be.   It would require a
large outlay to complete the improvements, and when 
14
 finished the Hospital would be, at best, but a patched
 up concern.  It would fail to meet the requirements
 of its purpose, and would be unworthy of the enlight-
 ened intelligence and liberality of our citizens.
   As anything  done now should  be with a  view to a
 permanency of, it may be, a  half  a century  or  more, >
 the Committee may well  hesitate in recommending im-
 provements at the present location.   The city is but as
 a giant in its infancy.   The next decade, should  our
 national  troubles be happily settled, will be likely to
 double its population, and will roll up  its  numbers
 with accelerated speed in succeeding years.  With the
 proportion of the business of the great  teeming West,
 which, for the  want of seaports elsewhere to accom-
 modate the trade, must come here,  nothing  can stop
 her progress in commercial importance.  It cannot be
 many years before the entire water front of that section
 may be required for shipping, and  perhaps  converted
 into a dock with a basin  and wharves.
   With this change would come  the necessary  store-
 houses and work-shops, and sooner or later, it may be
 in five or ten years, the' institution would  be found
 almost surrounded by  an  active  business  community.
 As a lunatic asylum should always be situated so that
 the patients may be free  from the  chance of  any kind
 of annoyance or excitement from outside, it will  read-
ily  be  seen how improper the present site would be
under such circumstances as we have suggested.
   The more the Committee examine the subject  the
more they are embarrassed by its  magnitude and  im-
portance, and the difficulties attending it.  That some-
thing must be done is apparent to all who have  given 
15
the matter any attention.  The want of more  accom-
modations is pressing now and daily augmenting.  The .
excitements  consequent upon  the  present war  will,
when peace  is restored, tend largely to  increase the
de^Cjf
   It is for the City Council to say what shall be done,
and not for this Board to dictate.  It may not  be im-
proper, however, to suggest the  consideration whether
good economy and a regard for the future does not
commend a removal and the erection of suitable build-
ings elsewhere.
                MOSES KIMBALL,
                JUSTIN JONES,
                J. P. BRADLEE,
                JONAS FITCH, 
If