PART IV.]

SECRETARY'S REPORT.

[CHAP. I.

department from which they came, or to their families on account of their support. Government wisely regulates all this with a view to encourage occupation."

Of one of our greatest needs-a systematic arrangement and control which puts every one to some useful labor-he continues::

"Our system finds its weakness mainly in the meagre advantage we have at our command to classify, employ and occupy the minds and the bodies of our patients. It overlooks, to a great extent, the important fact that inactivity is not compatible with bodily vigor, and that exercise of all the faculties, bodily and mental, is the best method of preserving health, as well as regaining it when lost."

As the labor of insane patients is now almost compulsory, Dr. Bemis suggests a fair remuneration as a stimulant to those disposed to labor, the wages to be kept for their benefit by the Treasurers of the Hospitals, provided proper accommodations can be had for the successful operation of such a system. An illustration of what might result therefrom is found in facts already cited, and also in English usage, under which an extra allowance of some luxury has had powerful effect in producing not only quiet and good conduct, but in promoting habits of industry. As elsewhere, under the influence of such motives, many patients in our Hospitals, who would otherwise be idle and restless, perhaps noisy and destructive, would engage eagerly in useful labor. The suggestion is certainly worthy of consideration.

General Remarks.

In addition to the usual exercises of manual, intellectual and recreative occupation at the Hospitals, daily religious services have been as heretofore observed at each, and with good results. At Northampton, religious exercises, lectures, reading, musical and social entertainments, and recreation and amusement, in their diversified forms, have interested and benefited a larger average number of inmates than in preceding years. Of the importance and value of Sabbath services in the Lunatic Hospitals, Dr. Earle says:

OCCUPATION CONTINUed.

"The experience of another year has in no wise diminished my opinion of the utility of these assemblies, but, on the contrary, has confirmed it; and it may not be improper here to repeat what was expressed last year, that, were the design of a hospital of this kind committed to me, the chapel would be made to seat as many persons as the house would accommodate of patients."

In his comments on the moral treatment of insanity, Dr. Earle mentions one or two points not often alluded to. He remarks:

"The first is the practice, very general among the people at large, and, it is to be feared, only too common in hospitals, of pretending to believe, and even encouraging, the delusions of the insane. It is a false method, and injurious as it is false. Like falsehood in all its forms, it works to evil ends. No honest, true and faithful minister to a mind diseased' will ever yield assent to the delusive ideas and notions of his patient. Much less will he openly express his belief that they are true, and treat his patient as if they were so."

The injurious results of such a practice are illustrated in the perpetuation of the patient's delusion, which is confirmed, not by his own convictions alone, but by what he believes to be the convictions of those who assent to his delusive ideas.

The other point, which is closely allied to the one already mentioned, though not identical with it, is the propriety of conversing with the insane upon the subject of their mental disorder. Upon this topic, he says:

"When accompanying Dr. Damerow, 'Director' of the large hospital at Halle, in Prussia, through that establishment, I was surprised at the freedom with which he talked to his patients in regard to their insanity. The example has not been forgotten, and since that time I have pursued the practice to a much greater extent than before. If properly approached, a considerable number will enter into conversation upon the subject, and apparently, in some instances, with restorative benefit." * "At any rate, it must be clear to every one, that appropriate argument against delusion, and the knowledge on the part of the patient that no one but himself believes the delusion, must, in many cases, eventually have a very different effect from assent to the delusion and encouragement of it by others."

PART IV.]

SECRETARY'S REPORT.

[CHAP. I.

II. THE STATE PAUPER ESTABLISHMENTS.

The Rainsford Island Hospital.

No change has taken place in the condition of this Institution or its property, since the last Annual Report, no occasion having arisen for its occupancy for hospital purposes. None of the buildings have been occupied, except the small cottage in which the Keeper and his family reside; and as all the public property now upon the Island is faithfully cared for by him, and in good preservation, a re-valuation has been deemed unnecessary, the only addition thereto during the year being a small boat purchased for his use. The expenses for the year ending September 30, 1868, were $2,232.75, viz.: salary of the Keeper, $1,000; compensation of three Inspectors, $450; contingent expenses, including boat, wharfage, repairs, etc., $782.75. The appropriation for the present calendar year is $3,000, nearly or quite one-third of which will remain unexpended. Should the Hospital continue unoccupied, no material increase of expenditure will be required, although the unexpended balance of the present appropriation might be judiciously used in repainting the buildings, in order to insure their better preservation.

The Tewksbury State Almshouse.

Buildings and Grounds.

This Institution, which receives the greater proportion of the State poor, and which, as the Inspectors say, "is really the poor-house of the Commonwealth," has been materially improved during the past year, by the enlargement of its facilities for heating and other purposes, and by the partial remodelling of some of its interior arrangements, so as to secure new and desirable accommodations not hitherto enjoyed. The Farm has also been enlarged by the addition of ninety acres of land, which, with the construction of a reservoir and the completion of the plan for protecting the premises against fire, will furnish, as the Superintendent believes, wholesome employment for all the men likely to have a residence there for several years to

come.

LUNATICS AT TEWKSBURY.

The necessity for a more capacious and suitable building for hospital purposes, further removed from the main structure, and the want of additional barn room, are urged by the Superintendent and Inspectors. It is evident that the first, at least, is much needed. Mr. Marsh thinks that hospital accommodations for two hundred persons are wanted, and wisely valuing utility rather than ornament, he suggests, as a practical and economical plan, the erection of two buildings after the manner of the army hospitals recently used by the United States, one story high, of simple construction, with a small, separate building for cooking and dispensary purposes. The Inspectors add the following testimony:

"The buildings we now have for hospitals are better than none; but are too small, and in many other ways unsuitable. Not more than fifty cases can be properly cared for in these buildings. We believe the sick who are dying for days and weeks from loathsome diseases, should be removed from the rooms occupied by the old and feeble, and those comparatively well. Separate rooms should be provided for the dying, so that, when dead, they may be properly laid out and prepared for interment, without being witnessed by all in the room. We do not think the feeble and sick should be obliged to witness such scenes; but, as now situated, it cannot be avoided. The mortality has been greater this year than last,-the number of deaths being two hundred and seventy-eight."

The Lunatic Department.

There has been a small increase in the number of insane patients at Tewksbury, 267 remaining in the Institution at the close of the year, against 251 the previous year. A large proportion of the inmates of the Asylum are middle-aged; and Dr. Nichols, the Resident Physician, who was transferred from the Monson Almshouse in April, speaks thus of their condition. and treatment:

"The system of employing the insane in various kinds of labor, on the farm and about the house, so happily inaugurated last year, has been continued through the year just now closed with the same happy results.

PART IV.]

SECRETARY'S REPORT.

[CHAP. I.

"I asked Dr. Draper, the physician at the Worcester Hospital for the Insane, who visited us last June, how the physical condition of his former patients compared at that time with what it was when they left Worcester, and he promptly replied, improved in almost every instance. We have likewise similar testimony from three of the officers of this house who were for several years attendants, one at the Worcester and the other two at the Taunton Hospital for the insane. They declare that they consider the physical condition of those patients who have been removed from the Taunton and Worcester hospitals as having been improved from what it was when they knew them in their respective hospitals."

Referring to the same topic, Mr. Marsh says:

"Another year's experience has fully justified the views expressed in my Report of last year concerning the insane transferred to this institution, as harmless and incurable, regarding both the individual and the Commonwealth. Indeed, so apparent has been the improved condition of those who have performed manual labor, especially upon the farm, that the friends of those who have been too feeble to be thus employed, when visiting them, have frequently solicited as a favor that their friends, too, might be permitted to labor upon the farm."

General Statistics for the Year.

These are shown in the printed Report of the Institution, as follows:

TEWKSBURY ASYLUM.

Remaining in this department September 30, 1867, .

* Reported by the Institution last year as 248.