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the Province-house. This condition was, however, removed; mainly, it would seem, to prevent any odor of pauperism attaching to the establishment. In 1816 the legislature granted authority for the sale of the Province-house estate, on the sole condition that the hospital should give bonds for paying. the actual proceeds of the sale into the State treasury, unless the additional sum of $100,000, for the use of the establishment, should be raised within five years. In 1816 a Resolve was passed that the stone to be used in building the hospital should be hammered and fitted by the convicts in the State prison, free of charge. In 1824 a bill of $4,176.33 was rendered for stonework done at the State prison for the insane asylum at Charlestown (now Somerville), but was remitted by the legislature. Still more valuable privileges were conferred upon the hospital, by Acts of 1814 and 1824, which gave to it all earnings over and above six per cent. of the Massachusetts Hospital Life Insurance Company. Thus it appears that the State was an early friend of the hospital; and still exercises her prerogative as guardian, especially of the insane, by the appointment of trustees.

The benefits of this establishment, however, were confined necessarily to a small circle of lunatics, and did not ameliorate the condition of the insane as a class throughout the Commonwealth. There were no free beds in the asylum, and the cost to boarders was too high for the indigent. Its benefits were mainly confined to the wealthy and their friends; and were hardly felt beyond Boston and its neighborhood.

Throughout the Commonwealth it was common to find lunatics confined in cages, in attics, in cellars or out houses.

Being objects of terror, they were often chained and left, in their wretched isolation, to suffer from neglect and hunger and filth; and, in some cases, to perish by cold.

Such scenes of wretchedness and misery as Miss Dix* has so

In January, 1843, she memorialized our legislature, and said (among other things), "I come as the advocate of helpless, forgotten, insane and idiotic men and women; of beings sunk to a condition from which the most unconcerned would start with horror; of beings wretched in our prisons, and more wretched in our almshouses.

"I call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods and lashed into obedience."-Memorial, 1843, p. 4.

EIGHTH ANNUAL REPORT, 1871.

long been engaged in showing up in other States and countries, once abounded within our borders also.

About forty years ago Horace Mann, and a few like him, made a strong appeal to the hearts and consciences of our people; who answered promptly through the legislature by providing means for hospital treatment ample enough for all whom it was supposed would need it.

The discussion of the matter by wise and liberal men resulted in the conclusion, that establishments for the care and cure of lunatics could be more properly and more effectually provided by the State than by individuals, or corporations, or towns; since they must have custodial powers, and yet present no temptation to retain persons for improper purposes. Moreover, the State seemed specially called upon by self-interest, as well as by duty, to undertake it and do it thoroughly.

The common weal, the well-being of the State, depends upon the welfare of individuals. The possession of reason is essential to industrial productiveness, to self-support and selfguidance, to citizenship indeed.

Deprived of reason the individual becomes not only unproductive, but a burdensome, costly, sometimes a dangerous consumer. He becomes a ward, and the State has the responsibility for his guardianship.

The fewer lunatics, and the shorter the duration of their lunacy, the better for the Commonwealth.

The leading idea was, not that the State should provide for its own pauper lunatics only, but for the insane, of whatever class, belonging to Massachusetts.

The hospital was also to be an asylum. It was to be remedial and custodial. It was to have charge of lunatics and of idiots.

Under this general idea a hospital was built at Worcester in 1832. It was soon filled to overflowing, so that many patients who had been sent thither from towns and cities had, after a few years, to be sent back again.

This was done under authority granted by the legislature to the trustees, to remove to jails and houses of correction as many patients as might be necessary to prevent undue crowding of the hospital; subject to the condition, however, that they should

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select (other circumstances being equal) "foreigners before citizens, among citizens those who are least susceptible of improvement." So many were sent to Boston that the city built a hospital within her own limits in 1839. This met the requirements of the law for a county receptacle. At first it afforded shelter to lunatics but little better than they had had in the cages and cells of the houses of correction and industry. But it was gradually improved, and furnished with the best means for treating lunacy, though its building and ground were unsuitable.

But still the demand for more accommodations increased so rapidly that the State was obliged to build a second hospital, at Taunton in 1854.

This only gave temporary relief; and in about four years a new establishment of the first order was built at Northampton.

Even these three large hospitals, with the McLean Asylum and the Hospital of the city of Boston, would not have prevented the urgent necessity for a fourth State hospital, if the existing ones had not been relieved of the pressure upon them by the erection of a State receptacle, for a certain class of pauper lunatics, at Tewksbury.

This constantly increasing demand for more hospital accommodations did not necessarily indicate an increase of the number of lunatics, as compared with the general increase of the population, but rather that people had become aware of the advantages of hospital treatment, and brought their lunatics to be healed or cared for. This appeared more strongly from the fact that the number of patients from any given population was always greatest from the area of country adjacent to the hospitals. Ten thousand people living within an area of ten miles around a State hospital, sent many more patients than ten thousand living in an area between ten and twenty miles distant.

During this period, when the demand for hospital accommodations greatly exceeded the supply, several establishments for treating the insane were started by individuals with a view to profit; but the public hospitals were so good, and so cheap, that they prevented competition, and no private mad-house now exists in the Commonwealth.

EIGHTH ANNUAL REPORT, 1871.

So great has been the change and improvement within the last half century, that, whereas at the beginning of it there were no suitable accommodations even for the rich who should become insane, now not even paupers need lack them.

There is wanting only a little legislation to provide sufficient inspection and protection of those unfortunates who are unable to guide and protect themselves, and who revert from the condition of citizens to that of wards of the Commonwealth.

Before proceeding to notice the several hospitals, let us glance at the number and condition of the class whence they draw their patients, especially of that division of it which has heretofore been little noticed in the reports of this Board; viz., idiots.

Present condition of these classes.

The number of persons in Massachusetts beyond the age of childhood, set down as lacking the degree of reason necessary for self-guidance, is 4,000 approximately.

They may be considered as two classes. First, those who never possessed reason, and who are called idiots. Second, those who have been bereft of reason, and are called insane or lunatics.

There is no social or legal difference between these persons and others until they pass the age, fixed by law, at which parental authority and responsibility cease and individuals independence commences. It then becomes manifest that they are incapable of self-guidance and support; and, as the law does not provide for continuance of parental or other control, they necessarily become wards of the Commonwealth.

The State asserts her right and duty of guardian on the statute books; but seldom exerts it except in cases where the lunatic or idiot is heir to property which is considerable in amount, or in the shape of real estate, when she interferes through the judges of probate, and appoints her representative guardian.

She shows less vigilance in the exercise of her guardianship than in some other countries,-England, for instance,―where the commissioners in lunacy take cognizance of the condition

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of all idiots and lunatics. This Board has two duties towards both classes-one, direct; the other, indirect.

It is the direct duty of the Board,

First. To remove from the State all who do not properly belong in it, provided those who are properly responsible for their maintenance are willing to assume it, or can be made to do so.

Second. To see that those belonging within the Commonwealth, and rightfully chargeable to towns or individuable shall be removed forever from the list of those chargeable to the State.

Third. To transfer idiots and lunatics from one State establishment to another, when it is desirable to do so.

The indirect duty of the Board is,

First. To see that persons recently deprived of reason and all who require remedial treatment of a hospital shall have it. Second. To take note of the condition of the public institutions for the care and treatment of these classes, and recommend to the legislature such changes as may seem necessary. To do this understandingly a few explanatory remarks are necessary.

Idiots, Imbeciles, Undeveloped Persons.

Two apparent facts are noticeable in regard to both classes, -idiots and lunatics.

First. They increase in numbers; and the rate of increase is greater than that of the general population.

This comparative increase is mainly, if not entirely, among those of foreign birth.

Second. The opposite is true of those chargeable to the State; that is, State pauper idiots and lunatics: they decrease theirs not only relatively to the general population, but relatively to own numbers in former years.

This is owing to changes in the laws of settlement; and to the activity of the General Agent of this Board. Part of his duty is, first, to deport foreign idiots and lunatics found within our borders. These, of course, disappear entirely from the general list. Second, to require that towns and individuals properly responsible for idiots or lunatics found in the State institutions,