Insanity In Massachusetts
110 Art. IX.?
The reports of the Massachusetts hospitals and asylums for the insane are never all made at one time, and some may be said never to report at all except in an imperfect way, through the board of state charities, whose annual report contains a summary view of all the establishments, other than private families, where the insane are treated or simply lodged and fed. There are eleven such establishments, besides about 100 town almshouses in which one or more insane persons are maintained. These are the Northampton hospital, which had 446 patients on New-Year’s day ; the Worcester hospital, which in its two branches, the new and the old hospital, had 855 patients?457 in the ne’w stone hospital and 398 in the old brick one, now called an ” asylum for the chronic insane the Taunton hospital, with 575 patients; the new Danvers hospital, with none at all as yet; the South Boston city hospital, with about 200 patients ; the Te’wksbury pauper asylum, with 283; the McLean asylum for private patients at Somerville, with 175 patients; the Ipswich county receptacle for pauper lunatics, with 70 patients, and three small private hospitals at Northampton and Worcester, with about 30 patients. In these eleven establishments, there- fore there are at this moment about 2600 inmates or patients, while in the Bridgewater state workhouse there are some 30 insane persons, and in the care of the town and city overseers of the poor chiefly in almshouses, about 500 more; making in the whole state, under the care of public officers, or subject to their visitation not less than 3,130 insane persons January 1, 1878. On the 1st of October 1877 there were but 3050, and the average number for the year preceding that date was but little more’than ^900. Of the 3050 thus publicly supported on the 1st of October”about 770 were state paupers, about 1785 were city and town ^npers, and 495 were private patients, supported by their own means or by their friends Of the 3130> now supported, it is probable that 780 are the State s poor, 1840 are the town s poor and 510 are private patients. By this calculation more than tive-sixths of all the insane in these establishments are paupers, and the proportion is increasing; 2620 pauper lunatics, and only 510 who were not paupers, shows a very great disproportion ; amonc the admissions of the year, however, the number of self- supporting patients is a little greater-namely, 248 out of 1510. Of these 1510 admitted during the year, 571 were classified when admitted as state paupers, and 491 as town paupers.
Bub so many ” town settlements ” were afterwards found, that probably tlie number of town and city poor among these admissions was at least equal to the number of the state poor. The whole number of different patients during the year was at Worcester 821, at Taunton 1*200, at Northampton 594, at Tewksbury 338, and at Somerville 271?at all the ten establish- ments that received patients, 3501 persons, who represented 3G88 cases of insanity. Among these 3501 persons there were 280 deaths and 283 recoveries. The whole number of deaths at Northampton was 42, at Worcester 69, at Taunton 105, at Tewksbury 20, at South Boston 18, at Somerville 15, at Ipswich 7?jn an 280 deaths. The death rate at Northampton is about 6^ per cent., on the whole number of patients 8?, and on the average number (476); at Worcester the rate is 8*4 per cent, on the whole number and 13*6 per cent, on the average number (506^); at Taunton the rate is 8J per cent, on the whole number and 14-4 per cent, on the average number (727); at Tewksbury, which used to have the highest death-rate, there is this year the lowest, 5*9 per cent, on the whole number and only 6*8 per cent, on the average number (292). So much for the ” demoralising effects of legislative investigation” on a high death rate among the chronic insane. The whole death rate on the whole number wras 8 per cent., on the average number lli per cent.
The recoveries do not much exceed the deaths anywhere, and at some establishments fall far below them. At Worcester there were 72 recoveries, 69 deaths; at Taunton 126 recoveries, 105 deaths; at Northampton 32 recoveries, 42 deaths; at Tewksbury no reported recoveries and 20 deaths. Dr Earle, in his very able report?by far the best of all that we have seen this year?pursues his discussion of the curability of the insane and comes to the same conclusion with Dr Thurnam, the English expert, who said, after tracing out the history of 244 patients of his : ” Of ten persons attacked by insanity, five recover and five die, sooner or later, during the attack. Of the five who recover, not more than two remain well during the rest of their lives ; the other three sustain subsequent attacks, during which at least two of them die.’’ Uius seven of the ten die insane, and only three permanently recover,?say 30 per cent, of all the eases treated. This, Dr Earle thinks, will be the result even though we ” should build as a hospital for the insane a temple as costly as that of Solomon, or a tower like that of the plain of Shinar upon the highest hill-top of every county in the land.” This is a shrewd gibe at the new temple and tower for lunatics in Essex county, the ” final report” of whose building commissioners comes to us with the other reports. Ah, if it only were the final report! But besides the #1,500,000 already spent at Danvers, or pledged for spending, and besides the #150,000 that will have been paid for interest on the cost before a single patient is admitted there, the state will have to pay at least #150,000 to put the Danvers hospital in anything like a state of satisfactory completion. The interest charge alone on the cost of two new palaces, at Danvers and Worcester, will be about #156,000 a year, or #3,000 a week?enough to board 800 or 1000 insane persons.
Apart from the interest charge?which, upon all the build- ings used for the insane in Massachusetts, must be more than #250,000 a year?the direct cost of supporting the 4025 insane persons above mentioned was not less, in 1877, than #450,000, and may have been #500,000. Of this the state paid about #140,000, the cities and towns more than #250,000, and private individuals the remainder?say #100,000. This burden yearly increases, and is now one of the most serious component parts of the whole public outlay for paupers and poor relief in Massa- chusetts, which may be estimated for 1877 at something more than #1,650,000. Next spring, when the Danvers hospital shall be opened, not less than #50,000 will be added to this yearly burden, and when that hospital is full the addition will be more than #100,000 a year. In any revision of our charitable system special attention should be paid to that branch of it which deals with the insane.
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