In 1829, the Massachusetts legislature ordered the formation of a committee to investigate the condition of its insane citizens in every city, town, and village in the state. The investigation uncovered deplorable scenes of lunatics “dressed in rags” in “dark dungeons,” with “no bed, filthy straw, no orifice for light, [and] air so fetid as to produce nauseousness.” On March 10, 1830, the state legislature passed a resolve to erect a lunatic hospital with accommodations for 120 patients. Legislators described their actions in pragmatic terms, expressing certainty that the asylum would “restore” lunatics to a condition of health that would relieve their “burden upon the State.”
The commissioners tasked with the planning of the hospital initially debated between Worcester and Boston, ultimately settling upon the former for its more central location in the state. While Worcester had yet to gain the social and economic stature it would achieve at mid-century, it was poised to become an important hub in developing trade networks, as well as a center for intellectual and reform activity. Members of the local mercantile elite were eager to claim the hospital for Worcester as a means of drawing state funds and prestige to the up-and-coming town, and contributed to its development by serving on its board of trustees and purchasing bonds to underwrite its construction.
Under the principles of the new approach to insanity called moral treatment, the siting of the asylum itself was thought to play a crucial role in shaping its therapeutic environment. Accordingly, the commissioners were purposeful in their choice of location, selecting a 12-acre plot on Summer Street that they described as “a singularly regular and beautiful elevation, commanding a view of the town, and the rich scenery of the surrounding country, sufficiently near to the market, and principal places of business for necessary accommodation, yet so retired as to be secured from improper intrusion or disturbance, and within a short distance of the head waters of the Blackstone Canal.”
The next consideration was the building itself. Moral treatment called for “an edifice” that was “materially different, both in form and in interior arrangement, from ordinary habitations.” Commissioners needed to meet the basic needs for warmth, light, fresh air, and comfort while also securing the building against patients’ potential violence and attempts at escape. Because moral treatment stressed the importance of classification, the building would require sufficient accommodations to allow for the organization of patients into separate wards. In order to achieve these aims, the commissioners turned to a new genre of guidebooks. Samuel Tuke’s Practical Hints on the Construction and Economy of Pauper Lunatic Asylums (1815) was most likely among the sources consulted by the commissioners, as they chose to incorporate a window design identical to that used at Tuke’s York Retreat.
The layout of the Worcester State Hospital also adhered to Tuke’s suggestions, comprising two symmetrical wings — one for men and one for women — branching from a central administration building that would house the superintendent, his family, and other employees. Patients in each wing would be further segregated based on their social standing and type of illness. The building’s Neo-Palladian facade echoed that of the private McLean Asylum in Boston, a country mansion that had been retrofitted for hospital use in 1811 by its original architect, Charles Bulfinch. Unlike McLean, the Worcester State Hospital was built with a close attention to expenses, utilizing brick instead of the more expensive granite. With the addition of gardens for recreation and fields for agricultural employment, the hospital was fully equipped to meet the standards for moral treatment, with one important exception: the superintendent.
The superintendent played an essential role in moral treatment, serving not only as the head of staff and primary medical officer but also as a moral guide to the “family” of the asylum. Dr. Samuel B. Woodward, who served as the physician at the Hartford Retreat, a private Connecticut asylum that was modeled after the York Retreat, was an ideal choice. Although not a Quaker himself, Woodward ascribed to the model of treatment practiced at the Quaker-run institution, believing that “the benign influence of sympathy and compassion” exerted by the asylum was capable of “disarm[ing] [the] fury” of the “maniac” and transforming him into “a quiet, peaceable, intelligent and reasonable being.” Woodward also held progressive beliefs surrounding prison reform, public education, and intemperance, which he believed “should rather be considered as a disease than as a crime.” As one of his first actions as Worcester’s superintendent, Woodward accepted the commitment of Howard Trask, a notorious lunatic who was “looked upon as a Demon” and had been “exhibited as a show” in the villages of Massachusetts. In March of 1832 Woodward proudly reported to Horace Mann that Trask was “without chains[,] associating with our better class of patients[,] as yet perfectly quiet and peaceable.” Woodward’s success in pacifying Trask presented a bold illustration of the promises of moral treatment.
Yet Woodward’s descriptions of the asylum, widely disseminated through his annual reports, also testify to the difficulty of realizing the ideals of moral treatment. Recognizing that the asylum would be “judged by the proportion of cures,” he wrote that its curative potential was compromised by the short terms that patients spent at the hospital, the lack of trained staff, and the severity of patients’ illnesses. Unlike their counterparts at private institutions such as McLean and the Hartford and York Retreats, Worcester’s administrators could not discriminate in their admissions, and were compelled to accept “a selection of the most deplorable cases.” As a result, Woodward expressed the fear that “the Hospital will soon become the mere receptacle of foreign paupers, idiots, imbeciles, and incurables.” Some would not recover; others might show moderate improvement, but never regain the ability to live independently. Even Trask, following his seemingly miraculous transformation, quickly reverted to his former pattern of behavior. Despite the construction of a specialized room to contain him, Trask escaped from the asylum several times over the next decade.
To make matters worse, the hospital reached full capacity within its first few months of operation. The resultant straining of its resources undermined the aims of moral treatment – namely, individualized care and healthy, comfortable living conditions – and was most frequently cited as the main factor threatening the success of its mission. Administrators framed the solution to this problem in primarily architectural terms, believing that the spatial and material dimensions of the asylum were key to its therapeutic efficacy. The first addition to the Worcester State Hospital, which appended two additional wings and nearly doubled its capacity, was completed in 1836. Over the next decades, administrators would continuously entreat the state legislature for funds to construct additional space for patients, as well as separate accommodations for “imbeciles,” the violently insane, African Americans, and immigrants.
Despite these challenges, the Worcester State Hospital held a reputation as a “model institution” for its first few decades. Through the dissemination of its annual reports and frequent visitations by physicians from other states, the design and administration of the hospital were highly influential. The optimistic attitude assumed by the hospital’s administrators reflected the dominance of a so-called “cult of curability” in the treatment of insanity, a natural outgrowth of the optimism of the age. Woodward’s statistics, published in each annual report, corroborated this theory, indicating a 90% cure rate for patients who were admitted within six months of the onset of symptoms.
Over the course of the 19th century, however, it became painfully obvious that the hospital was not nearly as effective as had been anticipated. Growth of the native population, a massive influx of immigrants, and the rising public image of the asylum as a therapeutic — or at least respectable — repository for insane family members combined to swell the number of new admissions. At the same time, the asylum retained a steadily growing class of “incurables”: chronically ill patients who remained at the asylum for years or decades. In 1877 Pliny Earle, the superintendent of the Northampton State Hospital, dealt a damaging blow to the legitimacy of the Worcester State Hospital with his treatise The Curability of Insanity, in which he asserted that the published statistics of Worcester and other institutions had dramatically misrepresented the number of cures. In fact, Earle wrote, the proportion of asylum patients who were “curable” was much smaller than originally projected and was growing ever smaller. Earle’s statements represented a new generation of psychiatrists whose belief in the promises of moral treatment had soured into “therapeutic pessimism.” While the early proponents of moral treatment had viewed lunatics as the victims of environmental factors, later psychiatrists were increasingly liable to attribute insanity to degeneration and heredity.
The statistics collected by administrators and published in the annual reports of the Worcester State Hospital seemed to corroborate Earle’s claim that lunatics were not only less curable than was previously believed, but that they were becoming increasingly resistant to treatment. At the same time, the percentage of patients who were discharged “not improved” increased. The inflation of the number of “not improved,” particularly in certain years – such as 1853 and 1886 – was partly a product of efforts to reduce the patient population by offloading “incurable” yet quiet patients to other institutions, such as poorhouses and prisons. The relinquishing of these patients to non-therapeutic settings reflected administrators’ beliefs that they were beyond hope of recovery.
The deterioration of the “cult of curability” was reflected in the decay of the asylum itself. Year after year, state appropriations fell far below the amount needed to expand the hospital in proportion to its growing population or even to keep its existing buildings in repair. With a patient population more than double that of its capacity, under the care of only three medical officers (the superintendent and two assistant physicians), the hospital could hardly expect to maintain the quality of treatment it had offered in the 1830s. Administrators bemoaned the fact that “[o]ur Hospital at Worcester has not only ceased to be regarded as a model institution, but it has fallen into the rear rank in the march of improvement.” Their complaints were corroborated by the Massachusetts State Commission of Lunacy, whose investigation of the hospital in 1855 discovered “unsatisfactory” drainage, obsolete ventilation and heating systems, and severe structural deficiencies. The lead investigator, Edward Jarvis, suggested that the asylum property be sold and the proceeds used to fund a “new and satisfactory hospital with all the recent improvements.” Instead, the state authorized the construction of a second state hospital at Northampton, completed in 1858: a measure that provided only a temporary reprieve, as both hospitals were quickly filled beyond capacity. The Worcester State Hospital would continue to operate in a state of worsening crowding and dereliction for the next two decades.
Continued: The Second Worcester State Hospital
Bibliography and Further Reading
- Callaway, Enoch. 2007. Asylum: A Mid-Century Madhouse and its Lessons about Our Mentally Ill Today. Connecticut and London: Praeger.
- Grob, Gerald N. 1966. The State and the Mentally Ill: A History of the Worcester State Hospital in Massachusetts, 1830-1920. Chapel Hill: University of North Carolina Press.
- Little, Nina Fletcher. 1972. Early Years of the McLean Hospital: Recorded in the Journal of George William Folsom, Apothecary at the Asylum in Charlestown. Boston, MA: The Francis A. Countway Library of Medicine.
- Woodward, Samuel B. Personal Papers of Samuel B. Woodward. American Antiquarian Society, Worcester, Mass.