Massachusetts Hospital and Schools National Register Nomination draft 7.28.19934
Overview l ov r Sheet 8 /31/92 7/2 g/q 3
A. Name of Multiple Property Listing
Commonwealth of Massachusetts Hospital and School System
B. Historic Contexts
1. The Organizational Framework: 1830 -1940 (Criterion
A)
2. Methods of Care and Treatment: 1700 -1940 (Criterion
A)
Eighteenth Century Background
Care of the Insane
Care of the Mentally Retarded"
Care of the Poor _
Care of the Sick
Care of Juvenile Delinquents.
3. Noted People Involved in the System: 1830 -1940
(Criterion B)
Early Advocates
Hospital Administrators /Physicians
Architects /Designers
4. Architecture and Landscape: ,1830 -1940 (Criterion C)
Insane Asylums
Schools for the Mentally Retarded
Reform Schools
Almshouses
Sanatoria
Landscape and Land Use
Historic and Pre - historic Archaeological
Potential
C. Form Prepared By
Candace Jenkins
Massachusetts Historical Commission y�
8/31/92 1 ��
80 Boylston Street
617- 727 -8470 AUG1 9
Boston, Mass. 02116
D. Certification MAYQR'S OFFICE
n/a
E. Statement of Historic Contexts: see continuation sheets
pp. 1 -49
F. Associated Property Types: see continuation sheets
G. Geographical Data: seie continuation sheets
H. Summary of Identification and Evaluation Methods: see
continuation sheets
I. Major Bibliographical Reference: see continuation sheets
E. STATEMENT OF HISTORIC CONTEXTS final draft
6/7/93
I. Introduction
Concern for the disadvantaged, including the poor, the sick, the
mentally disturbed or handicapped, and the disadvantaged or
wayward youth, has been recognized as a responsibility of the
public sector in Massachusetts since its early seventeenth
century settlement period. For two hundred years, until the
mid - nineteenth century, the charge for their care rested
primarily with the towns in which they resided through locally
elected overseers of the poor, and in some eases, through
specially established poor farms. Lock -ups. served for the
criminally inclined. Gradually, the towns;'• duties in this regard
became unwieldy and largely unfulfilled, due In part to the
pressures of immigration and rapidly increasing numbers of
unsettled poor. Thus, the state stepped in, influenced by vocal,
liberal reformers to create an 'extensive, humane, and nationally
renowned system to care for its varied classes of dependent
citizens.
Over the course of one hundred years, from 1830 to 1930, the
Commonwealth gradually assumed full responsibility for the
disadvantaged, and created a remarkable public institutional
system, noted for both its extent and its innovations. At least
thirty --one facilities were constructed across the state including
thirteen hospitals for the insane, three schools and one farm for
the mentally retarded, four reform schools for wayward juveniles,
three almshouses for the poor, four sanatoria for tubercular
patients, and three specialized institutions for alcoholics, for
crippled children, and for laboratory research. Several were the
first of their type in the nation, or exerted national influence,
reflecting Massachusetts' pioneering leadership role.
The Commonwealth was generous in constructing these facilities,
with the exception of the almshouses, underscoring its commitment
to provide the best available care for those who were unable to
r, care for themselves. Hospitals and schools constructed in the
nineteenth century were often designed by well -known architects
and still evidence an exceptional quality of construction and
attention to architectural detail. Although twentieth - century
facilities were often designed by less prominent architects, and
began to rely on standardized plans, they too are well
constructed. Many campuses are enhanced by well - landscaped
grounds and /or hi.11top:sites providing fine views of the
surrounding countryside, although few landscape architects or
engineers have been identified.' Most also encompass several
hundred acres of wetlands, wooded areas, and agricultural fields
that remained in active use until the 1970s.
The extent of the State Hospital and School System in
Massachusetts provides an unusually complete picture of the
changing role of state - sponsored institutional care in the United
N
r
States. Along with Pennsylvania and New York, the Commonwealth
of Massachusetts was on the forefront of institutional reform and
theory. One scholar has defined Massachusetts' role thus:
The Bay State had pioneered in nineteenth century
welfare. Its policies had helped to legitimate the state
mental hospital in the early part of the century.
Massachusetts had also established the first Board of
State Charities in 1863 and a State Board of Health six
years later. The cultural and intellectual leadership of
its citizens reinforced its political significance, and
where Massachusetts led other states traditionally
followed .(Grob 1983: 82).
Extensive campus networks that integrate buildings and landscapes
in large -scale rural settings remain as testimony to the ideals
of the - system in the nineteenth century, and its eventual failure
by the mid - twentieth century. In particular, the campuses
included in this nomination embody the central role that ideal
asylum environments played in nineteenth and early twentieth
century treatment programs. The Boston Psychopathic Hospital of
1912 stands.apart as an urban facility devoted to research and
acute care that pointed the way toward future directions for
psychiatry. The integrity of a few campuses has been permanently
compromised, but most remain as clear manifestations of the
state's social conscience.
As a whole, the system meets criteria A, B, C, and D of the
National Register of Historic Places, and is significant on the
local, state, and national levels. The significance and
integrity of individual campuses are evaluated on their separate
nomination forms. The following narrative establishes the
framework for that evaluation by examining the following key
contexts and their relationship to the National Register
criteria. Those contexts are The History of Public Involvement:
Its Organizational Framework (criterion A) , Methods of Care and
Treatment (criterion A), Important People Involved in Creation
and Maintenance of the System (criterion B) , Physical
Developments: Architecture and Landscape (criterion C), and
Potential for Pre- historic and Historic Archaeological
Significance (criterion D). This narrative is weighted toward
facilities and programs for 'the insane, reflecting their
dominance within the state system...
The overall-period of significance for the Massachusetts State
Hospital and School System extends from 1830 when its first
facility was constructed, to ca. 1940, when the institutional
system was near its peak size and several statewide reviews of
its utility were initiated. Nationally, 1940 is seen as the end
of the era when institutional care was accepted as the best
available response to problems like insanity. After World War
11, criticism of institutional care intensified, as it was seen
"to disregard the rights of sick and dependent persons by
isolating and subjecting them to cruel abuse" (Grob 1983: 5, 6).
0J
At the same time, this "ineffective" care was absorbing
approximately one -sixth of the state budget (DMD 1930: 6)
creating a forerunner to our present health -care crisis.
The result supported the 1970s policy of deinstitutionalization,
which radically reduced patient populations, and left campuses
vacant and deteriorating. The individual hospital and school
campuses included in this nomination evolved gradually during the
nineteenth and early twentieth centuries, responding to increased
state involvement, as well as to changing theories of care and
treatment. Thus, buildings and landscapes from a broad time
period will generally contribute to their significance, although
those that date from the initial founding of the particular
campus are often-of primary importance.
r,
22. History of Public Involvement: Its Oxgatizational Framework
The history of public involvement in the care of disadvantaged
citizens arises from a context of changing social /political
attitudes and realities, accompanied by advances in scientific
medical theory. It encompasses major shifts in responsibility
from the local level in the eighteenth century, to the state
level in the nineteenth and early twentieth centuries, to the
federal level in modern times..
The Colonial period response to the issue of dependency was
profoundly different from that of the post - industrial period. It
did not differentiate between various types of misfortune but
encompassed all under the heading of poverty; it accepted
misfortune as part of the natural order and did not attempt to
eradicate its-causes; it did not establish a specialized
institutional framework but dealt with the problem on a personal
and local level. Stable family and community structures provided
sufficient socializing influences to balance individual problems
and defects.
A profound shift in attitude occurred in the early years of the
new republic, for which social historians such as David J.
Rothman and Gerald N. Grob have identified many causes. These
include rapid population growth accompanied by a sharp jump in
the rate of immigration, great improvements in transportation
networks leading to increased mobility, and rapid
industrialization and urbanization. These trends were coupled
with the rise of Enlightenment and Utopian philosophies that
emphasized the power of human reason and the basic improvability
of mankind.
All of these physical and philosophical changes tended to disrupt
the homogeneity, parochialism, and religious. determinism of the
established social order that had hitherto provided for local
support of the disadvantaged, supplemented by limited state
remuneration for those without legal residence in any town. The
unanimous national response to individual need and its perceived
effect on social stability in the early and mid - nineteenth
century was to create ideal "asylum" environments to shelter,
cure, and /or reform those citizens who could not cope with what
was viewed as an increasingly complex and corrupt society. The
goal of institutional proponents was "to secure social stability
through individual rehabilitation" (Rothman 1971: 217), and to
improve the quality of life for those most in need (Taunton
Lunatic Hospital; 2nd Annual Report 1855). The ideal asylum
environments had much in common with ideal Utopian communities of
the period.
Eastern Massachusetts was on the forefront of change in all the
areas discussed above. Thus, it is not surprising that active
advocacy for improvement in the living conditions of the
disadvantaged began in the earliest years.of,,the nineteenth
century with the establishment of numerous.,private charitable
institutions like the Boston Female Asylum for Orphans (1800),
the Boston Dispensary (1801), the Massachusetts General Hospital
and its psychiatric subdivision, McLean Asylum (1811), and the
New England Asylum for the Blind.(1829). Many of the same social
reformers and philanthropists involved in these institutions
began to petition the state to expand its role in the 1820s.
The first major step toward full -scale state involvement in
charitable endeavors came in 1821 with a report to the General
Court by Josiah Quincy on the subject of pauperism. Examining
the post - Revolutionary period 1791 -1820, Quincy found that the
settled poor (those having legal residency in a town and thus
having claim to its support) had remained at a fairly constant
level, while the unsettled poor (those without legal residency
and thus dependent on remuneration from the state) had increased
fivefold (Sanborn 1876: 17). Quincy recommended that the subject
of the poor be put under the annual supervision of the
legislature, taking for granted "that the present system of
making some public, or compulsory provision for the poor, is too
deeply riveted in the affections or the moral sentiment of our
people to be loosened... ''(Sanborn 1876: 18). No concrete action
on Quincy's report was taken by the state until 1852, when three
state almshouses were established and quickly filled to
overflowing. -
In 1829, eight years after Quincy's report on poverty, the
legislature was again asked to consider the condition of the
state's dependent citizens. This time Horace Mann brought forth
the issue of humane treatment and accommodations for the insane,
who were then kept in local poorhouses or jails if not at home
and were frequently chained and otherwise mistreated. Mann was
appointed chairman of a committee to investigate "the
practicability and expediency.of erecting or- procuring, at the
expense of the Commonwealth, an asylum for the safe - keeping of
lunatics and persons furiously mad" (Sanborn 1876: 39). At the
same time, towns were directed to provide statistics on their
insane to the Secretary of the Commonwealth (Hurd 1916: 586).
she was at the mercy of profligate men and boys. Generally, Dix
observed that these conditions arose from ignorance on the part
of local caretakers rather than sadism, arising from the general
belief that the insane and retarded lacked human emotion and
feeling.
The hopeless and inhumane conditions of the insane at most local
facilities stood in sharp contrast to the comfort, care, and
enlightened understanding offered at Worcester.. Dix's detailed
observations clearly defined the value of the asylum approach and
the comparative haven it offered. She stated:
I do not know how it is argued that mad persons and
idiots may be dealt with as if no spark of recollection
ever lights up the mind. The observation and experience
of those who have had charge of`hosL:)itals show opposite
conclusions (Dix 1843: 10).
The scope of state welfare efforts was greatly expanded when two
additional committees were appointed by the Legislature in 1846
to study the question of state facilities for the care of
"idiots" and the reform of juvenile offenders. The former,
headed by Samuel: Gridley Howe, resulted in the Massachusetts
School for Idiotic and Feeble- Minded Youth (South Boston,
1848 --52 /Waltham, 1887), which is seen as the initial step toward
public involvement in the care and training of the
"feeble- minded" nationwide (Wallace 1941: 7 -9). The latter,
strongly influenced by Theodore Lyman, resulted in the
Massachusetts State Reform School (Westborough, 1848). Both of
these institutions were the first state - operated facilitiep of
their type in the nation.
State involvement in the charities continued to expand over the
next thirty years to include two additional hospitals for the
"insane" (Taunton, 1851; and Northampton, 1855), three almshouses
for the poor (Bridgewater -now Mass. Correctional Institution,
Monson, and Tewksbury of 1852), and two establishments for
adolescents: the Nautical Reform School (Marion, 1859; now Mass.
Maritime Academy), and the Industrial School for Girls
(Lancaster, 1854; now MCI) . All were run by independent Boards
of Trustees who reported to the .Governor and Council.
Additionally, the state cooperated with the three
counties--- Suffolk, Essex, and Middlesex- -that had established
facilities for "idiots and lunatics not furiously mad," in
compliance with a state law of-'1836. (Tthe Suffolk facility,
known as the Boston Lunatic Asylum at South Boston, 1839, was
eventually taken over by the state in 1908.)
By 1863, the system had become extensive and complex enough to
require some type of coordination, so the legislature established
the Massachusetts Board of State Charities (Chapter 240, Acts of
18 63) and charged it with supervision of the whole system of
public charitable and correctional institutions. This board
developed from the 1854 Commission on Lunacy (DMD 1930: 3).
Typically, its mission was to gather data, define issues, and
establish public policy, rather than to regulate. As the first
of its type, and one of the most influential in the nation (Grob
1983: 40, 50, 79), it epitomized the optimistic liberal outlook
of early reformers and institutional managers. Two statements by
Dr. Samuel Gridley Howe (1801 - 1876), its chairman from 1865 to
1874, illuminate contemporary thought in Massachusetts. In the
Board's Annual Report of 1867 he said:
...the purpose of charity in New England has been to
diminish the number of the helpless, to make them
sounder, stronger, more hopeful and self - reliant.
Justice, no less than mercy, has been in the thoughts of
our people; a justice not satisfied'wi.th almsgiving, but
seeking zealously to establish a Social condition in
which alms would be less and less needed.
Painful as the sights of woe in many of our charitable
institutions must be, they are made more tolerable by
the thought that in America - -the home of the poor man- -
we are in the way to throw off and neutralize much of the
misery handed down to us from older countries and less
hopeful times.
In 1870, he continued in this vein saying, that "longer
acquaintance with the condition of the dependents
strengthens the belief that the existence of whole
classes of. defectives, of paupers and of criminals, is
not among the essentials, but the accidents of a highly
civilized state; and that the number and condition, of
those classes is largely under human control."
Thus one can see that early and mid - nineteenth century reformers
believed passionately in the eventual eradication of poverty,
crime, and disease, both mental and physical, and in the ultimate
perfectibility of society. In this they were closely allied with
contemporary Utopian thinkers, many of whom resided in
Massachusetts. Two additional "insane hospitals" at Worcester
(1870; NR 1980) and Danvers (1873; NR 1984) were established
under the sixteen -year tenure of this innovative Board.
Chapter 291 of the Acts of 1879 consolidated the state's approach
to public welfare by merging- the Board of. State Charities with
the State Board of Health (est.•1869) and several institutional
boards that had remained semi - autonomous up to that point. These
included Boards of Trustees of the State Reform School-(Lyman.
School, Westborough, 1848/84), and the State Industrial School
(Lancaster Industrial School for Girls, 1854; now MCI) , as well
as the Boards of Inspectors of the State Primary School, the
State Almshouse, and the State Workhouse (formerly the almshouses
at Monson, Tewksbury, and Bridgewater respectively; the latter
now part. of MCI) . During the seven -year tenure of the Board of
Health, Lunacy, and Charity, only the Westborough. insane Hospital
was established, in 1884, incorporating the early buildings of
the Boys' Reform School, which was moved a few miles eastward.
By the end of this board's tenure, there was a marked change in
attitude, reflecting the national mood of pessimism about the
ability of institutions to cure mental problems, reform criminal
behavior, or eradicate poverty. It was also noted that the
consolidation of Charities and Health was unsuccessful because
the board "had to scatter its forces in so many directions."
Typically, Massachusetts was one of the first states to
experiment with a centralized administrative structure to
maximize efficiency and accountability in the face of a growing
state welfare function. Influenced by the size and strength of
its professional medical community, it was also one of the few
states to reject central political control at;.the turn of the
century (Grob 1983: 211, 233). At this time, Massachusetts was
noted as a pioneer in the development of wise legislation for the
insane by a 1884 national study entitled "Legislation on
Insanity" (DMD 1930: 3).
The responsibilities of the multi - faceted Board of Health,
Lunacy, and Charities were reapportioned when the Board of Health
was re- established by Chapter 101 of the Acts of 1886 and the
Boards of Insanity and Charity were separated by Chapter 433 of
the Acts of 1898. Between 1886 and 1898, three innovative
institutions were established under the auspices of the Board of
Charity and Insanity: the Massachusetts Hospital for Dipsomaniacs
and Inebriates at Foxborough (1889; the nation's first public
hospital specifically for alcoholics, separating that class from
the general insane population), the Medfield Insane Asylum (1892;
the state's first facility erected specifically for chronic cases
of insanity) and the Templeton Colony of the Fernald School
(1899; the state's only facility specifically for chronic cases
of retardation). Additionally, Monson was converted to the
Massachusetts Hospital for Epileptics (1895).
Establishment of these specialized institutions reflects the
ferment of late- nineteenth century psychiatry, and its growing
belief in the possibilities of scientific progress. This led to
experimental programs for some classes of the insane such as
alcoholics and epileptics, whose disease had a known- -and thus
more treatable -- physical basis...It also led to segregation of
chronic patients in institutions where the goal was to enhance
the quality of their lives rather than to return them to society.
The concurrent determination to-hold maximum patient populations
at 2,000 per institution attempted to limit the negative impact
of rising populations on the hospitals' ability to treat and care
for patients. A fourth institution, the Rutland State Sanatorium
(1895; the nation's first public hospital for tubercular
patients) , established by the Board of Health, reflected advances
in scientific understanding of the causes of physical disease.
One of the primary tasks of the new Board of Insanity was to
complete the transition of care for the insane that had begun in
1830 from the local to the state level. State responsibility,
7
which resulted in transfer of insane inmates from local
Poorhouses to state asylums, was mandated in 1900 with funding
provided in 1904 (Grob 1983: 86; Chapter 451 Acts of 1900) .
Towns took this opportunity to reclassify the senile aged as
insane, thus greatly increasing the state burden of aged chronic
patients who generally remained within the system until their
deaths. The state developed two large rural campuses at this
time to provide accommodations for the anticipated influx of new
chronic patients. These were the State Colony for the Insane at
Gardner (Chapter 451, 1900; now MCI) and Grafton State Hospital
(Chapter 434, 1901).
Similarly, the Legislature transferred responsibility for the
care and support of indigent feeble- minded children to the state
in 1908, resulting in the establishment of a second state school
at Wrentham (Wallace 1941: 69). Epileptics were also remanded to
state care in 1908 (DMD 1930: 3), following up on the 1895
initiative to convert the former Almshouse and State Primary
School at Monson to the Massachusetts Hospital for Epileptics.
As a result of this massive expansion of the system, the Board of
Insanity conducted a systemwide review in 1904 -1905 to establish
uniform standards of capacity that could be impartially applied
to avoid overcrowding at any of the campuses (DMD 1926: 104 -107).
During the twentieth century, the State Board of Insanity was
reorganized several times, then renamed the Massachusetts
Commission on Mental Diseases by Chapter 285 of the Acts of 1916,
the Massachusetts Department of Mental Diseases by Chapter 350 of
the Acts of 1919, and finally the Massachusetts Department of
Mental Health by Chapter 486 of the Acts of 1938. Similarly, the
State Board of Health was renamed the State Department of Health
by Chapter 792 of the Acts of 1914, and the Department of Public
Health by Chapter 350 of the Acts of 1919. The same Act of 1919
created the Department of Public Welfare out of the former State
Board of Charities. Chapter 350 of the Acts of 1919 established
a Division of Juvenile Training within the Welfare Department to
oversee the state reform schools. Chapter 638 of the Acts of
1969 created the Department of Youth Services and mandated
closure of the state reform schools.
Separate acts of this period also changed the names of the
individual institutions from lunatic or insane asylums to state
hospitals, and from schools for feeble- minded youth to state
schools. These changes in name-reflect psychiatry's new focus on
scientific understanding of mental diseases and the desire for
institutions to evolve :from ideal places of retreat to .ones of
cure.
These administrative and departmental refinements reflected the
ever - increasing size and expense of the state institutional
system after full responsibility for the mentally, ill and
retarded was assumed in 1900 -1908. They also created an
increasingly unwieldy bureaucratic structure, at least partially
controlled by political rather than medical objectives, which
10
helped to dilute the zeal and idealism of earlier institutional
managers. Institutions added during this period included: four
state hospitals aimed primarily at chronic care at Grafton
(1902), Gardner (1902; now MCI), Norfolk (1914; now MCI), and
Waltham /Lexington (Metropolitan State Hospital; 1930); a clinic
for acute cases of insanity (Boston Psychopathic Hospital; 1912);
two state schools at Wrentham (1906) and Belchertown (1922); a
boys' reform school at Shirley (1908; now MCI); three
tuberculosis sanatoria all established in 1907 at Lakeville,
North Reading, and Westfield; a school for crippled children at
Canton (1904); and a research laboratory at Jamaica Plain (1904).
Additionally, several colonies for tubercular patients were
created at the state hospitals. In 1929 - 1930, facilities
controlled by the Department of Mental Diseases were valued -at
$27 million and absorbed one - -sixth of the.�state budget.
Annually, they cost over $8.5 million to maintain, with another
$2.25 million expended for new construction (DMD 1930: 6). .
III. Methods of Care and Treatment
The care and treatment of dependent citizens, including the
physically and mentally ill, as well as -the young and the
destitute, can be seen to evolve through several stages beginning
with the general acceptance and grouping together of these
conditions under the general heading of "poor" in the Colonial
period. This was followed in the early nineteenth century by
classification of misfortunes, and an initial optimism about the
possibility of effecting change and /or cures through a program of
Moral Treatment. This strategy included removal of the afflicted
one from an increasingly complex society to an ideal physical and
social environment created within the boundaries of an asylum.
The hopeful tenets of Moral Treatment, with slight refinements,
were extended from the "insane to the "idiotic," the poor, and
the juvenile delinquent by mid - century. Early asylums offered
great improvements in the lives of their inmates, and so enjoyed
widespread public approval and support.
As reality tempered optimism in the second half of the nineteenth
century, doubts began to grow about the possibility of curing or
eradicating these conditions, especially insanity. One of the
first to publicly voice the new.pessimistic attitude was Pliny
Earle, whose widely read essays on The Curability of Insanity"
(or perhaps more properly, the incurability) in the 1870s refuted
favorable early statistics on cures. Tewksbury's establishment
as a facility for the chronic,,'or long -term, pauper insane in
1866 was the first institutional response to the problem.
The change in attitude was partially related to the maturing of
the system and -the overcrowding of its facilities, which
undermined the close patient -staff relations of the earlier
years. Limits on patient populations grew from 250 per
institution in the 1850s, to 600 in the 1870s, to 1,000 by 1900,
and to 2,000 in the 1910s. Another factor was a marked increase
in chronic cases, especially the aged and senile, for whom there
P
was no hope of cure. Both of
to the state's assumption of
mentally ill and retarded in
of psychiatry to keep up with
medicine, which was beginning
relationships between causes,
of diseases.
these factors were directly related
full responsibility for care of the
1900 -1908. A third was the failure
the scientific advances of general
to establish meaningful
symptoms, and cures for a variety
All of this resulted in an increased emphasis on the custodial or
parental functions of institutions, especially insane asylums,
which were briefly glorified at the turn of the century. In its
annual report of 1886, the State Board of Lunacy and Charity
explained that asylums had a broader mission than to simply
effect cure: ;
The utility of our hospitals and asylums must not be
tested by holding them to any impossible standard in this
respect. The protection of the community from the harm
and loss which the insane inflict, if left at large; the
protection of the insane themselves from great sufferings
of various kinds; the relief to families that would
otherwise be burdened beyond their strength, by the care
of insane relatives; these and other benefits which our
Massachusetts hospitals and asylums confer, are an
evidence of their great utility, both past and present
(Grob 1983: 41).
Acceptance of a custodial role is clearly seen in the
increasingly complex bureaucracy and proliferation of campuses
(Context I) , and in the rise in acceptable population limits with
accompanying changes in building form (Context IV) .
Some of the pessimism surrounding insanity was allayed by
advances in medical theory that provided new treatment strategies
for mental illness with a known physical basis. Establishment of
the Massachusetts Hospital for Dipsomaniacs and Inebriates at
Foxborough in 1889, the Massachusetts Hospital for Epileptics at
Monson in 1895, and three tuberculosis sanatoria in 1907 reflect
this trend. Psychiatry's growing belief in the possibility of
scientific progress also helped. -to recreate a limited sense of
optimism and to refocus energies from care back to treatment. In
Massachusetts, this trend is. epitomized by establishment of the
Boston Psychopathic Hospital (1912) as an acute care facility
based on innovative German modOls. Community outreach programs,
including traveling clinics and social workers, were instituted
throughout the state hospital and school system, following the
Psychopathic Hospital's successful lead. The mental hygiene
movement, with its emphasis on prevention through education and
early intervention, attempted to counteract the rapid growth of
the system.
0
The Depression, which forced many families to give up care of
dependent members to the state while substantially reducing
institutional budgets, and World War II, which drained both staff
and funds, seriously depleted an already foundering system.
Thus, by the mid - twentieth century, institutional care began to
be seen as an outmoded and expensive practice that disregarded
patient rights and subjected them to abuse, the very conditions
that asylums were founded to counteract. This perception,
coupled with development of psychoactive drugs, provided a
rationalization for the policy of. deinstitutionalization. At its
best, that policy has returned patients to responsible community
life. At its worst, it has contributed to the conditions that
Mann and Dix fought against in the early nineteenth century, with
the destitute and mentally disturbed living,-on the streets
without hope or care.
A. Eighteenth - century Background
During the colonial period, Massachusetts thought of and treated
dependent citizens in a manner typical of other provincial
governments. As has been mentioned, there was no attempt at
classification, even into the broad categories of poor, -
physically ill, or mentally ill. All were considered poor, with
men and women, young and old, housed together. Neither was there
any attempt to effect cures, since poverty and illness were
considered to be natural components of the hierarchical
social/ religious order. Thus, the poor and ill were cared for by
family or friends where possible, or by the town when these
supports were lacking or the recipient was too unruly or
"furiously mad." Large towns erected poorhouses or acquired
existing farmhouses to shelter the poor, the ill, the orphan, the
"insane," and the "idiotic," together. Smaller towns often
auctioned these dependent citizens to the lowest bidder to care
for as they saw fit. This system was accepted and deemed
adequate until what David Rothman terms "the boundaries of
colonial society" began to break down under the pressures of
immigration, industrialization, improved transportation; and the
rise of a rationalist Enlightenment philosophy stressed the
improvability of all men.
Obviously these "boundaries" broke down at different times,
varying from town to town and state to state. Massachusetts in
general, and its coastal section in particular, was on the
forefront of intellectual, social, technological, and economic
change in the early nineteenth, -century. Its capital city,
Boston, was a major point of entry; it was the birthplace of the
Industrial Revolution in American; it quickly adopted improved
modes of transportation such as arrow - straight turnpikes in the
period 1800 -1810, canals in the 1810s, and railroads in the 1820s
and 1830s; and finally, it was home to many early Enlightenment
reformers and Utopian thinkers. Thus, it is not surprising that
Massachusetts was also on the forefront in developing laws,
institutions, and treatment programs for the physically and
mentally ill throughout the nineteenth and twentieth centuries.
t'
)3
State Care of the Insane: 1830 -1940
The "insane" were the first class of dependent citizens to
receive specialized institutional treatment from the state when
the Worcester Insane Asylum opened in 1830. That facility, and
others constructed in the mid - nineteenth century, including
Taunton (1851) and Northampton (1855), were run according to the
principles of "Moral Treatment." This reflected the influence of
European physicians such as Phi ,llipe Pinel, who began to advocate
kind and sympathetic treatment of the insane in the late
eighteenth century and achieved some success in effecting cures.
Pinel's ideas, published in America by 1811, emphasized removal
of the insane to ideal asylum environments in,rural settings, and
the imposition of a regular schedule of sleep;. labor, meals,
moral instruction, and recreation, as well.:as gentle treatment,
eschewing chains and corporal punishment (Zimmer 1981: 1 -2) .
This philosophy fit well with the dominant American belief that
the increasingly open and fluid nature of their society was
responsible for an increase in insanity, and that such problems
could be cured within an ideal asylum or institutional setting.
The hegemony of Moral Treatment at this time also reflects the
status of medical knowledge, which did not yet relate etiology,
symptomatology, and physiology (Grob 1983: 12). Moral
Treatment's emphasis on ideal physical and social environments
resulted in exceptional buildings accompanied by extensive
agricultural and designed landscapes at nineteenth - century
asylums.
Pliny Earle, the nationally noted theorist and Superintendent at
the Northampton Lunatic Hospital, described Moral Treatment thus
in his Annual Report of 1855:
Moral Treatment, as the term is generally understood,
includes some agencies which might more strictly be
called hygienic, as their curative influence is
primarily exerted upon the body. The mental or moral
influence is secondary. It includes all agencies, the
direct and immediate operation of which is upon either
the intellect, the passions, the propensities, or the
moral and religious sentiments. Practically, in a
hospital, everything in the management of patients other
than the administration of medicine, the nursing
of the sick, and the use of the bath, is considered as
moral treatment. Then - internal polity of the house, the
regular hours, :the extension of privileges, the
imposition of restraints, all the details of what is
called discipline, are included under this head, no less
than those other agencies which will demand more special
notice, as manual labor, religious worship, intellectual
employment, and recreation and amusement, in their
diversified forms (11th Annual Report 1855).
91
At Taunton, they explained the purpose of Moral Treatment and
revealed its strong religious basis by saying that the aim of
treatment was "to renew, to revive, to recreate that soul, whose
original creation was God's greatest work" (2nd Annual Report
1855) Taunton, which is the oldest extant insane asylum in
Massachusetts, provides a clear example of the limits of Moral
Treatment and the problems caused by growing numbers of
incurable, chronic patients throughout the system. Like other
early asylums, Taunton was quickly filled to capacity, indicating
general popular support and acceptance. However, its very
success spawned the seeds of failure, as it was quickly
recognized that the "old, helpless, and demented" tended to
accumulate (2nd Annual Report 1855), and that, the numbers of
those who could be cured and released di.d.no�, equal those who
desired admittance. By 1860, the Trustees, and Superintendent
were asking what was to be done with the growing number of
chronic patients. Sending them back to overburdened families,
local poorhouses, or lock -ups was considered inhumane. The
short --term answer was to move chronic pauper patients to
Tewksbury. The longer - -terra answer, realized over the next
hundred years, was to enlarge the system and the hospitals within
it, gradually refocusing-attention from active cure to reactive
maintenance.
Earle, who was one of the early proponents of Moral Treatment,
was also one of the first professionals to vocally express doubt
in its ability to consistently effect cures. He did this through
a series of lectures and widely circulated essays in the 1870s on
the "The Curability of Insanity," which refuted favorable early
statistics. Through retrospective studies, Earle demonstrated
that cures had been calculated on the ratio of recoveries to
cases discharged rather than admitted, that readmissions had been
ignored, and that recoveries of a single patient were often
counted several times (Grob 1983: 39) .
As Moral Treatment, with its reliance on an environmental /social/
religious approach, was gradually seen to be limited in its
application, other methods with a more physical basis were
explored. The Westborough Insane Hospital of 1884, for example,
based its treatment program on homeopathic principles that
emphasized rest, nutrition, massage, and hydrotherapy. Other
less innovative institutions relied more heavily on available
drug therapy to control "excitable patients" without recourse to
physical restraint. Drugs available in the second half of the
nineteenth century included elixir of iron and bark to promote
strength, bromide of potassium to control epileptic seizures, and
an array of sedatives of varying strengths such as morphine,
opium, belladonna, chloral hydrate, paraldehyde, sulphonal,
calomel, hyoscyamin, stramonium, and varatrin. An 1875 report to
the Massachusetts Legislature noted the importance of medication
in treatment of the insane as well as the wide disparity of use
among the various state institutions, with some spending three
times as much on drugs as others (Grob 1983: 13 -14).
1-5-
Physical restraints, including straitjackets, muffs, straps,
handcuffs, cribs, and isolation rooms, were used on about 5% of
patients nationwide as demonstrated by data from the 1880 U.S.
Census. The issue of restraints was always controversial, with
their use generally seen as undesirable but sometimes necessary
when patients threatened harm to themselves or others (Grob 1983:
17 -18). Soon after opening, Taunton did away with its strong
rooms, or small windowless cells, for "excited" patients,
preferring instead to.offer sympathy and individual treatment,
demonstrating their distaste for restraint and its implied
cruelty (1st Annual Report 1854).
Ever - increasing patient populations made this approach difficult,
if.not impossible. Patient employment, which'-offset the monotony
of institutional life, often calmed "excitable" patients without
recourse to drugs, and provided some sense of normalcy, routine,
and self- esteem, was an important therapeutic tool from the
beginning. Out -of -doors tasks were favored because the
experience of nature combined with the health -- promoting qualities
of fresh air and sunlight were considered especially therapeutic.
Male patients were generally assigned to farm, construction, and
maintenance work while women accomplished household tasks such as
sewing and cleaning; supplemented by tending kitchen gardens and
greenhouses. At Grafton, farmwork was encouraged for women, too.
Many of the better - staffed and funded institutions erected
special workshops. Patient labor did provide some economic
benefit, but few suggested that as its primary value, or that
patients be required to earn their keep (Grob 1983: 23 -34). The
following descriptions of the value and purpose of work at
Grafton are typical: "...patients have been encouraged to' work
wherever possible... with profit both to themselves and the
institution" (27 Annual Report 1904).
"In carrying out such a work as this it should always be borne in
mind that the improvement of the individual is the prime end
sought, and that the occupation is a purely subordinate means to
an end. Work of this sort would be a remedial measure, -
prescribed in the treatment of disease" (31st Annual Report
1908). "...this out --of -doors crew was largely recruited from
patients who have formerly sat around the house and done very
little or nothing at all .... it has relieved the wards of some of
its noisy and turbulent women, and in most instances with marked
benefit to the patients. The measure of success in this work has
not been so much the amount of labor accomplished as the numbers
of patients who have been takers out and led back into habits of
industry" (32nd Annual,-Report 1909).
A popular method of managing patients was through increasingly
refined systems of classification, primarily based on external
behaviors or symptoms. Annual Reports for all of the
institutions cite classification efforts. Classification by type
kept similar patients together, which tended to reduce conflict
and the attendant need for discipline, medication, or restraint
(Grob 1.983: 22 -23). Medfield (1892) is an especially good
H
example of the classification and isolation of various types of
patients within a single institution. Original plans show that
separate buildings were provided for "quiet," "excited,"
"untidy," and "epileptic" male and female patients. The 1880
Federal Census included seven categories of mental illness, all
based on symptoms, which included mania (affecting 38% of
patients) , dementia (28%), melancholia (19 %) epilepsy (9%),
monomania (2g), paresis or tertiary syphilis (2%), and dipsomania
(1%) (Grob 1983: 8) .
The late nineteenth century's growing reliance on drugs,
restraints, work therapy, and symptomatic classification all
reflect the fact that the causes of insanity were not yet
understood. For example, the role of heredity, had been observed
for many years, but the failure to understand it is demonstrated
by the following statement from the asylum at Taunton:
Could we trace it closely enough, I think we should find
this hereditary taint in the blood far more potent in the
production of insanity than all'the array of alleged
causes which makes so much show in tables. It is a
leprosy, poisoning life at the Very fountain, which,
concealed in one generation, breaks out in the next (21st
Annual Report 1874).
The impossibility of establishing a scientific psychiatric
classification system based on etiology was recognized by Pliny
Earle in 1886:
In the present state of our knowledge no
classification of insanity can be erected upon a
pathological basis, for the simple reason that,
with but slight exceptions, the pathology of the
disease is unknown .... Hence, for the most
apparent, the most clearly defined, and the best
understood foundation for a nosological scheme
for insanity, we are forced to fall back upon the
symptomatology of the disease - -- the apparent
mental condition, as judged from the outward
manifestations (Grob 1983: 35).
Creation of specialized hospitals for alcoholics at Foxborough
(1889), and for epileptics at Monson (1895; reassignment of
former Almshouse and State Primary School) reflect classification
as well as psychiatry's desire'to work with populations whose
insanity had a demonstrable physical and treatable basis.
Foxborough was the first of its type in the nation, while Monson
was third after Ohio (1892) and New York (1894) (DMD 1930:4).
Increased numbers of chronic insane, especially the aged and
senile, made a substantial contribution to the pessimism that
pervaded asylums in the late nineteenth century. During the
period 1880 -1886, more than 12% of the state's asylum population
was over 60 years'of age (Grob 1983: 10). Many institutions
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tried to avoid this burden by requesting permission to transfer
chronic cases elsewhere, or at least to segregate them within
separate wards or buildings at their own institutions.
The assignment of the chronic pauper insane to Tewksbury in 1866
was the first instance of a purely chronic care facility in
Massachusetts, followed by conversion of the original Worcester
Asylum to the Asylum for the Chronic Insane in 1877 after the new
Worcester Lunatic Hospital (NR 1980) was completed. The Medfield
Insane Asylum of 1892 was the first state hospital established
specifically for chronic cases. Soon thereafter, in the early
twentieth century, three separate colonies for quiet, chronic
insane patients were built at Westborough, and Grafton was
established as the Worcester Farm Colony in 1'901 with four large
colonies, all for chronic cases. Gardner "(now MCI) was
established in 1900 as the State Colony for the Insane.
This major increase in chronic care facilities in the early
twentieth century reflected the state's. full assumption of
responsibility for the insane in 1900, and the transfer of insane
and senile aged inmates from local poorhouses to state hospitals
in 1904. At Grafton the mission of chronic care was described
thus:
...while not ending in recovery, such limited improvement
sometimes takes place as greatly contributes to the
capacity of the individual to appreciate the enjoyment of
living. A careful and painstaking attention on the part
of nurses is necessary, if we are to detect and fan into
flame these flickerings of reason (29th Annual Repbrt
1906) .
A rural setting that.allowed the maximum of personal freedom,
with opportunities to enjoy nature and work out --of- doors, was
considered crucial to successful chronic care. The colony form
of Grafton and Gardner State Hospitals was specially developed to
meet this objective.
Another problem that began to affect mental hospitals in the late
nineteenth century was difficulty in finding and keeping
well - trained nurses and attendants because of low wages and
prestige, long hours, and the arduous, sometimes dangerous nature
of the work. Some established training schools to alleviate this
situation. The first in the country opened in 1882 at McLean
Hospital in Belmont, a private"asylum associated with
Massachusetts General Hospital (Hurd 1916: 609). The second in
Massachusetts opened in 1,889 at Danvers State Hospital (NR 1983).
By 1895, more than thirty such schools existed nationwide (Grob
1983: 20), including several in Massachusetts.
Many hospitals also began to segregate staff and patient living
quarters at this time by building separate dormitories for nurses
and attendants, as well as single -- family houses for
superintendents and doctors. This not only created more
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pleasant living arrangements for staff, but also provided more
space for patients in the ward buildings. Nevertheless, many
institutions cited problems in securing suitable employees, and
in 1906, the Massachusetts State Board of Insanity stated that:
"It has been barely possible at times during the past year to
procure respectable persons enough to do absolutely necessary
work in caring for patients and safeguarding against danger"
(Grob 1983: 20) .
In the early twentieth century, state legislation increased wages
and lessened hours. During World War 11, however, almost all of
the institutions included in this nomination reported operating
with about 50% of.their staff positions unfilled (Gov /Council
1945) .
With Moral Treatment discredited, no viable substitutes in sight,
increasing numbers of incurable, chronic cases, and constant staff
shortages, the institutional treatment of insanity came more
generally into question by the turn of the century. At this
time, psychiatrists began to divorce themselves from the asylums
within which their speciality had developed, further tarnishing
the institutional image. Psychiatric thought turned from
management and administration of patients in an institutional
setting toward a scientific understanding and potential cure of
mental disease through such varied disciplines as neurology,
cellular biology, pathology, psychotherapy, and mental hygiene.
The hopeful turbulence of the time is summed up in a statement by
New York neurologist Bernard Sachs: "The past of psychiatry has
been full of discouragement; the present is involved in a maze of
uncertainty; but the future is full of hope" (Grob 1983: 110).
The two major vehicles for modernizing psychiatry in the early
twentieth century were research institutes and psychopathic
hospitals, both of which were pioneered in New York in 1895 and
1900 respectively (Grob 1983: 127, 136),. In Massachusetts, these
changes are most apparent at the nationally influential Boston
Psychopathic Hospital of 1912, now the Massachusetts Mental
Health Center. Established specifically to treat acute cases of
insanity, it was based on the model of innovative German
psychiatric clinics and was intended to produce "an earlier and
more intelligent method of treatment which will reduce hospital
admissions by cure or prevention" (4th Annual Report), It also
evidenced the period's growing social mission and emphasis on
prevention, which focused on mental health rather than mental
illness. The American Medical-Association described the new
approach thus in 1913:,
The psychopathic hospital in a community is bound
to be one of the most concrete sources of
enlightenment as to psychopaths, and every
society for mental hygiene, for sex hygiene, for
the amelioration of alcoholism, for eugenics,
should make it part of its business to help
start a psychopathic hospital with its outpatient
11
service in every community in which there is any hope for
awakening social sense (Grob 1983: 140).
Cure was to be effected through scientific research into the
causes of insanity, while prevention was encouraged through
development of outpatient and social service departments. Elmer
E. Southard, who had been appointed as the first state
pathologist in 1909, also served as the first director of the
Boston Psychopathic Hospital. Thus, research institute and
psychopathic hospital were combined in Massachusetts in an'
illustrious facility noted for the exceptional quality of its
staff and its close ties with the Harvard Medical School (Grob
1983: 137 -140). Massachusetts hospitals were'said to be the
first in the country to establish scientific laboratories (DMD
1930: 5). Hospitals throughout the sys:tem.at this time followed
the lead of Boston Psychopathic by developing outreach clinics
and social service departments. In 1922, Massachusetts
established the nation's first mental hygiene program for
pre- schoolers, and physicians were required to pass an
examination in psychiatry before they could be licensed in that
speciality (DMD 1930: 5).
Scientific progress led to development of several controversial
intervention therapies for chronic patients in the 1920s, 1930s,
and 1940s. Their experimental nature led to extensive debates
about whether psychiatrists should wait until conclusive data
were available, or whether treatment should be extended without
delay to patients who were otherwise without hope of any type of
non - institutional life. These treatments included: fever
therapy, which was sometimes successful in treating paresis or
tertiary syphilis; insulin, metrazol, and electroshock therapy,
which seemed to alleviate the symptoms of schizophrenia; and
pre- frontal lobotomies, which calmed violent personalities (Grob
1983: 293 -305).
By 1930, the total population in Massachusetts institutions had
reached 23,680, including 18,300 mentally ill, 1,230 epileptics,
and 4,150 feeble - minded, its expenses absorbed one -sixth of the
state budget (DMD 1930: 6). Nationally, chronic patients
occupied almost 80% of the available beds in mental hospitals by
that time (Grob 1983: 197). That they needed care far more than
treatment was an unglamorous fact that was sometimes ignored by
doctors, politicians, and the public.
Attempts had been made to accommodate these growing numbers in
the nineteenth century:by increasing acceptable limits for
patient populations from 250, to 600, to 1,000. Nevertheless,
exhaustive studies in the early twentieth century documented
severe overcrowding throughout the system. Unlike other states,
Massachusetts instituted a final limit of 2,000 because "a large
hospital militates against individual observation and treatment
of patients" (DMD 1926: 108). Overcrowding was resolved through
establishment of Metropolitan State Hospital in 1927 -1930, and
through enlargement of many other campuses, most notably
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Northampton. Many construction programs of the 1930s were funded
by the Works Progress Administration and other Federal relief
programs.
Despite these physical improvements, and renaming of the old
asylums and lunatic hospitals as state hospitals, they were
popularly and professionally associated with psychiatry's past
failures. Disassociation of psychiatric progress and prestige
from the hospitals, coupled with the increasing chronic
populations and decreased funding, led to their perception as
backward warehouses where patients were abused and confined
against their will by the mid - twentieth century. Thus, by the
1940s,
"there was general agreement that'too many patients had
become 'institutionalized` and hence were destined to
spend the rest of their lives as pitiful guests dependent
on public largesse; that brutality and neglect were
endemic; that deteriorating physical plants and
inadequate care were common; that lethargy, neglect, and
overcrowding had reduced mental hospitals to the status
of inadequate poorhouses" (Grob 1983: 199),
once viewed as the-harbingers of progress, mental
hospitals were now portrayed as monuments to human
degradation, brutality, and indifference (Grob 1983;
318 ),
The national population at state and county mental hospitals
peaked at 559,000 in 1955. After that time, a national public
policy of de institutionalization was promoted by the availability
of new psychoactive drugs and psychiatric therapies, by alleged
violations of patient rights and the perceived ill effects of
long -term institutional care, by the deteriorating condition of
the physical plants, and by the shift of fiscal responsibility
from the state to the federal level. The latter became
particularly important in the 1960s when the Joint Commission on
Mental Illness and Health recommended a national policy of no new
construction at mental hospitals, and federal grant programs
encouraged the shift of aged patients from hospitals to nursing
homes (Grob 1983: 317 -319). A recent report of the Governor's
Special Commission on Consolidation of Health and Human Services
Institutional Facilities noted that:
the Commonwealth's inpatient facilities system, which was
built to accommodate over 35,000 individuals at its peak,
today cares for 6,200 clients. Encompassing some 10,500
acres and over 1,000 buildings, stretched over 34
campuses, the inpatient system is grossly oversized for
the number of people in its care,(Special Commission
1991: i).
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IN
C. State Care of the Mentally Retarded: 1848 -1940
The inhumane living conditions of "idiots" was brought to the
attention of the state by Samuel Gridley Howe, a reformer
previously noted for his work with the blind, deaf, and dumb. He
was successful in securing a small appropriation in 1848 to teach
ten "idiotic" children in an experimental program that quickly
expanded into the Massachusetts School for Idiotic and
Feeble- Minded Youth. This was the first public institution for
the feeble- minded in the United States, followed by schools in
Syracuse, N. Y., in 1851, Lakeville, Conn., in 1852, and Elwyn,
Pa., in 1853. By 1892, nineteen public institutions had been
founded with populations ranging from twenty -five to more than
800, for a total of 6000 patients nationwide.- The 1890 U. S.
Census counted 95,571 feeble - minded persons,;,only 420 of the
3,000 counted in Massachusetts at that time were receiving
institutional care (Wallace 1941: 45 -46). Massachusetts
established three schools including Wrentham (1906 -07) and
Belchertown (1915 -20). As was the case with insane asylums,
national organizations developed as the public institutions
became more common. These included the Association of Medical
Officers of American Institutions for the Feeble -- Minded, and the
American Association for the Study of the Feeble - Minded, both
established in 1876 (Wallace 1941: 47, 67).
Treatment programs at these schools for the feeble- minded were
based on the tenets of Moral Treatment combined with special
teaching methods developed by Edouard Seguin. Seguin, who began
instruction of "idiots" in Paris in 1837, was the first to
theorize that idiocy was caused by an arrested development, of the
brain occurring before, during, or after birth. More
importantly, Seguin developed a system of painstaking
physiological training of. the senses, which "might restore them
to society and .life." Seguin's Treatise on Idiocy, published in
1846, sparked international interest in the subject and was still
held in high esteem one hundred years later. Seguin's ideas were
also instrumental in development of the Montessori teaching
methods in the early twentieth century. Thanks to Seguin's
genius, treatment of "idiots" was initially more successful than
treatment of the "insane," resulting in placement of the
Massachusetts School under the Board of Education in 1886.
The intent of the treatment program developed for "idiots" during
the nineteenth century, and its 'moral rather than scientific
basis, was summed up by Dr. Howe at the school's outset in 1848:
"it is proposed] to train all the senses, to strengthen
the power of attention,' develop the muscular system, and
some degree of dexterity in simple handicraft. To call
out their social affections, to inculcate feelings of
regard for others in return for love and kindness shown
them, to appeal to the moral sense and to develop
religious sentiment.
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It is to be hoped that part of them will gain useful
knowledge, most of them become cleanly, decent and
industrious, and that all of them will be better and
happier from the efforts on their behalf (Wallace 1941:
10).
By 1875, Howe defined "idiocy" as-
... the condition of a human being in which, owing to some
morbid cause in the bodily organization, the faculties
and sentiments remain dormant or undeveloped, so that the
person is incapable of self - guidance, and of approaching
that degree of knowledge usual with others of his age.
He had also defined three classes of persons with imperfect
cerebral organization based upon their ability to use language:
"idiots" who could use no words by age 12; "simpletons" or
"imbeciles" who could use nouns only; and "fools" or "morons" who
could construct simple sentences.
Other factors that Howe considered important to classification
were physical examination of form, weight, and dimensions; habits
and general temperament; and color perception (Wallace 1941: 22) .
The treatment programs developed in the nineteenth century
combined study, manual training, and recreation in a highly
structured and supervised routine. The abilities of small
children were developed through the Seguin and Kindergarten
methods, while older children were assigned to graded classes in
reading, writing, geography, and history, and also participated
in occupational therapy programs. Trained adults who were
employed at the hospital during the day at farming, kitchen and
laundry work, sewing, etc., attended evening programs in music,
gymnastics, dancing, basketry, etc. The importance of industrial
training and physical exercise to the overall program were
described thus in 1892:
We do not expect to make skilled artisans of new pupils.
The finished work is a secondary consideration, the
mental discipline secured the accurate doing is the
desired result. Nearly -all our pupils receive systematic
physical training. Mental awakening generally follows
increased physical development" (Wallace 1941:,43).
There is also frequent mention`of the relationship between
productive labor and self- esteem in the annual reports for the
state schools.
The Massachusetts School entered the twentieth century expanding
its innovative programs rapidly and retaining its national and
international stature. Many of the new programs reflected the
national mental hygiene movement with its emphasis on mental
health. A school department with graded classes was opened in
1892 (Wallace 1941: 42). Teaching clinics for Tufts and Boston
a3
University Medical School students were instituted in 1903,
expanding the program initiated in 1884 with Harvard (Wallace
1941: 32, 61) . A formal parole or vacation system was adopted in
1912 along with the new position of field or social worker to
supervise pupils with outside placements. At the same time, an
out- patient clinic was established, further strengthening
community ties. By 1915 monthly clinics had been started in
Worcester, Fall River, New Bedford, and Haverhill, and that year
the school held a total of 32 clinics involving 743 patients
(Wallace 1941: 92). Patients' general health needs were treated
more scientifically in a small campus hospital as methods and
products developed by the State Board of Health, such as
diphtheria antitoxin, were employed in 1915, and tuberculosis
tests were introduced in 1920 (Wallace 1941. -90, 100) . More
complete profiles of the patients' mental.condition were also
made available through the use of new psychological tests such as
the Binet -Simon and the Intelligence Quotient (Wallace 1941: 82;
104). Dental Clinics, held by Tufts University, were
established in 1917 (Wallace 1941: 94). The first women
physicians- -Drs. Anna M. Wallace and Edith Woodill- -were
appointed in 1907 (Wallace 1941: 68). X -ray examination of the
brain was introduced as a diagnostic tool in 1920 (Wallace 1941:
100) .
At the same time, several issues arose that deflected some of the
state schools' energy away from their primary educative purpose,
and toward custodial care and management. They arose from a
growing societal fear of increased deviancy, as science
illuminated the role of heredity and began to link
feeble- mindedness with crime, pauperism, and immorality. A
governor's commission was appointed by Chapter 59 of the Acts of
1910 to investigate "the increase of criminals, mental
defectives, epileptics, degenerates, and allied classes" and to
make recommendations for the protection of the Commonwealth and
its citizens. Among the commission's recommendations were
provision for permanent custodial care of defective delinquents
and the prohibition of marriage, and reproduction for such
classes. Dr. Walter K. Fernald, who headed the Massachusetts
School and was a national leader on these issues, was, appointed
the chairman of the commission. These concerns expanded the
mission of the state schools, to-acceptance of chronic, pauper,
delinquent, epileptic, and physically disabled cases who were not
considered suitable for training, but who were nevertheless in
need of proper care. Thus, the-early twentieth century was a
period of major growth at public institutions for the
feeble- minded as illustrated by the Massachusetts School, where
applications for admission rose from 142 in 1889 to 484 in 1911
(Wallace 1941: 75 -78), and by the founding of a second school at
Wrentham in 1907.
In Massachusetts, the need to provide permanent care for some
chronic patients was recognized by the 1870s. A farm school for
adult males was established at Dover in 1880, with a much larger
successor at Templeton in 1899. The farms were designed to
A�
provide a useful and happy living situation for adult males
trained at the main school, with programs based primarily on
closely supervised exercise and farmwork in a healthy
out -of -doors environment; the idea was based on colonies for
epileptics in Germany and New York. The other campuses were
developed with separate wards for adult chronic patients as well.
In 1905, the British Royal Commission on the Care and Control of
the Feeble - Minded provided the following glowing report on
Massachusetts facilities, showing particular admiration for the
Templeton Colony:
This is a most interesting institution, embodying
in itself the whole history of American methods
of dealing with the feeble- minded from its
earliest beginnings in the training school for
the idiot to its latest development- the colony
(Templeton) for the permanent custodial care and
employment of defectives unfit for free life.
Its superintendent is Dr. W. E. Fernald, who is
not only one of the greatest authorities in the
United States of America on the medical aspect of
the care of mental defectives, but is an
institutional manager of great energy,
enthusiasm, resource, and capacity (Annual
Report, 1905) .
Annual reports of
deficient patients
schools and insane
might be caused by
said:
--he period cite the need to care for mentally
who had been assigned to the state reform
asylums, but also recognize the problems that
these individuals. In the 1901 report it
Attention is called to the large number of
admissions over 14 years of age of both sexes,
from Mental Hospitals, Girls' Industrial School
at Lancaster, and Lyman School for Boys. Many
received or admitted show an increased proportion
where the moral deficiency is greater than the
mental. defect. Many problems of this type came
from the Children's Aid Society, Society for
Prevention of Cruelty to. Children, and from
police courts. Many of the above had been placed
out repeatedly without success. They are a
perplexing problem in the School. They must be
isolated in special buildings which will be
required for proper classification (Wallace 1941:
59-61). il
Chapter 796 of.the Acts of 1913 provided for segregation and care
of defective delinquents in the. state's criminal facilities, but
this was apparently not enforced, and they continued to be placed.
at the state schools until 1922, when provisions were made at
Bridgewater (Wallace 1941: 96, 107).
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The Massachusetts School reports also stress the need to provide
permanent institutional protection for adult females and to
segregate adult male and female patients within the institution.
By 1901, when chronic female patients of child- bearing age
numbered 200, it was stated:
The principal department of the Massachusetts School for
the Feeble- Minded is the custodial department, and the
protection of feeble- minded women its most important
office.
Public opinion now requires the segregation of adult
males and females of the higher grades of
feeble-mindedness to prevent marriage,of such
individuals, and resulting increase of mental defect in
the community. The purchase of' 50 acres of added land in
Waverley is advised on-which the new buildings may be
built (Wallace 1941: 59-61).
In 1909, Dr. Fernald further stated:
it has been recently said that practically all high -grade
indigent feeble- minded women become mothers of
illegitimate children, many of them soon after reaching
the age of puberty; that most of the children of
feeble - minded women are feeble- minded; that the histories
of these feeble - minded women and their feeble- minded
children are practically the same. Their birth, poverty,
helplessness, ruin and bearing of illegitimate children
form parts of an endless chain, a recurring sequence. By
means of it the State is continually supplied with
degenerate human beings (Wallace 1941: 74).
The question of sterilization arose in the 1920s and 1930s, and
while the procedure was generally favored, the Massachusetts
state schools were not considered to be the appropriate place.
In 1933 it was noted that 27 states had passed laws to allow
sterilization (Wallace 1941: 126, 142).
The results of the growing patient population are seen in several
ways. One is in the establishment of additional schools in
Massachusetts at Wrentham (1906 - 1907), and at Belchertown
(1915- 1922), and in all of the other New England states during
that period. By 1933, with a waiting list of 1,829 at the parent
institution at Waltham, renamed as the Fernald School,
discussions about the necessity of a fourth school began (Wallace
1941: 141). The other result is the major building campaign that
transformed the Waltham campus between 1895 and 1925, expanding
its capacity from 600 patients to over 1,000.
Public concern about the hereditary nature of mental defects,
mental disease, and criminality, and the links between them
encouraged scientific research in the early twentieth century.
Research included studies of the hereditary nature of
ll
t'
Mongoloidism and spastic paralysis, and of diseased brain
conditions undertaken by the Neuro - Pathological Laboratory of
Harvard Medical School (Wallace 1941: 91). In the 1920s, research
began to show the relationship between diseases of the ductless
glands, such as the thyroid and endocrine, and feeble- mindedness
(Wallace 1941: 101). By the 1930s, research was exploring the
relationship between mental deficiency and psychosis, and ways to
distinguish between them in diagnosis (Wallace 1941: 142). At
this time, Dr. Greene, Superintendent of the Fernald School,
began advocating for a full -time research staff, stating:
There is nowhere in the world an accumulation of
material, records., facts, and types of cases for such
work as there is to be found here.. ;
The etiological factors of mental defect are of deep
interest; also eugenic studies and the problem of
psychoses. These alone would constitute a program to
fill the entire time of such a department (Wallace 1941:
In 1937, Dr. Paul I. Yakovlev was appointed Director of Clinical
Research at the Fernald School (Wallace 1941: 155). His work was
described thus:
clinic and bio- chemical routines as well as pathological,
histological and microscopic studies, X -ray, etc, are
being carried on; research is directed to both laboratory
and clinical symptomatology and an attempt to get at
etiology --- the hereditary and environmental factors and
diagnoses and thus provide a scientific basis for therapy
and prevention of mental defect (Wallace 1941: 159)
The impact of the national Mental Hygiene movement is seen in
Chapter 277 of the Acts of 1919, which formally divided the state
into districts and established out - patient clinics served by
psychiatrists from the state institutions. Traveling clinics
consisting of a psychiatrist, psychologist, and social worker
were also instituted. These clinics helped to fulfil the
provisions of Chapter 318 of the Acts. of 1919, which called for
free clinics and a registry of the feeble- minded (Wallace 1941:
102 -103). The traveling clinic examined 1,564 patients in 1922,
and found 1,271 to be feeble- minded. It was recommended that 489
stay in grade school, 803 attend special classes, 68 be
institutionalized, and 885 attend manual and industrial training
classes (Wallace 1941:.109). By 1931 it was noted that
facilities for special classes in public schools were available
(Wallace 1941: 131).
In the 1938 annual report of the Fernald School, Superintendent
Dr. Ransom Greene.articulated the current philosophy of the
institution. Although he professed to be a believer in
tradition, his words demonstrated the vastness of change that had
occurred since the mid - nineteenth century:
C7 7
I wish to pay tribute to all the predecessors of the
position which I now hold, in that they have always been
more concerned about principles than standards and their
primary interest has been the possibility of ameliorating
the burden to society of those for whom they and we have
to care, and in addition determine, if possible, how
future generations may be protected or relieved from such
a burden....
The problem as a whole is far from simple; it involves
primarily medical knowledge and, not secondary, but in
addition, problems of education, sociology, psychology
and legal affairs .... The principles involved have been
not only that of ameliorating the. burden and immediate
stress of the individual but the.probiem as a whole from
the standpoint of welfare of our communities and
relieving them of this• burdenfor.future
generations .... This has been the aim from the time of Dr.
Howe, Dr. Sequin, Dr. Jarvis and Dr. Fernald. We are
making progress along these lines .... We have reached the
stage in the last year where we have been able to start
on a definite research program.-...the ends for which we
aspire are., based on purely the principles exemplified by
the founder of such an institution as this, Dr. Samuel
Gridley Howe." (Wallace 1941: 156 -57).
The contrast between Howe and Greene is great. While Howe
stressed individual improvement, and the responsibility of
society to help "defectives" achieve their personal best, Greene
stressed the responsibility of the schools to relieve society of
the burden they caused.
D. State Care of the Poor: 1852 -1910
The poor were cared for in local poorfarms and lock -ups until
1854, when three state almshouses were opened at Bridgewater,
Monson, and Tewksbury. These almshouses, which were almost
immediately filled to overflowing, probably did little more for
the poor than provide basic shelter and food although their
Annual Reports indicate that there were limited attempts at Moral
Treatment through Sunday religious services and work programs.
The poor received less attention than the insane, the idiots, or
juvenile delinquents because they were seen as responsible for
their condition, rather than as'victims of society. Many were
also foreign -born, lacking the' support of other groups.
A Memorial History of 1880 described the origins of the
Almshouses thus:
the State Almshouses of Massachusetts are unlike any
other charitable institutions of the country, -in that
they were established and supported by the State
government, and even here they were originally intended.
as mere temporary expedients to meet a pressing
off$
emergency. The immediate cause of their establishment
was the large influx of foreign immigration, following
the period of general famine and great distress which
prevailed through Ireland in the year 1847, and populated
the manufacturing towns of the State beyond their
capacity to provide, filling the town almshouses to
overflowing and burdening the towns with a large and
insupportable pauper dependence. Petitions for relief
poured into the legislature of 1852 from every side, and
the State Almshouses were the result (Harden 1880: 158).
Perhaps because the almshouses were built as a temporary measure,
or because classification of the poor became increasingly
refined, the almshouses were quickly turned'to,specialized
functions, which remained directed at the. poor. Monson became
the State Primary School in 1873; Bridgewate'i;(now MCI) became
the State Workhouse in 1873; and Tewksbury, the last of the three
to remain an almshouse, became the State Hospital in 1900.
State Care of the Sick: 1852 -1940
Although the symptoms of various disease's were recognized
throughout the nineteenth century and some were treated at the
poorhouses, no specialized state institutions were developed to
treat them until the end of the century. The first was.the
Massachusetts Hospital for Dipsomaniacs and Inebriates,
established at Foxborough in 1889, responding to state
legislation of 1885 that recognized alcoholism as a disease; it
was replaced by a colony at Norfolk (now MCI) in 1912. Patients
were treated in a similar fashion to those in insane hospitals,
although they were less confined. The value of labor, gymnastic
exercise, and a regular schedule were especially emphasized, as
were therapeutic baths. The intended effect of the treatment.was
described in the Annual Report of 1894:
These exercises make the mind more alert, train the
muscles and the willpower over the muscles, and so over
the man. By the muscular exercise the effete matter and
poisonous accumulations in the body, the results of
prolonged use of alcohol, are thrown off and replaced by
new tissues in the body-and brain. The bath acts as a
most powerful stimulant, especially to the nervous
system.
In 1895, the first of four state sanatoria was developed at
Rutland. The initiation of a program to treat tuberculosis at
that time reflected Robert Koch's 1882 breakthrough in isolating
the tubercle bacillus and demonstrating its causative role.
Treatment of tuberculosis at the turn of the century relied as
much on prevention as it did on cure and was thus allied with the
mental hygiene movement. Most Western nations developed complex
networks consisting of hospitals for advanced cases, sanatoria
for mild cases, and dispensaries to diagnose new cases, combined
with active public education. Treatment in the hospitals and
,Q9
sanatoria consisted of long -term bedrest, nutritious meals, and
exposure to as much fresh air as the patients condition could
withstand. Rutland's opening was followed by establishment of
other state sanatoria at Lakeville, North Reading, and Westfield
in 1907, by the creation of a county hospital system, and by the
addition of tubercular colonies to several of the existing
"insane asylums," most notably Westborough and Tewksbury.
Accompanying the growing interest in the detection, diagnosis,
and treatment of disease, the state established a research and
production (of.vaccines and antitoxins) facility at Jamaica Plain
in conjunction with Harvard University. Originally known as the
Bussey Institute, it is now the Institute of Labs.
F. State Care of Juvenile Delinquents: 1847. -1940
Juvenile reform schools sprang from the same general movement to
classify the poor that produced orphanages in the early
nineteenth century. Their founders believed that by separating
children from the corrupting influences of inadequate parents or
other adults, and placing them in an ideal and disciplined
environment, they could greatly improve their chances of becoming
productive citizens: Specialized houses of refuge began to be
established by private charities in the early nineteenth century
to reform disobedient children. They took in juvenile offenders
who had been convicted of petty crimes, wandering street arabs
picked up by local constables, and willfully disobedient children
turned over by their parents. By 1857, -the movement was broad
enough to hold a national convention of refuge superintendents in
New York, at which time it was estimated that seventeen '
institutions existed with a combined population of over 20,000
(Rothman 1971: 209). Typically, the earliest institutions
established for the care of wayward juveniles in Massachusetts
were private charities in Boston, including the Boston Female
Asylum of 1800, and the Boston Asylum for•Indigent Boys of 1814.
The Commonwealth of Massachusetts established three juvenile
reform schools in the mid - nineteenth century and a fourth in the
early twentieth century. The first step in this process was
appointment of a committee in 1846 to consider the need for a
"State Institution for the Reformation of Juvenile Offenders."
A Resolve of April 1846 authorized construction of a State Manual
Labor School. The Massachusetts State Reform School at
Westborough was established the•following year, with Theodore
Lyman supplementing the $10,000 state appropriation with his own
money and serving as president of the Board of Trustees until his
death in 1849. The institution was renamed the Lyman School for
Boys in his honor. Contemporaries noted this as the first
state- operated juvenile reformatory in the United States (Sanborn
1876: 71). It was described in the 1854 National Magazine as
the first enterprise in our country whereby a state, in
the character of a common parent, has undertaken the high
and sacred duty of rescuing and restoring her lost
5D
children, not so much by the terrors of the law as by the
gentler influences of the school (Allen 1985: 317).
In 1855, the State Reform School for Girls, renamed the State
Industrial School for Girls in 1850, was established in Lancaster
as a counterpart to the boys' institution. The State Nautical
Reform School at Marion was established in 1859 as an adjunct to
the Lyman School, providing programs for older and more hardened
boys. This followed the traditional practice of apprenticing
especially troublesome boys to ship captains, thus subjecting.
them to the exacting discipline of a long voyage (Rothman 1971:
230). The Massachusetts Industrial School for Boys was
established at Shirley in 1908. Lancaster and Shirley have been
transferred to the Department of Corrections,;while Marion has
evolved into the Massachusetts Maritime Academy.,_
The familiar tenets of Moral Treatment provided the basis for the
programs offered by reform schools nationwide. Managers of these
institutions sought to instill moral values and respect for
authority through establishment of rigid routine and enforcement
of consistent discipline. Optimism was particularly high because
the inmates were young and impressionable. The New York House of
Refuge summed up this attitude, stating that "the minds of
children, naturally pliant, can, by early instruction, be formed
and molded to our wishes" (Rothman 1971: 213). The daily routine
offered by reform schools included prayer, work, exercise, and
limited educational instruction (Rothman 1971: 225 -225, 228). By
the turn of the century, rigid mass discipline was tempered by
recognition of the role that individual love and affection play
in a child's development (Rothman 1971: 220). Architecturally,
this is reflected in the change from congregate to dispersed
campus plans characterized by moderately scaled "family " - oriented
cottages (see Lyman School).
The program and goals offered by the Lyman School were typical of
the national trends documented by Rothman. The stated goal was
to keep the boys "disciplined, instructed, employed, and
governed" until age 21 or until they were reformed, placed with a
family, or sent to prison if incorrigible. The program involved
instruction in "piety and morality, and in such branches of
useful knowledge as shall be adapted to their age and capacity,
as well as in manual labor and the arts and trades." The result
of the instruction was "to secure to the boys the benefits of
good example and wholesome instruction, and the sure means of
improvement in virtue and knowledge and thus the opportunity of
becoming intelligent, moral, useful and happy citizens of this
Commonwealth" (2nd Annual Report 1850). Mid-- twentieth century
reports indicate that the institution's programs continued to
include a mix of academic and vocational training (Governor and
Council Report 1945). All of the four reform schools have been
converted to other uses in accordance with the passage of reform
legislation in 1969.
r
31
children, not so much by the terrors of the law as by the
gentler influences of the school (Allen 1985: 317).
In 1855, the State Reform School for Girls, renamed the State
Industrial School for Girls in 1860, was established in Lancaster
as a counterpart to the boys' institution. The State Nautical
Reform School at Marion was established in 1859 as an adjunct to
the Lyman School, providing programs for older and more hardened
boys. This followed the traditional practice of apprenticing
especially troublesome boys to ship captains, thus subjecting
them to the enacting discipline of a long voyage (Rothman 1971:
230). The Massachusetts Industrial School for Boys was
established at Shirley in 1908. Lancaster and Shirley have been
transferred to the Department of Corrections ,'while Marion has
evolved into the Massachusetts Maritime Academy.:
The familiar tenets of Moral Treatment provided the basis for the
programs offered by reform schools nationwide. Managers of these
institutions sought to instill moral values and, respect for
authority through establishment of rigid routine and enforcement
of consistent discipline. Optimism was particularly high because
the inmates were young and impressionable. The New York House of
Refuge summed up this attitude, stating that "the minds of
children, naturally pliant, can, by early instruction, be formed
and molded to our wishes" (Rothman 1971: 213). The daily routine
offered by reform schools included prayer, work, exercise, and
limited educational instruction (Rothman 1971: 225- 226, -228). By
the turn of the century, rigid mass discipline was tempered by
recognition of the role that individual love and affection play
in a child's development (Rothman 1971: 220). .Architecturally,
this is reflected in the change from congregate to dispersed
campus plans characterized by moderately scaled "family " -- oriented
cottages (see Lyman School).
The program and goals offered by the Lyman School were typical of
the national trends documented -by Rothman. The stated goal was
to keep the boys "disciplined, instructed, employed, and
governed" until age 21 or until they were reformed, placed with a
family, or sent to prison if incorrigible. The program involved
instruction in "piety and morality, and in such branches of
useful knowledge as shall be adapted to their age and capacity,
as well as in manual labor and the arts and trades." The result
of the -instruction was "to secure to the boys the benefits of
good example and wholesome instruction, and the sure means of
improvement in- virtue and knowledge and thus the opportunity of
becoming intelligent,. moral, useful and happy citizens of this
Commonwealth" (2nd Annual Report 1850). Mid - twentieth century
reports indicate that the institution's programs continued to
include a mix of academic and vocational training (Governor and
Council Report 1945). All of the four reform schools have been
converted to other uses in accordance with the passage of reform
legislation in 1969.
a
Iv. Noted People Involved in the System
A. Early Advocates
Dorothea Lynde Dix (1802 -1887) was one of the most influential
humanitarian reformers.-in nineteenth- century America, devoting
most of her energies to the "insane." Writing in 1918, scholar
Henry Hurd stated, "this remarkable woman contributed more to the
general awakening of the country to the needs of the insane than
all other agencies combined. Her most important contribution
was to stimulate public awareness and involvement. She was born
in Hampden, Maine, but soon moved to her grandmother's Boston
home in 1814. Her career began in 1815, at age 14, when she
became involved in teaching, opening a day school in Worcester
that year. In 1827, she came under the influence of Dr. William
Ellery Channing, the eminent Boston Unitarian minister and
humanitarian, when she was engaged as his children's tutor.
Her involvement with the insane began when she was teaching
Sunday School to women inmates at the East Cambridge jail on
March 28, 1841, and discovered several insane women in unheated
cells. She spent the following year investigating care of the
insane in jails, asylums, and poorhouses throughout
Massachusetts, and documented her shocking findings in a January,
1843, Memorial to the Legislature of Massachusetts. Her work was
instrumental in expanding Massachusetts' facilities for the
insane with two new asylums in the 1850s at Taunton (1851) and
Northampton (1855). She also attracted noted psychiatrist Pliny
Earle'to the latter institution. From 1843 to 1851, she expanded
her efforts to most of the eastern United States and Canada, and
in thirty -two cases was directly responsible for construction of
public insane asylums. In 1851 she was appointed superintendent
of women nurses by Secretary of War Cameron, a position she held
throughout the Civil War. She returned to advocacy for the
insane in 1855. In 1882, declining health caused her to retire
to an apartment at the New Jersey State Lunatic Asylum at
Trenton, the first hospital established as a direct result of her
efforts. She died there on July 17, 1887, and was buried at Mt.
Auburn Cemetery in Cambridge, Massachusetts (Johnson 1904: I11;
Muccigrosso 1988: 399 -403).
Theodore Lyman (1792 - -1849) was an author, politician,
philanthropist, and member of an-old, wealthy, and illustrious
Boston family. He graduated from Harvard in 1810 and studied in
Europe until 1819. From 1820 -1825 he served in the state
legislature as a member, of the.'Federalist party, actively
campaigned for and supported President Jackson in the late 1820s,
and served as mayor of Boston from 1832 to 1835. Lyman's later
life was devoted to philanthropy. His involvement as president
of the Board of the Boston Farm School, a private charity devoted
to "morally exposed" children, introduced him to the issue of
reform schools. 'One, of his major achievements was establishment
of the nation's -first state reform school* at Westborough in 1845,
supplementing the $10,000 appropriation with his own money, and
serving as president of the Board of Trustees. Lyman donated an
33
additional $22,500 to the school before his death in 1849, and
left a $50,000 bequest in his will. The school was named the
Lyman School for Boys in his honor (Johnson 1904: VII; Malone
1935: IV, 518; see form for Lyman School).
B. Hospital Administrators /Physicians
Pliny Earle (1809 -- 1892), whose career spanned the period
1840 -1892, was one of the most eminent psychiatrists of the
nineteenth century, with an unusual knowledge of both American
and European asylums and an extensive body of publications to his
credit. He was born in Leicester, Massachusetts, and educated at
the Friend's School in Providence, where he taught and served as
principal from the time of his graduation.ift,1828 until 1835. In
1837 he earned a medical degree from the University of
Pennsylvania, followed by a year in Parisian general hospitals
and a second year touring European insane asylums. Returning to
the United States, he was appointed Superintendent of the
Friend's Hospital for the Insane at Frankford, Pennsylvania in
1840, and Superintendent of the Bloomingdale Asylum for the
Insane in New York City in 1843. From 1845 to' 1853, he returned
to Europe to continue his study of asylums there. In 1853 he
opened a private psychiatric practice in New York, was appointed
visiting physician to the New York City Insane Asylum, and
continued to lecture and publish. During the Civil War
(1862 - -1864) he served at the Government Hospital for the Insane
at Washington. Influenced by Dorothea Dix, his last appointment
was at the Northampton Lunatic Hospital, where he served as
Superintendent and Physician in Chief from 1864 until 1885 and
remained in association until his death. It was here that, he
wrote his famous essays on "The Curability of Insanity" in the
1870s. Earle was co-- founder of the American Medical Association,
the American Medico - Psychological Association, the Association of
Medical Superintendents of American Institutions for the Insane,
and the New England Psychological Society (Johnson 1904: III;
Malone 1935: III, 595 -96; see form for Northampton State
Hospital).
Dr. Walter E. Fernald (1859 -1924) was the third superintendent of
the Massachusetts School for the Feeble - Minded, serving for 37
years, from 1887 until his death in 1924. The following year,
Chapter 293 renamed the institution as the Walter E. Fernald
State School in his honor. He was a native of Kittery, Maine,
and a graduate of Bowdoin Medical School. As the British
Commission had noted in 1905, Fernald was a renowned authority on
mental retardation with many publications to his credit. These
included the History of the Treatment of the Feeble-Minded
(1895), Some of the Methods Employed in the Care and Training of
Feeble- Minded Children (1894), Feeble- Minded Children (1887),
Care of the Feeble - Minded (1904), and Imbeciles with Criminal
Instincts (1909). A eulogy.. published in the 1924 Annual Report
of the Fernald School described Dr. Fernald's distinctions and
achievements in greater detail.
3 �'
His achievements as an educator have been far - reaching.
He recognized the first step in education of the
feeble- minded was to make them happy; that the
feeble - minded, like other persons, are happy only when
they are doing something for which their capacity fits
them. He arranged a 24 -hour program in which the child
is doing all the time, whatever its capacities demanded.
This school became in a real sense a university. During
the past year individuals and delegates were sent from 28,
states and 13 countries and 4 provinces in Canada. He
gave lectures to medical students, to teachers of special
classes, public health nurses, physicians taking
post - graduate work in pediatrics, psychiatry, etc. As an
organizer he standardized everything:he undertook,
whether in erecting a building,, clearing a field of
stones, etc. His scientific standing was widely
recognized. In 1912 he received the honorary degree of
Master of Arts at Harvard. He was widely sought as a
lecturer on mental disease and criminology. Twice
President of the Association for the Study of the
Feeble - Minded, in 1915 and 1924, he was at the time
of his death, President of the Massachusetts Society of
Psychiatry and the Boston School of occupational Therapy.
He was a leader in the National Society of Mental
Hygiene. He was the originator of the ten -point system
for testing and classifying of the feeble - minded. He
proved the psychological tests alone were not enough. He
secured practically every piece of legislation that had
anything to do with these subjects for the last 30 years.
Samuel Gridley Howe (1801 -1876) of Boston was an educator and
"champion of peoples and persons laboring under disability." He
graduated from Brown in 1821, received a medical degree from
Harvard in 1824, then spent six years as a surgeon in the Greek
War for Independence. Returning to the United States in 1831, he-
was engaged to run the newly incorporated Massachusetts School
for the Blind, which he started in his father's house with six
pupils. His successful forty -four -year directorship resulted in
establishment of the noted Perkins Institution for the Blind. At
the same time, Howe started an experimental school for the
training of "idiots," which resulted in establishment of the
Massachusetts School for Idiotic and Feeble- Minded Youth at South
Boston in 1848. This was the first.state --run facility of its
type in the nation. Howe served as Superintendent from
1848 -1875. The indefatigable Howe also supported Horace Mann in
his crusade for better:-public schools and normal schools, helped
Dorothea Dix in her efforts on behalf of the insane, agitated for
prison reform, and was involved in the abolitionist movement. He
also served as the chairman of the pioneering Massachusetts Board
of State Charities from 1865 -1874, where he had the opportunity
to fully articulate his views on public charity (Johnson 1904: V;
Malone 1935: V, 296 -297; see form for Fernald School) .
3 �,
Edouard Seguin (1812 -80) was the first to develop a comprehensive
and widely accepted system for training of "idiots" in the early
nineteenth century. He was born in Clemecy, France, to.a family
of distinguished physicians. During his medical training he
became interested in psychiatry, and especially the study of
"idiots." He established a training school in 1839, and in 1844
received the approval of several medical bodies and academies
including the Paris Academy of Sciences. His training method was
based on the premise that the "idiot's" brain was not diseased,
but arrested in its growth. His chief work, the Traitement
Moral, Hycr_iene et Education des Idiots, was published in 1846.
A few years, later he emigrated to the United.-States and became
involved in various schools and institutions throughout the
country, including the new Massachusetts - School for Idiotic and
Feeble -- Minded Youth at South Boston (1848.),. In ,.1866, he
published a second book, IdiocV_an_d I_ts. TreaEment by the
Physi.ological'Method, which especially influenced the development
of English and American treatment methods (Johnson 1904: IX;
Malone 1935: VIII, 559 -60; see form for Fernald School).
C. Architects /Designers
Elbridge Boyden (1810 -1898) designed the fine Renaissance
Revival -style main building at the Taunton State Hospital for the
Insane in 1851. This remains as the oldest extant insane asylum
in the system, and as an excellent example of the influential
"Kirkbride" plan. Boyden was born in Somerset, Vermont, trained
with Athol house carpenter Joel Stratton, and studied the
published works of Asher Benjamin. He moved to Worcester,
Massachusetts, in 1844, where he started his own architectural
practice. He no doubt became familiar with the state's first
insane asylum of 1830, which was in the center section of that
city. Mechanics Hall of.1854 is one of his best -known works.
Others include the Bannister House (Harvard St. 1844), the East
Worcester (1863) and Cambridge Street (1869) Schools, the
Cathedral of St. Paul (1869), and the Webster Street Firehouse
(1893). He also designed the Worcester County Superior
Courthouse in Fitchburg (1871) and prepared a landscape plan for
Falmouth Heights (1870). Boyden also worked throughout the
midwest and had plans published in national magazines. and pattern
books such as those by A. J. Bicknell (Jenkins 1992: 5 -6;
Worcester Survey).
Brigham & Spofford: Charles Brigham (1841 -1925) and John C.
Spofford (1854 - ?) , who were in, partnership after 1888, designed
the Massachusetts Hospital for Dipsomaniacs and Inebriates at
Foxborough in 1889. Mr. Brigham, who had previously been in
partnership with John Sturgis from 1866 -1886, was a charter
member of the Boston Society of Architects. Brigham & Sturgis
designed the Boston Museum of Fine Arts at Copley Square (1876)
and the Church of the Advent (1880), also in Boston. Mr.
Spofford began his career as a draftsman with Brigham & Sturgis.
Brigham & Spofford are noted for their public institutional
commissions, including the rear wing of the Massachusetts State
91
House (1889 -95), the Memorial Hall at Belfast, Maine, the City
Hall at Lewiston, Maine, and several public buildings in
Fairhaven, Massachusetts, including the Town Hall (1894), High
School (1905), and Library (Withey 1970: 76 -77, 565 -66; Mass.
State House HSR 1984).
Elias Carter (1783 -1864) and James Savage designed the original
building at the Lyman School for Boys (now Westborough State
Hospital) which is the oldest extant component of the
Massachusetts Hospital and School system. Apparently
self- trained as an architect, Carter was born in Brimfield and
spent most of his career in nearby Worcester. He is particularly
noted for his fine Greek Revival -style mansions, including the
Governor Levi Lincoln House (1834). Other works include the
Second Unitarian Church (1828), the Union'Chu,rch (1835- 1837), and
the City Insane Hospital, all in Worcester. Elsewhere he
designed a church at Templeton (1811), the First Parish Church at
Mendon, and the Insane Hospital at Concord, New Hampshire (Withey
1970: 112; Worcester Survey).
George Clough (1843 -1916) was responsible for early construction
at the new Lyman School for Boys and for remodeling the old
campus for use as Westborough State Hos ital. Clough was born in
Blue Hill, Maine, studied architecture in the Boston office of
Snell & Gregerson, and established his own practice in that city
in 1869. He is perhaps best known for his service as the Boston
City Architect from 1875 to 1885. Some of his most notable works
include the Boston English and Latin Schools (1877), the Suffolk
County Courthouse (1886), St. Mark's Church in Brookline
(1892 --96), and the Soldiers' Home in Chelsea (Withey 1970: 127).
Autos P. Cutting (d. 1896), as a partner in the firm of Cutting
Holman, designed a major addition to the Lyman School now
Westborough State Hospital) in 1876. Cutting was a native of New
England and maintained a practice in Worcester. His work,
particularly churches, was noted as scholarly and correct. He
designed the Franklin - Wesson House in Worcester in 1874 and the
New Hampshire State Library at Concord in 1889. Cutting died in
Los Angeles (Withey 1970: 157; Worcester Survey).
Stephen C. Earle (1839 -1913) designed buildings at both the Lyman
School and Westborough State-Hospital in 1889 -1890. Earle was
born in Leicester, Massachusetts, and studied architecture at
M.I.T. He-opened a practice in Worcester after the Civil War,
and soon went into partnership�'with James Fuller, with whom he
designed the Church of,All Saints. From 1872 -1875, he practiced
in Boston, then returned to Worcester. From 1892 to 1903, he
practiced with Clellan W. Fisher, designing St. Matthews
Episcopal Church (1888) and the Worcester Art.Museum (1897) as
well as many other public and private commissions.-,,Earle is
especially noted for his skill in the Queen Anne style, which is
employed for the buildings at Westborough and the Lyman School
(Withey 1970: 186 -187; Worcester survey).
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John A. Fox (1835 -1920) designed the Administration Building and
several others at the Tewksbury State Hosj2ital during its
conversion from an almshouse in the 1890s. In 1902 he was
selected as architect for the Gardner State Colony for the Insane
(now a prison and not included in this nomination). Fox was born
in Newburyport and was educated at Dorchester High School. He
trained with the civil engineering firm of Garbett & Wood and was
later a draftsman with Ware & Van Brunt. He designed several
institutional buildings including the Boston Museum (1870), the
New Theatre at Brockton (1873), and the Provincetown Town Hall
(1886) . Mr. Fox was a charter member of the Boston Society of
Architects (Withey 1970: 217 - 218).
Kendall, Taylor & Co. was a well -known Bostori,_firm at the turn of
the century that specialized in hospital. design,. Not
surprisingly, Henry H. Kendall (1855 - 1943), Albert S. Kendall
(1883 - -1941) and Bertrand E. Taylor (1855 -1909) designed buildings
at several state hospital and school campuses including
Worcester, Monson_ (_1910), Westborough (1897, 1902), Wrentham
1907 Mass. Mental Health Center 1910 Belchertown 1920s
and Taunton (1930s) . Henry Kendall was born in New Braintree,
studied architecture at M.I.T., and trained in the office of
William G. Preston... From 1879 -1889 he served as Assistant to the
Supervising Architect of the Treasury. Albert Kendall, who was
Henry's son, graduated from Harvard in 1905 and trained in his
father's office, soon becoming a partner. Mr. Taylor was born in
St. Johnsbury, Vermont, trained in the Boston office of Ober &
Rand, and attended classes at M.I.T. Other partners in this
firm included Edward F. Stevens (1860 -1946) and George Dutton
Rand. Rand, practicing as part of the firm Weston and Rand,
designed the Worcester Lunatic Hospital in 1870. In addition to
their Massachusetts state hospital and school work, the firm
designed buildings at the New Hampshire Hospital for the Insane,
Hitchcock Hospital at Hanover, Massachusetts; the City,
Homeopathic, and Corey Hill Hospitals at Boston, and the Newton
City Hospital (Withey 1970: 339 -340, 590).
Jonathan Preston (1801 -1888) designed the main building at
Northampton Lunatic Hospital of 1855. He was noted as one of the
most accomplished Boston architects of the mid -- nineteenth
century. He designed several notable buildings such as the
original Massachusetts Institute of Technology (1864) and the
companion Museum of Natural History (1864) in Back Bay with his
son William G. Preston. He is also credited with the Church
Green Building (1873) in Boston (Withey 1970: 486; Boston
Survey) .
William Gibbons Preston (1844 - -1910) designed numerous early
buildings at the Fernald__ School, the Lyman School, and the
Industrial School for Girls. The sot of architect Jonathan
Preston, he was educated at Harvard and the Ecole des Beaux -Artes
in addition to training in his father's office. Some of his
notable buildings include the First Corps of Cadets Armory
(1891- 1897), the Hotel Vendome (1871), the Chadwick Leadworks
M.
(1887), and the International Trust Company Building (1906), all
in Boston; the Central Exchange Building in Worcester (1895); and
the Cotton Exchange Building and First Presbyterian Church, both
in Savannah, Georgia (Withey 1970: 487; Boston Survey).
Gordon Robb designed Metropolitan State Hos ital in 1927 -1930 as
well as.buildings at several other state campuses including
Taunton and Northampton. His Met State buildings served as
models for 1930s expansion throughout the system. Little is
known about this architect other than the fact that he maintained
an office in Boston from 1925 -1930, 1932 -1940, and 1944 -1959
(COPAR Directory of Boston Architects 1846 - 1970).
William Pitt Wentworth (1839 -1896) designed the Medfield Insane
Asylum in 1892 as the state's first "cottage" -plan hospital; it
exhibits a highly unusual mirror -image site plan. Wentworth was
a native of Vermont who was educated in New York City. He
returned to New England where he practiced in Boston for thirty
years. Wentworth was especially noted for his church and
hospital designs. Other works included the Church of the Messiah
in Woods Hole, Massachusetts (1888); the Flower Memorial Church
in Watertown, New York; the Washington Home in Boston; and
several residences in Cambridge (Withey 1970: 644; AABN Obituary
4/18/1896: 22; Falmouth Survey).
V. Physical Developments: Architecture and Landscape
Massachusetts developed an extensive system of at least
thirty -one state hospitals and schools during the one-hundred-
year period from 1830 -1930. These included thirteen hospitals
for the mentally disturbed, three schools and one farm for the
mentally retarded, four juvenile reform schools, three
almshouses, four tuberculosis sanatoria, one hospital for
alcoholics, one hospital for crippled children, and a
laboratory /research facility. One third were located in or near
the Boston metropolitan area to serve the state's major
population center, while the remainder were dispersed across the
state to provide equal access to citizens of the southeastern,
northeastern, central, and western sections.
Development of this multi - faceted asylum system obviously
responded to the needs of dependent citizens. It can also be
seen within a broader context in which a wide range of
institutions was being created to both serve and symbolize the
values of a new nation in the post - Revolutionary period. These
included capitol buildings, post offices, courthouses, custom
houses, naval hospitals, etc. In The Federal Presence, Lois Craig
notes that public buildings and institutions reveal society's
intentions and reflect changing notions about the proper. extent
of the public domain (Craig 1978: xiv -xv) . The vast numbers and
variety of institutional buildings created in the nineteenth
century provide clear evidence of the growing importance of the
public domain. Asylums are just one type of institution that
3q
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arose and proliferated after the Revolution to serve an
increasingly complex society.
Nineteenth - century treatment methods for dependent citizens
relied heavily on physical setting, so institutions were located
in rural or at least semi -rural areas to provide a sense of
tranquility. This also helped to avoid dissention from neighbors
while keeping acquisition costs as low as possible. When three
of the four earliest facilities (pre -1850) were engulfed_ by urban.
expansion in the second half of the nineteenth century, they
solved the problem in two ways. The Worcester Insane Asylum
developed an extensive farm colony at nearby Grafton in the early
twentieth century, while the Boston Lunatic Hospital and the
Massachusetts School for the Feeble- Minded sold their cramped
South Boston quarters and moved to the suburbs in 1895 and 1887,
respectively.
Generally the state looked for well - drained hilltop sites with
good farmland and an adequate water supply that were somewhat
removed from population centers but in proximity to a railroad
line. The sites were developed with either a massive centralized
"Kirkbride" structure or, from the 1880s' through 1920, with
dispersed "cottages ". serving patient, staff, administrative, and
support functions. The first cottage -plan state institutions in
Massachusetts were the new Lyman (Reform) School of 1884, the new
Massachusetts School for the Feeble - Minded of 1887, and the
Medfield Insane Asylum of 1892. Colony -plan campuses like
Templeton (1899) , Gardner (1900; now MCI), and Grafton (1901) are
a subset of the cottageplan. Devoted to chronic care in a rural,
agricultural setting, they consist of loosely grouped satellite
colonies united under a common administration.
Nineteenth - century campuses were often designed by the best
architects of the period, and they still evidence an exceptional
quality of construction and attention to architectural detail.
As construction increased by the turn of the century, less
prominent architects were usually employed. By the 1910s and
1920s, standardized designs began to appear in response to the
ever- increasing size of the system.
Chapter 451 of the Acts of 1900 .directed the state to take
responsibility for all mentally ill citizens, relieving towns of
any responsibility. Similar legislation in 1908 affected the
retarded and epileptic. As a result of this massive expansion of
the system, the Board of Insanity conducted a system -wide review
to establish uniform standards of capacity that could be applied
to each campus to avoid overcrowding. Capacity was computed on
the basis of fresh air supply, ability to introduce air without
causing drafts, and amount of floor area necessary to avoid
confrontations between patients. The factors taken into account
included methods of ventilation, heating,and lighting, type of
building (especially the extent of outside walls and windows) ,
the dimensions of rooms and height of, stories, the character or
classification of the patients, and constancy of their presence.
�a
That standard, developed in 1906, specified fifty feet per
patient in day rooms, an equal amount in dormitories, and 100
square feet in rooms used continuously by the sick in bed or
other classes, with the exception that in buildings where the
patients are all quiet, clean, able - bodied, and
out -of -doors most of the day, the day space has been reduced to
30 square feet (Department 1926: 105).
Later, the standard was modified to thirty square feet per
patient in day rooms, 50 square feet in dormitories with the
exception that 100 square feet be used in rooms occupied by the
newly admitted and acutely sick classes, by tubercular, adult
epileptic or disturbed patients, by patients who are both noisy
and untidy, and by patients suffering from acute physical
disease, the 100 square feet to be either 'in rooms occupied both
night and day or 50 square feet in day rooms 'and 50 square feet
in dormitories (Department 1926: 108).
Standardization of design was first implemented at Metropolitan
State Hospital of 1927 -1930, and then through expansion at other
hospitals for the mentally ill. Metropolitan State Hospital
represented the final evolutionary step in the mental hospital
form, by combining the economies of the congregate plan with the
greater intimacy of 'the cottage plan. The use of similar campus
plans and buildings at the Wrentham State School. (1906) and the
Belchertown State School (1922) also reflect the move toward
standardization.
In all cases and throughout the period of significance, the
grounds around the buildings were generally landscaped wit#
specimen trees, flower gardens, and meandering paths to encourage
out -of -doors activities. Support buildings, including
powerplants, workshops, and barns, were located in peripheral
areas with the whole surrounded by agricultural fields and
woodlands. The agricultural land provided important
opportunities for patients to work, develop habits of industry,
and acquire self- esteem, while providing limited economic support
for the institution. Many campuses include one or more
pre- existing farmhouses or barns. These were reused for
institutional purposes to save money and to allow quicker
occupation of the site.
A. Insane Asylums
Moral Treatment, which was the dominant philosophy of
institutional managers. during much of the nineteenth century,
relied heavily on creation of an ideal physical environment.
Thus, great emphasis was placed on a tranquil natural setting,
appropriate architecture, and to a lesser extent, landscape
refinements. While Americans could and did look to Europe for
models of treatment, they found little to guide them in the area
of architectural design since Europeans tended to reuse
monasteries, forts, or prisons (Rothman 1971: 135). Lacking this
supply of existing large -scale institutional buildings, Americans
off
were forced to develop their own. In so doing, they scrutinized
one another efforts closely and engaged in heated debates about
the proper form, either congregate or dispersed, that hospitals
should take to achieve the goals of Moral Treatment.
Local poorfarms, which generally resembled contemporary two -
story, wood - frame, rectangular -plan farmhouses, appear to have
served as the model for the earliest asylums erected in
Massachusetts and other states. Asylum builders generally
employed masonry rather than wood as a more durable and fireproof
construction material, however, and frequently followed classical
tradition in extending the central structure with symmetrically
designed lateral wings and end pavilions. The best example of
this early form-in the Massachusetts system`wAs Elias Carter's
Worcester Asylum, which was designed for 130 in 1830, expanded to
320 in the 1840s, and demolished in the'19706. As shown in early
engravings, it consisted of a four -story rectangular block
flanked by three -story lateral wings that were extended by two -
story wings in the mid- 1840s. Stylistically, it retained the
flat planar quality of the Federal period while adding
fashionable Greek Revival style accents such as a two - -story
pentastyle Doric portico. Late nineteenth- century city atlases
show that it had sprouted additional wings by that time.
Dr. Thomas S. Kirkbride, head of the prestigious Pennsylvania
Hospital for the Insane from its opening in 1840 until his death
in 1883, was the first to develop an institutional model
acceptable to the majority of his colleagues. Described in his
influential textbook of 1847, On the Construction, Organization,
and General Arrangements of Hospitals for the Insane with some
Remarks on Insanity -and its Treatment, the congregate "Kirkbride"
hospital represented a refinement of the Worcester type,
compressing and adding wings to create a large, highly
centralized building consisting of an administrative core flanked
by numerous stepped -back patient wings. The core housed kitchen,
storerooms, reception areas, business and medical offices,
chapel, library, and living quarters for the superintendent and
medical officers, while the wings included rooms for nurses and
attendants as well as patients.' New wings could be added as
needed, and their division into wards allowed for classification
and separation of patients by behavioral symptoms as well as sex.
Taunton (1851) and Northampton (1855), both of which were
constructed to house Kirkbride's..limit of 250 patients and
expanded in the late-nineteenth 'century, provide good examples of
this additive, centralized quality.
Kirkbride's treatise was based on 26 propositions concerning
construction and administration. Together, it was believed that
these propositions would produce an ideal physical and behavioral
environment that would counteract the - deficiencies of society at
large while providing a model for its reform. He specified that
hospitals for the "insane" should be built in the country, where
they could be set on grounds of at least 100 acres to provide an
abundance of fresh air, that they should be of fireproof masonry
42
construction with slate or metal roofs, that they should be
organized with a central administrative core flanked by wings
with "excitable" patients housed in the outermost sections, and
that they should be composed of eight wards housing a maximum
total of 250 patients separated according to sex and class of
mental illness. Details were considered as well, including the
proper location of heating /ventilating ducts, the best type of
plaster, and the optimal room width and ceiling height. He and
others believed that insanity would eventually be understood and
cured through solution of technical problems such as these.
"Kirkbride" hospitals received the official endorsement of the
influential Association of Medical Superintendents of American
Institutions for the Insane from 1851 to 1888,,(Deutsch 1949:
211 -212). They were built in all of the states throughout the
nineteenth century, dominated architectural discussions at least
through the 1870s, and represented the initial triumph of the
centralized congregate system of organization. Even examples
dating from the turn of the century followed Kirkbride's ideas
closely with the exception of his 250 -- patient limit, which had
been raised to 600 in 1866 and 1,000 by 1900. These buildings
were widely adopted because they embodied prevailing psychiatric
theories such as:
separation of patients from the community; creation of a
new therapeutic environment; the importance of
classifying patients; the dominant and controlling role
of the psychiatrist/ superintendent; and reassurance to
the family and community that patients would be cared for
in a secure moral and medical environment that would
promote their comfort, happiness, and even recovery (Grob
1983: 12).
The Commonwealth of Massachusetts, demonstrating currency with
national ideas, erected four "Kirkbride" hospitals at Taunton
(1851), Northampton (1855), Worcester (1870; -NR 1980), and
Danvers (1873; NR 1984). All four were designed by well - known
architects, and all except Worcester remain in near - original form
despite years of neglect, displaying Kirkbride`s tenets including
setting, plan, and use of fireproof materials. Worcester,
portions of which still stand despite a devastating fire in 1991,
well illustrates the effectiveness of nineteenth- century
fireproof construction.
Taunton, the oldest extant "insane" hospital in the state, is the
most important of these four due to its age and its exceptional
architectural quality. Designed by Worcester architect Elbridge
Boyden in an early use of the Renaissance Revival style, it is a
three - story, red - -brick building trimmed with cast -iron Corinthian
pilasters supporting a cast iron cornice. Its long central
section is organized with pedimented central and end pavilions
surmounted by Baroque domes that appear to have served
ventilating as well as decorative purposes. Typically, a
dining /kitchen ell is attached to the rear of the central
43
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pavilion while patient wings extend back from the end pavilions.
These wings, in turn, are extended laterally and then joined to
freestanding end pavilions by elegant curved, glazed second -story
walkways. The outer wings are shown on the original plans for
the building but were not constructed until 1875 and 1909.
Boyden (1819 -1896) was a nationally recognized architect with
domestic designs published in contemporary pattern books. One of
his best known Massachusetts buildings is Worcester's Mechanics
Hall (NR), also designed in the Renaissance Revival style.
Northampton offers a contrast to the rich architectural
sophistication of Taunton in its rather naive handling of the
Gothic Revival style. It nevertheless.closely follows
Kirkbride's plan and siting principles. I.t"was designed by
Jonathan Preston (1801 - 1888), a well -- known - Boston
builder /architect who went on to practice with his son William
Gibbons Preston (see Fernald School, Waltham). Worcester (NR
1980) and Danvers (NR 1984), which are similar institutions
designed in the High Victorian Gothic style, are constructed of
granite with red brick trim and red brick with granite trim,
respectively. Designed for the new patient limit of 600, they
are substantially larger than their predecessors. Worcester is
important as the first hospital designed by the firm of Weston
and Rand, later succeeded by Rand, Taylor, Kendall, and Stevens,p
architects of numerous twentieth - century state hospital and
school buildings. Danvers was designed by noted Boston architect
Nathaniel J. Bradlee (1829 -1888) as an adaptation of an unbuilt
1867 design for an insane asylum at Winthrop.
Danvers, the last of Massachusetts' great congregate "Kirkbride"
hospitals, was followed by the Westborough Insane Hospital of
1884. As Westborough was a reuse of the old congregate Lyman
School building (see Reform Schools), it falls somewhat outside
the congregate /dispersed argument. Nevertheless, the 1880s
renovations did create one immense congregate structure, larger
than any of the preceding "Kirkbride "- design hospitals, fully
illustrating the abandonment of the original 250 - patient limit
for asylum buildings.
All subsequent hospitals and schools followed some variant of the
dispersed cottage plan, which consisted of relatively small -scale
freestanding buildings where patients were separated and
Classified as they had-been under the old -ward system. The new
plan came into favor because it allowed a more personal level of
care and treatment by helping to reduce density within buildings
as hospital populations.increas -ed rapidly. The rise of cottage
hospitals is closely linked with the need to provide comfortable
long -term accommodations for chronic patients. McLean Hospital
in Belmont, Massachusetts, designed in 1875 - -1891, represents the
"first full -- fledged cottage plan mental hospital in America"
(Zimmer 1983: 7). The trustees of this noted private institution
specifically chose the cottage plan to distinguish themselves
from state institutions. The chairman of the building committee
t'
44
described their intent thus during the facility's early planning
stages in 1875:
I think you are aware that we do not intend following the
present fashion of State Asylums, such as are now
building at Worcester and Danvers in this state, at
Buffalo etc. in others, but on the contrary to avoid both
the structural appearance and the economical methods,
which are, probably, all right in them - -- but to adopt
to a liberal extent what may be called a domestic plan,
in distinction to that of a
public institution (Zimmer 1983: 4).
The therapeutic intent of the proposed plan, and its relation to
the principles of medical class if ication,, was described by
Superintendent Cowles in 1882:
The proposition for new buildings was to erect a number
of cottages surrounding a large one for administrative
purposes, and thus allowing the placing of patients
similarly affected in a house by themselves, where they
might have their own degrees of, mental disease. Also
much benefit was anticipated from the use of the
beautiful grounds, and from the pleasant drives possible
in all directions (Zimmer 1983: 7).
The earliest and most noteworthy of the state's cottage -plan
hospitals is the Medfield Insane Asylum, erected in 1892,
concurrently with McLean. Designed by Boston architect William
Pitt Wentworth (1839- 1896), the hospital follows a unique and
complex plan of mirror -image wards facing onto a central green
that contained a chapel, a congregate dining room, and power
plant. The hospital campus, which resembles that of a college,
seems to have been inspired by the homey vision of New England
town commons. In this case, and most others, the individual
buildings took the place of the old ward system, more fully
classifying and separating patients into behavioral categories
such as "quiet," "untidy," "excited," and "epileptic." Given the
linkage between rising chronic populations and development of the
cottage plan, it is not surprising that the state's first
cottage "plan insane asylum was devoted to chronic care.
During the late - nineteenth and early twentieth centuries, all of
the monolithic congregate hospital campuses were expanded with
smaller -scale buildings for patients and staff, adding a
dispersed component to:their characters. Additionally, isolated
colonies for the quiet, chronic insane began to be erected at
several hospitals at the turn of the century, including Medfield,
Danvers, and Westborough. At Tewksbury, which served as the
state pauper hospital, including cases of both physical and
mental disease, colonies for tubercular patients were added.
This architectural development is a direct reflection of the
changing patient population, which included increasing numbers of
the aged and senile.
146-
Colony --plan campuses developed as a variant of the cottage plan
in response to Chapter 451 of the Acts of 1900, which directed
the state to take responsibility for all insane persons. That
piece of legislation provided for establishment of the State
Colony for the Insane to house the expected influx of chronic
cases. Gardner has since been converted to a state prison.
Grafton State Hospital remains as the most intact of the
colony -type campuses. It was established in 1901 as a rural
conjunct of the old Worcester Insane Asylum of 1830 which had
itself been relegated to the status of a chronic -care facility in
1877. Developed in the early twentieth century, Grafton
consisted of four sub - colonies, united under one administration.
Each colony was characterized by freestanding,wards of varying
size, staff housing, and support buildings. Many were designed
for quiet patients in a rustic Craftsman -style mode, featuring
natural fieldstone basement stories with shingled or clapboarded
upper stories and overhanging bracketed roofs. Larger -scale
masonry structures, reminiscent of the old "Kirkbride" buildings,
were erected for "excited" patients..
The Commonwealth's last facility for the- "insane" was the
Metropolitan State Hospital of 1927 -1930 in Waltham, which
consciously combined the economies of congregate -plan hospitals
with the greater individuality of dispersed plans. Designed by
Gordon S. Robb, another little -known Boston architect, it is
important because its Colonial Revival style buildings responded
to the need for standardization and served as the model for
post -1927 additions to most other hospital campuses. Its Y --plan
infirmary and use of hopper sash designed to prevent escapes were
particularly influential. It is unique in that almost all of its
buildings were constructed during the late 1920s and early 1930s,
creating an architectural unity unknown at other hospitals with
the possible exception of Medfield.
All of the state's nineteenth- century hospitals include buildings
from throughout their history, as they were expanded to meet
ever -- growing patient populations, often many times the size of
those originally projected and provided for. Typical additions
include patient wards, dormitories for nurses and attendants,
single - family houses following contemporary.suburban designs for
doctors and administrators, chapels, powerplants, laundries,
workshops, and farm buildings. Cemeteries are often included as
well. Generally, wards are constructed as additions to the main
complex or adjacent to it, staff residences are scattered in the
front and to the side, while support and farm buildings are
located in peripheral areas, often to the rear. Many campuses
received large H -plan admissions buildings in the 1950s and 1960s
as the result of a 1954 systemwide analysis of needs.
B. Schools for the Mentally Retarded
The state erected three schools for the mentally retarded, all on
the "cottage" plan. The first was the Massachusetts School for
0
the Feeble- Minded, established in South Boston in a
mid - nineteenth century wood -frame building of domestic appearance
(photographs at Mass. State Archives). When the school moved to
Waltham in 1887, William Gibbons Preston of Boston and an unknown
landscape architect were hired to give it form. The campus was
laid out with reference to the natural contours of the site, and
original wards faced south to allow the patients as much sun as
possible. Preston's buildings and succeeding ones are handsome
examples of the Queen Anne and Romanesque Revival styles
characterized by red brick. construction,, rockfaced sandstone
trim, wide - arched entries, and fieldstone foundations dug and
assembled by adult male patients as part of their work therapy
programs.
Wrentham (1906 -1907) and Belchertown (191571922) represent a
standardization of building and site planning. Both are
characterized by a tight rectangular site plan developed with
similar cruciform patient wards and stuccoed staff cottages.
Buildings are designed in the Craftsman and Colonial Revival
styles. Both were designed by Kendall & Taylor, who specialized
in hospital design and were the state's most frequently employed
early twentieth - century firm.
The Templeton Colony of the Fernald School was established in
1900 as a unique facility devoted to the care of chronic male
adults who had been trained at the parent institution. It was
developed with four dispersed sub - colonies, established around
the nuclei of existing farmsteads. Some of the finest
late - eighteenth and early nineteenth century dwellings in the
system remain here. New buildings were designed in a rustic mode
by noted architect William Gibbons Preston. Both the colony plan
and rustic buildings were similar to those at Grafton State -_
Hospital, one of the state's primary chronic facilities for the
insane. Templeton includes 2,600 acres of hilly agricultural
fields and woodland, reflecting the facility's strong emphasis on
supervised exercise and farmwork in a healthy out -of -doors
environment.
The state schools were developed with the same building types as
the insane asylums, including administration buildings, patient
wards, staff dorms and houses, support buildings, and farm
groups. Both schools and hospitals considered farm work to be an
integral part of patient work therapy programs as well as a
prudent economic measure, often-keeping their budgets in the
black. Special, less restrictive dormitories were often erected
for patients who worked_ on the farm. Schools differed from
insane asylums in that they had special classroom buildings, and
more frequently employed patients in construction, particularly
the erection of foundations from fieldstone found on the site and
the laying out of roads.
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C. Reform Schools
Only the Lyman School for Boys was included in the survey upon
which this nomination is based (see Methodology). Thus,
discussion will be limited to its initial development on the
eastern shore of Lake Chauncy in Westborough (1848), and its
subsequent move to the lake's western shore in 1884. The
original Lyman School of 1848 was designed by Elias Carter and
James Savage in a transitional Greek Revival /Italianate style.
Constructed of brick with granite and terra cotta trim, it is a
rather severe structure with a three -story central core flanked
by two -story wings that extend backward (see Lyman School for
description, early plans, and engravings; see,Westborough State
Hospital for photos) . Carter (1783 - 1864),. aru,early Worcester
architect with numerous public buildings to. his .credit, including
insane asylums, was particularly noted for his elaborate Greek
Revival - -style mansions. The school was expanded in 1876 by the
Worcester firm of Cutting and Holman. Soon thereafter, this
large congregate -plan building 'was declared unfit for a school
due to its size and jail --like appearance, despite the fact that
the commissioners had originally specified that it should be
substantial but not ornate, and not look like a jail.
The jail -like appearance of the original Lyman School is
consistent with the character of reform schools or houses of
refuge nationwide. Rothman describes the contemporary New York
House of Refuge thus:
The institution's architecture was as monotonous as its
timetable. Boys and girls occupied separate buildings,
each structure of bare brick and unvarying design; as _.the
refuge expanded, adding more wings, the repetition and
uniformity increased. The buildings were usually four
stories high, with two long hallways running along either
side of a row of cells. The rooms, following one after
another, were all five by eight feet wide, sevenfeet
high, windowless, with an iron - lattice slab for a door
and flues for ventilation near the ceiling .... On the
first floor of each wing was a huge tub for bathing,
sizable enough to hold fifteen to twenty boys; on the
fourth floor were ten special punishment cells" (Rothman
1971: 226).
Massachusetts created a separate facility for girls at Lancaster
in 1854 (now MCI).
The New York facility was one of several visited by the Lyman
School commissioners when they were developing plans. However,
they seem to have been influenced primarily by Samuel B.
Woodward, superintendent of Worcester State Hospital, who advised
that:
The building should have a central edifice of three
stories including a high basement, mostly out of the
ground, and two parallel wings, running back, with or
48
without a colonnade front. The stories should be of
medium height, in this climate; the lower and upper not
less than 10', the middle 121, with a high and capacious
attic to serve the purpose of ventilation. In the
basement of the center building may be located the office
of the managers, the kitchen, laundry, storerooms and
rooms for the furnaces, and dining rooms the inmates. In
the second story, the schoolrooms, dining rooms for the
manager and his family, chaplain and teachers, chapel,
apartments for the officers. In the upper story may be
the single and associated dormitories, clothing rooms and
storerooms for articles made. The wings may be
two stories high, with capacious attics. In them may be
lodging rooms, storerooms and workshops..... The
Commissioners will doubtless build,-of stone or brick.
The former is preferable ... (2nd Annual Report of the
Massachusetts State Reform School).
As shown in a frontispiece engraving in the First Annual Report
of the Massachusetts State Reform School' (see Lyman School form),
the school building did include a three -story central section
with a colonnaded porch, flanked by four -story towers, with two -
story wings extending to the rear. Plans and sections of the
building reveal that many of Woodward's ideas on internal
arrangement were heeded as well.
In 1885 the school moved to the opposite shore of Lake Chauncy
and erected a new campus, known as the Lyman School, on the
cottage --plan then coming into vogue. This was the first
cottage -plan campus in the Massachusetts state system, and one of
the first in the nation. George Clough (1843- 1915), formerly
city architect for Boston, and Stephen Earle (1839 -1913) of
Worcester were cited as architects for some of the earliest
buildings designed in the Queen Anne /Romanesque Revival style.
Reform Schools operated on the familiar Moral Treatment program
qq
and included the same building types as the insane asylums and
schools for the retarded already discussed.
D. Almshouses
The Commonwealth established three almshouses at Bridgewater,
Tewksbury, and Monson in 1852 "as temporary expedients to meet a
pressing emergency" (harden 1880: 158) caused by the
unprecedented influx of Irish immigrants at that time. According
to all sources examined, the original almshouse structures were
considered inadequate at best. All were identical wood -frame
structures consisting of four -story central cores, flanked by
U -plan three -story wings that extended back tQ a depth of 125
feet around central courtyards. Typical ly,i t)he central cores
served administrative purposes, including. chapels on the upper
stories, while the wings contained patient dormitories. The
almshouses appear to have been - modeled on the original 1848 Lyman
School structure described above (see Westborough State
Hospital), but because they were constructed of wood, they were
considered drafty firetraps that were difficult to heat.
Tewksbury was described thus:
The main building has a frontage of 2001, is four stories
high, with wings extending backward from both ends to the
depth of 125', and is almost identical in every respect,
to the main buildings at Monson and Bridgewater, having
indeed been constructed from the same plans and
specifications. The center of the front of the main
building is occupied by the Superintendent and officers
as living apartments, and the entire capacity of the
wings, with the exception of the sewingand dining rooms,
is devoted to sleeping dormitories for the
inmates (harden 1880: 158).
Within a decade of establishment, the almshouses were converted
to specialized functions as the poor were more closely
classified. Bridgewater became the State Workhouse, receiving
the criminal poor and insane, and Monson became the State Primary
School, 'receiving pauper children (see form). Tewksbury remained
the State Almshouse, but with an increasingly large department
for harmless, chronic insane of. -the pauper class established in
1855. The original almshouse buildings do-not survive at
Tewksbury or Monson; and it is unlikely that the original
Bridgewater structure survives either (now-a state prison,
Bridgewater was not included in the survey on which this
nomination was based).: All that remains of the almshouses are a
landscape. feature at Tewksbury and a portion of a possible
foundation at Monson.
E. Sanatoria
Like the almshouses, the four sanatoria erected by the state
survive poorly if at all, probably because their buildings were
also of wood -frame construction. The first, at Rutland (1895),
t'
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was by far the most elaborate, consisting of eleven buildings of
varied plan, elevation, and probably function, arranged in an
arc, and connected at the rear by an enclosed passageway.
Rutland was sold by the state in 1966 and demolished soon
thereafter. The other three, erected at Westfield, North
Reading, and Lakeville in 1907, were similar, but substantially
smaller, simpler institutions than Rutland. They generally
consisted of a central administration building flanked by closed
wards for advanced cases and open pavilions for new cases. All
three of these sanatoria have been substantially rebuilt so that
none retain significant portions of their original design.
Tubercular colonies were developed at some of-the state hospitals
as well, most notably Tewksbury. Most have disappeared with the
exception of two small cottages at the Danvers. and Medfield State
Hospital campuses. Finally, the countigs developed a parallel
system of hospitals, primarily to treat tuberculosis, but they
were not included in the present study, which focuses on
state -owned facilities.
F. Landscape and Land Use
The majority of institutions included in'this study --- whether they
originated as insane. asylum, training school, reform school, or
almshouse -- include large amounts of open space. The only
exception is the Massachusetts Mental Health Center in Boston.
There are several reasons for this. The most important is found
in the tenets of Moral Treatment, which provided the
philosophical underpinnings for care of all types of dependent
citizens in the nineteenth century. As discussed in the Care and
Treatment Context, early reformers believed that mental illness
and deviancy were caused by rapid changes in the nation's social.
structure. Thus, treatment focused on creation of an ideal
physical, moral, and social environment, set apart from the
corrupting influence of society.
Landscapes at these institutions fall into three distinct
categories: designed pleasure grounds, working agricultural
lands, and undeveloped natural acreage including woods and
wetlands. The areas immediately surrounding patient and staff
housing usually fall into the first category. They were often
landscaped with broad lawns, specimen trees, flower beds, and
meandering paths with ornamental light fixtures to provide a
pleasant atmosphere for patients to-enjoy the outdoors. The
presence of greenhouses, the evidence of historic photographs,
and citations in annual reports', indicate that these pleasure
grounds once played a much more important role in campus
aesthetics than they do today. Many buildings were sited on
hilltops to take advantage of views of the surrounding
countryside or in proximity to each other to form sheltered
quadrangles where patients could congregate. Northampton is an
especially good example of the former, while Tewksbury provides
an excellent illustration of the latter. Many of these
landscapes have been compromised by poorly sited new buildings,
Iff
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introduction of paved parking areas, and lack of maintenance
resulting in scrub growth and loss of original plantings.
Peripheral areas fall into the other two categories. Those that
were suited to it, were devoted to agriculture, providing both
therapeutic and economic benefits. These are typical New England
vernacular landscapes characterized by cultivated fields and
pastures, sometimes defined by stone walls. Large -scale
agricultural activities were discontinued in the 1970s throughout
the system, and many of the fields and pastures are reverting
back to woodland. A small number of campuses are protected by
agricultural preservation restrictions and /or leasing to local
farmers. The remaining acreage has remained in its natural state
as woodland or wetland, fulfilling its ecological role while
providing a buffer from surrounding land - uses;,, as well as room
for expansion. All three types of landscapes are important
components of each campus and should beItaken into consideration
when new construction is planned.
Dr. Thomas Kirkhride, who so influenced mid - nineteenth century
asylum design, provided specifications for landscapes as well as
buildings. He firmly believed that asylums should occupy large
rural sites with adequate gardens and pleasure grounds (Deutsch
1949: 208 -210; Pennsylvania 1855 Appendix: 7 -9). He expounded on
the importance of landscapes in. early annual reports (1842, 1843)
of the Pennsylvania Hospital for the Insane:
The importance and utility of having the grounds about a
hospital for the insane highly cultivated and improved,
and everything in perfect order, is much greater than is
generally supposed. It. exercises a beneficial influence
on all patients and on their friends. The good taste of
many enables them to appreciate all such things in
detail, many are pleased with them as a whole, and .even
those who are not capable of realizing their beauties,
still have an indistinct recollection of something
pleasant in connection with them ... it should never be
forgotten, that every object of interest that is placed
in or about a hospital for the insane, that even every
tree that buds, or every flower that blooms, may
contribute in its small measure to excite a new train of
thought, and perhaps be.the first step toward bringing
back to reason, the morbid wanderings of a disordered
mind (Pennsylvania 1883: 50).
Rothman describes asylum settings thus:
the institution itself, like the patients, was to be
separate from the community.... the institution was to
have a country location with ample grounds, -to sit on a
low hillside with an unobstructed view of the surrounding
countryside. The scene ought to be tranquil, natural,
and rural, not tumultuous and urban (Rothman 1971:
137 -138).
I
J;�a
This description fits most of the campuses included in this
nomination, especially the early ones, where the dominant
"Kirkbride" building was inevitably set on the highest ground.
An early description of Northampton State Hospital demonstrates
the parallels between Massachusetts asylums and the national
model:
The hospital stands on a commanding elevation nearly on
the center of the farm, fronting the east. It is
protected on the North and Northeast by a dense grove, .
but has on the East and Southeast an extensive open lawn,
over which is an unobstructed view of..- Northampton and the
Holyoke range of mountains, of the broad meadows
bordering on the Connecticut River and the town of Hadley
on the opposite banks and beyond,and higher up the
hillside of Amherst and its college buildings (Annual
Report 1858).
Few of the hospitals' Annual Reports mention landscape
architects. The only state hospital known to have employed a
noted practitioner is Boston State, where the landscape was
designed by Arthur Shurtleff. Boston State was a city facility
at the time, however, and the present campus unfortunately bears
little or no evidence of his hand. Other campuses are greatly
enhanced by pastoral landscape designs. These include Taunton,
Northampton, Tewksbury, Medfield, and Metropolitan State (R.
Loring Haywood, landscape engineer). Foxborough was laid out by
Boston landscape architect, Joseph H. Curtis (1841 - 1928) .
Landscape issues, unlike designers, are frequently mentioned in
annual reports and include statements such as the following. .At
Northampton, it was noted that the trustees had "visited several
similar institutions ... and consulted a gentleman of taste and
experience in this department who has examined the grounds, and
aided them by his suggestions and advise" (1st Annual Report
1856). When the Fernald School moved from Boston to a more
spacious Waltham campus in 1887 -1888, it was reported that the
buildings would not be laid out in "checkerboard" fashion, but
that siting would follow the natural contours of the land (1st
Annual Report 1888). In this case, the trustees may have been
influenced by concurrent developments at the nearby private
McLean Hospital, where Frederick Law Olmsted was providing
similar advise (Zimmer 1983: IV 2 -6) and Joseph Curtis was
providing the actual design. Annual reports for all of the
campuses provide abundant information on landscape improvements
ranging from plantings:,to road layout to grading activities.
Rural settings and large campuses provided more than an aesthetic
therapeutic benefit. They also provided opportunities for
healthy out -of -doors work. Manual tasks were considered to be
crucial components of a well- ordered patient's day, with
productive work inculcating habits of industry while providing
both self - esteem and physical well - being. Agricultural work
played an important role in the routine of male, and in some
53
cases female, patients until the 1970s when it was discontinued
systemwide. Westborough State Hospital retains an especially
well - preserved agricultural landscape, with historic uses
documented by an earlytwentieth century map showing the division
of woodlands, wetlands, and fields. Evidence of agricultural
uses prior to purchase by the state also remains in the form of
forestation patterns, old stone walls, and former carriage roads
lined by old overarching trees. Other campuses with especially
important agricultural landscapes include Northampton, Danvers,
Medfield, Templeton, Grafton, Wrentham, and Belchertown.
The integrity of campus landscapes, including"viewsheds, are
presently being compromised by several factors. The "designed"
zones are affected primarily by introduction'bf new buildings and
paved parking lots into former lawn areas,"and by lack of.
maintenance. This reduces recreational areas' and the sense of
tranquility that was such an important part•of early treatment
programs. This is especially a problem at the state schools.
Careful siting of new construction that considers original
spatial layout, circulation systems, and topography could lessen
further impact. At the hospitals, neglect of landscape features
and introduction of parking lots are the greatest problems. In
almost all cases, the "rural /vernacular" zones are affected by
neglect that has resulted from disuse over the last twenty to
thirty years. Outbuildings are generally in deteriorated
condition and fields are beginning to revert to woodland.
Information Potential to be completed by MHC
V1. Current Status
The system thus developed has remained remarkably intact even
though it has been grossly underutilized over the past twenty
years, leaving many buildings vacant and deteriorating. The
vacant status of the state's four Kirkbride buildings at Taunton,
Northampton, Worcester, and Danvers is a matter of special
concern, especially after a major fire destroyed much of
Worcester in 1991. The few major losses that have occurred
include the original Worcester Asylum of 1830, the original South
Boston facilities of Boston State Hospital (1839) and the Fernald
School (1856), all of the original wood -frame Almshouse buildings
(1852 --54) at Bridgewater, Monson, and Tewksbury, all but
fragments of the Tuberculosis Sanatoria at Lakeville, North
Reading, and Westfield (1907), and most of the farm complexes and
chronic colonies throughout the system. Factors affecting the
integrity of the remaining system include neglect, incompatible
reuse (generally as prisons), and extensive new construction and
rehabilitation (generally at the State Schools).
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F. ASSOCIATED PROPERTY TYPES
I. Hospital /Campus Area
a. Description
1. Physical Characteristics. Hospital Campuses /Areas are located
throughout the state and encompass large areas, ranging from
hundreds to thousands of acres in extent. These campuses are
developed with either a massive centralized "Kirkbridell building
and /or dispersed "cottages" serving administrative, patient, and
staff functions. Support buildings, including powerplants,
laundries, workshops, maintenance buildings, and barns, are
grouped around the main buildings with the whole surrounded by
large tracts of agricultural fields and undeveloped wetlands and
woodlands. Within this general framework, great variety exists
at the individual campuses. Developed over a span of 100 years
from the 1840s to ca. 1940, they reflect changing taste in their
architectural style, and embody changing ideas about treatment in
their configuration. Some are designed by noted architects and
are masterful examples of particular architectural styles. A few
are characterized by a single group of buildings developed at one
time. Most, however, include buildings from several periods of
historic development. Some include, or consist of,
well- developed isolated colonies. Most include substantial
groups of farm buildings. The materials chosen for construction,
whether wood or masonry, are related to architectural style,
period of construction, and intended use. Scale is related to
these-factors as well. Noncontributing buildings in the form of
large scale patient care facilities were added to many campuses
after the period of significance (1830- 1950).
In practice, most of the campuses have a two -part landscape that
consists of a "designed" section where the buildings are
clustered, and a "rural /vernacular "" section that provides a
buffer zone. The "designed" zones are characterized by vehicular
drives and footpaths that are often lined by trees and /or
ornamental light fixtures, by broad lawns, and to a lesser extent
by ornamental plantings. Buildings are often arranged to create
sheltered quadrangles. The presence of greenhouses, along with
mentions in the annual reports, Indicate that planting beds once
played a much more important role in campus aesthetics than they
do today. The "rural /vernacular" zones are typical of the New
England landscape as a whole with their interspersed pattern of
farmland, wetland, and woodland.
Refer to Statement of Historic Context: Physical Developments:
Architecture and Landscape for more detailed information.
2. Associative Characteristics
Hospital Campuses /Areas are the major physical manifestation of
the public health care system developed by-the Commonwealth of
Massachusetts from 1830 to ca. 1940. All examples will have
S-5-
f'
intimate historical associations with the state's continuing
attempts to care for varied classes of dependent citizens
including the poor, the sick, the insane, the mentally retarded,
and the juvenile delinquent. They are located throughout the
state, and generally sited on rail lines, to provide equal access
to care for all citizens of the Commonwealth. The earliest
campuses (1850s-- 1870s) are dominated by a large -scale highly
centralized "Kirkbride" buildings, surrounded by later
small - -scale "cottage" buildings. Later hospitals are built on
the dispersed "cottage" plan. Hospital campuses encompass large
amounts of open space to provide the "ideal setting" required by
early treatment methods and to provide room for the agricultural
activities that were part of patient therapy as well as campus
economy. Boundaries should encompass all buildings and all land
that were associated with the campus during its period of
significance and retain integrity as discussed in Registration
Requirements.
Refer to Statement of Historic Context: Physical Developments:
Architecture and Landscape for more detailed information.
b. Hospital Campus /Area Significance
Hospital Campuses are the major physical manifestation of the
public health care system developed by the Commonwealth of
Massachusetts from 1830 to ca. 1940, and are described in the
various historic contexts above.
1. Criteria
A. All examples will meet criterion A for associations with
development of the state public health system, and of the
community or region in which they are located. Refer Statement
of Contexts: "The History of Public Involvement" and "Methods of
Care and Treatment" for more detailed information.
B. Some examples will meet criterion B for integral associations
with the productive lives and work of noted persons in public
health field. Refer to Statement of Historic Section E: "Noted
People" for more detailed information. .
C. All examples will meet criterion C as examples of
state - developed public health care facilities, and as groups of
buildings that create distinguishable entities although their
components may lack individual-distinction. Some will be the
examples of the work of master designers and /or possess high
artistic value. The natural landscape that forms the setting for
the buildings is important as an expression of early treatment
methods. Refer to Section E: "Architecture and Landscape" for
more detailed information.
D. Many examples will meet criterion D due to their potential to
yield important information about the evolution of public health
care either through study of extant buildings and landscapes, or
through historic archaeological remains. There is also the
potential to yield information about prehistory through
archaeological investigation. Refer to Section E: "Information
Potential" for more detailed information.
2. Criteria Considerations
The criteria considerations do not apply to this property type as
a whole. Religious properties, usually chapels, are sometimes
contributing and integral parts of campuses (A). Some buildings
may be moved within a campus and remain as contributing
components if they maintain appropriate historic relationships to
other parts of the campus (B). Cemeteries are often contributing
and integral parts of campuses, reflecting -their self- contained
nature, and possessing the potential to yield information about
inmates (D) . Some components of the campug that are less than
fifty years old may be considered to contribute if they have
demonstrated state- or national -level associations with one of
the contexts (G).
Level of Evaluation
Evaluation of this statewide system most properly takes place at
the state level. Where appropriate and possible, some campuses
are also judged within a national context.
C. Hospital Campus /Area Registration Requirements
Hospital Campuses /Areas must possess the physical and associative
characteristics discussed above and in Section E to be considered
eligible for National Register listing. The primary associative
characteristic, and the key registration requirement, is integral
connections with the Commonwealth of Massachusetts' development
of an extensive public system to care for dependent citizens who
were incapacitated by mental or physical health problems, by
poverty, or by juvenile truancy, during the period 1830 -ca. 1940.
To be eligible for nomination to the National Register of
Historic Places under this property type, a campus /area must have
been developed as part of this system and possess sufficient
physical integrity to convey that association.
Campuses must also retain integrity to their period of
significance. Their physical condition and integrity is
primarily being affected by the-downsizing of the state public
health care system, a process that began in the mid - twentieth
century. Historic buildings are being affected by neglect,
abandonment, and inappropriate rehabilitation. Historic campus
landscapes are being compromised by several related factors. The
"designed" zones are affected primarily by introduction of new
buildings and paved parking lots into former lawn areas. This
reducing recreational areas and the sense of tranquility that was
so important to early campuses. This is especially a problem at
the state schools. Careful siting of new construction that
considers original spatial layout, circulation systems, and
51
Q
topography could lessen further impact. At the hospital's,
neglect of landscape features and introduction of parking lots
are the greatest problems. In almost all cases, the
"rural /vernacular" zones are affected by the neglect that has
resulted from disuse over the last twenty to thirty years.
Former agricultural buildings are generally in deteriorated
condition and fields are beginning to revert to woodland.
Limited loss of land or minor historic buildings will generally
not preclude registration. Limited amounts of new construction
that respect the character of. contributing buildings and
landscapes will generally not preclude registration. Present -day
ownership and use by the state is not required as long as other
qualifications are met.
Several campuses, including Northampton, Danvers_, Foxborough, and
Metropolitan State, have recently been declated surplus by the
Department of Mental Health.
1. Specific Integrity Factors
A. Location and Setting: Campuses will always possess integrity
of location and setting. These are considered to be key integrity
factors for this property type. Early treatment methods,
especially Moral Treatment, relied heavily on creation of an
ideal rural physical setting that would remove the afflicted one
from an increasingly complex society to effect cures. Thus, the
mental health institutions were located in rural or at least
semi- -rural areas to provide a sense of tranquility for patients,
to avoid dissention from neighbors, and to keep acquisition costs
for the state as low as possible. These latter considerations
also apply to campuses developed for reasons other than mental
health. Campuses were invariably large areas encompassing
hundreds, and in some cases, thousands of acres in order to
preserve an ideal self- contained setting within their boundaries.
Agricultural components were included as measures of work therapy
and campus economy. Setting refers to the campus itself rather
than to its surroundings. Refer to Section E, especially
"Methods of Care and Treatment," and "Architecture and Landscape"
for more detailed information.
Factors that affect this type of- integrity include modern
hospital or non - hospital related development, the sale or leasing
of all or part of the campus; and neglect of contributing
landscapes. These factors may be sufficiently detrimental to
integrity to preclude registration of this property type, or to
exclude portions of the historic hospital campus.
B. Design, Materials and Workmanship: Campuses will always
possess a high degree of integrity of design, materials, and
workmanship. These are important integrity factors for this
property type. Like setting, building design was an important
component of early treatment methods. Design also refers to the
relationships of buildings to one other within the campus
landscape. Refer to Section E, especially "Methods of Care and
I
5-F
Treatment," and "Architecture and Landscape" for more detailed
information.
Factors that affect this type of integrity include the
demolition, alteration, or moving of buildings, the addition of
new buildings, the loss or alteration of landscape features
including reforestation of agricultural land, and the loss of
historic period acreage. These factors may be sufficiently
detrimental to integrity to preclude registration of this
property type, or to exclude portions of the historic hospital
campus.
C. Feeling and Associations: All campuses must possess historic
associations with the state public health care system. This is a
key integrity factor. They must retain sufficient physical
integrity as described above to be able'to convey their
relationships to and associations with the historic contexts
described in Section E.
II. Small -Scale Facilities and /or Individual Buildings
a. Description
1. Physical Characteristics
This property type includes facilities that consist of single
buildings or small numbers of related buildings set on small
amounts of land. In some cases, this configuration is original;
in others, it results from major losses or changes to a larger
campus (see property type I) . Examples of the former include
compact urban hospitals such as the Massachusetts Mental Health
Center that were originally developed with a minimum of buildings
and landscape features. In the latter case, the building(s) must
include one or more major components of the original campus.
Examples include a centralized "Kirkbride" building, an
administration building and associated patient care or staff
residence building(s), or an isolated colony. A single patient
ward, staff residence, support or farm building would be unlikely
to qualify. Individual examples will display great variety in
location, setting, scale, materials of construction,
architectural style reflecting their historic uses, and periods
of construction.
Refer to Section E: Architecture and Landscape for more detailed
information.
2. Associative Characteristics: This property type is an
important physical manifestation of the public mental and
physical health care system developed by the Commonwealth of
Massachusetts from 1830 to ca. .1940. All examples will have
intimate historical associations with the state's continuing
attempts to care for varied classes of dependent citizens
including the poor, the sick, the insane, the mentally retarded,
and the juvenile delinquent. Boundaries should encompass all
679
buildings and land that was associated with the facility during
its period of significance and retain integrity as discussed in
Registration Requirements.
Refer to Section E: Architecture and Landscape for more detailed
information.
b. Small -scale Facility and /or Individual Building Significance
This property type is an important physical manifestation of, the
public health care system developed by the Commonwealth of
Massachusetts from 1830 to ca. 1940, and described in the various
historic contexts that comprise Section E.
1. Criteria
A. All examples will meet criterion A for associations with
development of the state public health system, and of the
community or region in which they are located. Refer to Section
E: "The History of Public Involvement" and "Methods of Care and
Treatment" for more detailed information.
B. Some examples may meet criterion B for integral associations
with the productive "lives and work of noted persons in the public
health field. Refer to Section E: "Noted People" for more
detailed information.
C. All examples will meet criterion C as examples of
state - developed public health care facilities. Some will be the
examples of the work of master designers and /or possess high
artistic value. Refer to Section E: "Architecture and Landscape"
for more detailed information.
D. A few examples may meet criterion D due to their potential to
yield important information about the evolution of public health
care either through study of extant buildings or through historic
archaeological remains. Refer to Section E: "Information
Potential" for more detailed information.
2. Criteria Considerations
Religious properties, usually chapels, are unlikely to meet the
National Register criteria as examples of this property type (A)
Moved buildings are unlikely to meet the National Register
criteria as examples of this property type (B) .. No birthplaces
are associated with this property type (C) . Cemeteries are are
unlikely to meet the National Register criteria as examples of
this property type (D) . A reconstructed building is unlikely to
be considered as a significant example of this property type (E)
No commemorative properties are associated with this property
type (F). Properties that are less than fifty years old may be
considered significant examples of this property type if they
have demonstrated state- or national- -level associations with one
of the historic contexts (G)'.
60
3. Level of Evaluation
Evaluation of this statewide system most properly takes place at
the state level. Where appropriate and possible, some campuses
are also judged within a national context.
C. Registration Requirements
This property type must possess the physical and associative.
characteristics discussed above and in Section E to be considered
eligible for National Register listing. The primary associative
characteristic, and the key registration requirement, is an
integral connection with the Commonwealth of 'Massachusetts`
development of at extensive public system to,care for dependent
citizens who were incapacitated by mental,or'physical health
problems, by poverty, or by juvenile truancy, during the period
1830 -ca. 1940. To be eligible. for nomination to the National
Register of Historic Places under this property type, a
building(s) must have been developed as an important component of
the state hospital and school system, and must possess sufficient
physical integrity to convey that association.
The physical condition and integrity of this property type is
primarily affected by the downsizing of the state public mental
and physical health care system, a process that began in the
second half of the twentieth century. This has led to building
neglect and abandonment, to inappropriate rehabilitation, and to
incompatible new construction. Present -day ownership and use by
the state is not required as long as other qualifications are
met.
1. Specific integrity Factors
A. Location and Setting, These are not important integrity
factors for this property type. Most examples of this property
type will survive as key remnants of campus /areas, and thus by
definition will lack integrity of setting. The few examples such
the Massachusetts Mental Health Center, which were developed as
urban research/ treatment facilities, are not dependent on setting
for their significance.
S. Design, Materials and Workmanship: This property type will
always possess a high degree of integrity of design, materials,
and workmanship. These are critical integrity factors in this
property type. Building design was an important component of
early treatment methods. Refer to Section E, .especially
"Architecture and Landscape" for more detailed information.
Factors that affect this type of integrity include the
demolition, alteration, or moving of buildings.
C. Feeling and Associations: All examples must possess historic
associations with the state public health care system. This is a
key integrity factor. They must retain sufficient physical
IN
integrity as described above to be able to convey their
relationships to and associations with. the historic contexts
described in Section E.
G. GEOGRAPHICAL DATA
The geographical area encompasses fifteen state -owned hospital
and school campuses within the Commonwealth of Massachusetts.
H. SUMMARY OF IDENTIFICATION AND EVALUATION METHODS
Identification: The Multiple Property listing for the
Commonwealth of Massachusetts Hospital and School System is based
on a 1984 survey of historical /architectural, resources conducted
by Candace Jenkins for the state Division.of Capital Planning and
Operations (DCPO). It was conducted as'parf.'of their systemwide
campus planning study designed to identify surplus state
properties. That study examined all state hospitals and schools
managed by the Department of Mental Health (DMH); all facilities
managed by the Department of Public Health (DPH); and all such
surplus facilities under the management of DCPO. The purpose of
the historical /architectural survey component was to assist DCPO
in fulfilling their- responsibilities under Section 106 of the
National Historic Preservation Act (NHPA) and Chapter 254 of the
Massachusetts General Laws (MGL). The survey used the general
methodology and-forms established by the Massachusetts Historical
Commission (MHC) .
Specifically, the survey began with a review of DCPO records
including dates of campus establishment and component buildings,
and an extensive slide collection. Five campuses were deleted
because they had been established less that fifty years ago
(Dever, Hogan, Gentile, Glavin, Shattuck). Four others were
deleted because they had previously been listed in or voted
eligible for listing in the National Register of Historic Places
(Danvers, Worcester, Taunton, Shirley) . One other was deleted
because all historic buildings had been demolished (Rutland).
Thus, the original list of thirty -one facilities was reduced to
twenty (see Appendix A).
Those remaining twenty campuses -were visited and photographed to
determine their architectural significance and integrity and were
researched (primarily through Annual Reports at the State
Library) to determine their historical significance. Research
identified eleven other facilities that were originally
associated with the state hospital and school system but have
been since demolished or transferred to other agency control,
primarily the Department of Corrections. These were not visited
or fully researched, but were included on a chronological list of
hospitals and schools established between 1830 and 1930 (see
Appendix B).
The 1984 survey resulted in a Narrative Overview, tracing the
history of the system, a chronological list of the system, and
f�
M
standard MHC area inventory forms for the individual campuses.
Preliminary National Register evaluation was undertaken and the
significance of campuses was ranked on the local, state, or
national level. In general, the system was found to possess a
high level of historic /architectural significance and to retain a
high degree of integrity.
Evaluation: In 1991 -1992, Candace Jenkins prepared this
multi - property nomination for the MHC. Initial evaluation
meetings with MHC staff deleted .Boston State Hospital from
further consideration due. to substantial loss of integrity. DPH
facilities were deleted due to time and budgetary constraints.
Taunton, which had previously been voted eligible but not
nominated due to 'insufficient information, was added. The
contexts developed for this nomination, including public health,
represent a refinement of the Narrative' Overview prepared for the
1984 survey. They were designed to consider the key issues that
influenced development of the system as they relate to the
National Register criteria. They were expanded with additional
research to develop a national context and to add components that
considered important people involved in the system, and the
potential for archaeological resources (the latter completed by
Leonard W. Loparto,.MHC staff).
The remaining fifteen campuses were visited and rephotographed to
determine any changes that had taken place since 1984 and to
gather the more detailed building by building and landscape
information required by the National Register. Limited
additional research was undertaken as necessary. Interim
meetings of the consultant and MHC staff considered issues,such
as integrity, boundaries, period and level of significance,
appropriate levels of information, and supporting documentation.
Property types were based on function and integrity.
Registration requirements were developed on the basis of specific
knowledge about the historic evolution and current integrity of
the state hospitals and schools. Nomination forms, including
district data sheets and accurate maps that identify all
buildings and landscapes, were prepared.
In the future, this nomination may be amended with DPH properties
and with former DMH properties that have been transferred to
other agencies such as Corrections.
(OS
I. MAJOR BIBLIOGRAPHICAL REFERENCES
Bochoven, J. Moral Treatment in American Ps chiatr . Springer
Co. New York. 1963-
Caplan, P. B. Psychiatry and the Community in Nineteenth Centur
America. -Basic Books. New York. 1969.
Commonwealth of Massachusetts. Annual Reports of State Hospitals
and Schools. .
Craig, Lois. The Federal Presence: Architecture, Politics, and
Symbols in United States Government Building.-' MIT Press.
Cambridge, Mass. 1978. _
Deutsch, Albert. The Mentally Ill in America: A'History of Their
Care and Treatment from Colonial Times. New York. 2nd edition.
1949.
Dix, Dorothea. "Memorial to the Legislature of Massachusetts:
1843 ". Old South Leaflets, Vol. VI. Boston. n.d.
Governor & Council. Resort of the Committee on Charitable
Institutions and the State House. State Printing Office. 1945.
Governor's Special Commission on Consolidation of Health and
Human Services Institutional Facilities. "Actions for Quality
Care. Executive Office of Human Services. 1991.
Governor's Committee on Public Institutions. "Report of Visits
to Certain Institutions." Wright & Potter Printing, Boston.
1924.
Governor's Committee on Public - Institutions. Recommendations
based on Investigations of Public Institutions. State
Printing Office. 1942.
Governor's Committee. "Report of the Governor's Committee to
Study State Hospitals." Wright & Potter Printing, Boston. 1954.
Grob, Gerald N. Mental Illness and American Society: 1875 -1940.
Princeton University Press. 1983.
Hildreth, J. L., M.D. The Public Care of the Insane in
Massachusetts. Riverside Press. Cambridge, Mass. 1897.
Hurd, Henry M., et al.
the United States and
Baltimore. Md. 1916.
stitutional s
. Vol. II. Johns Hopkins Press.
Kelso, Robert Wilson. The Histo of Public Poor Relief in
Massachusetts: 1620 -1920. Houghton Mifflin Co. Boston and New
'York. 1922.
(0 �
Johnson, Rossiter, ed. The Twentieth Century Biographical
Dictionary of Notable Americans. The Biographical Society.
Boston. 1904.
Jenkins, Candace. "The Development of Falmouth as a Summer
Resort: 1850 - 1900." Spritsail. Vol. 6, Number 1. Winter
1992.Woods Hole, Mass.
Jenkins, Candace. Survey of the Massachusetts State Hospital and
School System. Division of Capital Planning and Operations.`
1984.
Malone, Dumas. ed.. Dictionary of American Biography, Vol. I - X.
Charles Scribner's Sons. New York. 1935.=
Massachusetts Committee for the Preservation'of Architectural
Records .(COPAR). Directory of-Boston Architects 1846 -1970.
Massachusetts Department of Mental Diseases. The Care of the
Mentally Ill in Massachusetts. Occupational Printing Plant, DMD.
,
Gardner State Colony. 1930.
Massachusetts Department of Mental Health. Architectural
Records.
Massachusetts State Archives.
Massachusetts Department of Public Safety, Division of
Inspection.
Architectural Records. 1890s ff. Massachusetts State Archives.
Massachusetts Medical Society. The Massachusetts Bay
Tercentenary in New England 1630 -1930: A Reference to the More
Important Medical Institutions
� of ,Massachusetts. Boston. 1930.
Massachusetts State Charities. "Report of the Special Joint
Committee appointed to investigate the whole system of Charitable
Institutions in the Commonwealth of Massachusetts." William
White. Boston. 1858 -59.
Muccigrosso, Robert, ed. Research Guide to American Historical
Biography. Beacham Publishing Co. Washington, D. C. 1988.
Pennsylvania Hospital for the Insane. Report for 1853:
„
Appendix; On the Construction of for the Insane (T. S.
Kirkbride). Philadelphia. 1855.
Pennsylvania Hospital for the Insane. Report for 1883: Memorial
of Dr. Thomas S. Kirkbride. Philadelphia. 1884.
CO
4
Pevsner, Nicholas. A History of Building Tvpes. Bolligen Series
XXXV. Princeton University Press. 1976.
Rothman, David J. The Discovery of the As lum: Social Order and
Disorder the New_ Republic. Little, Brown, & Co. Boston and
Toronto. 1971.
Sanborn F. B. "The Public Charities of Massachusetts during the
Century ending January 1, 1876: a report made to the
Massachusetts Centennial Commission." Wright & Potter, State
Printers. Boston. 1876 -:._ . 1-1 '.. ,
Vogel, Morris J. The Invention of the Modern Hospital: Boston
1870 -1930. University of Chicago Press. 1980.
Wallace, Dr. Anna M. "History of the Walter;Fernald State
School." 1941. unpublished manuscript at the school.
Withey, Henry F., and Elsie R., Bio ra hical Dictionary of
American Architects (Deceased). Hennessey & Ingalls, Inc. Los
Angeles. 1970.
Zimmer, Edward J. "History of the Development of McLean
Hospital." Unpublished manuscript. Shepley, Bulf inch,
Richardson & Abbott. 1981.
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