STATE HOSPITALS OF MASSACHUSETTS  |   CHRONOLOGY   |   BEYOND MASSACHUSETTS



Introduction  (text excerpts courtesy of the Massachusetts Historical Commission)

   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 cases, 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 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 hilltop 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 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 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 II, criticism of institutional care intensified, as it was seen “to disregard the plights of sick and dependent persons by isolating and subjecting them to cruel abuse” {Grob 1983: 5, 6).  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.

History of Public Involvement: Its Organizational 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 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 Josian Quincy on the subject of pauperism. Examining the post-Revolutionary period 1791-1820, Quincy found that the settled poor (.:hose 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).

   This time, the Legislature was immediately convinced of the need to care for such a population, and appointed three commissioners to select a site and erect a hospital for 120 insane persons. The committee chose the large central Massachusetts city of Worcester, whose geographic location offered equal access to all citizens of the Commonwealth. The fact that it was the hometown of Governor Levi Lincoln may also have been a factor. Thus, the state’s first insane asylum, which was one of the first in the nation, was completed in 1832 adjacent to the developing city center.

   A decade later, Mann’s findings were amplified, and the inadequacies of a 120-bed state facility revealed, by Dorothea Dix, who visited local poorhouses and jails throughout the Commonwealth. Many of the insane she found. In those facilities had spent some time at Worcester, but had been returned even when they showed improvement, due to lack of local funds and/or to make room for others at the already overcrowded asylum. The nationally known Dix delivered an eloquent Memorial to the State Legislature in 1843. Her moving testimony resulted in immediate expansion of the Worcester asylum to 320 beds, and in establishment of two new asylums within the decade. In her address she stated:

I come to present the strong claims of suffering humanity. I come to place before the Legislature of Massachusetts the condition of the miserable, the desolate, the outcast. I come as the advocate of helpless, forgotten, insane, and idiotic men and women; of beings sunk to a condition from which the most unconcerned would start with real horror; of beings wretched in our prisons, and more wretched in our almshouses. And I cannot suppose it needful to employ earnest persuasion, or stubborn argument, in order to arrest and fix attention upon a subject only the more strongly pressing in its claims because it is revolting and disgusting in its details...I proceed gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, and pens! Chained, naked, beaten with rods and lashed into obedience (Dix 1843: 2).

   These strong words were backed up with the hard data of specific examples. Among her findings were an idiot who had been chained in a small stall in Lincoln for 17 years; an insane man in Granville who was losing use of his limbs due to the closeness of his confinement; a woman at Danvers who was tearing her skin off due to the filthy conditions in which she existed; a naked skeletal woman kept for years in a small lightless and airless closet beneath the cellar stairs at Newburyport; a man at Wayland crippled from the effects of confinement and unrelieved cold; and a young woman at Newton who was confined naked in a stall where 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 hospitals show opposite conclusions (Dix 1843: 10).

   The scope of state welfare efforts was greatly expanded when 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 facilities 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 established 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 (the 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 1863) and charged it with supervision of the whole system of public charitable and correctional institutions. This board developed from the 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 with almsgiving, but seeking zealously to establish a So9~al 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 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 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 (l892; the state’s first facility erected specifically for chronic cases 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 (1899; 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, which resulted in transfer of insane inmates from local poorhouses the 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 system-wide review in 1904-05 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 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 treated 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).

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