The turn of the century was accompanied by little-known attempts at reform on the hill. I had been surprised to learn that in its formative years, Danvers was actually considered a leader in humane treatment. For instance, the innovative superintendent, Charles Page, M.D.--who served twice, from 1888 to 1898 and from 1903 to 1910--instituted a non-restraint policy that was commended by Clifford Beers, the noted patient advocate and hospital critic. Page acknowledged his indebtedness to the great French psychiatrist, Pinel. He also referred to the English Quaker, William Tuke (1733-1815), and the Retreat at York, where lunatics would be treated as sick people, and where gentleness and patience would. . . be exercised towards them. . . . Chains, straps, straitjackets, threats, force, and coercion held sway in practically all public asylums, while the York Retreat continued its gentle and most successful non-restraint ministrations to the insane (Page 1904, 2-3). In 1897, Page asserted that it had been more than one and a half years since a male patient had been restrained at Danvers and about six years since the restraint of a female patient (Trustees 1898, 19). These facts contrasted sharply with the controversial institution Danvers had become by the time of its demise in 1992.

Page also created a large congregate dining room to replace the separate ward dining areas. Danvers's annual reports in this period paint an idealistic image of a large room with some one thousand patients happily enjoying one another's company among potted plants while a hospital quartet played a variety of music ranging from the hymn old Hundred to the Schubert overture Rosamunde to Sousa's Stars and Stripes. I took a skeptical position toward these idyllic pictures. I wondered instead how the attendants--already overworked with the incessantly escalating census--coped with the confluence of diverse diagnoses on that large a scale. It brought to my mind the 1888 masterpiece by the Belgian painter James Ensor, The Entry of Christ into Brussels, where the viewer is confronted by swarming crowds of colorful masks and human expressions of every sort. The Danvers congregate dining room carried the image of legions of phantoms from another era who had been ushered to their communal repasts inside the brick city on the hill.

Page also instituted a pathology laboratory that eventually became associated with Harvard Medical School. The roots of biopsychiatry were growing steadily in these labs with continuing reports in such arcane areas of interest as organ weights and frontal lobe lesions in catatonic, paranoid, and hebephrenic brains (Page 1910, 68-69). Page's laboratory papers provide firm proof that the biopsychiatric model was in full swing at the turn of the century and that the medical foundation was being built for such optimistic statements as the one shared several years ago by psychiatrists before an Alliance of the Mentally Ill audience: that schizophrenia sometime in the future "will be like polio. It just won't exist" (Rees 1995, 11). Should a medical cure be found some day for schizophrenia, then perhaps pathology laboratories such as Page's will receive their due. However, I admit that I found some of the clinical information from Page's notes morbid. One person I interviewed about the pathology laboratory recalled seeing a large jar filled with human brains in a clear liquid.













Taking into account my social worker bias, I felt there were times when the pathology reports were too focused on the medical data in their conclusions about patients. Autopsies, to the exclusion of psycho-social factors, were implemented as ways of trying to understand aberrant behavior. This became clear in the notes concerning an extremely paranoid patient of Italian descent during the early 1900s. He had had a fixed delusion regarding persecution by anarchists. Overlooked in the doctor's assessment of this patient was the social milieu he came from, which included some of the most intense labor demonstrations in U.S. history. The patient had been employed as a weaver during the famed Bread and Roses Strike in Lawrence, Massachusetts, which pitted workers and socialists against the textile manufacturing interests. This was never discussed in the post-mortem dissection of the man's behavior, but his brain weight and color were neatly identified (Page 1910, 82).

Social work was clearly lacking, and in Danvers's case, it was not put into operation until 1903, when the hospital's first social worker was given a caseload of one hundred. As bad as that may sound, it pales against the figure for one social worker in a twentieth-century southern institution whose caseload approached nine thousand (Deutsch 1948, 93). The Danvers's social work job description included family support and placement, investigations into patients' home conditions, and clinic visits. The creation of community clinics represented a determined effort by the institution to decrease the swelling census inside the Castle and along with similar efforts by other state hospitals, predated the federal Community Support Program and the Community Mental Health Center policies by nearly half a century.

The opportunity for social work was endless in an area as culturally diverse as early twentieth-century Merrimack Valley. An institution built according to the Kirkbride passion for classification and segregation, Danvers faced a stiff challenge from the multiethnic nature of its admissions. Its catchment area included Lawrence, Lowell, and Lynn, all industrial centers, with the first two having been the home of the American textile industrial revolution. The textile corporations depended on foreign labor to both build and then work in the mammoth textile mills. For example, Lawrence was known as "Immigrant City" and by 1910, 74,000 of its 86,000 inhabitants "were born abroad or had foreign-born parents" (Cole 1963, 94).

In 1895, the hospital superintendent wrote, "As far as could be ascertained, but 157 of the 429 admitted were natives of Massachusetts and only 230 were born in the United States"(Trustees 1887, 9). The foreign country with the highest representation of patients in the 1896 patient census was Ireland, with citizens from the following nations also represented: British Provinces, England, Scotland, Wales, Norway, Sweden, Denmark, Russia, France, Germany, Spain, Italy, and Greece (25). How did the wards cope with the different languages and customs of its patients? What had it been like for someone from Lawrence--where by one report there were some fifty-seven different churches and social clubs supporting cultural homogeneity--to be thrown into the psychotic melting pot of the castle where patients must literally have been speaking in tongues?

Danvers was also sent a difficult assortment of diagnostic classifications, among them many elderly persons with dementia and a variety of medical problems. When one of the hospital's first superintendents went to Europe on sabbatical in 1883, he found that the industrial centers of Europe were similar to those from which Danvers drew its population. That Danvers was accepting persons with complex clinical diagnoses was pointed out by this superintendent upon his return: "This hospital is quite exceptional for an American institution, in the exceedingly large proportion of cases broken down and enfeebled by organic brain disease, which it treats. This is probably chiefly explained by the fact that it receives its patients from one of the most thickly-settled manufacturing districts in the world, where the influences tending to produce such breakdowns are especially prevalent and the conditions of family life do not allow care of such patients at home. It is also true that one finds the same character of patients in the crowded manufacturing regions of Great Britain and the Continent. This is the chief factor which makes our recovery rate small and our death rate high"(Trustees 1885, 15-16).

There were other difficult patient populations. One, involving a large and unwanted influx of criminals, precipitated a thorough investigation of other facilities' methods of dealing with this problem. The trustees' sixth annual report indicated that the hospital closely monitored studies done by the Criminal Lunatic Asylum at Broadmoor in England (Trustees 1884, 12). This problem was largely resolved in 1886 with the construction of a hospital for the criminally insane in Bridgewater, Massachusetts. Another difficult group to treat were those admissions suffering from "intemperance" and "dipsomania," the nineteenth-century equivalents to substance abuse patients. Patients with "alcoholic psychoses" arrived on the hill in increasing numbers, much to the dismay of the hospital administrators who sometimes referred to this diagnostic category as "The Ancient Enemy." The drug of choice was frequently "Jamaica ginger" (Trustees 1920, 14-15).

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