I last week visited localities respectively in Waltham, Arlington, and Belmont, upon the comparative suitability of which, as sites for your Retreat for the Insane, I now have the honor to report in accordance with your request.

The main Considerations upon which a project for an insane hospital should be framed, may, I think, be grouped under the following heads, the order of which also indicates their relative importance:

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1st Atmospheric; conditions of purity, moisture, exposure, &c

2nd Structural; relating to efficiency, Convenience, and economy of administration

3rd Moral; Conditions limited, as far as this report is concerned, to natural scenery, and the capabilities of ground for improvement in this respect.

In regard to the first, though the Belmont Hill would appear to me least arid and also least liable to be affected by marshy exhalations, it may be assumed that neither of the three localities has any assured superiority.

As to the second, or structural, Class of considerations, it is a good plan in designing a construction for any purpose to begin by forming an outline of such an arrangement as will appear, in the highest degree possible, adapted to the ends in view, and then proceed by a method of reduction and modification to practically accommodate the same general design to necessary controlling circumstances.

Such a primary or typical plan having been formed for an insane hospital, it will be evident that that locality among several should be chosen as a site for it, the topography of which would require the least reduction and modification of the plan.

I judge that a typical plan for a hospital of the class which you have in view would provide;

1st a series of rooms for patients so arranged that each would have a window opening to the South wind;

2nd that windows accessible to men would not look upon windows or grounds accessible to women;

3rd for a division of patients into groups, according to the kind of treatment required by each; each group being separated from all others in such a manner as would secure the greatest advantages for ventilation; for restricting epidemic and infectious influences, and for limiting the spread of fire.

4th for so placing the violent and noisy patients, that the quiet and convalescent would escape disturbance or annoyance from them.

These four classes of provisions might all be found in a series of Cottages, each having accommodations for a single patient and attendant, so arranged that the windows of neither would be opposite those of any other; but the requirement of convenience and efficiency of administration where so many as you propose are to be under one superintending physician, to say nothing of economy of capital, would demand a more compact arrangement. Probably in the very best planned hospital, even assuming unlimited means, there would be a central building for offices of administration with a series of buildings two stories in height branching from it on opposite sides, each building adapted to lodge a number of patients, and each series arranged en echelon, [586] the wings either advanceing or receding from the line of front of the administration building.

Unaffected by topographical conditions I know of no reason by which you would be forced, practically, to depart from such an arrangement in your plan. Considerations of cost might determine the length of each building for patients, but would not, I presume, lead you to build more than two stories in each.

For convenience of classification under a variable demand the number of bed rooms would be larger than the number of patients intended to be accommodated. You would, probably, either have three buildings on each side with fifteen or sixteen beds on each floor, or, two with twenty four or five; each building being connected with those adjoining it by corridors on the lower floor. Each building would contain a common room on each story opening, as well as the bed rooms, on the south, and the buildings would stand perhaps twenty feet apart. Finally you would have an additional building on each side for, say ten, special patients with rooms of double the average frontage of the others.

Assuming that the administration building would be fifty feet in length (of front) each ordinary bed room twelve feet, each ordinary sitting room twenty feet, the length of the combined series would be from seventeen to eighteen hundred feet (this whether the patients are divided in four or six buildings).

A continuous level basement would be desirable in which heating and ventilating pipes, and a tram-way could be carried.

A perfectly suitable site, as far as structural considerations are concerned would, then, present a level field, of crescent form or of an S form,

Considerable variation might doubtless be made from the arrangement which has been indicated, with comparatively small cost to the efficiency and convenience of each day’s administration, but it remains true that, other things being equal, the less the topography of any site which may be selected shall either oblige you to make alterations of the surface by grading, or, compel you to modify such an arrangement, the better it is for your purpose.

If you take the Waltham site you will find it best to vary very much in your plan of buildings from the typical arrangement, nor will you probably be satisfied with any plan which will not oblige you to make a considerable and costly change of the present surface.

At Arlington it would be possible, without an impracticable amount of grading, to place the necessary buildings nearly in the best way but as the [587] basement would have to be excavated chiefly from rock, and the grounds on all sides would be inconveniently rugged, the site cannot be considered as positively well adapted to your purpose.

At Belmont the theoretically best arrangement for your buildings could be perfectly realized with but slight and inexpensive alterations of the surface. The excavation for the basement would be chiefly if not wholly in earth instead of rock. Belmont is, then, as far as structural considerations are concerned positively well adapted to your purpose.

In respect to what I have termed moral considerations, the distant landscape is more pleasing at Waltham, but it is broad and fine and suitable in each locality. In respect to nearer landscape conditions, the most desirable qualities in the home grounds of a retreat for the insane are probably those which favor an inclination to moderate exercise and tranquil occupation of the mind, the least desirable those which induce exertion, heat, excitement or bewilderment. The wooded land of Belmont, judiciously thinned to groups and glades, opened by walks of long curves, and easy slope, would by the time your buildings were ready for occupancy, afford what is chiefly wanted in this respect better than it would be possible to provide it with the most generous use of all available means, in many years, either at Arlington, Waltham, or any other locality with which I am acquainted in the suburbs of Boston.

Under this class of considerations also, therefore, the Belmont place is a positively excellent one. You might go far and find none essentially better.

I should recommend it for your purpose in preference to the Waltham or Arlington places, even though in order to secure its advantages you were obliged to limit your purchase to a considerably smaller body of land, and also to fix a considerably higher annual charge for rent upon the institution.

Instrumental surveys would be necessary to a much more definite comparison.