By 1919 the North Attendant’s home was all complete. Also known as the North Home and the Nurses’ Home, it was built to house 63 nurses, replacing two smaller buildings behind Old Main from the 1890s. The State Hospital under Superintendent Dr. John A. Houston was crossing the threshold of 1000 inmates. Through the Annual Reports the Superintendent and Trustees decry the poor funding, staffing and conditions of their own facility, even though two new buildings, including the North Attendant’s home have just been paid for.
From the superintendent’s report it will be noted that our condition of overcrowding continues despite the many patients, 92 in number, transferred to institutions in the eastern part of the State. We still believe that our hospital should care for all the patients of the district served by it, and we refer to the recommendations repeatedly made in former reports for suitable provision within the district for all the mental cases of western Massachusetts. This matter is so important that we feel it our duty to again call attention to it. The present conditions are not just to the institution nor to the patients who are here and the patients who are to come to us.Northampton State Hospital Annual Reports. (1919, November 30), pp.7.
In the 1920 Annual Report the Superintendent details major staffing shortfalls, reporting that the State Hospital has been operating with nearly 100 fewer staff than prescribed. Only two doctors served the entire population.
All the routine activities of the hospital were conducted as usual, but under great stress, due to an extreme shortage of help in all departments. With a quota of 223 employees allowed us the average number on our pay roll throughout the year was only 127, and at times there were less than 100. Every one did extra duty. On the wards and in some other departments patients were given keys and conducted themselves as well as the employees, so well, in fact, that eight patients were placed on the pay roll.Northampton State Hospital Annual Reports. (1920, November 30), pp.11.
Houston details the overcrowded conditions of the State Hospital in the 1921 Annual Report in another attempt for adequate funding.
Serious overcrowding makes it difficult to give our patients the care we should like to give. Too many of them are obliged to share a room with others. This is disquieting to the relatives and does not contribute to the comfort of the patients themselves. We realize that every State hospital has the same problem to deal with, and we accept the situation with what grace we may, hoping that in time adequate provision will be made for the care of all the patients of our district somewhere in this district, and not so far from their homes as are the institutions to which so many have been transferred in recent years.Northampton State Hospital Annual Reports. (1921, November 30), pp.7.
And again regarding staffing in 1922, two years after the completion of the North Attendant’s building.
Despite frequent advertising and repeated applications to the employment bureaus, we have been unable to fill our quota of nurses and attendants. The quota of women nurses allowed us last year was 58, but the average number on the pay roll during the year was only 31. We have been fortunate in having patients comfortable and quite trustworthy, to help in the care of the wards and of other patients. Nine of them are now acting very acceptably as nurses and to their own pleasure and benefit, and four have done so well that they have been put on our pay roll.Northampton State Hospital Annual Reports. (1922, November 30), pp.10.
Houston continues in the ’22 report…
The Department of Mental Diseases estimates our capacity at about 820, which is considerably larger than our estimate. The numbers we have been requested to maintain during each of the past five years have been, consecutively, as follows: 980, 990, 1,000, 1,010, 1,025, and for the coming year we are asked to make estimates for the maintenance of 1,060 patients. As a result of this constantly increasing growth in numbers, we have been seriously handicapped in the care of our patients. We cannot transfer our most troublesome patients, consequently a larger proportion of those who remain are of the disturbed class. The wards where easily distracted patients are cared for should accommodate only a very limited number of patients, but now our wards are occupied by anywhere from 40 to 60 patients, and many of these are obliged to sleep in corridors and day spaces. Naturally and inevitably they have an un-favorable influence on each other.Northampton State Hospital Annual Reports. (1922, November 30), pp.11.
Like any building on Hospital Hill, the North Attendant’s home was as insignificant as staffing, funding and treatment were to the State Hospital system. Though the 1000 inmate threshold far exceeded the State’s own maximum for the facility, which in turn exceeded the staff’s estimate, the population would only continue to grow over the next three decades to reach 2500.