Practicing Medicine on a Frontier

September 28th, 2014
Frontier Doctor Andrew Taylor Still

Frontier Doctor Andrew Taylor Still

Any reasonably ambitious man could become a doctor during the nation’s early years. Few licensing requirements existed, and men could choose to attend one of many substandard medical schools that were unbelievably slack in their requirements for both entry and graduation. Some men never went to school at all, but either “read” to be a doctor or served as apprentices under a practicing physician until they felt able to go out on their own. Though some aspiring doctors took these routes to avoid overtaxing themselves mentally or financially, many others simply were not able to “go East” to an established medical school. They studied earnestly–probably harder than many of their college-educated peers. In Appalachia, many doctors took an interest in herbs and local healing folklore, and incorporated this knowledge into their practices.

Because it was so easy to become a doctor, physicians in the early 1800s often saturated their markets to the extent that nearly none of them could earn a real living. (This is one reason that a well-paid superintendency at an insane asylum was initially such a coveted position.) Physicians moving into Appalachian territory often advertised their services, and sometimes offered testimonials from (supposedly) impartial and healed patients they had helped. Others made money on the side through the sale of medicines, or pulled teeth, preached, or farmed. Many physicians were paid in produce or livestock and found it difficult to actually earn cash.

Despite some undisputed charlatans and incompetents, frontier doctors in Appalachia and elsewhere were incredibly dedicated. Many doctors risked their lives to travel tremendous distances over dangerous terrain to attend patients who might pay them with fresh eggs and produce, or not at all.

Patent Medicines Thrived Despite the Availability of Doctors

Patent Medicines Thrived Despite the Availability of Doctors

Dr. Carl Hoffman, circa 1910, courtesy Orgeon Health and Science University Archives

Dr. Carl Hoffman, circa 1910, courtesy Oregon Health and Science University Archives

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The Push West

September 25th, 2014
Appalachian Homesteads Had Few Comforts, 1933, courtesy TVA archives

Appalachian Homesteads Had Few Comforts, 1933, courtesy TVA archives

In April, 1750, “Colby Chew and his horse fell down the bank,” wrote Dr. Thomas Walker, an Appalachian explorer, in his journal. “I bled and gave him valatile [sic] drops and he soon recovered.”*

Pioneers going to the West encountered harsh conditions as they moved away from settlement and civilization  (see last few posts), but the western frontier itself was an ever changing border. It began in what we would now say was the East, and simply slid westward as the growing population overwhelmed their available land and resources. As might be expected, medicine and medical care on these borders were crude and unenlightened, though not much more so than what was seen  in cities. Bleeding a patient after a physical injury, as Walker did, sounds counterproductive today but was a common response to almost any illness during Walker’s time.

As each new frontier settled a bit and doctors moved into regions like Appalachia, they brought a variety of experiences, philosophies, and training with them. Doctors were not required to have licenses or even to attend medical school, and they thrived or failed upon the public’s perception of their success. When patients lived through bleeding, dosing with calomel (a toxic compound of mercury chloride), narcotics, and other dangerous concoctions, doctors–rather than the patient’s robust constitution–received credit for the recovery.

* Quoted from Frontier Medicine by Ron McCallister.

Medicine Wagon Allowed Traveling Medical Care

Medicine Wagon Allowed Traveling Medical Care

Huge Trees Led to Extensive Lumbering in Appalachia, photo circa 1895, courtesy of Shelley Mastran Smith and foresthistory.org

Huge Trees Led to Extensive Lumbering in Appalachia, photo circa 1895, courtesy of Shelley Mastran Smith and foresthistory.org

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Territories Not Immune to Mental Illness

September 21st, 2014
Arizona Bad Lands, circa 1905 to 1910, courtesy Library of Congress

Arizona Bad Lands, circa 1905 to 1910, courtesy Library of Congress

The vast expanses of the West usually meant adventure, opportunity, and fresh beginnings for the people who traveled there. However, the road West was rigorous, dangerous, and oftentimes dismal. Frontier travelers could not escape mental illness any more than their brethren in the East could, and authorities quickly understood that they needed to build Territorial insane asylums (see last post). The Insane Asylum of Arizona was established in 1886 at a cost of $100,000–a tidy sum for such a sparsely populated region.

The asylum’s original capacity was 200 patients. When it opened in 1887, administrators immediately admitted the 61 patients from Arizona Territory (49 males and 12 females) who had been cared for in a Stockton, California institution because of Arizona’s lack of facilities. By 1900, the institution–now named Territorial Asylum for the Insane–held 175 patients. The asylum eventually became overcrowded, since it took in all the Territory’s (and later, state’s) feeble-minded and alcoholics as well as its insane. Because the Territory had so few public institutions for social care, the asylum at first also accepted the merely old or tubercular.

Like most asylums, Arizona’s tried to be as self-sufficient as possible. Set on 160 acres of land about three miles east of Phoenix, the grounds contained a vegetable garden and an area to grow grains. Patients who were able worked in the gardens and helped tend the orchard’s 2,000 trees.

Photo, Arizona Insane Asylum, courtesy Phoenix, Arizona Historical Images

Photo, Arizona Insane Asylum, courtesy Phoenix, Arizona Historical Images

G. L. Rule Residence With Family, Arizona Territory, 1898

G. L. Rule Residence With Family, Arizona Territory, 1898

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An Asylum in South Dakota

September 18th, 2014
Scene From Yankton, SD, circa 1903

Scene From Yankton, SD, circa 1903

The Canton Asylum for Insane Indians was not the state’s first asylum; the Yankton Insane Asylum was established in 1879 during South Dakota’s territorial days. Interestingly, Canton had been considered as a site for that asylum, as well. The Territory had been served by the St. Peter State Hospital in Minnesota before that time, and by 1878, the facility housed 22 patients from Dakota. The hospital became overcrowded, and Governor William A. Howard was advised that Dakota patients would have to be removed by October of that year. By scrambling for other resources and extending Minnesota’s contract for a few more months, the governor managed to keep the status quo until early 1879.

Frugality and speed were drivers in the effort to relocate Dakota Territory’s mentally ill. Governor Howard wanted to house patients in preexisting buildings within the Territory, but had no luck finding suitable accommodations in Canton, Vermillion, or Elk Point. Yankton had two large wooden buildings which the governor secured and had rebuilt north of the city for under $2,500. He used his personal funds for the enterprise, for which he was reimbursed in 1880. The territorial legislature was similarly frugal and only appropriated enough money for the patients’ basic needs; real treatment of any kind was not available. In 1899, a fire killed seventeen female patients, and funds were finally appropriated for a more suitable building. By 1909, the institution’s Mead Building followed the norm in insane asylum architecture, and stood out as a beautiful structure.

Mead Building Lobby, courtesy Christopher Payne via NPR

Mead Building Lobby, courtesy Christopher Payne via NPR

Yankton Insane Asylum

Yankton Insane Asylum

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Going Insane in the West

September 14th, 2014
Covered Wagons Pulled by Oxen, circa 1870 - 1880, courtesy Library of Congress

Covered Wagons Pulled by Oxen, circa 1870 – 1880, courtesy Library of Congress

People went West for many reasons, but most carried a dream of creating a better life for themselves in this new, undeveloped territory. Homesteading was advertised as attractively as possible, and though emigrants may have prepared for it physically by bringing as many supplies as they could carry, few were prepared psychologically for the intensity of the pioneer experience. When they reached the vast stretches of the Great Plains after losing equipment, livestock, and perhaps even family members, it became harder to keep believing the propaganda about new railways, bustling towns, and bountiful harvests–because they were nowhere to be seen.

Loneliness and isolation soon took their toll. Women, especially, seemed to find the West filled with nothing but chores amid all the discomforts of a prairie (sod) home filled with insects, snakes, and ugliness. Men who did not realize their dreams of wealth or farming success could easily become depressed; unremitting stress could impact both genders. Hysteria, melancholia, or “nervous exhaustion,” as well as alcohol abuse and violence could destroy isolated prairie families, who seldom had anywhere to turn for help.

Women seemed to succumb to mental illness more than men, but that may only appear so because women wrote more about what they felt and experienced. Diaries from the trail tell a dismal story of death and privation. From Cecilia McMillen Adams’ 1852 diary:

June 25: Passed seven graves . . .

June 26: Passed eight graves . . .

June 29: Passed ten graves . . .

July 1: Passed eight graves . . .

A Pioneer Home, 1880, courtesy Library of Congress

A Pioneer Home, 1880, courtesy Library of Congress

Pioneer life in 1882, courtesy Library of Congress

Pioneer life in 1882, courtesy Library of Congress

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Prairie Madness

September 11th, 2014
he High Plains in Kansas, 1920, courtesy U.S. Department of the Interior, Geological Survey

The High Plains in Kansas, 1920, courtesy U.S. Department of the Interior, Geological Survey

Life on the edges of the Western frontier was difficult, and by necessity, attracted mostly rugged, committed people who believed they could carve a good life for themselves in these untested regions. Despite the [general] sense of hope and adventure they carried, pioneers could not escape from mental illness any more than their counterparts in the more settled East. A  form of mental illness peculiar to the people settling the Great Plains was “prairie madness.”

It was an apt name, since the empty vastness of the prairie was an important contributor to the condition. Men and women who left an established home and social ties to face the isolation of the Great Plains could fall into depression that led to withdrawal and hopelessness. Some sufferers responded with anger and violence or with changes in behavior and character, and some went so far into despair that they committed suicide. Aside from returning East, there was little help for anyone who began to suffer from the condition, and it would have been difficult to differentiate normal feelings of homesickness and loneliness from the more extreme symptoms in the condition’s beginning stages.

Risk factors of the prairie environment included:

— Isolation

— Lack of transportation

— Harsh weather

— Unfamiliar hazards such as grasshopper plagues, prairie fires, and drought

— Lack of medical facilities and professionals, which made any sort of physical sickness more difficult to endure

— The unceasing wind and lack of familiar vegetation like trees

Prairie madness was not a defined, clinical condition with precise symptoms, but many people wrote about it. One memoir that includes an account of prairie madness is Adela Orpen’s Memories of the Old Emigrant Days in Kansas, 1862-1865.

A Sod House Was a Far Cry From Most Settlers' Former Homes, courtesy Library of Congress

A Sod House Was a Far Cry From Most Settlers’ Former Homes, courtesy Library of Congress

An Interesting Read for Modern Urbanites

An Interesting Read for Modern Urbanites

 

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What Could Go Wrong?

September 7th, 2014
Virginia Woolf

Virginia Woolf

Simple as it was, the rest cure ended up being quite controversial, since the majority of its patients were women. Dr. Mitchell’s theory about the rest cure centered around the belief that women were weak and could be hurt by too much education or stimulation. The nervous exhaustion so prevalent during the late 1800s was a consequence, in his view, of women trying to exceed their natural limitations. In fact, part of the cure involved putting female patients into a state of childlike dependence by forcing them to stay in bed and submit to a nurse’s care for even bathing and eating. (See last post.)

Charlotte Perkins Gilman, a writer and early feminist, took Mitchell’s rest cure and was nearly destroyed by it. In her words, she, “came so near the borderline of utter mental ruin that I could see over.” After going home and refusing to follow his advice, Gilman left her marriage and continued to write. Her short story, “The Yellow Wallpaper,” published in 1913, describes her despair while taking the cure. Virginia Woolf also took a rest cure (though not with Mitchell) and wrote disparagingly of it afterward.

These women, and others, successfully rebelled against the restrictions and paternalism of the rest cure. However, it actually reflected prevailing medical views of the time: that women were frail and needed to do whatever their [male] physicians told them to do.

Gilman Believed That Her Short Story Influenced Mitchell to be More Humane

Gilman Believed That Her Short Story Influenced Mitchell to be More Humane

Charlotte Perkins Gilman

Charlotte Perkins Gilman

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The Rest Cure

September 4th, 2014
Dr. Silas Weir Mitchell

Dr. Silas Weir Mitchell

The rest cure was probably the most fashionable of responses to a condition of “nerves” or neurasthenia (see last three posts). Only the wealthy could afford such a complete withdrawal from obligations or work, let alone take on the obvious expenses of accommodations and treatment involved in the cure. Women took the treatment in disproportional numbers from men, but may have been kept out of asylums with its help. Even though some patients deplored this cure, surely it was better for both reputation and psyche than a stay in a madhouse.

Dr. S. Weir Mitchell was the leading authority on treatment through the rest cure, and was highly influential in popularizing it during the late 1800s. The rest cure worked in two ways: like a stay in an asylum, the rest cure took patients out of their homes and isolated them from whatever atmosphere, people, or situation had caused the problem; the cure secondarily worked on their body and mind by keeping patients at rest in a pleasant, cheerful environment.

Patients were literally forced to rest in a bed for six to eight weeks; massage and electrical stimulation helped keep their muscles toned during the enforced inactivity. Patients were washed by nurses, who also fed them a milk-based diet; milk alone might be given for the first week, or raw eggs if a patient couldn’t tolerate milk. Feeding was nearly continuous, and patients could be force-fed if they would not voluntarily down the quantities the staff tried to give them. Sometimes patients were not allowed to read, talk, or enjoy even the most minimally physical amusements. This probably separated the patient who merely wanted a change of pace or sanctioned escape from an unpleasant household situation from patients who truly needed care.

Patient Undergoing Rest Cure

Patient Undergoing Rest Cure

Dr. Mitchell at the Infirmary for Nervous Diseases, Philadelphia, 1902, courtesy National Library of Medicine

Dr. Mitchell at the Infirmary for Nervous Diseases, Philadelphia, 1902, courtesy National Library of Medicine

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Insanity a Privileged Disease?

August 31st, 2014
The Surge in Nervous Diseases Created Interest in the Public

The Surge in Nervous Diseases Created Interest in the Public

Though insanity would never be welcomed by either victims or their families, it was perhaps a comfortable notion to think that it primarily afflicted “civilized” people and nations. Nervous diseases did not affect “savages.” Furthermore, the upper, leisured class could sometimes ascribe their whims, phobias, and “nerves” to their sensitivity and developed intellect, even when the conditions bordered on insanity.

Wealthy women could be dainty, frail, and too refined to bear anything sordid or “common.” They could afford to be highly strung, indulging in hysteria, moodiness, nervousness, and hypochondria. Men shied away from hysteria, but they could manifest both hypochondria and melancholia without losing respect. People who had these nervous disorders, or neurasthenia, as coined by Dr. George Brown (see last two posts) could go to spas, travel, or take rest cures that might include bed rest, massage, and hearty meals. Sometimes for men, treatment would be vigorous outdoor exercise.

Though all these conditions caused distress and should not be considered false or amusing in any degree, only the leisured, wealthier class could manage to indulge in them without societal disapproval. A delicate blue-blood who could eat only the daintiest food was acceptable; a factory girl would be expected to eat what she was given. A wealthy man could afford to be melancholic and withdraw from business or social obligations, whereas a working man would incur only anger or exasperation for the same behavior. Finally, the wealthy could manifest these somewhat fashionable nervous conditions without acquiring the label of insanity or suffering the trauma of  commitment to an asylum. Because they had the means to help themselves in gentler ways via the advice and services of specialists, they could perhaps cope better with their condition so that it did not become worse, the way it might for a person in poverty and with no ability to get help at the onset of the problem.

Massaging Arm in the Rest Cure, circa 1890

Massaging Arm in the Rest Cure, circa 1890

Victorian Woman Fainting of Neurasthenia

Victorian Woman Fainting of Neurasthenia

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Insanity and Physical Causes

August 28th, 2014
Charles Hamilton Hughes, Eminent Alienist, Founded and Edited The Alienist and Neurologist

Charles Hamilton Hughes, Eminent Alienist, Founded and Edited the Alienist and Neurologist

Alienists had long pondered the causes of insanity, and attributed some often-laughable (to modern sensibilities) reasons for its onset. They realized that sudden shocks, grief, worry, and other emotional traumas could at least temporarily affect a patient’s mind, but they also understood that insanity could derive from physical causes. Unfortunately for many patients, syphilis and epilepsy were two primary physical conditions behind much of the insanity found in insane asylums during this time. Sunstroke, fevers, and alcohol abuse could also damage the body enough to cause insanity.

In the 1870s, Dr. George Beard (see last post) made some important connections between stress and neurosis, attributing “American nervousness” to the sudden onslaught of a rapidly developing modern era which could overwhelm many people. However, he ultimately believed that insanity was due to physical causes.  “The central nervous system becomes dephosphorized, or perhaps, loses some of its solid constituents,” Beard wrote. In mental illness, the nervous system underwent morbid changes in its chemical structure, which diminished the patients “nervous force.” These changes could ultimately be viewed under a microscope in an autopsy, though Beard could not actually prove his theory. He was firm in his conviction, however, that all insanity was a result of some sort of diseased physical condition.

Conditions Like Anorexia Were Accepted by Physicians in the Industrial Age, photo circa 1900

Though Identified Much Earlier, Conditions Like Anorexia Became Widely Accepted by Physicians in the Industrial Age, photo circa 1900

Nerve Syrup

Nerve Syrup

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