Part-Time Physicians

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Doctor with Horse and Buggy, 1894

Doctor with Horse and Buggy, 1894

Early physicians were prepared to handle a variety of medical cases, and rural practitioners often took on mental illness as well, if their territories were too far away from asylums for treatment. They had a difficult and uncertain occupation, however, that didn’t necessarily provide a good living. We may be used to seeing doctors earning comfortable salaries today, but that wasn’t always the case.

 

View of Taunton State Hospital, Interior

View of Taunton State Hospital, Interior

Rural doctors could not set extraordinarily high fees for their work or they wouldn’t have been able to find and keep patients. But, the time-consuming trips they made to see patients (during the age of house calls) prevented them from seeing many patients on any given day. Few patients, of course, meant meager salaries. Earnings were all too often along the lines of the doctor in 1849 who billed a patient $12 for services–but then deducted two dollars in exchange for two bushels of buckwheat.

Because it was so difficult to earn a living as a full-time physician, many doctors took on second jobs. During the early 1800s in Burke County, North Carolina, doctors held second jobs ranging from Superior Court clerk, to school teacher, to hotel operator, to farmer, in order to supplement their wages as physicians.

Doctor's Parlor, Willard Asylum for the Chronic Insane

Doctor’s Parlor, Willard Asylum for the Chronic Insane

It is no wonder that a position as an asylum superintendent would be so attractive to medical men, and so jealously guarded by physicians who were alienists. Because they could squeeze out competition, asylum superintendents enjoyed decent salaries and pleasant places to live. Though they didn’t own the homes or living areas they received on the asylum’s grounds, the buildings were grand and elegant (at least at first), and the grounds beautifully landscaped. Such a situation was much better than the salaries and living arrangements available to many other physicians outside the field.

Interesting Cases

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Alienists Could Be Prominent Public Figures

Alienists Could Be Prominent Public Figures

Alienists (psychiatrists) wanted to provide good care for the insane in their midst, and in the early years offered assistance primarily  through therapeutic stays at insane asylums. These doctors’ favored regimens of rest, occupational therapy, and structured time probably served many patients well, but such programs could not help everyone. Alienists were still exploring the causes and treatments of insanity, and some of their thoughts missed the mark widely.

In an 1871 paper on mental disease (reported in the Transactions of the Medical Society of the State of North Carolina), the author described a “case of violent cerebral excitement” in a 5-year-old, which had been relieved by an oral dose of bromide of potassium. This case of “mental disease” seems to be clearly a case of epilepsy, and we can only wonder if the child was tagged for life as insane.

Another paper in the same publication discussed “Mania Transitoria,” or insanity of very short duration. During this type of mania, people could be fully aware of their surroundings (or not) and actions. It was brought on by such things as physical disease or the “accumulation of harbored feelings over a number of years.” The author seems to be describing explosions of temper or momentary passionate outbursts, but he attributed this type of insanity’s cause–or attributed it at least in part–to masturbation and petit mal epilepsy.

Craig Colony for Epileptics, courtesy museumofdisability.org

Craig Colony for Epileptics, courtesy museumofdisability.org

Cures For Epilepsy Were Plentiful

Cures For Epilepsy Were Plentiful

Early Problems Providing Mental Health Care

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Civil War Soldier Angelo Crapsey, 1861, Who Committed Suicide in 1864 After a Period of Mental Illness, courtesy Kutztown University of Pennsylvania

Civil War Soldier Angelo Crapsey, 1861, Who Committed Suicide in 1864 After a Period of Mental Illness, courtesy Kutztown University of Pennsylvania

Leaders in many states recognized early on that they needed to provide treatment for mental illness at public expense. The North Carolina Hospital (Raleigh) opened in 1856, but an influx of patients after the Civil War forced the state to find other places for care, such as in private homes. It is likely that this increased need for care occurred just as families were hurting for cash: Fraud became so widespread that the state  had to pass laws requiring counties to care for the insane, instead.

Early care in North Carolina’s asylum consisted primarily of rest, occupational therapy, and treatment for physical problems. Cure rates during this period were in the neighborhood of 30 – 40 percent. Though high, these cure rates may be accurate. After the trauma of fighting during the Civil War, patients who were former soldiers may have been truly helped by a stay in a calm, well-regulated environment where not much was demanded of them.

North Carolina’s constitution mandated that the state care for all of its “insane, blind, and deaf-mute persons.” However, there was still a great deal of stigma attached to insanity and public acknowledgement of it by families. By 1884, the general population–though it recognized the need for care–wanted it provided at home. Consequently, many family physicians found it necessary to study insanity so they could at least recognize and provide some sort of treatment for it among their patients.

Peaceful Scene at North Carolina Hospital, 1924

Peaceful Scene at North Carolina Hospital, 1924

 

Drug Room at North Carolina Hospital, 1924

Drug Room at North Carolina Hospital, 1924

Building Plans

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Epileptic Cottage in Abilene, Texas

Epileptic Cottage in Abilene, Texas

In 1915, the 47 patients at the Canton Asylum for Insane Indians filled the building to capacity. Both the present superintendent, Dr. Harry Hummer, and the previous one, Oscar Gifford, had made requests for additional buildings. The buildings were not only for the purpose of expansion, but also to separate types of patients. Dr. Hummer was extremely happy to see his capacity almost double when a requested hospital was approved; he mentioned that he would initially use it to separate epileptics from the rest of Canton Asylum’s patients.

Hummer was also delighted when he gained approval for a residential cottage. He, his wife, and two sons could live separately from the patients and gain a bit of privacy and respite from the constant activity inherent in an asylum. Hummer received two bids for the project and recommended accepting the bid from Martin Granos:

“He agrees to give us three coats of plaster, a larger basement [than the other bidder], a larger cistern, beamed ceiling in the living-room, stained shingles, a $58.00 range, a $31.00 ice-box built in, oak finish throughout the interior, fireproofed fireplace and three kinds of water in the bath-room.”

Later inspectors found this cottage very nice, indeed, especially in contrast to the living quarters of the rest of the asylum’s employees.

From a Bathroom Catalog, 1915

From a Bathroom Catalog, 1915

1915 Kitchen Range

1915 Kitchen Range

Exercising Care

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Patients and Staff Playing Croquet at Willard Asylum, circa 1880, courtesy Robert Bogdan Collection, disabilitymuseum.org

Patients and Staff Playing Croquet at Willard Asylum, circa 1880, courtesy Robert Bogdan Collection, disabilitymuseum.org

Inspections are simply written and verbal snapshots of an investigator’s particular visit. That visit may have occurred during an exceptionally good or bad time, or during a relatively normal period. Inspections at the Canton Asylum for Insane Indians are somewhat erratic in content, but it does seem clear that it was a better-run place during its earlier years. When it was inspected in 1916, the patient population was small enough that the staff could engage with them in a positive way:

“Calisthentics, [sic] breathing exercises, and marching are provided for such patients as are able to receive physical training. The play-ground equipment consists of outfits for baseball, basket ball, quoits, tennis, and one giant stride [slide], six swings, one portable see-saw, one teeter, tennis and a sixteen pound shot, all of which are popular especially the swings and shot. The play-ground exercises are supervised by the attendants.” The inspector added that instruction in hygiene and sanitation “with especial reference to personal cleanliness is given by the attendants.”

At the time, there were 47 patients in the asylum, mainly in their 20s – 40s. Many would have had some physical problems, but in general, they represented a relatively vigorous age group. Attendants and laborers may well have had a little more time than they did later, to interact with patients who were not otherwise taking up a great deal of their time with nursing duties.

Patient Picnic at Ancora Psychiatric Hospital, late 1950s

Patient Picnic at Ancora Psychiatric Hospital, late 1950s

Metropolitan Lunatic Asylum, Kew: female patients exercising Credit: Wellcome Library, London.

Female Patients Exercising at the Metropolitan Lunatic Asylum, Kew, Australia, courtesy, Wellcome Library, London

Combating Smallpox

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Lokata Sioux Winter Count Showing Smallpox Outbreak, courtesy National Institutes of Health

Lokata Sioux Winter Count Showing Smallpox Outbreak, courtesy National Institutes of Health

Smallpox decimated Native Americans (see last post) after Europeans arrived and spread this virulent disease on a population with no immunity to it. However, the disease was not simply accepted and endured. Though native peoples did not immediately connect smallpox with Europeans, they did understand illness and how to treat it.

Native Americans first turned to traditional medical practices to help combat smallpox. Drums, rattles, and incantations helped patients rally, while fasting and dreaming also followed traditional healing ways. Herbs and oils were used to alleviate discomfort. Unfortunately, the common use of the sweat lodge in treatment may have made a patient’s condition worse, since heat and steam caused sweating and dehydration, while cold water plunges may have overly shocked the body.

The Cherokee developed a Smallpox Dance in the 1830s, and other tribes formed curing societies and developed healing rituals. Families eventually stopped their traditional practice of crowding around a sick patient and allowed a quarantine for those with smallpox; people also avoided traveling to places with active cases, and burned (or thoroughly cleaned) homes where someone had died of smallpox.

The smallpox vaccine was available as early as the 1700s, though Native Americans were not routinely vaccinated. When the vaccine was offered, however, many native peoples took advantage of it. The Bureau of Indian Affairs (BIA) was the official vaccination administrator, but missionaries and  traders also urged vaccines. Traders, especially, who cared little for Washington politics and did not need to put white settlers’ needs ahead of their trading partners’, were probably just as successful in helping the vaccination effort as the BIA.

The Mandan Tribe Suffered Greatly From Smallpox

The Mandan Tribe Suffered Greatly From Smallpox

Medicine Man Administering to a Patient, courtesy National Institutes of Health

Medicine Man Administering to a Patient, courtesy National Institutes of Health

Other Ills at the Asylum

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Blankets Infected With Smallpox Were Distributed to Native Americans to Start an Epidemic, courtesy sphtc.org

Blankets Infected With Smallpox Were Distributed to Native Americans to Start an Epidemic, courtesy sphtc.org

Though there is no mention of any smallpox epidemics at the Canton Asylum for Insane Indians, the threat of this terrible disease was very real. Smallpox had devastated Native American communities once Europeans arrived, since native peoples had no immunity to a disease they had never encountered. Mortality estimates range from 50% for the Cherokee, Catawba, and Huron, and as high as 90% for the Mandan after first contact.

Native Americans did not immediately connect smallpox to the Europeans who brought it. Plains tribes thought the disease was the Bad Spirit appearing, while the Creeks and Cherokees thought it came to them because they had violated tribal laws. Missionaries and Jesuits were later blamed for smallpox because of their religious paraphernalia and concern about dying, and they may well have carried infection to the various peoples they visited in the course of their work.

By the early 1900s, Native Americans were well aware that Europeans had brought this tremendous disaster with them. In 1914, Dr. Harry Hummer vaccinated 48 patients and five employees against smallpox. (Another five employees had previously contracted smallpox, and 13 refused the vaccination.) Hummer asked  the Commissioner of Indian Affairs what he should do about the employees who had refused the vaccine, and he had a right to be concerned. Considering the frail health that many of his patients endured, smallpox would have been an overwhelming illness for them to fight.

Smallpox Prevention Poster Distributed by the Minnesota Department of Health, circa 1924

Smallpox Prevention Poster Distributed by the Minnesota Department of Health, circa 1924

A Navajo Hogan is Burned After Occupation by a Smallpox Victim, Leupp Indian Reservation, circa 1890 to 1910, courtesy National Library of Medicine

A Navajo Hogan is Burned After Occupation by a Smallpox Victim, Leupp Indian Reservation, circa 1890 to 1910, courtesy National Library of Medicine

Material Improvements

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Operating Room at Georgia State Lunatic Asylu

Operating Room at Georgia State Lunatic Asylum

For such a small institution dependent on government funds, the Canton Asylum for Insane Indians had a surprisingly robust building program. Dr. Harry Hummer constantly requested new buildings, upgrades to old ones, new farm acreage (and then new outbuildings to accommodate more livestock and feed), as well as new patient buildings. Near and dear to his heart were two buildings in particular: an epileptic cottage and a hospital.

 

Virginia State Epileptic Colony Cottage for Feeble-Minded Women

Virginia State Epileptic Colony Cottage for Feeble-Minded Women

Dr. Hummer never received his epileptic cottage, though he requested one many times. He did get the hospital, which presumably made more sense to the appropriations committee which designated money for such projects.

When the hospital was approved for construction, Dr. Hummer received full credit for it: “The entire enterprise owes its inception, development and consummation to Dr. Hummer,” said a writer for the Sioux Valley News. The paper went on to say that when the two-story, brick and concrete building was completed, “the sick will be provided with the best that science means and experience can contribute.”

Epilepsy Was Considered a Form of Insanity, so Cures Were Widely Sought

Epilepsy Was Considered a Form of Insanity, so Cures Were Widely Sought

When Dr. Samuel Silk inspected the hospital in 1929, its operating room had “no equipment whatsoever, except for a surgical table, a slop sink and two wash bowls.”

A Full Time Job

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Chiefs of the Yankton Sioux With Their Indian Agents, courtesy S. J. Morrow Collection, the W. H. Over Museum, University of South Dakota

Chiefs of the Yankton Sioux With Their Indian Agents, courtesy S. J. Morrow Collection, the W. H. Over Museum, University of South Dakota

Indian inspectors had their hands full trying to ensure that laws and policies were properly carried out within all the reservations (see last post).

But, it was the Indian agent who actually made things tick at the local level. Almost all reservations had an agent, who wielded enormous power over the lives of the Native Americans who were living on them as wards of the U.S. government.

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Too Much to Inspect

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Board of Indian Commissioners, courtesy Library Company of Philadelphia

Board of Indian Commissioners, courtesy Library Company of Philadelphia

The federal government has long provided for inspection in most areas over which it has control, and Indian reservations were no exception. In 1904, the legislature published Laws and Treaties, Vol. I, which outlined laws, policies, and procedures pertaining to its “Indian Affairs” responsibilities. Continue reading →