Physical Ailments

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Death of Chopin by Consumption

Tuberculosis (TB) was often known as “consumption” during the Victorian era, and novelists conjured up romantic images of beautiful young women wasting away until they offered a last, gentle breath in the arms of their loved ones and suffered no more. The Bronte siblings (Anne, Emily, Branwell, and perhaps Charlotte) died of TB, as did Eugene O’Neill, Dylan Thomas, Henry David Thoreau, Alexander Graham Bell, and Doc Holliday. There was nothing romantic about dying of TB, though. Symptoms could be subtle at first, with coughing, weight loss, and fever very common. Eventually, TB patients developed pockets and cavities in their lungs that could become infected and filled with pus, or bleed. Breathing became extremely difficult and, without intervention, the disease would eventually prove fatal.

Dr. Hummer wanted a separate cottage for epileptics at the Canton Asylum for Insane Indians, but he really needed to separate TB patients from others. He was faulted as late as 1933 for his staff’s sloppy monitoring of TB and their failure to isolate patients with possible TB from healthy ones. Since a healthy person can catch TB by inhaling bacteria exhaled by an infected person, allowing patients with TB to mingle with healthy patients was a serious matter. Isolating TB patients was such an elementary precaution that Hummer’s failure to do so was inexcusable.

TB Anti Spitting Campaign

TB Sanitorium at Phoenix Indian School circa 1890 to 1910, courtesy National Archives

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And More Statistics

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Menominee Indian Family, 1931

The government always liked to gather statistics (see last post), and Dr. Hummer was forced to complete many reports for the Commissioner of Indian Affairs. A report from June 30, 1924 gives a good snapshot of the institution. There were 50 males and 47 females from 31 different tribes; six patients were of unknown tribal affiliation. At the time of the report, the Sioux and Chippewa tribes were disproportionally represented; 19 patients were Sioux, and 14 were Chippewa. Statistics since opening told the same story: 68 Sioux had been admitted since 1902, 40 Chippewa, and 20 Menominee.

Though Hummer continually advocated for an epileptic cottage, epilepsy did not seem to be his biggest problem. Before the asylum closed, an independent doctor from St. Elizabeths noted that Hummer had lumped patients with any kind of convulsions into “epileptic” status, even though they were not truly epileptic. What Hummer really needed were good protocols and staff to care for lung issues. By 1924, the asylum had had 143 deaths. Fifty-one of them were from tuberculosis, and another 17 from some type of pneumonia. Only 14 patients had died of epileptic convulsions, with another four dying from exhaustion following convulsions.

Chippewa Indians in Ceremonial Dress, courtesy University of Minnesota, Duluth

Calvin Coolidge Meets with Sioux Indians from Rosebud Reservation on Lawn of White House, 1925

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Insanity on the Rise

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Government Statistics About Insanity

Because it was more cost-effective to house many patients rather than a few, insane asylums tended to grow larger and house more patients over time. Dr. Harry Hummer of the Canton Asylum for Insane Indians felt his disadvantage in numbers very keenly. He strove continually to find ways to cut costs, and to increase his number of patients. The latter required an increased capacity for his institution, which Congress did not necessarily support. Hummer repeatedly made a case for more buildings, more farmland, and more patient beds.

Though no one ever conclusively settled the question of whether or not Indians had as much, more, or less insanity than whites, statistics about the growing number of insane were on Hummer’s side. The various states had compiled statistics on the number of insane for many years, and the rate per 100,000 rose steadily each decade of the census. In 1840, 50.7/100,000 of the population were reported as mentally ill, while 169.7/100,000 were reported so by 1890.

The number of insane in hospitals (all races) had risen to 252.8/100,000 by 1920, though the census also shows that Indian hospitalization was only 104.5/100,000. The figures for Native Americans may have been skewed due to a lack of access to mental health care, or lack of room at state mental institutions or at the Canton Asylum. The Native American population stood at 244,437 in 1920. Even with their remarkably low rate of hospitalization for insanity (it was 259.8 for whites) Hummer could have conservatively estimated the number of insane Indians to be around 250. In 1920, Hummer had only 86 patients.

Patient Beds in Hallway Due to Overcrowding, Colorado Insane Asylum

Patients Working in Fields at Western North Carolina Insane Asylum, courtesy Western Piedmont Community College

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The Low Cost of Care

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Norwich State Hospital for the Insane

Taxpayers today cry out against waste and unchecked expenses within the public health care system, and demand value for each health care dollar. It was the same a hundred years ago, and state insane asylums felt constant pressure to keep their expenses down. Care at that time was largely custodial, and patients eased their institution’s expenses somewhat by contributing labor in gardens, kitchens, and laundry rooms. Today’s strides in medical care and the curtailment of patient labor make comparisons between the eras difficult, but it is plain that life in an institution was never luxurious.

The average income a hundred years ago was $1,033. A gallon of gas cost seven cents, and a loaf of bread five cents; a medium-priced home was $2,750. The cost of living sounds great, but in 1912, Alabama insane asylums were confined to a per capita expenditure of $3.25 per week, or $169 per year. (In today’s dollars, that would be a little over $77 per week, or $4,004 per year.) That weekly $3.25 had to pay for food, clothing, entertainment, and medical treatment; wages for physicians, nurses, and attendants had to be covered; and utilities, equipment, tools, supplies, and repairs to the buildings also came from that sum.

The more patients in an asylum the lower the per capita costs. The Norwich State Hospital for the Insane in Connecticut began operations in 1905 with an average pf 77 patients and a weekly per capita cost of $6.58. By 1915, it had 1,109 patients and had dropped its weekly costs to $3.51. The Canton Asylum for Insane Indians, which held fewer than 100 patients, could not compete cost-effectively with larger institutions. Its superintendent faced the constant danger that Congress would decide to close the institution for financial reasons and disperse its patients to their respective state insane asylums.

Dairy Herd, State Lunatic Asylum No. 1, circa 1900, courtesy Missouri State Archives

Bryce Hospital for the Insane in Alabama

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Recent Insanity

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Patent Medicine Like Nervuna Cured Nervous Weakness and Physical Exhaustion

Alienists made a distinction between chronic insanity, which was difficult to cure, and insanity which had only recently manifested and might be cured through quick intervention. An article written in 1900 by Dr. C. B. Burr, medical director of the Oak Grove Hospital for Nervous and Mental Disorders, explained the steps alienists ought to generally take when confronted by a potentially curable case of insanity. The first step was to reduce excitement. That meant that patients should lie in bed in a quiet room, under the observation of a day nurse and night nurse. Family members should be excluded from the sickroom.

Burr then discussed the chronic constipation found among Americans at that time, saying that neglect of the bowels led to a large percentage of nervous diseases. The first order of the day, then, was to administer calomel (a toxic mercury compound) to purge the insane person’s body of impurities, and then to keep it purged with laxatives and/or enemas.

Cocaine Products Were Sold Over the Counter in the U.S.

“Tonics and remedies to promote tissue building are needed in all cases,” continued Burr. Among milder preparations like eggnog and milk punch, Burr also recommended “the bitter tonics and strychnine, capsicum, and nux vomica” (a strychnine preparation). Burr discussed depression separately, saying that general treatment remained the same as for other types of insanity, but “certain drugs like kola, coca, and caffein, are useful also in painful emotional states.”

Nurse at South Carolina State Hospital Nursing School

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Understanding Insanity

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Alienist Dr. Allen McLane Hamilton, 1910

Alienist Dr. Allen McLane Hamilton, 1910

Even though alienists (the term for early psychiatrists) treated insanity with vigor and resolution, they usually could not say with any certainty what had caused the condition.

An 1879 article, “Early Indications of Insanity,” in The American Journal of Insanity stated that in general, the cause of all insanity could be found in the neglect of, or an infraction of, the “established laws of physical or mental health.”

Since this could encompass almost anything, the writer went on to the core of his article, which was how to determine that someone was going insane. Continue reading →

Suspect Diagnosis

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Jury of Clergymen to Try Insane, Chicago Daily News, 1911

Patients were committed to insane asylums with relative ease during the 1800s and into the 1900s. Though many undoubtedly needed help, others were simply a nuisance to their relatives for one reason or another. Though whites were improperly committed sometimes, Native Americans were particularly helpless when it came to defending themselves against a charge of insanity; most were wards of the government at this time and had few rights. Reservation superintendents had great power, and their opinions about a particular Indian’s mental state carried great weight.

Superintendent O. S. Gifford wrote to the Commissioner of Indian Affairs, Francis Luepp, in 1908, with a dilemma. A woman named Blue Sky had been admitted to the asylum from the La Pointe Agency at some earlier time, but seemed to be ready for discharge. The snag was how to get her home. Since she didn’t speak or understand English, Gifford was reluctant to just release her on a difficult journey. He asked Luepp for funds to provide an escort to her home in Minnesota.

Commissioner of Indian Affairs, Francis E. Luepp

Though the correspondence seems to end there, escorts were provided to other discharged patients and  Blue Sky probably received one. The real problem is how she could be committed if she couldn’t understand English. Gifford and his assistant, Dr. Turner, would have found it difficult to diagnose any real complaint or provide treatment, unless she had a physical, rather than a mental problem. Yet, Blue Sky apparently recovered from whatever had sent her to the institution and displayed some sort of behavior that indicated that she had. Perhaps she had suffered an emotional blow that led to depression or excessive grief. Perhaps she had problems with family members, and simply needed a break from them. Speculation is all that is possible at this point, but the language barrier is a particularly ominous aspect of the case.

Old Indian Burial Ground in La Pointe, Wisconsin

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Payrolls

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Attendants at Central Islip Psychiatric Hospital, 1910, courtesy Minnesota Governor's Council on Developmental Disabilities

Insane asylums were important to local economies. Local men were needed for construction work or repairs, and businesses could count on meeting at least some of an asylum’s supply needs. Perhaps more importantly, insane asylums provided steady work for locals. From 1900 to 1907, the Canton Asylum for Insane Indians spent $54,896.78 on maintenance, some of which found its way into local pockets. It spent almost as much on wages, though–which was probably far more important. The payroll went from a bare $2,080 at the end of 1902 to $11,340 by 1907.

The first salary list included: a superintendent and assistant superintendent, a financial clerk, an attendant, three laborers, and a night watch (8 total). By 1909, the list included: a superintendent and assistant superintendent, clerk, matron, seamstress, laundress, cook, dining room girl, engineer, two male and two female attendants, three laborers, a night watchman, and a laborer (18 total). As buildings and the patient population went up, the asylum pumped more and more money into Canton and the surrounding area. It’s little wonder that the townspeople had a soft spot in their hearts for the facility and considered it a valuable resource.

Graduation Class of Nurses at Utica State Insane Asylum, 1899, courtesy Minnesota Governor's Council on Developmental Disabilities

Woman Attendants With Dumb Bells at the Pennsylvania Hospital for the Insane, early 1860s, courtesy Minnesota Governor's Council on Developmental Disabilities

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Economic Impact

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Portion of Building and Grounds of Insane Asylum in Lexington, courtesy University of Kentucky

Insane asylums provided regular payrolls to local economies, and often needed additional labor for special projects. As a government facility, the Canton Asylum for Insane Indians had to bid out almost all its work and supply needs, but that did not mean that the city of Canton did not enjoy the benefits of those projects. Available records do not show who actually performed all the labor associated with the asylum’s projects, but it is likely that any construction company ended up using local labor for some of its work.

The asylum’s original buildings included the main building, a pump and power house, a horse barn and a cow barn. No specific mention is made beyond “small outbuildings,” but the facility probably included a number of small sheds and storage buildings as well. In December, 1907, Gifford paid a carpenter $3/day for six days, to repair wind damage to a horse barn, cow barn, and carriage house; this would amount to about $431 today. Just a month later, he spent $75 to install window guards on the windows of patient wards, about $1,830 today. From 1900 to 1907, the government spent $80,882.03 on buildings and similar hard structures (versus maintenance)–$1,460,000 in today’s dollars.

As more patients were added, more buildings were needed and constructed. Ironically, each of the two superintendents who ran Canton Asylum wanted special buildings which they never received. Gifford particularly wished to separate noisy and violent patients from quieter ones, feeling that housing them together was bound to be excessively irritating for his quiet patients. Dr. Hummer wanted a separate epileptic cottage.

New Orleans Insane Asylum

Broughton Hospital, North Carolina

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Hiawatha Asylum

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Canton Asylum for Insane Indians

One institution that Canton’s “boosters” hoped would put the town on the map was the Canton Asylum for Insane Indians, which was usually called Hiawatha or Hiawatha Asylum by locals. Large asylums for the mentally ill were still the norm across the country, and Hiawatha’s unique patient population seemed to promise renown. Alienists (mental health experts) tended to be very forceful and positive about their field of study, and were eager to add to their knowledge. Town leaders hoped that specialists would come to Canton to study the Indians there, or even conduct their own research.

The facility was smaller than most asylums, but still impressive. It was shaped like a cross, 184 feet long and 144 feet wide, with jasper granite foundations. The outside was of pressed brick with white stone trim on the windows and doors, and inside, a cement-floored basement ran across the entire floorprint. The building had over 100 light fixtures, as well as radiator heat and a modern sewage system. There were also tiled bathrooms and water closets which used range toilets. (This was a unified system which shared a common pipe–toilets flushed at intervals rather than after each use.) Hundreds of trees and bushes were planted on the facility’s acreage, and except for the seven-foot fence around the grounds, nothing indicated that it was a type of prison. Especially for a rural area, Canton’s asylum was a noteworthy structure.

One of the primary reasons the town fought the asylum’s closing was because of the blow it meant to Canton’s economy. During the Depression, the asylum was a reliable source of jobs, and could pay real money for the goods and services it procured. Except for a few local asylum opponents, no one wanted to see the institution shut down.

Center Building, St. Elizabeths, Another Government Insane Asylum

Colorado Insane Asylum, circa 1890

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