Suggested Changes From The Problem With Indian Administration

Patients Seated in Dining Room at Pennhurst, circa 1915, the Former Eastern Pennsylvania Institution for the Feeble Minded and Epileptic

Patients Seated in Dining Room at Pennhurst, circa 1915, the Former Eastern Pennsylvania Institution for the Feeble Minded and Epileptic

When The Problem With Indian Administration was delivered to the Secretary of the Interior by Lewis Meriam’s team (see last post), the report made many recommendations for the hundreds of schools, reservations, and hospitals the team had visited. These included increasing salaries of personnel who had direct contact with Indians (to attract better people to the Indian Service), more cubic feet per child at boarding schools, and adopting the standards established by the American College of Surgeons for accredited hospitals to all Indian Service hospitals.

The team recommended several specific improvements for the Canton Asylum for Insane Indians: Increase the personnel; put a graduate nurse in charge of each building with patients; provide additional laborers for the farm and dairy; segregate epileptics, children, and the tuberculous into three groups apart from the other patients; and improve equipment in the hospital, kitchen, and bakery. The team included a call for installing “a system of records conforming to accepted psychiatric practice in hospitals for the insane.”

Cottages 6 and 5, Epileptic Colony, Abilene, Texas

Cottages 6 and 5, Epileptic Colony, Abilene, Texas

Children's Dayroom at Byberry Mental Institution, circa 1938, courtesy Historical Society of Pennsylvania

Children’s Dayroom at Byberry,  Later the Philadelphia State Hospital,, circa 1938, courtesy Historical Society of Pennsylvania

Dr. Harry Hummer, superintendent at the Canton Asylum, did try many times to get a separate cottage for epileptic patients, but was never successful. However, a later inspector who was a psychiatrist–which no one on Meriam team had been–believed that most of the patients with convulsions were not even epileptic. Meriam’s team likely had to go by Dr. Hummer’s diagnoses, in which he had identified any patient with convulsions as epileptic.

Scrutinizing the BIA

Hubert Work

Hubert Work

Soon after he took office, Secretary of the Interior Hubert Work contacted the Institute for Government Research; he wanted them to take an intensive look at how his organization was managing the Native American population under its control. The Institute gathered a team of experts headed by Lewis Meriam to survey reservations, schools, and other Indian Bureau facilities. On February 21, 1928, they presented Work  with a report called “The Problem of Indian Administration” that didn’t mince words.

Meriam’s report reviewed the Canton Asylum for Insane Indians, and found it lacking. By this time, the institution had several buildings, and the report began with a brief description of them: “At Hiawatha (the local name for the asylum) . . . the central portion of the main building contains the administrative quarters and the culinary section on the first floor, and the employees’ living quarters on the second floor.”

Sample Pages From The Problem of Indian Administration

Sample Pages From The Problem of Indian Administration

The bakery was located in the basement of the building and “was in disorder and the oven was in a bad state of repair.” The inspectors noted the sleeping arrangements for patients and said that: “Equipment is confined almost entirely to iron beds.”

It was a dismal picture, and it seemed consistent. “The hospital building is located about fifty yards from the main building. On the first floor is a good sized dining room in great disorder.” It added later, “The dairy barn was very disorderly,” and that “the power plant and laundry are located in a separate building . . . both were in disorder.”

Much of Meriam's Report Dealt With Indian Boarding Schools Like This One at Fort Spokane

Much of Meriam’s Report Dealt With Indian Boarding Schools Like This One at Fort Spokane

Many Asylums Have Stood the Test of Time

Dr. Isaac Ray, First Superintendent of Butler Hospital

Dr. Isaac Ray, First Superintendent of Butler Hospital

Though the medical era they represented is usually dismissed as inferior nowadays, the actual physical structures where treatment for the insane took place retain respect. Many asylums from the 1800s still stand, and represent a type of architecture which is impressive, interesting, and, for the most part, unlikely to be duplicated. Anyone who has enjoyed the grandeur of older public buildings like banks, capitol buildings, libraries, and the like, know that modern architecture is all too often merely utilitarian rather than beautiful or majestic.

Efforts to keep old asylums intact, or to restore them, are constant. A nomination form to place Butler Hospital on the National Register of Historic Places discusses the institution’s buildings in detail. The hospital had been expensive to build because its supporters wanted spacious, uncrowded rooms with good ventilation and heating–unlike the prison atmosphere so prevalent in facilities for the insane up to that point. One of the structures on the premises was the Richard  Brown house, built circa 1731, and one of the first brick homes in Providence, Rhode Island.

Butler Hospital, courtesy City of Providence

Butler Hospital, courtesy City of Providence

The hospital grew and added structures over the years, and some the architectural detail the writer discussed included: frontal gables with glazed carriage entrances, octagonal columns, and a “three-story crenelated stairtower.” Building styles included Tudor, Colonial Revival, and Gothic Revival, set within beautifully landscaped grounds.

Description of the Butler Hospital for the Insane, courtesy National Library of Medicine

Description of the Butler Hospital for the Insane, courtesy National Library of Medicine

Though few people would willingly go to an asylum, Butler Hospital’s original champions seemed to have made every effort to ensure the building was as beautiful and comfortable as its patient population would allow.

Asylums and Public Inspections, part 2

Pamphlet for Visiting Board Members

Pamphlet for Visiting Board Members

When Drs. Billings and Hurd created a short pamphlet with suggestions for Boards of Hospital and Asylum Visitors (see last post), they were anxious to help these independent “eyes and ears” of the public understand what they should look for during their inspections. Though they urged these visitors not to come in with preconceived ideas or to be excessively judgmental, the doctors did urge them to take their responsibilities seriously and really look at conditions.

One detailed admonition was for visitors to “rub or press a surface [such as the tops of cabinets and shelves or the valves of fresh air registers] with the tips of the fingers, or with a white handkerchief,” to see whether the surface had been actually cleaned, rather than merely dusted. Visitors were to take note of odors and try to discover what caused them: “. . . iodoform or some other drug; to a recent discharge from the bowels; . . . or is it merely a vague, slightly dusty odor, which gives a sense of oppression, indicating insufficient ventilation?” The authors asked them to note whether rooms were neat and clean, if bedside tables were in the proper position, whether dishes or clothes were ever rinsed in the bathroom tubs, etc. First-time offenses should be brought to the attention of the superintendent so he could have a chance to correct them, rather than immediately to outside authorities.

Dr. Henry M. Hurd

Dr. Henry M. Hurd

When Billings and Hurd moved on specifically to asylums, their concern for the well-being of patients was evident. Many questions concerned attendants. Besides asking if they were well-trained, tactful, and respectful, the doctors asked: “Do they have the manner of nurses upon the sick, or of guards in a house of detention?”

Boards of Visitors Were Created to Prevent Scenes Like These at Byberry Farms in 1938, courtesy Historical Society of Pennsylvania

Boards of Visitors Were Created to Prevent Scenes Like These at Byberry Farms in 1938, courtesy Historical Society of Pennsylvania

The answer to this question would have likely made all the difference in the world to patients.

Asylums and Public Inspection

Staff at the Illinois Asylum for the Incurable Insane, 1903

Staff at the Illinois Asylum for the Incurable Insane, 1903

Public insane asylums and hospitals were monitored in part by committees whose members inspected the facilities and made recommendations for changes and improvements. These committee members were laypeople who took an interest in a particular institution and volunteered their time to visit and inspect it.

Sometimes outsiders get a different sense of a situation than people who are immersed in the field, and can be useful in pointing out conditions professionals have gotten used to seeing. However, asylum and hospital professionals were wary of these public “visitors” simply because they didn’t understand institutions and their limitations. In 1895, two physicians (Dr. John S. Billings and Dr. Henry M. Hurd) created a short pamphlet with suggestions for hospital visitors. They urged these laypeople to come “in a friendly spirit”–not to find fault or with preconceived notions, but with an open mind that sought to understand what was going on.

John Shaw Billings, circa 1896

John Shaw Billings, circa 1896

The authors explained that any visitor would find shortcomings. “No hospital, however wealthy it may be, has means sufficient to furnish the best known means of treatment and the best care to all who apply to it for relief,” they acknowledged. Few, if any, hospitals (or asylums) had all the medical equipment its doctors wanted, or served the best food, and so on. With these limitations in mind, the authors asked visitors to go through the institution with the idea that they could help its administrators improve its function.

Patients Playing Billiards at Bryce Hospital in Alabama, 1916

Patients Playing Billiards at Bryce Hospital in Alabama, 1916

Though Drs. Billings and Hurd may have begun their pamphlet sounding as though they wanted to protect medical institutions from hard scrutiny, they made it plain that visitors were to examine the place thoroughly. Some of the things visitors were to look out for will be mentioned in my next post.

Attempts at Christmas Cheer

Christmas Tree in Wisconsin State Hospital, 1895

Christmas Tree in Wisconsin State Hospital, 1895

Even when overcrowding and underfunding began to eat away at the effectiveness and relative comfort of asylum care, superintendents often went to great lengths to create a festive atmosphere during Christmas and other major holidays. These efforts eased the monotony of asylum life for patients as well as for staff.

 

Ward Decorated For Christmas, Fulton State Hospital, 1910

Ward Decorated For Christmas, Fulton State Hospital, 1910

 

 

At Northern Hospital for the Insane, staff decorated the chapel with a Christmas tree and placed evergreens and candles throughout the room. Many patients had received presents from their friends and family, and the superintendent, Dr. Wigginton, and his staff had purchased additional gifts to place under the tree so that no one would be forgotten.

Christmas at Morningside Hospital, Portland, Oregon, circa 1920s, courtesy Oregon Historical Society

Christmas at Morningside Hospital, Portland, Oregon, circa 1920s, courtesy Oregon Historical Society

At the Canton Asylum for Insane Indians, patients also celebrated Christmas with a decorated tree, special meals, and stockings filled with edible treats. In 1927, the asylum received additional holiday help from the Chilocco, Oklahoma YWCA; its girls gathered (and likely contributed) gifts like dolls, games, and books to the asylum’s patients as a service project. These were delivered on Christmas Eve, to the delight of the patients. Hummer asked the coordinator to continue with the service project, and the girls evidently did so, since there is record of the asylum receiving gifts again in 1932 or 1933.

A Deadly Fear

A Comforting Advertisement

A Comforting Advertisement

Doctors’ competency during the 1800s was not always comforting to patients facing a dire illness, and Victorians developed a great fear of being buried prematurely. Though a well-known device called Bateson’s Revival Device or Bateson’s Belfry, is actually a fictional account (by author Michael Crichton in The Great Train Robbery) of a device to rescue patients buried during comas and so on, many “safety coffins” did exist.

Dr. Johann Gottfried Taberger in Germany invented an elaborate system of ropes that linked a corpse’s limbs and head to an above-ground bell. Theoretically, if the “corpse” woke from a coma or similar state, he or she could alert the living to come to the rescue. One problem with this device was that decomposition and the bloating that accompanied it would shift the body and cause the bell to ring. Rescuers were undoubtedly horrified with these false alarms, and Taberger’s invention fell out of favor.

Dr. Taberger's Safety Coffin

Dr. Taberger’s Safety Coffin

A system that made more sense had already been invented by Duke Ferdinand of Brunswick in the late 1700s. He incorporated a window and air tube in his coffin, along with a lid with a lock (rather than one nailed shut) that included a key to keep in the pocket of his shroud. This was a private device for his own burial, but it must have provided good ideas to others.

Franz Vester of Newark, New Jersey invented an improved coffin that included a tube which allowed an interested person to see the corpse, and through which the revived “corpse” could climb to escape. It also included a bell in case the victim was too weak to climb the provided ladder.

Franz Vester's Burial Case

Franz Vester’s Burial Case

Though modern fears are not as pronounced as in the Victorian era, they still exist–a U. S. patent for a portable alarm system was filed January 7, 2013. The system includes a signal-transmitter secured in the coffin or tomb and a light source to keep the victim from panicking; a receiving device is monitored by security or other personnel. After a predetermined period, the system can be removed from the coffin for reuse.

Were Cures Worse Than the Condition?

Medicine Chest circa 1850 and Pocket Pill Case circa 1820, courtesy University of Virginia Historical Collection at the Claude Moore Health Sciences Museum

Medicine Chest circa 1850, and Pocket Pill Case circa 1820, courtesy University of Virginia Historical Collection at the Claude Moore Health Sciences Museum

By the middle and late 1800s, so-called “heroic” medicine (in which extraordinary measures to cure a condition often endangered the patient) had been abandoned. However, patients were sometimes little better off calling a doctor than if they had simply endured the illness they suffered.

To treat diarrhea, for instance, doctors may have first ordered a cathartic–a medicine to accelerate the evacuation of the bowels, and then followed it with laudanum, Dover’s powder (a combination of ipecac and opium), or morphine. The latter concoctions probably relieved distress, and opium does slow the gut so that it will treat diarrhea, but they certainly shouldn’t have been taken for any chronic condition.

Popular Cathartic Medicine

Popular Cathartic Medicine

Head lice were common in crowded living conditions, and patients were advised to soak the hair on their heads with kerosene and wrap it up in a cloth for 24 hours. Since smoking was also common during this era, patients would have to take great care that nothing worse happened to their hair than an invasion of lice.

Calomel

Calomel

Doctors commonly used arsenic and mercury–both deadly–to treat syphilis in the 1800s. They also used mercury to treat typhoid fever, parasites, depression, cholera, teething pain in babies, and scurvy, usually through a mercury-based compound called calomel. Heroin, opium, and morphine were commonly used by physicians and dispensed readily (and without prescriptions) by town druggists; these ingredients permeated common medicines or what we now call “patent” medicines, sold over the counter throughout the country.

The Price of Convenience

Great Blizzard of 1909, Canton, SD

Great Blizzard of 1909, Canton, SD

The vast majority of employees at the Canton Asylum for Insane Indians lived on the premises as part of their compensation package. Though it could certainly be a bit restrictive to seldom leave the asylum grounds, they benefited by not having to trudge through blizzards and ice to get to work in the winter, and very likely saved a great deal of time each day by not having to add travel time to what was usually a very long work shift.

Employees' Dining Room, Clark County Insane Asylum, Wisc., 1922, courtesy Clark County History Buff

Employees’ Dining Room, Clark County Insane Asylum, Wisc., 1922, courtesy Clark County History Buffs

Dr. Hummer, the asylum’s superintendent (evidently in answer to a letter from the Indian Office about the availability of quarters), wrote a letter to the commissioner of Indian Affairs in September, 1916 about his financial clerk’s living arrangements. Hummer stated that it would be possible to furnish quarters at the asylum for the clerk, except for the inconvenience it would cause. The clerk had a wife and daughter, and the family would need three rooms to live in–which wouldn’t be possible unless Hummer gave up his office, the matron’s kitchen, or the sitting room “now used by all the employees.” The financial clerk didn’t want to cause this hardship, and asked that the government provide coal for him to use in his home in Canton.

Hummer’s position was that “I would prefer to furnish him with this coal, rather than make it unpleasant for him or any of the employees.” The commissioner’s office replied: “The Office does not believe it advisable to furnish Mr. T. T. Smith, Financial Clerk, with coal for his home at Canton.”

Jamison No 7 Mines, October 16, 1916, Barrickville, WVa

Jamison No 7 Mines, October 16, 1916, Barrickville, WVa

The price of coal was about $1.24/ton wholesale at this time, and the clerk had estimated he would need about five tons of it each winter.

 

A Favorite Project

Epilepsy Was a Feared Condition

Epilepsy Was a Feared Condition

Dr. Harry Hummer, superintendent of the Canton Asylum for Insane Indians, almost continually made and implemented plans to expand the facility. One building that he especially wanted and never received was a separate cottage for epileptics. Though it came out near the end of his career at the asylum that he had erroneously classified anyone with seizures as “epileptic,” Hummer definitely wanted patients with these symptoms separated from the others.

In a letter dated January 15, 1916, he discussed his vision for such a cottage: “The structure should be two-story, one for males and one for females, and the sleeping-space should be an open dormitory arrangement, with one room for disturbed cases and one room for the employee, on each floor. If possible, it would be an excellent plan to surround the structure on three sides with sleeping porches, and we should have a day (living) room, separate from the dormitories.” Hummer asked that the building be constructed of brick and stone or brick and concrete so that it would match the other buildings on site.

Epileptic Hospital in Kansas

Epileptic Hospital in Kansas

Epileptic Asylum in Abilene, Texas

Epileptic Asylum in Abilene, Texas

Hummer’s rationale for a separate building was that: “All institutions for the insane make an effort to segregate the patients, and it [is] a well known fact that epileptics get along much better when to themselves than when housed with other classes.”

His first statement was probably true, but the second had little data to support it.