Government Care of Insane Native Alaskans

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Tlingit Healer and Patient in Posed Healing Ceremony, Alaska, 1906, courtesy Library of Congress

Tlingit Healer and Patient in Posed Healing Ceremony, Alaska, 1906, courtesy Library of Congress

The Oregon State Hospital in Salem, Oregon was created in 1880 by an act of the state’s legislature, and opened its doors in 1883 to 370 patients. By 1896, the number of patients had grown to 1,106.

On January 16, 1901, the U.S. government entered a contract with the hospital to house the insane of Alaska at $20/month for each patient. The contract was renewed for an additional year, but in 1904, Alaskans with mental health care needs were sent to Morningside Hospital in Portland, Oregon. They were typically arrested and convicted on insanity, then transported by dog sled and boat to Oregon. Like American Indians, many of these patients were railroaded into an institution because they were inconvenient to someone in power.

Inside Morningside

Inside Morningside

The care for the Territory of Alaska’s native population fell under the Secretary of the Interior, as did care for American Indians. Because there were no facilities in Alaska to provide for the mentally ill , they were brought–often unwillingly–to the mainland for treatment under the care of the Sanitarium Company of Portland, Oregon. The hospital was understaffed and relied on drugs to keep patients subdued and manageable.

Inspection at Morningside Hospital, courtesy National Institutes of Health

Inspection at Morningside Hospital, courtesy National Institutes of Health

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The First Government Hospital for the Insane

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St. Elizabeths

St. Elizabeths

The Government Hospital for the Insane (St. Elizabeths) had been in operation about a decade when the Civil War began. Wounded soldiers were treated there, and in January, 1863, the surgeon-general of the U.S. army requested that a separate room be set aside “for the convenience of one of the manufacturers of artificial legs.” A soldier who had lost a limb through amputation could then be easily and conveniently fitted for an artificial limb. Soldiers from close-by hospitals could request a transfer to St. Elizabeths when their wounds healed, for an artificial limb-fitting.

The government hospital expanded greatly over the next two decades, and was a leader in the scientific treatment of its patients. Dr. I.W. Blackburn, its first special pathologist, was one of the first in the country assigned to a hospital. St. Elizabeths was also one of the first hospitals to use hydrotherapy to treat the insane. Dr. G.W. Foster began using this therapy around 1893, mainly in the form of cold packs to the head. The hospital purchased a complete hydrotherapeutic outfit in fiscal year 1897-1898.

A school of nursing instruction began in 1894, and became more formalized around 1899, when it was reorganized and expanded. The school began giving certificates after a two-year course, along with a promotion and raise in pay for graduates.

Private Columbus Rush, courtesy National Museum of Health and Medicine

Private Columbus Rush, courtesy National Museum of Health and Medicine

Private Rush with Prosthetic Legs, courtesy National Museum of Health and Medicine

Private Rush with Prosthetic Legs, courtesy National Museum of Health and Medicine

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Training for Nurses

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Civil War Nurse

Civil War Nurse

Just as war in the Crimea led the way for women’s involvement in nursing for Great Britain, the Civil War led to similar breakthroughs in the U.S. Dorothea Dix led the effort to get women into the hospitals. She wanted her nurses to be old and plain so that decorum would not be upset, but eventually accepted women outside those parameters because of the great need. The inroads females made in overcoming the exclusivity of male nursing care during the war helped them retain their place in hospitals afterward.

Doctors particularly saw the need for nurses in insane asylums, because of the often long-term nature of patient care. In 1880, the McLean Hospital for the Insane began to give instruction to attendants in the “manipulations of  nursing,” and introduced the term “nurses” for attendants and “patients” for boarders.

In 1883, the Buffalo State Asylum began instruction for female attendants. Some of the questions included:

What are the physical conditions of acute melancholia; detail the care such patients need.

What are the characteristics of a fit?

Give method of applying moist heat–a turpentine stupe fomentation–poultices–a mustard plaster.

What is a deodorizer; an antiseptic; and a disinfectant?

Give apothecary’s weights; dose of powdered opium; tincture of opium, morphine; symptoms and treatment of opium poisoning?

McLean Asylum for the Insane

McLean Asylum for the Insane

Buffalo State Asylum

Buffalo State Asylum

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Nursing the Insane

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Florence Nightingale

Florence Nightingale

Nurses fill a vital role in caring for patients in any institutional setting, and today’s nurses are trained, skilled, and professional. That was not always the case. In the late 1800s, attendants were typically male, and often incompetent or uncaring. Florence Nightingale set the bar higher for nursing when she went to Crimea in 1854, but twenty years later, medical men were still lamenting the lack of qualified and willing people to help the insane.

One problem the profession faced was a lack of systematic instruction for attendants or nurses. Except for the religious orders, there were no permanent schools to train people for nursing even as late as 1880. Some medical superintendents tried giving lectures on nursing care, but they were often attended by just a handful of people. Alienists (early psychiatrists) understood that they could help the situation by attracting women to nursing.

Stewards and Nurses, Brooklyn Navy Yard Hospital, Detroit circa 1890-1901

Stewards and Nurses, Brooklyn Navy Yard Hospital, Detroit circa 1890-1901

 

Group of Male Attendants, 1890s, Spring Grove Hospital

Group of Male Attendants, 1890s, Spring Grove Hospital

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Tough Women

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Gathering Cow Chips

Gathering Cow Chips

Going West was hard for everyone, but women faced extra difficulties. Besides abandoning a familiar home and surroundings, the physical demands of travel could also take a heavy toll. Passengers in a wagon might have to walk a good portion of the time, to spare the livestock and lighten the load. Long skirts were confining and difficult to keep clean during travel. Thunderstorms drenched a woman’s wagon and all her possessions, blazing sun burned her  body and dried her  skin, and the endless wind could leave all of her family parched for water. Along the way, a woman might lose a baby or child. Then she would be forced to leave the body in a grave, to never see again.

Women were remarkably brave and cheerful through these trials. Here is a journal entry by Mary Richardson Walker in 1838: “In the afternoon we rode 35 miles without stopping…but[when I] came to get off my horse, almost fainted. Laid as still as I could till after tea, then felt revived. Washed my dishes, made my bed & rested well.” (From Women of the West by Cathy Luchetti & Carol Olwell)

Mormons on Their Way West

Mormons on Their Way West

Pioneer Women

Pioneer Women

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Hardships In the West

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Cattle On Farm Ruined by Grasshoppers in North Dakota, 1936, courtesy Library of Congress

People from the East did not always understand how dramatically different conditions were in the West. Without forests of trees, the wind blew unchecked across the plains. The land didn’t offer much in the way of building material–brick or wood homes were impossible dreams for early settlers. Instead, they had to dig into the land itself to build sod homes.

After settling on the land, pioneers discovered that insects (like grasshoppers) could wipe out their crops when devastating numbers of them arrived to feed. Settlers faced blizzards that were made worse because of the emptiness of the land. There were few neighbors for social networking or even practical assistance. The worst thing settlers discovered, was that 160 acres in the West was not the same as 160 acres in the East. That amount of land wouldn’t support them in the dry conditions they faced in the West. Many of the early pioneers abandoned their land and returned home.

Plowing a Field, courtesy Colorado State University Archives

Plowing a Field, courtesy Colorado State University Archives

Pioneers Going West, courtesy Kansas Department of Transportation

Pioneers Going West, courtesy Kansas Department of Transportation

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The Next Push Westward

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Pioneers near Gates, Custer County, NE, 1886, courtesy Library of Congress

Pioneers near Gates, Custer County, NE, 1886, courtesy Library of Congress

Efforts by the government to distribute land at a price wasn’t as successful as it had hoped. (See last post) However, the government’s efforts to let people settle land and then pay for it were opposed by people in the East, who thought a huge number of workers would leave. Southerners were afraid that a large number of people in western territories would lead to the creation of free states , since they assumed most small farmers would oppose slavery.

After the South seceded, the government passed the Homestead Act in 1862. The law allowed a homesteader to file an application for a 160-acre plot of surveyed land, farm and improve it for five years, and then file for a deed of ownership. There were certain requirements within this framework that unscrupulous people tried to make a profit from (like whether the 12 X 14 house they had to build could be in inches, since the law didn’t specify).

What kept fraud down was the fact that free or not, land in the western territories was hard to conquer. My next post will describe some of the difficulties settlers faced.

Homesteaders at Strool, SD, 1909, courtesy Library of Congress

Homesteaders at Strool, SD, 1909, courtesy Library of Congress

Homesteaders in Custer County, NE, 1887, courtesy Library of Congress

Homesteaders in Custer County, NE, 1887, courtesy Library of Congress

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Settling the Old West

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Wagon Train Between Echo Head & Hanging Rock, 1867, courtesy Library of Congress

Wagon Train Between Echo Head & Hanging Rock, 1867, courtesy Library of Congress

Many popular myths and conceptions surround the settling of America’s Old West. The truth is that it was a long, difficult process–both to distribute land and to settle it. The federal government began to distribute land almost since the country was founded, but it wasn’t especially easy. At first, land was measured against landmarks. Boundaries could be a little fuzzy with this method, and the government eventually began to measure against astronomical points.

The government didn’t want to just give away land–they wanted to add to the new country’s treasury. Prior to 1800, the government sold 640-acre parcels of land for $1 an acre. Buyers had to purchase the whole plot, and $640 was a lot of money. After 1800, the purchase requirement was dropped to 320 acres–which was a little bit easier for settlers to clear and plant–and purchasers were allowed to pay in installments. The new price was $1.25 an acre, and was still steep for most would-be farmers.

After 1852, the government priced land based more on its  perceived value. Land that had been available and unsold for 30 years, for instance, was re-priced at 12.5 cents an acre. To 21st-century landowners, that price seems unbelievably cheap. However, clearing land without powerful machines was difficult and backbreaking, and it was hard for families to leave their communities and social networks to strike out on their own.

The government had to get creative to really get settlers willing to push westward, and my next posts will show the settlement process.

O.H. Gilman & Co. General Store, 1890, courtesy Library of Congress

O.H. Gilman & Co. General Store, 1890, courtesy Library of Congress

Sod House, SD, 1898, courtesy Library of Congress

Sod House, SD, 1898, courtesy Library of Congress

 

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Dr. W.W. Godding

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Dr. W. W. Godding, courtesy Library of Congress

Dr. W. W. Godding, courtesy Library of Congress

Dr. William Whitney Godding was the second superintendent of St. Elizabeths, still called the Government Hospital for the Insane in 1877 when he took over from Dr. Nichols. The asylum had 700 patients at the time, far more than originally planned on. Godding accommodated this large number of patients by building 18 cottages for them, where chronically ill patients could live in more homelike settings.

Godding wrote nearly two dozen articles about mental illness, and served as president of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII) from 1889- 1890.

In 1897, the Department of the Interior asked Godding his opinion about building a government hospital for insane Indians. Godding said that since he had only seven Indian patients at his own hospital, he didn’t think there was any need for a separate institution for them. Though he knew there might be a number of mild cases elsewhere, he couldn’t see expending money for a separate hospital and the upkeep for it, when the entire cost for taking care of the insane Indians at the Government Hospital only totaled $2,267.00.

Senator Pettigrew from South Dakota managed to push through the Canton Asylum for Insane Indians, though, at an initial cost of $45,000.

First Pathology Lab in a Mental Hospital, St. Elizabeths, 1884, courtesy National Institutes of Health

First Pathology Lab in a Mental Hospital, St. Elizabeths, 1884, courtesy National Institutes of Health

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St. Elizabeths Superintendents

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Grand Review of the Union Army, Washington DC, courtesy Library of Congress

Grand Review of the Union Army, Washington DC, courtesy Library of Congress

Reformer Dorothea Dix was instrumental in founding St. Elizabeths in Washington DC, as a place for “enlightened curative treatment of the insane of the Army, Navy, and District of Columbia.” She recommended Charles H. Nichols for the position of superintendent. President Millard Fillmore appointed him to that position in 1852.

The hospital was constructed during Nichols’ tenure as superintendent. When the Civil War broke out, Congress authorized the unfinished east wing as a temporary hospital for Union soldiers, and the 60-bed West Lodge was used for sailors in the Potomac and Chesapeake Fleets. General Joseph Hooker was a patient at St. Elizabeths after the battle of Antietam, but was cared for in Dr. Nichols’ quarters.

Dr. Nichols and other male staff rode out to battlefields around the DC area, to treat wounded soldiers. Recuperating patients filled in for them when possible. Not all patients survived, and both Union and Confederate soldiers are buried on the grounds of St. Elizabeths.

Dr. Nichols remained as St. Elizabeths’ superintendent until 1877.

General Joe Hooker, Matthew Brady photo

General Joe Hooker, Matthew Brady photo

Civil War Ambulance Train

Civil War Ambulance Train

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