Author Archives: Carla Joinson

School and Work

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Boys Working at an Indian Boarding School, location unknown, courtesy Minnesota Historical Society

The Indian Office liked to hire Native Americans who had been educated in its boarding school system, figuring that graduates would be more familiar with white American culture than people who had stayed on reservations. Unfortunately, many boarding school educations prepared students for entry level work rather than supervisory positions. Students frequently spent half their school day in manual labor rather than academics, and then worked as servants in white homes during vacations.

Charles Eastman (1858-1939) was an exception to this typical educational path. He attended mission schools and later Beloit (a private college), before graduating from Dartmouth in 1887. He then attended Boston University, graduated in 1889, and became the first Native American with a certified European-type medical degree. Eastman worked in the Indian Health Service within the Bureau of Indian Affairs (known at that time as the Indian Office) and was able to minister to Native Americans casualties at Wounded Knee.

Charles Eastman, 1897, courtesy Smithsonian Institution

Charles Eastman, 1913, courtesy Smithsonian Institution

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Jobs for Indians

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Pueblo Indians Working in the Indian Service School, Taos, New Mexico, courtesy Library of Congress

When Dr. Harry Hummer found himself understaffed as a result of the manpower shortage created by WWI, he asked the Indian Office to approve higher wages to help him fill positions. (See last post.) Otherwise, he would have to look at hiring Indian workers. For him, Indian staff was a last resort; for the Indian Service, hiring Native American workers was becoming much more commonplace. One of the most important reasons for hiring Native Americans was the hope that it would make the process of assimilation (submerging Indians into white culture as a way of “killing the Indian” without actual bloodshed) quicker and easier. Indians’ employment within the Indian Service itself seemed a perfect way to give Native Americans a stake in white culture and for them to serve as role models for others on their reservations.

Before the Civil War, not many positions were filled by Native Americans, but the government pushed employment for them after the war. Employment within the Indian Service’s education department went from 15 percent in 1888 to 45 percent in 1899. By 1912, Native American employees made up nearly 30 percent of all regular employees in the Indian Service, not just in its education department. (There aren’t statistics that break down employment in every job category for this period.) Teachers were still mainly white, but the number of Native American teachers had risen from 0 in 1888 to 50 in 1905.

Yakama Indian Employees and School Children, Fort Simcoe, Washington, circa 1888, courtesy Library of Congress

Hospital Staff, Tulalip Indian School, circa 1910, courtesy University of Washington Libraries, Special Collection Division

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Other Obstacles to Health Care

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Everyone Helped the War Effort, courtesy baylor.edu

The Bureau of Indian Affair’s efforts to provide health care to Indians was always hit or miss (see last post). One of the obstacles to providing quality–and timely–care resulted from the vast expanses of land out West. Reservation lands could include acreage that rivaled that of some states, but often only one or two doctors were assigned to cover these huge areas. Even if the Indian population had been in comparatively superb health, doctors’ travel time would have prevented them from seeing many patients. Officials knew that many Indians suffered from serious health problems, but didn’t have the personnel to minister to them effectively.

World War I created more problems. Physicians throughout the Indian Service bailed out to work instead for the U.S. Army or to work in the civilian sector; both venues usually meant better pay. The government concentrated most of its construction and supply effort on the army rather than civilian organizations, and there was little done in the way of new construction or even repairs, stateside. Even if the government had wanted to ramp up its efforts to build hospitals and clinics, or provide better health care, it faced the same manpower shortages affecting the rest of the country. Most young, healthy men were overseas or in war-critical positions stateside, and unavailable for more ordinary concerns. Dr. Harry Hummer had such a problem finding and keeping staff at the Canton Asylum for Insane Indians that he implored the Indian Office to raise wages so he could fill positions.

Base Hospital 21, Organized in One Week

Nurse Helen Grace McClelland, Who Served at Base #10 Hospital in France, courtesy University of Pennsylvania

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Indian Health Programs

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President Taft Speaking at Manassas Court House, Virginia in 1911, courtesy Library of Congress

The Bureau of Indian Affairs tried to address the many health issues developing among tribes who had lost their traditional lands, lifestyles, and occupations. However, funds were always far too short to do much good, and healthcare was not provided with any kind of continuity. As time went on and the country began to use  surveys and statistics as a basis for action, the government surveyed reservations and schools to discover the extent of the sanitation and health issues which were being reported. When President Taft received the information, which showed a high incidence of tuberculosis and trachoma (an eye disease which often led to blindness), along with a scarcity of medical care, he was shocked.

“The death rate of the Indian country is 35 per thousand as compared with 15 per thousand–the average death rate of the United States as a whole . . .,” he told Congress in 1911. “Last year, of 42,000 Indians examined for disease, over 16 percent of them had trachoma . . . . Of the 40,000 Indians examined, 6,000 had tuberculosis.” Taft asked Congress for more money to go toward Indian health care. . . . “It is our immediate duty to give the race a fair chance for an unmaimed birth, healthy childhood, and a physically efficient maturity.”

Appropriations for Indian medical service rose from $40,000 in 1911 to $350,000 in 1918.

A Grandfather and Two of His Grandchildren Infected With Trachoma, Rincon Reservation, Californina in 1912, courtesy National Library of Medicine

Group Picture at the Phoenix Indian School Tuberculosis Sanitorium Phoenix, AZ, circa 1890-1910, courtesy National Institutes of Health

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And For Everyone Else…

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Front View of Canton Asylum, courtesy National Library of Medicine

For non-wealthy patients entering an insane asylum, both admitting procedures and accommodations were much different than for the wealthy (see last post). Alienists did not have as much time to spend with new patients, and often took short personal histories  solely from family members’ who were often biased. Patients may then have been taken straight to their rooms and left by themselves to sort out their new, distressing situation. Some patients would first face a bath and delousing–neither of which would have been done with delicacy.

At the Canton Asylum for Insane Indians, language barriers would complicate the process for many patients. They, too, were frequently deloused and/or bathed. Their clothes were inventoried, and any money they had brought with them was taken for safekeeping. In many insane asylums, patients with similar behaviors were grouped together, and as patients recuperated, they would be moved to appropriate wards or floors. Canton Asylum never took that approach, partly because they never had a high concentration of single-gender patients who could be combined that way. Therefore, quiet patients might room with violent ones, or well-oriented patients be shut in with people who raved or hallucinated. This mismatch could only serve to make the experience worse for patients who were aware of their surroundings.

Committal Document from Ireland

A List of Patients in St. Louis Asylum

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The Luxury of Time

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East House Dining Room, circa 1903, courtesy harvardmuseums.org

The wealthy at McLean Asylum for the Insane enjoyed many amenities that less affluent patients did not (see last post). Some patients lived in single-dwelling cottages with several bedrooms, a dining and living room, modern bathrooms, and sometimes even servants’ quarters. Typically, these cottages were paid for by the patient’s family and later deeded to McLean, in exchange for the relative’s care. Though many patients appreciated their surroundings, what they and their families benefited most from was the time that their alienists and physicians could give them.

Doctors caring for a wealthy patient had the time to give detailed instructions on how a particular person was to be treated; for instance, one patient’s entry stated that she could come and go from her cottage as she pleased, read whenever she wanted, and shampoo her own hair when it suited her. Alienists at McLean could take their time with patients’ histories, noting what pleased and displeased them, what might have caused the onset of their disorder, how they reacted to certain situations, etc. More than that, the nursing and attendant staff were not so hurried and harried. They could accompany patients on leisurely walks, talk to them and assist them in numerous ways, and retain the patience and kindness that other hospitals drove out of its staff by overwork. Many of McLean’s patients undoubtedly were helped simply by the respectful treatment they received.

First Graduating Class of McLean Nursing School, 1886, courtesy McLean Hospital

Hope Cottage at McLean Hospital, 1903, courtesy Harvard Art Museum

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Wealth Has Its Privileges

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Room in a Cottage for Women at Michigan Asylum for the Insane, circa 1891, courtesy kalamazoo public library

The great majority of insane asylum superintendents did not set out to be deliberately cruel to patients. They understood that newcomers to the institution would be frightened and/or confused, and made an effort to meet new patients as soon as as possible so they could welcome and reassure them. Even when asylums grew too large to permit this, superintendents and staff looked at ways to make their asylum more homey and comforting. Some set up cottages or separate buildings where the number of patients could be kept small, or moved patients to wards where similar patients stayed. Quiet or reserved patients would therefore stay with others like themselves (no matter what brought on their condition) versus mixing with loud and/or violent patients who perhaps had the same complaint as theirs.

As always, money made a difference. Wealthy families could often keep their family members at home, cared for by a private nurse or attendant. However, if the patient grew too violent or uncontrollable, even wealthy families might find it better to take their loved one to an asylum. The majority of asylums were state-run, and took patients at low-income levels; however, a few asylums catered to paying clientele. The McLean Asylum for the Insane was such an asylum, and its lush accommodations began with its exterior. Rain gutters were copper, views were spectacular, and the golf course was ready for play.

My next post will describe McLean further.

Portrait of John McLean, courtesy harvard.edu

Frederic Packard, a Member of McLean's Staff and Later Superintendent, circa 1920, courtesy harvard.edu

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Many Kinds of Cruelty

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A Book Written by a Former Asylum Patient

One of the worst kinds of abuse patients at insane asylums suffered occurred simply because of the situation. Many patients were tricked into accompanying relatives or friends to an asylum, or to a sanity commission that had been convened to arrange for commitment. Elizabeth Stone recounted her own commitment as this kind of deception. Her brother asked her to take a ride with him and conveyed her to McLean Asylum , where he abruptly left her without telling her where she was and what was going on. Stone was distressed beyond words when she finally realized what had happened, and later wrote: “O! That a dagger had been plunged into my heart in the midnight hour!”

Once in an asylum, many patients were frightened, angry, and bewildered. Many were distraught and emotionally overwhelmed by a sense of betrayal and shock at what had occurred. Women from sheltered homes were often terrified by the chaos around them. Patient accounts speak of real fear–of both patients and doctors whom they did not trust–and fear that they would never be released. Some learned to adapt and become model patients, hoping that by exhibiting desirable behavior, they might be set free. For far too many, the trip to the asylum was the last trip they would every make. By the time family members committed a person to an asylum, they were generally ready to be rid of him or her for a very long time.

McLean Asylum for the Insane

Scene From New York Lunatic Asylum, Blackwell's Island, 1898 Woodcut

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Abuse Was Convenient

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Locks Were Common at Insane Asylums

From accounts by former patients, it seems probable that many cases of cruelty and abuse were deliberate. Attendants were often uneducated, uncaring, or of a type who found it impossible to get a job anywhere but in an asylum. Those who enjoyed dominating weak or helpless patients often had  little oversight to prevent their doing what they liked; patients reported beatings and punishments which were clearly typical and sustained rather than lapses in judgment or reactions during a crisis. However, attendants often used restraints and other methods of control because they were convenient. Attendants in a short-staffed ward might reasonably believe that it was better to restrain a violent patient or lock him up, rather than let him hurt himself or other patients. Attendants might force feed a patient that they feared would starve because she wouldn’t eat of her own accord. Many attendants undoubtedly did these kinds of things with a perfectly clear conscience.

At the Canton Asylum for Insane Indians, both types of abuse occurred. A few patients complained of witnessing cruel teasing that would make the targets upset, or of seeing patients treated with unnecessary force or bullied. Attendants more frequently treated their patients badly out of convenience. The asylum was usually short of attendants, particularly under Dr. Harry Hummer. One attendant might have to take care of an entire ward, or at night, an entire building. It was vastly easier to lock patients in their rooms or put them in a restraint, than forgo a meal or get behind on chores for which they would be disciplined if they didn’t complete. Though restraints were supposed to be used only with the permission of the superintendent, the restraints at Canton Asylum were kept in the financial clerk’s office and given out to any attendant who asked for one.

A DeKalb Crib, circa 1905, Used for Patient Restraint, courtesy Maryland State Archives

Exhibit of Patient Restraints From Glore Psychiatric Museum

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Compassionate Doctors

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Dr. William A. White, Superintendent at St. Elizabeths, courtesy National Institutes of Health

Dr. William A. White, Superintendent at St. Elizabeths

Though many abuses toward patients  were either condoned or ignored by senior staff, some doctors cared very much about patient abuse.

When Dr. William A. White took over as superintendent of St. Elizabeths (the federal government’s hospital for insane soldiers, sailors, and citizens of Washington, D.C.), he immediately issued a terse letter absolutely revoking use of the saddle (a harness fashioned around a patient in bed and tied so that he/she could not raise up) as a restraining device. Continue reading →