Archive for the ‘medical history’ Category

Tiny Steps

Thursday, July 24th, 2014
ield Matron and Assistants, 1905

Field Matron and Assistants, 1905

Most Europeans settlers believed that their respective cultures were superior to Native American ones, and set about imposing their own ideas upon native peoples as soon as they were able to do so. This thinking led to many tragedies, including reservations and assimilation, with all their cascading ills. The federal government made a concerted effort to stamp out Native American culture by making job security and food dependent on compliance and forcing children to go to boarding schools, among other strategies. Not everyone supported this thinking or behavior, but it ruled.

By the 1920s, significant protest to federal policy (and field experience) caused leaders to rethink some of their practices. In a paper from 1924, “Is the Indian Susceptible to Health Education,” Dr. A. J. Chesley pointed out that many problems with Indian health had to do with the lack of health education and resources available to native peoples. After discussing a few of the problems a colleague had discovered among Chippewa families, Chesley discussed one of the doctor’s major recommendations to improve their health.

“First, that Chippewa nurses be employed to undertake public health work,” advised the colleague, Dr. S. J. Crumbine. “Experience shows that little progress has been made by white nurses, field matrons, or other workers among the Indians. Considering that the Indian nurses know the customs of the people, understand their point of view and speak their language, it is believed they might earn the confidence of the Indians and induce them to do the things which would benefit the children.”

This suggestion seems like basic common sense to anyone at all sensitive to the cultural needs of other people, but it was evidently a novel  idea. Though a better suggestion might have been to allow traditional native healing practices rather than imposing Anglo-based ones, Dr. Crumbine had been speaking specifically about tuberculosis and the close living quarters which spread the disease. In this instance, information about contagion would have been helpful in preventing the spread of the disease, and certainly would be most effective if delivered by a Chippewa nurse.

A Havasupai Indian Woman Receiving an Injection in Knee From Public Health Service Officer, courtesy National Library of Medicine

A Havasupai Indian Woman Receiving an Injection in Knee From Public Health Service Officer, courtesy National Library of Medicine

An Indian Health Service Field Nurse Demonstrates X-Rays, courtesy National Library of Medicine

An Indian Health Service Field Nurse Demonstrates X-Rays, courtesy National Library of Medicine

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Paperwork

Sunday, July 20th, 2014
Record of Patients at St. Louis Insane Asylum, 1886

Record of Patients at St. Louis Insane Asylum, 1886

Running an insane asylum involved a great deal of administrative work, and it is no wonder that some records were not as meticulous as inspectors and latter-day researchers would have liked. Dr. Harry Hummer, superintendent of the Canton Asylum for Insane Indians, was often accused of poor-record keeping. However, not all of his records were badly kept; the problem lay in where he chose to put his efforts. A February, 1927 journal voucher lists 30 patients along with small sums spent on their behalf. These sums ranged from a few dollars to fifteen cents, yet Dr. Hummer kept track of them for reimbursement purposes. Conversely, he spent almost no time updating patient medical records during the asylum’s later years; he left that task to his attendants who often jotted repetitive, meaningless updates that were useless for diagnostic purposes. Perhaps Dr. Hummer put his energy only into those tasks he thought would benefit himself and contribute to the efficiency of the asylum.

Many asylums have not retained all their patient records (or have deliberately destroyed them), so Canton Asylum’s incomplete patient records does not present an unusual situation. One inadvertent benefit to Hummer’s attention to detail in certain areas is that it is at least possible to cull patient names from these types of documents.

By going through vouchers and reports, researchers can fill in gaps that might exist in the records they would prefer to have, or uncover tidbits of information that present a clearer picture of  their subject matter. For instance, a payroll list from June 1923 shows that Dr. Hummer’s father, Levi, and his son, Harry Hummer, Jr. were employed at the asylum; additionally, a separate letter to the Indian Office that same month shows that Dr. Hummer’s other son, Francis, acted as an escort for patients coming to the asylum from Taos, New Mexico. It would certainly be interesting to speculate or do further research on the dynamics of this family employment.

Death Certificate From Western State Hospital

Death Certificate From Western State Hospital

Patient Record From Nineteenth Century

Patient Record From Nineteenth Century

 

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A Difficult Life for All

Sunday, June 22nd, 2014
People Seated on a Bench Near Van Deusen Cottage, Kalamazoo State Mental Hospital

People Seated on a Bench Near Van Deusen Cottage, Kalamazoo State Mental Hospital

Though patients undoubtedly had wretched experiences at most asylums, the life of an attendant was also difficult. Even in the first decades of the twentieth century, it was usual for attendants and other staff (including physicians) to reside at the asylum where they worked. In some ways the arrangement was a benefit, since it eliminated commutes and gave employees housing and food; however, it added to employee stress because they could never get away from constant reminders of their job. The Canton Asylum for Insane Indians followed this pattern, and some employees even had to share a room.

Stressful as it was to be an attendant, though, their duties were clear. The Indian Office had provided governing rules and regulations for Canton Asylum’s employees, though its first superintendent had not passed them out. Dr. Harry Hummer did, and the instructions provided were comprehensive:

“[Attendants] will see that the patients are at all times kept as comfortable and clean as their condition will permit. They will keep them comfortably clothed, bathing them and changing their clothing as frequently as required for the purpose. They shall keep their apartments at all times clean and neat, and free from every contamination which is unpleasant and injurious to health. They shall look carefully after every portion of the housekeeping, including bed making, sweeping, dusting, brightening of floors, hardware, plumbing fixtures, etc.”

The preceding is only one small segment taken from several pages of instruction, and it is easy to see that an attendant with 15 or more patients could be easily overwhelmed. Many inspectors found the patients’ quarters woefully neglected, dirty, and disordered; the condition likely came about because attendants had to choose between caring for rooms and caring for people.

One of St. Elizabeths Dorm Rooms, 1905

One of St. Elizabeths Dorm Rooms, 1905

Patients and Staff at Christmas Party at State Hospital, Jamestown, courtesy Historical Society of North Dakota

Patients and Staff at Christmas Party at State Hospital, Jamestown, courtesy Historical Society of North Dakota

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A Patient’s Work is Never Done

Thursday, June 19th, 2014
Gardner State Colony for the Insane

Gardner State Colony for the Insane

Insane asylums used patient labor for both occupational therapy and cost-containment (see last post). However, that labor didn’t always start after the facility had been completed and simply needed to be maintained. Asylum administrators often brought in patients after only a limited space was ready for occupancy, and then used them to help build the rest of the asylum.

In October of 1902, Governor Crane of Massachusetts declared its newest asylum, the Gardner State Colony, ready to receive patients and admitted five men from the Taunton Insane Hospital. Five more men were transferred from Westborough two months later, and over the winter these male patients worked in the woods to cut down 46,000 feet of lumber. That summer, they worked on the farm and excavated for the asylum’s water supply; in 1904 the institution received 111 patients.

A case can surely be made that patients enjoyed certain types of occupational therapy such as fancy needle-work or light gardening, but tasks such as building roads, chopping down trees, clearing fields, working in hot laundry rooms, etc. were not for their benefit. Though some administrators (and the public) may have seen the practice as simply expecting able-bodied men and women to work for their room and board, there is really no way to know what kind of coercive measures were used to get some of the more difficult and undesirable tasks completed.

Photo of Patients Collecting Maple Syrup from Trees on the Grounds of the London Asylum for the Insane

Photo of Patients Collecting Maple Syrup from Trees on the Grounds of the London Asylum for the Insane

Male Patients at Spring Grove Hospital

Male Patients at Spring Grove Hospital

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Who Says You’re Crazy?

Thursday, June 12th, 2014
Dedicated Alienists Tried to Stay Informed

Dedicated Alienists Tried to Stay Informed

One of the major problems with the Canton Asylum for Insane Indians was that commitment rules were so lax. Like most asylums, there were patients incarcerated because they were inconvenient to others or created problems for civil authorities, but there were also some patients who genuinely needed help. In either case, few patients admitted to the asylum had actually been evaluated by a physician of any kind, let alone one who specialized in mental illness. Instead, they were usually sent to the asylum on the assessment of only a layperson (Indian agent or reservation superintendent) which was terribly unfair. Abuses of power could, and did, take place, because even if these lay persons were actually trying to help someone, they weren’t necessarily right in their opinion of the person’s mental state.

Though abuses of power probably occurred everywhere at times, patients in other states and institutions often had stronger protections. Massachusetts had always been a progressive state when it came to helping its citizens facing mental health issues, and its commitment laws were fairly strict. In 1916, the editors of Institutional Care of the Insane in the United States and Canada wrote: “Commitment [in Massachusetts] may not be made unless there has been filed with the proper judge or justice a certificate of the insanity of the person by two physicians nor without an order signed by the proper judge that he finds the person insane.”

The judge could see and examine the person if he thought it needful, could also call in a third physician, and could summon a jury of six men to hear and judge whether the proposed patient was insane or not. Furthermore: “A physician making a certificate of insanity must be a graduate of a legally chartered medical school, in actual practice for three years and for the three years last preceding, and be registered. His standing, character and professional knowledge of insanity must be satisfactory to the judge.”

Though there could certainly be an “old boy” system that would allow a motivated complainant the opportunity to have a family member or enemy committed to an insane asylum, it was still much more difficult for two physicians and a judge to collude against a person than it was for one layperson to decide that an Indian was crazy.

Newpaper Story Argued Whether the Woman Was Insane From Booze or Religion

Newspaper Story Argued Whether Man Was Insane From Booze or Religion

Danvers State Hospital, circa 1893

Danvers State Hospital, circa 1893

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Alienists’ Diagnoses Were Never Foolproof

Sunday, June 8th, 2014
Nellie Bly, circa 1890

Nellie Bly, circa 1890

Alienists’ assessments of their patients’ mental conditions could be suspect at the best of times. They were particularly suspect when alienists dealt with people who did not fit the norms of an Anglo-centric society. Newly arrived immigrants were vulnerable to a misinterpretation of their mental status, and of course, non-English speaking Native Americans could easily be misunderstood or be so frustrated and frightened that they couldn’t communicate effectively. One reporter’s experiment showed how easily alienists could be fooled.

In 1887 New York World reporter, Nellie Bly, posed as an insane woman by practicing “insane gestures” and later claiming she had amnesia. She was sent to Blackwell’s Island Lunatic Asylum after several doctors examined her and declared her definitely insane. She was, “Positively demented,” said one, “I consider it a hopeless case. She needs to be put where someone will take care of her.”

Worse than the alienists’ initial assessment was their later inability to see past it. Bly dropped her insanity act immediately and yet made no impression on the doctors who had decided she was insane. She wrote, “From the moment I entered the insane ward on the Island, I made no attempt to keep up the assumed role of insanity. I talked and acted just as I do in ordinary life. Yet strange to say, the more sanely I talked and acted, the crazier I was thought to be by all….”

When Nellie was released after ten days–and wrote about her experience in the New York World–embarrassed doctors could not explain how they had been so easily fooled. A New York grand jury promptly launched an investigation into conditions at the asylum, which Bly had written about in horrifying detail.

Blackwell's Island Lunatic Asylum

Blackwell’s Island Lunatic Asylum

Nellie Bly's Book

Nellie Bly’s Book

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Patient Histories

Thursday, May 29th, 2014
Many Physicians Believed Insanity Stemmed from Physical Causes

Many Physicians Believed Insanity Stemmed from Physical Causes

An important innovation in the treatment of the insane was to obtain a history of patients’ past life and behavior. This allowed doctors to see how much the patient was deviating from previous behavior that was “normal” for that person; it also allowed them to see if anything important might have happened to cause the patient’s decline in mental health. Illnesses, shocks, losses, and so on could be precipitating events, as could lifestyle practices such as alcohol or opiate use. All mental illness wasn’t connected to outside factors, of course, but alienists began to realize that for them to understand and help patients, they had to understand what they had been like before they became insane.

Most patient records are missing from the existing files on the Canton Asylum for Insane Indians. Medical files seemed to have been fairly up-to-date when the asylum first opened, since the asylum’s assistant superintendent, Dr. John Turner, could ascertain the date of a patient’s pregnancy by the menstrual records he kept. When Dr. Harry Hummer took over as superintendent, one report mentioned that his record-keeping was modeled after that of St. Elizabeths, where he had been a physician. However, the doctor was criticized in later reports for poor record-keeping. The reports on patients that he sent to relatives varied little from month to month, and Hummer put a stop to even this slight gesture after a number of years.

When patients were transferred to St. Elizabeths after the Canton Asylum closed, staff reviewed what was known about them and then wrote their own assessments after a short period of observation. Sometimes these short notes are the only ones available, and they at least give a glimpse as to why a patient came to the asylum.

In my next couple of posts, I will share a few of these patients notes.

Psychoanalysis Is News, courtesy National Archives

Psychoanalysis Is News, courtesy National Archives

Group of Prominent German Alienists

Group of Prominent German Alienists

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Appropriate Care

Sunday, May 18th, 2014
Native American Known as Shields Who Served as a Healer or Medicine Man, Crow Creek Reservation, courtesy Blue Cloud Abbey Native American Photograph Collection

Native American Known as Shields Who Served as a Healer or Medicine Man, Crow Creek Reservation, courtesy Blue Cloud Abbey Native American Photograph Collection

Though some patients may have considered their stay at an asylum as a period of respite from the cares of the world, most patients just wanted out. Some understood that they needed help and could agree with the commitment decision, but even these patients wanted to get well and go home. Native American patients would have had these same feelings, but their stay in a facility like the Canton Asylum for Insane Indians probably helped them less than asylums helped Anglo patients. Unless their mental symptoms resulted from physical  ailments–which would benefit from nutritious food, rest, and mild medications–asylum medicine was so different from Native American practices that it was not likely to help them.

Both native peoples and newcomers relied on herbs and nature-based tonics to help them get well, but except for certain very well-known ingredients, the herbal preparations of either group could be hit or miss when it came to curing ailments. However, Native Americans derived a great deal of benefit from their culture’s method of treatment as well as from any herbal concoction they might take in conjunction with it. Native peoples were community oriented, and relied heavily on ceremonies, chants, music, dancing, and so on that required many participants. This sort of community medicine varied greatly from the much more private doctor/patient practice of Europeans. When Native Americans went to a non-native hospital (or asylum), they had to step out of their culture and away from all the comfort, security, and faith that it held. Without their customary practices in place, particularly with mental issues, there would be little hope of gaining a cure.

Sand Painting in Sacred Kiva, circa 1890 to 1900

Sand Painting in Sacred Kiva, circa 1890 to 1900

 

A Navajo Man in Ceremonail Dress, Including Mask and Body Paint, 1904, Edward S. Curtis

A Navajo Man in Ceremonial Dress, Including Mask and Body Paint, 1904, Edward S. Curtis

 

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Policies and Procedures

Thursday, May 15th, 2014
Full Men's Ward, Fergus Falls State Hospital, 1900

Full Men’s Ward, Fergus Falls State Hospital, 1900

No asylums had an overabundance of staff, and asylum administrators walked a fine line between doing what was necessary and convenient for their personnel, and what was best for patients. A 1906 article in The American Journal of Insanity discussed the pros and cons of hiring night nurses and unlocking patients’ doors at night. The superintendent of the Missouri State Hospital No. 2 wrote that after doing away with the system of night watches–who passed through the halls and wards once an hour–and going instead to a full staff of night nurses, the incidence of suicide immediately dropped. Patients were also much more comfortable and quiet.

“The idea of locking one, two …seven or eight patients in a room or dormitory, expecting patients to remain quiet, to sleep well, and to get well, is not only absurd,but is inhuman,” Dr. C. R. Woodson wrote. “The morbidly suspicious should certainly not be blamed for imagining that there was danger when locked up in a remote room of an institution with those who may or will domineer over them.”

Woodson went on to say that even violent patients responded well to the unlocked door policy. “The fact that a patient can get up and go to the toilet-room when he wants to, get a drink of water, or even get up and look down the hall, is a source of satisfaction; it makes him less rebellious, less obstinate, and less violent.”

Woodson was doubtlessly correct, and it is strange that it would have taken practitioners in the field so long to circle back to Philippe Pinel’s discovery in the early 1830s that removing chains from the madman did much to subdue his violence.

Restraints for Patients, courtesy National Library of Medicine

Restraints for Patients, courtesy National Library of Medicine

Nursing Students at Minnesota's Third Hospital for the Insane, 1900s

Nursing Students at Minnesota’s Third Hospital for the Insane, 1900s

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Motherhood and Mania

Sunday, May 11th, 2014
Puerperal Mania in Four Stages, 1858

Puerperal Mania in Four Stages, 1858

The “baby blues” or its more severe form, postpartum depression, afflicted women well before the modern era. Asylum notes indicate many cases of melancholy in new mothers, as well as other types of difficulties in adjusting to a birth. In 1830 British physician Robert Gooch noted: “Nervous irritation is very common after delivery, more especially among fashionable ladies, and this may exist in any degree between mere peevishness and downright madness.”

Some new mothers may have been depressed, some simply exhausted in an era where families were large and housework involved a great deal of manual labor, while others may have been resentful of the demands motherhood placed on them and the lack of control they had in determining whether or not to have more children. Doctors and midwives alike noted the special mental state, called “puerperal insanity” that women could fall into after labor. Many believed that the stress of labor and confinement caused some mothers to kill their babies.

By 1858, puerperal insanity sometimes made up 25% of  female admissions to British asylums. Surprisingly for the era, treatment was not the usual regimen of bleeding, blistering, and purging, but instead incorporated gentle common sense–plenty of rest and quiet, patience and understanding, and a good diet. Particularly for poor women, a stay in an asylum could have meant the only bit of uninterrupted rest they would ever have from the demands of a large family; some women seem to have appreciated their stays very much.

A Woman With Typical Large Family

A Woman With Typical Large Family

 

Puerperal Mania, 1890 Death Record from Michigan

Puerperal Mania, 1890 Death Record from Michigan

 

 

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