Canton Asylum

Athens Female Ward, 1893, courtesy Athens County Historical Society and Museum

Going to an asylum was psychologically difficult at the best of times, but women could be expected to suffer a bit more . . . after all, many asylum patients had been homemakers unused to much interaction outside their own houses. Ironically, the paternalistic society in which women lived, with all its “protections” gave them few skills to cope with sudden changes to their routines and environments. Of course, women have responded heroically to all sorts of negative situations, but it seems reasonable to assume that between the two genders, women would have been less exposed to communal living and interactions with strangers during the 19th century. In general, women had been taught to seek protection and rely on others, and to find their satisfaction in home, family, and close friends. Their feelings of abandonment and friendlessness upon entering an asylum would be dependent upon how strongly they had adhered to this “womanly” ethic.

A letter from Mary Page to her sister (in 1871) speaks to the anguish many forgotten women felt:

“It has been a long and trying time since I saw or heard from you or any of the rest of your family or any of my relations. . . . Almost four years have this band of enemies been at work on me with foul play . . . . You all can pity my condition and picture to yourselves my sad fate all too unjustly committed. I have never given anyone in this whole world the first cause for themselves to fight poor me . . . ”

The letter is written from Williamsburg Hospital in Virginia, probably referencing Eastern Lunatic Asylum. Though the letter is somewhat rambling and makes a series of bitter comments and accusations against “unjust enemies” (which may have been the result of hallucinations/paranoia and the reason for her commitment), the woman’s pain is evident. Undoubtedly men were sent to asylums and forgotten, too, but given their social conditioning, women would have felt it more keenly.

Eastern Lunatic Asylum

Female Department, Michigan Asylum for the Insane, 1892, courtesy Kalamazoo Public Library

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Western Lunatic Asylum, Male Ward 1892, Female Ward, 1893, courtesy Virginia.gov

Women were assumed to be more delicate–mentally as well as physically–than men, and thus would become insane more often. Alienists (early psychiatrists) accepted this as the truth, but there does not seem to be a comprehensive 19th-century study that actually verifies this assumption. If some asylums held more women than men, it may have been because women had fewer legal rights and were easier to commit. And, as homemakers and primary caregivers, women often looked after male household members who were insane and thus kept them out of asylums. Men could not always do the same even if they had been inclined to, since most heads of household had work obligations. It is likely that many women ended up in asylums because no one could take care of them, or it was simply easier on their male relatives.

At the Canton Asylum for Insane Indians, men outnumbered women as patients over the life of the asylum. From available records, about 212 men and 155 women spent time at Canton Asylum; this figure includes two babies who were confined with their mothers for a period. Though the patient list is doubtlessly incomplete, it does show both the gender imbalance at the asylum as well as how few patients the asylum actually treated over more than 30 years. Though Dr. Hummer pleaded continually for expansion, there does not appear to have been a patient population which would have made expansion justifiable.

Female Ward in Athens, Ohio, Lunatic Asylum circa 1893

Staff, Athens Lunatic Asylum

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Death Caused by Childbirth Insanity

Male alienists often thought that women were more susceptible to certain forms of insanity because of their female body organs (see last post). In the American Journal of Insanity, Dr. Fleetwood Churchill describes the evolution of merry childhood into womanhood, when a female becomes more serious and feels more deeply. “In short, under the influence of bodily development, her mind has expanded,” he says. In an article he published titled “On the Mental Disorders of Pregnancy and Childbed,” Churchill quotes other doctors; one noted that “insanity and epilepsy are often connected with menstruation,” and gave a case where a woman who had been confined for sixteen years, suddenly recovered when her periods ceased.

In a somewhat peculiar case in which the modern reader might find more than the doctor apparently did, a girl of 17 who had menstruated regularly for a year, suddenly stopped. Her mind became clouded, she spoke of herself as a castaway and doomed, and became completely insane. “Neither medicine nor change of air and scene did her any good,” said the doctor whom Churchill quoted. There was a happy ending, though. “The menses suddenly re-appeared, after eight or ten months absence. and she immediately recovered her mental health.”

Lydia Pinkham, Whose Patent Medicine Vegetable Compound Cured Female Problems

A Female Medicine

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Woman Demonstrating the Stages of a Hysterical Attack, courtesy Wellcome Library

Early alienists (mental health specialists) were men. They attributed much of women’s mental health issues to “female” problems with their ovaries or uterus. In 1893, Dr. Thomas Morton, Surgeon to the Pennsylvania Hospital and Chairman of Philadelphia’s Committee on Lunacy, wrote that surgical advances had made surgeries to the abdominal cavity relatively safe. Consequently, procedures removing the uterus and ovaries had been successful and had provided relief for patients with diseases of these organs. He added: “Frequently, such diseases are complicated by hysteria . . . and various forms of well recognized insanity which are thought to originate in and be maintained by the diseased or disordered state of these organs.”

When female organs were removed for disease, women were often relieved or cured of their accompanying mental disorders, said Morton, but just as often, were not. Some surgeons were evidently jumping onto an ovary-removal bandwagon, and Morton cautioned against an overenthusiastic use of these operations. “In many instances, insanity has resulted from this operation,” he warned. Morton gave a strong opinion that unless female organs were actually diseased, there was no justification for removing them. He included in his article a legal opinion from a colleague on the Committee on Lunacy, who concurred. “I am of the opinion that the operation . . . unless necessary to save life, is not only illegal, but, in view of its experimental character, is brutal and inhuman and not excusable on any reasonable ground.”

These two men had almost remarkable restraint toward women in an age when patronization and coercion were much more often the rule. Morton, in particular, recognized that symptoms of hysteria and other common “female” types of insanity might be associated with their uterine or ovarian distress, without being caused by it.

Hospital Demonstration of Hysteria in 1887, courtesy of Science Museum.org

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American Journal of Insanity

Asylum superintendents tended to support each other and their profession, and presented a united front to the public. Though they published studies and treatment-oriented articles in the American Journal of Insanity (AJA) and other medical organs, the AJA in particular reflected much of their philosophy.

In a July, 1868 article, “Admission to Hospitals for the Insane,” the author contended that it was especially unkind to make the insane endure a public hearing on their sanity. “If we find a man sick or wounded in the street, we take him forthwith to the nearest hospital, without stopping to canvass our legal right to restrain him of his liberty,” the author stated.

With the insane, however, relatives force publicity by requiring “an inquisition to establish the delirium or the lunacy,” the article continued. He said that there was no more reason why a magistrate or civil authority should inquire into treatment [for an insane person] than there was to “rescue a patient from the hands of a skillful surgeon who is binding him to an operating table to perform an amputation.”

This article is only one instance of an ongoing disagreement between the psychiatric profession and private citizens about the value of admitting (or coercing) patients into asylums without due process.

Amariah Brigham, founder of the AJA

Mary Todd Lincoln (Judged Insane by a Jury After a 10-Minute Deliberation)

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Missouri State Hospital Nurses, circa 1914, courtesy Missouri State Archives

Many superintendents took the opportunity to observe their patients and write about them, both to enhance their own reputations and to share information with colleagues. The American Journal of Insanity was the most important publication superintendents wrote for, since it had a wide readership among fellow alienists. The titles of their works show far-ranging subject matter:

“The Care of the Insane” by Charles Wagner, Superintendent of Binghamton State Hospital in New York.

“The History and the Use of the Term Dementia” by G. Alder Blumer, Medical Superintendent, Butler Hospital in Rhode Island.

“Night Nurses for the Insane” by C. R. Woodson, Medical Superintendent, Missouri State Hospital.

“The Favorable Modification of Undesirable Symptoms in the Incurable Insane” by A. B. Richardson, Superintendent, State Hospital, Columbus, Ohio.

In his quarter-century tenure as superintendent at the Canton Asylum for Insane Indians, Dr. Harry Hummer wrote one article about insanity: “Insanity Among the Indians.” He read this piece during the 1912 session of the American Medico-Psychological Association, and it was included in the four-volume work, The Institutional Care of the Insane in the U.S.A. and Canada, published in 1916.

Binghamton State Hospital

Butler Hospital for the Insane

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Dr. John Gray, Superintendent of the New York State Lunatic Asylum at Utica

Every insane asylum superintendent faced challenges that made the job more difficult. Lack of funds and overcrowding were two perennial problems, along with shallow labor pools and constant administrative tasks. Most superintendents had to take an active role in overseeing new construction, as well as drumming up support for it in the first place. Still, for many alienists, superintendent was still the plum job.

After taking time out for the Civil War, Dr. Patrick Livingston Murphy graduated as a physician from the University of Maryland at the age of 23. He settled in his home state of North Carolina, in Wilmington, and began his practice. He found “the routine of practice irksome” for some reason–he may have been bored by the types of cases he treated, or his practice may have been too small to support him. When he heard that there would be a new asylum in Broughton (the Western North Carolina Insane Asylum), Murphy immediately applied for a position at the Western Virginia Asylum to obtain experience. As soon as the Western North Carolina asylum opened, he applied for the superintendent’s position. He got it, and remained the asylum’s superintendent for the next 25 years.

Western North Carolina Insane Asylum, circa 1886, courtesy Burke County Public Library

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Patients Working in Laundry Room at Texas State Lunatic Asylum, 1898

How much attendants were paid (see last post) mattered a great deal to superintendents, and generally not for the right reasons. The public began to exert extraordinary pressure on institutions to accept their afflicted family members, which resulted in overcrowding at nearly every insane asylum in the country. Doctors couldn’t cure patients when they had too many to properly care for, and asylums began to lose their roles as sanctuaries and restorative institutions.

With cure rates down, superintendents had to look for other reasons the public should continue to endorse the use of asylums. One argument was that it was much cheaper to keep patients at an asylum than at home or in jails. Many superintendents prided themselves on how cheaply they could run their asylums, and often compared their rates with unfavorably high rates at other asylums. Salaries were nearly always the largest single expense  at asylums, so superintendents had an incentive to hire the cheapest staff they could find. Unfortunately, as Beers pointed out, one could expect very little from an attendant who would work for eighteen dollars a month.

Patients on Floor in Eloise Women's Mental Ward in Michigan

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Commissioner of Indian Affairs, Cato Sells

Asylum superintendents were very powerful, but they were (theoretically) denied free rein. Most asylums had a board of directors or a board of commissioners to give oversight to the entire asylum, including the superintendent. Boards were often composed of local men who might be assumed to know what was going on, though sometimes board members had to travel from a distance to meet. Not all boards had direct hiring and firing authority, however, and could run into problems controlling or disciplining a superintendent protected by appointment.

At the Canton Asylum for Insane Indians, superintendents reported directly to the Commissioner of Indian Affairs on the other side of the country. No boards met on a regular basis to supervise the asylum, though visiting doctors within the Indian Service occasionally stopped by to inspect and report on the facility. Because they weren’t trained in psychiatry and therefore not competent to discuss patient treatment, most inspectors concentrated on the physical part of the institution, commenting more on its buildings and farming operation than anything else. Sometimes the inspectors were not even doctors, but merely field agents who happened to be in the area. Because of this situation, it was generally easy for superintendents Gifford and Hummer to explain away any problems inspectors might bring up.

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Canton Main Street

Just as in other workplaces, insane asylums had personnel problems that administrators had to deal with. Though some superintendents tried hard to find the best attendants possible, they had to ultimately accept the kinds of employees available in the marketplace. In 1895,the superintendent at  Kentucky’s Eastern Lunatic Asylum mentioned that he had been able to employ “four bright young men from the State College.” Other institutions, and probably Eastern Asylum as well, had to sometimes accept attendants who were just a step above criminals. With its demanding schedule and lack of freedom, a job as an asylum attendant was not likely to appeal to anyone who could find something better.

Both Gifford and Hummer, while superintendents at the Canton Asylum for Insane Indians, ran into the same personnel problems as other superintendents. The work they offered was demanding and difficult, and didn’t pay well. They faced an additional problem with the size of their labor pool. Canton was not large, and even though the city of Sioux Falls was not far away, it was too far away to expect many people there to find work at the Canton asylum desirable. Attendants were required to live on the premises, which also made the work less attractive to non-Canton residents.

Staff at Ridges

Attendants at Pennsylvania Hospital for the Insane, circa 1860s, courtesy University of Pennsylvania

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