Category Archives: medical history

Water Treatments

Continuous Bath Room, Kalamazoo Psychiatric Hospital, 1918, courtesy Kalamazoo Public Library

Continuous Bath Room, Kalamazoo Psychiatric Hospital, 1918, courtesy Kalamazoo Public Library

Patients entering an asylum were frequently given sedatives or tonics, depending upon their physical state, as well as a strong laxative to clean them out. Warm baths were thought to be calming and were frequently prescribed for agitated patients. However, what might have begun as a soothing experience could develop into something close to torture in the extreme treatment called continuous bathing, which could last for hours or days.

Cold water was generally thought to be invigorating, acting as a non-pharmaceutical tonic. Cold water might also be used to “shock” patients out of a certain behavior. Wet pack treatments were versatile in that they acted as both a shock and a sedative. Patients were wrapped in wet sheet and shocked by the cold, but the thinking was that the body would soon warm the layer of air directly beneath the sheets and create a calming effect. Attendants particularly favored wet packs, since their supposed calming influence was enhanced by the fact that the patient couldn’t move and struggle if they tied the sheet to the bed.

None of these treatments seem to have been specifically invented for asylum patients. However, there was a world of difference when a patient took a treatment willingly and in relative luxury as part of a medical cure –as the wealthy did at medical spas–or were forced to endure a treatment they did not want, as often happened in asylums. Some treatments were so uncomfortable–or could be made so–that they were viewed as punishments by patients. Since there are many instances of attendants threatening patients with these water treatments, they were obviously misused in this way.

Wet Sheet Pack, 1902

Wet Sheet Pack, 1902

Patients Were Restrained For Hours During Some Hydrotherapy Treatments

Patients Were Restrained For Hours During Some Hydrotherapy Treatments

 

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Water Therapy

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Taking the Waters at the Columbian Springs

Taking the Waters at the Columbian Springs

Water therapies, known collectively as hydrotherapy, were popular forms of treatment for insanity. Most people today have relaxed under the influence of a warm, soothing soak in a tub, but it is interesting to note that bathing for health or medical reasons was popular long before bathing as a sanitation practice became nearly universal. Even after bathing for cleanliness was adopted, unless a family had running water, plenty of pots, a means to heat large quantities of water, plus a large enough container to sit in, bathing in a tub was either impossible or a huge undertaking. (Dedicated bathrooms piped for washing were not the norm in most homes until the 20th century.) Washing with a cloth from a basin would have met most people’s needs.

This may be one of the (many) reasons why asylum hydrotherapy was sometimes fearfully or passionately resisted by patients. Wealthy families were more familiar with immersion bathing at mineral spas and the like, but ordinary people from a crowded city or even a home in the country may have been more used to soaking their feet in a foot-bath each night, or scrubbing up once a week from a basin or small tub. It would have been intimidating to walk (or be forced) into an asylum’s hydrotherapy room with its strange-looking equipment and gushing streams of water.

My next post will look at the reality of various forms of hydrotherapy.

Various Forms of Water Treatment

Various Forms of Water Treatment

Spray Hydrotherapy Room, courtesy University of Western Ontario

Spray Hydrotherapy Room, courtesy University of Western Ontario

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Gender Inequality

Portrait of An Insane Woman, Hugh Welch Diamond, 1852

Portrait of An Insane Woman, by Hugh Welch Diamond, 1852

Treatment for mental disorders was generally hit-or-miss in most insane asylums, and many superintendents embarked on experimental procedures simply because there weren’t any reliable ways to help patients. Some treatments were more bizarre than others, and unfortunately, some of the treatments aimed at female patients were based on mistaken physiology-based causes of insanity.

Many doctors in the nineteenth century believed that the reproductive organs caused insanity, and removed female patients’ ovaries to abate symptoms that seemed to appear during the menses. (Hysteria was another type of female insanity attributed to physiology.) Some doctors applied electrical current to a patient’s uterus, or injected the vagina with hot water. For women who masturbated–often considered a cause of insanity–doctors ensured that the patient would find it extremely painful by cauterizing her clitoris.

Feeble-minded Subjects for Sterilization, courtesy Truman State University

Feeble-minded Subjects for Sterilization, courtesy Truman State University

At the Canton Asylum for Insane Indians, neither superintendent favored these extreme treatments. However, Dr. Harry Hummer firmly believed that female patients in their child-bearing years should not be released unless they could be sterilized.

Since he had no means to do that, he decided to keep many female patients who were otherwise candidates for discharge. Hummer was sometimes overruled in these types of decisions if a woman had a strong advocate, but his policy was most often unchallenged.

Account of A Woman Declared Insane Apparently After a Fortune-Telling

Account of A Woman Declared Insane Apparently After a Fortune-Telling

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Few Patients Came Voluntarily

Elizabeth Packard Being Kidnapped in Broad Daylight and Taken to an Insane Asylum, courtesy National Library of Medicine

Elizabeth Packard Being Kidnapped in Broad Daylight and Taken to an Insane Asylum, courtesy National Library of Medicine

The case of Peter Thompson Good Boy (see last three posts) shows how easy it was for a Native American to lose his freedom. It would be safe to say that few or no patients at the Canton Asylum for Insane Indians actually wanted to be there. Patient Susan Wishecoby thought she was going to a hospital when she agreed to go; she apparently had epilepsy or something like it that gave her “spells” that were disruptive. She wrote plaintively that if she had known where she was going, she never would have agreed to come.

Former Patients Often Wrote Bitterly About Their Experiences in Insane Asylums

Former Patients Often Wrote Bitterly About Their Experiences in Insane Asylums

White patients also resisted commitment to an asylum. Many patients have written about the way they were tricked into asylums. Some went on carriage rides that ended at an asylum entrance; women, in particular, were sometimes arrested unexpectedly (usually at the request of a male relative or husband) and taken to an asylum; other times women or men were asked to accompany a friend or relative to a law office or some such place to help with a legal matter, only to find that the legal proceedings were loose insanity hearings against themselves!

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

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

Though outrageous tricks were played on men and women alike, women were particularly vulnerable to abuses of authority. Many women wrote about how easy it was for husbands to commit their wives to asylums. In her book, Behind the Scenes, or Life in an Insane Asylum* (1878), Lydia A. Smith writes: “If a man tires of his wife .¬† . . it is not a very difficult matter to get her in an institution of this kind. Belladonna and chloroform will give the appearance of being crazy enough . . . .”

*Available today as a reprint or free ebook.

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New Reasons for Insanity

Blackfoot Family

Blackfoot Family

Many (white) observers over the years believed that insanity was rare among Native Americans. Their conclusion was born out during the Indian Bureau survey that tried to assess the need for a special asylum for insane Indians; among the thousands and thousands of Indians living on reservations, fewer than a hundred could be identified with mental problems.

Though J. Lee Humfreville (see last post) had nothing to do with this survey, he backed up earlier thoughts about the prevalence of insanity with his own observations made during his Army career. In speaking about the scourge of smallpox among the Blackfeet, Humfreville told of their extreme reaction to smallpox scars.

“. . . they were so humiliated at sight of these blemishes and scars [from smallpox] that some of them committed suicide. As suicide was almost unknown . . . one may obtain from this some idea of the distress of the Blackfeet over their disfigured appearance.”

Humfreville continued, “Some of the survivors of this dreaded disease became insane; as insanity was something new to them, they believed that the anger of the Great Spirit was especially directed to those who had had the disease.”*

Clearly, mental illness among Native Americans was not common at all if even an Army captain could make that case when speaking about another matter entirely.

Manifestation of Smallpox

Manifestation of Smallpox

* Italics mine.Native American Boy in Yukon Territory Receiving Smallpox Vaccine, circa 1900

Native American Boy in Yukon Territory Receiving Smallpox Exam and Vaccine, circa 1900

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The Insane as News Items

Doctor's Parlor, Willard Asylum for the Chronic Insane

Doctor’s Parlor, Willard Asylum

Though early alienists did a great deal to de-stigmatize insanity and help families feel better about seeking help for their mentally ill members, insanity was still a delicate subject that most families preferred to keep private. Asylum superintendents understood this. They tried to be as soothing and discreet as possible, often bringing families into nice parlors for a private chat to quiet their embarrassment and fears and to find out more about the patient’s problem. Many asylums also had fences around them, not just to keep patients inside, but to keep the curious public out while patients walked or worked on the grounds.

A Work Train Transporting Patients at Willard Insane Asylum

A Work Train Transporting Patients at Willard Insane Asylum

When patients were transferred from one asylum to another, as often happened when a new asylum opened to alleviate overcrowding, the public usually came out in force to watch the transfer. When the East Tennessee Insane Asylum received fifty female patients from the Nashville institution, the Knoxville Daily Journal (March 21, 1886) said that, “The curiosity of about one hundred men, women and children, who had hovered around Erin station all yesterday afternoon was gratified when the train of female lunatics arrived at 4:00 o’clock.”

Postcard of Patients at Asylum Number 3, in Missouri

Postcard of Patients at Asylum Number 3, in Missouri

A few weeks later, the same paper ran an article about two new patients–referred to as inmates–brought to the asylum. A woman was brought by her daughter, and a man by the sheriff of Campbell county. A third person who had gone “crazy about religion” had been tied hand and foot in a train that then passed through town on its way to Wytheville (Virginia) where the man was to be incarcerated. He was accompanied by two sisters and a brother, but spent his time sitting in his seat “singing, cursing and gesticulating frantically.”

The paper called the latter a sad case, but went ahead and printed the man’s name–as well as the names of the other two patients–and as many details about them as it could. It surely did not make anything easier for these patients or their families to receive so much publicity about a situation they would rather have remained private.

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Public Interest in Insane Asylums

Asylum for the Insane in Nashville

Asylum for the Insane in Nashville

The construction of an insane asylum was usually a welcome event for most towns or cities, since the work meant jobs and a continued money flow into the local economy. Newspapers had little but praise for these projects, as the Knoxville Daily Journal  demonstrates:

An article titled “The New Asylum Opened,” and dated March 18, 1886 begins, “. . . the East Tennessee Insane Asylum, which is a branch of the main asylum at Nashville, and is located at Lyon’s View, the most lovely spot in the part of the world.” It continues, “A brief description of the magnificent structure, as it now stands overlooking the Tennessee river and surrounding country commanding some of the most enchanting views in the south . . . . The main front entrance, through a neatly constructed verandah and vestibule, is by means of marble steps, into a broad and stately hall-way, provided with suitable furniture.”

East Tennessee Insane Asylum

East Tennessee Insane Asylum

Readers are left to imagine the particulars of the building, but they could scarcely do otherwise than think that the new institution was a fine place for the “unfortunates” who would live there. “Altogether, there are about 185 rooms in the building and annexes, and there are ample accommodations for about 225 patients.” With so much room and an additional 300 acres that would be improved and beautified over time, the asylum sounded almost luxurious.

In summation, readers were told that “this grand structure looms up as a monument to the sound judgment and executive ability of the three able commissioners, who certainly performed the work assigned to them honorably and well . . . .”

Undated Photo of East Tennessee Insane Asylum

Undated Photo of East Tennessee Insane Asylum

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The Chronic Insane

Outagamie County Asylum for the Chronic Insane, Wisconsin, circa 1889

Outagamie County Asylum for the Chronic Insane, Wisconsin, circa 1889

 
Alienists stressed that the prompt treatment of insanity was imperative to a cure. They cautioned the public that it was far wiser to bring an afflicted person to an asylum for a cure as soon as possible, rather than let the patient languish at home for years until an asylum became a last resort. By that point, the disease might have too strong a hold and never be shaken.

State Asylum for the Chronic Insane in Wernersville, Pennsylvania

State Asylum for the Chronic Insane in Wernersville, Pennsylvania

 

Despite their sharp division of “acute” and “chronic” cases of insanity, few alienists wanted to shunt the chronic insane into separate asylums. First, few alienists wanted to be in charge of hopeless cases that gave them no scope for meaningful treatment and possible success. Second, alienists hated to pass sentence on patients, fearing that a “chronic” label would take away any chance for recovery that the patient might have had. Rather than give a patient a life sentence to custodial care, alienists preferred to keep these patients with their more hopeful cases on the remote chance that he or she could still make a recovery.

Female Patients and Staff at Willard Asylum, courtesy Robert Bogdan Collection

Female Patients and Staff at Willard Asylum, courtesy Robert Bogdan Collection

Lawmakers did not often share the alienists’ concerns. Custodial care was far cheaper than active treatment, and state legislatures usually felt that chronic patients unlikely to respond to treatment should not use up the state’s precious monies in a facility that actively treated acute cases. Against most alienists’ wishes, several asylums for the chronic insane were built. (Willard Asylum for the Chronic Insane in New York is perhaps the most well-known of these.) And, as the alienists had foretold, most patients in them spent the remainder of their lives in custodial care.

 

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Evolution of Treatment for the Insane

Dr. Benjamin Rush's Tranquilizing Chair, courtesy National Library of Medicine

Dr. Benjamin Rush’s Tranquilizing Chair, courtesy National Library of Medicine

Most modern readers would consider the mid-1800s a fairly rough and rugged period, inhabited by correspondingly rough and rugged individuals. However, changes in the treatment of insanity during this period point to the idea that people in the middle 1800s believed they had declined from the vigor of their ancestors.

When Dr. Benjamin Rush began treating the insane during the late 1700s, most of his treatments were aimed at depleting patients. Because of the vigorous nature of American society at the time, physicians believed that men and women tended to be out of balance on the side of too much “excitement” in their bodies. Excitement irritated blood vessels and resulted in inflammation, fevers and breathing difficulties that could only be relieved by the intense bleeding and purging protocols that Rush practiced all his professional life. In contrast, people of the mid-1800s had become more lethargic, weak, and nervous. Treatments for the insane tended toward tonics, physical exercise, and regimented days full of activity to invigorate the patient.

A Caricature Sadly Based on Reality

A Caricature Sadly Based on Reality

Opium Was Used Routinely

Opium Was Used Routinely

 

 

 

 

 

 

 

 

 

 

 

 

Even though alienists’ views on why insanity occurred and how it affected the body changed over time, they still knew too little about the causes of insanity to do much more than treat its symptoms. Rush bled and purged his manic patients, while later alienists gave them opium and morphine to calm them. The emphasis on treating symptoms may be a reason for the multitude of techniques alienists used–they simply experimented until they found something that seemed to work.

 

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What Caused Insanity?

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1854, courtesy Missouri State Archives

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1854, courtesy Missouri State Archives

The causes for insanity that early alienists compiled can seem amusing–as well as appalling–to modern readers. Almost anything, from disappointment in love, financial reverses, over-study, improper diet, use of alcohol or tobacco, and masturbation could derail mental health, it seemed. However, most of these causes really stemmed from one primary cause: civilization.

An eminent statistician who was deeply interested in insanity, Edward Jarvis, explained that the growth of knowledge, increased comfort, more refined manners, better appreciation of art, opportunities for indulgence, and so on that arose from an advancing civilization, did not themselves lead to mental disorders. However, their effects could.

Edward Jarvis

Edward Jarvis

The astonishing strides in civilization present in the mid-nineteenth century also gave people “more opportunities and rewards for great and excessive mental action, more uncertain and hazardous employments and consequently more disappointments . . . more dangers of accidents and injuries, more groundless hopes, and more painful struggle to obtain that which is beyond reach . . .” The mental anguish these byproducts of civilization could cause created more cases of insanity than possible when people had lived with more limited lives and opportunities.

Many Asylums Were Modeled After Thomas S. Kirkbride's Linear Plan

Many Asylums Were Modeled After Thomas S. Kirkbride’s Linear Plan

Alienists agreed with Jarvis’s premise, and therefore saw a need for more insane asylums and more alienists to meet the needs of a country¬† which was both moving toward an even higher degree of civilization and quickly expanding its population.

 

Their position seemed to be correct, for most asylums filled up almost as soon as they could be built. While there are many other reasons for the popularity of asylums during the 1840s and beyond, there is no denying that these institutions filled a perceived need within that period’s society.

 

 

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