Archive for the ‘medical history’ Category

An Asylum in South Dakota

Thursday, September 18th, 2014
Scene From Yankton, SD, circa 1903

Scene From Yankton, SD, circa 1903

The Canton Asylum for Insane Indians was not the state’s first asylum; the Yankton Insane Asylum was established in 1879 during South Dakota’s territorial days. Interestingly, Canton had been considered as a site for that asylum, as well. The Territory had been served by the St. Peter State Hospital in Minnesota before that time, and by 1878, the facility housed 22 patients from Dakota. The hospital became overcrowded, and Governor William A. Howard was advised that Dakota patients would have to be removed by October of that year. By scrambling for other resources and extending Minnesota’s contract for a few more months, the governor managed to keep the status quo until early 1879.

Frugality and speed were drivers in the effort to relocate Dakota Territory’s mentally ill. Governor Howard wanted to house patients in preexisting buildings within the Territory, but had no luck finding suitable accommodations in Canton, Vermillion, or Elk Point. Yankton had two large wooden buildings which the governor secured and had rebuilt north of the city for under $2,500. He used his personal funds for the enterprise, for which he was reimbursed in 1880. The territorial legislature was similarly frugal and only appropriated enough money for the patients’ basic needs; real treatment of any kind was not available. In 1899, a fire killed seventeen female patients, and funds were finally appropriated for a more suitable building. By 1909, the institution’s Mead Building followed the norm in insane asylum architecture, and stood out as a beautiful structure.

Mead Building Lobby, courtesy Christopher Payne via NPR

Mead Building Lobby, courtesy Christopher Payne via NPR

Yankton Insane Asylum

Yankton Insane Asylum

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Going Insane in the West

Sunday, September 14th, 2014
Covered Wagons Pulled by Oxen, circa 1870 - 1880, courtesy Library of Congress

Covered Wagons Pulled by Oxen, circa 1870 – 1880, courtesy Library of Congress

People went West for many reasons, but most carried a dream of creating a better life for themselves in this new, undeveloped territory. Homesteading was advertised as attractively as possible, and though emigrants may have prepared for it physically by bringing as many supplies as they could carry, few were prepared psychologically for the intensity of the pioneer experience. When they reached the vast stretches of the Great Plains after losing equipment, livestock, and perhaps even family members, it became harder to keep believing the propaganda about new railways, bustling towns, and bountiful harvests–because they were nowhere to be seen.

Loneliness and isolation soon took their toll. Women, especially, seemed to find the West filled with nothing but chores amid all the discomforts of a prairie (sod) home filled with insects, snakes, and ugliness. Men who did not realize their dreams of wealth or farming success could easily become depressed; unremitting stress could impact both genders. Hysteria, melancholia, or “nervous exhaustion,” as well as alcohol abuse and violence could destroy isolated prairie families, who seldom had anywhere to turn for help.

Women seemed to succumb to mental illness more than men, but that may only appear so because women wrote more about what they felt and experienced. Diaries from the trail tell a dismal story of death and privation. From Cecilia McMillen Adams’ 1852 diary:

June 25: Passed seven graves . . .

June 26: Passed eight graves . . .

June 29: Passed ten graves . . .

July 1: Passed eight graves . . .

A Pioneer Home, 1880, courtesy Library of Congress

A Pioneer Home, 1880, courtesy Library of Congress

Pioneer life in 1882, courtesy Library of Congress

Pioneer life in 1882, courtesy Library of Congress

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Prairie Madness

Thursday, September 11th, 2014
he High Plains in Kansas, 1920, courtesy U.S. Department of the Interior, Geological Survey

The High Plains in Kansas, 1920, courtesy U.S. Department of the Interior, Geological Survey

Life on the edges of the Western frontier was difficult, and by necessity, attracted mostly rugged, committed people who believed they could carve a good life for themselves in these untested regions. Despite the [general] sense of hope and adventure they carried, pioneers could not escape from mental illness any more than their counterparts in the more settled East. A  form of mental illness peculiar to the people settling the Great Plains was “prairie madness.”

It was an apt name, since the empty vastness of the prairie was an important contributor to the condition. Men and women who left an established home and social ties to face the isolation of the Great Plains could fall into depression that led to withdrawal and hopelessness. Some sufferers responded with anger and violence or with changes in behavior and character, and some went so far into despair that they committed suicide. Aside from returning East, there was little help for anyone who began to suffer from the condition, and it would have been difficult to differentiate normal feelings of homesickness and loneliness from the more extreme symptoms in the condition’s beginning stages.

Risk factors of the prairie environment included:

— Isolation

— Lack of transportation

— Harsh weather

— Unfamiliar hazards such as grasshopper plagues, prairie fires, and drought

— Lack of medical facilities and professionals, which made any sort of physical sickness more difficult to endure

— The unceasing wind and lack of familiar vegetation like trees

Prairie madness was not a defined, clinical condition with precise symptoms, but many people wrote about it. One memoir that includes an account of prairie madness is Adela Orpen’s Memories of the Old Emigrant Days in Kansas, 1862-1865.

A Sod House Was a Far Cry From Most Settlers' Former Homes, courtesy Library of Congress

A Sod House Was a Far Cry From Most Settlers’ Former Homes, courtesy Library of Congress

An Interesting Read for Modern Urbanites

An Interesting Read for Modern Urbanites

 

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What Could Go Wrong?

Sunday, September 7th, 2014
Virginia Woolf

Virginia Woolf

Simple as it was, the rest cure ended up being quite controversial, since the majority of its patients were women. Dr. Mitchell’s theory about the rest cure centered around the belief that women were weak and could be hurt by too much education or stimulation. The nervous exhaustion so prevalent during the late 1800s was a consequence, in his view, of women trying to exceed their natural limitations. In fact, part of the cure involved putting female patients into a state of childlike dependence by forcing them to stay in bed and submit to a nurse’s care for even bathing and eating. (See last post.)

Charlotte Perkins Gilman, a writer and early feminist, took Mitchell’s rest cure and was nearly destroyed by it. In her words, she, “came so near the borderline of utter mental ruin that I could see over.” After going home and refusing to follow his advice, Gilman left her marriage and continued to write. Her short story, “The Yellow Wallpaper,” published in 1913, describes her despair while taking the cure. Virginia Woolf also took a rest cure (though not with Mitchell) and wrote disparagingly of it afterward.

These women, and others, successfully rebelled against the restrictions and paternalism of the rest cure. However, it actually reflected prevailing medical views of the time: that women were frail and needed to do whatever their [male] physicians told them to do.

Gilman Believed That Her Short Story Influenced Mitchell to be More Humane

Gilman Believed That Her Short Story Influenced Mitchell to be More Humane

Charlotte Perkins Gilman

Charlotte Perkins Gilman

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The Rest Cure

Thursday, September 4th, 2014
Dr. Silas Weir Mitchell

Dr. Silas Weir Mitchell

The rest cure was probably the most fashionable of responses to a condition of “nerves” or neurasthenia (see last three posts). Only the wealthy could afford such a complete withdrawal from obligations or work, let alone take on the obvious expenses of accommodations and treatment involved in the cure. Women took the treatment in disproportional numbers from men, but may have been kept out of asylums with its help. Even though some patients deplored this cure, surely it was better for both reputation and psyche than a stay in a madhouse.

Dr. S. Weir Mitchell was the leading authority on treatment through the rest cure, and was highly influential in popularizing it during the late 1800s. The rest cure worked in two ways: like a stay in an asylum, the rest cure took patients out of their homes and isolated them from whatever atmosphere, people, or situation had caused the problem; the cure secondarily worked on their body and mind by keeping patients at rest in a pleasant, cheerful environment.

Patients were literally forced to rest in a bed for six to eight weeks; massage and electrical stimulation helped keep their muscles toned during the enforced inactivity. Patients were washed by nurses, who also fed them a milk-based diet; milk alone might be given for the first week, or raw eggs if a patient couldn’t tolerate milk. Feeding was nearly continuous, and patients could be force-fed if they would not voluntarily down the quantities the staff tried to give them. Sometimes patients were not allowed to read, talk, or enjoy even the most minimally physical amusements. This probably separated the patient who merely wanted a change of pace or sanctioned escape from an unpleasant household situation from patients who truly needed care.

Patient Undergoing Rest Cure

Patient Undergoing Rest Cure

Dr. Mitchell at the Infirmary for Nervous Diseases, Philadelphia, 1902, courtesy National Library of Medicine

Dr. Mitchell at the Infirmary for Nervous Diseases, Philadelphia, 1902, courtesy National Library of Medicine

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Insanity a Privileged Disease?

Sunday, August 31st, 2014
The Surge in Nervous Diseases Created Interest in the Public

The Surge in Nervous Diseases Created Interest in the Public

Though insanity would never be welcomed by either victims or their families, it was perhaps a comfortable notion to think that it primarily afflicted “civilized” people and nations. Nervous diseases did not affect “savages.” Furthermore, the upper, leisured class could sometimes ascribe their whims, phobias, and “nerves” to their sensitivity and developed intellect, even when the conditions bordered on insanity.

Wealthy women could be dainty, frail, and too refined to bear anything sordid or “common.” They could afford to be highly strung, indulging in hysteria, moodiness, nervousness, and hypochondria. Men shied away from hysteria, but they could manifest both hypochondria and melancholia without losing respect. People who had these nervous disorders, or neurasthenia, as coined by Dr. George Brown (see last two posts) could go to spas, travel, or take rest cures that might include bed rest, massage, and hearty meals. Sometimes for men, treatment would be vigorous outdoor exercise.

Though all these conditions caused distress and should not be considered false or amusing in any degree, only the leisured, wealthier class could manage to indulge in them without societal disapproval. A delicate blue-blood who could eat only the daintiest food was acceptable; a factory girl would be expected to eat what she was given. A wealthy man could afford to be melancholic and withdraw from business or social obligations, whereas a working man would incur only anger or exasperation for the same behavior. Finally, the wealthy could manifest these somewhat fashionable nervous conditions without acquiring the label of insanity or suffering the trauma of  commitment to an asylum. Because they had the means to help themselves in gentler ways via the advice and services of specialists, they could perhaps cope better with their condition so that it did not become worse, the way it might for a person in poverty and with no ability to get help at the onset of the problem.

Massaging Arm in the Rest Cure, circa 1890

Massaging Arm in the Rest Cure, circa 1890

Victorian Woman Fainting of Neurasthenia

Victorian Woman Fainting of Neurasthenia

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Insanity and Physical Causes

Thursday, August 28th, 2014
Charles Hamilton Hughes, Eminent Alienist, Founded and Edited The Alienist and Neurologist

Charles Hamilton Hughes, Eminent Alienist, Founded and Edited the Alienist and Neurologist

Alienists had long pondered the causes of insanity, and attributed some often-laughable (to modern sensibilities) reasons for its onset. They realized that sudden shocks, grief, worry, and other emotional traumas could at least temporarily affect a patient’s mind, but they also understood that insanity could derive from physical causes. Unfortunately for many patients, syphilis and epilepsy were two primary physical conditions behind much of the insanity found in insane asylums during this time. Sunstroke, fevers, and alcohol abuse could also damage the body enough to cause insanity.

In the 1870s, Dr. George Beard (see last post) made some important connections between stress and neurosis, attributing “American nervousness” to the sudden onslaught of a rapidly developing modern era which could overwhelm many people. However, he ultimately believed that insanity was due to physical causes.  “The central nervous system becomes dephosphorized, or perhaps, loses some of its solid constituents,” Beard wrote. In mental illness, the nervous system underwent morbid changes in its chemical structure, which diminished the patients “nervous force.” These changes could ultimately be viewed under a microscope in an autopsy, though Beard could not actually prove his theory. He was firm in his conviction, however, that all insanity was a result of some sort of diseased physical condition.

Conditions Like Anorexia Were Accepted by Physicians in the Industrial Age, photo circa 1900

Though Identified Much Earlier, Conditions Like Anorexia Became Widely Accepted by Physicians in the Industrial Age, photo circa 1900

Nerve Syrup

Nerve Syrup

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Industrialization and Mental Illness

Sunday, August 24th, 2014
Americans Sought Help for Nervous Diseases

Americans Sought Help for Nervous Diseases

Americans may have enjoyed many of the new inventions and opportunities the dawning industrial age offered, but many were also thrown off balance by the increasingly fast pace of the late 1800s. Dr. George Beard noticed that Americans were having difficulty coping with life as new forms of transportation, communication, and automation made their way into society. He tried to make sense of the physical symptoms cropping up in far too many ordinary, upper and middle-class people, and determined that they were caused by an “exhaustion of the nervous system.” He termed the syndrome neurasthenia.

Though Beard’s observations were quite astute to some degree, he also perpetuated some stereotypes. He believed that “civilization” and its higher demands led to certain nervous conditions and physical complaints: “The savage can usually see well; myopia is a measure of civilization.” Likewise, American women, who were given the opportunity to socialize more easily than women in other countries, developed their “cerebral activity” more quickly. This, in turn, influenced their physical development, with the end result that American women were typically more beautiful and expressive than women in other countries.

Beard's Book on American Mental Illnes

Beard’s Chart on American Mental Illness

George Beard

George Beard

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New Century, Old Ways

Thursday, August 14th, 2014
New York Street Scene, 1903

New York Street Scene, 1903

Life was difficult around the turn of the twentieth century. A simple scratch or sore throat that developed into strep could still cause death since there were no effective antibiotics, most homes had no indoor plumbing, and heating fuel was dirty and inconvenient. Though most women no longer had to weave their own cloth, many were still cutting out patterns and sewing their family’s clothes. Farming was labor-intensive, with a lot of human-power to supplement whatever farm animals were available for plowing, planting, and other tasks. Canning food for the winter was hot, exhausting, and seemingly endless when the crops came in and food had to be processed right away.

It is little wonder that the townspeople in Canton, South Dakota were so proud and impressed with the new Canton Asylum for Insane Indians,with its electric lights and indoor plumbing. (The asylum had range toilets; these flushed at intervals rather than after each individual use, but were still a great convenience.) In an age when even very young children worked hard on farms or in dangerous factory and mining jobs, the public could feel gratified that an institution existed which could provide food, shelter, and medical care to people who were struggling to get through life.

Feeding Chickens in Montana, 1908

Feeding Chickens in Montana, 1908

 

Farm House in Nebraska, 1903, courtesy Library of Congress

Farm House in Nebraska, 1903, courtesy Library of Congress

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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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